Gustav MAIHLER and 1H1S ILLNESSES the Relation of Physical

Home , Felix Weingartner, Ferruccio Busoni

GuSTAV MAIHLER AND 1H1S ILLNESSES By NICHOLAS P. CHRISTY, M.D., ANI) (by invitation), BEVERLY M. CHRISTY, AND BARRY G;. WOOD. M.D.

NEW YORK The relation of physical and mental illness to the work of creative artists is a subject that has long preoccupied students of medicine, psy- chology and aesthletics. People continue to speculate on how Miltoni's blindness and gout might have affected his work; similar questions are raised about Swift's Meniere's disease, Sainuel Johnson's depressions, Bee- thoven's deafness, Coleridge's addiction to laudanum, Byron's flamboyant neuroses, Dostoevsky's epilepsy, Moussorgsky's alcoholism, Scriabin's hy- pochlondria, sado-masochism and manic-depressive tendency, and so on. In the case of the composer, Gustav Mahler, (fig. 1) his work was initially rejected by critics because it was judged to be undisciplined and morbid. Curiously, the current critical acceptance and great popularity of his symphonies are sometimes also ascribed to his neuroticism. The theory is that he was a great composer because he was a great neurotic, that because this is an age of pain, the musical public is in tune with Mahler because he was in such pain himself: "He's a sufferer who forces man to look into a inirror. He exposes naked nerves"; "Mahler was a high-strung genius who speaks today to a high-strung generation." 1 It is true that Mahler suffered a great deal, but to claim that this music is great music because he was very ill is equivalent to Macauley's statement that James Boswell was a great author because he was a great busybody. Recent information2 makes it possible to rectify this picture of Mahler as just an hypochondriacal, obsessive, self-centered, difficult man, torn apart by early traumas, by doubts and fears.3 Indeed, it should have been clear even to the earliest critics that Mahler was a forceful and unique personality in order to have attracted as his enthusiastic admirers such poeple as From The Department of Medicine, Roosevelt Hospital, New York, New York 10019. The authors acknowledge with thanks the help of many people. For general advice we are grateful to Miss Anna Mahler, Mr. Winthrop Sargeant, Dr. Arthur Hutner, Dr. Sanford Farrer, Dr. Euigene Schorr, and the staff of the Library of Performing Arts, Lincoln Center. Many items of specific information were obtained from Dr. Gerhart Schwarz, Mr. Jack Diether, Dr. Louis Bergmann, Dr. Laurence Taylor, Dr. Edward R. Reilly, and Dr. G. Fruewirth of the Austrian Institute in New York City. Particu- larly valuable were the detailed notes on Mahler's endocarditis communicated to us by Dr. George Baehr, and the translation of a previously unpublished manuscript of the late Dr. Theodor Reik given to us by his son, Mr. Arthur Reik. 200 GUSTAV MAHLER AND HIS ILLNESSES 201 Thomas Mann,* Anton Webern, Gerhart Hauptmann, Arnold Sch6nberg, Alban Berg, Ferruccio Busoni, Richard Strauss, Bruno Walter, Willem Mengelberg and Otto Klemperer. Mahler's personality and music have interested so many commentators that there are already more than 20 biographies of him, although he has been dead less than 60 years. We attempt to make three points in this paper: We propose that Mah- ler's much-publicized neuroses have been overdone by early biographers and later theorists; present a new, precise diagnosis of his terminal cardiac disease never previously defined in medical terms; and show that his physical and mental sufferings tell us a little about the character of his work, but do not account for its quality or its power. Mahler was born of Jewish parents in 1860 in a backwater of the Austro-Hungarian empire in what is now Czechoslovakia, and in the same year moved to the slightly larger town of Iglau where, as the recent biographer de la Grange2 has discovered, the Mahler family was not in such dire financial straits as used to be thought. Mahler's musical talents became obvious early ;4 he had his first pupil at the age of 7; he was sent to Vienna to study at the Conservatory when he was 15. He was a superior student; his teachers did not foster his considerable talent as a pianist, preferring to steer him toward composition. From some of his professors he earned a reputation for "arrogance", and from the institu- tion, highest honors in 1878. He became a good friend of Anton Bruckner, but was never formally his pupil. From 1878 to 1880, Mahler did various teaching odd jobs, and finished the first composition which he allowed to be published, Das Klagende Lied. For the next 8 years, he held progres- sively more important conducting posts at Hall, Laibach, Olmiitz, Kassel, Prague and Leipzig. In all of these positions his standard of performance was disproportionately higher than those of the local performers or audiences. His domineering perfectionism became a byword and his reputation grew. During this period he completed the Lieder eines fahrenden Gesellen in his spare time, and began to assume a large share of the financial * Mann had almost unlimited admiration for Mahler. In a letter to the composer written in 1909. after the first performance of the Eighth Symphony, Mann described Mahlier as ".. . the man who ... expresses the art of our time in its profoun(lest and most sacred form". In Mann's nov-el, Doktor Fa?ist?ts (1948), the hero, Adrian Lever- kiihn is a composite of many real (Arnold Schiinberg, Nietzsche) and imaginary people, hut; there are a few resemblanices to Maliler's life an(l work. Leverfiilin's I eacher was ani or'ganiist aind pJolyphonist. Mahler was a1n informial pupil of Bruiclkner; Leverkiilhn wrote 13 songs to words by Brentano, Mahler wrote several songs to folk-poems col- lected and revised by von Arnim and Bretano. (Des Kuiaben WIioderhorti); Lever- kuhn's early style was a "travesty of innocence", Mahler's work is often characterized bv deliberate niiivete; both wrote vast orchestral-choral wAorks on mnilverlsl and re- ligious themes; Leverkiiln lost a nephew, Mahler lost a daughter. 202 CHRISTY, CHRISTY AND WOOD

FIG. 1. Gustav Mahler at age 47. In this year, 1907, Mahler's clder daughter died, he was ousted from the Directorship of the Vienna Imperial Opera, and discovered that he had serious cardiac disease. responsibility for his several surviving brothers and sisters, five siblings having died in infancy or childhood. In contrast to the reputation for asceticism fostered by Engel,4 Mahler's widow5 and other early biographers, Mahler had a nuimber of intense emotional relationships with women around this time.2 Also during this phase, he began to be troubled GUSTAV MAHLER AND HIS ILLNESSES 203 with two ailments that plagued him much of his life: migraine headaches and hemlorrhoidls, the latter reqtuirinig at least 3 operations anid once caus- ing a near-fatal heimiorrlhatge. It is noteworthy that the textbook character- ization of the inigrainious patient fits what, we kniow of AMahler: "anxious, striving, perfectionistic, ord(r-loving, rigil ." 6 In 1888, at age 28, he became Director of the Royal Opera in Btudapest where he gave the premiere of his IFirst Symphony in 1889; the autdience "squirmed about uneasily . . . one [critic] seemed . . . favorably impressed, but the other ... fell upon the symphony with a destructive fury which ... inaugurated a newspaper opposition3 to Mahler's works that is still flourishing ...4" In 1891, at 31, he was a conductor at the Hamburg Opera and remained there until 1897. In this period, he finished his Second Symiphony, first performed under his onn direction in 1895 in Berlin; the symphony favorably impressed Strauss and the genieral audienice but the critics blasted it.4 Wthile still at Hamburg, he also completed his enormous Third Symphony, performed in part in 1897 in Berlini by Felix Weingartner; MIahler himself reported its receptioni in a letter: "... the enemy was victoriotus. There was much approval, but also just as mutch op)position, hissing and ap- plause! ... I took a bow, that w-as the signal for the audience to become really noisy . . When the whole symplhoniy was played in Krefeld in 1902, it was a considerable popular stuecess, btut the critics remained hos- tile: they recommended variously that the composer should be jailed7 or shot.' A similar greeting was accorded the IF'ourth Symiiphony in Munich the same year: Bruno Walter remembers that "fisticuffs" broke out in the hall.8 At this point in his career, 1897, Mahler received the greatest musical plum in Europe: he was macle Artistic Director of the Vienna Imperial Opera. His revolutionary, uncompromising anid endlessly painstaking management at Vienna destroyed the "star" system, produced authentic performances of M\ozart operas, opened the door to many new works, disciplined the casual Viennese audiences, and micade him a popular figure, almost a local hero with most of the mtusical publie, but cordially detested by some of the artists who fell under his lash. At 42, well established as the musical czar of Vienna he also conductedl the Vienna Philharmonic -he married "the mlost beautiftul girl ili Vienna", the musically talented, intelligent and much youniger Alma MNlaria Schlindler. The relationship between Mahler and his bride was on both sides a mixture of domination or attempted domination and idolatry. During these years, it was MIahler's customii, both before and during his marriage, to spend summers on the lakes in the Salzkammergut region of Austria, doing the great bulk of his composing there and reserving the busy winters in Vienna for revision and orchestration. It is astounding to 204 CHRISTY, CHRISTY AND WOOD recall that from the time of his marriage, 1902, to 1910, he managed to write most of two song-cycles and seven long, complicated symphonies in his spare time, time stolen from the myriad administrative duties of his work as a conductor. In the period, 1902-1908, he finished his Fifth, Sixth and Seventh Symphonies, which were coolly and indifferently received in Cologne, Essen and Prague.4 9 The year 1907 (fig. 1) was a disaster for Mahler. His harsh methods had created powerful enemies at the Opera and at Court; this, together with a virulent anti-Semitic campaign, was enough to oust him from the Directorship. In July of that year, his elder daughter, Maria Anna died at age 5 of scarlet fever and diphtheria. In the same month, a casual physical examination of Mahler by a general practitioner, a Dr. Blumenthal, dis- closed valvular heart disease, a diagnosis later confirmed by cardiologists; according to a letter from Mahler to his wife (September 30, 1907): "Dr. Hamperl ... found a slight valvular defect, which is entirely compensated, and he makes nothing of the whole affair. He tells me I can certainly carry on my work just as I did before and in general lead a normal life, apart from avoiding over fatigue." 10 According to Mrs. Mahler's biography, however, a Dr. Kovacs "confirmed the verdict ... [and] forbade him to walk uphill, bicycle or swim: indeed he was so blind as to order a course of training to teach him to walk at at all; first it was to be five minutes then ten, and so on until as was used to walking; and this for a man ... accustomed to violent exercise! And Mahler did as he was told. Watch in hand, he accustomed himself to walking-and forgot the life he had lived up to that fatal hour." 11 Mrs. Mahler says further that in that winter, "Mahler was so shattered by the verdict on his heart that he spent the greater part of the day in bed ... he got up only for rehearsals or for the performance ... if he was conducting." 12 And again, to confirm the suspicion that Mahler was made unduly "heart-concious" by his doctors: "... we avoided strenuous walks owing to the ever-present anxiety about his heart. Once we knew he had valvular disease ... we were afraid of everything. He was always stopping on a walk to feel his own pulse; and he often asked me ... to listen to his heart and see whether the beat was clear, or rapid, or calm. I had been alarmed for years by the creaking sound his heart made-it was particularly loud at the second beat-and I had always known that it must be diseased ... he had a pedometer in his pocket. His steps and pulse-beats were numbered and his life [was] a torment." 13 The picture painted by Alma Mahler is not entirely in harmony with the vigorous conducting and composing activities of his remaining years, 1908-1911, when, mainly to earn enough money to support his family and retire exclusively to composing, he came to New York City to conduct a GUSTAV MAHLER AND HIS ILLNESSES 205 part of the Metropolitan Opera season and to lead the Philharmonic Society orchestra. The story is told that after rehearsals and performances in New York he was bundled up and taken off home like an invalid. Yet he had enough energy to work hard at composition-he completed the orchestration of the Eighth Symphony in that disastrous summer of 1907, wrote Das Lied von der Erde and the Ninth Symphony, both immensely complex scores, in 1908 and 1909; sketched the 5-movement Tenth in 1910; and thoroughly revised the Fourth and Fifth Symphonies in 1910-11. He also kept busy conducting; he led the first performances of the Eighth Symphony in Munich on September 12 and 13, 1910, and had then and there his only unqualified popular success as a composer-the work was received with ovations; in America, he conducted 46 concerts in several cities in the winter of 1909-10, and in his last winter, 1910-11 completed 48 of a scheduled 65 performances. This record of achievement and activity is less in keeping with the biographer Specht's statement that "Er war ein arger Hypochonder"-"he was an utter hypochondriac", for whom "to be sick was frightful", and more in tune with Mahler's own often-repeated joke, "Krankheit ist Talentlosigkeit"-"sickness is lack of talent"'14 and with the stoicism of his conversations with Bruno Walter: "Now he spoke of the serious consequences of the discovery of his illness and of the revolutionary change in his life and work which would result from the precautions he would have to take . . . he had now to restrict all bodily movement as much as possible ... [which] entailed not only a heavy sacrifice, but anxiety about his work ... the tone of our talk was unsentimental and realistic.... 'I shall,' he said, 'soon get used to it'." '5 The late photographs show him worn but he does not appear beaten. Figure 2 shows the hard face that earned him the epithet, "der ha-ssige Mahler"-"ugly Mahler". The record of Mahler's last years, rich as they were in accomplishment, is bleak. Bearing the news of his presumably fatal cardiac lesion with anxious fortitude, he worked hard through the summer of 1910, when there occurred a crisis in his marriage. This story has been told many times, by Alma Mahler herself,5 by the analyst Theodor Reik,'6 by Ernest Jones in his life of Freud,'7 and most recently by Henry-Louis de la Grange.2 Briefly, Mrs. Mahler adored the image of her husband as a great man ("Youi are married to an abstraction",5 friends tol(d her) but resented the fact that hiis work took prece(ldece over lher.2 Mahler felt guiilty about this, already feeling guilty about having marrie(l a muchl younger woman, and although he was domineering in his home, he was more solicitous of Alma's welfare than he has been givren credit for.2 When Mahler discovered Alma's platonic liaison with the young arelhitect, Walter Gropilis, he not only feared the loss of his wife, but became deeply concerned about 206 CHRISTY, CHRISTY AND WOOD

FIG. 2. Mahler in the New York years (1908-1911). See text for comment. his emotional state, and souglht the advice of Sigmund Freud, with whom he had a one-dav "anmalytic" session in Leiden, Holland. From this single interv-iew anlel Freud's brief account of it has emerged the standlar(d psy- chological view of Mlahler as sufferinig from a muotlher-fixation, a "Holy Mary complex", and anl obsessional neurosis.'6 W1'e cannot know now how correct tliis view was, but M\alhler's distress of 1910 seeins adequately provoked on a reality level when we consider that he was 50, that he GUSTAV MAHLER AND HIS ILLNESSES 207 operated undiler the asstuiption that lie ha(l l)otentially fatal hcart disease, had lost his hoinorific post at the Vrieniiia Opera, had lost his elder child, and nlow lhad discovered that he was, for all he knew, aboout to lose his wife. This accumulation of disasters rather than failing physical or mental health mniglht explaiii very Well why lh never finished the Tenth Symphony. Some idea of what Mahler was feeling at the timie may be obtained from examining the autograph sketches of that work. The 3rd movement, labeled by iMahler "Pttrgatorio" or "Inferno" has in the margin of p. 4 the words "Death! Transfiguation!" On p. 3 in the margin and interline- ated, "O God, God, why hast thou forsaken me?", and, "Thy will be done". On the title page of the 4th movement there is the inscription: "The devil dances this with me. Madness seizes me, accursed. Destroy me, that I may forget I exist, that I may cease to be, that I . . ." On the last page of the finale there is the notation: "to live for thee, to die for thee" (fig. 3) and his wife's nicknamue, "Almschi" over the final 5-note sequence, the same phrase that ends the NVinth Syymphony and the fourth of the Songs on the Death of Children (fig. 4). Fig. 5 is the opening phrase of the symphony which we show simply to indicate that whatever anguish was bedevilling Mahler, his power to create elaborate and coherent musical structures was intact. The 3-note figure in bars 2-3 and 3 keeps recurring in various guises throughout all 5 movements. Although several authiorities (H. F. Redlich, Erwin Ratz, Leonard Bernstein) have thought it was a mistake to publish this unfinished facsimnile score or to allow perfornming versions to be made from it, many musicologists and critics (MIitchell18, Cooke19, Roy20 and others) have analyzed its merits and do not see evidence of "failing powers". Furthermore, it has won wide acceptance by audiences, and is thought by many musicologists to have exerted seminal influence upon the atonal composers of the 20th century. Whatever reasons Mlahler may have hlad for abandoning this sketch, he apparently did no more witlh it after the summer of 1910, but spent his remaining months revising earlier works (see above) and in his conducting duties in New York. Duirinig that Ninter, lhe lhad several attacks of what his biographers call "anginia"; in February 1911 he had a bout of pharyngitis-he had had frequent sore throats-and despite fever, conducted a concert on February 21. He collapsed and worked no more. The fever became lhectic, streptococci wzere isolated from his blood5; the Mah- lers returned to France for a "serum treatment"; the streptococcal bacteremia was confirmed in Paris; the case was diagnosed as hopeless by Chvostek; and Mahler went home to Vienna to die, with preterminal pallor, monarticular arthritis and uremia. Death, which came on May 18, 1911, was apparently due to congestive heart failure-he was taking digi- talis or pneumonia. No autopsy was performed. 208 CHRISTY, CHRISTY AND WOOD

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TABLE I Evidence for Rheumatic Heart Disease with Superimposed Subacute Bacterial Endocarditis Mother and possibly siblings had "heart disease" "St. Vitus dance" in childhood Frequent sore throats in childhood and as adult Two episodes of ?cardiac arrhythmia Finding of heart murmur at age 47, 1907, "loud second sound" "Angina pectoris", 1908-1911 Streptococcal bacteremia found twice, New York City and Paris, February-April, 1911 Intermittent fevers, Febiuary-May, 1911 Pallor (anemia), weakness, March-May, 1911 Arthritis, uremia (?embolic phenomena), "pneumonia" (or heart failure), died May 18, 1911 The most probable diagnosis is rheumatic heart disease with superimposed subacute bacterial endocarditis. The evidence is this (see Table 1). Mahler's mother and perhaps siblings had "heart disease", not further defined. Rheumatic heart disease notoriously runs in families. Mahler is said by at least two biographers to have had St. Vitus' dance in childhood.4' 9 He had had many bouts of pharyngitis throughout life, some with visible exudate.5 There were two bouts of sudden weakness and "heart-consciousness" that might have been arrhythmia-the dates are uncertain.8 A heart murmur, said to denote a "compensated, slight valvular defect" 5 was discovered when he was 47. The fact that it was virtually asymptomatic before that is entirely consistent with rheumatic valvular disease. The character of the murmur we only know from Alma's description;5 the alleged "angina" could have been associated with aortic stenosis or with the pulmonary hypertension of mitral stenosis. The evidence for endocarditis is presented in non-technical terms in Alma Mah- ler's biography.5 The authors are able to give here an accurate technical recital of this evidence based on the very detailed recollections of Dr. George Baehr, formerly Chief of Medicine at Mt. Sinai Hospital, New York, who was in 1911 Fellow in Pathology and Bacteriology in Libman's laboratory. Dr. Baehr's vivid account, extracted from his personal communication to us, follows: "Sometime in February 1911, Dr. Emiianuel Libman was called in consultation by Mahler's personal physician, Dr. Fraenkel, to see the famous composer and director. Apparently Dr. Fraenkel had suspected that Mahler's prolonged fever and physical debility might be due to subacute bacterial endocarditis and therefore called Libman, Chief of the First Medical Service and Associate Director of Laboratories at the Mt. Sinai Hospital, in consultation. Libman was at that time the outstanding authority on the disease. At the time of the consultation. the Mahlers were occupying a suite of 212 CHRISTY, CHRISTY AND WOOD rooms at the old Savoy Plaza Hotel (or it may have been the Plaza) at Fifth Avenue and 59th Street overlooking Central Park. Libman confirmed the diagnosis clinically by finding a loud systolic-presystolic murmur over the precordium characteristic of chronic rheumatic mitral disease, a history of prolonged low grade fever, a palpable spleen, characteristic petechiae on the conjunctivae and skin and slight clubbing of fingers. To confirm the diagnosis bacteriologically, Libman telephoned me to join him at the hotel and bring the paraphernalia and culture media required for a blood culture. On arrival I withdrew 20 c.cm. of blood from an arm vein with syringe and needle, squirted part of it into several bouillon flasks and mixed the remainder with melted agar media which I then poured into sterile Petri dishes. After 4 or 5 days of incuba- tion in the hospital laboratory, the Petri plates revealed numerous bacterial colonies and all the bouillon flasks were found to show a pure culture of the same organism which was subsequently identified as streptococcits viridans. As this was long before the da)ys of antibiotics, the bacterial findings sealed Mahler's doom. He insisted on being told the truth and then expressed a wish to die in Vienna. Accordingly, he and his wife left shortly thereafter for Paris, where the diagnosis and p)rognosis were reconfirmed, and then proceeded to Vienna."2' Mahler's death has been seriously attributed, at least indirectly, to psy- chosomatic causes.22-24 On the basis of the foregoing evidence, this idea is untenable. The endocarditis, predictably, incapacitated Mahler, but there is certainly no evidence that his rheumatic valvular disease and his awareness of it had any deleterious effect on his creativity. In fact, most critics rank his Ninth Symphony and Das Lied von der Erde at the very top of his works. If physical illness did not spoil Mahler as a composer, what about his much-publicized neuroses? We have heard a great deal about his obses- siveness, his compulsiveness, his fastidious perfectionism. His scores, even the last ones, are full of the most minute instructions to the conductor and to the players. Fig. 6 shows an example in the 4th movement of the Ninth Symphony, a short passage that contains no fewer than 84 instruction marks in 5 bars. Fig. 7 shows a passage in the second movement of the Ninth where Mahler tells the 4th bassoonist to put down his bassoon and pick up the contrabassoon; he doesn't trust the man to look ahead 8 bars, he leaves nothing to chance. This kind of finickiness pervades all his scores, early and late. In the Second Symphony, 1st movement, he tells the contrabasses exactly how to tune their strings an(d warns darkly that an easy, "end-arounid" maneuver is "here, as oii all following occasions, inacl- missible". In the Fourth S,yqnphony, 4th monvement, the conductor is firmly told: "It is of the utmost importance that the singer be accompanied with extreme discretion"; in Das Lied von der Erde, the 2nd song, to the strings, "use the whole how on each niote". This might be construed as obsessive-compulsive neurosis, but is jUst as likely the work of a master GUSTAV MAHLER AND HIIS ILLNESSES 213

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FiG. 6. Excerpt from Malhler's Ninth Symphony, fourth movement, bars 65-61 before the end. These 5 bars contain 84 specific markings dealing with dynamics, bowing and accent. "Viel bogen" "lots of bow". Nearly every note has an accent or bowing (irection. A good example of Maliler's minute instructions to tile orchestral players. ® Copyright Universal Editions, Vienna, revised version © (opyright 1969. Universal Editions Vienna and Universal Editions, London, Ltd. Used by permission of the publisher. Theodore Presser Co., sole representative in the United States, Canada and Mexico. craftsman who knows that musical notation is inexact, but also knows what he wants, intends to get it, and knows how to get it. Many of the directions are poetic. In the First, Third and Tenth Sym- phonies and elsewhere: "Wie ein Naturalut"-"like a sound of nature"; the Second Symphony, third movement, "very sustained and songful, standing out in bold relief"; the Fourth Symphony, the 1st movement is to be played "carefully, prudently"; and the soloist in the final movement is to sing "with childishly serene expression, absolutely no parody!"; the slow section of the Scherzo of the Sixth is to be played "altvaterish"-"in a grandfatherly, old fashioned way"; in Das Lied von der Erde, the violin is to be played "caressingly"; the second movement of the Ninth is marked not Allegretto, but "in the tempo of an easygoing country dance, rather clumsy and very uncouth." This relentless attention to detail in order to achieve a poetic end also characterized Mahler as a conductor. It was he who exhumed the authentic method of performing Mozart's operas. The review of his Jan., 1908 Met- ropolitan performance of Don Giovanni in the New York Times said: 214 CHRISTY, CHRISTY AND WOOD

"In the ballroom scene he at last attained the result that has long been waited for anid never achieved." 2 In The u1ariuge of Figaro, the Tinles praised the "precision and elaboration of the finer details of the action on the stage ... the exquisite ancd delicate beauity of the orchestral part, tlle skillful co-ordination of these factors in onie imiipression upon eye and ear".26 The reviews of the New York period spoke of Mahler's tighit control over his forces: "Such a performance shows the dominating influence of a master mind ...;" "most striking was the firm hand with which he kept the volume of orchestral sound controlled" 27; ". the performances .. . exhibit the domination of his imposing musical individuality ... this one was transfigured by his touch . .28 A pattern emerges. Mahler had a strong wish to dominate. (Whether this was neurotic or not, we cannot say.) His willfulness as Director in Vienna was legendary. He "demanded that each performance should be perfect".16 The examples above show h1ow completely he attempted to direct the playing of his own works, how successfully he imposed his dominant personality on singers and orchestral players. The very choice

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FIG. 7. Excerpt from Mahler's Nituth Symphiogly, second movement, bars 41-42. The note over the bottom staff reads "4th bassoonist takes up the contrabassoon" which has an entrance 8 bars later. Mahler doesn't trust the player to look ahead. Someone has made the comment that Mahler's scores all but tell the players, "Rauchen ver- boten!"-"No smoking". Copyright Universal Editions, Vienna, revised version( copyright 1969, Universal Editions Vienna and Universal Editions London, Ltd. Used by permission of the publisher. Theodore Presser Co. sole representative in the United States, Canada and Mexico. GUSTAV MAHLER AND HIS ILLNESSES 215 of orchestral conducting as a profession is probably significant. His wish for vastness, cosmic scope and omnipotence is in his work, too. The larger symphonies are vast and complicated structures in which intense emotion is barely contained by elaborate forms. His remarks about them are revealing. M\ahler himnself calledI the Third Symphony a "work of such scope that the whole world actually is reflected in it" 29; of the Eighth, ... it is the biggest thing I have done so far . . . imagine that the universe begins to vibrate andi to soun(l. These are nlo longer human voices, but planets and suns rotating." 30 Of the rehearsals for the performance of this symphony, he wrote in a letter: "Full rehearsal today . . . there, too, God (M\Aahler) saw that it was good" 31 (see Genesis 1:10). He once said: "I must keep on the heights. I canniot let anything drag me down".5 Mahler often repeated, sometimes alimost wistfully, sometimes confidently, that "M\1eine zeit wird noch kommen"-"my time will yet come", which sounds suspiciously like Christ in the St. .John Gospel: "... mine hour is yet to come" (see John 2:4). It is possible to suppose but impossible to prove, that this largeness of conception and the emphasis on eternity and resurrection (Second, 'Resur- rection' Symphony) were related in some way to Mahler's constant preoc- cupation with death. As a child, he wished to be a martyr. His first work, Das Klagende Lied is a story of brother murdering brother. Five of the TVunderhorn songs are about dead soldiers, dead children, ghosts. The First and Fifth Symphonies contain funeral marches; part of the Sixth Symnphony ('Tragic'), concerns blows of fate that fell the hero; there is the song-cycle Ki'ndertotenlieder-"Sonlgs on the Death of Children". One rnight say that these preoccupations constituted AMahler's denial of his own fear of death, denial by confrontation, so to speak. After he really knew death was imminent, there came the Ninth and Tenth Symphonies and Das Lied von der Erde, obviously farewells to life, but loftier and more serene than what had gone before. It is as if the proximity of death had somehow purified MIahler's feelings toward it. This change in tone and style is superbly expressed by the psychoana- lyst and author, Theodor Reik in a paper fouind among his literary remains and translated and very kindly communicated to us by his son, Mr. Arthur Reik. This manuscript, not previously published, is entitled, Mah- ler vor demn Ende "MIahler before the end". These are some excerpts. "The last Mahler is thte real one, is lie liiiieself ... No more flirtation with German folk-songs, no theatrical. operatic arrangements. no thouglhts about effects nor about impressions. He no longer looks toward the balcony or the orchestra. The vision is straiglht ahead to see what is comin'g, wN-hat is so near, wlhat is nearly here already, the en(l. the terror of tle end( which lhe has always tlhouighii about and vet whieh is abso- lhilely inthinkahle. death ... Thiouiglhts abouit death had occupied him often, he had looked at it, sometimes seriously, sometimes playfully ... Now it is no longer an idee 216 CHRISTY, CHRISTY AND WOOD fixe with doubts and speculations, now there is safety, now that death stands at the threshold ... Death is no longer the riddle that it has always been before ... Now no philosophy, no meditation, no metaphysics could help ... Now it became not a matter of "the ultimate questions" but a matter of one's own final dissolution. Now it was no longer important to have some conceptual grasp of general humanity but to under- stand one's own humanity, its most human part, before one stopped being a human being, before one became a thing... One can trace through his letters, through cer- tain things he said, but most of all through his music how his reaction to the near end was changing, how he himself changed, how hie discarded everything that was alien to him ... When he confronts perdition naked, there is no more sentimentality, no false emotionality, no false tones... Here a man rises highest at the moment he is crushed, when he realizes ... how small he is. Here, where fate crushes him, he becomes master of himself. While blessing the earth and while wondering whether to curse his own artisanship, he becomes artistically the greatest. There, where others are lost, he finds himself. There, where others sink, he soars to an unsurpassable height." '3 To summarize, this paper has attempted to define accurately Mahler's cardiac disease, to show that the physical illness affected his work only insofar as his awareness of it refined his later style, and to suggest that many earlier writers have tended to over-emphasize his "neuroses", because his life was filled with turbulence and drama, because he made a powerful impression on many contemporaries, and because many of these have left copious if inaccurate reminiscenices. Mahler's early life and later sufferings "explain" very little about his music; as with other first-rate artists, he had qualities ordinary people are reluctant to recognize-creative genius and the will and capacity to overcome formidable obstacles within and outside of himself. REFERENCES 1. 'The man who speaks to a highi-strung generation'. 7'Time, Julne 23, 1967. 2. DE LA GRANGE, H.-L.: Mahler: a new image. Saturday Review, March 29, 1969, p. 47. 3. SCH6NBERG, H. C.: With malice toward Mahler. Newtv York Times, March 2, 1969, p. D21. 4. ENGEL, G.: Gustav Mahler: Son g-Symphonist. New York, David Lewis, 1970 (originally published, 1932). 5. MAHLER, A.: Gustav Mahler: Memories and Letters (transl. B. Creighton). New York, Viking, 1946. 6. BEESON, P. B. AND MCDERMOTT, W. (eds.): Cecil-Loeb Textbook of Medicine, 12th ed., Philadelphia, Saunders, 1967, p. 1477. 7. CARDUS, N.: Guistav Mahler: His Mind and His Mqusic, vol. 1. London, Gollanez, 1965. 8. WALTER, B.: Gustav Mahler. New York, A. A. Knopf, 1968 (first published in America, 1941). 9. REDLICH, H. F.: Bruckner and Mahler (2nd edition). London, J. M. Dent and Sons, 1963. 10. Reference 5, p. 245. 11. Reference 5, p. 110. GUSTAV MAHLER AND HIS ILLNESSES 217

12. Reference 5, p. 124. 13. Reference 5, p. 129. 14. SPECHT, R.: Gustav Mahler. Berlin, Schuster and Loeffler, 1918, p. 53. 15. Reference 8, p. 61-62. 16. REIK, T.: The Haunttitng Melody: Psychoanialytic Experienices in Life and Music. New York, Grove Press, 1960 (first published, 1953). 17. JONES, E.: The Life and Work of Sigmund Freud, vol. II. New York, Basic Books, 1953-1955, pp. 79-80. 18. MITCHELL, D.: Some notes on Mahler's Tenth Symphony. The Alusical Times, 96: 656, 1955. 19. COOKE, D.: The facts concerning Mahler's Tenth Symphony. Chord and Discord 2(10): 3,1963. 20. Roy, K. G.: The creative process and Mahler's Tenth Symphony. Chord and Dis- cord 2 (8): 17, 1958. 21. BAEHR, G.: Personal communication to the authors: letter dated November 17, 1970. 22. DIETHER, J.: Mahler and Psychoanalysis. Psychoanal and Psychoanalyt Rev 45: 3, 1958-1959. 23. MOONEY, W. E.: Gustav Mahler: a note on life and death in music. Psychoanalyt Quart 37: 80,1968. 24. STILL, R.: Gustav Mahler and Psychoanalysis, American Imago 17: 217, 1960. 25. New York Times, January 24, 1908, p. 7. 26. New York Times, January 14, 1909, p. 7. 27. New York Times, January 2, 1908, p. 9. 28. New York Times, February 8, 1908, p. 7. 29. DOWNES, E.: Symphony No. 3, D Minor, Gustav Mahler (quotes a letter from Mahler dated July 18, 1896). The Philharmonic Hall Program, May 15-16, 1969, p.B. 30. Reference 9, p. 162. 31. Reference 5, p. 267. 32. REIK, A.: Personal communication to the authors dated December 20, 1970: Translation of a paper found among the literary remains of his father, Theodor Reik, entitled Mahler vor dem Ende-"Mahler before the end". DISCUSSION DR. ARNOLD S. RELMAN (Philadelphia): That is a fascinating account, and of special interest to me because my grandfather was the principal contrabass player in the New York Philharmonic and told me very vividly of his experiences as a player under Mahler. He told me that no conductor in his experience other than Toscanini was as demanding as Mahler. DR. CHRISTY: There is a record you may know about, a Columbia record in Leonard Bernstein's set of Mahler's symphonies, which contains oral reminiscences by people who played under Mahler. There is one quite long section comparing Toscanini and Mahler, in which the musician concluded that Toscanini could certainly extract superior, accurate playing from the orchestra, but that Mahler penetrated much farther into the spirit of the music.