A Psychiatric Analysis of Ludwig van Beethoven

A Psychiatric Analysis of Ludwig van Beethoven
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Ludwig van Beethoven is one of the most acclaimed pianists and classical composers of all time. Nearly two centuries after his death in 1827, Beethoven's legacy transcends time and space. His music is still widely played in orchestra halls on Earth and a couple of his compositions are etched into the Voyager Golden Records onboard the two Voyager spacecrafts currently traversing interstellar space. Perhaps, one day, intelligent aliens will hear them.

Beethoven likely couldn't have fathomed his future extraterrestrial celebrity during his virtuosic heydays in the early 1800s. Dedicated to his craft and often socially withdrawn, the composer had an "untamed personality," as described by heralded German poet and renaissance man, Johann Wolfgang von Goethe. This distinction has made Beethoven an attractive subject of biographers. More recently, it also earned him a psychiatric evaluation in a scientific journal.

Dr. Andreas Erfurth, Head of the Department of Psychiatry and Psychotherapeutic Medicine at Klinik Hietzing in Vienna, originally presented this perspective at a Beethoven-focused event in October 2020 at the Natural History Museum of Vienna. He cautions that psychiatric evaluations not conducted in-person generally lack credibility, especially those performed on current popular figures (i.e. Donald Trump, and Britney Spears) based solely upon publicized actions and events. In Beethoven's case, however, numerous writings, accounts, and biographies shed copious light on his exploits, character, and upbringing, making a psychiatric analysis more tenable.

"As in other successful and productive people, numerous features of the hyperthymic temperament can be found in Beethoven’s biography, namely increased energy and productivity, vividness, emotional intensity, resilience, tirelessness and strong will," Erfurth said. Someone with a hyperthymic temperament tends to be almost exclusively positive, though their optimism can fluctuate up and down in a rollercoaster-like fashion. That Beethoven would be hyperthymic is fascinating, especially considering he suffered from near-deafness for much of his life, which occasionally weighed greatly upon his psyche.

"The Heiligenstadt Testament, a letter written by Beethoven to his brothers in 1802, has been linked to a depressive symptomatology," Erfurth said. "But while the letter clearly reflects the anguish of a 32-year-old man over his deafness, including a contemplation of suicide, it does not seem to be a document of depressive thought disturbance. It shows real and adequate despair and at the same time the attempt to overcome the consequences of this impediment."

Erfurth notes that some authors have pondered whether Beethoven was bi-polar, perhaps frequently suffering from depressive and manic episodes. However, he says that the existence of clearly defined episodes cannot be proven. "Nor can any evidence be found of an anxiety disorder or an obsessive-compulsive disorder," he said.

The only psychiatric disorder that Beethoven could be credibly diagnosed with is alcohol use disorder, Erfurth said. Alcohol use disorder is a "problematic pattern of alcohol use leading to clinically significant impairment or distress". And Beethoven's disorder was apparently severe. He would drink a lot, for long periods of time. Whenever he attempted to control his drinking, cravings would force him back to the bottle. He grew tolerant, requiring him to imbibe significant amounts to get drunk, and would suffer withdrawal symptoms. Lastly, his drinking apparently caused cirrhosis of the liver, which is what ultimately killed him at the age of 56.

Lending credibility to the posthumous diagnosis of alcohol use disorder is the fact that drinking apparently ran in his family. Two of his grandparents were problematic drinkers.

Still, Erfuth said there's no evidence that Beethoven's drinking weighed on his musical talents. While Beethoven left the world too early, his magnificent music will endure for an eternity.

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