Interview with Hannah Hedrick

Getting the most out of Life, Breath and T’ai Chi Chih

My first encounter with Hannah Hedrick, PhD, was at the 1995 Denver conference when I was a newly minted teacher. At the end of a group practice I asked for help in closing Rocking Motion, and with great self-assurance and efficiency, she showed me not only how to close it but explained why she closed it that way. I soon learned that Hannah was one of the “grandmothers” of TCC. She and three friends whom she introduced to TCC became the first teachers in Chicago after becoming accredited in California in 1986; many progeny following in her footsteps participate in the Chicago TCC network. She is arguably also one of the most committed TCC proponents on the planet. Her original students, some of whom also became teachers, were people in cancer and HIV/AIDS support groups — people with the diseases and family members. Her attention during the past decade has focused on the Herculean effort to form a national network to bring public awareness to a “quiet killer”: chronic obstructive pulmonary disease (COPD). She was among physicians, clinicians, respiratory and physical therapists, and patients who in 2001 formed an organization called the National Emphysema/COPD Association (NECA). NECA’s patient-centered mission is to empower people with COPD and their families to achieve a better quality of care and of life. Because of its safety and efficacy, TCC is an integral part of NECA’s “Self-Care/Peer Support” program, presented through networks nationwide. She also takes COPD and TCC awareness wherever she goes as director of Fern Forest Haven, secretary to NECA and the local community development organization, and member of the local Red Hat Society.

VFJ: I didn’t know that you’d left Chicago to live in Hawaii. Will this be your last move?

Hannah: I moved to Fern Forest, in an isolated rural area right above where Kilauea Volcano flows into the sea, five years ago to be with my mom and two sisters. It turned out that neither of them could move away from Alaska, but I feel I belong here for now. Since the universe gets me where it wants me to be, I don’t really know where I’ll end up.

VFJ: So did you have any challenges getting a new practice started?

Hannah: I’ve traveled extensively for NECA since I moved here; I was gone 50 percent of the time in 2005. So I’ve focused on taking TCC wherever I go. And that means all kinds of groups related to impaired lung function, including the tobacco-free groups that I work with nationally as well as on the Big Island, and new venues like the Red Hat Society.

VFJ: The Red Hat Society?

Hannah: A national organization with local groups of women who wear red hats and purple clothes. They help one another develop more independence and have fun in their older age. I’m trying to get the local group I attend to focus on healthy aging, including TCC. Since COPD symptoms become more apparent in this 50+ age group, this fits well with my focus on TCC and COPD.

VFJ: COPD means again?

Hannah: Chronic obstructive pulmonary disease.

VFJ: Is TCC helpful for other diseases that impair lung function?

Hannah: Yes, in the sense that stress is such an incredible aggravation for people with asthma, COPD, or other lung diseases. TCC benefits include helping people calm down; even without any attention to the breath, the movements soften the breath.

VFJ: How are people with COPD in particular different from people with other serious chronic diseases?

Hannah: People with COPD have to be very conscious about getting the breath out. So I am experimenting with myself and some people with COPD in incorporating “pursed lip” breathing with TCC movements. PLB involves inhaling through your nose gently as if sniffing a rose — a very gentle, slow inhalation. This is followed by an exhalation through gently pursed lips, at least twice as long as the inhalation, as if you were making a candle flicker or cooling a spoon of soup. This one-to-two ratio works well with the TCC movements. Say you’re stepping out and then shifting the weight forward — you inhale softly through your nose. And then you would extend the slow, gentle exhalation through pursed lips to the backward weight shift and the next forward weight shift. This requires focus, but it is not difficult. I invite you to try this, Kathy: inhale gently and slowly through your nose and then gently out through pursed lips, just enough to flicker a candle. I think you will notice a calming effect.

VFJ: You mentioned that you want to bring TCC to people with COPD across the nation?

Hannah: Yes, through a TCC COPD Network. When I’m in Minnesota for the conference this year, I really hope to bring together people with COPD and asthma and their advocates, health care and educational institutions, lung association leaders, and interested TCC teachers. The first cadre of TCC teachers working with people with impaired lung function will be limited to certified teachers who consistently attend at least one TCC educational experience a year, whether an intensive, an accreditation course, a Seijaku course, or conference.

VFJ: Would you also look for a certain propensity for this kind of work?

Hannah: I believe only teachers with a propensity for working with this population will be attracted to the TCC COPD Network.

VFJ: Because it’s … narrow?

Hannah: There are an estimated 30 million people with COPD (only about half are diagnosed), so it’s not very narrow with regard to numbers.

VFJ: I was thinking in terms of a TCC teacher target audience.

Hannah: TCC teachers already target groups with arthritis, Alzheimer’s, heart disease, cancer, and so forth. People with impaired lung function can benefit from TCC as much as, if not more than, people with other serious chronic diseases.

VFJ: I would agree. And what about the spiritual benefits from TCC practice?

Hannah: People who have a life-threatening illness are frequently more in touch with their spirituality than people who haven’t had a “wakeup call.” This certainly applies to people with conditions that impact breathing.

VFJ: … and spirituality and breathing go together. Most meditation techniques involve some kind of breathe-in, breathe-out awareness.

Hannah: Many people with COPD who are fortunate enough to go to pulmonary rehabilitation, or who learn to do pursed-lip breathing, feel so much better. We know about breath and its impact on the brain, and it really does stimulate “heightened awareness.” It’s more than just “Oh, I feel better and physically I have less pain.” Breathing is a direct connection to your spiritual energy. As we know from TCC, just the moving meditation creates this connection without having to think about it.

VFJ: The “fun-focused” Red Hat Society seems like a polar opposite to your service mission. How did you happen to get interested in something so removed from your usual activities?

Hannah: It came through a woman with COPD who is helping me with NECA Hawaii; she started a local Red Hat Society group. These social groups for women over 50 are growing at an amazing rate across the country. I’ve never seen anything like it. I thought I would never wear a red hat and dress in purple, but I wanted to be supportive of this wonderful woman. Usually the members just play dominoes or go to concerts or on nature excursions. Many of them do not have a history of being physically active or healthy. So the challenge is to help them experience how much fun it is to feel better. TCC has, as we know, a playful aspect to it. I’d been wanting to do something with “older” Americans, and here it is, just put in my life.

VFJ: A friend gave me a book when I turned 50, When I’m An Old Woman I Will Wear Purple. The Red Hat Society is based on that.

[INSERT QUOTE HERE: Jenny Joseph, 3 lines beginning “I shall go out in my slippers”]

I’d forgotten about that book.

Hannah: Yes, now they are everywhere. I was at the International Post-Polio meeting this summer, and there was a picture of a woman in her wheelchair with a red hat on. Since TCC is part of NECA’s self-care peer support program, I may just as well be talking to all the compatible groups that have a national network.

VFJ: So TCC crosses all borders. Isn’t it grand?

Hannah: The strength to me of TCC is not just that its teachers are wonderful people, but that they do pretty much the same thing in pretty much the same way. Basically, I can trust accredited TCC teachers to individualize a practice that is safe for the student. When I go to yoga classes, I frequently see people doing postures that are not safe for them.

VFJ: Wouldn’t yoga teachers be required to know what is contraindicated?

Hannah: No teacher could know all the contraindications for each posture for each disease, especially when so many diseases are undiagnosed. That’s why NECA is also organizing a Yoga/COPD Network. What if someone with heart disease and COPD had a heart attack? Would you know what to do? Their lung sacs have been destroyed through smoking or whatever and their lungs tend to be hyperinflated. One of my goals is not only to find people who want to be involved in our TCC COPD network, but also to make sure that the general TCC community knows to be as sensitive to lung disease as they are to heart disease, cancer, and the like.

VFJ: Have you had to adapt the movements at all? I know seated TCC is quite accommodating of students’ special needs, for example.

Hannah: One reason I selected TCC as part of my self-care and peer-support program is that if a person can do the movement, it is usually safe. If they have difficulty, the movement should be modified. For example, people with advanced COPD have difficulty raising their arms above their heads, so we modify Light at the Top of the Head and Light at the Temples. Joyous Breath should emphasize a GENTLE exhalation through pursed lips on the way down, and the breath should not be retained at the end of a gentle inhalation. We would emphasize the two-to-one pursed-lip breathing ratio for people with diagnosed COPD. I hope that the TCC COPD Network will develop guidelines, but in the meantime, we can remind all students (and each other) to emphasize the exhalation and to press the stale breath out of the lungs.

VFJ: I’m not sure we teachers really know what we are getting into when we form a class.

Hannah: We need to stress the importance of paying attention to individual needs, especially when we form a class directed to seniors, many of whom have age-related and other chronic diseases. Most seniors know “Oh, that hurts my joints, I can’t do that.” But many people with COPD are living and dying without being diagnosed. Every orifice and organ in your body is examined at some point, everything except your lungs.

VFJ: So if you go in with symptoms, then the doctor does pulmonary function testing?

Hannah: They do not. They do NOT. That is why we have between 13 and 15 million people with active symptomatic COPD who’ve not been diagnosed. And I hear story after story from people who’ve repeatedly told a health care professional “There’s something wrong with my lungs.” Even if they were long-time smokers and have symptoms associated with COPD, they are not given simple diagnostic tests and they are frequently NOT referred to a lung specialist. By the time they do get diagnosed (if ever), their lung function is so impaired that it’s that much more difficult to do the kind of physical activity essential to survival. Three things — stopping smoking, exercising, and using oxygen as prescribed — are the things that improve the quality and length of life. But many places I go to start NECA Networks, there is no pulmonologist, no rehab center, no services for people with COPD. Even getting people to do TCC would be helpful for stress reduction and breath awareness. I believe we should focus more on the stress-reduction benefits of TCC, because stress aggravates every serious chronic disease. With COPD, avoiding exacerbations is of paramount importance. Someone with impaired lung function may not return to baseline after an exacerbation. If you have normal lung function and you have pneumonia or acute bronchitis, your lungs return to baseline or close to baseline when you recover. But if you have a chronic progressive lung disease and you have an extreme exacerbation, this can reduce your lung function permanently. That’s why preventive techniques such as TCC that help reduce stress and contribute to overall immune system function are so valuable. TCC teachers can increase COPD awareness just by being members of their community. And then they can promote the value of TCC to people with COPD.

VFJ: What got you interested in this?

Hannah: I was involved in end-of-life care for more than two decades, which is one of the reasons I was immediately attracted to TCC as a “tool” for people who could not do more challenging practices. Daryl Isenberg, my best friend who was accredited with me, worked with me to introduce TCC to the Family Cancer Support Network she started. Many of her students in other cancer groups are TCC leaders in the Chicago area. One of our FCSN members (who became a teacher) credits TCC with saving her life after the death of her daughter. When she was overwhelmed by grief at work, she would just go into the restroom and do a few movements. Daryl continued with cancer groups when I shifted my focus to people with HIV/AIDS. One of my most gratifying and inspiring TCC experiences was helping people in late stages of HIV infection become TCC teachers, sometimes just months before they died. It was so empowering for them to be embraced by the TCC community and to be of service to others in the final months and weeks of their lives. After the HIV/AIDS movement changed the face of treatment for that disease, I decided to focus on lung disease, since so many of my friends with cancer and HIV/AIDS actually died from lung failure. Pain was being addressed, but dyspnea (shortness of breath) was not. COPD was the fourth-leading cause of death and the only one in the top ten that was still growing. There was no national association to promote any of the things that we’re talking about — better medical care, self-care techniques, or whatever — so I worked to form NECA and saw from the very beginning how helpful TCC would be. Five years later, our organization is solid and has an executive director. I’m hoping to be able to do less writing and administrative activities and focus more on delivering the Self-Care/Peer Support Program (including TCC) through geographic, professional, and special COPD networks.

VFJ: Well, that’s quite a calling, Hannah. Did your work with life-threatening diseases and end of life care start as a career choice, or did it just happen?

Hannah: It’s nothing that I ever planned. I got involved in a cancer group because my Daryl was running it. I got involved in HIV/AIDS because my students got sick before there was even a name for HIV/AIDS. They were sick and I visited them in the hospital and we started a support group around someone’s kitchen table, which led to a group with national influence. We need the same thing for people with COPD. There’s no magic bullet for COPD; people have to change behavior if they want to lead a longer, healthier life. If we can get people with emphysema and COPD to say, wow, this TCC stuff really works for me, maybe that will get other people out of their recliners and onto their feet. That’s another reason I’m so drawn to work with people with life-threatening illness. By gum, if they can take responsibility for improving their health, then the rest of us have less excuse not to.

VFJ: I can see how TCC would fit right in with both self-care and peer support in your program.

Hannah: TCC undergirds almost all of the seven categories of the self-care/peer support program: breathing, hydration, nutrition, rest, activity, service, intimacy, and spirituality. We have all experienced that even thinking about doing TCC can calm the breath. Hydration includes hydrotherapy, and doing TCC in the water is one of the healthiest activities I know of to do while partially submerged. With regard to nutrition, I believe TCC helps people reduce the stress that leads to unhealthy eating habits. Fourth is adequate rest — if you are doing TCC, you rest and sleep better. And a TCC practice obviously makes a major contribution to healthy activity. Of great importance to me is the role of TCC and “service,” which Justin emphasizes. Being able to share TCC with others has brought meaning to many people with a chronic disease who felt somewhat useless before TCC entered their lives. TCC also provides avenues for “intimacy,” the feeling of closeness to others that is essential for survival. I believe this kind of intimacy is created in many classes and it certainly exists whenever two or more TCC teachers are together. There is no better intimacy than the intimacy shared among TCC teachers and with our students. Every class is an intimate grouping. The TCC connection to the final component, spirituality, may not be as obvious as the relationship to intimacy, but for me, every TCC class becomes a spiritual community. Even those who would not describe the experience as spiritual feel something special.

VFJ: Exactly. I don’t think a student finishes a class and says, “Oh that was nice, let’s see what we will do next week.” They actually have some spiritual conclusion, shall we say.

Hannah: Even if they don’t recognize it — I’m amused by people who deny their spirituality. It’s as if someone were standing in water and saying “What’s water? I don’t believe in water.”

VFJ: I’m glad we’re doing this in the Vital Force so people can know the depth and extent of what you’re doing.

Hannah: It’s very timely for a number of reasons. I think our TCC community has reached a level of maturity. We have enough experienced teachers to begin to consciously actualize Justin’s service component. Do you perceive the same thing?

VFJ: Yes, I do. It’s like a tipping point, or reaching critical mass.

Hannah: We’re ready to really put TCC at the service of mankind.

VFJ: What does that involve in the trenches?

Hannah: It takes networking at the deepest grassroots. I’m convinced that nothing changes from the top down. You can think globally, but, like the saying goes, you have to act locally. And why is TCC part of my self-care/peer support network? From my perception and experience, the TCC community is unique in having people of all walks of life, of all ages, and of all shapes and sizes, as teachers. We don’t describe ourselves at “masters” or “gurus” — we’re all just regular people who want to consistently share a safe, effective, healthy activity that benefits all levels of our being.

VFJ: And you don’t have to have advanced degrees, belts, or skills to teach it.

Hannah: Which is exactly why I was so attracted by my first experience with TCC after studying Tai Chi Chuan for a couple of years! I was “guided” to study t’ai chi so I could share the principles to help people with cancer and HIV. Several t’ai chi chuan teachers were very discouraging, commenting that I might be adept enough to begin so share after studying and practicing for five years. Well, many of my friends with cancer and HIV/AIDS had less than a year to live, so I needed something I could share as their health declined. Two minutes into my first TCC class, in Rio Caliente, Mexico, I got an “Aha!” that this was the t’ai chi for me.

VFJ: That’s always impressed me about TCC. It’s so accessible.

Hannah: And people get confident and are willing to share even if they can never think of themselves as teachers. When you encourage them to be teachers, they say “Oh, no, I could never be a teacher!” But when I suggested that they just share movements that helped them, they were more than willing to reach out to others with cancer or AIDS. This “sharing” brought such meaning into the lives of people with a variety of serious progressive terminal illnesses. It’s when you can give something back to others, especially to others like you or to your caregivers, that your life can have meaning until the day you die. One of my dear friends who got accredited was so marked with Kaposi’s sarcoma — the cancer that makes the purple welts on the faces of some people with AIDS — that people who did not know and love him would not even look at him. But the students in his TCC accreditation course did not pull away from him. They were perhaps even more loving and “touchy-feely” with him than with the “healthy” students. I think that becoming an accredited TCC teacher was perhaps the most meaningful thing in his life. I look forward to identifying TCC teachers with COPD to play central roles in the TCC COPD Network.

VFJ: Do you plan to include a scientific research component, too?

Hannah: NECA has an impressive Medical Advisory Council with NECA. As we’re moving forward with the TCC COPD Network, we’ll try to put a research component in place, similar to the one for the breathing/stretching DVD produced by Vijai Sharma, which was reviewed by the MAC. At the annual conference, I hope we can develop a plan to bring TCC teachers and people with COPD together to do a DVD. Pam has offered a discounted price for her TCC instructional materials to people with impaired lung function, and she has indicated interest in getting involved. But we don’t have to have a controlled, randomized study to “prove” the efficacy or safety of TCC for people with COPD before offering it widely. We can develop a product in which people with COPD themselves say, “I can’t raise my arms above my head” or “I tend to hold my breath when I do Bird Flaps Its Wings,” and then demonstrate an adaptation that works for them.

VFJ: It reminds me of the specialized video about seated TCC.

Hannah: That’s what’s important for me — being in tune with individual needs in your class, rather than teaching a “canned” class. While each student will always reflect a variety of conditions that need to be taken into consideration, the TCC COPD Network could help address the impaired lung function needs.

VFJ: Is there an expected life span after contracting COPD?

Hannah: Length and quality of life so much depend on what people do and on their access to appropriate medical care and rehabilitation. After diagnosis (which may be late in the disease), three things are highly recommended: stop smoking; exercise regularly; use medications and oxygen as prescribed. People who don’t stop smoking are at increased risk for exacerbations (bronchitis, pneumonia, flu, etc), which may permanently lower lung function. If they don’t exercise and learn how to use muscles to help them breathe, lung function decreases dramatically. And if they don’t use medications and oxygen as prescribed, they can experience unnecessary exacerbations, decrease lung function, and damage other organs (such as their heart). The self-care/peer support program is designed to get people to accept responsibility for themselves. Our mission is to empower people with COPD. The first step to empowerment for any of us is to assume responsibility for our own health. Others, including health care professionals, are just helpers. It’s your body that does or does not heal itself.

VFJ: What would you tell new teachers coming in to our community, based on your experience?

Hannah: My strongest recommendation to new teachers is to piggyback TCC on what they already do rather than struggling to develop something totally new. Where are you already? You belong to a faith-based community or a civic organization. You attend a “Great Books” groups, or do mall-walking. Invite them to a TCC demonstration, and offer to teach a class that is convenient to an existing group. Align TCC in the service of other complementary groups, such as support groups for people with COPD, Compassionate Friends for grief, etc. Share your commitment with your own networks. My path is now leading me to share TCC with end of life and tobacco-free networks.

VFJ: Hannah, I guess we’ll be hearing more from you about this at the conference in Minnesota this summer. Thanks for bringing your work and vision to our teachers community through the Vital Force.

Hannah: You are most welcome.