Was Freud a Freudian?
Not in your dreams.

Sigmund Freud asked that we reveal our deepest secrets. Acknowledging the truth about one's past, he insisted, offered relief for even the most stubborn neurosis.

But this acolyte of soul-searching had a very casual relationship with telling the truth. Freud's rationalizations, omissions and deceptions were the very opposite of the treatment he offered his patients. More disturbing, his deceit was intricately connected to his abuse of cocaine.

Freud's love affair with this dangerous substance began in April 1884 when he was a neurologist at Vienna General Hospital. Casting about for a research project that would make his name, he was captivated by medical reports of a miracle cure-all called cocaine hydrochloride. Freud hoped to use cocaine as an antidote for a friend, the talented physiologist Ernst von Fleischl-Marxow, who was suffering the ravages of morphine addiction. Sadly, Freud's therapy turned Fleischl-Marxow into an addled morphine and cocaine addict who died at age 45.

But Freud carried on with his studies, consuming extraordinary amounts of cocaine in the name of scientific research. Ignoring evidence that he was falling prey to the drug, he simply loved the way it made him feel. His realization that the white powder made him talk endlessly about repressed memories made it an integral part of a toxic version of what he would later call the "talking cure." By 1895, he was abusing so much cocaine that he experienced serious heart pain, depression and difficulty concentrating. His nose was so congested that he required surgery to have a hole cut in the swollen linings of his nostrils.

Still, refusing to acknowledge objective reality, Freud recommended this cure to others. At the peak of his cocaine abuse, he struggled to treat a hysteric named Emma Eckstein. After months of fruitless psychotherapy, Freud wondered whether Eckstein's symptoms might be physical rather than psychological. He called in a trusted medical colleague, Wilhelm Fliess, to examine her. Fliess, who insisted that physical illnesses emanated from disturbances in the nose, recommended surgery and cocaine.

The operation was a disaster, permanently disfiguring Eckstein and causing a near-fatal infection. Weeks later, the guilt-ridden Freud dreamed about a party where a bloody Eckstein scolded him for gross negligence in front of Vienna's most prominent citizenry.

Wracked with remorse after killing one patient and mutilating another, Freud could have followed his own method — that is, confessed his wrongdoing and obtained some measure of psychic peace. Instead, he incorporated a sorry explanation of his actions into "The Interpretation of Dreams," the groundbreaking book that launched psychotherapy. "This group of thoughts seemed to have put itself at my disposal, so I could produce evidence of how highly conscientious I was," Freud wrote of his dream, "of how deeply I was concerned about the health of my relations, my friends and my patients." This revisionist history couldn't be further from the honesty the doctor demanded of his patients.

After his father's funeral in October 1896, Freud said he had put "the cocaine brush" aside for good. Whether or not he truly recovered, he never fully acknowledged cocaine's subversive influence on his work and his life. He simply compartmentalized — that is, repressed — the consequences of his addiction.

The man who invented psychoanalysis, a method so many have used to understand the truth about themselves, was prey to the same big lie addicts tell themselves every day.


Howard Markel, a professor of medical history at the University of Michigan, is the author of "An Anatomy of Addiction: Sigmund Freud, William Halsted, and the Miracle Drug Cocaine."