Keynote Speech POCAfest 2012
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POCAfest Keynote: Report from the UK
This is actually the second keynote speech I’ve done this spring. The first one was for ACMAC’s conference in March in Brighton in the UK. ACMAC is the Association of Community and Multi-bed Acupuncture Clinics, run by our friend Charlotte -- Charlie -- Stone. ACMAC is like POCA’s British sister; we drank a lot of tea at that conference. I’ve been wanting to give a report on the trip, and this seems like a good opportunity. Travel can give you perspective in a way that nothing else really can, and I feel like I learned a lot about our movement by going to Brighton.
There were definitely some comic elements. Charlie originally invited me to do the keynote address via Skype, and I said yes, and then I panicked at the thought of giving a speech to a crowd of people that I couldn’t actually see. There would just be me talking to the computer screen, and I’d be waving my arms and swearing, and I’m sure I would both look and feel unhinged. On the other end would be all these polite Brits drinking tea, thinking I was up the wrong pole, as they say. So I said, no, I’d rather just come to the conference, even though I don’t love traveling. And because I don’t love traveling, I enlisted Skip and Cris to go too. I suspected I’d have a lot more fun if they were there, and I was right about that, we had an amazing time.
But it started out with a comic episode in Heathrow Airport, when Skip and I were supposed to meet Cris at the bus station so that we could all catch the bus together to Brighton. We happened to have Cris’ bus ticket as well as our own because we had bought them all together online. We had just been up all night because our flight was a red-eye, and when we got to the bus station, Cris wasn't there. We couldn't figure out what was going on, because her flight had come in hours ago. It turns out that there is not just one bus station in Heathrow Airport, there is a bus station at EVERY TERMINAL. And we, of course, had not exactly specified where we were meeting because we thought "the bus station" could only mean one place. And our cellphones didn’t work in the UK.
Anyway, at one point I was sitting on a bench in the bus station -- one of the four possible bus stations -- while Cris and Skip were running around in different terminals, trying to page each other. If you haven't been there, Heathrow Airport is huge. I was staring into space because I was exhausted, and my eyes landed directly on the notebook of the woman who was sitting next to me on the bench. It looked like she was a teacher, and she was correcting papers for a class. Because I was so bleary, it took me a couple of minutes to realize first, that the papers she was correcting weren’t in English, and second, that I could sort of read them anyway, because they were in classical Greek. Then I started to wonder if I was actually awake, or if I was still asleep on the plane, having a weird dream in which we couldn’t find Cris in the airport and everybody in the UK read Greek and I was actually a classics professor like I’d planned to be in college.
Yeah, I was a Greek major. And one of the things you do when you’re a Greek major is that you have to write composition exercises, in which you demonstrate that you understand all that Greek grammar by actually using it. Because ancient Greek is a dead language, the things you can say in these exercises are generally a little strained and awkward. You can’t write, “I got up in the morning and went to a cafe and drank some coffee and read the news on my laptop” because “coffee” and “laptop” are not words in ancient Greek and never will be, because it’s dead. It’s fossilized, it stopped growing as a language a long, long time ago. So if you are writing composition exercises in ancient Greek, you end up writing things like, “In the morning I went down to the seashore and made an offering of bulls and rams to Athena, that she might protect the triremes of the king as they sail on the wine-dark sea” and some poor teacher has to correct them while she’s waiting for the bus.
Anyway, eventually Cris and Skip connected with each other via the public address system, which was hilarious in its own right, and we found each other and all got on the same bus going to Brighton. I spent the 2 hour trip alternately thinking about my ACMAC keynote and falling asleep. Seeing those Greek composition exercises was timely, because I had antiquities on my mind anyway. The keynote speech I was supposed to give at the ACMAC conference was on the theme of "Making Buckets from Ming Vases", which was also the title of an article I wrote in preparation from the conference. I know that a lot of you read the article -- thank you -- so I won't completely rehash it, but let me just revisit the themes briefly.
Basically the idea was to contrast the thinking and motivations behind the respective practices of conventional acupuncture practice and community acupuncture practice. I compared the majority of conventional acupuncture practice in the West to an orchid -- a fragile, exotic, attractive but not very useful air plant -- and community acupuncture to a dandelion. (Actually, the truth is, I started out by comparing conventional acupuncture practice to an orchid and community acupuncture to crabgrass -- "spiky, tenacious, and challenging" -- but Nick read an early draft of the article and suggested I use dandelions, which of course worked much better. Because dandelions are useful for all sorts of things.) Dandelions are tough and common and nutritious and most of all, rooted in the soil where they grow. We community acupuncturists are fixated on the process of rooting acupuncture within our communities, within the lives of ordinary people. The Latin word for root is radix, and apparently, the fact that we care about roots makes us radicals.
And because one metaphor is never enough as far as I'm concerned, I then went on to say that a lot of conventional acupuncturists treat their education like a Ming vase, while community acupuncturists treat our eduction like a bucket. I accused the acupuncture profession in the West of being passive and self-absorbed, and also, of handling our knowledge of acupuncture as if it were an ancient and exotic antique -- handling it very gingerly, not wanting to get it dirty by, you know, actually using it to help people. I accused the acupuncture profession of wanting to display acupuncture for other people to admire, but not actually trying to do anything with it that was genuinely useful to society. And I described community acupuncture as the process of taking the Ming vase off the shelf and using it as a bucket to bring water to people who were thirsty -- of recognizing acupuncture as a humble tool rather than an exotic antique, something relevant and needed because it's a vessel for healing. Something that is valuable not for its provenance, but for the good it can do in the lives of ordinary people. So I was thinking about how to turn all that into a speech.
Anyway, when we got to Brighton, we met Charlie at the bus stop -- with no comic interludes this time -- and she took us back to her house in the village of Uckfield where we met her family. Charlie and her family are lovely, that's another thing I could go on and on about, but I won't because we don't have all day. I will say, late one night after her husband Nate took us to experience the Uckfield pub, we got into a discussion about acupuncture and Nate -- who's not an acupuncturist -- said that he believed that acupuncture was actually a means of communication. We went back and forth about that for a while, was that true, what did it mean, but we didn't get very far because we were all kind of tipsy, and except for Nate, very jet-lagged, so I filed that idea away to think about later.
Which I did, quite a bit, during the conference. But before I talk about the conference, let me give you some background about the acupuncture profession in the UK. This is the part of the trip that was a lot like visiting an alternate universe. You know that concept, that there are actually an infinite number of alternate universes, that every time anybody makes a choice, that another universe comes into being in which they made the opposite choice? Well, the acupuncture profession in the UK is like the alternate universe of acupuncture in the US -- it's the universe where acupuncturists decided to actually get along and be nice to each other.
In the weeks leading up to the conference, Charlie and Cris and I spent a lot of time talking to each other, in various combinations, about what we were trying to accomplish by having the three of us come to the ACMAC conference. Charlie had been feeling considerable frustration about how the multi-bed movement in the UK had evolved in such a way that she alone was doing all of the organizing work, and of course, as it grew, that became unsustainable. And Cris and I had said, of course, wow, that it is really not the case with the community acupuncture movement in the US; we are continually grateful for all of the ways so many different people contribute their time and their talents. So we were all wondering if we could use our visit to collectively figure out what was up with that, that business of Charlie doing all the work all by herself, and ideally, to do something to fix it. The other thing that Charlie wanted to talk with us about was involving patients in the movement. She said that in the UK, their patients seemed to be passive consumers for the most part, and not the enthusiastic contributors that they are in the US. And between patients being passive consumers, and the multi-bed acupuncturists really just wanting Charlie to do everything for them, Charlie was pretty concerned about the future of ACMAC.
We also had some discussions about how provocative we could be with our audience at the ACMAC conference. We heard a number of comments, not only from Charlie, about how Brits are really polite and really hate conflict and how you can't say anything provocative or incendiary to them because they'll just politely tune you out completely. Of course, we started hearing these comments afterwe had booked our flight. I stopped short of asking Charlie, now why did you want me to do this keynote again? I'm not sure I can be anything other than provocative and incendiary, what am I going to do? I was a little worried.
And then, of course, there was the gracious invitation from Peter Deadman to write the article for the Journal of Chinese Medicine in order to stir up interest in the conference. I did say to the editors of the JCM, so, how do you feel about controversy? Because if you're going to offer me a platform, as you kindly just did, I'm going to use it to say something controversial. And they responded, it's OK, controversy is fine, it's interesting, just no ad hominem attacks. I said, fine, no problem, I don't want to pick on individuals anyway, it's the whole profession that I'm cranky with. But when I sent the first draft of my article, in which I made a distinction between conventional acupuncturists and community acupuncturists, and said that we community acupuncturists called ourselves acupunks or just plain punks, the editor who was working with me wrote back and said that the term punks would probably turn other acupuncturists off. He was worried that they would feel repelled and not listen to the rest of the message in the article. So then I did a revision in which I explained whycommunity acupuncturists wantedto turn other acupuncturists off, why we wantedto repel them, because we needed to filter out the people who would take the model and totally screw it up in the real world. By acting like acupuncturists , naturally.
I was surprised and relieved when they accepted the revision. And of course when the article was published, it did indeed stir up a bunch of controversy -- over here, actually, I don't know how it was received in the UK. Maybe they were too polite to tell me. But so I had already been through a few rounds of this by the time I got to the conference and my keynote. I was thinking a lot about communication, not just acupuncture as a means of communication, but communication period -- was I going to be able to get anything useful across in my speech.
And by then, Cris and Skip and I were all wondering -- were all the problems that ACMAC was having with people's lack of engagement becausethe acupuncturists were too nice? At one point, Cris and I went out for a walk so that I could supposedly practice my keynote speech, but what we did instead was have a discussion about how maybe the problem was that ACMAC didn't have any bad guys to mobilize against. You know how a good villain can really move a plot along? Charlie had told us that overall, the acupuncture establishment in the UK was quite supportive of community or multibed acupuncture. Nobody ever accused herof being a terrorist. Nobody showed up on the opening day of new multibed clinics in the UK and yelled at the acupuncturists for devaluing the profession and stealing their livelihood. No multibed acupuncturists ever got fired from acupuncture publications for articulating ideas that had "dangerous potential" -- otherwise known as the sliding scale, we all know how dangerous that is. Apparently the Brits don't find it so alarming. But Cris and I started wondering if maybe all of the animosity we'd encountered for so many years had an upside we hadn't previously appreciated: it was motivating. (I mean, we do realize that we have Acupuncture Today to thank for inadvertently launching the community acupuncture movement online with their "talk back" forums for columnists on their website, but this is a whole other level. Um, thanks, AT, for hating us? It made us more productive?)
Part of why the acupuncturists in the UK seemed to get along so well was an atmosphere in which acupuncture itself was much more common and established than it is in the US. The National Health Service provides acupuncture, at least on a limited basis, along with all the other forms of free health care that it offers. Apparently, a lot more medical doctors use acupuncture in the UK as part of their practices than they do in the US. And while physiatrists and physical therapists also practice acupuncture in the UK -- and the acupuncturists there do "whinge" (that's how they say "whine" in England, don't you think it sounds better?) about how the physiatrists get paid more than the acupuncturists do for it -- you don't have all the craziness of turf war that we have here. People get along. They don't try to stop each other from practicing acupuncture or legislate each other out of existence. They might not be best friends, but they do in fact manage to get along.
As Cris wrote in her blog post, "Ginger in New England", the community acupuncture movement in the US pretty much leapt from a pinnacle of dissatisfaction with the larger acupuncture profession. (I love that image.) And we did leap, we got airborne really fast when you think about it. There seemed to be less dissatisfaction in the UK and also less momentum around community acupuncture, and we weren't sure we'd be able to talk about any of it without gravely offending our hosts.
And, finally, one of the mostimportant things you should know about acupuncture in the UK besides how friendly it is -- acupuncture as an independent profession is not regulated. There are no licenses. Any of us could go to the UK and open up a clinic, for instance. (And maybe somebody should, but I'll get to that later.) The group that represents the British acu-establishment, the British Acupuncture Council or BAcC (Baksie) as they are affectionately known, are both a promotional group for professional acupuncturists and a self-regulating body. So they are like the AAAOM and a state licensing board all rolled into one. Except since there are no licenses, membership in BAcC is entirely voluntary, and like every acupuncture professional organization, they are always trying to get more members. But nobody has to join them. The Executive Director of BAcC, Nick Pahl, who is a very nice person, made a presentation at ACMAC's conference right before I gave the keynote.
As it says on BAcC's website, they are working with the Department of Health in the British government for statutory regulation of acupuncture in the UK. BAcC would like for acupuncture to be regulated in the UK the way it is in the US, with laws and licenses and mechanisms to control the boundaries of the profession. The day before the conference, we got to meet with a British acupuncturist, Paul Blacker, who wanted to talk with Charlie about a project he was working on of setting up a multibed/community clinic in an acupuncture school. Paul, as he described it, knows pretty much everyone in the UK acupuncture world, and he had some recent news on the statutory regulation issue. Apparently, representatives of BAcC had met with representatives of the government, and the government folks had said: sorry, we don't want to regulate you. It would cost us money, and in the current era of austerity, we can't afford it. And besides, you all are doing such a good job of voluntarily regulating yourselves. Acupuncture is so safe, it's not like you're going to hurt anybody, you don't need laws. Just keep doing what you're doing, thanks very much! And of course the representatives from BAcC were disappointed, because they'd been working on this for quite a long time.
Another interesting thing we learned from talking to Paul was about the state of acupuncture education in the UK. It is possible to get an acupuncture degree from a public university there, but also, just like here, a lot of acupuncture schools are private. According to Paul, recently there was an attempt to get a new acupuncture training program going at an existing university and it looked like it was going to happen. And then, near the end of the approval process, the university administrators got a look at the workforce data for acupuncturists in the UK and they said, wait a minute. There's no evidence that people are actually able to earn a living by practicing acupuncture after they graduate from acupuncture school. This workforce data is terrible. We are not going to offer this acupuncture training program, because it doesn't lead to real work.
I know I've heard quite often, and I suspect that the rest of you have too, that the reasons why so many acupuncturists can't seem to make a living in the US are that the healthcare system doesn't recognize that acupuncture is safe and effective, and also, that the acupuncture profession is filled with infighting and that's why we never get anywhere. Well, it's interesting to look at those explanations in light of the alternate universe of our British cousins. Their nationalized healthcare system DOES recognize acupuncture; it even pays for it. There's nota lot of infighting amongst acupuncturists. BAcC has over 3,000 acupuncturist members -- proportionally, they are doing a lot better than the AAAOM in terms of people joining and supporting their national organization. There seems to be much more unity than we have here. And yet their basic economic situation is the same: the the idea of an acupuncture "profession" only exists, in truth, because there are acupuncture schools to promulgate that idea. Just like in the US, there isn't really an economic foundation of healthy, thriving practices, there's an economic foundation of schools. There's an economic foundation of training for work that, for the most part, isn't there. The difference being, British society seems to be catching on to that.
And what was fascinating was that the only time the atmosphere in the conference got tense or heated was around the issue of the membership fee for BAcC. (Yeah, the only time things got uncomfortable had nothing to do with me, it was a miracle.) Because BAcC is self-regulating and voluntary, and they don't get any help from the government, their yearly membership fee is the equivalent of about $1,000 US. It's quite expensive to regulate yourself. When Nick Pahl, the executive director of BAcC, did his speech, in part he addressed BAcC's support of community and multibed acupuncture, and in part he was trying to encourage more people to join BAcC in addition to joining ACMAC. And just like in the US, there were a fair number of people in the audience who had joined the national association but were no longer members because they felt that their money wasn't well spent. And they were pretty cranky. We got to see the Brits become less polite.
I was sitting in the back of the room at that point with Skip and Cris, and some of our newfound ACMAC comrades were giving us whispered explanations of what was going on. They said some very interesting things. They said that BAcC had been promising, for years, that they were going to be able to give acupuncturists "one of the nice reserved parking spaces in the hospital parking lot" -- just like here, the establishment has been promising acupuncture jobs in hospitals, but just like here, they haven't been able to deliver on that promise. And in this case, the hospitals in question alreadyrecognize the usefulness of acupuncture, which means in theory the goal should be more achievable. So a lot of British acupuncturists are angry that these hospital parking spaces, and attendant paychecks, haven't materialized for them. And furthermore, BAcC recently spent the equivalent of about $100,000 US on a national PR campaign to promote acupuncture. But what the acupuncturists said was that all that PR didn't have any discernible impact on their actual businesses, so they're cranky with BAcC about that, too. The PR campaign didn't change the fact that acupuncture is a hobby, not a job, for an awful lot of British acupuncturists just as it is for an awful lot of American acupuncturists.
So that's fascinating, right? You can change all these variables -- you can take out the infighting and you can throw in socialized medicine that pays for acupuncture and you can add a well-funded national PR campaign -- and the economic reality for the practitioners still looks the same. It looks terrible. It looks so bad that it's starting to affect the availability of acupuncture education itself, which unfortunately is the only solid aspect of the whole house of cards.
As I said, the British acu-establishment in the form of BAcC is actually quite friendly to community acupuncture. Not only did Nick Pahl come to give a speech in which he reiterated that, he watched our documentary when it was screened during lunch. He stayed for my speech -- though he did make some jokes that weren't really jokes about being scared that I would be too radical. But he said several times that BAcC supports community acupuncture not just because of its ideals, but because of the economic hope that our model offers. BAcC would really like to get all of the ACMAC practitioners to join, not just because BAcC needs more members if it is ever going to be able to lower its membership fees, but because the ACMAC practitioners are, relatively speaking, doing a lot of acupuncture. I went to shake his hand when he was leaving and instead he grabbed me and kissed me on the cheek. He said he thought the work that we're doing with POCA is fabulous. Nobody in the acupuncture establishment in the US ever kisses me and tells me that the work POCA is doing is fabulous -- good Lord, not that I want them to. I told Nick that if his counterparts in the US were as nice as he is, I wouldn't be such a scary radical.
So it seemed pretty clear to me, by the time the executive director of BAcC kissed me, that acupuncture, as an independent profession in the West, is in serious trouble. That's one of the things I went to the UK, apparently, to learn. Acupuncture as an independent profession in the West isn't really like a Ming vase, because a Ming vase is generally recognized as valuable. And it isn't really like an orchid, because an orchid, even though it grows on air, at least, it grows. I remembered the Greek teacher in the bus station, and Nate saying that acupuncture is a means of communication and I thought, oh, I get it -- acupuncture as an independent profession in the West is like a dead language.
It's not an extinct language. An extinct language no longer has any speakers, or is no longer in current use for anything at all. A dead language, on the other hand, survives in a fossilized form; it gets used in formal, ceremonial, or academic contexts. I found two definitions of a dead language that made a lot of sense: it's “no longer spoken by anyone as their main language” according to the Cambridge dictionary; and it's “known and used in special contexts in written form, but no longer as ordinary spoken language for everyday communication”, according to Wikipedia.
A living language is one that is used by ordinary people to talk about ordinary things in ordinary ways. A dead language isn't. If you think of acupuncture as a means of communication, as a language, what we're looking at, with acupuncture as an independent profession in the West, is a language whose existence depends on this formalized, academic context. It depends on schools teaching it; it doesn't depend on people actually using it. Acupuncture as an independent profession in the West wouldn't exist, just like classical Greek wouldn't exist, if it weren't for the schools keeping it alive. Classical Greek isn't being used for anything, in the world outside of academia. People don't speak classical Greek to communicate about their lives in the present. It's an uncomfortably close analogy.
When we, the community acupuncture movement in the US, leapt from our pinnacle of dissatisfaction, a big part of what we were dissatisfied with was the way that acupuncture in the US was not connected to ordinary reality. We started out with the issue of price: acupuncture was taught and practiced in such a way that 80% of the population at least couldn't afford to use it in a way that it would really work. And when we challenged the acupuncture establishment on that, when we called that elitism, the response we commonly got back was, well, acupuncture practicehas to take so much time and cost so much because otherwise it won't adequately reflect acupuncture theory. Essentially, what we heard, and what we're still hearing, is that to the acupuncture profession, the academic theories matter more than the living reality of 80% of the population. It's not even about efficacy. We know that doing simple treatments, consistently and frequently, produces solid clinical results. People get better. A lot of the resistance among acupuncturists to the community acupuncture model is that what we do, what we do that works, does not reflect what they learned about acupuncture in an academic context.
Think about that with the metaphor of language. It would be like telling people, you can't communicate in a simple and straightforward way, out in the real world, even if everybody understands what you're saying, because it's too simple and too straightforward. If you're going to communicate, you can only write an essay that would earn you an "A" in school. That's how you have to communicate because that's the right way. It doesn't matter if everybody else doesn't communicate like that, an if everyone else clearly doesn't want to have conversations with you when you insist on only writing essays. You have to keep writing essays, no matter how isolated that makes you. Because the point is not really to connect with anyone, it's not really to communicate, it's to write the perfect essay.
It's interesting to be talking about the problems of acupuncture as an independent profession in the West here, in California. Because acupuncture wouldn't exist as an independent profession in the first place, in the US, were it not for the contributions of Miriam Lee in California in the 1970s. For anybody who doesn't know, Miriam Lee was largely responsible for the legalization of acupuncture, and the ability of acupuncturists to practice independently, in California -- and other states in the US that legalized acupuncture followed California's lead. If we had to name a single founder of the acupuncture profession in the US, it should be Miriam Lee.
For anyone who doesn't know her story, she was born in mainland China and was a nurse-midwife there as well as an acupuncturist. She immigrated to Singapore and eventually to the US, to California. Acupuncture wasn't legal here when she arrived, so that's where the story gets dramatic. She worked in a factory, and she only started practicing acupuncture when she encountered examples of suffering and illness in her neighbors that she knew she could do something about. There was so much demand for her work that she would treat 17 people an hour for 5 hours before going to work a shift on the factory assembly line. Eventually she was arrested for practicing medicine without a license, her patients packed the courtroom at her trial, the governor legalized acupuncture, and the rest is history.
Dr. Michael Smith, the founder of NADA, knew Miriam Lee, and he says a couple of very interesting things about her. One is that she didn't just happen to get arrested; she actually planned it pretty carefully. Once she understood how many people in the US could benefit from acupuncture, she located her practice in a place where she would be able to attract not only her coworkers from the factory, but some people with enough influence that they could pressure the authorities. She wasn't just minding her own business, she had a vision for a future profession.
The second thing he said about her was that she complained, at least to him, about the difficulty of attracting American students who were sincere about helping people and who would practice the way that she did. Everybody who hasn't read her book, Insights of a Senior Acupuncturist, please get a copy and read it as soon as you can. She probably forgot more about acupuncture theory than any of us could hope to know. And yet she designed her actual practice around a radical simplicity -- using the same 10 points over and over -- for the explicit purpose of being able to help as many patients as possible. In her book, she talks about the problems that she saw predominating in her American patients, and how she created a protocol that would work for the vast majority of them, the vast majority of the time. She needed to treat 17 patients an hour, and out of the vast reservoir of her theoretical knowledge, she created an efficient, effective, simple way to do it.
Miriam Lee passed away in 2009 and so unfortunately, we can't ask her what her vision was for acupuncture as an independent profession in the US. But from looking at her life and reading her book, I think it's a pretty safe assumption that she didn't envision acupuncture as a dead language. She didn't envision an elaborate academic education that left students a hundred thousand dollars in debt, and also struggling to help real people with real problems. I think it's probably safe to say that she didn't work as hard as she did, and take as many risks as she did, hoping for our current state of affairs. She also says very clearly in her book that you shouldn't be an acupuncturist if your goal is to make a lot of money; she maintained that you wouldn't get good results unless your motives were altruistic. I really hope she never heard about all the acupuncture practice management classes where students are encouraged to buy an expensive car so that patients will respect them.
Just like students of classical Greek learn how to write sentences about sacrifices and goddesses and kings sailing the wine-dark sea, things that exist only in memory and imagination, a lot of Western students of acupuncture learn to come up with treatments that are best suited to memory and imagination, not to the lives of ordinary people in the present day. I graduated from acupuncture school quite well-prepared to treat dysentery, phlegm misting the orifices of the Heart, and running piglet syndrome -- and to treat those things really well in a world in which neither money nor time was a limiting factor for patients. As far as I can tell, that's still true for acupuncture students today, and like me when I graduated, they are still for the most part unprepared to make acupuncture useful in the lives of ordinary people, right now. They are trying to speak a language that doesn't work outside an academic context, a language that is frozen in the realm of memory and imagination. And they're surprised when nobody understands them, when nobody wants to talk to them, when they're isolated and unable to connect. They're surprised when it's hard to make a living by speaking a dead language.
Now, don't get me wrong, I lovethe realms of memory and imagination. That's why I got a degree in classical Greek and another degree in acupuncture and oriental medicine. For a long time, I wanted to live in the realms of memory and imagination, because the real world was simultaneously boring and heartbreaking and terrifying. I wanted to escape into fantasy. Into history. I totally understand the impulse. But there are two major problems with that impulse, when it comes to acupuncture.
One problem is pain. The lives of ordinary people in the present day are full of pain, all different kinds of pain. Most of it is not romantic, not the pain of kings and goddesses. And as we know, acupuncture relieves pain. Even when it doesn't relieve it, it often gives people the ability to cope with it better. Acupuncture gives people hope and relief and strength in the face of pain. I would argue that the knowledge of how to relieve pain does not come free from the responsibility to use that knowledge to help people in pain. A dead language only exists in formal, ceremonial, academic contexts, but pain is not, unfortunately, similarly constrained. If you insist on being faithful to a dead language, you're going to miss the chance to help a lot of real, live people. I think fossilized languages are fascinating, but fossilized medicine? A medicine that is only functional in formal, ceremonial, academic contexts? In the midst of so many people in so much immediate pain? I loved reading ancient Greek, but I'd be hard pressed to say that I thought the majority of the rest of the world that couldn'tread it was really missing out on something that might make their lives better. Acupuncture's a different story.
So that's one problem with acupuncture as a fantasy; the other problem is training people for an occupation that mostly exists in imagination and memory, but charging them real, present-day money for it, in the form of dollars, in the form of student loans that will need to be repaid. It's hard to repay those loans on an imaginary salary. Nobody ever accused Sallie Mae of being romantic. It's no wonder that so many graduates of acupuncture schools turn right around, if they can, and get a job at their alma mater. That's the only place the formal, ceremonial, academic context translates into a paycheck.
This is why acupuncture as an independent profession in the West is in serious trouble: too many of us acupuncturists want nothing more than to escape from the messy, painful world that other people have to live in. Those other people that we could, potentially, help. And our main way of escaping, by making schools, by focusing on the learning of acupuncture rather than on the doing of acupuncture, is not economically sustainable. We're behaving nothing like Miriam Lee, who plunged into all the difficulty of trying to help real people in the real world, despite all the problems that she encountered.
Then there's the other aspect of the definition of a dead language: one that is no longer spoken by anyone as their primary language, their main language. In terms of acupuncture as an occupation, it's enlightening to notice how many "acupuncturists" would never dream of using acupuncture as their primary means of economic support, their main way of making a living. In so many practice management classes in acupuncture schools, what students hear is that if you want to be a success, you can't just do acupuncture. If you want to do acupuncture along with a whole bunch of other things, well, OK, especially if some of the other things are clever angles like affiliate programs on your website and maybe your own trademarked style of health coaching. And then there's the heated debate in the larger profession in the US about how to "brand" ourselves, and all the discussion about how it's not adequate to our vast education to call ourselves "just acupuncturists". Miriam Lee had no problem with describing herself as an acupuncturist. The title of her book is not Insights of a Senior Doctor of Chinese Medicine, though she arguably had more right to claim that title than all sorts of other people who currently want it. The person who is responsible for all of us having licenses was not ashamed to call herself an acupuncturist, but we are?
It's like our profession is no longer even trying to produce native speakers anymore. Our profession has accepted that the language is dead, that there won't be any more people who primarily identify as acupuncturists.
How many people in this room primarily identify as acupuncturists?
How many of us depend on doing acupuncture as our primary means of economic support, or are working toward that?
Right. We are the new native speakers of a language that is coming alive again, by means of our efforts to use it outside of the formal, ceremonial, academic context. Acupuncture as an independent profession is coming alive because we are using acupuncture to communicate with ordinary people about ordinary things. I would like to think that we are the heirs to Miriam Lee's intentions.
And, I hate to tell you guys, but because of that, we are also probably the best hope of acupuncture's survival as an independent profession in the West. No pressure! That's what I came back from the UK thinking about. That acupuncture as a profession in the West could end up not merely dead, but really extinct, if it keeps going the way it's been going, towards increasing economic unsustainability. The best case scenario is that acupuncture as a profession continues to be a dead language -- it continues on in this ceremonial, limited context when it could be so much more, for so many more people. We are the possibility for that trend towards the moribund to turn around. I wonder if other acupuncturists might be more comfortable with us if we called ourselves The Acupuncturist Conservation Society? Doesn't that sound -- safer? And that's a neat thing, that acupuncture can't be conserved by putting it in a museum. That's where it is now, essentially. Acupuncture can only really be conserved by being put to use, by ordinary people, for ordinary things, right now.
I didn't end up talking about Ming vases much in my ACMAC keynote. What I ended up talking about was how and why to use buckets, and specifically what I called the bucket brigade, by which I meant, our efforts within POCA to work as a collective. I rehashed my tungsten speech from last April a little bit; I said that acupuncture doesn't make sense in small quantities, in little individual bits, spaced far far apart. But the truth is, acupuncturists don't make sense in small quantities either; we don't make sense as separated individuals, spaced far far apart. We make sense primarily as a collective.
We've all learned by now, I think, how much better it feels to treat lots of people, and lots of different kinds of people, than it does to treat only a few people. We've learned how much fun it is to treat whole families, whole swaths of a neighborhood. The secret is out. As Michelle Faucher wrote in her excellent blog post, How to Succeed at CA Without Really Trying, "If, however, you can genuinely smile and welcome all comers to your clinic, you will find die-hard fans in the unlikeliest of places. Especially among the marginalized populations who don’t often receive respectful health care (think “people who have recently immigrated” and “people who are obese”), if you provide a space they can easily use as their own, they will send every last member of their circle in to see you – you’ll get the fiancée of the cousin of the co-worker of the client of the hairdresser. The webs of connection will be astonishing and delightful." We've learned that there's a whole dimension to our practice that is far beyond individual treatments and individual patients. What we are learning now, together, with POCA, is that there's a whole dimension to our movement that's beyond acupuncturists as individuals.
And that, I think, is what acupuncture needs not only to survive as a profession in the West but to be truly and uniquely useful to our society: the emergence of a collective. That's where acupuncture can come alive. We are coalescing into that collective around our experience of doing acupuncture with ordinary people for ordinary things. One of the results of the ACMAC conference was that a bunch of British acupuncturists got very excited about the idea of collective action, and unless I'm gravely mistaken, I think Charlie is going to have a lot more help from here on out with ACMAC. One of the things that wegot excited about was the idea of starting an actual POCA clinic in the UK. Since it's not regulated, any of us could go over there and work. We could each go for a month every year, take turns, doesn't that sound like fun?
What we noticed about the British acupuncturists, despite their different circumstances, was that they were pretty much struggling with the main thing that American acupuncturists struggle with, which is how to make sense of being an acupuncturist in the West, how to connect to real people with real needs. The ACMAC acupuncturists, like all of us POCA punks, basically want to connect. The charm of studying a fossilized medicine has worn off for many of them, the way it's worn off for many of us, and now they want to be part of something that's alive. They want to be engaged with people who need them; they want to be useful; they want to feel fulfilled in all the ways that memory and imagination can't give you, all the ways that only real life can provide.
Even though our trip to the UK happened essentially on impulse, and on the impulse that I didn't want to do a keynote speech at a computer screen, I feel like it was really important that we went. We went not just as individuals, but as representatives of all of you; it was about community acupuncture in the US meeting community acupuncture in the UK and realizing that we weren't all that different. It was a moment when the community acupuncture movement as a whole made a significant shift.
And a big part of the shift was the clarity that the individualistic way of thinking about acupuncture and about acupuncturists as a profession truly isn't going anywhere. It's not only a dead language, it's a dead end. Which is not that surprising, if you think how little the individualistic mode has to do with where we started from, where Miriam Lee was coming from when she launched acupuncture as a profession in the US. Even when you do the individualistic thing as kindly and collegially and with as many advantages as the Brits have done it, it has no future. Our only future is as a collective -- a collective that includes a lot of ordinary people.
There's no external power in Western society that is going to save acupuncture as an independent profession. No law, no insurance company, no national health service, no exclusion of other practitioners, no form of recognition that we can dream up, is going to save this for us. It's up to us. And it's a big job.
This makes me think of the old story about the three bricklayers. A long time ago, in the middle ages, a traveller wandered by a construction site. Everywhere there were people working. The traveller walked up to a man who was kneeling on the ground, slapping straw and mud together. He looked tired and sweaty and unhappy. The traveller asked, "What are you doing?" The man responded, "What does it look like I'm doing, you idiot? I'm making bricks. All day I make bricks. I hate it." The traveller walked on and found another man, also kneeling on the ground, also slapping straw and mud together, but he was humming to himself. "What are you doing?" the traveller asked. "Oh," said the man, "I have a large family, with many children, and making bricks is how I support them. I'm providing for the people I love." The traveller walked on until he came to a third man, likewise kneeling on the ground, combining handfuls of mud and straw, but with great care and concentration. "Excuse me," said the traveller, "what are youdoing?" The man looked up at him and his eyes shone. He said, "I'm building a cathedral."
There’s a poem by a UK poet, John Ormand, titled “Cathedral Builders”:
They climbed on sketchy ladders towards God,
with winch and pulley hoisted hewn rock into heaven,
inhabited the sky with hammers,
took up God's house to meet him,
and came down to their suppers
and small beer,
every night slept, lay with their smelly wives,
quarreled and cuffed the children,
lied, spat, sang, were happy, or unhappy,
and every day took to the ladders again,
impeded the rights of way of another summer's swallows,
grew greyer, shakier,
became less inclined to fix a neighbor's roof of a fine evening,
saw naves sprout arches, clerestories soar,
cursed the loud fancy glaziers for their luck,
somehow escaped the plague,
decided it was time to give it up,
to leave the spire to others,
stood in the crowd, well back from the vestments at the consecration,
envied the fat bishop his warm boots,
cocked a squint eye aloft,
and said, "I bloody did that."
So much of what we're doing, both within our clinics and within POCA, is hard work, day in and day out, so many tiny, grinding details that we really hope are adding up to something meaningful -- but sometimes we all wonder. So I'm here to tell you, the view you can see by looking at what we're doing from a long distance, the view from 35,000 feet up in an airplane over the Atlantic, the big picture perspective on our movement, is that we are making something dead come alive again. It might seem like we're just putting in needles, and taking out needles, and answering the phone, and answering emails (how on earth did there get to be so many emails?), and showing up at meetings, all the little things we do over and over to keep our clinics going and to keep POCA going -- and then we have to get up every morning and do them all again -- but I'm here to tell you, we're not just making those particular bricks. We're building something that I hope would have pleased Miriam Lee. We're saving acupuncture as a profession in the West. One day we'll be able to step back and say, "We bloody did that."
health care debate
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