The book, the Spirit Catches You and You Fall Down by Anne Fadiman is an
objective look into the world of two different cultures and their belief
systems. The viewpoints of the Hmong and of the American doctors represent Hmong
culture and the root of Western medicine. The book takes into account how two
cultures, rather, two completely opposite worlds are “collided” and their
impact on each other (Fadiman 1997). The book uncovers the underlying meaning of
how different Western medicine can be from different cultures and its challenges
and consequences. In addition, Fadiman questions the very basics of philosophy
by taking into account the simple metaphysics and moral ethics that face Lia’s
doctors and parents and what role society plays. The book questions the belief
system 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 as
well as learning about the Hmong’s beliefs. Which is more relevant? When a
patient is in a life or death situation, whose opinion and expertise on medicine
holds higher ground? In the case of Lia Lee, this was the problem. Why was Hmong
culture and practice irrelevant in the eyes of the many doctors and nurses that
cared for Lia? Reading this book, it is obvious to see the philosophy of western
medicine versus the Hmong culture. This book helps clearly define western
culture and its biomedical system by contrasting it to the Hmong’s. The book,
more than anything, else analyzes the epistemological, metaphysical, and moral
viewpoints of both western medicine and that of the Hmong culture and questions
their 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 Lea
get sick? This question leads to two different viewpoints – Western medicine
and culture and the Hmong. The root of Western medicine is biomedicine. What
makes biomedicine unique and sets it apart from other cultures is the idea that
there is only one answer and one truth behind that. Simply stated, it is a
matter of facts and the question of what, not how(Tauber). This is the primary
difference between Hmong culture and Western medicine. In the book, Lia’s
doctors wanted to know the one problem that was causing Lia to have severe
seizures. They neglected to ask how Lia got sick. The view of Lia’s parents
was the complete opposite. They wanted to know how Lia got sick and if this
meant Lia was blessed with a gift and would become a “txiv neeb(Fadiman).”
To understand the epistemological perspective of the Hmong, we must first take
into account their cultural identity and how they practiced it. The Hmong were
adamant in their belief system and were wary of the doctors in Merced in there
care of Lia. Under their care, they believed; Lia would have been healed. The
Hmong cultures to cure an illness, in Lia’s case the quag dab peg, there were
animal sacrifices made. Lia’s parents say that Lia’s soul had left her when
her sister had unintentionally slammed the door. This rationalization that the
door frightened Lia and was the cause of the series of medical problems she
would face, is an example of the epistemological view of Lia’s parents. It was
interesting to read in the book, as Faddiman recounts, the way the doctors
treated Lia’s parents. Because of the cultural barrier, communication problems
pertained to everything from signing a document to administration of medication
for Lia. Because of the cultural barrier, there were problems of moral ethics as
well. Did the doctors ever take into account the parents wishes for their child?
Lia’s parents believed that the only medication they were willing to give Lia
would be the kind that would be fast and preferably in a pill. The Hmong culture
is against shots and blood being taken in large quantities as well as anything
that could affect the dab and cause evil spirits to enter her soul(Fadiman).
Epistemologically speaking, the doctors had a completely different viewpoint of
what happened to Lia than her parents. From the doctor’s point of view, their
main concern was not primarily how Lia got sick but rather where the existence
of the illness came from. There main goal as Lia’s doctors was to stop the
seizures that were taking control of Lia’s body and to do that they needed to
know where the problem was located. Was the uncontrollable epilepsy caused by a
neurological deficit in Lia’s brain? On the other hand, was there something
microscopic that the doctors could not see that caused Lia to have a unique
disease that had nothing to do with normal standard epileptic patients? This is
where the Hmong perspective and the view of Western medicine take different
paths. One could question if they were ever on the same path to begin with. The
doctors questioned where the illness came from while the Lia’s parents asked
how. 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. It
tries to arrive at a knowledge of knowledge itself(www.md.com). It is also a
speculative branch of philosophy and tries to answer such questions as: Is the
world as people perceive it the basic reality, or do people perceive only
appearances (or phenomena) that conceal basic reality? What are the boundaries
between reason and knowledge, on the one hand, and what some thinkers call the
illusions deriving from metaphysics? What is the basis for knowledge? Is it
observation, experience, intuition, or inspiration? On the other hand, is there
some other basis?(www.comptons.com) In Lia’s case, the basis for knowledge
stemmed from two completely different cultures. The belief and basis for
knowledge that the Hmong had believed for years centered on the sprit and the
dab. Western medicine was far more narrow and straightforward dismissing any
idea that the practices and rituals of the Hmong would be of any help. Knowledge
may be regarded as having two parts. There is, first, what one sees, hears
touches, tastes, and smells. Next there is the way these perceptions are
organized by the mind to form ideas or concepts. The problem of epistemology is
based on how philosophers have understood the relationship of the mind to the
rest of reality(Tauber). The Hmong believed in animal sacrifice and treating the
body with herbs and liquids rather than injecting the patient with needles and
drawing blood. This process harms the individual according to the Hmong, and
damages it so the soul will have a harder time coming back. One of the primary
concerns with the treatment of Lia was the medication she was on. Since doctors
did not know for certain what Lia had and what was causing her seizures,
numerous combinations and doses of medicine were given. From the doctors
perspective it was all they could do at the time(Fadiman 97)). Lia’s parents
believed that the administration of so many drugs was the problem. In addition,
the cultural barrier led to frustration and anger when medication was not given
properly and when Lia’s parents decided against western medicine. Since the
Vietnam War ended in 1975, approximately 150,000 Vietnamese refugees have begun
their lives in the United States in Westminster, Calif., and a community south
of Los Angeles in Orange County(Fadiman 97). Similarly, ethnic communities of
Laotians and Cambodians sprang up in such states as Texas, Louisiana, Illinois,
Washington, Oregon, Virginia, Minnesota, Florida, and Pennsylvania. California
had the largest concentration of all Indo-Chinese groups, except for the
Indo-Chinese Hmong, formerly a mountain-dwelling people of Vietnam and Laos,
whose largest community was in Minnesota(www.comptons.com). Each group had its
own language and culture and preferred to live isolated from the others. The
refugee problem in Southeast Asia had been escalating ever since large-scale
bombing attacks were launched on North Vietnam in the mid-1960s. By the end of
the conflict thousands were homeless and thousands more sought refuge from the
victorious Communists. American military forces evacuated many of the Vietnamese
(among who were large numbers of ethnic Chinese). As repression and genocide
followed the Communist takeover, still more refugees fled. Among them were vast
numbers of boat people, who used any sea vessel at their disposal to escape
Indochina. Many were first sheltered in refugee camps throughout Southeast Asia
before reaching the United States(www.comptons.com). While these immigrants were
allowed into the United States under various refugee laws, the government sought
the help of volunteer agencies to find American sponsors and to arrange for jobs
and housing. The immigrants were then sent to various parts of the country to
begin new lives. The government's purpose in this program was to scatter them
and thus prevent the growth of ethnic colonies such as the one that developed in
Westminster(www.comptons.com). The plan failed quickly. Not long after their
original settlement, the refugee families, driven by loneliness, began to
relocate to ethnic communities. Thus, the present settlement of the Indo-Chinese
refugees developed from this second migration. These resettled immigrants found
life difficult. While most of the first Indo-Chinese refugees had been
well-educated city dwellers, the later arrivals came from rural backgrounds and
had limited, if any, schooling. (The Hmong, for example, were subsistence
peasants without a written language.) They did not speak English, and their few
skills were useless in an urban, industrialized society. Many suffered from
physical and psychological traumas that they had experienced before fleeing
Indochina(Fadiman 97). Desperate for money and humiliated by their oppressed
situation, a few turned to criminal activities, but most worked hard to become
less dependent upon public aid. Members of large families usually helped one
another 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. Fadiman
goes into detail about the history of the Hmong and their culture struggle to
keep their identity. What I found interesting was that even in America where the
Hmong attained their freedom, they were still unhappy. The cultural barrier was
never broken partially because the Hmong did not want to assimilate and lose
themselves. Consequently, they often secluded themselves and did not bother
learning English and finding jobs. What they wanted most of all was a piece of
land where they could grow food and livestock to survive and practice their
beliefs. Ironically, they fled their country to be free and came to America,
only to feel the opposite. In Lia’s case, there was an underlying question to
Lia’s sickness. The main question was why did Lia get sick? The doctors
questioned the existence of Lia’s sickness while her parents questioned why
there ever was an illness. Lia’s doctors looked to rationalism and logic while
her parents took this as a sign to mean that her symptoms made her special. They
said that Lia’s condition was because she possessed a special trait that the
txiv 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 a
book written by Aristotle after he had completed his 'Physics', and it was
placed immediately afterward in the body of his writings(www.askjeeves.com).
Whereas 'Physics' deals with the observable world and its laws, 'Metaphysics' is
concerned with the principles, structures, and meanings that underlie all
observable reality. It is the investigation, by means of pure speculation, of
the 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 it
differ from an idea? Are humans free to decide their fate? Is there a first
cause, 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 the
doctors of Merced knew more about Lia’s sickness and medicine in general based
on their knowledge of Western medicine. The doctors of Merced felt that the
medicine they practiced held a higher ground, in their eyes, and most believed
that the Hmong’s ritual practices of animalism and sacrifice were a waste of
time. Because observation, experience, or experiment cannot arrive at the
answers 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 religious
framework. In much 20th-century Western philosophy, metaphysics has been
dismissed as pointless speculation that can never achieve positive
results(Tauber). Nevertheless, metaphysics has many defenders who still explore
notions put forward by Plato and Aristotle(www.comptons.com). For the average
person, 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 of
Lia’s health, her parents felt that less medication, and less hospitalization
would make Lia better. They felt that their touch and healing power alone could
cure their beloved child. The doctors felt otherwise and based this on the
assumption that they were right and that Western medicine was the only accurate
and trustworthy method to treat a patient. In Western culture, being sick “is
technical not moral (Tauber).” The underlying question was how much of the
illness 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 Lia’s parents
ask themselves is if the problem could have been avoided. This leads us to
question both their value systems. The main concern for Lia was her health and
the doctors of Merced made sure that they did everything they could despite
irreconcilable differences regarding Lia’s medication with her parents as well
as the notion that Lia would be better if she stayed at home without the
treatment of doctors. While reading the book, Faddiman questions whether the
choice to put Lia in a foster home was a moral one. Would she have been better
off in the care of her parents whom neglected to give her the numerous
combinations of drugs because they believed it would harm her? This brings in
the role of ethics and moral, and what they mean in Western culture. Another
name for ethics is morality. One word is derived from the Greek ethos, meaning
"character," and the other from the Latin mores, meaning
custom.(www.compton.com)" Because both words suggest customary ways of
behavior, they are somewhat misleading. The Greek philosopher Aristotle had a
better term--practical wisdom. It was called practical because it was concerned
with action, both on the part of the individual and on the part of society. It
had to do with what should or should not be done(www.askjeeves.com). Aristotle
divided practical wisdom into two parts: moral philosophy and political
philosophy. He defined them together as a "true and reasoned state of
capacity to act with regard to the things that are good or bad for
man.(www.comptons.com)” The field of ethics has several subdivisions.
Descriptive ethics, as its name suggests, examines and evaluates ethical
behavior of different peoples or social groups. “Normative, or
prescriptive”, ethics is concerned with examining and applying the judgments
of what is morally right or wrong, good or bad(Blais 93). It examines the
question of whether there are standards for ethical conduct and, if so, what
those standards are. Comparative ethics is the “study of differing ethical
systems to learn their similarities and contrasts”(Blais 93). In modern
developed societies, the systems of law and public justice are closely related
to ethics in that they determine and enforce definite rights and duties. They
also attempt to repress and punish deviations from these standards. Most
societies have set standards, whether by custom or by law, to enable those in a
society to live together without undo disruption(ww.comptons.com). It is
possible for law to be neutral in moral issues, or it can be used to enforce
morality. The prologue to the United States Constitution says that insuring
domestic tranquility is an object of government. This statement is morally
neutral. Such laws as those passed to enforce civil rights, however, promote a
moral as well as legal commitment(Blais 93). So much human activity is simply a
matter of custom or habit that little thought may be given to many actions. When
an individual in Western society gets up in the morning, it is normal to get
dressed and to put on shoes before going out. However, in doing so, one does not
usually bother thinking “This is a good and necessary thing that I’m
doing.” There is a great deal of behavior, however, in which people are
conscious of why they act in a certain way. They are confronted with the need to
make choices. At the basis of choice two questions arise: "What good do I
seek?" and "What is my obligation in this circumstance?(Blais
93)" Ethics is primarily concerned with attempting to define what is good
for the individual and for society(Tauber). It also tries to establish the
nature of obligations, or duties, that people owe themselves and each other.
Philosophers have said for thousands of years that people do not willingly do
what is bad for themselves but may do what is bad for others if it appears that
good for themselves will result. It has always been difficult to define what is
good and how one should act to achieve it(www.askjeeves.com). Some teachers have
said that pleasure is the greatest good. Others have pointed to knowledge,
personal virtue, or service to one's fellow human being. Individuals, and whole
societies, have performed outrageous criminal acts on people, and they have
found ways to justify doing so based on some greater "good.(Blais 93)"
The difficulty in deciding what good and obligation are has led moral
philosophers to divide into two camps. One camp says that there are no definite,
objective standards that apply to everyone(Blais 93). People must decide what
their duties are in each new situation. Others have said that there are
standards that apply to everyone, that what is good can generally be known. If
the good is known, the obligation to pursue it becomes clear. The position that
insists there are ethical standards is called “ethical absolutism”, and the
one 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 from
Aristotle in his 'Nichomachean Ethics (Blais 93)'. He realized that what people
desire they regard as good. Nevertheless, to say no more than this means that
all 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 by
delineating 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 food
and shelter. Beyond these, people also have a desire for health, knowledge, and
a measure of prosperity. By being natural, these desire, or needs, are good for
everyone. Since there can be no wrong basic needs, there can be no wrong desire
for 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 of
good becomes clouded. Individuals may want something they desire as a good, but
it may be bad for them. People with sound judgment should be able to decide what
is good for them, in contrast to what is only an apparent good(Blais 93). This
sound judgment comes with experience. Young children have little experience of
what is good or bad for them, so they must be guided by parents and other
adults. 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 decide
what is good for others as well as for themselves(Fadiman 97). That is, they
expect that goods for them apply equally to other people. To be able to treat
others in the same way one treats oneself, Aristotle said it is necessary to
have the three virtues of practical wisdom: temperance, courage, and
justice(www.comptons.com). Relativists do not believe that there are
self-evident moral principles that are true for everyone. They say that people's
moral judgments are determined by the customs and traditions of the society in
which they live(Blais 93). This is a clear example of why the Hmong’s views
differed 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 that
a certain society has developed for itself. What is right is what society says
is right, and whatever is considered good for society must be right. If this
were the case, did Lia’s doctors do everything they could? Were they clouded
by the mentality that Western medicines was superior to the Hmong culture and
disregard the practices that Lia’s parents strongly believed would save their
child? If the doctors had taken a different approach from the beginning and
hired interpreters and had not been one-sided in their beliefs, would Lia’s
fate be changed? As with life, all choices involve risk. There are no principles
or standards that are right for all people at all time. New situations demand
new approaches. What was once valid may be inappropriate now. In the world of
the 20th century--with its rapid changes, endless wars, and moral upheaval--the
ideas of existentialism have seemed correct to many people in the
world(www.comptons .com). Some existentialists base their position on
religion(Blais 93). Even here they say it is impossible to fall back on moral
laws or principles in making decisions. Choices must be made on faith, often in
conflict with traditional moral guidelines. Individuals trust that what they are
doing is right, but they can be entirely wrong. They commit themselves to the
unknown, and the decision can often be an agonizing problem. The Hmong’s
beliefs were based on their faith in the healing power of their medicine. Before
Lia became severely ill, Hmong did not entirely dismiss Western medicine. They
did, however, believe that a combination of the two would be more effective than
just Western medicine. Students of comparative ethics have found that most
societies--from the ancient to the modern period--share certain features in
their ethical codes(Blais 93). Some of these have applied only within a society,
while others have been universal. Most societies have had customs or laws
forbidding murder, bodily injury, or attacks on personal honor and reputation.
Societies rely on rules that define elementary duties of doing good and
furthering the welfare of the group. In societies where the major
religions--Judaism, Christianity, Islam, and Buddhism--are predominant, the duty
of 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. When
Lia was taken away to a temporary foster home, the doctors promised Lia’s
parents that she would return to them in six months. When their promise fell
through and Lia was not returned as promised, Lia’s parents began to
disbelieve the system, which was intended to protect the individual. The United
States represents a series of ideals. For most of those who have come to its
shores, it means the ideal of freedom--the right to worship as one chooses, to
seek a job appropriate to one's skills and interests, to be judged equally
before the law. It means the ideal of the frontier, of overcoming obstacles--
taming the West, curing diseases, voyaging to the planets(Fadiman). It means the
ideal of progress--that personal life and political, social, and economic
institutions will improve through hard work, fair play, and honest endeavor. It
means the ideal of democracy--the right to be heard as an individual, the right
to cast a ballot in a free election, the right to dream of a better life and to
work toward one's goals(Fadiman). The Hmong did not have this voice, nor felt
their opinions mattered in the case of Lia’s health. In America they felt like
foreigners, in their homeland they felt the same. The fate of Lia Lee may have
been different if not for ignorance, superiority in Western medicine, and a
cultural 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 Spirit
Catches You and You Fall Down. Noonday Press. Canada, (1997).