When Nietzsche Wept

by Irvin D. Yalom

“Sig,” Breuer chuckled, as he wiped his mouth and mustache with his napkin, “here’s where we always part company. When you start talking of another, separate mind, a sentient elf inside of us designing sophisticated dreams and disguising them from our conscious mind—that seems ridiculous.”

  “I agree, it does seem ridiculous—yet look at the evidence for it, look at all the scientists and mathematicians who have reported solving important problems in dreams! And, Josef, there is no competing explanation. No matter how ridiculous it seems, there must be a separate, unconscious intelligence. I’m sure——”

  Mathilde entered with a pitcher of coffee and two pieces of her apple-raisin strudel, covered with a mound of Schlag. “What are you so sure of, Sigi?”

  “The only thing I’m sure of is that we want you to sit down and stay awhile. Josef was just about to describe a patient he saw today.”

  “Sigi, I can’t. Johannes is crying, and if I don’t go in to him now, he’ll wake the others.”

  As she departed, Freud turned to Breuer. “Now Josef, what about your strange meeting with that medical student’s sister?”

  Breuer hesitated, collecting his thoughts. He wanted to discuss Lou Salomé’s proposal with Freud but feared it would lead into too much discussion of his treatment of Bertha.

  “Well, her brother told her about my treatment of Bertha Pappenheim. Now she wants me to apply the same treatment to a friend of hers who is emotionally disturbed.”

  “How did this medical student, this Jenia Salomé, even know about Bertha Pappenheim? You’ve always been reluctant to talk to me about that case, Josef. I know nothing about it, aside from the fact that you used mesmerism.”

  Breuer wondered whether he detected a trace of jealousy in Freud’s voice. “Yes, I haven’t talked much about Bertha, Sig. Her family is too well known in the community. And I’ve especially avoided talking to you ever since I learned that Bertha is such a good friend of your fiancee. But, a few months ago, giving her the pseudonym of Anna O., I briefly described her treatment at a medical student case conference.”

  Freud leaned eagerly toward him. “I can’t tell you how curious I am about the details of your new treatment, Josef. Can’t you at least tell me what you told the medical students? You know I can keep professional secrets—even from Martha.”

  Breuer wavered. How much to tell? Of course, there was a great deal Freud knew already. Certainly, Mathilde had for months made no secret of her annoyance about her husband’s spending so much time with Bertha. And Freud had been present in the house on the day Mathilde had finally exploded with anger and forbade Breuer ever again to mention his young patient’s name in her presence.

  Luckily Freud had not witnessed the final catastrophic scene of his treatment of Bertha! Breuer would never forget going to her house on that awful day when he found her writhing with the labor pains of a delusional pregnancy and proclaiming for all to hear: “Here comes Doctor Breuer’s baby!” When Mathilde heard about that—such news rapidly making the rounds of Jewish housewives—she demanded that Breuer instantly transfer Bertha’s case to another physician.

  Had Mathilde reported all this to Freud? Breuer didn’t want to ask. Not now. Perhaps later, when things had settled down. Accordingly, he chose his words carefully: “Well, you know, of course, Sig, that Bertha had all the typical symptoms of hysteria—sensory and motor disturbances, muscular contractures, deafness, hallucinations, amnesia, aphonia, phobias—and also unusual manifestations as well. For example, she had some bizarre linguistic disturbances, being unable—sometimes for weeks on end—to speak German, especially in the mornings. We held our conversations in English. Even more bizarre was her dual mental life: one part of her lived in the present; the other part of her responded emotionally to events that had occurred exactly one year before—as we discovered by checking her mother’s diary for the preceding year. She also had severe facial neuralgia, which nothing but morphia could control—and, of course, she became addicted.”

  “And you treated her with mesmerism?” Freud asked.

  “That was my original intent. I planned to follow Liebault’s method of removing symptoms by hypnotic suggestion. But, thanks to Bertha—she’s an extraordinarily creative woman—I discovered an entirely new principle of treatment. In the first few weeks, I visited her daily and invariably found her in such an agitated state that little effective work could be done. But then we learned that she could discharge her agitation by describing to me in detail every annoying event of the day.”

  Breuer stopped and closed his eyes to collect his thoughts. He knew this was important and wanted to include all the significant facts.

  “This process took time. Often Bertha required an hour every morning of what she called ‘chimneysweeping’ just to clear her mind of dreams and unpleasant fantasies, and then, when I returned in the afternoon, new irritants had built up requiring further chimneysweeping. Only when we had entirely cleared this daily debris from her mind could we turn to the task of alleviating her more enduring symptoms. And at this point, Sig, we stumbled upon an astounding discovery!”

  At Breuer’s portentous tone, Freud, who had been lighting a cigar, froze and let the match burn his finger in his eagerness to hear Breuer’s next words. “Ach, mein Gott!” he exclaimed, shaking out the match and sucking his finger. “Go on, Josef, the astounding discovery was——?”

  “Well, we found that when she went back to the very source of a symptom and described it all to me, then that symptom disappeared on its own—with no need for any hypnotic suggestion——”

  “Source?” asked Freud, now so fascinated that he dropped his cigar into the ashtray and left it there, smoldering and forgotten. “What do you mean, Josef, the source of the symptom?”

  “The original irritant, the experience that gave rise to it.”

  “Please!” Freud demanded. “An example!”

  “I’ll tell you about her hydrophobia. Bertha had been unable or unwilling to drink water for several weeks. She had great thirst, but when she picked up a glass of water, she couldn’t bring herself to drink and was forced to quench her thirst with melons and other fruits. Then one day in a trance—she was a self-mesmerizer and automatically entered a trance every session—she recalled how, weeks before, she had entered her nurse’s room and witnessed her dog lap water from her drinking glass. No sooner did she describe this memory to me, along with discharging her considerable anger and disgust, than she requested a glass of water and drank it with no difficulty. The symptom never returned.”

  “Remarkable, remarkable!” Freud exclaimed. “And then?”

  “Soon we were approaching every other symptom in this same systematic manner. Several symptoms—for example, her arm paralysis and her visual hallucinations of human skulls and snakes—were rooted in the shock of her father’s death. When she described all the details and the emotions of that scene—to stimulate her recall, I even asked her to rearrange the furniture in the same way it was at the time of his death—then all these symptoms dissolved at once.”

  “It’s beautiful!” Freud had risen and was pacing in his excitement. “The theoretical implications are breathtaking. And entirely compatible with Helmholtzian theory! Once the excess cerebral electrical charge responsible for symptoms is discharged through emotional catharsis, then the symptoms behave properly and promptly vanish! But you seem so calm, Josef. This is a major discovery. You must publish this case.”

  Breuer sighed deeply. “Perhaps, some day. But now is not the time. There are too many personal complications. I have Mathilde’s feelings to consider. Perhaps now that I’ve described my treatment procedure, you can appreciate how much time I had to invest in Bertha’s treatment. Well, Mathilde simply couldn’t, or wouldn’t, appreciate the scientific importance of the case. As you know, she grew to resent the hours I spent with Bertha—and, in fact, still is so angry she refuses to talk about it with me.

  “And also,” Breuer continued, “I cannot publish a case that end
ed so badly, Sig. At Mathilde’s insistence, I removed myself from the case and transferred Bertha to Binswanger’s sanatorium at Kreuzlingen last July. She is still undergoing treatment there. It’s been hard to withdraw her from the morphia, and apparently some of her symptoms, like her inability to speak German, have returned.”

  “Even so”—Freud took care to avoid the topic of Mathilde’s anger—“the case breaks new ground, Josef. It could open up a whole new treatment approach. Will you go over it with me when we have more time? I’d like to hear every detail.”

  “Gladly, Sig. In my office I have a copy of the summary I sent to Binswanger—about thirty pages. You can start by reading that.”

  Freud took out his watch. “Ach! It’s late, and I still haven’t heard the story of this medical student’s sister. Her friend—the one she wants you to treat with your new talking cure—she’s a hysteric? With symptoms like Bertha’s?”

  “No, Sig, that’s where the story gets interesting. There is no hysteria, and the patient’s not a ‘she.’ The friend is a man, who is, or was, in love with her. He fell into a suicidal love-sickness when she dropped him for another man, a former friend of his! Obviously she feels guilty, and she doesn’t want his blood on her conscience.”

  “But, Josef”—Freud seemed shocked—“love-sickness! This is not a medical case.”

  “That was my first reaction as well. Exactly what I said to her. But wait until you hear the rest. The story gets better. Her friend, who is, incidentally, an accomplished philosopher and a close personal friend of Richard Wagner, doesn’t want help, or at least is too proud to ask for it. She asks me to be a magician. Under the guise of consulting with him about his medical condition, she wants me to sneak in a cure for his psychological distress.”

  “That’s impossible! Surely, Josef, you’re not going to attempt this?”

  “I’m afraid I have already agreed.”

  “Why?” Freud picked up his cigar again and leaned forward, frowning in his concern for his friend.

  “I’m not sure myself, Sig. Since the Pappenheim case ended, I’ve felt restless and stagnant. Perhaps I need a distraction, a challenge like this. But there is another reason I took this case! The real reason! This medical student’s sister is uncannily persuasive. You cannot say no to her. What a missionary she would make! I think she could convert a horse into a chicken. She is extraordinary, I can’t describe to you just how. Perhaps one day you’ll meet her. Then you’ll see.”

  Freud rose, stretched, walked over to the window, and opened wide the velvet drapes. Unable to see through the vapor on the glass, he used his handkerchief to wipe a small section dry.

  “Still raining, Sig?” Breuer asked. “Shall we fetch Fischmann?”

  “No, it’s almost stopped. I’ll walk. But I have more questions about this new patient. When are you seeing him?”

  “I’ve not heard from him yet. That’s another problem. Fräulein Salomé and he are on bad terms now. Indeed, she showed me some of his enraged letters. Still, she assures me that she’ll ‘arrange’ for him to consult me for his medical problems. And I have no doubt that, in this as in all things, she will do exactly what she sets out to do.”

  “And does the nature of this man’s medical problems warrant a medical consultation?”

  “Definitely. He is extremely ill and has already stumped two dozen physicians, many with excellent reputations. She described to me a long list of his symptoms—severe headaches, partial blindness, nausea, insomnia, vomiting, severe indigestion, equilibrium problems, weakness.”

  Seeing Freud shake his head in perplexity, Breuer added, “If you want to be a consultant, you’ve got to get used to such bewildering clinical pictures. Patients who are polysymptomatic and hop from one physician to another are an everyday part of my practice. You know, Sig, this might be a good teaching case for you. I’ll keep you abreast.” Breuer reflected for a moment. “In fact, let’s have a quick one-minute quiz now. So far, just on the basis of these symptoms, what’s your differential diagnosis?”

  “I don’t know, Josef, they don’t fit together.”

  “Don’t be so cautious. Just guess. Think out loud.”

  Freud flushed. However thirsty he was for knowledge, he hated to display ignorance. “Perhaps multiple sclerosis or an occipital brain tumor. Lead poisoning? I just don’t know.”

  Breuer added, “Don’t forget hemicrania. How about delusional hypochondriasis?”

  “The problem,” Freud said, “is that none of these diagnoses explains all the symptoms.”

  “Sig,” said Breuer, rising and speaking in a confidential tone, “I’m going to give you a trade secret. One day it’ll be your bread and butter as a consultant. I learned it from Oppolzer, who once said to me: ‘Dogs can have fleas and lice, too.’ ”

  “Meaning that the patient can———”

  “Yes,” Breuer said, putting his arm around Freud’s shoulders. The two men began to walk down the long hallway. “The patient can have two diseases. If fact, those patients who reach a consultant generally do.”

  “But let’s go back to the psychological problem, Josef. Your Fraulein says this man won’t acknowledge his psychological distress. If he won’t even admit he is suicidal, how will you proceed?”

  “That shouldn’t pose a problem,” Breuer said confidently. “When I take a medical history, I can always find opportunities to glide into the psychological realm. When I inquire about insomnia, for example, I often ask about the type of thoughts that keep the patient awake. Or after the patient has recited the entire litany of his symptoms, I often sympathize and inquire, off-handedly, whether he feels discouraged by his illness, or feels like giving up, or doesn’t want to live anymore. That rarely fails to persuade the patient to tell me everything.”

  At the front door, Breuer helped Freud on with his coat. “No, Sig, that’s not the problem. I assure you I’ll have no difficulty gaining our philosopher’s confidence and getting him to confess everything. The problem is what to do with what I learn.”

  “Yes, what will you do if he’s suicidal?”

  “If I become convinced that he means to kill himself, I’ll have him locked up immediately—either in the lunatic asylum at Brünnlfeld or perhaps in a private sanatorium like Breslauer’s at Inzerdorf. But, Sig, that’s not going to be the problem. Think about it—if he were truly suicidal, would he bother to consult with me?”

  “Yes, of course!” Freud, looking flustered, tapped himself on the side of his head for his slowness of wit.

  Breuer continued, “No, the real problem will be what to do with him if he is not suicidal, if he is simply suffering greatly.”

  “Yes,” Freud said, “what then?”

  “In that case, I’ll have to persuade him to see a priest. Or perhaps to take a long cure at Marienbad. Or invent a way to treat him myself!”

  “Invent a way to treat him? What do you mean, Josef? What kind of way?”

  “Later, Sig. We shall talk later. Now, off with you! Don’t stay in this heated room with that heavy coat on.”

  As Freud stepped out the door, he turned his head. “What did you say this philosopher’s name is? Anyone I’ve heard of?”

  Breuer hesitated. Remembering Lou Salomé’s injunction for secrecy, on the spur of the moment he made up for Friedrich Nietzsche a name according to the code whereby he had devised Anna O. to represent Bertha Pappenheim. “No, he’s an unknown. The name is Müller, Eckart Müller.”

  CHAPTER 4

  TWO WEEKS LATER, Breuer sat in his office, wearing his white consultation coat, and reading a letter from Lou Salomé:

  23 November 1882

  My dear Dr. Breuer,

  Our plan is working. Professor Overbeck fully agrees with our view that the situation is indeed very dangerous. Never has he seen Nietzsche in worse condition. He will exert all possible influence to persuade him to consult with you. Neither I nor Nietzsche shall ever forget your kindness in this, the time of our need.


  Lou Salomé

  “Our plan, our view, our need. Our, our, our.” Breuer put down the letter—having read it for perhaps the tenth time since its arrival a week ago—and picked up the mirror on his desk to watch himself say “our.” He saw a thin pink sliver of lip encircling a small black hole in the midst of auburn bristles. He opened the hole wider and watched elastic lips stretch around yellowing teeth that stuck out of his gums like half-buried tombstones. Hair and hole, horn and teeth—hedgehog, walrus, ape, Josef Breuer.

  He hated the sight of his beard. More often these days, clean-shaven men were to be seen on the street; when would he find the courage to shave off the whole hairy mess? He hated also the outcropping of gray that had insidiously appeared in his mustache, on the left side of his chin, and in his sideburns. These gray bristles were, he knew, the advance scouts of a relentless, wintry invasion. And there would be no stopping the march of the hours, the days, the years.

  Breuer hated all the mirror reflected—not only the gray tide and the animalistic teeth and hair, but the hooked nose straining toward his chin, the absurdly large ears, and the massive naked forehead—the balding had begun there and had, without pity, cropped its way back, displaying the shame of his bare skull.

  And the eyes! Breuer softened and looked into his eyes; he could always find youth there. He winked. He often winked and beckoned at himself—at his real self, at the sixteen-year-old Josef dwelling in those eyes. But no greeting today from young Josef! Instead, his father’s eyes peered at him—old, tired eyes surrounded by wrinkled, reddened eyelids. Breuer watched with fascination as his father’s mouth formed a hole to say, “Our, our, our.” More and more often, Breuer thought about his father. Leopold Breuer had been dead for ten years. He had died at the age of eighty-two, forty-two years older than Josef was now.

  He put down the mirror. Forty-two years left! How could he endure forty-two more years? Forty-two years of waiting for the years to pass. Forty-two years of staring into his aging eyes. Was there no escape from the prison of time? Ah, to be able to begin again! But how? Where? With whom? Not with Lou Salomé. She was free, and she might flutter, when she so chose, in and out of his prison. But it would never be “our” with her—never “our” life, “our” new life.