An Introduction to The Spirit Catches You and You Fall Down

Anne Fadiman’s The Spirit Catches You and You Fall Down opens by introducing Lia Lee, a Hmong child in 1982 in Merced, California, born to refugee parents who had recently fled Laos in Southeast Asia. If she had been born in Laos, her mother, Foua, would have carried out the delivery herself in their house, squatting over the dirt floor. Fadiman explains the various Hmong beliefs surrounding one's health and spirituality. In particular, the Hmong ritual of burying a baby's placenta, which they believe is a jacket in which a person's spirit upon death must retrace their footsteps until they reach the placenta. Only once the soul has put on the jacket can it join its ancestors before being reborn. Without the placenta, the soul will live in the eternity of wandering naked and alone. Because the Lees fled Laos along with thousands of other Hmong people to one Thai refugee camp, then to Portland, Oregon, and not Merced, their souls have a long journey to get back to their placenta. 

On July 19, 1982, Lia was the 14th child in her family, and the first Lee child to be born in America to her parents, Nao Kao and Foau Lee, in the Merced Community Medical Center (MCMC). The Lees wanted to keep their daughter's placenta, but the doctors incinerated it as it was likely that the Merced doctors wouldn’t have allowed them to take it home, assuming that they wanted to eat it. This is one of the many Hmong traditions and beliefs that are introduced and misunderstood by the Merced doctors in this book. Three days later, they were released from the hospital after her mother signed a release form, even though she could not read or speak any English. At just 3 months old, Lia experiences her first seizure. Her sister, Yer, accidentally slams a door, which startles Lia, who begins to convulse and lose consciousness. Lia’s Parents were terrified but also found this event meaningful. In Hmong culture, epilepsy is called quag dab peg, meaning “the spirit catches you and you fall down”, in which they assumed Lia’s soul fled her body from the loud noise. Additionally, they believe seizures can indicate that a person has been chosen by spirits and may possess spiritual power, while her American doctors see epilepsy as a neurological disorder, requiring strict medical intervention. Both sides believed they’re doing what's best for Lia, yet they lack a shared language to understand each other, which raises concerns later on in the story. 

To provide some historical and cultural context for the Hmong people, Fadima explains the long history of migration, resistance, and persecution during the “Secret War” in Laos against the communist forces. The United States fought alongside the Hmong, but after the US withdrew, the Hmong were targeted for retaliation. This resulted in thousands of Hmong people being forced to flee to refugee camps in Thailand and eventually being resettled in the United States. This background is crucial as it explains the Deep mistrust many Hmong refugees feel toward American institutions, including hospitals and government agencies. 

 The focus returns to Lia's medical Care. After her first seizure, Leah had at least 20 more during the next few months. Despite her parents not entirely trusting Western medicine, Foua and Nao Kao brought her to MCMC. The Lees speak a little English, and the hospital provides no consistent interpreters; this is the start of many misunderstandings between the two parties, which only escalates. Dan, a family practice resident, diagnoses Lia with epilepsy and prescribes anti-convulsant medications, but with their limited English, her parents struggle to follow the complex dosing instructions. Dan saw her epilepsy as something to be cured, not knowing that her parents had already determined that her seizures were caused by the spirit catches you and you fall down

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Fadmina goes on to describe a woman's experience returning to a refugee camp in Thailand. This story further solidifies the Hmong’s distrust of Western medicine. After numerous rumors, people asked her whether the United States medical system practiced the same practices they did, such as shamans, soul loss, animal sacrifice, and spiritual balance in Hmong medicine. They believe that many Western Medical practices didn't help the patients but rather harmed them. One particular instance is that the Hmong insist that each person contains a finite amount of blood, so as blood is drawn from the patient, it becomes dangerous. Additionally, they opposed anesthesia as it made the soul vulnerable to dabs, evil spirits, during unconsciousness. These practices that seem so normal in Western medicine appear very dangerous to the Hmong.

Nonetheless, the Lees took Lia to MCMCTo help treat her. Despite the numerous doctor visits, Leah continued to have frequent seizures, many of which were violent and dangerous. She reached a state known as “status epilepticus” in which her oxygen intake was greatly compromised, which threatened her life and cognitive function. Lia continues to have serious seizures along with many different medications prescribed to her by her primary pediatricians, Neil Ernst and Peggy Philp. In addition to these prescriptions, it brought discrepancies in how and when to administer the medication as a result of the language barrier. After raising Leah's dosage and seeing that the blood test showed a lack of medication in her bloodstream, her doctors concluded that either her parents weren't administering the drug properly or that they didn't want to give Lia her medication. Both parties became increasingly frustrated with the level of miscommunication. Even with at-home checkups, Leah continues to have serious seizures, which Peggy and Neil believe could have been avoided if her parents had properly administered Lia’s medication. After the long cycles of non-compliance and the discovery of a double dosage of Tegretol in Lia’s blood, Neil wrote a letter to Child Protective Services advising them to place Leah in foster care as a result of neglect from her parents. The state eventually intervenes, which sets the stage for a tragic struggle over who ultimately decides what the best care for Leah looks like.