ARTICLES BY OR ABOUT GERALD D. KLEE
An Early Experiment With Managed Care Within a few short years, managed care, in one form or another, has altered the practice of medicine in the United States in alarming ways. As doctors and patients are swept up in these changes, many look back nostalgically to the Golden Days of medical practice, when managed care was unknown. If historians ever study the matter they may find, however, that there were early precursors to managed care, going back at least for decades.
Listening to Patients Maryland Psychiatric History: Psychiatrists used to listen to patients. HMOs and other forms of managed care seldom allow them much time for that any more. A 1965 study done by Klee and Warthen showed that most patients seeing psychiatrists in private practice in Maryland were receiving psychotherapy, regardless of whether they were being treated with psychotropic drugs. Today, patients get more drugs and less psychotherapy. What is being lost when the psychiatrist doesn't listen?
OF SLUGS AND FLIES AND THE NOBEL PRIZE One morning at breakfast, while cutting into a juicy honeydew melon I noticed a tiny fruit fly (Drosophila) landing on the melon. Before I had time to brush it away, my hand was stayed by the thought of what a miracle it is that a creature 1/8th of an inch in length is equipped with complex body structures, including a brain of 250,000 neurons (compared to our 100 billion or so) that is capable of behaviors similar to our own, including learning and memory. It is even more amazing that the molecular mechanisms involved in encoding memories are like those in other species, including humans and sea slugs. This makes it a useful and highly popular experimental animal for neuroscientists. The fruit fly and a sea slug, Aplyisia, are among the humble creatures whose chemistry and physiology helped Nobel Prize winners unlock secrets of how the human brain works.
Solomon Snyder Wins Prestigious Medal of Science
Lysergic Acid Diethylamide (LSD-25) and Ego Functions; Archives of General Psychiatry, May 1963
Molecules and Memory -- The Coming Epidemic of Alzheimer's and other Dementias Neurobiologists are creating new classes of memory enhancing drugs that may help. The “decade of the brain” did not end with the 1990’s. Brain sciences continue to advance exponentially. Enormous breakthroughs have been made in understanding the molecular and physiological basis for memory.
Riots and Mental Illness During the Baltimore riots of 1968 there were significant changes in psychiatric admissions to mental hospitals, as described in this report. Other civil emergencies may occur in the future. How well prepared will the psychiatric system be to deal with them?
Neural Nets, Chaos and Psychotherapy The 19th century psychologist William James turns out to have been right about the indeterminate and unforeseeable nature of brain activity. Modern research shows that the "chaos" and complexity of brain activity reinforces novelty and creativity. The recognition of these features of brain activity has major implications for clinical neuroscience including the learning mechanisms involved in psychotherapy.
Super Snoopers Your privacy may be endangered. Who is reading your medical record without your permission?
What Ever Happened to Orgone Therapy? Also called orgasm therapy and vegetotherapy by its originator Wilhelm Reich, this controversial therapy is still around and is far more popular than you may think. Although Reich died in a federal prison, his movement flourishes as a form of alternative medicine. Its practitioners, including some mental health professionals, promote it as a form of treatment for mental and physical disorders.
A Half Century of Change in Psychiatry In the spring of 1952 I attended the 50th Anniversary celebration of my Harvard Medical School Class graduation. My generation grew up in a badly battered world. We hoped to leave it in better condition than we found it. The comments in this article summarize some of my views about how psychiatry evolved into its present state. Despite many great scientific advances, the quality of care psychiatric patients receive is often disappointing. Details are discussed.
Prison Riot; Baptism Under Fire; The scene is at around midnight at The Medical Center for Federal Prisoners. I am a young US Public Health Service Doctor on night duty and get an emergency call to help deal with a riot on Cell block 3, which houses the most dangerous inmates.
Miscellaneous Articles
Special Delivery A Jewish woman from Europe who had lost her legs in a bombing during WWII came to the US in 1952 to obtain prostheses (artificial legs). She was detained at Ellis Island because she was found to be pregnant and she didn't have an immigration visa. Before she could be sent back home she went into labor. As a medical intern I had the exciting job of delivering her baby under very unusual conditions This story describes the adventure.
The Best Medicine, Sometimes a good dog can accomplish more than a psychiatrist.
The Single Layer System This is a story about what will happen if the Government takes complete control of medical care.
Tea Time With Einstein I had a life changing encounter with Albert Einstein when I was a student at Princeton in the summer of 1944! This story describes what happened.
Hippocrates on HMOs I interview the father of medicine and ask for his guidance in dealing with rapacious HMOs.
Gambling With Healthcare Finally Pays Off This is a satire on HMOs and other forms of managed care. It was originally published in the Maryland Medical Journal on April 1, (April Fools Day) 1995 under the title of Healthcare 2001.
Research in Psychotherapy -- A Backward Leap Into the Future, or Chutzpah's Laws
Some Special Articles on Public Health Psychiatry by Gerald D. Klee
The Public Health Nurse in Psychiatric Home Care
How I Got Into Public Health Psychiatry
An Ecological Analysis of Diagnosed Mental Illness in Baltimore
Putting Epidemiology to Work in Community Mental Health Chapter XVI in its original