Remembering Ronald R. Fieve, M.D.

I am saddened to learn of the passing of Dr. Ronald Fieve earlier this year at his home in Palm Beach, Florida, at the age of 87. Few psychiatrists have had as great an impact on the actual practice of psychiatry in the last century than Ronald Fieve.

Best known for his pioneering work on the use of lithium carbonate in the treatment of manic depression, Fieve was the author of four popular books and countless scientific articles in the areas of mood disorder, psychopharmacology, and lithium therapy. He is also noted for first identifying the clinical syndrome of hypomania, which later led to the inclusion of bipolar II disorder as a psychiatric diagnostic entity.

Dr. Ronald Fieve (1930-2018) left a lasting impact on American psychiatry and was a pioneer in the use of lithium as a psychiatric medication.

Source: Ronald R. Fieve, M.D., PA, used with permission

As a resident at New York's Columbia Presbyterian Medical Center in the 1950s, Fieve was informed of groundbreaking research by psychiatrist John Cade in Australia on the use of lithium, a naturally-occurring salt, in the treatment of acute mania. Fieve is chiefly responsible for lithium's widespread introduction in the United States as a psychiatric medication, and in 1966 he established the first lithium clinic in North America at Columbia University.

In the 1960s, a "lithium underground" developed in the United States as physicians began prescribing the drug without Food and Drug Administration approval (Shorter, 2009). Since lithium is a natural element, it could not be patented—and thus the drug companies had little interest in pursuing it as a treatment. Nevertheless, Fieve and several other researchers convinced the FDA to approve lithium as a treatment for manic depression in 1970 (see Ruffalo, 2017).

In the years to follow, Fieve became a tireless advocate for lithium, appearing frequently on radio and television programs and writing of its benefits in the professional and popular literature. Interestingly, Fieve pointed out that lithium had been found in natural mineral waters prescribed by Roman and Greek physicians 1,500 years earlier to treat what were then called manic insanity and melancholia (Roberts, 2018). More recent research has shown that suicide rates and other indicators of mental disorder are lower in areas where there are greater trace amounts of lithium in the drinking water (Schrauzer & Shrestha, 1990). Seventy years after lithium's (re)discovery as a psychiatric medication, it remains the "gold standard" in the treatment of bipolar illness.

Fieve was also instrumental in the adoption of the "bipolar II disorder" diagnosis, noting that many patients with bipolar conditions do not demonstrate the classic, full-blown manic euphoria but rather show subtler "hypomanic" symptoms. He called this "bipolar beneficial".

"I have found that some of the most gifted individuals in our society suffer from this condition—including many outstanding writers, politicians, business executives, and scientists—where tremendous amounts of manic energy have enabled them to achieve their heights of success," Dr. Fieve told a symposium in 1973 (Roberts, 2018).

Fieve was distinguished professor emeritus of psychiatry at New York-Presbyterian Hospital and founded the Foundation for Mood Disorders in Manhattan. He maintained a successful private practice of psychopharmacology in New York City, described by actress Patty Duke in 2010 as "crammed with Wall Street tycoons and Hollywood producers".

Fieve starred in a short 2014 film on lithium titled Manhattan, Manic City in which he is seen interviewing and treating patients with bipolar disorder at his private office in New York. It is available on Youtube and can be watched here. Fieve's commentary on the film and his role in the introduction of lithium to the United States can be viewed here.

Dr. Fieve's dedication to the field over a span of more than 50 years is rivaled by only a select few in the history of psychiatry. While his contributions to psychopharmacology and psychiatric nosology represent major clinical advances, it was his devotion to finding better, more effective treatments for the most seriously mentally ill for which he will be most remembered.

Ronald Fieve died on January 2, 2018. He is survived by his wife of 54 years, Katia von Saxe, as well as two daughters and four grandchildren.