Saturday, March 30, 2013

Vincent Van Gogh

Born March 30, 1853.

Van Gogh has always been an fascinating case study for psychiatrists and others. Historical psychiatric detective work is always an interesting diversion.

I have always been partial to Kay Redfield Jamison's argument for a manic-depressive illness diagnosis for Van Gogh.  This letter to the editor by Kay Redfield Jamison ("Vincent Van Gogh's illness") is well worth reading as an example of sound diagnostic reasoning (which happens to take base rates into account). She rips apart another diagnostician's conclusion that Van Gogh suffered from acute intermittent porphyria and makes a solid case for manic-depression. This special edition of Scientific American has a good article by Jamison on manic-depressive illness and creativity (starting on page 44).

In 2002, the American Journal of Psychiatry published a case study by Dietrich Blumer that argues for a form of epilepsy (combined with a bipolar illness). Here's the abstract:

"Vincent van Gogh (1853–1890) had an eccentric personality and unstable moods, suffered from recurrent psychotic episodes during the last 2 years of his extraordinary life, and committed suicide at the age of 37. Despite limited evidence, well over 150 physicians have ventured a perplexing variety of diagnoses of his illness. Henri Gastaut, in a study of the artist’s life and medical history published in 1956, identified van Gogh’s major illness during the last 2 years of his life as temporal lobe epilepsy precipitated by the use of absinthe in the presence of an early limbic lesion. In essence, Gastaut confirmed the diagnosis originally made by the French physicians who had treated van Gogh. However, van Gogh had earlier suffered two distinct episodes of reactive depression, and there are clearly bipolar aspects to his history. Both episodes of depression were followed by sustained periods of increasingly high energy and enthusiasm, first as an evangelist and then as an artist. The highlights of van Gogh’s life and letters are reviewed and discussed in an effort toward better understanding of the complexity of his illness."Abstract Teaser

Here's a portrait by Van Gogh of one of his psychiatrists, completed while in the asylum at Saint-Remy.
Portrait of Doctor Gachet
Letters by Van Gogh suggest some ambivalence about the good doctor:

"I think that we must not count on Dr. Gachet at all. First of all, he is sicker than I am, I think, or shall we say just as much, so that's that. Now when one blind man leads another blind man, don't they both fall into the ditch?"

In a letter dated two days, he wrote, "I have found a true friend in Dr. Gachet, something like another brother, so much do we resemble each other physically and also mentally."

Finally, last summer 60 Minutes aired an interesting segment that suggests that Van Gogh was a victim of a firearm accident, not suicide. You can view it here.


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