Barry Blackwell’s response to Gregory de Moore and Ann Westmore’s response
Gregory de Moore and Ann Westmore: Finding Sanity: John Cade, Lithium and the taming of Bipolar Disorder. Reviewed by Barry Blackwell
Greg and Ann provide important background on the origins of their sympathetic interest in John Cade at both the cognitive and emotional level. They also solve the puzzle of where Cade probably obtained his supplies of lithium.
However, there remain subtle and significant areas where our opinions differ. Just as chance favors the prepared mind so do extrinsic factors influence the search for truth, especially withan assessment where there is a paucity of contemporary data. Among them are cultural and nationalistic expectations.
That Cade was “largely unappreciated in Australia” at the time of publication is surprising especially as Schioldann’s book on a similar topic was published a few years earlier which assigned a sentinel role to Cade in the evolution of psychopharmacology.
Contrary to that claim I believe Cade’s discovery of the lithium’s effect in the control of acute manic psychosis had a minor impact on a relatively rare disorder, especially after anti-psychotic medications began to appear three years later. Widespread interest was sparked by Schou’s discovery of lithium’s prophylactic effect two decades later and attribution of his own discovery to Cade’s earlier work over that ofpredecessors in Scandinavia including his father and the Lange brothers.
It is true that Cade was scrupulously honest in his private interactions with the coroner investigating the death of his first patient but when other deaths occurred elsewhere soon after, he recommended banning its use and did so in his own hospital. That he was sensitive to the risk of public disapproval is a likely explanation of this difference.
In describing his discovery of lithium for the first time at an award ceremony in America (Cade 1970), there were three things Cade chose not to mention. In providing the case history of his first patient he describes the excellent initial response to lithium. The patient had been ill for so long that he remained well in hospital for two months before discharge but after that he was “soon working happily at his old job.” Six months later he relapsed due to poor compliance but within two weeks of re-admission he was “completely well and ready to return to home and work.” End of story- no mention is made of the patient’s eventual death from lithium toxicity.
Secondly, Cade remained silent about the entire problem of lithium toxicity, failing to mention the work of Trautner and colleagues who had convincingly demonstrated and published on lithium’s safe use at almost the same time Cade banned it in his own hospital and recommended others do likewise.
Third and last he made no mention of the young psychiatric resident under his supervision who, disappointed he could not work with lithium, was taught that a good clinician did not need laboratory tests. Undeterred Sam Gershon completed his own work on lithium with Trautner, migrated to America and became a leading researcher and lifelong proponent of its efficacy.
Cade was the last to speak among more than 20 pioneers who received awards at the symposium (Ayd and Blackwell 1970). Frank Ayd followed with a masterful synopsis of the impact of these discoveries on psychiatric practice. He focused on the role of anti-psychotics in closing the asylums in favor of community care and did not mention lithium. My own talk on the process of discovery was first on the agenda, prelude to the discoveries themselves. Included was the work of Merton and others describing the behavior of scientists including squabbles over priority and selective forgetting (Cryptomnesia).
Kay Jamison’s (1997) failure to mention Cade is hardly surprising. Her presentations were focused on the personal experience of lithium’s effects on her own illness. Cade became better known in America only after his talk at the Taylor Manor Symposium; lithium had been banned in this country by the FDA since the time of his discovery and was available only for experimental protocols.
Metaphors are appealing to me but Cade “opening the door for others to follow” may be an idiom too far. Cade handed the key to Schou who flung the door wide open.
Ayd FA, Blackwell B.(Eds).Discoveries in Biological Psychiatry. Philadelphia; Lippincott, 1970.
Cade F. The Story of Lithium in Discoveries in Biological Psychiatry (Eds Ayd FA, Blackwell B). Philadelphia; Lippincott, 1970; pp. 218-229.
Jamison, K. "An Unquiet Mind" Vintage Books, New York, 1997.
June 14, 2018