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An Anatomy Of Addiction: Sigmund Freud, William Halsted, And The Miracle Drug Cocaine (2011)

by Howard Markel(Favorite Author)

3.85 of 5 Votes: 5

ISBN

0375423303 (ISBN13: 9780375423307)

languge

English

genre

Memoir & Autobiography

publisher

Pantheon

review 1: 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 sanatorium. I am not really a history of medicine kind of person but this one is certainly at the top of its game.
review 2: Two medical pioneers -- including pioneers in the potential medical use of, and actual personal misuse of, cocaine. Howard Markel paints a cautionar... morey 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 theorizing.Markel gets behind the story, not just with Freud, but a somewhat older near-contemporary, William Halsted. Halsted, less familiar to many, was essentially the father of modern American surgery, a pioneer in introducing the use of antiseptic techniques in surgery, introducing new operating techniques and more, mainly from his perch of director of surgery and one of the founding doctors at Johns Hopkins School of Medicine.When I was a kid, I read a mini-biography of Halsted in a compendium of lives of great doctors, so I had heard about his "sea cruise" attempt to overcome his cocaine addiction. But, the story closed with what Markel notes was long the "official line" about Halsted: that he had no major problems, or problems at all, after that.How wrong I was, Markel shows.I had no idea he was "committed" to Butler Hospital, a "sanitarium." Nor that he was given morphine to "help" with cocaine withdrawal. Nor that he, as a result, apparently became a lifelong morphine addict. Nor that he apparently struggled to some degree with cocaine addiction for the rest of his life.Markel, an M.D. and Ph.D. with addiction support help background, shows a clinician's skill in diagnosing how addiction affected Halsted's life, his work at Johns Hopkins, his relation to surgical interns and patients and more.In parallel chapters, he also looks at how cocaine use affected Freud's personality, his own medical theorizing (including, in reverse of Halsted's time at Butler, the idea that cocaine could be used to treat morphine addiction), his psychological theorizing (including how "The Interpretation of Dreams" was likely largely affected by guilt trip over his participation in how a doctor friend and fellow cocaine touter, Wilhelm Fliess, medically mistreated one Emma Eckstein) and more.Was Freud, like Halsted, an addict? Markel carefully uses the distinction between "abuse" of a drug and "addiction" to a drug to say that Freud was clearly a cocaine abuser, and may have crossed the addiction line, without us being able to know for sure.A few lines from the epilogue show Markel's insight:"When Freud and Halsted first became acquainted with their chemical bete noire, they fully expected cocaine to become the wonder drug of modern medicine. Neither had any idea of its potential to dominate and endanger their lives. Addiction as a bona fide medical diagnosis was not yet in the doctor's lexicon, let alone his textbooks. ..."Each man actively participated in the birth of the modern addict, and their clinical histories prefigure the ever-challenging spectrum of substance abuse, addiction and recovery. Freud somehow escaped from his cocaine dependency even as he was plagued by periods of sexual turmoil, increased alcohol consumption, and depression. Decades after Halsted restricted his cocaine use to occasional binges, he still availed himself of daily morphine injections to quell his addictive urges, often with negative results."Going beyond the parallel biographies, Markel then discusses issues of drug addiction in general, from how it was understood at the time of Halsted and Freud to how our understanding has evolved today. Without being harsh, he also notes his medical peers today are often like those of a century ago in still often offering biochemical help to addicts that turns out to promote a substitute addiction.He then, behind that, notes the development of cocaine from a raw substance in coca leaves to its refinement into cocaine hydrochloride of snorting use both then and today, as well as other methods to use it. Besides Coca-Cola, which did, yes, originally have a bit of cocaine in it, though not much,there were cocaine-laced alcohol products, quite popular then. I had heard of them, but didn't know the details, including that alcohol actually combines with cocaine to produce an even more intoxicating compound, cocaethylene, in the liver. So, in addition to the "speed-ball" like effect Halsted had when he was using both morphine and cocaine, we already were having cross-addiction being promoted back then.I definitely now want to read Markel's "Quarantine" about East European Jewish emigration to the U.S. and the diseases that came with this. less

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