anthropology and medicine

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The ethnography The Spirit Catches You and You Fall Down by Anne Fadiman outlines two stages of a story centered on Lia Lee and her family, who are trying to heal her epilepsy but are having difficulty reconciling what they believed. Following the Vietnam wars, in which they partnered with Americans, the Lees, who belong to the Hmong ethnic community, found it difficult to adapt to Western ways of life, especially medical techniques. When Lia’s seizures worsen, her physicians abandon the drug and determine that she should be allowed to die (“The left atrium,” 1999). It is, however, apparent that the conflict of cultures and staunch principles that the Hmong people had was a key reason for the worsening of Lia’s seizures and later death though it took time before she passed on. The author depicts the significant culture disconnect from the illustration of the rift that existed between the westerners and the traditionalists’ understanding of the origin of illness.

The first clash that is imminent results from the contradiction in the appreciation of the local traditions by the doctors. The rigidity of the doctors made them be resistant to the culture that the Hmong seemed to demonstrate. It is particularly interesting that while the Hmong ethnic group appreciated the western way of life, the doctors in America did not consider the traditions to be feasible and worth copying. The Hmong thought that the medicine that as being introduced should only act as a supplement rather than a substitute for what they believe in. According to Nao Kao, “the doctors can fix some sicknesses that involve the body and blood, but for us Hmong, some people get sick because of their soul, so they need spiritual things. With Lia, it was good to do a little medicine and a little neeb, but not too much medicine, because it cuts the neeb’s effect” (Fadiman, 2012, p. 100). From this text, it is apparent that the Hmong were welcoming to the new medicines and it was only required for the doctors to be appreciative of the stand that the ethnic group was holding to as they had been surviving without the new knowledge that they had introduced.

It is also critical to highlight the lack of appreciation of the concerns that the patient presents within the doctor’s way of treating the Hmong people. Throughout the novel, it is clear that the westerners were despising of the beliefs that the Hmong were presenting in California and it was apparent when they were treating Lia of her seizures. It explains the contraction that the doctors had tried to reconcile a culture that they appeared close to but could not consider as realistic. Dr. Neil Ernst asserts, “…it felt as if there was this layer of Saran Wrap or something between us, and they were on one side of it and we were on the other side of it. And we were reaching and reaching and we could kind of get into their area, but we couldn’t touch them. So we couldn’t really accomplish what we were trying to do, which was to take care of Lia” (Fadiman, 2012, p. 48). The concept that is demonstrated from the doctor’s assessment was that they were treating just the body but the fact that the patient and the doctor were separated by a clash of cultures meant that they could not touch the human and the concerns that the patient was presenting with. It is particularly important for the author because it underscores the author’s point of view regarding the need for a restructuring of the clinical gaze so that the doctors could demonstrate cultural relativism and improve the outcomes of the treatment.

Another cause of distension between the culture in Fadiman’s book it is in the consideration of eternity and the fate of the human soul. The westerners had a different perspective from the one that the Hmong believed in based on the manner in which they perceived the subject of spirituality and science. Considering their conservative and traditional way of life, the Hmong thought that the defining feature of life is the spiritual context, which even guided their thinking regarding the soul and Lia’s seizures. The author depicts the ethnic groups as a society that was so preoccupied with the science behind medicine that they had devoted most of their time trying to reconcile their soul and protecting it from wandering. For instance, the author writes, “the life-souls of newborn babies are especially prone to disappearance since they are […] poised between the realm of the unseen […] and the realm of the living” (Fadiman, 2012, p. 35). It is apparent that the Hmong beliefs were guided by the assumption that the when the seizures occurred, the girl’s soul escaped her body and then she would begin suffering as her soul was wandering. It implies that while the ethnic group was thinking in terms of the personalist explanation of illness, the westerners were more naturalistic and believed that diseases were as a result of body complications related to biological occurrences (Paul, 2008). It explains the cause of the rift that was imminent and that was threatening to destroying the appreciation of life in the book.

The last feature that is worth describing in the assessment of the interrelationship between cultures in the novel is the consideration of how the doctors believed in their efforts. Meanwhile, the Hmong thought that the doctors were being arrogant because the doctors were not considerate. For example, it is apparent that the physicians suggested that Lia should be taken home when her condition worsened as they thought that the move would constitute a necessary idea based on the girl’s condition. The author writes that, ‘What the doctors viewed as clinical efficiency the Hmong viewed as frosty arrogance” (Fadiman, 2012, p. 67). It is apparent that that two cultures were conflicting based on the manner in which they perceived human emotions whereby while the doctors were less sensitive, the Hmong were more concerned.

In summary, it is clear that the conflict of cultures that is imminent in the book was as a result of the difference in the understanding of the origin of illness whereby, while modernists were more naturalistic, the traditionalists tended to be personalist. Based on the varying principles that the doctors and the Hmong ethnic group had, it is apparent that the suffering that Lia underwent was due to the lack of common ground between the two groups. The author’s approach to the theme is relevant because it enables the reader to understand the consequences of a clash in cultures in a sensitive profession as in healthcare provision.


Fadiman, A. (2012). The Spirit Catches You and You Fall Down. New York.

Paul, O. (2008). The Spirit Catches you and you fall Down: A Hmong child, her American Doctors, and the Collision of Two Cultures. Harvard Medical School. Retrieved from

The left atrium. (1999). The Canadian Medical Association, 161(2). Retrieved from

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