The Illness of Vincent van Gogh

Abstract

            Many forensic psychologists and psychiatrists have argued over what ailed the famous painter Vincent van Gogh, was his illness mental or physical, or a combination of both? This article seeks to diagnose the painter under the DSM-IV-TR,

“And They Were all Yellow”: The Illness of Vincent van Gogh

            Vincent van Gogh (March 30, 1853 – July 29, 1890) was a 19^th century Dutch painter whose vast influence in the art world on expressionism and early abstraction cannot be denied, although during his tumultuous life, he only sold a single painting. It is also undeniable that attached to the beauty and creativity that van Gogh had to offer the world was a very sad, unsuccessful life painted with spurts of depression, restlessness, and psychotic episodes.

Vincent’s Childhood

            In order to understand the illness of this legendary artist, we must first explore his tortured existence. Vincent van Gogh was born in Zundert in the Southern Netherlands to a family that was well respected in the church and in the art world. His father was a protestant minister, many of his family members were successful art dealers, and his uncle, who had the same name as Vincent, was a famous sculptor. Interestingly, Vincent was given the name of his older brother upon birth, who had been born a year earlier but died shortly after birth (Hudson, 2006). As a child, Vincent had five younger siblings, three sisters and two brothers. Of them, the only sibling that Vincent was close to was his brother Theo, who supported him financially throughout most of his life, and actually believed in his brother’s art and ability to succeed, despite van Gogh’s repeated failure to generate income from his paintings.

            Throughout his childhood and adolescence, Vincent displayed evidence of mental instability and was described as a difficult and moody child who would often withdraw from social situations. Vincent’s sister, Elizabeth, described him as, “intensely serious and uncommunicative, and walked around clumsily and in a daze, with his head hung low. Not only were his little sisters and brothers like strangers to him, but he was a stranger to himself.” A servant of the van Gogh family also referred to him as, “an odd, aloof child who had queer manners.” (Butterfield, 1998).

Failed Career Paths

            As he reached early adulthood, Vincent attempted to take the professional path that was expected of him by his family, as he was already in danger of becoming a failure in their eyes. He first became an apprentice to an art dealer before entering the trade himself, but this was fairly short-lived. Vincent poured himself into his work, learning every detail about what constituted a great piece of art, often swaying customers from purchasing what he considered to be a poor painting, and often arguing with customers. His failure as an art dealer can be greatly attributed to Vincent’s inability to understand interpersonal diplomacy.

He began to feel a great rejection by his family, but this was only the beginning. Around this time, Vincent experienced rejection in love for the first time, falling in love with an upper class woman and openly expressing his love for her. She was greatly insulted by his unwanted advances, and Vincent was unable to understand that she had never had any real interest in him, probably due to his inability to read the intent of others (Butterfield, 1998).

            Vincent then attempted to enter the ministry, hoping again to gain the respect of his family. He worked as an evangelist in a poor mining district in Belgium, but soon after living among these people, he sold all of his belongings and became poor and disheveled himself. It was during this time that Vincent first began doing charcoal drawings of the poor people with whom he lived. One of his most famous paintings, The Potato Eaters began here as a charcoal work.

Vincent was soon dismissed by the church for a refusal to conform to their ways of teaching, and they were mortified by his sudden lack of concern for his own well being. This marked an episode of depression, where he abandoned his religious beliefs.

In a letter to Theo, he wrote, “My only anxiety is, how can I be of use in the world?” (Blumer, 2002).

Art as a Profession

            After many failed career attempts, Vincent decided to become serious about art, and immediately became very passionate about it. He read multiple manuals and worked very long hours to perfect his style, creating over 900 paintings and 1100 drawings in his ten year career (Ayoub, 2005). It was quite rare for the time period for someone to decide to take such a career path late in life, although he was only in his late 20s, this was an age when one should already be established in a field. Perhaps Vincent worked at such a furious pace because he believed that he had much catching up to do with this career path, and this might have been the only chance he had left to possibly please his father.

Vincent’s Alienation

            Vincent alienated himself from his family except for Theo, who continued to support him. The climax of Vincent’s family issues came about during an extended visit back home, where the artist fell in love with his first cousin, Kee, despite her repeated rejection of his advances. In a desperate attempt to express his love, Vincent approached Kee’s father and placed his hand over a kerosene lamp. “Let me see her for as long as I can keep my hand in this flame!” (Butterfield, 1998). Having relational intentions with a cousin was an outrage to his family and to what was socially normal in 19^th century Holland, so this was the initial cause for Vincent’s alienation from the family. Vincent later invited Sien, a prostitute, to live with him, mostly out of empathy for her deep sorrow. Vincent eventually entertained the idea of taking her as his wife, and although the marriage never materialized, such an idea caused Vincent and his father to cut ties for good. Vincent’s father wrote in a letter to Theo, “…Vincent is again in a wrong mood. He seems to be in a melancholy state of mind, but how can he be otherwise? Whenever he looks back into the past and recalls to his memory how he has broken with all former relations, it must be very painful for him. If he had only the courage to think of the possibility that the cause of much which has resulted from his eccentricity lies in himself. I don’t think he ever feels any self-reproach, only soreness against others…” (Davidson, 1997).

            After 6 years as an artist in the Netherlands and Belgium, Vincent went to live with Theo in Paris for two years, where he met many painters who would later become famous. This is where Vincent began to use the alcoholic beverage absinthe, which was popular at the time among French artists. His use of the drug was not severe according to standards of that society, but its use possibly played a crucial role in the precipitation of the illness of Vincent van Gogh. (Blumer, 2002). His temperament was wild and quarrelsome, and he caused many scenes in public places that were a concern. Theo sympathized but was increasingly burdened by Vincent’s presence, so he eventually set Vincent up with a flat in Arles to continue his work. At this time Vincent was an “accomplished artist”, although not recognized and still in need of financial support.  

In a letter to his younger sister, Theo wrote of Vincent: “It seems as if he were two persons: one, marvelously gifted, tender and refined, the other, egotistic and hard hearted. They present themselves in turns, so that one hears him talk first in one way, then in the other, and always with arguments on both sides. It is a pity that he is his own enemy, for he makes life hard not only for others, but also for himself.” (Blumer, 2002).

Axis I Diagnosis: Bipolar I Disorder

            It was here that Vincent’s mental state worsened, and a pattern of abnormalities and violent oppositions in mood are seen. He described his shifts of dysphoria and euphoria in a letter to Theo: “I am unable to describe exactly what is the matter with me; now and then there are horrible fits of anxiety, apparently without cause, or otherwise a feeling of emptiness and fatigue in the head…. There are moments when I am twisted by enthusiasm or madness or prophecy, like a Greek oracle on the tripod. And then I have a great readiness of speech.” (Blumer, 2002).

            The character swings that Vincent experienced at this time could have been the product of bipolar I disorder, periods of deep depression or anxiety coupled with periods of grandiosity and creativity. Vincent’s behavior meets criteria for bipolar I disorder as stated in The Diagnostic and Statistical Manual of Mental Disorders (DSM-IV-TR). (American Psychiatric Association, 2000). To carry the diagnosis of bipolar I disorder, a person must have experienced a heightened state referred to as “mania” or a slightly lessened heightened state referred to as “hypomania”.  The DSM-IV-TR criteria for manic episodes states that a “distinctly elevated or irritable mood” must be present, followed by at least 3 or 4 of the 7 criteria for the disorder. We can see in evidence gathered from his own letters and his behavior that Vincent met at least 4 of the 7 criteria, which are: an increase in goal-directed activity or restlessness, flights of ideas or racing thought, decreased need for sleep, and excessive involvement in pleasurable activities that are likely to have negative consequences (Kring, Davidson, Neale, Johnson, 2007). We can tell that Vincent was very into his work, and when reading his letters, one can find a “flight of thought” as in one lengthy letter to Theo in July 1880, where he changed topics often and couldn’t quite get his point across (Bernard, 1985). We can also see evidence of this in his seemingly inability to communicate or read the intentions of others. There are also accounts of Vincent painting for sometimes days on end without sleep, where he would eventually drop from exhaustion and then enter a depressive state (Davidson, 1997). We can look to Vincent’s frequent visits to the brothels as evidence of his behaving in negative pleasurable activities. For the time period, men did visit brothels from time to time, but few flaunted it the way Vincent did, and still even less “fell in love” with prostitutes. This Axis I diagnosis of bipolar I disorder would also explain the mood swings of his adolescence. Vincent kept a constant flow of letters to his brother Theo, which offers documented accounts of intense creativity, grandiosity, activity, and lack of sleep, followed by periods of fatigue and depression (Bernard, 1985). He did not maintain any functional disability after each attack, and those around him were surprised at how well he would recover from them (Loftus, Arnold, 1991).

We can contrast the different aspects of Vincent’s moods by looking at two different confessions from his parents. His father wrote, “It grieves us so when we see that he literally knows no joy of life, but always walks with bent head, whilst we did all in our power to bring him into an honorable position! It seems as if he deliberately chooses the most difficult path” (Davidson, 1997). This monologue of a seemingly depressed and hopeless Vincent contrasts with the words of his mother, “I am always so afraid that wherever Vincent may be or whatever he may do, he will spoil everything by his eccentricity, his queer ideas and views on life” (Davidson, 1997). There is evidence of mania and hypomania throughout Vincent’s history, such as during his time as an evangelist, when he horrified his family by giving away all of his possessions and becoming a poor member of the mining community, while doing little evangelistic work among them (Hudson, 2006). These are clearly all examples of bipolar I disorder in Vincent, and perhaps if lithium had been an available medication in the 19^th century, things would have turned out differently for the troubled artist (Wolf, 2005).

Psychotic Features

We can also find evidence of psychotic features during phases of severe mania, with reported delusions and sometimes hallucinations. Little is known about the nature of Vincent’s hallucinations, so we cannot really conclude whether the psychotic features are mood-congruent or mood-incongruent. It has been suggested that there might be evidence of these in his art, such as the spiral color in the sky that is seen in the famous painting, The Starry Night.

In Arles, the artist became very lonely so Theo persuaded Gauguin, another artist, to move in with Vincent. This only lasted a couple of months and ended catastrophically. The two quarreled constantly, and finally Gauguin decided to move. Upon telling Vincent the news, Vincent became very angry and wild and threw a glass in Gauguin’s face. When Gauguin left the house, Vincent followed him and approached him with an open razor, and was repelled. Vincent then went back home and cut off part of his earlobe, which he took to the local brothel and presented to his favorite prostitute, Rachel, with the instructions, “keep this object carefully.” It is thought that Rachel actually favored Gauguin over Vincent, and that this was perhaps the reason that she was involved in this episode (Cohen, 2003).

The police later found Vincent in his home unconscious and he was hospitalized. Vincent then fell into a psychotic state of agitation, experiencing delusions and requiring three days of solitary confinement, upon which he was given potassium bromide to help calm his episode. Vincent later reported, “The intolerable hallucinations have ceased, in fact have diminished to a simple nightmare… I am rather well just now, except for a certain undercurrent of vague sadness difficult to explain. While I am absolutely calm at the present moment, I may easily relapse into a state of overexcitement on account of fresh mental emotion.” (Blumer, 2002).

Vincent van Gogh suffered another two psychotic episodes following this one, both with brief hospitalizations. He later voluntarily entered the hospital for a full year, because citizens were uncomfortable with him, and the taunting from them was more than Vincent could bear. Brief psychotic episodes were then reported, as well as bouts of amnesia and partial seizures.

Axis II Diagnosis: Borderline Personality Disorder

Evidence points to borderline personality disorder in Vincent van Gogh, but we must be careful with this diagnosis because there are many features of a mania that can mimic borderline personality disorder traits. It is important that we can see these traits extending across the life span, and not just in situational events.  Five or more of the diagnostic criteria as stated in the DSM-IV-TR must be met to diagnose the disorder, and Vincent meets at least 6 of the criteria, which include: desperate efforts to avoid real or imagined abandonment, a pattern of unstable and intense interpersonal relationships (with extremes of idealization and devaluation), recurrent suicidal behavior or self mutilating behavior, affective instability due to a marked reactivity of mood, chronic feelings of emptiness, and inappropriate intense anger and difficulty controlling that anger (Kring, et. al., 2007).

We can look to Vincent’s self mutilation behavior as one good example, as well as his anger and dramatic response to learning the news that Gauguin was leaving him. Perhaps the news and fear of abandonment and Vincent’s dramatic personality is what triggered his manic episode. The dramatic encounter with Kee’s father is also a good example of a borderline personality, especially when we look at what happened immediately after the incident. Kee’s father accompanied Vincent to a local bar and explained why he and Kee would not be a good match. It did not take much convincing for Vincent to see his uncle’s side, causing him to renounce his love for Kee (Butterfield, 1998). This quick shift in emotion suggests that Vincent was not in love with Kee, but rather “in love with the idea of being in love”; needing someone to attach to in order not to feel abandoned. Another example of borderline personality was when Theo, whom Vincent relied on the most, got married in 1888 and became a father in 1890. There is evidence that Vincent perceived Theo’s new family as a threat, and felt in many ways that Theo had abandoned him. In one letter to Theo, Vincent wrote: “and without your friendship I would be driven to suicide without pangs of conscience—and as cowardly as I am, I would finally do it” (Blumer, 2002).

Although Theo continued to support Vincent, we can see this that Vincent had a deep fear of losing Theo and used frantic efforts to hold on to their relationship. The idea of there being others revered above him made Vincent feel very vulnerable and negatively reactive. Consistent with borderline personality disorder, Vincent required excessive admiration but at the same time compromised it with his impulsive emotions. There were many “Para suicidal” attempts during this time in which Vincent would ingest paint, turpentine, or lamp oil, most often in the presence of another person, earning him repeated stays at the asylum. Vincent’s repeated episodes of sadness also suggest a borderline personality, and he never seemed to have a problem expressing his grief to others, often in long tedious letters to Theo or with socially obnoxious behavior. It is also reported that Vincent would often wear unwashed clothing and appear very ragged at times, which for the time period could be an example of acting out behavior by using an extreme appearance to draw attention to oneself,  which is consistent with the desperate need for attention that people with this disorder exhibit (Butterfield, 1998).

Axis III: Brain Abnormalities

Vincent was diagnosed with epilepsy in his lifetime and by a few doctors who examined his case after his death, but his partial seizures were rare and not severe. He only seemed to experience them after drinking absinthe, and even then his psychosis caused him much more grief, and when abstaining from absinthe, his seizures would go away but his behavior and cognitions would remain constant. It is believed that Vincent ingested too much absinthe, and that this might have been the cause of some of his grief. Contrary to this popular belief, Vincent did not ingest as much absinthe as his contemporaries, and was known not to become intoxicated. It might have been that Vincent was simply more vulnerable to the absinthe because of its thujone, a substance known for inducing convulsions (Blumer, 2002). Vincent reportedly received a diagnosis of epilepsy and was treated with digitalis by his physician Dr. Gachet. In Vincent’s painting of Dr. Gachet, he is holding the plant Digitalis purpurea, from which the drug digitalis is extracted (Wolf, 2001).

 (Vincent’s portrait of Dr. Gachet would eventually become the most expensive painting ever sold, for a record 85.2 million dollars in 1990) (Ayoub, 2005). If Vincent was treated with digitalis, it might interestingly explain Vincent’s fascination with the color yellow, because people receiving repeated doses of this drug report seeing things with a “yellow hue” and it might also explain the dull yellow hue that Vincent often used in his paintings of the night sky (Wolf, 2001). Another good example is the portrait The Night Café

Vincent reportedly painted his house yellow, and created the series of portraits called Yellow Sunflowers for the purpose of filling his home with the beloved color. His own self portrait and other pictures, as well as accounts from people close to Vincent suggest a significant craniofacial asymmetry, which would suggest some sort of physical brain deformity. It has also been suggested that he might have suffered a brain injury, possibly at birth (Blumer, 2002).

There is no way to know for sure if Vincent suffered from epilepsy or some other brain dysfunction, but we conclude that there was some sort of biological explanation for Vincent’s rare seizures, such as an early limbic lesion, and therefore this phenomena is diagnosable under Axis III of the DSM-IV-TR as a general medical condition (2000).

Vincent was finally declared “cured” of mental ailments and was released from the hospital for good in the spring of 1890, where he lived out the last 10 weeks of his life in Auvers. Theo chose this place for Vincent so that he could be near Dr. Gachet. During this time in Vincent’s life, he did not suffer from any psychotic episodes, and his art was beginning to gain recognition. It was also during this time that someone purchased Red Vineyard at Arles, which was the only painting sold during Vincent’s lifetime.

As Theo’s health began to fail, financial support became bleak and Vincent considered himself to be a larger burden than ever. Perhaps using this as fuel, he created 70 paintings and 30 drawings during his last 10 weeks at Auvers. His over-productiveness could have also been that Vincent wanted to take every opportunity to work, before “a more violent attack [destroys] forever my ability to paint.” (Todkill, 1999). Vincent liked to venture out into the field near his small yellow home and paint amongst the yellow wheat, alone and quiet. One such day, Vincent took a gun with him into the field and shot himself in the lower chest. He died two days later. He told a friend, “I couldn’t stick it any longer, so I shot myself.” (Blumer, 2002).

Axis IV: Psychosocial Problems

It is important to note also some psychosocial problems ailing Vincent van Gogh, diagnosable under Axis IV of the DSM-IV-TR. Vincent obviously had problems with his primary support group, having never felt accepted by his parents, and having never been able to live up to the family name. He also suffered from occupational problems, never being able to settle in a field of interest and not being able to keep a job because of his social awkwardness and fits of anger. Even when Vincent found a career, he was unsuccessful. The artist suffered from economical problems, having to rely on his brother Theo to provide for his basic needs. Vincent’s personal relationships were always rocky, as he was a person who had few friends but still placed himself in social situations very often and seemed to need people.

Axis V: Global Assessment of Functioning

On the GAF scale under Axis V of the DSM-IV-TR, Vincent van Gogh would have scored about a 50 upon leaving the asylum for the final time before his death, as he was suffering from suicidal ideation and impairment in social situations.

The Curtain Closes

Vincent was always an awkward man with “strange” ideas, who was irritable, impulsive, and probably very hard to love or maybe even have a conversation with. Perhaps that was the price he paid to leave his mark on the art world, as such was always his main concern. Vincent van Gogh died with Theo by his side, the only person who attempted to understand his heart. Theo reported Vincent’s last words to be, “La tristesse durera toujours” (the sadness will last forever), (Ayoub, 2005). Theo expressed grave grief after Vincent’s death. He wrote in a letter to his mother, “One cannot write how grieved one is nor find any comfort. It is a grief that will last and which I certainly shall never forget… life was such a burden to him; but now, as often happens, everybody is full of praise for his talents…” (Davidson, 1997). Those people that Theo described, the ones who only loved Vincent in death, mourned with reverence at his funeral and tearfully covered his coffin in flowers… and they were all yellow.

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