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Richard Schain, The Legend of Nietzsche's Syphilis

Contributions in Medical Studies, no. 46. Westport, Conn.: Greenwood Press, 2001. xiii + 130 pp. Ill. $62.95 (0-313-31940-5)

Reviewed by Brian Domino

Nietzsche, it seems, was as much a patient as a philosopher. "Diets, hydrotherapies, physical therapies, electrotherapies, all kinds of medications, and home remedies were tried by him at different times" (19), all to little or no avail. Friends and family didn't hesitate to offer their own diagnoses. His sister Elizabeth thought his breakdown in 1890 was the culmination of too much work and excessive use of somniferous drugs (2). Less charitably, Richard Wagner thought that Nietzsche's debilitating illnesses were due to masturbation (22). The diagnosis now fixed in popular lore, however, is that Nietzsche's collapse was due to syphilis of the brain, a diagnosis shared with the world by the prominent neurologist Paul Möbius, who in 1902 published a tell-all account entitled Nietzsche's Pathology (xi).

Richard Schain belongs among a growing number of medically trained scholars who have all but rebuked the long held notion that Nietzsche's dementia originated in a syphilitic infection. Because the serological test for syphilis was not developed until several years after Nietzsche died, and curiously no autopsy was performed on him, there may never be a definitive answer. Schain's own diagnosis is that Nietzsche suffered from chronic schizophrenia. Other candidates include frontotemporal dementia and slowly growing right-sided retro-orbital meningioma.

Pathographies of historically important people are of course somehow intrinsically interesting. Getting the "facts" right is no easy task. As Foucault warned, medical terms and categories are not fixed and often not even objective even in a straightforward sense. Schizophrenia was not a recognized clinical entity during Nietzsche's lifetime (75), whereas the cause of Nietzsche's father's death, a "brain softening," has no counterpart in today's medical lexicon. More generally, it's easy to forget how rapidly medicine has developed. For example, the clinical use of something as basic as the thermometer began during Nietzsche's college days. Schain carefully describes these and other surprisingly frequent problems in reading Nietzsche's medical records a little more than a century later.

The important question for Nietzsche scholars is whether this diagnostic controversy has any interpretative bearing. We know, for example, that Nietzsche suffered from insomnia but it's not clear how that information impacts how one interprets Nietzsche. Of course dementia of any kind is a far more serious condition and seems to bring with it textual implications. But what exactly are those implications? Möbius warned: "If you find pearls [in Nietzsche's writings], don't think that they all are genuine. Be suspicious, because this man has a sickness of the brain" (81). Being suspicious is always good hermeneutic advice, but why should the author's mental condition ruffle the reader? Möbius' pearl analogy suggests that readers will mistakenly adopt bad ideas as good ones, but this happens even with a sane author. More generally, to believe that a reader needs to know about the author's mental condition seems to require adhering to the following assumptions (among others): the insane are always insane, the reader cannot separate the ideas of a lunatic from those of a genius, the ideas of the insane are always deleterious, and knowing that the author was insane will allow the reader to accurately assay the baccated text. Aside from the fact that the first and third assumptions obviate the fourth, they are all false. Why, then, would an interpreter of Nietzsche's works care whether he suffered a progressive and rapid loss of mental acuity?

What separates Schain's account from every other known to me is that he addresses this hermeneutic question head-on. His argument begins already in the introduction, by asserting the easily accepted claims that mind-body dualism is false in any relevant sense, and that "if Nietzsche's brain were infested with spirochetes, it would function differently than if it were not so contaminated" (xi). Schain notes that the difference could be a positive one, as those who thought that the spirochetes produced a disinhibition that unleashed Nietzsche's innate genius believed (33). Others point to the grandiose claims in Ecce Homo as evidence of the negative effects of the disinhibition. Schain handily dismisses both claims: "Whatever one may think of the ideas expressed in these late works, there can be no doubt that the author is in full command of his mode of expression. There is no decline in organizing ability and certainly not of intelligence; it has been pointed out that his works of 1888 are more consistently theme oriented than his earlier works" (38). Anyone wishing to dismiss the works of 1888 as the products of undiluted madness will have a difficult time responding to the passel of evidence Schain brings to bear on this question.

By the end of the book, the hermeneutic-psychiatric question has morphed into: Is it important whether Nietzsche had syphilis or schizophrenia? If Nietzsche had syphilis, then Schain avers, "it was an acquired disease that put the stamp on Nietzsche's thought; his ideas were a consequence of general paresis" (104). The problem for Schain is not that Nietzsche's oeuvre thereby becomes the manifestation of a disease, but that syphilis is an exogenous disease. Thus, Nietzsche is Nietzsche because of, say, a chance sexual encounter with a syphilitic, which means that Nietzsche is Nietzsche because of something decidedly not Nietzsche. Schain doesn't go as far as to say that schizophrenia is endogenous, but suggests that it develops in individuals with a "constitutional vulnerability" (105) for it. By this expression, I take Schain to mean genetically predisposed. Someone genetically predisposed to schizophrenia will not necessarily develop the disease; that requires the addition of environmental factors, which is to say external events. Even if schizophrenia were discovered to be entirely genetic, it's unclear how that improves our estimation of Nietzsche as it would mean that Nietzsche is Nietzsche because of the chance concatenation of various traits. If one is willing to go down this reductive path, why is that any better or worse than attributing Nietzsche's Nietzsche-ness to spirochetes?

Although I disagree with Schain on the hermeneutic value of any diagnosis, I nonetheless recommend that anyone interested in Nietzsche read his book. Perhaps because of the combination of its focus on the medicinal and its compact length, The Legend gives the reader the best idea of the conditions under which Nietzsche worked. It is all too easy to forget how quickly medicine has advanced since Nietzsche's day. For example, while at Pforta, Nietzsche's headaches were treated with leeches, cupping, and Spanish flies attached behind each ear (8); the first two treatments he continued later in life (19). When Nietzsche writes to Dr. Eiser in 1880 that he is suffering from what feels like sea-sickness and from bouts of vomiting (26), we might forget that he couldn't go to the corner drugstore for meclizine and an antiemetic. More profoundly, the extensive descriptions of Nietzsche while a "patient" at the Friedmatt asylum made me realize that even after two decades of studying Nietzsche, I had fallen into the very trap he warned us about in Ecce Homo and subconsciously inverted his preference "to be even a satyr to being a saint" (EH Preface 1). Perhaps Schain is right after all.

Miami University