The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures

Lia Lee, a Hmong child, is the protagonist of the book. Fadiman tells Lia’s story from personal observations, memories, and medical records. Lia has a severe epilepsy disorder, medically diagnosed as Lennox-Gastaut Syndrome. Up until her final neurological crisis, Lia is the focus of intense cross-cultural conflict, for her parents and doctors have radically different ideas about the cause of her illness and the best course of treatment.

Foua is a Hmong refugee and mother of Lia. She loves her daughter and takes exceptional care of her, although this is not recognized by Lia’s doctors, who believe Foua is undermining their efforts to treat Lia’s seizure disorder. Foua prefers to use traditional Hmong healing practices to heal her daughter.

Nao Kao is a Hmong refugee and father of Lia. Like Foua, he loves his daughter and believes her illness is caused by soul loss, which marks Lia as special in Hmong society. Nao Kao devotes a lot of time and effort trying to heal Lia by arranging special ceremonies for her and taking her to shamans known as txiv neebs.

Neil is married to Peggy Philp. He is Lia’s primary pediatrician at MCMC. Although an excellent doctor, Neil struggles to communicate with the Lees, especially during the early years of Lia’s treatment. He reports them to Child Protective Services for not administering Lia’s medicines correctly. Neil eventually develops a close relationship with Foua when she learns that his son has leukemia, but this occurs after Lia’s brain death.

Peggy is married to Neil Ernst and is one of Lia’s primary pediatricians at MCMC. Like her husband, Peggy also is an excellent doctor and struggles to communicate with the Lees during the early years of Lia’s treatment. Later on, Peggy develops a closer relationship with Foua.

May Ying is a young woman whom Fadiman hires as a cultural broker to help translate and facilitate meetings with the Lees. May Ying proves to be an invaluable resource and explains many Hmong customs to Fadiman.

Jeanine is an American social worker who develops a close and trusting relationship with the Lees. She is a patient advocate for Lia and helps the Lees navigate confusing and complex government bureaucracies so that they can receive the necessary resources to care for Lia.

Dee and Tom Korda are Lia’s foster parents when Child Protective Services (CPS) removes Lia from the Lees’s care. They are kind and responsible foster parents, but Lia still has seizures. Dee recognizes that the Lees are good parents and makes a formal recommendation for CPS to reunite Lia with them, but her recommendation is not granted.

Bill is Fadiman’s college friend and former chief resident at MCMC. He tells Fadiman about the cultural misunderstandings occurring at MCMC, which becomes the primary site of her field research. Bill provides Fadiman with a lot of medical and cultural insights as well.