TO BE SURE, the effects of professional jealousy or a love affair gone sour eat away at the most stable of human relationships. Yet still another explanation is worth considering. Freud may have felt a need to pull away from Fliess in the years after forsaking cocaine. Many substance abusers predictably share drugs or alcohol with others. Addiction experts today characterize such acquaintances as “using buddies” and insist that terminating these relationships is the sine qua non of successful recovery. This is especially true for a tantalizing drug like cocaine. As recovering addicts have learned the hard way, spending significant time with one’s using buddies all but invites relapse. Any doctor in Vienna at the turn of the last century could have procured as much cocaine as his pocketbook allowed. But there is no question that Freud’s cocaine abuse was often facilitated by Wilhelm Fliess. The two doctors may have even abused the drug together during their many “congresses.” One only wonders if Freud, at some level, appreciated this risk to his sobriety as he converted Fliess from an “intimate friend” into his “hated enemy.”
Sigmund represented many fields of inquiry during his long and productive life, but for much of it he enjoyed his standing as a member of the medical profession. In 1925, Freud glibly recalled that as a young man he did not feel “any particular predilection for the career of a doctor. I was moved rather by a sort of curiosity, which was, however, directed more towards human concerns, than towards natural objects.” Retrospective recollections aside, there can be no question about his profound commitment to being a healer. He was immersed and socialized into the profession during the most formative years of his adult life, a period that coincided with one of the most progressive periods in the history of medicine. Even after years of enduring hostility and verbal abuse from his colleagues, he devoted his life to caring for patients and developing new ways to make them feel better. In 1908, for example, an associate declared his desire to elevate Sigmund’s status to that of a revolutionary moral philosopher. Freud replied, “We are doctors, and doctors it is our intention to remain.”
Freud with G. S. Hall and Carl Jung, front row. Second row, left to right, are some of Freud’s best pupils: A. A. Brill, Ernest Jones, and Sándor Ferenczi. The occasion was the Clark University Vigentennial Celebration, which featured Freud’s lectures on the origins and development of psychoanalysis as well as a symposium on psychology and pedagogy, 1909. (photo credit 11.4)
By understanding the depth of Sigmund’s identity as a doctor, one begins to appreciate why Emma Eckstein so thoroughly haunted his dreams. The cunning Freud, always with his eyes aimed toward posterity, was often less than candid about the actual details of the episode. Nevertheless, it seems almost inevitable that a soul as sensitive as Sigmund’s would frequently revisit it in a distressed state of mind or during his late-night hours of self-analysis. Even as late as 1910, Sigmund confessed to Ferenzci that he continued to be troubled by his relationship with Fliess and, perhaps by extension, the Emma Eckstein fiasco: “That you surmised I had great secrets, and were very curious about them, was plain to see and also easy to recognize as infantile.… My dreams at that time were concerned, as I hinted to you, entirely with the Fliess affair, which in the nature of things would be hard to arouse your sympathy.”
When contemplating or dreaming about the botched nose operation, Sigmund must have realized at some level that had Emma Eckstein died, much of the blame and consequences would have rested upon his painfully rounded shoulders. Such an act of malpractice could only have added to the guilt he felt over the death of his friend Fleischl-Marxow, whom Sigmund had accidentally transformed into a cocaine addict a few years earlier.
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.” Caught in a maelstrom of catastrophe, many substance abusers can be inspired or forced into taking the necessary steps to quit or, at least, temporarily abstain. The bottom that Sigmund experienced featured far more than the physical and mental ravages of consuming too much cocaine; it involved Wilhelm Fliess, Emma Eckstein, and the misguided surgical procedure that nearly took Emma’s life and destroyed Freud’s hard-won career. If he was ever to rid himself of these destructive forces, he needed to abandon cocaine, sever his friendship with Fliess, and alter his experiences with Emma from a clinical debacle into the dazzling thesis that helped shape The Interpretation of Dreams.
BETWEEN 1896 AND HIS DEATH IN 1939, Freud rarely discusses cocaine in his letters or published work. Indeed, he did his best to distance himself from the subject. On occasion, he comments on Koller and the events of 1884–86, spinning tales about missing an important discovery that was literally in front of his nose. At a few other points in time, he mentions recent publications about cocaine that caught his eye. But there are a few instances where he offers far more alluring references to the drug.
In June 1908, Jung was treating a patient named Otto Gross, a physician, psychoanalyst, and colleague of Freud’s, for acute paranoia. Gross also had a long history of active addiction to both cocaine and morphine. Writing to Jung, Freud observed, “I attributed it [Gross’s behavior] to the medication, especially cocaine, which, as I well know, produces a toxic paranoia.” The phrase “as I well know” is alluring, to say the least, but with the distance of time it is difficult to discern whether Freud was referring to his own experiences with cocaine or was basing this comment on his clinical observations of either Gross or Fleischl-Marxow.
Nearly a decade later, in June 1916, Freud explained to Sándor Ferenczi that cocaine, “if taken to excess,” could produce symptoms of paranoia and that those who stopped using the drug experienced severe withdrawal symptoms, often leading to a relapse. He further observed that drug addicts were not very suitable for analytic treatment because every backsliding or difficulty in the analysis led to further recourse to the drug. Only a few months earlier, in February 1916, Sigmund had obliquely written to Ferenczi that his love of cigars kept him from working out specific psychological problems. One wonders whether his compulsive cocaine abuse from 1884 to 1896 was one of those unexplored problems.
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. She may have complained of relentless domestic tasks, but her close attention to the schedules, meals, and virtually every other activity in their spacious flat allowed Sigmund to focus exclusively on his work and patients. Because he conducted most of his career in a set of three rooms directly attached to the family quarters, Martha orchestrated reliable but controlled contact with his children, whom he numbered among the great joys of his life.
From Monday through Saturday, during his working life as a psychoanalyst in Vienna, Freud rose from his bed promptly before seven a.m., bathed, partook of a light breakfast and coffee, and sat for a daily trim of his beard and hair by a barber who made house calls. At eight a.m., Freud greeted his first patient and began a fifty-five-minute analytic session. Once his practice started to flourish, Sigmund saw twelve or more patients a day. He typically took a break from one to three p.m., enjoying a family lunch and a walk to clear his head before returning to his consulting room with the famous couch and more patients to analyze. There were also brief visits with colleagues and his children, trips around the corner to the tobacconist for his daily fix of cigars, perhaps another cup of coffee for energy, lectures to his medical students at the University of Vienna, and an evening meal with the entire family. Virtually every week, he attended meetings of the Vienna Medical Society and the Vienna B’nai B’rith men’s lodge, as well as gatherings of his like-minded colleagues and acolytes eager to discuss psychoanalysis.
Freud and the famous couch, c. 1932. (photo credit 11.5)
This overflowing agenda does not even begin to account
for the time he spent each night, and well into the early morning, reflecting on his psyche and those of others. These were the critical hours when he composed and ruminated over the many books and papers containing his claim to intellectual immortality. From fall to late spring, he limited his recreation to Saturday nights, attending lectures and plays or playing cards and chess, although later in life he claimed to find the latter too stressful a leisure activity. Sundays were supposed to be a sacrosanct day of rest in the company of his beloved children, mother, wife, and friends. More often than not, he managed to steal a few hours away from his self-imposed, secular Sabbath to write a few pages of his latest manuscript. Every summer, Sigmund and his family took a long vacation filled with restorative hikes in the mountains, playful activities with his children, and reading for pleasure.
With Freud’s intense work schedule and the daily demands he made on his mind and body, one could easily argue that there was little room for cocaine abuse. Cocaine may have briefly picked him up and given him energy during the early years of his career, but, especially as he aged, his body began to rebel against the intensely draining peaks and valleys of mood the drug instigated. Cocaine highs resulted in a disjointed prose that was best relegated to the wastebasket. The lows of cocaine abruptly halted the productive commitment of pen to paper and thwarted his ability to complete useful thoughts about the complex topics he tackled. The ever-driven Sigmund, one of the most prolific and persuasive intellectual authors of the twentieth century, simply did not have the time for cocaine’s hour-stealing and rapidly debilitating effects.
All of these exercises—the never-ending demand for new manuscripts, students and patients to see, friends and colleagues to talk with, thinking about his mental health as well as the mental health of others, packaged in predictable routines and demanding constant accountability to so many—served as the ideal therapeutic program he required for his recovery from substance abuse. Admittedly, the precise means Freud used to keep his mind off cocaine were markedly different, if not unique, when compared to the methods of the overwhelming majority of recovering addicts.
One only wishes that he’d had similar fortitude to put down his addictive and cancer-producing cigars, which, beginning in 1923, at age sixty-seven, robbed him of an intact, functioning mouth and forced him to undergo multiple painful surgeries and wear ill-fitting prostheses. On September 21, 1939, a year after he fled Nazi-dominated Austria for London, a cancer-riddled Freud asked his physician Max Schur for a fatal dose of morphine to end his life. Freud was reported to have said, “Schur, you remember our ‘contract’ not to leave me in the lurch when the time had come. Now it is nothing but torture and makes no sense.” Dr. Schur administered a large dose of morphine that day, after which Freud sank into a deep sleep but did not die; a second (and perhaps a third) dose was given the following day, and Freud went into a coma from which he did not awake. He died at three a.m. on September 23, 1939.
THE DIVIDENDS OF SIGMUND’S “recovery program” from 1896 to 1939 are easily quantifiable. These were the years when he became one of the greatest intellectuals of his generation and provided a modern language for understanding the unconscious mind; when his fertile mind brimmed over with new ideas about neuroses, psychoses, sexuality, the development and refinement of the psychoanalytic relationship, and the interpretation of just about everything; and when he delivered countless lectures and led seminars for aspiring therapists, students, and acolytes. All of these accomplishments grew out of his Herculean ability to summon the intense concentration and mental acuity to write book after book—works that continue to shape our beliefs about human behavior and incite heated debate among great minds.
Just as there have been multiple arguments over the veracity of Freud’s ideas, there have been contentious discussions about his cocaine abuse and its influence on his work. One of the most controversial studies was published in 1983 by a British librarian named E. M. Thorton. In a book entitled Freud and Cocaine: The Freudian Fallacy, she presents a disjointed ad hominem brief claiming that all of Freud’s “bizarre set of hypotheses” resulted exclusively from cocaine intoxication and should, therefore, be considered invalid. In recent years, other scholars have offered more nuanced contemplations on the connection of Sigmund’s cocaine abuse to his signature ideas about accessing unconscious thoughts with talk therapy; the division of how our mind processes pleasure and reality; the interpretation of dreams; the nature of our thoughts and sexual development; the Oedipus complex; and the elaboration of the id, ego, and superego. Most intriguing is a theory articulated by the historian Peter Swales that “Freud’s [concept of the] libido is merely a mask and a symbol for cocaine; the drug, or rather its invisible ghost, haunts the whole of Freud’s writing to the very end.”
It is enticing to suggest a causal relationship between Sigmund’s cocaine abuse and the thinking that produced the origins of psychoanalysis. Such a singular answer appeals to the way we humans think but rarely, if ever, explains the human predicament. Although his dependence on the drug and the behavioral highs and lows produced by its abuse were certainly factors in his complex intellectual and psychological life between 1884 and 1896, I remain hesitant to consign Freud’s entire body of work during that period to an endless line of cocaine. For all the reasons enumerated, it appears unlikely that Sigmund used cocaine after 1896, during the years when he mapped out and composed his best-known and most influential works, significantly enriched and revised the techniques of psychoanalysis, and, in keeping with his identification with Sophocles’ Oedipus Rex, attempted to “explain some of the great riddles of human existence.”
That said, we also know that the last four years of the nineteenth century marked a significant period of depression for Freud. Many addicts who give up their drug of choice seek other intoxicants or pleasures, and Sigmund was no exception. There remains the suggestive evidence of a rather risky sexual relationship with Minna Bernays, especially during the summer of 1898 in the Swiss Alps. A year later, Sigmund engaged in a brief attempt to self-medicate away his melancholia by consuming dozens of bottles of wine. It is all but certain that his depression, cocaine urges, occasional binge drinking, sexual affairs, caustic behaviors, and emotional absence negatively affected his wife, children, colleagues, and friends. Recovering alcoholics and addicts today might recognize the Freud of these years as a “dry drunk,” a person who has quit drinking or abusing his drug of choice but is unhappy about it and often makes everyone else around him miserable. In the decades that followed, Sigmund’s constant endeavor at self-analysis may have helped tamp down his desire to abuse cocaine or engage in counterproductive behaviors. But during the early years after quitting cocaine, he must have been difficult to live with.
The clinical odds of beating cocaine dependency are daunting; recent studies of addicts have found that, statistically speaking, fewer than one in four remain sober after five years. One doubts that the chances were that much better in 1896 when Freud testified to putting aside his cocaine brush. Yet many cocaine abusers, past and present, do enter recovery successfully. And with Sigmund Freud, we are describing a self-controlled individual highly motivated to protect grand professional ambitions and treasured personal relationships that were imminently threatened by cocaine.
It is also clear that Freud kept his own counsel as his id battled his ego and superego and he attempted to divine the secrets of others. The precise details of his cocaine use both before and after 1896 may well be among those secrets. Such elusive puzzles recall the historian’s basic dilemma: the absence of evidence does not always signify evidence of absence. In the end, we will likely never know.
CHAPTER 12
Dr. Halsted in Limbo
IN 1905 MARY ELIZABETH GARRETT, heiress to the fortune generated by the Baltimore and Ohio Railroad and a major benefactress to the Johns Hopkins Medical School, commissioned John Singer Sargent to paint a portrait of William Welch, William Osler, Howard Kelly, and William Halsted. That June, Welch
, Kelly, and Halsted sailed for Southampton and traveled to London. There they reunited with Osler, who had left Johns Hopkins a year earlier to become the Regius Professor of Medicine at Oxford, and all four made their way to Sargent’s famous studio at 33 Tite Street, near the Chelsea Embankment.
For days, the physicians sat under a sunlit skylight in a stifling hot, poorly ventilated room redolent with the noxious fumes of oil paint, turpentine, and sweat. Some afternoons all four were in the studio; others, they each came alone. All four doctors agreed to pose in their heavy woolen academic robes and hoods, resplendently lined in satin with the class colors of their alma maters: McGill, Yale, the University of Pennsylvania, and Columbia.
Initially, Sargent could not make up his mind about the painting’s composition. He paced up and down the room, chain-smoking cigarettes, while the doctors, none of them known for their patience, allowed themselves to be positioned and repositioned according to the artist’s latest whim. Sargent was said to have pulled at his hair, exclaiming, “It won’t do. It isn’t a picture. I cannot see just what to do.”
By the time his subjects left the studio and returned to their demanding work, Sargent was on his way to creating a divine gem of portraiture; the painting captures the men’s characters and insatiable lust for inquiry. On a canvas measuring roughly eleven by nine feet, the four doctors are arranged around a book-strewn reading table and an antique Venetian globe so large that Sargent had to chop open the doorway and surrounding wall of his studio to allow for its entry. In the painting’s background hangs a facsimile of El Greco’s Saint Martin and the Beggar. Osler appears as if about to leap to his feet to aid a patient; Welch, the kingmaker, sits satisfied, his fingers resting on the leaves of an open tome; Kelly is beatific, as if he has just “saved” another soul for Jesus. Even truer to life, standing in Welch’s shadow, with a dark, brooding pall cast over his face, is William Stewart Halsted.
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