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

After more than two centuries, we remain intrigued by the figure of Beethoven as man and artist. We still ask how the composer, whose life was affected by a range of afflictions both physical and psychological that might well have crushed most people, nonetheless remained so prodigiously energetic and productive in his creative life.

Central to this study by psychiatrist François Martin Mai is an exploration of the relationship of Beethoven’s medical biography to his creative drive. There is certainly much material to address. The superbly gifted though admittedly eccentric composer was understandably preoccupied with all aspects of his health. Besides deafness, he dealt with chronic and distressing gastrointestinal disorders, intermittent respiratory ailments, eye inflammation so serious that at one point he feared blindness, rheumatoid symptoms, and, to be sure, a range of psychiatric symptoms such as recurrent depression, anxiety, suspiciousness, and outbursts of temper. Mai offers a systematic and lucid review in the context of the evolving medical culture of the composer’s time, including detailed discussions of specific (and now obsolete) programs of treatment Beethoven himself undertook. This review adds fresh perspective on the impact of the quest for health on Beethoven’s quality of life, hours and methods of work, relationships, and even recreation. Strikingly, the composer emerges as a stoic but far from passive sufferer. The romantic archetype of the afflicted artist is to some extent at variance with Beethoven’s immense ego strength and his active and long-sustained attempts to heal.

Mai derives medical evidence mostly from primary sources –Beethoven’s letters and Conversation Books, friends’ and physicians’ reports, and the 1827 autopsy report. He also ponders the implications of the now-famous 1990s discovery of toxic levels of lead in the composer’s hair. Though cautious about drawing final conclusions, he believes that Beethoven’s auditory symptoms were most consistent with a diagnosis of otosclerosis; that he probably had irritable bowel syndrome; and that he did not have syphilis, as has sometimes been alleged. Examining Beethoven’s immediate cause of death – cirrhosis of the liver – draws Mai into an etiological inquiry that not only is intriguing reading but functions as a unifying linchpin in his study.

In Beethoven’s psychological history, Mai finds a youth who possessed exceptional gifts, musical and mental. (Although as the result of a deficient general education he could not do simple multiplication, his iq is estimated by some to have been around 165.) Though intense by nature and at times socially difficult, he did not have an early-onset personality disorder per se. Rather, Beethoven’s behavioural problems began to be noticeable in his early thirties, and they worsened progressively as a result of the psychological and social consequences of increasing deafness, affective disorder, and apparently the misuse of alcohol. The evidence for this last matter is conflicting and long-disputed. Mai, however, makes an important distinction between alcohol abuse, which can lead to serious and recurrent legal or interpersonal problems,and alcohol dependence, in which a susceptible person might drink sufficiently to cause liver damage without taking so much as to cause profound behavioural or neurological effects. Clearly, Beethoven was not a drunkard, but Mai concludes that numerous factors support the case that the composer had a dependency on alcohol as a coping mechanism that likely contributed to his terminal liver disease. This part of Mai’s total psycho-medical portrait is given a full frame of reference in his review of recent medical literature on creativity. He reminds us how often greatly creative personalities have endured serious physio- or psychopathologies and yet produced astounding work. The inner strength of the creative drive in certain of these individuals can be so massive that it demands and achieves expression even in the face of seemingly insuperable obstacles. Although, as in the case of his deafness, his ailments caused Beethoven much grief and radically altered his life and career, he deliberately responded by channelling all of his...