Digital Asset Information
Project: Alaska Mental Health Trust History
Date of Interview: Apr 20, 2010
Narrator(s): Dr. Joseph Bloom
Interviewer(s): Karen Brewster, Bill Schneider
Transcriber: Carol McCue
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Section 1: Improving coordination in delivery of mental health services in Alaska, working with doctors, and providing educational training.
Section 2: Patients being sent home from institutions, and people who made important contributions to mental health services in Alaska.
Section 3: Comparing the early Alaska Psychiatric Institute facility with other institutions.
Section 4: How he got interested in the field of psychiatry.
Section 5: Work with the Oregon Health and Science University Medical School in Portland, Oregon and involvement with health boards and physician oversight in Oregon.
Section 6: Establishing the first mental health programs in the Indian Health Service.
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Section 1: KAREN BREWSTER: My other question had to do with -- well, we were just talking about how the institutional facilities were receiving your attempts at changing the practice for mental healthcare. I'm wondering how people in the communities and in the villages received your presence.
JOSEPH BLOOM: Well, our main work was in the towns. The villages were ‑‑ we were mainly functioning as consultants to the doctors or other people, social service agencies, all of these main offices were in the towns.
So I would say that ‑‑ that most of our work was there were village trips were to see a specific person or to find out something about a specific person, and they were not ‑‑ they were usually done just within the local area to the hospital. They weren't cost effective to go flying out to one place just to find out a little bit more that we could ‑‑ than we could get from health aides or doctors who have been there, or social workers who had been there.
So within the towns, I think people were very receptive to us. I mean, I don't ‑‑ I don't remember instances where there were any kind of major difficulties. Again, because we were trying to bring people together.
A couple of times, you know, when I said we had consultants, we had ‑‑ we put on seminars for people in the towns.
I remember one, smiling about we had one seminar, I brought a man who was one of my teachers who was a family therapist from Boston, Norman Paul. He's a well‑known family therapist. And we had a seminar for anyone who wanted to come.
And it was one of those days, it was like 35 below and the wind was ‑‑ it was about as cold a day as I ever had up there in Alaska. And we had a whole bunch of people came out at night to ‑‑ to hear Norm talk about family therapy. And he was very good, he had a lot of tapes and videotapes and audio tapes of families, so we would ‑‑ we would try to do that, too, have educational sessions for people with consultants.
And so we didn't ‑‑ I think, you know, people were working ‑‑ I said this earlier, but they were working hard, and many times in isolation, and bringing people together, it never ‑‑ it wasn't an issue. It just ‑‑ I don't remember it was ‑‑ there wasn't very much resistance. We weren't doing anything that was that radical. It wasn't a problem.
KAREN BREWSTER: Well, I was wondering more, were people just so happy to finally have some help in the mental health services?
JOSEPH BLOOM: Well, I don't know how happy people were, but I don't think ‑‑ I would say it was more even.
It was ‑‑ you know, I think when you're out in difficult environments, I think people are ‑‑ they know that there's limits, so just having some services was good, trying to get some coordination with the state services was very good for people, but you know, they were operating in difficult situations, and we were not overselling what we were doing.
Section 2: KAREN BREWSTER: The other question I have is when you were talking about Morningside, and patients returning to Alaska from Morningside, and we've heard stories about many times patients being sent home to the village, they didn't go to API, they just were sent home, and then their having to cope with transitioning back into community life. And if you saw any of that returning as patients into your services.
JOSEPH BLOOM: I ‑‑ I don't remember that. You know, there ‑‑ Morning ‑‑ people were sent to Morningside, I'd imagine many people were civilly committed to Morningside, and they didn't have to necessarily go back or they went back before API ‑‑ I mean, people were going back before API opened.
So I don't remember encountering many Morningside people. We certainly encountered people who were discharged from API within the few years who had been out for a long time in the villages, but I don't ‑‑ I don't have a recollection of Morningside people.
But it's not surprising what you say because on a civil commitment, usually people can just be sent, released by the ‑‑ by the hospital and the physicians. And you know, I would guess that there wasn't very much coordination between Morningside and what ‑‑ wherever they sent them to.
BILL SCHNEIDER: I guess one final question is when you look at the ‑‑ the history of delivery of services, who are some of the people that really stand out as having done a major job in bringing services to Alaskans? You've mentioned Dr. Wolf and some of the ‑‑ and one or two other people, but I wondered if you might pick up on that as a conclusion here.
JOSEPH BLOOM: When I was in Indian Health Service, the initial ‑‑ the first year I was there, the person who was in charge of the whole Indian Health Service in Washington was a man named Stu Rabow. And he was ‑‑ he came from the earlier days of the Bureau of Indian Affairs, and he was in Alaska. And he understood the situation there quite well. And I think he was very sympathetic to developing more services in Alaska.
I mentioned some of the psychiatrists. The early pioneers, I would say, would be Dr. Langdon and Dr. Rader. There was a woman who also, I knew her later on, Virginia O'Malley, who did a lot of work in public services.
People who came later, like Dr. Koutsky and Dr. Stillner, I think they made very good contributions.
Bill Richards, has his name come up at all?
BILL SCHNEIDER: I don't have it.
JOSEPH BLOOM: Bill Richards, when I left ‑‑ I left Indian Health Service in '68, there was a ‑‑ another person who was assigned to a man named John Ackerman, and he stayed there for two years and then left Alaska. And Bill Richards took over the head of the Indian Health Service psychiatric unit. And by then it had grown, it continued to grow.
And I had mentioned the consultation that I did with YKHC; well, Dr. Richards was involved in that from the Indian Health Service, and he was a long‑time director of psychiatry or of the mental health services for Indian Health Service.
And you remember when there first started to be contacts between Alaska and Siberia? Dr. Richards was on one of those trips and died in a boating accident. And he ‑‑ he was a very quiet guy. I mean, he ‑‑ he was not out front and you wouldn't know in a room that he was there, but he was an extremely steady person. And built things year after year.
And he would be somebody who should be remembered. I don't remember what year that was; probably, what, ten years ago, or maybe more than that.
BILL SCHNEIDER: When he passed away?
JOSEPH BLOOM: When he died, yeah. Yeah. And he was ‑‑ he was ‑‑ he died in a boating accident. And my understanding of it, he was ‑‑ they were out boating and ‑‑ or they were with some hosts there, and the boat disappeared, or they disappeared, the boat may have been found. Flipped over maybe. And ‑‑ but he's some ‑‑ he made a major contribution to the services there.
I'm not ‑‑ I'm not sure about the people at API after ‑‑ after Dr. Koutsky. Dr. Koutsky was at API and then became head of the ‑‑ also head of the mental health division for the state, and then subsequently moved to Oregon; actually, he was in Klamath Falls for many years, a very solid person.
There are some people on the research side, does the name Bob Kraus come up at all?
BILL SCHNEIDER: It hasn't.
JOSEPH BLOOM: Bob Kraus was a psychiatrist who very interested in anthropology; and he came from Philadelphia with another psychiatrist, Ed Faulks, and both of them were mostly in Alaska as research people.
Ed may have been with the Communicable Disease Center as a psychiatrist, but they ‑‑ a lot of Ed is ‑‑ both went on to distinguished careers in transcultural psychiatry. Ed's now in New Orleans. Both are about my age or a little older, and probably both retired. But they ‑‑ they made good contributions over the years, mainly on the research and writing ends.
Now, you had mentioned over the phone Thelma Langdon. She's a person who just, from ‑‑ we knew her from the mid '60s on, you know, and she just worked and worked and worked in trying to improve services. And so she certainly should be mentioned.
I don't ‑‑ I don't know if any others come ‑‑ and I certainly don't ‑‑ oh, and you were going to see Jerry Schrader.
BILL SCHNEIDER: We have talked with him. Uh‑hum.
JOSEPH BLOOM: Yeah. Jerry was also an Oregon person from Salem, and trained at the Oregon State Hospital, and I just saw him about a month ago. And certainly he figured out something that no one else did, as far as I understand it, in terms of the lands issue, or ‑‑
I always heard that as kind of a ‑‑ oh, yeah, there's lands out there, but that's about as far as I ever knew. Mental health lands.
BILL SCHNEIDER: Uh‑hum. Uh‑hum. Yeah. It played a, looks like, a key role.
JOSEPH BLOOM: Yes.
Section 3: KAREN BREWSTER: Talking about API, I know it was only a few ‑‑ it had only been in operation a few years when you got there, but if you have a sense of the type of care and the quality of care and type of facility that it was. And I know things have changed in delivery of services, you know, and it's hard to assess from a modern -- to what it was like then, but if you have had thoughts on that at the time?
JOSEPH BLOOM: Well, API was startling to me. I came from training in Boston and I did a paper in my last year of residency on a hospital called Danvers Hospital. Danvers Hospital was North Shore of Boston, and it was affectionately known by the local people as the Pauper's Palace. It was built in 1860s or seventy ‑‑ probably 1870s, late 1870s. And it's like a medieval dungeon.
And by the middle of the '60s, these hospitals had started to ‑‑ these state hospitals had started to reduce their census, but Danvers, still, I went up there a few times, and I felt like it was awful.
And I had been ‑‑ earlier when I was in medical school, I had been in one of the New York ‑‑ Harlem Valley, which was a New York State psychiatric hospital that served the Bronx, where I went to medical school. It made Danvers look good. It was awful. But that was even earlier.
And I got to API, I mean, this was a 200‑bed hospital, it was new, it was brand new, and it was clean, and it had nice rooms, and it was staffed. And you know, as I said, it was startling to me. I always described it as a new, small ‑‑ it was a key small hospital.
And whatever its shortcomings, all of those things, you know, made up to it, from my frame of reference.
I mean, I'd never seen anything like it, frankly, in any of the eastern places. You know, to see a new, small facility that was staffed was very good. So that ‑‑ that was my initial response there. I mean, it ‑‑ it just was such a contrast for me that it was a very appealing place.
Section 4: KAREN BREWSTER: One thing we haven't talked about is what inspired you to go into psychiatry in the first place?
JOSEPH BLOOM: I actually can answer that question. I and many medical students make up their minds about what ‑‑ what they want to do kind of in their third year, or it's very difficult before to actually know what you want to do because you don't ‑‑
at the time I was in medical school, we had just very minimal clinical activities prior to the third year. It was mostly basic science. We did have some, but not a lot.
And then I ‑‑ I ‑‑ I was interested in internal medicine, and I had my clerkship in internal medicine, and then I did the psychiatry clerkship, and the teachers were wonderful and they were very dynamic.
I can remember one person who was a very famous psychiatrist in the states, and I went to Einstein and they had an excellent Department of Psychiatry. And this guy was going to demonstrate to the medical students the difference between mania and agitated depression. And he's showing you the person was agitated and depressed and kind of slumped over and talking very low, and he was giving a demonstration of agitated depression; and he gets to mania and he jumped up on the table.
Of course, I've never seen anybody do that, but he jumps up on the table, we're all sitting around the table, the students, and he's walking across the top of the table. And talking a mile a minute. And he said, this is what mania looks like. And as I said, I'd never seen anybody do that, but I've seen some pretty wild things. And I said, that's pretty interesting. This is a pretty interesting field.
And then the ‑‑ the stories that the patients had, and again, in the third year, you interview, you know, you're running mostly on an inpatient service and you get to interview people, and I couldn't believe the stories, they were just so different than a regular medical story, or questions.
And then in my fourth year, I went and did six months in a psychiatric facility in Cambridge, England, which only magnified the stories, and at Fulbourn Hospital in Cambridge, and I did training rounds at the University Hospital, and so that kind of solidified it for me.
But I was pretty much sold after the third year, after the clerkship. And I have no regrets on that. It's been a very interesting career. And this job that I had, it's my first job, and I often describe it to people as my best job. You know, I had some good jobs.
BILL SCHNEIDER: The Alaska job?
JOSEPH BLOOM: The two years in the Indian Health Service. It was just unique. You know, it had frustrations, it had its this's and that's with the bureaucracy, and disappointments, but minimal. Minimal. So that's how I got interested in it.
Section 5: BILL SCHNEIDER: And I guess we should say what your current job is.
JOSEPH BLOOM: Well, I'm ‑‑ well, I have a current job right now, but I ‑‑ I basically I was Dean of the medical school for close to 10 years here. And I stopped doing that in 2001. And from then to now, I've been doing small things. I've been teaching; we have a fellowship in forensic psychiatry, and I've been teaching in that. And I do some cases.
I've been consultant to the Oregon Medical Board since 1984, and just a month ago, they asked me to help them with a transition of their impaired physicians program. We had some legislation last year that's mandating the transfer to a ‑‑ from a board‑run program to a non board‑run program that's going to encompass all the other health boards.
So we have a big transition. We have about 100 physicians on the impaired physicians program. So I agreed to work two days a week for them for April through June.
BILL SCHNEIDER: What's impaired physicians?
JOSEPH BLOOM: Well, these are people mostly who have been impaired by substance abuse.
BILL SCHNEIDER: Physicians you're talking about?
JOSEPH BLOOM: Physicians. Yes. And then who get referred ‑‑ they go through an extensive evaluation and inpatient treatment. I mean, these are programs that have been around in the country since the mid '70s, or before. And through rigorous monitoring and treatment programs, sometimes inpatient programs, about 80 percent are able to return to productive work.
Our program is basically a five‑year program. So it's a rigorous program. I mean, there's some wrinkles in that, but that's basically the program. So I'm doing that from now ‑‑ as a matter of fact, I'm going to go this ‑‑ to work this afternoon, but until the end of June.
And I'm back doing what I've been doing, which is writing some and ‑‑ and teaching and just hanging around the medical school a little. Not a lot. Maybe a day a week.
BILL SCHNEIDER: Good.
Section 6: KAREN BREWSTER: My one sort of last question is, it sounds to me like your work with the Indian Health Service, you sort of launched its mental health program in Alaska. And is that how you see it and how you feel about that? What's that meant to you?
JOSEPH BLOOM: Well, yeah. I mean, we were the first mental health program in Indian Health Service, along with the small Pine Ridge program, same kind of thing in Pine Ridge, a small team; and the program in Gallup, these were the first forays into mental healthcare. So from that point of view, we did launch this program and it was, I think that's accurate.
And it ‑‑ you know, it's always nice when you have the opportunity to start something and to try to put things that you've learned into practice. And not come into something "that's this is the way we do it around here."
That, by the way, is my definition of culture. This is the way we do it around here. And that's ‑‑ you have cultures, mini cultures all over the place.
So yeah, you could put a little stamp on it. You know. I probably ‑‑ no reason to suspect that I would recognize what exists now, but that's the way it felt for me.
KAREN BREWSTER: And how did your years in Alaska influence the rest of your life and your career?
JOSEPH BLOOM: Well, I always ‑‑ I developed this interest in transcultural psychiatry, and that ‑‑ and then I developed this interest a little further in transcultural forensic psychiatry, and that's been an area where I've written in and done work in for years. And I learned some methods up there, I alluded earlier to the anthropological literature.
Well, when I was putting it ‑‑ putting a little library together, which, by the way, I still have somewhere up in a storage place up at the medical school, I mean, if you read a hundred papers, you would know a lot of what people had written and thought about in this kind of overlap between anthropology and psychology and sociology, and so I learned methods.
And I've done pretty much that and community psychiatry, which we talked about earlier, putting that together. That's pretty much what I've done.