Diagnosing Genius: The Life and Death of Beethoven (review)

Unrelenting illness plagued Beethoven throughout his entire adult life. His disorder (or disorders) produced myriad physical and psychological torments, the etiology of which has never been diagnosed definitively. For him the most distressing consequence of his illness was its effect on the auditory nerves, which it left shrunken and useless after causing years of pain and ringing in the ears. The disorder’s most lethal effect, however, was its destruction of the liver, which it rendered fibrotic and riddled with nodules “the size of a bean” (135), causing secondary ascites, an enlarged spleen, nose bleeds, and bleeding esophageal varices. These were its dominant features. However, numerous other associated abnormalities have complicated efforts to identify a unifying diagnosis. There were decades of recurrent abdominal pain and diarrhea, attacks of bronchitis and feverish catarrhs (with no gross postmortem pulmonary pathology), repeated episodes of rheumatism, tormenting headaches, and postmortem abnormalities of the brain, pancreas, and kidneys. There were also possible episodes of smallpox and typhus, heavy alcohol consumption, a family history of alcoholism, sexual promiscuity (at least late in life), and high levels of lead detected in samples of hair analyzed over a century and a half after the composer’s death.

Professor Mai’s book is yet one more attempt to name the multifaceted disorder (or disorders) that wrecked Beethoven’s hearing and drove him into social isolation and bouts of depression. It is more ambitious than most, in that it also attempts to identify those social, physical, and genetic elements that hone genius, such as that of the great Beethoven.

Mai’s book is beautifully written and full of relevant and fascinating details about the man and the times in which he rose to greatness. It begins by describing the setting in which Beethoven lived and worked and then leads the reader through all of the important events of his life. The composer’s medical history is reviewed next in considerable detail, with liberal reference to the contemporary sources from which information about his illness is derived. In the penultimate chapter, Mai, the diagnostician, offers his thoughts as to the etiologies of Beethoven’s varied disabilities and then concludes his work with an attempt to “illuminate the puzzling relationship between genius, creativity, and the various degrees of mental abnormality” (x).

Mai is a psychiatrist. Thus it is no surprise that his most extensive and informative discourse concerns Beethoven’s eccentric behavior, social isolation, and episodes of melancholia that grew pari passu with his deafness. Unfortunately, Mai’s grasp of concepts of physical medicine is not equal to those concerning disorders of the mind. He, for instance, informs the reader that in liver failure, fluid accumulates in the legs because of “mechanical constriction of the main vein that returns blood from the legs. . .as it passes through the liver” (92), when, of course, venous blood from the legs bypasses the liver in returning to the heart via the inferior vena cava. He dismisses secondary syphilis as a disorder that “affects mainly the skin causing widespread skin rashes” (210), when in reality it is the stage of the infection characterized by a systemic vasculitis involving virtually every organ system. Even more astonishing is his contention that the calcium deposits in Beethoven’s kidneys (a condition known as “papillary necrosis”) and the composer’s shriveled auditory nerves found at autopsy were most likely the result of alcoholic liver disease and otosclerosis, respectively. If papillary necrosis is associated with alcoholic liver disease or otosclerosis ever destroys the auditory nerves, the hepatologists and otolaryngologists with whom I consulted in writing this review are unaware of such connections. Unfortunately, Mai does not cite the references upon which he bases these conclusions.

The limitations of Mai’s grasp of concepts of internal medicine are especially evident when he takes on the task of diagnosing Beethoven’s welter of physical complaints and autopsy findings. He criticizes others for their “tendency to isolate one symptom (such...