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Ted Kaptchuk

transcript

2021 

Early Studies

 

TED KAPTCHUK

I'm an ex-practitioner. I have one patient a month and I'm lucky to have one, or two a month. I stopped because my hands are no longer good. I started because I was involved in the anti-war movement in the sixties. My undergraduate degree is in religious studies, primarily Buddhism. I was intrigued by Buddhism. I was in San Francisco when there was a grand jury in New York City, investigating the death of some of my closest friends who were blown up in an explosion that probably was related to preparing to do terrible things.

 

I didn't want to get called to a grand jury because you have to testify. I didn't know what was going on. So I asked some friends who were in the San Francisco, red guards, which is like the Black Panther Party for Asians. They had two houses. I think one was in San Francisco and one was in Berkeley. I asked if I could stay in their house for a while.

 

I knew the rule was no non-Asians were allowed in it. I figured that's a good place to be white. Caucasians were allowed. And so I stayed there and every week they would get copies Beijing review. The back would say: Chinese medicine, a great treasure to be exploited. That's interesting because I was really interested in Marxism. When that was over, I decided that I would study that. I asked the kids in the commune who their grandparents went to for doctors. I figured out who was a practitioner of traditional Chinese medicine in San Mateo.

 

Unfortunately, he was an alcoholic at that point. I said, could I study with you. He said, of course, and he was drunk by three o'clock. I loved him because he was a good man. It took me a while to understand if what he said was true or not true. I used to try to get there early and try to stop him from drinking. He would take a patient every day. I would bring patients, other people would bring patients. He was this grand student of the founder of the New England school. Dr. So was the teacher who studied with Qing Tan-Ah, who was really an important figure. He was modernist too in many ways.

 

It took me a long time to figure out what he was talking about. I studied with him for a long time and then realized that I didn't understand anything. He'd talk about the wind, and he would be drunk half the time. There was an article about him in the New York Times, about eight years ago, he treated John Lennon for a while for drug abuse and alcohol abuse. It's his specialty. He wished to be a doctor on the boats between Liverpool and Shanghai for Chinese laborers. And so he specialized in sex and drugs. He was amazing, but I couldn't study with him. I went and finally said, I have to go someplace else. I wound up studying in Taiwan. Later on, when I finished all my studies in China, I realized that he was probably the most interesting and coolest doctor I ever studied with. And I wrote him a letter saying, I'm coming back and I want to come work with you for a while. Is that okay? And he essentially took his own life by putting alcohol in his IV drip in the hospital. And he died.

 

So I studied. I was crazy and I was young. I wanted to do something interesting and I didn't wanna be part of that system. I thought if Buddhism was interesting, there were positive things in Chinese Buddhism and the convergence of different ideologies. Of course, now I realize that's not a dependable way of doing things.

 

I left in 1949 and then went up to Macau. I went to a patriotic school that was set up during the cultural revolution for Indonesians, Burmese, Cambodians, and Vietnamese who normally would have gone to the mainland. They weren't allowed to or didn't want to because they wanted their families to visit. 


 

Schooling in Macau


TED KAPTCHUK

It was really hard. There were pictures of Mao in every room, because s a patriotic school. I assumed everyone liked Mao because there's a picture in every room. I didn't understand for a while that everyone hated Mao and they were terrorized by him. I would quote on contradiction or democracy and people would go, what the hell is this? I used to eat at a Buddhist restaurant because I'm a vegetarian. And they said, oh, he's a Buddhist. And then I had long hair, so they thought I was a hippie. And then they weren't sure if I was a CIA agent because I wanted to study in Beijing, but I wasn't given permission. 


 

I actually gave a letter to the Black Panther delegation in the Bay Area who going to China to visit Beijing. They delivered it to the members of the central committee of the people's Republic of China, asking for me to go. There was a petition to go study and I was told I can't. Macau was hard. Macau is a weird place. There's a lot of everyone doing things that no one talked about. That said, I lived with a Chinese family that I adored. I was adopted and had one great classmate and my family and my classmate kept me on.

 

She was Macanese. I believe her side of the family was from Burma. Her dad was a bus driver, and during the cultural revolution, there was a call from Beijing to Macau. He became vice mayor of the city because he was a member of the union, which operated out of Guang Zhou, which was a communist union. So everyone knew he was very powerful. They said, stop the cultural revolution. And he went back to driving buses. But everyone was afraid of her because they knew her dad had real power. It took me a long time to understand this, but she was very protective of me and read a lot of Chinese notes to me endlessly. So that made me okay. And ultimately I really loved the place. 

 

The schooling was terrible. They were all people who graduated in the sixties when the Indonesians went back to China, returned to the motherland and went to really good schools. But they had an inferiority complex. They would've probably preferred studying modern Western medicine. It was just not a well-run school. It was not like classes were banned. I had a copy of a book that was published remotely in that period. And so whenever a class would happen, I would go home and read three other books because it would help me understand things. The language was a problem. I'd always find the book that the teacher copied their lecture on and it was horrific.

 

You couldn't ask questions, so if there was a question, people would write me a note. I'm thankful that I had that opportunity to study. I'm thankful I was able to use text from the mainland because I thought there was something special about that. I asked for a scholarship because my father was a member of the proletariat and a member of Tommy's party and they gave it to me. That was really nice. It was $3 a year, which is really good. And I taught English that night to make money. Ultimately I'm very thankful for every moment I spent there. I'm very excited to go back and visit.

 

I actually applied for a license to practice Chinese medicine in Macau and I wanted to stay there for another year to study with some people. They didn't know what to do with me. It was like I have all the credentials. I worked in the school clinic and practiced a lot. 

 

Seeing Patients in Macau

 

TED KAPTCHUK

It was aches and pains. It was a lot of depression and emotional disorders that I didn't know what they were. I knew how to meditate. So some of my teachers studied in schools in the early sixties when they had meditation practices in Chinese medical books. Those patients had a lot of really cultural-bound syndromes. They had symptoms of serious illnesses. I'd say that's a lot of women's disorders, geriatric disorders, and a lot of functional illnesses. People went to Western doctors for hardcore biologically defined illnesses, like heart disease or cancer. But I treated a little bit of everything. 

 

Practicing here was a total mind-boggling experience. A whole 20, 30%, maybe even 35, 40%, 30% of your practice disappears. People would start to cry and start to talk about anger and self-esteem. You were dealing with a lot of psychological illnesses. I also noticed that the effects of my treatments were much more effective here. I'm not as good as some of my teachers, especially the old ones I studied with in Taiwan and Dr. Hong.

 

We did acupuncture five days in a row and then maybe six days in a row. And head off on Sunday. I'd write prescriptions and people would get completely better before. And I was waiting, acting cool and calm. And then I cut the dosages down, I cut it down. I used fewer needles. I have a lot of colleagues and friends that are practicing Chinese medicine. 

 

They all cut their dosages right away. I think it raises real questions about the intervention not being dose-dependent on some level, which raises questions of what is its biology. It's usually dose-dependent if it's a strong drug. I would use small amounts and get these really good results. It was very complicated adjusting to the psychological vocabulary people had. Their expectations were much higher than in China, but they also responded better. 

 

I remember even when I started, I started teaching right away because I never made a living as a practitioner. My students would come to me and I treated them, but they only got a little bit better. And it's like, oh my God, this is a disease where no one gets better. I was immersed in something different than I was immersed in China. I think my placebos worked. I point out that people would get better before I even treated them. Someone called me up and said, I'm one of your patients. They said, you gave me a prescription. I felt better immediately. I'm not saying Chinese medicine is a placebo because that's mixing metaphors or constructs. But those were some of the key questions that happened as a practitioner. And I have to say my acupuncture wasn't very good when I returned. 

 

Culturally-Bound Illness and Teaching in NY

 

TED KAPTCHUK

I have a good friend who spent 13 years as a Buddhist monk in a Chinese monastery. His name in English is Steve Clara. And his Buddhist name is Hung Jing. His only fluency was in Tang dynasty Chinese. Every week we'd sit for a couple of hours and it was the most amazing experience. One of the great enlightening experiences of my career in Chinese medicine was this was totally different than what I got taught. There's a Talisman and burning of magic words and putting them in water. There are descriptions of pathology beyond anything else. If you want to get from this level of meditative clarity to this level, this is the prescription you use. He's talking about celestial matters left and right. And I go, wow, there's something going on here. It's beyond anything I've ever encountered in the official version that I got taught in China. And that was really a mind-boggler. I spent a lot of time doing that and I really loved it. It was hard for me to give it up, but I didn't know what to do with it. I'm not trained as a scholar as much as a practitioner.

 

I decided that I was going to study placebo effects and that liberated me. The other thing that liberated me was a culturally-bound illness. When I came back to the country, someone told me to read Patients and Healers in the Context of Culture by Arthur Kleinman. I read it in one night, especially the chapter on Frigophobia, which I had as a disease. Dr. Kleinman describes it as a kind of anxiety disorder or depressant, but I definitely was anxious. I got something that only Chinese really are sensitive to. That was liberating too and complicated historically and culturally.

 

There was a huge influx of Asian practitioners in the eighties, especially after Tiananmen Square. There's a huge flourishing of non-Asian practitioners who get trained primarily. And the acupuncture schools that are licensed all over the country and in Boston. I got here on July 4th, 1976 in New York. I went over and said, can I get hired to teach? Dr. So said he can't teach here because I teach everything. He's an amazing, charismatic, and difficult character. I told them, okay, I can't teach acupuncture. I can teach herbs. And they said, sure. They asked me how much money I wanted to get paid. I said something and they said, we'll pay you four times that amount. I said, well, this is a good place to stay. I'm staying here.

 

I loved every minute of it because I love their herbs. I would study the text and always find new things. I did a lot of reading. I don't have many unfinished books in my closet. When I read Sun Simiao, I said, this is weird, there's a whole other vocabulary. I asked several Chinese doctor friends who had just come here. I said to them, could you underline everything you think is superstitious and psychological. And they said, what do you want it for? I said, just do this. I mostly handed them the material medicas and fungi books.

 

If you look at enough books, you'll find anything in them. I had found some Japanese texts that were also written in Chinese characters. I was teaching stuff that I would dig out and it was really fun. I had a good time. When I was practicing all year, I mostly wrote prescriptions and people would go to Chinatown to pick up theirs, but I would have patient remedies around the house all the time. I think there's an ethical question about whether a practitioner should do that. But I started in China where the ethics were quite different. I never charged them for money because I used to make a living teaching.

 

I was willing to go into places that were more severe illnesses, more complex illnesses. I had more trust in myself. I treat lots of people with cancer, but not a lot of people with different neurological problems. I didn't try to cure cancer, but I tried to help and realized I was part of the medicine. I didn't feel my training was anywhere adequate for that. I became seasoned as a practitioner. I could smell, I could taste.

 

Web-book Writing Process

TED KAPTCHUK

I wanted to explain Chinese medicine as if one could understand it. The goal was to take the mystery out of Chinese medicine and keep the mystery simultaneously. I wrote it because I knew that what was going on in English was all garbage and literature. I felt originally it was a translation effort. You can't see a real difference in the first edition. The second edition is where you see the difference. For the first one, I was careful not to go too far. In the second edition, I knew I had to go far because unless I was able to say what I really thought was going on, I wasn't doing the service I needed to do to China and repay the debt of having studied there.

 

And also I didn't want American practitioners to think that the way people practice in China is the way they have to practice. I mean, it's a culture-bound system like Western cultures. There's a much more fluidness in the second edition and that came out of feeling more comfortable. And I always made sure to footnote things because you always have to worry if you're hallucinating when you're doing a cross-cultural translation. You saw all of a sudden things became three-dimensional and it was complicated. I immediately published it because I knew if I held it on too long, I would not be able to do it with integrity. It is trying to expand the boundaries because practitioners need integrity in any system of medicine. There are so many contradictions. It's really hard to figure out how to interpret that. I realized my students didn't like a contradiction. It's a majority rule and the question is, the majority is sometimes wrong. I had someone redraw the Meridian section because there are male and female bodies. We put in female bodies.

 

The emergence of Meridian theory and herbal medicine I would teach people that. All the maps and that the truth was you need to understand that prescription and match it to a human being. All the other steps in between were ways of you holding on until you can make the final match to this herb. They're so complicated, beautiful, and elegant. There are no herb formulas. They all have complexity written into them. Human beings are complex. The most important thing I learned about Chinese medicine was studying the herb formulas and then translating them back to my clinical experience These herbs are really like biochemical entities.

 

Placebo Research at Harvard

 

TED KAPTCHUK

At Harvard, I was recruited to do research by David Eisenberg and some of his colleagues. They liked my background in Chinese medicine because I had a good reputation, but they also liked the fact that I was interested in all kinds of alternative medicines. They wanted me to do research and I was pretty shocked when I got there. Is it more than a placebo effect? I'd never heard the word placebo in China. That's what research is. You have to force nature to speak without all the noise. How do you select the points? I saw people using points and was like, where'd they get there? I got it from some Shanghai text. The point location is an interesting question. It raised real questions for me when I was a practitioner.

 

The depth location gets problematic. The text of the Japanese is used to justify a very shallow location. You make that person feel something. And all these questions came up. When I was doing research on the original dosage of the herbs, it has nothing to do most of the time with the dosage prescribed in modern China or modern Japan. If you go to a practitioner of Eastern medicine in Japan, they use very small dosages. There were a lot of questions and needling was a big question. I really wanted to know, but I never really found out.

Ted J. Kaptchuk is a professor of medicine at Harvard Medical School and director of the Harvard-wide Program in Placebo Studies and the Therapeutic Encounter (PiPS) at Beth Israel Deaconess Medical Center in Boston, Massachusetts.  He is also a professor of Global Health and Social Medicine.  As a leading figure in placebo studies, a scholar of East Asian medicine, and an academic authority on medical pluralism, Professor Kaptchuk's career has spanned multiple disciplines, drawing upon concepts, research designs and analytical methods from the humanities and basic and clinical and social sciences.