When Lia Lee was three months old she had her first seizure. Her parents believed that the seizure occurred when her sister slammed the door and the noise caused her soul to flee from her body. They referred to her illness as “quag dab peg”, the belief that “the spirit catches you and you fall down.” Conversely, Western doctors diagnosed her illness as severe epilepsy, a neurological condition. Living in California, Lia’s parents were split between their own traditional Hmong practices to treat her, versus using Western medicine. Lia’s parents wanted nothing but the best for their daughter as did her doctors. The Spirit Catches You and You Fall Down by Anne Fadiman demonstrates the clash of two cultures: the American and the Hmong. Unfortunately, it is the misunderstanding between the two cultures that eventually leads to tragedy.

I was drawn to Medical Anthropology as a subfield of Anthropology. I wanted to learn just how to get a holistic understanding of health and medicine by drawing upon social, cultural and biological Anthropology. Fadiman's book, which was required reading for my course at MIT, did more than satisfy my curiosity. By contexulizing the work and aims of Medical Anthropology in a poignant story, Fadiman reached me at an emotional level. She makes me want to speak out for the relevance of the personal story and the cultural traditions of the patient, in order to ensure the most appropriate care. I agree with Fadiman's assessment that lack of communication can be a weakness in medical practice. I can see how Medical Anthropology has a very important role to play in the health care system.

By interspersing the history of Laos into the book with vivid examples and historical accounts, Fadiman gives her readers a wider background for the situation in the story. One of the key examples Fadiman brings up is the political condition in Vietnam during 1954. According to the Geneva Accords, three independent states had been recognized: Cambodia, Vietnam and Laos. The United States at the time wanted to support the anti-communist government in South Vietnam. They could not do this openly as they had pledged not to send any troops to Laos at the Geneva Conference. However, the United States wanted to cut supply lines through Laos to North Vietnam, and took support from the Hmong people. This was known as the “Quiet War,” which ultimately resulted in the loss of lives of many Hmong. The “Quiet War” can also be seen symbolic of the conflict between Lia’s parents and her doctors. Having witnessed that they could not rely on the United States in the past when it came to their soldiers and country, it is no surprise that the Lees were skeptical when it came to the treatement of their daughter.

Fadiman states that, “every illness is not a set of pathologies but a personal story.” (Fadiman 262). This, to me, is the heart of medical anthropology. In our melting pot world we need to develop a better appreciation of cultural diversity in our communities. The medical world needs to evolve with these perspectives. Conversely, doctors still believe that “the emotional skin-thickening is necessary — or so goes the conventional wisdom — because without it, doctors would be overwhelmed by their chronic exposure to suffering and despair. Dissociation is part of the job.” (Fadiman 275) Doctors take an oath to save lives. They will go to great lengths to keep their patient alive and well. Dissociating their emotions from their job helps them to stay focused on their goal. However, in order to save a life you have to understand whose life you are saving. As William Olser said, “Ask not what disease the person has, but rather what person the disease has.”(Fadiman 275) Why must we accept that humanity and saving someone’s life are mutually exclusive? As Lia’s story comes to a close, the second half of the book examines the ethics of medicine and the doctor-patient relationship in depth. It is important that medical professionals work with their patients to create a bond. Validating someone’s feelings is essential. Showing respect for cultural practices goes a long way in assuaging patient concerns. It helps to make a successful case for medical procedures, rather than stating that the patient is wrong and the only “right” way is the cold and clinical way. This especially resonates with me after interviewing nephrology patients in Pakistan. I was exposed to the range of cultural taboos and beliefs people harbor. When asked why several patients receiving dialysis never ventured to get a kidney transplant I was surprised to see how many replied that that transplants were not allowed in their culture and could result in death. Doctors at the Sindh Institute of Urology and Transplantation in Pakistan have to work with these patients, attempting to acknowledge their feelings but also educating them with information. This can give them a spectrum of options from which to make their own decisions.

I was pleasantly surprised when I learnt that The Spirit Catches You and You Fall Down is now a required reading for many medical schools such as the University of California-Irvine and the Yale School of Medicine. “Cultural competence” as Fadiman describes, is now believed to be an important trait in medical schools. Fadiman convinces me that Medical Anthropology makes an important contribution to the human side of medicine.