Freud recommended cocaine to Ernst Fleischer von Maxx

Freud’s recommendation that his friend Ernst Fleischl von Marxow try cocaine to overcome morphine addiction became a source of lasting guilt. The episode connects Freud’s professional enthusiasm for cocaine with a personal loss, and the book’s account uses that connection to show how the apparent professional self-defence in his dream interpretation also conceals painful responsibility and grief.

Background and Recommendation

Fleischl was a physiologist in Ernst von Brücke’s laboratory whom Freud greatly admired. A painful infection in Fleischl’s right hand required repeated surgery, and he took morphine to dull the pain, eventually becoming addicted to it. Freud, who had helped pioneer cocaine as an anaesthetic, encouraged him to switch to cocaine, which was then thought not to be addictive under ordinary conditions.

Consequences

Fleischl’s cocaine abuse hastened his death. That outcome made the recommendation more than a failed therapeutic experiment: it tied Freud’s scientific advocacy to the death of a friend he admired. The account places this history among the guilty associations behind Freud’s dream of Irma’s injection, complicating the dream’s discreet published interpretation as a defence against professional blame and rivalry.

The Dream and Its Disclosed Guilt

The published reading of the Irma dream, as the book summarizes it, presents Freud as wishing that a mistaken diagnosis would be blamed on a colleague rather than on himself. Yet the dream’s associations also reach back to the friend whose death followed cocaine use. In that fuller context, a dream that seems to manage professional embarrassment carries a more serious burden of guilt than its public interpretation admits.

The episode also sharpens the book’s account of Freud’s method: everyday and professional material can be rearranged in dreams, allowing feelings that are not directly acknowledged to find expression. Fleischl’s place in the dream’s background therefore makes the contrast between Freud’s tactful explanation and the painful personal history behind it central to understanding what the dream both reveals and leaves concealed.