Whilst we do not know the exact nature of Robert Schumann's psychiatric problems, we can be confident that he suffered very severe psychiatric disorder. We know that he continued to compose music during a period of psychosis and that those closest to him were painfully aware of this, destroying or withholding much of his late work. Although now over 150 years old, we have impressive contemporaneous documentation and intimate music that supports and breathes life into this story, bringing us to the nature and social understanding of 'madness.

We begin with a traditional biographical narrative, accompanied by some shorter pieces for the piano, such as Carnival, Op. 9, Nos 24 and 25, and sections of longer works, such as the Fantasy (Grand Sonata) in C, Op. 17, that help to support the story and show some aspects of Schumann's early musical style. The two pieces from Carnival, entitled Eusebius and Florestan, are used to illustrate different states of being that Schumann identified in himself, as the introspective Eusebius or more flamboyant Florestan. The Fantasy, Op. 17, illustrates Schumann's mental state within a period of enforced separation from the woman he loved and thought he was losing, but who in fact later became his wife, Clara. This latter piece, written in the key of C (possibly for Clara) contains quite conscious musical quotes of Beethoven's 'An die ferne Geliebte' (To the distant beloved). As Schumann later wrote to Clara, 'you can only understand the Fantasy if you imagine yourself in the unhappy summer of 1836, when I gave you up.6 For Schumann then, all three of these pieces were deeply personal accounts reflecting different psychological states.

We use piano music in the earlier part of this biography, partly to enhance comparison with music written during Schumann's evolving, severe psychosis of 1854. By that time, the occasional experience of hearing a single tone A, not heard by other people, had developed through intervals to fully orchestrated music that was initially 'more wonderful than ever one hears on earth', but later the cause of dreadful suffering associated with clear accounts of visual hallucinations, complex auditory hallucinations, evolving delusions and possible cognitive impairment.7 Within this state Schumann is documented as having said that either an angel, or the then-dead Franz Schubert, dictated a musical theme to him. This theme is in fact readily identifiable in the second movement of Schumann's violin concerto of1853 but apparently unaware he had used it before, perhaps experiencing it now as a complex auditory hallucination, he wrote out the simple E flat major theme with five variations, published as the Ghost Variations (WoO 24). Within hours of completing a first draft, Schumann made a violent attempt at suicide, only narrowly failing. Days later, he dedicated the final manuscript of this final piano work to Clara who had by that time left their home on the advice of a physician fearful of her safety.8 Within weeks Robert Schumann admitted himself voluntarily to Endenich asylum where he died just over two years later.

We listen to the E flat theme and variations in the context of this story and the earlier piano music. The theme is calm, perhaps resignedly melancholic and according to one student, 'much too calm for someone who was about to attempt suicide'. In fact, sudden calmness, following more agitated distress, often prefigures completed suicide in a way that can mislead both loved ones and professionals. The variations, composed during Schumann's psychosis, retain the introspective feeling of the theme without the expansive development seen in earlier work, such as Op. 17. They feel denser, less gentle, less clearly structured and more dissonant than the E flat theme. The first variation creates frequent dissonance through repeated minor seconds, with an intricate internal melody tightly caught between inner and outer phrasing that has the overall effect of blurring the clarity of the theme without greatly developing it. The third variation threatens to become more flamboyant but never fully develops. There is very little in this work that suggests a manic phase of bipolar disorder. Perhaps instead there is a disintegrated, melancholy awareness of what was beginning.

We then present a medical/psychiatric account of Schumann from the point of his admission to Endenich. This is a way of using the available phenomenology to arrive at potential medical formulations. It is also a way of comparing the perspectives of biographical and medical narratives. We discuss aspects of Schumann's family history, medical history and personality that may have made him vulnerable to psychiatric disorder and consider a wide range of main and subsidiary diagnoses, including organic illness (such as general paralysis of the insane), bipolar disorder and recurrent depressive disorder. The point of this is not to establish 'the truth' of Schumann's psychiatric disorder but instead to debate the possibilities.

We finally consider how this illness affected the perception of Schumann's late work. The Ghost Variations of 1854 and violin concerto of 1853 were both deliberately held back from publication until the late 1930s. Although the concerto is now considered an important part of the repertoire, Joseph Joachim for whom it was written, never played it in public. Other works from this time, including a set of romances for cello, appear to have been deliberately destroyed. Why was this immediate reaction so different to the current opinion of many violinists who see the concerto as an important work? What might have caused this reaction and how should we respond to work associated with mental illness? If there is a chance that the mental state evoked is not introspection, flamboyance or loss but instead psychosis, should we then keep this work away from others, perhaps even destroy it? Students have been able to see how intimate Schumann's music was to Clara and can understand the grief, fear and love involved in her reaction to her husband. They have been equally grateful for the chance to listen to his late music that may, with all its idiosyncrasies, tell us something important about a very human state.

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