Contributions to a Pathography of the Musicians: 2. Organic and Psychotic Disorders
By Eliot Slater and Alfred Meyer, Confinia Psychiatrica, 3, 129-145, 1960.
In the first of our papers on this subject, in which we discussed the medical history of Robert Schumann, we explained how we became involved in a systematic study of the German composers. The probands were selected by musicological experts solely on the basis of their achievement, and were in the first place investigated by Adele Juda, her findings having been published posthumously in her monograph Höchstbegabung (1953). The biographical data accumulated by Juda, together with her psychiatric and diagnostic appreciations, were most kindly made available to us by the late Professor Schulz of the Forschungsanstalt für Psychiatrie in Munich. This material has been further supplemented principally from English sources, and is being investigated along lines which seem to us important, though many of them did not fall within Juda's terms of reference. The first question which arose was the incidence and the nature of psychotic disorders in the probands. The case of Robert Schumann was one of critical importance in this connection, and was discussed in detail in our first paper. It now remains to consider the cases of the other composers whom Juda diagnosed as having been psychotic, namely Gluck and Wolf, and of two others, Mozart and Handel, in whose cases some questions arise.
Christoph Willibald Gluck
Gluck was born on the 2nd July, 1714. He had three strokes, the first in 1781 at the age of 66, the second in 1784, and the last in 1787 after which he died, at the age of 73. With the second of these strokes, at the age of 70, his right arm and leg were affected and he had a dysphasia. He made some degree of recovery, but ever after had difficulty in expressing his thoughts, and would mix Italian, French and German in his utterances. His wife had to nurse him, and did so devotedly until the end.
Cooper (1947) records that in his last will, out of a great fortune, he left one florin each to the Poor House, the General Hospital, the Town Hospital, and the High School, "in all, four forms". Such a bequest has the ring, not of miserliness (though Gluck had a peasant's sense of the value of money), nor of irony, but rather of the act of a demented patient.
There is no record of Gluck having been anything but exceedingly robust mentally until the first stroke. His terminal mental disorder was clearly of an organic type determined by a series of cerebrovascular accidents. Juda's diagnosis was one of arteriosclerotic dementia.
Wolfgang Amadeus Mozart
Mozart was born on the 27th January, 1756, and died on the 5th December, 1791, aged 35. His illness, and the cause of his death, have been repeatedly discussed, especially in publications of 1956, the bicentenary of his birth. Greither (1956) and Reinhard (1956), following the earlier view of Barraud (1905), are of the opinion that he suffered from chronic kidney disease, with terminal uraemia. His health all through his life was very poor. He was undernourished as a child, and later bore the marks of rickets. At the age of six he had a severe and extensive rash, which has been interpreted as erythema nodosum. He had many infections, scarlet fever in 1762, typhoid fever in 1766, smallpox in 1767, an undefined febrile illness in 1768, and pneumonia in 1781. Severe attacks of colic in 1784 and 1787 are attributed by Greither to superadded pyelitis with stone formation, and a probable eventual pyelonephritis and glomerulonephritis. Greither believes that he was already mortally ill in 1790.
Kerner (1956, 1957) is a notable dissenter from the general view, in that he revives the old idea that Mozart was poisoned by Salieri; and he suggests that Salieri may have used a slow‑working poison given at long intervals, mercury for example. According to this author some of Mozart's terminal symptoms fit into the picture of mercurial erethism; headache, vertigo, nausea, irritability, terminal nephrosis. However, this interpretation, with its rather sensational presentation, including an alleged confession by the dying Salieri quoted from a Russian book by Igor Boelza, sounds more than unconvincing; it has been rejected on both historical and medical grounds by Greither (1957) and Blorn (1957).
In the last year of his life, Mozart was undoubtedly ill also in a psychiatric sense, and suffering from severe depressive moods. There is, however, no reason to doubt that his psychiatric symptoms were attributable to his physical illness. Thus his feeling, when the Requiem was commissioned by an anonymous patron, that this was a message from Heaven of his own impending death, the Requiem to be written for himself, though it has been called delusional, accords well with a depressive state and can be wholly accounted for in that way. In itself, it seems hardly more than a superstitious notion, appropriate to the age, to Mozart's religious faith and to his state of health. His statement that he felt the taste of death in his mouth, in the last days of his life, has also in the past been attributed to mental disorder; a bad taste is, however, a characteristic symptom of uraemia. A more definitely delusional idea is his notion that he was being poisoned by the Italians, or by Salieri, which also came to him in his last days. There is no satisfactory evidence that this was more than a passing idea, that it was repeated or firmly maintained or held for any length of time. Though certainly a morbid idea, it can be partly explained on normal psychological principles: he had, in fact, met with hostility from the Italian school of music during his life, and the popular predominance of Italian music had been a large factor in preventing his receiving the recognition he had earned.
All these symptoms must be regarded as amounting, at the worst, to a not very severe symptomatic psychosis, carrying no implication of constitutional instability. Mozart was not naturally a paranoid personality, and in all his misfortunes there is no evidence that he ever bore grudges. In the affective field, he had his melancholic side, which finds appropriate and balanced expression in his music; but he was not liable to severe depressive moods until, according to Greither, he was a dying man. Juda's diagnosis in his case is "nicht geisteskrank, nicht psychopathisch, gesund".