What Anne Fadiman originally intended to write as a short magazine article turned into years of research and investigation, which she eventually crafted into one of her most widely celebrated books. The Spirit Catches You and You Fall Down details the story of a Hmong family’s clash with the American medical world as their daughter, Lia, suffers from severe epilepsy.

The Lee family was from a mountain region near Laos in Southeast Asia, from which the Hmong culture hails. Many Hmong immigrated to the U.S. in the 1970s in an attempt to escape encroaching communist forces. A private people who possess no written form of their language, the Hmong hold many traditional oral beliefs. Therefore, when the Lee’s daughter, Lia, born in 1982, began having fits and convulsions at three months old, they attributed it to an occurrence known in their culture as qaug dab peg. In other words, a spirit was attempting to take the soul of their daughter. In the Hmong culture, this is both an affliction and a gift, as possessing this condition is deemed a qualification for most Hmong shamans and healers. Lia became a revered member of both her family and her neighboring Hmong community in California.

Despite this, out of concern for their daughter’s well being, the Lee’s took Lia to the nearby physicians of Merced Community Medical Center. Physicians disagreed with the Lee’s explanation for Lia’s condition and diagnosed Lia with severe epilepsy. Lia was prescribed several different medications and underwent multiple dosage adjustments (a common practice). Consequently, the Lee family assumed that these frequent changes and alterations in Lia’s medical regimen were an indication that the doctors were incompetent. As such, the Lee’s felt it best to cease supplying their daughter with the medication deemed necessary by her physicians. Lia once again began to experience seizure after seizure.

The pediatricians overseeing Lia noticed this drastic change in response to the medication and immediately ordered a drug screen. The results confirmed what they had suspected: the Lee family was not dispensing the medication prescribed to Lia. The physicians of Merced decided to alert child protective services. Lia was placed into foster care, where she was able to receive the appropriate doses of medications as prescribed. Her parents, however, were devastated.

After a period of time had passed, the Lee’s regained custody of their daughter, as a result of promising to provide Lia with the strict regimen of medications as ordered by the court and physicians. Despite the Lee’s cooperation, in November of 1986, Lia suffered a severe nonstop seizure, known as status epilepticus. She developed septic shock from a serious bacterial infection and ultimately suffered brain death. While Lia appeared to be physically alive and was no longer suffering from seizures, her mind was no longer functional.

Upon hearing the news from the doctors, Lia’s parents refused to listen. They still believed that their daughter’s soul would one day be returned to her.
Fadiman’s book not only details the tragedy that resulted due to a cultural barrier, but also addresses the way in which doctors communicate with their patients. Lia’s pediatricians had the same interest at heart that Lia’s parents did; they wanted to help her get better. The physicians, however, felt that their medical expertise overruled the spiritual beliefs of an unfamiliar culture. Interestingly, Fadiman’s visit to one of Lia’s physicians uncovered that Lia’s acquisition of the bacterial infection that killed her could have come from a common bacteria prevalent in many hospitals. In addition, over-prescribing of anti-seizure medications could have had impeded her immune system, making her body more susceptible to such bacteria. The same science that tried to save Lia’s life may have also contributed to her death.

Fadiman brings to light the issue of communication between doctors and their patients. The importance of doctors relating to their patients is critical, be they patients from a small village in Laos or suburban California. While Lia’s physicians might not have been able to identify with Lia’s parent’s spiritual beliefs, the physicians might have been able to understand the fear of losing a child. Part of caring for the patient should include the doctor learning to understand the point of view and concerns that the patient and their family may have regarding treatment. When a patient or the family becomes resistant to recommended medical treatment, attempts should be made by the physician to comprehend the reasons for such opposition. When physicians pursue an understanding of a patient’s perspective, they are more likely to achieve the ultimate goal- healing.