Abigail Philip
Dr. J Elizabeth Clark
Mid Term LIB 200
4/30/07
Midterm: Medicine as a Cultural Practice
It is commonly stated that all medicine is ultimately a cultural practice. I also
believe this sentiment because every culture has its own practices and rituals where
medicine is concerned. The book The Spirit Catches You and you Fall Down by Anne
Fadiman is a perfect example of the differences in culture and medicine in the United
States and other parts of the world.
In Fadiman’s book, the premise that all medicine is ultimately a cultural practice
is revealed in the different methods used by the American doctors and the methods of the
Hmong. It also reveals that each culture regardless of “power” and “status” does not
believe that scientific or Americanized medicine is the best cure. In this book we saw a
clash of two cultures. We saw the biased behavior of some doctors and nurses who
thought they knew best and were under the impression that Lia’s parents knew absolutely
nothing because of the cultural barrier. The Lee’s idea of medicine and the Americans
idea of medicine were completely different from the other. The Americans prided
themselves on medicine and technology while the Hmong were more spiritual and
ritualistic.
In the Hmong culture, when someone falls ill or has any problems they do not
seek medical help, instead they seek a txiv neeb or a shaman. This person is seen as
having the power to heal others. An example of differences in culture is the way we view
the placenta. In the United States the placenta is generally thrown out but in the Hmong
culture “it is considered one’s finest garment” (5). It has more to do with the spirit and
the soul than just an insignificant unclean after thought.
This book created a more complete picture of the medical world because it gave
us an inside look on the complications of medicine, interacting and clashing with cultural
differences and barriers. Through language and cultural differences we saw the
government step in at the request of the doctor when he thought Lia’s health was being
compromised. On page 79 it states “Neil finally decided that he had no choice but to
request that Lia be placed in foster care. Other options he considered in retrospect, such
as arranging for a nurse to visit the Lee house three times every day to give Lia her
medicine or enlisting the help of the Hmong community leaders to increase parental
compliance, either seem at the time to have insuperable bureaucratic obstacles or simply
didn’t occur to him.”
This step may have seemed right to him but the fact was the Lee’s weren’t
accustomed to using traditional medicine. In their opinions on trying to administer it to
Lia they were of the impression that it was not making Lia feel better but it was instead
making her worse. It states on page 48 “It wasn’t hard to tell that the parents were really
unhappy with the medical care.” This was probably because her parents did not see any
results in the doctor’s dealings with Lia. They did not understand basically what was
happening. Firstly Lia’s condition was extremely serious and dangerous in the eyes of
American medicine but in the eyes of the Hmong and Lia’s parents they saw it as a gift
and at times thought Lia herself would become a great txiv neeb.
The ways in which the Americans dealt with Lia and the ways her parents tried to
deal with her illness also exposes the difference in the cultures and the barriers. Firstly,
there was an obvious language barrier and the only person on staff who spoke Hmong
was a janitor who was not always around. We have to take also into account that although
there was a translator at hand, the Lee’s still would not have understood the medical
terms and the language because in Hmong those terms didn’t exist (pg. 46).
The Lee’s little faith wavered as a result of the amount of medication Lia was
being given without promising results. On page 46 it states “By the time she was four and
a half, Lia’s parents had been told to give her at various times, Tylenol, Ampicillin,
Amoxicillin, Dilantin, and Phenobarbital...” It was perfectly normal for the Lee’s to have
doubts because these were tremendous amounts of medication some of which were in
large dosages for such a young child. Bearing in mind that the Lee’s were accustomed to
sacrificing animals, using herbs and spiritual remedies, so this was all very new and
shocking to them.
This book also at times made me think about if all doctors perceived themselves
as “knowing what is truly best” and if they judged others especially immigrants who do
not speak English. Sometimes the doctors felt the Lee’s were being purposely difficult.
On page 47 it states “Neil felt that Nao Kao put up a “stone wall” and was sometimes
deliberately deceitful. Peggy felt that Foua was either very” stupid or a Looney bird.”
Neither doctor could tell how much of their inability to get through was caused by what
they perceived as defects of intelligence or moral character, and how much of it was
caused by cultural barriers. I think this summarizes the topic of medicine and culture.
The Hmong saw student doctors as only wanting to experiment on the poor
people and try to kill them. They saw doctors as being very busy while a shaman is
patient and takes his time (62). Some doctors such as Dr. Small thought of the Hmong to
be “highly uncooperative obstetrical patients” (73). These quotes give us an idea of how
each side perceived the other.
In conclusion, Anne Fadiman’s book opened our eyes to the trials and error of
medicine, the complexities of medicine and culture, how extremely different it can be and
the ignorance of especially American medicine when it come to other cultures. Other
cultures are sometimes seen as wrong and inconsequential on how they deal with
sickness. I think that each culture has its own way of dealing with sickness and it should
be respected. We in Northern Americas pride ourselves on medicine but other cultures
aren’t exposed to our technological skills and medicine. Some cultures such as the
Hmong prefer spiritual versus medical treatment.