The Spirit Catches You and You Fall Down: Culture and Medicine

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Table of Contents

  • Synopsis
  • Perspectives of Evaluating Lia’s Family and Hmong Community
  • System's Perspective
    Conflict Perspective
    Social Constructionist Perspective
  • Genogram and Economap Showing Main Character in Her Environment
  • Merits of Multiple Perspective and Implications for Social Work Practice
  • Evaluation of Lia’s Family and Community Through Different Theories:
  • Theory of Spirituality
    Psychological Theory
  • Cultural Sensitive Systems in the Book
  • Assessment of Forces in Lia and Her Family
  • Human Rights and Justice in the Book


Anne Fadiman’s The Spirit Catches You and You Fall Down documents the health challenges Lia Lee, a young girl from the Hmong community in California faces. Trouble starts when Lia is three months old in what the family believes is a result of evil forces. When she was three months old, her older sister slams the door frightening Lia. As a result, she develops seizure in what the family describes as a spirit that catches its victims prompting them to fall or rather, ‘the spirit catches you and you fall down’ as directly translated from the Hmong language. According to the parents, the fear scared the soul from her body leading to the seizures.

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From the medical perspective, Lia is epileptic and her condition has nothing to do with spirits (Fadman, 2012). Her frequent seizures trouble the girl and her family who seek all means possible to find healing for their daughter. Through a focus on Lia, Fadiman manages to reveal the interplay between culture and medicine. For the family of Lia, the daughter has the potential of becoming a shamanistic healer owing to her seizures common among such traditional therapists. From the narrative, it is apparent that the misunderstanding between Lia’s family and the American doctors results from poor communication in a world of two cultures taking situations in their own approaches. Lia’s family and doctors blame each other making Lia’s treatment complicated. As disagreements between the two sides continue, Lia’s heath worsens leading to symptoms of mental retardation. However, Jeanine Hilt, a social worker, intervenes by placing the child in foster care, which does little to change the situation as the seizures continue.

Perspectives of Evaluating Lia’s Family and Hmong Community

System’s Perspective

From the systems perspective, Social worker Jeanine Hilt focuses on the situation of the patient, both internal and external factors (Hutchison, 2016). Hilt focuses on the existing problem of seizures and disregards other influences that might divert her attention. Jeanine considers the sensitivity of the culture of Lia’s family and treads with caution. She works with Foua as she teaches Lia’s family how to attend their ailing daughter. Remarkably, she realizes that attending to Lia was an impossible task at the hospital because of the cultural conflict. Hence, she intervenes and finally, Lia manages to live at home with her family. With that significant step, she wins the trust of the family which readily accepts to abide by her directives on how to administer treatment. Essentially, the systems perspective is sensitive to the culture of the Hmong people and by extension, the family of Lia. The approach reflects respect to one’s culture and is largely collaborative than forceful. Through the approach, experts are not only able to administer services but also incorporate the people into joining hands with them without building resistance.

Conflict Perspective

Conflict perspective perceives a situation as competition (Hutchison, 2016). In the book, the conflict is between the American doctors and the Hmong community led by Lia’s family. On one hand, the doctors feel disrespected by the unwillingness of Lia’s family to accept the medical procedure for their daughter. On the other hand, the family feels the doctors are forcing them into forbidden ways of treatment. The contest is what deteriorates the health of Lia. From the perspective, Jeanine realizes the contest between the two forces and decides to play a neutral ground. She does not want to conflict with the Hmong family despite not subscribing to their ideals. Hence, she initiates a compromising process that takes Lia to her home to stay with her parents. However, she does not abandon the sick child but rather follows her into the home where she changes tactics of treatment. Rather than administering the medication herself, she uses the accepted people in the family to do it. She teaches them how to carry out the procedure so that they have a sense of ownership in medical treatment. In other words, the intention is striking a compromise, a win-win situation for two conflicting forces.

Social Constructionist Perspective

The perspective looks at the social constructs and looks at how cultures perceive the world (Hutchison, 2016). From this approach, cultures create meanings that are not entirely accurate reflections of realities. From the book, Jeanine explores the culture of the Hmong people and understands their worldview. From her research, she establishes that they do not subscribe to the western system of healthcare. Some of the practices including removal of blood and hospitalization are unacceptable. Equipped with the knowledge, Jeanine can rid herself of the blame of Lia’s family. That is, she understands that the rebellion is not because of the dislike of medication or the strange cultures of the Americans but rather a long-held belief on how they seek healing. Consequently, she manages to devise a workable approach of home nursing to accommodate the need of the family.

Genogram and Economap Showing Main Character in Her Environment

The communication between Lia’s parents and American doctors is not tenable. However, the parents and the community can communicate directly with Lia. Social Worker Jeanine can communicate with the parents and Lia through a translator and with the ease of communication brings all parties into understanding.

Merits of Multiple Perspective and Implications for Social Work Practice

The multiple perspective approach provides a range of interpretations of a social situation (Hutchison, 2016). It enables the social workers to looks at the possible worldviews that can lead to a possible solution to a problem. For example, in the Hmong culture’s worldview, looking at it from conflict systems and social constructionist approaches give diverse views that make understanding of the situation avoids the temptation of looking at a challenge from one perspective and drawing erroneous conclusions. In essence, the multiple perspective approach gives a range of answers.

Evaluation of Lia’s Family and Community Through Different Theories:

Theory of Spirituality

The theory involves an innate belief that supernatural powers influence the actions of individuals or communities (Hutchison, 2016). Proponents of this approach believe that supernatural forces predetermine happenings in society and the lives of persons. In the book, the Hmong community and Lia’s family believe that health is from a supernatural being and no one can change the course of the situation except traditional healers anointed by the Supreme Being. Hence, when Lia falls ill, the understanding by the family is that it is as a result of the soul leaving the body. The panacea to the problem is seeking treatment from traditional healers. At the same time, the seizures the child exhibits echo their spirituality that she is destined to be a healer. From the approach, it is possible to understand why the Hmong and Lia family are rebellious to the American doctors. Lack of spirituality from the position of doctors is what enables them to diagnose the problem and recommend a method of treatment.

Psychological Theory

The theory focuses on an understanding of human emotions, behaviors, and thoughts to explain situations and predict the future (Rosiek & Leksowski, 2016). In the book, Lia’s family understands seizures from the perspective where they argue that the soul left the body of their child. They claim that it came as a result of the banging of the door that scared the child leading to the exit of the soul reflected through seizures. At the same time, the Hmong people reject attempts to take a sample of blood from the body on claims that by so doing, some inner elements of the body and the soul are extracted and could turn fatal. They have rejected autopsies claiming it will prevent a rebirth of souls. However, American doctors perceive this as weird behavior entrenched by fear of cultural change.

Cultural Sensitive Systems in the Book

First, the training of the family members on how to administer treatment to Lia is one of the culturally sensitive approaches evident in the book (Waugh & Crutche, 2011). Considering that the Hmong community and specifically Lia’s family do not accept medication from strange-looking American doctors, the approach of ensuring that the locals participate in the treatment works efficiently. It becomes possible for Lia to receive medication. Nevertheless, there are fears that the level of medication might not be equivalent to what doctors recommended. However, the fact that the family has accepted to learn the ways of western medicine is a positive development that breaths hope into the future. Predictably, even if Lia’s condition does not change, the western culture with its improved healthcare is penetrating a resistant culture. In essence, the health revolution happens because of the system.

Second, the choice of home nursing is another cultural sensitive approach employed (Rosiek & Leksowski, 2016). For Lia’s family that does not like having their child in a hospital, the use of foster care illustrates the accommodate nature of modern medicine as spearheaded by a social worker. Ideally, it is a change of setting to the preference of the resistant culture. With time, the Hmong will realize that modern medicine works better than its traditional antidotes. When that happens, it becomes easier to slowly accept the need to embrace change. Arguably, the sensitization of people on the need to change their worldview takes time and persuasion and foster care is an effective strategy that will revolutionize the Hmong’s culture.

Assessment of Forces in Lia and Her Family

The person-in-environment perspective detaches misconceptions about other people’s cultural beliefs (Rosiek & Leksowski, 2016). Before Lia gets sick, several misplaced notions about Hmong culture took center stage. The Hmong people appeared as a weird barbaric assembly of people with little understanding about health and general living. The American doctors read resistance from a historical understanding of the conservative culture. Notably, the sickness of Lia is the greatest force to happen for the sake of the cultural interaction of the western and Hmong culture. It starts the history of the medical revolution among the locals and a better understanding of other cultures for the American doctors. When Lia falls ill, forces fall into place including the struggle of doctors to diagnose and to treat the epileptic condition. During the struggle, American doctors realize their medical approach, despite its perceived superiority, does not give an instant solution. Instead, the healing delays widening the time for interaction of the two traditions. They seek to understand each other’s worldview as the treatment proceeds.

Debatably, the convergence of politics, social structures, history, and other influences is as a result of the contributions of Jeanine, the social worker (Waugh & Crutche, 2011). Having observed the differences between the two cultures and cognizant of the history of both cultures, she brings everything together to work for Lia and her family. She navigates between two cultures and reconciles them in an approach that does calm the existing differences as focus channels the sick Lia. What gives an advantage to Jeanine is the fact that she chooses to be available at both levels of social structures, instead of relying on misconceived perceptions about either side. At the same time, the presence of a translator, considering Hmong people do not speak English, Jeanine brings an end to the miscommunication which largely contributed to the cultural conflict.

Human Rights and Justice in the Book

From the reading of Fadiman’s text, it emerges that marginalization takes place in different ways. In the book, the American doctors discriminate against the Hmong people as primitive and unable to attend to their health conditions (Waugh & Crutche, 2011). They do not want to consider their worldview to reach a consensus on how they can address the problem. In the text, it is evident that the doctors are unable to offer an immediate cure and rather than admitting the shortfall of the modern system of medication, they blame the Hmong people and Lia’s family for not sticking to the prescriptions. Needless to say, even at the hospital, they were unable to effectively treat the patient. Arguably, there is a neutral; ground because the two cultures cannot solve the epileptic condition of Lia.

It follows that social workers should understand their environment (Rosiek & Leksowski, 2016). They should not allow misleading history to guide their operations. Ideally, they need to research how people behave and their expectations to minimize cultural clashes. Significantly, they have to know that society requires them to be neutral to deliver their goals. Any criticism of culture generates resistance; hence, social workers should have a positive attitude towards other people’s way of life.

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