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An Anatomy of Addiction: Sigmund Freud, William Halsted, and the Miracle Drug, Cocaine

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Acclaimed medical historian Howard Markel traces the careers of two brilliant young doctors--Sigmund Freud, neurologist, and William Halsted, surgeon--showing how their powerful addictions to cocaine shaped their enormous contributions to psychology and medicine.
When Freud and Halsted began their experiments with cocaine in the 1880s, neither they, nor their colleagues, had any idea of the drug's potential to dominate and endanger their lives. An Anatomy of Addiction tells the tragic and heroic story of each man, accidentally struck down in his prime by an insidious malady: tragic because of the time, relationships, and health cocaine forced each to squander; heroic in the intense battle each man waged to overcome his affliction. Markel writes of the physical and emotional damage caused by the then-heralded wonder drug, and how each man ultimately changed the world in spite of it--or because of it. One became the father of psychoanalysis; the other, of modern surgery. Here is the full story, long overlooked, told in its rich historical context.  

314 pages, Paperback

First published January 1, 2011

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About the author

Howard Markel

15 books47 followers
Howard Markel, M.D., Ph.D., is the George E. Wantz Distinguished Professor of the History of Medicine, professor of pediatrics and communicable diseases, professor of psychiatry, and director of the Center for the History of Medicine at the University of Michigan. His books include the award- winning Quarantine! and When Germs Travel. His articles have appeared in The New York Times, The New England Journal of Medicine, and The Journal of the American Medical Association. A member of the Institute of Medicine of the National Academy of Sciences, Markel lives in Ann Arbor, Michigan."

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Displaying 1 - 30 of 94 reviews
Profile Image for Robert.
Author 14 books94 followers
June 6, 2020
An Anatomy of an Addiction about Cocaine, Sigmund Freud and William Halsted by Howard Markel, a physician with extensive experience in treating addictions, is a well-written and well-researched book that moves fluidly from history to science and back again.

Freud, we know. Or think we know. This account provides insight into his life far beyond his troubles with cocaine. The picture painted here is of a very competitive and yet insecure, strong and yet needy individual, who spent many years abusing cocaine, which provided him with energy for huge amounts of work and a form of release for substantial internal pressures and contradictions. It's often noted but bears repeating that Freud had the makings of a superb neurologist before he developed psychoanalysis. One of his major contributions was his early paper, Über Cocaine, which failed to generate the acclaim he sought because he overlooked a key property of cocaine: it can be used effectively as a local anesthetic. So another doctor stole a march on him in reporting this.

Freud viewed himself in his pre-psychoanalytic days as a successor to the greatest neurologists in Europe. All he needed was a discovery. What he personally discovered about cocaine was that as an antidote to a friend's morphine addiction, it could be effective and destructive. He also discovered that cocaine provided him with a boon companion to his grandiosity.

Markel cannot be sure why cocaine did not destroy Freud. He points out substitute self-medications in excessive drinking, up to twenty cigars a day, and apparently the release of homosexual desires in a relationship with Wilhelm Fliess, a nose specialist based in Berlin.

Markel's account of the devastation to the body and brain of a cocaine addict is horrifying. This drug is Russian roulette. He explains its migration from South America to Europe in the latter part of the 19th century and he introduces us to William Halsted, a brilliant surgeon whose life was twisted inside out by cocaine, wrecking his first spell in the medical spotlight in New York and then after extensive and difficult treatment, a second spell of great success at Johns Hopkins in Baltimore...but while living the haunted life of an addict whose personality was corrupted and whose unreliability was only compensated for by his surgical genius.

Some of Halsted's greatest insights, like Freud's, remain valuable today. But they paid high prices for glory. Their drug and substance addictions added nothing to their accomplishments. Rationalizing drug use as a means of unleashing genius is a misbegotten piece of street wisdom. Cocaine is its own boss.
913 reviews389 followers
November 6, 2011
I love good non-fiction reads -- the ones that engage you and also make you feel intelligent for reading them. This book, the story of two highly accomplished individuals' struggles with cocaine, falls squarely into that category.

Freud was a cocaine addict? Who knew? What does this do to any credibility his ideas have at this point? Okay, I'm exaggerating. According to this book, Freud ended his battle with cocaine prior to writing "The Interpretation of Dreams." Although apparently, I'm not the only one to speculate about the extent to which Freud's cocaine abuse may have influenced his ideas.

William Halstead (inventor of the radical mastectomy and founding surgeon at Johns Hopkins), on the other hand, continued to struggle with cocaine and later, morphine, throughout his distinguished career. Interestingly, this book differs from "The Emperor of All Maladies" which claimed that Halstead abandoned cocaine in favor of his career.

It was interesting to read about the initial excitement about cocaine as a miracle drug, gradually followed by the slow realization of its addictive properties and side effects. As my sister pointed out, it makes you wonder about today's miracle drugs and what we may discover about them tomorrow. It was also interesting to read about Freud and Halstead's personalities, careers, and struggles with the drug. After reading this book I wanted to seek out another biography of Freud for more detail, and when a book inspires me to learn more about something, I see that as a very good thing.

It wasn't perfect; I agree with my sister that there were a few draggy places and that some of the author's speculations and imagined dialogue seemed a bit questionable. Overall, though, an engaging and worthwhile read.
Profile Image for Molly.
Author 1 book18 followers
September 12, 2011
I don't think I'll ever unlearn the terrible things done to Freud's (and his patient's) nose in this book.
Profile Image for Barbara.
198 reviews12 followers
December 10, 2011
I was first introduced to Sigmund Freud as a teenager, and, as most of his theories seemed to revolve around sex and inhibition (joyfully celebrated in song by Melanie Safka), I wholeheartedly embraced his ideas. It was some years later that someone commented to me, "Well, you know he got half of Vienna hooked on cocaine, right?" Well, no, I didn't, and after reading this book I'm still not convinced that's an accurate assessment.

This book explores the history of cocaine as a medicinal aid through the addictions of Freud and William Halsted, a brilliant and promising surgeon. Both men, dedicated physicians, were seduced by the drug's mood- and energy-enhancing properties, as well as its anaesthetic potential. Their slide into the abyss was subtle, occurring in an era of unrestricted medical experimentation, and in which addiction was not yet a recognized illness. Their careers were jeopardized, with differing consequences; Freud's crash on the bottom resulted in total abstinence and recovery. Halsted struggled with a dual addiction to cocaine and morphine, and his path was more like the winning toss in a stone-skipping challenge: multiple hard bounces along the surface before ultimately sinking.

Freud did share this miracle drug with his patients; he mistakenly believed it to be harmless, and prescribed it as both an antidote to morphine dependency and a relief for hysteria. On more than one occasion the results were disastrous, but the addict's forte is self-deception and he did not immediately recognize the truth.

I enjoyed this book from a biographical standpoint, but felt a disconnect between the physicians' histories and that of the drug. While I found it well-written, interesting, and having excellent historical perspective, I wanted to know more about the men and their accomplishments, with or without the influence of cocaine. It was hard to grasp a solid position from the author, and the interesting question he posed late in the book, whether they were brilliant in spite of or because of their addiction, remained largely unexplored.
Profile Image for Jordan.
27 reviews11 followers
December 16, 2011
Have you ever thought that you could give up eating ice cream by smoking crack? What about giving up morphine and taking up the habit of snorting cocaine? What about developing a hierarchy of doctors who can do your job while you get high on coke and morphine? Well what seems obvious today was discovered though experimentation by the medical intelligentsia who encountered different miracle drugs in the past.

Less than 100 years ago Sigmund Freud obsessively experimented with cocaine. He even misguidedly attempted to treat morphine addicted patients and fellow doctors with coke. The results are obvious in retrospect but we forget that new medical discoveries have to be experimented with before we can find out there usefulness or danger. The book also explores Freud's scholastic career and the upward climb he endured to get to a stable income let alone any notoriety. William Halsted, whose life is also profiled in the book, had a medical career fraught with the odd combination of substance abuse & the brilliance of a doctor who building the foundation of many modern operational techniques and the very system hospitals use to train doctors today.

A great read for anyone in addiction treatment, counseling, the medical field in general, or for anyone who likes a good focused bio of Freud the psychoanalyst and William Halsted the surgeon.
Profile Image for Ardon Pillay.
138 reviews18 followers
August 9, 2020
I was really excited by the premise, given how the 2 key figures became known as the fathers of psychoanalysis and general surgery respectively.

Unfortunately, the book isn't very well organised, and the writing style makes it monotonous to read despite the interesting subject matter. However, the sheer horrors of this "wonder drug," as it was heralded as at the time, come through very clearly.
Profile Image for Maryann Jorissen.
180 reviews1 follower
May 27, 2013
There were interesting bits of history throughout the book. However, the general story did not flow well. The story line was hard to follow. Plus the intellect of these two people were so complex, that it would seem difficult to write of their personality on the premise of a single trait. The main take- home message: they succeeded in spite of their addiction.
Profile Image for Abrar Touq.
147 reviews3 followers
November 26, 2021
An easy and an engaging read. Although, now it makes sense why Freud was the way that he was; he was a coke addict. Who would’ve known.
Profile Image for Mandy.
813 reviews11 followers
September 29, 2018
I hate Freud so much and usually refuse to read anything about him, but this book piqued my interest and even had me feeling vaguely sympathetic for him. It helped that only one chapter really covered his psychoanalytic techniques or Interpretation of Dreams.

Written in a compelling, easy-to-read style with alternating chapters on Freud and Halstead. It was a quick and interesting read with lots of cool pictures (and several unnecessary and gratuitous ones). The author shares many primary source documents as evidence and excerpts from letters from Freud and Halstead themselves. The author didn’t come off as overly moral or condemning of cocaine, merely described its effects and the experiences of many addicts. Some tangents went too long and could use better editing, but overall, I really enjoyed this read.
Profile Image for Socraticgadfly.
962 reviews321 followers
November 16, 2012

Two medical pioneers -- including pioneers in the potential medical use of, and actual personal misuse of, cocaine. Howard Markel paints a cautionary tale of addiction that powerfully resonates a century and more later.

Many people know a bit about Sigmund Freud's history with cocaine, despite the best efforts of generations of Freudian acolytes and disciples to cover up just how much he used (or abused), how long he used it, and how much it affected his general work habits and his psychological theorizing.

Markel gets behind the story, not just with Freud, but a somewhat older near-contemporary, William Halsted. Halsted, less familiar to many, was essentially the father of modern American surgery, a pioneer in introducing the use of antiseptic techniques in surgery, introducing new operating techniques and more, mainly from his perch of director of surgery and one of the founding doctors at Johns Hopkins School of Medicine.

When I was a kid, I read a mini-biography of Halsted in a compendium of lives of great doctors, so I had heard about his "sea cruise" attempt to overcome his cocaine addiction. But, the story closed with what Markel notes was long the "official line" about Halsted: that he had no major problems, or problems at all, after that.

How wrong I was, Markel shows.

I had no idea he was "committed" to Butler Hospital, a "sanitarium." Nor that he was given morphine to "help" with cocaine withdrawal. Nor that he, as a result, apparently became a lifelong morphine addict. Nor that he apparently struggled to some degree with cocaine addiction for the rest of his life.

Markel, an M.D. and Ph.D. with addiction support help background, shows a clinician's skill in diagnosing how addiction affected Halsted's life, his work at Johns Hopkins, his relation to surgical interns and patients and more.

In parallel chapters, he also looks at how cocaine use affected Freud's personality, his own medical theorizing (including, in reverse of Halsted's time at Butler, the idea that cocaine could be used to treat morphine addiction), his psychological theorizing (including how "The Interpretation of Dreams" was likely largely affected by guilt trip over his participation in how a doctor friend and fellow cocaine touter, Wilhelm Fliess, medically mistreated one Emma Eckstein) and more.

Was Freud, like Halsted, an addict? Markel carefully uses the distinction between "abuse" of a drug and "addiction" to a drug to say that Freud was clearly a cocaine abuser, and may have crossed the addiction line, without us being able to know for sure.

A few lines from the epilogue show Markel's insight:

"When Freud and Halsted first became acquainted with their chemical bete noire, they fully expected cocaine to become the wonder drug of modern medicine. Neither had any idea of its potential to dominate and endanger their lives. Addiction as a bona fide medical diagnosis was not yet in the doctor's lexicon, let alone his textbooks. ...

"Each man actively participated in the birth of the modern addict, and their clinical histories prefigure the ever-challenging spectrum of substance abuse, addiction and recovery. Freud somehow escaped from his cocaine dependency even as he was plagued by periods of sexual turmoil, increased alcohol consumption, and depression. Decades after Halsted restricted his cocaine use to occasional binges, he still availed himself of daily morphine injections to quell his addictive urges, often with negative results."

Going beyond the parallel biographies, Markel then discusses issues of drug addiction in general, from how it was understood at the time of Halsted and Freud to how our understanding has evolved today. Without being harsh, he also notes his medical peers today are often like those of a century ago in still often offering biochemical help to addicts that turns out to promote a substitute addiction.

He then, behind that, notes the development of cocaine from a raw substance in coca leaves to its refinement into cocaine hydrochloride of snorting use both then and today, as well as other methods to use it. Besides Coca-Cola, which did, yes, originally have a bit of cocaine in it, though not much,there were cocaine-laced alcohol products, quite popular then. I had heard of them, but didn't know the details, including that alcohol actually combines with cocaine to produce an even more intoxicating compound, cocaethylene, in the liver. So, in addition to the "speed-ball" like effect Halsted had when he was using both morphine and cocaine, we already were having cross-addiction being promoted back then.

I definitely now want to read Markel's "Quarantine" about East European Jewish emigration to the U.S. and the diseases that came with this.
Profile Image for Andrew.
279 reviews32 followers
May 3, 2012
The depths of the mind

"..as tempting as it is to singularly ascribe all of Sigmund's revolutionary ideas to his cocaine use, this tack ultimately constitutes as simplistic and unsatisfying explanation. The "Interpretation of Dreams" covers a skein of thoughts and ideas beyond those set in motion by the Irma episode. Freud's psychological constitution was marked by multiple compulsions, perfectionism, risk taking resentments, loneliness, alienation, emotional pain, traumatic family experiences, phobias, neuroses, depression, denials and secretiveness about his sexuality, a possible sexual relationship with his sister-in-law, a brief flirtation with excessive drinking, and his self-documented cocaine abuse, to name some of his demons. What makes Sigmund Freud's life and work so remarkable is that instead of sinking under the weight of these psychic challenges, he was able to process them all through his formidable intellect and thereby create a means for exploring the depths of the mind." (p.184-5, hardcover)

Markel's book offers a clear window about Freud's personal life and his vice of cocaine. We get to see one of the early lights of modern medicine and psychiatry through his toughest professional times, when he wasn't a household name: his book only sells a few hundred copies in the first six years, he gets passive aggressive in correspondence to his wife (because she's holding him back), he stunningly asserts and reasserts that cocaine is not addictive, he becomes irrationally jealous when ophthalmologist Carol Koller is credited with discovering cocaine's anesthetic properties, and drug abuse itself threatens to derail him at every turn. Freud had a number of years wherein he treated morphine addiction by cocaine administration (this in his early career as an aspiring neurologist) and he himself was subjected to repeated nasal cauterization procedures to control swelling and bleeding from so much use of the latter. Much of the 1890s seem to be spent draining large amounts of pus from his nasal turbinates.

Halsted is actually the more fascinating character. He is institutionalized early in his career and treated unsuccessfully for cocaine dependence at Butler Hospital in New England. He proceeds to become the foremost surgeon at the nascent Johns Hopkins medical school and his irascible, often absent persona is given pardon because of his unparalleled surgical skill (when he arrives to work, that is). He is credited with the sterile technique of scrubbing in to a case, wearing gloves and gown during surgery (gloves from the Goodyear rubber corporation are the subject of a fantastic anecdote and his future wife), and he trains some of the fathers of modern surgery in the late 19th century. The form and function of the surgical residency, something about which I know a great deal, was given first shape under Halsted's wing. Later in life he becomes addicted to morphine in quantities of 200mg/day, an exceedingly high dose that would cause the average postoperative patient to become apneic. And biographers have continued to deny his drug use throughout history.

The comination of these two mens' tales makes for a powerful narrative, and Markel seems to fall in the sympathetic column of medical historians. Plus their tale is the more interesting because of reader context - cocaine is merely wicked and evil and its users deadbeats, or so we are taught to believe. Markel euologizes these men and their achievements in the face of such considerable vice. The level of notoriety and place in history achieved by Freud and Halsted is not available to the average coke-addict of today. That is something to celebrate.
Profile Image for Sean Byrne.
58 reviews3 followers
February 23, 2021
Part history, part biography, Anatomy of Addiction is an account of the effects that cocaine had on the lives and careers of William Halsted and Sigmund Freud. Written by Howard Markel the book chronicles each man’s first contact with the drug and provides insight into how they became gripped by the possibilities it promised. Through liberal use of contemporary accounts as well as biographical material, Markel outlines how both Halsted and Freud ignored the negative effects of cocaine use, and instead hoped that it would help them make a name for themselves in their chosen medical fields.


An Anatomy of Addiction pulls no punches in its description of cocaine’s effects on the lives of Freud and Halsted. One, however, does get the feeling from the book’s conclusion that the author is more lenient on passing judgement on Freud than on Halsted. Having gone into detail about how the drug negatively affected both men, and having shown that both men were extremely dedicated to their work, Markel comes across as more willing to accept that Freud was able to overcome his addiction whilst building a strong case of the opposite against Halsted. It makes for an unusually jarring ending to an otherwise interesting book. Indeed, it’s the author’s infrequent incursions into the narrative with his own thoughts that mean I don’t rate the book higher.

[Full Review at Plates & Pages]
799 reviews136 followers
October 16, 2011
I'm going to go ahead and give this four stars even though by the end I felt, as I often do when reading non fiction, that it got repetitive and draggy by the end.
Anatomy is a well researched and well written if somewhat imaginative biography of cocaine as a drug as well as its impact on some of the finest minds in medicine. Did you know cocaine was used as an anesthetic? Or that many stressed out moms were prescribed morphine? In short it;s a miracle that we all made it here today given what we now know about these drugs, and it makes me wonder what the next generations will be discovering about our current miracle pills.
Addiction is pretty fascinating stuff, and it affecting the father of psychotherapy was particularly interesting. But I felt at times it was too detailed and confusing as to the many characters the book took on, and that certain things went unanswered - like how Freud was impacted on a daily basis by his addiction, which went on for over a decade! Anyway I do recommend it, it;s highly readable and interesting, but I question its veracity and would have liked more hard core info.
Profile Image for Rosanne.
371 reviews3 followers
September 30, 2011
A highly readable account of the cocaine abuse of Halstead and Freud at a time when the devastating harm cocaine could do to an abuser were not fully known. Towards the end of the book, when Halstead and Freud were no longer abusing drugs, or, in Halstead's case, no longer regularly abusing cocaine, Markel seems to go off on tangents and I found myself wondering what these little asides had to do with these doctors' drug abuse. Overall, though, this was a great read that gave a high-level picture of addiction and what addiction meant for two prominent historical figures.
25 reviews
December 16, 2011
I started this with great hesitation, but it was my Book Group choice for January. I found it to be an interesting change from my usual choices. It is a little slow at the start, but becomes absorbing when you realize you are reading about giants of medicine, Freud, Halsted, Osler, and the era when cocaine was considered to be the miracle drug to cure all. The addiction of Freud & Halsted as they used themselves as trial subjects, is a major part of the book.
Not a book for everyone, but written in a lighter tone than most medical histories, it is accessible to everyone.
Profile Image for Pamela J.
422 reviews
January 3, 2012
Wow. Markel's well-crafted prose imparts knowledge, humor, and a surge of interest in the topic. His knowledge of medical history and its context is impressive. Interesting to think there was a time when cocaine use was not demonized, yet alcohol and opium were. Everyone knows that the original Coca-Cola derived its magic from the eponymous leaves. But before Coke, there was vin Mariani.
Interesting portraits of late 19th century personas who liberally used and became addicted to cocaine: Freud--who is rather insecure (surprise, surprise...)-- and Halsted.
Profile Image for Dave Biggus.
35 reviews1 follower
October 2, 2011
There's so much of this history I've never known about, or just incidentally. Howard Markel is an excellent historical writer, bringing together the beginning of commercial cocaine, and it's subsequent abuse by Freud and William Halsted (responsible for many modern surgical techniques). Fascinating stuff, combined with dozens of pictures (I love history books littered with pics, to put you THERE). It was a page turner from beginning to end. Highly recommended.
Profile Image for Rhonda.
156 reviews2 followers
November 12, 2011
Fascinating, esp for me as a Johns Hopkins staff member, to know more of the "story behind the story" about these famous personages, both doctors. Since cocaine is still a huge problem in the city of Baltimore, it was also interesting to read about its history. This was actually a quick read, and left me wanting to know more about the lives of both Freud and Halsted.
692 reviews4 followers
November 28, 2011
I found this book very, very interesting. There was one grammatical error that I spotted but nonetheless, I felt as though I was learning a great deal more about Freud and early medicine than I expected. It is truly an interesting and informative book. It would be a good book for a nonfiction book club selection.
Profile Image for Stephanie.
66 reviews
September 2, 2011
Pretty good book about how cocaine addiction affected the lives of two medical pioneers (Freud and Halsted), how cocaine use evolved into abuse, and what medicine/surgery and psychiatry were like at the turn of the 20th century.
Profile Image for Amos.
634 reviews73 followers
July 24, 2011
Fascinating read about the fathers of psychoanalysis and modern day surgery and their struggles with the brand new "wonder drug" cocaine. Eye opening in many ways....
Profile Image for Sally Anne.
563 reviews27 followers
August 24, 2011
The beginning is a little rough, writing-wise, but it smoothes out. A lively, interesting read, if not terribly deep.
21 reviews
August 27, 2011
This is not only an excellent book for understanding the disease of addiction but a great piece of history well researched.
October 2, 2011
It was a good book albeit due to the lack of documents many aspects are just suppositions from my point of view.
Profile Image for David.
131 reviews
November 10, 2011
Who would have known? . . . Sigmund a coke addict. . . just saying . . . Fascinating read.
Profile Image for Louise.
1,631 reviews285 followers
June 19, 2012
An interesting read on the early uses of cocaine. The portrait of Sigmund Freud that emerges suggests that I need to find a good interpretive biography.
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