The importance of cultural awareness and communication - Book Report/Review Example

? The importance of cultural awareness and communication. [Book Report on: The Spirit Catches You and You Fall Down The importance of cultural awareness and communication. Section 1. The title of the book The Spirit Catches You and You Fall Down comes from an expression in the Hmong language which originates in the country of Laos. Its meaning is explained near the beginning of the book when the Lees, a large immigrant Hmong family in America observe their three month old baby Lia having what in the West would be called an epileptic seizure. At the time of the event the parents were not long in the United States and could not speak English. The book describes what this event meant to them, in their own language and using imagery and concepts from their very different Hmong culture. The book’s title is a literal translation of the Hmong phrase qaug dab peg and it is explained by American author Anne Fadiman as follows: “The spirit referred to in this phrase is a soul-stealing dab; peg means to catch or hit; and qaug means to fall over with one’s roots still in the ground, as grain might be beaten down by wind or rain.” (p.20) This explanation refers to the largely rural culture from which the family came, and it mentions a type of spirit which is not familiar to American readers. This is the way that Hmong language captures the rather frightening event, and it is typical of all cultures in all ages that explanations are sought in all sorts of ways to explain sudden events for which there is no obvious material cause. This type of interpretation of a spirit temporarily taking hold of a person is not unique to the Hmong, since many medieval and ancient texts make similar mention of “spirit possession” or “demon possession” and describe fits and seizures that more than likely were due to epilepsy. One aspect of this belief in Hmong culture is that it singles the person out for a special role in society and they often are chosen to become initiated as a txiv neeb which is a special shaman who performs rituals and chants for different occasions, including situations when someone needs healing. A neeb is another kind of spirit, not like the dab, because it is said to be a healing spirit which enters the body of the shaman. The reaction of the parents was a mixture of concern and pride: “Even if an epileptic turns out not to be elected to host a neeb, his illness, with its thrilling aura of the supramundane, singles him out as a person of consequence.” (p. 21) Section 2. One of the best qualities of this anthropological account of the baby Lia’s illness and her family’s experiences in coming to terms both with the practical needs of their large family and at times very obtrusive interventions of the American health services. The book shows how loving and tender the Hmong parents are towards their children, and there is also a strong sense of community which helped them in the traumatic times of war when they assisted American troops in their home country against an oppressive communist regime. This strong attachment to their own culture and community is still important for those who leave their home and settle in America, but the community here struggles to maintain its values because it is now a minority. What is normal and ordinary at home, becomes strange and problematic in the eyes of their new neighbors. A key element in Hmong culture is the practice of making offerings of food, or money, or even animal slaughters, especially chickens, because there is a strong belief in animism. This is an approach to the world which is very widespread in Asian countries, and it is based on reverence for the life (or spirit) which is inherent in everything that exists in the world. The Hmong believe that bad and good spirits are out and about all the time, and they need to propitiate these spirits in order to keep the bad ones away, and enlist the help and protection of the good ones. This is a bit like Roman Catholicism’s practice of praying to the saints, or Hindu offerings to their many small deities in and around their villages. Everything, however ordinary, is imbued with spiritual meaning for the Hmong. In contrast to this the American Medical Culture is based on a belief in science. Events are understood as cause and effect relations, and there is a strong belief in the ability of professionals to intervene in the world and make things better. Long initiation into Medicine is required, but just as there is for the Hmong Shaman, and instead of an attempt to balance good and bad spirits, there is a much stronger focus on the physical body. Most doctors are specialists in just a few areas of the body, and the extent of medical knowledge available is so vast, that no one expects to know it all. This means that often a whole chain of professionals work together with one patient, each bringing a certain expertise to the case. Surgery or drugs are the preferred treatments, and sometimes psychological therapies are offered if the patient is perceived to have a mental illness. The advantage of this approach is that it very often cures physical diseases and healing even of severe illness or injury can be dramatic and effective. It does tend to see the person as a set of symptoms, however, and as the The Spirit Catches You and You Fall Down shows, this can have the effect of blinding the professionals to the wholeness of the person and that person’s significance and role within the family unit. Section 3 The Hmong are very family oriented. They see themselves indebted to their clan, and their ancestors, and their children are the most important thing of all to them. The two parents, Nao Kao and Foua Lee would do anything for their children and one of the greatest tragedies of the book is that their loving care for Lia is not fully understood and appreciated by the American health professionals who get involved with the family. Because of a very long history of persecution of their race, first from the dominant Chinese around them and then from the brutal communist regimes of Laos and surrounding nations, they cling to their cultural stories much more strongly than most cultural groups. This oppression explains also why they are so trusting in their own shamanic traditions and so distrustful of outsiders. All the experience of their long history has been that outsiders bring disaster and destruction, and this results in a conservatism and unwillingness to break from the tradition that has served them well in the past. One aspect of Hmong culture that caused problems for the Lees was the fact that they believe in reincarnation, and they accept what happens to them in what westerners might perceive as a fatalistic way. This means that they feel an obligation to suffer bad things, and trying to find a way round a bad experience is seen as not acceptable. Fadiman cites an example of a boy who had a tumor, and was offered an operation to save his life but “His parents fled the state, certain that if their son had the surgery he would be reincarnated, over and over again, with an incomplete body.” (p. 263) For the Hmong, the soul is much more important than the body, and there is a focus on the afterlife rather than the present life. Amerian doctors are guided by the Hippocratic oath which dictates that they should not cause any harm and should always try to relieve suffering. In the United States there are also a number of very binding rules such as taking care of the most vulnerable people, usually old people and children, even if their family object to treatment. Doctors may have their own faith and beliefs about the afterlife, but they are asked to put these aside when treating patients, and to focus on preserving life, and maintaining quality of life above any consideration of the soul or the afterlife. Section 4 The events of this book might have turned out differently if the medical professionals had stopped to think a bit more about the family that they were dealing with. They focused on the symptoms of the child, and assumed that their western cures would be appropriate in this case, as they would be in any other American case. The disease is the same all over the world, they reason, and so the cure can be universal too, taking account of how the disease develops in the individual body. The point of the book is, however, that the Hmong family saw it as the physical manifestation of a spiritual affliction. There was insufficient attention to this aspect of the case, and it meant that the doctors’ misinterpreted the parents’ resistance to treatment as stupidity, or stubbonness, or lack of education. If my own doctor were to take more account of my individuality, and my circumstances, then it may be that a more accurate diagnosis could be made. People often suffer from multiple stresses, mental, physical and spiritual, and the doctor would have a better picture if he or she could take in more than just the symptom that I bring to be discussed. It is clear that the same disease can have very different outcomes depending on the patient’s outlook on life, and this is evidence that there is more to a doctor’s work than just tracking symptoms and looking for cures like a detective. Section 5. The American doctor might learn to develop a better relationship with his or her patients from the tvix neeb. Very often patients have a lot of worries and problems that weigh them down, and a person who has a long term relationship based on mutual trust will develop sensitivity to non-verbal clues and understanding of the reasons why people behave in the way that they do. A shaman is very aware of moral and spiritual factors, and this is something that most American doctors just do not have the training or inclination to develop. The shaman could also teach American doctors a great deal about the power of suggestion, and the importance of gaining the trust and co-operation of patients. On the other hand, the shaman could learn a lot from American doctors about the need for scientific approaches in some cases. Often simple drugs can work amazing cures, but they need to be administered in carefully judged and measured ways. Learning more about such things would enhance the Shaman’s skills and help him to achieve better results. The shaman could also learn about the ethical attitudes of western doctors, and see that they are not evil or dangerous, but come from the very same desire to help people. Section 6 Defining what a good parent is and what a good doctor is can be a very difficult proposition. These roles are crucial in human society, and they entail a focus on the needs of individuals who are in a position of weakness and dependence. Ultimately it comes down to love, and both roles derive from a desire to provide support and help. There are boundaries, however, in both roles. A parent has to accept that children are separate from the parents, with their own needs, and yet they also have to ensure that children grow into their social setting as balanced and confident individuals. This means that children need to be taught the beliefs, values and behaviors that prevail in the setting where the family lives. A good parent does these things to the best of their ability. A good doctor administers medical aid to people, but must observe the rule that they respect the values of those whom they treat. Children are minors, and the parents have the right to decide how treatment is given, short of the point where a child’s life is in danger. It is arrogant to assume that western medicine is the only and best way to deal with people and so a good doctor will go along with family wishes as far as possible. When there is a conflict, in the eyes of a doctor, between the family wishes and the patient needs, then these issues need to be carefully and patiently clarified on all sides, ideally with a solution being negociated that all find acceptable in the interests of the patient. Section 7 Life is something that we can demonstrate and see with our instruments. Soul is something we can sense but find hard to define. When doctors consider issues like dignity and respect, they are also considering the human soul. I believe, therefore, that life is the most pressing concern for a doctor, but that it life should not be preserved at all costs and in the face of opposition from the patient. I would be very reluctant to take a decision based on some supposed consequence for the human soul, but I would hope that I could listen to any argument that a patient or a family are bringing forward in this area, and be sympathetic to their feelings and wishes. Section 8 The single big message that I have learned from this book is that so much can go wrong in translation. The source of the problem from the very beginning was not that the Lees had different beliefs and values, but that their beliefs and values were neither understood nor listened to. This had severe consequences because it made them retreat into a defensive position, instead of reaching out to work together with the doctors to find the best treatment for their daughter. The doctors on the other hand were blind to the significance of their actions, and too sure of their own belief system to countenance any other way. It is a tragedy that all those well-meaning people could not talk these things through and come up with a better way. This book has taught me to look behind what patients say and do, and to be more open to approaches which would never work for me, but might be great for them. I need to read and learn a lot more about other values systems than my own. References Fadiman, Anne. The Spirit Catches You and You Fall Down. New York: Farrar, Straus and Giroux, 1998. Read More