The Spirit Catches You and You Fall Down

Anne Fadiman Character Analysis

The author of The Spirit Catches You And You Fall Down. Fadiman came to Merced in 1988 after hearing that the hospital was experiencing a swath of cultural misunderstandings and miscommunications with the Hmong community. As a writer, Fadiman herself moves in and out of her scenes; in some moments, she describes her conversations with Lia’s doctors and parents, inserting her own thoughts into the scene. In other moments, though, she removes herself from consideration in the name of providing more objective, ethnographic information about Hmong culture or history. After interviewing Lia’s family, doctors, involved interpreters, and other community members, Fadiman establishes close, meaningful relationships with her subjects. Nao Kao and Foua welcome them into their home, considering her a friend and ally, sharing their culture and family stories with her.

Anne Fadiman Quotes in The Spirit Catches You and You Fall Down

The The Spirit Catches You and You Fall Down quotes below are all either spoken by Anne Fadiman or refer to Anne Fadiman. For each quote, you can also see the other characters and themes related to it (each theme is indicated by its own dot and icon, like this one:
Cultural Values, Spirituality, and Medicine  Theme Icon
). Note: all page numbers and citation info for the quotes below refer to the Farrar, Straus, and Giroux edition of The Spirit Catches You and You Fall Down published in 2012.
Preface Quotes

I have always felt that the action most worth watching is not at the center of things but where edges meet. I like shorelines, weather fronts, international borders. There are interesting frictions and incongruities in these places, and often, if you stand at the point of tangency, you can see both sides better than if you were in the middle of either one. This is especially true, I think, when the apposition is cultural. When I first came to Merced, I hoped that the culture of American medicine, about which I knew a little, and the culture of the Hmong, about which I knew nothing, would in some way illuminate each other if I could position myself between the two and manage not to get caught in the cross fire.

Related Characters: Anne Fadiman (speaker)
Page Number: viii
Explanation and Analysis:

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After I heard about the Lees’ daughter Lia, whose case had occasioned some of the worst strife the Merced hospital had ever seen, and after I got to know her family and her doctors, and after I realized how much I liked both sides and how hard it was to lay the blame at anyone’s door (though God knows, I tried), I stopped parsing the situation in such linear terms, which meant that without intending to, I had started to think a little less like an American and a little more like a Hmong.

Related Characters: Anne Fadiman (speaker), Lia Lee
Page Number: viii
Explanation and Analysis:

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By chance, during the years I worked on this book, my husband, my father, my daughter, and I all experienced serious illnesses, and, like the Lees, I found myself spending a lot of time in hospitals. I passed many hours in waiting rooms gnawing on the question, What is a good doctor? During the same period, my two children were born, and I found myself often asking a second question that is also germane to the Lees’ story: What is a good parent?

Related Characters: Anne Fadiman (speaker)
Page Number: viii
Explanation and Analysis:

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Chapter 2 Quotes

The Hmong have a phrase, hais cuaj txub kaum txub, which means “to speak of all kinds of things.” It is often used at the beginning of an oral narrative as a way of reminding the listeners that the world is full of things that may not seem to be connected but actually are; that no event occurs in isolation; that you can miss a lot by sticking to the point; and that the storyteller is likely to be rather long-winded.

Related Characters: Anne Fadiman (speaker)
Related Symbols: Fish Soup
Page Number: 12
Explanation and Analysis:

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The history of the Hmong yields several lessons that anyone who deals with them might do well to remember. Among the most obvious of these are that the Hmong do not like to take orders; that they do not like to lose; that they would rather flee, fight, or die than surrender; that they are not intimidated by being outnumbered; that they are rarely persuaded that the customs of other cultures, even those more powerful than their own, are superior; and that they are capable of getting very angry. Whether you find these traits infuriating or admirable depends largely on whether or not you are trying to make a Hmong do something he or she would prefer not to do. Those who have tried to defeat, deceive, govern, regulate, constrain, assimilate, intimidate, or patronize the Hmong have, as a rule, disliked them intensely.

Related Characters: Anne Fadiman (speaker)
Page Number: 17
Explanation and Analysis:

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Chapter 3 Quotes

Although the inklings Dan had gathered of the transcendental Hmong worldview seemed to him to possess both power and beauty, his own view of medicine in general, and of epilepsy in particular, was, like that of his colleagues at MCMC, essentially rationalist. Hippocrates’ skeptical commentary on the nature of epilepsy, made around 400 B.C., pretty much sums up Dan’s own frame of reference: “It seems to me that the disease is no more divine than any other. It has a natural cause just as other diseases have. Men think it is divine merely because they don’t understand it. But if they called everything divine which they do not understand, why, there would be no end to divine things.”

Related Characters: Anne Fadiman (speaker), Lia Lee, Dan Murphy
Page Number: 29
Explanation and Analysis:

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Chapter 4 Quotes

Txiv neebs were polite and never needed to ask questions; doctors asked many rude and intimate questions about patients’ lives, right down to their sexual and excretory habits. Txiv neebs could render an immediate diagnosis; doctors often demanded samples of blood (or even urine or feces, which they liked to keep in little bottles), took X rays, and then, after all that, sometimes they were unable to identify the cause of the problem. Txiv neebs never undressed their patients; doctors asked patients to take off all their clothes, and sometimes dared to put their fingers inside women’s vaginas. Txiv neebs knew that to treat the body without treating the soul was an act of patent folly; doctors never even mentioned the soul.

Related Characters: Anne Fadiman (speaker)
Page Number: 33
Explanation and Analysis:

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Chapter 5 Quotes

The MCMC nursing staff came to know Lia well—better, in fact, than most of them would have wished. After she was old enough to walk, whenever she was well enough to get out of bed she ran up and down the corridor in the pediatric unit, banging on doors, barging into the rooms of other sick children, yanking open the drawers in the nursing station, snatching pencils and hospital forms and prescription pads and throwing them on the floor.

Related Characters: Anne Fadiman (speaker), Lia Lee
Page Number: 44
Explanation and Analysis:

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The idea that the drugs prescribed to cure, or at least attempt to treat, an illness are in fact causing it is not one that most doctors ever encounter. Doctors are used to hearing patients say that drugs make them feel bad, and indeed the unpleasant side effects of many medications are one of the main reasons that patients so often stop taking them. But most patients accept the doctor’s explanation of why they got sick in the first place, and even if they resist the recommended treatment, they at least believe their doctor has prescribed it in good faith and that it is not designed to hurt them. Doctors who deal with the Hmong cannot take this attitude for granted. What’s more, if they continue to press their patients to comply with a regimen that, from the Hmong vantage, is potentially harmful, they may find themselves, to their horror, running up against that stubborn strain in the Hmong character which for thousands of years has preferred death to surrender.

Related Characters: Anne Fadiman (speaker), Lia Lee
Page Number: 50
Explanation and Analysis:

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And the other thing that was different between them and me was that they seemed to accept things that to me were major catastrophes as part of the normal flow of life. For them, the crisis was the treatment, not the epilepsy. I felt a tremendous responsibility to stop the seizures and to make sure another one never happened again, and they felt more like these things happen, you know, not everything is in our control, and not everything is in your control.

Related Characters: Dan Murphy (speaker), Lia Lee, Anne Fadiman
Page Number: 53
Explanation and Analysis:

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A handful of times, Neil gave Foua a hug while Lia was seizing, but most of the time, while Lia was between the ages of eighteen months and three and a half years, he was too angry to feel much sympathy toward either of her parents. “The best thing I could have given Lia’s mother was compassion, and I wasn’t giving her any and I knew that I wasn’t giving her any,” he said. “There was just too much aggravation. It was like banging your head against a wall constantly and not making any headway. There was the frustration of the nighttime calls and the length of time it took and the amount of energy and sorrow and lack of control. […] When she came to the emergency room in status there would be sort of like a very precipitous peak of anger, but it was quickly followed by the fear of having to take care of a horribly sick child who it was very difficult to put an IV in.” Peggy added, “Some of the anger came from that. From our own fear.”

Related Characters: Anne Fadiman (speaker), Lia Lee, Neil Ernst, Peggy Philp
Page Number: 56
Explanation and Analysis:

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Chapter 6 Quotes

I hovered uncertainly, pages in hand, and realized that I was suspended in a large bowl of Fish Soup. Medicine was religion. Religion was society. Society was medicine. Even economics were mixed up in there somewhere (you had to have or borrow enough money to buy a pig, or even a cow, in case someone got sick and a sacrifice was required), and so was music (if you didn’t have a qeej player at your funeral, your soul wouldn’t be guided on its posthumous travels, and it couldn’t be reborn, and it might make your relatives sick). In fact, the Hmong view of health care seemed to me to be precisely the opposite of the prevailing American one, in which the practice of medicine has fissioned into smaller and smaller subspecialties, with less and less truck between bailiwicks. The Hmong carried holism to its ultima Thule. As my web of cross-references grew more and more thickly interlaced, I concluded that the Hmong preoccupation with medical issues was nothing less than a preoccupation with life. (And death. And life after death.)

Related Characters: Anne Fadiman (speaker)
Related Symbols: Fish Soup
Page Number: 60
Explanation and Analysis:

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Hmong patients might not understand the doctors’ diagnoses, but if they had summoned the courage to visit the clinic, they wanted to be told that something was wrong and to be given something, preferably a fast-acting antibiotic, to fix it. The doctors had a hard time meeting these expectations when the Hmong complained, as they frequently did, of vague, chronic pain.

Related Characters: Anne Fadiman (speaker)
Page Number: 69
Explanation and Analysis:

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Chapter 7 Quotes

Neil was pretty sure, however, that because Lia’s condition was progressive and unpredictable, he could treat it best by constantly fine-tuning her drug regimen. If he had chosen a single pretty-good anticonvulsant and stuck with it, he would have had to decide that Lia wasn’t going to get the same care he would have given the daughter of a middle-class American family who would have been willing and able to comply with a complex course of treatment. Which would have been more discriminatory, to deprive Lia of the optimal care that another child would have received, or to fail to tailor her treatment in such a way that her family would be most likely to comply with it?

A decade ago, that is not the way Neil looked at the situation. He never seriously considered lowering his standard of care. His job, as he saw it, was to practice good medicine; the Lees’ job was to comply.

Related Characters: Anne Fadiman (speaker), Lia Lee, Foua Lee, Nao Kao Lee, Neil Ernst
Page Number: 78
Explanation and Analysis:

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Chapter 8 Quotes

Sukey’s business card read, in Hmong and Lao, “Fixer of Hearts.” She explained to me, “Psychological problems do not exist for the Hmong, because they do not distinguish between mental and physical illness. Everything is a spiritual problem. It’s not really possible to translate what I do into Hmong—a shaman is the closest person to a psychotherapist—but fixing hearts was the best metaphor I could find. […]” When I asked Sukey why the Hmong community accepted her so readily, she said, “The Hmong and I have a lot in common. I have an anarchist sub-personality. I don’t like coercion. I also believe that the long way around is often the shortest way from point A to point B. And I’m not very interested in what is generally called the truth. In my opinion, consensual reality is better than facts.”

Related Characters: Anne Fadiman (speaker), Sukey Waller
Page Number: 95
Explanation and Analysis:

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While Foua was telling me about the dozens of tasks that constituted her “easy” work in Laos, I was thinking that when she said she was stupid, what she really meant was that none of her former skills were transferable to the United States—none, that is, except for being an excellent mother to her nine surviving children. It then occurred to me that this last skill had been officially contradicted by the American government, which had legally declared her a child abuser.

Related Characters: Anne Fadiman (speaker), Foua Lee
Page Number: 105
Explanation and Analysis:

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Chapter 11 Quotes

Their technology was cutting-edge and their clinical skills irreproachable. At first, however, they were too busy trying to save Lia’s life to focus on a great deal besides her pathology. [The doctor], for example, who worked on Lia for more than twelve hours straight, failed to notice her sex. “His metabolic acidosis was decreased after initial bolus of bicarbonate,” he wrote. “His peripheral perfusion improved and pulse oximetry started reading a value that correlated with saturation on the arterial blood samples.” Here was American medicine at its worst and its best: the patient was reduced from a girl to an analyzable collection of symptoms, and the physician, thereby able to husband his energies, succeeded in keeping her alive.

Related Characters: Anne Fadiman (speaker), Lia Lee
Page Number: 146
Explanation and Analysis:

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Chapter 13 Quotes

Calling Lia a vegetable was, it seemed to me, just one more form of avoidance. In describing what had happened to her, [Neil] and Peggy both used the kinds of terms favored by the doctors in MASH, gallows-humor slang wielded in times of extreme stress on the theory that if you laugh at something it can’t break your heart. “Lia gorked.” “She crumped.” “She fried her brain.” “She vegged out.” “She crapped out.” “She went to hell.” “No one’s at home, the lights are out.”

Related Characters: Anne Fadiman (speaker), Lia Lee, Neil Ernst, Peggy Philp
Page Number: 173
Explanation and Analysis:

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Chapter 15 Quotes

At this point, [Lia’s sister], who was three at the time, ran over to Lia and started banging her on the chest.

“Don’t do that, there’s a good boy,” said Martin, addressing the little girl in English, of which she did not speak a word. “[… P]lease tell them they have got to watch these other little children. Lia is not a doll.”

Related Characters: Anne Fadiman (speaker), Lia Lee, Foua Lee, Nao Kao Lee, Martin Kilgore
Page Number: 222
Explanation and Analysis:

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Chapter 17 Quotes

Once I asked Neil if he wished he had done anything differently. He answered as I expected, focusing not on his relationship with the Lees but on his choice of medication. “I wish we’d used Depakene sooner,” he said. “I wish I’d accepted that it would be easier for the family to comply with one medicine instead of three, even if three seemed medically optimal.”

Then I asked, “Do you wish you had never met Lia?”

“Oh, no, no, no!” His vehemence surprised me. “Once I might have said yes, but not in retrospect. Lia taught me that when there is a very dense cultural barrier, you do the best you can, and if something happens despite that, you have to be satisfied with little successes instead of total successes. You have to give up total control. That is very hard for me, but I do try. I think Lia made me into a less rigid person.”

Related Characters: Anne Fadiman (speaker), Lia Lee, Foua Lee, Nao Kao Lee, Neil Ernst
Page Number: 257
Explanation and Analysis:

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Anne Fadiman Character Timeline in The Spirit Catches You and You Fall Down

The timeline below shows where the character Anne Fadiman appears in The Spirit Catches You and You Fall Down. The colored dots and icons indicate which themes are associated with that appearance.
Preface
Cultural Values, Spirituality, and Medicine  Theme Icon
History and Ethnic Identity Theme Icon
Integration and Assimilation Theme Icon
Fadiman begins by calling attention to a carton of cassette tapes she keeps beneath her desk.... (full context)
Cultural Values, Spirituality, and Medicine  Theme Icon
Blame and Power Theme Icon
...her desire to explore the intersection between medicine and Hmong spirituality was originally “all theory,” Fadiman explains how Lia Lee’s story changed her perspective. Lia’s medical case challenged the Merced hospital... (full context)
Chapter 1: Birth
Cultural Values, Spirituality, and Medicine  Theme Icon
Fadiman explains various Hmong beliefs surrounding health and spirituality, including the idea that humans must be... (full context)
Cultural Values, Spirituality, and Medicine  Theme Icon
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...or not the placentas they buried in their home are still safely in the ground. Fadiman points out that, since the Lees fled first to one Thai refugee camp, then to... (full context)
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...the Lees had to wait an entire month to save money from their welfare checks. Fadiman briefly outlines the many ways in which the Hmong believe illness can manifest, eventually maintaining... (full context)
Chapter 2: Fish Soup
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Fadiman relates a story told to her by a French professor who taught an intermediate class... (full context)
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Taking this longwinded comprehensive approach to heart, Fadiman says that she will go back “a few hundred generations” in order to explain the... (full context)
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...especially in the Laos highlands, where they rarely interacted with the French or lowland Laotians. Fadiman argues that this history serves as a valuable lesson that the Hmong “do not like... (full context)
Chapter 3: The Spirit Catches You and You Fall Down
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Fadiman notes that the Hmong are well-known for showering their children with love and affection. Their... (full context)
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...and Nao Kao brought their nephew, who was able to translate (though not very well). Fadiman includes Dan Murphy’s recollection of this first encounter with the Lee family, in which he... (full context)
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...already determined that she was afflicted by the spirit catches you and you fall down. Fadiman notes that Dan would have been surprised to learn that Foua and Nao Kao attributed... (full context)
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Fadiman calls Dan’s view of epilepsy “essentially rationalist,” saying that, like the rest of his medical... (full context)
Chapter 4: Do Doctors Eat Brains?
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Fadiman further explores Hmong distrust of Western medicine by describing one woman’s experience returning to Ban... (full context)
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To make matters worse, Fadiman writes, the Hmong believe that many Western medical practices run the risk of harming patients.... (full context)
Chapter 5: Take as Directed
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...Kao were intentionally deceiving them by acting more ignorant than they actually were. Neil told Fadiman in retrospect that it felt as if Nao Kao “put up a ‘stone wall’ and... (full context)
Chapter 6: High-Velocity Transcortical Lead Therapy
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Fadiman considers the fact that the Hmong view health concerns as not only relating to the... (full context)
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Fadiman’s old college friend Bill Selvidge (and the former chief resident at MCMC) explained to her... (full context)
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...to illustrate the seemingly inscrutable atmosphere MCMC doctors must work in when treating Hmong patients, Fadiman lists the many things that seem odd about Hmong culture, eventually describing the practice of... (full context)
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Fadiman details the myriad difficulties doctors faced when treading into Hmong culture. One of the easiest... (full context)
Chapter 7: Government Property
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Unlike other doctors, Fadiman points out, Neil Ernst remained unbending in his care for Lia, ultimately unwilling to compromise... (full context)
Chapter 8: Foua and Nao Kao
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Fadiman details the difficulty she encountered upon trying to meet Merced’s Hmong population. Her first attempts... (full context)
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Sukey suggested that Fadiman find a good interpreter, or what she called a “cultural broker,” somebody who could integrate... (full context)
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As the Lees and Fadiman became closer, Nao Kao and Foua hoped to provide her with knowledge about Hmong culture... (full context)
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When Fadiman’s boyfriend visited her in Merced, Foua decided that she would help get her married. Dressing... (full context)
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In a conversation about Laos, Foua expressed to Fadiman the differences between living in her homeland and living in the United States. In America,... (full context)
Chapter 9: A Little Medicine and a Little Neeb
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...1986, Nao Kao and Foua held a sacrificial ceremony in which they killed a cow. Fadiman gives a survey of sacrificial events in Hmong culture, explaining that rumors spread throughout Merced... (full context)
Chapter 10: War
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Fadiman turns her attention to Hmong history, surveying the origins of their time in Laos, where... (full context)
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Fadiman focuses on the influence the Vietnam War had on the Hmong community in the 1960s... (full context)
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Fadiman suggests that the Hmong sided with anti-communist forces because capitalism was less likely to impede... (full context)
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...of game, more than 100,000 Hmong were kept alive by U.S. Sponsored food drops,” writes Fadiman. But when the Vientiane Agreement of 1973 was signed, America cut off its aid program... (full context)
Chapter 11: The Big One
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...after Lia and were troubled to learn about the spinal tap that had been inserted. Fadiman notes that many Hmong believe spinal taps are “potentially crippling both in this life and... (full context)
Chapter 12: Flight
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Fadiman rounds out the Lees’ family story by detailing their escape from Laos. They first tried... (full context)
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Fadiman describes Blia Yao Moua, the Hmong leader in Merced who arranged her initial meeting with... (full context)
Chapter 13: Code X
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...stay at MCMC a bit longer; “I was sure she was dying,” she later told Fadiman, “but that’s the quandary of Western medicine, that you can’t let people die.” In the... (full context)
Chapter 14: The Melting Pot
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At this point, Fadiman focuses on the concept of immigration and assimilation. She explains that Foua and Nao Kao,... (full context)
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Fadiman suggests several reasons why Hmongs did not assimilate into American culture (other than the fact... (full context)
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...abounded, hate crimes rose in frequency, and anti-Asian bigotry proliferated amongst students and adults alike. Fadiman quotes an anthropologist who wrote that, when asked why “his people did not ‘fight back’... (full context)
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Fadiman notes that most Hmong liked to believe they would someday return to Laos. However, the... (full context)
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Sukey Waller told Fadiman a story in which an old Hmong man asked, “Why, when what we did worked... (full context)
Chapter 15: Gold and Dross
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Fadiman writes that Lia was seven when she first met her, which was two years after... (full context)
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...an incredibly intelligent public health nurse who made routine visits to the Lee household, let Fadiman accompany him one day as he checked in on Lia and her family. Despite Nao... (full context)
Chapter 16: Why Did They Pick Merced?
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Fadiman continues to examine the arrival of the Hmong in California, rehashing some of her earlier... (full context)
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...any county in California. Unfortunately, the non-Hmong citizens of Merced blamed the Hmong; Dang told Fadiman a story about a man who pulled up to him on the street and asked,... (full context)
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Fadiman discusses Blia Yao Moua and Jonas Vangay, two other successful Hmong leaders in Merced. Blia... (full context)
Chapter 17: The Eight Questions
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Fadiman discloses that Lia neither died nor recovered. As her siblings aged and assimilated into American... (full context)
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...heard the news—expressed great concern, asking Peggy how he was doing. In a letter to Fadiman about this encounter, Neil wrote: “At the end of the visit Mrs. Lee was hugging... (full context)
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In an effort to gain some clarity about the anticonvulsant medications prescribed to Lia, Fadiman visited Dr. Hutchinson at Valley Children’s Hospital. He explained that Lia’s final seizure was the... (full context)
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Fadiman repeated Hutchinson’s theory to Neil and Peggy, who pored through their notes before determining that... (full context)
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In an attempt to postulate what could have happened differently in Lia’s medical history, Fadiman spoke to Dan Murphy, who expressed that he believed there was a “gulf” between the... (full context)
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Fadiman brings up a program of eight questions designed by Arthur Kleinman, a psychiatrist and medical... (full context)
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Fadiman answered these questions in the way she thought the Lees would respond and brought the... (full context)
Chapter 18: The Life or the Soul
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Fadiman considers whether or not Lia’s life would have been better if she had been treated... (full context)
Chapter 19: The Sacrifice
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Fadiman describes a healing ceremony for Lia that she attended at the Lees’ apartment in Merced.... (full context)
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Fadiman was surprised to find that the txiv neeb was a small man who watched TV... (full context)
Afterword to the Fifteenth Anniversary Edition
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Fifteen years later, Lia is still alive. Fadiman writes that most people in similar nonresponsive states die within five years. Lia, though, has... (full context)
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Fadiman reminds readers that The Spirit Catches You And You Fall Down was written in the... (full context)
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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... (full context)
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Fadiman was deeply upset by Nao Kao’s death, since she had become so close with the... (full context)