These two glistening metal discs would be wired up to an apparatus that sat on a table next to the patient. This was the electrical kit—an assemblage of dangling wires, battery and series of switches—that delivered the current to the patient. At the centre-piece of this jumble was a large circular Bakelite telephone dial, to ring up the length of time the current would flow.
Bill would be asked to lie on his back on the treatment bed, while a quintet of nurses gathered about him, the first four each holding down one of his limbs. With arms and legs pinioned, a fifth attendant would place a gag in Bill’s mouth and carry out the task of firmly pressing down on Bill’s forehead, keeping the head hard upon the pillow. This was to stop his head bucking forwards when the electrical current was applied; such violent head movements had been known to crack the vertebral column.
At the appointed time, with each attendant gripping their assigned body part, the doctor rotated the telephone dial, twiddled with a knob or two, and a short blast of electricity would surge into Bill’s body—rendering him unconscious, a merciful release from any memory of that moment.
The next phase was remarkably choreographed.
Immediately after Bill blacked out, his torso would have buckled and thrust upwards from the bed, head snapped back hard and jaw clenched, his entire body locked in a mass of contracting muscle, like some hideous and twisted slab of stone.
Next, the body would break into shuddering violent movements, limbs rocking back and forth, each threatening to tear itself out of its socket along the seam that held it fast to the torso, but kept in place and subdued by the firm grasp of the attendants at each station. This agitation of flesh and bone continued, perhaps for a minute or two until, drained, the body went limp, the mind stilled and the sweating attendants released their hold.
This was electroconvulsive therapy in 1946. Treatments were given to a patient two or three times a week—sometimes more frequently.
John Cade wrote that Bill ‘had nine ECT treatments [with] remarkable improvement. He is now quiet, clean and tidy in his appearance, well behaved and an excellent and willing worker.’
Bill’s mental state remained settled over the next few months, despite the occasional oddity, such as his request to wear sunglasses about the asylum grounds. Improved enough, he was sent on leave but trouble soon stirred. While he stayed with his parents, a ‘friend rang on behalf of the ex-soldier, stating latter is “going off his head”’. An ambulance, now presumably well acquainted with Bill Brand’s address, was summoned and he was taken to the Repatriation General Hospital in Caulfield. Bill breezed back into the wards and—bypassing social etiquette—chatted to his old doctors on a first-name basis. Mentally aloft but physically worn, Bill resumed what he saw as his exalted position and boasted of his accomplishments, though we can’t imagine what they might have been. He wandered about the hospital but soon his irrational and disconnected thoughts twisted into persecutory notions and he threatened hospital staff. He was injected with the sedative paraldehyde, an act so familiar to him that he must have known what was about to take place next. His exasperated doctor wrote in piqued finality that ‘No treatment is likely to do any good’, and with that Bill was bundled into an ambulance and despatched back to Bundoora Mental Hospital.
When Bill’s mental state continued to slide, John Cade elected to trial more electroconvulsive therapy. Disappointingly, the shock therapy, which had temporarily improved his state on previous desperate occasions, did not help. A month later Bill slid into a permanent state of disordered, garrulous mania: the dirtiest street urchin in an asylum of urchins. By the end of 1947, Bill had been ‘in a state of chronic mania’ all year.
The two Cade boys—Jack and David—were ten and eight years old in 1948. They loved Bill and called him Monkey without any self-conscious restraint. They had known Bill for two years and were familiar with his outrageous antics:
We probably saw more of Monkey than Dad. Monkey did things like squeeze the toothpaste out all over the bathroom mirror and put nasty things between the sheets in people’s beds and be delighted when they reacted. Things like that. Nothing malicious.
I think Monkey was the main one who helped set the rabbit traps down near the creek. He also took us fishing to the little creek. The plan was to blow up some fish. There was lots of redfin down there. Nothing ever came of it.
Jack and David met Bill weekly after every Sunday concert: ‘We’d file out and meet up at the same spot.’ The three of them sat on a bench, a typical park bench, about 50 metres from the Cade house on a slope looking towards the asylum wards. Bill would sit in the middle, Jack and David on either side of him:
He talked quickly, loudly; lots of jokes and puns. He was happy to be with us; was kind to us; we weren’t frightened one bit. He talked, at times, to non-existent people and did so fluently. I’d look around for the recipient of Monkey’s talk but there was never anyone.
The two boys devoured Bill’s offerings, wide-eyed, knowing instinctively when eccentricity merged into insanity and when to step back. When they sat down they didn’t have long to wait for Bill to concoct a story; indeed it was the same story every week.
From a brown paper bag that jutted from the side pocket of his soiled suit coat, Bill pulled out, like a conjuror, his weekly treat for the boys: ‘They were always humbugs . . . black-and-white striped ones. We’d suck on them like there was no tomorrow.’
The humbugs, candy-coated capsules—like the casing of some enlarged tropical beetle—glistened and sparkled in the sunlight as Monkey plucked them from the bag. The boys received one each. The big, hard-boiled lollies lolled about the boy’s mouths, gathering scoops of saliva until their mouths overflowed. Then Bill channelled a directive from God and whispered to them, gravely: ‘Boys, they’re poisonous, you know.’
And in a hushed tone: ‘And if you swallow, you’ll die.’
But Monkey, the Supreme Being with a direct pathway to God, had a strategy to help the boys extricate themselves from death’s path. He instructed Jack and David that the only solution was not to swallow the sticky goo collecting in their mouths but to lean forward, crane their necks, and allow the venom to trickle from their mouths and spill to the earth. So the two boys, in unison, would bend their necks forward, open their mouths, and allow a pool of spittle to collect at their feet until it could be said a small lake had formed.
‘You had to spit out the juice! And we believed him!’
‘Nothing was ordinary with Monkey. It was great fun, we loved it and we loved him.’
Monkey’s tales enthralled the boys. He brought to them the voyages of his roaming mind and his jangly words excited and refreshed the ordinariness of the world about them. His mania, rich and succulent, illuminated their world.
For the first time, perhaps in decades, Bill Brand was not leashed to a bed, or laughed at, or belted, or spat upon as he had been in a world that cared little and understood his illness not at all. With the Cade boys he was neither beggar nor thief. To the boys he was an incandescent figure shedding light in their world. The boys saw charm, not threat.
For the rest of the week, Bill scuttled around the wards, rodent-like, from dormitory to pantry to the outside, seeking food and goodies wherever he could find them or steal them or barter them. His hands—fluttering appendages—were constantly moving, touching, stroking and beseeching, and pickpocketing what they might.
By the start of 1948, Bill Brand had been in a state of mania for close to five years. Never a powerful man, he bore little meat on his bones. When his fizzing maniacal energies were spent, he sat, depleted; sometimes huddling in a corner, eyes sunken and thoughts distant, the soft breath of life just visible.
The remnant of a near-demolished human being, Bill was a wreck by the time John Cade resorted to giving him lithium.
When John made the decision, there was no hand of convention to thwart him, nor was there a whiff of an ethics committee to question his action. Nothing could stall John except his co
nscience. And this, he felt he had answered.
The first evidence we have that John might select Bill as his first subject comes in a brief chemical annotation written on 6 March 1948. He noted that Bill’s blood uric acid was ‘extremely high’. John believed, from his guinea pig experiments, that he had found evidence implicating uric acid in the state of mania, evidence we now know was false. And in his mind, he felt that administering lithium to Bill might induce the state of tranquillity he had observed in his guinea pigs.
Just over two weeks later, John took the step that was the culmination of work that had first stirred in his mind on the voyage home from Changi three years earlier.
Gathering all the strands of Bill’s case, he condensed them and, like a military leader, made a final push into alien lands:
Bill Brand, age 51, chronic mania of about five years’ duration. Fair but temporary improvement after ECT two years ago. Since November ’46 has completely reverted to his usual state—noisy, restless, untidy and mischievous.
One afternoon in the second half of March, John returned home after his routine ward rounds. It had been an intense day at Bundoora and he was flustered and preoccupied. His wife recalled that there was ‘trouble in the hospital’ and patients were ‘stirring up’ on the wards. Cade returned to his shed and made up a solution of lithium citrate.
It is unlikely that John bothered to discuss lithium with Bill’s family and we certainly have no idea what, if anything, he said to Bill before offering the elixir.
We don’t know if Bill gulped or sipped the proffered potion, if he swallowed obediently, or was enticed, even held down. But what is almost certain is that he had little idea of what he was consuming. Patient and doctor were as wise or as ignorant as one another as to what might unfold over the next few weeks.
After administering the lithium, at day’s end John walked the short distance home. It is likely that his routine that evening was no different to any other day at Bundoora. Indeed John’s routine at Bundoora was so fixed that his children recall it with some precision 60 years later, as did his wife:
John would come in and the first thing he did was put down his bag and go to the pantry and pour out a very large sherry; and as he came out of the pantry he had a glass about twice the size he should have . . . He had a sip so he wouldn’t spill any.
Before dinner he said grace with the family and then, after dinner, adjourned to the lounge room to sit in the regal oak chair he was given for his 21st birthday:
David remembers this clearly:
He sat in this chair every night of his married life; he was a man of rituals. He’d sit in that chair sometimes until 2 or 3 in the morning if he was reading . . . and much to Mum’s chagrin he’d still be there in his suit from work.
John’s understanding of mental illness was underwritten by his acceptance of its physical basis. Mania, he thought, might be caused by an excess of some unknown chemical percolating through the body; depression caused by a deficit. John had dispensed with Freud, his bête noire, years ago. To John, Freudian fantasies could no more explain manic depression than they could measles. The answer, he was convinced, lay not in our dreams but in our body’s chemistry. Giving lithium to Bill was the pragmatic endpoint of all his thinking.
John sat down to record his experiment with lithium on a set of lined cards. The cards, today, are archived in the Medical History Museum at the University of Melbourne, and the detailed notation laid out for us gives us a fascinating glimpse into John Cade’s mind. A man of few idle words, he crafted each line. The experiment was probably recorded in his favourite Swan fountain pen, used in Changi.
The man who taught himself how to cut his sons’ hair, and how to re-sole his own shoes, wrote on these cards with the precision of snipping bonsai: crisply and pedantically. Post-Changi, nothing was to be wasted in John’s world: not paper, not ink, not words. The thin stream of ink from his fountain pen shaped words to reflect his distilled thoughts: each word laid out precisely, mindful of the impact on an observer.
He started writing the first of his cards soon after he gave Bill his first treatment:
29/3/48: Commenced lithium citrate mixture 10 grains thrice a day. After a few days increased to 20 grains thrice a day and then for a few days to 40 grains thrice a day—commenced to vomit and complain of nocturnal enuresis [bed-wetting]. Mental state improving. Dosage reduced and still sensitive so discontinued and replaced with capsules of lithium carbonate 5 grains twice a day [one grain is the equivalent of 64.8 mg].
His notes point to an early improvement in Bill. One might have anticipated eagerness to express satisfaction, or something akin to excitement in these lines. But no. John’s emotions, severely clipped by three and a half years in Japanese hands, remained buttoned down.
As early as the fourth day of treatment, John wondered if Bill was a little quieter. Jean remembered this moment:
The attendants were very faithful to John. John had said about his lithium work: ‘Now I don’t want you talking about this to anyone. If you think so and so is better on the lithium don’t say it until we really prove it.’ And he used to say to me: ‘They’re very faithful they’re sure Billy’s a bit better today but I said don’t guess, make sure.’
John recorded that Bill was transferred to Ward ‘A’, where patients were less disturbed, less disruptive, and reflected that Bill ‘had been ill so long and confined to a “chronic ward”, [that] he found normal surroundings and liberty of movement strange at first’.
5/5/48: Has been in ‘A’ ward for about 10 days and after steadily settling down, now has appeared perfectly normal both to my observation and that of his relatives for over a week. Continues on lithium carbonate 5 grains twice a day.
20/5/48: Continues well.
29/5/48: A little unsettled today. Discontented that he has not been able to go home (housing difficulty). Lithium carbonate increased to 10 grains thrice a day.
30/5/48: Settled down again.
3/6/48: Lithium carbonate reduced to 5 grains thrice a day.
7/6/48: Well.
9/6/48: Lithium carbonate increased to 10 grains thrice a day.
14/6/48: Very well. More self-confidence.
The initial nursing observations had been astute. Each day when John walked into the ward and saw with his own eyes Bill’s restored mind and behaviour, doubt vanished, and in that moment of percussive discovery John Cade knew that he had stumbled upon something quite remarkable.
Bill’s metamorphosis was as unpredicted as it was exhilarating.
By the last week of June, Bill Brand, as sane as any man on earth, was allowed brief temporary leave from the asylum. Every eddying hallucination that wreathed through his mind, each bizarre thought, and all the grotesque phantasms that had over three decades tormented him, all just simply dissolved into the air. It was as though something mystical had happened and indeed, in times past, Bill might have been revered—or burned—such was the change in his manner. Irritability yielded to beguiling charm, mischief to merriment. The world was about to see a new man transformed by an element of nature, and observe what the young Cade boys, Jack and David, had always intuitively understood about Bill.
John’s wife affectionately remembered this time:
Everyone was very fond of Monkey; yes, it was remarkable. But what amazed me was that his parents and all turned up and dressed him up. I never knew that Bill had any relatives. Visitors just didn’t come.
But Bill did have relatives and on this day the consoling hand of his family took their son, their brother, home. With the optimism of life newborn, he greeted his mother and brothers. The Cade boys remember them arriving in a Buick.
It was arranged for Bill to be discharged on indefinite trial leave from the asylum on 9 July 1948.
On that July day, a single penny would buy Bill a small bag of humbugs on the streets of Melbourne; the Australian Immigration Minister, Arthur Calwell, proclaimed that Australia might accept 200,000 Baltic migrants; Melbourn
e employers bemoaned that modern boys were ‘dead-end kids’ who ‘were poor workers, always looking for the easy way out’; terrorists slaughtered 27 people in Malaysia; and the South Melbourne Swans football team made final preparations for their weekend match.
While the city was busy in myriad ways, Bill, with a stiff breeze at his back, unfurled his spinnaker and set sail from the asylum harbour, relieved of his burden of 30 years. Lithium, a salt of the earth, had found its way into the mind of a man who had lost his. And in so doing, after five years of continuous insanity, Bill Brand stepped out through the asylum gates and into the Melbourne of 1948.
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Bill was the first to receive this magical elixir, lithium, but he was not the last. Within weeks of starting Bill on lithium, John Cade scanned the asylum grounds and looked for another patient. And then another. His lithium net spread wide.
In this one tiny corner of all the mental hospitals around the world, something incredible was germinating. New growth and hope were nurtured in the most unlikely of places and people. Men, lost to themselves and others in a haze of delusions and hallucinations, returned to a life long forgotten. A transformation in how mental illness was treated was underway.
John’s second patient was a man—shorn of his surname—known around Bundoora as P.J. Manic, wild and mutinous, P.J. was in a locked ward. Within a couple of months of starting lithium, P.J. made a miraculous recovery. He started making daily trips into the city of Melbourne like any respectable suburban commuter, and, in an astonishing turnabout, seven months after his first dose of lithium, he was working, steadily, reliably, at General Motors Holden.
Finding Sanity Page 15