Anne Fadiman’s 1997 book The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures won her literary prizes, national attention, particularly from the medical and social work communities, and many similar accolades. I read that the the book is required reading for first year medical students in many American medical schools, and I am convinced after reading the book, that it should be required reading for all doctors and medical students. It should also be required for spiritual “doctors”, missionaries and pastors, especially those who relate to refugee populations or who attempt to minster cross-culturally.

The book tells the story of a Hmong family from Laos and their difficulties with the medical system in Merced County, California, as it related to their epileptic daughter, Lia Lee. However, the story is much more than just a history of tragic misunderstandings across cultures. Ms. Fadiman also intersperses a great deal of the history and folklore of the Hmong people, and she explains some of the deep cultural differences between the Hmong and the Americans who welcomed them into this country. The story of Lia Lee and her family shows how those differences became insurmountable walls that led to Lia’s eventual “living death” of entering into a persistent vegetative state for the final twenty-six years of her life.

Hmong spiritual practices such as shamanism and ritual sacrifice clashed with modern medical practice. Hmong beliefs in patriarchy and demons causing sickness conflicted with doctors who believed that their authority and medical education entitled them to prescribe what treatment Lia should get. The doctors expected Lia’s parents to trust them and follow their directions. Lia’s parents expected the doctors to “fix Lia” and then leave them alone to care for her as they saw fit. Neither the doctors nor the parents were listening to the other, partly because of the language barrier, but even more because of a cultural barrier that made them disrespect and distrust one another. As a result of miscommunication and stubbornness on both sides, Lia became “quadriplegic, spastic, incontinent, and incapable of purposeful movement. Her condition was termed a persistent vegetative state.’

My thoughts about this story tended toward the spiritual, even though the very few brief mentions of Christians or Christianity in the book are uniformly disparaging. How would I talk about Jesus or share His love with a Hmong neighbor? To begin to communicate the love of Christ to a person of a very different background and culture would take what Eugene Peterson called “long obedience in the same direction.” (The phrase actually comes from Nietzsche, of all people.) I would have to put myself and my own feelings aside and live my life before God as a loving and patient and understanding neighbor, always being ready to give a reason for the hope within me. In fact, that’s what we are going to have to do more and more as our culture moves away from a Christian consensus such that there’s a deep cultural chasm between Christians and almost anyone else that we try to love and evangelize. We have to be patient and kind and persistent and faithful.

And we have to be willing to fail, and leave the ending to God and His mercy.

Lia Lee 1982-2012
Lia Lee died on August 31, 2012. She was thirty years old and had been in a vegetative state since the age of four. Until the day of her death, her family cared for her lovingly at home.