When Nietzsche Wept

by Irvin D. Yalom

  Still standing, she held tightly to the back of a chair as she spoke these words. Then, sitting, she continued more calmly, “As you may imagine, my three weeks at Tautenberg with Nietzsche and Elisabeth were complex. My time alone with him was sublime. Wonderful walks and deep conversations about everything—sometimes his health permitted him to talk ten hours a day! I wonder if ever before there has been such philosophical openness between two persons. We talked about the relativity of good and evil, about the necessity to free oneself from public morality in order to live morally, about a freethinker’s religion. Nietzsche’s words seemed true: we had sibling brains—we could say so much to one another with half-words, half-sentences, mere gestures. Yet this paradise was spoiled, because all the while we were under the eye of his serpent sister—I could see her listening, always misunderstanding, scheming.”

  “Tell me, why would Elisabeth slander you?”

  “Because she’s fighting for her life. She is a small-minded, spiritually impoverished woman. She cannot afford to lose her brother to another woman. She realizes Nietzsche is, and will forever be, her sole source of significance.”

  She glanced at her watch and then at the closed door.

  “I’m concerned about the time, so I’ll tell you the rest quickly. Just last month, despite Elisabeth’s objections, Paul, Nietzsche, and I spent three weeks in Leipzig with Paul’s mother, where we once again had serious philosophical discussions, particularly about the development of religious belief. We parted only two weeks ago, with Nietzsche still believing we three would spend the spring living together in Paris. But it will never be, I know that now. His sister succeeded in poisoning his mind against me, and recently he began sending letters full of despair and hatred for both Paul and me.”

  “And now, today, Fraulein Salomé, where do things stand?”

  “Everything has deteriorated. Paul and Nietzsche have become enemies. Paul grows angry every time he reads Nietzsche’s letters to me, every time he hears of any tender feelings I have for Nietzsche.”

  “Paul reads your letters?”

  “Yes, why not? Our friendship has grown deeper. I suspect I will always be close to him. We have no secrets from one another: we even read one another’s diaries. Paul has been entreating me to break off with Nietzsche. Finally I acquiesced and wrote Nietzsche that though I shall always treasure our friendship, our ménage à trois was no longer possible. I told him that there was too much pain, too much destructive influence—from his sister, from his mother, from the quarrels between him and Paul.”

  “And his response?”

  “Wild! Frightening! He writes crazed letters, sometimes insulting 01 threatening, sometimes deeply despairing. Here, look at these passages I’ve received just this past week!”

  She held out two letters whose appearance even showed agitation: the uneven script, the many words abbreviated or underlined several times. Breuer squinted at the paragraphs she had circled, but then, unable to make out more than a few words, handed them back to her.

  “I forgot,” she said, “how difficult it is to read his script. Let me decipher this one addressed to both Paul and me: ‘Don’t let my outbreaks of megalomania or wounded vanity bother you too much—and if I should one day happen to take my own life in some fit of passion, there wouldn’t be anything in that to worry about overmuch. What are my fantasies to you! . . . I came to this reasonable view of the situation after I had taken—from despair—an enormous dose of opium——’ ”

  She broke off. “That’s enough to give you an idea of his despair. I’ve been staying at Paul’s family estate in Bavaria for several weeks now, so all my mail comes there. Paul has been destroying his most vitriolic letters in order to spare me pain, but this one to me alone slipped through: ‘If I banish you from me now, it is a frightful censure of your whole being. . . . You have caused damage, you have done harm—and not only to me but to all the people who have loved me: this sword hangs over you.’ ”

  She looked up at Breuer. “Now, Doctor, do you see why I so strongly recommend that you don’t ally yourself with me in any way?”

  Breuer drew deep upon his cigar. Though intrigued by Lou Salomé and absorbed in the melodrama she was unfolding, he was troubled. Was it wise to have agreed to enter into it? What a jungle! What primitive and powerful relationships: the unholy Trinity, Nietzsche’s ruptured friendship with Paul, the powerful connection between Nietzsche and his sister. And the viciousness between her and Lou Salomé: I must take care, he told himself, to stay out of the way of those thunderbolts. Most explosive of all, of course, is Nietzsche’s desperate love, now turned to hatred, for Lou Salomé. But it was too late to turn back. He had committed himself and in Venice had blithely told her, “I have never refused to treat the sick.”

  He turned back to Lou Salomé. “These letters help me understand your alarm, Fräulein Salomé. I share your concern about your friend: his stability seems precarious, and suicide a real possibility. But since you now have little influence over Professor Nietzsche, how can you persuade him to visit me?”

  “Yes, that is a problem—one I have been considering at length. Even my name is poison to him now, and I shall have to work indirectly. That means, of course, that he must never, never know of my having arranged a meeting with you. You must never tell him! But now that I know you are willing to meet with him——”

  She put down her cup and looked so intently at Breuer that he had to reply quickly: “Of course, Fraulein. As I said to you in Venice, ‘I have never refused to treat the sick.’ ”

  Upon hearing these words, Lou Salomé broke into a broad smile. Ah, she had been under more tension than he had imagined.

  “With that assurance, Doctor Breuer, I shall begin our campaign to place Nietzsche in your office without his knowing my part in the matter. His behavior is now so disturbed that I’m certain all his friends are alarmed and would welcome any sensible plan to help. On my way back to Berlin tomorrow, I’ll stop in Basel to propose our plan to Franz Overbeck, Nietzsche’s lifelong friend. Your reputation as a diagnostician will help us. I believe Professor Overbeck can persuade Nietzsche to consult with you about his medical condition. If I am successful, you will hear from me by letter.”

  In speedy succession, she put Nietzsche’s letters back into her purse, rose, flounced her long ruffled skirt, gathered up her fox stole from the couch, and reached out to clasp Breuer’s hand. “And now, my dear Doctor Breuer——”

  As she placed her other hand on his, Breuer’s pulse quickened. Don’t be an old fool, he thought, but gave himself up to the warmth of her hand. He wanted to tell her how he loved her touching him. Perhaps she knew, for she kept his hand in hers as she spoke.

  “I hope we stay in frequent contact about this matter. Not only because of my deep feelings about Nietzsche and my fear that I am, unwittingly, responsible for some of his distress. There’s something else. I hope, too, you and I will become friends. I have many faults, as you’ve seen: I am impulsive, I shock you, I am unconventional. But I also have strengths. I have an excellent eye for nobility of spirit in a man. And when I have found such a man I prefer not to lose him. So we shall write?”

  She dropped his hand, strode to the door, then stopped abruptly. She reached into her bag to draw out two small volumes.

  “Oh, Doctor Breuer, I almost forgot. I think you should have Nietzsche’s last two books. They’ll give you insight into his mind. But he must not know you have seen them. That would arouse his suspicion, since so few of these books have sold.”

  Again, she touched Breuer’s arm. “And one more point. Despite having so few readers now, Nietzsche is convinced that fame will come. He told me once that the day after tomorrow belongs to him. So don’t tell anyone you’re helping him. Don’t use his name to anyone. If you do and he finds out, he’d consider it a great betrayal. Your patient—Anna O.—that’s not her real name, is it? You use a pseudonym?”

  Breuer nodded.

  “Then I’d advise yo
u to do the same for Nietzsche. Auf Wiedersehen, Doctor Breuer,” and she held out her hand.

  “Auf Wiedersehen, Fräulein,” said Breuer, as he bowed and pressed it to his lips.

  Shutting the door behind her, he glanced at the two slim, paper-covered volumes and noted their strange titles—Die Fröhliche Wissenschaft (The Gay Science) and Menschliches, Allzumenschliches (Human, All Too Human)—before putting them down on his desk. He went to the window to catch one last glimpse of Lou Salomé. She raised her umbrella, walked quickly down his front steps, and, without looking back, entered a waiting fiacre.

  CHAPTER 3

  TURNING FROM THE WINDOW, Breuer shook his head to dislodge Lou Salomé from his mind. Then he tugged the cord hanging over his desk to signal Frau Becker to send in the patient waiting in the outer office. Herr Perlroth, a stooped, long-bearded Orthodox Jew, stepped hesitantly through the doorway.

  Fifty years ago, Breuer soon learned, Herr Perlroth had undergone a traumatic tonsillectomy—his memory of that procedure so searing that, until this day, he had refused to consult a physician. Even now he had delayed his visit, but a “desperate medical situation,” as he put it, had left him no choice. Breuer immediately doffed his medical demeanor, came out from behind his desk, and sat in the adjoining chair, just as he had with Lou Salomé, to chat casually with his new patient. They talked about the weather, the new wave of Jewish immigrants from Galicia, the Austrian Reform Association’s inflammatory anti-Semitism, and their common origins. Herr Perlroth, like almost everyone in the Jewish community, had known and revered Leopold, Breuer’s father, and, within minutes, had transferred this trust for the father onto the son.

  “And so, Herr Perlroth,” said Breuer, “how may I be of service to you?”

  “I cannot make my water, Doctor. All day long, and night too, I have to go. I run to the toilet, but nothing comes. I stand and stand, and finally a few driblets come. Twenty minutes later, same thing. I have to go again, but. . . ”

  A few more questions, and Breuer was certain about the cause of Herr Perlroth’s problems. The patient’s prostate gland had to be obstructing the urethra. Now only one important question remained: Did Herr Perlroth have a benign enlargement of the prostate or did he have a cancer? On rectal examination, Breuer palpated no rock-hard cancer nodules but found instead a spongy, benign enlargement.

  Upon hearing there was no evidence of cancer, Herr Perlroth broke into a jubilant smile and grabbed Breuer’s hand and kissed it. But his mood darkened once again when Breuer described, as reassuringly as possible, the unpleasant nature of the required treatment: the urinary passageway would have to be dilated by the insertion into the penis of a graduated series of long metal rods, or “sounds.” Because Breuer himself did not perform this treatment, he referred Herr Perlroth to his brother-in-law Max, a urologist.

  After Herr Perlroth left, it was a little after six, time for Breuer’s late-afternoon house calls. He restocked his large black leather medical bag, put on his fur-lined greatcoat and top hat, and stepped outside where his driver, Fischmann, and his two-horsed carriage were waiting. (While he had been examining Herr Perlroth, Frau Becker had hailed a Dienstmann stationed at the intersection next to the office—a red-eyed, red-nosed young errand man who wore a large official badge, a pointed hat, and an oversized khaki army coat with epaulets—and given him ten Kreuzer to run to fetch Fischmann. More affluent than most Viennese physicians, Breuer leased a fiacre by the year, rather than hire one when needed.)

  As always, he handed Fischmann the list of patients to be visited. Breuer made house calls twice a day: early, after his small breakfast of coffee and crisp three-cornered Kaisersemmel; and again, at the end of his afternoon office consultations, as today. Like most internists of Vienna, Breuer sent a patient to a hospital only when there was no other recourse. Not only were people cared for better at home, but they were safer from the contagious diseases that often stormed through the public hospitals.

  As a consequence, Breuer’s two-horse fiacre was in frequent use: indeed, it was a mobile study, and kept well stocked with the latest medical journals and reference works. A few weeks ago, he had invited a young physician friend, Sigmund Freud, to accompany him for an entire day. A mistake perhaps! The young man had been attempting to decide on his choice of medical specialty, and that day may have frightened him away from the practice of general internal medicine. For, according to Freud’s calculations, Breuer had spent six hours in his fiacre!

  Now, after visiting seven patients, three of them desperately ill, Breuer had finished the day’s work. Fischmann turned toward the Café Griensteidl, where Breuer usually shared a coffee with the group of physicians and scientists who, for fifteen years, had met each evening at the same Stammtisch, a large table reserved in the choicest corner of the café.

  But tonight Breuer changed his mind. “Take me home, Fischmann. I’m too wet and tired for the café.”

  Resting his head on the black leather seat, he closed his eyes. This exhausting day had begun badly: he had been unable to return to sleep after a nightmare at 4:00 A.M. His morning schedule had been heavy: ten house calls and then nine office-consultation patients. In the afternoon, more office patients, and then the stimulating but enervating interview with Lou Salomé.

  Even now, his mind was not his own. Insidious fantasies of Bertha seeped in: holding her arm, walking together with her in the warm sun, far from the icy gray slush of Vienna. Soon, however, discordant images intruded: his marriage shattered, his children left behind, as he sailed away forever, to start a new life with Bertha in America. The thoughts haunted him. He hated them: they robbed him of his peace; they were alien, neither possible nor desirable. Still, he welcomed them: the only alternative—banishing Bertha from his mind—seemed inconceivable.

  The fiacre rattled crossing a plank bridge over the Wien River. Breuer looked out at the pedestrians hurrying home from work, mostly men, each carrying a black umbrella and dressed much as he was—dark fur-lined greatcoat, white gloves, and black top hat. Someone familiar caught his eye. The short, hatless man with the trim beard, passing the others, winning the race! That powerful stride—he’d know it anywhere! Many times in the Vienna woods, he had tried to keep pace with those churning legs, which never slowed except to search for Herrenpilze—the large pungent mushrooms that grew among the rootwork of the black firs.

  Asking Fischmann to pull over, Breuer opened the window and called out, “Sig, where are you going?”

  His young friend, wearing a coarse but honest blue coat, closed his umbrella as he turned to the fiacre; then, recognizing Breuer, grinned and replied, “I’m heading toward Bäckerstrasse seven. A most charming woman has invited me for supper tonight.”

  “Ach! I have disappointing news!” Breuer laughed in reply. “Her most charming husband is on his way home this very minute! Jump in, Sig, ride with me. I’m finished for the day, and too tired to go to the Griensteidl. We’ll have time to talk before we eat.”

  Freud shook the water off his umbrella, stamped his feet on the curbstone, and climbed in. It was dark, and the candle burning in the carriage generated more shadows than light. After a moment of silence, he turned to look closely at his friend’s face. “You look tired, Josef. A long day?”

  “A hard one. It started and ended with a visit to Adolf Fiefer. You know him?”

  “No, but I’ve read some of his pieces in the Neue Freie Presse. A fine writer.”

  “We played together as children. We used to walk to school together. He’s been my patient since the first day of my practice. Well, about three months ago, I diagnosed liver cancer. It’s spread like wildfire, and now he has advanced obstructive jaundice. Do you know the next stage, Sig?”

  “Well, if his common duct is obstructed, then his bile will continue to back up into the bloodstream until he dies of hepatic toxicity. Before that, he’ll go into liver coma, won’t he?”

  “Precisely. Any day now. Yet I can’t tell him that. I keep up my hope
ful, dishonest smile even though I want to say an honest goodbye to him. I’ll never get used to my patients dying.”

  “Let’s hope none of us do.” Freud sighed. “Hope is essential, and who but we can sustain it? To me, it’s the hardest part of being a physician. Sometimes I have great doubts whether I’m up to the task. Death is so powerful. Our treatments so puny—especially in neurology. Thank God, I’m almost finished with that rotation. Their obsession with localization is obscene. You should have heard Westphal and Meyer quarreling on rounds today about the precise brain localization of a cancer—right in front of the patient!

  “But”—and he paused—“who am I to talk? Only six months ago, when I was working in the neuropathology lab, I was overjoyed at the arrival of a baby’s brain so I could have the triumph of determining the precise site of the pathology! Maybe I’m getting too cynical, but more and more I grow convinced that our disputations about the location of the lesion drown out the real truth: that our patients die, and we doctors are impotent.”

  “And, Sig, the pity is that the students of physicians like Westphal never learn how to offer comfort to the dying.”

  The two men rode in silence as the fiacre swayed in the heavy wind. Now the rain was picking up again and splattered down on the carriage roof. Breuer wanted to give his young friend some advice, but hesitated, choosing his words, knowing Freud’s sensitivity.

  “Sig, let me say something to you. I know how disappointing it is for you to go into the practice of medicine. It must feel like a defeat, like settling for a lesser destiny. Yesterday at the café, I couldn’t help overhearing you criticize Brücke for both refusing to promote you and advising you to give up your ambitions for a university career. But don’t blame him! I know he thinks highly of you. From his own lips I heard that you are the finest student he’s ever had.”