When Nietzsche Wept by Irvin D. Yalom
“Max, listen to me, suppose you have a patient with—Max, you’re not listening. You’re turning your head.”
“I’m listening, I’m listening,” Max insisted.
“Suppose you have a patient with prostatic enlargement and a totally obstructed urethra,” Breuer continued. “Your patient has urinary retention, his retrograde renal pressure is rising, he’s going into uremic poisoning, and yet he absolutely refuses help. Why? Maybe he has senile dementia. Maybe he’s more terrified of your instruments, your catheters, and your tray of steel sounds than of uremia. Maybe he’s psychotic and thinks you’re going to castrate him. So what then? What are you going to do?”
“Twenty years in practice,” Max replied, “it’s never happened.”
“But it could. I’m using it to make a point. If it happened, what would you do?”
“It’s his family’s decision, not mine.”
“Max, come on—you’re avoiding the question! Suppose there were no family?”
“How should I know? Whatever they do in the asylums—put him in restraints, anesthetize him, catheterize him, try to dilate his urethra with sounds.”
“Every day? Catheterize him in restraints? Come on, Max, you’d kill him in a week! No, what you would do is try to change his attitude toward you and toward treatment. It’s the same thing when you treat children. Does a child ever want to be treated?”
Max ignored Breuer’s point. “And you say you want to hospitalize him and talk to him every day—Josef, look at the time involved! Can he afford so much of your time?”
When Breuer spoke of his patient’s poverty and his plan to use the family-endowed beds and to treat him without a fee, Max grew even more concerned.
“You worry me, Josef! I’ll be frank. I’m truly worried about you. Because a pretty Russian girl whom you don’t even know talks to you, you want to treat a crazy man who doesn’t want to be treated for a condition he denies having. And now you say you want to do it for free. Tell me,” said Max, wagging his finger at Breuer, “who’s crazier, you or him?”
“I’ll tell you what’s crazy, Max! What’s crazy is for you always to bring up the money. The interest on Mathilde’s dowry keeps accumulating in the bank. And later, when we each get our share of the Altmann inheritance, you and I both will be swimming in money. I can’t begin to spend all the money that comes in now, and I know you’ve got a lot more than I have. So why bring up money? What’s the point of worrying about whether such-and-such a patient can pay me? Sometimes, Max, you don’t see past money.”
“All right, forget the money. Maybe you’re right. Sometimes I don’t know why I’m working or what’s the point of charging anyone. But, thank God, no one hears us: they’d think we were both crazy! Aren’t you going to eat the rest of your strudel?”
Breuer shook his head, and Max lifted his plate and slid the pastry onto his own.
“But, Josef, this is not medicine! The patients you treat—this professor—what’s he got? The diagnosis? A cancer of his pride? That Pappenheim girl who was afraid of drinking water, wasn’t she the one who suddenly couldn’t speak German any more, only English? And every day developed a new paralysis? And that young boy who thought he was the emperor’s son, and that lady who was afraid to leave her room. Craziness! You didn’t have the best training in Vienna to work with craziness!”
After eating Breuer’s strudel in one mammoth bite and washing it down with a second glass of slivovitz, Max resumed. “You’re the finest diagnostician in Vienna. No one in this city knows more than you about respiratory diseases or about equilibrium. Everyone knows your research! Mark my words—some day they’ll have to invite you into the National Academy. If you weren’t a Jew, you’d be a professor now, everyone knows that. But if you keep treating these crazy conditions, what will happen to your reputation? The anti-Semites will say, ‘See, see, see!’”—Max stabbed the air with his finger—“That’s why! That’s why he’s not the professor of medicine. He is not fit, he is not sound!”
“Max, let’s play chess.” Breuer jerked open the chess box and angrily spilled the pieces onto the board. “Tonight I say I want to talk to you because I’m upset, and look how you help me! I’m crazy, my patients are crazy, and I should throw them out the door. I’m ruining my reputation, I should squeeze florins I don’t need——”
“No, no! I took the money part back!”
“Is this a way to help? You don’t listen to what I ask.”
“Which is? Tell me again. I’ll listen better.” Max’s large, mobile face grew suddenly earnest.
“I had in my office today a man who needs help, who is a suffering patient—and I handled him poorly. I can’t correct the situation with this patient, Max, it’s finished with him. But I’m seeing more neurotic patients, and I have to understand how to work with them. It’s a whole new field. No textbooks. There are thousands of patients out there who need help—but no one knows how to help them!”
“I don’t know anything about this, Josef. More and more you work with thinking and the brain. I’m at the opposite end, I——” Max chortled. Breuer braced himself. “The apertures I talk to don’t talk back. But I can tell you one thing—I get the feeling you were competing with this professor, just like you used to do with Brentano in philosophy class. Do you remember the day he snapped at you? Twenty years ago and I remember like yesterday. He said, ‘Herr Breuer, why don’t you try to learn what I have to teach rather than prove how much I don’t know?’”
Breuer nodded. Max continued, “Well, that’s what your consultation sounds like to me. Even your ploy of trying to trap this Muller by quoting his own book. That wasn’t smart—how could you win? If the trap fails, he wins. If the trap works, then he’s so angry he wouldn’t cooperate anyway.”
Breuer sat silent, fingering the chess pieces while he considered Max’s words. “Maybe you’re right. You know, I felt even at the time that probably I shouldn’t have tried quoting his book. I shouldn’t have listened to Sig. I had a premonition that quoting his words to him wasn’t clever, but he kept parrying me, goading me into a competitive relationship. It’s funny, you know—all during my consultation I kept thinking of playing chess. I’d spring this trap on him, he’d get out of it and spring one on me. Maybe it was me; you say I was like that at school. But I haven’t been that way with a patient in years, Max. I think it’s something in him—he pulls it from me, maybe from everyone, and then calls it human nature. And he believes that it is! That’s where his whole philosophy goes wrong.”
“See, Josef, you’re still doing it, trying to punch holes in his philosophy. You say he’s a genius. If he’s such a genius, maybe you should learn from him instead of trying to beat him!”
“Good, Max, that’s good! I don’t like it, but it sounds right. It helps.” Breuer drew a deep breath and exhaled noisily. “Now let’s play. I’ve been thinking about a new answer to the queen’s gambit.”
Max played a queen’s gambit, and Breuer responded with a bold center-counter gambit, only to find himself in deep trouble eight moves later. Max cruelly forked Breuer’s bishop and knight with a pawn and, without looking up from the board, said, “Josef, as long as we talk such talk tonight, let me talk, too. Maybe it’s not my business, but I can’t close my ears. Mathilde tells Rachel that you haven’t touched her in months.”
Breuer studied the board for a few more minutes and, after realizing he had no escape from the fork, took Max’s pawn before answering him. “Yes, it’s bad. Very bad. But, Max, how can I talk to you about it? I might as well talk directly into Mathilde’s ear, because I know you talk to your wife, and she talks to her sister.”
“No, believe me, I can keep secrets from Rachel. I’ll tell you a secret: if Rachel knew about what’s going on with me and my new nurse, Fraulein Wittner, I’d be out on my ass—last week! It’s like you and Eva Berger—screwing around with nurses must run in the family.”
Breuer studied the chessboard. He was troubled by Max’s comme
Now Eva was gone. And he had never been able to set things right with her. After he discharged her, she never spoke to him again and had ignored his offers of money or assistance in obtaining a new position. Though he could never undo his failure to defend her against Mathilde, he determined now that he could at least defend her against Max’s accusations.
“No, Max, you’ve got it wrong. I’m no angel, but I swear I never touched Eva. She was just a friend, a good friend.”
“Sorry, Josef, I guess I just put myself in your place and then assumed that you and Eva——”
“I can see how you’d think that. We had an unusual friendship. She was a confidante, we spoke about everything together. She got a terrible reward after all those years of working for me. I should never have knuckled under to Mathilde’s anger. I should have stood up to her.”
“Is that why you and Mathilde are—you know—estranged?”
“Maybe I do hold that against Mathilde, but that’s not the real problem in our marriage. It’s much more than that, Max. But I don’t know what it is. Mathilde is a good wife. Oh, I hated the way she acted about Bertha and Eva. But in one way she was right—I paid more attention to them than to her. What happens now, though, is strange. When I look at her, I still think she’s beautiful.”
“And?”
“And I just can’t touch her. I turn away. I don’t want her to come close.”
“Maybe that’s not so uncommon. Rachel’s no Mathilde, but she’s a good-looking woman, and yet I have more interest in Fraulein Wittner—who, I must admit, looks a little like a frog. Some days when I walk down the Kirstenstrasse and see twenty, thirty whores lined up, I’m very tempted. None of them are prettier than Rachel, many have gonorrhea or syphilis, but still I’m tempted. If I knew for sure no one would recognize me, who knows? I might! Everyone gets tired of the same meal. You know, Josef, for every beautiful woman out there, there exists some poor man who is tired of shtupping her!”
Breuer never liked to encourage Max in his vulgar mode, but couldn’t help smiling at his aphorism—true in its own gross way. “No, Max, it’s not boredom. That’s not the problem for me.”
“Maybe you should get yourself checked out. Several urologists are writing about sex function. Did you read Kirsch’s paper about diabetes causing impotence? Now that the taboo about talking about it is lifted, it’s obvious that impotence is far more common than we thought.”
“Impotent I’m not,” replied Breuer. “Even though I’ve stayed away from sex, there’s lots of juice flowing. That Russian girl, for example. And I’ve had the same kind of thoughts as you about the prostitutes on Kirstenstrasse. In fact, part of the problem is I have so many sexual thoughts about another woman that I feel guilty touching Mathilde.” Breuer noticed how Max’s self-revelations made it easier for him to talk. Perhaps Max, in his own crude way, could have handled Nietzsche better than he.
“But even that’s not the main thing,” Breuer found himself continuing, “it’s something else! Something more diabolical inside me. You know, I think about leaving. I would never do it, but over and over again I think of just picking up and leaving—Mathilde, the children, Vienna—everything. I keep getting this crazy thought, and I know it’s crazy—you don’t have to tell me, Max—that all my problems would be solved if I could only find a way to get away from Mathilde.”
Max shook his head, sighed, then captured Breuer’s bishop, and began to mount an invincible queen’s side attack. Breuer settled back heavily into his chair. How was he going to live through ten, twenty, thirty more years of losing to Max’s French defense and the infernal queen’s gambit?
CHAPTER 11
BREUER, LAY IN BED that night still thinking about the queen’s gambit and Max’s commentary on beautiful women and tired men. His troubled feelings about Nietzsche had diminished. Somehow the talk with Max had helped. Perhaps, all these years, he had underestimated Max. Now Mathilde, returning from the children, climbed into bed, moved close to him, and whispered, “Good night, Josef.” He pretended to be asleep.
Rap! Rap! Rap! A pounding on the front door. Breuer looked at the clock. Four forty-five. He roused himself quickly—he never slept deeply—grabbed his robe, and started down the hall. Louis came out of her room, but he waved her back. As long as he was awake, he would answer the door.
The Portier, apologizing for waking him, said there was a man outside who wanted him for an emergency. Downstairs Breuer found an elderly man standing in the vestibule. He wore no hat and had obviously walked a long way—his breath came quickly, his hair was covered with snow, and the mucus leaking from his nose had frozen his thick mustache into a great icy broom.
“Doctor Breuer?” he asked, his voice trembling with agitation.
At Breuer’s nod, he introduced himself as Herr Schlegel, bowing his head and touching the fingers of his right hand to his forehead in an atavistic remnant of what undoubtedly had been, in better times, a smart salute. “A patient of yours in my Gasthaus is sick, very sick,” he said. “He cannot talk, but I found this card in his pocket.”
Examining the formal card Herr Schlegel handed him, Breuer found his own name and address written on one side and on the reverse:
PROFESSOR FRIEDRICH NIETZSCHE
Professor of Philology
University of Basel
His decision was instantaneous. He gave Herr Schlegel explicit instructions for fetching Fischmann and the fiacre. “And when you get back here, I’ll be dressed. You can tell me about my patient on the way to the Gasthaus.”
Twenty minutes later, Herr Schlegel and Breuer were wrapped in blankets and being driven through the cold, snowy streets. The innkeeper explained that Professor Nietzsche had been at the Gasthaus since the beginning of the week. “A very good guest. Never any problems.”
“Tell me about his sickness.”
“All week he spends most days in his room. I don’t know what he does up there. Whenever I bring his tea in the morning he’s sitting at his table scribbling. That puzzled me because, you know, I’d found out he can’t see well enough to read. Two or three days ago, a letter came for him postmarked Basel. I took it up to him, and a few minutes later he came downstairs squinting and blinking. He said he was having some eye trouble and asked if I’d read it to him. Said it was from his sister. I started, but after the first couple of lines—something about a Russian scandal—he seemed upset and asked for it back. I tried to catch a glimpse of the rest before handing it over but had time only to see the words ‘deportation’ and ‘police.’
“He takes his meals out, though my wife offered to cook for him. I don’t know where he eats—he didn’t ask me for advice. He scarcely talked, though one night he said he was going to a free concert. But he wasn’t shy, that’s not why he was quiet. I observed several things about his quietness———”
The innkeeper, who had once served ten years in military intelligence, missed his old trade and amused himself by regarding his guests as mysteries and attempting to construct a character profile from small housekeeping details. On his long walk to Breuer’s home, he had gathered together all his clues about Professor Nietzsche and rehearsed his presentation to the doctor. It was a rare opportunity: ordinarily he had no suitable audience, his wife and the other Gasthaus owners being too lumpish to appreciate real inductive skill.
But the doctor interrupted hi
“Yes, yes, Doctor.” And swallowing his disappointment, Herr Schlegel reported how around nine on Friday morning Nietzsche had paid his bill and gone out, saying he would be leaving that afternoon and would come back before noon to collect his baggage. “I must have been away from my desk for a bit because I didn’t see him come back. He walks very softly, you know, as if he doesn’t want to be followed. And he doesn’t use an umbrella, so I can’t tell from the downstairs umbrella stand if he’s in or not. I don’t think he wants anyone to know where he is, when he’s in, when he’s out. He’s good, he is—suspiciously good—at getting in and out without attracting notice.”
“And his sickness?”
“Yes, yes, Doctor. I only thought some of these points might be important for diagnosis. Well, later in the afternoon, around three o’clock, my Frau, like always, went in to clean his room, and there he was—he hadn’t left on the train at all! He was stretched out on his bed moaning, his hand on his head. She called me, and I told her to replace me at the desk—I never leave it unguarded. That’s why, you see my point, I was surprised that he got back into the room without my seeing him.”
“And then?” Breuer was impatient now—Herr Schlegel had, he decided, read one too many pulp mystery stories. Yet there was still plenty of time to indulge his companion’s obvious wish to tell all he knew. The Gasthaus in the third, or Landstrasse, district was still a mile or so ahead, and in the thickening snow visibility was so poor that Fischmann had climbed down and was now walking his horse slowly through the frozen streets.
“I went into his room and asked if he was sick. He said he wasn’t feeling well, a little headache—he’d pay for another day and leave tomorrow. He told me he often had headaches like this, and it was best if he didn’t talk or move. Nothing to be done, he said, but wait it out. He was quite frosty—he usually is, you know, but today more so, icy. No doubt about it, he wanted to be left alone.”