The Spirit Catches You and You Fall Down

I read this book in early June, but it's taken me so long to process this book in my head and write a proper review on it.  Epilepsy, a.k.a. qaug dab peg, a.k.a. the condition where "the spirit catches you and you fall down" - is what marked the start of a cultural clash between baby Lia Lee's Hmong family and community and the doctors of Merced, California. While Lia's parents were doing what they thought was best to take care of her, doctors at Merced saw the Lee family's treatment of Lia as negligence and non-compliance to their medical instruction.  The Hmong believe that humans afflicted with epilepsy are destined to become txiv neeb - sanctified shamans.  Epilepsy allows the txiv neeb to go into a trance-like state and enables them to forsee the future and speak with the gods.  Therefore, having epilepsy was not much of a curse and instead, was more of a blessed calling, which they accepted and treated with faith, in their own ways.  

The medicinal treatment that the doctors prescribed to Lia had 2 major issues. 1) The instructions were comprised of pages of fine print addendum, accompanying small, identical bottles merely labelled: "take as directed".  The Lee family was illiterate and did not have a concept of the timekeeping required for the strict medicinal regimen since they judged time by the sun, rooster crows, and livestock feeding behavior.  2)  The drugs were too strong for baby Lia and had harsh side effects.  As soon as they saw an adverse reaction, they stopped administering the medicine immediately.  From the Lee family's perspective, the best thing you could do for your baby was to lovingly care for her so she could endure her fate, and if the strange medicine that the doctors were giving her were making her sicker, she should stop taking them ASAP.  Instead of sticking to the prescriptions, they spent their meager welfare checks and life savings on expensive livestock for sacrificial rituals, pendants for Lia, and painstakingly grew their own medicinal herbs in the parking lot by their apartment.

Instead of taking an appreciative stance on the Lee family's faithful care for Lia, the doctors saw the untouched medicine bottles, concluded that they were killing her with their negligence and 'abuse', and called Child Protective Services, who took Lia away and placed her into an already full foster home.  As a result, she became physically sicker as she grew stressed and homesick.  When she was finally reunited to her family for a brief time, she lapsed into a 2-hr seizure that cut off all oxygen to her brain, leaving her brain dead and barely 'alive' when returned to her parents.  

Though Lia's story was heartbreaking to read, the book carefully covered all sides of this upsetting case of "medicinal anthropology" and urged doctors and students to broaden their cultural understanding of medicine.  It raised questions pertaining to faith-based healing versus western medicine.  Though you can get a little lost when Fadiman sidetracks to the Vietnam War, the "secret military", and refugee camps in Hawaii, she will always bring you back to the main point and neatly tie in her historical anecdote and its relevance to Lia's story.  Anne Fadiman's research is impressive and thorough while keeping the story and her relationship with the Lee family heartfelt and personal.  Read it!