Book review: ‘An Anatomy of Addiction’ by Howard Markel

An Anatomy of Addiction

Sigmund Freud, William Halsted, and the Miracle Drug Cocaine

Howard Markel

Pantheon: 352 pp., $28.95

Sigmund Freud sniffed it. William Halsted injected it with a hypodermic needle. Both men, as ambitious and driven young doctors in the 1880s, became addicted to cocaine. History suggests that Freud kicked his habit; Halsted never did. Halsted pioneered a host of surgical methods, the use of anesthesia, and antiseptic procedures in surgery rooms. Freud gave us a lantern with which to illuminate the dark labyrinth of the subconscious. Both men played their part in the invention of our modern world, and their stories, as well as that of cocaine itself, are braided together by Howard Markel in “An Anatomy of Addiction.”

When Freud and Halsted first became acquainted with their chemical bête noire, they “fully expected cocaine to be the wonder drug of modern medicine,” Markel writes. Neither had any idea about cocaine’s dangers. Addiction as a medical diagnosis had not yet entered the textbooks. Freud was treating a friend, a surgeon who had lost a hand and was reliant on morphine to quell the pain. Freud hoped that cocaine would help his friend break free from morphine.

“The initial results were nothing short of miraculous,” Markel writes, but then the friend’s condition “soon plummeted.” Meanwhile Freud, unwilling to experiment with a drug without personal scientific knowledge of its effects, started taking cocaine himself, and discovered that he liked it, not least because it gave him a sexual thrill.

“In my last severe depression, I took coca again, and a small dose lifted me to the heights in a wonderful fashion. I am just now busy collecting the literature for a song of praise to this magic substance,” Freud wrote to his fiancé, Martha, on June 2, 1884.

That “song of praise” became “On Coca,” a scientific paper that Freud published in 1885 and hoped would make his name. Freud analyzed his responses to cocaine in that paper, and this new system of autobiographical self-probing would prove crucial to his career, but he completely missed something else — cocaine’s effect as a local anesthetic. That potential use was discovered by Carl Koller, one of Freud’s rivals at the Vienna General Hospital, and it was Koller’s paper, much to Freud’s chagrin, that flew around an admiring world.

“The development of an agent that could be safely injected under the skin, leaving a patient completely awake yet insensate to the surgeon’s pointedly sharp manipulations, was earthshaking,” Markel writes, and news of Koller’s cocaine breakthrough was seized upon by Halsted, a young physician working simultaneously at Bellevue and various other New York City hospitals. Halsted came from a wealthy New York family. At Yale he’d been captain of the football team. Against the grain, almost, he’d become a doctor, a disciplined and daring surgeon of “incandescent curiosity.” Halsted started experimenting with cocaine as soon as he heard about it. Like Freud, he used himself as a guinea pig and soon became an accidental addict.

A professor of medical history and a doctor who has treated addicts, Markel attempts to apply a novelist’s touch to his tale that can be heavy-handed. “The atmosphere was thick with the exhaust of cigarettes, cigars, and inspired minds,” he writes, evoking the atmosphere at the Café Landtmann, a “pungently academic restaurant,” and suddenly plunging us into Freud’s Vienna as Robert Ludlum or Tom Clancy might conceive it.

Markel is terrific, though, when writing about the greasy pole of medical ambition, and when detailing the scientific stuff. Here the prose feels more energized and more solidly grounded, and he offers excellent sidebar portraits, including one of Angelo Mariani, who marketed “Vin Mariani,” a French tonic drink laced with cocaine. “His great eureka moment arrived when he mixed ground coca leaves with a far more traditional French intoxicant, Bordeaux wine. Through careful experimentation and measurement, the chemist realized that the alcohol in the red wine acted to unleash the power of the coca leaves. In the decades that followed, scientists discovered that when alcohol and cocaine are combined a new, even more intoxicating compound, called cocaethylene, is formed in the liver.”

Small wonder, then, that Vin Mariani was a huge success, endorsed by Ulysses S. Grant, Queen Victoria, the shah of Persia, Thomas Edison, Arthur Conan Doyle and a host of others. Cocaethylene populated the Victorian world with unknowing cokeheads. “If nature set out to design an addictive drug, it could hardly do better than cocaine,” Markel writes. “This is because the drug brilliantly fools the neurons ending in the nucleus accumbens into sensing a virtual abundance of enjoyable feelings and emotions.”

Cocaine freed up Freud’s writing and a cocaine-induced dream opens his first masterwork, “The Interpretation of Dreams.” Ideas of pleasure, pain, suppressed guilt and subsequent liberation, all of which Freud came to associate with the drug, lie behind his development of psychoanalysis, the talking cure. The analytic process, for those who’ve experienced it, is itself almost like a narcotic, inviting the subject to wander, trance-like, through the ruins of dream and memory.

Too much can be made of what cocaine might or might not have meant to Freud’s work, and Markel doesn’t belabor an argument. Instead, like a good analyst, he merely points out possible connections.

There’s no doubt, however, that cocaine almost destroyed Halsted’s life and career. Halsted survived, and through the benevolence of a friend and protector, William Welch, who believed in his genius, became the first professor of surgery at the newly built Johns Hopkins Hospital in Baltimore. Once there, Halsted became a legendary medical innovator and a great, if feared and eccentric, teacher of other surgeons.

Halsted was an active user of morphine and cocaine until the final days of his life. Binges explained his frequent absences from Johns Hopkins, and he and those close to him arranged his life to keep his addiction in the dark while his professional life stayed at a remarkable level of performance. He and Freud never met, though their paths came teasingly close at various times in Paris and Vienna. “Even fervent substance abusers can achieve greatness,” Markel writes, while of course not recommending addiction as a method. Rather, this rich, engrossing book reminds us of the strangeness of even heroic destinies.

Rayner is the author of “A Bright and Guilty Place: Murder, Corruption, and L.A.’s Scandalous Coming of Age.”