The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures

Chapter 1 begins with a description of the birthing experiences of Foua Yang, who is the mother of Lia Lee—Foua’s 14th child and a central character in the book. Twelve of Foua’s children were born in the highlands of northwest Laos. They were born at home without a birth attendant. Foua did not have fertility problems or complications during her pregnancies, but if she did, she would have consulted with a txiv neeb, a shaman, for help. Fadiman describes the many remedies of txiv neebs who enter trances and combat bad spirits called dab.

Fadiman explains that, after the birth of a child, burying the placenta in the home is extremely important in Hmong culture. In their language, “the word for placenta means ‘jacket.’ It is considered one’s first and finest garment” (5). When a Hmong person dies, their soul must travel back to their place of birth to put on their jacket/placenta. This allows them to reunite with their ancestors and someday be reborn as the soul of a new baby.

Fadiman provides a brief history of Foua’s family, who are part of the 150,000 Hmong who fled Laos in 1975 when the country became communist. The Lees stayed in two different refugee camps in Thailand where Foua gave birth to her 13th child, Mia. Afterwards, the family came to the United States, first living in Hawaii, then Oregon, and finally Merced.

Foua’s 14th child, Lia, is born in 1982 at Merced Community Medical Center (MCMC). Foua’s delivery with Lia receives a lot of medical intervention even though the birth is uncomplicated. Foua finds the hospital experience strange but is not critical about her doctors or her treatment, except for her dislike of the hospital food, which breaches many Hmong taboos. The hospital incinerates Lia’s placenta, and Fadiman describes the disgust that many doctors express when Hmong patients ask to take their baby’s placenta home.

Foua and her husband chose Lia’s name following a soul-calling ceremony (hu plig) that occurs one month after Lia’s birth. Fadiman details the importance of the soul and the many illnesses and cultural taboos that cause soul loss, especially in babies who are vulnerable because they are so close to the realm of the unseen. The Hmong go to great lengths to protect their babies from dabs and soul loss, and Fadiman ends the chapter by describing the Lees’s vow to love Lia and her elders’ blessings and prayers wishing her a long, healthy life.

Fadiman narrates the story of a Hmong student who makes a 45-minute presentation to his French class on how to prepare fish soup. The presentation is a symbol for what one professor describes as “the essence of the Hmong” and their preference “to speak of all kinds of things” that are connected even though they might not appear so at first (12). Fadiman uses this story as a starting point to discuss the sociopolitical history of the Hmong dating as far back as 2700 B.C.

Fadiman largely focuses on the presence of the Hmong in China from 400 A.D. onwards, drawing on scholarly sources from historians, anthropologists, and missionaries. She notes the intense animosity between the Hmong and Chinese. The Chinese try to dominate the Hmong while they wish to be left alone. To maintain their autonomy, the Hmong fight or flee from their oppressors, often inhabiting unreachable parts of China to secure their independence. The Chinese term “Miao” or “Meo” illuminates a negative and insulting view of the Hmong, as it means: “‘barbarians,’ ‘bumpkins,’ ‘people who sound like cats,’ or ‘wild uncultivated grasses’” (14). The term “Hmong” refers to “free men” or “the people” and is a term the Hmong prefer to use to describe themselves (14).

Starting in the early 19th century, approximately half a million Hmong migrated to Indochina, settling in what today is known as Vietnam, Laos, and Thailand. In 1920 French colonialists granted the Hmong special administrative status in Laos, leaving them alone. As a result, many more Hmong emigrated to Laos. Fadiman ends the chapter by explaining the ambivalence outsiders often feel towards the Hmong. When they try and dominate and control the Hmong, antagonism ensues. If they accept the Hmong on their terms, then the Hmong tend to be conciliatory, and many outsiders report “a great fondness for them” (17).

Chapter 3 opens with an event that the Lees attribute to the origins of Lia’s lifelong sickness. Their daughter, Yer, slams the front door to their apartment, and a few minutes later Lia has a seizure. As Fadiman explains, “They recognized the resulting symptoms as quag dab peg, which means ‘the spirit catches you and you fall down’” (20). English-Hmong dictionaries typically translate quag dab peg as epilepsy. The Hmong regard epilepsy with ambivalence. They recognize it as a dangerous illness but also revere it. For instance, many epileptics in Hmong society are shamans. Seizures are a sign that a person has been chosen for a divine role in their society: “Their seizures are thought to be evidence that they have the power to perceive things other people cannot see, as well as facilitating their entry into trances, a prerequisite for their journeys into the realm of the unseen” (21). Because the Hmong associate epilepsy with shamanism, it is not stigmatized in their society. The Lees view Lia as spiritually distinguished, and she is their favorite child.

Fadiman cites numerous studies that show the high degree of attentiveness and care that Hmong parents demonstrate toward their children. Lia has 20 seizures during the early months of her life, but her parents take her to the hospital (MCMC) only twice during this time, in large part because they have their own beliefs about the causes and cures for illnesses. During these two visits, the medical staff misdiagnose Lia’s illness as a lung infection because they cannot communicate with her parents. MCMC does not have official Hmong translators at this time.

Fadiman elaborates on the economic situation of MCMC, which she describes as a modern, well-equipped teaching hospital. Despite its good reputation, MCMC suffers from financial troubles. It accepts all patients whether they can pay or not for services. The majority of their patients do not have private insurance and rely on state and federal aid. In the late 1970s, shifting demographics in the city of Merced did not improve this “payer mix” (25). One in five residents are Hmong, and while they generally avoid the hospital, they still constitute a large percentage of patients. Hmong patients also are costly since they require translation services, which the hospital navigates by hiring bilingual staff and relying on patients’ younger, American educated family members.

The third time the Lees bring Lia to MCMC, the doctor on duty, Dan Murphy, recognizes her illness as a seizure. Dan Murphy later develops a deep appreciation for Hmong culture but at the time is a new resident at MCMC and views epilepsy purely in biomedical terms. The medical staff give the Lees anticonvulsant drugs to control Lia’s seizures. They run tests but cannot explain the cause of her epilepsy.