When Nietzsche Wept

A Novel Of Obsession


By Irvin D. Yalom

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In nineteenth-century Vienna, a drama of love, fate, and will is played out amid the intellectual ferment that defined the era. Josef Breuer, one of the founding fathers of psychoanalysis, is at the height of his career. Friedrich Nietzsche, Europe’s greatest philosopher, is on the brink of suicidal despair, unable to find a cure for the headaches and other ailments that plague him.

When he agrees to treat Nietzsche with his experimental “talking cure,” Breuer never expects that he too will find solace in their sessions. Only through facing his own inner demons can the gifted healer begin to help his patient. In When Nietzsche Wept, Irvin Yalom blends fact and fiction, atmosphere and suspense, to unfold an unforgettable story about the redemptive power of friendship.


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Some cannot loosen their own chains and can nonetheless redeem their friends.

You must be ready to burn yourself in your own flame: how could you become new, if you had not first become ashes?

Thus Spake Zarathustra


THE CHIMES OF SAN SALVATORE broke into Josef Breuer’s reverie. He tugged his heavy gold watch from his waistcoat pocket. Nine o’clock. Once again, he read the small silver-bordered card he had received the day before.

21 October 1882

Doctor Breuer,

I must see you on a matter of great urgency. The future of German philosophy hangs in the balance. Meet me at nine tomorrow morning at the Café Sorrento.

Lou Salomé

An impertinent note! No one had addressed him so brashly in years. He knew of no Lou Salomé. No address on the envelope. No way to tell this person that nine o’clock was not convenient, that Frau Breuer would not be pleased to breakfast alone, that Dr. Breuer was on vacation, and that “matters of urgency” had no interest for him—indeed, that Dr. Breuer had come to Venice precisely to get away from matters of urgency.

Yet here he was, at the Café Sorrento, at nine o’clock, scanning the faces around him, wondering which one might be the impertinent Lou Salomé.

“More coffee, sir?”

Breuer nodded to the waiter, a lad of thirteen or fourteen with wet black hair brushed sleekly back. How long had he been daydreaming? He looked again at his watch. Another ten minutes of life squandered. And squandered on what? As usual he had been daydreaming about Bertha, beautiful Bertha, his patient for the past two years. He had been recalling her teasing voice: “Doctor Breuer, why are you so afraid of me?” He had been remembering her words when he told her that he would no longer be her doctor: “I will wait. You will always be the only man in my life.”

He berated himself: “For God’s sake, stop! Stop thinking! Open your eyes! Look! Let the world in!”

Breuer lifted his cup, inhaling the aroma of rich coffee along with deep breaths of cold Venetian October air. He turned his head and looked about. The other tables of the Café Sorrento were filled with breakfasting men and women—mostly tourists and mostly elderly. Several held newspapers in one hand and coffee cups in the other. Beyond the tables, steel-blue clouds of pigeons hovered and swooped. The still waters of the Grand Canal, shimmering with the reflections of the great palaces lining its banks, were disturbed only by the undulating wake of a coasting gondola. Other gondolas still slept, moored to twisted poles which lay askew in the canal, like spears flung down haphazardly by some giant hand.

“Yes, that’s right—look about you, you fool!” Breuer said to himself. “People come from all over the world to see Venice—people who refuse to die before they are blessed by this beauty.”

How much of life have I missed, he wondered, simply by failing to look? Or by looking and not seeing? Yesterday he had taken a solitary walk around the island of Murano and, at an hour’s end, had seen nothing, registered nothing. No images had transferred from his retina to his cortex. All his attention had been consumed with thoughts of Bertha: her beguiling smile, her adoring eyes, the feel of her warm, trusting body and her rapid breathing as he examined or massaged her. Such scenes had power—a life of their own; whenever he was off guard, they invaded his mind and usurped his imagination. Is this to be my lot forever? he wondered. Am I destined to be merely a stage on which memories of Bertha eternally play out their drama?

Someone rose at the adjoining table. The shrill scrape of the metal chair against the brick roused him, and once again he searched for Lou Salomé.

There she was! The woman walking down the Riva del Carbon, entering the café. Only she could have written that note—that handsome woman, tall and slim, wrapped in fur, striding imperiously toward him now through the maze of tight-packed tables. And as she neared, Breuer saw that she was young, perhaps even younger than Bertha, possibly a schoolgirl. But that commanding presence—extraordinary! It would carry her far!

Lou Salomé continued toward him with no trace of hesitation. How could she be so sure it was he? His left hand quickly stroked the reddish bristles of his beard lest bits of breakfast roll still clung there. His right hand pulled down the side of his black jacket so that it didn’t hunch up around his neck. When she was only a few feet away, she stopped for an instant and gazed boldly into his eyes.

Suddenly Breuer’s mind ceased its chattering. Now looking required no concentration. Now retina and cortex cooperated perfectly, allowing the image of Lou Salomé to pour freely into his mind. She was a woman of uncommon beauty: powerful forehead, strong, sculpted chin, bright blue eyes, full and sensuous lips, and carelessly brushed silver-blond hair gathered lackadaisically in a high bun, exposing her ears and her long, graceful neck. He noticed with particular pleasure the wisps of hair that had escaped the gathering bun and stretched out recklessly in every direction.

In three more strides, she was at his table. “Doctor Breuer, I am Lou Salomé. May I?”—gesturing toward the chair. She sat down so quickly that Breuer had no time to offer her a proper greeting—to rise, to bow, to kiss her hand, to pull out her chair.

“Waiter! Waiter!” Breuer snapped his fingers crisply. “A coffee for the lady. Café latte?” He glanced toward Fräulein Salomé. She nodded and, despite the morning chill, removed her fur wrap.

“Yes, a cafè latte.”

Breuer and his guest sat silent for a moment. Then Lou Salomé looked directly into his eyes and began: “I have a friend in despair. I’m afraid he’ll kill himself in the very near future. It would be a great loss for me, and a great personal tragedy because I would bear some responsibility. Yet I could endure and overcome it. But”—she leaned toward him, speaking more softly—“such a loss could extend far beyond me: this man’s death would have momentous consequences—for you, for European culture, for all of us. Believe me.”

Breuer stared to say, “Surely you exaggerate, Fräulein,” but could not utter the words. What would have seemed adolescent hyperbole in any other young woman seemed different here, something to be taken seriously. Her sincerity, her flow of conviction were irresistible.

“Who is this man, your friend? Do I know of him?”

“Not yet! But in time we shall all know him. His name is Friedrich Nietzsche. Perhaps this letter from Richard Wagner to Professor Nietzsche may serve to introduce him.” She extracted a letter from her bag, unfolded it, and offered it to Breuer. “I should first tell you that Nietzsche knows neither that I am here nor that I possess this letter.”

Fräulein Salomé’s last sentence gave breuer pause. Should I read such a letter? This Professor Nietzsche doesn’t know she’s showing it to me—or even that she has possession of it! How has she obtained it? Borrowed it? Stolen it?

Breuer took pride in many of his attributes. He was loyal and generous. His diagnostic ingenuity was legend: in Vienna, he was the personal physician of great scientists, artists, and philosophers like Brahms, Brücke, and Brentano. At forty, he was known throughout Europe, and distinguished citizens from all over the West traveled great distances to consult him. Yet more than anything, he took pride in his integrity—not once in his life had he committed a dishonorable act. Unless perhaps he could be held accountable for his carnal thoughts of Bertha, thoughts that rightfully should be directed to his wife, Mathilde.

So he hesitated to take the letter in Lou Salomé’s outstretched hand. But only briefly. Another glance into her crystalline blue eyes and he opened it. It was dated 10 January 1882 and began: “My friend, Friedrich”; several paragraphs had been circled.

You have now given to the world a work that is unequaled. Your book is characterized by an assurance so consummate as to betoken the most profound originality. In what other way could my wife and I have realized the most ardent wish of our lives, which was that some day something might come to us from without and take full possession of our hearts and souls! Each of us has read your book twice—once alone during the day, and then aloud in the evening. We fairly fight over the one copy and regret that the promised second one has not yet arrived.

But you are ill! Are you also discouraged? If so, how gladly would I do something to dispel your despondency! How shall I begin? I can do no other than lavish my unqualified praise upon you.

Accept it, at least, in a friendly spirit, even though it leave you unsatisfied.

Heartfelt greetings from yours,

Richard Wagner

Richard Wagner! For all his Viennese urbanity, for all his familiarity and ease with the great men of his time, Breuer was dazzled. A letter, and such a letter, written in the master’s own hand! But he quickly regained his composure.

“Very interesting, my dear Fräulein, but now please tell me precisely what I can do for you.”

Leaning forward again, Lou Salomé rested her gloved hand lightly on Breuer’s hand. “Nietzsche is sick, very sick. He needs your help.”

“But what’s the nature of his illness? What are his symptoms?” Breuer, flustered by the touch of her hand, was now pleased to coast in familiar waters.

“Headaches. First of all, tormenting headaches. And continued bouts of nausea. And impending blindness—his vision has been gradually deteriorating. And stomach trouble—sometimes he cannot eat for days. And insomnia—no drug can offer him sleep, so he takes dangerous amounts of morphia. And dizziness—sometimes he is seasick on dry land for days at a time.”

Long lists of symptoms were neither novelty nor enticement for Breuer, who usually saw twenty-five to thirty patients a day and had come to Venice precisely for a reprieve from such fare. Yet such was Lou Salomé’s intensity that he felt compelled to attend closely.

“The answer to your question, my dear lady, is yes, of course, I will see your friend. That goes without saying. After all, I am a physician. But, please, allow me to pose a question. Why don’t you and your friend take a more direct route to me? Why not simply write to my office in Vienna requesting an appointment?” And with that, Breuer looked around for the waiter to bring his check, and thought how pleased Mathilde would be by his returning to the hotel so quickly.

But this bold woman was not to be put off. “Doctor Breuer, a few more minutes, please. I can’t exaggerate the seriousness of Nietzsche’s condition, the depth of his despair.”

“I don’t doubt that. But I ask again, Fräulein Salomé, why doesn’t Herr Nietzsche consult with me in my office in Vienna? Or visit a physician in Italy? Where is his home? Would you like me to provide a referral to a physician in his own city? And why me? For that matter, how did you know I was in Venice? Or that I am a patron of the opera and admire Wagner?”

Lou Salomé was unruffled, and smiled as Breuer began to fire questions at her, her smile growing mischievous as the fusillade went on.

“Fräulein, you are smiling as though you have a secret. I think you are a young lady who enjoys mysteries!”

“So many questions, Doctor Breuer. It’s remarkable—we have conversed for only a few minutes, and yet there are so many perplexing questions. Surely that bodes well for future conversations. Let me tell you more about our patient.”

Our patient! As Breuer marveled again at her audacity, Lou Salomé continued, “Nietzsche has exhausted the medical resources of Germany, Switzerland, and Italy. No physician has been able to comprehend his malady or relieve his symptoms. In the last twenty-four months, he tells me, he has seen twenty-four of Europe’s best physicians. He has given up his home, left his friends, resigned his university professorship. He has become a wanderer in search of a tolerable climate, in quest of a day or two’s relief from pain.”

The young woman paused, lifting her cup to sip while keeping her gaze fixed on Breuer.

“Fräulein, in my consulting practice, I often see patients with unusual or puzzling conditions. But let me speak honestly: I have no miracles at my disposal. In such a situation as this—blindness, headaches, vertigo, gastritis, weakness, insomnia—where many excellent physicians have been consulted and found wanting, there is little likelihood I can do more than become his twenty-fifth excellent physician in as many months.”

Breuer leaned back in his chair, took out a cigar, and lit it. He blew out a thin blue fume of smoke, waited for the air to clear, then continued, “Again, however, I extend my offer to examine Herr Professor Nietzsche in my office. But it well may be that the cause and cure of a condition as intractable as his seems to be are beyond the reach of eighteen hundred and eighty-two’s medical science. Your friend may have been born a generation too soon.”

“Born too soon!” She laughed. “A prescient remark, Doctor Breuer. How often have I heard Nietzsche utter that very phrase! Now I am certain you are the right physician for him.”

Despite his readiness to leave, and his recurring vision of Mathilde, fully dressed and impatiently pacing their hotel room, Breuer immediately expressed interest. “How so?”

“He often terms himself a ‘posthumous philosopher’—a philosopher for whom the world isn’t yet ready. In fact, the new book he is planning begins with that theme—a prophet, Zarathustra, bursting with wisdom, decides to enlighten the people. But no one understands his words. They aren’t ready for him, and the prophet, realizing that he’s come too soon, returns to his solitude.”

“Fräulein, your words intrigue me—I have a passion for philosophy. But my time today is limited, and I have yet to hear a direct answer to the question of why your friend does not consult me in Vienna.”

“Doctor Breuer”—and Lou Salomé looked directly into his eyes—“forgive my imprecision. Perhaps I am unnecessarily indirect. I’ve always enjoyed basking in the presence of great minds—perhaps because I need models for my own development, perhaps I simply like to collect them. But I do know I feel privileged to converse with a man of your depth and range.”

Breuer felt himself flush. He could not hold her gaze any longer and looked away as she continued.

“What I mean to say is that perhaps I am guilty of being indirect simply to prolong our time here together.”

“More coffee, Fräulein?” Breuer signaled the waiter. “And more of these droll breakfast rolls. Have you ever reflected upon the difference between German and Italian baking? Allow me to describe my theory about the concordance of bread and national character.”

So Breuer did not hurry back to Mathilde. And as he took a leisurely breakfast with Lou Salomé, he mused upon the irony of his situation. How strange that he had come to Venice to undo the damage done by one beautiful woman and now sat tête-à-tête with another even more beautiful! He also observed that, for the first time in months, his mind was free of his obsession with Bertha.

Perhaps, he mused, there’s hope for me, after all. Perhaps I can use this woman to crowd Bertha off the stage of my mind. Can I have discovered a psychological equivalent of pharmacologic replacement therapy? A benign drug like valerian can replace a more dangerous one like morphine. Likewise, perhaps Lou Salomé for Bertha—that would be a happy progression! After all, this woman is more sophisticated, more realized. Bertha is—how to say it?—presexual, a woman manqué, a child twisting awkwardly in a woman’s body.

Yet Breuer knew that Bertha’s presexual innocence was precisely what drew him to her. Both women excited him: thinking about them brought a warm vibration to his loins. And both women frightened him: each dangerous, but in different ways. This Lou Salomé frightened him because of her power—of what she might do to him. Bertha frightened him because of her submissiveness—because of what he might do to her. He trembled when he thought of the risks he had taken with Bertha—how close he had come to violating the most fundamental rule of medical ethics, to bringing ruin upon himself, his family, his entire life.

Meanwhile he was so deeply engaged in conversation and so entirely charmed by his young breakfast companion that at last it was she, not he, who reverted to her friend’s illness—specifically to Breuer’s comment about medical miracles.

“I am twenty-one years old, Doctor Breuer, and have given up all belief in miracles. I realize that the failure of twenty-four excellent physicians can only mean we have reached the limits of contemporary medical knowledge. But don’t mistake me! I have no illusions that you can cure Nietzsche’s medical condition. That was not why I sought your help.”

Breuer put down his coffee cup and blotted his mustache and beard with his napkin. “Forgive me, Fräulein, now I am truly confused. You began, did you not, by saying you wanted my help because your friend is very sick?”

“No, Doctor Breuer, I said I had a friend who is in despair, who is in grave danger of taking his life. It is Professor Nietzsche’s despair, not his corpus, that I ask you to heal.”

“But, Fräulein, if your friend is in despair over his health and I have no medical therapeutics for him, what can be done? I cannot minister to a mind diseased.”

Breuer took Lou Salomé’s nod to mean she had recognized the words of Macbeth’s physician, and continued, “Fräulein Salomé, there is no medicine for despair, no doctor for the soul. There is little that I can do except to recommend one of a number of excellent therapeutic spas in Austria or Italy. Or perhaps a talk with a priest or some other religious counselor, a family member—perhaps a good friend.”

“Doctor Breuer, I know that you can do more. I have a spy. My brother, Jenia, is a medical student who attended your clinic earlier this year in Vienna.”

Jenia Salomé! Breuer tried to recall the name. There were so many students.

“Through him I learned of your love of Wagner, that you would be vacationing this week at the Amalfi Hotel in Venice, and also how to recognize you. But, most important of all, it was through him that I learned that you are, indeed, a doctor for despair. Last summer he attended an informal conference where you described your treatment of a young woman called Anna O.—a woman who was in despair and whom you treated with a new technique, a ‘talking cure’—a cure based on reason, on the unraveling of tangled mental associations. Jenia says you are the only physician in Europe who can offer a true psychological treatment.”

Anna O.! Breuer started at the name, and spilled coffee as he lifted the cup to his lips. He dried his hand with his napkin, hoping that Fräulein Salomé hadn’t noticed the accident. Anna O., Anna O.! It was incredible! Everywhere he turned, he encountered Anna O.—his secret code name for Bertha Pappenheim. Fastidiously discreet, Breuer never used his patients’ true names when discussing them with students. Instead, he constructed a pseudonym by moving a patient’s initials back one letter in the alphabet: thus B.P. for Bertha Pappenheim became A. O., or Anna O.

“Jenia was extraordinarily impressed with you, Doctor Breuer. When he described your teaching conference and your cure of Anna O., he said he was blessed to be able to stand in the light of genius. Now, Jenia is no impressionable lad. I’ve never heard him speak like that before. I resolved then that I should one day meet you, know you, perhaps study with you. But my ‘one day’ became more immediate when Nietzsche’s condition worsened over the past two months.”

Breuer looked around. Many of the other patrons had finished and left, but here he sat, in full retreat from Bertha, speaking to an astonishing woman whom she had brought into his life. A shiver, a chill, passed through him. Was there to be no refuge from Bertha?

“Fräulein”—Breuer cleared his throat and forced himself to continue—“the case your brother described was just that—a single case in which I used a highly experimental technique. There is no reason to believe that this particular technique would be helpful with your friend. In fact, there is every reason to believe it wouldn’t.”

“Why so, Doctor Breuer?”

“I’m afraid time does not permit a long answer. For now I shall simply point out that Anna O. and your friend have very different illnesses. She was afflicted with hysteria and suffered from certain disabling symptoms, as your brother may have described to you. My approach consisted of systematically wiping out each symptom by helping my patient to recall, with the help of mesmerism, the forgotten psychic trauma in which it originated. Once the specific source was uncovered, the symptom dissolved.”

“Suppose, Doctor Breuer, we consider despair to be a symptom. Couldn’t you approach it in the same manner?”

“Despair is not a medical symptom, Fräulein; it is vague, imprecise. Each of Anna O. ’s symptoms involved some discrete part of her body; each was caused by the discharge of intracerebral excitation through some neural causeway. Insofar as you’ve described it, your friend’s despair is entirely ideational. No treatment approach exists for such a condition.”

For the first time, Lou Salomé hesitated. “But, Doctor Breuer”—again she placed her hand on his—“before your work with Anna O., there was no psychological treatment for hysteria. As I understand it, physicians used only baths or that horrid electrical treatment. I’m convinced that you, perhaps only you, could devise such a new treatment for Nietzsche.”

Suddenly Breuer noticed the time. He had to get back to Mathilde. “Fräulein, I shall do everything in my power to help your friend. Please allow me to give you my card. I shall see your friend in Vienna.”

She glanced only briefly at the card before placing it in her purse.

“Doctor Breuer, I’m afraid it is not so simple. Nietzsche is not, shall I say, a cooperative patient. In fact, he doesn’t know that I’m speaking to you. He is an intensely private person and a proud man. He’ll never be able to acknowledge his need for help.”

“But you say he speaks openly of suicide.”

“In every conversation, in every letter. But he doesn’t ask for help. Were he to know of our conversation, he would never forgive me, and I’m certain he would refuse to consult with you. Even if, somehow, I were to persuade him to consult with you, he’d limit the consultation to his bodily ailments. Never—not in a thousand years—would he place himself in the position of asking you to alleviate his despair. He has strong opinions about weakness and power.”

Breuer began to feel frustrated and impatient. “So, Fräulein, the drama becomes more complex. You want me to meet with a certain Professor Nietzsche, whom you consider to be one of the great philosophers of our age, in order to persuade him that life—or, at least, his life—is worth living. And, moreover, I must accomplish this without our philosopher knowing it.”

Lou Salomé nodded, exhaled deeply, and sat back in her chair.

“But how is it possible?” he continued. “Simply to accomplish the first goal—to cure despair—is in itself beyond the reach of medical science. But this second condition—that the patient be treated surreptitiously—transfers our enterprise to the realm of the fantastic. Are there other obstacles you have yet to reveal? Perhaps Professor Nietzsche speaks only Sanskrit—or refuses to leave his hermitage in Tibet?”

Breuer felt giddy but, noticing Lou Salomé’s bemused expression, quickly controlled himself. “Seriously, Fräulein Salomé, how can I do this?”

Now you see, Doctor Breuer! Now you see why I sought out you rather than a lesser man!”

The bells of San Salvatore pealed the hour. Ten o’clock. Mathilde would be anxious by now. Ah, but for her.… Breuer again motioned to the waiter. As they waited for the check, Lou Salomé issued an unusual invitation.

“Doctor Breuer, will you be my guest for breakfast tomorrow? As I mentioned before, I bear some personal responsibility for Professor Nietzsche’s despair. There is a great deal more I must tell you.”

“Tomorrow is, I regret, impossible. It’s not every day that a lovely woman invites me to breakfast, Fräulein, but I am not free to accept. The nature of my visit here with my wife makes it inadvisable to leave her again.”

“Let me then suggest another plan. I’ve promised my brother to visit him this month. In fact, until just recently I had planned to travel there with Professor Nietzsche. Permit me, when I am in Vienna, to provide you with more information. Meanwhile, I shall try to persuade Professor Nietzsche to consult with you professionally about his deteriorating physical health.”

They walked together out of the café. Only a few patrons lingered as the waiters cleared away the tables. As Breuer prepared to take his leave, Lou Salomé took his arm and started to walk with him.

“Doctor Breuer, this hour has been too short. I am greedy and desire more of your time. May I walk with you back to your hotel?”

The statement struck Breuer as bold, masculine; yet from her lips it seemed right, unaffected—the natural way people should talk and live. If a woman enjoys a man’s company, why shouldn’t she take his arm and ask to walk with him? Yet what other woman he knew would have uttered those words? This was a different sort of woman. This woman was free!

Never have I so regretted declining an invitation,” Breuer said, pressing her arm closer to him, “but it is time for me to return, and to return alone. My loving but concerned wife will be waiting at the window, and I have a duty to be sensitive to her feelings.”


On Sale
Aug 6, 2019
Page Count
320 pages
Basic Books

Irvin D. Yalom

About the Author

Irvin D. Yalom, MD, is professor emeritus of psychiatry at the Stanford University School of Medicine. He was the recipient of the 1974 Edward Strecker Award and the 1979 Foundations’ Fund Prize in Psychiatry. He is the author of When Nietzsche Wept (winner of the 1993 Commonwealth Club gold medal for fiction); Love’s Executioner, a memoir; Becoming Myself, a group therapy novel; The Schopenhauer Cure; and the classic textbooks Inpatient Group Psychotherapy and Existential Psychotherapy, among many other books. He lives in Palo Alto, California.

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