John and Louise Maakestad - Tape #ORAL HISTORY 2006-15-30-tp1
John and Louise Maakestad were interviewed by William Schneider and Karen Brewster on December 8, 2010at their apartment at the Anchorage Pioneer Home in Anchorage, Alaska. John was born in Petersburg, Alaska, became a Lutheran pastor, served in Shishmaref and Nome in the 1950s and early 1960s, and served as the chaplain at the Alaska Psychiatric Institute from 1963-1984. In this interview, John talks about his ministry career working with the mentally ill and the specialized training he received in pastoral care. In addition, as parents of a developmentally disabled daughter, the Maakestads discuss delivery of and access to services for the developmentally disabled.
Part two of this interview.
Click to section:
Section 1: John Maakestad talks about being born and raised in Petersburg, Alaska, and following in the footsteps of his father to become a Lutheran pastor.
Section 2: His education and training, and getting involved with pastoral care issues.
Section 3: His training in pastoral care in California.
Section 4: Louise Maakestad talks about meeting and marrying her husband, John, and their early years of living in Shishmaref and Nome.
Section 5: Working as staff chaplain at Alaska Psychiatric Hospital and McLaughlin Youth Center in Anchorage, Alaska.
Section 6: Responsibilities of staff chaplain, including patient consultation and holding religious services in the hospital.
Section 7: Importance of having clergy involved in delivery of mental heath services and how acceptance of that has changed.
Section 8: Personally benefiting from mental health services for their developmentally disabled daughter and another daughter who was diagnosed bipolar.
Section 9: Sending their daughter to Harborview Hospital in Valdez, Alaska.
Section 10: Difficulties for patients being separated from family, encouraging family visits, and changes in medical care in the villages.
Section 11: The pros and cons of family visitation to patients and of returning a patient home, and living in Shishmaref in the 1950s.
Section 12: Types of counseling provided by clergy.
Section 13: Assessment of Alaska Psychiatric Institute's treatment program, and example of a patient on work release who committed murder.
BILL SCHNEIDER: All right. Well, today is December 8th. Seems like this month is flying by already.
JOHN MAAKESTAD: It is.
KAREN BREWSTER: 2010.
BILL SCHNEIDER: 2010. And I'm Bill Schneider, Karen Brewster's with me. And we have the pleasure today of doing an interview with John and Louise Maakestad, and we're here in the Pioneer Home in Anchorage in their lovely apartment. And you've been here just about a year, you say?
LOUISE MAAKESTAD: Yes. BILL SCHNEIDER: Uh-hum. So thank you for taking time to meet with us and talk.
Let's begin a little bit about where you were brought up and how you got involved in your life's work. And John, we'll start with you.
JOHN MAAKESTAD: Well, I'm a native-born Alaskan, I'm going to say, though not of one of the Native tribes, but one of the immigrant groups that have come in to Alaska and the United States in quite large numbers. And I'm speaking of the Norwegian population that has become part of the citizenship of Alaska.
My father was a Lutheran pastor, and the Norwegian people are largely of Norwegian -- of Lutheran faith, denominational wise. And so his first parish was in Petersburg and his first pastoral experience was from '17, that is 1917, to '20.
I was born in 1918, and we moved South from Petersburg in 1920. Then my -- at that time, my father began a mission development among the Norwegians in Pasadena, California, were quite a number of Midwestern Scandinavians, particularly Norwegians, in -- in the way in which we are speaking. So that's how I came to be born in Alaska. And my father was called back to serve an additional time at Petersburg in 1928, and he was there for five years. During that time I was 10 to 15, and so that's my experience in Alaska. And then as an adult, I felt the call into the Lutheran ministry and became a pastor, and I also have served congregations in Alaska as my father did. So... Section 2:
BILL SCHNEIDER: Did you get your schooling in Alaska?
JOHN MAAKESTAD: The lower grades, that was true, but my -- my graduate work was done in the Midwest at one of our seminaries, Luther seminary, St. Paul, Minnesota. And so otherwise, I -- my schooling was not inclusive of the schools in Alaska, other than special symposiums, or whatever, were carried on in the -- in the line of Christian ministry and how it relates to the problems of life. And I was always particularly interested, after World War II there was a great deal of emphasis on holistic treatment of human illness, as you well know, and I was glad to be a part of that because the spiritual nature of human -- humanity or humankind is inclusive of why am I here and why do these things happen to me. LOUISE MAAKESTAD: And what year was it that you left for your mental health training to be a chaplain?
JOHN MAAKESTAD: Oh, yes. That was -- let's see. Louise? I --
LOUISE MAAKESTAD: '62?
JOHN MAAKESTAD: Yes. It would be in the summer of '63, wasn't it? That's all right, dear. It's quite immaterial. But I had come to a point where I had a year of sabbatical for study, and at that time, the religious forces of -- of society were trying to step into rhythm with the rest of human life, and -- and the human helping activities available, such as social work and -- and mental health. The idea was for clergy to become acquainted with the in-depth work of psychiatrists, psychologists, social workers, and of course, nursing -- the nursing emphasis or the particular part that they have in holistic treatment of human problems. BILL SCHNEIDER: So this was specialized training that you got?
JOHN MAAKESTAD: Yes. There were two religious agencies that had developed after the World War II, and they were particularly interested in how pastoral care could be helpful in treatment of human problems. And those two agencies, the Institute for Pastoral Care and the -- the other agency that developed became a part of that Institute for Pastoral Care. They went through a process of consolidating. And these included Protestant and Catholic, as well as whatever their religious affiliation a person might claim or have. Yeah. Section 3:
Have I gone afield, or --
BILL SCHNEIDER: No, I think you're -- I think you're doing a fine --
JOHN MAAKESTAD: Well --
BILL SCHNEIDER: I was just trying to figure out how to ask you about how that training, then, fit into your life's work.
JOHN MAAKESTAD: Uh-hum. All right. I find -- found myself with a year of sabbatical freedom to pursue studies related to the work of pastoral care that I was in. And so I had a very good social work person, an elderly single woman, she was a Dane, and she -- she was a social worker, and had done time in Europe working in the Red Cross structure, and she said, why don't you take a quarter of clinical pastoral education? That's what they began calling this where clergy were requested to come along and make contributions and insights and so on from the spiritual side of human problems. LOUISE MAAKESTAD: And instead of just having a quarter, you found out that you could have four quarters in the --
JOHN MAAKESTAD: Yes. The first quarter was done at Herrick Hospital in Berkeley, California, so I moved our family down there and we leased a house for a year because I decided that I was going to take a full year, that was four quarters, three-month quarters was how it was offered. And people like the administrator of the -- the hospitals and other staff members would be included in their care plans and so on. So -- so my first orientation and exposure to this -- this point of view, this way of going about treatment of human ills. And part of that was done at the University of California. The first month and a half or six weeks was done over at Herrick Hospital, which is general medical/surgical. Then I was transferred over to University of California in San Francisco in pediatrics and -- pediatrics and cancer research. So I worked in that milieu. And then the next quarter was at San Quentin Prison with the correction aspect. So they were very thorough exposures. You -- in fact, I was assigned to two men on death row, you know, and went with one of them, I went home at five o'clock on Tuesday, and at ten o'clock the next morning he was scheduled to be executed. And they used the gas chamber. But when I came to work at eight o'clock and was going to walk with him down the last mile, as they say, the -- some lawyers had found some way to delay it, and so that man, he actually died in prison. They kept delaying his -- there were all kinds of maneuvering, you know, to -- it was a feather in the lawyer's cap to have delivered a man from the gas chamber. LOUISE MAAKESTAD: And your last quarter? The last quarter for the mental --
JOHN MAAKESTAD: Yes, Louise. She hurries me along, and that's needed very much.
After I had been in a correctional setting, then I was able to get into Metropolitan State Hospital down in Norwalk, California, which is a 4,000-bed mental hospital, or was at that time. And that was my third quarter, then. And the final quarter was completed at Norwalk. So I had general hospital at Berkeley and cancer research in San Francisco. So it gives you the idea that these organizations, the Institute for Pastoral Care, were interested in making a connection for therapy and the benefit of humanity. And particularly in our health structure here in the United States.
I am afraid I have gone far afield, but -- BILL SCHNEIDER: No, that's -- that's okay. That background --
JOHN MAAKESTAD: Is -- general rambling is acceptable.
BILL SCHNEIDER: That background must have prepared you pretty well for --
JOHN MAAKESTAD: It did.
BILL SCHNEIDER: -- coming back to do the work here.
JOHN MAAKESTAD: It was very interesting, too. Section 4:
BILL SCHNEIDER: Before we get into getting you back to Alaska, though --
JOHN MAAKESTAD: Yeah.
BILL SCHNEIDER: -- let's ask Louise about how you met John and raising a family. And I suppose you had your family in California at that point?
LOUISE MAAKESTAD: Yes. That was interesting because we'd had seven years in Alaska, we had had twelve years in Alaska, he served a parish in Fairbanks five years, and then had the call to the little village of Shishmaref, and we had been there three years and then to Nome for four years, and by that time we had five children when he had this opportunity for pastoral clinical education. And it was, you know, a change, but we had realized that the Native people were in a time of change, too, this way, that we were seeing more mental problems, and -- and John wanted to be more of help to them that way.
And then we had had one child that had severe developmental disabilities that was born in Nome, and we were eager for her to have an evaluation. But back to the time when we met as young people, our families knew each other, and we've always said our courtship was more by letter than -- because he's nine years older than I am, but we -- I grew up in North Texas near Amarillo, Texas. My father was a cattle rancher and wheat farmer. And one summer I went to the University of Bould -- of Colorado at Boulder and John's mother lived near there, so anyway, we became engaged and were married in 1948 in Texas. And I followed him to his first parish up near Everett, Washington, and from there he had the call to Alaska. So that's where we are. BILL SCHNEIDER: Well, we should go back to those earlier years a little bit when you were in Shishmaref and -- Kotzebue, did you say?
KAREN BREWSTER: Nome.
BILL SCHNEIDER: Nome.
LOUISE MAAKESTAD: Nome.
JOHN MAAKESTAD: Nome, yes.
LOUISE MAAKESTAD: Seven years on the Seward Peninsula.
JOHN MAAKESTAD: Which is south of Nome. Kotzebue is -- let's see, Nome is south of Kotzebue. LOUISE MAAKESTAD: And it was very much a subsistence life-style in those days. You know, people had no electricity and they had no -- they -- it was interesting to watch how the seasonal work. Shishmaref very much had a pattern of seasonal work from catching herring by net in the fall and going up rivers with their fishing in the summer, and I just really marveled at how much food they could put away for their large families, and rugged life-style they had. KAREN BREWSTER: What years were you there?
LOUISE MAAKESTAD: We were in Shishmaref from '55 to '58, and in Nome until '62, and that's when he found out about this pastoral -- clinical pastoral education that was an opportunity. Section 5:
BILL SCHNEIDER: And then you came back from that training --
JOHN MAAKESTAD: Yes.
BILL SCHNEIDER: And where was the next place?
JOHN MAAKESTAD: Well, you see, at that time, in '58 to '62 was when I was in Nome, and that's when I made the decision to go into clinical training after that period. That -- it was then that I decided that I would apply for this scholarship and made plans to move to California for a year. And so...
BILL SCHNEIDER: But when you came back from -- from the fellowship --
JOHN MAAKESTAD: Oh. Oh, yes. From --
BILL SCHNEIDER: -- what was your next assignment? JOHN MAAKESTAD: Yeah. During that time, you see, Alaska had become a state, and Alaska was seeking to build up its -- its structure to function in this new, wonderful experience and freedom of statehood. And so they were building the psychiatric hospital and they needed a qualified clergy to be this staff chaplain. And I applied for that. I had done a little forethought about it, you know, I knew that it was coming up and I saw or heard the building plans for API.
API had already been built, then when I came, and so they had the structure and so on. And it just was a matter of stepping into the role. And I really had to introduce the idea of chaplaincy in institutions, the helping institutions, hospitals, and...
And so I was accepted and became a member of API's staff, but I also served in McLaughlin Youth Center halftime for a while when they -- because they needed chaplain services periodically. BILL SCHNEIDER: Tell us about your duties at API.
JOHN MAAKESTAD: Uh-hum. Well, we used to think in concepts of the reason for having a chaplain, a religious person of bona fide qualifications such as being an ordained pastor and being accepted as a person of the helping professions, a qualified person, and so I would sit in on the staff meetings and help with -- that is, accept the role of consultation for individual patients. And then as chaplain, I was not only available for consultation with, you know, we had a young lady that said she was the Virgin Mary and she was expecting a child; I mean, such things as that the chaplain would deal with. And then the chaplain would also be available for staff members asking about particular, oh, dietary abstinence in various ways as -- as requested by the religious, like fish on Friday and somehow or other, that's just a minor consideration, but -- and I arranged for the attendance of orthodox patients at the special Christmas services, you know, they are a week later than the rest of Christendom, but that's a big segment of Christendom, too, the Orthodox. Section 6:
BILL SCHNEIDER: I was wondering how you dealt with the woman who said she was the Virgin Mary.
JOHN MAAKESTAD: Yes. The psychiatrist was in charge of her, you know, and she -- today she's well married, mother of several more children, lives down in Florida, and she actually was the daughter of a Lutheran family that belonged to one of the Lutheran churches in south Fairbanks. Let's see. It's -- LOUISE MAAKESTAD: What are they?
JOHN MAAKESTAD: Christ Our Saviour Lutheran Church, I think it is.
But it could have been any. And there were other denominational attachments that it didn't make any difference. There's something in the growing-up process that some -- some people have that they just -- they have to have some extraordinary reason for living, and it's just a part of the difficulties that they have to learn to deal with. And so this -- this young lady, as I say, is a very successful mother of her family. So --
LOUISE MAAKESTAD: She had regular -- you had regular Sunday services and chapel services.
JOHN MAAKESTAD: Oh, yes, yes.
LOUISE MAAKESTAD: And family.
JOHN MAAKESTAD: Excuse me, I --
BILL SCHNEIDER: No, that's all right. JOHN MAAKESTAD: That was a very important part of a chaplain's position, too, to provide a religious service within the hospital. There were many patients who could not leave the hospital, and so we -- we had a Sunday morning service and -- BILL SCHNEIDER: How did you -- how did you think about making that service in a way that it would be welcoming to different denominations?
JOHN MAAKESTAD: Well, we -- we sought to make it a general Protestant service, and then we did have a Catholic, there was quite a large Catholic population, and so we had a priest come in once a week and conduct that service, but there were Catholic patients that would attend also the general service, which was Protestant in -- in its -- its structure. But acceptable. Yep.
I'm -- I don't -- am I --
BILL SCHNEIDER: No, that's fine. JOHN MAAKESTAD: -- getting -- yes. The chaplain provides religious services within the hospital.
BILL SCHNEIDER: Uh-hum.
JOHN MAAKESTAD: So I have said he -- he or she acts as a religious reference and -- within the hospital. He -- he functions as a part of the consultation and available for working out differences between patients and whatever medication or the requirements they have, and helping them to understand the treatment process and what it is for and why it's done and -- Section 7:
BILL SCHNEIDER: I would imagine that they would be very important to make sure that the spiritual aspects of people's lives weren't cut off when they became institutionalized.
JOHN MAAKESTAD: Yes. That is very true. And also, there are some times when religion must be removed or, you know, say, now, don't -- we won't participate in some peculiar religious rite. The little girl from -- a little Native girl, she was about 12 or 15, she came down from Nome and she put her foot under a hot water shower until she burned her foot, you know. And they said what are you trying to do? And she said, I'm trying to drive the evil spirits out. Well, that's a religious concept, and damaging your body in which the spirit lives will not be pleasing to God or helpful to yourself. I mean, there are problems of that nature. BILL SCHNEIDER: So you were able to help out, provide some --
JOHN MAAKESTAD: Oh, yes. And -- and there were some people that thought, well, mental illness is really a religious problem that we can exorcize, the religious term, you understand. Tell the spirit to flee. And you have to have realistic explanations and understanding or help.
It's been quite a few years, I was chaplain for 20 years, from '63 to '84. That's 20 years, isn't it? LOUISE MAAKESTAD: That's a long time ago now, since you've retired.
JOHN MAAKESTAD: The years have worked to fade.
BILL SCHNEIDER: Sure. Sure.
JOHN MAAKESTAD: Yes. But I remember with great satisfaction and gratitude that I could be a part of developing this aspect of religion as an active part of the treatment of human ills, so that -- so that a clergy is cast in a helpful -- helpful concept, so... BILL SCHNEIDER: Yeah. That's quite a change, isn't it?
JOHN MAAKESTAD: Yes. It -- it has been. And it now is very much accepted. For instance, there is a program out at Providence Medical Center that offers clinical pastoral education to clergy in Alaska, and when I was there, I was the only chaplain that had graduated, so to speak, or I had completed the four quarters required for -- which include corrections and mental health and physical mental -- medical/surgical problems.
BILL SCHNEIDER: But that's common now, you say?
JOHN MAAKESTAD: Yes, it is. And accepted. Yeah. Section 8:
BILL SCHNEIDER: Back to your -- your family and -- how was your daughter treated? Did she receive the care she needed?
LOUISE MAAKESTAD: Well, we went to Shishmaref in '55 with three children, they were at that time four, two, and six months. And when we lived there, we had one more daughter, Ellen, and she was born in Nome; and then after we left Shishmaref and moved to Nome, then we had Muriel, who was born in '59, and that evening that she was born it was a big baby night. They had 12 babies, they had never had that many, and a set of twins. And Muriel had some breathing problems, and anyway, it turned out she had some brain damage that was much more severe than we thought at first. And I realized she -- we needed to get some more evaluation of her. And that was the way it was.
And we went to California, then, when she was three years old for John to take this clinical pastoral education, and she was evaluated then, and then we realized that she would need more attention. She didn't have that early infant stimulation that they have nowadays for kids, I think it would have helped her a great deal.
But anyway to make a long story short, she went through the Special Ed program here in Anchorage and is now in a group home, and she's not physically handicapped except for her mental age is about five years old or reading readiness age. And she's had various little jobs that -- under Assets, and they do a good job in Anchorage of helping these young people. And then we had one more child when we lived here in Anchorage, Carol. And now our children are scattered all over the world. We have a son teaching school in Saudi Arabia, oldest daughter is retired with her husband, went to Hawaii, and we still have Muriel here and our daughter Ellen. And our daughter Ellen is the one who developed a mental problem, bipolar, which is quite commonly known nowadays, but at the time, I had no idea why she was having a sudden personality change in her early twenties.
She had been in Norway for six years, and I could tell from her letters there was something wrong. And so we brought her back and she spent a couple of days at API, which was very -- she was very against that because of her dad's association. But I'm going on too long about that, but it was a traumatic time for our family because she typical bipolar, she refused any -- any medication, she refused -- and she would get a job and lose a job. And she, all of a sudden, disappeared to California. And then we tried to find out how she was, and it was getting more difficult, and finally she -- she was diagnosed down there and she accepted it for the first time and came back to Anchorage, and then has been here 10 years now and is doing well. She's off medication, but she has a little condo and is working and so we're real thankful for that. And so -- JOHN MAAKESTAD: We've -- we've benefitted from the full spectrum of help.
LOUISE MAAKESTAD: Yeah.
JOHN MAAKESTAD: Needed and offered.
LOUISE MAAKESTAD: Well, there's so much help available now. And our youngest daughter married an ophthalmologist who is a medical missionary in Borneo, so the children are far and wide. And we are very thankful they all seem to be doing quite well right now. Section 9:
KAREN BREWSTER: Did you have any experience with Harborview Hospital in Valdez?
LOUISE MAAKESTAD: Yes, we did.
JOHN MAAKESTAD: Yes, we did.
LOUISE MAAKESTAD: She was there for a period of time.
JOHN MAAKESTAD: And -- and Muriel was residing there, too.
LOUISE MAAKESTAD: Yeah, that's what I mean.
KAREN BREWSTER: Yeah.
LOUISE MAAKESTAD: Yeah. KAREN BREWSTER: And how was that for her?
LOUISE MAAKESTAD: You know, it was amazing. It just went well. When she was at Denali School, she was having some difficulty behavior wise, and the school psychologist said that -- he noted that Muriel kept comparing herself with her older brothers or sisters, and she's saying, when I get my driver's license, she was very frustrated. And so he thought she would do better away from the family for a period of time. And we first sent her to a Lutheran school in Beatrice, Nebraska, and they -- they -- she did well there. She brought up her skills more for group home living; and at that time, Harborview had improved considerably, so we decided we wanted her closer to home.
And so we brought her to Valdez, and she did well there. And people had a lot of criticism, and they -- they closed down, and sent these kids to group homes, and she had quite a hard adjustment to Anchorage because she was used to that little town of Valdez and they knew her and she had a good program. So I -- I was very positive about that experience in Harborview, contrary to much publicity against it. Anyway, that about sums up the family, I think.
BILL SCHNEIDER: Yeah. But that's interesting about Harborview because --
LOUISE MAAKESTAD: Yeah.
BILL SCHNEIDER: -- in talking with other people, the issue has come up of a small community that was somewhat accepting of and inviting of people.
LOUISE MAAKESTAD: Right. I just really think -- Section 10:
BILL SCHNEIDER: But this whole question of separation, I want to ask both of you about this, both from a personal standpoint as well as from a professional standpoint, how did you deal with separation, both professionally with people being separated from their home communities and coming to API? And both from a personal standpoint, your being separated from your children. So maybe the first part would be professional. JOHN MAAKESTAD: And by the way, we haven't mentioned Morningside.
BILL SCHNEIDER: Yes.
JOHN MAAKESTAD: Maybe that's on your list. But Morningside was being replaced by API, that's really what was -- or went on.
LOUISE MAAKESTAD: And we forgot to mention we lost our second son in a hang gliding accident in '76, and that was a real trauma for the family. He was 21, and he'd climbed Mt. McKinley that summer, and I thought if he gets off that mountain, he'll be safe, but you know, life has strange turns, but he -- he very much accomplished what he wanted to do in life. JOHN MAAKESTAD: Excuse me, you asked a question, and I left it hanging.
LOUISE MAAKESTAD: Separation.
KAREN BREWSTER: Separation.
JOHN MAAKESTAD: Oh, yes.
BILL SCHNEIDER: The separation, from a professional standpoint, how did you counsel and minister to people who were separated from their families? Was that an issue? LOUISE MAAKESTAD: At API.
JOHN MAAKESTAD: Oh, yes. We would try to find relatives that lived in Anchorage or could come along and -- we didn't have residence for families of patients at API, but that is a difficulty, but the Native Medical Center has come a long way by providing residence for family members to come right along with -- LOUISE MAAKESTAD: Well, the fact that you knew so many of the Native families from Nome and further north --
JOHN MAAKESTAD: Yes. Yeah.
LOUISE MAAKESTAD: -- you could -- you could make connections and help them see their family here in Anchorage.
JOHN MAAKESTAD: Some of -- a number of the people that lived at Shishmaref, for instance, would go to Kotzebue for medical treatment, unless it was very severe, then they'd airlift down here. So that's how I became acquainted with Kotzebue patients and so on. Kotzebue is -- you know, is -- it's positioned to benefit from these oil developments in the future, in the not too distant future. LOUISE MAAKESTAD: Well, and medical care has improved so much compared to the early '50s when the school teacher usually would be the health representatives in the village, and be on the radio with the doctor in Kotzebue for advice on how to treat this patient or that one patient.
JOHN MAAKESTAD: Yes. Yeah.
LOUISE MAAKESTAD: You know, it was very -- JOHN MAAKESTAD: When we were at Shishmaref, there were times when the teacher would be away, and the teacher had the radio, but I would cover for him --
LOUISE MAAKESTAD: Yeah, the doctor.
JOHN MAAKESTAD: -- or the powers that be. Section 11:
KAREN BREWSTER: When you worked at API, did families come to Anchorage to visit their --
JOHN MAAKESTAD: Oh, yes.
KAREN BREWSTER: -- family members in the hospital?
JOHN MAAKESTAD: Sometimes, yeah.
LOUISE MAAKESTAD: That increased.
JOHN MAAKESTAD: Sometimes that could be helpful and sometimes not so helpful. You know.
LOUISE MAAKESTAD: But that visitation increased in those 20 years compared to --
JOHN MAAKESTAD: Oh, yes.
LOUISE MAAKESTAD: And the travel, people traveled a lot more. JOHN MAAKESTAD: Yeah. And the residence for families is a very good thing because it's very expensive, but -- well, yeah. That problem that you mentioned, separation from the family, sometimes it's better to send them home as soon as you can to -- rather than, you know, keeping them here and far away from family. KAREN BREWSTER: As you said, though, in some cases, the family situation might not be a healthy situation.
JOHN MAAKESTAD: Yeah. Yeah. That's true. And it's not easy. I was just reading in the paper for yesterday about this family in Teller.
LOUISE MAAKESTAD: Alcoholism related.
JOHN MAAKESTAD: Terrible. I wouldn't want to -- I shouldn't read it to you. I mean, that's --
KAREN BREWSTER: No, that's okay.
JOHN MAAKESTAD: You can --
LOUISE MAAKESTAD: Well, being in Barrow, I imagine you --
KAREN BREWSTER: Yes.
LOUISE MAAKESTAD: -- run into situations like that.
JOHN MAAKESTAD: Oh, yes. Well, now, I think your experience is -- KAREN BREWSTER: Well, nothing compared to Shishmaref in the '50s.
LOUISE MAAKESTAD: Well, you know, in a way, it was healthy and easier; life was harder, but the people themselves say that. Life was harder but we enjoyed life more.
KAREN BREWSTER: It was a healthier community.
LOUISE MAAKESTAD: I think you see that, the Native foods were very much eaten. JOHN MAAKESTAD: And you know one of the spectacular things when you live in a place like Shishmaref at that time was that the North Star made one trip up, and Louise had to make the grocery list for a year. I mean, it sounds spectacular.
LOUISE MAAKESTAD: All the basics, yeah. All the basics.
JOHN MAAKESTAD: But it's very true, and workable.
LOUISE MAAKESTAD: And the way that people would work together unloading that thing when it did come. You know, they had their teams and it was so well done. Section 12:
KAREN BREWSTER: I'm wondering about, again, your work at API and working with the patients. What kind of individual counseling might you have provided that was different than what a psychiatrist-type session might be?
JOHN MAAKESTAD: Uh-hum. Well, for one thing, you can clear up misunderstandings about religious teachings. The thing that comes to my mind quickly is, you know, the -- Jesus was asked, what must I do to be saved, and the New Testament says, he that believes and is baptized shall be saved. And then some little baby boy dies, and the family will say, well, does the -- is the baby rejected because the family was unable to carry out the Rite of Baptism and -- and the attached teaching responsibilities, Sunday School and, you know, so on, to build upon the ministry of the church. And -- am I. BILL SCHNEIDER: So how did you respond?
JOHN MAAKESTAD: Oh. Oh, yes. Well, God is a God of love, and we know that -- and the Scripture itself says he that -- he that lives without the law is judged without the law. There is -- there's some clear teachings. But they -- they aren't easily apprehended by some people. Some people find distortions of religion more attractive than realities, and --
BILL SCHNEIDER: Boy, that's for sure, isn't it?
JOHN MAAKESTAD: Yes. Section 13:
KAREN BREWSTER: How do you think patients were cared for at API? Do you think they got good treatment there?
JOHN MAAKESTAD: I think they got treatment that was available.
Louise reminded me of this man that killed three teenagers in Russian Jack Springs Park, you know. And -- LOUISE MAAKESTAD: He had been at API for quite -- quite some time.
JOHN MAAKESTAD: Yes. And they -- they had -- he had moved along in the treatment program to where they even approved him. The initial infraction that brought him to API was that he beat up a Native grocery boy to death. And among the things that -- the reason or in the process of taking him into the API and setting up a program of treatment, he -- he said, I wanted to show the police authority that I'm real tough, and that they -- they ought to put me in the Marines and make me commandant of an elite -- he had a bad distortion, you know. And I, myself, had misgivings about the way they were pushing him along. They actually, you see, had approved his going out and working at Sears Roebuck a couple hours a day, and these were things that you can read in the files. In other words, I'm conscious of not to -- divulging information that is not available. But that shows you some bad mistakes can be made. He was on a work release for two, three hours, and he had gotten himself a pistol, bought someplace, see, loose control, but -- and I had been teaching -- I'm speaking as a part of the team, that -- well, so...
KAREN BREWSTER: Were there residents at API, people who came for treatment, and spent the rest of their lives there, or was it an in and out? JOHN MAAKESTAD: There are a few that, for instance, they have committed very serious murder, in particular. Quite a few. You know, I'm not very mentally agile.
BILL SCHNEIDER: That's fine.
JOHN MAAKESTAD: And it's frustrating. So did I answer your question?
KAREN BREWSTER: I'll ask it again. I want to change the tape, then I'll ask it again.
Working in Fairbanks and moving to API (Alaska Psychiatric Intstitute)
His involvement with the court system and evaluating patients
Instance of a patient who was a psychopath
Working at the hospital in Fairbanks
Removing the mentally ill from the hospitals
Importance of having a place for the mentally ill to receive treatment
API helping people
Acting superintendent for API
DR. HAROLD SOUTH: Well, how -- you know, I've wondered sometimes, I mean, people have asked me, I mean, like with this psychiatrist who had three suicides the first month of his practice, he never asked me, but -- but if a person asks me, "How do you account for the fact that you don't have this experience?" And so I didn't -- I -- I never did know.
I remember -- I remember some -- I remember one -- I could count on one hand or less all the suicides I've had in my whole career that is if the person had seen me, was seeing me, and if he was on medication and was taking his medication, but -- but I -- I guess I guessed wrong. I remember one -- one boy who was 16 who called me one night, you got a -- I mean, understand the situation there, because of my own values and what I consider the ethics of medicine and psychiatry, I was working 24/7. I was on duty -- I was available to anybody any time. And I think this -- this -- this had damaging effects on my own family.
BILL SCHNEIDER: Sure. DR. HAROLD SOUTH: And -- but I remember this young man called me one night, and said, "I'm terribly depressed and I'm having trouble going to sleep."
And I said, "How come?"
And he said, "Because I'm thinking about girls. I can't quit thinking about girls and sex." And I said -- I was laughing. I just laughed out loud. I know I chuckled probably. I said, "That's great. I'm glad to hear that. Because that is perfectly normal."
And I said, "I went through that, and all boys go through that when they are teenagers, and don't worry about it; eventually, you know, it will work out. And be happy that you got it because it's -- it's just -- you're a normal teenager." And so I went back to sleep being very happy, but I found out the next day that he had got his rifle and shot himself. And there's so many -- there's so many elements in these things, it's hard to single them out. And I don't -- I don't really think that what I said had all that to do with it that has caused his suicide or something. It's -- but -- but I do think -- I think that people are always looking for some simple answer that -- and they go from one extreme to another. There must be some pill you can give people to keep them from suiciding. Well, there are a lot of pills. And actually, psychiatry has become -- it is just a special branch of internal medicine. Because the frontiers of psychiatry are -- are in the area of the brain, the hormones, the neurohormones. And all the CME that I had to do this year, most of it was -- was to do with that. That is, I remember when I was in pre medical training, some -- some person in the class, immunology class, said -- some guys just come out and said it, and I think they were telling me that particularly because he knew I was going into psychiatry, "You're going into psychiatry? Ha ha!" I just read in the paper that some guy says, some guy says that mental illness is caused by neurohormones, biochemical ailments, phenomena. And so but -- but -- in other words, well, we had a guy in Ypsilanti, Michigan when I was a resident there, he said, "There is no twisted thought without a twisted molecule." And that's become -- that is becoming the focus. KAREN BREWSTER: CME, is that continuing medical education? Is that what that stands for?
DR. HAROLD SOUTH: Yes.
KAREN BREWSTER: And that's to keep yourself board certified? Is that why you --
DR. HAROLD SOUTH: Well, I don't think it would affect my board certification. I mean, I've done that, and it could be -- it can be used, it can be used for what they call recertification, but my -- my particular purpose in it was just to renew my state license to practice. All doctors are required to have CME. And if -- if you're lucky, you find some CME that's in your specialty. You know, I could -- I could have -- I could have, if there were -- if there were lots of meetings in Anchorage about ear, nose, and throat, OB/GYN, or proctology, or whatever, I could go and take those, but -- but I always take these psychiatric courses because that's -- that's what I want to keep up with. So it doesn't -- I don't -- actually, they don't require it, the state doesn't require you to take it in your specialty, but --
BILL SCHNEIDER: What are you looking for in there?
DR. HAROLD SOUTH: I was -- I was -- I was just looking for what -- what I was -- find a representative article to, like, just read it -- read a title or something, or a little bit about what sort of things. And here's one that I just found that I think just kind of serves as an example of the sort of things that psychiatrists have to study and learn these days. The whole field, the whole field of, well, what's loosely related to mental health. Psychology, psychiatry, social work, sociology, whatever, is -- is becoming more biological oriented constantly. And in the '50s, when I was studying psychology, I remember one article I read that was probably by a psychiatrist who said there's no further need for psychiatrists to be medical doctors because the basis of -- you know, their basic theory is Freudian theory, and the basic treatment, the basic therapy is like talking to each other. The -- the pure -- the purest treatment, I mean, in theory, the treatment in theory is Freudian analysis. And so there's no point in studying biochemistry and all that. Because the behavioristic school never wanted to look into that. Behaviorism started in the 1920s as a named phenomenon, and a man named Watson, I think, seems like it might have been Charles Watson, but anyhow, what they -- what they were teaching in behavioristic psychology is we don't know anything that goes on in the organism. And there's no use talking about it or thinking about it because for thousands of years, philosophers have wasted their time talking about, you know, the difference between good and bad and good and evil or how people make choices or what is the right way to live and all that stuff and we don't know. We -- you know, it's just how many angels can dance on the head of a pin? That was something they talked about in the Middle Ages. BILL SCHNEIDER: So are you saying --
DR. HAROLD SOUTH: So forget that, they said. What we're going to do is we've got a stimulus here and we get a response here. We study the stimulus and the response and try to develop a learning curve, see if you -- if you reward them, do they perform better; or if you punish them, do they perform better. I mean, you -- if you shocked a rat in this end of the cage but give him food pellets in that end of the cage, he will always gravitate to that end of the cage. That is true. And it is really helpful in very similar situations, I mean, very simple situations like where you're trying to get your mule to plow the corn. But -- but since -- but they figure this is our strength, this is our power, this is the way B. F. Skinner is thinking. I could manipulate the stimulus and I can study and classify the response, and what's in between there, the organism is a black box. That was the term they used. A black box and don't worry about it because we don't know anything about it. Now the psychology departments in the universities are -- the graduate departments, they are doing the same things that the psychiatrists are doing, kind of. They've got functional MRIs that -- in their departments. They are studying people's -- the changes in people's brains, the chemical and electrical changes that occur during behaviors or whatever. This -- the title of this article was Dopamine. Dopamine is one of those neurohormones, it's a very important one. Dopamine is what makes you feel good, basically. And everybody knows way back there adrenaline or epinephrine, that's what causes the fight or flight syndrome. And so dopamine in alterations of the sense of self and personality in Parkinson's Disease. BILL SCHNEIDER: So the point is that it's become much more chemically and neurologically oriented, the whole field of using drugs to treat patients?
DR. HAROLD SOUTH: Yeah. Let me -- let me just read a -- a line or two.
BILL SCHNEIDER: Let's leave it to a line or two so we can move on to get you down to API and your work. DR. HAROLD SOUTH: Yeah. Well, about Parkinson's Disease, it says, "Enhanced rigidity, inflexibility, and harm avoidance behavioral strategies may begin to occur before the onset of disease's motor symptoms, and thus may constitute precursor symptoms. As the disease progresses, harm avoidance diminishes, whereas novelty seeking and impulsivity increases in selected individuals." Well, it didn't even -- I didn't even hit a place where it talks about that the chemical changes, but the hardest things to study and keep track of for me is the changing levels of chemicals in the brain associated with -- with changes in behavior. But in the meantime, the behavior has got so strong that now it's called -- they don't talk about psychiatry, and it will soon be not talking about mental health matters. Some people would say now that that's a hangover from 20, 30, 40, 50 years ago, it's behavioral health, which is another -- it's a malignant influence. It began with Skinner. Because if all you're treating is the people's behavior, then the way to manage that is like you manage a -- with, like, other species, like with the mule or the rat. BILL SCHNEIDER: Let's get back to your career, though. So you were working in Fairbanks?
DR. HAROLD SOUTH: Yeah.
BILL SCHNEIDER: And then what -- what made you move to API?
DR. HAROLD SOUTH: Thank you. The state. The state made me move to API. Let me -- let me talk a little bit about the highlights, a lot of fun I had in Fairbanks.
BILL SCHNEIDER: Okay.
DR. HAROLD SOUTH: Although a lot of stress, as well. One thing that I -- one thing that I did was to be involved in a lot of court matters. A person can't be put in a hospital or treated against his will unless he has a Superior Court finding that he's dangerous or gravely disabled, can't take care of his own minimal survival needs. And so we had -- we had some hearings like that in Fairbanks, but actually, more of that I was involved in at API because there's a special session of the court that meets every week at API to take care of those kind of matters. So you don't have to drag patient, family, you know, professionals and security and everything down to the regular courthouse. The judge and the stenographer and a couple of lawyers come out to API, so I was into more of that there.
But one thing that was interesting was some -- some psychiatrists found, I think they -- I think maybe I shouldn't say this, but I think it was mostly it was kind of lucrative, people accused of serious crimes could claim that they were mentally ill at the time. And since most people have got a very, very fuzzy idea about what mental illness is, they -- the first thing that happens when people do some things is to -- is to say he must have been crazy. So they -- they go with that as like, you know, that's a given. Anybody would have to be crazy to do that. Well, I might say that, you know, but I -- I have to be careful, I wouldn't want to say it in public, you know, like I had a friend who was wiped out on a K 2 within the last couple of years. I'd have to be crazy to do that. But I'm too old and feeble now, but even when I was young, I tried to watch my step and be careful. And somebody would say, "Why don't you go up there?"
I'd say, "You go, I don't want to go. I didn't lose nothing up there." I mean, I've got into a few hairy kind of situations, but I wasn't looking for them. I'm not going to go -- there's enough danger in the world without going and looking too hard for it too many places.
I used to ride a motorcycle down in Indiana, but I was kind of restless and -- KAREN BREWSTER: So what was your involvement with the courts, then?
DR. HAROLD SOUTH: Well, if anybody's accused of murder and they've got no excuse otherwise, they think that they are not guilty by reason of insanity.
And later the law got changed, but it took a terrible tragedy to change it. But if you would have found -- if you murdered somebody, you're found not guilt -- if you are found to be mentally ill or the legal term is insanity, they are -- they are different but similar. You could be put in a hospital by the court. Instead of put in prison, because you weren't bad, you were sick. The question is -- the issue is between bad and sick. And that -- that keeps on being -- being an issue, and I think it will be for a long time yet, I mean, forever, probably. So the lawyer says, "My client is not bad, he is sick." And so a lot of people chime in and say, "You have to be sick to do that." KAREN BREWSTER: So you would assess the --
DR. HAROLD SOUTH: Well, so -- so sometimes, I mean, if I found out, I learned something about the law, some things about the law by being in court so often because the person that doesn't want to get convicted of a crime will -- can hire a psychiatrist to say that he's not bad, he's sick. The court -- I mean, the state court realizes -- the state furnishes a psychiatrist there who is available to anybody for any time for any purpose for nothing. So they would say, "Well, we've got this report from this psychiatrist who came up from Anchorage and evaluated this patient." "Well, send him over to Dr. South and see what he thinks."
Well, I -- I remember saying to one lawyer one time, I said, "Oh, it was to hell you would have pled not guilty by reason of insanity. I mean, why did you do that? I mean, why don't you plead, say, self defense?" And he said, "Oh, you think that will work?
I said, "Well, I don't know, but" I said, "I don't see any sign of mental illness in this guy, and I'm not going to -- and I'm -- that's my report."
And so -- so that's the way it went. But because -- because the courts figured I was pretty reliable. And there were a lot of -- you know, there were a lot of really harry cases there, I mean, really bad situations. I just remembered one of them that there was a -- a Native guy, there was -- they started having coed dorms at the campus, and a Native guy there, I forget his name now but it was notorious at the time, he went to a girl's room and murdered her and raped her, you might say had sex with her corpse, I think actually is what happened. Well, it happened that I had been going out to the college when I first got there one afternoon in the week to see students because I'd just go out there and see several, and they wouldn't have to come down to town at the clinic. But this guy had been working in the kitchen there and his supervisor had sent him downtown to see me one time, which was a mistake. It was a mistake because the average person should not -- is not really qualified to -- to know who should see a psychiatrist, but you could say that with anybody. I mean, if that's a choice between that and some other maybe more appropriate action, I'm not saying that -- I mean, I don't care if anybody -- actually, nowadays, it's -- it's kind of an insult probably, you should see a psychiatrist. And there's an interesting thing I've learned, too, that real religious people, religious fundamentalists, if they say, "I will pray for you," that's -- that's an insult. That means you're praying so badly that I will do -- I'll intercede with God, I mean, the most powerful weapon I've got, I'll put that on you. So... BILL SCHNEIDER: So you had seen this young boy, huh?
DR. HAROLD SOUTH: I had seen this young man. He came down to the clinic, and he had -- I don't remember exactly what he did do, but I think maybe -- I think maybe he wrote a bad check but, I mean, you know, I'm not attesting to the facts of this, I just don't remember exactly what he did. It was something that could have got him involved with the law; I mean, he could have been arrested for it. But his supervisor, you know, just was in charge of some of the kitchen workers in the kitchen, and he -- he decided, he said, "You should see a psychiatrist," you know, like it's crazy to do that. Well, thank God that they don't send -- that everybody didn't send all the people who wrote bad checks to me because I was swamped enough anyhow.
But anyhow, so I talked to the guy a good while. And -- and, of course, the idea was that maybe I would write a report. So then I told him, I told the young man -- he was Eskimo, by the way -- I said, "If I -- if you sign this release, sign a release, I'll send a report to your -- to your supervisor, because he's the one that requested a consultation. But without your permission, I can't do that. So do you want me to do that, sign this." He said, "What are you going to tell him?"
I said, "Well, I can't discuss with you what I'm going to tell him." But I said, "I won't tell him nothing if you won't sign the paper, but if you sign it, why, then, you just got to risk whatever I'm going to tell him."
Well, he was pretty shrewd, I mean, I think he had it scoped out. And I don't know, I think maybe he got drunk, he wrote a bad check or something. So I was influenced in a very negative direction by this, being a bad guy, really, isn't -- BILL SCHNEIDER: So after the rape, he got referred to you, or how did that --
DR. HAROLD SOUTH: No, this was before the murder.
BILL SCHNEIDER: Oh.
DR. HAROLD SOUTH: Then when he came up for murder, it turned out that a psychiatrist from Anchorage saw him and said, yeah, he was crazy. There was another psychiatrist came and was stationed at Wainwright, and -- and started some part-time practice and later came into full time practice there, so he got into some of this actually, and I think -- I think he might have been the guy, been the psychiatrist who said that guy was mentally ill and, I mean, not bad, but sick. Well, the court was more influenced by my report because I knew him before he did that. And I had put down that my impression was that he was a psychopath when I had seen him at the university. So that's what got him put in prison instead of put in the mental hospital. BILL SCHNEIDER: What's a psydopath?
KAREN BREWSTER: Psychopath.
DR. HAROLD SOUTH: Psychopath.
BILL SCHNEIDER: Psychopath.
DR. HAROLD SOUTH: Now they tend to be called more sociopath. More often they are called sociopath. And that's the whole -- that's part of this sort of major difference that is some of -- some of the older doctors used to make -- some -- originally, most medical people thought that the mental illness was -- it was hereditary, that was clearer, it was very strongly hereditary, and it was often the cause of -- it was often related to the presence of specific diseases with a known physical cause, like -- like beriberi, or like alcohol abuse for a long period of time, or like taking various drugs. I mean, it was sort of -- but everybody -- but -- and actually, the people who were interested in social -- some -- the jokes that some people made, some of the people who believed that there was a physical cause, mostly medical people and psychiatrists, they -- they made fun of these other people by saying those people think that schizophrenia, for example, is a social disease. And by which there was a big move in -- in somewhere along in there, I think it started in the '60s, to attribute things to social causes. And that is still, that's very common among -- I mean, just in general now. I mean, if I would say, "Well, you know, there's not very many fish in the Finger Lake anymore; I mean, the rainbows, you can't catch as many rainbows as you used to could," somebody will tell me, "That's because of Reagan's economic policies" or, on the other side, that's -- that's those, what do they call them, Tea Party people that are causing that. I mean, this is really true. I mean, it's kind of sad but it's true. And I -- and here I am between them. You're both wrong and a pox on both your houses. That ain't got nothing to do with that. But anyhow, they changed it from psychopath because "psycho" would be like in your own mind. And when I was studying psychology, you did not use the term "mind." There was no such thing as mind. It could not be defined, it couldn't be measured, and so I think -- I think there's a lot to conditioning, psychology, but it's -- it's -- but it's trivial, mainly. It's true that if you want to train your dog to jump up, you know, you hold up a bone and say jump, and he will, and you keep doing that and pretty soon you just hold up your finger and say jump and he will. But -- but it's -- that's got nothing to do with anybody's mental health. Well, let me see, back to where was I. Back to court. I did go to court a lot and learned a lot about the law. And this became a problem after I got down to API.
BILL SCHNEIDER: Yeah, we've got to get you down to API.
KAREN BREWSTER: Yeah, so talk to us about working at API. That was in 1979 you came down here? DR. HAROLD SOUTH: Yeah. Well, the Division of Mental Health, I never saw -- I never saw, like, the director of the Division of Mental Health come up to Fairbanks. We was -- we were kind of a free -- free agency. When I first went there, the people there had the practice of -- people would come in and sign up, they wanted to get therapy, see somebody about problems. They'd put them on a waiting list. They would -- somebody would interview them and put down a little bit about them, and what they were bothered by, and then they'd make a waiting list, and then the people who worked there would -- would pick out who they would want to see and they would let them know to come in and you can see this worker. Well, after I got there, I said, "Ain't going to be no waiting list." I don't believe in waiting lists. I mean, if a person needs help, needs help now, we'll see them then.
Well, it wound up, you know, I had to see people in the hospital, as well. At first it wasn't so hard because it was old Saint Joe's right across the river, but then -- but then they built the new hospital and that was the more time to go over there.
By the way, I want to mention something about the travel, because I was going to say, it wasn't so hard to travel to the new hospital. I knew people who worked for the state, and you may know some of them, too, who have per diem for travel. They travel all the time. There are people who do not -- who can bank their salary because they live on their per diem. They travel all the time. Now, you watch and see about this big conference about suicide that's going to meet at Nome. I mean, you know, and watch it for another 10 years or something and see what happens as a result. It ain't going to do it. It ain't going to do it. Because people want to overlook what is -- that is -- the question, like, is not why are these people dying in these streets and alleys and stuff. It's what can we do -- I mean, it is what can we do for this person. I mean, if you would just know one of those people and say, "Come on, I'll buy you a cup of coffee," you'd be doing a lot more than if you fly to Nome and have some meeting about it. I always thought -- when I've been involved with agencies, they are always having meetings about everything, so they -- but they don't really do anything about it. Anyhow, so travel was like that. Travel -- travel is a -- a benefit, it's like, what are your benefits in your -- in your agency? Well, that's one of them. If you travel enough, well, then you don't have to spend any of your regular salary, you just put that in the bank. So I didn't -- I don't really think it's effective to go around and talk. And I -- I think I was kind of unpopular in -- in the state Division of Mental Health, although I was popular enough when they wanted me to do something. I was -- I was seeing people in the clinic every day, going to court very often, seeing more and more people in the hospital and trying to develop a psychiatric service in the Fairbanks Hospital against an organized effort by the administration of the hospital. The hospital administrator told me, I mean, he did not want any mentally ill people in his hospital. I mean, I could -- I could go on with that. I mean, I've got a lot of passion accumulated up in me about things that I had to fight all the years, but at the same time, I -- I was trying to say draw a line across the Alaska Range and we don't have to send people down to API for treatment, we treat them up here. But it turns out that the community don't want them.
So I got a book called Madness in the Streets, and it's by a couple of social workers who -- who point out that we used to have -- we used to treat mentally ill people in hospitals, but now they are on the street. And that's very interesting, I'd like to talk more about that. That's one of my -- my, you know, what do you call them, obsessions. But -- but I'll try to get on to -- what happened was the -- the whole country was going the direction of -- and this was happening in Indiana before I left there. And I saw some terrible results; that is, we had a -- this is back to Indiana. We had a new commissioner in Indiana who came to our hospital and said, "Half the people in this hospital do not need to be here. And I want you to discharge them. And I don't care which half. I don't care what criteria you use to discharge them, but you've got to discharge half of them," because he was going to make this his reputation by saving money. Well, we -- it's true, we had a lot of people in the hospital, but they needed a home. They need -- that's the least I can say about it, and a lot of them did need special handling and mental health treatment, and some of them I had to -- had to be put in restraints from time to time.
I mean, I got attacked there several times, I got attacked several times up here, I got attacked at API. Well, in Fairbanks, I took a -- took a gun away from a woman who came in and held a loaded, cocked .38 automatic against our secretary's head. And I came out and took the gun away from her. Believe it or not. But that's just a fun story.
What was I talking about?
BILL SCHNEIDER: Well, we were getting down to API.
DR. HAROLD SOUTH: We got to get to API.
BILL SCHNEIDER: Yeah. DR. HAROLD SOUTH: Well, there's got to be some alternative if you're going to get the people out of the hospital, what's going to happen to them, who is going to take care of them. Well, we'll have community mental health operations. And if they need to take medicine, they just go to the community mental health, and they prescribe the medicine and they fill a prescription and/or they just come in there and they give them their pill and then they go back where they are living. Well, where are they living? Well, on the street, as it turns out. I mean, originally they said boarding houses, county homes, there's a lot of places for people to live that don't need acute hospital treatment. This is getting to be a problem with other problems.
There's a lot of ads in the paper now for a St. Elias Hospital, and a doctor or somebody comes on there and he -- and I think they identify him as a doctor, he explains that a lot of people go in the hospital, they don't need an acute hospital care for them, but just for a day or two or three, I mean, to get operated on or something, so they don't need all of the facilities like Alaska Regional Hospital or Providence Hospital, but now they've got St. Elias Hospital because a lot of them need to stay in the hospital for two or three weeks, maybe, and have continued medical care, and see the doctor every day, have physical therapy, et cetera, but -- so that's where St. Elias comes in. And there's a -- there's a lady who very emotionally says, "Those people saved my life and I really appreciate them," or something. Anyhow, that's -- that's happening there, too; that is, what he was saying was these people do not need acute hospital treatment. But what we did, and what we did there was I had gone to Michigan and finished up my residency and then come back, and in the meantime they built a new intensive care unit, and me and the other guy that had board training took that over and -- and I had the idea to starve the rest of the hospital where we just kind of gave people board and room by -- by not sending people to them, but discharging them back to where they came from. But -- but when I was off, I think the superintendent and the assistant superintendent was afraid that the hospital would wither away totally, so they would transfer a bunch of people while I was off. And I remember I took a weekend off. But anyhow, they decided to start community mental health centers and where people would be treated in the community mental health center. Let them be in their own community. Well, they never really asked the communities. That's the problem, was one problem. They are having a big hassle down in Anchorage down at the Red Roof, I think they call it, it's a motel or hotel that they were able to buy cheap, and the idea was to -- to let alcoholics live there so they wouldn't freeze to death in the park. And they'd have to pay rent and they -- they wouldn't have to quit drinking, though. It's not necessary that they be successfully treated because by and large, that hasn't worked. I mean, they would rather die than quit drinking. So don't require them to quit drinking because just -- just give them a warm room. KAREN BREWSTER: So do you think that's effective?
DR. HAROLD SOUTH: Well, it's -- it's better than what's happening. It's better than what's happening.
I think some of them might -- they might move from that and it's like people always say, that won't work because it ain't enough. Well, that's a spurious argument, you know. I mean, if I say, "Look, I'm starving, give me a biscuit," and some politician gets up and says, "I'm against giving him a biscuit because that will not do. That ain't going to do him. I mean, he needs new clothes, he needs a bath, he -- he needs more than that, and he'll be calling on us tomorrow for three meals if you let him get away with that. So -- and besides, I want to keep all the biscuits for myself." That's the main message. But you might try it, it might help, and some things are, like, counterintuitive a lot of people -- I mean, to a lot of people. They -- KAREN BREWSTER: So did API help people?
DR. HAROLD SOUTH: Oh, very definitely. Very definitely. I could give a lot of testimony to that. I could give a lot of testimony for a long time, after I left Fairbanks, I would run into somebody now and then who would say, "I saw you in Fairbanks, I came to the clinic and saw you. Do you remember?" And I'd say, "Vaguely. I can't remember your name." And maybe they would tell me, but they would sometimes surprise me, but -- KAREN BREWSTER: So they would come and say, "You're welcome"?
DR. HAROLD SOUTH: Yeah. It would please me. It would please me.
BILL SCHNEIDER: Sure.
DR. HAROLD SOUTH: And so -- but I -- I see people -- I see people once in awhile who were in API. Well, what happened was the state decided -- and I never did have much to do with the Division of Mental Health, in a way, because they didn't invite me to their meetings, and I remember being at one meeting in Juneau, and I thought that most of them, including the director of the division, they had far out ideas. One idea was that they kept hammering is we cannot to prevent mental illness, and we've got to do that. I mean, it starts out with the kids. We've got to start with the kids, somehow we've got to get access to the kids. And, you know, I said stupid things, I mean, undiplomatic things like, "I don't know how, what to do with kids, to prevent their being mentally ill. And I don't think you guys know what to do with anybody to keep them from being mentally ill." I mean, psychiatrists become psychotic. I've seen it myself.
We don't -- it's -- it's not -- it's not as if one -- everybody knows the story about small pox, and apparently we have eradicated small pox. If we had something like a small pox vaccine, well, even if we had the inkling of that, you know, the cow pox connection and so on, we could hope for it, perhaps, but we don't have that. And -- and we probably will sometime, but I mean, we're a long way from it. So that's just wasting time. What we need to do is just like you do with anything else. I mean, it's triage, essentially, but the triage is in reverse; that is, the more -- the more disturbed the person is, and the more help he needs, the less likely he will get anything from anybody because he's hard to deal with. I mean, I didn't have people coming in, you know, separate and coming in and please may I get into API most of the time, I had people who are trying to fight to get out of API while the cops and their families were trying to push them in API, and I was in the middle. I remember one -- one guy that the cops brought in and then left him there, and I went down to see him in the entryway, and his mother was there, and he called me all kind of choice names, and -- and he had a bottle, and he was drunk. And so he had a bottle in his pocket, I think it was empty, and he gets it out, he's -- he's going to hit me with his bottle. I mean. In the meantime he's ragging on me, you know, like you blankety blank, blank, blank, blank, blank. I'm not going to stay in your blank blank hospital, and so on. But so he's going to hit me with this bottle, and so I push him up against the wall and I'm taking the bottle from him, in the meantime I got to laughing because his mother's over there screaming, "Don't hurt my baby, don't hurt my baby," and he's trying to hit me with a whiskey bottle. That's the kind of typical scene in my -- my day. But -- KAREN BREWSTER: So at API you were the admission -- admitting psychiatrist?
DR. HAROLD SOUTH: Yeah. But back before that, when I was still in Fairbanks because there was no money in the system, I mean, couldn't make any money working with the state at that time, because they hadn't got the pipeline flowing yet and so the state was still poor. So they -- the -- they got down to where the -- we had three psychiatrists. One was the regional psychiatrist in Juneau, so he's sort of fixed there and can't do anything much; and one is the director of the division, well, he has to be in Juneau, because that's a requirement of the position. And -- and then, I said, me in Fairbanks. Oh, we had two doctors at API. And neither -- neither one of them was board certified. And neither one of them wanted to be superintendent, or -- or had the proper qualifications, that whole thing. I don't know about all the ins and outs of some of these things, but -- but the division director asked me if I could help out with this situation. And I said, "Yeah." And I remember that the guy that was, like, the administrative assistant he sent to talk to me about it, and he asked me that, I said -- and when I said, "Yeah," he said, "Oh, you can? Oh, good. Oh, wonderful." So -- so in addition to seeing people at the clinic all the time, and seeing people in the hospital, and going to court, and travelling to Fort Yukon and Tanana, I agreed to be the acting superintendent at API. And I would -- what I would do is fly down Wednesday -- Wednesday afternoon after I got off work up there, I'd come down, fly down to Anchorage, and then take call that night to give the two doctors at API a break, so they didn't have to take -- be on call every other night, I'd be on call Wednesday night. And then be the superintendent on Thursday, and then fly back to Fairbanks Thursday evening. I'd usually go to sleep on the plane.
BILL SCHNEIDER: Yeah, I bet.
DR. HAROLD SOUTH: Without -- without even having a drink, I would just pass out. But that was fun. But then it was kind of a -- it was kind of my itinerary, once I went to -- to -- I did -- I was doing my regular trip to Tanana Hospital, so I went down there, and they had a guy there that they pulled off a log floating through there trying to get to Siberia or something who was psychotic. And that night I played the fiddle for a dance.
BILL SCHNEIDER: Tanana? DR. HAROLD SOUTH: At Tanana. And so then -- then the next morning, we got a -- we got a ticket arranged there to -- for that guy. I mean, we had to call back to my office so they could -- administratively, they could set him up a ticket. And so then he and I and the pilot flew in a little air taxi to -- to Fairbanks, and I didn't get to go home or back to the office because we only had, like, an hour or two to wait there until the plane to Fairbanks, I mean, to Anchorage, because at the same time I was going down there to be superintendent acting for -- well, I was acting superintendent all the time. Once -- once -- once I remember while I was down there acting as superintendent, I got a call from one of the social workers at the clinic in Fairbanks that said one of her patients had come in to talk to her but was flourishing a firearm. So I said, "Well, put him on this line." So she gave the phone to the patient and got her to talk to me, so I talked her into giving the pistol to the social worker. So I was trying to -- anyhow, so that went well, and if I had wanted to, I guess I could -- I would have had first dibs on being full time superintendent at Anchorage, but -- but I wanted to keep on in Fairbanks because I thought the job there was important. And so I just wanted to stay there, and besides, I didn't want to uproot my family. But as it happened, then, in '78, the state, the Division of Mental Health decided we don't need a mental health clinic. I mean, we'll close the mental health clinic in Fairbanks, except for the administrator who can kind of revert to doing what he used to do, furnish transportation and that sort of thing. A community mental health center will be set up. And they will take care of all the mental health needs. So then I was looking at out of a job. And I -- at that time, when they first were going to do that, I called -- I contacted API and they didn't even have any positions open at that time because -- because by then, they had more people. Oh, the -- I had been the temporary, the acting superintendent just for the winter of '74 to '75, then we got a full time, so now from '75 fast forward to '78, I'm back working in Fairbanks, and don't have to come to Anchorage anymore, and we've got a superintendent.
Section 1: Connection between vocational rehabilitation program and mental health services, and thoughts about the practice of psychiatry as giving medication versus using talk therapy.
Section 2: Use of technology to keep in contact with patients and need for insurance billing to understand this process.
Section 3: Assessment of Harborview Hospital in Valdez, Alaska for the care of the developmentally disabled.
Section 4: The care of people at Harborview Hospital in Valdez versus what came afterwards.
Section 5: Examples of successes and challenges of community based mental health centers in Alaska.
Section 6: Problems faced by behavioral health aides in the villages.
Section 7: Improvements in the delivery of mental health services to rural Alaska, and a lack of trained psychiatrists available in Anchorage and to provide services in the private sector.
Section 8: Practicing psychiatry in the private sector versus the public sector, and the types of patient care provided.
DR. ARON WOLF: Well, one of the other major influences, and psychiatry has always been a part of this, is vocational rehabilitation. The division -- voc rehab is funded by both the feds and -- and the state. And they have been -- their beneficiaries are anybody with a disability where that disability keeps them from employment. And so they've been very influential in directing mental health services and paying for a lot of the mental health services around the state.
BILL SCHNEIDER: That's interesting.
DR. ARON WOLF: The -- and Dr. Doolittle is their consultant for Fairbanks, so of course, as chair of the Trust, he's knowledgeable about that, and -- and I've been -- Dr. Langdon was their first statewide medical consultant, and at his death in '81, I've been that since then. So, you know, there are a series of medical consultants, but we review the charts, we make recommendations, they have money to spend, a lot of it's federal money, federal mandate money.
BILL SCHNEIDER: Yeah.
DR. ARON WOLF: So that's a nice adjunct that's actually only grown over the -- it's been there all this time, it's grown over the years. BILL SCHNEIDER: Just a general personal question. What -- what do you see in the way of this relationship between psychiatry as -- as medicine and psychiatry as therapy, dialogue therapy, what I would call?
DR. ARON WOLF: Um. Yes.
BILL SCHNEIDER: Yes, all of the above?
DR. ARON WOLF: Yes, all of the above. There -- there have been any number of really wonderful studies that say that the best results are when you combine talking therapy and a judicious use of medications, of appropriate medications. Now, you know, this is almost from the time that Thorazine was developed in 1954, you know. This -- this is where -- where it went. I -- I was trained in Baltimore, and one of -- one of the places that I was trained was Chestnut Lodge, and Chestnut Lodge is where Frieda Fromm-Reichmann was from "I Never Promised You a Rose Garden," and actually I have had the privilege of meeting the woman who wrote that book, and she's wonderful. But Frieda Fromm-Reichmann and Hunter Will (phonetic) were some of my supervisors, so I got trained in all of that very early intensive talking, analytic kind of thing. The medications are important. I'm sure you've heard from Jim Gottstein that he feels that they are significantly overused, they probably are significantly overused, really a judicious use of the medications, along with an interpersonal relationship, which goes to your questions earlier about the doc over the television. You know, but yeah. Knowing your doc. But you don't necessarily have to know your doc face-to-face if that can't happen. You know. But yes. Having a relationship is really, really, really important. Section 2:
BILL SCHNEIDER: Okay. Well, what are we missing?
DR. ARON WOLF: I -- I think one of the -- one of the places that we're missing is -- and I know people are trying to develop this, is the use of technology. For the moment, you can't bill, and there's no mechanism of billing for e-mails. If you're in your office, use -- the use of Skype or other things. I actually occasionally do both. I have some oil folks who have been sent to Kazakhstan, they can't get here for six months at a time. Having that relationship continue by e-mail, by occasional face-to-face where I've said -- said to them, you know, please sign here, you know, you know this is an open -- potentially open mic, it's worked wonderfully. Now, how do we get the technology so that it really meets HIPAA so that we don't have to get them to double sign that they understand this. So I -- I think that, I think the fact that we're moving by the national health law to electronic health records, and even in a small office like this, I'm -- I'm in the process. So we're going toward more quality, we're going toward more use of all the -- all the tools that we have with it, and I think an understanding, at least in Alaska, of -- of the issue of the proper use of medication. So that -- that you're really are trying to give folks as they have their mental illness issues that you're not just trying to lie them out on the floor.
BILL SCHNEIDER: Yeah. Yeah. Well -- Section 3:
KAREN BREWSTER: You mentioned vocational rehabilitation, which made me think about Harborview Hospital, which is an institution we haven't talked very much about in this project, and I'm wondering if you had any knowledge of it and experience with it.
DR. ARON WOLF: Oh, yeah. Oh, yeah. One -- one of the places I consulted to was the fledgling Valdez Mental Health Center. And I know the people in the DD [developmental disability] community thought Harborview was awful for the developmentally disabled. I thought -- they thought Harborview was awful? Harborview was not awful. Harborview was -- did a -- a very wonderful job for their residents. The City of Valdez was very involved in Harborview. A number of the Valdez residents would take the Harborview residents out to their homes and be involved with them and tried to give them a home-like atmosphere. Their real families had no access to them, and that -- that was the problem. What was actually happening at Harborview was really positive lots of the time. Really, really positive. And in its own way, very sad that -- that it demised, if you will. So if Harborview had been in a place that was more accessible to the families and where they also could have been part of that, I think some form of it would still be functioning. KAREN BREWSTER: So what were the criticisms of it?
DR. ARON WOLF: Oh. The criticisms, is you sent -- the state sent Johnny off to this place, and he was packed away, and nothing was happening. Well, the family, lots of the families, didn't know what was happening. Lots of the families certainly couldn't afford to get there. They -- they were mourning the loss of their family member because they had no access to their family member, and all of that engendered a lot of anger on the part of the families.
And then there was a movement within the DD community for home-based programs. And at least -- and I -- and I've not kept track, but at least at the beginning, the places that a number of the Harborview folks were placed in after Harborview were nowhere near as good. Nowhere near. I mean, they -- they were -- they were in an environment that was, in many ways, loving, and they -- they were taken out of there and placed in a new place, in Anchorage, you know, where they couldn't walk around. I mean, one of the nice things about Valdez is that, you know, they could be outside and go to the supermarket or go down to the rec center or whatever or go down to the university, and everybody would -- you know, if they looked lost, somebody would bring them back. So -- so all of that was lost.
Now, in the long run, will it be better? Maybe. But we -- we lost a good thing because it was -- it was in the wrong place at the wrong time. Section 4:
KAREN BREWSTER: Similar criticisms were made of Morningside, I believe, that, you know, family members were taken away and never came back to the --
DR. ARON WOLF: Exactly. Exactly. Exactly. Well, and -- but a lot of these -- of the developmentally disabled folks, although family can be closer now, they can't live in there. I mean, their -- their disabilities are such that they still need to be in a supportive living environment. And -- and so yes, there's more access to them, somebody needs to do a study to see whether families are actually using that access. Are they seeing their family members even though they are in Anchorage? I don't think we've done a study on that.
BILL SCHNEIDER: Yeah. That was going to be my question is -- is how do families deal with the loss of -- of a member knowing that they are probably getting better care at another facility, but -- DR. ARON WOLF: A lot of anger. Well, and the fact that -- that Harborview was really remote and they couldn't afford it, there was just a lot of anger and regret and guilt and whatever of shipping Johnny off to that place.
BILL SCHNEIDER: Have people looked at that in terms of the family itself?
DR. ARON WOLF: Oh, yeah. Yeah. Not here, but in the Lower 48, what -- what that does. And -- and the lobby for the rights of the developmentally disabled has been a very strong lobby for a long time, they've done a lot of really good things, but there was this incessant pounding about you've got to close Harborview for years and years and years and years. And it was sort of like this is happening here, somebody should take a look at what's happening at Harborview here, and they didn't because they were of narrow focus with really good intentions. Section 5:
KAREN BREWSTER: That leads me to ask about the whole community mental health movement and the effectiveness of that for patients.
DR. ARON WOLF: It's -- well, I -- in the places where it works well, it's really nice. A stellar example of one that works well is Petersburg. Their staff has been there a long while, they really care, people see it as a part of the community, it's -- it's as good an example of how this kind of thing works as you could possibly want. I'm not sure where YK [Yukon-Kuskokwim Health Corporation] is now, but during the years I was there, most of their staff was Yup'ik, and go to the villages and they were accepted and caring and, you know, the village trips were -- were wonderful, I mean, and they -- you get off the plane and they'd always have people out there and they'd hug the -- the workers and it was wonderful. Now, I felt privileged, if you will, to be a part of it, but, you know, people would say, oh, Doctor, thank you, but it wasn't me. It really was them.
The more urban ones have gotten bogged down over the years in administrative things, and fund-raising and -- and tried to do a number of programs, but really, a number of them have not been anywhere as near as flexible as they probably need to be. And, they have had a terrible time in recruiting staff. Jerry Jenkins over here at Anchorage Community Mental Health has been functioning on Rent-A-Docs, locum tenens, for four or five years. He really has been unable to attract and keep psychiatrists there, and so the other folks do their job in as good a way as they can, but some of the flexibility of what all that was meant to be has gotten lost in the translation. So, you know, I think the basics are there, it needs to get tinkered with, some of the tinkering fairly -- fairly substantial. Section 6:
KAREN BREWSTER: I have just one more question. You mentioned -- you were talking about the telemedicine and how the community mental -- community health aides have utilized that. Isn't there a program for mental health behavioral specialists following the community health aide model?
DR. ARON WOLF: There is.
KAREN BREWSTER: What are your thoughts on that? DR. ARON WOLF: Oh, that -- that's great. It's been a problem in a number of villages because if somebody's labeled the mental health aide, either everybody comes to them, or this is Auntie Sue, and -- and you don't want to tell your problems to Auntie Sue who is going to tell it to Uncle Henry who is going to -- you know. And so in some -- some ways, some -- it's better if it's just one of the village health aides who doesn't have that label with them. When I was at Providence, we had a grant to help the North Slope Borough reform -- reformulate their mental health programs. They -- instead of the Native corporation -- well, they do it in conjunction with the Native corporation, but -- but the borough actually runs the mental health programs. And they did have mental health aides, and they would burn them out in, you know, six months. And especially in the Anaktuvuk and some of the more remote villages.
So -- so some of the problem is with how the villages, the milieu of the villages, some of it -- but it isn't the training. I think the general health aides really need some of this training, they do very well. I mean, one of the things that I used to find aghast is the Public Health Service does something called auto refill on meds. And so somebody prescribes, you know, antipsychotic, and they send a year's worth. Now, 20 pills will kill you. Send a thousand pills. To my knowledge, there was nobody who -- at least no one in my care, who ever committed suicide on their auto refill. They would hang themselves, they would run themselves through the ice, they -- they'd slice their wrists, they would do whatever. They'd take other pills. They would never take their prescribed pills. So there was a respect for the auto refill kind of thing because I would look on a shelf and I'd be talking to somebody who is really depressed, and there's enough, you know, to kill seven people in this jar. You know, they -- they would -- they would respect that. Which I thought was a -- a fascinating sort of sub context to this. Section 7:
KAREN BREWSTER: So you think the behavioral health aide specialists would be able to handle the problems compared to, I mean, a trained psychiatrist travelling to those villages?
DR. ARON WOLF: I think a behavioral -- a health aide with behavioral training who has access to telemedicine can do it. I mean, if you go back to the old days, prior to our even going -- a number of us going out there, that the health aide in the village would have radio traffic, you know, two hours on a Wednesday, and maybe they -- the radio traffic would talk to the social worker in Bethel who would then call the psychiatrist in Anchorage, and then respond three days later to the health aide. You can now do -- do, you know, your hour to do your six patients this week with a psychiatrist who you're seeing, talking to, who you know, who you could e-mail in between. You know, that -- huge change. And much better. And much more access. Much more access. KAREN BREWSTER: Are there -- are there changes that have happened that have maybe been not so good?
DR. ARON WOLF: We're actually, in many ways, down psychiatrists from where we were 10 or 15 years ago. And, although a number of us don't like to admit it, we're aging, and a number of us are going to age out of this. So we are 49th in the nation per hundred thousand for psychiatrists. And it's a huge problem. API [Alaska Psychiatric Institute] functions a lot on Rent-A-Docs. Community Mental Health Center here does, Fairbanks does. Dr. Stilner in Juneau has five psychiatrists, he -- Juneau is great. Juneau has -- has enough.
SEARHC [SouthEast Alaska Regional Health Consortium] Hospital in Sitka has enough. But there -- Dr. Winn in Anchorage does -- for 22 years has been going one week a month to Ketchikan, and he still does. But someday he's going to stop doing that. And so -- so the recruitment of that, we -- we are -- I don't know whether we talked to Alex von Hafften, he's a psychiatrist, he sort of inherited the psychiatry WAMI program, a number of us have done it over the years, but he has been working with the Trust and the state, he had been working with Delisa [Culpepper] at the Trust and the state to do a full-fledged psychiatric residency here in Anchorage. Hopefully get funded this year and start in 2012.
BILL SCHNEIDER: That's going to be great. DR. ARON WOLF: But those folks won't graduate until 2016, so this is not an immediate fix.
But there -- there is that piece of, you know, if -- if four or five of us retired tomorrow, Anchorage would be in terrible shape.
As an example, Langdon had seven people, or Providence Behavioral Medical Group, is what it's called these days. Somebody at Providence decided to really be difficult about pay to the psychiatrists. Six of their seven psychiatrists left. They left this gaping hole. Four of them went to the VA, and that's great for the VA system, but left this huge gaping hole in the private practice in Anchorage. And so we're thinner in many ways than we were many, many years ago. BILL SCHNEIDER: Pretty vulnerable.
DR. ARON WOLF: We're very vulnerable, both in the public sector and the private sector, and I'm really pleased that the Trust has gotten into that kind of recruitment, as well. That's another wonderful thing the Trust's doing. Section 8:
KAREN BREWSTER: What's the difference between private sector and public sector psychiatry and services?
DR. ARON WOLF: Well, interesting, if you go to public meetings, you never hear that there's a private sector. Yeah, you go to all these meetings, and hmm, but the reality is that almost all of us in the private sector have had contracts in the public sector all these years. I mean, we -- we've all consulted to all the community mental health centers. Almost everybody. Almost everybody has had contracts to do that, or they -- they worked at API to help out, or they've worked at the mental health center here.
So the private sector, and the public sector we call that we -- in the private sector we see the walking wounded. But you -- to put that more politely, if you're going to run a private office, you're going to see folks who are not chronic -- chronic and severe, and -- and where you could handle the acuity on an outpatient practice. The other issue with that, and again, which goes to access, which the mental health center is working on, is nobody in the private sector can afford to take all the Medicare or Medicaid people that would like to come and see them. You can't afford it. They pay 40 cents on the dollar. So most of us have taken the people who have aged into Medicare and Medicaid and an occasional referral, but we can't afford to keep the doors open if you go more than that. And so even in this little practice, I get calls daily, and Panup (phonetic) has to apologize, you know, we can't, our quota is full. We can not. And so they are being seen by Anchorage Neighborhood Health [Center] or -- and the community health -- health center, the mental health center, their grants say chronic and severe, so the person with depression or anxiety can't get in there either. Because their grant doesn't pay for it, nor do they have the staff. So those are some of the -- the access issues and -- and staff issues that need to be addressed as -- as we go forward. Okay?
BILL SCHNEIDER: Thank you very much.
DR. ARON WOLF: You're welcome.
Dr. Aron Wolf was interviewed by William Schneider and Karen Brewster on December 7, 2010 at his private psychiatric office in Anchorage, Alaska. He came to Alaska in the late 1960s with the United States Air Force to provide mental health services to soldiers at remote bases, to dependents, and to veterans. He worked at the Langdon Clinic from 1970 to 1995, was medical director for Providence medical system until 2004, and then returned to private practice. In this interview, Dr. Wolf talks about the evolution of mental health services in Alaska, the role of community mental health centers, the field of forensic psychiatry, vocational rehabilitation programs, and the behavioral health aide program.
Part two of this interview.
Click to section:
Section 1: How he became interested in psychiatry, his early influences, and his educational background.
Section 2: Coming to Alaska with the Air Force and providing mental health services to people stationed at remote sites around the state.
Section 3: Types of mental health problems seen in the military population and types of services provided.
Section 4: Psychiatric services available in Alaska to the non-military population in the late 1960s.
Section 5: Assessment of Morningside Hospital, lack of services in villages, and development of community based mental health centers.
Section 6: Delivery of mental health services in rural Alaska, particularly in the Bethel region, and teaching psychiatry in the Washington, Alaska, Montana and Idaho medical education program [WAMI].
Section 7: Describes the field of legal or forensic psychiatry.
Section 8: Research into blackout and using it as a psychiatric defense in legal cases.
Section 9: Research methods used to study blackout and how it was used in legal defense and conviction.
Section 10: Development of Alaska's first community mental health centers.
Section 11: Working in private practice in Anchorage, and his involvement with the American Psychiatric Association.
Section 12: Assessment of therapeutic courts, and role as medical investigator helping law firms with medical and psychiatric cases.
Section 13: Changes in the delivery of mental health services in Alaska, especially in rural Alaska and development of telemedicine as a way to see and treat patients.
Section 14: Development of consumer based entities for delivery of mental health services in Alaska, and their differences in approach to mental illness.
Section 15: Changes in mental health services with in-patient programs and dedicated psychiatric units at hospitals.
Section 16: Assessment of expanded services to beneficiaries, and of the Alaska Mental Health Trust Authority.
BILL SCHNEIDER: Okay. Today is December 7th, 2010. I'm Bill Schneider, Karen Brewster's here, and we have the privilege today of doing an interview with Dr. Aron Wolf. And this is part of the Mental Health Trust series. And we're here in his office with his companion, Kayla, a lovely golden retriever. So thank you for taking the time to do this.
DR. ARON WOLF: You're welcome. BILL SCHNEIDER: Let's start by a little bit of your career, where you grew up and some of the early influences, and then how did you get into psychiatry and medicine?
DR. ARON WOLF: I grew up in New Jersey, and my father was a physician, he was a surgeon. And he -- although he, for his entire life, said he never pushed me to be a doctor, I started making rounds with him when I was 7, and I was in the OR with him when I was 8 or 9, and at least once a week I made rounds with him, so that I was familiar with the hospital. I am not very technically adept with my hands, so surgery was not going to be my forte; however, a friend of my father's, who was an intern when my father was a resident, was my wife's uncle, and he was the premier forensic psychiatrist in the United States and the vice-president of the American Psychiatric Association. And Uncle Henry, Dr. Davidson, actually influenced three of us who are psychiatrists, one -- one who is a retired professor at Columbia, a retired professor at Cornell, and myself. So we were all family, we all became psychiatrists, and we are -- we are all within three years of one another. So Uncle Henry wrote the first book of forensic psychiatry that is still used. So -- so he was our major influence in terms of psychiatric practice.
BILL SCHNEIDER: Well, that's pretty good.
DR. ARON WOLF: Yes. BILL SCHNEIDER: Where did you end up going to school?
DR. ARON WOLF: I wound up going to college in New Hampshire at Dartmouth, and was a -- was a premed and a psychology major, and then I followed my father's footsteps and went to the University of Maryland where I stayed for medical school. In those days you had to take a separate internship, so I did, an internship in internal medicine, and then stayed for psychiatry for three years of psychiatry, being the chief resident the year before I left. Section 2:
BILL SCHNEIDER: Well, you certainly have a lot of qualifications on your resume.
DR. ARON WOLF: Yeah. Well, that's a lot of years.
BILL SCHNEIDER: Yeah.
DR. ARON WOLF: That's a lot of years. The -- I -- I am old enough that you had to go into the service, there was doctor draft, and so it was called the Barry Plan. And you had -- you -- the first day of medical school, the first lecture was the military, and they got up and said you can either sign your deferment or there's a bus outside. Somebody looked out the back window and there was a bus outside. So all -- all of the guys signed, women were not in the military, we did have some women in the class even then, and so we all signed up.
And so 8 years later I had to go in the military. And I was already in the Air Force, I mean, that's what you signed up for, and I did not want to go to Vietnam at that point. And one way of not going to Vietnam was to go overseas. So I signed up for overseas; in fact, I even went down to Washington and to the Department of the Air Force, where -- where do you have slots? Oh, Wiesbaden and Barcelona and the Philippines and Tokyo and whatever, and three weeks later we got assigned to Alaska. So that's how I got to Alaska.
BILL SCHNEIDER: That's a good story. DR. ARON WOLF: It is still overseas. It is still overseas. And we called the nearest Army base and said, what was living like at Elmendorf Air Force Base, and they said, well, we don't know, we think it's up near the DEW Line, so that's what we were expecting when we got here.
So I -- I -- so I came up and spent three years at Elmendorf. KAREN BREWSTER: And what year did you come up?
DR. ARON WOLF: August 12th, 1967.
BILL SCHNEIDER: And so what did you find at Elmendorf?
DR. ARON WOLF: I found probably the biggest psychiatric department in the state at that point. There were five psychiatrists, one of whom was a child psychiatrist. There were -- there was two social workers and two psychologists and scads of corpsmen, and it was an inpatient program and an outpatient program here in Anchorage, and it served the entire state. So it -- it was a huge program. It was in the middle of the Vietnam War, we had air evacuation planes coming through every hour, and so we had -- we had all the bases in Alaska, we had the Army bases in Alaska to serve, we had the dependents to serve, there was no VA hospital so we served the veterans, and then we served the 18 remote sites around the state. BILL SCHNEIDER: Are we talking DEW Line sites and White Alice?
DR. ARON WOLF: No. No, they were private. They were -- you they were the DEW Line sites, but White Alice was -- was private. Within six months of my getting here, because people left and whatever, I was made chief of all this. There were five new folks. And -- and one of the things that the chief did is they became the human reliability monitor, which is an interesting thing. And so that person had to have a top secret cryptographic clearance, and that became me. They -- I heard they even asked my kindergarten teacher what -- what I was like for part of this clearance. My kindergarten teacher is supposed to have said, what did he do now?
But that got me -- there were all these remote sites. The two around Anchorage were one up by Arctic Valley and one on Fire Island. And -- and then all of the state. Cape Romanzof, wherever, all over the state, all of Western Alaska that were listening to Russia. And guys were sent there for 12 months, remote sites. The two hardest sites were the ones around Anchorage because they could see Anchorage. If -- if you were out on the tundra, you know, that's where you were for a year.
But people really had problems, and I started my travelling around the state within those six months. I went to Eielson. I got here in August, I went -- made my first trip to Eielson in October of that year, and then I went out to the sites on -- on a regular basis. I got to all the sites. I got to Shemya, I got to Adak, I got to Kodiak on a regular basis, so I was doing travelling. What was absolutely fascinating, and I think I mentioned this in our telephone conversation, was that I had met Joe Bloom, who was the first psychiatrist to the Native Service, Joe and I became friends, he was serving the villages, I was serving the sites, many of them were within a half a mile of one another, they -- they were two separate systems serving two sets of people and not communicating. His -- he was serving the same villages, they weren't allowed to fraternize, my guys weren't allowed to fraternize, and so we were dupli -- even then we were duplicating services in the same area around Alaska. Section 3:
BILL SCHNEIDER: What were some of the key problems you were seeing at that time?
DR. ARON WOLF: Well, we were certainly seeing PTSD, coming back, if the guys got on the planes, and -- and then we also rode the air-evac planes back to the Lower 48 and -- and they were hungry for any physician to help with these guys who were both mentally and physically wounded from Vietnam. So I did that a lot. We served the bases in Greenland, so I got to go to Greenland, and -- and you landed in C-130s on skis for those bases in order to serve them. And that -- that was pretty fascinating in those days, to -- to fly across Canada and then land in Greenland, and then do that remote site. But it was the isolation. One of the issues that I was amused at recently in this whole controversy about Ask -- Don't Ask, Don't Tell is that one way of getting out of the military in those days was to say you were gay, and so there were several people in Anchorage who would aver that they had slept with the guys, and then they would be admitted to the psychiatric unit and -- and then they would be discharged. So that was a way of -- of young men who simply didn't want to serve of getting out of the service.
We -- we never asked whether they actually had to do anything or whether they just had to pay these guys downtown to say so, but I mean, similar kinds of things, the stress, because there were rotations to Nam, and these young men didn't -- didn't want to go. The wives felt very lonely, especially they didn't pay the non-coms very much, there wasn't housing on base, housing in Anchorage was not what it is now, and so a lot of these young women from Arkansas or Texas, or whatever, were totally isolated up here, and so we had -- we had a lot of that going on. BILL SCHNEIDER: So you were treating the wives, too?
DR. ARON WOLF: We were treating the wives, too. Yeah. And the child psychiatrists were treating the families.
BILL SCHNEIDER: Yeah. Wow. What a reach.
DR. ARON WOLF: Yeah. No. It was a huge reach. It was a huge reach. Section 4:
BILL SCHNEIDER: And for the people that are listening, explain what was going on with the rest of the population in terms of psychiatric services.
DR. ARON WOLF: At that point, there were -- you know, this is -- this was '67, '68, and '69, so we were less than 10 years out from Statehood, and the state had started three state clinics at that point. And there was an Anchorage clinic, a Juneau clinic, and a Fairbanks clinic, each one with one psychologist, one psychiatrist, and one social worker.
Mrs. -- Mrs. Doctor O'Malley of O'Malley Road and whatever, in Anchorage, was -- was the doctor in -- for the state clinic in Anchorage. So it was that. There were several people in private practice. API was newly functioning, and Dr. Carl Koutsky had been brought up to run API and Carl did a great job in -- in those days. Even though -- and I don't know whether in your years here you had ever been through the old API? BILL SCHNEIDER: No. I know his daughter, but I --
DR. ARON WOLF: Oh, okay. Well, the old API was built on a 1950s model, 1940s and '50s model, and so the third floor of the old API had an operating room to do lobotomies, and -- and that was never used, but API was outdated the day it opened. But Carl did a great job of doing what he could with -- with a building that was -- was really outdated. I don't know where they got the plans from, but you know, it was to do ECT and it was to do lobotomies, and the kind of stuff they did pre World War II.
KAREN BREWSTER: What's ECT?
DR. ARON WOLF: Electric shock treatment. BILL SCHNEIDER: And so there were private clinics at that time? Was --
DR. ARON WOLF: No, there were individual private psychiatrists. There were three. Dr. Langdon, who I later joined; Dr. Bill Rader, whose daughter is now practicing here at Langdon Clinic, and now Providence; and Dr. Barbara Uri (phonetic), who was a child psychiatrist. They were the three. That was it. BILL SCHNEIDER: What about the rest of the state?
DR. ARON WOLF: The rest of the state didn't have -- they had the two -- and I don't even remember who they were. They -- there were two state psychiatrists, one in Juneau, and one in Fairbanks. That was it. Section 5:
BILL SCHNEIDER: One of the things we've been trying to come to grips with, before we get into the development of services in Alaska, one of the things we've been trying to come to grips with is the level of treatment in Oregon when people were sent out to Morningside. What was your assessment of that when you first came up here?
DR. ARON WOLF: Well, API had already opened. And I didn't know that much about Morningside until I was here a little bit. And then I guess I'm biased because I joined Dr. Langdon, who had been the medical director there, and then was sent here to help develop API, and then opened his own clinic. And J. Ray was just the most marvelous leprechaun and wonderful doc. And his view was that, given the years, that Morningside was as good a hospital as -- as any state hospital anywhere in the country. And -- and in some ways better because it was smaller. I was talking about Uncle Henry, Dr. Davidson, and he ran a hospital in New Jersey that had 3500 people at any one time, so these were huge hospitals. Morningside was better because it was really almost on the model of the private clinics, like Institute of Living in New Haven. So -- so once they got there, you know, you had to spend -- you know, if you had your breakdown in Nome, you stayed in the Nome jail for six months; but once you got to Morningside, it was okay. But lots of these people then stayed because there was no going back. I mean, the villages didn't want the folks. So -- so there was a problem in, if you will, discharge planning. BILL SCHNEIDER: Yeah. And no level of services, really, in those remote villages.
DR. ARON WOLF: No. Oh, no, there was no level of services, very little services other than -- than Anchorage, really. Now, we were a much smaller state. BILL SCHNEIDER: One of the things that's emerged is the growth of community groups where parents or families with members who had disabilities would form organizations.
DR. ARON WOLF: Yeah. Well -- well, Juneau -- Juneau was great that way, and especially with the developmentally disabled community, Juneau was the forerunner of that. Prior to the Federal Community Mental Health Centers Act, there were two mental health centers here in the state that formed with community groups. They are both still functioning. One is Gateway in Ketchikan, and the other one's Kodiak. And so they were two functioning mental health centers, 1965, I believe, they both opened. And Dr. Langdon became the consultant to the Kodiak one, so he would fly down there to that one. A number of us did that for many years afterward. Section 6:
BILL SCHNEIDER: We've been amazed at the stories coming out of Bethel, the efforts out there to provide services.
DR. ARON WOLF: Yes, but that was after -- that was after YK [Yukon Kuskokwim Health Corporation] was formed. I mean, that -- and I -- I worked for YK, I consulted for YK for five years. Anyway, but that was much later. Bethel was much later. And it was an outgrowth of YK. BILL SCHNEIDER: I was thinking of John Malone's efforts out there to --
DR. ARON WOLF: But John did that at about the same time. Well, and John -- about the same time that the state did a mental health clinic through YK. So -- so there was John and Vicky doing their group home, and it was wonderful, and then -- and then the YK clinic that served all 40 villages, and in my years of going out there, I had the privilege and honor of going to all 40 YK villages. Yeah. Yeah. So -- so there's that. The other -- the other thing that developed almost on another train -- well, Joe Bloom and the people that followed him developed an entire system for -- through Public Health, so there was that system that was developing. And they brought up a number of people along with them, the one who is still here is Vern Stilner in -- in Juneau, but Vern spent 10 years or 12 years in Bethel. He came from Harvard, two nights in Anchorage with Joe and I, and then went to provide services in -- in Bethel.
KAREN BREWSTER: And he was a psychiatrist?
DR. ARON WOLF: He is a psychiatrist. Head of Bartlett -- he's a head of the psychiatry department at Bartlett and been around all this time. No, he actually went -- went back to be a professor at University of Kentucky because Bob -- I don't know whether anybody's mentioned Bob Krause, but Bob was up here, and he became the first director of the WAMI [Washington, Alaska, Montana and Idaho medical education program] program down here, and we all taught WAMI both in Fair -- and Joe and I taught WAMI in Fairbanks, I did for 12 years before it moved down here. I taught the freshman psychiatry class in Fairbanks. I went up every spring, every Thursday in the spring for -- for 12 years to Fairbanks. So -- so there was that development. So -- so you had Public Health, and there are a number of people who are still here who were brought up by the Public Health program, Wandell Winn, Royal Keel (phonetic) are all practicing psychiatrists all these years later for that. So you had that program. Section 7:
And then the other thing that J. Ray got us all involved in is the legal issues. He -- J. Ray Langdon started doing legal psychiatry in Alaska probably from the moment he got here, and interested both Joe Bloom and I in legal psychiatry. And I was already one of the founding members of the American Academy of Psychiatry and the Law of which, along the line, Joe became president at some point, but we have con -- I have continued to do forensic psychiatry all these years. So I've also traveled rurally helping -- helping the lawyers on both sides of cases, and developing case law in forensic psychiatry, helping Corrections develop -- I was asked and did run the sex offender program for the State of Alaska for 10 years. BILL SCHNEIDER: Give us some general history on that. That's the first time I've heard that term, legal psychiatry.
DR. ARON WOLF: There is a whole branch and a subspecialty of psychiatry called forensic psychiatry. These days you've got to take a fellowship in it. There were 12 of us. I don't know where that certificate is. There were 12 of us to take -- who got grandfathered, and we took the first boards, Joe was number 2 being B, and I was number 12 being W, but there are now probably a thousand psychiatrists in the United States who are board certified in forensic psychiatry. KAREN BREWSTER: And what exactly is forensic psychiatry? What do you do?
DR. ARON WOLF: The interface of psychiatry and the law, if you will. It -- on the criminal side, you make -- can help make the determination whether somebody's competent to stand trial, whether somebody's responsible for what they did, and there are laws on that, and help develop the laws. On the civil side, it -- it really is a person's mental health relative to either what they are suing for or what they are being sued about. So the whole mental health aspect of -- of the law, both civil and criminal, are -- you're involved in -- in doing that. BILL SCHNEIDER: So what would be a case in that?
DR. ARON WOLF: Well, I -- I was just in Fairbanks and was asked by the District Attorney to evaluate and be involved in the case of the gentleman who killed the mental health worker in Fairbanks, and whether he's competent or not competent. And he's -- if he were not competent to stand trial, he would be released because there's no holding somebody, and yet here's somebody who most likely killed somebody. So then -- then the trial -- and this hasn't happened yet, but the trial needs to happen, and then under Alaska law, is he responsible for what he did. That's a really totally separate question. Section 8:
Another thing I've been working on, and I was a little surprised at how long I've been working on it, but I pulled my original articles on it, is a number of people, especially in rural Alaska, have done their crimes and not remembered anything. It is -- after drinking. It is the usual in rural Alaska, unfortunately. There is an entire body of literature in blackout in Natives and -- and northern peoples. And we were fortunate enough with the help of the Public Defender to do some of the original research, and published on it of a number of people who had committed their crimes in blackout, and didn't remember it, and these were violent crimes. And we were able to get them drunk again on the same stuff that they drank, and we hooked them up to brainwaves because your brainwaves change during blackout.
And so I've been working with the lawyers and mental health people for now 30 years because I pulled the 1980 article out on what this means legally, what this means for people. We -- we actually ran a blackout offender group in the sex offender group because there were a lot of people who were at Hiland [Mountain Correctional Center in Eagle River, Alaska] who were sex offenders who had no idea that they had done this. So -- so that -- that whole piece on the forensic side that -- has taken up a lot of my interest. An interesting total aside of changing the law is there is a Supreme Court case, I was asked to testify actually on a blackout case in Juneau, and suddenly the District Attorney said to me, do you belong to any nonprofits? And I -- I thought to myself, this is going nowhere. And I had modeled as a male model the Saturday before for the Anchorage Arts Council, and after drinking one more glass of champagne than I should have, I was talked into modeling a set of briefs that said some things that were appropriate for that kind of thing and got a laugh. Well, they were not appropriate in court. And he said didn't -- didn't they say such and such. And the guy was convicted because I was thought to be not very professional. And the Supreme Court case that came out of that now says you can only ask a professional witness about their professional qualifications. So we got a really -- and then went back to trial for that case, and he was acquitted. But -- so that there were -- there have been all of these interesting kinds of legal things setting precedent, setting law, all -- all of those kinds of things over the years. Section 9:
BILL SCHNEIDER: Just a clarification of that. So in these cases, you would insist that the person drink until they reached a certain level of inebriation?
DR. ARON WOLF: Yeah. We measured their blood-alcohol every half hour.
BILL SCHNEIDER: Okay. So they would reach it --
DR. ARON WOLF: They would reach -- they would reach it, their brainwaves would change, that was our hypothesis, and it was true. They reached a certain level, 150 milligrams percent or more, which is what the literature said. They reached it. They -- their whole demeanor changed, their brainwaves changed. And we kept measuring it, and then we at some point would stop because we didn't want them to, you know, get problems. We would keep them in the hospital until the next morning, and that -- and we would then ask them what happened, and their memories stopped at the point their brainwaves changed. BILL SCHNEIDER: And were these -- did they do it voluntarily, or --
DR. ARON WOLF: They -- well, certainly, they did it voluntarily, and they did it part -- as a part of their defense. This was all paid for by the Public Defender. And where we've gotten to by and large over the years is that these individuals, when they are in that state, it's, for want of a better word, akin to sleepwalking, and so they can't -- they can't plan. They can't -- so it goes from, for instance, first degree murder, which has intent, to either second degree murder or -- or manslaughter. So it isn't a question of getting the person off, it's a question, if you will, of incarcerating the person for the crime they committed.
BILL SCHNEIDER: How do you treat that?
DR. ARON WOLF: Well, lots of these folks, you know, the fact that they spent 10 or 15 years in jail and are in alcohol treatment programs, most of them don't commit these crimes. You know, it -- it's unfortunately horribly rampant still in rural Alaska.
And what's been found is that Native peoples, whether here or in the Lower 48, or the Sami people or the northern people in -- in Scandinavia all are able to drink much higher amounts of alcohol and sustain blood-alcohol levels that most Caucasians cannot, and they have blackouts early. So very different. It isn't a question of good or bad, it's just very different.
And so the literature is American Indian and northern peoples for all of this. And there's a huge -- there's a huge literature. I just amassed the thing because the Federal Public Defender is doing habeas corpus about this, and one of the Federal Public Defenders, somebody's been in jail where they didn't bring it up at trial, and he's been in jail 22 years, and so the Federal Public Defender has just asked me whether I would copy a piece of the file so she could put it in his habeas case.
BILL SCHNEIDER: Right. Well, let's -- let's back up.
DR. ARON WOLF: So I've gotten off track. I'm sorry.
BILL SCHNEIDER: No, that's --
DR. ARON WOLF: I like talking about this.
BILL SCHNEIDER: That's very interesting, and pretty important. Section 10:
KAREN BREWSTER: I wanted to ask about the Federal Community Mental Health Centers Act --
DR. ARON WOLF: Yes.
KAREN BREWSTER: -- that you mentioned. If you could tell us more about that and what that meant here in Alaska.
DR. ARON WOLF: Yeah. The Federal Community Mental Health Centers Act was part of Johnson's Great Society. And this was part of -- of the whole deinstitutionalization of the mentally ill. And so the feds divided up the entire country into catchment areas. And Alaska was allotted 22 catchment areas. And so we -- we had no mechanism to -- to create these. What -- what do you do with them and how do they get funded, and yet there was some federal funding for this.
So Governor Hammond appointed the first Mental Health Board, and I had the privilege of serving on that, and being chairman of it the third year I was on. Chairman -- the first chairman, either the first or second chairman is Representative Max Gruenberg, so he was involved in it right from the beginning.
And what that first Mental Health Board did was get applications from mental health centers, fledgling. They weren't even centers, they were fledgling groups of community people who wanted to run a nonprofit or community-based mental health center.
And so the first two we got were the two that were functioning, which were Kodiak and Ketchikan. The third we got was what's now Anchorage Community Mental Health Services, and then I believe we got one -- one from Fairbanks and one from Sitka. Those were the very first. Followed -- followed by YK. Section 11:
BILL SCHNEIDER: Well, let's go back. So you were in the military, you got out of the military, you worked for Langdon at that point?
DR. ARON WOLF: At the point I got out, and Joe -- and Joe got out of the Public Health Service, Dr. Langdon was looking for partners, and -- or people. And he very graciously said let's do a clinic. I mean, it was his practice. He had eight psychologists and a social worker working for him at the point. And so rather than working for him, we became equal partners right from the start. And so we -- we started what then became Langdon Clinic. It had been his practice.
We hired a number of more social workers, we hired a child psychiatrist, so we became the largest private provider very quickly. And we built our own building up the street on -- on the corner of Dale and 42nd Street.
BILL SCHNEIDER: Then did you stay with that for a while, or --
DR. ARON WOLF: I stayed with that -- well, I ran it -- Dr. Langdon died in '81, and then I ran it from '81 to '95, when I left to become the first medical director of Providence Health System in Alaska. So I almost -- got out of psychiatry for almost 10 years, '95 to '05. And got back into medicine being medical director for the entire Providence system here in the -- in the state. They never had one of those before, and so that was fun, too.
KAREN BREWSTER: So Langdon you started in '79? DR. ARON WOLF: Langdon we started in '70. And the three of us ran it. Joe left in '77, J. Ray died in '81. Left me.
BILL SCHNEIDER: But then you got back into psychiatry.
DR. ARON WOLF: I got back into psychiatry in '04. I never quite left, I kept a couple of patients that I saw at Langdon during those years. I mean, I would -- I would work all day there and then come back, see two, three, four hours of patients in the early evening.
The other thing that I did is psychiatry wasn't very organized. As I said, there was the three of -- three older generation folks, and then there were a number of us younger generation. The American Psychiatric [Association][APA] sort of saw us as the tail end of things. And every -- every state had a branch of American Psychiatric except Hawaii, Alaska, Oregon, and Washington were all one branch. And -- oh, and British Columbia. And British Columbia wanted to break away and -- because we were rotating who was president of our little branch -- our little whatever we had then.
I had met somebody from British Columbia and he said, come to the meeting with me in Washington, and we got passed that every state should have their own branch. So we became the Alaska District Branch, the five or six of us. And so we -- we had that.
And I stayed with the APA during the years that Joe went with the American Academy of Psychiatry and Law, and wound up running that. I stayed with the American Psychiatric and actually wound up being the vice-president of the assembly of the APA, and also the national membership chairman. Section 12:
BILL SCHNEIDER: But I want to maybe return to these courts a bit. We just finished an interview, was it last week, with Jeff Jessee.
DR. ARON WOLF: Yeah.
BILL SCHNEIDER: And he was talking about the -- the courts that are held, set up particularly for people with mental illness, cases that come in where --
DR. ARON WOLF: The API cases? KAREN BREWSTER: Therapeutic courts is what they are.
DR. ARON WOLF: Oh, therapeutic courts.
BILL SCHNEIDER: Uh-hum. Was -- was your involvement in -- in that at all, that aspect of it?
DR. ARON WOLF: No. No. I certainly think it's a great idea, but that -- that was the Trust and -- and the Court system. And they had gone to several national meetings where there were similar kinds of things through the -- through the court system, so -- so no, the -- no. And I've actually done more civil stuff over the last 10, 12 years than I've done criminal. I mean, even though I have to do the Fairbanks thing and I'm still doing some of the blackout stuff, my major involvement is on the civil side.
BILL SCHNEIDER: Meaning that you -- explain a little bit more about that aspect of it. DR. ARON WOLF: For instance, a case where with -- with an employer and somebody was injured and then they have PTSD [post-traumatic stress disorder] after their injuries, and what part does that play, and how -- how compens -- well, you know, what percentage is he -- he or she disabled, and how compensable is that, and there are all sorts of rules about all those kinds of things.
BILL SCHNEIDER: Uh-hum. DR. ARON WOLF: I -- the other thing is a number of -- no, several law firms have used me as their medical investigator. So I review all of their medical data, medical and psychiatric, and then I help them find experts, medical and psychiatric, through -- from throughout the country. BILL SCHNEIDER: But they would be having a particular case where they are trying to get --
DR. ARON WOLF: They would have a -- they would have a particular case, their lawyers don't understand all the nuances of the medical data, they ask me to review them, write sort of a precis about it, and then help the lawyers. And I'm never noted in that one. I'm under the confidentiality of their law firm. But then I go, they need a neurosurgeon or they need a psychiatrist or they need a X or Y, I've now, through my APA stuff and through my Providence stuff, know a wide variety of folks, and call Dr. X who is a neurosurgeon or an orthopedist, or whatever, would you review this material and see whether you can help these folks. Section 13:
BILL SCHNEIDER: Back to the big picture, what -- what have you seen in terms of the changes in evolution of services to people over the years?
DR. ARON WOLF: Both good and bad. There's probably less duplication of systems. The -- as -- as the Native system morphed into the nonprofits such as YK or whatever, they all became part of the community mental health system. So for good or bad, it became one system. Really difficult getting folks to serve out in the rural communities. The other thing, a number of -- a number of us have done, Greg McCarthy, who I helped hire who was trained by Joe Bloom in Oregon, is now doing full-time consultation. He worked at Langdon, he doesn't work in town at all anymore. He works for Barrow, he works for Sitka, or he works for -- he -- he only goes out. A number of us did that part-time in and out. One of the big advancements right now is the grant to do telemedicine. And so that's done out of API [Alaska Psychiatric Institute] and it's done to all the rural mental health centers, or there's a separate system of telemedicine through ANMC [Alaska Native Medical Center], so they also have a -- a studio over there. But there's a studio at API, and Dr. Wandell Winn sees folks there. And -- and that's a huge advancement and a huge financial saving because the -- the health aide in Kwethluk or whatever can be sitting with, you know, somebody in Kwethluk and Wandel can be here, and they both have the chart, and -- and it really -- that's -- that's a huge advance that way. BILL SCHNEIDER: So it might be that the person is having some sort of a psychiatric condition, and the health aide recognizes it needs the treatment, and they would hook up --
DR. ARON WOLF: Yeah.
BILL SCHNEIDER: -- telegraphically.
DR. ARON WOLF: They would hook up telegraphically and -- and it's now ethical to prescribe that way, and so you can prescribe. You know. And so you have your session on -- you know, via television and -- and voice activation. KAREN BREWSTER: And does that provide a --
BILL SCHNEIDER: How does it work?
KAREN BREWSTER: Yeah. How does it work in terms of patients not being -- versus being in person?
DR. ARON WOLF: Probably 70 percent, but -- but if you have it every month so you get to know your doctor, rather than -- when I went to YK, as I said, I was privileged to get to all 40 villages, but you'd get to any one village every two years. And, you know, otherwise maybe they could get to Bethel but maybe in a snowstorm they couldn't.
So this is much more reliable; much, much more reliable. And so you get to know your doctor every month, you have -- you come in and you have your session, and how's your medicine doing, and, you know, what's happening with this, and are you having any side effects. It works. It works. BILL SCHNEIDER: And they are able to maintain privacy in some degree?
DR. ARON WOLF: Yeah. One of the -- one of the things of using that thing is it's encrypted. You can't -- I mean, I would love to sit here and use Skype, but it's not encrypted. And so you -- you can't use those kind of networks to -- to see patients. BILL SCHNEIDER: When you say "encrypted," you mean no one could break in?
DR. ARON WOLF: Nobody can break in.
KAREN BREWSTER: It's private.
DR. ARON WOLF: It's private.
BILL SCHNEIDER: Are those -- those videos kept? Do you keep them as a record?
DR. ARON WOLF: I don't know whether they do. I don't know. Ron Adler at API can -- can probably answer that. I -- I don't know whether they record them. Section 14:
BILL SCHNEIDER: What other changes have you seen? That's a big one.
DR. ARON WOLF: That -- that's a huge one. The other one, and I know you've talked to Jim Gottstein about a number of things, but the entire movement -- and this really was the Trust, is the Trust -- for consumer-based move -- movements. And so there are a number of very functional consumer-based entities that are providing really good services.
KAREN BREWSTER: What's a consumer-based entity example? DR. ARON WOLF: The Web in Anchorage. Choices and Soteria in Anchorage, which Jim started, and which I -- he had me write the original business plan for, but the Polaris House in Juneau. Polaris House and The Web are drop-in centers. All of these programs, being they are consumer run, must have a board, they are all nonprofits, must have a board that's at least 51 percent consumers, either folks who are receiving mental health services or who have received mental health services or families of people who have received significant mental health services. And then a number of the providers are also folks who either are or were consumers, and they all have an emphasis on recovery. So this is an entire recovery-based focus. This is a -- a real change, fostered by the Trust, funded by the Trust, at least as startups. So, for instance, Soteria, which is a program that's a residential program that is based on one National Institute of Health did for 15 years in the San Francisco area, has been up and -- well, we -- we wrote the business plan five years ago, the Trust funded it three years ago, it opened 18 months ago. The Trust funded all of that. They funded the first year of operation, and then we're now -- last year, the state funded it out of their budget.
So that is hopefully the progression of this -- what the Trust wants to do, and I think it's wonderful, is get a number of these very creative programs in a number of spheres started, funded, and then on their own. You know, either funded by Medicaid or funded by state general fund monies. KAREN BREWSTER: How is their emphasis on recovery different than other mental health service providers's focuses?
DR. ARON WOLF: I think for the very seriously mentally ill, unfortunately, many of the more traditional mental health centers, the emphasis is not on recovery, the emphasis is on containment. And so, you know, you need to come and take your medicine and this is -- and you need to get on Social Security and this is the best you're ever going to be.
And the recovery programs really say, look, if this can happen early, if we can get ahold of you early, the data prior to the major psychotropics were that a certain percentage of people recovered. They had one, perhaps, very difficult psychotic break, but a substantial number of people recovered.
And so there's less emphasis on medication in these programs, and more emphasis on what used to be known as milieu therapy, and so they do that.
And, you know, the -- Soteria is only 18 months old, but it's having some success with the young people who are just starting into this who don't see themselves as disabled. You know. Can you -- can you catch them before -- before they be -- you know, they label themselves disabled. You know, there are -- just like with any illness, there's some folks who are -- you're not going to be able to keep from being disabled.
BILL SCHNEIDER: That's amazing. Section 15:
BILL SCHNEIDER: What other programs? What other things have you seen that are advancements, in your mind?
DR. ARON WOLF: I do -- I do think -- well, one of the things that we've had is the -- Providence [Hospital in Anchorage] has done a very good -- well, Providence, in opening its mental health unit 20 years ago now, was a big advancement. Their average, like the state, is between five and seven days. They moved to a hospitalist mode in which there are just docs at the hospital who focus on the inpatient side of things, who -- who are adept at running an inpatient program to really focus on the needs of the patient while they are in. So it isn't that we're running over there and we're doing this and whatever. Dr. [David] Telford and his people do -- do a really good job of -- of that.
So -- so I think the fact that we have that, and then the fact that Bartlett, Fairbanks, and the SEARHC program [SouthEast Alaska Regional Health Consortium] in Sitka all have designated psychiatric units, so you don't have to come to Anchorage. That's all very positive. And it would -- it would be wonderful if it was elsewhere. Well, but it is, sort of.
When they built the new Kodiak hospital, there are a couple of rooms, and the Kodiak Mental Health Center is also run by the hospital, and so their psychiatrist functions inpatient and outpatient, there's a psychiatrist in Kodiak that's been there 15 years, or a little bit longer. The other major change, and I'm not sure it's happened in reality as much as it had happened on paper, is about six or seven years ago, the state made the mental health programs and the substance programs combined. They were funding -- the state was funding two separate lines of programs, the mental health programs and substance dependence programs. And they had two separate boards, advisory boards, and two totally separate sets of providers. And the state said there shall be one of these in -- in each venue, in each of the 22 catchment areas, there will only be one of you, and you will provide both sets of services. Well, the cultures of those two kinds of things certainly are different, but they -- they have grown together, and so because most of the folks with mental health problems have substance problems, they -- they self-medicate, and -- and lots -- lots of the substance dependence folks secondarily to their substance, you know, get depressed or have mental health issues.
BILL SCHNEIDER: Yeah. DR. ARON WOLF: So -- so the fact that that is -- they are working toward that is really, really important, and a really good change.
BILL SCHNEIDER: One of the --
DR. ARON WOLF: And I think that was -- that was -- the state did it, but that was another thing that was sort of arm-twisted by the Trust. Section 16:
BILL SCHNEIDER: I know that there's been an expansion of the beneficiaries.
DR. ARON WOLF: Yes.
BILL SCHNEIDER: And one of the areas that they, I think, got included was Alzheimer's.
DR. ARON WOLF: Yes.
BILL SCHNEIDER: And so that seemed to me to be an example of expansion of services.
DR. ARON WOLF: It -- that's an expansion of services, for the moment, more in name. There are -- there are -- there are not enough services for those with Alzheimer's, especially younger folks. You know, there are, unfortunately, folks who start their mental degradation in their forties rather than in their eighties.
And -- and so that -- that is one where it's really great that there's a focus, but there needs to be -- as we go forward, there needs to be more action on that front. BILL SCHNEIDER: That probably is true of all of the services you see.
DR. ARON WOLF: Well, but mental health is -- is the big one. If you go to a Trust meeting and during -- during the years that I was pushing on Choices and Soteria, Dr. [Bill] Doolittle is chair of this, who I think is a great guy, you know, kept saying, you know, I was a -- I was a Trust groupie, but -- but as I listened to that, I would say that 90 percent of the discussion, even at the Trust meetings, is on traditional mental health kinds of services. So even -- even though the Trust does all of this other stuff, you know, maybe 90 percent is -- is on mental health, 7 percent is on substance, and then the other stuff you don't hear, yeah, there's a report by Aging and there's a report by this. As they move forward, they -- they -- they need to spread out because their mission really is that. BILL SCHNEIDER: I guess that brings us to that general question of how would you assess the -- the Trust, and what it's been able to do or not do?
DR. ARON WOLF: I think the Trust -- the Trust is a wonderful thing. I mean, I -- it was -- it was given a -- a mandate that no one -- no one could tackle immediately. I think Jeff and the staff have done an amazing job with the money and staff that they've had. They've had to narrow it, you know, because the staff can only do just so much.
So, for instance, in just the couple of years, they've been focusing on housing. Well, housing is incredibly important and will benefit all the -- all the classes of their beneficiaries. But then what didn't get looked at, you know, because you're focusing on housing, you know, and doing that, but I think you need to look at what the Trust does over a 20-year period or a 25-year period. It's there, it -- it's creative, and it's nipping away at -- at all of the stuff. We'll get -- and it has the freedom to do it much more than the state department. I mean, the state department is responsible, the commissioner who's responsible to the Governor and his or her whims at that given time. The Trust has a little bit of that, but it's somewhat -- well, it's significantly freer of -- of the political end of this.