Lithium is a drug, also used in batteries, but the drug
lithium has had significant impact on the field of bipolar disorders. The book
by Brown, Lithium[1],
is a wonderful history of the discovery of lithium as a therapeutic for
manic-depression, the earlier name for bi-polar disorders. Cade, the
investigator who established its efficacy and effectiveness, was an example of
the lone researcher, no funding, and using himself as the Phase I test subject
to determine if it were even safe.
I first saw bi-polar disorder in the mid-1950s in a
relative. The patient would swing from a normal state, to a depressed state,
sometimes exacerbated by alcohol, then rapidly swing to a manic state. The
manic state would involve extremes of behavior, avoiding any base in reality,
often attempts at life changing actions totally inconsistent with the patient's
capabilities. For example, the patient would suddenly want to enter the
wholesale fish business, then buy a truck, fill it with fish, and then collapse
into a depressive state. Needless to say, the fish were left unattended.
In those days the remedies were limited. There was Bellevue
Hospital in New York, a short term critical care facility and then the city
mental hospital on Ward's Island. Some patients underwent shock therapy but for
many it was just a wait and see. Extreme manic states could be medicated and
then electro convulsed.
I saw several other patients during that period, thanks to
my grandmother's friend from Medical School days, Dr. Louise Despert, a prominent
New York psychiatrist. She dealt with many children and this was often a
significant ailment. It was not till the late 1960s that in visits to McLean
Hospital, a Harvard affiliate in Belmont MA that I saw the large number of
bipolar patients, but by this time various medications were becoming available,
lithium amongst them. From 1968 to 1978, the patients in Massachusetts psychiatric
facilities went from some 20,000 to less than 2,000, due mainly to the increase
in various therapeutics. Many bi-polar patients could now live a normal, as
best as possible, life.
Lithium was one of the key therapeutics used. Brown thus
details this tale of Cade, returning from WW II, working at an Australian
psychiatric hospital, and personally and individually exploring the use of
lithium, in a salt form. Cade eventually writes this up and slowly gets some
notice, not so much in the 1950s but more so in the 1960s. It is a tale of a researcher
focused on a specific disorder with a target medication then facing the world
of the professional researchers, some believers and many deniers. Brown does a superb task in relating the times
and the nature of others looking into this disorder, those accepting and those
rejecting. Much of what Cade did was before the time of well-structured clinical
trials and his approach would not even be allowed in today's world, but Brown
shows how quickly Cade was able to demonstrate effectiveness and efficacy,
albeit limited.
Brown then continues with the acceptance by the psychiatric
community of lithium and how it made life much more acceptable to those with
bi-polar disorder. Overall this is a wonderful book showing the dedication and
brilliance of Cade and then showing the complexity of getting a new approach
accepted by a complex medical community. This is a superb book and worthy of a
read.
My only criticism, and this is quite limited, is that a
better understanding of the bi-polar patients and their plights. For almost
all, they have no control of their often extreme and bizarre behavior. Also, as
with many therapeutics, pharmaceuticals, the side effects can be quite severe
and limits the drug's effectiveness. Most people have limited exposure to
bi-polar disorders, but they are more common than one thinks and this book
sheds light on these facts.
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