[xrr rating=3.75/5]Walter Lippmann, in Public Opinion, describes the cognitive limitations of human beings, our inability to fully understand the entirety of the world around us. Through media images, our upbringing, value system and a host of other influences, we create what he calls a pseudo-environment, one that is not true to the world around us, but rather a lens that helps us understand the grandiosity of the human condition. These pseudo-environments inform the way we think about places we’ve never been, important moments in history and people we’ve never met. Bridging this gap between the environment and the pseudo-environment is the struggle of Howard Markel’s An Anatomy of Addiction. The names Sigmund Freud and William Halsted come with a multitude of connotations and images; most are culled from psychology classes or the paraphrased musings of a friend. It can be hard to separate the fact from the myth. Throughout An Anatomy of Addiction though, Markel, an acclaimed medical historian and director of the Center for the History of Medicine at the University of Michigan, deals with both the mythology and the science behind Freud, Halsted, their historic importance and how it all ties in with their heavy dependence on cocaine.

Jumping back and forth with individual chapters on Freud and Halsted, Markel creates a dizzying portrayal of two men dedicated to their work but ultimately consumed by an addiction to cocaine, a drug that was in the earliest, embryonic stages of academic and medical testing and understanding. Early on, he paints a dreary picture of a young Freud, who grew up as part of a poor Eastern European Jewish family, struggling to get his due at the University of Vienna, consumed by ennui and stress. As if at the opposite end of the spectrum, Halsted is described as a lively, muscular athlete from a privileged, if not somewhat cold and restrictive upbringing. This tension between the two classes Halsted and Freud were part of enrich the separate stories that follow, inextricably linked by a dedication to their craft and propensity for experimentation.

Markel’s connective tissue between the two is the arguable effect of cocaine on Freud’s theories of psychoanalysis and Halsted’s significant contributions to the development of surgical practices. What intrigues in this book is not the historical fact that Freud and Halsted used cocaine, but the effects of this use on their bodies of work. As Markel points out, much of Freud’s cocaine use was pre-1896, before he started most of his groundbreaking work in the field of psychology. But the suggestion is that, when Freud was self-experimenting, taking varied doses of the drug, giving some to his patients and documenting the emotions, feelings and physical actions that came after, he was developing the pseudo-Gonzo prose style that would define his later writings. Freud often wrote himself into his own experiments and medical articles, a manner of writing that can be connected to his earliest trials with cocaine. Eventually, Freud moved away from the drug after some disastrous experiments that clouded his judgment and his writing. These moments, where dated views on addiction and drug use are spelled out for the reader, are not used by Markel as a humorous juxtaposition of past and present society, but rather as a serious landmark in the development of psychoanalytical practice.

Just as Markel contrasts the early lives of his two subjects, his detailed description of Halsted’s steady physical deterioration creates a much more tragic narrative than that of Freud’s. Like Freud, he self-experimented with the drug in order to apply its apparently magical qualities (it’s often referred to as a “miracle drug” by Freud and Halsted) to the field of surgery; mainly, he hoped to find ways of operating on extremities and certain parts of the body by blocking out nerve receptors through the direct injection of cocaine. It sounds crazy now, but at the time, Halsted was a confident, respected surgeon with remarkable skill, and this experimentation was just another in a line of what he hoped would be revolutionary ways of developing surgical procedures. From the minutiae of primary sources, Markel extrapolates on Halsted’s time at the John Hopkins Hospital, where he brought into practice much of what would later become part of the Halstedian Principles. His acute awareness and unhurried approach to surgery (effects of the cocaine, Markel suggests), helped develop his innovative surgical practices such as hemostasis, sterile surgery and the nuanced treatment of tissues in open wounds. The precision with which Halsted operated while under the influence of cocaine is remarkable, noteworthy and more than a little frightening.

Ultimately, An Anatomy of Addiction is a connective narrative of two people that never met, but share a common thread throughout their lives. Both were promising young students who would later be regarded as some of the finest masters of their respective fields. And both experimented with cocaine, allowing it to not only mold their physiologies, but also their mindsets. Halsted’s book is an insightful and absorbing illumination of the perils of addiction – not just to substances, but to innovation, academics and the constant push towards progress.

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