McGill-Queen's University Press Blog

François Martin Mai's "Diagnosing Genius" reviewed in the NEJM

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.

Mai's "Diagnosing Genius" -- on the CBC and in JAMA

From the Journal of the American Medical Association:

" Diagnosing Genius: The Life and Death of Beethoven

By Francois Martin Mai, 270 pp, $29.95.
Montreal, Quebec, McGill-Queen's University Press, 2007.
ISBN-13 978-0-7735-3190-1.

JAMA. 2007;297:2643-2644.

Genius. How can we explain it? How do we define it? How does illness impact it? Maybe a genius is that rare someone smarter than you. Or an individual with raw intellectual power—say, an IQ greater than 160. Perhaps a genius is a person with a single extraordinary talent whose "product" is novel, useful, and enduring. Even if we cannot agree on the exact definition of a genius, most of us would still recognize one. Diagnosing Genius: The Life and Death of Beethoven is an intriguing biography of a remarkably gifted and troubled man whose deafness and depression did not prevent his ascent to the stature of musical genius and icon. Written by a professor of psychiatry who happens to be a pianist, Diagnosing Genius addresses 3 main topics: Beethoven's personal life, the uncertainty surrounding his declining health and death, and the link between creativity and illness. 

Ludwig van Beethoven (1770-1827) was a composer, orchestra director, and pianist. He wrote more than music. He was a prolific letter writer, and more than 1500 of his letters still exist. Along with these, the author of Diagnosing Genius uses 4 other sources in reconstructing the life and death of Beethoven: letters written by others; physician reports, including the postmortem examination document; passages from the "Conversation Books" (notepads that Beethoven used to communicate with visitors and friends from 1819 until his death); and a toxicological study of Beethoven's hair. The life that takes shape from this collection of data is luminous, odd, and tragically ironic. 

Beethoven's musical training began at age 4 years. His father deliberately misrepresented his son's age to present him as a child prodigy. Beethoven acquired a reputation as an irksome student who was somewhat lacking in arithmetic and grammar skills. Yet his IQ has been estimated to have been 165. He was considered to be eccentric in behavior and dress. He was extremely sensitive, stubborn, and apparently prone to episodes of hyperventilation. Goethe described him as "an utterly untamed personality" and "by nature laconic." Although he never married, at least 3 women rebuffed Beethoven's proposals of marriage. One of these women, a singer, purportedly rejected marrying him "because he was so ugly and half crazy." Everyone's a critic . . . even 2 centuries ago! 

At least 11 doctors cared for Beethoven during his lifetime, and some of them were among the most prominent physicians in Vienna and Europe. Near the end of his life, though, all of Beethoven's former physicians declined to treat him. Beethoven was preoccupied with his health. He could be a demanding and sometimes difficult patient. He was quite interested in experimental treatments and particularly fond of water spa therapy. Although he tried many remedies for his deafness, he was impatient with some recommended medical treatments. Several explanations have been offered to account for Beethoven's failing health and his deafness—syphilis, typhus fever, sarcoidosis, and Paget disease, to list just a few. His death has also been viewed as a bit of a medical mystery. In 1996, a toxicological analysis performed on a lock of Beethoven's hair demonstrated exceedingly high lead levels—60 parts per million, or nearly 100 times higher than the average North American standard. Such large quantities of lead might arise from ingestion of mineral water, use of lead dishes and crystal, lead salts added to sweeten wine, or artifact due to contamination. Arsenic, mercury, and narcotics were notably absent from the hair sample. 

The author of Diagnosing Genius attempts to solve Beethoven's puzzling death. He believes the autopsy findings are consistent with cirrhosis of the liver and speculates that wine containing lead salts accounted for the excessive level of lead in Beethoven's hair. The author concludes that Beethoven's cirrhosis was alcohol-induced and contends that the composer meets at least 3 of the 7 criteria of the Diagnostic and Statistical Manual of Mental Disorders (Fourth Edition) classification of alcohol dependence (not alcohol abuse). The author additionally formulates a medical problem list for Beethoven: cirrhosis, otosclerosis, irritable bowel syndrome, renal papillary necrosis, recurrent depression (possibly bipolar disorder), bronchitis, idiopathic uveitis or scleritis, and possible fibromyalgia. 

The final chapter of this book, "Illness and Creativity," considers the concepts of genius and creativity in the setting of medical illness, psychopathology, and substance abuse. Factors promoting creativity include a vivid imagination, strong motivation, unusual experiences in childhood, and birth order (first-born children). The effect of music on the brain is also discussed. One researcher notes that "music activates the areas of the brain that are essential for evolutionary survival—the nucleus accumbens, the dorsal midbrain, and the insula—even though music itself is not essential." Another scientist has determined that "the human brain has neural networks that are specific to the processing of music and suggests that music has biological roots." 

Two of the most interesting sections of this book are brief appendices. "Beethoven's Medical History" is a 3-page summary of the composer's health history in the format of a clinical-pathological conference. "Dr. Andreas Wawruch's Medical Report" is a 5-page statement written by Beethoven's attending physician 6 weeks after the composer's death. More than 20 black-and-white illustrations—portraits of the composer, life and death masks of Beethoven, and his various hearing aids and spectacles—are an added treat. Diagnosing Genius: The Life and Death of Beethoven wi l strike a chord with anyone interested in music, medical history, medical mystery, and the connection between creativity and disease. Bravo!" 

-- Tony Miksanek, MD, Reviewer

Francois Martin Mai was also interviewed by Gian Ghomeshi on CBC Radio's Q on 31 July 07.