Lithium: A Doctor, A Drug, and a Breakthrough

Book review by Laura Grace Simpkins
Walter A. Brown. Liveright. 2020. ISBN 9781631497902

I was prescribed lithium carbonate—two 400mg tablets to be gulped down with a large glug of water before bed—nearly four years ago. For a while I knew only several vague details about my medication: it was ‘natural’, it could easily be ‘toxic’, and family and friends were surprised and shocked when I informed them I was on it. I understood that lithium, thanks to its cameo roles in copious film and TV shows, including an appearance of lithium sprinkled ice cream in an episode of Sex and the City­, inhabits a particular place in public consciousness unlike that of any other psychopharmaceutical drug. At once familiar and unfamiliar, lithium exudes, or perhaps has imposed upon it, a kind of misplaced, uninformed mythology, and I wanted to know more. What is it? Where does it come from? What does it do?

These questions are taken up by psychiatrist and scholar Walter A. Brown in his book Lithium: A Doctor, A Drug, and A Breakthrough (2020). Fascinated with lithium since his psychiatric training at Yale towards the close of the 1960s, Brown admits his primary motive here is to write a biography of who discovered lithium’s antimanic, mood-stabilising, and prophylactic (relapse preventing) properties. ‘Who was this man,’ he asks in the introduction, ‘and what were the circumstances that brought him to a groundbreaking moment?’ (ix). Lithium is not the first attempt to historicise those responsible for how mood disorders are managed today, nor is it the first suitable for less specialised audiences (see Finding Sanity: John Cade, Lithium, and the Taming of Bipolar Disorder, 2016) but Brown aims to give the story an expert, and perhaps exhaustive, spin.

Lithium was recognised as an element in 1817, after four per cent of a stone from the Swedish island of Uto was unresponsive to regular metallurgical tests. Singled out for its neutralising effect on uric acid (since disproven), lithium was initially administrated for gout, until it became unfashionable and fell into disusage at the end of the nineteenth-century. Then, so the story goes, in 1949 an article by Australian psychiatrist John Cade in The Medical Journal of Australia claimed that lithium had abated symptoms of mania in patients under his care at Bundoora Repatriation Mental Hospital, Victoria. What follows is well known in psychiatric circles: a staunch believer in the biological origins (still unproven) of bipolar disorder, then known as manic depression, Cade was certain he could find the ‘cure’. For reasons that are not entirely clear, Cade tested lithium urate on guinea pigs, then himself, then his patients, and was intrigued by its ability to seemingly sedate and tranquillise. Brown comments: ‘Some believe that the readiness with which Cade went from these unexpected observations in guinea pigs to a treatment trial in manic patients defies scientific logic’ (67). Indeed, Cade’s article was met with little celebration, although it did catch the eye of Danish psychiatrist Morgen Shou, who, as Brown explains, began tirelessly trialling lithium in manic patients. Shou and his research were crucial to lobbying the FDA, which eventually approved lithium in 1970, kickstarting prescriptions in the US, and the UK, Europe, and Australia thereafter.

Brown neatly summarises lithium’s nebulous history, impressively balances opposing views and deals confidently with the many controversies, whilst keeping his writing accessible and well-paced. What is curious about Brown’s book is his ambivalent, tending towards favourable, characterisation of Cade. Early on, Brown runs through Cade’s background, his childhood, education, professional training, and his time as a POW during WWII. Brown’s account is, occasionally, unnecessarily fan-girlish and risks being uncritical: his valorisation of Cade’s stint in the military rather heavy-handedly implies that his later scientific discovery wasn’t merely predictable but inevitable, transforming him from a doctor to a superhero with his own elaborate origin story. Star-struck, Brown repeatedly minimises and brushes off Cade’s bad behaviour. Throughout his life, Cade ‘neglected’ to mention that one of his patients, ‘WB’ in the now-famous 1949 article, died shortly after the article’s publication in The Medical Journal of Australia, from prescribed doses of lithium which had been far too high. ‘While WB’s death from lithium toxicity has no relevance to the significance of Cade’s discovery, his consistent failure to mention it may well point to the sort of things that motivated him and how he coped with unpleasant realities’ (81). Unlike Brown, I think WB’s death is relevant to the lithium story, and to the history of medicine, beyond what it may reveal about Cade as an individual.

Playing down the seriousness of WB’s death exemplifies the attitude latent in Brown’s book: an oversight or lack of engagement with patients. Brown rarely includes first-person experiences from the real specialists; strangely it feels as though Lithium was written without thinking anyone who takes the drug would (or could?) read it. Moreover, Brown’s choice of words like ‘suffering’ and ‘agonising’, standardised as they may be, speaks for and over the reality of those living under the description of bipolar disorder, those who may negotiate a more nuanced and less pathologising vocabulary. Many of us wouldn’t say that we ‘suffer’; it is too pathos-laden and dramatic, too biblical almost. Calling this out might seem unnecessarily pedantic, but patients’ experiences are often eclipsed by the fame of valiant doctors coming to the rescue: ‘One expert’, Brown records, ‘suggested that it [bipolar disorder] might be called Cade’s disease’ (183). Lithium should have done more to problematise that suggestion.

 

Laura Grace Simpkins is Medical Humanities’ blog Book Reviews Editor. See her profile here.

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