The Spirit Catches You and You Fall Down: Afterword Summary & Analysis

Fifteen years later, Lia is still alive. Fadiman writes that most people in similar nonresponsive states die within five years. Lia, though, has survived under the care of her family. Fadiman updates readers on the whereabouts of her subjects, describing that Nao Kao died of congestive heart failure in 2003 and that Yer and her siblings have grown up to be successful Hmong-Americans. Yer, a dental assistant, tells Fadiman, “I used to blame the doctors for all my parents’ obstacles with Lia […]. Then I started working here and realized no one was to blame.” Dan Murphy works in Oregon and has become an advocate for Patient- and Family-Centered Care, a medical approach in which patients and families are fully involved with their medical treatments and free to voice their wishes. Neil and Peggy joined Dan’s practice and often think about Lia—they think that the results of Lia’s story “would have been the same” even if they were to do it all over again.

MCMC has thoroughly changed and has even implemented—with the help of a social service agency called Healthy House—a program that introduces txiv neebs into the hospital system, showing them how certain machinery works and teaching them the basic concepts of American healthcare, providing them with badges that grant them access to the various wards. This acceptance of shamanistic healers has greatly increased the Hmong willingness to visit the hospital without grave suspicions.

Fadiman reminds readers that The Spirit Catches You And You Fall Down was written in the 1990s and concerned itself with events that took place in the ’80s. It’s no surprise, then, that things have changed in the fifteen years that have elapsed between the book’s last chapter and this afterword. Fadiman notes that most Hmong now speak English and hold steady jobs. Nao Kao and Foua’s generation sacrificed its own comfort and happiness by coming to the United States, but the young adults who grew up in the States now see America as their home. Unfortunately, racism toward the Hmong has continued, and the majority of Americans remain ignorant of Hmong culture, as evidenced by Clint Eastwood’s inaccurate depiction of the Hmong in his movie Gran Torino.

In reminding readers that this book belongs to a past decade, Fadiman also explains that she has resisted the temptation to go back and correct various ideas and phrases to reflect current trends. For example, she frowns upon her use of the word “retarded,” but has decided to allow the book to be a document of its period, in which “retarded” was the acceptable term for somebody with cognitive challenges.

Fadiman was deeply upset by Nao Kao’s death, since she had become so close with the family in the years during and after she wrote The Spirit Catches You And You Fall Down. However, she would have been even more distraught if not for a certain event that happened two months before his death. Having been asked by the University of California at Davis (where one of the Lee daughters was a student) to speak about her book, Fadiman invited Neil and Peggy to join her on the panel. She also invited Foua and Nao Kao to attend, along with a competent interpreter. Neil spoke passionately, and after the event, Nao Kao—who had never formally forgiven Lia’s doctors—approached him. “On that afternoon,” Fadiman writes, “he looked Neil in the eye—something Neil never remembers him doing before—and told him, with his daughter translating, that now he understood how much Lia’s doctors had cared about her. And he thanked Neil.”