Canference 2 Keynote: Occupy, Resist, Produce

This is a unique time; the community
acupuncture movement is in the process of shifting its foundation
from CAN to POCA, from a 501c6 nonprofit to a cooperative. There’s
change happening at every level. We’re only about five years old as
an organization, and yet we’ve done a total overhaul already.

In the interests of exploring that
change, I’d like to spend some time talking about producers and
consumers.

(This controversial keynote speech is
dedicated to Macey Webb, John Weeks, and Victor Kumar. And they will
know why.)

In May 2010, some of us from WCA took a
field trip and drove up I 5 to visit the Northwest Cooperative
Development Center in Olympia to talk to the experts about
cooperatives.

They had all these brochures about
setting up co-ops published by the US Dept of Agriculture and they
gave them to us. The covers of the brochures all had illustrations of
things like combines and tractors. I remember taking them and feeling
kind of reverent. I thought, see, that’s how you know things have
gotten serious – when farm machinery is involved.

You can convey a lot with an image,
even when it’s just a line drawing of a tractor on a brochure. As you
all know, I’m sort of obsessed with the images that the acupuncture
profession uses to represent itself, so I’m going to talk about those
for a while. I promise, I swear, this is not just egregious snark,
I’m going somewhere with this — producers and consumers.

I’ve noticed, in looking at acupuncture
websites, there is often a kind of template for how the
acupuncturists describe themselves. In the “about us” section.
For example.

“While seeking her own path, Jane Doe
L.Ac discovered the ancient art of Chinese medicine. She has traveled
many times to Asia to study in various programs and found that these
experiences greatly enriched her practice and her life. She is
fascinated by energy work, qi gong, and the healing power of nature.
She enjoys gardening, hiking, long walks on the beach, spending
quality time with her family and friends, and quietly contemplating
the beauty of the natural world. She also devotes a great deal of
time to her yoga and meditation practices. She embraces acupuncture
as one of many paths to a rich and balanced life.” Especially
for herself.

Seriously, is that what you would put
on a resume? From the perspective of normal people – which is to
say, not acupuncturists – what does any of this actually have to do
with work? And don’t get me started on the photos that usually
accompany these bios. Like the text, they are often more suited to a
dating website than a business. But there’s a reason for this.

If the acupuncture profession had to
make the kind of brochures that the Dept of Agriculture does,
instead of pictures of tractors, we would probably end up with lovely
illustrations of reclining acupuncturists, gazing at the moon. Not
doing acupuncture — just quietly contemplating its beauty and
complexity. Dreaming about our lifestyles.

Because one of our big problems is that
we acupuncturists are not producers, we are consumers.

Skip actually brought this up quite a
while back, when we were talking about the issue of renting spaces
for clinics. 10 years ago, when we found our big, cheap, ugly space,
there were no other acupuncturists in our particular neighborhood in
Portland – and if there had been, they would not have touched that
building with a 10 foot pole. 10 years later, there are still no
other acupuncturists in our particular neighborhood in Portland,
although there are over 800 licensed acupuncturists in the Portland
metro area. We have noticed that they tend to concentrate themselves
in a few trendy, pretty areas – which of course does not and never
will describe where we live. This kind of issue can also come up with
community acupuncturists when they are looking for space: they often
go for something too small and too expensive. Instead of looking for
the biggest, cheapest space that they can find – something they
could grow into over time, something that would allow them to reach
the most underserved people – they gravitate towards what they
think of as a desirable location. Which often means a place that
someone else has already made desirable, and of course pretty. They
are approaching the issue of finding space from the perspective of a
consumer, not of a producer.

I’ve written about this before in a few
different blog posts, and we’ve all talked about it periodically, but
I think at this point in our collective evolution, it’s really worth
digging into – there are two main business models within
acupuncture, and I’m not talking about the community model and the
conventional model. I’m talking about the business of acupuncture,
and the business of acupuncture education. Most of what we call “the
acupuncture profession” is really just an aspect of the business of
acupuncture education. A lot of us think that being an acupuncturist
means being a very serious, very committed consumer of acupuncture
education. It’s not really about doing it, it’s about endlessly
learning to do it, to the point that you don’t know when you can stop
learning and just get down to business with what you’ve got.

Often this looks like being a consumer
of knowledge: going to seminars and workshops and classes, maybe even
going back to school to get a DAOM degree. Because we never question
that consuming more knowledge makes us better practitioners, right?
I’m not saying learning new things is bad. I am saying that there is
a noticeable emphasis among acupuncturists, and it’s very
uncritical, on the process of consuming and absorbing knowledge, and
a very noticeable lack of emphasis on using whatever knowledge we
have to help real live people. We tend to be passive rather than
active. And like the template that you see in so many acupuncturists
website bios, it’s all about us and what we consume, the fascination
of Chinese medicine and the fascinating lives we have, not on the
results we can produce – such as relief from pain — for people who
need those results.

One of the challenges you often hear to
the community acupuncture model is that it doesn’t allow for patient
education. When you treat 6 or 8 people an hour, how can you talk to
them about how acupuncture works? You can’t, of course; you don’t
have time. You do have time, and you can listen to them tell
you about how acupuncture works for their lives and their
bodies, and I’ll get to why that’s important a little later. But you
can’t give them lectures about the seasons and the elements and
damp-producing foods. When I first started talking and writing about
the model, that particular criticism was one that I heard all the
time, and especially as a reason that there was no market for
community acupuncture. People seek out alternative medicine, I heard,
because they are drawn to learning about holistic concepts.
They don’t just want to experience acupuncture in silence and draw
their own conclusions – that’s ridiculous! – they want to hear
their acupuncturist talk about it. I think there are some very
interesting assumptions in there about who is coming to acupuncture
and what they are coming for, and whether they have the luxury of
learning an entirely new paradigm about how the universe works in the
midst of also being in pain, but that’s all I’ll say about that for
now.

There really are a lot of elements in
the acupuncture profession that resemble multi-level marketing, and
this idea of patient education is one of them. Many of us became
acupuncturists because we were fascinated with the concepts of
Chinese medicine, and we paid a lot of money to listen to people talk
about them. Now it’s our turn, and so we go looking for people who
will pay us to talk about those concepts, and we call that having a
practice, and we like to think that we are in business for ourselves.
But like all multi-level marketing schemes, the only people who truly
benefit from this arrangement are the ones at the top of the pyramid;
in the end, it’s all their business, and we are still just
the consumers, even if we have managed to create another level of
consumers under us. The acupuncture schools are at the top of the
pyramid, and everything else supports them.

You know what’s interesting about this,
is that acupuncture itself is poorly suited to this kind of multi
level marketing, and poorly suited to a consumer mentality, period.
And that of course is what I love about it, what a lot of us love
about it. Essentially, it’s so simple: needles and cotton balls and
stillness. It’s so powerful, and when it works, you don’t really know
why. There’s nothing flashy that you can grab and show off to the
world; there’s really nothing that you can sell. There’s just a
person sitting quietly with needles and finding relief from pain or
stress or tension. There’s not much there that you as a practitioner
can claim – not if you’re really honest – because the source of
the power is inside the patient. The experience of healing belongs to
them. How terribly inconvenient for capitalism.

It’s been 20 years exactly since I
started acupuncture school, and during that time, I’ve met an awful
lot of acupuncturists who didn’t really believe in acupuncture. And I
think this is why. I’ve met even more acupuncture educators and
acupuncture practice management gurus who didn’t believe in
acupuncture. I’ve heard over and over, if you want to be successful,
you can’t just do acupuncture. You have to give patients herbs. You
have to give them counseling. You have to sell them supplements and
scented candles. You can’t make a living just doing acupuncture. The
irony here of course is that successful acupuncturists who make a lot
of money selling supplements and scented candles and doing lifestyle
counseling didn’t really need to go to acupuncture school. They could
have skipped the whole thing and just gotten a really good inventory
of supplements and scented candles.

I’m going to propose, that if you do a
lot of acupuncture, or even if you get a lot of acupuncture – and
if it’s just acupuncture, not a kitchen sink full of dietary theory
and scented candles and balance balls – it will actually ruin your
ability to be a good consumer. It might even knock you right out of
the pyramid. Because it will give you so much direct experience of
healing itself, which can’t be bought or sold.

A lot of patients describe how they
feel when they get acupuncture as being centered. Feeling
like themselves again. Even getting their lives back. This
is actually the opposite of being a consumer. When you’re a consumer,
you’re reaching for something outside yourself. There is almost
always something off balance, even desperate about it. Acupuncture
cures that kind of imbalance. It allows you to drink from your own
wellsprings. It allows you to be nurtured by your own energy.

And that makes our jobs as
acupuncturists into something that is, ideally, simultaneously very
humble and very sacred; very simple and very respectful. We do a lot
of standing back and getting out of the way while people heal
themselves. That position is not conducive either to being a consumer
of acupuncture education, or to creating other consumers. We’re not
interested in showing off all the knowledge we have that patients
don’t have, in hopes of trying to sell it to them. We’re interested
in letting people discover their own experience of acupuncture, which
is often the same thing as helping them have a deeper experience of
themselves. Not of acupuncture theory; of themselves.

A lot of us went to acupuncture school
because we bought, without knowing it, a fantasy. A fantasy about
being a healer – and I know that the version I paid for did not
involve images of me getting out of the way while my patients did all
the really important stuff themselves. There are several school
websites that suggest that being an acupuncturist, professionally, is
about being an agent of transformation. They’re sort of hazy about
what that actually looks like; you wouldn’t necessarily assume that
it looks like shutting up and getting out of the way. A lot of us
bought a fantasy about the kind of life we would have as an
acupuncturist; we would have a great work-life balance, for
instance. When we weren’t being agents of transformation, we’d have
lots of time for walks on the beach. Unfortunately we didn’t realize
that we might have more time than we really wanted for walks on the
beach because we wouldn’t actually be working or making a living by
doing acupuncture. We didn’t realize that we were approaching
acupuncture as if it were a kind of decoration, a kind of lifestyle
accoutrement, rather than a genuinely demanding vocation. Getting out
of the way, over and over and over, for lots of different kinds of
people, demands discipline and patience and a certain kind of
selflessness. It’s work. It’s not a pleasant fantasy about a personal
lifestyle – it’s work.

The truth is, healing doesn’t look like
much, and being a healer isn’t glamorous. It’s lots of things, but
glamorous isn’t one of them. I think those of us who really get into
being acupuncturists, who treat lots of people over the long haul, do
it because we know that it benefits us to cultivate that kind
of discipline and patience and selflessness. It makes us better
people, and we need to be better people. We stay in this job because
we’re the ones who need to be transformed. We are aware that
consuming pleasant fantasies – or even consuming fascinating
knowledge – isn’t going to do it for us. To be transformed, we need
to do something. In fact, we need to do something over and
over, and we need to do it for other people. We need to be useful. We
need to work.

I’m going to stick with what I said
earlier – you know things are serious when there’s farm machinery
involved. Our version of those drawings of tractors is Circle
Community Acupuncture’s line drawing of a recliner, which I am proud
to see on the cover of our documentary. Recliners are our tools, and
as such, they have beauty and dignity. (j/k) Becoming a producer
gives you some dignity that being a consumer doesn’t. Being a
producer means being continually creative, and continually useful.
It’s hard, but it’s hard in a good way; ask any farmer. Being a
consumer can be fun for short bursts, but if you’re committed to it
as a lifestyle, it’s pretty depressing. It’s particularly depressing
if what you’re consuming is a fantasy; an artificial dream that
someone else dreamed for you; a dream that was constructed for the
purpose of making someone else some money. It takes energy and
initiative to dream your own dreams, especially the kind that you can
turn into reality by working on them. Being a consumer involves less
effort, and plenty of other people will facilitate it for you. Being
a producer takes some courage.

In 2001, the economy in Argentina
basically collapsed. Many businesses went bankrupt or were shut down
because they were no longer profitable, leaving their workers without
jobs and without a means of supporting their families. And then
something very interesting happened. They call it “the movement of
recovered companies”. Workers formed cooperatives and took over
the abandoned factories in a desperate attempt to keep their jobs.
And it worked. Apparently it’s still working. There are hundreds of
factories that were abandoned by their owners that are now engaged in
production again as cooperatives, and are self-managed by their
workers. The slogan of the recovered companies movement was, “Occupy,
Resist, Produce.”

One of the most common questions I get
from people outside of the community acupuncture movement – and
occasionally from people within it – is, “So where do you see
this thing going?” They want to know if I expect that acupuncture
schools will begin to teach community acupuncture, if I expect that
more insurance companies will pay for acupuncture, if Western
medicine will embrace us, if Walmart will set up community
acupuncture clinics in its stores. (That particular Zang Fool blog is
still hitting some nerves.) And often I don’t know what to say. In
part that’s because I can’t see the future any better than anybody
else, and in part it’s because it’s really challenging, even if you
spend a lot of time on it as I do, to fully get your head around the
economic state of the acupuncture profession. But I keep trying, and
I’d like to share my latest best guess.

My latest best guess is that we should
think hard about that slogan from the recovered companies movement,
maybe try it out for POCA. Occupy, resist, produce.

Awhile back, a very senior practitioner
who is also a public figure in the acupuncture world wrote a blog
post in which he wondered whether acupuncture would survive as a
profession in America beyond this generation. He didn’t give a lot of
details, but he was alluding to the situation that everyone knows but
most people don’t want to talk about, which is the simultaneously
high failure rate of acupuncturists and the skyrocketing tuition at
acupuncture schools. Basically, it looks like not only the
acupuncture profession, but the acupuncture education profession
itself, is unsustainable. Right now, we are most likely experiencing
a bubble. An acupuncture education bubble, in which tuition keeps
expanding, and at least for some schools, enrollment expands as well.
It expands and expands and expands. Right up until the moment that
it pops.

What do you think will happen when the
acupuncture education bubble pops? A major reason that we seem to
have an acupuncture profession at all is that we have an acupuncture
education profession. Acupuncturists graduate and go out of business
in rapid succession, state acupuncture associations flounder and
languish, the AAAOM is having serious budget issues; but the schools
are still around, and of course the ACAOM and the NCCAOM, which are
really just extensions, economically, of the schools. The acupuncture
establishment, as we like to call it around here, is essentially all
about the schools.

I hate to be cynical, but sometimes
from my perspective it looks like we have things like licensing laws
and independent practice acts and state acupuncture associations only
as window dressing for the real product, which is schooling. Most
acupuncturists aren’t producing anything, although we like to think
that we are; we are really just the consumers in this scenario. And I
hate to suggest that the people involved in the acupuncture
establishment are anything less than scrupulous, but don’t you think
it’s odd that they are not worried about the failure rates in the
profession? Don’t you think it’s strange that we – this community
— have emerged as a kind of collective professional gadfly, that we
are always the ones bringing up the issue of sustainability? What do
you think the odds are that the people in the acu-establishment, like
the owners of the factories in Argentina, are going to abandon the
whole mess when it is no longer convenient and profitable for them?

I want to propose to you that there’s a
lot of overlap between our situation and the situation that sparked
the recovered companies movement. In the case of the factory workers
in Argentina, some things were a little more obvious: they had jobs
and were getting paid, and then one day they weren’t getting paid,
they still had jobs but were owed back pay, and then the next day,
the factory where they worked was shut down, and they didn’t have
jobs at all anymore. Most of us in this room never had jobs in the
first place unless we created them for ourselves. But we did think
that we had a profession. We went to the schools, and we sat for the
tests, and we applied for the licenses, and we thought we had a
profession. But from where we stand right now, we can see the
hollowness of what we thought, at one time, was solid. Our profession
doesn’t have a padlock on the outside, like the factories in
Argentina, it doesn’t have a sign that says, “closed for business”
but if we look carefully we can see how it could empty itself out. We
can see how, when it ceases to be a vehicle for extracting money from
unsuspecting students, it could just collapse altogether.

I have been thinking a lot about the
Occupy Wall Street movement, and it’s so encouraging, and I’m almost
afraid to get my hopes up about it. But regardless of where that all
goes, I think we need to think about what we occupy and how we occupy
it. There are other places besides Wall Street that need to be
occupied. Such as, our own creativity. That is one of the things you
give up when you acquiesce to being just a consumer. You give up
being able to create your world, and you settle for buying someone
else’s version. You give up your power and your imagination and your
love, in return for a certain kind of validation and safety, maybe a
certain kind of anesthesia. But when you’re a producer, you need all
of your power, all of your imagination, all of your love, because you
are responsible for the process of creating. When you are a producer,
you have to occupy your own creativity. You have to hold your own
center. And that’s where your dignity comes from.

The factory workers in Argentina
demanded the right to be producers. They occupied the means of
production, and they resisted any force that tried to take that away
from them. What can we learn from them? The hollow shell that is our
profession actually has tremendous potential. The parts of it that
don’t have any value for anyone else have value for us. This is our
chance.

It has been hard for the acupuncture
profession to define itself or to brand itself because, as I
mentioned earlier, it’s hard to sell acupuncture. The other day one
of my patients was telling me about how she had learned about
community acupuncture. A group of her friends was talking about
acupuncture, they had all had it, and one of them was describing
community acupuncture. One of her other friends said he would never
want to be in a room with other people getting treated. My patient
was laughing and saying that she wishes she could tell him that the
thing about community acupuncture is that it’s not like being in a
room with other people, because actually, you’re not there yourself.
I thought that was funny, but it’s also a good description of one of
the paradoxes of an acupuncture treatment: it both returns you to
your center, but it’s also this incredibly charged, empty space. That
charged empty space is what we have all been building our clinics and
our clinic communities around, and it works great for that. But a
charged empty space is not the easiest thing to market.

So what has happened, in the process of
branding, is that acupuncture has been used as a kind of decorative
adjunct to things that are more familiar, like the education
industry, or the beauty industry. There’s a lot of weird, problematic
overlap between the beauty industry and the so-called alternative
medicine industry in general, and the overlap happens because of how
the money flows. But it’s no good when you start confusing health
with beauty, or health with knowledge.

One of the things that happens to you
as a community acupuncturist is that you end up spending a lot of
time with people who are in very challenging circumstances, both with
respect to their health and respect to everything else. Many of our
patients with chronic conditions end up having to redefine what
health is for themselves, and that definition is not something that
is going to reconcile with the beauty industry’s definition or the
education industry’s definition. The World Health Organization
defines health as physical, mental and social wellbeing – and
wellbeing can look a lot of different ways for a lot of different
people. Health isn’t about a number on a blood test or a number on a
scale; it isn’t about what you look like or whether you can meet
somebody else’s standards of physical or mental prowess. I would say,
watching a lot of very brave, very gracious patients, that health is
basically about your ability to love, to be connected to the people
and the things that you want to be connected to, to live your own
life in a way that is satisfying to you.

One of the main things people get out
of acupuncture is a sense of wellbeing – we hear that all the time,
and we hear it from people in all kinds of circumstances, including
people who are dying. One of the things I love about POCA is that it
includes patients, and that reflects the reality that patients are
the ones who produce and create their own health. They not passive
consumers, they are active producers, and they produce a marvelous
diversity of wellbeing. That’s why it’s such a great thing to listen
to them describe what acupuncture does for them – because the
answers are all different just like their lives are all different.
When we listen to their answers, we affirm their creativity. Since we
don’t know how acupuncture works, we affirm the mystery.

I’m going to go out on a limb here and
suggest that acupuncture is never going to be a big commercial
success in the way that a lot of people hoped. They hoped, and so
they tried to make it part of the beauty industry, and they tried to
make it part of the education industry. I’m going to suggest that the
purpose of acupuncture is not to make money, it’s to make people
well, however they define well. And so, to the people who have been
using it as a decorative adjunct to the beauty industry and to the
education industry, I’d like to suggest that it’s not going to work
for you in that way. And so would you please stop waving it around as
a marketing gimmick, because we would like to actually use it.

If we are going to use it, we need to
occupy, resist, and produce.

We need to occupy our own profession.

We’re going to spend a lot more time
this morning talking about the details of what that means. Don’t
worry, it doesn’t mean that we have to do a sit-in at the ACAOM
offices. That might be interesting, of course, but it’s not the
point. The point is that we need to look at the business of
acupuncture and make it belong to us, and to our patients. We need to
look at all of the structures that make the profession what it is and
figure out how we can use them to make acupuncture genuinely
accessible to people of ordinary incomes – and if we can’t figure
out how to do that, we need to figure out how to build our own
structures. A cooperative makes that possible.

We need to resist consumerism. This can
be harder than it sounds, because consumerism is often like a trance.
You don’t always realize when you’re walking around entranced, as
most acupuncturists are. Waking up is an ongoing process. I think we
need to understand that we have been conditioned to be consumers, and
that our default setting in how we approach most things is as
consumers. Our default setting is passive rather than active,
uncreative rather than creative; it takes some effort to shift that.

A lot of us find this out in our
practices when we realize how active, creative and engaged we need to
be in order to be successful; it’s a shock. On some level we all
thought that if we did what we were told to do, if we just hung up a
shingle in the right place, patients would walk through our doors. We
thought we could consume our practices rather than create them, and
it’s a painful wake-up call to find out it doesn’t work that way. You
have to give all of yourself, and you have to do that first;
you can’t wait to commit until you’re sure that it’s safe and
patients will love you. You have to love first.

This also applies to POCA. Ask not what
your co-op can do for you; ask what you can do for your co-op. A
cooperative is pretty much the antithesis of consumerism. But plenty
of co-ops have failed because their members have approached them with
a consumer mentality, waiting for the co-op to give them what they
want before they put anything of themselves into the co-op. I really
believe that POCA has the potential to utterly transform our
profession and to create a kind of collective security for all of us.
Paradoxically of course, that isn’t going to happen unless we
collectively take the risk of investing ourselves and our resources
first. If we hang back until we’re sure it’s safe, nothing good is
going to happen here.

The recovered companies movement has
been going on for a decade now, but it’s not that easy to find
English-language updates. I did find one translation of an Argentine
research study from 2009 that said, looking at how the recovered
companies were doing, a lot of them struggled with self-management.
It’s hard having that much responsibility, and it’s hard to work
together. Some of the self-managed companies struggled even more
because the people who had marketable skills often left to work
somewhere easier, somewhere they could just get a paycheck and sit
back. And sometimes these were the people who had the management
skills or the technical skills, which meant the co-ops were left
without those things. The people who stayed in the recovered
companies, in the self-managing co-ops, were generally the ones who
had nowhere else to go. Who had no other way to make a living. And so
they had to make their co-ops work.

I think that will be true of us.
Community acupuncture is enormously demanding, all by itself. To
build a new economic foundation for it by means of a cooperative is
only for those of us who have nowhere else to go. Or who don’t want
to go anywhere else. It’s for those of us who are desperate, or
desperately in love with it and with our patients.

The primary thing that we need to
produce, with POCA, is a new society for ourselves. Consumerism is
isolating, and conventional acupuncture culture is especially
isolating. One of the purposes of POCA is to give us a structure to
really relate to each other – both socially and economically. But
it’s not there for us just to walk into; we need to build it.

Everything you’ll hear this weekend is
basically about how to be better producers within the context of a
clinic – how to produce better clinical outcomes, how to produce
more treatments by being more efficient in different ways, how to
produce opportunities for patients to volunteer for the movement. And
there are a lot of details involved, there’s a lot to take in. But I
hope as you move through all the break out sessions and the
presentations, you’ll keep the big picture in the back of your mind.
Our profession, the acupuncture profession, is basically standing
empty and idle. It’s not doing what it could be doing for society,
it’s not doing what people need it to do, whether they are patients
and practitioners. We can change that. We need to change that. We
need to occupy, resist, produce.

Author: lisafer