2018/09/19 by Emilio Fernández-Egea · 1 citation
Arts and Humanities · Medicine · Psychology · #Mental Health and Psychiatry #Schizophrenia research and treatment #Historical Psychiatry and Medical Practices #Schizophrenia (object-oriented programming) #Psychology #Psychiatry #Medicine
paper · pdf · doi:10.1093/brain/awy262
openalex publication_date 2018/09/19 · openalex created_date 2025/10/10 · openalex updated_date 2026/08/04
A footpath in the Square de la Tour Saint-Jacques in Paris is named for the dancer Vaslav Nijinsky (1889–1950). It was in the nearby Théâtre du Châtelet that the ‘God of Dance’ astounded audiences and scandalized critics with his pioneering choreography. However, it would not last—in March 1919, Nijinsky was diagnosed with schizophrenia, and the world lost the art of its greatest dancer. His case captured the interest of clinicians and the general public during the first half of the 20th century. An acquaintance with royalty, politicians and leading artists, he became a case for some of the most renowned psychiatrists of the day, including Bleuler, Binswanger, Wagner-Jauregg, Jung, Adler and Sakel. However, this is not merely a case of historical interest. Schizophrenia is a neurodevelopmental disorder in which premorbid motor and intellectual abnormalities are present before the onset of psychosis, which generally occurs in late adolescence; but Nijinsky was aged 30 at the time of his diagnosis and had arguably the most finely tuned motor skills in history. Here, his case is revisited, and discussed through the prism of novel pathophysiological mechanisms. Born in Ukraine in 1889 (or 1890), Vaslav was a child prodigy. His parents, of Polish origin, were talented ballet dancers touring in Russia, and they introduced Vaslav to the stage at an early age. The family was not without misfortune; his older brother Stanislaw (1887–1917) suffered a severe brain injury at young age after falling from a window and spent most of his life in asylums. His younger sister Bronislava (1891–1972) followed in his steps to become a famous ballerina also. However, there are no reports that Vaslav’s birth was problematic, and he was described as a hyperkinetic boy, full of energy. In 1900, he entered the Imperial Russian Ballet School in St Petersburg, arguably the greatest school of dance. (Nureyev and Baryshnikov, who later dominated the world dance scene, also trained there.) His school years are described in The Tragedy of Nijinsky (1937) written by his classmate Anatole Bourman (1888–1962). From the day he joined the school his teachers recognized his sensational talent: ‘His body is perfect. The most symmetrical human I have ever seen’. However, he was also an instant target for all the other children. As a member of a poor family amid the aristocratic elite, with a strong Polish accent, unsophisticated manners, a timid character and an academic boldness, these were not easy days for him. As Bourman puts it, ‘he was made to feel inferior at every turn; he was ignored in our games, and utterly despised. He was someone to be ordered about, to be sneered at and scorned. Whether or not he deserved criticism, Nijinsky found it’. This bullying masterclass lasted 8 years and included a somewhat unexplained accident on the stage in which Nijinsky allegedly lost consciousness for a week. But he endured, perfecting his dance leap during extensive hours of rehearsing. As Bourman wrote, ‘Nijinsky seems to linger two or three seconds in the air before coming down, suspended in the air’. Before the age of 18, he performed a pas de deux with Anna Pavlova (1881–1931), the greatest ballerina at the Mariinsky Theatre in St Petersburg. He became a rising star and began giving lucrative private lessons to aristocrats in order to top up his modest income and to support his mother. A wealthy aristocrat, Prince Lvov, became his benefactor and probably his first partner, but he soon grew tired of Nijinsky and ‘passed him on’ to other lovers. It was at this time that Sergei Diaghilev (1872–1929), a dance impresario who was gaining success in Europe, entered his life as both a lover and as a key figure in his artistic career. Les Ballets Russes was the iconic dance company of the age. With Nijinsky, prima ballerina Tamara Karsavina (1885–1978), Michael Fokine’s choreography and Stravinsky’s music, the company exhilarated Europe. Between 1909 and 1913, Petrushka, Les Sylphides, Scheherazade and Le Spectre de la Rose became instant ballet classics (Fig. 1). In his book Memoirs of a Ballet Master (1961), Fokine (1880–1942) describes Nijinsky’s enthusiasm and how ‘he grasped everything quickly and exactly, understanding thoroughly the purpose of each detail’. His performances were so exceptional that Nijinsky was soon named ‘The God of Dance’. He was known not only for his technical perfection, but also his sense of theatrical drama through which he embodied the delicate emotions of his roles. Nijinsky at his peak as a ballet dancer during the period 1909–12. On the left as Petrushka and on the right in Les Orientales. Left: © Victoria and Albert Museum, London; Given by Jean Hugo. Right: Eugène Druet [Public domain], via Wikimedia Commons. Nijinsky’s debut as a choreographer, with L’après-midi d’un faune (Fig. 2), opened modern dance to a wider audience. It was on 29 May 1912, at the Théâtre du Châtelet in Paris, that this first ‘dissonant’ ballet was premiered, uncoupling music and movement, with ungracious and angular postures replacing classical dance positions. (Debussy’s original scores, complete with the notation for the dance movements, are on permanent display as part of the Sir John Ritblat Treasures at the British Library; it was these that first triggered my interest in Nijinsky’s case.) The controversy following the premiere of L’après-midi d’un faune was extraordinary. The editor of Le Figaro, Gaston Calmette, dismissed a favourable critic to make his own front page comment, describing his outrage at Nijinsky’s ‘faux pas’; however, by contrast Auguste Rodin saluted the renovation of dance. A detailed musical analysis by musicologist Dr Davinia Caddy (The Ballets Russes and Beyond, 2012) mirrors this ballet with other artistic dissonant movements of the time, such as cubism. The ‘flat’ positions of Nijinsky’s choreography mimic the two-dimensional ancient Egyptian and Greek art that he saw in the Louvre. Nijinsky in his first choreography, L’apres-midi d’un faune, in 1912. Image shows Nijinsky dressed as the faun, in one of the ballet’s unorthodox dance positions. Credit: By Adolf de Meyer (1868–1946) (Unknown) [Public domain], via Wikimedia Commons. There is some evidence to suggest that Nijinsky’s partnership with Prince Lvov and Sergei Diaghilev were less driven by love than by a tacit agreement for mutual interest. In Paris, Nijinsky frequently escaped Diaghilev’s supervision and spent time with female prostitutes. The Copernican turn occurred in late 1913. At the end of a 3-week voyage to Brazil for a tour with the Ballets Russes (during which Diaghilev remained in Europe), Nijinsky became engaged to the Hungarian aristocrat Romola de Pulszky (1891–1978). They married in Buenos Aires and the news was cabled to the company’s director. Upon his return to Paris, Nijinsky was fired and Diaghilev found a new protégé in Leonid Massine (1896–1979). For the first time, Nijinsky was in charge of his own destiny. However, he had never been interested in management, always delegating non-artistic, day-to-day affairs to others—he had never even had a contract. Suddenly, he found himself newly married, with no income and no job prospects. An attempt as a dance impresario in London was a financial disaster and led him to a nervous breakdown. In 1914, he and his pregnant wife travelled to Budapest where ‘neurasthenia with depressive state’ was later diagnosed. The outbreak of World War I found them on the wrong side as a Russian, and Nijinsky spent 18 months under house arrest. It took interventions from Pope Benedict XV, Emperor Franz-Joseph I of Austria, King Alfonso XIII of Spain and the US ambassador in Vienna to get him a safe passage home (with the condition that he rejoined the Ballets Russes)—this list illustrates the celebrity he had gained during his golden years. Nijinsky was given control of the company during a long tour of the USA and Canada, while Diaghilev retreated to Europe. The total managerial chaos of this tour resulted in a financial loss of 250 000; however, artistically it was a greatly acclaimed success. President Wilson congratulated him personally and he met Charlie Chaplin, who was greatly impressed by him, but noted his sadness. While the war continued, the company visited neutral Spain. It was the first time that Nijinsky had travelled with both his wife and Diaghilev, and conflicts, over finances but also due to jealousy, were permanent. At the paroxysm in Barcelona, Nijinsky refused to dance, but was detained at the train station by the police, who forcibly returned him to the Gran Teatre del Liceo. June 1917 saw Nijinsky’s last professional performance in Europe, before he sailed to South America. Barcelona was also the last appearance of ballerina Olga Khokhlova before she married Picasso, who at the time was designing costumes for the company. Bourman, his former classmate who was now also at the company, wrote about the onset of Nijinsky’s psychosis in Argentina: ‘I realised that some terrific change had taken place in his innermost being…before answering the simplest question, he would pause for a long moment, searching me with distrustful look’. Bourman goes on to describe how ‘the delusion of persecution showed itself repeatedly during our four weeks at Buenos Aires. It became habitual for Vaslav to hunt me out, and after glancing about fearfully, half whisper, “They will kill me here! Watch and you will see that this time, at least, I am speaking the truth. I know I am going to die. They will kill me!”. No particular person or persons seemed to be suspected and the “They” remained a mystery’. During the last days there ‘his answers were eccentric. He was planning a series of original interpretations, but they were dances that I, who knew dancing, recognized as physical impossibilities. Vaslav, my friend, seemed mad’. Highlighting the paranoia, another source (L. Moore, Nijinsky, 2013), indicates that Nijinsky and Romola felt so threatened that a bodyguard was hired. Nijinsky’s time with the company was over. With Europe still at war and the Russian revolution and civil war impeding his return home, Nijinsky, his wife and their first daughter Kyra (1913–98) moved to St Moritz in Switzerland at the end of 1917. Isolated, unable to dance and mentally fragile, the bubble of Nijinsky’s world, where he had always lived, burst. Clearly there are limitations to the retrospective diagnosis of mental disorders, and historical cases are subject to heated debate (Jaspers, 1922). However, Nijinsky is different. From January to March 1919, he captured his thoughts and experiences in four diaries, which became a classic self-portrait of the symptoms of schizophrenia. A heavily edited version was published by Romola (The Diary of Vaslav Nijinsky, 1936) to raise funds for his care, but unexpurgated full editions became available a few years after her death. The English translation edited by Joan Acocella (1995) and the French translation edited by Christian Dumais-Lvowski (Nijinsky Cahiers, 1995) are the best known. The diaries are written using basic grammar and vocabulary, as he struggled with verbal communication in any language. The sentences are short, simplistic, repetitive and frequently contradictory (p.24; ‘The ape is descend from an ape, and that ape from God. God is descended from God, and God from God’), and classic clanging and phonetic associations typical of thought disorder are seen. Poems are rich in perseveration and incoherence, with the frequent iteration of meaningless phonemes (p. 292. ‘Je me tu quante tu te tu/ Je me tu quante tu te tu/ tu te tu te tu te tu / tu tu tu tu tu tu’). Delusions of influence (p.41 ‘I write without thinking. I scratched my nose, thinking something was tickling me, but I realised that God did this on purpose so that I would correct my notebook. God writes all this for me and men’s’) and grandiose delusions with omnipotence are frequently described (p. 184. ‘I understand people without words. I see their actions and understand everything. I understand everything. I can do everything. I am peasant. I am a factory worker. I am servant. I am a gentleman. I am an aristocrat. I am a tsar. I am an Emperor. I am God. I am God. I am everything. I am life. I am eternity. I will be always and everywhere’) as well as auditory hallucinations (p.14; ‘God said to me, ‘Go home and tell your wife that you are mad’). Nevertheless, amid the psychotic symptoms, the diaries also contain his memories (for an update on the phenomenology of schizophrenic delusions, see McKenna, Delusions, Understanding the un-understandable, 2017). Particularly revealing are those concerning Diaghilev. Nijinsky describes their first meeting (p.104) in crude terms: ‘I hated him, but I went in search of luck. I found luck there because I immediately made love to him. I trembled like an aspen leaf. I hated him, but I put up a pretence, for I knew that my mother and I would starve to death. I realised one had to live, and therefore it did not matter to me what sacrifice I made’. In modern terms, a traumatic sexual experience. The excellent biography Nijinsky a leap into madness by professor of psychiatry Peter Ostwald (1991) contains a detailed psychopathological analysis. Dr Fränkel was the St Moritz doctor and also Prof. Eugen Bleuler’s former student, who he approached asking for his assistance. Nijinsky was seen by Bleuler on the 6 March 1919 at the Burghölzli, a large state psychiatric asylum near Zurich. His report concluded: ‘Intelligence evidently very good in the past, now he is a confused schizophrenic with mild manic but did not his he his days following an of Bleuler is a key figure in the of He the in or the of replacing the In the had three and into the of were the and in contrast to psychosis in which the However, the of was not by all most by It is in this that the was first to a of of with not a but pathophysiological mechanisms. all psychiatrists still the four that Bleuler’s and as well as the delusions and the was seen as not which his with days of care, Nijinsky was to the in with the diagnosis of This was by who trained with and Bleuler and was a of is also known as a in The in In this was Nijinsky’s was a professor of psychiatry in and The was a with a where and were the and no physical or were only showed a of in and were for Nijinsky was to be with a During his first months are including and the of including at his Nijinsky was to her Upon his months Nijinsky’s state had He suffered with hallucinations and delusions, but with motor symptoms, or with of and and poor as well as and In March Nijinsky was to the in by who was later the for the of general of with of Nijinsky’s (or were but indicates that novel were or his Whether was or not is but Nijinsky was not one of his Vienna also Nijinsky’s first with his sister and but it did not have the in a state at the time, he did not even emotions were and Nijinsky did not Tamara his was His daughter years of in Budapest with her The years were spent in and of psychiatric during and At this time Nijinsky was under the of his wife moved to the USA to her in and his He was in Paris from to and some during the have His communication was he with and and unable to after In Paris, there is a he have been with an on the that was with the of The following years at with followed by of and his own to Adler and of visited him in he also with the diagnosis of schizophrenia, and was later to write the for the first of Nijinsky’s however, Romola did not like his of and it was only to be and published in By this time, Romola had returned and had for to the with which Nijinsky was the novel was that of the of the a that gained before the Nijinsky from first at the and in near He seems to have a of the state (Fig. soon after to the motor state and Nijinsky and Romola were in Switzerland at the of World War but to to Budapest in to During Nijinsky with in However, by as someone with schizophrenia, he was at of a of the and moved to a In May were given to all psychiatric and Nijinsky had to in nearby Nijinsky during his his first ballet movements in after Credit: A change occurred after the took over Russian who recognized him, Nijinsky a for the first time in he was and and at one was even seen to and with This was but Nijinsky became less during his years. the he and Romola first moved to Austria, where was and to London in It seems he never saw a or during his time in the He on 8 due to with in St in his are now at in Nijinsky’s diagnosis seems as all the clinicians who visited him with the the of his he all symptoms for schizophrenia. Nijinsky suffered with delusions and auditory hallucinations and thought but also with motor symptoms and a end Prof. Ostwald the a because of the of symptoms and with In my the to with no period in 30 schizophrenia. motor symptoms are a they still be as a of and 2017). is Nijinsky’s case into the the the of from a brain to a A was the of as a neurodevelopmental disorder and on a and that early brain No brain abnormalities are but in and in communication are physical and motor abnormalities are the long before the onset of psychosis time, other life have been most and a into an and Nevertheless, it is still how early are in other psychotic disorders, such as the However, how can the neurodevelopmental into Nijinsky’s It is to that the most tuned body in with movements, had motor that the had been his to the emotions of his or the he It is also that Nijinsky was not was to and had with but in my of his of mental of an is the of traumatic in Nijinsky’s He was heavily at and his early life was not As Diaghilev him him, him in a he went him to be with his and him evidence indicates that and physical is recognized as an for its is still to be Nijinsky’s be to these and life than to an brain For is in those who have with and with those who have severe traumatic have a but is that is a or even a like with pathophysiological a long in our from Bleuler to such as and in the neurodevelopmental to the to novel including the of traumatic experiences in Nijinsky’s case be a of the The of mental symptoms into their and Bleuler’s symptoms seems a in the understanding of this disorder and its years Nijinsky still be the to Dr for the and for me to Nijinsky at the British to Dr and and for and and to the for always my to Christian of the Vaslav and Romola Nijinsky for the and the No was this The reports no