Thursday, 23.03.2017

Reply to Gershon by Blackwell

A response to Sam Gershon’s comment.

By Barry Blackwell


Sam Gershon’s comments on the Lithium controversy provide little known facts about his own early contributions. These cast light on an important aspect of the discovery process relative to Cade’s and Gershon’s roles.

To help clarify the issues the following is a brief synopsis of the substance of Sam’s comments relative to the discovery of lithium’s efficacy in mania.  A fellow Australian to Cade, Gershon graduated from medical school in Sydney in 1951 and then spent three months as a psychiatry intern during which he was allowed to treat several manic patients with lithium. Enthused by this new discovery he began a psychiatric residency at the Royal Park Hospital where Cade was the Medical Superintendent only to discover that, following three reported deaths, Cade had made a public decision that lithium was unsafe for clinical use. Disappointed by these events Sam consulted with Professor Wright, Chairman of Physiology at the University who introduced him to Trautner, then engaged in his seminal work on developing a way to measure lithium levels in humans, eventually ensuring its safety. Wright provided help securing laboratory and technical support at a time when “Nothing was easy when you had the whole psychiatric establishment against you.” Trautner and Gershon, first mentor and pupil then friends, published two papers on the outcome of their research (Gershon & Trautner, 1954; Trautner, Morris, Noack & Gershon, 1955).

Fast forward to 1970, when Frank Ayd and I planned and convened a conference in Baltimore to honor the original discoveries and the scientists who made them at the beginning of the psychopharmacology revolution. These verbatim first person accounts were published the same year in a book we edited, “Discoveries in Biological Psychiatry.”

Included is Cade’s chapter, “The Story of Lithium.” In it he provides a detailed account of the lithium ion’s historical role in medicine culminating in its withdrawal in 1949 following deaths due to its use as a salt substitute in congestive cardiac failure. His account goes on to state, “One can hardly imagine a less propitious year in which to attempt the pharmacological rehabilitation of lithium. That the attempt was made by an unknown psychiatrist, working alone in a small chronic hospital with no research training, primitive techniques and negligible equipment was hardly likely to be persuasive especially in the United States. And so it turned out. It is a source of singular satisfaction to me that after the lapse of years the therapeutic and theoretical importance of lithium has at last been recognized. The person who has done most to achieve this recognition by validating and extending my original observations is Mogens Schou in Denmark.”

Nowhere in this twelve page chapter does Cade mention the hiatus he imposed on lithium usage, when it commenced or when and why it was lifted. His paper is supported by only five references, two to his own work (Cade, 1949 & Cade 1964). The remaining three references are all historical, dating between 1907 and 1927. There is no mention and no references to the work of Trautner and Gershon. The unreferenced recognition of Schou’s contribution is accomplished without detracting from his own.

In designing the Baltimore conference Frank and I contributed its bookends. I opened the proceedings with a scholarly review of the “Process of Discovery” supported by 108 references and using the MAOI-tyramine story as a backdrop. Frank concluded the conference with a masterful 14 page chapter on “The Impact of Biological Psychiatry.”

Oddly enough, although lithium was the first of the new generation of drugs Cade’s paper was the last to be presented, preceding Frank’s essay. So Cade had considerable time to consider and weigh the following verbatim statements from “The Process of Discovery” much of which was derived from Robert Merton’s career long study of scientists and their behaviors in the discovery process.

The section in that essay on The Discoverers” (pp.17-18) discusses the literature on the personality traits that impact on the discovery process. It concludes with the following … “Unfortunately it is this type of dominant personality and driving lifestyle that also results in what Merton named “The Matthew Effect” after a verse in the Gospel: “For unto everyone that hath shall be given, and he shall have abundance.” (Merton 1968).

A subsequent section “Priority and Cryptomnesia in Discovery” (pp 19-21) elaborates further … “The ambivalence created by the dilemma of claiming priority and remaining modest is considerable.” Merton provides an example concerning Freud and his early work on cocaine. (Merton 1963). Merton challenges Ernest Jones’ erroneous claim that “Freud was never interested in questions of priority” by identifying 150 examples from Freud’s own work including a dream which Freud interprets as an expression of regret that he lost priority in the discovery of cocaine by postponing experiments in order to visit his fiancé.  Recent examples in psychopharmacology of overlooking the work of junior scientists are cited in an essay on adumbration – a term coined by Merton (Blackwell 2015).

Cryptomnesia, a term also coined by Merton (Merton, 1957), describes unconscious plagiary associated with ‘selective forgetting’. Darwin noted this tendency and made a point of always recording negative events as he forgot them more readily. (Beveridge, 1957). Cade was 37 when he published his first paper on lithium (Cade, 1949) and 58 when he presented his paper in Baltimore (Cade 1970). While 21 years had elapsed between the two events, Cade’s memory appeared intact.

But the literature on scientific discovery also suggests that personality may play a larger part than faulty memory in assertive and selective claims for priority. Charles Darwin also noted, “My love of natural science has been much aided by my ambition to be esteemed by my fellow naturalists.” (Merton, 1957). Speaking of himself Hans Selye made an even bolder claim, “All the scientists I know sufficiently well to judge (and I include myself in that group) are extremely anxious to have their work recognized and approved by others. Is it not below the dignity of an objective scientific mind to permit such a distortion of his true motives? Besides what is there to be ashamed of?” (Selye 1956). If alive and challenged today who knows what Cade might say or how generous he would be concerning Sam Gershon’s important and newly revealed contributions.


Ayd FJJr. The impact of biological psychiatry. In: Ayd FJ, Blackwell B, eds. Discoveries in Biological Psychiatry. Philadelphia: J.B. Lippincott Company; 1970, pp. 230-43.

Ayd FJJr. Blackwell B, eds. Discoveries in Biological Psychiatry. Philadelphia: J.B. Lippincott Company; 1970.

Blackwell B. The process of discovery.  In: Ayd FJ, Blackwell B, eds. Discoveries in Biological Psychiatry. Philadelphia: J.B. Lippincott Company; 1970, pp. 11-29.

Blackwell B. Adumbration: A History Lesson. INHN Controversies, 28. 01. 2015.

Beveridge WIB. The Art of Scientific Investigation. New York: Norton; 1957.

Cade JFJ. Lithium salts in the treatment of psychotic excitement. Med J Aust 1949; 2:  349-52.

Cade JFJ. A significant effect elevation of plasma magnesium levels in schizophrenia and depressive states. Med J Aust 1964; 1: 195-7.

Cade JFJ. The Story of Lithium. In: Ayd FJ, Blackwell B, eds. Discoveries in Biological Psychiatry. Philadelphia: J.B. Lippincott Company; 1970, pp. 218-29.

Gershon S. Comment on Lithium Controversy INHN Controversies 02. 12. 201.

Gershon S, Trautner EM. The Treatment of shock-dependency by pharmacological agents. J Med Aust 1956; 43(2): 783- 7.

Merton RK. Priorities in scientific discovery: a chapter in the sociology of science, Amer Sociol Rev 1957; 22:635-9.

Merton RK. Resistance to the systematic study of multiple discoveries in science. Europ J Sociol 1963; 4: 237- 82.

Merton RK. The Matthew effect in science. Science 1968; 159: 56-63

Selye H. The Stress of Life, New York: McGraw-Hill; 1956.

Trautner EM, Morris R, Noack CH, Gershon S. The excretion and retention of ingested lithium and its effects on the ionic balance in man. Med J Aust 1955; 35(2); 282-91.


Barry Blackwell
February 19, 2015