From Hierarchy to Harmony: The Necessity for Community Led Organizing in Holistic Health & Medicine

Buddhas encircle a central figure in a lotus pattern, embodying harmony and unity on the cover of Inside Yoga Magazine.

This article was originally published in Inside Yoga (Issue No. 1), a first of its kind trade magazine for yoga professionals.

The fields of Yoga Therapy and Ayurveda are at a critical juncture in their professional development here within the Capitalistic paradigms we have ourselves enmeshed within across North America; of which extends to nearly all of the holistic health and medicine professions at present. The intersection we have arrived at is a deeply complex amalgamation of socio-political and economic matters all pertaining to hierarchy, who holds positions of power and authority, and who has access to the necessary resources enabling them to gain both personal and professional mobility in life, if they so desire.

These interweaving struggles are ubiquitous at both macro and micro levels within society; from the American government’s perpetual imperial/colonial war machine to the technocratic billionaires all vying for unceasing power, to the smaller hierarchies that happen within universities, medical centers, professional organizations, and beyond.

Truthfully, many of us, having grown up within these Western hierarchies have gone years or maybe even decades of our life completely unaware that they even exist; let alone acknowledging the reality that we collectively have the power to change them.

Hierarchies of Harm Overview

When discussing both hierarchy and harm, it is important to deliberately name what is happening within the microcosm of holistic health and medicine of which is simultaneously occurring across the greater macrocosm of Western society.

In a recently published article entitled Hierarchies of Harm in Holistic Health & Medicine, I extensively addressed the history of medicine within North America, how that history has influenced present-day progress within holistic health and medicine, and alternative pathways for us to build more equitable, egalitarian, non-hierarchical, and community led professional organizations across the fields of Yoga Therapy, Ayurveda, Acupuncture/Chinese Medicine, Naturopathic Medicine, and Chiropractic.

Being at the intersection of most of these professions within my own professional life, I have been witnessing these hierarchies over the last two decades of my career in holistic health.

My own awareness of this was heightened throughout the duration of naturopathic medical school where I became enmeshed in a system that essentially forces medical students into a four-to-six-year educational hazing. From the rigorous scheduling to the endless lectures, studying, and sleepless nights, to the narcissistic abuse and psychological power plays inflicted upon students by those in positions of leadership; hierarchy and authority is rampant in medical education whether holistic or conventional.

As I processed these experiences over time, I began recognizing that these pervasive hierarchies are intentional structural mechanisms built into the fabric of the Western world that have conditioned the masses from childhood to unconsciously submit to authority, even in liberatory spaces like yoga and holistic healing.

What I’m pointing to here is that through societal conditioning, our individual and collective sovereignty has been eroded and chipped away at slowly over many years so that authority can be concentrated and dissent discouraged. Ultimately, through this process we've come to believe that power must flow downward rather than outward.

It is this same conditioning that has allowed Trump's fascist administration to rapidly accelerate their building of concentration camps across the United States and why Americans’ have largely done nothing about it. Collectively, we don't believe we hold any power.

So long as we maintain subservience politically, so too will this persist in many other facets of our lives.

I recognize many of us are exhausted, burnt-out, numb, and feeling gob smacked by the collective trauma of endless wars, famine, global epidemics, and the deterioration of human rights over the last six to seven years.  For many of us, these ongoing world events have facilitated a mass executive dysfunction often causing feelings of paralysis and overwhelm. However, if we maintain our current trajectories and do not start organizing in more non-hierarchical, community-led, and egalitarian ways, we will continue digging our collective grave because the fact remains, none of these hierarchies are sustainable for our collective well-being as a human species.

Given the existential nature of these concerns at the societal level, I personally believe there is a greater ethical imperative to facilitate change given our positionality as health professionals that have a holistic orientation which enables us to view the complexity of present-day issues expansively and from an interconnected lens.

With this framing, what specifically do these hierarchies of harm look like within holistic health and medicine and what pathways can we pursue to spread power horizontally across our professions?

Naming Hierarchies within Holistic Health & Medicine

Across our professions we must actively work to abolish and dismantle…

1. unchecked power and authority within our professional organizations and within our academic/training institutions.

2. the false pretense of progress without sincere transparency, accountability, and change.

3. roles which allow people to maintain lifelong careers in their position(s) of power.

4. the capacity for professional organizations or governing bodies to make decisions about the profession without the explicit consent of the diverse body of professionals of which they serve.

5. organizations that ignore the voices of the most marginalized within society.

6. harmful, abusive, and authoritarian behavior within our professional organizations, governing bodies, and educational institutions.

7. top-down hierarchical organizations that dictate the trajectory of our professions based on the consensus of a small group of leaders.

8. a singular rigidly enforced pathway for professionals to gain entrance to practice after completion of their training.

9. policies that allow students to take on massive debt with no infrastructure in place to build a viable career.

10. professional organizations and educational institutions that negate their responsibility of creating competently trained professionals with employable skills.

This may seem like a massive undertaking to re-write so many of the wrongs persisting within our professions, and it is, though with great awareness comes great responsibility.

It is my sincere hope that some aspect of this article awakens your inner power and resolve to contribute to much needed equitable change within the professions all of us have worked diligently to be a part of.

The time has come for us to stop relegating decision making powers to a select few within our professional organizations and governing bodies and engage with the unwavering fire of tapas (discipline) to mold our beloved professions into those that not only serve our needs as professionals’ but the needs of clients’ we care for.

So, how can we create non-hierarchical, egalitarian, community-led organizations that work for us?

Moving from Hierarchy to Harmony

When I speak of “harmony,” I would like to emphasize that I am not referring to the creation of some dystopian organization where everyone is agreeable and no one offers their unique perspectives and life experiences. Largely, this is what already exists and moving forward we need to be very intentional about not replicating all of the hierarchies of which I have outlined in this article.

Harmony in this context should be seen similarly to the work that all of us do which is creating the conditions for health within the lives of our clients; in other words, we help their mind, body, and spirit return to the natural state of balance that already exists within them. In this same fashion, we must work to bring our professions back into balance by working to build the conditions for successful and viable career pathways; this will not ever be accomplished by maintaining the existing status quo within our professions.

One very recent example of leadership failures within holistic health and medicine occurred this March when the National Advisory Committee on Institutional Quality and Integrity (NACIQI) recommended to the Department of Education in a unanimous vote of 12-0 to reject the renewal of accreditation for the Council on Naturopathic Medical Education (CNME), the programmatic accreditor of all of the naturopathic medical schools within North America. This sent shock waves across the profession. To the unassuming eye this is a major blow to the profession, but to those of us within the profession that are aware of the negligence of our leadership, this is welcome accountability.

A major part of my sincere hope in facilitating this dialogue within Yoga & Ayurveda specifically is that we can avoid some of the massive leadership failures occurring across Acupuncture/Chinese Medicine, Naturopathic Medicine, and Chiropractic by working to equitably distribute power and leadership across the profession through engaging as many of us as possible as we gather together to envision the future of our profession and its professional formation.

To do this we need far more participation than we currently have. This responsibility should not be placed on one singular individual, on a small group of people, or even on those who are perceived as leaders within our respective professions.

Our professions are the collective responsibility of all of us.

Building Non-Hierarchical, Egalitarian, & Community-Led Organizations

In order to shift from the current hierarchies embedded within holistic health and medicine, we must shift our professions from representative organizing to participatory organizing. The representative model of which is ubiquitous across our professions is one that involves a false sense of participation among its members.

This lack of participation shows up across the board in the following ways:

1. members vote in new leaders into various governing bodies then disengage thereafter; a participatory model requires that members engage in ongoing decision-making in a prolonged and sustainable way.

2. power and authority is centralized and concentrated to its elected officers rather than power being equitably distributed across the profession.

3. communication flowing from top-down rather than communication flowing horizontally via open forums and mass participation among professionals.

4. meetings within a representative organization are often passive rather than in participatory organizing where meetings are active through breakout groups, consent building, and deliberation across participating professionals.

   
   

To create viable career pathways, we must first start with how we organize.

We can begin by working to create participatory organizations that do not demand too much commitment of its membership upfront which is integral to our longevity; doing the work that many of us do, we understand that creating too much demand will breed overwhelm and burnout for everyone involved. Again, we must diligently work to avoid replicating harmful hierarchies.

Upon initially organizing egalitarian structures, there are several practices of which we can use to prevent too much demand including offering open working group sessions, feedback forums, and project-based pods that actively allow people to contribute without joining a board.

Onboarding into such a group should involve some level of education around participation; in this framework members should not only gain awareness of mission, vision, and history but on how to participate including how decisions are made, how to raise concerns or objections, and how to take on various roles including that of a facilitator.

In this vein, rotating facilitators after a period of time should be prioritized. This means that holding meetings in various groups involves rotation among participants by providing a very clear framework and template for facilitation; thus, this becomes a teachable and learnable skill rather than yet another position of power.

In designing our group gatherings, we should be mindful to share relevant information within the meeting itself rather than privileging those with extra time by having people prepare for upcoming meetings through reading documents or reports ahead of time. Valuing diverse participation styles is also important in building egalitarian groups as the skills that one person has may not be shared by others. For example, not everyone may be comfortable speaking in a meeting or participating in a lively debate; thus, there needs to be other channels for participation including written channels, small group forums, and asynchronous options which value behind-the-scenes participation equally to visible group facilitation.

Furthermore, roles within our groups should be defined collaboratively with clear responsibilities outlined, standards around decision-making, and term-limits that detail the duration of time-limited, non-permanent roles. Transparent documentation regarding all decisions, meeting minutes, budgets, and decision-making rationale should be openly accessible as transparency is the foundation of horizontal organizing and accountability. Beyond this, a pathway for communication between various working groups is essential to ensure the flow of information is multi-directional verses flowing in a unidirectional manner upward to leadership.

These confluence of ideas offer a powerful model for moving above and beyond our existing structures of power within holistic health and medicine which ultimately are no longer tenable if we wish to progress these professions forward into robust career pathways.

Co-Creating Viable Routes to Professional Practice

Nearly all of us within holistic health and medicine know and understand that we are severely overworked and underpaid with salaries that are often unsustainable and impoverish many; this includes the mountainous debt many of us have from pursuing the educational path required to become a competent practitioner.

Stated plainly, we cannot continue on our current trajectories.

Understanding this is what prompted me to write my article Hierarchies of Harm in Holistic Health & Medicine, of which I outlined some of the alternatives for creating viable career pathways across our professions. What I detail there involves democratizing professional practice and building true networks of cooperation over competition through the creation of equitable structures of which could include:

1. portfolio review and preceptorship-based pathways for existing licensed professions (ND, DC, LAc);

2. integrated peer-review, community-based credentialing, apprenticeship, and cooperative practice structures for both licensed & non-licensed professions (yoga & ayurveda)

   
   

Whereas I detailed all of these ideas in my prior article, in this one, I would like to prioritize why such pathways will help us create long-term sustainable careers as holistic health professionals which is a topic I did not address in my previous article.

Peer Validation/Portfolio Review, Not Top-Down Credentialing

In this model, creating peer-review or portfolio review collectives would allow practitioners to assess one another’s competence through collaborative/transparent processes rather than opaque standardized exams controlled by some distant board. This would also help promote skill-sharing that is rooted in mutual accountability where mentorship is horizontal rather than hierarchical through experienced practitioners helping newer ones. Overall, this helps practitioners build their standing and thus professional practice through demonstrated competence, community recognition, and peer endorsement, rather than through purchasing credentials through a centralized authority.

Cooperatively Owned Clinics & Wellness Centers

The problem for many of us within holistic health and medicine is that many are forced into solo practice which breeds isolation or those that do become employed within a practice have to tolerate their labor being extracted without any decision-making power or autonomy. Worker-owned cooperatives would help practitioners collectively own and govern their practice where decisions about hiring, scheduling, compensation, and clinical direction would be made democratically. This scenario would also help establish resource sharing to help pool resources for marketing, billing, continuing education, and other administrative needs. In this model, practitioners would not enter the field as a solo entrepreneur struggling to build a practice alone, nor would employees be subject to hierarchical management; they would be seen as co-owners of a democratically run practice of which will prove critical to the stability and longevity of their collective practice.

Community Led Apprenticeships & Training Programs

Training in holistic health and medicine is extraordinarily expensive when isolated to centralized institutions; the situation as it stands has created yoga teacher trainings, acupuncture schools, and naturopathic programs that create massive debt dependency while offering limited real-world preparation. Developing community-sponsored training programs where local practitioner collectives design, deliver, and implement curriculum collaboratively with costs shared by community investment, sliding-scale tuition, and mutual aid. This model would allow practitioners to enter the field through affordable, community-rooted training that prepares them clinically speaking but also prepares them for participation in a democratic and collectively governed practice from day one of entering professional practice.

Democratizing Continuing Professional Education (CPE)

CPE is often controlled by centralized boards and delivered through costly conferences and workshops. A beneficial alternative would be to create peer-led learning collectives where practitioners take turns teaching one another based on their expertise in a specific area. A collaboratively led CPE collective could be composed of rotating elected practitioners rather than permeant appointees; this would ensure that educational requirements reflect the needs of practitioners and the community at large rather than institutional interests. This reciprocal and community led learning would help strengthen the employable skills of those across the profession rather than enriching a select few of approved CPE providers.

Developing Collective Advocacy & Regulatory Representation

Most of professional advocacy within holistic health and medicine is led by hierarchical organizations claiming to represent practitioners that operate without collective accountability or decision-making. To improve these conditions, we should prioritize coalitions of practitioner cooperatives that directly advocate for regulatory changes thus bypassing centralized organizations that often do not represent us well. Practitioner consent should always be prioritized in policy development to ensure guidelines emerge from broader practitioner input which means practitioners are afforded a genuine voice in the regulations and professional standards that shape their careers.

Mutual Aid & Resource Pools

Throughout our professions, financial hardship is the norm due to educational debt and practice needs including licensure/certification fees, liability/malpractice insurance, disability coverage and innumerable expenses related to providing competent clinical care of which when carried alone by solo practitioners creates severe vulnerabilities. Mutual aid serves the purpose of building collective funds for emergency support, CPE, and sliding-scale client care. Group insurance cooperatives would also allow practitioners access to affordable liability/malpractice insurance, health insurance, and disability coverage by harnessing collective buying power. Shared administrative collectives would also help practitioners pool resources for bookkeeping, scheduling software, marketing, legal support thus reducing the overall burden on individual practitioners. In this scenario, a practitioner’s personal economic stability is not solely dependent upon their own client load but is supported by a collective infrastructure that distributes both risk and necessary practice resources.

Conclusion

For too long, holistic health and medicine professionals have been conditioned to believe that that the only legitimate path to stability is through submission and subservience to certifying bodies, hierarchical institutions, and by keeping an elite few in their positions of leadership. My sincere hope in you reading this article is that it has planted seeds of awareness that building viable career pathways do not require hierarchy; they require community, mutual accountability, resource/skill sharing, and horizontal decision-making power. The models outlined herein are not speculative, they are practices that are already emerging in cooperative clinics, peer-led training collectives, and mutual aid networks across North America and abroad. The question we have to sit with both individually and collectively is not whether it is possible to build non-hierarchical, egalitarian, and community-led career pathways but whether we have the courage to stop waiting for permission to transform the very people, organizations, and circumstances that have led us to where we are today. May the transformation begin…