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

Howard Markel

3.91 · Rating details · 767 ratings · 86 reviews

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, h ...more

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Paperback, 314 pages

Published July 3rd 2012 by Vintage (first published 2011)

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Oct 29, 2011 K rated it really liked it · review of another edition

Recommended to K by: M

Shelves: readablenonfiction

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 ...more

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Sep 07, 2011 Molly rated it really liked it · review of another edition

I don't think I'll ever unlearn the terrible things done to Freud's (and his patient's) nose in this book. ...more

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Jun 06, 2020 Robert rated it really liked it · review of another edition

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 abusi 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. ...more

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Nov 30, 2011 Barbara rated it liked it · review of another edition

Shelves: biography-memoir, medicine, psychology, history

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 throu 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. ...more

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Dec 07, 2011 Jordan rated it it was amazing · review of another edition

Shelves: counseling-recovery, memiors

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 mi ...more

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Aug 08, 2020 Ardon Pillay rated it liked it · review of another edition

Shelves: medicine

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. ...more

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May 14, 2013 Maryann Jorissen rated it it was ok · review of another edition

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.

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Sep 29, 2018 Mandy rated it really liked it · review of another edition

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 ...more

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Nov 16, 2012 Socraticgadfly rated it it was amazing · review of another edition

Shelves: biography, history, psychology-human-development

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 ...more

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Dec 25, 2011 Andrew rated it really liked it · review of another edition

Shelves: biography, history, medicine

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, 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. ...more

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Jul 21, 2011 M rated it really liked it · review of another edition

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 ...more

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Feb 11, 2013 Jennifer rated it liked it · review of another edition

I enjoyed this way, way more than I thought I would. Dr. Markel is a wonderfully immersive writer, taking us inside the heads of two fascinating physicians and their dizzying spirals into addiction. I love that there's a voice to the narrative; I get a real sense that I'm being told a story by someone who's enraptured by the material he's found and can't wait to share it with us. I like everything about it: the imagined dialogues, the fugues on the history of the coca plant, the scenes at the sa ...more

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Sep 14, 2011 Rosanne rated it really liked it · review of another edition

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 pictur ...more

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Dec 16, 2011 Patricia rated it really liked it · review of another edition

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 ...more

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Dec 27, 2011 Pamela J rated it it was amazing · review of another edition

Shelves: history, non-fiction-topical

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- ...more

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Sep 24, 2011 Dave Biggus rated it it was amazing · review of another edition

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. ...more

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Oct 31, 2011 Rhonda rated it really liked it · review of another edition

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. ...more

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Nov 28, 2011 Ellen rated it really liked it · review of another edition

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.

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Jul 28, 2011 Stephanie rated it really liked it · review of another edition

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.

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Jul 18, 2011 Amos rated it really liked it · review of another edition

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.... ...more

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Jul 24, 2011 Meg marked it as to-read · review of another edition

Shelves: about-people, history

Found this via NY Times review: http://www.nytimes.com/2011/07/24/boo... ...more

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Aug 08, 2011 Sally Anne rated it liked it · review of another edition

The beginning is a little rough, writing-wise, but it smoothes out. A lively, interesting read, if not terribly deep.

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Aug 20, 2011 Joanne rated it it was amazing · review of another edition

This is not only an excellent book for understanding the disease of addiction but a great piece of history well researched.

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Aug 23, 2011 Stacia rated it really liked it · review of another edition

Shelves: nonfiction, biography-memoir, 2011

This was a fascinating book--well written, well researched.

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Sep 27, 2011 Elementary Particle rated it liked it · review of another edition

It was a good book albeit due to the lack of documents many aspects are just suppositions from my point of view.

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Oct 26, 2011 David rated it really liked it · review of another edition

Who would have known? . . . Sigmund a coke addict. . . just saying . . . Fascinating read.

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Nov 17, 2011 Sarah rated it really liked it · review of another edition

Shelves: american-author, nonfiction, male-author, read-in-2011

A little repetitive in the opening chapters, but the look at two influential minds struggling with addiction is worth it.

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Nov 07, 2012 Samantha Stambaugh rated it really liked it · review of another edition

Shelves: non-fiction, bio-true-story, real-issues, psychology, history

Very interesting read.

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May 20, 2018 Lois rated it it was amazing · review of another edition

Seeing the devastation caused by the drug cocaine, which has led to the enslavement and death of so many, it is hard to think that its virtues as a miracle drug were once extolled by the medical profession. However, such is the case, as the renowned medical historian, Dr. Howard Markel, reveals in An Anatomy of Addiction: Sigmund Freud, William Halsted, and the Miracle Drug Cocaine, which tells of how both the innovative New York surgeon William Halsted and the father of psychoanalysis, Sigmund Seeing the devastation caused by the drug cocaine, which has led to the enslavement and death of so many, it is hard to think that its virtues as a miracle drug were once extolled by the medical profession. However, such is the case, as the renowned medical historian, Dr. Howard Markel, reveals in An Anatomy of Addiction: Sigmund Freud, William Halsted, and the Miracle Drug Cocaine, which tells of how both the innovative New York surgeon William Halsted and the father of psychoanalysis, Sigmund Freud, independently discovered at least some of the benefits of cocaine for therapeutic use, including as a means of overcoming addiction to morphine and as a treatment for depression.

That neither of the medical experts saw the dire consequences of becoming addicted to such a drug is patently clear, in that both Halsted and Freud not only experimented with using the drugs on themselves, but also on their own students, in the case of Halsted, and on members of their own family, in the case of Freud, who even prescribed it for use by his “beloved little woman,” Martha Bernays.

Dr. Markel’s lively account of the life of Halsted and Freud traces the histories of both men in relation not only to their medical practices, but also to their home life, showing how their addiction to cocaine impacted their performance both at home and abroad. His straightforward and realistic description of the medical advances made by both men reveals both their greatness and their shortcomings. For instance, he does not gloss over the fact that Freud, despite writing a treatise on cocaine, entitled Über Coca, in which he described his “most gorgeous excitement” about its efficacy, failed to make more than passing mention of its anesthetic qualities.

An Anatomy of Addiction: Sigmund Freud, William Halsted, and the Miracle Drug Cocaine is a fascinating revelation of conditions prevailing in hospitals and medical circles in the late 19th and early 20th centuries. Dr. Markel is not only an erudite scholar, but is also able to convey the most complex of concepts in the simplest of terms, making this book a valuable addition not only to college and university libraries, but also to school libraries and home collections.

For anyone who wishes to learn more about the evolution and effects of the drug cocaine, the work should prove an enlightening and informative read. Biographers and historians should take note as well of how fascinating a comparative study of two like-minded individuals can be. Despite Halsted and Freud never apparently meeting, their approach to the use of cocaine had some notable similarities—of interest to anyone interested in the health sciences.
...more

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Apr 06, 2019 Marilyn rated it really liked it · review of another edition

Shelves: biographies, sherlock-holmes, mental-illness-history-19th-c, medicine-and-nursing-history, arthur-conan-doyle, drug-action-abuse

It was supposed to be the wonder drug at the start of the age of wonder drugs. Pain reliever. Anesthetic for delicate surgical operations, particularly in ophthalmology. Mood enhancer. Anti-depressant. Tonic for tired people (like medical interns) with too much to do and remember, but little time to do it in and still eat and sleep. Curative agent for morphine and opium addiction. Cocaine! Better than Bayer Aspirin! No need for patent medicine nostrums! The Coca in Coca Cola!

But oh! How addictiv It was supposed to be the wonder drug at the start of the age of wonder drugs. Pain reliever. Anesthetic for delicate surgical operations, particularly in ophthalmology. Mood enhancer. Anti-depressant. Tonic for tired people (like medical interns) with too much to do and remember, but little time to do it in and still eat and sleep. Curative agent for morphine and opium addiction. Cocaine! Better than Bayer Aspirin! No need for patent medicine nostrums! The Coca in Coca Cola!

But oh! How addictive it was! It destroyed the life of one brilliant physician and nearly the lives of two who would change the practice of surgery and the study of the mind.

Dr. Howard Markel narrates and describes the history and actions, reactions, and the progress of the addictions of two very, very significant medical men: Doctor William Halsted, chief of surgery at Johns Hopkins Hospital and University in Baltimore, MD and Doctor Sigmund Freud, neurologist and psychoanalyst in Vienna, Austria. I wasn't able to understand all Dr. Markel wrote about cocaine, but he took great pains in explaining in lay terms how cocaine worked in the brain and how Freud and Halsted became addicts, refused to believe they were slaves of cocaine through their experiments ("We're DOCTORS! SCIENTISTS! And it really boosted our endurance and acuity."), and how they were gradually weaned from the drug. Not entirely, Markel states, but enough that they could function despite the craving until they could take mini-vacations to binge. Very secretive sorts, these two cocaine addicts.

This book is useful to the medical historian as well as to the interested lay-person (and maybe to the interested cocaine user. Someone put a copy of another book inside the jacket of the book in my library and I had to ask for another copy.) This book would interest a student of Sir Arthur Conan Doyle and his creation Sherlock Holmes. Doyle, Markel states, also experimented with cocaine (he cites a few articles in his end-notes) and Holmes told Watson he preferred a "seven-per-cent solution" of cocaine in "The Sign of Four". Reading about Dr. Halsted's case in particular, I was struck by how he resembled Holmes. Tall, sinewy, dedicated to his profession. A surgeon's surgeon like Holmes was a detective's detective. It was almost like seeing Holmes in silhouette behind Dr. Halsted, going through his movements. And the withdrawl he went through! Dr. Watson would have said the same of Halsted's pangs as of Holmes', "The fiend was not dead but sleeping." I recommend it to fellow Sherlockians / Holmesians as an eye-opener. ...more

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About Howard Markel

Howard Markel

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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 Engla ...more

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