Mozart’s 140 causes of death and 27 mental disorders

A recent epidemiological study has reintroduced the hypothesis that Mozart died from a nephritic syndrome caused by a streptococcal epidemic.1 It rests on the assumption that “according to the eyewitness accounts, the hallmark of Mozart’s final disease was severe edema.” However, the assumption is undocumented. In fact, four of the eyewitnesses reported their observations and none noticed severe oedema: Guldener wrote that he “made a careful inspection of the cadaver and saw nothing unusual.” Sophie Haibel, who attended his last illness, mentioned a swelling of the extremities⇓.2

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Last known portrait of Mozart (by Johann Georg Edlinger)

Gemaeldegalerie Berlin/Sean Gallup/Getty Images

Is this an isolated case? Not at all. This diagnostic inflation springs from the procrustean bed fallacy (selection and manipulation of the evidence),3 as well as from the build-up of undocumented manifestations, such as severe oedema, dyspnoea, convulsion, hemiplegia, lancinating pain, tender joints, and such like4; moreover, the “Mozarteum” skull is now known not to be Mozart’s.5

I have identified 140 (sometimes overlapping) possible causes of death, in addition to 85 other conditions. But Mozart died only once. Some causes are plausible, only few—maybe one, or maybe none of them—can be true, so most if not all of them are false.

Several dividing lines separate those authors who believe in foul play and those who reject it, between those who cling on to some sort of chronic disease process and those who believe in an acute condition, between those who twist the evidence and those who display a critical respect for the facts, as well as between those who seek some rare condition and those who are satisfied with some commonsensical explanation.6

Many authors have favoured the hypothesis of an acute condition such as influenza; staphylococcal, streptococcal, or meningococcal infection; various septicaemias; scarlatina or measles; typhoid or paratyphoid fevers; typhus; tuberculosis; trichinosis; and so on. Postinfectious glomerulonephritis was first proposed by Barraud in 1905. Schoental, an expert in microfungi, thought that Mozart died from mycotoxin poisoning. Drake, a neurosurgeon, proposed a diagnosis of subdural haematoma after a skull fracture identified on a cranium that is not Mozart’s. Ehrlich, a rheumatologist, believed he died from Behçet’s syndrome. Langegger, a psychiatrist, contended that he died from a psychosomatic condition. Little, a transplant surgeon, thought he could have saved Mozart by a liver transplant. Brown, a cardiologist, claimed he succumbed to endocarditis. On the basis of a translation error of Jahn’s biography of Mozart, Rappoport, a pathologist, thought Mozart died of cerebral haemorrhage. Ludewig, a pharmacologist, suggested poisoning or self poisoning by drinking wine adulterated with lead compounds. For some, Mozart manifested cachexia or hyperthyroidism, but for others it was obesity or hypothyroidism. Ludendorff, a psychiatrist, and her apostles, claimed in 1936 that Mozart had been murdered by the Jews, the Freemasons, or the Jesuits, and assassination is not excluded by musicologists like Autexier, Carr, and Taboga.

Deutsch, a Mozart musicologist, listed some methodological concerns such as mixing fact and fiction, and the spreading of errors to produce a saleable story. The diagnostic criteria may themselves be adapted to the hypothesis.

In clinical medicine, we try to reach a diagnosis on which every reasonable and informed doctor agrees. But in historical medicine all the facts are in, so that alternative hypotheses cannot be eliminated through further investigation. Some diagnoses, such as rheumatic fever, have been carefully considered. Many others, such as heart or kidney failure, have been aired without proper assessment. Yet others have been arrived at by rigging the evidence through “data torturing,” usually in good faith. The probability of a diagnostic hypothesis decreases as the number of alternative possibilities increases. Preference should be given to the most common ones; the rarer a disease the stronger the evidence needed for its support.

Finally, preference should be given to contemporary rather than retrospective sources and to observational rather than inferential ones. Henoch-Schönlein purpura has been one of the most successful among the groundless hypotheses: myths and legends as well as startling diagnoses have a strong selective advantage over mundane hypotheses in the competition for successful circulation.

The upshot is that the whole exercise becomes vacuous. One author gave us a key to this situation: “Shapiro proposed that Mozart’s fatal illness was due to streptococcal septicaemia complicated by acute renal failure. Bär argued in favour of rheumatic fever. Franken diagnosed a toxic carditis and heart failure following staphylococcal, streptococcal or meningococcal sepsis, or toxic scarlet fever. We have argued in favour of Henoch-Schönlein syndrome.”7 This brings to mind a horse race where gamblers bet on their cherished horse although they know that no horse will win because the race will not be run. Lange-Eichbaum complained early in 1930 that too often pathography becomes a “historical game, a literary feuilleton, or a medical entertainment.” The motto of Mozart’s biography written by Nissen (Constanze Mozart’s second husband) was: de mortuis nil, nisi vere.8

What clearly emerges is that Mozart’s medical historiography is made out of various alternatives, with a general time trend as tenable diagnostic hypotheses are progressively exhausted: the more recent they are the less probable. The most likely diagnoses—such as influenza, typhoid fever, and typhus—were proposed first, and only rare and irrelevant conditions such as Goodpasture’s syndrome, Wegener’s granulomatosis, Still’s disease, or Henoch-Schönlein syndrome were left for those who came later⇓.

Mozart’s requiem, whose composition was interrupted by the composer’s death

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Even in the absence of new evidence, there is still some future in the business for those who want to attach their name to some new speculative hypothesis. It will always be possible to suggest a new diagnosis, so that a complete tabulation, although denumerable, could be theoretically infinite. Mozart’s death has become a free for all, a grabbing of hypotheses.9

Even so, Nissen held that Mozart’s health was “always delicate like all men of weak constitution.” Ever since, the legend that Mozart was delicate and in poor health has been the accepted view. The contrary view is that Mozart had a strong constitution: he did not have an unusual number of childhood illnesses and he recovered safely from the life threatening ones; neither did he show evidence of any serious chronic disease.10

Most of the 27 psychiatric disorders attributed to Mozart result from disregarding or misquoting the criteria that demarcate normal from abnormal behaviour.11 Some authors upgrade daily worries into paranoid ideas or anxiety neuroses; blues or genuine worries into depression; elation into hypomania; linguistic games into jargonophasia; wit into immature or manic behaviour or into a childish, psychotic other self12; the dissonant harmonies of the Haydn quartets into Tourette’s syndrome13; and, at the end of his life, a small shuddering into a convulsion.

Thus, highly selective readings of the sources, blatant misquotations, and perversions of the diagnostic criteria have led to shoddy medical interpretations. Mozart allegedly had thought disorder, delusions, musical dysfluency, and epileptic fits, plus he did not actually compose music but merely displayed musical hallucinations.14 He was a manic depressive,15 a pathological gambler, and had an array of psychiatric conditions such as Capgras’ syndrome, attention deficit/hyperactive disorder, paranoid disorder, obsessional disorder, dependent personality disorder, and passive-aggressive disorder. This has resulted in psychiatric narratives that blend an uninterrupted long tradition of defamation—the film Amadeus was one of the last public expressions of this tradition.

With psychoanalytical stereotypes, the shadows keep lengthening. Being an artist, Mozart was not far removed from being a “psychoneurotic.” Mozart’s music is characterised by its “feminity or lack of sexual provocativeness”7 and its “feminine polarity.”16 Some have learnedly made analogies between Mozart’s musical ornamentation and urinary dribbling,17 between musical creativity and farting,18 between writing music and vomiting,19 or between musical expression and defecation.20 So the final account leaves us with those 19th century speculations that Mozart, like most geniuses, was mentally and physically degenerate: didn’t he show signs of atavism,21 22 such as reptilian23 or cercopithecoid ears?24 For all that, psychobiographers often indulge in the illusion of uncovering Mozart’s hidden mental life while they actually described their own preoccupations and obsessions.

Eliot Slater, a Maudsley hospital psychiatrist, observed about Mozart that critics of today “are fascinated so much by the breaking of conventional restrictions, by the chaotic and disorderly, by the neurotic and the deviant, even by phenomena which are directly evil, that they can find little interest or merit in the products of an energetic and healthy normality.” Did not Mozart himself write: “Talk much—and talk badly, but this last will follow of itself: all eyes and ears will be directed at you.”

Slater added, “If, however, we find [the composer’s] personality strange or difficult to understand, then we may only be able to bear comparison by trying to cut down the man or his work to our own scale. We can do this more easily if, at any point, we are able to look down on him from above, from a superior level of sanity, or social competence or moral integrity.”25

This phenomenon is Mozart’s medical nemesis. It covers the hidden intent to pull an exceptional creator down from his pedestal through some obscure need to cut great artists down to size. It is reminiscent of Rameau’s nephew in Diderot’s novel who says about people of exceptional creativity: “I never heard any single one of them praised without it making me secretly furious. I am full of envy. When I hear some degrading feature about their private life, I listen with pleasure. This brings me closer to them. It makes me bear my mediocrity more easily.”

If there ever was a musician in the whole history of music who was mentally healthy it was beyond the shadow of a doubt Mozart, in the probable company of Joseph Haydn.26