Previous Solutions of the Diagnostic Problem

The postmortem findings are, measured against modern standards, incomplete and vague, and do not permit of definite conclusions, though the findings are compatible with dementia paralytica. In view of Schaafhausen's negative findings the diagnosis of a disease of the cranial bones (as maintained, for instance, by Stanford and Forsyth [1917]) seems to be without foundation. Richarz himself, more on clinical than postmortem grounds, was definitely in favour of an organic disease against one of the hereditary dernentias, which were, in the terminology of the time, the equivalent of dementia praecox (schizophrenia). His description of Schumann's illness as one which combines the signs of speech disturbances with elation leading to dementia, certainly alludes to dementia paralytica, as it was then defined. Richarz called the disease in Schumann's case "incomplete paralysis", probably referring to Bayle's "la paralysie generale incomplete". He thought that, with Schumann, elation was replaced by melancholia; but he disregards the marked and sustained phase of elation which had preceded the attempt at suicide.

    Möbius, in his book on Schumann's illness, gives a fairly full but still incomplete account of it, and he discusses the differential diagnosis in detail. However, he only considers the alternatives of general paresis and dementia praecox, and not that of manic-depressive illness. Correctly pointing out that Schumann was liable to nervous illness from youth on, he takes the view that this must have been schizophrenic. Once this is accepted, then he thinks there is insufficient evidence to call for a superadded organic illness during the last years.

    Without going back to the original data, but accepting those provided by Möbius, Gruhle pointed out the alternative which Möbius had missed. The very facts which led MObius to a diagnosis of schizophrenia lead Gruhle to a diagnosis of cyclothymia. The personality traits, looked at in detail, are all those of the cyclothymic personality. Then the many recurrent illnesses, if they had been schizophrenic, must have damaged Schumann's creativity. One might find a patient, who had an early attack of catatonia, and thereafter recovering worked well through many years of health. But Schumann had hardly a single complete year when he was fully healthy; and yet he was always able to recover his productivity when health im­proved again after a spell of illness. Gruhle thinks nothing of the diagnostic value of the moue as for whistling; the taciturnity was psychomotor inhibition; the irrita­bility was cyclothymic; hypomanic signs were the ordering of expensive wine and the sudden overthrow of firmly made decisions. Gruhie says that the outspoken psychic inhibition shown during phases of illness, accompanied by an intense subjec­tive feeling of illness, point with certainty to the manic‑depressive syndrome. He quotes a number of examples from Schumann's self‑descriptions, giving vivid expres­sion of his feeling of illness and incapacity. This phenomenological evaluation has a very modern ring.

    Gruhle admits that the last illness, which he takes as beginning about 1850, cannot be manic‑depressive. There is much that speaks for general paralysis: the speech disturbance, the impaired judgment, the rapid dilapidation interrupted by short improvements, the eventual deterioration to death. Yet there can be no cer­tainty about this. The illness might have been not general paresis but some other severe organic psychosis, perhaps of a luetic kind.

    According to Feis (1910), Dupré in 1907 supported the view that Schumann was subject to manic‑depressive phases. A rather different opinion was expressed by Pascal (1908), in a noteworthy article in which the biographical data and the argu­ments of Möbius are subjected to analysis and criticism from the clinical standpoint. In her view, Schumann had ten major depressive attacks, but in the interim periods between them was left with some persisting symptoms, especially in the nature of obsessive fears, scruples and doubts. She cannot see that he ever had symptoms of a hypomanic kind, and regards the depressive states as reactive to psychic traumata, particularly overwork. She criticises Möbius' arguments for a diagnosis of dementia praecox with severity and in detail, and has no doubt that the last illness, coming on after 1850, was a general paresis. Before that he had been, not a manic‑depressive, but a constitutional psychasthenic, in English parlance an obsessional personality.

    Gruhle's view, that dementia praecox can be definitely excluded, is still not universally agreed. An important document is Nussbaum's unpublished thesis. After an extensive exposition of the mood changes in Schumann's earlier life, Nussbaum considers that they have to be taken as manic‑depressive, showing no schizophrenic feature. Yet he feels that later changes were schizophrenic in nature, and that the final illness was either general paresis or else a continuation of the schizophrenia "which probably is often of organic origin". This failure to consider the differentia­tion of schizophrenic from organic states robs this part of Nussbaum's thesis of much of its value.

    The most recent work which sustains the view that Schumann's illness was schizophrenic is that of Wörner. He supports this in the main on the change in personality which occurred between about 1840 and 1849. Furthermore, since Schumann's later work is not as highly regarded as his earlier work, taking lessened achievement with change in personality a case is made for (schizophrenic) deteriora­tion.

    This view appears to be unjustified, since it receives no support from the musi­cologist. Thus Abraham in Grove's Dictionary (1954) explains the fall in level, at least at dates earlier than the last two years, along normal psychological lines. Abraham points out that in his youth, 1828‑40, Schumann was the composer of small forms. He was at his best with simple and clear melodic ideas which he gave in a rich, diffused romantic light. The turning point was in 1841 when, partly under the influence of his wife, he turned to larger forms. His inability to cover a larger canvas is painfully apparent in his first symphony in B-flat as well as in his sonatas.

    Only genuine dramatic talent reveals itself in Manfred and Faust, as well as in his only opera, Genoveva. Some of the manifestations that have been taken for symptoms of mental decay melodic and thematic angularity, increased harmonic complication betoken nothing more than a normal development of musical style, influenced partly by the Zeitgeist and partly by intensive study of J. S. Bach. A more profound failure is recognisable in the last two years of his life. A certain element of heavy, sometimes bombastic, banality may have already appeared earlier. But such fairly late works as the Rhenish symphony (1850), the D minor violin sonata (1851) and the song Der Gärtner, Op. 107 (1851-52), show that the general decline must not be dated too early.

    Joan Chissell, in her biography (1948), takes a similar view. She points out that in such an early work as the F sharp minor sonata of 1835, Schumann was having difficulty in filling out time, and using sequence, decoration and mere repetition, in a thick matted texture, in the endeavour to do so. On the other hand the Rhenish symphony of 1850 and the two violin sonatas of 1851 are masterpieces; and only after that year is his spontaneous imagination smothered and destroyed.