Artifact 2 – Book Analysis (Final Paper)
Intercultural Communication
Spring 2009
Created by:
Dan Polaski
Life Lessons Learned from Lia Lee 1
Dan Polaski
Com207 – Intercultural Communication
Final Paper
April 24, 2009
Life Lessons Learned from Lia Lee: How The Spirit Catches You and You Fall
Down Conveys a Powerful Argument for Proficient Intercultural Communication
Although some might be quick to underestimate its power, pseudo conflict has the potential to
be the most dangerous type of conflict known to man. Pseudo conflict is simple
misunderstanding – misinterpreting what someone else says, decoding a message in a way other
than the sender intended, or perceiving a disagreement with other groups or individuals when, in
actuality, the parties involved are fighting over the same goal or concept. Useless arguments
occur between the groups or individuals, and until the barriers causing the pseudo conflict are
lifted, the disagreements and hard feelings persist.
These are the circumstances surrounding the early life of Lia Lee, the main character in Anne
Fadiman’s nonfiction book The Spirit Catches You and You Fall Down. Following her diagnosis
of epilepsy at three months old, Lia’s parents, Nao Kao and Foua, soon found themselves in a
pseudo conflict with the doctors and staff of two local hospitals. While each group had their own
ideas of how to handle the situation, both sides were aiming to achieve the same goal: to regulate
Lia’s condition to the best of their abilities and allow her to live a normal, happy life. However,
due to an overwhelming language barrier and Nao Kao and Foua’s strong tie to Hmong culture,
there was often a misunderstanding of why a certain method of treatment was ordered or why
messages could not always be communicated effectively. Teaching how inadequate intercultural
communication can lead to disaster, The Spirit Catches You and You Fall Down can be analyzed
Life Lessons Learned from Lia Lee 2
using the intercultural communication concepts of language, intercultural transitions, and the
differences-similarities dialectic.
One of the most prominent and tedious themes in the book is the incredible language barrier
that separates the Lees and the individuals charged with caring for Lia. These two groups of
people do not speak the same language, and have no knowledge of the language that the
members of the other group speak. Thus, if no interpreter is present, communication between the
groups is virtually impossible. However, even if an interpreter is present, the words exchanged
between the groups are meaningless because Lia’s parents look at the situation, concept, or
object at hand from a different perspective than Lia’s doctors. For example, Lia’s doctors
diagnose her condition as epilepsy, a concept (or condition) familiar to American patients and
medical personnel. However, even if Nao Kao and Foua were able to understand the English
word “epilepsy,” it would not mean anything to them. They view Lia’s condition as “qaug dab
peg,” which means, “the spirit catches you and you fall down.” While “epilepsy” and “qaug dab
peg” represent the same idea in their respective cultures, they do not make sense out of context
and without individuals who understand the word or phrase.
From an intercultural communication perspective, language in The Spirit Catches You and
You Fall Down can be viewed from the nominalist position. From this position, perception of
concepts, events, or objects is not affected by language, which is seen as arbitrary. The words
themselves do not give identity to someone or something. Instead of the labels “epilepsy” and
“qaug dab peg” defining the condition, individuals perceive the set of symptoms surrounding
“epilepsy” or “qaug dab peg” while using those labels to describe them in communication.
While the words spoken do not define Lia’s condition, this perceived incompatibility of ideas
causes the conflict between her parents and the physicians caring for her.
Life Lessons Learned from Lia Lee 3
According to Dr. Marc A. Nivet and a group of educators from various medical schools in
New York and Georgia, “underrepresentation of underrepresented minorities in the healthcare
professions has a profoundly negative effect on public health, including serious racial and ethnic
health disparities” (Nivet et al., 2008, p. 491). They point out that non-white minorities are
slowly becoming the majority, and the small amount of representation among minority groups in
the medical profession is a detriment to their overall health. One of the minority groups
examined in the study is the Asians, specifically people of Vietnamese, Cambodian, and Hmong
heritage. The optimal way to reduce these language barriers and patient conflicts is for medical
school faculties to include more minority instructors. This will hopefully encourage more
minority students to enroll in medical school. Upon successful completion of their education, the
minority individuals will be doctors who will be proficient at communicating with people of their
own ethnicity. Patients and their families similar to the Lees would view a doctor of their own
culture with less skepticism and as more of an advocate than an adversary. This would ultimately
lead to increased rapport.
When physicians are members of the same cultural background as their patients, they are able
to comprehend and appreciate the perspectives of these patients, in addition to speaking their
language. In a study conducted using Hmong individuals living Sydney, Australia, it was found
that:
Hmong would first consult a Western-trained doctor and follow the prescribed
advice and medication. They would often turn to traditional Hmong medicine if
they did not recover within a few days. If neither system gave them relief then
they may suspect that the illness was spirit-based and thus required a shaman. In
Life Lessons Learned from Lia Lee 4
general, Western medicine and Hmong herbal treatments were often taken
together (Wang, 2005, p. 422).
Though this stands in stark contrast to Hmong people residing the United States, it can be
deduced from this study that Hmong people are satisfied using Western medical practices in
conjunction with traditional herbal methods and shamans. However, in the case of Lia Lee, the
physicians caring for her were unable to agree with and understand her parent’s traditional
treatments. Conversely, her parents were unable to understand the lengths the doctors were
going to in an attempt to treat Lia, and generally viewed these attempts as incorrect or inferior.
Again, this goes back to the initial conflict arising from a lack of comprehension and
understanding due to language barriers.
The Spirit Catches You and You Fall Down also provides examples of intercultural
transitions. According to the book, “[t]he Lee family – Nao Kao, Foua, Chong, Zoua, Cheng,
May, Yer, and True – arrived in the United States on December 18, 1980” (Fadiman, 1997,
p.181). Despite the anticipation surrounding their immigration to the United States, this event
would change their lives forever. The Lees, with some help from relatives already living in
America, had to learn basic facts about daily life, including indoor plumbing, electricity, and
cooking meals on a stove.
Though the Lees wanted to learn how to survive in America, they were less concerned with
“fitting in” and more concerned with staying true to their cultural beliefs and practices. “What
the Hmong wanted here was to be left alone to be Hmong” (Fadiman, 1997, p.183). Thus, the
migrant-host relationship most closely associated with the Lees’ behavior is separation. This
occurs when the migrant group in question strongly maintains their original culture in their new
environment. Little intercultural interaction is encouraged, and the individuals keep to
Life Lessons Learned from Lia Lee 5
themselves unless circumstances dictate that they have contact with people from another culture.
While this may appear to be a method of reducing conflict or ensuring that a culture will
continue to thrive in the group’s new surroundings, it poses a problem in the case of Lia Lee.
Her parents continue to subscribe to the theory that their cultural remedies and treatments will
cure her of her condition. However, with this mindset, it precludes the Lees from accepting the
American doctors’ suggestions and treatments as valid. By not attempting to integrate their
culture into the mainstream culture, they are missing out on valuable help for their daughter.
According to a 1990 study performed by University of Oklahoma – Norman communication
professor Young Yun Kim, the separation lifestyle is prevalent among many sects of Asian
refugees (including Hmong) who settle in America. She found that the “data revealed a
predominant affiliation within the respondents’ own ethnic groups, followed by other Asian
Pacific refugees and White Americans” (Kim, 1990, p. 200). The study showed that, on average,
the refugees had fifty-four ethnic acquaintances, as opposed to thirty-two White American and
twenty-three other Asian Pacific acquaintances. The findings also show that the reason most
interpersonal communication occurs within one’s own ethnic group is due to an “overall lack of
English competence among the new arrivals” (Kim, 1990, p. 203). These findings, while
demonstrating the separation of Hmong in America, also show the power of the language
barriers previously described.
In the case of Nao Kao and Foua, Fadiman explains in her book that they still have not made
any attempt to integrate their culture into that of mainstream America, even though they have
lived in the United States for (at that time) seventeen years. According to her, the Lees “still
speak only Hmong, celebrate only Hmong holidays, practice only the Hmong religion, cook only
Hmong dishes…and know far more about current political events in Laos and Thailand than
Life Lessons Learned from Lia Lee 6
about those in the United States” (Fadiman, 1997, p. 182). This demonstrates that the Lees feel
very strongly about separation from the culture of America.
A final intercultural communication concept prevalent in The Spirit Catches You and You Fall
Down is the differences-similarities dialectic. This approach focuses on the idea that people are
both similar to and different from each other simultaneously. The various cultures and people
who inhabit the earth, while extremely different from each other, also share many similarities at
the same time. Different groups of people may vary in terms of ideas, values, and methods to
accomplish goals, but at the same time want to derive the same end result.
In the book, the approaches viewed as correct and conventional are completely based on
context. As such, the approach of the doctors caring for Lia differs from the approach her
parents would to see being taken. Lia’s doctors feel the best way to control her epilepsy is by
writing her prescriptions and adjusting the dosages as needed. Although they do not fully
understand why and how often they need to administer Lia’s medicine, Nao Kao and Foua also
believe that giving their daughter too many pills is an incorrect remedy. Instead, they would
rather utilize traditional Hmong treatments, including coin and herbal remedies. In addition, the
Lees seek the help of a shaman, a form of alternative medicine popular among Asians and AsianAmericans. According to a 2004 study, Shamans are frequently summoned to aid with
“tiredness, weakness, headaches, body aches, loss of appetite, anxiety, and bad dreams” (Helsel
et al., 2004, p.935). Shamans often describe their patients as missing intact souls, and work to
restore them by helping them return to the body they originally came from. Shamans also work
to diagnose and heal problems that cannot be fixed by physicians (Helsel et al., 2004).
While this approach to healing is very different than the traditional forms of healthcare found
in the United States, it is what the Lees prefer due to their cultural background. However,
Life Lessons Learned from Lia Lee 7
despite the discrepancies in the approach to healing, both the Lees and Lia’s doctors agree that
they all want to see Lia as healthy and comfortable as possible. Despite the differences that
separate them, both parties are interested in the end result, which is Lia’s overall health and wellbeing.
In The Spirit Catches You and You Fall Down, three intercultural communication concepts
can be used to analyze the interactions among the individuals in the book: language, intercultural
transitions, and the differences-similarities dialectic. Applying these three concepts to the
relationships in the book can help the reader to better understand the motivations that fuel the
actions of the individuals profiled. In a similar fashion, these same concepts can be used to
analyze circumstances in daily life, explaining the relationships between members of various
cultures in order to live in a more harmonious, understanding world.
Life Lessons Learned from Lia Lee 8
Works Cited
Fadiman, A. (1997). The Spirit Catches You and You Fall Down. New York: Farrar, Straus and
Giroux.
Helsel, D.G., Mochel, M., & Bauer, R. (2004). Shamans in a Hmong American community. The
Journal of Alternative and Complementary Medicine, 10(6), 933-938.
Kim, Y.Y. (1990). Communication and adaptation: The case of Asian Pacific refugees in the
United States. Journal of Asian Pacific Communication, 1(1), 191-207
Nivet, M.A., Taylor, V.S., Butts, G.C., Strelnick, A.H., & Herbert-Carter, J., et al. (2008).
Diversity in academic medicine no. 1: Case for minority faculty development today.
Mount Sinai Journal of Medicine, 75(6), 491-498.
Wang, J.A. (2005). The changing health care behaviour of the Hmong refugee population in
Sydney. Geographical Research, 43(4), 417-428.