Dr. Ronald R. Fieve, who pioneered the prescription of lithium to treat mania and other mood disorders-while avowing that some gifted individuals, like Abraham Lincoln, Theodore Roosevelt and Winston Churchill, might have benefited from being bipolar-died Jan. 2 at his home in Palm Beach, Florida. He was 87.
The cause was congestive heart failure, his daughter Vanessa Fieve Willett said.
Alerted by his adviser, Dr. Lawrence Kolb, to groundbreaking research in Australia, Fieve (pronounced FEE-vee) began experimenting with lithium to mitigate depression in the 1950s, when he was a resident at the New York State Psychiatric Institute.
He and a colleague, Dr. Ralph N. Wharton, went on to identify lithium as the first naturally occurring medication to prevent and control a specific psychiatric disorder and reduce the risk of relapses.
In 1966 Fieve established the first lithium clinic in North America.
"During the 1970s, it was apparent that psychiatry was going through a difficult transition and suffering from an identity crisis," Fieve wrote in "Bipolar Breakdown" (2009), one of several of his popular books.
"While many psychiatrists, psychologists and psychoanalysts held on to Freud's psychoanalytic explanation of the major mood disorders," he continued, "there was compelling scientific evidence to the contrary. The medical model, with an emphasis on heredity and brain chemistry, began to replace Freud, and the age of psychopharmacology was born."
In 1970, when he was chief of research in internal medicine at the psychiatric institute and the psychiatric department of what was then called the Columbia Presbyterian Medical Center (it is now NewYork-Presbyterian Hospital/Columbia University Medical Center), Fieve and several other researchers persuaded the Food and Drug Administration to approve the prescription of lithium salts for acute mania.
He cited estimates that as many as 1 in 15 people experienced a manic episode during their lifetimes, and that bipolar disorder-characterized by swings from elation, hyperactivity and a decreased need for sleep to incapacitating depression-was often misclassified as schizophrenia or other illnesses, or undiagnosed altogether.
He cautioned, however, that some highly creative, exuberant and energetic people have derived benefits from the condition because they have what he called "a hypomanic edge."
"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," Fieve told a symposium in 1973.
But without proper treatment, he said, those individuals afflicted with manic depression "more often than not either go too 'high' or suddenly crash into a devastating depression that we only hear about after a successful suicide."
In contrast to antidepressant drugs or electroshock treatments, he said, regular doses of lithium carbonate appeared to stabilize mood swings without cramping creativity, memory or personality.
He promoted the use of lithium in the 1970s on radio and television talk shows, where he often appeared with theatrical and film director Joshua Logan, a former patient.
Fieve's books included "Moodswing: The Third Revolution in Psychiatry" (1975) and "Prozac: Questions and Answers for Patients, Family and Physicians" (1994).
In "Moodswing," he wrote that the family histories of Lincoln, Roosevelt and Churchill suggested that they may have been manic depressives.
Lithium, a powdery chemical element that is extracted from igneous rock and mineral water, is also used in batteries, lubricating grease and rocket fuel.
Before it was approved to treat depression, lithium was found in the late 1940s to be potentially unsafe as a salt substitute. But Fieve pointed out that lithium had been found in natural mineral waters prescribed by Greek and Roman physicians 1,500 years earlier to treat what were then called manic insanity and melancholia.
Since then, researchers have found that people with genetic markers for colorblindness and a specific blood type were susceptible to manic depression.
Fieves, who learned decades ago that he had diabetes, told The New York Times in 1975 that "the public should now be educated that depression is a medical illness like many others."
"It's like diabetes or a thyroid condition," he added-if you take the prescribed medication, the condition is under control and "you're not sick anymore."
Ronald Robert Fieve was born on March 5, 1930, in Stevens Point, Wisconsin, about 80 miles west of Green Bay. His parents, Bjarne Ellertson Fieve and the former Evelyn Knudsen, were Scandinavian immigrants. (His father had changed the spelling of his surname from Five because he didn't want people to pronounce it like the number.)
Bjarne Fieve was an engineer, and Ronald studied to become one, too. But he became more interested in medicine when he received his diabetes diagnosis at 19. After graduating from the University of Wisconsin with a Bachelor of Science degree, he attended Harvard Medical School.
He interned in cardiology at Bellevue Hospital in Manhattan and was a resident at what is now NewYork-Presbyterian Weill Cornell Medical Center and at Columbia University Medical Center, which is affiliated with the New York State Psychiatric Institute, under the aegis of the state Office of Mental Health.
In 1953 Fieve married Katia von Saxe, a novelist who writes under the name Jane Huxley. She and his daughter Vanessa survive him, as do another daughter, Lara Fieve-Portela, and four grandchildren. He had homes in Manhattan and Southampton, New York, as well as Palm Beach, Florida.