From the New England Journal of Medicine:
"François Martin Mai is a psychiatrist who has written an excellent book describing Ludwig van Beethoven’s life, his health problems, and how his illnesses may have influenced his creativity. Mai examines Beethoven’s inauspicious childhood and lifelong chronic illnesses. By the time he was 28 years old, Beethoven had already become profoundly deaf, a circumstance that damaged his self-esteem and jeopardized his professional and artistic future. His life was also made miserable by chronic diarrhea, abdominal pain, chronic respiratory illness, depression, and alcohol abuse. However, he made all these detrimental personal matters subservient to the composition of beautiful music.
Deafness was the most infamous of Beethoven’s illnesses, but its cause is still controversial. Mai speculates that it was caused by otosclerosis, which is the most common cause of deafness in young men. However, the high-frequency loss described by Beethoven is not typical of the condition, and for this reason Mai’s diagnosis is doubtful.
The cause of Beethoven’s death was liver failure due to alcohol abuse. The autopsy was performed by Dr. Johann Wagner, who was assisted by Dr. Karl von Rokitansky. Rokitansky was a resident in pathology, and Beethoven’s autopsy was the first one he performed. He subsequently performed 59,786 autopsies in his outstanding career as a pathologist and became famous for his observations on the gross features of pathologic abnormalities of organs.
At Beethoven’s autopsy, Wagner and Rokitansky — besides cirrhosis of the liver due to alcohol abuse — ascites, splenomegaly, pancreatitis, and thickened bones of the skull. The eighth cranial nerves were wrinkled and shriveled because they had been compressed by the thick skull bones, a finding consistent with Paget’s disease of bone, which can cause deafness. Other conditions that have been put forth as the cause of Beethoven’s deafness — including head trauma inflicted by his alcoholic father, syphilis, and otosclerosis — lack credibility. There is also some question of whether lead poisoning caused Beethoven’s illnesses. In 1996, a lock of his hair was found to contain high levels of lead. Lead poisoning
was common in Europe during Beethoven’s time because wine contained lead that had leached from its containers.
Beethoven is an icon of classical music. His music has the power to ennoble the human spirit and to evoke a heroic spirit in the struggle against adversity and oppression. At the time of his death, Beethoven was at the height of his powers as a composer. Mai believes that Beethoven had bipolar depression; at times he was suicidal, and he was hypomanic — he could compose several different works simultaneously. In his Symphony no. 3 in E-flat Major, Eroica, there is a sudden change of musical mood that is consistent witha hypomanic temperament. And despite his depression, Beethoven had the drive and energy that are characteristic of a person with bipolar disorder. Mai thoughtfully analyzes the ways in which Beethoven’s chronic illnesses and psychopathology may have contributed to his creativity. But it is also important to acknowledge that Beethoven had an inner impulse that demanded expression — even in the face of many obstacles. "
Paul Wolf, M.D.