Freud: Simply Human and Victim of Cocaine Addiction and Denial Freudwas a cokeheadbetween roughly 1884 and 1896,

when he was in his 20s and 30s and in his major cocaine period, he tended on many days to have a red, wet nose. (Garner, 2011, p. C-1) Freud wrote about Leonardo da Vinci There is no one so great that it would be a disgrace for him to be subject to the laws that govern normal and pathological activity with equal severity. (Gay, 1998 p. 1) Sigismund Schlomo Freud was no exception. Even Freud's genius and his unconscious desire to repress the truth about his true relationship with cocaine couldnt prevent his inner desires and the struggles that accompanied them from working their way to the surface. Although highly self-aware, Freud was simply a human being who fell victim to cocaine addiction and denial. When I set myself the task of bringing to light what human beings keep hidden with him ... by what they say and what they show, I thought the task was a harder one than it really is. He that has eyes to see and ears to hear may convince himself that no mortal can keep a secret. If his lips are silent, he chatters with his fingertips; betrayal oozes out of him at every pore. (Thurschwell, 2009 p.26) To the outside world this was perhaps not as obvious as parapraxis, but a little research into his behavior and enormous body of work tell the story of denial and how his first exposure to cocaine led him to another taste, then another until he acquired a habit which lasted over a decade. The drug made him feel exhilaration and lasting euphoria, which in no way differs from the normal euphoria of the healthy person...You perceive an increase of self-control and possess more vitality and capacity for work...In other words, you are simply normal, and it is soon hard to believe you are under the influence of any drug. (Freud, 1884 pp. 289-314)

2 Freud was a pioneer of research into the properties of cocaine. In fact his review on the properties of cocaine has been described as the definitive description of the effects of cocaine in humans. (Dyke, 1981) He was a proponent of the drug as both a stimulant and analgesic and initially regarded it as something of a panacea for treatment of everything from anxiety, indigestion and asthma, to morphine and alcohol addiction. Long-term use of coca is further strongly recommended and allegedly has been tried with success in all diseases which involve degeneration of the tissues, such as severe anemia, phthisis, long-lasting febrile diseases, etc.; and also during recovery from such diseases. (Freud, 1884 pp. 289-314) He went further to explain why more people werent using coca, given its successful treatment. Coca is a far more potent and far less harmful stimulant than alcohol, and its widespread utilization is hindered at present only by its high cost. (Freud, 1884 pp. 289314) He also claimed cocaine was not addictive. I discoveredin myself and in other observers who were capable of judging such things that a first dose or even repeated doses of coca produce no compulsive desire to use the stimulant further; on the contrary, one feels a certain unmotivated aversion to the substance. - (Freud, 1884 pp. 289-314) Years later in his 1887 article published in the Viennese medical weekly Craving for and Fear of Cocaine, Freud stressed that unsavory reports of cocaine referred solely to misuse of the drug by morphine addicts, most of were physicians, pharmacists, or doctors' wives. He argued: I have countless experiences with the extended use of cocaine in individuals who were not morphine addicts, and have myself taken the drug for months, without feelingor hearing ofany special condition similar to morphine addiction, or of a further use of cocaine. (Bernfeld, 1953, p. 603). Significant for many reasons, but primarily because his use of the word months clearly shows either his wish to appear as though he were not addicted, or his complete denial

3 that he washe had been using the drugs for years by this point, not months. His choice of words also illustrates his desire to separate himself from the others, the addicts. On April 21, 1884, just prior to his first entanglement with the drug, Sigmund Freud was a relatively unknown 28-year-old neuroscience researcher at Vienna General Hospital. He penned the following to his fiance, Martha Bernays: I have been reading about cocaine, the effective ingredient of coca leaveswhich some Indian tribes chew in order to make themselves resistant to privation and fatigue. (S. Freud, personal communication, April 21, 1884) Historical evidence shows people in the Andes began chewing coca leaves around the year 600 and that they were given as offerings, used in religious and burial ceremonies. Freud described the legend of coca as descending from Manco Capac, a figure of Inca mythology, who descended from the cliffs of Lake Titicaca. He wrote I never knew that lake Titicaca was a real place, shows what an ignoramus I am. (S. Freud, personal communication, April 21, 1884) As early as 1861, people began publishing experiments on the effect of cocaine testing on animals. The overall consensus was that it was stimulating in small quantities and paralyzing in large doses. There were reports of convulsions and deaths in rabbits by a Dr, Scroff, but it was Dr. von Anreps work that initially intrigued Freud. Dr. von Anrep issued trials of up to 0.01g/kg a day on animals for up to 30 consecutive days and reported motor stimulation and head swinging but no effects on the bodies of the animals he tested. Of course during the time doctors didnt have access to medical advances we have today such as brain imaging technology that would have shown a very different story.

4 In 1883 the German physician, Theodor Aschenbrandt published The Physiological Effect and the Importance of Cocaine which reported the drugs ability to suppress appetite and increase mental powers and endurance in Bavarian soldiers during military training. On the second day of Marchit was a very hot daythe soldier T. collapsed from exhaustion. I gave him a tablespoon of water containing twenty drops of cocaine muriaticum (0, 5:10). And about five minutes later, T. got up by himself, continued the march for several kilometers to the point of destination; in spite of a heavy pack and the summer heat, he was fresh and in good shape on arrival. (Bernfeld, 1953, pp. 581-582) Less than a month after his first mention of cocaine to his fianc, Freud wrote to her about numerous experiments in which he found the drug effective in relieving his own minor depression, indigestion and anxiety. He gushed: A small dose lifted me to the heights in a wonderful fashion. I am just now busy collecting the literaturefor a song of praise to this magical substance. (S. Freud, personal communication, May, 1884) And in July 1884, he did just that, publishing his now famous monograph ber Coca, a virtual love letter, singing the praises of cocaine in which he described his most gorgeous excitement. ber Coca was highly regarded by his peers and published in a well-respected science journal. It has since been republished in 1984s Journal of Substance Abuse Treatment. 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, writers 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 didnt comprehend the rebound effects that were rendering cocaine a trigger for the very miseries he was treating with it. (Crews, 2011, pp. 17-18)

5 Freud prided himself on his studiousness, scientific acumen and desire to be in control of his faculties. He didnt drink alcohol and rarely listened to music, so its interesting he would hand himself over to a drug like cocaine. But cocaine had no prior reputation and Freud lived in an age when self-experimentation was the norm. He also believed in practice over theory and that theory is all very well, but that does not prevent facts from existing so it would make sense scientifically that he would want to try it on himself as well as observe other subjects. (Gay, P. 1998 p. 51) I have tested this effect of coca, which wards off hunger, sleep, and fatigue and steels one to intellectual effort. and The feeling of excitement which accompanies stimulus by alcohol is completely lacking; the characteristic urge for immediate activity which alcohol produces is also absent. One senses an increase of self-control and feels more vigorous and more capable of work. (Freud, 1884 p. 289-314) When Freud began studying cocaine, physicians were struggling to treat a large population of opium and morphine addicts. In addition, no one knew the consequences of cocaine use and it was as overprescribed as opium and morphine-- one could even buy it at a drugstore without a prescription. Regardless, Freuds simultaneous eagerness to make a name for himself and explore the drug in unconventional ways, as well as his blinding refusal to admit his own ignorance to cocaines detrimental side effects, resulted in dire consequences for his friends, his patients, himself and even the scientific community as a whole. Two situations in particular highlight Freuds struggle with addiction and denial; Freuds treatment of his patient Emma Eckstein, and that of his friend and colleague Ernst Fleischl von Marxow. Freuds Interpretation of Dreams introduced the unconscious to dream interpretation and explained that dreams are all forms of "wish fulfillment," attempts by

6 the unconscious to resolve a conflict. Later in Beyond the Pleasure Principle, Freud would discuss dreams that did not appear to be wish fulfillment. In any event, in this seminal work his model dream was about Irma, his patient Emma Eckstein and a cocaine treatment debacle. (Freud, 1900, p. 107) A large hall - numerous guests, whom we were receiving. Among them was Irma. I at once took her on one side, as though to answer her letter and to reproach her for not having accepted my 'solution' yet. I said to her: 'If you still get pains, it's really only your fault.' She replied: 'If you only knew what pains I've got now in my throat and stomach and abdomen - it's choking me' I thought to myself that after all I must be missing some organic trouble. I took her to the window and looked down her throat, and she showed signs of recalcitrance, like women with artificial dentures. I thought to myself that there was really no need for her to do that. - She then opened her mouth properly and on the right I found a big white patch; at another place I saw extensive whitish gray scabs upon some remarkable curly structures which were evidently modeled on turbinal bones of the nose. - I at once called in Dr. M [who] said: 'There's no doubt it's an infection, but no matter; dysentery will supervene and the toxin will be eliminated.'....We were directly aware, too, of the origin of her infection. Not long before, when she was feeling unwell, my friend Otto had given her an injection of a preparation of propylInjections of that sort out not to be made so thoughtlessly....And probably the syringe had not been clean. (Freud, 1900, p. 107) In reality, Eckstein almost died from an infection from a botched operation per Freuds recommendation. Ear Nose and Throat Doctor, William Fleece invented and performed an unorthodox procedure to treat what he called nasal reflex neurosis by cauterizing the inside of the nose under local anesthesia with cocaine used as the anesthetic. Fleece left a sponge in the surgical site after performing the operation. Today, an error of this magnitude would be considered malpractice. Freuds recommendation to try to cure Ecksteins malady with Fleeces unorthodox cocaine procedure was a failure that, were it not for a third Physician stepping in to save the day, would have likely resulted in her death. It would seem Freud had a vested interest in keeping the situation a secret-- his reputation and career. Instead, almost like a smoke

7 screen, he spotlights the event by allowing it to take main stage in his Interpretations of Dreams. The dream illuminates the responsibility and guilt that Freud felt, that in his conscious waking hours he couldnt admit to himself or society. His response to the dream was even more telling than the dream itself. Although Freud explained There is at least one spot in every dream at which it is unplumbablea navel, as it were, that is its point of contact with the unknown, (Freud, S. 1913) Unavoidably, Freud's own interpretations seem incomplete, leading one to speculate about lines of association that he either fails to recognize or deliberately avoidsSuch is the case with the dream of Irma's injection, which Freud referred to as his specimen dream. (Sprengnether, M. 2003 pp. 259-284) Looking at the dream as wish fulfillment could have been Freuds way to displace some of the blame to others in his dream. Even Freud surmised that the dream shifted blame from himself to Otto and that he had revenged himself in the dream on both Irma and Dr. M. but ultimately concluded that the dream must be interpreted as a manifestation of his deep concern for his friends and patients. (Freud, S. 1989 p.138) Looking through a psychodynamic lens, there wasnt just an unknown spot but a blinding omission of reality and accountability. Freuds feeling of guilt, his desire to place blame outside himself, and his desire to believe had come to terms with the situation is obvious in his letter to Fliess on March 8, 1885, a few months prior to the Irma dream. He wrote about the botched operation So we had done her an injusticethat this mishap should happen to youwhat others could make of ithow wrong I was to urge you to operatehow my intention to do my best for this poor girl was insidiously thwarted and resulted in endangering her lifeI have worked it through by now. (Frieden, K. 1990 pp. 14-15)

8 Freud cared tremendously about his patients, his practice and his reputation. If exposed, he could have lost everything. The conscious reason he gave, his deep concern for his friends and patients, was only a half-truth; His recommendation had nearly cost Eckstein her life and he was riddled with guilt over his negligence. Freud was seemingly unaware of the inner conflict between different parts of his personality, or psyche: the hedonistic and pleasure seeking id, which sought power, wanted immediate results and craved cocaine. The guilt oriented super ego that induced anxiety and demanded he adhere to societys idea of morality, and finally the ego, what Freud called "the reality principle," which worked as a mediator between the two. To simplify, Freuds awareness surrounding cocaine had expanded from what he wanted to how he could get it within accepted societal norms. Social norms are subject to change and vary over time, and what may seem acceptable in one era can be deemed inappropriate in another. Deviance from social norms does not necessarily indicate psychological abnormality. However, Freuds behavior is not simply eccentric or idiosyncratic, it is that of an addict in denial. His hubris with cocaine leads to repetitive negative incidences followed by remorse and feelings of guilt.

Another example is the situation involving his close friend and esteemed colleague Ernst Fleischl von Marxow, an Austrian physiologist and physician known for his investigations on the electrical activity of nerves and the brain. Marxow suffered painful and chronic complications from an accident years earlier. His thumb was amputated after a botched procedure on a cadaver and he developed a harrowing

9 addiction to morphine and heroin as a way to deal with the pain. Freud admired Marxows intelligence and described his friend as: A most distinguished man, for whom both nature and upbringing have done their best. Rich, trained in all physical exercises, with the stamp of genius in his energetic features, handsome, with fine feelings, gifted with all the talents, and able to form an original judgment on all matters, he has always been my ideal and I could not rest till we became friends and I could experience pure join in his ability and reputation. (Jones, 1953, p) Freud believed so strongly in his unorthodox belief that cocaine could be used to wean morphine addiction that he encouraged his ailing friend to undertake treatment. The treatment of morphine addiction with coca does not, therefore, result merely in the exchange of one kind of addiction for another it does not turn the morphine addict into a coquero; the use of coca is only temporary. (Freud, 1884 p. 289-314) Sadly, at only 45 years of age, this is exactly what transpired and Marxow suffered an agonizing death addicted to both drugs. Freud, in essence, transformed his highly functioning, albeit opiate-dependent, friend into an addled cocaine and morphine addict who was dead seven years later. (Markel, 2011, para. 6) It is difficult to say what caused Freuds behavior regarding cocaine. Perhaps he became fixated and regressed back to an oral, anal or phallic stage. He was signaled out as his mothers golden child and given special treatment compared to his siblings, including his own room and the ability to dictate that no music be played in the home, even though his sisters wanted to learn to play the piano. Perhaps his behavior was driven by his genetic makeup. That cocaine was Freuds drug of choice made common sense given his personality. He was notorious for having a strong will and not shy about seeking power in both his career and personal endeavors. In view of the wellknown touchiness and grandiosity of habitual cocaine users, Crews wrote in Physician

10 Heal Thyself, it is hard to avoid the inference that the drug contributed tothe contentious, self-dramatizing, and persecution minded side of Freuds personality. (Crews, 2011, p. 17) He wrote to his fianc and if you are forward you shall see who is the stronger, a gentle little girl who doesnt eat enough or a big wild man who has cocaine in his body. (S. Freud, personal communication, April 21, 1884) Whatever force drove Freuds use and entanglement with the drug, the fact remains that he was a vocal advocate and proponent of the drug, even dispensing it to colleagues and close relations including his sisters and fianc, and himself used cocaine for over ten years until his fathers death. Freud remained in denial, at least to the general public, until his deathbed. In fact, Marie Bonaparte, one of Freuds disciples, bought a collection of Freud-Fleiss correspondence that contained ample references to their mutual use and amorous feelings about cocaine. She alerted Freud of their existence who asked her to destroy them on the basis that they contained material an embarrassing nature. (Streatfeild, 2003 p. 106) Freud, who continued to smoke cigars, battled jaw and throat cancer for sixteen years until he asked his doctor to end his life. He died at 83 years old of a physicianassisted morphine overdose in London on September 23, 1939.*

[*] Peter Gay, Freud: A Life for our Time (1988), citing a work by Freud's personal physician Max Schur, "The Medical Case History of Sigmund Freud", 27 February 1954. From a subsequent lecture given in 1964 by Schur, "On September 21st [Freud] indicated to his doctor that his suffering no longer made any sense and asked for sedation. Given morphine for his pain, he fell into a peaceful sleep and then lapsed into a coma and died at three o'clock in the morning of September 23rd."