Book review

This is cross-posted from Goodreads.  I finished "The Spirit Catches You and You Fall Down" yesterday, and it was a book that gave me a lot to think about.  Please enjoy.

This was a really interesting book that we read for a med school book club.  The main idea here is the huge cultural divide between the Hmong people's paradigm and that of Western medicine.  Fadiman dispenses a lot of information about the history of the Hmong people, their beliefs, and their difficulty adjusting to life in the US.  Interwoven through this is the sad story of Lia Lee, an epileptic child caught in the space between these two worlds.

Lia's parents view her disease as something spiritual--her spirit is caught away during her epileptic episodes.  The doctors view it as a storm of electrical activity in her brain.  Both sides have different ideas about how she should be treated, but communication between the groups (and even more so, understanding) is exceptionally difficult.  There is no shared language, and Lia's parents are illiterate.

What do you do when you are faced with a situation like this?  I felt extremely frustrated for and with both sides as I read this book, and I think the book presented more questions than answers.  This isn't necessarily a bad thing, but it leaves a lot of thinking to be done (and some good discussions at book club).  Lia ends up a vegetable, but with parents who love and care for her in a very powerful way.  Tough stuff here.

When I was in Bolivia, I was told many things there by well-meaning people about how to maintain good health.  Their counsel included warnings about not sitting on a hot seat ("it will give you hot blood") and not sleeping with a fan blowing on you ("you'll get sick").  I did both of these things and was just fine (I wouldn't have slept at all otherwise).  Looking back, I laugh at some of the ideas they had and the consequences.  I can't laugh the same way about the consequences of Lia's parents' ideas.

One of the biggest things I will take from this book is the need to connect with the patients I work with over the coming decades.  If I don't understand them, everyone is in for a world of hurt.  My medical school has made a good effort to teach us patient-centered interviewing and care, which I think will be a helpful way to approach my interactions with patients and prevent situations like that of Lia.

I appreciated that the book was very balanced--it bashed neither the doctors or the Hmong people, and presented both sides as very invested in helping Lia, but with their own strengths and weaknesses.

This book was written almost 15 years ago, about a series of events almost 20 years ago.  I'm curious to know how the situation has changed in that time--I think it would be great if Fadiman wrote a follow-up article or book.

Rating: R, for language (3 or so F-words, little else).