When Nietzsche Wept: A Novel Of Obsession

Breuer agrees to answer Nietzsche’s questions, and Nietzsche asks whether he will go blind, whether he will have his illness forever, and whether he will suffer from a progressive and fatal brain disease. Before Breuer answers the questions, he and Nietzsche discuss the ethics of whether a doctor should always be direct and reveal to the patient the full extent of their conditions; Nietzsche claims that medical ethics require total honesty, while Breuer maintains that there are exceptional circumstances in which it is best to withhold information from the patient, especially when the patient is not stable enough to handle the diagnosis or when offering the diagnosis when not asked for it would be cruel. Breuer cites an example of a patient that he will see later that day who is dying from liver failure and has only weeks to live. The man has asked Breuer about his condition and seems to know that he has limited time to live, but Breuer does not explicitly say it. Instead, they engage in small talk. Nietzsche sees this as an act of great disservice. He maintains that Breuer should tell the man the truth no matter how hard it might be for him to hear it. The discussion turns to God, which gets Nietzsche worked up. He mentions his famous line “God is dead” and then mentions passages from the two books that Breuer has obtained from Salome, The Gay Science and Human, All Too Human. Nietzsche and Breuer also disagree on the value of hope, with Breuer seeing it as an essential component to a happy life, while Nietzsche sees it as an evil that must be avoided. Breuer asks Nietzsche where he can get the books, and Nietzsche says to get them straight from the publisher. Breuer offers him a compliment for being so dedicated to his work, and the remark seems to make Nietzsche go cold. He abruptly gets up to leave, saying that he will see the doctor again at his next appointment.

That night, Breuer has the same dream he previously described to Freud, in which the ground turns to liquid and he falls exactly 40 feet before landing on a marble slab with mysterious symbols on it. After the nightmare, he cannot return to sleep. He runs through a litany of anxieties in his head, beginning with Bertha’s deteriorating condition. Breuer also remembers that a younger member of the psychiatry staff, Dr. Exner, had fallen in love with Bertha and had proposed marriage to her before recusing himself from her treatment team. This raises Breuer’s anxiety level because of jealousy. He then reflects on the antisemitism that was growing at the time in Vienna. This increases his anxiety even more, and when he looks at Mathilde, he begins to imagine her getting old and frail, and this leads him to even further anxiety about death. His thoughts shift to his meeting with Nietzsche, and he recalls some of Nietzsche’s beliefs, positions, and aphorisms. He begins to develop an admiration for Nietzsche and envies the ascetic, fiercely independent lifestyle Nietzsche lives.

The next day, Freud pays a visit to Breuer. Once they finish their meal, Breuer performs a mock academic examination of Freud on his opinion of what may be causing Nietzsche’s illness. He pretends to be a professor of Freud’s named Northnagle. Breuer uses the pseudonym Eckhart Müller for Nietzsche to protect his identity. Freud believes that Nietzsche’s condition is being caused by a brain tumor and that his vision problems that are not caused by the tumor directly could also be from macular degeneration. Breuer, posing as Northnagle, refutes Freud’s diagnosis and offers his own, that Nietzsche suffers from migraines and anemia and perhaps an edema of the cornea. Breuer drops the Northnagle act, and the two men discuss Nietzsche’s psychology. Breuer describes the question-and-answer session of his meeting with Nietzsche and some of the latter’s answers. When Freud asks about Nietzsche’s suicidal ideation, Breuer expresses uncertainty as to whether it is authentic. Freud speculates that perhaps this ideation is caused by Nietzsche’s subconscious, which Breuer dismisses with the strong suggestion that Freud keep his discussion of the subconscious, or what Breuer refers to as “the little unconscious homunculus” (82), limited to only their personal conversations, implying that others might find Freud’s ideas ridiculous. The discussion moves on to the question of how Nietzsche should be treated, and after Breuer reads Freud some passages and aphorisms from the Gay Science, Freud suggests that Breuer should approach the treatment as a kind of psychological surgery. Breuer mentions that any act of empathy pushes Nietzsche away, which most likely has to do with Nietzsche’s belief that such acts demonstrate one person’s attempt at gaining power over another. Because of his resistance, Freud suggests that Breuer mention to Nietzsche that stress is behind his health conditions, which might make the patient more amenable to discussion and could ultimately lead to a better understanding of his despair. The chapter concludes with a letter written by Elizabeth Nietzsche to her brother expressing her antipathy toward Lou Salome. Elizabeth also mentions that she does not know where Nietzsche is, and she wants his approval to bring forth a complaint against Lou that will get her deported back to Russia for living with Paul Ree while unmarried.

It is the morning of Breuer and Nietzsche’s next meeting. Mathilde prepares breakfast for her husband, and when he mentions that he may be gone all day meeting with Nietzsche, Mathilde becomes upset. The conversation turns to Eva Berger, a former nurse of Breuer’s whom he fired after Mathilde became jealous of their close relationship. Mathilde argues that Breuer tends to become too invested in his work; Breuer is somewhat dismissive of this argument, and the tension between the two once again rises. Mathilde demanded that Breuer fire his nurse on the same day that Bertha had claimed, while in psychological distress, that she was pregnant with Breuer’s baby. She was not, but Mathilde demanded that Breuer step away from her case and fire his nurse because she suspected that Breuer was not faithful.

The meeting with Nietzsche begins. Breuer tells Nietzsche what he thinks is causing the health problems, beginning with the migraine concern and the edema of the cornea. He answers Nietzsche’s three questions and lays out a medical explanation for why stress might be the cause of the migraines. Breuer hopes this will create an opening for a more in-depth conversation and essentially be a version of talk therapy. Since he knows Nietzsche is highly protective of his inner thoughts, Breuer must try a sideways approach, and he feels confident that it is working; he is getting Nietzsche to open up somewhat. When Nietzsche asks Breuer if the doctor believes he has profited from his illness, Breuer turns the question back on Nietzsche, who explains that, for two or three reasons, maybe he has. The illness got him dismissed from his professorship at Basel, and because he felt imminent death was coming for him, he worked with a strong sense of urgency. Nietzsche then tells Breuer that perhaps the mind has hidden areas that operate independently, recalling Freud’s similar theory from the previous chapter. When Breuer begins to explain his treatment protocol, the goal of which is to help Nietzsche reduce stress, Nietzsche offers immediate and strong resistance, claiming that stress is needed for his work as a philosopher and writer. He also mentions that he has reduced all non-essential stress that comes from family life, professional life, and business life. Breuer insists on revealing to Nietzsche his proposal for treatment, recommending that a stay at the hospital in Lauzon should be considered so that experimental medicines for migraines can be tried. As Breuer inches closer to revealing a version of talk therapy as treatment, he mentions that the stress of isolation is perhaps causing tension that Nietzsche does not realize. Nietzsche remains resistant, at one point mentioning that he cannot attend the clinic in Lauzon because he cannot afford it, an objection that Breuer overcomes by alluding to the fact that he is married to a woman from one of the richest families in Vienna, and that the clinic has free beds available for Breuer to use at his discretion. The chapter ends as Breuer once again recommends the treatment, this time in a decisive manner.