This book was everywhere for a while. I know that I resisted its pull for a long time before I bought a copy. I was intrigued, but this was maybe 10-12 years ago and I knew myself to be very bad at finishing nonfiction books. I’m better now, although I haven’t been keeping stats on the matter. When I finally started reading it, I was captivated from the beginning. I recommend it widely to readers interested in anthropology, medicine, and Asian cultures, as well as to anyone intrigued by human-interest reporting at its finest.

This book is about a Hmong family who lived in Merced, California after they were displaced from their home in Laos at the end of what we would call the Vietnam War. In the very earliest years of this conflict – circa 1962 – the CIA recruited the Hmong to fight a “proxy war” against the Viet Cong. The goal was to do damage to the Viet Cong and minimize the fighting that would need to be done by American troops. We all know how that worked out. Because they fought on the American side, the Hmong were seen as traitors by the victorious North Vietnamese after the war. The CIA had promised the Hmong that they would be rewarded for their service and recognized as heroes by the U.S. government and citizens. As you might guess, the U.S. stopped somewhat short of keeping this promise; however, it did admit a large population of Hmong refugees into the country in the years after the war ended in 1975, when it became clear that they would be persecuted and possibly exterminated in their home country — or home countries, since the Hmong actually never had a nation of their own. They are an ethnic group that historically lived in the remote mountainous region that straddles the borders of China, Laos, Cambodia, and Vietnam.

Once they settled in the U.S., the Hmong largely continued to live in densely populated enclaves within a foreign culture. In Merced and other small towns, they took over entire low-rent apartment complexes, where they turned the communal outdoor spaces into herb gardens and barnyards. Hmong children in the U.S. went to school and largely assimilated, but most Hmong who were adults when they left Asia never learned a word of English. As asylum-seeking refugees, they were entitled to housing assistance and other forms of welfare, and most Hmong adults did not get jobs – not because they couldn’t do so or didn’t want to but because they possessed not a single skill useful in the American job market.

The family at the center of this book is the Lee family: father Nao Kao, mother Foua, and a brood of children to rival the Duggars. Foua and Nao Kao lost several of their children to disease and violence during the many years they spent fleeing Laos and living in terrible conditions in refugee camps in Thailand, but many of their children did eventually go to school in the U.S. Their second-youngest child, Lia, began having severe seizures when she was still an infant. The relationship between this family, their doctors, and their native culture and beliefs is at the heart of this book.

Hmong beliefs fall into the category of what we would call animism, shamanism, or superstition. Hmong immigrant families were devastated, for example, when they were not allowed to bury their children’s placentas under the beds in which the children were born. In Hmong culture, this is an essential way to guide a child’s soul back to its body if it gets lost. In the Hmong way of seeing the world, many physical ailments are caused by “soul loss,” and many of their customs are designed to create road maps of sorts to help lost souls come home. Epilepsy in particular is believed to be caused by soul loss, and while the Lee parents do worry a great deal about Lia when she has her seizures, they also believe her epilepsy marks her as special. They believe that when she is seizing she is communing with spirits in ways no one else ever can.

In Merced, the Lees have access to an excellent teaching hospital called MCMC (Merced County Medical Center). The co-heads of the pediatric department are Neil Ernst and Peggy Philp, a husband-and-wife team that embodies what I see as the core values of western medicine, which is to say that they care deeply about their work and about their patients, they work tremendously hard, and they take both their successes and their failures personally, while also unintentionally looking down on beliefs and customs that cannot be explained by Western medicine. While they care very much about stopping Lia’s seizures, they mostly see her parents as nuisances who hover anxiously around her bedside, don’t speak English, and rarely give Lia her medicine as prescribed. Because the Lees believe that Lia’s epilepsy makes her special in the eyes of the gods, they treat her like a princess, carrying her everywhere they go and letting her sleep in bed with them while their other children sleep on mats on the floor. To the medical staff, who in typical Western fashion believe that children should be active and independent, the Lees seem almost to be neglecting Lia by hindering her physical development. At one point Neil Ernst even calls Child Protective Services and has Lia put in foster care, even though he admitted that he knew the Lees loved Lia and weren’t abusing her. In one of this book’s many fascinating twists and turns, Lia’s foster family ends up allowing the entire Lee family to visit Lia every weekend, and the two families became quite close. Even the foster parents thought it was a shame that Lia was taken away from her parents.

There’s so much that I could tell you about everything that happens in this book, but I’m going to hold off in favor of some general statements instead. A couple of months ago I reviewed Laura Hillenbrand’s Unbroken and complained that the author overused facts and details, piling example after example into the text while also failing to develop most of the characters adequately. Anne Fadiman’s work is precisely the model of what I wished Hillenbrand had done in Unbroken. These two books are similar in some ways. They are both about individuals at odds with societies alien to them, and they both deal with the clash of American arrogance and idealism with Asian militarism (in Unbroken) or traditional customs and beliefs (in The Spirit Catches You and You Fall Down). They are both nonfiction books that deal with individual people who are caught up in the grand sweeping politics and history of the twentieth century. But Fadiman’s book is everything that Hillenbrand’s isn’t. It’s funny, compassionate, and perceptive where Hillenbrand’s is repetitive and shrill. Fadiman’s empathy encompasses every human being on the pages of her book, from ER trauma teams to elderly Hmong men who try to sacrifice chickens in hospital waiting rooms, while Hillenbrand never seems even to try to see the humanity behind the Japanese characters in Unbroken. At the same time, Fadiman’s novel is less P.C. than Hillenbrand’s. Fadiman is not afraid to characterize the Hmong as strange and weird; this characterization is not offensive because she also portrays them as fiercely human, strong, and proud. I was able to make so much more sense of why I disliked Unbroken while I was reading Fadiman’s novel, which is an example of everything a nonfiction book should be.

I highly recommend this book. It reads like a novel, and Americans who read it will learn new things not only about the Hmong but also about our own culture. To us, MCMC would likely look like any other hospital, with the familiar emergency room and long mysterious hallways we’ve known from childhood. Fadiman is able to portray the hospital as it is seen by the Hmong, and as a result we see it from a new perspective – we see how alienating and intimidating it is, how arrogant its staff, how opaque its rules and regulations.

And there’s so, so much more that I’m leaving out. Read the book!