Book Review: The Spirit Catches You and You Fall Down

The complete title of this book is, The Spirit Catches You and You fall Down:  A Hmong Child, her American Doctors, and the Collision of Two Cultures by Anne Fadiman.  I started reading this book because it was assigned reading for my son’s AP English class.  I always like to stay ahead of the kids in their reading when possible, and the title of this book caught my eye.

I have been interested in whether or not it is really possible for two cultures to understand each other for some time.  Ever since our family was in the Spanish language congregation for five years, I have pondered this problem.  It seemed to me that with the best of effort and desire on both sides, there was still a gulf that was impossible to cross between our two cultures.  Sometimes I felt that although I was speaking Spanish, I might as well have been speaking Chinese.  I didn’t feel like it was failure to understand, it was refusal to hear that caused our miscommunication.  Of course the same thing could happen to two people speaking the English language, but this was a different sort of frustration.  Something that seemed trivial to me would be very important to my Hispanic friends, while things that seemed obvious to me were ridiculous to them.  For example, they had very strict traditions about what a person should eat while they were pregnant.  No amount of research would convince them that it was okay to eat salsa while you were expecting a baby.  On the other hand, my exertions on behalf of my children’s musical education seemed like wasted effort to them.

In this book, the cultures clash on a much more important topic — the care of an epileptic baby.  While her Hmong family loves Lia very much, they are not even certain that treatment of her disease is necessary.  After all, the seizures mark her as a very special person, perhaps even a shaman, in their culture.  Her doctors are not only convinced that treatment is necessary, but will not acknowledge the limits of Western medicine in fully treating disease.  They want to place the guilt for the continued illness on the family’s inability or refusal to comply with treatment, rather than acknowledging that medicine is not able to cope with the disease.

In the chapter “The Eight Questions”, the author quotes Dr. Arthur Kleinman, a psychologist at Harvard Medical School, and his words rang true and powerful to me as ways of dealing with those outside our own culture.

“First, get rid of the term ‘compliance.’  It’s a lousy term.  It implies moral hegemony.  You don’t want a command from a general, you want a colloquy.  Second, instead of looking at a model of coercion, look at a model of mediation.  Go find a member of the Hmong community, or go find a medical anthropologist, who can help you negotiate.  Remember that a stance of mediation, like a divorce proceeding, requires compromise on both sides.  Decide what’s critical and be willing to compromise on everything else.  Third, you need to understand that as powerful an influence as the culture of the Hmong patient and her family is on this case, the culture of biomedicine is equally powerful.  If you can’t see that your own culture has its own set of interests, emotions, and biases, how can you expect to deal successfully with someone else’s culture?”

When we are able to recognize not only that we have a powerful cultural bias ourselves, but that the other culture has just as much value as our own, we are able to relate to each other in a much better way.  Unless my opinion is informed, isn’t your opinion as good as mine?  And even if my opinion is informed, your preferences still have validity.  Let me illustrate:  I have often heard Americans say, “I just don’t know how they can stand to live with so many people together!  They just crowd two or three families into one house!”  On the other hand, Hispanic people often comment on how Americans waste their homes because they have great big homes, and often one or two people or no one at home inside those homes.   Just because the cultures are different, does not mean one is superior to another.  If everyone has the room they feel they need, why is it better to have a bigger house?

Most of us do not find ourselves in a position of authority over people of another culture.  However, for those that do, the doctor’s statement about mediation and compromise is especially helpful.  Decide what is critical.  Perhaps there is only one safe way to do a job.  Or perhaps a form must be filled out a certain way.  But perhaps we could help to find a path of compromise that would lead to success and satisfaction for all.  This book also served as a reminder against condescension.  Even people with the best of intentions show their prejudice by condescending to people of another culture.

This book helped me to think about shifting perspective — not thinking outside the box, but thinking from someone else’s shoes.  Even if we were born and raised in the same culture, sometimes even to the same parents, we are each individuals with different thoughts and emotions.  But every single human is equally valuable, and deserves to be treated as such.  The parents of Lia Lee may not have agreed with and believed in modern medicine, but few people who believe in modern medicine would have been capable of giving such excellent long-term care to a brain dead child as they did.  If we really look for the interests of others, we still may not be able to “see where they’re coming from.”  But we can treat them with respect, as they deserve.

On my reading list right now:  Anna Karenina by Leo Tolstoy (re-read), The Wings of the Dove by Henry James (another attempt), There are No Children Here by Alex Kotlowitz, Becoming Naomi Leon (girls book club), and The Nature Principle by Richard Louv.  Hope you’ve got a good book list to enjoy during these long winter evenings.

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