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  1. jon-q
    On April 21, 1884, a 28-year-old researcher in the field now called neuroscience sat down at the cluttered desk of his cramped room in Vienna General Hospital and composed a letter to his fiancée, Martha Bernays, telling her of his recent studies: “I have been reading about cocaine, the effective ingredient of coca leaves,” Sigmund Freud wrote, “which some Indian tribes chew in order to make themselves resistant to privation and fatigue.”

    Less than a month later, Freud was writing to Bernays about the many self-experiments in which he had swallowed various quantities of the drug, finding it useful in relieving brief episodes of depression and anxiety. Later, he described how “a small dose lifted me to the heights in a wonderful fashion. I am just now busy collecting the literature” — in German, French and English — “for a song of praise to this magical substance.”

    That song of praise was “Über Coca,” a monograph published in July 1884 in a highly regarded journal. In his perceptive new book, “An Anatomy of Addiction,” Howard Markel points out that this landmark essay — Freud’s first major scientific publication — was in fact a turning point for the young scientist. “The most striking feature of ‘Über Coca’ is how Sigmund incorporates his own feelings, sensations and experiences into his scientific observations,” Markel writes. “When comparing this study with his previous works, a reader cannot help but be struck by the vast transition he makes from recording reproducible, quantitatively measurable, controlled laboratory observations to exploring thoughts and feelings. In essence, ‘Über Coca’ introduces a literary character that would become a standard feature in Sigmund’s work: himself. From this point on, Freud often applies his own (and later his patients’) experiences and thoughts in his writings as he works to create a universal theory of the mind and human nature. It was a method that for its time would prove scientifically daring, at times somewhat incautious, and, in terms of the creation of psychoanalysis, strikingly productive.”

    Thus does Markel set the scene for his absorbing and thoroughly documented account of the ways in which cocaine may or may not have influenced Freud’s transformative notions of psychology, and most certainly did shape the pathbreaking American surgeon William Halsted’s vast contributions to the development of surgery.

    Though some of Freud’s major biographers — most notably the British historian Peter Swales — remain convinced of the influence of the drug on Freud’s entire edifice of psychoanalytic thought, most agree with Markel’s conclusion that he completely stopped 12 years of what Markel calls “compulsive cocaine abuse” in 1896, just as he was beginning to formulate the concepts that laid the groundwork for his historical legacy. During the period of Freud’s addiction (or, at the very least, abuse), he wrote frequently about cocaine, making plenty of references to its debilitating effect on his clarity of thought. But the drug is rarely mentioned after 1896. That was the year in which two major events occurred in Freud’s life. The first was the publication in a French medical journal of his influential article “The Aetiology of Hysteria,” in which the word “psychoanalysis” is used for the first time; the second was the death of his father. Freud was no doubt influenced by having been close witness a few years earlier to the anguished death of one of his dearest friends, the accomplished young phsyiologist Ernst von Fleischl-Marxow, whose morphine addiction Freud had tried to treat with cocaine, with disastrous results. As Freud wrote almost three decades later, “the study on coca was an ¬allotrion” — an idle pursuit that distracts from serious responsibilities — “which I was eager to conclude.”

    Markel, a professor of medical history at the University of Michigan who has also done clinical work involving the treatment of addicts of all sorts, has instructive ways of explaining Freud’s method of turning away from what he had by then realized were the deleterious consequences of drug use. “Most recovering addicts,” he writes, “insist that two touchstones of a successful recovery are daily routines and rigorous accountability.” Around 1896, Freud began to follow a constant pattern of awakening before 7 each morning and filling every moment until the very late evening hours with the demands of his ever enlarging practice (he was soon seeing 12 or more patients per day), writing, lecturing, meeting with colleagues and ruminating over the theories he enunciated in such articulate literary style. Markel concludes: “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 . . . attempted to ‘explain some of the great riddles of human existence.’ ”

    As Markel shows, the addiction of Freud’s contemporary William Halsted played out very differently. Halsted was a consummately brilliant and flashy surgeon who had captained the Yale football team and then gone on to medical training in New York, where he soon established a reputation not only for his operative skills and speed but for the outgoing personality that distinguished him as a bon vivant and hail-fellow-well-met. In 1884, while working mainly at Bellevue Hospital, he and a small group of rising young doctors began to self-experiment with cocaine, in order to develop techniques that would permit surgery on the extremities and other areas whose nerve supply could be blocked by direct injection of the drug. Unaware of its dangerously addictive qualities, each of the young men gradually fell under its diabolical spell.

    After several failed attempts to break his habit, including two long hospitalizations, Halsted was invited in 1888 to do laboratory research at the newly established Johns Hopkins Hospital, where his talents brought him an appointment two years later as chief of surgery. But those talents were of a different sort from the ones that had made his reputation in New York. The operating technique of the now reclusive surgeon had become meticulous to the point of painstaking slowness, characterized by minute attention to detail that enabled him to perceive the physiological characteristics of tissues and of wound healing that eluded his speedier, less observant colleagues. Working with single-minded patience, he developed a wide range of unique methods whose therapeutic results, abetted by the punctilious, biologically-based skills that became known as Halstedian technique, were remarkably improved over those reported by hospitals elsewhere. The cocaine habit that had resulted in his many peculiarities and his aversion to colleagues was now, with masterful self-control, being used in the service of his art.

    Halsted had emerged from his hospitalizations a man completely changed in virtually every way. He married a favorite scrub nurse, Caroline Hampton. The couple had no children, lived on separate floors of an enormous town house in Baltimore and entertained reluctantly, but only after scrupulous — one might say obsessional — preparation.

    Decades after Halsted’s death in 1922, it emerged that he never did break his addiction, though it appears to have been at least partially transferred to morphine, which he used until the end of his life. Markel describes the “remarkably high-performing addict” rushing home most afternoons to administer his dose: “He took out his own morocco case containing a syringe and a soothing dose of morphine. Ever the measured surgeon, he worked hard to calibrate his dosage to calm his jitters and angst but not cloud his senses or interfere with his medical judgment; on not a few occasions, however, he miscalculated and sailed off to narcotized oblivion, abandoning his responsibilities.”

    Freud and Halsted never met. But Markel’s alternating chapters bring them together in a vivid narrative of two of the most remarkable of the many contributors to our understanding of human biology and function. He has written a tour de force of scientific and social history, one that helps illuminate a unique period in the long story of medical discovery — and the not insignificant cohort of experimenters who have fallen victim to their own research.

    New York Times 21st July 2011



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