[Gurdur]

[born out of a flamewar on RDF]
Everyone "knows" Nietzsche had syphilis and he went mad from it, except most likely Nietzsche never had it, and it is very unlikely indeed it caused him to go mad. It's like how everyone "knows" Lucrezia Borgia was a poisoner, and she caught syphilis from her brother Cesare, except most likely Lucrezia never had syphilis, and it is quite likely she never poisoned anyone, and it is likely she never even went to bed with Cesare.

Now, syphilis used to be much more widespread and virulent. Though only for around 50 years or so after its outbreak in 1494. At the time of its main epidemic, it rivalled the Black Plague for ferocity, though less for transmission.

But that period of spread, virulence and speed of morbidity was a hell of a long time before Nietzsche's time, that initial period having ended somewhere around 1545 or so. By Nietzsche's time, 1844 to 1900, it did not have the virulence it had before, and was rather slow in morbidity, as it is today. I am not aware of any significant differences between the syphilis of say around 1870 and of today; if you know of any, then please inform me, since I would be quite interested. If there are no differences between the syphilis of today and of the time of Nietzsche, then such differences are irrelevant.

Syphilis roared out of nowhere in 1495, was a terrible and fast epidemic killer for fifty years, then quietened down to become a very slow killer. There are a large number of very good books on the emergence of syphilis. Most likely (though there is still a huge amount of medical and scientific debate about this) it came over as a mutated pinta infection with some of the sailors of Christopher Columbus' ships. There is a good albeit small book on it by Desowitz, "Who Gave Pinta To The Santa Maria?", a very interesting collection of small essays on epidemology. There are a number of other good books which are much more detailed and lengthy, and deal only with the sudden emergence. Like the Black Death, yellow fever, the Athenian plague and so on, it's all good clean fun.

Now let's get on to Nietzsche. We can use a summary of his condition easily accessible to all here to do this with.

Nietzsche's health difficulties:

Born 1844. His father was Carl Ludwig Nietzsche, who was born in 1813, and died when IIRC Nietzsche was 4, in 1849, of an unspecified "brain ailment". So let's start the analysis: Nietzsche's father carks it aged what, between 35 and 36. Pretty damned young. So do we look for something genetic? But then Nietzsche suffered his own crisis in 1889, which would have made him aged roughly 44, which is already almost 10 years after the time period of his father's death. Nietzsche's crisis was also not immediately fatal; he went on to live another ten years, and had good periods interspersing his overall illness and a slow debilitory course till his death in 1900.

His early health difficulties in life were "moments of shortsightedness that left him nearly blind, migraine headaches, and violent indigestion" all since "early childhood" (quoted from the Wikipedia article).

So immediately one thinks of chronic migraine, which can easily cause all those symptoms, but very importantly, so can a lot of other things cause these symptoms. One would easily be tempted to think of a blood vessel deformation in or near the brain, or an arachnoid cyst. But such a blood vessel deformation would probably blow out at some stage in a big way, and be quite lethal when it did; since Nietzsche surivived his famous crisis by ten years, it is really unlikely to be that. An arachnoid cyst is more plausible, but it would seem odd to then, after around 40 years of life, to blow out in a crisis, then sort of just stumble on for ten years. So as a diagnosis of his crisis in 1889, it is not compelling. So we are left with a long history of migraines, cause unknown.

Nietzsche then had a bad fall accident while riding a horse in 1868. Can't have been good, but wasn't lethal, and his crisis was in 1889, 21 years afterwards. We can probably ignore it. We know that he worked as a medical orderly in 1870 to 1871 in the war, and contacted diphtheria and dysentery at the time, which can't have been nice at all, but he survived both. Neither could have plausibly caused his crisis in 1889. So we discount those as well. It is speculated (by Walter Kaufmann et al) that 1870 to 1871 was the period where he caught syphilis, and it sounds speciously attractive as a diagnosis, with the army life and prostitutes and all; but as we shall see here a bit later, syphilis is not a good match for his symptoms.

Now, do Nietzsche's published works hint of madness? Do they give any clues? Well, not really at all. Seperately, a biographer named Joachim Köhler has claimed Nietzsche was gayer than a row of tents, and that it plays a part; it does not look to me as if Köhler has established a good case for either claim at all (i.e., Nietzche is unlikely to have been gay, and even if he was, it most likely played no part at all in his medical crisis). Around about the time Nietzsche lived and wrote, it was often quite common to write very perfervidly, very emotionally, with a good deal of overstated sentiment. The fact that Nietzsche did so in stretches too does not mean he was cuckoo, it only means to some extent he was a creature of his time. His writings cannot really be adduced as examples of mania either, since they don't have the incoherence of a genuine, highly manic state.

As for whether he talked himself into "madness", well now, while it can happen (people can voluntarily obsess themselves into being kinkier than a gila monster on angeldust), it is very unlikely in Nietzsche's case; the form of his crisis in 1889 does not match any such conclusion. But Nietzsche did have several periods of severe illness before this, and sometimes what appears to be depressive interludes with suicidal ideation.

Then, in 1899, at the age of around 44 or so, he has a sudden crisis. What happens? From Wikipedia again:

On January 3, 1889, Nietzsche .... Two policemen approached him after he caused a public disturbance in the streets of Turin. What actually happened remains unknown, but the often-repeated tale states that Nietzsche witnessed the whipping of a horse at the other end of the Piazza Carlo Alberto, ran to the horse, threw his arms up around its neck to protect the horse, and then collapsed to the ground.

In the following few days, Nietzsche sent short writings — known as the Wahnbriefe ("Madness Letters")—to a number of friends (including Cosima Wagner and Jacob Burckhardt). To his former colleague Burckhardt, Nietzsche wrote: "I have had Caiaphas put in fetters. Also, last year I was crucified by the German doctors in a very drawn-out manner. Wilhelm, Bismarck, and all anti-Semites abolished." Additionally, he commanded the German emperor to go to Rome in order to be shot and summoned the European powers to take military action against Germany.

On January 6, 1889 Burckhardt showed the letter he had received from Nietzsche to Overbeck. The following day Overbeck received a similarly revealing letter, and decided that Nietzsche's friends had to bring him back to Basel. Overbeck traveled to Turin and brought Nietzsche to a psychiatric clinic in Basel. By that time Nietzsche appeared fully in the grip of a serious mental illness, .....

Now take a look at that. There is an emotional incident, the alleged protecting of a horse from being whipped, followed by a sudden physical collapse. Very soon after that physical collapse, he goes off his head and writes to various people he actually knows.

I will continue the rest in my next post, since there is a lot to get through, and since this is very long already.

[Makbawehuh]

Sounds to me like he was just pissed off. My mom and I pull that kind of shit every time something major happens... Except we don't write directly to heads of countries. We just shout in letters and online that they ought to be shot.

[Gurdur]

Originally Posted by Makbawehuh

Sounds to me like he was just pissed off. My mom and I pull that kind of shit every time something major happens... Except we don't write directly to heads of countries. We just shout in letters and online that they ought to be shot.

* resists making diagnoses *

_______________

Will post 2nd part of piece on Nietzsche and syphilis very soon.

[Makbawehuh]

Diagnosis: Hair-Triggered Tempers.

On a more serious note, my mom defines it in terms of "When you get kicked around so much, the only right and proper thing to do is kick it back until it stops. Then you get a little peace."

So far it seems to be working. *eyes the long list of people who have called her a tenacious, evil, foul-tempered bitch* *notes that all of them are much less verbally violent now than they were when she first met them...*

[Gurdur]

Moving onto the 2nd part of my very long screed on Nietzsche and syphilis.

Now, we have seen that Nietzsche had, according to accounts, an emotional reaction, very quickly followed by a physical collapse, followed in the very next days by his writing off letters to friends, the Wahnbriefe, letters in which he is more off-planet than your average astronaut off to Alpha Centuri, and he is way off-planet with no oxygen supply, but what is interesting is what is absent. When you read the Wahnbriefe, they do not sound like the writing of a classical paranoid. There are sudden disconnects, abrupt changes, incoherence, and there are complaints from the personal ("Also, last year I was crucified by the German doctors in a very drawn-out manner"), mixed in with complaints from the impersonal, where he "commanded the German emperor to go to Rome in order to be shot and summoned the European powers to take military action against Germany".

A large part of forming some sort of a differential diagnosis is also including what is missing. It is exactly like when Sherlock Holmes speaks to Watson of the mystery of why the dog did not bark in the nighttime. Again and again, when we try to understand what happened with Nietzsche, we are going to have to look at what is absent as well as what is present.

And what is absent here is crucial. Note that his crisis starting Jan 03 1889 is sudden. No-one reports a long lead-up, though this is misleading. His friends don't say he has finally gone over the edge after a fair long period of manic build-up, instead they seem to say he's suddenly off the deep end; and he has a physical collapse, along with everything else. Now of course you can postulate the physical collapse is something seperate and coincidental; but that would start getting very implausible indeed and very silly as soon as one knows that Nietzsche suffered several symptoms very reminiscent of a stroke. So let's look for an answer that comprehensively deals with all that was reported of the incident on Jan 03 to Jan 08 or so, 1889, and afterwards till his death in 1900.

Now, first off, we can very probably wipe out bipolar syndrome out of the list of answers. The bugger went and physically collapsed, and went on to become somewhat uncommunicative, and had physical symptoms in keeping with a stroke. To postulate he was only undergoing a bipolar syndrome crisis doesn't match the full picture; and if we have an answer that would match the physical symptoms as well as the mental symptoms, then we really don't need bipolar syndrome (manic-depressiveness) as an answer.

Don't get me wrong here. It is quite possible Nietzsche was bipolar; a hell of a lot of people seem to be, more than is usually reported in the official figures of incidence. But bipolar syndrome simply does not explain the physical side of his very sudden collapse, and it becomes wholly superfluous to it all. IOW, we can conclude Nietzsche may have been bipolar, but since he never got himself locked up for it before, then if he did have bipolar it was relatively mild. Going on, since bipolar syndrome does not explain a lot of things, and answers that explain those other things can also explain the mental / emotional side that is vaguely reminiscent of bipolar, then it really is bloody superfluous and more importantly totally useless, and we can leave that one behind.

I'll post this, and go onto the 3rd part in my next post.

[Fizzle]

Mebbe I should start getting into flamewars. Very productive, by the looks f it.

[Gurdur]

Originally Posted by Fizzle

Mebbe I should start getting into flamewars. Very productive, by the looks f it.

Only if they annoy you enough into action, One thing is for sure, the others won't give you any useful or true info. Third part coming up soon.

[Gurdur]

Now for this 3rd part, I am going to cheat a little, and use another reference which is not the Wikipedia article (I did this before too, but it wasn't such a biggie then). However, this next reference, one which is the most helpful of all on the specific collapse of Nietzsche, is in fact linked to in the Wikipedia piece, and is available in full online, so none of you need buy a book on this, and we can see what cases we can build using readily available stuff accessible to most. The next reference I am using here is:

Hemelsoet D, Hemelsoet K, Devreese D (March 2008).
The neurological illness of Friedrich Nietzsche
Acta Neurologica Belgica 108 (1): 9–16. PMID 18575181.

And it is available in full in a .pdf file here.

That paper is quite excellent. WARNING --- like everything else here on this thread, like my words, like yours if you have posted anything, it could be all wrong, I could be all wrong, anyone can be all wrong, so if this debate really seriously interests you, then you will need to do a lot of study and you will need to check everything for yourself. It gets hard, because not everything Nietzsche is supposed to have said was actually said by Nietzsche --- the amount of alterations of his works by others is quite surprising.

Nonetheless, we press on. Hemelsoet et al in the above paper cite the letters of Nietzsche (Colli, G.; Montinari, M.: M. Friedrich Nietzsche : Sämtliche Briefe, Kritische Gesamtausgabe, Berlin : de Gruyter, 1986) to conclude Nietzsche was already showing episodes of psychiatric symptoms in 1873, long before the crisis in 1889, together with increasing visual difficulties, localized to one side. In 1883 he used the word "madness" of himself. So as I said before, the suddeness of the crisis in 1889 is a little misleading; there was in fact some build-up to that crisis. But none of the build-up was at the time obvious in permanency , excepting perhaps the blindness in one eye. The crisis in 1889 may well have had build-up, but it was nonetheless a sudden crisis of its own -- Hemelsoet et al note that he then almost induitably suffered strokes afterwards, in the last years of his life, and they say several "photographs from 1899 clearly show Nietzsche in a bedridden state, with a paresis of the left hemisoma with flexion of the left arm, suggesting pyramidal involvement".

Hemelsoet et al then go on to discuss a good many of his symptoms, those throughout his life as well as those during and after the crisis of 1889; there is too much to quote here, and reading the paper for yourself will give much interesting insight, history and thoughts.

What is really relevant here is whether Nietzsche had syphilis, and if that was what he had, was syphilis which sent him mad?

Hemelsoet et al note that Nietzsche was neither rich nor truly famous when he was taken to the clinic after his crisis in 1889, and that he was given a diagnosis of paresis, neurosyphilis, quite likely despite his symptoms, not because of them, since he was not given the best treatment possible nor a thoroughgoing, unprejudiced examination and diagnosis. After all, neurosyphilis was rather the vogue in diagnoses back then, and it didn't take much to get the label hung on you -- and to be fair, neurosyphilis was rather common back then too.

Moreover, one psychiatrist at that time, Dr Muthmann who was a psychiatrist at the Basel clinic where Nietzsche was placed, read Nietzsche's notebooks, and declared that in his clinical opinion they were not the notes of someone suffering from neurosyphilis.

Sax, Leonard
What was the cause of Nietzsche's dementia?
J. Med. Biogr., 2003
11: 47-54

Merrit, H.H.
A Textbook of Neurology
Philadelphia : Lea & Febiger, 1959

Leonard Sax and Houston Merrit (cited in Hemelsoet et al) gave lists of symptoms that contradict any diagnosis of syphilis in Nietzsche's case --

a) One retina was smaller than the other, and this was adduced to show syphilis; but Nietzsche had had differing retinal sizes almost his entire life, in childhood too, and remarked upon by his mother.

b) The appearence of grandiosity in thinking and of bizarre ideation, and the development of dementia. But Leonard Sax showed that the appearence of bizarre ideation was not sudden, but had happened before in Nietzsche's life. Moreover, bizarre ideation etc. can have a good many other causes.

c) Nietzsche's facial expressions (a fair bit after the crisis in 1889) remained vivid --- whilst neurosyphilis would normally present with an expressionless face.

d) His reflexes were normal --- whilst neurosyphilis would normally present with hyperactive tendon reflexes.

e) Nietzsche showed no tremor --- whilst neurosyphilis would normally present with tremor of facial muscles and tongue.

f) His handwriting remained stable --- whilst neurosyphilis would normally present with problems with handwriting owing to intention tremor.

g) And his speech remained fluent --- --- whilst neurosyphilis would normally present with dysarthria with slurred speech.

h) Nietzsche lived on over ten years after his crisis and collapse in 1889 --- whilst neurosyphilis would normally present with the sufferer undergoing an ongoing mental breakdown and death would occur three to four years after the crisis had shown itself.

i) Nietzsche suffered from migraines most of his life from the age of 9 years old --- whilst neurosyphilis would normally present with the sufferer only experiencing massive headaches only a few days or months before the collapse.

j) Nietzsche presented with definite lateralization of symptoms, with right-sided headaches and hemiparesis of his left side --- whilst neurosyphilis would normally present with no laterality, since syphilis is an equal-opportunity bacterial disease that doesn't give a stuff about sides of the body, but does as much as it can everywhere.

Given all that and more, we can safely conclude he showed no signs of neurosyphilis, and syphilis seems a very unlikely explanation.

So if not syphilis, what then?

Some postulated Nietzsche's thoughts, his philosophy, drove him mad. Well, bollocks to that, and there is no evidence for that view. More on this later, but bollocks.

Leonard Sax proposed Nietzsche had a retrobulbar meningioma (= "brain cancer" in this article) of the right optic nerve underlying the front frontal lobe. However, as Hemelsoet et al note, dysarthria and complete hemiplegia are very unlikely indeed to be caused by such a meningioma. I have my own problems with such a diagnosis -- I would have expected a meningioma to be doing much more, to be more ambitious, over the over ten years of his life between his collapse and his eventual death from pneumonia.

Hemelsoet et al propose instead that Nietzsche suffered from CADASIL, meaning Cerebral Autosomal Dominant Arteriopathy with Subcortical Infarcts and Leukoencephalopathy, a nice little diagnosis that has the advantage of explaining almost all of Nietzsche's symptoms (with the possible exception of his visual problems) throughout his life, and the progession of his ill-health after his collapse.

Whatever he had, it was not neurosyphilis, and it was very unlikely to be brain cancer (a meningioma, or another idea, a cerebral benign tumour); and yes, he did have actual physical and psychiatric problems, contrary to what some claim.

More on summation in next post.

[Gurdur]

Now, what the fuck do those horribly long walls of text actually all fucking mean?

1) Is Nietzsche over-rated?

No doubt he is, by some. Just as Nietzsche is under-rated, by some. Just as some have never even heard of him.

2) What did Nietzsche actually say?

Bit difficult, that one, since he wasn't sure himself sometimes, and since some of what is published under his name has been forged by others (in particular passages). Read him for yourself, but also read the commentaries on him where they discuss what he said or did not actually say, but someone decided to "correct" his manuscripts.

3) Is Nietzsche the bee's knees?

At the time he wrote, yes. That was a long time ago. Otherwise, pretty much all that he said that was valid has largely been incorporated into public thinking and into the works of other writers. It is important to read him if you want the real genuine info on the history of the development of ideas, but otherwise, he can be over-stretched and occasionally boring.

4) Was Niezsche syphilitic?

There is no evidence for that at all.

5) Did Nietzsche go mad?

For various periods of time, he was far loonier than your average squirrel on meth, starting in earnest around 1889, but beginning for short periods before that.

6) Was it syphilis that drove him mad?

The evidence is actually all against that notion; there is evidence enough to conclude he did not suffer from neurosyphilis at all.

7) So what drove him bonkers then?

Most likely, a succession of small, micro-strokes and a couple of slightly bigger strokes, as well as white-matter lesions in the brain, over the course of his life, caused by a genetic condition that affected the small arteries and capillaries of his brain. However, it is impossible to tell now, since no autopsy was performed on him, and no conclusive evidence exists any longer.

8) Did his ideas affect his madness? Did his philosophy cause him to go over the edge?

It's impossible to make a convincing case as to how that could happen in his specific case.

9) Were his ideas affected by his illnesses?

That is perhaps so sometimes. Nietzsche did have a kind of style and drive that struck others as being akin to neuralgia, a kind of shrinking back and occasional despair; he suffered from depressive interludes, and G.K. Chesterton once described Nietzsche as vocalising the attitudes of someone complaining about being stuck in a crowded bus on a long, hot day, and being sick of the people around him. In certain passages of Nietzsche, that judgment by Chesterton seems apt. But that goes only for certain parts of what he wrote.

On the whole, his main ideas do not seem too much affected by his illness. But then, he was far from systematic, and he would do one idea in a big way for one book, and ignore it in the next.

10) Was he anti-Semitic or pan-Germanist?

No to both. He actually disliked both anti-semitism and pan-Germanism.