Explain the meaning of the book's title.
"The spirit catches you and you fall down" is the literal translation of the Hmong name for epilepsy, qaug dab peg. The spirit referred to in the name is a soul-stealing dab; thus, the Hmong believe that epilepsy has a spiritual origin and should be treated accordingly. At the same time, it is considered an illness of some distinction, with seizures as evidence that an epileptic can see things that others cannot and can more easily enter trances to journey to the spirit world. The Hmong understanding of epilepsy is at the root of the conflict between Lia's parents and doctors. Foua and Nao Kao wanted Lia's doctors to help control her seizures; however, they also felt she should be treated using shamanic ritual, which could be hindered by too much medication.
Compare and contrast the Lees' life in Laos and the United States. In what ways was their new life better or worse than their old life?
In Laos, the Lees lived in a small village in the highlands. They had few possessions but were self-sufficient, growing rice, corn, and vegetables and raising pigs and cows. Their house had an earthen floor and beds made of bamboo, and Foua had to carry water from the stream on her back. Life was much more comfortable in the United States, but the family missed the freedom they had in Laos. In the US, Foua and Nao Kao had to learn about electricity, refrigerators, televisions, toilets, grocery stores, and stoves. They couldn't speak the language and were reliant on welfare. Foua disliked having to depend on others to eat and not being able to do as she wanted. In Laos she never would have had Lia taken from her, as parents were considered responsible for making decisions about the medical care of their children.
What do Hmong folktales teach us about their culture?
Fadiman uses Hmong folktales to illustrate aspects of Hmong temperament and values. For instance, the Orphan is a recurring character who serves as a symbol for the Hmong people. Despite living alone on the margins of society, he is actually clever, courageous, resilient, and a virtuoso of the qeej, a highly esteemed musical instrument. Another character, Shee Yee, escaped nine evil dabs by shapeshifting, reflecting how the Hmong would rather fight or flee than surrender.
Describe Neil Ernst and Peggy Philp. What were some of their strengths and weaknesses?
Neil and Peggy are both hard-working, compassionate, and capable physicians who are married to each other. They are idealistic, compulsive workaholics who coordinated their schedules so as to take turns being home for their children after school and taking long runs in the morning. While these qualities generally made them excellent physicians, they also made it difficult for them to compromise and adapt their methods to accommodate the wishes of their Hmong patients. Neil changed Lia's medication frequently in an attempt to give her the best care possible, but he failed to take into account the difficulty her parents faced in following his instructions or in tolerating the side effects of the medicine. He referred Lia's case to Child Protective Services because he felt it was the only way to ensure Lia would receive the medical care she needed, rather than working with the family to seek a better solution. On the other hand, both he and Peggy readily admitted their mistakes and did not let pride keep them from self-improvement.
Lia Lee ended up in a vegetative state despite how hard both her parents and doctors tried to save her. How did this tragedy happen? How, if at all, might it have been averted?
Lia's care was suboptimal from the start due to a lack of interpreter services at the hospital. Thus, for the first six months, doctors didn't even realize that Lia had epilepsy. Once they began treating her properly, they failed to effectively communicate the reasons that it was so important to give Lia her medication. Neil Ernst also frequently changed her medical regimen, making it even more confusing to administer. He believed it would be better for Lia to live with a foster family who would follow his instructions; however, the emotional anguish caused by Lia's separation from her parents may have further hurt her health. Lia's parents did their best, but they didn't understand why they needed to give Lia medication with harmful side effects. They also believed that too much medication would limit the effectiveness of the spiritual healing performed by a tvix neeb.
It is possible that the tragedy could have been avoided with better cross-cultural communication and a willingness to compromise on both sides. Lia's doctors could have found a bicultural interpreter to teach the family about the importance of medication, engaging the help of clan leaders. They also could have hired a nurse to administer Lia's medication at home, rather than placing her in foster care. Had they listened to the Lees' explanation of Lia's illness, they might have understood the family's concerns and been able to address them. Acknowledging their viewpoint may also have built trust, so essential for effective communication.