Juda's material of German‑speaking composers consists of the persons named in Table 1, together with one other who has been omitted, as he is still alive. Of these people, some had their names proposed by all of Juda's assessors, and are marked with an asterisk in the list, some only by a majority. Out of the entire list of 27 persons, Juda considered that 10 were psychiatrically abnormal. Those whom she classed as psychopaths of one or another kind were: Friedemann Bach, Gluck, Liszt, Mahler, Pfitzner, Schubert, Johann Strauss the younger, and Wagner; those whom she classified as psychotic were Gluck, Schumann and Wolf. In addition to these three, we consider that two others, Handel and Mozart, should be taken into consideration, as the possibility of a psychotic illness does arise. The diagnostic problem of the nature of the psychosis, if any, is not of any difficulty in the cases of Gluck, Mozart and Wolf; but with Handel and Schumann there are difficulties which will have to be resolved before the general problem of an enhanced tendency to psychosis in the composers can be considered. In the paper which follows the case of Schumann is particularly discussed. In a second paper we propose to consider the evidene of psychosis or neurological disease in Gluck, Handel, Mozart and Wolf; and in a third paper we hope to take up the central problems of the relation­ship of creativity to abnormality of personality.

[I] However, it should be noted that none of the representatives of the modern twelve‑note school were included. 

The Problem

    Robert Schumann was born on the 8th June, 1810. On the 27th February, 1854, he threw himself into the Rhine, but was rescued. On the following 3rd March he went of his own free will into the mental hospital at Endenich; and he ended his days there on the 29th June, 1856.

    The Superintendent of the asylum at Endenich, Dr. Richarz, called Schumann's illness "partial paralysis", and from the context of his report it is clear that by that term he meant general paresis. The first suggestion that a diagnostic problem was involved was made by Möbius in 1906. After considering the evidence, he con­cluded that Schumann had suffered from a succession of schizo­phrenic illnesses from youth on; he rejected the diagnosis of any final organic illness. This view was countered by Gruhle (1906), who argued that the facts adduced by Möbius led, instead, to a different conclusion, i.e. that during the earlier part of his life Schumann was cyclotliymic, but that his last illness was an organic disease of the brain, most probably general paresis. Since then many other writers have taken up the problem. In the review of the literature provided by Lange‑Eichbaum, the writers quoted are almost equally divided between three views, that of Möbius, that of Gruhie, and an inter­mediate one which sees the psychosis as an organic one arising on the basis of a psychopathic personality. The personal opinion of Lange‑Eichbaum, which is sustained by Kurth, the editor of the last edition of his work, is in conformity with the last of these three. Juda herself did not go further than to classify the case as one of endogenous psychosis of unclear nature, with a final organic psychosis not to be excluded.

    Of recent work, that of Garrison (1934), Wörner (1949) and of Reinhard (1956) should be mentioned. Garrison concerns himself principally with the family history, but states that Schumann was schizophrenic. Worner argues that an earlier schizophrenic state was followed by a final organic psychosis. Reinhard believes that a final general paresis can be confidently excluded, and the psychosis was an endogenous one, nature not clear.

    Our own view is approximately that of Gruhle; but in view of the discrepancies of opinion, we propose to reexamine the relevant evidence in order to establish it on a firm foundation.

    It was not possible for us to consult all the contributions quoted by Lange‑Eichbaum in the original; but it is hoped that no major point has escaped our attention.

The Evidence

Family Background and Personality 

    Robert Schumann was the youngest of six children, of whom four brothers and one sister survived childhood. There was mental illness in the family. In his biography of Schumann, Young (1957) says that his father August had a nervous breakdown from which he never entirely recovered. He is said to have had attacks of giddiness, and to have had a melancholic tendency; but there is no evidence known to us that he had a mental illness. Juda classified him as normal. He was a publisher and successful in business, but also a writer on his own account and with an interest in romantic literature though no talent for music. He died when Robert was sixteen, so that Robert was for a number of years under the guardianship of his mother. She was a dominant personality, who resisted his attraction to music as a profession, but was psychiatrically normal. The eldest child, Robert's sister Emilie, became mentally ill at the age of 17 and drowned herself at 29. She was regarded as a ease of dementia praecox by Mobius, and this diagnosis was accepted by Juda, although it is by no means certain. Robert's three brothers, who all died before him, of brain fever, cancer and tuberculosis, were all mentally normal.

    Robert and Clara Schumann had eight children, one of whom, Ludwig, began to show signs of mental illness by the age of 20, and two years later was regarded as incurable. He died in a mental hospital at the age of 51. Juda considers that this case, too, was most probably one of schizophrenia. All of the other children were mentally normal, though one son took morphine in the course of a chronic physical ailment. From the family history alone, therefore, a suggestion of schizophrenia in Robert's ease arises.

    Schumann seems to have changed in personality during the course of his lifetime. As a young man he was sociable, fond of a gay life, interested in girls, champagne, cigars and billiards, and he had a number of minor love affairs. He was somewhat irresponsible and unsteady in his intentions and even after giving up the law for music, he varied from time to time in the application he brought to his studies.

    With all this, however, and underneath his romanticism, his idealism, his vague optimism, his unpractical ways, he had a funda­mental seriousness. He pursued Clara through all difficulties until he won her; and the devotion of the two to one another only in­creased with the years.

    Wasielewski (1906) gives a portrait of Robert in middle life as a man of more than average height, with slow and deliberate gait. His expression was mild and kindly, but with a good deal of reserve. He had little conversation, none on ordinary matters; but in an intimate circle would become quite eloquent on subjects which moved him. In the course of time he became more and more taciturn, and even to questions would not reply, or would answer in a murmur, in fragments of sentences, as if lie were thinking the answer out for himself. Apart from his eyes, the most attractive feature was his mouth, finely cut, with lips thrust a little forward as if to whistle. Mobius says that this was a mannerism, and did not appear till after 1833. He was very fond of his children, but somewhat distant and passive as a father; he was a most tender and loving husband. The life he preferred to lead was an exceedingly quiet one; and one of great regularity, the same routine being followed every day. Throughout his life he had strong interests in romantic literature and poetry. He edited the Neue Zeitschrift für Musik, and, in the numerous essays and reviews which he wrote for this journal, he showed amply his remarkable generosity of spirit, full of warm appreciation of the merits of younger composers, without envy or reserve. The same warmth and natural feeling (Innigkeit) pervade his compositions, particularly his short piano pieces and songs. Perhaps the natural expression of his personality in his music is not quite as direct as, for instance, that of Schubert. This may have been due, partly as Abraham (1954) suggests to strong literary interests which somewhat deflected his musical inspiration, partly to the strong influence of the phantastic romanticism of Jean Paul and others.

    In a self‑description, made by choice of adjectives, which Möbius quotes, Schumann chose as appropriate: quiet, shy, hypo­chondriacal, good‑humoured, genial, sociable, highminded, sensitive, emotional, enthusiastic, tenderhearted. One might add that, he himself characterised the main contrasts of his personality by the pseudonyms of Florestan, the gay, energetic iconoclast, and Eu­sebius, the gentle, pious and melancholy.

    Schumann was, socially, never very competent. In Dresden the Schumanns found themselves in a provincial society entirely do­minated by a philistine Court. It is not surprising that they shut themselves away in a circle of their own. When they came to Düsseldorf, though they were received with the greatest friendliness and enthusiasm, they never fitted in with the gay light‑hearted Rhine­landers. The collapse of Robert's career there must be partly at­tributed to mutual lack of understanding. Young says that he appeared at committee meetings as seldom as possible, and never stayed more than a few minutes; he generally delivered his instruc­tions to the choral society in writing, though a committee member.

    However, one cannot speak of a pathological withdrawal. Throughout his life he continued to make intimate and devoted friends, such as Mendelssohn, Jenny Lind, Hiller, Joachim, Brahms. He first met Brahms when he was a very sick man, and on the point of his final breakdown.

    Schumann was something of a hypochondriac, and throughout his life was afraid of death and of madness. He was extremely shocked and upset by all the deaths of near and dear ones, of his sister‑in‑law Rosalie, his brothers, and of Mendelssohn. After Mendelssohn's death he feared that he would die in the same way, i.e. after a succession of strokes. More than once in his life he ex­pressed the fear that he would lose his reason; and at other times he had a fear of heights and of metal objects.

    On the sexual side, we must regard him as normal in every way. A normal sexual life with his wife must have continued throughout their time together. She bore him eight children, in 1841, 1843, 1845, 1847, 1848, 1849, 1850 and 1854, and in 1852 she had a miscarriage.

 

Schumann's Illness: First Stage

From early on in his life, Schumann was troubled by variations of mood, which cannot be adequately accounted for by circum­stances. Nussbaum (1923) showed that while outwardly taciturn he could be eloquent in his letters. The following calendar can be drawn up.

     1828: Predominant mood melancholic. “Jetzt bin oft wie ganz zermartert von diesem winzigen Leben mit semen erbarmlichen Mensehen… Ich befinde mich schlecht unter Menschen, die mich nicht verstehen und die ich nicht lieben kann.”

    1829: One and a half years of almost continuous happiness, with humorous letters, demands for money from home, much in society, complete forgetfulness of law studies. Occasional interrup­tions by short depressive moods. “Die ledernen preußischen Soldaten ‑ lederne Tischgesellschaft ‑ lederne Flügel ‑ lederner Moselwein ‑ ledernes Essen ‑ ich selbst außerordentlich ledern.”

    1830: in October, recurrence of melancholy; complaints of in­decisiveness. “Mein Herz ist tot und öde wie die Zukunft.”

    1831: Persistence of melancholy; in May it takes him three weeks to complete a letter. Very few letters during the summer. In September an agitated mood; for some weeks a fear of cholera and fear of death; this succeeded by an apathetic mood. On the 31st December sudden recovery of mood.

    1832: Mood elevated; plans for going to America as a virtuoso; in June: “Kopf und Herz voll Glücksgotter”. August: “Auch spür' ich eine Kraft und eine herrliehe Straffheit im ganzen Korper.”

    1833: In June: “Im glücklichsten, heitersten Phantasieren, woin freilich manchmal der Schmerz selbst eine Schönheit wird.” A severe feeling of illness in the autumn, when the deaths of his brother Julius and his sister‑in‑law Rosalie occurred. In a letter to Clara of 11.2.1838 he described this time: “Schon damals um 1833 fing sich em Trübsinn einzustellen an .... Anerkennung fand ich nur wenig: dazu kam der Verlust meiner reehten Hand zum Spielen… Dies war im Sommer 1833. Dennoch fühlte ich mich nur selten glück­lich; es fehlte mir etwas; die Melancholie, durch den Tod eines lieben Bruders noch mehr über mich herrschend, nahm auch noch immer zu. Und so sah es in meinem Herzen aus, als ich den Tod von Rosa­lien erfuhr. – Nur wenige Worte hieruber, - in der Nacht vom 17ten zum 18ten Oktober 1833 kam mir auf einmal der fürchterlichste Gedanke, den je ein Mensch haben kann, ‑ der fürchterlichste, mit dem der Himmel strafen kann, der den Verstand zu verlieren ‑ er bemächtigte sich meiner aber mit so einer Heftigkeit, daß aller Trost, alles Gebet wie Hohn und Spott dagegen verstummte.”

    It is noteworthy that Schumann injured the third (ring) finger of his right hand, in a contraption he had invented for the practising of finger movements, between the end of May and the beginning of June. The effects of this accident were such as to close for him the career of a piano virtuoso. But the depression did not occur then, but in October. Wasielewski states that he had heard that on the night Schumann describes, he had wanted to throw himself out of the window, but adds that the report is unconfirmed. Möbius states that Schumann's fear of heights and upper storeys dated from this night.

    1834: The depression, which had persisted since October, began to yield in January. In May almost well. In August an elated mood.

    1836: In the summer: “Habe ich doch auch meine herrlichcn Stunden, am Klavier, im Ideenaustausch mit trefflichen Menschen, im Bewußtsein eines ehrenvollen Wirkungskreises mid in der Hoff­nung, noch mehr und Größeres zu fordern. Eben diese ehöhte Geistesstimmung artet aber oft in Übermut aus, wo ich gleich die ganze Welt mit Sturm nehmen möchte. Die Abspannung folgt auf dem Fuße naeh und dann die künstlichen Mittel, sich wieder aufzu­helfen.” In June: “Das melancholische Wetter und immer schwere Leiden, von denen ich Niemandem sagen darf, hatten mich wüst gemacht.” December: “in einer totlichen Herzensangst.”

    1837: September: “Tröste mich, bitte Gott, daß er mich nicht in Verzweiflung untergehen laßt. Ich bin angegriffen an der Wurzel meines Lebens.” On 28th November, to Clara, “Und nun auch, daß Du so gar wenig von meinem Ring haltst ‑ seit gestern habe ich Deinen auch gar nicht lieb mehr und trag' ihc auch nicht mehr. Mir träumte, ich ginge an einem tiefen Wasser vorbei, da fuhr mir's durch den Sinn und ich warf den Ring hinein ‑ da hatte ich unend­liche Sehnsucht, daß ich mich nachstürzte.”

    1838: February, Clara writes: “.. so heiter kenne ich Dich ja gar nicht.” March shows a hysterical note: “Ich wachte auf und konnte niclh wieder einschlafen ‑ und da ich mich dann immer tiefer und tiefer in Dich und Deine Seelen ‑ und Traumleben hinein­dachte, so sprach ich auf einmal mit innerster Kraft 'Clara, ich rufe Dich' ‑ und da horte ich ganz hart wie neben mir 'Robert, ich bin ja bei Dir'.” April: Und dann wie wohl befinde ich mich körperlich, daß ich ordentlich meine Kraft und Jugend fühle. In June and July, again melancholic. In August: Ich war die Tage her so schreck­lich traurig, krank und angegriffen, daß ich dachte, meine Auf­lösung wäre nahe.” Towards autumn, better.

    1839: February, an anxiety attack. April, ruminations about death. July: “Nur bin ich manchmal sehr krank jetzt, so eigen schwach im ganzen Körper und namentlich auch im Kopf ... es grift mich alles so fürchterlich an.” “Ich schweige oft tagelang ‑ ohne Gedanken und murre nur vor mich hin.” “Ist die erste Auf­regung vorüber, so überkomrnt mich dann in so starker Lebensmut, eine Lust zum Wirken, daß ich gleich Hand anlege an irgendeine Arbeit.”

    This account is extracted principally from Der junge Schu­mann (1917), and from Nussbaum's extensive quotations from Schumann's letters. From the time of his marriage in 1840, the material available in letters is less and the principal source of in­formation is the joint diary kept by Robert and Clara, later kept by Clara alone. The best source for Schumann's life and later illness is the biography by Litzmann (1918).

 

The Second Stage 

With his marriage, there came no end to Schumann's mood changes, although he was extremely happy with Clara and devoted to her. It seems clear that she was the dominant partner in their relationship, and that though she maintained an attitude of wifely submission, in fact he fell more and more under her influence. His life took on an unvarying daily routine, with hours set aside for composition, for a long walk, and for society of a small and intimate kind. It was probably under her influence, too, that he tried to rise superior to his romantic, half‑literary and lyrical nature, and to model himself on the classics and attempt larger forms.

    The first years of his marriage were very good years for Robert, and a large part of his best work was done then; 1840 was one of his peak years. However, at the end of 1842 and at the beginning of 1843 he was suffering from nervous weakness, and had to give up composing for some months. This was succeeded in March 1843 by a period of elevation of mood; and Clara records that he was then working on the Peri with such enthusiasm that it made her anxious.

    In the autumn of 1843 Robert was very indecisive about the Russian journey which was then being arranged; and in February 1844 he was in a low state which is anxiously recorded by Clara. In April, however, the couple set forth for St. Petersburg and Moscow. Robert broke down on the way, and had to interrupt the journey at Dorpat, where he spent six days in bed. A deep melancholy was accompanied by anxiety symtoms and physical complaints such as giddy attacks. He was incapable at this time of any work of compo­sition; but lie wrote five melancholic poems which show, according to Litzmann, remarkable helplessness both in form and content. If this is right, it must be put down to psychic inhibition, since Robert was a professional writer of articles on music, and an enthusiastic reader of poetry.

    In May 1844, back home again, lie began to feel better; but it was only a short and incomplete intermission. In August he was suffering again from a total nervous collapse, making work impos­sible. In September he was still worse, and unable to leave his room. In October they went to Dresden to stay with the Wiecks. Clara writes: "There were now eight terrible days. Robert did not sleep a single night, seeing in his imagination the most dreadful pictures; early in the morning I would find him drenched in tears; he gave himself up for lost."

    It was at this time that he first made contact with a homoeopa­thic doctor, Dr. Helbig, who remained his physician for a number of years. In a report quoted by Möbius, Helbig describes numerous phobias, fear of death, of heights, of metal objects, etc., and physical symptoms such as tiredness, tremor, cold feet. Highly significant symptoms he mentions are insomnia and a diurnal rhythm, the patient feeling his worst in the morning hours. Ilelbig also makes the first mention of auditory symptoms ("Gehörs­tauschungen") as occurring at this time.

    In November and December there was gradual improvement. But again the following year, in May 1845, he had more of his trouble and there were again attacks of giddiness. The symptoms persisted into August, so that a proposed journey to Bonn had to be cancelled.

In May 1846, as well as more giddy attacks, there was the first definite mention of tinnitus. This was a constant singing and roaring in the ears, and a distressing effect by which noises became musical tones. He was deeply hypochondriacal, weighed down with physical fatigue, full of melancholy ideas. He could not bear the sight of the asylum from his window.

    However, from July 1846 he made steady improvement, in­deed an apparently complete remission, which lasted for over a year. In September 1847 there was a slight return of the hypochon­driacal mood; but he was in good health over Christmas 1847 and full of joy in work. Then in January 1848 there was a sudden relapse, improving somewhat during February, but leaving him in only moderate health and spirits over the summer. By the winter he had dropped again into a low state, which lasted into January 1849, when the death of his brother Karl had a shattering effect on him.

    Once again there was a complete remission; and 1849 proved to be the high point in productivity of his career, with invention and versatility at their height. His mood was so much better, that there is a suggestion of more than normal elation: unlike his wont, he ordered in large quantities of expensive wine.

    In 1850, during preparations for the performance of Genoveva in Leipzig, symptoms recurred, including the fear of heights. He had to exchange an upper‑floor bedroom in the hotel for one on the ground floor. Otherwise, in the earlier part of the year, his health was fairly good. On the first of September the family moved to Düsseldorf. They were at first disappointed in their new home. Clara wrote that Robert was in a highly nervous, irritated, excited mood. From early on, Schumann's official duties as musical director in Düsseldorf did not go well, his principal fault being that he was in­capable of maintaining discipline. He and Clara were equally blind to his deficiencies. An article in the Düsseldorf paper in May 1851, criticising the concert direction, was felt by the Schumanns as an insult. Nevertheless his mood did not suffer. In May 1851, after a successful concert, Clara wrote that Robert was unusually happy. By September, Clara's complaints in the diary of the Diisseldorfer have become bitter and persistent; in a single year, Robert's relations with the local musical society, which had begun in a mood of great friendliness, had been entirely spoilt.

    In 1852, symptoms showed which we must take as ominous: a certain apathy and dreaminess, an occasional clumsiness of speech. By the summer he had reached the point where the preparation and conducting of the first two concerts of the season had to be taken by Julius Tausch as his deputy. He took over the direction again in December, but was ill received by the public. Three of the Com­mittee of the Gcsangverein approached with a request that he should resign as unfit. Efforts by others at a compromise were regard by Clara as an infamous intrigue. Another year had to go by before, on the 9th November 1853, Schumann decided to conduct no more.

    In April 1852 there were more physical symptoms, thought to be rheumatic, and insomnia and a depressive mood. In May he was better, but worse again in June. In July he had "em nervöser Krampfanfall" (a convulsive attack?), while out walking; and after it there were hypochondriacal ideas. After this he was a good deal better for a number of months, apart from more giddiness in October.

    In 1853 melancholic and anxiety states were remarkably few, despite the fact that his official difficulties were now reaching a head. In the spring of the year he took a great interest in table­rapping seances, to the surprise and misgiving of his friends. On his birthday, the 8th June, he was well and happy. A little later, on the 30th July, he had a sudden attack of what the doctor called lumbago, which Nussbaum thinks was a cerebral vascular stroke. Nussbaum says that the physician, Dr. Kalt, actually remarked “Der ist ein verlorener Mann, hat cein unheilbares Gehirnleiden (Gehirner­weichung, in common German parlance, synonymous with general paresis.) On the 30th August speech disturbances were noted. The physical symptoms did not impair Schumann's mood. On the 10th September he was outstandingly gay. Again there is a sug­gestion of elevation of mood above the normal. On their fourteenth wedding anniversary, Robert gave Clara a piano, which certainly delighted her, but also caused her great concern on account of the expense. The 30th September is a day of moment, as it was the day on which Brahms paid his lirst visit, to become a firm friend of both of them and a devoted admirer, indeed lover in all but the physical sense, of Clara. Robert immediately conceived the greatest ad­miration for Brahms' genius, and gave it expression in the renowned article "Neue Bahnen".

    In November the Schumanns went off on a triumphal tour of Holland, Robert in gay, almost elevated mood, which was not in the least impaired by the fact that he had just had to resign his post. While on this tour, he had a temporary return of auditory sym­ptoms; and from this time all creative activity ceased. Instead, lie developed for a time a preoccupation with making an anthology of the sayings of famous authors on the subject of music.

    On the night of the 10th February, 1854, he had a sudden attack of tinnitus, the same note sounding in his head all night. On Saturday the 11th he was better during the day, but bad again all night and all through the Sunday, apart from an intermission of two hours. Again sounds came to him as musical tones. Later, a hallucinatory element entered in, for the tinnitus progressed to the point where he was hearing entire pieces, as from a full orchestra, from beginning to end.

    On the night of Friday 17th February, he was up in the night to write down a theme which he said the angels had sung to him. When he had finished he lay down, wrapped in pliantasy for the rest of the night, always with open eyes lifted to heaven. He believed that angels hovered over him and gave him glorious revelations, all in wonderful music. However, the next morning there was a dread­ful change, and the angel voices changed to the voices of devils. They told him he was a sinner and they would throw him into Hell.

    He saw them about him in the shapes of tigers and hyaenas. Later in the day lie quietened down to the point where he could get up and set himself to the correction of musical manuscript. On the next day, Sunday 19th, there was a return of hallucinations, in a state of consciousness at least partially preserved. He was firmly convinced that lie was surrounded by spirits, but recognised the presence of his wife and spoke to her.

    On Monday 20th, he was listening to the angel voices all day, his face full of happiness, and he tried to write down some of the music lie heard. From the next day, Tuesday, the hallucinatory voices were more in words than music. He spent the time writing variations on an angelic theme, and lie also wrote two business letters. He gave directions on what was to be done when he was dead, and he said farewell.

    On Sunday 26th he was rather better. He received a visitor and played to him a sonata by a young composer who interested him, ending in a state of joyful exaltation. At the evening meal, he ate a lot and in fearful haste. He suddenly stood up and said he must go to the asylum, and went and laid out all the things he would wish to take with him. The following morning he was deeply melancholic and told Clara that he was not worthy of her love. He set himself to write a fair copy of his variations, but suddenly broke off and left the room. Without the others realising it, he went out of the house into stormy rain without boots or other protection. An hour later he was brought home again, having thrown himself into the Rhine, but seen to do so and immediately rescued. He must have taken off his wedding ring and thrown it into the river first; for it was never recovered, and at a later time a note was found: “Liebe Clara, ich werfe meinen Trau­ring in den Rhein, tue du dasselbe, beide Ringe werden alsdann sich vereinigen”. So he carried out in fact his dream of November 1837.

    Clara was not allowed to see him again after this, before he was taken to hospital. He left a week later, on Saturday 4th March. She wrote: "Robert dressed in a great hurry, climbed with Hasenclever and his two male nurses into the carriage, and did not ask after me, nor after his children." Robert settled happily into the asylum, and took an immediate liking to his personal nurse. In succeeding weeks he spent part of the time quietly in bed, or taking a walk, or talking to the doctors; but lie also had spells of agitation in which lie would walk up and down his room or kneel and wring his hands. On the 31st March Clara recorded with sorrow that Robert asked for flowers, but never for news of her. When he did receive a bouquet from her, he smiled in a pleased way, nodded his head, but said nothing. At the end of April he was worse again, with auditory hallucinations and confused talk, with never a mention of Clara. At the end of May he was unusually cheerful, and on the 21st July Clara received flowers Robert had sent her.

    For the knowledge of Robert's state in the asylum, we are principally dependent on letters to Clara from friends, especially Brahms. Very little is available in medical reports. The report by Richarz, given in 1873, quoted by Wasielewski, says that spells of hallucination were repeated again and again, but that they tended to change in type from auditory hallucinations to hallucinations of taste and smell. Gradual and progressive impairment of his in­tellectual powers was very slow, and never reached an extreme degree. At the latter end of his illness he frequently refused food, and he eventually became extremely emaciated. The hospital notes themselves are not available; when Mobius enquired after them, they could not be found, and Möbius thought that they had been removed from the hospital records at Endenich by Richarz himself. We have to rely therefore on technically less competent sources.   

    On the 13th August, 1854, Brahms wrote a letter to Clara describing a visit to Endenich. He saw and heard Robert from a place where he was himself concealed. Robert was telling his doctor of a walk to the cemetery; his talk was clear and sensible, not con­fused. Brahms records that during the entire conversation, Robert held a white pocket handkerchief to his mouth. He was looking well and strong, and had put on some weight. Dr. Peters told Brahms that he was very changeable, and periods of clarity and confusion followed in quick succession. The day before, while drinking his wine, he had suddenly stopped, said there was poison in it, and had thrown the rest on the floor. He wrote much, but illegibly; once, "Robert Schumann, Ehrenmitglied des Himmels". The doctor also com­mented on his weakness of memory, and his incapacity to remember what he had done an hour ago.

    On the 15th September, 1854, Robert wrote Clara a letter. Superficially, it contains nothing grossly abnormal. Yet Litzmann is right when he comments on it, that it is like a voice from the grave, from someone who does not know that he is dead; touching, childishly tender, but wholly concerned with the past. He asks Clara whether she plays as well as ever, where the album is, whether she still has his letters written from Vienna to Paris. In fact, trivialities, thrown together in an indiscriminate way, with never a word about the vital and tragic issues that faced them both.

    There appears to have been no o consistent change during the winter of 1854-5; musical hallucinations continued to occur. On the 23rd February, 1855, Brahms wrote Clara a letter describing a second visit to Robert. He says:

    “Robert Schumann received me with the same warmth and gaiety as on the first occasion . . . . He immediately showed me your latest letter and told me what a delightful surprise it had been… I showed him your portrait ‑ you should have seen the depth of his emotion… He asked for news of the children. He complained that writing paper was not given to him to write to his wife. When he got writing paper, he sat down at his table with a charming expression on his face and started several times to write to you. Finally he gave up, saying that he was too agitated. He mentioned several times that his publisher should not wait for his corrections and I told him that he had already received them long ago. He insisted with violence that it was impossible for the publisher to have received them. We discussed the matter for some time and I was unable to convince him.”

    Brahms goes on to describe how Robert wanted to play a duet with him, and that it was not very successful.

    The things which will interest the psychiatrist in this letter are the clear signs of defects of memory, and the lack of recognition by the patient of their existence. When lie is corrected he is first pathologically obstinate, and then has a catastrophic reaction, showing a pathological increase in emotional lability. It is also important to note that general emotional responsiveness is main­tained and natural.

    On the 5th May 1855 Robert wrote his last letter to Clara, after which he descends into a perpetual silence. This is:

“Liebe Clara!

    Am 1. Mai sandte ich Dir einen Frühlingsboten; die folgen­den Tage waren aber sehr unrihige; Du erfährst aus meinem Brief, den Du bis übermorgen erhälst, mehr. Es wehet ein Schatten darin; aber was er sonst enthält, das wird Dich, meine Holde, erfreuen.

   Den Geburtstag unsres Geliebten wußt’ ich nicht; darum muß ich Flügel anlegen, daß die Sendung noch morgen mit der Partitur ankömmt.

    Die Zeichnung von Felix Mendelssohn hab' ich beigelegt, daß Du (sie) doch ins Album legtest. Em unschätzbares Andenken! 

    Leb wohl, Du Liebe,

    Dein Robert”.

    The psychiatrist notes that, while a normal affect is still pre­served, this letter is completely fragmentary and incoherent.

    Brahms made another visit in April 1856. Schumann received him with signs of pleasure, but could only express himself in single inarticulate words. At another visit on the 18th June, Brahms found that Schumann scarcely noticed him, but spent the time poring over an atlas and picking words out from it. That month Schumann was losing strength fast, and was mostly confined to bed with swollen feet. On the 27th July Clara went to see him. He smiled at her, and tried to put an arm around her, with great difficulty as he could not control his limbs. His expression was clouded but mild. His speech was practically unintelligible: he said, looking at her, "Liebe ... ich kenne. . ." ("Dear I know. . ." and Clara concluded that he wished to say, "Liebe Clara, ich kenne dich"). On the 28th his limbs were in almost continuous convulsion, and on the 29th he died.

    The results of the autopsy were published in 1873 by Richarz, the Superintendent of the asylum at Endenich; they are quoted by Wasielewski. The abnormalities in the cranial cavity consisted of: (1) growth of bone at the base of the skull, forming exostoses which in some places penetrated the dura mater; (2) thickening of the leptomeninges and adherence of the pia mater with the cerebral cortex in several places; (3) considerable atrophy of the brain; its weight was below that which would have corresponded with his age; (4) hyperaemia, especially at the base. Part of these findings have been modified by Schaafhausen's re-examination of Schumann's skull, quoted by Möbius. Schaafhausen did not find any appreciable new growth of bone and, judging the intracranial capacity, he arrived at the conclusion that the atrophy of the brain was not as considerable as assumed by Richarz.

 

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.

 

Discussion 

    If we are to come to any final opinion about the nature of Schumann's illness, we must first try to decide what it was that killed him. There can, we think, be no reasonable doubt that when Schumann was in Endenich he was suffering from organic disease of the brain. When, twelve days after the onset of acute psychotic symptoms, he voluntarily went to the asylum, he was in a fatuously euphoric state, entirely forgetful of his wife and family. From the letters of Brahms we get a clear picture of Schumann in hospital retaining his emotional responsiveness, even when intellectual failure had become profound. Gross failure of memory was reported by the doctor as present a few months after his admission to hospital. In course of time intellectual failure reached the point of not being able to speak or write coherently, and it was succeeded by increasing physical weakness and emaciation, decubitus, incapacity to carry out ordinary voluntary movements, and death in convulsions. During the earlier part of his stay there were hallucinatory episodes and short-lived delusional ideas; a prominent feature of these states is their transitory nature, and they have every appearance of being organically determined phenomena. The existence of some form of organic disease of the brain seems to be beyond dispute. Going back into the past, we find the first mention of symptoms characteristic of an affection of the nervous system not earlier than 1844. In that year there is the first mention of attacks of giddiness, and Dr. Helbig reports "Gehörstäuschungen." We do not know exactly what was meant by this word, but it seems improbable that it meant auditory hallucinations. It is much more probable that some form of tinnitus was intended, since that is the auditory symptom which is more precisely described later. Giddiness recurred in 1845, and tinnitus in 1846. It is then described in unmistakable terms as a constant singing and roaring in the ears, and an effect by which noises became musical tones.

    From this time until 1852 there is a gap, and no symptoms of a characteristically organic kind are recorded. In 1852, however, they reappeared in more ominous form, first as a dreamy apathy and disturbance of speech, then the occurrence of a “convulsive" attack. From that time deterioration was steady. There were more speech difficulties and more auditory symptoms in 1853; and in February 1854 there came the sudden outbreak of a florid psychosis. In the course of a week Schumann was reduced from normal mentality to a state of raving.

    Of this state the first sign was an intense tinnitus, which was soon translated into a continuous and vivid auditory hallucinosis. It is interesting that the hallucinations took at first a musical form, only later to become voices. One might suppose that stimulation of the auditory centres by pathological stimuli caused this reaction in his case because so much of his normal mental activity was musical rather than verbal. In this delirium‑like psychosis, it is not easy to say how large a part was played by clouding of consciousness. At times at least it was not wholly clouded over, since he could recognise his wife at his side; but there is a suggestion of a twilight state with a varying degree of clouding. The hallucinosis, also, was variable in degree, and at times passed off. We hear of his getting quieter, getting up and setting about the correction of manuscript, of writing business letters, and still later receiving and entertaining a visitor. Other symptoms were fleeting delusional ideas and sudden impulsive actions. The total picture is a very familiar one, that of a delirious state, an exogenous organic reaction.

    We agree with Gruhle that dementia paralytica is by far the most probable diagnosis, and accounts for the entire course of the illness from 1852 onwards. There are other possibilities, such as presenile and arteriosclerotic dementia, hypertensive encephalopathy, vitamin deficiency (pellagra, aneurin deficiency or related deficiencies which are known to occur in depressives or after chronic alcoholism), a deep‑seated new growth, etc. MacMaster (1928) thought of (obviously atypical) tuberculous meningitis. But on careful consideration none of these alternatives fits all the facts as well as syphilitic disease.

    Relating this hypothesis with his productivity, we can say that an organic psychosis, such as dementia paralytica, would explain the failure of Schumann's musical powers in 1852 and later. Furthermore, the type of failure is consonant with organic changes. Schumann was quite productive in 1852 and 1853. All critics are agreed that these later works are without merit, the last occasions when he reached his old mastery being the violinsonatas of 1851. Of the work of 1853, Chissell notes that mental tiredness and emotional apathy were accompanied by an unhesitating flow. It seems very probable that organic psychotic changes were making their effects felt in 1852, and unlikely that their onset was any earlier than 1851. We have, then, to account for the tinnitus and giddy attacks which appeared much earlier, i.e., in 1845. Consistently with the diagnosis of dementia paralytica, these may be attributed to a luetic infection. A combination of cerebrospinal syphilis and dementia paralytica, though rare, is well known to occur; and, following Lange‑Eichbaum, there seems to have been a similar sequence in the illness of Nietzsche. An exceedingly far‑fetched suggestion is also, perhaps, just worth mentioning, that of a lesion such as a tumour of the temporal lobe. The later appearance of gustatory and olfactory hallucinations might be thought to fit in with this, but otherwise there is nothing to support it. Ménière's disease, as a cause for tinnitus and giddiness, can be excluded, since there is no evidence that Schumann ever became deaf.

    Having reached this point, we now have to consider the nature of the depressive and anxiety states which afflicted Schumann from the age of eighteen onwards. We believe that any impartial examination of the self‑descriptions, such as those we have quoted, leads irresistibly to the conclusion that these were cyclothymic in nature. Let us, however, first consider the alternative hypothesis, which is so constantly repeated, that Schumann was schizophrenic.

    The whole basis for a diagnosis of schizophrenia depends on a schizophrenic interpretation of the final psychosis of 1854‑56, and a determination to regard earlier symptoms as caused in the same way. This was the position taken by Möbius, who said, in a paragraph which has often been quoted:

    "Angst und Verstimmung, wunderliche Manieren, Neigung zur Stummheit, Misstrauen, Gehörstäuschungen, schwere Sprache, allmähliches Abnehmen der Geisteskräfte, alles schubweise hervortretend und langsam, aber unaufhaltsam zunehmend, das ist die Krankheit, die jetzt Dementia praecox genannt wird."

    In the light of the description which has been provided, this clinical summary can be seen to be inaccurate. There were numerous phases of illness from youth on, always with complete recovery and no indication of progression until the 1850's. The speech difficulties and mental impairment are confined to the last years, and are organic in nature. The auditory symptoms are peripheral in nature, until the delirious state of February 1854 brings genuine hallucinations. The only "hallucina­tory" experience before that time is the hypnagogic hallucination of February 1838. Evidence for mistrust or a paranoid reaction at any time in life is very scanty: at Düsseldorf Clara was more mistrustful than Robert. The states of anxiety and de­pression are, surely, characteristic of cyclothymia and not of schizophrenia.

    The "Neigung zur Stummheit," which Nussbaum also calls "Mutismus," is worth a little more discussion. There can be no doubt that in the course of his married life Schumann became very taciturn; yet evidence is lacking that his taciturnity was pathological. At times, especially in an intimate circle, he would be very talkative, when the subject discussed was one which interested or moved him. Nussbaum's "Schnauzkrampf" and Möbius' "wunderliche Manieren" appear both to be over­statements of a position of the lips at rest suggestive of whistling, and of a habit Schumann had of walking up and down in his room on tiptoe. Both of these would appear to fall well within the range of normal mannerisms.

    The family history is a point which counts in favour of schizophrenia. The mental illnesses of both his sister and his son have been diagnosed as schizophrenic; this diagnosis seems very probable in the case of the son, less so in the case of his sister Emilie. However this is a point which cannot carry great weight. We have to diagnose schizophrenia by the clinical features shown by the patient himself, and to do so with any justification we have to show the presence of at least one or two incontestably schizophrenic symptoms. We can find no evidence of any schizophre­nic symptoms in the illness itself; and the most that can be safely asserted is that Schumann's basic personality, which of course lent an individual colouring to the features of the illness, was not of an exclusively cyclothymic kind. His unrealistic idealism, his dreaminess and romanticism are certainly character traits which are not typical of the cyclothymic extravert, and could perhaps, together with his manner­isms, be regarded as schizoid. In such qualities as these one might justifiably trace the influence of the familial predisposition. The fact remains that Schumann never showed any overt symptom, and that the whole course of his illness is of a totally different kind.

    The portraits of Schumann (figs. 1 to 3) show a markedly pyknic habitus, with soft, rounded, almost feminine features. His personality also had qualities which might be called soft or feminine. In youth he was extremely extraverted, gay, active, and sociable, without a sign of schizoid sensitivity or withdrawal. In his married life he changed much, in a way which can be accounted for by the increasing predominance of depressive moods, and by the domesticating influence of Clara. Schumann was, of course, a complex personality, to which his classification as cyclothymic does not do full justice.

 

 

    However, the course of the mood changes is characteristically cyclothymic. There were depressive phases in 1828, 1830, 1831, 1833, 1836, 1838, 1839, 1842, several such in 1844 taking up nearly the whole of the year, 1847, 1848. In 1829, 1832, 1833, 1836, 1838, 1843, 1849 and 1851 there were phases of marked eleva­tion of mood, sometimes of a rather extreme degree. On two or three occasions, Schumann recorded in self‑descriptions emotional states of a mixed kind ("tot und selig zugleich," "so arm und reich, so matt und kräftig, so abgelebt und so lebenslustig" ). There is a suggestion of correlation of mood changes with the seasons. Many of the down‑swings took place in the autumn, with a number of others in the spring; the principal up‑swings also occurred in the months February to June. However there was no consistent regularity; the main mood changes in 1836, 1842 and 1848 were in December.

    If one examines a chart of Schumann's production against the years, the inhibi­tory effect of his depressive phases and the excitatory effect of the elevated phases are made strikingly obvious (Table 2). 1840 and 1849 were his peak years, and in both of them he was in a consistently elevated mood throughout the year. In most of the other years he had some weeks or months of depression, not enough to distin­guish one year from another on the chart; but the year 1844 was remarkable for low spirits practically throughout the entire year. It is also noteworthy that, regardless of quality, his production was consistently high in the four years 1850‑53. Despite the onset of symptoms of an organic type, he was unusually free from depressive and hypochondriacal moods during these years, apart from a phase of depression in April and May 1852. The fact that the organic symptoms themselves had no inhibitory effect on his productivity is confirmatory evidence that the earlier and the later psychiatric illnesses were different in nature.

    Gruhle laid stress on two signs which he regarded as pathognomonic of endoge­nous depression, both shown by Schumann to a conspicuous degree; the inhibitory effect of the depression on mental life, and the subjective experience of intense physical malaise. There are other points which we may add. In his depressions Schumann suffered from an intractable insomnia, which Dr. Helbig said had resisted all previous medicines; from Clara's account of finding her husband in the morning awake and drowned in tears, it would seem that the insomnia was of that type, with early morning waking, which is most characteristic of endogenous depression. Helbig also observed a marked diurnal rhythm, with the morning hours being the worst, a feature which is again typical of the endogenous depression. Psychogenic precipita­tion for the depressive phases is not easily to be found, and in general these moods do not appear to be of the reactive type. They could not be alleviated by distrac­tions, and, until they spontaneously remitted, Schumann was hypochondriacal, oppressed by irrational fears and bodily malaise, dependent and self‑reproachful. The evidence of a manic‑depressive constitution could hardly be more complete.

 

Summary 

The controversy about Robert Schumann's mental illness has never been satis­factorily resolved. Möbius' diagnosis of dementia praecox has been severely criticised by Gruhle, who regarded Schumann as a manic‑depressive succumbing finally to an organic brain disease, probably dementia paralytica. Subsequent reviewers have more or less adopted either the one or the other of these diagnoses, schizophrenia finding more favour recently.

    The present authors have re‑examined the available evidence and consider the interpretation of Gruhle to be preferred. The terminal psychosis presents unambigu­ous organic features, and may well have been a dementia paralytica, with atypical prodromata, but typical course and outcome. When that is eliminated from the picture, no signs or symptoms of schizophrenia remain to be accounted for. The earlier illnesses, both depressive and hypomanic, are essentially affective in sympto­matology and all ended in complete recovery.

References 

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Alley, M. and Alley, J.: A passionate friendship: Clara Schumann and Brahms. Translated by M. Savill (Staples, London 1956).

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Brion, M.: Schumann and the romantic age (Collins, London 1956).

Chissell, J.: Schumann. Master Musicians Series (Dent, London 1918).

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Juda, A.: Hochstbegabung: Ihre Erbverhältnisse sowie ihre Beziehungen zu psychischen Anomalien (Urban & Schwarzenberg, München 1953).

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Litzmann, B.: Clara Schumann: Ein Künstlerleben, 5th edition (Breitkopf & Härtel, Leipzig 1918); Letters of Clara Schumann and Johannes Brahms, 1853‑1896 (Arnold, London 1927).

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Schumann, A.: (ed.) Der junge Schumann: Dichtungen und Briefe (Insel‑Verlag, Leipzig 1917).

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