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Cultural Clash Between Biomedicine and

Analysis of Differences in Healing Practices

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Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and
the Collision of Two Cultures” is an ethnography written by Anne Fadiman,
revolving around the tragic life of Lia Lee, a Hmong child living in Merced.
Lia Lee, having been afflicted with severe epilepsy at a young age, eventually
experiences a grand mal seizure brought on by a septic shock, permanently
damaging her brain and rendering her in a vegetative state. Fadiman’s
ethnography narrates a compelling story entailing the differences in cultural
practices between the Hmong and the Western doctors, with their respective
cultural differences creating a profound rift impeding Lia Lee’s recovery. In
this essay, I will analyse the cultural clash of biomedical and shamanic practices
between the doctors at the Merced Clinic and the shamans of the Hmong tribe,
elaborate on how they each viewed their respective healing practices as
rational and superior, and how their ethnocentrism ultimately interfered with
saving Lia Lee’s life.

Shamanism is a form of ethnomedicine practiced
by a variety of ethnic and cultural groups, whereby the practitioner, a shaman,
enters an altered state of consciousness to acquire information for healing and
maintaining harmony between the community and the spirit world (Rodd, 2002). It
encompasses elaborate rituals and storytelling to symbolise leaving the mundane
world and entering the sacred world. These rituals possess significant cultural
traditions, with the shaman enacting the struggles within the spirit world and
summoning spirit allies with the aid of artefacts while singing, chanting and
dancing. Through these rituals, divine tasks such as healing the sick and
warding off malevolent spirits are accomplished (Winkelman, 2002). Shamans are
therefore seen as psychopomps, spiritual guides that travel between the
physical and spiritual realms, possessing the ability to make contact with
spirits and perform acts of healing or vengeance. A shaman can also be
identified as a wounded healer, one who has endured great hardship or an
ardours journey before reaching enlightenment (Lundberg, 2015).

Biomedicine, on the other hand, is in itself a
culture that prides itself in its solid foundation in undisputable science.
Biomedicine, being the all-encompassing term for modern Western medicine, has
its roots deeply ingrained in the domains of biology and chemistry, viewing
diseases as an outward manifestation of illnesses and ailments affecting the
body (Lundberg, 2015). The biomedical model places great emphasis on physiological
data, relying heavily on technology and charts to accurately pinpoint specific
illnesses in the patients (Helman, 1991). Western doctors are also trained to
adopt clinical perspectives on disease and illness rather than a social
perspective through the experiences of working with innumerable patients and
cadavers. Eventually, not only do medical students learn to see bodies as
inanimate objects, they also learn espouse the demeanours and psychological
attitudes of medical profession, developing an equilibrium of ”detached
concern”, and the ability to act calm in the midst of turmoil and uncertainty.
(Holmes, S. M., Jenks, A. C., & Stonington, S., 2011). The differences in
approaching patients afflicted with ailments and their methods of treatment
will ultimately form the underlying bedrock for the chain of events, leading up
to the conflicts between the Hmong refugees and the Western doctors working at
the Merced clinic.

The difference approaches shamanism and
biomedicine takes towards their patients are a result of the unique ways each
culture perceives and treats various illness and sickness. Understanding that
the body and soul are a holistic concept, the shamans, also known by the Hmong
tribe as txiv neeb, consider treating
the body without treating the soul as an act of patent folly, as physical
manifestations of illness represents a soul that is unwell. For example, during
her recovery phase from her seizures, Lia Lee’s parents utilise therapeutic
healing by inserting a silver coin into the yolk of a boiled egg, wrapping the
egg in a cloth, and rubbing the her body with it until the egg turns black.
Other remedies they use include tying amulets with healing herbs around her
neck and changing her name to trick the spirits into returning the soul. They
also seek healing through a renowned txiv
neeb, who ties spirit-strings around her wrist, and gives her some green
medicine from roots to boil and consume (Fadiman, 1997).

To the Hmong, the biomedical treatments are
irrational, as doctors neglect the patient’s soul when healing them, and
completely disregarding their perceived caused of illness. Biomedical
procedures involving blood loss are also perceived to be causing more harm than
good, as the Hmong believe in the body’s inability to replenish the amount of
blood that is removed. Most importantly, the Hmong regard their bodies as the
guardian of their souls. Therefore, any disfiguration or surgery on the body
will render it in a state of perpetual imbalance, with the damaged person more
prone to illness, (Fadiman, 1997).

Yet these procedures, considered as taboo to the
Hmong, are essential for the successful treatment of major illnesses in
biomedicine. Doctors perceive illnesses from a biological perspective, and
therefore use scientifically proven methods to treat patients. Armed with an
impressive array of cutting-edge technology such as X-ray machines, EEG
(electro-encephalography) and CT (computerise tomography) scanners, specialists
from various domains are able to effectively save Lia Lee under the extenuating
circumstances, desperately working furiously together to bring her back from
the brink of death. After administering a potent anaesthesia to stop her
seizure, she is attached to a respirator that delivers 100 per cent oxygen. Two
intravenous catheters are then inserted to monitor her blood pressure and
deliver drugs. Finally, a Swan-Ganz catheter is threaded through two chambers
of her heart to monitor her heart function, and her entire blood supply is
removed and replaced twice with fresh blood to prevent further clotting of her

From the doctors’ perspective, shamanistic
practices of sacrificing animals to restore the patient’s soul are deemed
irrational and unfounded in science. In the midst of their scientific analysis,
doctors who are unable to comprehend the notion of patients having souls will
flippantly dismiss shamanism and its lack of scientific evidence as primitive
(Fadiman, 1997).

These differences in culture of biomedicine and
shamanism, and their respective misconception are further exacerbated by their
ethnocentric views during Lia Lee’s diagnosis with epilepsy. In Hmong
tradition, epilepsy, or “quag dab peg”,
is translated as “the spirit catches you and you fall down”. This occurred when
Lia Lee’s older sister slammed the door, causing the spirit to flee from her
body. Those afflicted with quag dab peg are
bestowed with a high social status within the community as they are considered
chosen as shamans, leading Lia Lee’s parents to view her condition with a sense
of pride. Epilepsy, however, is treated aggressively with a cocktail of
anti-convulsion medicine. Due to the confusing nature of the various
medications being prescribed and their potential side effects like
hyperactivity, liver failure and abnormal hair growth, Lia Lee’s parents view
medications as a threat to their child’s health, harming her instead of healing
her. Their distrust towards doctors also increase as they perceive the doctor’s
clinical efficiency as being cold and aloof. As quoted by a Hmong patient, “The
doctor at MCMC are young and new. They do what they want to do. Doctor want to
look inside the woman body. The woman very pain, very hurt, but the doctor just
want to practice on her.” (Fadiman, 1997, p. 82). Thus, they are reluctant to
medicate their child, considering their non-invasive rituals and sacrifice the
better option, and in the process failing to acknowledge the countless hours
and resources the Western doctors have dedicated to the treatment of their
child (Fadiman, 1997). 

This causes consternation amongst the Western
doctors, as medications have to be strictly adhered to, if a full recovery is
expected. Doctors diagnose epilepsy as a neurological abnormality, causing her
brain cells to fire uncontrollably and give her seizures, resulting in brain
damage and reduce developmental growth. 
Not complying with the proper medication regimes and treatments is
considered an offence, and doctors perceive Lia Lee’s parents’ ambivalent
attitude towards her condition as self-defeating ignorance. As quoted by a
doctor at the clinic:

“They don’t do a damn thing you tell them,” he
said. “They just come in late and drop it out. In fact, they wouldn’t come at
all if they didn’t need to get the birth certificate so they could get more
welfare. You or I, we can’t conceive of the degree of ignorance. They’re almost
a Stone Age people.” (Fadiman, 1997, p. 96).

their failure to recognise that the concept modern medication is extremely
novel, and to an extent untrustworthy, to people of a different culture leads
them to aggravate the situation by taking matters into their own hands. By
calling in social services to remove Lia Lee from her parents, it results in a
degradation of trust between the doctors and Lia Lee’s parents. Through the
misconstrued notion that their medications and treatments are the better option
for her, an unnecessary void is created. This can be avoided if both the
doctors and Lia Lee’s parents have been more accepting of each other’s
approaches and treatment to epilepsy, and understand that both parties have the
best intentions for Lia Lee, saving her in the only way they know how to
(Fadiman, 1997).

In summary, the clash between biomedicine and
shamanism can be attributed to the binary views that have been enculturated
into both the Western doctors and shamans, with each of them viewing their
respective practices as the optimal solution, while dismissing one another’s
practices as irrational. The concept of the human body encapsulating a soul is
as hard to comprehend to rational Western doctors as the notion of scientific
measures and methods to the spiritual Hmong tribe. The ethnocentricity present
in both parties thwarted their ultimate goal of healing Lia Lee, with
devastating consequences as the result of their prejudices. If both parties
were willing to come to a compromise and settle on a mix of both spiritual and
scientific healing, accepting that they both wanted the best possible outcome
for Lia Lee, she could have potentially avoided her predicament and made a full