Hidden History

That Time Sigmund Freud Nearly Killed a Patient—and Then Got Hooked on Cocaine

In 1895, the psychoanalyst tried to treat a young woman by giving her cocaine. His failure sent him on a course of drug addiction that changed the course of psychiatric history.

That Time Sigmund Freud Nearly Killed a Patient—and Then Got Hooked on Cocaine

“I need a lot of cocaine,” wrote Sigmund Freud to his friend and colleague Wilhelm Fleiss. “I am overflowing with new ideas, theoretical ones as well.”

It was 1895, and Freud was in a career crisis. According to several biographers, one of Freud’s patients, Emma Eckstein, had come to him complaining of stomach pains and depression related to her menstrual cycle. Freud diagnosed her with hysteria and “masturbating to excess,” something he believed was both a mental illness and the root of all addiction, as he wrote in the abstract of “Masturbation, addiction and obsessional neurosis” (1897).

He called in Fleiss, an otolaryngologist, for the treatment: cauterization of the nose. Fleiss believed the nose was linked to the genitals, and that operating on it could quell sexual problems such as Emma’s. He and Freud cauterized her nose with cocaine, which was legal at the time, and sometimes used as a local anesthetic and for cauterization. They shoveled gram after gram of pure cocaine up Emma’s nose; the chemicals burned through her tissue and sinuses, emitting both a surge of pus and the putrefying smell of burning flesh. After the operation, they bandaged her up, and Emma was sent on her way.

Two weeks later, she returned to Freud with implacable nosebleeds. This time, Freud called a different doctor to inspect her nose; the doctor pulled out twenty inches of gauze that Freud and Fleiss had accidentally left up there. According to both men present, blood poured from her nose like a faucet; her eyes bulged, she turned white, and for thirty seconds she lost her pulse.

Over the next few days, she returned to Freud with near-fatal hemorrhages. Half of her face had caved in. Freud continued treating her, giving her morphine and reapplying bandages, though he felt enormous guilt over his malpractice. Looking for stress-relief, Freud took to his two favorite vices: cigars and cocaine.

“Today I can write because I have more hope,” he wrote Fleiss. “I pulled myself out of a miserable attack with a cocaine application.” Shortly after, he wrote Fleiss again: “Since the last cocaine ization three circumstances have continued… 1. I feel very well 2. I am discharging ample amounts of pus 3. I am feeling very well.”

For a young Freud, cocaine was a miracle drug. Before developing psychoanalysis and the theories for which he is now famous – the unconscious mind, psychosexual development and the Oedipus complex, the interpretation of dreams – Freud was a coke addict. As his racy love letters to his fiancée Martha Bernays prove, he used cocaine for pleasure and relief, to relax and to concentrate; he took it at glamorous parties in Paris; he used it to treat his illnesses and nasal irritations; he prescribed it to his patients, friends, and Martha herself. He wrote extensively on it, and he even attempted to use it as a springboard to medical fame. When the dark side of cocaine began to emerge, after more than a decade of using the drug, Freud kicked his habit, and did everything in his power to erase public knowledge he had ever touched it.

While humans had been chewing coca leaves for thousands of years, the synthesized cocaine hydrochloride had been around only for some 25 years when it crossed Freud’s path. In 1884, Freud read an article about a German soldier who had collapsed from exhaustion, and, after swallowing cocaine, stood up and walked “easily and cheerfully with a pack on his back.” Looking for his big break in medicine, Freud decided to test the drug himself and report his findings. He ordered a gram of pure, unadulterated cocaine – far more potent than the cut substances sold on the street today – and swallowed just a twentieth of it.

After his first trial, Freud reported, “Long intensive mental or physical work is performed without any fatigue. This result is enjoyed without any of the unpleasant after-effects that follow exhilaration brought about by alcohol.” He then described the beauty of his coke rush: “One senses an increase of self-control and feels more vigorous and more capable of work; on the other hand, if one works, one misses that heightening of the mental powers which alcohol, tea, or coffee induce. One is simply normal, and soon finds it difficult to believe that one is under the influence of any drug at all.”

Oblivious to cocaine’s addictive properties, Freud prescribed cocaine to his friend and teacher, Ernst von Fleischl-Marxow. His friend was a morphine addict, and Freud thought cocaine could cure his addiction. Fleischl-Marxow temporarily replaced his morphine addiction with a cocaine addiction, and displayed no symptoms of morphine withdrawal.

“Triumph,” Freud wrote. “Rejoice for me. Through cocaine we achieved something beautiful.”

High off the coke and success, he prescribed it to another patient, and burned through his gram. After five weeks of swallowing pure cocaine, he wrote Über Coca, the first of four papers he would publish on the drug. The essay chronicles a short history of the coca plant and cocaine, explains its effects, and praises its possible uses in psychology and medicine. The tone of Freud’s writing reflects his infatuation with the drug; he calls his paper a “song of praise” for the “magical drug,” and refers to the high as a “gorgeous excitement.”

As Freud studied cocaine, his friend, Carl Koller, also researched the drug. Koller “discovered” the anesthetizing properties of cocaine after administering it to a frog’s eyeball. When the frog didn’t flinch through eye surgery, Koller published his findings and shot both cocaine and himself to fame.

Freud narrowly missed the breakthrough, though he didn’t abandon studying the drug. He wrote three more papers, Nachtrage Über Coca (Supplementing Cocaine), Über die Allgemeinwirking des Cocaïnes (On the Working of Cocaine), and Beiträge über die Anwendung des Cocaïns (Posts on the Application of Cocaine), all of which fiercely rejected the criticism cocaine had begun to garner as doctors observed its dangerous properties. He lectured on the uses of cocaine, and continued prescribing it to his patients.

In 1899, Freud completed his magnum opus, The Interpretation of Dreams. While not an instant success, the book later became the definitive text of his studies. If we are to think like Freud about his own text – that all our dreams are “wish-fulfillments,” or unconscious attempts to resolve our conflicts – The Interpretation of Dreams is the dream journal of an addict. The book is awash in cocaine; out of the 39 personal dreams he discusses, only seventeen are fully-developed narratives; of these seventeen, eight involve cocaine.

Shortly after Freud nearly killed Emma Eckstein by stuffing her nose with coke and gauze, he dreamt about her. The dream contributed heavily to his book, and is now known as the “Irma’s Injection” dream. In it, Freud stands before a great hall, welcoming guests to a party. Emma, referred to as Irma, enters the hall, and Freud takes her aside. She complains to him that her operation was so painful she still feels like she is choking. Freud notices a change in her face; she has grown pale and puffy, and looks as though something wicked is bubbling inside of her. By the window in front of the party guests, Freud inspects her mouth to find an enormous white patch coating her throat. Beside the patch, he sees turbinate bones – the bones found inside the nose – encrusted with white scabs.

“The scabs on the turbinal bones,” Freud wrote, “recalled a worry I had about my own state of health. I was making frequent use of cocaine at the time to reduce some troublesome nasal swellings and I had heard a few days earlier that one of my women patients had developed an extensive necrosis of the nasal mucous membrane.” He concludes that her sickness arose from another doctor’s misconduct – a botched injection – before the dream ends without resolution.

Even without Freud declaring his “frequent use of cocaine” a “worry,” any Freudian can see the ghastly effect his addiction had on “the most famous dream in psychoanalysis,” as Jay Greenberg wrote. The symbols are all there: the exposure of his malpractice in front of important members of society, the scabrous white patch in Emma’s throat and on her nasal bones, the injection that ends the dream; after all, Freud injected several of his patients with cocaine – sometimes a gram daily, according to Howard Markel, author of An Anatomy of Addiction: Sigmund Freud, William Halsted, and the Miracle Drug Cocaine.

As the evidence against cocaine became irrefutable, and his fame grew, Freud quit coke and destroyed the letters and documents that discussed his affair with it. He provided little evidence as to what exactly instigated his sobriety. David Cohen, author of Freud on Coke, suggests he may not have needed the drug anymore, as he had solidified his reputation following The Interpretation of Dreams. He accepted the evils of cocaine, and no longer needed it personally. “I know very well how [the cocaine episode] happened to me,” he wrote his friend and biographer, Fritz Wittels, in an attempt to remove all biographical discussion of his cocaine use. “The study on coca was an allotrion [a distracting, futile pursuit] which I was eager to conclude.”

According to Freud’s famous (though apocryphal) remark, “Sometimes a cigar is just a cigar.” But is a line of cocaine ever just a line of cocaine, or does each line lengthen a trail that leads the user down a certain path?

Markel believes that Freud’s “cocaine episode” may have influenced his theories and the founding of psychoanalysis. He discusses how cocaine partly inspired Freud’s famous “free association” technique, where he asked his patients to voice their unconditioned, “stream of consciousness” thoughts. Freud loved the liberating effect of cocaine and how it made him and his patients more excitable, chatty, and open; even after he stopped prescribing the drug, he still wanted his patients to respond like they were high on coke. Other biographers, such as E. M. Thornton, author of Freud and Cocaine, have suggested that since Freud’s theories were both scientifically unfounded and developed by someone frequently under the influence of a mind-altering substance, they are untrustworthy and must be studied in light of his addiction. In her introduction, Thornton stakes the claim that Freud’s “central postulate, the ‘unconscious mind,’ does not exist, that his theories were baseless and aberrational and, greatest impiety of all, that Freud himself, when he formulated them, was under the influence of a toxic drug with specific effects on the brain.”

Cohen has noted that Freud’s cocaine experiments were one of the first times he treated himself as his own patient. He used himself as the guinea pig, and the introspection directly led to discovery. This started a trend in his career; many of his ideas came from his own self-awareness and reflection on his own psyche. Über Coca was the first time Freud included himself in his work, essentially making his debut as a character in his own literature. There’s also the chance that without cocaine’s bitter effect on his patients and mental state, his dreams may not have interested him at all. What greater concern to a young Freud than a nasty drug addiction with several casualties that may have left him out of a job?

It was a destructive influence, yes, but an influence nonetheless; through cocaine, Freud really may have “achieved something beautiful.”