The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures

Fadiman begins the chapter with an autobiography that May, one of Lia’s sisters, writes for a school assignment about her family’s experience fleeing Laos in 1979. When the United States military withdrew from Laos, former North Vietnamese forces came in to occupy the villages. They retaliated against the Hmong, viewing them as enemies of the state for supporting the United States during the war.

Rather than accept these persecutions, 150,000 Hmong, like the Lees, escaped to Thailand, a dangerous journey that they covered by foot through the forests and mountains. During their travels, they experienced mass shootings, explosions from landmines, and drownings in the Mekong River. They also encountered starvation and disease. To quiet babies, families often drugged them with opium, causing unintended overdoses and death; to survive, many Hmong left their elders, the sick, and wounded behind. When Fadiman remarks that the Hmong seem like a cohesive community, one of her respondents replies that most suffer from survivor’s guilt.

Fadiman also discusses the origins and living conditions of Ban Vinai, a refugee camp in Thailand, which at its peak in 1986 accommodated 42,858 inhabitants, 90 percent of them Hmong. Fadiman refers to the work of Dwight Conquergood and his observation that most camp officials blame the Hmong for their poverty and economic dependency. Despite ongoing hardships, the Hmong maintain their cultural traditions, to the extent that many of the older inhabitants do not want to leave Ban Vinai when given the option to emigrate. In 1992, the camp closes, and officials revoke the option to emigrate. They send many Hmong back to Laos, despite the threat of political retaliation. Fearing reprisals, 10,000 Hmong flee Ban Vinai for a Buddhist monastery in Thailand. Fadiman concludes the chapter with a Hmong folktale about a healer and magician named Shee Yee who similarly outwits his adversaries.

After learning about the Lees’s postwar experiences, Fadiman remarks to Foua that it must have been terrible. Foua responds that during this time they at least had hope for a better future. She thinks what they have experienced in the United States is worse. Fadiman explains Foua’s rationale: “Violence, starvation, destitution, exile and death were, however horrific, within the sphere of the known, or at least conceivable, tragedies. What had happened to Lia was outside that sphere” (171).

When Lia returns to MCMC, she is non-responsive to most external stimuli but not at peace. Peggy describes Lia as an “angry vegetable,” and Fadiman notes that she frequently hears Lia’s doctors use “gallows-humor slang” to avoid dealing with the emotional stress of their profession (173). The doctors allow Foua to take care of Lia directly since there is not much else the staff can do for her. Rather than celebrate the Hmong New Year, the Lees bring special funerary garments for Lia to wear. Many relatives, as well as Dee and Jeanine, come to the hospital to keep vigil over Lia.

The Lees ask the doctors to remove Lia’s subclavian line and stop administering medicines to her. The doctors think the Lees want Lia to die with dignity. The Lees meanwhile think the medicines are killing Lia. They also want to take Lia home, but they must wait for a formal discharge. Nao Kao signs documents, which explain the severity of Lia’s condition. Providing a timeframe of death is taboo in Hmong society. Enraged, Nao Kao flees with Lia, and hospital security stops him. The doctor is angry because Nao Kao should have followed formal procedures. The doctor has to reinsert the nasogastric tube that Nao Kao took out, which delays Lia’s departure from MCMC. When the Lees bring Lia home, they put her on a shower curtain on the floor and bathe her body with herbs. At the hospital, she sweated profusely, wetting her linens, which the Lees attribute to the medicines the doctors gave her. She stops sweating at home and does not die.

This chapter describes the experiences of the Hmong as refugees in the United States. The Lees arrive in the United States in 1980 and, like many of their compatriots, find their new living situation disorienting. Fadiman provides a lengthy narrative of how the Hmong adjust to American routines and modern technologies yet choose not to assimilate to American cultural norms and expectations. She describes the Hmong as “involuntary migrants” who want to be left alone to practice their own way of life that is “protected from government interference, self-sufficient, and agrarian” (183).

The chapter also details the mistakes of resettlement agencies that pay little attention to the cultural preferences and special circumstances of the Hmong. Dispersed across many cities, the Hmong are placed in areas with inadequate housing and high unemployment rates. Their reliance on government welfare, which the Hmong feel entitled to for their contributions to the US military, fuels widespread resentment against them. The Hmong experience a lot of xenophobic violence, which Fadiman links to processes of “Othering” (189). Most Americans have little knowledge about the Hmong and project their own ideas of who the Hmong are and what they embody—as evidenced by news articles that describe the Hmong in racist terms as “primitive,” “Stone Age” people who eat dogs (188). Yet, while known for their fighting skills in Laos, most Hmong do not retaliate when accosted in America; instead, they follow in the tradition of the folk legend Shee Yee and flee, choosing to relocate and congregate in larger Hmong communities.

A substantial portion of the chapter thus focuses on the psychological and emotional stress the Hmong experience in the United States. Fadiman attributes their high rates of depression to broader socioeconomic factors, such as the role of schools and employment opportunities in the United States, which subvert traditional age and gender hierarchies. She also describes the cultural dislocation and “bereavement overload” that many Hmong feel with the realization that they cannot return to prewar Laos (205). Yet, despite all of these losses, Fadiman notes that the Hmong culture remains largely intact.

The chapter opens with a description of Lia who, at the age of seven, is still alive. “Although Lia was not dead, she was quadriplegic, spastic, incontinent, and incapable of purposeful movement. Her condition was termed ‘persistent vegetative state’” (210). As Fadiman further explains, “She continued to breathe, swallow, sleep, wake, sneeze, snore, grunt, and cry, because those functions were governed by her unimpaired brain stem, but she had no self-aware mental activity, a function governed by the forebrain” (211).

Lia’s brain damage cures her epilepsy, and she no longer has seizures. From the perspective of her doctors, Lia is now an easy patient and her parents model caregivers. As Fadiman writes,

Now that anticonvulsants were no longer prescribed and compliance was no longer an issue […] the clamorous army of authority figures who had been telling the Lees for four years that they were not taking good care of their daughter—suddenly fell silent (214-15).

The Lees do not understand why the medical staff treats them better and attribute it to Lia’s clean body, which Peggy describes as immaculate. When Neil sees Lia, he apologizes to Foua for not being able to prevent what happened. She hugs Neil and thanks him, and he is grateful for her compassion.

Nonetheless, the Lees continue to fear the government will take Lia away from them. Foua cares for Lia 24 hours a day, every day, never leaving her alone—carrying, bathing, feeding, and sharing a bed with her. Everyone showers Lia with affection, treating her like a well-loved baby or pet. Fadiman writes that, in some ways, Lia’s condition does not seem bad, as “she was a love object, not a pariah” (219), but then, every once in a while, she sees explosive rage from Nao Kao who blames the doctors for Lia’s soul loss or despair from Foua who is exhausted from the caregiving.

Fadiman concludes the chapter with the experiences of Martin Kilgore, a nurse from the Merced County Health Department who visits patients’ homes. While Martin is knowledgeable about Hmong history and politics and respectful of Hmong culture, his visit with the Lees is disastrous. They share very little information with him about Lia and do not trust his recommendations. Martin’s status as an outside authority figure compromises his ability to connect with them.

This chapter discusses the reasons for why the Hmong chose to live in Merced, an agricultural town in the Central Valley of California. By the time Fadiman conducts her research in the 1980s, the Hmong constitute about one fifth of the total population of Merced. Fadiman traces the origins of their migration to Dang Moua, who came to Merced with his family in 1977 in search of a better life. By word of mouth, news of Merced’s favorable agricultural conditions and welfare benefits spread throughout the Hmong community, prompting an influx of Hmong refugees from other parts of the country.

Initially, the residents of Merced do not notice the Hmong in their community; this changes as their numbers grow. The more established residents begin to attribute economic cutbacks in their city to public assistance programs for the Hmong. Starting in the early 1980s, a nationwide recession prompted austerity measures for both state and federal programs. The restructuring of property taxes, which gave less money to the county and more to the state, contributed to Merced’s fiscal crisis. Yet, most of Merced’s residents do not recognize these underlying cutbacks and instead blame the Hmong for their economic troubles.

While government welfare helps the Hmong survive economically, their solidarity as an ethnic group provides critical social and emotional support. Fadiman provides the example of the Hmong helping each other pass driving tests through elaborate, handsewn crib sheets, which she describes as a “differently ethical” approach to rules and regulations (242). The Hmong use strategies of ethnic cohesion to circumvent seemingly senseless, counterproductive rules. Yet, while providing many benefits, ethnic solidarity for some highly educated and respected leaders, like Blia Yao Moua and Jonas Vangay, is a source of stress and burnout. The unrelenting pressures of caring for family and community members leads them to suppress individual achievements for the collective good, often at the expense of their personal wellbeing.