How do we work with behavioral health issues as EAMPs?

I believe that one of the biggest untapped potential of the field of East Asian Medicine is how we can work with mental health. The stigma of mental health is present on every level of our society. Fear of being put on medications, of receiving a disturbing diagnosis, of having to face our psychological and emotional pain…the list goes on. For some, it can be so much easier to approach a holistic care provider of some sort, one who won’t necessarily label you, who can see the connectedness of body, mind, and spirit.

Or so it seems. The reality is that many if not most CAM providers are not trained to deal with people who are in crisis. We’re taught some theory about it in school, but when it comes to learning hands on approaches to working with people whose behavior is bizarre, disruptive, or disturbing, we conveniently default to this being outside of our scope of practice. This may be true, but this person may also not approach a professional for whom it is because of the reasons listed above. If that is the case, we have a unique opportunity to provide care that would otherwise be rebuffed. Why not take that opportunity?

First, we have to deal with our own prejudice against people whose behavior is outside the norm. I’ve dealt with a number of people over the years who other acupuncturists have not liked treating. Rather than seeing this as a failure of the other acupuncturist, I would attribute it to the fact that our education here in the US is geared toward people who are otherwise stable and resourced. The bulk of our clinical training is focused on acupuncture techniques and theory, and not how to work with a wide range of patient populations on a regular basis. While I was given externships at places where there were marginalized and underserved populations, the understanding was always that I wouldn’t make a career out of it because such positions don’t often exist outside of an academic setting in the field and aren’t profitable.

We as a profession need a better strategy on how we work with and view people with behavioral and mental health issues that avoids stigmatization. We have the opportunity to do better than labeling such people as having a “shen disturbance”; working with them through our own unique lens that can empower patients through speaking back what’s going on with them not as a static diagnosis, but as a fluid pattern of interacting elements. We just need to start extending ourselves to this patient base, and begin resourcing ourselves to deal with them better.

Why do we sideline our medicine?

Why do we put ourselves as acupuncturists and EAMPs in such a tight career bracket? After school, it feels like we have one option: to open our own practice and do acupuncture and herbs, or else leave the medicine.

I’ve sought to expand this by trying to get another conventional medical degree, but that isn’t working out. So I’ve been asking myself: if I don’t want to be a small business owner and I want to work with underserved and marginalized populations, what can I do as an EAMP?

Last year, I had the good fortune and networking prowess to make a volunteer position I was doing turn into a paid position at the Seattle Institute of East Asian Medicine. The future of this position is uncertain, but for the past year, we’ve been able to provide free acupuncture to low income seniors affiliated with Pike Market Senior Center, while I as an acupuncturist get paid. This is wonderful, but not enough.

Two weeks ago, I got a job at DESC, an organization that helps people who’ve lived in chronic homelessness. My new position is support and resource people who have received housing so that they can maintain stability in their lives.

This is medicine, and it is fully in the scope of the role we have as EAMPs.

As CAM providers, it seems like we feel that we need to practice the most literal interpretation of our medicine to be practicing. In order to do that, we’re reliant on people being able to pay out of pocket or have excellent insurance plans that cover CAM without too many restrictions. This limits access to our services to many people, and in this way we perpetuate inequity. It’s as if we’re saying that only middle and upper income level people deserve holistic healthcare. Services like community acupuncture seek to address this, but in a way that is incredibly difficult for anyone but the owner of the clinic to make a living wage working there.

By doing this, we’re sending a message, and that message is that our medicine isn’t essential, and that practitioners of our medicine shouldn’t expect the financial stability of conventional medical providers.

It’s been my experience that CAM providers are incredibly idealistic about their medicine–it’s part of what makes us accept the far lower wages and uncertain employment. We become holistic care evangelists, perpetuating a dichotomy of us versus them in the “allopathic” medical community. This only serves to further the above message that we’re not essential, and we are cut off from being a part of larger medical systems that would allow us access to more patients that could benefit from our care. We lag behind in addressing social inequity and trauma-informed care, despite being in a great position to be a part of that movement.

We need to start getting ourselves into these systems in whatever way we can if we’re going to change this. We have something extremely valuable to offer–validation of people’s subjective feelings of being unwell. If we’re to do this, we need to learn to get over ourselves. The forms we currently utilize in our practice is limited. If we’re in medicine because we wish to be healers–something you hear a lot of from CAM providers–we must be able to make our medicine work for all people, including ourselves.

I have my first job with guaranteed income and benefits for the first time in years. No, I won’t be sticking needles in people or recommending herbs, but I’m still working to benefit people and help them live to the best of their potential. Isn’t this what we’re trying to do in medicine?

I have a theory that I’m putting into practice by taking this job that if I put in my dues, I can find my way back to working under the capacity of a licensed acupuncturist. I believe that what we have is of value to underserved people, and that we can be an ally to them in receiving the full range of care they need. I think our scope is broader than we think, if only we’re willing to extend ourselves.