Running head: THE SPIRIT CATCHES YOU

The Spirit Catches You and You Fall Down:

A Reflection on the Text
Julia Hart
George Washington University

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The Spirit Catches You and You Fall Down: A Reflection on the Text

As someone who has been working with children for many years, I found The Spirit Catches
You and You Fall Down to be simultaneously heartbreaking and horrifying. The ways in which the
medical and social services agencies failed the Lee family were shocking, and yet somewhat familiar.
I found several personal connections to the story of Lia Lee and her family as I read the book, and yet
also connected with the voices of the doctors and social workers that strived to help Lia. The culture
clash between Western medicine and this Hmong family resulted in a continual struggle to do the
right thing for the child.
Unfortunately, I have seen how Western medicine reacts to immigrants and those not wellversed in medical knowledge. A dear family friend from Thailand, Lex, spent many days in a local
hospital in terrible pain before doctors were able to diagnose a gallstone attack. Lex has been in the
US for many years, and is here legally, but has limited English vocabulary and a strong accent that
makes her English challenging to understand. Had this friend been able to converse more fluently in
English or had a doctor willing to take the time to listen to her and understand the problem, she would
have been spared days of pain and thousands of dollars in hospital bills. At the time, it had not
occurred to this woman to seek help from friends who could help advocate for her. Since her
hospitalization a few years ago, Lex has asked my mother to help her as a healthcare advocate. My
mother goes to each and every doctors appointment with Lai to ensure that she understands what the
doctor is saying and that the doctors will listen more closely to Lexs needs. Because of my familys
experience with Lex, I found myself wishing that the Lee family had someone to advocate for them
and to help them understand the American medical system.
Another, more recent, personal experience helped me connect with this book in other ways.
This past school year I had a child in my class who has epilepsy, Ill call him Max. The past nine-

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months have been an incredible learning experience for me and my colleagues in the management of
epilepsy and the behavioral effects of the medications used to control seizures. This experience made
me sympathetic to the doctors and social workers that strived to help Lia Lee. My work with Max
and his family was both frustrating and rewarding. I made many mistakes in my interactions with his
family, but I was fortunate that at least there was no language or cultural barrier getting in the way of
our having a successful relationship. Ultimately, my co-teacher and I were able to form a successful
partnership with Maxs family and we helped them to understand that we all wanted the best for their
little boy.
After my experience with Max and his family, I did find myself condemning the parents of
Lia Lee for their non-compliance with the medications Lias doctors had prescribed. It was
challenging to be able to set aside my experiences with a family that had tried so many types of
medications and dosages to control their childs seizures, and to understand how any parents could
allow their childs condition to go untreated. And yet, even while I felt great anger at the situation,
the love that Foua and Nao Kao Lee felt for their daughter was evident. It was obvious that they were
doing what they thought was right for their child. The acceptance of children with special needs in
the Hmong culture is something that one might wish for any child. It was the love of their child that
may have kept Lia Lee alive even when her doctors were unable to treat her in the ways they thought
appropriate.
The Lees experience with the medical and social services in Merced, California was a
catastrophe. The systems that sought to protect the welfare of the child were unable to form a
successful partnership with the family and the family was unable to understand the Western ways of
their new home. Perhaps had there been a better system of interpreters available at the hospital or had
the doctors found a simpler regimen of medications for Lia to take, the situation would not have

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escalated to such a disastrous state. Perhaps if Anne Fadiman had come into their lives sooner, she
could have helped to form a bridge between the cultures.
As Fadiman (1997) says in chapter 17, it is easy to wonder how Lias story might have played
out given just one change in the circumstance. There are so many what-ifs? in the case of Lia Lee.
The intersection of Hmong culture and American medical culture produced unfavorable results in the
case of Lia Lee. How could this go differently in the future, is a question posed by Fadiman, and
very much an overall theme of the book. A quote from Arthur Kleinman in response to this question
rings true, you need to understand that as powerful an influence as the culture of the Hmong patient
and her family is on this case, the culture of biomedicine is equally powerful. If you cant see that
your own culture has its own set of interests, emotions, and biases, how can you expect to deal
successfully with someone elses culture? (Fadiman, 1997, p.261). This statement gets at the heart
of the role of practitioners- balancing legal and procedural policies with family needs and desires.
In order to do the best job for children, it is essential that we are able to see how our own
perspectives influence our work. If we are not able to see how our own culture influences our
actions, we will not be able to work within the cultures of others. The book Families, Professionals,
and Exceptionality (2011) also addresses the issue of cultural understanding. The authors suggest that
it is important for professionals working with families to act as cultural interpreters. They explain,
By serving as interpreter or translator of Western practices, professionals can convey American
practices and at the same time learn about families practices and cultural beliefs (Turbull, Turnbull,
Erwin, Soodak & Shogren, 2011, p.167). This is a message I will take away from the story of Lia
Lee. While I feel that my school works hard to embrace the differing cultures of all our students and
their families, it is also something that can always be improved upon. One practice that puts value on
family culture are the home-visits we conduct each year before school begins. These serve for the

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teachers to gain a greater understanding of the childrens home lives, and for families to see that we
value the important work they do at home.
Sometimes parents have different goals for their children than the goals of professionals such
as educators or doctors. It can be a hard lesson to learn that as professionals, it is our job to try to
marry our goals. This is a lesson of acceptance that I imagine must take years to learn, since I
certainly do not feel as though I have achieved this level of acceptance. Every year I must remind
myself that working with families and maintaining positive relationships is a far greater success than
having complete control over the educational experiences of the children in my class. No matter how
much time children spend in my care, their parents are their most important caretakers, and as such,
they should be equal partners in their childs education. I am sure that when I experience frustration
with a familys beliefs or desires in the future, I will remind myself of this book and strive to seek a
compromise that will still benefit the child.

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6
References

Fadiman, A. (1997) The spirit catches you and you fall down. New York, NY: Farrar, Straus
and Giroux.
Turnbull, A., Turnbull, R., Erwin, E. J., Soodak, L. C., & Shogren, K. A. (2011). Families,
professionals, and exceptionality: Positive outcomes through partnerships and trust.
Upper Saddle River, NJ: Pearson Education, Inc.