Dr. Howard Markel
Editor’s note: Nearly 130 years ago, cocaine was the world’s newest wonder drug – touted as a cure for everything from morphine addiction to tuberculosis. And its biggest supporter was Sigmund Freud.
Whenever Big Pharma unfurls its latest “blockbuster” drug, I am carried back to the era when the biggest wonder drug on the market was cocaine. Yes, cocaine!
In the early 1880s, pharmaceutical houses touted it as a cure for everything from morphine addiction and depression to dyspepsia and fatigue. It was widely available in tonics, powders, wines and soft drinks before its mass consumption created a cadre of raging addicts demanding medical attention.
One of cocaine’s leading medical advocates was a struggling Viennese neurologist named Sigmund Freud. He began studying cocaine’s effects in 1884, and his clinical notebooks amply demonstrate that his favorite experimental subject was himself.
The evolution of the once ‘wonder drug’
Initially, Sigmund was eager to employ cocaine as an antidote for his best friend’s morphine addiction. Ernst Fleischl-Marxow was a brilliant physiologist who injured his thumb while dissecting a cadaver, resulting in chronic pain tamed only by large doses of morphine.
Substituting one addictive drug for another was a common means of treating substance abuse in the late 19th century. What all these well-intentioned games of medical musical chairs did most reliably was to create “new and improved” addicts.
Freud, in essence, transformed his highly functioning, albeit opiate-dependent, friend into an addled cocaine and morphine addict who was dead seven years later at age 45.
One would think that this episode would have soured Freud on the drug. Yet like most humans ensnared by cocaine’s addictive grip, for the next 12 years, he continued to sing its praises and consumed a great deal of cocaine to quell his physical aches and mental anxieties. In a perverse way, Freud loved how cocaine made him talk endlessly about memories and experiences he previously thought were locked in his brain for no one to hear, let alone judge.
Freud’s most haunting encounter with the drug occurred in 1895 after he and a colleague named Wilhelm Fleiss nearly killed a patient named Emma Eckstein with a botched operation and too much cocaine. Several nights later, he had a disturbing dream about a party where Eckstein blamed Freud for his gross negligence.
Today, Eckstein is better known as “Irma,” the pseudonym Freud gave her in his masterpiece, “The Interpretation of Dreams.” When writing about his dream, Freud glossed over his obvious malpractice, an act that today would have resulted in disgrace, loss of medical license, lawsuits and even jail time.
Instead, Freud explained the dream meant he was a caring doctor who was, if anything, overly concerned about his patient, “Irma.”
Like so many others, Freud suffered from the most maddening symptom of addiction: the stealthy process by which the addict’s mind conspires to convince that nothing, nothing at all, is askew or dangerous about something that most decidedly is.
Indeed, if one set out to design addiction as an implacable disease, he would be hard pressed to come up with a more diabolical symptom than denial, the need to lead a double life – feeding the addiction in private while struggling to starve, or at least conceal, it in public for long periods of time.
Until, that is, the addiction completely takes over with disastrous results and public masquerade is no longer possible.
One assumes that his clinical experiences with Eckstein, if not Fleischl-Marxow, taught him that cocaine was far too dangerous for any therapeutic application. In the fall of 1896, the day after his father’s funeral, Freud claimed to have put his “cocaine brush” aside. No documentary evidence exists to refute his testimony.
But for the remaining days of his life, Freud had far greater difficulty in fully comprehending the dangerous consequences of his substance abuse. He decidedly, and repeatedly, misinterpreted his famous dream of cocaine. Instead, he chose to elaborate a far more flattering and positive analysis that epitomizes an addiction’s power of subterfuge.
The man who invented psychoanalysis, a revolutionary pursuit for self-truth, succumbed to the same “big lie” most every practicing addict tells himself every day.
Dr. Howard Markel, a professor of the history of medicine at the University of Michigan, is the author of “An Anatomy of Addiction: Sigmund Freud, William Halsted, and the Miracle Drug Cocaine” (Pantheon)