Near the end (p. 227) of Anne Fadiman?s The Spirit Catches You and You Fall Down (which I discussed on Monday), there?s a dialogue between a doctor and psychotherapist. They have been talking about Lia Lee, the Hmong girl whose treatment for epilepsy violated several basic Hmong beliefs. I?ve reformatted Fadiman?s paragraphs into a mini-dialogue:
Physician: You have to act on behalf of the most vulnerable person in the situation, and that?s the child. The child?s welfare is more important than the parents? beliefs. You have to do what?s best for the child, even if the parents oppose it, because if the child dies, she won?t get the chance to decide twenty years down the road if she wants to accept her parents? beliefs or if she wants to reject them. She?s going to be dead.
Psychotherapist (tartly): Well, that?s the job you have taken on in your profession.
Physician: I?d feel the same way if I weren?t a doctor. I would feel I am my brother?s keeper.
Psychotherapist: That?s tyranny. What if you have a family who rejects surgery because they believe an illness has a spiritual cause? What if they see a definite possibility of eternal damnation for their child if she dies from the surgery? Next to that, death might not seem so important. What?s more important, the life or the soul?
Physician: I make no apology. The life comes first.
Psychotherapist: The soul.
The psychotherapist mentions beliefs about the after-life, which are especially thorny because no one can know what happens after death?there is no empirical evidence. If a treatment saves lives but causes damnation, then one should certainly forgo the treatment. However, just because parents believe that a treatment will put their child?s soul in peril of eternal torture, that doesn?t make them right. Parents do not own their children. As I argued earlier in discussing the Amish, there is a profound conflict between children?s freedom and parental freedom. I believe that a liberal state should protect children against their parents, although it is harrowing to read about California?s unjust and harmful decision to take custody of Lia Lee.
In any case, the Hmong don?t believe in eternal damnation. Although Lia?s parents were concerned about what would happen to her reincarnated soul if her blood were drawn (violating a taboo), that was not the main problem. The main problem was their belief in the efficacy of traditional Hmong healing and their skepticism about the effects of Western medicine. In short, they thought that a Hmong shaman could cure their daughter, while American doctors were making her worse. Fadiman argues that there was some limited truth to this; the physicians made serious errors, whereas Hmong shamans are non-invasive healers who work only on the spiritual level and often get good psychological results. They would have done Lia no harm and might at least have helped her parents.
But ultimately, Western medicine is going to work better than Hmong shamanism for a lot of diseases. Hmong people are learning this; some are even becoming doctors. Thus their traditional culture is bound to change. Even if they preserve shamanistic medicine, it will have a new meaning for them. They will either use it to fill gaps left by Western medicine (especially psychiatry), or they will choose to preserve it because of its cultural significance. But a ritual performed because it is traditional is fundamentally different from a ritual performed because it cures a disease.
Cultural institutions address problems and must change when they are no longer effective. Sometimes there is a lag, because people understandably cling to what they know; but there is no way to stop history. Contrary to the racist articles that described Hmong immigrants as moving out of the ?Stone Age? when they reached America, they had been part of history all along. In fact, they had participated in high-tech battles and suffered a holocaust during the Vietnam War. Some had learned to fly fighter jets. And this was by no means the first time that they had adjusted to a changing world.
The argument against preservationism also applies to cases in the West. For example, some people want to preserve jobs for Yorkshire coal-miners and the Chesapeake Watermen. But their ways of life no longer make sense. Coal is expensive and bad for the atmosphere; crab-trapping doesn’t pay. Preserving these traditional jobs and cultures would require state subsidies or new ?business models? based on tourism instead of commodity sales. A tough, blue-collar culture must change fundamentally if its function changes. It cannot be ?preserved,? because its traditional values included efficiency and self-sufficiency, and those are gone. The only way is forward.