When Nietzsche Wept

by Irvin D. Yalom

  Nor, he knew, would it ever again be “our” with Bertha. Whenever he could escape the old, circular remembrances about Bertha—the almond fragrance of her skin, the mighty swell of her breasts under her gown, the heat of her body as she leaned against him when entering a trance—whenever he succeeded in stepping back and gaining perspective on himself, he realized that, all along, Bertha had been a fantasy.

  Poor, unformed, mad Bertha—what a foolish dream it was to think I could complete her, form her, so that she, in turn, could give me . . . what? That was the question. What was I searching for from her? What did I lack? Did I not have the good life? To whom can I complain that my life has led irrevocably into an ever-narrowing chute? Who can comprehend my torment, my sleepless nights, my flirtation with suicide? After all, haven’t I everything one could wish: money, friends, family, a beautiful and charming wife, renown, respectability? Who will comfort me? Who refrain from asking the obvious question: “What more can you want?”

  Frau Becker’s voice, announcing the arrival of Friedrich Nietzsche, startled Breuer, even though he had been expecting it.

  Stout, short, gray-haired, vigorous, and bespectacled, Frau Becker ran Breuer’s consulting office with astonishing precision. In fact, she filled her role so consummately that there were no visible leftovers of the private Frau Becker. In the six months since he had hired her, they had not exchanged a personal word. Though he tried, he could not remember her first name or imagine her doing anything but nursely duties. Frau Becker on a picnic? Reading the morning Neue Freie Presse? In the bathtub? Pudgy Frau Becker naked? Mounted? Breathing hard in passion? Inconceivable!

  Still, despite his dismissal of her as a woman, Frau Becker was an astute observer, and Breuer had come to value her initial impressions.

  “How does this Professor Nietzsche strike you?”

  “Herr Doctor, he has a gentleman’s bearing but not a gentleman’s grooming. He seems shy. Almost humble. And a gentle manner, very different from many of the gentlefolk who come here—for example, that Russian grand lady, two weeks ago.”

  Breuer had himself noted a gentleness to Professor Nietzsche’s letter requesting a consultation, at Dr. Breuer’s convenience, within the next two weeks, if at all possible. Nietzsche would, he explained in his letter, journey to Vienna expressly for the purpose of a consultation. Until he received word, he would remain in Basel with his friend, Professor Overbeck. Breuer smiled to himself when he contrasted Nietzsche’s letter with Lou Salomé’s dispatches ordering him to be available at her convenience.

  As he waited for Frau Becker to bring Nietzsche in, Breuer scanned his desk and suddenly noted with alarm the two books given him by Lou Salomé. During a free half-hour yesterday, he had skimmed them and left them carelessly in plain view. He realized that if Nietzsche were to see them, the treatment would end before it began, as it would be all but impossible to explain them without mentioning Lou Salomé. How uncommonly careless of me, Breuer thought. Am I trying to sabotage this enterprise?

  Quickly slipping the books into a desk drawer, he rose to greet Nietzsche. The professor was not at all what he had expected from Lou’s description. His demeanor was gentle, and while of solid physique—about five-foot eight or nine, and one hundred and fifty or sixty pounds—there was something curiously insubstantial about his body, as though you could pass your hand through it. He was dressed in a heavy, almost military-weight, black suit. Under his jacket he wore a heavy brown peasant sweater which almost entirely covered his shirt and his mauve cravat.

  As they shook hands, Breuer noted Nietzsche’s cold skin and limp clasp.

  “Good day, Herr Professor—but not such a good one for travelers, I should imagine.”

  “No, Doctor Breuer, not good for traveling. Nor for the condition that brings me to you. I have learned to avoid such weather. It is only your excellent reputation that lures me this far north in winter.”

  Before sitting down in the chair to which Breuer directed him, Nietzsche fussily put a bulging, scuffed briefcase first on one side of the chair and then on the other, apparently seeking some suitable resting place for it.

  Breuer sat quietly and continued to inspect his patient as the latter made himself comfortable. Despite Nietzsche’s unassuming appearance, he conveyed a strong presence. It was the powerful head that commanded attention. Especially his eyes, soft brown, but extraordinarily intense and deeply set beneath a prominent orbital ridge. What had Lou Salomé said about his eyes? That they seemed to stare inward, as though at some hidden treasure? Yes, Breuer could see that. His patient’s brown, gleaming hair was carefully brushed. Aside from a long mustache, which fell like an avalanche over his lips and on either side of his mouth, down to his chin, he was clean-shaven. The mustache evoked in Breuer a sense of hairy kinship: he had a quixotic impulse to warn the professor not to eat a Viennese pastry in public, especially one heaped high with Schlag, or he would be combing it out of his mustache long afterward.

  Nietzsche’s soft voice was surprising: the voice in his two books had been forceful, bold and authoritative, almost strident. Again and again, Breuer was to encounter this same discrepancy between the Nietzsche of flesh and blood and the Nietzsche of pen and paper.

  Aside from his brief talk with Freud, Breuer had given little thought to this unusual consultation. Now, for the first time, he seriously questioned the wisdom of being involved in this matter. Lou Salomé, the bewitcher, the major conspirator, was long gone, and in her place sat this unsuspecting, duped Professor Nietzsche. Two men maneuvered into meeting under false pretenses by a woman who was now, no doubt, off to some new intrigue. No, he had little heart for this venture.

  Still, it’s time to put all that behind me, Breuer thought. A man who has threatened to take his own life is now my patient, and I must give him my total attention.

  “How was your journey, Professor Nietzsche? I understand you’ve just come from Basel?”

  “That was but my last stop,” Nietzsche said, sitting stiffly. “My whole life has become a journey, and I begin to feel that my only home, the only familiar place to which I always return, is my illness.”

  Not a man for small talk, Breuer reflected. “Then, Professor Nietzsche, let us proceed immediately to investigate your illness.”

  “Would it be more efficient for you first to peruse these documents?” And Nietzsche drew from his briefcase a heavy folder crammed with papers. “I have been ill perhaps all my life, but most severely so for the last decade. Here are the full reports of my previous consultations. May I?”

  Breuer nodded, and Nietzsche opened the folder, reached across the desk, and placed the contents—letters, hospital charts, and laboratory reports—in front of Breuer.

  Breuer scanned the first page, containing a list of twenty-four physicians and the dates of each consultation. He recognized several prominent Swiss, German, and Italian names.

  “Some of these names are known to me. Excellent physicians all! Here I see three—Kessler, Turin, and Koenig—whom I know well. They trained in Vienna. As you imply, Professor Nietzsche, it would be unwise to ignore the observations and conclusions of these excellent men—yet there is great disadvantage in my beginning with them. Too much authority, too many prestigious opinions and conclusions oppress one’s own imaginative synthetic powers. For much the same reason, I prefer to read a play before seeing it performed and certainly before reading reviews. Have you not found that to be the case in your own work?”

  Nietzsche seemed startled. Good, thought Breuer. Professor Nietzsche must see that I am a different kind of physician. He is not accustomed to physicians who converse about psychological constructs or inquire, knowledgeably, about his work.

  “Yes,” Nietzsche replied, “it is an important consideration in my work. My original field is philology. My first appointment, my only appointment, was that of professor of philology at Basel. I have an especially strong interest in the pre-Socratic philosophers, and with them I have always found it crucial t
o return to the original text. Interpreters of texts are always dishonest—not intentionally, of course—but they cannot step outside their own historical frame. Nor, for that matter, out of their autobiographical frame.”

  “But does not an unwillingness to pay homage to interpreters make one unpopular in the academic philosophical community?” Breuer felt confident. This consultation was on course. He was well embarked on the process of successfully persuading Nietzsche that he, his new physician, was a kindred spirit with kindred interests. It was not going to be difficult to seduce this Professor Nietzsche—and Breuer viewed it as seduction indeed, as enticing his patient into a relationship he had not sought in order to obtain help he had not requested.

  “Unpopular? Without question! I had to resign my professorship three years ago because of illness—the very illness, yet undiagnosed, that brings me to you today. But even were I perfectly healthy I believe my distrust of interpreters would have ultimately made me an unwelcome guest at the academic table.”

  “But, Professor Nietzsche, if all interpreters are limited by their autobiographical frame, how do you escape the same limitation in your own work?”

  “First,” Nietzsche responded, “one must identify the limitation. Next, one must learn to see oneself from afar—although sometimes, alas, the severity of my illness impairs my perspective.”

  It did not escape Breuer that it was Nietzsche, not he, who was keeping their discussion focused on his illness, which was, after all, the raison d’être of their meeting. Was there perhaps a subtle rebuke in Nietzsche’s words? “Don’t try too hard, Josef,” he reminded himself. “A patient’s confidence in a physician should not be explicitly pursued; it will ensue naturally from a competent consultation.” While often self-critical in many areas of his life, Breuer had supreme confidence in himself as a physician. “Do not pander, patronize, scheme, or strategize,” his instincts told him. “Simply go about your business in your usual professional manner.”

  “But let us return to our task, Professor Nietzsche. What I have been meaning to say is that I should prefer to take a medical history and conduct an examination before I examine your records. Then, at our next meeting, I shall try to provide you with as comprehensive a synthesis as possible.”

  Breuer placed a blank pad of paper on the desk before him. “Your letter told me a few things about your condition: that you have had headaches and visual symptoms for at least ten years; that you are rarely free of your illness; that, as you put it, your illness always awaits you. And now today you inform me that at least twenty-four physicians have failed to be of help. That is all I know about you. So, shall we begin? First, please tell me in your own words everything about your illness.”

  CHAPTER 5

  FOR NINETY MINUTES, the two men talked. Breuer, sitting in his high-backed leather chair, was taking rapid notes. Nietzsche, who occasionally paused to allow Breuer’s pen to keep pace, sat in a chair of the same leather, equally comfortable but smaller than Breuer’s. Like most physicians of the day, Breuer preferred to have his patients look up to him from below.

  Breuer’s clinical evaluation was thorough and methodical. After first listening carefully to the patient’s free-form description of the illness, he next systematically investigated each symptom—its first appearance, its transformation over time, its response to therapeutic efforts. His third step was to check every organ system in the body. Starting from the top of the head, Breuer worked his way down to the feet. First the brain and nervous system. He began by inquiring about the functioning of each of the twelve cranial nerves—the sense of smell, vision, eye movements, hearing, facial and tongue movement and sensation, swallowing, balance, speech.

  Descending the body, Breuer reviewed, one by one, every other functional system: respiratory, cardiovascular, gastrointestinal, and genital-urinary. This painstaking organ review jostled the patient’s memory and ensured that nothing was overlooked: Breuer never omitted any part of it, even if he was certain beforehand of the diagnosis.

  Next, a careful medical history: the patient’s childhood health, his parents’ and siblings’ health, and an investigation of all other aspects of his life—occupational choice, social life, military service, geographic moves, dietary and recreational preferences. Breuer’s final step was to allow his intuition full rein and to make all other inquiries that his data thus far suggested. Thus, the other day, in a puzzling case of respiratory distress, he had made a correct diagnosis of diaphragmatic trichinosis by inquiring into the thoroughness with which the patient cooked her smoked salt pork.

  Throughout this procedure, Nietzsche remained deeply attentive: indeed, he nodded appreciatively at each of Breuer’s questions. No surprise, of course, to Breuer. He had never encountered a patient who did not secretly enjoy a microscopic examination of his life. And the greater the power of magnification, the more the patient enjoyed it. The joy of being observed ran so deep that Breuer believed the real pain of old age, bereavement, outliving one’s friends, was the absence of scrutiny—the horror of living an unobserved life.

  Breuer was surprised, however, at the complexity of Nietzsche’s ailments and at the thoroughness of his patient’s own observations. Breuer’s notes filled page after page. His hand began to weary as Nietzsche described a gruesome assemblage of symptoms: monstrous, crippling headaches; seasickness on dry land—vertigo, disequilibrium, nausea, vomiting, anorexia, disgust for food; fevers, heavy night sweats which necessitated two or three nightly changes of nightshirt and linen; crushing bouts of fatigue which at times approximated generalized muscular paralysis; gastric pain; hematemesis; intestinal cramps; severe constipation; hemorrhoids; and disabling visual problems—eye fatigue, inexorable fading of vision, frequent watering and pain in his eyes, visual blurring, and great sensitivity to light, especially in the mornings.

  Breuer’s questions added a few more symptoms Nietzsche had either neglected or been reluctant to mention: visual scintillations and scotomata, which often preceded a headache; intractable insomnia; severe nocturnal muscle cramps; generalized tension; and rapid, inexplicable mood shifts.

  Mood shifts! The words Breuer had been waiting for! As he had described to Freud, he always sniffed for a propitious point of entry into a patient’s psychological state. These “mood shifts” might be just the key that would lead to Nietzsche’s despair and suicide intention!

  Breuer proceeded gingerly, asking him to elaborate on his mood shifts. “Have you noticed alterations in your feelings which seem related to your illness?”

  Nietzsche’s demeanor did not change. He seemed unconcerned that this question might lead into a more intimate realm. “There have been times when, on the day before an attack, I have felt particularly good—I have come to think of it as feeling dangerously good.”

  “And after the attack?”

  “My typical attack lasts from twelve hours to two days. After such an attack, I generally feel fatigued and leaden. Even my thoughts are sluggish for a day or two. But sometimes, especially after a longer attack of several days, it is different. I feel refreshed, cleansed. I explode with energy. I cherish these times—my mind swarms with the rarest of ideas.”

  Breuer persisted. Once he found the trail, he did not easily give up the chase. “Your fatigue and the leaden feeling—how long do they last?”

  “Not long. Once the attack lessens and my body belongs to itself again, I assume control. Then I will myself to overcome the heaviness.”

  Perhaps, Breuer reflected, this might be more difficult than he first thought. He would have to be more direct. Nietzsche, it was clear, was not going to volunteer any information about despair.

  “And melancholia? To what extent does it accompany or succeed your attacks?”

  “I have black periods. Who has not? But they do not have me. They are not of my illness, but of my being. One might say I have the courage to have them.”

  Breuer noted Nietzsche’s slight smile and his bold tone. Now, for the first time, Breue
r recognized the voice of the man who had written those two audacious, enigmatic books concealed in his desk drawer. He considered, but only for a moment, a direct challenge to Nietzsche’s ex-cathedra distinction between the realms of illness and being. And that statement about having the courage to have black periods, what did he mean by that? But patience! Best to maintain control of the consultation. There would be other openings.

  Carefully, he continued. “Have you ever kept a detailed diary of your attacks—their frequency, their intensity, their duration?”

  “Not this year. I’ve been too preoccupied with momentous events and changes in my life. But last year I had one hundred and seventeen days of absolute incapacitation and almost two hundred days in which I was partially incapacitated—with milder headaches, eye pain, stomach pain, or nausea.”

  Here were two promising openings—but which to follow? Should he inquire about the nature of those “momentous events and changes”— surely Nietzsche was referring to Lou Salomé—or strengthen the doctor-patient rapport by being empathic? Knowing that it was impossible to have too much rapport, Breuer. chose the latter.

  “Let’s see, that leaves only forty-eight days without illness. That is very little ‘well’ time, Professor Nietzsche.”

  “Thinking back over several years, rarely have I had times of well-being that have persisted for over two weeks. I think I can remember each one of them!”

  Hearing a wistful, forlorn tone in Nietzsche’s voice, Breuer decided to gamble. Here was an opening that could lead directly into his patient’s despair. He put down his pen and, in his most earnest and professionally concerned voice, remarked, “Such a situation—the majority of one’s days a torment, a handful of healthy days a year, one’s life consumed by pain—seems a natural breeding place for despair, for pessimism about the point of living.”