“The Spirit Catches You and You Fall Down” by Anne Fadiman

Subtitle: A Hmong child, her American doctors, and the collision of two cultures

Recommended to me by: Emily Ross

This is a beautifully written history of the Hmong people from Laos in the 20th century, interwoven with the story of one Hmong family who took refuge in Merced, California. Their daughter Lia Lee had her first epileptic seizure at age 4 months. Both the family and Lia’s doctors struggle with her illness and with the communication barriers between their cultures.

The Lees are frustrated because Lia continues to have seizures, and her prescribed medicines cause side-effects they don’t expect. The doctors are frustrated because the Lees don’t speak English and “aren’t compliant” with the medicine schedule. Also, the Lees have very little money.

Dr. Arthur Kleinman, a psychiatrist and medical anthropologist at Harvard Medical School, developed a set of eight questions to elicit a patient’s “explanatory model.” After getting to know the Lees, Anne Fadiman answers the eight questions from their perspective. The American doctors continue full-tilt in their own medical explanatory model, unable to consider a different model.

1. What do you call the problem?
   Qaug dab peg. That means the spirit catches you and you fall down.
2. What do you think has caused the problem?
   Soul loss.
3. Why do you think it started when it did?
   Lia’s sister Yer slammed the door and Lia’s soul was frightened out of her body.
4. What do you think the sickness does? How does it work?
   It makes Lia shake and fall down. It works because a spirit called a dab is catching her.
5. How severe is the sickness? Will it have a short or long course?
   Why are you asking us those questions? If you are a good doctor, you should know the answers yourself.
6. What kind of treatment do you think the patient should receive? What are the most important results you hope she receives from this treatment?
   You should give Lia medicine to take for a week but no longer. After she is well, she should stop taking the medicine. […]
7. What are the chief problems the sickness has caused?
   It has made us sad to see Lia hurt, and it has made us angry at Yer.
8. What do you fear most about the sickness?
   That Lia’s soul will never return.

My only issue with the book is that chapters about Hmong history are inserted at cliff-hanger portions of Lia’s story, causing me to flip ahead and find out what happens to her. The history is worth reading in its own right and doesn’t need manufactured suspense to pull the reader through it.

Recommended to anyone who wants to learn about Hmong culture and history, medical communication at its worst and best, and the story of one much-loved child.

Available at bookshop.org.