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Saturday, 08.08.2020

 

Samuel Gershon: Lithium History
Barry Blackwell’s Comment

 

            I thank Sam Gershon for agreeing to enter the debate over the nature of John Cade’s discovery of the effect of lithium on acute manic excitement. Sam is uniquely equipped to perform this service: he began his career as a psychiatrist in Melbourne, trained as a resident under Cade and became a colleague of Trautner before migrating to America to pursue a lifelong interest in lithium and its clinical properties. He extended my own involvement in the controversy over John Cade’s contribution by asking me to review Schioldann’s 2009 magnum opus “History of the Introduction of Lithium into Medicine and Psychiatry.” Both Sam and I commented enthusiastically on Part 1 which related the entire world history of lithium’s medicinal properties from its discovery as a metallic ion until 1949, the year of Cade’s publication.

Sam focuses entirely on Cade’s work going forward and begins by drawing attention to two earlier publications linking dietary factors to the etiology of Schizophrenia and Mongolism. He does not comment or draw any conclusions but on summing up the nature of Cade’s lithium discovery states that it might be considered “serendipitous and deductive.”  This concurs with my own suggestion in reviewing Schioldann’s book that Cade’s cognitive style andresearch modus operandiwas deductive -- it lacked a logical sequence of experiments to test a well-defined hypothesis but was more a cognitive leap akin to Cade’s clinical teaching in the style of Sherlock Holmes. Sam supports this by noting that neither he nor Schioldann could discern a logical sequence to Cade’s studies which Schou was unable to replicate in his own animal experiments. Sam concludes that Cade’s work was not “an authentic original contribution” and makes a final statement: “I must end with significant doubts on how this history has become a legend.”

       The main difference between Sam’s important synthesis and my commentary is that Sam sticks wisely to the scientific facts while I made an intrepid attempt to explain the historical and cultural conundrum to which he refers.

       In doing so I disagreed vehemently with Part 2 of Schioldann’s volume;The Birth of Modern Psychopharmacology,” a designation that inflates national fervor and creates the Cade myth in several ways. First, by invoking an error of the historiographic method that the presence of an impressive body of earlier work would inevitably be known to Cade and might provide logic to his experiments despite the total lack of any corroboration.  Secondly, by concurring with Schou’s adoption of Cade as the progenitor of his own research leading to prophylaxis - a totally different but far more significant clinical indication. In doing so Schou failed to credit the Lange brothers, his own ethnic ancestors. Schioldann does recognize the Lange’s priority, why not Schou? Was he creating his own Scandinavian myth?  Thirdly, Schioldann ascribes an unrealistic and undeserved accolade to Cade’s work as the origin of the biological revolution in psychiatry. At a 1970 conference on “Discoveries in Biological Psychiatry” (Ayd and Blackwell 1970a)John Cade was included as one among 18 pioneers whose work was recognized and awarded, including clinicians Elkes, Deniker, Klein, Kuhn, Lehman, Hoffmann, Ayd and Berger. Frank Ayd concluded with an overview on The Impact of Biological Psychiatry(Ayd and Blackwell 1970b) that singled out no individual contributor. He was a friend and colleague of them all. Finally, Schioldann fails to mention the flaws in Cade’s scientific behavior. His failure to mention Trautner and his colleagues (including Sam Gershon), despite work which made lithium safe but did not deter him from banning the use of lithium at his own hospital for an extended but unexplained time period. Lastly, was Cade’s egregious behavior in concealing the death of his first patient due to lithium toxicity.

       Sadly, one must acknowledge that impugning the credibility of a national mythical figure is a thankless, unpleasant, dangerous and usually ineffective undertaking. Doubtless I shall be disparaged for doing so. But if history is to have a purpose it must convey the truth. Mea Culpa.

References:

Ayd FJ, Blackwell B. Discoveries in Biological Psychiatry. Philadelphia, JB Lippincott; 1970.

Ayd FJ, ibid. The Impact of Biological Psychiatry; pp 230-243.

September 6, 2018