Jul 19 2011

Anatomy of an Addiction by Howard Markel

Tess Taylor

web exclusive


Recently, reading an article about the oxycodone addiction that's sweeping the nation, I came across a sidebar about one of its victims: A respected Ohio physician who'd begun to pop a few pills himself, felt wonderful and elated for a few weeks, and ended, in short order, with a full-blown problem that led to the loss of his license, his marriage, and his house. He's sober now, but his story is sobering: He's working at a local rug store, barely making ends meet. And his tale—about the way unexpectedly powerful new drugs can ravage the lives not only of patients but of medical professionals—is eerily familiar. (Think Nurse Jackie.) It's a story that compresses medicine's productive and destructive power into one vessel, reminding us how doctors—tasked with medicine's powers to heal—are also vulnerable to medicine's powers to harm.

This duality is stitched into the history of medicine itself, and it motivates medical historian Howard Markel in Anatomy of an Addiction: Sigmund Freud, William Halsted, and the Miracle Drug Cocaine. Here we've shifted back a hundred and thirty years to the moment when a different drug first appeared on the scene. It's the mid-1880s and the vaunted coca plant—long celebrated by explorers—has finally been refined into the powder cocaine. As such it could be easily transported to western markets and explored for medical uses. Markel traces the moment when two prominent physicians—Halsted, a father of modern surgery, and Freud, the father of modern psychoanalysis—fell under its power.

Although the two doctors probably never met, both are figureheads in the history of modern healing practice. And both are remarkable because they made their strides as active (or recovering) addicts—just at a time when the history of addiction was beginning to be understood. Markel notes that before the late nineteenth century the word "addict" referred to "the bond of slavery that lenders imposed upon delinquent debtors." But in the nineteenth century, even as medicine was making amazing forward strides, a new class of slaves was emerging—those who had been prescribed, and then inadvertently addicted to, some of science's new drugs. One early prominent drug was morphine; the next, in short order, was cocaine.

With his own precise strokes, Markel cuts between the fate of Halsted, a promising New York surgeon who began a promising surgery practice just as cocaine came on the scene, and Freud, a nervous young Jewish physician who used the new drug to ease his own social anxiety in Viennese society. Halsted and his cadre used the drug on patients to beat pain, and on themselves to beat long hours. Eventually, Halsted became so hooked the on cocaine solution that he left a dying patient on the operating table, fleeing the hospital to sink into a weeks-long binge. Cut to Freud, an ocean away, who—convinced that cocaine would help him think, talk, and write better—made his first mark in the medical establishment by penning a study that prescribing cocaine could break the bonds of morphine addiction. (He missed its own addictive force, and also, unfortunately, its implications for anesthesia, which quickly become central to its clinical use.)

As they praise the new drug and use it on patients, each doctor also takes his own body as a medical experiment. Freud's fascination with cocaine lasts about a decade, culminating with a botched surgery on a patient named "Anna" and extreme trauma to his own nose. Halsted's addiction, more immediately severe, forces him to leave New York for prolonged stays at a Rhode Island sanitarium. While he eventually achieves a kind of functional sobriety—and goes on to prominence at the emergent Johns Hopkins Hospital—Markel argues that Halsted is never really cured. In fact, rather than using cocaine to get off morphine, as Freud had once suggested, Halsted is prescribed morphine to numb his cocaine cravings, resulting in a new addiction that haunts him the rest of his life.

Aside from the voyeuristic pleasure we sometimes get from reading about other people's stories of addiction, this book is fascinating because its subjects compress significant changes in modern medicine, and modern drug use, into the frame of their own bodies. These two doctors dramatize the way that any advance contains its opposite: The medical need to cure pain results in the addiction to pain killers; the history of talk therapy was penned by a deeply self-denying addict who used cocaine to help him talk; and some of our best advances in sanitation and anesthesia, furthered by Halsted, were created by a doctor who had become a slave to opiates. Is the history of healing always so inseparable from the history of harm? Markel doesn't presume to answer, but instead leaves us with a glimpse at two remarkable doctors who, in the end, triumphed enough to leave us with lasting contributions.

Although Markel (who has written about oxycodone in the past) never mentions this moment's sad and ravaging new drug, the story lingers as a kind of cautionary tale. When we look for miracles, or experiment with new substances, we may not always know what powers we unleash. Cocaine and morphine, both commonly prescribed throughout the late nineteenth century, turned thousands of innocent patients into addicts. What's more, even as they paved the way for new advances, they ravaged the very people who were tasked with studying them. Markel's fascinating chapters about two important physicians also succeeds because it is achieves the status of cautionary fable about the duplicitous power of medical miracles—not only then, but now and beyond.

Tess Taylor's poems, articles and reviews have appeared in Poetry, The Oxford American, The New York Times, and The New Yorker.

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