The book is set in Vienna in 1882 where the famous physician, Joseph Breuer, had his medical practice. The other characters of note in the novel are Fredrich Nietzsche, Sigmund Freud, Lou Salome, and Bertha Pappenheim. Breuer is at that time already famous both as a physician and medical researcher, and young Freud is a protégé and frequent visitor at Breuer’s home and a medical student finishing up his degree. Besides his well known research in the physiology of respiration and equilibrium, Breuer also became interested for a brief time in his career in psychology. Indeed, his work with a patient he calls Anna O, actually a young woman, Bertha Pappenheim, who herself became famous later in her life as a social worker, was very influential in the development of psychotherapy, or what Breuer called “the talking cure.” Anna O. suffered from numerous debilitating ailments and was under the daily care of Breuer for a considerable period of time. It is alleged that Breuer was able to cure Anna O. of many symptoms simply by uncovering the origins of the symptoms.
In fact, as Yalom is quick to admit in his afterward, Breuer and Nietzsche never actually met, but they well might have had Nietzche’s friends been able to persuade him to visit Breuer for treatment of his horrible migraines and for suicidal depression. In Yalom’s fictional account, Nietzsche’s stunningly beautiful friend, Lou Salome, approaches Breuer and asks him to treat Nietzsche in order to save the future greatest philosopher of Europe, but she insists that Breuer cannot ever tell Nietzsche that it is she who has requested his intervention, nor that it is more for treatment of his depression than his migraines that is required.
The story then spins itself out as a kind of mystery in which Nietzsche’s existential philosophy contributes to Breuer’s talking cure. I won’t be giving away much of the mystery by telling you that Nietzsche does consult Breuer, not for psychological help, but for a diagnosis of his many physical ailments, his migraines at the top of the list. Nietzsche initially refuses to go to a clinic Breuer works out of both because it would require a winter stay in Vienna (which he insists would exacerbate his medical problems), and because he simply cannot afford a stay in the clinic. Breuer’s offer to treat him for free and to make space available for him at the clinic also free of charge both raises Nietzsche’s suspicions (since his view is that no one every really wants to help another, but only seeks to dominate and increase one's own power), and somehow offends his dignity; he does not accept charity. Nietzsche leaves Breuer with a demand that he be sent a bill for services, and announces his intention to leave Vienna for southern Europe the next day.
Fortunately for Breuer, Nietzsche is struck with a mighty migraine before he can depart Vienna, and the hotel keeper finds Breuer’s card in Nietzsche’s coat and seeks him out to attend to the extremely ill and unconscious Nietzsche.
While it is Nietzsche’s suicidal depression that Salome hopes Breuer can cure, it turns out that Breuer, too, is in a crisis of depression—unable to reciprocate the love and care his wife Mathilde extends to him or to really attend to his three young children, unable to stop fantasizing about his recent patient Anna O., and no longer sufficiently driven by either his medical research or his patients.
Breuer is able to drastically shorten the duration and intensity of Nietzsche’s migraine, and again exhorts him to enter his clinic for treatment. Finally, in what begins simply as a ploy to overcome Nietzsche’s reluctance, Breuer confesses to Nietzsche his own suicidal depression and begs Nietzsche to treat him with his profound philosophical insights, to attempt a philosophical cure of Breuer’s mental malaise.
Breuer has by this time read two of Nietzsche’s early works, The Gay Science, and Human All Too Human, and insists that in this case it is the physician who requires healing from the patient. Finally, Nietzsche agrees to begin talking to Breuer about his existential crisis, and to do so under the guise of being a patient at Breuer’s clinic.
I realize that this sounds like quite a convoluted plot, and it is both fanciful and complicated, but Yalom’s interest in German philosophy along with his lifelong work as a psychoanalyst make for a fascinating read. Along the way, the reader is treated to what I think is a very perceptive interpretation of Nietzsche’s puzzling doctrine of eternal recurrence, and tantalizing suggestions about how Nietzsche’s ideas of existential freedom accord with parts of psychoanalytic theory. There are also passages in which female characters, Breuer’s wife Mathilde and an assistant whom Breuer fired because of domestic problems caused by his obsession with Anna O., criticize in very insightful ways the so-called freedom sought by the men—a freedom that appears to be quite exclusively male.
In the end, it is Breuer who is cured as he comes to accept Nietzsche’s claim that he must will what is necessary, and then live what is willed, but Nietzsche also learns something along the way about friendship, and comes to realize that the desire for human companionship need not always be viewed as weakness.
The book has stayed with me, and the more I have thought about it, the more I have wanted to recommend it to others.