JEFFREY BROWN: Now, a tale of cocaine addiction involving two leading figures in the history of medicine.
NewsHour health correspondent Betty Ann Bowser has our book conversation.
BETTY ANN BOWSER: Sigmund Freud and William Halsted were two medical revolutionaries, Freud, the well-known father of psychoanalysis, Halsted, the less well-known father of modern surgery. But just beneath the black-and-white success, there’s another story. Both men shared a blinding addiction to cocaine.
In a new book called “An Anatomy of Addiction,” pediatrician Howard Markel tells how the two tried to ward off self-destruction in the quest for knowledge.
We caught up Markel at Johns Hopkins Hospital in Baltimore, where Halsted connected some of his greatest work.
Dr. Markel, thank you so much for doing this.
DR. HOWARD MARKEL, “An Anatomy of Addiction”: Thanks for having me.
BETTY ANN BOWSER: So, what was the connection between Sigmund Freud and William Halsted
DR. HOWARD MARKEL: Well, they both were contemporaries.
They never met, or at least I can’t find any evidence. But they were braided — their lives were braided together. They were bound together by a fascination with cocaine and several medical papers that some they each wrote or some they read about the latest, newest miracle drug of their era, 1884.
BETTY ANN BOWSER: So, here we are, in the medical library of William Halsted at Johns Hopkins University, one of the great medical centers in the world, and he was a first here. What did he do?
DR. HOWARD MARKEL: Most of the modern safety procedures we take of how to cut open a body, how to handle the tissue very delicately and gently, so that it heals well, how to suture it correctly, this was all William Halsted.
He was also fascinated with aseptic surgery, not introducing germs into the surgical wound.
BETTY ANN BOWSER: So, at this point in medical history, cocaine was found to do what that would allow Halsted to do all these things in surgery and Freud to do all these things with his medicine?
DR. HOWARD MARKEL: Here, you had something you could inject or treat or rub on there, and it numbed it to the surgeon’s knife. And so Halsted became fascinated with using this deeper and deeper into the body to do all sorts of procedures without putting a patient under.
BETTY ANN BOWSER: So, Halsted got involved with cocaine by experimenting with it in ways to use it in surgery?
DR. HOWARD MARKEL: Yes.
It was very common for many a doctor in the late 19th century and the early 20th century to use themselves as guinea pigs. And no doctor at this time knew of the terrible addictive effects of cocaine. None of this had been figured out yet. And so the first arm to be put out and injected was Halsted’s.
BETTY ANN BOWSER: Did Halsted understand at the time what he was doing to himself?
DR. HOWARD MARKEL: At some point, he did, when he still lived in New York and he was literally ruining his career. He stopped going to the operating room. He stopped going to the hospital. He stopped going to medical meetings.
And, in fact, at one point, he was called down to the emergency room, bombed on cocaine, and he literally pulled away from the table and said, “I can’t operate,” and walked out, took a cab back to his townhouse and skittered away the next seven months high on cocaine.
BETTY ANN BOWSER: Halsted eventually committed himself to an insane asylum in Rhode Island, hoping to be freed of his addiction. But in those days, there was no real treatment. So, for the rest of his life, he struggled with the disease.
Across the Atlantic and long before psychoanalysis, a young Dr. Freud also believed that cocaine might be his ticket to fame and fortune. One of his closest friends was addicted to morphine. And Freud published journal articles proclaiming cocaine was the cure. But he also had a more personal interest in the drug’s effects.
DR. HOWARD MARKEL: Freud loved the way cocaine made him feel. And he was very interested in its psychological components. For one, it did make him feel better when he was sad.
He also was amazed at how it made him talk about things endlessly that he thought were locked away in his brain. Sound familiar? That’s talk therapy, but without the toxic side effects of cocaine. But he got to like it a little bit too much.
BETTY ANN BOWSER: Did any of his writings, the dreams, the sense of euphoria, all the things that he got from using cocaine, did any of those lead to anything that we now see in psychiatry today?
DR. HOWARD MARKEL: Well, it did. It did.
To begin with, the idea of talk therapy where you talk freely or free associate from one thing to another, may have been inspired by the cocaine unleashing his tongue or his repressed memories. But most importantly, cocaine haunts the pages of “The Interpretation of Dreams.”
The model dream is a cocaine dream, what addiction therapists would call a using dream. He was using cocaine quite a bit in 1895 on himself, to the point he was having chest pain. He was depressed. And he also — his nose was so congested, he had to have a surgeon open it up with a knife so he could breathe, lots of signs that you might want to lay off the stuff.
BETTY ANN BOWSER: In the 1890s, after almost killing a patient while under the influence of cocaine, Freud stopped using the drug. It was after that when some of his most famous work was produced.
When cocaine was being used by Freud and Halsted at this point in time, did the world look at cocaine as something fantastic or something to be experimented with? How was it viewed?
DR. HOWARD MARKEL: All they saw were the good aspects. No one knew — down the road, it was very obvious when you had all these addicts that were created. And it was overprescribed, as was morphine and opium, for everything.
And it wasn’t until about five or 10 or 20 years later, that people started to say, hey, everybody I know is addicted to this stuff. There was no such thing as controlled substances either. You didn’t need a prescription. You could just buy it at a drugstore on your own.
It really outlines the morality play that continues to this day of every blockbuster pharmaceutical agent: This drug, when it comes out, is the greatest, the newest, the best.
And then, as we find out more and more, well, it’s not so great. It has to be used under certain conditions.
BETTY ANN BOWSER: So, would you say beyond this old story is a contemporary cautionary tale?
DR. HOWARD MARKEL: Absolutely. It’s a morality play for today, as well as yesterday. And that’s why I could find all of these issues in their two lives about addiction in general.
And we had to be very careful, because, as we’re learning more and more about addiction, not just one’s environment or the drug they use or the root of administration, but also one’s genetic predisposition — so think of it as a wheel of misfortune. And as it goes around, if you wind up on the bad wedge, you could become an addict.
BETTY ANN BOWSER: Dr. Markel, thank you for being with us.