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Monday, 01.03.2021

Mogens Schou: My journey with lithium
Written on the invitation of Johan Schioldann

Walter Brown’s comments

 

          This is an important document. In 2000 Johan  Schioldann invited Mogens Schou to write an autobiographical sketch for inclusion in Schioldann’s book, “History of the Introduction of Lithium into Medicine and Psychiatry” (Schioldann 2009). Schou updated it until May  2005 just a few months before he died.  Schioldann’s book was  published in 2009 and the sketch, “My journey with lithium,” appeared in it as an  appendix.  That appendix is reviewed here.

           Schou provided a Danish version of this memoir  to the Danish medical journal Bibliotek for Laeger (Library for Doctors). It appeared  in the September 2005 issue in connection with that issue’s celebration of  Schou’s 50 years with lithium. Schou died on September 29, 2005,  at age 86. As far as I can tell, “My journey with lithium”  is Schou’s last published description of his life’s work. (Though not his last published paper; he was the first author on three book chapters published in 2006 and coauthor on one published in 2011).

          Much of what this memoir covers is familiar ground. Schou’s  earlier recollections of his life and work, along with published interviews, obituaries and histories of lithium therapy, including essays and comments on this website, amply record Schou’s family background, medical education, sources of inspiration, early and later lithium studies and his often uphill battle to get lithium treatment accepted. What distinguishes this autobiographical note from other accounts is the personal  50-year perspective; we get here a singular look at the experiences, research and otherwise, that inspired and sustained Schou over many years and the matters which remained most important to him.

          Schou is open here, as he was throughout his life, about the presence of manic-depressive illness in his family. He often mentioned, as he does here, that his younger brother had suffered severe recurrent depressions for 25 years and that they came to a halt with lithium treatment. His brother’s excellent response to lithium preceded the studies by Schou and others that proved lithium’s prophylactic value.

          To Barry Blackwell and Michael Shepherd of the Maudsley - and some others - Schou’s experience with his brother biased him in favor of lithium and brought into serious question the validity of his research. Schou, to the contrary, maintained that the presence of this illness in his family provided a constructive spur to his research. His brother’s experience with lithium - along with other anecdotal findings - motivated him to apply scientific methods to pin down lithium’s true clinical effects (Healy 1998). And anyway, as he says here, Schou believed that his personal motives, even his sanity, were beside the point; his research should be judged on the basis of its methods and data.

          The dispute between Schou and the Maudsley crew, and its nasty ad hominem turn, has been discussed on this website. What comes through loud and clear in “My journey with lithium” is that 40 years later (the dispute  began in 1966 at a psychiatric meeting in Gottingen) and many years after Schou’s research had been fully confirmed and he had received innumerable accolades, his  indignation at Shepherd’s disparaging comments ( “believer,”  “enthusiastic advocate”) was undiminished. Schou’s memoir reminds us (if indeed we need reminding) that science is far from a dispassionate search for the truth.  It  is a highly competitive, sometimes rancorous, endeavor.

          Noteworthy in this sketch is Schou’s generosity and diligence in acknowledging the contributions of his colleagues and collaborators. As readers of this website’s posts are well aware, not all lithium researchers were this conscientious when it came to recognizing the contributions of predecessors and contemporaries.

          Schou was a meticulous and innovative scientist; he gave  scrupulous attention to methodological details from measuring serum lithium levels to random assignment and the blindness of ratings. At the same time, as one reads this memoir, his abiding sympathy for those with manic-depressive illness is unmistakable. He and his collaborator, Poul Baastrup, well understood that a placebo-controlled study was required to definitively prove lithium’s prophylactic value.  But, as Schou recounts here,  they were deeply concerned about the risks and consequences of relapse when people who had done well with lithium were required to stop it.  And the humanitarian concerns that were behind their reluctance to conduct a controlled study were not, as Shepherd implied, a trivial matter. Schou’s compassion for people who suffered with manic depressive illness was heartfelt - and lifelong.  Upon receiving one of many awards he said: “For me every single patient whose life was changed radically by lithium outweighs honors and awards. I trust that you understand and agree. . .” (Grof 2006). Ultimately, Baastrup and Schou came up with a design that minimized the risks and they did the controlled study.       

          Schou tells us here that he retired in 1988. Some retirement! He continued to do research on lithium and write papers,  book chapters and reviews. Just a few days before he died he attended an IGSLI meeting in Poland where he proposed a new study in “hidden bipolars.” Back home he collapsed while he was working on a manuscript and  succumbed to pneumonia a few hours later.

 

References:

Grof, P.  Mogens Schou (1918-2005): Obituary. Neuropsyhopharmacology 2006; 31: 891-2.

Healy, D. The Psychopharmacologists. Vol 2, London: Chapman and Hall; 1998.

Schioldann, J. History of the Introduction of Lithium into Medicine and Psychiatry: Birth of Modern Psychopharmacology 1949. Adelaide: Adelaide Academic Press; 2009.

 

April 11, 2019