Linda L Barnes

This article explores ways in which Chinese healing practices have undergone acculturation in the United States since the early 1970s. Reacting to what is perceived as biomedicine's focus on the physiological, those who describe themselves as favouring a holistic orientation often use the language of 'energy blockage' to explain illness, whether thought of as 'physical' 'emotional', or 'spiritual'. Acupuncture in particular has been appropriated as one modality with which to 'unblock' such conditions, leading to its being used by some practitioners in conjunction with more psychotherapeutic approaches which include valuing the verbalising of feelings. Some non-Chinese practitioners in the United States, returning to older Chinese texts to develop 'an American acupuncture' are reinserting diagnoses eliminated from Traditional Chinese Medicine (TCM) by the People's Republic of China as 'superstition'. The assumption has been that many such diagnostic categories refer to psychologial or spiritual conditions, and therefore may be useful in those American contexts which favour this orientation. Among these categories are those drawn from traditions of demonology in Chinese medicine. What was once a religious category in China turns psychological in the American setting. At the same time, many who use these terms have, since the late 1960s, increasingly conflated the psychological and the religious, the latter being reframed as 'spiritual'. Thus, this indigenisation of Chinese practices is a complex synthesis which can be described as simultaneously medical, psychotherapeutic, and religious.

Transplanted from China into the United States, a rich and complex body of traditional healing practices has been filtered through not only a foreign language, but also a foreign way of thinking. Such filtering tends to characterise the translation of any tradition from one culture into another. When groups within one culture voluntarily adopt the concepts and practices of another tradition, it is often because they believe the foreign tradition will address questions being raised on native soil. This has been the case with the indigenising of Chinese healing practices in the American context.

It began in July of 1971, when James Reston, a reporter from the New York Times, had his appendix removed at the 'Anti-Imperialist Hospital' in Beijing. The doctors used biomedical anaesthesia. When Reston suffered abdominal pain the next night, however, the hospital acupuncturist treated him by inserting three needles into his right elbow and below his knees. The pain went away and did not come back. Reston reported his experience on the front page of the Times (Wolpe 1985: 411). For months thereafter, stories continued to come out of China reporting procedures that astonished an American audience, not the least because the tellers of tales included American physicians.

'. . . the impact of acupuncture on the United States in 1972 would be difficult to exaggerate. This miracle cure for everything from baldness to frigidity was reported in all the popular media, from Life ... to Vogue ... to the National Review.... One reporter called acupuncture 'a darling of the American media' due to its potential for dramatic photography, tales of miracle cures, and accusations of quackery' (Wolpe 1985: 411).

Acupuncturists in the United States, most of them from Asian countries, suddenly found themselves besieged by patients. The first acupuncture clinic to open in New York City in 1972 may have been closed down a week later for practising medicine without a license, but even by then some 500 patients had been treated, and the clinic booked four months in advance (1985: 412). Yet within a few years, the interest in acupuncture seemed to fade away. The modality received diminishing attention from the press, and did not take root in biomedical practice as had once seemed likely. Had it been only a matter of physician interest, acupuncture might have returned to being primarily the province of practitioners in Asian communities.'¹

But acupuncture had also caught the imagination of a non-Asian audience drawn to new modalities perceived as foreign and ancient. By 1991 there were thought to be some 9,000 practising acupuncturists in the United States. The AMA estimated in the same year that 1,500 physicians had been trained in acupuncture, with 2,000 to 3,000 additional doctors having taken short courses and been exposed to enough of the technique that they could use it in their practice occasionally (1985: 412). It was not known to what degree the two estimates overlapped. According to a 1993 report for the US Department of Health and Human Services, 'If one assumes that half the acupuncturists practise full-time and the remainder practise one-third time, [the] numbers extrapolate to 9-12 million patient visits per year for acupuncture treatments (or around $500 million at $45 per visit) nationwide' (1985: 413).²

This growth on the grassroots level came about as westerners like Ted Kaptchuk and others sought training in Chinese medical schools or from Chinese teachers.3 It involved, too, the establishing of acupuncture schools in the United States. One of these was the New England School of Acupuncture (NESA) founded in the late 1970s by former Christian missionary Dr James Tin Yau So in Watertown, a suburb of Boston. Thus, the initial information coming into American culture was a mixture of popular press, PRC presentations of 'Traditional Chinese medicine' (TCM),⁴ and the teachings of Chinese practitioners who had come over to the United States along with those Americans who had gone to China or other parts of Asia to study and bring things back.

Initially, there was a tendency among the non-Chinese to adopt these teachings uncritically. Over time, however, they began to look for sources and methods through which to articulate questions which, in some instances, they themselves had introduced into the Chinese practices. This has been the case, for example, with formulations of illness, especially concerning the relationship between illness states and the emotional life of the individual. In the following discussion, I shall describe some of the ways that Chinese practices have undergone this acculturation in the United States over the past two and a half decades, using the city of Boston, Massachusetts, as a case study.⁵ The participants in this study are both Chinese and non-Chinese practitioners, patients, and students of Chinese healing practices, with whom I conducted some two hundred interviews in the Boston area between 1990 and 1993.⁶

The Language of Blocked Emotions
Within North American culture, there are many codes of feeling. The ethnic, racial, and class complexity of the country is such that no uniform approach to the emotional life holds sway. Certain codes are informed by gender as well. At the same time, something of a public norm has emerged in recent years, according to which the verbalised articulation of feelings is valued and the suppression of feelings criticised. This valorisation has informed and been informed by talk-shows, popular magazines, and various approaches to psychotherapeutic training. It has also entered explanatory models of illness used by different schools of complementary medicine. Among these, one finds non-Chinese practitioners of Chinese healing practices.

Many of these practitioners refer to the mental, emotional, and spiritual causative factors of illness which are, in turn, connected to 'energy blockages.' Such terminology also informs popular psychological models which describe the individual as 'stuck' or 'blocked,' and in need of 'letting go of' or 'releasing' the blocks in order to become 'unstuck.' Illness is thereby construed as the somatised expression of blocked or suppressed emotions. In Chinese practices, which emphasise discerning the correct relationship between 'the root' and 'the branches' in a given situation, getting at the root then comes to mean tracing things back to an emotional source.

Many non-Chinese practitioners of Chinese healing practices in the United States explain illness as blockages in a person's qi, which are in turn expressions of blockages in his or her emotions. As one practitioner put it, 'Blocked qi is blocked emotion. So if your liver qi is stuck, you also have clogged emotions.' Some practitioners also introduce theories about 'suppressed memories' the basic premise of which is that traumatic experiences can so overwhelm a person that memories become stored in the body, remaining inaccessible to the conscious mind. Through psychotherapy, either with or without 'bodywork' these memories may be recovered. Proponents of this approach assume that such retrieval is essential for real healing to happen.

Acupuncture is one of the 'bodywork' modalities sometimes thought to help in this process. A basic tenet among those who adopt Chinese practices is that qi, by its very nature, is related to 'physical,' 'emotional,' and 'spiritual' states. Schools of practice like that of J R Worsley7 emphasise the issue of blocked emotions and, sometimes, of spiritual 'stuckness':

'With chronic problems, it is rare that it is not a psycho-spiritual problem influencing and aggravating the symptom. It may be the anxiety about the problem that creates numerous other problems, making it harder for the original injury to heal' (Michael Hussin, Worsley acupuncturist and herbalist).

The incorporation of language deriving from psychotherapy into that of acupuncture has also surfaced among non-Chinese practitioners of TCM:

'We have painful experiences when we are young, and learn to protect ourselves from the pain. We layer it over. That's the essence of my theory of therapy. In that, acupuncture is helpful to help people drop some of their armouring.

A depression related to anger is one that, in TCM, is stagnant liver qi, so acupuncture then addresses those points. It is very different from a depression that comes from grieving over a loss. Then you treat a person's lungs. If it is a depression from the absence of qi, you treat the heart. Kidney depression is related to fear. If you are treating with TCM, you get at these different levels. You have access to their anger, and you have to go through their anger to get at their depression. I try to make sure that people understand if they get emotional in a session, that that's beneficial' (Edwin Geiger, TCM acupuncturist, herbalist, and clinical psychologist).

Formulations concerning addiction, child abuse, and eating disorders have been woven into acupuncture practice and incorporated into both patients' and practitioners' assumptions and expectations:

'In the past few years, more people are saying they hear acupuncture treats depression and panic, or that it's useful if their therapy hits some kind of a block.... For example, more people will say on a first visit that they are a recovering alcoholic or that they experienced child abuse. Or they will say that they are coming because of one problem, but in the background is the fact that they are bulimic. Ten years ago, this was unheard of. I have had to educate myself in these things through workshops, about these levels that are helpful for me to understand in my practice. I had not anticipated that' (Mary McCabe, TCM acupuncturist and Clinical Director at the New England School of Acupuncture).

For some practitioners, these associations lead to a more explicit redefinition of their own practice as overlapping with psychotherapy.

'I really blend psychological training with the things I've learned in Chinese medicine, in particular when what's happening for the person is something I can describe from a westem psychological perspective as well as from the standpoint of traditional Chinese medicine - for example, someone with lots of disharmony in the gall bladder and liver, which from a Chinese medicine standpoint can be associated with emotions like anger and the expression of decisiveness.

From a western perspective, this would have to do with solidifying their adult sense of themself - to have a sense of power as a person, to have the ability to make decisions and execute them - all of which involves the blockage of anger and expressions of the will. So these things are very easy to talk about for me. I'm a little different in doing all that, although it's not altogether unusual. But I have a little more psychological training than many, versus the Worsley psychological orientation, which is different.' (Jonathan Ammen, TCM acupuncturist and herbalist).

For other practitioners, acupuncture is a plausible alternative to psychotherapy. Indeed, they feel it is possible to perform interventions for psychological problems that would eliminate the need for psychotherapy altogether. Still other practitioners, who distinguish between what one does as an acupuncturist and as a psychotherapist, choose not to blend the two:

'I work hard to keep relations with patients very clear and simple because of how we do acupuncture. It tends to be a very intimate process. I know a lot about these people. I see them over long periods of time and over different periods of life and illness. For myself, the best way is to maintain a somewhat crisp relationship with my patients. Then I can do the best job. People over time want me to be involved with psychotherapy issues and life problems. I back off from that. I make sure I don't become a therapist to my patients.

I get a lot of referrals from therapists. ‘Mary, we've reached a plateau. There's a block in the pelvic area.’ I make it clear that I don't need to know the details. I only need to know if they have difficulty swallowing, or if their respiration is shallow. I don't need to know why. I really want my patients to know I am here to do acupuncture' (Mary McCabe).

McCabe relates her approach to her experience of being in China and of working with doctors: 'Given the kind of acupuncture I like to practice, it was like going home. It was like a confirmation of what I felt was strong about acupuncture.' Her practice represents a closer adherence to the TCM of the People's Republic originally introduced through NESA, without the more explicitly American additions that have emerged during the past two decades.

Not all patients think of themselves as going to a practitioner of Chinese medicine in search of help for 'non-physical' problems. It may sometimes be the case that such issues are raised in the actual course of treatment by the practitioner him - or herself. At the same time, other patients describe their emotional state undergoing transformation as a consequence of acupuncture, even when such change was not their original objective.

It is difficult to say where it all begins. There is a larger backdrop of shared assumptions related to complementary practices, along with an emotion-related set of diagnoses within certain versions of Chinese practices. Patients also have therapeutic experiences - and in some cases, expectations - which North American culture supports and, in some unquantifiable measure, generates. They bring these assumptions and experiences into the clinical encounter as well. But when the focus turns psychological, even though the paradigm and terminology derive from the Chinese, the particular focus is of American making. To appreciate the distinctions, it is useful, therefore, to return to some of the ways in which emotion is defined and expressed in a Chinese medium.

Emotion as Contextualised Response
Two approaches are useful in this context. The first involves the Chinese notion of emotion as the response one feels in a particular situation in the midst of lived reality. The word for this response is renqing - 'human feeling,' or 'human sympathy.' Because of the situational nature of renqing, it implies dimensions of relatedness.

Part of the project of self-cultivation proposed within the Confucian tradition entails deepening one's capacity to feel, as well as one's sensitivity in discerning the feelings of others. Unlike the American expectation that feelings should be voiced, it was more often the case in China that one's innermost thoughts were private, rarely to be shared except perhaps on occasion with the closest of friends or with members of one's family. Traditionally, other vehicles were often more artistic, as in the poetry of separation between good friends. What went unsaid was, in some cases, the more important content of the poem, similar to the spaces left empty in a painting. Indeed, it was thought, the sensitive person knows the feelings of others without needing to be told, and is able to respond empathically.

Such a person is said to 'know renqing,' and is able to read 'his and others' responses to the situation through all the senses: sight, smell, sound, and other sensations, including an inner resonance.'8 Just as the true physician in Chinese medicine is understood to be one who discerns the state of a person through observing subtle cues, without the patient ever having to explain anything, so the profound person can recognise the emotional state of others without their saying a word.

A cultural emphasis favouring the harmonising of relationship also works to inhibit the free-wheeling expression of emotion. Indeed, excessive emotion is understood as one cause of illness. A person is to be balanced in his or her self-presentation, opting for reserve over candour. More recently, the political danger of speaking one's mind too freely has meant that matters of self-cultivation have been overlaid with matters of self-preservation. The damages to human-relatedness brought about by the Cultural Revolution, for example, corroded the balance of emotional exchange between people, making it unsafe to open one's inner life to others, particularly with regard to the experience of suffering. When a network of relationships based on the interchange of renqing and loyalty is torn apart, the whole setting of the self suffers damage that afflicts one's entire experience of being in the world. One remains, in the words of TCM acupuncturist and herbalist Lu Weidong, 'the same person,' and yet is 'treated differently.' He or she is left with a sense of spoiled identity.

Nor does the experience ever fully end. Instead, one knows that the consequences of these episodes will dog the rest of his or her life, the self never fully free from stigma. To respond to such experience with grief, anger, or depression only takes one further into another stigmatised realm, that of 'emotional problems.' The punishment is therefore doubled. What begins as a culturally informed reticence with respect to the expression of emotion - a reticence that is, in its own way, also an aesthetic - becomes imprisoned in the inhibitions imposed through the political environment.

In either case, people do not tend to think of these matters as belonging in the medical arena. Not only are 'emotional problems' not generally seen as having to do with the medical realm; they are also not usually thought of as falling within the domain of matters for which one would seek professional help. People in mainland China have also been reluctant to talk about having 'psychological problems,' because these have been another way of referring to 'incorrect' political attitudes. The lines between the personal and the medical are thus clearly drawn, the relationship between the doctor and the patient not being envisioned as including the personal. Indeed, for the Chinese practitioner, the encounter with non-Chinese patients in the United States can be an unsettling experience.

'The Chinese practitioners I know have a hard time dealing with the expression of emotions. Like when I worked with Yao [Zhang] during my second year. She didn't know how to deal with me. She talked about an American patient bursting into tears, and said, 'American people do that'.' (Julie Zinkus, TCM acupuncturist).

Lu Weidong adds:
'The whole relationship with patients is different. Here the patients seem to want to know more about what you are going to do, the components of the herbs, and their side effects. In China, people don't ask because they already know. It is part of their background, even if it is the first time they are going to see a practitioner. Also, Chinese people are not tending to ask questions. They don't ask why.'

The not asking is due to the popular assumption that herbs have no side effects and can be used to offset those of biomedicine. Lu continues:

'Here at the school, in the clinic [at NESA], people want to know why and what's going to happen, at least when they first come. The patients are more sensitive emotionally and physically. Like when I put a needle in lightly, they jump up and scream. It surprised me at first. I realised it was a different culture. Emotionally, Americans seem a little sensitive, and more fragile. They seem to pay more attention to spiritual and emotional questions. They talk about what is happening with their husband or wife or families. Some patients talk a lot about what's going on. Their emotional level goes up and down; it is more irregular.

It is not like Chinese people, who are very even. They can feel what is happening to them, but they were taught as kids not to express their feelings too much. I don't know why. In China, they taught the traditional Chinese gentleman way. You can't just cry in public or lose your temper and get angry or upset. You control your emotions more, because this will make the group or community work more as a unit and be more close. Even if you feel someone is wrong, if it is not a big deal, you may want to explain but it is better if you don't just jump up.'

In China, an emotional state described in a medical setting may be expressed in a language of the body. This becomes the shared code that respects the privacy of the person while, at the same time, leaving room to state that there is a problem. In the realm of what is expressed, patients are frequently able to speak in detail, resorting to a commonly understood language of distress. As Kaptchuk notes:

'First-hand clinical experience [in China] frequently prompts westem observers to remark it seems as if all the patients have read the text-books. Patients in China often report neat problems with details concerning particulars of perspiration, gradations of thirst, various tastes in the mouth and other descriptions that are routine components of health care discourse in China. People have learned to monitor themselves on this level and this is what doctors elicit. Little psychological and existential detail is involved. Westerners wonder why western patients never quite have these kinds of simple textbook presentations or descriptions' (Kaptchuk 1987: 3).

The fact that non-Chinese patients cannot provide descriptions that coincide precisely with Chinese diagnostic criteria, while Chinese patients can, illustrates the ways in which medical language is a learned phenomenon, and people's attention schooled with respect to what counts as significant detail. The non-Chinese patient, therefore, is less well-equipped with the nuances that would allow the Chinese doctor to target as precisely the nature of the problem being expressed.

Within the framework of these nuances, the distinction made in the West between mind and body - and the language describing the conditions of both - becomes problematic. Within the Chinese medical language, each organ function is simultaneously the seat of different emotions. Therefore, although one might not actually use the word 'anger,' to talk about the condition of the liver could be tantamount to doing so from a different direction. Stephen Birch, a teacher and practitioner of Japanese acupuncture, cites the case of a group of Chinese traditional doctors who came to Boston as part of a conference on Chinese medicine.

'At the end of their presentation a member of the audience asked the esteemed practitioners how they treated patients with psychological problems. Looking very perplexed, they huddled together. Eventually one of them announced that they couldn't understand the question' (Birch n.d.: 19).

Birch goes on to suggest that these doctors were so accustomed to conceptualising mental and physical events in terms of qi that 'they had no frame of reference in which a problem could be only psychological' (Birch n.d.: 19). Despite their own self-styled 'holistic' framework, the non-Chinese questioners still could not fully conceptualise a system in which such issues could not be addressed separately.

Returning to the Texts
When Ted Kaptchuk first returned from China and began to teach at NESA in the 1970s, he stayed strictly within the boundaries of TCM. Over the years of teaching courses in herbal medicine both in the United States and Europe, however, Kaptchuk has turned increasingly to older texts, searching for diagnoses and treatments removed by the PRC. One way he has done this is by showing these older texts to another physician trained in traditional medicine in China, asking her to point out all the parts that she had been taught were superstition. These parts have then became the focus of his study. He argues now that Chinese medicine has historically recognised psychological and physiological processes to be fully interrelated, and that the religious project of self-cultivation intersects with certain areas of medical treatment.

'Either you assume Chinese medicine can treat the self and self-awareness, which I think it can, or you don't.... My favourite Chinese doctor Sun Si Miao [ca. 58 1-082] clearly gives me license to do this.... I certainly feel comfortable that I'm not stretching Sun Si Miao's ideas about self-cultivation at all. I think I'm not even near to catching up with what he thinks is possible in the context of Chinese therapeutics. As a simple example, he talks about the most elaborate individual experiences as being susceptible to manipulation by herbs or acupuncture. He has descriptions of being stuck in the 3rd and 4th Dnana, in a particular form of Buddhist meditation, and saying if this is the problem take these herbs. Now I believe in this case he is clearly talking about individual consciousness, and he says you can use herbs and acupuncture' (TAS Interview 1992: 4-41).

The notion of recovering older versions of Chinese medicine, for writers like Kaptchuk, is part of the process of creating what is increasingly referred to by practitioners as an 'American' acupuncture and herbal medicine, rooted in Chinese systems. It is based on the argument that many non-Chinese patients in the United States are oriented to think about their experiences in more explicitly psychological terms, and that there may be resources in older texts that can address this American orientation.

This 'recovery' involves the comparative project of taking earlier diagnostic categories and, through textual analysis, trying to reconstruct the experiences to which they refer. Diagnoses such as 'seeing ghosts,' 'running piglet syndrome'or 'mountain top naked screaming syndrome' do not readily fit into the diagnostic categories of DSM IV (Kaptchuk 1987: 2). Insofar as varying degrees of guesswork are involved, these diagnoses form the basis for further translating Chinese practices into American terms and phrasing them in ways that will be meaningful to the non-Chinese practitioners and patients here. As in any process of translation, some of the old meaning is retained, even as new meaning is inserted. Kaptchuk himself sees what he is doing both as a project of interpretation for the needs of a different culture and as one of retrieval and preservation:

'I feel I pay attention to things that were articulated in earlier eras that need to be in the open instead of collecting dust. And that may be only one thing we can bring to Chinese medicine.... Chinese medicine has never been until recently anything like western medicine in its approach to life and illness. Westerners may help Chinese medicine discover itself anew' (TAS Interview 1992: 44).

This broader project raises curious questions as to what practitioners see themselves as having the 'real' Chinese medicine. In some cases it is vaguely reminiscent of nineteenth-century western observers in China who staked out a territorial claim to possessing a deeper appreciation of ancient Chinese texts, seeing contemporary practices as representing a decline. At the same time, it is true that the PRC did systematically eliminate anything that struck its advisers as 'non-scientific,' and that students are, indeed, taught to think of such elements as representing nothing but superstition. It is also legitimate to acknowledge that American culture is distinct from the Chinese setting in significant ways, and that the medicine may need to be adapted so that it can speak the language of its new setting with some fluency.

'As more accurate information and knowledge moves West, we can begin to be selective in our adaptation. Westerners can begin to examine the Oriental tradition with our own health care needs in mind.... The Oriental tradition needs to be examined to find earlier engagements with the type of questions westerner practitioners face daily.... A new variant of Oriental medicine must be based on careful and thoughtful study of primary sources, reflection and information. Otherwise, it will be a mutant based on fantasy' (Kaptchuk 1987: 8).

Kaptchuk is not alone in this integration of Chinese theory and practice with American concerns. Leon Hammer and Yves Requena are two other writers who are working to synthesise the principles of Chinese acupuncture and western psychology, in a process I would describe as 'the psychologising of acupuncture.'

This effort has not gone uncritiqued. As we have seen, for example, researcher Stephen Birch argues that Chinese theory does not distinguish between body and mind in the same way as does western theory, seeing both, instead, as expressions of qi. The joining of western theories of psychology to Chinese practices can, therefore, be philosophically problematic. If the mind is not separable in essence from the body, then mental-physical events cannot be neatly separated either. Theoretically, the regulation of qi should be enough to address any condition of the system as a whole. Birch does not dismiss the possibilities of deepening the practice of acupuncture in this country through a dialogue with psychology, but has reservations as to how effective the resulting synthesis will be. The prevailing counter-argument, however, is that each of the acupuncture points does correspond to some psychological effect. In an American context, the argument goes, it therefore makes sense to place these dimensions in the foreground.

How do Chinese practitioners trained in China and now practising and teaching in the United States view this return to the old texts? Some say it is nothing new.

'People are always investigating old texts. In five years [of medical school], you cannot teach everything. So people also go and look at old things. What is good lasts; what is not, does not' (Mai Ruixiong, TCM acupuncturist and herbalist from the PRC).

However, Chinese practitioners in the United States also represent and transmit different perspectives on the PRC's version of TCM. Dr Mai's comments do not address the concerted elimination of specific aspects from traditional medical practices; for him, the study of older texts is therefore not an explicitly political act. The sojourn into American culture and the contact with American practitioners has made other practitioners, like Lu Weidong, more acutely aware of these issues with respect to their earlier medical training in China.

'After 1949, and even before, at the beginning of this century, the Chinese government changed the whole educational system. Many students were taught in a western educational system. They didn't have much Chinese philosophy....Chinese medicine before was so different from this. There was a lot to memorise and a very different explanation of the universe, of nature, and of the human being....

Ted Kaptchuk's idea of looking at old texts for things that the PRC has eliminated from medical training is a good idea. The formal textbooks just teach what is 'correct.' It is not like the old style.... But what is also new in China is that many schools also have seminars and workshops that are not included in the credit hours. There, the teachers introduce a lot of the old medicine. So people can also have these seminars and special programs if they are interested.... Those who are interested in older versions of Chinese medicine can also ask to read a lot of Asian texts. They also have to learn ancient Chinese if they want to study the ancient textbooks. This is difficult even for Chinese people. Most people get more into the older systems after they graduate. They come back to the study of old text books. There are not many people who do this, but some people are also interested in the spiritual stuff' (Lu Weidong).

It is worth noting that older cosmological elements such as yin and yang or the Dao permeate the texts as basic paradigms informing everything from diagnostic categories to treatment approaches. At the same time, these formulations are not, themselves, the direct point of medical training in China. Rather, they are the givens and, as such, are not necessarily spoken about very much. In contrast, non-Chinese students of Chinese medicine in the West are more likely to have read about such concepts for explicitly philosophical or spiritual reasons outside of their training in Chinese medicine. Indeed, interest in such concepts leads some people to study Chinese healing practices.

Chinese practitioners in the United States are aware of this interest in psychological interpretive approaches, and compare it with increased interest on the part of Chinese practitioners in mainland China in matters described as psychological.

'Now the medical wards are starting to pay attention to emotional problems. There is a new course - the psychology of TCM. There is an annual meeting, they have published a book, and many schools will look at older books about these things. One of my friends is studying TCM in France. She has a lot of experience in psychological TCM, looking at both western and TCM ideas of psychology. I read a book about both styles maybe three years ago. It was new in China. People think it's a good idea, especially practitioners' (Lu Weidong).

It would thus appear that the inquiry has extended to some Chinese circles. As we saw in Lu's earlier comment, this is at least partly due to a felt need to find new ways to address the after-effects of the Cultural Revolution. It may also be partly due to questions coming out of the West. Arthur Kleinman notes that some Chinese-style doctors in Taiwan have begun to see psychological stress as a factor in some cases, although, he adds, 'Ironically, this insight is not the result of a closer reading of the Chinese medical classics but has been acquired from popularisation of western psychological ideas' (Kleinman 1980: 271).

Why do these aspects of practice in China matter with respect to the Americanisation of Chinese healing practices? Given the active recruitment of practitioners and teachers from mainland China by American acupuncture schools, it is likely that this cross-fertilisation will gradually find its way back into the United States through the teaching content and practice style of these individuals. It thus becomes increasingly difficult to speak about Chinese and American versions of Chinese practices in any fully discrete way.

Demons and Other Possessions
For centuries, the various versions of medicine in Chinese culture, including both acupuncture and herbal medicine, had diagnostic categories related to demonology. Indeed, Paul Unschuld believes that one cannot fully understand Chinese medicine without understanding different traditions of demonology, some of which have persisted into the twentieth century in other parts of the Chinese-medicine world (Unschuld 1985). These categories were cut from the medical corpus constructed by the PRC. Yet they also represent one of the topics being rethought by some non-Chinese practitioners in the United States. We must therefore also look at different ways in which demonology - and, more specifically, affliction caused by ghosts, or gui, of different kinds - is being construed. Such affliction can include everything from a pain in one's belly to conditions defined as possession by ghosts, or gui.

Current dictionaries from the PRC define the term gui in such terms as: 'Ancient people did not understand natural phenomena; they considered that after a person died, the spirit (linghun) was not extinguished, [but] became a ghost' (Xuexi Hanzi Cidian, translation mine).9 In common usage, gui can refer to a ghost or 'to something wrong in the mind, depending on the context.'10

When I asked Dr Mai Ruixiong how he understood the phrase guimixinqiao - a term given in Chinese-English dictionaries for being possessed by ghosts - he reformulated it into quasi-psychological terms:

'This not a medical diagnosis. It when people have only one idea in their mind, like money, or their job, and they think only about that. If they less educated, maybe they say it is a ghost. Their mind is imbalanced, so you treat them to balance their mind. You explain it to them, but you don't tell them it's not a ghost, because otherwise they will not believe you and maybe they will not come back. But you try to explain that it is they have only one thing in their mind. So, then they can understand.

I not have any cases of this - one boy, he was eighteen years old and he study qi gong and learn it wrong. When he think of his teacher's name, he become afraid and very upset. He do things like walk out in the middle of the street, in traffic. His mother very angry. She think the teacher do something to the oy. I treat him several times, and he better. A few years later, he still okay. Before he come to me, he go to hospital and get medicine, but it don't help. He live in Chinatown.'

Note that Dr Mai's first response is that 'possession' is not a medical diagnosis. Drawing on popular usage of guimixinqiao which can also be used, metaphorically to mean 'to be obsessed with,' he rejects any explanation based on ghosts or demons, restating the problem as one of obsession, or fixation.11 Therefore, according to him, only certain patients - in particular those who are less educated - say it is a ghost. He does not try to dissuade them; instead, he offers an alternative explanatory model. His explanation is in keeping with western explanatory models that redefine possession states in terms of the language of the mind. At the same time, he retains older ideas that such conditions can be treated effectively with acupuncture and herbs.

Martial arts teacher Yon Lee offers a different explanatory model based on the qi paradigm and drawn from his experience in teaching wushu:

'I haven't encountered cases of spirit possession, but I have run into something close - qi possession, or excessive qi, where the qi builds up and will not go away on its own. It makes the person act as if possessed. Lots of times they stay awake, or move as though they're possessed. I've seen it.

The spiritual aspects are more likely dealt with through occult means, like monks or prayers or selections of magic writings or chanting. I haven't had much dealings with these things. On the other hand, part of the possession - I have a theory that it can be manipulated and relieved by manipulation of the qi. It could be that if you move the qi out there, it may move the spirit out. Sometimes I think they are one and the same ...

The easiest way the excess happens is with beginners who do the exercises wrong for too long, or without supervision. Excess qi has happened with a few students of mine. Someone from Harvard once took out some old classics from Yenjing library and practised what he read in them. But the books didn't explain how to release or extinguish the qi each time you pick it up. So he had really excessive amounts of qi. He went to an acupuncturist who released a lot of qi, but he kept replenishing it, because still there were certain reservoirs. So I had to help him to undo it with certain exercises that drain and neutralise the qi, and certain exercises to let it internally shut off or go around another circle to neutralise it.

What does it look like? Someone's standing there. Suddenly the person jumps up and bangs into the wall. They may also be rolling on the ground with it. You can induce your own rolling, but that is different from when the rolling is out of control, and you throw something on top of it to block its passage and it continues, and afterwards the person has no idea what happened, and says they didn't feel anything - they can see it happening, but have no control over it. Occasionally you see someone's eyes rolling up, but they have no recollection of it. You can call that somewhat possessed.'

Dr Mai and Yon Lee present two cases independent of each other, both related to qi gong and described as being similar to possession but, in actuality, the outcome of incorrect practice. For one patient, an adolescent boy from Boston's Chinatown, the results are extreme fearfulness and agitation; for the other, a non-Chinese Harvard student, the outcome is a physical manifestation of excessive qi. Dr Mai's case is not an illustration of the obsessive preoccupation he initially describes; instead, he moves right into the description of the boy. Likewise, Yon Lee immediately says that he has not encountered cases of spirit possession, but of 'something close - qi possession, or excessive qi.' That both practitioners so readily make this association has to do with a diagnosis that has become more prevalent in China, namely 'qi gong psychosis.' This is understood to be brought on by the incorrect or excessive practice of qi gong.12 The diagnosis also reminds us that, within the Chinese framework, the underlying stuff of all reality and experience is qi, which can become disordered even to the point of resembling a possessed state.

Yon Lee's model is one of a circulatory system that is either in or out of balance. Unlike Dr Mai, he does not reject the idea of ghosts, but suggests that the condition may be just as related to the state of one's qi, and therefore susceptible to manipulations of qi. He also locates the more 'spiritual' illnesses in the realm of folk healers and monks, implicitly removing them from the realm of 'medicine.'13

I cite these two instances to suggest several ways that Chinese practitioners at work in the United States may respond to questions concerning the diagnostic category of affliction or possession by ghosts. Such responses reflect not only the combined influence of PRC TCM, but also of older understandings of qi and of qi gong practice. These practitioners treat patients and teach students in the United States. Their perspectives thus inform the views of those they treat and teach.

Of the two, Dr Mai - like Kaptchuk's colleague - understands ghosts to be no more than superstition. It is ironic, then, that among non-Chinese involved in Chinese healing practices in the United States, there is apt to be a greater acceptance of things like ghosts. One has only to think, for example, of the practice of channelling and the use of psychic mediums, both of which trace back at least to nineteenth-century Spiritualism. It is not altogether surprising, therefore, that a language of demonology has surfaced in relation to Chinese practices as taught and understood in the United States. For example, what a Chinese textbook widely used in Chinese traditional medical schools refers to as 'the seven emotions,' and relates to the general idea of excessive emotion as a pathogen (Farquhar 1994: 81), becomes, in the work of Leon Hammer, 'the Seven Internal Demons'. The demons themselves are still described in a language of the emotions - anger, grief, fear, excessive joy, anxiety, worry, and passion - but the category to which they are assigned is not the emotional but the demonological (Leviton 1989: 53). Indeed, Hammer's conceptual framework bears a greater similarity to the theory of demonology used in some Catholic Charismatic healing groups, in which a person may be troubled not by demons with names like Beelzebub, Gog, or Magog, but rather by evil spirits named Rebellion, Resentment, Anger, or Anxiety - terms which are more culturally and emotionally meaningful. Note that, for these Catholic Charismatics, such names refer not only to psychological states, but to actual demons who must be subdued (Csordas 1990).

In The Fundamentals of Chinese Acupuncture, an American textbook widely used in TCM training in the United States, the authors address the concept somewhat differently:

'In presenting the traditional indications of acupuncture points, we have not been shy to include what a modern Westerner might regard as 'culturally determined' or superstitious elements. When listing such things as 'dreaming of intercourse with ghosts' and 'ghost attacks' among supplementary indications from the classics, we are not asking the student to believe in ghosts, but are merely presenting information that may help the student to understand China's cultural development and the changes in Chinese medicine that parallel it. In a discipline produced by people who have traditionally believed that approach to perfection is made through correct interpretation of ancient teachings, rather than through pursuit of progress, historical questions cannot be ignored' (Ellis, Wiseman, and Boss 1988:iv)

Influenced by Unschuld's emphasis on the persistent presence of demonological medicine in China, the authors conscientiously include such elements, at the same time defining them as historical artifacts. The text includes a brief reference to 'the thirteen ghost points,' tracing these to the Tang dynasty physician Sun Si Miao, and explaining them as acupuncture points once used 'for treating what we now consider to be severe psychiatric disorders and epileptic conditions' (1988: iv).l4 Embedded among the many descriptions is a single reference to the symptom of 'wailing and ghost talk,' and another to 'dreaming with pressure sensation as if being held down by a ghost' (1988: 81, 148). The symptoms go unexplained: they are simply there, ghostly presences of once living categories

For Worsley practitioners, 'possession' is both an active diagnostic category and an explanatory model. When I spoke with Worsley practitioner Bill Mueller, and asked him whether Dr Mai's explanation coincided with that offered by the Worsley system, he said that it did not.

'Possession is something different from obsession. Many people may be obsessed without necessarily being possessed. We would draw a distinction between the two - although a person may have equal degrees of both. We make the distinction in terms of our contact with the person, and our ability to make contact. We do this by looking into their eyes and seeing if we can get in. A person we would call 'possessed' is someone with whom we can't make that contact.

It's like a sheet of glass - a barrier - is over their eyes. If someone is obsessed, we may be able to get in, but there is nothing there. But if someone is possessed, you can't make contact with their spirit, or shen.

It's caused by some force taking over their energy. It's like something beyond their control is running their life. They become almost robotic. This can be due to something internal - one of the internal causative factors, like some emotion - or an external causative factor, like some event. It can happen in an instant, when someone's guard is down, or over time, if they get run down.

The effect is that their sense of themselves and of their energy would change. They say things like, 'I don't feel like myself'. They may say this kind of thing under other circumstances, too, but this is what is absolutely the case when they are possessed. So there are certain spirit points you would use to treat them.

Worsley himself does talk about demonological medicine, although not so much in his larger classes. He'll talk about it more in small groups. He uses the words 'demonology' and 'ancestral medicine.' So he does use that language, although he doesn't cite texts. When he talks about demonology, even though he does come from a Christian background, I get more of a Chinese sense from him on this issue than a Christian one.'

Possession therefore becomes a condition that the practitioner may have to treat first, in order to be able to 'get in' to address other issues. 'Demons,' in this case, becomes an ambiguous category, better understood as a metaphor for a causative factor which is actually understood to be some emotion or an event such as 'exterior wind' or 'exterior cold.' Worsley refers to these as 'the Seven Internal Devils' and 'the Seven External Devils.' The resulting condition to which this category refers is perceived as one in which the person is taken over by something in a way that not only is real, but that can also be differentiated from other states. Nor is it either the kind of obsession or the 'qi possession' described by Dr Mai or Yon Lee.15 According to Worsley acupuncturist Jim McCormick, insofar as Worsley refers to demonology or ancestral medicine, he is talking about 'what the Chinese meant back then, as the historical place where it came from.'

To treat possession, as it is defined in the Worsley system, there are particular acupuncture points similar to those used in TCM, that are defined as 'spirit points':

'I don't necessarily know Worsley's spiritual inclination. One dimension of his practice, though, is reading the person's spirit. Certain points have special names, like 'the spiritual burial ground ' or 'the stone house to calm the spirit', and so on. This is a part of Chinese medicine that has been submerged in TCM. It means you can affect someone's spirit without having to believe there is a God' (Jim McCormick, Worsley acupuncturist).

The term 'spirit', as used these days in alternative and New Age circles in the United States, is frequently separated from any clearly defined religious tradition. As McCormick says, it is not necessary to believe in a particular deity. What is worth noting here is that, despite strongly felt and expressed concerns on the part of many of the non-Chinese practitioners in this study - concerns which they explicitly defined as 'spiritual' - terms such as 'demons' and 'possession' are still, by and large, reformulated into a language that is essentially emotional and psychological. Thus, a language which, in China, originally derived from religious interpretations of experience has, in its new appropriation, been translated into the language of psychology.

I spoke about this with another practitioner, Dolores Heeb, knowing that she had originally trained with Worsley, and been involved for some years in an Eastern Orthodox Church. She interpreted things somewhat differently:

'There’s a series of points that J.R. taught us, to deal with the demons. If you think someone is possessed, that's what you're supposed to do. What I understood him to be teaching us was that people can be consumed by worry, or other things, but traditionally, there could also be possession by demons.... In the first six months of my practice, I had a woman come in who was from Haiti. She was pretty anxious and depressed - she talked about how her grandmother was putting a curse on her. So I did the diagnosis, and included possession points as part of the treatment.... I also have a patient who says she suffered Satanic ritual abuse as a child. I think she's possessed, in a Christian sense. Maybe when she's baptised, the same thing could happen. It's like the driving out of the unclean spirits in the New Testaments, that went into the pigs and the pigs ran off a cliff.

In Orthodox Christianity, there is a service for possession, at the beginning of every baptism, at the narthex, before someone comes in the church. There was one man who was pretty strange. When he was baptised, he was spitting as if he was possessed. After that, it was all gone.... I would guess that was the kind of thing that J.R. and the Chinese were talking about with possession. Because I do think it exists.

In Catholicism and Orthodoxy, there are also the Seven Deadly Sins.16 These are talked about as the Passions - the places where we're attached. I think these things keep us from seeing ourselves clearly, so that these are both Christian and Buddhist ways of talking about something similar. In the Orthodox Church, these are the ways, too, that a demon - which can be anything from the outside at work to grab our souls - can get in. It certainly can't do so without a weakness already being there, like pride. That's what lets them in - it's a continuum.'

Acknowledging that a range of secular meanings can attach to the notion of possession, Heeb also distinguishes these from the religious interpretation deriving from her own tradition. More significantly, what are talked about as the even Demons by other alternative practitioners are, within this religious framework, the Seven Deadly Sins - different types of passion and attachment. The demons remain something else which is not solely psychological in nature.

Who Are The Demons?
One of the difficulties in translating the concept of demons from the older Chinese understanding into a modern western one is that, while both cultures ostensibly point to the same phenomenon, each derives its understanding from a different religious history. In China, as early as the Shang dynasty (traditionally dated 1766-1122 B.C.), demons were included in the explanatory models of illness, often expressed as the 'curse of an ancestor' (Unschuld 1985: 19). By the Zhou dynasty (beginning in 1122 B.C.), it was believed that the dead could become evil, harmful demons, but there was no longer a connection between individual people and individual demons. The notion of demons arose from the belief in two souls: one, the corporeal soul (po), which was present from birth and perished with the body, and the ethereal soul (hun), which entered the body at some point after birth and could depart from the body during periods of sleep or unconsciousness. Unattached po souls, or po souls provoked by the neglect of their graves or by the failure to offer sufficient sacrificial offerings to sustain them, were likely to inflict harm.17 This led to practices of exorcism as well as to the use of herbs and acupuncture to expel them.

Demons were linked to qi, to the interaction of yin and yang, and to the relationship between the living and the dead. Gods, ghosts, and ancestors, as Arthur Kleinman notes, are understood to be part of the 'natural world' and, as such, are natural forces with which humans interact (Kleinman 1980: 126). By virtue of also being a form of qi, as well as formerly human, they are not utterly distinct from the human realm either.

There is no exact correspondence to this in a western framework, within whose Christian traditions demons are evil spirits that can bring about possession, and whose expulsion requires exorcism (See Cross and Livingstone 1974: 493). Located within a dualistic framework in which the forces of good battle the forces of evil, demons are neither part of the substance that constitutes the natural world, nor are they formerly human. Unlike a world view in which all things can transform the one into the other by virtue of their commonality in qi, there is no line of common descent for humans and demons of the West. The latter are perceived, rather, as malevolent forces who, on occasion, not only possess, but also consort - as in the case of the Church's understanding of witches.18 Individuals become 'landscapes on which spiritual forces do battle with each other' (Frohock 1992: 105).

There is little place for the dead in New Age spirituality, except in the practice of channeling - a fairly direct descendant of nineteenth-century American Spiritualism. Here, spirits are not understood as the malevolent dead, but rather as generally helpful guides. That is, they do not cause illness. In contrast to someone like John Nevius, a late-nineteenth-century missionary to China for whom the Chinese idea of demons and exorcism found confirmation within his Christian Biblical frame of reference, for those who identify with a New Age orientation the idea of darker demons may feel too uncomfortably Christian and reminiscent of traditions they have sought to leave behind.19

Indeed, within much of New Age spirituality, one rarely finds a discussion of radical evil, the demonic, or much about human darkness at all. To the extent that such questions surface, they are often lumped under categories borrowed from the Hindu and Buddhist traditions, which assign such things to human ignorance. Despite the presence of demons in both of these traditions, however, non-Chinese Americans have passed over these dimensions in their appropriations of Chinese healing practices, staying rather at the level of analysing the nature of the human mind. This is similar to other ways that the non-Chinese in this country have borrowed from Chinese religious traditions - a borrowing that generally excludes the more popular cosmologies and folk practices, and allows instead for translation into psychological terms.

What follows, therefore, stands in contrast to the formulations of many of the non-Chinese practitioners and patients with whom I discussed these issues. It is a story told to me by Steve Klarer, a licensed acupuncturist and craniosacral therapist with a degree in counselling psychology, who spent seven years as an ordained monk in Chinese Buddhist monasteries, the first in San Francisco, and the second in Taiwan.20 It is a story of qi gong, magic, healing powers, and dealings with ghosts and demons. It is significant because it suggests some of the distance between the psychologised demons and those encountered in older, traditional contexts:

'When I met him, my teacher was living in a cold-water walk-up flat that was in the oldest surviving Chinese temple in this country. It had been built to the Queen of Heaven by railroad workers in San Francisco, and had once been a free-standing building, I think. All the interior walls were covered with old Chinese temple gods and carvings. I had studied Chinese for five years before I signed up to become a monk. My teacher was a magician, a shaman in monk's clothes, and I thought that's what I wanted to do....

There are four different Daoist sacred mountains in China that are associated with various kinds of exorcism. They specialise. My teacher was from the same county as the mountain that specialised in violent exorcism, and that's sort of what he did. I don't know why he was a Buddhist. But that's how it was. What he did was known as the violent exorcism of gui. The story he liked to tell at the time was about how all these Dao-shis and famous people had been brought in to exorcise a house, and the ghosts still wouldn't go. So, they called him in. Of course, there was always a ceremony, and that meant food, and in Northern China that meant a big pile of mantou - those little steamed dumplings. Vulcanised steamed white bread. Apparently, he took a whole pile of these and started running around the house throwing them at the walls, screaming at the ghosts, 'Get out of here!' He exorcised them by throwing mantou around. That was sort of his style. Everyone else was doing proper, decorous ceremonies, and he was kind of a wild man.

What's a gui, exactly? In spite of all the dozens of different categories of ghosts, this, that, and the other thing, the reality is that, when it comes down to it, none of that applies. It's like anything else - textbook examples and real examples are never quite the same in anything you do, and I think that's the way it is. My sense is that all those categorisations are basically structures to help you think about something. Once you get there, it's never like that. In my own experience, there were tons of those things out there. I'm not sure that even any of the ones I dealt with exactly fit into any of the categories. In fact, that was sort of my litmus test as to how real something was. If some striking experience I had fit exactly into one of those categories, chances were it wasn't real, whereas if it was something similar in pattern, but wasn't exact, it tended to be more likely to be real.

Some of the demon stuff is psychological, but some of it is also spooks. There are spooks out there. There's psychology and there's spooks, and there's also the psychology of spooks - which is different from the psychology of people. I suspect that my teacher was actually a very good ghost, or demon, psychologist. I think his real mission was to preach the dharma to the ghosts. I think he was better at doing that than he was at teaching it to people. You'd teach it to ghosts for the same reason you'd teach it to people - everybody needs the dharma. There's no difference there between ghosts and people. And each form of sentient being hears the dharma differently and bonds to it differently.

The point of this isn't to make the ghosts benevolent; it's so you could help save them. For example, each day - in fact, I was the one who did this every day I was there - there was a ritual at lunch. Before you eat, you go out and offer food on alternate days to the hungry ghosts. So, every day I would go out, and be standing there in the Mission District of San Francisco, dressed up in Chinese robes, putting out noodles for the ghosts. It seemed reasonable enough to me.

One of the reasons they get pissed is because they get hungry, that's the thing. So, how do you teach the dharma to the hungry ghosts? What you do is, you magically transform food into something that they can accept. Then, while they're there, you recite mantras at them. It's exactly like, how do you get Christian converts on Skid Row? You make them sit through a sermon before you feed them. It's the same deal. Except that, instead of a sermon, it's mantras.'

This is very different from talking about demons as psychological states, or as terminology borrowed from another culture and used to talk about various forms of mental illness. For Klarer, the encounter with power became a double-edged sword which he ultimately rejected. But in the course of cultivating it, he experienced bodily sensations which, he later discovered, followed the different acupuncture meridians, and various altered states that corresponded to descriptions found in Buddhist texts. He also experienced forces that he describes as belonging to the broad category of gui. He differentiates quite explicitly between states of the mind and these other forces, which he located within the category of the real and the experiential.

Unlike Klarer, even to the extent that non-Chinese practitioners may subscribe to the possible reality of ghosts or spirits, they do not generally integrate such beliefs into their understanding of Chinese practices. Instead, to all appearances, they relocate this dimension of Chinese medicine within the framework provided by a sort of generic psychotherapy. As we have seen, practitioners of TCM are schooled to define such demonological practices as artifacts unearthed in the archaeology of knowledge. When I consulted with Ted Kaptchuk about the American tendency to translate religious oncepts into psychological ones - and specifically as this seemed to play out among non-Chinese practitioners of Chinese modalities - he observed that he had witnessed something similar. His framework, however, was Confucian:

'It all becomes internal and personal. This shift in dynamics is an amazing phenomenon. When I teach about herbs, I insist on using the Chinese virtues, as a way of trying to critique the contemporary devaluation of these things as religious. In Chinese medicine, the various virtues have a correspondence with the different organ functions. So, the kidneys are related to wisdom, the liver is human kindness, or ren, the spleen is awareness of possibility, the heart is the sense of propriety, or li, and the lungs, righteousness.

When I teach about these things, I insist that they are not psychological, but are part of the whole Confucian paradigm of self-cultivation. This means that you cannot separate the cultivating and balancing of the body from this other religious project. I also talk about how, in both the Confucian and Buddhist paradigms, the emotions - or, more precisely, the passions - are devalued. So, I try to reduce this American focus on the emotions. But people tend to be obsessed with them, so they don't hear.

Sun Si Miao, the Tang dynasty scholar, integrates these things along different lines. He treats the passions like physical symptoms. What we call emotions are related to a cognitive emphasis on values and morality, and to different states of mind cultivated within Buddhism. When he's dealing with the physical, he deals with existential, spiritual issues within Buddhism and Taoism. He's talking about the arduous efforts of the will related to self-cultivation. But my audience can't tell the difference. They put it all in terms of the emotions.'

Do we conclude, then, that in the American world of alternative practices, the religious has been altogether cancelled out by the psychological? Yes and no. I once heard a story about Dovid Din, a learned Kabbalist who came to this country. During the few weeks that he was here, he lit the Shabbos room with candles that burned night and day. It was said that later, some time after his departure, he committed suicide. But those few who spoke with him about Kabbalah during his stay were surprised to hear him explain it in the language of psychology. Where, in the Zohar had such things ever been said? To their questions, he replied, 'Plotinus borrowed the language of Plato, because it was the one that everyone was using in his day, and he wished to be understood. I merely do the same when I use the language of psychology. But Kabbalah - it is something entirely different.' How much of the reformulation of Chinese practices and diagnostic categories into the language of psychology is a matter of being understood, and how much of it is something else altogether?

Translating the Language of Psychology
The acculturation of Chinese practices and their reformulation into a language of psychology can, in fact, represent multiple coinciding orientations which make sense when set in the context of broader changes in the American religious landscape, influenced particularly by the third of the American population referred to as the 'baby boomers' (particularly the middle- and upper-middle-class members).21 Older American ideals of self-reliance, independence, and voluntarism have been appropriated and reformulated by this generation to construe the self as:

'. . . fluid, improvable, adaptable, manipulatable, and above all else, something to be satisfied - the assumption being, of course, that the self's appetite is insatiable. With a more fluid, adaptable, and insatiable self, religious identity becomes less ascribed and more of a voluntary, subjective, and achieved phenomenon. America's religious pluralism feeds into this 'new voluntarism' by demonopolising any single version as the religious truth and by making a wide variety of religious options open to everybody' (Roof 1994: 195).

This choice-making self also increasingly defines itself not as 'religious,' but as 'spiritual' - a distinction which began to emerge in the 1960s and which has become increasingly common.22 Insofar as 'religion' is identified as one of the older mainstream traditions, to deny being religious is more likely to mean that one no longer identifies as a member of a Christian or Jewish congregation, and not that one is without interest in religious concerns. To talk about being 'spiritual' has become code for saying that one may also be searching for practices and traditions understood to emphasise the affective, and that one will piece together a personalised approach often consisting of elements from both eastern and western traditions.

These elements represent a complex blend brought together much in the spirit of Levi-Strauss's bricoleur. They include, on the one hand, the influence of writers like William James, with his emphasis on the primacy of religious experience and, on the other, that of post-Freudian writers like Carl Jung and Abraham Maslow, whose work encouraged a focus on inner experience, 'the nonrational, the mythic, and the dreamlike ' and various ways of understanding human potential and self-actualisation (Roof 1994: 47, 69). Since the 1960s, psychotherapy has, for some groups, increasingly been understood as a means to liberate and fulfill the self, insofar as the self-understanding it promoted supported the goals of 'empowering the self' (Bellah et al. 1985: 47-48).

What does all this have to do with what might be called 'religious,' or 'spiritual?' This becomes clearer when we look at the influences exercised since the 1960s by religious traditions from countries such as India, Tibet, China, and Japan. In particular, concepts borrowed from Hindu and Buddhist texts and schools of practice filtered into American religious language. The most pertinent with respect to this discussion have to do with the focus in both traditions on the human mind as the obstacle to profound awareness. To become enlightened involved an inquiry into the nature of the mind and of human consciousness.

The most striking instance of the cross-fertilising of western approaches to human psychology with these analytical systems (along with symbols and notions borrowed from other religious traditions) took the form of transpersonal psychology, which emerged in the late 1960s. In a review of titles by representative writers spanning almost three decades, one finds terminology adopted from Hinduism (Atman, or Self), Native American tradition (medicine wheel), Buddhism (Samadhi), different theories of psychology (Jung's archetypes and Freud's ego), and scientific theory (evolution, as well as a general reference to 'modern science'); one also finds theologians from Christian tradition, such as Anselm of Canturbury and Paul Tillich. Alternate reality states are introduced through allusions to LSD and comparative mysticisms.23

This is not to say that the religious and the psychological become fully intersecting sets, as the introduction to an anthology on the subject is quick to point out:

'One simple definition of religion is that which is concerned with, or related to, the sacred. Since some, but not all, transpersonal experiences are experiences of the sacred, and since some, but not all, religious experiences are transpersonal, there is clearly some overlap between transpersonal experiences and religious experiences . . . Transpersonal disciplines and religion should therefore be regarded as distinct fields with partially overlapping areas of interest and also significant differences' (Walsh and Vaughan 1993: 5-6).

Nevertheless, we see the boundaries between the religious and the psychological blurring and even breaking down. In the fashion of post-modern genre-bending, the two projects are no longer interpreted as being distinct, but rather flow the one into the other.

This blending of discourses received further reinforcement in the work of writers like M. Scott Peck, whose The Road Less Travelled remained on the New York Times best-seller list for over thirteen years. Spiritual growth and psychological maturing increasingly came to be seen either as two sides of a single coin or, for some people, even as synonymous. This merging was further supported by the self-help movement and by the Twelve-Step programs in particular. Finally, the growth of the ecology movement and the concern with 'Nature' and various constructions of the term 'natural' also inform the religious sensibility of the boomers.

The identification of Chinese healing practices with the unblocking of emotions, along with the identification of demonological categories with psychological or emotional states, therefore becomes far more ambiguous in its implications. To talk about the 'psychologising' of Chinese practices takes on different meanings, depending on the practitioner. I would like, therefore, to suggest a range of meanings, none of which cancels out the others.

As we have seen, the separating out of the 'psychological' finds little precise correspondence for the Chinese practitioners, who perceive Americans as more directly interested in such issues. For these Chinese practitioners, older demonological categories are either rewritten as superstition or related to qi gong psychosis. Yet insofar as qi is involved in all such cases, it is not entirely possible to say that even these interpretations are devoid of religious dimensions. As Confucian scholar Tu Wei-ming notes:

'All modalities of being, from a rock to heaven, are integral parts of a continuum (ta hua). Since nothing is outside of this continuum, the chain of being is never broken. A linkage will always be found between any given pair of things in the universe.... The continuous presence of ch'i in all modalities of being makes everything flow together as the unfolding of a single process. Nothing, not even an almighty creator, is external to this process' (Tu 1985: 38).

While Chinese practitioners do not, for the most part, identify themselves as religious, this has much to do with carry-over influences of nineteenth century western missionaries who equated religion with Christianity, and the Chinese traditions with 'philosophies.' As Tu's work has endeavoured to demonstrate, however, once we re-examine these traditions as religious projects of human self-cultivation within the triad of Heaven, Earth, and human, then even a term such as qi is full of profound religious and moral implications. I would argue that these aspects have not been stripped away, even with the PRC attempt to eliminate all the 'superstitious' dimensions of Chinese medicine.

For the non-Chinese practitioners, it is certainly the case that the psychological vocabulary, for some, represents either the nullifying of the religious dimensions of Chinese practices, or issues which have no relation to matters spiritual. For most of those whom I interviewed, however, it was more often a case of the blurring of the psychological into a bricoleur's approach to spirituality that tends to be generic. As Deborah Rose put it:

'The spirituality of Chinese medicine is about human beings in relation to nature. You don't have to have any God concepts. So, it's something a lot of Americans can receive. It hooks up the mind and body and it hooks us back to nature in a very generic way.'

For these practitioners and many of their patients, the psychological and the spiritual are not fully separate. Practices like acupuncture, herbal medicine, and qi gong are explicitly seen as ways of pursuing the two through practices involving the body. In the words of one practitioner, 'It is a deeply spiritual medicine,' or what I have referred to elsewhere as a form of 'embodied religiosity' (Barnes 1995). Because of the fluid nature of each of the categories, there is a certain amount of slippage between them. To know which aspects are being emphasised, bracketed, or not included at all, one must therefore ask the individual practitioner or patient.

In Our Own Image: A Matter of Felt Needs
Thus, it seems that the transformation which some Chinese practices are undergoing through having been transplanted into American soil has had the effect not only of intensifying certain nuances that were already present, but also of introducing questions that had not even entered the Chinese system as rejected possibilities. The themes that have predominated have increasingly been those of particular concern to non-Chinese practitioners and patients, especially with respect to psychological as well as spiritual issues. The result is a Chinese medicine that is, at the same time, peculiarly American.

Nor is it clear that all non-Chinese practitioners distinguish between what is actually traditional medicine as understood in China today, and the traditional medicine of their own formulation. Going on the assumption that they are working within the Chinese framework, they assume that what they are doing remains entirely consistent with 'the traditional approach' - despite the historical reality that there never was a single 'traditional approach.' In addition to seeing the American versions as replacing what was removed by the PRC, some practitioners also see it as drawing out what was implicit. Many are quite clear that they are engaged in a process of adaptation and modification. We may also be at a point where the process of cross-fertilisation is just beginning to get underway in ways that will affect the approach to 'psychological' issues both in China and among practitioners of traditional Chinese modalities in the United States. Bob Felt, himself an acupuncturist and head of Redwing Books (a publisher and large distributor of Oriental medicine books), reflects on what has been taking place in this country

'Some people want to drive Chinese medicine through the hole of psychotherapy and the question of how we get to our own psychology. They feel this is an important aspect of well-being and health. As we've identified the non-holism of western medicine, people are looking for ways to address these two aspects. Our problem is one of acculturating this medicine. What are we telling people about our own black box? We offer an alternative to the insoluble problems. We sell hope, we sell to the perceived need, and offer someone to talk to, the hope that someone will make us better. What's happening is that acupuncture is attached to powerful currents in our own society related to needs that we perceive. For example, it has become, in some uses, a form of psychotherapy. We rebuild it after our own image. Everybody's doing that on a daily basis.

We've taken Chinese texts to say that we're not just going to relieve an imbalance, which will relieve a condition, which will make you feel better. We go further, to say that we will improve your performance. This is hard to find in the Chinese sources. We're trying to fill this hole we perceive in the western sources, so we've added things. It's hard to say that our 'me-generation' ethic hasn't pretty solidly coloured our view. Still, there is nothing wrong with using acupuncture as psychotherapy; it is impossible to argue against the concept if you can deliver the goods. These are ways of dealing with the fuzzy stuff' (Bob Felt).

Kaptchuk has pointed to the ways in which westerners often come to Chinese practices with assumptions that grow out of their perceptions of biomedicine. If biomedicine is held to be excessively somatic, the reasoning goes, then Chinese medicine will be 'especially capable in nonsomatic areas.' (Kaptchuk 1987: 6).24 When this proved not to be as true of the TCM developed by the PRC as expected, rather than abandoning the hope, many non-Chinese practitioners have continued to search out other versions of Chinese medicine to find what they were looking for, and to reformulate older concepts in ways that would coincide with their own concerns. In the process, what were once simultaneously medical and religious terms have become psychological ones as well. What looks back at us remains Chinese medicine, but now wears a distinctly American face.

Acknowledgments
I thank Arthur Kleinman, John Carman, Tu Wei-ming, and Ted Kaptchuk for their ongoing mentoring of my work. I also thank the colleagues, practitioners, students, and patients whose insights and comments gave me the wherewithal to write this study.

(Full references for this article are printed in the hard copy of The European Journal of Oriental Medicine Vol. 3 No. 4; Winter 2000.)

Linda L Barnes
Linda L Barnes is an Assistant Professor of Medical Anthropology in the Department of Pediatrics at Boston University School of Medicine. She directs the Boston Healing Landscape Project, a fieldwork program that researches the complementary healing practices of the cultural communities serviced by the School's teaching hospital. She is currently working on a book, Needles, Herbs, Gods, and Ghosts: The Foundations and Social History of American Repsonses to the Chinese and Their Healing Practices.