The Spirit Catches You and You Fall Down

by Anne Fadiman

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The Spirit Catches You and You Fall Down Summary

The Spirit Catches You and You Fall Down is the story of Lia Lee’s struggle with epileptic seizures and the conflict between her parents and doctors as they seek healing for her. 

  • Three months after her birth, Lia suffers her first seizure. Her parents distrust Western medicine, whereas her doctors think traditional medical practices are making Lia worse.
  • Lia is placed in the care of a foster family. Despite her foster mother’s strict adherence to Lia’s drug regimen, she fails to get better and is allowed to return to her parents. 
  • Lia suffers massive seizures that leave her officially brain dead. Her parents keep her alive, caring for her constantly.


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Last Updated on May 5, 2015, by eNotes Editorial. Word Count: 1475

The Spirit Catches You and You Fall Down is the riveting narrative of a showdown between modern American medicine and ancient Hmong beliefs, a blow-by-blow account of the battle fought over the body and soul of a very sick young girl. Anne Fadiman’s thorough, compassionate, and scrupulously fair presentation of Lia Lee’s story provides a balanced and unbiased view of events. Clearly sympathizing with both the girl’s family and her doctors, Fadiman examines every facet of a complex situation, while challenging her readers’ perspectives on medicine and spirituality.

The Spirit Catches You and You Fall Down alternates chapters on Lia Lee’s medical record with accounts of Hmong history, culture, and religion. The author’s comprehensive research is evidenced by the inclusion of “Notes on Hmong Orthography, Pronunciation, and Quotations,” an extensive bibliography, detailed source notes, and an index. By combining the universality of a family tragedy with a scholarly history of Hmong culture, this book offers a unique and thoroughly satisfying reading experience.

The focal point of this family tragedy is Lia Lee, the fourteenth child of Hmong immigrants Nao Kao and Foua Lee, born in Merced, California, in 1982. The first of the Lees to be born in the United States (and in a hospital), Lia was a healthy baby until she suffered her first seizure at three months of age. Although emergency room doctors at the Merced Community Medical Center initially failed to diagnose Lia’s epilepsy (mistakenly treated as a bronchial infection), her family correctly identified her affliction immediately. They understood that Lia was suffering fromqaug dab peg (the spirit catches you and you fall down), or epilepsy. They believed that her soul, frightened by the sound of their apartment door slamming, fled her body and got lost. Although concerned for their daughter, they had mixed feelings regarding her condition, because the Hmong (and many other cultures) believe that epilepsy is indicative of special spiritual powers. The Lees “seemed to accept things that . . . were major catastrophes as a part of the normal flow of life. For them, the crisis was the treatment, not the epilepsy.” During the following few months, Lia suffered nearly twenty more seizures, was admitted to the hospital seventeen times between the ages of eight months and four-and-a-half years, and made more than one hundred outpatient visits to the emergency room or pediatric clinic. Her medical chart eventually reached five volumes and weighed nearly fourteen pounds, the largest in the history of the hospital. The case frustrated and confounded Lia’s doctors, husband and wife Neil Ernst and Peggy Philip, who possessed a “combination of idealism and workaholism that had simultaneously contributed to their successes and set them apart from most of their peers.” Although exceptionally conscientious and concerned, Ernst and Philip were hampered in the treatment of Lia not only by their inability to communicate with her parents (hospital translators were seldom available) but also by their ignorance of the Hmong culture. While “failing to work within the traditional Hmong hierarchy . . . [they] not only insulted the entire family but also yielded confused results, since the crucial questions had not been directed toward those who had the power to make decisions.”

In an attempt to control her ever-worsening seizures, the doctors placed Lia on a complicated drug regime that would have been difficult for English-speaking parents to follow, let alone the non-English-speaking Lees. The Lees failed to comply with this complicated regimen both because they did not understand it and because they did not want to. As Foua Lee explained:

The doctors can fix some sicknesses that involve the body...

(This entire section contains 1475 words.)

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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.