There is no consensus on the state of Vincent van Gogh's physical and mental health, with many competing hypotheses advanced as to possible medical conditions that he may have had. These include epilepsy, bipolar disorder, borderline personality disorder, sunstroke, acute intermittent porphyria, lead poisoning, Ménière's disease, schizophrenia, schizoaffective disorder, substance use disorder, non-suicidal self-injury disorder ("self-harm"), and a possible generalized anxiety disorder. His death in 1890 is generally accepted to have been a suicide: infection from a self-inflicted gunshot wound to the chest.
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, manic episodes, depressive episodes, stupor, absent-mindedness, impotence, insomnia, and anxiety.
Van Gogh suffered from some seizures or crises, and in one of these attacks, on 23 December 1888, he cut off a part, or possibly all, of his left ear."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.letter to Paul Signac, underlining symptoms of depression 1889 Retrieved June 25, 2010 Following that attack, he was admitted to hospital in Arles, where his condition was diagnosed as "acute mania with generalized delirium". Dr. Félix Rey, a young intern at the hospital, also suggested there might be "a kind of epilepsy" involved that he characterized as mental epilepsy. These attacks became more frequent by 1890, the longest and most severe lasting some nine weeks from February to April 1890. Initial attacks of confusion and unconsciousness were followed by periods of stupor and incoherence, during which he was generally unable to paint, draw, or even write letters.
One of the most frequent complaints in Van Gogh's letters is the problems he endured with his stomach and poor digestion.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. Van Gogh suffered from hallucinationsSee letters 574, 576, 592, 607, 620, and the Saint Rémy asylum register and nightmares at times.See letters 574, 602a, 613, 640, W4 He often reported that he was suffering from fever.See letters 172, 173, 200, 206, 215, 216, 302, 469, 576 and R10 At various times he reported bouts of insomnia.See letters 230, 261, 266, 355, 463, and 735. He was unable to sleep for three weeks before his diagnosis of gonorrhea in The Hague (sleeplessness and fever probably due to infectious disease)."I have been not 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 On occasions he sunk into a kind of stupor.See letters 489, 628. Van Gogh reported his impotence to Theo, his brother, in the summer after he arrived in Arles,See Letter 506 and a month later, when he wrote to Bernard, it seemed to still be very much on his mind.See Letter B14 Van Gogh mentioned suicide several times in his letters towards the end of his life; nevertheless, Naifeh and Smith note that Van Gogh was fundamentally opposed to suicide.Naifeh and Smith (2011), 852 ff.
Behavior
Many analysts, such as American psychiatrist Dietrich Blumer, agree that one of the things Vincent van Gogh had was bipolar disorder. Bipolar disorder is characterized by manic and depressive episodes; manic episodes feature reckless behavior, euphoria, and impulsiveness. Depressive episodes feature symptoms of depression, anger, indecisiveness, social withdrawal, and often recurring thoughts of death or suicide. Many of these symptoms can be detected throughout his biography and explain many of his actions.
From a young age, Van Gogh grew up with a strong connection to painting and religion. After having worked at his uncle's art dealership in the Netherlands, he transferred to another dealership location in London, where he fell in love with his landlord's daughter, Eugenie Loyer. After she declined his marriage proposal, he had his first psychotic break, which caused him to change his entire life in order to devote it to God. This setback at age 20 certainly marked a first step in the downwards spiral representing his health, which would lead to his suicide in 1890. One author points out that "[T]here was a family history of mental illness", and Van Gogh displayed symptoms of bipolar disorder, in which heredity plays a significant role. Now an official devotee to the Church of Christ, Van Gogh aspired to become a priest. His disarranged life style, however, caused him nothing but disrespect and rejection, such as the rejection from several theology schools throughout Europe around 1878. Reports of his reckless and indecisive yet impulsive behavior all point towards bipolar disorder. Things like pursuing the work of an art salesman only to tell the customers "not to buy this worthless art" can be very well explained by the illness. Notions of indecisiveness and identity problems can be seen in the next years. Van Gogh moved frequently due to sexual rejection in the next 10 years. He moved to Brussels in 1880 to become an artist. He moved to The Hague because his cousin, Kate, rejected him. He moved to Paris in 1886 because his companion, Clasina Maria Hoornik, recommenced prostitution and alcohol addiction. Van Gogh found shelter in his brother Theo's small apartment, showing up on his doorstep uninvited. In Paris, it seemed that painting leveled and calmed his emotions.
Van Gogh indulged in various activities which undermined his health, such as constant smoking, excessive alcohol and coffee consumption, and eating 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.See letters 507, 579, 585, 595. He also drank alcohol to excess, particularly 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?" Theo's alarm is somewhat reduced after hearing from Vincent, and five days later he explained:
Diagnoses
Epilepsy
Epilepsy has been a popular diagnosis. Van Gogh himself thought that he might have epilepsyVan Gogh wrote from Arles that the townspeople regarded him "a madman or an epileptic" — letter 589 and his doctor Dr. Félix Rey at the Old Hospital in Arles made the same general diagnosis,"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 as did Dr. Peyron at St Rémy."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 A diagnosis of temporal lobe epilepsy was originally put forward in 1928 by Leroy and DoiteauDoiteau, V. and Leroy, E. La Folie de Vincent van Gogh, Paris, Éditions Æsculape, 1928. and has received much support.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. 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. 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.
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.'My brain is still feeling tired and dried up' in letter 558b 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. Arnold has suggested the association between bipolar disorder and creativity is a popular one, and may be spurious in Van Gogh's case.
Borderline personality disorder Van Gogh is believed by some to have had borderline personality disorder; he "displayed symptoms best consistent with a borderline (personality) disorder: impulsivity, variable moods, self-destructive behaviour, fear of abandonment, an unbalanced self-image, authority conflicts and other complicated relationships." Dutch psychiatrist Erwin van Meekeren proposed in his book, Starry Starry Night: Life and Psychiatric History of Vincent van Gogh, that borderline personality disorder is the most likely explanation for Van Gogh's behavior. Dr. John G. Gunderson, an expert on borderline personality disorder, concurred that Van Gogh's "longings for love, his sudden mood changes (and most particularly his seemingly unpredictable and unwarranted rages), and his pattern of impulsive acts, including substance abuse, are all recognizable components of the borderline syndrome...whether Van Gogh was borderline or not, it is a useful prism through which to view his troubled life."
Sunstroke The possibility that Van Gogh might have suffered some form of chronic sunstroke was advocated strongly by Roch Grey.Grey, R. Vincent van Gogh, Valori Plastici, Rome, 1924. 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."letter B15 to Émile Bernard, c. 18 August 1888 A month earlier he had mentioned the effects of the sun in passing in a letter to Theo:
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," but attempts to confirm this attribution have failed.
Ménière's disease