A Queer Perspective on Acupuncture Safety

An acupuncturist colleague, let’s call her B, told me a story about some (unfortunately) common acupuncturist attitudes about safety. B was participating in an outreach event at a busy workplace, with several acupuncturists giving mini-treatments to patients sitting in lounge chairs, outside in a tent. It was summer, and quite warm. In the early afternoon, a patient that B had just treated went into needle shock.

Needle shock is one of the most common acupuncture adverse events. It means, basically, that an acupuncturist inserts one or more needles and the patient faints, or almost faints.

B’s patient didn’t quite faint, but he did get clammy and nauseated. B did what acupuncturists are supposed to do, which is to take all the needles out, bring the patient a glass of water, and sit with them until they’re feeling better. B’s patient recovered quickly and the event went on. Afterwards, B brought up the topic of acupuncture adverse events with the other acupuncturists who were there, and one of them scolded her, saying the reason her patient went into needle shock was because B had chosen the wrong acupuncture points. If she’d done the right treatment, it wouldn’t have happened.

Pardon me for a moment while I bang my head against my laptop.

The acupuncturist who accused B of causing needle shock by choosing the wrong points was making two assumptions:

1. that safety issues/adverse events only occur when somebody makes an error; and

2. that there’s an objectively right way to do acupuncture.

Although many acupuncturists share these assumptions, there’s no evidence for either of them. Also, in my experience, they’re not useful ways to think about acupuncture safety. And if you want to build a culture of safety, they need to be challenged.

The year after I graduated from college, I worked full time at a tiny grassroots AIDS nonprofit that ran an educational hotline, so I got to hang around a bunch of queer safer-sex educators. In hindsight, that experience shaped me in lots of ways; it was a queer institution that gave me my first real job, so no wonder my work trajectory has been interesting since then. Also, I first learned about safety in a pandemic in the context of queerness (though that term wasn’t used much back in 1990).

I think I’m lucky, not just because queerness is so good for my life in general, but because a queer perspective can help build a culture of safety. I’m going to argue that all of us need to learn how to think and talk about acupuncture safety in the same way that a lot of people in the queer, poly, and kink communities have learned how to think and talk about sex: without shame, without judgement, enthusiastically and in a lot of detail.

The main thing I learned from the queer safer-sex educators: safety is about establishing and navigating boundaries, with as little judgement as possible towards yourself or anyone else. In the context of safer sex -- notice “safer” as opposed to “safe” -- some of the boundaries were physical, like condoms and dental dams. But a lot were mental and emotional: being able to identify what you want, knowing what you feel comfortable and uncomfortable with, and believing that you have the right to take care of yourself.

That you are worth taking care of.

A core aspect of boundaries, and thus of safety, is self-esteem. A lot of queer people can’t take self-esteem for granted. But really, it’s best if nobody takes it for granted and we all assume it’s something we might need to work on as opposed to something we’re just supposed to be proficient at already.

Navigating boundaries requires both self-awareness and communication, and those take practice. Communicating boundaries can be really, really uncomfortable. It helps to tell yourself that you don’t need to be ashamed of having boundaries, talking about boundaries, or needing support to have better boundaries. Most conversations about acupuncture safety would be more productive if they focused on establishing and navigating boundaries -- non-judgmentally and in detail -- as opposed to assigning blame.

Let’s return to those two erroneous assumptions about acupuncture safety:

1. that safety issues/adverse events only occur when somebody makes an error.

Here’s a place to get into detail. In fact, safety issues and adverse events are different from errors, and in building a culture of safety, it’s important to distinguish them. An acupuncture adverse event (like needle shock) is a negative consequence or injury to a patient because of treatment and not necessarily because of error. An acupuncture error (like forgetting to remove a needle) is an incorrect action or plan that may or may not cause harm to a patient. There may be overlap between adverse events and errors, but they shouldn’t be confused, because the remedies are often different.

2. That there’s an objectively right way to do acupuncture.

The queer safer-sex educators at my first job approached their work from the perspective that there’s no right way and thus no wrong way to have consensual sex. Which indeed, there isn’t; humans are very diverse in how they experience pleasure. If you’re not preoccupied with finding the one right way, you’re much freer to think about safer ways. One of the gifts of a queer perspective is the way it can disentangle you from unhelpful binaries, including the binaries of safe/unsafe and right/wrong. A queer perspective opens up space for experimentation, which means space for learning.

There isn’t one way to do acupuncture, there are many ways, and some are safer than others. Rather than looking for a right way, it would be better to consider what ways meet the needs of the people involved, particularly the patients.

Maybe nothing could have prevented B’s patient from going into needle shock. It’s important to recognize that some adverse events can’t be prevented, they can only be managed. Maybe it was just the heat that made him light-headed, being outside in a tent on a warm summer day.

Considering the situation as a whole, though, it’s more likely that if there were any preventative measures to take, they might have involved the patient’s boundaries. The treatment happened when he was at work; was he feeling rushed, trying to fit acupuncture into the middle of his day when maybe he needed to do something else instead? Had he eaten lunch, had he eaten breakfast, was his blood sugar low and he needed a snack? Did he really want to be trying acupuncture -- possibly for the first time -- or did one of his coworkers talk him into it? Sometimes safety issues have their origins in someone ignoring or being unaware of their own needs, or being rushed and distracted.

Part of building a culture of safety is is cultivating an atmosphere in which paying attention to yourself -- for both acupuncturists and patients -- is both modeled and encouraged, and talking about boundaries is a normal occurrence. Let’s be safety-positive!