On Shame and Class and the Acupocalypse
this is a pep talk, believe it or not
As I was saying, having a better, more specific vocabulary for shame is making me revise my assessment of various interactions I’ve had with the acupuncture profession over the years. Particularly in terms of what Patricia DeYoung calls stigmatizing shame, or “the chronic shame that afflicts people who experience belonging to a stigmatized social group — for example, people of low socio-economic status or with physical disabilities, people who are racialized or who identify as queer or transgender”.1
Not long after I started writing about community acupuncture, I encountered the term “class straddler”. That’s me: somebody who was born into one class (working class/working poor) and ended up in another (middle class, or whatever being an acupuncturist is in this society, more about that presently). Being a straddler means moving between worlds, back and forth, all the time. It’s confusing, overwhelming, infuriating, and also illuminating because of the vantage point it gives you. Straddlers occupy fertile ground, or as the permaculturists say, “the interface between things is where the most interesting events take place”. At this point, I wouldn’t trade it for anything.
There really are differences in class cultures in America, and it helped me enormously to recognize that the acupuncture profession’s fervent devotion to upper middle class professional culture is constantly colliding with my working class/working poor instincts and sensibilities. I know I don’t sound like it (when I write or when I speak2) but I’m low-class to the core. Anyway, I’ve had lots of practice reflecting on my problems with the acupuncture profession through the lens of class, but until now I hadn’t really thought about them in terms of shame.
There’s an amazing essay that I wish everybody would read: The Logic of Stupid Poor People, by Tressie McMillan Cottom (also a straddler). It starts out:
We hates us some poor people...they insist on being poor when it is so easy to not be poor.
And it ends with:
At the heart of these incredulous statements about the poor decisions poor people make is a belief that we would never be like them. We would know better. We would know to save our money, eschew status symbols, cut coupons, practice puritanical sacrifice to amass a million dollars... What we forget, if we ever know, is that what we know now about status and wealth creation and sacrifice are predicated on who we are, i.e. not poor. If you change the conditions of your not-poor status, you change everything you know as a result of being a not-poor. You have no idea what you would do if you were poor until you are poor. And not intermittently poor or formerly not-poor, but born poor, expected to be poor and treated by bureaucracies, gatekeepers and well-meaning respectability authorities as inherently poor...
(Emphasis mine, because I relate so hard.)
Everything in the middle of the essay (which isn’t long, did I mention you should read it) is vividly and beautifully written. It’s about status symbols, but it’s also about stigmatizing shame. And (ironically) it makes me think about how, and why, the acupuncture profession can’t admit that it can’t afford the status symbols — like doctoral degrees — that it wants.
One of the ways I’ve stayed sane as a class straddler among acupuncturists is to lean on my acupuncturist friends who also grew up working class. Two people who’ve been instrumental in the sanity-preserving department are Jade Fang (the Board President of POCA Tech) and Tyler Phan. (Prior posts about conversations with Jade are here and here; with Tyler, here’s part one, part two, and part three). A few years ago, Jade commented, “One of the ways you learn about class as a child is watching how people, especially authority figures, treat your parents” and that one observation was worth approximately $1000 of therapy for me.
Anyway, besides talking about things like class and PTSD on a personal level, Jade and I also talk about the acupocalypse in the context of our roles as Board President and Executive Director3. In order to be an acupuncture school, POCA Tech depends on a national infrastructure of acupuncture education, regulation and credentialing, the survival of which can’t be taken for granted these days. In any case, Jade and I don’t take it for granted. (Maybe you can identify your class based on what you take for granted?) Recently we were talking about the crisis in acupuncture education, and I mentioned yet another acupuncture school that’s in trouble.4 Jade said, “Most of the schools have to be in trouble at this point” and I said, “Do you think anybody in leadership is ever going to, I don’t know, have an honest conversation about what’s happening and try to deal with it?” and Jade said, “I think it’s a class thing. A lot of middle class people have a really hard time talking openly about money.”
And I was like, oh God, you’re right. They can’t talk about it. At least part of that is shame.5
I’ve known forever that the acupuncture profession’s stigmatizing shame about class was aimed at me and at my kind. See also: “Those are the people (in majority of the cases) who refuse to prioritize their health over other things like booze, eating out, shopping, recreations etc…What is the meaningfulness of making acupuncture treatment more affordable financially?” meaning, why even bother to treat people who can’t afford $100 per treatment? They’re not worth the effort!
I feel like this shouldn’t need to be spelled out, but it does: The less social status someone has, the less power they have to change their “lifestyle, job selection, relationship, sleeping schedule, eating habits and lack of exercise” at their acupuncturist’s direction (or for any other reason). One of the most motivated patients I ever had was a kind, funny, charismatic woman, a former bus driver who had to quit her job due to debilitating sciatica. She loved acupuncture, and she showed up diligently for treatments even though she was on a fixed income and it was hard for her to get to the clinic. Her pain improved something like 75% after six months (along with her blood pressure) and she started doing activities she hadn’t done in years. Unfortunately, she also had a complicated family situation that led to her getting evicted from her rent-controlled apartment through no fault of her own. She ended up in a shelter, where she promptly suffered a heart attack. Even then she managed to get to WCA a couple more times, but after that I never saw her again. She’s the person I think of when other acupuncturists tell me that acupuncture’s worthless without lifestyle advice. Because, you know, somebody who just had a heart attack due to losing her housing really needs a lecture about her eating habits.
But it didn’t occur to me before now that the acupuncture profession’s stigmatizing shame about class was hurting it too, paralyzing it to the point that it can’t adapt to changing economic conditions — because it’s too embarrassed to be honest, or even rational, about money. That the acupuncture profession could literally die of snobbery. Or shame, really — because the snobbery, obnoxious as it may be, is just shame projected outward.
The core problem that the acupuncture profession is facing is that, as one person working on a Borrower’s Defense application put it, “you can’t earn enough money with the education you get at an acupuncture school to pay back the loans it costs to go there.” The acupuncture profession’s response is to say: well, it shouldn’t be that way. You should be able to pay back your loans if you try hard enough, if you get a job in a hospital, if Medicare will only cover acupuncture. It can’t be true that acupuncture just doesn’t pay well enough (even in hospitals) to justify a hundred, or two hundred, or three hundred thousand dollars in student loans.
An acupuncture education should be worth a hundred thousand dollars or more because acupuncture medicine is beautiful and we deserve it. Acupuncturists should be paid in the six-figure range (by hospitals!) because acupuncture medicine is beautiful and we deserve it. We refuse on principle to recognize a world in which most acupuncturists aren’t paid well and lots are struggling to get paid at all — and we refuse even more passionately to adapt to it.
Okay? I guess you can refuse to recognize and adapt to reality? And I get it, I also would like a world in which everybody is paid well — not only acupuncturists but other people doing crucially important work like childcare workers, home health aides, housekeepers, and of course small business owners. But one of the few upsides of being expected to be poor is that you don’t waste energy on being indignant. You just deal with it.
I grew up in an environment where nobody expected that people would get paid based on what they thought they deserved. (I can barely type those words, even now.) I’m not sure anybody thought much about deserving, period, because it didn’t make any difference (see above: “treated by bureaucracies, gatekeepers and well-meaning respectability authorities as inherently poor”; see also, White Trash: the 400 Year Untold History of Class in America by Nancy Isenberg). These days, as I watch the acupuncture profession refuse to deal with what’s happening, I’m actually grateful.
Being able to embrace my class background instead of rejecting it made it possible for me to survive and even thrive as an acupuncturist and an entrepreneur. Once I realized I could get away with being joyfully low-class in public — nobody was going to arrest me or take away my license and everything in my life worked out better, not worse — I also realized it was possible for me to speak transparently, shamelessly even, about money. About what I could afford and what my target patient demographic could afford and what was important to us. About the overhead and invisible labor of having a business. I could do the math, and get gleefully creative with the numbers. I could do what people like me are really good at: scavenging, repurposing, DIY’ing, making do. Adapting.
Refusing to submit to stigmatizing shame made it possible for me to make something out of nothing — and not just something, but something I loved wholeheartedly. Something I could share with a community that I also loved wholeheartedly. Necessity is the mother of invention, even when necessity involves not having the kind of money or status you wish you did. This is my pep talk (and my hope) for the acupuncture profession: It’s not (quite) too late (yet) for you to be honest about money. It’s not too late to adapt. Like me, you might be glad you did. There’s a whole new world on the other side of stigmatizing shame.
My family couldn’t afford to send me to Catholic school, so they moved to a better public school district in the suburbs, and as a result I got five years of sorely needed speech therapy which had the side effect of dismantling my inner-city Baltimore accent. There were consonants I couldn’t say (n, r, d) and in the process of learning to say them I had to enunciate in ways that a lot of people from Baltimore just…don’t. See “Aaron earned an iron urn” — it was like that.
Actually I am one-third of POCA Tech’s Executive Director function. My co-Directors are Sonya Gregg and Jersey Rivers. I wholeheartedly recommend not trying to be an Executive Director all by yourself.
The latest school to be in trouble (that I know of) is a good illustration of this dynamic: Bastyr University , which to all outward appearances was wealthy and respectable, is running out of money and refusing it to deal with it.
No doubt some of it is also naked self-interest. Hi, NCCAOM.
Oh! It's a pep talk! I somehow missed that on the first read. 😀