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Tortured Artist

A piece of art depicting Van Gogh's masterpiece, part of the Neurology, Illustrated exhibition at Tufts Medical Center in Boston.Vincent van Gogh
The Garden of the Asylum at Saint-Rémy
May 1889
oil on canvas
91.5 x 72 cm
Kröller-Müller Museum
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Vincent van Gogh painted this work toward the end of his short life, after voluntarily admitting himself to an asylum following a breakdown that resulted in the artist cutting off his own ear. While at Saint-Rémy, the artist produced paintings of the asylum and surrounding landscape, including his famous Starry Night. It is clear from Vincent’s history and letters to his brother, Theo, that he suffered from a neurological disorder, though we cannot be certain of his specific condition(s). Epilepsy, schizophrenia, dementia, porphyria, bipolar disorder, and depression have all been proposed as possible diagnoses. One scholar suggested that van Gogh had xanthopsia, possibly stemming from an over-ingestion of foxglove to treat epilepsy, resulting in a yellow tint to his vision.

Vincent van Gogh is, perhaps, the quintessential tortured artist. Largely ignored by critics and patrons during his lifetime, it was not until after his death at the age of 37 that van Gogh became widely recognized. Van Gogh (1853-1890) spent much of his life in poverty, supported by his younger brother, Theo. In the many letters between the two brothers, Vincent writes about his art and his life in general, often commenting on his emotional state. Van Gogh clearly suffered from some sort of psychiatric of neurological disorder. Art historians and doctors have attempted to diagnosis Vincent, based on both his letters to Theo and his paintings themselves. Suggested possibilities include psychiatric illnesses, such as bipolar disorder or schizophrenia. The more neurological diagnoses include epilepsy, porphyria, syphilis, or even a brain tumor. In one letter, written to his sister, it is clear that Vincent believes he is suffering from epilepsy. Note his reference to alcohol and how it can interact with seizures in an unpredictable way:

"The doctor from here has been to Paris and went to see Theo, he told him that he does not consider me a lunatic but that the crises I have are of an epileptic nature. So it isn’t alcohol either that was the cause, although of course it doesn’t do one any good. But how difficult it is, how difficult it is to resume one’s ordinary life without being absolutely too demoralized by the certainty of unhappiness. And one clings on to the affections of the past."

The brain consists of brain cells, or neurons, that communicate with each other electrically. A seizure occurs when there is an abnormal or chaotic disturbance in this electrical function and epilepsy is a predisposition to recurrent seizures. Epilepsy has many causes. The most common cause is idiopathic which in Greek means “a disease known to itself,” and in English means there is no known cause. Other epilepsies are genetic, due to abnormal brain development, brain trauma, or anything else that results in injury, infection, infiltration, or inflammation in the brain. In adults, stroke and hemorrhages are frequent explanations. When regions of the brain are damaged, certain cell populations can become electrically excitable which results in a tendency to have recurrent, unprovoked seizures. Anyone can have a seizure under the right physiologic circumstances, but epilepsy refers to the condition where a patient will have unprovoked seizures from an underlying cause in the brain. The Institute of Medicine report indicates that the frequency of epilepsy in the general population is about 1 in 26 people. The Epilepsy Foundation of America says that about 200,000 patients each year will develop epilepsy. The most likely time to develop epilepsy is in childhood or late in life. There are several medications that can treat epilepsy well and that can significantly reduce the number of seizures that people have. They are generally well tolerated without side effects. Rarely do the medicines treat the underlying process. Generally, they just make neurons less excitable. When seizures are refractory, that is resistant to being suppressed with medication, then other treatments are tried including the ketogenic diet, vagal nerve stimulation, and sometimes, even, brain surgery.    

Self-Portrait with Bandaged Ear by Vincent van Gogh, a piece in the Neurology, Illustrated gallery at Tufts Medical Center in Boston, MA.Vincent’s early paintings are similar in style to the Impressionists, focusing on the lives of the everyday people in the poor village where he lived in the Netherlands. Over time, his work became much more expressive, using bold colors and pulsing brushstrokes, such as those found in his iconic painting Starry Night. In 1888, van Gogh moved to Arles in southern France, where he painted a number of works of the town and surrounding countryside. Van Gogh’s friend and fellow artist Paul Gauguin visited for a period, but the relationship became tumultuous, resulting in van Gogh cutting off his own ear. Van Gogh had previously suffered from delusions and hallucinations, though it is not sure what prompted his violent action towards his ear. After the incident, van Gogh checked himself into an asylum in Saint-Rémy, near Arles. This painting, along with Starry Night and many of the artist’s other iconic works, was painted while van Gogh was at the asylum. During his first month there, van Gogh was not permitted to leave the grounds, so he took the asylum and surrounding landscape as the subject for many of his paintings.

The Bedroom in Arles by Vincent van Gogh, a piece in the Neurology, Illustrated gallery at Tufts Medical Center in Boston, MA.In the same letter quoted above, Vincent describes, apologetically, his humble surroundings in Arles. Nevertheless, it led to the creation of one of his most famous paintings and one that he felt was amongst his best, The Bedroom in Arles.

"You’ll probably find the interior the ugliest, an empty bedroom with a wooden bed and two chairs – and yet I’ve painted it twice on a large scale. I wanted to arrive at an effect of simplicity as described in Felix Holt. In telling you this you’ll perhaps understand the painting quickly, but it’s likely that it will remain ridiculous for others, not forewarned. To make simplicity with bright colours isn’t easy though, and I find that it can be useful to show that one can be simple with something other than grey, white, black and brown. That is the raison d’être for that study."

Portrait of Dr. Gachet by Vincent van Gogh, a piece in the Neurology, Illustrated gallery at Tufts Medical Center in Boston, MA.Van Gogh may have suffered from episodes of xanthopsia, a temporary toxic effect of digitalis on the retina that causes one’s vision to have a dominance of yellow. Digitalis is an extract of the foxglove plant. It is still in use today for cardiac conditions but is useless for seizures, a condition for which in the past it was given as a treatment. Clearly both van Gogh and his doctor were aware of the plant: in van Gogh’s painting of Dr. Gachet, foxglove is unmistakable on the table in front of the yellow books. Was digitalis-toxicity related to van Gogh’s exuberant use of color, particularly yellow, in his later works?

references:

Correa, R.  “Vincent van Gogh:  A pathographic analysis.”  Medical Hypotheses Vol. 82 (2014):  141-144.

Gruener, Anna. “Vincent van Gogh’s yellow vision.” British Journal of General Practice (July 2013): 370-371.

Lee, Thomas Courtney.  “Van Gogh’s Vision:  Digitalis Intoxication?”  JAMA Vol. 245, No. 7 (February 20, 1981):  727-729.


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