Spirit Catches You and You Fall Down

December 11, 2012
Section 1: Who is the one to delineate fault for a miscommunication and misunderstanding between two cultures? In Anne Fadiman’s novel, The Spirit Catches You and You Fall Down, she begins the novel as an attempt to allocate responsibility for the mistreatment and exacerbation of Lia Lee’s epilepsy. The tension between the Hmong and United States medical culture exemplified the strain in America between a foreign culture dependent on rituals and society’s norm. As the novel progress, Fadiman realizes that neither culture is truly at fault. Lia’s situation stemmed from a clash of cultural beliefs and practices that could have been solved by a respect and empathy of the significance of cross-cultural communication. Throughout the narrative, there were characters that were able to be culturally empathetic while some were unable to appreciate the cultural differences between the two entities and realize the necessity for cooperation and understanding.
The Hmong have a saying that they repeat at the beginning of every story, “Hais cuaj txub kaum txub,” which means, “speak of all kinds of things” (Fadiman 13). These words depict the belief in the Hmong culture that the world is full of things that might not appear related but actually are. This concept relates to the Hmong’s history. Their development as a culture is tainted with inconsiderate counter cultures that restricted their freedom to practice their cultural rituals. This greatly influenced their ability to trust cultures that are not their own. Their general distrust in any culture different from their own can be mainly traced back to the Chinese and Indochinese portion of their saga. Basically, the Hmong have been chased out of any home they have ever had due to their unwillingness to take orders, their affliction to losing and the imperative detail that they would rather flee, fight, or die than surrender. This all boils down to the fact that they are not easily swayed by other culture’s customs. This ethnocentric attitude has greatly attributed to the Hmong culture’s general distrust and distaste for any culture but their own.
Lia’s parents, Nao Kao and Foua Lee, and much of the Hmong community were skeptical of trusting the “white people” in the medical profession and in the community. In fact, Lia’s case became the litmus test for Hmong community and turned out to be a deciding factor as to whether the Hmong community in Merced, California would trust the medical professionals when they found themselves at MCMC in a similar state as Lia. Despite this inherent distrust of any culture dissimilar to their own, the Lee’s were able to trust one CPA worker, Jeanine Hilt, who took the Lee’s case very personally. Jeanine made it her mission to fight the medical industry tyranny on behalf of the Hmong culture and became the only person to ask the Lees their opinion.
Because of the language barrier, many medical professionals saw talking to the Lee’s as a lost cause to communicate with, which led the Lees to believe they were being taken advantage of. Jeanine was the only one who thought to ask how the Lees felt about how the doctors were treating Lia and their culture. Because of this openness to communication and genuine interest in their answers, she explained to the hospital how the Lees, and the Hmong culture, felt about Lia’s epilepsy and why they were running into to so many conflicts with the Hmong culture.
Jeanine’s open approach allowed her to see what the barrier was between the Lees ad the medical profession. The Lee’s and the Hmong culture considered Lia an anointed one and her “illness” as a blessing rather than a weakness. In the Hmong culture, people born with epilepsy are believed to be the anointed ones and are destined to a life as a shaman. They call it “qaug dab peg,” or “the spirit catches you and you fall down.” People in the medical profession did not understand the concept of spirits and the importance of epilepsy for the Hmong. Jeanine was the only white person who adamantly fought for the rights of the Hmong. She was able to do this by the ability to effectively and cross culturally communicate.
A similar problem occurred when the Lees refused to give their daughter her daily medicine regimen. Lia was taken away from her family and put into foster care. Jeanine fought to get Lia back to her family as her epileptic episodes became more frequent and dangerous. After she succeeded, it was Jeanine’s mission to educate the Lees, especially Foua, on the drug regimen and explain to her the importance of the drugs and to understand Nao Kao and Foua’s aversion to medicine. Hilt was the only person that took the time to listen to Foua and her concerns regarding the unnatural substances. And after Lia’s large grand mal seizure, she was the only one who tackled the problem of how the Hmong family was treating Lia’s developmental delays.
Jeanine’s key to success was always keeping the lines of communication open between herself and the Lees and therefore between the Lees and the MCMC. In order to cross culturally communicate, Jeanine focused on a caring approach that was “culturally empathetic” and used the Lees daughter, May, as her translator. She did this because having another unfamiliar person in the room, especially a translater, would make the Lees uncomfortable and less open to effective communication. Hilt also took the time to get to know the Lees. She knew the names of all their seven surviving children and most importantly never abandoned Lia or her family even in Nao Kao’s darkest moments. As part of the Hmong culture, they are naturally very violent and are not deterred by being outnumbered. Nao Kao threatened a translator that came and told the Child Protective Services were taking Lia away. Jeanine understood the aversion to having someone’s child taken away and made sure the threats Nao Kao made didn’t affect the courts decision to let Lia return. Jeanine’s empathy was deepened by two factors. She understood the burden of a chronic illness because she had asthma. She also admired the connection and closeness of the Hmong families. She was deeply connected to this family and to this child so she harassed the government and the hospital until the Lees got what they deserved. This included a pediatric hospital bed for Lia’s last days at home. This led the Lees to hold Jeanine in high esteem and allowed for a trust that was incredibly hard to earn from the Hmong culture. While Jeanine took the time to understand the Hmong culture, Nao Kao, Lia’s father, did little to reciprocate. He greatly appreciated her attempt at being understanding, however he never believed it was his responsibility to do the same. Even then, Foua was usually the most receptive to Jeanine’s triumphs. Historically Hmongs have become the pariahs of society. With this in mind, Nao Kao never really made the effort to be part of a society that he knew went against his beliefs and therefore was rejecting him. It is also prominent in Hmong culture, that the man is the strongest part of the family and the most emotionally disconnected. While the Hmong were fighting the Chinese, they even killed their wives and children so they wouldn’t be emotionally distracted. Nao Kao hyper masculine attitude led him and his wife to be passively obedient. In the book, Fadiman writes “It was typical for Hmong patients to appear passively obedient – thus protecting their own dignity by concealing their ignorance and their doctor’s dignity by acting deferential – and then, as soon as they left the hospital, to ignore everything to which they had supposedly assented” (Fadiman 68). This is no way to effectively communicate between two cultures. By Nao Kao affirming that he would give the medicine and not at least trying to explain that it is against his belief and/or he does not understand how to give the medicine, he falsely gives the impression to the doctors that Lia will be cared for at home. Not only does not communicate that he will not give the medicine, but he also doesn’t communicate that he has not given the medicine to Lia when the Lees continue to take her to the hospital seizure after seizure. While the Hmongs believed being epileptic was a sort of blessing, they also understood the repercussions and knew the disease was at least semi-dangerous. That is the reason the Lees continued to take Lia to MCMC over and over again, despite their hatred for the medical culture and the inability to effectively communicate. However Nao Kao Lee was most definitely stuck in his ways. Fadiman explains a observation by Francois Marie Savina as to his first impressions to the Hmong in 1924. Savina, a missionary, stated “ethnic durability can be attributed to six factors: religion; love of liberty; traditional costumes; refusal to marry outside their race; life in the cold, dry mountainous areas; and the toughening effects of war” (Fadiman 208). The Lee family did little the acculturate themselves into the United States culture and came here to merely escape prosecution. When the Lees came to America, their relatives had to show them how the country worked. They relied greatly on their children. After Seventeen years of living here they still speak only Hmong and practice only Hmong traditions.
The Hmong culture is famously stuck in its ways and it was no different for Nao Kao. The mixture between his role in his culture as well as the culture itself lends itself to the inability to communicate between the Lee family and the MCMC medical staff. The first thing that would allow two cultures, such as the Hmong and the United States medical culture, to effectively communicate is knowing what their core values, core distinction, and some key elements to their culture in regards to value dimensions. The Hmong’s value dimensions tend to fall on one extreme, while America falls on the other side of the spectrum. For example, in the Identity value dimension, the Hmong are highly collectivist, which means their core value is group harmony and their core distinction is whether you’re in group/out group. However, the United States population is based on individualist side of the identity spectrum. This means they believe in individual freedom and the core distinction is whether its me/others (Hofstede Pederson Hofstede 94-97). This has a large impact in how two cultures interact with each other because while the United States will believe that the Hmong should do whatever it takes to protect themselves while the Hmong believe they should maintain the peace with the gods or else they will be punished which focus’ on group harmony. The virtue value dimension also has a strong effect on the differences between these cultures. The Hmong are considered extreme long-term orientation, which values the long-term benefits. The US medical culture is more oriented on today’s effects, otherwise known as extreme short-term orientation (Hofstede Pederson Hofstede 109-112). This shows why the Hmong are so superstitious because they are worried about the futures of their children and even their grandchildren. The medical industry is not superstitious and therefore believes in saving the life that needs saving now and not later. They do not discriminate on between now and later.
A lot of lessons can be learned from how Jeanine was able to effectively communicate between the Hmong and US medical cultures. First of all, it is important to be open to new ways of communication between cultures and to not only find similarities, but also understand the differences between cultures. The Hmong culture and the Medical culture in the United States seem on opposite ends of the cultural spectrum. In that brief period of Lia’s seizures being decreased and her seemingly getting better, the Lees understood that they had to give Lia her medicine regularly and the hospital understood why the Lees were hesitant about giving their child too many unnatural substances. When the two entities understood each other’s culture and cultural differences, Lia’s health improved and they were able to understand each other beyond the most basic level. This is called being culturally empathetic.
Lia’s illness was a test for the two cultures. It was a situation that forced a broken system to recognize its faults and demonstrate how it needs to be fixed. At the end of the day, it doesn’t matter who worsened Lia’s illness because placing blame won’t help either culture understand each other. By the end of the text, as Fadiman is reflecting on the case, she writes “I do not know if Lia would be able to walk and talk today had she been treated by Arthur Kleinman instead of by Neil Ernst and Peggy Philp. However, I have come to believe that her life was ruined not by septic shock or noncompliant parents but by cross-cultural misunderstanding” (Fadiman 262). The MCMC has learned multiple lessons from Lia’s epilepsy. They learned to be culturally conscious, they removed the organ donor box from the hospital waiver and posted details about Lia’s case so her illness won’t be mistreated ever again. The key to communicating effectively is to realize that a culture is different from yours and value their judgments just as much as you value your own. Jeanine was able to do it, hopefully Nao Kao will one day do it as well as every doctor in the medical profession, and especially the doctors that are in heavily populated minority areas.

Bibliography 1. Fadiman, Anne. The spirit catches you and you fall down: a Hmong child, her American doctors, and the collision of two cultures. New York: Farrar, Straus, and Giroux, 1997. 2. Hofstede, Gert Jan, Paul Pedersen, and Geert H. Hofstede. Exploring culture. Yarmouth, Me.: Intercultural Press, 2002

Section II: Throughout my life, I have always been a person who loved traveling. I will always love traveling and someday, I hope to have a job where traveling is a requirement. When I travel, I hoped to come as close to emersion as possible in the time span I’m there. I believe interacting with other cultures can seriously give you a whole new outlook on life and learning perspectives of different cultures and humans always fascinates me which is why, next year, I am planning to take a year off to work at a bed and breakfast in France. People from all over the globe come to bed and breakfasts, which will give me a lot of face time with a lot of different cultures and learn a little bit about everything. My housing and dining will be paid for while I meet people, make lifelong connections and put all the things I learned about in cross cultural communication to work. Cross Cultural Communication opened up my eyes to some pretty basic things that you just never really put names to. The best lesson I learned was on cultural empathy. The idea that you don’t only tolerate another culture, but you understand it at its most basic level is incredibly important in how you connect with other people. A lot of my best friends are actually international and live in other countries. One of my best friends ever lives in Greece and looking back on our friendship, I realize how I subconsciously underwent the process of cultural empathy by asking her about the different practices she went through and the different ways she understood American culture and society. Unfortunately, I did not do the same with my German ex-boyfriend who lived in Germany which probably could have saved a lot of grief on my end. Another lesson I found interesting in cross-cultural communication was reflexivity. Reflexivity is the ability and willingness of a researcher to acknowledge their bias. When I went to H Street, I realized my bias growing up in small town liberal suburbia. I realize my bias everyday when I meet people who grow up in different countries, parts of the country or even socio economic class. While interviewing Josh Parrish for my interview project, I saw how different our lives were and yet how similar we were. Reflexivity is not only important to acknowledge for reliable research, but for dependable relationships as well. Talking about white privilege really interested me throughout the course. Growing up as white, I kind of always resented the doors that automatically opened for me in some sense of the word. I can’t pinpoint why, but I like the challenge of overcoming adversity. In the School of Public Affairs Leadership Program, we talked about the idea of Privilege and Power and we watched an interesting TED talks that introduced the idea of “The Power of a Single Story.” Acknowledging the different presets in society is important to society and to be able to communicate with each other. If I could change one thing about this class, it would definitely be about the reading. The readings were incredibly numerous and sometimes, I couldn’t finish everything, which led to a serious cycle of me falling incredibly behind. I would’ve loved for a way to cut down the readings, perhaps only read important excerpts or something because the workload was either really hard or very laid back. The lessons I learned in cross cultural communication feel less immense than other classes, but I already notice how I look around and see how these lessons are applicable in real life. I constantly look back at my history and realize how helpful these skills would have been months and even years ago. Being culturally empathetic is the most important lesson I could have learned and I feel was the overarching theme to the whole course. I found it helpful to learn how to properly acculturate into a foreign culture and while I may not become a foreign diplomat because of this class, I definitely learned some important imformation.

Bibliography: 1. Fadiman, Anne. The spirit catches you and you fall down: a Hmong child, her American doctors, and the collision of two cultures. New York: Farrar, Straus, and Giroux, 1997. 2. Hofstede, Gert Jan, Paul Pedersen, and Geert H. Hofstede. Exploring culture. Yarmouth, Me.: Intercultural Press, 2002 Section II: Throughout my life, I have always been a person who loved traveling. I will always love traveling and someday, I hope to have a job where traveling is a requirement. When I travel, I hoped to come as close to emersion as possible in the time span I’m there. I believe interacting with other cultures can seriously give you a whole new outlook on life and learning perspectives of different cultures and humans always fascinates me which is why, next year, I am planning to take a year off to work at a bed and breakfast in France. People from all over the globe come to bed and breakfasts, which will give me a lot of face time with a lot of different cultures and learn a little bit about everything. My housing and dining will be paid for while I meet people, make lifelong connections and put all the things I learned about in cross cultural communication to work. Cross Cultural Communication opened up my eyes to some pretty basic things that you just never really put names to. The best lesson I learned was on cultural empathy. The idea that you don’t only tolerate another culture, but you understand it at its most basic level is incredibly important in how you connect with other people. A lot of my best friends are actually international and live in other countries. One of my best friends ever lives in Greece and looking back on our friendship, I realize how I subconsciously underwent the process of cultural empathy by asking her about the different practices she went through and the different ways she understood American culture and society. Unfortunately, I did not do the same with my German ex-boyfriend who lived in Germany which probably could have saved a lot of grief on my end. Another lesson I found interesting in cross-cultural communication was reflexivity. Reflexivity is the ability and willingness of a researcher to acknowledge their bias. When I went to H Street, I realized my bias growing up in small town liberal suburbia. I realize my bias everyday when I meet people who grow up in different countries, parts of the country or even socio economic class. While interviewing Josh Parrish for my interview project, I saw how different our lives were and yet how similar we were. Reflexivity is not only important to acknowledge for reliable research, but for dependable relationships as well. Talking about white privilege really interested me throughout the course. Growing up as white, I kind of always resented the doors that automatically opened for me in some sense of the word. I can’t pinpoint why, but I like the challenge of overcoming adversity. In the School of Public Affairs Leadership Program, we talked about the idea of Privilege and Power and we watched an interesting TED talks that introduced the idea of “The Power of a Single Story.” Acknowledging the different presets in society is important to society and to be able to communicate with each other. If I could change one thing about this class, it would definitely be about the reading. The readings were incredibly numerous and sometimes, I couldn’t finish everything, which led to a serious cycle of me falling incredibly behind. I would’ve loved for a way to cut down the readings, perhaps only read important excerpts or something because the workload was either really hard or very laid back. The lessons I learned in cross cultural communication feel less immense than other classes, but I already notice how I look around and see how these lessons are applicable in real life. I constantly look back at my history and realize how helpful these skills would have been months and even years ago. Being culturally empathetic is the most important lesson I could have learned and I feel was the overarching theme to the whole course. I found it helpful to learn how to properly acculturate into a foreign culture and while I may not become a foreign diplomat because of this class, I definitely learned some important imformation.