Philosophy Of Medicine The Spirit Catches You and You Fall Down By Anne Fadiman Deepa Parikh April 27,0000 Professor Tauber PH273 The book, the Spirit Catches You and You Fall Down by Anne Fadiman is an objective look into the world of two different cultures and their belief systems. The viewpoints of the Hmong and of the American doctors represent Hmong culture and the root of Western medicine. The book takes into account how two cultures, rather, two completely opposite worlds are collided and their impact on each other (Fadiman 1997). The book uncovers the underlying meaning of how different Western medicine can be from different cultures and its challenges and consequences. In addition, Fadiman questions the very basics of philosophy by taking into account the simple metaphysics and moral ethics that face Lias doctors and parents and what role society plays.
The book questions the belief system of Western medicine as well as the Hmong beliefs and cultural practices. Fadiman encourages us to think of the root of Western culture and medicine as well as learning about the Hmongs beliefs. Which is more relevant? When a patient is in a life or death situation, whose opinion and expertise on medicine holds higher ground? In the case of Lia Lee, this was the problem. Why was Hmong culture and practice irrelevant in the eyes of the many doctors and nurses that cared for Lia? Reading this book, it is obvious to see the philosophy of western medicine versus the Hmong culture. This book helps clearly define western culture and its biomedical system by contrasting it to the Hmongs. The book, more than anything, else analyzes the epistemological, metaphysical, and moral viewpoints of both western medicine and that of the Hmong culture and questions their validity and effectiveness.
Epistemology is the theory of knowledge(Tauber). In this book, the theory of knowledge can be posed by one question. How did Lea get sick? This question leads to two different viewpoints Western medicine and culture and the Hmong. The root of Western medicine is biomedicine. What makes biomedicine unique and sets it apart from other cultures is the idea that there is only one answer and one truth behind that.
Simply stated, it is a matter of facts and the question of what, not how(Tauber). This is the primary difference between Hmong culture and Western medicine. In the book, Lias doctors wanted to know the one problem that was causing Lia to have severe seizures. They neglected to ask how Lia got sick. The view of Lias parents was the complete opposite.
They wanted to know how Lia got sick and if this meant Lia was blessed with a gift and would become a txiv neeb(Fadiman). To understand the epistemological perspective of the Hmong, we must first take into account their cultural identity and how they practiced it. The Hmong were adamant in their belief system and were wary of the doctors in Merced in there care of Lia. Under their care, they believed; Lia would have been healed. The Hmong cultures to cure an illness, in Lias case the quag dab peg, there were animal sacrifices made.
Lias parents say that Lias soul had left her when her sister had unintentionally slammed the door. This rationalization that the door frightened Lia and was the cause of the series of medical problems she would face, is an example of the epistemological view of Lias parents. It was interesting to read in the book, as Faddiman recounts, the way the doctors treated Lias parents. Because of the cultural barrier, communication problems pertained to everything from signing a document to administration of medication for Lia. Because of the cultural barrier, there were problems of moral ethics as well.
Did the doctors ever take into account the parents wishes for their child? Lias parents believed that the only medication they were willing to give Lia would be the kind that would be fast and preferably in a pill. The Hmong culture is against shots and blood being taken in large quantities as well as anything that could affect the dab and cause evil spirits to enter her soul(Fadiman). Epistemologically speaking, the doctors had a completely different viewpoint of what happened to Lia than her parents. From the doctors point of view, their main concern was not primarily how Lia got sick but rather where the existence of the illness came from. There main goal as Lias doctors was to stop the seizures that were taking control of Lias body and to do that they needed to know where the problem was located. Was the uncontrollable epilepsy caused by a neurological deficit in Lias brain? On the other hand, was there something microscopic that the doctors could not see that caused Lia to have a unique disease that had nothing to do with normal standard epileptic patients? This is where the Hmong perspective and the view of Western medicine take different paths.
One could question if they were ever on the same path to begin with. The doctors questioned where the illness came from while the Lias parents asked how. Epistemology is derived from the Greek episteme, meaning knowledge, and logos, which has several meanings, including theory.(www.comptons.com). Whereas metaphysics is concerned with the underlying nature of reality, epistemology deals with the possibilities and limits of human knowledge. It tries to arrive at a knowledge of knowledge itself(www.md.com).
It is also a speculative branch of philosophy and tries to answer such questions as: Is the world as people perceive it the basic reality, or do people perceive only appearances (or phenomena) that conceal basic reality? What are the boundaries between reason and knowledge, on the one hand, and what some thinkers call the illusions deriving from metaphysics? What is the basis for knowledge? Is it observation, experience, intuition, or inspiration? On the other hand, is there some other basis?(www.comptons.com) In Lias case, the basis for knowledge stemmed from two completely different cultures. The belief and basis for knowledge that the Hmong had believed for years centered on the sprit and the dab. Western medicine was far more narrow and straightforward dismissing any idea that the practices and rituals of the Hmong would be of any help. Knowledge may be regarded as having two parts. There is, first, what one sees, hears touches, tastes, and smells. Next there is the way these perceptions are organized by the mind to form ideas or concepts. The problem of epistemology is based on how philosophers have understood the relationship of the mind to the rest of reality(Tauber).
The Hmong believed in animal sacrifice and treating the body with herbs and liquids rather than injecting the patient with needles and drawing blood. This process harms the individual according to the Hmong, and damages it so the soul will have a harder time coming back. One of the primary concerns with the treatment of Lia was the medication she was on. Since doctors did not know for certain what Lia had and what was causing her seizures, numerous combinations and doses of medicine were given. From the doctors perspective it was all they could do at the time(Fadiman 97)). Lias parents believed that the administration of so many drugs was the problem.
In addition, the cultural barrier led to frustration and anger when medication was not given properly and when Lias parents decided against western medicine. Since the Vietnam War ended in 1975, approximately 150,000 Vietnamese refugees have begun their lives in the United States in Westminster, Calif., and a community south of Los Angeles in Orange County(Fadiman 97). Similarly, ethnic communities of Laotians and Cambodians sprang up in such states as Texas, Louisiana, Illinois, Washington, Oregon, Virginia, Minnesota, Florida, and Pennsylvania. California had the largest concentration of all Indo-Chinese groups, except for the Indo-Chinese Hmong, formerly a mountain-dwelling people of Vietnam and Laos, whose largest community was in Minnesota(www.comptons.com). Each group had its own language and culture and preferred to live isolated from the others.
The refugee problem in Southeast Asia had been escalating ever since large-scale bombing attacks were launched on North Vietnam in the mid-1960s. By the end of the conflict thousands were homeless and thousands more sought refuge from the victorious Communists. American military forces evacuated many of the Vietnamese (among who were large numbers of ethnic Chinese). As repression and genocide followed the Communist takeover, still more refugees fled. Among them were vast numbers of boat people, who used any sea vessel at their disposal to escape Indochina. Many were first sheltered in refugee camps throughout Southeast Asia before reaching the United States(www.comptons.com). While these immigrants were allowed into the United States under various refugee laws, the government sought the help of volunteer agencies to find American sponsors and to arrange for jobs and housing.
The immigrants were then sent to various parts of the country to begin new lives. The government’s purpose in this program was to scatter them and thus prevent the growth of ethnic colonies such as the one that developed in Westminster(www.comptons.com). The plan failed quickly. Not long after their original settlement, the refugee families, driven by loneliness, began to relocate to ethnic communities. Thus, the present settlement of the Indo-Chinese refugees developed from this second migration.
These resettled immigrants found life difficult. While most of the first Indo-Chinese refugees had been well-educated city dwellers, the later arrivals came from rural backgrounds and had limited, if any, schooling. (The Hmong, for example, were subsistence peasants without a written language.) They did not speak English, and their few skills were useless in an urban, industrialized society. Many suffered from physical and psychological traumas that they had experienced before fleeing Indochina(Fadiman 97). Desperate for money and humiliated by their oppressed situation, a few turned to criminal activities, but most worked hard to become less dependent upon public aid. Members of large families usually helped one another with living expenses and education costs. The origin of Hmong, I felt, was an important component in understanding where the Hmong came from and why, in America, they secluded to themselves far more than any other race. Fadiman goes into detail about the history of the Hmong and their culture struggle to keep their identity. What I found interesting was that even in America where the Hmong attained their freedom, they were still unhappy.
The cultural barrier was never broken partially because the Hmong did not want to assimilate and lose themselves. Consequently, they often secluded themselves and did not bother learning English and finding jobs. What they wanted most of all was a piece of land where they could grow food and livestock to survive and practice their beliefs. Ironically, they fled their country to be free and came to America, only to feel the opposite. In Lias case, there was an underlying question to Lias sickness.
The main question was why did Lia get sick? The doctors questioned the existence of Lias sickness while her parents questioned why there ever was an illness. Lias doctors looked to rationalism and logic while her parents took this as a sign to mean that her symptoms made her special. They said that Lias condition was because she possessed a special trait that the txiv neeb also possessed. Her parents thought she was blessed in a way. Metaphysics is a word coined almost accidentally. It is the title given to a book written by Aristotle after he had completed his ‘Physics’, and it was placed immediately afterward in the body of his writings(www.askjeeves.com). Whereas ‘Physics’ deals with the observable world and its laws, ‘Metaphysics’ is concerned with the principles, structures, and meanings that underlie all observable reality. It is the investigation, by means of pure speculation, of the nature of being–of the cause, substance, and purpose of everything.
Metaphysics asks: What are space and time? What is a thing and how does it differ from an idea? Are humans free to decide their fate? Is there a first cause, or God, that has made everything and put it in motion?(www.comptons.com) The view of Western beliefs and ideology are reinforced in the book that the doctors of Merced knew more about Lias sickness and medicine in general based on their knowledge of Western medicine. The doctors of Merced felt that the medicine they practiced held a higher ground, in their eyes, and most believed that the Hmongs …