Ritual Medicine

Where do we go when doctors don't have answers?

“There’s stuff inside my body.”

“What stuff?” my partner asks, wary. I am crying on the couch, hard sobs shaking me. Unable to contain them, they roll over my chest. It feels like an attack – a sad attack, is what I used to tell the psychiatrist. 

“Emotions,” I manage to get out between waves. 

It starts with pain. My shoulder, my head, my jaw, my lower back, my hands. It roams around my body over time, but it’s the same dull aching. And, after I have ached all day, or maybe two, the sobs come, the sad attacks. How else can I think of it but my body manifesting what I refuse to feel?

Psychosomatic has become a bad word in the world of chronic pain, and I know why. It feels like you’re being told it’s not real, but what happens in your head happens in your body, too. There’s no separation. The phenomenon is biological. The body is the experience.

I am not so naive that I would tell a doctor that my pain is emotion manifested – I know how they use it against us. Hysterical! I’d be shuffled off to a psychiatrist, who would shuffle me off onto some antidepressants. Check in every other month for 15 minutes.

I’d rather have very tiny needles stuck into my joints.

So I go get acupunctured, lying in a dim room full of tables, full of other people lying there, needles sticking out. It’s a tiny community practice four floors up downtown, and they put me on a table by the window. It smells like jasmine and eucalyptus.

I study the anatomical diagram of energy meridians hanging on the wall, each point on each line correlating to an organ. It looks complicated. There’s 365, one for every day of the year.

The practitioner asks me what’s wrong (my jaw, my temples) and what I thought about my last visit (very chill). I tell him they put a needle right in the top of my head, and it felt like Xanax. 

“That’s not usually how it works, but we can try that point,” he says. 

“I know it’s probably just the whole…experience,” I shrug, and he sticks me in the inside of my right foot, just below the knuckle. (Later I will ask what that point is for, and he will tell me it’s the spleen.)

The needles are so small, you can’t really feel them. It takes less than a minute to put them in – one in each foot, one in the left wrist, one on either side of my jaw, and one in the top of the head – and then he leaves me there for half an hour.

“Try to rest your eyes.” 

It’s the only time in the day when I am really, truly just doing nothing, in a room full of other people doing nothing, while someone delicately cares for us. As I lay there, I start to feel tingling come in waves through my limbs. I cry, for no apparent reason.

The spleen point in my foot starts to pang a little, even though I didn’t feel it go in. I get sleepy and stare at the ceiling, breathing. I let my thoughts cycle through my head without catching them. 

Skeptics say that acupuncture is a “theatrical placebo”, but I don’t really care, because it feels like relief. It’s been shown to be clinically effective (meaning it makes a difference in people’s lives) but the jury is still out on whether it’s really doing anything, technically, that a placebo procedure doesn’t. How does it work, biologically?

On the FAQ page of the People’s Organization of Community Acupuncture, they admit, “no one has a definitive explanation.” (Private acupuncture can be prohibitively expensive, but if you can find a community clinic nearby, most have sliding scales that start around $20.)

Some think it eases you into a parasympathetic state, which allows your body to begin recuperating from chronic fight-or-flight. Some studies have suggested it releases endorphins and affects opioid receptors. I think it’s probably just the whole experience, and you can’t quantify an experience.

In October, the pain was in my hands again, so I went to get blood tests. That’s what you do, right? The doctor was very thorough, but all the tests came back fine. I had no inflammatory markers, and he had no answers. If a doctor can’t explain my symptoms, then why shouldn’t my treatment be equally inscrutable?

The placebo effect has components: ritual, expectation, the therapeutic relationship. We look at a doctor’s visit as a purely physiological check-up and don’t see that it’s also a kind of ritual, because we think, we’re scientific now, we have stats and data, we don’t do rituals anymore. Except, we do. We are always performing rituals.

I dread the doctor ritual: the bright room, the high table, the crinkly paper. I avoid it at all costs. It’s cold and rushed and it makes me anxious – too often I leave feeling more like a number and less like a person. I much prefer the incense, and the soft sitar music, and the tiny needles.

Where can we turn when science has no answers for our pain, but to ritual?

I did not tell the acupuncturist very much, just that I had anxiety, and my jaw had been hurting, and it was traveling up into my head. That it happens, from time to time. After our session he told me not to eat acidic foods, explained that it’s possible my digestion is connected to my jaw pain.

“You have been chewing on your thoughts.” 

This statement struck me in its poetry. No doctor had ever said something like that to me. It’s simple, and obvious I guess — anxiety causes teeth grinding and stomach issues — but to me, it felt meaningful. He didn’t need to do a blood test to understand. He heard “anxiety” and “pain” and he did not neglect one for the other, but treated them the same. 

There’s stuff inside my body. I’ve been chewing on my thoughts. 

There are things that live in between my bones that I can’t know. I have become so practiced at locking them up in there that I don’t even realize I’ve done it. Let alone know where the key is, or how to stop. I can’t even tell you why my heart is pounding, when everything around me says “You are safe, you are fine.” My body disagrees. It cannot hear reason. 

Breath in for two, out for four. Visualize the four sides of a box. That’s what they teach soldiers, an autonomic nervous system hack. It helps but I don’t think it would get me through a war zone.

Five things you can see, four things you can hear. I forget how it goes. I sit on the floor crying and tap around my eye socket, repeating: even though I feel anxious, I accept myself. Feel anxious, feel anxious, accept myself. 

I don’t know what else to do but hurt and cry and recover again. I don’t have a neat and tidy ending for a thing I am still living. I’m gathering my incense and my candles, setting my altar, circling myself in salt. I’m submitting to the needles, suspending my disbelief for ritual, for whatever works to quiet the demons that medicine can’t diagnose.