Abstract
Australian and New Zealand psychiatry has benefited enormously from the contributions of overseas trained psychiatrists. In the last 20 years Johan Schioldann, a Danish graduate, has worked as a clinician in Perth, Townsville and Adelaide, and as well he has researched and published seminal work on the history of psychiatry, work which has probably been better acknowledged in Europe than in the Antipodes.
As a longstanding friend and colleague of Professor Schioldann, I clearly have a conflict of interest in drawing his work to the attention of Australian and New Zealand psychiatrists. However, perhaps by referring to the reviews of others one can convey the potential importance of his historical review of lithium therapy.
The fellow Dane, Munk-Jorgensen [1], correctly observed: ‘Every psychiatric registrar knows that the effect of lithium in the treatment of affective disorders was discovered by Cade in 1949 and implemented in the clinic by Schou. It is only known to a few, however, that the Danish psychiatrist, Fritz Lange, at Middelfort Psychiatric Hospital, Denmark, in the late 1800s and early 1900s, routinely used lithium in the treatment of affective disorders on the basis of the clinical investigations of periodical depressions by his brother, the famous Carl Lange’. Munk-Jorgensen noted: ‘The book combines scholarly historiography with detective novel surprise and is recommended to all with an interest in the historical background of current psychiatric practice’.
The distinguished British medical historian, Berrios [2], described Professor Schioldann as ‘one of the world experts on the history of lithium therapy’, and stated that his ‘book carries clinical summaries showing that the Langes actually prescribed lithium salts to their patients with periodic depression, and that some actually improved’. In commenting on Cade's precedence in the history of the use of lithium, he noted that ‘those wanting to support Cade might say that the Langes’ reports were poor and they did not include sustained follow ups; or that they did not carry out a “proper trial”; or that they believed in the existence of a condition that Kraepelin had “demonstrated” to be non-existent; or that the uric acid hypothesis was nonsense, etc., etc. An interesting question is how many of these arguments would apply to Cade's report’.
In a further recent review, the American Himmelhoch observed that ‘the clinical observations and orderings of Lange are most original and remarkable. It is surprising therefore that his papers and clinical research ‘have not been given proper recognition for originality’. He noted that ‘the book is very much worth reading not only because it describes the first effective use of lithium salts but also the clinical material is excellent…’ Himmelhoch [3] concluded, somewhat provocatively, that ‘I would guess that Cade himself was well aware of Lange's ideas.’
Dr John Cade has held a special place in the history of Australasian psychiatry, but the assumptions of history, as with science, can be challenged. It can be seen from the reviews of Munk-Jorgensen, Berrios and Himmelhoch that Professor Schioldann's book is an important addition to our understanding of the evolution of the use of lithium in psychiatric practice.