The Spirit Catches You and You Fall Down

My girlfriend, Lauren, has been recommending this book to me for over two years and I have continued to put it off. It's not due to a lack of respect for her literary judgement; her other recommendation, Wild Swans, is one of my favorite books. My idea about The Spirit Catches You and You Fall Down was, "Yeah, I get it. Cultural differences lead to misunderstandings. What more can I learn by reading the book?" Well, I learned a lot. This book is a page-turner that made me think.

Author Annie Fadiman begins with a brief introduction on Hmong history. They are an ethnic group that has lived in mountainous areas of Asia for thousands of years. Their culture has been protected from assimilation due to remote living and a fierce independence. During the Secret War in Laos they were utilized by the CIA as soldiers to combat the communist Pathet Lao. Now, thirty years later, tens of thousands make their home here in the United States. The Hmong's transition and continued challenges to adapt to Western living serve as the basis for the book--specifically the challenge of a single Hmong family trying to receive medical care for their sick daughter.

The Spirit Catches You does an excellent job of fairly presenting both perspectives: the doctors come across as compassionate and intelligent, while the Hmong family, the Lees, are depicted as very caring parents. In fact, although Ms. Fadiman eventually spills the beans and admits her preference for the family, she initially emphasizes the frustrations of the doctors trying to provide medical care to a non-compliant patient.

The conflict centered on two disparate views of medicine. The Hmongs are shamanistic and view healing holistically. This knowledge has been passed down for generations and they believe in its efficacy as surely as we believe in aspirin. The Western medical community has its own distinguished history and is confident in its technical knowledge of how the body works. I side with the American doctors. What was intriguing to me about the tension in this book, however, was not which side was right, but what rights do each side have in a conflict of interest.

The doctors have all taken the Hippocratic oath. Does this mean that they have the right--indeed, the responsibility--to provide what they think is the best care, regardless of what the parents think? Or, do the parents have the right to select what treatment they want for their daughter even if it flies in the face of current medical understanding?

In the end I support the family's rights over the doctors' responsibilities. Like abortion, it is their body and there is a line of personal autonomy that is inviolable. Where the Lee family lost me is when they insisted on following their traditional methods, but then raced their daughter to the hospital when those methods failed. It was unjust to drop off such a heavy load of stress and financial commitment if you weren't willing to follow the necessary steps to prevent these occurences.

Overall, I would recommend this book to everyone. There is only one catch: The author's tone is a bit anti-American, which gets old. For example, she writes scathingly about culturally unaware Americans and then praises the Hmong's cultural insularity and naivete about foreign customs. She would bash the American looking for a McDonald's burger in India, then insist that we make major accomodations to allow cultural inflexibility here at home. In my opinion, being open to other's values does not require us to forget our own. But, like I said, overall this book is a great read and I wouldn't let this minor annoyance to stand in the way.