The Spirit Catches You and You Fall Down is the poignant story of a young Hmong girl suffering from epilepsy who is caught in the cultural chasm between her family and her rationalist American doctors. The story shows the tragic consequences of a lack of cross-cultural communication and reveals the weaknesses of western medicine in caring for patients with beliefs that are different from that of their doctors.
Fadiman first became interested in writing the story after talking with her friend Bill Selvidge, the chief resident of family practice at the country hospital in Merced. Bill shared how his Hmong patients were incredibly interesting but also very difficult, as they rarely complied with doctors' instructions and had taboos against many medical procedures. Fadiman believed it would be revealing to tell a medical story from both the doctors' and patients' point of view. She left her job as a staff writer at Life to turn the story into a three-part article for the New Yorker. When a new editor canceled the story, Fadiman decided to turn her research into a book instead.
Published in 1997, The Spirit Catches You and You Fall Down has won numerous accolades, including the National Book Critics Circle Award, the Salon Book Award, the Los Angeles Times Book Prize for Current Interest, and the Ann Rea Jewell Non-Fiction Prize. It was selected as a best book of the year by a number of publications, including People, Newsday, Glamour, and the Detroit Free Press, and was a New York Times Notable Book. In 2009, the Young Adult Library Association chose it as a recommended title.
Because it so clearly reveals the dangers of a lack of cultural understanding, Spirit is frequently used to teach "cultural competence" to health care practitioners. It has been required reading for first-year medical students at a number of institutions, including the University of Minnesota, the University of Virginia, the University of California-Irvine, and the Yale School of Medicine, and is featured in many medical anthropology courses. By 2012, it had sold nearly 900,000 copies.