“The Divine Sarah”: Sarah Bernhardt in 1905, at age sixty-one, in Victor Hugo’s romantic drama Angelo. Bernhardt was one of Freud’s favorite actresses; as a postgraduate fellow in Paris in 1886, he saw her perform. (photo credit 7.1)
Some afternoons, Sigmund walked through the grim grounds of the Père-Lachaise Cemetery to pay homage to a large number of recumbent but great French literary, medical, scientific, and artistic lights. On others, he smelled the flowers and greenery of the glorious Tuileries Gardens, negotiated the traffic of the Champs-Élysées, gazed at the “real obelisk from Luxor” in the Place de la Concorde, and sat on hard pews in the Cathédrale Notre-Dame. Less attractive were the Parisians, whom Sigmund found to be “possessed of a thousand demons…they are people given to psychical epidemics, historical mass convulsions, and they haven’t changed since Victor Hugo wrote Notre-Dame. To understand Paris,” he wrote Martha, “this is the novel you must read; although it is fiction, one is convinced of its truth.”
THE SALPÊTRIÈRE WAS one of the largest hospitals in all Europe. As its name implies, it was originally a gunpowder and saltpeter factory but was converted, by order of Louis XIV in 1656, into a giant warehouse for Paris’s most rejected yet still living flesh and bones. At the dawn of the French Revolution, the hospital had a capacity of more than ten thousand patients and at least three hundred prisoners, including some of the city’s most defiled prostitutes. Home to a quivering, teeming mob of the mentally impaired, epileptic, insane, and simply destitute, it was the largest madhouse in the world. But on May 24, 1793, a medical revolution transpired there when the Salpêtrière’s physician-in-chief, Philippe Pinel, descended into the hospital’s subbasement ward of poorly lit and badly ventilated cells. In one of these dank hospital wards, Pinel ceremoniously liberated forty-nine insane patients from the chains holding them down, thus inaugurating an era of humanism toward the mentally ill that has continued in fits and starts for more than two centuries.
The smell that afternoon in 1793 must have been overpowering to the well-bred doctors and students making their historic rounds: rotting feces, fetid urine, and nauseating vomit spilled onto the floor from buckets serving as makeshift toilets; feculent sludge oozed from walls built too close to the city’s sewers, which ran at the same subterranean level. All of these nasal assaults were combined with the sweaty and foul emanations of unwashed patients locked up for years on end. In an era when many considered the cause of ill health to be inhaling miasma and vitiated effluvia—or tainted air—it was little wonder that the doctors attending these patients covered their mouths and noses with scented handkerchiefs, in a misguided effort at self-protection. Other than the physicians, nurses, orderlies, students, and the multitude of inmates, the only other living beings down there were the cockroaches, fleas, and a herd of ferocious rats, which tortured the incarcerated on a regular basis. Dr. Pinel’s removal of the iron restraints binding these unfortunates must have been very welcome indeed, and from every account of the event, all of the patients responded favorably.
Less than a century later, on the morning of October 20, 1885, Sigmund Freud first entered the Salpêtrière. Situated on seventy-four acres and bounded by a grid of cobblestoned streets, its forty-five buildings housed more than six thousand patients. The complex’s grandest suites, wards, clinics, and amphitheaters were reserved for Dr. Jean-Martin Charcot. At its center and replacing the manacles and chains Pinel had once found were rows of polished-wood display cabinets with beveled-glass fronts, their shelves holding cylindrical glass jars; the latter were filled with formaldehyde and the brains and spinal cords of patients who’d failed to be discharged alive. Each jar was pristinely labeled in tiny French script, giving the precise pathological details of the individual’s case. This macabre but impressive hallway—essentially a museum of neurology and insanity—led directly into Dr. Jean-Martin Charcot’s consultation room.
The Salpêtrière Hospital of Paris, where Freud studied under Charcot. (photo credit 7.2)
“Souvenir of the Salpêtrière, 1886. 24 February”: Jean-Martin Charcot nscribed this photograph as a farewell of sorts commemorating Freud’s taking leave of Paris for Vienna. (photo credit 7.3)
Neurology, as a clinical specialty, was in its infancy when Dr. Charcot entered the field. The complex set of diseases met its match in a mind laserlike in focus and as wide as a canyon in terms of what the great physician collected, analyzed, and processed. Charcot was particularly gifted at synthesizing a patient’s signs, symptoms, and medical history and then correlating them to the brain lesions and anomalies he’d found at the autopsy table. His major discoveries included the first definitive descriptions of multiple sclerosis, amyotrophic lateral sclerosis (often referred to as Lou Gehrig’s disease, after the famous New York Yankee first baseman who was diagnosed with it in 1939), and a group of the most common inherited degenerative neurological disorders that still bears his (and his colleagues’) name, Charcot-Marie-Tooth disease.
A mesmerizing speaker, Charcot illustrated his formal tutorials with vivid chalk diagrams he drew on the blackboard while lecturing, never losing his train of thought or misplacing an anatomical structure. A technophile long before the term was coined, he employed the latest lantern slides, lighting techniques, photographs, and clay models. Like many an excellent neurologist, he was a superb mimic of his patients’ symptoms. Each morning, Charcot masterfully demonstrated to his students the limping gait of a polio victim, the storklike walk of someone with end-stage syphilis, the slurred speech of a stroke victim, or the unresponsive face of a person with Parkinson’s disease. Such techniques were neither a form of ridicule nor a means of entertainment. Instead, they were critical tools in teaching nascent doctors to better recognize these diagnostic features in their own patients.
Freud arrived at Charcot’s neurology clinic on the morning of October 20, 1885, and promptly paid a deposit of 3 francs for a key to the laboratory closet and an apron. Soon after, he found Charcot’s chef du clinique, Dr. Pierre Marie, examining outpatients in front of a captive audience of interns and physicians, many of whom came from distant locales and all of whom leaned off their seats with such absentminded intensity that only a few inches of buttocks kept them from falling onto the floor. A valued collaborator of Charcot’s and a skillful neurologist in his own right, Dr. Marie made his name in 1886 by identifying the pituitary gland tumors that cause acromegaly, a rare disorder in which the brain produces too much growth hormone, leading to enlargement of the hands, feet, and facial features, as well as damage to the heart, eyes, and other organs.
Precisely when the clinic’s big wooden clock struck ten, Dr. Marie brought his comments to a rapid close and deferentially stepped aside. Before the second hand had a chance to mark the passage of a single minute, Charcot made his dramatic entrance from a side door. Without looking at his notes, the professor thrust himself into pontificating on a puzzling case with the confidence of a virtuoso playing a Mozart piano concerto. What developed was an intricate rondo of competing stories, one containing the mystery within the patient and the second the physician’s compulsion to unravel that secret. But there was never a doubt as to who was in command and playing the role of featured soloist.
Afterward, Sigmund shyly approached Drs. Charcot and Marie. Summoning up as much courage as he could muster, he presented his impressive credentials and letters of reference to Marie, who quickly read them and handed them to Charcot for the senior professor’s review. After a pregnant pause, the clinical lion warmly welcomed Freud by exclaiming, “Charmé de vous voir.” He then graciously proceeded to advise the young physician about how to make his working arrangements with the chef du clinique and showed Freud around the impressive laboratory and wards. To Sigmund’s great delight, he was accepted into the Salpêtrière “without further ado.”
The bonhomie of Charcot’s clinic must have been remarkably freeing for the tightly wound and repressed Sigmund. On a daily basis, he was exposed to some of the finest clinic
ians and pathologists alive. Instead of feeling snubbed because of his Jewish-outsider status, as in Vienna, Sigmund was welcomed with joyous salutations. Added to this freedom was the French clinicians’ willingness to think outside the box of conventional wisdom and explore such controversial methods as hypnotism and electrotherapy in the treatment of nervous disorders.
The next night, after returning to his hotel room satiated by a hearty dinner with some wine that was “very cheap, a deep red, and otherwise tolerable,” Sigmund wrote Martha a long letter. He described Charcot as “a tall man of fifty-eight, wearing a top hat, with dark, strangely soft eyes (or rather, one is, the other is expressionless and has an inward cast), long wisps of hair stuck behind his ears, clean shaven, very expressive features with full protruding lips—in short, like a worldly priest from whom one expects much wit and an appreciation of good living.”
In an excellent example of the literary abilities that would one day make him world-famous, Sigmund recorded all of Charcot’s mannerisms and actions as he examined patients that morning. The young physician was bedazzled by Charcot’s brilliant diagnostic powers “and the lively interest he took in everything, so unlike what we are accustomed to from our great men with their veneer of distinguished superficiality.” Freud, of course, was always in search of father figures like Brücke, Nothnagel, and Meynert to elevate his spirit and his professional standing. As Martha read Sigmund’s latest dispatch from Paris in her cosseted bedroom in Hamburg, it was clear that Freud had discovered his next hero.
During the following weeks, Sigmund’s emotional geyser continued to erupt. On November 24, he wrote Martha:
I am really very comfortably installed now and I think I am changing a great deal. I will tell you in detail what is affecting me. Charcot, who is one of the greatest of physicians and a man whose common sense borders on genius, is simply wrecking all my aims and opinions. I sometimes come out of his lectures as from out of Nôtre Dame, with an entirely new idea about perfection. But he exhausts me; when I come away from him I no longer have any desire to work at my own silly things; it is three whole days since I have done any work, and I have no feelings of guilt. My brain is sated as after an evening in the theater. Whether the seed will ever bring forth fruit, I don’t know; but what I do know is that no other human being has ever affected me in the same way.
At the same time that Sigmund’s thoughts were expanding with inspiring neurological insights, his brain and body were becoming increasingly accustomed to his favorite chemical substance. He’d likely have brought a supply of cocaine with him from Vienna, but even if he ran out, there were plenty of chemists in Paris glad to sell him more. And, in a pinch, a tasty bottle of Vin Mariani could be purchased and quickly consumed.
Between January and February 1886, Freud was invited to a series of six balls, dinners, and “at homes” at Dr. and Madame Charcot’s palatial residence at 217 Boulevard St. Germaine. On January 18, Sigmund excitedly wrote Martha about an invitation to the neurologist’s home the following evening. Sigmund anticipated his nervousness and told Martha how he planned to pharmacologically alter it:
[Charcot] invited me (as well as Ricchetti) to come to his house tomorrow evening after dinner: “Il y aura du monde.” You can probably imagine my apprehension mixed with curiosity and satisfaction. White tie and gloves, even a fresh shirt, a careful brushing of my last remaining hair, and so on. A little cocaine, to untie my tongue. It is quite all right of course for this news to be widely distributed in Hamburg and Vienna, even with exaggerations such as that he kissed me on the forehead (à la Liszt). As you see, I am not doing at all badly.
In preparation for Charcot’s formal soiree, Sigmund had his hair set and his “rather wild beard” trimmed by a barber “in the French style.” To complete the picture, he donned evening dress, a custom with which he was not yet comfortable despite having spent a huge sum for a brand-new tailcoat. In fact, Sigmund had a devil of a time attempting to tie the white bow tie he had just purchased. After several botched tries, he was reduced to putting on a ready-tied black one he had brought with him from Hamburg. Later, he learned that Charcot, too, could not tie his own bow tie and had had to ask for his wife’s help earlier that evening.
The starry-eyed Freud must have found his first visit to chez Charcot, on January 19, 1886, breathtaking. At one point in the evening, an envious Freud snooped about Charcot’s study. It was, he later told Martha, a “room worthy of the magic palace he dwells in,” divided into two sections: “the larger one devoted to science, the other to comfort [with] two slight projections from the wall [to] mark them off.” Sigmund swooned at the sight of Charcot’s elaborate bookcases stretching from the floor to the house’s second level, “each with steps to reach the upper one,” the stained-glass windows overlooking a leafy green garden, an “enormous long table covered with periodicals and odd books,” Charcot’s writing table, “quite flat and covered with manuscripts and books,” an ornate fireplace, “closets containing Indian and Chinese antiques,” and walls “covered with Gobelins and pictures.”
All of Sigmund’s insecurities screamed at him to self-fortify with cocaine. Whether out of sight in his hotel room, before walking up to the Charcots’ front door, or during the party itself, Sigmund consumed more. As soon as the drug took effect, his pulse began to bound. He sweated profusely, a reflection of cocaine’s elevating effect on internal body temperature. And because cocaine numbs whatever human tissue it touches (the very quality Sigmund had missed but had brought Carl Koller international acclaim), his mouth was dry and fuzzy and his speech was slurred. No amount of swishing his tongue against his teeth and lips or swigs of wine seemed to resolve this oral desiccation. All these signs conspired to reveal that he was under the influence and gave Sigmund good reason to worry about the impression was making. Yet despite having so much at stake, Freud convinced himself that cocaine enhanced his performance at these nerve-racking parties, even as the objective evidence suggested otherwise.
One night in early February, before he went for a return engagement at the Charcot home, he wrote a cocaine-influenced but remarkably self-analytic note to Martha:
The bit of cocaine I have just taken is making me talkative, my little woman. I will go on writing and comment on your criticism of my wretched self.… I believe people see something alien in me and the real reason is that in my youth I was never young and now that I am entering the age of maturity I cannot mature properly. There was a time when I was all ambition and eager to learn, when day after day I felt aggrieved that nature had not, in one of her benevolent moods, stamped on my face with that mark of genius which now and again she bestows on men. Now for a long time I have known I am not a genius and cannot understand how I ever could have wanted to be one. I am not even very gifted; my whole capacity for work probably springs from my character and from the absence of outstanding intellectual weaknesses. But I know that this combination is very conducive to slow success, and that given favorable conditions, I could achieve more than Nothnagel, to whom I consider myself superior, and might possibly reach the level of Charcot. By which I don’t mean to say that I will get as far as that, for these favorable conditions no longer come my way, and I don’t possess the genius, the power, to bring them about. Oh, how I run on!…You know what Breuer told me one evening? I was so moved by what he said that in return I disclosed to him the secret of our engagement. He told me he had discovered that hidden under the surface of timidity there lay in me an extremely daring and fearless human being. I had always thought so, but never dared tell anyone. I have always thought I inherited all the defiance and all the passions with which our ancestors defended their Temple and could gladly sacrifice my life for one great moment in history. And at the same time I always felt so helpless and incapable of expressing these ardent passions even by a word or a poem. So I have always restrained myself, and it is this, I think, which people must see in me.
Here I am making silly confessions to you, my sweet darling, and re
ally without any reason whatever unless it is the cocaine that makes me talk so much.
As Sigmund tells Martha about the “defiance and all the passions with which our ancestors defended their Temple,” he suggests a heroic image of the Jew breaking out of the mortification and repression that was Vienna. Warmed by the glow of intellectual fraternity permeating Dr. Charcot’s salon, Freud began to embrace a mind-set in defiance of the norm; it was a mentality that celebrated his outsider status in the rigid medical profession and yet still clung to the righteous anger that ignited his brilliance. Equally fascinating, Sigmund freely declares his most repressed thoughts, ideas that he “always thought” but had “never dared tell anyone.”
In the short term, of course, cocaine inspires loquaciousness. In many, the drug instantly releases a torrent of repressed thoughts, ideas, or feelings that formerly enjoyed sanctuary. In one sense, Sigmund’s cocaine abuse represents a pharmacologically induced, perverse object lesson about the power of uninhibited expression for gaining access to deeper, unconscious levels of psychological meaning. As Freud was to learn in the coming years, however, the drug-free techniques of talk therapy and free association contain far fewer dangerous side effects than those encountered with regular cocaine consumption.
There is also the notorious “crash” of moods that follows cocaine ingestion, and Freud demonstrates this depressive experience in the reprise of his letter to Martha that night. Upon returning from Charcot’s party that evening, Sigmund wrote:
Thank God, it’s over and I can tell you at once how right I was. It was so boring I nearly burst; only the bit of cocaine prevented me from doing so. Just think: this time forty to fifty people, of whom I knew three or four. No one was introduced to anyone, everyone was left to do what he liked. Needless to say, I had nothing to do: I don’t think the others enjoyed themselves any better, but at least they could talk. My French was even worse than usual. No one paid attention to me, or could pay attention to me, which was quite all right and I was prepared for it.
An Anatomy of Addiction Page 13