Vincent van Gogh's health

There is no consensus on Vincent van Gogh's health. His death in 1890 occurred after a self-inflicted bullet wound. Many competing hypotheses have been put forward about possible medical conditions he had. These include epilepsy, bipolar disorder, sunstroke, acute intermittent porphyria, lead poisoning and Ménière's disease.

Contents

Symptoms and characteristics

Various symptoms are described in Van Gogh's letters and other documents such as the asylum register at Saint-Rémy. The symptoms include: poor digestion and a bad stomach, hallucinations, nightmares, stupor, absent mindedness, impotence, insomnia, and anxiety. Van Gogh suffered from some sort of seizures or crises, and in one of these attacks cut off a part of his ear.[1][2]

One of the most frequent complaints in Van Gogh's letters is the problems he endured with his stomach and digestion.[3] Van Gogh suffered from hallucinations[4] and nightmares at times.[5] He often reported that he was suffering from fever.[6] At various times he reported bouts of insomnia. He was unable to sleep for three weeks prior to his diagnosis of gonorrhea in The Hague (sleeplessness and fever probably due to infectious disease).[7] On occasions he sunk into a kind of stupor.[8] Van Gogh reported his impotence to Theo, his brother, in the summer after he arrived in Arles,[9] and a month later when he wrote to Bernard it seemed to still be very much on his mind.[10] Towards the end of Van Gogh's life he had thoughts of suicide.[11]

Behavior

Self-portrait, 1889, private collection. Mirror-image self portrait with bandaged ear
Still Life with Absinthe, 1887, Van Gogh Museum

Van Gogh indulged to an abnormal degree in various activities which undermined his health, such as constant smoking, drinking alcohol and coffee to excess, and eating very poorly, even fasting at times.[12] The natural consequence of all this was malnutrition. He was never without his pipe and smoked it even on his deathbed, and he admitted on several occasions that he smoked too much.[13] He also frequently drank alcohol to excess; in particular, he often drank absinthe.

There is some evidence that Van Gogh nibbled at his paints, and the eating of paints is possibly connected with his seizure around New Year 1890. In January 1890, after another one of Vincent's seizures, Theo wrote to him saying "if you know that it is dangerous for you to have colours near you, why don't you clear them away for a time, and make drawings?"[14] Theo's alarm is somewhat reduced after hearing from Vincent, and five days later he explained: "In [Doctor Peyron's] first letter he gave me to understand that it was dangerous for you to go on painting, as the colours were poison to you, but he went a little too far, which might have been due to his having relied on unverified rumours, as he himself was ill at the time."[15]

Diagnoses

Epilepsy

Epilepsy has been a popular diagnosis. Van Gogh himself thought that he might be an epileptic[16] and his doctor Dr. Félix Rey at the Old Hospital in Arles made the same general diagnosis,[17] as did Dr Peyron at St Rémy[18] A diagnosis of temporal lobe epilepsy was originally put forward in 1928 by Leroy and Doiteau[19] and has received much support.[20] Arnold states that the pattern of van Gogh's seizures, their timing and duration, does not fit well with the complex partial seizures associated with temporal lobe epilepsy.[21] Furthermore, it seems that Vincent's condition was controlled by the administration of bromide, which is effective against grand mal seizures, as well as absinthe intoxication and porphyria, but not for temporal lobe epilepsy.[21]

Bipolar disorder

Perry in 1947 was the first to put together a serious case for a diagnosis of bipolar disorder, or "manic depression."[22] It fits with the well documented periods of intense activity interspersed with periods of exhaustion and depression.[23] It has been suggested that van Gogh was not just bipolar, but that the crises in his last two years were brought about by the additional effect of thujone poisoning from his consumption of absinthe.[24] His surviving sister later suffered mental illness which could suggest a predisposition to bipolar.

Sunstroke

The idea that van Gogh might have suffered some form of chronic sunstroke was advocated strongly by Roch Grey.[25] Vincent described the effects of the Arles sun in a letter: "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. But as I was so to begin with, I only enjoy it."[26] A month earlier he had mentioned the effects of the sun in passing in a letter to Theo: "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."[27] A remark has been attributed to Dr Gachet describing a diagnosis of "turpentine poisoning and the effects of too intense sun on a Nordic brain,"[28] but attempts to confirm this attribution have failed.[29]

Ménière's disease

The hypothesis that Vincent may have suffered from Ménière's disease — a balance disorder of the inner ear which is accompanied by nausea, vomiting, hearing loss, and vertigo — was first published in 1979 by Yasuda.[30] This idea then reappeared in 1990 in the Journal of the American Medical Association (JAMA).[31] Arnold refutes the hypothesis, stating that there is no case for Ménière's, and that the logic of the JAMA article was flawed in that it put forward only epilepsy as an alternative diagnosis.[32] The Ménière's diagnosis relies on interpreting van Gogh's gastrointestinal problems as the nausea and vomiting associated with Ménière's. The JAMA article's suggestion that Vincent's cutting of his ear was an attempt at self-performed surgery to relieve the Ménière's symptom of tinnitus has been regarded as far-fetched.[32]

Lead poisoning

According to a doctoral thesis in 1991,[33] Van Gogh used in his impasto technique lead pigments in an abusive way and careless, and some months later he suffers the key symptoms of lead poisoning (anemia, stomatitis, abdominal pain, signs of radial neuropathy, etc.) and other characteristics of saturnine encephalopathy in Arles with states of delirium and probable epileptic crises, which were diagnosed in life.[34] Regardless of the premorbid personality of Vincent (impulsive and emotionally unstable), these crises with disturbance of consciousness or psychotic symptoms coincided with his prolific artistic activity, and never in the North; as the Dutch painter says in a letter (Letter 607) . Other painters exposed to toxic colors suffered lead poisoning.[35] However, this thesis could only be confirmed by a forensic examination of the bones of Van Gogh;[36] as Caravaggio's remains. In any case, recent chemical research on toxic lead pigments used recklessly by Van Gogh, reinforce the diagnosis of saturnism.[37]

Acute intermittent porphyria

Arnold and Loftus put forward the diagnosis of Acute Intermittent Porphyria (often referred to as simply "AIP").[38] Arnold suggests the AIP was exacerbated by malnutrition and absinthe abuse.[39] He cites two case histories of men in their 30's who were demonstrated to have AIP and displayed some symptoms similar to that of Van Gogh, including depression and hallucinations in one case, and complex partial seizures in the other. However, Erickson and other refutes this diagnosis arguing that the key symptom of urine discoloration was never noted, and that Van Gogh's "bad stomach" does not match the commonly experienced "excruciating abdominal pain" associated with AIP.[40][41] Erickson and Arnold disagree as to the support offered by the family history, and in particular regarding the status of Vincent's father's health: Arnold, basing his opinion on Tralbaut, believes Theodorus to have been in not-very-good health for most of his life, whereas Erickson chooses to see him as being essentially an active man until a relatively sudden death at age 63. Arnold suggests that Theodorus' quiet and balanced life meant that he avoided several factors that precipitated symptoms and progress of the disorder in his children. In any case, the hereditary defect of this rare disease is not confirmed in Theo's descendants . However, lead poisoning can cause symptoms similar to the AIP with crisis also exacerbated by malnutrition or alcohol.[42]

Other diagnoses

It is speculated that Vincent and Theo had syphilis. But according to Theo's death certificate,[43] the cause of death was a "chronic kidney disease" for possible "kidney stones".[44] On the other hand, recognized psychiatric research rule out that Vincent had suffered a mental disorder by syphilis.[45] Moreover, assuming that both brothers had contracted syphilis in the brothels of Paris (March 1886-February 1888), it is impossible that they developed so quickly neurosyphilis mental disorder, which occurs late 10 to 20 years after infection.[46] Dr. Cavenaille diagnosed with "syphilis" to the artist, according to his grandson,[47] but this diagnosis was not confirmed by the physicians caring for Vincent in the hospital (Dr. Urpar, Dr. Rey and Dr. Peyron) or Dr. Gachet in Auvers. A complex disease, it has been speculated that it fits all his symptoms, in concert with absinthe intoxication.[48][49][50] But doctors who treated Vincent, and who were familiar with absinthe drinkers, did not diagnosed Vincent of "absintheur". Hulsker also denies Vincent's addiction to absinthe.[51] Additionally, recent research reveals that the thujone of liquor is safer than alcohol.[52]

It has been postulated that Van Gogh may have exhibited a form of digoxin toxicity from foxglove plants used to treat his epilepsy. His yellow period ('yellow vision'), missing ear ('oto-toxicity') and penchant for painting halos around landscape objects ('halo vision') are often used by medical students as a mnemonic to remember the sequelae of digoxin toxicity.[53] Speculation further fueled by Van Gogh's portrait of his physician, Dr. Paul-Ferdinand Gachet (1890), in which Gachet holds Digitalis purpurea. But Van Gogh was not treated with digitalis, and Dr. Arnold dismisses the plant as a cause of Xantopsia (yellow halos).[54]

Notes

  1. ^ "It can be said that with the exception of the sister-in-law Johanna van Gogh-Bonger, who had family-related reasons for playing down the injury, not a single witness speaks of a severed earlobe. On the contrary, the mutually independent statements by the principal witness Paul Gauguin, the prostitute who was given the ear, the gendarme who was on duty in the red-light district, the investigating police officer and the local newspaper report, accord with the evidence that the artist’s unfortunate “self-mutilation” involves the entire (left) ear. The existing handwritten and clearly worded medical reports by three different physicians, all of whom observed and treated Vincent van Gogh over an extended period of time in Arles as well as in Saint-Rémy ought to provide ultimate proof of the fact that the artist was missing an entire ear and not just an earlobe." Quoted from Van Gogh's Ear by the art historian Rita Wildegans.
  2. ^ letter to Paul Signac, underlining symptoms of depression 1889 Retrieved June 25, 2010
  3. ^ See letters 215, 307, 316, 321, 442, 448, 449, 450, 458, 469, 474, 478, 480, 492, 520, 530, 569, 590b, 592, 606, 607, 638, W5, B4, B17. Also Tralbaut page 177.
  4. ^ See letters 574, 576, 592, 607, 620, and the Saint Rémy asylum register
  5. ^ See letters 574, 602a, 613, 640, W4
  6. ^ See letters 172, 173, 200, 206, 215, 216, 302, 469, 576 and R10
  7. ^ "I have not been able to sleep for several nights, and have been feverish and nervous."Letter 200 from The Hague, circa 23 May 1882. (Hulsker September 1958 assigns it the range 16 to 26 May) and "For three weeks I have been suffering from insomnia and low fever, and passing water was painful." — Letter 206 from The Hague, 8 or 9 June 1882
  8. ^ See letters 489, 628.
  9. ^ See Letter 506
  10. ^ See Letter B14
  11. ^ See letters 588, 602a, 605
  12. ^ Vincent Van Gogh - Biography, Quotes & Paintings, retrieved June 14th 2007.
  13. ^ See letters 507, 579, 585, 595.
  14. ^ Letter T23
  15. ^ Letter T24
  16. ^ Van Gogh wrote from Arles that the townspeople regarded him "a madman or an epileptic" — letter 589
  17. ^ "Most epileptics bite their tongue and injure themselves. Rey told me that he had seen a case where someone had mutilated his own ear, just as I did, and I think I heard a doctor from here, who came to see me with the director, say that he too had seen it before." — Vincent to Theo, letter 592
  18. ^ "I have every reason to believe that the attack which he has had is the result of a state of epilepsy" — letter from Dr. T. Peyron to Theo van Gogh
  19. ^ Doiteau, V. and Leroy, E. La Folie de Vincent van Gogh, Paris, Éditions Æsculape, 1928.
  20. ^ for example, Vinchon, J. 'Diagnostic de la "folie" de van Gogh,' in Historie de la Médecine Communications présentées à Paris â la Société Francaise d'Histoire de la Médecine en 1960 1960, pages 23 - 24, and Godlewski, G. 'Vincent van Gogh, prince des maudits' in Diamant Actualités Médicales, 1982, Volume 29, 12-16.
  21. ^ a b Arnold, page 172
  22. ^ Perry, I. 'Vincent van Gogh's illness: a case record' in Bulletin of the History of Medicine, 1947, Volume 21, pages 146-172.
  23. ^ 'My brain is still feeling tired and dried up' in letter 558b
  24. ^ Hemphill, R.E. 'The illness of Vincent van Gogh', in The Proceedings of the Royal Society of Medicine, 1961, Volume 54, pages 1083-1088.
  25. ^ Grey, R. Vincent van Gogh, Valori Plastici, Rome, 1924.
  26. ^ letter B15 to Emile Bernard, c. 18 August 1888
  27. ^ letter 512 c. 19 July 1888
  28. ^ Beer, J. 'Van Gogh: diagnosis of the tragedy', in Art News Annual, 1950, Volume 19, special number, pages 82-90.
  29. ^ Arnold, page 181
  30. ^ Yasuda, K. 'Was van Gogh suffering from Ménière's disease?' Otologia Fukuoka, (1979) 25: 1427 - 1439.
  31. ^ I. K. Arenberg, L. F. Countryman, L. H. Bernstein and G. E. Shambaugh Jr, 'Van Gogh had Ménière's disease and not epilepsy', Journal of the American Medical Association, Vol. 264 No. 4, July 25, 1990
  32. ^ a b Arnold, page 185
  33. ^ Gonzalez Luque FJ. "The materials of painting in the cause of the psychopathology of Vincent van Gogh." Doctoral Thesis. University of Salamanca, September 1991. Published in: Gonzalez Luque FJ., Montejo AL. “Vincent van Gogh poseído por el color y la luz”. Salamanca, Juste, Talleres Gráficos Nuevo Siglo; 1997.
  34. ^ Medical certificates of Van Gogh: In Tralbaut ME, editor. "Van Gogh". Barcelona: Blume, 1973. p. 280-81
  35. ^ Montes Santiago J. “Goya, Fortuny, Van Gogh, Portinari: lead poisoning in painters across three centuries”. Rev Clin Esp. 2006;206 (1):30-2.
  36. ^ Weissman E. “Vincent van Gogh (1853-90): the plumbic artist”. J Med Biogr 2008;16(2):109-17.
  37. ^ Monico L, Van der Snickt G, Janssens K, Dik J, Cotte M et al. Degradation Process of Lead Chromate in Paintings by Vincent van Gogh Studied by Means of Synchrotron X-ray Spectromicroscopy and Related Methods. Anal. Chem., 2011, 83 (4), pp 1214–122
  38. ^ Loftus, L.S., Arnold, W.N. 1991. Vincent van Gogh's illness: acute intermittent porphyria. British Medical Journal 303: 1589-1591.
  39. ^ Arnold, pages 139-164
  40. ^ Erickson, Kathleen Powers. At Eternity's Gate: The Spiritual Vision of Vincent van Gogh, 1998, ISBN 0-8028-4978-4, pages 120 - 123
  41. ^ Gonzalez Luque FJ, Montejo AL. “Vincent van Gogh and the toxic colors of Saturn”."The Vincent van Gogh Gallery". Visitor Submissions, September 2004: p. 13.
  42. ^ Wetterberg L. Acute porphyria and lead poisoning. Lancet 1966;1(7435):498.
  43. ^ Death certificate signed in the Clinic of Dr. Willem Arntsz in Utrecht on January 25, 1891. In: Leprohon P, editor. "Van Gogh". Biography. Barcelona: Salvat, 1991: p. 247.
  44. ^ Doiteau V. París. Esculape 1940:30,76.
  45. ^ Vallejo-Nágera JA. “El crepúsculo de Van Gogh”. Estudios psiquiátricos. En: “Locos egregios”. Barcelona, Planeta, 1989; 178-198.
  46. ^ Lechevalier B. Sífilis del Sistema Nervioso. En: Lhermitte F., Marno H., eds. Los Sistemas Nervioso y Muscular. Barcelona, Espaxs, 1974; 365-372.
  47. ^ Wilkie K. “Van Gogh viaje a la luz enloquecida”. Madrid, Calpe, 1990; pp. 196-200.
  48. ^ The fine art of patient-doctor relationships
  49. ^ Loftus LS, Arnold WN. Vincent van Gogh's illness: acute intermittent porphyria? BMJ 1991;303: 1589-91.
  50. ^ Jamison KR, Wyatt RJ. Vincent van Gogh's illness. BMJ 1992;304: 577.
  51. ^ Hulsker, Jan. “Vincent and Theo van Gogh; A dual biography”. Ann Arbor: Fuller Publications, 1990: p.402-4.
  52. ^ . Lachenmeier DW. Thujone-attributable are only an urban legend-toxicology incovrs alcohol as real cause of absinthism. Med Moatsschr Pharm 2008;31(3):101-6.
  53. ^ Lee TC . Van Gogh's vision digitalis intoxication? Journal of the American Medical Association 1981 ; 245 : 728 – 9
  54. ^ Arnold WN, Loftus LS. Xanthopsia and van Gogh's yellow palette. Eye (Lond). 1991;5 ( Pt 5):503-10.

References

External links