The Story Catches You and You Begin To Understand

Abstract

This paper explores the literature on cultural competence, medical ethics, and the provision of culturally competent medical care in the United States. It uses the book The Spirit Catches You and You Fall Down, by Anne Fadiman, as the basis for discussions about cultural differences and effective medical care and understanding. In addition, it attempts to show the need for improved cross-cultural communication in medicine. A limited literature search was undertaken using Medline, CINAHL, and OhioLink. The search terms utilized included: “Fadiman,” “The spirit catches you and you fall down,” “cultural competence,” “medical ethics,” and “Hmong,”—the ethnic group among whom the story of Fadiman’s book unfolds. The Hmong in the United States illustrate vividly the potential pitfalls of cultural miscommunication because they differ significantly from the dominant culture in terms of religious and health beliefs. According to 2000 Census figures, there are 186,310 Hmong in the United States. Interest in Anne Fadiman’s book about the Hmong crosses professional boundaries. The book is a useful adjunct to any medical ethics or cultural competence curriculum. Cultural competence should, I believe, be a core competency in medical education.