Friedrich Nietzsche was bipolar

Nietzsche's Disease: Genius and Madness

The mental breakdown took place in different stages.

On Sunday, January 6th, 1889, Franz Overbeck, Professor of Church History in Basel, received an unexpected visitor. His colleague Jacob Burckhardt, the well-known art historian, had rushed to see him. Jacob Burckhardt was holding a letter that he had received on the same day. The letter came from Turin, the sender was Overbeck's friend Friedrich Nietzsche. Overbeck was shocked when he read the letter:
"My venerable Jacob Burckhardt. That was the little joke that made me look after the boredom of having created a world. Now you - until you - are our greatest teacher, because I, together with Ariadne, only have the golden balance to be of all things, in every piece we have those who are above us ... Dionysus. " (17)
Overbeck rushed to the "Friedmatt" psychiatric clinic and placed the director and founder of the institute, which opened only three years ago, Professor Dr. med. Ludwig Wille, presented the letter. On Wille's urgent advice, Overbeck took the train from Basel to Turin that same day. With difficulty he found the small pension where Nietzsche lodged modestly. Seeing his friend, Nietzsche rushed to him, hugged him fiercely and, recognizing Overbeck, burst into tears. Then he sank back on the sofa with a convulsion.
Suspected diagnosis
Overbeck was now faced with the difficult task of having to bring his sick friend to the clinic in Basel. With the help of the suggestion of a young German dentist, the excited patient was transferred to the Basel clinic. (7)
"Pupils different, right larger than left, reacting very sluggishly. Strabismus convergent. Severe myopia. Tongue heavily coated; no deviation, no tremor! Facial innervation little disturbed, feels extremely comfortable and uplifted. Indicates that he has been sick for eight days and had often suffered from severe headaches. He had also had a few attacks, during which the patient felt extremely comfortable and upscale, and would have loved to hug and kiss all the people on the street, and would love to be up against the walls climbed ", was the finding of the receiving doctor (1). The diagnosis was noted: progressive paralysis. The fact that the suspected diagnosis determined the neurological examination can be seen from the stated findings. The described pupillary disorders (anisocoria and impaired pupillary reaction) and the lively self-reflexes were typical symptoms of progressive paralysis. The typical trembling of the tongue with perioral restlessness ("facial tremor") and the often noticeable dysarthric speech disorder are not yet present. The psychopathological appearance corresponded most closely to the expansive course form: megalomania with changing megalomania with largely intact orientation towards other people.
Much has been written and discussed about a possible syphilitic primary effect of Nietzsche. To anticipate the result of the discussion: Despite numerous indications, the proof of such an infection has not been successful. A visit to a brothel in Cologne from his student days in Bonn - which Thomas Mann has woven into his "Dr. Faustus" in a unique way - has led to some speculation. It is often assumed that Nietzsche was infected during his Leipzig years. In the Basel medical record there is an entry that Nietzsche stated that he was "specifically infected twice". (1) This meant that they had found evidence of a syphilis infection in the anamnesis. However, this evidence becomes uncertain again when one looks at the more recent sources. The Richard Wagner biography of Gregor-Dellin, published in 1980, is the first reproduction of a letter from a Frankfurt doctor, Dr. Otto Eiser, who examined Nietzsche in October 1877 together with an ophthalmologist. In this letter to Wagner it says: "When discussing his sexual conditions, N. not only assured that he had never been syphilitic, but he also answered my question about strong sexual arousal and any abnormal satisfaction of it in the negative. But the last point was answered in the negative touched by me only fleetingly, and I must therefore not attach too much weight to N.'s words on this page. It seems to me more valid as a counter-reason that the patient reports of gonorrhea infections during his student days - then also that he recently went to Italy medical advice wants to have exercised the coitus several times. " (5) Did Nietzsche mean gonorrhea when he stated that he had been through a "specific infection"? However, it must be taken into account that for centuries syphilis was not differentiated from gonorrhea and both were called syphilis.
Overbeck, who accompanied his friend to the clinic, froze with astonishment when Nietzsche greeted Wille in the most obliging manner of his best days and with dignified attitude: "I believe that I have seen you before, and I am very sorry that I was the only one you Name is not present, do you want - "will:" I am will ". Nietzsche (without changing a face, in that manner and in the calmest tone, continuing without any reflection): "Wille? You are a psychiatrist. I had a conversation with you about religious insanity a few years ago. The occasion was a crazy person, Adolf Vischer, who lived here at the time. " (8) What so shocked Overbeck was that Nietzsche did not bring these memories into the slightest relation to his own current situation and that there was no sign that the psychiatrist was anything to do with him: "He lets the assistant doctor who comes in calmly by prescribing one Hand over breakfast and a bath for the next one and leaves the room with him without further ado when asked to follow him... " (8th)

The following entries can be found in the Basel medical record (11):
"January 11th: Didn't sleep all night. Talked incessantly. Got up often. Breakfast with great appetite. Constant motor excitement. Occasionally lies down on the floor. Speaks confused.
January 12th: feels so infinitely at ease that he can only express this in music.
January 13th: Shows tremendous appetite, keeps asking to eat. Sing, hoot, scream.
January 14th: Constantly spoken and sung. Visit of the mother. "Mother makes a limited impression." One of the mother's brothers died in a mental hospital. The father's sisters were hysterical and a little eccentric. (Mother's information.) Father has a brain disease from falling off the stairs. At first Nietzsche talks harmlessly with his mother, then suddenly: "See in me the tyrant of Turin." Then keep talking confused.
January 15th: Very loud. Screaming and gesturing loudly.
January 17th: Paresis of the left facial nerve much more evident. Language: No detectable interference. "

Against all odds, the mother who had traveled there managed to have Nietzsche transferred to the nearest clinic in his hometown of Naumburg in Jena. The then head of the Jena clinic, Professor Otto Binswanger, had also dealt intensively with progressive paralysis. At times he came to completely different insights into the etiology of the disease and in 1894 discussed in the "Berliner Klinische Wochenzeitschrift" a psychogenic genesis, according to which the paralytic disease process "is undisputed as the consequence of a functional overexertion of the central nervous system and primarily the cerebral cortex" consider (2). Emil Kraepelin decisively contradicted Binswanger in the fifth edition of his widely used textbook "Psychiatrie" (1896), but could not yet clearly decide in favor of syphilis as the cause. This merit goes to Nietzsche's first pathobiographer P. J. Möbius. Kraepelin 1896: "Möbius also considers tabes and paralysis to be after-effects of syphilis. Unfortunately, the facts available today do not yet allow such a simple interpretation as it seems to me." (14)
Upon admission to Jena, a slightly irregularly distorted pupil is diagnosed when the somatic findings are taken. In the next few months, delusional ideas with strong states of excitement dominate the clinical picture. In October 1889 there was a certain internal and external calming down, which was interpreted as a clear remission. Against all odds, his mother took him home to Naumburg in March 1890, where she looked after him until her death in 1897.
Nietzsche's mental breakdown took place in various stages, which in the first few years were also associated with brief lightening - a course that could be observed in many paralytics. The slight remissions, however, did not represent the hoped-for start of recovery. In the fall of 1890, his mental state deteriorated rapidly. "It now seems as if madness is turning into nonsense," wrote a childhood friend to Overbeck in February 1891. (4) Nietzsche spoke very little, appeared increasingly apathetic, rarely showed a smile or any other reaction other than disproportionate admiration. In contrast to this, his appearance in those years was remarkably healthy and fresh. However, will and drive decreased.
A tabes dorsalis also developed from 1893, which is also a Quaternary manifestation of syphilis: he no longer recognized old friends, from autumn 1894 only his mother, sister and housemaid Alwine. After the mother's death in 1897, to which Nietzsche no longer reacted in any recognizable way, his sister Elisabeth took over the care. She had already set up a Nietzsche archive on the premises in Naumburg and then moved with the patient and Alwine to a representative villa in Weimar. Selected visitors were allowed to take a look at the patient, while Elisabeth Nietzsche skillfully and ingeniously acquired the rights to her brother's writings and ruled the Nietzsche archive.
Disease and work
Friedrich Nietzsche, little known until the beginning of his illness, quickly became famous. He has mostly split his readers into two camps. Ardent supporters and admirers faced the most severe critics irreconcilably. For its part, Nietzsche's illness contributed to this polarization. For some, this established a myth that can be described as genius and madness; for others, Nietzsche's illness was evidence of the pathological in his writings. Möbius ’already cited pathography ends with a warning to Nietzsche readers:" Be suspicious, because this man is a brain sick! " (15) To draw such conclusions, to retrospectively criticize the work from knowledge of the disease, is dangerous and scientifically incorrect. The work as such must be examined for its value and its message.
On the night of August 24th to 25th, 1900 Nietzsche had a stroke. On August 25, 1900, he took his last breath. An autopsy to confirm the diagnosis did not take place.

Literature from the author

Author's address
Dr. med. Johannes Wilkes
Psychiatric clinic with
University Polyclinic
Department of Children's and
Adolescent psychiatry
Schwabach system 6 and 10
91054 Erlangen

Friedrich Nietzsche's illness contributed to the polarization of his readers.