On Shame
and community acupuncture
One of the great things about writing a Substack is how loose and improvisational it can be. It lets me follow themes, make connections, and write my way to a better understanding of WCA’s and POCA Tech’s messy, organic reality.
Okay, that’s my introduction for a series of posts about shame. Didn’t see that coming, did you? Me neither!
I’ve been writing about acupuncture school debt for awhile, and shame is all over that topic. For example, this comment from a subscriber on a recent post:
My shame has morphed into anger (directed outward), realizing that (the schools) most certainly knew what they were doing to us. THEY KNEW…It almost seems that the setup for internal shame was part of the education, at least at my school (PCOM). If we're not successful, it's our fault. Be the best, charge "what you're worth" (whatever the fuck that means).
That comment made me think of another quote about shame. As some of you know, POCA Tech is mentioned in a couple of academic books (not written by me; yes it’s weird to be written about). One of those is Practicing Cooperation: Mutual Aid beyond Capitalism (Diverse Economies and Livable Worlds) by Andrew Zitcer. The author defines cooperation as a practice that occurs at multiple, interconnected scales, beginning at the level of the body itself:
“...it is within bodies and between bodies that cooperation starts, and ultimately returns. As much as it is social, cooperation is nevertheless a transformative act at the level of the individual. Cooperation also requires a kind of shared labor, so it is necessary to understand cooperative work at a scale that derives from the body but transcends it as well. Cooperative businesses have traditions of shared labor and mutual aid”
He describes the foundation of POCA’s cooperative practice as a distinctive relationship between the body of the acupuncturist and the bodies of their patients:
“POCA is the cooperative outlier in a very competitive acupuncture industry. It tries to overcome the training most acupuncturists receive from conventional acupuncture schools. This training regimen is built around excluding bodies that do not fit the ideal acupuncture patient...POCA has developed training for its acupunks that helps them overcome their biases against bodies that differ from them in skin color, in gender, in size and shape, in hygiene. The movement’s goal is radical inclusion and what POCA calls liberation acupuncture, which can only occur when the acupunk can care for all the bodies in the clinic’s neighborhood…
(POCA’s ultimate purpose is) the empowering, and shame-free, provision of community health.”
I’ve been thinking about how hard it is to provide shame-free anything, whether it’s community health or acupuncture education. And not incidentally, I’ve been reading a really amazing book about shame: Understanding and Treating Chronic Shame: Healing Right Brain Relational Trauma (2nd Edition) by Patricia A. DeYoung.
The author is a psychotherapist writing for other psychotherapists. Although the book is dense, it’s accessible to laypeople — she notes that her patients have read it. I want to recommend it to acupuncturists, particularly community acupuncturists. (More about why in future posts). Patricia DeYoung’s thesis is that chronic shame “is a much more powerful and pervasive phenomenon than most of us realize…shame feels like solitary pain, and chronic shame seems like personal failure due to one’s own negative thinking and low self-esteem. But in fact, shame in all its forms is first of all relational.” She defines shame as the experience of one’s felt sense of self disintegrating in relationship to a dysregulating other.1
According to DeYoung, a lifetime of shame can start with relatively subtle interactions in childhood when children need something important and their parents don’t respond. Ever after, being vulnerable and needing help can evoke shame — which makes it difficult to navigate life in a fragile, imperfect human body/mind. At some point all of us need help.
She distinguishes different forms of shame, including annihilating shame, which begins in childhood “as repeated ruptures with someone who is either neglectful or abusive and is also a powerful arbiter of the child’s value”. Also stigmatizing shame, which is linked to “something picked out as ugly or evil in a child’s identity”. Stigmatizing shame is a result of power structures in society rather than interpersonal relationships, and it isn’t necessarily absorbed on a personal level in the same way as other types. People can experience stigmatizing shame while knowing that it’s not really about them — it’s about how they’re treated due to factors like race, class, culture, sexuality/gender identity, etc.
I have so many thoughts about how shame relates to community acupuncture in general — along the lines of Andrew Zitcer’s observations about including vs. excluding people and their variable, imperfect bodies — and 5NP in particular.
For example, one topic I’ve wanted to write about here, but couldn’t find a way into, is why WCA and POCA Tech don’t give lifestyle advice to patients. We not only don’t give it, we explicitly teach students to steer clear of it. This no-lifestyle-counseling position reinforces our outlier status in the acupuncture industry, so it’s worth talking about. But I couldn’t figure out how to describe the context for our position — because the context is shame. It’s incredibly difficult not to shame someone while telling them how to live differently so that they’ll be healthier. In our culture, not being healthy (or perceived as being unhealthy) means being shamed. Patricia DeYoung’s book was unexpectedly validating on that score; she describes in detail how hard it is — and how important — not to shame someone when you’re trying to help them.
For community acupuncturists, shame is the backdrop and shame is the challenge.
In terms of 5NP, shame is deeply involved with substance use disorders and also, people with those disorders are terribly stigmatized in our society. One of the distinguishing characteristics of 5NP is how little it asks of the person receiving it. You don’t have to describe what you’re struggling with; you don’t have to disclose your history. You don’t even really have to ask for help — you just have to be willing to sit down and let somebody needle your ears. Understanding more about shame makes me really appreciate the value of 5NP as a possible first step towards treatment. Someone dealing with a combination of annihilating shame (manifesting as addiction) and stigmatizing shame (for having a substance use disorder, as well as any other marginalized identities) might find relief with 5NP when other forms of help are too daunting to access. And that experience of relief might give them some hope to keep moving toward recovery.
Speaking of hope and 5NP, huge congratulations to 5NP advocates in Massachusetts! After six years (!!) of dedicated advocacy, their acudetox bill passed and is just awaiting the governor’s signature to become law, which represents a low-key triumph of patience and persistence. There were so many opportunities for them to give up on 5NP, and they didn’t, and as a result so many people in Massachusetts are going to have access to acudetox.
But back to shame, which I’m now fascinated by.
I’m grateful to have an improved vocabulary and an expanded framework for understanding shame, because I think it’s worth looking for in every area of WCA’s and POCA Tech’s world. The idea that conventional acupuncture education is a set up for shame, particularly around small business, makes me more motivated to look for ways to defuse that potential for POCA Tech students. Small business is vulnerable and scary and involves needing so much, so publicly. And I think Andrew Zitcer’s take is right on, in that the community acupuncture business model is inextricable from our goal of providing community health without shaming or excluding people.
And I’m looking forward to talking about shame in relationship to our 1000 X 25 exercise, which required students to ask for donations. Asking is hard! Nonetheless we’ve been doing it! By my count we’ve collectively managed to ask about 600 people for donations, and we’ve raised about $13,400. Thank you to everyone who has generously contributed! So for (almost) the last time —
If you’re getting anything out of this newsletter, or you’re encouraged in any way by POCA Tech’s efforts to re-imagine acupuncture education, will you donate $25?
Here’s the link to donate and the QR code:
DeYoung, Understanding and Treating Chronic Shame: Healing Right Brain Relational Trauma (2nd Edition): pg 4, pg 18, pg 21