The Spirit Catches You and You Fall Down (45 page)

somatization

Sonom

soul-calling ceremonies

soul loss

Souvanna Phouma, Prince

Soviet Union

spinal deformity

Ssu-ma Ch’ien

Stanford Medical School

State Department, U.S.

status epilepticus

Sult, Tom

Superior Court of the State of California

Supplemental Security Income (SSI)

Supreme Court, U.S.

swidden (slash-and-burn) agriculture

taboos, Hmong

Tegretol, side effects of

Temkin, Owsei

Thailand, U.S. military training camps in, escape from Laos to, Hmong settlements in, refugee camps in, traditional medicines imported from

Thao, Mao

Thao, Pa Vue

Thao clan

thiopental

Thueson, Gary

Todorov, Tzvetan

Tragic Mountains
(Hamilton-Merritt)

trichothecene mycotoxins

Truman, Harry S.

tuberculosis

txiv neebs
(shamans), banned by communists, sacrifices performed by, Western medicine and

typhoid

Uebner, Rick

United Nations High Commissioner for Refugees

U.S. Agency for International Development (USAID)

U.S. Committee for Refugees

U.S. Council of World Freedom

vaccination,
see
immunizations

Valium

Valley Children’s Hospital (Fresno)

Vang, Arnie

Vang, Chao Wang

Vang, Seng

Vangay, Jonas

Vang clan

van Gogh, Vincent

Vang Pao, Gen., and CIA, and Merced Hmong community, resettlement proposal of, resistance group of

Vientiane Agreement (1973)

Vietnam, Hmong in, refugees from, war in

VOLAGs

Vue clan

Walker-Moffat, Wendy

Waller, Sukey

Wall Street Journal

Washington Post

Wat Tham Krabok monastery

Welch, Richard

Wells, Marvin

Willem, Jean-Pierre

Wisconsin, University of, at Eau Claire

World War II

World Wide Web

Xeu, Vang

Xieng Khouang Air Transport

Xiong, Bravo

Xiong, Chaly

Xiong, Ching

Xiong, John

Xiong, May Ying

Xiong, Sue

Xiong, Yia Thao

Xiong clan

Yale University

Yang, Foua, arrival in U.S. of, brings Lia home, cares for Lia in persistent vegetative state, and catastrophic seizure, court order obtained by, doctors’ relationship with, escapes from Laos, and foster care placement, gives birth to Lia, gulf between Western medicine and beliefs of, Hilt’s relationship with, during hospitalizations, in Laos, Lia as favorite child of, Lia returned to, at MCMC emergency room, and medication regimen, Murphy and, during
neeb
ceremony, pregnancies of, in refugee camp, and soul-calling ceremony, and traditional medicine for Lia

Yang, Xou

Yang clan

Yang Dao

Yang family

Yanomamo

Yates, Sharon

yellow rain

Yosemite National Park

Youth Conservation Corps

zij poj niam
(marriage by capture)

Zinn, William M.

The Spirit Catches You

and You Fall Down

A Hmong Child

Her American Doctors

and the Collision of Two Cultures

Anne Fadiman

This guide is intended to enrich your experience of reading
The Spirit Catches You and You Fall Down
, winner of the National Book Critics Circle Award. This moving chronicle of a very sick girl, her refugee parents, and the doctors who struggled desperately to treat her becomes, in Anne Fadiman’s deft narrative, at once a cautionary study of the limits of Western medicine and a parable for the modern immigrant experience.

Lia Lee was born in the San Joaquin valley in California to Hmong refugees. At the age of three months, she first showed signs of having what the Hmong know as
qaug dab peg
(the spirit catches you and you fall down), the condition known in the West as epilepsy. While her highly competent doctors saw the best treatment in a dizzying array of pills, her parents preferred a combination of Western medicine and folk remedies designed to coax her wandering soul back to her body. Over the next four years, profound cultural differences and linguistic miscommunication would exacerbate the rift between Lia’s loving parents and her caring and well-intentioned doctors, eventually resulting in the loss of all her higher brain functions. Fadiman weaves this personal tragedy, a probing medical investigation, and a fascinating look at Hmong history and culture into a stunningly insightful, richly rewarding piece of modern reportage.

1. What do you think of traditional Hmong birth practices? Compare them to the techniques used when Lia was born. How do Hmong and American birth practices differ?
   
2. Over many centuries the Hmong fought against a number of different peoples who claimed sovereignty over their lands; they were also forced to emigrate from China. How do you think these upheavals have affected their culture? What role has history played in the formation of Hmong culture?
   
3. Dr. Dan Murphy said, “The language barrier was the most obvious problem, but not the most important. The biggest problem was the cultural barrier. There is a tremendous difference between dealing with the Hmong and dealing with anyone else. An
   infinite
   difference”. What does he mean by this?
   
4. The author says, “I was struck…by the staggering toll of stress that the Hmong exacted from the people who took care of them, particularly the ones who were young, idealistic, and meticulous”. Why do you think the doctors felt such great stress?
   
5. Dr. Neil Ernst said, “I felt it was important for these Hmongs to understand that there were certain elements of medicine that we understood better than they did and that there were certain rules they had to follow with their kids’ lives. I wanted the word to get out in the community that if they deviated from that, it was not acceptable behavior”. Do you think the Hmong understood this message? Why or why not? What do you think of Neil and Peggy?
   
6. Dr. Roger Fife is liked by the Hmong because, in their words, he “doesn’t cut”. He is not highly regarded by some of the other doctors, however. One resident went so far as to say, “He’s a little thick.” What do you think of Dr. Fife? What are his strengths and weaknesses? The author also speaks of other doctors who were able to communicate with the Hmong. How were they able to do so? What might be learned from this?
   
7. How did you feel about the Lees’ refusal to give Lia her medicine? Can you understand their motivation? Do you sympathize with it?
   
8. How did you feel when Child Protective Services took Lia away from her parents? Do you believe it was the right decision? Was any other solution possible in the situation?
   
9. Were you surprised at the quality of care and the love and affection given to Lia by her foster parents? How did Lia’s foster parents feel about Lia’s biological parents? Was foster care ultimately to Lia’s benefit or detriment?
   
10. How did the EMT’s and the doctors respond to what Neil referred to as Lia’s “big one”? Do you think they performed as well as they could have under the circumstances?
    
11. How does the greatest of all Hmong folktales, the story of how Shee Yee fought with nine evil
    dab
    brothers, reflect the life and culture of the Hmong?
    
12. Discuss the Lees’ life in Laos. How was it different from their life in the United States? Foua says, “When we were running from Laos at least we hoped that our lives would be better. It was not as sad as after Lia went to Fresno and got sick”. What were the Lees running from? What were they hoping to find in the United States?
    
13. When polled, Hmong refugees in America stated that “difficulty with American agencies” was a more serious problem than either “war memories” or “separation from family.” Why do you think they felt this way? Could this have been prevented? If so, how? What does the author believe?
    
14. The Hmong are often referred to as a “Stone Age” people or “low-caste hill tribe.” Why is this? Do you agree with this assessment of Hmong culture? Does the author?
    
15. What was the “role loss” many adult Hmong faced when they came to the United States? What is the underlying root cause? How does this loss affect their adjustment to America?
    
16. What are the most important aspects of Hmong culture? What do the Hmong consider their most important duties and obligations? How did they affect the Hmong’s transition to the United States?
    
17. What does Dan Murphy mean by, “When you fail one Hmong patient, you fail the whole community”?
    
18. The author gives you some insight into the way she organized her notes. What does it say about the process of writing this book? She chooses to alternate between chapters of Lia’s story and its larger background—the history of the Lee family and of the Hmong. What effect does this create in the book?
    
19. The concept of “fish soup” is central to the author’s understanding of the Hmong. What does it mean, and how is it reflected in the structure of the book?
    
20. It is clear that many of Lia’s doctors, most notably Neil Ernst and Peggy Philp, were heroic in their efforts to help Lia, and that her parents cared for her deeply, yet this arguably preventable tragedy still occurred. Can you think of anything that might have prevented it?
    
21. What did you learn from this book? Would you assign blame for Lia’s tragedy? If so, to whom? What do you think Anne Fadiman feels about this question?
    

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Virginia Barnes Lee,
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; Michael Bérubé,
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; Robert Olen Butler,
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; Lan Cao,
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; Temple Grandin,
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; Jamaica Kincaid,
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; Maxine Hong Kingston,
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; Oliver Sacks,
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; Esmeralda Santiago,
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; Susan Sheehan,
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; Abraham Verghese,
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.