On Missing the Interpreter

On Missing the Interpreter

SpiritCatchesYAYFDIf you have taken ‘Bridging the Gap’ you already heard of Anne Fadiman’s book “The Spirit Catches You and You Fall Down”.  But, did you have a chance to read it? I strongly recommend it.

Originally published in 1997 by Farrar, Straus and Giroux, ‘The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures’, a book recipient of The National Book Critics Circle Award, is a mandatory book for medical students at the University of Michigan.


The Book portrays the story of Lia Lee, a Hmong child diagnosed with severe epilepsy and the youngest daughter of a refugee family from Laos that settled in central California, who was treated for her condition in a small county hospital where no professional medical interpreters were available. More than the language barrier the book emphasizes the importance of the professional interpreter (an in this particular case, the lack of it) in bridging the cultural nuances among different world views and perspectives. It clearly places the interpreter’s role as cultural broker as important, if not more, than the interpreter’s role in bridging the language barrier.

Dan [Dr. Murphy] had no way of knowing that Foua and Nao Kao [Lia’s parents] had already diagnosed their daughter’s problem as the illness where the spirit catches you and you fall down. Foua and Nao Kao had no way of knowing than Dan has diagnosed it as epilepsy, the most common of al neurological disorders. Each has accurately noted the same symptoms, but Dan would have been surprised to hear that they were caused by soul loss, and Lia’s parents would have been surprised to hear that they were caused by an electrochemical storm inside their daughter’s head that had been stirred up by the misfiring of aberrant brain cells.


Except through surgery, whose risks consign it to the category of last resort, epilepsy cannot be cured, but it can be completely or partially controlled in most cases by anti-convulsant drugs.

The Hmong are not the only people who might have good reason to feel ambivalent about suppressing the symptoms. The Greeks called epilepsy “the sacred disease”.


Although the inklings Dan had gathered of the transcendental Hmong worldview seemed to him to possess both power and beauty , his own view of medicine in general, and of epilepsy in particular, was, (…), essentially rationalist.”

Besides the contrasting visions and ways of approaching a given medical problem (disease, according to the physician’s point of view, versus illness, the patient’s point of view of the disease), the extremely different ways to address a patient or a family member or simply to who address questions and concerns, behavioral attitudes deeply embedded within each interacting culture (the Western culture of medicine and the traditional Hmong society culture), may cause intercommunication to miserably fail.

(…) When doctors conferred with a Hmong family, it was tempting to address the reassuringly Americanized teenaged girl who wore lipstick and spoke English rather than the old man who squatted silently in the corner. Yet failing to work within the traditional Hmong hierarchy, in which males ranked higher than females and old people higher than young ones, not only insulted the entire family but also yielded confused results, since the crucial questions had not been directed toward those who had the power to make the decisions. Doctors could also appear disrespectful if they tried to maintain friendly eye contact (which was considered invasive), touched the head of an adult without permission (grossly insulting), or beckoned with a crooked finger (appropriate only for animals). And doctors could lose the respect of their patients if they didn’t act like authority figures. (…)

Complementing the case of Lia Lee, the book intersperses and discusses other medical interactions where conflicting cultural approaches to medical problems highly influenced the outcomes.

(…) In his opinion [of Dwight Conquergood, an ethnographer sent to Ban Vinai by the International Rescue Committee], the physicians and nurses at Ban Vinai [camp hospitals in Ban Vinai refugee camp, Laos] failed to win the cooperation of the camp inhabitants because they considered the relationship one-sided, with the Westerners holding all the knowledge. As long as they persisted in this view, Conquergood believed that what the medical establishment was offering would continue to be rejected, since the Hmong would view it not as a gift but as a form of coercion.

Only when cultural barriers were tore down the possibility for medical outcomes to become satisfactory both to the medical team and to the patient and family alike became feasible.

Therefore, the book accentuates the importance for professional interpreters in a medical setting in bridging the cultural gap between interacting parties if achievement of satisfactory outcomes is sought. Mainly, because all parties are aiming to the same goal: the well-being of the patient.

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