What caused Nietzsche’s insanity and death?

A paper just published in Acta Psychiatrica Scandinavica reconsiders the insanity and death of philosopher Friedrich Nietzsche, who is commonly thought to have died of neurosyphilis.

In contrast, the authors of the new study suggest that Nietzsche died of frontotemporal dementia – a type of dementia that specifically affects the frontal and temporal lobes.

While many people have ‘diagnosed’ historical figures in retrospect, this study is different, in that the authors reviewed Nietzsche’s actual medical notes in light of what is known about the progression of syphilis and dementia today.

More than 100 years after his death, Friedrich Nietzsche remains one of the most contentious figures in the history of philosophy. His writings contain some of the most profound philosophical statements of the 19th century, and have been exceptionally influential. However, they also express ambiguities and contradictions, which leave scholars perplexed and still arguing about their meaning and intent. Such ambiguities are reflected not only in Nietzsche’s life, but also in his terminal illness and death.

Following a psychotic breakdown in 1889, at the age of 44 years, he was admitted to the Basel mental asylum and on 18 January 1889 was transferred to the Jena mental asylum. He remained in demented darkness until his death on 25 August 1900. In Basel, a diagnosis of general paralysis of the insane (GPI; tertiary cerebral syphilis) was made. This diagnosis was confirmed in Jena and is still widely accepted. However, even some of Nietzsche’s contemporaries doubted this. The lack of certainty about his primary luetic infection, the long duration of the disease and some clinical features lead us to question the diagnosis of GPI.

In this study, we re-construct the anamnesis [clinical history] of Nietzsche’s illness and review the clinical presentation. We then note the natural history of GPI as it was at the turn of the 19th century, and suggest an alternative diagnosis, namely that of frontotemporal dementia (FTD) which has been characterized in detail only in the last two decades.

Link to abstract of paper.


  1. Posted December 4, 2006 at 4:10 am | Permalink

    Thank you for alerting me to this article. I have read two other studies which refute the syphilis hypothesis, including one short paper by Dr. Leonard Sax (http://home.cfl.rr.com/mpresley1/fn.pdf), which was published in the Journal of Medical Biography in 2003, and a short monograph by Dr. Richard Schain called *The Legend of Nietzsche’s Syphilis*. Both were intriguing, well-researched investigations which interrogated the standard analyses of Nietzsche’s health.
    I look forward to reading this new study. I will inform other Nietzsche readers of it through an organization I am involved with, the Nietzsche Circle.

  2. Posted December 6, 2006 at 9:50 am | Permalink

    Please excuse my broken english and my lack of neurological knowledge, but perhaps this is the only chance to ask this right: Can we relate this lobe-damages to the use of some drugs like opium? As far as i know frontal and temporal lobes can be affected by consuming compulsively drugs -like opium- for long periods of time. But this study seem to open a new interpretation about Nietzsches breakdown. if the study is based on Nietzsches clinical history it could be a chance to interpretate that his breakdown could even be caused by a lobotomic intervention. We must remember the fact that Nietzsche was firstly recluded on Basel´s Pschiatric Clinic, and then a week later on Jenas´s University for 15 months.
    Thanks in advance
    and cheers.

  3. Kschltr
    Posted December 18, 2006 at 7:19 pm | Permalink

    Actually, it was most likely caused by too much introspection and self absorbtion. Der Alte Ubermann likely did not become demented nor did he succumb to neurosyphillis as was reported. Although quite common and affecting a very, very large portion of the population during the 19th century, both here in America and in Europe. Are you familiar with the term IATROGENIC OVERDOSE? That is a overdose caused by the caregiver or healthcare practitioners themselves when the treatment results in complications secondary to OVERDOSE or INJURY and/or DEATH from the treatment itself?
    Well, I sure you all know that and IAMTROGENIC OVERDOSE is an occupational hazard for PHILOSOPHERS. It’s a well known fact that Decartes made the statement “Cogito Ergo Sum”. However, he does not appear to be extant at the present time since I have not seen any recent citations or published works online or at the bookstores. I think and therefore I am… I THINK? Of course, I might not be and then I would have to reevaluate my position. Perhaps CARTESIAN COORDINATES would help and I could then do some reality testing with my map and trusty GPS device. When I was a sailor I used to do that with a sextant, a watch, and a compass. Of course RADAR was helpful at times as well. This by itself is not sufficient without knowledge of speed, wind, current, and computing the drift to offset and refine one’s geographical self knowledge.
    Vieleicht Herr Doktor Neitsche just failed to adjust for the current and drift during his internalizations of self knowledge. When really self absorbed narcissists get into their own GESTALT a bit too much then just APPEAR DEMENTED.

    • lma
      Posted November 6, 2013 at 12:37 am | Permalink

      i love you. thank you for this. im right with you.

      • lma
        Posted November 6, 2013 at 12:44 am | Permalink

        i want to agree with you, based on personal experience… it gets scary in there too, i might add… i wonder if i have any temporal “damage” considering what i’ve been through. perhaps this following comment will only add to the argument that this is a condition of the narcissist, but i must have “adjusted” to the current in the nick of time “in my internalizations of self knowledge” to have escaped and to appear not so demented here in the present… although i do get some weird looks sometimes… i guess i must still be sailing on choppy waters and am in the midst of the process of convincing myself that i’ll make it out fine, or perhaps i see a clearing up ahead… unless it’s just a mirage, or perhaps what will eventually turn into another mind storm once i pull up into that space…

    • Derek Asirvadem
      Posted August 21, 2015 at 11:01 am | Permalink

      Young sir, you fail to realise that when studying philosophy, and especially after humanity lost the war to the neanderthals, one must set one’s intellect and connection to reality aside. Unless you can do this, you cannot follow the fragmented and disconnected thoughts of philosophers (Aristotle excluded of course). Complete disconnection from humans, intimate relations with animals and undiagnosed narcissism. That is the minimum requirement, no suggestion that you would do well.

      Now if you have schizophrenia or any of the raft of mental diseases that cause you to feel superior to undamaged humans while being completely unable to execute the task of being human, then you are qualified to do well at philosophy, from the first disconnected fragment.

      If you hate humanity, or you are in violent rebellion to God, you will do extremely well. No doubt a teaching position, in the “education” system, and a few books, that only your relatives will obtain benefit from, due to your being incarcerated in either prison or asylum. They are very good these days, with windows and everything, and the relatives can bring food, etc.

      If you have been sacrificing children or slaughtering and dismembering women, and you have not been caught yet, or you pay your dues to the slavers to ensure that you won’t be caught, then you are set for fame. Not that a few women and children here and there are not enough, the numbers have to be large, there are many in competition at that level, the devil keep count.

      But of course some tribes are more gifted than others, that is just the result of the Darwinian Theory, you will have to live with whatever that God or Darwin or Syphilis or Tourette or your mother gave you. The more gifted ones have mental diseases in double digits, genetic diseases in triple digits. That will guarantee you being published.

      But of course, if you want world-wide fame, people writing blogs about you, you need (a) to be ono of the self-described Gifted Ones, and (b) to nurture and develop your narcissism to the point where coprophilia alone feeds you. Then, you will be in the same class as Nietzsche.

  4. d-anonymous-b
    Posted May 25, 2008 at 2:12 am | Permalink

    “Can we relate this lobe-damages to the use of some drugs like opium?”
    No. Brain damage caused by drug use is different from Pick’s Disease, and does not preferentially affect either the frontal or temporal lobes.
    “Actually, it was most likely caused by too much introspection and self absorbtion.”
    Actually, neurodegenerative diseases cannot be caused by introspection or self-absorption. Did you study medicine at a clown college?

    • Blake
      Posted April 4, 2012 at 6:39 am | Permalink

      I think “appear demented” excluded the idea of actually being demented. Which I think there may still be a valid point. I have no background in this field at all; I apologize I I offend anyone. Couldn’t a narcissitic personality get so absorbed he actually SEEMS demented?

  5. spivey
    Posted October 11, 2008 at 5:56 am | Permalink

    A brain tumor can cause a rapid dementia of the type Nietzsche had. A person can have a (certain types) brain tumor for decades without knowing it. Frontal lobe(s) involvement probably was the cause of his inability to resume writing and publishing.

  6. Nkanyiso
    Posted May 4, 2011 at 8:00 pm | Permalink

    I suspect we can conclusively confirm the cause of death with current medical technology, and determine whatever medication he may have been on. I think he is important enough to do this. All we need is some tissue from him.

  7. Johann
    Posted May 8, 2012 at 10:12 pm | Permalink

    fn got Binswanger’s disease. The funny thing is that Binswanger himself agreed with the syphilis. fn was mentally ill all his life, with anxiety and obsessive–compulsive disorders, ending in megalomania when all inhibitions were broken.

  8. John
    Posted May 24, 2012 at 2:38 am | Permalink

    God will not be mocked. What a man sows, so shall he reap.

    • Abraxas
      Posted June 11, 2012 at 11:03 am | Permalink

      So that whole “judge not lest ye be judged” thing sort of went in one ear and out the other, didn’t it?

  9. grant d. boggs
    Posted June 25, 2012 at 12:49 am | Permalink

    That which does not kill me can only make me stronger……

    • lma
      Posted November 6, 2013 at 12:45 am | Permalink

      not always?

      • Elaine Leggett
        Posted November 19, 2015 at 8:47 am | Permalink

        I agree Irma. I too have been through the mill as you seem to have been. Nietzsche has resonated with me as has never happened with other writers or poetry before. I see my fighting against things that have happened to me and people’s attitudes to me, and to my final ‘giving’ up and trying to play the game instead, but knowing it to be full of hypocrisy – I hope that by knowing that people feel as you do will help ‘make you stronger’.

  10. Posted March 1, 2013 at 9:30 pm | Permalink

    Just got interested in looking into his illness. Guess we will never know but although his father died by falling down some steps and Fred Wilhelm the 4th also went “mad” I, as an MD, would look into conditions along the lines of the Bovine Spongiform Encephalopathy, or Creutzfeldt-Jakob diseaseb It may be been endemic in Prussia at that time. Any historians or neurologists around?

  11. george d conger
    Posted March 1, 2013 at 10:42 pm | Permalink

    Oops. A little research shows the most likely cause to be Cadasil. Look it up.
    Hemelsoet D, Hemelsoet K, Devreese D. The neurological illness of Friedrich Nietzsche. Acta Neurol Belg. Mar 2008;108(1):9-16. [Medline].
    He had Cadasil. I got the reference from this article and it fits best with what is known of FN’s illness. But it is also mentioned in the current Wikipedia entry on N. http://en.wikipedia.org/wiki/Friedrich_Nietzsche

    Interesting huh?

  12. Ouroboros
    Posted March 23, 2013 at 1:09 am | Permalink

    He came to realize too late the truth of eternal recurrence and was maddened by the colossal regret of not having aspired to a life that one would wish to live endlessly. So desperate was he to know such a life of purity and benevolence, even if only for his remaining days, he would rush to the aid of a horse that was being whipped by its master.

  13. lma
    Posted November 6, 2013 at 12:48 am | Permalink

    whats interesting is that he discusses the idea of eternal recurrence in such profundity that one would think he’d reached such a point…

  14. Stephen John
    Posted December 17, 2013 at 11:38 am | Permalink

    “In our interactions with people, a ‘benevolent hypocrisy’ is frequently required—acting as though we do not see through the motives of their actions.”
    -Friedrich Nietzsche
    Matthew 9:12
    On hearing this, Jesus said, “It is not the healthy who need a doctor, but the sick.
    Matthew 9:13
    But go and learn what this means: ‘I desire mercy, not sacrifice.’ For I have not come to call the righteous, but sinners.”

  15. Linda Gilbert
    Posted June 24, 2014 at 2:21 pm | Permalink

    How very interesting! I decided to look up the latest ideas on the cause of Nietzche’s dementia as I am preparing a talk on medical and genetic conditions that mimic mental illness. With (most) of these great contributions this material will support my presenting our illustrious “patient” as my last case study.

  16. robin
    Posted November 11, 2014 at 3:27 am | Permalink

    he had CADASIL

  17. Dan Palacios
    Posted April 24, 2015 at 4:48 pm | Permalink

    I only know a little bit about Nietzsche but what I read indicates that his writings attacked a great deal of the moral basis of what we would call the ‘power elite’. In many countries insurgent ideas are dealt with by declaring the champions of them insane and even putting them in mental institutions for ‘treatment’. Thus are the ideas discredited. Back in Nietzsche’s day treatment of mental illness was still a horror story. His bouts of so called madness appear to be little more than eccentricities in today’s world. Performance artists and great thinkers do weird stuff all the time. Was Robin Williams mad? Was Andy Kaufman? Was Nick Tesla? Diogenes? Later I’m sure drugs may have contributed to his mental collapse. Who prescribed them and why? There seems to be a great effort to tie Nietzsche’s writings to his ‘madness’ as if to diminish their relevance by declaring them the work of a crazy man. Not cool.

  18. Jack Rob
    Posted December 5, 2015 at 5:15 am | Permalink

    Dan, I tend to agree. The popular culture with the predominant narrative, which in the past few millennia had been the Philosophy of Christindom, at least in the Western world, has never taken kindly nor lightly to any dissenting ideology that it considered to be a major threat. So, it wouldn’t surprise me if Nietzsche was a victim of a sinister Christian plot intended to systematically discredit his work. Afterall, the Christian churches have a notorious track record for intimidating and torturing free-thinkers like Bruno and Galileo, and many others. The tragic insanity and deaths of Frederick Nietche and Ignaz Semmelweis are identical in cause and manner, as both were victims of high societies steeped in a pool of profound ignorance, piety, and arrogance. For one it was the clergy, the other it was doctors who cannabilized one of their own!

  19. Posted December 5, 2015 at 9:55 pm | Permalink

    I could write a lot in this comment about my thoughts on the matter, except instead I’ve written in a succinct blog article. This is the link.

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