Dislocation

Anne Fadiman tells the tragic story of Lia Lee, a Hmong child, who becomes the site of negotiation between two seemingly opposed worldviews or explanatory models of medicine. In her book, The Spirit Catches You and You Fall Down, Fadiman portrays the tragic circumstances involving grave cultural misunderstandings and misconceptions of two cultures, immigrant Hmong culture and American bio-medical culture. Lia’s parents attributed Lia’s illness as qaug dab peg, which is roughly translated to, “the spirit catches you and you fall down,” which is then temporalized into the western medical term - epilepsy. The author explains that Hmong culture generally regards one that exhibits symptoms of quag dab peg as potentially destined to become a tvix neeb, divine healer, or someone who can slip into the spiritual realm. Fadiman states, “Becoming a tvix neeb is not a choice; it is a vocation” (21). Lia’s illness did not improve in spite of the efforts of the American medical system. Her family was channeled through painful avenues of American bureaucracy that were ill equipped and seemingly inflexible to the task of handling culturally discordant metaphors of illness.

Fadiman’s book has captured and inspired readers both as an ethnography that contains all the elements of a tragic drama and as an effective portrayal of the urgent need for a culturally sensitive approach to Western medicine. The book has been used to facilitate discussions among medical anthropology students as well as students of biological medicine (Taylor 162). It has inspired models of “cultural competence” that have infiltrated Western hospitals. Author Janelle Taylor points out the complications associated with the “cultural competence” model and the reification of culture. In her writing, "The Story Catches You and You Fall Down: Tragedy, Ethnography and ‘Cultural Competence,’” Taylor defines culture as a dynamic ever-changing process rather than Fadiman’s reified, static view of Hmong culture. Fadiman states, “…the Hmong have responded to persecution and to pressures to assimilate by either fighting or migrating—a pattern that has been repeated so many times, in so many different eras and places, that it begins to seem almost a genetic trait, as inevitable in its recurrence as their straight hair of their short, sturdy stature ” (emphasis added, pg.13). She notes that the essentialization of Hmong culture, depicted in Fadiman’s book, should be viewed not as “solid lumps of congealed truth,” but rather as “invitations” to interpret relevant messages of meaning to the dynamic nature of culture, not static and by no means genetic (Taylor 179).

Fadiman provides historical accounts of Hmong involvement as American allies in the Vietnam War and the resulting migration of many people, including the Lees, from Laos to Thailand and eventually Merced, California. Upon finishing the book, one may begin to view similar themes of dislocation as contributing to the lack of comprehension between two cultural belief systems. The geographic and emotional dislocation of Hmong-American immigrants is juxtaposed with the American dislocation of the individual from society, the physical from the spiritual, and the mind from the body. Western biomedicine is compartmentalized and the individual becomes viewed as essentially dislocated from nature.

“..in Western cosmology humans have been exclusive possessors of a spirit, or a soul, or conscious intentionality, rendering other animate and inanimate aspects of the natural world spiritually dead or merely instinctual” (Henry 39).

The collectivism displayed and valued in Hmong culture clashes with the drive for individual autonomy and the individual versus society model that is observed in American culture. The metaphors used to describe illness vary cross-culturally and are often diametrically opposed, as in the case with American metaphors of illness and Hmong metaphors of illness. In the article, "Measles, Hmong, and Metaphor: Culture Change and Illness Management under Conditions of Immigration," Rebecca R. Henry, contrasts the “warfare” metaphor utilized in Western medicine with the Hmong metaphor of “harvesting crops” and the interrelation of the natural and spiritual worlds (34). The human immune system in Western terms is described as a militant counter-attack on invading organisms (33). The Hmong, however, tend to view the course of disease as cyclical, in tune with other environmental factors, such as season change, and as a natural process that needs to take its course (33-34). There, however, are human interventions that may expedite the course of nature. For example, in the treatment of measles, Henry points out that the Hmong view the presence of a rash as the “growth” or natural and necessary progression of the disease. The “growth” must be allowed to run its full course or else it runs the risk of lying dormant in the body inevitably causing illness later in life (38). Fever is explained in terms of the heat needed to allow for the progression of the disease, like how heat and sunlight are needed to facilitate plant growth (41-42). Henry indicates that Western approaches of treating fever with Tylenol actually compound the illness as it interferes with its natural course (42). Hmong belief systems regarding illness etiologies and treatments may be disregarded by Western medical practitioners due to language barriers and, consequently, misconstrued as medical non-compliance, as demonstrated in the case of the Lee’s.

Fadiman’s book appears to capture the social drama between the “collision” of differing views of health and illness and transcribes it into an aesthetic drama containing the pertinent elements of tragedy. I like to think of the book as a liminal piece that transcends the rigid classifications of reified culture and serves to provide a holistic interpretation of a patient as both a biological and cultural being, where prevailing science and cultural belief systems compliment each other, rather than remaining relatively mutually exclusive.