The Spirit Catches You and You Fall Down

I am always humbled to come across a book that speaks its own narrative, yet delves deeply into themes that are relevant to broader cultural conversations. I am forever excited about The Spirit Catches You and You Fall Down by Ann Fadiman, a creative non-fiction novel from 1997 that continues to be a part of conversation about multiculturalism, particularly in the medical community.

The Spirit Catches You and You Fall Down is an exploration of issues of assimilation and cultural divide in the tenuous balance of the refugee immigrant experience in the United States, in a particularly nationalist and conservative time. But rather than being structured around broader macro-sociological elements, the heart of the story is Lia Lee, a young Hmong girl who develops a severe epileptic disorder, Lennox-Gastaut Syndrome, as an infant. Her life is fraught with the frustrations of both her refugee Hmong family and her white American doctors, as both parties fight for the health of this little girl. Here we see, as the subtitle calls it, “a collision of two cultures”—American and Hmong. While her doctors prescribe medication to help her symptoms, her family turns to their cultural roots to help the child, and the tension between these two lifestyles places Lia’s life in jeopardy. What I found to be most intriguing about Fadiman’s work is how she uses a multitude of voices, not just the Lee family and Lia’s doctors; cultural and medical experts, foster parents, small town Americans, Hmong refugees of the Vietnam conflict, and their American-born children all tell their own stories. Fadiman pays particular attention to details of their daily existence, such as Doctor Dan Murphy’s beard, and humanizes them in the process. With this, Fadiman encourages what she calls “Cultural Humility”, which she defines as: “‘Cultural Humility’ acknowledges [individuals] bring the baggage of their own cultures … and that these may not necessarily be superior” (295).

Knowing that her audience will most likely side with Western medical experts, Fadiman chooses to dive deeply into the Hmong culture and history in order to frame the mindset of the Lee family. The opening chapter, for example, begins with a traditional Hmong birth in Laos, the manner in which the Lee’s first twelve children were delivered. At first, it seemed to play into the stereotypes and fears of backwards living that many people harbor within themselves about the undefined other. However, Fadiman uses this moment to show Foua Lee, the family matriarch, as a pillar of strength and motherly love. Fadiman’s words breath rich life into the Hmong life and traditions, such as burying the placenta:

Soon after the birth, while the mother and baby were lying still together next to the fire pit, the father dug a hole at least 2 feet deep in the dirt floor and buried the placenta…. In the Hmong language, the word placenta means “jacket.” It is considered ones first and finest garment. When a Hmong dies, his or her soul must travel back from place to place retracing the path of its life geography until it reaches the burial place of its placental jacket, and puts it on … If the soul cannot find its jacket it is condemned to an eternity of wandering, naked and alone.

She creates this beautiful image, so that when Lia’s placenta is incinerated, because she is born in a hospital in California, that moment of mundanity tugs at the heart, echoing the pain the Lees feel at not being able to embrace their culture in this new world. The author is able to create a wonderful portrait of the culture without resorting to ugly stereotypes of orientalism. She chooses, for example, to talk about the use of the shamanism txiv neeb in a way that does not mystify the belief system by making it seem ancient, ivy-covered, or use other cloying stereotypes about eastern Asian culture. At the same time, she does not portray this belief as witch doctoring or spooky backwards superstition. She uses the txiv neeb as a beautiful focal point in her book, returning to this important cultural figure over and over again as she juxtaposes the shaman to the doctors at the hospital. Fadiman opens the floor to discussions of ambiguity, because in a similar vein, Fadiman does not vilify the doctors either. She extensively interviews the staff of Merced Community Medical Center, where Lia receives treatments, and each of them express such deep convictions about Lia’s case. Peggy Philip and Neil Ernst, her ER physicians, express such love for Lia and sorrow over her condition, going back forth about how to help her best, but at times doing harm.

The experience of this book brings a cathartic pain into the conversation about globalization. I felt the tension as the child’s life hung in the balance between these two worlds. There is no right answer of how Lia can be best helped. But more importantly, Lia’s family is left completely unprotected in a society that shuns multiculturalism in favor of assimilation. At times, I grew frustrated as a reader; small acts that should have prevented suffering, such as correct pill dosage could have easily been achieved through the use of a good interpreter or doctors learning about Hmong culture. Similarly, the Lee family’s refusal to adjust their trajectory would sometimes cause me to grow anxious for young Lia. Ultimately, I would return to the sentiment of love and compassion that all parties felt for the girl; their goals are the same, to find a cure for Lia’s epilepsy, even though their methods are disparate. Fadiman openly encourages communication between doctors and patients of different cultural backgrounds, a sentiment that I argue should be explored in all professional and personal backgrounds. Though published 20 years ago, The Spirit Catches You and You Fall Down and the conversation it engenders seem especially prescient in our time as much of the Western World is divided on issues of nationalism and globalization. Now more than ever, we need narratives that ask for cultural understanding to be the dialogue.


Kayla Chenault is an African American who resides in the northern Midwest region of the United States. She was published in childhood starting from age 7. She is currently completing a Master’s in Creative Writing from Eastern Michigan University.