Mending The Mind

By David Cade

When this book was originally published in 1979, mental illness was a closed book to the general public. It is not surprising that in the climate of widespread ignorance, mental illness was a taboo subject. It was rarely mentioned in the media, useful information and professional help was hard to find and so it was not a topic for open discussion.
It is fascinating to keep this perspective in mind when reading this book. Dr J. F. J. Cade gives a lucid account of the false theories and beliefs, mistaken practices, the many discoveries and the advances in the field of mental illness up to that time. He presents an account of the first specific psychiatric treatment for bipolar disorder (at that time called manic depression), namely lithium salts but he refrains from mentioning that he made this momentous discovery himself.
There has been much progress in the 36 years since then. These days we are all aware of the frequency and significance of mental illnesses which have at last, well and truly, come out into the open.
Various aspects of mental illness are now drawn to our attention every day. Everyone has some familiarity and empathy with bipolar disorder and with schizophrenia. Information about these and other mental disorders is readily available and easily found in printed texts and on the internet. There are contact persons and focus groups within the community who are willing and able to help sufferers of mental illness and their families to recognize the nature of their problem and to assist them in finding professional help.
Psychiatry has come along way since this book was written and it is interesting to be told by this psychiatric pioneer where it has come from.

• Language: English
• Publisher: David Cade
• Release date: Jan 18, 2016
• ISBN: 9781310215292

David Cade

Dr David Cade is an Australian retired consultant physician (called an internist in USA) in Critical Care medicine. He has written these camera notes with attention to clarity and precision. Together with his wife Robyn (a retired physiotherapist) they spend their leisure time gardening, bird watching, hacking at golf, long distance swimming, paddling a marathon canoe and walking their two poodles.Recently David has written a Golf Instruction Summary available at Smashwords for pre-order and due for release in early December, 2015.

Book preview

Mending the Mind

A Short History of Twentieth Century Psychiatry

J. F. J Cade

A.O., M.D., F.R.A.N.Z.C.P., F.A.P.A.

Formerly Professorial Associate University of Melbourne,

Dean of the Clinical School and Psychiatrist Superintendent,

Royal Park Psychiatric Hospital, Melbourne.

Copyright 2015: The Trustees of the Estate of the late J. F. J. Cade

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Table of Contents:

Foreword

The Nature of Psychiatry

Mental Hospitals in 1900

What Causes Insanity? Masturbation Madness, Syphilis (GPI)

The First Milestone: Malarial Treatment of Syphilis

Schizophrenia: the Unsolved Riddle

Convulsive Therapy

Largactil for Psychotic Exhaustion

The Conquest of Epilepsy

Highly Controversial: FCI and Leucotomy

Depressive Illness

Out of the Ground: Lithium

Anxiety: the Universal Fate

Mental Deficiency

The Great Thinkers

Today and Tomorrow

Afterword

About the Author

Foreword

The author of this book is known to the international medical world as the man who introduced lithium into psychiatry. He discovered the beneficial effects of this compound on patients suffering from psychotic excitement, in particular those suffering from manic episodes of manic-depressive illness. That happened in 1948-49 and was the start of modern psychopharmacology, preceding by three to four years the introduction of the much more publicized tranquillizing drugs. For his distinguished contribution to psychiatric chemotherapy John Cade has received the Order of Australia and been given a number of coveted scientific prizes and awards.

In the present book Dr Cade speaks as the experienced physician rather than as a scientist. With broad strokes he paints a canvas which shows the advance of physical treatment in psychiatry during the twentieth century. His own work with lithium is mentioned in the context of the other major discoveries.

The book is packed with observations and information. It is also delightfully personal and entertaining, its lines being punctuated with illustrating and often humorous details. Compassion with the mentally ill is one of its guidelines. Another is fascination with the history of medical discovery. As one of those who became part of that history John Cade tells a tale that cannot but inform and engage.

Mogens Schou, M.D., F.R.C.Psych. (Hon.)

Professor of Biological Psychiatry and Research Director

The Psychopharmacology Research Unit, Aarhus University Institute of Psychiatry, Risskov, Denmark

The Nature of Psychiatry

In the most general terms, psychiatry is concerned with anyone who arrives on the psychiatrist’s doormat. Psychiatry is about patients, people.

What sorts of problems do they present with? There are five categories of patients: those who suffer from defective cerebral development, the intellectually handicapped; those with demonstrable brain damage and its resulting behavioural deterioration; those with illnesses that are biochemically determined without demonstrable cerebral structural change – such as manic-depressive illness and perhaps more dubiously schizophrenia – but which are clearly illnesses in the traditional medical sense; those who react to environmental stress with either psychological symptoms – these suffer from so-called neurotic illness – or with bodily symptoms – the ‘psychosomatics’ (this is a purely theoretical distinction, a matter of emphasis, because it is in fact impossible to react mentally without reacting bodily and vice versa); and lastly a vast, ill-defined array of patients, almost always young, who are exhibiting socially maladaptive behaviour. It is this group particularly about which most modern controversy rages. Are they sick in the medical sense or are they maladapted in the sociological sense? The answer is that their condition reflects an element of both. Some are clearly victims of their inborn temperament (‘cyclothymes’, described later in depressive illness); their behaviour is largely symptomatic of their mood swings. Others are the product of their unfortunate environment and upbringing. While the psychiatrist is essential in the treatment of the former, he is no more successful than many other treating agencies in the management of the latter.

Next it might be useful to outline what psychiatric treatment really is. What goes on when a patient is admitted to an acute psychiatric ward, or seen as an out-patient?

Firstly, there may be general medical treatment, which is sometimes of an extremely urgent nature; this is frequently the case with in-patients, for it must be realized that a distinct proportion of such patients are seriously physically ill and that their mental aberration is secondary to their bodily infirmity. For this reason alone a psychiatrist must be medically trained. In such cases he is a physician first. Even amongst out-patients sent for consultation the occasional medicopsychiatric emergency arises. A middle-aged man, an orderly at a teaching hospital, was referred for treatment of his anxiety state. Certainly he was anxious and tremulous, and had lost a great deal of weight. But his pulse was irregular and too rapid to count, and he had a diffuse swelling in his neck. He was promptly referred back for urgent treatment of his thyrotoxic cardiac failure.

Many patients initially are very disturbed and require sedation, tranquillizers and not infrequently, even now, electroconvulsive therapy (ECT). This may be categorized as physical psychiatric treatment.

In others, psychotherapy is indicated. There is a vast range of theories and techniques in this area, whether the therapy be with or without the aid of drugs, individual, or in groups.

It may seem reactionary to refer to spiritual therapy, but occasionally the patient’s distress is due to spiritual turmoil. Even the agnostic psychiatrist is lacking in sophistication if he fails to discern this. In these cases he should abdicate psychotherapeutic primacy in favour of the hospital chaplain. To tell of a rather extreme case: a poor woman was admitted to hospital in a state of despairing agitated depression. She was an obvious candidate for ECT and antidepressants. But when time was taken to listen to her story, it revealed a tragic, if faintly ludicrous situation… Two years previously her favourite brother lay dying, and the family invoked the aid of a spiritual healing group. The brother died but the family was converted to the extreme tenets of this faith. They were told, ‘Down with the demon drink or you are damned to Hell fire’. The patient admitted that they enjoyed an occasional glass of celebratory wine, but this was an easy command to obey. Then they were told, ‘Television is the work of the Devil’. They sold their set although this was rather a wrench. Then came the final command: ‘Smoking is sinful. Smoke and you are damned’. With bitter tears of despair the poor woman sobbed, ‘I can’t give up smoking’.

The psychiatrist wisely thought that at this point he should opt out as primary therapist. In short the hospital chaplain did an expert job in restoring the poor soul’s perspective, and rescued her from her anguish. It is well to ask what, in a case like this, ECT or anti-depressants would have achieved, although initial observation might have indicated their use.

Although such extreme examples are rare, spiritual problems of a lesser degree often trouble patients. The chaplain is thus an integral member of the therapeutic team.

The most important person in the patient’s eyes and in reality is the nurse. She (references to ‘he or ‘she’ are used for convenience and may be interchangeable) is, as it were, the final common path of all treatment, the adviser, the confidante and the support of the patient. She is the person who enjoys, or in troublesome cases endures, the most prolonged contact with the patient. Not only must she be a skilled observer, recorder and technician, but also trained and empathetic in human relationships. The doctor may enjoy more prestige in the patient’s eyes, but he is more remote. The nurse is immediately accessible and available.

Devoted nursing – that is, the kind of loving care, not necessarily skilled, that a daughter might be expected to show towards her aged parent, or a mother her infant – is essential in the case of the totally dependent, whether they be the aged, the physically infirm or the profoundly mentally defective.

The psychiatric social worker may turn out to be the most important person therapeutically, especially with those patients who are the victims of environmental adversity that can only be rectified by knowledgeable intervention before, during or after hospitalization. Who is to care for children whilst their mother is in hospital for much-needed treatment or rest? What are the family dynamics? What about unemployment or sickness benefits? What are the retraining and re-employment possibilities and practicalities?

Then again a patient may be successfully treated for his illness but suffer the demoralizing effects that hospitalization, especially when it is involuntary, tends to have. As a result of this he may be socially incapacitated and require the skills of the occupational therapist in training or re-training in social competence and confidence.

Lastly, the young mentally handicapped must be trained to make maximum use of their limited capabilities. This is the task of special remedial teachers and trade instructors.

That, in summary, is the totality of psychiatric diagnosis and treatment.

This is, for the most part, the story of end-of-the-road psychiatry, of mental hospitals and the rejected ones detained therein: the chronically insane, the grossly defective and the irreparably brain-damaged. In this field there have been greater advances in my own professional lifetime than in all the