Tag Archives: Sigmund Freud

06/20/17

Freud’s Nanny

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Sigmund Freud is widely known to have been an atheist or agnostic. Ernest Jones, his biographer, friend and close colleague said he went through life from beginning to end as an atheist: “One who saw no reason for believing in the existence of any supernatural Being and who felt no need for such a belief.” His daughter Anna, herself a psychoanalyst, said her father was a “lifelong agnostic.”  He regularly described religion as “a universal, obsessional neurosis.” In The Future of an Illusion (1927), he said religious doctrines were also illusions—wish fulfillments of the oldest, strongest and most urgent desires of mankind. But what would you think if, as a child, Sigmund Freud had been taken regularly to Catholic Mass and quite possibly had been secretly baptized?

Paul Vitz supported these claims in his book: Sigmund Freud’s Christian Unconscious. He said Freud had “a strong, life-long, positive identification with and attraction to Christianity.” According to Vitz, this was offset by a concurrent and unconscious hostility to Christianity, reflected in his preoccupation with the Devil, Hell, and the Anti-Christ. He thought this substantial Christian and anti-Christian part of Freud provided an understanding of his adult ambivalence towards religion; and should suggest a re-evaluation of Freud’s psychology of religion.

Freud was born on May 6, 1856, in Freiberg Moravia—a town now part of the Czech Republic. At the time, Moravia was a predominantly Catholic region, with a particular devotion to the Virgin Mary. The main church in Freiberg was called “The Nativity of Our Lady.” The town had a population of about 4500, over 90% of whom were Roman Catholic. About 3% of the city were Jewish. Freud lived there with his family until he was three years old. After a brief time in Leipzig, the family moved to Vienna, where Freud lived all but the last fifteen months of his life. Vienna was also predominantly Roman Catholic. “As a result, Freud spent almost his entire life as a Jew in a society dominated by Roman Catholic culture.”

Birthplace of Sigmund Freud

Resi (short for Theresa) Wettik was in the employ of the Freud family by June of 1857 at the latest. Freud himself wrote that he was in her charge from some time “during early infancy.” Family matters support the likelihood that Resi assumed a major maternal role with young Sigmund from an early date. Sigmund had a younger brother, Julius, who was born when Freud was fifteen months old (August of 1857). Julius was sickly and died on April 15, 1858, just before Sigmund was two. Seven and a half months later, his mother gave birth to his sister, Anna.

So when Freud was between the ages of one and three, his mother Amalia went through two pregnancies and births, and was caring for the sickly Julius, who died when he was eight months old. Vitz observed that Freud must have found his mother relatively unavailable from around the age of one until he was close to three years old. “There is, then, every reason to believe that the nanny filled the maternal vacuum during this important period, and that Freud experienced her as a second mother—or even … as his primary mother.”

Amalia Freud was 21 at the time she gave birth to Sigmund. During the first 32 months of his life, she was pregnant for a total of 18 months. Since during pregnancy, a mother’s milk supply diminishes, there is a strong possibility that she did not breast-feed, or at least did not fully breast-feed very long after her children’s births. Vitz explained that it is rare for a woman to get pregnant while nursing her baby regularly the first six months after giving birth. “In any case, it is unlikely that Sigmund was nursed by his mother for more than a brief period.”

While not definitive, this and others evidence suggests that Resi was also a wet nurse to young Sigmund. A biographer of Freud’s indicated the Freud women frequently worked together in a “garment district” warehouse, while the children were cared for by a maid, presumably Resi. “If so, Sigmund would have been almost exclusively with the nanny for many weeks during his earliest years.” Freud himself seems to have acknowledged this in letters he wrote to his friend, Wilhelm Fliess. This was during the time he was in the midst of his own self-analysis when he was in his forties.

Vitz quoted from a letter Freud wrote to Fliess on October 3, 1897. He said there had been something interesting things with his self-analysis over the previous four days. He referred to his nanny as the “prime originator” figure of his dream, meaning she was a parent (an originator) to him. “The ‘prime originator’ was an ugly, elderly, but clever woman, who told me a great deal about God Almighty and hell and who instilled in me a high opinion of my own capacities.” Resi may have only been in her later thirties or early forties. “Elderly” here could then be the perspective of Freud as a child in the dream or his mother, who was herself only in her early twenties at the time.

I have not yet grasped anything at all of the scenes themselves, which lie at the bottom of the story. If they come [to light] and I succeed in resolving my own hysteria, then I shall be grateful to the memory of the old woman who provided me at such an early age with the means for living and going on living.

In The Interpretation of Dreams, Freud wrote that he had a vague memory of his nanny. He added that: “it is reasonable to suppose that the child [Freud] loved the old woman.” Vitz commented that Freud didn’t make such claims about the early importance of his own mother. “Indeed, this lack of evidence further supports the present view that the nanny was the primary mother.” In an October 15, 1897 letter to Fliess, Freud said he’d asked his mother if she remembered his nurse. “’Of course,’ she said, ‘an elderly person, very clever, she was always carrying you off to some church; when you returned home you preached and told us all about God Almighty.’”

Paul Vitz said while it would have been unusual in most Christian homes at the time to attend Mass several times a week, it would not have been unusual for a pious woman of the time to do so.  However, for it to occur “within a Jewish home would have been quite striking.” There was no synagogue in Freiburg, so Freud would not have had the opportunity to be exposed to any Jewish religious experience in these early years.  Nor is there any evidence that the Freuds celebrated the Jewish holidays, or kept the Jewish dietary laws while living in Freiberg. Additionally, “There is no reason to believe that Freud’s mother gave him religious instruction; she is known to have been uninterested in religion.”

 In any case, the nanny, this functional mother, this primitive Czech woman who was the “primary originator” of Freud, was his first instructor in religion. These first lessons were of a simple, no doubt often simple-minded, Catholic Christianity.

Vitz said that given the likelihood of a close relationship between the nanny and young Sigmund, there is a distinct possibility that she may have secretly baptized him. With the death of his sickly, infant brother, the nanny may have even baptized Julius. Or his death without baptism would have been a disturbing tragedy to her. Either possibility would arouse her fears and concern for Sigmund. “Such a possible covert baptism, in church or otherwise, may have had a lasting effect on Freud’s memory; if the nanny had talked about the meaning of baptism, it would have left permanent traces.”

Freud’s mother related a story that his nanny was abruptly dismissed by the Freuds, supposedly because she was discovered to have been stealing. Reportedly, Amalia told her son this happened while she was still bed ridden after the birth of Anna in December of 1858. Vitz questioned both the timing of the dismissal, suggesting it occurred in late May or early June of 1859, and the circumstances of the nanny’s dismissal. He noted Amalia’s recollection of the event was almost forty years after it occurred. Also the alleged circumstances were odd. The nanny was said by Freud’s mother to have been found with coins and toys that had been given to Sigmund. Why, asked Paul Vitz would such a clever woman keep the toys with the coins and not hide them in a safe place?

All this is most odd, especially given the extreme likelihood that Freud’s mother must have looked on the nanny with increasing jealousy and dismay. Here was this peasant woman who was in many ways taking over the role of a mother in the life of her lively and attractive first-born son. Not only was the nanny coming to be extremely important to her son’s affections, but she was also taking him to church and instructing him in Christianity. Amalia Freud was never very serious about her own Judiasm; still, there is certainly no reason to think she was benevolently disposed towards Christianity. Possibly, her young son’s early training in Christianity roused real concern. If so, this was a reason why the Freuds, in particular Amalia, would have wished to get rid of the nanny.

So soon after Sigmund turned three, he was suddenly separated from his nanny; his motherly “prime originator.” Again in the letter to Fliess on October 15, 1897, Freud wrote that if he was suddenly parted from her, “it must be possible to demonstrate the impression this made on me.” He then described to Fliess what he believed to be a childhood memory that had emerged repeatedly into his conscious memory over the years (without understanding it). The memory was of a time when he couldn’t find his mother, and he was crying uncontrollably for her. “When I missed my mother, I was afraid she had vanished from me, just as the old woman had a short time before.”

The significance of these events is striking when they are seen in the light of Freudian theory. Ernest Jones said in his biography of Freud that he taught: “The essential foundations of character are laid down by the age of three and that later event can modify, but not alter the traits then established.” Paul Vitz observed that you don’t have to believe this theory of character is universally true “to accept that it was most certainly true of its originator.”

Quotes used in this article are from Sigmund Freud’s Christian Unconscious, by Paul C. Vitz, and The Complete Letters of Sigmund Freud to Wilhelm Fliess 1887-1904, translated and edited by Jeffrey Moussaieff Masson.

05/30/17

Psychoanalysis Without Freud

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An article in STAT News on Freud and psychoanalysis, “Saving Sigmund,” caught my attention. It described how psychoanalysis is trying to “reinvigorate” itself. In the process, psychoanalysts are trying not to be “unduly fixated” on Freud’s stages of psychosexual development or his tripartite psyche of the id, ego and superego. One psychoanalyst said assuming she was Freudian was “like asking a modern-day nuclear physicist whether he’s Copernican.” While much of what Copernicus said was not true, it was a helpful foundation.

The analogy is a bit over the top and seems to be an attempt to distance current psychoanalysis from the rejection of many of Freud’s ideas. Writing for STAT, Carter Maness pointed to what may be the foundation of the need to reconceptualize psychoanalysis: only 15% of the members of the American Psychoanalytic Association (APA) are under 50. Traditional Freudian analysis is a dying art. “Lying on a couch, talking about your childhood, day after day for years — is widely seen as a musty relic, far too expensive and intensive to fit into modern life.”

The 1945 film Spellbound, directed by Alfred Hitchcock, captured Freudian psychoanalysis at the zenith of its popularity. The movie’s producer, David O. Selznick wanted Hitchcock to make a movie reflecting his own positive experience with psychoanalysis. Selznick even brought in his own analyst as a technical advisor for the film. The advisor clashed frequently with Hitchcock. Of course in a pro-Freudian movie like Spellbound, there was a dream sequence, which was designed by the artist Salvador Dali. In it, the Freud look-a-like character encouraged Gregory Peck to continue recalling the details of his dream—“the more cock-eyed, the better for the scientific side of it.”

Freud saw himself as a pioneering scientist and repeatedly asserted psychoanalysis was a new science. In his work, An Outline of Psycho-Analysis, Freud said conceiving mental life as a function of the psychical apparatus of id, ego and super-ego was “a scientific novelty.”

We assume that mental life is the function of an apparatus to which we ascribe the characteristics of being extended in space and being made up of several portions—which we imagine, that is, as resembling a telescope. . . . we have arrived at our knowledge of this apparatus by studying the individual development of human beings.

However, Freud’s claim that psychoanalysis was a science of the mind is the subject of continuing debate. As was pointed out in the article on Sigmund Freud in the Internet Encyclopedia of Philosophy, the scientific status of psychoanalysis is undermined since it cannot be falsified. Karl Popper’s criterion of demarcation between the scientific and the unscientific is that for something to be scientific it must be testable and therefore falsifiable.

 It is argued that nothing of the kind is possible with respect to Freud’s theory–it is not falsifiable. If the question is asked: “What does this theory imply which, if false, would show the whole theory to be false?,” the answer is “Nothing” because the theory is compatible with every possible state of affairs. Hence it is concluded that the theory is not scientific, and while this does not, as some critics claim, rob it of all value, it certainly diminishes its intellectual status as projected by its strongest advocates, including Freud himself.

Psychoanalytic thought finally lost its stranglehold on psychiatry in the 1980s with the reformulation of the Diagnostic and Statistical Manual (DSM). That was also the beginning of the rise of biological psychiatry. The heroic figures of psychoanalytic therapists in movies like Spellbound, The Snake Pit (1948), and The Three Faces of Eve (1957) changed. Psychiatric treatment began to be seen through the lens of movies like One Flew Over the Cuckoo’s Nest (1975) and Frances (1982).

Modern popular thinking on Freudian thought is satirically captured in the 1991 comedy, What About Bob? Bill Murray plays Bob Wiley, the unstable patient of an egotistical psychiatrist, Leo Marvin, played by Richard Dreyfuss. Unable to cope on his own, Bob Wiley follows and befriends Dr. Marvin’s family when the family leaves for a month-long vacation. Ultimately this pushes the good doctor over the edge and there is a role-reversal of sorts. Look for the appearance of a bust of Sigmund Freud in several scenes throughout the movie. By the way, Dr. Marvin’s son is named Sigmund. Here is a clip of the therapy session at the beginning of the film.

In order to reinvigorate their profession, psychoanalysts are repackaging the concepts underlying analysis and introducing them to school kids. A past president of the APA said: “We’ve started applying psychoanalytic ideas outside of our offices—in schools, in agencies, in business . . . . We’ve made social issues much more on the minds of our membership.” Project Realize, an alternative school for at-risk teenagers in Cicero Illinois, has treated more than 400 students expelled from regular school for aggressive and dysfunctional behavior. Now in its 12th year, it is said to have lowered rates of violence and improved graduation.

Training requirements have been altered somewhat. In the past, would-be analysts had to first earn an MD, a PhD, or an LCSW (a license to practice social work). Then they had to complete four years of coursework in psychoanalysis AND 200 hours of clinical training. In addition, they had to undergo analysis (four sessions per week) for at least two years.

One psychoanalyst in private practice remarked those requirements fit the 1950s, when every psychologist wanted to be an analyst. “If you’re doing a MD or a PhD or an LCSW, the conditions of starting a private practice and having a job don’t fit with analytic training anymore. Candidates find their analytic voice at 50. That’s nuts.” When Mark Smaller became the president-elect of the APA at 62, he said he could have been considered “a Young Turk.”

Freud has been dethroned as the king of psychotherapy and classic psychoanalysis is increasingly seen as a dying art. Now there is a two-year training for “psychoanalytic psychotherapy” offered by some training centers. It incorporates Freudian ideas about motivation and the unconscious and offers an easier and cheaper way to train as an analyst. And recent studies of Freud have suggested new, and intriguing perspectives into the man and the development of his theories.

In The Freudian Fallacy, E.M. Thornton said Freud’s personal use of cocaine was not just limited to his late twenties and early thirties, between 1884 and 1887.  She presented evidence that Freud resumed using cocaine in the latter half of 1892, “the year coinciding with the emergence of his revolutionary new theories, and asserts that these theories were the direct outcome of this usage [of cocaine].”

The false prophet of the drug world can propagate his message with as much conviction and authority as the true and his manner will have the same burning fervor and sincerity. In common with other victims of brain pathology, Freud would still have been able to reason skillfully from his false premises and so hide his psychotic traits from his followers. And yet, over the years, one by one, most of Freud’s inner circle of early disciples left him.

Paul Vitz developed a fascinating thesis that Freud had a strong, life-long positive identification and attraction to Christianity in Sigmund Freud’s Christian Unconscious. Vitz said there was also a concurrent secondary influence of unconscious hostility to Christianity seen in his preoccupation with the Devil, Hell, and the Anti-Christ.

All of this very substantial Christian (and anti-Christian) part of Freud should provide an understanding of his ambivalence about religion. It should also furnish a new framework for understanding major aspects of Freud’s personality, and allow us … to re-evaluate Freud’s psychology of religion.

As a young child, Sigmund had a Catholic nanny from around the age of one until he was two years and eight months old, maybe longer. It is likely that given that his mother had two pregnancies and births, and took care of a sick child who died during this time, that the nanny was also his wet nurse. Freud himself admitted that his nanny told him a great deal about God and hell. In a letter to his friend Wilhelm Fiess, he said:

I asked my mother whether she remembered my nurse. “Of course,” she said, “an elderly woman [Freud’s mother was 21 at the time of his birth], very shrewd indeed. She was always taking you to church. When you came home you used to preach, and tell us all about how God conducted His affairs.

In “Reassessing Freud’s Case Histories,” science historian Frank Sulloway said the intellectual quicksand upon which Freud built his theories and assembled his “empirical” observations was extensive. “His controversial clinical methods only served to magnify the conceptual problems already inherent in his dubious theoretical assumptions.” The training methods he supported were “highly influential” in removing psychoanalysis from academic science and medicine. “As a result, the discipline of psychoanalysis, which has always tapped considerable religious fervor among its adherents, has increasingly come to resemble a religion in its social organization.”

In “Why Freud Still Isn’t Dead,” John Horgan pointed out how there has been a recent trend in trying to find common ground between neuroscience and psychoanalysis. From one perspective, this fits as Freud originally trained as a neurologist and tried to base his theory of the psyche on an evolutionary sense of brain development. Here he followed the thought of Ernst Haeckel, who theorized the soul/psyche evolved biologically. In his classic 1892 work, Monism as Connecting Religion and Science, Haeckel said:

What we briefly designate as the “human soul,” is only the sum of our feeling, willing, and thinking—the sum of those physiological functions whose elementary organs are constituted by the microscopic ganglion-cells of our brain. Comparative anatomy and ontogeny show us how the wonderful structure of this last, the organ of our human soul, has in the course of millions of years been gradually built up from the brains of higher and lower vertebrates.

Horgan observed that science has failed to produce “a theory/therapy potent enough to render psychoanalysis obsolete once and for all.” Neither Freudians nor proponents of “more modern treatments” can point to any unambiguous evidence that psychoanalysis works or doesn’t work. “Until science yields an indisputably superior theory/therapy for the mind, psychoanalysis–and Freud–will endure.” Here’s the rub. When psychoanalysis asks “fundamental questions” like, “Why do people do the things they do,” it goes beyond the limits of what can legitimately be investigated by science. So science will never be able to develop unambiguous evidence for ANY theory/therapy for the mind.

Psychoanalysis may not be dead as a therapy, but it is not the science Freud thought it was. In a world dominated by the DSM, neurotransmitter dysregulation, and the search for the biomarkers of mental disorders, there is increasingly less room for Freudian constructs like psychosexual development and the id, ego and super ego. We might even say that Freudian thought is in danger of being overcome by its own death instinct.

08/18/14

Sigmund Freud was a Cocaine Evangelist and Addict

Sigmund FreudSo here is the continuing story on Sigmund Freud and cocaine begun in “Raising the Stakes in the War on Cocaine Addiction.” To give a quick recap, Freud began experimenting with cocaine in April of 1884. He used it to treat depression, saying it was a “magic drug.” He hoped that with his help cocaine could “win its place in therapeutics by the side of morphine.”

According to Paul Vitz, Freud’s evangelism of cocaine seems to have been driven by three things:

  1. his intense desire to get married to his fiancée and fear of losing her (a separation anxiety, in Freudian terms);
  2. his drive to become a medical success story in championing the positive effects of a new drug, thus advancing his career and financial prospects (so he could marry); and
  3. to treat his personal struggle with depression (largely induced by his separation anxiety).

When describing his personal experiences in treating his depression with cocaine, Freud said he felt “exhilaration and lasting euphoria, which in no ways differs from the normal euphoria of the healthy person.” He saw an increase in his self-control and capacity for work. He had no unpleasant after effects, as with alcohol and “absolutely no craving” for more cocaine, even after repeated use. “In other words, you are simply normal, and it is soon hard to believe that you are under the influence of any drug.”

He recommended cocaine to family, friends and professional colleagues alike. A friend of Freud’s, Dr. Ernst Fleischl became addicted to morphine while attempting to treat a painful neurological disease. Freud attempted to counteract his morphine addiction with cocaine. At first, cocaine was a helpful substitute for the morphine.

But Fleischl had to increase his cocaine dose as tolerance set in. After one year of cocaine use he was taking a full gram of it daily—TWENTY TIMES the dose Freud personally used. Fleischl was now dually addicted to opiates and cocaine. He soon developed a full-fledged cocaine psychosis, with visions of “white snakes creeping over his skin.”

Freud and other physician friends had little success in weaning Fleischl from his drug use. By June of 1885, Freud thought his friend had about six months to live. Fleischl remained alive for another six pain-filled years. Freud later acknowledged he might have hastened his friend’s death, by “trying to cast out the devil with Beelzebub.”

In July of 1885 a German authority on addiction began publishing a series of articles on cocaine as an addictive drug. A friend of Freud’s, originally favorable towards cocaine, reported that it produced severe mental disturbances. One prominent doctor said Freud had unleashed “the third great scourge of mankind.” The first two were opium and alcohol.

By 1890, the addictive and psychosis producing nature of cocaine was well documented. Freud had moved on in his search for fame and fortune to other interests. And when he co-authored Studies on Hysteria with Joseph Breuer in 1895, psychoanalysis was born. However, Freud continued to use and prescribe cocaine until at least 1896.

Freud 1893 script

image credit: Robert Edwards Auctions.

A handwritten prescription for a “white powder”, signed by Sigmund Freud in 1893, is evidence of his continued cocaine use. In 2004, Robert Edwards Auctions sold this prescription for $2,875.

Freud’s letters to a friend and fellow cocaine user, Wilheim Fleiss, contained several references to his ongoing cocaine use. On January 24, 1895, Freud described to Fleiss how a “cocainization” of his left nostril helped him to an amazing extent. He wrote on April 20, 1895 that he pulled himself out of a miserable (depression?) attack with a cocaine application. On June 12th, 1895, Freud wrote: “I need a lot of cocaine.”

Several scholars have debated whether Freud’s use of cocaine influenced his developing theories. Both Fredrick Crews and E. M. Thornton have argued that Freud’s use of cocaine had a significant influence on his developing theories, especially their emphasis on sex. Thornton claimed that Freud’s psychological theory was the natural outcome of his extensive cocaine usage.

Paul Vitz took a more nuanced approach in Sigmund Freud’s Christian Unconscious, stating that much of Freud’s psychology was evident before he began using cocaine. Freud’s cocaine use may have contributed to sloppy thinking at times. It could have contributed to his preoccupation with sex, or made his depressions darker and more difficult to fight. “But cocaine did not create the primary content and structure of Freud’s mind and thought.”

Yet Thorton presented some rather convincing evidence of Freud’s cocaine “problem” and its potential influence on his theories. Freud himself said that psychoanalysis began with his research into hysteria: “The Studies on Hysteria by Breuer and myself, published in 1895, were the beginnings of psycho-analysis.” Freud began to have heart problems (one of the side effects of cocaine abuse) early in 1894. He suffered from “fainting” spells—four of which were publically witnessed by others. He had an obsession with dreams; some paranoid traits and a tendency towards grandiosity.

In The Interpretation of Dreams, Freud recounted a dream he had in 1895 where he saw a patient with scabs on her turbinal bones, which recalled a worry he had about his own health:

At the time I frequently used cocaine in order to suppress distressing swellings in the nose, and I had heard a few days previously that a lady patient who did likewise had contracted an extensive necrosis of the nasal mucous membrane. In 1885 it was I who had recommended the use of cocaine, and I had been gravely reproached in consequence. A dear friend, who had died before the date of this dream, had hastened his end by the misuse of this remedy.

By 1895 Freud had probably been using cocaine (nasally) for over two years. Physically, the effects of this heavy usage would have been essentially identical to the catalogue of symptoms noted by Fleiss as those for “nasal reflex neurosis” (headache, vertigo, dizziness, acceleration and irregularity of the heart, respiratory difficulties, etc.). So the physical problem that Freud treated with cocaine (nasal reflex neurosis) was essentially caused by his use of cocaine.

His paranoia was evident in the public breakups he had with formerly close associates like Breuer—with whom he wrote Studies in Hysteria (1894), Fliess (1900), and Jung (1913). Freud’s interpretation of Jung’s dream in 1907, just after they met face-to-face for the first time, was that Jung wished to dethrone him and take his place in the psychoanalytic movement.

 
05/28/14

If God Spoke to You, Would You Tell Your Psychiatrist?

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As a young Christian, I remember being anxious as an agency treatment team meeting approached. A young woman I counseled reported strange things began happening to her soon after she started to read a Bible. Although her experiences seemed to have a spiritual aspect, they were also borderline delusional. And I had suggested that she read her Bible.

The thought crossed my mind to not say anything at the treatment team meeting. But I reported the woman’s experiences and my suggestion that she read her Bible. I said I did not think she was becoming psychotic, gave my opinion why, and held my breath. After a slight pause, the psychiatrist said to let him know if her condition deteriorated. The woman continued to read the Bible; the strange experiences stopped; and she eventually went to YWAM (Youth With a Mission) for a short time.

Beginning with Sigmund Freud, psychiatrists have been less religious than the general population; and sometimes even anti-religious. Freud himself was a life-long atheist and critic of religion. He said religion was a “universal obsessional neurosis.”

In 1928 Freud published a short paper entitled: “A Religious Experience.” There he psychoanalyzed an American physician who had attempted to convert him. The American doctor wrote of a time when he himself questioned whether or not God existed, and heard an internal voice say: “ I should consider the step I was about to take.” This was a religious turning point for the doctor. He said knew then that Jesus was his only hope; and that the Bible was God’s Word.

Freud wrote that he was glad the experience enabled the man to retain his faith, but that God had never allowed him to hear an inner voice. He commented that if God did not hurry, it would not be Freud’s fault if he remained “an infidel Jew.”

The American doctor wrote back that being a Jew was not an obstacle to true faith. Prayers were being “earnestly addressed” that Freud be granted faith to believe. He begged Freud to give thought to the matter of life and death. After describing this exchange in his paper, Freud said: “I am still awaiting the outcome of this intercession.”

Freud then gave an “obvious” analytical explanation of the doctor’s religious experience. “All of this is so simple and straightforward that we cannot but ask ourselves whether by understanding this case we have thrown any light at all on the psychology of conversion in general.”

By the 1970s, internal changes began in psychiatry that largely threw over the influence of psychoanalysis on the field. Research studies began to demonstrate that religion has many psychological benefits. But psychiatrists continued to be less religious than other physicians.

In 2007, a study published in the journal Psychiatric Services found that psychiatrists were less religious than other physicians. Psychiatrists were less likely to believe in God than other physicians (65% versus 77%). And they were less likely to say they looked to God for strength, support and guidance (36% versus 49%).  See the original study here.

Not all psychiatrists, even those who don’t believe in God, would view an individual who said God spoke to them as delusional or psychotic. But there is a risk that what the person sees as a purely religious experience will be interpreted as a symptom of schizophrenia or a delusional disorder.

05/26/14

Raising the Stakes in the War on Cocaine Addiction

War on Drugs

image courtesy of iStock

A 28 year old Viennese neurologist named Sigmund Freud read about the benefits of cocaine on Bavarian soldiers. He decided to use it to treat his own problems with depression and chronic fatigue and acquired some from Merck. On April 30th 1884, Freud used cocaine for the first time. He thought it was “a magic drug.”

Cocaine turned his bad mood into cheerfulness; it even helped his indigestion.  He wrote to Martha, his fiancée: “In short, it is only now that I feel I am a doctor, since I have helped one patient and hope to help more.” Freud encouraged Martha to try cocaine, “to make her strong and give her cheeks a red color.” He warned her that when he came for a visit, she should expect “a big wild man who has cocaine in his body.”

He gave cocaine to his sisters and also to medical colleagues—both for themselves and for their patients. By July of 1884 he had written and published his first essay praising the therapeutic uses for cocaine. His hope was that he would become a pioneer in the medical uses of cocaine. But there would not be a happy ending to the story of Freud and cocaine.

These days the ongoing saga of medicine and cocaine is the quest to find a vaccine to cure those who become addicted to it.

I’ve been following the attempts to develop a vaccine for cocaine and other illicit drugs since 2009, when the National Institute of Health (NIH) reported on the work of Thomas Kosten with TA-CD. Nora Volkow, the Director of the National Institute on Drug Abuse (NIDA), said: “The results of this study represent a promising step toward an effective medical treatment for cocaine addiction.”

But some of the participants in Phase 1 of the clinical trials reported using TEN TIMES as much cocaine when trying to override the blocking action of the cocaine vaccine. The Washington Post, reported on the Kosten’s research in January of 2010, saying: “Some of the addicts reported to researchers that they had gone broke buying cocaine from multiple dealers, hoping to find a variety that would get them high.”

A 2011 article in the New York Times highlighted the work of Kim Janda who was working on a cocaine vaccine. His laboratory, the Scripps Research Institute, has also worked on vaccines for nicotine and heroin. In June of 2011 Janda published positive results with what he called an “anti-heroin vaccine.”

New York Magazine reported in September of 2013 that Ronald Crystal, the head of genetic medicine at Weill Cornell, had success with the third version of Janda’s original cocaine vaccine. He hopes to begin human trials by the middle of 2014. A side bar indicated that vaccines were in development for alcohol, nicotine, marijuana, heroin, methamphetamine and rohypnol (the date rape drug).

But as Clint Rainy commented in his New York Magazine article, the problem with addiction is it’s not just a physical problem, it’s also psychological. “Even if you can cancel the effects of drugs, can you make us not want to take them?” Crystal thinks that shouldn’t be a problem for his compound, as it was with TA-CD, because they tweaked their compound (dAd5GNE) to have a “more robust” immune response. Crystal’s response seems to miss an important limitation to a purely physiological attempt to cure addictive “disease.” The vaccine can only inhibit the physiological response to the drug; not the psychological one.

While Kosten’s work with TA-CD has begun clinical trials with humans, the work of Janda with heroin and Crystal with cocaine has yet to be tried on humans. But it’s coming soon. One person who responded to the New York Magazine article about Crystal’s cocaine vaccine said: “This would be a dream come true for me and save my life.” He believed that with the vaccine, he wouldn’t get high. After a few months, he imagined he wouldn’t be thinking about it anymore, but would “just keep getting vaccinated to be safe.”

But it seems that developing a cocaine vaccine as an attempt to end cocaine addiction merely raises the stakes for some addicted individuals by requiring larger amounts of the drug to overcome the vaccine. A vaccine doesn’t address the psychic desire for the drug. If a vaccine is successfully developed for heroin and other opioids, their current potential for deadly use could also increase tenfold.