Explain the meaning of the book's title.
"The spirit catches you and you fall down" is the literal translation of the Hmong name for epilepsy, qaug dab peg. The spirit referred to in the name is a soul-stealing dab; thus, the Hmong believe that epilepsy has a spiritual origin and should be treated accordingly. At the same time, it is considered an illness of some distinction, with seizures as evidence that an epileptic can see things that others cannot and can more easily enter trances to journey to the spirit world. The Hmong understanding of epilepsy is at the root of the conflict between Lia's parents and doctors. Foua and Nao Kao wanted Lia's doctors to help control her seizures; however, they also felt she should be treated using shamanic ritual, which could be hindered by too much medication.
Compare and contrast the Lees' life in Laos and the United States. In what ways was their new life better or worse than their old life?
In Laos, the Lees lived in a small village in the highlands. They had few possessions but were self-sufficient, growing rice, corn, and vegetables and raising pigs and cows. Their house had an earthen floor and beds made of bamboo, and Foua had to carry water from the stream on her back. Life was much more comfortable in the United States, but the family missed the freedom they had in Laos. In the US, Foua and Nao Kao had to learn about electricity, refrigerators, televisions, toilets, grocery stores, and stoves. They couldn't speak the language and were reliant on welfare. Foua disliked having to depend on others to eat and not being able to do as she wanted. In Laos she never would have had Lia taken from her, as parents were considered responsible for making decisions about the medical care of their children.
What do Hmong folktales teach us about their culture?
Fadiman uses Hmong folktales to illustrate aspects of Hmong temperament and values. For instance, the Orphan is a recurring character who serves as a symbol for the Hmong people. Despite living alone on the margins of society, he is actually clever, courageous, resilient, and a virtuoso of the qeej, a highly esteemed musical instrument. Another character, Shee Yee, escaped nine evil dabs by shapeshifting, reflecting how the Hmong would rather fight or flee than surrender.
Describe Neil Ernst and Peggy Philp. What were some of their strengths and weaknesses?
Neil and Peggy are both hard-working, compassionate, and capable physicians who are married to each other. They are idealistic, compulsive workaholics who coordinated their schedules so as to take turns being home for their children after school and taking long runs in the morning. While these qualities generally made them excellent physicians, they also made it difficult for them to compromise and adapt their methods to accommodate the wishes of their Hmong patients. Neil changed Lia's medication frequently in an attempt to give her the best care possible, but he failed to take into account the difficulty her parents faced in following his instructions or in tolerating the side effects of the medicine. He referred Lia's case to Child Protective Services because he felt it was the only way to ensure Lia would receive the medical care she needed, rather than working with the family to seek a better solution. On the other hand, both he and Peggy readily admitted their mistakes and did not let pride keep them from self-improvement.
Lia Lee ended up in a vegetative state despite how hard both her parents and doctors tried to save her. How did this tragedy happen? How, if at all, might it have been averted?
Lia's care was suboptimal from the start due to a lack of interpreter services at the hospital. Thus, for the first six months, doctors didn't even realize that Lia had epilepsy. Once they began treating her properly, they failed to effectively communicate the reasons that it was so important to give Lia her medication. Neil Ernst also frequently changed her medical regimen, making it even more confusing to administer. He believed it would be better for Lia to live with a foster family who would follow his instructions; however, the emotional anguish caused by Lia's separation from her parents may have further hurt her health. Lia's parents did their best, but they didn't understand why they needed to give Lia medication with harmful side effects. They also believed that too much medication would limit the effectiveness of the spiritual healing performed by a tvix neeb.
It is possible that the tragedy could have been avoided with better cross-cultural communication and a willingness to compromise on both sides. Lia's doctors could have found a bicultural interpreter to teach the family about the importance of medication, engaging the help of clan leaders. They also could have hired a nurse to administer Lia's medication at home, rather than placing her in foster care. Had they listened to the Lees' explanation of Lia's illness, they might have understood the family's concerns and been able to address them. Acknowledging their viewpoint may also have built trust, so essential for effective communication.
The two cultures
1. Do you think the author was evenhanded in her presentation of Hmong culture and medical culture?
2. The book contains many Hmong phrases and many medical phrases, both unfamiliar to most readers. Why do you think the author included them?
3. Over the centuries, the Hmong fought against many different peoples who claimed sovereignty over their lands. What role has this tumultuous history played in the formation of Hmong culture?
4. How does the Hmong folktale about how Shee Yee fought with nine evildab brothers, told at the end of chapter 12, reflect Hmong culture?
5. What do traditional Hmong consider their most important duties and obligations? What do American doctors consider their most important duties and obligations?
6. In chapter 18, Fadiman writes, “As William Osler once said --- or is said to have said --- ‘Ask not what disease the person has, but rather what person the disease has.’” How might the events of this book have unfolded if Osler’s dictum were universally followed in the medical profession? How would your relations with your own doctors change?
7. In matters of attitude, what might the average American doctor learn from a Hmong txiv neeb (shaman)? What might the txiv neeb learn from the doctor?
8. In her preface, the author says that while she was working on this book, she often asked herself two questions: “What is a good doctor?” and “What is a good parent?” How do you think she might have answered her own questions? How would you answer them?
9. At the end of chapter 18, Sukey Waller asks, “Which is more important, the life or the soul?” What do you think?
10. The Spirit Catches You and You Fall Down revolves around a small child who for much of the book is too young to speak for herself, and at the end is unable to. Do you nonetheless feel you know Lia Lee? Do you believe that even though she cannot walk or talk, she is a person of value? Why?
11. In chapter 8, after describing Foua’s competence as a mother and farmer in Laos, Fadiman quotes her as saying, “I miss having something that really belongs to me.” What has Foua lost? Is there anything that still “really belongs” to her?
12. How do you feel about the Lees’ reluctance to give Lia her medicine as prescribed? Can you understand their motivation? Do you sympathize with it?
13. In chapter 7, Neil Ernst says, “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.” Why didn’t this message get through to the Lees? If you were Neil, would you feel this way too?
14. In chapter 15, Foua, who has heard that one of the Ernst sons has leukemia, embraces Peggy. After all the conflict between them, why are they finally able to resolve their differences? Do you think this could have happened earlier?
15. Since the publication of the book, Anne Fadiman has said that if she lived in Merced, she would choose Neil and Peggy as her children’s pediatricians. Would you?
16. Fadiman describes May Ying Xiong as not just an interpreter but a cultural broker. What’s the difference? What were May Ying’s contributions to the book?
17. Were you surprised by the quality of care and affection given to Lia by her foster parents? How did Lia’s foster parents feel about Foua and Nao Kao? Was foster care ultimately to Lia’s benefit or detriment?
18. The only American who fully won the Lees’ trust was Jeanine Hilt, their social worker. Why did Jeanine succeed where so many others had failed?
19. The book contains brief but important sections on three Hmong leaders --- Jonas Vangay, Blia Yao Moua, and Dang Moua --- who are multilingual and gainfully employed. What did they teach Fadiman? Why did she include them?
20. How might this book have been different if it had been written by a Hmong? A doctor? An anthropologist?
21. From a writer’s point of view, what are the advantages and disadvantages of being an outsider in the two cultures Fadiman explores?
22. “The spirit catches you and you fall down” is a literal translation of the Hmong phrase for epilepsy. Why do you think the author chose such a long and difficult title?
23. The book has an unusual structure: Lia’s story occupies the odd-numbered chapters, and background material occupies the even-numbered chapters. Why do you think Fadiman organized her narrative this way?
24. At the beginning of chapter 2, Fadiman tells the story of a Hmong student who gave an oral report on Fish Soup. What is the concept of “fish soup,” and how is it reflected in the book itself?
25. One of the ways by which Fadiman places the doctors and the Lee family on equal footing is her decision to refer to all of them by their first names (instead of saying, for instance, “Dr. Ernst”). What are some other ways?
26. Many readers have commented that The Spirit Catches You and You Fall Down is a book without villains. Do you think that from a literary point of view this is a flaw?
The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures
by Anne Fadiman
- Publication Date: April 24, 2012
- Paperback: 368 pages
- Publisher: Farrar, Straus and Giroux
- ISBN-10: 0374533407
- ISBN-13: 9780374533403