Acupuncture & TCM Articles
Neil R. Gumenick is the founder and Director of The Institute of Classical Five-Element Acupuncture. Neil is a Worsley certified advanced teacher of Classical Five-Element Acupuncture and a practitioner with over 27 years of private practice experience. Neil holds three degrees from the College of Traditional Acupuncture (U.K.), and he participated for 10 years in the Master Apprentice Programô, led by Profs. J.R. & J.B. Worsley. Neil has taught at the USC and UCLA Schools of Medicine, the Worsley Institute of Classical Acupuncture, the Traditional Acupuncture Foundation, California Acupuncture College, Santa Barbara College of Oriental Medicine, and Pacific College of Oriental Medicine. He has been a Professor at Emperor's College of Traditional Oriental Medicine and SAMRA University of Oriental Medicine. Neil is co-author of The Art of Practice Management for Acupuncture Health Care Practices
Practitioner/Patient Rapport, Part V: Developing Rapport with the Emotion of the Earth Element
By Neil Gumenick, MAc (UK), LAc, Dipl. Ac
In this article, we will look at the emotion Grief; how it arises from the nature of its corresponding element, Metal; what it looks like when balanced; how we can determine if it is out of balance; and how to recognize when and how this aspect of a patient's psyche needs to be supported.
Healthy Grief: The Grace of Letting Go
As long as we are alive, our every breath requires a taking in and a letting go, challenging us to experience the newness of each moment arising and passing. Throughout our lives, we all lose loved ones; situations change for better and worse. As we mature, we recognize that separation and loss are continual processes for all human beings. It is appropriate to grieve about such losses. Nature equips us with the emotion of grief to wash away the old and release the emotional hold of the past. After an outpouring of grief, we feel lighter and cleaner. Virtually all religions have developed specific grief rituals to enable people to honor their losses properly, and to return to life when it is time. Grief is thus an essential human process, and is the key to regaining our vitality after periods of suffering and loss.
Autumn is the season of the Metal element, in which Nature lets go of the old leaves and rotting fruits of the previous growing season. Trees, for example, do not hold onto last year's leaves because they might need them the next year. It is only by the grace of letting go of the old that the new leaves can sprout in Spring. The rotting and decomposing remains of last year's growth enriches the soil for new growth. Like the trees, we also have a past from which we can learn valuable lessons in order to move forward.
The two Officials of the Metal element, the Colon and Lung, are responsible for letting go of the old and taking in of the new. When the Metal element is healthy, the Officials help us to respond appropriately to situations that call for the emotion of grief. We can take in fresh new energy, because we have released what no longer serves us. We can appreciate and use our own unique qualities, and maintain a balanced sense of respect for authority outside ourselves.
When the Metal element is imbalanced, we cannot let go, nor can we take in anything new and fresh. If one is unable to let go of the old, it just builds up and becomes a toxic mess. Those with Metal imbalances see themselves and the world through a screen of toxic accumulation. Though it may have been valuable and necessary at one time, what is inappropriately retained at the physical, mental and spiritual levels simply festers and rots. It is as if people so afflicted are imprisoned in a metal box, filled with an ever-growing collection of waste and negativity: old beliefs, anxieties, assumptions, opinions, grudges, hatreds, prejudices, etc.
Some people continue to grieve long past what is appropriate or useful for their system. They are unable to fully let go so, like living in a perpetual autumn, grief and the weeping voice become continuous and predominant and express inappropriately. Imagine a tree that turns every new leaf brown and drops it, transforming potential nutrients and sources of life into immediate losses. People in this range of a Metal imbalance cannot, for example, perceive much humor in life's comedic turns. Such people will often be intensely serious, preoccupied with protecting and defending their own image, acutely aware of the defects and the negative in any situation. Fun? Not likely, except at someone else's expense so as to bolster their own feelings of inferiority. They will find something to criticize or some reason to grieve. We often hear such people automatically respond to new ideas with words such as, "That's a load of crap; that will never work; don't give me that garbage."
Authority, Respect and Self-Worth: Additional Aspects of Metal
The Metal element is associated with both the personal and archetypal Father: the source of wisdom, authority, inspiration and guidance, all-knowing and all-powerful. Our father (or father figure) is the first person with whom we must relate. The mother, as we saw in Part IV of this series, is our source of nourishment and sustenance and is connected with the Earth element. From the father, we get our sense of social image, identity and worth in relation to others and the world at large. Do we measure up? Are we worthy? Good enough? We answer these questions internally by measuring ourselves against the real or imagined image of the father.
The senses of awe, wonder, and inspiration we can feel in the presence of a power larger than ourselves is a gift of the Metal element. Metal grants us our sense of connection to God, the Ultimate, the Heavenly Father - call it what you like. Metal gives value to the earth (gems, minerals and trace elements); it gives the pure refined essence and sparkle to all aspects of life. Metal gives us our personal sense of self-worth. Knowing it or not, believing it or not, we are all connected to the Ultimate every moment.
Lacking this perception, a person suffers what is perhaps the worst grief of all: the imagined loss of one's own core essence. One is cut off from guidance and direction from above (and within), disconnected from Spirit, and to one's own sense of meaning and purpose. People suffering from this aspect of a Metal imbalance often spend a lifetime engaged in a futile yet compulsive search for compensatory richness and essence outside themselves. Without the ability to perceive or use the strength of Metal's quality, perhaps related to a lack of fathering, the Metal-imbalanced person may strive to accumulate money, status, sexual conquests, titles, degrees, awards, spiritual empowerments, etc., chasing from guru to guru or drug to drug. Yet none of these externally oriented attempts to bolster self-esteem and image quells the deep hunger and emptiness, which can only be satisfied from within.
At the other extreme, the Metal imbalance may manifest as a rejection of all the foregoing symbols of self-worth. Such a person might say to himself, "Nothing is of any real value anyway. It's all BS, so why bother?" Both sides of this dichotomy are equally expressions of an imbalanced relationship to the sense of self-worth that lies within the domain of Metal.
Rapport as Portal to Our Patient's Mind/Body/Spirit
As I have stressed throughout this series of articles, we must begin the exploration of the qualities and needs of the unique patient before us by establishing, maintaining and deepening rapport. Rapport is not aimed at manipulating the patient into liking us or intended to provide us with a comfortable working environment. Rapport is the unity that occurs when our perception of and response to the patient's needs are precisely accurate. At that moment, you and your patient are at one with each other. There is nothing wanting, not even the desire to be in rapport. What it takes to be in rapport will vary from person to person, and will also vary with each individual from moment to moment.
Without rapport, the time we spend with patients is largely a waste of time in terms of learning who the patient really is. Until patients feel safe, they will give us a fa‚ade, a pretense, but once they trust us and feel understood, they will open up and tell us who they are and what is really going on inside. In the vast majority of cases, these deeper issues are the causes of their symptoms and must be the focus of our attention and treatment if we are to truly cure them. Once we have rapport, patients will tell us things they have, perhaps, never revealed to any other person. As practitioners, we must respect that trust, maintain strict confidentiality, and endeavor to meet them at the level of their needs.
Rapport may not always produce "comfortable" feelings in the practitioner, especially when the patient is experiencing the pain of an emotion that is unresolved within you. Yet, you cannot be at one with a patient whose predominant emotion is grief if you cannot enter the emotion yourself. It is thus important for you to consider your own relationship to this element. How in touch with the emotion of grief are you? Are you able to cry and give full release to the emotions within you? Is your life one big cry? Is your own self-respect healthy enough that you are able to serve the patient's needs and not make it about you? Can you be at one with the patient in grief so that the patient feels you are absolutely with him/her, giving support in just the right amount? If you are uncomfortable with grief, might your physical proximity leave the patient feeling abandoned and disconnected? If, on the other hand, you are yourself perpetually (or at least inappropriately) in grief, how will you be able to turn it off and see the reaction in the patient? An overwillingness to enter into and remain in grief may leave your patient feeling smothered and overwhelmed. Your balanced response will help you relate to patients who need joy, sympathy, reassurance, or firmness, as appropriate to the situation.
Obviously, the giving of respect and affirmation of someone's value must be delivered in a way that communicates this intention. It does no good to say, for example, "You are truly one of the most creative people I have ever met," or "I admire so much how you handled that" if the words are delivered in a tone of laughter, pity, indifference, etc. The words and the energy behind them, including your touch, must all convey a congruent message of awe and respect. Consider how you would take the hand of a child who trustingly looks to you for guidance; how the child would take your hand in order to be led. Consider how you would present an award to someone you deeply respect and honor. Your patient is just as worthy a recipient.
As I have written in previous articles, one cannot learn how to diagnose from a book. There are no symptoms that can lead us to conclude that a patient's underlying elemental imbalance or Causative Factor is Metal, or any other element, for that matter, because an imbalance in any element can produce symptoms anywhere. Therefore, learning any kind of symptomatic associations would be meaningless. However, color, sound, emotion and odor will absolutely tell us the cause. We only awaken and develop these senses by practice and skilled guidance.
In interacting with a patient, and most certainly on the first visit, there are numerous opportunities to test a patient's grief. We can detect the problematic relationship to grief in the sound of weeping that often becomes predominant in such people, or in a flatness of affect where the tones of grief would be expected. Suppose, for example, you ask at an appropriate point in your interview, "Are your parents living?" If they are not, you would expect some degree of grief to show in the patient. The sound of the voice of Metal is weeping and, similarly, you would expect to hear that sound; but is that emotion forthcoming? Do you hear that sound? If you get some other emotion (joy, sympathy, fear or anger), is it appropriate? What emotion stands out beyond all the rest? Does the weeping sound persist long after the discussion of the loss has ended? Has the sense of regret over the past dragged on for years?
If the emotional and vocal expression is inappropriate, we will feel jarred, because the content and the way it is being delivered do not match. (This reminds me of the joke where Mr. A meets Mr. B and says, "I'm so sorry; I heard you buried your wife. Mr. B replies, laughing, "Had to, dead, you know!") The inappropriate expression of grief, the weeping sound of the voice, along with the predominant color (white) lateral to the eyes and the patient's odor (rotten), is how we diagnose the underlying elemental imbalance or Causative Factor as Metal.
Diagnostic Clues through Probing and Observation
As explained earlier, people with Metal imbalances are very concerned with matters of respect, value and acknowledgement. They may crave it, may love to receive it, but it will never satisfy them. They may either want more and more, or may reject or dismiss your offers of acknowledgement. We can discover our patient's relationship to this aspect of Metal by deliberately testing it. When a patient does something or tells you of something praiseworthy, give acknowledgement. Give a compliment. Find something to praise. Examples:
- "That's a great color on you."
- "That must have felt wonderful."
- "Your (husband, wife, friend, etc.) is very lucky to have you."
- "Great job. I'm proud of you."
- "That's amazing!"
- "You look marvelous."
- "That was so thoughtful of you."
- "Thank you for your willingness to be so open and honest. Most people couldn't do that."
Give sincere praise in obvious and unexpected situations. Observe carefully how your comment is taken in. Can it be taken in at all? Is it rejected outright? Is it taken in and soon trashed?
When you give proper respect to a person who needs it, you may see a palpable change in the breathing (i.e. a deep breath or a slowing); the body may noticeably relax; the facial expression may soften; there may be tears; or the patient may hold your hand in an entirely different way (i.e. inviting you in rather than keeping you away).
What happens when your patient invites your praise, is fishing for compliments, and you do not respond? Does the patient become angry, sullen, sarcastic, insistent? Does the countenance drop or tighten? Does the body become tense? Does the patient pull away? Sometimes, we learn about our patients by withdrawing what they crave. We note the reaction and immediately shift into the precise gear that will reestablish rapport. With practice and guidance, this can be done so smoothly that the patient is unaware of even a ripple.
Any of these reactions and changes, plus many more (such as changes in the intensity of the color, sound of the voice, presentation of emotion, and odor) will tell you who your patient is, the cause of the presenting symptoms, and the level of the disease. In this system of medicine, we assert that the presence of physical symptoms and our ability to heal is invariably connected with trauma and imbalance at the level of the mind and, much more commonly, at the level of the spirit. As with the giving of any emotion in response to a real need, it is like a healing, life-giving balm. Such changes as those just described will definitely occur in patients, whether you notice them or not. The more we have awakened our senses, the more we will perceive of what is there to be perceived.
Though there are no absolute checklists for reaching a specific element, particularly since how you ask is far more important than what you ask, the following questions tend to engage the Metal element. Consider asking yourself, as well as your patient:
- What is unique or special about you?
- Who do you respect and admire? Why?
- Describe your relationship with your father. What did he teach you? How did he make you feel special? How - did he hurt you?
- What, if any, is your religious or spiritual practice?
- What do you need to let go of?
- What do you need to grieve about?
- What is precious to you?
- What are your standards? What will you simply not accept?
- When have you felt inspired or awestruck?
Restoring the Balance in Our Patients and Ourselves
If Metal is the Causative Factor (CF) and is treated with this system of medicine, assuming there are no unresolved energetic blocks, the emotion of grief will heal and will express more normally and appropriately. The incessant craving for attention and recognition from the outside will diminish as the void is filled from within. The patient will begin to find satisfaction, beauty, and fulfillment from the simple things in life. The accumulated waste and garbage of the body, mind and spirit will release, and life will take on a new luster and freshness, as indicated in the point name of LI 20, Welcome Fragrance. Such changes, along with the pulses, are sure indicators that we are treating the correct Causative Factor (CF) meridians and reaching the patient at the deepest levels.
When we can feel the Divine spark alive and vital in ourselves, we cannot help but perceive it in others, regardless of whether the others perceive it themselves. When we perceive it, we sincerely can acknowledge it in others, thereby empowering them as well as ourselves by reminding ourselves what we actually are. When we know that we are connected to the Eternal, there is no need to cling to the past, no image to defend, and nothing to prove or fear. This is the key to developing ourselves as instruments of Nature, and the basis of developing rapport with anyone. The more resolved and at peace we are with the Five Emotions in ourselves, the easier we will be able to shift in and out of any of them, fluctuating with the needs of our patients. Learning this system of medicine is first and foremost working on ourselves.
The Art of Practice Management for Acupuncture Health Care Practices
What you will find in this book is a specific, comprehensive approach that gets to the root cause of success in practice.
This new book presents acupuncture practice as art from the standpoint of centering, qi, and wholeness. It builds on the premise that practices succeed from bridging inner and outer aspects of the self. It is an inquiry into the self and addresses clear understandings and approaches to reputable patient care and practice qi. It brings in the five elements and work with the seasons of practice from training and start-up to growth, stability, expansion and transformation. The authors artfully bridges the essence of both patient and practitioner well-being without excluding the practicalities of financial well-being. This book very specifically and extensively shows how the different parts of practice nourish and feed one another and are interdependent on one another for the qi to flow synchronistically.
It explores the dual nature of procedures that work and those which do not in acupuncture health care practice, returning again and again to the delicate balance of practicality and spirituality.