First published in 2016
Copyright © Greg de Moore and Ann Westmore 2016
All rights reserved. No part of this book may be reproduced or transmitted in any form or by any means, electronic or mechanical, including photocopying, recording or by any information storage and retrieval system, without prior permission in writing from the publisher. The Australian Copyright Act 1968 (the Act) allows a maximum of one chapter or 10 per cent of this book, whichever is the greater, to be photocopied by any educational institution for its educational purposes provided that the educational institution (or body that administers it) has given a remuneration notice to the Copyright Agency (Australia) under the Act.
Every effort has been made to locate the owners of copyright material. If you have any information in that regard please contact the publisher at the address below.
Allen & Unwin
83 Alexander Street
Crows Nest NSW 2065
Australia
Phone: (61 2) 8425 0100
Email: [email protected]
Web: www.allenandunwin.com
Cataloguing-in-Publication details are available from the National Library of Australia
www.trove.nla.gov.au
ISBN 9781760113704
eISBN 9781952534751
Set by Midland Typesetters, Australia
Cover design: Nada Backovic
Front cover photo: John Cade holding a lithium tablet, in 1974. (News Ltd/Newspix)
Contents
Prologue
PART 1
Playing ball with Jesus
PART 2
The interminable years
PART 3
Salt of the earth
PART 4
After the face, the hands reveal most
PART 5
Even the dogs were barking lithium
Epilogue
Acknowledgements
Authors’ note
Select bibliography
About the authors
Index
To my wife, Heather, and my children, Eve and Willem, for their continued love and support during the research and writing of this book. To my mother, Eileen, for planting in me a love of study. To Ann and her family for helping complete this biography. To the many wonderful mental health nurses with whom I have worked over the years, in particular to the nurses of the Bega Mental Health Unit.
Greg de Moore
To David and my extended family for their support and encouragement, and to Greg and his family for aiding and abetting the development and completion of this project.
Ann Westmore
Prologue
On a summer’s day in early 1948, Edward sat alone, perched on the edge of the Sydney Harbour Bridge. For two hours he stared at the water below and contemplated what to do next.
Earlier the same day Edward had walked along Bondi Beach and conceived the idea of counting every grain of sand on the beach. It was part of his majestic plan—to sell off Bondi Beach, grain by grain. He figured that this would make him close to the richest man in the world. Of course, it was all part of Edward’s delusional fantasy that summer’s day. But to Edward it was all real; he just couldn’t get this across to anyone.
Edward was suffering from mania, as part of his mental illness. He’d had this illness—manic depression, also known as bipolar illness or disorder—for nearly twenty years. He knew the inside of hospitals in and around Sydney and Melbourne well. And they knew him.
For weeks in early 1948 he’d been high, sky-rocket high, in the thick of a month-long manic episode; it was sweet and exhilarating. Selling Bondi Beach was just the latest of his many magnificent obsessions. He was known for them. Once, for example, he wrote a string of impassioned letters to the King of England seeking permission to construct a new naval base in Sydney Harbour. No answer was received from the Royals. Edward set about construction anyway, until the police picked him up. Another time he’d boasted of having invented a new type of engine to sell to General Motors Holden but nothing came of that either. Sometimes he hit the grog to slow things down, when words flowed furiously from his lips and he couldn’t plug them. And this time Edward knew he was on a winner: selling Bondi Beach, now surely there’d be something in that.
As he took one final stroll along Bondi, he sensed the manic high and exaltation of the previous weeks start to fade; and in its place Edward felt the black chill of depression seep into his body. It was the first glimpse of a dark expanse he knew so well. The swing from high to low mood is the calling card of bipolar disorder. That’s when Edward left the beach and made his way across town to the city’s signature structure, the Sydney Harbour Bridge.
Edward believed that—if he survived the day—he would continue to live his life in and out of asylums, accumulating life’s wreckage around him. In 1948, there was no effective medication for bipolar disorder. But while Edward sat and contemplated taking his life, something was taking place nearly 1000 kilometres away that would offer him a glimmer of hope. In that year, an Australian doctor, John Cade, discovered a treatment that has become the gold standard for bipolar disorder—lithium.
John Cade changed the course of medicine with his discovery of lithium; yet most doctors have never heard of him. His discovery has stopped more people from committing suicide than a thousand helplines, yet few counsellors know his name. And it has saved hundreds of billions of dollars in health care costs—enough to rival a nation’s economy—but you can bet that no politician has the slightest idea of who John Cade was.
Lithium is the penicillin story of mental health. It was the first effective medication discovered for the treatment of a mental illness, and it is, without doubt, Australia’s greatest mental health story.
Back in the summer of 1948, as Edward sat on the Sydney Harbour Bridge, wondering whether to jump, he could not have known that the world was on the cusp of a discovery that might change his life, and change the lives of the millions of ‘Edwards’ around the world, all sitting on their own bridges, and offer them a fighting chance in life. As it turned out, Edward stepped down from the bridge and returned to safety; many others over the years did not.
This is a book about a singular man, John Cade, and how he came upon a treatment that changed the face of medicine.
To start to understand that man, we have to go back to early in the twentieth century, to a small town in country Victoria. That’s where the John Cade story takes flight.
PART 1
Playing ball
with Jesus
THE DISEASE:
Manic Depressive Insanity
As a rule the disease runs its course in isolated attacks . . . we distinguish first of all manic states . . . and melancholia or depressive states . . . These two opposed phases of the clinical state have given the disease its name.
‘Manic-Depressive Insanity’
Emil Kraepelin, 1921
1
John Frederick Joseph Cade was born on 18 January 1912 at Nurse Carroll’s private hospital in Roberts Avenue in the Victorian country town of Horsham.
Sometimes Christian names mean very little; a mother’s or a father’s fancy, or a compromise when partners can’t agree. But in John’s case, never has a triplet of forenames so completely defined the roots of a man. And it is in the full flowering of John’s name—John Frederick Joseph Cade—that the ancestral trail can be traced, at least on the paternal side.
In order, he ‘was named after his great-great-grandfather, great-grandfather and grandfather’, so John’s father proudly wrote. The names of John, Frederick and Joseph were the first names of a string of male Cades dating back to late eighteenth-century England—nearly all were medical men or pharmacists, a near unbrok
en line of chemists and doctors breeding true for close to 150 years. And of these forebears, it was Frederick Cade, born in 1802, who migrated from England to the Antipodes, putting down roots in a very youthful Melbourne and establishing one of the earliest pharmacies in the fashionable east end of Collins Street. We can find Frederick Cade’s name as a ‘druggist’ at 134 Collins Street, Melbourne, from 1842, just seven years after John Batman signed a treaty with Wurundjeri Aboriginal people and the site was settled.
John’s birth, as far as we know, was without incident. Certainly his father, Dr David Cade, had taken pains to make sure that a trusted colleague, a Dr Read, resident in Horsham, was present as Ellen gave birth to their first child. David Cade, however, was not present—the norm for husbands at the time—presumably doing his rounds as a country doctor. As for Nurse Carroll, she assisted Dr Read in bringing John Cade into the world.
Nurse Carroll’s private hospital was one of several private hospitals in Horsham in the early twentieth century. A beautiful timber building with luxuriant palms and large pine trees in the front garden, it has long since gone, replaced by a motel. The only thing of beauty and substance remaining from the original hospital are two tall pine trees standing in the bitumen carpark of the motel; trees, rather than distinguished and beautiful old buildings, seemingly more immune to a developer’s wallet.
Several faded black and white photographs exist of this early twentieth-century private hospital. They show a small hospital, actually more like a large gracious home with two decorated timber gables overlooking the front garden than a hospital. In one photo, three nurses stand erect in the garden dressed head to toe in glowing white fabric, like a vision from heaven. Nurses to whom you’d entrust your baby’s and wife’s health.
Just before the birth of his first child, we find Dr David Cade highlighted in the local Horsham Times newspaper. It reported on 16 January 1912 that David Cade was urgently summoned to attend the one-eyed Reverend Hillier who, in the midst of a church service, dramatically lost all sight in his good eye. Apparently, this blackout took place as the service was ending, just after the benediction and before amen. Whilst David Cade was tending him, the reverend’s sight miraculously returned. Whether this was a case of divine intervention or the healing powers of a country general practitioner is not quite clear. Not being an assiduous churchgoer himself, David Cade may have preferred an explanation that credited his medical skills while his wife, Ellen, a fervent Catholic, may have given more weight to spiritual factors. If nothing else, it was the best of omens. For two days later Ellen gave birth to a healthy son.
Some of John Cade’s personality traits clearly sprang from his medical father. But he owed at least one important characteristic to his mother. And, in the end, that single dimension may have been the most vital attribute of all: tenacity. Without it even the most talented man falls short. Family stories recall a tough, thick-skinned and determined woman. Well before her marriage, Ellen Edwards showed plenty of character:
As a younger woman she was fierce. She was one of those strong pioneer-type women. A reasonably tall woman, she was physically strong. I remember a story of a time when she went to collect eggs from the hen house. She’d been losing a few eggs and she thought the culprit might have been a fox; but when she went in there was a rat in the chook pen. She saw this rat and quick as a flash she grabbed it by the tail and slung it on the timber post.
Originally from Clunes, near Ballarat, Ellen Edwards was a trained nurse and gained appointments to a string of country hospitals in New South Wales and Victoria. In 1896 the Goulburn Evening Penny Post reported that a Miss Edwards of Bathurst had been appointed assistant nurse at Narrandera, in the Riverina region of southern New South Wales.
By 1903 she was contending with a typhoid outbreak in Condobolin, where she was matron. Later the same year, at a farewell at Condobolin Hospital, a large number of friends and well-wishers heard the mayor praise her to the rafters for her contribution to the central NSW community among whom she had lived for the previous six years. He commended her ‘kind attention to all who had come under her care’, adding that by her ‘genial manner, she had endeared herself to all’. The local Justice of the Peace intoned that the hospital had never had a more conscientious matron. She was showered with presents from the hospital committee. But what impressed the local newspaper even more was the gift of a lady’s handbag from a Miss Gertie Simpson, a former patient who simply wanted to express her gratitude to the departing matron.
Nurse Ellen Edwards was a substantial woman from all accounts: straight-backed and broad at the shoulders. For Ellen to succeed in nursing it helped to have a strong back and broad shoulders, particularly in country hospitals where access to attendants was limited. Although accustomed to running her own show, when Ellen gained appointment to Mildura Hospital in northern Victoria in 1904 she was third in charge. But typhoid once again struck and ten people died, including members of the senior nursing staff. So Ellen was soon appointed matron. By 1905 her repute was such that nearby Balranald Hospital enticed her to join, and while working there she met David Cade, who had recently bought into a general practice in the town.
Three years later the pair married in the Catholic Cathedral in Bendigo. There was no talk of David, who had been brought up in the Church of England, converting to Catholicism. But it is likely, in accordance with Catholic ecclesiastical tradition, he agreed that any children would be raised as Catholics. Ellen Edwards was a hard-bitten Catholic and her Irish Catholic heritage was a matter of great pride to her. But as one of her future daughters-in-laws was to slyly remark when asked about Ellen’s religion: ‘She was a devout Catholic when it suited her.’
When John, her first child, came into the world, a resolute Ellen Cade (née Edwards)—rat killer and Catholic—kept a sharp eye on her newborn son.
Not a great deal is known of John’s first few years. His father simply stated, as if observing John purely from a scientific standpoint, that his firstborn ‘developed satisfactorily and made steady progress mentally and physically during his first year of life’. Some years later David Cade, through that same detached lens, cut to the core of his son’s temperament: ‘In his infancy he was a strange mixture of gravity and brightness and quite early he manifested signs of that spirit of investigation and experimentation.’
On one memorable morning, while Ellen was attending Mass and David was having a sleep-in, John gave his father a terrible shock by inserting something into his father’s ear canal, seemingly endeavouring to find out more about it. Jumping up, his startled father told him to desist, but John was soon at it again.
From the very beginnings of his life, he was a child whose logical manner, curiosity and persistence impressed observers. John Cade, whatever else his attributes, was born with a tidy, tenacious and inquisitive mind.
Although he was born in the rural town of Horsham, about 300 kilometres northwest of Melbourne, if you journey there you won’t find much evidence of John’s existence, or indeed of the Cade family history. For that you need to take a short pilgrimage of another 30 kilometres to the smaller town of Murtoa, where John’s father—Dr David Cade—was the local general practitioner, and where the Cade family lived.
When you get to Murtoa, there is no way you can miss the Memorial Archway—right next to the splendid lake in the town’s centre. Just about every country town in Australia boasts a similar memorial, listing all the local men and women who fought in the First and Second World Wars. Rarely do people take the time to look closely, but if you run your eyes down the column of names for the Great War, about halfway down you will come to the name of Dr David Duncan Cade chiselled into the granite. When the First World War broke out, Dr David Cade enlisted; before long he was heading to Europe.
In 1915, David Cade left his country practice in Murtoa to fight for ‘King and Country’. The 40-year-old country doctor, already a veteran of the Boer War, was imbued with the deepest sense of patriotism, and when the First World
War ignited he readily signed up. On his departure from Australia he left his wife, Ellen, and three young boys to do their best in the circumstances; John, the oldest, was just three years of age.
David Cade spent four dark and disturbing years in Gallipoli and France. On one occasion, anticipating a Turkish assault, he prepared for the inevitable casualties—setting out bandages, stretchers and all the accoutrements a doctor at war might need. When he looked up from the neat piles of white cloth that lay before him, he observed ‘a young soldier carrying a petrol tin of water for a machine gun’ rushing past, ‘but he had hardly gone five or ten yards further when an enemy shell came up the valley and carried his head away’. David Cade records this in a matter-of-fact manner, implicitly understanding that embellishment could only detract from its telling.
At another time, near the village of Pozières, in France, he recalls ‘a German who was wounded in No-Man’s Land and brought in after four days’ with a ‘leg smashed above the knee’ and ‘stinking horribly’. Festering bacteria would normally bloat the leg with gas gangrene—an ominous portent for any soldier—but on this occasion David Cade noted with a deep curiosity the absence of the toxic, swelling gas. As he separated the folds of rotting flesh in the German’s leg, both doctor and patient observed a writhing mass of maggots in the congealed blood, the stench of dead meat terrific. A dispassionate David Cade dismembered the soldier’s leg using a ‘butcher’s amputation’ and, although we never learn what this exactly entailed, it sounds sufficiently gruesome and descriptive to appreciate that no great sophistication was involved. The following day, the now one-legged German soldier awoke, apparently much improved and ravenous to boot. He turned and politely asked his captors for a sausage. We can only hope it was duly given.
Not long before war’s end, while stationed in France, David Cade recorded how a boyish-looking soldier prepared to take off a backpack. Without warning, a shard of shrapnel from an exploding shell pierced the boy’s chest; death was instant. Cade, who was standing nearby, was spared, unhurt. Years afterwards, David Cade recalled how he looked upon this young man lying in the mud, mesmerised by the youth’s untouched face, now drained of life. That image of innocence—angelic, white and dead—never left David Cade.
Finding Sanity Page 1