The Primitive Culture of Hmong

Treatment is care provided to improve a situation, especially medical procedures or applications that are intended to relieve illness or injury. In the Hmong society, people go to a txiv neeb, a shaman, who is believed to be a “person with a healing spirit” (Fadiman, 1997, p. 21) to cure their illnesses. A txiv neeb knows that to cure an illness you must treat the soul, in addition to the body. This is important to the Hmong because in their society the soul has a great deal of importance.

In Anne Fadiman`s The Spirit Catches You and You Fall Down, the Lees, a family of Hmong refugees from Laos, are placed in a difficult situation when their three month old daughter, Lia, is diagnosed with epilepsy at Merced Community Medical Center (MCMC). Due to a language barrier her parents, Foua and Noa Kao, find themselves not following the treatment their daughter is recommended from Doctors because of miscommunication of medicine dosages and a series of conflicts with Hmong beliefs, which ultimately leads Lia`s epilepsy to worsen.

To her parents the crisis was the treatment, not the epilepsy because of their cultural beliefs and history in regard to epilepsy. The Hmong have a primitive culture that includes many taboos toward their way of living. For example, once a Hmong woman became pregnant there were things she needed to pay close attention to food cravings or else her baby could be born with an extra finger or toe or have a lumpy head.

A woman must also give birth in her own house or one of her husband’s cousins or else a dab might injure her. (Fadiman, p. 4) A dab is an evil spirit who steals souls.

A dab sometimes steals babies’ souls if it hears someone say aloud that the baby is pretty or if the baby is not loved enough by its parent (Fadiman, p. 10) . To prevent a dab from stealing someone’s soul the Hmong perform a hub plug, or a soul calling ritual, three days after the baby is born to greet its soul (Fadiman, p. 11). Since Lia was born in a hospital and was still in the hospital on the third day her soul calling ritual was not performed until about a month after her birth (Fadiman, p. 10). During the ritual pigs and chickens were sacrificed by family members to greet her soul and welcome it to Lia’s body.

To bind her soul to her body, her parents and elders each tied a string around one of Lia’s wrist (Fadiman, p. 11). If the strings are cut off the Hmong believe the person runs the risk of losing their soul. A life-soul is necessary for health and happiness but tends to get lost and become separated from its body through anger, grief, fear, curiosity, or wanderlust( Fadiman, p. 10). According to Fadiman (1997) “Althought the Hmong believes that illness can be caused by a variety of sources—by far the most common cause of illness is soul loss’’ (p. 10).

The Hmong have little to no confidence in Western medicine because it leaves out the importance of the soul. Shamans know that the soul is the key to health and Western doctors treat the body but never even mention the soul. Doctors don’t have the same cultural beliefs and customs that a shaman and the Hmong share. For example, doctors often ask for samples of blood for a diagnosis and wait for days for the results, (Fadiman, p. 33) but the Hmong don’t like blood sampling because they “believe that the body contains a finite amount of blood that it is unable to replenish so repeated sampling can be fatal. (Fadiman, p. 33). But shamans don’t need to take samples and can render a diagnosis quickly. The Hmong also felt that some of the doctors’ procedures made more damage to their health than to heal it. The Hmong are against anesthesia, surgery, and autopsies because they can all lead to some sort of soul alteration (Fadiman, p. 33). The only forms of medical treatment accepted by the Hmong are antibiotics because it was a quick way to cure an infection (Fadiman, p. 34). But they don’t believe that any treatment should be long term.

In Hmong society epilepsy is translated to qaug dab peg, “the spirit catches you and you fall down’’ (Fadiman, p. 20). Even though epilepsy is thought by Americans as a severe illness, Lia`s parents had a conflicting view of pride and concern. On one side epilepsy was thought to be a special sign that the person will become a shaman because “Their seizures are thought to be evidence that they have the power to perceive things other people cannot see, as well as facilitating their entry into trances, a prerequisite for their journeys into the realm of the unseen. ’ (Fadiman, p. 21). “They felt Lia was kind of an anointed one, like a member of royalty… and so sometimes their thinking was that this was not so much a medical problem as it was a blessing. ” (Fadiman, p. 22) because a shaman is seen as a person of high moral character and is treated with respect in the Hmong society. This is where conflict arises because unlike the doctors at MCMC who wanted to stop the seizure from happening, Lia`s parents saw this as a divine calling for their daughter and they did not see a need to suppress the seizures.

When Lia is first diagnosed with epilepsy the doctors prescribed an anti convulsant to suppress the seizures, but they never thought about the possibility of her parents not following the prescription correctly or not wanting to give Lia the medicine due to the side effects. When Lia continues to have frequent seizures while being on the medication her doctors start prescribing other medication for a less serious type of seizure.

When this change in medication doesn’t improve Lia`s seizures, her doctor starts prescribing her multiple drugs simultaneously for the seizures plus antibiotics, antihistamines, and bronchodilating drugs due to the lung and ear infections frequently accompanied by seizures (Fadiman, p. 46). “These medications were prescribed in varying combinations, varying amounts, and varying numbers of times a day, the prescription changed twenty-three times in less than four years. ’’ (Fadiman, p. 46). This quickly got confusing to Lia`s parents because due to the language barrier they were not instructed correctly on how to give Lia the correct dosages.

Even if someone were present to translate instructions when a bottle was handed to Lia`s parents there was no way of knowing that they would remember them and since the prescription frequently changed it would have been difficult for even a English speaking parent to follow correctly. (Fadiman, p. 46) When doctors begin to notice that the seizures are still occurring they start thinking about the possibility that Lia`s parents were either confused or lying about the medication and ultimately the problem was both. (Fadiman, p. 7-48) The Lee`s would give Lia incorrect drugs because they were being stored in medicine bottles with incorrect names. They would also fail to give Lia the correct dosages because some medication needed to be measured or cut into fractions (Fadiman, p. 47). The Lee`s were also knowingly not giving Lia her medication because they didn’t believe that she needed to be on it due to the seizures, they saw it more as a suggestion. The side effects that came with the medication caused Lia`s parents to stop giving her certain drugs because she was becoming hyperactive.

The Lee`s would one day say they wanted to stop giving a drug but would then decide that they do like it but would decide on stopping on giving another drug (Fadiman, p. 49-50). This quickly became very frustrating to the doctors because they felt the Hmong were being stubborn. They didn’t understand that because of the difference in culture there was also a difference on how to heal a person. For a Hmong, medicine is religion, religion is society, and society is medicine (Fadiman, p. 60).

Due to factors in the cultural beliefs of Hmong, epilepsy is not something that has to do with the brain but that has to do with Lia`s soul and the possibility of her divine calling. This brings up the problem of the treatment between Lia`s parents and her doctors. Her doctors goal are to stop the seizures from happening to prevent damage to the brain but her parents goal is to make Lia`s soul healthy and get rid of the qaug dab peg. They had more trouble understanding the medication and why they were giving it than why Lia had epilepsy. This is why the treatment was the crisis for Lia`s parents and not the epilepsy.

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