24
In July 1952, John, Jean and their quartet of boys moved into their new home in Brunswick, a working-class suburb of Melbourne. The house spoke of past glory: a splendid Victorian manor, just outside the gates of Royal Park Mental Hospital, it was an imposing two-storey building with wrap-around verandahs, intricate cast-iron embellishments, a bay window and—as markers of a gentrified past—a maid’s parlour, sewing room and stables out the back. A red brick courtyard in the rear, a garage and above it a hay loft, set off the property just nicely—the perfect home for John and his brood.
Inside, on the ground floor, included the dining room, John’s expansive study, a large kitchen and scullery, a toilet, and, of all things, a ‘flower’ room, whatever that might be. One set of timber stairs led down to the depths of a cellar lined by bluestone walls; another set of stairs led upwards to the first floor, which had six bedrooms. From this floor, a further set of stairs led heavenwards to a lookout platform on the roof, where John could visit the stars and see the Melbourne skyline. Most rooms in the household had open fireplaces framed by marble and, as a remnant of a more leisured and socially stratified past, there were buttons in each room that summoned the domestic staff via a labelled signal box in the kitchen. The domestic staff were long gone by the time the Cades arrived.
Recently, over a thousand pounds had been spent on renovating the house for the new superintendent and his family. The estate was large, about an acre, and the garden impressive, and stood on the side of a hill that presided over the asylum and commanded views over much of Melbourne. It spoke of power and privilege; it was the natural position for the superintendent’s house.
Brunswick, once the enclave of white Anglo-Saxon workers was in the 1950s a suburb undergoing serious demographic makeover. Post-war Melbourne saw a torrent of southern Europeans—especially Italians and Greeks—bulge through the Australian immigration sieve, the White Australia Policy. When the Cade children came to Brunswick they saw backyards all around them transformed into miniature vineyards thick with the pungent odour of fermenting grapes; creepers dangled from trellises as plots of land from Calabria were replicated in backyards across suburban Melbourne. Thousands of Mediterranean men in thick, heavy coats poured out of suburban trains after a day of grime in factories; middle-aged, round-faced women who uttered not a word of English roamed about in black dresses in a land that must have been as strange to them as they were to the Australians about them. These were the smells, the colours and the clothes, the culture of Brunswick, when John and his family arrived.
Inspired by the changes around him, it didn’t take long for John to start his own garden filled with vegetables—sweet corn, asparagus, marrow and beans—and fruit trees, draped with a profusion of plums, apricots, nectarines and peaches, dropping their wares when ripe. John, hemmed in by the agriculture of southern Italy, even tried his hand at olive tree cultivation. And just like Bundoora, a dozen or so hens clucked about in the chook-house, offering the Cades fine, fresh eggs.
Royal Park was a very different hospital to Bundoora. Gone were the dairy cattle to milk, no acres of orchards brimmed with apples to pluck, and no drays meandered in tussocky paddocks for the Cade boys to ride; there was certainly less grassland to saunter about in taking pot shots at rabbits. The two older Cade boys—Jack and David—no longer forged intimate friendships with patients or entered into games in their imaginative worlds as they had once done at Bundoora. They, as much as their new hospital, had changed. Royal Park was bigger than Bundoora, but to these now older boys, it seemed smaller.
Royal Park, the most important psychiatric hospital in Melbourne, was a kind of central clearing house for the city’s mentally ill. Opened in 1907, its original stated aim was to take in only those who had a reasonable chance of being cured of their affliction. But by 1952, all men and women who fell mentally ill in metropolitan Melbourne were sent for assessment to this one institution, and into its all-embracing arms came the alcoholics, the epileptics, the brain-injured, the manics, the depressives and every shade of mental affliction. Gone was the plodding lassitude of Bundoora; Royal Park was fast-paced and buzzed with life. It was the hub around which all of psychiatry in the state swirled. For the most part, Royal Park’s aim was to treat people quickly and discharge them home. Those with incurable illnesses—such as the majority of people with schizophrenia—were shipped out to an archipelago of ‘chronic’ hospitals, like Beechworth and Sunbury, dotted around the city and the state. There, more likely than not, a patient would live out his or her natural life. Decisions that were made at Royal Park could determine the course of the rest of an individual’s life.
John was 40 when he took up his appointment at Royal Park; in the conservative world of medicine, this was still a relatively young age for such an exalted position. John’s speedy elevation to the crest of superintendent was not incremental but more as if he’d been flung from a catapult towards the heavens; not everyone was happy with such a rapid rise for the youngish doctor. It is little wonder that envious eyes tracked John Cade—a youthful-looking, springy squire of the manor—as he stepped into that role in 1952.
In the eyes of some, John was just a little too young, and a tad too inexperienced; and some of the aggrieved wives of psychiatrists, whose husbands had missed out on this plum post, weren’t shy in letting people know of their dissatisfaction. This feminine disgruntlement came to the ears of John’s wife, who heard of the whispered slurs accusing her husband of having ‘jumped the queue’. Jean recalled: ‘I remember a couple of the wives saying to me, “How did your husband get the post? Why did they favour John?”’ Some designing wives were covert operatives for their men and ambitious for material gain and social status, even if their husbands were tardy about such distinctions. If sly words were daggers, Melbourne circa 1952 would have been awash with blood.
Two years before John Cade took up his appointment, the legislative framework for a spanking new government administration was set up to oversee mental health services in Victoria. It went by the slightly absurd name ‘The Victorian Mental Hygiene Authority’, terminology borrowed from the United States, implying that mental illness was a stain that needed cleansing. Well, if cleansing was needed, then fresh leadership was required to revamp and revitalise mental health services and break up the old cabal. Sadly—as was typical of the times in Australia—help was seen as coming from overseas, and overseas still meant one thing: England. That’s how Dr Dax came to Australia.
Dr Eric Cunningham Dax was an imposing man of supreme erudition and lofty manner, of wide and passionate sensibilities, who drum-rolled his rrrr’s, and confessed, on occasion, to being ‘overbearing’ to get the task done. He was just the man for the job. A princely Dax arrived in Melbourne in December 1951 to take up the chair of the newly created authority. With gusto, he set about the task of reforming a malnourished medical service.
Dax brought a breadth of interest and urgent intention that breathed life into a moribund mental health service. His psychiatric pedigree in England was varied; a master of craniometry—the craft of skull measurement—he once measured the head circumferences of 2000 severely mentally handicapped patients. And later, he worked on psychosurgery—treating mental illness by operating on the brain—helping to refine the size of the incision down to that of a five-cent piece.
And above and below and in between all of his medical work, Eric Cunningham Dax passionately collected Staffordshire China and pewter and adored fine music, all of which he innovatively brought to the banquet of ideas with which he was about to enrich Melbourne.
What Dax found in Melbourne’s psychiatric asylums visibly distressed and shocked him: ‘I remember well going to Kew [an institution for mentally disturbed children] and running my thumbnail down the wall; there was so much dirt and grease that a ridge was left behind.’ On another occasion he recalled asking what the black colour on the tablecloth was, only to find that it was a thick swarm of flies. Among the many grotesque descripti
ons of grime, worn linoleum, cracked sewers and flaking paint, he remembered with detached English understatement that ‘a good deal was done by improving the cleanliness and issuing toilet paper to avoid the drains being stopped up with newspaper’.
And what of Royal Park Hospital, John Cade’s new domain? Well, in Dax’s view it was little better, in fact, no better than ‘a second-class boarding house and was quite unfit to receive early cases’ of the mentally ill. John concurred with Dax on this point. But after a respectful beginning, theirs was a rocky relationship. John Cade, as the newly baptised superintendent of Royal Park, was to enjoy warm relationships over the years with many of his colleagues; Dr Dax was not one of them.
When John Cade took up his appointment at Royal Park he emphasised regular routines and the highest of clinical standards. Each morning John rose with the sun, consumed his customary breakfast of eggs and toast, smoked the first of his strategic cigarettes that marked out his day like the lines on a ruler, and drank his two piping hot cups of tea. He was on the wards by 8 am. He took the greatest of private pleasures in arriving on the wards before his junior doctors and reviewing the patients who had arrived during the night. The patients were often the fringe dwellers—the wanted and unwanted—of Melbourne, who walked the streets at night. Among them were the mentally ill, who stole into the darkness seeking safety and sustenance; others were criminals, usually of the petty type; still others were just homeless and lost. Many arrived unannounced at Royal Park; some were dragged in by the police, some by their families. Royal Park, at least, was a place of refuge for the night.
John Cade was not always comfortable in his role as medical superintendent. Indeed he often expressed his disdain for bureaucracy, for the minutiae of administration and its bloated and constipated rituals. He was first and foremost a clinician whose eyes sparkled in anticipation of a new patient. Not that he was a poor administrator; no one ever said that, but administration did not offer his fine brain the opportunities of detailed observation and deep reflection that clinical care so abundantly did. And as for research? John’s new promotion meant that between his clinical and administrative duties there was little time for medical research. Despite this, John advocated that all psychiatrists should continue to question widely held beliefs on the cause and treatment of mental illness and undertake some sort of research. In his own assessment of his research capabilities, he still regarded himself as very much a novice in this field.
Jack and David recall being shown around the grounds of Royal Park by their father during these first few years. They still possess the most vivid recollections of watching electroconvulsive therapy, and roaming into the infamous padded cells where patients were isolated. ‘The padded cells looked like a couch covered in leather and studded; the walls were also studded, all in a browny leather.’ Straitjackets seemed more common here than at Bundoora, and were constructed of a coarse bone-coloured canvas: ‘The sleeves had an extension on them that could be passed around the patient’s waist, and tied just like a belt so that the arms were totally enclosed.’ These were images of an era of asylum psychiatry that was about to fade, and fast.
At the end of each day John would leave his hospital office, stroll up the hill to his home and retire to his study, a luxury not offered at Bundoora. The study was an expansive wood-panelled room, and in winter there was an open fire framed by a rather ornate marble mantelpiece, flanked by bookshelves on either side. French windows looked out on to a gracious urban garden. John’s library was a treasure and he read widely within and outside medicine: the shelves contained a complete set of Churchill’s A History of the English-speaking Peoples; Gibbon’s The Decline and Fall of the Roman Empire; mathematics and science texts; and Osler’s The Principles and Practice of Medicine. Among them, almost forgotten among these hefty tomes, was the slim volume of Malay vocabulary from his Changi days. One could also find the evocatively titled gem Rats, Lice and History, in which John had underlined for attention: ‘Yet, as everyone who has really been to war knows . . . it takes no time at all before the louse comes back to its own.’ It’s a safe bet that few psychiatrists were reading about the life and times of a louse. But then, John was never your average psychiatrist.
Although not embedded on the asylum grounds as they had been at Bundoora, the Cades still had their share of inquisitive patients who’d saunter up the hill to keep an eye on the new doctor. Jean remembers the ‘occasional patient who came up and did some ironing; and we had a funny old fellow who dug around the garden’. Another patient or two would come for a cup of tea; John would give them cigarettes. ‘They always called him Dr Cade.’ Then there was psychotic Miss Ritchie, who entranced the Cade boys by sailing up and down the hill on her bicycle, which had a wire basket on its handle bars, carting things here and there, between hospital and house. Norman, a shrivelled-up man in a grey suit, worked in the woodshed; and then there was Doreen, the self-appointed housemaid for the Cades who—in the midst of her regular conversations with God—remembered with wonderful precision all the birthdays and anniversaries of John, Jean and the boys, and was a regular bearer of gifts for all the Cades.
The Cade household was one that bubbled with life; where hospital ended and home began was not always clear cut. And as for John’s family, they were growing up: Jack and David were at Melbourne’s prestigious Catholic boys school, Xavier College; Peter and Richard were at home, capering down to the hospital on tricycles or billy-carting down local streets, and attending primary school.
In 1952, the preferred treatment for the mental illness called schizophrenia was insulin coma therapy. And it is a therapy worth examining, to record and remember the types of care available to the mentally ill. Looking back, it seems preposterous that this treatment could have bloomed for so long and held such sway in the minds of psychiatrists. It was, simply put, a queer and at times hazardous treatment. But in the 1950s everyone, including John Cade, thought that insulin coma therapy was the gold-standard for schizophrenia, in the absence of anything more effective. And, like the hula hoop, insulin therapy for schizophrenia was a raging fad around the world. Every mental hospital that saw itself at the cutting edge of care had an insulin coma ward. At Royal Park, the insulin coma ritual started every Monday morning at 7 am on the dot, as the asylum grounds stirred to life.
At the appointed hour, about twenty or so young adult patients, all diagnosed with schizophrenia, were collected from around the hospital and ushered towards the insulin ward. Each patient was put into a bed and tucked tightly beneath a sheet; the blinds were drawn to darken the ward, and for the duration of the treatment no loud sounds were permitted. Next, a nurse pushing a trolley moved silently from bed to bed, injecting a small amount of insulin into each patient. Insulin, of course, lowers your blood glucose and, if you give enough, it makes you drowsy as your blood sugar falls. If you give a little more still, the patient drifts into coma. This was the desired treatment objective, with patients ideally experiencing one coma every day for at least a fortnight. One theory was that imposing this stress on the weak brain cells thought to be responsible for schizophrenia encouraged their destruction. Improvement rates varied wildly, somewhere between 20 and 50 per cent, though the statistical studies were fatally flawed by today’s standards. Acceptance of these sorts of results by the psychiatric profession in the 1940s and 1950s, not to mention desperate families, underscores the hunger for any kind of treatment that offered even a glimmer of hope.
John Cade’s son Jack volunteered as a nursing assistant during his school holidays. Part of his brief was to help give the insulin treatment, something we might now think inconceivable for a work-experience student. But his presence gives us a front-row seat. Jack remembers how, after the injections, sweat poured from the patients’ pores and their skin glistened in the half-light; their faces drained of all colour until they were pasty and grey, and their breathing sank to a shallow and rapid flutter. For the next half an hour, the ward remained in this twilight state, patient
s softly breathing, nursing staff moving from bed to bed. From the end of the room it is not hard to imagine the scene: a line of bed-bound, linen-wrapped young men and women, pale heads poking above the sheets, eyes closed, wet hair pressed against their scalps.
Here and there one might see a patient wriggling like a worm beneath a sheet or hear an occasional moan crack the silence. Sometimes a full-blown epileptic convulsion (a side effect of the treatment) burst forth in one of the patients to snap the unnatural quiet of the room. But, for the most part, the room was filled with the soft sounds of rhythmic respiration.
Then, at a set time, John Cade or another one of the ‘seniors’ would instruct the nurses and junior doctors to bring the patients out of their soggy hibernation. To do so a tube was inserted via a patient’s nostril and threaded down their oesophagus and into their stomach. A solution of glucose was sloshed down this tube to rapidly raise the person’s blood glucose level and resurrect them into consciousness. Across the ward, figures would come to life, as though thawing out after a winter’s deep freeze.
Very occasionally an individual patient did not move; that’s when all hell broke loose on the ward. It is estimated that this treatment may have killed about one to five per cent of patients; many more were permanently brain damaged. These are rough figures, for only the scantiest of statistics were kept at the time. Older psychiatrists, who remember administering this treatment, recall it as the most terrifying experience of their careers.
The insulin coma treatment was repeated (although we might shudder at the thought) for each patient Monday to Friday, sometimes, for a period of up to twelve weeks. The deeply held belief was that in the afterglow of such treatment, delusions and hallucinations would vanish.
Finding Sanity Page 20