Dark Visions

Francisco de Goya, the greatest Spanish Romantic painter, lived a long and, at times, deeply troubled life. Goya (1746-1828) had a fruitful career, working for a number of influential patrons and serving as court artist for the Spanish royal family. A skilled portraitist, he was equally adept at designing prints and even tapestries. A number of his paintings served as a form of political commentary, such as his famous Third of May, 1808, in which Goya depicts the ruthless massacre of helpless Spanish peasants by French soldiers. Many of Goya’s works are quite dark, even disturbing. A painting from late in his career depicts the gruesome scene from classical mythology of Saturn bloodily devouring one of his own children. A series of etchings from the late 1790s, known as Los Caprichos, portray distressing images of nightmares and monsters. Goya’s physical and mental health likely had a great impact on the art he produced. He suffered from a number of ailments, including an illness in 1793 which left him deaf. Many have attempted to diagnosis Goya’s mystery illness which resulted in deafness, with suggestions including viral encephalitis, syphilis, a series of small strokes, dementia, traumatic brain injury, or even lead poisoning. Prof. Smith and his colleagues in the Department of Neurology at the University Hospital of Wales carefully studied Goya’s symptoms, and believe he likely had either Cogan’s syndrome or Susac’s syndrome, whereas Drs. Ravin and Ravin in Ohio have diagnosed the artist with an infectious disease, such as meningitis, encephalitis, or malaria. Late in life he suffered from a stroke, which left him paralyzed on the right side, and his eyesight began to fail. This painting, executed in 1820 (before his stroke), is a self-portrait of the artist with his doctor, Eugenio García Arrieta. In 1819, Goya suffered from another illness, the cause of which is unknown, and was treated by Dr. Arrieta. The inscription at the bottom states that the artist created the painting for the doctor in gratitude for Arrieta saving his life. "Goya gives thanks for his friend, Arrieta, for the expert care with which he saved his life from an acute and dangerous infection which he suffered at the close of the year 1819 when he was 73 years old." Stylistically, the painting is similar to many of Goya’s later works, with a darker palette, more somber tone, and bold brushstrokes. Goya is considered a Romantic artist, a movement present throughout Europe, in various forms (fine art, literature, music), during the first half of the nineteenth century. The style is characterized by great emotional drama, whether that be anger, despair, melancholy, or love. Though some of his earlier works, particularly those for the Spanish royal family, are in the more frivolous Rococo style, after his debilitating illness of 1793 Goya’s paintings took on a much darker tone. Stylistically, this painting is similar to other works by the artist from the same time, but the mood is more uplifting: here, we do not see death and misery, but a man being cured of his suffering.   We cannot know for sure from what he was suffering but it is clear that headache was part of the illness. The great majority of headaches are benign but almost everyone with headache has, at some point, wondered whether they have a brain tumor. Fortunately, of all of the headaches that occur only a tiny fraction are due to brain tumors. Almost all headaches are “primary” rather than “secondary.” Secondary headaches are ones that are caused by something else—tumors, meningitis, arterial tears, increased pressure, and so on. The primary headaches (in decreasing order of frequency) include tension-type headache (affecting about two-thirds of the whole population each year), migraine, chronic daily headache, and cluster headache (less than one-tenth of one percent of the population each year). It should be reassuring to most, if not also surprising, but the brain itself does not hurt. For most of the primary headache disorders, there are no tests that can make the diagnosis—all blood tests, scans, EEGs, etc. would be normal. The diagnosis is made with a careful headache history and a detailed neurological examination. The headache history should include the location of the pain (one side, both sides), the nature of the pain (burning, throbbing, dull), symptoms before the pain (flashing lights, tingling), factors that worsen the pain (lights, sounds, smells, coughing, movement, position), factors that improve the pain (position, medications, exercise), symptoms that come with the pain (nausea, vomiting, double vision), triggers for a headache (sleep deprivation, fasting, stress), time of day that headache occurs, pace of onset (sudden, gradual), duration of pain (moments, seconds, hours, days), intensity (0-10 on a pain scale), impact of headache (missing work or school), when they started (childhood, adult), frequency (once a day/week/month/year), and responsiveness to treatment. The neurological examination is aimed at confirming that there is not likely to be a secondary headache due to infection (fever), mass lesion in the brain (weakness on one side), or vascular problems (noises to hear with a stethoscope). The treatment of most primary headaches works along three routes: behavioral, abortive, and prophylaxis. Behavioral treatment aims to identify those things that trigger the headaches and then remove them. Poor sleep, skipping meals, not wearing eye glasses, or erratic caffeine intake are common. Abortive medications are those to take to stop a headache when it comes. These can be simple over the counter drugs (like acetaminophen, aspirin, ibuprofen, naproxen, Excedrin), or prescription medications. Sometimes anti-nausea medications can be helpful too. Prophylactic (preventative) medications are those that are taken every day whether there is a headache or not. These are useful for people who have headaches that are severe, frequent, disruptive, resistant to abortive therapy, and for people who do not mind taking an extra pill every day.

references:

Ravin, James G. and Tracy B. Ravin.  “What Ailed Goya?”  History of Ophthalmology Vol. 44, No. 2 (Sept.-Oct. 1999):  163-170.

Mathiasen, Helle.  “Empathic Art:  Goya and Dr. Arrieta.”  The American Journal of Medicine Vol. 121, No. 4 (April 2008):  355-356.

Smith, Phil E. M., et al.  “Goya’s deafness.”  Practical Neurology Vol. 8 (2008):  370-377.