Barry Blackwell’s reply to 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
I am grateful for Ned’s kind words about my review, but both Ned and Sam Gershon (in a personal communication) have raised the serious issue of the degree to which a scientist’s accomplishments might be colored by national pride and the way a reviewer’s critical comments can arouse ire. Ned states: “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 … here was a real revolution and this is how it happened.”
In the Preface to Schioldann’s mammoth volume, German Berrios, Chair of Epistemology in Psychiatry at the University of Cambridge, England, comments on how questions about priority in discovery often raise issues of a nationalistic nature: “The Lange brothers and Schou in Denmark fulfill the same social function as Cade does in Australia. All that a good historian can (and should) do is try and understand why it is important for countries to have heroes, and why some official stories, however mythological they may be, cannot be changed or replaced.”
Before starting my review, I challenge this tactful, tongue-in-cheek statement by noting that the “historiographic” model on which it is based makes the flawed assumption that the existence of a massive volume of historical work on lithium (Part 1) inevitably implied that Cade knew of its existence and that this therefore marked the “Birth of Modern Psychopharmacology” (Part 2).
After an exhaustive review of every detail of Cade’s discovery as described by Schioldann, I provide my own comments on the issues raised. The final one is titled “National Heroes.” After complimenting the extensive historical review of lithium therapy worldwide (Part 1) I comment on Cade, his discovery and its significance to the evolution of psychopharmacology (Part 2).
This includes the significance of the historical Zeitgeist in the post-World War II era which set the stage for myth building and the manner in which Cade’s Hero status is created, preserved and protected.
In the final paragraph I reflect on how my earlier experience of critiquing Schou’s study announcing the discovery of prophylaxis acquainted me with “an unfortunate side effect of commenting on a Hero status in anything less than affirmative terms which may be perceived as an ad hominem attack on their persona or integrity. I plead with the reader’s indulgence to avoid such an attribution and accept my assurance that Cade and Schou, Trautner and Gershon each deserve a place in any lithium pantheon of pioneers; but as colleagues and peers, diverse and without preferred status.”
My earlier review of another book on the topic of Cade (Blackwell, 2017) ends with an imagined mythological idiom that directly confronts the issue of awarding relative credit among individuals involved in the discovery of lithium and its use in the treatment of psychiatric disorders. It is presented in full below (Blackwell 2017).
Themis and Hippocrates
Let us imagine that Themis, Greek Goddess of Justice, blindfolded and holding her scales, and Hippocrates, Father of Medicine, have met to assign credit to the humans who discovered how lithium, one of earth’s three primeval ions might mitigate human suffering.
Themis and Hippocrates, seated on thrones, after diligently studying the evidence, deliver their verdict to a waiting world:
“First, we determine the Australians take precedence over Denmark. Evidence suggests that Schou was inspired by Cade, not by his own ancestors, although he deserves credit for prophylaxis, a far broader and significant indication. (If only the British would not disparage it and the Americans would give it full credit and demonstrate its superiority to more expensive ‘mood stabilizers’).
“Among the Australians, Cade, Trautner and Gershon we yield to the principle and precedent of “first do no harm.” Cade troubles us for two reasons. He never gave credit to Gershon and Trautner for reasons buried in his psyche, but more seriously, he concealed the deaths due to toxicity, including his first patient. Evidence suggests he ‘dropped lithium like a hot potato’ when its toxicity threatened his reputation and only picked it up again when its safety was assured and its indications expanded.
“Between Gershon and Trautman our choice is hard. Trautner was the true innovator but left before the story was fully told. Gershon on the other hand became a persistent, lifelong advocate for lithium in America and certainly deserves equal or greater credit.
“Taking all this into consideration we believe Trautman and Gershon equally deserve credit for the safety and utility of lithium overall while Cade and Schou deserve separate credit for discovering the use of lithium in acute mania and prophylaxis in recurrent mania and bipolar disorder.”
Having delivered their verdict, the judges relinquished their thrones, turned towards Mount Olympus and headed for home. Themis removed her blindfold and glanced towards Hippocrates who was clearly distressed. Enquiring for the cause he reveals a preference for Schou over Cade because he believes the Scandinavian to be a superior scientist and better man.
The two pause to consider this turn of events. Themis reminds Hippocrates that, in matters of science, justice is blind to issues of creed, culture and character. The verdict is just and must stand. Hippocrates concedes without demur and the couple resume their journey. Themis places a consoling hand on Hippocrates shoulder as they slowly disappear into the clouds that shroud Mount Olympus.
Ned may not have seen this mythological analysis of the hero myth. Does it read like “insidious disparagement” searching for the “dirty underbelly” or a carefully considered assessment of the kind academia and the reader is entitled to expect?
Blackwell B., Review of Gregory de Moore and Ann Westmore; Finding Sanity: John Cade, Lithium and the Taming of Bipolar Disorder. Sydney/Auckland/Melbourne/London: Allen & Unwin; 2016 on INHN.org in Controversies. 02.02.2017.
April 5, 2018