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Breuer considers the hypocrisy inherent in Nietzsche’s attempts to rid him of his obsessive thoughts about Bertha. Having seen Nietzsche’s letters to Lou, Breuer realizes that Nietzsche is contending with similar obsessions. Breuer begins the next session by describing a dream he had. Nietzsche is in the dream, dressed as a general. Breuer has dropped a razor between a crack in the floor, and each time Nietzsche tries to retrieve it, the razor becomes further lodged inside the crack. The two men then begin interpreting the symbolism of the dream, and Breuer suggests that their sessions are effectively driving the razor deeper into him rather than removing it from him. They then start discussing more practical solutions for Breuer’s obsessive thoughts about Bertha. These include reframing, thinking of her in her worst moments, pinching himself when he thinks of her, and shouting “stop” when he thinks of her. Nietzsche significantly mentions his friend Paul Ree for the first time as a way of pointing out how perceptions of the same situation yield differing realities. Breuer continues to feel as though the intellectual approach to his despair is not helping him, and when Nietzsche recommends that he look at the problem from a cosmic perspective, Breuer claims that he does not know how. He simply cannot remove himself from his obsessive thinking for long enough to perform this task of changing perception. Nietzsche continues to maintain that the power to remove obsession rests exclusively within the individual. Nietzsche also becomes more forceful with Breuer and pushes him to become angry, believing that the suppression of anger is what is causing his problems. Breuer offers excuses for Bertha and refrains from letting his anger bubble up. The meeting ends abruptly as Nietzsche says the time for excuses is over. The chapter closes with a return to excerpts from each man’s notes on the session. Breuer is becoming exasperated and concedes that, at this point, the ruse has become real: His meetings with Nietzsche are really about him trying to help himself. He recognizes the progress experienced when Nietzsche mentions Paul Ree and that he has been burned by love. He also recalls the anger and animosity that Nietzsche demonstrates in his letters to Lou, and he sees why Nietzsche would want him to express his anger. In Nietzsche’s excerpt, he elaborates on how Breuer seems preoccupied with subduing his anger. Significantly, because he feels that no progress is being made, Nietzsche begins considering whether to start speaking about his own experiences with love and obsession. Finally, the chapter closes with a letter from Nietzsche to Lou Salome. The tone is different in this one, and it is implied that Salome has been able to send him letters. Nietzsche takes the tone of her letters to be vengeful and tells her that he cannot forgive her and then wishes her well.
Breuer and Nietzsche both agree that the previous session was unsuccessful because it resembled animal training rather than a deeper inspection into the cause of Breuer’s obsession. Breuer suggests that his obsession with Bertha contains some deeper meaning, and Nietzsche pushes Breuer to fully consider what that meaning is, imploring Breuer to chimney sweep on it. Breuer mentions that the obsession means safety in addition to being a diversion against his angst. For Breuer, his obsession also means passion, mystery, and magic. He is obsessed with her smile because it shows what he perceives to be unconditional love, that no matter what his transgressions in life, he will always be sheltered by her smile. He recalls seeing that smile in a childhood friend named Mary and remarks that he does not recall seeing that smile from his mother because she died when he was three. He also points out that he has never felt that way when Mathilde smiles, even though she is beautiful. Nietzsche remarks that perhaps, after 14 years of marriage, Breuer takes Mathilde’s beauty and mystery for granted. Breuer agrees and then says that his obsession with Bertha is in part because he sees her as a conquest, as someone who belongs all to him. Bertha also represents an escape from his safe, socially approved domestic life. The conversation continues to probe deeper. Nietzsche begins to align himself with Breuer, at one point very briefly alluding to his own experiences with beauty and love. Breuer then pushes back and, without referring to her by name, talks about the time Lou Salome appeared in his office. Nietzsche immediately changes the conversation back to Breuer. Nietzsche finally points out that Bertha is an icon that Breuer has built up to help him avoid the universal human fear of being alone. The chapter once again concludes with the same first-person excerpts as previous chapters. Breuer remarks on the process that is unfolding in his talks with Nietzsche. He wonders if what is happening is a kind of mutual therapy. He also considers the future evolution of talk therapy and whether it will emanate from university philosophy departments. Nietzsche believes that the things Breuer has never told himself are now at the brink of coming out. He also argues that, though Breuer thinks what he feels for Bertha is love, it is instead prayer. For Breuer, Bertha is an idol that can be prayed to for protection against the unknown and against the advance of time. He sees his objective now as one of removing Breuer’s projected meanings of Bertha to reveal her as only herself.
Instead of holding their session at the clinic, Breuer asks Nietzsche to join him on a trip to the cemetery where he visits the graves of his parents on every sabbath day. The weather is pleasantly brisk, and Breuer suggests that after the session they go for a walk. Nietzsche agrees with the idea. When they arrive at the cemetery, Breuer points out a section of the cemetery in which the graves are not kept up. He remarks that these are the people who really know what death is since the living no longer even know who they were. Nietzsche notices that Breuer’s mother was named Bertha. He also asks why Breuer places pebbles around his parents’ graves, but Breuer has no answer. Nietzsche then asks why Breuer never told him that his mother’s name was Bertha. After Breuer responds that it never occurred to him, Nietzsche talks about the unconscious aspects of the mind, suggesting a connection between his mother and the Bertha with whom he is obsessed. Nietzsche says that Bertha is not real, that she is a manifestation of the past and the future. Their discussion eventually turns back toward Breuer’s dream, and Nietzsche helps him make connections. The marble slab that Breuer lands on in his dream is a tombstone. The Bertha in his dream is his mother. Nietzsche then reveals a dream that he had, one of the few that he can remember. In it, he is in bed with a woman, and after a struggle, he finds himself tied up in the bed sheets. Breuer remarks how different their dreams are in their perception of women; for Breuer, women rescue him, while for Nietzsche, women trap and suffocate him. Nietzsche reveals another dream, this one from his childhood, in which his father ascends from the grave, grabs a child, and then falls with it back into the grave. The possible interpretations of this dream lead to a discussion on Breuer’s father, who he says was his primary audience. Without his father around to hear him anymore, Breuer feels that nobody really hears him. They talk about death and the fear of it. Anticipating Freud’s later concept of the “death drive,” Nietzsche says that the way to remove terror from death is to “die at the right time,” which only happens when “one has consummated one’s life” (247). Nietzsche then asks Breuer if he feels he has consummated his life, and Breuer struggles to answer. Finally, Nietzsche explains to him the idea of eternal recurrence. Nietzsche posits that “eternal recurrence means that every time you choose an action you must be willing to choose it for all eternity” (251) because effectively, one will. Nietzsche tells Breuer that this is the answer to his despair and that he should live his life so that the idea of eternal recurrence imposes itself on his thought and behavior. Breuer becomes increasingly exasperated and insists that he cannot liberate himself from the life that he has chosen, which includes his sacred vows to Mathilde. Nietzsche recognizes this but then says that it is better to break his vows than to be broken by those vows. This chapter breaks from the pattern in previous chapters as only Nietzsche’s notes are provided. In it, he discusses his methods and the results of his approach to helping Breuer. He expresses concern for his friend and questions whether the reason he pushes so hard on Breuer is due to some unconscious desire to have an audience like Breuer had with his own father, which Nietzsche did not have.
At the beginning of the chapter, Breuer is releasing the pigeons he uses for research, and soon it becomes evident that he is making preparations to leave his family and his life in Vienna. He confronts Mathilde with the news that he is leaving, and she responds with an ultimatum: If he proceeds with his objective, then she will close the door on him forever. There will be no possibility of returning. Breuer considers this and then proceeds with his plan to leave. Breuer sees his leaving as an act of self-determination; rather than passively accepting his life, he is actively choosing a life for himself. For her part, Mathilde points out that while Breuer feels trapped in his life, he does not know what it’s like to be truly trapped in the way that she is, as a 36-year-old Jewish woman. Because of the social atmosphere, her options are entirely limited in a way that Breuer does not experience.
After leaving Mathilde and exiting his office, Breuer visits Max, who unsuccessfully tries to dissuade him from his plan. He departs from Max and makes his way to Kreuzlingen, Switzerland, where Bertha is institutionalized. While there, he discovers Bertha out with her new doctor, and he sees her enact the same exact behavior patterns that she did while with him. Effectively, Breuer notices that she is using her health condition as a way of seducing the new doctor, and he realizes that perhaps Nietzsche was right about her. The experience is jarring for Breuer. He then impulsively visits Eva, his former nurse, who gives him an indifferent reception, shocking him further. He wants to make things right with her, and when he asks her about the time when she apparently offered herself to him sexually, she does not remember the incident at all. Breuer realizes that this incident, powerful and memorable for him, only held significance for him as a story he has told himself. He leaves Eva and heads to Venice where he imagines himself working as a chef. He stops for a shave, and once completed, he gets a look at himself in the mirror and sees his age, a reminder of his biggest fear that his life is at a point where he is descending toward death. Just as he contemplates this fact, he hears a voice calling to him to wake up, followed by a countdown. It is Freud’s voice, waking Breuer out of the hypnosis that he has entered. The entire sequence of events of the chapter has been imagined; he has lived these experiences only in his imagination, but they have nonetheless had a profound impact on his mood. Once Breuer has come to and has discussed with Freud some of his experiences while under hypnosis, Mathilde knocks on the door. Freud leaves them alone, and Breuer embraces her. His whole disposition toward her has changed dramatically. He does not see her as an obstacle in the way toward his ideal life; instead, he has discovered a new appreciation for her that is evident throughout the remainder of the chapter. Later, Mathilde prepares a family dinner. Max is there, and Breuer speaks with him about the hypnosis experience, how it felt like he had undergone a surgery of sorts to have his obsession with Bertha removed entirely. Max speculates that the vicarious experience of losing Mathilde has made him fully appreciate the privilege of having her in his life.
The following Monday, Breuer visits Nietzsche and describes his experience with hypnosis. Nietzsche appears very interested, and he provides Breuer with his opinions on what makes a marriage doomed to fail: Essentially, when two people are too entirely dependent on each other, the marriage is destined to fail. Breuer then describes seeing Bertha and realizing that his obsession with her was really more about him and his despair than it was about her, a fact that Nietzsche had been trying to point out. Bertha had become a symbol of escape from the advance of middle age and eventually old age and death. The two then discuss the principle of amor fati, loving one’s fate. Rather than resisting mortality, even subconsciously, it is better to accept it, thus embracing life more fully. The discussion then turns even more personal. Breuer asks Nietzsche more direct questions about his own outlook, and because of the friendship they have established, Nietzsche finally opens up. He first discusses friendship and camaraderie, both of which have been lacking in his life. He discusses his view on emotional openness and reveals that he is reluctant to open up himself and to ever be in a position where others open up to him. The experience with Breuer shows Nietzsche a more positive outcome than he would have expected, and he is grateful for that.
Their regular sessions are coming to an end, and both men are sad at this fact, but Nietzsche is insistent that they must part ways. Breuer accepts this and mentions the curious words Nietzsche uttered when he was extremely ill in the guesthouse. Breuer asks about “no slot” and “help me,” and Nietzsche has no recollection of having said these things. They discuss superficially what the comments may mean, but this discussion serves as a catalyst for the deeper, truthful discussion that follows. Eventually, Breuer reveals the whole backstory of Lou Salome’s involvement in getting Breuer to treat him. Breuer shows Nietzsche the letters Salome sent him. At first, Nietzsche is furious, both at Breuer and Salome, but eventually, his anger toward Breuer dissipates and is directed exclusively at Salome. His anger subsiding, Nietzsche finally begins to examine his own childhood trauma, mentioning that after his father died, he was looked after by emotionally cold women. He recognizes this has likely influenced his reluctance to fall in love and engage in a healthy relationship with any woman. When he fell for Lou and was rejected, all his past pain returned to him, and Lou became the target for all the pain he experienced in his youth. Breuer says that Lou is to Nietzsche what Bertha was for him and that she is not the real target of his anger. Nietzsche starts to feel a headache and a migraine coming on. Breuer provides him with care and medicine. After some time, Nietzsche wants to continue the conversation, picking up on the “help me” that Breuer heard him speak. They probe into what this could mean and then wander into their impressions of Lou and her unique personality. Remembering his hypnotic dream, in which he saw Bertha behave with another doctor just as she had with him, Breuer points out that Salome did the same kinds of things with him as she did with Nietzsche. While Breuer sees no malice, Nietzsche feels anger at her. Breuer reminds him of his own experience and that the anger for Salome is a mask that hides something deeper. At long last, Breuer finally convinces Nietzsche to chimney sweep, and though Nietzsche is very resistant at first, he finally begins. He reveals that his biggest fear is to die alone, and while he insists on an isolated life, that fear is never quite too far behind him. They again talk about Salome, and when Breuer asks Nietzsche how he sees her, he says as a predator, to which Breuer reminds him that it was she who sought help on his behalf. This fact tempers Nietzsche somewhat, though he claims, in accordance with his skeptical outlook on altruism, that she only did so to make herself feel good. The emotional toll of the conversation becomes too much for Nietzsche, and he finally begins to weep. The weeping is cathartic for Nietzsche, and he understands what a truly intimate friendship is and the kind of positive impact it can have on a person if that person is able to receive the friendship without suspicion. After both men express sincere gratitude for their shared experience, they part ways.
The novel begins to ascend toward its climax as the agreed upon duration of Nietzsche and Breuer’s sessions concludes. Breuer’s Despair in Response to Mortality actually gets worse as his dialogues with Nietzsche proceed. Breuer also grows increasingly frustrated with Nietzsche the more that time passes and the more despair he feels. This is because Breuer wants practical, “how-to” advice. He wants Nietzsche to direct him toward healing and overcoming despair. Nietzsche instead insists that Breuer must figure out his own way to overcome. He says, “No, Josef, the important issue here is not for me to tell you about my way, but to help you find your way to grow out of your despair” (208). Critically, Nietzsche points out that there is no singular moment that can be reached when Breuer can finally say that he is out of despair. Nietzsche uses the phrase “grow out of your despair” to signal to Breuer that the way to overcome despair is by growing as an individual. Breuer’s resistance here is emblematic of the tension between his dual identities—as a physician and as an amateur philosopher. There is a good deal of philosophy in the nascent field of psychotherapy and therefore a good deal of ambiguity and uncertainty. Treating a wounded psyche is not like applying a mustard plaster to treat a cough, and Breuer the physician is initially impatient with the slow progress and the lack of a definitive prognosis. Nietzsche—the true philosopher—suggests taking a different perspective on his suffering, saying to Breuer, “A cosmic perspective always attenuates tragedy. If we climb high enough, we will reach a height from which tragedy ceases to look tragic” (209). When considered in the immense scope of time, Breuer understands that his problems are rather insignificant. However, he responds to Nietzsche, stating, “I know that intellectually. Still, Friedrich, such a statement as ‘a height from which tragedy ceases to look tragic’ simply does not make me feel better” (209). The disconnect between Nietzsche’s intellectual and philosophical advice and Breuer’s need for more practical guidance reveals a limitation between philosophical and psychological approaches to therapy.
In his notes that close Chapter 19, Nietzsche directly diagnoses what he sees as Breuer’s primary affliction—his Obsessive Desire for Bertha is a means of protection from the deeper fear that drives his despair. Nietzsche writes, “She is a shield against the teeth of time, offering rescue from the abyss within, safety from the abyss below. Bertha is a cornucopia of mystery, protection, and salvation! Josef Breuer calls this love. But its real name is prayer” (233). Breuer objectifies and mythologizes Bertha because it fills a void in his life. Breuer finally understands this for himself. It begins after his trip with Nietzsche to the cemetery where his parents are buried. He thinks to himself that “all motives, his and Nietzsche’s, sprang from a single source—the drive to escape death’s oblivion” (246). His understanding fully emerges when he sees Bertha while hypnotized. When he sees her behaving toward another doctor the same way she did with him, Breuer understands that the obsession he has had for her is not mutual. He understands that he has invented the whole myth. He thinks to himself,
I’m incidental, interchangeable. I’m not necessary for Bertha’s drama. None of us is—not even the leading men. Neither I, nor Durkin, nor those yet to come. He felt overwhelmed: perhaps he needed more time to absorb all this. He was tired; he leaned back, closed his eyes and sought refuge in a Bertha reverie. But nothing happened! (265).
The recognition that he was not necessary to Bertha’s life ostensibly frees him from his obsession with her.
When Breuer, under hypnosis, experiences the alternate vision that he has fantasized about, it frightens him. He learns that life is not lived elsewhere in a fantasy; instead, one must live as though each moment will happen for eternity. This is Nietzsche’s concept of eternal recurrence, and it offers a way to overcome the fear of death. Nietzsche says, “[L]ive! Death loses its terror if one dies when one has consummated one’s life! If one does not live in the right time, then one can never die at the right time” (247). Breuer finally understands what Nietzsche means after he returns from his hypnosis.
As for Nietzsche, when Breuer finally breaks through his abundant defenses, he discovers that Nietzsche struggles with the same fears. Nietzsche confesses, “Despite my bravado about being the posthumous philosopher, despite my certitude that my day will come, despite even my knowledge of eternal return—I am haunted by the thought of dying alone” (295). Soon after, Nietzsche begins to weep. Eventually, he says to Breuer, “The moment I told you I had never been touched was the very moment I first allowed myself to be touched. An extraordinary moment, as though some vast, interior icepack suddenly cracked and shattered” (300). This is an indirect allusion to Freud’s iceberg theory of the subconscious, and it reveals how the expression of inner anguish leads one to find hope. He has taught Breuer that, and in turn, he has learned that one cannot do it alone. Breuer says to Nietzsche, “Isolation exists only in isolation. Once shared, it evaporates” (300), and Nietzsche, at long last, finally understands that the path to overcoming despair is less steep when one shares it.



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