Multimedia: The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures
Authors: Caroline Richmond
Journal: BMJ (1999)

Anne Fadiman


Farrar Straus and Giroux, £7.73, pp 352 




ISBN 0374 525 641

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Rating: ★★★★

Merced is a town in a depressed area of California’s central valley with a population of 61 000. A fifth of the population are Hmong refugees, and the proportion is growing as the Hmong value children and have plenty of them. Most of the older Hmong are illiterate, speak no English, and live on welfare benefits. The younger ones do well, rather better than white children in school and at university. No one knows where the Hmong originated; they are lighter than most Asian people and don’t have an epicanthal fold to their eyes. They reached China over 1000 years ago, and in the past century responded to persecution by migrating on foot to Laos, Thailand, and Vietnam. The Chinese called them the Meo, which means “bumpkin,” “barbarian,” or “people who sound like cats.”

In recent times many Laotian Hmong have fled to the United States, partly because they had fought with the US forces in the South East Asian conflict and had been given the impression that they would be treated well in the United States. Refugee organisations have dispersed them around the country, from where they migrate to the parent community in Merced. Here they can speak their own language, meet enough Hmong from other tribes to ensure that their children can marry (marriage within a tribe is forbidden), and buy Hmong food from Hmong food shops.

The Lee family arrived in Portland, Oregon, with their seven surviving children, six of whom had been born in Laos and one in a refugee camp. A further five children had died in infancy. Those born in Laos had their placentas buried beneath the mud floor of the hut: a placenta is a jacket, and when a person dies their soul must migrate back to their birthplace to reclaim the jacket. Lia, the Lees’ youngest child but one, was born in Merced County Hospital, and thus her placenta was callously discarded. When Lia was 3 months old her sister slammed a door, and Lia immediately rolled her eyes and had an epileptic fit. To her family this meant she was ill, but it also meant that she was special—“the spirit caught her.”

Lia’s tale becomes a tragedy of Shakespearian dimensions. Over the next four years she went to the emergency room hundreds of times, often in status epilepticus. Her prescription was changed 22 times. Her parents found that most of the drugs made her worse and withheld them. If any drug seemed to make her better they gave her extra. Every time she attended, one of the two dedicated supervising paediatricians, Peggy Philp and Neil Ernst, would come and see her, even at 3 am. Peggy and Neil are married to each other. They could not fathom whether Lia was convulsing despite her drugs or because she wasn’t getting them. Neil felt that Lia’s father was stonewalling him, and Peggy felt that Lia’s mother was a bit crazy because, on the rare occasions when a translator was present, her answers didn’t make sense. A brigade of visiting nurses burnt out by visiting Lia’s home and trying to educate her “non-compliant” mother. To make things worse, the Lees doted on Lia, allowed her to rampage around, and totally spoiled her. To the nurses, Lia’s parents seemed courageous and polite but obstinate.

Anne Fadiman’s book has won accolades in the United States, including the National Book Critics Award. It is unputdownable, heartbreaking, scrupulously researched, and riveting. I would give my right arm to write a tenth as well. I have read it twice, will read it again, and will give it to friends for Christmas. What makes it additionally interesting is the response from Lia’s doctors and family (which can be perused on the Amazon Bookshop’s website, http://www.amazon.com).