It has become a common complaint (sometimes valid, sometimes not, in my opinion) that immigrants 100 years ago wanted to become assimilated into the American culture as quickly as possible, whereas now they demand that the existing American culture adapt to them. But if you are unhappy with Mexicans or Pakistanis on those grounds, wait till you read about the Hmong! It is really not so much that they demand that Americans adapt to them, but that they cling to their own culture with a ferocity, a stubbornness, and a relentlessness, that is hard to believe. That culture includes animal sacrifices, a highly structured clan system, complex folk tales and hierarchies of spiritual beings, early marriage, and an eye-popping birth rate.

The primary focus of the book is how that culture clash made it nearly impossible for the epileptic child to be treated effectively either from the standpoint of Western medicine or in they eyes of the Hmong family who loved her. Fadiman goes into the history of the Hmongs in Asia and how their experiences have hardened them into the people they are now. It is very easy for the American layperson to lump them together with all other Asians, but that would be a huge mistake. Even to refer to them as "Laotians" - as I did before reading this book - would be a serious dismissal of their uniqueness. The Hmong have suffered hardships almost inconceivable in the eyes of modern Americans.

The book has no happy endings, and not an awful lot in the way of lessons. Fadiman provides some suggestions for what the American doctors and social workers should have done differently. (It's noteworthy that, like most multiculturalists, she says very little about what the HMONG should have done differently - even though Western medicine is demonstrably far more effective than the Hmong procedures of animal sacrifices and religious ceremonies.) Those suggestions, at the end of the day, would not have changed the outcome - at least not in my opinion. Those suggestions might have avoided some hurt feelings, and that in turn might have given the Hmong community a greater confidence in the doctors in Merced and Fresno. In that respect, things might have been better over the long term than they are now.

But the primary lesson I came away with was that there is an almost impenetrable barrier between the two cultures, and that it certainly would have been far better if the Hmong had never been forced to come here. And underlying THAT lesson is the realization of the incredible cruelty that is visited upon otherwise peaceful people when the "Great Powers" make pawns of them in a global conflict. The only reason the Hmong are in Merced is that Southeast Asia was a battleground between the United States and the communist countries, and that each side was willing to use any means to win - even at the cost of the complete destruction of people the like Hmong.

I have no hesitation in stating that I think communism was evil, and that we were right to fight it. But did anyone ask the Hmong, and other people like them, whether THEY were willing to pay the price for the victory of democracy? And did we have the right to decide for them? This book will have you thinking about those questions and more, long after you close the last page. And you are unlikely to find easy answers.


A divine liqueur distilled from a murky cultural clash   April 6, 1998
 27 out of 29 found this review helpful

I was one of the physicians involved in the care of Lia Lee. I'm referred to in the book as the physician that first diagnosed Lia's spells as seizures. Neil Ernst and Peggy Philp, the principal pediatricians in the book, were and are good friends of mine. Having experienced Lia Lee's saga personally, and then having read the book, I can only refer to Anne Fadiman's talent as astounding. Anne walks an incredibly fine, and very well documented, line as she describes what happens when American medical technology meets up with a deep and ancient Eastern culture. My team (Western medicine) failed Lia. Never have I felt so fairly treated in defeat, and never have I felt so much respect for an author's skillful distillation of a tragically murky confrontation of cultures. Incidentally, the hospital administrator of the hospital I'm currently associated with rated the book "The best book I read in 1997". He reads prodigiously. Dan Murphy, MD


A spirit caught me up in this book   January 22, 2000
 26 out of 27 found this review helpful

Anne Fadiman's book is a fascinating account of what happens when a left-brain culture (the American medical establishment) and a right-brain culture (a Hmong refugee family) go on collision course over a very ill little girl.

Lia Lee is epileptic; she has uncontrollable seizures which require medical intervention and treatment. Lia's doctors see her family as negligent and ignorant because their inability to follow a complicated medical regimen makes her condition deteriorate; her family see the doctors as arrogant and insensitive, and insist the medicine they are giving her actually made her sicker. The tragedy is that both the doctors and the family genuinely want to help Lia, but their total lack of communication and inability to understand each other, linguistically and culturally, makes cooperation impossible. Those of us in the 'helping' professions (medicine, nursing, social work) often lose sight of the fact that the relationship between 'helper' and 'helpee' is most effective when each sees the other as an equal partner who deserves equal consideration and respect; instead, the 'helpers' often dole out advice and directions which the 'helpees' are expected to follow without question, and are then labeled backwards, resistant, or even negligent, when they refuse.

The book zeroes in on the dangers of ethnocentric thinking in working with or treating people of different cultures; the Lees may have been illiterate and 'backwards' by American cultural standards, but they knew and loved their child. We end up admiring and respecting the Hmong for their warm family life and their support of each other in times of crisis, as well as respecting the medical personnel who grew as human beings as they came to recognize the Lees' humanity and their incredible strengths as parents. Many, if not most, American families would institutionalize a child such as Lia; but to her family, the sicker she became, the more precious she became. Anne Fadiman has given us an informative, excellently researched, uplifting and yet humbling book about a very special family and a very special child.

Judy Lind


This is an exceptional piece of work!!   November 5, 1997
 26 out of 27 found this review helpful

I don't think I should be writing in here since I am a part of the book. This book was amazing! It took me two days to read it and of course I shed a few tears on the way. My sister, Lia Lee, is doing well although she will never be able to see the bright sunlight or the incredible stars that we see everyday and everynite. She is an incredible child with so much love and affection from her family and the many friends she have encountered during her hardships. I was only 7 when all this happened, but I do recall everything from the door slamming incident to the day the doctors told my family that it was okay for her to come but she will not live pass 7 days. I will never forget that week or those many years of pain my family or the doctors had to go through. This book has given me a better view of what can really happen when two different cultures have their own ways of interpreting medicine or life in general. We must understand that different cultures have different ways of curing a person and doctors have their policy they must follow. To avoid another incident like this, we must work together as a whole and not blame each other for not cooperating with one another. Lets hope this book tells us what can happen in the future if we don't work with this now.Anne did a great job on this book! My family couldn't have ask for more. She has become a great friend of my family and we are greatful for it. Anne-thank you !