Hierarchy of Needs: Too Sexy for This Work?

Got your attention? I hope so. This post in the Hierarchy of Needs series is about things it’s hard for people to pay attention to, so if it helps to play the Right Said Fred song in the background, please do! (Can you tell I’ve been putting in some hours as a classroom teacher?)

The previous post in this series was about punks complaining about how conventional acupuncturists “don’t get it” — memorably demonstrated by somebody no less famous than Peter Deadman. This post has nobody famous in it (unless you count Right Said Fred); it’s just about us, and what’s going on (I think) when veteran punks complain that newbie punks, or potential punks, or sometimes very misguided punks who don’t even have the excuse of being new anymore — don’t get it. This is about the unsexy levels of the Hierarchy of Needs, and how to pay attention to them.

I’m using the word sexy here with its more general meaning: attractive, interesting, appealing, captivating, glamorous. The first two levels of the Hierarchy of Needs are significantly less of all those things, I think, than any of the other levels, and so people often resist paying attention to them until it’s clear that they absolutely have to. (What’s more compelling in the moment, filing an AERD report about a bruise or having an argument about “the profession”, catching up on Quickbooks or geeking out on trauma-informed care? I’m as guilty as anybody.) For the purposes of this particular post, I’m going to focus more on the second level of economic access than the first level of physical safety, because in general, physical safety in acupuncture is easier to get right with a lot less effort. Proportionally it requires less attention than economic access.

I’ve been reading Michael Pollan’s book about psychedelics, How to Change Your Mind (thanks Ellen and Lisa B for the repeated nudges!) (also, sorry, that’s another famous person in this post) and one of the excellent points he makes is that the therapeutic use of psychedelics, despite having a lot of promising research behind it, has been impeded due to the lack of, as he puts it, “a sturdy social container”. The use of psychedelics for healing purposes, like acupuncture, comes from another culture, and our culture has had a lot of trouble figuring out how to make it work. Everybody knows that I think acupuncture is a psychedelic, that it works because it increases neuroplasticity, so I won’t go on about that any further — let’s just say that the lack of a sturdy social container is also the biggest obstacle to ordinary people using acupuncture.

At this moment, I can’t think of a problem in my professional life — and I have plenty of problems! — that doesn’t in some way relate to the difficulty of making a sturdy social container for community acupuncture. Maybe especially, people’s inability to recognize it as a priority.

Hello, level two in the Hierarchy of Needs! A sturdy social container for acupuncture encompasses all of the relationships, boundaries, resources and systems that are required to hold a POCA clinic together. Gathering them, organizing them, and maintaining them for the long haul, so that your community has economic access to acupuncture, is an epic amount of work. If you’re not the person who did that work yourself, though, it’s easy to overlook it down there at the bottom of the pyramid. And it’s easy to take a social container, and the economic access that it provides, for granted. And that’s a big problem when it happens.

If you can take something for granted, it means you don’t have to be grateful for it; heck, you don’t even have to be aware of it.   And if you’re not aware of it, it’s impossible to pay attention to it, let alone to take care of it. I think this is the substance of many (most?) conflicts between veteran punks and newbie punks, who are in a position to take things for granted that the veterans had to build from scratch. It can be an issue with training employees, and it’s been an issue at POCA Tech; not only because veteran punks get mad about it but because, if newbie punks can’t pay attention to social containers, they can’t learn how to build or maintain them. The vast majority of POCA clinics exist because somebody decided to suck it up and learn how to create a small business, even though they probably didn’t want to. When there were very few community acupuncture clinics, I don’t think most of us who were making them assumed the process would be easy, or that we could take it for granted; we looked at the wasteland around us and figured (correctly) it was going to be hard to build anything. Now that there are more clinics, it’s more tempting to take those existing social containers for granted.

Cue Right Said Fred! Some would-be punks are just… too sexy for this work. Too geeky for this work, too dreamy for this work, too idealistic for this work. One way or another, they refuse to drop down to the grind of level two and pay attention to what it takes to make, and run, a clinic, particularly for the long haul. They’d rather float up to the higher levels.

Yeah, says the veteran punk bitterly, who wouldn’t?

Let’s talk about the stigma against small business. As I wrote in Holes, the only useful business education I got was outside of acupuncture school, when my mentor showed me how to fill out IRS Schedule C and gave me a copy of Paul Hawken’s book, Growing a Business. Hawken describes how his upper middle class family didn’t think much of him being “a shopkeeper” and because of the stigma, he didn’t immediately realize how interesting,creative, and socially useful small business could be. A lot of acupuncture schools have their own version: the challenges of small business aren’t compelling or valuable enough to put real time and energy into exploring — instead, let’s just hope everybody gets hired by a hospital. (Getting hired by a hospital is sexy!) Being a lowly small business owner is, well, lowly, and being good at small business, no matter how socially useful that business is, is a lot less impressive than looking good in a white coat.

At this moment in time, though, the only reliably workable blueprint we have for a social container for community acupuncture requires creating a small business, or a nonprofit that supports itself like a small business. It’s so, so tempting for people to look at small business as somehow extraneous to community acupuncture, instead of foundational to community acupuncture.

Trying to transcend level two with magical thinking is pretty obvious when acupuncture schools do it, but POCA has to contend with more subtle versions, and alas, sometimes the worst of it comes from a certain subset of anti-capitalists. Yup, you know the ones who would rather dream about the sexy, sexy revolution than build an actual social container so that ordinary people can get acupuncture in their own neighborhood. Some would-be punks are, unfortunately, too radical for this work. They’re quite skilled at critiquing social containers for acupuncture, but they themselves won’t buckle down to build or maintain any. Critique is all they’ve got to offer. As Peter Deadman demonstrated, it’s easy (*cough*  lazy *cough*) to negatively compare something that exists to something better and purer and more lofty — that doesn’t. There’s a new-age version of this magical thinking too, where certain enlightened would-be punks don’t understand why the veterans didn’t just manifest a reality with more rainbows and unicorns. It’s easy to create a social container, right?

If you can take something for granted, it means you don’t have to be grateful for it.  (Not to mention the unjustified taking of CREDIT FOR IT ALL by virtue of their sexiness. And then getting pissed at you for not appreciating how sexy they are and how much magical and important work they have actually done… in their dreams. GASLIGHTING ANYONE? —  from a particularly pissed-off veteran punk –OK, more than one — with regrettable personal experience in this area.)

Taking the container for granted can show up in a variety of ways, all on the spectrum of annoying through infuriating and demoralizing, for the people who built and tend it. There’s being too sexy for tasks like cleaning the toilet and taking out the garbage and constantly “forgetting” to do them. There’s being too sexy to try to get along with the sometimes irritating neighbor or landlord even though the container depends on those relationships. There’s being too sexy to commit (and to be honest about it) as a partner or an employee or a student, and also, too sexy to communicate (making everybody else do extra work in the communication department). There’s believing you’re so sexy that all the clinic systems will just naturally revolve around you, and if they don’t, then there’s something wrong with the clinic and the other people in it.

Being good at small business is less impressive than being (insert relevant version of “sexy” here):  radical, enlightened, clever, a free spirit, charmingly contrarian, etc., etc., etc. The problem is, none of those things are foundational to community acupuncture because none of them will get you a social container, absent the actual work of building a business.  And they can all be powerful distractions from the unsexy work of taking care of the container. (Which somebody else might actually be doing, says the veteran punk bitterly, and getting no credit.)

For most people who want to work in community acupuncture, there’s a stark choice: you can be an entrepreneur yourself, or you can work with/for entrepreneurs, which entails getting along with them. Check out this nifty worksheet about the personality traits of entrepreneurs, which is most definitely going to become a POCA Tech homework assignment:  https://srdc.msstate.edu/care/files/busi_worksheet1.pdf  Industrious, sincere, responsible, organized, realistic, able to get along with others — a lot of acupuncturists are, alas, just too sexy for all that.

Once I got a long email from someone who felt duty-bound to explain to me, in small words to be sure I understood, that community acupuncture couldn’t by itself, solve the healthcare crisis in the US. I don’t want to get any more emails like that from all the sexy, sexy people out there who feel that small business is beneath them, so I’ll just say it once: I know. If community acupuncture is a solution at all (I think of it as prefigurative intervention, which is different), it’s a micro-level solution to a macro-level problem. And if micro-level solutions are not your jam, that’s fine! If you want to go work in a think tank or organize huge marches or run for office, best wishes with all that, really! If community acupuncture clinics don’t meet your standards for any number of reasons, I’m not going to argue with you! But I will say, please, if all this isn’t good enough for you, please do not skulk sexily around the edges of these social containers that we built out of nothing (because that’s what we had to work with), taking the parts that you want while contributing no energy to the whole and also, demanding that we pay more attention to you and your many, many criticisms. Your sexiness is exhausting.

A really basic part of paying attention is identifying distractions and dragging your focus away from them. The upper levels of the hierarchy of needs can be a distraction from the lower levels. Sexy ideals can be a distraction from unsexy work. Attention really is magic, though, and I think the more practice we get, collectively, with hauling our attention back down to the foundational levels of the hierarchy of needs, the more people we’ll be able to serve.

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Conference Keynote: Breaking the Ceiling

The theme for this conference is “Breaking Barriers”. You know, there are so many barriers to break in acupuncture that it was really hard to choose which ones to talk about for this speech. But since I’ve spent so much time talking about classism as a barrier, I thought it might be fun to shift gears a little and talk about numbers.


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  1. hell yes! Great article and I can tell you I would not be in NE without old time CAN/POCA folks who made this all happen! Creating the container out of zip/nothing/nada – so true. Holding attention, not getting pulled away by sexy sexy is super important. May we all hold on and keep doing community acupuncture for the sake of doing it – providing affordable acupuncture because we know that’s the right thing to do and, what the hell else would we do anyways?