Friedrich Nietzsche
Friedrich Nietzsche was a German philologist and philosopher who worked in Basel from 1869 until physical and mental collapse forced his retirement in 1879. For twenty years before his death in 1900, he was cared for by his family, probably destroyed by an untreated illness. His ideas about the death of God, the body as philosophical instrument, the genealogy of morality, and the will as fundamental in life had wider consequences for medicine than his brief career might suggest. He gave psychoanalysis the concept of the unconscious through Georg Groddeck; he gave Viktor Frankl his most cited phrase; he gave phenomenology its basic diagnosis of modernity; and he gave medical ethicists a name for the tradition they were arguing against. This page tracks those specifically medical and clinical inheritances.
Background and Formation
Nietzsche held the chair of classical philology at Basel from age 24, one of the youngest appointees in the university’s history. He resigned in 1879 on grounds of ill health (chronic headaches and vision problems throughout his professional life) and spent the following decade as a traveling invalid, writing in boarding houses across Switzerland and Italy. His philosophical method was shaped by reading Arthur Schopenhauer in adolescence, which convinced him that unconscious drives govern behavior more fundamentally than conscious thought.(Makari, George, 2008) Makari summarizes Nietzsche’s mature self-understanding: after losing his religious faith he came to conceive of himself as “physician to a diseased culture,” diagnosing European civilization as sick from the repression of emotional and irrational life beneath a thin rational veneer, with what people called “truth” exposed as a falsified consolation in a chaotic world.(Makari, George, 2008) Crosby places Nietzsche, alongside Maupassant, on a list of European men of letters who “both died insane” and were “probably syphilitics” — making the collapse of 1889 most likely an end-stage neurosyphilitic illness, though Crosby’s framing is cautious rather than diagnostic.(Alfred W. Crosby, 1972)
Nietzsche argued that health is not a fixed standard but a relational concept, depending on “your goal, your horizon, your energies, your impulses, your errors, and above all on the ideas and phantasms of your soul.”(James Aho, Kevin Aho, 2009) This formulation suggests that health might be present even in the incurably diseased.(James Aho, Kevin Aho, 2009)
The Body, Illness, and Philosophical Method
Nietzsche diagnosed European modernity in terms that were simultaneously cultural and medical. His proclamation of the “death of God” was not primarily a theological argument but what Kevin Aho and James Aho read as a cultural diagnosis: that “given the skepticism of scientific inquiry, the technologies birthed by it, and their globalizing, industrializing, and militarizing effects, Europeans were finding it increasingly difficult to believe in anything with transcendent value.”(James Aho, Kevin Aho, 2009) What replaced transcendent value was a mechanistic universe in which human beings were “expendable cogs,” a world that Aho and Aho describe as reduced to the Körper, the quantifiable, de-animated body managed by objective procedures.
Aho and Aho argue that phenomenology, from Heidegger forward, shares Nietzsche’s skepticism toward scientism, the dogmatic acceptance of natural science as the only method to obtain truth. They read Nietzsche’s “death of God” as equivalent to Heidegger’s claim that scientism “severed the event of life from its connection to earth, and living beings from their ties to each other.”(James Aho, Kevin Aho, 2009) Both diagnoses point toward the same clinical consequence: the more frantically medicine treats the body as a technical problem to be solved, the more patients suffer the anxiety of being unhoused in their own flesh.
His claim about truth bears directly on medical epistemology. Aho and Aho identify a central tension: Nietzsche’s assertion that truth is “a mobile army of metaphors, metonyms, and anthropomorphisms… which after long use seem firm, canonical, and obligatory to a people” enables productive critique of biomedical truth claims, but becomes morally difficult when applied to life-and-death decisions. Edmund Husserl, founder of phenomenology, was suspicious of Nietzsche’s rejection of foundational truth precisely because “when it comes to matters life and death, as in the case of my own cancer or heart disease… it can be unsatisfying; some would say, morally intolerable.”(James Aho, Kevin Aho, 2009) This tension between perspectivism and the need for some epistemological ground runs through the philosophy of medicine to this day.
Aho and Aho invoke Thomas Kuhn when discussing the incommensurability of monomorphic germ theory and pleomorphic terrain theory, two frameworks for understanding disease that cannot adjudicate between themselves by any agreed standard.(James Aho, Kevin Aho, 2009)
Influence on Psychoanalysis
The concept of the Id (das Es, the It), one of the three structural elements in Freud’s final model of the psyche, did not originate with Freud. Georg Groddeck, the German physician who developed psychosomatic medicine at Baden-Baden, acknowledged in his Book of the It (1923) that he had taken the term from Nietzsche. Freud then acknowledged in The Ego and the Id (1923) that he owed the concept to Groddeck.(Groddeck, Georg, 1923) The genealogy runs: Nietzsche’s impersonal “It” that drives human life, through Groddeck’s holistic organism-as-It, to Freud’s structural unconscious. This is one of the most concrete instances of Nietzsche’s direct technical influence on clinical theory.
Thomas Szasz, in The Myth of Mental Illness (1960), identifies Nietzsche as one of the philosophical sources from which Freud drew his ethical values. Freud’s ethical framework (rationalism, self-awareness, self-discipline, and preservation of social arrangements) was drawn from nineteenth-century science, classical philosophy, and also from “some moderns, such as Schopenhauer and Nietzsche.”(Szasz, Thomas, 1960) Szasz’s point is that these values were present but disguised as value-neutral science, whereas Adler explicitly named his ethical commitments, presenting them as ethical rather than scientific claims.
Carl Jung’s early intellectual formation combined neo-Romantic philosophy with an interest in the occult.(Makari, George, 2008) George Makari’s historical account of psychoanalysis shows that “in the 1890s, the teenage boy discovered Arthur Schopenhauer and was captivated by the philosopher’s tragic vision of man driven by blind desires… Carl also absorbed the work of Friedrich Nietzsche, who made a great impression.”(Makari, George, 2008) [GAP: The cited card does not discuss Jung’s later redefinition of libido or his divergence from Freud.]
Otto Rank, another key member of Freud’s inner circle, came to psychoanalysis through philosophy rather than medicine. Makari notes that “in his neo-Romantic intellectual passions, Rank mirrored the interests of many of his peers in turn-of-the-century Vienna. Rank’s journey took a turn when in October 1904 he noted in his diary… The young man tried to synthesize his prior intellectual idols with this one, welding the Freudian unconscious to the Schopenhauerian will.” Those idols included Nietzsche and Weininger.(Makari, George, 2008)
At the level of cultural context, Makari demonstrates that Nietzsche was a shaping presence in the Viennese intellectual world that gave birth to psychoanalysis. In fin-de-siècle Vienna, Nietzsche “reminded his readers that humans were animals driven to maintain their species. The imperatives of the species required little of consciousness. Unconscious thought, feeling, will, memory, and action drove human behavior.”(Makari, George, 2008) This emphasis on the primacy of the unconscious over conscious reason created the intellectual atmosphere in which Freud’s proposals could find a hearing. Makari treats Nietzsche’s diagnosis of repression as a critique that “paralleled and reinforced Freud’s own model of repression and the unconscious,” rather than a direct doctrinal source from which Freud borrowed.(Makari, George, 2008)
Influence on Phenomenology of Illness
Karen Horney, in The Neurotic Personality of Our Time (1937), invokes Nietzsche’s concept of principium individuationis when analyzing the masochistic drive toward self-relinquishment. In her account, the neurotic’s desire to dissolve individual identity is “a feeling of intrinsic weakness… The obtaining of satisfaction by submersion in misery is an expression of the general principle of finding satisfaction by losing the self in something greater, by dissolving the individuality, by getting rid of the self with its doubts, conflicts, pains, limitations and isolation. This is what Nietzsche has called liberation from the principium individuationis.”(Horney, Karen, 1937) Horney uses this Nietzschean frame to distinguish pathological self-relinquishment from genuine surrender: both reach for dissolution of the self, but genuine surrender is “a manifestation of inner strength” whereas masochistic surrender is “ultimately a manifestation of weakness.”(Horney, Karen, 1937)
Fredrik Svenaeus, in his phenomenological analysis of suffering in Phenomenological Bioethics (2018), identifies three philosophical and theological ways of dealing with apparently meaningless suffering: insisting it has a purpose, developing indifference or acceptance, or deeming it an evil to escape and alleviate.(Svenaeus, 2018)
Oliver Sacks quotes Nietzsche directly in his discussion of biofeedback as a treatment for migraine. Writing about the nature of will and voluntary control, Sacks cites Nietzsche: “‘One cannot will,’ writes Nietzsche, ‘one can only will something.’” Sacks uses this observation to explain the mechanism by which biofeedback works: the patient must be given something concrete and measurable to direct attention toward before voluntary modulation of autonomic functions becomes possible.(Sacks, Oliver, 1970/1992)
Influence on Anti-Psychiatry and Critical Medical Theory
R.D. Laing, in The Politics of Experience (1967), names Nietzsche as one of a small number of thinkers who share a common insight about the fundamental condition of modernity. “Viewed from different perspectives, construed in different ways and expressed in different idioms, this realization unites men as diverse as Marx, Kierkegaard, Nietzsche, Freud, Heidegger, Tillich and Sartre.” The realization they share is that alienation is not an aberration but the starting condition of modern existence.(Laing, R. D., 1967)
In the same volume’s chapter on transcendental experience, Laing lists Nietzsche among artists who were “shipwrecked” while trying to explore inner realities: “Small wonder that the list of artists, in say the last 150 years, who have become shipwrecked on these reefs is so long — Hölderlin, John Clare, Rimbaud, Van Gogh, Nietzsche, Antonin Artaud.”(Laing, R. D., 1967) Laing’s framing is sympathetic rather than diagnostic: these figures had “exceptional qualities” but were destroyed by the combination of what they encountered and “the hatred of their fellows for anyone engaged in this pursuit.” The passage is anti-psychiatric in its implication: these individuals were not primarily specimens of pathology but explorers penalized for their explorations.
Haller’s survey of postmodernism and medicine in Shadow Medicine (2014) notes that applied to medicine, postmodernism infers that “the ‘truth’ of an illness is no longer in the physician’s objectivist and biomedical account, but in the patient’s narrative.”(Haller, 2014)
Maurice Merleau-Ponty, in his working notes later published as The Visible and the Invisible, invokes Nietzsche when developing his concept of an “indirect method” for ontology, an approach that discloses being through concrete beings rather than through direct metaphysical assertion. Merleau-Ponty describes his method as like “negative philosophy” or “negative theology,” and at this point the notation includes Nietzsche as a reference for this approach of knowing being obliquely, through what it is not.(Merleau-Ponty, Maurice, 1968)
Influence on Medical Ethics
Edmund Pellegrino and David Thomasma, in The Virtues in Medical Practice (1993), identify Nietzsche as part of an “antivirtue tradition” that persistently challenges virtue ethics by asserting self-interest or power as the true basis of morality. The genealogy they trace runs from Callicles through Machiavelli, Mandeville, Nietzsche, and Rand.(Pellegrino, 1993) Their text Genealogy of Morals is cited explicitly in this connection. This framing situates Nietzsche as the intellectual challenge against which virtue-based medical ethics defines itself, rather than as a contributor to it.
Suffering and Meaning
Viktor Frankl, writing in Man’s Search for Meaning (1946) from his experience as a prisoner in Nazi concentration camps, centers his logotherapy on a line he attributes to Nietzsche: “He who has a why to live for can bear almost any how.”(Frankl, Viktor, 1946) Frankl argues that the knowledge that there is a meaning in one’s life is the most effective aid to survival even under the worst conditions, as demonstrated by concentration camp survivors.(Frankl, Viktor, 1946)
Wider Significance
Nietzsche’s medical significance is indirect but real. He did not write clinical medicine, but his observations about the body as philosophical instrument, the inadequacy of conscious reason as a full account of motivation, the cultural construction of health and disease standards, and the relationship between suffering and meaning fed into virtually every major alternative to mainstream biomedicine in the twentieth century: psychoanalysis, phenomenological medicine, anti-psychiatry, narrative medicine, and medical ethics alike. What connects these inheritances is his central move: taking the body and its experience seriously as a source of philosophical insight rather than simply as an object of scientific management.
Scholarly Assessment
The scholarly assessments of Nietzsche available in this evidence base are evaluative rather than neutral. Pellegrino and Thomasma treat him as an adversary to virtue ethics.(Pellegrino, 1993) Szasz identifies him as a source for Freud’s hidden ethical commitments.(Szasz, Thomas, 1960) Aho and Aho treat his “death of God” and perspectivism as foundational diagnoses, but acknowledge that Husserl’s critique of Nietzschean relativism has force when life-and-death medical decisions are at stake.(James Aho, Kevin Aho, 2009) The most sympathetic use is Frankl’s, a Holocaust survivor who found in Nietzsche’s aphorism a practical principle of survival under conditions Nietzsche himself never encountered.(Frankl, Viktor, 1946)
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See Also
- georg-groddeck
- sigmund-freud
- carl-jung
- karen-horney
- martin-heidegger
- r-d-laing
- viktor-frankl
- phenomenology-of-illness
- lebensphilosophie
- anti-psychiatry