فصل 17

CHAPTER 17

THE NURSES AT THE LAUZON CLINIC rarely talked about Herr Müller, Dr. Breuer’s patient in room 13. There was little to say. To a busy, overworked nursing staff, Herr Müller was the ideal patient. During the first week, he had had no attacks of hemicrania. He made few demands and required little attention aside from the monitoring of vital signs—pulse, temperature, respiratory rate, and blood pressure—six times a day. The nurses regarded him—as had Frau Becker, Breuer’s nurse—as a true gentleman.

It was clear, however, that he valued his privacy. He never initiated conversation. When called upon by the staff or other patients, he spoke amiably and briefly. He chose to take his meals in his room and, after his morning sessions with Dr. Breuer (which, the nurses assumed, consisted of massage and electrical treatments), he spent most of his day alone, writing in his room or, if weather permitted, scribbling notes while strolling around the garden. About his writing, Herr Müller courteously discouraged inquiries. It was known only that he was interested in Zarathustra, an ancient Persian prophet.

Breuer was impressed by the discrepancy between Nietzsche’s gentle manner in the clinic and the shrill, often combative voice in his books. When he put the question to his patient, Nietzsche smiled and said, “It’s no great mystery. If no one will listen, it’s only natural to shout!” He seemed content with his life in the clinic. He told Breuer not only that his days were pleasant and pain-free, but also that their daily talks together were productive for his philosophy. He had always been contemptuous of philosophers like Kant and Hegel, who wrote, he said, with an academic stylus solely for the academic community. His philosophy was about life and for life. The best truths, he always said, were bloody truths, ripped out of one’s own life experience.

Before his connection with Breuer, he had never attempted to put his philosophy to practical use. He had casually dismissed the problem of application, claiming that those who could not understand him were not worth troubling with, whereas the superior specimens would find their way to his wisdom—if not now, then a hundred years later! But his daily encounters with Breuer were forcing him to take the matter more seriously.

Nevertheless, these carefree, productive Lauzon days were not so idyllic for Nietzsche as they seemed on the surface. Subterranean crosscurrents sapped his strength. Almost daily, he composed enraged, longing, desperate letters to Lou Salomé. Her image incessantly invaded his mind and diverted his energy from Breuer, from Zarathustra, and from the sheer joy of luxuriating in days free of pain.

Whether viewed from the surface or the depths, Breuer’s life during the first week of Nietzsche’s hospitalization was harried and tormented. The hours spend at the Lauzon taxed an already-burdened schedule. An invariable rule of Viennese medicine was that the worse the weather, the busier the physician. For weeks, a grim winter with unremitting gray skies, chilling blasts of northern wind, and heavy, soggy air sent patient after patient trudging in a steady stream into his examination room.

December diseases dominated Breuer’s docket: bronchitis, pneumonitis, sinusitis, tonsillitis, otitis, pharyngitis, and emphysema. In addition, there were always patients with nervous diseases. That first week of December, two new young patients with disseminated sclerosis entered his office. Breuer especially hated this diagnosis: he had no treatment whatsoever to offer for the condition and dreaded the dilemma of whether to tell his young patients about the fate lying ahead of them: increasing disability, and episodes of weakness, paralysis, or blindness that could strike at any moment.

That first week as well, two new patients appeared who had no evidence of organic pathology and who, Breuer was certain, were suffering from hysteria. One, a middle-aged woman, had, during the past two years, experienced spastic seizures whenever she was left alone. The other patient, a girl of seventeen, had a spastic disorder of the legs and could walk only by using two umbrellas as canes. At irregular intervals, she had lapses in consciousness when she shouted such strange phrases as: “Leave me! Get gone! I’m not here! It’s not me!” Both patients, Breuer believed, were candidates for the Anna O. talking treatment. But that course of treatment had taken too heavy a toll—on his time, his professional reputation, his mental equilibrium, and his marriage. Even as he was vowing never to undertake it again, he found it demoralizing to turn to the conventional, ineffective therapeutic regimen—deep muscle massage and electrical stimulation according to the precise, yet unvalidated guidelines Wilhelm Erb had worked out in his widely used Handbook of Electrical Therapeutics.

If only he could have referred these two patients to another physician! But to whom? No one wanted such referrals. In December of 1882, there was, aside from him, no one in Vienna—no one in all of Europe—who knew how to treat hysteria.

But Breuer was exhausted not by the professional demands upon him, but by the self-imposed psychological torment he was suffering. Their fourth, fifth, and sixth sessions had followed the agenda established in their third meeting: Nietzsche pressed him to confront the Existenz issues in his life, especially his concerns about purposelessness, his conformity and lack of freedom, and his fears of aging and death. If Nietzsche really wants me to become more uncomfortable, then, Breuer thought, he must be pleased by my progress.

Breuer felt truly miserable. He was growing even more estranged from Mathilde. Anxiety weighed him down. He could not free himself of the pressure in his thorax. It was as though a giant vise were crushing his ribs. His breathing was shallow. He kept reminding himself to breathe deeply; but no matter how hard he tried, he could not exhale the tension that constricted him. Surgeons had now learned to insert a thoracic tube in order to drain a patient’s pleural fluid; sometimes he imagined plunging tubes into his chest and armpits and sucking out his Angst. Night after night, he suffered from dreadful dreams and severe insomnia. After several days, he was taking more chloral for sleep than was Nietzsche. He wondered how long he could continue. Was such a life worth living? Sometimes he thought about taking an overdose of Veronal. Several of his patients had endured suffering like this for years. Well, let them do it! Let them cling to a meaningless, miserable life. Not he!

Nietzsche, supposedly there to help him, gave him little comfort. When he described his anguish, Nietzsche dismissed it as a trifle. “Of course you suffer, it’s the price of vision. Of course, you are fearful, living means to be in danger. Grow hard!” he exhorted. “You are not a cow, and I am no apostle of cud chewing.” By Monday night, one week after they had agreed upon their contract, Breuer knew that Nietzsche’s plan had gone seriously awry. Nietzsche had theorized that the Bertha fantasies were a diversionary tactic on the part of the mind—one of the mind’s “back alley” tactics to avoid facing the far more painful Existenz concerns clamoring for attention. Confront the important Existenz issues, Nietzsche had insisted, and the Bertha obsessions would simply fade away.

But they did not fade! The fantasies overran his resistance with ever greater ferocity! They demanded more from him: more of his attention, more of his future. Again, Breuer imagined changing his life, finding some way to break out of his prison—his marital-cultural-professional prison—and to flee from Vienna with Bertha in his arms.

One specific fantasy gathered strength. He imagined returning home one night to see a cluster of neighbors and firemen gathered in his street. His house is on fire! He throws his coat over his head and charges past restraining arms up the stairs into the burning house to save his family. But the flames and the smoke make rescue impossible. He loses consciousness and is rescued by firemen, who tell him his entire family have died in the fire: Mathilde, Robert, Bertha, Dora, Margarethe, and Johannes. Everyone praises his courageous attempt to save his family, everyone is aghast at his loss. He grieves deeply, his pain inexpressible. But he is free! Free for Bertha, free to escape with her, perhaps to Italy, perhaps to America, free to begin all over again.

But will it work? Is she too young for him? Are their interests the same? Will love stay? No sooner did these questions appear than the loop began again: once more he is on the street, watching his house consumed in flames!

The fantasy fiercely defended itself against interruption: once started, it had to be finished. Sometimes even in the brief interval between patients, Breuer would find himself in front of his burning house. If Frau Becker entered his office at this juncture, he pretended to be writing a note in a patient’s chart and motioned for her to leave him for a moment.

While at home, he could not look at Mathilde without suffering paroxysms of guilt for having placed her in the burning house. So he looked at her less, spent more time in his laboratory doing research with his pigeons, more evenings at the coffeehouse, played tarock with friends twice a week, accepted more patients, and returned home very, very tired.

And the Nietzsche project? He was no longer actively struggling to help Nietzsche. He took refuge in a new thought: maybe he could best help Nietzsche by letting Nietzsche help him! Nietzsche seemed to be doing well. He was not abusing drugs, he slept soundly with only a half gram of chloral, his appetite was good, he had no gastric pains, and his migraine had not returned.

Breuer now fully acknowledged his own despair and his need for help. He stopped deceiving himself; stopped pretending he was talking to Nietzsche for Nietzsche’s sake; that the talking sessions were a ploy, a clever strategy to induce him to talk about his despair. Breuer marveled at the seductiveness of the talking treatment. It drew him in; to pretend to be in treatment was to be in it. It was exhilarating to unburden himself, to share all his worst secrets, to have the undivided attention of someone who, for the most part, understood, accepted, and seemed even to forgive him. Even though some sessions made him feel worse, he unaccountably looked forward to the next with anticipation. His confidence in Nietzsche’s abilities and wisdom increased. There was no longer doubt in his mind that Nietzsche had the power to heal him—if only he, Breuer, could find the path to that power!

And Nietzsche the person? Is our relationship, Breuer wondered, still solely professional? Certainly he knows me better—or, at least, knows more about me—than anyone in the world. Do I like him? Does he like me? Are we friends? Breuer wasn’t sure about any of these questions—or about whether he could care for someone who remained so distant. Can I be loyal? Or will I, too, one day betray him?

Then something unexpected happened. After leaving Nietzsche one morning, Breuer arrived at his office to be greeted as usual by Frau Becker. She handed him a list of twelve patients, with red checks beside the names of those who had already arrived, and a crisp blue envelope on which he recognized Lou Salomé’s handwriting. Breuer opened the sealed envelope and extracted a silver-bordered card: 11 December 1882

Dr. Breuer,

I hope to see you this afternoon.

Lou

Lou! No reservations about first names with her! Breuer thought, and then realized Frau Becker was speaking.

“The Russian Fraulein strolled in an hour ago asking to see you,” explained Frau Becker, a frown creasing her usually smooth forehead. “I took the liberty of telling her about your heavy morning schedule, and she said she’d return at five. I let her know that your afternoon was just as heavily scheduled. Then she requested Professor Nietzsche’s Vienna address, but I told her I knew nothing about it, and she’d have to talk to you about that. Did I do the right thing?” “Of course, Frau Becker—as usual. But you seem perturbed?” Breuer knew that she had not only taken a great dislike to Lou Salomé during her first visit but also blamed her for the entire burdensome venture with Nietzsche. The daily visit to the Lauzon Clinic introduced such a strain into Breuer’s office schedule that he now rarely had time to pay much attention to his nurse.

“To be honest, Doctor Breuer, I was irritated by her strolling into your office, so crowded with patients already, and expecting you’d be here waiting for her and that she should be ushered in ahead of everyone else. And, on top of that, asking me for the professor’s address! Something not right about it—going behind your back and the professor’s too!” “That’s why I say you did the right thing,” said Breuer soothingly. “You were discreet, you referred her to me, and you protected our patient’s privacy. No one could have handled it better. Now, send in Herr Wittner.”

At around five fifteen, Frau Becker announced Fraulein Salomé’s arrival and, in the same breath, reminded him that five patients were still waiting to be seen.

“Whom shall I send in next? Frau Mayer has been waiting almost two hours.”

Breuer felt squeezed. He knew that Lou Salomé expected to be seen immediately.

“Send Frau Mayer in. I’ll see Fraulein Salomé next.”

Twenty minutes later, when Breuer was in the midst of writing his note on Frau Mayer, Frau Becker escorted Lou Salomé into the office. Breuer jumped to his feet and pressed to his lips the hand she offered. Since their last meeting, her image had dimmed for him. Now he was struck, once again, with what a beauty she was. How much brighter his office had suddenly become!

“Ah, gnädiges Fräulein, what a pleasure! I had forgotten!”

“Forgotten me already, Herr Doctor?”

“No, not you, just forgotten what a pleasure it is to see you.”

“Then look more carefully this time. Here, I give you this side”—Lou Salomé turned her head flirtatiously first to the right, then to the left—“and now the other—I’ve been told this is my best side. Do you think so? But now tell me—I must know—you read my little note? Were you not perhaps offended by it?” “Offended? No, of course not—though certainly chagrined at having so little time to offer you—perhaps just a quarter of an hour.” He motioned to a chair and, as she settled herself—gracefully, slowly, as though she had at her disposal all the time in the world—Breuer took the chair next to her. “You saw my full waiting room. Unfortunately, there’s no leeway in my time today.” Lou Salomé seemed unperturbed. Though she nodded sympathetically, she still gave the impression that Breuer’s waiting room could not possibly have anything to do with her.

“I must,” he added, “still visit several patients at home, and tonight I have a medical society meeting.”

“Ah, the price of success, Herr Doctor Professor.”

Breuer was still not content to leave the matter. “Tell me my dear Fraulein, why live so dangerously? Why not write ahead so I can arrange time for you? Some days I have not a free moment, and on others I am called out of town for consultation. You could have come to Vienna and been unable to meet with me at all. Why take the risk of making a trip in vain?” “All my life people have warned me about such risks. And yet thus far I have never—not once—been disappointed. Look at today, this moment! Here I am, talking with you. And perhaps I shall stay over in Vienna, and we can meet again tomorrow. So tell me, Doctor, why should I change behavior that seems to work very well? Besides, I am too impetuous, I often cannot write ahead because I do not plan ahead. I make decisions quickly and act on them quickly.

“Still, my dear Doctor Breuer,” Lou continued, serenely, “none of this is what I meant when I asked if you were offended by my note. I wondered whether you were offended by my informality, by my using my first name? Most Viennese feel threatened or naked without formal titles, but I abhor unnecessary distance. I should like you to address me as Lou.” My God, what a formidable—and provocative—woman, Breuer thought. Despite his discomfort, he saw no way to protest without allying himself with the stuffy Viennese. Suddenly he appreciated the nasty position into which he had placed Nietzsche a few days ago. Still, he and Nietzsche were contemporaries, while Lou Salomé was half his age.

“Of course, with pleasure. I shall never cast a vote for barriers between us.”

“Good, then Lou it shall be. Now, as for your waiting patients, rest assured that I have nothing but respect for your profession. In fact my friend Paul Rée and I often discuss plans for entering medical school ourselves. Thus I appreciate obligations to patients, and shall rush to the point. You’ve guessed, no doubt, that I come today with questions and important information about our patient—if, that is, you are still meeting with him. I learned from Professor Overbeck only that Nietzsche left Basel to come to consult with you. I know nothing else.” “Yes, we have met. But tell me, Fraulein, what information do you bear?”

“Letters from Nietzsche—so wild, and enraged, and confused he sometimes sounds as if he’s lost his mind. Here they are,” and she handed Breuer a sheaf of papers. “While waiting to see you today, I copied excerpts for you.”

Breuer looked at the first page, in Lou Salomé’s neat hand:

Oh the melancholy. . . where is there a sea in which one can really drown?

I lost that little that I had: my good name, the trust of a few people. I shall lose my friend, Rée—I have lost the whole year due to the terrible tortures which have hold of me even now.

One forgives one’s friends with more difficulty than one’s enemies.

Although there was much more, Breuer abruptly stopped. However fascinating Nietzsche’s words, he knew that every line he read was a betrayal of his patient.

“Well, Doctor Breuer, what do you think of these letters?”

“Tell me again about why you felt I must see them.”

“Well, I got them all at once. Paul had been withholding them from me but decided he had no right to do that.”

“But why is it urgent that I see them?”

“Read on! Look what Nietzsche says! I thought certainly a physician must have this information. He mentions suicide. Also, many of the letters are very disorganized: perhaps his rational faculties are deteriorating. And also, I am only human, all these attacks on me—bitter and painful—I can’t just shake them off. To be honest, I need your help!” “What kind of help?”

“I respect your opinion—you’re a trained observer. Do you regard me in this fashion?” She flipped through the letters. “Listen to these charges: ‘A woman without sensitivity. . . without spirit. . . incapable of love . . . undependable. . . crude in things of honor.’ Or to this one: ‘a predator clothed as a house pet,’ or to this: ‘You are a small gallows bird, and I used to think you were the embodiment of virtue and honorableness.’ ” Breuer shook his head vigorously. “No, no, of course I do not view you in this way. But in our few meetings—so brief and businesslike—how much value can my opinion be? Is that really the help you seek from me?”

“I know that much of what Nietzsche writes is impulsive, written in anger, written to punish me. You’ve talked to him. And you’ve talked about me, I’m sure. I must know what he really thinks about me. That is my request of you. What does he say about me? Does he really hate me? Does he regard me as such a monster?” Breuer sat silent for a few moments, thinking through all the implications of Lou Salomé’s questions.

“But, here I am,” she continued, “asking you more questions, and you haven’t yet answered my previous ones: Were you able to persuade him to talk to you? Do you still meet with him? Are you making progress? Have you learned to become a doctor of despair?” She paused, staring directly into Breuer’s eyes, waiting for a reply. He felt the pressure build, pressure from all sides—from her, from Nietzsche, from Mathilde, from his waiting patients, from Frau Becker. He wanted to scream.

At last, he took a deep breath and replied, “Gnädiges Fraulein, how very sorry I am to say that the only reply I can make is none at all.”

“None at all!” she exclaimed in surprise. “Doctor Breuer, I don’t understand.”

“Consider my position. Although the questions you ask me are entirely reasonable, they cannot be answered without my violating a patient’s privacy.”

“That means, then, that he is your patient, and that you are continuing to see him?”

“Alas, I cannot even answer that question!”

“But surely it is different for me,” she said, growing indignant. “I’m not a stranger or a debt collector.”

“The motives of the questioner are irrelevant. What is relevant is the patient’s right to privacy.”

“But this is no ordinary type of medical care! This entire project was my idea! I bear the responsibility for bringing Nietzsche to you to prevent his suicide. Surely I deserve to know the outcome of my efforts.”

“Yes, it’s like designing an experiment and wanting to know the outcome.”

“Exactly. You’d not deprive me of that?”

“But what if my telling you the outcome jeopardizes the experiment?”

“How could that happen?”

“Trust my judgment in this matter. Remember, you sought me out because you deemed me an expert. Therefore I ask you to treat me as an expert.”

“But Doctor Breuer, I’m not a disinterested bystander, not a mere witness at the site of an accident with morbid curiosity over the fate of the victim. Nietzsche was important to me—is still important. Also, as I mentioned, I believe I bear some responsibility for his distress.” Her voice grew shrill. “I, too, am distressed. I have a right to know.” “Yes, I hear your distress. But as a physician, I must first be concerned with my patient and align myself with him. Perhaps some day, if you go through with your own plans to become a physician, you will appreciate my position.” “And my distress? Does that count for nothing?”

“I am distressed by your distress, but I can do nothing. I must suggest you go elsewhere for help.”

“Can you supply me with Nietzsche’s address? I can contact him only through Overbeck, who may not be passing my letters to him!”

Finally, Breuer grew irritated at Lou Salomé’s insistence. The stand he must take became clearer. “You are raising difficult questions about a physician’s duty to his patients. You force me to take positions I haven’t reasoned through. But I believe, now, that I can tell you nothing—not where he lives, or the state of his condition, or even whether he is my patient. And, speaking of patients, Fraulein Salomé,” he said, getting up from the chair, “I must return to those who await me.” As Lou Salomé, too, started to rise, Breuer handed her the letters she had brought. “I must return these to you. I understand your bringing them, but if, as you say, your name is poison to him, there is no way in which I may use these letters. I believe I erred in reading them at all.” Swiftly she took the letters, wheeled, and, without a word, stormed out.

Mopping his brow, Breuer sat down again. Had he seen the last of Lou Salomé? He doubted it! When Frau Becker entered the office to ask whether she could send in Herr Pfefferman, who was coughing violently in the waiting room, Breuer asked her to wait a few minutes.

“As long as you want, Doctor Breuer, just let me know. Maybe a nice cup of hot tea.” But he shook his head and then, as she left him alone again, closed his eyes and hoped for rest. Visions of Bertha assailed him.