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BYMIKEJAY

C

OCA-COLA, we are of-
ten reminded, used to
contain cocaine. Less
frequently do we recall
that the recipe for 7 Up
once included lithium. Just as Coca-
Cola was part of a late-19th-century
vogue for stimulant drinks, 7 Up was
one of many products, including lith-
ium waters and lithium beers, pro-
moted in the early 20th century as
a calming tonic. Lithia Springs, Ga.,
became a booming resort on the
strength of its lithium-rich waters:
A direct train from New York trans-
ported the wealthy, including several
presidents—Cleveland, McKinley,
Roosevelt and Taft—to its spas.
Lithium, a silvery-white metallic
element, is abundant in natural
sources, including rocks and sea-
water. It is highly reactive, however,
and was only discovered in its
pure form in 1817. By the time of
the lithium health craze, lithium
had established industrial uses in
ceramics, glassmaking and lubri-
cants. Its electroconductive prop-
erties have since made it an impor-
tant component of batteries and
cellphones.
In 1949 an Australian psychiatrist
named John Cade made the curious
discovery that lithium was extremely
effective in treating mania. As the
psychiatrist Walter Brown writes in
his thorough and highly readable
“Lithium: A Doctor, a Drug, and a
Breakthrough,” this was “the first
demonstration that a drug can alle-
viate the fundamental symptoms of
a mental illness.” It was followed by
a succession of psychotropic drugs
that transformed the landscape of
psychiatry—which until then had
been dominated by psychoanalysis—
into the pharmaceutically driven
profession of today.
Yet lithium’s story is not the tri-
umphant march of an irresistible
new wonder drug. It was promptly
abandoned by its discoverer and
largely ignored by the psychiatrists,
despite increasingly persuasive evi-
dence of its efficacy. This was partly
due to bad timing and partly to
problems with dosage and toxicity.
But the major obstacle was that
lithium, as an element, could not be
patented, a factor that continues to
limit its use today.
Cade was a provincial doctor
with, as Dr. Brown puts it, an “incli-
nation to thoroughly examine the
world around him” and “an aptitude
for taking in the unforeseen.” His

early papers considered the role of

vitamins and nutrition in disease,

a phenomenon he observed during

World War II while interned by the

Japanese in Singapore’s notorious

Changi Prison.

Cade’s study of deficiency dis-

eases such as pellagra and hypo-

thyroidism convinced him that some

mental illnesses had a biological

basis. By collecting urine samples

from patients in the mental hospi-

tal where he worked and injecting

the samples into guinea pigs, he

established that the urine of those

patients diagnosed with mania was

particularly toxic. Following a

rationale that remains somewhat

murky, he focused his research on

lithium salts. He began by testing

safe dosage levels on himself and

subsequently on patients in his hos-

pital. The first patient, whom he

referred to as “W.B.,” had been in a

chronic state of mania for several

years, but after a course of lithium

treatment was able to leave the

hospital and resume his old job.

Despite this spectacular early

success, Cade’s discovery bore no

further fruit. The vogue for lith-

ium tonics had already extended to

lithium compounds being used as a

substitute for table salt in dosages

that proved toxic and led to lithium

being banned from beverages by

the U.S. Food and Drug Adminis-

tration. Dosage was also a problem

for Cade’s research, as the drug

accumulated in the body during ex-

tended use. In 1950 W.B. developed

seizures, became comatose and even-

tually died from lithium poisoning.

Cade never mentioned this in his

subsequent papers and lectures,

but he banned its use in his own

hospital.

His work was soon picked up by

Mogens Schou. In 1954 the Danish

psychiatrist tested lithium in ran-

domized controlled trials, the first

to be carried out in psychiatry,

which confirmed the drug’s remark-

able efficacy. Schou established a

safe dosage level and a blood-serum

test to monitor it, and made the

further discovery that lithium not

only relieved the symptoms of mania

but acted as a prophylactic against

its recurrence.

Mind in Motion

By Barbara Tversky

Basic, 375 pages, $32

BYIANGROUND

H

OW ARE we to think
of how we think? Are
our minds a separate
internal world in
which we manipulate
mere proxies—symbols, ideas, repre-
sentations—for real things? Are they
software running in the brain whose
connection to the real, “external”
world is then a further mystery in
need of explanation? Or is it rather
that we are embodied all the way
down , such that even our most
abstract thoughts—about mathe-
matics, say, or relations between
ideas—are still creatures of our crea-
turely nature?
In “Mind in Motion,” the distin-
guished cognitive scientist Barbara
Tversky makes the case that our em-
bodiment as living, acting creatures
is no mere add-on to our problem-
solving cognitive capacities. Rather,
she argues, the fact that we live and
move and act in a physical world
is fundamental, in very particular
ways, to the very nature of our
thought. Moving beyond theory, she
draws lessons about how to design
education, our environment and our
problem-solving strategies to help
us to live and think better.
Connoisseurs of TED talks and
popular books about cognitive sci-
ence will find some familiar exam-

ples here, including research about

cognitive biases, the patchy struc-

tures of attention, the active charac-

ter of sensory perception and so on.

There are also provocative discus-

sions of comic books, calendars and

cartography, and lessons from artists

and writers of instruction manuals.

Though these have much intrinsic

interest, Ms. Tversky’s examples are

more persuasive when they draw on

her own research on, for example,

our navigational abilities. She has

shown that we happily make sense

of perspectives that mix our own

(“egocentric”) position—turn right

and then left—with a neutral (“allo-

centric”) reference frame—turn

north, then west: a result that un-

dermines a presupposition in psy-

chology and linguistics that “we

need a uniform, coherent perspec-

tive not only to talk and understand

but also to think.”

Ms. Tversky’s prose is energetic

and muscular, constantly moving to

make new connections. In one of

several lists of verbs that we use to

describe our thinking, she writes

that “we arrange and rearrange,

enlarge, stretch, reverse, join, copy,

add, scramble, subtract, lift, glue,

push, fold, mix, toss, embellish, sep-

arate, nail, scatter, bury, eliminate,

turn, elevate, and poke holes in both

real objects and mental ones.” This

has its own kind of poetry, almost

enough to quiet a worry about why

everyday talk about our cognitive

processes—what is sometimes called

“folk psychology”—should lead to

hard conclusions about our cog-

nition. Of course, it is of interest

that we use action and spatial meta-

phors to characterize thought. But

we might wonder whether there

is any well of metaphor we could

draw from that is not somehow con-

nected with the ways we exist in the

physical world.

Ms. Tversky succeeds in assem-

bling from a vast range of sources

plenty of evidence for something

within touching distance of her cen-

tral claim. There is an interesting

discussion of research on how land-

marks anchor our judgments of dis-

tance. We are inclined, for example,

to think that the distance between

Jack’s apartment and the Empire

State Building is shorter than the

distance between the Empire State

Building and Jack’s apartment.

Yet the argument seems some-

times to lightly dance from one meta-

phor to another, as stepping stones

across deep waters. Ms. Tversky

avoids bringing to bear the more

general theoretical and philosophical

context for her work. Thus she makes

only passing reference to the intellec-

tual movements that have shaped the

history of the cognitive sciences, and

none to those that have for some

years been reshaping broader philo-

sophical conceptions of mind.

Furthermore, there remains some

mystery at the heart of the book

about the relationship between its

key concepts. The central concept is

action—though it is not quite clear

how this is distinguished from mere

that are still latent in the cogni-

tive sciences. Mind is conceived of

as an engine for processing exclu-

sively internal representations—

what were once called “ideas”—with

Ms. Tversky adding the notion that

this processing is shaped by our

having bodies and moving in space

and time. This is rather like saying,

to adapt a remark by the philoso-

pher Mary Midgley, that the inside

of the teapot is shaped by the out-

side. Overcoming that unnecessary

division may require more radical

reorientations in our thinking.

There are some tantalizing signs

that Ms. Tversky understands the

conventional picture needs rethink-

ing. “The mind is too small,” she

writes at one point; “the world has

far more space.” That is, we don’t

process a separate internal model of

the world but actively use the world

itself to do cognitive work: texts,

pictures, gestures, arrangements of

objects and so on. But she quickly

reverts to the more mainstream

thought that we use the world to do

the work only when our cognitive ca-

pacities are overloaded. The trouble

is that this contention is quite differ-

ent from claiming that the world and

our actions are implicated in the

very possibility of thinking.

Ms. Tversky has written an im-

pressive, passionate and mildly he-

retical romp through cognitive sci-

ence. Not long ago, it was considered

intellectually sophisticated to believe

that while computers might one day

think, dogs don’t. We humans are,

like other thinking creatures, cogni-

tive animals, and not merely soggy

computers. Every reminder of that

fact deserves, like this high-spirited

account, to be warmly recommended.

Mr. Ground is a research fellow

in philosophy at the University of

Hertfordshire.

No Ideas

But

In Things

GETTY IMAGES

movement. For much of the book,

however, she focuses on how our

cognition is informed by the spatial.

It is true that we act or move in

space, but does that mean that ac-

tions shape thought or that space

does? Even then, dealing with the

spatial, the emphasis is almost en-

tirely on the visual, with only pass-

ing references to touch: what is

called the “haptic.” We are left to

wonder whether our haptic judg-

ments, about the center of gravity of

an object we hold in our hands, say,

are structured by space or the visual

or bodily activity.

Perhaps part of the problem here

is that Ms. Tversky has not com-

pletely freed her thinking from the

oversharp divisions between mind

and body, representation and world,

The fact that our brains

are in bodies shapes

how they think. We are

cognitive animals, not

merely soggy computers.

Lithium

By Walter A. Brown

Liveright, 222 pages, $27.95

Schou’s attempts to establish lith-

ium therapy was met with resistance

from within the psychiatric profes-

sion. A 1968 Lancet article suggested

it was “another therapeutic myth”

being pushed aggressively by a small

cadre of “enthusiastic advocates.”

Dr. Brown, who at the time was be-

ginning his own psychiatric train-

ing at Yale, recalls that he “was

instructed to treat depressed pa-

tients in line with the prevailing psy-

choanalytic formulation” and “was

encouraged to avoid or minimize the

use of psychiatric drugs.”

Larger and more rigorously de-

signed trials eventually swung the

balance of medical opinion toward

lithium. Yet no pharmaceutical com-

pany filed a new-drug application

with the FDA until 1970, at which

point the FDA approved its medical

use. Uptake remained slow, especially

in the U.S., where it was undercut in

the 1980s by the arrival of valproate,

a compound with no great thera-

peutic advantages but one that could

be patented and that the pharma-

ceutical industry promoted heavily.

Today, lithium inhabits a psychi-

atric world that is in many ways

the opposite of the one in which it

emerged. Psychoanalysis has given

way to biomedicine, and lithium

competes in a teeming marketplace

of medications. Yet it remains an

anomaly. In Dr. Brown’s assessment,

it is “uniquely specific” in its action,

“effective only in manic-depressive

illness” (now commonly known as

bipolar disorder). But despite its

chemical simplicity, we still have

no idea how it works. Nor has it

revealed a biological cause for bi-

polar disorders.

At the same time, recent research

has validated the old idea that small

quantities of lithium are broadly

beneficial to health. It appears to

preserve and foster the growth of

nerve cells, and areas where the

water has higher lithium levels show

lower suicide rates. It seems at small

doses to be a general mental tonic,

much as advertised during the last

century by the “lithiated lemon-lime

soda” sold as 7 Up.

Mr. Jay is the author, most

recently, of “Mescaline: A Global

History of the First Psychedelic.”

A Mysterious Balm for Mania

UP AND DOWN John Cade in 1974. The Australian psychiatrist recognized lithium’s medical potential.

NEWSPIX

The naturally occurring

element is effective in

treating bipolar disorder.

But scientists still have

no idea how it works.

BOOKS

‘It’s terrible to think that all I’ve suffered and all the suffering I’ve caused might have arisen from the lack of a little salt in my brain.’—ROBERT LOWELL