Nietzsche's Mental Disorders: Madness, Being Sick, "How To Become What You Are"

Gustavo Figueroa


Nietzsche suffered from his chilhood of several diseases and ever since he tried to apprehend the meaning of the question “What means to be ill”? 1] During his last years a profound progressive dementia evolved diagnosed as atypical paralysis progressiva, but developments in molecular genetics have questioned the original concept. 2] Nietzsche´s medical history consisted of several mayor problems including headaches persisting for several hours, gastric disturbances having a major impact on his daily life, a progressive loss of visual acuity, rheumatism, intermittent mood disorders. 3] To be ill for Nietzsche was a world-project, the mode and manner in which beings were accessible to him, that resulted in a narrowing, constricting, expanding or creative way of being-in-the-world.

Key words: Nietzsche, creative disease, dementia, humanism, mental disorder, genius


As a child Nietzsche had various diseases. From that time, he tried to comprehend the meaning of - “Does it make sense to be sick”? 1] When he was old he had a progressive dementia diagnosed as an atypical progressive palsy, but advances in molecular genetics have questioned such original concept.  2] His medical record consisted of various severe problems, such as lingering migraines, gastric disorders which caused a big impact on his daily life; he progressively loss of visual acuity; rheumatism, intermittent affective disorders. 3] Being sick for Nietzsche was a world-project, the way and manner in which beings were accessible to him,  resulted in a narrowing, constricting, expanding or creative way of being-in-the-world.

Friedrich Nietzsche (1844-1900) had various mental disorders which burst into his own being (Self, soi-même).  The main question, this relationship between genius, madness, and creativity, although has been answered numerous times from ancient times, still remains unsolved1,2. In Nietzsche´s case Psychiatry is entitled to think about other questions. As a basic science, to prove determining biological factors; as an operational science, state the personal meanings of the process; as a human reality science, to question his relationship with himself and the way how he modeled his tormented life. What it means to be mad?, what it means to have a psychological illness?, how is illness as a a way of living?    The scope of this study is related with three areas - his illness that drove him mad, the various emotional disorders he lived with since he was young and being sick as a way of living.

1.- Madness: background. He crumbled down after a long history. His father was a Lutheran Minister. He died in 1849, at the age of 36 because of a weird condition named as “cerebral softening”, after being in bed for several months. 2] His older brother Joseph, died in 1850, when he was two years old due to “teething spasms”, preceded by a Friedrich´s prophetic dream: “my father digged out of his grave in a shroud...and returned with a little child back into his grave ”3. 3] a weird dream - with no context - from 1868/1869: “what fills me with fear is not this terrible figure behind my chair, but his voice; it is not his words, but the inhuman and terribly inarticulation of that figure. Oh, if I could speak as humans do”4. 4] He was named professor of classic philology at the University of Basel. He was granted a pension after 10 years working, in 1879 because of his health condition (lingering hemicranea, progressive loss of visual acuity), preceded by six months of partial medical leave due to similar reasons, in 18765. 5] Before he had another dream disconnected from his life: “…I saw a toad that lying down on my hand. I felt a craving to eat it.  I could overcome my atrocious repugnance and I forced myself to eat it”6. 6] As a retired professor and having an easy and free life, in early 1888 with no further reasons, he started to suffer some sudden changes-a sort of different tone-, specially in his mood and humor, his memory (forgetting things), facilitated thought, breaking relationships with with his closest friends. He became irritable, impatient and demanding; these unusual moods deepened continuously and progressively, which could be witnessed in his writings, his letters send to his friends and confidents. 7] Praise to himself and a sensation of a spell he casted on every one which, progressively, disturb other with his feelings of superiority, mission and purpose; from this arrogant exacerbation of himself he assures he irradiates an unprecedented authority onto the world, as if something inescrutable comes out from his inner side, exceeding daily things, casual, and his writings proclaim a break  and elimination of the western civilization: from that year on, history shall re-start from year 17. 8] Significant increase of his productivity, so between 1887 and 1888 he wrote six books and wrote the introduction of several others. 9] After he stood in awe of the people in the street greeting him with great affection, his behavior became distorted and disturbing. He was in his room singing, masturbating, not eating, irritated and locked in in a mutism he does not want to get out from. Out of his wits, boosted by distorted thoughts, by affections coming from an  impenetrable inner side, he started to send letters to his friends, authorities, cardinals, Umberto from Italy , containing extravagant unprecedented, obscure proclaims signing as the “Crucified”, or “Dioniso”. 10] At the Piazza Carlo Alberto, in Turin he took a dog curled up at his feet to bandage him while he was having coffee and also he defended a horse from being whipped by embracing him-the versions are different-; from this moment on, his uncontrollable conduct made necessary to take urgent measures8.

Madness: dénouement 1]  Alarmed by these letters J.Burckhardt called F.Overbeck, a good friend of Nietzsche, who visited  the town doctor. Doctor Turina gave him a sedative. He was in the Basel Clinic from January 8th to 17th. Professor Wille and his colleague Miescher diagnosed him with a “progressive paralysis”. His mother and Overbeck decided to take him to the College Clinic in Jena, on March 24th, 1889 till May 13th, 1890. Professor Otto Binswanger arrived at the same conclusion, “progressive paralysis”. The prognosis was “irreversible”. He showed intense psychomotor agitation, aggressiveness, disoriented in time and space, speech incoherence, erratic use of Italian, French, and German, presence of  short lasting visual and hearing hallucinations, unsystematized persecution delusion, loss of recent memory, getting worse during the nights. A mercury treatment seemed to soothe him, although Julius Langbehn´s therapy did not. He was nicknamed as the “German Rembrandt”. His written language got worse and quickly deteriorated. He started to play piano, although it was only as rhythm. He could keep brief conversations about facts from his young past. 2] He did not obey medical advice. He felt better for a short period of time and his mother was glad about. She took him back home in Naumburg, until she died in 1897. From 1892 his speech was limited to repeat short sentences making sense, but no related to any context. He named objects by using one or two words. By early 1893 he could only move on a wheelchair. Half a year later he looked weak, atrophied and with a reduced body. Unexpectedly between 1893 and 1895 shouting restarted, persistent legs tremors, he scratched his chest all the time9. 3] In 1897 his sister Elisabeth took him to Weimar under the care of a nurse Alwine and to the end, he was not capable to speak or move. He was absent minded and apathetic, not responding to any kind of stimuli. He got worse after three vascular accidents until he caught fulminating pneumonia thus leading him to death when he was 5510-12.

Madness: Diagnosis. Controversies have proliferated from his death to date. 1] Main findings: presence of asymmetrical pupils with ocular paralysis at the right side and Argyll Robertson pupil, alteration on the left side, asymmetrical pupils, convergent strabismus, progressive loss of visual acuity, phosphenes, dyseonjugate gaze, hyperesthesia, scars on preputium, chronic genital eccema, pulsating hemicrany, progressive dementia with delusions of grandeur. 2] The discussion has been focused on his contagion of  syphilis. a]When he was at the Clinic, in 1889 Nietzsche reported he had a venereal infection when he was a student, 1866; b] The mails exchanged between Wagner and Dr.Eiser they commented that Nietzsche confessed the musician he had suffered blennorrhagia when he was studying at college, in Sorrento between 1876-1877, and he had sexual intercourse with prostitutes, as advised by a doctor13. c] His friend Deussen reported that Nietzsche in February, 1865 went to Colonia, he did not find the place he was heading to and ended up in a brothel by chance. He was surrounded by women, he approached the piano and “played some tunes”14. d] Lange-Eichbaum asserted that a well known neurologist told him in 1930 that  Nietzsche confessed when he was a young student in Leipzig he had visited a brothel and he had been treated by doctor twice15.e] Critics of the syphilis etiology have argued data about his infection are blurred and contradictory, long duration of his disease, laterality of the symptoms, absence of characteristic neurologic symptoms(lack of tremors, normal reflections). 3] The following diagnosis have been stated: progressive paralysis due to syphilis16, meningioma of the right optic nerve17,18, fronto-temporal dementia19, dominant autosomic cerebral arteropathy with subcortical infarctions y leukoencephalopathy (CADASIL)20, manic psychosis or manic depression attached later, although independently, by progressive vascular dementia21, mitochondrial encephalopathy with lactic acidosis y episodes similar to cerebrovascular infarctions (MELAS)22. 4] His incontrovertible organic dementia still remains in the darkness regarding its etiology and lack of autopsy and lab examinations make his symptoms remains blurred as a challenge for genetics. See Table 1.

2.-Suffering. When he was a child he suffered several medical conditions 1] At school he had repeated crisis of migraines with aura phenomena, light hypersensitivity, vomits, hypertonia of the digestive tract, severe myopía, plus other issues, such as articular rheumatism and state of psychic excitement he deemed as “epileptoid type”. 2] During the war, in 1870 he fell off his horse, so he had to remain in bed for about 9 months, because of all sequels; he caught dysentery followed by numerous gastro-intestinal disorders till that became chronic which he fought with strict diets, various medications, potions, long walks, which gave him the possibility to write and follow warm seasons, thanks to constant changes of residence. 3] His medical record became horrible since 1873; he became tortuous and glassy, full of complaints, disorders and impediments (repeated migraines, dyspepsy, increasing myopia); deep mood changes with predominant depressions move him and make his relationships harder with his friends, leading him to be interned in a retirement home for brief periods of time; visit many physicians through the year who prescribed him  various treatments, even drugs with an addictive potential, even though he was never dependent on medications; some medication were made by himself and signed as Dr Nietzsche. 4] Decisive moments strongly impacted his body, such as his meeting and rupture with Wagner. Rejection by Lou Andreas-Salomé to marry him, bad intellections and ruthless criticisms on his works made by his friends and enemies, his sister´s evil talk, his devastating/unsurmountable loneliness. 5]Brief explosions de spiritual ectasy turned into long somatic depressions, dysthymic oscillations,  irritability, helplessness-1880-1882- which made him feel immersed in postration, reclusion, bashfulness, detachment from his friends, mistrust, aversion and absent minded, due to his organic diseases23.

Illnesses: the why of his diseases. Medicine, has proved Heidegger, uses a calculating thinking(Verrechnen) whose diagnosis is to unveil (Entbergen) which classifies, measures, apprehends which is shown as as an object and this is “the disease” 24. ¿What type of medical reality had Nietzsche´s  endless suffering?25. Medical rationality used by the various clinicians tried to explain the various perspectives, levels, practices and conceptions. 1] “Morbid species” effective  anatomoclinic, physiopathologic or ethiopathologic diagnosis: myopia, migraine, reumatic disorders, chronic gastroenterytis26,27. 2] Being(disease), feeling (illness) being considered (sickness) sick , which respectively required and according to circumstances, “to cure”, “to heal” or “to take care ”28. 3] Malignant malfunctions, i.e., harmful failures of his internal biologic mechanisms for performing functions naturally selected29. 4] Biopsychosocial disorders, covering and impairing behavioral/biological/psychological/social dimensions30. 5] Disorders socially and culturally prohibited by his environment, regardless of his will, desire and personal considerations31. 6] Practical/useful tools that allowed him to face, elaborate, and solve his existence32. 7] Morally negative values, because of his rejection, rejection, abomination of his religious beliefs thus causing him unconscious suffering, disabilities and limitations33. 8] Response coming from his vulnerable, hypersensitive, scrupulous, delicate y punctilious inner self before interpersonal intimate relationships affectively overwhelming34. 9] Ways to face, carry out and solve unsatisfactory and impersonal meetings between physician and patient which look like the patient is an object35, 36.

3.Getting sick as a way of living. 1] So far his medical condition was medically diagnosed, successively or independently as deficiencies, defects, lacks, impotence, relationships with short means, different organizations, unmanageable facts. 2] But Nietzsche´s getting sick is a way to carry out his life, a project of being in the world, a program that opened his own intimacy, his most self, unavoidable and intransferible, and this is his soul, his spirit, his psyche, just as western philosophy has thought about, it is his vivid body (Leib) understood as the “center of gravity ” of his existence totally different from his somatic body(Körper). 3] His assertion as “a necessary thing: for mankind to find his own satisfaction”37, no doubt it means to assume his body pain that had made him suffer, but creatively, that is to say following the “common thread of the body”, because in our body,¾ instincts, desires, physiology, sensations, affections¾lies a reason, it is our own wise and powerful self, whose “great reason” “ does not say I, but it does I”38. 4] However, this satisfaction of his self was not that of the weak people who “do not have power over his own character”, but that of strong people “who put style to his own character”, “those who do not let their nature free by itself”, of those who conquer themselves primarily by means of unhappiness, suffering, and thus leading to become what one is”39; in other words, his disease was the decisive experiment in his existence, more precisely, the late experience of his inclusion in the abyss of life. 5] Nietzsche was clear: I am not a  “sickly” being (krankhaft), that is to say, weak, lacking life, with no perspective or consciousness, lacking strength and will, morbid, but “sick (krank),-this must be understood-, to be  self critic, who exceeded himself, plenty of instinctive energy, projecting himself in a goal and only dependant on that drug named “art”. The paradox is only apparent, he did not want to renounce his disease, because it was "a means and a hook for knowledge, even that mature freedom of the spirit that is also self-control and discipline of the heart", "excess of plastic, healing, reproductive and restoring forces and ”38. 7] Nietzsche understood and assumed “there is no health in itself…, what health means for your own body it all depends on your goal, horizon, strengths, impulses, mistakes and, especially, your ideals and ghosts of your soul "35, which, as an egregious representative of the" school of suspicion ", made him decipher what is hidden, what is cloaked behind the deceptive concept of" normal-health”39, hence he meant to name one of his last writings "Idleness of a psychologist". 8] He accepted himself as a decadent, however “having forced myself not to let myself be cared for, served, treated by doctors ... reveals the unconditional certainty about what I needed: I put myself in my hands, I healed myself by myself: the condition of this is to be healthy, after all”; shortly, "I converted my will to health, life, health", so he resigned, becoming a foreigner of his own profession (Beruf), to follow his inner call (Ruf) "chosen in favor of his own instincts" 35, of the passions of his body. 9] His goal and his means was to conquer "great health", "a stronger, more chastened, more tenacious, more daring ..., one that is not only had, but is also continuously acquired and must be acquired"39, a sort of "transvaluation of values" until now dominant, a subversion against the prevailing deceptive ideals40.  10] "What is missing are doctors, real doctors for those whom until now we have called practical morality becomes a chapter in the art of healing ..., of the study of the body and the health regime”41, doctors he did not find, so he had to learn his own "wisdom of life, in that idea of prescribing himself health for a long time, only in small doses" 42 11] The warning of his last outlined, but never finished writing was addressed to himself: "Health and sickness,  be careful! 

Final considerations

 1] The force of Nietzsche's thought mercilessly tried to unravel the masks of his intimacy: “There are no facts, only interpretations…, and this is also an interpretation”41, so when elucidating his illness he did not forget his own paradox: “those we know are strangers to us ..., we have never looked for each other - how could it happen that one day we would meet? ”44. 2] Perhaps his friend Overbeck was right when he said that “Nietzsche was not properly a great man”14, but he was wrong, as he did not understand that his will in truth encompassed his entire existence, including that of being ill as a task “for the elevation of value of life ”, no compassion because it “ persuades us to surrender to nothingness ”45. 3] Somehow he glimpsed that getting sick is,  in its fundamental aspect, “misterium doloris, the abysmal wound of human existence”46, perhaps the inherent “moral disorder of human life”47, something properly “human, too human”40 4] He suffered from an organic brain disorder that led him to dementia and, although its etiology is not yet clear, most likely it was syphilitic cerebral palsy. 5] From a very young age, he suffered from various diseases based on the background of an inheritance with a propensity for mental and nervous system disorders that forced him to resign from his profession, his resignation that was both suffered and sought, a hidden desire that meant living a wandering but free existence, fugitivus errans, a lucky odyssey without ever reaching its Ithaca. 6] Towards 1873 his diseases worsened significantly. Between 1880-1882 they progressed or, did they favor? parallel to his deepest visions of his philosophy, "at 6,000 feet above sea level and much more above all human things": "the new center of gravity: the eternal return of the same”48. 5] The disease has been understood historically, for being the historical man, and thus in its subjective aspect, it has been apprehended as invalidity, annoyance, threat, suction by the body, loneliness, anomaly and resource25; but it is more than a resource, it is a project, a way of being-in-the-world and that is how it was in Nietzsche who, following “the common thread of his body”, tried to “become who you are”39.


  1. Jaspers K. Strindberg und van Gogh. Versuch einer pathographischen Analyse unter vergleichender Heranziehung von Swedenborg und Hölderlin. 3. Aufl. München: Piper; 1977.
  2. Heerlein A, editor. Creatividad, genio y psiquiatría. 2ª. edición. Santiago: Mediterráneo, 2018.
  3. Janz CP. Friedrich Nietzsche. Biographie. Erster Band I. Kindheit und Jugend. München: Hanser, 1978
  4. Nietzsche F. Autobiographisches aus den Jahren 1856-1869. Werke in drei Bänden. Band III. München: Hanser, 1966. p. 7-154.
  5. Janz CP. Friedrich Nietzsche. Biographie. Erster Band II. Die zehn Bassler Jahren (19 April 1869 bis 2. Mai 1879). München: Hanser, 1978
  6. Bernoulli CA. Franz Overbeck und Friedrich Nietzsche. Eine Freundschaft. 2. Bänden. Jena: Diederichs, 1908.
  7. Figueroa G. El último año de lucidez de Friedrich Nietzsche. Rev Med de Chile 2007; 135: 661-668.
  8. Verrechia A. Zarathustras Ende. Die Katastrophe Nietzsches in Turin. Wien: Böhluas, 1986.
  9. Nietzsche F. Der kranke Nietzsche. Briefe seiner Muüter an Franz Overbeck. Wien: Bermann-Fischer, 1937.
  10. Nietzsche E. Das Leben Friedrich Nietzsches. 3 Bänden. Berlin: Severus, 2016.
  11. Podach E. Nietzsche´s Zusammebruch. Beiträge zu einer Biographie auf Grund unveröffentlichter Dokumente. Heidelberg: Kampmann, 1930.
  12. Janz CP. Friedrich Nietzsche. Biographie. Dritter Band. Die Jahre des Siechtums. München: Hanser, 1979
  13. Gregor-Dellin M. Richard Wagner: his life, his work, his century. London: Harcourt Brace Jovanovich, 1983.
  14. Overbeck F. Erinnerungen an Friedrich Nietzsche. Berlin: Berenberg, 1912.
  15. Lange-Eichbaum W. Nietzsche. Kranheit und Wirkung. Hamburg: Lettenbauer, 1947.
  16. Volz PD. Nietzsche im Labyrinth seiner Krankheit. Eine medizinisch-biographische Untersuchung. Wu?rzburg: Königshausen und Neumann, 1990.
  17. Sax L. What was the cause of Nietzsche´s dementia? J Med Biogr 2003; 11: 47-54.
  18. Owen CM, Schaller C, Binder D. The madness of Dionysus: a neurosurgical perspective of Friedrich Nietzsche. Neurosurgery 2007; 61: 626-632.
  19. Orth M, Trimble MR. Friedrich Nietzsche´s mental illness – general paralysis of the insane vs. frontotemporal dementia. Acta Psychiatr Scand 2006; 114: 439-445.
  20. Hemelsoet D, Hemelsoet K, Devreese D. The neurological illness of Friedrich Nietzsche. Acta neurol belg 2008; 108: 9-16.
  21. Cybulska EM. The madness of Nietzsche: a misdiagnosis of the milennium? Hosp Med 2000; 61: 571-575.
  22. Koszka C. Friedrich Nietzsche (1844-1900): a classical case of mitochondrial encephalopathy with lactic acidosis and stroke-like episodes (MELAS) syndrome? J Med Biogr 2009; 17: 161-164.
  23. Jaspers K. Nietzsche. Einfu?hrung in das Verständnis seines Philosophierens. 2 Aufl. Berlin: de Gruyter, 1981.
  24. Heidegger M. Wissenschaft und Besinnung. Vortäge und Aufsätze. 5. Aufl. Pfullingen: Neske, 1967. p. 41-66.
  25. Laín Entralgo P. Antropología médica para clínicos. Barcelona: Salvat, 1984.
  26. Kendler KS, Zachar P, Craver C. What kind of things are psychiatric disorders? Psychol Medicine 2011; 41: 1143-1150.
  27. Laín Entralgo P. El diagnóstico médico. Historia y teoría. Barcelona: Salvat, 1982.
  28. Klein DF. Harmful dysfunction, disorder, disease, illness, and evolution. J Abn Psychology 1999; 108: 421-429.
  29. Wakefield JC. Evolutionary versus prototype analyses of the concept of disorder. J Abnorm Psychology 1999; 108: 374-399.
  30. Schmücker P. Wider den “Geist der Schwere”. Nietzsches Leiden in ihrem psycho-physischen Zusammenhang. Praxis 2001; 90: 1245-1256.
  31. Kendler KS. The nature of psychiatric disorders. World Psychiatry 2016; 15: 5-12.
  32. Zachar P. The practical kinds model as a pragmatist theory of classification. Phil Psychol Psychatry 2003; 9: 219-227.
  33. Fulford KWM. Moral theory and medical practice. Cambridge: Cambridge University Press, 1986.
  34. Figueroa G. ¿Al fin una medicina humanista? Rev Méd Chile 1999; 127: 94-100
  35. Ricoeur P. La différence entre le normal et le pathologique comme source de respect. Le Juste 2. Paris: Éditions Esprit, 2001. p. 173-182
  36. Laín Entralgo P. La relación médico-enfermo. Historia y teoría. Madrid: Revista de Occidente, 1964.
  37. Nietzsche F. Die fröhliche Wissenschaft (“la gaya scienza”). Werke in drei Bänden. Band II. München: Hanser, 1966. p. 7-274.
  38. Nietzsche F. Also sprach Zarathustra. Ein Buch für Alle und Keinen. Werke in drei Bänden. Band II. München: Hanser, 1966. p. 275-562.
  39. Nietzsche F. Ecce homo. Wie man wird, was man ist. Werke in drei Bänden. Band II. München: Hanser, 1966. p. 1063-1159.
  40. Nietzsche F. Menschliches, allzumenschliches. Ein Buch für freie Geister. Werke in drei Bänden. Band I. München: Hanser, 1966. p. 435-1009.
  41. Nietzsche F. Sämtliche Briefe. Januar 1885-Oktober 1887. Kritische Studienausgabe in 8 Bänden. Band 7. Berlin/New York: dtv/de Gruyter, 1986.
  42. Nietzsche F. Zur Genealogie der Moral. Eine Streitschrift. Werke in drei Bänden. Band II. München: Hanser, 1966. p. 761-900.
  43. Nietzsche F. Der Antichrist. Versuch einer Umwertung aller Werte. 13.Auf. Stuttgart: Kröner, 1996.
  44. Nietzsche F. Morgenröte. Gedanken über die moralische Vorurteile. Werke in drei Bänden. Band I. München: Hanser, 1966. p. 1010-1280.
  45. Nietzsche F. Der Antichrist. Fluch auf das Christentum. Werke in drei Bänden. Band II. München: Hanser, 1966
  46. Laín Entralgo P. Mysterium doloris. Hacia una teología cristiana de la disease. Madrid: Publicaciones de la Universidad Internacional “Menéndez Pelayo”, 1955.
  47. Laín Entralgo P. Disease y pecado. Barcelona: Toray, 1961.
  48. Nietzsche F. Nachgelassene Fragmente. 1875; 1882: Kritische Studienausgabe in 8 Bänden. Band 7. Berlin/New York: de Gruyter, 1980.


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