Class Cultures, POCA and Peter Deadman

So I guess we were all somewhat surprised by Peter Deadman's recent comments about community or multibed acupuncture(CA/MB) and best practices.  After all, I had remembered that the person who is credited with co-compiling the definitive tome of point location used in most American acupuncture schools had recently been recorded at an ACMAC conference saying that the multi-bed acupuncture movement was among the "most exciting current developments in acupuncture in the world".  I thought that was pretty cool, if unexpected.  So what gives?

I read and re-read his brief statements (which I hear will be fleshed out more in an upcoming journal article, woohoo!) and decided I needed to understand why the turn.  After reflecting on that a bit, it became clear to me that once again we are looking at how class cultures and values determine to a large extent how one thinks and acts in the world.  For us, of course, how that translates into acupuncture practice and accessibility is of interest.

The most likely culprit behind the recent Deadman comments would be Lisa Rohleder's piece in the Journal Of Chinese Medicine entitled "Community Acupuncture: Making Buckets from Ming Vases".  It is a great piece that illustrates what is at the heart of the acupunk and the community acupuncture movement.  What I most admire, however, is how her words demonstrate how that heart beats brilliantly and proudly with working class values, values that see to it that working class people actually get acupuncture, find it useful and are able to recommend it to their friends and family.  

So, what about class values?  Here is a great class culture comparison chart from http://www.classmatters.org via Barbara Jensen and Jack Metzgar to consider:

Professional Middle Class

Working Class

Doing and Becoming

—achievement-oriented

—future-oriented

—life as transformative

—status concerns

—individualistic

Being and Belonging

—character-oriented

—present-oriented

—life as tangled web of relationships

—anti-status

—solidaristic

Unintended Homogeneity

—more cosmopolitan

—weaker loyalties to persons, places, groups, institutional affiliations

Unavoidable Diversity

—more parochial

—stronger loyalties to persons, places, groups, institutional affiliations

Best result:

Individual achievement has positive human impact.

Best result:

secure community

Worst result:

the lonely individual

Worst result:

unachieved potential

Can anyone say yin and yang?

In reading the Ming Vase piece along with Deadman's recent comments we get a glimpse of these class cultures and understand how they guide and direct acupuncture practice, professional and personal priorities as well as the interaction with both other practitioners and the public.

Let's look at how some choice quotes demonstrate class cultures, both professional middle class(PMC) and working class cultures.

Lisa: "Acupuncturists define themselves by what they know; community acupunks define themselves by what they do."  being and belonging, present oriented, anti-status, character oriented, strong loyalties to community

Peter:  In fact I think that lots of practitioners need to raise their game – continuously studying to build on their initial education. How many practitioners for example know the diagnostic tests, natural progression and prognosis of the hundreds of different musculoskeletal disorders the human body can suffer from? This despite the fact that musculoskeletal problems probably form the majority of the cases we treat." doing and becoming, achievement oriented, future oriented, life(or acupuncture practice) as transformative, individualistic, individual achievement has positive human impact

Lisa: "If there were the acupuncture training equivalent of a bucket that allowed us to pour the water of relief over as many suffering people as possible with as little fuss as possible, we would be delighted, since we do not care that much about knowing everything there is to know(italics mine)." character oriented, present oriented, life as a tangled web of relationships, anti-status, solidaristic, strong loyalties to community, secure community

PeterThe hardest thing is to get a rewarding (emotionally and financially) practice. So many new practitioners never get a practice off the ground – at least one that can give them a decent living. In my mind there are two answers. The first is the work being done in the field of community acupuncture … matching patients who simply can’t afford high fees with practitioners happy to work in multibed clinics. The other is the development of the highest level of skill and knowledge allied with a degree of specialization(italics mine)."  achievement oriented, future oriented, life(or acupuncture practice) as transformative, status concerns, individualistic, weaker loyalties to persons, places, groups, individual achievement has positive human impact

Lisa, on critiquing the professional acupuncture culture and community in the US: "There is a notable, uncritical emphasis on accumulating and consuming knowledge, as opposed to simply using what we already know to help real people." character oriented, present oriented, life as a tangled web of relationship, anti-status, solidaristic, strong loyalties to persons, places, groups, secure community

Peter, on critiquing multibed/community acupuncture: "There is a buzz about multibeds right now, and lots of patients benefit from the affordability, the communal atmosphere and the ability to have more frequent treatments. They are a pragmatic solution to a particular problem. However, I don’t think they represent best practice and I feel very strongly that best practice (which is almost inevitably more time consuming) risks being diminished by the need to offer quick treatment." achievement oriented, future oriented, individualistic, weaker loyalties to persons places or groups

Upon reading Lisa's and Peter's words within the context of class cultures and values it became a bit more clear to me why he seemed to turn an about face on the topic of community acupuncture.  Let's face it.  Ours is largely a white profession mostly consisting of professional middle class peoples.  Who else in the West would not let the fact that there are no job prospects after graduation stop them from studying "the medicine"?  Who else would spend or borrow up to 6 figures to pursue said "career"?  Now, I do not labor under the delusion that working class people make up the majority of the CA movement as punks here in the US.  No, it is an effective and transparent collusion between individuals hailing from different class cultures that has propelled the movement to its current position and it has required a lot of self-reflection, often painful and in public for many of us.  Each class culture has positive and negative aspects which can either help or hinder the movement.  That much has been proved over time.  This is not an attempt to lambast one set of values while holding up the other to be perfect.  Both have promise and peril within.  Indeed, we could speculate that we would not have Mr. Deadman's tome if not for professional middle class culture and values.  However, be you black, white, red, yellow, working class, professional middle class, male, female, able-bodied, disabled, whatever, If you are going to do this work you are going to be doing a lot of looking in the mirror while encouraging others to do the same.  And you do it knowing that it is not enough to simply say you think everyone has a right to acupuncture because we are all equal, whether or not people actually get acupuncture or not.  You do it because we must be the ones to help bring acupuncture into as many communities as possible and this will not be done merely by learning the complexities of a particular style or system of acupuncture which by itself is entirely symbolic and without worth.  Through self-reflection within a supportive community we can change ourselves for the better and do the work required to bring acupuncture to the masses.  Our friends and neighbors.  Our families.  People that don't look or talk like us.  People that don't care about theories but do care about their unrelenting back pain.  Everybody.

One thing we have observed time and again is that PMC practitioners that are initially supportive of the model and the movement tend to bring in their own idea of what CA is or should be sprinkled as it is with their class values.  However, when that idea meets the reality as demonstrated by those working within the movement, that idea is blown apart right quick.  And then, that person either begins the (often private and personal, at least initially) process of looking into topics such as class, race, gender, inequality and how that informs their practice or idea of how acupuncture practice should be taught and decides to work on themselves in order to further the movement or they critique the movement (primarily done by white male professional leaders through what passes as a respectable professional publication or media outlet in this trade) in an attempt to defend privilege, status and entitlement and uphold their vision or interpretation of "the medicine", based as it is on class, race and gender.  They get insulted and defensive and standing behind the complex and beautiful science of whatever brand of acupuncture theory they are enamored with, they issue declarations that CA/MB acupuncture is "debasing", "degrading" or "devaluing".  "Lesser than".  "Rushed".  "Irresponsible".  "Limited". "Simplistic".  "Unclean".  All tinged through the narrow lens of their class value structure, with all the inherent privilege and entitlement that comes with it.  Now, we have progressed into outright "betrayal"!  And such I believe to be the case with Peter Deadman.

There is no doubt that it takes some degree of proficiency to sling needles and perform a treatment.  And there can be a place for lifestyle advice or nutritional counseling, although I would prefer the idea that we are sharing some information that we have found useful rather than styling it as counseling or advice for a number of reasons and do not engage very much in it in any case.   However, I and others I know working at CA/MB acupuncture are quite pleased to offer acupuncture in such a way that it may help as many people as possible while doing our best to make a sustainable income.  In doing this, I feel that I am working toward the "best result" of working class culture as defined in the chart above: "secure community".  It is kind of sad as well as just a bit funny to see Peter Deadman say that "The hardest thing is to get a rewarding (emotionally and financially) practice. So many new practitioners never get a practice off the ground…" and then go out to say that the preferable route, the one that entails "best practice", is the one that narrowly pursues and adheres to the professional middle class value system and culture when it is well observed that that road is littered with practitioners that have gone into it with the idea that individual achievement would have a positive human impact(best result) only to find themselves fulfilling the destiny of the worst result of professional middle class culture: "the lonely individual".  No practice.  No community.  In a lot of debt.  Isolated in a competitive professional culture.  Disillusioned and embittered.  Specialized though not special.  

 If there is a profession with more lonely individuals than the acupuncture profession I don't want to know about it.

Ultimately, we must observe that the very birth of the Community Acupuncture Network, ACMAC and now POCA illustrates that the best of both class cultures is working within the CA/MB movement.  If the folks at Working Class Acupuncture decided that they found a great model for their little slice of heaven in Portland, Oregon and that was that, well then there would be no movement.  This conversation wouldn't even be happening.  Rather, they saw that something worked for the people they know and understand and decided to share it with others in the professional community.  And it grew.  And grew.  We can see an element of doing and becoming within the CA/MB movement from it's outset to balance the being and belonging element.  The more we grow, the more we demonstrate the best of integrated class cultures within this movement.  We ensure that individual achievement has a positive human impact while avoiding the pain of unachieved potential.  Ah, that old yin yang symbol brought to life, yet again.  Who says we don't love ourselves a little theory now and again?

Accordingly, the movement has taken many twists and turns as it goes forward.  It has no precedent so it must make some mistakes.  But those mistakes inform future direction.  And more and more people continue to take up the CA/MB practice model and more and more people get acupuncture.  The movement grows.  Like a dandelion.

If an acupuncturist wants to all but assure for themselves the fate of the lonely individual in regards to their professional life and experience, rigid adherence to the professional middle class value sphere, the value sphere that so pervasively permeates any and every American acupuncture school and is espoused by professional leaders and authority figures on either side of the pond, will all but assure this.  Outliers excluded, the NCCAOM Jobs Task Force Analysis lays to rest any argument to the contrary.  So take, and give, your advice with caution.

Peter Deadman said that the two strands of acupuncture practice that have a shot at making a practitioner a living, CA/MB and specialization, "can find a way to co-exist".  Perhaps.  But for my money, the only way that can happen is within the context of a clear understanding of class cultures and values, as well as race and gender, backed up by conversation, criticism, and action.  That is how we have been successful within our movement thus far and it must be the basis for any further growth and development both within and without of the movement.  The "need to offer quick treatment" is not merely a "pragmatic solution" based solely or even primarily on the satisfying the financial side of the coin for any one individual.  It is entirely imbued with working class values, full stop.  I hope that Mr. Deadman can come to understand this when considering what is best practice in the future, both for individuals as well as for the professional community.

 

This story was posted on June 21 2012 by LarryG.

Comments

  • June 21 2012 at 10:07 PM
    melissa writes:

    thank you for this, Larry. just a big, fat thank you, man.

      3 likes
    • LarryG
    • spitfire
    • obnicole
  • June 21 2012 at 11:05 PM
    obnicole writes:

    Amen! I love this post so much I kept wanting to call out favorite parts but the entire thing is my a favorite. I will look at this many many times in the future.

    Thank you thank you thank you.

      3 likes
  • June 22 2012 at 3:11 AM
    Tom Hirons writes:

    Brilliant.
    *Please* send this to the JCM!
    I believe that there can be a useful conversation between these yin-yang poles of the profession, but it seems (like you write) that the CA end of it has undertaken a hell of a lot more soul-searching and assumption-unpacking than the BA end. When and if that evens up, things might get really interesting, but for now, regarding the dialogue through the yin-yang class-culture lens helps me see it in a more useful way. Thanks!

      2 likes
  • June 22 2012 at 10:32 AM
    korbenp writes:

    Oh, but i sure like this one, Larry.
    More required reading for acu school.

      5 likes
  • June 22 2012 at 1:08 PM
    Demetra writes:

    Thank you for this, Larry, this really clarifies a lot of what has been coalescing in my mind for some time, mostly about how much unexamined preference is given toward professional middle class values in the mainstream culture.

    What it really comes down to for me is clarity about what the community acupuncture movement is actually doing. Are we here to provide acupuncture? Or are we here to address social injustice in health care, using community acupuncture as a means to that end? I think it’s obviously the latter, but it’s evident that this goal is not shared by people like Peter Deadman.  We need to seek allies in our goal for addressing social injustice in healthcare outside the members of the acupuncture establishment, who are increasingly irrelevant to our mission. At some point they’ve got to realize they’re not even a part of this conversation. We have hundreds of thousands of patients in our clinics every year, talking with us, growing this movement. Who are the PMC acupuncturists even talking to, besides their own reflections? I would feel sorry for them, if they didn’t keep getting in my way.

      8 likes
  • June 25 2012 at 10:34 AM
    Pauline writes:

    Yo Larry:
    Thank you for your clarity. I’m often struck when talking to BA practitioners that they don’t get what and why I’m doing, and we seem to be speaking two different languages. And I’m right.
    I’ve been sponsoring Dr. Tan seminars here in Canada for the last year (gives me enough money to pay for my music lessons so far and not much more) and at every seminar I hold a talk early Sunday morning about CA. I always get a good turn-out, so it’s also a chance to spread the word about what we’re doing People have a lot of questions, and there’s a lot of interest.
    But here’s what gets me in the heart every time. It’s the tone of desperation in the voices of the acupuncturists who think that maybe taking just one more course will help them earn a living. So many scared underemployed acupuncturists out there. It makes me feel so sad. And scared that if they give up the five patients a week they have who pay $75 a treatment, maybe they’ll still only have 5 a week but they’ll only pay a treatment. There’s a huge lack of imagination out there, and far too much fear.
    PV

      2 likes
  • June 25 2012 at 1:26 PM
    Lisafer writes:

    It’s probably incorrect somehow to love a post that quotes you, but I love this post. And not because you quoted me. Thank you. And yeah, if there’s another profession with more lonely individuals than ours, I don’t want to know about it either.

      3 likes
    • LarryG
    • Spartacus
    • Roppy
  • June 25 2012 at 5:44 PM
    Nic writes:

    Hot damn!  Some good stuff here Larry!

      2 likes
  • June 26 2012 at 11:52 AM
    tatyana writes:

    This was definitely me before CA: ““the lonely individual”.  No practice.  No community.  In a lot of debt.  Isolated in a competitive professional culture.  Disillusioned and embittered.”
    I would add to that: tired of running around and working way too many jobs and in the end not doing much acupuncture. and just tired, and not in a good way.

    Larry - this is a great post and it is very thought-provoking and interesting to see those two sets of quotes side by side.
    Some practitioners will never live in the real world, no matter what we say. I am glad I landed there myself, as the fantasy land that Deadman thinks we all should aspire to sounds like a really a lonely and unhappy place to be.

    Last week I had lunch with a friend / patient who is dead-set on attending acupuncture school in the near future (I wasn’t able to dissuade him, sadly). He said to me he was not much interested in a practice situation that was not incorporating the goals of social justice and accessible healthcare. I was proud to say to him with confidence that, as far as I know, POCA is the main game in town for that type of practice, and the only one that will actually provide the acupunk with any stable income.

      5 likes
  • July 2 2012 at 11:19 AM
    TessBois writes:

    Larry,

    That was indeed a brilliant piece of writing, thank you for taking the time to articulate your thoughts on the differences between the classes.  It actually hit me like a ton of bricks as I straddle both worlds and struggle with wanting and having, belonging and feeling isolated.  Just so much there that it makes me feel sad for those (and me at times) who cannot be happy with themselves and their communities; always trying to get out of their communities or being encouraged to leave by misguided family members who believe the media cultures imaginings that achieving is better than belonging.

    I am also struck how the CAN/POCA community has blossomed a group of thoughtful, articulate writers who are finding their voices in the larger acupuncture and probably social justice community.  Larry, it is a pleasure to see how your thoughts online have become deeper, less defensive and this is the voice that will make change happen. 

    Thanks for your great words Larry.

     

     

      1 likes
  • July 2 2012 at 12:41 PM
    Clayton Willoughby writes:

    One of the things I was happy to be reminded about yin yang theory recently is that nothing is by itself one or the other; it’s only in contrast to another that one becomes yin and the other yang. One could easily put “working class” people onto the left hand column with all of the negative words & terms and make room for another group on the right that we want to sound noble and awesome.

    Not that Larry, or the many other proponents of our model, are wrong at all in their views of the practice. It’s just that class issues are above my head - maybe because I’m not American or English. I first read about the subject of class when I was 10 (OK sure, it was in a Dungeons & Dragons book, but that’s not the point) and the whole thing seems to this day unnecessarily complicated.

    As any good scientist (Einstein, Sagan, Tyson, etc.) would tell you, our continued existence as a species, even a planet depends on us treating everyone else with compassion and respect. Yes, love is logical. Healthcare, including acupuncture is really just applied compassion. I didn’t change my practice because of social justice, any kind of political or idealogical reasons or a punk attitude. It helped that I had been running acudetox programs for several years, but I see our model as a marriage between logic and compassion; it’s a good thing to do and a good way to do it.

    This is just me reframing the debate a bit here; I might be wrong in my opinion here, but I don’t really want to be.

      1 likes
  • July 5 2012 at 2:38 AM
    Mark M writes:

    Thanks for the support your words give to us PMC white males who are in recovery smile

      0 likes

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