When Nietzsche Wept

by Irvin D. Yalom

  “Exactly, and a shortcoming I don’t think Liveling realized. An excellent answer, Sig. Shall we have a celebratory cigar?” Freud eagerly accepted one of Breuer’s fine Turkish cigars, and the two men lit up and savored the aroma.

  “Now,” Freud commented, “can we talk about the rest of the case?” He then added in a loud whisper, “The interesting part.”

  Breuer smiled.

  “Maybe I shouldn’t say this,” Freud continued, “but since Northnagel’s left the room, I’ll confess to you privately that the psychological aspects of this case intrigue me more than the medical picture.”

  Breuer noticed that his young friend did indeed appear more animated. Freud’s eyes were sparkling with curiosity as he asked, “How suicidal is this patient? Were you able to advise him to seek counsel?”

  Now it was Breuer’s turn to feel sheepish. He flushed as he remembered how, in their last talk, he had exuded confidence in his interviewing skills. “He’s a strange man, Sig. I’ve never met such resistance. It was like a brick wall. A smart brick wall. He gave me plenty of good openings. He spoke of feeling well only fifty days last year, of black moods, of being betrayed, of living in total isolation, of being a writer without readers, of having severe insomnia with malignant nocturnal thoughts.”

  “But, Josef, those are just the types of openings you said you were looking for!”

  “Exactly. Yet every time I pursued one of them, I came up empty-handed. Yes, he acknowledges often being ill, but insists it’s his body that is ill—not him, not his essence. As for black moods, he says he is proud of having the courage to experience black moods! ‘Proud of the courage to have black moods’—can you believe it? Crazy talk! Betrayal? Yes, I suspect he refers to what happened with Fraulein Salomé, but he claims to have overcome it and does not wish to discuss it. As for suicide, he denies being suicidal, but defends the patient’s right to choose his own death. Though he might welcome death—he says that the final reward of the dead is to die no more!—he has too much still to accomplish, too many books to write. In fact, he says his head is pregnant with books, and he thinks that his cephalgia is cerebral labor pain.”

  Freud shook his head in sympathy with Breuer’s consternation. “Cerebral labor pain—what a metaphor! Like Minerva born from the brow of Zeus! Strange thoughts—cerebral labor pain, choosing one’s death, the courage to have black moods. He’s not without wit, Josef. Is it, I wonder, a crazy wit or a wise craziness?”

  Breuer shook his head. Freud sat back, exhaled a long fume of blue smoke, and watched it ascend and fade away before he spoke again. “This case becomes more fascinating every day. So, what about the Fräulein’s report of suicidal despair? Is he lying to her? Or to you? Or to himself?”

  “Lying to himself, Sig? How do you lie to yourself? Who is the liar? Who is being lied to?”

  “Perhaps part of him is suicidal, but the conscious part doesn’t know it.”

  Breuer turned to look more closely at his young friend. He had expected to see a grin on his face, but Freud was entirely serious.

  “Sig, more and more you talk of this little unconscious homunculus living a separate life from its host. Please, Sig, follow my advice: speak about this theory only to me. No, no, I won’t call it a theory even—there’s no evidence whatsoever for it—let’s call it a fanciful notion. Don’t talk about this fanciful notion to Brücke: it would relieve his guilt for not having the courage to promote a Jew.”

  Freud responded with unusual resoluteness. “It will remain between us until it is proven by sufficient evidence. Then I shall not refrain from publication.”

  For the first time Breuer became aware that there was not much boyishness left in his young friend. Instead, there was germinating an audaciousness, a willingness to stand up for his convictions—qualities he wished he had himself.

  “Sig, you speak of evidence, as though this could be a subject for scientific inquiry. But this homunculus has no concrete reality. It’s simply a construct, like a Platonic ideal. What would possibly constitute evidence? Can you give me even one example? And don’t use dreams, I won’t accept them as evidence—they, too, are insubstantial constructs.”

  “You yourself have supplied evidence, Josef. You tell me that Bertha Pappenheim’s emotional life is dictated by events that occurred precisely twelve months ago—past events of which she has no conscious knowledge. And yet they are described accurately in her mother’s diary of a year before. To my mind, this is equivalent to laboratory proof.”

  “But this rests on the assumption that Bertha is a reliable witness, that she really does not recall these past events.”

  But, but, but, but—there it is again, Breuer thought—that “demon but.” He felt like punching himself. All his life he had taken vacillating “but” positions, and now he had done it again with Freud as well as with Nietzsche—when, in his heart, he suspected they were both right.

  Freud jotted down a few more sentences in his notebook. “Josef, do you think I can see Frau Pappenheim’s diary sometime?”

  “I’ve returned it to her, but I believe I can retrieve it again.”

  Freud took out his watch. “I’ve got to get back to the hospital soon for Northnagel’s rounds. But before I go, tell me what you’re going to do with your reluctant patient.”

  “You mean, what I’d like to do? Three steps. I’d like to establish a good doctor-patient rapport with him. Then I’d like to hospitalize him at a clinic for a few weeks to observe his hemicrania and regulate his medication. And then, during these weeks, I’d like to meet with him frequently for in-depth discussions of his despair.” Breuer sighed. “But, knowing him, there’s little likelihood he’ll cooperate with any of this. Any ideas, Sig?”

  Freud, who was still looking through Liveling’s monograph, now held up a page for Breuer to scan. “Here, listen to this. Under ‘Etiology,’ Liveling says, ‘Episodes of migraine have been induced by dyspepsia, by eyestrain, and by stress. Prolonged bed rest may be advisable. Young migraine sufferers may have to be removed from the stress of school and tutored in the peace of the home. Some physicians advise changing one’s occupation to a less demanding one.’ ”

  Breuer looked quizzical. “So?”

  “I believe that’s our answer! Stress! Why not make stress the key to your treatment plan? Take the position that, to overcome his migraine, Herr Müller must reduce his stress, including mental stress. Suggest to him that stress is stifled emotion, and that, as in the treatment of Bertha, it can be reduced by providing an outlet. Use the chimneysweeping method. You can even show him this statement by Liveling and invoke the power of medical authority.”

  Freud noticed Breuer smiling at his words, and asked, “You think this is a foolish plan?”

  “Not at all, Sig. In fact, I think it’s excellent advice, and I shall follow it carefully. The part that made me smile was the last thing you said—‘invoke the power of medical authority.’ You’d have to know this patient to appreciate the joke, but the idea of expecting him to bow to medical, or to any other type of, authority strikes me as comical.”

  And opening Nietzsche’s The Gay Science, Breuer read aloud several passages he’d marked. “Herr Müller contests all authority and conventions. For example, he stands virtues on their head and renames them vices—as in this view of faithfulness: ‘Obstinately, he clings to something he has come to see through; but he calls it faithfulness.’

  “And of politeness: ‘He is so polite. Yes, he always carries a biscuit for Cerberus and is so timid that he thinks everyone is Cerberus, even you and I. That is his politeness.’

  “And listen to this fascinating metaphor for both visual impairment and despair: ‘To find everything profound; that is an inconvenient trait. It makes one strain one’s eyes all the time, and in the end one finds more than one might have wished.’ ”

  Freud had been listening with interest. “To see more than one wishes,” he murmured. “I wonder what he has seen. May I take a look at the bo
ok?”

  But Breuer had his answer ready: “Sig, he made me give an oath that I show this book to no one, since it has personal notations. My rapport with him is so tenuous that for now I had better honor his request. Later, perhaps.

  “One of the strange things about my interview with Herr Müller,” he went on, stopping at the last of his markers, “was that whenever I tried to express empathy with him, he took offense, and broke the rapport between us. Ah! ‘Footbridge’! Yes, here’s the passage I’m looking for.”

  As Breuer read, Freud closed his eyes the better to concentrate.

  “ ‘There was a time in our lives when we were so close that nothing seemed to obstruct our friendship and brotherhood, and only a small footbridge separated us. Just as you were about to step on it, I asked you: ”Do you want to cross the footbridge to me?“—Immediately you did not want to any more; and when I asked you again you remained silent. Since then mountains and torrential rivers and whatever separates and alienates have been cast between us, and even if we wanted to get together, we couldn’t. But when you now think of that little footbridge, words fail you and you sob and marvel.’ ”

  Breuer put the book down. “What do you make of it, Sig?”

  “I’m not sure.” Freud rose and paced before the bookcase as he talked. “It’s a curious little story. Let’s reason it out. One person is about to cross the footbridge—that is, get closer to the other—when the second person invites him to do the very thing he planned. Then the first person cannot take the step because now it would seem as though he were submitting to the other—power apparently getting in the way of closeness.”

  “Yes, yes, you’re right, Sig. Excellent! I see it now. That means that Herr Müller will interpret any expression of positive sentiment as a bid for power. A peculiar notion: it makes it almost impossible to get close to him. In another section somewhere in here, he says that we feel hatred toward those who see our secrets and catch us in tender feelings. What we need at that moment is not sympathy but to regain our power over our own emotions.”

  “Josef,” said Freud, sitting down again and tapping off his ash into the ashtray, “last week I observed Bilroth using his ingenious new surgical technique to remove a cancerous stomach. Now, as I listen to you, it seems to me you have to perform a psychological surgical procedure equally complex and delicate. You know he’s suicidal from the Fräulein’s report, yet you cannot tell him you know. You must persuade him to reveal his despair; yet, if you succeed, he will hate you for shaming him. You must gain his confidence; yet, if you act in a sympathetic manner toward him, he will accuse you of trying to gain power over him.”

  “Psychological surgery—it’s interesting to hear you put it that way,” said Breuer. “Perhaps we’re developing a whole medical subspecialty. Wait, there’s something else I wanted to read you that seems relevant.”

  He turned the pages of Human, All Too Human for a couple of minutes. “I can’t find the passage now, but its point is that the seeker after truth must undergo a personal psychological analysis—he terms it ‘moral dissection.’ In fact, he goes so far as to say that the errors of even the greatest philosophers were caused by ignorance of their own motivation. He claims that in order to discover the truth, one must first know oneself fully. And to do that, one must remove oneself from one’s customary point of view, even from one’s own century and country—and then examine oneself from a distance!”

  “To analyze one’s own psyche! Not an easy task,” said Freud, rising to leave, “but a task that obviously would be facilitated by the presence of an objective, informed guide!”

  “My thought, exactly!” Breuer responded as he escorted Freud down the hallway. “Now, the hard part—to persuade him of that!”

  “I don’t think it will be difficult,” said Freud. “You have on your side both his own arguments about psychological dissection and the medical theory about stress and migraine—subtly invoked, of course. I don’t see how you can fail to persuade your reluctant philosopher of the wisdom in a course of self-examination under your guidance. Good night, Josef.”

  “Thank you, Sig”—and Breuer clasped his shoulder briefly. “It’s been a good talk. The student has taught the teacher.”

  26 November 1882

  My dear Fritz,

  Neither Mother nor I have heard from you in weeks. This is no time for you to disappear! Your Russian simian continues to spread her lies about you. She shows that disgraceful picture of you and that Jew, Rée, in harness to her and jokes to everyone that you like the taste of her whip. I warned you to retrieve that picture—she will blackmail us with it all our lives! She mocks you everywhere and her paramour, Rée, joins in the chorus. She says that Nietzsche, the otherworldly philosopher, is only interested in one thing: her. . .—a part of her anatomy—I cannot bring myself to repeat her words—her filth. I leave it to your imagination. She is now living with your friend, Rée, in open vice before the eyes of his mother—a fine lot, all of them. None of this is unexpected behavior, not unexpected by me anyway (I still smart at the way you dismissed my warnings at Tautenberg), but it is now becoming a more deadly game—she is infiltrating Basel with her lies. I have learned that she has written letters both to Kemp and to Wilhelm! Fritz, hear me: she will not stop until she has cost you your pension. You may choose silence but I will not: I shall call for an official police investigation of her behavior with Rée! If I am successful, and I must have your backing, she will be deported for immorality within the month! Fritz, send me your address.

  Your only sister,

  Elisabeth

  CHAPTER 8

  EARLY MORNINGS NEVER VARIED in the Breuer household. At six, the corner baker, a patient of Breuer’s, delivered Kaisersemmel, fresh from the oven. While her husband dressed, Mathilde set the table, made his cinnamon coffee, and laid out the crisp three-hatted rolls with sweet butter and black cherry preserves. Despite the tension in their marriage, Mathilde always prepared his breakfast while Louis and Gretchen attended to the children.

  Breuer, preoccupied this morning with his upcoming meeting with Nietzsche, was so busy leafing through Human, All Too Human that he scarcely looked up as Mathilde poured his coffee. He finished his breakfast in silence and then muttered that his noon interview with his new patient might extend into the dinner hour. Mathilde was not pleased.

  “I hear so much talk about this philosopher I begin to worry. You and Sigi spend hours talking about him! You worked through dinner on Wednesday, yesterday you stayed in your office reading his book until the food was on the table, and today again you read him at breakfast. And now you talk again about missing dinner! The children need to see their father’s face. Please, Josef, don’t make too much of him. Like the others.”

  Breuer knew Mathilde was referring to Bertha, but not only to Bertha: she had often objected to his failure to set reasonable limits on the time he spent with patients. To him, commitment to a patient was inviolable. Once he took on a patient, he never shirked from providing that person with all the time and energy he felt necessary. His fees were low and, for a patient who was hard-pressed financially, he charged nothing at all. At times, Mathilde felt she had to protect Breuer from himself—that is, if she was to have any of his time and attention.

  “The others, Mathilde?”

  “You know what I mean, Josef.” She still would not speak Bertha’s name. “Some things, of course, a wife can understand. Your Stammtisch at the cafe—I know you must have a place to meet your friends—the tarock, the pigeons in your laboratory, the chess. But the other times—why give so much of yourself unnecessarily?”

  “When? What are you talking about?” Breuer knew he was being perverse, that he was guiding them toward an unpleasant confrontation.

  “Think about the time you used to give to Fraulein Berger.”

  With the exception of Bertha, this—of all the examples Mathilde could have given—was the one guaranteed to irritate him most. Eva Berger, his previous nurse, had worked
for him for ten years or so, since the day he began his practice. His unusually close relationship with her had caused Mathilde almost as much consternation as had his relationship with Bertha. Over their years together, Breuer and his nurse had developed a friendship that transcended professional roles. Often they confided deeply personal things to one another; and when they were alone, they addressed one another by first name—possibly the only physician and nurse in all Vienna to do so, but that was Breuer’s way.

  “You always misunderstood my relationship with Fraulein Berger,” Breuer replied in an icy tone. “To this day, I regret listening to you. Firing her remains one of the great shames of my life.”

  Six months ago, on the fateful day when the delusional Bertha had announced that she was pregnant by Breuer, Mathilde had demanded not only that he take himself off Bertha’s case but also that he fire Eva Berger. Mathilde was enraged and mortified and wanted to cleanse every stain of Bertha from her life. And of Eva, too, whom Mathilde, knowing that her husband discussed everything with his nurse, regarded as an accomplice in the whole awful Bertha affair.

  During that crisis, Breuer was so overcome with remorse, so humiliated and self-accusatory, that he acceded to all of Mathilde’s demands. Though he knew Eva was a sacrificial victim, he could not find the courage to defend her. The very next day, he not only transferred Bertha’s care to a colleague but fired the innocent Eva Berger.

  “I’m sorry I brought it up, Josef. But what am I to do when I watch you withdraw more and more from me and from our children? When I ask for something from you, it’s not to plague you, but because I—we—want your presence. Consider it a compliment, an invitation.” Mathilde smiled at him.

  “I like invitations—but I hate commands!” Breuer immediately regretted his words, but did not know how to retract them. He finished his breakfast in silence.