The Spirit Catches you and you Fall down

Cross-Cultural Family Assessment Stephanie Boardman University of Southern Maine 1. The client system, in this case the Lee family, defines Lia’s seizures as both a spiritual and physical ailment. According to Fadiman (1997), “…the noise of the door had been so profoundly frightening that her soul had fled her body and become lost. They recognized the resulting symptoms as qaug dab peg, which means ‘the spirit catches you and you fall down’”(p. 20). To the Lee family, Lia’s condition was as revered as it was frightening.

While a person with qaug dab peg was traditionally held in high esteem in the Hmong culture, it was also terrifying enough that the Lee’s rushed Lia to the emergency room more than once in the first few months of her life. 2. While the Lees recognized that Lia had an illness, I do not believe that they recognized the severity of her problems. One the one hand, the understood that it was a dangerous illness, but on the other hand, the Hmong believed that qaug dab peg “singles him out as a person of consequence” (Fadiman, 1997, p. 21). At times, the Lees believed that Lia’s epilepsy wasn’t as much of a medical problem as a gift. Fadiman tells us, “They therefore hoped, at least most of the time, that the qaug dab peg could be healed” (p. 22). So while they recognized that Lia was sick, they also had hope that she could be cured. Their hope was that if the spirits decided to keep hold of Lia, that long-term she would become a Tvix neeb, a “person with a healing spirit” (as cited in Fadiman, 1997, p. 21). If she did not become a Tvix neeb, then their hope was that the sickness would be short-term. It seems that either way, they had no idea what the future held for Lia. They could only hope for the best. 3. Fadiman does not tell us what the Lees did the first time Lia had a seizure. She does tell us that the Lees brought Lia to the emergency room for the first time on October 24, 1982 when she was only three months old (Fadiman, 1997, p. 25) and was admitted to the hospital seventeen times before the age of four and a half (Fadiman, 1997, p. 38). Because of the cultural and language barriers between the doctors and the Lees, there was a lot of mix up and confusion as to the medications that Lia should have been given As a result, the Lees were either giving Lia too much or too little medicine.

Dan Murphy, one of the first physicians to encounter Lia at the hospital tells us that, “The parents report that they had discontinued the medications about 3 months ago because the patient was doing so well” (as cited in Fadiman, 1997, p. 53). Just before her second birthday, Lia was removed from her parents’ custody and placed in foster care for a minimum of six months. When the Lees “failed to demonstrate their ability to comply with their daughter’s medical regimen” (Fadiman, 1997, p. 89), the court decided that Lia remain in foster care. In February of 1986, Lia’s medication became a lot easier to administer when a doctor prescribed only one medication to take the place of the many she had been receiving.

With the help the social worker, Jeanine Hilt, Foua Lee (Lia’s mother) practiced giving this “medication” with a syringe and water until she got it just right, and then was able to administer it to her own daughter. Thanks to the empowerment provided to the Lees by Jeanine, Lia returned home on April 30, 1986. When Lia did return home, Fadiman tells is that the Lees sacrificed a cow to “celebrate her homecoming and bolster her health” (p. 06). Fadiman also tells us that “In order to keep Lia’s condition from deteriorating further, the Less stepped up their program of traditional medicine” (p. 110). They tied expensive herbal amulets around her neck, pinched Lia to “draw out noxious winds” (Fadiman, 1997, p 111), sacrificed many pigs and chickens, and even tried changing her name to confuse the dab who had taken her soul. The final act of healing that Fadiman write about recounts the Lees bringing in a Txiv neeb to perform a healing ceremony for Lia. Fadiman (1997) writes the following: It was Lia’s turn now. Foua and Nao Kao believed that her condition was probably beyond the reach of spiritual healing…And there was still the faintest flicker of a chance, not altogether extinguished even after years of failed sacrifices, that Lia’s soul would be found after all, that the dabs who were keeping it would accept the pig’s soul in its stead, and that she would be restored to health. (p. 283) 4. There were many people affected by the Lia’s seizures and the cultural clashes that ensued. I will focus on the two that seemed most significant.

The first people who were affected were her family, namely her parents. Nao Kao and Foua were obviously distressed that their youngest daughter was having these seizures. The Hmong in general are excellent parents, providing their children with an extraordinary amount of love and attention (Fadiman, 1997, p. 22) and I can’t even imagine the amount of grief the Lees dealt with as they watched Lia’s soul slip away during those several tumultuous years of her life. Because the Lees blamed the medical system for the end result of Lia’s vegetative state, they became increasingly angry people, Nao Kao in particular. Fadiman tells us how angry he was several times in the book, angry enough to try to steal Lia away from the hospital (p. 213). While Foua more evenly tempered than her husband, she did show severe signs of depression and even suicide when Lia was first taken away from them and placed in foster care (Fadiman, 1997, p. 89). Regardless of Lia’s condition, the one thing that was never affected was the love the Lees had for Lia. If anything, Lia became “her parents’ favorite, the child they considered most beautiful, the one who was dressed in the most exquisite garments” (Fadiman, 1997, p. 3). The doctors involved were also deeply affected, namely Neil Ernst and Peggy Philp, the two supervising pediatricians at MCMC who were also married to each other.

The two were known for their “glacial unflappability” (Fadiman, 1997, p. 56). Referring to a Pediatric Clinic Note regarding the Lees inability (intentionally or otherwise) to give Lia her medicine, Fadiman (1997) tells us, “Neil said he could still remember the rage he had felt when he wrote it. He and Peggy…couldn’t remember a case that had made them feel this way. I remember wanting to shake the parents so that they would understand,’ said Peggy” (p. 56). Even though they were incredibly frustrated with the situation and the Lees, they never gave up on Lia. Neil was on duty at the clinic when the Lees brought Lia in for a checkup after her grand mal seizure. He tells us, “That first visit was very significant for me…And what absolutely blew me away is that I, well I was afraid they were going to blame me for what happened, but the mother showed me compassion” (Fadiman, 1997, p. 213). Neil and Peggy seemed to live in this constant state of guilt, feeling like they were the ones to blame for the Lia’s outcome. 5. Because of the cultural clash between the Lees and the doctors, the Lees became even more wary of Americans and their culture. They already felt like outsiders, people who didn’t belong in this country. In a conversation that Foua had with Fadiman, Foua told her, “I am very stupid…because I don’t know anything here. I don’t know your language. America is so hard…in Laos it was easy. I didn’t know how to do anything but farm (Fadiman, 1997, p. 03). When Lia became sick, they tried using their own ways of healing to make her well, but were told they were wrong. In our textbook, we are told that “social functioning encompasses striving toward a lifestyle that meets basic needs, establishing positive relationships, and accentuating personal growth and adjustment” (DuBois & Miley, 2011, p. 63). While the Lees social functioning within the Hmong culture was effective, the same was not to be said for their functioning in American culture. Fadiman (1997) writes, “Indeed, as George M. Scott, Jr. has observed, the Hmong have responded to the hardships of life in the United States ‘by becoming more Hmong, rather than less so’” (p. 208). I believe that such is true of Nao Kao and Foua Lee. 6. Certainly, the value of the sanctity of life crossed the cultural barriers and was displayed by both the Lees and the medical personnel.

Lia’s life was the most important thing, the bottom line. I also think that the values of religion and ethnic heritage also played an important role in the cultural clash, but not in the same positive way that the sanctity of life played. The Lees believed that through animal sacrifices, traditional tvix neeb ceremonies and traditional Hmong medicines, that Lia would be cured. On one hand, the doctors thought the Lees were deliberately putting their child at risk by their refusal to give the proper dosages of medicine, or refusing to give Lia her medicine at all. Fadiman (1997) tells us, “…no one could deny that if the Lees had given Lia her anti-convulsive medications from the beginning, she might have had-might still be having-something approaching a normal life” (p. 258). The Lees thought they were doing the right thing by their culture and standards, while the doctors thought the Lees were negligent. On the other hand, the Lees blamed the medicine, procedures and doctors for putting Lia in her final vegetative state. In regards to a spinal tap done on Lia, Nao Kao told Fadiman, “The doctors put a hole in her back before we got to the hospital…and it makes me disappointed and sad because that is how Lia was lost” (as cited in Fadiman, 1997, p. 148). Foua’s response was much the same: “They just took her to the hospital and they didn’t fix her. She got very sick and I think it is because they gave her too much medicine” (as cited in Fadiman, 1997, p. 148). 7. Once the Lees became compliant with Lia’s medicine routine, I believe that became a step in the right direction for change. It is never a question if Nao Kao and Foua loved Lia. As described in question four, the Lees loved Lia very much and favored her over the other children. Because of this love, they wouldn’t and have not, stopped fighting for Lia’s life.

These are certainly great family strengths and competencies. An environmental strength was that the Lees were living in Merced, whose hospital housed two of the country’s best pediatricians, Neil Ernst and Peggy Philp. Neil and Peggy were certainly committed to making Lia well again.

Another environmental strength was having Jeanine IHinnnnnHilt as their social worker. Neil Ernst tells us that “Jeanine took on the Lees like a crusade…Jeanine was an incredible patient advocate. There was nothing she wouldn’t do for this kid” (as cited in Fadiman, 1997, p. 114). Certainly having someone like Jenny, as Foua called her, on their side was a great strength. . As stated in the above question, Jeanine was the social worker helping the Lee family. The Lee family loved Jeanine very much.

Fadiman (1997) tells us of Jeanine, “…the Lees chose to categorize her not as Lia’s abductor but as her patron, ‘the person who gave Lia her disability money’…she was also the only American I ever heard Foua or Nao Kao refer to by name” (pp. 112-113). Upon hearing of Jeanine’s death in 1993, Foua told Fadiman (1997), “When I heard Jenny was dead, my heart broke…I felt I had lost my American daughter” (p. 252). Clearly, Jeanine was one of the few Americans that the Lees actually accepted. Neil and Peggy were also accepted and loved by the Lees. “Their understanding of the Lees, and the Lees’ understanding of them, deepened significantly when they, too, experienced a child’s grave illness” (Fadiman, 1997, p. 252). Neil wrote a letter to Fadiman and told her about a time that Foua had encountered Peggy at the clinic. In the letter, he wrote: “Mrs. Lee was very concerned about Toby’s health, how he was doing etc. There was very genuine concern expressed by her questions and facial expression. At the end of the visit Mrs. Lee was hugging Peggy and they were both shedding a few tears. Sorrows of motherhood cut through all cultural barriers” (as cited in Fadiman, 1997, p. 252). 9. a. Neil and Peggy’s values, ethics and principles certainly guided their interactions with the Lee family. Neil told Fadiman that one of the main reasons they chose to work in Merced was “to serve underserved people regardless of their form of payment” (as cited in Fadiman, 1997, p. 57). The value of human life was too great to Neil and Peggy for them to just go where there was money to made.

Neil also exhibited ethical behavior when admitting his own mistakes and regrets to Fadiman when she asked if he wished he had done anything differently with Lia. He said, “I wish we’d used Depakene sooner. I wish I’d accepted that it would be easier for the family to comply with one medicine instead of three, even if three seemed medically optimal…Lia taught me that when there is a very dense cultural barrier, you do the best you can, and if something happens despite that, you have to be satisfied with little successes instead of total successes. You have to give up total control. That is very hard for me, but I do try. I think that Lia made me into a less rigid person” (as cited in Fadiman, 1997, p. 257). b. Jeanine was also guided by noble values, ethics and principles. Fadiman (1997) tells us that, “Aside from Dee Korda, Jeanine was the only American I talked to who didn’t describe the Lees as closemouthed and dim; not coincidentally, she was also the only American I ever heard Foua or Nao Kao refer to by name” (pp. 112-113). Jeanine recognized the value of the Lee’s religion and ethnicity and respected them.

She had empathy for the Lees because she too had an illness-chronic asthma-and respected the Hmong culture for their familial relationships, as she had a strained relationship with her parents because she was gay. From what Fadiman has written about Jeanine, it seems to me that she took to heart and put into practice the NASW Code of Ethics. She respected the inherent dignity and worth of the Lee family; challenged the social injustice surrounding the cultural clash between the Lee family and the doctors; and recognized the importance of having a trusting and open relationship with the Lees, which eventually won her over to the Lee family. These are just a few ways that Jeanine exemplified her noble values, ethics and principles. 10. I think one of the most important things to remember when working with the Hmong is that being a Hmong is life to them. Fadiman (1997) tells us that “The Hmong came to the United States for the same reason they had left China in the nineteenth century: because they were trying to resist assimilation” (p. 183). Their ethnicity was their life, so it is important to remember that what may seem as strange traditions, methods of healing and spirituality to us is the normal way of life to the Hmong.

Trying to force them to adapt and integrate into our society only makes them like us, and therefore trust us, even less. Believing ourselves to be elite would be a mistake, one that would certainly cause the Hmong people to instantly distrust us and our intentions. I believe that if I were assessing the Lees, they would instinctively distrust me because I am an American, an outsider to their culture. I would hope that I would be culturally sensitive and empathetic enough that I would show them I could be trusted as their social worker. I would ask about their family, their way of life in Laos, why they came to America. I would ask what injustices they felt had been done to them and ask how they think I could help change these injustices. I would acknowledge their positive characteristics, such as their work ethic, their close relationships within their extended family, and their deep love for their children. I believe that it would be difficult for them to open up about any of their own faults or flaws.

The Hmong seems like very proud people and wouldn’t easily admit to any wrongdoings, if what they were doing was culturally correct. I think I would have the toughest time asking them about any injustice or mistreatment they felt. I think I would be almost afraid to hear the answer, the long list of pain Americans have caused them because mostly, I think they would be correct. I think working with the Lees would be eye opening but very difficult. I’ve always had a more difficult time interacting with people from different cultures, which is why I try to push myself to do things that have me stepping out of my comfort zone (ie, my trip to Africa). I think I would feel ashamed that they had been treated the way that they were, angry at the mistreatment to them and their family. I was very wary as I began to read this book. As I stated earlier, I’ve always had a more difficult time interacting with cultures and religions that are different from my own. This book helped me see that different isn’t always bad. I know that’s such a simple thing to come away with, but to me it is a profound concept. Tolerance and respect are the keys in interacting with people from a different culture, such as the Hmong. As I read through these pages, I experienced a lot of emotions that I wasn’t expecting to have, such as anger, frustration and sadness. This story was beautifully told, and I really appreciated the way Fadiman jumped back and forth from the Lee’s story to Hmong history and culture. It helped me understand and see things a lot more clearly as I went on with the book.

Anne Fadiman really made me fall in love with the Lee family, despite so many of their obvious flaws. When I read about the love and care they gave Lia, despite her being in a vegetative state, it really forced me to think of what I would do if I were in that situation. They never stopped giving Lia unconditional support and love, regardless of whether or not she could respond to it. The Lees, Neil and Peggy and Jeanine all showed me that there are people that care about others more than themselves. Reading about Jeanine’s advocacy for the Lee family was touching. Finding out that she was practically adopted into this family was heartwarming.

This gave me such hope for humanity. It is so easy for me to ignore the beauty and goodness in the world and only see the ugly things such as hatred, racism, prejudice and death. It is easy to lose sight of the fact that as social workers it is not about us and what we think is best for our client. It is about empowering the client in a way that helps them reach their full potential. We are there to assist them in recognizing what is best for them, settin goals for themselves and then helping them to attain those goals. We are to do this regardless of our client’s religion, race or beliefs. Our clients are going to come in all shapes and sizes, races and religions, and we are called to appreciate and encourage their diversity. This book helped me to understand these principles.

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