Reviewed by Sue Bond
Our understanding of mental illness has improved since the early days of John Cade’s training and practice as a psychiatrist, when the institutions for the mentally ill were often crowded, ill kept, served poor food, and treated their patients as less than human beings. There were few effective treatments and some dangerous ones. When he arrived in 1936 at Beechworth Hospital for the Insane in Victoria as their new medical officer, he shocked the staff by conducting daily ward rounds, speaking with the patients, and actually examining them. Clearly, John Cade was going to be different.
Finding Sanity is a fascinating book for those interested in the treatment of mental illness, especially in Australia, in the last century. It is well written, engaging, offers both a character portrait of Cade and a feel for the social and political tone of his times. The book itself is well designed, with an insert of black and white photographs, a select bibliography and an index. Greg de Moore is a psychiatrist and Ann Westmore a scientist and medical historian.
John Cade came from a medical family of doctors and chemists and his father was a doctor, his mother a nurse. His father was badly scarred by his experience of World War One; Cade himself was a prisoner of war in Changi and saw his best friend murdered. The authors have portrayed not only the horror of the experience of those at war, but the difficulties of those back in Australia as well, detailing how Cade’s wife Jean and their two sons coped. A scene involving the slaughter of a chicken gives the reader a graphic example of the trying times Jean endured, her resilience notwithstanding.
The core of the book describes Cade’s experimentation with chemicals in order to find out what might be deficient in his patients with manic depression, now known as bipolar disorder. The idea for this actually began stirring in his mind during his war years, when he noted the effects of poor nutrition, and how excesses or deficiencies in the smallest of elements could cause ill health in his comrades. He began to wonder if some excess of an unknown chemical could make you manic and a deficiency make you depressed. The descriptions of his trials with lithium on guinea pigs and then on himself are fascinating and awe-inspiring.
The stories of the patients are just as important, and provide that human face upon scientific experimentation. John Cade was a devout Catholic but kept his faith to himself as a private matter; it seems to have been an integral part of the man, but his treatment of his fellow humans was not coloured by moral judgement but rather compassion and a respect for choice and each person’s freedom to live as they wish. I suspect his antipathy to Freud and his theories may stem at least partly from his religious belief, but also from his observations of nutrition and rejection of theories around the family as the cause of mental health problems (for example, schizophrenia being caused by the mother’s behaviour or general family milieu). He treated a number of sufferers of bipolar disorder, including William Brand, or Bill, whose full history is given in the book. Cade’s family treated the patients who came to visit them when they lived on the premises of hospitals as friends, and his sons learned respect and acceptance through the example of both their parents. Bill became a much loved friend, through all of his trials with the illness and the treatment. It is interesting how the sons remembered that the lithium treatment made Bill lose his sense of fun, despite the other improvements in his mental health. Similar feelings about lithium today make some patients view it with ambivalence.
Cade published his historic paper on his discovery on the 3rd of September 1949 in the Medical Journal of Australia and it is the most cited paper from that journal to date. The authors state that Cade’s research findings changed the way we think about mental illness. There were difficulties in lithium being accepted as a treatment for quite some time, as the United States banned it after lithium chloride was used to replace sodium chloride with disastrous results, but it had been used in different forms, apparently, for a long time before that. The problems of using lithium for bipolar disorder are described, with subsequent researchers finally solving the problem of measuring lithium in the blood and helping to deal with the toxicity that resulted from too high a dose.
John Cade was remarkable enough for discovering lithium as a treatment for a condition that destroyed lives and families and previously had no effective method of alleviation. But he was also compassionate in his treatment of his patients, in his acceptance of difference, and his zest for lifelong learning. I would like to remind the reader, however, that mental illness generally is still not fully understood, and that while lithium is an effective treatment for bipolar disorder, mental illnesses are complex conditions, unlikely to all be caused by one element alone. This does not take away from the achievement of Cade, nor does it diminish the achievement of the authors of this fine book, which will introduce many readers to an important episode in medical history.
by Greg de Moore and Ann Westmore
Allen & Unwin
$AU32.99; 336pp; paperback