{"id":3581,"date":"2023-01-19T10:00:57","date_gmt":"2023-01-19T09:00:57","guid":{"rendered":"https:\/\/blogs.bmj.com\/medical-humanities\/?p=3581"},"modified":"2023-01-13T10:39:15","modified_gmt":"2023-01-13T09:39:15","slug":"a-new-take-on-the-canonic-book-the-spirit-catches-you-and-you-fall-down","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/medical-humanities\/2023\/01\/19\/a-new-take-on-the-canonic-book-the-spirit-catches-you-and-you-fall-down\/","title":{"rendered":"A New Take on the Canonic Book The Spirit Catches You and You Fall Down"},"content":{"rendered":"<p><strong>Book Review by Luxin Yin<\/strong><\/p>\n<p>More than two decades after its publication in 1997, Anne Fadiman\u2019s <em>The Spirit Catches You and You Fall Down <\/em>is frequently required reading in medical schools and used to train future practitioners on the importance of cross-cultural communication. The book concerns the difficulties faced by a young Hmong epileptic, Lia Lee, who ultimately lands in a coma because of miscommunication between her immigrant parents and her doctors\u2014a conflict, Fadiman suggests, caused by either implicit racism or cultural hegemony on the part of the medical establishment. Fadiman strove to cultivate a more inclusive medical atmosphere and a shared language among health practitioners, nurses, administrative personnel and patients, goals the medical profession still seeks today. However, today\u2019s readers might find the book\u2019s claims problematic: it romanticises patients and the Hmong community, and therefore may not present an effective way of realistically cultivating empathy in medical settings. After reviewing these shortcomings, I provide a perspective on medical empathy that focuses on patient-doctor collaboration rather than practitioners\u2019 cultural competence.<\/p>\n<p>Fadiman argues that cultural differences were the primary source of Lia\u2019s medical failure. While Lia\u2019s parents approached her illness through Hmong religious beliefs, physicians approached Lia with a perspective shaped by American medical culture. Consequently, these two communities both recognised Lia\u2019s symptoms but ascribed them to different causes; for example, one doctor, Dan, could not understand Lia\u2019s parents when they described her seizures as, \u201cwhere the spirit catches you, and you fall down.\u201d Where Dan saw epilepsy, Lia\u2019s parents saw a loss of soul that, for the Hmong, is \u201cnecessary for health and happiness\u201d (18). This dispute around soul, or life, is discussed between Sukey Waller, a psychiatrist familiar with shamanism, and Bill Selvidge, a medical practitioner. Their discussion highlights the child\u2019s agency during treatment. While Lia\u2019s parents have reservations about curing her epilepsy, as her seizures make \u201cher noble in our culture, and when she grows up she might become a shaman\u201d (260), the medical establishment interprets this view as depriving the child of the agency to make decisions regarding her own health. Bill expresses the medical establishment\u2019s perspective: \u201cif the child dies, she won\u2019t get the chance to decide twenty years down the road if she wants to accept her parents\u2019 beliefs or if she wants to reject them. She\u2019s going to be dead\u201d (27). Thus, the medical establishment sees itself as making life-or-death decisions in the name of patients themselves, particularly those it considers too young or too feeble to understand their condition.<\/p>\n<p>In addition to recounting Lia\u2019s story, Fadiman delves into Hmong folklore, religion, ethnomedicine and history in her attempt to describe Lia\u2019s family\u2019s and the medical professionals\u2019 social backgrounds. Fadiman has explicitly stated that cultural differences must be resolved within medical settings to ensure fair treatment to minority patients, her preface encouraging cooperation between cultures so that \u201cthe Hmong and \u2026 American doctors could be heard on a single tape, speaking a common language\u201d (ix). While Fadiman believes this commonality can be achieved by elevating doctors\u2019 \u201ccultural competency\u201d (271) and empathy, recent empathy research shows us how difficult this is in practice. Cultural theorist Ann Albright (2016) argues that complete empathy for the other is unattainable, as each interaction brings new layers of feeling, resulting in new dimensions and predicaments. Fadiman\u2019s goal of speaking a common language is therefore too idealistic in ways that can be seen in her own narrative, as she frequently romanticises Hmong culture and, in turn, creates unrealistic treatment expectations. Hmong immigrants are depicted as having a symbiotic relationship with their culture, which defines their identities in a circular, self-perpetuating and ultimately static way. They are destined to take actions to protect their culture, and those who do not align with this identity may be considered non-Hmong.<\/p>\n<p>What would the merging of two essentialist cultures such as the Hmong and the American medical establishment look like? Fadiman seems to expect the two to merge in America\u2019s melting pot in a shift toward an unknown greater cultural understanding, rather than toward the atomised view of doctors and experts. This assumption, however, is too optimistic and even orientalist. Lee and Farrell (2006) argue that a stress on \u201ccultural competence\u201d may be a \u201cbackdoor to racism\u201d in its reification of trait-based cultural differences (9). Even more critically, Fadiman\u2019s view may hinder the direct medical communication required to provide all communities with adequate health care. Today\u2019s medical humanities researchers argue that culture must instead be considered fluid rather than fixed, allowing for greater interaction between patients and doctors rather than placing the onus on doctors\u2019 \u201ccultural competency\u201d (10).<\/p>\n<p>Fadiman forgets that communication between doctors and patients must be mutual. In portraying the Hmong community\u2019s lack of compromise with doctors as heroic and embedded in Hmong history, an extension of their resilience in travelling to the United States after the Vietnam War, Fadiman romanticised lack of compromise as cultural integrity. Therefore, she portrayed them as people who hate \u201ccoercion\u201d (44,\u00a0100,\u00a0255). Given Lia\u2019s coma by the end of the book, this scepticism toward authorities appears justified and\u00a0 Fadiman\u2019s approach has successfully aroused readers\u2019 sentiments. However, considering her rich cultural and historical introduction to the Hmong people, she gave no comparable background on the development of Western medicine, itself a long story of persecution and resilience. Perhaps this lack of balance is easier to see now than it was two decades ago.<\/p>\n<p>Lia\u2019s parents and her doctors could be both right and wrong. A Chinese saying goes, \u201cIf someone is at the last stage of cancer, Western doctors will tell them to try Chinese traditional medicine or <em>Shaman<\/em>.\u201d The statement has two meanings: when Western medical practitioners have tried everything but nothing has worked, the patient must either pray for a metaphysical miracle, or, more realistically, prepare for impending death. My own uncle, in the final stages of brain cancer, took a regimen of herbal remedies recommended by both my father and grandfather, traditional Chinese medicine practitioners. As with Lia\u2019s family, our house was filled with herbal smells over the summer until he passed away\u2014nothing worked, including our beliefs, herbs and family love.<\/p>\n<p>&nbsp;<\/p>\n<p><strong>References<\/strong><\/p>\n<p>Albright, Anne Cooper. 2016. &#8220;Feeling In and Out: Contact Improvisation and the Politics of Empathy.&#8221; In <em>Zwischenleiblichkeit Und Bewegtes Verstehen &#8211; Intercorporeity, Movement and Tacit Knowledge<\/em>, edited by Undine Eberlein, 289-298. Bielefeld: Verlag. https:\/\/doi.org\/10.14361\/9783839435793-011.<\/p>\n<p>Fadiman, Anne. 1998. <em>The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures<\/em>. New York: Farrar, Straus and Giroux.<\/p>\n<p>Lee, S. Agnes and Michelle Farrell. 2006. &#8220;Is Cultural Competency a Backdoor to Racism?&#8221; <em>Anthropology News<\/em> 47, no. 3: 9\u201310. https:\/\/doi.org\/10.1525\/an.2006.47.3.9.<!--TrendMD v2.4.8--><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Book Review by Luxin Yin More than two decades after its publication in 1997, Anne Fadiman\u2019s The Spirit Catches You and You Fall Down is frequently required reading in medical schools and used to train future practitioners on the importance of cross-cultural communication. The book concerns the difficulties faced by a young Hmong epileptic, Lia [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/medical-humanities\/2023\/01\/19\/a-new-take-on-the-canonic-book-the-spirit-catches-you-and-you-fall-down\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":345,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2965],"tags":[15166],"class_list":["post-3581","post","type-post","status-publish","format-standard","hentry","category-book-reviews","tag-book-review"],"yoast_head":"<!-- This site is optimized with the Yoast SEO plugin v27.4 - https:\/\/yoast.com\/product\/yoast-seo-wordpress\/ -->\n<title>A New Take on the Canonic Book The Spirit Catches You and You Fall Down - Medical Humanities<\/title>\n<meta name=\"description\" content=\"Luxin Yin considers medical empathy in Anne Fadiman\u2019s The Spirit Catches You and You Fall Down.\" \/>\n<meta name=\"robots\" content=\"index, follow, max-snippet:-1, max-image-preview:large, max-video-preview:-1\" \/>\n<link rel=\"canonical\" href=\"https:\/\/blogs.bmj.com\/medical-humanities\/?p=3581\" \/>\n<meta property=\"og:locale\" content=\"en_US\" \/>\n<meta property=\"og:type\" content=\"article\" \/>\n<meta property=\"og:title\" content=\"A New Take on the Canonic Book The Spirit Catches You and You Fall Down - 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