“Shamans are, first and last, quintessential mediators. They are threshold crossers, endowed creatures who can go between the earth and the sky. Grand articulators, shamans’ special gift and mission is to bring opposities together – to bring the physical and moral worlds into meaningful conjunction. That is why they are identified with archetypal connectors such as images of ladders, bridges, ropes, and cosmic trees that sink roots into the earth while branching towards the sky… It is the special responsibility of the shaman to celebrate and actualize the coincidences between these two kingdoms and to amplify their resonances, on into another.”
I just finished reading an amazing book, The Spirit Catches You and You Fall Down. The author, Anne Fadiman, is an exceptional writer. The book is hilarious and tragic. Fadiman’s ability to navigate the complexities of her research and story telling is nothing short of mastery. The complexity of the tale is captured in the books subtitle: “A Hmong Child, Her American Doctors, And The Collision Of Two Cultures.”
The story piviots around the central character of Lia, a Hmong child who suffers from what the Hmong describe as, “The Spirit Catches You and You Fall Down.” Her American doctors call her illness epilepsy. In the course of her condition, Fadiman opens the reader into two very different worlds. We come to know Lia’s family as their struggle to live in America unfolds amidst language barriers, aid dependency, unemployment, untranslatable custom, culture, and change. The Hmong history and worldview enters the MCMC emergency room in Merced, CA as a little girl, seizing. The doctors, all of them “hundred’s of hours dissecting cadavers… had had a single hour of instruction in cross-cultural medicine.” Because when a Hmong patient entered the hospital the problem was not a stomach ache or a seizure, rather that the, “entire universe was out of balance.” For the Hmong, “Medicine was religion, Religion was society. Society was medicine.” The frustations with this primal cultural collision overwhelmed the patients and the MCMC doctors whose aim was their health. “It was typically Hmong for patients to appear passively obedient –thus protecting their own dignity by concealing their ignorance and their doctor’s dignity by acting deferential–and then, as soon as they left the hospital, to ignore everything to which they had supposedly assented.” They didn’t know what a “lung” was, they didn’t believe in taking blood because they didn’t know the body replenished its own blood supply. They didn’t know that the organs they saw in animals corresponded to their own because they always buried their own intact. The Hmong would sometime slaughter live animals in the hospital for sacrificial ceremony; they would bang gongs; often more than 60 tribe members at a time would expect to be by the patients bed side. One doctor, a friend of Fadiman’s from college would jokingly suggest that the “preferred method of treatment for them (Hmong) was high-velocity transcortical lead therapy. (When asked what that meant, he explained, “The patient should be shot in the head.”)
Fadiman makes the small differences between the cultures the point of study. She honors radical difference while preserving the hope that through time understand, empathy, and healing are our natural aim.
I was assigned this book in a course I took a few years ago called, “Science, Ecology, and Contested Knowledge,” at the California Institute of Integral Studies. A fantastic course taught by Elizabeth Allison, we looked critically into sciences studies and how culture constitutes what shows up as “science”. The Spirit Catches You… is a course of luminosity into this truism, as it highlights the barriers and the “collisions,” between Western Medicine – a hyper-materialist worldview surrounded by experts, legality, and control – and the Hmong worldview – a collective spiritual animism, whose understanding of the entire world extends from its religio-sacred quality.
In one of Fadiman’s final chapter’s called, “The Life or the Soul,” she had sit down with an psychotherapist sympathetic to the Hmong’s worldview and one of the attending doctors familiar with the drama at MCMC brought by the Hmong and Lia’s case in particular. Over a discussion of Hmong shamanism, the psychotherapist volunteered that she had once told a doctor at MCMC that a txiv neeb (Hmong shaman) of her acquaintance had a direct line to God. The doctor had responded, “Well, I have a direct line to biochemistry.”
There are no conclusions to these matters. There is time. There is an open hospitality to change and common humanity. I was recently told that, The Spirit Catches You… is now, and has been for some time, required reading in many, many medical courses facing cross-cultural issues.