Arthur Kleinman's Eight Questions

In the chapter "The Eight Questions," Anne Fadiman introduces Arthur Kleinman's explanatory model of illness that is designed to elicit the patient's perspective of illness. Fadiman illustrates how incorporating the answers to these eight questions from the Lees' perspective into the medical history might have provided an excellent starting point for becoming aware of critically important cultural perceptions. She then records how she believes the Lees might have answered these questions "after Lia's earliest seizures, before any medications had been administered, resisted, or blamed." Compare your responses to these eight questions to the following imagined responses that Fadiman included in her book.

What do you call your illness? What name does it have?

From the parents' perspective, their daughter Lia Lee does not have a seizure disorder but rather qaug dab peg, which means "the spirit catches you and you fall down." They understand that qaug dab peg is a dangerous problem but hope that it can be healed. At the same time, they believe that it is an illness of honor for those afflicted with qaug dab peg can become txiv neebs (people with the healing spirit.)

What do you think has caused the illness?

Although Lia's doctors can explain the pathophysiology of a seizure disorder, they cannot really answer the question of what caused the seizure. Lia's parents have a clear cultural explanation. They attribute her seizure disorder to soul loss. The Lees concept of Lia's illness is well developed and internally consistent. They believe that doctors can fix sicknesses that involve the body and blood, but for illnesses that are caused by "soul loss," spiritual healing is required. Spiritual healing is performed by a txiv neeb. Furthermore, too much Western medicine will diminish the neeb's healing efforts.

Why and when did it start?

Explanations about the cause of disease, and why a disease begins are cultural and spiritual and shaped by the patient's understanding of the disease process and the patient's cultural philosophy that governs such things as destiny, justice, and death. In Lia's case, her parents believe that Lia's sister, Yer, slammed the door, causing Lia's soul to be frightened out of her body. In fact, they subsequently harbored resentment toward Yer for of this seemingly innocuous action.

What do you think the illness does? How does it work?

What her doctors attribute to an abnormal discharge of electrical activity in the brain, Lia's parents attribute to a spirit called a dab. Lia's parents believe that the sickness makes Lia shake and fall down. The shaking and falling down are caused by a spirit called a dab that is catching her and shaking her.

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