Diagnosing Vincent van Gogh

“I put my heart and soul into my work, and have lost my mind in the process.”  This quote, attributed to the painter Vincent van Gogh embodies both the beauty displayed in his paintings and the presumed mental illness he suffered during his life.  While the iconic swirls and visual auras of the former have fascinated museum-goers and art collectors alike, the enigmatic nature of the latter has also stupefied art historians and other curious academics

The subject of mental health is quite prevalent in my life.  Both of my parents are mental health professionals who have dealt with severely mentally ill patients, with conditions similar to that of van Gogh, and their passion for the human mind has inspired me to want to pursue a career in the field.  Thus, it was of great excitement to me when, one day, in class we discussed the apparent severe mental illness of Vincent van Gogh.  We were able to further immerse ourselves into his life when our class took a trip to the south of France and visited the town of Arles, where van Gogh’s infamous ear incident took place.  These experiences encouraged me to think about what illness actually ailed the iconic man.

A few classmates and I at a recreation of the cafe Vincent van Gogh was known to frequent in Arles

While it is impossible to retroactively diagnose someone with a mental illness, it is a popular opinion among scholars that Vincent van Gogh suffered from manic depression, or bipolar disorder, as it is known today (Wolf, 2001).  Much of the evidence for this possible diagnosis comes via letters between Vincent van Gogh, his brother, Theo, and his sister, Wilhelmina (Blumner, 2002).  In a letter to his sister, Theo described Vincent as seeming, “as if he were two persons … with arguments on both sides” (Blumner, 2002).  Later, Vincent complained to his brother about his “heightened emotionality” and increasing reliance on alcohol to dull “the storm within” (Blumner, 2002).  Vincent also noted “horrible fits of anxiety” and attacks of “melancholy and atrocious remorse” which would be followed by “enthusiasm or madness or prophecy, like a Greek oracle on the tripod,” in letters to his brother (Blumner, 2002).  The mental turmoil that Vincent noted in his letters culminated in an acute psychotic episode in which he sliced off a section of his left ear lobe and presented the piece to a prostitute (Blumner, 2002).  During this episode, van Gogh experienced hallucinations and delusions, which required a multi-day stay in solitary confinement (Blumner, 2002).

Image result for van gogh portrait with bandaged ear

Self-Portrait with Bandaged Ear- Vincent van Gogh: This work by van Gogh was painted shortly after the severed part of his left ear during a psychotic episode

Both van Gogh’s description of his condition in notes to his brother and his subsequent psychotic episode are potentially indicative of bipolar disorder.  According to the National Institute of Mental Health bipolar disorder is characterized by “periods of unusually intense emotion” (NIMH).  These periods of emotion usually oscillate between manic episodes and depressive episodes.  Van Gogh’s description of periods of increased enthusiasm is consistent with mania, while his feelings of extreme melancholy are consistent with depression.  Additionally, bipolar patients often present with other illnesses such as anxiety disorder and substance abuse (NIMH).  Van Gogh experienced extreme levels of anxiety and he was a known to frequently have “a glass too much” of absinthe (Blumner, 2002).  Occasionally, patients experiencing severe bipolar disorder can exhibit psychotic symptoms, including hallucinations or delusions, as van Gogh did during the incident in which he severed his ear (NIMH).

Another key facet of bipolar disorder, as noted by the National Institute of Mental Health is its genetic risk factor (NIMH).  In class, we discussed the prevalence of mental illnesses, specifically schizophrenia, depression, and anxiety, in the van Gogh family.  There appears to be a strong presence of mental illness in the van Gogh family; however, there are no reported cases of bipolar disorder.  How then, could Vincent van Gogh appear to have suffered from a disease that no one else in his family had?

While there are no explicit cases of bipolar disorder in his family, there is a strong genetic link between bipolar disorder and schizophrenia; in fact, heritability estimates of the disorders are estimated to between 60 and 80 percent (Nöthen et al., 2010).  In 2017, the Bipolar Disorder and Schizophrenia Working Group of the Psychiatric Genomics Consortium published a large-scale investigation into the genetic markers of bipolar disorder and schizophrenia.  This study, which examined genomic data from over 53,000 individuals with either bipolar disorder or schizophrenia, identified 114 locations in the human genome as risk factors for both schizophrenia and bipolar disorder (Ruderfer et al., 2017).

In addition to the genetic risk factors identified in both bipolar and schizophrenic patients, the study produced another, extremely novel, finding.  Instead of comparing only patients with bipolar disorder to patients with schizophrenia, the researchers compared data from schizophrenic patients to two subpopulations of bipolar patients: those that presented psychotic symptoms and those that did not (Ruderfer et al., 2017).  Through this comparison, the researchers concluded that bipolar patients with psychosis are significantly more like to possess genetic risk factors associated with schizophrenia than bipolar patients without psychosis (Ruderfer, 2018).  This genetic overlap between bipolar disorder patients with psychosis and schizophrenic patients could serve to provide the seemingly missing link in the mental illnesses attributed to the van Gogh family.

To me, it is a stark, yet beautiful, reality that such a creative and influential person as Vincent van Gogh potentially suffered from a disease a debilitating as bipolar disorder.  I think that my experience in both traveling to Arles and researching van Gogh’s mental health gave me a greater appreciation of the fact that people’s illnesses do not need to define them.  The human brain, in all its diversity, is capable of creating masterworks, even in the most unlikely of places.

References

Blumer, D. (2002). The Illness of Vincent van Gogh. American Journal of Psychiatry, 159(4), 519-526. doi:10.1176/appi.ajp.159.4.519

NIMH » Bipolar Disorder. (n.d.). Retrieved from https://www.nimh.nih.gov/health/topics/bipolar-disorder/index.shtml

Ruderfer, D., Sklar, P., & Kendler, K. (2017). Genomic dissection of bipolar disorder and schizophrenia including 28 subphenotypes. doi:10.1101/173435

Ruderfer, D. (2018, October 17). A Revealing Genetic Comparison of Schizophrenia and Bipolar Disorder. Retrieved from https://www.bbrfoundation.org/content/revealing-genetic-comparison-schizophrenia-and-bipolar-disorder

Wolf, P. (2001). Creativity and chronic disease Vincent van Gogh (1853-1890). Western Journal of Medicine, 175(5), 348-348. doi:10.1136/ewjm.175.5.348

 

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