Health and Other Worthwhile Things: On The Ecology of Care by Didi Pershouse


Photo of Green String Farm byLyle Poulin

A few years after finishing my undergraduate degree in creative writing, I apprenticed and worked on small farms, inspired in part by the writing of Wendell Berry. In an interview in one of my favorite magazines at the time, The Sun, Berry had spoken persuasively about the importance of being rooted in community, caring deeply for the land, and cultivating local economies, in an effort to rebuild sustainability for ourselves and our troubled environment. He also gently suggested that the interviewer not get too hung up on the identity of writer, because “there are lots of other worthwhile things you can do.”

This sentence was jarring. It allowed me to admit my frustration in viewing my creative work as my single purpose, and translating that into my sole means of financial support. I felt I wasn’t meant to do just one thing, and yet much of my training and the gist of the popular idea of a “serious” writer pushed me to do just that.

Beyond restlessness and money fears, I also felt hungry for work that would feed me and my neighbors, while addressing some of the dysfunction of modern life that nagged at my consciousness. As I apprenticed at Green String Farm, then worked for non-profit Petaluma Bounty Farm, I got firsthand lessons in growing food using natural process farming.

One of the main tenets of this approach is that to grow truly nutritious food, you need to feed the soil first— and to understand it as a community of microbes, fungi, organic material, and more. Soil health depends on diversity and balance. What a perfect metaphor for my own health! I, too, needed to do a range of “worthwhile things” in order to find balance. In tending the soil, I was tending not just the plants that grew in it, but also my body and spirit. In experiencing the satisfaction of nourishing myself and others, I got a taste of the fulfillment I was looking for.


Book cover image courtesy of Didi Pershouse

This deeper understanding of the foundations of health is at the heart of a surprising new book: The Ecology of Care: Medicine, Agriculture, Money, and the Quiet Power of Human and Microbial Communities, by Didi Pershouse (Mycelium Books, 2016). Part memoir and part fact-driven analysis of modern farming and medicine, The Ecology of Care describes Pershouse’s gradual shift from her work in private acupuncture, to community acupuncture and advocacy for soil restoration. It’s a beautifully-written, hope-filled prescription for an embrace of community at every level— perhaps our best shot of surviving our climate crisis.

Pershouse draws connections between the soil degradation wrought by the industrial food system, and the harm done to our bodies by industrial medicine. Since “we are what we eat,” there’s a lot of overlap. Over the past century, we’ve shifted from small, diverse farms to profit-driven mono-cropping, and our guts reflect that change. Stripping the topsoil of micronutrients and microbes, and lacing food crops with pesticides and herbicides, we’ve experienced a corresponding loss of microbial diversity in our bodies, and an increase in disease processes related to the ingestion of chemicals. Likewise, as our systems of care shifted from village doctors, midwives, and herbalists to for-profit hospitals and privatized insurance, the cost of care has skyrocketed while quality has plummeted.

But there’s hope.

A re-invigoration of community-based healthcare can decrease costs and increase quality of care, while reducing the vast carbon footprint of an over-reliance on hospitals for basic care. An embrace of farming practices dedicated to creating a “soil carbon sponge” can help harness the excess carbon driving climate change, while restoring soil health.


Photo by Lyle Poulin

A born scientist and gifted artist, Pershouse is both methodical in her research and emotionally persuasive in her writing. She brings humor and nuance to her discussion of the complicated history described above. In an era of alarmism, Pershouse’s work is refreshing in its commitment to both honesty and optimism. She moderates her appraisal of each system’s failures by offering tangible alternative frameworks, and allowing for emotional responsiveness. These challenges are significant, and Pershouse’s work is sustained by listening partnerships with friends involved in many different aspects of healing. In adopting such a practice for ourselves, healers of all kinds can avoid burnout. We can listen to one another when each of us inevitably reaches a moment of despair, acknowledging that pain before identifying what is working and what to focus on next.

For me, Pershouse’s work picks up where Berry leaves off. As I enter another surprising twist in my career path, The Ecology of Care helps me see how my seemingly-disparate interests—writing, agriculture, and community health— are in fact needfully interconnected.

“Hope is a discipline,” Pershouse writes toward the end of her book. This worthwhile work of restoring our health must be undertaken together, and everyone is invited.

Future Punk: Why I’m Training as a Community Acupuncturist


Image: Welcome to Aculand, courtesy of Nancy Norman.

Sunlight pours onto the funky orange couch in the classroom, and dapples the circle of mismatched recliners around it. A couple of worn, wheeled stools cluster in the center. There are piles of neatly folded fleece blankets in one corner, a bank of folding chairs and tables and a whiteboard against the other wall. Floor to ceiling bookshelves buffer one long wall, alphabetized in sections from Acupuncture and Auricular to Physiology, Pediatrics, and Spirituality. The walls are filled with acupuncture point charts and the kind of hand-written reminders you often see in shared spaces, where the plumbing and lighting are finicky, the fridge has to be cleaned out regularly, and everyone has a job to do before going home.


This is the POCA Tech classroom where I’ve been learning the art of community acupuncture for the past four months. This month we’re on break, but I’ve come here to spread out my notes and charts and books— to gain some distance from the sweet chaos of a home with two kids under four, and also to be close to the energy created in this classroom with a warm cohort of students, all of us excited to become community acupuncturists. Punks, we say, with affection and pride, because the culture and position of the community acupuncture model, as it has emerged from the framework of liberation acupuncture (combining social action with healthcare) and within the broader field of acupuncture in the Unites States, is radical in its insistence on accessibility and affordability.

What is Community Acupuncture?

POCA stands for the People’s Organization for Community Acupuncture, and so POCA Tech is a school specifically for people who want to practice acupuncture in a community setting. That means people receive treatments in a group setting, often sitting or reclining in La-Z-Boy armchairs arranged in a circle, in a dimly-lit room with soft music playing. The punks use distal points— acupuncture points easily-accessible on the lower arms, legs, hands, feet, and head— to treat a wide range of symptoms and challenges. Intakes last 10-20 minutes, wherein the patient describes the health goals they want to work on, and the punk devises a treatment plan and gently “pins” the patient. The patient is then covered with a soft blanket and allowed to nap for as little or as long as they like— typically about an hour, sometimes more, sometimes less.


Why community-style?

Because the needling itself can be done quickly and discreetly using distal points, a punk can see five fully-clothed patients in 60 minutes. By contrast, an acupuncture treatment in a private room limits the punk to treating one patient per hour, depending on available space. While the treatment itself may only take 15 minutes, the acupuncturist must charge $120, the current minimum rate, on average, for private acupuncture. Divide that treatment room and treatment hour into 5 or 6, and patients are able to share the cost, making treatments $20-$25 per person. At that rate, acupuncture becomes more affordable for more people, meaning people with, for example, chronic pain are able to come more frequently. Because acupuncture works best through consistent, regular treatment, patients have a better chance of finding relief and experiencing ease in their lives. This shared success, with the punk facilitating and the patient’s body doing the healing, also leads to a more satisfying work experience for punks. They get to do more of what they love and treat more people— and in turn their treatments have a better chance of being successful.

But community style acupuncture is more than simply cheaper acupuncture. Healing is a complex thing, and there’s a great deal to it that has to do with relationships. Anyone who has had a bad (or good!) experience with a medical professional’s bedside manner can attest to this, and science backs it up. In healing, it’s not just what you do, but how you do it. There is something about receiving acupuncture in a calm room of sleeping people that heightens its impact. Call it whatever you like– collective healing energy is powerful.

Community acupuncture is also a more trauma-informed approach. It lowers not just barriers of cost, but barriers of safety for people who have experienced trauma. Many traumatic experiences are connected to healthcare environments, and community clinics can avoid triggering those trauma histories by looking, feeling, and operating in markedly different ways. Touch can also be extremely challenging and triggering. Offering acupuncture in a shared space, where people are fully clothed and can choose how much of their bodies to reveal (rolling sleeves to elbows and pants to the knee, or just offering hands, feet, head, and ears), can help to reduce triggers related to touch. When the patient is seated in a recliner and the punk is seated on a rolling stool, listening, there’s a powerful sense of equality, of teamwork. The punk and the patient play equal roles in the healing relationship, and this is communicated by their physical positions in space.

This is a model based on many forms of community treatment traditionally practiced throughout Asia and elsewhere. So while in the United States it may be considered “radical,” elsewhere in the world it’s closer to the norm than the exception. For much of acupuncture’s complex, diverse history, people received acupuncture treatments in shared spaces as a regular part of preventive care in mutually-dependent, tight-knit communities. It is a recent shift in the U.S., a shift rooted in this country’s history of white supremacy and systemic oppression, for acupuncture to have become privatized, professionalized, and commodified into a medicine inaccessible to all but the upper class.

Take some time to read about this process. Read about Miriam Lee. Read about Lincoln Detox.

This is not a new story, unfortunately, this pattern of stealing models and resources from communities and movements, of criminalizing mutual aid and privatizing the commons. The U.S. economy is based on exploiting resources, extracting profit, and unrestricted growth, and the ongoing history of those practices impacts the health and well-being of its people. As the healthcare system continues to fail people in the U.S., more and more community clinics are opening across the country, and more and more people are finding relief, empowerment, and hope within their walls.

Poke CA

Image courtesy of Poke Community Acupuncture. Original artwork by Ann Carroll at

Why now?

Why is community acupuncture important now? Because we can only be as healthy as the environment and systems in which we live, and for those of us in the US, both are deeply unhealthy. On day one of my schooling at POCA Tech, we discussed the very real ways in which our individual and collective health is a reflection of our country’s foundations in a history of violence and trauma. Systemic racism, sexism, gender repression and discrimination, a denial of the existence of an oppressive class system, and practices that favor profits over environmental and human health, all take a toll on our bodies. 2/3 of Americans have experienced at least one adverse childhood event, with the majority of those having experienced more than one. The higher our ACE score, the greater the likelihood of poor health and a shortened lifespan. (1) And finally, we are facing a climate crisis unlike anything we’ve experienced before, with corresponding levels of the anxiety that is a normal response to something so deeply troubling.

We’re up against a lot, and we need health, connection, and resilience in order to effectively face these challenges and develop solutions together. We can’t wait for the adoption of universal healthcare in the U.S .to claim the health we deserve. Community acupuncture offers a creative, effective, trauma-informed approach to co-creating health and resiliency for ourselves and our communities— outside of the medical-industrial complex and insurance system that continue to fail us.

I’m joining POCA’s vision for “a world where community acupuncture clinics are as common and accessible as a family restaurant, starting with the U.S.,” as a sign reads on the door to the staff room at the clinic where I’m observing. In studying to become a punk, I hope to work in or open a clinic in a neighborhood that needs it, and be part of a solution to the many challenges we face.

On a more personal level, since my first treatment back in 2014, community acupuncture has been life-giving and life-changing for me as a patient. It has offered me healing, hope, and empowerment through a wide range of life challenges, from miscarriage and grief through pregnancy, motherhood, traumatic injury, and chronic pain. Community acupuncture clinics have offered me a refuge from the daily onslaught of the micro stresses I experience as a city-dweller, including a false sense of separation or separateness. Napping next to my neighbors in a calm, quiet room has filled me with a sense of connection and ease that can be hard to find elsewhere. There is something truly healing about simply resting with others in peace.


But back to the orange couch.

For now, the road to becoming a punk looks like a lot of memorization of acupuncture point locations. From my perch on the worn couch cushions, I fill in KD 3, Kidney 3, next to the dot behind the ankle bone on the inside of the foot. It’s a Shu Stream transport point, an earth point on a water channel. I check my blank sheet against my textbook, then reread the anatomical description I’ll need to know when I sit for the boards in three years, and then I touch my foot and try to locate it on my body. Repeat for KD 4 and KD 5– three points I keep mixing up and am determined to get straight this month.

Sometimes I get discouraged and overwhelmed. It makes sense: acupuncture is thousands of years old, and it seems like there are at least as many ways to interpret known points and design treatments using them. This medicine is complex, ancient, beautiful, contradictory, mysterious, confusing, powerful. There’s going to be a lot I don’t “get,” and I’m learning to befriend that feeling.

At the same time, this approach to healing makes a lot of sense to me as a poet, with a lifelong fascination with pattern-making and metaphor. Like yin and yang, where each is contained within the other and our life force arises out of their interdependence, learning this medicine (for me) is a constant dance of frustration and passion.

I’m hopeful, and so excited, that this will continue to be a path of meaning and growth for me, and the people I get to work with in the future. I expect that I will continue to write about themes I’ve just barely touched on here. Please forgive the broad strokes in this first post! There’s so much to learn and to say about it all, and I need to start somewhere.

Want to experience community acupuncture for yourself?
Find a clinic near you!

Further reading and watching:
Acupuncture Points are Holes, Lisa Rohleder
The Ecology of Care, Didi Pershouse
“Community Acupuncture: The Calmest Revolution Ever Staged,” 30-min documentary
What is POCA Tech?
ACEs Too High
Trauma-Informed Oregon
“How the Young Lords Took Lincoln Hospital, Left a Health Activism Legacy”


  1. A high ACE score isn’t necessarily an irreversible life sentence to increased rates of suicidality, alcoholism, and shortened life span. There are many studies demonstrating that interventions such as counseling, EMDR, mindfulness training, and others can reverse the negative impact of adverse childhood experiences. Check these out for a start: