A book that changed my mind: ‘The Spirit Catches You and You Fall Down'
Centuries ago, the Greek physician Hippocrates rejected spiritual explanations of epilepsy. 'It seems to me,' he remarked, 'that the disease is no more divine than any other. It has a natural cause just as other diseases have. Men think it is divine merely because they don't understand it.'
Medical science applies his verdict more broadly. Witchcraft, demonic possession, angry ghosts, divine retribution: These are superstitious placeholders for ignorance. As knowledge progresses, they are replaced by natural causes. Germs, not vengeful spirits; genetics, not cosmic destiny.
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For most of my life, I insisted on the obvious and exclusive truth of this perspective. I treated belief in supernatural explanation — and its companion, religious healing — with contempt and impatience. Contempt because humoring fantasies is for children, not adults. Impatience because those falsehoods are dangerous. When Christian Scientists let God do the healing, people die.
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My scorn extended to spiritual-adjacent 'woo-woo' healing and alternative medicine like crystals, natural healing, and the power of positive thinking. There is no such thing as alternative medicine, I believed. There is only medicine that works and medicine that doesn't.
And then I read Anne Fadiman's modern classic, 'The Spirit Catches You and You Fall Down.' All it took was one book to redirect that impatient contempt toward my prior self, so full of condescending hubris, so ignorant and dangerous.
The title translates the term for epilepsy used by the Hmong people, an indigenous minority group from Southeast Asia. Fleeing persecution, the Hmong have established refugee communities all over the world, and one of the largest is in Merced, Calif. Fadiman's book tells the heartbreaking story of Lia, a Hmong child born in Merced and diagnosed with what her Western doctors called epilepsy but her parents understood only as the-spirit-catches-you-and-you-fall-down.
Fadiman didn't change my mind with an argument about the truth of spiritual explanations. Instead, she showed me what happens when you insist the truth is all that matters. The physicians who took my contemptuous approach were least capable of helping their Hmong patients, of treating them as fellow humans. The more they insisted on
epilepsy
, not
spirit-catches-you-and-you-fall-down
, the more they alienated Lia's family and, therefore, endangered Lia's life.
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I had always told myself that insisting on the truth is the best way to care for other people. Reading 'Spirit' shattered that illusion. Beliefs are not parts of a car, ready to be replaced when the expert mechanic tells us they are false. Our humanity is woven with what we believe, and true healers must acknowledge that humanity, instead of reducing us to machines.
Fadiman also tells the story of a Hmong refugee camp struggling with a rabies outbreak among the dogs. Medical staff began a mass vaccination campaign, but the Hmong refused to bring in their dogs — that is, until an American named Dwight Conquergood came up with the Rabies Parade. He picked characters from Hmong folktales, designed costumes, and soon a tiger and a chicken were marching through the camp, singing and playing instruments, while explaining 'the etiology of rabies through a bullhorn.'
The next day, the dog vaccination stations were at capacity.
Did Conquergood share the Hmong belief that chickens are endowed with prophetic gifts? Asking that question, I realized, was deeply misguided, at least when it came to the vaccination campaign. If you focus myopically on the truth of people's beliefs, the people disappear. And if you are interested in helping people, that's a real problem.
'I'm not very interested in what is generally called the truth,' explains Sukey, a Merced psychologist who was beloved and trusted by the Hmong community. 'In my opinion, consensual reality is better than facts.'
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At one time, I would have dismissed Sukey's approach as philosophically inconsistent and potentially harmful. Prioritizing 'consensual reality' over facts feels like endorsing a worldview that sees epilepsy as a divine disease and thus one that can't get be treated medically.
But treating Lia's disease, I came to see, involved more than understanding the biological reality of epilepsy and prescribing the proper medicine. Lia was a human being, a member of a family, which in turn was part of a community and a culture. Healing her suffering was impossible without taking that broader context into account and treating it with the respect that all humans deserve and require. If what I really care about is medicine that works, then this truth is no less important than the ones they teach in medical textbooks.
Fadiman showed me that respect is not synonymous with sharing someone's beliefs. I finished her book uncertain where she stood on Hmong spirituality. But that's exactly the point. I don't know if Fadiman believes in the power of shamanic healing, but I'm certain she respects people who do.
Not only that, her respect for the Hmong is completely compatible with her respect for the medical professionals who were trying to save Lia's life — the doctors who were fed up with Lia's parents for refusing to follow their instructions. Respect, for Fadiman, does not depend on the truth of someone's beliefs, but rather the fact of their humanity, and it comes across in every sentence she writes.
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