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This article represents a personal discussion about Nietzsche's mental illness, which formed part of a larger paper 'The masks of Nietzsche and eternal return of the repressed'. This was presented at the 6th Annual Conference of The Friedrich Nietzsche Society, September 1996, Manchester UK, as reported by Nussbaumer-Benz (1998).

Globus hystericus has been often classified as a conversion disorder. More than half of the sufferers are overtly depressed and only a handful have hysterical personality. It is argued that it might be more appropriately viewed as a psychophysiological symptom of depression that responds to antidepressant treatment.

Objective: An association of "globus hystericus" with depressive illness has already been established. Successful treatment with antidepressants has been previously reported but this is the first report of globus symptom responding to electroconvulsive therapy (ECT) followed by long-term remission on maintenance dose with tricyclic antidepressant., Method: A detailed retrospective study of an elderly patient's General Practice medical notes revealed 45-year history of recurrent globus symptom, interspersed with other somatic complaints. Patient's frequency of consultations with her family physician was noted before treatment and during the 5-year follow-up period. Using DSM-III diagnostic categories, the patient was diagnosed as suffering from major depressive disorder with globus symptom. The notes were insufficient to ascertain whether past episodes of globus occurred in a setting of depressive disorder., Results: A prompt response of globus symptom to ECT was observed with 5-year symptom-free follow-up period as long as the patient remained on a maintenance dose of antidepressant. A marked reduction in frequency of medical consultations for other somatic complaints was noted., Conclusions: The case illustrates a strong association of globus symptom with depressive disorder and other somatic concerns. Patients with recurrent globus symptom and family history of depressive illness should be screened for a possibility of depressive disorder. ECT and antidepressants may be successfully used in treatment of globus in a setting of depressive illness. Long-term maintenance with antidepressive medication may keep at least some of these patients symptom-free. It is suggested that globus hystericus could be more appropriately viewed as a somatic symptom of depression rather than a conversion disorder.