Nietzsche stopped. For once he did not have a ready answer. His head swayed from side to side as if he were pondering whether to permit himself to be consoled. But his words said something else.
“Undoubtedly that is true, Doctor Breuer, for some people, perhaps for most—here I must defer to your experience—but it is not true for me. Despair? No, perhaps once true, but not now. My illness belongs to the domain of my body, but it is not me. I am my illness and my body, but they are not me. Both must be overcome, if not physically, then metaphysically.
“As for your other comment, my ‘point of living’ is something entirely divorced from this”—here he thumped his abdomen—“sorry protoplasm. I have a why of living and can put up with any how. I have a ten-year point of living, a mission. I am pregnant, here”—he tapped his temple—“with books, books almost fully formed, books only I can deliver. Sometimes I think of my headaches as cerebral labor pains.”
Nietzsche apparently had no intention of discussing or even acknowledging despair; and it would be futile, Breuer realized, to attempt to snare him. He suddenly recalled feeling being outmaneuvered whenever he played chess with his father, the best player in the Jewish Viennese community.
But perhaps there was nothing to acknowledge! Perhaps Fraulein Salomé was wrong. Nietzsche sounded as though his spirit had overcome this monstrous illness. As for suicide, Breuer had an absolutely infallible test for the risk of suicide. Does the patient project himself into the future? Nietzsche had passed that test! He was not suicidal: he spoke of a ten-year mission, of books he had yet to extract from his mind.
Yet with his own eyes, Breuer had seen Nietzsche’s suicidal letters. Was he dissimulating? Or was it that he did not now feel despair because he had Already decided upon suicide? Breuer had known patients like that before. They were dangerous. They appear improved—in a sense, are improved; their melancholia lightens; they smile, eat, sleep once more. But their improvement means they have discovered an escape from their despair—the escape of death. Was that Nietzsche’s plan? Had he decided to kill himself? No, Breuer remembered what he had told Freud: If Nietzsche intended suicide, why was he here? Why take the trouble to visit yet another physician, to journey from Rapallo to Basel, and thence to Vienna?
Despite his frustration at not obtaining the information he sought, Breuer could not fault his patient’s cooperation. Nietzsche responded fully to each medical question—if anything, too fully. Many headache sufferers report sensitivity to diet and weather, so Breuer was not surprised to learn that this was true for Nietzsche as well. But he was astonished by the exquisite detail of his patient’s report. Without pausing, Nietzsche spoke for twenty minutes about his response to atmospheric conditions. His body, he said, was like an aneroid barometer-thermometer reacting violently to every oscillation of atmospheric pressure, temperature, or altitude. Gray skies depressed him, leaden clouds or rain enervated him, drought invigorated him, winter represented a form of mental “lockjaw,” the sun opened him up again. For years his life had consisted of a search for the perfect climate. Summers were endurable. The cloudless, windless, sunny plateau of the Engadine suited him; and for four months every year, he resided in a small Gasthaus in the little Swiss village of Sils Maria. But winters were a curse. He had never found a friendly wintering spot; and during the cold months, he lived in southern Italy, moving from city to city in search of salubrious climate. Vienna’s wind and wet gloom poisoned him, Nietzsche said. His nervous system cried out for sun and dry, still air.
When Breuer asked about diet, Nietzsche delivered another lengthy discourse on the relationship between diet, gastric distress, and headache attacks. What remarkable precision! Never before had Breuer encountered a patient who answered every question so comprehensively. What did it mean?
Was Nietzsche an obsessional hypochondriac? Breuer had seen many boring, self-pitying hypochondriacs who relished describing their innards. But these patients had a “Weltanschauung stenosis,” a narrowing of world view. And how tedious it was to be in their presence! They had no thoughts but those of corpus, no interests or values but those of health.
No, Nietzsche was not one of these. His range of interest was extensive, his persona engaging. Certainly Fräulein Salomé had found him so, still found him so, even if she found Paul Rée more romantically congenial. Furthermore, Nietzsche did not describe his symptoms to elicit sympathy or even support—this Breuer had learned early in their interview.
So why this exquisite detail about his bodily functions? Perhaps it was simply that Nietzsche had a good mind, with perfect retention, and approached a medical evaluation in a fundamentally rational manner, providing comprehensive data to an expert consultant. Or, he was uncommonly introspective. Before the end of his evaluation, Breuer obtained still another answer: Nietzsche had so little contact with other human beings that he spent an extraordinary amount of time in conversation with his own nervous system.
His history taking complete, Breuer proceeded to the physical examination. He accompanied his patient to his examining office, a small, sterile room containing only a dressing screen and chair, an examining table covered with a starched white sheet, a sink, a scale, and a steel cabinet containing Breuer’s instruments. A few minutes after leaving Nietzsche to strip and change, Breuer returned to find him, though already wearing the open-backed dressing gown, still in his high black socks and garters and carefully folding his clothes. He apologized for the delay, saying, “My nomadic life dictates that I can have only a single suit. Hence, I make certain it’s comfortable whenever I put it to rest.”
Breuer’s physical exam was as methodical as his medical history. Beginning with the head, he slowly worked his way down the body, listening, tapping, touching, smelling, feeling, looking. Despite his patient’s abundance of symptoms, Breuer found no physical abnormalities aside from a large scar over the sternum—a result of a riding accident while in the military; a minute oblique dueling scar on the bridge of the nose; and some signs of anemia: pale lips, conjunctiva, and creases of the palm.
The cause of the anemia? Probably nutritional. Nietzsche had said that he often avoided meat for weeks at a time. But later Breuer remembered that Nietzsche had said he occasionally vomited blood, and thus might be losing blood from gastric bleeding. He drew some blood for a red-cell count and, after a rectal examination, collected a stool specimen from his glove which he would later examine for occult blood.
What of Nietzsche’s visual complaints? First, Breuer noted a unilateral conjunctivitis which could be easily managed with eye salve. Despite considerable effort, Breuer was unable to focus his ophthalmoscope on Nietzsche’s retina: something was obstructing the view, probably a corneal opacity, perhaps an edema of the cornea.
Breuer particularly focused on Nietzsche’s nervous system, not only because of the nature of the headaches but also because his father had died, when he was four, of “softening of the brain”—a generic term which might refer to any of a number of abnormalities, including stroke, tumor, or some form of inherited cerebral degeneration. But after testing every aspect of brain and nerve function—balance, coordination, sensation, strength, proprioception, hearing, smell, swallowing—Breuer found no evidence whatsoever of structural nervous system disease.
While Nietzsche dressed, Breuer returned to his office to chart the results of his examination. When, a few minutes later, Frau Becker brought Nietzsche back into the office, Breuer realized that, though their time was drawing to a close, he had failed utterly to elicit any mention of melancholia or suicide. He tried another approach, an interview device that rarely failed to yield results.
“Professor Nietzsche, I would like you to describe, in detail, a typical day of your life.”
“Now you have me, Doctor Breuer! That’s the most difficult question you have posed. I move so much, my surroundings are inconstant. My attacks dictate my life——”
“Choose any ordinary day, a day between attacks in the past few weeks.”
/> “Well, I awaken early—if, indeed, I have slept at all——”
Breuer felt encouraged. Already he had an opening. “Allow me to interrupt, Professor Nietzsche. You say if you have slept?”
“My sleep is dreadful. Sometimes it is muscle cramps, sometimes stomach pain, sometimes a tension that invades every part of my body, sometimes my thoughts——usually malignant, nocturnal thoughts; sometimes I lie awake all night, sometimes drugs give me two or three hours’ sleep.”
“Which drugs? How much of each?” Breuer asked quickly. Though it was imperative that he learn about Nietzsche’s self-medication, he realized immediately that he had not chosen the best option. Better, much better, to have inquired about those dark nocturnal thoughts!
“Chloral hydrate, almost every night, at least one gram. Sometimes, if my body is desperate for sleep, I add morphia or Veronal, but then I am in stupor the next day. Occasionally hashish, but it also blunts my thinking the following day. I prefer chloral. Shall I continue with this day, which has already dawned badly?”
“Please.”
“I take some breakfast in my room—you want this much detail?”
“Yes, exactly. Tell me everything.”
“Well, breakfast is a simple affair. The Gasthaus owner brings me some hot water. That’s all. Occasionally, if I feel particularly well, I ask for weak tea and dry bread. Then I bathe in cold water—necessary if I am to work with any vigor—and spend the rest of the day at work—writing, thinking, and occasionally, if my eyes permit, a little reading. If I feel well, I will walk, sometimes for hours. I scribble as I walk and often do my best work, have my finest thoughts, while walking——”
“Yes, I too,” Breuer rushed to add. “After four or five miles, I find I have clarified the most puzzling problems.”
Nietzsche paused, apparently thrown off balance by Breuer’s personal comment. He started to acknowledge it, stuttered, and, in the end, ignored it and continued his account. “I dine always at the same table at my hotel. I’ve described my diet to you—always unspiced food, preferably boiled, no alcohol, no coffee. Often for weeks I can tolerate only boiled unsalted vegetables. No tobacco, either. I speak a few words to other guests at my table but rarely engage in prolonged conversation. If I am particularly fortunate, I encounter a thoughtful guest who will offer to read to me or take dictation. My funds are limited, and I am unable to pay for such services. The afternoon is the same as the morning—walking, thinking, scribbling. In the evening I take supper in my room—again, hot water or weak tea and biscuits—and then I work until the chloral says, ‘Halt, you may rest.’ Such is my corporeal life.”
“You speak only of hotels? And your home?”
“My home is my steamer trunk. I am a tortoise and carry my home on my back. I place it in the corner of my hotel room, and when the weather becomes oppressive, I hoist it and move to higher, drier skies.”
Breuer had planned to return to Nietzsche’s “malignant nocturnal thoughts” but now saw an even more promising line of inquiry—one that could not fail to lead directly to Fräulein Salomé.
“Professor Nietzsche, I am aware that your description of your typical day contains little mention of other people! Pardon my inquiry—I know these are not typical medical questions, but I adhere to a belief in organismic totality. I believe that physical well-being is not separable from social and psychological well-being.”
Nietzsche flushed. He took out a small tortoiseshell mustache comb and for a short time slouched in silence, nervously grooming his ponderous mustache. Then, apparently having reached a decision, he sat up, cleared his throat, and spoke firmly: “You are not the first physician who has made this observation. I assume you are referring to sex. Doctor Lanzoni, an Italian consultant whom I saw several years ago, suggested that my condition was aggravated by isolation and abstinence and recommended that I acquire a regular sexual outlet. I followed his advice and worked out an arrangement with a young peasant woman in a village near Rapallo. But at the end of three weeks I was almost moribund with head pain—a little more of such Italian treatment, and the patient would have expired!”
“Why was it such noxious advice?”
“A flash of bestial pleasure followed by hours of self-loathing, of cleansing myself of the protoplasmic stink of rutting, is not, in my view, the route to—how did you put it?—‘organismic totality.’ ”
“Nor in my view either,” Breuer quickly agreed. “Yet can you deny that all of us are embedded in a social context, a context that historically has facilitated survival and provided the pleasure inherent in human connectedness?”
“Perhaps such herd pleasures are not for everyone,” Nietzsche said, shaking his head. “Thrice have I reached out and attempted to build a footbridge to others. And thrice I have been betrayed.”
At last! Breuer could scarcely conceal his excitement. Certainly one of Nietzsche’s three betrayals was Lou Salomé. Perhaps Paul Rée was another. Who was the third? Finally, finally, Nietzsche had opened the door. Without doubt, the path was now clear for a discussion of betrayal, and the despair betrayal induced.
Breuer mustered his most empathic tone of voice. “Three attempts, three terrible betrayals—and since then a retreat into painful isolation. You have suffered, and perhaps, in some manner, this suffering bears upon your illness. Would you be willing to trust me with the details of these betrayals?”
Again, Nietzsche shook his head. He appeared to retreat into himself. “Doctor Breuer, I have trusted you with a great a deal of myself. Today I have shared more of the intimate details of my life than I have done with anyone in a very long time. But trust me when I say my illness has long antedated these personal disappointments. Remember my family history: my father died of brain disease—perhaps a familial disease. Remember that headaches and ill health have plagued me since my schooldays, long before these betrayals. It is also true that my illness was never ameliorated by the brief intimate friendships I have enjoyed. No, it is not that I have trusted too little: my mistake was to trust too much. I am not prepared to, cannot afford to, trust again.”
Breuer was stunned. How could he have miscalculated? Only a moment ago, Nietzsche had seemed willing, almost eager, to confide in him. And now to be so rebuffed! What had happened? He tried to recall the sequence of events. Nietzsche had mentioned trying to build a footbridge to another and then having been betrayed. At that point Breuer had sympathetically reached out to him and then—and then—footbridge—the term struck some chord. Nietzsche’s books! Yes, almost certainly there was a vivid passage involving a footbridge. Perhaps the key to obtaining Nietzsche’s confidence lay in those books. Breuer also vaguely recalled another passage that argued for the importance of psychological self-scrutiny. He resolved to read the two books more carefully before their next meeting: perhaps he might be able to influence Nietzsche with his own arguments.
Yet what could he really do with any argument he found in Nietzsche’s books? How even explain how he happened to have them? None of the three Viennese bookstores where he had inquired for his books had even heard of the author. Breuer hated duplicity and, for a moment, considered telling Nietzsche everything: Lou Salomé’s visit to him, his knowledge of Nietzsche’s desperation, his promise to Fraulein Salomé, her gift of his books.
No, that could lead only to failure: without doubt Nietzsche would feel manipulated and betrayed. Breuer was certain that Nietzsche was in despair because of his entanglement in—to use Nietzsche’s fine term—a Pythagorean relationship with Lou and Paul Rée. And if Nietzsche were to learn of Lou Salomé’s visit, he would undoubtedly view her and Breuer as two sides of another triangle. No, Breuer was convinced that honesty and sincerity, his natural solution to life’s dilemmas, would in this case make matters far worse. Somehow he would have to find a way to obtain the books legitimately.
It was late. The wet gray day was turning into darkness. In the silence, Nietzsche stirred uneasily. Breuer was tired. His prey had eluded him, and h
e had run out of ideas. He decided to temporize.
“I believe, Professor Nietzsche, that we can proceed no further today. I need time to study your past medical records and to perform the necessary laboratory tests.”
Nietzsche sighed softly. Did he look disappointed? Did he want their meeting to continue longer? Breuer thought so but, no longer trusting his judgment regarding Nietzsche’s reactions, suggested further consultation later in the week. “Friday afternoon? Same time?”
“Yes, of course. I am entirely at your disposal, Doctor Breuer. I have no other reason to be in Vienna.”
The consultation over, Breuer arose. But Nietzsche hesitated and then abruptly sat back in his chair.
“Doctor Breuer, I’ve taken much of your time. Please do not make the mistake of underestimating my appreciation for your efforts—but indulge me for a moment more. Allow me, in my own behalf, to ask you three questions!”
CHAPTER 6
“ASK YOUR QUESTIONS, please, Professor Nietzsche,” said Breuer, settling back in his chair. “Considering the barrage of questions I have directed at you, three is a modest request. If your questions lie within my realm of knowledge, I shall not fail to answer you.”
He was tired. It had been a long day, and ahead of him were still a six o’clock teaching conference and his evening calls. But even so, he did not mind Nietzsche’s request. On the contrary, he felt unaccountably exhilarated. Perhaps the opening he had sought was at hand.
“When you hear my questions, you may, like many of your colleagues, regret that promise. I have a trinity of questions, three questions, but perhaps only one. And that one question—a plea as well as a question—is: Will you tell me the truth?”