The Spirit Catches You and You Fall Down Book Review

I first read Anne Fadiman’s 1997 award-winning book The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures over 10 years ago as assigned reading in a graduate level anthropology class. It is one of those stories whose premise you don’t easily forget, and the book has experienced a resurgence in popularity over the last year. I have been contemplating using it as a textbook in an undergraduate seminar I am teaching this fall, so I added it to my summer reading list.


The Spirit Catches You and You Fall Down tells the story of Lia Lee, the 14th child of Hmong refugee parents who fled Laos in the early 1980s and began a new life in Merced, California. As an infant, Lia begins to experience severe seizures, which result in frequent emergency room visits. At first Lia’s parents, welfare recipients who do not speak English, have a hard time explaining to emergency room staff what has led to these visits; Lia has stopped seizing by the time she reaches the hospital and is mistakenly diagnosed with fluid build-up in her lungs and sent home with a course of antibiotics, of which her parents have no idea what to do with.

Finally, on Lia’s third visit she is in a continuous state of seizing and her American doctors diagnose her with epilepsy. Her parents, however, have another explanation. Lia’s soul has been stolen by an ill-meaning spirit, and the translation of this condition in the Hmong language gives the title to this book. They also don’t want Lia to fully recover, only for her condition to be eased somewhat, because in Hmong culture when a person seizes they may experience divine visions during those seizures and may grow up to become a shaman.

What follows is an ethnographic account of Lia’s family’s experiences with the American medical system, and American physicians’ experiences with a non-compliant family that is nearly impossible to communicate with. Fadiman gives a solid overview of the Hmong culture and their history, including how they served as front-line soldiers for the American side during the conflicts in Laos and Vietnam during the 1960s/1970s. She also raises important questions in medical ethics, questions those who work with clients from diverse backgrounds — especially in the medical field — should fully take to heart.

Re-reading this book nearly 12 years later, I was also interested in how my perceptions of it would change. A.M.B., who writes the blog, Misfortune of Knowing, wrote a reflective post last year on how her views on the book had changed over a similar length of time. While as a graduate student in medical anthropology, I was already interested in cross-cultural studies upon my first reading of this book. However, what surprised me the most upon re-reading is how much my views on Western medicine have changed in adulthood. I found myself more often feeling empathy with Lia’s parents. Who could really prove their views on health and healing wrong? I felt disgusted by how many times Lia was dehumanized by the medical establishment and given treatment with severe side effects, although it should be noted the medical establishment perhaps saved her life on several occasions. Moreover, I felt embarrassed about mainstream American culture for their perceived superiority complex.

It is also interesting to note that Lia Lee survived in a persistent vegetative state for 26 years, not on a costly life support machine at a county hospital (they pulled the plug within a few weeks), but by constant and diligent home care by her loving parents, who themselves subsisted on welfare. Lia passed away last August from pneumonia at the age of 30. Perhaps this recent news item is also why the book has seen a resurgence in popularity. In any case, this is one of those books destined to influence your worldview no matter where you ultimately lie on the ethical spectrum, and is a good pick for book group discussions as well.

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4 Responses to The Spirit Catches You and You Fall Down Book Review

  1. A.M.B. says:

    It’s interesting to read how your thoughts on this book have changed! I had the opposite reaction, finding myself less sympathetic to Lia’s parents. I can’t quite put a finger of why that is, except to say that in the intervening decade I had two children who were very sick at birth and spent 3 months each in the hospital, and I now have my own experience with client interaction that makes me sympathize more with the physicians. I am less willing to accept the parents’ unscientific approach to their daughter’s condition, while still being annoyed that the doctors didn’t find a better way of communicating with this family (ideally, integrating what they could of Lia’s culture into Lia’s treatment). They didn’t respect Lia’s culture, and so why should her family have trusted them? This book certainly teaches an important lesson about the perils of cultural misunderstanding, and I think anyone who works with clients or patients should read it.

    • Becky says:

      I whole-heartedly agree that the book teaches an important lesson on the importance of cross-cultural competency and communication. For me, I also think my own personal experiences in the intervening decade changed how I viewed the experiences outlined in the book. Firstly, living in another culture that did not have Western medicine readily available, and watching people use other therapies to treat illness, some of which appeared to be remarkably successful. Secondly, I have had a few very frustrating encounters with allopathic physicians, which has unfortunately tainted my view of Western medicine. I have to remind myself to keep an open-mind!

      • A.M.B. says:

        It’s interesting how our different life experiences shape our reactions to this book. I also had a nightmarish interaction with physicians while I was pregnant with my twins, but I owe their survival to modern, western medicine in the NICU. That doesn’t mean that I discount other practices, but in my own personal decisions, I prefer evidence-based medicine, and I can see why it’s frustrating for physicians and other medical personnel who treat patients from diverse backgrounds. I also feel conflicted about the parental right to raise a child with particular cultural traditions and the harm that may cause when imposed on a child (and the child is too young to decide for herself). There are no “right” or “wrong” answers. Each situation is unique and challenging. Have you decided whether you’re going to use the book in the course you’re teaching?

      • Becky says:

        Yes, I do plan to use the book as a text for the seminar I am teaching. It will be interesting to listen to the students’ discussion of the book, especially since it is a rather international school.

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