[Type text]
[Type text]
1
Sarah Grannis
Com 207
Spring 2011
Book Analysis Final Paper
Power Struggles Within Intercultural Communication
For the final few weeks of this class, we focused on reading “The Spirit
Catches You And You Fall Down”. This novel, based on a true story, focused on a
Hmong child with severe epilepsy and the struggles that resulted in her treatment
due to cultural differences between her American doctors and Hmong family. While
the book focused on many different issues, what stuck out most to be was the power
struggle between the two cultures. The American doctors, while not necessarily
coming straight out and saying so, expected the Lees to assimilate to Western
medicine. However, the Lees saw it differently; they wanted the doctors to respect
their beliefs in dealing with Lia’s epilepsy. These power differences ultimately led to
the tragic grand mal seizure that left Lia in a permanent vegetative state – where she
still remains today.
Throughout the semester, we learned that power is always an issue in
relationships; however, it is obviously not very ethical in medical situations. While
it’s obvious this wasn’t an intentional struggle, the Lees were forced to accept their
child’s condition as a “problem”, rather than a miracle as it would have been
consider in their homeland of Laos. Children with epilepsy are usually seen to have
[Type text]
[Type text]
2
special powers and typically become shamans – a very valued position in the
community (Fadiman, 1997).
Additionally, there was a lot of fear from the Lees about Western medicine. In
Laos, there are rumors of American doctors eating brains or placentas from their
patients. While these are certainly untrue, it was extremely nerve-wracking for the
Lees during their initial emergency room visits with Lia. The Lees also did not speak
much (if any) English, and there wasn’t always a translator on hand to help them.
This is not uncommon, even today.
Hospitals can’t be expected to staff translators 24 hours a day, and even if
they do happen to have one, it can still be difficult to communicate to the family
what is going on (Malina, 2005). The doctors did not fully consider the spiritual
aspects of the Lee’s understanding of Lia’s condition, which ultimately may have
helped them communicate better. Because the Lees didn’t see the epilepsy as a
serious problem, they neglected treatment of it – which doctors decided allowed
them to obtain a court order to place Lia in foster care.
“As long as doctors and parents continue to negotiate, even if they disagree,
the conflict is confined to differences in belief systems….once police are called and
court orders are obtained, the differences escalate to another level. The differences
are no longer about beliefs, the differences are about power. Doctors have power to
call the police and access state power the Hmong don’t have,” (Fadiman, 1997).
[Type text]
[Type text]
3
Because of the lack of understanding on the Lees’ part, it’s unlikely they
would have been able to provide a suitable defense to prevent the court order, and
though the foster mother supported Lia being returned to her parents, the courts
refused until the six months were up. She was eventually returned to her parents,
who began giving her the medication – forcing questions on if this was a power
struggle to prove a point (ie: “if you don’t do what we say, we’ll take her away from
you?”). Was it warranted? That certainly depends on your view on the situation, but
Lia’s seizures temporarily stopped for a few months.
Throughout the book, there are a lot of questions asked on if the Western
medicine approach was the right choice, or if it would have been better to use the
Hmong course of treatment. This right here is a good example of the migrant-host
relationship and the challenges that resulted from it.
While the Lees wanted to cherish their Hmong culture, they understandably
wanted their daughter to survive and thus, were willing to seek Western medicine
treatment. This was a clear form of assimilation in a sense, even though they did not
fully follow the doctors’ recommendations and medication plans (this was the
separation portion of the relationship). Overall, they were able to integrate their
cultures somewhat towards the end as Lia’s prognosis looked slim and their doctors
agreed to let the family perform their rituals in the hospital in hopes it would
restore her back to her pre-epileptic self.
There were certainly instances of inequality due to misunderstanding, as the
Lees were not farmilar with Western medicine. As previously mentioned, there was
[Type text]
[Type text]
4
a lot of fear involved for many immigrants from Laos as they had heard such
horrible stories about the hospitals (Fadiman, 1997).
Additionally, they considered mental and physical illnesses to likely be more
“spiritual” problems. Because they considered the seizures to be “the spirit catching
Lia and her falling down” – it wasn’t easy to explain this was rather a very severe
case of epilepsy.
Language barriers are not uncommon, and one way of dealing with it was
invoking a trusted cultural member to translate (Eckhardt, Mott, Andrew, 2006).
While the author used a girl named May Ling to translate, she found the Lees opened
up about their experience and what was going on with Lia. A lot of focus is also put
upon cultural elders and clan leaders, so Ling had to gain access to those people who
approved or disapproved medical decisions. By translating to them – in terms they
could understand – some inequality due to misunderstanding was prevented.
Also, there was some egocentricism on hand, which certainly plays a role in
power struggles. By, rather intentionally or unintentionally, having a belief that your
own culture is superior, you run very high risks, especially when medical issues are
involved and cannot have any bias.
The Lees were also guilty of being their Hmong ways were superior to the
doctors. As Nao Kao noted when they visited Lia in the hospital after a seizure, “She
was going to die if she stayed in the hospital. But we boiled up some herbs and
[Type text]
[Type text]
5
washed her body…..she had too much medicine and her body gave way. But then we
boiled the herbs and we washed her and she didn’t die.” (Fadiman, 1997).
This proves that while well meaning, there was certainly a bias amongst the
Hmong towards the doctors and they questioned the treatment and if it was right
for Lia. Rather than believing that the hospital care assisted in her brief recovery,
they were convinced that their Eastern medicine ways were the correct, and saved
her life.
Since there ethnocentrism is difficult to avoid amongst cultures at times, it
can be suggested that we adapt to a more harmonious perspective amongst Angloand Asian cultures (Kuoa, Chew, 2009).
By allowing the family to come in and perform their rituals, the doctors did
help in easing some anxiety. While it did not prevent any ethnocentrism on the Lees’
part, it certainly did give them some confidence in Lia’s recovery. Having a nonpolarizing approach of medicine can be extremely beneficial, and allows both sides
to feel like they have combated the discrimination of their culture. (Kuoa, Chew,
2009).
There was obvious discrimination against the Hmong, and the doctors
blamed the family at times for not going along with the plan for Lia’s recovery. Was
this right? Certainly in Western medicine, we don’t question a regular regime of pills
and other drugs, but these were foreign concepts to Lee’s. Both sides believed that
[Type text]
[Type text]
6
their medical routines would ultimately cure Lia, but unfortunately it did not
happen.
Could a compromise ultimately have saved her? It’s difficult to tell because of
the severity of the seizure disorder. Overall though, I believe there were an immense
amount of power struggles in the patient-provider relationship. Both sides were at
fault for this, but they were only trying to do what they felt was best for Lia.
As we move into the 21st century, more is being done to bridge the cultural
gap between immigrants and American doctors. More and more hospitals are
providing translators, and Eastern medicine is becoming much more mainstream
(even covered under some insurance policies). The general belief is that these two
different medical practices can compliment each other, and overall, increasing our
understanding of different cultures will lead to more communication amongst them
(Burroughs, 2008).
Lia ultimately remains in a permanent vegetative state, of which she is
unlikely to ever recover this. This is a result from the massive seizure she suffered
at the end of the book, and is extremely tragic as she was so young when this
happened and never got a chance to lead a full life. Her parents continue to care for
her, and her case today is one of the leading examples of intercultural
communication within the medical community. Ultimately, it also provides a
warning that power struggles have no basis in the field of medicine.
[Type text]
[Type text]
References
Burroughs, Nancy F. (2008). Raising the question #10 non-native speakers of
English: What more can we do? Communication Education. 57 (2, April), 289-295.
Eckhardt, R., Mott, S., & Andrew, S. (2006). Culture and communication: identifying
and overcoming the barriers in caring for non-English-speaking German patients.
Diversity in Health & Social Care, 3(1), 19-25.
Fadiman, Anne. The Spirit Catches You and You Fall Down: a Hmong Child, Her
American Doctors, and the Collision of Two Cultures. New York: Farrar, Straus, and
Giroux, 1997.
Kuoa, Eddie C. Y., and Chew, Han Ei (2009). Beyond ethnocentrism in
communication theory: Towards a culture-centric approach. Asian Journal of
Communication. 19 (4), 422-437.
Malina, D. (n.d). Compliance, Caricature, and Culturally Aware Care. New England
Journal of Medicine, 353(13), 1317-1318
7