Tag Archives: bipolar disorder

Now You See It, Now You Don’t

With 3 weekends having gone by already, I can easily say that this past weekend’s excursion to Provence was the most enjoyable one yet. The countryside in Provence was beautiful and the sights were breathtaking. From the Palais de Papes in Avignon to Pont du Gard to the city of Arles, this weekend gave me an enlightening glimpse into life in southern France. Earlier this week in class, I learned how Van Gogh spent the last years of his life in the Provence region, more specifically in the city of Arles. While in the city, I was able to visit the places around Arles that Van Gogh captured in many of his artworks. Van Gogh’s impressionistic paintings seem to have a life of their own, with golden strokes and dark blue swirls that seem to come right off the page. Standing in the same town that Van Gogh once called home and created masterpiece after masterpiece left me feeling in such a state of wonder. My state of wonder then began to stray away from the aesthetic aspect of his paintings towards pondering how did such a town inspire so many priceless works of art. I thought back to class when we discussed what Van Gogh’s life in southern France was like and the hardships he endured. Looking out over the Rhone, I began to ask to what level did Van Gogh’s mental state affect his work?

Actual location for the inspiration behind Van Gogh’s “La Nuit Etoilee”.

Amidst the beauty of these masterpieces lies hints toward the state of mind of Van Gogh. Surprisingly, many famous artists, inventers, composers, and the artistically creative show manic-depressive tendencies (Z. Janka, 2004). As discovered in class, Van Gogh was in fact plagued by many mental ailments, including hallucinations, seizures, night mares, insomnia, anxiety, manic episodes, depressive episodes, and alcohol abuse. One of Van Gogh’s most famous pieces, “Starry Night”, is thought to be inspired by a hallucination as he was admitted to a mental asylum at the time with no view of the cityscape accessible to him. Based on his reported behavior and mental ailments, I would most likely diagnose Van Gogh with bipolar disorder. Bipolar disorder is characterized by the National Institute of Mental Health as manic and depressive episodes that can be accompanied by psychotic symptoms (hallucinations and delusions) as well as substance abuse (NIMH). Approximately 15% of those with bipolar disorder have visual hallucinations and 28% have auditory hallucinations (F. Waters et al., 2014). The notion that multiple of Van Gogh’s artworks may have been a result of a hallucination intrigued me, as his paintings appear highly vivid, rich in color, with realistic yet whimsical details. Upon investigation into the neural mechanisms behind hallucinations, I learned that there are multiple ways that neurocircuitry plays a role in producing hallucinations.

When a sensation is perceived, let’s say a visual sensation, information from that sensation is sent from the retina to the visual cortex (V1). This is called bottom-up processing. When the brain first perceives a stimulus and then uses previous knowledge to influence what you are perceiving, it is known as top-down processing (A. Engel et al., 2001). A popular theory to the occurrence of hallucinations faults failures in either top-down or bottom-up processing that results in a perceptively false experience (L. Zmigrod et al., 2016). In psychiatric disorders such as bipolar disorder and schizophrenia, signals between top-down and bottom-up processing may become tonically hyperactive, causing top-down sensory expectations that result in false conscious experiences, otherwise known as a hallucination (S. Grossberg. 2000).  Another theory behind the manifestations of hallucinations focuses more strongly on bottom-up processing. When visual hallucinations occur, there is heightened activity in secondary and association visual cortices, the occipital lobe, and in visual processing areas in the parietal lobes. This hyperactivation of different brain regions may cause over-perceptualization which results in a change in activity in areas such as the prefrontal or premotor cortices, allowing for individuals to have a false sense of agency and perceive their own internal auditory or visual activity as “vivid external percepts” (L. Zmigrod et al., 2016). Either way, these false senses of stimuli or experiences cause an individual to perceive a false reality, hallucinating visual or auditory experiences and believing them to be authentic.

Diagram comparing top-down processing to bottom-up processing

Even given Van Gogh’s medical history, his personal account of his struggles, accounts from people who interacted with him, it is still difficult to fully understand the impact that his mental/physical  health had on his work. Was “Starry Night” a complete illusion? Did Van Gogh cut off his ear due to an auditory illusion? While we may never know the true answers to the questions, we can still infer that Van Gogh was, at the least, influenced by his possible bipolar disorder and the hallucinations that may have accompanied it.

Map of Arles, France


Works Cited

Engel, A. K., Fries, P., & Singer, W. (2001). Dynamic predictions: oscillations and synchrony in top–down processing. Nature Reviews Neuroscience2(10), 704.

Grossberg, S. (2000). How hallucinations may arise from brain mechanisms of learning, attention, and volition. Journal of the International Neuropsychological Society6(5), 583-592.

Janka, Z. (2004). Artistic creativity and bipolar mood disorder. Orvosi hetilap145(33), 1709-1718.

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

Waters, F., Collerton, D., Ffytche, D. H., Jardri, R., Pins, D., Dudley, R., Larøi, F. (2014). Visual hallucinations in the psychosis spectrum and comparative information from neurodegenerative disorders and eye disease. Schizophrenia bulletin40 Suppl 4(Suppl 4), S233–S245. doi:10.1093/schbul/sbu036

Zmigrod, L., Garrison, J. R., Carr, J., & Simons, J. S. (2016). The neural mechanisms of hallucinations: a quantitative meta-analysis of neuroimaging studies. Neuroscience & Biobehavioral Reviews69, 113-123.

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 6th 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.


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.