POCA and the Commons: POCAfest Keynote 2018

 by Lisa Baird and Lisa Rohleder

1. Lisa B: the tragedy of the commons

A couple years ago one of my patients asked if her uncle could interview me. He’d written a book about business, and he was very interested in Guelph Community Acupuncture. I wasn’t all that surprised that the opening paragraphs uncritically referenced the tragedy of the commons. “The Tragedy of the Commons” is an article published in Science magazine in 1968, written by Garrett Hardin. The commons was a term used in England (what time period?) to refer to fields used to keep livestock and grow food, fish-ponds, forests in which to gather timber, wild berries and herbs, and open spaces in which to meet. Communal farming & living arrangements like this existed in much of Europe for a long time and still exist today in many places—human beings have lived this way for thousands of years.

Hardin’s argument, though, says that the “rational herdsman” will add more animals to his herd to increase his short term gain, and everyone else will do the same, and soon the commons is overgrazed and destroyed and no one can use it. The only solution, Hardin concludes, is private ownership of the land that once was the commons, because the rich person who runs it as a personal empire is personally invested in protecting it (and presumably will hire cops to protect it as needed). So the commons are fenced off and the herdsman works for a wage (or, starves to death)—which is exactly what happened in Europe during the enclosures when the rich eliminated much of the communal land property.

Hardin used the word “tragedy” as Aristotle did, to refer to an outcome that is the inevitable but unwanted result of a character's actions—so in Hardin’s mind, the destruction of the commons is a tragedy because it’s the unavoidable result of sharing it. The really weird thing about Hardin’s article is not that it’s poorly written and not based on facts or actual historical events—it’s that it’s widely cited as a sacred text. But again, maybe that’s not surprising. It’s a very convenient story to support the dominant economic system.

It was a busy week for me and I didn’t make time to talk to my patients’ uncle about how confused I thought his book was. But if we’d had a conversation, I might have pointed out that for centuries the “rational herdsman” didn’t overgraze the commons. That the “transition to capitalism” was not a natural progression but something that was forced upon people. That the peasants in England and the rest of Europe (and the rest of the world) engaged in anti-enclosure struggles for hundreds of years, that groups of women went out at night with scythes and pitchforks to dig up and cut down the hedges that enclosed the land their communities depended on. I might have pointed out that if human society was just a bunch of self-interested individuals who don’t care about the impact of their actions on other people, that Guelph Community Acupuncture wouldn’t function at all.

You don’t have to be familiar with Garrett Hardin’s horrible little article to know that the tragedy of the commons is a myth. Anyone who’s worked in a community acupuncture clinic has watched their patients prove how a community can and will take very good long-term care of a precious shared resource.

2. Lisa R:  The reconstruction of the commons

But still, in our culture there’s that ambient fear, that it’s impossible to share resources without destroying them. So all of our clinics, as they go about their day to day business of helping people manage their health — helping people collectively manage their health — they’re quietly challenging the myth that sharing inevitably leads to depletion.

For a lot of people I know, this is a scary time, in general. People are legitimately concerned that human society and the natural world, as we’re familiar with them, are both falling apart. The pace of change seems to be accelerating, and it’s hard to keep up. It’s hard to know if keeping up is even a good idea.

One of the things that keeps me hopeful is the sense that on a small scale — which is the only scale available to me — I’m participating wholeheartedly in a kind of reconstruction of the commons.

Healthcare in the US is most definitely falling apart; it’s gotten to the point where everybody basically admits this, though it’s not clear if anybody has a workable idea about what to do next. So that’s fairly scary. The fabric of healthcare is tearing — or being shredded by capitalism — and so there are these giant gaping holes. One of those holes is the absence of affordable, non-pharmaceutical options for pain relief and pain management, for most people. That particular hole is where I live my professional life. And it actually doesn’t feel like a hole to me when I’m fully engaged with it.

It feels like a space where something is rebuilding itself, something older and more reliable than our current healthcare system. Something that has been repeatedly declared, by business experts, to be tragically dead — but what do they know.

Near where I live and work in Portland, on clear days driving down Cully Boulevard, you get a great view of Mt St Helens. So I’m often prompted to think about what happened to that mountain, the volcanic eruption in 1980, and what’s been happening since. The destruction was amazing, including the way that volcanic ash transformed old-growth forests into lifeless deserts. There were a lot of apparently empty spaces where life used to be. But in reality, life started to re-establish itself in the dead spaces almost immediately, and it’s been very busy ever since. The landscape of Mt St Helens is different than it was before the eruption, but it’s most definitely alive. In fact, in some areas, there’s more biodiversity than there was before the eruption.

An ecologist studying the process, Charlie Crisafulli, said this in an interview: ”Restoration efforts weren't really needed because life is enormously competent and well practiced at re-insinuating itself into disturbed areas. Our expectation should be that life is incredibly tenacious.” 

I think that’s true about the commons. The commons is a form of life, and so no matter how it gets displaced and disturbed, it’s enormously competent and incredibly tenacious about coming back.

I think of POCA clinics like that, in relationship to the disaster that is capitalism in healthcare — we’re the green shoots coming up in the wasteland, we’re the pocket gophers burrowing through the volcanic ash, we might not look like much but we’re surviving in an environment that doesn’t look like it can support much life at the moment. But we’re here, and the longer that we’re here, the better we get at insinuating ourselves.  We’re holding on, and our presence changes things. Life begets life. Our survival under seemingly unpromising conditions will eventually make a stronger commons possible.

We’re a foothold for a different kind of future. Capitalism might enjoy — and benefit from — the story of the tragedy of the commons, but nature loves resurrection narratives.

And as many different people have said, what we pay attention to, grows. The best fertilizer is the gardener’s shadow, etc. One good way for us to challenge the myth of the tragedy of the commons is to put our full attention into reconstructing, stabilizing, strengthening and expanding acupuncture as a communal resource.

That was clearly the vision of the Young Lords and the Black Panthers when they established their acupuncture collective as part of the occupation of Lincoln Hospital in the early 1970s.

And speaking of history, in 2006, before there was POCA, before there was POCA’s predecessor, the Community Acupuncture Network, there was a story floating around the acupuncture profession — actually it was a prediction, so a story that involved the future — that in the United States, it was inevitable that the entry level qualification for acupuncture was going to become a doctorate degree. That there was only one direction for acupuncture education to go, and that was for it to become longer and more expensive, because that was just the natural order of things. Master’s level education was going away. Kind of like the “tragedy of the commons” — if you can get everybody to believe that something is inevitable, it really helps in making it happen.

If you had asked anybody back in 2006 — would it be possible for people who cared about acupuncture being affordable and accessible to band together to create a knowledge commons, and from there to make a school for community acupuncturists that cost 1/2 to 1/5 of what other schools (in the US) cost, and as part of establishing that school, to get assurance from the powers that be (in the US — ACAOM, in this case) that in fact they were committed to preserving master’s level education?  Depending on who you asked, they might have just laughed, or they might have explained that there really wasn’t anybody who cared about acupuncture being affordable and accessible other than a handful of marginal weirdos, and even if there were enough of those weirdos, there’s no way there would ever be an organization for them, and even if there were an organization it would probably never accomplish anything (because acupuncture organizations are not known for functionality), let alone create a school, and if there were such a school ACAOM would never approve of it because ACAOM wants all schools to eventually adopt an entry level doctorate.

There was only one way to disprove this tragedy as it was being written: to live a different reality. One that was more like a resurrection narrative about acupuncture as a communal resource.

So we’ve already proved our competence at insinuating ourselves into unpromising environments.

3 Lisa B: Social joy

At its core the myth of the tragedy of the commons is a belief about humans being fundamentally selfish: because you won’t care about me, I cannot care for you. My wellbeing is not interconnected with yours—in fact, it is pitted against yours. A look into what happens in the wake of major disasters reveals a very different story about human behaviour. Decades of sociological research by disaster scholars shows that in the wake of a hurricane, a bombing or a fire most people are altruistic, generous and brave, caring for those around them, strangers and family alike. I don’t mean to romanticize disasters, and of course they’re not all the same. But disasters can push us into situations where we are urgently required to do vitally necessary work—the work of moment to moment survival, in some cases—and engage with our neighbours far beyond small talk.

We live increasingly private and privatized lives, dwelling in secured spaces with our purchases, communicating electronically, consuming media rather than speaking to each other. Disasters interrupt that. Social ties and meaningful work are intensely rewarding and something that many people are missing whether they know it or not, which is probably why many disaster survivors, when interviewed about their experiences, recall at least some of those days of uncertainty when the electricity was off and people spilled out onto the streets with an intense kind of joy even alongside their grief and loss. Rebecca Solnit has written a lot about this, and she refers to this joy as social joy, comparing it with the feeling you get when participating in a carnival, or marching with thousands of other people with shared purpose (or, I’d add, watching the World Cup in a sports bar if you like soccer and like bars).

I think that the backdrop of capitalism, particularly of capitalism in healthcare, this slow ongoing disaster, is to some degree interrupted in our clinics, and that a low-key kind of social joy is at play as a result. You know how sometimes someone looks around and their face lights up and they say “Boy it’s busy in here today!” They’re not pissed that they’re possibly getting less of the punk’s attention or that the likelihood of a major snoring event increases with every filled chair. I honestly think that they’re just stoked that everyone’s here together. Our clinics, in small ways every day, are telling the story of social joy.

We’re going to end with an excerpt from Lisa’s latest book, Praxis, as I decided that it’s not cheating to include part of a book in a keynote, especially as the book’s pretty new and most of you haven’t read it yet. It’s free as a download from the POCATech website.

Lisa R:

Also, this particular section of the book very much emerged from conversations the two of us had, so we’re definitely not cheating. We just didn't know we were drafting a keynote when we were talking about it.

“More than once POCA and/or the community acupuncture movement has been accused of being a cult. I’ve always been pretty sure that it wasn’t; I mean, if I had founded a cult, I would notice, right? Like, wouldn’t I have at least one Mercedes? The perks of cult leadership were most definitely missing from my life so I figured we were probably OK. One element in the is-or-isn’t-POCA-a-cult discussion that was a little confounding, though, was the fervor that often arose in POCA gatherings (workshops, the conferences we call POCAfests, and even sometimes ordinary meetings). When POCA people got together, it always had the potential to turn into something resembling a revival, even when the topic at hand was budget spreadsheets for clinics or the best way to deal with biohazard containers. There was something euphoric and rapturous, a whiff of love-soaked mysticism that didn’t really square with the ordinary reality of being a cooperative where people had all the conflicts that people have when they try to work as a team. The fervor sometimes weirded out the newcomers; were we trying to love-bomb them? I wasn’t trying to do anything, and I was pretty sure that nobody else was either. It was just something that happened when we got together. We got so happy, so inexplicably happy.

Rebecca Solnit suggests that in our culture, we have no language to describe social joy: the love and happiness of caring for our neighbors, of coming together in freely chosen cooperation. It was a relief to recognize the revival-like qualities of POCA gatherings as a kind of eruption of social joy. We get like this when we get together not because we’re a cult, but
because our human desire and need for social joy has been driven underground. So when there’s an outlet, an opportunity, it’s like a broken water main in a city street on a hot day: it bursts through like a fountain, and people take off their clothes and dance in it. We can’t help it.

It’s not really about POCA per se, it’s about what human beings are like when they get the chance.

All thriving community acupuncture clinics have that quality in a low-key way. All of them feel like a breakthrough, like a celebration, like seizing a chance. My working theory, using Rebecca Solnit’s framework, is that capitalism is a disaster (especially for healthcare); on some level we all feel it and know it; and community acupuncture, especially the ongoing job of punking, is our improvised, creative, cooperative response to disaster. We’re doing what humans naturally do when things fall apart.

This is another reason why community acupuncture clinics are an appropriate intervention for toxic stress. According to Paolo Freire, oppression is dehumanizing. If community acupuncture clinics, like the communities that arise in the wake of disasters, are an opportunity for people to be human in ways that we want to be but often can’t in capitalism, then they can function as a counterweight to the dehumanizing forces of structural violence — and not only because inserting acupuncture needles,on a biomedical level, seems to decrease cortisol levels.

Community acupuncture is something that people do together, not just something that acupuncturists do to patients.

The community acupuncture model itself allows for many ways to express that: it’s why the POCA cooperative exists; it’s why patient members of POCA volunteer their time to support both individual clinics and the larger co-op; on the material level, it’s why many POCA clinics fill up over time with donated recliners that patients brought in themselves.

Lisa B:

In the book A Paradise Built in Hell, Rebecca Solnit also brings up the difference between private joy and public joy. She suggests that one of the long-term, unrecognized consequences of the San Francisco earthquake of 1906 was the establishment of the Catholic Worker, the Christian anarchist organization devoted to community living in solidarity with the poor and resisting social injustice. Dorothy Day, one of the founders of the Catholic Worker, was eight years old during the earthquake and never forgot it. She wrote, “What I remember most plainly about the earthquake was the warmth and kindliness of everyone afterward…While the crisis lasted, people loved each other.” In her autobiography The Long Loneliness, Dorothy Day had a lot to say about love; she recounted falling in love not only as a romantic/erotic experience but also in a variety of other contexts: enthusiasm, devotion, solidarity and religious awakening. (pg 59-61) Rebecca Solnit contrasts Day’s passionate life of “other loves” with our current “privatized sense of self”. She argues that most of us want what Dorothy Day wanted — a life that is larger than private satisfactions and a series of individual relationships — but we have no language for describing that kind of abundance. We have no way to articulate our yearning for a love for society.

On a much smaller scale, this distinction between private joy and public joy explains a lot about punking. A lot of conventional acupuncturists can understand why punks care about patients having access to acupuncture, but what they can’t understand is why we insist on providing treatments in big shabby rooms filled with second-hand recliners, or why we have to be so militant about it. You could say that a lot of acupuncturists look at acupuncture as a form of private joy. No matter how many patients they treat, each patient represents an individual relationship to the acupuncturist. For them, access to acupuncture means admitting some more individual people into that kind of private joy; it means keeping acupuncture itself basically the same, with the acupuncturist in control — but just allowing a few more people to have it.

For punks, lowering barriers to acupuncture in order to create more access is public joy in action, and it demands a radical deconstruction and reconstruction of how we think about acupuncture itself. Sometimes, as in Dorothy Day’s life, public joy disrupts and displaces private joy; she broke up with a man she loved when she fell in love with God and religious practice, and ultimately, channeled her love into the Catholic Worker movement. Discovering community acupuncture has blown up a lot of acupuncturists’ previous relationships with acupuncture (another reason POCA gets described as a cult). For those of us who have experienced it, though, it’s all about falling in love with something larger. Many of us found practicing certain styles of acupuncture to be interesting and fulfilling, at least for a while; but then we fell in love with the possibility of taking care of thousands of people, and that love made us willing to do whatever we had to do, including letting go of practice styles that we’d been attached to, in order to lower the barriers for those thousands of people to come into our clinics. Even the letting go feels joyful and liberating. Even the grief that often arises in accompanying patients through painful experiences is part of the love. That feeling of the barriers coming down is worth everything. Punking is a fierce affirmation that we are our brothers’/sisters’/siblings’ keeper. Punking is holding on to our humanity with both hands in the face of for-profit healthcare and saying, not so fast, capitalism.

Punking is a very large love, an exercise of our capacity for social joy.”

Author: lisafer