That Time Sigmund Freud Nearly Killed a Patient—and Then Got Hooked on Cocaine

In 1895, the psychoanalyst tried to treat a young woman by giving her cocaine. His failure sent him on a course of drug addiction that changed the course of psychiatric history.

Illustrations by Claire Merchlinsky

“I need a lot of cocaine,” wrote Sigmund Freud to his friend and colleague Wilhelm Fleiss. “I am overflowing with new ideas, theoretical ones as well.”

It was 1895, and Freud was in a career crisis. According to several biographers, one of Freud’s patients, Emma Eckstein, had come to him complaining of stomach pains and depression related to her menstrual cycle. Freud diagnosed her with hysteria and “masturbating to excess,” something he believed was both a mental illness and the root of all addiction, as he wrote in the abstract of “Masturbation, addiction and obsessional neurosis” (1897).

He called in Fleiss, an otolaryngologist, for the treatment: cauterization of the nose. Fleiss believed the nose was linked to the genitals, and that operating on it could quell sexual problems such as Emma’s. He and Freud cauterized her nose with cocaine, which was legal at the time, and sometimes used as a local anesthetic and for cauterization. They shoveled gram…