Greg De Moore: Lithium – the Penicillin of Mental Health [& the story of John Cade, a truly great, decent & remarkable Australian]

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Greg De Moore: Lithium – the Penicillin of Mental Health [& the story of John Cade, a truly great, decent & remarkable Australian]

Summary:
– Psychiatrist Dr De Moore (from Westmead Hospital in Sydney) discusses Dr John Cade, the Australian psychiatrist who discovered Lithium for the treatment of Bipolar Disorder
– Cade, in the post WW2 era, was working at Bundoora Repatriation Hospital (outside of Melbourne) treating veterans with what was then called Manic Depression
– conventional wisdom at the time was that such conditions resulted from disturbances experienced during childhood (I.e. how the person was raised or brought up – in particular what the mother had done to the child a this was based on the popular Freudian psychiatric notion of the era)
– Cade had been captured during the war & was imprisoned for 3.5 years at Changi Prisoner of War camp outside of Singapore – he worked in a hospital at the camp, in a mental health ward (the experience in the camp changed him physically & emotionally)
– based on his experience there, he believed that it was possible that conditions such as Manic Depression (today known as Bipolar Disorder) could arise from chemical imbalances in the body, in particular brain chemistry
– at Bundoora, he first used Lithium on a human patient (following trials on guinea pigs)
– Lithium has since been used to treat millions of patients suffering with Bipolar Disorder
– Cade’s name & his discovery has largely been forgotten until De Moore’s recently published book
– Lithium is a light metal which is highly reactive to other substances (it is often used as a salt, a solution & a compound)
– it is also found in naturally-occurring spa waters
– Cade was born in 1912 in Horsham, Victoria
– he was the son of a psychiatrist & grew up & played with patients living in asylums
– he had a deep & abiding affection for people treated in asylums (in the 1920s patients typically stayed for months, years or spent their entire lives on asylum grounds)
– Cade had planned to be a pediatrician, but during a period of serious illness as a young adult, he decided to become a psychiatrist, working at Beechworth Psychiatric Hospital in country Victoria
– psychiatry was not seen as a reputable profession at the time
– Cade wrote a book called Mending the Mind where he discusses Lithium (in one chapter), but not once states that he discovered the applicability of Lithium in modern psychiatry [De Moore notes the humility which would not be found today]
– bipolar disorder affects approx 2% of people
– type 1 is the most severe form & affects approx 0.5% of people
– type 2 is less severe & affects approx 1.5% of people
– bipolar disorder is long-term & serious mental illness
– it is characterised by episodes where people can be either high or depressed
– when people are high, or elevated, they present with a raft of symptoms, including:
– agitation
– speaking quickly typically in a “torrent of words”
– making grandiose plans
– heightened impulsivity / recklessness
– libidinal changes
– the other aspect of the condition are profound experiences of depression which can last weeks or months & where the person’s thoughts can slow down to a trickle, where speech is impaired, where the person feels suicidal
– therefore people with Bipolar Disorder oscillate between these two extremes; however, between these episodes a person can be what De Moore describes as being “completely & utterly normal”
– his thesis was that there was a physical cause for mania based on either a toxin or chemical imbalance
– he collected urine to test if this was discharged from the body (this part of his thesis was subsequently proved incorrect – he thought it may be related to Uric acid, but it was hard to manipulate without adding Lithium to form Lithium Urate & this is when Lithium entered the picture so to speak & “changed everything”.) He noted that Lithium by itself sedated experimental guinea pigs
– he then tested further before using on human patients
– Lithium worked quickly on a human being named Bill Brand, & was fully recovered & well within 3 months (however, the mania returned when Bill stopped taking Lithium)
– the treatment was best for Bipolar Disorder, & much less so for Schizophrenia
– lithium continues to allow people to be more functional
– however, in the 1940s it was not known that too much Lithium dosage could lead to Lithium toxicity & premature death [Bill Brand would die as a result of this toxicity]
– Cade was both a scientist & a conservative Catholic (the latter of which formed the bedrock of his personality)
– the more widespread process of the adoption of Lithium as an effective treatment for Bipolar Disorder was very slow
– 1950s measurement of blood levels to determine Lithium dosage levels
– subsequently found that Lithium could treat both the mania, and thwart the onset of depressive episodes by the 1970s

– Cade was awarded with the Order of Australia, was invited to the White House & awarded for his work
– he remained humble about this & never boasted (thought to be linked to his time at Changi – he was a quiet man & saw people with mental health issues as being a fully-rounded person/human beings (rather than a constellation of symptoms & signs)
– Cade was also ahead of the curve regarding sexuality, noting that homosexuality was defined as a psychiatric disorder in the DSM up until the 1970s – he did not believe homosexuality was a disorder, nor that it was the business of psychiatry
– Lithium was the first medication developed for mental illness
– Cade died in 1980, and he was of modest means only (not flashy/showy in any way)
– Lithium is not a patented substance
– today, it is still not known why it works, even though it is the gold standard of treatment for Bipolar Disorder (there are theories about circadian rhythms, membranes in the brain)
– Bipolar Disorder is better known today & there is some controversy about the spectrum of presentations & at the lower end merging with disruptions to the personality
– treating: understanding the person as an individual human being
– understanding the condition & triggers such as disruption of sleep, the importance of relationships, employment

Source: ABC RN Conversations podcast | broadcast date: 10 October 2016

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