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.

When I am ill, my experience of reality changes. My subjective experience of illness rather than disease alters the way that I approach things.  As a consumer of health care and as someone who hopes to go into the health care profession, I found the article “The Social Construction of Diagnosis and Illness” very impactful.  At times in psychology courses, I have found that the focus is on treating the pathology or disease, rather than the illness that the patient experiences.  The theoretical shift to a focus and legitimation of the patient’s experience is an important one in many ways, especially when we look into aspects of treatment such as adherence.  The article highlights that some illness are stigmatized, some are contested, some considered disabilities and others not, illustrating some of the struggles that individuals can face in seeking treatment for their ailments.  When I am ill I know my experience of illness, but conveying that can be a challenge. This challenge is especially relevant to those suffering from diseases that cannot always be seen or that are not understood.  It is interesting to note that at times as patients we face both the challenges of having to battle to have a set of symptoms legitimized with a diagnosis of a contested illness and on the other hand having to be wary of doctors over-prescribing (sometimes) unnecessary drugs. When I am ill, I must now choose where to seek symptom relief, and there are some things that a call to my mom or cup of tea cannot fix.  Ben Goldacre reminds us of the importance of examining the research and taking the evidence into our own hands, to see for ourselves what the data say. We must choose between medicine, supplements, lifestyle changes, dietary changes, homeopathic treatments, and other alternative forms of medicines.  As a patient, I have chosen a combination of these approaches – I believe in medicine, I believe in the biological basis of disease, but I also understand that not everything needs to be treated by medication and that we do not always have a perfect treatment that comes without important side effects.  I am also wary that my doctors may be prescribing drugs because of the monetary benefit that that may provide rather than because I need them.

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