In response to:

Physician, Heal Thyself: Part II from the October 13, 2011 issue

Physician, Heal Thyself: Part I from the September 29, 2011 issue


Rue des Archives/Granger Collection

Sigmund Freud posing for a portrait bust by Oscar Nemon, Vienna, 1931

To the Editors:

Most of us thought that the “Freud Wars,” fought in large part on the pages of The New York Review of Books during the 1990s, had long ended. Unfortunately, Frederick Crews’s two-part review of my book, An Anatomy of Addiction [NYR, September 29 and October 13], attempts to reignite historically contingent battles over the validity of Sigmund Freud’s psychoanalytic theories.

My book has no such purpose. It is a cultural and social history of cocaine abuse and, using the clinical histories of Drs. William Halsted and Sigmund Freud, how medical understandings of addiction have changed over time.

More problematic is how often Crews enlists trivial or unsubstantiated errors in my book in service of his antipathy for all things Freudian.

For example, Crews insists Freud was only interested in cocaine as a “novelty that could lift him out of poverty” and had no interest in treating his friend and colleague Ernst von Fleischl-Marxow for morphine addiction. This is incorrect. Freud clearly contradicts Crews’s assertion in the Library of Congress archival copy of a letter Sigmund wrote to Martha dated April 21, 1884, and in the Ernst Freud edited, translated, and published version of the same letter.

Crews claims that I misclassify Freud as a cocaine addict. I expressly avoid applying that diagnostic term to him. As I discuss in An Anatomy of Addiction, medical doctors and substance abuse professionals have long attached separate and distinct meanings to the terms “addiction” and “substance abuse.” The former is defined by a loss of control and impairment of one’s mental faculties with continued use; the latter refers to use with adverse consequences. Freud would not be diagnosed as an addict by a physician today, let alone in 1885. Freud abused the drug, possibly to the point of dependence, between 1884 and 1896. Despite claims to the contrary, there is no sustaining medical evidence of cocaine abuse after that point.

I am grateful to Crews for pointing out that I mistakenly exchanged G.D. Searle’s name with that of his grandson John. I inadvertently dropped a word, an indefinite article, a comma, and a period in a quote by Halsted and misspelled the surname of E.M. Thornton. I also agree that Gerald Imber wrote a fine biography of William Halsted; I did not mention it in An Anatomy of Addiction because it was published after my manuscript was in production. In the book’s next printing, I will, of course, correct these and the other minor typographical mistakes he notes in his essays but they will not affect my argument.

An Anatomy of Addiction is about the risks of self-experimentation in the name of science; how even the most astute or talented, such as Freud and Halsted, can fall prey to mind-altering drugs; the secrecy, shame, and tragedies that typically accompany substance abuse problems; and the remarkable struggle required of those who try to tame their drug abuse or addictions into some semblance of recovery.

Crews is entitled to pursue his skirmish against the “pseudoscience” of psychoanalysis. But the irony of his rhetoric is too rich to ignore. Crews’s notions about Freud’s ideas and their relationship to cocaine abuse are simply that—notions that are scientifically and medically impossible to prove.

Howard Markel, M.D., Ph.D.
George E. Wantz Distinguished Professor of the History of Medicine
Professor of Psychiatry
Professor of Pediatrics and Communicable Diseases
Professor of Health Management and Policy
Director, Center for the History of Medicine
The University of Michigan
Ann Arbor, Michigan

Frederick Crews replies:

Howard Markel seems to be hoping that readers won’t have seen the annotated versions of my two articles at nybooks.test. Those texts document and expand upon his unwarranted assumptions, his biographical errors (one note lists ten of them), and his failure to have even noticed the existence of recent editions and studies that are essential to his topic. His patronizing letter evades these matters, which are rather more important than the correct spelling of “Thornton.” Nor does Markel dispute my other charges that his quotations and citations are undependable: that he is unfair to the predecessors whom he does cite, that his boast of having done extensive research in unpublished Freud materials is a sham, and that he has failed to support his categorical assertions that Freud injected himself with cocaine, took ever greater quantities of the drug, and conducted multiple extramarital affairs.

The Freud wars are indeed over. (Just ask any research psychologist who isn’t also a psychoanalyst.) It is difficult, however, to write social history involving Freud without implying an opinion about his alleged discoveries and cures, independent evidence for which is lacking. Markel’s Freud, once freed from befogged cocaine dependency and embarked upon psychoanalysis with amazingly unimpaired intellectual powers, is the hero concocted by Ernest Jones in the 1950s—an “unabashed medical genius,” in Markel’s gushing phrase, who bestowed his “healing gifts” on the world. A large body of scholarship, overlooked by Markel, has long since put such vacuous propaganda to rest.


Was Freud a cocaine addict? My complaint wasn’t that Markel misclassified Freud as such but that he waffled on the issue, sometimes implying that Freud’s habit went well beyond merely occasional abuse. Significantly, reviewers of An Anatomy of Addiction (note the title!) have inferred that Freud was addicted to cocaine until 1896 and that he then entered what Markel calls a “‘recovery program’ from 1896 to 1939.” Perhaps the reviewers were misled by such language and by passages like these:

At some point in every addict’s life comes the moment when what started as a recreational escape devolves into an endless reserve of negative physical, emotional, and social consequences. Those seeking recovery today call this drug-induced nadir a “bottom.”…The bottom that Sigmund experienced featured far more than the physical and mental ravages of consuming too much cocaine….

Most recovering addicts insist that two touchstones of a successful recovery are daily routines and rigorous accountability. Fortunately for Freud, Martha managed the household at Berggasse 19 with precision.

As for Ernst Fleischl von Marxow,* I didn’t write that Freud “had no interest” in treating him. Obviously, Freud had all too much interest in doing so. But his biographers agree, contra Markel, that the initial attraction of cocaine was the prospect it offered of advancing his own career. The letter of April 21, 1884, is quite clear on the point. To get Fleischl off morphine with the aid of cocaine would be a benefit, Freud told his fiancée, but not the main one: “We need no more than one stroke of luck of this kind to consider setting up house.”

Finally, Markel asserts that Gerald Imber’s Genius on the Edge was published too late to be mentioned in An Anatomy of Addiction. The first book appeared on February 2, 2010; the second, on July 19, 2011. Do the math and draw your own conclusion.