Anxieties and Depression Disorders in Composers'

Pathographies

Alcoholism and Psychiatry Research 2015;51:151-168 Received May 21, 2015

Anxieties and Depression Disorders in Composers’

Tomislav Breitenfeld1, Darko Breitenfeld1, Mislav Pap1, Križo Katinić2, Ivica Kostelić1, Ivana Rešetar1 1Croatian Physicians´ Music Society, C.M.A., Zagreb, Croatia, 2University Department of Psychiatry, Sestre Milosrdnice University Hospital Center, Zagreb, Croatia

Summary – In this paper, we presented an overview of composers diseases in the last five hundred years. The collected data were obtained from the biographies of more than ten thousand composers and over a thousand pathographies. It is the world’s largest processed sample so far. The diseases mentioned and their comorbidities had an impact on lives and work of composers (87). They have shortened their life span from just over sixty years average to approximately fifty years. Key words: composers´ diseases, anxieties, depressions

Introduction Rolande (Orlando) de Lassus From the biographies of more than ten (C 1532-1594) thousand composers and over a thousand Flemish – renaissance conductor and pathographies it appears that in the last five composer. In 1586 his mental and physi- hundred years the average lifespan of com- cal health worsened so he withdrew to the posers was more than sixty years. Composers countryside, which helped him a lot. In ap- presented in this work were sorted chrono- proximately 1590 he became more and more logically by the year of their birth. [1-7] Some depressed, paranoid, amnesic, leading to de- pathographies were more deeply elaborated, mentia. He had a stroke, which resulted in a and all pathographies with diagnoses were speech disturbance. shown chronologically in the additional list of composers affected by anxiety and de- Carlo Gesualdo (1560-1613) pression. [8-11]. Italian composer. He married his cousin for dynastic purposes, his wife was a daugh- ter of the marquis of Pescara. She was not a very sincere and faithful wife. So he pun- ished her by killing her. This act forced him Correnspodence to: Darko Breitenfeld, Derenčinova 25, 10000 Zagreb, Croatia to withdraw from the public life and he spent e-mail: [email protected] the rest of his life in his castle. Later he mar- 152 ried a niece of the duke and this was another believed that he suffered from depression, mistake. His marriage failed for the second anxiety and melancholy. After he had turned time, there were conversations that he also sixty, he died in just three weeks. from a fe- killed his younger, maybe illegitimate daugh- verish acute illness. ter. All these circumstances caused a severe mental crisis to the point of the break down. George Frideric Handel (1685-1759) A social misfit inclined to masochism, he let German composer, organist and conduc- himself be whipped. Strangely enough, this tor. He was qualified as a man of a big ap- was the only way he could empty his body petite, a trencherman, and it was even said he properly. He died three weeks after the death was apt to drink and change his mood. Thus, of his only son Emanuel who was born from in the cases of overworking or failure in his marriage with Carla, his first wife. He died business dealings, and probably due to his deeply depressed, probably from the conse- picnic constitution and cyclothymia, he was quences of asthmatic problems when he was prone to shorter or longer depressive con- 53. ditions which always ended with decreased activities. His frankness, extrovert nature, Claudio Monteverdi (1567-1643) cheerfulness up to hypomania were rarely in- Italian composer and violinist. There was terrupted by deeper depressions, particularly a tragedy in his family when he was 40, his in the years 1729, 1734, 1737, 1742, 1743, wife died and left him with two underage 1745, (strokes?, embolisms?, alcohol abuse?). children. This resulted with depression and When he was about seventy years old, he was illness and consequently, he became less ac- especially down, due to his blindness and im- tive. His later activities are tied with Venice. possibility to lead further dynamic life of a When he was 65, there was another period performer and composer. He was often sit- of depression and illness. It was the time of ting “in the dark”, feeling bad. If he had plague epidemic which eliminated all social lived in modern times of alienation but also activities, therefore orders for musical pieces of professional developed improvement, he as well. Whenever there was a hard time for would probably go to see a psychiatrist, more him, he used to return to his family in Cre- probably because of the expressed distur- mona, so did he just before his death. He had bances than because of a severe manic-de- a need to see his family, hometown and Lom- pressive disorder. bardia in general, since he was most appreci- He was still great, had an excellent mem- ated there. All this was too tense for him, he ory, his creativeness was still alive but due to returned home to Venice already ill and died diminished abilities to act, he sunk into lone- in fever at the age of 76. liness and sorrow. Since 1753. he has been totally blind. While he was still able to write Arcangelo Corelli (1653-1713) music on the paper, he wrote down about the Italian composer and violinist. He was difficulties he had with his sight. (“I am hin- known as a humble, mild and moral man. dered in my work because of relaxation of Due to frail health he receded from public my left eye’s sight’’). The cataract is not to life, probably after prolonged hardship. It is be blamed as the only reason for his blind-

Alcoholism and Psychiatry Research 2015;51:151-168 Breitenfeld at al. 153 ness, according to many experts. Maybe it es in his favor, motions of the pupil, light, was a question of some other eye illness. Ac- etc., but upon drawing the curtain, we found cording to Evers, Handel’s eye-disease can the bottom defective from the paralytic dis- be best interpreted as a central vascular disorder.” order with degeneration of retina or with It was all a big failure, but the only thing ischemic changes in the corresponding brain good is that Handel, in comparison to Bach, nuclei and tracts, complicated by a simple se- lived long enough to reach his seventies. Al nile or post-traumatic cataract, diabetes and though mentally alert, he was after all, gloomy hypertension. Handel’s profile of risk factors and depressed, but nevertheless he lived to points most probably to a vascular degenera- his 74 year, far below his composing activi- tion of macula or a damage of choroid ves- ties. In October 1758, he started to weaken, sels. lose his well known gluttony, became orien- But we also indicate the possibility of the tated to himself and sullen. alcoholic damage of the optic nerve in the He still intended to take a cure in the wa- sense of retro bulbar neuritis, optics fasci- ter-place. On April the 7th 1759, it said in the cle. The cataract, by systematically worsened papers, that Handel intended to undergo a possible alcoholic retro bulbar neuritis of treatment in Bath. Then he was present at the optic nerve could entirely explain his blind- performance of “Messiah”, he maybe even ness. However, he continues to attend the performed some improvisations (because it performances, especially of his works, per- was announced so), but it is more likely that forms separately by improvising. The whole due to his worsened health condition, he medicine staff of London rally around him was only present at the performance. After in order to help. They try to improve his de- he returned home he felt sick, and took to stroyed sight and to remove his pains, oper- bed, aware of the nearness of his death. He ating by means of needles and cuts. At first wrote a codicil and by his last will he left all the operation was done by a well-known eye- he possessed to his relatives, acquaintances, doctor from the Guy Hospital and then by friends and also for humanitarian purposes. the court surgeon William Bromfield in 1752. According to the statement of his doctor, After that in the year 1753 he underwent dr. Warren, he died in the evening of April an operation again, carried out by the well- the 13th, although the day after has been known wondering operator who was mostly stated more frequently as his day of death. seen on the fairs and was probably a medical Handel’s pathography turns to obscurities charlatan. His name was John Taylor and he regarding his diseases in 1729, 1734, 1737, reports as follows: “I have seen a vast vari- 1742, 1743 and 1745, because the complete ety of singular animals, such as dromedaries, recovery from manifold stroke at the age of camels, etc., and particularly at Leipzig, where fifties is quite unusual. It also points out his a celebrated master of music (J.S.Bach), who picnic constitution with inclination to this- had already arrived at his 68th year, received worldly delights and pleasures, his unstable his sight at my hands, it was with this very states of his mood (depressive states particu- man that the famous Handel was first edu larly during his illness), but not up to the level cated, and with whom I once thought to have of mental disease of circular psychosis, and the same success, having all the circumstanc- also the sad development of his fruitful and

Anxiety and depression in composers Alcoholism and Psychiatry Research 2015;51:151-168 154 dynamic life directed towards too much lone- improve his health significantly. He fell into liness, sorrow and “the darkness” of a blind religious and feeble moods more and more person exhausted by operations. often. He tended to be hypochondriac and He died of an old man’s decrepitude, wrote down his symptoms, therapies and which was perhaps aggravated by some ma- doctors, who treated him very eagerly. Even lignant illness, stroke – as his mother?, pneu- though he did not have a good opinion of monia or heart weakening. Although his dy- doctors, being afraid of tuberculosis he asked ing could be interpreted as an arteriosclerotic for advice from doctors in Montepellier. In condition with possible stroke, it could also his opinion, they did not take him seriously, be explained even better as a specific (up to so their help was of no use. praedelirium) standstill of organism due to His psychological condition worsened to long-lasting alcoholic damage. His inclination the level of evolutive psychosis with bouts to food and drinking, which made him suffer of crying, deep melancholia to the level of from gluttony and alcohol abuse, can be un- psychosis, with ideas of relation and prosecu- derstood only like a symptomatic – co mor- tion. bid, depressive alcoholism, i.e. his unhealthy alcohol addiction due to the existing primary disease, i.e. depression he was apt to so much Wolfgang Amadeus Mozart and of which he tried to look for a way out (1756-1791) very frequently by means of alcohol, which Austrian composer, pianist and conduc- he, as the time went by, was unable to main- tor. Amadeus was not a handsome man. He tain under control in an adequate way. As a was sensitive to comments about his looks, man of genius, according to Beethoven, the but his psyche was complex and rather more greatest living composer of that time, he was impressive. He was a man of higher intelli- certainly an unusual, strong and dynamic per- gence and showed an extraordinary capacity sonage whose cyclothymia was almost always for imaginative creation and original thought. within normal limits. Also, he was able to put great effort into everything he did, His inflated inner image of Jean-Jacques Rousseau (1712-1778) himself some-times led him to excessive nar- cissism, exhibitionism and arrogance. That French philosopher, publicist and com- resulted in creating a great deal of enemies poser of Swiss descent. He lived in poverty throughout his life. and was often ill. He was restless, incoherent, emotionally unstable and often agitated. At He showed a certain trait of dependence times he was quite adventurous. and was compliant and submissive to his fa- After his recovery, from the age of 25, ther’s will, He was spontaneously generous, he started experiencing depressive periods which made him easy prey for hangers-on. with attacks of tachycardia. He was also very He used to suffer in silence. His way of deal- afraid of death and hell which triggered his ing with aggression was a passive, self-de- depressive periods, mostly in 1743, 1750, structive one. 1753 and 1756. Mozart suffered from something that He moved to Charemette outside of Paris might be referred to as cyclothymic disorder. to spend more time in nature, but it did not There is some evidence that his mother suf-

Alcoholism and Psychiatry Research 2015;51:151-168 Breitenfeld at al. 155 fered from the same disorder. His hypoman- a common expression of his artistic person- ic swings were characterized by an elevated ality (over sensibility, etc.). He drank alcohol mood, excessive energy, inflated self-esteem, (especially punch) throughout his whole life, increased productivity, physical hyperactiv- and even before his symptomatic alcohol- ity and inappropriate behavior with no sense ism (under the influence of Schikanaeder’s of outcome. Sometimes he wrote nonsense group) mentioned earlier, he suffered some in his letters. Techniques used in those letters praedelirant states and epileptic seizures. include paraphrases, anagrams, cancrizans and foolish rhymes and verses, Sometimes he Ludwig van Beethoven (1770-1827) would behave in a manner of deliberate, self- German composer, pianist and conductor demeaning clowning. His economics seemed born in family of musicians. to be a part of his hypomanic syndrome and However, only four years after, about led him to serious financial troubles. 1800 his musical career was seriously jeopar- Depressive spells would develop after hy- dized when he slowly started to lose his hear- pomanic swings. Sometimes these depressive ing. Not being able to accept his illness, he and hypomanic symptoms alternated rapidly lived a miserable, solitary life trying to keep within a day, or even an hour. In his depres- his deafness in secrecy. Ludwig found no un- sive phases, he was extremely irritable, mel- derstanding among people, especially among ancholic, apathic and dominated by imagina- women. He was very unhappy because wom- tion. He would-suffer insomnia and certain en had, in spite of his small height and aver- trends of paranoia, jealousy, exhaustion and age look, till then enjoyed the company of fatigue. Depression got worse after his fa- the famous musician. ther’s death. Therefore, as early as in 1802 he wrote There are at least two important elements “Heiligenstadt’s will”, where he described his of Mozart’s cyclothymic disorder that could health problems and his complete despair. have significantly contributed to shortening But fortunately, he decided not to give up. his life. First is his ergoholism, a fatal swing Hand in hand with his personal problems, of a genius who cared no more for his health, Ludwig experienced serious professional cri- and kept exhausting himself working. Second sis which resulted in lower musical produc- is his alcoholism, which might be referred to tivity. Although his popularity was growing, as symptomatic – comorbid. Schikanaeder’s the progressive loss of his hearing made him group pushed Mozart to excessive drinking, unable to perform as well as he did before ei- through which he was shortly able to escape ther as a pianist or a conductor. Very quickly, life’s reality, and probably alleviate the symp- all that started to affect his career because he toms of depression, somatic illness and even failed to maintain the interest of the public. hangovers. It is possible that he suffered He didn’t have any permanent relationship some praedelirant states, which partly oc- with a woman, however, he managed to get curred in fever during his terminal illness. himself into troubles because of possible ho- Due to his temper and his character, Mo- mosexual tendencies towards his nephew and zart lead a reckless life and used to work frequent quarrels with his sister-in-law. With obsessively to the point of complete exhaus- his uncontrollable and violent temper, he had tion. His neurasthenia could have been just to change his residences often. He was rude

Anxiety and depression in composers Alcoholism and Psychiatry Research 2015;51:151-168 156 and distrustful toward his landladies, doctors, Rossini was seriously ill for the first time, acquaintances, even toward his friends. He forced to stay in bed for weeks. According to led a solitary, emotionally intensive life that. the certain secrecy it could be presumed that in a way, contributed to his musical creativity. gonorrhea has seriously taken place. In 1831 For more than 30 years he had been mis- these symptoms were repeated. He also had using alcohol, hoping to come out of the se- lumbago with expressive depressive moods rious depression he had fallen into because and general nervous exhaustion. Since then, of his deafness and other illnesses. He used he had begun his periodical spa therapy, or to drink about 100 grams of absolute alcohol maybe that was his escape from other’s peo- per day, usually 1 liter of wine. It was known ple company to illness. All that brought him that traders with his music used to bribe him to exhaustion, expressive general declining, with bottles of his favorite wines, some of overall spiritual depression, isolation from which had never been delivered because of other people and a complete loss of creativi- his death. He was a regular customer at local ty. He was deeply troubled with father’s death, inns, usually drinking champagne, punch and although his father died very old. Having ar- beer. He was not a pleasant company when rived in Paris he applied to a surgery (not he was drunk. The opinion is that even the serious but delicate) with the help of Dr. Jean smaller quantity of alcohol than previously Civialea. After recovering, he was able to un- mentioned could cause serious liver damage. dertake an exhausting journey and returned Beethoven’s alcoholism was also evident in to Bologna. He was spiritually exhausted and his swollen face. He completely disregarded depressive to the extent that he suffered seri- doctors’ advice to avoid alcohol; on the con- ous insomnia with suicidal thoughts. trary, he drank even more, not being able to But his creative life was over long time control himself anymore. before that. Specialists do not agree whether it was a result of wealth or self-satisfaction Gioacchino Rossini (1792-1868) or the result of laziness, in a way. It can cer- Italian composer. He did not compose tainly be determined that he was a cyclothy- anything from since he was 37 for the next miac, with a number of depressive phases. 30 years. His inactivity was caused by the sat- That could have led to paralysis in social uration with his former life, with the financial and creative activities, because of an expres- security guaranteed as long as he lived – high sive chronic illness. One should not omit his pension and other benefits. His inactivity was probable inclination to hypochondria and connected with his long time illness, which overreaction in the acceptance of his illness. exhausted him, both physically and psychi- cally. Hector Berlioz (1803-1869) According to his behavior later on, it French composer and conductor. Lack of could be concluded that he had hypochon- mother’s love was evident in Berlioz’s almost dria and temporary longer depressive periods desperate seek for love of other, older women. when he separated from other people. Due Berlioz usually expressed his feelings to his physical build-up, even a minor organic for those he loved strongly and directly. At illness was taken seriously. Already in 1825 twenty-three, his at first unrequited love

Alcoholism and Psychiatry Research 2015;51:151-168 Breitenfeld at al. 157 for the Irish Shakespearean actress Harriet Alcohol produced many harmful effects Constance Smithson was the inspiration for on his physical and mental health; he expe- his Symphonie fantastique. In creating that rienced great fears, developed a split person- Symphonie, it is also probable that the artist ality, and had hallucinations. His imagination was under influence of opium. Berlioz’s let- broadened under the influence of black cof- ters were considered so overly passionate by fee and nicotine from tobacco. Schumann Smithson that she initially refused his advanc- described his hallucinations as dreaming es. Berlioz became very depressed and tried awake, sometimes with hearing hallucina- to commit a suicide with laudanum (opium). tions. Those hallucinations were often con- In 1853 he had gastritis, and remaining nected with sexual excitement. He had de- duodenal ulcers caused him intestinal pains pressive and hypochondriac phases. for more than 15 years, which he treated by In his diary he wrote about his drunken opium (laudanum) with the consecutive opi- states and hangovers afterwards, sleepless- um-addiction. He had some sleeping distur- ness, tiredness, murmurs and sounds in his bances, which he also treated with opium. ears, complaining that it bothered him much, The cause of his intestinal pains could be ei- and seriously thinking about committing sui- ther intestinal neuralgia or they could be just cide. He wrote also that there was a differ- an excuse for opium misuse. That opium mis- ence between creative guzzling and drunk- use was probably inspiring in the beginning, enness (unfortunately the last one was one but during time, it became a disabling factor. of his major problems). On the other hand, Berlioz was in abstinence - dependence syn- guzzling helped him in his creative work. In drome, becoming passive and in deep per- Schumann’s diary, we encounter lines where sonality dissipation. That states he described he mentioned masturbation, and wrote in his Symphonie program, letters and later phrases like “damn pederasty” and “a night printed memoirs. with Greek dreams” which suggest homophile and pedophile tendencies. He suffered Robert Schumann (1810-1856) severe hangovers and abdominal pain with German composer, pianist and conduc- diarrhea, with anxious panic states and lone- tor. There were some psychiatric diseases in liness and feeling lost. his family, like schizophrenia, and depression, According to Robert’s diary, frequent sex- which occasionally ended with hospitaliza- ual intercourses with some “Christel” got tion or suicide. Alcoholism and cerebrovas- him primary syphilis infection with the af- cular infarctions were not rare either. It was fect on “typical” place (penis), described as a family of intellectuals and very sensible in- “glowing pain on a place of ulcer”. That fact, dividuals. at the age of 21, marked his further life. At Schumann’s childhood was shaded with the age of 23 he was under treatment for cold his mother’s long-time illness because of fever, which appeared as a consequence of which she neglected raising her children. He his night-life, soaked in alcohol. That year was a very sensitive and anxious child, some- brought him a lot of excitement, alcohol times depressive, and having a sleeping dis- excesses and stress. Again, he was shocked order. by the death of his brother’s wife, showing prepsychotic signs with hallucinations. Even

Anxiety and depression in composers Alcoholism and Psychiatry Research 2015;51:151-168 158 though Schumann drank a lot in order to go against his will. After that suicidal attempt, over his neurosis and schizoid - pseudoneu- feeling depressed and worrying about his ag- rasthenic disturbances more easily, he had gressions towards his family, Schumann de- hallucinations and “light-seeing” states and manded to be institutionalized. heard music inside his head. The last 2 years of his life he spent in the At the age of 43 Robert started to change. sanatorium Endenich near Bonn/Rh (30 He became more and more quiet, unsociable, miles from his home). As a famous person, had problems with conducting, conflicted he was treated with great care and respect. with the orchestra, what ended in conducting He had several rooms at his disposal and a only his compositions. great comfort, but only a few friends to talk Because of frequent feelings of dizziness to, especially from the same social class. The and loss of consciousness, the doctors in- sanatorium was run by dr. Richarz, who tervened with a venesection – bloodletting made a great effort to treat patients nicely. (hypertension?), and dr. Kalt diagnosed an Schumann’s condition, with only few excep- incurable mental disease!!! - neurosyphilis? tions, worsened continuously. Robert fell into severe apathy, slowed down It is not clear what drugs doctors gave him. and had ideas of being pursuit, what was his His legs keep swelling; he ate very little, and excuse to drink even more. He constantly was fed on probe. During his last days, the heard the tone A, had problems with speak- doctors gave him only wine and alcohol punch ing and writing. He was very excited with his (for he refused other food). His body slowly acquaintance to Brahms in whom he recog- decayed, he contacted with his surroundings nized a musical talent. less and less, using only writing for commu- His movements become stereotyped with nication. His family (except Brahms) did not kyphotic posture and in time he became less visit him until the very end, at first for their creative. At the age of 44, he wrote about own safety (prevention of physical attacks), the telepathic connection with Brahms. In and later for his apathy and personal decay. the letters he imagined words secretly written In time he started to lose ability to rec- between the lines. Finally his madness busted ognize people around him. He got cramps, out: he had unpleasant and painful sound ex- probably epileptic attacks, unwilling stereo- periences during the nights, constantly hear- type head and limb movement with grimaces. ing tone A. Every murmur sounded like an His pupils were not stiffed, but irregular and amplifying music in his head. unsymmetrical. He had hallucinations and Those experiences became more and more ideas of being pursuit and he had not only unpleasant, and he felt that music turned dissociated but incoherent judgment too, de- into scares which were hounding him. He spite some better phases. screamed in pains, became violent to his wife The causes of his relatively early death and children. He even saw Schubert’s figure, could be the stimulative psychoactive rem- who allegedly sent him a beautiful melody. edies that was Schumann continuously tak- Full of fear and frustrated, escaping from ing: alcohol on the first place, coffee, tobac- home, Schumann tried to drown himself by co, and drugs (as an analgesic therapy and for jumping into the river Rhine in 1854, but psychological reasons he was taking an opi- the fishermen pulled him out of the water um derivate – laudanum).

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The psychiatric condition of Robert dition was so bad, that the bishop organized Schumann concerned doctors particularly. a permanent company for him – a monk to Severe attacks of depression and hypomania help him to get rid of a terrible loneliness, help and in contrary psychotic states of schizo- his bad thoughts and prevent him to commit phrenic origin exchanged during his lifetime suicide. Bruckner was inclined to do it openly. (as his schizoaffective disturbance?), with They used to find him crying at the brink of alcohol and other psychoactive substances the step rock. He didn’t even know how he misuse as “auto therapy”. His mental, neuro- had got up there and they hardly succeeded logical and physical condition was destroyed to save him. A number of cures helped him mostly during the last three years by a syphi- only partly and particularly it was warm lead- litic progressive paralysis – general paresis, ing of Dr Keyl. Those conditions were repeat- whicht ended Schumann’s life far too early, at ed, worse and harder as he became elder. He the age of 46. wrote to a friend: “It was a complete feeling of abandonment, loss. I lost my nerves and I am Anton Bruckner (1824-1896) constantly frustrated and too sensitive. I was in the worst condition, I confessed Austrian composer and organist. In St. this only to you – don’t talk about it. A little Florian monastery near Linz, he was a very lonely boy, who learned music with solid mu- more of this and I would be lost forever. sic teachers-monks, the only persons he could With age, Bruckner started to show a very lean on sentimentally and sensitively. Only strange inclination and a strong, overreacting there was he accepted with understanding, curiosity towards death and the dead. He was being a deeply neurotic person. He wrote to dreaming about ghosts, seeing ghosts of the the others: ”I am always sitting, being poor, dead people in his dreams. He used to go to lost and melancholic, in my little room”. This cemeteries, once crying and crying on Wag- melancholy was characteristic for many of his ner’s grave, studying graves epitaphs, show- ancestors, his three sisters and a mentally re- ing and counting dots on epitaphs. tarded brother and he felt very lonely- When In newspapers, he was reading about he was already twenty-one, he returned to murder cases, executions and criminal af- well known St. Florian monastery near Linz fairs, touching bodies of great composers to instruct the young men in musical knowl- (during funeral ceremonies – Beethoven and edge and abilities. Schubert). He wanted to get hold of the skull When he was forty-two he wrote to a friend: of his music teacher. These were the main “Under melancholy I understand… mainly ar- Bruckner’s occupations in seventies. rogance towards people, their friendship, cor- He died as a lonely neurotic who had cho- rectness and fidelity…” Next year, Bruckner sen his own way to serve his ultimate love felt an unbearable strong call for so called hard – the music. One of his admirers said: “He and forced labor. He had to obsessively count was divided from his environment with an leaves and trees, windows and houses dots and unavoidable obstacle, he did not go to par- signatures, stones in pebbles and stars in the ties, he had not a group of equal-minded ad- sky. He was endlessly spending time in pray- mirers as Schubert – nor friends, nor did he ing. He was imagining things. He tried to cure make heroic plans, nor had he Royal admirers it with cold baths in bad Kreuzen. His con- like Wagner, nor family like Bach.

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Mily Alexeyevich Balakirev bicarbonate. Modern medicine would re- (1837-1910) late such symptoms to gastritis, gastric ul- Russian composer. At 21, he started ex- cer or even some intestinal disease. Tchai- periencing headaches, as well as digestive kovsky often felt depressed and cried a lot, and mental problems. His depression and especially when he was alone in the evening. frustration could have been described as an He suffered from phobic fears of thun- encephalitis, but also as the first symptoms derstorms (it is the theme he exploited in of his melancholic-depressive states. One some of his works). As a passionate cigar of the Stasov brothers helped him cure that smoker he was nervous and oversensitive, particular illness, and soon he was ready to generally lacking self-confidence and feeling continue his progressive music ambitions. guilt and strong fear of life. He was good- In June 1861, he became severely depressed natured and of mild temperament, polite in and introvert, destroying his manuscripts and his contacts with others but rather timid and longing for death to free him from his mental tense. However, other people considered pains. He constantly felt that he did every- him a warm and charming person. He had thing the wrong way but somehow managed several nervous breakdowns and suffered to recover from his depressive state. from nightmares and phobias. His appearance had certain effeminate quality and his His supporters were helping him. Upon personality was of neurotic structure. Un- reaching the top of his career in 1870, new fortunately, he was neurotic and inclined to problems began to arise due to his bad tem- wrong compensations. per, inflexibility and inclination towards quarrels. The roots of the problems in his relation- ships with women should be searched for in Balakirev himself experienced financial his childhood. He was extremely attached to ruin when his concerts were no longer suc- his mother and his governess, both of whom cessful. Left jobless and without any kind of he had lost early in life. support, Balakirev became a depressed con- servative monarchist obsessed with mysti- He wrote about his mother’s death: “Ex- cism and religion. actly five years ago my mother died. It was the first time I had experienced real grief and It took him no less than ten years to make pain ... Her death had an enormous impact his comeback, yet he could never re-attain his on my own fate and the fate of my family. former status. Younger and more adaptable, Every minute of that terrible day is still vivid talented and educated people took over. in my memory as if it all happened only yes- terday.” Pyotr - Peter Ilyich Tchaikovsky Next person in order of importance in his (1840-1893) life, was his German governess Fanny Dürn- Russian composer, conductor, music writ- berg. Due to the family’s financial problems, er, critic and teacher. she was forced to leave them when Peter was Tchaikovsky suffered from gastric prob eight years old. He was so sensitive that she lems, particularly in stress-inducing situ used to call him “porcelain child”. Tchaikovsky ations, associated with diarrhea, which felt terrible loss when left, cried for days and he treated with high doses of sodium withdrew from the rest of the family.

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Until the certain age, an adult motherly of darkness, unnoticed, I got into the river up figure, whose presence is necessary and logi- to my waist and was sure to get a fatal cold”. cal, must exist in everyone’s life. Tchaikovsky Tchaikovsky got only a mild cold. He tried felt a very strong need for such a person be to get a legal divorce but failed. cause he had lost that kind of support too Nadezhda Filaretova Frolovskaya von early in life. Meck realized her dreams of becoming a Therefore, it is understandable that he mighty patron of young musicians. She did wrote that “sometimes he feels a need for not support only Tchaikovsky, but Debussy women’s guidance and care”. As a handsome and Wieniawski as well. man of discreet charm ho was attractive to Interestingly enough, they never talked in emancipated women artists and aristocrats, person but kept their intensive relationship, even more so since it was impossible to se- almost an open platonic love affair, strictly duce him. He was a sensitive, well-meaning confined to letter writing. and unobtrusive man with great appeal for This great and unusual friendship lasted women who were older than himself. He for almost fifteen years to be suddenly bro- often expressed friendly feelings for older ken in 1890. women artists, particularly opera singers, and in that context his affair with the Belgian op- A list of his close male friends is very long era singer Desiree Arthot is often mentioned. and certainly at least some of them can be In that period his ex-student from the suspected of homosexuality. Tchaikovsky conservatoire, Antonina Ivanovna Milyu- started his career as a music teacher in Mos- kova, tried to find the way into his life. She cow and since he was still not completely ab- wrote him a letter in which she disclosed her sorbed by his composing, he dedicated much feelings for him. of his time to his students. He showed great consideration for some of them, particularly Tchaikovsky decided to marry Antonina the one called Vladimir Shilovsky. He tried to Ivanovna and the basic motive for such a decision is seen in another of his letters: “I eliminate rumors by marrying Antonina Iva- must try hard to marry someone with all the novna Milyukova. formalities. I am fully aware that my inclina Tchaikovsky had a serious quarrel with tions are the most serious and almost unsur his beloved sister Alexandra Davidova some passable obstacle on my way to success and five years before her death and it was only on therefore, I must fight nature with all the her death-bed that she forgave him. Maybe strength I have ... I will do everything to get his too strong feelings for her son Vladimir married this year, but I should also use all my Davidov were the seed of discord between courage to break from my habits.” them. Tchaikovsky gave all his love and care It is hard not to suspect that the mysteri- to his nephew Bobyk after his mother’s ous “habits” (he usually wrote openly about death. He took him to the tours and to the other vices) are related to his homophile ten- spas and dedicated his best works to Bobyk. dencies and homosexuality. Oddly enough, Tchaikovsky became a vic- “On one such evening I approached the tim of one of his transitory affairs. It was river Moscow and suddenly it occurred to me recently discovered that on a Dnyepr steam- that I should get deadly ill. Under the cover boat journey to Odessa he had seduced a

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14-year old boy. Tchaikovsky’s sexual prefer- He was sick that night and went straight ence was no more a secret to anyone. This to bed. He woke up after a few hours in fe- last mistake was inexcusable and an impartial ver and feeling stomach spasm; soon diarrhea committee was formed to deal with this issue and vomiting started. Tchaikovsky died un- of honor and morality (see The last year of conscious. life and death). He poisoned himself with arsenic. Such Tchaikovsky started drinking with his fri an assumption seems reasonable because ends as a very young man. His tolerance to al all the symptoms were characteristic for the cohol increased with time and he wrote about acute arsenic poisoning. that in his letters and his diary. He lost control over his drinking and tried Edvard (Hagerup) Grieg (1843-1907) to alleviate the symptoms of abstinence syn- Norwegian composer, conductor and pia- drome by drinking more. nist. He got specific tuberculosis of the left He practically drowned his depression in side in 1859. alcohol. Although he tolerated alcohol in the He was a sensitive neurotic man treated beginning, later he developed an addiction many times in spas and sanatoria. He was with the loss of control over drinking and in- aware that his sensitivity reflected in his mu- ability to abstain (gamma and delta types of sic. alcoholism). Last three years of his life and specially Tchaikovsky was not an alcoholic who last year of his life he became more and more typically drinks in the company, but rather nervous, weaker and depressed, saying good- symptomatic - comorbid alcoholic who start- bye to his friends forever, aware of the near- ed drinking to ease his neurotic disturbances. ness of his death. Alcoholism is quite common in homosexuals who try to eliminate their emotional problems and the feeling of guilt. Claude Debussy (1862-1918) Tchaikovsky was also a passionate card French composer. Although he was not player and gambler. He lost large amounts physically attractive, he was always surround- playing cards but always paid his debts on ed by women. Being very sensitive and emo- time. When he did not drink he took a seda- tionally insecure that helped him build his tive, potassium bromide, soon developed a low self-esteem. habit and later even mixed it with alcohol. At the age of 43, Debussy started to feel From everything said, it is evident that this physical as well as mental exhaustion. He was a case of multiple dependency. turned into a person with a very complex He went 1893 to a business dinner and personality - self-centered, egocentric and as- poured himself a glass of unboiled water sociable. In the attempt to ease the feeling of which was a very unreasonable thing to do emotional emptiness, he sought the comfort since cholera epidemic partly raged in St. Pe- in various sedatives and even hard drugs such tersburg. He drank the water to his friends’ as morphine and cocaine. That was an effort terror. Tchaikovsky was said to state that he of a desperate man to find comfort and ful- was never afraid of getting cholera (although fillment as well as inspiration for the compos- his mother, died of it). ing. When Debussy tried to give up his addic-

Alcoholism and Psychiatry Research 2015;51:151-168 Breitenfeld at al. 163 tion, he often experienced severe withdrawal ince, where he managed to stop drinking and symptoms – drowsiness and headaches. In making excesses, but went to the other ex- 1914 he started to suffer serious abdominal treme and devoted himself violently to com- spasms with rectal bleeding. In order to re- posing. Thus, he created numerous composi- lieve pain, he was taking quinine and some tions and started to perform more and more. other stimulating drugs. He played organ-pipe, piano, conducted and did some pedagogical work. Max Reger (1873-1916) At the age of 28, he moved to Munich German composer and organist. He was with his father’s family, what gave him an op- not able to master the rules of such social portunity to expand his musical activities. surroundings. Being of rebellious nature, Soon, he got married to his long-time strong and early matured in conflicts with au- companion Else von Bercken, primarily for thorities (from his father on), he revolted and support she used to give him. However, he made all kinds of alcohol and other excesses still seemed to be uncompromising in his re- throughout Wiesbaden with his gang, almost lations to other people, and got into many tyrannizing other people. He smoked exces- conflicts. People considered him “good for a sively. At night, he used to roam through the madhouse“. His constitution was picnic or a town drunk and drive his landladies to de- bit dysplasticaly athletic. Mentally, apart from spair. So, he was considered an „enfant ter- cyclothymic hypomania, depressive symp- rible“. His genius was not understood, but we toms dominated his behavior. He showed must say also that his creativity was not at its anxiety, sensitivity, naive and violent contact- best and his composing was still not acknowl- ibility, warmth, harshness, fidelity, honesty edged. However, at the age 23, he succeeded and endurance, but no control. his professor at conservatorium. That did not inspire him, but only pushed him to further Maurice Ravel (1875-1937) wanderings from tavern to tavern, where, French composer, pianist and conductor. ever more lonely, deep in the night he would Maurice Ravel was slightly built, short in stat- gaze at one spot, experiencing restlessness ure (1,60 - 1,62 m) with large head. His father and insomnia. He acknowledged the danger apparently suffered from a slowly progressive of alcohol, which he could not drink moder- dementing illness and died at age of 74. He ately, but nevertheless lost control over that. was a good swimmer and enjoyed taking long In the mornings, he would not remember walks. He was a passionate smoker, and liked what happened last night and suffered severe strong coffee, heavy wines and hot spices. hangovers. During his whole life he never had any seri- He voluntarily joined the army, but that ous intimate relationship with women (even did not sooth him either. His excesses under “Apache” was men only club). Ravel was self the influence of alcohol (some quote that he declared atheist (even buried without any reli- was even delirious) led him to military hospi- gious ceremony) and paid special attention to tal as a psychiatric patient, where he passed his appearance, always well groomed, dressed through few psychotic and severe aggressive elegantly. Before the World War I, his physi- episodes. When he was 25, his devoted sis- cal health was generally good but in 1908 he ter Emma barely returned him home in prov- had a depression period after the death of his

Anxiety and depression in composers Alcoholism and Psychiatry Research 2015;51:151-168 164 father (for next 7 months he completed only Bela Bartok (1881-1945) one small work - a folk song). In 1912, after Hungarian composer and pianist. Even an exhausting schedule, his health deterio- as a child he was of delicate disposition and rated and his illness was diagnosed as an in- often ailing. After vaccination he developed cipient neurasthenia. During the World War a recurring eczema with unpleasant itch- I, in 1914, he was initially rejected for military ing lasting for five years. Allergy was also service (volunteered) for being underweight the cause of his chronic bronchitis and later and for having a hernia. 1915, he succeeded the catarrhus of upper pulmonary lobes and to join as an army driver. In 1916, he was as- pneumonia, probably of a tubercular genesis. signed to front near Verdun. In his letters All this made him withdrawn, uncommunica- he frequently wrote about insomnia and ex- tive and diffident. haustion. The same year, he had an extended He was nervous, highly hypersensitive and convalescence, when he contracted amoebic constantly dissatisfied with his things done, dysentery. craving always for something better (the trait In 1917 he suffered the second prolonged of many researchers). Although of a schizoti- state of grief and depression after his mother mous character he was often melancholic and died. After The World War I he complained depressive. He was graceful, medium height, again about the symptoms of insomnia and browning eyes, rather far sighted (often wear- lassitude. This time they were accompanied ing glasses) early turned grey. by bouts of fever and occasional chest com- plaints. Tuberculosis was suspected and he was sent to an alpine resort Megeve for 3 Paul Hindemith (1895-1963) months. Between 1918 and 1927, no serious German composer, violinist and conduc- health deteriorations were registered. tor. It could be sad that he was suffering from a father figure complex which resulted in a At the age of only 52, in 1927, the first certain timidity and lack of trust in people, clear signs of neurological upset appeared - although he was well known for his kindness occasional difficulties in playing the piano, and generosity. Deep down he was emotion- writing and also early symptoms of dyspha- ally insecure and probably lonely. Short and sia. rather plump, he suffered from cyclothymia However, he did not show any signs of and his moods alternated from extreme ac- uninhibited and socially inappropriate be- tivity to melancholy and depression – which havior, inappropriate sexual behavior, loss of he had in common with some other compos- concern about personal appearance and hy- ers and creative artists. His dependency on giene, major increase in appetite that leads to music making and composing could be un- constant eating and weight gain (to mention derstood as a need to compensate a certain only few of them). degree of emotional insecurity and not only Obviously no conclusive diagnosis can be a sign of his general talent. Already in 1959, made. Probably several pathologies affecting he suffered a mental breakdown – probably Ravel’s brain were superimposed. Therefore the first signs of progressive arteriosclerosis the latest theory of Ravel’s disease belonging with high blood pressure. to a form of the Pick complex is attractive.

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LIST OF ALL COMPOSERS AND THEIR DIAGNOSES

Name State years of Type of accident birth and death Rolande (Orlando) de Lassus NLD (1530-1594) strokes, depression Carlo Gesualdo ITA (1560-1613) asthma, depression John Dowland GBR (1562-1625) old age, melancholia Claudio Monteverdi ITA (1567-1643) plague?, depression Thomas Weelkes GBR (1576-1623) alcoholism Girolamo Frescobaldi ITA (1583-1643) personality disorder Lawes William GBR (1602-1645) killed, alcoholism Robert Cambert FRA (1627-1677) alcoholism Michael Wise GBR (1647-1687) alcoholism Arcangelo Corelli ITA (1653-1713) failing health, depression Jeremiah Clarke GBR (1674-1707) alcoholism, suicide George Frederic Handel GBR (1685-1759) alcoholism, blindness, stroke Francesco Geminiani ITA (1687-1762) old age depression Wilhelm Friedemann Bach DEU (1710-1784) personality disorder, alcoholism, pneumonia Jean-Jacques Rousseau FRA (1712-1778) personality disorder, kidney failure Johann August Bodinus DEU (1725-1800) arm paralysis, depression Antonio Sacchini ITA (1730-1786) alcoholism, gout Jean - Baptiste Krumpholtz CZE (1742-1790) anxiety Louis - Henry Paisible FRA (1748-1782) suicide Frantishek Koczwara POL (1750-1791) sexual perversion Emanuel Schikaneder DEU (1751-1812) alcoholism Johann Christoph Vogel DEU (1756-1788) alcoholism Wolfgang Amadeus Mozart AUT (1756-1791) bipolar disorder, depression Adelheid Eichner DEU (1762-1787) depression Vojtech Jirovec CZE (1763-1850) old age, depression Ludwig van Beethoven DEU (1770-1827) personality disorder, alcoholism, deafness Friedrich August Kanne AUT (1778-1833) alcoholism John Field IRL (1782-1837) alcoholism Daniel Auber FRA (1782-1871) old age, depression Friedrich Kuhlau DNK (1786-1832) blindness, tuberculosis, depression Carl Czerny AUT (1791-1857) blindness, disability Gioacchino Rossini ITA (1792-1868) depression

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Name State years of Type of accident birth and death Franz Schubert AUT (1797-1828) alcoholism Alexey Nikolayevich Verstovsky RUS (1799-1862) psychosis, depression Andrey Petrovich Esaulov RUS (1800-1850) drowned Joseph Augustine Wade IRL (1801-1845) alcohol and opium addiction Lortzing Gustav Albert DEU (1801-1851) hypertension, headaches, stroke, anxiety Antonio d´ Antoni ITA (1801-1859) suicide, depression Friedrich Theodor Frohlich CHE (1803-1836) suicide, depression Adolphe Adam FRA (1803-1856) hypertension, heart failure Hector Berlioz FRA (1803-1869) opium addiction Robert Fuhrer CZE (1807-1861) anxiety Karl Friedrich Kuhmstedt DEU (1809-1858) loss of wife, depression Norbert Burgmüller DEU (1810-1836) alcoholism Robert Schumann DEU (1810-1856) schizoaffective disorder, alcoholism, neurosyphilis Samuel Wesley GBR (1810-1876) head trauma, alcoholism William Vincent Wallace IRL (1812-1865) alcoholism Charles Henri Valentin FRA (1813-1888) depression Morhange Alkan Thomas Attwood Walmisley GBR (1814-1856) alcoholism Carl Wilhelm DEU (1815-1873) alcoholism Theodor Furchtegott Kirchner DEU (1823-1903) old age, anxiety Anton Bruckner AUT (1824-1896) phobic and obsessive disorder Louis Moreau Gottschalk USA (1829-1869) apendicitis, peritonitis, depression Kalman von Simonffy HUN (1831-1888) psychosis, schizophrenia, neurosyphilis Mily Alexeyevich Balakirev RUS (1837-1910) headaches, influenza, heart failure Peter Ilyich Tchaikovsky RUS (1840-1893) alcoholism, suicide Antonin Dvořak CZE (1841-1904) obsessive disorder Edvard Hagerup Grieg NOR (1843-1907) asthma, tuberculosis, depression Gabriel Faure FRA (1845-1924) tuberculosis, anxiety Engelbert Humperdinck DEU (1854-1921) arteriosclerosis, stroke, pneumonia Leosh Janachek CZE (1854-1928) heart failure, anxiety Rudolf Dellinger DEU (1857-1910) neurosyphilis, anxiety Edward Elgar GBR (1857-1934) cancer with metastasis, depression Hugo Wolf AUT (1860-1903) neurosyphilis, phobia Anton Stepanovich Arensky RUS (1861-1906) alcoholism, tuberculosis Claude Debussy FRA (1862-1918) depression

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Name State years of Type of accident birth and death Eugene d´ Albert DEU (1864-1932) heart failure, depression Ferruccio Busoni ITA (1866-1924) heart failure, anxiety Franz Lehar AUT (1870-1948) cancer, depression Wilhelm Stenhammar SWE (1871-1927) depression Max Reger DEU (1873-1916) alcoholism, heart attack Sergey Vasilevich Rachmaninov RUS (1873-1943) depression Arnold Schoenberg AUT (1874-1951) triskaidekaphobia Joseph-Maurice Ravel FRA (1875-1937) head trauma, anxiety Manuel de Falla ESP (1876-1946) heart attack, anxiety Joseph Holbrooke GBR (1878-1958) old age, depression Bela Bartok HUN (1881-1945) leukemia, depression Anton von Webern AUT (1883-1945) depression Dora Peyachevich HRV (1885-1923) puerperal sepsis, kidney failure, depression Ivor Gurney GBR (1890-1937) schizophrenia, tuberculosis Peter Warlock GBR (1894-1930) suicide, depression Paul Hindemith DEU (1895-1963) neurosyphilis, kidney stones, pancreatitis, stroke Marc Blitzstein USA (1905-1964) anxiety, personality disorder Willy Ferrero ITA (1906-1954) alcohol cirrhosis Dmitry Dmitryevich Shostakov- RUS (1906-1975) hepatal cancer, heart attack, anxiety ich Lou Harrison USA (1917-2003) depressive states, psychosis, heart attack Charlie Parker USA (1920-1955) alcohol and drug abuse, suicide

Discussion and Conclusion are less represented. The consequence of This is the world’s largest sample of col- these pathologies is a reduced life duration lected pathographic data concerning this pa- of composers from over sixty years to just thology. It includes a distinct representation over fifty, which also shortened the period of of certain subspecies. while other subspecies their creativity and productivity.

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Anksiozni i depresivni poremećaji u kompozitora

Sažetak – U ovom radu iznijeli smo pregled bolesti skladatelja u posljednjih pet stotina godina. Prikupljeni podaci dobiveni su iz biografija više od deset tisuća skladatelja i preko tisuću patografija. To je najveći svjetski dosad obrađeni uzorak. Spomenute bolesti kao i njihovi komorbiditeti utjecale su na živote skladatelja i na njihovo stvaralaštvo te su skratile njihov životni vijek sa nešto iznad šezdeset godina u prosjeku na približno pedeset godina. Ključne riječi: bolesti skladatelja, anksioznost, depresija

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