Self Reflection Book Review: “The Spirit Catches You and You Fall Down”

Introduction


The book, “The Spirit catches you and you Fall Down” captures the essence of humanity, ways in which the uniqueness of each individual challenges the rationality and compassion of one another while maintaining cultural autonomy and adapting to a world that is constantly changing. In this book, the collision of ideals is experienced between the staff of Merced Hospital in California and a Hmong family of refugees from Laos.

The practice of medicine is in a constant state of evolution as interaction with various types of cultures ignites the need for education in the delivery of medical treatment and procedures unique to each patient according to race, culture, religion, etc. Technology assists everyone in increasing awareness, but it also distorts notions about how each other lives and believes [This last statement is a very good point]. This book demonstrates the need to look beyond differences and bridging the gap that makes us different in an effort to bring us closer. Each culture’s belief system is neither right nor wrong. There is no room for exploitation or judgment of anyone, but to appreciate culture is essential for survival.

The Incident


The incident most meaningful to me in this book was Chapter 8. The Hmong do not know of psychological problems because they do not distinguish between mental and physical illness. Everything in their culture is spiritual. This touched me. I identified with all aspects of this, not only as a person trying to practice the original spiritual traditions of my Native American Indian (Iroquois) and various European blood lines within my family heritage, but also my values as a nurse. I recognized, during my assignment on Culture Bound Syndromes that Ghost Sickness is actually experienced by many different cultures, it is just called something else! However, in the traditional Western Medical Model, these spiritual afflictions believed to be true by the culture can lead to similar symptoms linked to anxiety and depression that causes stress, wear and tear on body organ systems as if it was an actual physical infection.

Reflections


My personal experience was in regard to anxiety, depression and acute intermittent pain in my abdomen that led me to the Emergency Room. The tests were negative for ulcer, pancreatitis, heart problems and gall stones, although the pain increased. The doctors couldn’t find anything wrong on their tests and examinations, so I received IV doses of pain medications. The doctors did not know how else to help me. One doctor came to me and asked directly: “Tell me about your life.” Compared to the other physicians, he stuck with the basic principles and gave me a verbal mini-mental exam that linked my phenomenal symptoms to spiritual depression and anxiety. I was having an internal conflict about meaning of life issues compounded by other dynamics relating to my career (because I was being laid off from a job I enjoyed).

He realized that even though we are both Caucasian, we come from a different culture that needed an intervention that was culturally relevant. The health problem could not be solved through medications, but through spiritual expression and increasing my activity as a healthful outlet for reducing stress, anxiety and the depression.

Conclusion


In conclusion, I realized through closer examination of these experiences that there has to be a balance in interventions between personal belief systems and the practice of traditional medical interventions for our patients. As a nurse, I can use this knowledge to advocate better for my patients, while supporting treatment options provided by the primary care providers I work with.

Written by Dianne DeNardo, CVT, LATg, RN, BSN
All Species Nurse


Book review for:
Fadiman, A. (1998). The Spirit Catches You and You Fall Down. NY: Farrar, Straus and Giroux.

Paper review for HCR 571, Edited by Dr. Carol Balwin, PhD, Cultural Diversity, Arizona State University