“The Spirit Catches You and You Fall” by Anne Fadiman
The Principles of Relational Practice in the book “The Spirit Catches You and You Fall” by Anne Fadiman
Health care is an essential aspect that requires actively participation of relational
practitioner. However, different cultures have different approaches of addressing patients
suffering from different health conditions. In that regard, health care become diversified based
on cultural beliefs, religion, and spirituality. Thus, the chief objective of this paper is to explore
the connection of the relational practitioner in line with the spiritual, religious and cultural safety
of Lia Lee in the American medical system as in "The Spirit Catches You and You Fall Down."
Mainly, the story provides detailed ethnographic research of Hmong culture based on the nature
of American medicine and the connection with relational practice.
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The book "The Spirit Catches You and You Fall Down" was written by Anne Fadiman to
explore how cross-cultural interaction can affect the process of medical treatment. Mainly, the
book presents the story of Lia Lee. Lia is a child brought up by her parents Foua Lee and Nao
Kao Lee. However, Lia Lee suffers epilepsy that propels her parents to seek further medical care
in a new destination (Fadiman, 2012). Unfortunately, she got worse and dies. Thus, the central
idea presented by Fadiman is to reveal how Lia Lee's tragic demise exposes the dangers of a lack
of cross-cultural communication in nursing and medical practice. The community represents a
group of refugees who have immigrated to California and has previously lived in the highlands
of Laos. Thus, the book demonstrates the challenges of seeking health care faced by refugees and
immigrants. The author uses Lia Lee as a reference to explore how refugees struggle in the
American medical system.
The Concept of Relational Practice in the Book
Mainly, the author presents a literary nonfiction work that chronicles challenges and
tribulations suffered by Lia Lee when seeking medical care. It is important to note that Lia Lee is
a member of the Merced Hmong population residing in California (Fadiman, 2012). Typically,
relational practice refers to the philosophy of understanding the health care needs of patients.
Thus, nurses, doctors, other health care providers can understand the basic needs of patients in
complicated contexts. Health care providers use reflective and respective strategies to determine
the health care needs and life experiences of patients.
Using the medical experience of Lia Lee, then it is possible to understand whether the
American medical system adhered to the principles of relational practitioners. Mainly, relational
practice is connected with anti-discriminatory social work, constructive social work, and anti-
oppressive social work (Fadiman, 2012). The perception of relational practice involves the
provision of a solution to social life issues to improve the well-being of society. The relational
practice is enhanced by coping action and reflective networks that ignore individualism.
Therefore, relational practitioners are relational guides of action and reflective networks.
Connection between the Book and Cultural Safety
Typically, the philosophy of cultural safety in "The Spirit Catches You and You Fall
Down" indicates how people cling to tenets established by their culture. People should
understand that relational practice is guided by the standard principles that enhance benefits to
both the patients and physicians. However, American medical practitioners involved in Lia Lee's
medical issues cling to various tenets of the American culture (Fadiman, 2012). The nature of
miscommunication between American doctors and Hmong patients indicates that the philosophy
of relational practice has not been applied. Therefore, the misunderstanding between American
doctors and Hmong patients is a form of cross-cultural problem that hinges on a disconnect
between the interests of two cultures (Spector, 2016). In relational practice, communication
between different parties is paramount towards achieving benefits to the patients and doctors.
Therefore, the differences between American and Hmong approaches of interpreting issues on
Lia Lee's medical experience are exacerbated by poor communication (Fadiman, 2012). Poor
communication is a constraint that undermines the implementation of relational practice.
In "The Spirit Catches You and You Fall Down," communication between American and
Hmong fails ideologically and linguistically. Therefore, the two cultures fail to establish a
common ground to assist Lia Lee in recapitulating her epileptic medical condition (Fadiman,
2012). In any medical setup, doctors are required to demonstrate relational practice through
compassion and empathy. Unfortunately, American doctors did not express compassion and
empathy when treating Lia Lee. According to Fadiman, use of compassion and empathy could
have assisted the American doctors and Lee's family to put their cultural differences aside
(Fadiman, 2012). In other words, America doctors and Lee's family are to blame for Lia's demise
because their compassion and empathy would have offered multifaceted and nuanced medical
care to treat her health condition. It is unfortunate that both the American doctors and Lees
neglected the philosophy of relational practice. Their ways of interpreting issues limited them
from stepping outside of their own deeply entrenched cultural beliefs that made it difficult for
them to work together.
In medicine, the philosophy of relational practice is the primary standard guideline that
connects patients with their doctors (Spector, 2016). Any party neglecting relational practice
contributes to miscommunication. Fadiman asserts that cultural differences limit relational
practice in Lee's story. In other words, the chief cultural miscommunication in "The Spirit
Catches You and You Fall Down" is a considerable concern in the provision of quality
healthcare. For example, the Hmong community believes that medical issues are intertwined
with essential elements that define human life.
Connection between the Book and Spirituality
The element of spirituality that relational practitioners should embrace is the helper
therapy principle (Fadiman, 2012). This principle allows relational practitioners to take the
responsibility of helping others. Their help has automatic benefits to the relational practitioner
who assists. The principle of the helper therapy has not been applied by American medical
practitioners who were handling Lia Lee's medical struggle. Fadiman tries to narrow down on the
nature of medical practitioners in the American medical system by focusing on the Lees
(Baldacchino, 2015). However, the author speaks with many members from the Hmong
community and several experts from the Hmong community to determine whether the relational
practice was applied. After considering how Lia Lee's issue was handled, the principle of helper
therapy was not applied. The story portrays the America medical system as a rich and complex
spiritual beliefs. Therefore, the idea of the author to reveal how the philosophy of relational
practice is ignored in medical systems is fueled by Lia's medical struggles (Jones, 2012).
Moreover, Fadiman's idea is fueled by an anthropological curiosity concerning the complicated
intersection between the American and the Hmong’s spiritual life.
In "The Spirit Catches You and You Fall Down" it is difficult to achieve the ideas of
relational practice because Hmong and American doctors do not subscribe to similar approaches
in healthcare. Hmong people believe that Lia Lee's health issue of epilepsy has an association
with the divine practice. They also believe that medical practice has a spiritual connection.
Therefore, cultural differences affect the performance of a relational practitioner, thereby
jeopardizing the health care status of the patient.
On the other, the American medical system presents a different view by claiming that
medical problems are based on various subdivisions of medical research (Murthy, 2016). The
health-seeking behaviour of many people in society does not align with medical
recommendations. Therefore, it is the role of doctors to set the way forward for those seeking
help. In the book, American doctors should have acted as relational practitioners to guide Hmong
people on the standard medical procedures to follow. Instead, Hmong patients associated Lia
Lee's health condition with broader issues in her life. On the contrary, Americans focused solely
on the body parts, causing the ailment through medical specialization.
A medical doctor aiming to act as a relational practitioner should consider the opinions of
the patient. After viewing the beliefs of the patient regarding the health condition under review,
the doctor should guide the patient on the best treatment based on medical skills and training.
Ideally, American doctors base their medical practice on research and science (Fadiman, 2012).
Therefore, cultural beliefs and spiritual beliefs partially guide American doctors in medical
practice. Cultural and spiritual beliefs are not research-based approaches in medicine that follow
logical reasoning. It seems that Fadiman also supports a relational practice that is research-based.
She even evokes Hippocrates' assessment of epilepsy by saying: "Men think epilepsy is divine
merely because they don't understand it. But if they called everything divine which they do not
understand, why, there would be no end of divine things" (Fadiman, 2012, pp. 67). This quote
emphasis that a medical doctor is acting as a relational practitioner should embrace research-
based evidence when providing medical care rather than dwelling on the cultural and spiritual
beliefs of patients.
In the book, Hmong people value the body because of spiritual beliefs. Americans value
the body in and of itself because they believe in evidence-based research in medicine (Fadiman,
2012). Besides, Fadiman claims that missing empathy and communication in Lia's medical care
proves an unwillingness of Hmong people and American doctors to reason together. This form of
attitude causes the demise of Lia because the attitude is difficult to adopt in relational practice.
Relational practice cannot work in conditions characterized by rigid confidence of people about
their beliefs and medical methods. If relationship practice was used in Lia's case, then American
doctors could have saved her life.
Connection between the Book and Religion
The principle of respect for humanity also guides the philosophy of relational practice.
Mainly, this principle claims that social problems are not inevitable because they often have
solutions, but it takes the dedication of relational practitioners to solve them; otherwise, they can
never be solved. Besides, a relational practitioner should not manipulate people so that they
agree with his opinions. In "The Spirit Catches You and You Fall Down," the principle of respect
for humanity is violated by both American doctors and Hmong people. Each group is rigid and
fails to accommodate ideas presented by the other group. For example, Foua Lee and Nao Kao
believe that epilepsy affecting their daughter Lia Lee is religiously connected (Rumun, 2014).
They even attempt to manipulate American doctors to believe the same idea. Foua Lee and Nao
Kao appear to prioritize their religion at the expense of the health condition of their daughter.
Similarly, American doctors are rigid about their medical beliefs. They prioritize their
beliefs at the expense of human life. As a result, through religious conflict, relational practice is
undermined, resulting in the demise of Lia. Thus, the action of American doctors and Hmong
people brings a misconception about humanity that forms the basis of relational practice in
Relational also practice emphasis on the network's action and individual neglect action. In other
words, social problems can be solved through the network's action. In "The Spirit Catches You
and You Fall Down," individual action dominated the while story (Baldacchino, 2015). For
example, Hmong people wanted Lia Lee to be treated based on their religious beliefs about
On the other hand, American doctors wanted to treat Lia on research-based evidence. The
confrontation between the two groups compromised human life. If the relational practice were
used in Lia's case, both groups would have consulted each other and unanimously decide how to
treat Lia Lee. These groups attempt to cope with uncertainty and grief of medical complications,
a young girl by assigning blame. Blaming each other is not the solution because their negligence
and religious differences caused her demise (Fadiman, 2012). Relational practice implement
ethics, and it is unfortunate the American doctors and Hmong people continuously seek to
determine the group acted ethically and which acted unethically. Hmong people are angry that
American doctors fail to acknowledge their beliefs about health conditions affecting Lia. On the
other hand, American doctors feel disappointed and disrespected by Lee's family due to their
unwillingness to trust their medical views.
To sum up, the story presented by Fadiman illustrates how a lack of relational practice
can compromise human life. In health care, it is essential to dismiss some beliefs and act
according to the issue at hand. It is quite challenging to determine which culture violated the
philosophy of relational practice in Lia's case. However, one can frankly say that Lee's family
and American doctors failed to demonstrate compassion and empathy to define a relational
practitioner in health care. Therefore, the relational practice requires the unity of stakeholders
involved in a case. Overall, the non-hierarchical comparison between Hmong spirituality and
Western medicine demonstrates how society undermines relational practice, thereby resulting in
Baldacchino, D. (2015). Spiritual Care Education of Health Care Professionals. Religions, 6(2),
Fadiman, A. (2012). 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.
Jones, D. A. (2012). Loss of faith in brain death: Catholic controversy over the determination of
death by neurological criteria. Clinical Ethics, 7(3),
Murthy, V. (2016). From religion to spirituality (1 st ed.). Chennai: Notion Press, Inc.
Rumun, A.J. (2014). Influence of Religious Beliefs on Healthcare Practice. International Journal
of Education and Research, 2(4), 37-48. https://ijern.com/journal/April-2014/05.pdf
Spector, R. E. (2016). Cultural diversity in health and illness (9 th ed.). London: Pearson.