I first heard about absinthe, not as a Scrabble SATINE steal , but in high school during art history class. I later encountered absinthe, not through romps in clandestine Swiss distilleries, but in my university course on French literature of the nineteenth century. I have been in awe of the green fairy ever since, and Absinthe: History in a Bottle by Barnaby Conrad III presents a history of the drink from the nineteenth century to the present day. History in a Bottle is a large-size book luxuriously illustrated with drawings, photographs and most especially, colour paintings which depict absinthe, such as L'Absinthe by Degas from 1876:
Sunday, July 6, 2014
The Spirit Catches You and You Fall Down: A Hmong Child, Her American Doctors, and the Collision of Two Cultures
The Spirit Catches You and You Fall Down: A Hmong child, her American doctors, and the collision of two cultures by Anne Fadiman contains dozens of passages that I'd like to share. My library copy is shamefully dog-eared, and I intend to buy a copy of the book for my bookshelf. But I'll restrain myself and will share only a single anecdote, related in the early pages, which drew me in.
In an intermediate French class at Merced College a few years ago, the students were assigned a five-minute oral report, to be delivered in French. The second student to stand up in front of the class was a young Hmong man. His chosen topic was a recipe for la soupe de poisson: Fish Soup. To prepare Fish Soup, he said, you must have a fish, and in order to have a fish, you have to go fishing. In order to go fishing, you need a hook, and in order to choose the right hook, you need to know whether the fish you are fishing for lives in fresh or salt water, how big it is, and what shape its mouth is. Continuing in this vein for forty-five minutes, the student filled the blackboard with a complexly branching tree of factors and options, a sort of piscatory flowchart, written in French with an overlay of Hmong. He also told several anecdotes about his own fishing experiences. He concluded with a description of how to clean various kinds of fish, how to cut them up, and, finally, how to cook them in broths flavoured with various herbs. When the class period ended, he told the other students that he hoped he had provided enough information, and he wished them good luck in preparing Fish Soup in the Hmong manner.Fish Soup is also a good metaphor for this book, as Fadiman untangles a complexity of threads that caused "the collision of cultures" of the book's subtitle.
The professor of French who told me this story said, "Fish Soup. That's the essence of the Hmong."
The Spirit Catches You and You Fall Down is the story of Lia Lee, a Hmong child with epilepsy, the many people who were responsible for her care - her parents and a large contingent of extremely dedicated doctors, nurses, social workers, and others, and the extreme cultural misunderstandings that compromise and obstruct that care.
It is also a work of anthropology and sociology, an ethnography (that is, an in-depth description of a culture) of the Hmong people, whose worldview and practices are radically different than any in modern society. Most Westerners know very little, if anything, about Hmong culture, and I found this aspect of the book fascinating.
The book is also a history: of the Hmong people, and of their participation in the American wars in Southeast Asia, in which they played a crucial, unacknowledged role, and which ultimately left them victimized, traumatized, and dislocated almost beyond imagining. (When thinking about The Spirit Catches You and You Fall Down, I am constantly reaching for words like unbelievable and incredible, not only as expressions of amazement, but almost as literal truth.)
Fadiman alternates between the history/ethnography and Lia's medical story. This structure builds suspense for Lia's story and prevents the history chapters from becoming tedious or overwhelming. The conflict at the heart of this story is complex and not easily unpacked. Piece by piece, Fadiman lays out the puzzle for the reader.
* * * *
From Lia's very first seizure, the conflict begins. The first seizure is brief, and by the time Lia's parents arrive at the hospital with their daughter, it has passed. The hospital has no Hmong interpreters, and Lia's parents cannot communicate what has happened, but is no longer apparent. And so Lia is misdiagnosed. Lia's parents are sent home with medication and instructions that they cannot read or understand.
What's more, Lia's parents view their child's condition partly as an illness, and partly as a sign of a special spiritual state. For the Hmong, medical practices are also religious, and religious practices involve medicine and healing rituals. Based on their understanding of the world, passed down from generation to generation over thousands of years, Lia's parents strongly object to many forms of treatment.
With one of Lia's siblings, herself a child, pressed into service as a translator, and most Western medical concepts having no Hmong equivalent, Lia's parents rarely understand the doctors' questions or instructions. The time-honoured Hmong way of dealing with such incomprehension or distrust of authority figures is to nod and say yes.
As Lia's condition worsens, the doctors prescribe ever more complicated medication regimens, further reducing the parents' ability and willingness to cope. Over time, Lia's parents would come to believe that their daughter's doctors were worsening or even causing her condition.
Everyone wants what's best for Lia, but without trust and with little or no communication, the medical staff and Lia's parents are in constant conflict. Before Lia reaches the age of five, she has been at the hospital more than 100 times, and has been admitted 17 times.
At one point, Lia is placed in foster care, an absolutely heartbreaking situation which almost kills her mother, and is so traumatic that Lia's highly experienced, loving foster mother advocates for the family to be reunited. Ironically, a doctor who is considered inexpert is able to break Lia's downward spiral by greatly simplifying her medication routine.
For the Hmong family, cultural traits that once had enabled them to survive, such as an extreme distrust of authority, or the propensity to have huge families, are, in this new context, maladaptive, even dooming. The medical staff sees Lia's parents as intractable, ungrateful, stupid, and maddeningly stubborn.
For the medical team, actions that are caring, unselfish, even heroic, end up poisoning relationships and endangering health, even putting Lia's life at risk. Talented, dedicated doctors, unaccustomed to being ignored or defied - especially by patients who are poor, illiterate refugees - find their efforts utterly thwarted. Lia's parents sees them as dangerous dictators who must be placated but ignored.
This is not a story of low-income, non-English-speaking people who were denied quality medical care. Quite the opposite. The family receives the services of huge numbers of people, all at no cost. Doctors, social workers, nurses, and psychologists lose sleep and become physically ill from the tensions of trying to provide care for people who reject it.
Nor is this a story of neglectful parents, clinging to old-world folkways or insisting that prayer will cure their child. It's hard to imagine parents investing more time in a child's comfort and welfare than Lia Lee's parents did for her.
And despite both these truths, Lia's condition worsens.
It's as if the medical staff was attempting to force a Hmong family through a narrow funnel called Western Medicine. The only way the family could have fit through that bottleneck would be to cut off their own heads. If you've ever wondered what "culturally sensitive medical practices" would look like - or if you've scoffed at the idea, believing that medicine is medicine, no matter who the patient - this book will be very illuminating.
Throughout, Fadiman maintains tremendous respect for all the actors in this complex drama, and views them all with compassion, yet with enough objectivity that the reader gets a clear picture. As a writer, I was awed by the amount of research this book represents, and by Fadiman's unerring ability to translate a huge amount of information in a lively and compelling way.
* * * *
The obvious and catastrophic mistakes chronicled in this book are not made by doctors, nor by Lia's parents. They are made by governments.
The Hmong didn't want to come to the United States, Canada, or any of the many countries in which they were re-settled. They wanted to live as they had, in peace and isolation, an isolated ethnic group in Southeast Asia, a people without a country. The Hmong were uprooted and devastated by war and its aftermath, then again by the incredibly inept ways in which they were resettled, a recipe for disaster which added trauma on top of (those words again) almost incredible trauma. Once in the U.S., the Hmong (like most refugees) have been vilified, hated, and subjected to bigotry. But because they vehemently resist assimilation - just as they resisted imperialism and forced assimilation for thousands of years - this racism can be intensified and prolonged.
Fadiman finds instances where Western intervention was filtered through a culturally Hmong lens, with brilliant results. When a healthcare worker in a refugee camp organizes a vaccination pageant, compliance rises from zero to complete success. When a resettlement agency is able to give a small group of Hmong a plot of rural land, within two years the community is self-sufficient - while the Hmong resettled in modern urban environments languish on public assistance and fare more poorly than almost any other immigrant group. Sadly, these positive solutions were extremely time-consuming and labour-intensive, and depended on the unusual involvement of one dedicated, resourceful organizer, making them all but impossible to replicate.
Researching online, I've learned that several medical schools have adopted The Spirit Catches You and You Fall Down as a required text for their medical ethics classes. The book has also led to changed medical practices in the state of California and elsewhere. You can read more about that here; the link contains spoilers that I have tried to avoid in this post. (This review was originally published here, on wmtc.)
Friday, July 4, 2014
Dark Age Ahead, by the late Jane Jacobs, contains some important insights about the state of North American society. For me, however, the book is more notable for what it doesn't contain.
Picking up where Jared Diamond left off in Guns, Germs, and Steel (which Jacobs references several times in her introduction) and Collapse, Jacobs identifies five pillars of society that she believes are in decay: community and family, higher education, the effective practice of science and science-based technology, taxes and governmental powers directly in touch with needs and possibilities, and self-policing by the learned professions.
To readers who are puzzled by her choices for the list itself, Jacobs writes:
It may seem surprising that I do not single out such failings as racism, profligate environmental destruction, crime, voters' distrust of politicians and thus low turnouts for elections, and the enlarging gulf between rich and poor along with the attrition of the middle class. Why not those five, rather than the five I have selected to concentrate on? . . . Perhaps my judgment is wrong, but I think these second five are symptoms of breakdown in the five I have chosen to discuss. Furthermore, many North Americans are already aware of them as dangerous and are trying to focus on intelligent corrections.I disagree with this judgment – racism, for example, is not a symptom of any of Jacobs' five pillars, but a core issue of its own – but this is the list with which Dark Age Ahead grapples.
The book itself reads like an extended essay - unfocused and discursive. Whereas Diamond based his conclusions on facts and statistics, Jacobs draws on anecdotal evidence (often her own firsthand observations), plus some secondary sources (a few books). The claims are monumental, but the evidence often feels very flimsy.
In a chapter called "Dumbed-Down Taxes," Jacobs bemoans a lack of local control over tax distribution and expenditures. She mentions the public's increasing agitation over rising taxes, and the increasing distrust of federal and provincial governments. She mentions the de-funding and slashing of public services. However, Jacobs never mentions the sea change that stripped public coffers of funds, burdened the average taxpayer, and led to the decimating of so many public services: the decline in the corporate tax rate. Most corporations in the US pay zero taxes, and Canadian corporate tax rates – slashed by 50% by the late Finance Minister Jim Flaherty – are among the lowest in the world. On this subject, Jacobs is silent.
Similarly, in a chapter about a lack of self-policing by industry, Jacobs never mentions that government agencies originally formed as watchdogs are now largely headed by former industry lobbyists. If we want to know why policing and regulating doesn't work, it's odd to not even put this in the mix.
It should be difficult, too, to compare the society of the United States, and to a lesser but still very real extent, Canada, to the collapse of the Roman Empire and not reference the enormous tax burden of military expenditures.
To discuss redlining – the denial of investment to certain geographic areas – and never mention racism, when redlining is primarily a racist tool, is not just strange. It's incorrect.
There were highlights, too. When Jacobs discusses the decline of family and community, she's not talking about what some think of as morality - acceptance of LGBT families, or abortion, or a decline in church-going. The segment on the family is titled "Families Rigged to Fail," and it focuses on the brutal and unjust economic conditions faced by most working people, and the lack of social supports available. I appreciated this.
In another good segment, Jacobs decries universities that, to her mind, have become institutions to dole out credentials, rather than places where people learn to think critically and expand their worldview.
To readers familiar with Jacobs' work, especially her 1961 masterpiece The Death and Life of Great American Cities, Dark Age Ahead includes much familiar ground: Jacobs' hatred of all things auto-related, her critique of the suburbs as hollow and soulless, and her leadership in community opposition to destruction by highway. All good stuff, all worth contemplating.
Jacobs' assessment of what ails our society contains much worth reading. But it might be best approached as a jumping-off point, rather than a definitive work in itself. (A version of this review was originally published here, on wmtc.)
Thursday, July 3, 2014
If you were to write a history of knowledge how would you go about your task? It is a dauntingly broad topic. Ian McNeely (with Lisa Wolverton) provides an interesting answer to this question with his book Reinventing Knowledge: from Alexandria to the Internet. He studies six essential places and/or institutions that generated and disseminated new knowledge in the Western world. The list includes the obvious ones like libraries and universities, and some unexpected institutions such as the republic of letters and academic disciplines. The republic of letters, for example, involved many of the brightest minds across Europe (and to a lesser extent America) during the age of enlightenment. The men and women of this letter writing republic shared their ideas and the world is a better place as a result of this activity. McNeely’s book is interesting in that it compares all of these knowledge institutions in a tour of the historical development of the apparatus around creating and conveying ideas.
The impression I had reading the book was of climbing up the mountain of truth and out from the valley of ignorance, and that the various stops along the way (let’s call them the library stop, the monastery stop, the republic of letters stop, etc.) faded and disappeared as we, the West, moved up to the next plateau. The great Alexandrian library, for example, lost the prominence it knew in days past with the rise of the Christian religion, its famous collection of books ebbed away (i.e were stolen) or disintegrated from neglect; and so the world moved past the library stop. Yet this impression is erroneous, as McNeely notes, libraries would continue to have a bright future for many years to come. The point that McNeely wants to make with his book is that the spirit, the living force of our seemingly endless desire and pursuit of truth is constantly shifting, continually finding new places to flourish. New, sometimes unexpected, institutions would sprout from the ashes of an old set of knowledge generating practices and these green buds would grow to generate novel rationales and methods for pursuing knowledge—and so the climb up the mountain continues. What is the current paradigm of progress? No surprises here, it is science and specifically laboratories. Part of the shift in the modern era to a new approach in gathering and generating knowledge is an emphasis on real world experimentation and statistics gathering. This approach replaces the old paradigm of interpretive and text based philological work which dominated the social sciences in years past.
McNeely makes some interesting and insightful comments about knowledge as always being about connecting people. He insists that the task of coming generations is to ensure that the laboratory’s values of ceaseless experimentation, democratic equality and social betterment are institutionalized in their broadest, most empowering, and most humane senses. This is a lofty and worthwhile goal.
One final thought on a topic only hinted at but not addressed in depth within the scope of the book. McNeely suggests that knowledge creation and dissemination in today’s global society is driven in part by powerful technologies. No controversy there. But in a world of rising costs and declining resources what will the future hold for humankind’s irrepressible desire to know if the means of pursuing and generating knowledge requires ever more sophisticated and expensive hi-tech equipment? Is endless progress self-evident? Will the mountain peak remain forever out of reach?