22 - 36 The fear of not diagnosing the "right" element

A wise young man told me something very important.  He said, "We grow when we are challenged", and I often think that there is no greater challenge for a five element acupuncturist, amongst the many challenges we face, than that of learning how to deal with the natural fear we all have of not getting our diagnosis of a patient's element "right".  We each have to learn to deal with this particular fear in our own way, but what it requires of us is honesty and humility, which can be characteristics some of us may find difficult to accept as forming a necessary part of a five element acupuncturist's role.  I have observed many reactions to my students' finding that the element that they think is "obviously" Fire turns out instead to be Wood or Metal.  Their reaction is sometimes disbelief, or a need to cast doubt on even the most experienced practitioner's diagnosis rather than accept that their practice requires so much of them. In extreme cases, students or practitioners have felt compelled to move away from five element acupuncture to practising other forms of acupuncture which do not rely so heavily on our subjective senses and emotional antennae to diagnose our patients.

I have said many times that five element practitioners have to learn to accept that they are themselves, as JR Worsley so beautifully put it, instruments of nature.  Rather than relying on physical equipment to give us our diagnostic information we have to rely on ourselves, on our eyes, ears, noses and emotional antennae.  I have always found this a quite lovely aspect of my work, but some people are daunted by the need to put themselves at the forefront of practice in this way.  No physical instrument can diagnose a patient's element;  only our own senses and feelings can do that.

 

And we are all fallible human beings, each with our own particular emotional hang-ups, each of us hoping against hope that we will get that most difficult aspect of any five element practice, the accurate diagnosis of our patient's element, right.  But we must learn to say to ourselves that, if we don't get it right to start with, it does not matter, because elements are elusive things, which often hide themselves behind other elements, having learnt that life often forces them to put on masks in order to survive.

 

We have to accept that a five element practice requires us to come to terms with not getting our diagnosis right immediately, and that once we acknowledge that this is so, we will, as my young friend said, grow as a result of meeting this challenge.

 

11. Learning to build up good relationships with patients of different elements

Like all skills, we have to practise how to create a good relationship with our patients.  A successful relationship is one where we are able to match what we have to offer with what our patients need as smoothly as possible.  Here, of course, our knowledge of the elements will act as our guide, for what one person needs will differ very markedly from what somebody of a different element will need. Some people are lucky, and either by their nature or by the circumstance of their lives have an ability to empathize with other people that a fellow practitioner has first to learn, and all of us will find it easier dealing with some elements than with others.  Perhaps to some people’s surprise we are not necessarily most at our ease with those of our own element, because seeing our own needs reflected in a patient may make it difficult for us to maintain an appropriate distance.  The secret here is to recognise that we may always find certain relationships with patients of certain elements more complex and difficult than others, and remain aware of this as we engage with these patients.

I will describe some of my own reactions and difficulties with patients of certain elements. These are personal to me, and every other practitioner must study their own responses and learn from them.  But learn they must, otherwise they will not understand their patients’ needs.  More importantly their patients will not feel understood, and then their elements will take to hiding themselves away. How can a five element acupuncturist treat if we don’t know which element is crying out for help?

Nobody should think that this comes easily to any of us.  When I look back at my own practice, I can see many instances where I did not understand what a patient needed, and I offered my help in a way which was not wanted.  Inevitably it was these patients who decided quite quickly that I was not the practitioner for them.  And they were right!  How could I help somebody if I was misreading what they were asking of me?  It was as though I was talking in an emotional language foreign to these patients, or rather assuming that both of us were talking in the same language when we very obviously were not.  One way of looking at relationships with our patients is thus to see them as though they require us to learn to speak in an emotional language with which only our patient is familiar and at ease in.  We therefore need to learn to speak in a different emotional language for each patient.  And like learning any new language, this takes time and a good deal of practise.  

We all know the warm feeling we have when we have got it right with a patient.  It is those times when we know that we have not which we should accept as teaching us the most.  JR always said that it was far better if students observing him with patients did not get the elements he diagnosed right, because the only true learning is through our mistakes.

If I look at my relationship with the Wood element, as my first example, I realise that it has taken me a long time to work out a way of dealing with its strong needs.  I tend to go through almost the same pattern of behaviour each time I encounter a Wood patient.  I pass through an initial period of wanting to step away, as though shrinking from the push I feel coming towards me, then I experience a flicker of irritation, or more than a flicker, at feeling that I am being outmanoeuvred in some way, before I finally reach a more balanced stage of understanding, where I know that to help my Wood patient I have to stand firm and, as it were, counter-punch, however gently.

With all Fire patients, on the other hand, I experience first a slight feeling of relief, since I am moving on to the familiar territory of my own element, accompanied by an initial sense of relaxation.  Fire is the most articulate of all elements, enjoying speech as its way of communicating.  Since I, too, like communicating through speech, it is easy for the patient and me to fall into the habit of indulging in a kind of idle chatter with which we both feel at ease.  Experience has taught me, though, that I must issue a warning to myself to take care and not let the ease of this interaction divert from the reason why the patient is here.  I have to be aware, too, that in its need to make other people happy, Fire may also feel it should make light of its problems, and I have to be on the look-out in case I buy into the cheerful mask and ignore what lies beneath it. 

One way I have devised of helping me here is through the simple expedient of employing silence, a tool we too seldom use in the practice room.  I try consciously to quieten the emotional tone by reminding myself to fall silent.  Silence on my part gives my patient permission to stop any superficial chatter, and offers them the space to think out what they really need to tell me.   I have often found falling silent is the most difficult thing for me to do, and I have had to train myself to be on the alert against encouraging a babble of words to flood the practice room. 

Although it is easy for me to develop a very warm relationship with all my Fire patients, this ironically makes it harder to set the correct emotional tone which is helpful for my patients.  Familiarity does not breed contempt, far from it in this case, but it certainly breeds a false sense of relaxation.

The difficulties I experience with Earth patients are of a different kind from those with Wood or Fire.  I have found that the need to be nurtured which all Earth people have awakes an echo of the same need in me, because at some deep level within me I would like some of the same kind of nurturing I am being asked to offer Earth.  A few days ago, interestingly, an Earth practitioner told me that he finds his first interaction with his patients disturbing because he feels their differing needs tugging at his Earth element which is reluctant to offer what is being demanded of it.  

Once I am aware of this reaction in myself, I remind myself firmly that I am here for the patient and not for my own needs.  What Earth needs is not a blanket response of sympathy of the “Oh, you poor dear” kind, but instead it needs to be understood.  It wants to be heard, and wants to be heard to the end if possible without interruption.  Its thinking is a circular process, ending where it began and then beginning again.  If it is out of balance, it begins again with the same words and goes over the same ground, like an oxen tied to a circular grindstone, going round and round.  When it is in balance, this need to churn over the same thoughts is lessened, but never disappears completely.  Since its function is to process all things, thoughts as well as food, it has to perform this task endlessly as the other elements pass their energies to it for processing. 

If I remain clear that my Earth patients need to be allowed time to circle round a subject, even though I may have heard the same thing in the same words before, I am able to stand back and allow this circular movement to continue without getting irritated.  But being a quick thinker and talker myself, the slow chewing-of-the-cud which is Earth’s way of thinking can tend to irritate me and make me want to interrupt it if I am not careful.  So a warning sign goes off in my head with every Earth patient I treat:  Let the patient speak, Nora, and only interrupt or add your own comments when you have given your patient time to process his/her thoughts and express them fully in the way they want.

With Metal I seem to have a far less difficult relationship than with the other elements, perhaps because it demands space to be itself and allows me time to catch my breath, as it were.  No immediate reaction is demanded of me, except an acceptance that it wants to be the judge of how our relationship should develop in a way satisfactory to itself.  It is happy with space and is the most comfortable of all the elements with silence, for it needs silence in which to work out its own solutions to life’s problems.  This need for space and silence presents a great challenge to my Fire element, if I do not recognise it in time, and find myself starting to gabble to fill the silence.  With all Metal patients I have learnt, too, that I must hold back my own impulse to share my thoughts, for this can easily lead to a kind of role reversal since I find that I can often learn from Metal’s detached wisdom.

Metal patients are not, however, there to teach me, nor for me to teach them, but to find the support for their Metal energies which treatment will offer them.  With Metal I need say almost nothing and let the treatment do its work silently.  The practice of silence which Metal needs is that which respects its need to solve its own problems.  The silence which I have to encourage myself to offer Fire is different;  it is aimed at preventing it from talking so much that it forgets why it is coming for treatment.

Finally I come to the problems I may experience in dealing appropriately with my Water patients.  I do not find the demands Water makes upon me difficult to meet, although others may.  The need for a reassuring approach to still the panic which lies deep within the heart of all Water people is not something alien to me, but something I feel at ease with and able to offer without feeling in any way diminished.

My main difficulty comes from my inability to recognise the Water element in my patients quickly enough in the first place.  We all know how Water likes to disguise itself and hide, and it has taken me longer to detect its presence than that of the other elements.  Even now I have a tendency to see Water’s uneasy laughter as coming from Fire.  Its elusive nature will often make me question whether I am really in the presence of Water or not.  Once recognised, though, I feel able to offer what I think it needs, provided that I stay focused on the profound fears which lie beneath its often apparently confident surface.  This most ambitious of all elements, and the one most likely to get to the top of whatever profession it chooses, harbours a terrified underbelly.  I must never overlook its need for these hidden fears to be acknowledged by me, and for me to offer them the correct level of reassurance.

 

 

 

 

 

 

 

10. The risks involved in trying to diagnose famous people

Since all five element acupuncturists know that diagnosing a patient’s element takes a great deal of time and patience, it is obvious that trying to do this by looking at the necessarily brief glimpses of politicians and other famous people on television or social media can at best be a rather hit and miss affair, and at worst may lead us to making completely erroneous conclusions.  I remember well that I was convinced that the film actress, Julia Roberts, was Fire, because this is how I interpreted her endless smiling.  I told all my students this until one day, a good few years later, when my understanding of the different qualities of the elements had obviously deepened, I noticed a different reaction in me to this smile.  It certainly did not warm me, but, instead, irritated me with what I now thought was its artificiality.  I realised suddenly that, rather than giving me something, as Fire always tries to do, it was demanding something of me.  Once I had noticed this, I changed my diagnosis from Fire to Earth, and have stuck with that ever since.  This was a good warning to me always to hedge my conclusions about elements around with a few question-marks.

I always emphasize how difficult it is to pinpoint a person’s element, particularly that of a famous person whom I only know from the TV.  Perhaps, indeed, it is a bit risky of me to make the selections that I do, because I can so obviously only too easily get things wrong.  But somebody has to have the courage to stick their neck out, otherwise novice practitioners would have few examples of the elements to base their understanding on.  I therefore do the best I can, however inadequately I may sometimes be doing this.  My justification here is that I now have many years’ experience to draw upon, whilst students have none at all, and as I always tell everybody, we owe those coming after us to hand on whatever knowledge we have acquired.

I hope that most of the examples I give, such as those of David Beckham and Elvis Presley in my Keepers of the Soul, are still valid, but if those reading what I write disagree with me, that is all to the good, because it forces them to study the elements deeply and develop their own understanding.  And in any case, until I treat a person, I am never sure that I have found the right element.  I think, therefore, that I need to continue giving my take on the elements of famous people, otherwise there would be so few examples to offer those who are unfamiliar with the elements.  It is also good that I offer myself as a living example of somebody who doesn’t mind getting things wrong and admitting to it.  As I have said on many occasions, we all need to be humble enough in whatever field we work to accept that we will get things wrong, and to have the courage to admit that we have. 

If we are treating a “wrong” element, we may assume that we are doing something wrong.  But that is not what I believe.  No treatment we give should be considered the wrong treatment provided that we follow some basic rules of five element practice.  And these consist in ensuring that we are not going against nature by taking more energy away from an already depleted element, or adding energy to an element which already has an excess of energy.  This is gauged from our pulse-taking.  If our fingers are sensitive enough to assess the relative levels of energy in the different pulses we are taking, any treatment we give on whatever element we choose can not only not harm, but must be beneficial, because it will bring greater balance to the different levels of energy in the five elements.  And anything which brings greater balance is to be recommended.

Of course, if we can add to our assessment of the energies in the different elements that additional component of concentrating our attention on helping the dominant, guardian element to greater health by trying to balance the level of its energy in relation to that of the other four elements, then any treatment we offer will be more successful because it will be focussing itself exactly where it is most needed.