Big Questions with Big Answers
Getting regular acupuncture has made me realize that I want to practice this medicine. Where should I go to school?
Great question, and I’m so excited that you want to pursue this - we need you!
In order to answer this without writing an entire book (if you’re interested in the book version of this answer, see link below), I’ll simply say that the only acupuncture training program currently offered in the U.S. that I can fully stand behind is POCA Tech.
I did not attend POCA Tech, but if the school had been around when I decided to study acupuncture formally, I would have gone in a heartbeat. (For the record, I receive no incentives, financial or otherwise, to promote POCA Tech.) Here is why I support this program:
Affordability. If you’re a potential student, and you make an ordinary income, this training is excellent and reasonably priced and will not leave you saddled with massive loans.
Trauma-informed care. The curriculum does not shy away from the problems of health care in this country; for instance, training includes trauma-informed care, social determinants of health, and effects of structural violence. In other words, POCA Tech is graduating compassionate, informed practitioners, which I believe is essential to the practice of good medicine.
(From the POCA Tech website): POCA Tech offers its students something no other school can provide: the collective, freely-shared wisdom earned from delivering over 1,000,000 treatments annually to a combined patient base in the hundreds of thousands. These numbers provide POCA Tech students with significant research opportunities, due to large patient samples. In addition, POCA member clinics provide dozens of employment opportunities per year for its graduates.
Along these lines - I’m occasionally asked if getting an acupuncture treatment in the community setting is a “lesser” treatment than getting a treatment in a private setting, and the answer is no. Since my graduation from OCOM in 2009, I’ve given over 50,000 acupuncture treatments due to working in the community model, which means I’ve had the honor of more than 50,000 instances of taking pulses, palpating meridians, choosing points, and lightin’ up meridians. I’m so thankful for the opportunity to treat such a wide variety of patients from different backgrounds; because of my patients, my hands are seasoned.
Lastly, Lisa’s quote that sums it all up for me: “We need to decouple acupuncture from competitive self-care in capitalism. We need to restore it to a context of cooperation, to emphasize it as a way of cherishing our common humanness. We need the sunny meadow, which has room for everybody, more than we need a bunch of individually perfect lawns.”
If you’d like to read more about the community acupuncture movement, and whether it’s right for you, consider reading Lisa Rohleder’s Acupuncture Points are Holes or visit her blog here.
TELL ME MORE ABOUT THE ORIGINS OF COMMUNITY ACUPUNCTURE?
"Here’s an overview of what I wish I had known, an abridged people’s history of acupuncture in the United States.
Chinese immigrants in the 19th century, fleeing famine at home and seeking work on the railroads and in the gold mines, brought acupuncture and Chinese medicine to the US. The oldest recorded practitioner was Doc Ing Hay who settled in John Day, Oregon, about 5 hours away from Portland. For decades, Doc Hay practiced out of the Kam Wah Chung store, apothecary for the Chinatown in John Day.
Most of the Chinese laborers there lived in tents. Sometimes at night, for entertainment, local cowboys would ride through shooting randomly into the darkness. The Kam Wah Chung store, now a museum in a state park, is a little wooden building reinforced with tin. The windows are narrow and shuttered, and the shutters are pocked with bullet holes. The kitchen and the living quarters of the store has an especially thick floor by the stove, so that Doc Hay and his business partner could chop wood without having to venture outside. Anti-Asian racism at that time was vicious; the Chinese Exclusion Act of 1882 was the only law in the history of the US to prohibit immigration on the basis of race.
Doc Hay, despite being brought up on charges three times for practicing medicine without a license, treated hundreds of patients, both within and outside the Chinese community until 1948. In 1910, many of the Chinese laborers moved out of John Day, but Doc Hay stayed, treating local farmers and ranchers for a long list of frontier problems, including blood poisoning, frostbite, typhoid, infertility, and venereal disease. And influenza. When flu broke out within a highway construction crew near John Day in 1919, Doc Hay reportedly arrived on the scene with huge pots of steaming, bitter herbal decoctions. The crew recovered. Long-time John Day residents claimed not one of Doc Hay’s patients died during the Spanish Flu epidemic that killed 3,500 people in Oregon alone.
After Doc Hay’s death, his family bequeathed the store to the town of John Day. In the process of creating the museum, workers found a box under Doc Hay’s bed with $23,000 in uncashed checks, the equivalent of a quarter of a million dollars today. It seems he didn’t cash the checks because he knew, especially during the Depression, many of his patients couldn’t afford to pay him.
20 years after Doc Hay retired, another talented Chinese Medicine practitioner (acupuncturist, previously nurse-midwife) named Miriam Lee was working in California, where acupuncture was illegal. She had a day job on a factory assembly line and treated patients out of her house; people lined up on her back staircase until the stairs broke. A sympathetic doctor offered her the use of his office in the mornings, where she treated 80 patients in 7 hours, 5 days a week. Eventually she, too, was charged with practicing medicine without a license, but her patients packed the courtroom and the authorities yielded, first making acupuncture an experimental procedure and eventually legalizing it. Later in her life, Miriam Lee admonished her acupuncture students:
'To practice acupuncture, you must be certain of your intention, your purpose in doing so....If the intention is wrong, if you are concentrating on earning money, treating fewer patients and charging high fees, doing little for much profit, you may get some results from your treatments or you may not.'
At the same time Miriam Lee was treating 14-17 patients an hour in California, on the other side of the country, the Black Panthers were experimenting with delivering acupuncture as part of their community service work. Also known as Survival Programs, these efforts included free breakfast for children, health and dental clinics, sickle cell anemia testing, food and housing cooperatives, support for prisoners and their families, even an ambulance service. Besides developing black self-determination and self-organizing, the Survival Programs were intended to provide a model to all oppressed people for taking concrete steps to address their situation.
In the South Bronx, the Young Lords, a Puerto Rican nationalist group, and the Black Panthers, took over Lincoln Hospital to protest poor medical care, discrimination, and lack of services, including addiction treatment. During their occupation of the hospital, they established the People’s Drug Program, which later became Lincoln Detox and included an acupuncture collective. They learned that a Dr. Wen in Hong Kong was reporting miraculous success in treating opiate addiction by means of auricular acupuncture, and they set out to duplicate it.
Dr. Wen’s protocol involved using electrical stimulation on a point in the ear. The acupuncture collective of Lincoln Detox found that this approach got good results, until the electro-stim machine broke, and they found out that ear acupuncture alone got even better results. It was also cheaper and easier to learn. Eventually, through trial and error, they developed a 5-point auricular protocol used for all kinds of addiction. The ear is an acupuncture microsystem, often pictured as an upside-down baby, with points corresponding to internal organs on the inside of the ear, and the toes, fingers, and other extremities on the outer edge. The 5-needle protocol includes the points corresponding to the lung, liver, kidney, sympathetic nervous system, and a “spirit” point called Shen Men.
In 1979 the authorities dismantled Lincoln Detox by force. The use of acupuncture to treat addiction continued at Lincoln Hospital with the work of NADA, the National Acupuncture Detoxification Association, and the 5-point protocol became known as NADA 5NP. NADA has trained over 10,000 health workers, including nurses, social workers and counselors, to use the protocol for what is now known acu-detox.
Most of the Cascade AIDS Project clients and volunteers I knew who were getting acupuncture were reaping the long term benefits of the Lincoln Hospital occupation, in the form of acupuncture having a modest role in public health. They didn’t know that, and neither did I.
During the same years that the Lincoln Detox acupuncture collective was operating outside the law, a small group of white students of Chinese acupuncturists were working steadily to build what would become the infrastructure of the future acupuncture profession, including schools and standardized curricula. They were mostly professionals, and their priorities reflected their socioeconomic position. They were going to build the acupuncture profession that white upper- middle-class professionals thought the US should have.
It’s as if there are two different directions in the development of acupuncture in the US, like separate moving walkways in an airport: marginalized communities using acupuncture and Chinese medicine to take care of themselves, and more privileged individuals working to fence it off with the goal of increasing its status."
-Lisa Rohleder, Acupuncture Points are Holes
Can acupuncture help with chronic pain?
The answer to this question is complex, but in short, yes.
From Lisa Rohleder's Punking: The Praxis of Community Acupuncture:
The largest cluster of nerve cells in the body is the brain, and all pain, no matter where we perceive it, is actually happening in the brain. Many people know that we don’t really see with our eyes or hear with our ears; our brain takes information from the sensory organs to produce what we experience as vision and hearing. However, most of us don’t realize that pain is similar: we don’t feel pain with our peripheral nerves, we feel it with our brains — which means the experience of pain arises out of the brain integrating enormous amounts of information about every aspect of our lives, including emotional and social.
One of the most important qualities of the nervous system is its plasticity. All of the nerves in the body, including those in the brain and the spinal cord, are constantly changing in response to what’s happening and what they, themselves, are doing. This has huge implications for pain: it’s a complex, dynamic, organic process as opposed to the equivalent of a light blinking on a dashboard indicating a mechanical problem that can be fixed by replacing a part.
Our brains evolved to survive and what we call neuroplasticity is a function of survival priorities. Our brains are wired to respond as quickly as possible to rewards, and to make our responses more efficient over time. The more we access pathways in the brain, the faster and more efficient those pathways become. Think of an early human who’s foraging for food and trying to avoid saber-tooth tigers. Both reward circuits and fear conditioning operate towards the back of the brain, and they’re much faster than the functions that happen in the front of the brain, like rational judgement and planning. When you need to get away from a saber tooth tiger, you need to move fast and instinctually, not sit back and reflect.
Recent research shows that the neuroscience of persistent or chronic pain has overlaps with both the neuroscience of learning and the neuroscience of addiction, because of the nature of reward circuitry in the brain. Feeling pain is something we learn to do the way we learn to play a musical instrument: the more we do it, the more we practice, the better we get at it. And like addiction, feeling pain involves both anticipation and reward, in the form of relief from pain.
Just like alcoholism involves drinking more and more alcohol to get diminishing returns of pleasure and relaxation, persistent pain can involve diminishing returns in seeking relief by lying down on a couch or taking pain medication. Certain things swamp the reward circuits of the brain, like opioids, smoking, and junk food. The more the reward circuits are swamped, the faster those circuits get, which can look like a person in pain compulsively seeking relief, even when the methods of relief are helping less and less. Meanwhile, as the nervous system learns to feel pain more and more efficiently, it’s as if an amplifier has been turned up and the pain becomes more and more intense. Anticipation of pain increases pain; fear of pain increases pain.
A vicious cycle is engaged, where the back-of-the-brain circuits of anticipation and reward get faster and faster. Feeling pain and seeking relief take over a person’s experience in a similar way that addiction can take over a person’s life. Even if the person rationally knows that what will help with persistent pain is gentle exercise, the part of the brain that can make rational decisions is less and less accessible. The small, ordinary pleasures of day to day life get crowded out, which means that the person gets less practice feeling pleasure and more practice feeling pain. And of course, the social aspect of persistent pain can be as profound as the social aspects of addiction: as anticipation of pain leads a person to withdraw from the activities of daily life, they become isolated. Isolation increases stress and negative emotions, which in turn increase pain.
At this point, research suggests that the only way to heal the brain from the vicious cycle of compulsive relief-seeking and amplified pain is to gently re-establish connections in the brain that provide small, reliable doses of positive feeling. Over time, low-key rewards that don’t swamp and overwhelm the circuitry can begin to have an effect on the pain amplifier, and actually turn it down. Neuroplasticity can be engaged for the purpose of learning how to feel other things than pain.
Recovery from chronic pain is a gentle, supportive, non-judgmental, active process — which is where community acupuncture clinics can really shine. Many of the same principles involved in trauma informed acupuncture come into play, because using community acupuncture to address persistent pain is about people learning to use the clinic as a source of small, reliable doses of positive feeling. Relaxation is a skill. Accessing support is a skill. Being in a social setting even though you’re in pain is a skill. Community acupuncture patients tend to develop a sense of competence around receiving acupuncture, which means developing neural connections of learning and reward that are different from the grooves of the vicious cycle of persistent pain. It’s all about people being empowered to use the clinic on their own terms.
Let’s reiterate: Recovery from chronic/persistent pain is a gentle, supportive, non-judgmental, active process.
According to our biomedical friends who work in safety-net clinics in Portland, acupuncture works because it increases neuroplasticity. (You could probably explain that in terms of qi if you wanted to.) But acupuncture treatment isn’t something the practitioner does to the patient, it’s something the patient and practitioner do together (and we don’t mean the patient has to quit smoking, or otherwise change their habits, in order for the treatment to “work”). Receiving acupuncture is an active process for the patient, even when they’re sitting or lying still. The acupuncturist can support the patient’s process by providing a safe environment in which to practice the skills of relaxing, receiving treatment, and accessing support.
Understanding persistent pain (video)
Can acupuncture help with weight loss?
In short, maybe. Acupuncture can help you unwind and manage stress, and therefore assist in making more intuitive choices around foods that support your body/mind. But to thoroughly answer this question, we need to dig a little into weight loss as an industry, and our culture’s obsession with fat-shaming (which has sadly made its way into medicine, and harmed people).
If Only Poor People Understood Nutrition: A piece on social determinants of health, including food insecurity.
Poodle Science (video): An animated video exposing the limitations of current research on weight and health.
Maintenance Phase: Hilarious. Dedicated to debunking the junk science behind health fads, wellness scams and nonsensical nutrition advice. Did I mention hilarious?
Tell me more about acupuncture and substance abuse?
I’m grateful that there have been people/organizations that have taken the time to answer this question in detail.
Penn North Acupuncture video: A pioneer in the holistic approach to substance abuse and addiction recovery, Maryland Community Health Initiatives (Maryland CHI), Penn North’s parent organization, was one of the first programs in the United States to use acupuncture in the treatment of addiction—launching the first acupuncture and meditation program in the Baltimore City Detention Center in 1993. Expanding on the demonstrated effectiveness and success of that original program, Maryland CHI opened the Penn North Neighborhood Center in 1995. Today, Penn North is a fixture in the community—a safe haven for individuals seeking support, guidance, friendship, treatment, and a healthy retreat from the negative influences in their daily lives.
A visual journey through addiction: NY Times piece, informative, heartbreaking, necessary.
Erased History (video): An essential piece of acupuncture history, too frequently neglected. The Black Panthers were instrumental in bringing healthcare to neglected communities - and in the form of community acupuncture!
Understanding Adverse Childhood Experiences (ACES) video
On shame and judgment, two quotes by Gabor Maté to sum it up.
The first:
In short, the addiction process takes hold in people who have suffered dislocation and whose place in the normal human communal context has been disrupted: whether they’ve been abused or emotionally neglected; are inadequately attuned children or peer-oriented teens or members of subcultures historically subjected to exploitation.
To know the true nature of a society, it’s not enough to point to its achievements, as leaders like to do. We also need to look at its shortcomings. What do we see, then, when we look at the drug ghetto of Vancouver’s Downtown Eastside and similar enclaves in other urban centers? We see the dirty underside of our economic and social culture, the reverse of the image we would like to cherish of a humane, prosperous and egalitarian society. We see our failure to honor family and community life or to protect children; we see our refusal to grant justice to Aboriginal people and we see our vindictiveness toward those who have already suffered more than most of us can imagine. Rather than lifting our eyes to the dark mirror held in front of us, we shut them to avoid the unsavory image we see reflected there.
The Torah says that Aharon, the brother of Moses, was commanded to take two hairy goats and bring them before God. Upon each, he was to place a lot—a marker. On one he was to place the lot of the people’s sins, “to effect atonement upon it, to send it away to Azazel into the wilderness.” This was the scapegoat—who, cast out, must escape to the desert.
The drug addict is today’s scapegoat. Viewed honestly, much of our culture is geared towards enticing us away from ourselves, into externally directed activity, into diverting the mind from ennui and distress. The hardcore addict surrenders her pretense about that. Her life is all about escape. The rest of us can, with varying success, maintain our charade, but to do so, we banish her to the margins of society. ~Excerpt from Ch. 23 (The Social Roots of Addiction) from Dr. Gabor Mate's book, In the Realm of Hungry Ghosts
And quote #2:
If our guiding principle is that a person who makes his own bed ought to lie in it, we should immediately dismantle much of our health care system. Many diseases and conditions arise from self-chosen habits or circumstances and could be prevented by more astute decisions. According to a recent study by British Columbia’s health officer, the provincial government spends $1.8 billion dollars on diseases caused by unhealthy lifestyles. The average per capita health care cost for those with no risk factors is $1,003 compared with $2,086 per capita for those with three risk factors, including smoking, being overweight/obese and physically inactive.
All of these factors, we might say, represent “choices,” and even after a heart attack, for instance, some patients will continue to bring these risks upon themselves. The same is true of people with chronic bronchitis who persist in smoking, skiers who brave moguls and steep slopes despite having sustained fractures and people who remain in a stressful marriage despite requiring treatment for depression or anxiety. No cardiologist, respiratory specialist, orthopaedic surgeon or psychiatrist would refuse treatment on the ground that the problem was “self-inflicted.”
When it comes to drug addicts, some people believe we ought to apply different criteria. One afternoon in August 2006 I called a CBC radio program to discuss Insite, Vancouver’s controversial supervised injection facility for drug users. Just before the moderator turned to me, he interviewed an RCMP officer. Dozens of addicts who have overdosed at Insite have been successfully resuscitated, the host pointed out. Lives have been saved that might otherwise have been lost. That’s not necessarily a good thing, the Mountie spokesman explained. “It’s well known that negative consequences are the only major deterrent to drug use. If you are saving people’s lives, you are sending the message that it’s safe to use drugs.” This officer, on behalf of Canada’s national law enforcement agency, seemed willing to let people die in the hope of teaching a lesson. He seemed unaware, or not to care, that in the 1990s Vancouver’s injection users had received an average of 147 such “lessons” every year in the form of overdose deaths, without any discernible deterrent effect.
It would be encouraging to believe that such a dark perspective is confined to the minds of some police officers. Not quite so. At about this same time the Globe and Mail published an article on Insite that approvingly quoted Anthony Daniels, a retired British psychiatrist. “I suppose the argument for the safe injection site is it would reduce the number of deaths,” he told Globe columnist Gary Mason. “But I don’t see why we should reduce the number of deaths. It is not our responsibility to do so. It is the responsibility of the addicts themselves. If they want to inject themselves with heroin, it’s a very bad choice. If people die from it, I don’t feel any particular guilt because I don’t feel any responsibility for it.”
It would have been instructive to know whether or not the psychiatrist and his faithful scribe at the Globe were willing to extend this principle to other groups, such as, say, smokers with lung cancer or emphysema, type A business executives who work themselves into a heart attack, battered women who remain loyal to an abusive partner or people injured in automobile accidents in full knowledge of the risks of driving.
According to this same logic no smoker should be defibrillated and brought back to life after a heart attack and no one who drinks alcohol should receive a blood transfusion in the wake of intestinal bleeding. Anyone worried about the possibility of a myocardial infarction or a stroke ought to wear a large badge identifying him as a nonsmoker, nondrinker, regular exerciser and non-consumer of trans fatty acids. Absent such a marker, no bystander should even dial 911 on their behalf.
