Trying to Be Trauma-Informed about Everything
Note: I wrote the following reflection at the invitation of Sara Bursac, as a result of conversations with her, Jo Ann Lenney, and Tyler Phan about the history of NADA. The intention was for it to be cross-posted in NADA's Guidepoints; I'm posting it here for ease of access.
Since I re-read, in the summer Guidepoints issue, the letter I wrote about Mike Smith after his death in 2017, I’ve been reflecting on my memories of him, at the same time that I’ve been taking in the impact of the excellent NADA Full Circle history series.
According to Tyler Phan Ph.D, the best metaphor for the medicine of acupuncture (as opposed to the profession of acupuncture in the US) is the kids’ toy Slime. One of the most significant characteristics of acupuncture as a medicine is how it sticks to things and how things stick to it, how it adheres and is adhered to. Its nature is to be shapeless, sticky, malleable -- and fun to play with. Acupuncture, minus the influence of professionalization, is a blob.
One of the things that the medicine of acupuncture has stuck to, in a variety of ways, is the treatment of trauma. Research into Adverse Childhood Experiences (ACEs) shows that the more ACEs you have, the greater the risk for chronic disease, mental illness, violence and being a victim of violence. Research into substance abuse disorders shows links between drug and alcohol use with both Adverse Childhood Experiences and PTSD. The NADA Protocol addresses addictions, behavior health, disasters and emotional trauma.
I became an acupuncturist because of my own trauma history, basically. My need to address it and to make meaning out of it has kept me involved with acupuncture for my whole adult life. Receiving and practicing acupuncture did for me what it’s done for many other survivors of trauma: it helped me cope, allowed me to move forward with my life, and over time, brought me genuine healing and integration.
My trauma history is inseparable from my family’s trauma history and also inseparable from the wider trauma of being working-class/working-poor in this society. One of my uncles died in the military (Vietnam), one of my uncles shot himself, one of my cousins (the one closest to me in age) drank herself to death, a number of my relatives have been in jail (and more would’ve been if they’d gotten caught). There’s too much neglect, sexual abuse, and mental illness to even bother to make a list. Collectively, our ACE scores are high. Those of us who have decent lives, as adults, are lucky and we know it.
There are a lot of families like mine.
One thing I know about trauma is that recovering from it requires facing as much of the truth as you can. You might not be able to stand much truth at first and so you have to build up your tolerance over time. Facing the truth, like other forms of healing, is often a slow, incremental process. But I’ve learned that I can count on the truth to show up as a relief and also as a friend -- eventually.
I notice differences between me and people who haven’t had to learn how to live with the truth that their families not only suffered bad things but did bad things -- a lot of bad things. I developed the community acupuncture model because, for my own sanity, I needed to treat people like my family, people who are dealing with chronic diseases, mental illness, violence and being victims of violence, not to mention the ordinary stresses of surviving capitalism. I’m grateful that the blob-like medicine of acupuncture stuck to the needs of people like my family and gave me a way to be useful to my working-class community -- and also, a lot less dissociated than I used to be.
I wasn’t all that surprised to learn that the acupuncture profession has a painful history (I’m hugely grateful for Tyler Phan’s research for illuminating how we got where we are). And I’m not all that surprised that NADA is grappling with a painful history, as well. Given where I come from, how could I be surprised?
I’m thankful to the people who take risks to bring these histories to light. Acupuncture is a beautiful intervention, especially for marginalized people, and it’s been taken away from them over and over and over, in all kinds of ways. We all have to figure out how to live with and integrate our collective painful history. (I don’t recommend denial as a long-term strategy.)
Discovering the concept of trauma informed care gave me a framework for how to live with my history -- and other people’s. Trauma informed care is all about safety, so now I try to see everything through that lens: reflecting on the safety that people needed that they didn’t get, the ways they try to regain a sense of safety (even and especially when it’s counterproductive), and the ways we can all make more safety for each other. Humans learn how to create safety in part by making mistakes -- that’s how we learn about everything. We have to recognize that 20/20 hindsight is a superpower not given to people in the moment that they are dealing with hard things and making choices which later turn out to be mistakes. We can still move forward with what we know now.
I owe the work of NADA, and Mike Smith’s work, a great debt of gratitude. I wouldn’t have my community acupuncture clinic, or our community acupuncture school, without them. I hold Mike’s memory in love and appreciation. But I don’t need him to be infallible, or a saint, or incapable of making wrong choices. I wonder, now, how much safety he experienced throughout his long career (I’d estimate, a lot less than he needed, and I’m not thinking only about the impact of Richard Taft’s murder).
Trauma informed care is mostly about systems rather than individuals, which means it pertains to organizations. It’s HARD to have an acupuncture organization in the US. Not only because of the ambient hostility and dysfunction of the acupuncture profession, but because of the squishy, indeterminate nature of the medicine itself. Where do you put the boundaries, when what’s inspiring your organization is so blob-like? I think at best it’s a matter of continual trial and error, and acupuncture organizations will always represent, to some degree, an artificial set of limits for the blob, which in turn will always be oozing out around the edges. Maybe, despite everyone’s best efforts, after decades of organization-building it becomes apparent that some boundaries ended up in the wrong places, there were some bad judgement calls, and now reparations and repairs are needed.
When Mike came to present at my acupuncture school back in 1992, I remember being struck by his elliptical style of speaking. He talked about the quiet empty space that’s the center of an acupuncture treatment and he ended his talk by quoting Ernest Hemingway “nada y pues nada y nada y pues nada” , “nothing and then nothing and then nothing”. In hindsight, I think he was talking about the blob, how you can’t really wrap your mind around acupuncture, and how that’s a good thing. You can’t nail it down into a fixed, unchanging state, it’s too open and too empty for that.
I like to think that Mike would have wanted NADA to be open, to allow ambiguity, and to let the truth be difficult when it’s difficult. I like to think he would have encouraged us to learn how to live with uncertainty and also with a painful history, with all our mistakes (including his). Isn’t that what the patients we serve are trying to do in their own lives, in their own healing processes?
Making meaning out of a painful past isn’t a one-time event. I think you have to do it and then re-do it every day, because that’s how you keep going. You keep going even when it feels like both the past and the future are ruins looming over you. What I’ve learned is that you can live a good life in the wreckage, you can do good work even in the shadow of huge damage, you can always keep trying to do useful things for people who are in pain.