Abstract
The Indiana State Museum’s Fix: Heartbreak and Hope: Inside Our Opioid Crisis is the first large-scale exhibit dedicated to the opioid epidemic. It involves diverse groups of visitors in learning about the history and science of opioid use disorder, making decisions that will help resolve the opioid crisis, and practicing techniques that for many people are essential to long-term recovery. By reviewing the different components of the exhibit, I show how the exhibit can serve as a basic model for advancing health promotion in museums. The exhibit illuminates the ways interactive health exhibits can engage adult visitors, reduce stigma, provide knowledge that visitors can use to exercise control over their health, and expand awareness of the need for evidence-based approaches to public health crises.
Because museums rarely provide opportunities for a deeper exploration of a major public health issue, the new exhibit at the Indiana State Museum Fix: Heartbreak and Hope: Inside Our Opioid Crisis (hereafter Fix) stands out. The 7,000 sq. ft. exhibit opened on February 1, 2020, at the state-funded museum in downtown Indianapolis and will remain on view through August 1, 2021; from there, it will move to another Indiana venue for a similar run. Fix features art, historical objects, and interactive installations, and it is the first large-scale exhibit in the United States to examine different facets of opioid use disorder (OUD) and recovery.
Fix provides a basic model for advancing health promotion in museum spaces. The model consists primarily of immersing visitors in personal stories about chronic disease and, along with these stories, engaging visitors in explorations of scientific knowledge and introducing simple action steps that visitors can take to protect and to improve community health. Following this model, Fix contributes to reductions of the stigma associated with OUD, increases acceptance of evidence-based harm reduction measures, such as naloxone distribution programs, and demonstrates that recovery can follow different pathways. Furthermore, it illustrates the crucial role that storytelling plays in health interventions, a fact that researchers have documented in different settings (Briant et al., 2016; LeBron et al., 2014). While this review focuses on the strengths of Fix, it also points out some of the exhibit’s shortcomings and suggests that a more thorough collaboration between the exhibit’s developers and public health professionals would have produced an even stronger exhibit.
The Potential of Museum Partnerships
Museum practice has evolved to keep pace with technological and societal changes, and museum practitioners are increasingly committed to working with a wide range of professionals and local stakeholders on museum projects, creating spaces in museums for interactive and participatory learning, and contributing to improvements in community well-being (Kadoyama, 2018; Skramstad, 1999). Amid these developments, museums—including art museums, history museums, and science centers—can be crucial partners for health promotion, yet they remain underutilized. I located only one report from recent years of public health professionals and museum practitioners working together on the development of educational exhibits (Bonnelycke et al., 2020). Since the 2000s, several museums and science centers in the United States have presented health-themed exhibits; however, their target audiences have primarily been children and young adults (Christensen et al., 2016). Only a few new, comprehensive exhibits—such as Mental Health: Mind Matters at the Science Museum of Minnesota, now offered as a traveling exhibit—have focused on a major public health concern and sought to educate and to empower museum visitors of all ages. Because of this, relatively few reviews of museum exhibits are published in health promotion and education journals.
Given the untapped potential of museums for health promotion, I believe it is important to carefully examine Fix and consider how it could yield more fruitful partnerships between public health professionals and museum practitioners. I offer here a brief yet thorough examination of the exhibit based on my visit to the museum in early February 2020, before the museum closed to the public for nearly 3 months during the COVID-19 pandemic, and again in August. During my first visit, I also attended one of the inaugural public programs for Fix, which featured a roundtable discussion with recovery advocates, health care professionals, and researchers, and after my second visit, I conducted a telephone interview with Brian Mancuso, the Indiana State Museum’s Vice President of Experience, about the exhibit’s development.
The museum’s staff planned and developed Fix largely on their own, with input from Indianapolis-area recovery advocates, including Brandon George of the Indiana Addiction Issues Coalition. For the exhibit’s interactive installations, the staff contracted the Richard Lewis Media Group, a leading U.S.-based experience designer, and Next Level Recovery, a state government initiative that coordinates access to addiction treatment and recovery resources for Indiana, served as the exhibit’s lead sponsor. The museum staff’s commitment to drawing on a wide range expertise and incorporating multiple perspectives are the exhibit’s greatest strengths. As a result, even though the exhibit’s development was not directly grounded in health promotion research and best practice guidelines, the exhibit reflects an emerging consensus among public health professionals regarding evidence-based approaches to OUD and recovery.
The Exhibit’s Multiple Perspectives
Before entering Fix, visitors first take a touchscreen quiz that tests their knowledge of the opioid epidemic. The quiz introduces ideas that are reinforced throughout the exhibit, including the ideas that prescription opioids may not be safe for some people, OUD is a brain disease, and recovery is possible. In the main exhibit space, visitors find a variety of colorful panels and displays, and a nonlinear organization allows visitors to freely explore the exhibit’s components. One prominent panel near the entry addresses the question “What is an opioid?” with a list of several drugs, including buprenorphine, heroine, oxycodone, and morphine, alongside their street names. It does not offer any information about how each drug is distinct from another, nor does any other aspect of the exhibit. This is one of the exhibit’s major shortcomings.
Another panel titled “Should you take opioids or not?” invites visitors to determine when it is appropriate to take prescription opioids for managing pain. It presents visitors with photos of 12 individuals representing different age-groups, races, and ethnicities. The reverse side of each photo describes the individual’s diagnosis, substance use history, and other risk factors for OUD. Visitors are invited to read the information and move the photo into one of five categories in another section of the panel. The categories include “Try over-the-counter pain medication,” “Take opioids for long-term pain management under your doctor’s care,” and “Seek treatment for possible physical dependence.” This panel is a relatively simple interactive component that could easily be adapted to other settings for helping people to be more reflective and cautious about using prescription opioids. The panel could be improved, however, by returning to the question what is an opioid and incorporating text that explains the different kinds and uses of opioids.
Fix includes displays featuring photographs and materials from the museum’s collections that allow visitors to see the opioid epidemic within larger historical and social contexts. These materials include 19th-century correspondence from the museum’s Lincoln Financial Foundation Collection suggesting that Mary Todd Lincoln, the widow of President Abraham Lincoln, suffered from “opiomania,” and the 19th-century medical bag, vials, and ledger of an Indiana country doctor who prescribed opium and morphine. The displays provide information on other potentially addictive behaviors in modern society, such as alcohol consumption and shopping, and compare the stigmatization of people with AIDS, like Indiana teenager Ryan White, in the 1980s with the stigmatization of people with OUD today.
The exhibit also features a panel contrasting responses to the crack cocaine epidemic in the late 1980s and early 1990s with the opioid epidemic. It points out that the crack cocaine epidemic disproportionately affected urban Black communities and resulted in more drug enforcement and the criminalization of crack users, while the opioid epidemic has affected mostly White areas, including small towns affected by deindustrialization, as well as affluent suburban areas, and has resulted in more public investments in harm reduction and treatment in White communities. Although researchers have offered a much more complex picture of cocaine and opioid use and access to treatment in Black and White communities (e.g., Hansen & Netherland, 2016), the panel is an essential addition to the exhibit that highlights systemic racism in drug policies and invites further examination of the issue. The panel’s ending tagline is, “Have we learned from past mistakes? Let’s talk.”
Interactive Video Installations
The exhibit’s interactive video installations include “Be a Brain Explorer,” which educates visitors about the neurochemical mechanisms associated with OUD, withdrawal, and recovery by projecting colorful, animated depictions of chemical and electrical messaging in a giant brain-shaped tent, and “Sharing Our Stories,” which is the most compelling installation and one that can be easily adapted to other exhibits in which personal stories are a major focus. For “Sharing Our Stories,” visitors step into booths, sit in front of a large rectangular monitor, and watch a short video loop in which five or six individuals in recovery share their experiences (see Figure 1). Some visitors find that sitting in the booths and listening to the stories is like sitting in a mutual-help group meeting. The topics of the stories include dealing with stigma, the progression of OUD, and experiences with recovery. Nearly all the stories note that the individual’s addiction began with an opioid prescription. Although museums have made efforts to incorporate personal stories into exhibits of different kinds, “Sharing Our Stories” is the most effective of these efforts that I have seen to date. It provides visitors an intimate encounter with individuals in recovery, while making the booths easily accessible and keeping the video presentations concise.
Story Booths for an Exhibit About the Opioid Epidemic at the Indiana State Museum in 2020 Offer Encounters With People in Recovery From Opioid Use Disorder
Another engaging installation is a touchscreen monitor allowing visitors to practice using nonstigmatizing language in a simulated conversation with a person with OUD (see Figure 2). This installation insists on the rejection of terms such as addict and relapse and encourages acceptance of medication-based treatment as a necessary and valuable pathway to recovery. In addition, a touchscreen monitor offers a choice of eight “Community Stories” videos describing the ways communities in Indiana have responded creatively and strategically to the epidemic. The videos are among the most informative components of the exhibit and can now be viewed on the museum’s website. They introduce viewers to a drug court program, a needle exchange program, and an innovative, full-service recovery center, among other projects. The “Community Stories” monitor sits in front of a screen on which a rotating series of slides presents annual data about opioid prescriptions, hospitalizations, and overdose deaths in Indiana, showing a dramatic increase in the numbers through the early 2010s and a slow decline in numbers in the late 2010s. The exhibit also includes a display of Narcan (naloxone), with information about how visitors can receive training to administer Narcan to someone experiencing an opioid overdose.
An Interactive Video Installation at the Indiana State Museum Allows Visitors to Practice Using Nonstigmatizing Language in Simulated Conversations With People in Recovery From Opioid Use Disorder
Explorations of Recovery Pathways
A special feature of Fix is a display of the original Big Book, the original text of Alcoholic Anonymous (AA), which was loaned to the museum by the book’s owner Jim Irsay. Despite this, the exhibit does not offer a fully developed explanation of AA’s 12-step recovery program or other recovery pathways. Instead, a somewhat disconnected series of panels and stations invites visitors to practice techniques that for many people are essential to recovery and emotional well-being. These include stations where visitors can write down worries on a small piece of paper and shred their worries; cope with stress by placing their hand on a sensor and watching the effects on a screen as they breathe deeply and slowly; listen to different samples of music and consider how music reduces anxiety; and learn and practice yoga poses.
Finally, the exhibit incorporates work by Indianapolis-area artists and highlights the therapeutic value of art for people in recovery. The art on display includes “We,” a large quilted installation that conveys the collaborative nature of the recovery process, by artist and recovery coach Philip Campbell. On my second visit to the exhibit, I noticed that the staff had added a small stand near “We,” with brief reports from Campbell about the impacts of the pandemic on his work as a recovery coach. In a report from June, he notes a dramatic increase in opioid overdoses, providing a glimmer of insight into the how the pandemic has erased some of the gains made in reducing opioid overdoses. Leaving the exhibit, visitors encounter a sign in the middle of the exit that reads, “Choose your words. Reach out to someone in need. Get Narcan training.” With this sign, the exhibit reminds visitors of three simple action steps they can take in response to the exhibit. Perhaps if the museum staff had collaborated more intensively with public health professionals, this sign might have also directed visitors to a website or other information source with a more detailed set of steps that visitors could take to get help with OUD.
Conclusion
The development of Fix clearly involved the input of many health professionals and recovery advocates and a significant investment of financial resources. The result is a pioneering, nationally significant exhibit that supports efforts to reduce overdose deaths, to expand access to treatment, and to improve recovery support. The exhibit’s impact hinges on immersing visitors in the stories of people who have struggled with OUD, involving visitors in decisions that will improve care and community support, and inviting further examination of and discussion about the opioid epidemic. The exhibit merely hints at the fact that an increase in the marketing and prescription of opioids for chronic pain and the loss of stable, good-paying jobs for people who do not have a post-secondary education have been major contributing factors to the opioid epidemic. Finding hope amid the opioid epidemic will ultimately require a reevaluation of approaches to pain, as well as more critical and sustained reflections on economic and social conditions and their impacts on health. In sum, Fix illuminates the ways multifaceted, interactive museum exhibits can advance health promotion, by helping to reduce the stigmatization and marginalization of people suffering from chronic disease, providing visitors of all ages access to knowledge and skill development that will allow them to exercise control over their health, and expanding awareness of the need for changes in health care systems and public policies. Indeed, it offers a path forward for further dialogue and more effective collaboration.
