Vincent van Gogh's medical condition
Encyclopedia
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
.
. 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.
One of the most frequent complaints in Van Gogh's letters is the problems he endured with his stomach and digestion. Van Gogh suffered from hallucinations and nightmares at times. He often reported that he was suffering from fever. 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). On occasions he sunk into a kind of stupor. Van Gogh reported his impotence to Theo, his brother, in the summer after he arrived in Arles, and a month later when he wrote to Bernard it seemed to still be very much on his mind. Towards the end of Van Gogh's life he had thoughts of suicide.
.
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?" 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."
made the same general diagnosis, as did Dr Peyron at St Rémy A diagnosis of temporal lobe epilepsy
was originally put forward in 1928 by Leroy and Doiteau and has received much support. Arnold states that the pattern of van Gogh's seizures, their timing and duration, does not fit well with the complex partial seizure
s associated with temporal lobe epilepsy. 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.
poisoning from his consumption of absinthe
.. His surviving sister later suffered mental illness which could suggest a predisposition to bipolar.
describing a diagnosis of "turpentine poisoning and the effects of too intense sun on a Nordic brain," but attempts to confirm this attribution have failed.
— a balance disorder of the inner ear
which is accompanied by nausea, vomiting, hearing loss, and vertigo — was first published in 1979 by Yasuda. This idea then reappeared in 1990 in the Journal of the American Medical Association (JAMA). 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. 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.
(often referred to as simply "AIP"). Arnold suggests the AIP was exacerbated by malnutrition and absinthe abuse. 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 seizure
s 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. 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.
. But according to Theo's death certificate, the cause of death was a "chronic kidney disease" for possible "kidney stones". On the other hand, recognized psychiatric research rule out that Vincent had suffered a mental disorder by syphilis. 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. Dr. Cavenaille diagnosed with "syphilis" to the artist, according to his grandson , 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. 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.
Additionally, recent research reveals that the thujone of liquor is safer than alcohol.
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. 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).
Vincent van Gogh
Vincent Willem van Gogh , and used Brabant dialect in his writing; it is therefore likely that he himself pronounced his name with a Brabant accent: , with a voiced V and palatalized G and gh. In France, where much of his work was produced, it is...
's health. His death in 1890
Vincent van Gogh's death
The death of Vincent van Gogh, the Dutch post-Impressionist painter, occurred in the early morning of 29 July 1890, in his room at the Auberge Ravoux in the village of Auvers-sur-Oise in northern France. He suffered a gunshot wound two days earlier not far from the inn...
occurred after a self-inflicted bullet wound. Many competing hypotheses have been put forward about possible medical conditions he had. These include epilepsy
Epilepsy
Epilepsy is a common chronic neurological disorder characterized by seizures. These seizures are transient signs and/or symptoms of abnormal, excessive or hypersynchronous neuronal activity in the brain.About 50 million people worldwide have epilepsy, and nearly two out of every three new cases...
, bipolar disorder
Bipolar disorder
Bipolar disorder or bipolar affective disorder, historically known as manic–depressive disorder, is a psychiatric diagnosis that describes a category of mood disorders defined by the presence of one or more episodes of abnormally elevated energy levels, cognition, and mood with or without one or...
, sunstroke, acute intermittent porphyria
Acute intermittent porphyria
Acute intermittent porphyria is a rare autosomal dominant metabolic disorder affecting the production of heme, the oxygen-binding prosthetic group of hemoglobin. It is characterized by a deficiency of the enzyme porphobilinogen deaminase. Acute intermittent porphyria is the second most common...
, lead poisoning
Lead poisoning
Lead poisoning is a medical condition caused by increased levels of the heavy metal lead in the body. Lead interferes with a variety of body processes and is toxic to many organs and tissues including the heart, bones, intestines, kidneys, and reproductive and nervous systems...
and Ménière's disease
Ménière's disease
Ménière's disease is a disorder of the inner ear that can affect hearing and balance to a varying degree. It is characterized by episodes of vertigo and tinnitus and progressive hearing loss, usually in one ear. It is named after the French physician Prosper Ménière, who, in an article published...
.
Symptoms and characteristics
Various symptoms are described in Van Gogh's letters and other documents such as the asylum register at Saint-RémySaint-Rémy-de-Provence
Saint-Rémy-de-Provence is a commune in the Bouches-du-Rhône department in southern France.-Geography:...
. 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.
One of the most frequent complaints in Van Gogh's letters is the problems he endured with his stomach and digestion. Van Gogh suffered from hallucinations and nightmares at times. He often reported that he was suffering from fever. At various times he reported bouts of insomnia. He was unable to sleep for three weeks prior to his diagnosis of gonorrhea
Gonorrhea
Gonorrhea is a common sexually transmitted infection caused by the bacterium Neisseria gonorrhoeae. The usual symptoms in men are burning with urination and penile discharge. Women, on the other hand, are asymptomatic half the time or have vaginal discharge and pelvic pain...
in The Hague (sleeplessness and fever probably due to infectious disease). On occasions he sunk into a kind of stupor. Van Gogh reported his impotence to Theo, his brother, in the summer after he arrived in Arles, and a month later when he wrote to Bernard it seemed to still be very much on his mind. Towards the end of Van Gogh's life he had thoughts of suicide.
Behavior
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. 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. He also frequently drank alcohol to excess; in particular, he often drank absintheAbsinthe
Absinthe is historically described as a distilled, highly alcoholic beverage. It is an anise-flavoured spirit derived from herbs, including the flowers and leaves of the herb Artemisia absinthium, commonly referred to as "grande wormwood", together with green anise and sweet fennel...
.
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?" 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."
Epilepsy
Epilepsy has been a popular diagnosis. Van Gogh himself thought that he might be an epileptic and his doctor Dr. Félix Rey at the Old Hospital in ArlesHospital in Arles (Van Gogh series)
Hospital at Arles is the subject of two paintings that Vincent van Gogh made of the hospital in which he stayed in December 1888 and again in January 1889. The hospital is located in Arles in southern France...
made the same general diagnosis, as did Dr Peyron at St Rémy A diagnosis of temporal lobe epilepsy
Temporal lobe epilepsy
Temporal lobe epilepsy a.k.a. Psychomotor epilepsy, is a form of focal epilepsy, a chronic neurological condition characterized by recurrent seizures. Over 40 types of epilepsies are known. They fall into two main categories: partial-onset epilepsies and generalized-onset epilepsies...
was originally put forward in 1928 by Leroy and Doiteau and has received much support. Arnold states that the pattern of van Gogh's seizures, their timing and duration, does not fit well with the complex partial seizure
Complex partial seizure
A complex partial seizure is an epileptic seizure that is associated with bilateral cerebral hemisphere involvement and causes impairment of awareness or responsiveness, i.e. loss of consciousness.-Presentation:...
s associated with temporal lobe epilepsy. Furthermore, it seems that Vincent's condition was controlled by the administration of bromide
Bromide
A bromide is a chemical compound containing bromide ion, that is bromine atom with effective charge of −1. The class name can include ionic compounds such as caesium bromide or covalent compounds such as sulfur dibromide.-Natural occurrence:...
, which is effective against grand mal seizures, as well as absinthe intoxication and porphyria
Porphyria
Porphyrias are a group of inherited or acquired disorders of certain enzymes in the heme bio-synthetic pathway . They are broadly classified as acute porphyrias and cutaneous porphyrias, based on the site of the overproduction and accumulation of the porphyrins...
, but not for temporal lobe epilepsy.
Bipolar disorder
Perry in 1947 was the first to put together a serious case for a diagnosis of bipolar disorder, or "manic depression." It fits with the well documented periods of intense activity interspersed with periods of exhaustion and depression. 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 thujoneThujone
Thujone is a ketone and a monoterpene that occurs naturally in two diastereomeric forms: -α-thujone and -β-thujone. It has a menthol odor. Even though it is best known as a chemical compound in the spirit absinthe, recent tests show absinthe contains only small quantities of thujone, and may or may...
poisoning from his consumption of absinthe
Absinthe
Absinthe is historically described as a distilled, highly alcoholic beverage. It is an anise-flavoured spirit derived from herbs, including the flowers and leaves of the herb Artemisia absinthium, commonly referred to as "grande wormwood", together with green anise and sweet fennel...
.. 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. 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." 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." A remark has been attributed to Dr GachetPaul Gachet
Paul-Ferdinand Gachet was a French physician most famous for treating the painter Vincent van Gogh during his last weeks in Auvers-sur-Oise. Gachet was a great supporter of artists and the Impressionist movement...
describing a diagnosis of "turpentine poisoning and the effects of too intense sun on a Nordic brain," but attempts to confirm this attribution have failed.
Ménière's disease
The hypothesis that Vincent may have suffered from Ménière's diseaseMénière's disease
Ménière's disease is a disorder of the inner ear that can affect hearing and balance to a varying degree. It is characterized by episodes of vertigo and tinnitus and progressive hearing loss, usually in one ear. It is named after the French physician Prosper Ménière, who, in an article published...
— a balance disorder of the inner ear
Inner ear
The inner ear is the innermost part of the vertebrate ear. In mammals, it consists of the bony labyrinth, a hollow cavity in the temporal bone of the skull with a system of passages comprising two main functional parts:...
which is accompanied by nausea, vomiting, hearing loss, and vertigo — was first published in 1979 by Yasuda. This idea then reappeared in 1990 in the Journal of the American Medical Association (JAMA). 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. 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
Tinnitus
Tinnitus |ringing]]") is the perception of sound within the human ear in the absence of corresponding external sound.Tinnitus is not a disease, but a symptom that can result from a wide range of underlying causes: abnormally loud sounds in the ear canal for even the briefest period , ear...
has been regarded as far-fetched.
Lead poisoning
According to a doctoral thesis in 1991, 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, from which was diagnosed in life. 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. However, this thesis could only be confirmed by a forensic examination of the bones of Van Gogh;as Caravaggio's remains. In any case, recent chemical research on toxic lead pigments used recklessly by Van Gogh, reinforce the diagnosis of saturnism.Acute intermittent porphyria
Arnold and Loftus put forward the diagnosis of Acute Intermittent PorphyriaAcute intermittent porphyria
Acute intermittent porphyria is a rare autosomal dominant metabolic disorder affecting the production of heme, the oxygen-binding prosthetic group of hemoglobin. It is characterized by a deficiency of the enzyme porphobilinogen deaminase. Acute intermittent porphyria is the second most common...
(often referred to as simply "AIP"). Arnold suggests the AIP was exacerbated by malnutrition and absinthe abuse. 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 seizure
Complex partial seizure
A complex partial seizure is an epileptic seizure that is associated with bilateral cerebral hemisphere involvement and causes impairment of awareness or responsiveness, i.e. loss of consciousness.-Presentation:...
s 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. 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.
Other diagnoses
It is speculated that Vincent and Theo had syphilisSyphilis
Syphilis is a sexually transmitted infection caused by the spirochete bacterium Treponema pallidum subspecies pallidum. The primary route of transmission is through sexual contact; however, it may also be transmitted from mother to fetus during pregnancy or at birth, resulting in congenital syphilis...
. But according to Theo's death certificate, the cause of death was a "chronic kidney disease" for possible "kidney stones". On the other hand, recognized psychiatric research rule out that Vincent had suffered a mental disorder by syphilis. 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. Dr. Cavenaille diagnosed with "syphilis" to the artist, according to his grandson , 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
Absinthe
Absinthe is historically described as a distilled, highly alcoholic beverage. It is an anise-flavoured spirit derived from herbs, including the flowers and leaves of the herb Artemisia absinthium, commonly referred to as "grande wormwood", together with green anise and sweet fennel...
intoxication. 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.
Additionally, recent research reveals that the thujone of liquor is safer than alcohol.
It has been postulated that Van Gogh may have exhibited a form of digoxin toxicity
Digoxin toxicity
Digoxin toxicity is a poisoning that occurs when excess doses of digoxin are consumed acutely or over an extended period. The classic features of digoxin toxicity are nonspecific: fatigue, blurred vision, change in color vision Digoxin toxicity is a poisoning that occurs when excess doses of...
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. 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).
External links
- Wayne State University Medical School course notes on Van Gogh's illness
- The Illness of Vincent van Gogh by Dietrich Blumer, M.D.; published in the American Journal of PsychiatryAmerican Journal of PsychiatryThe American Journal of Psychiatry is a monthly peer-reviewed medical journal covering all aspects of psychiatry and the official journal of the American Psychiatric Association. The first volume was issued in 1844, at which time it was known as the American Journal of Insanity...