Running head: THE SPIRIT CATCHES YOU PAPER

The Spirit Catches You Paper

Sarah Fennewald
Fontbonne University

THE SPIRIT CATCHES YOU PAPER

The Spirit Catches You Paper

In The Spirit Catches You and You Fall Down, by Anne Fadiman, the Lee family faces
many obstacles when it comes to their cultural beliefs. As a Hmong family, their culture is
extremely important to them, but living in America often challenges many of their traditions. The
Lees, along with many other Hmong, came to America after living in the mountains of Laos
where they lived a much simpler life. The history and cultural traditions of the Hmong, including
the Lees, have a significant impact on daily life, especially when it comes to food and healthcare.
As the Lees story demonstrates, beliefs about food and healthcare vary greatly across different
parts of the world and different cultures.
Food plays a very important part in the Lees life and the Hmong traditions; it has both a
geographical and spiritual significance. Since the Hmong traditionally live in the mountains of
Laos, their food choices are largely based on geography. The Hmong mostly eat rice, vegetables,
and herbs and occasionally eat meat including pork or chicken. According to Foua, they usually
ate leftover rice with a little vegetables for dinner because they ate meat about once a month in
Laos (Fadiman, 1997, p. 105). In the mountains, the Hmong produced all of their own food
either through farming or hunting and gathering. Farming actually had a huge impact on the
Hmong in Laos, as they spent most days in the fields and would move when the land could no
longer produce crops. According to Fadiman, The practice of swidden farming is inextricably
intertwined with migrant identity of the Hmong (1997, p. 123). The Hmong also used food and
farming as the bases for time and date. Foua was told by her parents that she was born during the
season in which the opium fields are weeded for the second time. She does not know what month
she was born, but equates it with October due to her parents description (Fadiman, 1997, p. 7).
While the mountains may have dictated the Hmongs food choices, they did not stop the Hmong

THE SPIRIT CATCHES YOU PAPER

from providing for themselves. The Hmong may have not had much in Laos, but they had their
own land and could provide for themselves. However, in America, the Hmong lost this very
important aspect of their identity. Once in America, the Lees were unemployed welfare recipients
rather than farmers, and each months activities were the same so they stopped orienting
themselves to the Hmong calendar and had trouble remembering when or in what a season an
event had occurred (Fadiman, 1997, pp. 99-100). The sense of independence that food provided
to the Hmong in Laos, was lost in America. The Hmong had a hard time adjusting to being
dependent and completely changed their lifestyle.
Even though Hmong in America are no longer farmers, food still has a major impact on
their spiritual beliefs. In Hmong tradition, food provides more than just nutrients. The Hmong
believe that food can cause illness or heal the sick. While there is belief in America that certain
foods provide health benefits and others lead to disease, such as cancer, the Hmongs beliefs are
not based on research. The Hmong traditions have been passed down over generations and
remain extremely important. After birth, the diet of the mother is extremely important so that the
mother and baby remain healthy. For example, Foua never shared meals after birth because she
believed that spilling grains of rice into chicken could cause her baby to break out across the
nose and cheeks (Fadiman, 1997, p. 9). Foua also would not eat cold foods after birth because it
could make the blood congeal in her womb (Fadiman, 1997, p. 9). The Hmong have many
beliefs about food and rules that they follow to protect themselves or loved ones. They also use
herbal remedies (Foua grew her own herbs in the apartment parking lot) and animal sacrifice to
cure illness or celebrate (Fadiman, 1997, p. 98). The most important aspect to health for the
Hmong is their soul. This relates to animal sacrifice because it is often done to bring back a lost
soul. The Lees sacrificed a pig in order to invite the soul of one of Lias ancestors to be born in

THE SPIRIT CATCHES YOU PAPER

her body (Fadiman, 1997, p. 11). And once Lia became sick, they performed many sacrifices to
bring back her lost soul. In America, the Hmong continue to sacrifice animals, but it has been
much more difficult for them and caused issues with other Americans. In Merced, animal
sacrifice caused a rumor to start that the Hmong were raising rats in order to eat them (Fadiman,
1997, p. 67). Overall, animal sacrifice is one of the Hmongs most important traditions and
continues to be a part of their life as they live in America.
Just like the Hmong were stereotyped for their animal sacrifices, they were also
stereotyped and stigmatized for many of their traditions and beliefs. Ultimately, these stereotypes
affected the healthcare of immigrants, especially for Lia Lee. Many of the doctors and staff at
Merced did not understand the Hmong traditions and instead stereotyped the Hmong immigrants
as inferior. When the Hmong first came to America, they were already resistant to Western
medicine. According to Fadiman, the Hmong view of health care seemed to be precisely the
opposite of the American view (1997, p. 61). The Hmongs spiritualism was completely different
than anything American doctors had ever learned in school. However, instead of trying to
understand the Hmong, doctors assumed their beliefs were stupid or crazy. According to
Fadiman, To most of them, the Hmong taboos against blood tests, spinal taps, surgery,
anesthesia, and autopsies- the basic tools of modern medicine- seemed like self-defeating
ignorance (1997, p. 61). The doctors did not understand the Hmongs beliefs, but they also often
had a hard time communicating with Hmong patients. A lack of cultural competency in the
American health care system resulted in what one doctor referred to as practicing veterinary
medicine when it came to treating Hmong patients (Fadiman, 1997, p. 25). The belief that the
Hmong were ignorant and that their culture was inferior ended up having an impact on Lia Lees
life.

THE SPIRIT CATCHES YOU PAPER

Lia Lee was not even properly diagnosed with epilepsy until her third visit to the
emergency room. Even when she was properly diagnosed, her care was subpar due to the cultural
barriers and the stereotypes of the staff at Merced hospital. There were many issues with the
medications prescribed to Lia because her parents did not believe that was the best way for her to
be cured. However, of the forty or more doctors, nurses, and Merced County employees that had
helped Lia, none had any idea that spirits were involved in her condition because none had
actually asked the Lees what they thought was the cause of their daughters illness (Fadiman,
1997, p. 22). The fact that the American doctors thought their knowledge was superior and the
Hmong were ignorant about medicine led them to leave Lias parents out of her care. This
ultimately led to many problems for Lia because her parents did not give her the medicine as
prescribed. The Lees believed that for Lia it was good to do a little medicine and a little neeb, but
not too much medicine because it would cut the neebs effect (Fadiman, 1997, p.100). If the
doctors had taken the Hmong beliefs into consideration, they may have been able to reach the
Lees better. In fact, the one person who did take the time to ask the Lees what they thought was
wrong, Jeanine Hilt, actually did have some success. She was eventually able to help the Lees
administer Lias medicine properly. Jeanine provided extensive supervision three times a day to
make sure the Lees administered the medication. She also commended the Lees for cooperating
in spite of divergent cultural beliefs (Fadiman, 1997, p. 92). Jeanine Hilt is an example of how
Lias care could have been handled from the beginning if the medical staff had not viewed the
Hmong as inferior.
Neil and Peggy Ernst were the two main doctors for Lia. Even though they truly cared
about the little girls health, they too stereotyped Hmong immigrants as inferior and this
influenced their care for Lia. It is clear that Neil thought his way of medicine was better when he

THE SPIRIT CATCHES YOU PAPER

had Lia taken away from her parents. He stated, I felt it was important for these Hmongs to
understand that there were certain elements of medicine that we understood better than they did
(Fadiman, 1997, p. 79). Neils statement sounds very harsh, but overall I do understand where he
is coming from. I agree with Neil that it was important for the Lees to follow his orders to give
Lia her medicine properly, but I think he could have stated it in a better way and also dealt with
the problem differently. His goal was to let other Hmongs know they had to listen to the doctors
in Merced, but having Lia taken away did not help the Hmong to trust doctors. If Neil would
have understood the Hmong culture better I believe he could have been more successful in
helping the Lees and reaching other Hmong immigrants. Jeanine Hilt did eventually help the
Lees to follow Lias prescriptions, but she did it by spending time with the Lees. Even Neil says
he considered other options in retrospect, but at the time he either didnt think of them or thought
there were too many barriers (Fadiman, 1997, p. 79). Ultimately, after Lia was taken away from
her parents, they began administering her medicine properly, but it is unclear whether Neils
actions, Jeanines actions or both were the reason for this change. After reading the book I know
that Neil only wanted what was best for the Hmong patients, but his statement ultimately
stereotypes Hmong traditions as inferior. Overall, I think his statement and his approach to
reaching the Lees did not work. In Merced, the news of Lias disappearance was known, but it
confirmed what many Hmongs had suspected, that doctors were not to be trusted and they were
in league with other coercive authorities (Fadiman, 1997, P. 83). He may have followed the law
and in the long run it may have resulted in Lia taking the proper medication, but it did not teach
the Hmong to listen to doctors.
I think the cultural practices of my future clients will have a fairly large impact on my
career. I do not know exactly what area I want to work in, but I do know that the United States

THE SPIRIT CATCHES YOU PAPER

becomes more diverse every day. I am leaning toward clinical or community nutrition and both
of these areas deal with a wide range of people with different religions, ethnicities, ages, and
cultural beliefs. It will be necessary to be culturally competent and to have an open mind when
working with clients in the future. If I want to truly help my patients in the future I have to be
able to communicate with them and reach them on the level they are at. I am currently working
on lesson plans for elementary students in my teaching methods and I have found that I have to
teach children in a way that they are comfortable with. I started my first lesson with a power
point because that is how I feel comfortable teaching. The point is that I have to use tools that the
clients are comfortable with and not that I am comfortable using otherwise they will not be
interested or understand. I have already encountered how cultural practices affect health care
through my classes at Fontbonne and through my work experiences. At Mercy Hospital we
sometimes have patients who are kosher or vegetarian and it is important to not only know what
those terms mean, but also what foods fit into those categories. It would be a good possibility a
kosher patient may not return if the proper food is not available for them to eat or someone sends
them the wrong item. Not understanding different cultures will ultimately lead to the loss of
clients in the future.
I think the best way to be more sensitive to cultural practices and beliefs in my future
career is to always keep an open mind and learn as much as I can about different cultures. It is
not possible to know everything about every culture, but just being aware that culture has a huge
impact on people is the first step. In the future it is my goal to take the time to learn about a
culture if I have a patient from a specific culture that I do not know that much about. There are so
many resources available on the internet that is simple to do a little research beforehand. One
thing that I would like to do in the future is learn to speak Spanish fluently. There are so many

THE SPIRIT CATCHES YOU PAPER

Spanish speaking people in the United States that I truly think it would be beneficial for any one
working in health care. The book already demonstrated the challenges in communicating when
language is a barrier. Fortunately, there are many more translators in health care today, but it is
still more personal to communicate with a patient yourself. I also think it would be beneficial to
talk to people from different cultures even if they are not my patient. There are so many diverse
people in the United States that it is easy to talk to someone from a different culture. For example
there are many Bosnians in St. Louis and it would be easy to get involved with or learn about the
community even if I didnt have a Bosnian patient. From past experiences it seems that most
people are open to sharing their culture with others and are glad to answer questions. Lastly, I
will try to ask patients about their culture when I dont know. I think this book really shows how
important it is to understand the patient and what they think. None of the doctors helping Lia
even thought to ask her parents what they thought was wrong. Overall, you cannot make
assumptions about your patients and simply taking the time to understand someone can make a
huge difference.

THE SPIRIT CATCHES YOU PAPER

9
References

Fadiman, A. (1997). The spirit catches you and you fall down. New York: Farrar, Straus, and
Giroux.