The Spirit Catches You and You Fall Down: Cultural Divides in Healthcare

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The narrative unfolds within the Lee family, immigrants from Laos, focusing on Lia Lee, their daughter born with epilepsy in 1981 at Merced Community Medical Center (MCMC) in California. The challenges arise when Lia, at three months old, experiences her first major seizure, prompting the Lees to seek medical help. However, communication barriers hindered Lia's treatment due to the family's limited proficiency in English. Frustrated obstacles in Lia’s care lead her pediatrician, Neil Ernst, to place her in an English-speaking foster home, underscoring the clash between Western medicine and Hmong traditions.

Understanding Hmong Culture and Traditions

As the title suggests, "The Spirit Catches You and You Fall Down" conveys a rich cultural tone by delving into Hmong history and traditions. Fadiman intricately weaves aspects of Hmong life, including food, clothing, language, and intimate family structures, providing readers with a comprehensive view. The clash between Western medicine and Hmong traditions is evident from the start, as American doctors restrict traditional Hmong birth practices due to concerns about Hepatitis C.

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This sets the stage for exploring the challenges of cultural differences in healthcare.

Delving deeper into Hmong traditions, Fadiman elucidates the significance of rituals and practices surrounding childbirth. In the initial chapters, she describes how the American doctors' refusal to allow traditional Hmong birthing practices created tension. The healthcare providers were driven by their own cultural beliefs and concerns about the risk of Hepatitis C within the Hmong refugee population. This clash highlights the complexities that arise when Western medical standards clash with deeply rooted cultural practices.

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Throughout the book, Fadiman skillfully intertwines the Lee family's journey with insights into Hmong culture. Readers are exposed to the nuances of Hmong life, from the rituals of birth to the intricate details of their daily lives. This immersive approach not only enriches the narrative but also fosters a deeper understanding of the challenges faced by the Lees and, by extension, other immigrant families grappling with cultural clashes in healthcare.

Navigating Cultural Divides in Healthcare

The book navigates the delicate balance between Western medical perspectives and Hmong cultural beliefs, urging readers to empathize with both sides. Fadiman sheds light on the complexities faced by healthcare providers and emphasizes the importance of cultural competence. Chapters four and 17 highlight how medical professionals must consider cultural backgrounds, acknowledging their limitations and understanding that Westernized care may not always align with the best interests of the patient. The book advocates for humility, cultural acceptance, and a collaborative approach to healthcare.

As we journey through Lia's medical care, we witness the struggles faced by the Lees in understanding and adhering to Western medical advice. The language barrier exacerbates the challenges, leaving Lia's parents, Nao Kao and Foua, feeling helpless in providing the best care for their daughter. This predicament not only underscores the need for effective communication but also prompts reflection on the role of healthcare professionals in bridging these gaps.

Chapters dedicated to Lia's seizures and the subsequent decisions made by the medical team delve into the heart of the cultural clash. Neil Ernst's decision to place Lia in a foster home, despite the evident love and care provided by the Lees, showcases the profound impact of differing cultural perspectives on healthcare decisions. Fadiman crafts a narrative that encourages readers to question preconceived notions and consider the broader implications of cultural competency in medical practice.

Fadiman's Purpose and Impact

Fadiman's purpose in writing the book was to draw attention to the challenges faced by the Lee family, with the hope that such situations could be avoided in the future. She aimed to prompt reflection and change in the practices of doctors dealing with cross-cultural relations and patient care. The book serves as a valuable resource for healthcare professionals and those entering the social services field, offering insights into the intricacies of navigating cultural barriers. Fadiman's successful endeavor to humanize the narrative makes the book a compelling read, challenging preconceived notions and fostering a deeper understanding of cultural diversity in healthcare.

Interviews with Fadiman reveal the depth of her commitment to the cause. In a conversation at Columbia School of Journalism (DartMedia, 2017), she expressed her desire for the book to serve as a catalyst for change in medical practices. Fadiman's hope was that healthcare professionals, after reading her work, would learn to adapt their approaches in cross-cultural interactions and patient care. The impact of "The Spirit Catches You and You Fall Down" extends beyond the pages of the book, influencing conversations and practices in the healthcare field.

Reflections and Lessons Learned

Upon completing the book, one cannot help but reflect on the lessons learned and the implications for future healthcare practices. Fadiman's narrative prompts readers to consider the importance of cultural humility, an essential quality for healthcare professionals working in diverse communities. The complexities faced by the Lees underscore the need for a nuanced understanding of cultural practices and effective communication strategies in medical settings.

One takeaway from the book is the recognition of the reciprocal nature of cultural understanding. While advocating for the preservation of one's cultural identity, Fadiman also emphasizes the importance of openness to understanding and accepting other cultures. This dual perspective encourages a balanced approach, fostering a healthcare environment where both patients and providers actively engage in cultural competence.


In conclusion, "The Spirit Catches You and You Fall Down" provides a poignant exploration of the challenges that arise when cultural differences intersect with healthcare. Fadiman's narrative skillfully portrays the complexities faced by both the Lee family and healthcare professionals, urging readers to reflect on the importance of cultural competence and empathy. This book is not merely a recounting of a specific case but serves as a call to action for improved cross-cultural relations in healthcare. As we delve into the intricate layers of Hmong traditions and Western medicine, Fadiman encourages us to bridge the gaps and strive for a more inclusive and understanding approach to patient care.

Updated: Dec 01, 2023
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The Spirit Catches You and You Fall Down: Cultural Divides in Healthcare. (2021, Aug 10). Retrieved from

The Spirit Catches You and You Fall Down: Cultural Divides in Healthcare essay
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