On Acupuncture (1992)

A Letter to Ivan Illich on Acupuncture
1992

David B. Schwartz


A few days before Christmas, the evening before my then wife Beth was to
get on a plane for Cincinnati, she was suddenly afflicted with a severe,
unremittting, pain in her left arm. We knew what it was because she had had
it before, exactly two years ago. It was a pinched nerve in her neck. Then she
had spent six weeks on her back on painkillers, and the siege had left her with
a deadened nerve. Now it had come again, this time even more severe. And
this time there was another thing: Beth was six months pregnant. It was a
holiday weekend, and she was in agonizing pain.

When you suddenly are faced by a loved one who is an extreme and
possibly dangerous medical situation, you reach for everything to help
healing that you know. You call the obstetrician, of course, who digs up a
neurologist to meet you at the emergency room, and then you deal with the
bureaucracy of the emergency room, which is all jammed up with poor people
whose kids have the flu and who have no money to see a doctor, and you and
the neurologist have to wait to get together because you have to go through
triage to get a room. And of course when he examines Beth you have to think
to yourself that he could have talked with her and checked her reflexes in the
hall, or in a booth of the corner diner, or even in our own home. He gives her a
prescription for codeine, which you can get over the counter in other
countries and which I now know is of course is inferior to opium by
inhalation, which has been illegal ever since the Chinese built the railways. The
doctors can't do a Magnetic Resonance Image test because Beth is pregnant,
and they can't of course do surgery unless it's an emergency, since she's
pregnant. So I bring her home to lie in bed on a special pillow and suffer the
pain and see if she gets better or worse. If it gets bad enough so that she
loses bowel and bladder function, we're to call. As it turns out it gets worse,
but not worse in that way.

We started with our chiropractor, who was very helpful but who could not
affect the problem with the sensory root, then went to the neurologist, as I
described. The pain intensified and Beth started visibly sinking in color and
vitality, and started to cease eating. It got pretty scary. I called up my
mother, who drove down and immediately took over the kitchen and bought a
soup chicken. I got Beth's closest sister, who is a neurological intensive care
nurse, to get on a plane and fly up from Florida. They were on their way now.
Finally I called up my friend and master acupuncturist Bob Duggan at home
down in Maryland. Bob grasped the situation immediately in a very broad way,
and gave me some acupuncture points to start massaging. And because Beth
could not move, let alone travel two hours, he did something that was to me
just incredible; out of friendship he got in his car and he drove all the way up
here on a Sunday afternoon and treated her right in her own bed. After that
point she started to get better, and Beth's sister Joanie arrived and started
arranging ice treatments and traction and all sorts of other nursing things
and my mother made delicious meals that sparked Beth's appetite. Soon what
had been a very scary, sinking situation in which we were alone and sliding
slowly towards surgery and the potential loss of this child started to be
reversed. After a week and a half, for the first time, Beth got up, walked
downstairs gingerly in her neck brace, and joined us for dinner.
So that is what happened.


Caring and Compassion

A friend of mine named Seymour Sarason once wrote a quite wonderful book
called Caring and Compassion in Clinical Services. In it he examined the
frequent complaint about modern medicine; that doctors were increasingly
distant, technological, and lacking in real compassion. Of course he ended up
looking at what he called the "disease of professionalism," a subject that I
have learned so much about from both he and Illich. In the people involved with helping
Beth there was a great range of caring and compassion, and I think a certain
theme emerged. The obstetrician is an excellent person, somebody who would
talk to us directly at 7:50 on a Sunday morning, and who could rustle up a
neurologist, something we would have been unable to do directly. But she was
a medical specialist; all she could do ultimately was make a referral.
Dr. Shaffer, the chiropractor, was much more accessible; he lived above his
office, he answered his own phone at home, and he immediately opened up his
office and saw Beth; twice on one Sunday. He was personal and concerned.
Perhaps above all, he touched; his fingers ran up and down the surfaces of
my wife's back, bringing up a picture of the minute alignment of vertebra, of
muscles in spasm. He hammered tiny light vibrations into the resonance of
muscles and bone and nerve, attempting to change their tune, head cocked to
hear like an intuitive piano tuner. But while he worked, while he figured, his
fingers, his hands, his close presence reassured, cared, and made evident his
desire to cure Beth, this particular person in this particular distress here on
his treatment table.

The neurologist was a nice, evidently kind, but somewhat distant physician
who was not in a rush. We saw him later at his office. He sat behind a big
desk; we sat on the other side. Then Beth sat on an examining table and he
briefly checked her reflexes; yes, some further deterioration was taking
place. Neurologists, even within the medical profession, have a reputation for
being cool, emotionally isolated, "cerebral." Surely he was picturing a lot from
his verbal and brief physical examination. But the main difference from the
chiropractor was pointed out by Beth as we walked out the door of his office.
"You know," she said, compared to Dr. Shaffer, he hardly touched me."
In fact, the only kind of touch proposed was that which was scheduled for
two weeks if she did not get better; an electromyogram. Beth had had this
before; what it consisted of was sitting very quietly while the doctor drove
steel needles into the muscles of her already throbbing arm, moved and
wiggled them around, while ink lines were made on chart paper. This would tell
us with some accuracy if deterioration was taking place in the motor root. I
already had noticed that Beth did not have the strength in her left hand to
squeeze the toothpaste tube, so I knew some deterioration was taking place.
This was not very accurate, of course. But for what end accuracy in this
case? If the only treatment was referral to a neurosurgeon, and they won't
and shouldn't do surgery anyway, why do the test? It was in this instance
that your phrase "medicalized torture" came to mind.

Then, at the most desperate moment, Bob Duggan appeared. I thought it was
tremendously interesting, as I sat in the room watching Bob examine and
treat Beth, what was taking before me. For Bob was not sitting in a chair by
the bed; he was leaning over, and crawling around on the bed on either side of
her, and behind her, and scrunching up against the headboard to get to and
reach the right places; touching, testing, probing, looking in her eyes, at her
face, inserting needles, massaging points, tracing meridians. There was no
professionalistic barrier at all. He was just my friend Bob, up here to help
Beth. Flat on her back, in bed, was where she was; therefore he had to drive
all the way up here, come to her bedroom, and get onto the bed with her.
thought what the neurologist might think if I proposed that he should do the
same. He would, I am sure, be stricken with anxiety! But this is what
had to be done.

Bob was with us all of the time; as guide through this experience, as helper an
interpreter. He would call every morning to talk to Beth and see how she was
progressing. After this one treatment, things really got stirred up and begin
to move around. For the first time she got pains in her other arm. Her skin
color started to improve. Then she started to get well.

What about Joanie, Beth's sister, the nurse? She immediately came in and
kissed her and hugged her and started treating the spine aggressively with
icepacks, lovingly and firmly helping Beth to stand them because the cold
hurt at first. As the pain started to ebb slightly, she lured her through the
risk of more excruciating pain to try some hours without codeine. They got
so she could be out of pain if perfectly immobile; then the next day up to eat
breakfast, then a brief journey out of the sick room downstairs, then a rest;
now take the codeine now before it starts to hurt; now let's do traction.
Aside from her intuitive and skillful nursing gifts, the kinds of practical
things to help of which the neurologist apparently knew nothing, Joanie, like
Bob, was where Beth was; in the bed, snuggled up in my ordinary place,
drinking coffee together, watching movies on the television, talking, napping. I
could see that Joanie was not only giving her nursing care, she was coaxing
and luring Beth out of the paralysis and pain she had become encapsulated in,
back tentatively into the world of upright movement.
In asking Joanie about what she was doing, she replied that she wasn't sure
she really knew, completely; it was intuitive, it was seat-of-the-pants. "The
main thing," she said to me, "is that when you start helping someone, anyone,
they have to know that you are absolutely there for them, you are in this
with them, that even if you're not exactly sure of what to do you are not
going to retreat and go away."

Finally, there was my mother, who works most winters caring for elderly
wealthy people in Florida. There was chicken soup, and more chicken soup,
and roast chicken, and snack trays brought to the room, and daily trips to
the grocery store to bring back mountains of stuff that I was just
confounded we could need all of, but it was as if she was going out to gather
sustenance, activity, color and smell and taste, to bring the wind of life into
the house that had formerly been so sick and still. We had a birthday party
for my mother in the midst of it all, right around Beth's bed.

Now each of these people, these healers were, it could be said, professionals.
But what an incredible range there was. What was the essential difference? I
must say, I was impressed with what seemed to be the influence of
economics. The one who was the strongest part of the economic system, the
neurologist, with his office and his instruments and network of referrals and
need to see patients in the emergency room, was the least influential of the
healers. The chiropractor, who lived above his office and who really
had a healing touch, was much more of a simple "tradesman." But the real
healing presence came from Bob and Joanie, who had no economic connection
at all. Joanie, of course, because she was Beth's sister, who Beth in turn had
once cared for and run her pig farm when she was laid up. The unexpected
event here was Bob, a friend who I had met through a friend in faraway Lee
and Manfred's and Ivan’s apartment in Oldenburg, Germany. Who would leave
the clinic, the desk, and just come. For what? I would have to ask him. For
care and compassion? Surely. But primarily from philia, because we were
friends and when I was in distress and called him he not only talked to me, but
he came.

This also reinforced something that I have been thinking about much lately;
that under the smothering and distorting layer of economics, of the
commodification of care, that here and there the caring, skilled, ethical
professional clinician can still be found to exist. They are a fragment of an
older culture of healing not yet displaced by modernism.


Which Body?

I had thought a bit about compassion and clinical professionalism before, of
course, so these events served mostly to help me notice a few finer points
about it. What was completely new to me was the evident and striking
difference in the body of my wife that each of these clinicians saw.

I began to see for the first time what my friend Ivan Illich was pointing to in
his work on the 'history of the body." And I had recently read a book by his
and my friend Barbara Duden. One phrase which kept coming back to me from
it was her realization in The Woman Beneath the Skin that in reading about
the bodies of 18th century Frenchwomen that her own experience of her
body was useless as a basis and guide. Visiting Bob Duggan’s school of
acupuncture I began to hear about this very unfamiliar acupuncture body,
which was similarly different from the allopathic medical body I had been
trained to see, and which I unreflectedly thought the body was.

Here all these acupuncturists were talking about six superficial pulses on each wrist that I had never even heard of. Of qualities of fire and of wood. They were talking
about a body I had never seen, but which was very evidently there.
In the space of a very few days, I saw three practitioners examine my wife as
I watched. I tried to follow along and picture in my mind what they were
seeing. The chiropractor, as I mentioned, followed the alignments and
movements and tensions of the body with a delicate sensing hand. It was
clear that he could feel the spine as his hand rippled along it; all of its fine
bony edges, where the nerves inserted; how the slight turn of a foot turned
up the tension in the right shoulder just so. The neurologist's body, in
contrast, seemed very abstract. He didn't need to touch it. From my own
limited training in that area, I could I think picture what he might be seeing.
There were all of these neurons, and synapses, and disks. It was a cool, clean
wiring diagram of sorts. The neurologist's icon for the body seemed to be the
computer-generated images of the MRI, showing the solid architecture of the
body, the map the neurosurgeon clipped to the back-lit screen before he
began to cut.

In the body seen by the neurologist, the fact that my wife's skin had started
to get pale and flaky at the same moment that the pain had started, or the
fact that her head was chronically congested, or what might be happening in
her emotional life when this pain erupted, were not part of his picture of the
body; they simply didn't exist. Even my wife's good obstetrician, when
questioned about the skin change, suggested she see a dermatologist if she
really wanted to pursue it. These aspects of the body were apparently part
of another specialist's picture. And all pictures in allopathic medicine seemed
to be taken at extreme magnification, like a snapshot with the wrong lens
that turns out showing only somebody's belt buckle, with their head and feet
beyond the frame.

Then there was Bob's picture of the body. Trying to follow what he was doing,
I watched him closely. It was clear that the body he was working on was
almost a completely different body that the body of the neurologist, and very
different in many ways from much of the chiropractor's. He put tiny needles
in the right arm, and made the pain in the left arm moved around. He showed
me where to press under the right armpit to reduce the pain in the left arm -
and it did! He had me massage a point near the right collarbone, and Beth
reported a warmth going down her left arm, ebbing away the pain. He saw the
fact that the pain was moving around as good, and helped I think to free the
energy up so that it could move around some more.

To Bob, the skin and the congestion were intimately connected; breathing
related to ability to heal and reduce inflammation, something that must be
opened up. He saw drinking hot things and avoiding cold as things that had
effects on the body before him. He looked at Beth's eyes; asked about her
energy level, saw the health crisis as a process with the nadir behind us, and
stirred the fires of healing. Even to the small extent I could follow the image
of the body he saw in my wife it was quite astonishing.

I began though this to see a little bit of what Illich was talking about in
examining the certainty that I had assumed to be the body. Can I say that the
body is a participatory creation? What a wonderful body the body of
traditional Chinese medicine seems to be. In the allopathic medical body,
there is no way of healing in this case but rest; no way of controlling pain but
giving the entire central nervous system a mild painkiller. In the acupuncture
body, I sit and massage points on the foot, wrist, and breastbone. When I
move the latter, my wife's breathing instantly slows down and deepens, the
tension starts to go out of her body, and the pain subsides a bit. I put my
hand on her swollen stomach. Every time I massage the breastbone, the baby
kicks.

Community

I did not consider myself to have deep roots in the community of Harrisburg
back when Beth was sick. So it really was a kind of a surprise to me to learn
what connections we actually had when we needed them so much.
Since we were unexpectedly at home for Christmas with nothing much in the
house, a friend from my office dropped by with a complete Christmas dinner
that we could eat on the bed. Jack at the pharmacy on the corner ordered
the special pills Beth needed. When I stopped by our neighborhood Greek diner
to pick up a milkshake to try to get Beth to eat something, the owner
refused to charge me for it, sending it along with get-well wishes. Since funny
movies helped distract Beth from the pain, I'd go over to the little movie
store on the next street to get her daily "movie prescription" refilled. Every
day the owners, true movie fanatics, would debate what would be the best
"classic" to send over, and inquire how she liked the last one. After a week,
they started to keep a list of ideas they had on the bulletin board behind the
counter in preparation for my evening visit.
The most moving thing, though, was Mary and David's visit. Two years ago
when we were in town alone we had a homeless mother and her three kids
over from the shelter for Christmas with us, and we became friends. We
helped them to get out and to set up, and I had thought to myself that this
Christmas they would again be celebrating it in their own home. We hadn't
seen them for a while but then Christmas night Mary and her oldest son David
rang the doorbell to come and wish us Merry Christmas and bring some gifts.
They had heard Beth was ill from a friend who runs a stand at the market.
Them reappearing was really the nicest Christmas gift of all. We had been
there for them, I guess, and they were there for us. We were there for each
other.

All of these things; the response of our friends and neighbors, my mother
and Beth's sister appearing, made me think about something that Illich said
once; that culture was ”that with which we faced illness, suffering, and death.”
I had thought that this seemed a somewhat unusual definition of culture at
the time. This experience brought home to me in a deeply personal fashion
how all we have to look to really is our culture, and that even when you think
that you are in a place where there is not much surrounding you there is
often more than you think.

Everything good that happened to us through this; Bob's trip up, the help of
family and friends and neighbors, took place within the realm of friendship, or
family, or neighborhood. And even the useful clinical help we received was
cultural first, and professional second.

A month or two later Beth was much better. In fact, she seemed completely
recovered. We had since seen a neurosurgeon, and he told us that despite the
lack of pain there was progressive motor loss, and that if she did not have
surgery after the baby is delivered (presuming there was no recurrence
before) that there was a danger of becoming significantly disabled. It was a
worrisome prospect. He seemed quite sure. He looked at the MRI (seeing,
incidentally, a different structural problem than the other physicians read
there) and there the problem was, plain as day. Perhaps, I worried, he was
correct.

Neurosurgeons are trained, and skilled, and can see something - the nerves -
much better than I could. But I, I learned, could see something that he could
not; that the body which he saw and accepted with such certainty is only one
body of many. There are many healers, and correspondingly many bodies. And
beyond the individual body, there is also the vision that includes the person,
physically, psychologically, spiritually (to use the closest available terms) as
one part of a network of others of which this body is inextricably part, such
networks themselves being part and expression of a larger culture of
meaning. Perhaps, I began to understand, culture is not only that with which
we face illness, suffering, and death, but that which defines these very
experiences. It is culture, after all, that gives us the specific bodies that we
are so certain that we have. This helped me to reflect more about why in my
own work on healing I have been so continuously drawn to the structure of
culture, rather than to the structure of nerves, whence I started twenty-five
years ago.
Our son Nate, who was three months away from his birth when Beth was sick,
is now ten years old. And Beth is fine. She seems just about as strong with
her left arm as she is with her right. Maybe a little less; I don’t know. She
carries heavy things around and doesn’t favor one arm. So I guess it remains
no problem for her.

She does have a problem every once and a while. Her back starts to knot up
in the same way that preceeded her terrible attack. Curiously, it is always at
the same time; around the winter solstice, when the days are shortest, a few
days before Christmas. She always tends to slow down, rest, and take a few
days off work. She gets some chiropractic adjustments from Dr. Shaffer,
and maybe a massage. Sometimes we used to drive down to see Bob for
an acupuncture treatment. The pinched nerve has never, so far,
come back. We felt lucky.

When Christmas comes, though, we always used to think back on what
happened that Christmas tenyears ago, when Beth didn’t have surgery after
all, and I learned so much about our bodies and about our community.


Previously published as: “An Occasion to Think About Healing: A Letter to Ivan Illich.”
The Journal of Traditional Acupuncture, XIV, 2, Spring, 1992, 15-18, 49-50. Excerpted in Quintessence, 13(2), 1-2, as The Acupuncture Body.