Installment 2 of the “Finding Normal” Study Guide

Self Esteem

The issue of self-esteem comes up over and over in the movie Finding Normal. Watch the trailer and take note of how many times the issue at hand is self esteem, either directly or indirectly.

http://www.findingnormal.org/?page_id=7


I count at least 16 times. Here are some examples of what I mean:


First scene: David and Ray
David knows who he is, he’s integrated his own experiences, and so he is able to lay out boundaries right away in a firm, clear, kind way. He doesn’t need Ray to like him and he doesn’t need to save Ray -- although he is clearly wants to help Ray save himself.

Ray also is clear about where he is in his life -- and that he deserves something different: "I feel like it's time for me to do something for myself."(Bonus points if you notice what an enormous deal it is for him to say that he wants to do something for himself, what a deep place he is drawing those words from. How easy would it be for you to say that to someone you just met?)

David takes the opening Ray offered and says:
“You don’t have to be perfect, you don’t have to have all the answers ...”
That’s a foundation for self-esteem right there.
“...and as long as your intentions are genuine...”
Another kind boundary check.
“...I will have your back. Like nobody’s had your back in a long time."

Watch Ray’s face as he is listening. You can see him respond to what he’s hearing David say: You have worth and I see it. You don’t have to prove to me that you are worthy. I am willing to commit my time and energy and focus to you, unconditionally. You deserve it.

Later on in the movie, there’s a scene of Ray saying, basically, how amazing it is that somebody could care about him without even knowing him. It’s clear that people in recovery learn to value themselves, in part, by having the experience of other people valuing them without conditions. Our patients might not be in such dire life-or-death circumstances, but I think they need something similar from us: to hear, verbally or nonverbally, you have worth and I see it. You don’t have to prove it to me by changing your diet or quitting smoking or doing qi gong every morning. I am willing to give you my time and energy and focus, unconditionally; you deserve it.

Second scene: Jill and Penny
Jill also knows who she is, she knows what recovery requires because she’s done it. She lays out boundaries in a similar firm, kind, clear way: you have to commit. I see that you are scared and out of your depth. I’m here for you, I see what you’re going through. You can do it.
She asks Penny for a commitment, not in order to test her, but because she knows that making a commitment will help Penny -- because making and keeping commitments builds self-respect. Two scenes later, Jill talks directly about self-esteem: “We do deserve good things. We are capable of creating a good life for ourselves.” (Notice how important that “we” is; Jill isn’t lecturing Penny, she’s inviting her into a shared reality.) Whatever you did in your past (and it’s clear that Penny is horrified by her past), what matters is that you survived. No matter what you did, you’re a good person -- I see it, and I’ll reflect it back to you.

It’s worth looking closely at these half-minute interactions to see exactly how the mentors convey with their voices, their eyes and their bodies: I AM HERE FOR YOU. And we could go second by second through the whole trailer like that. But I want to take a detour away from the film to look at some bigger issues around self-esteem.

The Pyramid:  Oppression, Self Esteem and Intersectionality

Awhile ago, Nora posted a link to an excellent article by Paul Kivel. Everybody please read it!  If you don’t have time right now, check out just the second page, for his picture of “the economic pyramid”.  When I wrote to him, requesting permission to use the pyramid picture in our study guide, he offered the following update: 1% of the  population now controls 42% of the wealth,  the next 19% controls 50% of the wealth, and the remaining 80% has to divide up somewhat less than 8% of the net financial wealth of the United States.

Sometimes acupuncturists start rolling their eyes and muttering about “political correctness” when we raise the topic of oppression, but I’m going to raise it anyway. Just look at those numbers; this isn’t about some kind of abstract self-righteousness, it’s about arithmetic, 80% of the population controlling only 8% of the resources, and it’s about self-esteem, yours and your patients. Your grasp of oppression dynamics has a direct impact on your ability to attract and retain patients in a community acupuncture clinic.

Here’s my understanding of oppression, in a nutshell: 20% of the population controlling 80% of the resources is not exactly natural or effortless. It requires lots of different structures, visible and invisible, to sustain this level of political and economic inequality. A multitude of visible and invisible structures are contained in the term “oppression”.  In general, the folks in control of the most resources in this society, the ones at the top of the pyramid, are overwhelmingly white, male, able-bodied, within a certain age range, heterosexual, Christian, and upper class or upper middle class.  All of these qualities confer social power. A  multitude of -isms, or systematic oppressions, such as racism, classism, sexism, ageism, ableism, and homophobia, help keep the folks in the disenfranchised 80% from organizing to challenge the structure of the pyramid itself.

There is a scene in Finding Normal in which David describes the beginning of his process of recovery like this: “And then I started fighting for my life.”  All of us acupuncturists have people in our practices who are, one way or another, fighting for their lives. Whether they are doing it literally, like my patients who are dealing with cancer, late stage lung disease, and severe bipolar with suicidal thinking, or more metaphorically,  patients who are fighting for a better quality of life, for relief from depression, anxiety, or chronic pain, the common element is that you can’t fight for your life unless you believe that your life is worth fighting for.  That you are worth fighting for. That’s why self-esteem matters so much. And that’s why it also matters that society conveys to many people, directly or indirectly, that they are worth less or worth nothing because of their race, class, gender, age, disability, etc. People internalize that stuff, and it demolishes their self-esteem.

Which of course assists the overall dynamic of concentrating power and resources in the hands of the few. If more of us believed that we were worth something, we probably wouldn’t put up with the pyramid. We are much less trouble to the powers that be when we are full of self-doubt and self-hatred. We are less trouble still when we are reinforcing each other's oppressions, when we believe consciously or unconsciously that, thank God, maybe we are sort of OK because AT LEAST we are not queer or disabled or old or uneducated or (insert oppression here), as opposed to insisting that everybody is inherently valuable because we are human.

If you don’t recognize that oppression is real, and is probably actively interfering with your patients’ ability to heal by undermining their self esteem, you can’t see clearly what your patients are dealing with. You also risk doing the work of the pyramid: getting sucked into -isms that oppress your patients, and thinking they are responsible for problems in their lives that are actually a function of the pyramid itself. The pyramid isn’t YOUR friend, either, and you don’t want to work for it if you can possibly help it -- so it’s worth some effort to figure out how to really represent your best interests’ and your patients’. Which means, among other things, thinking about intersectionality.

Intersectionality means that all of the oppressions are operating simultaneously and all reinforcing each other to concentrate power in the hands of the few. It also means that different people experience oppression differently based on the intersections of their oppressions. For example, a  young, able bodied working class person experiences classism differently than an elderly, visibly disabled working class person. If the young working class person is African American and male, and the elderly disabled person is white and female, their experiences diverge more. Society makes most of us feel awful in some way, but the individual details of the awfulness will vary.

But you know what everybody has in common?

The Game.

Getting ahead is the name of the game.

Paul Kivel writes:

Getting ahead is the mantra of capitalism. Getting ahead is what
we try to do in our lives. Getting ahead is what we urge our
children to do. Getting ahead is how many of us define success.
The United States is built on the myth that the deserving get ahead.
Many people believe that it is the responsibility of our society to
see to it that everyone has an equal opportunity to get ahead. Many
of our recent political struggles around civil rights, affirmative
action, and the end of various forms of discrimination against
lesbians, gay, bisexuals, trans people, people with disabilities,
women, people of color, and recent immigrants have become
defined as struggles for equal opportunity for everyone to compete
to get ahead.
But in a pyramid shaped economic system only a few can
get ahead. Many are doomed to stay exactly where they are at the
bottom of the pyramid, or even to fall behind. With so much
wealth concentrated in the top of the pyramid there are not enough
jobs, not enough housing, not enough health care, not enough
money for education for most people to get ahead.
How does the system change? How do people gain access
to money, jobs, education, housing, and other resources?
Historically, change happens when people get together. In fact, we
have a long history—thousands of examples—of people getting
together for social change, some of which I mentioned earlier in
the article. Each of these efforts involved people identifying
common goals, figuring out how to work together and support each
other, and coming up with strategies for forcing organizational and
institutional change. When people get together they build
community by establishing projects, organizations, friendships,
connections, coalitions, alliances, and understanding of
differences. They do not acquiesce to, but rather fight against the
agenda of the ruling class. They are in a contentious relationship to
power.vii

I believe that deep down, everybody knows there is a game and everybody knows it’s not fair. The closer you are to the bottom of the pyramid, the more thoroughly you know it.  (The more material comforts and relative social power you have, the easier it is to forget the existence of the game, or to believe that you might be able to win.) The closer you are to the bottom of the pyramid, the easier it is to persuade you that the reason you aren’t winning the game is that there is something wrong with YOU. Not the game, YOU.  Underclass addicts are way down at the bottom of the pyramid, if not actually underneath it, and their self-esteem is destroyed as a result. Finding Normal is a radical work of art because it allows us to see the process of people recovering and recreating their self-esteem, learning to value themselves despite the fact that society doesn’t, and watching this process has the potential to inspire all of us to stop playing the game.

I love the scene in the trailer of Jill addressing the meeting:

"Remember that you were picked. When your head tells you you’re a piece of shit, you don’t deserve this, you’re worthless, blah blah blah, you know that crap we all hear from time to time? If you don’t believe it, believe that we saw it, okay? You are worth having a life. You do deserve to be happy. You are of value. You are a deserving human being, and one of us saw it. If you don’t believe it for yourself, believe that we saw it, and believe what we believe."

When you are at the bottom of the pyramid,  valuing yourself is radical, brave and transformative. Valuing other people LIKE yourself is a revolutionary act. When you decide to value yourself and others whom society does not value, you are refusing to play the game.

As a community acupuncturist, you need to see the game and its effects on your patients. You need to think about the pyramid and decide what your relationship to the pyramid is going to be. Are you willing to be in a contentious relationship to power? Or do you still have some hope that you, personally, can get ahead? If you are inclined to dismiss all of this as political correctness, you are missing something essential about community acupuncture. Many acupuncturists are desperately trying to play the game, desperately grasping for any available shreds of relative power and privilege, trying to establish a claim to special knowledge, special status, special abilities. I think that practicing community acupuncture requires you to renounce the hope of getting ahead, because that hope inevitably leads acupuncturists to behave oppressively towards patients and to undermine their self esteem, whether they intend to or not.

The alternative to all of that desperate, demoralizing grasping is to do what the mentors in Finding Normal are doing, which is to pour all of themselves into being there for the people they serve. Not doing anything to them, not fixing them, not saving them, just being there, offering themselves, as if they were valuable, to people like themselves, who are also valuable. This is a form of organizing, because it concentrates certain resources down at the bottom of the pyramid, resources like presence, attention, and most importantly, love. One of my favorite scenes in the movie is when David skewers the camera with his eyes and explains, "What you really need to understand, man? I give a fuck. If you was suffering like I was suffering, as I know it and I felt it -- it ain't got to be like that."

Questions to consider: how is your self esteem? Really? What is it based on? Can you think of times when other people helped you realize you deserved good things, that you were of value, not because of anything you did or had, but just because you were a human being? How did they do it? How did it affect you? How do you do this for other people?

Harder questions: what's your experience of oppression? for yourself, for others? Paul Kivel has a bunch of helpful articles here about oppression and intersectionality (see especially "The Power Chart Revisited"); if you think you've never been on the receiving end of oppression, check out his article on "Adultism".

This story was posted on June 29 2009 by Lisafer.

Comments

  • June 29 2009 at 1:03 PM
    Marty Calliham writes:

    Keep it coming.

    I always sigh with relief when I see that Lisa has blogged again. She keeps it real, gets our feet back on the ground.  Once again she hasn’t disappointed us.  Here’s some real soul food - it changes us forever, making us more compassionate,  more useful.  Thanks, Lisa.

    Marty

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  • June 29 2009 at 2:09 PM
    lumiel writes:

    I haven’t finished reading this yet, but must thank you.

    I don’t know how I missed Nora’s post on Paul Kivel, but I’m so glad to be reading it now.  It answers some unexplained feelings and questions I’ve had.  This is a very important and powerful blog.

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  • June 29 2009 at 3:05 PM
    Demetra writes:

    Wow.

    That part about The Game and self-esteem really opened my eyes to how I view my own personal class history.

    I’ve honestly had a very difficult time embracing the idea that I must be willing to let go of my own class “achievement” in fully understanding the community acupuncture model, due to the fear I constantly felt as a teenager, when I was poor, working full-time in a grocery store, and terrified that I would never escape a life of desperately trying to get by. Now as a solidly middle-class urban college graduate living a life I never dared imagine (driving a nice car! being able to afford fresh fruit!), I realize that I have connected my personal self-worth to my accumulation of wealth. I wonder if this is a common scenario to children of immigrants- after all, I was raised knowing that my father came to this country to make more money that he ever could have in Greece, and I was taught that if I worked hard enough, I could also achieve the American dream. But the unspoken shadow of that is more clear to me now- that if I failed to achieve middle-class status, than I was a failure as a human being. And the result of that belief is an unconscious judgement of all those people at the bottom of the pyramid- that little voice insisting that they must not have worked hard enough, or they wouldn’t be there. 

    Thanks for all this food for thought. I see that I have a lot of unexamined beliefs, and it looks like some of those links you provided will help me look through them with more confidence. I really appreciate this!!

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  • June 29 2009 at 3:58 PM
    Moses.C writes:

    Fierce and brilliant! Thank

    Fierce and brilliant! Thank you Lisa for tuning into the silent bully of opression, in all of it’s many ‘ism’ forms. As we acupunks clarify for ourselves the origins of low self-esteem, I agree that we have a chance to develop more reality-based and healthy practitioner boundaries. With healthy baoundaries that are based in reality, our practitioner-patient relationships have the potential to encourage genuine self-esteem and growth in our patients step at atime, without falling into mothering/ caudling them. Finally, some information regarding the practitioner-patient relationship that resonates with my own experience in clinic…thanks again!

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  • June 29 2009 at 7:12 PM
    Lisafer writes:

    thanks everybody…

    you guys are good for my self esteem. smile

    Demetra, a big yes (at least from my perspective) to the immigrant experience. You identified the whole hope/fear dynamic really well. My great-grandparents were immigrants, and I’m definitely familiar with the hard work = hope perspective. And I don’t think that’s wrong, because hard work does pay off, at least some of the time, for some people.( For that matter, hard work is potentially a good thing in its own right, because knowing you can do it is another way to develop self-respect.  That’s a working-class thought, I guess.)

    But for lots of members of my family, the American dream stayed far out of reach. Hard work doesn’t necessarily equal hope if you mix enough bad luck, family violence, and mental and physical illness into the equation. And no matter what, the game is STILL rigged. The fear of ending up at the bottom of the pyramid is what keeps lots of us from seeing how the pyramid works, how unfair it really is. One of the ways to handle the fear is, as you pointed out,to rationalize that it really couldn’t happen to us because we DO work so hard.

    I think it’s set up that way: reward just enough people, just enough of the time, that there isn’t enough collective motivation to question the system itself. And then you’ve got all the oppression-internalization dynamics, all the ways that working class people, for instance, believe that we’re worthless and that things would get better if only we could become more like the people who are telling us that we’re worthless. If only we worked a little harder…

    “You know how people always say there’s a reasonable explanation for things like this? Well, there isn’t.” Daniel Pinkwater, The Neddiad

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  • June 29 2009 at 8:25 PM
    LarryG writes:

    great

    thanks for this!  i am looking forard to the study guide and think it will be an invaluable tool for all CA punks.

    here’s to flipping the pyramid on its head, generating people power and getting together.  

     

    cheers.

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  • June 30 2009 at 9:25 AM
    Guest writes:

    A common problem

    “Our patients might not be in such dire life-or-death circumstances, but I think they need something similar from us: to hear, verbally or nonverbally, you have worth and I see it. You don’t have to prove it to me by changing your diet or quitting smoking or doing qi gong every morning. I am willing to give you my time and energy and focus, unconditionally; you deserve it.”
    I think this might be the hardest thing for middle class/upper middle class practitioners to “get.”  The upper middle class value of professionalism (see Acupuncture is Like Noodles by LIsa Rohleder et. al. http://www.workingclassacupuncture.org) for definition of upper middle class values) that permeates our society preaches all of us that those with more education know more than the rest of us and that an integral part of the responsibility of the professional is to educate their patients in things that are good for them.  This notion coupled with the sincere desire to help is a disastrous recipe. 
    It can result in the practitioner/professional thinking that every moment is a teaching moment.  Giving information that isn’t asked for sets up a power dynamic that is so familiar it is often not even on the radar screen of either party in the exchange.  However, the one up one down that this creates is FELT by both.  To the patient it feels sticky and can cause them to doubt their own knowledge of themselves.  It causes resentment  which can become anger or guilt if the patient isn’t clear about what is going on.  The practitioner may feel benevolent and pleased initially to share information.  However it is disrespectful on the part of the practitioner and creates a barrier to real connection on a level that promotes healing.  The practitioner will feel, knowing or not, the distance this dynamic creates between them.
    To meet another, to connect without an agenda for changing them, to honor their wisdom and to trust the needles and the group qi to do the healing is not only a wonderful privilege, it’s liberating for the practitioner.  Gone is the requirement to know more, teach more, be more.  Present is the simple but profound connection of two people together to create healing.

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  • June 30 2009 at 8:33 PM
    Lisafer writes:

    great comment, Ann!

    a class-related thing that I totally missed, just like I missed the stuff that Larry pointed out in the comments on the first installment. God, what would I do without you guys. Boy am I glad I am posting these drafts, the final result is going to be a lot better as the result of your input.

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  • June 30 2009 at 10:08 PM
    Whitsitt writes:

    The pyramid is also

    The pyramid is also maintained by violence.  Where you are in the pyramid determines who gets to inflict violence on who (violence that flows down the heirarchy is rationalized, violence that flows back up is horrifying).  Sometimes the violence looks like economics, or public safety, or foreign aid.  Sometimes it’s not as structural.

    I get the sense from alot of middle class folks and liberals that oppression is about “feeling bad.”  All that self esteem stuff is important, and it plays into actual physical suffering.

    I don’t know who thinks you’re being “politically correct” by bringing this stuff up, Lisa.  I think you’re totally right on, and can take your analysis even further.  The best part about what you’re doing, however, is that it’s all very grounded in *what to do about it*.  Thank you.

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  • July 1 2009 at 1:25 PM
    MattGulbransen writes:

    Right On!

    This is exactly what I was thinking.  Though, it’s not just the violence itself, it’s also the FEAR of violence. You can’t always blame the middle class, especially for the violence, often they are held in check because they know how close “that world” is to them (most of the middle class can’t afford to live in the gated communities, etc that keep the owning class from the reality of their selfishness).  That said, the system re-enforces fear of being at the bottom and the hard scrabble, so many who see the negative effects of the system are goaded into supporting it by fear of falling victim to its worst oppressions.  

    I’d say on a day to day level, it’s the power elite’s turning a blind eye to the violence.  Violence that seems to be a natural consequence of a small group hoarding all of the resources.  They do violence through inaction.  Of course, the self esteem rap is the justification for this inaction, “those people are just like that”.  Which ignores the fact that in order to survive, the people of the owning class would just as soon steal and kill etc.  They are not better humans, their situations just enable them to avoid DIRECT killing or stealing.  It makes them seem better, but it’s built on lying by omission.  That’s why it’s so important to throw this into the light of truth.  

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  • July 1 2009 at 2:49 PM
    Whitsitt writes:

    I can’t really blame the

    I can’t really blame the middle class.  I even have a hard time blaming the owning class (unless I’m feeling grouchy, then it’s all “eat the rich”).  Hell, I’d kill and steal to eat too, either by proxy or directly (and it’s fair to point out that my participation in our system, and more importantly, my ineffective action is stopping this sytem, is just that).  We all do what we can.

    One of the differences between liberal and radical values (and maybe middle class and working class, too?)  is that to liberals, it’s about personal achievement and experience.  From a radical perspective, it’s about structure and group identity.

    At the end of the day, it is all interconnected.  We need every approach to dismantling this culture: liberal, radical, individual, structural, etc.  Of course, the best tactics and strategy are those that get the most results from the least effort.

    Matt, you are so right that we need to throw this into the light of truth.  We all have work to do.  We can’t get too hung up on guilt and blame, and we need to have a good analysis and practice for making change happen.

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  • July 1 2009 at 3:56 PM
    Guest writes:

    The other side

    of the self esteem issue is how we as practitioners view our patients.
    I suspect one reason the acupuncturists at Lisa’s public health job weren’t committed was rooted in fear and stigma. “I’m not like them.”  Addiction is not well thought of in our culture and those who become addicted are judged very negatively.  One reason I think the mentors do so well is that they have had the experience so they understand it.  They are “wounded healers.”  They can identify/connect through a common history.  And they are inspiring because they found successful ways to deal with their addiction.
    Our work as practitioners - and as people - is to challenge our judgments of others and put them aside to see the person in front of us.  Genuine connection with another can’t happen if we greet others with thoughts like, “Too fat” “a smoker” “doesn’t exercise enough” “a hypochondriac” “a complainer” “too needy” “doesn’t eat right” “too angry” “hasn’t taken care of themselves”.   Once again, the one up one down dynamic is there.  Power over.  It doesn’t feel good to either party, if you can be quiet enough and honest enough with yourself to feel it.
    We are all taught the isms in print, in movies and TV, at school, at home, everywhere.  Millions of messages daily.  Who has worth and who doesn’t.  As practitioners we are also taught to evaluate what “is wrong” and “what people need.”  This plays right into judgments and the isms.  It keeps us judging and distancing ourselves from those who come to us for help.
    To value others because they are human beings, to see worth in just this, to respect that they are living their lives in ways that make sense to them and to know that if I make judgments, I will be putting a distance between us, is to do radical work.  To realize that my judgments come from my life which is not theirs.  To see that the judgments also come from our culture and are designed to keep us all distracted from the reality of the pyramid and to keep us defining “us” and “them” over and over so we won’t join together and challenge the pyramid is to be a revolutionary.  To open up your soul to another, to invite a relationship based on mutual respect and equality is both simple and profound and is something we must learn to truly be helpful to others.  

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  • July 1 2009 at 4:12 PM
    chaitime writes:

    .

    very nice post ann. a simple truth to always come back to.

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  • July 1 2009 at 4:48 PM
    David Lesseps writes:

    That last paragraph should

    That last paragraph should be etched in stone somewhere.

    -David 

    Circle Community Acupuncture

    San Francisco

    http://www.circleca.com

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  • July 1 2009 at 4:51 PM
    tessmcginn writes:

    you wrote that in a way we can all see for ourselves, well

    ourselves.  Thanks for your poignant post.

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  • July 2 2009 at 11:44 AM
    mollyfread writes:

    .

    THANK YOU, ann.

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  • July 5 2009 at 3:16 PM
    chrisk writes:

    Questions

    I’ve been reading Lisa’s recent blog posts, and the comments you’ve all written, with interest and curiosity.  I’ve also been reading as much as I can of the resources on classism that have been suggested here, such as ClassMatters.org and more recently Paul Kivel’s articles.  

    I was raised in a middle/upper-middle class family in a middle/upper-middle class community.  Five years ago I married a woman who grew up in a working class family in a working class town.  Through conversations with my wife and the resources I mentioned above I have gained an awareness of class and classism that I didn’t have before.  That said, I still feel I have an enormous amount to learn.

    A lot of what I’ve read in Lisa’s posts and the subsequent comments makes sense to me and resonates as true. And there are parts of what I read that raise questions.  

    I understand the dynamic that gets created when a practitioner offers unsolicited advice on diet or lifestyle to a patient.  And I am 100% on board with meeting people where they are with acceptance and compassion in any kind of healing relationship.

    Here is the issue for me.  I think everyone is capable of change.  I think there is a way to facilitate learning without preaching or teaching - a way to support people in supporting themselves that respects their autonomy and wisdom.  I believe it’s possible to work for change, in our own lives or in the larger world, without being attached to that change ever happening.

    Perhaps what I’m describing is more like mentoring than it is teaching.  It acknowledges the inherent goodness and adequacy of a person while supporting them in making changes, rather than starting from a place of “not enough” or trying to “correct” some deficiency. 

    To use an example that comes up here frequently, let’s consider what happens when a patient comes to us with a serious health problem that their diet and lifestyle is directly contributing to?  

    If we offer them dietary or lifestyle advice without being invited to do so, we run the risk of creating the dynamic that Ann eloquently described.  We make the assumption that they’re interested in what we have to say even when they may not be.

    But if we do not offer that advice, aren’t we making the opposite assumption, i.e. that they don’t want to know that their lifestyle or diet is in some way contributing to the pain/disease?  Aren’t we also making the assumption that they are either uninterested in or incapable of changing their lifestyle or diet even if they knew it was contributing to their condition?  Are these assumptions safe or fair to make?

    I get that there are many factors that influence whether someone is willing or able to make dietary and lifestyle changes.  For example, many of the “healthy foods” that a practitioner would recommend might not be affordable for working class people, or are not even available in their communities.  And a lot of workiing class folks may not be interested in a yoga class even if the practitioner thought it was good for them.

    But what about those who would be interested in making changes?  What about those who weren’t aware that their diet is contributing to their disease, but would like to know that so they can make changes?  What about those who are interested, for example, in learning some relaxation techniques to help manage stress between acupuncture treatments?  

    If we simply assume that all working class patients aren’t interested in such things, aren’t we doing a disservice to those that are?

    Obviously one solution is to simply share that information with people who ask for it.  But just because someone doesn’t ask, it doesn’t necessarily mean they aren’t interested. They may not be aware of the connection, or they simply may not be thinking of it.  Is there some way to find out who is interested without creating the dynamic that Ann described?

    What about saying something like this: “Sometimes making dietary and lifestyle changes can boost the results of acupuncture treatment with your condition.  Are you interested in hearing more about that?  It’s not necessary, but it could help.”

    That is more or less how I present herbs to my patients in the community clinic I work in at my school.  It is notable that so far I haven’t been able to predict which patients will be interested in herbs based on their class or income level.  As a case in point, the patient I have right now that is most committed to making dietary and lifestyle changes is a 62 year-old African-American woman that was a crack addict for 20 years and lived on the streets for a lot of that time.

    She comes to see me not only for acupuncture, but also for advice on what she can do outside of her twice weekly acupuncture treatments to support her health.  She is poor, but a lot of what I suggest to her doesn’t cost anything or is very affordable.  I recognize that not all patients are like her in this respect, and I don’t expect them to be.  But I do want to make that kind of information available to those that want it.

    I’d like to hear your thoughts on this. 

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  • July 5 2009 at 4:42 PM
    annmongeau writes:

    If you say this

    “Sometimes making dietary and lifestyle changes can boost the results
    of acupuncture treatment with your condition.  Are you interested in
    hearing more about that?  It’s not necessary, but it could help.”

    and then respect what they say in response, I think that’s fine.  It becomes insulting when you offer advice that wasn’t asked for or go ahead and give it when the answer to the above is some variation of , “I’m not interested.”

    You also have to watch carefully if they said, “Yes, tell me.”  Sometimes they say yes to 1) please you 2) to not want to be contrary 3) some other reason - but they really didn’t want to know.  If they don’t seem interested or start saying, “Yes, but…” it’s time to stop or you risk making them angry/insulting them.

    In my experience, this doesn’t apply only to working class patients.  It applies to everyone.

      0 likes
  • July 5 2009 at 5:14 PM
    chrisk writes:

    Yes, I agree

    that people might say “yes” even though they mean “no”, for the reasons you mentioned.  Obviously the question itself implies that there’s more the patient could be doing, and some may interpret that as a subtle hint from the practitioner that they should be doing it.  It’s a very tricky situation to navigate and “watching carefully” as you suggested seems essential, since each person will have a different response based on their personality, beliefs, history, etc.

     

      0 likes
  • July 7 2009 at 12:32 AM
    tatyana writes:

    who are you

    chris, i think lisa pretty much answered your questions with her most recent blog post: http://www.communityacupuncturenetwork.org/blog/installment-3-finding-normal-study-guide

    i know that it was said / written somewhere here before, but the community acupuncture experience is often enough for many people to figure out what they need to do on their own - what changes they need to make to heal, what healing realy means for them. this is related in my mind to what lisa said about the importance of holding the space for healing. i think of this space as both external (community treatment space) and internal (the space within both patient and practitioner that is created by stillness and being with suffering).

    i sometimes wind up making suggestions about diet / lifestyle adjustments with patients. i also have gotten at least a couple of patients to try qi gong recently (they found it very helpful). i think the question is really “who are you when you are recommending these things?”. or as lisa says, what is your “practitioner persona”? this makes all the difference, i have found. whenever i wind up making any kind of lifestyle  / diet etc recommendations to my patients, i never make them as some kind of an expert, teacher, mentor or authority on anything. i make them as JUST ME, a person they know that is committed to help them heal. this never works if we do not feel a connection, if the patient does not know IN THEIR BONES that i really truly “give a fuck”.

     

      0 likes
  • July 7 2009 at 2:31 PM
    chrisk writes:

    Well said, Tatyana

    And I imagine that is true in not only any kind of acupuncture practice (CA or BA), but any kind of healing practice or relationship.

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