Barry Blackwell’s Reply to Johan Schioldann’s comment
Barry Blackwell’s Review
The History of the Introduction of Lithium into Medicine and Psychiatry
Birth of Modern Psychopharmacology 1949
Professor Schioldann has used the weight of his incomparable and admirable knowledge of lithium to scold me by challenging the validity of the opinions I express about John Cade’s discovery of lithium and its significance. These rest largely on concerns about the validity of the historiographic method. There are well established doubts about the wisdom and veracity of combining this kind of approach with biography which poses a fundamental conflict of interest between the neutral zone of history and the bias inherent when a historian is assessing the merits and flaws of a fellow national. A fellow historian notes, “No individual is free from the social environment in which they live” (Carr 2001). That concern is more vividly promoted by the opinion that “Historians are to nationalism what poppy growers in Pakistan are to heroin addicts. We provide the potential raw material to the market” (Hobsbawn 1992). This metaphor is satirically validated by Johan’s fellow Australian castigating him for “cutting down one of our tall poppies.”
In the forward to Schioldann’s book Berrios, an international leader in psychiatric epistemology, gently warns the reader that myth making is an intrinsic risk of historiography, an opinion he softens by implying it is inevitable and therefore to be expected and accepted – a viewpoint I am challenging here.
The main difference between us is the domain of epistemology. Weighed down by the mass of his own knowledge of lithium and by natural cultural empathy Johan has a positive view of what Cade might, could or should have known in making his discovery based on slender assumptions the most significant of which is that because a body of knowledge exists an individual, often decades later, must have an awareness of it. This is a flaw in the historiographic method. (Blackwell 2014).
This is perfectly illustrated in the third paragraph of Johan’s riposte when he lists 51 references by 22 international authors whose work on lithium he states were “of special interest” to Cade. This allows the favorite son to bask in the light shed by predecessors of whom Cade was manifestly unaware. Schioldann’s references list only four papers by Cade. The first, in 1949, describes Cade’s original work but does not invoke the history of lithium. The other three references written in 1967, 1970 and 1978, come two to three decades after the original paper during which time Cade had established a close friendship with Schou who doubtless made Cade better informed.
My Maudsley training, at the feet of Aubrey Lewis, imbued me with an exacting and critical standard for divining the truth. This got me into trouble in 1968 when Shepherd and I called lithium prophylaxis “a myth,” an error I subsequently retracted on the grounds I was wrong but for the right reasons. Everyday clinical use was compelling but the scientific method chosen to prove it was faulty. The same might be said for Cade’s discovery resting as it did on a handful of uncontrolled case studies – but they were compelling. (Blackwell 2017).
To further debate the Cade issue would repeat the Schou controversy, stirring up similar ad hominem allegations I prefer to avoid. Perhaps an impartial judgement will come from an American psychiatrist who is in the final stages of writing a third Cade biography.
I also stand firm on the issue of historical significance. It is absurd to attribute the birth of modern psychopharmacology to a single discovery. In addition Cade’s discovery was relatively trivial resting on a rare condition (acute manic psychosis) and of questionable safety without plasma monitoring, which Cade dismissed as unnecessary. It was also a disorder for which other treatments soon appeared; America managed without lithium, banned by the FDA, until 1970.
Cade and Lithium’s significance were wildly inflated 20 years later by Schou’s discovery of prophylaxis and the credit he awarded Cade over and above his own ancestors. By that time (1968) almost all the modern discoveries had been made by scientists and psychopharmacologists of equal or greater clinical and academic stature. (Ayd and Blackwell 1970).
The evolution of modern psychopharmacology in the mid-20th Century can be ascribed to the composite contributions of more than a single person however significant their individual discovery might be.
Ayd FA, Blackwell B. (Eds). Discoveries in Biological Psychiatry.Philadelphia; Lippincott, 1970.
Blackwell B. Adumbration: A History Lesson on INHN in Controversies, 12.18. 2014.
Blackwell B. Reply to Ned Shorter’s comment on Blackwell’s The Baby and the Bathwater on INHN.org in Controversies, 12.7. 2017.
Carr in Windshuttle, K (ed) The Real Stuff of History.Sydney Line. 2001; 8-13.
Hobsbawn EJ, Ethnicity and Nationalism in Europe Today; Anthropology Today 1992; 8 (1), 3-8.
April 12, 2018