“And the three questions?” Breuer asked.
“The first is: Will I go blind? The second: Will I have these attacks forever? And finally, the most difficult question: Do I have a progressive brain disease which will kill me young like my father, drive me into paralysis or, worse, into madness or dementia?”
Breuer was speechless. He sat in silence, aimlessly leafing through the pages of Nietzsche’s medical dossier. No patient, in fifteen years of medical practice, had ever posed such brutally direct questions.
Nietzsche, noting his discomfiture, continued, “Forgive me for confronting you so. But I have had many years of indirect discourse with physicians, especially German physicians who anoint themselves as sextons of the truth, yet withhold their knowledge. No physician has the right to withhold from the patient what is rightfully his.”
Breuer couldn’t help smiling at Nietzsche’s characterization of German physicians. Or bristling at the pronouncement about the rights of the patient. This little philosopher with the large mustache stimulated his mind.
“I am most willing to discuss these issues of medical practice, Professor Nietzsche. You ask forthright questions. I shall attempt to respond with equal directness. I agree with your position about the rights of the patient. But you have omitted an equally important concept: the obligations of the patient. I prefer a completely honest relationship with my patients. But it must be a reciprocal honesty: the patient, too, must be committed to honesty with me. Honesty—honest questions, honest answers—makes for the best medicine. Under this condition, then, you have my word: I shall share with you all my knowledge and my conclusions.
“But, Professor Nietzsche,” Breuer went on, “I do not agree that it should always be thus. There are patients and there are situations when the good physician must, for the sake of the patient, withhold the truth.”
“Yes, Doctor Breuer, I’ve heard many physicians say that. But who has the right to make that decision for another? That posture can only violate the patient’s autonomy.”
“It is my duty,” Breuer replied, “to offer comfort to patients. And it is not a duty to be taken lightly. Sometimes it’s a thankless duty: sometimes there’s bad news I cannot share with a patient; sometimes it’s my duty to remain silent and bear the pain for both patient and family.”
“But, Doctor Breuer, that type of duty obliterates a more fundamental duty: each person’s duty to oneself to discover truth.”
For a moment, in the heat of the dialogue, Breuer had forgotten that Nietzsche was his patient. These were enormously interesting questions, and he was completely absorbed. He rose and began to pace behind his chair while he spoke.
“Is it my duty to impose a truth on others that they do not wish to know?”
“Who can determine what one wishes not to know?” Nietzsche demanded.
“That” said Breuer firmly, “is what may be called the art of medicine. One learns such things not from texts but from the bedside. Allow me to use, as an example, a patient whom I shall visit in the hospital later this evening. I tell you this in complete confidence and shall, of course, withhold his identity. This man has a fatal disease, a far advanced cancer of the liver. He is jaundiced because of liver failure. His bile is rising in his bloodstream. His prognosis is hopeless. I doubt that he will live more than two or three weeks. When I saw him this morning, he listened calmly to my explanation of why his skin has turned yellow, and then he put his hand on mine as though to ease my burden, as though to silence me. Then he changed the subject. He inquired after my family—I have known him for over thirty years—and talked about the business awaiting him when he returned home.
“But”—Breuer drew a deep breath—“I know he will never return home. Shall I tell him that? You see, Professor Nietzsche, it is not so easy. Usually what is not asked is the important question! If he had wanted to know, he would have asked me the cause of his liver’s malfunctioning or when I planned to discharge him from hospital. But on these matters he is silent. Shall I be so hard as to tell him what he does not wish to know?”
“Sometimes,” Nietzsche responded, “teachers must be hard. People must be given a hard message because life is hard, and dying is hard.”
“Should I deprive people of their choice of how they wish to face their death? By what right, by what mandate, do I assume that role? You say that teachers must sometimes be hard. Perhaps. But the physician’s task is to reduce stress and to enhance the body’s ability to heal.”
A hard rain slashed against the window. The pane rattled. Breuer walked over and peered out. He wheeled about. “In fact, as I think about it, I’m not sure I even agree with you about a teacher’s hardness. Perhaps only a special kind of teacher—perhaps a prophet.”
“Yes, yes”—Nietzsche’s voice rose an octave in his excitement—“a teacher of bitter truths, an unpopular prophet. I think that this is what I am.” He punctuated each word of this sentence by pointing his finger into his chest. “You, Doctor Breuer, dedicate yourself to making life easy. I, on the other hand, am dedicated to making things difficult for my invisible body of students.”
“But what is the virtue of an unpopular truth, of making things difficult? When I left my patient this morning, he said to me, ‘I place myself in God’s hands.’ Who can dare to say that this, too, is not a form of the truth.”
“Who?” Now Nietzsche, too, had risen and paced on one side of the desk while Breuer paced on the other. “Who dares to say it?” He stopped, held to the back of his chair, and pointed toward himself. “I dare to say it!”
He might, Breuer thought, have been speaking from a pulpit, exhorting a congregation—but, of course, his father had been a minister.
“Truth,” Nietzsche continued, “is arrived at through disbelief and skepticism, not through a childlike wishing something were so! Your patient’s wish to be in God’s hands is not truth. It is simply a child’s wish—and nothing more! It is a wish not to die, a wish for the everlastingly bloated nipple we have labeled ‘God’! Evolutionary theory scientifically demonstrates God’s redundancy—though Darwin himself had not the courage to follow his evidence to its true conclusion. Surely, you must realize that we created God, and that all of us together now have killed him.”
Breuer dropped this line of argument as though it were a hot ingot. He could not defend theism. A freethinker since adolescence, he had often, in discussions with his father and with religious teachers, taken Nietzsche’s identical position. He sat down, and spoke in a softer, more conciliatory tone, as Nietzsche, too, returned to his own chair.
“Such fervor for the truth! Forgive me, Professor Nietzsche, if I sound challenging, but we agreed to speak truthfully. You speak about the truth in a holy tone, as though to substitute one religion for another. Allow me to play devil’s advocate. Allow me to ask: Why such passion, such reverence, for the truth? How will it profit my patient of this morning?”
“It is not the truth that is holy, but the search for one’s own truth! Can there be a more sacred act than self-inquiry? My philosophical work, some say, is built on sand: my views shift continually. But one of my granite sentences is: ‘Become who you are.’ And how can one discover who and what one is without the truth?”
“But the truth is that my patient has only a short time to live. Shall I offer him that self-knowledge?”
“True choice, full choice,” Nietzsche responded, “can blossom only in the sunshine of truth. How can it be otherwise?”
Realizing that Nietzsche could discourse persuasively—and interminably—in this abstract realm of truth and choice, Breuer saw he had to force him to speak more concretely. “And my patient this morning? What is his range of choices? Perhaps trust in God is his choice!”
“That is not a choice for man. It is not a human choice, but a grasp for an illusion outside oneself. Such a choice, a choice for the other, for the supernatural, is always enfeebling. It always makes man less than he is. I love that which makes us more than we are!”
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“Let us not talk about man in the abstract,” Breuer insisted, “but about a single flesh-and-blood man—this patient of mine. Consider his situation. He has only days or weeks to live! What sense is there in talking choice to him?”
Undaunted, Nietzsche responded instantly. “If he doesn’t know he is about to die, how can your patient make a decision about how to die?”
“How to die, Professor Nietzsche?”
“Yes, he must decide how to face death: to talk to others, to give advice, to say the things he has been saving to say before his death, to take his leave of others, or to be alone, to weep, to defy death, to curse it, to be thankful to it.”
“You still discuss an ideal, an abstraction, but I am left to minister to the singular man, to the man of flesh and blood. I know that he will die, and die in great pain in a short time. Why bludgeon him with that? Above all, hope must be preserved. And who else but the physician can sustain hope?”
“Hope? Hope is the final evil!” Nietzsche all but shouted. “In my book Human, All Too Human, I suggested that when Pandora’s box was opened, and the evils Zeus had placed therein had escaped into man’s world, there still remained, unbeknownst to anyone, one final evil: hope. Ever since then, man has mistakenly regarded the box and its contents of hope as a coffer of good fortune. But we have forgotten Zeus’s wish that man continue to allow himself to be tormented. Hope is the worst of evils because it protracts torment.”
“Your implication, then, is that one should shorten one’s dying if one wishes.”
“That is one possible choice, but only in the light of full knowledge.”
Breuer felt triumphant. He had been patient. He had allowed things to take their course. And now he would see the rewards of his strategy! The discussion was moving precisely in the direction he had wished.
“You are referring to suicide, Professor Nietzsche. Should suicide be a choice?”
Again, Nietzsche was firm and clear. “Each person owns his own death. And each should enact it in his own way. Perhaps—only perhaps—there is a right by which we can take a man’s life. But there is no right by which we can take a man’s death. That is not comfort. That is cruelty!”
Breuer persisted. “Would suicide ever be your choice?”
“Dying is hard. I’ve always felt the final reward of the dead is to die no more!”
“The final reward of the dead: to die no more!” Breuer nodded appreciatively, walked back to his desk, sat down, and picked up his pen. “May I jot that down?”
“Yes, of course. But let me not plagiarize myself. I did not just create that phrase. It appears in another book of mine, The Gay Science.”
Breuer could hardly believe his good fortune. In the past few minutes Nietzsche had mentioned both of the books Lou Salomé had given him. Though excited by this discussion and reluctant to interrupt its momentum, Breuer could not pass up the opportunity to resolve the dilemma of the two books.
“Professor Nietzsche, what you say about these two books of yours interests me greatly. How may I purchase them? A bookseller in Vienna perhaps?”
Nietzsche could hardly hide his pleasure at the request. “My publisher, Schmeitzner in Chemnitz, is in the wrong profession. His proper destiny would have been international diplomacy or, perhaps, espionage. He is a genius at intrigue, and my books are his greatest secret. In eight years he has spent nothing—not one pfennig—on publicity. He has not sent out one copy for review, nor placed one book in one bookstore.
“So, you will not find my books in any Viennese bookstore. Nor even in a Viennese home. So few have been sold I know the name of most purchasers, and I recall no Viennese among my readers. You must, therefore, contact my publisher directly. Here is his address.” Nietzsche opened his briefcase, jotted down a few lines on a scrap of paper, and handed it to Breuer. “Although I could write him for you, I would prefer, if you don’t mind, that he receive a letter from you directly. Perhaps an order from an eminent medical scientist may incite him to reveal the existence of my books to others.”
Tucking the paper into his vest pocket, Breuer replied, “This very evening I’ll send in an order for your books. But what a pity I cannot, more quickly, purchase—or even borrow—copies of them. Since I’m interested in the entire life of my patients, including their work and beliefs, your books might instruct my investigation of your condition—to say nothing of the pleasure it would be to read your work and discuss it with you!”
“Ah,” Nietzsche replied, “in that request I can assist you. My personal copies of these books are in my luggage. Let me lend them to you. I’ll bring them to your office later today.”
Grateful that his ploy had worked, Breuer wanted to give something back to Nietzsche. “To devote one’s life to writing, to pour one’s life into one’s books and then to have so few readers—awful! For the many writers I know in Vienna, that would be a fate worse than death. How have you borne it? How do you bear it now?”
Nietzsche did not acknowledge Breuer’s overture, either by smile or by tone of voice. Looking straight ahead, he said, “Where is there a Viennese who remembers there is space and time outside of the Ringstrasse? I have patience. Perhaps by the year two thousand, people will dare to read my books.” He rose abruptly. “Friday, then?”
Breuer felt rebuffed and dismissed. Why had Nietzsche so quickly grown cold? This was the second time today it had happened, the first being the footbridge incident—and each rebuff, Breuer realized, had followed his extending a sympathetic hand. What does this mean? he pondered. That Professor Nietzsche cannot tolerate others coming close or offering help? Then he recalled Lou Salomé’s warning not to try to hypnotize Nietzsche, something to do with his strong feelings about power.
Breuer allowed himself to imagine, for a moment, her response to Nietzsche’s reaction. She would not have let it pass but would have addressed it immediately and directly. Perhaps she would have said, “Why is it, Friedrich, that every time someone says something kind to you, you bite their hand?”
How ironic, Breuer reflected, that though he had resented Lou Salomé’s impertinence, here he was conjuring up her image so that she might instruct him! But he quickly let these thoughts drift away. Perhaps she could say these things. But he could not. Certainly not when the frosty Professor Nietzsche was moving toward the door.
“Yes, Friday at two, Professor Nietzsche.”
Nietzsche bowed his head slightly and strode quickly out of the office. Breuer watched from the window as he descended the steps, irritably refused a fiacre, glanced up at the darkened sky, wrapped his scarf around his ears, and trudged off down the street.
CHAPTER 7
AT THREE THE NEXT MORNING, Breuer once again felt the ground liquefy beneath him. Once again, while trying to find Bertha, he fell forty feet to the marble slab adorned with mysterious symbols. He awoke in a panic, his heart racing, his nightshirt and pillow drenched with perspiration. Taking care not to awaken Mathilde, he climbed out of bed, tiptoed to the toilet to urinate, changed into another nightshirt, turned his pillow over to the dry side, and tried to coax himself back to sleep.
But there would be no more sleep that night. He lay awake listening to Mathilde’s deep breathing. Everyone slept: all five children, as well as Louis the house servant, Marta the cook, and Gretchen the children’s nurse—all asleep but him. He stood guard for the entire house. He—the one who worked hardest and most needed rest—it fell to him to stay awake and to worry for everyone.
Now he suffered an onslaught of anxieties. Some he fended off, others kept coming. Dr. Binswanger had written from the Bellevue Sanatorium that Bertha was worse than ever. Even more unsettling was his news that Dr. Exner, a young staff psychiatrist, had fallen in love with her and transferred her care to another physician after proposing marriage to her! Had she returned his love? Surely she must have given him some sign! At least Dr. Exner had enough sense to be unmarried and to resign from the ase with alacrity. The thought of Bertha smiling at you
ng Exner in the same special way she had once smiled at him seared Breuer’s thoughts.
Bertha worse than ever! How stupid he had been to have boasted to her mother about his new hypnotic method! What must she think of him now? What must the whole medical community be saying behind his back? If only he hadn’t touted her treatment in that case conference—the very one Lou Salomé’s brother had attended! Why couldn’t he learn to keep his mouth shut? He shivered with humiliation and remorse.
Had someone guessed that he was in love with Bertha? Surely everyone had wondered why a physician would spend one to two hours every day with a patient month after month! He had known that Bertha was unnaturally attached to her father. Yet hadn’t he, her physician, exploited this attachment for his own benefit? Why else would she have loved a man of his years, of his homeliness?
Breuer cringed when he thought about the erection that always popped up whenever Bertha entered a trance. Thank God he had never given in to his feelings, never declared his love, never caressed her breasts. And then he imagined giving her a medical massage. Suddenly he was clasping her wrists firmly, extending her arms over her head, raising her nightgown, spreading her legs apart with his knees, putting his hands under her buttocks, and lifting her toward him. He had loosened his belt, and was opening his trousers when suddenly a horde of people—nurses, colleagues, Frau Pappenheim—burst into the room!
He sank deeper into the bed, ravaged and defeated. Why did he torment himself so? Over and over, he surrendered and let worries swarm over him. There was plenty of Jewish worry—the rising anti-Semitism which had blocked his university career; the emergence of Schönerer’s new party, the German National Association; the vicious anti-Semitic speeches at the meeting of the Austrian Reform Association, inciting the artisan guilds to attack Jews: finance Jews, press Jews, railway Jews, theater Jews. Only this week, Schönerer had demanded the reinstatement of the old legal restrictions on Jewish life and incited riots throughout the city. It would, Breuer knew, only worsen. Already it had invaded the university. Student bodies had recently decreed that since Jews were born “without honor,” they would henceforth not be permitted to obtain satisfaction through a duel for insults suffered. Invectives about Jew doctors had not yet been heard, but it was just a matter of time.