The Spirit Catches You and You Fall Down

by

Anne Fadiman

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The Spirit Catches You and You Fall Down: Chapter 7 Summary & Analysis

Summary
Analysis
Unlike other doctors, Fadiman points out, Neil Ernst remained unbending in his care for Lia, ultimately unwilling to compromise the quality of his services to accommodate Foua and Nao Kao’s beliefs or abilities. In retrospect, Fadiman writes, he questioned this decision, but at the time he was steadfast in his belief that he was doing the right thing. Fadiman wonders if his refusal to find a middle ground of sorts with the Lees may have negatively affected Lia; if he had proposed a simpler—albeit less medically effective—treatment, perhaps he and the Lees could have prevented the girl’s later medical problems that may have been the result of her failing medicinal regimen.
By thinking in this hypothetical manner—positing that perhaps Lia’s life could have been improved if Neil had been willing to provide her with manageable but “suboptimal care”—Fadiman ultimately advocates for a certain capacity toward cultural leniency, or a disposition that might allow doctors to reasonably assess the limitations placed on them by various cross-cultural complications.
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On May 2, 1985, Child Protective Services (CPS) placed Lia in temporary foster care for two weeks, after which she returned home. Because Foua and Nao Kao continued their pattern of noncompliance by neglecting to properly administer the drugs again, she was once more taken away on June 6th, this time for six months. CPS workers arrived at the Lee house with Sue Xiong, a Hmong interpreter whom Nao Kao disliked because he believed she told the doctors that he wasn’t following his daughter’s prescribed medicinal regimen. Foua was out of the house at the time. Nao Kao remembered the situation, saying, “I almost killed the translator. I said, This is my child and I love her. The police said for six months Lia is government property.” Using a master’s thesis in anthropology as a jumping-off point, Fadiman argues that once matters like this one go from the doctor’s office to the courts, suddenly they aren’t about disagreement or conflicting beliefs, but about power.
Nao Kao and Foua’s refusal to follow the suggested medical regimen indicated their desire to treat their daughter according to their own beliefs. This attitude recalls Fadiman’s earlier assertion that the Hmong can often be stubborn and resilient in the face of authority, though it’s hard to deny in this moment that their unwillingness to cooperate lacked a certain amount of foresight, since it was so clear that they would lose Lia if they didn’t follow the doctors’ rules. Nevertheless, the situation had turned into a power struggle—and as Fadiman has already pointed out, the Hmong are very much averse to power and coercion. To follow Fadiman’s model of understanding the Hmong, the Lees were merely engaging in the culture’s age-old tendency to fight authority or flee: in this case, of course, they were fighting.
Themes
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For the six months that Lia was “government property,” she was placed in the care of Dee and Tom Korda, two seasoned parents who had already housed many foster children (many with disabilities) in addition to their five biological offspring. Jeanine Hilt, the culturally sensitive social worker assigned to Lia’s case, made a point of frequently visiting the Kordas, noting that Lia exhibited intense behavioral problems and that she was in general wildly difficult. Nonetheless, Dee treated the child incredibly well and began inviting Foua and Nao Kao over to visit. The two families eventually grew quite close, and Dee even asked Foua to babysit for her. What’s more, though she loved having Lia in her life, Dee formally urged CPS to return the girl to her family.
It is clear that Dee Korda possessed the ability to accept cultural differences, an ability Lia’s doctors seemed on the whole to lack, despite their best intentions. Rather than assuming Nao Kao and Foua were terrible parents, she invited them to her home and actually got to know them, taking the time to try to understand the situation’s myriad complexities. As a result, she had a more comprehensive view of the situation and knew that it was wrong for Lia to have been taken from her family.
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Unfortunately, Lia was not returned to the Lees after six months because of two reasons. First, her parents refused to sign a Social Services Plan stating their willingness to administer their daughter’s medications because they believed that she should be returned immediately. Second, when Lia came home for a one-week trial, Foua and Nao Kao again neglected to administer her medications—she was rushed to the hospital the day after returning to the Kordas’ because of a grand mal seizure.
Once again, Foua and Nao Kao demonstrated their unbending will to attend to Lia according to their own beliefs. Although they perhaps showed some flexibility in the past by taking Lia to the hospital, in this moment they exhibited an unwillingness to mediate between their culture and the culture of Western medicine—the same kind of cultural narrow-mindedness demonstrated by MCMC’s staff.
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Jeanine Hilt continued to work with Foua, teaching her how to correctly give Lia the proper amounts of medication. This task was made slightly easier by the fact that Terry Hutchinson—a doctor Dee had taken Lia to at Valley Children’s Hospital in Fresno—had decided to prescribe Depakene without any other medications. Jeanine made considerable progress with the Lees, clearly having invested in them a confidence and fondness, exemplified by the fact that she remained supportive of them even when, on a subsequent trip to their house, Nao Kao wielded a baseball bat and threatened to beat Sue Xiong to death. Despite this incident, Jeanine continued to advocate for the Lees, and on April 30, 1986, Lia was reunited with her family.
Just as Dee Korda exemplified what it might look like to competently bridge two clashing cultures, Jeanine Hilt proved herself capable of acting as an intermediary between the strict American government and the stubborn Lees. By calling attention to Jeanine’s devotion to working with both sides, Fadiman once more advocates for cultural flexibility in the context of medical disaster.
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