The Spirit Catches You and You Fall Down: Chapter 18 Summary & Analysis

Fadiman considers whether or not Lia’s life would have been better if she had been treated by somebody like Arthur Kleinman instead of Neil Ernst and Peggy Philp. Regardless, she says, the real culprit of Lia’s demise was no single doctor, but rather the great beast of cross-cultural misunderstanding. She evokes Kleinman’s idea that doctors would do well to incorporate Hmong healing practices into their own medical care. Conjoint treatment, wherein Western medicine accommodates and incorporates various elements of Hmong spirituality, both establishes trust between Hmong patients and their doctors and “actually improves the outcome” of the medical regimen, since “illness is so profoundly affected by psychosocial factors.”

One night, Fadiman invited Bill Selvidge and Sukey Waller to dinner in the hopes of provoking an interesting conversation about the intersection of physical and spiritual treatment. Talking about cross-cultural patients, Bill argued that the doctor must act on behalf of the child by treating her regardless of the parents’ spiritual beliefs, “because if the child dies, she won’t get the chance to decide twenty years down the road if she wants to accept her parents’ beliefs or if she wants to reject them.” Sukey disagreed, saying that a family might view the spiritual risks of surgery as worse than death. She then asked him what he thought was more important, “the life or the soul.” “I make no apology,” he said, “The life comes first.” Again, Sukey disagreed, saying, “The soul.”