Nietzsche's Syphilis

It is a terrible irony that the herald of the Superman - of human triumph, excellence and self overcoming - should have suffered such an agonising, ignominious, drawn-out end to his life.

Bed-ridden, confused, nursed by his sister and mother, unable to write, he rotted away in obscurity for over a decade. The crowning indignity was the diagnosis of his condition given at the time, and repeated ad nauseum, in the century since his death: syphilis.

'The French disease', as it was known, was one of the most feared and notorious sexually transmitted infections prior to the rise of HIV and AIDS. Not least because if its shameful associations with brothels, skin eruptions, facial deformities and insanity.

These days syphilis is an infection that can be cleared up with a simple course of antibiotics. But prior to the discovery of penicillin in 1928, a case of 'the pox' could be a long, slow descent into madness, physical disintegration and death.

Nietzsche's breakdown in 1888 followed a lifetime of shockingly poor health. Even as a boy he was prone to debilitating migraines. As an adult he was afflicted with partial blindness, daily episodes of nausea and seizures. The poor man was even plagued by haemorrhoids! Unsurprisingly, he also had depression, which would be a natural, perhaps even a healthy reaction to his dire physical state. All this adds up to a woeful burden of suffering, but does it add up to syphilis?

Some of his symptoms, particularly his mental collapse, are phenomena associated with syphilis, but this diagnosis is far from robust and has been convincingly challenged.

It is undoubtedly the case that, in some quarters, the ugly presence of syphilis in Nietzsche's story has been seized upon as a refutation of the man and his controversial philosophy. Though Nietzsche was no debauchee, the truth is he probably did visit a brothel at least twice - during his student years, and later in life on the advice of a doctor who prescribed sexual release as a means of improving his already poor health.

As we all know, it only takes the one time, but to contract such a serious infection after such a limited exposure would be a stroke of very bad luck indeed. Other than these episodes, Nietzsche was known for his restraint, sobriety, scrupulousness and exquisite courtesy to the point of shyness. He never married and it seems unlikely he ever had a serious physical relationship with anyone.

This didn't stop outrageous speculations about his sex life, even while he was alive. His own doctor, with scant regard for confidentiality, communicated about his patient by letter with the great composer, Richard Wagner. Nietzsche and the Wagner family had a close friendship at one point but Nietzsche was starting to break away from his overbearing, erstwhile hero and perhaps there is some resentment in Wagner's cruel, amateur diagnosis of his former disciple's medical state. Wagner claimed that he detected in Nietzsche 'unnatural debauchery with indications of pederasty’. He recommended immediate marriage as the appropriate treatment.

The good doctor replied that he had explored and discounted the possibilities of masturbation or 'abnormal satisfactions' as the root cause of the patient's intermittent blindness (yes, people really did think masturbation caused blindness). Nietzsche later found out that Wagner had been disseminating these cruel and unfounded rumours and never forgave him.

It does not help matters that once Nietzsche's breakdown occurred at the age of 44, he was quickly and sloppily diagnosed with syphilis - a relatively common disease at the time. Nietzsche was neither famous nor wealthy, so a second-class medical assessment was all that his sister and mother could afford or expect. He was sent home as incurable, to be slowly and inexorably overtaken by dementia, strokes, paralysis and finally pneumonia which did for him on the cusp of the new century in August 1900.

It is true Nietzsche that could have acquired syphilis in a brothel, but this is to ignore the very obvious fact that he had suffered with his various complaints since he was a child. Can it also be disregarded that his father died aged just 36 with what was then diagnosed as 'softening of the brain'. Here was another shy man or temperate character, not given to excesses of any kind, and a religious minister to boot. Syphilis seems a little unlikely, but then they say it is the quiet ones you have to watch.

In recent times, the complex of symptoms that Nietzsche suffered from has been re-examined by clinicians. It seems that there are a number of other possible diagnoses that might better fit with the circumstances of this case (if you head over to PubMed, you can see a range of informed theories presented in academic papers).

For example, a particular kind of brain tumour called a meningioma may have been the cause; or any one of a number of kinds of vascular dementia; or a genetic condition called CADASIL, which causes damage to the blood vessels of the brain. Such a genetic condition might even explain the similarly neurological character of his father's death.

Another disease that shares an uncanny resemblance to Nietzsche’s illness is MELAS. This is a condition that affects the brain, nervous system and muscles. The signs of this disease generally begin in childhood and can include recurrent headaches, vomiting and seizures. Affected individuals suffer stroke-like episodes beginning before middle age. These repeated episodes progressively damage the brain, leading to vision loss, problems with movement, and dementia.

MELAS also causes temporary muscle weakness on one side of the body - so called hemiparesis, so it is interesting to see in the extant photographs of Nietzsche when he was sick, evidence of hemiparesis. Note his left arm and hand in the photograph below.

We will never know what killed Nietzsche. No autopsy was carried out. But the point is not to try and arrive at a true diagnosis, but to relegate the syphilis hypothesis to what it really is - just a hypothesis, and even on grounds of clinical presentation alone, a hypothesis that is far from being the most likely.

It is a melancholy thought: this earnest man with his explosive ideas, confined to his sick bed, his memory crumbling, his sense of self shattered, unable to pursue his work or even defend his own reputation against the shameful indictment summarily handed down with little real evidence to support it: an incurable syphilitic! In the prudish, Prussian society of the later 1800s we can only imagine how heavy was the stigma that hung over his family and their household.

Embedded below is a video of what purports to be film of Nietzsche in his last days. This is clearly spurious and seems to be some of the existing photographs of the great man's final years that have been subtly animated. However, I do think it manages to convey an eerie sense of the pathos and sadness of Nietzsche's deterioration in his final years. It is worth watching.

Ultimately, is it arguably the case that this tale of unmerited suffering is somehow apt? Nietzsche believed that, in life, pain was as necessary as it was inescapable. Could it even be that without his lifetime of torment, Nietzsche would not have been able to produce his remarkable work? Certainly, it gave grist to his mill.

In a future post we will again explore Nietzsche's infirmity and how it informed his worldview and maybe even inspired some of his most profound teachings.

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