Radio as a Public Health Intervention

[[{"type":"media","view_mode":"media_crop","fid":"38454","attributes":{"alt":"Anne Hallward, MD","class":"media-image media-image-right","id":"media_crop_8394527391519","media_crop_h":"0","media_crop_image_style":"-1","media_crop_instance":"3817","media_crop_rotate":"0","media_crop_scale_h":"0","media_crop_scale_w":"0","media_crop_w":"0","media_crop_x":"0","media_crop_y":"0","style":"float: right;","title":"Anne Hallward, MD","typeof":"foaf:Image"}}]]When Anne Hallward, MD began her private practice in 2002, it became clear that one single emotion resonated in almost every patient story she heard: shame. Shame was at the heart of depression, addiction, suicide, loneliness, trauma, and much more. After 11 years of training, Dr Hallward was determined to make an impact. Yet she wanted to reach more than just the patients who walked through her door.

Her idea was to establish a public health intervention to reduce shame and stigma by creating a forum where people could hear stories from others who gave voice to the feelings and experiences we all hide. Dr Hallward explains, “Sharing these courageous stories is contagious. It inspires listeners to come forward with their stories, and little by little we make the culture safer for those with mental illness and for any number of other stigmatized differences.”

It wasn’t long before Dr Hallward realized radio was the perfect medium for her idea. She says, “When patients started to cover their faces, put their heads down, or avoid eye contact, it told me that we were right where we needed to be. Right at the place of shame. And so I knew a public health intervention should minimize visual exposure.”

Safe Space Radio became the vehicle for hundreds of hidden experiences to be brought into the light and transformed into inspiring narratives. The show won a Public Affairs Award from the Maine Association of Broadcasters in both 2013 and 2014 and is in its 7th year. I spoke with Dr Anne Hallward about shame, the power of telling stories, and how this medium intersects with the field of psychiatry today.

Amy Amoroso (AA): In your TEDx talk you describe shame as a lethal public health threat, particularly when it comes to suicide. Can you talk about this?

Anne Hallward (AH): Let’s start with the definition of shame and make a distinction between shame and guilt. Guilt is a very particular feeling of, “This thing that I did was bad.” It is a very specific feeling about an action or inaction that was bad. Shame involves a much more global sense of the self as bad and unloveable. It makes us want to hide.

Suicide is about feeling hopeless about things ever changing and part of that is feeling like, “I can’t reach out for help. I can’t reveal who I really am. No one would get it or love me if they knew this thing about me.” This is shame. So, I see shame as a lethal public health threat. Suicide is one of the top 10 leading causes of death in this country.¹ And shame is at the heart of that. So if we can reduce shame, we can save lives.

"Sharing these courageous stories is contagious. It inspires listeners to come forward with their own stories, and little by little we make the culture safer for those with mental illness and for any number of other stigmatized differences.”
-Anne Hallward, MD

AA: Is there any research that supports the fact that telling and listening to stories is good for our health?

AH:Jamie Pennebaker² at the University of Austin Texas did a study on how talking about painful life experiences that happened before age 18 affected health. He found that those who had not talked about their experiences had poor outcomes in terms of cancer, hypertension, ulcers, flu, and headaches. He went on to study how writing about serious struggles can improve health. His team measured immune function, natural killer cells, wound healing, and so on, and these areas all improved when participants wrote about painful, hidden feelings.³

Thomas Houston and researchers4 at the University of Massachusetts looked at listening to stories as a health intervention. They did a study in which low-income inner city African Americans with uncontrolled hypertension watched videos of people from their own neighborhood telling stories about what it was like to live with hypertension. Three months later, this group continued to have an 11-point lower systolic blood pressure without any change in medication, compared with the control group who watched instructional health improvement videos.

"I had to remind myself that I had lived through it already. I had known the pain, and survived it. It only remained for me to give it voice, to share it for use, that the pain not be wasted.”
-Audre Lorde

AH: What I hope is that psychiatrists will personally recommend the show to their patients. They can link to Safe Space Radio on their websites, they can have a handout about it in their waiting room, or they can hand patients a “prescription” with Safe Space Radio written on it as a recommendation. Let’s say they have a patient whose child has autism, a clinician could suggest our series for parents of kids on the autism spectrum who have had to learn how to address sensory difficulties, school challenges, and emotional outbursts. It helps to know that someone else has been there and has useful ideas to share. We end every show with suggested resources.

Shedding light on hidden differences and feelings also helps to reduce stigma. One way that stigma affects families with mental illness is through what I call the “casserole effect.” If you have a child or parent in the hospital, your neighbors make you food; they bring you flowers in the hospital. But if you have a family member in the hospital for mental illness, the patient never gets any flowers and the family never gets casseroles. There’s an implicit gag rule of silence, where communities pretend this isn’t happening to protect the family from the stigma. So patients and families can listen to the podcasts on mental illness and find people talking about the issues no one wants to discuss.

"If you invite someone into a safe space, they will tell the most compelling story. They will dare to speak the thing that they’ve made so quiet inside, and this is actually the place where we connect with each other. The most personal is the most universal.”
-Anne Hallward, MD

Sometimes when a feeling is hard to identify and someone finally names it, the feeling begins to be more finite. For example, we did a series on caregivers for loved ones with dementia. I interviewed Dr Pauline Boss about ambiguous loss and she talked about how hard it is to grieve someone when they are simultaneously present and not present. Just naming this is so helpful. The person’s body is right there, but loved ones are not sure that the person is “there” anymore, which makes the process of grief so much more complicated. Just giving the feeling that label of ambiguous loss and describing the ambivalence that it generates is very validating and less isolating.

AA: Describe an interview that really touched you or where you learned something important that you hadn’t understood before.

AH: I spent a day recording interviews at a Hospice volunteer program within a maximum security prison. The inmates were the Hospice volunteers to their fellow prisoners. These men were in prison for life and had very few possessions to their name. While I was there, the director gave each of the men a holiday present, a card from Heifer International. In each of their names, a poor family in Honduras had received 12 chickens or one goat. All of the men seemed genuinely delighted with their gift.

I was moved because what the hospice director gave them was the chance to give to someone else. I could see the value it offered these men, who had essentially been discarded by society, to feel that they were giving something of value. This experience reminded me that everyone wants and needs to feel that they are making a contribution, no matter how dire their own circumstances are. This is true for every one of my guests on radio. Each individual is offering his or her own personal struggle as a gift to others by telling it in public. It is a way of redeeming the wound and, as Audre Lorde says, to share it with others “for use.”

AA: Can you describe the impact that your program is having on your listeners?

AH: The Safe Space Radio podcast is now part of the curriculum in psychology and sociology courses. It is used in training for teachers, psychiatry residents, social workers, and hospice volunteers, and it is also affecting many individuals and their families. For example, I went to pick my son up from a play date with a new friend. When I got to the door, both parents came to meet me and they clearly knew who I was, which surprised me. They said, “We want to thank you so much for the radio show you did about a camp for transgender kids. Our daughter was born a boy and she heard your show and she wanted to go to that camp. It was the first time she was able to be herself in public and to feel safe and be with other kids like her. It was a turning point in her life and we thank you so much.” There I stood at the door, trying to pick up my child to go home, and the impact was truly touching. That show aired years ago and I hadn’t known about the effect of it.

When I began the show, I was really hopeful and I remain convinced that if you invite someone into a safe space, they will tell the most compelling story. They will dare to speak the thing that they have made so quiet inside and this is actually the place where we connect with each other. The most personal is the most universal. No matter what the particulars are-parenting a transgendered child, caring for someone with dementia, or having a felony record and trying to reform. We all identify with feelings of vulnerability when spoken from the heart.

Disclosures:

Ms Amoroso is a freelance writer in Portland, Maine. Dr Hallward is a Board certified psychiatrist in Portland, Maine and founder of Safe Space Radio.

References:

1. The Centers for Disease Control and Prevention. Deaths and mortality [Leading Causes of Death in the US. 2013.] http://www.cdc.gov/nchs/fastats/deaths.htm. Accessed June 11, 2015.
2. Pennebaker JW, Sussman JR. Disclosure of traumas and psychosomatic processes. Soc Sci Med. 1988;26:327-332.
3. Pennebaker JW, Kiecolt-Glaser JK, Glaser R. Disclosure of traumas and immune function: health implications for psychotherapy. J Consult Clin Psychol. 1988;56:239-245.
4. Houston TK, Allison JJ, Sussman M, et al. Culturally appropriate storytelling to improve blood pressure: a randomized trial. Ann Intern Med. 2011;154:77-84.