The Spirit Catches You and You Fall Down

by Anne Fadiman

  Some of the details of Dang Moua’s story come from Frank Viviano, “Strangers in the Promised Land,” and Arlene Bartholome, “Future Is Uncertain for Area Refugees.” Dang Moua and Jonas Vangay told me about Vang Pao’s plan to buy a local fruit ranch. Jeff McMahon provided minutes from the June 7, 1977, and June 21, 1977, meetings of the Merced County Board of Supervisors on the proposed purchase, which was also reported in “Laotians Drop Ranching Plan.” The Merced Sun-Star headlines about the Hmong influx are from January 21, 1983; October 20, 1982; and May 11, 1983. The John Steinbeck quotations are from The Grapes of Wrath.

  A great deal of helpful information on Merced’s economic and welfare situation was provided by Andrea Baker and Rhonda Walton; also by Jim Brown, John Cullen, Michael Hider, Bev Morse, George Rodriguez, Van Vanderside, Houa Vang, and Charles Wimbley. The California State Department of Finance and the California State Census Data Center also assisted. Ron Dangaran, Jean Moua, and Terry Silva supplied background on Merced schools; Joe Brucia, Randy Carrothers, Charlie Lucas, Pat Lunney, and Rick Oules, on crime; and John McDoniel and Margaret Ogden on driver’s license examinations. “Gang Pak” contains information on Merced’s youth gangs. Pat McNally and Daniel Silva, “Asians, Game Laws in Conflict,” reports on Hmong hunting and fishing. Mark Arax, “A Final Turf War,” describes the Tollhouse Cemetery where “CIA veteran” Chua Cha Cha is buried.

  The most authoritative source on Hmong education is Wendy Walker-Moffat, The Other Side of the Asian American Success Story. See also “The Other Side of the Asian Academic Success Myth” by Wendy D. Walker (Walker-Moffat’s former name); Rubén Rumbaut and Kenji Ima, The Adaptation of Southeast Asian Youth: A Comparative Study; Donald A. Ranard, “The Hmong Can Make It in America” Chia Vang, “Why Are Few Hmong Women in Higher Education?” George M. Scott, Jr., “Migrants Without Mountains” Miles McNall and Timothy Dunnigan, “Hmong Youth in St. Paul’s Public Schools” and Susan Dandridge Bosher, “Acculturation, Ethnicity, and Second Language Acquisition: A Study of Hmong Students at the Post-secondary Level.”

  Malek-Mithra Sheybani, “Cultural Defense: One Person’s Culture Is Another’s Crime,” discusses marriage by capture. For more on Hmong marriage, see T. Christopher Thao, “Hmong Customs on Marriage, Divorce and the Rights of Married Women,” and William H. Meredith and George P. Rowe, “Changes in Lao Hmong Marital Attitudes After Immigrating to the United States.”

  Paul DeLay, Karen Olmos, Court Robinson, and Jonas Vangay told me some of the examples of “different ethics.” (They all mentioned these examples to illustrate how Hmong and American ethical systems differ, not to disparage the Hmong system.) Charles Johnson, Dab Neeg Hmoob, and Ruth Hammond, “Strangers in a Strange Land,” also explore Hmong ethics.

  For a provocative, though to my eye lopsidedly anti-Hmong, view of a Wisconsin city’s response to a Hmong influx similar to Merced’s, see Roy Beck, “The Ordeal of Immigration in Wausau.”

  17. The Eight Questions

  Arthur Kleinman’s “Eight Questions” have been published often, in slightly differing versions. The original version appeared in Kleinman et al., “Culture, Illness, and Care: Clinical Lessons from Anthropologic and Cross-Cultural Research.” I consulted Dr. Kleinman on the phrasing that appears here.

  18. The Life or the Soul

  The literature of social and cross-cultural medicine is rich, and rapidly getting richer. I suggest that interested readers start with the unfailingly perceptive Arthur Kleinman, who wrote the seminal article cited under the previous chapter as well as Patients and Healers in the Context of Culture; The Illness Narratives: Suffering, Healing, and the Human Condition; and other works on related subjects.

  Recommended brief introductions to cross-cultural health issues include Shotsy C. Faust, “Providing Inclusive Healthcare Across Cultures” Debra Buchwald et al., “The Medical Interview Across Cultures” Karen Olness, “Cultural Issues in Primary Pediatric Care” and Daniel Goleman, “Making Room on the Couch for Culture.” Those who wish to pursue this subject further are directed to the excellent cross-cultural bibliography in Robert C. Like et al., “Recommended Core Curriculum Guidelines on Culturally Sensitive and Competent Health Care.”

  Among those who provided ideas and details for this chapter are Daniel Good-enough and Arthur Kleinman, Harvard Medical School; Ronald Garcia and Gary Lapid, Stanford Medical School; Shotsy Faust and Chloë Wurr, Refugee Medical Clinic, San Francisco General Hospital; Gerald Hejduk, American Academy of Family Physicians; Robert Berkow and William R. Harrison, Merck Manual; Garry Shirts, Simulation Training Systems; Ira SenGupta, Cross-Cultural Health Care Program, Pacific Medical Center; Dan Murphy, Merced Community Medical Center; and Marilyn Mochel, Merced Refugee Health Program, Merced County Health Department. Many themes I have developed here were sparked when I audited a course on the Psychosocial Aspects of Illness at Stanford Medical School and spent time in Stanford’s anatomy laboratory.

  I learned of the Hmong medical cases summarized at the beginning of the chapter from lectures by or conversations with Tuan Nguyen, Long Thao, Blia Yao Moua, Roger Fife, Yia Thao Xiong, Thomas Bornemann, Doreen Faiello, and Francesca Farr.

  Bruce Thowpaou Bliatout’s suggestions for improving Hmong health care are from “Hmong Refugees,” “Hmong Attitudes Toward Surgery,” “Mental Health and Prevention Activities,” “Guidelines for Mental Health Professionals,” “Prevention of Mental Health Problems,” and Hmong Sudden Unexpected Nocturnal Death Syndrome. The Hmong-English medical glossary mentioned here is Thai Fang, Tuabneeg Lubcev Hab Kev Mobnkeeg.

  Pam Belluck, “Mingling Two Worlds of Medicine,” reports on New York City doctors who work with folk healers. The observations on shamanism are from Dwight Conquergood et al., I Am a Shaman, and Jacques Lemoine, “Shamanism.” Mother Clean’s sanitation poem is from Dwight Conquergood, “Health Theatre.” The mental health program in which txiv neebs were consulted on ailing gall bladders and penises, among other maladies, is described in Kou Vang, Hmong Concepts of Illness and Healing. Sukey Waller recounts her collaborative work with txiv neebs in “Hmong Shamans in a County Mental Health Setting: A Bicultural Model for Healing Laotian Mountain People.”

  The 1996 Course Guide for Community-Based Patient-Doctor I, a division of the Patient-Doctor I course at Harvard Medical School, contained reprints of several helpful articles. San Francisco General Hospital’s “Refugee Clinic Orientation Manual” was similarly fertile.

  The article instructing doctors on how to recognize their emotions is William M. Zinn, “Doctors Have Feelings Too.” Esther B. Fein, “Specialty or General Practice: Young Doctors Change Paths,” includes statistics on how many medical students are choosing to become generalists.

  19. The Sacrifice

  Descriptions and interpretations of Hmong healing ceremonies can be found in Dwight Conquergood, “Establishing the World,” and Conquergood et al., I Am a Shaman; Eric Crystal, “Buffalo Heads and Sacred Threads” Kathleen Ann Culhane-Pera, “Description and Interpretation of a Hmong Shaman” Jacques Lemoine, “Shamanism” Jean Mottin, “A Hmong Shaman’s Séance” Kou Vang, Hmong Concepts of Illness and Healing; Don Willcox, Hmong Folklife; and Sukey Waller, “Hmong Shamanism.” The most exhaustive study is Guy Moréchand, Le chamanisme des Hmong. A txiv neeb’s ritual work can be seen in “Between Two Worlds: The Hmong Shaman in America,” a short documentary film produced by Taggart Siegel and Dwight Conquergood.

  Dwight Conquergood, Say Hang, Blia Yao Moua, Chong Moua, Sukey Waller, May Ying Xiong, and Mayko Xiong also provided helpful background information.

  There are innumerable, and often inconsistent, versions of the Shee Yee myth. In telling the early parts of his story, I have closely followed the phrasing in Charles Johnson, Dab Neeg Hmoob. For Shee Yee’s later exploits, I have drawn on retellings in Kathleen Ann Culhane-Pera, “Description and Interpretation of a Hmong Shaman” Bruce Thowpaou Bliatout, Hmong Sudden Unexpected Nocturnal Death Syndrome; Kou Vang, Hmong Concepts of Illness
and Healing; Keith Quincy, Hmong; and Jean Mottin, “A Hmong Shaman’s Séance.”

  Note on Hmong Orthography, Pronunciation, and Quotations

  The folktale about the great Hmong book that was eaten by cows and rats is from Robert Cooper et al., The Hmong.

  Shong Lue Yang’s writing system is summarized in William A. Smalley, “The Hmong ‘Mother of Writing’: A Messianic Figure,” and Gary Yia Lee and William A. Smalley, “Perspectives on Pahawh Hmong Writing.” For greater detail, see Smalley et al., Mother of Writing: The Origin and Development of a Hmong Messianic Script, and Chia Koua Vang et al., The Life of Shong Lue Yang: Hmong “Mother of Writing.”

  The Romanized Popular Alphabet is described in “A Note on Hmong Orthography” in Glenn L. Hendricks, The Hmong in Transition. I also relied on unpublished resource materials written by Jonas Vangay for his Hmong language course at Merced College.

  For readers interested in learning or teaching the Hmong language, I highly recommend Annie Jaisser’s textbook and audiotape, Hmong for Beginners. (It can be obtained through the CSSEAS Publications Office, 2223 Fulton Street, Room 338, University of California, Berkeley, California 94720.) There are also two useful dictionaries, Ernest E. Heimbach’s comprehensive White Hmong-English Dictionary and Brian McKibben’s basic English-White Hmong Dictionary.

  If you wish to speak to a Hmong by phone and need an interpreter, AT&T Language Line Services (800-628-8486) can provide one for a fee.

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