A unique project at the Indiana University School of Health and Human Sciences in Indianapolis is working to reduce medical stigma and strengthen health care provider empathy with one of the oldest and most powerful storytelling mediums: theater.
The effort seeks to address a challenge in modern health care: A strong focus on data and efficiency - although aimed to support patient outcomes - can risk making people feel stripped of their humanity, said Department of Occupational Therapy professor Sally Wasmuth, who leads the project.
Summit Theater Indianapolis actors, from left, Shawnté Gaston, Bridget Haight and Énjoli Desirée perform "Push," a play about birth and postpartum experiences based on IU researchers' interviews with eight Black women and eight white women. Photo by Hillary Gordon
"My research focuses on the use of innovative or creative methods to address major concerns in health care," Wasmuth said. "My theater work is rooted in the field of narrative medicine, which is based upon the idea that the health care community tends to receive a lot of factual information, but they don't necessarily get enough exposure to arts and literature in training and education. These fields are uniquely suited to conveying people's experiences to build empathy and reduce stigma."
By sharing individual patients' experiences on difficult or stigmatized health topics, including highly personal and emotional moments, Wasmuth aims to help health care professionals become better listeners so patients won't feel like they are seen as merely a cluster of symptoms.
For the past six years, she has partnered with Summit Performance Indianapolis to script and produce plays about health care topics based on the real-life experiences of Indianapolis-areas residents.
The collaboration has tackled topics such as racial disparities in health care, women's experiences with reproductive health, birth and postpartum care, and issues of substance abuse. More recently, Wasmuth has begun to produce videos of patient stories for providers within large health care systems. She and colleagues conduct surveys to measure the impact of the stories on viewers' sense of empathy and understanding.
She is currently working on two video projects with the Roudebush VA Medical Center in Indianapolis that will be shown to center providers. One of the projects will focus on patients' experiences accessing pain treatment during the pandemic, when many people struggled to access care. The other project will explore the health care experiences of transgender veterans.
The theater project also traces back to Wasmuth's work with veterans. As part of a team that delivered care to veterans recovering from addiction, she helped lead an exercise in which patients wrote and performed a play about their experiences. Performance was chosen as a tool to support recovery since theater requires close collaboration, emotional openness and long-term planning, all of which are challenges for people struggling with addiction, she said.
Audience members attend a performance of "Push" by Summit Theater Indianapolis in 2022. Photo by Hillary Gordon
Although the exercise was well received by patients, Wasmuth said the small-group format was not able to reach enough people. This realization grew into the idea of producing plays, and later videos, for larger audiences based upon the experiences of real people.
The impact of the work can be seen in the reactions of viewers, Wasmuth said. Audience members often share emotional experiences of their own during "talkback" sessions after performances. These sessions include audience members, actors, subject-matter experts and the people whose experiences inform the production.
"The talkbacks are always incredibly motivating and inspiring," Wasmuth said. "People tend to be really moved and really engaged. They often share very vulnerable experiences. Performance creates a sense of safety and camaraderie that facilitates that openness."
The sessions also provide a unique opportunity to place the performance topics within the context of larger issues of stigma and social justice, said Lauren Briggeman, artistic director at Summit Performance Indianapolis.
"What the audience experiences at first as a creative piece of theater immediately becomes real, personal and tangible as they hear directly from those individuals," she said. "Time and time again, Dr. Wasmuth's follow-up research, along with comments made by patrons, show that the pieces create empathy and awareness that often didn't exist before. It's a really powerful form of storytelling."
Supporters include Eskenazi Health; Indiana CTSI's Trailblazer Award program; and Linda S. Riccio, a donor to the School of Health and Human Sciences who supported the project because she found the work so emotionally powerful, Wasmuth said.
Sally Wasmuth. Photo courtesy of the IU School of Health and Human Sciences
To collect the stories, Wasmuth works with graduate students in the occupational therapy program at the School of Health and Human Sciences, as well as undergraduate students. Some of the participating students are from the Norman Brown Diversity and Leaders Scholars Program, which supports students historically underrepresented in institutions of higher education.
The interview work, often emotional, presents an important learning opportunity to students. Many will need to navigate sensitive patient interactions in their future careers as occupational therapists.
Wasmuth's research has also shown that the work's impact is measurable. In public presentations about the project, she has said that on average, people who viewed patient story videos experience a 10-point reduction in stigma toward the topic explored in the video.
"That's a significant number," she said. "Stories have a powerful effect."
