Sigmund Freud and Cocaine: A Love Story?

Sigmund Freud’s cocaine use is old news. Freud provided extensive documentation himself, including letters, academic publications, and autobiographical material. He even left behind a small sample of his drug of choice, which was recovered from an envelope in the Library of Congress Reading Room in 1995 among his colleague’s papers. Freud was not shy about describing his cocaine use because at the time, physicians were not widely aware of the adverse effects of the drug, and because it was common for medical researchers to test chemicals on their own bodies. Though evidence for Freud’s cocaine use is clear as day (especially through dilated pupils), experts still don’t agree on some key issues concerning Freud’s cocaine years, namely the extent of Freud’s cocaine use and the degree to which the drug affected Freud’s seminal work, The Interpretation of Dreams.

When Freud was a young researcher in 1884, cocaine was gaining a reputation as the new miracle drug. Coca, the plant from which cocaine is derived, had been growing in South America for some 10,000 years. The natives chewed the plant’s leaves for energy and to suppress hunger. After the Spanish invaded, Europeans made money selling coca to the native labor force. The drug enabled them to work longer hours and kept them coming back for more. Coca leaves, however, do not travel well, so the drug didn’t gain notoriety within the European medical community until the 1860s. By 1884, cocaine was available in pharmacies and some doctors were experimenting with its possible applications in the medical and military fields. But according Dominic Streatfeild, author of Cocaine: An Unauthorized Biography, “if there is one person who can be held responsible for the emergence of cocaine as a recreational pharmaceutical, it was Freud.”

In 1884, Freud was a research student at the University of Vienna. He had had two minor successes; he had devised a new method for staining nerve tissue and had published a paper theorizing the probable location of eel’s testicles. Neither venture earned Freud the acclaim he was looking for, and he needed money as soon as possible. He was trying to put together a sizable nest egg to marry his fiancé, Martha Bernay, a woman from a wealthy and reputable family. Freud learned about cocaine from the Therapeutic Gazette, a “medical journal” that was sponsored by a pharmaceutical company called Parke, Davis. The Therapeutic Gazette advertised cocaine as a cure-all wonder drug, and started the insidious rumor that cocaine was an effective remedy for morphine addiction. Parke, Davis paid Freud $24 to endorse their product.

Sometime during the week on April 24, 1884, Freud received his first sample of cocaine from Angel’s Pharmacy in Vienne. He first tested the drug on himself and, unsurprisingly, he thought it was just spectacular. Too spectacular not to share. In the following years, Freud handed cocaine out like skittles, giving samples to colleagues, friends, and even his father. He mailed Martha a sample, writing that it would “make her strong and give her cheeks a red colour.” In his letters to Martha, Freud also noted that cocaine made him want to talk and write for hours. Freud later popularized the use of talk therapy.

During the same year, Freud published a paper called Über Coca, a “song of praise” for cocaine. He used phrases like “the most gorgeous excitement,” and wrote that cocaine produces “exhilaration and lasting euphoria,” and “wards off hunger, sleep, and fatigue and steels one to intellectual effort.” He speculated that the “magical drug” was a viable treatment for melancholy, stomach problems, fatigue, and addiction.

Freud also defended the drug against potential comparisons to inebriants like morphine and alcohol. He assured the reader that cocaine, “if used protractedly but in moderation, is not detrimental to the body” (false) and noted that “opinion is unanimous that the euphoria induced by coca is not followed by any feeling of lassitude or other state of depression” (wrong again). He advocated the use of cocaine to treat morphine addiction, writing that:

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… I am rather inclined to assume that coca has a directly antagonistic effect on morphine...

Freud had a personal reason to be interested in treatments for morphine addiction. His friend Ernst Fleischl-Marxow, a lab assistant and fellow Austrian Jew, had become addicted to the morphine he used to treat a painful and permanent injury on his right thumb. Freud introduced Fleischl-Marxow to cocaine after spending an agonizing night at his friend’s house trying to help him manage the pain. At first, the treatment seemed to have worked. After twenty days of cocaine use, Freud believed that Fleischl-Marxow was cured of his morphine addiction that “no cocaine habituation set in.” Freud continued to advocate the cocaine treatment for addiction.

About a year later, Freud learned that Fleischl-Marxow was actually spending 6,000 marks a month on cocaine, experiencing fainting and convulsions, and complaining that there were bugs and snakes underneath his skin. Fleischl-Marxow died in 1891, but Freud kept using cocaine for at least another five years, having declared in 1885 that cocaine was only addictive when injected.

Fleischl-Marxow was not the only colleague who Freud shared with. He also gave an ophthalmology intern named Carl Koller his first helping of the drug. Koller was the one who left behind a small dose of that first cocaine sample that made its way to the Library of Congress in 1995. And Koller was the one who got famous as the result of his experiments cocaine. After the publication of Über Coca, Freud traveled to Wandsbek to spend the summer with Martha. While Freud was away, it dawned on Koller that the numbing quality that cocaine produced on the gums and mouth may also occur when cocaine was applied to a patient’s eyes. Koller had been looking for an anesthetic to use while preforming eye surgery, which was dangerous and usually unsuccessful because it had to be performed while the patient was fully conscious. Carl Koller was credited with discovering the first local anesthetic.

Freud was disappointed by the missed opportunity, but he kept on looking for a project that would earn him respect in the medical field and enough money to marry Martha. From 1887 to 1904, Freud was engaged in a correspondence with Wilhelm Fliess, a German Otolaryngologist (ear, nose, and throat specialist), who shared his enthusiasm for therapeutic cocaine use. Fliess was convinced that the nose was a microcosm of the human body, so any ailment, including hysteria and depression, could be healed by focusing on its corresponding location in the nose. Fliess called it nasal reflex neurosis, and he published his findings in The Relationship between the Nose and the Female Sexual Organs, which one reviewer commented “has nothing to do with medical or natural science,” and gives the reader “the impression that the author is making fun of him.”

Freud disagreed. He had been experiencing depression, angina, and migraines, and at Fliess’s suggestion, Freud painted part of the inside of his nose with cocaine. The nose is a mucus membrane, so ingesting cocaine through the nose maximizes absorption, producing a better high. Besides, it was better than the other doctors’ suggestions that Freud cut down on smoking. Over time, however, cocaine began to destroy the insides of Freud and Fliess’s noses. The solution? More cocaine. When that didn’t work, Freud and Fliess, naturally, began operating on each other’s noses.

Freud’s nose experiments certainly influenced the publication of The Interpretation of Dreams insofar as they did more harm than good. After a badly botched nose surgery that Freud and Fleiss preformed on a hysteria patient who he called “Emma,” Freud decided to focus on treating hysteria as a psychological problem rather than a nasal one.

Some have cited a dream that Freud had in 1895 as evidence for the cocaine theory, but the dream has little to do with cocaine. Freud used the dream to explain his theory of wish fulfillment. In the dream, Freud talks to another hysteria patience called Irma at a party. She has an infection, caused by an injection of a chemical called Trimethylamine that Freud had administered. Trimethylamine produces a strong scent when cocaine is extracted from coca leaves. It is also “responsible for the smell of decomposing semen.” The dream of Irma’s injection is a juicy piece of psychoanalytic gossip, but the dream’s relation to cocaine, and to semen, is tenuous.

We will never really know how much Freud’s cocaine use influenced the birth of psychoanalysis for the same reason we will never know how much opium influenced Colridge’s writing, or how much anyone’s environment influences their work. On the one hand, Freud was a brilliant doctor and a tireless researcher. He was a talented and ambitious man, and he was in the right place at the right time in history to make a lasting contribution to the medical field. On the other hand, how could twelve years of habitually using cocaine not have influenced his thinking in some way? It is more productive to focus on the work that Freud produced than on his foray with the white lady, but it is also important to remember that no one’s work is infallible. After all, nasal reflex neurosis was not the only screwball theory that Freud attempted to popularize.

*For more information, see Dominic Streatfeild’s Cocaine: An Unauthorized Biography, Howard Markel’s An Anatomy of Addiction, and E.M. Thorton’s The Freudian Fallacy.