A guest post from Caroline Picker of Providence Community Acupuncture
Dear Prospective Acupuncture Student–
So you want to be a community acupuncturist. That's great! In this time of mounting violence, destruction of any minimal social safety net that previously existed, and ongoing crisis in many communities, we need as many people as possible prepared to offer low cost effective healthcare that also supports coping with the impacts of trauma and stress.
I’m a little over two months into working at a community clinic and I have to say, this work is pretty damn amazing. I connect with people about what ails them, how they are doing amidst the shields and masks that capitalism, white supremacy, and patriarchy require of us in daily living, and then offer them a concrete tool to alleviate some small part of that pain and suffering. And then they nap. In a room with strangers who are also napping. It’s weird and fabulous all at the same time, and really, not like anything else I’ve ever experienced.
Before I went to acupuncture school, I was very clear on my vision of why I wanted to be an acupuncturist. I've worked in public health clinics and social justice movement organizations my entire adult life, and decided to pursue training in acupuncture because I think helping people feel better and cope with pain and trauma is a small but necessary part of the liberation and healing we need collectively.
Obviously I needed more than vision to do this work: that’s why I went to school, to get the skills I needed. But I attended a conventional acupuncture school and that largely didn’t happen. Much has been written about the economics of attending conventional acupuncture school, and the broader problem of for-profit schools ripping off students with false promises of mythical job markets. In addition to these huge problems, I think there are additional reasons why you should think long and hard before you go to conventional acupuncture school if you want to treat in a community setting. The things I learned at acupuncture school are not just irrelevant but in direct opposition to the skills and vision I need to do the work I'm learning to do day in, day out at a community clinic.
(Note: Through talking to many current and former acupuncture students, either practicing community style or not, I don’t think that my experiences were unique to my school or me. It’s important for me to say that I had some great individual teachers, was able to take electives that focused on distal needling, and chose my supervisors based on who didn’t think community acupuncture was a “disgrace to the profession” or at least knew enough not to tell me that on a regular basis, and who would let me get away with never doing back treatments. But at the end of the day, I paid a lot of money and didn’t get trained in a way that prepared me for the work I knew I wanted to do, felt constantly alienated, and had to continuously fight to not have my vision of what acupuncture can do be narrowed beyond recognition.)
Here’s what I did learn in school:
1. A LOT of unnecessary, irrelevant things (including 3 semesters of chemistry!): Bloated curriculums can be attributed to a bigger push in the acupuncture profession to legitimize acupuncturists to other medical providers by increasing the hours of biomedical training we receive, as well as a money-making scheme on the part of individual, privately-run schools. I forget absolutely everything I learned in all three of my chemistry classes and never once while treating a patient have I thought, if only I remembered the difference between the chemical structure of tyrosine and glutamine….
2. How to be really judgmental of people’s lifestyles (choices or otherwise): This lesson was embedded in the culture of my school. It came from classmates, teachers, ways I was encouraged to interact with patients. From sneers at what other people brought for lunch if it wasn’t “clean” enough, to my qigong teacher telling me that no one would ever want to see a fat acupuncturist, to being repeatedly told to tell my patients they would never feel better unless they a. stopped eating dairy/sugar/coffee/raw foods/etc b. let go of their attachment to their past trauma (whatever that means) c. put their complete trust in me as their only hope to get to perfect health/enlightment/heaven/fill in the blank, I think that judgment was one of the primary skills acupuncture school tried to teach me. Sometimes it was blatant, sometimes it was very minimally masked as “clinical discernment.” It’s a horrible and unethical way to interact with people seeking help or support from you, doesn’t acknowledge the systems at play that dictate what choices people have access to and the real root causes of illness and dis/ease, and is definitely not a good business practice if you want people to come and see you more than once and to tell their friends and family about you.
3. That acupuncture probably doesn’t work all that well on its own: Over and over, I was told to add on adjunctive treatments, to spend extra time giving my patients tuina, moxa, cupping, herbs, lifestyle advice, etc. All of these other modalities can be very useful, but my training didn’t prepare me to trust acupuncture as a reliable, effective, simple tool. Instead, I was encouraged to pile on every technique I learned in the hopes that something would work well enough for someone to come back the next time they could afford treatment. I wanted training in healthcare, and I was taught that the only way people would seek out acupuncture is if it felt like a kind of spa treatment.
4. How to fetishize East Asian people/medicine/religion/culture: So there’s huge problems with this is in the broader acupuncture world (our licenses, national regulatory agencies all use the word “Oriental,” as one example among many), but cultural appropriation and overt anti-Asian racism was an integral part of the curriculum. As a white person, the work to practice acupuncture in a way that acknowledges acupuncture’s roots and lineage, challenges colonialism that led acupuncture to be stolen from communities, and integrates acupuncture as people’s medicine in my current context is life’s work. The least school could do is prepare those of us positioned in this way to begin that process and be aware of some of the questions this raises, as opposed to instilling in us a sense of ownership over anything related to East Asian medical theory and culture, while continually degrading and exoticizing Asian people.
5. How to ask a lot of personal questions in a disrespectful, insensitive way: There’s this diagnostic tool called the 10 questions in East Asian medical theory, in which you are supposed to ask all people who walk through your door about many personal topics the first time you meet them, including but not limited to their emotional state, bowel habits, and sex lives. This applies whether they are seeking treatment for knee pain, sleep problems, or allergies. All of these things may be relevant to their state of ease/disease at the current moment, but a) the answers to these questions are almost always entirely irrelevant to how we TREAT someone for knee pain, sleep problems, or allergies and b) we received NO training in how to address potentially sensitive topics in a respectful, trauma-informed way. There was one “Counseling and Communications” class that I was supposed to take, but I managed to finagle my way out of that requirement after I heard that one whole class session consisted of a seance. I have nothing against seances, but I don’t see how that would in any way prepare me to talk to living people about what ails them. Combine this with being taught judgment and condescension as primary ways of interacting with patients and it’s a lose-lose situation.
6. How to be constantly on the defensive with other healthcare providers to prove how legitimate I was. I had to wear a white coat in student clinic, as an attempt to show that I was as professional as any doctor and to visibly claim a position of power and expertise compared to my patients about their own bodies. Oh yeah, and constant reminders that community acupuncture is a disgrace to the profession. There’s something deep in this teaching about individuality, our ability to do it all by ourselves, to pursue success in a way that leaves our loved ones, our neighbors, our communities behind. When you try to put yourself up on a pedestal, you will definitely be lonely and will probably topple off sooner or later.
None of the above lessons are useful in any way—in fact, they are mostly harmful to the work of being any sort of acupuncturist and especially a community acupuncturist. Most of my training in what it takes to be a community acupuncturist is happening now, in these early days on the job, and has happened through other life experiences.
What does it take to be a community acupuncturist? I’m not entirely sure yet, but these days, the skills I’m learning are:
how to needle in a way that causes minimal pain (I’ve already needled twice as many people as I did in my entire student internship);
how to effectively communicate treatment plans and manage expectations about what acupuncture can do and how people can best use it as a tool for their own health and healing;
how to be spacious enough inside myself to be as present as I can in the three to eight minutes I have with people;
how to manage the entire room while attending to individuals within it;
how to trust my clinical and diagnostic skills while disregarding my ego enough to get myself out of the way and let people do the healing they need, on their own terms;
how to position aching people in recliners and tuck blankets comfortably around needled people;
how to support people in finding their power to be responsible for their own experience during treatment;
how to clearly communicate the systems, boundaries, and limits of the clinic while helping people who struggle work to fit within those so they can access care if at all possible;
and above all, how to just hold space for whatever people bring into the clinic.
For those of us who know we want to be acupuncturists embedded in our communities, I would hope for school as a time of relevant technical skill development and a widening of our vision of what acupuncture can do for people, for communities, and for movements for change.
The only reason I didn’t lose sight of this vision was because I was grounded by an awesome POCA clinic a few blocks from my house and lived a double life while I was in school: my day job was working at a fierce grassroots community organization led by undocumented people working to stop deportations and get people out of immigrant detention and prison, in which I learned daily lessons about what resilience and healing look like in practice. The gulf between with whom and how I wanted to provide acupuncture and the way it was being taught to me was obvious and widening every day during those four years I was in school.
There is no reason why acupuncture education can’t align with our values for practice and prepare us for the real work of providing care in our communities, while building the network of people with similar vision that we need in order to do anything hard and worthwhile and that goes against the dominant river dragging us along through pain, trauma, violence, and isolation. To prepare us adequately, education should be practical and visionary, boots on the ground, eyes toward the horizon, hands making possible what we could barely dream up yesterday. From what I see, POCA Tech is working to make that a reality.