StayOnTop: Depression

(a longread story) 

Are you often depressed? And are you addicted to sweets or smoking or drinking or maybe something even worse?

    Addiction and depression are not the same thing, absolutely not. But there are a few things they have in common. Like this: if you’ve never been seriously depressed, you may never fully understand depression. And if you’ve never been seriously addicted, you may never fully understand addiction.

    Although they’re not the same thing, addiction and depression often do indeed come together. Not always, not for everyone, but they can form a pair. A kind of marriage-from-hell: addiction will contribute to self-demeaning depression, while the depression will contribute to comfort-seeking addiction.

    My own addiction, for many many years, has been smoking. Cigarettes. One after another, all day long.

    Next June it will been a year since I stopped. Yes: I’ve managed to not touch a cigarette for nine months now – my effort to completely stop smoking appears to be successful so far. But it was difficult, too. And it feels like it’s much too early to be proud of anything.

    It still is difficult: because not smoking anymore does not mean that the addiction has gone. It’s still there, as a longing, a feeling of missing something, an often nagging temptation. Every day again. Once an addict, always an addict. After my nine smokeless months, I’m still not completely sure if I will be able to keep resisting for the rest of my life.

    So the positive thing I can say about my feat is not that I am no longer addicted. I can say only that apparently, my addiction was not so strong that all resistance was doomed to fail right away.

    Do you want an example of a great and strong person who still failed miserably? So you can feel little better when failing yourself? Well, take a look at Sigmund Freud. A brilliant psychoanalyst, but one who managed to deceive himself when it came to his addiction. As such, it’s a revealing case.

Freud: Hooked

Let me say first that I do admire Freud as a kind of giant. Of course his theories about the subconscious part of our mind are over a century old now, and thus outdated in many respects. Science has progressed; when it comes to what happens inside our head, we today know all kinds of things that Freud didn’t know. Much of his work was just a kind of inspired guesswork. Still, he remains the one who more or less invented psychotherapy. He is great not for being right or wrong, but for what he tried to do.

    To me, it’s Freud’s terrible addiction – his cigar – that adds a somewhat more human dimension. It makes him curiously recognizable (at least to some of us). And if you insist: yes, a bit tragic too.

    Freud began smoking in 1880, when he was 24: cigarettes at first, but soon only cigars. In the next fifteen years he tried several times to give up smoking, especially after he suffered repeatedly from heart arrhythmia and nasal catarrh. His doctor, otolaryngologist Wilhelm Fliess, urged hem to stop.

    One time he tried really seriously, but came to describe the consequences (withdrawal symptoms and depression) like this: “There were tolerable days. Then there came suddenly a severe affection of the heart, worse than I ever had when smoking. And with it an oppression of mood in which images of dying and farewell scenes replaced the more usual fantasies. [...] It is annoying for a doctor who has to be concerned all day long with neurosis not to know whether he is suffering from a justifiable or a hypochondriacal depression.”

    After seven weeks of cigarless misery, he gave up. He wrote to Fliess how horrible he had felt, depressed and unable to work: and that now, “since the first few cigars, I was able to work and was the master of my mood; before that life was unbearable.”

    Having failed to overcome his addiction, Freud began to rationalize it, finding reasons to defend his behavior. Often in rather contradictory ways.

    He not just explained to Fliess that his smoking habit helped him to concentrate better on his work; at the same time, he admitted it was of course a “bad habit”. But he chided Fliess (who didn’t smoke himself) that for a non-smoker it was too easy to advise others to stop. Right – that’s just about the same thing I began with: if you’re not addicted, you don’t understand addiction…

    In 1893 he bluntly told Fliess: “I am not observing your ban on smoking. Do you think it’s such a glorious fate to live many long years in misery?” So implicitly, he already admitted that in order to feel happy, he needed his daily dose of cigars.

    The longest period he ever managed to do without them was a heroic effort of fourteen months, after which he succumbed again. In the words of his biographer Ernest Jones: “Then he resumed, the torture [of not smoking] being beyond human power to bear.”

    For the rest of his life Freud remained dependent on his cigars. For over forty years he smoked at least 20 of them every day, so he was rarely seen without one. He kept himself enveloped in smoke from breakfast until late at night: the cigar between his lips or in his hand became an integral part of his personality.

Freud: The Smoker

It was impossible to meet Freud without meeting his cigar. And it was not just as a special treat or pure generosity that Freud presented his cigars to other men (cigar-smoking women were unthinkable at the time). Freud made his offer of a cigar into something social, a gesture of sharing that created a bond. It was difficult to have a meeting with Freud without accepting that cigar (he always had a stack of them at hand).

    To some, this felt like a kind of initiation rite. By accepting Freud’s cigar and smoking together, you demonstrated and confirmed that you belonged to the club.

    Hanns Sachs, a close colleague and friend, later remembered that Freud “was so fond of smoking that he was somewhat irritated when men around him did not smoke. Consequently nearly all of those who formed the inner circle became more or less passionate cigar-smokers.”

    Freud’s eldest son, Martin, once described the atmosphere in the room right after one of the weekly gatherings of the Psychoanalytical Society (where each participant was always provided with his own ashtray). The room “was still thick with smoke and it seemed to me a wonder that human beings had been able to live in it for hours, let alone to speak in it without choking.”

    When Freud’s nephew Harry (age 17) declined the offer of a cigar, Freud shook his head and told him earnestly: “My boy, smoking is one of the greatest and cheapest enjoyments in life, and if you decide in advance not to smoke, I can only feel sorry for you.” A cheap enjoyment? How could he say that? I’ll get back to that below.

    Raymond de Saussure, who was analyzed by Freud in the 1920s, vividly remembered how the smell of Freud’s cigar provided a kind of sensory connection during therapy sessions.

    Freud always took a seat behind the head end of the patient’s couch, outside direct view, in order to not disturb the patient’s flow of associations with his own physical presence. As De Saussure recalled: “Contact was established only by means of his voice and the odor of the cigars he ceaselessly smoked.”

    It appears that everyone near Freud (close friends and colleagues, family, frequent therapy clients) after a while simply accepted his smoking habit, considering it an integral part of his identity. And Freud himself did not really appreciate others reminding him of the detrimental consequences of his addiction; he didn’t like it when he felt forced to defend his behavior (I will get back to that). The only ones who consistently kept urging him to stop, were his physicians.

    Some people noted how his wife always chased after him to clear the full ashtrays (and the stray ash) that he left everywhere. She did so without ever commenting. It looked like she was so used to it as to find it self-evident: if you accepted Freud, then of course you also had to accept his trail of ashes.

Freud: The Connoisseur

Sometimes, alcoholists will do their best to prove that in fact they are connoisseurs, experts in selecting only the very finest vintage French Bourgogne. They can present themselves as real collectors, generously inviting you to try out their exquisite single-malt Scotch whiskeys.

    In a similar way, Freud acquired a reputation as a true cigar connoisseur.

    There were a few high-quality brands he preferred: first of all the Don Pedro (a fairly big and particularly strong cigar), and the Reina Cubana or (for a smaller quickie) the Dutch-Indonesian Liliputtano.

    Problem was, due to Austrian government tobacco regulations, such top-quality cigars were not easy to find in Vienna. You had to travel all the way to Bavaria to get your hands on them. Freud kept complaining that the smaller and relatively mild Austrian trabucco cigars were absolutely inferior.

    No wonder, then, that most of his friends went out of their way to get him his favorite fix. Freud sometimes asked them to bring him his favorite cigars from across the border, but often he didn’t even need to ask. For example, in 1931 his colleague Max Eitingon traveled to Berchtesgaden in Bavaria, just to locate Freud’s favorite tobacconist there and to order several hundred of Freud’s favorite Don Pedros (in Freud’s case, this was just enough for a few weeks).

    By the way, those Don Pedro cigars are still being produced in Puerto Rico today. Here is a box of Don Pedros, model Original, type Torpedo. They come with a blurb: “carefully crafted with the finest tobaccos”, they are “aged to perfection”. That’s right – just like your Scotch.

    To get an idea of the price, presently the 25-cigar box shown here will cost you $157.50, meaning $6.30 for one cigar. Should you, like Freud, want to burn 20 of them a day? Then every single day would cost you $126. A month, $3780. A year? Figure it out for yourself…

    Maybe such cigars were much cheaper in the 1920s and 1930s, I don’t know. Anyway, regardless of cost, many of Freud’s friends did their best to keep him supplied with his top-quality brands. After all, he needed them, didn’t he?

    Not just his friends indulged him in this way. Some of his therapy clients were well aware that Freud (or it least his mood) might be softened a little by offering him some fine cigars as a present. And although this was dangerously close to what was considered unacceptable for a practicing psychiatrist, Freud (as we will see below) happily accepted such gifts from his clients, as if it was a natural gesture.

    How Freud saw himself as a connoisseur, prizing his collection of excellent cigars as a valuable and enjoyable asset, was made clear shortly before his death. Knowing he was going to die soon, at the birthday of his brother Alexander he bequeathed him the precious stock of cigars.

    In his letter to Alexander he wrote that as brothers, they were “on the verge of separating after long years of living together. [...] I would like you to take over the good cigars which have been accumulating with me over the years, as you can still indulge in such pleasure, I no longer.”

Intermezzo: Smoke Rings

Time for a brief pause, a musical intermezzo, to give you some air.

    Here is some sound from Freudian times; a song that Freud, theoretically, may have heard himself. In 1932, The Mills Brothers recorded Smoke Rings, on music written by Gene Gifford. Ned Washington wrote the lyrics:

where do they go,
those smoke rings I blow each night
oh what do they do
the circles of blue and white?
 
why do they seem
to picture a dream of loving
why do they fade
my phantom parade of love?
 
puff – puff – puff – puff your cares away
puff – puff – puff – night and day
blow, blow them into air
silky little rings, blow, blow them everywhere
give your troubles wings
 
oh little smoke rings I love
please take me above, take me with you

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Freud: The Patient

Freud would die in 1939, in exile in London (as the Nazis had taken over Austria). His last 20 years had been painful – literally.

    Already in 1917, he suffered from what he himself at time described as “an inflammatory and extremely painful lesion on the palate.” In 1923, after this had been diagnosed as a form of cancer, Freud was sent for his first surgical operation to Markus Hajek, a University of Vienna professor of laryngology. Hajek made sure the carcinoma was also treated with a radiation therapy at the Vienna General Hospital X-ray laboratory.

    Freud must have known, or at the very least suspected, that his heavy smoking had something to do with this. Or not? Let me address a popular misconception first.

    I mean the idea that, due to the evil tobacco industry fiendishly hiding the truth, smokers in Freud’s time were innocent victims who had no inkling of the health risk whatsoever.

    This is nonsense. Yes, the tobacco industry did try covering up. See the 1930s Lucky Strike ads I put as illustrations in this post. It’s not for nothing they liked to claim that doctors recommended their brand: this was meant to allay fears that already existed. But do you really think that people back then, simply by looking at what happened to smokers around them, couldn’t put two and two together?

    It is true that the first official (government-backed) reports on the health risks of smoking didn’t appear until about 1960. But individual researchers, like chemist Angel Roffo, already published since 1920 how cancer could be experimentally induced by exposure to tars from burned tobacco. At the time, not everyone (perhaps not even Freud with his own medical training) may have known about such research.

    But as I said, most people could simply put two and two together: people already saw a fairly evident link between smoking and cancer.

    To illustrate this, here is a quote from the 1920 novel Main Street by Sinclair Lewis. It’s from a dialogue in chapter 13, where character Guy Pollock explains why he’s staying in a small town:

 She asked impulsively, “You, why do you stay here?”
 “I have the Village Virus.”
 “It sounds dangerous.”
 “It is. More dangerous than the cancer that will certainly get me at fifty unless I stop this smoking.”

    Do you see? In 1920, the novelist Lewis already made the connection. And he could only write this from the assumption that his readers would understand the reference, too.

    Freud must, or shall we say, should have known. If only because not just Fliess in the 1890s, but all the physicians who treated him since (and there were many) kept telling him explicitly that his problem was aggravated and probably caused by his smoking, and that he really ought to stop. Freud, like so many addicts, just didn’t want to know.

    Between 1923 and 1939, Freud would undergo a total of 33 mouth or jaw operations, most of them complicated and painful: on average, that is twice a year. None of all these surgical operations ever succeeded in completely removing the cancerous growth, so in the end radiation therapy was advised again, too. Freud’s heart condition began to suffer from the intake of adrenaline (used in anesthetics) and cocaine (which he began to use in mouthwashes as a quick pain killer). Meanwhile, he kept smoking.

    One of the surgeons treating Freud’s oral carcinoma was specialist Hans Pichler, who also built him his first prosthesis. Dubbed by Freud “the monster”, it covered the large defect in his palate that was the result from the operations. In the long run this prosthesis caused Freud so much discomfort that he had a new one made of rubber and gold, and later yet another one. The definitive one cost him $6000. By then, a large part of his upper jaw had been removed. Meanwhile, he kept smoking.

    In fact, all the time – the last 16 years of his life – not only was the cancer never fully suppressed, but the recurring operation wounds not even properly healed, causing constant ulcers and pain. The infections spread far enough to even cause permanent deafness in his right ear.

    These constant infections had not just to do (as some suppose) with irritation caused by the prosthesis, or with incompetence of the surgeons who tried to treat him. For a large part, this was simply the price he had to pay for his stubborn refusal to give up his habit of nonstop smoking, contrary to the strong advice of all his doctors.

Freud: The Analyst

Now what did Freud think himself? Did he try to analyze himself with a view on his addiction?

    First of all, some debunking is in order. There is one very common Freud quote that may have been fabricated after his death – something he might have said, but likely never did. It is the story of how Freud reacted to an obvious or banal suggestion that in a psychoanalytic interpretation, a cigar might be seen as a phallic symbol. According to this popular story, Freud retorted: “Sometimes a cigar is just a cigar.”

    In his Quote Investigator blog, Garson O’Toole has tried to thoroughly research the original source of this particular quote. Based on his well documented overview, O’Toole concludes that “it is reasonable to assert that Freud probably did not make this statement.” I think he is right.

    Publicly, Freud simply avoided the subject: he never published anything about a psychoanalytic view on smoking. But in an early phase, in 1897 when he was still struggling with doctor Fliess about changing his habits, he wrote in a private letter to Fliess that addictions, smoking included, might be substitutes for the “single great habit, the ‘primal addiction’, masturbation.” This was in line with the general development of his views at the time.

    In 1922, Freud’s own International Journal of Psycho-Analysis published an article by Eric Hiller that openly interpreted smoking in an orthodox Freudian context, albeit somewhat crudely. Hiller wrote: “Cigarettes and cigars can symbolize the penis. They are cylindrical and tubular. They have a hot, red end. [...] The reason, or at least one of the reasons, why people start smoking (and, of course, why they go on), is the phallic significance of the cigarette, cigar and pipe. It is thus a substitute for the penis (mother’s breast) of which they have been deprived.”

    Apparently, Freud did not object to this interpretation. I myself think that in the meantime, his addiction by now firmly rooted, he had developed a way of looking at himself that excluded him in this respect: making such symbolic psychoanalytic speculations irrelevant to his own special situation.

    In his general self-analysis, in writings like his famous The Interpretation of Dreams, Freud always came across as open and frank about himself: he often used examples from his own experiences or dreams to illustrate his psychoanalytic ideas. But when writing about himself he never referred to addiction or to smoking: in his public self-analysis, this was not mentioned at all.

    And whenever Freud in private letters did admit (to some degree) being addicted, he always did so in a defensive way, giving his usual reasons (such as being more productive). That was how he had explained himself in the 1890s to doctor Fliess, and that was still how in 1939, a few months before his death, he explained it to his friend Arnold Zweig: “Cigars have served me for 50 years as protection and a weapon for life’s struggles and strife. To cigars I owe a huge intensification of my work capacity and an improvement in self-control.” Freud added that in this, he just followed the example of his father who had been a life-long smoker.

    A few other times, he also indicated (and you may recognize this as another typical addict’s reaction) that his smoking was no one’s business. When in the 1920s he was attacked for believing in telepathy, in his Not-Your-Business defense he for once included his smoking: “My adherence to telepathy is my private affair like my Jewishness, my passion for smoking, and other things.” In this casual way he suggested that just like being Jewish or being interested in telepathy, being a smoker was “inessential for psychoanalysis.” And, in fact, something he didn’t need or want to discuss.

    In hindsight, two different (and somewhat conflicting) mechanisms can be recognized in Freud’s attitude: on the one hand denial, and on the other hand internalization.

    Denial: Freud never denied outright that was an addict, although he preferred to call his continuous smoking a “passion”. But what Freud kept trying to deny, all his life, was the causal relation between his heavy smoking and his health problems.

    In the 1890s, when his physician Fliess had urged him one more time to stop smoking, Freud told Fliess in a letter that he was not convinced that smoking caused his physical problems: “I was deprived of the motivation which you so aptly characterize in one of your previous letters: a person can give something up only if he is firmly convinced that it is the cause of his illness. [...] For the first time I have an opinion that differs from yours on some matter. [...] You have been so absolute and strict in your smoking prohibition, the merit of which is all relative.”

    And in March 1939, after many years of suffering, shortly before his death, in his letter to Arnold Zweig he still implied that the course of events had hardly been predictable: “There is no longer any doubt that we are dealing with a new outbreak of my dear old carcinoma with which I have shared my existence for the past 16 years. Who would turn out to be the stronger could not, of course, have been predicted.” Note the personification here of “my dear old carcinoma”: I’ll get back to that in a moment.

    Freud’s denial of causality illustrates something that he himself was always keen to analyze in others: how we can use psychological defense mechanisms to keep intolerable thoughts and feelings at a distance. It is a striking example of the “knowing and not knowing” mechanism in Freud’s own theory, where a person when confronted with a rationally true but unacceptable insight, remains unable to act appropriately.

    Internalization: in 1923, when Freud was recovering from his first major palate operation, he wrote in a letter: “I am still out of work and cannot swallow. Smoking is accused as the etiology of this tissue rebellion.”

    Accused? Yes, for Freud it must have felt like your doctor blaming a friend, like having a long-time battlefield comrade incriminated of treason. In the battle of life, smoking was the friend who supported him day after day, who kept him going, who gave him moments of comfort and bliss, who helped him to concentrate on his work. And now, this faithful ally was brutally accused of doing something terrible. Well, Freud would stand by his friend!

    In his defense of this “friend” he even (and not just once) managed to present a reverse story: telling others that it was smoking that helped him ease the pain. Saying that lighting a cigar not just improved his mood and his productivity, but also made the sore less acute. A typical example is what Freud wrote to his colleague Sandor Ferenczi after having abstained from smoking for one day, due to the swelling in his mouth. He tells how one of his therapy clients arrived and gave him a present: a box of cigars.

    “Yesterday I smoked my last cigar and since then have been bad-tempered and tired. [...] Then a patient brought me fifty cigars, I lit one, became cheerful, and the affection of the palate rapidly went down. I should not have believed it had it not been so striking.” This is how far Freud’s self-deception could go. Believing that once again his “friend” had not let him down, he no doubt started the therapy session in a less somber mood, cigar in hand.

    And when Freud spoke of “my dear old carcinoma”, this may have been a little more than just a brave, half-ironic acceptance of the inevitable.

    On one level he had battled his cancer for years. On another level he may have realized that this illness and pain was what his addiction, his ever-helpful “friend”, had brought upon him as a kind of price he had to pay.

    And on yet another level he may have realized that he himself was the sole source of that addiction, and that therefore this “dear old carcinoma” was not some external curse, but actually a part of himself – of his identity as well as his body. Battling his cancer, he had in fact been battling himself – and in the end, after sixteen years of a draw, lost.

    In June 1939 Freud wrote to his friend Marie Bonaparte about his latest treatment: “The radium has once again begun to eat away at something [...] and my world is what it was previously, a small island of pain floating on an ocean of indifference.”

    Soon after, physicians made clear to him that his illness had progressed to a point where it had become inoperable. Suffering terribly, Freud asked his physician Felix Schur to help him make an end to his life. On 21 en 22 September 1939, Schur gave him heavy doses of morphine.

Freud died the next day.

Conclusion

Of course you understand that all this was not just about Freud, but also (in a few respects) about myself.

    As I told, nine months ago I suddenly dropped my chain-smoking habit. I’ve touched not a single cigarette since. One of the results was a deep and lasting and recurring feeling of sadness and loss. In due time that sadness evolved into mourning. For my smoking habit had been one of my best friends, a supporting one who gave me confidence through a relaxed kind of concentration. I terribly missed it. And I still miss it.

    At times I feel not just mourning, but also guilt. Real guilt. When I killed my smoking habit, I willfully killed my best friend. To save my health, I killed a part of myself.

    Freud never managed to definitively bring that off, and of course many people have speculated why he couldn’t. One of the simplest and perhaps most plausible explanations is that he really could not function properly without the extra stimulant that the high daily dose of nicotine gave him.

    In his youth Freud had already experimented with cocaine as a stimulant; it is possible that for the rest of his life, nicotine served in that way. Maybe Freud always had some kind of innate tendency towards depression and apathy: a tendency he could suppress only with a regular dose of a stimulant. With the nicotine from his Don Pedros.

    Of course I don’t know if this guess is true. Just like I don’t really know if something similar might apply to myself. If it is, maybe that explains why I’m so afraid that in the future I might cave in and start smoking again.

    One thing I do know for sure. Addiction is not just a matter of conscious or subconscious urges, fears, satisfaction or emotions. It also is something that we all try to carefully consider on a rational level: in terms of rewards versus costs.

    The problem is, of course, that addiction often brings immediate short-term rewards, while the costs (both in money and in physical health) are more a future, long-term affair. This makes it easy to deceive ourselves by fully recognizing some short-term rewards, while underestimating the long-term costs. By not clearly comparing actual rewards with actual cost, we keep making the wrong decision.

    That’s what Freud did, even though he did his best to stop, repeatedly. And that same kind of wrong decision is what I will always be afraid of when I look at myself. Do I need to tell you that right now I’m craving for a cigarette? I cope with that by trying to do the reverse of what Zeno did.

    The Confessions of Zeno is the best, absolutely the best failing-to-stop-smoking novel ever written. Italo Svevo wrote it in 1923, the same year as Freud’s first mouth operation. Svevo has a lot in common with Freud: another brilliant, inspiring Jewish writer who just was addicted to smoking… I sometimes wonder, did Freud ever read Svevo?

    Svevo did read Freud, that much is sure. The main character in his novel, chain-smoking Zeno Cosini, desperately and in vain keeps trying to stop. Zeno tries out Freudian psychoanalysis in the hope that it will help him, will make him understand why he smokes, why he can’t stop.

    In the meantime, Zeno employs a simple technique that allows him to keep smoking: every single cigarette of the endless series that he lights, is (honestly) his very last cigarette, and therefore it is to be enjoyed intensely.

    I nowadays use the mirrored Zeno-technique. Every single day is my very last no-smoking day; I keep saying to myself that, okay, if I really must smoke again, I’m allowed to: just not now, but tomorrow. This promise makes the day a little more bearable – just. And tomorrow I’ll repeat to myself: no, no, no, not today, if you really must you may smoke tomorrow again.

Oh my God, what would I give for a cigarette now!

Finale: Smoke Rings, Again

I promise, this is the end. I’ve got something sweet for you now.

    Halfway, we had Smoke Rings as it was recorded in 1932 by The Mills Brothers. I absolutely must let you hear that same song now, but arranged and sung in a vastly superior way – I don’t hesitate to say, in an outright brilliant way. Recreating those 1930s smoke rings with a modern double-bottomed languidness.

    In 1997, Canadian-American singer k.d.lang came with her album Drag, her own cover version of several well-known songs. “Drag” has a funny double meaning here; one of them being that all the songs on this album had something to do with smoking.

    I wish I could let you hear the complete Drag album: for example, the way she sings the 1974 The Hollies song The Air That I Breathe makes it into something new that in my opinion is much, much, much better than the original. OK, if you want to know more about her and her fabulous voice, then please go take a look at the official k.d.lang website.

Here is her version of Smoke Rings:

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Author: Henk van Setten