Lisa's keynote speech from last weekend at POCA Fest 2013 in Providence, Rhode Island.
Welcome everybody, to our second POCAfest…
Within the acupuncture profession, POCA stands out as being effective. We get a lot done, especially considering how lean our budget is. That’s unusual. Over the years, I’ve heard a lot of people say that organizing acupuncturists is like herding cats. And that’s why most acupuncture organizations can’t get anything done, because of course you can’t herd cats. Well, if organizing acupuncturists is like herding cats, then creating a multi-stakeholder cooperative with acupuncturists and patients and acupuncture clinic staff, and getting acupuncturists to participate in it — that’s more like, I don’t know, organizing cats to play instruments in a rock band?
There is actually a real cat rock band. There are three cats and they play drums, guitar and keyboard. It’s kind of a punk rock sound, or maybe experimental music. They travel around in a tour bus, doing shows. They’re called Tuna and the Rock Cats — and we’ve booked them for the coffeehouse tomorrow night. No, we haven’t. But you can look them up on the internet and see that it’s possible, it can be done. You can teach cats to play instruments in an ensemble.
You can actually teach cats, and other animals, to do all sorts of complex tasks, by using clicker training and what they call behavioral shaping. Behavioral shaping was originally introduced by the psychologist BF Skinner; he trained pigeons to pull levers, which is easier than teaching cats to play drums. But the principles are the same. Let me read you something that he wrote about behavioral shaping:
“We first give the bird food when it turns slightly in the direction of the spot from any part of the cage. This increases the frequency of such behavior. We then withhold reinforcement until a slight movement is made toward the spot. This again alters the general distribution of behavior without producing a new unit. We continue by reinforcing positions successively closer to the spot, then by reinforcing only when the head is moved slightly forward, and finally only when the beak actually makes contact with the spot. … The original probability of the response in its final form is very low; in some cases it may even be zero.” Note: pigeons don’t go around pulling levers on their own. “ In this way we can build complicated operants which would never appear in the repertoire of the organism otherwise. By reinforcing a series of successive approximations, we bring a rare response to a very high probability in a short time. … The total act of turning toward the spot from any point in the box, walking toward it, raising the head, and striking the spot may seem to be a functionally coherent unit of behavior; but it is constructed by a continual process of differential reinforcement from undifferentiated behavior, just as the sculptor shapes his figure from a lump of clay.”
So if you want a cat to play the drums, the first thing you have to do is to just to get the cat to look at the drum set. Whatever the complicated end performance that you want — pigeons pulling levers, cats playing drums, acupuncturists and patients working together in a cooperative to build economic infrastructure for a profession that doesn’t quite exist yet — you have to break it down into the tiniest components. And the first step is, literally, just to turn and look in the right direction.
I thought about this when we had some visitors at WCA from another multistakeholder cooperative. We spent all this time trying to explain how POCA works, the different member categories, all the projects we’re working on, how our governance structure is set up — and when we finally gave them a tour of the clinic, the first thing they commented on was, wow, so people really don’t mind being treated in the same room together? Really? That’s amazing. I would have thought you’d have a lot of problems with that.
So it was good for me to have this prospective on the stages of cooperative behavior with regards to community acupuncture. It’s very hard, in this culture, for people to get past thinking of themselves solely as isolated individuals, especially with regards to health care, and even more especially if they are acupuncturists. With POCA, we’re trying to think of ourselves as a collective, we’re trying to behave like a collective, and the very first step in that process was just to get people to receive acupuncture in a room together. To turn towards cooperation.
As everybody knows by now, I believe that POCA’s a fractal. An elegant, self-organizing pattern. I also believe that POCA’s an intelligent fractal — that the fractal knows more about itself and how it works than we know about it, and it’s teaching us to understand it. To embody it. It’s patiently shaping our behavior. If POCA weren’t such a lovely thing, I would probably feel kind of disturbed about having it go all BF Skinner on me.
But at this point, I’ve had a decade or so to get used to it, and I have to admit that I like how the fractal has shaped my behavior. My life — especially my life as an acupuncturist — is a lot better now, being part of the community acupuncture fractal, than it was before. I didn’t used to have any other cats to play drums with. Anyway, it’s not like the fractal is standing off at a distance somewhere, holding a clicker, rewarding me when I turn in the direction of cooperation. We are the fractal, and actually, we’re teaching each other. Turning in the direction of cooperation feels good. The experience of people getting acupuncture together in a space is inherently rewarding, for the acupuncturists and the patients — which is what I said to the folks from the other co-op. No, we didn’t have a lot of problems with getting people to have acupuncture in the same space, because they LIKE it. We need each other, and we’re starting to really understand how much we need each other, and every time we turn toward each other, it feels good. Click.
There was an article in the New York Times awhile back titled, “What Shamu Taught Me about a Happy Marriage”. The author was researching a book on training exotic animals, and she encountered the practice of behavioral shaping, and naturally, she decided to try it out on her husband. He was driving her crazy with a variety of behaviors, like leaving his socks on the floor, and so she started using what she learned from dolphin trainers to get him to put his socks in the hamper. This article was the most viewed and emailed of the New York Times online for the entire year. And of course some of the response online was not altogether positive; if you google the title, you’ll find some horrified blog posts. When the author joked about feeling like she should toss her husband a mackerel, some people definitely did not find it funny. And yeah, tossing your mate a mackerel is perhaps not the most romantic vision of married love.
Anyway, I thought of that article too when we were talking to the folks from the other co-op. I thought about how far we’ve come in our experiment with cooperation. And I remembered, a couple of years ago, talking with someone who’s been in the acupuncture profession a very long time, with a lot of experience with acupuncture organizations. I was talking about how much fun we were having with CAN, getting so much done, and he kind of sighed and said, yes, Lisa, that’s because you all like each other right now. Let me tell you, that’s not going to last. Back in the day, when we were first getting acupuncture legalized, we liked each other too.
And at the time I was like, wait — what do you mean it’s not going to last? (Also — you liked those people?) And I didn’t really believe him, because let’s face it, one thing I’ve learned by being an acupuncturist for nineteen years is not to readily believe anything anybody tells me about acupuncture or the acupuncture profession. But of course he was right. The days when everyone involved with this organization was also best friends with each other are definitely over. We’ve hired each other and fired each other; had business partnerships go down in flames; we’ve poached each other’s punks — because there aren’t really enough to go around yet; we’ve had some bitter arguments and we’ve lost our tempers with each other — OK, except for Andy. Everyone still loves Andy — except for all the new people, who haven’t had the pleasure of meeting him yet. But if all goes as it should with POCA, eventually not everybody will have the pleasure of meeting Andy. We’re too big to all be best friends anymore, and that’s a good thing.
But I do think we have to wrap our heads around the idea that having a cooperative together may be less like being in love all the time, and more like tossing each other a mackerel.
The ultimate goal of POCA is to create a new, sustainable economic foundation for the delivery of acupuncture. Which really means, a new acupuncture profession that has many more real benefits to offer both acupuncturists and patients than the current model does. That’s a very complex undertaking. It involves lots of people doing things that they wouldn’t necessarily do on their own. It involves a lot of us doing things that we don’t necessarily feel like doing; it involves all of us learning new, cooperative behaviors. Without some very careful planning, without tremendous intentionality, without patient attention to very incremental changes in our behavior — we wouldn’t have a cooperative or a new profession at all. As BF Skinner said, “The original probability of the response in its final form is very low; in some cases it may even be zero.”
That doesn’t mean it’s impossible, it just means we have to know what we’re doing. We have to know what we’re doing with each other.
In this room, many of us are acupuncturists — but I think I can safely say that almost ALL of us are acupuncture patients. Some of us provide acupuncture, and almost all of us receive it. I think I can probably also safely say that all of us are connected to other patients and potential patients — people around the country who need acupuncture; for all of us, there are people we can think of, that it really matters to us that they can get acupuncture. In our own lives, and in the lives of people we care about, acupuncture makes a positive difference, sometimes a huge positive difference. So this is what we’re trying to do with each other: as acupuncture patients, we’re trying to ensure a stable, reliable supply of affordable acupuncture for ourselves and everyone we care about; and for acupuncturists, we’re trying to build a collective patient base that is big enough to support all of us to make a living. Obviously, those are not goals that any of us can accomplish alone.
And of course there are reasons why we don’t already have these things: they are, as Dr. Skinner said, “complicated operants which would never appear in (our) repertoire” without conscious intervention. A lot of people are passively waiting for the state of health care to get better, hoping somebody or something is going to save us. POCA’s decided not to wait for somebody or something to magically make acupuncture affordable and acupuncturists employed; we are doing it. We’re doing it now. And we want to keep doing it at a bigger and bigger scale, and include more and more people, and in order to do that, we have to look at how to shape our behaviors into more and more cooperation. We can do a lot more than we think we can do, and gradually, incrementally, we’re proving that to ourselves.
A lot of acupuncturists get attracted to POCA because acupuncture can be such a miserably lonely profession, and there’s so much support and camaraderie here. We’re not just here to support each other, though; we’re here to train each other. The support and the camaraderie are not our reasons for being — they’re the mackerels we’re tossing to each other (cue mackerel tossing) on our way to creating the cooperative of our dreams. So this weekend, remember that we might be in love with community acupuncture, but we don’t all need to be in love with each other. We came here to make something, something that none of us could make on our own, something really big that is ultimately made up of tiny, repeated increments of cooperation. We’re here to practice our cooperative behaviors, and we can practice them with people we like, people we don’t like, and people we’re just getting to know. Because all those people are part of POCA.
So was that a good speech? Somebody throw me a fish. Thank you.