The Spirit Catches You and You Fall Down - Book Analysis Essay

Introduction

The Spirit Catches You and You Fall Down by Anne Fadiman is a true account of a Hmong toddler named Lia Lee and her immigrant family's experiences within the American healthcare system. Lia suffered epilepsy, resulting to seizures. In the Hmong culture, epilepsy is referred to as qaug dab peg, which is translated as "the spirit catches you, and you fall down." Among the Hmong, seizures are believed to happen when a spirit captures a person's soul. The book offers an empirical perspective on how health and illness are experienced differently among people based on their culture. The model of doctor-patient relationship capable of generating an environment of trust allows interaction in a context that respects the autonomy of the patient or their guardians and their right to decide freely and informally within the framework of their own culture.

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Multiculturalism and Relevance of Cultural Competence in Medicine

The Spirit Catches You and You Fall Down raises tough questions about Western medicine, immigration, American government, and the law particular in whose responsibility it is to educate the doctors about the Hmong culture, their rituals, and religious beliefs; the Merced doctors or the Lee family. It raises concern on whether doctors should follow the spiritual wishes of the parents when a child is not of age to decide his or her own religious beliefs or whether child protective services should be called if parents don't understand how to administer drugs to their kids. While contemporary society believes in the power of the government and the good in American culture and the laws they have, Lia's heartbreaking story excites the inquest as to why laws have such strict conditions and give no leeway for interpretation or scenario-based judgment. The fact that this is a true story adds to the overall drama and heartbreak.

Lia spent her whole life at home, assiduously being cared for by her family. According to the author, Ms. Fadiman, this devotion is what kept her alive for so long. In medicine, the vegetative state describes a person who is awake, but who is not aware of what is happening around him. Patients can open their eyes and have sleep and wake cycles. However, it is unable to respond to any instructions. These patients spontaneously maintain vital signs and functions, the sleep-wake rhythm, and lack voluntary activity. The patients can be assisted at the primary level of health. The family doctor, as a specialist in Comprehensive General Medicine, the psychologist, the nurse, and all the members of the primary group are prepared for the comprehensive rehabilitation of patients basing the treatment is based on two essential pillars: treating the underlying disease and offering general care.

The book also raises concerns over the influence of collaborative care, especially the role of the family in treating chronic disorders. In recent decades, the need has been seen to work in a collaborative intervention modality with the system of relationships between professionals, patients and families in the treatment of chronic diseases. In the case of severe mental disorder, this becomes especially relevant, given the clinical evolution of these patients, often accompanied by progressive deterioration. Lia's family was part of general care at home.

For professionals, family adherence is an important concept, since the role that the family plays in ensuring compliance with treatment is central and, therefore, must have active participation in the therapeutic process. This participation should include a job in the family itself for its adjustment and adaptation to severe disorders because the whole family experiences mental illness. The attention to patients with these health problems can be ineffective since it is an arduous chronic process, which implies the abandonment of relationships and social activities. The social support and the relationship with health service professionals are vital, both for the patient and for their family. The Spirit catches you, and you fall demonstrated that knowing how to establish good communication is essential in improving these relationships, and helps in ensuring that the care offered is of quality. Besides the cultural chasm between Lia's family and the western doctors, the Lees gave up control of their child to a system that they did not quite understand.

The book also raises a concern about the importance of multicultural awareness in the provision of treatment to culturally diverse communities. When Lia experiences her first seizure at just 3-months old, the resident nurse at Merced Community Medical Center misdiagnosed her condition. Since the Lees could not speak English and lack of Hmong interpreter in the hospital, it was impossible to communicate. Given the persistent situation of vulnerability of Indigenous Peoples, the book addresses the scope of the right to health in multicultural contexts. It outlines the difficulties that arise in the development of public policies intended to satisfy the demand of this reality in the provision of health services by the state.

The intercultural approach postulates a more conducive model for the development of a process of cultural interaction with an emphasis on dialogue, respect, mutual knowledge, and coexistence. From the anthropological perspective, "culture" can be understood as a complex and dynamic set of beliefs, knowledge, values , and behaviors learned and transmitted between people through language and their life in society. Culture is understood as a dynamic entity that is acquired, transformed and reproduced through a complex learning and socialization process in which two dimensions converge: an ideational or cognitive that synthesizes the symbolic world of people (their thoughts, knowledge and acquired beliefs); along with another material aspect, which corresponds to how the symbolic manifests itself in behaviors, practices, cultural artifacts and norms of social relationship between people.

In the field of health, and accepting that medicines are cultural constructions that respond to the needs of a specific social environment, it is possible to affirm that both dimensions of culture are capable of generating "medical models", consisting of how patients and professionals understand the phenomenon of health and illness and the practices or procedures faced by the processes of recovery and maintenance of health. Lia's parents chose to work with a shaman to "call back her soul," including seeking treatment at a hospital near their home in Merced, California. The doctors had difficulty communicating with Lia's parents due to the language barrier and a lack of translators. A profound cross-cultural misunderstanding between the Lia's family and her American doctors existed: while her parents already diagnosed her problem as an illness where the Spirit catches you, and you fall, the doctors diagnosed it as epilepsy, which is a common neurological disorder.

As the book demonstrates, the phenomenon of health is closely related to that of culture and implies more than just preventing or curing the disease. On the contrary, it comprises a "global state of the person," which has an impact on culture, while the culture itself determines its structural elements. It is, therefore, a dynamic process of creation and recreation, which occurs within the culture itself and is expressed as a specific cultural phenomenon, capable of being configured as an identity element of a particular human group.

The book advocates for the consideration of the cultural determinants of health as one of the elements of developing equity in health for indigenous peoples, through the collective construction of a health model with an intercultural approach, which aims to incorporate the culture of the user in the health care process. Pretending to avoid the ethnic and cultural identity of the user constitutes a barrier in the access and opportunity to better attention in health. There is a concern about the operation of this policy, as it is manifested through public policy plans and programs, on whether this application accounts for the intercultural approach that is reflected in its objectives or whether its use has the limited scope of the multicultural approach. The idea is to identify which of these perspectives allows for the adequate protection of the right to health in multicultural contexts.

The experience of Lia's care presents the intercultural approach as more appropriate since, in the multicultural perspective, agents are limited to accepting cultural differences in a disaggregated manner, without integration processes being experienced. In other words, people interact within the margins of their culture, limiting themselves to accepting the cultural difference present in the other. On the other hand, the intercultural approach implies an integration product of a cultural exchange in which the participants learn from each other through an "intercultural dialogue", which means a change in the traditional paradigm of the doctor-patient relationship that the predominant western culture has developed based on the elements of asymmetry and verticality among the participants.

Conclusion

The Spirit Catches You and You Fall Down is a touching story that draws attention to the significance of cultural competence in the provision of health care. The intercultural approach postulates a more conducive model for the development of a process of cultural interaction with an emphasis on dialogue, respect, mutual knowledge, and coexistence. We are in a country where migrations are rooted in the very root of our history. It is a phenomenon that, over time, acquires new forms but in no way loses its volume. The problem that arises in a multicultural society, such as the American one, when it comes to performing health care, is a particular area of work related to how the patient is treated with cultural or linguistic barriers that can be found. Along with the elimination of cultural or linguistic obstacles, the conditions under which immigrants access the health system must be taken into account. Healthcare professionals must acknowledge and respect people's cultural beliefs as a central aspect of treatment. Because of the book, cultural competence is currently embedded in many areas of multicultural professional practice and medical schools.

References

Fadiman, A. (2012). The spirit catches you and you fall down: A Hmong child, her American doctors, and the collision of two cultures. Macmillan.