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Irvin D. YalomA modern alternative to SparkNotes and CliffsNotes, SuperSummary offers high-quality Study Guides with detailed chapter summaries and analysis of major themes, characters, and more.
As depicted in the novel, despair arises out of the individual’s fear of aging, death, and dying alone. The fear of death is the wellspring from which despair emerges. Both Breuer and Nietzsche experience despair, and their relationship is one of mutual care, as each attempts to serve as doctor to the other. Both men lost their fathers early in life, and these losses informed their understanding of death. The death of Breuer's father affected him because his father was a primary audience. When the father passed, Breuer felt alone and adrift without his father there to hear him. Breuer says, “For years I imagined him peering over my shoulder, observing and approving my achievements. The more his image fades, the more I struggle with the feeling that my activities and successes are all evanescent, that they have no real meaning” (245). After the death of his father, Breuer was faced with a new outlook, one in which death seemed enlarged. For Nietzsche, his father died when he was young. In a dream that Nietzsche describes, his father appears from out of the grave and grabs a child to bring with him into the land of the dead. Nietzsche says, “Over the last few years, however, I’ve begun to suspect that the dream was unrelated to my brother, that it was me my father had come for, and that the dream was expressing my fear of death” (244). The abandonment that occurs as a result of death leaves Nietzsche feeling alone, a trait that remains with him into the novel’s present time. The abandonment also informs his greatest fear: that he will die alone and nobody will even take note of his absence. For both men, the source of their fears is death and abandonment.
Nietzsche provides Breuer with a blueprint for how to come to terms with his fear of death and, in turn, his despair. First, he says that to conquer the fear of death, one must die at the right time. He says, “Live when you live! Death loses its terror if one dies when one has consummated one’s life! If one does not live in the right time, then one can never die at the right time” (247). To eliminate the fear of death, one must live in the right way; otherwise, that fear will never go away. When Breuer asks how it is possible to know whether one is living in the right way, Nietzsche explains to him his idea of eternal recurrence. Nietzsche says, “Eternal recurrence means that every time you choose an action you must be willing to choose it for all eternity” (251). In Nietzsche’s view, the only way to conquer despair is to conquer the fear of death, and if one lives according to the practice of eternal recurrence, one is best situated to overcome despair.
Dr. Breuer’s obsessive desire for his patient, Bertha, is the central problem of his life and the reason he seeks treatment from the philosopher Friedrich Nietzsche. Of his all-consuming fantasies about her, he says, “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?” (2). While he implicitly recognizes the precarious position he is in as Bertha’s doctor, he nonetheless struggles to process his desire for her. The fact that he cannot act on his desires has the paradoxical effect of making them even more powerful. Effectively, Breuer mythologizes Bertha and, in fact, objectifies her. His obsession with Bertha becomes the symbol for something much deeper in his life.
Nietzsche contends that Breuer’s obsessive desire for Bertha covers over his real fears of aging and death and that Bertha represents for him a tempting escape from confronting these fears. Nietzsche says to Breuer, “Lust, arousal, voluptuousness—they are the enslavers! The rabble spend their lives like swine feeding in the trough of lust” (176). In this case, Breuer’s original lust was not dealt with appropriately. Instead, Breuer chose to linger in his lust until finally it became an all-consuming force in his life. Nietzsche again says, “Therefore, he welcomed lust into his mind, and lust, a ruthless competitor, soon crowded out all other thoughts. But lust does not think; it craves, it recollects” (180). Obsession also distracts from the guilt he feels for being mentally absent and emotionally unavailable to his family, specifically his wife Mathilde. The guilt builds upon itself so that in time, Breuer can barely stand to be in the same room as Mathilde. Sensing himself falling ever deeper into a negative feedback loop, Breuer begins to doubt whether he will ever be able to get control of his intrusive thoughts. What starts as simple lust for Bertha transforms into an obsession because it distracts him from his real fears, which include aging and eventually death. However, what Breuer ultimately realizes while under hypnosis is that Bertha is not just an object. He begins to empathize with her and realizes that she is not a possession to be taken hold of for his own sake. What effectively breaks the chain in Breuer’s mind is that while he felt like he had no control of the intrusive thoughts, he actually did, and he chose to keep the story alive because in that story of her, he created an escape from what truly ailed him. The novel suggests that what people often think are obsessions are likely diversions they create because the obsessions are familiar. This is especially the case with sexual desire. What first begins as a simple biological response to someone attractive soon becomes a fixation because it serves the purpose of making Breuer feel better even when it seems he is not.
The novel takes place in 1882, which is well before the psychological practices that are generally now familiar such as talk therapy. Breuer’s treatment of Bertha is one of the first recorded instances of using talk therapy to help alleviate mental anguish and suffering. Breuer shows his place in time by referring to Bertha’s illness as a manifestation of hysteria; however, his approach in treating her by getting her to discuss her deepest fears is novel at the time. He even uses a variation of immersion therapy to help her face her fear of water.
While Breuer sees success in his treatment of Bertha, the underlying dynamics at play remain difficult for him to understand. His friend Freud posits his own explanation. Freud says, “No matter how ridiculous it seems, there must be a separate, unconscious intelligence” (39). In dramatizing the friendship between Freud and his mentor, the novel grants a view into the origins of psychoanalysis and of the concept of the subconscious. In Freud’s view, as depicted in the novel, there are elements of the human consciousness that have not been studied or observed and that influence our behavior without our knowledge. As Breuer and Freud discuss Breuer’s sessions with Nietzsche, Breuer unintentionally alludes to some deeper aspect of Nietzsche’s personality that directs his behavior. Freud says, “You mean the unconscious consciousness trapped inside your patient” (153). In response to Breuer’s suggestion that the goal should be to liberate Nietzsche from this hidden consciousness, he then says, “But is ‘liberation’ the term? After all, he has no separate existence; he’s an unconscious part of [Nietzsche]. Isn’t integration what we’re after?” (153). This is Freud further developing his ideas on both what the subconscious is and how to integrate it with awareness. Breuer at first is not particularly converted to Freud’s way of thinking, but he later underscores the same idea as he reflects on his treatment of Bertha. Breuer says, “How foolish to have spent month after month attacking symptoms—the silly, superficial skirmishes—while neglecting the real battle, the mortal struggle underneath” (266). Here, Breuer understands that while his work with Bertha yielded great gains, namely that her symptoms were removed, the real problems lie underneath in some interior aspect of her psyche. This is the goal of psychoanalysis: to dig into the person’s subconscious to find the keys to help unlock possible solutions. The novel does not pursue how Freud and Breuer’s work informed the field of psychology as it advanced through the early 20th century. Instead, it provides an origin story for how the ideas of the two men were initially pondered and put into practice.