As a way of coping with the grief and uncertainty of Lia’s medical complications, both the Lee family and MCMC’s team of doctors try to assign blame. They are constantly seeking to decide if the other party has acted ethically or unethically, which is in part due to the fact that both the family and the doctors believe that their power hierarchies have been undermined. The doctors feel disrespected by the Lees’ unwillingness to wholly trust their advice, while the Lees are angry that the doctors dismiss their beliefs about Lia’s condition. This is particularly painful for the Lees because the doctors’ dismissal seems, in part, racially tinged. With both the Lee family and the doctors feeling that their authority is threatened in a life-or-death situation, everyone seems prone to leverage what power they have to discredit the other.
The Lees, for their part, appear particularly eager to blame other people for Lia’s sickness—and not only her doctors, either. For Lia’s initial seizure, they blamed their older daughter Yer slamming a door, and when Lia fell off a swing and went into status epilepticus, Nao Kao determined that her teacher made her drop off the swing. It’s difficult to say why the Lees—who are kind, well-meaning people—appear so quick to blame others, but perhaps it is a reaction to the distress of seeing a loved one in pain. Blaming, it seems, gives the Lees agency. This suggests that they yearn for some sort of power, which makes sense, given that they live in a country that gives them few opportunities and that looks down on them. Furthermore, since they can’t perform the rituals and healing ceremonies that would normally give them a sense of power over Lia’s condition, the Lees’ best chance of coming to terms with Lia’s misfortune is by blaming somebody in the very community that has so much power over them. Pointing the finger at Lia’s teachers or doctors or social workers gives them a tangible outlet for their helpless and lovesick worries.
The most prominent manifestation of this sort of blame is, of course, Nao Kao and Foua’s belief that the doctors at the Children’s Valley Hospital—where Lia was treated for septic shock—actually made her sicker. Readers steeped in the culture of Western medicine may find this an absurd misplacement of blame, but it’s worth considering the fact that Depakene, the medication given to Lia to keep her from seizing, may have made her more susceptible to septic shock. “Go back to Merced,” Dr. Hutchinson told Fadiman after Lia lost almost all brain activity, “and tell all those people at MCMC that the family didn’t do this to the kid. We did.” In this statement, Hutchinson makes it clear that the Lees should not be held accountable for what happened to Lia; all of Lia’s doctors—himself included—should recognize their own shortcomings in this particular situation. In doing so, he essentially reinforces the notion that somebody must be at fault for what happened to Lia, a notion that once more demonstrates the human tendency to seek meaning (by way of fault and blame) in the face of difficult emotions—even if it means blaming oneself.
Neil and Peggy also blame others. As shown by his suggestion that Lia be taken away by Child Protective Services, Neil portrays Nao Kao and Foua as ill-equipped to care for their own daughter. This is, of course, based on their inability or unwillingness to follow the course of treatment he suggested. In effect, Neil was so confident that his plan was the right one that he used his power as a doctor to hold Nao Kao and Foua responsible for the problems Lia was having. According to most of his colleagues, this was a surprisingly ill-advised move, one that failed to take into account the fact that Nao Kao and Foua were extremely attentive, loving parents.
Fadiman herself doesn’t take a strong position about how—or even whether—blame should be assigned to individuals. Instead, she illuminates the various failures of empathy and inquiry that led to Lia’s tragic medical crisis, and shows the well-meaning logic behind both the doctors’ and the Lee family’s decisions. Although Fadiman respects both sides and doesn’t condemn either the Lees or their doctors, she does subvert the expectation that Western medicine is unequivocally effective, thereby asking readers to question the biases inherent to a system that most Westerners consider to be objective and rational. By placing Western medicine and Hmong spirituality in a non-hierarchical comparison, Fadiman implicitly attributes blame for Lia’s condition on the failure of the two systems to be effectively reconciled.
Blame and Power ThemeTracker
Blame and Power Quotes in The Spirit Catches You and You Fall Down
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.
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.”
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.”
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.”
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.”
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.”