Finding Sanity

by Greg de Moore

  We would gather on the top floor of a two storey building and he would recount it . . . I can remember it so clearly . . . John delivered the news just as though he was the BBC news announcer himself . . . he did it, maybe, several times a week . . . you had to be careful how all this was done. We’d have our lookouts—‘cockatoos’—posted and John used to read out the news but then came a time when it was too dangerous to bring it back on paper . . . and so he committed it to memory.

  If you were searched and found to have notes on you . . . if you were found out. Well, obviously the Kempei Tai . . . that’s the Jap military police . . . you’d be put in prison . . . there were fellows who had fallen foul of the Japanese, and they then received terrible treatment . . . It was very dangerous carrying the BBC news . . .

  John’s view about the cause of mental symptoms was profoundly influenced by his time in Changi. He kept a record of his ‘mental ward’ cases, and, what is more, he wrote at least one report summarising his observations. So in the midst of war and malnutrition and the hideous deformity of what is good in humanity, the wheels of organisation continued to whir: ‘I had ample time to meditate on the possible causes [of serious mental illnesses such as manic depression] and plan some sort of research programme for when the fruitful years might return. I certainly did not come up with any specific hypotheses but these could be regarded as germinal years.’ And there is no doubt that John’s thinking about the cause of illnesses such as manic depression underwent a radical change. Fortunately for us, he described a series of cases in which the evolution of his thinking can be reconstructed to some degree.

  Two of these cases left a deep impression on John. The first was of an intrepid young soldier with ‘a very gallant battle record’. Soon after captivity in Changi, this young soldier’s mind unravelled. He dissolved into an untameable manic state of excitability, restless activity and utter irresponsibility. As John looked into the eyes of this young soldier, he made the diagnosis of a manic phase of manic depression. He looked, for all the world, like one of the patients incarcerated in Beechworth. And then, unexpectedly, this young soldier dropped dead. John immediately performed an autopsy. What he found astounded him. The soldier had ‘the biggest chronic subdural haematoma’ John had ever seen, ‘the size of a partly deflated football’.

  A subdural haematoma is an abnormal collection of blood wedged between the brain and the skull. It is a kind of bruising of the brain, caused by trauma to the head. As the blood collects it exerts pressure on the brain and alters human behaviour. In this case, it caused the soldier’s manic state. Somewhere in the recent past this soldier, probably in the last days of battle, had suffered a head injury. It was enough to start the bleeding between the brain and skull, but it took some time for the symptoms to develop. And when they did, he became manic. Years later, John wrote carefully of this story as one of his salutary lessons in medical life, teaching him the pitfalls of drawing conclusions before obtaining all the available evidence.

  The second case was of a medical orderly room sergeant who complained that his hearing was failing. Next his body became ‘spastic’, which in neurological circles means his muscle tone increased to the point where he might lose control of bodily movements. This increase in muscle tone might result in bizarre uncoordinated muscle contractions such as coarse tremors and a stiff gait. At first glance, such a man might be suspected of fabricating an illness. In this light, John, who was called in to consult on the sergeant, at first wondered if this might be a picture of hysteria. Hysteria was the diagnosis psychiatrists made when a patient presented to them with an apparent physical illness—such as paralysis of the legs or a bizarre gait—but where the cause was purely psychological. Like the first patient, the sergeant died suddenly. At his autopsy, his central nervous system revealed a loss of myelin—the protective coating around the nerves—a condition that also occurs in multiple sclerosis. John knew immediately that the cause of this sergeant’s odd presentation had nothing to do with psychiatry; it had all to do with an abnormality in his spinal nerves.

  These two cases—the ‘manic’ soldier and the uncoordinated ‘hysterical’ sergeant—stuck in John’s mind for the rest of his medical career. The notion that mental symptoms were somehow anchored to an underlying physical or chemical problem was one John kept coming back to. He later wrote that ‘I could see that so many of the psychiatric patients suffering from [illnesses such as manic depression and schizophrenia] appeared to be sick people in the medical sense. This fired my ambition to discover their aetiology.’

  This single distilled idea—that mental illness should be seen in the same light as physical illness—foreshadowed much of John Cade’s future work. It was an idea that kindled gently in his mind. And, once accepted by him, the verity of this finding never faded.

  On 6 August 1945 the Americans dropped an atomic bomb on Hiroshima, then another on 9 August, obliterating Nagasaki; six days after Nagasaki the Japanese unconditionally surrendered.

  In the days after surrender, John’s throat tightened with the fear that he, along with his fellow POWs, might be executed before they were rescued. And, just for a moment, his immaculate composure wobbled. In one of his letters home he wrote of this uncertain period: ‘One of our worst fears . . . [was] . . . that [the Japanese] would never let us be recaptured alive if it came to a fight to the finish.’ Three decades later he recalled these ‘final frightening few days’ when he and several other POWs ‘planned a last funk hole—up a sewer with three days’ supplies’. As it turned out John’s survival plans were thankfully not needed and, surprisingly, the Japanese acquiesced with little bloodshed. After three and a half years, John Cade was about to walk free.

  Newly liberated, John furiously set about writing letters to Jean. He carefully marked the number 100 at the top of the first page of the first letter; and reminded himself that his last letter, number 99, was penned before capitulation in February 1942. He wrote letter after letter, pouring everything into this cathartic act. Some were posted singly; others despatched in batches. And he waited, anxiously, for Jean’s first letter to arrive.

  Re-reading these letters, we feel his urgency to make up for stolen time—what the children might look like, what presents they might like—and we understand his need to please and surprise them. But his deepest doubt was that he may somehow fail them. That, somehow, five years of war may have filleted out the best of what he was, leaving just the leftovers. Several times his anxieties surfaced when writing about his two boys, Jack and David: ‘How I look forward to smiling into those two eager young faces, and how I hope that the real daddy does not fall short by too far, of their dream daddy.’ In these darker moments, self-doubt, the assassin of dreams, took root in John’s mind.

  He was also very anxious to make sure Jean was aware that he had survived:

  we still have no assurance that you have been notified that we are alive and well . . . It has been a horrible anxiety for you, far more than for me because I have been reasonably sure that you have been all right whereas you knew almost nothing about me.

  He repeatedly reassures Jean about his physical state, as if dispelling her concerns that somehow he might have been damaged or is no longer the man she married—the deep and disturbing dread of all returning married POWs.

  In other moments, John swells with the anticipation of coming home, and lets fantasy run wild. ‘Making up for this lost time. I’ve thought and dreamed and planned about that glorious holiday that you and I and the kiddies are going to have . . .’ He dreams of going to a restaurant with Jean and slicing into a prime cut of beef, ‘a porterhouse steak at Flosie’s’.

  In his final weeks in Changi, John kneels at the altar to receive the sacrament and gives thanks for his salvation: ‘It has been possible to go to Holy Communion for the first time since Easter (owing to the shortage of altar bread) and I have been daily from Sunday until today (Thursday) . . . kneeling in adoration and thankfulness to Our Lord.’ Several times in these
early letters home he stops short of more brutal descriptions of his captors, implying that these words can wait. But every now and then a moment of fury overwhelms him and it penetrates his conversation:

  our long deferred Red Cross Supplies are being brought in and distributed—supplies that had been held up indefinitely by the incredibly grasping, corrupt Japanese administration. The Jap war machine is the foulest most soulless thing ever invented by the wickedness of man . . . it blisters my soul when I dwell on it . . .

  Over the previous five years there had been small hard-won victories of life over death. From now on, nothing was to be wasted; particularly time. Reflectively, he wrote: ‘I believe all of us consciously or unconsciously have a much better sense of values, and a greatly enhanced appreciation of the good things in life.’ John developed a deep affection for the local Chinese population, doing ‘a wonderful job in Malaya throughout the Japanese occupation, spying, sabotaging, non-cooperating’. At war’s end it was decided that the AIF would come up with something, perhaps an award, to honour the local Chinese population for their bravery and sacrifice. John proposed that a scholarship fund be set up to support local nurses in Malaya to travel to Australia, and was, later, deeply involved in administering it. Called the AIF Malayan Nursing Scholarship, it is the official war memorial of the AIF who served in Malaya.

  Almost a month after the Japanese surrender, John was yet to leave the camp, still working as a doctor as the number of sick and injured swelled to record levels.

  And then he writes, ‘[I] hope to go in tomorrow to take three British officers (mental cases) to the British hospital ship’. The following day John took his first steps outside the camp. He escorted the psychiatrically disturbed British officers to their ship—one senior RAF officer with a manic condition travelled home in ‘a steel-mesh cage’. Singapore, John reflected as he walked through the remnants of a city obliterated by an orgy of violence, was a city ‘of the dead. The Nips have apparently not had any repairs done to buildings—you see decay and inattention everywhere, gardens overrun with weeds . . . crumbling walls, shuttered shops.’ Soon after, John took his first dip in the sea and was repeatedly stung by a jellyfish; but he was a hardened man by then and nothing could detract from the moment of joy. Especially, he writes, ‘with not a Nip on the horizon to mar the scene’.

  There was one moment in these giddy days of emancipation that marked John’s transition from captive to free man. It occurred while he walked through the smoking ruins of Singapore. Looking to the skies, his eyes caught a shimmer of iridescent blue ascending above the city. A kingfisher, the shade of sapphire, streaked by—John’s ‘first glimpse of beauty’ in over three years.

  Even then John was mindful not to allow his spirits to swing wildly. Changi had changed John; he had learned well the survival skill of never allowing emotions to spill over, of not allowing his facial expression to betray his thoughts. Uncontrolled emotions could be misunderstood, and John was always mindful of the presence of Japanese guards who might respond with violence. Controlling one’s emotions was a skill needed to stay alive. His deep-seated reserve would confuse some people in the post-war years when trying to assess John Cade.

  Changi changed John in many ways, but one thing Changi could not break was John’s addiction to tobacco. Rapturously, on liberation, he wrote home to Jean of his first pack of Camel cigarettes, ‘I inhaled it all the way down to my G-string.’

  At war’s end Jean dashed off a telegram and a letter to friends—Dr Frank Prendergast and his wife, Lil, living at Claremont Mental Hospital, Perth—capturing the moment of joy. The scribbled and obviously hastily sent telegram, stamped 12 September 1945, stated in staccato words: ‘John’s name radio today Singapore list write when official.’ Jean had finally heard on the radio that John had survived.

  And she does write to them, one week later:

  Gosh! I hardly know how to start . . . my hand and mind is rather unsteady . . . Yesterday two letters one dated 6th and one 10th Sept. By his handwriting and the way he expressed himself I could tell he was well and had not changed one bit . . . His writing is tidy and well controlled as of old—he is as loving as ever . . . The phone here and at Bundoora has hardly stopped ringing since last Wednesday . . . We have been told that Beechworth, Sunbury, Mont Park and Bundoora are agog . . . The children are so sweet, they gave me tremendous hugs as Daddy’s letter told them to do. The other morning about 5 am David heard a plane and wondered if Daddy would be in it. He seemed to think John might parachute down. Our house has been painted and garden tidied.

  As John steamed back from Singapore on the cargo vessel Largs Bay in the September of 1945, he took pen to paper and wrote these prescient lines to his wife:

  Then to work—as you guessed in one of your early letters the old brain box is simmering with ideas. I believe this long period of waiting has allowed many of my notions in psychiatry to crystallise, and I’m just bursting to put them to the test. If they work out, they would represent a great advance in the knowledge of ‘manic-depressive’ insanity and primary dementia [schizophrenia]—sounds like my usual over-optimism, doesn’t it?! Well, there is only one way to find out—test it and see.

  And then, on Friday 28 September, ‘Tomorrow will be a great day for us—Australia!’

  John’s two boys have their own distinct memories of waiting for their father. Jack was turning seven and David just five. Their memories, although rusty in patches, still cling to them; Jack’s recollections are more restrained than his younger brother’s:

  Mum didn’t know if Dad was alive or dead towards the end of the war. She had very limited information. I recall her telling us that he was on his way home . . . she was probably scared as to what he was like if he was still viable, the man she knew . . . she didn’t want to raise expectations.

  David’s memory, no doubt mingled with what he has absorbed from family stories over the years, evokes the moment of anxiety and anticipation, common in so many Australian households huddled round radios at war’s end:

  I remember the radio quite clearly . . . it was about a foot high and a foot and a half wide and was timber framed, with a dial which the vertical pointer moved along. It had a circular vent at the top with a couple of grill bars, cloth mesh . . . I don’t remember what we listened to during the war but I do remember that we were sitting on the floor in the small lounge room listening to the radio when peace was declared . . .

  Mum was listening to the names of POWs on the Largs Bay vessel . . . And they were reading out the names in alphabetical order and we heard Dad’s name read out . . .

  David can reach back into time and recall further snippets from those heady post-war days—how his mother always had her hair in a bun the size of a squashed tennis ball and wore floral dresses, always neat and clean, even if she did not own many. Somehow these visible attributes fixed themselves in David’s young mind, and, closing his eyes, he describes the scene as if lived today. Jean, he went on, was quiet at the time of the announcement, not demonstrative; relief in her husband’s homecoming was something she savoured silently and, we have no doubt, with bountiful prayer.

  During the Changi years, the thought of meeting his wife and two boys was John’s most cherished desire; it was also his most feared. Jean was cut from a stoic cloth—he could count on her, no matter how affected and worn by war he appeared. But his children? That was another matter. He barely knew them; Jack was little more than a toddler and David was a baby in Jean’s arms when he walked away from their home in January 1941. It was now almost five years later. They would be strangers to him, but even more so, he knew he would be a stranger to them.

  On his return to Melbourne John was met by his parents, who whisked him off immediately to the Repatriation Hospital in Heidelberg, where he was treated for malnourishment and bronchitis. Jean and the two boys were to meet him there.

  As Jean and the two boys stood in the hospital hallway, a gaunt, yellow-faced, dressing-gowned apparition approached
. Jean and the boys can still remember the exchange of words as John tentatively came towards his children.

  ‘I seem to recall mum saying, “This is your dad”,’ remembers Jack. ‘Is that really my dad, I wondered?’ If he had doubts, he was old enough and diplomatic enough to keep his lips clipped. That couldn’t be said for his younger brother David, always the more voluble of the two.

  David, wide-eyed and disbelieving, bellowed, ‘Mummy, that’s not my daddy! How do I know he’s my daddy?’

  Jack, older and wiser, countered, ‘I know he’s my daddy because I can remember him coming to our place with a little wooden train set.’

  David replied, ‘But his teeth are all black!’

  When the scenario of exchanges is replayed for David today, he laughs. The images he had of his father were formed by those he saw around the house—of a well-nourished, fit young man in uniform: ‘When I saw him my mental picture was of the photos I’d seen before the war . . . I thought that this chap walking down the corridor towards us didn’t look at all like him, and I hid behind Mum.’

  Jean was true to form—calm and undemonstrative, measured and loving. She managed John and the boys because no one else could. Privately she was dismayed by her husband’s appalling appearance, made worse by skin made yellow by the anti-malarial drug Atebrin: ‘I could hardly recognise him myself. He looked dreadful; his knee bones stuck out from the opening in his dressing gown. I remember when he came home, his nose was just bone, and his skin was horrible . . . it was the first thing I saw, his hollowed face . . . he looked as though he’d been starved.’