Cocaine is the second most popular illicit drug in the world after cannabis. The white powder that millions of people sniff, smoke and inject is extracted from the leaves of a plant called Erythroxylum coca, which grows in South America. As far back as three thousand years BC, the local inhabitants found that chewing coca leaves relieved hunger and increased physical stamina. By the mid-19th century, the beneficial properties of the plant were also recognised in Europe, and cocaine soon became a panacea for ailments of all kinds. At that time, anyone could afford it without guilt or penalty – it was available in any decent pharmacy.
The side-effects of cocaine have not been a major concern for the doctors who have prescribed it for depression, among other things. Some even used it to treat addiction to morphine, one of the most popular painkillers of the era. Sigmund Freud, then a young and impoverished doctor at the start of his career, also visited his pharmacist frequently towards the end of the 19th century. He was firmly convinced that cocaine had great medical potential, as he had managed to cure his good friend, a heavy morphine addict, with it, or so it seemed to him.
He could not believe that the Viennese medical community had not yet discovered all the remarkable properties of the white substance, and he saw in the myopia of his colleagues the opportunity of a lifetime. If he could turn his own fascination with cocaine into serious scientific work, it could be a major step forward in his career. What’s more. He had the promise of world fame.
Freud is certainly considered one of the greatest minds of humanity, but not thanks to cocaine. He earned his eternal fame in spite of cocaine. His fascination with white powder, which lasted for many years, was nothing more than an addiction. That is how any doctor today would describe his relationship with the drug. In the 1880s, when he first encountered it, the consequences of long-term cocaine use had not yet been the subject of medical research, and for a long time Freud could not or would not believe that he was an addict.
The secret of the sacred plant
The first Westerners to encounter cocaine, or rather coca leaves, were the Spanish conquistadors in South America. They noticed that every local man carried a pouch stuffed with coca leaves. At first, the colonisers looked down on local customs, and the more pious ones even considered chewing coca leaves to be the work of the devil and wanted to ban it. But this was not easy, as coca had always been part of the Andean culture and was considered a sacred plant.
Freud also knew the legend from Inca mythology in which Manca Capaca, the son of the sun, descends to earth and brings two gifts to the people – light and coca, which “feeds the hungry and strengthens the weak so that they forget their misfortune”. The Spaniards quickly came to terms with the Indians’ customs, finding that they could even benefit from them. The natives, who had toiled in the mines for their new masters, were much more productive if they stuffed coca leaves into their mouths.
Other Europeans became interested in the Inca sacred plant relatively late, in the early 19th century. The intoxicating properties of tobacco, for example, another New World stimulant, had already been tapped much earlier, in the 16th century. On the old continent, attention was drawn to coca mainly thanks to the adventurers and explorers of South America who, in their travelogues, brought this remote continent to the attention of the European public. Freud, for example, read the works of Alexander von Humboldt, a German naturalist and one of the most famous scientists of the time, who travelled through Central and South America at the turn of the 18th and 19th centuries. The versatile Humboldt, who wrote on subjects as diverse as geology and political economy, among others, also described in detail in his books the effect that chewing coca leaves has on humans.
In the following decades, interest in coca gradually grew in Europe, also thanks to Humboldt’s travelogues. “The Andean Indians chew coca leaves and endure inhuman hardships without difficulty. They know no injuries or other bodily ailments. They have no need of a baker, brewer or distiller”, we read in the London Gentleman’s Magazine of 1817. The author of the article was so enthusiastic about the Inca plant that he urged the best British chemists to abandon all the research they were currently engaged in and unravel the mystery of the coca, “as it might be the greatest achievement in the history of mankind”.
Dust and wine
The mystery was finally solved in 1844 by the German chemist Friedrich Gaedcke. He managed to isolate from the coca leaf the ingredient responsible for the magical sensations dreamt of by his contemporaries. In chemistry, such compounds are called alkaloids, and a few years later, the alkaloid Gaedcke discovered was officially named cocaine. Since then, laboratories around the world have been searching for new ways to extract the purest possible ingredient from the coca leaf that could be used medicinally and make money.
At the same time, coca leaves have become very popular in the Western world. Since Westerners did not like chewing them, they added them to tea and other drinks. By far the most popular combination was invented by a Corsican, Angelo Mariani, a chemist by profession, who added crushed coca leaves to Bordeaux. The mix of drugs from two worlds became a global hit. Vin Mariani, as the drink was called, had a whole range of beneficial and curative effects.
Drinking Mariana wine strengthened the mind and body, helped with digestive problems and increased concentration. It was also an excellent cure for flu and even malaria. At least that was the claim of its inventor, who also started producing cigarettes, dragees and other coca-containing products because of the incredible response. It was even possible to buy margarine with his name on it in the shops.
Vin Mariani was also very popular among the important men of the time, for example Queen Victoria of Great Britain, Thomas Edison, Emile Zola and Pope Leo XIII. Much of Mariani’s success can certainly be attributed to the simple fact that humans by nature have a hard time resisting intoxicating substances, and a mixture of two substances that are very easily addictive is even harder.
By the second half of the 19th century, hundreds of different coca products were available. The iconic drink, which can still be found at every corner today, also dates back to that period. It was also at that time that the pharmaceutical industry recognised the extraordinary potential hidden in the coca leaf. Laboratories produced more and more of the white powder and it soon began to fill the shelves of pharmacists around the world. Doctors recommended it for the treatment of all sorts of imaginary and real ailments. Cocaine was said to cure hysteria, hypochondria, relieve back pain and alleviate the effects of various chronic diseases. The wonder drug quickly captivated the world.
Freud’s Innovative Therapy
In the early 1880s, cocaine also caught the attention of Sigmund Freud, a young doctor in the Department of Nervous Diseases at the Vienna General Hospital. Freud, then still anonymous, was going through a difficult time. His fiancée, the German Jewess Martha Bernays, was waiting for him in Hamburg, but on his meagre salary he could not afford a marriage, let alone a decent house or a family. He lived in a small room, worked more than 12 hours a day and thought about how to move on in his career and earn something.
He was extremely motivated. He used every hour he did not spend among the mental patients in Vienna for self-education. He set himself an ambitious goal. He wanted to compile a complete review of all medical research on the effects and use of cocaine – an all-encompassing study of this seemingly miracle drug. He read every cocaine-related record he could get his hands on – from the aforementioned Humboldt travelogues, to American pharmaceutical brochures, to the most up-to-date German laboratory analyses.
His incredible zeal should not be equated with the sheer ambition of young scientists. Freud’s interest in cocaine stemmed from a personal experience that affected him deeply. One of his best friends, Ernst von Fleischl-Marxow, himself a young doctor, was seriously ill. While performing a routine autopsy, he cut his thumb with a scalpel and contracted an inflammation which, in a world without antibiotics, could have been life-threatening.
His condition deteriorated rapidly and soon the pain became so unbearable that he started taking morphine, the most powerful painkiller of the time. By the way – at the age of 83, Freud chose to die by overdosing on morphine. At that time, he could no longer bear the pain that resulted from the many jaw operations he had undergone in an attempt to cure his cancer. Freud was a lifelong cigar aficionado.
Morphine may have relieved the worst pain, but it was also dangerously addictive. At the time, doctors prescribed it in good faith to anyone who was suffering, unwittingly creating hundreds of thousands of morphine addicts. Marxow, too, needed increasing doses of morphine, and the withdrawal symptoms eventually became worse than the inflammation itself.
Freud, who watched over his friend’s bed every night, suggested cocaine treatment. The results were astonishing. After three weeks, Marx’s condition had improved to the point where he hardly needed morphine anymore. He felt so good that he even began to urge Freud to finish his study on cocaine. Freud, himself impressed by the success of the innovative therapy, was convinced that he had stumbled upon a miracle cure.
To scientifically back up his thesis, he needed more experiments and more – cocaine. In April 1884, he ordered a new, larger shipment from Germany. When he had to pay the bill, he became worried and frustrated, as he had to deduct almost a third of his salary. But he drank a glass of water in which he shook 200 milligrams of cocaine, and his well-being instantly improved. “It’s as if the man has no worries anymore,” he wrote.
O koki
In those days, it was not uncommon for doctors to test new therapeutic approaches first-hand. Freud may have gone a little too far, however, as he was so fascinated by cocaine that he started offering it to friends and relatives. He also put a few grams in an envelope with a letter he sent to Martha in Hamburg. In it, he expressed the high expectations he had of the drug:
“If all goes well, I will write a study on this and I expect cocaine to be as important in medicine as morphine, if not more so. I take it regularly in small doses – for depression and indigestion. It works great … I only now feel like a real doctor. I have helped one patient and hope to help many more.”
Martha and Freud had corresponded regularly for several years, but in the summer of 1884 their correspondence changed a little. Sigmund’s style became less platonic and articulate: “When I come to you, Princess, I will kiss you until you are red and drink you until you are round. And if you’re brave enough, you’ll know who’s stronger – the little girl who doesn’t cry enough, or the big, wild man with cocaine in his system.”
There were many similar cocaine-inspired letters that summer. Freud was also then completing his study on the “magic drug” and the “wonderful thrill” it produces. In July, Über Coca, or About Coca in Slovenian, was published, in which Freud combined his personal experience of cocaine use with empirical research and scientific observations. The study also marks the first appearance of the approach that characterises his later work – Freud is not merely an outside observer, but an active subject.
On Coke was his first serious academic work, but it had one major flaw. Freud completely overlooked the only truly useful property of cocaine that makes it part of medical practice to this day. Cocaine is an effective local anaesthetic used in minor otorhinolaryngological procedures. By the way, various countries today legally produce about one tonne of cocaine a year, while illegal production is estimated at around two thousand tonnes a year.
Blind love
Freud knew well that cocaine numbs the lips and nasal mucosa, because he had, quite literally, experienced it first-hand. Unfortunately, he devoted only a few sentences in his study to this useful property of the ‘magic drug’ and missed a historic opportunity.
Just a few months after the publication of On Coke, Freud’s colleague at the Vienna hospital, the ophthalmologist Carl Koller, became famous for having discovered the potential of cocaine as an anaesthetic. He presented his discovery in a spectacular way. In front of a packed room of eye specialists, where he was giving a lecture, he brought a dog and injected three drops of cocaine solution into the dog’s left eye, waited a few minutes and then began tapping the eye with surgical forceps. The dog did not even flinch and the room roared. Shortly afterwards, the first thing the Viennese doctors thought of when cocaine was mentioned was Carl Koller, not Sigmund Freud.
Freud, to say the least, was not thrilled to be overtaken on the road to fame by a younger colleague, an ophthalmologist to boot. He claimed that Coca Koller, as he derisively called him, had first become aware of the anaesthetic properties of cocaine thanks to him, having once invited him to join him during an operation. Later, he tried to blame his love for Martha for the oversight, saying that he had hurried to finish his studies because he wanted to get to Hamburg as soon as possible. In the same breath, he added that he did not hold anything against his fiancée. Some historians, however, wonder whether his love for someone else was not really to blame.
Initial failure did not deter him from pursuing his career breakthrough. In early 1885, he managed to persuade a reporter from the Vienna daily Neue Freie Presse to write a lengthy article on his research into the medical uses of cocaine. The article was picked up by a number of respected foreign newspapers and Freud finally had his moment of fame. Encouraged by his success, he wrote several more scientific treatises and had his life’s work, On Coke, reprinted. In his treatises, he wrote, among other things, about the incredible effectiveness of cocaine in the treatment of morphine addiction. But the truth was quite different.
Freud’s friend, Ernst von Fleischl-Marxow, was already in a desperate state. Morphine addiction was now joined by cocaine addiction. One day, Freud found him lying naked and unconscious on the floor of his apartment, delirious with pain. Hallucinating that white snakes were crawling on his skin, he had not slept for days. Marxow was then taking more than a gram of pure cocaine a day, in addition to huge amounts of morphine. The pioneering therapy proved to be a huge failure and the unfortunate Marxow never recovered.
Freud did not, however, stop his self-medication. He preferred to snort cocaine and drink it mixed with water. He also tried injecting, but soon gave up, as he was not very skilled in the use of the surgical needle, which was still a relatively new instrument in medical practice at that time. He resorted to cocaine when he had to work late or when he was in a bad mood, when he was alone in his room and when he was in company – during this period he always had a small supply of the “magic drug” with him.
Mind or body?
Then, at the end of 1885, Freud took another step forward in his career. He was awarded a prestigious scholarship to study abroad, which the University of Vienna gave to promising doctors. He went to Paris and worked under Jean-Martin Charcot, one of the most renowned neurologists of the time. He spent the next few months at the Salpêtrière, the largest mental hospital in Europe, among more than 6 000 patients with all kinds of mental and neurological disorders. It was an important formative period for Freud the scientist. Every morning, Charcot presented his students with a patient suffering from polio, stroke or some other neurological disease.
Freud was particularly attracted to lectures with patients suffering from hysteria, a disease that in those days was attributed exclusively to women, as it was thought to stem from a disorder in the womb. The only truly reliable method of treatment was therefore to remove this organ. Hysteria, which was also characterised by purely physical symptoms such as cramps or fainting, was thought to be a reflection of the dominance of emotional processes over the female body.
Charcot tried to treat his patients with hypnosis, which, even at the time, was not exactly considered a recognised scientific method, but his approach was nevertheless revolutionary in its own way. Charcot allowed for the possibility that hysteria might not be due to a malfunctioning of the uterus, but rather to a chemical imbalance in the human, and therefore male, body. When a man has a traumatic experience, a reaction is triggered that leads to hysteria – so thought the French neurologist.
Freud also later unsuccessfully ventured into hypnotic waters, but those few months in Paris are important precisely because it was then that he began to think that the origin of some psychological and physical disorders is not necessarily the brain or, more generally, the body, but the human mind.
Charcot’s thinking collided with chemistry, and Freud began to delve into the psyche. He realised that anatomy might not offer all the answers, and it was this leap of thought that later led to the birth of psychoanalysis, a completely new approach to alleviating various human ills, which made Freud world-famous.
Old habits and new insights
But it was still a long way off. Freud, meanwhile, was also living quite modestly in Paris. The scholarship was only enough for a room in the dormitory and an occasional visit to the theatre. Nevertheless, he still found enough money to indulge in his two favourite habits – cigars and cocaine. The latter came in particularly handy when he had to attend the dinners and parties that Charcot threw. Although Freud was flattered that his mentor opened the door of his home to him, he found such informal gatherings very stressful.
“You can imagine that I am overwhelmed by anxiety, curiosity and a sense of satisfaction all at the same time. I have a white tie, gloves, a fresh shirt and everything else ready. And some cocaine to loosen my tongue,” he wrote in a letter to Martha.
Taking cocaine in the company of strangers, who were sophisticated Parisians to boot, did not always end well for Freud. In letters to his fiancée, he complained that he sometimes sweated so profusely that he was embarrassed in front of distinguished guests. In addition, his heart was pounding and even his already less than perfect French was worse than usual. He also mentioned that his speech was slurred and his mouth was constantly dry. Even French wine did not remove the feeling of numbness and dehydration. In his letters to his fiancée, Freud could be said to have described the side-effects of cocaine – including one that he had overlooked in his study.
In the autumn of 1886, he returned to Vienna with new experiences and bold plans for the future. He abandoned his academic career for more lucrative waters – he opened his own medical practice. He also married Martha and soon after had his first child. At the age of 30, a new and exciting period in his life began. However, the financial situation of the Freud family was still rather bleak, as Sigmund’s practice was more or less empty. There were more than enough psychologists, neurologists and lubricators of all kinds in Vienna.
Freud was still under the impression of his French mentor’s lectures and his observations on hysteria. Towards the end of the 19th century, many Europeans were suffering from this mysterious and difficult-to-define disease. Doctors’ surgeries and psychiatric clinics were full of depressed and alienated people with a thousand and one symptoms. Even Sigmund Freud, the newly-emerged physician of nervous diseases, dealt almost exclusively with this illness. During this time, he worked with Josef Breuer, an experienced Viennese physician who had an even greater influence on his professional development than Charcot.
It was Breuer who treated his hysteria patients by getting them to talk about their forgotten and repressed traumas through hypnosis. Physical symptoms, such as paralysis or speech disorders, disappeared when the hypnotized patient recalled the traumatic event when the symptom first appeared.
Freud’s and Breur’s methods were ridiculed in Viennese medical circles. It was inconceivable to many that something as intangible as a person’s memories could be to blame for symptoms that were quite palpable. Freud had to pay a heavy price for his beliefs, as his colleagues began to shun him. But it was this unorthodox approach, the so-called ‘talking cure’, that would later prove to be the historic discovery he pursued throughout his life. We should add that even while exploring the invisible links between body and mind, Freud found time to take cocaine.
The almighty nose
It was during this time that he met Wilhelm Fliess, a general practitioner from Berlin, who eventually became his confidant and, according to some accounts, even his lover. He and Freud had much in common. Fliess was also a young and misunderstood doctor of Jewish origin, eager to prove himself. Although they were friends and corresponded for many years, Freud later, when the world already knew him as the father of psychoanalysis, tried to erase this chapter from his biography.
Fliess was considered an eccentric, if not a charlatan, in scientific circles. His theories were outrageous. He believed that there was a central organ in the body – the nose. It is in the nose that the processes that affect human health are thought to take place. The nose was also thought to be directly connected to the genitals.
Fliess also tested his theory in practice, in a very interesting and dangerous way. He dealt with people with all kinds of disorders, both imaginary and real. The first thing he did was to fill the nose of a patient who came to his surgery with cocaine. After a few minutes, when the anaesthetic took effect, he picked up a scalpel and got to work. He operated on sinuses, mucous membranes or other parts of the nasal cavity until he had removed the cause of the imaginary problem. After the procedure, the patient was given another dose of cocaine – this time for the pain. Among Fliess’ patients was his friend Sigmund Freud.
Fliess was not only Freud’s friend, but also his personal physician. One day he received a letter from Vienna in which Freud complained of a sore throat and probably also angina. He was also suffering from a severe migraine. Fliess prescribed a simple therapy – snorting cocaine through the nostril, which is on the side of the head where the migraine is strongest. Freud, probably as a preventive measure, extended the therapy to the other nostril and the migraine disappeared immediately.
There is also an interesting anecdote from 1894, when Freud again asked his friend for help. Fleiss had advised him to quit smoking a few months before, and Freud, who had been a lifelong avid smoker and smoked more than twenty cigars a day, followed his doctor friend’s advice. But problems soon arose. Freud reported nasal congestion, arrhythmia, chest pain and anxiety.
Although these are obvious signs of regular cocaine use, Freud and Fliess attributed them to nicotine intoxication and dysfunction of the most important organ in the body – the nose. At one point, Freud’s nose was so swollen that he had to burn it out with a red-hot knife. This could also have been a sign of alarm, since snorting large amounts of cocaine leads to narrowing of the nasal capillaries, but Freud conveniently overlooked this property of the magic drug.
Emma
Fliess, his bizarre therapy and his hefty piles of white powder are linked to another story that would almost ruin Freud’s career. The story dates back to 1892, when Emma Eckstein, a young and attractive Viennese woman, visited his office complaining of stomach problems and mild but disturbing depression. As Freud was unable to identify the psychological origin of her ailments, even after several years of arduous therapy, he turned to his colleague Fliess, who began to suspect that Emma’s problems might be physical in nature. Fliess, who lived in Berlin, quickly responded and came to Vienna. After a detailed examination of the patient, he gave a diagnosis that confirmed Freud’s suspicions. The problems were indeed physical – a nose job was needed.
Fliess operated on both Emma’s and Sigmund’s noses in January or February 1895, the exact date is unknown. As usual, the operation was accompanied by plenty of cocaine. Freud survived the operation well, but Emma’s condition deteriorated drastically after a few weeks. As Fliess was already in Berlin at the time, Freud should have been in charge of her rehabilitation, but it soon became clear that his neurological training would not be sufficient under the circumstances.
Ignaz Rosanes, an otorhinolaryngologist, had to come to the rescue. Emma was in a critical condition and Fliess’ operation would have almost cost her her life. She was bleeding profusely from her mouth and nose, which was completely swollen and congested. When she sneezed, a coin-sized piece of bone flew out of her nose – a souvenir of Fliess’ operation. The surgeon, searching for the cause of the bleeding in her nasal cavity, carefully removed one bone clot after another until he came across a small piece of gauze. After consulting Freud, he decided that the smelly and dangerous cloth should be removed with tweezers.
“Before we had a chance to think about how to proceed, the surgeon removed more than half a metre of gauze from my nose, and immediately afterwards blood poured out. The patient turned pale and her eyes bulged. She had no pulse …,” Freud wrote in a letter to Fliess, describing the horrific experience. The surgeon then cleaned the wound and applied fresh gauze, which stopped the bleeding and saved Emma’s life.
When the worst was over, Freud had a glass of cognac to calm himself. It was then that he realised that his Berlin friend had made an unacceptable mistake during the procedure – he had accidentally cut his nasal artery and tried to plug it with gauze. The wound then became inflamed and started bleeding. Without the help of the otolaryngologist surgeon, Emma would surely have died.
The event was so traumatic for Freud that it haunted him for a long time. His disastrous medical judgement, a strange friend and, last but not least, cocaine, all played a role that could have cost him his career. He therefore tried to relativise the procedure and the outcome. Fliess was comforted by the fact that such mistakes were common and part of the profession. He also assured Emma that he did not hold any grudges against either of them. This was true. Emma, whose facial scars reminded her of Fliess’s procedure for the rest of her life, later even began to practise psychotherapy herself. Nevertheless, Freud was aware that he had acted, to put it mildly, very irresponsibly as a doctor.
Irmina injection
In addition to his work with patients, Freud also pursued another project during this period, which in time brought him recognition from his peers, worldwide fame and money. In 1895, he began to write The Interpretation of Dreams, a book in which he tried to present his thoughts on a phenomenon to which no one at the time attached any useful meaning. He was convinced that the analysis of dreams could provide answers to many of the questions that plagued man. The Interpretation of Dreams, which was published in 1900, is considered to be the first work of psychoanalysis. But before Freud could analyse the other, he had to analyse himself.
At this point, it is worth returning to the story of Emma Eckstein. Freud not only thought about the unfortunate event, but also dreamt about it. Freud was also a conscientious recorder of his dreams, but it was the dream of Emma that he first analysed in detail. From this he developed his famous theory that dreams are a reflection of hidden desires.
In the dream, Freud finds himself at a party where the guests include Emma, or Irma, as he named her to protect his privacy. In front of the other guests, Irma complains to him that he is unwell and that his treatment has been unsuccessful. Freud began to doubt his medical abilities and wanted Irma to be examined again. When she opened her mouth, he saw a suspicious white clot in her throat. He called his friend Dr M for help, who told him that it was inflammation and that it was the fault of Otto, another friend of Freud’s who had treated Irma before and who must have used a dirty injection during the procedure.
Freud clearly had a bad conscience about Emma. He interpreted the dream as the fulfilment of a wish to rid himself of this bad conscience. By blaming Otto for Irma’s ill-being, Freud was suddenly redeemed. “The conclusion of the dream is that Irma’s pain is not my fault. In the dream, an actual state becomes what I would have wished it to be…The dream is the fulfilment of a wish,” Freud writes in his book in a chapter entitled Irma’s injection. An incident that could almost have ended tragically was masterfully turned to his advantage by Freud.
Epilog
Addicts rarely admit they have a problem, either out of shame or fear of judgement. When Freud was already famous, he did not like to remember the period when he was friends with Fliess. What is more, he destroyed all the letters he had once received from the Berlin doctor. By chance, however, the correspondence that he wrote back has survived, and in it we can read that Freud had been indulging in cocaine for more than ten years, at least until 1896. From then on, however, there is no trace of white powder in his letters. Even some of Freud’s biographers do not pay much attention to this unpleasant period. Probably because it is difficult to admit that the father of psychoanalysis is, after all, only human. Freud is by any measure a remarkable personality and one of the greatest minds of the modern age – cocaine up or down.
