MARGRET BERENDES is a psychoanalyst and clinical director of the Mental Health Division of the Yukon Kuskokwim Health Bethel, Alaska.

YEARS AGO, while traveling through Alaska, I was determined to be unlike the ordinary tourist. That was and illusion, I soon discovered, when the clutch of my Volkswagen camper burned out and I was left stranded in the Yukon just beyond the Arctic Circle. For almost two weeks I lived in a yellow school bus converted into a mobile home and patiently waited for a new clutch to be flown in from Seattle.

In those long evenings not only did I learn from Eric, the owner of the school bus, all about the 13 fractures of his nose and how he readjusted the broken bone each time himself, standing in front of a mirror. I also witnessed, night after night, the awesome display of colorful veils trembling all over the night sky and watched grizzly bears, wolves and moose pass by and wonder about that yellow school bus in their territory.

Today I know that in spite of that out-of-the-ordinary incident, I was still only an ordinary tourist who, having experienced Alaska's magnificent landscape and people in the towns of Anchorage, Fairbanks and Juneau, was ignorant of the real Alaskans, and their 5,000-year hold here. This native Alaska remained invisible to me as it will to anyone who does not venture out beyond Fairbanks to the north and beyond the Fairbanks-Anchorage highway to the west.

Except for Barrow, Kotzebue and Nome, most maps of Alaska seem to display a kind of terra nova as far as the western two-thirds of the state is concerned. It is in this countryside, however, where the 60,000 Alaskan natives live, Indians in the southeast and central area and Eskimos in the north and west.

Since the fall of 1984 I have been working among native Alaskans as a psychiatrist in the tiny western Alaska town of Bethel. The change from a resi- dence in Bethesda, Md., to a home in the tundra, from practicing psychiatry on Massachusetts Avenue to visiting Eskimo patients by plane in the bush is, to say the least, remarkable, but not as remarkable as the changes that have faced those whose ancestors owned this land.

MY HOUSE is in an outpost proudly called "Tundra Ridge," surrounded by flat empty landscapes on all sides. When a blizzard strikes, or when the sudden strong winds so typical of the Delta whip the tundra and the snowdrifts pile up, my house seems to be a world apart from the little town of Bethel three miles away, where nature has been somewhat tamed.

Houses in the tundra are not like houses in Bethesda. Here a house must be built like a dock in deep water, on stilts, or, more accurately, pillars, that have to be at least 20 feet deep to reach into the permafrost to be anchored. Furthermore, houses here have utility rooms that are almost life support systems, a far cry from the washer and dryer in the utility room in Bethesda. A homeowner here will show it off to visitors: the pipes, switches, motors, faucets, hoses, gauges, electrical cords, valves and reset buttons.

Some of it, like the 700-gallon water tank inside my house, is easy to understand. Most of it, though, is complicated, and yet it must all be learned. There is no room for error in the utility room. Once the temperature hits 10 below, for example, the heating element in the sewer tank outside the house has to be turned on, otherwise the sewer truck -- which comes once a week like the water truck -- needs an ax to work with rather than a suction hose. The water level in the plastic indicator hose on the water tank must never get too low, because the next storm may prevent the water truck from coming at all.

I am on my own, with my own gas, my own oil, my own sewer, all of it neatly tucked away outside and covered with polyurethane foam against the cold. The connecting pipe to the sewer, as well as the outside pipe that leads to the inside water tank, have their own additional heating wires that can be turned on and off as needed, more or less from my bedside. There is never a dull moment.

March 17, for example, was a day like any other, except it was a Sunday, and a particularly beautiful one with a clear blue sky, a radiant sun and no wind whatsoever. When the radio mentioned increasing winds to 45 miles per hour, I wondered about a weather change, but the sky outside looked innocent. Soon, however, I became aware of the wind picking up, and here and there I saw "streamers" -- dry, blowing snow that crept like white snakes across the tundra. From minute to minute the wind grew stronger and suddenly those streamers had multiplied into thousands that were no longer creeping but shooting forward. My house began to shake; the wind by now was roaring. In no time at all,tundra had turned into a fierce ocean with a gigantic surf, moving full force and without mercy toward our suddenly insignificant little shelters on the ridge.

The telephone rang suddenly, reminding me of my everyday life -- a psychiatric emergency at the Bethel hospital. But only a helicopter could have transported me there. About 10 impressive and still-growing snowdrifts -- as high as eight feet -- were blocking the northernmost lane of Tundra Ridge.

If one dares to live in Tundra Ridge, one can become a captive at seasons other than winter. May 1 was my goodbye to winter this year, but I did not know it then. As on so many other nights, I was skiing around 11 p.m. into the two setting midnight suns, uncertain which of the fireballs was the mirage -- the upper or the lower. The horizon was bleeding into the snow and hundreds of white ptarmigans enjoyed themselves as much as I did in an all-golden, truly spectacular tundra night. Ten days later what was once white, hard and beautiful had turned into knee-deep mud. Road signs announced Tundra Ridge "closed." No school buses came, no water trucks. My car was sunk tire deep in the mire. My lane in Tundra Ridge had frightening gaps, and all the melting water was happily skipping and rushing through those cavities, digging into them even deeper.

Some trucks with four-wheel drive, high clearance and special mud tires dared the adventure to come and go. Whenever I could, I hitched a ride. We'd get our momentum, and then -- on the mark, get set and go -- we would "schuss" through those battlefields of black muck. With lumps of mud splashing and sputtering like soap bubbles, one felt inclined to scream with the excitement felt on a horror ride in an amusement park.

BETHEL, the "downtown" of some 52 surrounding villages, a town with a "multiple personality," is the Byzantium of Alaska, situated at midpoint between Siberia and Anchorage and sepa- rated from Western civilization by the foreboding splendor of the blue, sparkling ice-encrusted Alaska Mountain Range. The only way out to Anchorage is by airplane.

The town has a population of about 4,000 -- half Eskimos, half "international," with Americans, Europeans, many Asians and a few Siberians and Lapps. It is a town of paradoxes and extremes, where rumor travels with the speed of light, yet cannot go any further than five miles to each of the dead-end points of the four roads: the airport, the river, Tundra Ridge and the junkyard.

Bethel is the "downtown of the bush" in an area of Alaska called the delta, which follows the Yukon and Kuskokwim rivers, as well as the coast along the Bering Sea. There are 3 million lakes in the delta and 10,000 rivers. The 52 villages have a population of about 100 to 500 each, mainly Yupik Eskimos, of whom there are 16,000 distributed in western Alaska and in a small part of eastern Siberia. No two villages, regardless of how close together, have any roads to connect them. Some villages do not have a landing strip and can only be reached in spring and fall by helicopter.

In Bethel the natives chew tobacco, not chewing gum, and have fun spitting it out whenever and wherever they are; here smoked dry fish has replaced hamburger; here puddles never drain. Snow does not behave like snow here, but rather like sand, and you may find a six-foot-high shifting dune in front of your house even though it has not snowed for weeks. Here your hairdresser drives an ambulance and is at times your salesman in the grocery store.

Most Eskimos from the outlying villages do not like this strange conglomeration called Bethel. This is a white man's miracle and his way of surviving. It does not fit in with the Eskimo ethic and it is the white man's miracles that have created a confusion in these people that is undoing them.

Yet, as most villages have only one small store, the availability in Bethel of three modestly sized, amazingly complete supermarkets with some department store features is quite phenomenal. Considering that there are no farms in all of western Alaska, and each potato, each onion, and each egg has to be flown in, one is willing to pay $1 per potato or cellophane-wrapped lemon. If you need a gun or a box of condoms, they are here too, not far from the lemons.

Besides having its own TV and radio station, the town boasts a tiny but charming museum, a community college and a good library. A hospital, which looks like a yellow submarine, and a brand new $5 million prison complete the picture.

The tough white guy who pushes drugs, the bootlegger, the emotionally lost soul, and the opportunist who hopes to rape Bethel for a fast buck -- they all inhabit this town in a not always peaceful coexistence with the exceptionally motivated and dedicated citizens who come from all walks of life and are contributing creatively to the positive aspects of this small outpost in the wilderness.

HARSH WEATHER, wilderness, human despair and alcohol in any combination do not mix well, and in Bethel the frequency of irreversible tragic outcomes is overwhelming. I am the only psychiatrist for miles and miles in any direction, the only one in the delta area. I constantly must deal with tragedy and death, an experience I lived through only once before -- in Berlin during World War II. When I was in private practice in Washington, death stayed out of sight most of the time. Here the minds of men, women and children are assaulted by life at the edge of the

world. A cross-section of a recent week's

events may illustrate:

*On Monday a school counselor

wants me to talk to a depressed teen-ager

who is ruminating about his parents' death

some years ago, when father killed mother

and then committed suicide.

*Tuesday the radio announces that a

missing local businessman has been found

dead in his crashed plane in the Alaska


*Wednesday the hospital calls for a

consultation with a woman whose husband

smashed a honey bucket over her head,

fracturing her skull. In the afternoon my

secretary has to leave work because her brother, who had been missing for three days after starting out for a remote village on his snowmobile, has been found frozen to death.

*Thursday a prison guard wants to learn from me how to break the news to a young inmate that his only brother has hanged himself.

*Friday morning, in the outpatient clinic, a woman needs special consolation after she learned details in the newspaper about the murder trial

concerning her niece and boyfriend who were coldbloodedly shot some time ago. In the afternoon a wrinkled old woman cries bitterly during a counseling session. On that day 25 years ago her four grandchildren had died in a fire in their home.

*Saturday there is a call from the prison, where an inmate is roaring like a lion behind bars. It has obviously occurred to him that he might have to spend the rest of his life in prison after clobbering his girlfriend to death while drunk.

*Sunday I read in the paper that a safety police officer arrested a former patient of mine who had killed a sleeping villager the night before with an ax. And in the afternoon, while I type this article, one of my neighbors, a young nurse from Minnesota, calls me in despair. Her boyfriend, running his snowmobile on the frozen river, had struck a landing plane, was thrown into the spillover and drowned.

MUCH OF MY WORK is with Eskimos. And the case of a young Eskimo girl named Katsoo illustrates why those people are so much in need of help and why, at the same time, I sometimes am painfully aware of my own helplessness.

Right after Christmas last year, I was asked to fly up to one of the mountain villages. The village health aide met me at the airstrip and as we walked through knee-high snow she told me about Katsoo. There had originally been 10 children in the family and, as usual, a lot of drinking. Several children had died over the years; an older brother once killed a younger sister after he raped her. Rumor goes that his drowning afterward was not an accident but was arranged as revenge by the family. Two older brothers have been in prison for years.

On the walk I met Katsoo's schoolteacher who told me that Katsoo had dropped out of school after her mother died of pneumonia a few years ago. The teacher described Katsoo, 16, as intelligent and interested in school, but quiet and not social. She considered the girl's family by no means unusual; the history of most families in this village is quite similar.

Katsoo had not come out of her sleeping bag for days. A week before, her father found a revolver that the girl had bought in Anchorage.

I am greeted at the house by her father, a small wrinkled and elderly Eskimo man. Katsoo is tucked away in a sleeping bag, and I try to spark a conversation with her. There is no response. I am suddenly afraid that there might not be anyone inside the bag -- nothing moves, breathes or makes any sound. Before long I give up. Who am I to convince this unhappy child to talk to me, a total stranger, who has nothing to offer for her disillusioned life?

With mixed feelings I commit Katsoo to the Psychiatric Institute in Anchorage. Katsoo, of course, will not go voluntarily, so I must contact the village public safety officer to take her by force.

He happens to be on a rescue mission for a crashed plane, and when we finally do contact him, he is not enthusiastic. He has a tender heart and hates psychiatric commitments. I finally convince him to fly up and ask him to bring Thorazine.

The safety officer knows Katsoo very well. First, he approaches her as a friend, then as a father, with no success. He then makes use of his authority as a policeman and speaks to Katsoo in a friendly, direct but extremely firm manner -- and it works. The sleeping bag comes to life. Finally, a boyish-looking teen-age girl is sitting next to me at the kitchen table. "I am okay. I just have a cold. Nothing is wrong," she repeats over and over again. I ask her why she bought a revolver. (The health aide had indicated that village boys had raped Katsoo -- maybe she only wanted to protect heself.)

"Oh nothing," she replies, "just to kill a chicken" -- which does not make much sense, as there are no chickens in the village.

I must break the news to her that she will be hospitalized. As I am trying to convince her, she returns to the sleeping bag. This time the safety officer removes her from the bag in seconds -- and finds with horror a 20-inch- long machete tucked away inside. He tries to hold her, she struggles and hits, and he handcuffs her. "God, do I ever hate this," he says.

I inject the Thorazine, the poor girl gives up and we walk with our heads down through the snow to the chartered four-seater airplane. Katsoo stares out at the mountain landscape, no tears, no reactions. She has given up long, long ago.

Three weeks later I receive a call from the village health aide. Katsoo has been discharged from the Psychiatric Institute. She is back in her sleeping bag. Katsoo has not changed. Or has she? She was threatening to sue us all for committing her.

TO BEGIN to describe the different emotional problems of Eskimos, one must first delve into their past. For thousands of years these arctic nomadic hunters survived an extreme environment where farming was not possible.

Survival against the odds by sheer subsistence became the meaning of life itself for Eskimos and is at the heart of all their legends. There was no time for boredom or mental illness, and the identity of the individual was never in question.

The clash with our cash-oriented and luxurious technical society has been devastating. Cash is naturally tempting to Eskimos, but at the same time it is not in harmony with the Eskimo value system, which measures strength in terms of survival. Even though snowmobiles, computers, satellite TV and washing machines are appreciated and integrated into their own life style, many Eskimos consider exactly these improvements to be responsible for the breakdown of their own value system.

With more ease comes more free time and boredom; with more cash, away go discipline and toughness, which in turn invites alcohol and drug abuse. Without the struggle to survive, the link to the deeper meaning of life disappears.

In all this ambivalence and struggle between holding on to the established values of the past and the adjustment to a new, questionable life style, the identity of each Eskimo is seriously tested and threatened. For many the hurdles to the future are insurmountable, but a return to the past, a life style of total subsistence, is not possible either. The mentally more vulnerable disintegrate emotionally. They find relief in the no man's land of schizophrenia. But the majority of Eskimos find themselves in a vicious circle on a more conscious level: Alcohol and drugs become handy for escape from a life without meaning; the new, temporarily heightened identity from these drugs leads to accidents, suicides and crime. Accidents, suicides and crime are followed by grieving, depression and anger by loved ones who then get their turn to try to alleviate their pain with alcohol and drugs -- and so on.

The profile of one family, one of unfortunately many, touches on this quagmire.

Theresa and Nick once lived on the Bering Sea, but after their marriage they moved up river. Away from their families, they soon started drinking. He drank on weekends; she drank all the time. He was a quiet man and rarely spoke. It was easy for her to beat him up because of his yielding personality.

She was a strong woman with amazing muscles. A physical fight with her was something to be avoided.

Nick and Theresa had many children. Except for one who burned to death in their kitchen, all of the children are alive. Oscar, Herb and Jim were the only ones living at home. Oscar, the oldest, would viciously trigger fights between his mother and Herb or Jim. Then he would call the village policeman and play the innocent. Oscar tortured his father so much, the story goes, that his old man drowned himself.

Herb ruined his brain with "angel dust" when he was a teen-ager. He is still quite bright, but he can no longer read and has been in and out of a mental hospital numerous times. Jim, the youngest of the three children, is a chronic schizophrenic.

Jim hates his mother. I have met him many times. Either I have to commit him to a hospital because he is confused and wants to kill his mother, or I run into him in prison, because he was picked up drunk in the village. When not intoxicated or in a schizophrenic rage against his mother, he is quite a sensitive human being.

Minnie, a daughter, is 24 and has already been married several times. Her many children are distributed all over to foster families because of her alcohol problem.

Wasillie just turned 15 but looks 10. He is a victim of Fetal Alcohol Syndrome and is physically and mentally retarded. Wasillie is actually quite a likable little fellow, but he has accumulated a lot of anger over the years and feels lost and lonely because he has no home in this world.