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Academic Medicine:
Medicine and the Arts

The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures: [Excerpt]

Fadiman, Anne

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Excerpt from “The Eight Questions” from The Spirit Catches You and You Fall Down by Anne Fadiman. Copyright © 1997 by Ann Fadiman. Reprinted by permission of Farrar, Straus and Giroux, LLC.

Lisa Dittrich, deputy editor of Academic Medicine, is the editor of “Medicine and the Arts.” (Unsolicited submissions are welcome.)

Hmong culture … is not Cartesian. Nothing could be more Cartesian than Western medicine. Trying to understand Lia and her family by reading her medical chart (something I spent hundreds of hours doing) was like deconstructing a love sonnet by reducing it to a series of syllogisms. Yet to the residents and pediatricians who had cared for her since she was three months old, there was no guide to Lia's world except her chart. As each of them struggled to make sense of a set of problems that were not expressible in the language they knew, the chart simply grew longer and longer, until it contained more than 400,000 words. Every one of those words reflected its author's intelligence, training and good intentions, but not a single one dealt with the Lees' perception of their daughter's illness.

Almost every discussion of cross-cultural medicine that I had ever read quoted a set of eight questions, designed to elicit a patient's “explanatory model,” which were developed by Arthur Kleinman … I thought the Lees might have answered his questions [this way] after Lia's earliest seizures, before any medications had been administered, resisted, or blamed, if they had a good interpreter and had felt sufficiently at ease to tell the truth. To wit:

1. What do you call the problem?

Quag dab peg. That means the spirit catches you and you fall down.

2. What do you think has caused the problem?

Soul loss.

3. Why do you think it started when it did?

Lia's sister Yer slammed the door and Lia's soul was frightened out of her body.

4. What do you think the sickness does? How does it work?

It makes Lia shake and fall down. It works because a spirit called a dab is catching her.

5. How severe is the sickness? Will it have a short or long course?

Why are you asking us those questions? If you are a good doctor, you should know the answers yourself.

6. What kind of treatment do you think the patient should receive? What are the most important results you hope she receives from this treatment?

You should give Lia medicine to take for a week but no longer. After she is well, she should stop taking the medicine. You should not treat her by taking her blood or the fluid from her backbone. Lia should also be treated at home with our Hmong medicines and by sacrificing pigs and chickens. We hope Lia will be healthy, but we are not sure we want her to stop shaking forever because it makes her noble in our culture, and when she grows up she might become a shaman.

7. What are the chief problems the sickness has caused?

It has made us sad to see Lia hurt, and it has made us angry at Yer.

8. What do you fear most about the sickness?

That Lia's soul will never return.

© 2001 Association of American Medical Colleges

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