It was typically Hmong for patients to appear passively obedient – thus protecting their own dignity by concealing their ignorance and their doctor’s dignity by acting deferential – and then, as soon as they left the hospital, to ignore everything to which they had supposedly assented” (page 68). This quote by author, Anne Fadiman, of ethnography The Spirit Catches You and You Fall Down demonstrates quite well the cultural clash between the Hmong and the MCMC doctors.
This quote is important and meaningful because I believe this ethnography’s main theme was cultural understanding.
This true story involves the life of Lia Lee, a Hmong child who is epileptic. She suffers severe grand mal seizures and eventually, as a result, becomes vegetative for the rest of her life. The key point of the book, however, is not Lia’s epilepsy as much as it is the cultural barriers that led to what simply destroyed Lia’s brain. Decisions between Lia’s doctors and her parents on treatment, healing, and what actions to make on saving Lia’s life is the base of the main conflicts we as readers saw.
Fadiman uses this battle as a way of discussing Western and Eastern medicine and how each group views the patient in such different ways. As the great ethnographer Anne Fadiman has many points to the book. I definitely see the most important one: cultural differences. The Americans versus the Hmong; two very different cultures together in one city Merced. These two cultures greatly show how just the difference in culture, location, and community make up to be two separate worlds.
The American doctors saw (and still do see) all biomedicine as a necessity to healing, sickness, and disease. The Hmong see all aspects regarding health, illness, and the body very differently. The Hmong view cultural traditions as the best medication, while the American doctors can hardly bare to even consider such ways. Therefore, the cultural differences were displayed in this book by the very different views of the medical world by both the American doctors and the Hmong. The ultimate consequence of the cultural differences cost Lia Lee her brain death.
As American doctors forcefully and reluctantly stressed modern medicine for Lia’s seizures, the Lee’s rejected. Right there we see a huge confliction. No matter what culture or what illness one is dealing with, if the patients (along with patient’s guardians) are not on the same page as one’s “healer,” the outcome will never be very optimistic. Thus, regardless of the huge cultural difference throughout this story, the factor that two major influence’s in patient’s life could not compromise, is seen to be another reason for the unfortunate outcome of Lia’s life.
As we see this big illness, we see the Hmong portraying the personalistic theory we discussed in class. This theory focuses on blaming an illness on “malicious agents. ” We learned that the agent (a culture) refers to can be: another person-a shaman or someone who uses a shaman’s abilities to cause illness-as well supernatural spirits or ancestors. Healing is based on the ide that the mind, body, and the spirit are deeply connected in each person. Thus, simply, to heal, all three must be taken into consideration and addressed.
So, in The Spirit Catches You and You Fall Down personalistic theory is shown through Lia’s ailment quag dab ped which translates to “the spirit catches you and you fall down. ” The Lee’s belief of reasoning for Lia’s condition came from after Lia’s birth, her placenta was never buried. This Hmong tradition includes the placenta is a fetus’s soul jacket and it must be buried in order to anchor the human soul to the physical world. On top of that, Lia’s older sister was weighed with a lot blame. As she once slammed a door which greatly startled and scared Lia at a young age, in turn was the final detach of Lia’s soul.
The bottom line to this personalistic theory of illness and death are caused by the ill will of others and is not “natural”. The healing includes natural remedies or wholistic approaches. On the other hand, the western or American approach we take is referred to as the Naturalistic Theory. This is demonstrated through the medical doctors in the story. In this theory we see “disease” result from natural causes: germs, bacteria, viruses, toxic substances. Nothing to do with ill will; all healing is done through medication to tackle whatever symptoms are present.
In this theory, we see westerners being quite tunnel-visioned with their actions to cure the disease (health ailment that is scientifically determined). This is where we see the “cure” come in versus healing all three aspects that the Hmong focus on. Like the doctors in the story, the only solution for this theory is biomedicine. Doctors do not believe in anything else. Continually, at the end of the ethnography, we see Fadiman questioning many things and rethinking a lot about what she had just went through. So, Fadiman explained the case to Kleinman, she thought she was right.
She told him how the doctors had interpreted the Lees’ noncompliance with the medications, and that Lia’s end move to a foster home and then in turn to the “big one,” (the seizure that ultimately contributes to her vegetative state). As Fadiman questioned Kleinman for advice to pass onto her pediatricians, he suggested that the term of “compliance” not be used since it implied “moral hegemony” (p. 261) and that a model of mediation be used with the best case scenario being a Hmong community member or a medical anthropologist as a mediator.
Which I agree with as well and do think is a good essential idea. Kleinman thought the medical doctors should realize that the “culture of biomedicine is equally powerful” (page 261). Continuing on by saying we need to understand our own cultural interests and biases in order to be able to understand anyone else’s culture. Also, true and agreeable, yet I felt both cultures could have been more open. In the end, Fadiman concludes that Lia’s life was not destroyed by “septic shock or noncompliant parents but by cross-cultural misunderstanding” (page 262).
Lia’s primary doctors were excellent in their medical field position, however sadly though they were “imperfect healers” (page 262). They were unable to view Lia’s illness in terms of the context and meaning of her culture, which is the exact truth! These last words the author states really helped me relate to the author and kind of gave the sense of ability to relate to the authors honest words. As she speaks of the doctor’s not disregarding any of their intellect, knowledge, or schooling; she honestly and simply states the truth. That right there helped me see how good of an author Fadiman is.
In conclusion, The medical community comes to realize that they must understand the cultural differences of immigrant patients as part of their medical treatment. I agree! I think us westerners are so hooked on medication, medication, medication to solve all our problems; and yet they always come back or still sick. I really think if we focused on mind, body, soul our country would be a lot different. The mind, body, soul such like yoga and meditation only make sense. With words like “mind over matter” and “whether you think you can or you think you can’t, you’re right. —all come full circle to mind and body as working together. So as we stay so focused on the physical traits to healing and curing, I see us not necessarily failing, just not succeeding to our full potential. Yet, vice versus in the end the Lees come to the conclusion that Lia was damaged; the doctors gave her too much medicine. I feel, like many others, it is neither one nor the other but both. So, this story of a little Hmong girl, born in the United States, develops a severe case of epilepsy. As they continue on to fight this, conflict striked between the medical authorities at Merced and Lia’s parents.
As a result, she was failed by not being properly medicated resulting in the grand mal seizure which leaves her brain dead. Fadiman uses this story to show cultural understanding and compromise is a must. I love this quote you stated during lecture of, “the human body is a universal, but the cultural construction of that body and what happens to it IS NOT. ” “Timothy Dunnigan: The kinds of metaphorical language that we use to describe the Hmong say far more about us, and our attachment to our own frame of reference, than they do about the Hmong” (189).