recent movie with daniel day-lewis, that's the fort we are currently digging in the summer through adirondack committee college and through the state university. however, this fall here on campus, here at penn state university we are taking on campus, universities all across america are doing campus digs these days, because it's hard for students to take the whole summer off to go far away to dig something. but during the school year campus digs, looking for the traces of the early university, that's what we love to do. i have students outdoors right now digging, and it's exciting for them. 100 feet from the classroom their digging up a storm right now. >> thank you so much for your time. >> good to be here. >> the c-span campaign 2012 us this is committees across the

country. to follow the travels visit www.c-span.org/bus. >> next on booktv, howard markel recounts the cocaine use of sigmund freud, the father of psychoanalysis, and william whole state, an early innovator in the field of modern surgery. mr. markel examines each man's introduction to and use of the drug and the respected edition action to cocaine -- addiction to go again. this is about an hour and 15 minutes. >> good evening, everyone, and welcome to the university of michigan offers form. joined hosted by the hatcher library where we're sitting outcome and the incident for the humanities in which i am the director. and ann arbor book affair. and also the college of literature science and the arts are involved as well. we are delighted tonight to be

speaking with doctor and professor, professor doctor howard markel who is speaking, will be speaking about his extraordinary book, "an anatomy of addiction." just a couple of words by way of introducing the author, first let me just say because in my particular culture that i come from your eyes begin talking about yourself under any circumstances. which is related to freud by the way, but in any case, it's called narcissism, in any case -- >> i have that. >> i am about to fly off to vegas after this particular occasion but i'm going immediately to the airport to take to the waters to buy myself addicted to strawberries no doubt which is of course, and to come back after with a raging case of tuberculosis which is not unrelated to professor markel's wonderful first two books. the first of which was the

award-winning "quarantinel," which johns hopkins press published in 1987, and then his completely marvelous when to travel, -- "when germs travel." i'm delighted to tell you that barnes and nobles bookstore first of all is still in existence which in itself deserves a round of applause, and second of all has the book back at the table so that it can be purchased afterwards and so forth. professor howard markel is that george want to stay with professor in history of medicine, professor pediatrics and communicable diseases, professor of history, professor of health management and policy,

professor of psychiatry and director of the center for the history of medicine at the university of michigan. it reminds me of a new yorker cartoon from the 1980s when there was a latin american general standing with grace kinds of strikes on him and he said president of the republic, ministry of health, president of et cetera. the versatility is extraordinary. professor markel is not only a practicing clinician, it also a historian, pediatrician and, indeed, his work for many years in a clinic with adolescent who have suffered from addiction. so dr. markel is a triple threat in the way he approaches this ex-ordinary topic of two completely luminous figures in history of medicine, sigmund freud and william halsted. we will hear about and the second. both of whom were raging addicts as a matter of fact, at one time in the life, if not continuously. and the point is dr. markel

approach is this not on from the point of view of a fantastic storyteller, he just in elegant prose he got dealt a store and putting these guys to get is the work of genius. secondly, he approaches the point of view historians of scholar, the archives, history of medicine. but also a clinician with an experience if you will of this induction of wonder drugs, what it means to work in a political culture where when new drugs, new techniques are discovered people feel the sense of trying to use them wisely, to try to understand how far they can go and what they will do. for example, in radiology i guess was first brought into being, used for everything, and what it produced was this raging set of disasters actually, radioactive and couldn't get through airport security anymore, something like that. be that as it may, the fact of the matter is there are very few people who actually can combine a real clinical experience in a sense of the medical culture of

research and the desire for your, the sense of new technologies and wonder drugs and the real history of the archives. and became wonderful storyteller which all combine to give us some story of freud and halsted. let me just say before we start that doctor howard markel is not just all of these things. he's consulted why did center for the history of medicine on pandemic preparedness, plan for the united states department of defense, along with his associate director of the center, professor alexander stern, and 2006 to the present jesus as the the principal historical consultant on pandemic repair disk, et cetera for the u.s. centers for disease control and prevention. contributed over 200 articles to scholarly publications and popular periodicals from new england journal of medicine to "the wall street journal." hewitt writes in "the new york times" regularly, and he has been on all manner of television

programs, and i'm delighted to get this program is being taped by c-span for its booktv weekend show. and so please try to catch if you want to watch it a second time, if you missed, for instance, the character of my introduction and you want to watch it again, please, c-span.org and you can find. let's hope that it doesn't conflict with michigan football, speaking affairs tide of cultural addictions. or lease forms of dependency. a couple of minor point. if your cell phones are now now is the time to change the. secondly, when we get to question, because after a brief conversation we're going to open this up, there's a mic in the middle so just please get yourselves in line to just ask a question from the mic. and third i do want to mention that professor markel was a john rich professor at the institute

for the humanities where this book was originally conceived and early drafts were produced in 2006. so professor markel, let me just call you howard now. if i may. for those who aren't familiar, tell us a little bit about these two addicts. what brought you to think about these two people and put them in one book? >> well, when i started, i wanted to write a cultural history of addiction. addiction is a rather new concept in medicine and medical history. the original meaning of the word comes from law, so what it meant in antiquity is a fight you a great deal of money, and i could not be back, you take me before a judge he would make me your addicts, or slave. i was enslaved to you until i get pay restitution. i love that. now, the concept of being enslaved is something extraneous

to you is really remarkable, but it wasn't really until the 1820s or '30s that doctor started to think about addiction, the modern definition is using a substance, but using a substance not only with great and grave consequences but a loss of control. you know it's going to harm you, but you still do it anyway. that's difference than substance abuse. you have a loss of that control. and opium really started the ball rolling but doctors love to prescribe opium because it's an incredible pain killer that nobody knew they would be creating all these, they called morphine eaters or opie features for people with -- and once the hyper dimmick -- even more

addicts were produced in 1880s, there was interest in a brand-new drug called cocaine hydrochloride. coca, coca leaves had been used by aboriginals and south america for a millennia, but finding out the way to chemically take those leaves and come out with a powder that is measurable, playable, spendable, prescribe ago, took quite some time. that happen in 1884, and it was touted in all the medical terms of the day to all the great doctors as the miracle cure. it was going to cure everything, tuberculosis, flatulence, and even more can addiction to a young man named sigmund freud who have not yet -- was sigmund for you that was his name, you studying to become a urologist in vienna. he was working in the vienna general hospital which was the parnassus of medicine at that

time. that was the place and all the world, greatest doctors, the greatest surgeons. it wasn't so great if you were a patient. it was more of a place where the diagnosis was rather than treatment because we didn't have great respect and. it's also the place where handwashing was first discovered to be an important issue. something dr. seal are working on learning. but freud became very interested in that. he diplomat on because he thought this could make my name, and he had to become not only a great physician if you want to have become a professor at the university of the vienna of medicine or garage, you have to discover something really great. and i love learning about that because he was an ambitious medical student, very eager to please and very eager to succeed. somehow i could identify. i remember that very well.

i remember that angst and desire to succeed, and not always knowing i would. or if i ever have. and he also had a very good friend named mark so. a very talented physician. but while dissecting a cadaver he cut his thumb and he developed such a raging infection, this is well before antibiotics, that the thumb was indicated and he developed a terrible, what was then called a neural tumor that caused this phantom pain of unimaginable, unimaginable. and he tried everything. he studied sanskrit to keep his mind off of it. he studied cactus and physically he took hot baths. nothing worked until he found morphine. that quickly became a raging morphine addict.

sigman was called to his room many times when he was in delirium are withdrawn or unless. so this connection that only can i discover something but i can help somebody. he was a healer after all. a wonderful, powerful combination to have. freud wrote a paper about this, famous paper called buber coco. meaning on cocaine. freud was on cocaine while he was on cocaine. he missed a critical issue of cocaine. it's a wonderful anesthetic to do you ever see a cop show with a look at a pile of cocaine they put their finger in and they touch the thumb? it will now become. that woman anything. so freud missed that. what he was too high or too anxious or what, or two into the issue because he is not in search and. but a friend of his, he

discovered that. and that changed the world. just as ether and chloroform dead. the idea that you have a local anesthetic that would now need effectively was literally front-page news around the world. it wasn't just medical news or doctors to recommend to read about that across the ocean, shortly after his reported was a man named thank you. is probably not a name that is as familiar to you. he became the greatest surgeon ever. he was then the boy wonder of new york. he was working at bellevue at what is now columbia college of physician and surgeon, along with some of the hospital. brilliant ideas about wound healing, about and deceptions and operating under a clean circumstance, which seems of course, but back then surgeons were wearing gold frock coats smeared with blood and pus. they were draping or dripping

their elbows into the surgical wound. interns would hold sutures in the mouth and then hand it to them. so it brings up the old vaudeville joke, operation was a success at the patient died because they get super infected and died. so halsted was always looking for infections and his operatives craft. he read in the paper about his anesthetic properties, i've got to get some. he thought it, started doing experiments, and the problem is most of the did experiments on themselves. freud did, halsted did but halsted was injecting it. for the next it with water or smith appeared halsted was actually ingesting it to find out how far he could go with the numbing technique. within a matter of weeks he became a cocaine addict as did most of his fellow assistance or students who helped work on this. and they came to the head where halsted stopped going to

meetings, you know, medical meetings to he stopped going to classes. by the way i forgot to mention halsted invention the surgical rubber glove, the iconic symbol of surgery, modern surgery. and halsted was called down to the operating room to the patient had broken their tb bone so badly that it was coming out of the skin, called a compound fracture, back in 1880s that was something you really survived because of infection. he was so high on cocaine, he walked away from the table and said i can't do this. he went home and he skidded away the next several months high on cocaine into his friends read him the riot act and tried to do an intervention. that i was so enchanted with these two stories, for all the reasons, they were remarkably high-performing and bright people, which disproves the notion you should've known

better, human disease, and smart people, rich people, poor people, all people are prey to this terrible disease. they fought so hard to break it, it had to do with a medical truck that was supposed to help people, not harm people. they were accidental addicts, because everybody is an accidental addicts. nobody says i'm going to take this heroin and become a raging addict it they are going to be the object every at it has their own story but they don't write it directly. the idea of all of this, while i was thing about writing about other people i was on a hilltop in tuscany one day, i thought i would work then, and -- to help with it. if i'm not compelled by this, surely somebody else must be. and i hope the leaders are. it so fascinating i became, i knew these gentlemen though i

never met them eric and likely they never met by the way. i understood where they came from. i understood what their ambitions were. i understood. i have great empathy and i felt for them. and i wanted to document their stories. but as a broader issue, to an atomized addiction and a human disease. so the joke, it's not a sensation, it's not the stuff of cable tv, even though it is the stuff of cable tv, it is a very serious problem for the individual, for the family and people who love the individual, and for the society at large but it's one of the greatest public health problems facing the world today. >> someone not part of the medical establishment another thing the book does an alluded to this order, it gives one of the seductions of clinical practice, and what it means to be living with something that

really is news that is untested whose limits are not yet come and then one if you talk more about that. i think that's what it so beautifully organized with two medical people. i'm wondering if you talk about that? >> it's an exciting view that is not well known to most people, even though it is on tv quite a bit. by the academic atmosphere isn't on television as much. and it's a very exciting place to be if you're a young man or young woman, or if you're an old man our old woman. there is the thrill of discovery even if you don't have a shot at it. there's always snooping around how can i make this better, both for patient and science, but also for me. and hospitals are filled, filled to the rafters with ambitious people who really want to change the world. so you're always looking, and

yet none of us seem to be unaware of this old morality play that plays itself out over and over and over again. the miracle cure, miracle procedure, the miracle this comment and doesn't turn quite a quite so miraculous. we only learned that after using it on quite a few people and looking at reactions to it. in fact, that happen with cocaine rather quickly into in 1884 it was a miracle drug. by the 1890s in the medical literature it is filled with racks of human beings who are former cocaine addict. but the thrill of discovery both for popular consumption and personal advance is the engine that drives the temples of health that we all benefit from today. >> liechtenstein himself, another story, one said the way in which we come to find out there is a limited understanding is by pumping our heads and only by bumping our heads against the limits of the understanding is

like a wall we realize there's a limit that was there. >> i think think that is very true. i remember moments in my own career where what we would do seemed rather outlandish. how we learn? that's where the separation comes from, the healer with the patient in front of you versus the scientist doctor, the medical scientist. and it's a huge issue. one of william halsted's colleagues, the great internist, separate man from animals is a desire to take from us. and it's true. it's true. we all want something that will make our lives better, that would make my sciatic pain less, that would make us less nervous, we all want a simple pill, pop it, gone. and i think that's a very human phenomenon that also conspires

into office, that the quest to heal ourselves with some kind of the drug, some feel. >> part of what makes this all fantastically one of the best i've had in a decade actually is that the way you carry out these two different characters and the differences. and i'm wondering if you tell us more about halsted seems to be costly on and off the wagon if you will wear as freud freud at a certain point stops or seems to, so tell us about those differences. >> that is another wonderful, you can find two people in hospital more at odds, more different, psychiatrist or psychoanalysis and the surgeon. they are different species. my medical school report terms as howard is not a surgeon. for years i didn't realize that was not a counselor. it is very different from a psychiatrist or psychoanalyst. but they are also very different

people. freud was the young jewish fellow who was told legally given, anti-semitic slurs were thrown at him. and he did experiment quite a bit with cocaine, and he nearly killed a patient, he and a college nearly killed a patient. and to me i interpret that as his bottom. he wrote about in the interpretation of dreams and actually became the model dream. and he and a friend of his was an emt man had a theory that all imbalances are due to the nose and can be cured with a removal of turbine nosed, carbonate bone in the nose. and healthy supplies of cocaine. one of his patient by the way was sigmund freud. was taking quite a bit of

cocaine to the point that he had stuffiness and had to have a hot heated knife to burn a hole in his nasal cavity so he could breathe. so they treated erma in this way. he left for berlin and erma nearly died. freud had a dream about this. the way he interpreted is that i'm such a good physician, so conscientious about this that when my patience go sour, i feel bad for them. he was telling himself as you've told me, the same big live at excel themselves, my edition is not that bad, my prom is not a. and yet at some level he must've known that not only did almost kill somebody, but his career would have been ruined. that would've been malpractice. there would've been no sigmund freud and it was around this time that he had this dream and that his father died.

he wrote by the way i put the cocaine brush aside. there's no evidence in his letters. kievo so many letters, and he's telling you what he wants you to know about himself. so he probably stopped using cocaine in october of 1896 and then lead to 1939. he had another addiction by the way, cigars, which lead to oral cancer and his death in 1939. halsted on the other hand who committed himself to an insane asylum twice. this was a rehab. going to an insane asylum back and was a very scary place. he with and even sign his name on the registry, he was so ashamed, so demoralized, he signed william stewart, and then a slash was last inch of him because he was so embarrassed. that's one of the major symptoms of this disease, shame, hiking,

secrecy. and he was brought to johns hopkins hospital by his friend who was going to found the greatest medical school in the world, had tons of money. and he said to halsted, i'm going to bring you, i'm going to bring you with me to baltimore but you will live with me, i will thought of you. so he did. and halsted was not a search in his first two years at hopkins. he was operating on dogs. but he was working on all sorts of excremental things. how did the wound heal? what type of suture will help that? how do you cut the intestines of our and then sell it back together so it doesn't leak? it seems all mundane. anyone who's ever got off an operating room table -- he was proving himself. he must've had the weight of apples, the world on his shoulders like that was because he knew he could never resurrect

his career again. another thing happened by the way that i neglected to mention is that butler hospital, decide to treat him with another truck to get him off cocaine. and that was morphine. the reverse. so we actually became a cocoa and -- a cocaine and morphine addict. there are times was handsome be too shaky to operate or he would be too stoned to operate. he could never get a hold of the man at 430 in afternoon because he would be at home with his morphine to and is very good evidence that suggests that he would go on cocaine binges often on for the rest of his life. and yet he had to live this double life of literally the world's greatest surgeon that every doctor in the world, what is halsted said about x.? what is halsted say about why? and yet he had this secret

raging drug addict and i cannot control myself. they had problems as a result of the substance abuse, for most of their life. >> if i remember from the book at certain moments he would be shaking so much he had asked his assistant and so the patient of the? >> absolutely. halsted was famous for being such a meticulous operating, the male brothers said the patient in studio three hours before halsted closes the wound. but there were times that trained to so shaky, and what he was on cocaine and that would give you a trimmer, or he was withdrawn, he didn't take morphine that morning and he is withdrawing or he was hung over, that's hard to figure out. but his surgical colleagues from his residence love them because they got to operate with them. the chance to cut, the chance to

heal. and they blamed it on his cigarette consumption but he used to smoke a lot of cigarettes but that doesn't seem very likely. and, in fact, one of his chief resident said we didn't like when he stopped smoking cigarettes because we didn't get as much a o.r. time. probably because he was cutting down on the substance abuse. and he would go awol from hospital. there's minutes in the johns hopkins medical school archives that the trustees are meeting, where is halsted? he would've been fired under any circumstances like that if he was anybody else. and yet whether people knew or didn't know or chose not to look very closely, he was enabled to continue this path for the rest of his career spent let me go beyond the book which is the second. you have written elsewhere in the 200 articles on f. scott fitzgerald and a number of others, so there's this issue arises deep in the book about the relationship between addiction and talent.

ivc one doesn't want to romanticize addiction, that somehow it's purely an artifact of opium and it allows the imagination to soar, this, that and the other. but on the other hand, there's material that you've alluded to, especially about freud about the way in which ambition is also so unsettling. i mean, they young freud coming from as you put it this position of being cursed indiana, if you will, having neither money no status, the wrong religion from everything else, certain that he had something there and yet having not discovered it waiting to find out and so forth. so i'm wondering, and now i'm asking you also not in terms of your work as a writer but also as a clinician. ..

>> this is risk factors if you, indeed, meet the wrong drug at the wrong time. there's good science about genetic predisposition. you may not have a problem with this drug, but you may turn on that frankenstein weapon switchr head. i sort of describe it as four wheels of misfortune; genetics, psychic trauma or physical trauma, the drug itself and the mode of administration. because some ways shooting up, injecting is far more addictive than sniffing or tasting, etc. and the addict falls short on all four wheels. >> in terms of talent, i

absolutely reject the notion that the drug abuse causes the greatness. >> oh, yeah. >> greatness that these two men, it came stitch by stitch, thought by thought, dream by dream, page by page, patient by patient. in fact, i write in this book it was really in spite of the addiction that i think their true greatness and genius comes from. there may be a spark of an idea whether thest the interpretation of cream -- dreams or a really neat rock song or whatever. but then to carry it out that it becomes that work of art or work of brilliance, that's work. and the addict, the practicing addict can't do that because he or she is too busy taking their drug to their ruin. it's death at its most repellant and seductive. it's a cat and mouse game that the addict plays with him or herself.

what is interesting is that a lot of talented people seem to have a lot of issues of angst and great ambition. who could become a great artist or a great mind in such a competitive, difficult world unless, a, they felt a -- sorry. a, they felt they had some greatness in them, they had ambition in them, and they had this upsetting and angry voice always saying you haven't done enough. you've got to do more. it's sad, but you do need that. well, i'm not great, but i assume you need to have that to achieve greatness. and that's what i think these two had and a lot of the addicts and alcoholics i have read and written about over the years. >> before we open it up, i've got a couple more questions that go into other things you've written in your clinical experience as a physician. the first one is if you could talk more generally about the differences, how you specify what addiction is as opposed to a culture of dependency, you

know, madmen, you know, everybody's drinking all the time. they're not all raging addicts. some of them are and whatever. um, here's another example. the advertising world which i know fairly well for various reasons. it's 2:00 in the morning, you have a presentation due at 6, you vice president got an idea -- you haven't got an idea. cocaine is there to even you out. how does one from the medical point of view distinguish these broader themes of dependency from actual addiction? >> well, if you read the definitions and they're problematic and everyone argues about them is that if you are using the substance to the point that not only are there bad consequences, and in all those problems you've mentioned like the mad help show, those characters have had bad con scweptions. that you still do it knowing it's going to harm you, you still seek it out despite all the warnings you've had, that is what -- how psychiatrists would define it. it's a very hard thing.

it's sort of like pornography. you know it when you see it, but it's hard to describe it. but i've met many people who have spent too much time denying it because nobody wants to say i'm an addict. nobody wants to say i'm an alcoholic. but if you're starting to think about it, if your starting -- if you're starting to even utter the words in your secret part of your brain, you probably have a problem. so when i see patients or i talk with others, friends, peers and so on, there's a problem here. let's take the word addiction off the table. let's take substance abuse off the table. but sure you you must admit taking cocaine five times a day to finish your ideas or some patients i've had smoking marijuana from morning until night, drinking several six-packs a day. that is a problem. that's not what normal earth people do. >> uh-huh. >> and so that's how i like to look at it.

>> uh-huh. >> when you start putting negative words on it like "addict," and like it or not, it's not a positive word for many people, then you get into the defensiveness. and defensiveness, denial, lying, these are the cardinal symptoms of addiction because you want to protect your addiction. that's your best friend. that drug, that alcohol, that whatever. you don't want anyone to interfere with your best friend. that helps you make it through the day. so i try to look at it as a problem and talk with people that way. >> so, um, one is perfectly prepared to believe that in some sense clinical practice is an art in a way that you describe. >> it's a complete art. >> but then there's another question about the science. are there specific brain pathways that changes -- >> uh-huh. yep. >> what can you actually see biochemically going on? >> that's some of the most fascinating stuff i learned, some of the most interesting stuff in science right now is neuroyo chemistry and addiction

biology, addiction vaccines that would form an antibody to the drug so you don't get high. other neuropathways because you literally change the anatomy of the brain. there's a pleasure center in the brain. you know, the brain is not that big of a space. the pleasure center is even smaller. some of my friends their brain is even that big of a space. but once you start rewiring it, there's sort of a circular loop, get high, get high, get more, get more, because the drug -- particularly a drug like cocaine -- fools the neurons into secreting enormous amounts of dopamine which tells us to smile on a sunny day, to enjoy an accomplishment, to enjoy our spouses, what have you, our chirp. and it's a trojan horse, if you will, because it presents so much dopamine that you feel

positively euphoric. and then nothing else can match that chemically-mediated euphoria. and to put it crudely, the wires actually change. and there's wonderful imaging studies to show this, that an addicted brain even ten or more years after recovery just showing recovering addicts pictures of cocaine, for example, that part of their brain lights up on a pet scan. so you've really changed the biology of that individual which is one of the many reasons that treating this disease is so difficult. and you use everything you've got. there is a lot of art, there's a lot of finagling, there's a lot of patience, and there are a lot of patients. that makes it very difficult to treat the disease. >> okay. following that description, this is my last question before i'll ask you if you want to talk, and so on. um, 21st century has from talk show, if you will, like us to

newspaper to everything else claimed an endless spate of new addictions. >> uh-huh. >> a whole generation addictioned to the internet and cell phones and god knows what else and so forth. how do you think of that from the medical point of view? >> well, it's been very evolving, the idea of new addictions. you know, the old definition was not only an exogenous substance, but a substance that you physically withdraw from. so alcohol and heroin, you'll physically withdraw to the point that you could die, particularly alcohol. cocaine was not considered addictive long ago because they didn't see physical withdrawal although there's quite a lot of psychological and physical withdrawal. marijuana when i was in medical school was not considered addictive because they didn't withdraw. well, they do. it stays in the fat cells, and you withdraw over a much slower period of time. but that has changed. and now even behaviors like hypersexuality, gambling, too much playing on the internet.

you know, i had a medical school professor used to say everything in moderation, including moderation. and i think we all have to be careful not to unleash the addict within. and there's many things -- too much exercise. so it's really an evolving puzzle that we're frantically trying to understand. and yet there's so many new culprits every year that our youth and the rest of us are summit to whether it's a behavior or a drug or what have you. there's so many enemies out there looking for us to pull us in. >> before i open it up to everyone here, um, is there something i didn't ask you, some piece of the book, something like that you'd like to mention? >> no, you've clear he read the book. [laughter] -- you've clearly read the book. >> and i reread the book. it's a great book. [laughter] please, we have -- no, um, let me just remind you, um, because of the nature of the taping, if you would go up to the mic and just, please, be at liberty to

go form a line up there if you want to ask something. i'm sorry to do this in a somewhat cumbersome way, but it's for the taping. so -- >> two very different kinds of questions. first, could you say something about halstead's family life, his family of origin as well as whether he married and what their involvement one way or another was in his addiction? >> sure. >> let me ask the other -- >> okay, but i'll ask you to repeat the second because i'm not so good at remembering. [laughter] >> i've forgotten the other. [laughter] >> well, if you think of the second one. um, halstead came from a very patrician family on both sides. his mother was an old new jersey

family, and his father was from an old new york family. they lived a very wealthy live on madison avenue, were actually nearby neighbors to theodore roosevelt's family. his father, william halstead's father, was a merchant, textile merchant but on many charitable boards. he was also a trustee of the college of physicians and surgeons which helped halstead get in to medical school because he was not the best student when he was at yale. he rarely cracked a book, if ever. his mother and father seemed to ignore him and the other children quite a bit. and they were in the care of governesses. his father was a very religious presbyterian who would read him fire and brimstone sermons of what he did wrong every night. halstead referred to his childhood as, quote, nightmarish. he even ran away at one point. it was a very cold, distant,

difficult relationship there. halstead did marry. he had several close relationships with men, roommates with men and loving relationships that are very hard to define 100 years after the fact. but he did marry a woman who was his o.r. nurse, carolyn hampton. and she was developing -- back then when she caught his eye, doctors were still dipping their hands in corrosive chemicals like carbolic acid and magnesium which were very caustic to the skin, and she developed a terrible skip rash all the way up from the fingertips to the elbows. and, in fact, that was the inspiration for the rubber glove. halstead went up to new york to the goodyear company, gave a design for his and her rubber gauntlets. then the other doctors saw it, hey, this could be really good for aseptic surgery. but they had a very odd relationship. they lived on separate floors in the same house.

they had dinner together but never breakfast. she was considered very odd and difficult herself. they went away every summer to her family's estate in the north carolina, and no one really knows what went on the there. he didn't have many close friends. he department have many -- he didn't have many dinner parties because he was so fastidious about everything. the coffee had to be ground and brewed just so. the table cloth had to be ironed just so that he drove mrs. halstead quite crazy. so it was a very singularly lonely life that he led. and particularly after his addiction was discovered, he changed from quite a gregarious man to an extremely difficult and caustic man who hated to have eye contact with people. medically, that's fascinating to me because if you're high on cocaine, it'll blow up the pupils of your eyes so they look like dolls' eyes. they'll be all black.

and if you're high on morphine, it'll make them pinpoint. and i wonder, i can only speculate, didn't want to make eye contact. there there are a lot of very smart doctors in that hospital, johns hopkins hospital, might have figured it out. >> i remembered my second question. when did the government, any government first assume some responsibility for regulating individuals' use of drugs? >> that's an excellent question. and i talk about this quite a bit in my book that the regulation of drugs, what we call controlled substances, was not in anyone's imagination back then. you could get opium, laud numb, morphine, cocaine, morphine at the druggist without any prescription whatsoever. and you could do that for many, many years in this country, until 1914 where there was such an alarming epidemic of drug abuse and addiction that the congress passed what's called the harrison narcotic control

act of 1914 which started the ball rolling of prohibition and controlled substances as we understand them today. that's only been refined in the decades since. but even by the 1890s there's a lot of medical literature of the problems of morphine addicts, cocaine addicts and on and on and on and on. so it didn't given until relative -- it didn't begin until relatively late in the history of these substances. >> who else would like to ask something, please? please. and by the way, don't wait. if you want to ask something, please, go in back and get in line. >> i'll feel badly if you don't ask questions. >> well, my question is sort of from the other end of the spectrum, but it does relate to your last answer. um, my understanding is that through research i've done is that african-american men in the late 18 -- and late 19th

century, i'm sorry, the 1880s, the time period we're talking about, um, dock workers were given cocaine to increase their productivity -- >> yes, yes. >> -- in terms of working on the docks. >> yes. >> and i'm wondering if, um, this all came about through a conversation about, you know, drugs and the black community. but in this particular instance as i said, you have these workers who have been given cocaine to increase their productivity, and then they're left with this addition that they are unleashing on a community. >> yes. >> and i wondered if you could speak to that a little bit. i mean, did the company, like, give them cocaine? >> yeah, yeah. >> how did this work? have you come across that? >> yes, quite a bit. the idea of giving workers cocaine or maybe coca leaves, tea or beverages, we didn't talk about that. there were many coca beverages that were very popular.

one was a bordeaux wine with coca leaves, and angelo mare yangny became the first cocaine millionaire on earth, and the other is coca-cola. but a lot of not just african-american dock workers, but other laborers -- this was particularly true in south america as well and goes way back before there was cocaine hydrochloride, but you'll see conquistadors giving cab ridgal -- aboriginals, farm workers as much as they can because it improved their endeuce, it allowed them to tolerate highal tuesday. i just makes you aware of it. and it's just medicating your workers, your slaves to work harder and causing enormous problems not just for those individuals, but for the society at large. very short-sighted stuff here.

no matter how you define it. and, yes, it was rather common to do that. women, women in america were more likely to become morphine addicts than men, about six to four odds. and that's because for every so-called woman's complaint from menstrual disorders to postpartum depression as we might call them today, a so-called well-meaning doctor, here you go, take some of this in a very paternalistic way, and they created many, many, many at districts that way. one of the most famous was written about in a wonderful play by eugene o'neill. that's about his family, and that's about his mother who became a morphine addict accidentally after the birth of eugene o kneel after she went into postpartum depression and could never get that monkey off her back. in case of the bosses on docks,

i will, but in the case of the doctors, i don't want to judge them, but they with respect really thinking it through, and they didn't have enough information based on what they were doing, and they unwittingly or wittingly created an epidemic of substance abuse that we've never recovered from. >> thank you. >> yes, well, thank you for this wonderful book, and, um, i'm wondering what you do with the question of what influence did addiction have on freud's theories? >> uh-huh. >> both in terms of his working productivity and how much he put out, the time in which he produced them and also the kind of work that he produced. so it's very interesting to me, for example, that freud is a lot about psychic boundary management, so it's about the ego and the superego and the id, it's all about compartmentalization. and you talk so eloquently about halstead and his living a double life. so i think that's an intriguing

question. on the other hand, i know in your book you seem to very carefully and astutely avoid making these kinds of causal arguments because they are just kind of, they're dangerous -- >> right. >> and they're too tempting. but i'm sure you get this question, i'm just wondering how do you answer it, and do you think there's any value in thinking about the role of his addiction in the his, um, literary and psychoanalytic work? >> i think there is, but i think you can go too far. it's never one plus one equals two with human beings. it always equals 57, and you have to figure out the other 55 items. there are issues in freud's life that i talk about in the book that cocaine really sparked some interesting ideas, and he writes about this to his then-fiancee and later becomes his wife, martha. for example, when he's in paris learning about neurology, he's

also taking a great deal of cocaine. he's saying he needs it to unleash his tongue, to feel more comfortable at these parties where he's trying to impress people. he also says, i feel so strong, i could knock down the gates of the temple. what a wonderful metaphor for a jew from vienna trying to break into academic medicine. but he also says i find it fascinating that when i do take cocaine, it unleashes ideas that i thought were locked away in my brain forever. sounds like free association and thought therapy. yet i think when you look at his letters and the examples he had, because he turned his mentor into a cocaine and morphine addict, he nearly killed emma eckstein. i think at some point he got the idea, this substance is too toxic to achieve those ends. i've got to come up with something else. and that was talk therapy and free association.

um, that said, freud was incredibly compartmentalized about his own substance abuse. he had reasons to do that. it was a very shameful activity back then. it might have harmed his career, and he was very career-oriented. but he never came to grips, i think, with understanding -- remarkable for a man who was so understanding of so many people and so many ideas. he had his own blind spots. and to me that tells me that he was just like every other addict, maybe smarter, maybe more accomplished, but the notion of an inability to come to grips with this is something we see all the time in the world of addiction. so did it have an ip influence? to be sure. it's part of his life just as his background, his love of books, his love of an tig bities. but to have a reductionist idea that all ideas flowed from a long line of cocaine i reject.

it's too simplistic, and i don't think it's intellectually appealing to me. >> but, howard, one thing a reader can get from your book, actually, i think, another reach into the answer of this, is you tell the story so well, it looks like freud's own partial but incomplete mastery of his addictive personality contributes unconsciously to his formulation of the theory of subly nation. >> yes, it does. >> it's something that wreaks havoc because it's primitive and basic and in the unconscious when it's raised up to a higher level of functioning -- >> right, yes. >> and in a way, that's what happens. >> yes. and the interpretation of dreams. the first dream is a cocaine dream, it's a using dream. so his substance abuse is part of ther to of freud -- part of the story of freud. what i hesitate and what i always worry about is i have patients -- i had one kid say to me, hey, man, i am such a better writer when i'm high. >> that means he doesn't know how to write.

[laughter] >> and i said, bring it in the next day and let's go over it. or i'm a better driver when i'm high. >> oh, yeah. for sure. >> it may seem that way to you t the time. but that's not really how it works. but to be sure, there's parts of this. this is part of his story. that's what was so interesting to me, so many historians and freud minneapolis, because it's addiction, it's substance abuse, it's cocaine. want to rub that under -- no, we need to understand. one of the reasons i wanted to write this book is i wanted to understand the influence. is it the only influence? no. it's just too complex a story. >> sure. >> but it is part of the story. >> sure. >> could you, please, speak to the idea of food as an addiction including the part where it's the one substance you cannot give up completely? >> yeah. >> well, food is an addiction, and this is why i've always had a problem with that notion because we all must eat to survive. you to not need to take cocaine

to survive. you don't need to smoke cigarettes to survive, etc., etc. and a lot of fuddy-duddy doctors like myself had problems with that. now, what we are finding in the neurochemistry and the neuroimaging is that the very similar pathways and similar lighting-up areas of the brain are there, but how do you control that in a certain way is a very different challenge. and very difficult. just an extra load of problems for addiction medicine and for people who suffer from it. and we're desperately trying to figure it out, and there's a lot of piece people who are really desperate to figure this out. so i don't have an answer for grow. but it's something i've really evolved in my own thinking that ten years ago, that's not part of it. i think there's many, many things we're going to find out that are addictive, and we may not even call it addictive, but that cause serious problems for people. >> thank you very much.

howie. i'm very amazed at the different disciplines you have mastered and how you -- >> that's debatable. ask my colleagues. [laughter] >> and we have met before in daniel's humanities institute. so i have a lot of appreciation for what, you know, you have done. and, um, this is just a very brilliant presentation. and i'm thankful to you. um, steve jobs has just died, and the whole world is mourning including my friends in nigeria who have the iphones, the ipod, la, la, la. now, one of them has said to me, look, father, we hate steve

jobs -- we heard steve jobs took some drug, you know, when he was young, and he has come out to say it's one of the three greatest things -- >> yeah. >> -- he did in his life. father, have you seen that drug in the u.s.? asking as if i could get -- [laughter] so there could be the incarnates of steve jobs. um, is it, is it possible that, or is it even useful for people who want to be successful to go in that, you know, go and try drugs so hoping something would come out of this? and if you have tried something like this in your past, how do you, how do you reap the rewards having escaped from -- >> with wow. that's a tough question. now, steve jobs, may he rest in peace, used lsd which is supposedly, i don't know, not an

adick tiff drug but a very dangerous drug nonetheless. and for every story of a wonderful acid trip, i have heard 20 or 30 of really detrimental experiences with lsd. i don't know everything, and i don't have a lock on the truth. i only know what i read, what i see, what identify experienced -- what i've experienced and what i have seen, what i treat. and i have seen so many more train wreck stories, wreckage of human life, of human relationships, of work, of all sorts of things through substance abuse that those singular stories i hear don't mean much to me. and they certainly don't make me want to recommend to anyone that

that's a path for success. that may have worked for him. he may believe that's what did it. he may be wrong, too, but that was what made steven jobs steven jobs. he also was a remarkable worker when you think of all his life was apple. and i doubt that he was on acid trips during much of that greatness. and so people attach certain things. it's not exactly a experiment, it's not a controlled study, but i will tell you from too many sad stories and too much experience that the perfect experiment is substance abuse to the point of addiction because it always comes out bad. the results are always the same, and the ultimate -- and the results are always reproducible. i cannot predict that you or you will not have a problem with substance a or you or you with substance b or all of you will

or all of you won't. but i do know as a physician who wants the best for you and your health that if you don't play with it, i can guarantee you won't have a problem with it. .. >> on an international scale, and by what i understand about statistics is that we are the main users of narcotics.

do you have any feeling -- you don't have to answer this if you don't want -- you have any feeling -- [inaudible] >> that's a tough one. the united states of america is the biggest consumer of illicit drugs in the world. while marijuana is the most commonly abused illness and substance, cocaine is number two. that doesn't take into account for illegal drugs. smoking cigarettes, nicotine and alcohol. nor does it account for a new epidemic of prescription drug abuse, opiates that are overprescribed, and sedatives and on and on and on. every time somebody buys an illicit drug, they are harming many people they never see. because the whole industry from slavery, criminality, bloodshed,

tragedy. so the guy who is snorting a line on football saturday, i'm feeling good, can harm people without even knowing it or without even acknowledging it. legalizing drugs is a very thorny issue. and prohibiting drugs, is a thorny issue. we tried prohibition in many shapes and forms in this country, not just with alcohol most famously, in the early part of the 20 century, but also the controlling of substance as well. narcotics, cocaine or marijuana. and even the places where the are legalized i can netherlands, it's not a disneyland very easy. a lot of collateral damage. and yet at the same time we're facing this problem as i said earlier, what separates humans from animals is the desire to

take drugs. the desire to escape, to feel good. so i think it's a much deeper social question, debate we all have to have. americans and people around the world, how do we want to handle this public health crisis, thoughtful, nonpunitive, medically correct, caring way? as well as legal and social issue. i don't think we are close to having a conversation. not a pro, not a con. there's a lot of gray area. i thank you for bring up the question. >> so, my question relates to, like to talk about cocaine, touted as a very powerful drug, wonder drug to after some of this addiction, it's basically been, my understanding is completely disappeared from clinical use. but it had some real powerful

qualities. my question is, in your professional opinion are there like appropriate applications of cocaine in a clinical setting that has been lost because of some of the misuse in the past? >> actually cocaine is still used to this day as a local anesthetic frequently bite your nose and throat doctor's. a similar drug, neither mccain our synthetic versions of that. anyone has been to a dentist has cocaine to thank for that because it's the same process that william halsted discovered and wrote about called nerve blockade that blocks the nerve sensation of pain. so we have wonderful synthetic versions, but there are still to this day at the university hospital down the street, there was one your nose into a procedure where they used a liquid cocaine solution to paint the area they were operating on.

so we haven't lost that. the problem isn't -- no one went into a raging cocaine page because the anesthesia. it was for other reasons. it's such a seductive drug by the way. there was an experiment years ago where they had a group of rats, they could press a button for pallets or heroin. didn't get high high and fall asleep and wake up and get some water, get high again. but they lived. the cocaine rats, they died. this goes to the trojan horse. it is so powerful drug of nor chemistry, fooling the brain into a euphoric sense that once again and again that it's a very dangerous substance.

>> regarding the legality or illegality of drugs, or setting aside that, the availability of it, i could probably go within 10 blocks of where we are sitting and find any drug in the world that's available. so, the problem is probably as bad is it can be from a medical or societal standpoint. therefore, making it legal probably wouldn't increase the number of addicts, but it might do away with a lot of the social problems that are attendant to it being illegal. >> the other thought i had in mind was freud analyzed himself. he never analyzed his drug use? >> no. that's a wonderful question. and that's where, in fact i remember having this conversation with danny and i still line of his and put in the

book that he was subject to the same allies that every addict tells him or herself every day. i don't have a problem. you have a problem, i don't have a problem. and he never came to terms. for him, the principal addiction was masturbation. that's equally times i hear the words i love. but he never came to grips with what cocaine did to his relationship with his wife, with his children, with fights he had. freud was famous. he would say this from dreams, i often love and hate the same person not necessarily at the same time. really rancorous fights with his former teachers and colleagues, karl jung, most famous, on and on and on, disruptive behaviors. and could never say at the

moment, maybe i had something to do with that. maybe my substance abuse had something to do with that. so he had all these layers of denial and explanation to compartmentalize that way, which is death to the attic. put it away, and only take it out in secret causes a lot of problems. he was the irony. a man known in history as the search of herself truth passionate searcher herself truth, was never able to delve into that particular truth. >> i read somewhere that it was observed addiction coming the of course treated gladiators and then under marcus are really as he was the real doctor for the roman army.

i can number his exact words, but he said something to the fact that it's better for people to endure pain than to become addicted, do drugs. >> you did. >> you know what drugs he was observing? >> it would probably poppy, which becomes opium. it becomes morphing and all the rest of it since then but it was probably that. there have been many doctors and many observers are worried about all of these substances in real-time whether it was a first or second century a.d. or 1500, 1700, worrying about the grip that the substances would have. but they were lone voices quiet voices, deafening roar, let's go for it. that's been a problem.

>> could you say something about the use of substances by soldiers? i'm sure you're aware, you're aware of the use of dolphins i believe they're called by the nazis, during the third reich. give any knowledge of that? i just read this, the german soldiers were given an amphetamine that were discovered by not see doctor's. there's a widespread -- i also read somewhere that napoleon soldiers were given a ration of vodka. so there's been sorted long-standing use of drugs by soldiers. for one purpose or another. if you just comment on that. >> well, better living through

chemistry. in fact some of the early reports of cocaine were with soldiers into -- so yes, and i get how to make a better killing machine through chemistry or arms or whatever has been with us for quite some time. >> hi. i'm interested in the control of behavior, or the influence of behavior, by oneself, by planting and are temporally as well as by an outsider, by saying this person can benefit from changing their behavior from this to this. and i'm wondering what insight you may have on effective means of doing that? >> that's a fascinating question. and as a pediatrician i wonder when you're with your children and they exhibit certain behaviors, that seems somewhat potentially problematic.

my daughter is not here, she's 11 years old, she's the greatest kid in the world and she's very ambitious in her class were she's in sixth grade and wants to get all a's. i was that kid. i know what she's going to. but i never told her he need to come home with all pays. and i'm worried about that behavior because if she doesn't get all a's, sometimes she's not going to them sometime she already has not, you start this whole cycle of feeling bad about yourself, about perfectionism, about beating upon yourself to the point you're hurting so bad that you might try, you might try -- fall prey to something. one thing i have done, i remember the other night she was talking about not getting in a. and i said you're a great kid, it doesn't matter what your greatest. you're going to be a great adult. i think we need to do that as parents and adults and mentors in our society.

you know, there's so many things in society that are designed to bring you down, tear you down. and not enough to pick you up. i think that's our job. perfectionism is silly, because for humans, i screwed up 20 times before you even got here today. i will probably screw up 20 more times. that doesn't mean i can screw up all the time and that doesn't mean i can use it as an alibi, but it means we have to learn how to love each other and love ourselves. that's something we are losing have to be very careful about. >> if i could just tweak that. part of which are bringing up, they need to disassociate compulsion from addiction. especially in popular culture of america. they both have to do with this since the