SIGMUND WROTE HUNDREDS of love letters to Martha during their lengthy courtship (for most of which they were physically separated and during all of which they apparently abstained from premarital sexual relations). Throughout the correspondence, Freud employed the ingratiating methods of a doggedly attentive and hopelessly besotted suitor. Every evening, thoughts of losing the woman he habitually addressed as “my precious darling,” “highly esteemed Princess,” and “beloved little woman” weighed heavily upon Sigmund’s already sloping shoulders. A poignant example of his longing can be found in a letter he wrote to his longtime fiancée in March 1885:
Now and again I see a girl in the street who looks like [Martha] in one way or another, whereupon I invariably follow her for a while to convince myself she isn’t here. She probably won’t see Vienna again until she is my wife. If only this could be soon.
Sigmund Freud at age twenty-eight, July 26, 1884. (photo credit 1.7)
But Freud’s letters also describe the travails of a young doctor negotiating the turbulent waters of Vienna’s medical pool. In August 1883, after returning from a month-long “country practice” clerkship, a twenty-seven-year-old Sigmund wrote Martha about the ridicule he encountered from an older colleague over the folly of marrying too early in one’s career. After nearly a decade of medical training, Sigmund was still looking at an additional “eight years to get anywhere,” but he also was fearful of losing Martha:
Defending my case valiantly, I told him [the doctor advising against marriage] he just doesn’t know my girl, who is willing to wait for me indefinitely, that I would marry her even if she had turned thirty—a matron, he interrupted—that I would bring it off by starting work elsewhere, that a man has to take some risks and that what I stand to gain is worth any risk.
Less than two years later, in June 1885, while preparing for an important oral examination required for a junior faculty position at the University of Vienna, Freud fretted to Martha about “the things that go with it! Top hat and gloves to be bought and then what kind of coat am I to wear? I have to appear in a dress coat—am I to hire it or have it made?”
Then as now, it was impolitic for a young doctor to admit to anyone, save a trusted lover or very close friend, that he had less interest in the hurly-burly arena of patient care than in the pristine, quiet, contemplative cocoon of the laboratory. As early as the summer of 1878, Sigmund wrote a friend about his laboratory work, “I am preparing myself for my real profession: flaying of animals or torturing of human beings and I find myself more and more in favor of the former.” But in Sigmund’s romantic notes to Martha he is far more introspective in explaining his calling. It was in the laboratory—and there only, it seemed at the time—where he could slake his thirst for intellectual fulfillment. The pursuit of discovery, fueled by his obsessive drive and focus, reliably numbed him to his worries; it was the perfect state for a nervous, easily excited, insecure, and prone-to-be-depressed chap like Sigmund. At the laboratory bench, specimen in hand and prepared for the microscope, he found an emollient that reliably calmed his nerves and heightened his sensations.
Yet if Freud was ever to convince Mrs. Bernays of his desirability as a son-in-law (read: his ability to provide for Martha in a manner that far exceeded his current income), he needed to bolster his career aspirations by establishing some type of carriage-trade practice. The conflict was clear. The deductive and seductive game of research was sublime but paid little. A private practice, on the other hand, did pay, but attending to an endless treadmill of Vienna’s worried well was not exactly the life Sigmund envisioned for himself.
Complicating matters, Sigmund had already cast his lustrous but solemn brown eyes on the grand goal of a professorial appointment at the Vienna Medical School. Once there, he would enjoy free rein to inquire, lecture, and debate medical issues with the finest experts and scientific minds, accompanied by membership into the most elite international societies and academies. This was no mean feat for any young doctor, but Jews in particular faced significant obstacles in achieving such lofty positions. If Freud wanted to become an esteemed Viennese medical professor, he needed to mount a precipitous climb up an intellectual Everest. Foremost, he had to discover something medically earthshaking. But he also had to acquire the acumen and abilities of a world-class physician who could diagnose any illness presented to him, no matter how arcane or exotic. Such accomplishments and skills were the time-honored prerequisites for greatness at the Krankenhaus.
THE MEDICAL STUDENT’S LIFE has long been filled with anxiety punctuated by flashes of ambitious overconfidence. Sir William Osler, the eloquent physician and a founding father of the Johns Hopkins Hospital, best described their mental condition in a lecture he delivered at the University of Toronto in 1903. Medical students, he said, were prone to all forms of “ill-health of the mind.” But the cause, Dr. Osler explained, was not merely hard work. Instead, “it is that foul fiend Worry.” Few medical students fit this diagnostic criterion better than Sigmund Freud.
From late afternoon until well into the night, Sigmund focused on hastily written lecture notes and the thick, dog-eared tomes of anatomical structures, pathology, and chemistry he was required to memorize and regurgitate on command. The worry his medical aspirations set in motion tortured his tired neurons. Before he turned in for the night, perhaps in an effort to calm himself, Sigmund likely succumbed to a common medical student fantasy: visualizing the bright morning when he would lead a parade of interns, residents, junior physicians, nurses, and assorted acolytes down a busy hospital ward. There, his minions would troop alongside the beds of the stricken and present for his consideration a treasury of medical mysteries; in return, he would bestow upon them his latest insight of medical brilliance.
IRONIC ONLY TO THE INEXPERIENCED OBSERVER, the patient’s suffering was secondary in the medical exercises conducted at the Krankenhaus. Making the right diagnosis was everything during an epoch when medicine’s therapeutic arsenal was rather puny. Every morning, junior doctors reported on the details of their patients’ courses along with the latest clinical tidbits culled from the piles of journals they read in the hours before rounds commenced. Their senior colleagues would then finesse, embellish, or clarify those findings.
By the close of these clinical spiels, all the heads in the crowded room would be turned to the superbly tailored attending physician, who immediately grasped what was going on with the patient, much to the amazement and admiration of his captive audiences. The cat-and-mouse games between the inquisitor-doctor and the witness-patient were composed of questions and answers, followed by more intricate questions and often vaguer answers; a dexterous dance of probing fingers; the percussion of knuckles across the patient’s chest and abdomen in order to determine the consistency, shape, and size of body organs; the careful listening to, or auscultation of, the heart and lungs with a relatively new device called the stethoscope; the flick of a feather or jab of a pin and the aggressive thrust of a rubber hammer to elicit key signs of how the brain and nervous system were functioning—all of these maneuvers helped determine what ailed unfortunate denizens of the Krankenhaus.
At the inevitable autopsy, when the pathologist pronounced his measured but far-too-late medical opinion on the cause of death, no clinician wanted to be found having made an incorrect diagnosis. Failures of this magnitude were simply not an option at the Vienna Medical School. Perfection—or at least the perception of it—was demanded and expected of those bearing or coveting the title Herr Professor.
Carl Claus, Vienna Institute of Zoology, Freud’s research mentor during his first year at the University of Vienna, 1875–76, when Freud was nineteen. Signaling his success there, Sigmund entered on his curriculum vitae in 1885, “I also worked a year in the laboratory of Professor C. Claus and was twice sent on vacation to the zoological station in Trieste.” (photo credit 1.8)
SIGMUND’S PROFESSIONAL ASCENT demanded that he become an internationally acclaimed medical investigator if he hoped t
o command laboratory space, financial compensation for his inquiries, and the freedom to pursue his ideas and theories. To achieve these ends, he began some of his earliest scientific work under Carl Claus, a biologist who ran the Institute of Zoology and had a long-standing fascination with hermaphroditism. Some have suggested that Sigmund was pleased neither by researching the gonads of eels nor with Professor Claus. In 1876, Sigmund left Claus for Vienna’s famed Institute of Physiology, a bustling and vibrant laboratory directed by a visionary scientist named Ernst Wilhelm von Brücke. For the next six years, Sigmund would work at what was formerly a rifle factory and before that a stable alongside dozens of eager students in pursuit of scientific discovery.
When Brücke, the son of a painter, matriculated at the University of Berlin in 1838, he secretly harbored the desire to become an artist. But Berlin was a leading capital of scientific discovery at the time, and Brücke soon fell under the spell of one of its most fertile minds, Johannes Müller (1801–1858). Müller is credited by many historians with dragging German science out of the fanciful muck and mire of Naturphilosophie, a now obscure theory of biology, nature, and mystical pantheism once adored by German academics.
Perhaps as a buttress against the lonely pursuits that constituted his studies, Freud bonded emotionally with Professor Brücke, the first of many teachers he latched onto during his long medical education. Sigmund’s relationships with his bumbling father and his domineering, overprotective young hausfrau of a mother—not to mention the rest of his family—were, well, Freudian. With such a background, it is intriguing to focus upon Sigmund’s frequent search for substitute father figures among his teachers. Too often the obscure young man experienced visceral pangs of longing, of not quite fitting in, or fears that others might declare him to be worthless that required the stern but comforting hand of a patriarch. But there were also practical reasons for Sigmund’s search for the perfect parent–mentor–instructor–idea sharer. Such benevolent guides were, and are, essential ingredients in any recipe for devoting one’s life to revolutionizing how the rest of the world thinks about and understands a particular corner of itself.
Ernst Wilhelm von Brücke, Freud’s beloved mentor and director of the Vienna Institute of Physiology. The impressionable Freud worked under Professor Brücke from 1876 to 1882, between the ages of twenty and twenty-six. (photo credit 1.9)
A small man with an oversized head, Professor Brücke was revered by his students and colleagues alike. He was obsessed with finding out precisely how the human body ticked, even as he struggled to explain how to put such a complex watch back together once he pulled it apart. Brücke was devoted to his students’ professional development but was also strict and demanding. One afternoon in the late 1870s, Sigmund was tardy, resulting in a severe reprimand. Years later, Freud reported how he was “overwhelmed by the terrible gaze of [Brücke’s] eyes” and that the professor’s steely blue orbits would appear in his mind whenever the founder of psychoanalysis was tempted to take a shortcut in his research. That one afternoon aside, Freud was completely enamored with and inspired by his teacher. Throughout his life, he told others that Professor Brücke “remained the greatest authority that worked upon me.” Freud also often referred to his assistantship in Brücke’s laboratory as “the happiest years of my youth.”
The historian Peter Gay suggests another more practical attribute that attracted Freud to Professor Brücke and, later, to his internal medicine professor, Hermann Nothnagel: they “had no use for the anti-Semitic agitation spreading across Vienna’s culture like a stain.” Anti-Semitism remained a distressing fact of Austrian life during this time and especially at the medical school, where Freud complained that his “Gentile fellow students impertinently expected him to ‘feel inferior’ and a stranger to the Austrian people [nicht volkszugehörig] ‘because I was a Jew.’ ”
At the Vienna Institute of Physiology, students were encouraged to conjure up original research projects and muddle through their execution. At the end of each week, armed with a sheath of notes and smoky black kymograph tracings, the scientific novices ceremoniously presented their labors to the professor for comment, occasional praise, and, more frequently, abrupt dismissal and immediate reassessment. Under Brücke’s exacting gaze, Freud progressed from fumbling with the nervous systems of slimy invertebrates all the way to examining human cadaver brains and spinal cords, in the quest to unravel the workings of nerve cells, nerve fibers, and their far-flung connections from the brain to the rest the body. As a result, young Sigmund completed a small corpus of competent, descriptive work, accompanied by his own meticulous pen-and-ink drawings of what he visualized under the microscope. A few of his studies even made their way into the respectable typeface of the leading journals of the day.
Acquiring the skills to become a microscopic neuroanatomist in the late nineteenth century was no simple task. The job required a strong streak of perfectionism, a keen eye, and great attention to detail, especially when finely cutting the tissues of eels, fish, crayfish, and other creatures so that each slice was thin enough to accommodate a gaze through a microscope without destroying its delicate structure. One had to then carefully “fix,” or harden, the intact tissue slices, typically in a pungent bath of alcohol solutions, followed by the meticulous application of stains and dyes so that the researcher could detect, as Sigmund detailed to his fiancée, “where the fibers and cells lie in relation to one another.… The fibers are the leading ducts of the different parts of the body, the cells are in control of them, so respect is due to these creatures.”
Sigmund mastered all these chores and described them in great detail. In a few of his papers, he even suggested some fundamental points of what Santiago Ramón y Cajal, H. W. G. Waldeyer, Camillo Golgi, and others subsequently described as the “neuron doctrine,” a concept that became the foundational tenet of modern neurobiology. Specifically, neurons are independent cellular structures, rather than a fused, continuous entity, that carry impulses from the central nervous system, neuron to neuron, to the peripheral parts of the body, resulting in some type of movement or action.
There was one short-lived moment, in 1883, when Sigmund thought a modicum of medical fame might be his, but the event quickly dissolved into professional disappointment. Brain tissue is distinctly gray in color, which makes exact visualization through a microscope difficult. During this period of intense anatomic identification, researchers played with all kinds of chemicals that might be picked up by discrete neuroanatomical structures, making them more visible. While working on the histological structure of nerves, Freud developed a novel staining technique employing potash, copper, water, and gold chloride that tinted the various neuronal fibers with red, pink, purple, black, and blue hues. He rushed his preliminary findings into print in the pages of Centralblatt für die medizinischen Wissenschaften, a local medical newsletter read primarily by his Viennese colleagues. He then craftily submitted a fuller, but essentially the same, account for the prestigious and widely read journal Pflügers Archiv für Anatomie und Physiologie, followed by still another version for the British journal Brain. Although this paper briefly created a mild stir among those who spent their days and evenings visualizing nervous tissue under the microscope, it lacked that essential ingredient of all good scientific research: reproducible results in the hands of others. Soon after the paper appeared in print, Sigmund’s method evaporated as quickly as a rain puddle on a sunny day.
Vienna Institute of Physiology, c. 1885, when Freud worked there. The building was a former gun factory dating back to when this portion of the hospital was an armory; before that, it housed a stable. (photo credit 1.10)
In fact, Freud’s anatomical labors made only a slight ripple in an already turbulent sea of discovery. From 1873 well into the 1880s, he was firmly fixed in the fat part of his class’s bell curve. To quote Sigmund’s career self-assessment, at this point he was “stuck.”
IN JULY 1882, a little more than a year after being awarded his M.D.,
Freud realized that his chances of obtaining a paying assistantship in Brücke’s laboratory were less than robust. The two paid assistants already working in the laboratory—Ernst von Fleischl-Marxow and Sigmund Exner—were young and gifted, and had no intention of relinquishing their coveted posts. As a result, Professor Brücke encouraged Sigmund to complete his qualifications to become a physician and helped him secure a niche on the lowest rung of the General Hospital’s steep professional ladder. The Viennese physicians called such clinicians Aspirants; today, they are called interns. Depending upon the medical procedure they were assisting on, these clinical subordinates were often green around the gills. But as a rule, they were ambitious, eager to please, and young of body, mind, and spirit. Sigmund was enough of a pragmatist to know that he had to find a way to earn a suitable living; but at the time, a life taking care of patients was a pale second choice to the low-paying but all-important assistantship at the Institute of Physiology. On July 31, a deeply disappointed Freud “inscribed himself in the General Hospital of Vienna.”
Through the hot, steamy summer and early fall, Freud toiled on the busy surgical wards controlled by Theodor Billroth. Few young doctors would dare to touch the hem of Dr. Billroth’s surgical gown. After all, Billroth had invented the procedures to circumvent age-old abdominal problems such as peptic ulcers and stomach cancer, attracting hundreds of ambitious young surgeons anxious to learn from the master. He was an enormous bear of a man with blue eyes as piercing as his surgical instruments and an imposing, luxuriant beard. But the surgeon also wielded a sharp tongue and refused to suffer fools or uncoordinated hands on his wards. Dr. Freud lasted only two months in this grueling position. Many evenings he complained about fatigue and aching muscles in his legs and arms from standing so long and so still in the operating room, where tradition and protocol dictated that he hold a senior surgeon’s retractors in order to keep the surgical wound open and accessible.
An Anatomy of Addiction Page 3
