Section 1: BILL SCHNEIDER: Okay. Today's April 20th, 2010. Bill Schneider is here, and Karen Brewster. We have the pleasure of talking today with Dr. Joseph Bloom, and we're going to talk a little bit about your personal history, and then get into your activities up in Alaska.
So tell us a little bit about your personal life, where you grew up and your education.

JOSEPH BLOOM: Yeah. I grew up in New York City and went to school in New York City. I went to ‑‑ through public schools in the city, and I went to college at Columbia College in New York and medical school at Albert Einstein College of Medicine, and again in the city.

I graduated in 1962 from medical school and was interested in a career in psychiatry, but in those days they had a separation which doesn't exist now between internship and residency. So that ‑‑ my first ‑‑ actually, we were married at the time, and our first trip out West was for internship. I went to San Francisco to the Mount Zion Hospital and was there for a year, and then I went to Boston and did my psychiatric training at the Massachusetts Mental Health Center.

And in those days, they were still drafting doctors; and I got a deferment through the Public Health Service, which the plan was called the Corps Plan, and the deferment allowed me to complete my specialty training, my psychiatry training, and so I entered the Public Health Service in 1966 as a specialist.

And Public Health Service at that time, and still today, runs many different types of services. The Coast ‑‑ they do the medical care for the Coast Guard, and just ‑‑ the Bureau of Prisons, many different things.
And I remember distinctly having to go to Washington to interview in these various different places to work on developing a assignment for myself, or where they would assign me in the Public Health Service, and one of the places that they had scheduled was the Indian Health Service.

And this was 1966. I don't know if people have told you much about the Indian Health Service in the past, but it ‑‑ the Indian Health Service was relatively new in the Public Health Service. It had ‑‑ the healthcare of American Indians and Alaska Natives had been in the Bureau of Indian Affairs until 1955.

And the care there was very problematic. And in '55 they switched the healthcare from the Department of Interior to ‑‑ Public Health to HEW. And they formed the division at that time, the Division of Indian Health.

And their initial problems, especially in Alaska, were problems of infectious disease, a huge tuberculosis epidemic in Alaska. And very, very high infant mortality all from infectious disease. And so for ten years, the Public Health Service in Alaska helped get these various epidemics under control.

And one of their major accomplishments, and I don't know if you've ever seen their slide of their ‑‑ the dramatic decreases in tuberculosis rates, and basically, the ‑‑ the halving of infant mortality rates. But that's not our topic.
So in ‑‑ in 1966 was the first year that the Indian Health Service did anything in Alaska or nationally to introduce major mental health programs. And they started small mental health units, one on Pine Ridge Reservation in South Dakota, one at Gallup Hospital in New Mexico.

And the other one, and when I went to the Indian Health Service office, they told me about this new initiative that Senator Bartlett had sponsored, which gave $100,000 to the Indian Health Service in Alaska to start a mental health program that would concentrate on the Eskimo areas of the state. So the west or the northern parts of the state. And the $100,000 was to put together a small mental health team.

And I swear to all my friends and my wife that I said to them, "That sounds interesting." And left, and was all set to do something else, and I got this letter saying, congratulations, you got your first choice, you're going to Indian Health Service in Alaska, which turned out it was ‑‑ it was really a great job. And so we went up there in 1966, and that was our first introduction to Alaska.

Section 2: We stayed in the Indian Health Service ‑‑ and we'll talk more about that ‑‑ for a couple of years; and then we had always intended to go back to Boston and we did. We went back for a year. I took a fellowship in community psychiatry in Boston, in 1968; and then we decided we hadn't had enough of Alaska, so we went back up there and we stayed there from 1969 to 1977.
I was in private practice at the Langdon Clinic.

And then in 1977, I took a job at the medical school here in Portland, wanted to get into academic psychiatry. And I basically have been here for the rest of my career in the Department of Psychiatry, in later years in administrative jobs in the medical school.

BILL SCHNEIDER: So that first period when you were working for the Indian Health Service, TB was a huge problem. And I know that you have some things to say about that, but one aspect of that that I wanted to ask you about was patients were taken out of the communities in many cases and taken to sanitariums?
JOSEPH BLOOM: Yes.

BILL SCHNEIDER: What was ‑‑ what did you see as a psychiatrist in terms of the impact on families of that period?
JOSEPH BLOOM: The TB epidemic was very extreme there. And as I was told then, and I haven't really researched this much since, but I was told then that they recorded the highest TB death rates ever recorded in the world in Alaska.

And the effects on the families were very dramatic. I mean, you'll hear many, many stories of how people were separated from the families, a plane comes into the village, drops a note, we need this person to come to the hospital, that person goes to the hospital, and many people died in the hospital. People died in the villages. It affected children and it ‑‑ I think it was a big disrupting influence on the lives of many, many people.

And I think I also, in my early days, I was up there, I was very impressed with the fact that there was extremely large family size; and as the death rates decreased from infectious disease, the size of the families increased. And the ‑‑ I believe ‑‑ and I always felt this was a very important area to study, never did do it myself ‑‑ that the burdens of disruption and grief would potentially play very heavily on the population.

And again, I followed closely when I was there for the ten years I was there, and then I've done work off and on, some work in Alaska, and work with Native American communities all over the country, and I just have ‑‑ have felt like the sequelae of these times kind of came down through the generations that we have today and play them ‑‑ plays itself out to some degree in some of the very high rates of disruption and substance abuse that people see today.

Now, again, that's not proved as far as I know. And as I said, I followed it in the literature, it was always mentioned to one degree or another in the anthropological literature, there never was a strong psychological/psychiatric literature, there were just some people working there and never was a strong literature investigation in these areas, but I've had that in my mind from the time I was there and some of the things I saw to the present time. And it would be interesting to see if people did follow up on that.

Section 3: BILL SCHNEIDER: Back in the early days, why do you think Bartlett was so interested in getting mental health services to rural Alaska?
JOSEPH BLOOM: Well, I think it was ‑‑ I'm not sure exactly where it started. It was obvious that there were very few services in Alaska in general. There wasn't a huge number of people. I think when we first got to Anchorage there in 1966, there may have been 50,000 people in Anchorage.

So ‑‑ and there weren't very many services anyplace, and there were ‑‑ there was a dearth of services in rural Alaska. You know, there was the Indian Health Service hospitals, and you know where they are. And then there were some other isolated hospital ‑‑ there were other rural hospitals, for example, in Nome. There ‑‑ there had been a hospital, or probably still is, that was run by a religious order.

So there were a few services to begin with, and I think people were beginning to feel within Indian Health Service like they had gotten ahead of the infectious disease problems, and they were beginning to see many behavioral and psychological problems, a lot of depression, a lot of substance abuse.

So I think it was a time, and as I mentioned earlier, it wasn't just up there that the Indian Health Service was interested in introducing these services and did start it in these three places, and then this program over the years has mushroomed into a very large program nationally. With changes in Alaska, which we could talk about later if you want.

But I think it was just a time to ‑‑ for them having caught their breath on a certain part of the ‑‑ of their responsibilities, so to speak, and just seeing this was obviously an area that they needed to get into.
And the state itself, although, you know, the state services, and one of the really good things of working in Alaska was the state services and the federal services were open ‑‑ well, the state services were open to everybody.

If you take Oregon as an example, we have two big reservations in Eastern Oregon, Warm Springs and Umatilla. Warm Springs is covered by federal law, Umatilla is covered by state law. So the state has certain responsibilities on the ‑‑ in relation to the Umatilla Reservation, whereas on the Warm Springs Reservation it's federal responsibilities, pretty much only federal responsibilities. And I've worked with these, in this area here.

Section 4: But Alaska, everything was on the state side was open to everybody, but there just weren't that many services. And they had just opened the state hospital a few years before, and there was at that time a beautiful new hospital when I went up there, and they didn't have great working relationships ‑‑ relationships with the rural areas and with the Public Health Service Hospital.

So one of the responsibilities that came to our small mental health team, we ended up hiring a psychologist and social worker, and I was the chief of the unit, and one of our responsibilities was to provide the interface between the rural hospitals of the Public Health Service, the ‑‑ the referral Public Health Service Hospital in Anchorage, and the state hospital at API.

BILL SCHNEIDER: Well, I guess I'm confused a little bit. You said the state hospital. That's not the same as API?
JOSEPH BLOOM: That is API. Yes. Yes.
BILL SCHNEIDER: Okay. So rural and API working out that coordination?
JOSEPH BLOOM: Yes.
BILL SCHNEIDER: And can you talk a little bit more about that?
JOSEPH BLOOM: Well, yeah. Well, one of the things we attempted to do, and I think we were quite successful in doing, is the Public Health Service in the area that we were mainly concentrating on had hospitals in Barrow, Kotzebue, Tanana, Bethel, and Dillingham.

And then the hospitals in Southeast and the big referral hospital in Anchorage.
And one of the things we did was we made a very simple rule that nobody could go to the state hospital from the rural hospitals from the Public Health Service hospitals without going through our mental health team. So we coordinated the admissions.

We also, in order to facilitate more treatment at the local level, we did a lot of rural clinics. I think we probably were on the road two out of four weeks, and we would go to Bethel or to Kotz ‑‑ Bethel and Kotzebue were our biggest places, Bethel mostly.
We'd go to these places, hold a clinic for a week, see people that were ‑‑ had been sent home from the hospital, see new referrals, try to deal with crises in the community if we could do that.

If we couldn't, we were able to bring people to Anchorage or to API.
We had this agreement, we negotiated an agreement with API that if we asked them to admit somebody, they would do it without making a lot of questions because they got to trust the ‑‑ the fact that we were all working together here and that we needed backup when we needed it, but for lots of things, we were able to handle it at the local level or within Anchorage.

Now, just say we didn't have any psychiatric beds in any of the Indian Health Service Hospital, so we were limited, but when I first started in practice in Anchorage in '69, we didn't have any psychiatric beds at Providence Hospital either, and we were able to have large numbers of people in the hospital on the general medicine unit. So it's not always the lack of beds that prevents you from using these hospitals.

Section 5: BILL SCHNEIDER: And what sort of issues were you addressing in these village clinics?
JOSEPH BLOOM: Well, you'd see just a wide range of general psychiatric practice. You'd see people with depression, you'd see people ‑‑ there was some people with psychosis, schizophrenia. You'd see people with severe moderate to severe drinking problems; mostly drinking problems, not much in the way of drugs at that time.

You'd see adolescents. You know, this was an interesting also. This was prior to the village high school. So we had large numbers of kids from Alaska who were in high school at Mount Edgecumbe, and then down here, I think you visited Chemawa ‑‑ did you visit Chemawa?
BILL SCHNEIDER: No.
JOSEPH BLOOM: Oh, I thought you did. Well, Chemawa school down in Salem had hundreds of Alaska students, and then there were hundreds of students in Oklahoma.

So we had lots of disrupted families, we'd see parents who missed their kids, we'd see kids who came back for the summer, and you know, didn't know what ‑‑ exactly how to orient themselves.
So it was a general psychiatric practice.

And at that time, there were no child psychiatrists, there were no child psychiatrists in practice in Anchorage at that time. There were a few years later. And so we saw children, I mean, it was just a general practice. And you'd ‑‑ it just was the whole range of what you'd see in a psychiatric practice. It was pretty interesting, actually.

BILL SCHNEIDER: Yeah, I would think so. Because how would you do follow‑up?
JOSEPH BLOOM: Well, that's good. We ‑‑ we would ‑‑ good question. We did follow ‑‑ we had village health aides. There were health aides in all of the ‑‑ you know, the ‑‑ we had the hospitals in the towns, but there were health aides in the villages, and we could coordinate through the radio communication.

We always had the doctors. So if we go to Bethel and we had somebody who was in Emmonak who needed to be followed up on, there was a doctor who did regular visits to Emmonak, that doctor could follow up, and the village health aide could follow up and make sure the person ‑‑ if the person was on medication.

So we had a network of services. And we tried to get, and again, were successful with a number of the general doctors. These hospitals were staffed by general medical officers who were people who didn't complete their specialty ‑‑ weren't allowed to complete their specialty training and were drafted in after internship or maybe a year of general medicine or family medicine.

But many of them were fine doctors and interested in psychiatry and they would follow up on people. So if we went to Bethel for a week and we had a list of people, we would have a doctor follow up with that person.
And in several of these hospitals, you'd always find one or two doctors that were really interested in this, and we kind of made them our mental health officers for the follow‑up.

And then if there was a problem, they or other doctors or the service unit director could call us and we'd either give them advice or say let's bring them to Anchorage. But it was much more coordinated; much, much more coordinated than in the past, which was basically, we've got to get this person on the airplane and get them to API.

So, I mean, there's many, many things you can do. And they actually had a very good network of high‑level and mid‑level providers of health services that covered the whole state, in a way.
And you know, there were ‑‑ the state had Public Health nurses, we worked with them, the BIA had social workers.

We worked with whoever we needed to, to try to provide what service was needed, whether it was family support or, you know, visiting health nurse support. I mean, it's so ‑‑ there was more than met the eye of what you could get done.

Section 6: BILL SCHNEIDER: But in terms of psychiatric counseling, it probably was fairly limited, I would suspect.
JOSEPH BLOOM: Well, yes and ‑‑ and no. I mean, it's not a lot of ‑‑ a lot different than if you went out here in Eastern Oregon in some of the towns of what's available, there probably was more available there because there was this network of ‑‑ of service providers.

But yeah, if you're talking about ‑‑ if you're talking about intensive psychotherapy, there was no psychoanalysis, you know, going on out there, but supportive treatment, medication monitoring, crisis intervention, crisis support, these were all things that could ‑‑ could be done.

Many techniques of public and community psychiatry, which has really been my career all the way through, and that's what I did when I came here was community psychiatry in the ‑‑ in the Department of Psychiatry here.

BILL SCHNEIDER: We've been very interested in the health aides and the role that they've played. Karen has done a major project interviewing health aides around the state. So it was interesting to hear your comment about that.

JOSEPH BLOOM: I had an interesting little anecdote you can ‑‑ you can look this up. I had ‑‑ during the two years I was in Indian Health Service, I had two or three nationally known consultants come visit. And one was a professor from ‑‑ he was the chairman of psychiatry of University of Maryland, Eugene Brody, and he and I ‑‑ I wanted to show him what a village was like.

So we went to Emmonak. But we didn't go there to be doctors, we went there, you know, kind of, we thought, as tourists.
And then after about a day ‑‑ we were going to be there three or four days, and after about a day or so, the health aide came to me and said, people are getting mad at you. And I said, why?

They said, well, you're doctors and you're not seeing any patients, and they believe that you're not seeing patients because you want to charge them money and you know they don't have money.

And I said, wait a minute. We ‑‑ we are just out here to do this little ‑‑ to make sure Dr. Brody understands what the transition from village to town to city is like, but we'll see ‑‑ we'll have a clinic.
So we ended up, we opened up a clinic and we saw a whole bunch of people.

And one of the senior men in the village, he ‑‑ we talked to him and he said that there's this woman who is very sick, and she needs to be seen, and I said, bring her over. And it turned out it was his mother who was very sick. And we ‑‑ she was very sick. And we ended up getting her flown into the Bethel Hospital.

And then we got ‑‑ you can look this up. We got written up in the Tundra Times as Bad Doctors Visit the Village. Yeah.
And you know, but we did, we ended up holding this very large clinic, and it was mostly not a psychiatric clinic, we are both psychiatrists, it was a general medical clinic; and we ‑‑ with the health aides, we did what we could.

But you probably could be interested in seeing that article again. But I think it was something like that, Bad Doctors Visit the Village.
BILL SCHNEIDER: Oh, that's interesting.
JOSEPH BLOOM: It's on the tape now.

Section 7: BILL SCHNEIDER: The ‑‑ the work back in Boston, was Boston ‑‑ why was Boston of interest to you to go back there for that year?
JOSEPH BLOOM: Well, in my last year of residency, before I went to Alaska, I had spent time with a professor named Gerald Kaplan, who was in many ways one of the people who led the community psychiatry movement, was consultant to the government and to President Kennedy's office and in determining the direction that the community mental health center movement would take.

And you probably know that after Kennedy died, President Johnson got the Community Mental Health Centers Act passed, and there were a number of mental health centers.
But anyway, I worked for Dr. Kaplan in my senior year of residency, and then when I went back there I took this fellowship in community psychiatry, which basically was a year more of immersion in this area.

And then when I went back to Alaska, even though I was in a private setting, we did a lot of consultation. I was consultant for years to the Indian Health Service, to the Yukon‑Kuskokwim Health Corporation, to the Norton Sound Health Corporation. We helped the Indian Health Service and YKHC put together the first mental health unit that lived in Bethel, kind of what we did in Anchorage, and we moved it, the model, to Bethel.

And the first psychiatrist who was recruited for that was Verner Stillner, who you may have gotten in touch with, he later became head of the Mental Health Division for the state and is now in Juneau again. He was chairman at Kentucky for a while and then moved back to Alaska.

He was an excellent person in Bethel, and I was his consultant. So from ‑‑ the basic point is in Alaska, from a private practice base at that time, you could do all kinds of interesting things. It wasn't a, you know, sit in your office eight hours a day and see patients. It was very active and we did lots and lots of consultation.

And I got interested myself in the criminal justice system, and we began to see nationally, and in Alaska to some extent, and probably a large extent now, mentally ill people ending up in the criminal justice system.
And later on when I was here, I put together a small team, was hired by the state to look at the care of the mentally ill in the jails in Alaska.

And we went to ‑‑ the team that I had, we went to all of the ‑‑ well, we went to the Anchorage, Fairbanks, Juneau, Ketchikan jails; and then we went to Kotzebue, may have gone to Nome. I don't ‑‑ I don't remember what other ones. And we wrote a big report about the handling of the mentally ill in the jails and the coordination that needed to be improved between the jail system and the state system, API in particular.

And you know, you usually see these problems more in the cities. I mean, this city, it's a typical example of it, where large numbers of mentally ill people are in jail, and there are fewer and fewer here, psychiatric beds in the state system, so the jail becomes the place where a lot of people end up for many reasons.

But I got ‑‑ the point I was making there is I got interested in this when I was in practice in Alaska and I got interested in Native Americans, and especially people from that same northern and western part of the state who ended up in the criminal justice system and I've written things about that, about transcultural issues and the court system.

Section 8: And another interesting initiative that we participated in a little bit then was ‑‑ I don't know if you remember Chief Justice Boney, Boney, he was the Chief Justice of the Alaska Supreme Court, and he had an initiative about introducing transcultural principles into the criminal justice system, and doing more at the village level and more at the ‑‑ more in the way of trial ‑‑ trial work, and the settlement of disputes at the village level.

So it was an area that I've pursued down here vigorously over the years.
BILL SCHNEIDER: What ‑‑ what have you learned and what have we learned in terms of how to handle that issue?
JOSEPH BLOOM: Well, we probably are handling the issue much worse than we did 20 years ago, or 30 years ago.

When I was in practice in Anchorage, in private practice, we were able to see anybody. I mean, we had ‑‑ people had even without designated health services, they could get support for psychiatric care, for medical care.
I don't remember people being turned away really for ‑‑ being turned away from care. And now, of course, we have very rigid rules about who gets care, and so I think we've actually gone backwards in the last few decades here.

I don't know the Alaska situation that well. When I say "here," I know a lot about the states around here. I mean, California used to be a model for community mental health services, and now it's not a model for anything you'd want to ‑‑ it's a model for how not to do it.

So I think we know the principles, we know how to provide community services, we know what is needed. Psychiatry as a discipline has advanced much further than it was when I started in terms of understanding the brain and understanding psychopharmacology, et cetera, but the amount of services that exist here and elsewhere decreased, in my opinion.

And hence, you have this kind of push toward the criminal justice system, which is hard to reverse because it's expensive to reverse, and the criminal justice system, the police, the criminal justice, they can't refuse people. Other entities can and do. So it's just a natural flow in that direction.
BILL SCHNEIDER: Uh‑hum.

Section 9: One of the things we wanted to talk about was bringing people back from Morningside. How did that come about?
JOSEPH BLOOM: Well, a lot of it ‑‑ I think I may have mentioned to you over the phone, a lot of it was history to me because API, as I ‑‑ as I understand it, opened in '64, and I got there in '66.

And I think what I told you, what I told you was that I was involved in the transfer of what I believe was the last patient in Morningside Hospital, last ‑‑ the last Alaska Native patient in Morningside Hospital. I know her name, but I ‑‑ I'm not going to put her name on the tape.
BILL SCHNEIDER: Yeah.

JOSEPH BLOOM: But you know, Morningside Hospital is here in Portland, Oregon. And we've talked about finding the records for Morningside Hospital, which I'm interested in for another reason, but this patient, as I remember it, was the last person to come back.

And she had been there for multiple years, and as I remember it, she was a woman in her forties, maybe, when she came back. And she was sent to API where most of the ‑‑ where the patients were sent to coming back from Morningside.

And I remember interviewing her and we talked about sending her home. Why couldn't we send her home? Well, she hadn't been there in years and years and years.
We did some checking and we found that there was a family and that they would have her come back and we sent her home.

And she was on medicine, she had carried a diagnosis, a diagnosis of a severe mental illness, but she was in remission at the time on the medicine. We sent her home, and basically, as far as I know, she did okay at home. So that was the last person that ‑‑ as I know it.

And you know, Morningside had the contract for ‑‑ for all of the patients from Alaska before API was built. And not long after ‑‑ I don't know the year per se, but not long after that, without the contract Morningside basically shut down. So that ‑‑ that ‑‑ that was my contact with ‑‑ with the hospital.

And you know, for a long time, API was able to handle the ‑‑ basically, the workload that was necessary for a small ‑‑ what I said earlier, it's the first small state hospital. They were able to recruit staff.
And I remember when I first got there ‑‑ does the name Carl Bowman come up at all?

Be mentioned ‑‑ he was the superintendent. Carl Bowman was an old man, a lot older than I am now when he was superintendent, but he was a very, very well known person in American psychiatry. Had been a professor, I believe, in New York and he was the superintendent at API. And John ‑‑ man named John Rawlins was their clinical director.

Then Dr. Koutsky came along after Dr. Bowman, and I remember Dr. Koutsky and I later on, when I was in practice, we went and traveled down to the new hospital in Valdez for the developmentally disabled, and we saw some patients there together. May have even been when I was still in Indian Health. I don't remember. But it ‑‑ it fulfilled a good place in the state system at that time.
Again, I don't know now how things are there, but that's the way it was then.

Section 10: BILL SCHNEIDER: What was your impression about Morningside and its history in terms vis‑a‑vis Alaskan residents?
JOSEPH BLOOM: Well, I don't have a really solid impression of it. It filled the need at the time. You know.

It was ‑‑ there were always a lot of ties, obviously, between Alaska and the Northwest. I suppose there could have been a contract, maybe there had been an investigation of a contract with something in Washington, but there were a lot of Oregon ties to Alaska. And it was the contract hospital.

It ‑‑ it ‑‑ when I came here, just ‑‑ and again, I'm not sure exactly when it closed. I think it was still open a little bit when I ‑‑ when I got here in the '70s, but I'm not sure of that. But it was not ‑‑ it didn't have a prominent place in Oregon Mental Health Services, it was just kind of struggling along, and then it wasn't here anymore.

So I never really even visited it. I know where ‑‑ where it is, it was out near the ‑‑ it was out near the airport. But I never had a solid impression of the services or...

I talked to Dr. Langdon about it some, because he had come to Alaska having been on the staff at Morningside, and he wasn't there that long, I don't think, and then he went to Alaska and, of course, had the remainder of his career, many, many years there in Alaska.

BILL SCHNEIDER: And when you were in private practice, was that with the Langdon ‑‑
JOSEPH BLOOM: Yes, it was.
BILL SCHNEIDER: ‑‑ clinic?
JOSEPH BLOOM: When I started there, in '69, I was the second psychiatrist in the clinic, and Dr. Wolf, Aron Wolf, was in the Air Force, and Aron joined us probably not very long after I started.

And then a little bit later on, we hired ‑‑ there was a child psychiatrist, John Wreggit who we hired, and then Barry Mendelson who was a child psychiatrist. John ended up going into practice, and then I think went to Washington; Barry went back to Maryland at some point, but so I ‑‑ I was the second psychiatrist there.

We had some social workers and a psychologist, Al Parker, who worked with us for years. And it was a small general psychiatric practice. And again, as I described the practice in Indian Health, there were no child psychiatrists in practice in Alaska, and there were very few psychiatrists in practice.

I don't know if the name Bill Rader had come up, Bill was in private practice, his brother was a state legislator, John Rader, Democratic party, very good, powerful legislator at the time.
But there weren't very many people. I think I may have been, if my recollection is correct, the fourth or fifth person in psychiatry in practice, ever in practice in Alaska. So it developed quickly after that.

We started ‑‑ you know, lots of people who ended up in practice there, like myself, came up there assigned, whether it was in Indian Health or in the Air Force or Army, and then people found it was a really nice place to live and stayed after their service.

Section 11: BILL SCHNEIDER: What were your impressions about Dr. Langdon?
JOSEPH BLOOM: Well, Dr. Langdon was a ‑‑ sort of a laconic, very effective individual. There was very little that actually rattled him, which was very helpful to younger people working there.

I mean, he was able to provide kind of a calm atmosphere within the practice where you were not afraid to take on difficult cases.
I remember he was ‑‑ when I was in Indian Health, I had talked to him on numerous occasions, and I had a lot of patients in ‑‑ we talked about tuberculosis in the beginning of this interview.

Well, the Alaska Native Medical Center, the hospital in Anchorage, had a whole floor, as I remember it, with tuberculosis patients. And many of them were ‑‑ some of them, many of them were also my patients. They were depressed.

And I remember the floor ‑‑ they were on the fifth floor. And I was always nervous about this. I mean, there was no ‑‑ the windows were open, you know, people were sitting on the open ‑‑ sitting by the open windows, and I asked them one time, do people commit suicide around here, does anybody jump out of these windows?

And his answer, he was, you know, just very encouraging to me that this was not an event that was likely to happen, which it didn't happen, but that was the kind of person he was.
In the public arena, he was feisty. I would say he was feisty.

And he had some of his pet hobby horses. He didn't like outside experts, he didn't ‑‑ he didn't like what ‑‑ he didn't like kind of obfuscation. He tried to cut through things. And so he ‑‑ he was ‑‑ he was a force politically.

And I remember he was involved in a lot of issues that brought him into the public eye, but as a practicing psychiatrist, he was a pretty calm individual, which was very helpful to me and to others.

BILL SCHNEIDER: And the impact of his clinic at that point in time?
JOSEPH BLOOM: Well, there was ‑‑ there was, again, very few services in the private sector. There were public mental health clinics in Anchorage, Fairbanks, and Juneau. We also served as consultants to that clinic.

Dr. Rader had a single practice, he practiced by himself in a ‑‑ in a more or less typical psychiatric office practice. He brought up an associate who had trained in his same residency program, who practiced for a while with him.

There was ‑‑ there was ‑‑ and I forgot, there was a child psychiatrist at API, Barbara Ure, who practiced there for many years, and then she went into private practice later.
But there just ‑‑ there weren't many services.

When I first started in practice, there were ‑‑ I don't remember anybody in practice in Fairbanks; a few years later there were. And then one year it just changed and there were 20 psychiatrists in practice. We all couldn't believe it. It was kind of like a culture shock for us, you know. Who are these people. But it did change.

Section 12: BILL SCHNEIDER: We should talk a little bit more about your thoughts on the TB epidemic, but also maybe in the larger framework of a whole history of epidemics that came to Alaska, starting back in the Russian period, and the cumulative impact of ‑‑ of that, of those dialogues, and your thoughts about that. I know you may not have done specific research on it, but I know it's of interest to you.

JOSEPH BLOOM: Yes. If you ‑‑ if you look at population data, and I don't know if I sent you ‑‑ one of the earlier papers I wrote was on population trends with Alaska Natives and the need for planning. I think that was the name of it. Did you see that paper?
BILL SCHNEIDER: No, I didn't see that.

JOSEPH BLOOM: I'll get you the reference and you can see the paper. But it was a paper that looked at population trends, and what you see going back into the 1800s is, you know, times when the population is growing, and then you have, you know, the infectious disease epidemics, measles, whatever ‑‑ whatever it was, and then dramatic changes again in the population.

And the time that I was involved with, as I said, the ‑‑ things were brought under control to a degree, excuse me, on infectious disease produced a population explosion.
And at the same time, the government, the Federal Government did not have any family planning services.

That was one of the main thrusts of the paper. And it just produced this ‑‑ this explosion where it was not unusual to go in a village ‑‑ and again, I don't know now ‑‑ and see a family with ten children, ten living children.

And what I was alluding to earlier was you have these different forces working together, and the idea that the issues of grief and mourning related to death and separation on the one hand, and the obvious strain on resources from extremely large families, which without ‑‑ with ‑‑ with many of the children surviving with making it extremely difficult to live in a manner that people lived in the past in terms of a subsistence manner.

And it put lots of strains on the ‑‑ on family life.
And of course, what I remember very well is you always had this migration pattern of village to town to city with problems in many ways picking up in the rural towns. Lots has been written about the ‑‑ at least were written.

I don't know, again, what people are doing now, but problems within the rural towns and problems within the cities for people, and as people drifted toward the cities, you tended to see more ‑‑ and of course, this is not everybody, but people who were on a downhill spiral who ended up in the cities, you'd often see some of the ravages of substance abuse and alcoholism.

So what we talked about is was there a residue of grief and stretching of resources that you saw in later ‑‑ come out in later generations in behavioral problems.
And again, I never liked to go, having spent all these years in the university, too far from that just being a theory, but it ‑‑ it just ‑‑ there's a lot of reasons why that would be a very interesting idea to pursue.

And it would be good to know ‑‑ as I said, I ‑‑ I knew the anthropological literature pretty well up until the time I left and a little bit after, so it would be interesting to spend some time and see what's happened since, what people have written.

And you know, the ‑‑ a lot of the anthropological literature did have, obviously, behavioral observations and psychological observations, and it would be fun to pick that up and see what's been written in the last 20, 25 years.
BILL SCHNEIDER: Yeah. That's good. Are there examples historically from other parts of the world that you could draw upon in that discussion?

JOSEPH BLOOM: Well, I don't know of an example that ‑‑ I don't know of an example that would mirror the twin issues we're talking about. Excuse me. So no, I don't know that I can cite ‑‑ now, you know, of course, there are parallels to Native American communities down here, too.

And even though, you know, you had the ‑‑ the death rates from, what, suicide, violence, accidents, and these illnesses, and they all paralleled ‑‑ they were high ‑‑ higher in Alaska, but they all paralleled Native American communities here in that the Native American communities, again, at the time I knew the literature, was at the higher ‑‑ was higher than the non‑Native community.

So you have those parallels. But I don't know where the ‑‑ part of those two things occurred at the same time, where you had a very, very substantial infectious disease burden followed by a population explosion. I'm sure there are examples, but I just don't know it.

Section 13: BILL SCHNEIDER: And I know that you've been away from Alaska for a bit, but what are your thoughts about the evolution of services in the area of disabilities and mental illness?
JOSEPH BLOOM: Well, I've been away for a quarter of a century, so I don't know the answer to that.

I knew when we did the ‑‑ the jail survey that I mentioned earlier, we did that in the '90s. And there were big problems between the jail correction system and the mental health system.
I have no idea if they've been eased or not over the last 15 or 20 years.

I just ‑‑ if I were going to guess, I would guess not, but I don't know because it certainly hasn't improved here, and in many other places in the country. But I just don't know.
It would be very interesting to contrast that with people who know the scene now.

Dr. Wolf would be a good person for you because he's of the people who were there for many, many years, he's the person with the longest ‑‑ with the longevity, so to speak, in this area.

But my connection has ‑‑ was in the jail, that jail survey, and from time to time I would give ‑‑ give some advice on some case here or there, some legal case, but other than that, my contacts have not been enough, actually, from my point of view. But ‑‑ but I just don't know.

BILL SCHNEIDER: Yeah. Before I ask Karen if she has any questions to ask you, are there aspects of your background that we're missing that I haven't asked you about but that I should, as it relates to Alaska and the issues?
JOSEPH BLOOM: I don't believe so. No.

Section 14: BILL SCHNEIDER: Okay. Karen, do you have some questions?
KAREN BREWSTER: I guess I just would like to hear more about working with the Indian Health Service and your experiences out in the villages, and so one question would be did you deal with the removal of people from their homes to taking them to API and what that experience may have been like for the patient and their family?

JOSEPH BLOOM: Well, I'll tell you one other anecdote, which was early in my career up there. We had a young woman from one of the villages downriver from Bethel who had severe developmental disabilities. And she was seen by the physicians in Bethel; this was in ‑‑ again, in '66.

And she was sent to Anchorage with a description of her functioning, which was quite low, with the idea that she needed to be hospitalized, basically institutionalized.

Now, when I got that referral, I actually ‑‑ it actually wasn't a referral, it was sent ‑‑ she was sent ‑‑ this was before we got things, so this was early. This is very interesting to me. So she was sent to the Anchorage hospital, basically, with don't send her back. And the family is in agreement, there was a note so big (indicating), don't send her back, the family's in agreement.

So there are laws about commitment and laws about sending people away, and of course, nobody is sent away necessarily forever anymore, but there are laws about that, there were laws about it then.
So I talked to my boss in the Indian Health Service, who was a man named Stan Stitt, who was a dentist, he was a high‑up administrator in the Indian Health Service.

And I said, you know, they just can't do this. I mean, they ‑‑ they may be right, they may not be right, but they didn't follow any of the statutes.
And he said, well, what do you want to do? And I said, I want to send her back.

So I sent her back to Bethel. And I said, while you may be right, you may not be right, but here's the statutes, here's the investigation you need to do, you have to do it right.
So needless to say, this made a big explosion between our little mental health unit and the physicians at Bethel, and we ended up going out there and we had two days of screaming at each other.

And it really was good because by the end of it, you know, we were able to say from now on we're going to operate within this framework, you know, that you have the statutory framework and you have a medical framework, and it can't be like the old days.

And I don't know if that speaks to your question, but to me, it was illustrative of the changes that had to be made in order for there to be a more orderly, and I want to say legal, it's not necessarily legal, but correct manner of people coming from place to place. So that's an example of being involved in a transfer and not accepting the transfer.

I was not involved at all in any of the transfers related to tuberculosis, and some of them were very brutal. I mean, in a way, just, you're gone. And sometimes, as I said earlier, you're not coming back.

But after we had these, what I always thought of as a sensitivity session, you know, we made the transfers correctly. And of course, maybe in a case like that, and I don't actually even remember if that person ever was institutionalized for a long period of time, but the expectations would change.

If we're going to follow the procedures and we're going to follow a process, the goal is in a community focused practice that people should stay home, and if they can't stay home, they should get the treatment and then go home.

So the expectation was not ‑‑ was changed. It wasn't ‑‑ you know, you probably have heard people refer to the airplane cure, take someone on the airplane and get them out of town on the airplane to the hospital, and that was the cure; and then you've probably heard the complaints that people who were sent out on the airplane often beat the people who escorted them back to the village. I mean, it was ‑‑ it worked both ways.

And we were trying to do away with both ends of it. You know, that if this ‑‑ stop the airplane cure, which is just put them on a plane and get them out of town.
Now, there's sometimes you ‑‑ from when you heard the case, you wanted to get them out of town.

But in other cases, you know, you just slow it down and let's reason a little bit here and maybe sending them to Bethel and the person could be contained or ‑‑ or treated in the Bethel Hospital, that was enough, and then they would be able to go home.

So you had that process. And then you tried to prevent on the other end, there had to be some sophistication at the state end, so to speak, at the API end of this, that they would try to do more to understand that there really was a problem out there.

Because you know, sometimes people go from the village to the hospital and they are not going to tell them what's wrong. You know. They are just everything's okay, or it's not very communicative.
So you had to basically slow down both ends of this, that there's nothing ‑‑ I mean, on this end, there's nothing wrong with the person, they don't need to be in the hospital, on this end we're getting him out of here, we don't want to see them again. You know.

So that was the kind of thing we were trying to do.
And again, there always are crises, there always are difficult situations, there always are going to be, when you have any kind of a practice like this, some bad situations. I don't remember really that many ‑‑ I don't remember bad results, maybe that's the blessing of time, but that's what you have to do.

And just try to put some thought on ‑‑ on all parts of this thing. And sometimes you could have a person, you could ‑‑ you talk to someone from a rural hospital and they would say, look, we've got a whole bunch ‑‑ the place is loaded with sick people from this, that, and the other thing, we can't do this, so then you would move the person to Anchorage. Other times they are not that full they can do it. So a lot of it is situational.

Section 15: KAREN BREWSTER: Can you talk a little bit more how you got the people on the API end to better understand the situation in the villages and maybe some of the cultural issues.
JOSEPH BLOOM: Well, the ‑‑ the best way ‑‑ you can't legislate stuff like this. I mean, the principles of how to work in this ‑‑ this setting or other settings that are similar is you have to go there and show up and, you know.

People, you have to be valuable to them. If you're valuable to them, i.e., and what does that mean, it means you have information, you can help them understand, this is the situation.

Oftentimes they were in the dark. So we had frequent meetings with them, we tended to have when we would go in the ‑‑ in the town trips, we would have multi‑disciplinary meetings, we would have multi‑agency meetings, when we would go work with API we would go over and talk to the people and talk to the doctors, and on occasion interview the patients with them, or those kinds of things, invite them to conferences.

And I mean, you just have to open up the system and be ‑‑ again, make it ‑‑ try to make it worthwhile for everyone involved in it. Not a waste of time for them. Everyone's busy. And again, most of the time your people are going to respond to that. Not all, you know, not every doctor is interested, not everybody wants to know stuff, but that's basically it.

KAREN BREWSTER: And you found people receptive?
JOSEPH BLOOM: Yes. Yeah. I mean, again, I think it ‑‑ it made their lives ‑‑ the type of program made their lives a lot easier.
I mean, they'd get people, you know. I can remember ‑‑ well, you may still see this, I can remember being in the airport all the time and yet people with notes pinned on their jackets.

Here's the history pinned in an envelope. People sent, and not just to the psychiatric ‑‑ not to the psychiatric hospitals, per se, but they often got people with very little information.
We were able to get information or to insist that we get information from the local level.