Health Communities Conference – November, 20021
Hmong Shamanism and Hmong Health Care Choices
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INTRODUCTION
- The story of How sickness came to earth – with qeej music
Before the earth began, a man and a woman, who were brother and sister, lived in the sky. Their first children were a boy, Lu Tu and a girl, Gao Tse, who learned how to make music and dance. Then the man and the woman had other children. There were two boys: Teng Chu, the older, held up the sky; and Lolo Chu, the younger, who caused lightning and rain. Their last child was an egg. The man and the woman waited three years for the egg to hatch, but nothing happened. So they broke open the egg to see what was inside. Many, many people came from the egg, and they spread out over the earth. There were so many people that they had to be given last names.
The man who lived in the sky looked at all of his children and said, “We have made many people to live on the earth; we have children who make music and dance and children who support the sky and bring lightning and rain. We have done enough.” Then the man and his sister died and went to earth to be human. He took the name Mon Yalu.
Later, Lolo Chu’s wife had children and they were also eggs. They waited nine years, but the eggs did not hatch. Lolo Chu sent a message to earth to ask his father what to do. Mon Yalu returned to heaven and looked at the eggs. “Before I was born on earth, he said, “your mother gave birth to eggs, and there were people inside. These eggs do not have people inside, they are filled with evil spirits that will make people sick and die. To save the people of earth, you should burn these eggs.”
Lolo Chu said, ”These eggs are my children; they are like my heart; I will keep them.” Mon Yalu went back to earth and, one year later, the eggs hatched. The evil spirits came out of the eggs and chased Lolo Chu and his wife all over heaven, trying to eat them. His wife could not escape and she was eaten, but Lolo Chu flew away to earth and was saved. “ I cannot have this,” said Lolo Chu; “I will make a hole in the sky so the spirits will go to earth and leave me alone.” Lolo Chu cut a hole in the sky, the evil spirits went to earth and people got sick and died for the first time.
To help the people, Gao Tse went to earth and taught them ua neeb (pronounced“wa neng”) (doing shamanism), so they could heal sickness. Lu Tu taught people to sing and play instruments at the funerals of those who died. (“How sickness came to earth” Vim li cas mob thiaj los rau ntiaj teb, from Living Tapestries [Folk Tales of the Hmong].)
This presentation shares insights regarding the importance of interviewing for the meaning, beliefs and interpretations which patients and their families bring to the experience of symptoms. The method incorporates both traditional stories and commentaries shared by the broad Hmong community as well as interviews with eleven Hmong shamans (traditional healers, five males, six females, ranging in age from thirty-five to eighty-five) and thirty-two community-referred Hmong patients (fourteen males, eighteen females ranging in age from twenty one to eighty-five). This inquiry was led by Creative Theatre Unlimited, St. Paul, MN, an organization with a twenty year history of work in the Hmong community. In a collaborative effort researchers were brought together from the University of Minnesota’s Center for Spirituality and Healing, The Hmong Circle of Peace (St. Paul, MN), UCare Minnesota (Minneapolis, MN), Boston University School of Medicine, and the Park RidgeCenter for the Study of Health, Faith and Ethics (Chicago, IL).
I.America is blessed with the presence of Hmong people who were fortunate to escape Laos after the Vietnam War. The twin cities of Minneapolis and St. Paul, MN, with its Caucasian population of north European descent, are now home to an estimated 60,000 Hmong. Their presence in Minnesota has gifted the medical community with innumerable insights into efficient, effective and empathy care for all people.
WESTERN BIOMEDICINE AS “ALTERNATIVE TREATMENT”
With the influx of immigrants and refugees from around the world over the past 30 years, health professionals increasingly recognize that for many, Western biomedicine is considered “alternative medicine.” Physicians, nurses and others struggle with challenges raised to conventionalbeliefs about health, disease, treatment and the relationship between healers, patients and families. Ethicists are also increasingly cognizant that normative autonomy-based bioethical reasoning is not shared universally. These trends are directing health professional educators to provide proactive preparation for cross-cultural care and communication.
One such effort is the inclusion of Anne Fadiman’s, The Spirit Catches You and You Fall Down in required healthcare professional curricula. This award winning non-fiction book depicts the unfortunate consequences of well-meaning, scientifically competent physicians who discount the importance of cultural difference. While the subjects are Hmong from Southeast Asia, the message is universal: culture is something you work with, not a problem to be subdued.2 However, there is an additional crucial message regarding cultural competence. If well-meaning health professionals believe, after reading the book, that they now “know” the Hmong, they may unwittingly participate in patient harm.Cultural humility, not cultural competence, should be the goal.
- The story of Shee Yee
Shee Yee (Siv Yis) was a special healer sent by god to live with the Hmong people in the cave near [a mountain in southwest China]. His mission was to provide medical cures for all the people. He married a Hmong woman...[but later] abandoned his people and traveled alone in Mongolia.... [An] orphan boy wandered the north for years until he found Shee Yee [who] was moved by the orphan boy's determination to find him. Shee Yee taught the orphan boy everything he knew. The orphan boy returned to his people and taught the elders what he had learned.... This created a tradition of shaman, earth medicines and magic that is still practiced to this day. [Source: This legend is part of Hmong oral tradition. It is known by everyone and has no real source other than the combined cultural memory of the Hmong people.] The foremost Hmong traditional healer is the shaman. There is no equivalent health professional in Western biomedicine: the power of the shaman as a healer goes beyond the capacities and expertise of physicians.
Being "chosen" (yuav ua neeb) is the first step in becoming a shaman, and this is generally precipitated by an unusual illness. Both men and women, even children, can be "chosen." One interviewee describes it as follows:
When I was twelve years old, I began to experience some body shaking and felt something awaking me. ... I was very ill and passed away for seven days and seven nights. My family thought I was going to die. They tried everything to help me, until they invited a shaman to look into my illness. Immediately, the shaman informed my family that I [was] chosen to become a shaman. The shaman called my soul and performed the shaman ceremony. During the ceremony, my body was shaking and felt the emotional movement.
Once a person has been "chosen" to be a shaman, their "treatment training" is provided almost entirely from the spirit world. Another shaman might help guide them in determining external details of their practice (i.e. tools needed [see glossary], altar set-up [teeb thaj neeb] etc.) but they do not provide "training" or "education" in any of the skills needed to be a shaman healer; that information is provided by the spirits.
There is no indication that training, education, learning or attempts to gain the right amount of knowledge in order to achieve a level of power are part of Hmong shaman traditions. Some shamans specialize in the very illness that afflicted them when they were chosen and will only treat people with similar ailments. Others may be referred to as "generalists" and treat more common spiritual causes of illness. It is also the case that a shaman must first be able to treat his/her own family in order to take on the role of community healer.
The Professional Practice
The act of being "chosen" requires that the person make a life-long commitment to being a healer. This includes the responsibility to be open and accessible to the entire community, it often involves certain diet restrictions, ritual regimens and it can be quite dangerous. Unlike physicians, Hmong shamans do not provide a physical diagnosis of the people they help. Rather, they try to determine the "soul status" (ua neeb saib) of the person through their entrance into the spirit world to confront the spirit(s) causing the illness.
The goal of the shaman's confrontation is not to overcome or defeat the spirits that have taken the soul. They engage in negotiation (puaj dab) for the person's soul. This might involve offering gifts such as spirit money (ntawv nyiaj) and/or the souls of animals in exchange for the soul of the sick person. Negotiation with the spirits often requires outsmarting the spirit and tricking it into giving up the person's soul. There is great risk involved in this engagement and stories are told of shamans who have died because the spirits they were negotiating with were too powerful for them and took their souls.
We are there to rescue the victim. In order to communicate with the spirit, we have to use their language. Our purpose is to have a good understanding of each other and a mutual respect of one another. Also, we are there to make peace between good and evil.
When a family approaches a shaman and asks if they can help the ill person, the shaman takes several steps to determine if they will be able to assist them. They never charge for their services. This is not to say there are no costs involved for the family of the ill person. There may be need to provide an animal for sacrifice. Incense (xyab) must be burned; spirit money provided, a temporary altar built, etc. Families may choose to reward the shaman in some way for a successful soul retrieval.
III. [CHARLES] THE IMPORTANCE OF STORIES
Awareness of the "back story" healing expectations that patients may have appears to be an important adjunct to biomedical knowledge. The stories of any culture are valuable in providing health practitioners in any setting with important insights into world-views, expectations and desires of patient. In 1985, Creative Theatre Unlimited published Living Tapestries (Folk Tales of the Hmong). This book was one of the first English language collections of the stories of these Southeast Asian refugees who were beginning to settle in this country following their disastrous assistance efforts for the United States military in Vietnam. This ancient culture has never had its own written language and the gathering, translation and publication of stories was just one attempt to preserve and promote this rich tradition. The following story from that volume illustrates the spiritual nature of the Hmong world-view.
THE STORY OF TUAM LOS PEJ AND XYUAM LIS KOO
“A young boy named Tuam Los Pej and a young girl named Xyuam Lis Koo lived in the same village and walked to school together every day. One day as they were walking home, they saw two birds in a tree talking to each other…and two chickens talking to each other. Xyuam Lis Koo asked, ‘Do you know what they are saying?’ The boy listened and then made the sounds of birds and chickens. The girl said, ‘You do not understand them….’”
“Xyuam Lis Koo knew that she was to marry someone else that night and never see Tuam Los Pej again. She said to him, ‘You do not understand the birds or the chickens, and you will not understand what I say to you. When you do, it will be too late, and you will be sad. Goodbye.’”
“The next day, Xyuam Lis Koo was not at school. Tuam Los Pej went to her house, and her mother told him that she had gone away to marry someone else. Tuam Los Pej was very sad. He went to all the places they had been together and cried: ‘You were right; I understand too late and I am sad. Now I will die for love.’ Then Tuam Los Pej died.”
“When Xyuam Lis Koo heard this, she went to the boy’s grave where she cried and cried. When her tears touched the ground, the grave opened up and she jumped in. The grave closed up and she was gone. When her husband heard about this, he went to the grave with his neighbors and told them to dig up the grave and get his wife; but they dug, and found nothing. Xyuam Lis Koo’s husband went home, very sad.”
“One of the neighbors went back to the grave to get his pipe. At the grave, he heard voices, like two people talking. He ran back to the husband and told him to dig up the grave again. Now Xyuam Lis Koo and Tuam Los Pej had turned into two stones. The husband was very angry and put the two stones on opposite sides of the river, so his wife could never be with Tuam Los Pej again.”
“The next day, the husband his friends went back to the river and found that the two stones had changed into two large trees, their branches joined together over the water. The husband was angry, cut the trees down and burned them, so his wife could never be with Tuam Los Pej again. In the fire, Tuam Los Pej and Xyuam Lis Koo changed into butterflies and flew up to heaven, where they are with each other forever.”
CONSULTING THE SHAMAN
As much as this story may resemble a “happily-ever-after,” “true love will always prevail” fairy tale, it is much more than that. Traditional Hmong view life as a cycle of birth and re-birth, with the physical and spiritual worlds coexisting side-by-side. Every person, animal, object has a spiritual element that survives independently and can directly affect the physical world. The Hmong believe that a person has several souls; some traditions say three others, as many as thirty. As seen in the story above, this belief system affects every aspect of traditional Hmong life. More specifically, it is the basis for Hmong healing traditions. A person’s souls and physical body must function harmoniously as one unit for spiritual, mental, and physical health. When this relationship is unbalanced, illness afflicts the individual. This condition is referred to as (poob plig), “loss of soul,” clearly the cause of Tuam Los Pej’s death. This is a term that has no clear meaning or corresponding treatment in Western medicine. As much as the visions of the spirit world are part of the ancient oral tradition of the Hmong, spiritual disease and healing are still important concepts in this immigrant community. The shaman continues to play an important and powerful role in the interpretation of the world and of personal lives, and represents a powerful health care professional for referrals and collaborative care. The following patients’ descriptions of their illness would certainly give any practitioner pause.
“The purpose for seeking a shaman is for when your spirit has departed … because as a person you have a spirit that guides your body. Sometimes when you are in a frightening situation, your spirit may depart from your body. Going to the doctor may not work for that purpose. If there is a lot of pain, then seeking a shaman would help, because the shaman may tell you that you lost your spirit. The shaman may be able to perform the ceremony to call your spirit back to join with your body. The healing ceremony may cure you and you would feel better.”
“If I go and seek a doctor for my lost spirit, the doctor may not know what to do or how to detect my problem, because the doctor only gives me medication for my illness and that may not be able to call my spirit back.”
As we recently reported elsewhere (Minnesota Medicine 85, no. 6 (2002): 29-34), up to 75% of the people referred by community leaders, who volunteered to be interviewed in our study, use shamans for spiritual healing on a regular basis. We cannot claim that the same holds true of the entire community, but it is a significant enough number to give clinical practitioners cause to pay attention to the spiritual needs of Hmong patients they may see. Additionally, it seems only logical to take these facts into account when serving any number of immigrant communities in clinical settings. In fact, this reality goes beyond immigrants to other patients who might have moral, ethical or spiritual reasons for accepting or rejecting certain medical treatments. It is only by asking as many appropriate questions as necessary, and listening carefully, that practitioners can find the appropriate path to effective healing. Hmong shamans recognize this need for themselves as well as others.