Use of Acupuncture by 1970s Revolutionaries of Color: The South Bronx “Toolkit Care” Concept

Abstract

Failed by mainstream medical institutions, 1970s revolutionaries of color sought to take health care into their own hands. A lesser-known phenomenon was their use of acupuncture. In 1970, an alliance of Black, Latinx, and White members at Lincoln Detox, a drug treatment program in the South Bronx area of New York City, learned of acupuncture as an alternative to methadone. In Oakland, California, Tolbert Small, MD, used acupuncture for pain management following his exposure to the practice as part of a 1972 Black Panther Party delegation to China. Unaware of one another then, the Lincoln team and Small were similarly driven to “serve the people, body and soul.” They enacted “toolkit care,”—self-assembled, essential community care—in response to dire situations such as the intensifying drug crisis. These stories challenge the traditional American history of acupuncture and contribute innovations to and far beyond the addiction field by presenting a holistic model of prevention and care. They advance a nuanced definition of integrative medicine as one that combines medical and social practices, and their legacies are currently carried out by thousands of health care practitioners globally.

At an opioid recovery center in New Hampshire, 10 people sat in the lounge, each with five needles sticking out of both ears. They were all White and identified as making low income.¹ This was the distinctive ear acupuncture treatment of the National Acupuncture Detoxification Association (NADA), used for substance use, anxiety, posttraumatic stress disorder, and more.² I asked if they believed in acupuncture, which they were receiving for free. They unanimously agreed—it made a difference. One man elaborated, “We don’t know what medicine is anymore. Whatever works, works.”³

FIGURE 1—

Tolbert Small, Back Right, and David Levinson, Third From Left, With Barefoot Doctors in Yenan, China, March 22, 1972

Source. Tolbert and Anola Small Papers, the archives of the Small family, which are in the early stages of being organized by the family and the author. Printed with permission.

FIGURE 2—

Tolbert Small Treating a Patient With Acupuncture for Back Pain in the Upstairs Room of the Harriet Tubman Medical Office in Oakland, CA

Note. This room was dedicated to acupuncture, 1993.

Source. Tolbert and Anola Small Papers, the archives of the Small family, which are in the early stages of being organized by the family and the author. Printed with permission.

FIGURE 3—

Unidentified Lincoln Detox Member Treating a Patient Using Ear Acupuncture

Note. Photo is a still from Mia Donovan’s EyeSteelFilm documentary, Dope is Death, 1973.

Source. Carlos Ortiz, courtesy of the Center for Puerto Rican Studies at Hunter College. Printed with permission.

According to a 2012 National Institutes of Health report on the use of complementary and alternative medicines (CAM), 33.2% of the adult US population, especially non-Hispanic Whites with higher incomes, had tried CAM practices in the 12 months prior.⁴ With biomedicine as a cause of the opioid epidemic, it is unsurprising that patients would look elsewhere, yet the crisis is likely shifting the CAM user demographic. Furthermore, in stark contrast to the 2012 report, the NADA protocol traces back to 1970s activists of color—to those connected with the Black Panther Party (BPP) or the Young Lords, two revolutionary groups advocating for the self-determination of poor and oppressed communities, the former consisting largely of Black activists and the latter of Latinx radicals.⁵ The revolutionaries sought to provide for the holistic needs of marginalized populations, such as health care access. This history includes the use of acupuncture.

In New York City, the BPP, Young Lords, and other revolutionaries founded Lincoln Detox, a drug treatment program, at Lincoln Hospital in the South Bronx. In 1970, Mutulu Shakur, an informal affiliate of the BPP, was introduced to acupuncture and suggested it to Lincoln as an alternative to methadone.⁶ Lincoln eventually became the site for the development of the NADA protocol, now used globally. Yet, this was not the only instance in which 1970s revolutionaries used acupuncture.⁷ In California, Tolbert Small served as the BPP’s medical director between 1970 and 1974. He visited China as part of a BPP delegation in 1972 and witnessed acupuncture for the first time.⁸ Fascinated, Small incorporated the practice into his medical toolkit upon returning home. He has since treated thousands with acupuncture for pain management, often in lieu of prescribing drugs.

These two stories have received sparse attention but offer significant contributions to the history and policy of public health.⁹ They challenge the traditional narrative of the arrival of acupuncture in the United States perpetuated by American Chinese medical schools and biomedical institutions, by preceding or running in parallel with New York Times reporter James Reston’s 1971 article on his acupuncture treatment in China.¹⁰ Furthermore, they argue for a nuanced definition of integrative medicine as one that combines medical and social practices.

Acupuncture in the hands of the revolutionaries carried sociopolitical meanings and motivations. They employed “toolkit care” as their logic of survival.¹¹ Based on the notions of health care for the people by the people, their approaches embodied and defined toolkit care—the endeavor for community self-efficiency and self-empowerment through self-assembled, mobile means.¹² It merged the concepts of do-it-yourself and first aid, connoting a care that responded to emergencies, including dire health care needs. In particular, the revolutionaries’ use of acupuncture as part of their toolkit explicitly addressed the intensifying crisis and criminalization of drug use in communities of color. With addiction seen largely outside the purview of medicine and public health during the War on Drugs (legacies of which have lasted well into the 21st century), these revolutionaries took health care into their own hands, using acupuncture as prevention and care for addiction.

Their toolkit care was born not necessarily out of desperation but rather a desire to reclaim authority and the right to heal. This practical care was built of essential skills the revolutionaries metaphorically and physically carried as they worked to meet the communities’ local needs and “serve the people, body and soul.”¹³ Acupuncture fit the revolutionaries’ toolkits; it was economical, accessible, responded to the drug crisis, and was understood as part of Maoist ideology, which significantly influenced the revolutionaries, especially in health care delivery.¹⁴

Expanding upon sociologist Alondra Nelson’s analysis of the BPP’s health activism, the employment of integrative medicine demonstrated the Black and broader revolutionary movement’s commitment to laying claim to the right to health equality.¹⁵ As AJPH Editor-in-Chief Alfredo Morabia has noted, dominant narratives of the BPP’s violent state confrontations have obfuscated the party’s broader community service legacies.¹⁶ These histories of Small and Lincoln fill in a fuller picture of not only the BPP, but also the 1970s revolutionaries of color and offer a detailed lineage of their influence on the wider American and global population from then to now.

THE 1972 CHINA LESSON

In August 1963, Mao Zedong, chairman of the Chinese government, issued a global call to support the Black struggle against oppression by the US government. Disseminated by the Chinese Communist Party’s The People’s Daily, Mao’s statement solidified many revolutionary groups’ commitment, such as the BPP’s, toward Maoist ideology. Founded in 1966, the BPP funded much of their arms purchases by selling the “Little Red Book,” a collection of Mao’s writings. BPP founders Huey Newton and Bobby Seale lifted the party’s signature term, “serving the people,” directly from the red book.¹⁷ Maoist ideology provided them guidance on the means for societal transformation; in particular, the barefoot doctor movement was a key influence.

Laypersons with basic Western and Chinese medical training, barefoot doctors carried “medical kits,” including acupuncture, into rural communities lacking medical care, resembling the health care deserts in many American communities of color.¹⁸ This movement informed the BPP’s health care praxis and toolkit care. With a 10-point platform, including the demand for “completely free health care for all black and oppressed people,” the BPP established a national network of People’s Free Medical Centers, which spanned 13 major cities, from Los Angeles to New York City.¹⁹ At the George Jackson Medical Clinic, the headquarters’ clinic in Oakland, California, physicians and laypersons worked as “24-hour revolutionaries” to provide medical care.²⁰

Tolbert Small was the director of the George Jackson Medical Clinic during its height in 1970 through 1974. Born in Coldwater, Mississippi in 1942, Small and his family moved to Detroit, Michigan when he was a few months old. While attending the University of Detroit, he cofounded the student chapter of the National Association for the Advancement of Colored People. Seeking to alleviate the health care needs of his community, Small graduated from the Wayne State School of Medicine in 1968 on a Sloan Foundation medical scholarship.²¹ His residency in internal medicine brought him to Oakland, where he approached the BPP in 1970. Although he did not join, believing he would be more effective as a nonmember, he provided medical services pro bono and served as the BPP’s physician. He visited jails and prisons, treating prominent BPP activists and affiliates such as George Jackson and Angela Davis. Small also codirected the national BPP Sickle Cell Anemia Project, which promoted education and screening among Black communities.²² This work pressured Richard Nixon’s administration to fund research to eradicate sickle cell anemia.²³

In March 1972, Small traveled to China with a BPP delegation organized by Newton, who visited China in November 1971 and asked if he could send a group the following spring.²⁴ Granted permission by the Chinese Communist Party, Newton selected 20 participants, including BPP members, other activists, social workers, health professionals, teachers, and children. According to the BPP newspaper, the group “had come from their different walks of life to work and live together under the tutelage of the Black Panther Party.”²⁵ Small was the only physician. The delegates visited factories, schools, and medical facilities over the course of seven weeks. David Levinson, then 19 years old and a White BPP member, recalled meeting “many revolutionary people … and there was much about that vision, much about that commitment, and heartfelt desire that we connected to.” The delegates believed they were witnessing their ideologies actualized “on a mass, grand scale.”²⁶

At urban hospitals and rural clinics, the group was introduced to acupuncture. At hospitals, they watched acupuncture anesthesia used for surgeries such as a thyroidectomy. In the countryside, they met barefoot doctors who carried aspirin alongside “one silver needle and a bunch of herbs” (yigen yinzhen, yiba caoyao) in their medical toolkit.²⁷ In Small’s audio recordings of the trip, the tour guides emphasized “the seamlessness of integration” of Chinese with Western medicine, referring to the national “East–West Medicine Integration” (zhongxiyi jiehe) policies. The guides suggested the delegates “integrat[e] traditional Black medicine with modern medicine to serve people better.”²⁸ This encouraged the revolutionaries’ self-assembled toolkit care, as “these were the tools and techniques that were available and easily disseminated without having to rely on Western technology or ideas of medicine.”²⁹

Intrigued, delegates bought acupuncture needles and tried needling themselves. “The Chinese came to us and diplomatically said that they were enthused by our interest but warned that it could be dangerous if we didn’t know what we were doing,” Levinson recounts.³⁰ The officials then organized acupuncture lectures, led by a certain “Dr Wu” in Shanghai. “It was spectacular,” Small recalled, “I had to learn more . . . I was inspired by how one million barefoot doctors brought medicine into the communities.”³¹ Upon returning home, Small taught himself acupuncture by trying points on himself, referring to an English-translated Chinese medical text.³²

Small was interested in biomedical understandings of acupuncture, although he was not opposed to “other ways of explaining.” Small recalled, “the meridian system is one way of explaining acupuncture, but I wanted to explain it in familiar terms.” He subscribed to translated Chinese medical journals and published two articles in the American Journal of Acupuncture in 1974: “The Neurophysiological Basis for Acupuncture” and “Acupuncture Anesthesia: A Review.” He specifically paid attention to acupuncture’s pain relief potential and described the practice as a mechanism of stimulating endorphin release and blocking pain transmission. Later, he presented a talk entitled “Traditions of Healing Acupuncture” to hospitals and community centers. “I had this business card that I got in Mexico that said, ‘Tolbert Small, Research Acupuncturist,’ ” Small recounted. He instructed the card’s maker to include “research acupuncturist” because practicing acupuncture was illegal in California in 1972; nonetheless, he did house calls for free. Embodying the spirit of toolkit care, he described, “I had a bag with a needle pouch and electroacupuncture machines everywhere I went.”³³

In 1980, Small and his wife Anola established the Harriet Tubman Medical Office, which operated until 2016. The upstairs room was dedicated to acupuncture, and Small largely resorted to the practice for pain management to prevent unnecessary drug use. “I try to avoid prescribing painkillers,” he explained.³⁴ He has introduced thousands to acupuncture, including writer-activist Daphne Muse, who was treated for pain in the early 1970s.³⁵ Small also taught patients points to needle themselves or apply pressure on themselves for pain relief.³⁶ He performed acupuncture on his wife for her childbirths and on himself for his colonoscopy. To this day, he continues using acupuncture alongside his general practice.

The China trip exposed the delegation to an alternative form of therapeutic treatment and health care delivery. The lesson of community service and the integration of medical practices reinforced the revolutionaries’ toolkit care, and Small continues to see medicine as part and parcel of a broader commitment to societal transformation. He believes “there isn’t a Western or Eastern medicine, just one medicine—what helps the people.” Dedicated to “serving the people,” Small, at age 78 years, is “not ready to retire yet!”³⁷

ACUPUNCTURE AS POLITICS

The history of Lincoln Detox, an acupuncture clinic in Lincoln Hospital in the South Bronx, is rooted in radical politics. Known by the community as the “butcher shop” for the extreme mistreatment of patients and its dilapidated conditions, Lincoln Hospital was the only medical facility in the area by the 1970s.³⁸ The Young Lords, BPP, and revolutionary health workers staged several takeovers at the hospital in 1970, demanding community self-efficiency with health care services.³⁹ In November, they began a drug treatment program, later called Lincoln Detox, in the nurses’ residence to tackle the ravaging drug epidemic.⁴⁰ The space functioned as a community gathering place, offering methadone treatments alongside political education courses.⁴¹

Posters distributed by the team featured skulls to represent oppressive forces, such as Eli Lilly, a prominent pharmaceutical company that manufactured and distributed methadone.⁴² Although methadone maintenance was the predominant detoxification treatment, community members viewed it as another method of sociopolitical regulation from the “white doctors, in white coats, in white hospitals.”⁴³ The Lincoln Detox team believed the community was under attack by “chemical warfare” and “genocide,” whereby the American government was a “dope pusher,” creating a “methadone plague” and neglecting dire health care needs.⁴⁴ Defense was to “organize,” “educate the people,” and employ acupuncture.⁴⁵

The Lincoln team was an alliance of Black, Latinx, and White revolutionaries with varying sociopolitical backgrounds, united by a spirit of “collaboration and solidarity.”⁴⁶ Prominent members included Walter Bosque and Vicente “Panama” Alba, both Young Lords activists.⁴⁷ White doctors, such as Richard Taft, were also significant team members.⁴⁸ Mutulu Shakur introduced the idea of using acupuncture to Lincoln.⁴⁹ Formally part of the Republic of New Afrika, an organization that advocated for the liberation of several Southern states to the Black community, Shakur described himself as “a crucial liaison” to the BPP as he shared similar principles.⁵⁰

In 1970, when car accidents left Shakur’s sons paralyzed, Shakur’s friend and fellow activist Yuri Kochiyama recommended acupuncture, a practice that was then known primarily within Asian American communities. His sons recovered, and Shakur described acupuncture as “a miracle,” fascinated that it was “non-chemical.” He noted that practitioners “didn’t wear traditional white coats,” which were associated with the poor treatment of minority communities.⁵¹ The team subsequently learned about acupuncture’s potential to treat withdrawal symptoms.⁵²

The Lincoln team purchased affordable needles and learned from Chinatown practitioners, “picking up books, finding points in the ear, and trying on patients willing to give it a go.”⁵³ Although toolkit care did not entail complicated technologies, it nonetheless required a learning process, as evidenced by the revolutionaries’ scrappy but dedicated endeavor to find what fit. In 1976, Shakur, Bosque, and others trained and received doctorates at the Montreal Institute of Traditional Chinese Medicine, run by practitioners Oscar and Mario Wexu, who helped set up Lincoln’s acupuncture program in the early 1970s.⁵⁴

Open to all, the acupuncture program treated more than 10 000 people within its first years, and treatment was paired with training in acupuncture and politics.⁵⁵ The Lincoln team sought to develop “a barefoot doctor acupuncture cadre,” empowering communities to build their own toolkits. They visited China in 1977 with Mario Wexu and aimed to actualize Mao’s barefoot movement at home.⁵⁶ They traveled around the United States teaching communities “the fundamentals of acupuncture . . . [and] how [the practice] was used in the revolutionary context in China.”⁵⁷ Bosque described, “We used to say, ‘Each one, teach one.’ We started teaching each other.”⁵⁸

The political significance of acupuncture was also embedded in the Chinese medical theory of the body’s innate abilities. The team taught that acupuncture was “a form of self-help therapy . . . the patient’s own rebalanced energy flow provides most of the health-giving relief.”⁵⁹ As dominant sociopolitical forces rendered minority patients powerless, the concept that their very bodies were agents of health was significant, even subversive. This self-healing, importantly, also scaled to the community level, where “patients who were healed became practitioners who helped,” creating a self-sufficient, empowered collective.⁶⁰ Acupuncture was not only a therapeutic but also a radical intervention of resistance and empowerment; disempowered communities were reclaiming the right to heal, which itself was healing.

Although these revolutionaries sought to “challenge Western occidental medicine by Eastern medicine” and criticized the medical establishment for its “patriotic” rejection of acupuncture, they did not dismiss biomedicine altogether. The Lincoln team advocated for scientific research on acupuncture “to give it legitimacy.”⁶¹ Western doctors, including Taft, “use[d] their licensing to benefit the people’s needs” by facilitating the state authorization of the program as a medical facility.⁶² The team used recognized research protocols, such as those of the National Institutes of Health, to measure acupuncture’s efficacy. This included a 20-bed inpatient unit where general detoxification methods were compared with methadone and acupuncture. “This was the most efficacious way to determine research results with statistics, case studies and findings,” Shakur recalled.⁶³

In using biomedical tools for strategic means, the revolutionaries symbolized what Nelson described as not a blanket rejection of biomedical practices and scientific research but instead a “more rigorous engagement with them anchored in a conception of healthfulness that included freedom from medical discrimination and entitlement to social rights.”⁶⁴ The employment of both biomedical methods and acupuncture signaled a crucial message: the “alternative” status of acupuncture read not as secondary, nor a last resort, but instead as preferred. Although certain biomedical interventions were available, especially methadone, the revolutionaries chose to rely on acupuncture. A drug-free and empowering practice with Maoist affiliations, acupuncture was a better fit for the revolutionaries’ toolkit, evidenced by the thousands of returning patients.⁶⁵ However, important questions of the program’s longer-term efficacy remain, which call for more analyses.⁶⁶

In November 1978, Mayor Edward Koch shut down Lincoln on allegations of fraud and the use of “questionable treatment methods.”⁶⁷ This ended a years-long battle between government officials and the Lincoln team, beginning with the revolutionaries’ hospital takeovers. Alba described the constant “political struggle . . .to maintain funding, keep the program alive, against the local police as well as hospital police who continuously tried to make their way into the program (Lincoln Detox was a sanctuary where addicts could go and not be afraid of police).” With city and state bodies frequently threatening to cut funding, the team often protested. “Even though we forced the government for years to underwrite our work, eventually they had the power and took it out,” Alba stated.⁶⁸ For Koch, “hospitals are for sick people, not for thugs,” and he was concerned with the revolutionaries’ direct actions and Lincoln’s network of radicals.⁶⁹ Shakur emphasized that “acupuncture in the hands of the revolutionary-minded, particularly addressing addiction, was an intervention that the government was not willing to accept at the time.”⁷⁰ More than 70 supporters gathered at Lincoln, holding signs that read “Reopen Detox, no methadone maintenance.”⁷¹

Shakur subsequently established the Black Acupuncture Advisory Association of North America (BAANA) in 1978, which trained hundreds of revolutionary-minded acupuncturists.⁷² Some members were linked to robberies, which they characterized as “expropriations”—the return of money from the rich to the poor from whom they had taken it.⁷³ In 1982, Shakur, several BAANA members, and others were federally indicted under the Racketeer Influenced and Corrupt Organization Act.⁷⁴ The charges included their involvement in a Brinks armored car robbery in 1981, which led to the death of two policemen and one guard.⁷⁵ Situated in the larger context of the 1960s and 1970s American underground movements in response to systematic suppression by local and federal law enforcement, the Black underground movement is particularly poorly documented, and this history is muddy on factual and moral dimensions.⁷⁶ Complexity and multiplicity of truths pervade the history of Lincoln and BAANA, as public health and history strike a balance between celebrating the innovative use of acupuncture for addiction and community self-empowerment, on the one hand, and condemning the endangerment and taking of lives on the other.⁷⁷

TOOLKIT CARE TODAY

Other Lincoln members founded a nearby successor program, called Lincoln Recovery. Known as “Phase Two,” this program did not offer political education but attracted socially oriented practitioners to train in ear acupuncture, many of whom worked on HIV/AIDS and addiction.⁷⁸ However, many considered the original “program”—of acupuncture and politics—as having ended in November 1978.⁷⁹ In 1985, Michael Smith, a White psychiatrist and director of Lincoln Recovery, formalized NADA and the five-point ear acupuncture protocol. Low-cost and efficient, the protocol is widely accessible for people of all backgrounds to receive or be trained in. From nurses to prison officers, the protocol was also used for first responders after the 9/11 World Trade Center attacks and Hurricane Katrina.⁸⁰ As one practitioner declared: “It’s first aid!”⁸¹ Now a global organization, NADA has chapters from Great Britain to Japan, with an estimated 25 000 members.⁸²

Lincoln also influenced the founding of other organizations. These include People of Community Acupuncture in the United States and Substance Misuse Acupuncture Register and Training (SMART UK) in England, where thousands of practitioners (either trained at Lincoln or trained by someone who was) employ toolkit care, working with marginalized populations at a sliding-scale rate or for free in group treatments.⁸³ Although some practitioners are directly inspired by the Lincoln team, recognition and awareness of the early history have not always been at the forefront of these modern organizations, including NADA itself, a fact that is now changing under calls by community members.⁸⁴

Small’s influence extends beyond his direct patient care since the 1970s. In Oakland, Freedom Community Clinic, whose founder was inspired by Small, has offered integrative medicine services since July 2019 to more than 2300 residents. Recently, the clinic organized pop-up “healing clinics” for Black, Indigenous, and people of color (BIPOC) patients in response to the COVID-19 pandemic and the killing of George Floyd. At these clinics, acupuncture was offered alongside primary care checkups. BIPOC practitioners employed toolkit care similar to that used by the 1970s revolutionaries and provided alternative healing options. Their message resonated, and hundreds of BIPOC patients attended.⁸⁵ Altogether, tens of thousands of practitioners, influenced by Small or the Lincoln team, practice integrative medicine, where medicine goes together with the social praxis of “serving the people, body and soul.”

Small and Lincoln members have never met.⁸⁶ The varying degrees of sociopolitical motivation of its adherents attest to the multiplicity encompassed by the Black and broader revolutionary movement. The Lincoln team’s toolkit was far more politically oriented, evidenced by the political education emphasis. Yet the simultaneous and parallel nature of their acupuncture uptake powerfully underscores similar messages that provide guidance for today’s public health issues. With the current opioid epidemic resembling the conditions of the 1970s drug crisis, the revolutionaries’ use of acupuncture offers a holistic image of prevention and care—acupuncture for pain management on the one hand and its pairing with social empowerment for addiction management on the other. Importantly, thousands of patients attest to its benefits.⁸⁷ These stories contrast with the current understanding of CAM practices, as mostly used by White patients.⁸⁸ The contributions and innovations to the addiction field and beyond by these revolutionaries have not been properly recognized by public health; political and conceptual occlusions from incomplete historical understandings of the Black and broader revolutionary movement and the dismissal of addiction interventions as only relevant to addiction have kept these histories from getting the attention and critical engagement they deserve.

Although medical practices with sociopolitical involvement are not new, they are seldom taught in public health, medical, and other health science schools.⁸⁹ But the lessons of their successes—and failures—in holistic health care delivery are widely applicable.⁹⁰ We must understand the facilities of (in)justice and conditions that made Lincoln possible—and then not. We must also evaluate the agency of the Lincoln team and how they were made into and made themselves targets of the state, which led to the cessation of a pioneering public health program. We ask, what features of Lincoln could be successful today? We may also wonder, was Small’s intentional peripherality what allowed him to sustain his practice?

What is clear is that the revolutionaries’ integration of medical with social practices broadens our conceptualization of health care. What sustained the reception of acupuncture was its ability to satisfy particular needs, which were not always medical but were nonetheless constituent of health. These lesser-known histories not only suggest the importance of considering medical needs together with social needs, but they also highlight their interplay, encouraging us to address the multiple axes that constitute the healing process. They impress on us the indispensability of attending to local needs and provide a practical vision of a modern barefoot doctor and grassroots implementation of toolkit care. Above all, these important histories should move us to pay attention to the creative and complex ways in which oppressed communities define, envision, and seek health as they lay claim to a fundamental human right.