The Lithium Saga

The use of lithium as an effective treatment for bipolar disorder was discovered in 1949 by the Australian John Cade MD. It would be nice to say that a whole new era immediately opened up for bipolars, but the unfortunate truth is that lithium only became commonly available for treatment in the US in the mid-seventies.

The lithium saga is told in Frank Mondimore MD's recent book, "Bipolar Disorder: A Guide for Patients and Families" (Johns Hopkins University Press). While Dr Mondimore reveals nothing new here, his retelling provides a bitter object lesson object lesson for all of us. The psychiatric profession back in the fifties and sixties was stuck in its Freudian couch phase, and bipolar was regarded as some form of extreme personality disorder rather than a biological malfunction of the brain.

That is, if the shrinks bothered with diagnostic criteria at all. In the name of rooting out childhood traumas, undiagnosis or misdiagnosis was the order of the day. Meanwhile, in Europe, a Danish psychiatrist, Morgans Shou, took up the cause of lithium, but it wasn't until 1970 that his work was given respectability in a British medical journal. The major hurdles had been cleared. A new day was about to dawn.

Meanwhile, Over at Another Book ...

Many of you probably read Katharine Graham's memoir, "A Personal History", when it came out two years ago. Ms Graham is best known as the publisher of the Washington Post, the paper that cracked open the Watergate scandal that brought down Richard Nixon.

She was also married to Phil Graham, the brilliant and charismatic Harvard Law graduate, and close confidante of both JFK and LBJ. Phil Graham also had bipolar. As Kathryn Graham describes it, Phil's psychiatrist didn't believe in medications. Why would he? This was the fifties and sixties now. By the time he was diagnosed it was already too late. His condition had deteriorated to the point where he was engaging in erratic behavior and making a spectacle of himself in public. In the end, he had to take extended leaves from running the family newspaper, sometimes in the hospital, sometimes out at their estate in rural Virginia outside Washington DC.

So it happened one fine day that Katharine heard a gun go off in the other room. In spite of having everything he had to live for, Phil Graham's brain had convinced him otherwise. And now no one on earth could help him

Keep in mind that lithium had been discovered as being effective in the treatment of bipolar some 16 or 17 years earlier. Yet Phil Graham, for all his wealth and personality and brilliance, would not have access to this simple salt found everywhere in nature. Nor would anyone else of his generation in the US, not for another good ten or twelve years.

And Back to Mondimore's Book

One possible reason for the slow acceptance of lithium, Dr Mondimore explains, is its high toxicity and the fine line between a therapeutic and fatal dose. But this explanation only begs the question, for doctors have been prescribing poisons and other harmful agents in the treatment of other diseases since the beginning of time. No, when we consider the times back then - when people with bipolar were often confined to institutions and force-fed knockout drugs and physically restrained and given jolts of electricity to their brains by then crude techniques or sometimes lobotomized - one can only question whether psychiatry had the safety of the patient at heart.

And the Lesson to be Learned Is ...

It took some twenty-five years for one simple life-saving treatment to be made available in the US. During that time many many good people needlessly died and many more suffered in their own private hells, their lives in ruins, never mind the grief and anguish it caused their families. Let's not allow something similar to happen again.

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Discussions

Melike (Oct 10, 2002): As a bipolar, I've been on Lithium for about 1 year now and as a short-term side effect, I've gained excessive weight although I have restricted myself on strict diet without sugar, carbohydrates). As I surf on internet for lithium, I've seen that the side effects both long-term and short-term) are underestimated. And another opinion of mine is that lithium and other anti-depressants mostly do not treat the illness but only abolish symptoms to some extent for the patient in order for him or her to cope with the outside world.
ANOTHER IMPORTANT SIDE EFFECT OF LITHIUM IS: As you are cured of the symptoms of bipolar depression, you feel yourself unusually insensitive, rational, objective to all sorts of phenomena in the world, i.e. death, love, anger, etc. Thus, your emotions are blocked in a way. I want this matter to be discussed, if you can arrange, on your Newsletter. I want to hear more about these complaints from other Lithium users all over the world.

McMan (Oct 10): Hi, Melike. You may want to see how a lower dose (under your doctor's supervision) works. Your next option would be to try a different mood stabilizer. All bipolar meds have heavy duty side effects profiles, so the trick is to find the one (or combination) that works for you that you can tolerate. We're all unique, so unfortunately finding the right combination is hit and miss. Please check the Treatment section of this website for a more detailed discussion on bipolar meds.

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John McManamy

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