Freud never questioned this bias and praised professors for pestering “the beautiful sex so little with scientific knowledge!”
But during his years at the Vienna General Hospital, he was in love, and more motivated than ever to solve some huge riddle—he needed to earn enough money to marry Martha. Still living with his parents, he was so poor that he often couldn’t afford train fare to go see her. He economized in every way—once spending what little money he had on a pen with a finer point so he could fit more words on a page.
Part of him would have been content to continue his medical research, but the impoverished life of a researcher would not gain him Martha. “Oh, my little darling, you have but one minor fault; you never win the lottery,” he wrote her jokingly.
In his haste to get his shaky career moving, he took a startling turn. His first important published article, in an 1884 medical journal, was on . . . the benefits of using cocaine. Why?
Freud hoped to make a discovery combining his knowledge of the brain as a physical organ with his wish to help people with emotional problems. A chemical, for example, that would act on the brain in a way that would help. Rashly, he convinced himself that cocaine was the scientific breakthrough he’d been looking for. This was a drug that would help people in emotional pain—millions of people, who would then reward him for prescribing this miracle drug.
The drug was then little known, little understood, and still legal. Its habit-forming nature hadn’t been discovered. Actually, in the 1880s, drinks containing cocaine were popular—they were called “brain tonics.” (The most famous brain tonic of all, Coca-Cola, contained a little cocaine until around 1903.)
Freud read a study in which German doctors had used the drug to increase soldiers’ endurance on the battlefield. He ordered his first gram of cocaine from the local apothecary (pharmacy). Using himself as an experimental subject, he swallowed the powder and soon felt great.
Most tellingly, it helped with his own troubling symptoms—anxiety, migraines, and stomach pains. Plus it gave him welcome surges of energy. “In my last serious depression I took cocaine again and a small dose lifted me to the heights in a wonderful fashion,” he wrote.
He researched anything he could find for writing “On Coca,” his “song of praise to this magical substance.” He considered it as an anesthetic, a remedy for morphine addiction, a treatment for stomach problems, a quick fix for seasickness, even a possible cure for diabetes. He gave samples of the drug to his patients, friends, sisters, even Martha. He continued to experiment on himself—for the next several years.
Cocaine
was
found to have a medicinal purpose—but not by Freud. Credit went to Freud’s friend and fellow experimenter, Czech eye doctor Carl Koller. Eye surgery was especially tricky then, requiring that patients stay awake and able to follow instructions, and not bolt in pain. General anesthetics were useless because they put patients to sleep, so the horrific method was to recruit several people to hold a patient down. One day Freud mentioned that cocaine numbed his lips when he drank it. Koller got the idea to try putting it in his patients’ eyes before performing surgery.
As a temporary painkiller it worked, but the response varied greatly from one person to another, with side effects sometimes alarming or fatal. For Freud, the outcome of this whole line of research was disastrous. Trying to cure the addiction of a close friend who was using morphine as a painkiller, Freud gave him doses of cocaine. He succeeded only in giving his friend horrible hallucinations and a new addiction. Indeed, some of the early experimenters with cocaine never recovered their health—Freud was lucky in this respect.
As more and more instances of addiction were reported, Freud’s marvelous wonder drug started to look suspect. Embarrassed, he dropped the notion of cocaine as a medical miracle. But his reputation was tarnished once the drug was quickly rejected by the medical profession. (In 1914 cocaine was made illegal in the United States except for doctors.) Even today it haunts him—critics who want to call into question Freud’s judgment as a scientist will bring up the cocaine episode.
At the very end of his life, Freud would return to the idea that drugs might help patients by correcting chemical imbalances in their brains. Meanwhile, what about an alternative to electroshock, some new, more benign, therapy for treating disturbing behavior?
Following another hunch, Freud left Vienna for Paris in 1885. He was determined to work in the lab of Jean-Martin Charcot, a professor of neurology and then the most famous doctor in France next to Louis Pasteur. Charcot was the resident genius at the Salpêtrière, a huge hospital for several thousand women, many with various symptoms and mysterious illnesses that defied traditional diagnosis.
There was at this time a catch-all diagnosis of “hysteria.” It affected patients, almost always women, who were not sick physically, at least as far as doctors could tell, and yet were plagued with mystifying symptoms. The list was long—tics, nausea, coughing, dizziness, severe pains, paralysis, seizures. Some patients seemed depressed, but not all.
The word “hysteria” came from the Greek word for “womb.” The ancient Greeks believed that a woman’s uterus could wander in the body and inflict these physical symptoms. The cause was physical, not mental. Hippocrates even recommended a serious bout of sneezing to force the uterus to snap back into position.
Later theories had blamed hysterical behavior on demons or satanic possession. Among his patients, Dr. Charcot observed, “there are many who would have been burned in former times”—as witches. He wanted to examine them from the perspective of a physician and find the root cause of the disease.
Charcot and other doctors debated—was hysteria genetic? Was it caused by physical trauma? Were these women faking it? Could a malfunctioning uterus actually be responsible in some way? Or did hysteria originate in the brain? What about lesions (damaged spots) in the brain? In other words, was the disease all in their mind?
One thing was sure—none of the current remedies worked. They ranged from the harmless (a milk diet) to the inhumane (bizarre surgeries). Patients with no money were abandoned in asylums. Those with resources were subject to rest cures. A patient would rest in bed in a dark room for a month (or many months), sometimes sedated with morphine or chloroform, and spoon-fed cold rice pudding and other soft white foods. Shocking the nervous system was thought helpful—hydrotherapy (being sprayed with jets of cold water) or electroshock, including “faradization,” or sitting naked with feet in a bucket of water while a doctor used a coil to pass electric current through the body.
Charcot’s first attempts to cure hysteria seem equally far-fetched. He devised a special hat for patients to wear that vibrated with an electric motor. He also was known to suspend patients in an iron harness from the ceiling. But his newest method was to treat hysteria through hypnosis.
Hypnosis had been popularized a century earlier by Franz Mesmer, another doctor from Vienna. By staring into patients’ eyes and speaking in a slow, soothing voice, Mesmer gradually put patients in a trance. Mesmer would then press the area of the body he believed caused the illness before returning the patient to a conscious state. Mesmer’s patients seemed to get better in his care, though other doctors accused him of being a fraud. By Freud’s time, Mesmer had been largely discredited, with most medical doctors scorning hypnosis as nothing more than a party trick. Half-asleep, half-awake, patients under hypnosis were not cured, only highly suggestible, apt to do whatever the hypnotist said. But now in the 1880s, Charcot wanted to revive the technique with his patients.
He thought that hypnotism could bring on hysteria in emotionally unstable people. Each week he held a seminar for the public to demonstrate how hypnosis could produce the symptoms of hysteria.
He would hypnotize patients. Once they fell into a trance, he could produce each symptom, one at a time, and then remove them, one by one. Followers of Charcot then went a step further. When they told hypnotized patients that their symptoms would be gone upon awakening, indeed they were.
Something of a performance artist, Charcot drew crowds to his lab. Freud for one was awed. He was learning the power of words, of suggestions, how potent they could be in the context of healing. As he was to write later, “Words were originally magic and to this day words have retained much of their ancient magical power.”
Of his nineteen weeks in Paris, Freud wrote, “No other human being has ever affected me in such a way.” It was Charcot who introduced Freud to the possibility that physical disorders might have their source in the mind rather than the body.
Alas, Charcot’s reputation declined, and eventually his faith in hypnosis was taken no more seriously than Mesmer’s. But the seed for Freud’s further investigation had been planted.
Freud was galvanized by the idea that hypnotism and hysteria were related in a way
the patient couldn’t see.
He had learned in his biology classes all about the germ theory of disease, that organisms unseen by the naked eye could nevertheless wreak havoc within the body. Now he decided that “there could be powerful mental processes which nevertheless remained hidden from the consciousness of men.” Charcot’s demonstration of hysterical symptoms, such as paralysis of an arm, appearing and disappearing under hypnotic suggestion pointed to the power of purely mental states. Were there forces affecting the mind that the mind was not aware of? If yes, what were they?
Freud’s vision of himself as a hero came into sharper focus. He couldn’t wait to set up his own practice, so he could learn about this relationship between physical and emotional illness, between the brain as an organ and as a place for “mental processes.” He always kept Charcot’s photo hanging in his office and saw himself as building on the other doctor’s work.
Heady with anticipation, he wrote to Martha, “I will cure all the incurable nervous patients and you will keep me well . . . and they lived happily ever after.”
Now thirty years old, he returned to Vienna in February of 1886. He promptly put a notice in the newspaper that a certain Dr. Sigmund Freud was available for consultation on “Nervous Diseases” from one o’clock to two thirty daily.
Eight months later, with some loans from relatives, he finally felt solid enough to marry his true love.
CHAPTER FOUR
The Case of Anna O.
AT FIRST FREUD had trouble filling up his few hours of office time.
He kept busy writing letters (more than 20,000 during his life). His letters were filled with details about his children—six of them over the next nine years.
He spent time translating lectures by his idol Charcot and giving unpaid lectures at the University of Vienna. He wrote articles about aphasia, a language disorder resulting from damage to the brain. Carl Wernicke, like him a former student of Meynert’s, had just compiled a hefty
Manual of Brain Diseases
, all about aphasia and other brain abnormalities. Freud kept up with his research and attended meetings of Vienna’s science societies.
One night he tried to give a lecture to the Society of Physicians. He was excited about his topic—male hysteria, a little-talked-about concept. Several professors in the audience pointed out they had been researching male hysteria for years. Freud felt humiliated and never went back.
But other doctors started referring their difficult patients to him, and he gradually expanded his hours. These were “hysterics” proving impossible to diagnose or cure, mostly educated women with the time and money for treatment.
At this point Freud was using hypnosis. His methods varied, from staring into the eyes of the patient to placing a firm hand on her forehead. He was pleased by how much new personal information, so far concealed, could be retrieved this way. He became more and more intrigued by what he was hearing—abusive parents, grief over the death of a brother, other events that created “powerful mental processes” he was eager to explore. Freud wrote it all down—the women’s memories, wishes, fantasies, dreams.
His closest friend at this point was another Viennese doctor, older by fourteen years—Josef Breuer. The two men had the same interests, and the much more experienced Breuer gladly shared all he had learned. Among many other things, Breuer was researching the inner ear’s role in keeping one’s balance. But most of his time was spent treating wealthy Vienna families, his reputation so high that he was personal doctor to most of the professors at the University of Vienna.
Freud said that talking to Breuer was like “sitting in the sun. . . . He radiates light and warmth.” Breuer sent many patients his way and even loaned Freud money during tight times. As a new father—his first child, Mathilde, was born in 1887—Freud needed money more than ever. He wanted to give his children relief from the financial worries that he felt had “robbed” him of his own youth.
The most important patient to Freud at this time was not even his, but one Breuer had treated from 1880 to 1882. “Anna O.”
Anna was a true puzzle. (Anna was not her real name—doctors made up names to protect their patients’ privacy.) At age twenty-one, she suffered from hysterical symptoms that were wide-ranging and hard to classify. Her arm was paralyzed. She had hearing problems and experienced numbness and headaches. Sometimes she suffered hallucinations about snakes and skeletons, or lost her ability to speak German, her native language, or refused to eat anything except oranges. She had a false pregnancy that gave her labor pains, and she showed evidence of two distinct personalities.
Anna was also highly intelligent and well-read (and frustrated at the limited role for women in her society). She was impressed with a book about catharsis, written, coincidentally, by Martha Freud’s uncle Jacob. Catharsis referred to Aristotle’s theory of drama, that watching a great tragedy left an audience “purified,” feeling safely released from painful emotions like fear and sorrow.