Not What, but Where: Piercings, Tattoos, and the Map of the Subconscious Mind

Introduction: “As Above, So Below”

Think it’s hard not to notice a piercing or tattoo when it’s right under your nose (figuratively or literally speaking)? Well, imagine one right under your acupuncture needle! This has happened to me enough times that I can’t help but wonder if my friend/colleague was onto something when she noted a correlation between where she needled her patients and where they had tattoos.

Right ear
My right ear. Taken by A.N. Rol, aka my mom, November 2019.

I am always careful to keep my thoughts about another person’s body art to myself, in a clinic setting and in general, but what if my reservations about commenting on someone’s eyebrow piercing or forearm tattoo aren’t just about a barbell or an ex-girlfriend’s name? What if where we pierce or tattoo ourselves has diagnostic and therapeutic value in and of itself?

Both acupuncture and body art involve the insertion of needles into the skin. It’s possible, then, that a needle in a particular part of the body serves a similar purpose whether it’s inserted for an acupuncture treatment, a piercing, or a tattoo.

In Chinese medicine, one meaning of the principle “as above, so below” is that the “interior” below the skin manifests on the “exterior,” the skin above. The state of our internal organs, which have both physical and mental aspects, reflects onto the body’s surface in visible and palpable ways. In other words, the surface of the body is a map of our physical, mental, emotional, and behavioral wellbeing–we just have to know how to read it.

Left ear
My left ear. Taken by A.N. Rol, aka my mom, November 2019.

Sounds simple enough, except that there are actually multiple maps we could read. The most extensive map is the system of acupuncture channels, connecting the entire body from head to toe and exterior to interior. Not all acupuncture points are located on acupuncture channels, but all acupuncture channels have acupuncture points. If you played connect the dots between the acupuncture points of a given acupuncture channel, this would approximate its external pathway. All acupuncture channels therefore have an external pathway, by virtue of having acupuncture points. Many also have an internal pathway that travels deeper within the body and illustrates the ability of acupuncture points on the body’s surface to treat internal medicine conditions such as constipation or high blood pressure.

The acupuncture points on the ear, however, do not belong to any acupuncture channels. Rather, they are located according to the theory of microsystems. A microsystem is a part of the body that can be seen as a map of the body as a whole. Not only is the ear one of the most common microsystems needled, but it is also a very popular place to get pierced. To figure out which part of the ear corresponds to which part of the body, we need to know that the body is mapped onto the ear upside down and in fetal position such that the head, facing inward, is at the lobe.1 (See the following image for a visual.)

Ear microsystem
The ear microsystem according to the inverted fetus map. Adapted from reference 1.

While legend has it that pirates got pierced at the center of the earlobe to improve their night vision, plenty of non-pirates have gotten pierced at this location without knowing that it corresponds to the eye (myself included). But what do we know, really?

The answer is: a lot more than we think. Or better yet: we think a lot more than we know.

All of us know how to read the surface of the body as a map of our physical, mental, emotional, and behavioral wellbeing; we just aren’t aware that we do. This is because consulting the map–to decide where to get pierced or tattooed, for example–occurs on a subconscious level. According to neuroscientist David Eagleman, it is the subconscious brain that drives decision-making.2 Note that the emphasis I’ve added is on the subconscious rather than the brain, however. In the interest of a broader, more holistic approach to our mental faculties, I will be using the term mind instead.

Rishikesh bridge_October 2011
A bridge in Rishikesh, India. There is a bridge between the conscious and subconscious divisions of the mind; we just aren’t always aware of it. Taken October 2011.

The subconscious mind has numerous “input channels” to consider in making a decision, but only one “output channel” that will determine our behavior.2 On the one hand, this results in a subconscious synthesis of influences ranging from sociocultural to personal. On the other, it creates a “battle” between a “multiplicity of selves,” conscious and subconscious.2 But don’t be fooled: no matter what the conscious mind brings to the table (steamed broccoli?), the subconscious mind almost always wins (cookies!).

Which begs the question: what else does the subconscious mind have access to that it may factor into the decision-making process? What guides it to one part of the map over another when we decide to get a piercing or tattoo?

As unsettling as it may sound, the subconscious mind is much more than the arbiter of our decisions. Big names in psychology such as Sigmund Freud have long proposed that it is also, writes neurologist Suzanne O’Sullivan, the storehouse for traumatic memories.3

And on that note, let’s talk about “mommy issues.”

Bellybutton Piercings, Lip Piercings, and “Mama Trauma”

The bellybutton and the lips are two very different places on the body that one might get pierced (or tattooed), but they have something in common in Chinese medicine: they are both located on the acupuncture channel known as the Conception Vessel, or Rèn Mài (pronounced “ren my”).

The following descriptions of acupuncture channels come from a standard text that my colleagues and I simply call “Deadman,” a reference to its first author’s last name but perhaps also a warning to potential readers about the state of (not) being that might befall them before they can fully appreciate its vast contents. But don’t worry–there is only so much we need to know for our purposes (and our sakes).

The Rèn Mài begins internally in the lower abdomen, specifically the uterus in females.4 Emerging externally behind the genitals, it then travels up the front of the body to the horizontal crease below the lips.4 At this point it becomes internal again, encircles the lips, and terminates below the eyes.4

CV-2 to CV-12
The dashed red line on the bottom right indicates that the pathway from the lower abdomen (the uterus in females) to the Rèn Mài’s first acupuncture point behind the genitals (originally shown beneath this image) is internal. The dashed red line to the left indicates that this acupuncture point is part of the external pathway that travels up the midline of the body and passes through the bellybutton. Each red dot represents an acupuncture point along the Rèn Mài’s external pathway, indicated by the solid red line. Adapted from reference 4.

As a general rule of thumb, acupuncture points are used to treat the areas traversed by the corresponding channels. The Rèn Mài, for example, can be used to treat conditions associated with the reproductive and digestive organs, as well as those associated with the organs in the chest. But if the body surface is a map of our physical, mental, emotional, and behavioral wellbeing, then it can also shed light on the experiences that have shaped us–physically, mentally, emotionally, and behaviorally.

Perhaps the leading voice on how these core experiences affect acupuncture channels like the Rèn Mài is that of dual Daoist lineage holder Master Jeffrey Yuen. You won’t find any books by Yuen on the subject, as he keeps to an oral tradition, but according to interpretations of his wisdom by acupuncturists Yvonne Farrell and Brodie Welch, the core experiences affecting the Rèn Mài relate to maternity, femininity, bonding, and conception,5 as well as motherhood, responsibility, nourishment, trust, and intimacy.6

Our most significant experiences, however, also tend to be our most traumatic, and our traumatic memories, if you’ll recall, are stored in the subconscious mind. So how do we know if the reason we thought we got a piercing or tattoo somewhere–because we thought it looked cool, for example–is the only reason?

While Freud says that we can consciously force our memories of a traumatic experience out of our awareness, he also emphasizes that this is no long-term strategy, as there is nothing to keep the memories from coming back.3 Recognizing the distress the memories bring, the subconscious mind comes up with a plan to help, but at a cost: in order for the subconscious mind to store the memories of a traumatic experience, it must preoccupy the conscious mind with something at least as stressful as these memories and, of course, as the traumatic experience that bore them. O’Sullivan offers this metaphor: if our traumatic memories are locked in a box in our subconscious mind, then we need a monster in the conscious mind to guard this box.3

CV-23 to CV-24
The last acupuncture point on the Rèn Mài (external pathway, solid red line) is at the center of the horizontal crease below the lips. The Rèn Mài continues on to encircle the lips via its internal pathway (dashed red line). Adapted from reference 4.

That monster–(drum roll please)–is illness.

As destructive as illness can be, the subconscious mind also has our best interests, well, in mind–and in more ways than one. The subconscious mind doesn’t choose just any monster to protect us from our traumatic memories, and it doesn’t choose this monster just to protect us from recalling the threats we faced in a traumatic experience in the past; it also chooses it to protect us from facing similar threats–and making similar memories–in the future.

According to Freud, illness derived from trauma expresses the very memories it is intended to repress.3 The subconscious mind can’t make nothing out of something, and so it makes something into something else. Contrary to Freud’s theory that illness derived from trauma replaces one’s traumatic memories, however, the awareness that something different was there before persists. When I was a child trying to get to the bottom of the severe and specific phobia I had by writing about it, I always hit a wall. I knew that something different had been there before, but I didn’t know what it was. This wall belonged to what I called my “empty space.” In the words of musical artist Eminem, “I can’t tell you what it really is / I can only tell you what it feels like.”7 Given this awareness, then, why would a trauma survivor have such a difficult time putting together the story of a traumatic experience from the story of the illness experience fashioned from it?

Plant_February 2017
A thorny plant “monster” in Monteverde, Costa Rica. Taken February 2017.

Trauma fragments our stories, as it fragments our selves. This is the (subconscious) sacrifice one makes in exchange for enrollment in the subconscious mind’s “survivor protection program.” In order for the subconscious mind to keep the traumatic parts of a story locked inside the box, it must keep the part of oneself that remembers those parts locked inside it too. The part of oneself outside the box is by no means free, however, compelled to do the bidding of the monster outside the box in what I call the “cover-up” story for the monster on the other side–what I call the “covered-up” story. Trauma survivors are caught between a rock and a hard place, torn between the part of themselves that wants to escape the monster outside the box, and the part of themselves that doesn’t want to release the monster it keeps locked away.

Eminem captures the ambivalence we can feel toward our monsters in the aptly-titled song “The Monster” as he raps: “I need an interventionist / To intervene between me and this monster / And save me from myself and all this conflict / ‘Cause the very thing that I love’s killing me / And I can’t conquer it.”8 Though a few lines later Eminem mentions his obsessive compulsive disorder (“my OCD is conkin’ me in the head”8), the monster he raps about most frequently is another “hard Vicodin to swallow:”9 drug addiction. But what about the monster inside Eminem’s box?

Cage_September 2009
“And I just can’t keep living this way / So starting today / I’m breaking out of this cage.”10 An empty cage at a zoo in Colorado Springs, CO. Taken September 2009.

It turns out that Eminem can tell us “what it really is,”7 and he does, but first he had to listen to the monsters outside his box: “to exercise these demons.”10 In other words, Eminem dug deeper to expose the trauma underlying the demons in his conscious mind, no matter how much worse it made them (“These muh’f^ckers are doin’ jumpin’ jacks now”10). As he puts it: “I guess I had to / Go to that place / To get to this one.”10

This place, for Eminem, exists “after the methadone,”9 an opioid used to prevent withdrawal when tapering off addictive drugs in the same class, such as heroin. But it was performing his music in spite of fear that got him there: “You can try and read my lyrics off of this paper before I lay ’em / But you won’t take the sting out these words before I say ’em.”10

If you need someone to help you dredge up repressed anger in order to uncover your “covered-up” story, Eminem’s your man. As you may have guessed, the nature of the traumatic memories hidden in his subconscious mind aligns with a theme of the core experiences related to the Rèn Mài: “mommy issues.”

Lab equipment_September 2011
Poison, medicine, or both? Lab equipment at a clinic in Aligarh, India. Ambivalence toward illness may indicate a subconscious protective function. Taken September 2011.

Eminem’s “mommy issues” even cross generations, from “mama trauma” with his own mother to “baby mama drama”11 with the mother of his children (his “baby mama”). We could read more of his lyrics to prove it (“B!tch do your song, keep telling yourself that you was a mom!”12), or we could just look at a photo of Eminem without a shirt on. There, smack dab on Eminem’s bellybutton–one of the acupuncture points on the Rèn Mài–is a tattoo. And although the location is evidence enough, what it depicts leaves little room for doubt about why Eminem put it there: tattooed on Eminem’s bellybutton is a tombstone, with his ex-wife’s name on it, above the words “ROT IN PIECES.”

This is not to say that everyone who becomes addicted to drugs has “mommy issues,” nor that everyone who has “mommy issues” will become addicted to drugs (and get a bellybutton tattoo). Effects of traumatic experiences are as layered and complex as the traumatic experiences themselves. “Mommy issues” and “trust issues,” two themes of the core experiences pertaining to the Rèn Mài, are umbrella terms. There is a whole spectrum of “mommy issues” for the whole spectrum of “mommy’s issues.” I have seen the detrimental effects of “helicopter” moms who watch over their child’s every breath, narcissistic moms who are hyper-critical of their child, complacent moms who don’t notice that their child has fallen prematurely into a maternal role for someone else in the household, and nearly or entirely absent moms who leave their child in charge of filling the gaps–any of whom could be “well-meaning” moms. “Trust issues” also exist on a spectrum. “Mommy issues” can result in “trust issues.” So too can divorce, adverse sexual encounters, and daddy issues (although that’s a topic for a different acupuncture channel). The list goes on.

Pool_February 2017
A pool in Manuel Antonio, Costa Rica. Taken February 2017.

Nevertheless, similar types of traumatic experiences do tend to manifest in similar illnesses across individuals who have something else in common: their sociocultural context. Paraphrasing medical historian Edward Shorter, Ethan Watters writes that the subconscious mind attempts “to speak in a language of…distress that will be understood in its time.”13(p32) While the subconscious mind may consider genetic predispositions when selecting an illness to tell the story of a traumatic experience, what matters more in this decision than the fish in one’s gene pool is those in a society’s “illness pool.” The “illness pool” contains the illnesses available to the subconscious mind as expressions of distress based on social conditions. For example, the prevalence of anorexia nervosa, whose core feature is compulsive restrictive eating (as opposed to dieting), increases in times of food security, when industrialization and urbanization (as opposed to “Westernization”) allow an economy to flourish, and decreases in times of food scarcity, such as economic depressions brought on by war or stock market crashes.14 In other words, the subconscious mind is more likely to gravitate toward starvation as a symbol of distress in one’s individual “experience pool” when it is not already serving this purpose in the “experience pool” of society at large.

But the subconscious mind’s creation of a “cover-up” story doesn’t end there. Illness to express the story of a traumatic experience is best thought of as a prototype. The subconscious mind may select the prototype for arthritis or anxiety from the “illness pool” (and perhaps one’s gene pool as well), but the specific symptoms adopted for this prototype come from a culture’s “symptom pool.”13,15 The “symptom pool” contains the symptoms of an illness that have cultural relevance–that make sense within a given cultural climate. For example, while the fear of feeling fat comprises one of the main symptoms of anorexia nervosa in the United States, where body size is seen as indirectly proportional to morality and control, in Hong Kong a more likely presentation–prior to the influence of media reports on the American version of the illness–involved a sensation of stomach bloating.15

Pool_July 2018
A pool (and my foot beside it) in Irvine, CA. Taken July 2018.

For the subconscious mind, choosing an illness to express the story of a traumatic experience is a delicate balancing act. If the illness the subconscious mind chooses aligns with the story of a traumatic experience at the top of one’s “experience pool,” but social conditions have pushed it to the bottom of the “illness pool,” the subconscious mind’s message may be lost in translation. In another nightmarish scenario, the illness may go entirely unrecognized if the cultural climate has pushed the symptoms the subconscious mind has chosen to the bottom of the “symptom pool.” As Watters points out, “those who minister to the…ill–doctors or shamans or priests–inadvertently help to select which symptoms” in a given era “will be recognized as legitimate.”15 I would even go one step further and say that these gatekeepers of the “symptom pool” also inadvertently help to select which traumatic experiences will be recognized as legitimate. When healthcare professionals dismiss trauma survivors’ symptoms, even if neither party is aware of the symptoms’ origin, the message is that the trauma survivors are making something out of nothing with the trauma they survived too.

While Eminem illustrates that Rèn Mài pathology can present as drug addiction, according to Welch it can also take the form of codependency disorders, such as feeling incomplete without a partner even or especially if that person is toxic for someone; valve or sphincter disorders, in which these “doors” of the body selectively become stuck open or closed; and eating disorders, including anorexia nervosa (mentioned above), bulimia nervosa, and binge eating disorder.6

Speaking of eating, that was a lot to digest. Allow me to take a page from the subconscious mind’s trauma avoidance manual and distract you with a different sort of headache: migraines.

Daith Piercings for Migraines: Fact or Fiction?

Daith piercings are located on the part of the ear called the helix crus. Helix comes from the Latin for “spiral,” and crus from the Latin for “leg.” The helix is the rim of cartilage that curves from the outer border of the lobe to the root, the upper attachment of the ear to the head. Its crus is the leg-like projection that continues toward the center of the ear, forming the beginning of a spiral.

Daith piercings are located on the part of the ear called the helix crus, indicated by the red circle. Adapted from reference 1.

Recall that the ear is a microsystem, meaning that it can be seen as a map of the body as a whole. Each part of the ear therefore corresponds to a specific part of the body. Daith piercings gained popularity due to a social media claim that they stimulated an acupuncture point for migraines, which is true–for a certain type of migraine.

One reason why daith piercings bring pain relief to some migraine sufferers but not others is that not all migraines are created equal. In microsystems theory, the helix crus corresponds to the digestive tract. It is therefore most effective for treating migraines when they are related to digestion.

If you’re thinking that migraines come from the brain, and not the belly, it is probably because you aren’t thinking that they could possibly come from both–you are probably not thinking of the brain in the belly.

Science discovered the enteric nervous system, the web of neurons lining the gastrointestinal tract, as much as Christopher Columbus discovered what are now the Americas (and were then already home to many native peoples). Once upon a time it was the cognitive abilities of the head that remained uncharted waters, while the center of the self was quite literally in the center of the self. (Columbus, on the other hand, was merely self-centered.)

But don’t take my word for it; take the words Philip Shepherd draws upon to chronicle the migration of the seat of thinking from the belly to the head.16 In the Indo-European roots of the English language, the word for “navel” formed the basis of that for the “hub” or “center” of a wheel, aligning with the Neolithic-era understanding that the center of the self resided in the belly.16 This began to change with the Neolithic Revolution, underway in most of Europe by 6,000 BCE, when widespread control of the environment through agricultural practices involving the domestication of plants and animals contributed to the belief that the self could be controlled as well.16 As a result, the seat of thinking started to move upwards. By 700 BCE, Homer’s poetry shows, the seat of thinking had reached the “diaphragm,” his word for which also translates as “mind.”16 Finally, Plato’s writings circa 350 BCE locate the seat of thinking in the head, referring to the body as a vehicle or machine, which has served as the prevailing metaphor ever since.16

Corn_September 2011
Corn in a rural village near Jaipur, India. The widespread transition from hunting and gathering to agriculture during the Neolithic Revolution played a role in the belief that the self had a control center, and that it was located in the head. Taken September 2011.

If you’ve ever had to rely on your “gut instincts,” you know that the brain in the head is not always in charge. The brain in the belly can be a lifesaver, but it can also be a pain in the you-know-what. (Hint: don’t let all of that Eminem profanity get into your head.)

Only some digestion-related migraines affect the head, however. While migraines due to food allergy frequently cause pain in the front of the head, along the acupuncture channel pertaining to the Stomach, the main symptom of abdominal migraines, Jyoti Mani and Shailender Madani report, is actually tummy ache–abdominal migraines are a common cause of abdominal pain in children.17 (For an explanation of the difference between the Stomach with an initial capital letter and the stomach with an initial lowercase letter, see my blog post “The Tongue, Untied.”) Additional symptoms of abdominal migraine can include headache, nausea, vomiting, and lack of appetite.17

According to one set of diagnostic criteria, abdominal migraines classify as functional gastrointestinal disorders.17 “Functional” disorders are conditions that elicit no abnormal findings upon examination, or “signs.” The sole evidence of their existence is therefore the patient’s report of what is going on, or “symptoms.” Unfortunately, in the “seeing is believing” world of diagnostic imaging and other tests, this means that functional disorders are often assumed to be “all in one’s head”–a figment of the patient’s imagination.

Chinese medicine, on the other hand, views functional disorders in quite a different light. First of all, signs do not take such forms as lab results, but present through the maps provided by the body’s surface–maps that do not fit into conventional medicine’s understanding of the body as a machine. For example, a patient with abdominal pain may have tenderness on an acupuncture point associated with the Stomach, or an abnormal appearance of the central region of the tongue. (The tongue, like the ear, is a microsystem: the center of the tongue corresponds to the center of the body.)

The Chinese character for shén, often translated as “mind,” consists of two parts. The left-hand part represents the sun, the moon, and the stars, the material manifestations of the immaterial–light. The right-hand part means “to extend.”

Secondly, functional disorders are seen as red flags–not of made-up symptoms that exist in one’s mind as understood to mean imagination, but of very real symptoms affecting body and mind. In contrast to conventional medicine, Chinese medicine does not view the body as separate from–a mere container for–the mind. In Chinese medicine, body and mind are one in the sense that they are two manifestations of the same component: qì. Qì (pronounced “chee”) does not have a direct translation into English. The Chinese character for qì consists of two parts: the top part means vapor, steam, or gas and represents the immaterial, while the bottom part means uncooked rice and represents the material.18 Qì gives rise to the material when it condenses, and the immaterial when it disperses.19 The body provides an example of the former, and the mind of the latter. As evidence of this, the Chinese character for shén, which describes each of the five named mental aspects individually and the complex of these mental aspects as a whole, paints the mind as “an immaterial quality that ‘extends’” toward others.19 The mind manifests in the material (i.e. the body), but its material manifestation can only be detected in the context of a system that recognizes the mutual influence of body and mind.

Just because the test results for a patient with abdominal pain come back normal, doesn’t mean that there is nothing wrong with the patient’s body–or that the only thing wrong with the patient’s mind is an overactive imagination. If I palpated this hypothetical patient’s abdomen, I would not do so to determine if the pain exists, but where it does–that is, which acupuncture channel(s) it affects. There is no question as to whether it exists, because people do not make up symptoms for the fun of it, and there is no question as to whether it exists in the body or the mind, because there is no distinction between the two. There is only one acupuncture channel for each internal organ–not one for its physical aspect and another for its mental aspect. Body and mind are inseparable from, and mutually dependent on, one another.

Ficus tree_February 2017
What lurks within? A strangler fig tree in Monteverde, Costa Rica. This tree may look harmless, but it actually “strangles” other trees to death. Similarly, functional disorders cause harm despite eliciting no abnormal findings upon examination. Taken February 2017.

While the helix crus corresponds to the digestive tract as a whole, daith piercings typically go through the part of the helix crus that corresponds to the mouth and the large intestine–the beginning and end of the digestive tract, respectively. The Large Intestine influences our capacity to “let go”–of waste products from food, but also from experiences. Traumatic experiences, however, often won’t let go of us, the story of our struggle to understand them told through the havoc they wreak on our bodies and minds–through illness. Only by telling our illness stories in our own way–perhaps with our own mouths–can we have any hope of uncovering the stories of the trauma we experienced, so that we no longer need our illnesses to tell our “covered-up” stories for us.

The message of distress that abdominal migraines convey may be this basic, reflecting an early stage of traumatic experience processing. This could explain the higher incidence of abdominal migraines among children, given the more limited understanding of the world in this early stage of development. As this understanding increases over time, however, the monster outside the box may become more specific. Alternatively, focusing on the “cover-up” story in the conscious mind without engaging the subconscious mind may bury the “covered-up” story even deeper, resulting in a monster that is more difficult to decode.

Monkey_September 2011
A monkey in Old Delhi, India. The subconscious mind can jump like a monkey from one illness to another in trying to tell the story of a traumatic experience. Taken September 2011.

The name for functional disorders consisting of symptoms recognized as neurological–conversion disorders–hints at the subconscious process by which the story of a traumatic experience becomes converted into the story of an illness.3 These disorders are also aptly named because of their own tendency to convert into other disorders, as a person’s subconscious understanding of a traumatic experience changes over time based on how the world (mis)reads it. If only conventional medicine would recognize that functional disorders affecting other bodily systems as well may also behave in this way–that digestive disorders, for example, can be neurological disorders too. After all, the nervous system connects the entire body, and therefore serves as a messaging network that may very well be a missing link in the pathogenesis, or development, of functional disorders. As for the etiology, or cause–well, that’s a different story: traumatic experiences belong on the list of risk factors for essentially any disorder.

And now, what you’ve all been waiting for: a treatise on the highly stigmatized, and highly misunderstood, lower-back tattoo.

“Tramp Stamps” and the Blame Game

A “tramp stamp” is a derogatory term for a woman’s lower-back tattoo. The name stems from this particular tattoo’s erotic (or eroticized) location just above the buttocks; a “tramp” is a derogatory term for a promiscuous–or allegedly promiscuous–woman.

The acupuncture channel that passes through “tramp stamp” territory is called the Girdle Vessel, or Dài Mài (pronounced “dye my”). A girdle is like a corset but sits slightly lower, extending from the waist to the hips. The Dài Mài is named after a girdle because both wrap around the waist and have a primary function of confinement. While a girdle confines fat, the Dài Mài leads acupuncture channels like the Rèn Mài of “mommy issues” past in serving as a reservoir to absorb inundation from emotions, thoughts, and memories in the wake of a traumatic experience.6 Its specialty, however, is taking on the surplus of two emotions in particular: guilt and shame.

Dài Mài
The Dài Mài (external pathway, solid red line) wraps around the waist like a girdle. Its three acupuncture points (red dots) are located symmetrically on each side of the lower abdomen. Adapted from reference 4.

This complicates the stereotype that women with “tramp stamps” have no shame about seeking sexual attention, with their lower-back tattoos or otherwise. Rather, it suggests that this behavior may also bring them guilt, and may have developed as a “cover-up” story for a traumatic experience that resulted in guilt first.

Guilt and shame occur when one feels judged in a negative light, by oneself in the case of guilt and by others in the case of shame. In other words, shame requires an external witness whereas guilt does not.

Shame serves as a sort of social checks and balances system when someone who commits wrongdoing appears not to feel guilty about it by not taking accountability. However, this system can break down when those who experience or witness the wrongdoing of others are afraid to address it. (For examples of reasons driving this fear, see my blog post “The Eighth Emotion.”) As a result, anger, a natural reaction to having experienced wrongdoing, can turn inward and cause survivors of interpersonal injustices to feel guilty instead of feeling angry with whomever wronged them.20 Without awareness of their anger toward the wrongdoer(s), survivors perceive the guilt as stemming from the traumatic experience that preceded it, misconstruing the wrongdoing as their own.

For example, survivors of abuse may blame themselves for employing one survival instinct in the fight-flight-freeze triad over another, even though these reactions originate in the autonomic nervous system, and are, by definition, subconscious–out of one’s control. The resulting “cover-up” stories in their uppermost reaches (trauma-derived symptoms) rehash this deeper down “cover-up” story, from guilt about one’s own behavior to the belief that one can make it right. Any relief gained in the plot of the “cover-up” story, however, is only temporary. Seeking sexual attention, for example, may bring feelings of self-worth, but these soon give way to guilt (and shame, if the behavior or its aftermath–the “walk of shame”–occurs publicly).

Bird eggs_July 2010
Chicken or egg? A bird’s nest in a cabin window in Divide, CO. Emotional distress both precedes and follows symptoms that derive from a traumatic experience, but often we are only aware of it as a consequence of our symptoms. Taken July 2010.

Ultimately, what survivors are looking for–subconsciously–is reassurance that they aren’t to blame for the traumatic experience driving the behavior. This provides one reason why survivors continue to do the behaviors that the monsters tell them to do, despite knowing from experience that the monsters’ promises don’t last. Additionally, it helps explain why survivors whose abusive behavior targets others instead of or in addition to themselves, may not take accountability when it comes time to face the music. Musical artist R. Kelly, for example, has pled “not guilty” to the charges of sexual abuse against him, and has also revealed that he previously survived sexual abuse himself. Unfortunately for R. Kelly, the abuse one survives in a “covered-up” story explains but does not excuse the abuse one perpetrates in a “cover-up” story. Though one of R. Kelly’s lyrics warns not to “shoot the messenger,”21 echoed by one of Eminem’s lyrics,8 that is precisely how the criminal “justice” system works in these cases. As long as the “cover-up” story is the “cover” story, the “covered-up” story is not. Perhaps this constitutes another reason why those of us with chronic illness regularly make a deal with the devil, so that the monsters outside our boxes protect us from the monsters inside–even if they turn us into monsters ourselves.

Of course, because body and mind are interconnected, guilt and shame can have physical consequences as well. Welch points out that Dài Mài issues may manifest in infertility or, in females, excessive vaginal discharge.6 Both conditions can be consequences of sexually transmitted infections and may derive from guilt and shame, as those who do not value themselves are less likely to practice safe sex because they are less likely to care how their behavior may negatively affect them.

Mandible_October 2009
A jawbone of one creature or another in Laramie, WY. Taken October 2009.

However, not all Dài Mài issues affect reproductive organ function or are mediated by sexual behavior. According to Welch, Dài Mài issues may also present as neuropathy (pain from nerve damage) in the lower limbs.6 While the only one of my patients who sought treatment for shame also had genital herpes, another patient whose Dài Mài I needled sought treatment for a grab bag of issues with no obvious reproductive or sexual connection, from digestive sensitivity to binge drinking to low back pain.

I treated this patient–we’ll call him “Sky”–once a week for over a year. Every week Sky’s illness narrative had a similar cast of characters, though every once in a while the protagonist–the monster causing him the most distress–changed. Feeling like I was causing more harm than good, I decided to quite literally take a stab at the acupuncture channel that Welch describes as a good place to go when other treatments are not working: the Dài Mài.6

While the Dài Mài wraps around the waist, its only three acupuncture points are located symmetrically on the lower abdomen. Two pairs of these acupuncture points looked different on Sky, however, than they did on anyone else I had seen them on before: they were covered in tattoo ink.

Lock_September 2011
A lock on a door in a rural village near Udaipur, India. Acupuncture can unlock the box of traumatic memories in our subconscious mind by calming the monster outside it, but the monster inside the box may or may not enter our awareness. Taken September 2011.

It was as if Sky knew where the Dài Mài traveled without even knowing what it was. Though it took a while to sink in, I finally put together that my prior treatments for Sky had been working. Over and over again, they had unlocked the box in Sky’s subconscious mind by calming one monster outside it, but the monster inside the box stayed put, or didn’t enter Sky’s awareness for long, because another monster reared its ugly head–and locked the box back up again.

About a year after I stopped treating Sky because I moved away, I passed through his neck of the woods while taking some time off to confront my own demons and went for a hike with him. When he told me he had some exciting news, I couldn’t help but hope what it was. Had Sky done some soul-searching inspired by all of that acupuncture on his Dài Mài and uncovered his “covered-up” story?

It wouldn’t be the first time someone I’ve treated shared a “covered-up” story with me. I was needling an acupuncture point on a patient’s spine one time when all of a sudden the patient screamed in pain. When I asked him if he wanted the needle removed, he said it was okay. The pain of the needle, he realized, reflected the pain of the memory it brought to the surface: as the needle traveled deeper into his flesh, my patient unexpectedly thought about the sexual abuse he had survived in his youth. He also volunteered that the person responsible for the sexual abuse was male. This is significant because, though my patient didn’t know it, the acupuncture channel I was needling is called the Governing Vessel, or Dū Mài (pronounced “doo my”), and is associated with issues of masculinity. (Remember when I said that daddy issues pertain to a different acupuncture channel than the Rèn Mài? Well, the Dū Mài is the one!)

Drawing from this experience, I prepared myself to thank Sky for sharing his story with me and to praise him for having the courage to get to the bottom of his “cover-up” story. But what Sky was excited to tell me was not a story of a traumatic experience he had uncovered; it was a new diagnosis he had received. Sky was excited because he thought he finally had an explanation for his chronic pain and fatigue, but he didn’t. He had a new name for an old “cover-up” story.

Door_October 2011
An unhinged door at The Beatles Ashram in Rishikesh, India. The way out of a “cover-up” story isn’t always what it seems. Taken October 2011.

On some level, Sky knows that the trauma he experienced in childhood–whatever that may be–is the reason for the demons he has faced since. Before I moved away, I put forth this theory in the letter I wrote on Sky’s behalf to support his disability claim. Citing the growing body of research on the negative impact of “adverse childhood experiences” into adulthood, I argued that Sky’s health issues are the sequelae of childhood trauma, and that processing that trauma is a full-time job. When I asked Sky about the letter, he said it was spot-on.

Sometimes Sky’s brief descriptions of the reactions he experienced while he was literally pinned down during treatment–such as sensations, emotions, thoughts, and memories–made me feel like if he just stayed with these reactions a little longer, recorded them somehow, then he could put them together as pieces of his “covered-up” story. This led me to recommend to Sky that he write down his reactions in a journal or express them in whatever medium resonated with him most so that he could keep track of them and identify patterns, but he was hesitant. Later Sky said he had tried, but it had made him even more uncomfortable. I wish I had had the terminology I have now, so that I could have explained to Sky why that discomfort is par for the course. No one is ever ready to dig deeper, but all it takes is to be ready enough.

House_March 2017
The house where I lived in Eugene, OR. You may not ever exorcise your demons, but you can keep them from setting the rules in your own “house.” Taken March 2017.

Admittedly, the letter I wrote on Sky’s behalf was not only descriptive; it was also prescriptive. Processing childhood trauma is a full-time job, but Sky was doing only part of the work. While engaging in mind-body interventions such as acupuncture that activate both the conscious and subconscious divisions of the mind takes a tremendous amount of trust and therefore courage for trauma survivors, it is only the first step. One way or another, the story has to come out. It may not exorcise the demons, but it will make it so that they don’t keep setting the rules in one’s own “house.”

The Dài Mài is like the Pandora’s box of acupuncture channels.5,6 The story of Pandora’s box comes from Greek mythology. In the story, Pandora is given a box to watch over. When Pandora opens the box, the various evils it had contained spread across the world. By the time Pandora closes the box, only one thing remains inside: hope.

Conclusion: The Meaning of Recovery

Sky’s story brings me sadness, but it also gives me hope–that one day he will put his “covered-up” story back in its rightful place: at the beginning of his “cover-up” story. It is a hope I have for all “covert” trauma survivors, as I call them–for those like Sky whose symptoms of post-traumatic stress disorder (PTSD) go unnoticed because they manifest in an entirely different disorder that appears, on the surface, completely unrelated to the trauma, but is actually both expressing and suppressing it.

Leaf_February 2017
Holes in a leaf in Monteverde, Costa Rica. Acupuncture needles can poke holes in our “cover-up” stories like they poke holes in our bodies. Taken February 2017.

The dismissal of people with “covert ” PTSD, as I call it, is not new. All that has changed is the name. In Freud’s time, it was called hysteria. Before that, it was called hypochondria. And now, it is called functional or psychosomatic illness. Anyone with a “functional” illness will attest, however, that there is really nothing “functional” about it. “Psychosomatic illness” has the potential to be a less inept moniker–“psychosomatic” simply means “pertaining to the relation between mind and body”–except that “mind” in this case is typically assumed to mean “imagination.” These terms therefore contribute to keeping “covert” trauma hidden as a potential cause of illness.

And yet, “covert” PTSD is everywhere these days, even in the White House. It can manifest in nearly any disorder, from narcissistic personality disorder (the greatest disorder there ever was, really trumps them all) to a new expression of distress that I believe has entered the American “illness pool,” “mass shooting disorder.” I do not believe that there is necessarily any underlying mental illness afflicting the mass shooters who have taken so many lives in this country, although there may be co-occurring or “comorbid” ones. Rather, I believe that “mass shooting disorder” is the illness, and what underlies it is “covert” trauma. It is an extreme, tragic example of the “cover-up” stories the monsters spin to keep our “covered-up” stories from entering our awareness. Seeking justice by taking down strangers is the ultimate “cover-up” story for the hard truth that those closest to us are often the ones who hurt us the most.

Our “cover-up” stories can become other people’s “covered-up” stories if we don’t do the work to address our own “covered-up” stories. Nowhere is this more obvious right now than in the political sphere, where allegations of crafting “cover-up” stories plague both sides of the aisle. According to the left, the right’s claim that mass shootings are a mental health issue is a “cover-up” story; according to the right, the “cover-up” story is the left’s claim that mass shootings are a gun issue. How do we reconcile these stories?

Ants_October 2011
Ants in Rishikesh, India, showing that non-human animals have society too. We cannot view personal ills and social ills as separate. Taken October 2011.

I believe that the truth is not so black and white. I believe that each story points out an influence in the subconscious mind’s development of a “cover-up” story, but on a different level: the right’s position focuses on the individual, the left’s on the social. While social ills, such as relatively unrestricted access to guns, determine which personal ills float to the top of a society’s “illness pool,” the trauma an individual experiences determines which of these socially relevant personal ills the subconscious mind selects as the simultaneous expression and suppression of that trauma. To have any hope of ending mass shootings, we must address the stories on both levels. Before joining a movement we believe in, we must analyze where our beliefs come from. This is the only way to know if our stance on gun rights, abortion, border (in)security, or any other “political” issue is another “cover-up” story derived from our personal issues, our “covered-up” stories. We must each dig deeper, together.

I believe that it’s uncomfortable to embrace the gray area, and I believe that it’s absolutely essential. I believe that Supreme Court Justice Brett Kavanaugh harmed Christine Blasey Ford as a teenager, and I believe that he was so caught up in his own story that he didn’t even consider what it was like for someone else directly involved in it–or that the part of himself that did consider this but proceeded to harm her anyway is buried in his subconscious mind. I believe that the denial of the wrongdoing one causes, intentionally or not, is cowardly, immature, and unjust. It is a sad comment on this country when people who commit wrongdoing can become Supreme Court justices because they believe that not intending to cause harm is the same as not causing it, when having this belief is the same as not knowing the difference between right and wrong.

Great Wall of India_October 2011
The Great Wall of India in Jaipur, India. It’s a long way down to the bottom of your “cover-up” story, but don’t let that stop you from digging deeper. Taken October 2011.

Please, hear my cry: do the work–all of it–when you are ready enough. When the monsters outside your box get bad enough, find a mind-body therapy that resonates with you, and a practitioner of it whom you can trust, and tell that person about your monsters–the knee pain, allergies, depression–at the forefront of your mind. If the monsters back down, your work may be done: there may be no monsters inside your box. But if they come back, or awaken a different beast, your work may be just beginning.

As you are looking for and eventually building this relationship, find a form of expression that resonates with you, and transform the reactions you experience during your mind-body therapy session–sensations, emotions, thoughts, memories–into art. If you are not satisfied with what you create, remember that it doesn’t have to be good. Doing it is good enough.

These rituals are a starting point, a way to fit the pieces of your “covered-up” story into the puzzle. As your understanding of the link between your “covered-up” story and your “cover-up” story increases, you will likely have to develop more rituals that are specific to each. At their core, our monsters are compulsions: irresistible crutches we lean on for a sense of control. While compulsions and rituals are both structured, repetitive acts to manage stress brought on by chaotic, unpredictable circumstances, compulsions often create stress as well.22 Compulsions seem sacred because they feel like they come from a higher power that promises a future free of discomfort, but they actually come from and recycle the profane–the very trauma of the past we are trying to escape.22 We do not choose our compulsions, but we do choose our rituals. This choice fosters the power and control we trauma survivors crave, the power and control that were stripped from us when we survived whatever trauma we survived, not the power and control our monsters make us think we have over them when really it is the other way around. Ritual, as a sacred act, is the antidote to compulsion.

Joshua Tree National Park_March 2019
A desert in bloom near Palm Springs, CA. Flowers can survive in even the harshest climates. Taken March 2019.

Tell your stories–all of them. Just as there are layers to our “cover-up” stories, there are layers to our “covered-up” stories too. The upper layers of a “covered-up” story draw from similar scripts–that it wasn’t that bad, that it was your fault, that whomever hurt you didn’t mean to, that it was a kind of justice because whomever hurt you was hurt by someone else first–but these too are “cover-up” stories. These too belong to the monsters, but you can’t realize this until you tell them for yourself. You can’t realize that you do not belong to the monsters–that the demons don’t possess you–until you tell their stories. Some people you tell might not be able to tell the difference–they will tell you, like a therapist once told my mom, to “get over it” rather than to dig deeper–and at first, you will probably believe them. But when experiences like this trigger the monsters outside your box, you will not dodge the bullet forever; when you are ready enough, you will bite it. You will put yourself back out there again because you are a survivor, now, as you were a survivor, then.

Tell your story–all of it–and then tell it again. Telling your story–from cover to cover, “covered-up” story to “cover-up” story–is a ritual. It is something we must repeat over and over again, whenever an experience triggers us, to put the current threat in perspective by checking it against the traumatic threat we faced in the past. The only way to expose a “cover-up” story for what it is, is to remind ourselves of the “covered-up” story that caused it.

Porch_February 2017
A perfect place to take in the sunrise and set one’s intention for the day in Monteverde, Costa Rica. Rituals don’t have to be complicated. Taken February 2017.

Saying that I took time off to confront my demons is somewhat misleading. I worked harder during this time off than I have ever worked. I had acupuncture at least once a week and acupressure from someone trained in body-centered psychotherapy every other week; I journaled after every treatment; and I listened to A LOT of the great poet himself, Eminem–all while the monsters outside the box in my subconscious mind were as loud as they’d ever been. While I had the privilege to afford to take time off thanks to financial support from family, I also couldn’t afford not to if I was going to learn to live with my demons instead of continuing to “play alive” or, worse, to listen to the demons trying to take my life. Privilege makes a difference in the resources we have to combat the effects of trauma, as long as the “systems” in this country value some lives over others, but it does not protect us from trauma or its effects. Trauma and “covert” PTSD can affect anyone. Just because you are shielded from trauma–your own or someone else’s–doesn’t mean that it didn’t happen, or that it isn’t happening. Just because you don’t see or feel the effects of a pandemic, or don’t fear for your life when a police officer pulls you over, doesn’t mean that these are “cover-up” stories–although it could very well mean that you have a “covered-up” story of your own.

Tell your story. If you are afraid of the hurt you may cause in the process, ask yourself whom else you are hurting by not telling it: your partner, your children, the random person who accidentally cut you off in traffic, yourself. Ask yourself if these people really deserve to bear the brunt of your reactions to the “offense” they committed against you, or if these reactions are more proportional to an earlier offense committed against you by someone else.

Tell your story in spite of fear, but not out of spite. You are in charge of what you say and how you say it. Tell your story, but if you have to, as Emily Dickinson writes, “tell it slant.”23

Road_October 2009
A road in Laramie, WY. “We’ll walk this road together, through the storm / Whatever weather, cold or warm / Just letting you know that, you’re not alone / Holla if you feel like you’ve been down the same road.”10 Taken October 2009.

The term “recovery” implies something that was covered up before. Recovery is a ritual, a constant uncovering to counteract the subconscious re-covering-up that will occur to “protect” us, time and time again. When I was a senior in college, I had some work done on the tattoos I had gotten three summers prior (and had loved ever since) and became convinced that they were the reason for the uptick in self-loathing I was experiencing. I thought about getting cover-up tattoos and looked into laser tattoo removal, but neither of those options felt right. What I really wanted, or so I thought, was to never have even gotten tattoos. In retrospect, hating the tattoos on my body was a “cover-up” story for hating the (subconscious) reason why I put them there–right on top of the acupuncture channel where the type of trauma I experienced as a child is stored. At the time, I felt so exposed but didn’t understand why. Now I wear my tattoos as a badge of honor, a reminder of the trauma I survived. Sure, they’re not perfect, but neither is trauma. It is messy. It is hard to articulate. And it is part of me, forever.

When strangers ask me what my tattoos mean, I tell a “cover-up” story. It isn’t wrong, but it isn’t the whole truth, either. They don’t need to know the whole truth–I do.

Tell your story, and if no one will listen, if no one understands, that’s okay. You are the only person who needs to hear it.


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