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An Interview with Donald A. Bloch, MD

Posted By Administration, Tuesday, October 14, 2014

Don Bloch, MD died on September 18, 2014 at 91 years of age. He founded the Collaborative Family Health Care Association and its affiliate journal, Families, Systems and Health (formerly Family Systems Medicine).  He was a funny, creative, authentic human being, one of the original family therapists who saw the importance of applying systemic approaches to healthcare.  Don was a generative visionary who found and nurtured new talent and created organizations, journals, even health care movements through recruiting and harvesting the energy of many colleagues. 


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In this CFHA blog, an interview of Don originally published in 1996 one year after the first CFHA conference, is republished with permission.  Don remained heavily involved in CFHA into his early 80s after founding CFHA at the young age of 72.  

 

With gratitude and deep respect for Don,

 

Larry Mauksch, M.Ed,

Susan McDaniel, PhD.,

and Jeri Hepworth, PhD

 

An Interview with Donald A. Bloch, M.D. by Eric Weiner, Ph.D., M.S.W.

Families, Systems, & Health 14:95-105, 1996

 

Prediction is difficult, especially about the future.

—Chinese saying

Let's begin by having you tell us what you believe is most noteworthy about your career.

I think what I value in myself is having a fairly good early sense of what will be important in the midterm. This meant abandoning psychoanalysis for family therapy in the mid-1950s and recognizing the unfolding importance of systems issues in healthcare in the early 1980s. In connection with the development of each of these fields, family therapy and collaborative family healthcare, I have been the Editor of the two key journals for important periods: I edited Family Process for the volume years 1970-82, thirteen years in all, when family therapy quite literally burgeoned. Similarly, I have edited Family Systems Medicine from its founding in 1983 up to the completion of 1995, again thirteen years, and again I think those were critical years for the early delineation of the field.

Tell us about your early family years.

In many ways, the family I grew up in was typical of the second-generation, Jewish immigrant families that arrived on these shores in the late 1880s. All four of my grandparents immigrated here as youngsters, met here, married and had their four children: two boys and two girls in each instance. Both grandfathers started out as itinerant workers, one a peddlar, the other a painter. They opened small stores, worked heroic hours to hoard up protection against the anxiety and dread that they brought with them from Eastern Europe. They raised their families in the often described atmosphere of gemiitlichkeit, guilt, and ambition that characterized immigrant Jewish families. My father, as oldest son, married a youngest daughter, as did I—twice. He became an attorney and ultimately, after many anxious years and before Alzheimer's struck, walked into the 20-year sunlight of his true vocation as a judge—a role that played to the best of his intrinsically sweet and thoughtful disposition. Truthful, quick sketches of my mother and sister are beyond me. My mother, like countless numbers of her sisters, certainly was an under-utilized woman, and angry and depressed about that—but still with a wonderful capacity for love and humor. My sister Barbara was and is my lifelong friend—at least after I recovered from the dark sense of gloom that attended her arrival when I was five, and the hot Oedipal love affair I was having with our mother was disrupted.

What about college and medical school?


My college years were very turbulent, continuing a pattern that had been established in high school. At the personal level, I was struggling with what I would later come to see as major difficulties in leaving my family of origin. I lived at home and went to college, riding the subway like so many New York City kids—just as I had done for high school. I had a hunger for knowledge and a total inability to conform to the official demands of education because that was what my parents were pushing—an evil combination. My adolescence was often chaotic and painful. Confusion and guilt abounded along with an idealistic yearning to be connected to the great causes of the world. Unfortunately, family therapy had not been invented yet.

 

It sounds as if politics would have been important to you under these circumstances.

 

Left-wing politics, with which I became heavily involved as a college student, was God-sent. The Spanish Civil War began in 1936 when I was 14, and the heroic struggle between good and evil—the Loyalists and the Franco Falangists, as transmuted and romanticized through the writings of Hemingway—was the stuff of my adolescent dreams. Heroism and sexuality: an unbeatable combination. Later on in college, I could be so busy selling the Communist newspaper, The Daily Worker, that there was no time for school work—actually I had a goodly number of devices for avoiding school work. The whole enterprise terrified my parents, but they could not do much more than leave me alone and hope for the best. I was frightened myself, but also fascinated and really enjoyed the endless discussions and the political work.

 

My first serious girl friend was a Young Communist, she later persuaded me to straighten up and become a pre-medical student as a "contribution to the class struggle." She correctly assessed that I could parlay a middle-class background from a working-class school into a rare and much sought after admission to medical school. 

 


When I began to think about going to medical school, I turned into a model student. The possibility of being a doctor wove together a multitude of strands in my life. Physicians were revered in my family and, it seems to me, there was a strong delegation for me to be the physician in my generation of the extended family, which had already had several distinguished doctors in earlier years. More than that, I had been asthmatic as a child and often had severe ear infections—painful and debilitating in the days before antibiotics, when deafness and mastoiditis were not uncommon sequelae. My mother was certainly the best nurse/ mother any child could have, an expert at creating a cozy counterpane world that almost made the extremely painful eardrum lancing for my many middle-ear infections endurable. My mother and I made the tightest of bonds around my illnesses. And, since I was a voracious reader, the romance of medicine and the high adventure of science captured me in a heady swirl. 

My mother and I made the tightest of bonds around my illnesses 

 

During the war, students were enrolling in the military, either the Army Medical Corps or the Navy V-12 program, so as to avoid being shipped overseas. I was accepted for the more desirable Navy program, very strange and somewhat embarrassing even at this remove because there was so much privilege involved. The intentions were good: not to tie attendance at medical school to the student's financial situation. But, of course, the majority of those admitted had the advantage of education and class background.

 

You married first at about this time?

               

I was married just a couple of weeks before medical school started. Natalie and I were just 21 years old. Among other things, she introduced me to psychoanalysis in a form that was understandable, and palatable to me, mostly through the writings of Karen Horney, whose most influential book was The Neurotic Personality of Our Time. 

 

Remember that the 1930s was the decade of the Great Depression. It is almost impossible to convey the impact of this on the lives of ordinary people. To say that one out of four workers was unemployed does not begin to convey the dread people felt. A sense of personal identity and any feeling of self-worth dissolved. Later, when I came to know Nathan Ackerman and to reconstruct some of his history, I learned how much his thinking was molded by the experience of the Depression, not only in his own family but also in his work as a young psychiatrist. 

 

Psychiatry as a profession began to make sense to me 

The appearance on the scene of the social science oriented psychoanalysts permitted psychoanalysis and my political and social interests to come together, and psychiatry as a profession began to make sense to me. It was also very evident, at the personal level, that I needed some help since I was faced with the stress of leaving home, a new young marriage, and the assault of medical school. Deciding to become a psychiatrist and psychoanalyst legitimized my getting into personal analysis in medical school, and undoubtedly helped keep me somewhere close to sanity.

 

 My first analyst was both a political Marxist and a psychoanalytic radical, Bernard Robbins. As I reconstruct him now in my memory, Robbins had the early intuition of an idea that has dominated my own thinking over the years. At that time, most theory was devoted to considering how personality unfolded from within and was modified by traumatic events. Against this background, it was a major dislocation to think that social responses to individuals played a significant part in maintaining the continuity of personality, and that individuals were active in constructing and modulating these responses.

 

You trained at Chestnut Lodge, did you not?

 

Chestnut Lodge Sanitarium, where I went as a first-year resident, was a small, private psychiatric hospital just outside of Washington DC, in Rockville, Maryland. It was then the premier, psychoanalytic hospital for treatment of psychotics and severe behavior disorders. Frieda Fromm- Reichmann, the remarkable refugee psychiatrist who was the central figure in the novel / Never Promised You a Rose Garden, was on the staff and one of my teachers. The brilliant and eccentric American psychiatrist Harry Stack Sullivan, who defined "psychiatry" as the "study of interpersonal relations," was a consultant and taught at the Washington School of Psychiatry where we all were students. It probably seems weird to the reader of today, but this small hospital, in many ways precious and self-involved, was a significant crossover location for the evolving field of what was to become systemic psychiatry. 

 

The "Lodge" had started life in suburban Maryland, just outside of the District of Columbia, as a drying-out place for congressmen and others of their ilk. Somehow, Dexter Bullard, the owner, on inheriting the place from his psychiatrist father had the glorious notion to turn it into a psychoanalytic hospital—just at the time when American psychiatry was being pumped up to previously unimaginable heights by the influx of refugee analysts interacting with the returning young doctor war veterans who were trying to find a place for themselves in a rapidly changing medical world. The residency appealed to me because it provided the opportunity to work intensely with a small number of patients. The custom was to see patients four, five times a week for one-hour analytic sessions; the focus of the work was on examining the interpersonal field constructed in the transference relationship—an effort to bridge interpersonal and classic analysis. I believe a persistent trend was established there, and that it has provided structures supporting the collaborative family healthcare movement some 40 years later. 

 

Why do I give it such importance? This hospital and the Washington School of Psychiatry were committed to understanding and treating psychosis in interpersonal terms. A broader view of this enterprise, and particularly of the idea that the treatment system included the therapist as much as the patient, is so powerful that we are still only at the beginning of understanding its importance— although the idea of collaborative family healthcare captures that notion in action. It provided the logical foundation for the transition from exclusive concern with intrapsychic events to a broader interpersonal and eventually an ecosystemic view of "mental" life.

[They] were committed to understanding and treating psychosis in interpersonal terms 

 

The influence of these ideas can best be illustrated by research that went on there—ultimately published in the still interesting book The Mental Hospital by the sociologist Morrie Schwartz and the psychiatrist Alfred Stanton. In what is still a model of research strategy, they attacked the problem of psychotic excitements. These days, heavily medicated patients are not likely to show the fearsome combination of behaviors covered by the term "psychotic upset or excitement"— grueling and dangerous outbreaks for patients and staff. These were patients in extreme psychic pain, restless, disoriented, combative, self-damaging. We did not have any medications available except for chloral hydrate and phenobarbital; Thorazine had not yet come on the market. We used cold, wet-sheet packs to help people quiet down, and we provided a tremendous amount of nursing for patients. But it was still a major source of distress for patients and staff. 

 

In what remains a model of research, Stanton, the psychiatrist, charted the excitements, Schwartz, the sociologist, monitored and charted staff interactions with patients, all of whom were on the closed women's ward, about 20 patients. These records were kept separately and analyzed later. The intriguing finding was that there were disagreements and covert struggles going on between key staff involved with patients and that these preceded the excitement. Let's say that the charge nurse and the patient's analyst might have a major disagreement about how she (the patient) should be dealt with; the covert disagreement would go on for day after day, after which she would go into a psychotic excitement. By independently charting the relationship between the nurses and administrators or individual therapists, and by demonstrating that there would be these hidden wars, it was possible to predict before the patient was going into an excitement that this would happen. Not uncommonly, the episode would end when one of the staff members left the field, by resigning, requesting transfer, or by hospitalization of the staff member for "mental disorder." Family therapists can recognize the isomorphism with patterns that undoubtedly characterized the families from which these patients came. 

 

A number of the people of my generation who went on to become leading innovators were there as residents when I was: Don Jackson and Harold Searles probably being the best known names. The "Lodge" had the quality of a golden land: we were intensely involved in new ideas about the "self." This involvement took us into looking at our own lives, looking at how we fit into what was happening with our patients, what our part was in creating the transference. Transference could no longer be thought of as something that the patient dropped on you like a soggy blanket, but rather something you participated in constructing. The notion of a co-constructed reality—although that was not the language for it then—was alive and well at this hospital in the late 1940s. The years have passed, but I think the early patterns of interest for me were really established at that time.

 

What happened next? 

The intellectual excitement was almost overwhelming at times. We were exploring the territory of the new social sciences and bringing back treasures for our work: linguistics, semiotics, cultural anthropology, sociology, general systems theory, cybernetics: Parsons, Goffman, Wiener, Korzybski, von Bertalanffy, McCulloch, Margaret Mead, Harry Stack Sullivan and, later, Gregory Bateson. Only a few names from a long list whose work we studied and whose ideas we adapted to the clinical problems with which we struggled. Their ideas were exciting in and of themselves, and they were applicable to the human dilemmas with which we were dealing. 

 

The intellectual excitement was almost overwhelming at times 

I finally had to fulfill some obligated military service because of my deferment during the war. I joined the Public Health Service, was stationed at the National Training School (NTS) for Boys in Washington DC for 2 years, and later at the National Institutes of Health for the same period. NTS was the federal prison for youthful offenders. At NIH, because I was now an expert in delinquency, I was on the planning staff of Bob Felix, the Institute Director. The entire Mental Health Institute was housed in a Quonset hut on the NIH campus in Bethesda—hard to imagine in the light of the Institute's current size. When the Clinical Research Center opened, I was invited to join Fritz Redl in opening the first research unit—improbably studying delinquency by housing a half dozen 10 years olds on a ward in the gleaming glass and steel building. It was an embarrassingly zany effort: the difficult task of getting the government to permit our nurses to wear street clothes on duty was topped only by the problems of the twice-a-day convoy of our kids past the glass-doored laboratories in the hall outside the ward. What kid, delinquent or not, could resist putting an occasional hammer through one of those doors?  

 

I published my first paper in 1952 based on this experience. The paper, "The Delinquent Integration," defined delinquency as an interactive pattern rather than as a personality characteristic. It attempted to identify what there was in the growing-up experience of the to-be-delinquent child, and what adaptive defenses he had to develop to live and minimize anxiety in that experiential world, defenses that would later be known as his character or personality structure. The paper was about the social interactions in which circularity was established so that responses were evoked and made for the reality in which one lived and that had to be dealt with by recycling the same interpersonal patterns. Some years after that I coined the term "portable reality" to describe how the individual, moving through time, evokes from the social fields in which they are moving, a set of responses that in effect create the same reality—so the reality is portable. That has interested me all of my professional life and is a large part of how I look at family and other areas as well.

 

Then, and perhaps now as well, I was always pushing—out of some inner discontent or restlessness—to the edges of wherever I was at the moment while trying to stay connected to the center. In the early 1950s, having heard dimly of something later called family therapy, I began to record my therapy sessions with analytic patients; this was before the days of taperecorders, and video of course was unheard of. I bought a magnetic wirerecorder that, in those days before transistors, was the size of a large suitcase. You could barely carry it. It would make a magnetic recording on the magnetized wire spool and play it back through what looked like a large radio. The entire project was suspect: analytic colleagues sniffed at your unanalyzed voyeurism. After making recordings for a while, I did something even more outrageous: I began to invite the spouse in when I had patients in analysis. I was intrigued by the notion that I could take a firsthand look at the folks I had been hearing about from their mates and check my impressions directly against what I had heard in the sessions. It also helped ward off analytic boredom, which threatened to descend all too often. 

 

Let me tell a story that I don't tell a lot. I have had only one "successful" suicide of a patient in my entire career. The patient was a woman who came to me for analysis. She was a PhD married to an MD, had two kids, and was pregnant with the third. It was very clear in the first couple of sessions that she was dangerously suicidal. I told her I needed to talk with her husband. She refused, saying that, if I did, she would not work with me. "I have to know that this is confidential," she said. So I didn't contact her husband. She killed herself. She took an overdose, and her husband woke up in bed one morning next to his dead wife. I've regretted that all my life; I know I would do it differently now. At times, the severe limitations of one-on-one, confidentiality oriented psychotherapy were compelling and evident.

 

How did you happen to go to the Ackerman Institute?

 

Altogether, I spent 13 years in Washington. My wife and I had our three children there. In 1961 we left Washington DC to move to Northern Vermont for what was to be a one-year sabbatical on a farm, and we ended up staying there for 7 years. I had a research consulting job in New York at the Jewish Board of Guardians, to which I would commute 2 days a week. It seemed as reasonable to commute to New York from Vermont as from the District of Columbia, and we could live on the reduced income under those circumstances. Midway through that period on the farm, around 1965, I began to become actively involved with Nathan Ackerman and the then Family Institute, renamed after Ackerman's death. 


Ackerman and I had been lurching toward each other off and on for several years. He fascinated me; I knew I was interested in family work, and a mutual friend, Marjorie Behrens, who was an associate of mine on a research project and a longtime and loyal friend of Nathan's, would talk about him to me a lot. One day, Marge felt it was time for us to get together, and we all had a drink together, which turned into several drinks and finally a night of talk between Ackerman and me. He asked me to come work for him, which I did, first as Research Director, then later as Associate Director.

I knew I was interested in family work 

 

Originally called The Family Institute, it was a very part-time enterprise originally run out of Nathan's private office; the staff consisted of Nathan, his secretary, and the wonderfully capable Judy Lieb who was titled administrator but did just about everything. I imagine Nathan paid them out of his private practice income. To say that it was a shoestring operation is to exaggerate. When I joined them in the mid-60s, the Institute had just bought the lovely townhouse on East 78th Street in New York City, which it still occupies. The Board, in those days, was made up mostly of Ackerman's present and past patients. They were just beginning to give the Institute some meaningful financial support, and about 1965 bought the building and finished paying off the mortgage. For the next 25 years this building was the sole capital asset providing, literally, a roof over our heads and the place where teaching and clinical work could go on with some measure of safety. 

 

Nathan Ackerman died suddenly but not unexpectedly in June of 1971. He was only 62 when he died; he had rheumatic heart disease, smoked and drank more than he should. I believe he had made no real effort to prolong his life. There was a way in which he was deeply sad at how things had gone in the world. He had dreamed the dream of family in a way that was rapidly becoming anachronistic since it was deeply rooted in the idealized image of the patriarchal family—not a bad deal when it was going well, but rapidly played out as a goal. Yet family therapy would live on and be incorporated into the newer ecosystemic approaches to human misery. Sometimes students are surprised to hear that there was a man called Ackerman, not only just an institution. That would certainly not have surprised Nathan, but it would have amused him.

 

I was Associate Director and the logical choice as Director. By 1971 there was a solid core of clinical and teaching talent as well as a fully operating low-cost family clinic that provided our student externs with clinical material. It was worth continuing for the possibility that, with people like Kitty LaPerriere and Peggy Papp, we could carry the ideas and techniques of family therapy into new project areas.

 

Did some of the activities at the Institute relate to family systems medicine?

 

Early on, Ackerman and I were involved in two hospital programs. We regularly visited with the head of Orthopedics at New York Hospital—he was a most unusual orthopod who had collected family case histories on a large series of his patients, and who was impressed with the unexpected frequency with which disasters ranging from divorce to homicide had been part of the lives of the families of his patients with severe orthopedic deformities. We also regularly visited the Obstetrics Department at Lenox Hill Hospital to explore the possible benefits of a family intervention early in the lives of vulnerable families. With this in mind, we set up a series of meetings with young families that were observed by professional staff. 

 

I'd also like to mention a project called Family House that I set up in my very early days at the Family Institute—the mid-1960s is the time period involved— because it clearly delineated the ideas that have been enunciated in the collaborative family healthcare paradigm. The Family House project design called for moving a multidiscipline team, built around social and healthcare services, on-site into a housing project building. It would selectively choose for residence those families denied access to more conventional housing projects, denied access because they were alleged to exhibit social or personal pathology too severe to be accommodated in such housing. For all intents and purposes, these were families that 20 years later would be identified as homeless, although that term had no currency then. A central idea of Family House was to deal with the pattern whereby families, as they strengthened themselves and became less "pathological," would move out of the community in which they lived—the housing project, for example. We had the notion of reversing this process and having the professionals "move out," hopefully leaving a vital community behind them.

The Family House project called for moving a multidiscipline team into a housing project building 

 

Amazingly, the project was approved for joint funding by both NIH and by the Children's Bureau. But that was in a year when all the funding crashed. So, we got a small amount of money but never got the project really funded. It was approved but never really came to be. Looking back on it now, I think it was laudable but naive and unsophisticated. My guess is that it, like so many similar projects, would have been sustained for a time only by unreasonable inputs of energy and financing. It would have demonstrated one kind of truth, that families can be rehabilitated with those levels of support, and also demonstrated another kind of truth, that such levels are unsustainable. A much more advanced and valuable demonstration of these points was being made around the same time by Dick Auerswald and the Gouverneur Hospital program in a well-funded project where an ecosystemic and family point of view was being applied to a community mental health center, and with outstanding results.

 

What were your goals for yourself and the Institute when you became Director?

 

My goal as Director, during the 19 years I held that position, was to have the Ackerman Institute be a flexible and dynamic home for outstanding people and exciting projects. We tried to build these on a first-rate, clinically based, teaching program. I believe doing this well meant setting quality standards, but not pretending to know just where it all would go or what the ultimate model to be promulgated should be. The choice to nail one's flag to the mast of a specific model of therapy has clear tactical advantages if the model works, as almost all do somewhat. The alternative is for an institution to teach clinicians more eclectically, with the best current models available. That way builds institutions along more of an academic model. At the Ackerman Institute we did both, not always without some conflict. Under the star system, it is often hard to persuade others as to what an equitable division of the glory or income should be. 

 

Running the Institute was not always smooth sailing for another kind of reason. Things kept changing in the field, and it was particularly painful to realize that sometimes people had to leave the Institute because they did not fully keep up with these changes. It is not always true that a rising tide lifts all boats. Mercifully, this did not come up too often because the people who had to leave had been my colleagues and friends for years.

 

How did you start Family Systems Medicine?

 

My pathway to a closer relation with physical medicine was long and, as I have tried to indicate, goes back to my childhood and my family. More proximately, at the Ackerman Institute I began to feel more and more strongly that our view of our work as family therapists was too limited and partial. Many family therapists still act as if people were disembodied. The comment that the physicians' view of a person stopped at the skin was as true in the opposite direction: family therapists had little to say about things taking place inside the skin. And yet I knew from my clinical, and indeed my personal experience, that this was just not so. People came into therapy for a multitude of reasons related to their biology; endowment, development, disease, aging were all slighted. Later on we learned that they often came into family therapy because they were getting better from some physical disease. So I began to be intrigued by that. It seemed to me that we were not thinking enough about the biological and, as an extension of this, that we were not thinking enough about our relations with physical healthcare providers. Little did I know then how true this would turn out to be.


We wanted to know more about families in which there is chronic illness 

Somewhere in the early 1980s I had invited Henry Lennard, a medical sociologist, to consult with us on a regular basis, and we spent many long hours discussing healthcare, where it was going, and what might be done to improve things. That began to get the juices flowing. Later, we set up a chronic illness unit under the direction of Robert Simon, with whom Peggy Penn worked so productively. Over the years, many projects at Ackerman have started in just this way: a group of families showing some common pattern of interest—school problems, AIDS, family violence—would be invited to work with us. This involved assembling a small staff group that would systematically observe sessions with these families. In this instance we wanted to know more about families in which there is chronic illness, to look at them really closely, and try to unriddle what relationship there was between the illness and the family. The chronic illness project continued for many years. 

 

In 1982, I had completed my term as Editor of Family Process and was feeling somewhat bereft. Michael Glenn, who earlier had been a student at Ackerman, and whom I valued highly for his intelligence, honesty, and clear views of corrupted systems, approached me for some help on his idea of starting a journal. At that point, Michael had left family therapy (to which he later returned), moved to Boston, and was practicing family medicine. Michael and Barry Dym had been discussing the idea of a new journal, but needed someone with enough credibility with publishers to persuade them to undertake this chancy venture. I seemed to fit the bill, and we set about putting it together. So, Family Systems Medicine was born 13 years ago, with Don Ransom, Michael, and Barry as the initial, core guiding group. Fortunately, we were supported by a generous private donation for the first 3 years of publication and, since then, have gradually built up a readership and group of authors and advisory editors. It is a source of great satisfaction to me to see the journal, renamed Families, Systems & Health, in the competent hands of its new Editors, Susan McDaniel and Tom Campbell, with the leadership of Bill Doherty as Board Chairman. It is the same sense of solid pleasure that I feel when I think of the Ackerman Institute being directed by Peter Steinglass. It is a great tribute to be succeeded by people whom I admire and to whom I can unhesitatingly pledge my own loyalty and support.

 

And, now you have started the Collaborative Family HealthCare Coalition.

 

Readers who will have followed the trail I've laid out about my life should not be the least bit puzzled as to my part in starting and building the Collaborative Family HealthCare Coalition (CFHcC). They could indeed say, "What else could the fellow have done given that long-term interest in doctoring, family, and ecosystemics?" In the winter of 1992/3, having left Ackerman almost 2 years earlier, I was occupied with editing the journal and doing a bit of teaching and private practice. I began to obsess over the directions being taken by the professions of psychiatry and family therapy, each of which seemed to be on a downward spiraling course. Psychiatry had long since chosen to define itself as a biological discipline—a decision that filled me with anguish when it first became evident, and then finally left me despairing about any possibility of change in the profession. It was particularly worrisome that family therapy, by defining itself exclusively as a mental health discipline, was condemning itself to eating crumbs from the psychiatric table. And it seemed to me that this was going to be leaner and leaner fare as things moved forward. 

 

There was a tangle of epistemological, clinical, and political issues here as well, which seemed to cry out for some new thinking. Paradigm change toward an ecosystemic model of healthcare (in my view, a somewhat more satisfactory term than George Engel's biopsychosocial model) might just be possible because of the economic and cultural changes that were taking place in the U.S. Certainly, if the holistic vision in healthcare was ever to come to pass, this was the time for it. Difficult as the situation was turning out to be nationally, the turmoil seemed to me to provide opportunities that had not existed before. The essential ingredients for paradigm change seemed to be in place: the prevailing linear epistemology was less and less able to handle the data being generated, and a systemic epistemology was available and more promising; the economic interests of large groups could benefit from a paradigm shift; a work force (mental health providers) and a technology (systemic interventions) were available to implement the operationalization of a new paradigm. It was hard to assess the meta-stability of the present system; the influence of the medical-industrial complex could not be overestimated; there were the enormous problems of redesign and retraining. Since all these issues would have to be dealt with at some point in time, this seemed as good a time as any. 


Moreover, it seemed that we were not fully connecting with the natural allies of family therapy—family medicine practitioners. In the course of my years as Editor of Family Systems Medicine, I had come to know many people from family medicine, especially through the Amelia Island meetings of the Task Force on the Family of the Society of Teachers of Family Medicine (STFM). We had been traveling parallel paths, often without fully knowing about each other's work. I had high regard for their ethical and technical excellence. It seemed that this was the appropriate core of a new movement if it were to take place. 

We were not fully connecting with the natural allies of family therapy—family medicine practitioners 

 

With that in mind, I initiated a planning meeting at the March 1993 Amelia Island meeting of STFM that, by happy accident, Lyman Wynne was able to attend. Lyman's early support for this development was critical; he brings impeccable credentials as a scholar and clinician/researcher, and his indisputable integrity gives a stamp of approval that is priceless. The group was wonderfully lively and wanted to continue the explorations. The Amelia meeting was followed the next January by a meeting at the Johnson Foundation Wingspread Conference Center. Wisconsin in the dead of winter is an unlikely place for buoyant new growth, but that meeting of 50 professionals from many different disciplines ended on a Spring-like note. The Collaborative Family HealthCare Coalition was born and named, and a possible conference was outlined. The ship was sailing even as it was being designed and built.

 

Do you have any final thoughts you would like to add?

 

 

I am particularly conscious of having said almost nothing about my present family: Abby Heyman and our son Lazar. Those who know us know how central they are to my life and how much they are in my heart. My three older children have lived a lifetime with me, and we still care deeply about each other—for which I am endlessly grateful. In addition to Lyman, Carlos Sluzki and Dick Auerswald and I have labored together in all kinds of contexts, and now, at the shank-end of life, are bound by deep ties of friendship, as I am with many other valued old friends. New, younger friends bring me much pleasure and stimulation, and I miss and mourn those who have passed on. I hope I can adequately repay them. 

 

I keep thinking of the line from the play Born Yesterday in which the girl says to the boy, "Tell me the story of your life." To which he replies, "Well, you know, it's a long story—and none of it true." It is a long story—but it is true.

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Susan McDaniel says...
Posted Wednesday, October 15, 2014
Very nice to see this re-published on line. Thank you.
Permalink to this Comment }

John Rolland says...
Posted Wednesday, October 15, 2014
A terrific piece. Great to re-read it after so long. Amazing life...His articulateness shines through.
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Jeri Hepworth says...
Posted Wednesday, October 15, 2014
Thank you for republishing. This is of course a story of Don, but also of the history of what we all care about. I am so happy he had an opportunity to write it in his eloquent words.
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Jennifer Hodgson says...
Posted Wednesday, October 15, 2014
Few people get to be branded the word extraordinary. Don was this word and lived his life to bring the extraordinary out in others. He is and always will be our illuminator for keeping the family in health care.
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1/5/2017
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