Question

The Spirit Catches You and You Fall Down

Would you assign blame for Lia's tragedy? If so, to whom? How do you think Anne Fadiman would respond to this question?

Answer 1

As a way of coping with the grief and uncertainty of Lia’s medical complications, both the Lee family and MCMC’s team of doctors try to assign blame. They are constantly seeking to decide if the other party has acted ethically or unethically, which is in part due to the fact that both the family and the doctors believe that their power hierarchies have been undermined. The doctors feel disrespected by the Lees’ unwillingness to wholly trust their advice, while the Lees are angry that the doctors dismiss their beliefs about Lia’s condition. This is particularly painful for the Lees because the doctors’ dismissal seems, in part, racially tinged. With both the Lee family and the doctors feeling that their authority is threatened in a life-or-death situation, everyone seems prone to leverage what power they have to discredit the other.
The Lees, for their part, appear particularly eager to blame other people for Lia’s sickness—and not only her doctors, either. For Lia’s initial seizure, they blamed their older daughter Yerslamming a door, and when Lia fell off a swing and went into status epilepticus, Nao Kaodetermined that her teacher made her drop off the swing. It’s difficult to say why the Lees—who are kind, well-meaning people—appear so quick to blame others, but perhaps it is a reaction to the distress of seeing a loved one in pain. Blaming, it seems, gives the Lees agency. This suggests that they yearn for some sort of power, which makes sense, given that they live in a country that gives them few opportunities and that looks down on them. Furthermore, since they can’t perform the rituals and healing ceremonies that would normally give them a sense of power over Lia’s condition, the Lees’ best chance of coming to terms with Lia’s misfortune is by blaming somebody in the very community that has so much power over them. Pointing the finger at Lia’s teachers or doctors or social workers gives them a tangible outlet for their helpless and lovesick worries.
The most prominent manifestation of this sort of blame is, of course, Nao Kao and Foua’s belief that the doctors at the Children’s Valley Hospital—where Lia was treated for septic shock—actually made her sicker. Readers steeped in the culture of Western medicine may find this an absurd misplacement of blame, but it’s worth considering the fact that Depakene, the medication given to Lia to keep her from seizing, may have made her more susceptible to septic shock. “Go back to Merced,” Dr. Hutchinson told Fadiman after Lia lost almost all brain activity, “and tell all those people at MCMC that the family didn’t do this to the kid. We did.” In this statement, Hutchinson makes it clear that the Lees should not be held accountable for what happened to Lia; all of Lia’s doctors himself included should recognize their own shortcomings in this particular situation. In doing so, he essentially reinforces the notion that somebody must be at fault for what happened to Lia, a notion that once more demonstrates the human tendency to seek meaning (by way of fault and blame) in the face of difficult emotions even if it means blaming oneself.
Neil and Peggy also blame others. As shown by his suggestion that Lia be taken away by Child Protective Services, Neil portrays Nao Kao and Foua as ill-equipped to care for their own daughter. This is, of course, based on their inability or unwillingness to follow the course of treatment he suggested. In effect, Neil was so confident that his plan was the right one that he used his power as a doctor to hold Nao Kao and Foua responsible for the problems Lia was having. According to most of his colleagues, this was a surprisingly ill-advised move, one that failed to take into account the fact that Nao Kao and Foua were extremely attentive, loving parents.
Fadiman herself doesn’t take a strong position about how or even whether blame should be assigned to individuals. Instead, she illuminates the various failures of empathy and inquiry that led to Lia’s tragic medical crisis, and shows the well-meaning logic behind both the doctors’ and the Lee family’s decisions. Although Fadiman respects both sides and doesn’t condemn either the Lees or their doctors, she does subvert the expectation that Western medicine is unequivocally effective, thereby asking readers to question the biases inherent to a system that most Westerners consider to be objective and rational. By placing Western medicine and Hmong spirituality in a non-hierarchical comparison, Fadiman implicitly attributes blame for Lia’s condition on the failure of the two systems to be effectively reconciled.