When Nietzsche Wept

by Irvin D. Yalom

  Opening his briefcase, Nietzsche took out a pencil stub and notebook and jotted down a few lines. Breuer stretched his head, trying, in vain, to read them upside down.

  Nietzsche’s complex line of thought had gone far beyond the little point Breuer wanted to make. Still, though he felt like a poor simpleton, he had no recourse but to press on. “As your physician, I shall take the view that even though benefit has accrued from your illness, as you have argued so lucidly, the time has come for us to declare war upon it, to learn its secrets, to discover its weaknesses, and to eradicate it. Will you humor me and entertain this point of view?”

  Nietzsche looked up from his notebook and nodded in acquiescence.

  “I believe it is possible,” Breuer went on, “for one to choose illness inadvertently by choosing a way of life which produces stress. When this stress becomes great enough or chronic enough, it triggers in turn some susceptible organ system—in the case of migraine, the vascular system. So, you see, I speak of indirect choice. One does not, strictly speaking, choose or select a disease; but one does choose stress—and it is stress that chooses the disease!”

  Nietzsche’s nod of comprehension encouraged Breuer to continue. “Thus stress is our enemy, and my task, as your physician, is to help you reduce the stress in your life.”

  Breuer felt relieved to be back on track. Now, he thought, I’ve prepared the soil for the next, and last, short step: to propose that I help Nietzsche alleviate the psychological sources of stress in his life.

  Nietzsche placed his pencil and notebook back into his briefcase. “Doctor Breuer, I have for several years now addressed the issue of stress in my life. Reduce stress, you say! It was precisely for that reason I left the University of Basel in eighteen seventy-nine. I lead a stress-free life. I have given up teaching. I manage no estate. I have no home to look after, no servants to supervise, no wife to quarrel with, no children to discipline. I live frugally on a small pension. I have no obligations to anyone. I have pared stress in my life to the barest minimum, to an irreducible level. How can it be cut further?”

  “I don’t agree that it is irreducible, Professor Nietzsche. It is precisely this question I should like to explore with you. You see——”

  “Keep in mind,” Nietzsche interrupted, “that I have inherited an exquisitely sensitive nervous system. I know this from my profound responsiveness to music and to art. When I heard Carmen for the first time, every nerve cell in my brain fired at once: my entire nervous system was ablaze. For the same reason, I respond violently to every nuance of change in weather and barometric pressure.”

  “But,” Breuer countered, “such neuronal hyperalertness may not be constitutional. It may itself be a function of stress from other sources.”

  “No, no!” Nietzsche protested, shaking his head impatiently, as though Breuer had missed the point. “My point is that hyperalertness, as you put it, is not undesirable: it is necessary to my work. I want to be alert. I do not want to be excluded from any part of my internal experience! And if tension is the price of insight, so be it! I am rich enough to pay that price.”

  Breuer did not respond. He had not expected such massive and immediate resistance. He had not yet even described his treatment proposal; yet the arguments he had prepared had been anticipated and were already battered. Silently he sought a way to marshal his troops.

  Nietzsche continued: “You have looked at my books. You understand that my writing succeeds not because I am intelligent or scholarly. No, it’s because I have the daring, the willingness, to detach myself from the comfort of the herd and to face strong and evil inclinations. Inquiry and science start with disbelief. Yet disbelief is inherently stressful! Only the strong can tolerate it. Do you know what the real question for a thinker is?” He did not pause for an answer. “The real question is: How much truth can I stand? It is no occupation for those of your patients who wish to eliminate stress, to live the tranquil life.”

  Breuer had no suitable rejoinder. Freud’s strategy was in shreds. Base your approach on the elimination of stress, he had advised. But here is a patient who insists that his life work, the very thing that keeps him alive, requires stress.

  Drawing himself up, Breuer reverted to medical authority. “I understand your dilemma precisely, Professor Nietzsche, but hear me out. You may see that there may be ways for you to suffer less while continuing to conduct your philosophical inquiries. I’ve thought much about your case. In my many years of clinical experience with migraine, I have helped many patients. I believe I can help you. Please let me present my treatment plan.”

  Nietzsche nodded and leaned back in his chair—feeling safe, Breuer imagined, behind the barricade he had erected.

  “I propose that you be admitted to the Lauzon Clinic in Vienna for a month of observation and treatment. There are certain advantages to such an arrangement. We will be able to conduct systematic trials with several of the new migraine medications. I see by your chart that you have never had a clinical trial of ergotamine. It’s a promising new treatment for migraine, but it requires precautions. It must be taken immediately at the onset of an attack; furthermore, if used incorrectly it may produce serious side effects. I much prefer to regulate the proper dosage while the patient is in the hospital and under close surveillance. Such observation may also give us valuable information about the trigger to the migraine. I see that you are a keen observer of your own condition—but, still, there’s real advantage in the observations of trained professionals.

  “I’ve often used the Lauzon for my patients,” Breuer hurried on, permitting no interruptions. “It’s comfortable and competently run. The new director has introduced many innovative features, including the serving of waters from Baden-Baden. Moreover, since it’s within range of my office, I can visit you daily, Sundays excepted, and together we shall explore the sources of stress in your life.”

  Nietzsche was shaking his head, slightly but determinedly.

  “Allow me,” Breuer continued, “to anticipate your objection—the one you have just presented, that stress is so intrinsic to your work and to your mission that, even were it possible to extirpate it, you would not agree to such a procedure. I have it right?”

  Nietzsche nodded. Breuer was pleased to see a glimmer of curiosity in his eyes. Good, good! he thought. The professor believes he has uttered the final word on stress. He is surprised to see me drag in its carcass!

  “But my clinical experience has taught me that there are many sources of tension, sources that may be beyond the ken of the individual who is stressed, and that require an objective guide for elucidation.”

  “And the sources of tension are what, Doctor Breuer?”

  “At one point in our discussion—it was when I asked whether you keep a diary of the events around your migraine attacks—you alluded to momentous and disturbing events in your life that distracted you from your diary keeping. I assume that these events—you are yet to be explicit about them—are sources of stress that might be alleviated through discussion.”

  “I have already resolved these distractions, Doctor Breuer,” said Nietzsche with finality.

  But Breuer persisted. “Surely there are other stresses. For example, on Wednesday you alluded to a recent betrayal. Certainly that betrayal begat stress. As no human being is free of Angst, so no one escapes the pain of friendship gone awry. Or the pain of isolation. To be honest, Professor Nietzsche, as your physician I am concerned by the daily schedule you described. Who can tolerate such isolation? Earlier you presented your lack of wife, children, and colleagues as evidence that you had eliminated stress from your life. But I see it differently: extreme isolation doesn’t eliminate stress but is, in itself, stress. Loneliness is a breeding ground for sickness.”

  Nietzsche shook his head vigorously. “Allow me to disagree, Doctor Breuer. Great thinkers always choose their own company, think their own thoughts, undisturbed by the herd. Consider Thoreau, Spinoza, or the religious ascetics like Saint Jerome, Saint
Francis, or the Buddha.”

  “I don’t know Thoreau, but as for the rest—are they paragons of mental health? Besides”—here Breuer smiled broadly, hoping to lighten the discussion—“your argument must be in grave peril if you turn to the religious elders for support.”

  Nietzsche was not amused. “Doctor Breuer, I am grateful to you for your efforts in my behalf, and have already profited from this consultation: the information you offered about migraine is precious to me. But it is not advisable for me to go into a clinic. My extended stays at the baths—weeks at Saint-Moritz, at Hex, at Steinabad—have always come to naught.”

  Breuer was tenacious. “You must understand, Professor Nietzsche, that our treatment at the Lauzon Clinic would have no similarity to a cure at any of the European baths. I regret I even mentioned the Baden-Baden waters. They represent the smallest part of what the Lauzon, under my supervision, has to offer.”

  “Doctor Breuer, were you and your clinic located elsewhere I would give your plan serious consideration. Tunisia perhaps, Sicily, or even Rapallo. But a Vienna winter would be an abomination for my nervous system. I do not believe I would survive.”

  Although Breuer knew from Lou Salomé that Nietzsche had expressed no such objections when she had proposed that she and Nietzsche and Paul Rée spend the winter together in Vienna, it was, of course, information he could not use. Still, he had a much better response.

  “But, Professor Nietzsche, you make my point precisely! If we hospitalized you in Sardinia or Tunisia and you were migraine-free for a month, we would have accomplished naught. Medical inquiry is no different from philosophical inquiry: risk must be taken! Under our supervision at the Lauzon, a developing migraine attack would be not a cause for alarm but rather a blessing—a treasure trove of information about the cause and the treatment of your condition. Let me assure you that I will be immediately available to you and can quickly abort an attack with ergotamine or nitroglycerine.”

  Here Breuer paused. He knew his response was powerful. He tried not to beam.

  Nietzsche swallowed before replying. “Your point is well taken, Doctor Breuer. However, it is quite impossible for me to accept your recommendation. My objection to your plan and formulation of treatment stems from the deepest, most fundamental levels. But these are beside the point owing to a mundane but pre-eminent obstacle—money! Even under the best of circumstances, my resources would be strained by a month of intensive medical care. At this moment, it is impossible.”

  “Ach, Professor Nietzsche, isn’t it strange that I ask so many questions about intimate aspects of your body and life, yet refrain, as do most physicians, from intruding upon your financial privacy?”

  “You were unnecessarily discreet, Doctor Breuer. I have no reluctance to discussing finances. Money matters little to me—as long as there is enough of it for me to continue my work. I live simply and, aside from a few books, spend nothing except what I need for my bare subsistence. When I resigned from Basel three years ago, the university granted me a small pension. That is my money! I have no other funds or source of income—no estate from my father, no stipend from patrons—powerful enemies have seen to that—and, as I indicated to you, my writing has never yielded me a penny. Two years ago the University of Basel voted me a small increase in my pension. I think the first award was so that I would go away, and the second so that I would stay away.”

  Nietzsche reached into his jacket and extracted a letter. “I always assumed that the pension would be for life. However, this very morning Overbeck forwarded a letter from my sister in which she suggests that my pension is in jeopardy.”

  “Why is that, Professor Nietzsche?”

  “Someone whom my sister does not like is slandering me. At the moment I do not know whether the charges are true, or whether my sister exaggerates—as she often does. Be that as it may, the important point is I cannot at this time possibly undertake a significant financial obligation.”

  Breuer was delighted and relieved by Nietzsche’s objection. This was an obstacle easily overcome. “Professor Nietzsche, I believe we have similar attitudes toward money. I, like you, have never attached emotional importance to it. However, by sheer chance, my circumstances differ from yours. Had your father lived to leave you an estate, you would have money. Although my father, a prominent teacher of Hebrew, left me only a modest estate, he arranged a marriage for me with the daughter of one of the wealthiest Jewish families in Vienna. Both families were satisfied: a handsome dowry in exchange for a medical scientist with great potential.

  “All of this, Professor Nietzsche, is by way of saying that your financial obstacle is no obstacle at all. My wife’s family, the Altmanns, have endowed the Lauzon with two free beds which I may use at my discretion. Thus, there would be no clinic charges, nor any fees for my services. I emerge wealthier from each of our discussions! So then, good! All is settled! I shall notify the Lauzon. Shall we arrange for admission today?”

  CHAPTER 9

  BUT ALL WAS NOT SETTLED. Nietzsche sat with his eyes closed for a long time. Then, suddenly opening them, he said decisively, “Doctor Breuer, I’ve taken enough of your valuable time. Your offer is a generous one. I shall long remember it, but I cannot—I will not accept it. There are reasons beyond reasons”—words spoken with finality, as though he did not intend further explanation. In preparation for departure, he closed the clasps on his briefcase.

  Breuer was astonished. This interview resembled more a chess contest than a professional consultation. He had made a move, proposed a plan, which Nietzsche immediately countered. He had responded to the objection, only to face still another of Nietzsche’s objections. Was there no end to them? But Breuer, an old hand at clinical impasses, turned now to a ploy that rarely failed.

  “Professor Nietzsche, be my consultant for a moment! Please imagine this interesting situation; perhaps you can help me understand it. I have encountered a patient who has been very sick for some time. He enjoys even tolerable health less than one day out of three. He then undertakes a long, arduous journey to consult with a medical expert. The consultant performs his task competently. He examines the patient and makes a proper diagnosis. Patient and consultant apparently develop a relationship of reciprocal respect. The consultant then proposes a comprehensive treatment plan in which he has complete confidence. Yet the patient shows no interest whatsoever, not even curiosity, in the treatment plan. On the contrary, he rejects it instantaneously and raises obstacle after obstacle. Can you help me understand this mystery?”

  Nietzsche’s eyes widened. Though he appeared intrigued by Breuer’s droll gambit, he did not respond.

  Breuer persisted. “Perhaps we should start at the beginning of this riddle. Why does this patient who does not want treatment seek consultation in the first place?”

  “I came because of strong pressure from my friends.”

  Breuer was disappointed that his patient declined to enter into the spirit of his little artifice. Though Nietzsche wrote with great wit and extolled laughter in the written word, it was clear the Herr Professor did not like to play.

  “Your friends in Basel?”

  “Yes, both Professor Overbeck and his wife are close to me. Also, a good friend in Genoa. I don’t have many friends—a consequence of my nomadic life—and the fact that every one of them urged me to seek consultation was remarkable! As was the fact that Doctor Breuer’s name seemed to be on all their lips.”

  Breuer recognized the adroit hand of Lou Salomé. “Surely,” he said, “their concern must have been ignited by the gravity of your medical condition.”

  “Or perhaps from my speaking of it too often in my letters.”

  “But your speaking of it must reflect your own concern. Why else write them such letters? Surely not to evoke concern? Or sympathy?”

  A good move! Check! Breuer was pleased with himself. Nietzsche was forced to retreat.

  “I have too few friends to risk losing them. It occurred to me that, as a mark of friendship,
I should do what I could to alleviate their concern. Hence my arrival in your office.”

  Breuer decided to press his advantage. He moved more boldly.

  “You have no concern for yourself? Impossible! Over two hundred days a year of punishing incapacitation! I have attended too many patients in the midst of a migraine attack to accept any minimization of your pain.”

  Excellent! Another file on the chessboard closed off. Where would his opponent move now? Breuer wondered.

  Nietzsche, apparently realizing he had to develop some of his other pieces, turned his attention back to the center of the board. “I have been called many things—philosopher, psychologist, pagan, agitator, antichrist. I have even been called some unflattering things. But I prefer to call myself a scientist, because the cornerstone of my philosophic method, as of the scientific method, is disbelief. I always maintain the most rigorous possible skepticism, and I am skeptical now. I cannot accept your recommendation for psychic exploration on the basis of medical authority.”

  “But, Professor Nietzsche, we are entirely in agreement. The only authority to be followed is reason, and my recommendation is supported by reason. I claim only two things. First, that stress may make one sick—and much scientific observation supports this claim. Second, that considerable stress exists in your life—and I speak of a stress different from that inherent in your philosophic inquiry.

  “Let us examine the data together,” Breuer continued. “Consider the letter you described from your sister. Surely there is stress in being slandered. And, incidentally, you violated our contract of reciprocal honesty by failing to mention this slanderer to me earlier.” Breuer moved more boldly yet. There was no other way—he had nothing to lose.

  “And surely there is stress in the thought of losing your pension, your sole source of support. And if that is mere alarmist exaggeration by your sister, then there is the stress of having a sister willing to alarm you!”