Crosscultural miscommunication

Rarely do I ever use the word "profound" in everyday conversation or even when I'm writing.

In this instance, it's the first word that comes to mind in describing Anne Fadiman's 1997 book "The Spirit Catches You and You Fall Down."

Don't know how this slipped below my radar but I have Kyndall, Simone's partner, to thank for this wonderful birthday gift.

Fadiman weaves together several narratives in telling the story of a Hmong child with severe epilepsy who winds up at the center of a cultural tug-of-war over her diagnosis and treatment. With amazing precision and a disciplined, non-judgmental style, Fadiman reveals the chasms in communication that leave her idealistic American doctors and her deeply traditional parents exasperated with and distrustful of each other, even though all parties want what is best for Lia, the 14th child born to Foua Lee and her husband, Nao Kao.

As the reader, you can't help but want to bridge the misunderstandings that contribute to Lia's repeat hospitalizations and the mutual feelings of frustration. Her doctors take great pains to prescribe medicines to the girl's parents, but they are illiterate, unable to read even the numbers on a measuring spoon, and convinced the drugs are making their daughter sicker. At the same time, you have parents whose beliefs in the folk healing arts practiced in their homeland of Laos are disregarded and yet whose recuperative powers are evident to the physicians and social workers who come to know and respect the parents' love and devotion to their daughter. It's a classic tale of good intentions among good people, undermined by language and cultural barriers.

But the book is so much more than the clash over Western and Eastern medicine.

Fadiman tells the story of the Hmong and their history as nomadic mountain people of Laos and the fierce pride they take in preserving their culture and customs.


She tells of the U.S. recruitment of the Hmong as surrogate fighters in the clandestine war in Laos during the years the United States was embroiled in Vietnam. She tells of their displacement to Thai refugee camps and their mass immigration to the U.S. in the late '70s and early '80s -- arriving in places like Minneapolis, Philadelphia and Portland. And she tells of a secondary migration, sparked by the desire of entire clans to reunite for the sake of family and tradition, which leads to the story taking place in the hardscrabble Central Valley town of Merced, California.

Today that city has the largest percentage of Hmong people among its residents, most of whom arrived speaking no English, with little or no money, and little ability to break into the job market. Initially, virtually all of the refugees were on federal assistance, which, of course, sparked considerable resentment toward the newcomers.

(Two quick asides: 1) One of the sources quoted in the book is Dr. Bruce Thowpaou Bliatout, a Hmong physician, who I actually interviewed years ago as a reporter when I was doing a story on the Multnomah County health department's multicultural services here in Oregon. 2) I once attended a Hmong ceremony at a North Portland residence following the death of a community member, and remember being mesmerized by the music, the traditional dress and the chanting that I was told would last for two or three days. How poorly prepared I was to write about that for the newspaper, I realize now after reading this book.)

Ultimately, "The Spirit Catches You..." is as much about cultural anthropology and history as it is about medicine and religion. Reduced to its essence, the critical question raised by Lia's story is this: "Which is more important, the life or the soul?"

Fadiman's book won the National Book Critics Circle Award for Nonfiction. I can attest that was a good call.

Map: studyabroad.com