Installment 6 of the “Finding Normal” Guide

Community : We Really Mean It

The most radical thing about community acupuncture is that it approaches acupuncture within the context of community rather than within the context of the individual. This is one of the most basic mental shifts an acupuncturist needs to make in order to be successful within a community clinic, and it’s one of the hardest aspects of deprogramming potential employees.


In the opening scene of Finding Normal(http://www.findingnormal.org/), David Fitzgerald says: “All these guys are different. You got to meet them where they’re at, you got to figure out where they’re at so you can meet them there and work with them from that point. Some people are more tired than others. Everybody has different issues. Some guys have done a lot of time, some guys haven’t. Some guys shoot methamphetamine, some guys smoke crack cocaine, some guys drink alcohol and some guys shoot heroin. But the common thing about it all is, we’re all addicts. There’s more similarities than there are differences. And just finding them similarities, and getting them to recognize it, and then finding a point that you can work from. I love my job, man, believe that. I was born to do this shit.”


This one-minute speech at the beginning of the movie refers directly or indirectly to most of the skills, the mindset, and the qualities of character that you need in order to be a successful community acupuncturist. You could translate David’s speech something like this, for community acupuncturists: "Your job is to treat all kinds of people. On the surface, there are all kinds of differences: age, gender, class, race, culture, language, disability, religion, personality, you name it. You need to be able to see those differences and understand how those differences affect your patients’ lives. You can’t ever fully understand what it’s like to be, say, of a different race, and so you need to approach everyone respectfully and without judgment.  Since you can’t necessarily fully understand,  you need to try to recognize and appreciate what your patients are dealing with in their lives that may be very different from what you are dealing with. You need to meet them where they are, or whatever is your best understanding of where they are, rather than where you think they should be.  But what matters even more than the differences are the similarities: everyone experiences pain and stress. As a community acupuncturist, your job is to appreciate the differences amongst your patients but to focus your acupuncture on the similarities. Learn what works for everybody, what simple approaches will be valuable to all kinds of people, rather than trying to reinvent your approach with each new patient. This way you will be able to help all kinds of people, connect with all kinds of people, and that is the most wonderful experience you can imagine.”

Here’s something else about David’s speech: note that he says, “we’re all addicts”, as opposed to “they’re all addicts.” A community acupuncturist needs to think in terms of “we”, not in terms of “they”. You can’t build community for other people, you have to be fully part of it yourself. You have to put your heart into it.


Thinking in terms of “we” rather than “they” has some concrete implications for how you are in the clinic. Check out this set of conversations from the film:

1:15
David: So, Louise. Who is he (nods head at Ray) and why are you referring him?
Louise: This gentleman has been through several treatment programs and appears to have done well in the programs.
David: How old are you?
Ray: I’m forty-five.
David: Forty-five? Is that what you said?...You don’t look that old. (Ray smiles.)
Louise: Problem is, he has no skills for the life after treatment.
David: What’s your drug of choice?
Ray: Crack and alcohol...I’m forty-five years old, here I am, I’m on the streets homeless, and I felt like what you said, it was time for me to do something for myself.

5:39 David talking to Ray about his own initial resistance to getting a sponsor:
But anyway, my sponsor’s standing out there right now. (Grins.) I got to be real careful, he might toss me up. That’s my sponsor. For real, Tom Young. (Tom waves at the camera)

13:09
David at Hooper Detox: So I’m here to get Mr. Daniel Winters out.
David meets Daniel in a group of clients waiting in the hallway.
David to Daniel:  So, you getting signed out? I’ll be waiting for you out here.
David to other client, out of camera range: Hey man, what’s your other brother’s name? Brad?  Hey, Brad’s ornery, man. (shaking head, laughing)

13:52
David and Daniel in the car.
Daniel:...I know what I need to do. It’s good knowing some folks down here, too.
David: We’re going to put you in a position to be successful...Anybody can come up, we’ve all come up a million times, but what THIS time is about, it’s about coming up and staying up. And that’s a different game. You know, you know some things, you’ve been exposed to some of the recovery process, but there’s some things that you missed.
Daniel: Definitely.
David: So what we’re going to do, is get you to slow down, pay attention, and I want you to evaluate me as much as I’m evaluating you, and you figure out who the fuck I am and what I’m really talking about, and check out what my motives are and what my intentions are. OK? And you can be skeptical, it’s OK, you don’t know me and I don’t know you.
Daniel: Exactly.
David: But what you’ll come to find out is, I’m pretty genuine about helping somebody get clean.
Daniel: Right on.

21:18
David to Daniel: Sarah told me to watch out for your girlfriend. Are you tripping?
Daniel: A little bit, man. (Describes his history with his girlfriend).
David: So, not for one minute am I going to try to be the relationship monitor, and tell you who to be with and who not to be with. But what I want to talk to you about is, here for a little while, Daniel, take your time, slow down,  you  know, we’re putting you in a room, getting you in a place where you can re-evaluate what’s going on with you, how things serve you, and where it is that you want to go. I’m not telling you to cut the girl loose, I’m not telling you anything but, what I’m telling you is, take some time for yourself to re-evaluate what’s going on.
Daniel: Sure.
David: All right?
Daniel: Yeah.
David: Don’t go running off to go hang out with her, don’t go find her, take some time for you because this is all about you. It’s not about her, it’s not about your mom, it’s not about your dad, it’s not about anybody BUT you. If something goes on with you, you need to figure out what the fuck it is, so that you can do some work around it, so that you can get a handle on this stuff, so that you can start to get some sanity and manageability around your life. (Pauses) You understand anything I just said?
Daniel: I do.
David: All right.

All of these conversations locate healing and communication in the context of community. In the first one, Daniel and Louise are talking about Ray in the third person in front of him -- without any disrespect or weirdness. There’s no difficulty at all for David to move from talking about Ray to talking to him and to connect immediately, in a way that allows Ray to open up. There’s no awkwardness for David to move from talking to Ray about sponsors to pointing out his own sponsor -- who of course is right there, in David’s workplace -- and to joke about David himself getting “tossed up”. There’s no uncomfortableness for David in joking with someone that his brother is giving David a hard time. There’s a lot of freedom, honesty, and connection; there’s no pretense or posturing. Because all of these people are clearly in this together.


Community demands a certain kind of transparency. David encourages Daniel to be skeptical, to check him out; in this context that means to watch him interact with other people and to analyze who he is by observing his relationships. This is one of the great things about being a community acupuncturist: your patients see you interacting with other patients. You can’t become a different person with each interaction, you can’t morph into what somebody wants you to be, because you are continually responsible to the entire community. As anyone who has gotten burned out on years of one-on-one treatments can attest, it’s much better to be responsible to a group of people than to be at the mercy of individual demands. The pressure to become or to do whatever someone wants, because that person is paying you a lot of money, vanishes in a community context. In return, you have to figure out who you really are and be that person all the time. You have to be very clear about what your boundaries are -- as David says to Daniel, “not for one minute am I going to try to be the relationship monitor”, something he can’t be and doesn’t want to be -- because your boundaries are on display for everyone to see. This is a good thing. Community creates “sanity and manageability”. Community reinforces integrity. Community means that you’re not juggling a series of relationships with individual “they”s , until you’re exhausted; you’re participating continually in an experience of “we”, which keeps you nourished and supported.

And a side note, some stuff that isn't going to go in the guide, because it needs Internet links, but which I can't resist because it is SO DAMN CLARIFYING:

Lonnie Jarrett seems to be doing something structurally similar to CAN -- and yet, oh so different. I stumbled across this site while I was in the process of writing this installment, and I'm going to link to it extensively because it's just so perfect. If you click on the "About" button on the Nourishing Destiny site, you get a list of their values.  Note #17 especially: "The vertical development of the practitioner is the most significant factor that makes possible a patient's healing". I glanced through some of the discussions on the site, and they are true to their principles. Like this thread, for instance: Hierarchy in the Treatment Room. (They're for it.)

OK, folks? Especially people new to CAN? This is the opposite of what I am talking about. In theory, it doesn't have to be the opposite, but in practice, it is. In theory, there is a continuum of what to emphasize in acupuncture: at one end is the practitioner, at the other is the patients, and in the middle is community. The Nourishing Destiny folks believe that by focusing enormous energy on the development of the practitioner, the patients will be transformed. On the other end, you could suggest that by practitioners putting all of their focus on to patients, they themselves will be transformed. David Fitzgerald occupies the (in my mind) perfectly balanced middle, where by putting energy into the community, everybody is transformed. An all-out emphasis on the practitioner shouldn't necessarily mean ignoring patients, but in practice, in the world of American acupuncture, it usually does. And that's probably because of class.

Here is a nifty example of what we're talking about: the Nourishing Destiny thread on Addiction. Basically, this thread deals with the question of whether it is possible for a healer to drink alcohol, ever. That is the important point: the healer's level of purity, clarity, and integrity. Contrast this, say, to the example of Lincoln Hospital, where the point about addiction is how it destroys communities, disproportionately communities that are poor and/or made up of people of color. The question on the ND thread is whether someone who has two drinks a week is really giving themselves to creating the future. The question is, as an acupuncturist, when you think about addiction, are you thinking about your own ability to have two drinks a week and create the future? Is that what addiction means to you? If so, I'm suggesting that you will not be happy doing community acupuncture.

Maybe you could argue that what David Fitzgerald is doing is influencing people, including me, by means of his superior vertical development.  Funny though, he just doesn't act like it. And I'll gratefully follow his example, any day, over anybody who claims to be spiritually evolved.

This story was posted on August 20 2009 by Lisafer.

Comments

  • August 21 2009 at 2:42 PM
    Justine writes:

    Something I’ve been thinking

    Something I’ve been thinking about all along since you mentioned Finding Normal and since I’ve watched it is that, even though there are good points to how we can look at David’s communication with the clients, there is still a fundamental key factor lying behind his ability to get the clients to trust him: the fact that he is also an addict.  When an addict is desparate and wants to get clean, they want to know another addict who has walked that walk and done it.  They find hope by relating to that other addict’s personal experience.  Unlike an addiction counselor who can relate to his clients on that personal level, we as acupuncturists can’t always relate to our patients on such a personal level - nor is it typically appropriate.  For me, this is where I see there is a challenge.  It is important always to convey empathy, and to tell someone with confidence that I know I can help them (and/or will do my best), and/or have experience with treating that particular condition they are seeking your help for; but I can never be able to express personally to someone my experience with something I haven’t personally walked through.  On the other hand, many of our patients already do this for us because they tell new incoming patients about their own personal experiences, which is great.  Despite the fact that most people have had some sort of challenge in their life they’ve had to overcome, it still doesn’t necessarily equate with someone being in need of care for something that may be entirely different.

    In any case, I’ve really enjoyed the movie and a lot of the pieces you write about as they relate to community acupuncture.

    In terms of the Nourishing Destiny thread - I can think of many other issues that would impact a “healer’s” “purity, clarity and integrity.”  (First off, I, for one, never considered myself a “healer.”  I hate that word, actually.  But that’s not the point.)  An acupuncturist is a human.  As humans, we all have problems.  Some of us have few problems, others of us have many - these could all trickle into our ability to care for people.  It could be addiction, sure, or it could be any number of other issues:  personal illness or illness of a family member; caretaking burdens; financial worries; personal battle with depression; etc.  To me, beyond the fact that it is essential for each of us to do the basic care we need to come to work and be ready to help people to the best of our ability, I see the “ideal shoulds and should-nots” according to some “highly evolved healer” as being frivolous.

    Just my opinion.

      0 likes
  • August 21 2009 at 11:17 PM
    Rose writes:

    I think it’s simpler and easier than that. 

    I don’t believe that the way to have patients trust you actually has
    much to do with whether you’ve personally been through whatever exact
    flavor of whatever condition they are suffering from.  This is based on
    my own personal experience.

    My father has had debilitating back pain on and off for all his life. 
    It’s been a part of our family’s life for as long as we can remember. 
    He went from doctor to specialist to chiropractor to doctor.  The thing
    that drove me crazy as a kid was that no one he saw honestly seemed to
    care if he got better or not.   Often doctors talked like they cared,
    but it was clear he was just another patient in pain in a long conveyer
    belt of patients in pain.   I loved my dad so much, and he was
    suffering so much, and I just couldn’t understand how they could be so
    clinical about a human being in pain.  I remember thinking, you know, I
    bet if it was YOUR dad it suddenly wouldn’t be ok for him to be in
    pain.

    A while back, when I first was introduced to acupuncture and the
    community acupuncture movement, I read Lisa’s posts on the boards.  The
    first thing that struck me was that she seemed to truly care about her
    patients, that their suffering was something real to her - that it
    personally offended her.  I thought, if I send my father to her, she’s
    going to care about him too.  It’s going to actually matter to her if
    he gets better or not.  That gave me the courage to talk to my dad
    about acupuncture, to ask him to please, please try just one more
    thing.  It was worth risking getting his fragile hopes up, because even
    if it didn’t help, we’d know for sure that someone who cared did
    everything they could.

    I can tell you 100% I didn’t care about Lisa’s background, her
    licensing, any previous experience treating back pain, or whether she
    ever personally felt a twinge in her back herself or not.  What would
    it matter?   If she actually cared, I knew she would fight for him to
    get better, that she would do whatever she could, that she would go
    that extra mile for him.  You can’t ask for more than that. Heck, you
    can’t even pay someone for that.

    So long story short, we did check Lisa out, and I did feel comfortable
    that she cared, and that I could trust her with my father, and he did
    get better.  A lot better.  But the point I’m trying to make here is
    that I think suffering is what it comes down to, not what particular
    form or illness that suffering takes.  You’re a human being, so the
    odds are you’ve suffered in your life, or had someone you love suffer,
    and you can no doubt relate to the fear/pain/anger/helplessness of it
    all.  If you can relate, and it actually really matters to you, and if
    you’re willing to do whatever you can with whatever skills you have –
    that is what patients and people who love your patients can put their
    trust in.

    The part of Finding Normal that really got to me, and what resonated
    with a lot of people on the boards based on the number of times it’s
    been quoted, is when David says, “What you need to understand, man, is
    that I give a fuck.  If you were suffering, like I was suffering, as I
    know it, and I felt it – it doesn’t have to be that way.”

    It really doesn’t have to be that way. 

    Nami

      0 likes
  • August 22 2009 at 12:42 AM
    Moses.C writes:

    very well put Nami! I agree

    very well put Nami! I agree that relating effectively to others who are experiencing stress and pain can be as simple as just ‘giving a fuck’, whether you have had that specific issue before or not.

      0 likes
  • August 23 2009 at 2:38 PM
    bottley writes:

    I think you nailed it.

    The issue is suffering. If you’ve experienced suffering, and we all have, you know what someone is going through. It doesn’t matter if it’s back pain, addiction, migraines, heartbreak, or anything else. Suffering is something everyone has experience with, and that’s all that’s necessary.

    I will never believe that an addict’s suffering is somehow different than that of someone who’s lost a loved one, or whose neck never quits hurting. Suffering varies in degree and specific effect, but the experience of suffering is something everyone knows.

    As far as my experience goes, a desire to help people work with that is all that’s really required. I’m all for the continued development of the practitioner, and agree that it’s a requirement to be successful, but the idea that there’s some kind of “purity” or heightened spiritual evolution that’s a prerequisite in order to help others is a complete load. The more a practitioner develops themselves, the better, absolutely, but the idea of never drinking alcohol or whatever else makes me laugh.

    I have a tremendous respect for Lonnie Jarrett, and have learned an awful lot from his writing, and I don’t even know if he’s the one propagating that idea, but that sounds like elitism to me, and if that’s actually necessary, I’ll need to quit tomorrow. By that logic, the people I’m trying to help aren’t actually getting better, because I although I do study constantly, and I’m always working on clarifying my own process, improving my diet and working through my shit, I’m about as “pure” as the driven mud.

    I have, however, a great interest in helping people feel better, and perhaps I’m badly misguided, but it seems to have worked ok so far. I have vast amounts still to learn, and I know I’m not even close to all I could be, but I personally think Ma Nature is willing to use all the help she can get, even if it’s provided by a deeply imperfect vehicle like me.

    If I offer help in the acknowledgement that my client and I share a common experience of suffering and weakness and human failing, then we have all the understanding we need. My acceptance of and compassion for my own suffering and weakness, and the work I’m doing on it, can be extended to others, precisely BECAUSE my own suffering and weakness aren’t really any different than anyone else’s. After that, it’s not up to me anymore. 

      0 likes
  • August 23 2009 at 3:59 PM
    Lisafer writes:

    Thank you, Nami

    I had no idea of the backstory, but I loved treating your dad. And the rest of your family. I’m very happy to see you on CAN.

      0 likes
  • August 23 2009 at 4:05 PM
    Lisafer writes:

    amen to that, Brent

    The frustrating thing about the “practitioner development” issue is that practitioner development IS necessary—it’s even sort of the point of the whole “Finding Normal” guide. It does usually take work and practice to become useful to other people, and I don’t just mean needling technique. But when the “development” sounds like it equals elitism, then that really undermines my desire to develop.

    I really like “My acceptance of and compassion for my own suffering and weakness, and
    the work I’m doing on it, can be extended to others, precisely BECAUSE
    my own suffering and weakness aren’t really any different than anyone
    else’s. After that, it’s not up to me anymore. “

    also, “pure as the driven mud” is pretty great, too.

      0 likes

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