Welcome to what is the final installment in our four part investigation into the history of lithium and it’s many uses. Parts 1, 2 and 3 can be accessed HERE , HERE and HERE for anyone late to the party.
Lithium has been applauded as the penicillin story of mental health. The first effective medication for a mental illness, it has also been labelled Australia’s greatest mental health story.
Australian scientist John Cade’s (1912 – 1980) re–discovery of the drug lithium, after it’s earlier use in the late 19th century, stands as a matchless accomplishment in the history of Australian psychiatry.
Yet a doctor is nothing without patients. Today we examine the incredible story of John Cade’s first ever human patient for lithium therapy, a man by the name of Bill Brand. It has been said no patient has been more important to the history of psychiatry than him. Hopefully by the end of reading this, you will understand why.
Bill Brand was a 51-year-old ex-World War 1 soldier who had been psychotic for 30 years. This was back in the time when post traumatic stress disorder from serving in war zones was referred to as ‘shellshock’.
When he first came in contact with psychiatrist John Cade, he had been an inmate at Bundoora Mental Hospital in Melbourne for five years. Official reports describe him as ‘restless, dirty, destructive, mischievous and interfering … the most troublesome patient in the ward’.
Bill’s existence was the quintessential life of the seriously mentally ill patient. He cut off the tips of two fingers while working as a labourer. He was disowned and alienated from his own family and had been left in the asylum. Concerned at his son’s extremities of mood and threats of violence, Bill Brand’s own father encouraged Bill’s wife Pearl to leave him. She eventually did in 1930, taking their adopted daughter with her.
In a depressive stupor for months on end, Bill would talk slowly, each syllable having to be almost prized from his mouth. In 1934, a shellshock specialist, Dr Clarence Godfrey, pronounced him as ‘very mental’. This represented a worsening diagnosis than his previous label as just ‘mental’. It was also noted he had a peculiarly shaped head and that in this mal-nourished head only two teeth remained.
At the asylum grounds he’d fossick around the rubbish bins, try to spend money he didn’t have and attempt to abscond. When it came time to select a patient to test the mood-stabilizing drug lithium on – after having first tested it on himself for three weeks – Bill Brand was an obvious choice for the asylum’s head psychiatrist Dr John Cade.
Brand’s response to treatment with liquid lithium was so dramatic and rapid that, within three months, the notorious patient was able to be discharged and returned to the community on indefinite leave. He walked out of the asylum perfectly sane. Nothing had been seen like it in mental health before.
He sought and found work while living back with his parents. His recovery was nothing short of miraculous and the most glowing endorsement for the transformative powers of lithium. Unfortunately, there was to be a tragic twist in events. In many ways it is the archetypal story of mental health. Bill Brand returned to his old job, and at some point decided he didn’t need to take his medication any more.
The first sign that something was seriously wrong again came in the form of a letter to psychiatrist John Cade. Bill’s parents wrote that he had been ‘excitable and argumentative after a trivial row’. The year was 1949. Bill Brand returned to his psychiatrist and confessed to ceasing his lithium. He had indeed become ill again with bipolar. He was re-admitted to the asylum as eye-poppingly manic as ever.
When Bill returned, psychiatrist John Cade pushed his lithium harder and harder in a desperate bid to get him back to a normal mental health state. In the late 1940s, the correct dosage wasn’t known. Because of this Brand became toxic with lithium and died in 1950.
John Cade confessed years later it was the greatest shock and disappointment of his life and made him uncertain about the future of lithium as a mental health treatment. But over the course of the next two decades, lithium’s cause was championed by other psychiatrists, and ultimately it was successful.
Seventy years after this roller-coaster history, the role lithium plays today in the treatment of bipolar disease varies depending on who you ask. Many physicians still regard lithium as the gold standard treatment for people with bipolar – especially those with more severe cases of the condition – and claim it continues to be the single most important treatment for mental health that has ever been discovered. Others have gone so far as to call lithium “dangerous nonsense”.
As with many other issues related to mental health, the real answer may lie somewhere between these extremes and is reflected in different practices around the world.
** Attribution** A sampling of the same dozen or so previously cited information sources were again consulted to compile this account.
PS. Your bonus read this week is – no other way to put it – pretty heavy, courtesy of THE SCIENTIST magazine. Click HERE if you’re up for the challenge.