Vincent van Gogh's health

Winter 1886/87 (F 295)
Oil on pasteboard, 41 x 32 cm
Rijksmuseum, Amsterdam

There is no consensus on Vincent van Gogh's health. His death in 1890 is generally accepted to have been a suicide. Many competing hypotheses have been advanced as to possible medical conditions from which he may have suffered. These include epilepsy, bipolar disorder, sunstroke, acute intermittent porphyria, lead poisoning, and Ménière's disease.

Symptoms and characteristics

Portrait of Doctor Félix Rey (F500, JH1659), oil on canvas 1889, Pushkin Museum.[1] Rey disliked his portrait and gave it away.[2]

Various symptoms are described in Van Gogh's letters and other documents such as the asylum register at Saint-Rémy. The symptoms include: poor digestion and a bad stomach, hallucinations, nightmares, stupor, absent mindedness, impotence, insomnia, and anxiety.

Van Gogh suffered from some sort of seizures or crises, and in one of these attacks, on December 23, 1888, he cut off a part, or possibly all, of his ear.[3][4] Following that attack, he was admitted to hospital in Arles, where his condition was diagnosed as "acute mania with generalised delirium".[5] Dr. Félix Rey, a young intern at the hospital, also suggested there might be "a kind of epilepsy" involved that he characterised as mental epilepsy.[6] These attacks became more frequent by 1890, the longest and severest lasting some 9 weeks from February to April 1890. Initial attacks of confusion and unconsciousness were followed by periods of stupor and incoherence during which he was generally unable to paint, draw, or even to write letters.[7][8]

One of the most frequent complaints in Van Gogh's letters is the problems he endured with his stomach and digestion.[9] Van Gogh suffered from hallucinations[10] and nightmares at times.[11] He often reported that he was suffering from fever.[12] At various times he reported bouts of insomnia. He was unable to sleep for three weeks prior to his diagnosis of gonorrhea in The Hague (sleeplessness and fever probably due to infectious disease).[13] On occasions he sunk into a kind of stupor.[14] Van Gogh reported his impotence to Theo, his brother, in the summer after he arrived in Arles,[15] and a month later when he wrote to Bernard it seemed to still be very much on his mind.[16] Van Gogh mentioned suicide several times in his letters towards the end of his life, nevertheless Naifeh and Smith note that van Gogh was fundamentally opposed to suicide.[17][18][19]

Behavior

Portrait of a clean shaven man wearing a furry winter hat and smoking a pipe; facing to the right with a bandaged right ear
Self-portrait, 1889, private collection. Mirror-image self portrait with bandaged ear
A table in a cafe with a bottle half filled with a clear liquid and a filled drinking glass of clear liquid
Still Life with Absinthe, 1887, Van Gogh Museum

Many analytics, such as American psychiatrist Dietrich Blumer, agree that one of the things Vincent van Gogh suffered from was bipolar disorder. This mental illness builds up on itself and will grow stronger if not treated.[20] Bipolar disorder is characterized by manic and depressive episodes; manic episodes feature reckless behavior, euphoria, and impulsiveness. Depressive episodes feature symptoms of depression, anger, indecisiveness, social withdrawal, and often recurring thoughts of death or suicide.[21] Many of these symptoms can be detected throughout his biography and explain many of his actions.

From a young age, van Gogh grew up with a strong connection to painting, religion, and a strong ambition towards the other gender. After having worked at his uncle’s art dealership in the Netherlands, he transferred to another dealership location in London, where he fell in love with his landlord’s daughter, Eugenie Loyer. After she refused his marriage proposal, he suffered his first mental breakdown, which caused him to change his entire life in order to devote it to God.[22] This setback at age 20 certainly marked a first step in to the downwards spiral representing his health, which would lead to his suicide in 1890. One author points out that “There was a family history of mental illness”,[23] and Van Gogh displayed symptoms of bipolar disorder, which is widely considered to be genetically inherited. Now an official devotee to the Church of Christ, van Gogh aspired to become a priest. His disarranged life style, however, caused him nothing but disrespect and rejection, such as the rejection from several theology schools throughout Europe around 1878. Reports of his reckless and indecisive yet impulsive behavior all point towards bipolar disorder. Things like pursuing the work of an art salesman only to tell the customers “not to buy this worthless art” can be very well explained by the disease. Notions of indecisiveness and identity problems can be seen in the next years. Van Gogh moved a lot due to sexual rejection in the next 10 years. He moved to Brussels in 1880 to become an artist. He moved to Den Haag because his cousin, Kate, rejected him. He moved to Paris in 1886 because his companion, Clasina Maria Hoornik, recommenced prostitution and alcohol addiction. Van Gogh found shelter in his brother Theo’s small apartment, showing up on his doorstep uninvited. In Paris, it seemed that painting leveled and calmed his emotions.[22]

Van Gogh indulged to an abnormal degree in various activities which undermined his health, such as constant smoking, drinking alcohol and coffee to excess, and eating very poorly, even fasting at times.[24] The natural consequence of all this was malnutrition. He was never without his pipe and smoked it even on his deathbed, and he admitted on several occasions that he smoked too much.[25] He also frequently drank alcohol to excess; in particular, he often drank absinthe.

There is some evidence that Van Gogh nibbled at his paints, and the eating of paints is possibly connected with his seizure around New Year 1890. In January 1890, after another one of Vincent's seizures, Theo wrote to him saying "if you know that it is dangerous for you to have colours near you, why don't you clear them away for a time, and make drawings?"[26] Theo's alarm is somewhat reduced after hearing from Vincent, and five days later he explained:

"In [Doctor Peyron's] first letter he gave me to understand that it was dangerous for you to go on painting, as the colours were poison to you, but he went a little too far, which might have been due to his having relied on unverified rumours, as he himself was ill at the time."[27]

Diagnoses

Epilepsy

Epilepsy has been a popular diagnosis. Van Gogh himself thought that he might have epilepsy[28] and his doctor Dr. Félix Rey at the Old Hospital in Arles made the same general diagnosis,[29] as did Dr Peyron at St Rémy[30] A diagnosis of temporal lobe epilepsy was originally put forward in 1928 by Leroy and Doiteau[31] and has received much support.[32] Arnold states that the pattern of van Gogh's seizures, their timing and duration, does not fit well with the complex partial seizures associated with temporal lobe epilepsy.[33] Furthermore, it seems that Vincent's condition was controlled by the administration of bromide, which is effective against grand mal seizures, as well as absinthe intoxication and porphyria, but not for temporal lobe epilepsy.[33]

Bipolar disorder

Perry in 1947 was the first to put together a serious case for a diagnosis of bipolar disorder, or "manic depression."[34] It fits with the well documented periods of intense activity interspersed with periods of exhaustion and depression.[35] It has been suggested that van Gogh was not just bipolar, but that the crises in his last two years were brought about by the additional effect of thujone poisoning from his consumption of absinthe.[36] Arnold has suggested the association between bipolar disorder and creativity is a popular one, and may be spurious in Van Gogh's case.[37]

Borderline personality disorder

Van Gogh is believed to have had borderline personality disorder; he "displayed symptoms best consistent with a borderline (personality) disorder: impulsivity, variable moods, self-destructive behaviour, fear of abandonment, an unbalanced self-image, authority conflicts and other complicated relationships."[38] The most thorough argument is made by psychiatrist Erwin van Meekeren in his book Starry Starry Night: Life and Psychiatric History of Vincent van Gogh. Van Meekeren proposes borderline personality disorder as the most likely explanation for Van Gogh's behavior. Dr. John G. Gunderson, an expert on borderline personality disorder, concurs that Van Gogh's "longings for love, his sudden mood changes (and most particularly his seemingly unpredictable and unwarranted rages), and his pattern of impulsive acts, including substance abuse, are all recognizable components of the borderline syndrome...whether Van Gogh was borderline or not, it is a useful prism through which to view his troubled life.[39]

Sunstroke

The possibility that van Gogh might have suffered some form of chronic sunstroke was advocated strongly by Roch Grey.[40] Vincent described the effects of the Arles sun in a letter: "Oh! that beautiful midsummer sun here. It beats down on one's head, and I haven't the slightest doubt that it makes one crazy. But as I was so to begin with, I only enjoy it."[41] A month earlier he had mentioned the effects of the sun in passing in a letter to Theo:

"Many thanks for your letter, which gave me great pleasure, arriving just exactly at the moment when I was still dazed with the sun and the strain of wrestling with a rather big canvas."[42]

A remark has been attributed to Dr Gachet describing a diagnosis of "turpentine poisoning and the effects of too intense sun on a Nordic brain,"[43] but attempts to confirm this attribution have failed.[44]

Ménière's disease

The hypothesis that Vincent may have suffered from Ménière's disease — a balance disorder of the inner ear which is accompanied by nausea, vomiting, hearing loss, and vertigo — was first published in 1979 by Yasuda.[45] This idea then reappeared in 1990 in the Journal of the American Medical Association (JAMA).[46] Arnold refutes the hypothesis, stating that there is no case for Ménière's, and that the logic of the JAMA article was flawed in that it put forward only epilepsy as an alternative diagnosis.[47] The Ménière's diagnosis relies on interpreting van Gogh's gastrointestinal problems as the nausea and vomiting associated with Ménière's. The JAMA article's suggestion that Vincent's cutting of his ear was an attempt at self-performed surgery to relieve the Ménière's symptom of tinnitus has been regarded as far-fetched.[47]

Lead poisoning

According to a doctoral thesis in 1991,[48] Van Gogh used in his impasto technique lead pigments in an abusive and careless way, and some months later he suffered the key symptoms of lead poisoning (anemia, stomatitis, abdominal pain, signs of radial neuropathy, etc.) and other characteristics of saturnine encephalopathy in Arles with states of delirium and probable epileptic crises, which were diagnosed in life.[49] Regardless of the premorbid personality of Vincent (impulsive and emotionally unstable), these crises with disturbance of consciousness or psychotic symptoms coincided with his prolific artistic activity, and never in the North; as the Dutch painter says in a letter (Letter 607) . Other painters exposed to toxic colors suffered lead poisoning.[50] However, this thesis could be confirmed only by a forensic examination of the bones of Van Gogh,[51] as Caravaggio's remains were. Recent chemical research on toxic lead pigments used recklessly by Van Gogh reinforces the diagnosis of saturnism.[52]

Acute intermittent porphyria

Arnold and Loftus put forward the diagnosis of Acute Intermittent Porphyria (often referred to as simply "AIP").[53] Arnold suggests the AIP was exacerbated by malnutrition and absinthe abuse.[54] He cites two case histories of men in their 30s who were demonstrated to have AIP and displayed some symptoms similar to those of Van Gogh, including depression and hallucinations in one case, and complex partial seizures in the other. However, Erickson and others refute this diagnosis arguing that the key symptom of urine discoloration was never noted, and that Van Gogh's "bad stomach" does not match the commonly experienced "excruciating abdominal pain" associated with AIP.[55][56] Erickson and Arnold disagree as to the support offered by the family history, and in particular regarding the status of Vincent's father's health: Arnold, basing his opinion on Tralbaut, believes Theodorus to have been in not-very-good health for most of his life, whereas Erickson chooses to see him as being essentially an active man until a relatively sudden death at age 63. Arnold suggests that Theodorus' quiet and balanced life meant that he avoided several factors that precipitated symptoms and progress of the disorder in his children.

In any case, the hereditary defect of this rare disease is not confirmed in Theo's descendants. However, lead poisoning can cause symptoms similar to the AIP with crisis also exacerbated by malnutrition or alcohol.[57]

Other diagnoses

It is speculated that Vincent and Theo had syphilis; indeed, Vincent was treated for gonorrhea in 1882.[37] But according to Theo's death certificate,[58] the cause of death was a "chronic kidney disease" for possible "kidney stones".[59] On the other hand, recognized psychiatric research rules out that Vincent had suffered a mental disorder by syphilis.[60] Moreover, assuming that both brothers had contracted syphilis in the brothels of Paris (March 1886-February 1888), it is impossible that they developed so quickly neurosyphilis mental disorder, which occurs 10 to 20 years after infection.[61] Dr. Cavenaille diagnosed the artist with "syphilis", according to his grandson,[62] but this diagnosis was not confirmed by the physicians caring for Vincent in the hospital (Dr. Urpar, Dr. Rey, and Dr. Peyron) or Dr. Gachet in Auvers. A complex disease, it has been speculated that it fits all his symptoms, in concert with absinthe intoxication.[63][64][65] But doctors who treated Vincent, and who were familiar with absinthe drinkers, did not diagnose Vincent as an "absintheur." Hulsker also denies Vincent's addiction to absinthe.[66] Additionally, recent research reveals that the thujone of liquor is safer than alcohol.[67]

It has been postulated that Van Gogh may have exhibited a form of digoxin toxicity from the foxglove plants used to treat his epilepsy. His yellow period ('yellow vision'), missing ear ('oto-toxicity') and penchant for painting halos around landscape objects ('halo vision') are often used by medical students as a mnemonic to remember the sequelae of digoxin toxicity.[68] Speculation has been further fueled by Van Gogh's portrait of his physician, Dr. Paul-Ferdinand Gachet (1890), in which Gachet holds Digitalis purpurea. But Van Gogh was not treated with digitalis, and Dr. Arnold dismisses the plant as a cause of Xantopsia (yellow halos).[69]

References

  1. ↑ Brooks, D. "Portrait of Doctor Félix Rey". The Vincent van Gogh Gallery, endorsed by Van Gogh Museum, Amsterdam. David Brooks (self-published). Retrieved 23 February 2011.
  2. ↑ Brooks, D. "Dr. Félix Rey, interviewed by Max Braumann (1928)". The Vincent van Gogh Gallery, endorsed by Van Gogh Museum, Amsterdam. David Brooks (self-published). Retrieved 23 February 2011.
  3. ↑ "It can be said that with the exception of the sister-in-law Johanna van Gogh-Bonger, who had family-related reasons for playing down the injury, not a single witness speaks of a severed earlobe. On the contrary, the mutually independent statements by the principal witness Paul Gauguin, the prostitute who was given the ear, the gendarme who was on duty in the red-light district, the investigating police officer and the local newspaper report, accord with the evidence that the artist’s unfortunate “self-mutilation” involves the entire (left) ear. The existing handwritten and clearly worded medical reports by three different physicians, all of whom observed and treated Vincent van Gogh over an extended period of time in Arles as well as in Saint-Rémy ought to provide ultimate proof of the fact that the artist was missing an entire ear and not just an earlobe." Quoted from Van Gogh's Ear by the art historian Rita Wildegans.
  4. ↑ letter to Paul Signac, underlining symptoms of depression 1889 Retrieved June 25, 2010
  5. ↑ "Concordance, lists, bibliography: Documentation". Vincent van Gogh: The Letters. Van Gogh Museum. Retrieved 16 February 2012.
  6. ↑ Naifeh and Smith (2011), 701 ff., 729, 749
  7. ↑ Hulsker (1980), 390
  8. ↑ Naifeh and Smith (2011), 707 ff., 814 - 816
  9. ↑ See letters 215, 307, 316, 321, 442, 448, 449, 450, 458, 469, 474, 478, 480, 492, 520, 530, 569, 590b, 592, 606, 607, 638, W5, B4, B17. Also Tralbaut page 177.
  10. ↑ See letters 574, 576, 592, 607, 620, and the Saint Rémy asylum register
  11. ↑ See letters 574, 602a, 613, 640, W4
  12. ↑ See letters 172, 173, 200, 206, 215, 216, 302, 469, 576 and R10
  13. ↑ "I have not been able to sleep for several nights, and have been feverish and nervous."Letter 200 from The Hague, circa 23 May 1882. (Hulsker September 1958 assigns it the range 16 to 26 May) and "For three weeks I have been suffering from insomnia and low fever, and passing water was painful." — Letter 206 from The Hague, 8 or 9 June 1882
  14. ↑ See letters 489, 628.
  15. ↑ See Letter 506
  16. ↑ See Letter B14
  17. ↑ "22 letters found". Vincent van Gogh: The Letters. Van Gogh Museum. Retrieved 23 February 2012.
  18. ↑ Naifeh and Smith (2011), 852 ff.
  19. ↑ Naifeh, Steven; Smith, Gregory White. "Notes, chapter 43". Van Gogh: The Life. VanGoghBiography.com.
  20. ↑ Blumer, Dietrich (2002-04-01). "The Illness of Vincent van Gogh". American Journal of Psychiatry. 159 (4): 519–526. doi:10.1176/appi.ajp.159.4.519. ISSN 0002-953X. PMID 11925286.
  21. ↑ "About Mood Disorders - Depression and Bipolar Support Alliance". www.dbsalliance.org. Retrieved 2015-10-08.
  22. 1 2 n/a, n/a (n.d.). "Vincent Van Gogh - Biography". Biography.com. Biography.com Editors. Retrieved 10/07/15. Check date values in: |access-date= (help)
  23. ↑ Arnold, Wilfried. "Journal of the History of the Neurosciences 2004" (PDF). Journal of the History of the Neurosciences 2004. Wilfried Arnold. Retrieved 10/07/15. Check date values in: |access-date= (help)
  24. ↑ Vincent Van Gogh - Biography, Quotes & Paintings, retrieved June 14th 2007.
  25. ↑ See letters 507, 579, 585, 595.
  26. ↑ Letter T23
  27. ↑ Letter T24
  28. ↑ Van Gogh wrote from Arles that the townspeople regarded him "a madman or an epileptic" — letter 589
  29. ↑ "Most epileptics bite their tongue and injure themselves. Rey told me that he had seen a case where someone had mutilated his own ear, just as I did, and I think I heard a doctor from here, who came to see me with the director, say that he too had seen it before." — Vincent to Theo, letter 592
  30. ↑ "I have every reason to believe that the attack which he has had is the result of a state of epilepsy" — letter from Dr. T. Peyron to Theo van Gogh
  31. ↑ Doiteau, V. and Leroy, E. La Folie de Vincent van Gogh, Paris, Éditions Æsculape, 1928.
  32. ↑ for example, Vinchon, J. 'Diagnostic de la "folie" de van Gogh,' in Historie de la Médecine Communications présentées à Paris â la Société Francaise d'Histoire de la Médecine en 1960 1960, pages 23 - 24, and Godlewski, G. 'Vincent van Gogh, prince des maudits' in Diamant Actualités Médicales, 1982, Volume 29, 12-16.
  33. 1 2 Arnold, page 172
  34. ↑ Perry, I. 'Vincent van Gogh's illness: a case record' in Bulletin of the History of Medicine, 1947, Volume 21, pages 146-172.
  35. ↑ 'My brain is still feeling tired and dried up' in letter 558b
  36. ↑ Hemphill, R.E. 'The illness of Vincent van Gogh', in The Proceedings of the Royal Society of Medicine, 1961, Volume 54, pages 1083-1088.
  37. 1 2 Arnold, WN (2004). "The illness of Vincent van Gogh" (PDF). Journal of the History of the Neurosciences. 13 (1): 22–43. doi:10.1080/09647040490885475.
  38. ↑ "Psychiatric case history of Vincent van Gogh". Ned Tijdschr Geneeskd. 144: 2509–14. 23 December 2000. PMID 11155509.
  39. ↑ Gunderson (2008), 47
  40. ↑ Grey, R. Vincent van Gogh, Valori Plastici, Rome, 1924.
  41. ↑ letter B15 to Émile Bernard, c. 18 August 1888
  42. ↑ letter 512 c. 19 July 1888
  43. ↑ Beer, J. 'Van Gogh: diagnosis of the tragedy', in Art News Annual, 1950, Volume 19, special number, pages 82-90.
  44. ↑ Arnold, page 181
  45. ↑ Yasuda, K (1979). "Was van Gogh suffering from Ménière's disease?". Otologia Fukuoka. 25: 1427–1439.
  46. ↑ I. K. Arenberg, L. F. Countryman, L. H. Bernstein and G. E. Shambaugh Jr, 'Van Gogh had Ménière's disease and not epilepsy', Journal of the American Medical Association, Vol. 264 No. 4, July 25, 1990
  47. 1 2 Arnold, page 185
  48. ↑ Gonzalez Luque FJ. "The materials of painting in the cause of the psychopathology of Vincent van Gogh." Doctoral Thesis. University of Salamanca, September 1991. Published in: Gonzalez Luque FJ., Montejo AL. "Vincent van Gogh poseído por el color y la luz". Salamanca, Juste, Talleres Gráficos Nuevo Siglo; 1997.
  49. ↑ Medical certificates of Van Gogh: In Tralbaut ME, editor. "Van Gogh". Barcelona: Blume, 1973. p. 280-81
  50. ↑ Montes Santiago, J (2006). "Goya, Fortuny, Van Gogh, Portinari: lead poisoning in painters across three centuries". Rev Clin Esp. 206 (1): 30–2.
  51. ↑ Weissman, E (2008). "Vincent van Gogh (1853-90) the plumbic artist". J Med Biogr. 16 (2): 109–17. doi:10.1258/jmb.2007.007023.
  52. ↑ Monico, L; Van der Snickt, G; Janssens, K; Dik, J; Cotte, M; et al. (2011). "Degradation Process of Lead Chromate in Paintings by Vincent van Gogh Studied by Means of Synchrotron X-ray Spectromicroscopy and Related Methods". Anal. Chem. 83 (4): 1214–122. doi:10.1021/ac102424h. PMID 21314201.
  53. ↑ Loftus, L.S.; Arnold, W.N. (1991). "Vincent van Gogh's illness: acute intermittent porphyria". British Medical Journal. 303: 1589–1591. doi:10.1136/bmj.303.6817.1589. PMC 1676250Freely accessible. PMID 1773180.
  54. ↑ Arnold, pages 139-164
  55. ↑ Erickson, Kathleen Powers. At Eternity's Gate: The Spiritual Vision of Vincent van Gogh, 1998, ISBN 0-8028-4978-4, pages 120 - 123
  56. ↑ Gonzalez Luque FJ, Montejo AL. "Vincent van Gogh and the toxic colors of Saturn"."The Vincent van Gogh Gallery". Visitor Submissions, September 2004: p. 13.
  57. ↑ Wetterberg, L (1966). "Acute porphyria and lead poisoning". Lancet. 1 (7435): 498. doi:10.1016/s0140-6736(66)91512-1.
  58. ↑ Death certificate signed in the Clinic of Dr. Willem Arntsz in Utrecht on January 25, 1891. In: Leprohon P, editor. "Van Gogh". Biography. Barcelona: Salvat, 1991: p. 247.
  59. ↑ Doiteau V. París. Esculape 1940:30,76.
  60. ↑ Vallejo-Nágera JA. "El crepúsculo de Van Gogh". Estudios psiquiátricos. En: "Locos egregios". Barcelona, Planeta, 1989; 178-198.
  61. ↑ Lechevalier B. Sífilis del Sistema Nervioso. En: Lhermitte F., Marno H., eds. Los Sistemas Nervioso y Muscular. Barcelona, Espaxs, 1974; 365-372.
  62. ↑ Wilkie K. "Van Gogh viaje a la luz enloquecida". Madrid, Calpe, 1990; pp. 196-200.
  63. ↑ "The fine art of patient-doctor relationships". BMJ. 329: 1475–80. 2004. doi:10.1136/bmj.329.7480.1475. PMC 535989Freely accessible. PMID 15604190.
  64. ↑ Loftus, LS; Arnold, WN (1991). "Vincent van Gogh's illness: acute intermittent porphyria?". BMJ. 303: 1589–91. doi:10.1136/bmj.303.6817.1589. PMC 1676250Freely accessible. PMID 1773180.
  65. ↑ Jamison, KR; Wyatt, RJ (1992). "Vincent van Gogh's illness". BMJ. 304: 577. doi:10.1136/bmj.304.6826.577-c.
  66. ↑ Hulsker, Jan. "Vincent and Theo van Gogh; A dual biography". Ann Arbor: Fuller Publications, 1990: p.402-4.
  67. ↑ Lachenmeier, DW (2008). "Thujone-attributable are only an urban legend-toxicology incovrs alcohol as real cause of absinthism". Med Moatsschr Pharm. 31 (3): 101–6.
  68. ↑ Lee, TC (1981). "Van Gogh's vision digitalis intoxication?". Journal of the American Medical Association. 245: 728–9. doi:10.1001/jama.245.7.727.
  69. ↑ Arnold, WN; Loftus, LS (1991). "Xanthopsia and van Gogh's yellow palette". Eye (Lond). 5 (5): 503–10. doi:10.1038/eye.1991.93.

Bibliography

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