The Legend of Nietzsche’s Syphilis (review)

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 did not hesitate to offer their own diagnoses. His sister, Elisabeth, 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 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 is 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 is not clear how that information affects 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’s 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...