Physician, Heal Thyself: Part II


In the first part of this essay, a review of books by Gerald Imber and Howard Markel, we saw that William Halsted and Sigmund Freud, though superficially alike in their concern for medical applications of cocaine, were attracted to the drug for different reasons.1 Halsted had one goal in mind, to develop nerve-blocking subcutaneous anesthesia. In contrast, Freud initially seized upon cocaine as a means to private ends: fame, solvency, and a hastening of his long-deferred marriage. When, knowing little about its risks, he employed the drug to treat the morphine addiction of his friend Ernst Fleischl von Marxow in 1884, the outcome was calamitous—a fact that didn’t prevent Freud, in several papers between then and 1887, from continuing to represent the treatment as a major success.

Granger Collection
Sigmund Freud and Wilhelm Fliess, early 1890s

In order to show that normal people have nothing to fear from cocaine, the last of Freud’s cocaine essays cited his own harmless consumption of the drug “for months” (it had actually been more than three years) without his “perceiving or experiencing…any desire for continued use.”2 The preceding papers, in which he had portrayed himself as an experimenter in pharmaceutical research, had already made it clear that since 1884 he had been a consumer of the drug. It was that fact, surely, and not just embarrassment over Fleischl’s double addiction and early death, that later prompted him to purge the telltale papers from his résumé and to dismiss his whole involvement with cocaine as having been only a passing hobby.

The truth about Freud’s cocaine habit was very different. Although the trail of evidence is spotty, it is consistent enough to show, first, that neither Fleischl’s addiction nor the mounting toll of other such reported cases dissuaded Freud from continuing to make use of cocaine for at least twelve years, though possibly with interruptions; second, that his purpose in doing so was primarily self-therapeutic rather than exploratory; and third, that his most intoxicating means of application—brushing the laboratory-grade powder into his nostrils—was practiced during the very years when he was incubating psychoanalytic theory. As for his 1887 denial of attraction to the drug, it bears comparison with a gallantry he had addressed to his fiancée, Martha Bernays, on January 9, 1885: “I think I would give all my cocaine for one hour in Wandsbek.”3

Soon after he first tasted the drug on April 30, 1884, Freud had noticed that it provided a quick high and seemed to banish his headaches, indigestion, depression, writer’s block, and sexual self-doubt. Thus the stimulant quickly became indispensable to the management of his daily life. In spite of ample opportunity for self-observation, he didn’t comprehend the rebound effects that were rendering cocaine a trigger for the very miseries he was treating with it.

According to the official version of Freud’s career, sexuality…

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