Families, Systems, & Health 2014, Vol. 32, No. 1, 6 – 8
© 2014 American Psychological Association 1091-7527/14/$12.00 DOI: 10.1037/fsh0000009
Don Bloch Award, 2013 Frank deGruy, MD, MSFM
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
University of Colorado
Thank you, Susan, and thank you selection committee. This is quite an honor, and the honor is twofold:
became the first Director, after Nathan Ackerman, of the Ackerman Institute for the Family. During that time he also became the second editor, after Jay Haley, of the journal Family Process. While focusing on the family as the unit of care for people with mental health problems, Don saw something else: a person’s psychological state was inextricably linked to his or her physical state. The health of one depended on the health of the other. Diabetics have more complications when they’re depressed, which they often are. Asthma is worsened by distress and anxiety. And we cannot be effective as healers unless both are taken together— unless the so-called biomedical clinicians and the socalled behavioral clinicians work together. Labor together. Collaborate. So he started the journal that is now called Families, Systems, & Health, and then decided we needed an organization, which became the Collaborative Family Health care Association (CFHA). In his first editorial, he called for a “dual optic”: at least two different professionals (mental health and medical) working together on behalf of the patient. Two sets of eyes on the problem. Well, it’s very easy for us to see this collaborative approach clearly today. It takes no imagination whatsoever, because the trail has been blazed, paved, and marked with signage. Since Don’s day, we have developed conceptual models that explain the world this way, and training programs that prepare our next generation to see things this way, to think like this. Imagine in your world a way of understanding and operating that went against how you were trained; for which there were no training tracks; no fellowships to help our next generation to see things like this and think like this and practice like this; no funding streams. Imagine that your “successful” colleagues could not see what you were pointing at and thought you a fool for leaving their fold to pursue this chimera. That’s the kind of world in which Don was acting.
1) I join a line of distinguished awardees. These are people who really have made the lives of people better, really have made people healthier. This is good, good company, and I’m honored and humbled. 2) The second reason is that now my name is linked with Don Bloch’s. Don is one of my heroes, and I’d like to tell you why. Don’s career was characterized by three traits that I admire and to which I aspire: imagination, courage, and grit. Grit is persistence against resistance. Don grew up at a time when most everyone around him was flush with fresh understanding about this extraordinarily complex and interesting thing called the mind—and had set it apart as something worthy of study in its own right. What’s wrong in here, inside this patient’s mind? And what can we do about it? Don (and, to be sure, a few of his predecessors and colleagues and friends) had a broader vision. They instead asked, What happened here? They noticed that whatever was wrong seemed as connected to what was going on outside the person as inside. Because the most important formative, reinforcing, and sustaining environment for us humans is family, Don recognized early on that family members were in the room, whether we were talking to them or not. Our wellbeing is always affected by our relationships, so we might as well talk to them. Healing is a collaborative process among family members. So Don became a Family Psychiatrist, and
Correspondence concerning this article should be addressed to Frank deGruy, MD, MSFM, University of Colorado Denver School of Medicine, Department of Family Medicine, Mailstop F496 AO1 12631 East 17th Avenue, #3613, Aurora, CO 80045. E-mail: frank.degruy@ ucdenver.edu 6
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
DON BLOCH AWARD, 2013
Now if we give Don too much credit for alone seeing the world of health as fundamentally relational and systemic, we run the risk of shorting a host of other pioneers and contrarians and visionaries, and I don’t want to do that. Don’s vision was original, and revolutionary, but he lived in revolutionary times, and he took much of what he saw and worked with from extraordinary colleagues who were storming the barricades and writing new articles of confederation all together. But Don’s singular contribution that followed from this shared vision turned on his courage. The conviction of the dual optic—that we bio- types and we psychotypes ought to practice together, meet together, and publish new findings together could not simply be reinforced by coming here to CFHA for a recharge. Don couldn’t say, Wow, I get it. I think I’ll go to CFHA and converse with those guys who think like me. No, he had to invent CFHA, and Families, Systems, & Health, because they should exist but didn’t. That took guts. He sacrificed his career to this vision. He opened his wallet, and invested his personal fortune, such as it was, and persuaded his friends to stick with him on this; he persisted for years, until both the organization and the journal had air under their wings, which they still do today. So now we have this sweet, comfortable, nurturing organization that you and I come to every year. We get our fix here. I’m glad about this, and I thank you, Don Bloch, for making this place for us. May CFHA and Families, Systems, & Health live long and prosper. But we can hardly honor Don’s legacy by simply enjoying what he has created. His genius was imagination and courage and grit, and we need that as much today as we ever did in the 1960s and 70s and 80s. We have work to do, and even though the way to this place has been made easier, our destination does not await us at the end of paved and marked roads. We still have a city to build up on the hill, just as Don did, and we desperately need your imagination and courage and grit. What does this mean for us today? I’m asking you to make yourselves uncomfortable. Imagine what we need so that every citizen, every inhabitant of this planet can be whole and healthy. Go make that happen. Muster the courage to give up your comfortable givens and wrestle a new reality into
7
existence. Get back up when you’re knocked down by those who cannot see what you mean, or stand to lose by what you will do. Link arms and borrow strength from your fellow traveler sitting next to you there, and do this together as a collaborative effort. What am I talking about? I’ll give you an example from my own experience, and then a few suggestions to get you started looking out there into the future that we are going to soon enter, either as leaders and shapers, or as unwilling and dispossessed followers. For most of my career I’ve stood up on the table and argued the case that we must have integrated care—that it produces better results, costs less, and is more rewarding. I’ve gotten pretty good at making that case, pretty comfortable speaking this vision. A few years ago people like hospital system executives, health plan leaders, and health care system architects started saying, Hmm. OK, maybe I see what you mean. We have these dozens of primary care practices in our footprint. What should we do about them? Buy them? Help them become PCMHs? Offer them community resources? How should we change so as to become more attractive to them? What, specifically should we do? How do we actually create these practices you say we need? How, specifically, should we invest our resources into this, and how long will it take before this pays off? Don’t just say we ought to do this, teach us how to do it without going out of business. How sure are you that this will work? How do we sell this to patients who have never heard of it, and won’t buy it? What do we do about this group of clinicians who want nothing to do with this? How do we deal with the fact that those clinicians over there have absolutely nobody to partner with? How do we deal with the wild variety of reimbursement within almost all of these practices? And on and on, serious, operational and financial and policy questions. And then they would sit in silence, taking notes, earnestly listening for help on how to actually do this thing I had been saying we should do. And the truth was that I didn’t have very well developed answers. I had gotten comfortable making the case that they—we—needed to change, but when they were earnestly asking me how to do that, I was coming up short. So at 65 years of age, I have to go back to school and learn what I need to know. Folks,
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
8
DEGRUY
this is my personal opportunity for imagination and courage and grit. I have to master new and unfamiliar material. I have to learn to think like people I don’t agree with, don’t even like very much, but who want to know how to come over. I have to learn to speak another language, live by different rules, much as Don did when he brought his psychiatric training into the medical setting where things move fast, are all tangled up together, don’t get paid for properly, where your partners speak a different language, sometimes value different outcomes, and move on to the next problem way too fast. So I want you to enjoy the sustenance and fellowship here—it’s good for us— but our success has brought us to the threshold of new challenges and possibilities. Now, for example, we need to get good at formulating policy that makes it easy to practice and train collaboratively. Better, policy that makes it impossible not to. Now, for example, we need training
programs that actually train team members together who go out and practice together, everywhere. Now, for example, we need clinic and health plan architects who understand what we have to work with, what we don’t have, and can design clinics and nonclinics and other systems of care that are deeply, irreducibly integrated. Now we need to get serious about collaboration, and pull all the partners into this team that we need, not just the behavioral clinicians and the family docs—all the partners, especially patients and their families. This is too important for us to just try to do ourselves. Study inside yourself and study the world and I’m confident that you will see your own way to what we need, and what your place in it is. Dream it into a clear vision, and be crazy enough and courageous enough and persistent enough to wrestle it into existence. Be like Don. This is worth committing to. Thank you for so much.
© 2014 American Psychological Association 1091-7527/14/$12.00 DOI: 10.1037/fsh0000009
Don Bloch Award, 2013 Frank deGruy, MD, MSFM
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
University of Colorado
Thank you, Susan, and thank you selection committee. This is quite an honor, and the honor is twofold:
became the first Director, after Nathan Ackerman, of the Ackerman Institute for the Family. During that time he also became the second editor, after Jay Haley, of the journal Family Process. While focusing on the family as the unit of care for people with mental health problems, Don saw something else: a person’s psychological state was inextricably linked to his or her physical state. The health of one depended on the health of the other. Diabetics have more complications when they’re depressed, which they often are. Asthma is worsened by distress and anxiety. And we cannot be effective as healers unless both are taken together— unless the so-called biomedical clinicians and the socalled behavioral clinicians work together. Labor together. Collaborate. So he started the journal that is now called Families, Systems, & Health, and then decided we needed an organization, which became the Collaborative Family Health care Association (CFHA). In his first editorial, he called for a “dual optic”: at least two different professionals (mental health and medical) working together on behalf of the patient. Two sets of eyes on the problem. Well, it’s very easy for us to see this collaborative approach clearly today. It takes no imagination whatsoever, because the trail has been blazed, paved, and marked with signage. Since Don’s day, we have developed conceptual models that explain the world this way, and training programs that prepare our next generation to see things this way, to think like this. Imagine in your world a way of understanding and operating that went against how you were trained; for which there were no training tracks; no fellowships to help our next generation to see things like this and think like this and practice like this; no funding streams. Imagine that your “successful” colleagues could not see what you were pointing at and thought you a fool for leaving their fold to pursue this chimera. That’s the kind of world in which Don was acting.
1) I join a line of distinguished awardees. These are people who really have made the lives of people better, really have made people healthier. This is good, good company, and I’m honored and humbled. 2) The second reason is that now my name is linked with Don Bloch’s. Don is one of my heroes, and I’d like to tell you why. Don’s career was characterized by three traits that I admire and to which I aspire: imagination, courage, and grit. Grit is persistence against resistance. Don grew up at a time when most everyone around him was flush with fresh understanding about this extraordinarily complex and interesting thing called the mind—and had set it apart as something worthy of study in its own right. What’s wrong in here, inside this patient’s mind? And what can we do about it? Don (and, to be sure, a few of his predecessors and colleagues and friends) had a broader vision. They instead asked, What happened here? They noticed that whatever was wrong seemed as connected to what was going on outside the person as inside. Because the most important formative, reinforcing, and sustaining environment for us humans is family, Don recognized early on that family members were in the room, whether we were talking to them or not. Our wellbeing is always affected by our relationships, so we might as well talk to them. Healing is a collaborative process among family members. So Don became a Family Psychiatrist, and
Correspondence concerning this article should be addressed to Frank deGruy, MD, MSFM, University of Colorado Denver School of Medicine, Department of Family Medicine, Mailstop F496 AO1 12631 East 17th Avenue, #3613, Aurora, CO 80045. E-mail: frank.degruy@ ucdenver.edu 6
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
DON BLOCH AWARD, 2013
Now if we give Don too much credit for alone seeing the world of health as fundamentally relational and systemic, we run the risk of shorting a host of other pioneers and contrarians and visionaries, and I don’t want to do that. Don’s vision was original, and revolutionary, but he lived in revolutionary times, and he took much of what he saw and worked with from extraordinary colleagues who were storming the barricades and writing new articles of confederation all together. But Don’s singular contribution that followed from this shared vision turned on his courage. The conviction of the dual optic—that we bio- types and we psychotypes ought to practice together, meet together, and publish new findings together could not simply be reinforced by coming here to CFHA for a recharge. Don couldn’t say, Wow, I get it. I think I’ll go to CFHA and converse with those guys who think like me. No, he had to invent CFHA, and Families, Systems, & Health, because they should exist but didn’t. That took guts. He sacrificed his career to this vision. He opened his wallet, and invested his personal fortune, such as it was, and persuaded his friends to stick with him on this; he persisted for years, until both the organization and the journal had air under their wings, which they still do today. So now we have this sweet, comfortable, nurturing organization that you and I come to every year. We get our fix here. I’m glad about this, and I thank you, Don Bloch, for making this place for us. May CFHA and Families, Systems, & Health live long and prosper. But we can hardly honor Don’s legacy by simply enjoying what he has created. His genius was imagination and courage and grit, and we need that as much today as we ever did in the 1960s and 70s and 80s. We have work to do, and even though the way to this place has been made easier, our destination does not await us at the end of paved and marked roads. We still have a city to build up on the hill, just as Don did, and we desperately need your imagination and courage and grit. What does this mean for us today? I’m asking you to make yourselves uncomfortable. Imagine what we need so that every citizen, every inhabitant of this planet can be whole and healthy. Go make that happen. Muster the courage to give up your comfortable givens and wrestle a new reality into
7
existence. Get back up when you’re knocked down by those who cannot see what you mean, or stand to lose by what you will do. Link arms and borrow strength from your fellow traveler sitting next to you there, and do this together as a collaborative effort. What am I talking about? I’ll give you an example from my own experience, and then a few suggestions to get you started looking out there into the future that we are going to soon enter, either as leaders and shapers, or as unwilling and dispossessed followers. For most of my career I’ve stood up on the table and argued the case that we must have integrated care—that it produces better results, costs less, and is more rewarding. I’ve gotten pretty good at making that case, pretty comfortable speaking this vision. A few years ago people like hospital system executives, health plan leaders, and health care system architects started saying, Hmm. OK, maybe I see what you mean. We have these dozens of primary care practices in our footprint. What should we do about them? Buy them? Help them become PCMHs? Offer them community resources? How should we change so as to become more attractive to them? What, specifically should we do? How do we actually create these practices you say we need? How, specifically, should we invest our resources into this, and how long will it take before this pays off? Don’t just say we ought to do this, teach us how to do it without going out of business. How sure are you that this will work? How do we sell this to patients who have never heard of it, and won’t buy it? What do we do about this group of clinicians who want nothing to do with this? How do we deal with the fact that those clinicians over there have absolutely nobody to partner with? How do we deal with the wild variety of reimbursement within almost all of these practices? And on and on, serious, operational and financial and policy questions. And then they would sit in silence, taking notes, earnestly listening for help on how to actually do this thing I had been saying we should do. And the truth was that I didn’t have very well developed answers. I had gotten comfortable making the case that they—we—needed to change, but when they were earnestly asking me how to do that, I was coming up short. So at 65 years of age, I have to go back to school and learn what I need to know. Folks,
This document is copyrighted by the American Psychological Association or one of its allied publishers. This article is intended solely for the personal use of the individual user and is not to be disseminated broadly.
8
DEGRUY
this is my personal opportunity for imagination and courage and grit. I have to master new and unfamiliar material. I have to learn to think like people I don’t agree with, don’t even like very much, but who want to know how to come over. I have to learn to speak another language, live by different rules, much as Don did when he brought his psychiatric training into the medical setting where things move fast, are all tangled up together, don’t get paid for properly, where your partners speak a different language, sometimes value different outcomes, and move on to the next problem way too fast. So I want you to enjoy the sustenance and fellowship here—it’s good for us— but our success has brought us to the threshold of new challenges and possibilities. Now, for example, we need to get good at formulating policy that makes it easy to practice and train collaboratively. Better, policy that makes it impossible not to. Now, for example, we need training
programs that actually train team members together who go out and practice together, everywhere. Now, for example, we need clinic and health plan architects who understand what we have to work with, what we don’t have, and can design clinics and nonclinics and other systems of care that are deeply, irreducibly integrated. Now we need to get serious about collaboration, and pull all the partners into this team that we need, not just the behavioral clinicians and the family docs—all the partners, especially patients and their families. This is too important for us to just try to do ourselves. Study inside yourself and study the world and I’m confident that you will see your own way to what we need, and what your place in it is. Dream it into a clear vision, and be crazy enough and courageous enough and persistent enough to wrestle it into existence. Be like Don. This is worth committing to. Thank you for so much.
