Book Review: Freud and Cocaine: the Freudian Fallacy by E.M. Thornton

My beliefs about Sigmund Freud have been severely challenged by reading E. M. Thornton’s blistering attack on the founder of psychoanalysis. I’d considered Freud one of the greatest thinkers of the Twentieth Century. If anything, I imagined him to be a victim of his own success - so many of his ideas are a part of mainstream culture that Freud has become associated only with the eccentric and unacceptable leftovers.

I think Freud represents a paradigm shift in how we think about the mind and human motivation. We accept the notion that individuals are driven by unconscious wishes and the idea that the mind can cause physical illness. But for E.M. Thornton, these are just two examples of the false beliefs that underpin psychoanalysis. Her argument is that Freud’s theories are a product of his cocaine addiction. She also argues that Freud’s case studies, on which the whole edifice is built, are more likely to be suffering from temporal lobe epilepsy than hysteria. She argues that a great deal of time has been wasted by physicians who could have been working on physical medicine and neurology rather than the drug induced fantasies of Freud.  Towards the end of her book she goes so far as to describe Freud as 'a man of pathological preoccupations' (291).

The early chapters of Thornton’s book are a disappointment, focused too much on medical history and hardly at all on Freud. She writes about Freud's early encounter with cocaine following its recent discovery and importation into Europe from South America as a new cure-all. Freud took it, recommended it to friends, prescribed it to patients, supplied his fiancé and published an article on its medicinal qualities, recommending it as a cure for opiate addiction. In his affection for coca Freud was joined by a great many others, particularly in America. Thornton calls this the great cocaine epidemic and provides an interesting account of cocaine use in the late Nineteenth Century, before cocaine was eventually outlawed in the United States in 1902. Initially it was seen as a wonder-drug and widely prescribed, even introduced into soft drinks; but over time the case against cocaine and its dangers emerged. Individuals, especially doctors, became addicted and developed an insatiable need for the drug. Side effects included paranoia, violence, hallucinations, egomania and physical effects such as heart problems and impotence. Addicts described obsessions with sex and had sexually explicit hallucinations, they believed they were in possession of a great truth and simply had to share it with others. Later on of course Thornton will argue that Freud suffered from these symptoms of prolonged cocaine use and that cocaine produced not just a runny nose but the Standard Edition of the Complete Works.

Thornton is claiming that just at the time Freud developed his most contentious theories, such as the Oedipus Complex, he was misusing and suffering the symptoms of cocaine addiction. How else, she argues can we explain Freud's belief in the sexual origins of the neuroses. My understanding is that Freud had come to the seduction theory because that is what his patients had been telling him and that Freud's reading and research in the late 1880s at La Salpetriere, which pointed to high levels of sexual abuse in French society, had made more believable the disclosures made by his patients.

Thornton reminds us that the patients treated at La Salpetrier by Freud’s mentor, Charcot, were more likely suffering from temporal lobe epilepsy than hysteria. She certainly paints a grim picture of the Salpetrier and its mainly female patients, performing for doctors and medical students from around the world, all attending to hear Charcot’s lectures and see demonstrations of hypnosis. She goes on to argue that because of their epilepsy these patients were susceptible to hypnosis, indeed that hypnosis is actually only possible with patients suffering from this pathology because hypnosis is a form of temporal lobe seizure. She scorns Bernheim of the Nancy School of hypnotism for believing that most people are hypnotisable and claims that most of Bernheim’s patients were pretending to be hypnotised out of fear of upsetting him. As someone who has experienced and practised hypnosis and studied the work of Milton Erickson I have to disagree with Thornton's narrow definition of what constitutes hypnosis and the hypnotic state. In the end her critique of hypnosis serves one purpose, it is in furtherance of her attack on Freud, who learnt and briefly practiced hypnosis but decided he wasn't proficient enough and abandoned the technique. For Thornton all the trees in the forest must be cut down so she can swing her axe at the mighty oak.

Thornton's analysis of the Anna O case is an excellent read. She argues that Anna O was not hysterical but suffering from meningitis contracted whilst nursing her father who had died of tuberculosis. She charts the changes in Anna O's presentation and makes the case for an organic cause, principally brain lesions, where Breuer had ascribed a psychological cause. She makes use of research by Ellenberger (1972) who had discovered what happened to Anna O after her treatment ended. It turned out to be an orderly handover to other physicians rather than the story put about by Freud in which Anna O developed a hysterical pregnancy that caused Breuer and his wife to flee the country. Ellenberger discovered that Anna O had not been cured by Breuer and that the account of her treatment in Studies of Hysteria differed from the contemporaneous case notes made by Breuer and found with Anna O's medical file in the asylum at Bellevue. Thornton also suggests that another case of Freud’s, "Frau Emmy", was not suffering from hysteria but almost certainty a variant of Tourette's disease. She suggests that Freud was mistaken when he took mild tonic seizures to be evidence of the effectiveness of the cathartic method. Thornton also writes about Freud’s “pathological” treatment of 'Dora', another of his cases with epilepsy rather than hysteria. Freud analysed Dora and her dreams, and with an imaginative use of symbolism discovered a sexual cause to 'Dora's' neuroses but after three months 'Dora' discontinued her therapy.

After her chapter on Anna O, Thornton begins looking for evidence of cocaine use in Freud's letters to Fleiss. She argues that Freud’s heart condition, messianic traits, 'monotony of interpretation', headaches, nasal problems, depression, death anxiety and dysphasia all point to cocaine misuse and appeared after April 1894. The idea that Freud experimented with cocaine in the late 1880s and then stopped is disproved by the Fleiss letters. Later on she suggests that Freud’s preoccupation with 'irregular modes of sexual gratification' (241) is a result of his cocaine addiction. She also thinks that Freud's relationship with Fleiss had a 'homosexual element' and this too 'would be consistent with the other symptoms of cocaine usage' (242).

Thornton attacks Freud for criticising Charcot: "Such brash interpolations by a then little known neurologist in the work of a man of Charcot's eminence were undoubtedly the result of a cocaine effect" (209). At that point I wondered if Thornton might also be making “brash interpolations” and just as Freud everywhere saw sex as a cause of mental distress so Thornton sees cocaine use as the cause of psychoanalysis. Thornton (254) correctly states that Freud's self-analysis (1897 - 1900) was responsible for some of the most basic ideas in psychoanalysis. She criticises the subjective nature of this process and argues that it is particularly untrustworthy as a method because Freud's cocaine use was distorting his memories and creating vivid dreams. Freud's first full analysis of a dream was his 'Irma dream' on 24 July 1895. Thornton makes an interesting point when she suggests that vivid dreaming is a mark of cocaine misuse and that Freud’s patients were also having vivid cocaine sponsored dreams. So it was that dreams came to occupy a major place in the practice of psychoanalysis.

A final attack on psychoanalysis comes at the end of the book when Thornton makes the point that psychoanalysis has had a negative impact on research into brain disorders - organic brain disorders being the true cause of neurosis/psychosis for Thornton.  She argues that patients who could have had cures were instead given ‘hopeless psychoanalytical diagnoses’, including the catch all diagnosis of hysteria. Freud’s nemesis puts her pen down at the end of her book, arguing that as Freud’s later work rests on unsupported theories he developed during his cocaine years there is little point discussing them. Her assessment is damning: 'As we have seen, the foundations of this edifice were presented in a series of papers characterised by inconsistencies and circular arguments, with a total lack of evidence for the postulates they contained' (290).

  

Thornton, E.M., (1983). Freud and Cocaine: the Freudian Fallacy, London: Bond and Briggs