Grounding in the medicine

I’m currently reading “Decolonizing Trauma Work: Indigenous Stories and Strategies” by Renee Linklater. For several years now, I’ve cultivated a lay interest in Indigenous studies because of the illumination it as a field gives to the shadow side of my country, culture and people. In this reading, I’ve come to see that though the land of our ancestors differs, we all carry a connection to our own Indigenous roots. By this, I mean the part of us that feels that the current system isn’t quite right, that something in it isn’t working for us, and hasn’t for a long time. This is the part of us that longs to connect to nature, to spirituality, to atone for the wrongs of our ancestors and to buck a conformity that may or may not work for us. I believe this to be the root of our modern discontent and the rise of burnout culture, where being anxious and depressed is strikingly pervasive.

When I think of it, that’s why I chose to become an acupuncturist. I wanted to tap into nature as my medicine, to learn about plants and the body’s way of healing itself. I wanted a different way of looking at the body, a holistic one that took into consideration the unique origin of pathology and strength in each of us. While CAM offers that, I didn’t question myself too deeply as to what it meant to take on a system of thinking that isn’t rooted here and that isn’t based on a scientific way of looking at the world. I got caught up on the flow of things, of academic performance and the idea of being able to offer something that could help people when other forms of therapy couldn’t.

My “ah-ha” moment in reading “Decolonizing Trauma Work” was when the author meets with a colleague at a conference. Neither of them are from that area, so they take a moment to smudge themselves and connect to the land where they are now.

When have I ever done that with the medicine I practice?

I practice a medicine that comes from East Asia, and that I am now practicing on American soil. So much effort was put into keeping my education “authentic” that even though I use the five elements as a framework to view the body, I’ve thought little of my personal relationship to those elements. Indeed, part of the attraction to Traditional Chinese Medicine was that it is a traditional medicine whose system of logic and practice is in tact and able to be studied in an academic format. We can never really take ourselves out of the frame, however. In my last post here, I began to think about cultural appropriation in TCM. Still meditating on that, I have to investigate further what I’m bringing to the table as an individual. While I wish to honor the ancestors of this medicine and the land it came from, I also have to honor my own ancestors, the land they came from, and the land I live on now. By virtue of who I am and where I live, I will always practice a hybrid form of East Asian Medicine.

On my maternal grandmother’s side, I have an ancestor from the Big Bend area of the Rio Grande who was a bonesetter. All of his knowledge is lost to me, but he remains a part of me; his DNA lives in mine. I’ve since begun to jet the long and complicated formulas I learned in school to get to know each herb that I use individually. From what little I know of Mexican traditional medicine, I have the impression of an herbalism similar to the traditional medicines of Europe that favor single herb recommendations. That’s what I grew up with, at least, with my grandmother cooking yerba buena after particularly filling meals for us to drink and favoring a wickedly pungent onion soup to combat colds.

I’ve also begun to directly approach the land and plants around me. Each week, I tend to the green space across the street from my house. Clearing the invasive plants, native species have begun to emerge. Skunk cabbage is shooting up from the banks of the creek, and Oregon grape is uncovered from ivy on a hillside. Long, seemingly dead stems of devil’s club can now be seen as the blackberries are hacked back, and salmonberries create spindly thickets. As I return to this space repeatedly, I’ve entered into a relationship with the land in a way I’ve never had before. Instead of sculpting the land and curating the plants as I do in my own yard, I’m tending to the plants that are already growing, a part of the indigenous ecosystem. I now spend hours contemplating the force that propels leaves through to the formerly dormant exterior of the plant and the growing strategies of different species. Slowly, I’m starting to feel what it means to be genuinely connected to the land, something that as a lifelong city-dweller, I doubted I could truly understand.

The third way I’m rooting myself is by remaining true to what patient population it feels right for me to work with. For better or worse, at this point in my life I am ridiculously compelled to work with people with severe mental health issues and who’ve lived in homelessness. I’ve tried to deny it, but it satisfies me in a way that a conventional acupuncture practice never has. Since CAM is a fringe treatment method in conventional healthcare, I’m unable to use my acupuncture license to do this, but it doesn’t matter. Being present, listening, and resourcing people is the same, regardless if you’re sticking needles in them. In addition, reading Linklater’s book bolsters my faith that I’m not wrong in the benefit CAM providers could bring to this work, if only we have the right additional training and are willing to work in larger health systems.

Where all of this will take me, I’m not sure. What I am sure of is how much more settled I feel in my own voice within this medicine. And for now, that’s enough.

American acupuncturists and cultural appropriation.

With the shooting in Atlanta directed at Asian-Americans, I feel the moment is ripe for acupuncturists here in the US to begin to unpacking the shadow side of our profession.

When we go to school to become acupuncturist, we go because we’re enamored of this different way of looking at the body. We go because we know there’s benefit to this non-scientific way of medicine, and in our education, we fall in love with it a bit.

What we don’t talk about, or even much think about, is what it means to be a non-Asian practitioner of a form of medicine that is deeply rooted in Asian culture. Our education is steeped in the old model of colorblindness, and we gleefully immerse ourselves in the five elements, zangfu theory, qigong and Taoism.

What are we doing when we do this? What is the harm?

This is something I’m still exploring for myself. I know that there’s harm in ignoring the racism that Asian people and Asian Americans endure in this country. I know there’s harm in exoticism, something Asian cultures routinely have directed at them. There’s negligence in not acknowledging what changes we’re necessarily bringing to the medicine as non-Asians.

I’m an American practitioner of both Buddhism and East Asian Medicine. I chose to practice these things because I believe that European-American culture doesn’t have all the answers. Yet I am participating in cultural appropriation the moment I stop thinking about what it means to cherry pick from other countries, cultures and societies the things I like, and leave behind what I don’t understand or agree with. I’m participating in a racist system when I don’t think take into consideration the history my country has of imperialism and colonialism, and the debt owed to BIPOC peoples.

In learning and practicing this medicine, we must fully take into account the cross cultural nature of this work. We need to stop blindly learning the taboos and superstitions that are woven into the fabric of EAM, and really look at what’s behind them. We must stop thinking of our medicine as being frozen in time and instead consider it as dynamic and informed by historicity, landscape and culture. We must take into consideration ourselves as American and European born practitioners steeped in our own land and culture, instead of trying to ape things as they have always been done.

It may not seem like it, but this is a profound way of respecting the origins of our medicine by fully acknowledging our own bias. The more we ignore what we ourselves are bringing into it, the more we participate in that exoticism and appropriation. When people immigrate to this country, there is a dialogue that happens on a very personal level, an trading of ideals, beliefs and values. This is an amazing opportunity, and also a loss.

We must face that the same is true for this medicine, and stop imagining that it is a pure way of looking at things, frozen in time and encapsulated solely in texts like the Shang Han Lun and Neijing. Yes, these are foundational works. But they exist in historical context.

To believe in purity is to unconsciously uphold a racist system, one that imagines that there is an ideal time and place to return to where everything was in balance. This has never been true, not in Asia, not in Europe or the good old days in America. There has always been conflict and disparity, and by practicing with this in mind, we prime ourselves to reckon with that which exists today in our own society.

Teaching the past as mythic and superior is harmful and propagandizing in any context. We need to grapple with things as they are now, and do a thorough accounting of the state of our profession as it exists in this country. Only then can we advance and take full ownership of what we’re able to offer.

The Roots of Inequity in CAM

When I think of the potential that CAM (complementary and alternative medicine) has in a truly integrative model of medicine, where CAM can be used not only to treat subjective complaints that have no real biomedical basis, but also to help those with medical trauma or who are reluctant to engage with a conventional care provider, I find myself simultaneously believing in the possibility whole-heartedly, and stumbling when I think of the reality. CAM is not a medicine built on equity, from the barriers to access built into our insurance system, right on down to how providers are educated. To truly extend our scope to all patient populations, we in CAM have much to reckon with.

The first thing I stumble on is healthism, originally defined by Robert Crawford as a “preoccupation with personal health as a primary — often the primary — focus for the definition and achievement of well-being; a goal which is to be attained primarily through the modification of lifestyles.” Though healthism occurs in conventional medicine, it is endemic in CAM. In practice, this manifests with CAM providers often making a slew of lifestyle recommendations without considering whether or not our patient is ready or willing to make that change. We gloss over the very real sociological barriers that these recommendations present to many people. Even a basic dietary recommendation of eating primarily based whole foods can be tremendously difficult for many due to access, time and education. There is also the prescription of supplements, none of which are covered by insurance, and the time and money it takes to maintain regular acupuncture appointments or yoga classes. Crawford put it this way: “To the extent that healthism shapes popular beliefs, we will continue to have a non-political, and therefore, ultimately ineffective conception and strategy of health promotion. Further, by elevating health to a super value, a metaphor for all that is good in life, healthism reinforces the privatization of the struggle for generalized well-being.”

I’ve made this mistake myself repeatedly in my acupuncture practice. It’s part of our education as providers. We’re taught that if the patient really wants to get better, that they should comply with the very practical suggestions we give them. It’s all too easy to gloss over what’s behind these benign seeming recommendations, which is not simply confined to the above. They also contain within them the seeds of paternalism and perfectionism, as if we CAM providers are somehow a step above others in our evolution as human beings, and creating the opportunity to confuse our role as healthcare ally with that of lifestyle guru.

Indeed, the pressure we put on ourselves as CAM providers here in the US is subtle but myriad. Holism becomes a coded perfectionism. We’re supposed to have a deep spiritual practice, meditate, mindfully exercise and keep fit, eat a diet so pure that even our perfectly formed shit is organic, abstain from anything more than moderate drinking or drug usage, avoid prescription drug dependency, and know what herbal tonics and supplements keep us from ever being ill for more than a day or two. Our lifestyles should keep us glowing with natural vitality. It’s taken me years to be at peace with the fact that my life doesn’t look like this, and that beyond that, that this is an expectation that reinforces inequity on a fundamental level. It’s as if we’re saying that those who can afford to keep such a lifestyle are somehow more worthy of good health than those who cannot, which is exactly what Robert Crawford was getting at.

How I see CAM as being able to bust out of this paradigm is by releasing any such expectations of our patients and ourselves. We have a unique placement in the healthcare system that has languished too long. Our very status of outsiders in mainstream healthcare give us the opportunity to work with people who fall through the cracks due to their reluctance to engage with conventional medical or behavioral health providers. Our training in looking at the individual as a whole is incredibly valuable, as is our ability to work with and treat conditions that may or may not have a biomedical diagnosis.

To do this, however, our education needs to change. For those with medical trauma or who distrust conventional care providers, having a CAM provider to talk to while undergoing treatment for a major medical condition can be enormously therapeutic. This involves a rethinking of CAM as an entire field. We’re taught that our primary therapeutic purpose is to give an alternative treatment, but the reality may be that the alternative treatment is the relationship itself with someone who is sympathetic and trained to look at the whole person. With this as a potential goal, we need to educate CAM providers to work with all people, not just the middle and upper classes. Students must learn to work with and value difficult patients as much as compliant patients, and we need better education regarding mental and behavioral health. Additionally, we need to know how to navigate and work with conventional healthcare systems and providers. Supplements, food therapy, and lifestyle recommendations should either take a backseat to training or be seen as equal in value to interpersonal skills such as reflective listening, motivational interviewing, anti-bias training, harm reduction, suicide prevention, and trauma-informed communication methods. If we emphasize the latter, we’ll be able to do the former with more skill and discernment than if the “Alternative” part of CAM is prioritized.

Going to step down from my soapbox now…FYI, this post has not been thoroughly edited, and may contain typos. Apologies.