A Hmong Child, Her American Doctors, and the Collision of Two Cultures.

Repeatedly, in spoken and written word, Margaret Mead complained of a certain ironic provinciality among anthropologists: they wander the world in search of people to observe the more obscure the tribe, the better yet studiously avoid taking a look at their own home territory, the way their fellow citizens live. Not that, one suspects, Mead would rejoice at the kind of scrutiny some of us in America get these days from certain social scientists, who have a way of burying their "subjects" (speaking of irony) in a dense, dreary, jargon-filled language, stripping them of their complexity and ambiguity, turning them into reductive caricatures of themselves, mere excuses, finally, for one or another pretentious theory. Still, a scholar who had roamed far-away continents in search of human variation, and who had tried hard to describe what she saw clearly as well as cogently, had realized the limitations of her own profession, even as she knew full-well how hard it can be for journalists, those other full-time witnesses of cultural conflict, to find the time and the publishing mandate to do thorough justice to what they get to see.

Some writers, though, have done exceedingly well at taking in one or another human scene, then conveying it to others - James Agee, for instance, in his justly celebrated, idiosyncratic Let Us Now Praise Famous Men, and George Orwell in his humble but provocative effort to understand the coal miners of midlands England (The Road to Wigan Pier), to name two examples of twentieth-century literary journalism, of documentary inquiry. It is in such company that Anne Fadiman's writing belongs. She found the time to observe closely and at substantial length, as the subtitle of her first book tells us, "a Hmong child, her American doctors, and the collision of two cultures." But wisely she went further, studied an Asian people's beliefs, their values, their recent social and political history - so that she tells us not only about an epileptic child and her parents, who were continually misunderstood by their American doctors, but about the way all of us, in our various ways, are apt to see others through the sometimes distorting lens of our own learned assumptions.

We learn in a preface that during the spring of 1988 the author first came to Merced, California, where many Hmong families had settled - a long voyage, indeed, for those mountain families of Northern Laos who had been caught in the terrible war that spread across what used to be called, collectively, French Indo-China, and that did so much harm to so many in the 1960s and 1970s. She wanted to investigate "some strange misunderstandings going on at the county hospital between its Hmong patients and its medical staff."

There she met the Lees, whose epileptic daughter so challenged her American physicians, even as her parents also frustrated and confounded and sometimes enraged them. There she met, listened to, learned from a wide range of other individuals: the various doctors who attended the Lees, tried to persuade them, win them over, and who finally took them on as opponents; and as well, nurses and social workers and Hmong relatives, neighbors, friends - in sum, the many men and women who made up two communities quite apart philosophically and spiritually, despite their proximity and their shared connection to a child whose epilepsy (and its consequences) would eventually take away much of her humanity (her consciousness and willfulness as they shape a normal life). For the doctors, for us who are at heart materialists of the industrial West, such an outcome had a neurophysiological, a biochemical explanation; for the Lees and their kinfolk the "illness" was metaphysical, a kind of spiritual abandonment or malaise (gang dab peg) wherein "the spirit catches you and you fall down" (hence the book's title: a soul on the loose, so to speak, makes for the vulnerability of its one-time possessor). In a sense, the Lees worried not about their daughter's epilepsy, but about her spiritual condition, her hurt soulfulness, it may be said, even as one earnest pediatrician after another tried to medicate a child regarded as neurologically impaired. Under such circumstances, inevitably, "what the doctors viewed as clinical efficiency the Hmong viewed as frosty arrogance."

It is to this book's considerable credit that the dignity of the Hmong is not purchased at the expense of the American doctors who earnestly worked with the Lees, and who constantly had to experience the behavioral consequences of their fears and suspicions. The author almost miraculously sustains an empathy that embraces all the characters who, one by one, appear in what is, really, a documentary narrative, which offers descriptions of events, evocations of mood and feeling, forays into the history and culture of a people, accounts of myths, beliefs, ceremonial practices. Well into this book one begins to take to each of its protagonists - as if absorbed in the magical momentum of a powerfully summoning fiction. We are spared abstract categorization, theoretical insistence, in favor of the sidelong insights of storytelling.

No wonder when I came to a chapter titled "Why Did They Pick Merced?" I thought of Raymond Carver's short stories: like his master and hero, Chekhov, he was always posing questions whose answers were less factual than fateful - the ultimate authority of chance and circumstance in all of our lives. That is what Anne Fadiman has managed to give us - lots of "cross-cultural perspective," as the phrase goes, lots of medical anthropology, but most compellingly and instructively, an account of certain lives as they quite improbably came together, with all the consequent and subsequent times of perplexity, confusion, misunderstanding. Needless to say, this tale offers no happy outcome - unless it be what happens to the reader of a persuasively rendered moral fable: a recognition of the blind spots which, in their many versions, variations, afflict and threaten us all, and with such awareness, of course, a sense of gratitude to the giver of such a gift, in this instance a talented young American writer who knowingly takes us far afield in the course of her California medical inquiry.

Robert Coles is a child psychiatrist, and the author, most recently, of Doing Documentary Work.