Barry Blackwell: Lithium Controversy
Barry Blackwell’s response to Hector Warnes’s response

Hector and I are in substantial agreement with the exception of only three issues.

In response to my assertion I was not contrasting the integrity of Mogens Schou with that of Linus Pauling, Hector fails to acknowledge the important scientific point I was making. As a rebuttal he contrasts the errors made by Pauling concerning Orthomolecular Medicine with the accurate conclusions made by Schou with regard to lithium. This overlooks the obvious fact that Pauling got a lot of things right in winning two Nobel Awards. But this is irrelevant. Science is not a zero-sum game. So to restate my point: in assessing the accuracy of any scientist’s piece of work we can never take into account that scientist’s reputation but must rely only on the integrity of the results and the methodology used to evaluate them. This is the whole reason for double blind methodology; to subtract the influence of persona in judging validity. Unfortunately this is often mistakenly perceived as an ad hominin attack on the integrity of the scientist rather than the results.

The second issue has to do with the role of imipramine in the treatment of depression. Hector accuses me of a “peremptory statement” alleging that lithium does not benefit depression. This subverts a nuanced comment about the observed effect of lithium in reducing suicide in bipolar disorder for which I offered a different interpretation of that outcome. During a manic episode accompanied by lack of insight the patient often perpetrates demeaning and shameful acts, awareness of which may trigger self-destructive impulses, often successfully implemented with manic vigor. Administered lithium a return to euthymia and self-awareness induces a more realistic and optimistic frame of reference with diminution of suicidal impulses. Is this outcome attributable to an 'anti-manic’ or an ‘anti-depressant’ action of lithium?  In the absence of adequate and detailed research I propose the former is more likely than the latter. However, this does not mean lithium has nothing to offer in recurrent unipolar depressive disorder especially when there may be covert or subliminal hypomanic tendencies, the evidence for which I cited.

The final issue is semantic and perhaps picayune. The OED defines agnosia as “inability to interpret sensations and hence to recognize things, typically as a result of brain damage,” Its origin is early 20^th Century; coined in German from Greek: agnosia: ignorance. There is no such word as anosognosia in the OED, nor does my spell check approve of it. I submit that although the OED confines its definition to ignorance or inability to interpret symptoms it could equally accommodate behaviors without the need to invent a new and longer word. Perhaps this dispute could be settled by INHN seeking historical and semantic advice about the origins and credibility of this newer and longer word for the Dictionary program of our website? 

Barry Blackwell
December 3, 2015