فصل 8

CHAPTER 8

EARLY MORNINGS NEVER VARIED in the Breuer household. At six, the corner baker, a patient of Breuer’s, delivered Kaisersemmel, fresh from the oven. While her husband dressed, Mathilde set the table, made his cinnamon coffee, and laid out the crisp three-hatted rolls with sweet butter and black cherry preserves. Despite the tension in their marriage, Mathilde always prepared his breakfast while Louis and Gretchen attended to the children.

Breuer, preoccupied this morning with his upcoming meeting with Nietzsche, was so busy leafing through Human, All Too Human that he scarcely looked up as Mathilde poured his coffee. He finished his breakfast in silence and then muttered that his noon interview with his new patient might extend into the dinner hour. Mathilde was not pleased.

“I hear so much talk about this philosopher I begin to worry. You and Sigi spend hours talking about him! You worked through dinner on Wednesday, yesterday you stayed in your office reading his book until the food was on the table, and today again you read him at breakfast. And now you talk again about missing dinner! The children need to see their father’s face. Please, Josef, don’t make too much of him. Like the others.” Breuer knew Mathilde was referring to Bertha, but not only to Bertha: she had often objected to his failure to set reasonable limits on the time he spent with patients. To him, commitment to a patient was inviolable. Once he took on a patient, he never shirked from providing that person with all the time and energy he felt necessary. His fees were low and, for a patient who was hard-pressed financially, he charged nothing at all. At times, Mathilde felt she had to protect Breuer from himself—that is, if she was to have any of his time and attention.

“The others, Mathilde?”

“You know what I mean, Josef.” She still would not speak Bertha’s name. “Some things, of course, a wife can understand. Your Stammtisch at the cafe—I know you must have a place to meet your friends—the tarock, the pigeons in your laboratory, the chess. But the other times—why give so much of yourself unnecessarily?” “When? What are you talking about?” Breuer knew he was being perverse, that he was guiding them toward an unpleasant confrontation.

“Think about the time you used to give to Fraulein Berger.”

With the exception of Bertha, this—of all the examples Mathilde could have given—was the one guaranteed to irritate him most. Eva Berger, his previous nurse, had worked for him for ten years or so, since the day he began his practice. His unusually close relationship with her had caused Mathilde almost as much consternation as had his relationship with Bertha. Over their years together, Breuer and his nurse had developed a friendship that transcended professional roles. Often they confided deeply personal things to one another; and when they were alone, they addressed one another by first name—possibly the only physician and nurse in all Vienna to do so, but that was Breuer’s way.

“You always misunderstood my relationship with Fraulein Berger,” Breuer replied in an icy tone. “To this day, I regret listening to you. Firing her remains one of the great shames of my life.”

Six months ago, on the fateful day when the delusional Bertha had announced that she was pregnant by Breuer, Mathilde had demanded not only that he take himself off Bertha’s case but also that he fire Eva Berger. Mathilde was enraged and mortified and wanted to cleanse every stain of Bertha from her life. And of Eva, too, whom Mathilde, knowing that her husband discussed everything with his nurse, regarded as an accomplice in the whole awful Bertha affair.

During that crisis, Breuer was so overcome with remorse, so humiliated and self-accusatory, that he acceded to all of Mathilde’s demands. Though he knew Eva was a sacrificial victim, he could not find the courage to defend her. The very next day, he not only transferred Bertha’s care to a colleague but fired the innocent Eva Berger.

“I’m sorry I brought it up, Josef. But what am I to do when I watch you withdraw more and more from me and from our children? When I ask for something from you, it’s not to plague you, but because I—we—want your presence. Consider it a compliment, an invitation.” Mathilde smiled at him.

“I like invitations—but I hate commands!” Breuer immediately regretted his words, but did not know how to retract them. He finished his breakfast in silence.

Nietzsche had arrived fifteen minutes before his twelve-o’clock appointment. Breuer found him sitting quietly in a corner of the waiting room, his wide-brimmed green felt hat on his head, his coat buttoned to his neck, his eyes closed. As they walked back into his office and settled into their chairs, Breuer attempted to put him at ease.

“Thank you for trusting me with your personal copies of your books. If any of your marginal notes contained confidential material, have no fear—I cannot decipher your script. You have a physician’s handwriting—almost as illegible as mine! Have you ever considered a career in medicine?” When Nietzsche merely raised his head at Breuer’s weak joke, Breuer continued, undaunted, “But allow me to comment on your excellent books. I did not have time to finish them yesterday, but I was fascinated and stirred by many of your passages. You write extraordinarily well. Your publisher is not only lazy, but a fool: these are books a publisher should champion with his life blood.” Nietzsche again made no reply, only bowing his head slightly to acknowledge the compliment. Careful, Breuer thought, perhaps he is of fended by compliments as well!

“But, to the business at hand, Professor Nietzsche. Forgive me for prattling on. Let us discuss your medical condition. Based on your previous physicians’ reports and my examination and laboratory studies, I am certain that your major condition is hemicrania, or migraine. I assume you have heard this before-two of your previous physicians mention it in their consultation notes.” “Yes, other physicians have told me that I have headaches with migraine characteristics: great pain, often in only one side of the head, preceded by an aura of flashing lights and accompanied by vomiting. These I certainly have. Does your use of the term go beyond that, Doctor Breuer?” “Perhaps. There have been a number of new developments in our understanding of migraine—my guess is that by the next generation we will have it under complete control. Some of the recent research addresses the three questions you posed. First, in respect to whether it will always be your fate to suffer such dreadful attacks, the data strongly indicate that migraine becomes less potent as a patient ages. You must understand that these are statistics only, referring simply to the odds—they provide no certainty about any individual case.

“Let us turn to the ‘hard one,’ as you put it, of your questions—that is, whether you have a constitutional condition like your father’s that will eventuate in death, madness, or dementia—I believe that’s the order in which you listed them?”

Nietzsche’s eyes widened, apparently in surprise at hearing his questions being so directly addressed. Good, good, Breuer thought, keep him off guard. He’s probably never had a physician who can be just as bold as he himself is.

“There is no evidence whatsoever,” he continued emphatically, “from any published study or from my own extensive clinical experience, that migraine is progressive or associated with any other brain disease. I don’t know what disease your father had—my guess is a cancer, possibly a brain hemorrhage. But there is no evidence that migraine progresses to these diseases or to any other.” He paused.

“So, before proceeding further, have I addressed your questions honestly?”

“Two of the three, Doctor Breuer. There was one other: Will I go blind?”

“I’m afraid that’s a question that cannot be answered. But I’ll tell you what I can. First, there is no evidence that your deteriorating vision is related to your migraine. I know it’s tempting to consider all symptoms as manifestation of one underlying condition, but that’s not the case here. Now, visual strain may aggravate, even precipitate a migraine attack—that’s another issue to which we will return later—but your visual problem is something entirely different. I do know that your cornea, the thin covering over the iris—here let me draw this picture. . . ” On his prescription pad, Breuer sketched the anatomy of the eye, showing Nietzsche that his cornea was more opaque than it should be, most likely because of edema, accumulated fluid.

“We don’t know the cause of this condition, but we do know that progression is very gradual and that, though your vision may become more hazy, it is unlikely you will ever be blind. I cannot be entirely certain, because the opaque condition of your cornea makes it impossible for me to see and examine your retina with my ophthalmoscope. So you understand my problem in answering your question more completely?” Nietzsche, who a few minutes before had taken off his coat and laid it in his lap along with his hat, now stood to hang both on the coat rack by the office door. As he sat down again, he exhaled loudly and appeared more relaxed.

“Thank you, Doctor Breuer. You are indeed a man of your word. Have you concealed nothing from me?”

A good opportunity, Breuer thought, to encourage Nietzsche to reveal more about himself. But I must be subtle.

“Concealed? A great deal! Many of my thoughts, feelings, reactions to you! Sometimes I wonder what a conversation would be like with a different social convention—with nothing concealed! But I give you my word I have concealed nothing of your medical condition. And you? Remember we have a reciprocal contract of honesty. Tell me, what do you conceal from me?” “Certainly nothing of my medical condition,” Nietzsche replied. “But I do conceal as much as possible of those thoughts that are not meant to be shared! You wonder about a conversation with nothing concealed—its real name is hell, I believe. To disclose oneself to another is the prelude to betrayal, and betrayal makes one sick, does it not?” “A provocative position, Professor Nietzsche. But while we are discussing disclosure, let me reveal one private thought. Our discussion on Wednesday was enormously stimulating to me, and I would welcome the opportunity for future talks with you. I have a passion for philosophy, yet studied far too little of it at university. My everyday medical practice rarely offers satisfaction for my passion—it smolders and longs for combustion.” Nietzsche smiled but made no comment. Breuer felt confident; he had prepared himself well. The rapport was building, and the interview was on course. Now he would discuss treatment: first drugs, and then some form of “talking treatment.”

“But let us turn to the treatment of your migraine. There are many new medications which have been reported effective for some patients. I am speaking of such drugs as bromides, caffeine, valerian, belladonna, amyl nitrate, nitroglycerine, colchicine, and ergot, to name but a few on the list. I see from your records that you yourself have tried some of these. Certain of them have proven effective for reasons no one understands, some because of their general analgesic or sedative properties, and some because they attack the basic mechanism of migraine.” “Which is?” Nietzsche asked.

“Vascular. Every observer agrees that the blood vessels, especially the temporal arteries, are involved in a migraine attack. They constrict vigorously and then seem to engorge. The pain may emanate from the walls of the stretched or constricted vessels themselves, or from the organs which cry for their normal blood supply, especially the membranes covering the brain—the dura mater and the pia mater.” “And the reason for this anarchy of the blood vessels?”

“Still unknown,” Breuer responded. “But I believe we will have the solution shortly. Until then, we can only speculate. Many physicians, and among these I include myself, are impressed with the underlying pathology of rhythmicity in hemicrania. In fact, some go so far as to say that the disorder in rhythm is more fundamental than the headache.” “I don’t understand, Doctor Breuer.”

“I mean that the rhythm disorder may express itself through any of a number of organs. Thus the headache itself need not be present in an attack of migraine. There may be such a thing as abdominal migraine, characterized by sharp attacks of abdominal pain, without head pain. Other patients have reported sudden episodes in which they feel suddenly despondent or elated. Some patients periodically have a sense that they have already experienced their current experiences. The French call it déjà vu—perhaps that, too, is a variant of migraine.” “And underlying the disorder of rhythm? The cause of causes? Shall we ultimately arrive at God—the final error in the false search for ultimate truth?”

“No, we may arrive at medical mysticism, but not God! Not in this office.”

“That’s good,” Nietzsche said with some relief. “It suddenly occurred to me that in speaking freely I have possibly been insensitive to your religious sentiments.”

“No danger of that, Professor Nietzsche. I suspect I am as devout a Jewish freethinker as you are a Lutheran one.”

Nietzsche smiled, more broadly than ever before, and settled even more comfortably into his chair. “If I still smoked, Doctor Breuer, now would be the time for me to offer you a cigar.”

Breuer felt decidedly encouraged. Freud’s suggestion that I emphasize stress as an underlying cause of migraine attacks is brilliant, he thought, and bound to succeed. Now I have properly set the stage. The time has come for action!

He leaned forward in his chair and spoke confidently and deliberately. “I am most interested in your question about the cause of a disordered biological rhythm. I believe, as do most authorities on migraine, that a fundamental cause of migraine lies in one’s general level of stress. Stress can be caused by a number of psychological factors—for example, upsetting events in one’s work, family, personal relationships, or sexual life. Though some consider this viewpoint unorthodox, I believe it is the wave of the future for medicine.” Silence. Breuer was unsure of Nietzsche’s reaction. On the one hand, he was nodding his head as though agreeing—but also flexing his foot, always a sign of tension.

“How does my answer strike you, Professor Nietzsche?”

“Does your position imply that the patient chooses his illness?”

Be wary, Josef, of that question! Breuer thought.

“No, that was not at all my meaning, Professor Nietzsche, although I have known patients who in some strange way profited from medical illness.”

“You mean, for example, young men who injure themselves to escape military service?”

A treacherous question. Breuer grew even more wary. Nietzsche had said that he had served in the Prussian artillery for a short time and been discharged because of a clumsy peacetime injury.

“No, something more subtle”—ach, a clumsy mistake, Breuer instantly realized. Nietzsche would take offense at the phrase. But seeing no way to rectify it, he continued. “I refer to a young man of military age who escapes the military because of the advent of some actual disease. For example”—Breuer stretched for something completely removed from Nietzsche’s experience—“tuberculosis or a debilitating skin infection.” “You have seen such things?”

“Every physician has seen such strange ‘coincidences.’ But to return to your question, I do not mean that you choose your illness—unless, of course, you profit in some way from your migraine. Do you?”

Nietzsche was silent, apparently deeply immersed in reflection. Breuer relaxed and commended himself. A good response! That’s the way to andle him. Be direct and challenging; he likes that. And phrase questions in a way that engages his intellect!

“Do I in any way profit from this misery?” Nietzsche finally responded. “I have reflected on that very question for many years. Perhaps I do profit. In two ways. You suggest that the attacks are caused by stress, but sometimes the opposite is true—that the attacks dissipate stress. My work is stressful. It requires me to face the dark side of existence, and the migraine attack, awful as it is, may be a cleansing convulsion that permits me to continue.” A powerful answer! One Breuer had not anticipated, and he scrambled to regain his balance.

“You say you profit from illness in two ways. The second?”

“I believe I profit from my poor vision. For years now, I have been unable to read the thoughts of other thinkers. Thus, separate from others, I think my own thoughts. Intellectually I have had to live off my own fat! Perhaps that’s a good thing. Perhaps that’s why I have become an honest philosopher. I write only from my own experience. I write in blood, and the best truth is a bloody truth!” “You have thus been cut off from all colleagueship in your profession?”

Another mistake! Again, Breuer caught it immediately. His question was off the point and reflected only his own preoccupation with recognition from colleagues.

“That’s of little concern to me, Doctor Breuer, especially when I consider the shameful state of German philosophy today. I long ago walked out of the halls of the academy, and did not neglect to slam the door behind me. But as I think about it, perhaps this is yet another advantage of my migraine.” “How so, Professor Nietzsche?”

“My illness has emancipated me. It was because of my illness I had to resign my position at Basel. If I were still there, I’d be preoccupied with defending myself from my colleagues. Even my first book, The Birth of Tragedy, a relatively conventional work, evoked so much professional censure and controversy that the Basel faculty discouraged students from signing up for my courses. In my last two years there, I—perhaps the best lecturer in Basel history—spoke to audiences of only two or three. I am told Hegel lamented on his deathbed that he had only one student who understood him, and even that one student misunderstood him! I am unable to claim even one misunderstanding student.” Breuer’s natural inclination was to offer support. But fearing to offend Nietzsche again, he settled for a nod of comprehension, taking care not to convey sympathy.

“And still another advantage of my illness occurs to me, Doctor Breuer: my medical condition resulted in my release from the military. There was a time when I was foolish enough to seek a dueling scar”—here Nietzsche pointed to the small scar on the bridge of his nose—“or to demonstrate how much lager I could contain. I was even so foolish to consider a military career. Remember in those early days I was without a father’s guidance. But my illness spared me all this. Even now, as I speak, I begin to think of even more fundamental ways my illness had helped me. . . ” Despite his interest in Nietzsche’s words, Breuer grew impatient. His objective was to persuade his patient to engage in a talking treatment, and he had made the offhanded comment about profiting from illness only as a prelude to his proposal. He hadn’t counted on the fertility of Nietzsche’s mind. Any question tossed to him, the smallest grain of a question, sprouted lush foliage of thought.

Nietzsche’s words flowed now. He seemed prepared to discourse for hours on the subject. “My illness has also confronted me with the actuality of death. For some time, I have believed that I had an incurable disease which would kill me at an early age. The spectre of imminent death has been a great boon: I have worked without rest because I feared I would die before I could finish what I need to write. And isn’t a work of art greater if the end is catastrophic? The taste of my death in my mouth gave me perspective and courage. It’s the courage to be myself that is the important thing. Am I a professor? A philologist? A philosopher? Who cares?” Nietzsche’s tempo increased. He seemed pleased with his flow of thoughts. “Thank you, Doctor Breuer. Talking to you has helped me consolidate these ideas. Yes, I should bless my illness, bless it. For a psychologist, personal suffering is a blessing—the training ground for facing the suffering of existence.” Nietzsche seemed fixed on some inward wision, and Breuer no longer felt that they were engaged in a conversation. He expected, at any minute, his patient to take out pen and paper and begin composing.

But, then, Nietzsche looked up and spoke to him more directly. “Do you remember, on Wednesday, my sentence of granite: ‘Become he who you are’? Today I tell you my second granite sentence: ‘Whatever does not kill me, makes me stronger.’ Thus I say again, ‘My illness is a blessing.’ ” Gone, now, was Breuer’s sense of command and conviction. He had intellectual vertigo as Nietzsche, once again, had turned everything topsy-turvy. White is black, good is bad. His miserable migraine, a blessing. Breuer felt the consultation slipping away from him. He struggled to regain control.

“A fascinating perspective, Professor Nietzsche, one I’ve never heard expressed before. But certainly we agree, do we not, that you have already reaped the major benefit of your illness? Now, today, in midlife, armed with the wisdom and the perspective that the illness begat, I am sure you can work more effectively without its interference. It has served its function, has it not?” While he was talking and collecting his thoughts, Breuer rearranged the objects on his desk: the wooden model of the inner ear, the Venetian swirled blue-and-gold glass paperweight, the bronze mortar and pestle, the prescription pad, the massive pharmaceutical formulary.

“Besides, as I understand you, Professor Nietzsche, you do not describe choosing an illness so much as you describe conquering and benefiting from one. Am I correct?”

“I do speak of conquering, or overcoming, an illness,” Nietzsche replied, “but as to choosing—I’m not sure; perhaps one does choose an illness. It depends on who the ‘one’ is. The psyche does not function as a single entity. Parts of our mind may operate independently of others. Perhaps ‘I’ and my body formed a conspiracy behind the back of my own mind. The mind is, you know, fond of back alleys and trapdoors.” Breuer was startled at the similarity of Nietzsche’s statement to Freud’s position the day before. “You suggest that there are independent walled-off mental kingdoms within our mind?” he asked.

“It is impossible to escape that conclusion. In fact, much of our life may be lived by our instincts. Perhaps the conscious mental representations are afterthoughts—ideas thought after the deed to provide us with the illusion of power and control. Doctor Breuer, once again I thank you—our conversation has presented me with an important project to consider this winter. Please forgive me for a moment.” 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?”