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The Spirit Catches You and You Fall Down

A Hmong Child, Her American Doctors, and the Collision of Two Cultures

Anne Fadiman

Farrar, Straus and Giroux

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ISBN10: 0374533407
ISBN13: 9780374533403

Trade Paperback

368 Pages



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Winner of the National Book Critics Circle Award for Nonfiction

Winner of the Los Angeles Times Book Prize for Current Interest

A Salon Book Award Winner

Boston Book Review Ann Rea Jewell Non-Fiction Award

A New York Times Notable Book

A Detroit Free Press Best Book of the Year

A New York Newsday Best Book of the Year

Finalist for the PEN / Martha Albrand Award for First Nonfiction

When three-month-old Lia Lee arrived at the county hospital emergency room in Merced, California, a chain of events was set in motion from which neither she nor her parents nor her doctors would ever recover. Lia's parents, Foua and Nao Kao, were part of a large Hmong community in Merced, refugees from the CIA-run "Quiet War" in Laos. The Hmong, traditionally close-knit, have been less amenable to assimilation than most immigrants, adhering steadfastly to the rituals and beliefs of their ancestors. Lia's pediatricians, Neil Ernst and his wife, Peggy Philip, cleaved just as strongly to another tradition: that of Western medicine. When Lia Lee entered the American medical system, diagnosed as an epileptic, her story became a tragic case history of cultural miscommunication.

Parents and doctors both wanted the best for Lia, but their ideas about the causes of her illness and its treatment could hardly have been more different. The Hmong see illness and healing as spiritual matters linked to virtually everything in the universe, while medical community marks a division between body and soul, and concerns itself almost exclusively with the former. Lia's doctors ascribed her seizures to the misfiring of her cerebral neurons; her parents called her illness, qaug dab peg—the spirit catches you and you fall down—and ascribed it to the wandering of her soul. The doctors prescribed anticonvulsants; her parents preferred animal sacrifices.

Anne Fadiman's compassionate account of this cultural impasse is literary journalism at its finest. The Spirit Catches You and You Fall Down moves from hospital corridors to healing ceremonies, and from the hill country of Laos to the living rooms of Merced, uncovering in its path the complex sources and implications of two dramatically clashing worldviews.


Praise for The Spirit Catches You and You Fall Down

"Ms. Fadiman tells her story with a novelist's grace, playing the role of cultural broker, comprehending those who do not comprehend each other and perceiving what might have been done or said to make the outcome different."—Richard Bernstein, The New York Times

"One of the best books I've ever read."—Jane E. Brody, The New York Times

"If tragedy is a conflict of two goods, if it entails the unfolding of deep human tendencies in a cultural context that makes the outcome seem inevitable, if it moves us more than melodrama, then this fine book recounts a poignant tragedy . . . It is a tale of culture clashes, fear and grief in the face of change, parental love, her doctors' sense of duty, and misperceptions compounded daily until they became colossal misunderstandings. It has no heroes or villains, but it has an abundance of innocent suffering, and it most certainly does have a moral."—Melvin Konner, The New York Times Book Review

"An intriguing, spirit-lifting, extraordinary exploration of two cultures in uneasy coexistence . . . A wonderful aspect of Fadiman's book is her evenhanded, detailed presentation of these disparate cultures and divergent views—not with cool, dispassionate fairness but rather with a warm, involved interest . . . Fadiman's book is superb, informal cultural anthropology—eye-opening, readable, utterly engaging."—Carole Horn, The Washington Post Book World

"A unique anthropological study of American society."—Louise Steinman, Los Angeles Times

"Anne Fadiman's phenomenal first book, The Spirit Catches You and You Fall Down, brings to life the enduring power of parental love in an impoverished refugee family struggling to protect their seriously ill infant daughter and ancient spiritual traditions from the tyranny of welfare bureaucrats and intolerant medical technocrats."—Al Santoli, The Washington Times

"When the Lees hedged their bets in 1982 in Merced by taking Lia to the hospital after one of her seizures, everybody lost. Fadiman's account of why Lia failed to benefit over the years from Western medicine is a compelling story told in an achingly beautiful prose."—Steven Weinberg, Chicago Tribune

"Fadiman's meticulously researched nonfiction book exudes passion and humanity without casting a disparaging eye at either the immigrant parents who don't speak English, or the frustrated doctors who can't decipher the baby's symptoms . . . The Spirit Catches You and You Fall Down conveys one family's story in a balanced, compelling way."—Jae-Ha Kim, The Plain Dealer (Cleveland)

"So good that I want to somehow make it required reading . . . The Spirit Catches You and You Fall Down explores issues of culture, immigration, medicine, and the war in [Laos] with such skill that it's nearly impossible to put down."—Linnea Lannon, The Detroit Free Press

"This is a book that should be deeply disturbing to anyone who has given so much as a moment's thought to the state of American medicine. But it is much more . . . People are presented as [Fadiman] saw them, in their humility and their frailty—and their nobility."—Sherwin B. Nuland, The New Republic

"A deeply humane anthropological document written with the graces of a lyric and the suspense of a thriller."—Abby Frucht, Newsday

"Fadiman's sense of reporting explores a vase cultural gap."—People

"The Spirit Catches You and You Fall Down is Fadiman's haunting account, written over a nine-year period, of one very sick girl in Merced, California . . . What happens to Lia Lee is both enlightening and deeply disturbing."—Kristin Van Ogtrop, Vogue

"Fadiman gives us a narrative as compelling as any thriller, a work populated by the large cast of characters who fall in love with Lia. This is a work of passionate advocacy, urging our medical establishment to consider how their immigrant patients conceptualize health and disease. This astonishing book helps us better understand our own culture even as we learn about another—and changes our deepest beliefs about the mysterious relationships between body and soul."—Elle

"The other day, I picked up a book I had no intention of buying. Eight hours later, having lifted my head only long enough to pay for the book and drive home, I closed Anne Fadiman's The Spirit Catches Your and You Fall Down and started calling friends . . . This is an important book."—Wanda A. Adams, The Honolulu Advertiser

"The Spirit Catches You and You Fall Down changed how doctors see themselves and how they see their patients. Anne Fadiman celebrates the complexity and the individuality of the human interactions that make up the practice of medicine while simultaneously pointing out directions for change and breaking readers' hearts with the tragedies of cultural displacement, medical limitations, and futile good intentions."—Perri Klass, M.D., author of A Not Entirely Benign Procedure

"This is a captivating, riveting book—a must-read not only for medical professionals, anthropologists, and journalists, but for anyone interested in how to negotiate cultural difference in a shrinking world. Fadiman's ability to empathize with the resolutely independent Hmong as well as with the remarkable doctors, caseworkers, and officials of Merced County makes her narrative both richly textured and deeply illuminating. Sometimes the stakes here are multicultural harmony and understanding; sometimes they're literally life and death—whether in wartime Laos or in American emergency rooms. But whatever the stakes and wherever the setting, Fadiman's reporting is meticulous, and her prose is a delight. From start to finish, a truly impressive achievement."—Michael Bérubé, author of Life As We Know It

"When a Hmong child and her parents encounter the American medical system, what takes place is a veritable explosion that reveals the weaknesses and rigidity of both systems. Ms. Fadiman's painstaking research and extraordinary writing skills make this into a compelling story that, once started, cannot be put down. And yet The Spirit Catches You and You Fall Down is also a unique anthropological study of our society, one that will endure and be referred to for years to come."—Abraham Verghese, author of My Own Country

"So extraordinary is this tale, no conventional label comes to mind. It is a story of the tragedy of an ill child, a debate between two improbably clashing cultures, an essay on the limits of reason and authority. Anne Fadiman has yoked all three forms into a remarkable book which touches on every aspect of human capability and makes one feel at once more and less in control of life. This is a beautiful and haunting piece of work."—Roger Rosenblatt

"Some writers . . . have done exceedingly well at taking in one or another human scene, then conveying it to others—James Agee, for instance . . . and George Orwell . . . It is in such company that Anne Fadiman's writing belongs."—Robert Coles, Commonweal

Reviews from Goodreads


Read an Excerpt

If Lia Lee had been born in the highlands of northwest Laos, where her parents and twelve of her brothers and sisters were born, her mother would have squatted on the floor of the house...

About the author

Anne Fadiman

Anne Fadiman was born in New York City and was raised in Connecticut and Los Angeles. After graduating from Harvard, she worked as a wilderness instructor in Wyoming before returning to New York to write. She has been a staff writer at Life, editor-at-large of Civilization, and editor of The American Scholar. Fadiman is also the author of Ex Libris and At Large and At Small, and the editor of Rereadings. She now lives with her family in western Massachusetts and serves as the Francis Writer-in-Residence at Yale.

Gabriel Amadeus Cooney

Restoring Vanished Worlds: Anne Fadiman and Cullen Murphy, An Epistolary Conversation

Opening Up a Life: Anne Fadiman and Jenny Allen In Conversation

Anne Fadiman at Yale