Around the World in Eighty Books

In which I read and reflect on eighty books from around the world.

Archive for the category “USA”

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

I initially chose to read The Spirit Catches You and You Fall Down by Anne Fadiman simply for pleasure, but then I realized that it would be a perfect second entry for this blog. Although the author is American, the book addresses many multi-cultural issues, namely the interactions – and especially miscommunications – between Hmong immigrants in the US and their American doctors. Fadiman’s book is a self-described “fish soup”, a non-fiction account that weaves many different perspectives and timelines together into a cohesive, complex narrative, which allows her to capture more truth than if she’d used a more traditional style of reporting.

I really admire Fadiman’s dedication to her project and impressive lack of ethnocentrism. The book is tied together around the case of Lia Lee, an American-born Hmong girl with severe epilepsy. Fadiman interviews doctors, social workers, anthropologists, and pyschotherapists as well as the Lee nuclear family, their extended family members, clansmen, and many prominent members of the vibrant Hmong community in Merced, California in order to understand her story and put her family’s perspective in context. Through the retelling of fables, anecdotes, case studies, and historical accounts, she also provides exquisite context for understanding Hmong history and culture, as well as the culture of biomedicine in the US (Fadiman 273).

Fadiman doesn’t dwell overly on distinguishing right vs. wrong, nor does she slip into cultural relativism. Instead, the focus of her book is cultural (mis)communication. More specifically, she explains how each side’s misconceptions and biases, as well as their shared language barrier, contribute to a mutual lack of trust and poor doctor-patient relationships (and therefore poor medical care). She also makes great effort to explain many of the parables, traditions, and beliefs of this Hmong community, which really bring the story to life. To my knowledge, hers is the most well-known book in the US today about the Hmong.

Cultural understanding requires cultural brokers, third parties who understand the languages and cultures of the involved parties (in this case the American doctors and Lia’s family) and can ease understanding and communication between them. And to crudely paraphrase what Fadiman states more eloquently, cultural brokers must be treated as equals instead of as mere word-for-word translators. They must even have the power to give commands, in order to get one party to do something which the other party may not know how to ask for. For example, Fadiman cites a case in which a Hmong husband wouldn’t let his pregnant wife take the pills prescribed to her by her doctor (264). Her doctor’s interpreter acted as a cultural broker by correcting the doctor’s breaches of Hmong etiquette (ex. by having her talk to the husband instead of his wife, and by having the doctor wish him good health and happiness before addressing medical issues). This relaxed the patient and her husband and helped her gain their trust, and as a result the pregnant woman took her pills.

The questions about parenting and medicine that Fadiman asks have real, potentially life-saving (or conversely, fatal) consequences. Their answers will change how patients interact with their doctors, what kind of care they receive, and doctors’ attitudes toward their patients when both come from different cultural backgrounds. These are some of the most interesting questions:

Should parents (or legal guardians) have the right to deny medical care to their children?

According to Fadiman, when a consenting adult declines medical care of some kind, most doctors may grumble but readily accept the autonomy of an individual and the right for an individual to refuse medical care. However, most become incensed when a child, too young to make decisions for herself, is denied access to modern American medical care when it could save her life. You can martyr yourself, but you can’t martyr your child (80).

Should doctors tailor their treatment methods to fit better with their patients’ cultural backgrounds?

As Fadiman herself asks, “Which would have been more discriminatory, to deprive Lia of the optimal care that another child would have received, or to fail to tailor her treatment in such a way that her family would be most likely to comply with it?” (78).

– How should doctors address their patients’ needs if there are no resources available to understand a patient’s cultural background (e.x. because of a lack of interpreters or cultural brokers)?

This book should be required reading for anyone who wants to learn about Hmong, lives near  Hmong communities, or wants to work in medicine or child protection services. Although to be perfectly honest, I think everyone should read this book. I feel obliged to issue a tissue alert for Lia’s story, to say nothing of the wartime recollections of Hmong who fought for the US in Laos. Were it not for the fact that I read most of it in a public setting (i.e. on the Metro) I would surely have cried many times.

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The Man in the Black Suit

The first stop on my adventure is the short story “The Man in the Black Suit” by famous American horror writer, Stephen King. I am not very familiar with King’s work, but I really like this story. According to the Wikipedia entry on this story, “The Man in the Black Suit” won King an O. Henry Award for Best Short Fiction in 1996. And I can see why, since this is a fantastic story. As one who loves linguistics and word humor, I appreciate that King creates words like “troutiest” (407) and “gaggy” (413) because that is exactly how nine-year-olds think, and it makes for better reading. The dialogue is very believable all-around, including one exchange in which Gary’s mother corrects his grammar.

The Man in the Black Suit by Stephen King

Story summary to follow. *SPOILER ALERT* You have been warned!

This macabre tales begins as a reflection told by Gary in his old age as he recounts an episode that happened in his youth. Gary recounts a fishing expedition one day in which he catches several fish before he falls asleep. When he awakens, he is frightened to discover a bee perched on his nose, primarily because his brother Dan recently died of a bee sting. Suddenly he hears a loud clap and the bee falls dead into his lap. Gary turns to see the terrifying figure who clapped to kill the bee, a man dressed in a long black suit with flaming pits where his eyes should be. Gary is immobilized with fear as the figure, whom he intuits to be the Devil, approaches him. The Devil tries to convince him that his mother just died from a bee sting, so therefore Gary should allow the Devil to eat him and end his misery. Gary offers the Devil one of the gutted fish that he caught before he runs away, and the Devil gives chase. The Devil disappears after a long chase and Gary finds his father, who returns to the stream with Gary to collect his fishing gear and assure him that his mother is alive and well. The reflection ends, and the present Gary reflects that he lived a normal, happy life despite this incident, although now at death’s door he begins to fear once more a meeting with the Devil.

I chose this story because I am intrigued by how the terrorizing and calming aspects balance each other in interesting ways. The ending maintains the fear built up through the story, but also illustrates Gary’s struggle against his fear, which was successful in that he lived a long, fruitful life. I am not frightened easily, but while reading this alone at night in my room, I jumped when the phone rang. I was also tempted to choose this story because its creepy, morbid tone is so perfect for a Halloween posting.

BOO!

King was heavily influenced by H. P. Lovecraft and Nathaniel Hawthorne. King is said to have named Hawthorne’s story “Young Goodman Brown” as the direct inspiration for “The Man in the Black Suit” (Wikipedia). But unlike Lovecraft and Hawthorne, King paints a more redemptive vision of mankind overcoming evil.[i] In King’s story, Gary’s parents are there to protect him, to scare away the Devil. I appreciate that King contrasts suffering caused by evil versus more natural causes, ex. the bee that kills Dan. Also, it’s worth noting that the Devil kills the bee on Gary’s nose.  I think King does this to make a clear distinction between the pure evil of the Devil and natural harm, an interesting juxtaposition between man and nature. The bee that killed Dan acted out of instinct and didn’t realize what it was doing, but the Devil is evil for putting Gary through intentional suffering (something which neither plant nor animal nor mineral, but only mankind can do).

Just before he meets the Devil, Gary says “If I had accepted this as gift enough for one day and gone back, I would not be writing now,” but he didn’t, and so he meets the devil (409). This statement sets a suspenseful mood for the reader, who has no idea what dangers will soon arise, and says a lot about the author’s belief in the nature of good and evil. The author and narrator both view Gary’s meeting the Devil as blind luck, just like the bee sting. Gary does not meet the Devil as punishment, nor as a cog in a machine, but rather through random chance.

And while meeting the Devil was bad luck, escaping from him was good luck. At the end of the story, the author reaffirms this position through Gary’s reflection that as the years pass, ”I feel more and more strongly that escaping him was my luck – just luck, and not the intercession of the God I have worshipped and sung hymns to all my life” (423). Yet King’s portrayal of loving, kind parents who take an active role in protecting Gary – such as when his father takes him to see his mother and face his fears – suggest that perhaps mankind is not always victim to pure luck. King seems to suggest that good people can and will protect the innocent (i.e. children), and more broadly that good will triumph over evil.

And on that pleasant note, Happy Halloween! 😀


[i] King, Stephen. “The Man in the Black Suit.” Telling Stories: An Anthology For Writers. Ed. Joyce Carol Oates. New York: W. W. Norton & Company, 1998. 387, 388, 405-423.

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