The Spirit Catches You and You Fall Down Book Review

Oct xix, 1997
Take Only as Directed
When medicine butts upward against traditional belief, tragedy ensues.
Read the Start Chapter

Past MELVIN KONNER

THE SPIRIT CATCHES YOU
AND YOU Fall DOWN
A Hmong Child, Her American Doctors,
and the Collision of 2 Cultures.
By Anne Fadiman.
339 pp. New York:
Farrar, Straus & Giroux. $24.

f tragedy is a conflict of two appurtenances, if information technology entails the unfolding of deep man tendencies in a cultural context that makes the outcome seem inevitable, if it moves united states of america more than melodrama, then this fine book recounts a poignant tragedy. It is the tale of an immigrant child whose family went in one generation from traditional tribal life in the war-torn mountains of Laos to a bustling existence in the boondocks of Merced in the fertile San Joaquin Valley of California. This was a celebrated transition, and this child's story is in many ways her people's tale in microcosm -- and taken to an extreme. It is a tale of civilisation clashes, fright and grief in the face of change, parental love, her doctors' sense of duty, and misperceptions compounded daily until they became colossal misunderstandings. It has no heroes or villains, but it has an abundance of innocent suffering, and it nigh certainly does have a moral.

The story told in ''The Spirit Catches You and You Fall Down,'' by Anne Fadiman, a freelance journalist and the newly named editor of The American Scholar, is that of Lia Lee, born on July nineteen, 1982, in the Merced Community Medical Middle. At the age of three months, Lia Lee had an epileptic seizure. She had about 20 more over the next few months, and three emergency room visits. They were generalized g mal seizures, and like most cases of epilepsy were of unknown cause. At first, the parents behaved equally cooperatively as most parents do in such cases. The doctors acted competently and humanely, doing advisable tests and prescribing standard medication.

Just over the next few years, Lia had many more seizures. It became clear that the parents were not following the doctors' orders about medication, though they did give her some; this is not unusual for relatively uneducated parents, regardless of indigenous background. It was likewise articulate that they loved their child, were anguished over her illness and did non agree with the treatment plan. Eventually, when the parents refused to requite a drug they idea was harming their daughter, phenobarbitol, ane of Lia's doctors got a court club taking her away from them. The resulting yr's separation was devastatingly stressful to the child, as the staff notes testify: ''Lia crying four days straight. Smearing feces,'' and ''Intense crying again. Stripped herself . . . went on a wave of destruction. Had to sedate her.''

When the parents finally got Lia back, they complied more than rigorously with doctors' directions almost medications, merely Lia went on having seizures. Eventually, ane afternoon she went into status epilepticus, a seizure that doesn't stop. Her parents took her to the infirmary, where she was as well found to exist in septic stupor, a life-threatening result of sure bacterial infections. The seizure and septic shock eventually were controlled, but not earlier Lia lost all higher brain functions. Her doctors ofttimes refer to these events as her ''death.'' Merely she didn't dice. Released from the hospital in her parents' care, she remained in a persistent vegetative land, but she no longer suffered seizures (they had been ''cured'' by her encephalon damage), and she confounded her doctors by staying live. In the doctors' view, the disastrous chain of events was started by parents who did not understand how medicine works.

Now consider these events from what anthropologists call the folk view -- in this example that of Lia'southward parents. Lia's seizures were, in their view, the result of their daughter's beingness both burdened and blessed past a status known every bit qaug dab peg (pronounced ''kow da pay'') -- ''the spirit catches you and you autumn downwards.'' Lia would suffer, but she would likewise be spiritually gifted -- a view that should shock no i who knows how contemporaries saw Julius Caesar or Fyodor Dostoyevsky. She should exist protected from injury during seizures, and should go the attentions of a txiv neeb (pronounced ''tsi neng''), or Hmong healer. Western doctors with their medications were fine; a little scientific discipline and a little neeb together would create a residual between the spiritual proficient and sick that can come from qaug dab peg. She needed some medication, simply she as well needed the chants, amulets and chicken and pig sacrifices that make upwardly effective neeb. She would do well in this globe and the next.

Merely soon the parents thought that Lia was getting too much of doctors and hospitals; the excess was doing her more harm than good. They decided not to give her the drug they thought was doing the most harm, the phenobarbitol. Then the doctors did what every parent most fears: they took Lia away, destroying her mental and spiritual wellness. Drastic to keep her when they finally got her back, the parents followed the hospital orders only, predictably, the spirit caught Lia again and again. Finally, her soul left her body. The txiv neeb came to the hospital bed where Lia lay comatose. Surrounded by her relatives, he sacrificed a chicken and a pig, using their blood and sacred chants to phone call her soul back. He recited a sevenfold repetition of the phrase ''Come home.'' Lia survived, and her parents took her habitation to treat her in their own mode.

Maximum possible misunderstanding would be a pretty off-white description of this sequence of events. Lia'southward parents, who greatly loved her, had a articulate and time-honored concept of what should be done for an epileptic child. Lia'due south doctors were decent, well-trained people; they even went to the library to read up on Hmong beliefs. But they saw only one manner to take care of Lia's illness. And despite their intendance, Lia nonetheless had what some might consider the worst possible outcome.

Anne Fadiman, in the class of her research, went to see the pediatric neurologist who had cared for Lia in this last emergency, which occurred at a unlike hospital from Merced, where she had received most of her prior care. In his view, the terrible progression of Lia'due south condition had nothing to do with her parents' noncompliance. He thought it likely that her infection, a typical hospital bacterium, was acquired during a hospital stay. He also thought that she might accept had too much anti-epileptic medication; one of these drugs is known to reduce resistance to leaner. ''Go dorsum to Merced,'' he said to Fadiman, ''and tell all those people . . . that the family didn't practise this to the kid. Nosotros did.''

Many in the medical profession would like to find ways to make the power of modernistic medicine more bachelor to people who do desire healing but who do non see illness in the same way doctors do. They might do well to emulate a family physician Fadiman interviews named Roger Fife. Non much admired by his high-powered colleagues (''He'south a little thick,'' one said), he had many more Hmong in his practice than they did, and was amend liked by them. Why? All Dr. Fife had to offering in explanation was, ''Maybe I talk slower than the other doctors.'' But the Hmong showed a consensus: ''Dr. Fife doesn't cut,'' a reference to his effort to avoid Caesarean section and episiotomy in delivering Hmong babies. Dr. Fife is not on some sort of mission, nor is he the production of anthropology course work; although he gives Hmong mothers their placentas to take home, he has no thought what they exercise with them. His philosophy? ''It'south their body.'' While this cannot serve in all situations, it is a good guideline and is usually the law.

The nearly hopeful episode in this often discouraging story is non an anthropological insight or even a family doctor's respect for his patients' rights. It occurs when the kid of ane of Lia's doctors becomes ill with leukemia, and Lia'due south mother's heart goes out to the other female parent. ''There was very 18-carat business concern expressed by her questions and facial expression,'' the child'southward father, also a md, wrote to Fadiman. ''At the cease of the visit Mrs. Lee was hugging Peggy and they were both shedding a few tears. Sorrows of motherhood cut through all cultural barriers.'' In this keen observation we find something that makes human life possible even in a globe where cultures constantly clash. Although anthropologists sometimes deny it, at that place is such a thing as man nature, and it works for practiced as well as for ill. In this case it led ii women to common understanding in one of the greatest of all possible sufferings: to be the mother of a very sick child.

That one was built-in onto the floor of a mud hut in a Laotian mountain village, that the other had years of scientific preparation that led her, however inadvertently, to cause hurting to the commencement -- these facts were well-nigh irrelevant. Human nature, along with a bit of ethnological knowledge, allowed them to transcend ethnocentrism, one of the main threats to man welfare. And it allows the reader to appreciate stories like the one told in this sorry, excellent book.

Melvin Konner, who teaches anthropology at Emory Academy, is the author of ''Condign a Doctor'' and ''The Tangled Fly.''

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