Finding Sanity

by Greg de Moore

  John Cade possessed, in particular, one rare and remarkable quality. He was wonderfully free of the fear of what his colleagues might think of him—an unusual quality in a doctor, perhaps an unusual quality in anyone. He was never encumbered by the craven need to look good before his fellow doctors. This liberated him to say things others would not. Best of all, he could not resist poking fun at the pomposity of his own profession. Take the Beattie Smith oration, for example. At one point in his oration John critiqued the then widely held, but absurd, belief that schizophrenia was caused by faulty parental upbringing. If this were indeed true, John went on, it would be preventable by an upbringing in a family with ‘healthy habits of mind’. And then, as a barb to his all-too-smug colleagues, he said, ‘but I may remark in passing that the offspring of psychologists and psychiatrists have not yet achieved a reputation for outstanding stability’. We have no record of how this was received by the psychiatrists in his audience, but we can imagine John bore a deep inner grin as the words left his lips.

  The Beattie Smith lectures gave John a chance to talk to the world, or at least to Melbourne, about his recent lithium discovery. But the word lithium never breached his lips. Surely he was tempted to tell a wider audience about lithium? But he chose not to. So what was going on in John’s mind? Was he so apprehensive about lithium’s safety that he chose to hold his fire? Or was it a touch of humility? The answer, it seems, might have been a bit of both.

  In his oration he does leave us an allusive clue about how he hoped lithium might prove its worth. He may not have articulated the word ‘lithium’, but everything about the words below points to his discovery of lithium as a treatment for mania:

  My qualifications for discussing medical research in general or even psychiatric research in particular are best left unstated. I might most kindly describe myself as an enthusiastic amateur, full of curiosity, with fair determination, golden opportunities, inadequate knowledge and woeful technique. But even the small boy, fishing after school in a muddy pond with string and bent pin, occasionally hauls forth a handsome fish . . . Even more important, perhaps, is the determination to use any and every means to the end, no matter how humble, how unorthodox or how tedious.

  When John questioned his own ability as a researcher, we can take it that this was not false modesty. Even his most ardent supporter, his wife, was happy to depose that John was ‘not even a researcher’s bootlace’, although we might suspect that she was quoting John himself in one of his more humorous and gently self-deprecating moments.

  There is one further memory of John’s oration, one that is not filed in the archives of oblivion in a State Library or printed in a 1951 broadsheet. Russell Meares, an eminent professor of psychiatry, recalls how his father, Ainslie Meares, also a psychiatrist, heard and remembered John’s speech. Ainslie Meares knew John Cade well. Indeed Ainslie was one of the few private psychiatrists who bothered to turn up for the regular quarterly educational meetings of a newly formed group of public hospital psychiatrists. Most psychiatrists who worked in private practice refrained from attending, regarding public-hospital psychiatrists as being of a lower station. When Ainslie turned up at these meetings as the lone private psychiatrist, he did so in grand style, pulling up in his Rolls-Royce.

  Russell Meares recalled his father’s comments on John’s Beattie Smith oration:

  My father remembers John Cade, and his rather unusual statements about Freud. He told me that the psychiatrists in the audience looked upwards, towards the ceiling; embarrassed, they groaned and smirked a bit and covered their mouths with their hands, as if somehow trying to expel the distaste of the criticism of Freud. My father put it down to Cade’s Catholicism.

  John Cade never flaunted his Catholicism—by nature he was disinclined to be demonstrative about anything; that was just not him. But neither could it be said that the social climate in Melbourne was conducive to revealing one’s Catholic faith in public.

  This was a time in Melbourne of mutual suspicion between Catholics and non-Catholics. Older Melburnians remember how it was not uncommon, for example, to find two adjacent local schools—one Catholic and one state school—where one started the day 15 minutes earlier than the other, just so Catholic and non-Catholic children didn’t mingle as they walked, ran or hopped into their respective schoolyards, lest one faith tainted the other or fisticuffs broke out.

  Eric Seal, a Catholic and a psychiatrist, recalls those bigoted days: ‘When I entered Psychiatry in the early 1950s, I was regarded with some disfavour by many Catholics for being a psychiatrist, and by most psychiatrists for being a Catholic.’ It was perhaps a touch of self-protective wisdom that kept John quiet about the deepest of his beliefs.

  The Catholic Church of the 1950s was ill at ease with psychiatry: uneasy about the way psychiatry sought to unravel and explain human behaviour; uneasy that psychiatry had no need for sin or to call for a higher power. And of all the types of psychiatry, the Freudian world of bestial impulse and sexual desire seemed the most godless of all. The Catholic fear was that Freudian ideas might undermine and usurp the Catholic way of understanding humanity. John Cade was a rising medical star, one the Catholic Church could ill-afford to let go. The Church saw John as a means of exerting influence in psychiatry, and approached him.

  Deeply religious, John attended church on Sunday with the precision of an atomic clock. In John Cade, the Catholic Church had a man who was not only a young prominent psychiatrist, but one who espoused an understanding of mental illness that was more acceptable to the church: that mental illness should be seen as a branch of medicine with a chemical basis to disorders, not some jiggerypokery world of Freudian fantasies.

  As a result John was invited to write a monthly article for a national Jesuit magazine, The Messenger. The first of these was published on 1 September 1951. John went by the nom de plume, ‘Mensana’, meaning ‘sound in mind’, and if the editorial comments are to be believed, his articles were a smashing success with Melbourne’s Catholics. John’s articles offered common-sense advice on anything from juvenile delinquency, to anxious children, to the elderly with dementia.

  John wrote, unapologetically, that the soul and spiritual belief were as central to mental health as any techniques employed by psychiatrists. In response to the question of how to raise children as cocksure Catholics in the modern world, John comes out swinging hard:

  I’d sooner a child were brought up by good Catholic parents, who had not read one paragraph in press or magazines on how to bring up their children than by the most learned psychiatrist whose approach was governed solely by the findings of modern secular psychology.

  In John Cade the church had a psychiatrist with a Catholic lining, a distinct and ecclesiastical elevation over a godless psychiatry.

  23

  Summer in January means one thing in Australia—holidays. And for the Cade family, like many Australians, it meant an annual pilgrimage to the beach. The Cades, with John at the helm, set forth every January in the early fifties to their favoured destination—the Kennett River. The campsite was on the coast just over 165 kilometres west of Melbourne.

  Each holiday John would pack the car (a Chevrolet having replaced the Dodge by the start of the 1950s), attach the caravan sitting in the backyard, and Jean, Jack, David, and the two younger Cades—Peter and Richard, born since the tragic death of Mary—would pile in. As they rumbled down the road from their house through the mental hospital, the patients would line up to watch their superintendent take off for a month.

  The Cades and their caravan travelled along the Great Ocean Road, which hugs one of the world’s most picturesque coastlines. Dug out of the cliff face, some of it by hand by returned First World War soldiers needing employment, the road is dedicated to those who perished in that conflict. It stands, according to tourism brochures, as the world’s biggest war memorial. But in the early 1950s it was less than flash and was what one might have expected in a time of post-war austerity—narrow, winding and inordi
nately dangerous in parts as heavy vehicles squeezed past in opposing directions.

  On arriving at Kennett River, Jean, John and the boys would catapult out of the car and dash to the beach, where the southern currents deep from the Antarctic brought chilled water to this Victorian coastline. Carved blue curls hit the rocks with a steady pulse that John would have admired. Jean remembers spending hours basking on a beach towel while John, like a mischievous seal, swam and gambolled in the waves. Their first year at the Kennett was in 1950. John adored its location so much that they soon purchased a house in the vicinity and ditched the caravan.

  In the first few years at the Kennett, John and the two older boys learned the art of body surfing from a local instructress, whom the boys remember as ‘built like a large beach ball on legs’, and they got to know the handful of other regular holiday visitors. There was always something to see, and not all of it related to the picture-book beauty of the coastline. While not quite Changi, the art of conserving anything of value at the Kennett was ever-present, and the boys recollect John taking great pride in showing them the value of wise water use:

  The drinking water was tank water, collected from roof run off . . . There was only a 500 gallon tank in the roof so there was none to spare for showering. Dad showed us how, when he was a POW, he had learnt to manage his morning ablutions with just an enamel mug of warm water. First he would clean his teeth; then he would wet his face and lather up and shave; then wet a flannel and soap his face and ‘APC’ (armpit and crutch) then rinse with the residual water from the mug. Of course, he’d boil the large kettle for Mum to have a more civilised wash.

  At the Kennett, John often withdrew into himself and struck out on long nature walks, combing the beach or exploring the abutting Otway Ranges, observing and listening in a manner that fed on the stillness about him. Deep from the belly of the ocean, the baritone rumble of the southern seas was the backdrop to all his wanderings. He observed and noted the geology of the rocks and the stories they told, and played in the surf, tasting the salt of the water upon his tongue as the sea foamed over his body like vintage champagne. On his haunches, John might trace a line of seaweed, or follow the meandering beach trail of a sea snail; at night he’d hear the tide pulsing in and the suck of the ocean pulling it all back again. In this world of solitary strolls, and sealed from the intrusions of an insistent world, there was nothing to rupture his reverie.

  The wilderness of the western Victorian coastline was a utopia for John. The Kennett River house had no electricity, no sewer, no water; the boys read by kerosene lamps and Jean cooked on a wood stove. Photographs of John’s time here are revealing. Some of his stiffness of manner, and lack of spontaneity, were shed on the sands of the Kennett River. His smiles wreathe his face from ear to ear. We can’t help but sense that this was where he was happiest.

  Melbourne was a political and social powder keg in the early 1950s, with rivals fighting to gain acceptance for their ideas about Australia’s future. Discord was rife within psychiatry, just as it was within the universities and within political parties. In 1948 and again in 1950, major reports slammed the administration and poor condition of Victorian mental hospitals, and John’s mentor, the ageing Dr John Catarinich, was widely scapegoated.

  Privately, Catarinich stood accused of trashing one of the cornerstones of Australian society—its secular, non-religious custom of employing public servants on their ability and aptitude, not on their religious beliefs. He was accused of favouring the employment and promotion of Catholic mental-health staff over those holding other beliefs. Little did anyone know that he was also surreptitiously attempting an even bigger heist—to woo Catholic students wanting a career in psychiatry away from the recently established postgraduate university education program. He promoted a Catholic teaching unit in psychiatry designed to foreground Catholic religious values and traditions over all others.

  The impulse that drove Catarinich and his allies in this endeavour was fear of ‘godless communism’. Communism had steadily gained ground in Europe, and closer to home—in China, Indochina, Malaya and Korea—after the Second World War. Taking a giant leap of logic, this group of psychiatrists conflated a godless communism with Freudian doctrines that interpreted a belief in God as childish nonsense. It goes without saying that Catarinich was right behind Prime Minister Menzies when he sought to ban the Communist Party in Australia in 1951 via a controversial referendum. This act by an authoritarian Menzies was incendiary and bitterly divisive; the referendum was defeated by a slender margin.

  John Cade was a conservative in political matters, voting either for the Liberal Party or for the Catholic-dominated Democratic Labor Party, after its formation in 1955. Although he had concerns about communism, how he voted that referendum day is far from certain. But John had other, more immediate, matters to deal with. Things were changing rapidly. While Menzies’ motion was in decline, John’s trajectory was on the rise. His work on lithium and his Beattie Smith lectures pressed John’s name forward; promotion was next. It was announced that he would move from Bundoora to take up the position of superintendent of Royal Park Mental Hospital in the heart of Melbourne, that city’s only receiving house for newly diagnosed mentally ill men and women. It was a dramatic elevation in status and profile, and a telling affirmation of John’s rising star.

  As John prepared to leave Bundoora, his home for more than six years, the patients gathered as one and prepared to farewell him. Some high-minded psychiatrists might have dismissed Bundoora as a drowsy backwater, but John, who had made much of the opportunity to study and befriend its patients, felt at home there. His time at Bundoora continued a deep connection with the war and those tumbledown men who had suffered mental torment in battle.

  John Cade, for his part, detested the war; he made no secret of that. And just as much, it seems, he abhorred any public show of emotion around its memory. He never joined the RSL; he never marched in unison with ex-soldiers on Anzac Day. He never joined the ex-serviceman who gambled their money in a game of two-up. It is likely that John saw this gambling game—a ring of ex-soldiers squawking over a couple of tossed coins like a mob of gulls around a hot chip—as a frivolous reminder of war. None of this was for John. What he did do was, privately and affectionately, meet the men of the 2/9th Field Ambulance to rekindle their kinship and refresh their bonds, drawn by a gravitational pull so powerful, outsiders were left to gaze and wonder. John cradled this extended army family close to his breast. They met, these men of the 2/9th, each year for an annual luncheon to dine on food and memories.

  Some of the inmates at Bundoora Mental Hospital were members of the 2/9th, cobbers who’d been captured in Singapore. John’s respect and love for these mentally crippled men was visible with every step he took on the grounds of the asylum. He spoke quietly with these men; there was nothing fancy about John. Nothing ‘jammy, just plain ordinary’, as Jean used to say.

  Before her death in 2002, Jean Cade mused about these men, and their shared grief:

  When I go to the 2/9th luncheons . . . the men are so careful of their fellow man, so interested in them, they know about their families, about the ones who’ve died . . . quite a few women come, now they’ve lost their men. There is the most amazing brotherhood and I can say, love.

  She recalled the sadness of uprooting her family from Bundoora, of packing their belongings in boxes, and the ascending affection of the mentally ill men for her husband as John prepared to leave:

  He loved his men at Bundoora. He really loved them and they loved him. They were all ex-servicemen. When we left we had a nice dinner, but patients were there and they presented something to John. It was a moulded figure on a solid block. I think it was pewter; a digger with his hat on with his knee up.

  As John drew a veil over his time at Bundoora, and just five days before he took up his new appointment at Royal Park, news came through to him of an unexpected death at the Ararat Mental Hospital, in northwest Victoria. Concetta Mollica, aged 49, was
one of thousands of Italians—fleeing poverty and fascism—who had poured into Melbourne between the two world wars. Never married, and with no relatives in sight, she’d been locked away in asylums since 1929 when she was arrested for maliciously wounding a Melbourne fruiterer with whom she’d had a dalliance. She’d been an excitable and sometimes violent patient, and when electroconvulsive therapy failed to produce any improvement early in 1952, her doctor resorted to lithium.

  Her doctor at Ararat was Dr Nick Roberts, the very same doctor who sounded the alarm about lithium after Mary Niblett died early in 1950. That Roberts returned to the lithium well for Concetta Mollica speaks to the desperation of doctors when they reached the bottom of the bag of treatment options for the mentally ill. It was now an inescapable fact: lithium could cure, but it could also kill. It raised the stakes enormously. And this was lithium’s conundrum: in the face of thousands of tortured individuals who might be resurrected from despair, should lithium be used, and if so, how should it be used? Should doctors wait for the evidence to mount in favour of a new treatment like lithium? Or should they try a promising therapy in the full knowledge that the evidence of benefit and how it actually worked was incomplete? Roberts chose the latter approach, stating in a written submission to the Coroner’s Inquest, held soon after Concetta’s death, that: ‘She was given not more than the dose [of lithium] found to have been safe in many hundreds of patients who have been treated in this way in many mental hospitals.’

  Evidently lithium, despite its imperfections, was making a mark in the mental hospitals of Victoria. That aside, when Concetta Mollica’s death was scrutinised, the coronial verdict was unambiguous: lithium toxicity.