All people perceive the external reality from their subjective perspective, as the impact of culture, worldview, and traditions are always implicitly present. It is especially applicable to the representatives of the dominant Western culture. People tend to assume that their worldview is necessarily correct if they enjoy high standards of living and are “civilized” according to some widespread criteria. This position becomes clear when the interaction and cooperation of Western people with the members of the minority ethnic groups is examined. This paper is a book review of The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures (1997) by Anne Fadiman.

The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures (1997) by Anne Fadiman

This book is unique as it integrates a large number of social and cultural issues while examining the story of a girl with epilepsy. It demonstrates how the same events and processes are evaluated differently by the representatives of different cultures. The author does not impose her views on the readers and allows them to make their conclusions and interpretations.

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The review will concentrate on several levels of analysis:

  • The first one refers to the story of Lia Lee presented in the book.
  • The second one is the underlying assumptions present in American and Hmong cultures.
  • The third one is a possibility of mutually beneficial cooperation of two different cultures and the principles that should be followed to enable it.

The book seems to provide a coherent philosophical system that can be extended and applied to a large number of social issues.

Author’s Credentials

The author of the discussed book is Anne Fadiman, a freelance journalist and the editor of The American Scholar (Konner, 1997). Fadiman is a well-recognized expert in her field. She specializes on the multi-cultural studies and the most urgent problems of the society. Therefore, the author provides reliable analysis of the situation and related issues as well as clarifies the scope of complementary problems that should be addressed in the near future, both by individuals and nations in general.

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Summary of the Book

It is reasonable to present briefly the major episodes and characteristics of the book under analysis. It centers on the life of Lia Lee (Fadiman, 2012). The problem comes from the fact that she is diagnosed with the strong form of epilepsy. However, the traditional Hmong culture perceives this issue differently in comparison with American one. As a result, the conflicts of cultures occur, and Lia Lee’s health tends to deteriorate. Lia’s family members consider that her illness makes her special, and she could even become a “shaman”. When they realize that her state of health is very problematic, they begin using the methods that are widespread among Hmong culture. They try to call back her soul and optimize her internal mental state in this way. However, these methods are inefficient as they do not address the essence of epilepsy symptoms.

Lia’s doctors who advocate the Western lifestyle and worldview adopt a pure rationalist position (Fadiman, 2012). They neglect the traditional views of Hmong culture as they consider them as being irrational and irrelevant. Although the doctors are motivated to provide the high-quality care, their neglect to cultural issues leads to new problems. In particular, the diagnosis is not formulated precisely and correctly from the very beginning due to the absence of interpreters. However, even when the diagnosis is specified, the doctors are unable to enforce the needed treatment as Lia’s family members do not share doctors’ principles and are unable to follow all the requirements. They are mostly concerned with the negative side effects and do not believe that doctors’ interventions could be efficient and lead to the desired results.

All these factors have contributed to the situation when her mental state starts to deteriorate. Jeanine Hilt, a social worker, proposes the way to organize the medication process which will allow her family to be reunited. However, the situation has not changed radically, and her brain dies. The doctors suggest that she will probably die in the near future. Her family take her home, and she is able to survive for the next twenty-six years. Although her mental state is very difficult and problematic, the care and attention of her family contribute to the positive results. Moreover, the Western doctors consider such impressive results to be impossible. The Hmong follow their rituals, and they help to improve the mental state of Lia even though it is difficult to explain from the perspective of the traditional medicine.

Author’s Thesis

Fadiman states that all cultures have their strengths and weaknesses. Moreover, every country can generate better outcomes for some categories of people. Therefore, it is important to respect all cultures and select the treatment strategy in accordance with the patient’s cultural beliefs and worldview (Fadiman, 2012). If the high level of cultural competence is achieved, the positive results may follow. It is also incorrect to evaluate the essence and implications of other cultures from the perspective of one’s culture.


In general, the author presents the story persuasively and provides a number of explicit and implicit arguments in favor of her thesis. Fadiman realizes that the conflicts of cultures and corresponding implications are very widespread nowadays. For this reason, she presents her story not as a unique case from the life of Hmong girl but as an illustration of one of the most serious social problems and concerns of the 20th and 21st centuries. Fadiman presents her story quite objectively as it shows how the same events are interpreted differently by different parties. It seems that both Hmong people and doctors realize that Lia has serious problems. At the same time, their interpretation of her mental state is different. Doctors realize that epilepsy is a very dangerous disorder that should be treated immediately. However, Hmong people do not consider epilepsy to be an exclusively negative event. Many such special people were chosen to be “shamans,” as their qualities were different in comparison with others. Fadiman states, “although the Hmong believe that illness can be caused by a variety of sources … the most common cause of human illness is soul loss” (Fadiman, 2012, p. 10). For this reason, the Hmong orient to the person’s internal world and beliefs rather than any physical symptoms. The author presents these different interpretations without imposing her views on readers and allowing them to make their suggestions about the future course of events.

The differences between both cultures become even more severe when they try to deal with the symptoms of epilepsy.

It seems that the following two characteristics are evident in this context:

  • First, every culture believes that its approach is effective and can improve the situation.
  • Second, every culture neglects the prescriptions and suggestions of other cultures completely.

People even do not try to comprehend the justification and arguments delivered by the representatives of other cultures. Neither doctors nor Hmong people make any steps in the direction of understanding the underlying causes and motivations by the representatives of other cultures. This issue may demonstrate the existing problems in the U.S. healthcare industry. As American doctors are “civilized” and follow the most developed and reliable practices, they are supposed to act according to cultural competence considerations. However, the positions of other cultures are considered as being irrational, and doctors do not pay any attention to Hmong’s attitude towards their prescriptions.

It seems that the author deliberately demonstrates the attitudes of American doctors in all details to stress that the fact of being “civilized” does not mean that the desired results will be achieved automatically. As any treatment process necessarily presupposes the active collaboration of different individuals including patients, positive results may be achieved only if the proper coordination between all parties is established. If all parties try to impose their understanding on others, the treatment process is negatively affected. Although Fadiman presents the story objectively, it is evident that she evaluates the traditional Hmong culture positively. She has comprehended that it is also meaningful, and it should not be rejected from the very beginning.

The author demonstrates that even Chinese people perceived the Hmong highly negatively. She states that “the Chinese called the Hmong the Miao or Meo which means … “barabarians”, “bumpkins”, etc.” (Fadiman, 2012, p. 14). However, it seems that the author does not agree with such an attitude as she writes that “it was an insult” (Fadiman, 2012, p. 14). In the U.S., this attitude has become even more widespread. All Hmong rituals are considered as being irrational, and both the doctors and the public in general do not desire to comprehend the hidden meaning of Hmong actions.

It seems that the author implicitly stresses the differences between the underlying assumptions regarding American and Hmong cultures. The American culture is mostly individually-oriented. Each social member is responsible for his/her life and choices.

It has a number of implications for the treatment process:

  • First, it is assumed that everyone is motivated to improve one’s health. Therefore, American doctors appear to be absolutely unprepared to Lia’s hesitations and the absence of any support from her family.
  • Second, the American doctors believe that medicine will have a specific and predetermined influence on individuals. As they deal with the patients who share Western principles, they understand the patterns of this influence and consider it to be equally applicable to all social members without any exception.

The author shows that the Hmong culture adopts a very different perspective on examining the external world. This culture is more collectively-oriented, but it is still very different from other collectivist cultures such as the Chinese one. The Hmong suggest that they should help each other especially when the soul of one of their members is in danger. They have developed a set of rituals that can lead to the desired results, i.e. may improve the mental state of a given person.

It seems that the positive effect is achieved due to the combination of several factors:

  • First, all Hmong people share this belief and they are absolutely certain that it will help a person in need.
  • Second, all their rituals are implemented in the atmosphere of love and support.

This psychological climate is highly important for all individuals especially those who experience serious mental problems.

The author explains that without additional efforts, both cultures will evaluate the situation from their perspectives without taking into consideration the positions of each other. It leads to even further misunderstanding and a higher possibility of social conflicts. Moreover, all parties are mostly oriented to addressing the opposite views of each other rather than assisting the person in need. The author shows that under the conditions of such a mutual misunderstanding the methods adopted by the culture that is closer to a given patient prove to be more effective. It is important to make a patient an active participant of the treatment process. Only in this way the results can be positive. If the interests of the medical personnel and a patient are antagonistic, even the most reliable medicine cannot generate the improvement of the patient’s physical and mental state. The neglect of American doctors to Lia’s beliefs and Hmong traditions has contributed to the situation when her mental and physical state has become critical.

Despite the existing problems, it seems that the author admits the possibility of a mutually beneficial cooperation between the representatives of different cultures in the future. Although the underlying assumptions of cultures and their orientation to individualist or collectivist principles cannot be changed by any external force, it is possible to promote tolerance among people and respect to the culture and traditions of others. Fadiman reports the thoughts of the anthropologist Eric Crystal who states, “How extraordinary it was to hear the Hmong language spoken … on J Street,” although previously it was impossible (Fadiman, 2012, p. 228). Thus, the author appreciates the diversity of languages and cultures and considers it to be highly important for the development of the modern civilization in general.

It seems that the attentive readers can come to similar conclusions. The reason is that when people face different alternatives, it is more likely that they will make the correct choice. Moreover, even if the majority of cultures are not highly open to transformations, they still experience the influence of other positions and worldviews. All cultures affect one another, and people also represent the mixture of cultures rather than the only one. It seems that the author encourages the readers to become more responsible and orient not only to their narrow interests but to those of other social members and the society in general.

The overall principles of justice seem to be simple:

  • First, people should respect the views of others as other people can also be correct in some issues.
  • Second, in case of disagreement, only persuasion can be used, while any forms of aggression (both physical and mental) are inadmissible.

The author presents her views very effectively as she concentrates on the objective facts related to Lia’s life. Fadiman demonstrates how various measures taken by American doctors do not lead to the expected results. At the same time, the non-scientific approach adopted by Hmong people appears to be more successful and effective in the long run. Although the readers can make their own conclusions, the objective facts show that positive results can be achieved only if the interests of a given patient are considered. Even the dominant culture should not adopt its world perception of specific individuals as it is both unethical and incorrect.

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One of the necessary prerequisites of the tolerant attitude to the representatives of other cultures is adopting an honest and objective perception of reality. For example, the author states, “the most frequent accusation I heard was that the Hmong were terrible drivers” (Fadiman, 2012, p. 241). It is evident that Americans had a negative perception of Hmong people due to the existing cultural differences. However, they do not explain their reasoning fairly and tend to create some irrelevant claims to support their already formulated position towards Hmong people.
In such cases, it is evident that the problem is not in other social members but in the people who are unwilling to accept the diversity of cultures and the contrasting opinions. In the modern democratic world, people tend to believe that that their position is correct if they belong to the majority group. However, the fact of belonging to the majority does not mean that one’s position is correct. Fadiman concentrates on people’s individual responsibility and implicitly advises to evaluate all cases objectively and be ready to accept the highest level of responsibility regarding the future development of the society.

It may be concluded that Fadiman’s book provides a unique foundation for considering the major inter-cultural problems and challenges of the 20th and 21st century. On the one hand, the ideas of mutual tolerance are cultivated actively, and a large number of people claim to support them. On the other hand, at the stage of the actual implementation of these ideas, numerous problems emerge. People do not tend to accept other cultures or consider them to be a priori inferior in comparison with theirs. It creates numerous hidden problems and may lead to the social isolation of several individuals.

The case of Lia Lee shows that health-related issues are also highly sensitive to cultural perceptions. Thus, the narrow implication of the book is a need for becoming more culturally competent by modern doctors and practitioners. However, the broader implication refers to all social members without any exception. All people should realize that they are the members of the global society. Thus, the needs and concerns of other people are also their personal responsibility. However, the mere positive intentions are insufficient in this context as it is important to be aware of the major cultural characteristics of other people and make the decisions that correspond to their cultural perceptions. Only in this way the desired changes and the social progress can be achieved. The reviewer recommends the book by Anne Fadiman as the major work for understanding the existing cultural challenges and the ways for overcoming them. This book may be reread several times in order to comprehend all hidden messages and meanings. In any case, it is highly relevant nowadays for the members of all social groups and citizens of the global community.

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