The Spirit Catches You and You Fall Down Literary Elements

Medical anthropology, Sociology

Merced, California, in the 1980s and 1990s; some flashbacks to Laos and Thailand in the 1960s and 1970s

Author Anne Fadiman narrates the story. While much of it is written in the third person, she uses the first person to insert herself into the story beginning in Chapter 8. In so doing, she reminds us that she, too, is a character in the narrative. Much as she would like to maintain objectivity while telling each side of the story, she too has biases and cultural baggage, which may influence her perspective. Fadiman herself highlights this point in the Afterword: "I constantly fought - and still fight - the assumption that my perspective was the(in italics) perspective. I knew this was the trap into which both sides in Lia's conflict had fallen, but the fact that it was the central lesson of my book made it no easier to avoid" (300).

The tone of the book is serious. Fadiman cares deeply about her subject and wishes to convey her story as objectively as possible. She does not cast blame, but rather shows how differences in beliefs based on culture can have tragic consequences even when both sides are acting as they think is best. Her fascination of the Hmong is evident through her detailed accounts of their history and culture.

The mood is generally somber, given the tragedy that befalls a little girl. However, Lia's story is interspersed with ethnographic information about the Hmong and amusing anecdotes, which lighten the mood. In addition, there is a sense of hope as Fadiman posits ways to improve health care for the Hmong so that Lia's story need never be repeated.

A protagonist contends with difficulties he or she must overcome, often caused by an antagonist. Lia's parents and doctors cause difficulties for one another, but who is the protagonist and who is the antagonist depend on one's point of view.

Foua and Nao Kao had very different ideas about how best to care for their epileptic daughter Lia than her American doctors, based on their vastly different cultures. Unable to bridge the communication and culture gaps, her doctors placed Lia into foster care, further eroding the trust that Foua and Nao Kao had in the American medical system.

The climax occurs when Lia has her big seizure and goes into septic shock, resulting in brain damage.

Many details foreshadow Lia's tragedy. One of the clearest is Neil Ernst's premonition: "I felt like there was this giant snowball that was coming down the mountain and we were trying to hold it up there and it just kept pushing us. I remember talking to the parents and telling them that Lia's seizures were getting worse and more frequent and that someday she might have one we couldn't stop. It was so haunting. I started to have nightmares that it was going to happen, and I would be the one on call, and I couldn't stop it and she was going to die right before my eyes. It was inevitable. It was just a matter of when" (118).

Fadiman continues to foreshadow the tragedy that befalls Lia as she describes the evening of her big seizure. When she tells us about Lia's trip to the hospital via ambulance, she notes: "If her parents had run the three blocks to MCMC with Lia in their arms, they would have saved nearly twenty minutes that, in retrospect, may have been critical" (141). Describing the doctors' reactions at the hospital, she shares details that suggest they have missed some vital signs: "No one thought of taking her temperature, which was 101, until after Neil had returned home. Two other unusual signs - diarrhea and a very low platelet count - were simply noted without comment on Lia's chart, eclipsed into invisibility by the monumental scale of her seizures. No antibiotics were administered because no infection was suspected" (144). Later, we learn that Lia was actually suffering from septic shock, a far more deadly condition that led to her brain damage.

More generally, Fadiman's descriptions of Hmong beliefs about illness and western medicine foreshadow the difficulties that they will have with the American medical system.

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There are a number of allusions to Hmong folktales. For instance, we learn about Shee Yee, a legendary healer and magician, who escaped nine evil dab brothers by shapeshifting into various forms. Shee Yee eventually transferred his powers to human tvix neebs, or shamans, who summon his spirit as they do his work. These folktales often serve to illustrate some aspect of the character of the Hmong people. Like Shee Yee, they are courageous and tenacious, and will fight or flee rather than surrender. Another folktale tells of an arrogant official who is turned into a mouse upon whom the hero, disguised as a cat, pounces, illustrating how much the Hmong dislike being belittled.

Fadiman uses rich visual imagery to help us to understand both Hmong culture and what happened to Lia. She uses details to "zoom in" on key scenes, such as Lia's big seizure, the Lee's escape from Laos, and a tvix neeb ceremony held for Lia.

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Fadiman employs a parallel structure when describing Hmong beliefs about food cravings: "If she craved ginger and failed to eat it, her child would be born with an extra finger or toe. If she craved chicken flesh and did not eat it, her child would have a blemish near its ear. If she craved eggs and did not eat them, her child would have a lumpy head" (4). The use of parallel structures gives this set of sentences a rhythm that is almost poetic, helping to paint a picture of life in Laos.

There are parallels as well between the two stories told in alternating chapters: that of Lia Lee, and that of the Hmong people. Both suffered severe hardships and were recipients of assistance by Americans, but both would have been better served had those Americans taken the time to understand their needs and their culture.

Fadiman employs metonymy when describing the tvix neeb ceremony in Chapter 19. She writes: "The tvix neeb sat on Shee Yee's winged horse" (286), referring to a board about ten feet long and ten inches wide sitting upon a pair of supports. Rather than describing the literal truth - that the shaman was sitting on a wooden bench which was meant to represent a mythical winged horse from Hmong legend - she tells us that he is sitting on the horse itself, thereby strengthening the relationship between the bench and the object it symbolizes. She explains that the horse is not just a metaphor, but rather that the bench was truly a flying horse to the people in the room.

One could argue that a dab is a personification of organisms that carry disease. The Hmong believe that evil spirits called dabs can steal souls (particularly those of babies), thereby causing a person to become sick. Living in isolated rural areas and lacking formal education, it was likely much easier to picture an evil spirit taking a child's soul than to attribute an illness to microscopic bacteria or viruses that could neither be seen nor imagined.

Animals are also personified in Hmong culture, in that they are believed to have souls and to be able to consent to being sacrificed. Fadiman explains how the tvix neeb at Lia's ceremony "spoke quietly to the pig, explaining that it would be well rewarded for its work and that at the end of the year its soul would be set free from its obligations" (285). He then threw a set of divination horns to see if the pig had accepted its role, only continuing the ceremony when it did so.