Finding Sanity

by Greg de Moore

  John took great delight in pointing out things that the average person just blundered through, not observing. And it could be the weirdest of things, like his conversation one day with his youngest boy, Peter, as they strolled around the garden at Royal Park.

  John abruptly turned around, faced his son, and interrogated: ‘Do you know that an emperor gum caterpillar’s arsehole is six-sided?’ It was the sort of question to raise the interest of any boy. And any boy in Melbourne worth his salt knew exactly what emperor gum caterpillars were. They were soft-bellied, thick-as-your-thumb, blue–green caterpillars that appeared each spring in Melbourne. The Royal Park property was full of them, a veritable army of marching caterpillars munching their way through kilos of eucalypt leaves, defoliating trees like a strip-mining operation. John pointed to some fresh leaves in the uppermost altitude in the eucalypts where the caterpillars were silently going about their work. In a flash John dropped to his hands and knees examining the grass. When he stood, his smile betrayed some mischief at work in his mind; he extended his hand towards his son. Peter recalled: ‘I saw these tiny six-sided pellets shaped like miniature hand-grenades in the hollow of his hand.’ John proudly announced, ‘Son, that’s caterpillar poop. If you watch one of the caterpillars, they eat so much that you’ll see a little turd coming out quite often.’ His boy was more than impressed with the old man. Poop, in all shapes and sizes and from all species, was a continuing John Cade specialty, often to the social discomfort of his wife.

  John, never shy of trying something new, had been inspired by the Italians living around him to have a shot at growing olive trees. And to his own eyes cultivation had gone well. Jean was less enamoured. Next came bottling the olives, as Jean recalled:

  I said, you don’t know how to bottle olives. He said that doesn’t matter I’ll find out. So we had olives and you could see them from the back gate . . . We had all these Italians knocking on the backdoor: ‘Could I have some olives, please’ . . . so we said yes. One of the hospital staff was an Italian and he gave me a recipe for preserving and my husband did that and we had big pots in the pantry . . . John did it very well . . . John made some liquid stuff, vinegar and God knows what . . . we ate olives after that with the meals . . .

  On one occasion John was stirred to do more for his Italian neighbours. Peter, his youngest, takes up the story:

  A lot of the migrants grew fruit, vegetables and grape vines in their front gardens, mostly over galvanised pipe structures. Back then, most Anglo-Saxon Australians couldn’t relate to this practice and considered these structures unsightly for a front garden.

  From memory a migrant lady placed rat traps amongst her vines in an attempt to stop Indian mynas or starlings from eating her fruit. These are not native birds and are considered a pest. When there was an article in the newspaper regarding this lady being summonsed to appear in the local court on something like cruelty charges . . . Dad felt it was unfair and contacted Frank Galbally to help the lady. At the time Frank Galbally was considered Australia’s leading criminal barrister. It caused quite a stir when Frank appeared in the Brunswick court to defend the lady. My understanding is that he was successful . . . I don’t know how Dad knew Frank but they appeared to have a lot in common. Both staunch Catholics, highly intelligent, always ready to defend the underdog and [both] Collingwood supporters. Frank was happy in the limelight; Dad on the other hand would avoid the spotlight.

  John was not content just to look out for his immigrant neighbours. He had increasingly turned his psychiatric attention to the travails of post-war immigrants. Take, for example, a headline article in The Argus. The journalist wrote of a young woman, just 27 years old, found dead in a vacant plot in Coburg, a working-class suburb of Melbourne not far from where John lived. Her frozen hand clutched a milk bottle; a couple of letters remained unopened. A forsaken woman, her suicide note read: ‘I am just a sleepwalker, a lost soul in the universe.’ It turned out that she had migrated from Latvia, a refugee like so many others, just after the war. The journalist sifted through her belongings and uncovered that she had recently been admitted to Royal Park Mental Hospital. He tracked down John Cade.

  ‘We certainly get plenty of New Australians in here,’ John said to the curious reporter, referring to Royal Park and employing the common phrase of the time to describe migrants. John rifled through the admission register and fished out the non-Anglo-Saxon-sounding names for the journalist. There seemed a disproportionate number of them.

  John elaborated:

  It does seem that the way these people are treated in Australia is a contributing factor in their breakdown. These paranoid patients tell me that they are being persecuted and talked about in a hostile way. The world is against them. Their hallucinations take the form of unsympathetic Australian voices hurling obscenities and abuse at them.

  For the interviewing journalist, John drew an analogy with the POWs he cared for while in Changi and in the years afterwards. The migrant, for so long straining to find a foothold, often broke down mentally when some security had been achieved. In the same way, John reflected, that some POWs—who refused to buckle under Japanese oppression—broke down when they returned home.

  John’s post-war home life at Royal Park, like his mental state, was regulated and routine. After work, he continued his well-worn practice of raiding the home pantry and filling a glass with sherry, right to the very rim. It’s the sort of thing you see in people who, having survived some form of deprivation, treasure every morsel of sustenance. And this pattern was not confined to home.

  When John went out for dinner he never bothered with a menu. He knew exactly what he wanted. Best remembered are the times at the RACV Club in Queen Street. It was always a dozen oysters and a beer for the doctor. And before he ate the oysters, he counted them, and if short-changed he’d summon the waiter: ‘Excuse me, I ordered a dozen oysters. I expect a dozen. Not eleven.’ And, before the waiter’s eyes, John, like a boy counting out his marbles on the playground, would precisely prise the oysters apart to count each and every one of them. It was a ritual that embarrassed his family no end. Mind you, there was never a hint of selfishness or belligerence in this, just simply that one got what one paid for. Everything had a value, and honesty, even in the smallest of things in life, was a moral to live by.

  This was a remarkably settled period in John’s temperate and middle-class life, with a stable ship to captain. In the evenings he watched his favourite TV shows—Bilko and Hogan’s Heroes—and religiously listened to the ABC radio news, taking care to set his wristwatch to the pips of the 7 pm time signal. Then, politely excusing himself, John retired to his study and set about his journal reading, in the same methodical manner as the caterpillars outside munching their leaves. To the left of his ever-present armchair rested a pile of unread journals; to the right was the pile of journals just read.

  Outside of home, John was still an accomplished ball player of just about any kind, playing golf and bringing home par scores at the local nine-hole Royal Park course with little more than two clubs in his slimmest of slim golf bags. At tennis, a game he still adored, he remained supreme within the family, whipping all the four boys at will.

  On Saturdays he took his boys to the footy. Peter remembers going to Victoria Park to watch Collingwood. Victoria Park was the kind of place ‘nice’ people didn’t attend—or if they did, they tended not to talk about it. The suburban footy ground was remembered best for beer and brawls, and that was just on the field. But, as Peter reminisces, it was in the crowd that things could get really sticky:

  We’d be there, standing on the terraces, Dad and me, and the players would run out. It was pretty rough around there, and I couldn’t see over everyone’s heads. So Dad would find me a couple of beer cans and I’d stand on them for the duration of the match. The cans back then were tall and strong, made of steel. Depending on how Collingwood went the crowd could be in a good mood or foul. Dad used to embarrass me when he started supporting the umpires! I
remember once—I thought we’d really end up in trouble this time—there was this huge cauliflower-eared Collingwood supporter standing near us and he started hurling abuse at the ump. Dad just as quickly started yelling support for the umpire. Everyone turned and looked at us, I thought Dad was a goner. As we made our way out of the ground, after the match, I told Dad to be careful around men like that; Dad just waved me away saying, ‘The person you really need to worry about is the one who gave him those ears.’

  On Saturday evenings, after the football, John and Jean headed into town with season tickets to the theatre, or took in the latest offering from the Melbourne Symphony Orchestra at the Town Hall, or went to a classical ballet performance. And it was well-known that—when the odd cocktail party for a visiting diplomat was held—John and Jean might be seen on the A-list of invitees, alongside various knights, consul-generals, men with a string of letters after their names longer than their own, and occasionally with Lady Bolte, wife of the Premier of Victoria, Henry Bolte.

  Most middle-aged Melbourne psychiatrists kept bottles of red wine in a spare room; John Cade kept his .22 single shot Winchester rifle. And although he rejoiced in Tchaikovsky’s Nutcracker Suite and hummed Chopin’s Les Sylphides, nothing quite got John’s blood running like a spot of pig shooting on the Murray River.

  Peter, his son, takes up the thread:

  Dad and I would often go camping up in the Riverina. I was about 14 to 16 years old. This was the early 60s. We’d go just outside Balranald, one of Dad’s favourite places. We’d fish and shoot; there were heaps of wild pigs.

  My dad loved it; he went walking, examining all the trees looking for seeds to identify them all . . . He’d know the prints of a sheep or a pig, then ask us questions about it . . . He was a good bushman . . . We went up at least once a year. We didn’t have lengthy chats, except, perhaps, about football. He was a good shot; he still used a single shot .22 that he was given by his parents.

  One of the things that fascinated Dad was Aboriginal culture; when we’d wander around Yanga Station especially around the banks of the Murrumbidgee, he’d come across one of the middens and sift through some of the shells and explain to me that this was an Aboriginal community . . . I remember once he started to make boomerangs and threw them. It was a fine art; he soon got good at it.

  During the late 1950s and into the early 1960s John’s fertile psychiatric mind was on the loose again. He wrote several letters and articles on widely divergent medical topics, liberating his discursive mind to take root in the most unlikely places. There was, for example, his letter to The Medical Journal of Australia on the perils of not drinking tea. John had this rather farfetched idea about the cause of ‘Mongolism’, which we now call Down syndrome. We now know that this is a genetic defect caused by an abnormality in chromosome 21, but this was unknown when John cast his speculative net. He had noticed, with his all-encompassing roving eye, that pregnant women often stopped drinking tea. Knowing that tea was high in the metal manganese, he wondered if just perhaps the cause of Down syndrome was a lack of manganese during foetal development. He shot off a letter to the journal. And what became of this idea? Nothing. It remained a dead stump, and went nowhere.

  John then directed his elastic curiosity towards the cause of schizophrenia, a perennial interest of his. He again suspected a faulty diet was at work. He put forward the unusual idea that eating fruit, especially cherries, apricots and peaches, offered some kind of protection against developing schizophrenia.

  Both John’s stone fruit idea for schizophrenia and tea-drinking for Down syndrome came to naught. Barren ideas? Perhaps. When you present these ideas to modern academics the response is almost universal. There is a kind of embarrassed looking away, of polite disregard, or maybe even a fleeting smirk at the absurdity of it all. But to dismiss this work and imply that John Cade was naive (which is sometimes done) is to miss the point. This was the same broad-gauge idiosyncratic thinking that had led John to lithium.

  If nothing else, John was prepared to be called wrong, even a clown. In one of his lectures to students, John reflected on the value of medical research and said one thing stood out to him. That too often medical research was conservative—that it played along lines that were unimaginative and did not strike out to pursue new ideas. This timidity, he went on, would never lead to great discoveries. There can be little doubt that John was thinking of his own spasmodic endeavours as a researcher when he spoke those lines.

  Although lithium had found a place in the treatment of the mentally ill, its niche was still small, and the frequency of its use desultory, even in Australia. In part this was because the United States had yet to legalise the use of lithium, and still feared its toxicity, therefore the marketplace was small; as well, other medications were discovered that threatened to usurp lithium. That they did not succeed in eclipsing lithium, which trundled along in quiet ambition, is testament to the fact that no other medication quite quelled the volatility of mood swings like lithium. Lithium was still used in different parts of Australia and in a handful of other countries for mania, but it needed a boost if it was to survive and prosper.

  As it turned out, on the other side of the world, a Danish doctor—with a mentally-ill brother—was experimenting with lithium. It was this connection with the far side of the globe that would ensure John Cade’s work with lithium was never forgotten.

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  In late 1963 John received a letter from Denmark. The letter was from a psychiatrist, Dr Mogens Schou, who, partly for personal reasons, had been drawn to John’s work with lithium. Schou’s brother suffered dreadfully from unstable moods and had been in and out of psychiatric asylums. Jean’s memory of this early contact was clear: ‘Mogens Schou wrote to John straight away . . . I must let you know, my brother, was a patient in a mental hospital for years. I gave him the lithium straight away, and within a few weeks he was fine.’ And, while this intensely personal communication was pleasing to John, it was the subsequent Scandinavian work that proved to be truly phenomenal. One of Schou’s colleagues, Poul Christian Baastrup, suspected there was something exceptional about lithium, something that had never crossed John’s mind. The idea that Baastrup and Schou decided to investigate was this: what if you kept giving lithium to a patient after their manic-depressive episode was over? Kept giving it even when the person was well? When they did this they found something no one had anticipated: lithium halted future episodes of the illness. In other words patients were protected from getting further episodes of mania or depression as long as they stayed on lithium. Lithium stopped bipolar disorder in its tracks. The results were far from perfect, and it didn’t work for everyone, but in a stroke, lithium’s potential role in psychiatry expanded. Not only could lithium be given when someone was sick with mania, it could, like insulin for diabetes, be taken each day to ward off future episodes. This discovery would prove to be lithium’s salvation.

  Schou’s work impressed John, and over the years their friendship deepened, riveted by a shared belief in lithium. Schou, for his part, pursued lithium with single-minded fidelity and, for the next 40 years, promoted its value in treating bipolar disorder around the world. Fortunately for us, some of John’s early letters to Schou survive, and we can glimpse a relationship that blossomed to one of great warmth. The first of John’s letters, penned in 1964, is a formal letter about chemicals and electrolytes, cold and technical. But this formality was soon to thaw, and the two men, thick over lithium and with a propinquity of spirit, came to delight one another.

  Schou’s correspondence rejuvenated John’s passion for lithium. After nearly fifteen years of little experimental lithium activity, John’s self-imposed mental embargo on lithium research lifted, and he looked upon this special metal with a refreshed curiosity. Smitten, John began to collect and catalogue journal articles on lithium, and we come across personal letters where his thoughts wander again and again into that area that so preoccupied him in the late 1940s. He annotates research papers on li
thium; writes to doctors and scientists for clarification on the various finer points of their lithium research; and coaxes those around him to take up lithium work at Royal Park. John’s resurgent interest in lithium saw him inspire the Serry brothers, a duo of brilliant GPs-cum-psychiatrists at Royal Park, to undertake research. Awakened from his hibernation, lithium was now all the go in John’s mind.

  It might seem odd to a modern reader that lithium—so clearly an effective treatment for manic depression—had struggled for legitimacy throughout much of the world during the 1950s and 1960s. There was the initial calamity of deaths from toxicity. But this had been solved in Melbourne by Edward Trautner and his team, by measuring blood levels of lithium. Toxicity was no longer a problem. So why hadn’t lithium been fully accepted? The stumbling block, really, was the United States, which had not lifted its ban on lithium, imposed in 1949. Getting the United States to rescind this ban would be the critical step in lithium’s acceptance worldwide. With the new Scandinavian research showing that lithium could also prevent episodes of mania and depression, lithium’s moment of glory seemed assured. But lithium’s acceptance around the world was never a fait accompli. And on the verge of what seemed like full acceptance, another hurdle arose and threatened to subvert lithium all over again.

  In the late 1960s, a series of highly critical articles appeared in medical journals taking aim at the recent Scandinavian work on lithium. They expressed doubt that lithium could be used to prevent future episodes of mania and depression in bipolar disorder, and implied that doctors, in using lithium, were dabbling with something incredibly dangerous. These sallies threatened to scupper lithium’s growing foothold in the treatment of bipolar disorder.