Fadiman’s The Spirit Catches You and You Fall Down

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Table of Contents

Introduction
Hmong’s History and Culture
The Fish Soup Concept
Dave Schneider’s View
Lia and Child Protective Services
Dan Murphy’s Argument
Kleinman’s Patient Explanatory Model
Conclusion
Works Cited

Introduction

Anne Fadiman’s book, The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures tells Lia Lee’s story and her tragic demise caused by epilepsy. Fadiman’s work explores the collision of the American medical system and Hmong culture regarding treatment procedures. Lia’s family believes her illness should be diagnosed as “the spirit catches you, and you fall down” and argue that Lia’s seizures make her special. In contrast, Lia’s American doctors treated her epilepsy as a neurological disorder. Fadiman’s book highlights cross-cultural communication’s importance in the American medical system through Hmong’s history and the fish soup concept to show the medical profession’s failure of the Hmong community and offers several solutions.

Hmong’s History and Culture

The history of the Hmong and the chaos they faced preserved their ethnic identity and reaffirmed their distrust of other cultures. The Hmong only wanted to be left alone, but the Chinese were uncooperative, causing the Hmong to move to higher altitudes and southern latitudes. The Chinese successfully crushed the Hmong by building the Hmong Wall, but the Hmong never obeyed the Chinese emperor (Fadiman 29). After migrating to Indochina, the Hmong opposed French rule and were granted special administrative status. Hmong’s history and challenges created a culture that is bold and respectful. The upheavals they encountered strengthened their culture and made it harder for them to accept other cultures, as they dislike taking orders from other people and hate losing. In addition, they would rather fight or die instead of surrendering (Fadiman 31). Ultimately, the Hmong’s troubles made the community cautious of foreign beliefs, explaining their difficulty accepting Western medicine.

The Fish Soup Concept

The fish soup concept involves a class assignment where a Hmong student explains how to prepare fish soup in forty-five minutes instead of five minutes. The class’s professor argued that fish soup was Hmong’s essence and emphasized that the world is made of things that seem disconnected but are not since events do not occur in isolation (Fadiman 26). The author argues that a person can miss crucial knowledge by sticking to the point like Lia’s American doctors. The fish soup concept is reflected in Fadiman’s book when she explains the biomedical culture disconnect. Doctors are unwilling to listen to and validate patients’ cultural views on problems (Morrison 115). Instead, Fadiman argues that biomedicine instructs patients to take directions without consideration for their worries.

Dave Schneider’s View

Fadiman offers Dave Schneider’s view on the Merced Community Medical Center (MCMC) problems. Schneider asserts that although the language barrier was a significant problem, the most serious challenge was cultural barriers. The difference between dealing with other people and the Hmong is tremendous and infinite. Most medical terms and concepts are either inexistent or difficult to translate for the Hmong. Thus, laborious paraphrases were needed, and most concepts lacked a Hmong equivalent (Fadiman 91). Ultimately, Fadiman argues that it is nearly impossible to intuit the existence of body organs that a person has not seen or learned about.

Lia and Child Protective Services

Neil Ernst’s decision to report Lia’s parents to Child Protective Services was sad since Lia was separated from her parents. It was the wrong decision because there were other possible solutions to the underlying problem. To solve the failure of Lia’s parents to administer appropriate medication timely, a single visiting nurse could have been instructed to oversee medical administration by visiting Lia’s parents thrice a day (Mas 102). In addition, the doctors should have coordinated with Lia’s parents to appoint a cultural broker with the Hmong community’s insights and understanding (Fadiman 262). A different outcome might have happened if the family had accepted a cultural broker.

Dan Murphy’s Argument

Fadiman provides insights from Dan Murphy regarding Lia’s treatment failure and its effect on the Hmong community. Dan Murphy implies that when one Hmong patient is failed, the entire Hmong community is failed. Hmong families likely avoided the MCMC because they feared their children would end up like Lia (Fadiman 253). Lia’s case reaffirmed the worst prejudices of the Hmong community and the medical profession towards each other.

Kleinman’s Patient Explanatory Model

Arthur Kleinman developed an explanatory model that argues for the removal of compliance in cross-cultural patient care, embraces mediation, and acknowledges each culture’s biases, emotions, and interests. Francesca Farr is an example of a medical staff who used Kleinman’s model successfully. She made house calls and sought the help of a cultural broker in care coordination for a tuberculosis patient. In addition, she worked within the confines of the family’s beliefs and avoided using her cultural bias in the negotiations (Fadiman 278). She was never patronizing, criticizing, or threatening and hardly said anything regarding Western medicine.

Another example of Kleinman’s model use in clinical settings is the case of a middle-aged patient in MCMC. He was asked if he wanted to donate his organs in case of death. Thus, he was furious and believed doctors would let him die, causing him to demand to leave the hospital. Sensing the agitation, the hospital brought an interpreter who explained that the doctors’ motives were honorable (Fadiman 278). Therefore, he stayed in the hospital while the administrator successfully removed the organ donor box from the admission forms.

Conclusion

In conclusion, Fadiman’s book argues for cross-cultural communication in biomedical care using Hmong history and the fish soup concept to understand the problem’s depth in America’s medical system. Lia’s case shows how the MCMC failed one Hmong family and successfully reaffirmed the worst of the Hmong community’s prejudices towards biomedical care. Fadiman argues that using Kleinman’s model could have helped Lia’s case. Ultimately, navigating cross-cultural misunderstandings in medical care requires constant vigilance and reevaluation.

Works Cited

Fadiman, Anne. The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, And the Collision of Two Cultures. Macmillan, 2012.

Mas, Catherine. “Falling-Out” in Miami and the History of Culture in American Medicine.”Bulletin of the History of Medicine, vol. 96, no. 1, 2022, pp. 102-134.

Morrison, Sharon D. “Immigrant and Refugee Explanatory Models of Chronic Disease: Provider “Learning Up” For Culturally Responsive Care.”North Carolina Medical Journal, vol. 80, no. 2, 2019, pp. 113-115.

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