Foucault defines culture as “a hierarchical organization of values, accessible to everybody, but at the same time the occasion of a mechanism of selection and exclusion.” What we perceive as culture, is a manifestation of the deeper meaning of culture – what we do, what we think, and how we feel.  Culture is symbolic in that it allows us to attribute meaning to behavior, words, and objects.  Culture is also embedded in how we understand health and illness, what we attribute to these “states”, and how we approach changing them.  This is pertinent in “The Spirit Catches you and You Fall Down” in that although Lia’s family has a strong connection to Hmong culture, they are somewhat estranged and at odds with American culture. This is evidenced in small details like the fact that Hmong families arriving in America were forced to make up birthrates in order to fill out various forms as well as in the different cultural understandings of illness and its treatment.

As illustrated in “The Spirit Catches You and You Fall Down”, the Hmong culture attributes illness and healing to spiritual matters that relate to all parts of the universe. This striking contrast to the medical community in North America that sees illness as having a biological cause to be treated with medicine, surgery, or another procedure to repair this biological error is a main focus throughout the book.  The Hmong understanding that Lia’s condition was caused by her soul fleeing her body as a result of being so frightened by the sound of a door slamming is very different from a Western medical perspective of the origins of epilepsy.  These differences in cultural understandings of medicine illustrate the dire importance for cultural competence in the health care system. This involves medical professionals recognizing their own cultural influences, developing knowledge about the cultural backgrounds of their clients, and developing appropriate skills to be able to intervene in ways that are culturally sensitive and relevant.

The fact that Lia’s parents did not agree with or carefully follow the treatment prescribed by the doctors emphasizes the difference in the cultural understandings of illness between Hmong and American medicine. This also brings up the important notion of health literacy, the degree to which one has the capacity to obtain, process and understand basic health information and services necessary to make appropriate health decisions. Although Lia’s parents seem to have a very good understanding of Hmong health and medicine, through the ways in which the author describes Foua’s previous labors and the spiritual rituals the family and shamans perform to “cure” Lia, they have very little understanding of the American medical system and understandably, because of this do not follow medical instructions very well early on in the book. This is compounded by the language barrier between Lia’s family and the American healthcare system.