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The Spirit Catches You and You Fall Down

By Ann Fadiman

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Review by Allison Martin

In The Spirit Catches You and You Fall Down, Anne Fadiman details the story of a Hmong girl with epilepsy and the conflict between the Hmong community and the Western-trained medical personnel over how to treat her. The difficulties encountered by her doctors were not merely those of language. Explanation and translation of doctor's orders had no effect on "compliance" by the patient's parents. The problems centered on conflicting belief systems about causation of disease and a means to "cure". The Western system holds that disease has a biological basis while the Hmong hold that disease is primarily spiritual. Because neither party understood the other's intentions, mutual distrust and hostility evolved. Ultimately, the confusion contributed to the brain-death of the child. Anne Fadiman meticulously lays out the course of nine years of care and the efforts of her family to retrieve her wandering soul, from the sacrifice of a pig in the apartment living room to the intervention of a Tvix neeb, or Hmong shaman.

The story is sobering for those trained in Western medicine who try to provide good medical care for patients from other cultures. To what extent do doctors actually exacerbate patients' problems? When is noncompliance equivalent to child endangerment? By what means can we communicate? The answers, such as they are, seem to lie not in translation but in the act of interpreting and educating both patients and doctors about the issues in terms of cultural context. They require an active interest by care givers to understand the patient's view of the problem.

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