The smartest person in the room: Donald F. Klein, M.D. (1928–2019)

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Donald Klein, MD, who played a transformative role in psychiatry’s evolution as a scientific discipline and longstanding member of the ACNP died August 8, 2019. At the time of his death, he was Emeritus Professor of Psychiatry at the Columbia University Vagelos College of Physicians and Surgeons and the New York State Psychiatric Institute and Research Professor at New York University Langone Medical Center.

Don entered the field of psychiatry when its theoretical orientation and mode of clinical practice were dominated by psychoanalytic theory. In an interview by John Davis for the ACNP History Project 12/12/07 Don said of the experience, “From 1957 through 1961 I was a candidate at the New York Psychoanalytic Institute and under the delusion that one could be a research psychoanalyst. I quit more than a little disappointed with what happened”.

This ostensible setback in his career proved fortuitous for the future of psychiatry as he joined a cadre of iconoclastic figures (including Jonathan Cole, Frank Ayd, Heinz Lehman, Joel Elkes, Bernard Brodie, Gerry Klerman, and Nathan Kline), who pioneered the discipline of psychopharmacology and in the process formed the American College of Neuropsychopharmacology(ACNP).

Beginning in the 1960s for over 3 decades Don was a vital intellectual force that galvanized the field of clinical psychiatry. His prodigious research in anxiety, mood, and psychotic disorders in collaboration with his late colleagues Fred Quitkin and Arthur Rifkin, and veritable “who’s who” of proteges (including Abby Fyer, Jack Gorman, John Kane, Mike Liebowitz, Pat McGrath, Ned Nunes, Danny Pine, Judith Rabkin, and Jonathan Stewart) conceived innovative scientific theories, emphasized methodological rigor, and reshaped clinical practice. He developed the concept of pharmacologic dissection of mental disorders using treatment response to distinguish subgroups within a diagnostic category, redefined the anxiety disorders and introduced the model of diagnostic specialty clinics. In addition to his research, Don was a gifted clinician widely known for his diagnostic acumen and innovative treatment approaches.

Donald Klein was born in 1928 in New York City, attended Bronx High School of Science, graduated magna cum laude from Colby College and received an MD from the SUNY College of Medicine (Downstate). In 1952 he entered the US Public Health Service where he was put in charge of a psychotic disorders unit in Lexington Kentucky filled with patients who had been “hospitalized forever”. In his ACNP interview Don recalled, “Although the patients had received excellent rehabilitation and nursing care most patients were mute, incomprehensible or grossly paranoid. I gave them all chlorpromazine. After 6 weeks, one patient said, “Hey Doc, when am I getting out of here”? It was the first time he had said anything in 30 years”.

After his government service, Don completed psychiatric residency at Creedmoor Psychiatric Center then in 1959 took a position at Hillside Hospital working under Max Fink where he embarked on his ground-breaking research career. In 1969, he co-authored with John Davis the first clinical psychopharmacology textbook, Diagnosis and Drug Treatment of Psychiatric Disorders. In 1976 Don was recruited by Ed Sachar to Columbia University and the New York State Psychiatric Institute as Director of Research and Chief of the Division of Therapeutics, where he oversaw the establishment of specialized programs for the study of depression and anxiety disorders and pursued studies of their pathophysiology and treatment.

Don served in many leadership positions including as president and council member of the ACNP, president of the American Psychopathological Association (APPA), scientific advisor to the Alcohol, Drug Abuse, and Mental Health Administration (ADAMHA), and was a consultant to the Federal Drug Administration (FDA) Psychopharmacology Advisory Board.

Throughout his career, he was a prolific writer and commentator on scientific and clinical topics in psychiatry, always with intelligence, candor and wit. While testifying before congress about contemporary psychiatric treatment he described psychotherapy as “rent a friend”. On another occasion during a debate with a prominent psychoanalyst who he had backed into a rhetorical corner, his desperate opponent accused Don of having had a “failed psychoanalysis”. Without missing a beat, Don agreed with him, then added that his personality was not the reason for its failure, it was the lack of efficacy of the therapy.

He was also a fearless activist on issues in which he believed. Following his tenure as ACNP President he became concerned about the predominance of basic neuroscience in the Annual Meeting program. In response he founded the American Society of Clinical Psychopharmacology to promote clinically relevant psychiatric research.

Despite his candor and frankness, Don embodied several paradoxes. While not suffering fools gladly, he was a caring and engaged mentor as evidenced by the time and interest he devoted to teaching and reviewing the papers and grants of not just his mentees but also colleagues from other institutions who sought his advice. He was notorious for returning his trainees draft manuscripts laden with revisions and comments, which were simultaneously critical and helpful to the young authors. Don was supremely confident, but at the same time generous ceding the spotlight of first authorship, leadership on grants and presenter spots on panels to colleagues and subordinates.

It is ironic that Don’s legacy may best be described by an excerpt from the W.H. Auden poem In Memory of Sigmund Freud: “to us he is no more a person now, but a whole climate of opinion”. It is with profound sadness, fond memories and deep respect that we mourn the loss of our friend and colleague and extend our collective sympathies to his wife, the distinguished child psychologist, Rachel Klein, his four daughters, and seven grandchildren.

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Correspondence to Jeffrey A. Lieberman.

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Lieberman, J.A., Fyer, A. The smartest person in the room: Donald F. Klein, M.D. (1928–2019). Neuropsychopharmacol. 44, 2296–2297 (2019) doi:10.1038/s41386-019-0525-2

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