Medical, racist, and colonial constructions of power in anne fadiman's the spirit catches you and you fall down

Author(s):

Chiu, Monica

Format:

Book section

Publisher:

Rutgers University Press, 2010.

Language:

English

Abstract:

This essay is about medical, racist, and colonial constructions of power. It incorporates the following seemingly disparate, but what I will prove to be inextricably connected, discourses: Those surrounding the Vietnam War and its subsequent stateside refugee management; current medical care for Southeast Asian patients; and so-called authorial (medical, textual, cultural) constructions of Hmong representation. My critique is based on a reading of literary journalist Anne Fadiman's The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures,1 her re-presentation of the actual case of epileptic Hmong American child Lia Lee. Her book raises thorny questions concerning why Lia's "proper" care remains a contentious debate between medical knowledge and Hmong cultural practice; how the historical construction of Asian American identity contributes to present and continued Hmong mythologization and feminization and to the Lees' identity as deviant parents; and how Fadiman's often ethnographic, and not always critical, text often contributes to reinscribing her subjects into the very colonial parameters from which she attempts to extract them. My work offers new readings of the book's stated "cultural collisions" in which cross-cultural healing is both accomplished and simultaneously denied via practices that Fadiman interrogates and employs. Briefly, Lia Lee was born in July of 1982, in Merced County, California, to firstgeneration Hmong2 refugees Fuoa Lee (her mother) and Nao Kao Lee (her father) as their fourteenth child. Delivered naturally and in good health, she suffered from her first epileptic seizure at three months of age. While the physicians conclude that Lia has suffered from an "electromagnetic storm inside her head," the more eloquent, iatric articulation of an epileptic seizure, they are unaware that the Lees have attributed Lia's symptoms to qaug dab peg, or "the spirit catches you and you fall down." Her family blames her condition on the departure of one of Lia's many spirits- The one responsible for health and happiness-which occurred at the moment her elder sister Yer accidentally slammed the door with such ferocity that she frightened a dab, a spirit, away (10, 20). The Lees intend to retrieve the lost dab through a shaman. The Hmong view those experiencing qaug dab peg as shamanistic, their seizures mimicking the trance-like states of shamans in the throes of contacting other-world spirits. Hmong medical and spiritual practices are steeped in animism-wherein spirits are ascribed to beings and objects and can be frightened away, causing disease and death- And shamans represent a necessary and positive link between the body and the lost spirit, between the world of the living and the dead. They are the designated arbiters between the corporeal and the spirit world, recalling lost spirits and relaying augurs of ill or good fortune through trance and animal sacrifice.3 At Merced County Medical Center (MCMC), however, such cultural explanations carry little weight in effecting a cure, even though the hospital had treated numerous Hmong patients since the late 1970s who made so-called unusual medical requests. Throughout Lia's subsequent, numerous, and severe seizures, MCMC legitimizes its own narrative, here the brain's "electromagnetic storm" and the appropriate use of drugs to quell them, despite frequent consternation exhibited by the Lees. Yet the family continues to transport her to the emergency room, placing some faith in Western biomedicine. Much to MCMC's and the Lees' anguish, Lia is eventually pronounced brain dead at five years of age but continues to live a vegetative existence disconnected from any life support system. That both MCMC and the Lees hoped for another outcome is the sole narrative uniting the two fraught parties throughout the ordeal. I therefore probe the limits of medical, colonial, and authorial knowledge and their attendant (often racist) power within this complicated case; my work investigates the value strategically attributed or denied to "culture" (whether medical culture or history) in order to refine the interconnecting parameters within and to respect the intermittent gaps between Lia's illness and health as they are inextricably bound up in a constant negotiation of Asian American cultural citizenship. My reading of Spirit involves an assessment, mediated by Fadiman, of what counts as knowledge for MCMC, for the nation, for the Lees, and for Fadiman herself, and how such competing knowledge constructs the involved actors and the medical establishment; how such knowledge is shaped by the politics of U.S. colonialism vis- À-vis Southeast Asian refugees and Asian American identity construction, broadly. I map Fadiman's motive to illuminate the Lees' healing beliefs against those of MCMC. Fadiman intends to unpack-yet often inadvertently problematizes- The utility of MCMC's diagnostic praxis in the face of the Lees' mytho-cultural perceptions shaping the life- And-death assumptions of Lia, its central, Asian American patient. Intertwined within this medical case is an historical narrative of the fraught acceptance and rejection of Asian Americans in general, and Hmong acceptance in particular, that exacerbate conditions surrounding the treatment of Lia's parents and therefore their growing consternation over Lia's declining condition and their escalating frustration with the MCMC staff. Because the Hmong threaten accepted, routine operations of not only this California County, but of MCMC's health care practices, both Fadiman and I necessarily contextualize the figure of Lia and the cross-cultural difficulties surrounding her care. I keep my summaries of necessary historical information-necessary both to understanding Fadiman's argument and to grasping mine- To what I consider a bare minimum. My discussion, unlike Fadiman's, considers how Asian American disruptions to the nation have resulted in Asian Americans' pathologization and internal colonization. That is, Southeast Asian refugees and immigrants (from Laos, Vietnam, Thailand, and Cambodia) are the most recent targets in a national, racist trajectory that has systematically vilified Asian American immigrants as "alien" and " polluting" threats to the health and welfare of the nation despite a seeming vindication as model minorities.4 As such, Lia is doubly de-humanized: first by her illness and then by her classification as Asian, which evokes an historical pathologization and feminization of Asian subjects, which I will discuss later. The frictions animated through Lia about the diagnosis and treatment of her epilepsy occur not only between MCMC's so-called paradigmatic Western (read: masculine) biomedicine5 and the Lees' Asian, feminine, mytho-cultural beliefs about the relevance and conception of the body; but the frictions also vex Fadiman's representation of the case in which she criticizes the colonizing practices of MCMC only to replicate them in her portrayal of the Lees. In this interpolated tale, written by a literary journalist who is neither a medical anthropologist nor an ethnographer, the narrative itself raises puzzling questions about her intent, her authorial method, and her audience. She finds "how hard it was to lay blame at anyone's door"-either with the Lees or Lia's medical staff-for the child's eventual, vegetative state at five years of age (x). Rather, she blames "crosscultural misunderstanding" for this particularly tragic case deemed "preventable" by Lia's physicians (262, 55). Despite such attempts at neutrality, Fadiman leans heavily toward sympathizing with the Lees, thus obligating the reader to untangle the various unspoken assumptions and strains that inflect the text and from which one gleans an understanding of Lia, her parents, and her physicians. Within the essay, I offer answers to the following complicated questions: How are Lia's parents being read (or even managed) by Fadiman? Is Fadiman's text a dialogic bridge between medical authority and cultural adherence? If the Lees' words and actions are Fadiman's interpretations of translations-given that her knowledge of the Hmong is circumscribed by her Western ways of thinking and given the Lees' inability to speak English-how do readers responsibly interpret Spirit, especially if the Hmong are known to strategically deliver only "acceptable" cultural information to their Western counterparts? 6 For whom, then, is the book written? Even if the Lees had spoken for themselves, would we understand their voices as partially constructed fictions accorded to Fadiman's purpose? And most pressing, whom does Spirit serve: did the Lees solicit Fadiman in order to make their story known or did Fadiman pursue this cultural drama? In the third section of the essay, such an analysis of the book's ur-narrative-Fadiman's contextualization through an ethnographic gaze that often renders the Lao Hmong exotic-complicates and contributes to Spirit's complexity and therefore to the urgency of negotiating cross-cultural solutions in an increasingly multicultural nation that, unfortunately, practices varying types of subtle but powerful and devastating colonization. © 2010 by Rutgers, The State University.

ISBN:

9780813545745 (ISBN)

Identifier:

HmongStudies0484