History of Neurology The neuropsychiatric ailment of Vincent Van Gogh Kalyan B. Bhattacharyya, Saurabh Rai Department of Neurology, Bangur Institute of Neurosciences, Kolkata, West Bengal, India Abstract Vincent Van Gogh is one of the most celebrated creative artists of all time. All his life, he was afflicted by some kind of neurological or psychiatric disorder, which remains a mystery even today. Many historians and his personal physicians believe that he suffered from epilepsy while others felt that he was affected by Ménière’s disease. Features such as hypergraphia, atypical sexuality, and viscosity of thinking suggest the possibility of Gastaut-Geschwind phenomenon, a known complication of complex partial seizure. On the contrary, some historians feel that he was forced to sever his right ear in order to get relief from troublesome tinnitus, a complication of Ménière’s disease. He was addicted to the liquor absinthe, which is known to lead to xanthopsia, and many authorities argue that this was the reason for his penchant for the deep and bright yellow color in many of his paintings. Others have suggested the possibility of bipolar disorder, sunstroke, acute intermittent porphyria, and digitalis toxicity as well. Key Words Absinthe, epilepsy, Ménière’s disease, Vincent Van Gogh For correspondence: Prof. Kalyan B. Bhattacharyya, Amrapali Point, Flat 1C, 59f, Bosepukur Road, Kolkata - 700 042, West Bengal, India. E-mail: [email protected] Ann Indian Acad Neurol 2015;18:6-9 Introduction He left the clinic in 1890 and moved to Auvers-sur-Oise, a commune in Paris, where he was treated by Paul Gachet, and There can be no gainsaying that Vincent Van Gogh is one of the later he sought refuge in the company of Theo. In the same most gifted creative artists of all time. Such was his intensity, year, he painted two of his most haunting works, The Irises it may appear that he was consumed by his own passion. and Wheat Field with Crows; the former being sold at a record However, the disease that afflicted and troubled him almost 53.9 million US dollars in 1987 and the latter often cited as all his life still remains a mystery. his last work. Soon he was terminally ill and was unable to write though he continued to paint and draw with unabated Van Gogh was born in a village named Groot-Zundert in zeal. A few months later, he presumably shot himself though Holland on March 30, 1853. In a letter to his younger brother no gun could be found in his vicinity, and Steven Naifeh and Theo with whom he had a deep and enduring relationship, Gregory White Smith, Van Gogh’s biographers, argue that he was accidentally shot by two boys who had been handling a he once wrote, “My youth was gloomy, cold and sterile”.[1] After malfunctioning gun.[3,4] He reeled back to his home and was peregrinations in different countries in Europe and dabbling attended by two physicians who however failed to remove the in various assignments, his serious interest in art grew while bullet from his body. He was left alone and was found smoking he was in Paris, and in 1887, he befriended Paul Gauguin, his pipe. Theo rushed toward him the following morning but the renowned post-impressionist artist, and a life-long van Gogh breathed his last the same evening on the July 29, camaraderie grew between them. In 1888, he moved to Arles 1890.[5,6] Thus, he was finally put out of his interminable pains in southern France and in the next year, volunteered himself and his troubled and tortured life. for hospitalization in Saint-Rémy, a province in France where Théophile Peyron, a physician treated him. During his stay there, he painted his immortal, The Starry Night and others.[2] His Illness There is no unanimous agreement on Van Gogh’s incapacitating Access this article online illness. Historians and researchers have variously felt that Quick Response Code: Website: he might have had suffered from epilepsy, bipolar disorder, www.annalsofian.org sunstroke, acute intermittent porphyria, lead poisoning, absinthe intoxication, Ménière’s disease, and digitalis toxicity. The symptoms were poor digestion, regular stomach upsets, DOI: hallucinations, nightmares, stupor, absent-mindedness, anxiety, 10.4103/0972-2327.145286 insomnia, and impotence.[7] These symptoms were described in many of Van Gogh’s letters and documents, such as the Annals of Indian Academy of Neurology, January-March 2015, Vol 18, Issue 1 7 Bhattacharyya and Rai: Vincent Van Gogh, the celebrated artist suffered from a number of neuropsychiatric disorders asylum register at Saint-Rémy. He suffered from seizures, his brother, Theo, and was virtually obsessed with it since he and during one such attack in December 1888, he indulged wrote on the same issue to his friend Bernard, a month later.[12] in self-mutilation and snipped off a part of his right ear. He He mentioned and contemplated about committing suicide on was admitted to a hospital in Arles where he was diagnosed several occasions, though Steven Naifeh and Gregory White to be suffering from acute mania with generalized delirium.[8] Smith drew attention to his moral compunction against such However, the story also goes that the ear was actually severed an act.[4] He was an inveterate drinker and his habit of incessant with a rapier by Paul Gauguin — the celebrated French artist smoking and coffee drinking, coupled with his aversion and Van Gogh’s close mate — during a quarrel and Van Gogh towards food and occasional fasting largely contributed presented the detached pinna to a prostitute in a nearby brothel. towards his declining health. He was seen with a pipe dangling Felix Ray, a young intern in that hospital, felt that he had been from his lips even in his deathbed, and in general, it is believed suffering from a condition he termed‘mental epilepsy’.[4] These that all these vices resulted in malnutrition.[13] There is some attacks were increased in frequency by 1890, the longest and evidence to suggest that he used to nibble at his paints, often the severest phase lasting for nine weeks from February to referred to as pica, and some historians have attributed this April 1890. habit to the genesis of seizures around 1890. Theo once wrote to him, “if you know that it is dangerous for you to have colours Most of the contemporary physicians, friends, and observers near you, why don’t you clear them away for a time, and make [14] felt that Van Gogh suffered from epilepsy and he himself drawings?” thought as much. Félix Ray, his physician at the Old Hospital, Arles, was of such opinion and Théophile Peyron at St Rémy Van Gogh might have had suffered from bipolar disorder since felt the same way.[9,10] On January 29, 1889, Peyron wrote a letter he had been exhibiting phases of intense activity followed [17] to Theo. The following is an excerpt from that letter, by periods of extreme exhaustion and depression. Thujone intoxication, resulting from his life-long addiction toward absinthe has been put forward as another hypothesis.[18] Roch ‘I am writing to you on behalf of M. Vincent, who is the victim Grey, a physician, felt strongly that he suffered from some of another attack… M. Vincent was getting on very well and was form of chronic sunstroke[19] and Van Gogh himself, while in completely himself when last week he wanted to go to Arles to see Arles, once wrote in a letter to Theo stating,“Oh! that beautiful some people, and two days after he made the journey the attack took midsummer sun here. It beats down on one’s head, and I haven’t place. At present his is unable to do any work at all and only replies the slightest doubt that it makes one crazy.’ Later, he wrote to his incoherently to any question put to him. I trust that this will pass brother, ‘Many thanks for your letter, which gave me great pleasure, again as it has done before.’ arriving just exactly at the moment when I was still dazed with the sun and the strain of wrestling with a rather big canvas”.[20] Edgar Leroy and Victor Doiteau, his biographers, advanced the diagnosis of temporal lobe epilepsy in 1928 and it was That Van Gogh suffered from Ménière’s disease has been a generally accepted among physicians of that time.[11] Others subject of serious speculation for a long time. Yasuda first indicated that the nature of Van Gogh’s seizures and the time adduced the hypothesis in 1979[21] and Arenberg et al., after and duration of the episodes did not follow the pattern of analyzing Van Gogh’s 796 letters, endorsed this view in an classical complex partial seizure and the therapeutic response article in the Journal of American Medical Association in 1990.[22] to bromide possibly refuted the diagnosis and indicated grand Symptoms such as nausea and vomiting from which he suffered mal seizure, as the condition was known in good old days. perpetually and the severing his own right ear, presumably in Additionally, some authorities feel that Van Gogh displayed order to relieve the troublesome symptoms of tinnitus are the some of the features suggestive of Gastaut-Geschwind arguments often advanced in favor of the diagnosis. Though syndrome, including hypergraphia, hyperreligiosity, atypical Prosper Ménière described the disease in 1861, two years sexuality, circumstantiality, viscosity of thinking, and intense before Van Gogh was born, it is likely that the condition was [12,13] mental attitude. Michael Trimble, the noted behavioral still not well known among physicians at that time and those neurologist from Queen Square, London, wrote that Van who attended him could not identify his illness.