The Spirit Catches You and You Fall Down

by Anne Fadiman

  2. Fish Soup

  Luc Janssens told me the Fish Soup story.

  My summary of Hmong history from ancient times until the early twentieth century is deeply indebted to Keith Quincy’s Hmong: History of a People. (I relied primarily on the 1988 edition; a revised edition was published in 1995.) Were I citing the source of each detail, Quincy’s name would attach itself to nearly every sentence in the pages on the Hmong in China.

  I drew many ideas from F. M. Savina’s Histoire des Miao. The story of King Sonom, also retold by Quincy, comes from an extraordinary contemporary document, a 1775 letter by a French missionary in China named Joseph Amiot, which Savina reproduces in full.

  Other useful works on Hmong history include Jean Mottin’s charming History of the Hmong; W. R. Geddes, Migrants of the Mountains: The Cultural Ecology of the Blue Miao (Hmong Njua) of Thailand, the standard anthropological study of the Hmong; Hugo Adolf Bernatzik, Akha and Miao: Problems of Applied Ethnography in Farther India; Sucheng Chan, Hmong Means Free: Life in Laos and America; and Yang See Koumarn and G. Linwood Barney, “The Hmong: Their History and Culture.”

  Background on the terms “Miao,” “Meo,” and “Hmong” is from the above sources (Bernatzik is the most detailed), and also from Yang Dao, Hmong at the Turning Point, and Christopher Robbins, The Ravens: The Men Who Flew in America’s Secret War in Laos.

  The passage by anthropologist Robert Cooper is from his Resource Scarcity and the Hmong Response.

  3. The Spirit Catches You and You Fall Down

  Delores J. Cabezut-Ortiz, Merced County: The Golden Harvest, recounts how Tony Coelho was rejected by the Jesuits because of his epilepsy. Blia Yao Moua told me about the offer to perform a Hmong healing ceremony for Coelho in Merced.

  On becoming a txiv neeb: Dwight Conquergood, I Am a Shaman; Jacques Lemoine, “Shamanism in the Context of Hmong Resettlement” Bruce Thowpaou Bliatout, “Traditional Hmong Beliefs” and Kathleen Ann Culhane-Pera, “Description and Interpretation of a Hmong Shaman in St. Paul.”

  On how Hmong parents treat their children: Hugo Adolf Bernatzik, Akha and Miao; Nusit Chindarsi, The Religion of the Hmong Njua; Brenda Jean Cumming, “The Development of Attachment in Two Groups of Economically Disadvantaged Infants and Their Mothers: Hmong Refugee and Caucasian-American” E. M. Newlin-Haus, “A Comparison of Proxemic and Selected Communication Behavior of Anglo-American and Hmong Refugee Mother-Infant Pairs” Charles N. Oberg et al., “A Cross-Cultural Assessment of Maternal-Child Interaction: Links to Health and Development” and Wendy Walker-Moffat, The Other Side of the Asian American Success Story.

  The information on Merced Community Medical Center was provided by Vi Colunga, Arthur DeNio, Doreen Faiello, Ed Hughell, Liz Lorenzi, Betty Maddalena, Marilyn Mochel, Dan Murphy, Theresa Schill, Bill Selvidge, Betty Wetters, and Janice Wilkerson.

  The Hmong population of Merced City is an estimate based on projections from the 1990 census. It attempts to take into account new refugees from Thailand, secondary migrants from other parts of the United States, and births (using Hmong, not American, birthrates). The Demographic Research Unit of the California Department of Finance and Rhonda Walton at the Merced Human Services Agency provided assistance.

  Much of the information here and elsewhere on the medical aspects of epilepsy is drawn from conversations with neurologist Elizabeth Engle of Boston Children’s Hospital and with Neil Ernst and Peggy Philp of Merced Community Medical Center. I also found these works helpful: Owen B. Evans, Manual of Child Neurology; Orrin Devinsky, A Guide to Understanding and Living with Epilepsy; Robert Berkow, ed., The Merck Manual of Diagnosis and Therapy; Alan Newman, “Epilepsy: Light from the Mind’s Dark Corner” and Jane Brody, “Many People Still Do Not Understand Epilepsy.” Eve LaPlante discusses the relationship between epilepsy and creativity in Seized: Temporal Lobe Epilepsy as a Medical, Historical, and Artistic Phenomenon. Owsei Temkin recounts the history of epilepsy in his fascinating work The Falling Sickness: A History of Epilepsy from the Greeks to the Beginnings of Modern Neurology. The Hippocrates quotation is from On the Sacred Disease, quoted in Richard Restak, The Brain; the Dostoyevsky quotation is from The Idiot.

  4. Do Doctors Eat Brains?

  Mao Thao’s visit to Ban Vinai is recounted in “Hmong Medical Interpreter Fields Questions from Curious,” and in Marshall Hurlich et al., “Attitudes of Hmong Toward a Medical Research Project.”

  Hmong health care taboos, and the differences between txiv neebs and doctors, are discussed in Charles Johnson, Dab Neeg Hmoob; Dwight Conquergood et al., I Am a Shaman; Ann Bosley, “Of Shamans and Physicians” Elizabeth S. Kirton, “The Locked Medicine Cabinet” John Finck, “Southeast Asian Refugees of Rhode Island: Cross-Cultural Issues in Medical Care” Joseph Westermeyer and Xoua Thao, “Cultural Beliefs and Surgical Procedures” Marjorie Muecke, “In Search of Healers: Southeast Asian Refugees in the American Health Care System” Scott Wittet, “Information Needs of Southeast Asian Refugees in Medical Situations” and two works by Bruce Thowpaou Bliatout, “Hmong Refugees: Some Barriers to Some Western Health Care Services” and “Hmong Attitudes Towards Surgery: How It Affects Patient Prognosis.” See also the five Bliatout sources on the causes of illness cited under Chapter 1.

  Asian dermal treatments are described in Donna Schreiner, “Southeast Asian Folk Healing” Lana Montgomery, “Folk Medicine of the Indochinese” and Anh Nguyen et al., “Folk Medicine, Folk Nutrition, Superstitions.” Koua Her, Kia Lee, Chong Moua, and Foua Yang also explained these treatments to me.

  Jean-Pierre Willem tells the story of the typhoid epidemic at Nam Yao in Les naufragés de la liberté: Le dernier exode des Méos. Catherine Pake presents her research at Phanat Nikhom in “Medicinal Ethnobotany of Hmong Refugees in Thailand.” Dwight Conquergood describes his health program at Ban Vinai in my hands-down favorite account of working with the Hmong: “Health Theatre in a Hmong Refugee Camp: Performance, Communication, and Culture.”

  5. Take as Directed

  I first met the concept of “angor animi” in Migraine, by Oliver Sacks.

  The side effects of anticonvulsant drugs are noted in Orrin Devinsky, A Guide to Understanding and Living with Epilepsy; Warren Leary, “Valium Found to Reduce Fever Convulsions” and Physicians’ Desk Reference. (I used the 1987 edition of the PDR here and elsewhere because it is roughly contemporaneous with Lia’s case.) In the opinion of pediatric neurologist Elizabeth Engle of Boston Children’s Hospital, the studies on phenobarbital’s association with lowered I.Q. scores are not conclusive. She believes it is a safe drug.

  Blia Yao Moua, Dia Xiong, Vishwa Kapoor, and Vonda Crouse told me about the case of Arnie Vang. It is also described in Pablo Lopez, “Hmong Mother Holds Off Police Because of Fear for Her Children.”

  6. High-Velocity Transcortical Lead Therapy

  Most of the works cited under Chapter 4 were also useful here. Two particularly helpful introductions to Hmong health care issues are Ann Bosley, “Of Shamans and Physicians,” and Elizabeth S. Kirton, “The Locked Medicine Cabinet.”

  Rumors about life in America are mentioned in Bruce Thowpaou Bliatout, Hmong Sudden Unexpected Nocturnal Death Syndrome, and Marc Kaufman, “Why the Hmong Spurn America.” May Ying Xiong and Long Thao also told me about some of these rumors.

  Koua Her, Kia Lee, Linda Lee, Nao Kao Lee, Blia Yao Moua, Chong Moua, Dang Moua, Moua Kee, Lao Lee Moua, Long Thao, Pa Vue Thao, Lee Vang, Peter Vang, Jonas Vangay, Sukey Waller, John Xiong, Xay Soua Xiong, Yia Thao Xiong, and Foua Yang helped me understand Hmong attitudes toward doctors. John Aleman, Steve Ames, Raquel Arias, Nancy Brockington, Teresa Callahan, Rick Dehn, Benny Douglas, Donna Earle, Neil Ernst, Doreen Faiello, Roger Fife, Kris Hartwig, Tim Johnston, Martin Kilgore, Phyllis Lee, Mari Mockus, Dan Murphy, Karen Olmos, Peggy Philp, Dave Schneider, Steve Segerstrom, Bill Selvidge, Barbara Showalter, Robert Small, Tom Sult, Richard Welch, and Fern Wickstrom helped me understand health care workers’ attitudes toward the Hmong.

  Alan M. Kraut has
written a cogent historical summary of immigrant health issues, “Healers and Strangers: Immigrant Attitudes Toward the Physician in America—A Relationship in Historical Perspective,” and a comprehensive book on the subject, Silent Travelers: Germs, Genes, and the “Immigrant Menace.”

  The challenges of treating Hmong patients in Merced are described in “Salmonellosis Following a Hmong Celebration” Thomas Neil Ernst et al., “The Effect of Southeast Asian Refugees on Medical Services in a Rural County” and Doreen Faiello, “Translation Please.”

  The Hmong-English medical glossary mentioned here is Thai Fang, Tuabneeg Lubcev Hab Kev Mobnkeeg Rua Cov Haslug Hmoob: Basic Human Body and Medical Information for Hmong Speaking People.

  Other sources on Hmong health care include Scott Wittet, “Information Needs of Southeast Asian Refugees” Kathleen Ann Culhane-Pera, “Analysis of Cultural Beliefs and Power Dynamics in Disagreements about Health Care of Hmong Children” Marjorie Muecke, “Caring for Southeast Asian Refugee Patients in the USA” Amos S. Deinard and Timothy Dunnigan, “Hmong Health Care: Reflections on a Six-Year Experience” Debra Buchwald et al., “Use of Traditional Health Practices by Southeast Asian Refugees in a Primary Care Clinic” Roy V. Erickson and Giao Ngoc Hoang, “Health Problems Among Indochinese Refugees” Agatha Gallo et al., “Little Refugees with Big Needs” and Rita Bayer Leyn, “The Challenge of Caring for Child Refugees from Southeast Asia.”

  On somatization: Joseph Westermeyer et al., “Somatization Among Refugees: An Epidemiologic Study.”

  On pregnancy and childbirth: James M. Nyce and William H. Hollinshead, “Southeast Asian Refugees of Rhode Island: Reproductive Beliefs and Practices Among the Hmong” Andrea Hollingsworth et al., “The Refugees and Childbearing: What to Expect” Linda Todd, “Indochinese Refugees Bring Rich Heritages to Childbearing” Peter Kunstadter, “Pilot Study of Differential Child Survival Among Various Ethnic Groups in Northern Thailand and California” Helen Stewart Faller, “Hmong Women: Characteristics and Birth Outcomes, 1990” Deanne Erickson et al., “Maternal and Infant Outcomes Among Caucasians and Hmong Refugees in Minneapolis, Minnesota” and Deborah Helsel et al., “Pregnancy Among the Hmong: Birthweight, Age, and Parity.”

  On the high Hmong birthrate: Rubén Rumbaut and John R. Weeks, “Fertility and Adaptation: Indochinese Refugees in the United States,” which provides fertility-rate statistics; Wendy D. Walker, “The Other Side of the Asian Academic Success Myth: The Hmong Story” George M. Scott, Jr., “Migrants Without Mountains” “Making Up for the Ravages of Battle: Hmong Birthrate Subject of Merced Study” and Donald A. Ranard, “The Last Bus.”

  The fertility rates for white and black Americans are from the Population Branch of the U.S. Census Bureau. Note that “fertility rate” means not the average number of children that a group of women of various ages have at a given time, but the average number of children they have during their entire childbearing lives. The first statistic would be lower, since it would include women who had not yet completed their childbearing.

  7. Government Property

  The information on reporting child abuse is from “Child Abuse Laws: What Are Your Obligations?” and from the National Clearinghouse on Child Abuse and Neglect. The legal conflict between religious freedom and the obligation to provide medical care for one’s children is reported in Martin Halstuk, “Religious Freedom Collides with Medical Care” David Margolick, “In Child Deaths, a Test for Christian Science” “Court Says Ill Child’s Interests Outweigh Religion” James Feron, “Can Choosing Form of Care Become Neglect?” and Caroline Fraser, “Suffering Children and the Christian Science Church.” Kathleen Ann Culhane-Pera, “Analysis of Cultural Beliefs and Power Dynamics,” is a penetrating study of the problem from the Hmong perspective.

  Justice Robert Jackson’s statement about parents making martyrs of their children is from Prince v. Massachusetts, 321 U.S. 158, 170 (1943).

  Linda Greenhouse, “Christian Scientists Rebuffed in Ruling by Supreme Court,” and Stephen L. Carter, “The Power of Prayer, Denied,” discuss the case of McKown v. Lundman.

  Useful background information was provided by CHILD (Children’s Healthcare Is a Legal Duty), an organization founded by Rita Swan, a former Christian Scientist whose sixteen-month-old son died of meningitis.

  8. Foua and Nao Kao

  My sources on Hmong etiquette included Charles Johnson, Dab Neeg Hmoob; Don Willcox, Hmong Folklife; and “Social/Cultural Customs: Similarities and Differences Between Vietnamese—Cambodians—H’Mong—Lao.”

  The tale of the Hmong princess who mistook her rescuer for a hungry eagle is from Charles Johnson, Dab Neeg Hmoob. The tale of the arrogant official who was turned into a mouse is from W. R. Geddes, Migrants of the Mountains. Keith Quincy, Hmong, notes that Hmong were forced to crawl when they approached Lao officials.

  The traditional Hmong divisions of the year and the day are described in W. R. Geddes, Migrants of the Mountains; Yang See Koumarn and G. Linwood Barney, “The Hmong” Charles Johnson, Dab Neeg Hmoob; and Ernest E. Heimbach, White Hmong-English Dictionary.

  For more on paj ntaub, see Paul and Elaine Lewis, Peoples of the Golden Triangle; George M. Scott, Jr., “Migrants Without Mountains” Egle Victoria ygas, “Flower Cloth” and Michele B. Gazzolo, “Spirit Paths and Roads of Sickness: A Symbolic Analysis of Hmong Textile Design.”

  9. A Little Medicine and a Little Neeb

  Jacques Lemoine, “Shamanism,” and Dwight Conquergood et al., I Am a Shaman, contain sympathetic interpretations of Hmong animal sacrifice. The following describe the sacrificial practices of other sects, chiefly Santería: Jeffrey Schmalz, “Animal Sacrifices: Faith or Cruelty?” Richard N. Ostling, “Shedding Blood in Sacred Bowls” Larry Rohter, “Court to Weigh Law Forbidding Ritual Sacrifice” Russell Miller, “A Leap of Faith” and Lizette Alvarez, “A Once-Hidden Faith Leaps into the Open.”

  Merced’s ban on animal slaughter is reported in Ken Carlson, “Hmong Leaders Seek Exemption” and “Sacrifice Ban Remains,” and Mike De La Cruz, “Animal Slaughtering Not All Ritualistic” and “Charges Filed After Animal Slaughtering Probe.”

  Bruce Thowpaou Bliatout, Hmong Sudden Unexpected Nocturnal Death Syndrome, explains the ploy of changing a sick person’s name in order to fool the soul-stealing dab.

  Thomas Neil Ernst and Margaret Philp, “Bacterial Tracheitis Caused by Branhamella catarrhalis,” discusses Lia Lee’s tracheal infection.

  10. War

  Here, as elsewhere, all the stories and quotations from F. M. Savina are from his Histoire des Miao. Jonas Vangay told me about the Hmong language’s rich stock of mountain vocabulary. Jean Mottin, History of the Hmong, classifies the ethnic groups of Laos by altitude. George M. Scott, Jr., “Migrants Without Mountains,” contains a nuanced discussion of Hmong attitudes toward the lowland Lao. The intimate relation between the Hmong of Laos and their natural environment is explored in Eric Crystal, “Buffalo Heads and Sacred Threads” Keith Quincy, Hmong; Paul and Elaine Lewis, Peoples of the Golden Triangle; Don Willcox, Hmong Folklife; Charles Johnson, Dab Neeg Hmoob; and Charles Johnson and Ava Dale Johnson, Six Hmong Folk Tales Retold in English. Christine Sutton, ed., “The Hmong of Laos,” and Yang See Koumarn and G. Linwood Barney, “The Hmong,” also provide good basic background on traditional village life.

  The onomatopoeic phrases are from Martha Ratcliff’s fascinating linguistic study, “Two-Word Expressives in White Hmong.” Ratcliff notes that her translations of these expressions are not definitions but associations; many of the expressions have multiple associations.

  Two works by William Smalley, Phonemes and Orthography and “Adaptive Language Strategies of the Hmong: From Asian Mountains to American Ghettos,” make interesting distinctions between illiteracy, the inability to read within a literate culture, and preliteracy, the inability to read within an oral culture. W. J. Ong, Orality and Literacy: The Technologizing of the Word, notes the magical potency of the word in oral cultures.

  Sources on o
pium include Sucheng Chan, Hmong Means Free; Alfred W. McCoy, The Politics of Heroin: CIA Complicity in the Global Drug Trade; Yang Dao, “Why Did the Hmong Leave Laos?” Ken Hoffman, “Background on the Hmong of Laos” W. R. Geddes, Migrants of the Mountains; Robert Cooper, Resource Scarcity; Christopher Robbins, The Ravens; Yang See Koumarn and G. Linwood Barney, “The Hmong” Paul and Elaine Lewis, Peoples of the Golden Triangle; and Keith Quincy, Hmong. It is Quincy who tells the legend of the opium poppy that grew from the grave of the promiscuous Hmong girl.

  Many of the above works also touch on the Hmong migrant identity, as does Nusit Chindarsi, The Religion of the Hmong Njua. The most detailed source is Cheu Thao, “Hmong Migration and Leadership in Laos and in the United States.” For a thought-provoking rebuttal of the idea that Hmong migration is a cultural phenomenon, see Ray Hutchison, Acculturation in the Hmong Community.

  My account of the war in Laos was enriched by Jonas Vangay; Vincent Demma, of the Center for Military History; Yvonne Kincaid, of the Air Force Research division; writer Gayle Morrison; and historian Gary Stone.

  Within the extensive corpus of work on the war, three nonacademic accounts deserve special mention. The first is Jane Hamilton-Merritt’s Tragic Mountains: The Hmong, the Americans, and the Secret Wars for Laos, 1942–1992. This ambitious book is essential reading for anyone interested in the Hmong. It has caused some controversy in scholarly circles because of the author’s partisan support of Vang Pao and her convictions about yellow rain. However, Hamilton-Merritt’s wealth of eyewitness reporting and her passionate commitment to the Hmong people are unmatched. The second is Christopher Robbins’s The Ravens, a swashbuckling but well-researched account of the U.S. Air Force pilots recruited by the CIA to fly in the Laos war. I have drawn many details from it. The third is Roger Warner, Back Fire: The CIA’s Secret War in Laos and Its Link to the War in Vietnam, which tells the story of the war by focusing on a few principal players. Most are American, but there is much on Vang Pao that I have read nowhere else. Warner’s book has since been republished in somewhat different form as Shooting at the Moon: The Story of America’s Clandestine War in Laos.