Caught Between the Twisted Stars: The Color of Mental Illness

There are only a few artists of any kind that possess as much mystery, illusion, and complexity of form and composition as Vincent van Gogh. When people hear of van Gogh, two facts usually come to mind: 1) he cut off his own ear, and 2) he painted “The Starry Night.” Both of these facts have given van Gogh a dramatic, and very often stereotypical, identity as “the tortured, psychotic, misunderstood artist” whose only true freedom and medicine was the creation of his art.

However understandable this idea may sound, it has falsely simplified the artist’s condition and attempted to feed a list of creators and artists who all seemed to have suffered from a similar psychotic fate, some of whom include: Ludwig van Beethoven, Virginia Woolf, Ernest Hemingway, and Robert Schuman. But the numerous art historians, medical historians, neuropsychiatrists, and neurophysiologists brave enough to investigate van Gogh’s mental illness have discovered not only how mysterious and unconventional his psychosis was, and still is today, but also how it informed and transformed his work in the last two years of his life. In order to respect the uniqueness of van Gogh’s mind we must search deeper into the artist’s family, his lifestyle, his relationships, his letters, and his colors.

Since his death on July 29, 1890, well over 150 art and science professionals from various fields have attempted to accurately describe van Gogh’s mental illness. Among the first physicians to have written reports about van Gogh’s condition were Felix Rey, Theophile Peyron, and Paul Gachet — all of whom attended directly to van Gogh throughout the course of his psychosis. Even though they wrote extensive reports regarding both his symptomatology and prognosis, the best sources of information which have survived over the 126 years since van Gogh’s suicide are his letters written to his brother Theo, with whom he had a long, complicated yet intimate, relationship throughout his short life.

In his letters, van Gogh describes suffering from frequent gastrointestinal problems, at least one bout of constipation that required medical attention, as well as auditory and visual hallucinations, partial seizures, fever, and sexual impotence. His condition was further exacerbated by malnutrition and fasting, excessive ingestion of alcoholic beverages (mainly absinthe), overwork, and a liking toward camphor and other terpenes. In a letter to Theo on March 7, 1877, Vincent writes about his depression: “But I am so angry with myself now because I cannot do what I should like to do, and at such a moment one feels as if they were lying bound hand and foot at the bottom of a deep, dark well, utterly helpless.”

The last two years of van Gogh’s life included six documented medical crises. Mysteriously, each of these crises had an abrupt onset, followed by a period of days or weeks of insomnia, hallucinations, aphasia, fever, and stupor, and then a swift resolution described by van Gogh as: “One day fine — the next day, down with sickness … yesterday I was too sick to write — today I pick up the pen … We’re all mortal and subject to all possible illnesses, what can we do about it when the latter aren’t precisely of a pleasant kind. The best thing is to try to recover from them.” From the above characteristics described by van Gogh, historians and researchers have argued over possible diagnoses, only some of which include: epilepsy, bipolar disorder, sunstroke, acute intermittent porphyria, lead poisoning, absinthe intoxication, Meniere’s disease, and digitalis toxicity.

Rey and Peyron both thought that van Gogh suffered from epilepsy. Epilepsy is a paroxysmal (sudden and recurring) transient disturbance in brain function manifested by episodic impairment or loss of consciousness, abnormal motor phenomena, psychic, or sensory disturbances, or perturbation of the autonomic nervous system. In a letter from January 29, 1889, addressed to van Gogh’s brother Theo, Peyron writes: “I am writing to you on behalf of M. Vincent, who is the victim of another attack. M. Vincent was getting on very well and was completely himself when last week he wanted to go to Arles to see some people, and two days after he made the journey the attack took place. At present he is unable to do any work at all and only replies incoherently to any question put to him. I trust that this will pass again as it has done before.”

Edgar Leroy and Victor Doiteau, van Gogh’s biographers, supported the diagnosis of temporal lobe epilepsy in 1928, but others, such as Wilfred Niels Arnold of the University of Kansas Medical Center, disagree, pointing out that the nature of his seizures, as well as the time and duration of the episodes, do not follow the typical pattern of the classical complex partial seizure.

In a 2004 article published by the Journal of the History of the Neurosciences, Arnold questions
the validity of Peyron’s diagnosis. Due to the fact that clinicians at the time were fully knowledgeable about the classical forms of epilepsy, Arnold wonders why van Gogh was never treated nor recommended to an epilepsy specialist during his lifetime. A diagnosis of temporal lobe epilepsy may explain van Gogh’s hallucinations, along with the episodic nature of his illness, and the interspersed periods of neurological normalcy. However, complex partial seizures usually last a few hours at the most, so this diagnosis does not fit the days and weeks of agony that van Gogh described. More importantly, epilepsy does not accommodate the numerous gastrointestinal irritations that the struggling artist often complained about. Instead, Arnold proposes that van Gogh actually suffered from acute intermittent porphyria (AIP), a hereditary metabolic disorder.

Acute intermittent porphyria, also known as “the royal malady” (as it is believed to have had afflicted King George III and his family) is known to disrupt a patient’s ability to generate “heme,” a vital molecular compound found in blood cells that is needed for the transportation of oxygen throughout the body. The term “acute” refers to the rapid onset, and abrupt cessation, of expressed symptoms, while the term “intermittent” refers to the typical periodicity (distinct periods of normalcy which come between episodes of illness). Arnold — along with Dr. Loretta S. Loftus of the University of Missouri-Kansas City School of Medicine — described in a later study how van Gogh’s illness and symptomatology is fully supported by AIP. This includes the gastrointestinal complaints, neurological disturbances, age of onset (between 20 to 40 years old), and jagged time course (which can be made worse due to inadequate nutrition or alcohol abuse — in van Gogh’s case, absinthe). The hereditary nature of van Gogh’s AIP is also supported by the fact that his younger sister Willemina spent the later half of her life in a psychiatric ward while his brother Theo suffered from mental illness, severe fevers, leg pain, and acute bouts of stress and anxiety. In a letter written to Theo, Vincent comments on the similarity in character of both of their illnesses: “Our neurosis [as] a fatal inheritance.”

Even though Arnold and Loftus’ diagnosis of AIP may seem to be the most plausible explanation for van Gogh’s illness to date, many other clinicians have a different interpretation. In the journal Neurological Disorders in Famous Artists, Julien Bogousslavsky, along with others, proposed that van Gogh suffered from a bipolar disorder, affective or schizoaffective, that may have played a role in his death by suicide. Other clinicians still support the idea, proposed in 1972 by Koichi Yasuda, that van Gogh suffered from Meniere’s disease. Some of the main symptoms used by the researchers to justify their diagnosis were van Gogh’s consistent nausea and vomiting and the severing of his own right ear, which he may have done to relieve the troublesome symptoms of tinnitus. Besides his letters, many clinicians also chose to view van Gogh’s artwork through a behavioral lens in order to diagnose his illness.

When one looks at his paintings, it becomes clear that van Gogh was infatuated by the color yellow. One of the defining elements of “The Starry Night” lies in the yellow coronas surrounding each star in the painting. Paul Wolf, clinical professor of pathology at the University of California, San Diego, addresses this in his paper, published by The Western Journal of Medicine. Wolf describes how van Gogh’s last attending physician (in the final 10 weeks of his life) may have treated Vincent’s “epilepsy” with digitalis, a drug extracted from the purple foxglove plant. People who receive large and repeated doses of this drug commonly see the world with a yellow-greenish tint, and in particular, report seeing yellow spots surrounded by coronas, much like those in “The Starry Night,” which was painted by van Gogh in June 1889. In one of van Gogh’s three portraits that he painted of Gachet, the physician holds a stem of Digitalis purpurea, the purple foxglove from which the drug is extracted, all painted in a yellowish hue.

Van Gogh’s recognizable yellow washes over many of his works, twirling around the stars that twinkled from his hotel room window in France’s Saint-Remyde-Provence, encircling the wheat fields that swayed before him, and illuminating from the faces that stared back at him. I too can see that yellow light which he spoke of in a letter to Theo, washing over him in Arles, France, as he painted the countryside: “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 … 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.”

We are wrestling with the fact that van Gogh’s illness is still a mystery, even after 126 years of scientific inquiry. It is a multilayered and unique condition colored by bright hues of yellow, clouded by the insights and opinions of over 150 art and medical professionals. At the end of the day, all we have are his words and his paintings — a style and voice that emerged from the mind and body of van Gogh and which acted as an offering placed within the intersubjective space between the creator and the audience, both challenging and transforming one’s relationship with their environment forever.

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