Samuel Gershon’s comment on Edward Shorter’s comment

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

            I would like to discuss your point about tilting the emphasis that finally comes with a historical event or story. The word “discovery” in scientific stories is loaded. With lithium, if we look at time lines, we have the Carl and Frederik Lange and William Hammond presenting clinical usage of lithium in the mid to late 1800s. The Langes’ work in Denmark followed Hammond (1871), a Professor of Psychiatry at New York’s Bellevue Hospital, where he treated patients, taught and wrote a textbook and papers on its use in Mania.

            There are a few things I would like to note: 1) Hammond only wrote of the clinical use of lithium in mania and not depression; 2) he made very important comments about the dosage schedule which were never mentioned again until our paper in Australia in 1955 - also on national attribution - I never heard of his work until years after I had published on lithium so, we could be accused of claiming Australian national importance, but this fact is very clear - Hammond’s work in NY was a new and major discovery; 3) it is  important that Hammond never mentioned lithium toxicity as a problem; and 4) also odd: did he encounter toxicities and dump the issue?  So, no one seemed to want to propose Hammond as a possible founder for the use of lithium anywhere in the world until we published a paper reporting his operational findings years later.

            Now, the Langes: Carl Lange was world famous for his work in psychology; his brother, Frederik, was the lead in introducing the concept of recurrent depression and followed this with his use of lithium to treat the depression and to implicate that its use should be continued to prevent recurrent Depression.  Thus, it is possible that the Danes could present THEMSELVES as discoverers of lithium usage in psychiatry.

            Another historical event intervened by chance: a major psychiatric congress where the Langes presented their recurrent depression findings - clinical issues, NO lithium story. At that meeting Kraepelin, supported by another German psychiatrist, Berios, presented a strong critique of their clinical concept of recurrent depression - no mention of Lithium. Kraepelin was famous, thus, a sort of nationalist split became apparent. How this affected psychiatric affairs I do not know, but I can understand why Schioldann may wish to present a strong case for the Langes.

            Another question: why did Hammond suddenly stop using lithium and never mention it again? My suspicion is (no facts on this) that his very rationally proposed dosage schedule could easily reach toxicity. Also, Hammond focused on lithium in treating his manic patients and while he must have seen some with depressive episodes, he says nothing about them. The same question can be asked of the Langes: why, after they successfully treated recurrent depression, but say nothing about mania, which they must have seen in their recurrent depressives, they don’t mention lithium again.

            Lithium again appears in an article by C. A. Good (1903) on lithium toxicity, a very thorough pharmacological study which was a warning to users of lithium. Now, who gets the cigar for the discovery of Lithium? 

            Berios raises the question of “biases,” “tilts,” pressures and nationalistic efforts to give dominant credit to one country, e.g., Denmark, the US or Australia, rather than another. I believe Shorter knows better than most. The stories developed over 100 years can sway interpretations on credit in many ways. I personally have seen in several different countries presenting their pre-eminence being affected by politics, involving direct political steps; by religion, which we have all seen over the centuries; and scientific conflicts justifying the importance of one aspect of a discovery over another.  Blackwell and Shorter both mention the possibility of a country presenting their person as a national hero. 

            So this, in my opinion, is also the story with lithium: there are facts and each candidate should also have an accompanying review of their other scientific work to see how it fits with the main claim being proposed. 

References

Good, Clarence A. An experimental study of Lithium. Amer. Journ. of the Medical Sciences, February, 1903.

Hammond WA. A Treatise on Diseases of the Nervous System. New York: Appleton; 1871.

February 8, 2018