The foundational theory of Acupuncture is like Noodles rests on a strong class analysis of the U.S.. Specifically: In the U.S., one of the richest nations in the world, why are so many people doing without health care?
Although Rohleder centers her answer to this question around acupuncture, in all reality, her answer is one that can very easily be fleshed out to understand the bigger picture of health care in the U.S.. For example, to start off with, Rohleder asserts that with class comes values–and with different levels of class comes different values. Rohleder very effectively brings home the point by painting a scenario of a woman getting ready to go out to a party. If she is rich, she more than likely will have gotten a nice glossy invitation and will have been invited by higher ups in her job. She will be going to the party because it will be a great way to network (i.e. make connections that will help her career) and because her boss will expect it of her. She will bring along her partner (if her partner is a “he”) and have a nanny stay with the kids. She will buy a new business outfit for the occasion and maybe go out to get her hair and nails done.
By way of contrast–Rohleder asserts that a working class woman would get a word of mouth invitation from a friend she works with. The party would be more “personal” in that it would probably be a baby shower or a wedding shower. She would more than likely not buy new clothes for the occassion and would bring kids with her rather than a partner (partner probably has to work and there’s no place to leave the kids otherwise).
By fleshing out this scenario of two women from different classes going to a party, Rohleder makes the conclusion that each of these women and their communities *value* something different. Rich(er) women value elegance, status, personal service, refinement, individuality, beauty, exoticism, and uniqueness. In other words, how can you get that promotion or raise if you aren’t unique? How can you show you are unique if you look like everybody else in blue jeans and a t-shirt?
Working class women value interdependence, creativity, hard work, resourcefulness, personal relationships, directness, and loyalty. Or, in other words, how are you going to get to that party and have a good time if you don’t figure out what to do with the kids? How are you going to figure out what to do with the kids if you don’t have a community of women to depend on?
So if you flesh out these values into the world of health care, you begin to see that health care is about a lot more than “getting insurance.” That it’s also about *values*. That, as Rohleder asserts, rich(er) communities are going to feel more comfortable going to a doctor that wears a white jacket, has an expensive stethoscope, uses big words, spends a lot of time asking questions and filling out paper work, and makes the patient feel as if s/he is the only patient that this doctor has or cares about (Individuality, uniqueness, etc, right?).
By way of contrast a person from a working class background will more than likely feel patently uncomfortable in those types of surroundings. Answering hundreds of questions? Filling out tons of paper work? All that attention on “me” when “me” knows from experience “we” is the only way to be creative and resourceful?
As a result of this class critique, Rohleder implemented the Community Acupuncture business model in her own practice. The community acupuncture model of practice has been around for a while (it is considered “normal” in China and was brought to the U.S. by various radical practitioners like Miriam Lee and NADA and the Black Panthers), but it is not necessarily recognized as a sustainable or “normal” way of practicing even within the acupuncture community. The main way most people in the U.S. learn acupuncture is through acupuncture schools–and acupuncture schools teach a business practice that encourages practices that model rich(er) class values: individuality, exoticism, multiple services in one place–and above all else–hugely expensive prices.
Community acupuncture models, on the other hand, center working class values. Interconnectedness is supported through multiple people in the treatment room. Mothers can bring kids, caretakers can bring loved ones, friends can bring friends. There is limited paper work. Few questions. The work is done by the needles and the client–so there really doesn’t need to be much talk between the acupuncturist and the client.
As I read this section of the book, I was really excited to see so much of my own personal experiences with health care acknowledged and respected. The number of times I have felt intimidated by all the questions and paper work of a doctors visit have been innumerable and have often led to bad situations where I was answering what I thought the doctor wanted me to say, rather than what was real for me. And I have definitely NOT gone to the doctor because I didn’t feel like dealing with the inevitable questions around weight or sexuality or drug use: when the hell was I going to lose weight? Oh, I don’t know, maybe when the doctor paid for my gym membership!
I’ve said it before, even if women of color all had free health care starting tomorrow, I really question if there would be a massive influx of women of color going to the doctor. Lack of access is NOT the only thing keeping so many of us away from the doctor, although it certainly is a huge obstacle.
I also come from a background of organizing that prioritizes intersectionality (race, gender, class, citizenship, all intersect and can not be seperated out of a person’s body. For example, you are NOT just white. You are a white upper-class white male citizen.), and so I constantly wondered, how might some of the “values” be changed according to other identities? In other words, a person who is in the U.S. without documents will really appreciate the lack of questions, the lack of paper work. At the same time, a woman of color who has been ignored and shunted aside by health care workers her entire life may find the lack of questions to be alienating. Or, just another example of health care workers not caring about her (I am thinking, by way of example, of the black woman who was ignored when she fell out of her wheel chair and then went into seizures, all while right in front of hospital workers). I also wonder at how many older people who have lived under the “doctors know best” rule would feel uncomfortable, or even stressed out, by the more free flowing “stand back” values of community acupuncture. If you don’t have the skills or strategies to trust yourself and what your body is doing to heal itself (because those ARE skills–skills that are purposefully challenged and destroyed by authoritarian structures that are modeled on “control” and “obedience” [i.e. schools, doctors, the army, police, etc]), it can be like free falling into hell to be told “trust yourself.” What happens when the last time you trusted yourself, you wound up being beaten until you passed out? What happens when what you really need to trust yourself is the presence of a person?
But in the end, I think that these are questions of practice. That is, they are questions that need to be dealt with on an individual level within the practice rather than incorporated into the actual theory. The *theory* of Acupuncture is like Noodles is sound, and can function on its own even without the race/gender/citizenship/etc analysis added in–namely because it is addressing the structural problem of ‘capitalism,’ and capitalism effects everybody who is not in the top five percent of the economic structure.
But I do think that if community models of acupuncture are going to be working with very specific communities (for example, native peoples who have gone through boarding schools, or older black folks who lived through apartheid in the U.S., Hurricane Katrina survivors, etc), it would be really good to open up the community acupuncture model just a bit–to allow the space to say, working class people of color who went through Hurricane Katrina may need a hand to hold onto while they work on recovering and healing themselves.
Cross posted at Detroit Community Acupuncture
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July 23rd, 2009 at 3:06 pm #
This is spot-on. It’s not just lack of access to healthcare—I had insurance for years before I used it. Part of that was being raised in a culture where….you don’t go to the doctor until it’s just about time to call a priest. Part of it was….”oh, I’ll go to the doctor in a month or so, after I get out from under some bills” because of co-pays and deductible. But a lot of it was….knowing full well I won’t be acknowledged as a real human being, an intelligent human being, a person worthy of being listened to, taken seriously, capable of understanding…
I knew something was wrong with me for years before I finally broke down and saw a physician to get my diagnosis of hypothyroid. I just spent those years in denial, giving my thyroid even more opportunity for shutting down, letting my symptoms build because….I didn’t know what it was that was wrong with me. And you just can’t be an older, working class woman (single mother no less) and present with those symptoms and not be told (a)there’s nothing wrong with you; it’s all in your head or “it’s just stress” and/or (b)here, have some anti-depressants! and/or (c)god, what a lazy, whiny bitch. maybe if she’d get off her ass and do something she wouldn’t feel so fatigued.
Because another part of that culture I was raised in was “work harder, dammit! people are counting on you! you don’t have time for this shit!!” Especially for women. Real mothers put themselves last kinda thing—I internalized that bigtime.
July 23rd, 2009 at 5:57 pm #
—because those ARE skills–skills that are purposefully challenged and destroyed by authoritarian structures that are modeled on “control” and “obedience” [i.e. schools, doctors, the army, police, etc]), it can be like free falling into hell to be told “trust yourself.”—
i am thinking about this and wondering how do we teach those skills. is there a modality for trusting yourself? and i am thinking about this personally like after i was raped i had to learn how to trust myself again. and i had to acknowledge that my responsibility in being raped was that i had ignored my instincts because i wanted to appear *nice*, i didnt want him to think that i didnt trust him…
and so i am trying to think how did i learn (as much as i have learned which is in no way ideal or concrete) to trust myself again…
i mean i know one of the things that i learned was to trust myself enough to ask for help when i needed it. but that is not a simple solution because often there is no one who can help in a way that wont demean you…
–What happens when the last time you trusted yourself, you wound up being beaten until you passed out?–
that. that. that is the question.
maybe we need to see that trusting yourself is not a full proof plan. its not a magic bullet. its not a promise that you will never experience violence again or that you will always be safe.
but being able to trust myself is a fundamental skill to being able to build healthier communities.
July 23rd, 2009 at 6:24 pm #
la lubu–that is the very thing I’ve been thinking of as I write/read about acupuncture–I was in that SAME situation. sexism/racism intersected to make me feel like the scum of the earth because I couldn’t function the way I was told to–and for YEARS I didn’t go to get help because I had been told by community AND doctors–this is a personality issue (too stubborn, lazy, bitchy, moody, etc), rather than an actual physical problem that has an actual physical diagnosis and multiple types of treatment methods.
And it makes me wonder–in medical care in general–what would be the thing that would open up the space where working class immigrant women *would* go to the doctor? I think many many many women I know who are now going to acupuncture are going because it’s cheap and because of word of mouth. Could that be translated into the medical system as it stands right now? That is, a good, cheap, efficient doctor gets a few patients and then they spread the word?
I think probably not, quite honestly–because of insurance. The first question everybody would ask–does this person take my insurance?
And you know, the funny thing is, I’ve heard this new strand of thought being put out by republicans and democrats alike–the *real* problem with health care in the u.s. is that patients are *alienated* from the “true” cost of health care. That is, they don’t really *think* about how much health care costs, because insurance will cover it. As such, rather than advocating for lower costs and forcing competition between doctors, patients are just being lazy suckers and ordering four tests for the same thing all by themselves.
Besides the fact that most people I know don’t even *have* health insurance, and as such, are almost violently aware of how much health care “really” costs–I think that this scenario (not being able to go to a doctor recommended by word of mouth because of insurance) shows that it is *insurance companies* that restrict patients ability to force competition. That as tricky as those fuckers are about twisting and turning reality into “patients fault”–all of us know that if we try to tell a doctor we already had that test and can we have a different one (because we’ve been doing a little research online), if we are women, the answer will be condescending attitudes, snottiness, etc.
I just am not really clear how we can all expect health insurance to fix the problem that health insurance created to begin with! I think state regulation would have a bigger effect–which I guess would be implemented through universal health care…I’m not sure. I don’t get all the nitty gritty details…but either way…if I could find a doctor that didn’t accept insurance and only charged 15 dollars a visit–maybe 50-75 for a hospital visit…i’d go. even though I do have insurance. at this point in my life, i could afford to go, and I’d be willing to pay money out of my pocket to fund the creation of a new system that is not dependent on health insurance.
which, i guess, is why I am going to community acupuncture so much!!! :p
July 23rd, 2009 at 6:40 pm #
maia…that question–what would a modality look like to rebuild trust in yourself….SUCH a good question, and one I’ve been thinking about ever since I first read this book. hearing it in your words–it made me remember the story told me about an acupuncturist in NY. a woman was going to acupuncture behind her husbands back. she was being beaten by him, and the kids were too. and when she went to acupuncture, the acupuncturists could tell that the kids were really stressed out so they offered to use ear seeds (which produce the same effect as needles but only go on the ears–just a bit of tape with small seeds on it), on the kids to help calm them down. Well, the woman said that if her husband saw the ear seeds, they’d all be in trouble, so the acupuncturist worked to find a new point on the ear where the seed would be hidden from view (he basically put the seed over the same spot he would have on the front of the ear, only on the back of the ear where the tape couldn’t be seen unless hair and ears and glasses were moved).
As the story went, a few months later, the woman shared with the acupuncturists that she had started school and was creating a plan for escape.
I think of this example ALL. THE. TIME. How amazing it must have been for that woman, what a relief it must have been to be able to admit, my kids need help–and not have to worry that they’re going to be taken away from her.
health care workers *especially* are trained to take kids away from parents, to force/pressure women into reporting assaults/abuse…health care workers are trained to undermine the trust you have in your choice making and skill building, really. we all feel like “we have to do something” to help people in abuse–and with that, everybody assumes that “doing nothing” means nothing is happening–that doing nothing can’t ever translate into–woman feeling like her choices are being respected for once in her life, and while her choices are being respected she is getting her health care taken care of…as are her children…that maybe getting health care might be the one thing that empowers a woman enough to be able to create networks of support that can help her escape or lessen abuse?
I mean–it’s a scary thought. How many murders have their been because health care workers looked the other way when they saw signs of abuse? But at the same time–maybe that’s not the choice either–maybe it’s not a choice between intervening or looking the other way–but….listening to what the woman says she needs and then doing it with her? i mean, how many women are going to ask for help when she knows what the consequences can often be? I’m thinking of women on drugs when they’re pregnant…ask for help they are told over and over again…and so they ask for help getting clean, and bam, they’re thrown in prison or have their kid taken away from them–just like you said was the *real* issue here–what happens when you trust yourself, but get your ass kicked any way….
so–on the question of modality–maybe–asking for help–but twist it just a bit, and make it, learn to trust your knowledge on WHO are safe people to ask for help from?
July 23rd, 2009 at 6:50 pm #
and i’m thinking too, of the kids I used to work with on campus–largely from detroit–I was ALWAYS called “ms. bfp” even when I told them it was alright to call me bfp…and then I had freaking 18, 19, 20 year olds, even, asking me, can I go to the bathroom? Can I get a kleenex to wipe my nose? At first this really irritated the fucking SHIT out of me–grow the FUCK UP, people, get a damn kleeenx and wipe your fucking nose!!!! JESUS!
but then I realized–this is the level of control the public school system has over youths. The level to which the public school system teaches children not to trust themselves. They don’t get to just go to the bathroom when they have to go–they have to ask for permission first. and what happens when a teacher tells them NO? After 18 years of being forced to defer to outside forces telling you when you can go pee….what have you learned about trusting yourself? You can’t even trust your damn self to know when you can go to the bathroom!!!!
as a university teacher, some of the methodology i used within that classroom environment was to be very non-judgemental about students need to ask first–to nod quickly and without comment and not make a big deal out of it–to sort of register their asking as a ‘ritual’ rather than an actual request. Also, many of us worked this sort of issue into papers the students had to write–like “what is the difference between highschool and university” etc…oh, and we would also spend a lot of time in the class room just talking about what this “transition” is to them….but that is a very structured environment where if a teacher is aware of how transition problems can effect a classroom, they can incorporate it into their teaching methodology…what do we do in the “real world??” where there are almost NO spaces created to relearn trust in oneself–and in fact, many in our communities outright undermine that trust building (ala bill cosby)…such that “learning to trust yourself” is actually threatening not just to the police/nation/state/etc–but to your next door neighbor and your partner and your mother?
July 24th, 2009 at 5:16 am #
This reminds me a little of the discussion here awhile back (forget which post it was on), about “listening to your body” in terms of what to eat (among other things), and how much is privilege involved in having the time/space/energy to do that listening. And even if individuals could somehow carve out enough time/space/energy for that, how do they have the sense of entitlement to do it? I don’t know if individual health care “providers” can provide that – I don’t know if individuals can do it for themselves. I suspect that this has to be done by small groups, by communities – that we provide this for each other, that we provide FOR this.
But what that looks like on the ground, I’m not sure – I’m not sure how much of it even has to be verbal (sometimes hand-holding is just that), but *especially* when things DO become more verbal, I agree that looking at specifics might be required, as you mention in your last paragraph above. I think it’s really important to open up the profession for that reason – to make it easier & less expensive to become an acupuncturist – because sometimes it *does* matter to people whose hand is holding theirs – it matters that they can directly relate to whatever you are going through. It’s a credibility issue. I’m not sure what it takes (besides desperation?) to trust that a person who might not have similar life experience actually cares about your life.
I really wonder what all these questions look like on the ground in places that have a more collective sense of health, and where a sense of entitlement is informed by collective responsibility (see myth #9 in http://www.pnhp.org/news/2008/february/10_myths_about_canad.php) Of course, you still have to deal with issues of alienation – theoretically our government is our collective responsibility but people still don’t vote…
July 27th, 2009 at 4:13 am #
Thanks for writing about health & care.
July 28th, 2009 at 10:02 am #
Dear bfp,
I appreciate SO MUCH the time and attention and careful reading you have given to “Noodles”. It means a lot to me and it means a lot to the fledgling community acupuncture movement.
One of the things I think a lot about is how acupuncture in this country ended up in its current sorry state. What particularly boggles my mind is how the luminous example of NADA and its community organizers has been essentially ignored in favor of creating a bloated, unsustainable acupuncturist bureaucracy that is apparently hellbent on hoarding acupuncture instead of sharing it. I guess I shouldn’t be boggled, given the obvious influence of race, class, etc. in how things have played out, and the general wretchedness of healthcare in the US. But it’s terrible, and it really only happened over about 30 years, within quite a small group of people — so it seems like it didn’t HAVE to happen that way. What obsesses me is, can we, and HOW can we, make sure it goes differently with community acupuncture? Can we alter the course of acupuncture in this country, so that it’s actually useful to people?
One of the things that has never really happened until now is that patients never weighed in on the issues, especially on how the acupuncture profession should be set up. Most of what happened in terms of licensing, legislation, etc., was driven by (middle/upper middle class) people who were acupuncturists or wanted to be acupuncturists. What makes NADA so beautiful also was a disadvantage to them in these terms: the acudetox technicians were mostly people who were already serving their communities by working in treatment programs, and they were BUSY. They were not really in a position to try to do anything about the course that acupuncture was taking in the country as a whole. And the people who are served by acudetox technicians in those treatment programs generally have more important things to worry about, also, than where acupuncture is going.
Also, nobody had the Internet.
What I think might make the difference this time around is what you are doing: being clear and eloquent about the meaning of acupuncture from the perspective of someone who is receiving it, and who cares about her community’s access to it. The thing is, the people who dominate acupuncture currently in this country have been successful in defining its meaning in a way that largely excludes patients -as ridiculous as that is — and that absolutely excludes communities. They’ve made it all about individual consumers, and all about professionals. And acupuncture is not really about individuals, and it’s not about consumption, and it sure as hell is not about professionals. So they have pretty much managed to make acupuncture meaningless. And it will stay that way unless and until we do something about it.
That you are using your voice towards restoring real meaning to the practice of acupuncture — and that’s exactly what you are doing — means the world to me. Like everything in this movement, it may take quite a while before it starts showing an obvious effect, but it’s hugely important. Thank you.