The Spirit Catches You and You Fall Down

The Spirit Catches You and You Fall Down Summary and Analysis of Ch. 1-2

Chapter 1: Birth  

Lia Lee was born on July 19, 1982 as the 14th child of Foua and Nao Kao, Hmong immigrants now residing in Merced, California. All but one of their other children had been born in Laos, where the birthing traditions were very different than in the United States. Foua delivered each child with her own hands, without a birth attendant, keeping silent to avoid thwarting the birth with noise. She then washed each baby with water she had carried from the stream. Her husband helped by bringing her hot water to drink if she needed it, cutting the umbilical cord, and tying it with string. He also buried the placenta, under the bed if the baby was a girl and near the base of the central pillar of the house if it were a boy. The Hmong believe that a person's soul travels back from place to place until it reaches the placenta, which it must put on like a jacket in order to continue its journey to the place where it reunites with its ancestors and will someday be reborn. Without the placenta, the soul is condemned to wander for all time.  

Had Foua had any problems, she could have called upon a number of Hmong remedies. If she had failed to conceive, she could have called in a tvix neeb, a shaman who could negotiate for his patients' health with the spirits. She could avoid becoming infertile in the first place by respecting certain taboos, such as avoiding caves, where evil spirits called dabs might dwell and make a victim sterile by having sexual intercourse with her. A pregnant woman could ensure her child's health by respecting her food cravings, lest the child be born with an extra finger or toe, a lumpy head, or some other deformity. It was important to give birth in her house or that of one of her husband's cousins to avoid injury by a dab. She could ease a hard labor by drinking water that had been boiled with a key, having her family chant prayers over bowls of sacred water, or, if the problem stemmed came from having treated an elder without enough respect, by washing the relative's fingertips and apologizing profusely until forgiven.  

Lia's birth was very different. She was born in the Merced Community Medical Center in California's Central Valley, where the Lees have relocated, along with many other Hmong forced to leave their country after the communist takeover in 1975. Lia's placenta was incinerated, as doctors generally fear that allowing the Hmong to take the placenta home may result in its consumption by mothers or in the possible spread of hepatitis B, and in any case, nobody at the birth spoke English. Foua gave birth on a steel table, unaccompanied by family members, her amniotic sac artificially ruptured to speed the birth. Lia weighed 8 pounds 7 ounces and was a healthy child. She was taken to the central nursery to receive an injection of Vitamin K and two drops of silver nitrate solution in each eye, and to be bathed with soap.

While Lia's birthday was a known fact, her mother's was not. She often gave different dates when asked for her birthday, knowing only that it was in October, since her parents told her she was born in the season when the opium fields are weeded for the second time. Inventing birthdays is common among the Hmong and rarely questioned by officials, even when the dates are highly improbable, as when a cousin stated that each of his nine children were born on July 15. Foua's signature is likewise variable, as she has never learned to read or write.  

Foua found the birth experience peculiar, but she had few complaints. She was impressed by the number of people there to help her and was concerned only with the food. She was surprised to be offered ice water, since the Hmong believe cold foods after giving birth make the blood congeal in the womb, and that consumption of such foods will make a woman have itchy skin or diarrhea in old age. Foua accepted only what she calls "hot black water" from the hospital and otherwise ate the Hmong foods prepared for her by her husband, Nao Kao. The doctors were used to this diet, some noting its fragrant aroma and others complaining of its stink, the comments reflecting their general opinions of the Hmong.  

Although some Hmong in Merced have given their children American names, the Lees chose a Hmong name, Lia, for their daughter. They officially conferred the name in a soul-calling ceremony called a hu plig. In Laos, this ceremony took place on the third day after the baby's birth, and the baby isn't considered fully human until the ceremony occurs. In the United States, the hu plig often occurs later, as the baby might still be in the hospital after three days. The Hmong believe that the most common source of illness is soul loss, and that the life-souls of newborn babies are particularly susceptible to becoming separated from their bodies. Babies' souls may wander away, leave if a baby is sad or lonely, get frightened away, or be stolen by an evil spirit called a ‘dab’. The soul calling ceremony allows parents to utilize a number of ploys to keep their babies' souls safe, such as placing them in cloth carriers embroidered with soul-protecting motifs, giving them silver necklaces with soul-retaining locks, or calling souls of children on an outing to be sure none remain behind.  

It took the Lees about a month to save enough money from welfare checks to hold Lia's soul-calling party. The ceremony was very well attended. Nao Kao sacrificed a pig to invite the soul of one of Lia's ancestors to be reborn in her body. An elder chanted a greeting to Lia's soul at the apartment's open door, two live chickens in a bag next to him. The chickens were then killed, prepared, partially boiled, and examined to see if their skulls were translucent and their tongues curled upwards, signs that Lia's new soul was happy to reside in her body and that the name was a good one. The soul-caller brushed Lia's hands with short white strings to sweep away sickness, and Lia's parents and the elders each tied a string around one of Lia's wrists to bind her soul to her body.  

Chapter 2: Fish Soup  

The Hmong believe that nothing occurs in isolation, and that there are many things in this world that may not seem to be connected, but that actually are. A Hmong student once demonstrated this in class, when he stretched a 5-minute presentation on fish soup into a 45-minute talk on all aspects of the subject. In this vein, Fadiman begins her story of Lia Lee by recounting the history of the Hmong, staring a few hundred generations ago.  

For all of their recorded history, the Hmong have been persecuted and have responded either by fighting or fleeing. Most of these conflicts took place in China, to which their prehistoric ancestors were thought to have migrated from Eurasia. A French missionary named Savina suggested that they may have spent some time in Siberia, as some rituals contain references to such a place, but others argue that Savina's translations were incorrect or that the songs referred to the land of the dead. Due to his affection for the people, he may have been trying to make the Hmong seem more like him by giving them European origins.  

The Chinese were not so kind. The Chinese name for the Hmong is Miao or Meo, an insult that means something like barbarian. (The name "Hmong," on the other hand, has been variously translated as "free men" or, simply, "the people.") The Chinese were offended at the fact that the Hmong preferred to keep isolated and maintain their own customs rather than assimilating. The Hmong saw the Chinese as oppressive and engaged in numerous revolts. In one probably mythical story dated around 2700 BC, a Chinese emperor named Hoang-ti determined that the Hmong, due to their barbaric nature, would have a special criminal code, whereby instead of merely being imprisoned they would be either executed or have their ears, noses, or testicles cut off. The Hmong rebelled and the Chinese cracked down, leading to the Hmong's eventual retreat to higher elevations in the south.  

Around 400 AD, the Hmong established an independent kingdom in southern China. Kings were chosen from among a former king's sons in an election by all arms-bearing men in the kingdom; since kings had a large number of wives, the choice was almost democratic. This kingdom survived for 500 years before being crushed by the Chinese, at which point most Hmong migrated west and engaged in frequent, violent insurrections. In the sixteenth century, the Ming dynasty constructed the Hmong Wall, 100 miles long and 10 feet tall, manned by armed guards. They tried, too, to "pacify" the Hmong by telling them to give up their weapons, to wear Chinese clothing, to adopt Chinese hairstyles, and so on. The fiercely independent Hmong refused. In 1730, hundreds of Hmong men even killed their wives and children, thinking they would fight more fiercely with nothing to lose. (Their revolt was initially successful, but the men were all eventually killed or captured.)  

By the beginning of the nineteenth century, the Hmong had had enough of the Chinese. They faced additional problems of depleted soil, epidemics, and rising taxes. While the majority remained in China (numbering around five million there today), about half a million Hmong migrated by foot to the highlands of Vietnam, Laos, and later Thailand. They generally built their villages in places undesired by others, but if necessary, they fought with local tribes and usually succeeded. When the French took over Indochina in the 1890s and began extorting the population through taxation, the Hmong violently revolted. In 1920 the French in Laos acknowledged that the best way to deal with the Hmong was to leave them alone and granted them special administrative status, at which point they settled down to peacefully farm rice and opium in the mountains.  

This history reveals many characteristics about the Hmong: they don't like to take orders or to surrender; they are not easily intimated by greater numbers; they rarely believe the customs of other cultures to be superior; and they can get very angry. Those trying to control the Hmong have abhorred these traits, but many scholars and missionaries have developed a great fondness for them and respect for their courage, integrity, self-sufficiency, and resiliency. The Hmong may be symbolized by a recurring character in their folktales, the Orphan, who lives by himself on the margins of society, yet is in fact clever, courageous, talented, and superior to those who look down on him.


The first chapters introduce the Hmong: both the family who suffers the book's tragedy, and the people as a whole. We learn that the Hmong have very different birthing traditions; that they believe in evil spirits called ‘dabs’; and these spirits can steal that they believe a baby’s soul. We learn, too, that the Hmong are a fiercely independent people who have maintained their unique customs over thousands of years, despite living as a minority culture dominated by the Chinese and later the French. Beginning the book in this way highlights the importance of understanding the Hmong culture in order to comprehend the tragedy that befalls the Lee family.  

While Fadiman is a member of the majority white culture, she serves as an ambassador for the reader and has clearly spent a lot of time learning about the Hmong culture and worldview. Following the Hmong custom of viewing seemingly disparate events as interconnected, she explains the circumstances of the Lees’ daughter Lia through the history of the Hmong people. In so doing she implies that the story cannot be separated from this history, and that the western practice of analyzing events in isolation has insufficient explanatory power.  

If one views the story as a tragedy in the classical sense, we can see these chapters as establishing the Lees' hamartia, the fatal flaw which, through no fault of their own, will inevitably lead to the story's tragic outcome. This "flaw" is the flip side of a virtue, a vulnerability of someone whose character is admirable due to possession of that virtue. In this sense, a tragedy is not the outcome of mistakes that could and should have been avoided, but is rather the result of an irony of human nature - that the same trait which leads to right action in some circumstances can also lead to disaster. These chapters establish Foua and Nao Kao's unwillingness to compromise as a cultural trait that has enabled the Hmong to survive over hundreds of years of domination.  

While looking at culture in this way sets up an engaging narrative with an unstoppable tragic trajectory, it also establishes "Hmong culture" as an unchangeable entity and removes agency from individuals to create their own history. Part of the problem may be that Fadiman is drawing from historical sources written from a Chinese point of view, sources which reflect prejudices about other cultures. Although she acknowledges that the Chinese were negatively biased towards the Hmong, she uncritically reiterates Chinese sources claiming that the Hmong are resistant to change.  

One of the reasons the book has had such an influence in the medical field is that it is written in a way that makes commonly dry ethnographic material come to life. Fadiman draws the reader in by starting many chapters with a highly descriptive and fascinating anecdote: in the first chapter detailing what Lia's birth would have been like had she been born in Laos, and in the second chapter describing a Hmong student's oral presentation about fish soup. These stories engage the emotions so that we are somewhat invested in learning the historical facts that come next. Fadiman also helps us to understand the Hmong people through the use of metaphors. She quotes a professor who proclaimed that "fish soup… [is] the essence of the Hmong" (12), referring to the 45-minute presentation which, rather than sticking to the point, showed how one topic is related to many others. She also retells a Hmong folktale about the Orphan, whom she considers to be a symbol of the Hmong people, to add to our understanding of their character. The writing also comes to life through the use of quotes from primary sources.