A physician’s task is not only to prescribe remedies but also, first and foremost, to identify the sickness, and consequently his first task is to ascertain whether the supposedly sick person is actually sick or whether the supposedly healthy person is perhaps actually sick. Such is also the relation of the physician of the soul to despair. [XI 138] He knows what despair is; he recognizes it and therefore is satisfied neither with a person’s declaration that he is not in despair nor with his declaration that he is. It must be pointed out that in a certain sense it is not even always the case that those who say they despair are in despair. Despair can be affected, and as a qualification of the spirit it may also be mistaken for and confused with all sorts of transitory states, such as dejection, inner conflict, which pass without developing into despair. But the physician of the soul properly regards these also as forms of despair; he sees very well that they are affectation. Yet this very affectation is despair: he sees very well that this dejection etc. are not of great significance, but precisely this—that it has and acquires no great significance—is despair.

The common view also overlooks that despair is dialectically different from what is usually termed a sickness, because it is a sickness of the spirit. Properly understood, this dialectic again brings thousands under the definition of despair. If at a given time a physician has made sure that someone is well, and that person later becomes ill, then the physician may legitimately say that this person at one time was healthy but now is sick. Not so with despair. As soon as despair becomes apparent, it is manifest that the individual was in despair. Hence, at no moment is it possible to decide anything about a person who has not been saved by having been in despair, for whenever that which triggers his despair occurs, it is immediately apparent that he has been in despair his whole life. On the other hand, when someone gets a fever, it can by no means be said that it is now apparent that he has had a fever all his life. Despair is a qualification of the spirit, is related to the eternal, and thus has something of the eternal in its dialectic.

Despair is not only dialectically different from a sickness, but all its symptoms are also dialectical, and therefore the superficial view is very easily deceived in determining whether or not despair is present. Not to be in despair can in fact signify precisely to be in despair, and it can signify having been rescued from being in despair. A sense of security and tranquillity can signify being in despair; precisely this sense of security and tranquillity can be the despair, and yet it can signify having conquered despair and having won peace. Not being in despair is not similar to not being sick, for not being sick cannot be the same as being sick, whereas not being in despair can be the very same as being in despair. It is not with despair as with a sickness, where feeling indisposed is the sickness. By no means. Here again the indisposition is dialectical. [XI 139] Never to have sensed this indisposition is precisely to be in despair.

This means and has its basis in the fact that the condition of man, regarded as spirit (and if there is to be any question of despair, man must be regarded as defined by spirit), is always critical. We speak of a crisis in relation to sickness but not in relation to health. Why not? Because physical health is an immediate qualification that first becomes dialectical in the condition of sickness, in which the question of a crisis arises. Spiritually, or when man is regarded as spirit, both health and sickness are critical; there is no immediate health of the spirit.

As soon as man ceases to be regarded as defined by spirit (and in that case there can be no mention of despair, either) but only as psychical-physical synthesis, health is an immediate qualification, and mental or physical sickness is the only dialectical qualification.23 But to be unaware of being defined as spirit is precisely what despair is. Even that which, humanly speaking, is utterly beautiful and lovable—a womanly youthfulness that is perfect peace and harmony and joy—is nevertheless despair. To be sure, it is happiness, but happiness is not a qualification of spirit, and deep, deep within the most secret hiding place of happiness there dwells also anxiety, which is despair; it very much wishes to be allowed to remain there, because for despair the most cherished and desirable place to live is in the heart of happiness. Despite its illusory security and tranquillity, all immediacy is anxiety and thus, quite consistently, is most anxious about nothing. The most gruesome description of something most terrible does not make immediacy as anxious as a subtle, almost carelessly, and yet deliberately and calculatingly dropped allusion to some indefinite something—in fact, immediacy is made most anxious by a subtle implication that it knows very well what is being talked about. Immediacy probably does not know it, but reflection never snares so unfailingly as when it fashions its snare out of nothing, and reflection is never so much itself as when it is—nothing.