Leading articles

THE VIENNA PSYCHOANALYST wants to give not only already internationally established psychoanalysts, but also still unknown psychoanalysts the opportunity to post a self-written and not yet published article on the FrontPage of our online magazine!

Our Users then can leave comments, ask questions or discuss the articles in our forum. Our aim is to provide an international platform where for the first time anyone interested in psychoanalysis can exchange ideas on certain topics.
Articles are welcome in German and/ or English.

If you are interested, please send your article to
leadingarticle@theviennapsychoanalyst.at


(For reasons of readability, the male form is used with personal names, however the female form is also always intended.)

When the name Sigmund Freud falls, most people immediately think of psychoanalysis. However, Freud was already a popular interesting researcher before developing psychoanalysis. Some of the key steps that have led him to develop psychoanalysis had already been made while working on his previous research areas, such as neurophysiology and psychopharmacology. In the following article, I would like to explore the path, which made psychoanalysis possible and in a certain sense signifies its beginning: In April 1884, when Freud was still a young assistant doctor at the Vienna General Hospital, he read about a new medicine called "cocaine". This effective ingredient of the coca leaf was itself not a new discovery.

In its pure form, it was available since the 1860s. The exploration of the coca plant already had a long tradition. Since the invasion of South America by the Europeans in the late 15th century, physicians and naturalists had been carrying out self-experiments with coca leaves. As the so-called Indians of South America knew, the leaves had a wonderful effect. They made one insensitive to hunger, thirst, fatigue, heat and cold, and could even lighten one’s mood. Cocaine and other coca-leaf products were barely associated with health risks until the 1880s. According to the research of 1884, cocaine was found to be slightly toxic and non-addictive. Cocaine was considered a potential harmless drug that could be safely consumed in moderate doses over a longer period of time (Nothnagel & Rossbach 1884, Husemann 1884).

At the end of 1883, the military doctor Theodor Aschenbrandt described that he had secretly mixed cocaine in the drinks of Bavarian soldiers during the annual autumn weapon drill. The soldiers, marred by heat, hardship and contaminated water, recovered and were able to join in the strenuous exercises and marches (Aschenbrandt 1883). Freud published this article in a prestigious medical journal and stated later: "My merit is perhaps only that I believed this statement. It was an occasion for me to study the effect of cocaine on myself and others" (Freud 1885b, p. 49). In his first twelve self-experiments (Spring 1884) Freud learned on his own body "what has been described as the wonderful stimulating effect of the Coca plant. Long intensive mental or physical work is performed without any fatigue and the need for food and sleep, which otherwise are imperative at certain times of the day, are none existing." (Freud 1884e, pp. 300-301). Freud was enthusiastic and expressed a completely new interpretation of the cocaine effect. Before Freud, the Coca researchers had assumed that the spectrum of the cocaine´s effects could be explained by its ability to stimulate or paralyze the nerves, depending on the height of the dose. They concluded that cocaine directly affected the nerves. However, nobody knew how exactly this interaction took place, until Freud´s research. In Freud´s new view, the physical aftereffect of cocaine is only a consequence of his mental effect. The performance-enhancing effects of cocaine is not the result of a direct influence on the nerves, but the result of an influence on the general condition and mood (Freud 1885a, Sp. 133). Putting the psyche first in the causal chain of effect and treating the cocaine effect primarily as a psychic effect, means breaking with the doctrine of contemporary medicine, which sees psychic phenomena only as epiphenomena of physiological processes, which cannot exert such a far-reaching material (physiological) retroactivity on the organism (Reicheneder 1988, p.173).

At first, Freud had conducted his new theory of cocaine effects in a purely introspective way. At the end of 1884, he verified it with a new series of experiments with dynamometers and neuramoebimeter (Freud 1885a). Freud was the first to try to measure the performance-enhancing effect of cocaine directly. With the dynamometer, he recorded the muscle strength of the hand (measure of physical performance), and with the neuramoebimeter, the reaction time (measure of mental performance). In addition, he observed introspectively detected, non-measurable effects, e.g. on general health and mood. Freud found a positive correlation between general well-being and performance improvement. In addition, it was shown that the improvement of the general condition (mood, euphoria) preceded the measurable performance improvement, which is conditional (see above). These experiments by Freud are remarkable: the context of his Coca´s research is not only innovative in its interpretation of the cocaine effect, but also in the use of these instruments and the systematic combination of measurement and introspection, through which Freud comes to its conclusion. Most Coca researchers before Freud had carried out their self-experiments after the example of the natives of South America. The researchers had mimicked the nature of Indian coca consumption, especially the chewing of coca leaves to increase physical performance. For example, they walked the same routes with and without coca consumption, and then developed the research about coca effect indirectly from the comparison of the effects that had been recorded (see Christison 1876). Self-experimentation was a common and accepted psychopharmacological method well into the 20th century to study the effect of a substance on the healthy organism. Nevertheless, let us return to Freud´s methodological innovations about his new interpretation of the cocaine effect:

Springer (2002, p. 22) considers this as an orientation towards psychosomatic concepts. I go a step further and speak of a paradigm shift: The fact that Freud puts the psyche first in the causal chain of effects requires a completely new way of seeing and thinking. Freud´s gaze is free to fully grasp the power of the psyche. He can  see the psyche as something that can entail or substantially influence everything else, such as physical states or even the whole world surrounding the subject. To place the psyche first in the causal chain of effects means that it suddenly makes sense to put it as the starting point of theory formation and medical treatment, even if the symptoms are seemingly of purely physical nature. The scientific and therapeutic value of this perspective, which Freud probably did not immediately recognize, is owned to his cocaine experience. In the following years, Freud  would sometimes return to the theoretical approaches, which were more in line with contemporary doctrines (see Freud 1950c).

An example of these ´regressive´ approaches is Freud´s last cocaine paper (1887d), which contributes to the international debate on the cocaine effect of the 1880s. In this debate, the study cases of intoxication and the potentially addictive effects of cocaine are now being discussed. The use of cocaine had become questionable, especially with regard to the withdrawal treatment of morphine addicts, for whom Freud had recommended cocaine as a remedy (1884e). Since the beginning of cocaine usage in this context (1884 in Europe), the number of psychoses have increased noticeably. At first, most doctors did not associate these dramatic complications of the withdrawal treatment with the ´harmless´ cocaine, but classified them as ´morphine abstinence psychoses´ (Smidt 1886). Individual clinicians, on the other hand, wondered if cocaine was addictive and sufficiently toxic to cause these psychoses. The "morphinism" - expert Albrecht Erlenmeyer finally provided the first relevant description of the new clinical picture of "cocaine addiction" in Europe (Erlenmeyer 1886). He noted that, as a result of the cocaine treatment, most morphine addicts had become "morphine-cocaine addicts". Erlenmeyer then vigorously warned against the destructive effect of cocaine because it causes much more and quicker harm to a person, both psychologically and physically, than morphine. Other doctors tended to agree at that time (Bornemann 1886, Villaret 1900). Confronted with the catastrophic consequences of cocaine application for therapeutic purpose, Freud (1887d) doubly defends his cocaine recommendations (at least for patients without morphine addiction): he cites scientific authorities to advocate his view of the general therapeutic value of cocaine, and he retreats to the traditional view in explaining the cocaine effect. The potentially strategic nature of this return in the context of an apology remains to be considered.

As of April 1886, Freud, as a neurologist in his newly founded practice in Vienna, is confronted more than ever with the situation of not having successful treatment methods available. In the course of the next few years, the already accomplished paradigm shift helped him find a treatment beyond medication and conventional physical healing methods (such as electricity, water, air). A thought once thought; a turn already taken as serious, fundamental and rare as a paradigm shift probably does not simply disappear from the world. As it had already existed in Freud´s head and experience, it is now easier for the new ´psychic´ view to fall on fertile ground. It made Freud susceptible to pathways and suggestions that led to psychoanalysis. The ´psychic´ view was, so to speak, the intellectual door to the development of psychoanalysis. In summary, it could be said that cocaine was the medium that enabled Freud´s paradigm shift, which in turn made it possible for him to develop psychoanalysis, which is associated with Freud´s name today.

As a cocaine researcher, Freud has been forgotten, although at the time he had played a significant role as an inspirer and facilitator of European cocaine research. With his first essay “On Coca” (1884e), he created the then most comprehensive German-language overview of international Coca(-in) research. Freud´s cocaine papers (1884-87) were not only broadly, but also largely positively received (see Villaret 1899, p. 378). The results of Freud´s self-experiments (e.g. that "the pressure of a hand is increased by 2-4 kilos by taking 0.10 gr cocaïnum mur.", Freud 1885b, p. 25) have been accepted as sound research results (see Joël & Fränkel 1924, p. 39). Freud has instigated numerous cocaine experiments in Europe, including the therapeutic cocaine tests on morphine addicts, from which the first European "cocaine addicts" emerged. In the fall of 1884 Freud also helped his colleague Carl Koller to realize something that made the name cocaine famous overnight across the "whole civilized world": cocaine was a useful local anesthetic for ophthalmology (Koller 1884, Sp. 1276 see Gutt 1885). Freud was not held responsible by his contemporaries for the fatal development of cocaine addiction in Europe.


Literature:
-) Aschenbrandt, T. (1883). Die physiologische Wirkung und Bedeutung des Cocain. muriat. auf den menschlichen Organismus. Klinische Beobachtungen während der Herbstwaffenübungen des Jahres 1883 beim II. Bayer. A.-C. 4. Div. 9. Reg. 2. Bat. Deutsche Medicinische Wochenschrift 9 (50), S. 730-732.
-) Bornemann (1886). Zur Cocainsucht. [Sonder-Abdruck aus der Deutschen Medizinal-Zeitung 71 (1886)].
-) Christison, R. (1876). Observations on the effects of cuca, or coca, the leaves of Erythroxylon coca. The British Medical Journal: Being the Journal of the British Medical Association 1 (1876), S. 527-531.
-) Erlenmeyer, A. (1886). Über Cocainsucht. Vorläufige Mitteilung. Deutsche Medizinal- Zeitung 7 (1886), S. 483-484.
-) Freud, S.  (1884e). Ueber Coca. Centralblatt für die gesammte Therapie 2 (1884), S. 289-314.
-) Freud, S. (1885a). Beitrag zur Kenntniss der Cocawirkung. Wiener Medizinische Wochenschrift 35 (5), Sp. 129-133.
-) Freud, S. (1885b). Ueber die Allgemeinwirkung des Cocains. Vortrag, gehalten im psychiatrischen Verein am 5. März 1885 von Dr. Sigm. Freud. Zeitschrift für Therapie mit Einbeziehung der Electro- und Hydrotherapie. Central-Organ für praktische Aerzte 3 (7), S. 49-51.
-) Freud, S. (1887d). Bemerkungen über Cocaïnsucht und Cocaïnfurcht mit Beziehung auf einen Vortrag W.A. Hammondʼs. [Beiträge über die Anwendung des Cocaïn. Zweite Serie. I.] Wiener Medizinische Wochenschrift 37 (28), Sp. 929-932.
-) Freud, S. (1950c) [1895]. Entwurf einer Psychologie. GW IV, S. 375-386.
-) Husemann, A. (Hrsg.). (1884). Die Pflanzenstoffe in chemischer, physiologischer, pharmakologischer und toxikologischer Hinsicht. Für Aerzte, Apotheker, Chemiker und Pharmakologen. Bd. 2. Berlin: Julius Springer.
-) Joël, E. & Fränkel, F. (1924). Der Cocainismus. Ein Beitrag zur Geschichte und Psychopathologie der Rauschgifte. Berlin: Springer Verlag.
-) Nothnagel, H. & Rossbach, M.J. (1884). Handbuch der Arzneimittellehre (5. Aufl.). Berlin: Verlag von August Hirschwald.
-) Reicheneder, J.G. (1988). Cocaineuphorie und Naturwissenschaft. Sudhoffs Archiv 72 (2), S. 170-184.
-) Smidt, H. (1886). Zur Kenntniss der Morphinismuspsychosen. Archiv für Psychiatrie und Nervenkrankheiten 17 (1886), S. 257- 273.
-) Springer, A. (2002). Kokain, Freud und die Psychoanalyse. Suchttherapie 3 (1), S. 18-23.
-) Villaret, A. (Hrsg.). (1899). Handwörterbuch der gesamten Medizin (2. Aufl.). Bd. 1. Stuttgart: Ferdinand Enke.
-) Villaret, A. (Hrsg.). (1900). Handwörterbuch der gesamten Medizin (2. Aufl.). Bd. 2. Stuttgart: Ferdinand Enke.