“But at least I am in familiar waters. I have visited this pain many times before.”
“This was a typical attack, then?”
“Typical? Typical? Let me think. For sheer intensity, I’d say this was a strong attack. Of my last hundred attacks, perhaps only fifteen or twenty were more severe. Still, there were many worse attacks.”
“How so?”
“They lasted much longer, the pain often continuing for two days. That’s rare, I know, as other doctors have said.”
“How do you explain the brevity of this one?” Breuer was fishing, trying to discover how much of the last sixteen hours Nietzsche remembered.
“We both know the answer to that question, Doctor Breuer. I am grateful to you. I know I’d still be writhing in pain on this bed if not for you. I wish there were some meaningful way I could repay you. That failing, we must rely on the currency of the realm. My feelings about debts and payment are unchanged, and I expect a bill from you commensurate with the time you have devoted to me. According to Herr Schlegel’s account—which does not suffer from lack of precision—the bill should be considerable.”
Though dismayed to hear Nietzsche return to his formal, distancing voice, Breuer said he would instruct Frau Becker to prepare the bill on Monday.
But Nietzsche shook his head. “Ach, I forgot your office is not open on Sunday, but tomorrow I plan to take the train to Basel. Is there no way we can settle my account now?”
“To Basel? Tomorrow! Surely not, Professor Nietzsche, not till this crisis is over. Despite our disagreements this past week, allow me now to function properly as your physician. Only a few hours ago, you were comatose and in a dangerous heart arrhythmia. It is more than unwise for you to travel tomorrow, it is perilous. And there’s another factor: many migraines may recur immediately if sufficient rest is not taken. Surely you have made that observation.”
Nietzsche was silent for a moment, obviously thinking over Breuer’s words. Then he nodded. “Your advice will be heeded. I agree to stay over another day and leave on Monday. May I see you on Monday morning?”
Breuer nodded. “For the bill, you mean?”
“For that, and I’d be grateful also for your consultation note and a description of the clinical measures you employed to abort this attack. Your methods should be useful to your successors, primarily Italian physicians, since I will be spending the next several months in the south. Surely the power of this attack proscribes another winter in Central Europe.”
“This is a time for rest and tranquillity, Professor Nietzsche, not for us to engage in further disputation. But please permit me to make two or three observations for you to mull over until we meet on Monday.”
“After what you have done for me this day, I am bound to listen carefully.”
Breuer weighed his words. He knew this would be his last chance. If he failed now, Nietzsche would be on the Basel train Monday afternoon. He quickly reminded himself not to repeat any of his previous mistakes with Nietzsche. Stay calm, he told himself. Don’t try to outwit him; he’s too clever by half. Don’t argue: you will lose, and even if you win, you lose. And that other Nietzsche, the one who wants to die but pleads for help, the one you promised to help—that Nietzsche is not here now. Don’t try to speak to him.
“Professor Nietzsche, let me begin by underscoring how critically ill you were last night. Your heartbeat was dangerously irregular and could have failed at any time. I don’t know the cause, I need time to evaluate it. But it was not the migraine, nor do I believe it was the overdose of chloral. I have never seen chloral produce this effect before.
“That’s the first point I want to make. The second is the chloral. The amount you took could have been fatal. It’s possible the vomiting from the migraine saved your life. I, as your physician, must be concerned about your self-destructive behavior.”
“Doctor Breuer, forgive me.” Nietzsche spoke with his head cupped in his hands and his eyes closed. “I’d resolved to hear you out entirely without interrupting, but I fear my mind is too sluggish to retain thoughts. I had best speak when ideas are still fresh. I was unwise about the chloral and should have known better from similar previous experiences. I intended to take only a single chloral tablet—it does dull the blade of the pain—and then put the bottle back in my suitcase. What undoubtedly occurred last night was that I took one pill and forgot to put the bottle away. Then as the chloral took effect, I became confused, forgot I had already taken one tablet, and took another. I must have gone through this sequence several times. This has happened before. It was foolish behavior, but not suicidal—if that’s what you mean to imply.”
A plausible hypothesis, thought Breuer. The same thing had happened to many of his elderly, forgetful patients, and he always instructed their children to dispense medications. But he did not believe the explanation sufficiently accounted for Nietzsche’s behavior. For one thing, why, even in his pain, did he forget to put the chloral back in his suitcase? Doesn’t one have responsibility even for one’s forgetfulness. No, Breuer thought, this patient’s behavior is more malignantly self-destructive than he claims. In fact, there was proof: the soft voice that said, “Living or dying—who cares?” Yet it was proof that he could not use. He had to let Nietzsche’s comment stand unchallenged.
“Even so, Professor Nietzsche, even if that were the explanation, it does not mitigate the risk. You must have a complete evaluation of your medication regime. But permit me another observation—this one about the onset of your attack. You attribute it to the weather. Without doubt that played a role: you have been a keen observer of the influence of atmospheric conditions on your migraine. But several factors are likely to act in concert to initiate a migraine attack, and for this episode I believe I bear a responsibility: it was shortly after I confronted you in a rude and aggressive fashion that your headache began.”
“Again, Doctor Breuer, I must interject. You said nothing that a good physician should not have said, that other physicians would not have said earlier and with less tact than you. You do not deserve the blame for this attack. I sensed it coming long before our last talk. In fact, I had a premonition of it even on my way to Vienna.”
Breuer hated to yield on this point. But this was not time for debate.
“I don’t want to tax you further, Professor Nietzsche. Let me merely say, then, that on the basis of your overall medical condition, I feel even more strongly than before that an extended period of thorough observation and treatment is necessary. Even though I was called in hours after its onset, I was still successful in shortening this particular attack. Had you been under observation in a clinic, I feel confident that I could have developed a regimen to abort your attacks even more completely. I urge you to accept my recommendation to enter the Lauzon Clinic.”
Breuer stopped. He had said all that was possible. He had been temperate, lucid, clinical. He could do no more. There was a long silence. He waited it out, listening to the sounds in the tiny room: Nietzsche’s breathing, his own, the whining of the wind, a footstep and a creaking board in the room above.
Then Nietzsche responded in a gentle, almost inviting, voice. “I have never met a physician like you, not one as capable, not one as concerned. Nor as personal. Perhaps you could teach me much. When it comes to learning how to live with people, I believe I must start from scratch. I am indebted to you, and believe me, I know how indebted.”
Nietzsche paused—“I’m tired and must lie down”—and stretched out on his back, his hands folded on his chest, his eyes fixed on the ceiling. “Being so indebted, I am distressed to go against your recommendation. But the reasons I gave you yesterday—was it just yesterday? It seems we’ve talked for months—those reasons were not frivolous, not simply dreamed up on the spot to oppose you. If you choose to read further in my books, you’ll see how my reasons are rooted in the very ground of my thinking, hence of my being.
“These reasons feel even stronger now—stronger today than yesterday. I don’
t know why that should be. I cannot understand much about myself today. Doubtless you are right, chloral is not good for me, certainly not a tonic for my cerebration—I’m not thinking clearly even yet. But those reasons I offered you, they feel tenfold stronger now, a hundredfold stronger.”
He turned his head to look at Breuer. “I urge you, Doctor, to cease your efforts on my behalf! To refuse your advice and your offer now, and to continue to refuse you again and again, only increases the humiliation of being so indebted to you.
“Please”—and he turned his head away again—“it is best for me to rest now—and perhaps best for you to return home. You mentioned once you have a family—I fear they will resent me, and with good cause. I know you have spent more time this day with me than with them. Until Monday, Doctor Breuer.” Nietzsche closed his eyes.
Before departing, Breuer said that should Nietzsche require him, a messenger from Herr Schlegel would bring him within the hour, even on Sunday. Nietzsche thanked him, but did not open his eyes.
As Breuer walked down the stairs of the Gasthaus, he marveled at Nietzsche’s control and resilience. Even from a sickbed, in a tawdry room still reeking with the odors of the violent upheaval of only hours ago, at a time when most migraine sufferers would be grateful simply to sit in a corner and breathe, Nietzsche was thinking and functioning: concealing his despair, planning his departure, defending his principles, urging his physician to return to his family, requesting a consultation report and a bill that was fair to his physician.
When he got to the waiting fiacre, Breuer decided that an hour’s walk home would clear his head. He dismissed Fischmann, handing him a gold florin for a hot supper—waiting in the cold was hard work—and set off through the snow-covered streets.
Nietzsche would leave for Basel on Monday, he knew. Why did that matter so much? No matter how hard he pondered this question, it seemed beyond understanding. He knew only that Nietzsche mattered to him, that he was drawn to him in some preternatural way. Perhaps, he wondered, I see something of myself in Nietzsche. But what? We differ in every fundamental way—background, culture, life design. Do I envy his life? What is there to envy in that cold, lonely existence?
Certainly, Breuer thought, my feelings about Nietzsche have nothing to do with guilt. As a physician, I have done all that duty calls for; I cannot fault myself in that regard. Frau Becker and Max were right: What other physician would have put up for any length of time with such an arrogant, abrasive, and exasperating patient?
And vain! How naturally he had said en passant—and not in empty boasting but out of full conviction—that he was the best lecturer in the history of Basel, or that perhaps people might have the courage, might dare, to read his work by the year two thousand! Yet Breuer took offense at none of this. Perhaps Nietzsche was right! Certainly his speech and his prose were compelling, and his thoughts powerfully luminous—even his wrong thoughts.
Whatever the reasons, Breuer did not object to Nietzsche’s mattering so much. Compared with the invasive, pillaging Bertha fantasies, his preoccupation with Nietzsche seemed benign, even benevolent. In fact, Breuer had a premonition that his encounter with this bizarre man might lead to something redemptive for himself.
Breuer walked on. That other man housed and hidden in Nietzsche, that man who pleaded for help: Where was he now? “That man who touched my hand,” Breuer kept saying to himself, “how can I reach him? There must be a way! But he’s determined to leave Vienna on Monday. Is there no stopping him? There must be a way!”
He gave up. He stopped thinking. His legs took over, and continued walking, toward a warm, well-lit home, toward his children and loving, unloved Mathilde. He concentrated only on breathing in the cold, cold air, warming it in the cradle of his lungs, and then releasing it in steamy clouds. He listened to the wind, to his steps, to the bursting of the fragile icy crust of snow underfoot. And suddenly, he knew a way—the only way!
His pace quickened. All the way home, he crunched the snow and, with every step, chanted to himself, “I know a way! I know a way!”
CHAPTER 12
ON MONDAY MORNING, Nietzsche came to Breuer’s office for the final stages of their business together. After carefully studying Breuer’s itemized bill to be sure nothing had been omitted, Nietzsche filled out a bank draft and handed it to Breuer. Then Breuer gave Nietzsche his clinical consultation report and suggested he read it while still in the office in case he had any questions. After scrutinizing it, Nietzsche opened his briefcase and placed it in his folder of medical reports.
“An excellent report, Doctor Breuer, comprehensive and comprehensible. And unlike many of my other reports, it contains no professional jargon, which, though offering the illusion of knowledge, is in reality the language of ignorance. And now, back to Basel. I have taken too much of your time.”
Nietzsche closed and locked his briefcase. “I leave you, Doctor, feeling more indebted to you than to any man ever before. Ordinarily, leavetaking is accompanied by denials of the permanence of the event: people say, ‘Auf Wiedersehen’—until we meet again. They are quick to plan for reunions and then, even more quickly, forget their resolutions. I am not one of those. I prefer the truth—which is that we shall almost certainly not meet again. I shall probably never return to Vienna, and I doubt you will ever be in such want of a patient like me as to track me down in Italy.”
Nietzsche tightened his grip on his briefcase and started to get up.
It was a moment for which Breuer had prepared carefully. “Professor Nietzsche, please, not just yet! There is another matter I wish to discuss with you.”
Nietzsche tensed. No doubt, Breuer thought, he has been expecting another plea to enter the Lauzon Clinic. And dreading it.
“No, Professor Nietzsche, it’s not what you think, not at all. Please relax. It is quite another matter. I’ve been procrastinating in raising this issue for reasons that will soon be apparent.”
Breuer paused and took a deep breath.
“I have a proposition to make you—a rare proposition, perhaps one never before made by a doctor to a patient. I see myself delaying. This is hard to say. I’m not usually at a loss for words. But it’s best simply to say it.
“I propose a professional exchange. That is, I propose that for the next month I act as physician to your body. I will concentrate only on your physical symptoms and medications. And you, in return, will act as physician to my mind, my spirit.”
Nietzsche, still gripping his briefcase, seemed puzzled, then wary. “What do you mean—your mind, your spirit? How can I act as physician? Is this not but another variation of our discussion last week—that you doctor me and I teach you philosophy?”
“No, this request is entirely different. I do not ask you to teach me, but to heal me.”
“Of what, may I ask?”
“A difficult question. And yet I pose it to my patients all the time. I asked it of you, and now it is my turn to answer it. I ask you to heal me of despair.”
“Despair?” Nietzsche relaxed his hold on his briefcase and leaned forward. “What kind of despair? I see no despair.”
“Not on the surface. There I seem to be living a satisfying life. But, underneath the surface, despair reigns. You ask what kind of despair? Let us say that my mind is not my own, that I am invaded and assaulted by alien and sordid thoughts. As a result, I feel self-contempt, and I doubt my integrity. Though I care for my wife and my children, I don’t love them! In fact, I resent being imprisoned by them. I lack courage: the courage either to change my life or to continue living it. I have lost sight of why I live—the point of it all. I am preoccupied with aging. Though every day I grow closer to death, I am terrified of it. Even so, suicide sometimes enters my mind.”
On Sunday, Breuer had rehearsed this answer often. But today it had been—in a strange way, considering the underlying duplicity of the plan—sincere. Breuer knew he was a poor liar. Though he had to conceal the big lie—that his proposal was a ploy to engage Nietzsche in
treatment—he had resolved to tell the truth about everything else. Hence, in his speech, he presented the truth about himself in slightly exaggerated form. He also tried to select concerns that might in some way interlace with some of Nietzsche’s own, unspoken concerns.
For once, Nietzsche appeared truly astounded. He shook his head slightly, obviously wanting no part of this proposal. Yet he was having difficulty formulating a rational objection.
“No, no, Doctor Breuer, this is impossible. I cannot do this, I’ve no training. Consider the risks—everything might be made worse.”
“But, Professor, there is no such thing as training. Who is trained? To whom can I turn? To a physician? Such healing is not part of the medical discipline. To a religious leader? Shall I take the leap into religious fairy tales? I, like you, have lost the knack for such leaping. You, a Lebens-philosopher, spend your life contemplating the very issues that confound my life. To whom can I turn if not to you?”
“Doubts about yourself, wife, children? What do I know about these?”
Breuer responded at once. “And aging, death, freedom, suicide, the search for purpose—you know as much as anyone alive! Aren’t these the precise concerns of your philosophy? Aren’t your books entire treatises on despair?”
“I can’t cure despair, Doctor Breuer. I study it. Despair is the price one pays for self-awareness. Look deeply into life, and you will always find despair.”
“I know that, Professor Nietzsche, and I don’t expect cure, merely relief. I want you to advise me. I want you to show me how to tolerate a life of despair.”
“But I don’t know how to show such things. And I have no advice for the singular man. I write for the race, for humankind.”
“But, Professor Nietzsche, you believe in scientific method. If a race, or a village, or a flock has an ailment, the scientist proceeds by isolating and studying a single prototypic specimen and then generalizing to the whole. I spent ten years dissecting a tiny structure in the inner ear of the pigeon to discover how pigeons maintain their equilibrium! I could not work with pigeonkind. I had to work with individual pigeons. Only later was I able to generalize my findings to all pigeons, and then to birds and mammals, and humans as well. That’s the way it has to be done. You can’t conduct an experiment on the whole human race.”