and blood, but for us Hmong, some people get sick because of their soul, so they need spiritual things. With Lia it was good to do a little medicine and a little neeb, but not too much medicine because the medicine cuts the neeb’s effect. If we did a little of each she didn’t get sick as much, but the doctors wouldn’t let us give just a little medicine because they didn’t understand about the soul.

The Lees believed that rather than helping Lia, the drugs were making her worse, and they “didn’t hesitate to . . . modify the drug dosage or do things however they saw fit.”

In a desperate move, Ernst removed Lia from her devastated parents and placed her with a foster family in an attempt to make sure her medications were administered properly. Lia lived with the Korda family for ten months, during which time Dee Korda scrupulously followed the complicated drug protocol and became devoted to the difficult but lovable Lia. Despite this, Lia deteriorated, improving only when she was put on a new, simpler drug regime. The Lees, shamed that their daughter had been taken from them and shattered by the loss, threatened suicide before Lia was finally returned to the family home.

During her first four months home, Lia improved markedly, suffering only one seizure. The Lees not only complied with her medical protocol but also gave her the best Hmong treatment available, including amulets filled with healing herbs from Thailand (at a cost of one thousand dollars) and a trip to Minnesota for treatment by a famous txiv neeb, or medicine man. Lia’s seizures did return, however, and in November of 1986 she suffered massive seizures that could not be controlled. She also suffered septic shock, fell into a coma, and became effectively brain dead. The doctors sent Lia home to die, but she defied their expectations and lived on, although in a vegetative state: quadriplegic, spastic, incontinent, and incapable of purposeful movement. At this point, the Lees became perfect caregivers, keeping the comatose Lia immaculate and well-nourished and lavishing her with attention and love.

Lia’s tragedy is placed in context by Fadiman’s thoroughly researched chapters on the history of the Hmong. A fiercely independent people, the Hmong, throughout history, have refused to assimilate with any other group. They lived in the mountains of China since 3,000 b.c.e. without mingling with the Chinese, fighting ferociously to maintain their identity. In the early nineteenth century, when Chinese repression became intolerable, a half million Hmong fled to Vietnam and Laos. In the 1960’s, the U.S. Central Intelligence Agency recruited the Laotian Hmong, known as skilled and brutal fighters, to serve in their war against the communists. They suffered massive casualties and devastating destruction of their villages; when the People’s Democratic Republic took over the Laotian monarchy in 1975 and attempted to exterminate the Hmong, they were once again forced to flee their homes.

The Lee family succeeded in fleeing Laos in 1979, making their way to a refugee camp in Thailand following a harrowing, twenty-six day journey. After two years in refugee camps, they were able to immigrate to the United States, and, like most Hmong, gravitated to the Central Valley of California. Three of their thirteen children had died from starvation and poor conditions during their flight, and the Lees arrived penniless and illiterate, determined not to be changed by their strange new surroundings.

Clearly, “Lia’s case had confirmed the Hmong community’s worst prejudices about the medical profession and the medical community’s worst prejudices about the Hmong.” While the doctors felt that the Lees failure to keep Lia on her initial drug regime contributed to her decline, the Lees felt that the medicine itself contributed to their daughter’s condition. A review of Lia’s medical records indicated that septic shock rather than epileptic seizures probably caused her vegetative state, septic shock to which her body was susceptible because of the heavy doses of medications she had been receiving. Thus, the Lee’s suspicion that the doctors were exacerbating Lia’s condition with their treatments was not entirely incorrect, while the doctors’ opinion that if Lia’s medication had been administered correctly from the start she might not have deteriorated so dramatically may have been accurate as well.

The Spirit Catches You and You Fall Down provides an education in Hmong history and American medicine, a compelling family drama, and a new outlook on the world. When seen from the Hmong perspective, “truths” previously taken for granted come under question and issues of right and wrong are no longer clear-cut when decent, well-meaning people come into direct conflict with one another over them. As the medical establishment increasingly splinters into specialized groups, this book serves as a vivid reminder that the best medicine must always recognize the interconnectedness of culture, family, body, and soul.

Sources for Further Study

Booklist. XCIV, September 15, 1997, p. 184.

Chicago Tribune. November 30, 1997, XIV, p. 3.

Elle. October, 1997, p. 132.

Glamour. XCV, November, 1997, p. 100.

Library Journal. CXXII, September 1, 1997, p. 208.

Los Angeles Times. September 18, 1997, p. E1.

The New Republic. CCXVII, October 13, 1997, p. 31.

The New York Times Book Review. CII, October 19, 1997, p. 28.

Publishers Weekly. CCXLIV, August 11, 1997, p. 393.

San Francisco Chronicle. December 14, 1997, p. 3.