Spirit Study Guide

Objectives for The Spirit Catches You and You Fall Down

The following terms and discussion questions are from Fadiman's The Spirit Catches You And You Fall Down, though more detail that may help answer some of them can be found in lessons and on Hmong chronologies. The chronologies in particular have links to countries and people.

Terms

Discussion Questions

Chapt. 1-3

1. Explain what a typical birth would be like in traditional Hmong culture, and the reasons for some of the specific practices involved in pregnancy, birth, and the postpartum period. (Note particularly specific beliefs relating to the soul and the disposal of the placenta, the use of food, etc.). What problems do traditional Hmong practices pose for American medical personnel? What are the solutions according to Fadiman?

2. What is the significance to the Hmong of the “soul calling” or naming ceremony traditionally held on the third day after birth?

3. When the Hmong were in China, how did the Hmong and the Chinese feel about each other? Why? Approximately how many Hmong remain in China? How many moved to Vietnam, Laos, and Thailand?

4. What was the general Hmong response to attempts by the Chinese to assimilate them, or “civilize” them?

5. Explain the traditional Hmong views on epilepsy or qaug dap peg. (Significance, cause, treatment) In her family's view, what specifically caused Lia's epilepsy? How is this different from the view of American medical personnel?

6. Are the Hmong alone in thinking that epilepsy may have supernatural or divine origins?

7. How do the traditional Hmong view and treat young children?

8. What difficulties were experienced on both sides from Lia's initial hospitalization for epilepsy?

Chapt. 4-8

1. In the refugee camp in Thailand, what were some of the attitudes some Hmong had toward American medical practices? Why did they have these attitudes?

2. What lesson did the doctor who had Lia removed from her parents want to teach the parents? What lesson was learned? Why was there such a discrepancy?

3. What cross-cultural differences, besides communication difficulties, created problems in ensuring that prescribed medications were taken as directed? In what ways does this represent differences between an American “medical culture” and the Hmong culture?

4. Could the circumstances leading to the decision to remove Lia from her family have been avoided? How?

5. What do you think of Foua's description of her “easy” life in Laos? Why did she prefer it in many ways to her life in the U.S.?

Chapt. 9

1. Why do the Hmong feel that animal sacrifice is necessary for various religious ceremonies? Why are so many meat-eating Americans shocked?

2. Why did Nao Kao sacrifice a cow to celebrate Lia's return from foster care? Describe this ceremony and what was actually done.

3. Explain the difference between the doctors' view and the parents' view of why Lia was sent into foster care, and why she was returned.

Chapter 10

1. How and why did the Hmong in Laos start to cultivate the opium poppy?

2. What is swidden or slash and burn horticulture, and how did opium cultivation worsen its negative effects in the mountains of Thailand, Laos, and Vietnam?

3. Why did Laos become important in the Vietnam War? Why specifically were the Hmong recruited by the US-CIA to fight the North Vietnamese and the Pathet Lao?

4. Describe the level of Hmong participation in the Vietnam War. Over the centuries, the Hmong had fought against a number of different peoples who have sought sovereignty over their lands. How did this affect their culture? How did this history influence the Hmong clan decisions to participate in the Vietnam War and the defense of Laos against the Vietminh and Pathet Lao?

5. Do you agree with the 1971 statement of a US Undersecretary of State that the US war in Laos “is something of which we can be proud as Americans.”? Why did the Undersecretary say this? (i.e. what was some of his reasoning?) With access to more information, including the events of 1975, would you agree or disagree? Why, or why not?

Chapt. 11-14

1. How did the EMT's and the doctors respond to what one doctor referred to as Lia's “big one”? Do you think they performed as well as they could have under the circumstances?

2. How does the greatest of all Hmong folktales, the story of how Shee Yee fought with nine evil dab brothers (p.170), reflect the life and culture of the Hmong?

3. Discuss the Lees' life in Laos. How was it different from their life in the U.S.? Foua says, “When we were running from Laos at least we hoped that our lives would be better. It was not as sad as after Lia went to Fresno and got sick” (p.171). What were the Lees running from? What were they hoping to find in the United States?

4. When polled, Hmong refugees in America stated that “difficulty with American agencies” was a more serious problem than either “war memories” or “separation from family.” Why do you think they felt this way? Could this have been prevented? If so, how? What does the author believe?

5. Initially, what were some of the problems the Lees and other Hmong immigrants faced when they arrived in the U.S.? How were the Hmong different from most other immigrants to the U.S.?

6. Is there an “American ideal of assimilation” (p.182)? If so, what is it? What do you think it should be?

7. What was the immigration “policy” of the US with regard to the Hmong as well as other groups? Was this the best policy for the Hmong?

8. Why does the author (p.190) say the Hmong “were an ideal blank surface on which to project xenophobic fantasies.” What were some of these fantasies?

9. Compare and contrast the American value of “rugged individualism” with the Hmong view of group interdependence.

To what extent have the Hmong (as of the time the book was written) managed to preserve some of their culture? What has been preserved?

10. What was the “role loss” many adult Hmong faced when they came to the United States? What is the underlying root cause? How does this loss affect their adjustment to America?

Chapt 15-19

1. What is xenophobia? Why would the Hmong trigger such a reaction in Merced? What are some examples provided by the author?

2. Why did the non-Hmong in Merced feel that the Hmong should be grateful to Americans? Why did the Hmong feel that Americans should be grateful to the Hmong? Why did each group have difficulty seeing the other group's point of view?

3. What does Fadiman mean when she calls the Hmong “differently ethical”? In what ways, from their own perceptions, are they ethical? In what ways, from many American's perceptions, are they not ethical?

4. Fadiman states that “Lia's case had confirmed the Hmong community's worst prejudices about the medical profession and the medical community's worst prejudices about the Hmong.” Do you think this is true? Why or why not? Did it have to be this way?

5. What actually caused Lia's brain death?

6. What does the author mean when she says that Hmong culture is not Cartesian, but that American culture, particularly medical culture, is?

7. Why did no medical practitioner ever ask the Lee's the eight questions from a cross-cultural medicine model? What do you think of Kleinman's conclusions that our medical culture frequently practices “moral hegemony”, coercion, and a refusal to see “its own set of interests, emotions, and biases.”? (p 260-61)

8. What is your reaction to this book? Do you agree with the author's belief that “[Lia's] ..life was ruined not by septic shock or noncompliant parents but by cross-cultural misunderstanding.”?