The book, the Spirit Catches You and You Fall Down by Anne Fadiman is anobjective look into the world of two different cultures and their beliefsystems. The viewpoints of the Hmong and of the American doctors represent Hmongculture and the root of Western medicine. The book takes into account how twocultures, rather, two completely opposite worlds are collided and theirimpact on each other (Fadiman 1997). The book uncovers the underlying meaning ofhow different Western medicine can be from different cultures and its challengesand consequences. In addition, Fadiman questions the very basics of philosophyby taking into account the simple metaphysics and moral ethics that face Liasdoctors and parents and what role society plays.
The book questions the beliefsystem of Western medicine as well as the Hmong beliefs and cultural practices. Fadiman encourages us to think of the root of Western culture and medicine aswell as learning about the Hmongs beliefs. Which is more relevant? When apatient is in a life or death situation, whose opinion and expertise on medicineholds higher ground? In the case of Lia Lee, this was the problem. Why was Hmongculture and practice irrelevant in the eyes of the many doctors and nurses thatcared for Lia? Reading this book, it is obvious to see the philosophy of westernmedicine versus the Hmong culture.
This book helps clearly define westernculture and its biomedical system by contrasting it to the Hmongs. The book,more than anything, else analyzes the epistemological, metaphysical, and moralviewpoints of both western medicine and that of the Hmong culture and questionstheir validity and effectiveness. Epistemology is the theory of knowledge(Tauber). In this book, the theory of knowledge can be posed by one question.
How did Leaget sick? This question leads to two different viewpoints Western medicineand culture and the Hmong. The root of Western medicine is biomedicine. Whatmakes biomedicine unique and sets it apart from other cultures is the idea thatthere is only one answer and one truth behind that. Simply stated, it is amatter of facts and the question of what, not how(Tauber).
This is the primarydifference between Hmong culture and Western medicine. In the book, Liasdoctors wanted to know the one problem that was causing Lia to have severeseizures. They neglected to ask how Lia got sick. The view of Lias parentswas the complete opposite. They wanted to know how Lia got sick and if thismeant Lia was blessed with a gift and would become a txiv neeb(Fadiman). To understand the epistemological perspective of the Hmong, we must first takeinto account their cultural identity and how they practiced it.
The Hmong wereadamant in their belief system and were wary of the doctors in Merced in therecare of Lia. Under their care, they believed; Lia would have been healed. TheHmong cultures to cure an illness, in Lias case the quag dab peg, there wereanimal sacrifices made. Lias parents say that Lias soul had left her whenher sister had unintentionally slammed the door. This rationalization that thedoor frightened Lia and was the cause of the series of medical problems shewould face, is an example of the epistemological view of Lias parents. It wasinteresting to read in the book, as Faddiman recounts, the way the doctorstreated Lias parents.
Because of the cultural barrier, communication problemspertained to everything from signing a document to administration of medicationfor Lia. Because of the cultural barrier, there were problems of moral ethics aswell. Did the doctors ever take into account the parents wishes for their child?Lias parents believed that the only medication they were willing to give Liawould be the kind that would be fast and preferably in a pill. The Hmong cultureis against shots and blood being taken in large quantities as well as anythingthat could affect the dab and cause evil spirits to enter her soul(Fadiman). Epistemologically speaking, the doctors had a completely different viewpoint ofwhat happened to Lia than her parents. From the doctors point of view, theirmain concern was not primarily how Lia got sick but rather where the existenceof the illness came from.
There main goal as Lias doctors was to stop theseizures that were taking control of Lias body and to do that they needed toknow where the problem was located. Was the uncontrollable epilepsy caused by aneurological deficit in Lias brain? On the other hand, was there somethingmicroscopic that the doctors could not see that caused Lia to have a uniquedisease that had nothing to do with normal standard epileptic patients? This iswhere the Hmong perspective and the view of Western medicine take differentpaths. One could question if they were ever on the same path to begin with. Thedoctors questioned where the illness came from while the Lias parents askedhow. Epistemology is derived from the Greek episteme, meaning”knowledge,” and logos, which has several meanings, including “theory. (www.
comptons. com). Whereas metaphysics is concerned with the underlying nature of reality,epistemology deals with the possibilities and limits of human knowledge. Ittries to arrive at a knowledge of knowledge itself(www. md. com).
It is also aspeculative branch of philosophy and tries to answer such questions as: Is theworld as people perceive it the basic reality, or do people perceive onlyappearances (or phenomena) that conceal basic reality? What are the boundariesbetween reason and knowledge, on the one hand, and what some thinkers call theillusions deriving from metaphysics? What is the basis for knowledge? Is itobservation, experience, intuition, or inspiration? On the other hand, is theresome other basis?(www. comptons. com) In Lias case, the basis for knowledgestemmed from two completely different cultures. The belief and basis forknowledge that the Hmong had believed for years centered on the sprit and thedab.
Western medicine was far more narrow and straightforward dismissing anyidea that the practices and rituals of the Hmong would be of any help. Knowledgemay be regarded as having two parts. There is, first, what one sees, hearstouches, tastes, and smells. Next there is the way these perceptions areorganized by the mind to form ideas or concepts. The problem of epistemology isbased on how philosophers have understood the relationship of the mind to therest of reality(Tauber).
The Hmong believed in animal sacrifice and treating thebody with herbs and liquids rather than injecting the patient with needles anddrawing blood. This process harms the individual according to the Hmong, anddamages it so the soul will have a harder time coming back. One of the primaryconcerns with the treatment of Lia was the medication she was on. Since doctorsdid not know for certain what Lia had and what was causing her seizures,numerous combinations and doses of medicine were given. From the doctorsperspective it was all they could do at the time(Fadiman 97)).
Lias parentsbelieved that the administration of so many drugs was the problem. In addition,the cultural barrier led to frustration and anger when medication was not givenproperly and when Lias parents decided against western medicine. Since theVietnam War ended in 1975, approximately 150,000 Vietnamese refugees have beguntheir lives in the United States in Westminster, Calif. , and a community southof Los Angeles in Orange County(Fadiman 97). Similarly, ethnic communities ofLaotians and Cambodians sprang up in such states as Texas, Louisiana, Illinois,Washington, Oregon, Virginia, Minnesota, Florida, and Pennsylvania.
Californiahad the largest concentration of all Indo-Chinese groups, except for theIndo-Chinese Hmong, formerly a mountain-dwelling people of Vietnam and Laos,whose largest community was in Minnesota(www. comptons. com). Each group had itsown language and culture and preferred to live isolated from the others.
Therefugee problem in Southeast Asia had been escalating ever since large-scalebombing attacks were launched on North Vietnam in the mid-1960s. By the end ofthe conflict thousands were homeless and thousands more sought refuge from thevictorious Communists. American military forces evacuated many of the Vietnamese(among who were large numbers of ethnic Chinese). As repression and genocidefollowed the Communist takeover, still more refugees fled.
Among them were vastnumbers of boat people, who used any sea vessel at their disposal to escapeIndochina. Many were first sheltered in refugee camps throughout Southeast Asiabefore reaching the United States(www. comptons. com).
While these immigrants wereallowed into the United States under various refugee laws, the government soughtthe help of volunteer agencies to find American sponsors and to arrange for jobsand housing. The immigrants were then sent to various parts of the country tobegin new lives. The government’s purpose in this program was to scatter themand thus prevent the growth of ethnic colonies such as the one that developed inWestminster(www. comptons. com). The plan failed quickly.
Not long after theiroriginal settlement, the refugee families, driven by loneliness, began torelocate to ethnic communities. Thus, the present settlement of the Indo-Chineserefugees developed from this second migration. These resettled immigrants foundlife difficult. While most of the first Indo-Chinese refugees had beenwell-educated city dwellers, the later arrivals came from rural backgrounds andhad limited, if any, schooling. (The Hmong, for example, were subsistencepeasants without a written language. ) They did not speak English, and their fewskills were useless in an urban, industrialized society.
Many suffered fromphysical and psychological traumas that they had experienced before fleeingIndochina(Fadiman 97). Desperate for money and humiliated by their oppressedsituation, a few turned to criminal activities, but most worked hard to becomeless dependent upon public aid. Members of large families usually helped oneanother with living expenses and education costs. The origin of Hmong, I felt,was an important component in understanding where the Hmong came from and why,in America, they secluded to themselves far more than any other race. Fadimangoes into detail about the history of the Hmong and their culture struggle tokeep their identity.
What I found interesting was that even in America where theHmong attained their freedom, they were still unhappy. The cultural barrier wasnever broken partially because the Hmong did not want to assimilate and losethemselves. Consequently, they often secluded themselves and did not botherlearning English and finding jobs. What they wanted most of all was a piece ofland where they could grow food and livestock to survive and practice theirbeliefs.
Ironically, they fled their country to be free and came to America,only to feel the opposite. In Lias case, there was an underlying question toLias sickness. The main question was why did Lia get sick? The doctorsquestioned the existence of Lias sickness while her parents questioned whythere ever was an illness. Lias doctors looked to rationalism and logic whileher parents took this as a sign to mean that her symptoms made her special. Theysaid that Lias condition was because she possessed a special trait that thetxiv neeb also possessed.
Her parents thought she was blessed in a way. Metaphysics is a word coined almost accidentally. It is the title given to abook written by Aristotle after he had completed his ‘Physics’, and it wasplaced immediately afterward in the body of his writings(www. askjeeves.
com). Whereas ‘Physics’ deals with the observable world and its laws, ‘Metaphysics’ isconcerned with the principles, structures, and meanings that underlie allobservable reality. It is the investigation, by means of pure speculation, ofthe nature of being–of the cause, substance, and purpose of everything. Metaphysics asks: What are space and time? What is a thing and how does itdiffer from an idea? Are humans free to decide their fate? Is there a firstcause, or God, that has made everything and put it in motion?(www. comptons.
com)The view of Western beliefs and ideology are reinforced in the book that thedoctors of Merced knew more about Lias sickness and medicine in general basedon their knowledge of Western medicine. The doctors of Merced felt that themedicine they practiced held a higher ground, in their eyes, and most believedthat the Hmongs ritual practices of animalism and sacrifice were a waste oftime. Because observation, experience, or experiment cannot arrive at theanswers to such questions, they must be products of the reasoning mind(Tauber). Such matters are very close, in fact, to the province of religion and in Asia,the answers to these questions are normally put in a strictly religiousframework. In much 20th-century Western philosophy, metaphysics has beendismissed as pointless speculation that can never achieve positiveresults(Tauber). Nevertheless, metaphysics has many defenders who still explorenotions put forward by Plato and Aristotle(www.
comptons. com). For the averageperson, common sense says that there is a real world of perceivable objects. These objects can be analyzed and understood with a high degree of accuracy.
Philosophers have not been able to let the matter rest there. In the case ofLias health, her parents felt that less medication, and less hospitalizationwould make Lia better. They felt that their touch and healing power alone couldcure their beloved child. The doctors felt otherwise and based this on theassumption that they were right and that Western medicine was the only accurateand trustworthy method to treat a patient.
In Western culture, being sick istechnical not moral (Tauber). The underlying question was how much of theillness was technical and how much of it was part of the social commune (Tauber). Finally, the question that both the doctors at Merced as well as Lias parentsask themselves is if the problem could have been avoided. This leads us toquestion both their value systems.
The main concern for Lia was her health andthe doctors of Merced made sure that they did everything they could despiteirreconcilable differences regarding Lias medication with her parents as wellas the notion that Lia would be better if she stayed at home without thetreatment of doctors. While reading the book, Faddiman questions whether thechoice to put Lia in a foster home was a moral one. Would she have been betteroff in the care of her parents whom neglected to give her the numerouscombinations of drugs because they believed it would harm her? This brings inthe role of ethics and moral, and what they mean in Western culture. Anothername for ethics is morality.
One word is derived from the Greek ethos, meaning”character,” and the other from the Latin mores, meaningcustom. (www. compton. com)” Because both words suggest customary ways ofbehavior, they are somewhat misleading.
The Greek philosopher Aristotle had abetter term–practical wisdom. It was called practical because it was concernedwith action, both on the part of the individual and on the part of society. Ithad to do with what should or should not be done(www. askjeeves. com). Aristotledivided practical wisdom into two parts: moral philosophy and politicalphilosophy.
He defined them together as a “true and reasoned state ofcapacity to act with regard to the things that are good or bad forman. (www. comptons. com) The field of ethics has several subdivisions. Descriptive ethics, as its name suggests, examines and evaluates ethicalbehavior of different peoples or social groups.
Normative, orprescriptive, ethics is concerned with examining and applying the judgmentsof what is morally right or wrong, good or bad(Blais 93). It examines thequestion of whether there are standards for ethical conduct and, if so, whatthose standards are. Comparative ethics is the study of differing ethicalsystems to learn their similarities and contrasts(Blais 93). In moderndeveloped societies, the systems of law and public justice are closely relatedto ethics in that they determine and enforce definite rights and duties. Theyalso attempt to repress and punish deviations from these standards.
Mostsocieties have set standards, whether by custom or by law, to enable those in asociety to live together without undo disruption(ww. comptons. com). It ispossible for law to be neutral in moral issues, or it can be used to enforcemorality. The prologue to the United States Constitution says that insuringdomestic tranquility is an object of government.
This statement is morallyneutral. Such laws as those passed to enforce civil rights, however, promote amoral as well as legal commitment(Blais 93). So much human activity is simply amatter of custom or habit that little thought may be given to many actions. Whenan individual in Western society gets up in the morning, it is normal to getdressed and to put on shoes before going out. However, in doing so, one does notusually bother thinking This is a good and necessary thing that Imdoing. There is a great deal of behavior, however, in which people areconscious of why they act in a certain way.
They are confronted with the need tomake choices. At the basis of choice two questions arise: “What good do Iseek?” and “What is my obligation in this circumstance?(Blais93)” Ethics is primarily concerned with attempting to define what is goodfor the individual and for society(Tauber). It also tries to establish thenature of obligations, or duties, that people owe themselves and each other. Philosophers have said for thousands of years that people do not willingly dowhat is bad for themselves but may do what is bad for others if it appears thatgood for themselves will result.
It has always been difficult to define what isgood and how one should act to achieve it(www. askjeeves. com). Some teachers havesaid that pleasure is the greatest good.
Others have pointed to knowledge,personal virtue, or service to one’s fellow human being. Individuals, and wholesocieties, have performed outrageous criminal acts on people, and they havefound ways to justify doing so based on some greater “good. (Blais 93)”The difficulty in deciding what good and obligation are has led moralphilosophers to divide into two camps. One camp says that there are no definite,objective standards that apply to everyone(Blais 93).
People must decide whattheir duties are in each new situation. Others have said that there arestandards that apply to everyone, that what is good can generally be known. Ifthe good is known, the obligation to pursue it becomes clear. The position thatinsists there are ethical standards is called ethical absolutism, and theone that insists there are no such norms is called ethical relativity(Blais 93). One of the clearest and most useful statements of ethical absolutism came fromAristotle in his ‘Nichomachean Ethics (Blais 93)’.
He realized that what peopledesire they regard as good. Nevertheless, to say no more than this means thatall desires are good no matter how much that they conflict with one another. Consequently, there can be no standards at all. Aristotle solved this problem bydelineating between two types of desire–natural and acquired(www. comptons.
com). Natural desires are those needs that are common to all human beings such as foodand shelter. Beyond these, people also have a desire for health, knowledge, anda measure of prosperity. By being natural, these desire, or needs, are good foreveryone.
Since there can be no wrong basic needs, there can be no wrong desirefor these needs(www. comptons. com). However, there are other desires as well. These are not needs but wants.
It is at the level of wants that the nature ofgood becomes clouded. Individuals may want something they desire as a good, butit may be bad for them. People with sound judgment should be able to decide whatis good for them, in contrast to what is only an apparent good(Blais 93). Thissound judgment comes with experience. Young children have little experience ofwhat is good or bad for them, so they must be guided by parents and otheradults.
Mature adults, however, should be able to decide what is good for them,though history demonstrates that this is not always the case. People must decidewhat is good for others as well as for themselves(Fadiman 97). That is, theyexpect that goods for them apply equally to other people. To be able to treatothers in the same way one treats oneself, Aristotle said it is necessary tohave the three virtues of practical wisdom: temperance, courage, andjustice(www.
comptons. com). Relativists do not believe that there areself-evident moral principles that are true for everyone. They say that people’smoral judgments are determined by the customs and traditions of the society inwhich they live(Blais 93). This is a clear example of why the Hmongs viewsdiffered from Western culture.
These may have been handed down for centuries,but their age does not mean they are true standards. They are simply norms thata certain society has developed for itself. What is right is what society saysis right, and whatever is considered good for society must be right. If thiswere the case, did Lias doctors do everything they could? Were they cloudedby the mentality that Western medicines was superior to the Hmong culture anddisregard the practices that Lias parents strongly believed would save theirchild? If the doctors had taken a different approach from the beginning andhired interpreters and had not been one-sided in their beliefs, would Liasfate be changed? As with life, all choices involve risk. There are no principlesor standards that are right for all people at all time. New situations demandnew approaches.
What was once valid may be inappropriate now. In the world ofthe 20th century–with its rapid changes, endless wars, and moral upheaval–theideas of existentialism have seemed correct to many people in theworld(www. comptons . com). Some existentialists base their position onreligion(Blais 93). Even here they say it is impossible to fall back on morallaws or principles in making decisions.
Choices must be made on faith, often inconflict with traditional moral guidelines. Individuals trust that what they aredoing is right, but they can be entirely wrong. They commit themselves to theunknown, and the decision can often be an agonizing problem. The Hmongsbeliefs were based on their faith in the healing power of their medicine.
BeforeLia became severely ill, Hmong did not entirely dismiss Western medicine. Theydid, however, believe that a combination of the two would be more effective thanjust Western medicine. Students of comparative ethics have found that mostsocieties–from the ancient to the modern period–share certain features intheir ethical codes(Blais 93). Some of these have applied only within a society,while others have been universal.
Most societies have had customs or lawsforbidding murder, bodily injury, or attacks on personal honor and reputation. Societies rely on rules that define elementary duties of doing good andfurthering the welfare of the group. In societies where the majorreligions–Judaism, Christianity, Islam, and Buddhism–are predominant, the dutyof helping the needy and the distressed has been implanted(www. comptons.
com). These obligations extend beyond family to acquaintances and even strangers. Telling the truth and keeping promises are also widely regarded as duties. WhenLia was taken away to a temporary foster home, the doctors promised Liasparents that she would return to them in six months.
When their promise fellthrough and Lia was not returned as promised, Lias parents began todisbelieve the system, which was intended to protect the individual. The UnitedStates represents a series of ideals. For most of those who have come to itsshores, it means the ideal of freedom–the right to worship as one chooses, toseek a job appropriate to one’s skills and interests, to be judged equallybefore the law. It means the ideal of the frontier, of overcoming obstacles–taming the West, curing diseases, voyaging to the planets(Fadiman). It means theideal of progress–that personal life and political, social, and economicinstitutions will improve through hard work, fair play, and honest endeavor. Itmeans the ideal of democracy–the right to be heard as an individual, the rightto cast a ballot in a free election, the right to dream of a better life and towork toward one’s goals(Fadiman).
The Hmong did not have this voice, nor felttheir opinions mattered in the case of Lias health. In America they felt likeforeigners, in their homeland they felt the same. The fate of Lia Lee may havebeen different if not for ignorance, superiority in Western medicine, and acultural barrier that still continues today. Bibliographywww.
md. health www. comptons. com Blais, Debbie.
The ethics of specialization. Unpublished paper. University of Alberta (1993). Fadiman, Anne. The SpiritCatches You and You Fall Down.
Noonday Press. Canada, (1997).Philosophy
