bjbjLULU JEFFREY BROWN: Now, a tale of cocaine
addiction involving two leading figures in
the history of medicine.
NewsHour health correspondent Betty Ann Bowser
has our book conversation.
BETTY ANN BOWSER: Sigmund Freud and William
Halsted were two medical revolutionaries,
Freud, the well-known father of psychoanalysis,
Halsted, the less well-known father of modern
surgery.
But just beneath the black-and-white success,
there's another story.
Both men shared a blinding addiction to cocaine.
In a new book called "An Anatomy of Addiction,"
pediatrician Howard Markel tells how the two
tried to ward off self-destruction in the
quest for knowledge.
We caught up Markel at Johns Hopkins Hospital
in Baltimore, where Halsted connected some
of his greatest work.
Dr. Markel, thank you so much for doing this.
DR.
HOWARD MARKEL, "An Anatomy of Addiction":
Thanks for having me.
BETTY ANN BOWSER: So, what was the connection
between Sigmund Freud and William Halsted
DR.
HOWARD MARKEL: Well, they both were contemporaries.
They never met, or at least I can't find any
evidence.
But they were braided -- their lives were
braided together.
They were bound together by a fascination
with cocaine and several medical papers that
some they each wrote or some they read about
the latest, newest miracle drug of their era,
1884.
BETTY ANN BOWSER: So, here we are, in the
medical library of William Halsted at Johns
Hopkins University, one of the great medical
centers in the world, and he was a first here.
What did he do?
DR.
HOWARD MARKEL: Most of the modern safety procedures
we take of how to cut open a body, how to
handle the tissue very delicately and gently,
so that it heals well, how to suture it correctly,
this was all William Halsted.
He was also fascinated with aseptic surgery,
not introducing germs into the surgical wound.
BETTY ANN BOWSER: So, at this point in medical
history, cocaine was found to do what that
would allow Halsted to do all these things
in surgery and Freud to do all these things
with his medicine?
DR.
HOWARD MARKEL: Here, you had something you
could inject or treat or rub on there, and
it numbed it to the surgeon's knife.
And so Halsted became fascinated with using
this deeper and deeper into the body to do
all sorts of procedures without putting a
patient under.
BETTY ANN BOWSER: So, Halsted got involved
with cocaine by experimenting with it in ways
to use it in surgery?
DR.
HOWARD MARKEL: Yes.
It was very common for many a doctor in the
late 19th century and the early 20th century
to use themselves as guinea pigs.
And no doctor at this time knew of the terrible
addictive effects of cocaine.
None of this had been figured out yet.
And so the first arm to be put out and injected
was Halsted's.
BETTY ANN BOWSER: Did Halsted understand at
the time what he was doing to himself?
DR.
HOWARD MARKEL: At some point, he did, when
he still lived in New York and he was literally
ruining his career.
He stopped going to the operating room.
He stopped going to the hospital.
He stopped going to medical meetings.
And, in fact, at one point, he was called
down to the emergency room, bombed on cocaine,
and he literally pulled away from the table
and said, "I can't operate," and walked out,
took a cab back to his townhouse and skittered
away the next seven months high on cocaine.
BETTY ANN BOWSER: Halsted eventually committed
himself to an insane asylum in Rhode Island,
hoping to be freed of his addiction.
But in those days, there was no real treatment.
So, for the rest of his life, he struggled
with the disease.
Across the Atlantic and long before psychoanalysis,
a young Dr. Freud also believed that cocaine
might be his ticket to fame and fortune.
One of his closest friends was addicted to
morphine.
And Freud published journal articles proclaiming
cocaine was the cure.
But he also had a more personal interest in
the drug's effects.
DR.
HOWARD MARKEL: Freud loved the way cocaine
made him feel.
And he was very interested in its psychological
components.
For one, it did make him feel better when
he was sad.
He also was amazed at how it made him talk
about things endlessly that he thought were
locked away in his brain.
Sound familiar?
That's talk therapy, but without the toxic
side effects of cocaine.
But he got to like it a little bit too much.
BETTY ANN BOWSER: Did any of his writings,
the dreams, the sense of euphoria, all the
things that he got from using cocaine, did
any of those lead to anything that we now
see in psychiatry today?
DR.
HOWARD MARKEL: Well, it did.
It did.
To begin with, the idea of talk therapy where
you talk freely or free associate from one
thing to another, may have been inspired by
the cocaine unleashing his tongue or his repressed
memories.
But most importantly, cocaine haunts the pages
of "The Interpretation of Dreams."
The model dream is a cocaine dream, what addiction
therapists would call a using dream.
He was using cocaine quite a bit in 1895 on
himself, to the point he was having chest
pain.
He was depressed.
And he also -- his nose was so congested,
he had to have a surgeon open it up with a
knife so he could breathe, lots of signs that
you might want to lay off the stuff.
BETTY ANN BOWSER: In the 1890s, after almost
killing a patient while under the influence
of cocaine, Freud stopped using the drug.
It was after that when some of his most famous
work was produced.
When cocaine was being used by Freud and Halsted
at this point in time, did the world look
at cocaine as something fantastic or something
to be experimented with?
How was it viewed?
DR.
HOWARD MARKEL: All they saw were the good
aspects.
No one knew -- down the road, it was very
obvious when you had all these addicts that
were created.
And it was overprescribed, as was morphine
and opium, for everything.
And it wasn't until about five or 10 or 20
years later, that people started to say, hey,
everybody I know is addicted to this stuff.
There was no such thing as controlled substances
either.
You didn't need a prescription.
You could just buy it at a drugstore on your
own.
It really outlines the morality play that
continues to this day of every blockbuster
pharmaceutical agent: This drug, when it comes
out, is the greatest, the newest, the best.
And then, as we find out more and more, well,
it's not so great.
It has to be used under certain conditions.
BETTY ANN BOWSER: So, would you say beyond
this old story is a contemporary cautionary
tale?
DR.
HOWARD MARKEL: Absolutely.
It's a morality play for today, as well as
yesterday.
And that's why I could find all of these issues
in their two lives about addiction in general.
And we had to be very careful, because, as
we're learning more and more about addiction,
not just one's environment or the drug they
use or the root of administration, but also
one's genetic predisposition -- so think of
it as a wheel of misfortune.
And as it goes around, if you wind up on the
bad wedge, you could become an addict.
BETTY ANN BOWSER: Dr. Markel, thank you for
being with us.
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