From Lisa's Inbox: Part Three -- Commentary on Lao Tsipher

OK, I just have to say this is one of those moments when I feel disparate parts of my life magically coming together. In a previous incarnation I was a Greek major (no, NOT the kind that anyone still speaks) and spent many hours poring over arcane texts. (If anyone is wondering, Homer in the original is lots of fun, while Aristotle is sheerest hell. But I have a feeling nobody was actually wondering, so I’ll shut up about all that now.) Anyway, in the margins of those arcane texts were often lengthy apocryphal comments, also in Greek, by some guy who found the original text a few centuries later and felt compelled to scribble around the edges. Often the later guy had no idea who the earlier author was -- but had plenty of opinions -- and modern day scholars made a living making guesses about all of it -- the original author, the later scribbler, what it was all about anyway. Now here I am, almost two decades later, creating my very own commentary on an anonymous manuscript. Only a consummate and irredeemable geek would find this so, so, satisfying. Ahh...

Okay! Enough! Back to business, which is Lao Tsipher’s take on acupuncture institutions. I actually want to refer back to an earlier post of Skip's, [url=http://www.communityacupuncturenetwork.org/forum/read.php?22,3965]The Long Term Futility of a Solo Practitioner[/url], to draw together some themes here.

First I have to say that it sounds like Lao is writing from very unpleasant firsthand experience, and I can’t speak to that. My own experience with the staff of the former AOM Alliance was that they were extremely helpful; and my brief experience with the staff of the current AAAOM is that they have been very courteous. However, I believe that any given perspective probably has its own validity and so is worth examining, especially when it’s provocative. And my thesis in this post is that IF there is truth to what Lao is saying about the national organizations, then we, the rank and file acupuncturists in the US, are ultimately responsible for this sad state of affairs, because we have let it happen.

Skip’s post referred to a saying I’ve heard over and over in the acupuncture world, which is that trying to organize acupuncturists is like herding cats. Acupuncture seems to attract a disproportionate number of practitioners who are absolutely determined to do their own thing in their own way. This kind of independent thinking can be a virture; combined with self-absorption, however, it becomes a crippling liability.

Acupunture is an art as well as a science. Like any art, it attracts practitioners who are very interested in self-expression and self-discovery. Unlike painting or sculpture or graphic design, however, acupuncture is also medicine, which means it can’t just be about self-expression; it also has to be about service and altruism and a kind of professional selflessness, or it will get ugly. Because acupuncture got established in this country in tandem with the personal growth movement, however, I think the reality that acupuncture is medicine, and that there are some attendant obligations on its practitioners, have gotten lost. Because acupuncturists as a group are so enamored with their own individuality, and have begun to conceive of acupuncture as primarily another personal service (facelifts, anyone?) for patients as individuals, we are missing the sense of collective responsibility that characterizes a profession that has grown up. Or, as one witty acupuncture student put it, “There’s way too much free-to-be-you-and-me around here.”

Which is not to say that being an acupuncturist isn’t supposed to be fun, or that you don’t need to cultivate an individual relationship to the medicine, or that being altruistic means being a martyr. What we need to find is a balance. One of the reasons I think that so few patients in America receive acupuncture is that acupuncturists are so focused on doing what we want, when we want it, that we lack the detachment and the consistency to relate well to the public as a whole. What acupuncturists have been communicating (as a group) to patients (as a group) is that we are unique, we are different, and we are special. What patients want to know is, can we help them. They don’t care that much about the intricacies of our individuality; they want to know if we can do something about their pain. But we don’t talk about what patients need; as a group we don’t even seem to think that much about it. That’s actually very sad.

CAN’s recent internal brouhaha about the Locate A Clinic page grew out of what one might define on the one hand as a healthy diversity of approaches, or on the other, an inability to agree about some basic definitions of accessibility. We realized that the clinics that we had listed had such different definitions of what was “accessible community acupuncture” that the Locate A Clinic page was rapidly becoming useless to the average patient searching for an “affordable” clinic. The Board decided, not without debate, to do what we had hoped to avoid and to make hard-and-fast rules, based on dollar amounts, about which clinics to list. It wasn’t a fun process. I think for me it clarified, however, why so many potential patients still think acupuncture is really weird, and that’s in part because acupuncturists have a hell of a time presenting themselves to the public at large with anything resembling consistency. We make it really hard for the general population to get its head around what we are offering.

And thus we arrive at the part of this post where I confess some sympathy for the national acupuncture orgs. All of them, in their own way, keep bringing up the issue of unity. I think that’s because on some level everyone in the acupuncture world realizes that our culture of terminal individuality is not getting us anywhere. Most acupuncturists are living a marginal existence, sporadically practicing their excruciatingly expensive hobby. They have a lot of a certain kind of freedom, but they don’t have much else. The national organizations, whatever else they want, are attempting to turn acupuncture into a real job.

Which gets us back to Skip’s post: hanging on to being a solo practitioner, because you don’t want anyone else to cramp your style, also pretty much ensures that acupuncture is never going to be a real job for you, if you define a real job as having hours and compensation that are reasonable and consistent. Making acupuncture into a real job requires a willingness to create systems in your practice that include other people. Creating systems requires putting your ego aside to think about what is going to work best in the long run for your patients, which means being honest about the things that you don’t necessarily do well, and could use some help with.

I also must confess to some unease with all of the rhetoric about professional unity. “Unity” has a sort of martial, Stalin-esque quality about it. (Am I allowed to make that comment, or does the five-foot red fist on the side of my clinic disqualify me?) I think what acupuncturists need is not so much unity, but community. We need to think about what patients need from us, what we need from each other, and what patients and friends can give to us when we’re not too proud to ask for help. We need to help each other come up with systems that really work in our practices. To make these kinds of realistic assessments, to be detached enough to create good systems, we collectively need to get beyond our “free-to-be-you-and-me” stage, and grow up a little.

Lao Tsipher, in “An Anonymous History of the Acupuncture Profession”, implied that rank and file practitioners were being preyed on by special interests within the profession. From what I read on the Internet, on this website and beyond it, an increasing number of students and recent graduates are beginning to describe their experience of their acupuncture schools as predatory. I know that many acupuncturists, like Lao, feel that the national organizations have little or nothing to offer rank and file practitioners, and on the contrary are looking to take whatever they can get. I think it’s important to have these discussions, but I think it’s even more important that we take responsibility for the state of our institutions. If our lack of cohesion has attracted predators, we need to do something about it. We’re going to be fair game until we grow up, and get serious about helping our patients and helping each other.