The Spirit Catches You and You Fall Down

The Spirit Catches You and You Fall Down Summary and Analysis of Ch. 7-8

Chapter 7: Government Property  

Neil Ernst didn't believe in giving a different standard of care to different patients, which is why he continuously fine-tuned her drug regimen. However, he now wonders if it might have been better to keep Lia's prescriptions more consistent so that her parents could more easily comply and so that they would have more confidence in the system. When first treating Lia, he never considered lowering his standard of care. He saw her parents' noncompliance as a form of child abuse, which is why he eventually notified Child Protective Services. He worried about the possible consequences, having heard and believed a rumor that a Hmong father had hanged himself in jail after being unjustly accused of child abuse, but he felt he had no choice. He also felt there were certain rules the Hmong needed to abide by, and that it was important for the community to see that.  

Neil had a right to file a report with Child Protective Services once he realized her parents were endangering her health, and in fact, by state law he was required to. In the case of minors, the state has the right to force compliance with life-saving treatments even if it goes against the family's religion. Neil did not wish to prosecute the parents, just to put Lia into the care of those who would administer her medications exactly as prescribed. In May 1985, Lia was placed in a foster home with a pair of Mennonite sisters who would strap her into a car seat in the living room every time she became hyperactive. Two weeks later, she went home and her parents were given one more chance. After blood tests showed she still wasn't receiving the proper dosages, Lia was removed again for a placement of at least six months. Her parents were not told of the decision ahead of time. Foua was out of the house, and Nao Kao was so angry he nearly killed the translator.  

The Hmong community was upset at what had happened. They did learn a lesson, but not the one Neil intended; rather, they believed even more strongly that doctors should not be trusted. The Lees loved Lia very much and were doing their best to be good parents, so it didn't seem fair that Lia should be taken. The Hmong believe that parents, not doctors, are ultimately responsible for deciding the treatment of a child. The fact that doctors can call the police and remove a child from her parents illustrates the power differential between doctors and refugees, despite the United State's reputation for freedom.  

Child Protective Services (CPS) held a hearing that Nao Kao attended, but he did not realize he had the right to object. Lia was to be placed in foster care for six months, which was the minimum time that Neil felt necessary to stabilize her disorder. Her parents would be allowed weekly visits, although these didn't start until after a month and they didn't even know where she was for several weeks. She would return to her parents after six months only if the court were persuaded that her parents would comply with the doctors' instructions. If the court didn't decide she could be returned within a year, the Lees would lose custody permanently.  

Lia was placed with Dee and Tom Korda, who at the time had four children of their own and another foster child. Lia cried continuously for ten days when she arrived. The Kordas spoke no Hmong; the only thing they found would comfort her was constant physical contact. Dee carried her in a backpack while she carried her own youngest child on her front; she let her sleep in her bed; and breastfed her along with her own baby. Still, Lia engaged in tantrums, peed and pooped on the floor, injured other children, and required constant supervision.  

Dee Korda took Lia to between two and five doctor's appointments each week and was religious about administering her medication, even when it meant repeating doses after Lia spat them out. Her new doctors at Emanuel Medical Center, close to where the Kordas lived, changed her prescription several times. Dee felt the new medications had fewer side effects and understood why Lia's parents didn't give her some of the previous medicines, as they made Lia practically drunk. Still, Lia's seizures continued, even increasing in frequency.  

Once the Lee's found out where Lia was living, they visited whenever they could get a ride. The Korda and Lee children became friends, and in an expression of trust, Dee started leaving her own baby with Foua when she took Lia to the doctor. She could see how loving Lia's parents were and recommended reunification, although CPS disagreed. Lia, for her part, tried to get in her parents' car at the end of each visit and screamed when she could not. Foua and Nao Kao were so distraught at the absence of their daughter that they both threatened suicide.  

Lia didn't return home after six months, as the court felt her parents had not demonstrated their ability to comply with her medical regimen. They hadn't signed a Social Services Plan that had stated that they must take Lia to appointments and administer her medication in order for reunification to take place, as they had wanted reunification to happen immediately. They had also failed to give Lia the proper medicine when she came home for a week. Instead, they had emptied the medication vials to show the doctors and administered a traditional dermal treatment of coin rubbing. Four days later, Lia had three grand mal seizures and six petit mal seizures, after which her developmental deficits became more severe. She would not eat or maintain eye contact, banged her head, defecated without control, scratched and bit herself, abused other children, and could not sleep.  

Jeanine Hilt worked hard to educate the Lees so that they could regain custody before they lost the chance. It helped that in February 1986 Lia's drug regimen was simplified. A pediatric neurologist tentatively diagnosed Lia with Lennox-Gastaut Syndrome, a rare form of epilepsy accompanied by mental retardation and difficult-to-control seizures, and prescribed Depakene, a good-tasting liquid that was far easier to administer than the previous pills. Jeanine spent dozens of hours teaching Foua how to squirt the liquid into Lia's mouth using a syringe, which she marked with masking tape at the correct level. The two gradually developed a good relationship.  

Nao Kao, on the other hand, remained wary of Jeanine and extremely angry at Sue Xiong, the Hmong interpreter who had accompanied CPS when Lia was taken from their home. She was unpopular in the community due to her marriage to an American and her abandonment of many traditional Hmong customs. She once told Nao Kao that she had told CPS she didn't think he should get Lia back, and he became convinced she wasn't translating his statements accurately to the doctors. When she later visited the house, he threatened to beat her to death with a baseball bat.  

Fortunately, Jeanine acknowledged Nao Kao's reasons to be angry and did not let the incident get in the way of gaining custody of his daughter again. Starting in February 1986, the family was allowed to keep Lia for a series of overnight visits, during which they administered the correct amounts of Depakene. Upon her recommendation, Lia returned home again on April 30, 1986.  

Chapter 8: Foua and Nao Kao  

When Fadiman first arrived in Merced in 1988, seven doctors mentioned Lia's case, but none felt it was worth investigating due to her parents' mistrust of Americans. She had never before met a Hmong, although she had been instructed on what to and not to do: take off her shoes; don't raise her voice; don't offer to shake hands with a man, as doing otherwise would lead people to think she was a whore; indicate her lower status if a man offered to shake her hand by placing her left hand under her right wrist, thereby supporting the weight of his important hand; if walking with a Hmong leader, stay behind him and to his left; use an older man interpreter to make up for the fact that she was a younger woman; and never refuse an offer of food.  

The Hmong were notoriously difficult to get to know. Fadiman's physician friend Bill Selvidge, a Peace Corps veteran with an interest in anthropology, still hadn't had an extended conversation with a Hmong over the age of 14 after two years of working in Merced. A Hmong-speaking nurse’s aide at MCMC set up Fadiman’s first meetings with Hmong families; this fact alone nearly guaranteed mistrust because the families associated her with the hospital. Her first two interpreters, older and well-respected men, were also a failure; while they would talk animatedly with the Hmong they were interpreting for, they would give Fadiman only a few words as translation.  

Fadiman finally made some headway when she met Sukey Waller, the psychologist at Merced Community Outreach Services and possibly the American most well respected by the Hmong. She introduced Fadiman to five Hmong leaders, who received her warmly; two became vital sources and valued friends. Sukey taught her that the best thing to do in terms of etiquette was to ask before doing anything. She also stressed the importance of finding not just an interpreter but a "cultural broker," someone who would teach her what to do as well as translate what people said. Following Sukey's advice, Fadiman found an interpreter named May Ying Xiong, a twenty-year-old clerk at the Merced County Office of Refugee Services.  

Due to their ages and genders, Fadiman and May Ying were low-status as a pair. However, this low status worked to their advantage when meeting the Lees. The family was used to people who made them feel that they didn't count for much; thus, they preferred someone with less status. It also helped that the initial meeting was set up by a well-respected Hmong leader, who had connection to the hospital or any other American institution, and that May Ying's husband turned out to belong to the same clan as the Lees. The family was therefore hospitable, talkative, and energetic. Fadiman often asked questions whose answers appeared glaringly obvious to any Hmong, but her hosts treated them with amusement rather than hostility.  

The Lees were an attractive couple. Foua looked around forty-five and her husband about ten years older. They were short and solidly built. Foua usually wore her hair in a bun, while Nao Kao wore glasses with thick black frames. They normally wore loose-fitting American clothes with pastel colors. When they and Fadiman first met, they were living with seven of their children in a three-room apartment. They had little furniture aside from a TV, which was usually on. Family photographs, posters, and a three-foot long qeej adorned the walls. Outside in the parking lot, Foua cultivated dozens of medicinal plants in plastic buckets and discarded motor-oil cans.  

Fadiman spent hundreds of hours with May Ying and the Lees, and the four became close enough to use Hmong terms of endearment with one another. The Lees gave Fadiman access to all of Lia's records at MCMC, Valley Children's Hospital in Fresno, the Merced County Health Department, and CPS. However, it wasn't helpful to ask them about particular events, as they lumped all of Lia's doctors together and the diagnoses meant little to them. They also thought of time in a different way, identifying years by salient event rather than by number, such as "the year Lia became government property." In Laos, the Lees had divided the year into lunar cycles identified by their agricultural activities, such as the cycle when corn was planted. In Merced, each month's activities were similar to every other's, and therefore it was hard to recall when events had occurred.  

The Lees answered Fadiman's questions, but they also had their own agenda: to explain Hmong culture to her so she could understand it and explain it to the doctors. For instance, they taught her that one's soul sometimes wanders off and causes a patient to become sad and sick. Doctors can fix some sicknesses involving the body and the blood, Foua explained, but sometimes people get sick because of their soul and therefore need spiritual things. She felt with Lia it was important to do both a little medicine and a little neeb, or shamanic ritual, but to limit the medicine as it could cut the neeb's effect. The doctors wouldn't let them give just a little medicine, she explained, because they didn't understand about the soul. Nao Kao likewise explained that the Hmong often get sick because they encounter a dab, but that doctors didn't understand this and therefore didn't treat them effectively. For instance, a man's son was once made sick by a dab living in a creek; the doctors tried to cure him with shots and medicines, but the only thing that would have saved him would have been to sacrifice a dog.  

As she got to know her, Foua took Fadiman in hand. She taught her to say please and thank you in Hmong and how to treat a headache by rubbing an egg-covered coin up and down her body. Once, she decided to get her married by dressing her as a Hmong bride for her boyfriend. She was adorned in piece after piece of paj ntaub, or embroidered cloth: a long sash to fatten her up and make her look strong, a skirt with hundreds of pleats that had probably taken several years to make, an apron, a jacket, four bags decorated with dangling silver coins, a five-tier necklace of silver, puttees, and a pagoda-shaped hat covered with silver coins. Fadiman's boyfriend George was stunned. While he didn't appreciate the beauty of the attire, a week later he asked Fadiman to marry him, which didn't surprise Foua at all.  

Although she acknowledged her skill at needlework, generally speaking Foua was self-deprecating. She felt she was stupid because she didn't understand English, couldn't read the numbers on a telephone, and couldn't even shop for food, not knowing what was in the packages. Fadiman suggested she herself would have just as much trouble in Laos and asked Foua to describe a typical day. Foua would wake up in the early morning, light an oil lamp, cook rice for her children, and clean the house with a handmade broom. She would then cut wild grasses for the pigs and cows, feed the animals, and walk with her husband to the fields with her baby on her back. The two of them would plant seeds, clear the fields, harvest the right, thresh and winnow the rice, or grind the corn, depending on the season. When they returned, she would fetch water from the stream and carry it on her back. She would bathe the babies by boiling the water and mixing it with water from another bowl. Then she would feed the animals, cook for her family, and sew by lamplight to make good clothes for the children for New Year's. Her house was made of wood, constructed with the help of her relatives. It had just one room, with an earthen floor and beds made of bamboo. They had no blankets and slept holding the babies near the fireplace to keep warm.  

Fadiman realized that when Foua had said she was "stupid," what she really meant was that none of her skills were transferable, except being an excellent mother to her nine surviving children. However, the US government had contradicted even this, declaring her a child abuser. When asked if she missed Laos, Foua explained how she missed the sense of freedom, of owning her own food sources and being able to do what she wanted to do. While she was more comfortable in Merced, she didn't like being dependent on others to eat.  


Chapter 7 continues the theme of power, as the Lees were rendered completely powerless. The entire Hmong community felt the injustice. Foua and Nao Kao were doing their very best for their daughter (who was quite a challenge behaviorally as well as medically), showering her with love and administering what they felt was the best regimen to make her get better, and her doctors - who had not yet been able to cure her - took her away. The only way the parents could get their daughter back was to follow the doctors' instructions to the letter, and yet this meant they had to capitulate and give medications that they honestly believed were hurting Lia.   There is a philosophical question here. Who should have the power when it comes to making decisions for a child? Doctors have scientific knowledge, yes, but the fact that Lia's seizures continued and even increased in frequency despite her foster parents following the doctors' instructions shows that their knowledge is fallible. There is something to be said for the Hmong view: that because they gave birth to the child, provide for his or her needs, and love the child, they are in the best position to make decisions.  

One of Neil Ernst's justifications was that the Hmong needed to understand there were certain rules they had to abide by. This attitude supports the idea that his behavior was part of the racist history of the United States, in which Asians were seen as needing to be "socialized" and made to conform to Western norms.  

Jeanine Hilt stands in stark contrast. While she is part of the system that removed Lia from her parents, she took a great interest in the family and grew to love them. In an interview, Fadiman described Jeanine as "a short, plump, Hmong-sized woman who would sit with them on the floor," and whose "heart was in a Hmong place." She alone among Lia's caregivers thought to ask Foua and Nao Kao their beliefs about the origins of Lia's epilepsy (see Chapter 3) and to learn about their customs. Because she loved them, they loved her too. For this reason, Foua accepted her help at "socialization" and learned to administer Lia's medication.   

In Chapter 8, Fadiman inserts herself into the story, explaining how she came to meet the Lees. It is important to recognize that she, too, had her own cultural biases, and that as an ethnographer, she likely influenced the people she was interviewing and the ways in which they told their story. Fadiman saw this firsthand when her first two interpreters, older men with high status in the community, would have animated conversations with her interviewees yet tell her almost nothing about what had been said. May Ying Xiong was far more helpful, as she didn't look down on Fadiman for being a young woman, interpreted what people said, and later explained the cultural background of what had been talked about. May Ying was clearly an excellent "cultural broker," but we should keep in mind that she was still young herself and may not have had a sophisticated understanding and/or appreciation of all of the concepts. Fadiman's interviewees may also have held back at times because, according to at least one Hmong critic, the Hmong are known to share only "acceptable" cultural information with Westerners.   

Fadiman's invisible cultural biases may also have influenced the way in which she described the Lees. She included extensive physical descriptions and described their determination by referring to natural forces: "They looked well-rooted, as if it would take a gale force wind, or maybe even an earthquake, to knock them over" (97-8). Her descriptions of Neil Ernst and Peggy Philp in Chapter 5, by contrast, primarily referred to their personalities and their intelligence. Although they too have strong determination, their descriptions were free of such language.  

Despite these inevitable biases, it seems that Foua and Nao Kao accepted Fadiman for the same reasons that they accepted Jeanine Hilt: she respected who they were, expressed a sincere interest in their culture and beliefs, and grew to love them. Furthermore, like Dwight Conquergood (see Chapter 4), believed that the Hmong had just as much to teach westerners as westerners had to teach the Hmong. She let Foua dress her up as a Hmong princess in the middle of the hot summer to inspire her boyfriend to propose, learned to rub a coin on her body to treat a headache, and acknowledged that she would likely have as much trouble living in a Hmong community in Laos as Foua was having in the United States. Once again, respect and two-way communication seems to be far more effective than coercion.