This blog, as many of you know, is named in honor of a classic book about books, written by the imcomparable Clifton Fadiman. As I have mentioned before, I knew the work of Fadiman's daughter before the work of the father. Although many book bloggers know her wonderful collection Ex Libris: Confessions of a Common Reader, she is also the author of one of my favorite works of social science: The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures.
The Spirit Catches You, written in 1997, is the story of how Laotian refugees in California interact with the American health care system. When young Lia Lee is diagnosed with severe epilepsy, the Hmong immigrants see her case very differently from the way the doctors trained in allopathic medicine do. Lia Lee's community sees the little girl through a spiritual lens, where the physicians analyze her disorder through a scientific one. The cultural dissonance is the source of misunderstandings and distrust which eventually obstruct her treatment and lead to tragic results.
The little girl's parents believe that she has seizures because her spirit became frightened and deserted her body when Lia Lee's sister slammed the door (shortly before Lia Lee's first seizure.) Traditional Hmongs often believe that epilepsy gives a person the ability to cross into the spirit realm in order to help others who are suffering from physical or emotional disorders. Among the Hmong, qaug dab peg (epilepsy, or literally "the spirit catches you and you fall down") is seen not as a shameful disability to be cured but as an honorable responsibility. An epileptic person might become a shaman since he or she can negotiate with the spirit realm in order to cure the illnesses of others.
Lia Lee's family believes the medicines prescribed by the doctors are making their daughter sicker. They are disturbed by the idea that doctors would undress patients, touch them, stick needles in them. Instead, the family wanted to use shamanistic practices to treat their daughter.
Anne Fadiman's book is a rigorous and accessible work of medical anthropology which argues forcefully that physicians must try to comprehend how their patients understand their own illnesses--not simply because it is the respectful thing to do but because it is essential in order to provide adequate care. The book ends with the recognition that doctors view their goal as the saving of their patient's life while the Hmong view the ultimate goal to be the saving of her soul.
Fadiman treads lightly here, showing how hard the doctors work to cure Lia Lee even while pointing out the flaws in their treatment. She shows the love and deep-seated commitment of the family, while never suggesting that their proposed animal sacrifices would have been more appropriate. In short, all characters here are complex and thoughtfully drawn. This is not a book of cheap political correctness but a deep analysis of the necessity for an awareness of the clash of cultures and how to move forward.
Those of you who know Fadiman's essays (in Ex Libris, At Large and At Small, and Rereadings) know how powerful and poetic her writing is. This book is no exception and will leave you changed for the rest of your life.
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Edited to add: Many people have been wondering if Lia Lee is still alive or if she has died. As of the time of the writing of this blog post, Lia Lee continues to live in a persistent vegetative state with her family in California. She is now in her late 20s.
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I wanted to post about this book for two reasons. One is that I have had the Fadiman family on my mind a lot recently as I've pored through different editions of Clifton's books and reread some of Anne's essays. The other is that I recently was quite surprised to learn that my father has not read (and did not even know of) The Spirit Catches You and You Fall Down. It is a book he will adore and I cannot wait to share it with him when I go down to visit him in a few weeks.
Meanwhile, I'm imagining the book he'll be astonished to learn I have never read: Herodotus. My father and I are both historians, and Herodotus and Thucydides are ancient Greek writers who more or less invented our field. I've put copies of both on my upcoming-reads shelf and will get there soon.
So here's a toast to sharing our favorite books with our favorite people!