Elaine Ritschard - Tape #ORAL HISTORY 2006-15-22-tp1
Elaine Ritschard was interviewed by Bill Schneider and Karen Brewster on April 20, 2010 at Summerset Lodge retirement community in Gladstone, Oregon, a suburb of Portland, where she currently lives. Elaine worked as a nurse at Morningside Hospital in the 1960s, first on the emergency unit and later she was head nurse of the children's ward where she established a kids activity center. In this interview, Elaine talks about becoming a nurse, balancing her work and home life, and conditions, patient treatment, and staff relations at Morningside Hospital. Her son, Brad, a recently retired police officer, joined in on part of the interview, but mostly he just listened.
Part two of this interview.
Click to section:
Section 1: Personal background, childhood, education, marriage and family life.
Section 2: Her early employment history working as a nurse.
Section 3: Working at Morningside Hospital in the emergency section, and the early years of giving patients medication.
Section 4: Description of the physical layout of Morningside Hospital and the patient care and work program, and working in the emergency section of the hospital where police would bring acute cases from the community.
Section 5: Observations about the patients and the type of care provided at Morningside Hospital, and long-term situation with Alaskan patients.
Section 6: Observations about why patients lost contact and did not return to Alaska.
Section 7: Stories about some of the patients, types of ailments patients had and the causes for these, and the type of care provided to the children at Morningside Hospital.
Section 8: Treatment of severe cases in children and her intervention in one particular case.
Section 9: Changes she implemented in treatment of children and use of discipline when she took over the children's unit at Morningside Hospital.
Section 10: Working in the geriatric unit at Morningside Hospital, and the types of activities she initiated for the children.
Section 11: Working with the children to prepare them for integration into the community and bringing in outside programs and music.
Section 12: Relationships between patients at Morningside Hospital, types of activities provided, and observations about the condition of patients.
Section 13: Administration of Morningside Hospital during its last years.
Section 14: Work environment at Morningside Hospital in its later years, and the focus on providing patients the skills for transition to other facilities or into the community.
Section 15: Death and burials at Morningside Hospital, patients records, and status of patients after the hospital's closure.
BILL SCHNEIDER: Okay. Today's April 20th, 2010, Karen Brewster's here and I'm Bill Schneider, and we have the pleasure today of talking to Elaine Ritschard. And we're here just south of Portland at the place where she's staying. And what's the name of this place?
ELAINE RITSCHARD: Summerset Lodge. BILL SCHNEIDER: Summerset Lodge. Yes. A nice retirement home. So thank you for taking the time to talk with us.
I'd like to start by having you talk a little bit about your background, where you grew up, and your parents and some of your early schooling.
ELAINE RITSCHARD: All right. I grew up in Gresham, Oregon. I went to Gresham High School, grade school. I married the young man I met in high school, we were married 58 years. His family is from Switzerland, my family's from Norka, Russia. I'm a German -- Volga German. I attended Emmanuel Hospital School of Nursing, got my degree in nursing from University of Oregon and Emmanuel Hospital, Bachelor of Science. I worked 45 years in my profession. I have five children. I adopted two, so I raised seven. I think I was chosen for the position at Morningside because I was a mother of five. And my husband was a outdoorsman. He was a policeman for the City of Portland, lieutenant. I have 20 grandchildren and seven great-grandchildren. And they are teachers, social workers, counselors, registered nurses, businessmen, and they are all around me, within 15 to 20 minutes away. We're a very close family. And my elder son was a Vietnam War veteran and passed away two months after my husband. He was injured and he lived with us for 30 years, and he took the death of my husband very seriously. We had a ranch in Central Oregon and we had that ranch because of my profession and my husband's profession and my children's profession, they needed a place to go to have an R and R, so we bought 200 acres of land and built a ranch. And they came constantly to relax, ride horses, catch the cows, hike, fish, hunt, whatever. And then when we came back to Portland, it was because my husband got too old to lift those bales of hay. And we came back and he passed away six years after we came back, and I'm here now. And I'm enjoying it. Section 2:
What else would you like to know?
BILL SCHNEIDER: Well, when did you have your first nursing job?
ELAINE RITSCHARD: My first nursing job was in California. My husband was in the Marines from the Second World War, and we -- I graduated from nurses training on the 1st of August and we got married on the 8th. Believe it or not, I was in the Army and didn't know it. When I signed up to go into nurses training, the recruiters came as supervisors of nurses from the different hospitals, in 1944. And recruited nurses to fill the hospitals that were emptying out because of the war. And I signed all these papers, I didn't see the small print. And I ended up being in the Army but fortunately, the Army did not take married women or women with children, so when I married and had all these children, I was exempt. But my husband was in California to finish his service, and I took my state boards in California, in Los Angeles, and it was the first national state boards that were given to nurses. This gave us reciprocity to work in any state without having to take the individual state tests. So that was very fortunate.
So I worked my first year Santa Ana, California. Then I came back to Oregon, and I worked for the Red Cross. And the first place I worked was in the Contagious Diseases Hospital here, and it was polio epidemics. And I worked in iron lungs and Sister Kenny hot packs, and that lasted about a year before the polio sugar cubes came in. And so then I worked there about two years and I worked for the Red Cross and traveled around Oregon, Washington, Idaho for the blood drives, drawing blood. And my husband decided that wasn't a good idea, to have me driving around all over, so here I am back in Oregon. And I started -- we lived close to Morningside Hospital, that's why I chose Morningside. I was within a couple miles, one mile of Morningside Hospital, our first home that we bought. My husband went to college, and entered Portland University, and he became -- he has a masters in education. And he did some teaching. My husband's had three retirements. He was a very active man. But I just kept working to pay for all of this. So all these kids, too, went to college. And so mom just kept working, in between children. I stopped a year every time I'd have one, and then I'd go back. Section 3:
And I went to Morningside Hospital with the idea that it was close at hand, and it was the job that I took after the infectious diseases and the Red Cross jobs. And I worked in -- I didn't start in the pediatric department at Morningside, I started in the emergency section. Now, the emergency section was the intake ward for the people in the community that needed acute care, emergency care, the police would bring them in off the street out of the hos -- out of the homes that were in a mental health crisis. That was the emergency. That's your big building that you see right in the front there. And those were always brought in as an emergency or a short term. And they had cells, locked cells. And that was also the treatment unit.
Now, remember this. My time at Morningside was less than ten years since the beginning of medication treatment for mental health. All of my background came from on hands, like your electric shock, your insulin shock, your water therapy. All these things that I was trained for in nurses training was not medication, but coming to Morning -- Morningside, they had already had the medications, but they were not stabilized yet. They were still -- medications were limited what you use, what they -- what was available, and limited to what the people, the doctors even knew, how they would respond to the medication. And some of the mental health medications gave some of our patients Parkinson symptoms. Parkinson Disease. So they had to be careful with the dosage, the length of time. They were still learning on medication.
So when people came in, in an emergency type of situation, we gave them Thorazine right away because that was the one that was available first. And -- and more stable for us to use. But this was the short term. Section 4:
Now, the Alaskan patients were already there when I arrived. They had been there for quite a few years. And by the way, Morningside Hospital was built by Henry Coe, Dr. Henry Coe from England. And the first -- first hospital was on Military Butte just west of I-205 here in Portland. And then he moved out here to Morningside, and it was a farm. It was a -- they grew vegetables, they had orchards, and they had beautiful park-like environment around them to walk.
And something interesting was by the time I got there, most of the patients were residential. They had been treated with medicine, they were stable enough to be out on their own outdoors during the day, if they were interested.
But a lot of the patients were sitting because they had to be motivated at this point. The ones that were outside were workers. They worked in the gardens, they worked in the farm. They did a lot of landscaping. They did the picking of the fruit. They did the harvesting of the vegetables. And our kitchens used all of those vegetables. So the Alaskan patients were outside doing that sort of thing at their own speed. And some of them got taken to shopping centers. They always got escorted to doctors. The young people that I saw, the Alaskan ones, were just strolling through the park and walking and visiting with each other during the day. At night, we locked all complexes. So my first experience at Morningside was the emergency section. And that was pretty traumatic. But something interesting happened. If a policeman would come in and that patient was under -- was immobilized maybe by handcuffs or whatever, even a straitjacket, he'd come in and he'd take everything off; and us nurses, now, we had white uniforms, white hats, and all we had to say is, we'd like to help you. Would you come with us, please. And they came very willingly. They were fighting with the police, there were traumatic incidents on the streets, that's why they were brought in, but when we met them at the door and said, come with us, we want to help you, they came without a -- I never had any problem with any of them. And that was interesting. Well, one I did. But we won't go there. But anyway, that -- that was an interesting thing. They came in and they knew they needed help. So -- now, that was community at Multnomah County, had that system with Morningside. And it was the Multnomah County people that brought their emergencies in. This was in 19 -- well, I -- I came in 1960, so it was from 1960 until it closed its doors, they were using the emergency section for the cases on the street or in the homes. Section 5:
Now, the Alaskan patients were limited when I got there. Many had already been taken to Alaska, or they were in our system.
I remember four wards outside the main hospital. There was a ward of young adults, male and female. There were two different ones. One male, one female. And the age bracket probably was some 16 -- I would say 16 to 50. And they were different levels of abilities.
Some could -- some had -- by the way, we had a school on the grounds. It was a little red schoolhouse. Portland Number 1 provided the teacher, she was full time. And there she had about 10 students at a time. Most of the students were only educable to the third grade. By the time I got there, the people that had been educated before I came were at a different level, but I didn't know them; and I didn't work at those two units, so I didn't have a lot of experience with them. But they were the ones that worked in the gardens, worked in the lawns, worked in the landscaping. And were free to come and go. But you know, they never left the grounds unless they were escorted. They never wandered away, they were content. Some worked in the kitchens. Some helped with children. Some young girls worked with the kitchen and worked with us with the children. Very nice, very easy to get along with. It was low key. They seemed content. BILL SCHNEIDER: So you -- just a bit of clarification. You were saying that they entered our system. Do you mean the Oregon Welfare System?
ELAINE RITSCHARD: Yes.
BILL SCHNEIDER: Would you explain how that worked. ELAINE RITSCHARD: Well, I don't know. I just know that in the following years that I was working in other areas, I ran into some of the patients in the nursing homes from -- the Alaskan patients that I recognized that were young adults or teenagers. And they were in nursing homes. But you have to remember that the people that were left at Morningside when I arrived were really very limited in their ability to function without some kind of help. This is the children's area I'm speaking of. The two wards I told you about where they were men and women wards, they were more active, but not able to cope with society without some kind of a structured environment. They would need to be -- those would go into group homes, into foster homes. No, not foster homes because they were too old. Some kind of supervision.
So if they got into apartments without supervision, that's where we lost them. But they were hired by different places, like I say, Goodwill. And they did find them jobs, like washing dishes or some kind of job that would give them an income, but the welfare was supporting them and giving them an income because they were now belonging to Oregon instead of Alaska, they belonged to Oregon because they had been residents in Oregon a long time. Section 6:
So they -- they established residency in Oregon by being here so long. And if they chose not to go back to Alaska and there were not family members or somewhere for them to go in Alaska, they stayed here. It was their choice to.
BILL SCHNEIDER: Were they given that choice? They were asked if they --
ELAINE RITSCHARD: If they were to make that choice. You've got to remember, this is -- this is -- it varied, wide vari -- variation of the type of patient they were or the type of resident they were.
The ones that could stay and have responsibility, they put them in the places where they could function. If they didn't, they'd also have to be in a place where they could be taken care of; but when Oregon closed all the institutions, they had no place to go. And if some tried to live on their own, they would fall by the wayside. The ones that chose to go back to Alaska had someplace to go in Alaska.
I will be very honest with you, I was there seven to eight years, and I don't remember any patient being visited by relatives, receiving letters from relatives, Christmas cards from relatives. When they came here, they were alone. These patients did not have continued connection with Alaska except by financial means and what Morningside gave them as a home.
BILL SCHNEIDER: Why do you think that was? ELAINE RITSCHARD: Well, it was a type of patient that I saw. Now, remember, I was the tail end. So that they were left here to be cared for. So they were in Morningside because there was no one in Alaska that connected with them where they could go back to. And I'll be -- I will tell you why. The children -- I'm only speaking of the children, I didn't work with the adults, but I think there were some of them -- they were birth defects, alcohol syndrome children, illness, injuries. They were very limited in what they could do without structured care, the children needed to have care.
I believe that the young people in those other two units were the same way, but they had -- they were taught how to take care of themselves, brush their teeth, dress themselves, eat well. They had good manners. Socialize with the people within their units. They were considerate, they -- they took care of each other.
That's one thing I did see. The -- the ones in the two units would come over and love to play with the children and take care of them. They stuck together. There was a cohesiveness about the Alaskan Natives. Now, I'm speaking of the Natives. I had very few Alaskans that were not Natives that didn't go back.
So the children that I saw and the patients that I saw were people with limited resources within themselves that could function by themselves. BILL SCHNEIDER: But I'm wondering about the people back in Alaska; you said that there were very few visitors.
ELAINE RITSCHARD: I believe that those families were already fragmented. I believe that those families already had problems of their own. I believe they came from families that didn't have structures that could support them anyway, or they wouldn't be down there. If they were Natives, they always took care of their own. They took care of their own in ways that they could do it. If they -- if these children got away from them and got down into Morningside, it's because they didn't have anybody. Or nobody that was interested. Because in all the background, a lot of these children had grandmothers that took them in. Aunts and uncles, they were -- they -- just like they showed up here taking care of the children in the units where I worked, they would love to take care of the children -- they stuck together. But it's because these children had no one. Or they didn't have anyone that was able to take care of them, they had problems of their own in Alaska. They were -- just didn't have the facilities or the family life-style that could take care of that kind of a child. So the families didn't show up, didn't keep letters. They probably were thankful they were safe and were taken care of, too. And they didn't have the means to get down here and visit them. They didn't have the education. They didn't have the background that said, oh, let's write them a nice letter or go out and buy some cards and send it to them. They didn't have that. We didn't -- we had limited connection with the families in Alaska. Section 7:
There were some patients that were very remarkable. I remember one woman that was a princess Inupiat. I-N-U -- is it -- from Barrow, up in the North. She was a princess. And she went out hunting with her husband, and her husband disappeared on the ice floes, and she had to walk through the ice and cold and snow back to her village or where she came from. And by the time she got back to her village, her feet were frozen.
And when we got her -- now, remember, this is long before I came, but she was there, her feet were gone, but they had prostheses and shoes. And she never complained. She was dignified. She was very quiet. But she actually worked in the kitchen. And her story was such a -- to me, I -- I felt very -- she was heroic. I just -- I felt good about that.
There was a lot of abuse in some children. Children locked in closets, children starving, this is histories that we read on their charts. The diagnosis for these children was varied. There was some schizophrenic, some birth defects, some autistic. Our job was just to make them ready to function as much as they could in the environment they were going to live in. So I don't think I'll go into a lot of the patient histories. That's too -- that's too hard to talk about. But some of it was very traumatic because of the violence of the environment that they lived in. Dark nights, cold. What, no sun for 87 days or something, and darkness. By the way, they -- the doctors did say that this contributed to a lot to the patient's depression and alcoholism. I don't know what -- you'd want to go with that, but that was something that the doctors did assume that the environment and the darkness and the wilderness and -- was contributing to the alcoholism and the depression. BILL SCHNEIDER: How did you treat those conditions?
ELAINE RITSCHARD: Now, I'm only going to speak to -- about the -- the children. Because it was such a wide variety of children, each one was treated individually. When I first arrived there, in 1963, they had a house mother and a house dad. And it was set up like a home. They were taught to get up, brush their teeth, get dressed. And they didn't treat them as individual mental health patients. They treated them as family. Children in the family. And the older children were assigned to the younger children to help them. Just like an older sister would help a younger sister.
They would also have them go to the dining -- we always went to the dining rooms. We walked to the dining room. All patients did, by the way. Even the outlying wards, they walked to the dining room. It was through the -- through the park-like setting. The ones that could not, if they were disabled, they had trays delivered to them. But I would say that was limited to maybe only two or three, and sometimes only periodically. So the children would be gotten up, bathed, dressed, toothbrushes, teach -- oh, by the way, potty trained. A lot had to be potty trained. A lot of them were in diapers. Section 8:
There was one unit that we had was for severely damaged children, it was a padded room. The bed was on the floor, and I remember walking into the unit the first week I was there and seeing this young man, young boy, about 12 to 13, all alone in that padded room sleeping on the pad. That was his bed. There was not another thing in the room. Well, I didn't like the looks of that. So I investigated what that was. And it was a disciplinary area when he was harming other children or himself, because the room had to be padded, the floor and everything. And he was -- he couldn't even be given a bed because he would hurt himself in the bed springs or whatever. So after I was there about a week or two, I decided to go in and sit with him. I -- I kind of observed how he would behave. He didn't like to eat, he threw things, the food -- you had to give him food on paper cups and paper dishes because he would harm himself or harm somebody else. And I took a radio from my home and found music that was music of nature, like waterfalls, birds singing, whatever. And I found the station that this was on, and I'd go in and sit with this young man. And not for very long. I started, what, 3 minutes, 5 minutes, whatever. And he responded to the music. And I don't have to say anything, we'd just sit there quitely, let him respond.
He started eating. He started -- not -- he never did communicate, but at least he was quiet. He could sleep. He could eat. He was soothing. And I did that for about two weeks, and then I assigned my helpers.
I had a lot of help. Morningside gave me a lot of help. I had at least eight caregivers, a male and female, young man, young women, and they were wonderful. They -- they took care of these children beautifully. Section 9:
By the way, I replaced the mother and father image. They were stronger in discipline. They got their work done, but they were doing some things that I had the choice to change.
One of them was they used food as discipline. Like if the child wouldn't do something, they held back their lunch, or held back their treat, or held back -- they didn't get to go to the dining room to eat. Well, I didn't like that. I thought, huh-um, I'm stuck with how I took care of my own kids. You can sit them on a chair. You can sit them in the corner.
One of my sons complained that he wondered if his nose would ever grow because he was in the -- in the corner, standing in the corner in the kitchen so much, that was Christopher.
[to her son, Brad, who is observing the interview] It wasn't you, dear. It was Christopher. But I started using the same techniques on my -- as I used on my children as I did on these children. And I felt it was much more -- well, it satisfied me.
I just didn't like the looks of that young man in that room. I didn't like the looks of the kids not going to the -- to the cafeteria to eat and -- or holding their food back. That didn't sound good to me. So those things I liked. And they responded. And believe it or not, 20 years later I heard on the radio about this new treatment for children using music. And I thought, ha. I did that 20 years earlier.
BILL SCHNEIDER: What was the reaction amongst other staff to what you were doing?
ELAINE RITSCHARD: Very, very good. Now, the staff in my unit. By the way, Lynette McCoy and Helen Nigh were the superintendent of nurses, and superintendent at Morningside Hospital, all nurses were under them. All nurses aides, all caregivers of all kinds. Orderlies, were under Lynette McCoy and Helen Nigh. And they went to Valdez and worked the first year in Valdez until that earthquake. That was 1964, wasn't it?
BILL SCHNEIDER: Uh-hum. ELAINE RITSCHARD: So the earthquake, I don't know what happened because I didn't keep a connection there, but they came back, I think in 1965. Was your hospital rebuilt in another section?
BILL SCHNEIDER: I'm not sure what -- what happened with Harborview, but it was in operation after that.
ELAINE RITSCHARD: Okay. I think they moved it after the earthquake.
BILL SCHNEIDER: Yeah. It was in operation. ELAINE RITSCHARD: But anyway, they were -- my superintendent of nurses went to Valdez and worked as supervising nurses there. It was the supervisor and the assistant. It was Lynette McCoy and Helen Nigh. Section 10:
BILL SCHNEIDER: But I was wondering what the impact was of your, what looks to me like, very progressive treatment.
ELAINE RITSCHARD: Well -- well, I wasn't -- I'll start with the children's unit now. I'll start telling you about the children's unit. First I worked in the emergency section where the -- and then I worked in the geriatric section. Now, those were Alaskans. They weren't all Natives, but they were Alaskans. When I say geriatric, I mean my age today. And they were pretty well regressed. They had had electric shock, they had been in an institution for a long time.
Our role at that point was to motivate them. Get them moving. And to do that, we gave parties, like New Year's Eve, I made them hats, made them march with kettles and bongs and horns. And get them up on their feet and move them around. They were content to sit, just sit. But they walked over to the cafeteria and they ate, and they walked back. That was their exercise. And you can see that the buildings are far enough apart so that it was a nice walk. That was their exercise. So then I worked from the emergency room to the geriatric. Then there was an intake ward where community people started coming in for short term. That's where Dr. Bowerman and Dr. Moss worked. Dr. Stewart was the head of all of them. And there were a couple other doctors, but I don't remember their names at this time. Then the superintendent of nurses, Lynette McCoy, asked me, she said, we have to prepare these children to live in the community. And she said, I'd like you to take over the unit and start getting them ready to move out into the community because these children will be taken care of in homes, foster homes, back in the community, maybe even enter the school system, which you know they did eventually. So she gave me two Volkswagon busses, it held eight people. She gave me a young man and two other nurses aides. And we started planning activities, not only on -- on campus, but out in the community. And I used the same system that I use for my kids. For instance, I would try out a lot of things at home that Brad may remember. Clay, play dough.
There was another system that was really neat. It was whipped Ivory flakes. I don't know if you still get Ivory flakes in the grocery stores, but you can take an Ivory flake with water and it whips up like a whipped cream, but you can make it thicker so the kids can work it with their hands. And you add food coloring to it so you have all kinds of colors, you have a bowl of yellow, bowl of red, bowl of green, whatever. And I tried this out at home. My kids had to experiment with this so I'd know how to do it. And then we'd put them on poster boards or just wooden things.
And Lynette gave me a whole building that used to be a patient care building for the kids to have activities in. Because in Oregon, it rains a lot. So we kept the kids inside, and we started all of these hands-on activities. We had a -- we set up a make-believe grocery store, got all kinds of little cans of things so they could learn how to work in a grocery store.
We set up work tables and they made beautiful pictures with -- you could make a mountain out of this Ivory flakes. You can make skies and stars. And then with their -- and then with their play dough, I've still got the recipe for the play dough because it was made with a lot of salt, flour, powdered alum, and of course, always food coloring. And these kids could make all kinds of things with the play dough. Then there was another thing that I made, it was a -- we called it Jansen Beach. And it was boxes and boards and tires and the kids could walk across bridges and crawl through tunnels. And I just did all kinds of play things that these kids could do. Then they allowed us to go out into the community. We visited schools. We went to shopping centers. We went to grocery stores. We went on picnics up the Columbia River. Rooster Rock, Benson State Park, all the places that I had taken my own family.
And we could take 8 at a time with two busses, there were 16. There was one thing wrong with those busses, those Volkswagon busses. They couldn't go up a hill. They would just chug along. But these kids learned to be out in the community. And that was my role. Section 11:
Now, how they responded to the music and the treatment, they responded to everything. Limited, of course. You've got to remember, these were educable kids, to the age, what were they, in the third grade, 9, 8 or 9. A lot of supervision. Had to hold hands. They'd take off. Had to hold hands. And we always had a system of two hands and the attendants out on the ends.
They had to learn to be quiet. And we learned to do that just by hand, like this. (Indicating finger to the lips.) Or no. (Indicating shaking head.) They responded beautifully. They did have good care, before I was put in the unit. They -- people taught them how to dress. They were potty trained. They ate well. They cleaned up after themselves. They picked up their toys. Morningside provided toys. Morningside provided everything. Everything that other kids got, these kids got. We had people come in from the Girl Scouts, the Boy Scouts. Now, this is where my kids got involved. I brought them over for programs. My kids played -- Heidi played the accordion, and I brought my kids over to interact with them. They had other community services come in. I'd call them and make dates with them, they'd come in just like they bring us music here. We had programs for them. I would say that Morningside did very well for them. For all of the patients. In the beginning, there was limited because we didn't have the medication to give them the ability to function like they were when I arrived. When I arrived, they had had medications for, what, 10 years.
What can I -- what can I -- BILL SCHNEIDER: So that's an interesting point. You -- your -- if I hear what you're saying correctly is that the medications had a big impact on being able to give the residents a greater degree of freedom in terms of adapting to society.
ELAINE RITSCHARD: Correct. Correct.
BILL SCHNEIDER: And before that, they were very limited methods, and -- ELAINE RITSCHARD: And they had their environment had to be very well lock and key; hurt themselves, hurt others. Not after the medication. That took care of a lot of that. However, to keep them on the medication, that was the difficulty that you're seeing now, they still needed a structured environment where those medications could be given so they could take care of themselves. That's where the loss is today. Section 12:
BILL SCHNEIDER: What about interactions between the residents? You mentioned the helping that occurred of older residents with the younger children.
ELAINE RITSCHARD: I don't understand what you're saying.
BILL SCHNEIDER: What were the -- obviously friendships developed between groups. ELAINE RITSCHARD: Yes, but these were young children. But I mentioned that the older ones came over. They were free to come and go, though. There wasn't a regular structured hour that they were there, but they come over and played with the children or join them in their activities, or just sit and read them a book, or just visit with them and play with them. There weren't a lot of them, but by the time I got there, we were limited in -- in how many were left at Morningside.
BILL SCHNEIDER: That's right. That was the --
ELAINE RITSCHARD: The young children got along with each other. If they didn't, they were disciplined. And when I say, for instance, if one child would start hitting the other one, you would treat them just like you would your own child, you don't do that, you sit in that chair or you say your sorry or you -- whatever the -- the behavior was, you took care of it immediately. And the discipline that was given by the couple before I came was very strict. I don't know if they got spankings or not. I don't know that. But I know it was very strict. And I know that these children, by the time I arrived, were well behaved. And if they weren't, we took care of it just like you would your own child. BILL SCHNEIDER: Yeah. Amongst the older residents, were there cases where romantic relationships developed between the residents?
ELAINE RITSCHARD: We had to watch that. We had to watch when they were out on the grounds that they didn't get into the bushes. And that was supervision. Just plain supervision. They -- we had a ballpark out back where the gardens were. They could play ball. They could play kick ball. The little kids did, too, like soccer, but it wasn't soccer but just kick ball.
Some of them had bicycles, now that I remember, rode bicycles around on the grounds. A lot of it was work. Kept them pretty busy working, the ones that could. The ones that were sedentary, we had to keep them moving. It was hard to -- but the thing that surprised me is they didn't wander away. They were content. I -- I think I picked up something else. They were content to sit a lot. It was harder to get them to move a good percent of them. It was like they were in a dream world. And I don't think it was all medication. I think it was their former environment. I think they came from a place where they did a lot of sitting and thinking. Or living within their own thoughts. I just feel that they came from a -- I know that they were different in the way they responded to people that were not Natives. They kept things to themselves. They did not open themselves up to share a lot of themselves. They shared with each other. You can see them giggling or laughing or punching each other, you know, or making believe of somebody, look at them, you know, sort of thing. They were -- yes, there was a connection with them. They connected with each other. And they helped each other. And I didn't see a lot of non-Natives by the time I got there. Section 13:
BILL SCHNEIDER: How -- how were the Coes to work with?
ELAINE RITSCHARD: The only one I knew was Henry Coe, Jr. And I tried not to have too much to do with the administration because I didn't always respect the administration for the fact that I saw some discrepancies in what was needed and what was allowed and what was given, and he was having a lot of trouble with financial stability because the hospital was closing. So we had a lot of trouble deciding what to keep and what to let go.
And there was an apartment above the administration buildings where he would stay periodically. And the superintendent of nurses and the assistant took care of all of that. And I didn't have any kind of decision. I didn't -- I stayed away from all the administrative type things. I wasn't interested in that. But as far as what the hospital was set up to do in the beginning by Mr. Henry Coe, the father, was very good. By the time I got there, it was changing in its environment and its hands, but it was still a -- the patients still got good care. They got excellent food because they were using the gardens. The kitchen was done as a cafeteria. It was -- they ate very well. I -- BILL SCHNEIDER: Why -- why did you mention the apartment above the administration?
ELAINE RITSCHARD: Because he would come and stay periodically for periods at a time.
BILL SCHNEIDER: And why was that?
ELAINE RITSCHARD: I don't know.
BILL SCHNEIDER: Okay. When -- were you there during the congressional investigation in the mid '50s, I guess that would have been before you? ELAINE RITSCHARD: Well, what year was it?
BILL SCHNEIDER: 1950s, in the '50s years.
ELAINE RITSCHARD: No.
KAREN BREWSTER: What were the exact years you worked at Morningside?
ELAINE RITSCHARD: Well, about -- well, 1960 to 1968, but I was off with my youngest daughter, so I was gone for about a year and a half in that period. When I first started was around 1960, but then I was gone for a while, then I came back. It was after I came back that I worked with the children. That was 1963. That's when I came back. But I was gone for a little while there. But I didn't know of any problems. And I made a point not to be interested.
BILL SCHNEIDER: Right.
ELAINE RITSCHARD: My job was taking care of the patient or the children. I didn't -- I didn't bother myself with any of that other stuff. Section 14:
BILL SCHNEIDER: Did you know a Dr. Keller?
ELAINE RITSCHARD: No.
BILL SCHNEIDER: That may have been earlier. But you knew Helen Nigh, you mentioned, and she was influential in endorsing the type of programs that you were trying to -- ELAINE RITSCHARD: Well, actually, Lynette McCoy was. She's the superintendent.
Helen Nigh was the person that was the assistant, and she was more in seeing that we got supplies, got the things that were needed to take care of whatever we needed to take care of. She was -- she took orders from Lynette McCoy. We didn't answer to Helen Nigh, we answered to Lynette McCoy. At least I didn't. I don't know --
BILL SCHNEIDER: And from what you're saying, she was pretty supportive of what you were doing? ELAINE RITSCHARD: Yes. Both of them were. Well, they assigned me there. They came to me and asked me to do it. It was something that they had to set up because it was -- it was getting ready to close, and it was getting ready to move the kids out into the community, and the Alaskan hospital, I believe, was built. And when I was there, they were already flying some of them back, but not as -- I just didn't see that many going back. The ones that I did see go back were maybe 8, and maybe one or two attendants would fly back. I had the opportunity to escort them back, and I -- I -- I didn't because I had my own family and I didn't want to leave my family, so I never escorted any groups back. I don't remember ever being involved in any administrative decision. I just wasn't interested.
BILL SCHNEIDER: But it would be interesting for us to talk to Helen Nigh and Lynette.
ELAINE RITSCHARD: I don't believe they are alive. They were already older than I was by maybe five to ten years. Lynette McCoy's family, however -- I did check the phone book to see if I could find either name in the phone book. Their -- when they came back from Alaska, they had a home in -- on the mountain near Welches. And I was invited to an outdoor gathering when they came back from Alaska, and my husband and I did attend. All the old superintendents and nurses and people that worked for them were invited. And my husband and I did go. We did drive out to Welches. That's the last I saw of them or had connection with them. But Helen Nigh was from the South of Florida, and Lynette McCoy's family were right here in Portland. She went to Reed College. So -- but I didn't find them in the phone book. I didn't find that name at all. So I couldn't check on that. Section 15:
BILL SCHNEIDER: Do you know where the people were buried who passed away at Morningside?
ELAINE RITSCHARD: No. No.
BILL SCHNEIDER: How were burials handled?
ELAINE RITSCHARD: I didn't see anybody die. I never knew anybody passed away. BILL SCHNEIDER: Do you have any information on the patient records? You mentioned they entered the Oregon Welfare System, many of the people at the time, when --
ELAINE RITSCHARD: No. Once they got into the welfare system, I only ran into them because I was in nursing.
And I did hear that someone adopted some children in Vancouver, and then in Onalaska, in Washington, there's a town called Onalaska in Washington. And I know one family adopted five Alaskan Native children. And I only heard that as a passing remark, but I told them I used to work at Morningside, and I never followed up on it or paid any attention.
But I did run into the patients in the nursing homes when I was working for a friend of mine that had a nursing home. I ran into a couple of them there. But I never followed up on any welfare. I was too busy with my own family. And I had other jobs.
I went from there into Providence Hospital and so I didn't follow up on -- when I left Morningside, I didn't -- I didn't follow up on anything. That was -- Morningside was -- was still going when I left because they were taking community patients. They were taking private patients when I was there in that children's department, I had private patients from Multnomah County, children. And then the police were bringing in from Multnomah County, too, in the emergency section. That all happened after the children and the Alaskans went home. But as far as anybody -- I don't remember anybody ever passing away. But then I -- you've got to remember when I was there. It was at the tail end of Morningside. And it was sold to a -- it's a -- it's a shopping center, mall 205 is a shopping center. I did see one shed or building in the back when I drove down through -- let's see, Seventh Day Adventist Hospital meets the back end of the property, I saw an old shed still standing on the property that was there. But it had a school on it, it had barns, it had -- it was a -- it was a farm. And I know that they all worked there, I know that the Alaskan patients. But we called them residents by the time I got there; they weren't even patients, they were residents.
BILL SCHNEIDER: I just keep thing about the older people, not in the children's ward, but the --
ELAINE RITSCHARD: The geriatric unit?
BILL SCHNEIDER: Well, that, yeah, and -- and where they might have ended up.
ELAINE RITSCHARD: In nursing homes.
BILL SCHNEIDER: Oh. ELAINE RITSCHARD: That geriatric unit went into -- if there was no one in Alaska that took them back, or called for them, they went into nursing homes. And I don't remember any of them ever passing away while I was there. They went into nursing homes.
BILL SCHNEIDER: So in terms of families tracing those people, it would be very hard, wouldn't it? But nursing homes -- ELAINE RITSCHARD: Yes. I would suggest they go -- I don't know what kind of a system the welfare system has, if they keep records or not. Does Alaska keep good records in their welfare system?
BILL SCHNEIDER: I don't know how good their records are.
ELAINE RITSCHARD: Well, I don't know what Portland -- or Oregon does, or the -- or even the county, but you'd have to go there, look at their records, and -- I don't know how you'd do it. I guess by the year. It would be 19 -- it would be 1963, the era would be '60 to '63, the years that they would be going into the nursing homes. Children would be foster homes. Adoptions.
I'll be very honest with you, I don't remember many going back to Alaska. They were lost in our system, in our welfare system.
BILL SCHNEIDER: I think that's probably true. ELAINE RITSCHARD: And I don't know how the families would find them except trying to find records from the -- from the state welfare system.
BILL SCHNEIDER: Uh-hum. Are there any parts of your experiences at Morningside that I haven't touched on or we haven't touched on that -- that you think are important for the record? Are there any memorable experiences that we ought to know? ELAINE RITSCHARD: I don't think any that would be helpful to the families or to you.
I was -- I was surprised at the type of children that were kept in -- in a hospital setting that were microcephalic, hydrocephalic, limited, so limited that they were only kept alive with tube feeding. They were picked up out of those cribs and rocked. They were dressed. They had zero response to their environment. Zero. And they were kept alive with IVs, with tube feeding. There were about eight of them. I couldn't believe that type of patient was there in that environment. There was about eight.
And we had special duty nurses that would care for them night and day. The ones that did respond were still going to respond only to limited amount of activity and education. Even the people that adopted them, but they are in our school system today, because my daughter-in-law takes care of them in the schools today. Brad's wife. So they are in our system.
BILL SCHNEIDER: I want to change the tape and I have a couple more questions.
Section 1: Improving coordination in delivery of mental health services in Alaska, working with doctors, and providing educational training.
Section 2: Patients being sent home from institutions, and people who made important contributions to mental health services in Alaska.
Section 3: Comparing the early Alaska Psychiatric Institute facility with other institutions.
Section 4: How he got interested in the field of psychiatry.
Section 5: Work with the Oregon Health and Science University Medical School in Portland, Oregon and involvement with health boards and physician oversight in Oregon.
Section 6: Establishing the first mental health programs in the Indian Health Service.
KAREN BREWSTER: My other question had to do with -- well, we were just talking about how the institutional facilities were receiving your attempts at changing the practice for mental healthcare. I'm wondering how people in the communities and in the villages received your presence. JOSEPH BLOOM: Well, our main work was in the towns. The villages were -- we were mainly functioning as consultants to the doctors or other people, social service agencies, all of these main offices were in the towns. So I would say that -- that most of our work was there were village trips were to see a specific person or to find out something about a specific person, and they were not -- they were usually done just within the local area to the hospital. They weren't cost effective to go flying out to one place just to find out a little bit more that we could -- than we could get from health aides or doctors who have been there, or social workers who had been there. So within the towns, I think people were very receptive to us. I mean, I don't -- I don't remember instances where there were any kind of major difficulties. Again, because we were trying to bring people together.
A couple of times, you know, when I said we had consultants, we had -- we put on seminars for people in the towns. I remember one, smiling about we had one seminar, I brought a man who was one of my teachers who was a family therapist from Boston, Norman Paul. He's a well-known family therapist. And we had a seminar for anyone who wanted to come. And it was one of those days, it was like 35 below and the wind was -- it was about as cold a day as I ever had up there in Alaska. And we had a whole bunch of people came out at night to -- to hear Norm talk about family therapy. And he was very good, he had a lot of tapes and videotapes and audio tapes of families, so we would -- we would try to do that, too, have educational sessions for people with consultants. And so we didn't -- I think, you know, people were working -- I said this earlier, but they were working hard, and many times in isolation, and bringing people together, it never -- it wasn't an issue. It just -- I don't remember it was -- there wasn't very much resistance. We weren't doing anything that was that radical. It wasn't a problem. KAREN BREWSTER: Well, I was wondering more, were people just so happy to finally have some help in the mental health services?
JOSEPH BLOOM: Well, I don't know how happy people were, but I don't think -- I would say it was more even. It was -- you know, I think when you're out in difficult environments, I think people are -- they know that there's limits, so just having some services was good, trying to get some coordination with the state services was very good for people, but you know, they were operating in difficult situations, and we were not overselling what we were doing. Section 2:
KAREN BREWSTER: The other question I have is when you were talking about Morningside, and patients returning to Alaska from Morningside, and we've heard stories about many times patients being sent home to the village, they didn't go to API, they just were sent home, and then their having to cope with transitioning back into community life. And if you saw any of that returning as patients into your services. JOSEPH BLOOM: I -- I don't remember that. You know, there -- Morning -- people were sent to Morningside, I'd imagine many people were civilly committed to Morningside, and they didn't have to necessarily go back or they went back before API -- I mean, people were going back before API opened. So I don't remember encountering many Morningside people. We certainly encountered people who were discharged from API within the few years who had been out for a long time in the villages, but I don't -- I don't have a recollection of Morningside people. But it's not surprising what you say because on a civil commitment, usually people can just be sent, released by the -- by the hospital and the physicians. And you know, I would guess that there wasn't very much coordination between Morningside and what -- wherever they sent them to. BILL SCHNEIDER: I guess one final question is when you look at the -- the history of delivery of services, who are some of the people that really stand out as having done a major job in bringing services to Alaskans? You've mentioned Dr. Wolf and some of the -- and one or two other people, but I wondered if you might pick up on that as a conclusion here. JOSEPH BLOOM: When I was in Indian Health Service, the initial -- the first year I was there, the person who was in charge of the whole Indian Health Service in Washington was a man named Stu Rabow. And he was -- he came from the earlier days of the Bureau of Indian Affairs, and he was in Alaska. And he understood the situation there quite well. And I think he was very sympathetic to developing more services in Alaska. I mentioned some of the psychiatrists. The early pioneers, I would say, would be Dr. Langdon and Dr. Rader. There was a woman who also, I knew her later on, Virginia O'Malley, who did a lot of work in public services. People who came later, like Dr. Koutsky and Dr. Stillner, I think they made very good contributions.
Bill Richards, has his name come up at all?
BILL SCHNEIDER: I don't have it. JOSEPH BLOOM: Bill Richards, when I left -- I left Indian Health Service in '68, there was a -- another person who was assigned to a man named John Ackerman, and he stayed there for two years and then left Alaska. And Bill Richards took over the head of the Indian Health Service psychiatric unit. And by then it had grown, it continued to grow. And I had mentioned the consultation that I did with YKHC; well, Dr. Richards was involved in that from the Indian Health Service, and he was a long-time director of psychiatry or of the mental health services for Indian Health Service. And you remember when there first started to be contacts between Alaska and Siberia? Dr. Richards was on one of those trips and died in a boating accident. And he -- he was a very quiet guy. I mean, he -- he was not out front and you wouldn't know in a room that he was there, but he was an extremely steady person. And built things year after year. And he would be somebody who should be remembered. I don't remember what year that was; probably, what, ten years ago, or maybe more than that.
BILL SCHNEIDER: When he passed away?
JOSEPH BLOOM: When he died, yeah. Yeah. And he was -- he was -- he died in a boating accident. And my understanding of it, he was -- they were out boating and -- or they were with some hosts there, and the boat disappeared, or they disappeared, the boat may have been found. Flipped over maybe. And -- but he's some -- he made a major contribution to the services there. I'm not -- I'm not sure about the people at API after -- after Dr. Koutsky. Dr. Koutsky was at API and then became head of the -- also head of the mental health division for the state, and then subsequently moved to Oregon; actually, he was in Klamath Falls for many years, a very solid person. There are some people on the research side, does the name Bob Kraus come up at all?
BILL SCHNEIDER: It hasn't.
JOSEPH BLOOM: Bob Kraus was a psychiatrist who very interested in anthropology; and he came from Philadelphia with another psychiatrist, Ed Faulks, and both of them were mostly in Alaska as research people. Ed may have been with the Communicable Disease Center as a psychiatrist, but they -- a lot of Ed is -- both went on to distinguished careers in transcultural psychiatry. Ed's now in New Orleans. Both are about my age or a little older, and probably both retired. But they -- they made good contributions over the years, mainly on the research and writing ends. Now, you had mentioned over the phone Thelma Langdon. She's a person who just, from -- we knew her from the mid '60s on, you know, and she just worked and worked and worked in trying to improve services. And so she certainly should be mentioned.
I don't -- I don't know if any others come -- and I certainly don't -- oh, and you were going to see Jerry Schrader. BILL SCHNEIDER: We have talked with him. Uh-hum.
JOSEPH BLOOM: Yeah. Jerry was also an Oregon person from Salem, and trained at the Oregon State Hospital, and I just saw him about a month ago. And certainly he figured out something that no one else did, as far as I understand it, in terms of the lands issue, or -- I always heard that as kind of a -- oh, yeah, there's lands out there, but that's about as far as I ever knew. Mental health lands.
BILL SCHNEIDER: Uh-hum. Uh-hum. Yeah. It played a, looks like, a key role.
JOSEPH BLOOM: Yes. Section 3:
KAREN BREWSTER: Talking about API, I know it was only a few -- it had only been in operation a few years when you got there, but if you have a sense of the type of care and the quality of care and type of facility that it was. And I know things have changed in delivery of services, you know, and it's hard to assess from a modern -- to what it was like then, but if you have had thoughts on that at the time? JOSEPH BLOOM: Well, API was startling to me. I came from training in Boston and I did a paper in my last year of residency on a hospital called Danvers Hospital. Danvers Hospital was North Shore of Boston, and it was affectionately known by the local people as the Pauper's Palace. It was built in 1860s or seventy -- probably 1870s, late 1870s. And it's like a medieval dungeon. And by the middle of the '60s, these hospitals had started to -- these state hospitals had started to reduce their census, but Danvers, still, I went up there a few times, and I felt like it was awful. And I had been -- earlier when I was in medical school, I had been in one of the New York -- Harlem Valley, which was a New York State psychiatric hospital that served the Bronx, where I went to medical school. It made Danvers look good. It was awful. But that was even earlier. And I got to API, I mean, this was a 200-bed hospital, it was new, it was brand new, and it was clean, and it had nice rooms, and it was staffed. And you know, as I said, it was startling to me. I always described it as a new, small -- it was a key small hospital. And whatever its shortcomings, all of those things, you know, made up to it, from my frame of reference.
I mean, I'd never seen anything like it, frankly, in any of the eastern places. You know, to see a new, small facility that was staffed was very good. So that -- that was my initial response there. I mean, it -- it just was such a contrast for me that it was a very appealing place. Section 4:
KAREN BREWSTER: One thing we haven't talked about is what inspired you to go into psychiatry in the first place?
JOSEPH BLOOM: I actually can answer that question. I and many medical students make up their minds about what -- what they want to do kind of in their third year, or it's very difficult before to actually know what you want to do because you don't -- at the time I was in medical school, we had just very minimal clinical activities prior to the third year. It was mostly basic science. We did have some, but not a lot.
And then I -- I -- I was interested in internal medicine, and I had my clerkship in internal medicine, and then I did the psychiatry clerkship, and the teachers were wonderful and they were very dynamic. I can remember one person who was a very famous psychiatrist in the states, and I went to Einstein and they had an excellent Department of Psychiatry. And this guy was going to demonstrate to the medical students the difference between mania and agitated depression. And he's showing you the person was agitated and depressed and kind of slumped over and talking very low, and he was giving a demonstration of agitated depression; and he gets to mania and he jumped up on the table. Of course, I've never seen anybody do that, but he jumps up on the table, we're all sitting around the table, the students, and he's walking across the top of the table. And talking a mile a minute. And he said, this is what mania looks like. And as I said, I'd never seen anybody do that, but I've seen some pretty wild things. And I said, that's pretty interesting. This is a pretty interesting field. And then the -- the stories that the patients had, and again, in the third year, you interview, you know, you're running mostly on an inpatient service and you get to interview people, and I couldn't believe the stories, they were just so different than a regular medical story, or questions. And then in my fourth year, I went and did six months in a psychiatric facility in Cambridge, England, which only magnified the stories, and at Fulbourn Hospital in Cambridge, and I did training rounds at the University Hospital, and so that kind of solidified it for me. But I was pretty much sold after the third year, after the clerkship. And I have no regrets on that. It's been a very interesting career. And this job that I had, it's my first job, and I often describe it to people as my best job. You know, I had some good jobs.
BILL SCHNEIDER: The Alaska job? JOSEPH BLOOM: The two years in the Indian Health Service. It was just unique. You know, it had frustrations, it had its this's and that's with the bureaucracy, and disappointments, but minimal. Minimal. So that's how I got interested in it. Section 5:
BILL SCHNEIDER: And I guess we should say what your current job is.
JOSEPH BLOOM: Well, I'm -- well, I have a current job right now, but I -- I basically I was Dean of the medical school for close to 10 years here. And I stopped doing that in 2001. And from then to now, I've been doing small things. I've been teaching; we have a fellowship in forensic psychiatry, and I've been teaching in that. And I do some cases. I've been consultant to the Oregon Medical Board since 1984, and just a month ago, they asked me to help them with a transition of their impaired physicians program. We had some legislation last year that's mandating the transfer to a -- from a board-run program to a non board-run program that's going to encompass all the other health boards. So we have a big transition. We have about 100 physicians on the impaired physicians program. So I agreed to work two days a week for them for April through June.
BILL SCHNEIDER: What's impaired physicians?
JOSEPH BLOOM: Well, these are people mostly who have been impaired by substance abuse.
BILL SCHNEIDER: Physicians you're talking about? JOSEPH BLOOM: Physicians. Yes. And then who get referred -- they go through an extensive evaluation and inpatient treatment. I mean, these are programs that have been around in the country since the mid '70s, or before. And through rigorous monitoring and treatment programs, sometimes inpatient programs, about 80 percent are able to return to productive work. Our program is basically a five-year program. So it's a rigorous program. I mean, there's some wrinkles in that, but that's basically the program. So I'm doing that from now -- as a matter of fact, I'm going to go this -- to work this afternoon, but until the end of June. And I'm back doing what I've been doing, which is writing some and -- and teaching and just hanging around the medical school a little. Not a lot. Maybe a day a week.
BILL SCHNEIDER: Good. Section 6:
KAREN BREWSTER: My one sort of last question is, it sounds to me like your work with the Indian Health Service, you sort of launched its mental health program in Alaska. And is that how you see it and how you feel about that? What's that meant to you? JOSEPH BLOOM: Well, yeah. I mean, we were the first mental health program in Indian Health Service, along with the small Pine Ridge program, same kind of thing in Pine Ridge, a small team; and the program in Gallup, these were the first forays into mental healthcare. So from that point of view, we did launch this program and it was, I think that's accurate. And it -- you know, it's always nice when you have the opportunity to start something and to try to put things that you've learned into practice. And not come into something "that's this is the way we do it around here."
That, by the way, is my definition of culture. This is the way we do it around here. And that's -- you have cultures, mini cultures all over the place. So yeah, you could put a little stamp on it. You know. I probably -- no reason to suspect that I would recognize what exists now, but that's the way it felt for me.
KAREN BREWSTER: And how did your years in Alaska influence the rest of your life and your career? JOSEPH BLOOM: Well, I always -- I developed this interest in transcultural psychiatry, and that -- and then I developed this interest a little further in transcultural forensic psychiatry, and that's been an area where I've written in and done work in for years. And I learned some methods up there, I alluded earlier to the anthropological literature. Well, when I was putting it -- putting a little library together, which, by the way, I still have somewhere up in a storage place up at the medical school, I mean, if you read a hundred papers, you would know a lot of what people had written and thought about in this kind of overlap between anthropology and psychology and sociology, and so I learned methods. And I've done pretty much that and community psychiatry, which we talked about earlier, putting that together. That's pretty much what I've done.
Dr. Joe Bloom was interviewed by Bill Schneider and Karen Brewster on April 20, 2010 at his home in Portland, Oregon about his career as a provider of mental health services in Alaska. As a psychiatrist, he helped establish mental health programs for the Indian Health Service in Alaska in the late 1960s, and worked to provide coordinated services for rural Alaska. He also worked as a private psychiatrist in Anchorage, and later went on to teach psychiatry and be the dean of the Oregon Health and Science University Medical School in Portland, Oregon. He retired in 2001, but has remained active with psychiatry and health board issues in Oregon. In this interview, Joe talks about becoming a psychiatrist, working for the Indian Health Service in Alaska, working in rural Alaska, coordination between different agencies and hospitals, and changes in Alaskan mental health services.
Part two of this interview.
Click to section:
Section 1: Personal background, education, psychiatric training, and getting a job with the Indian Health Service in Alaska.
Section 2: Focus on community psychiatry and mental health effects as the result of epidemics and population change in Alaska.
Section 3: Development of mental health services in Alaska and types of cases treated.
Section 4: Mental health services in Alaska and coordination between Public Health Service, Indian Health Service and the Alaska Psychiatric Institute.
Section 5: Providing periodic mental health clinics in rural Alaska, the mental health effects of leaving home for a high school education on adolescents, working with medical doctors on patient referral and follow-up, and continued efforts to coordinate services.
Section 6: Village mental health services.
Section 7: National focus on development of community mental health services, work in rural Alaska, and investigation of treatment of mental illness in Alaska's jailed population.
Section 8: Cultural issues in the criminal justice system, and availability of community mental health services.
Section 9: Transition between Alaskan patients being treated at Morningside Hospital in Portland, Oregon and at Alaska Psychiatric Institute in Anchorage, Alaska.
Section 10: Impressions of Morningside Hospital, working at Langdon Clinic in Anchorage, Alaska, and expansion of private practice psychiatry in Alaska.
Section 11: Description of Dr. J. Ray Langdon and role of the Langdon Clinic in psychiatry in Alaska.
Section 12: Effects of epidemics on the Alaska Native population and the after effects on mental health in later generations.
Section 13: Changes in mental health service in Alaska.
Section 14: Removal of patients from their homes and transfer to a hospital, and changes in the procedures and practices for doing this.
Section 15: Coordinating mental health services and need for cultural understanding between Alaska Psychiatric Institute, Indian Health Service, Public Health Service, and villages.
BILL SCHNEIDER: Okay. Today's April 20th, 2010. Bill Schneider is here, and Karen Brewster. We have the pleasure of talking today with Dr. Joseph Bloom, and we're going to talk a little bit about your personal history, and then get into your activities up in Alaska.
So tell us a little bit about your personal life, where you grew up and your education. JOSEPH BLOOM: Yeah. I grew up in New York City and went to school in New York City. I went to -- through public schools in the city, and I went to college at Columbia College in New York and medical school at Albert Einstein College of Medicine, and again in the city. I graduated in 1962 from medical school and was interested in a career in psychiatry, but in those days they had a separation which doesn't exist now between internship and residency. So that -- my first -- actually, we were married at the time, and our first trip out West was for internship. I went to San Francisco to the Mount Zion Hospital and was there for a year, and then I went to Boston and did my psychiatric training at the Massachusetts Mental Health Center. And in those days, they were still drafting doctors; and I got a deferment through the Public Health Service, which the plan was called the Corps Plan, and the deferment allowed me to complete my specialty training, my psychiatry training, and so I entered the Public Health Service in 1966 as a specialist. And Public Health Service at that time, and still today, runs many different types of services. The Coast -- they do the medical care for the Coast Guard, and just -- the Bureau of Prisons, many different things.
And I remember distinctly having to go to Washington to interview in these various different places to work on developing a assignment for myself, or where they would assign me in the Public Health Service, and one of the places that they had scheduled was the Indian Health Service. And this was 1966. I don't know if people have told you much about the Indian Health Service in the past, but it -- the Indian Health Service was relatively new in the Public Health Service. It had -- the healthcare of American Indians and Alaska Natives had been in the Bureau of Indian Affairs until 1955. And the care there was very problematic. And in '55 they switched the healthcare from the Department of Interior to -- Public Health to HEW. And they formed the division at that time, the Division of Indian Health. And their initial problems, especially in Alaska, were problems of infectious disease, a huge tuberculosis epidemic in Alaska. And very, very high infant mortality all from infectious disease. And so for ten years, the Public Health Service in Alaska helped get these various epidemics under control. And one of their major accomplishments, and I don't know if you've ever seen their slide of their -- the dramatic decreases in tuberculosis rates, and basically, the -- the halving of infant mortality rates. But that's not our topic.
So in -- in 1966 was the first year that the Indian Health Service did anything in Alaska or nationally to introduce major mental health programs. And they started small mental health units, one on Pine Ridge Reservation in South Dakota, one at Gallup Hospital in New Mexico. And the other one, and when I went to the Indian Health Service office, they told me about this new initiative that Senator Bartlett had sponsored, which gave $100,000 to the Indian Health Service in Alaska to start a mental health program that would concentrate on the Eskimo areas of the state. So the west or the northern parts of the state. And the $100,000 was to put together a small mental health team. And I swear to all my friends and my wife that I said to them, "That sounds interesting." And left, and was all set to do something else, and I got this letter saying, congratulations, you got your first choice, you're going to Indian Health Service in Alaska, which turned out it was -- it was really a great job. And so we went up there in 1966, and that was our first introduction to Alaska. Section 2:
We stayed in the Indian Health Service -- and we'll talk more about that -- for a couple of years; and then we had always intended to go back to Boston and we did. We went back for a year. I took a fellowship in community psychiatry in Boston, in 1968; and then we decided we hadn't had enough of Alaska, so we went back up there and we stayed there from 1969 to 1977.
I was in private practice at the Langdon Clinic. And then in 1977, I took a job at the medical school here in Portland, wanted to get into academic psychiatry. And I basically have been here for the rest of my career in the Department of Psychiatry, in later years in administrative jobs in the medical school. BILL SCHNEIDER: So that first period when you were working for the Indian Health Service, TB was a huge problem. And I know that you have some things to say about that, but one aspect of that that I wanted to ask you about was patients were taken out of the communities in many cases and taken to sanitariums?
JOSEPH BLOOM: Yes. BILL SCHNEIDER: What was -- what did you see as a psychiatrist in terms of the impact on families of that period?
JOSEPH BLOOM: The TB epidemic was very extreme there. And as I was told then, and I haven't really researched this much since, but I was told then that they recorded the highest TB death rates ever recorded in the world in Alaska. And the effects on the families were very dramatic. I mean, you'll hear many, many stories of how people were separated from the families, a plane comes into the village, drops a note, we need this person to come to the hospital, that person goes to the hospital, and many people died in the hospital. People died in the villages. It affected children and it -- I think it was a big disrupting influence on the lives of many, many people. And I think I also, in my early days, I was up there, I was very impressed with the fact that there was extremely large family size; and as the death rates decreased from infectious disease, the size of the families increased. And the -- I believe -- and I always felt this was a very important area to study, never did do it myself -- that the burdens of disruption and grief would potentially play very heavily on the population. And again, I followed closely when I was there for the ten years I was there, and then I've done work off and on, some work in Alaska, and work with Native American communities all over the country, and I just have -- have felt like the sequelae of these times kind of came down through the generations that we have today and play them -- plays itself out to some degree in some of the very high rates of disruption and substance abuse that people see today. Now, again, that's not proved as far as I know. And as I said, I followed it in the literature, it was always mentioned to one degree or another in the anthropological literature, there never was a strong psychological/psychiatric literature, there were just some people working there and never was a strong literature investigation in these areas, but I've had that in my mind from the time I was there and some of the things I saw to the present time. And it would be interesting to see if people did follow up on that. Section 3:
BILL SCHNEIDER: Back in the early days, why do you think Bartlett was so interested in getting mental health services to rural Alaska?
JOSEPH BLOOM: Well, I think it was -- I'm not sure exactly where it started. It was obvious that there were very few services in Alaska in general. There wasn't a huge number of people. I think when we first got to Anchorage there in 1966, there may have been 50,000 people in Anchorage. So -- and there weren't very many services anyplace, and there were -- there was a dearth of services in rural Alaska. You know, there was the Indian Health Service hospitals, and you know where they are. And then there were some other isolated hospital -- there were other rural hospitals, for example, in Nome. There -- there had been a hospital, or probably still is, that was run by a religious order. So there were a few services to begin with, and I think people were beginning to feel within Indian Health Service like they had gotten ahead of the infectious disease problems, and they were beginning to see many behavioral and psychological problems, a lot of depression, a lot of substance abuse. So I think it was a time, and as I mentioned earlier, it wasn't just up there that the Indian Health Service was interested in introducing these services and did start it in these three places, and then this program over the years has mushroomed into a very large program nationally. With changes in Alaska, which we could talk about later if you want. But I think it was just a time to -- for them having caught their breath on a certain part of the -- of their responsibilities, so to speak, and just seeing this was obviously an area that they needed to get into.
And the state itself, although, you know, the state services, and one of the really good things of working in Alaska was the state services and the federal services were open -- well, the state services were open to everybody. If you take Oregon as an example, we have two big reservations in Eastern Oregon, Warm Springs and Umatilla. Warm Springs is covered by federal law, Umatilla is covered by state law. So the state has certain responsibilities on the -- in relation to the Umatilla Reservation, whereas on the Warm Springs Reservation it's federal responsibilities, pretty much only federal responsibilities. And I've worked with these, in this area here. Section 4:
But Alaska, everything was on the state side was open to everybody, but there just weren't that many services. And they had just opened the state hospital a few years before, and there was at that time a beautiful new hospital when I went up there, and they didn't have great working relationships -- relationships with the rural areas and with the Public Health Service Hospital. So one of the responsibilities that came to our small mental health team, we ended up hiring a psychologist and social worker, and I was the chief of the unit, and one of our responsibilities was to provide the interface between the rural hospitals of the Public Health Service, the -- the referral Public Health Service Hospital in Anchorage, and the state hospital at API. BILL SCHNEIDER: Well, I guess I'm confused a little bit. You said the state hospital. That's not the same as API?
JOSEPH BLOOM: That is API. Yes. Yes.
BILL SCHNEIDER: Okay. So rural and API working out that coordination?
JOSEPH BLOOM: Yes.
BILL SCHNEIDER: And can you talk a little bit more about that?
JOSEPH BLOOM: Well, yeah. Well, one of the things we attempted to do, and I think we were quite successful in doing, is the Public Health Service in the area that we were mainly concentrating on had hospitals in Barrow, Kotzebue, Tanana, Bethel, and Dillingham. And then the hospitals in Southeast and the big referral hospital in Anchorage.
And one of the things we did was we made a very simple rule that nobody could go to the state hospital from the rural hospitals from the Public Health Service hospitals without going through our mental health team. So we coordinated the admissions. We also, in order to facilitate more treatment at the local level, we did a lot of rural clinics. I think we probably were on the road two out of four weeks, and we would go to Bethel or to Kotz -- Bethel and Kotzebue were our biggest places, Bethel mostly.
We'd go to these places, hold a clinic for a week, see people that were -- had been sent home from the hospital, see new referrals, try to deal with crises in the community if we could do that. If we couldn't, we were able to bring people to Anchorage or to API.
We had this agreement, we negotiated an agreement with API that if we asked them to admit somebody, they would do it without making a lot of questions because they got to trust the -- the fact that we were all working together here and that we needed backup when we needed it, but for lots of things, we were able to handle it at the local level or within Anchorage. Now, just say we didn't have any psychiatric beds in any of the Indian Health Service Hospital, so we were limited, but when I first started in practice in Anchorage in '69, we didn't have any psychiatric beds at Providence Hospital either, and we were able to have large numbers of people in the hospital on the general medicine unit. So it's not always the lack of beds that prevents you from using these hospitals. Section 5:
BILL SCHNEIDER: And what sort of issues were you addressing in these village clinics?
JOSEPH BLOOM: Well, you'd see just a wide range of general psychiatric practice. You'd see people with depression, you'd see people -- there was some people with psychosis, schizophrenia. You'd see people with severe moderate to severe drinking problems; mostly drinking problems, not much in the way of drugs at that time. You'd see adolescents. You know, this was an interesting also. This was prior to the village high school. So we had large numbers of kids from Alaska who were in high school at Mount Edgecumbe, and then down here, I think you visited Chemawa -- did you visit Chemawa?
BILL SCHNEIDER: No.
JOSEPH BLOOM: Oh, I thought you did. Well, Chemawa school down in Salem had hundreds of Alaska students, and then there were hundreds of students in Oklahoma. So we had lots of disrupted families, we'd see parents who missed their kids, we'd see kids who came back for the summer, and you know, didn't know what -- exactly how to orient themselves.
So it was a general psychiatric practice. And at that time, there were no child psychiatrists, there were no child psychiatrists in practice in Anchorage at that time. There were a few years later. And so we saw children, I mean, it was just a general practice. And you'd -- it just was the whole range of what you'd see in a psychiatric practice. It was pretty interesting, actually. BILL SCHNEIDER: Yeah, I would think so. Because how would you do follow-up?
JOSEPH BLOOM: Well, that's good. We -- we would -- good question. We did follow -- we had village health aides. There were health aides in all of the -- you know, the -- we had the hospitals in the towns, but there were health aides in the villages, and we could coordinate through the radio communication. We always had the doctors. So if we go to Bethel and we had somebody who was in Emmonak who needed to be followed up on, there was a doctor who did regular visits to Emmonak, that doctor could follow up, and the village health aide could follow up and make sure the person -- if the person was on medication. So we had a network of services. And we tried to get, and again, were successful with a number of the general doctors. These hospitals were staffed by general medical officers who were people who didn't complete their specialty -- weren't allowed to complete their specialty training and were drafted in after internship or maybe a year of general medicine or family medicine. But many of them were fine doctors and interested in psychiatry and they would follow up on people. So if we went to Bethel for a week and we had a list of people, we would have a doctor follow up with that person.
And in several of these hospitals, you'd always find one or two doctors that were really interested in this, and we kind of made them our mental health officers for the follow-up. And then if there was a problem, they or other doctors or the service unit director could call us and we'd either give them advice or say let's bring them to Anchorage. But it was much more coordinated; much, much more coordinated than in the past, which was basically, we've got to get this person on the airplane and get them to API. So, I mean, there's many, many things you can do. And they actually had a very good network of high-level and mid-level providers of health services that covered the whole state, in a way.
And you know, there were -- the state had Public Health nurses, we worked with them, the BIA had social workers. We worked with whoever we needed to, to try to provide what service was needed, whether it was family support or, you know, visiting health nurse support. I mean, it's so -- there was more than met the eye of what you could get done. Section 6:
BILL SCHNEIDER: But in terms of psychiatric counseling, it probably was fairly limited, I would suspect.
JOSEPH BLOOM: Well, yes and -- and no. I mean, it's not a lot of -- a lot different than if you went out here in Eastern Oregon in some of the towns of what's available, there probably was more available there because there was this network of -- of service providers. But yeah, if you're talking about -- if you're talking about intensive psychotherapy, there was no psychoanalysis, you know, going on out there, but supportive treatment, medication monitoring, crisis intervention, crisis support, these were all things that could -- could be done. Many techniques of public and community psychiatry, which has really been my career all the way through, and that's what I did when I came here was community psychiatry in the -- in the Department of Psychiatry here. BILL SCHNEIDER: We've been very interested in the health aides and the role that they've played. Karen has done a major project interviewing health aides around the state. So it was interesting to hear your comment about that. JOSEPH BLOOM: I had an interesting little anecdote you can -- you can look this up. I had -- during the two years I was in Indian Health Service, I had two or three nationally known consultants come visit. And one was a professor from -- he was the chairman of psychiatry of University of Maryland, Eugene Brody, and he and I -- I wanted to show him what a village was like. So we went to Emmonak. But we didn't go there to be doctors, we went there, you know, kind of, we thought, as tourists.
And then after about a day -- we were going to be there three or four days, and after about a day or so, the health aide came to me and said, people are getting mad at you. And I said, why? They said, well, you're doctors and you're not seeing any patients, and they believe that you're not seeing patients because you want to charge them money and you know they don't have money. And I said, wait a minute. We -- we are just out here to do this little -- to make sure Dr. Brody understands what the transition from village to town to city is like, but we'll see -- we'll have a clinic.
So we ended up, we opened up a clinic and we saw a whole bunch of people. And one of the senior men in the village, he -- we talked to him and he said that there's this woman who is very sick, and she needs to be seen, and I said, bring her over. And it turned out it was his mother who was very sick. And we -- she was very sick. And we ended up getting her flown into the Bethel Hospital. And then we got -- you can look this up. We got written up in the Tundra Times as Bad Doctors Visit the Village. Yeah.
And you know, but we did, we ended up holding this very large clinic, and it was mostly not a psychiatric clinic, we are both psychiatrists, it was a general medical clinic; and we -- with the health aides, we did what we could. But you probably could be interested in seeing that article again. But I think it was something like that, Bad Doctors Visit the Village.
BILL SCHNEIDER: Oh, that's interesting.
JOSEPH BLOOM: It's on the tape now. Section 7:
BILL SCHNEIDER: The -- the work back in Boston, was Boston -- why was Boston of interest to you to go back there for that year?
JOSEPH BLOOM: Well, in my last year of residency, before I went to Alaska, I had spent time with a professor named Gerald Kaplan, who was in many ways one of the people who led the community psychiatry movement, was consultant to the government and to President Kennedy's office and in determining the direction that the community mental health center movement would take. And you probably know that after Kennedy died, President Johnson got the Community Mental Health Centers Act passed, and there were a number of mental health centers.
But anyway, I worked for Dr. Kaplan in my senior year of residency, and then when I went back there I took this fellowship in community psychiatry, which basically was a year more of immersion in this area. And then when I went back to Alaska, even though I was in a private setting, we did a lot of consultation. I was consultant for years to the Indian Health Service, to the Yukon-Kuskokwim Health Corporation, to the Norton Sound Health Corporation. We helped the Indian Health Service and YKHC put together the first mental health unit that lived in Bethel, kind of what we did in Anchorage, and we moved it, the model, to Bethel. And the first psychiatrist who was recruited for that was Verner Stillner, who you may have gotten in touch with, he later became head of the Mental Health Division for the state and is now in Juneau again. He was chairman at Kentucky for a while and then moved back to Alaska. He was an excellent person in Bethel, and I was his consultant. So from -- the basic point is in Alaska, from a private practice base at that time, you could do all kinds of interesting things. It wasn't a, you know, sit in your office eight hours a day and see patients. It was very active and we did lots and lots of consultation. And I got interested myself in the criminal justice system, and we began to see nationally, and in Alaska to some extent, and probably a large extent now, mentally ill people ending up in the criminal justice system.
And later on when I was here, I put together a small team, was hired by the state to look at the care of the mentally ill in the jails in Alaska. And we went to -- the team that I had, we went to all of the -- well, we went to the Anchorage, Fairbanks, Juneau, Ketchikan jails; and then we went to Kotzebue, may have gone to Nome. I don't -- I don't remember what other ones. And we wrote a big report about the handling of the mentally ill in the jails and the coordination that needed to be improved between the jail system and the state system, API in particular. And you know, you usually see these problems more in the cities. I mean, this city, it's a typical example of it, where large numbers of mentally ill people are in jail, and there are fewer and fewer here, psychiatric beds in the state system, so the jail becomes the place where a lot of people end up for many reasons. But I got -- the point I was making there is I got interested in this when I was in practice in Alaska and I got interested in Native Americans, and especially people from that same northern and western part of the state who ended up in the criminal justice system and I've written things about that, about transcultural issues and the court system. Section 8:
And another interesting initiative that we participated in a little bit then was -- I don't know if you remember Chief Justice Boney, Boney, he was the Chief Justice of the Alaska Supreme Court, and he had an initiative about introducing transcultural principles into the criminal justice system, and doing more at the village level and more at the -- more in the way of trial -- trial work, and the settlement of disputes at the village level. So it was an area that I've pursued down here vigorously over the years.
BILL SCHNEIDER: What -- what have you learned and what have we learned in terms of how to handle that issue?
JOSEPH BLOOM: Well, we probably are handling the issue much worse than we did 20 years ago, or 30 years ago. When I was in practice in Anchorage, in private practice, we were able to see anybody. I mean, we had -- people had even without designated health services, they could get support for psychiatric care, for medical care.
I don't remember people being turned away really for -- being turned away from care. And now, of course, we have very rigid rules about who gets care, and so I think we've actually gone backwards in the last few decades here. I don't know the Alaska situation that well. When I say "here," I know a lot about the states around here. I mean, California used to be a model for community mental health services, and now it's not a model for anything you'd want to -- it's a model for how not to do it. So I think we know the principles, we know how to provide community services, we know what is needed. Psychiatry as a discipline has advanced much further than it was when I started in terms of understanding the brain and understanding psychopharmacology, et cetera, but the amount of services that exist here and elsewhere decreased, in my opinion. And hence, you have this kind of push toward the criminal justice system, which is hard to reverse because it's expensive to reverse, and the criminal justice system, the police, the criminal justice, they can't refuse people. Other entities can and do. So it's just a natural flow in that direction.
BILL SCHNEIDER: Uh-hum. Section 9:
One of the things we wanted to talk about was bringing people back from Morningside. How did that come about?
JOSEPH BLOOM: Well, a lot of it -- I think I may have mentioned to you over the phone, a lot of it was history to me because API, as I -- as I understand it, opened in '64, and I got there in '66. And I think what I told you, what I told you was that I was involved in the transfer of what I believe was the last patient in Morningside Hospital, last -- the last Alaska Native patient in Morningside Hospital. I know her name, but I -- I'm not going to put her name on the tape.
BILL SCHNEIDER: Yeah. JOSEPH BLOOM: But you know, Morningside Hospital is here in Portland, Oregon. And we've talked about finding the records for Morningside Hospital, which I'm interested in for another reason, but this patient, as I remember it, was the last person to come back. And she had been there for multiple years, and as I remember it, she was a woman in her forties, maybe, when she came back. And she was sent to API where most of the -- where the patients were sent to coming back from Morningside. And I remember interviewing her and we talked about sending her home. Why couldn't we send her home? Well, she hadn't been there in years and years and years.
We did some checking and we found that there was a family and that they would have her come back and we sent her home. And she was on medicine, she had carried a diagnosis, a diagnosis of a severe mental illness, but she was in remission at the time on the medicine. We sent her home, and basically, as far as I know, she did okay at home. So that was the last person that -- as I know it. And you know, Morningside had the contract for -- for all of the patients from Alaska before API was built. And not long after -- I don't know the year per se, but not long after that, without the contract Morningside basically shut down. So that -- that -- that was my contact with -- with the hospital. And you know, for a long time, API was able to handle the -- basically, the workload that was necessary for a small -- what I said earlier, it's the first small state hospital. They were able to recruit staff.
And I remember when I first got there -- does the name Carl Bowman come up at all? Mentioned -- he was the superintendent. Carl Bowman was an old man, a lot older than I am now when he was superintendent, but he was a very, very well known person in American psychiatry. Had been a professor, I believe, in New York and he was the superintendent at API. And John -- man named John Rawlins was their clinical director. Then Dr. Koutsky came along after Dr. Bowman, and I remember Dr. Koutsky and I later on, when I was in practice, we went and traveled down to the new hospital in Valdez for the developmentally disabled, and we saw some patients there together. May have even been when I was still in Indian Health. I don't remember. But it -- it fulfilled a good place in the state system at that time.
Again, I don't know now how things are there, but that's the way it was then. Section 10:
BILL SCHNEIDER: What was your impression about Morningside and its history in terms vis-a-vis Alaskan residents?
JOSEPH BLOOM: Well, I don't have a really solid impression of it. It filled the need at the time. You know. It was -- there were always a lot of ties, obviously, between Alaska and the Northwest. I suppose there could have been a contract, maybe there had been an investigation of a contract with something in Washington, but there were a lot of Oregon ties to Alaska. And it was the contract hospital. It -- it -- when I came here, just -- and again, I'm not sure exactly when it closed. I think it was still open a little bit when I -- when I got here in the '70s, but I'm not sure of that. But it was not -- it didn't have a prominent place in Oregon Mental Health Services, it was just kind of struggling along, and then it wasn't here anymore. So I never really even visited it. I know where -- where it is, it was out near the -- it was out near the airport. But I never had a solid impression of the services or... I talked to Dr. Langdon about it some, because he had come to Alaska having been on the staff at Morningside, and he wasn't there that long, I don't think, and then he went to Alaska and, of course, had the remainder of his career, many, many years there in Alaska. BILL SCHNEIDER: And when you were in private practice, was that with the Langdon --
JOSEPH BLOOM: Yes, it was.
BILL SCHNEIDER: -- clinic?
JOSEPH BLOOM: When I started there, in '69, I was the second psychiatrist in the clinic, and Dr. Wolf, Aron Wolf, was in the Air Force, and Aron joined us probably not very long after I started. And then a little bit later on, we hired -- there was a child psychiatrist, John Wreggit who we hired, and then Barry Mendelson who was a child psychiatrist. John ended up going into practice, and then I think went to Washington; Barry went back to Maryland at some point, but so I -- I was the second psychiatrist there. We had some social workers and a psychologist, Al Parker, who worked with us for years. And it was a small general psychiatric practice. And again, as I described the practice in Indian Health, there were no child psychiatrists in practice in Alaska, and there were very few psychiatrists in practice. I don't know if the name Bill Rader had come up, Bill was in private practice, his brother was a state legislator, John Rader, Democratic party, very good, powerful legislator at the time.
But there weren't very many people. I think I may have been, if my recollection is correct, the fourth or fifth person in psychiatry in practice, ever in practice in Alaska. So it developed quickly after that. We started -- you know, lots of people who ended up in practice there, like myself, came up there assigned, whether it was in Indian Health or in the Air Force or Army, and then people found it was a really nice place to live and stayed after their service. Section 11:
BILL SCHNEIDER: What were your impressions about Dr. Langdon?
JOSEPH BLOOM: Well, Dr. Langdon was a -- sort of a laconic, very effective individual. There was very little that actually rattled him, which was very helpful to younger people working there. I mean, he was able to provide kind of a calm atmosphere within the practice where you were not afraid to take on difficult cases.
I remember he was -- when I was in Indian Health, I had talked to him on numerous occasions, and I had a lot of patients in -- we talked about tuberculosis in the beginning of this interview. Well, the Alaska Native Medical Center, the hospital in Anchorage, had a whole floor, as I remember it, with tuberculosis patients. And many of them were -- some of them, many of them were also my patients. They were depressed. And I remember the floor -- they were on the fifth floor. And I was always nervous about this. I mean, there was no -- the windows were open, you know, people were sitting on the open -- sitting by the open windows, and I asked them one time, do people commit suicide around here, does anybody jump out of these windows? And his answer, he was, you know, just very encouraging to me that this was not an event that was likely to happen, which it didn't happen, but that was the kind of person he was.
In the public arena, he was feisty. I would say he was feisty. And he had some of his pet hobby horses. He didn't like outside experts, he didn't -- he didn't like what -- he didn't like kind of obfuscation. He tried to cut through things. And so he -- he was -- he was a force politically. And I remember he was involved in a lot of issues that brought him into the public eye, but as a practicing psychiatrist, he was a pretty calm individual, which was very helpful to me and to others. BILL SCHNEIDER: And the impact of his clinic at that point in time?
JOSEPH BLOOM: Well, there was -- there was, again, very few services in the private sector. There were public mental health clinics in Anchorage, Fairbanks, and Juneau. We also served as consultants to that clinic. Dr. Rader had a single practice, he practiced by himself in a -- in a more or less typical psychiatric office practice. He brought up an associate who had trained in his same residency program, who practiced for a while with him. There was -- there was -- and I forgot, there was a child psychiatrist at API, Barbara Ure, who practiced there for many years, and then she went into private practice later.
But there just -- there weren't many services. When I first started in practice, there were -- I don't remember anybody in practice in Fairbanks; a few years later there were. And then one year it just changed and there were 20 psychiatrists in practice. We all couldn't believe it. It was kind of like a culture shock for us, you know. Who are these people. But it did change. Section 12:
BILL SCHNEIDER: We should talk a little bit more about your thoughts on the TB epidemic, but also maybe in the larger framework of a whole history of epidemics that came to Alaska, starting back in the Russian period, and the cumulative impact of -- of that, of those dialogues, and your thoughts about that. I know you may not have done specific research on it, but I know it's of interest to you. JOSEPH BLOOM: Yes. If you -- if you look at population data, and I don't know if I sent you -- one of the earlier papers I wrote was on population trends with Alaska Natives and the need for planning. I think that was the name of it. Did you see that paper?
BILL SCHNEIDER: No, I didn't see that. JOSEPH BLOOM: I'll get you the reference and you can see the paper. But it was a paper that looked at population trends, and what you see going back into the 1800s is, you know, times when the population is growing, and then you have, you know, the infectious disease epidemics, measles, whatever -- whatever it was, and then dramatic changes again in the population. And the time that I was involved with, as I said, the -- things were brought under control to a degree, excuse me, on infectious disease produced a population explosion.
And at the same time, the government, the Federal Government did not have any family planning services. That was one of the main thrusts of the paper. And it just produced this -- this explosion where it was not unusual to go in a village -- and again, I don't know now -- and see a family with ten children, ten living children. And what I was alluding to earlier was you have these different forces working together, and the idea that the issues of grief and mourning related to death and separation on the one hand, and the obvious strain on resources from extremely large families, which without -- with -- with many of the children surviving with making it extremely difficult to live in a manner that people lived in the past in terms of a subsistence manner. And it put lots of strains on the -- on family life.
And of course, what I remember very well is you always had this migration pattern of village to town to city with problems in many ways picking up in the rural towns. Lots has been written about the -- at least were written. I don't know, again, what people are doing now, but problems within the rural towns and problems within the cities for people, and as people drifted toward the cities, you tended to see more -- and of course, this is not everybody, but people who were on a downhill spiral who ended up in the cities, you'd often see some of the ravages of substance abuse and alcoholism. So what we talked about is was there a residue of grief and stretching of resources that you saw in later -- come out in later generations in behavioral problems.
And again, I never liked to go, having spent all these years in the university, too far from that just being a theory, but it -- it just -- there's a lot of reasons why that would be a very interesting idea to pursue. And it would be good to know -- as I said, I -- I knew the anthropological literature pretty well up until the time I left and a little bit after, so it would be interesting to spend some time and see what's happened since, what people have written. And you know, the -- a lot of the anthropological literature did have, obviously, behavioral observations and psychological observations, and it would be fun to pick that up and see what's been written in the last 20, 25 years.
BILL SCHNEIDER: Yeah. That's good. Are there examples historically from other parts of the world that you could draw upon in that discussion? JOSEPH BLOOM: Well, I don't know of an example that -- I don't know of an example that would mirror the twin issues we're talking about. Excuse me. So no, I don't know that I can cite -- now, you know, of course, there are parallels to Native American communities down here, too. And even though, you know, you had the -- the death rates from, what, suicide, violence, accidents, and these illnesses, and they all paralleled -- they were high -- higher in Alaska, but they all paralleled Native American communities here in that the Native American communities, again, at the time I knew the literature, was at the higher -- was higher than the non-Native community. So you have those parallels. But I don't know where the -- part of those two things occurred at the same time, where you had a very, very substantial infectious disease burden followed by a population explosion. I'm sure there are examples, but I just don't know it. Section 13:
BILL SCHNEIDER: And I know that you've been away from Alaska for a bit, but what are your thoughts about the evolution of services in the area of disabilities and mental illness?
JOSEPH BLOOM: Well, I've been away for a quarter of a century, so I don't know the answer to that. I knew when we did the -- the jail survey that I mentioned earlier, we did that in the '90s. And there were big problems between the jail correction system and the mental health system.
I have no idea if they've been eased or not over the last 15 or 20 years. I just -- if I were going to guess, I would guess not, but I don't know because it certainly hasn't improved here, and in many other places in the country. But I just don't know.
It would be very interesting to contrast that with people who know the scene now. Dr. Wolf would be a good person for you because he's of the people who were there for many, many years, he's the person with the longest -- with the longevity, so to speak, in this area. But my connection has -- was in the jail, that jail survey, and from time to time I would give -- give some advice on some case here or there, some legal case, but other than that, my contacts have not been enough, actually, from my point of view. But -- but I just don't know. BILL SCHNEIDER: Yeah. Before I ask Karen if she has any questions to ask you, are there aspects of your background that we're missing that I haven't asked you about but that I should, as it relates to Alaska and the issues?
JOSEPH BLOOM: I don't believe so. No. Section 14:
BILL SCHNEIDER: Okay. Karen, do you have some questions?
KAREN BREWSTER: I guess I just would like to hear more about working with the Indian Health Service and your experiences out in the villages, and so one question would be did you deal with the removal of people from their homes to taking them to API and what that experience may have been like for the patient and their family? JOSEPH BLOOM: Well, I'll tell you one other anecdote, which was early in my career up there. We had a young woman from one of the villages downriver from Bethel who had severe developmental disabilities. And she was seen by the physicians in Bethel; this was in -- again, in '66. And she was sent to Anchorage with a description of her functioning, which was quite low, with the idea that she needed to be hospitalized, basically institutionalized. Now, when I got that referral, I actually -- it actually wasn't a referral, it was sent -- she was sent -- this was before we got things, so this was early. This is very interesting to me. So she was sent to the Anchorage hospital, basically, with don't send her back. And the family is in agreement, there was a note so big (indicating), don't send her back, the family's in agreement. So there are laws about commitment and laws about sending people away, and of course, nobody is sent away necessarily forever anymore, but there are laws about that, there were laws about it then.
So I talked to my boss in the Indian Health Service, who was a man named Stan Stitt, who was a dentist, he was a high-up administrator in the Indian Health Service. And I said, you know, they just can't do this. I mean, they -- they may be right, they may not be right, but they didn't follow any of the statutes.
And he said, well, what do you want to do? And I said, I want to send her back. So I sent her back to Bethel. And I said, while you may be right, you may not be right, but here's the statutes, here's the investigation you need to do, you have to do it right.
So needless to say, this made a big explosion between our little mental health unit and the physicians at Bethel, and we ended up going out there and we had two days of screaming at each other. And it really was good because by the end of it, you know, we were able to say from now on we're going to operate within this framework, you know, that you have the statutory framework and you have a medical framework, and it can't be like the old days. And I don't know if that speaks to your question, but to me, it was illustrative of the changes that had to be made in order for there to be a more orderly, and I want to say legal, it's not necessarily legal, but correct manner of people coming from place to place. So that's an example of being involved in a transfer and not accepting the transfer. I was not involved at all in any of the transfers related to tuberculosis, and some of them were very brutal. I mean, in a way, just, you're gone. And sometimes, as I said earlier, you're not coming back. But after we had these, what I always thought of as a sensitivity session, you know, we made the transfers correctly. And of course, maybe in a case like that, and I don't actually even remember if that person ever was institutionalized for a long period of time, but the expectations would change. If we're going to follow the procedures and we're going to follow a process, the goal is in a community focused practice that people should stay home, and if they can't stay home, they should get the treatment and then go home. So the expectation was not -- was changed. It wasn't -- you know, you probably have heard people refer to the airplane cure, take someone on the airplane and get them out of town on the airplane to the hospital, and that was the cure; and then you've probably heard the complaints that people who were sent out on the airplane often beat the people who escorted them back to the village. I mean, it was -- it worked both ways. And we were trying to do away with both ends of it. You know, that if this -- stop the airplane cure, which is just put them on a plane and get them out of town.
Now, there's sometimes you -- from when you heard the case, you wanted to get them out of town. But in other cases, you know, you just slow it down and let's reason a little bit here and maybe sending them to Bethel and the person could be contained or -- or treated in the Bethel Hospital, that was enough, and then they would be able to go home. So you had that process. And then you tried to prevent on the other end, there had to be some sophistication at the state end, so to speak, at the API end of this, that they would try to do more to understand that there really was a problem out there. Because you know, sometimes people go from the village to the hospital and they are not going to tell them what's wrong. You know. They are just everything's okay, or it's not very communicative.
So you had to basically slow down both ends of this, that there's nothing -- I mean, on this end, there's nothing wrong with the person, they don't need to be in the hospital, on this end we're getting him out of here, we don't want to see them again. You know. So that was the kind of thing we were trying to do.
And again, there always are crises, there always are difficult situations, there always are going to be, when you have any kind of a practice like this, some bad situations. I don't remember really that many -- I don't remember bad results, maybe that's the blessing of time, but that's what you have to do. And just try to put some thought on -- on all parts of this thing. And sometimes you could have a person, you could -- you talk to someone from a rural hospital and they would say, look, we've got a whole bunch -- the place is loaded with sick people from this, that, and the other thing, we can't do this, so then you would move the person to Anchorage. Other times they are not that full they can do it. So a lot of it is situational. Section 15:
KAREN BREWSTER: Can you talk a little bit more how you got the people on the API end to better understand the situation in the villages and maybe some of the cultural issues.
JOSEPH BLOOM: Well, the -- the best way -- you can't legislate stuff like this. I mean, the principles of how to work in this -- this setting or other settings that are similar is you have to go there and show up and, you know. People, you have to be valuable to them. If you're valuable to them, i.e., and what does that mean, it means you have information, you can help them understand, this is the situation. Oftentimes they were in the dark. So we had frequent meetings with them, we tended to have when we would go in the -- in the town trips, we would have multi-disciplinary meetings, we would have multi-agency meetings, when we would go work with API we would go over and talk to the people and talk to the doctors, and on occasion interview the patients with them, or those kinds of things, invite them to conferences. And I mean, you just have to open up the system and be -- again, make it -- try to make it worthwhile for everyone involved in it. Not a waste of time for them. Everyone's busy. And again, most of the time your people are going to respond to that. Not all, you know, not every doctor is interested, not everybody wants to know stuff, but that's basically it. KAREN BREWSTER: And you found people receptive?
JOSEPH BLOOM: Yes. Yeah. I mean, again, I think it -- it made their lives -- the type of program made their lives a lot easier.
I mean, they'd get people, you know. I can remember -- well, you may still see this, I can remember being in the airport all the time and yet people with notes pinned on their jackets. Here's the history pinned in an envelope. People sent, and not just to the psychiatric -- not to the psychiatric hospitals, per se, but they often got people with very little information.
We were able to get information or to insist that we get information from the local level.
Section 1: Returning to Alaska and working as a psychiatrist at the Langdon Clinic in Anchorage.
Section 2: Working with the Alaska Mental Health Association to promote suing the State of Alaska over mismanagement of the mental health trust lands.
Section 3: Beginnings of the mental health trust lawsuit.
Section 4: Expansion of the mental health trust lawsuit, and legislative involvement with the final settlement.
Section 5: Determining the cost of mental health services in Alaska, working with the Alaska Mental Health Association, and working for the Langdon Clinic.
Section 6: The mental health trust settlement and the State's resistance to it.
Section 7: Mental health services for the developmentally disabled.
Section 8: Treatment for alcoholics and early stages of mental health trust lawsuit.
Section 9: Role in the mental health trust lawsuit, and his work with mental health services in California in the 1980s.
Section 10: Assessment of mental health services in California in the 1980s.
Section 11: Types and quality of mental health services in California in the 1980s.
Section 12: Effect of the mental health trust settlement on delivery of mental health services in Alaska
Section 13: His commitment to resolving the mental health trust issue, and his assessment of the current mental health system in Alaska.
BILL SCHNEIDER: So in 1980, you returned to Alaska?
JERRY SCHRADER: Yes. And I returned -- let me think. I fished in the summer, and then I settled, actually, in Anchorage.
And I actually went to work for the Langdon Clinic. That's sort of an interesting aspect of history there. When I came to Alaska, the -- the private psychiatrists were not particularly happy with the idea that we were going to have a lot of government mental health treatment. I remember -- and it was funny because I was sort of told by some of my staff that J. Ray Langdon was Mr. Mental Health, Mr. Psychiatry of Alaska, and that I should -- whenever I went to Anchorage, I should see him.
And I explained to them that J. Ray Langdon had a nice little operation, and if you think in terms of boats, he had a yacht. And he was anchored up in this little bay. And now we've come into the bay, we're a 700-foot long cruiser. And if -- if the wind comes up and we swing on our anchor, we'll just wipe his boat out. You know. So there was a huge imbalance here in authority and power. I did meet with him once, and I -- he wanted to know what we were doing. And, see, one of the things that had never been done in Alaska was to write a mental health plan. Well, because we received Federal money, the state was actually obligated to write an annual mental health plan. So we started doing that. And he sort of suggested that was kind of communistic. Three-year plan? Five-year plan? You know. Just like those Russians. Anyway, so one of the groups that -- that hassled me a lot was the -- the Langdon Clinic. But you know, it's like you have to meet with these people and you have to air these things. And the -- it's -- it's the nature of things we do in government, you're not going to please everybody. And so I guess I had -- by the time I came back to Alaska, I had acquired enough credibility with the psychiatrists that they would make me a member of their clinic. And actually gave me a lot of flexibility, so that was good. And it's, like, well, while we didn't agree on a lot of things, we, nevertheless, respected each other. And so I -- I worked for them and I think I did some part-time work at the -- at a mental health clinic in Fairbanks, and I did some part-time work at a mental health clinic in Anchorage. Section 2:
And -- but what I did was I took my paperwork and I went to the Mental Health Association and basically told them that we were going to have to sue if we expected anything to come of the mental health lands. And so they made me the president of the Mental Health Association. And by then, Joyce, you know, had moved out of being executive director, and Natalie Gottstein was now the executive director. And we -- you know, the division was no longer putting out annual reports. We started putting out annual reports. And I think one of which I sent to you. And the -- one of the things that I -- I came to realize working with Natalie who was divorced from Barney Gottstein, the Carr-Gottstein group --
BILL SCHNEIDER: Yeah. Yeah.
JERRY SCHRADER: -- was that he was a Democrat. And I'm really -- I don't know that -- well, I know that we were -- after we had made the decision to file a lawsuit, we needed an attorney. And most of the large firms were already working stealing our land. They were already on the other side in many of these things. And -- but Cowper was available. And if I think about it, it's, like, Gottstein was an important man in the democratic world, and so one of the things I did was to pay my respects and I went and visited him at his house. And he was -- he was very congenial and he thought, you know, suing the state over the mental health lands was a good thing to do. And -- and about that time, somebody came out of the back of the house and it's, like, oh, Mike, come over here, I want you to meet Dr. Schrader. So that's the one and only time I met Mike Gravel. What was he doing, you know. So it must have been -- there must have been some sort of democratic tie there, I thought. BILL SCHNEIDER: Why would Gottstein be interested?
JERRY SCHRADER: Well, he's a land developer. I mean, I -- you know, I sort of had in my mind that, if we were going to invade this territory, we should at least be polite about it. And I would -- I don't know this, but I suspect that -- that it was through him that we got Steve Cowper to be our lawyer, who said up front that part of his reason for -- for doing this was that he wanted to keep his name, you know, in the public eye. I think he was at a stage where he had done very well in the primary, but he hadn't, you know, been nominated to be Governor. And so -- and see, it was like -- like when the -- the situation at the airport came up, we wanted to have a public hearing about the commitment law, so Natalie found a legislator, a state senator who would sponsor that, so we had a public hearing in Anchorage. And I talked about, you know, the problem with the commitment statute and what we needed to do, change this one section about imminent danger and so forth. And then when that played on TV on the news, the background was the airport. And I thought, God, you know, I mean, that wasn't my idea. Section 3:
So, you know, it was, like, through no fault of my own, I somehow fell in with people who could actually have an influence. You know, if -- if Natalie Gottstein wanted to have a meeting with somebody, they wanted to have a meeting with her. Especially if they were democrat.
BILL SCHNEIDER: And for the -- for the record, tell us why Natalie was interested in mental health. JERRY SCHRADER: The -- I was -- I talked to Joyce Munson last night. I haven't talked to her since God knows when. She -- when I told her who I was, she said, oh, heavens.
Anyway, she was telling me that after Natalie and her husband split up, Natalie was kind of -- you know, needed to have something to get her teeth into. And -- and I -- according to Joyce, she went to work with Joyce in the Mental Health Association. And then in '79 when Joyce left to be a legislator, Natalie took over. And that's really kind of as much as I know about that. She -- I -- I'm not sure of this, but I think it's possible that part of her interests about mental problems may have originated with the fact that her son was having some difficulties. And so initially when we talked about the lawsuit, she actually wanted her son, Jim, to be the lawyer. But that didn't seem like a good idea just because of some emotional instability that he had. And you know, it's like, I mean, it was interesting. I've read a number of the -- especially the people I knew, and you know, like, when I read Steve Cowper's statements about there was this psychologist or something who came to talk to him, that was me. And I -- actually, a friend of mine did some legal research about land grants, and that's part of what we provided for him. Scoop Jackson said this was a land grant like all the rest of the land grants we've made in the West for schools and other public purposes. So anyway. The -- when I read Jim's, Gottstein's interview, he talked about his parents had brought somebody out to the house, and that's when he jumped out the window and ran off. And, now, that was -- that was me. I didn't talk with him that night because, you know, I guess I was the one that he was trying to avoid. Not that he knew me from Adam at that time, and I don't know that I knew him from Adam at that time. But you know, when you run off down the street, and I think it was in the winter, with nothing but your pajama bottoms on, and neither of your parents are fleet-footed enough to catch you, what do you do? You have to call the police. So they did. Section 4:
But I -- I think having Steve Cowper as our lawyer was very good. And having, in a sense, the kind of backup, you know, that we had, sort of socioculturally speaking, you know, from the Gottstein influence and so forth helped. And, you know, I mean, it's like Natalie knew people on the Supreme Court.
BILL SCHNEIDER: Say -- say that again? JERRY SCHRADER: Natalie knew people on the Supreme Court. You know. Oh, I'm sure, you know, I forget who it was, you know. And so -- and that's part of why the decision was made to do it in the state because -- and the Supreme Court in Alaska, at least at that time, had a reputation for being pretty progressive and pretty liberal. I thought. Maybe a legal scholar would disagree, but that was my impression. And so that's how we embarked on that path. And -- and then later, you know, it was, like, it -- it seemed like the Mental Health Land suit started out with, like, me, the Lone Ranger, and by the time the whole thing came to pass, it was, like, I could barely get in the room there were so many lawyers. And Jim Gottstein, I think, did an Amicus brief. Again, his mother was trying to get, you know, something going on in his life, for the chronically mentally ill. And so he was representing a different person or group of people than Vern T. Weiss. And then, of course, the alcohol and drug people got involved and the thing sort of moved on. And it was, like, you know, my ability to control all of that was greatly reduced. You know. I mean, my influence, you know, it's like it sort of took on a life of its own with all of these different people. And the -- but, you know, it was, like, that was fine, as far as I was concerned.
I -- the -- I think at some point -- well, it amazes me to think that the thing drug on from 1985, when the Supreme Court said they had to reconstitute the Trust, until 1999. I mean, I left Alaska in 1990 and came back here. But the -- and all of the different sort of permutations and agreements and disagreements and so forth, it's, like, was amazing.
I -- you know, after the initial -- well, let's see. When was it. I'm trying to remember when Cowper became Governor. There was -- there was some sort of -- well, there was an interim committee of the legislation -- of the Legislature, and I was on that committee. And that led to an agreement about a certain amount of money was going to be put in the Mental Health Trust, except nobody ever did that. And I got a chuckle out of this. One time Jim Gottstein and I were being interviewed on TV, and they asked us what we would do -- if we had a contingency plan if the government didn't put the money into the Trust. And I didn't know. Jim Gottstein said, oh, yes, we do have. And they said, well, what is it? And he said, well, that's for the state to worry about.
So when we walked out of there, out on the sidewalk, I asked him, what -- what was the plan. And he said, well, we're going to take this yellow tape and go down and tie up the entire Federal -- or I mean the entire Marine Highway fleet. And I thought, that had -- that sort of had an appeal to me. I'm sure it would have been an attention getter, you know. But that never happened. Even though they didn't put any money in the plan. KAREN BREWSTER: Is this the Interim Mental Health Commission?
JERRY SCHRADER: Hmm?
KAREN BREWSTER: Is that called the Interim Mental Health Commission? Is that what you're talking about?
JERRY SCHRADER: Interim Legislative Committee on Mental Health Lands. That was in 1986. KAREN BREWSTER: Okay. Because there was a Mental Health Commission.
JERRY SCHRADER: At some point.
KAREN BREWSTER: At some point. That George Rogers was involved with.
JERRY SCHRADER: Which was I presume later.
KAREN BREWSTER: Okay. Section 5:
JERRY SCHRADER: And then in '87, they created an Alaska Mental Health Board, and I was the chairman pro tem.
KAREN BREWSTER: So what did that board do?
JERRY SCHRADER: Well, part of it -- part -- our function at that point was that the -- the thing had moved along to a point where they wanted an entity that would tell the Legislature what the necessary expenses for the mental health program were. Because that's basically what the law -- the law said, that this land shall be managed as a public trust. And the income and proceeds will first be used to pay the necessary expenses of the mental health program. So at one point, I actually told at the House and Senate Finance, and I think maybe there was some other committee involved from both the House and the Senate, what the necessary expenses were, you know, what needed to be done. And -- see, it was, like, my -- I was no longer the Director of Mental Health at that point, you know. I mean, I was just involved with the Mental Health Association. And I -- you know -- I noticed that I had an Outstanding Service Award from the Mental Health Association in 1978, '86, and '88. So that gives you an indication of how much I was involved, I guess, with the Mental Health Land issue.
KAREN BREWSTER: And you were still in private practice this whole time when you were involved with the association?
JERRY SCHRADER: Yeah. Yeah. And actually, I came back -- I came back to Anchorage and went to work at Langdon Clinic, in, like, what, '80 or '81, and I moved to Juneau in '85. For one thing, my boat was in Juneau.
And, you know, the -- I didn't think that the Langdon Clinic was very well run, really. It was -- it was sort of like a lawyer's sweat shop, you know, the new guys do all the work. And, I mean, I actually said in one meeting that I understood that, you know, one of the people who had been there a long time may only want to work, you know, part-time, but we ought to pay them part-time, too. You know. I don't think that probably added to my popularity at that point.
But one of the sort of phenomenons was that when I went to Alaska in '73, there was one really private psychiatric clinic. By the time I left, there were five. And it was the new people who, after a year or two at Langdon Clinic, decided they wanted to do something else, they would go start their own clinic. So these were all sort of offshoots. Section 6:
But when I was at the stage of being the first chairman of the Mental Health Board, it seemed like we had some kind of an agreement with the state, or at least the beginnings of an agreement. And -- but obviously, that didn't turn out to be the case. And I was looking through some of my stuff and later I wrote a lot about that. It didn't get published, it was just notes of mine, but it was like I had -- I had a hard time understanding what the state's resistance was to behaving, you know, as trustees for the mental health lands. And it's -- it was just hard to figure out. I mean -- I mean, one of the things I thought is, well, are they just being stubborn? I mean, it's, like --
BILL SCHNEIDER: Well they had a lot to lose economically. JERRY SCHRADER: Well, I think they did have a lot to lose. They had more to lose than I was aware of at that time in terms of what they would have to do to restore the Trust. It was pretty big. But, you know, it was, like, by then, Alaska had a lot of income. They could afford a couple billion dollars. You know. I think. That's what I think personally. But I think it was -- you know, when I -- when I think back on this, I wonder. I mean, it's -- I was impressed over the years working in the corridors of power that it was possible to get things done. But I've also been impressed that sometimes the things that get done aren't quite what they seem. You know, there is a certain disingenuousness about legislative and congressional bodies and how they act. And I've wondered if -- you know, because I did a little research about lands that had been granted for mental health purposes and other charitable purposes in other states. And I didn't -- I haven't really pursued that or followed it up, but my suspicion is that Alaska may not have done all that differently than many other states did.
And maybe it's occurred to me that from the point of view of the Senate, maybe this was just another way of giving a state some extra land. You know. Obviously, I mean, the -- the land -- the state that has the least federal land is Texas. I mean, aside from the Alamo, there is very little federal land in Texas. And there used to be a psychologist who worked at Eagle Creek, and his family had some wealth and they lived in Texas and he grew up there, and he talked about his family had owned a piece of -- huge piece of land out in West Texas for something like three generations. He was the first person from the family to ever set foot on that land. You know. And I wondered how much of that sort of thing went on in Texas. You know. It was, like -- but I --
BILL SCHNEIDER: Let's stop for just a second.
JERRY SCHRADER: Yeah.
(Pause.) Section 7:
KAREN BREWSTER: Okay. My question has to do with the lawsuit, the initial lawsuit, and you mentioned the Mental Health Trust -- the Mental Health Association was filing a lawsuit. But Vern Weiss' name is on that lawsuit.
JERRY SCHRADER: Right.
KAREN BREWSTER: And how is it that you got him involved and he was chosen to be the plaintiff? JERRY SCHRADER: Uh-hum. The -- I remember thinking about this, you know, when we were first considering a lawsuit, and the notion of the mental health lands. Well, the statute in Alaska provided for services for both mentally ill and the mentally retarded. And one of the bone of contentions when I went to Alaska from the citizens for the mentally retarded was that they just felt like, you know, the -- the institutional approach and the Valdez thing and so forth was just all wrong.
And -- and shortly after I became the Director of Mental Health, I inherited the Office of Developmental Disabilities organizationally. And that sort of had an interesting -- there's an interesting story there.
Someone had -- someone had held that office, and I think it was -- it was somewhere in the Department of Health and Social Services. And had testified before a committee and had referred to what we called crib cases. People generally are not aware of the fact that some people at birth are so developmentally disabled that they spend their whole life in a crib. They never learn to walk, they don't have speech, you know. And -- and it's, like, historically, it's sort of the old bughousers, as we used to call people who worked in mental institutions, refer to these kids, or -- and some of them were into their twenties, as crib case -- or as bridge cases, the implication being that you should just toss them off the bridge. Well, he made this remark in this committee hearing and referred to the crib cases as bridge cases. And within an hour, the Governor's telephone was ringing off the hook from angry parents.
And this is one of my favorite Governor Egan stories. He called the Commissioner of Health and Social Services and he said, I want that man fired. He told him what he'd done, and he said, I want him fired. And the commissioner said he'd take care of it. And the Governor said, I'll hold. And the commissioner told me this story. And so he walked down the hall and said, you're done, and walked back and said, it's taken care of. And I thought, you know, Egan understood bureaucracy in government, you know, a lot better than the average person.
So one of the things that -- that we did in the -- in the Division of Mental Health was we changed the name to the Division of Mental Health and Developmental Disabilities. Because we already had a lot of the institutionalized retarded people, and we'd had others that didn't need to be in the institution, could be elsewhere. And now we had the Office of Developmental Disabilities, and so it was all sort of together. And I -- I always thought that because of the way the statute was written, mental health, the mental health lands always included the mentally retarded. And as far as I was concerned, broadening that to the developmentally disabled was not -- you know, was in my -- in my thinking, it was sort of a nicer way of talking about the mentally retarded, in a sense. Although I think that there are people who are developmentally disabled who are not, in fact, handicapped mentally, you know. But -- so that sort of was not troublesome to me. Section 8:
And there was a -- a sort of long-standing issue about those people with alcohol and drug problems. The Office of Alcoholism and Drug Abuse was separate from the Division of Mental Health. And in many states, it was part of the Division of Mental Health or the Department of Mental Health. But it -- you know, and -- and early on, NIMH [National Institute of Mental Health] paid for somebody to do a consultation to see whether or not it made sense to integrate these programs in Alaska, and there was a lot of resistance from the alcohol and drug people to do that sort of thing. And I think it came down to they didn't want anybody committed for treatment. Now, it's different if the -- if the judge makes a condition of your sentencing that you get treatment, you know. That's viewed differently by the alcohol and drug world. But -- so, you know, it's like I -- I was not particularly motivated to try to build a bigger and -- you know, department. I was more interested in doing a good job with what we, you know, had to do. But the -- I think that the way Vern Weiss got involved was this grew out of some connection between Steve Cowper and Vern Weiss' father, that may not have had anything to do with mental health or mental health lands or what have you. I think he -- his father was a client of some -- some connection with Steve Cowper.
And I -- I didn't know that Vern Weiss' basic problem was developmental disability. I mean, I think that's what it was. I never met him, I never really knew anything about him. And I wasn't really involved in the selection of, you know, who -- I mean, I didn't -- not being a lawyer, I didn't think in terms of we need a name, we need a person, you know, what have you. I just saw it as a sort of a public interest lawsuit. So -- BILL SCHNEIDER: So Weiss didn't come to you?
JERRY SCHRADER: No. Huh-uh.
BILL SCHNEIDER: I see.
JERRY SCHRADER: Now, did he go to Natalie? Not that I know of, but I -- I don't know how that decision came about. And I do think that, you know, once it began to look like there was a pot of money, then the alcohol and drug people got a lawyer who want to be -- and he wanted them to be part of their beneficiaries, et cetera, et cetera, et cetera. And now I don't know. I've -- some people think you have to beat the bushes to find somebody who isn't a beneficiary, but I don't know that. Because I haven't kept up with it. Section 9:
You know, it's -- one of the things that I've given some thought to is whether or not what has evolved from the lawsuit is really something that I could feel good about, and I, of course, know people, I have friends who have, you know, worked in Alaska and mental health and so forth for a long time, and they all seem to feel that the mental health system has just gone by the wayside. And you know, I know people who, like, worked at the Anchorage Community Mental Health Clinic who have left. And I've had people say, well, I mean, the mentally ill just hang out on Fourth Street, they don't have any programs, they don't have anything to do. And it's -- the -- it reminds me of my experience when I went to California in '78. They had just survived Ronald Reagan's governorship. And Ronald Reagan felt that the state was spending too much money, so he cut the budget at the state hospitals, he cut the budget at the Department of Mental Health, he cut the budgets, you know, everywhere he could. You know, it -- the -- the budget at the State Hospital was trimmed to such a point that I believe it was in '70 -- 1979, the doctors filed a lawsuit, the psychiatrists at the State Hospital, alleging that their rights were being violated because they were unable to do their job because the hospital didn't have the necessary medicines, it didn't have alternative, you know, various programs for people to do, they didn't have enough nurses, you know, it's like they couldn't treat people in that environment. And interestingly enough, you know, it was, like, the lawsuit didn't go on because the state found some more money to fund the hospitals more appropriately. Section 10:
A lot of the -- the counties, you know, once they sort of scaled down the Department of Mental Health, then the counties were operating without any real management oversight from the state. They were getting money from the state, but they weren't having any direction, they weren't having any oversight, there was no program reviews, et cetera. And -- and they did -- they sort of drifted off in a lot of areas, in a lot of ways from local pressures. And one of the things that was kind of intriguing was that when we would discuss -- I mean, I had to sign off on the budgets for five counties, San Francisco, Contra Costa, and whatever, San Mateo. And so when we were discussing the money and the budgeting of these places, we had these various categories of money. And we had one category called one-time money. Now, that was money you could start a program with. Then we had another category called one-time one-time money. And that was like you could do a study, you know, or something, but you couldn't really start a program with it. And -- but what was happening was that, you know, like, San Francisco had Willie Brown and he was like Santy Claus; when San Francisco wanted something, and they would just get more money.
And they were -- the director of the mental health program in San Francisco was highly critical of the Department of Mental Health. And we were pretty tired of that, and so the -- we did a program review of the services in San Francisco, and we had -- I mean, I ran it, and I -- I was free to draw on staff, psychiatrists, social workers, psychologists from all over the city to put together a team. And I think we had about 40 people. And we did this in three days. And at the end of it, the man who was the director of -- of the Mental Health Services in San Francisco had two or three things to say. One was he criticized us because we didn't have enough gay people. And he didn't seem to realize that I'm not supposed to know how many gay people I had. I'm supposed to be blind. It so happened I did know that we had some gay people.
And the other thing was he -- he -- you know, he sort of complimented us on our overall work, but he failed to realize that the administrative review opened with these lines: This is a program that is apparently expecting an influx of new money. That's a nice way of saying it's overspending its budget. And Dianne Feinstein, I think, was the mayor. And he got fired. Section 11:
So -- but we found programs, I mean, we -- we reviewed programs that were just extraordinary, and extraordinarily inefficient and ineffective.
My favorite one was the Union Halfway House and Day Treatment Program. And over a period of a year, one person had stayed there one night. There were about two or three people who came for lunch about three times a week. That was the total number of people that they had served. They had a huge Victorian house. They had full-time secretary, a full-time social worker, a full-time psychologist, a consulting psychoanalyst, Union analyst, you know, it was like... And then, you know, another program that I was reviewing, it was a day treatment program for behaviorally troubled kids. And so I'm looking at the charts, and I open this chart and there's just all these blank pages. And it says, call Bill Smith, and a telephone number. That was all. That was the whole chart. You know. I -- I didn't call Bill Smith, but you know, so it was, like, recordkeeping was just kind of bizarre. And one time we were looking for a mental health clinic, and this was -- San Francisco had five districts and we were looking for the main mental health clinic in this one district. And it was kind of odd because here was this brick wall that just went on endlessly. There were no windows on the first floor, there were windows on the second floor, and there was a doorway. So we go to the doorway and look and there's a card in the corner that was card of the director of the mental health clinic. That was the only thing that clued you into the fact that this was a mental health clinic. And then when we tried to open the door, it was locked. We had to push this buzzer, you know, and it went baa ah, and you could go in the door and go in. We rated them real low on accessibility. So you know, it was like one of the lessons it taught me is that if you're going to put money out in the community, you need to monitor what it's used for, and you need to have an information system that can tell you, you know, whether or not you're serving people. I mean, another classic was Contra Costa County had an inpatient facility, and the average daily census was something like 28. And the capacity was 20. So every night certain patients would be selected to go over and sleep in the general hospital if there were beds over there. You know. And every day they would call the State Hospital to see if they could send somebody to the State Hospital. And -- and so here was this sort of not very satisfactory situation. Some poor woman was strapped down, you know, because she was -- had sort of violent tendencies, and somebody had discovered that someone had gone in there, she wasn't -- she doesn't have an attendant around, someone had gone in there and she had been raped while she was in leather straps in this bed. So that caused a big furor. But the other thing that was bizarre was there was another building, there were another 15 beds, but this had been turned over to a psychologist from the community college and he was only admitting people who were having a first episode of mental illness, schizophrenia, and so this was a research project. And so if they had been using their beds for what they need needed to use them for, and funding a research project wasn't a very sensible use of that public money, they would have had enough beds, probably. You know. So you just -- you know, it was like -- when you have these local sort of grant funding mechanisms, then you get what local pressures bring to bear. Section 12:
And I -- I'm afraid now that with, you know, essentially Alaska has two mental health authorities, the state is a mental health authority and the Mental Health Trust Land Authority is an authority. And I -- I am skeptical that these things are tied together in a way that is constructive. And I'm skeptical that there's anything like a chain of command. I think you have a chain of agreements maybe, but whether or not they are lived up to, I don't -- I don't think anybody knows. That's my suspicion. And, you know, I -- they -- I'm told by people that -- and I guess there's some evidence for that, that as soon as -- as soon as this money and the settlement in '90 -- 1999 came through, the state mental health commitment to mental illness then went down so that they started cutting budgets. And part of what I realize is that one of the reasons that, when I went there in 1973 and was developing a mental health program, one of the reasons that there was receptivity to that, I think, in retrospect was that their defense was always going to be, well, we've always taken care of the mentally ill, what's the complaint? You know. So what if we use the land for other purposes. You know. We -- everything Dr. Schrader said we had to do, we did. You know. And so I can't help but think, gee, maybe winning the lawsuit was the worst thing we could have done.
BILL SCHNEIDER: That's an interesting thought.
JERRY SCHRADER: We took away the incentive, you know --
BILL SCHNEIDER: Yeah.
JERRY SCHRADER: -- to actually do something constructive about the mental health program. BILL SCHNEIDER: Well, the final question I have is you know, we look at this period of time coming up to the lawsuit itself.
JERRY SCHRADER: Yeah.
BILL SCHNEIDER: You know, and I -- I pressed Steve Cowper a bit as to whether he could have done more --
JERRY SCHRADER: Uh-hum.
BILL SCHNEIDER: -- in his capacity. And so I guess I have to ask the same question of you. Is -- in retrospect, do you think you could have done more to bring the state to terms in --
JERRY SCHRADER: Without the lawsuit or -- BILL SCHNEIDER: Without the law -- well, without the lawsuit, or --
JERRY SCHRADER: Even after the lawsuit.
BILL SCHNEIDER: -- in prompting -- prompting it. Yeah.
JERRY SCHRADER: You know, it wasn't for want of trying.
I mean, to give you an example, I can't exactly guess the time frame, but I suspect -- let me think. Where was I. I was in Anchorage at that point. So sometime after '80, between '80 and '82 maybe before -- I think around that time frame, there was a bill which was designed to bring about a more -- a business-like way of managing the mental health lands. And it might have been introduced by Joyce Munson. I know she did introduce a bill and it never went anywhere. Got tied up in committee.
And I had a friend who was the president of the Alaska Federal Savings and Loan at that time, I think he was still there. And I was telling him about this, and he said that he had talked to a lobbyist he knew. And the report came back that it would cost 85,000 to get the bill out of the committee. And I liked that because it was such a nice, crisp number, you know. And I didn't ask, but I wanted to ask, could I see the budget? You know. Like do you get all the money, or does George get some and Ralph and, you know, how much? We didn't have $85,000. You know. And I -- I think that part of it is that the people on the other side, there was money involved, you know. A developer could buy Mental Health Land on the cheap and build houses on it and sell it, you know, at going rates, could make a lot of money.
BILL SCHNEIDER: Yeah. I see. JERRY SCHRADER: And -- so I think that's part of why it went on. And you know, it's like -- I think that -- that in '85, when the Supreme Court basically ruled in our favor and ordered the state to reconstitute the Trust, I think that we felt that it would then be done. I mean, I -- and so that it evolved into this 14-year struggle was amazing to me. I thought Supreme Court judges had a lot of power. And you know, I never really thought that the legal arguments and the legal questions that the state rose were compelling. It's just that, I mean, we did realize that once we had the ruling, then a -- you know, a settlement would probably be something that would grow out of the political arena as much as anything. And so the Mental Health Association, for -- for example, encouraged the development of the National Alliance For the Mentally Ill groups that grew up in Fairbanks and Juneau and other places. And because we knew that we had to have people involved.
BILL SCHNEIDER: Sure. Section 13:
JERRY SCHRADER: And but you know, it's like I had spent, you know, overall something like 10 or 15 years trying to get something done about the mental health lands, and I was ready to do something else with my life. BILL SCHNEIDER: So in 1990, did you -- when you -- did you retire then?
JERRY SCHRADER: No, I came -- I came back to Oregon and rejoined some people I'd been in private practice with before.
BILL SCHNEIDER: Uh-hum. Uh-hum. JERRY SCHRADER: And frankly, by that time in my life, I had to think more seriously about making money. I -- you know, it was, like, my -- my needs are not that great, but I knew that at some point, I would need to retire, and the only -- you know, I wasn't going to have a retirement from the State of Alaska or any other job I've been, you know, at. I had to do it through private practice. And so that really became more of a focus for me. And that started while I was still in Juneau but it continued on when I came down here.
BILL SCHNEIDER: And how long did you practice then?
JERRY SCHRADER: Here? Well, let's see. I retired about 10 years ago. So I was -- I think I retired before I was 65.
BILL SCHNEIDER: Hmm. JERRY SCHRADER: So I came down here in '90, and I retired after about 10 years.
BILL SCHNEIDER: Yeah. All right.
JERRY SCHRADER: I was -- you know, it's like people complain endlessly about the IRS. The IRS is your greatest friend if you're self-employed and you make, you know, 150,000 a year or something. There are so many wonderful ways to avoid paying taxes, it just, you know, boggles the mind. KAREN BREWSTER: We just have 5 minutes left on this tape, so I just want to interrupt with a quick question to tie all this together on the --
JERRY SCHRADER: Good.
KAREN BREWSTER: -- the settlement. And I know you haven't been in Alaska and practicing, but your sense of how the mental health services has changed since when you were there --
JERRY SCHRADER: Uh-hum. KAREN BREWSTER: -- and if the settlement has made any differences, good and bad.
JERRY SCHRADER: Could what?
KAREN BREWSTER: Good and bad differences, or changes.
JERRY SCHRADER: Well, one of the things that I think the Mental Health Land Trust should do is to pay for a team of people to really come up and review the program. And make recommendations about -- I mean, an assessment of how well it's functioning, and what needs to be done to have it function. I think that would be a genuinely very constructive use of Mental Health Land money. And because, you know, it's like I just don't think there's the oversight of the program, as far as I'm able to tell from talking to people, that there needs to be. And I -- you know, the people that I have talked to who were involved in this years ago have uniformly been disgusted with the program. And some of them have family members who are involved, you know, as chronically mentally ill people.
And Dr. Mander [Anthony?] and his wife who were psychologists in Juneau for a long time have left, I mean, he's still -- he still works as a consultant for the sex offenders programs for the Department of Corrections. But he's on a contract and they live in Seattle, and you know, they have a house in Juneau, but it's like they -- they all describe, you know, a deterioration in services to the seriously mentally ill. So I -- I think that unless someone goes and really looks at this, you know, I mean, from where I sit, I could see that there's -- this is a setup for dis-coordination, you know, and the creation of a lot of deficiencies in a network of services, just because of the way it's structured. So...
BILL SCHNEIDER: Okay. Thank you very much.
JERRY SCHRADER: Uh-hum.
BILL SCHNEIDER: Okay.
JERRY SCHRADER: Fun to tell all my old stories.