Providence POCAfest 2015 Keynote: Collapse, Liberation, and the Power of Words
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Collapse, Liberation, and the Power of Words
As is our custom in POCA, I’d like to start by acknowledging that this is the traditional home of the Narragansett people, and that we’re visitors here.
It’s great to be back here at Camp Aldersgate in Providence. How many people attended the last POCAfest here two years ago? I love every POCAfest, but the one here made a huge impression on me, because I got to meet a whole bunch of patients from Providence Community Acupuncture. And at the end of the weekend I had a couple of insights: one was that the patients here in Providence were just like my patients back home in Nashville. They were funny, generous, thoughtful, passionate people – exactly the kind of people I love seeing at my clinic every day. The other thing that struck me was how excited they were about POCA. The patients I met here didn’t just love community acupuncture because it helped their knee pain or allergies or insomnia; they loved being involved in the movement. PCA patients were here with us, full participants in the weekend, leading breakout sessions, sharing their stories. And they taught me that our patients are so much more than just people we help in our clinics.
Providence POCAfest was, to me, the model of how patients are the heart and soul of POCA. And I’ll admit, before Providence, I hadn’t quite caught the vision of how patients could be involved in POCA or why they would even want to. But here, two years ago, I GOT IT. Of course patients want to be a part of POCA. Because what we do matters. Affordable acupuncture is our gateway to larger social change. POCA gives our patients the opportunity not just to heal themselves, but to heal the world around them. Who wouldn’t want to be a part of that?
The last time we were in Providence, POCA had about 800 patient members. Now, thanks to the recent membership drive, we have almost 1400 patient members. To me, that perfectly illustrates the theme for this POCAfest: Progress and Celebration. It’s so appropriate that we’re back here in Providence to celebrate our progress, because we’ve done so much since the last time we were here two years ago. Besides our steadily growing membership base, here are some examples:
· Two years ago when we were here, we started filming breakout sessions and brainstorming ideas for POCA Tv. Now we have over 100 videos on POCA Tv. We have a robust CEU program through the POCA Department of Education and a POCA punk membership includes 8 free CEUs per year. We are the only acupuncture organization that offers its members free CEUs.
· Our treatment numbers continue to climb. According to the POCA annual survey, in 2012 we provided 753,648 treatments; in 2013 we did 914,687 treatments, and in 2014: 1,009,621 affordable acupuncture treatments. That’s progress.
· And then there’s POCA Tech. Two years ago we were somewhere along the tortuous path to approval as a Private Career School by the Oregon Department of Education. Getting approved by the Oregon Department of Education was no small feat in and of itself, but guess what happens in a few weeks? The first cohort of POCA Tech students will complete their first year of studies. Do you know what that means? In two years, we get to start hiring POCA Tech graduates. Or support them as they open their own clinics. In two more years, a radically different generation of acupuncturists is going to enter the field, and after spending two days with these students back in April, I can tell you this: these future punks are going to do things we can’t even imagine right now. More on that later.
But community acupuncture doesn’t just benefit our patients and communities. I daresay it’s even good for the acupuncture profession. Did everyone read Lisa Rohleder’s recent blog post, “Welcome to Our World?” I’m going to repeat some of the statistics she cites because the numbers are simultaneously mind-blowing and sadly unsurprising. The National Institutes of Health recently published the results of a survey they conducted on utilization of complementary and alternative medicine, or CAM. I won’t go into the details of their research methodology, but the data is sound. They found that overall, utilization of CAM plateaued between 2002-2008. And in the case of acupuncture, utilization rates actually dropped significantly. The researchers estimated that in 2002, 6.4 million acupuncture treatments were given in the US. In 2008, that number was estimated to be 5.4 million. Yes, you heard that right. One million FEWER treatments given from 2002 to 2008. Looking at some other research, a 2012 survey by the National Center for Complementary and Integrative Health showed that utilization of almost all types of mind-body approaches to healthcare stagnated over the past five years. So given the data, we can estimate the total number of acupuncture treatments given in the US in 2014 was about 5.6 million. Everyone remember how many treatments POCA clinics provided in 2014? 1,009,621. So almost 20% of acupuncture treatments in the US in 2014 happened in secondhand recliners. Another way to look at it is this. I have said many times that if it weren’t for community acupuncture, I probably wouldn’t be practicing acupuncture at all. I would have left the profession, frustrated, depressed, in debt, and moved on to something I could at least make a living at. Anybody else relate to that? So of those 5.6 million treatments in 2014, over a million of them might not have happened at all without POCA. Recently I was talking with some comrades about how someday community acupuncture would be the norm and getting treated on a table in a private room would be the weird thing. It’s happening faster than we imagined.
So, acupuncture utilization is dropping, and yet, POCA is thriving. Why? Why have we been able to make so much progress when the rest of the profession is stalling out? For an explanation, I think we can look to anthropologist Joseph Tainter and his theories of social complexity and system collapse. In his 1988 work The Collapse of Complex Societies, Tainter examines how human societies become more complex as they try to solve problems, and while this initially provides a net benefit to society, eventually the benefits reach a point of diminishing returns. Ultimately, societies collapse under the weight of their own burdensome, expensive infrastructure. The institutions that societies create to solve problems ultimately become their own undoing. Simply put, Tainter says, “A society or other institution can be destroyed by the cost of sustaining itself.”
This has happened throughout history – take the Roman Empire for example. As their society grew, agricultural output couldn’t keep up with the demands of an increasing population, so the Romans’ solution was to conquer nearby territories and take over their resources. This worked great for a while. However, more territory created a need for more military and government bureaucracy, but there weren’t enough resources to support all those people and institutions. As the society grew more complex, it became more unstable, and we all know what happened to the Roman Empire – it didn’t end well.
Let’s think of the acupuncture profession in the West as a type of society. There were some initial problems early on that needed to be solved. We couldn’t have acupuncturists getting arrested all the time so we created laws, regulations and licensing. We needed to make sure that the people out there calling themselves “Acupuncturists” knew what they were doing and could safely use needles, so we made practice standards and a credentialing body. We needed a way to educate new practitioners so we opened schools. We needed to make sure those schools were teaching the right things so we made a way to accredit them. All of these institutions we created solved the initial problems, but they started costing more and more money to maintain. If more patients were utilizing acupuncture then we might have the resources to support the complex infrastructure we’ve constructed. But the data shows that more patients aren’t utilizing acupuncture. We can’t support our society. Collapse is imminent.
Joseph Tainter argues that in the case of complex societies, external factors like crop failures and foreign invasions might be the apparent cause of collapse, but the origin is an economic one, inherent in a society’s burdensome infrastructure. And in the case of the acupuncture profession, the root of our problems is not other healthcare providers stealing our medicine or patients not valuing their health enough. It’s a simple math problem. The numbers don’t add up. The acupuncture profession in the West is based on economics that don’t work.
But we’re POCA, and we’re different. POCA is thriving because instead of building expensive, complex structures to solve problems, we rely on creative thinking and cooperation. We live in a world where we have to do more with less. POCA and our clinics have always embraced this idea. We can’t just throw money at a problem, which is a good thing, because that usually doesn’t work. It didn’t work for the Roman Empire and it doesn’t work in healthcare either. If you want an example from our own profession, how about this: in 2004, the American Acupuncture Council (yes, the malpractice insurance company) announced a 10-year, $1 million sponsorship agreement in support of one of our professional organizations, the AAOM. The AAOM merged with the AOM Alliance in 2007 to form the AAAOM, and since the American Acupuncture Council mediated and paid for the merger, I think it’s safe to assume that the AAAOM inherited that $1 million sponsorship deal. So what have our wonderful acupuncture organizations done with all that money? They haven’t started a school, they haven’t doled out any free CEUs to their members, they haven’t ushered in the era of universal health insurance reimbursement or hospital jobs for acupuncturists. As far as I can tell, they haven’t done much of anything to directly benefit patients or practitioners. Meanwhile, look what POCA has done with a couple thousand individual memberships starting at $25 a year, and an incalculable amount of social capital.
This is the power of grassroots cooperation, and it’s helping to build our own internal insurance policy against system collapse. Coops do this naturally because they’re based on the concepts of shared resources, shared costs and benefits. We do the same thing every day in our clinics. We’re all in this together.
Since we’re talking about Progress this weekend, I have to talk about what’s next on the horizon for community acupuncture, because if you’ve been around POCA for any amount of time, you know that there is always a Big Thing around the next corner, something to lead us into our next stage of progress. Stagnant, we are not. So what’s the next Big Thing for POCA? It’s called Liberation Acupuncture. Some of you here may know a little bit about Liberation Acupuncture; some of you are intimately involved with it. But if you’re just hearing about it for the first time, don’t worry. I’ll explain more in a minute, but first let me ask a question.
How many people here are POCA Tech sustainers? If you’re not a POCA Tech sustainer, you need to become one as soon as I stop talking. You just need to pledge a small monthly donation, as little as $5 a month. It's really easy to do. Just go to the POCA website and you’ll quickly figure it out. There are two important reasons why you should become a POCA Tech sustainer: one of course is that you’re helping POCA Tech, and specifically you’re helping with accreditation. It’s an expensive process and ACAOM needs to see that the school has a strong financial foundation. The other reason to become a sustainer is that you get a monthly sustainers newsletter, which sometimes features funny videos or pictures of kittens, but always contains interesting stories about what’s happening at POCA Tech. And trust me, these stories are genuinely interesting.
So back in the fall one of our sustainers newsletters talked about a recent class discussion on the Causes of Disease. Everyone remember this from first-year acupuncture theory? There are three categories: the External Causes, the Internal Causes, and the Miscellaneous Causes. Most acupuncture schools tend to emphasize the first two categories, talking about wind and dampness and the emotions, and then spend about one hot minute discussing the miscellaneous causes. But here’s what happened last fall: where most acupuncture schools would end the lesson on Causes of Disease, that’s where things got interesting at POCA Tech. Everyone started talking more about the Miscellaneous Causes of disease, and about the fact that social and economic inequality are causes of disease, but you never see those factors listed in any TCM textbooks or discussed in any classrooms. But our clinics, every day, by their very nature, are battling inequality as a cause of disease. In that class discussion in November, POCA Tech began to evolve a new, socially relevant language for acupuncture in today’s society: Liberation Acupuncture.
So Liberation Acupuncture. What is it exactly? The way I think of it, and I know I’m going to sound like a car insurance commercial, is acupuncture theory for the modern world. It’s a school of thought like TCM or Five Elements, but here’s what’s different: Liberation Acupuncture is rooted in the world we inhabit right now. For the past decade, we community acupuncturists have been using other people’s theories and they don’t work very well for us. Our textbooks say nothing about social and economic inequality as causes of disease, but research proves that they are. It’s our job as practitioners to engage with our patients and with the world around us. And to do that, we need the right tools. Needles are one tool we use. Back in the days of the Nei Jing needles were made of stone or bone. Fortunately for us and our patients, needles have evolved since then. I’m very grateful to use finely tuned precision instruments in my clinic today instead of whittled down pieces of bone. And if theory is another tool, why shouldn’t our theory evolve along with our needles? We don’t use the same needles the practitioners of old did, so why should we have to use the same theories? We don’t. If manufacturers can engineer a better needle, we can construct a better worldview.
One of the basic tenets of any Liberation studies, whether it’s Liberation Theology, Psychology, or now Acupuncture, is what’s called a preferential option for poor. This means that we build our structures, our clinics and schools, not just to be accessible to marginalized people, but to invite them to be co-creators. People who are oppressed have the power to be their own liberators. Our patients are not passive consumers of healthcare; they’re active participants, not only in healing themselves but in subverting the profit-driven medical-industrial complex. This is what I witnessed so vividly at Providence POCAfest two years ago. Ignacio Martin-Baro, who is credited with being the founder of Liberation Psychology, said that theories should not define the problems to be explored, but that problems generate their own theories. Liberation Acupuncture as a theory is our response to the unjust world we inhabit. It’s our way of looking around, asking “Who’s not here?” and then inviting those who are excluded to join us. It will be the foundation for how we educate our future generations of punks. POCA Tech is the world’s first Liberation Acupuncture school.
Liberation, ultimately, requires cooperation. Liberation happens in communities. And we’re living in a time when connection seems to be easy but cooperation is rare. America has always been the land of the rugged individualist, so it’s not surprising that the entire structure of the acupuncture profession in this country, from how students are educated to how the medicine is administered, has emphasized the individual: the uniqueness of each student, each practitioner, each treatment, each patient. It seems like the formula that most of us were taught is something like this: perfect practitioner (one who KNOWS EVERYTHING and does SPECIAL THINGS) plus perfect treatment (the one with all the right points and the perfect customized herbal formula that the perfect practitioner writes him or herself and the perfect amount of cupping producing perfect red rings on a perfectly beautiful back) plus perfect patient (you know, the one who values her health enough to comply with all of your perfect instructions) equals success. Except that it doesn’t. Perfection is a myth.
So back in April I got to teach at POCA Tech. I knew it was going to be very different from my own acupuncture school experience; I knew that the students were already needling in year one. I knew that the topic of their very first module was social justice and not something like zang-fu theory. I knew that the students would all be sitting in recliners. But I had two big insights that I didn’t expect. First, POCA Tech students have no problem making mistakes. During needling practice, when I’d correct them on point location or technique, it was no big deal. One student inserted three needles in the general vicinity of what she thought was Kidney 6 and asked me which one was right. They have the freedom to be creative in their learning, and the process isn’t inhibited by the need to prove anything. The students weren’t trying to convince me or anyone else how smart and special they are, because no one expects them to become uniquely special perfect practitioners. And I don’t know about you, but this is pretty much the exact opposite of the vibe at my acupuncture school. This ties into my second insight, which is that POCA Tech students are being brought up to work cooperatively from the start. Do you remember when you first joined either POCA or CAN? Did it seem a little suspicious that people were willing to share SO MUCH information with you, and it seemed like they genuinely wanted you to succeed? It was so weird, right? It was weird to me. I was like these people do not behave AT ALL like any acupuncturists I’ve ever met. It took me a while to get used to the idea of acupuncturists getting along and, you know, helping one another. But for the POCA Tech students, this is just the way things are. They work in teams; they have group assignments; they learn collaboratively. And what’s so brilliant about this approach is that not only is it a more enjoyable and effective way to learn, it’s creating a generation of punks who will be inherently resilient, because they’ll have each other.
The Words We Speak
Last year at Twin Cities POCAfest I called for an end to the acupuncture Gilded Age. For too long, we’ve had to put up with increasing educational requirements, skyrocketing tuition costs, and prohibitive licensing regulations. For too long those in power seemed intent on putting up barriers rather than building bridges. If we continue along this path, our complex acupuncture society is going to collapse. I said it’s time for POCA to usher in the new Progressive Era, and we’re doing it.
Recently a group of AOM Leaders got together to talk about the State of the Profession. They do this every year, and this year the subject of acupuncture education inevitably came up. One of the attendees was Mark McKenzie, Director of ACAOM. And if, like I do, you get confused as to which alphabet organization does what, ACAOM is the organization that accredits acupuncture schools. Mark McKenzie, being the ACAOM Director, probably knows more than anybody what’s happening in the world of acupuncture education. So at this meeting, Mark McKenzie speculated that the new federal Gainful Employment Guidelines scheduled to go into effect on July 1st (that’s in two weeks) could have a profound impact on acupuncture schools, even suggesting that “as many as half the schools could be closed in three years.” Let that sink in for a minute. By the time POCA Tech students start getting licensed, half of the acupuncture schools could be gone. This is on the heels of a recent watch list released by the US Department of Education that identified four acupuncture schools on alert for cash management problems. And in the past few months three acupuncture schools have announced that they’re merging with larger regional institutions. Acupuncture education as we know it is ending.
We started POCA Tech because we needed to hire qualified graduates for our clinics, and we wanted a way for practitioners to enter the field without crushing debt. Now, we realize, POCA Tech grads may soon be one of our only options. As the years go by, more and more acupuncture treatments in this country are going to happen at community clinics, and more and more, POCA Tech graduates will be the ones providing those treatments. They’re not just the future of community acupuncture. They’re the future of acupuncture. Period. So POCA Tech students, if you’re listening, I just want to say…NO PRESSURE. But without you we’re doomed.
So yes, it seems that the acupuncture Gilded Age is indeed coming to an end, and that got me thinking about the power of the words we speak. Words breathe life into the world we want to create. Think about it. Think about some of the feats POCA has been able to accomplish, that all started with the simple words, “Wouldn’t it be great if….”
Here are just a few things I thought of, a couple I mentioned earlier:
· 1 million treatments in a year
· Our own CEU program – we have so many CEUs available through POCA Tv and POCAfests that the next time I have to renew my NCCAOM certification, I’ll be doing it with all POCA CEUs.
· Jobs for acupuncturists: full-time, living wage, stable jobs with benefits as employees. This is now the standard. So many clinics do it that there’s not even a question if it’s possible.
· A patient-centered acupuncture org – patients make up the majority of POCA’s membership; there are more patient members than acupuncturist, organization and clinic members combined; patients serve on the POCA board, organize membership drives, teach CEU’s, help put on POCAfests, and participate in leadership circles.
· A microloan program. To date POCA has given out 6 microloans for a total of $40,000. And it’s a self-sustaining program. As long as the loans get paid off (and trust me, the finance circle will MAKE SURE they get paid off), we’ll always have a source of funding for more loans.
· A pathway to student loan debt forgiveness. There was a time when we didn’t think it was possible, but now community clinics are becoming non-profit organizations.
These things didn’t just happen. We spoke them into being. Our words have power.
So I’d like to invite everyone here to participate in speaking into being our next stage of progress. What do YOU want to see happen for POCA? Dream big! Look at what we’ve already accomplished; there’s really no limit to what we are capable of. Talk about it with your peers throughout the weekend. And write it down. We’ll have big sheets of newsprint in here all weekend where you can share your ideas. When we come back together at the end of the weekend, we’ll read everyone’s ideas aloud. We will speak these things into being.
And because POCAfest is a time to celebrate, I also want us to share what we are celebrating. It’s important to do that, to celebrate together, to recognize our accomplishments and say to one another, “Hey, good job.” So while you’re writing down your ideas for POCA’s next stage of progress, be sure to write down what you’re celebrating too. We’ll also read these aloud at the end of the weekend.
I’d like to leave you with a story about cooperation and the power of words. In 1948, a group of African-American families on John’s Island in South Carolina started a cooperative called the Progressive Club. They started the club after an island local, Sammy Grant, was shot for kicking a white man’s dog while defending himself from an attack, and the families pooled their money to help with Grant’s legal expenses. The Progressive Club eventually developed into both a consumer co-op and a mutual aid society.
Every member of the Progressive Club had to be a registered voter. One of the co-op’s co-founders, Esau Jenkins, ran a bus service that transported students and workers from the island to downtown Charleston, and one day in the 1950s, one of his passengers, a woman named Alice Wine told Jenkins that she wanted to join the Progressive Club, but she couldn’t register to vote because she couldn’t pass the literacy test that South Carolina required of blacks at the time. She told Jenkins she’d like to be able to hold her head up high like other people, and be able to vote. She said him “Esau, if you’ll help me a little when you have the time, I’d be glad to learn the laws and get qualified to vote. If I do, I promise you I’ll register and I’ll vote.”
Jenkins heard her plea, so he started copying the laws and handing them out to his passengers, teaching people to read and write on their daily commute while he drove the bus. His bus service became a rolling literacy school. Jenkins wanted to expand his literacy efforts to more disenfranchised blacks on the islands of South Carolina, so with the help of one of his former teachers, Septima Clark, he started the Citizenship School at the Progressive Club in 1957. By that time the Progressive Club had grown to over 400 members, and they didn’t have enough space. None of the local schools, churches or organizations would rent to them, so with the help of the Highlander Center in Tennessee, they bought land on John’s Island and built a new retail shop, meeting space, dormitory and basketball court. Alice Wine, Jenkins’ original student, worked as a cashier in the shop for many years. And she did register to vote. Throughout the 1960’s civil rights leaders came from all over to attend the Progressive Club’s workshops on voting and desegregation. The Southern Christian Leadership Conference spread the Citizenship School’s program throughout the South, bringing in other groups that eventually formed the Voter Education Project (VEP). Between 1962 and 1966, the VEP registered 700,000 black voters throughout the South, and by 1970, another million black voters had registered. This small cooperative on a remote island in the segregated South changed the course of history, and it all started with one woman on a bus, simply expressing her desire to vote.
We need the power of our words. There’s a lot we’re fighting against. Dr. Larry Churchill, professor of medical ethics at Vanderbilt University in Nashville, recently had this to say about our healthcare system. He said, “The current medical care system is not designed to meet the health needs of the population…It is designed to meet the needs of the people in power.” So let’s liberate acupuncture from those who hold all the power, and give it to the people in need. Let’s speak this new reality into being.
breaking the ceiling
code of ethics
job task analysis
laws and regulations
locate a clinic
put up or shut up
running a business
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- lumiel commented on the blog post 'On Locate-A-Clinic Changes, Circles, and POCA' in the blog 'Prick Prod and Provoke Blog' - Friday, March 24, 2017