The tone of The Spirit Catches You and You Fall Down is often somber. The Hmong people immigrate to America as refugees from a war-torn country. Many die and those that survive have a difficult journey. Integration into American society is difficult for many and impossible for some. Lia, the main character, has a medical crisis and is left brain dead and paralyzed before the age of five. The tragic events evoke a state of contemplation. The author manages to throw in some anecdotes that are humorous (see, for example, chapter two: Fish Soup) which helps to keep the book from being too heavy.