Rod of Aesculapian licensed by Pixabay
by Vladimir Chindea
“The Promise” is a contract that tied the Hmong of Laos with the C.I.A. personnel during the Vietnam War. In exchange for this ethnic minority’s loyalty in the fight that the Americans led until 1975—and the resulting persecutions and mass migrations that followed their loss—it is still unclear what the imperial power guaranteed to them: this pact only rescued Hmong high officers from Long Tieng, hardly accepted the rest as refugees, and gradually withdrew welfare from the ones who landed in the United States (Fadiman 201). Yet the lack of transparency of this initial contact determined a lot more than the hectic attempts to solve the humanitarian crisis that followed the political alliance; it shaped the relationships between both communities for decades.
In The Spirit Catches You and You Fall Down (1997), the reporter Anne Fadiman blends the genres of literary non-fiction, historical narrative, and testimony to tell a very similar story of misunderstanding—connecting the destiny of Hmong refugees in the U.S. with the moral hegemony that first provoked their displacement. She chronicles various episodes of the Lee family’s struggles not only against the violent seizures provoked by the disease of their beloved, Lia, but against the American medical system that is in charge of the young child.[1] Indeed, among many events, from the increasing amount of drugs injected into Lia’s body to her 11-month placement into foster care, Foua and Nao Kao see their daughter’s mobility and health degrading in a tragic way.
Although Fadiman believes Lia’s life was ruined by cross-cultural misunderstanding, the moving story that she brings to the surface suggests much more. It reminds us that, before even considering the possibility of understanding one another, two parties have to be able to clearly communicate and, before anything else, be genuinely willing to do so. In fact, Lia’s destiny conveys that it is love that can bridge the gap existing between two cultures.
Language is a set of fundamental tools of communication within and across cultures. Before scrutinizing (mis)understanding, the multiple chapters about the life of the Lees invite the reader to question its possibility through cases where one cannot even project words with the certainty of being received by others. Indeed, as reported in Fadiman’s work, the lack of preparation from the United States to offer appropriate linguistic resources to Hmong refugees combined with the Lee’s English illiteracy created multiple challenges for the family. For instance, on October 24th, 1982, when Foua and Nao Kao carried Lia to the emergency room of the Merced Community Medical Centre (MCMC) for the first time—luckily located only three blocks from their apartment—the hospital had not hired any Hmong interpreter (Fadiman 25). As a result, the parents of the child were not only unable to properly describe the seizure that caused Lia’s misdiagnosed bronchial congestion, but they also did not understand the signed paper containing medication instructions (Fadiman 26). Without an interpreter, the messages concerning the health of Lia could not even reach the parents’ minds. Their resulting meaninglessness augments frustration while opening paths for false assumptions about the other —such as the idea that Foua and Nao Kao mistreat their daughter or that the hospital wants to steal her from them. In this repeated case, it is not even cross-cultural misunderstanding that impedes measures to improve Lia’s conditions; it is the literal absence and void of communication—and, therefore, the impossibility to understand—that is responsible for it.
Furthermore, when Fadiman decides to learn more about the Hmong cultures by encountering various members of their condensed Merced community, she quickly realizes that, even when there is a proper interpreter, certain things cannot be translated from one language to another. As lengthy and animated conversations in Hmong were sometimes turned into short English words, the reporter pinpoints that there are ideas, expressions, and stories that cannot be shared (Fadiman 94). They are simply lost in translation—emphasizing the impossibility to communicate, and a seemingly insurmountable barrier of even conceiving the notion of understanding. Thus, it is a lot more than words that the Lees and the doctors are unable to express to one another: it is their entire worldview that words clumsily try to reveal.
In Fadiman’s text, the paradigms of the Americans and the Hmong are also extremely rigid and almost mutually exclusive. In fact, besides the idea that it is literally impossible to convey them with words, Lia’s story further adds that, before even discussing misunderstanding, one must realize that both the doctors and the parents lacked the genuine desire to try to comprehend the other’s worldview. The clearest example is their respective perception of Lia’s seizures. While Foua and Nao Kao would have been intrigued to even consider that their daughter suffered from epilepsy, one of their doctors, Dan Murphy, “would have been surprised to hear that they [the seizures] were caused by soul loss” (Fadiman 28). The gap between the conceptions of Lia’s suffering itself could not have been bigger since, until the end of the book— when a txiv neeb, a shaman, performs a traditional and sacrificial practice over the brain-dead body of the child (Fadiman 284)—Western medicine always described her state as a physical disease while the Hmongs solely focused on its spiritual dimension. This shared attitude only reinforced the rigidity of both paradigms.
On the one hand, Fadiman notes that, since Foua and Nao Kao believed that the prescribed drugs actually caused Lia’s illness, doctors might find themselves “running up against that stubborn strain in the Hmong character which for thousands of years has preferred death to surrender” (Fadiman 51). This paradigm—striving to save the Hmong ethnicity, ways of life, and to resist assimilation from Western medicine (Fadiman 183)—definitely pushed the parents to be strong enough to take care of Lia at home when hospitals gave up on doing more for her vegetative state. On the other hand, the intransigent mindset of the American doctors also led Dr. Neil Ernst, witnessing that Foua and Nao Kao refused to administer medications to their child, to send Lia to foster care (Fadiman 81). Both of these cases demonstrate how far the respective worldviews—and everything they encompass, from language and spiritual beliefs to daily habits and healing customs—not only obstruct each stakeholder’s grasp of their counterpart’s understanding of Lia’s illness, but that they self-legitimize actions that mutually exclude them.
In the aftermath of Lia’s most important seizure, the questions that Fadiman asks Neil about the outcomes and the ways he dealt with the Lees further prove the inelasticity of his American worldview. Although he asserts that Lia’s case made him “into a less rigid person,” this response follows the one in which he claims that, if he had to do anything differently, he’d “accepted that it would be easier for the family to comply with one medicine instead of three, even if three seemed medically optimal” (Fadiman 257). This contained contradiction is particularly striking because the doctor is not even aware of it! Indeed, it is totally absurd to realize that, at the same time that he believes that this troubling episode changed his fixed mindset, the solution that he suggests stays exactly within his worldview. Neil does not even consider engaging with the Hmong spiritual practices. This highlights the fact that he is not able to identify the pitfalls of his medicine despite how lamentably it failed and worsened Lia’s condition (Fadiman 255).
Although psychiatrist and medical anthropologist Arthur Kleinman recommends doctors to find a member of the Hmong community to find mediation between seemingly exclusive paradigms, the story of love that Fadiman’s chronicles convey seems to suggest that it is through this universal human emotion that one can end moral hegemony. To demonstrate this point, the reporter compares the approaches of both social worker Francesca Farr and the one of Neil and Peggy. The former did a lot more than like the Hmong to work successfully with them and with the Lees: she “loved them” (Fadiman 265). Farr always put her own beliefs system aside when working with them, almost never said anything about Western medicine, and consistently treated them as equals in their ways of seeing the world (Fadiman 265). It is as if true love and care for another human being are universally and intrinsically linked with the notions of respect, reciprocity, cultural appreciation, and genuine attempts to understand the other.
Contrarily, even though Neil and Peggy liked the Hmong, Fadiman emphasizes that they “did not love them” (Fadiman 265). The reason why they could not love is their lack of tolerance regarding the way that the Lees dared to even question their medical abilities because of their different cultural worldview. The couple of doctors not only have nightmares regarding who will have the responsibility to deal with Lia’s worst seizure—Neil did—but they also get frustrated and angry because of their fear of failing (Fadiman 57). Graduated from the best medical schools and benefiting from lifelong-built notoriety, neither Neil nor Peggy could bear to admit that their scientific certainties can mislead. Unfortunately, they did. It was their prescribed medication that compromised Lia’s immune system and made them lose hope after she became brain-dead (Fadiman 255).
Against all the odds, as explained by Fadiman in her 2012 afterword, Lia was nonetheless able to survive until the age of thirty—with the annual visits of a txiv neeb and the care of her parents at home (Fadiman 289). It is the love of Foua and Nao Kao that kept her alive. It is this book about the possibility of cross-cultural love that unveils novel ways to avoid misunderstanding.
Even though Fadiman claims that Lia’s life was ruined because of cross-cultural misunderstanding, this complex story seems to disclose that, actually, both the American doctors and the Lee family did not even attempt to understand each other in the first place. Linguistic impediments and comfort with one’s system of beliefs explained this mutually exclusive attitude. This being said, the various actors who played a critical role in the well-being of Lia and her parents also reveal a crucial dimension to what the author pictures, in the preface, as “where the edges meet” (Fadiman viii): the importance of love. Since ethnocentrism and individualism characterized the Americans’ first approach with the Hmong in the 80s, Fadiman shows that to have peaceful contact with another culture and to ensure co-existence is a question of mental models. Indeed, a vision of love—shaped with genuine care, cultural humility, respect, and real attempts to understand the other—can overcome the boundaries existing between two different paradigms.
With Lia’s story, it seems that a new contract between Americans and Hmong can be made to advance reconciliation: a Promise of Love. But with the current humanitarian crises in Syria, Yemen, and Venezuela, to name a few, the question remains: is Uncle Sam ready to learn anything from it?
Works Cited
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. Edition of 2012.
[1] The italicized words draw attention on the ways that the analyzed text constantly challenges the reader’s view on the nature of the perceived anomaly and on the legitimacy of who should be responsible.