Did Sigmund Freud use cocaine on his patients?

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Dear Cecil: My friends tell me that Sigmund Freud used cocaine on his patients while diagnosing them. Is this true? Blake Harnage, Birmingham, Alabama


Illustration by Slug Signorino

Cecil replies:

I’m not sure what you’re envisioning here. “Yo, Fraulein, have some cocaine. May I examine your organs?” So far as I know, this was not Freud’s procedure. However, he was an early advocate of cocaine, used it himself, and touted it to his associates, one of whom demonstrated that it could be used as a local anesthetic. Sales of the drug immediately took off, and an industry was born. In other words, not only did Freud give us psychoanalysis (and psychiatry in general, I venture to say), we can also thank him for the crack epidemic. Quite the career. What could this guy possibly have done for an encore — invented the atom bomb?

Freud wrote his famous paper “On Coca” in 1884, when he was 28. In it he described the history and effects of cocaine and spoke glowingly of its therapeutic benefits. A penniless young physician on the make, Freud thought cocaine would be his ticket to fame and fortune. He was partly right — both Merck & Company and Parke, Davis & Company, the leading makers of cocaine-based pharmaceuticals, paid him to write about their products.

By modern standards “On Coca” is a joke. Freud uncritically cited articles about cocaine that appeared in a magazine published by Parke, Davis — essentially paid advertisements. He gushed about “the most gorgeous excitement” the drug produced. Chances are he wrote the article under the influence. Evidence: (a) Cocaine enables users to work like maniacs. (b) The delivery of cocaine for research purposes arrived in late May, and the article was completed on June 18.

“On Coca” received wide notice, but the guy who really put cocaine on the map was Carl Koller, a Vienna surgeon with whom Freud was friendly. Freud had noticed that cocaine numbed the tongue when ingested (nobody snorted or smoked it in those days) and suggested that cocaine might be useful as a local anesthetic. Experimenting on animals and then on himself and an associate, Koller found that cocaine rendered the eyes insensitive to pain. A report presented on his behalf at a medical meeting in September 1884 galvanized the medical world — as the only effective local anesthetic, cocaine opened up vast new fields for surgery. Soon everyone was experimenting with the drug. Struggling to keep up with demand, pharmaceutical companies developed industrial production methods, and from there it was but a short step to Medellin.

Although Freud minimized the dangers of cocaine in his articles, the potential for abuse was evident from the outset and was greatly multiplied as techniques for purifying and administering cocaine improved. One early victim was Dr. Ernst von Fleischl-Marxow, who suffered from tumors of the peripheral nerves and had become a morphine addict while attempting to ease the pain. Freud thought cocaine might cure the addiction and sent some to his friend. Soon von Fleischl-Marxow was consuming a gram of cocaine a day, and he developed a classic case of “cocaine psychosis,” thinking that snakes were crawling over his body. He hung on for another few years but eventually died in agony. Numerous other cases of cocaine toxicity also came to light. Freud defended the drug as late as 1887 but eventually repented and stopped using cocaine both personally and professionally. However, some profess to see the influence of cocaine in his theory of dreams, introduced a few years later.

Freud never became dependent on cocaine. Some say that’s because he didn’t have an addictive personality, but the more likely explanation is that he was already addicted to something else, namely nicotine in the form of his famous cigars. Freud smoked 20 a day even though they began giving him chest pain and shortness of breath while he was still in his 30s. In his 60s he developed cancer of the jaw and soft palate and eventually had 33 operations, resulting in the complete removal of his jaw and the substitution of a prosthesis. His friends begged him to stop smoking but Freud continued to puff away even after his health had so deteriorated that he could no longer work. Despite chronic pain and the frequent inability to speak or swallow, he persisted in his use of cigars until his death from oral cancer in 1939 at age 83. Crazy, eh? No question, the guy should have seen a shrink.

Cecil Adams

Send questions to Cecil via cecil@straightdope.com.