On Shame and Neurobiology

and community acupuncture

Art by A. Cohen

This is the second post in an (unexpected) series about shame. The first one apparently struck a nerve — welcome, new subscribers! I’m going to continue unpacking what the book Understanding and Treating Chronic Shame: Healing Right Brain Relational Trauma (2nd Edition) by Patricia A. DeYoung has to offer those of us who’re interested in community acupuncture.

Spoiler alert: a lot.

Community acupuncture is a deep rabbit hole and apparently it’s easier to describe certain aspects of it if you can also talk about shame (in psychotherapeutic detail). As I wrote in the last post, having a better vocabulary for shame is helping me to write about topics I’ve struggled with in the past — especially for an audience as diverse as this one, which includes patients and acupuncturists, friends and foes, as well as a lot of people who apparently like really niche Substacks. I appreciate you all! (Including the foes).

Someone once said to me, jokingly, that I only write manifestos — but he was also being serious, and he’s right. Since I started writing about community acupuncture in 2005, a lot of what I’ve been doing is trying to justify it. Or maybe trying to write it into existence as fast as I could, before the acupuncture profession had a chance to crush it? It’s always in the back of my mind that the acupuncture profession doesn’t take what we do seriously (except as a threat). On some level, I’m always trying to answer the question, what are community acupuncturists even doing? (And is it legal?)

Patricia DeYoung’s book is helpful because a lot of what community acupuncturists are doing is trying to not shame people while providing acupuncture. But I think her book is also a deep dive into what community acupuncture is, through the lenses of affect regulation theory and interpersonal neurobiology. (I wasn’t familiar with those terms before reading the book.)

Her thesis is that “all the emotions, thoughts and self images we know as shame begin with a specific kind of event: the experience of falling apart inside when significant others respond to our needs with emotional disconnection”¹. This “falling apart inside” or “fragmenting visceral shame” is a right brain experience; it’s related to what polyvagal theorists describe as “dorsal vagal shutdown”. Left brain narratives like “there’s something wrong with me” come later, as a way to make sense of and mitigate the feeling of falling apart. In other words, shame and its remedies are non-verbal right brain experiences.

And so DeYoung has an entire chapter on “Right Brain Basics for Relational Practice” — and I find it fascinating that it dovetails neatly with what we teach POCA Tech students about how to be with patients, except we call it “holding space”.

“(M)y most important way of being with any client, but especially with relationally traumatized clients, could be seen as a direct enactment of polyvagal theory: communicating as best I can...that I am a safe human. I will do that through an open, non-threatening bodily presence, through eye contact and facial expressions that communicate friendly interest and non-intrusive, kind acceptance, and by an informal, calm way of speaking…

Right brain language is fundamentally the language of emotion expressed body to body -- in quality of eye contact and voice tone, in rhythms of response and modulated intensities, in overt gestures and subtle body language. The right brain hears the music, not the words, of what passes between people.”²

This echoes Andrew Zitcer’s observations that community acupuncture represents “a distinctive relationship between the body of the acupuncturist and the bodies of their patients.”

A consistent complaint from our critics is: how can community acupuncture be any good if the treatments are so simple and there’s so little talking? If so much of the treatment is about resting quietly with needles in the presence of other people who are doing the same? Doesn’t that “impoverish” the practice of acupuncture, as Peter Deadman suggested?

Nope. It just prioritizes the (neurobiological) needs of people who are likely to be shamed by the rest of the healthcare system — which is a lot of people. Including pretty much anybody who’s dealing with chronic pain.

Patricia DeYoung describes “specific de-shaming ways of engaging with clients: commitment to work from the client’s values rather than imposing our own, to equalize power and refuse the role of expert wherever possible, and to affirm the client’s strengths… the more shamed our clients are, the less they will be helped by advice or strategies, and the more they will need a sustained experience of being empathetically understood.”³ I think that sustained experience can be nonverbal. It can be communicated not only by the practitioner but the clinic space itself.

Everything about community acupuncture is meant to transmit you’re welcome here and its corollaries: We invite you to use acupuncture to support your own goals (whatever those may be). The clinic is a resource that we’re offering you and we want it to be easy for you to use; we understand that your life is hard enough already. (Everybody’s life is hard enough already.)

Art by A. Cohen

Going back to the question of, what are community acupuncturists even doing? I think we’re doing the same thing all acupuncturists do: we’re moving qi. One of the best definitions of qi I ever heard was “connectivity”.⁴ A biomedical translation of that idea would be something like: Acupuncture supports neuroplasticity. We’re encouraging the body/mind to rewire itself.

Here’s another quote from Patricia DeYoung: “In terms of neurobiology, an emotionally regulating relationship makes possible more interconnectivity in the right hemisphere’s of clients’ brains, more brain systems involved in their processing of emotion, with more plasticity, and more ease of connection between hemispheres”.⁵ Doesn’t that sound like a neurobiological version of qi?

And for community acupuncturists, an additional goal is for patients’ relationship with the clinic itself to be emotionally regulating. In the previous post, I quoted Andrew Zitcer’s description of how the business practices of a clinic like WCA dovetail with its clinical aspects in terms of being as inclusive as possible. We want our business practices to be de-shaming too. We want our clinic systems to communicate to patients that we’re happy they’re here, and we want them to get as much acupuncture as they need. That’s the foundation for our flexible sliding scale, our recurring free days (note to WCA people, treatments are free all day on January 1!) and our organizational partnerships.

Having a better vocabulary for shame is making me revise my assessment of various interactions I’ve had with the acupuncture profession over the years. For instance, there was a lot of dismay among acupuncturists when our school, POCA Tech, first opened. During one online discussion an acupuncturist (a recent graduate of the same school I went to, OCOM) said to me:

(The general public) are the people (in majority of the cases) who refuse to prioritize their health over other things like booze, eating out, shopping, recreations etc. Who are your target patients and what is your goal of acupuncture treatments to people beyond making acupuncture accessible to MORE numbers of people? I'm already sick of people who think acupuncture is a cheaper, and more natural version of steroid shots and/or SSRI, while they have no intention of changing any part of their lifestyle, job selection, relationship, sleeping schedule, eating habits and lack of exercises etc. $15 a pop acupuncture treatment, I think, only supports most people's bad habitual patterns to continue because they tend to "feel better" after needling without changing anything else in their lives. And it's affordable to do that! But is that what you are going for? What is the meaningfulness of making acupuncture treatment more affordable financially?

I think this comment is an example of how shaming is baked into conventional acupuncture education — represented by a practitioner who is already sick of people after only a couple of years of treating them. The attitude of “relief is only for patients who prove they deserve it — through personal sacrifice and also, cold hard cash” is absolutely something I remember from my own education at OCOM.⁶ And it’s a lot like the acupuncture profession’s conviction that graduates shouldn’t have any problem repaying their student loans, regardless of how huge those are and how mathematically impossible the task is. The more something costs, the more valuable it is; there’s nothing wrong with the system itself; everybody just needs to try harder!

In my personal experience, shame is elastic, expansive and consuming. Once it’s in the picture, it stretches out to cover everything in its vicinity — but it also has a kind of gravitational pull and so it sucks everything into itself like a black hole. I think something like that is happening to the acupuncture profession. Shame directed at patients ends up engulfing practitioners too. It replicates itself through impossible expectations.

Next up: shame and the acupocalypse.

But also, for the last time, since we’re at the end of December:

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 to our year-end fundraiser?

Here’s the link to donate and the QR code:

1. DeYoung, Understanding and Treating Chronic Shame: Healing Right Brain Relational Trauma (2nd Edition): pg 40-41

2. Ibid, 46

3. Ibid, pg 140

4. Ken Rose and Zhang Yu Huan, A Brief History of Qi

5. DeYoung, Understanding and Treating Chronic Shame: Healing Right Brain Relational Trauma (2nd Edition): pg 48

6. See also: “First, it is well known that your personal income will be the same as that of your average patient; (as a result) we suggest that you check out the financial demographics of the town or area in which you plan to set up a clinic...Second, it is a proven fact that people who are not charged at all or who are charged very low fees rarely get well as quickly and completely as people who are charged more.” That’s from Points for Profit (used by 25 acupuncture schools as a required text!) discussed further — by me, with much annoyance— here.