Dealing with Death & Dying in Medical Education and Practice
© 2001 Kirsti A. Dyer, MD, MS
AMSA Convention March 30, 2001
Cross-cultural Awareness of Death Issues

Eight questions designed to elicit a patient’s "Explanatory Model" developed by Arthur Kleinman, psychiatrist and medical anthropologist from the department of social medicine at Harvard Medical School.

1. What do you call the problem?

2. What do you think has caused the problem?

3. Why do you think it started when it did?

4. What do you think the sickness does? How does it work?

5. How severe is the sickness? Will it have a short or long course?

6. What kind of treatment do you think the patient should receive? What are the most important results you hope she receives from this treatment?

7. What are the chief problems the sickness has caused?

8. What do you fear most about the sickness?

Answers to Kleinman’s questions, as determined by the author of The spirit Catches You and You Fall Down:
1.  Qaug dab peg. That means the spirit catches you and you fall down.
2.  Soul Loss.
3.  Lia’s sister Yer slammed the door and Lia’s soul was frightened out of her body.
4.  It makes Lia shake and fall down. It works because a spirit called a dab is catching her.
5.  Why are you asking us those questions? If you are a good doctor, you should know the answers yourself.
6.  You should give Lia medicine to take for a week but no longer. After she is well, she should stop taking the medicine. You should not treat her by taking her blood or the fluid from her backbone. Lia should also be treated at home with our Hmong medicines and by sacrificing pigs and chickens. We hope Lia will be healthy, but we are not sure we want her to stop shaking forever because it makes her noble in our culture, and when she grows up she might be a shaman.
7.  It has made us sad to see Lia hurt, and it has made us angry at Yer.
8.  That Lia’s soul will never return. 

Fadiman A. The Spirit Catches You and You Fall Down: A Hmong Child Her American Doctors and the Collision of Two Cultures. New York: Farrar, Straus and Giroux, 1997.

Compilation of resources for this presentation and Website © 2001 Kirsti A. Dyer, MD, MS.
Journey of Hearts,