Finding Sanity

by Greg de Moore

  We might get a bit of rest and a holiday. Although somehow I doubt it. He is so involved in his work, but this makes me happy, too. The only thing that does scare me is that he persists in testing a drug on himself before giving it to his patients. I’m never sure just what is going to happen.

  As the date for the Baltimore symposium neared, Apollo 13’s mission—the third-planned moon landing—was spinning towards disaster. An explosion in a liquid oxygen tank saw power lost and temperature drop. The impotent spacecraft, like a crushed aluminium can, dangled in space. The world watched and wondered. Oxygen levels dropped; carbon dioxide levels rose. The rising tide of expired carbon dioxide in the malfunctioning lunar module was a chemical poison that would soon asphyxiate the astronauts. But the astronauts had one critical thing on their side: they had lithium. Canisters of lithium hydroxide rigged in a makeshift manner, and using some impromptu ingenuity, captured the rising carbon dioxide, converting it into non-toxic lithium carbonate. The astronauts could breathe freely again. As the astronauts scrambled to engineer a safe splashdown, President Nixon’s eyes were deflected towards the three spacemen saved by lithium. The President sent his apologies to Baltimore: he would not make it to the symposium to meet John Cade.

  Jean remembers the Baltimore occasion as lavish: ‘It was all very extravagant . . . we were put up in a mansion.’ The Cade family retain in their possession several glossy black and white photos of John’s time in Baltimore. They offer a sense of the occasion in a series of snapshots. The first is a group photo of nineteen conservative-looking men, arranged in three rows like football players in a year book. John sits in the front row, unobtrusive, on the left, his signature thin lips unparted for the photographer.

  The second photograph has John standing awkwardly in a crowd. Looking self-conscious, he slightly tilts at the waist, like a marionette, his elbows cocked at right angles; an ever-present thin cigarette protrudes from between his fingers. With his stereotypical thick-framed glasses, he is reminiscent of Brains in the TV program Thunderbirds. The final photograph shows John standing on the podium talking about lithium, peering straight ahead, above the listening audience, with a wide-eyed, mildly startled expression.

  John’s speech was characteristically gracious and modest. He spoke about his early days with lithium, his work to evaluate it, and his research on several other metallic solutions that might be expected to have pronounced effects on mental activity. Having been ‘unexpectedly presented with a therapeutic magic wand’, it was inevitable ‘that one would plunge one’s hand time and again into the same lucky dip’. The Baltimore Evening Sun, with a flourishing drum roll of American hyperbole (and with a misspelling or two), had earlier proclaimed ‘the announcement of a new psychiatric drug will be made at the symposium by Dr John F.J. McCade, of Melbourne, the discoverer of the drug lithium’.

  John did announce to the gathering that he’d been taste-testing another metal. He once quipped to a newspaper reporter that he’d eaten his way through half the Periodic Table. On this particular occasion, John had been swallowing strontium which, like lithium, is used in fireworks. The strontium solution had made him alarmingly ill. His son, David, remembers: ‘Mum was so cross. We were, too. We didn’t know what was wrong with him. He was terribly sick for a couple of weeks. He looked shocking. He was slate-grey in complexion.’ None of this seemed to have bothered John, who noted some mild drowsiness and headaches but was otherwise well. He then gave this strontium solution to patients with depression and schizophrenia. The results, he suggested to his Baltimore audience, were worth pursuing.

  Standing on the podium peering into the crowd must have seemed a long way from hovering over a sink injecting guinea pigs in the years after the war. As John delivered his speech, Time magazine, with an impeccable sense of occasion, announced that the FDA had finally approved lithium as a treatment for the manic phase of manic depression in the United States.

  During the Baltimore trip Jean remembered hearing the occasional caustic comment about her husband’s lithium discovery. The rumours suggested John’s discovery of lithium was a fluke, and that his rising fame was merely the consequence of this extraordinary luck. Although John was a man not given to casual malice, he was rankled by the insinuation that it all came down to good fortune; it was a slur, unsoftened by time, that he would occasionally hear for the rest of his life.

  Once the Baltimore speeches were over, elaborate plans were made for the formal dinner. And of the evening’s event, the local Baltimore newspapers reported that ‘The Most Rev. Luigi Raimondi’, the Pope’s delegate in the United States, would oversee the evening banquet at which John would receive his award. This must have been the sweetest of sounds to the ears of John Cade, the Catholic.

  From the United States, John flew to Denmark. There for the first time he met Mogens Schou, who was doing so much to promote lithium around the world. When Schou, years later, recalled this visit it was not John’s work or anything remotely medical he remembered. One impression in particular imposed itself on Schou’s orderly Danish mind.

  Schou took John and Jean to a medieval church, the ‘Church of Our Lady’ in Aarhus. The church is unusual, as it has a smaller ancient church hidden beneath the floor. Schou tells the story: ‘The discovery excited John, and when the party was again up in the church he started to go over the floor, systematically stamping on each individual stone slab and listening. He wanted to see whether perhaps yet another crypt church could be hidden under the floor.’ Jean remembers, from that day onward, whenever John entered a church in Denmark, he’d start hopping up and down, like a human pogo stick, crying out mid-hop: ‘I’m just wondering if I can find another church underneath.’ If anyone thought John odd—this balding Aussie psychiatrist leaping about Danish churches—we can imagine he would not have given a damn.

  Soon after arriving back in Australia, John received a present from Mogens Schou. The Cade family oral history has about three or four different versions of what took place next but they all illustrate the same thing: John’s love of a puzzle and the growing warmth between the two men. Of the various yarns the family spins, this is the one from Jean: the present was an amber pendant. As soon as Jean unwrapped the pendant, John, spotting it from the corner of his eye, jumped up from his own chair and rudely plucked it from her grasp. He took it away to the window and turned it over, carefully, in the light. After a moment’s silence he exclaimed with satisfaction, ‘I knew it! There’s a small insect in it. He’s sent us a fossil.’ And indeed Schou had, a tiny fossilised fly trapped in the amber. The pendant was a little experiment from Schou, who predicted that John would immediately look for a fossil in the amber—seeking the unexpected in the commonplace.

  In the 1970s John’s feet barely touched the ground as he buzzed about to all parts of the globe. At the start of the decade, he had assumed the position of President of the Australian and New Zealand College of Psychiatrists. Awards and honours piled thick: Distinguished Fellow of the American Psychiatric Association, Roche Travelling Fellowship through Southeast Asia, Chair of the Committee overseeing the first Pacific Psychiatric Conference; and elder statesman for this and that.

  Now more than ever in the public eye, John could still come up with the unexpected. John was always politically conservative, and on religious matters his convictions, though private, ran deep. In 1973 he was asked to contribute to a medical symposium on the issue of homosexuality, which, at that time, was a criminal offence in Victoria. Psychiatrists at the time misguidedly treated homosexuality with electric shocks to dissuade patients of this sexual preference. John thought this intrusion into a person’s sexuality by psychiatrists a nonsense, and said so. John comes across, in his writings, as the most compassionate of people and, as was his habit, he played down the role of psychiatry:

  I hasten to add that as a doctor I regard it as highly irrelevant and always mischievous to make moral judgments on patients’ problems and attitudes . . .

  My own view is that a
stable homosexual relationship is certainly not more psychiatrically abnormal than nail biting, or thumb sucking, or doodling or cigarette smoking. If homosexuality is perverse and an illness or abnormality surely deliberately inhaling large quantities of filthy disease producing smoke into one’s lungs day after day should also be defined in similar terms.

  Everyone knew that John was the heaviest of smokers. He was having a joke at his own expense.

  Anyhow neither I, nor any psychiatrist that I know, am burning with evangelical zeal to go out into the highways and by-ways searching for happy homosexuals to brain wash them into semi-impotent heterosexuality and so-called social conformity.

  It took backbone for John to take this public position. The medical profession was far from a beacon of enlightenment on this issue and it was rare for homosexual doctors to come out and declare their sexuality; the hospital system of promotion was hardly sympathetic to their plight. But this was John’s strength: his capacity to ruthlessly think through the issues and not bow to the politically expedient.

  John increasingly involved himself in public health policy. And there was no more important issue than the problem of alcoholism. Alcohol, John claimed, was ‘far and away the commonest single cause of admission of men to Royal Park’. Many alcoholics ate poorly, and so were vitamin deficient. This caused irreparable changes to their brain and behaviour. John, seizing the opportunity, introduced the policy of giving any alcoholic who entered Royal Park huge doses of the vitamin B1 (thiamine), in an effort to thwart brain damage. It was a brilliant manoeuvre and saved countless lives. There is no doubt that John’s action was influenced by his observations of POWs in Changi, who presented with a similar picture of vitamin B deficiency due to appalling diets.

  This vitamin work at Royal Park was almost as revolutionary as John’s lithium research. It brought him immense satisfaction and it was little wonder that, in May 1972, he was called upon to give a public address on this matter for the Alcoholism Foundation of Victoria. That evening he sat beside Sir Edward ‘Weary’ Dunlop—fellow doctor, University of Melbourne alumnus, pugilist and Changi POW—a heroic figure from Australia’s Second World War.

  In May 1974 John travelled to Detroit, Michigan, for the 127th Annual Meeting of the American Psychiatric Association. Representing the Australian and New Zealand College of Psychiatrists, he was called upon to make a short speech to his American colleagues. Beforehand, in his hotel, John scribbled his speech on the hotel’s notepaper kept on the bedside table in his room at the Sheraton-Cadillac Hotel. That notepaper—mottled and moulding—still exists, with the hotel name and address embossed at the top. It makes for intriguing reading.

  Towards the end of his short speech, which otherwise was on psychiatry, John informed his American colleagues, apparelled in their suits and gowns, that he had observed the water level rising and falling in the toilet bowl in his hotel suite. This, he continued to the audience (which we imagine was now slightly uncertain as to where this was all going), told him that rain was due in Detroit. It is not recorded what his American audience made of John’s discursive launch into the abstractions of toilet bowls and meteorology, or whether it rained that evening, but we imagine that they were left a little confused as to what this Australian psychiatrist exactly did during his working hours. Among John’s possessions from this evening, there survives a program of the night’s entertainment, suggesting that after his speech John and the aggregated delegates could look forward to the De Santis Singing Strings, and dance till dawn to the sounds of Bob Du Rant and his orchestra.

  That same year, it was announced in Melbourne that John and Mogens Schou would share the world’s richest prize in psychiatry—the Kittay Award. The prize was to be bestowed in New York City. In awarding this honour, the judges trumpeted ‘lithium as the most important development on the frontiers of psychiatry in the last 20 years’.

  Before John left Australia to collect the award, a journalist from The Sun newspaper tracked him down, finding him holed up like a brushtail possum at Royal Park in ‘a rather Spartan little office, very Public Service décor, with green imitation leather chairs, drab carpets and grey metal filing cabinets’. John took the journalist through his now well-worn story of how he came across lithium after the Second World War. Diffident at first with his growing international profile, John had grown more comfortable with his celebrity and by now savoured every lick of it. As the interview came to a close, he picked up a white lithium tablet and held it before the photographer’s camera, the circular pill nipped between thumb and index finger. John drew back from it and momentarily looked closer at this tiny pill, squinting, to study its mysteries all the more, and as much to himself as to his interviewer, he whispered in wonderment: ‘The stuff is so cheap.’

  And that was part of the problem: the cheapness of the stuff, as John so plainly put it. Lithium was cheap, dirt cheap. Most other medications in psychiatry, indeed the whole of medicine, were discovered and promoted with hefty pharmaceutical company support. A patent was then taken out, and, if all went well, millions of dollars were scooped up by investors. But not for plain old lithium; dug from the earth, no one owned the patent but God. Forged from the furnace of the universe, there was nothing new to patent. No man-made chemical trickery had created it. It therefore meant that no pharmaceutical company contorted itself to promote and push lithium hard in the marketplace.

  Not that making big money was on John Cade’s agenda. His son, Jack, remembers that when his father left Melbourne for the Big Apple to collect the world’s richest psychiatry prize, John silently slipped onto the plane, carrying a lone briefcase. Packed inside was little other than a toothbrush and a clean shirt.

  In January 1976 John Cade was honoured for his work on lithium with an Order of Australia, the newly minted awards that replaced the antiquated British Honours system. This honour did not surprise Ed Chiu, a medical colleague of John’s at Royal Park in the late 1960s, and from 1972 to John’s retirement in 1977: ‘John Cade was the kind of person who loved his patients, lived with them. I learnt from John that patients are humans, never mind the diagnosis. When you grow up with them, as John did, patients are very much extended family.’ And in John’s world, that extended family included the carpenters, the secretaries, the cleaners, the plumbers and all the invisible hands behind the running of a hospital.

  Ed Chiu fondly remembered, ‘When I came to work at Royal Park, the first thing John Cade told me was that when you finish your clinical work, spend time with the artisan staff: the plumbers, the cleaners and the office workers because they know a lot more about what’s going on around the hospital than doctors do. He often, in the mornings, had tea with them.’ To this day, John’s family believe it was an office worker, a pay clerk, or maybe a carpenter or cleaner at Royal Park Hospital who nominated John for the Order of Australia. Among these workers behind the scenes, John Cade was a legendary teller of stories and a keeper of the good. Whether or not one of these hospitals workers did forward his name for this honour we might never know, but it sounds just about right.

  The letters John appreciated most, however, were not the frippery letters of honour that suffixed his name; the letters that mattered most were the ones from patients. Sometimes they were written by patients he’d cared for; at other times the letters that landed on his desk were from complete strangers. Soon after the announcement of his Order of Australia, a copy of an anonymous letter to The Ararat Advertiser, dropped onto John’s desk at Royal Park. It was written by a woman, who gave only her first name, Claire. Claire asked, ‘Why does it give me pleasure to read of the recognition in Australia of Dr Cade’s work? A man I do not personally know?’ The answer was, of course, lithium. It had transformed her life.

  Claire was just one among thousands of women and men the world over grateful to John Cade. The image of John leaning back in his office chair and reading these letters is an appealing one. Perhaps this 1940s man, sitting at his government-issue desk, might have even allowed
himself the briefest of self-congratulatory smiles—but whatever else coursed through his mind, John must have felt satisfied that his life’s work was now complete.

  31

  In January 1977, John turned 65. For a man who oiled his life with a series of well-regulated rules, the age of 65 was the socially sanctioned time for John to retire. In 1977 there was no political pressure to extend one’s working life; you were expected to graciously down tools, hang up your boots, clip on the pen lid—and slide silently from sight.

  John did the rounds of farewell speeches and dinners and spoke intelligently, modestly, at them all. Nothing flashy about his attire—a loved cardigan or worn suit would usually do.

  John said goodbye to Royal Park Mental Hospital on 21 January 1977, after a quarter of a century as superintendent. On that day, nurses, doctors, cleaners, carpenters and others gathered to hear him speak for the final time. The hospital’s parting gift to him was a vinyl-covered Jason recliner rocking chair. There is an image of him—both comfortable and a bit crass in that 1970s way—captured by a photographer for The Age, in which John, wearing a pale suit, is perched on the shiny edge of his new gift, peering forward at his assembled guests. Dressed in the garish trademarks of that time—a psychedelic tie and flapping lapels—it all seems out of kilter with John, a man of a more conservative cut. In his hand he holds a microphone, like an Olympic torch, and before him, on the foot of the rocker, he spreads the notes of his farewell speech, as if he is back at home on the dining table. He spoke crisply, with not a suggestion of an ‘um’ or an ‘ah’ to foul his smooth delivery.

  In classic Cade style, John challenged moral certainty and talked about a favourite patient, whom he called a colleague: