Looking for a way to attract new clients to his private psychiatric facilities in Alexandria and Falls Church, David Charney came up with what seemed like a novel idea.
Each week he and the staff of Roundhouse Square Psychiatric Center would record a 2 1/2-minute telephone message on a different mental-health topic. The confused--or the curious--could simply dial a number and learn about eating disorders, phobias and other problems. With no human contact, the process would be as nonthreatening and anonymous as calling Weather or Time.
Since Weekly Topics on Tape was inaugurated earlier this year, the program has developed a loyal following, much like that of a radio program. If the center is late putting a new tape on the line, irate listeners call to complain.
"Some people are so anxious about their problems," says Charney, "that the only way they will touch the psychiatric system is to call a tape."
That phone line is the newest of many prepackaged information systems set up in the Washington area in the last several years, providing advice on everything from hiccups to herpes.
The systems are a dramatic departure from the traditional one-on-one physician-patient consultation. Often sponsored by area hospitals, they provide quick, impersonal information--no questions asked, no judgments made.
Some of the most popular tapes deal with sexual or relationship problems that callers may be too embarrassed to discuss with anyone else. Fears of the middle-aged man, venereal disease, sexual responses and homosexuality are among issues aired, along with abortion and sexual abuse of children.
Listening to the tapes, callers can hear advice like this:
* Don't swish whiskey in your mouth if you have a toothache. It could burn your gums and make matters worse.
* Avoid contact sports during a contagious herpes outbreak.
* Keep the faith if you have cancer. One in three victims is now cured.
* Get your children's eyes examined early--before they can read. An early checkup can identify birth defects.
* Try any home remedy you want for hiccups. Then wait five or 10 minutes for them to go away on their own.
The phone lines--large, nationally marketed information systems with names like Tel-Med, Counseline, and Health-Line--are offered to both educate the public and promote the sponsoring institution. They are not intended to replace the physician, sponsors say, and often encourage callers to get medical or psychiatric care.
Generally, the service is sold to one facility per community, presumably giving that institution a competitive advantage in attracting new business. One of the few studies done on such systems found that 25 percent of those adults who called Tel-Med were encouraged to seek medical or dental care, while another 30 percent said the information the tape provided made additional help unnecessary.
Although his center has hardly been deluged by new requests for therapy, Charney says Weekly Topics on Tape has brought in "some" business.
The marketing of mental-health services is a new and controversial phenomenon. Psychiatric organizations, once appalled at the idea of peddling their products, today pay fat consulting fees for help in expanding their clientele. Some psychiatrists worry, however, that the marketing of mental-health care may encourage those with the common problems of daily living to seek therapy needlessly.
To which Charney retorts: "Therapy is too hard, too costly and too energy-requiring for anyone but someone who is suffering a lot to do it." He sees the taped messages as providing that one last push troubled people often need before finally acknowledging that they need help.
Unlike Weekly Topics on Tape, which spoon-feeds listeners whatever information the Roundhouse Square staff decides they should have, other systems let listeners choose from a smorgasbord of tapes on almost any health or life-style topic imaginable.
Slick brochures, which list the tapes by number, appeal to callers who would rather not admit they are concerned about hemorrhoids, comsetic body surgery or sexual fulfillment.
Although little research has been done on the use of such systems, it appears that women call the tape more than men, and young people want to hear about social problems such as venereal disease and drug and alcohol abuse.
In the 11 years Tel-Med, one of the largest systems, has been operating, it has received more than 75 million calls, according to executive director Ken Steele. Started as a community service of the San Bernadino (Calif.) County Medical Society in 1972, the system is now available in more than 370 communities throughout the country.
Steele says the growth demonstrates that the phone lines are an important resource for a surprisingly large number of people "who are uninformed about basic body functions and disease in this supposedly informed population."
California psychologist Jacqueline Bouhoutsos, president of the Association for Media Psychology, believes that such information systems are popular today because they fit well with the current self-help phenomenon. "People want to find out how to handle little problems before they become big ones."
And the American Psychological Association no longer looks askance at so-called media psychologists who dispense mental-health advice to people they have never seen. Two years ago, the APA revised its ethical code to allow members carte blanche to take to the airwaves, phone lines and publishing houses. The only caveat: that the advice be sound.
Can such phone-information systems really make a difference in people's lives? Psychiatrist Charney says they can help people identify their problems. Typical new patients the Roundhouse Square tapes have attracted are those seeking help for phobias.
"There has been so much media coverage of this problem and yet most people don't know what it is they have. They don't see it as pertaining to them. Then they hear a lengthy discussion of it on the tape and suddenly a bell goes off and they say, 'Oh. My gosh. That's me. So that's what I've got.' "
In contrast to self-help books--"a dry and bloodless way to learn"--Charney believes the phone line is more appealing.
"I think it's reassuring to hear a human voice," says well-known media psychologist Joyce Brothers, who recently taped 50 messages on sleep disorders, relationship problems and other mental-health topics for a new service Tel-Med plans to offer soon.
But not everyone who calls, she says, needs treatment. Sometimes just getting more information can help. For example, a tape on insomnia with the information that everyone has different sleep requirements could reassure someone who doesn't need the standard eight hours of sleep.
Prepackaged information, Brothers claims, also can improve listeners' decision-making. The tape won't ensure that people always make the right choices in their lives, she concedes, "but it can increase our batting average."
Praise for the electronic information systems, however, is not universal. The availability of explicit sexual and abortion information has been attacked by conservative and anti-abortion groups throughout the country.
Locally, officials of the Prince George's County school system, stung by a raging debate over sex education in the 1970s, decided not to stir up any more controversy by distributing Tel-Med brochures to students as the health department had requested. Instead, select tape numbers are made available.
Les Butler, director of the Cancer Information Service of Metropolitan Washington, says his office has not had much luck getting Washington-area residents to use Can-dial, an electronic system that dispenses cancer information. Instead of the phone line, which he says is used rarely now, volunteers talk personally to callers.
"People would prefer not to talk to a prerecorded tape," says Butler, "when they can talk to a live human being." Electronic phone-information systems can be a valuable community-education tool for callers who don't expect too much, points out Carmine Valente, director of the Center for Health Education in Baltimore.
"But if people need to change their behaviors--stop smoking, lose weight or get a pap smear twice a year--listening to a three-minute tape is not going to do it." Support and reinforcement are necessary to make the change long-lasting and that support, claims Valente, must come from human contact.
Barbara Armstrong is a Washington free-lance writer.