Would Lithium be a Good Treatment for Vincent Van Gogh?

I am not an art enthusiast, but this summer of my junior year in college has brought me closer to the life of perhaps the most famous painter in the history of western art, Vincent van Gogh. Before I traveled to Europe this summer, I watched two recent movies “Loving Vincent” and “At Eternity’s Gate” that were made based on the life of Vincent van Gogh. My summer started in the Netherlands, and I traveled down to Belgium, Paris, and Provence. This route coincidentally followed van Gogh’s path of mental deterioration, which eventually ended with his suicide in 1890 at the age of 37.

Self Portrait (1887), Rijksmuseum, Amsterdam

Van Gogh Self Portrait (1889), Musée d’Orsay, Paris

Garden of the Hospital in Arles (1889), Espace van Gogh, Arles
Van Gogh was committed after the infamous episode of cutting off his left earlobe in December 1888.

The mental state of van Gogh has long been a subject of controversy. Three years ago, mental health doctors and art history experts came together at the Van Gogh Museum in Amsterdam to find a diagnosis for him (Siegal, 2016). (Read more at https://www.vangoghmuseum.nl/en/stories/on-the-verge-of-insanity) After having a thorough examination of the medical record of his case as well as personal letters, the doctors failed to come to the conclusion of a single diagnosis. Though there might be more than one illness van Gogh has suffered in his life, most analytics, including American Psychiatrist Dietrich Blumer, agree on that van Gogh has displayed many symptoms of bipolar disorder (Blumer, 2002).

Professor Isabella Perry first assigned van Gogh with a diagnosis of bipolar disease (Perry, 1947). People with bipolar disease have recurrent episodes of elevated mood and depression, together with changes in activity levels (Anderson, Haddad, & Scott, 2012). Van Gogh’s life has been also associated with periods of intense activity and depression (Perry, 1947). Bipolar disease is the 6^th leading cause of disability worldwide and has a prevalence of about 1-3% of our general population (Moreira, Van Meter, Genzlinger, & Youngstrom, 2017). This particular psychiatric illness has also been linked with creative accomplishment and many names in the history of creative art. Writers Ernest Hemingway, Virginia Woolf, Composer Robert Schumann, Painter Jackson Pollock and most likely Vincent van Gogh are all among the list (Rothenberg, 2001).

Lithium has been used as the main treatment for bipolar disease for the last sixty or more years (Won & Kim, 2017). Lithium has also been demonstrated to reduce suicide rates and prevent manic episodes in bipolar disease patients (Anderson et al., 2012). However, only one-third of bipolar disorder patients respond to the treatment. Why this treatment works in some patients and does not work in other patients is unknown (Tobe et al., 2017). Although the therapeutic pathways of lithium are complex, through recent research, lithium’s exact mechanism is progressively being clarified. It is becoming more evident that biological systems modulated by lithium are deeply intertwined with biological disruptions associated with bipolar disorder (Won & Kim, 2017).

A recent study published in PNAS used stem cells (cells that can differentiate into other cell types) to unravel lithium’s target and therefore gave the scientists an opportunity to look deeply into the cellular mechanism of bipolar disorder. In this article, the authors have cleverly used lithium, the most common treatment for bipolar disorder, as their “molecular can-opener for prying intracellularly to reveal otherwise inscrutable pathophysiology” in bipolar disorder. They mapped the “lithium-response pathway” which functions to govern the phosphorylation of a protein called CRMP2 involved in the neural network. Normally, the “tug-of-war” between the inactive state (phosphorylated) and active state (non-phosphorylated) is all done physiologically inside our brain. In bipolar disease patients, this “set-point” has gone all wrong. So, the role of lithium is to operate as a “referee” to normalize that set-point (Tobe et al., 2017). Though the “lithium-response pathway” is certainly not a complete picture of bipolar disorder, it helped us to gain significant insights into how lithium modulates our body and alleviate symptoms for patients with the disease.

(Watch Principal Investigator Evan Snyder explains this study)

Psychiatrist Albert Rothenberg argued in his paper that research has shown that lithium treatment has the risk of cognitive impairment and decreased productivity. Another impediment is that many creative people hold the false belief that there is an intrinsic connection between suffering and mental illness. Some believe that tampering with their illness will also destroy their creative talents. And therefore, non-compliance with the doctor’s prescription is fairly common (Rothenberg, 2001). Even if van Gogh had treatment available, whether he would have complied remains questionable.

So, to answer my question raised in the title of this blog post, yes, lithium could have been a useful treatment. But considering the fact that only a third of patients respond to treatments and also the fact that van Gogh had a history of drinking absinthe regularly, lithium would not a magical pill that will fix all the problems with him. By focusing our research on the molecular mechanism of lithium on bipolar disorder, we would be able to map out bipolar disorder in the brain and help these people suffering from this disease. Who knows, the next van Gogh might be among them.

Reference

Anderson, I. M., Haddad, P. M., & Scott, J. (2012). Bipolar disorder. 345, e8508. doi:10.1136/bmj.e8508 %J BMJ : British Medical Journal

Blumer, D. (2002). The Illness of Vincent van Gogh (Vol. 159).

Moreira, A. L. R., Van Meter, A., Genzlinger, J., & Youngstrom, E. A. (2017). Review and Meta-Analysis of Epidemiologic Studies of Adult Bipolar Disorder. The Journal of clinical psychiatry, 78(9), e1259-e1269. doi:10.4088/jcp.16r11165

Perry, I. H. (1947). VINCENT VAN GOGH’S ILLNESS: A Case Record. Bulletin of the History of Medicine, 21(2), 146-172.

Rothenberg, A. J. P. Q. (2001). Bipolar Illness, Creativity, and Treatment. 72(2), 131-147. doi:10.1023/a:1010367525951

Tobe, B. T. D., Crain, A. M., Winquist, A. M., Calabrese, B., Makihara, H., Zhao, W.-n., . . . Snyder, E. Y. (2017). Probing the lithium-response pathway in hiPSCs implicates the phosphoregulatory set-point for a cytoskeletal modulator in bipolar pathogenesis. 114(22), E4462-E4471. doi:10.1073/pnas.1700111114 %J Proceedings of the National Academy of Sciences

Won, E., & Kim, Y.-K. (2017). An Oldie but Goodie: Lithium in the Treatment of Bipolar Disorder through Neuroprotective and Neurotrophic Mechanisms. 18(12), 2679.