torsdag, 28-10-2021

Edward Shorter’s comment

Barry Blackwell’s Review of Johan Schioldann: History of the Introduction of Lithium into Medicine and Psychiatry:  Birth of Modern Psychopharmacology 1949

 

            First of all, both the Schioldann book and the Blackwell review are triumphs: Schioldann's as a product of North European Sitzfleisch, or library grubbing; Blackwell's as a triumph of thoughtful and learned synthesis.  The Blackwell essay has really everything you might want to know about the lithium story unless you yourself were full of Sitzfleisch (in which event you'd go to the library and dig it out of the primary sources, as Schioldann did).

            Very little troubled me about either triumph.  Both deserve to accelerate the re-uptake of lithium in psychopharmacology.  Younger psychiatrists now often prefer the commercial "mood stabilizers" to lithium, which they don't really understand; they find monitoring it bothersome and prefer industry's own, costlier remedies for "stabilizing mood" in bipolar disorder, which has now spread virally and is a new form of pest in psychiatry.  So, bravo Schioldann and Blackwell:  stop the slippage!  Restore lithium!

            That said, one thing bothered me about the Blackwell piece, and it is the insinuation that credit for scientific achievements in these more peripheral lands, such as Denmark and Australia, must inevitably reflect the lust for "national heroes," rather than well-deserved recognition for genuine scientific accomplishment.  This kind of disparagement has become a common motif today in history of science, searching for the dirty underbelly in the confident belief that it exists, rather than telling the story straight up -- in a reflective way to be sure -- but nonetheless:  here was a real revolution and this is how it happened.  If I were to write a doctoral dissertation today in a History of Science unit, guaranteed it would be turned back for not having enough on women, capitalism or alternative sexualities.

            So, some would treat Cade's historic reputation as really just a bit jumped up by nationalistic fervor.  But two can play at this game.  Let us regard many psychoactive compounds on the market today as more than a bit jumped up by commercial imperatives.  Historians of science really don't write about this very much, because they can't deal with it, but they can cast supercilious aspersions upon figures such as Cade because, after all, those Australians really need a hero of some kind, don't they?  (It is actually unclear why Mogens Schou, who was Danish, would fulfill issues of a nationalistic nature in Norway. p 27)

            In assessing Cade, the big question is, to what extent was he responsible for the "revolution" in psychopharmacology that took off in the 1950s?  Schioldann makes him into a master figure.  But it is no diminution of Cade's stature to note that his 1949 article really gave rise to very little.  It was Schou's work in 1954 that gave lithium its push-off.  (And neither writer makes note of the shameful attack of the big domes at the Maudsley, such as Michael Shepherd, upon Schou.)  But what really launched psychopharmacology was not lithium at all.  It was chlorpromazine (1952).  So, as long as we're rehabilitating people, let's rehabilitate Jean Delay, one of the brilliant minds of 20th century psychiatry.

 

October 19, 2017