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The Spirit Catches You and You Fall Down
by Anne Fadiman
Paperback : 341 pages
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When three-month-old Lia Lee Arrived at the county hospital emergency room in Merced, California, a chain of events was set in motion from which neither she nor her parents nor her doctors would ever recover. Lia's parents, Foua and Nao Kao, were part of a large Hmong community in Merced, refugees from the CIA-run "Quiet War" in Laos. The Hmong, traditionally a close-knit and fiercely people, have been less amenable to assimilation than most immigrants, adhering steadfastly to the rituals and beliefs of their ancestors. Lia's pediatricians, Neil Ernst and his wife, Peggy Philip, cleaved just as strongly to another tradition: that of Western medicine. When Lia Lee Entered the American medical system, diagnosed as an epileptic, her story became a tragic case history of cultural miscommunication.
Parents and doctors both wanted the best for Lia, but their ideas about the causes of her illness and its treatment could hardly have been more different. The Hmong see illness aand healing as spiritual matters linked to virtually everything in the universe, while medical community marks a division between body and soul, and concerns itself almost exclusively with the former. Lia's doctors ascribed her seizures to the misfiring of her cerebral neurons; her parents called her illness, qaug dab peg--the spirit catches you and you fall down--and ascribed it to the wandering of her soul. The doctors prescribed anticonvulsants; her parents preferred animal sacrifices.
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Discussion QuestionsFrom the Publisher:
1. What do you think of traditional Hmong birth practices (pp. 3–5)? Compare them to the techniques used when Lia was born (p. 7). How do Hmong and American birth practices differ?
2. Over many centuries the Hmong fought against a number of different
peoples who claimed sovereignty over their lands; they were also forced to
emigrate from China. How do you think these up-heavals have affected their
culture? What role has history played in the formation of Hmong culture?
3. Dr. Dave Schneider said, “The language barrier was the most obvious
problem, but not the most important. The biggest problem was the cultural
barrier. There is a tremendous difference between dealing with the Hmong
and dealing with anyone else. An infinite difference” (p. 91). What does he
mean by this?
4. The author says, “I was struck . . . by the staggering toll of stress that the
Hmong exacted from the people who took care of them, particularly the ones
who were young, idealistic, and meticulous” (p. 75). Why do you think the
doctors felt such great stress?
5. Dr. Neil Ernst said, “I felt it was important for these Hmongs to understand
that there were certain elements of medicine that we understood better
than they did and that there were certain rules they had to follow with
their kids’ lives. I wanted the word to get out in the community that if they
deviated from that, it was not acceptable behavior” (p. 79). Do you think the
Hmong understood this message? Why or why not? What do you think of
Neil and Peggy?
6. Dr. Roger Fife is liked by the Hmong because, in their words, he “doesn’t
cut” (p. 76). He is not highly regarded by some of the other doctors, however.
One resident went so far as to say, “He’s a little thick.” What do you think
of Dr. Fife? What are his strengths and weaknesses? The author also speaks
of other doctors who were able to communicate with the Hmong. How were
they able to do so? What might be learned from this?
7. How did you feel about the Lees’ refusal to give Lia her medicine? Can
you understand their motivation? Do you sympathize with it?
8. How did you feel when Child Protective Services took Lia away from her
parents? Do you believe it was the right decision? Was any other solution
possible in the situation?
9. Were you surprised at the quality of care and the love and affection given
to Lia by her foster parents? How did Lia’s foster parents feel about Lia’s biological
parents? Was foster care ultimately to Lia’s benefit or detriment?
10. How did the EMT’s and the doctors respond to what Neil referred to as
Lia ’s “big one”? Do you think they performed as well as they could have
under the circumstances?
11. How does the greatest of all Hmong folktales, the story of how Shee Yee
fought with nine evil dab brothers (p. 170), reflect the life and culture of the
12. Discuss the Lees’ life in Laos. How was it different from their life in the
United States? Foua says, “When we were running from Laos at least we
hoped that our lives would be better. It was not as sad as after Lia went to
Fresno and got sick” (p. 171). What were the Lees running from? What were
they hoping to find in the United States?
13. When polled, Hmong refugees in America stated that “difficulty with
American agencies” was a more serious problem than either “war memories”
or “separation from family.” Why do you think they felt this way? Could this
have been prevented? If so, how? What does the author believe?
14. The Hmong are often referred to as a “Stone Age” people or “low-caste
hill tribe.” Why is this? Do you agree with this assessment of Hmong culture?
Does the author?
15. What was the “role loss” many adult Hmong faced when they came to the
United States? What is the underlying root cause? How does this loss affect
their adjustment to America?
16. What are the most important aspects of Hmong culture? What do the
Hmong consider their most important duties and obligations? How did they
affect the Hmong’s transition to the United States?
17. What does Dan Murphy mean by, “When you fail one Hmong patient,
you fail the whole community” (p. 253)?
18. The author gives you some insight into the way she organized her notes
(p. 60). What does it say about the process of writing this book? She chooses
to alternate between chapters of Lia’s story and its larger background—the
history of the Lee family and of the Hmong. What effect does this create in
19. The concept of “fish soup” is central to the author’s understanding of the
Hmong. What does it mean, and how is it reflected in the structure of the book?
20. It is clear that many of Lia’s doctors, most notably Neil Ernst and Peggy
Philp, were heroic in their efforts to help Lia, and that her parents cared for
her deeply, yet this arguably preventable tragedy still occurred. Can you
think of anything that might have prevented it?
21. What did you learn from this book? Would you assign blame for
Lia ’s tragedy? If so, to whom? What do you think Anne Fadiman feels about
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