Vincent van Gogh's medical condition

There is no consensus on the medical condition of Vincent van Gogh. Many competing hypotheses have been put forward. These include epilepsy, bipolar disorder, sunstroke, acute intermittent porphyria, lead poisoning and Ménière's disease.

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.

One of the most frequent complaints in Van Gogh's letters is the problems he endured with his stomach and 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 hallucinations [See 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. He was unable to sleep for three weeks prior to his diagnosis of gonorrhea in The Hague. ["I have not been able to sleep for several nights, and have been feverish and nervous." [http://webexhibits.org/vangogh/letter/11/200.htm Letter 200] from The Hague, circa 23 May 1882. ( [http://webexhibits.org/vangogh/letter/12/etc-322b.htm 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." — [http://webexhibits.org/vangogh/letter/11/206.htm 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 [http://webexhibits.org/vangogh/letter/18/506.htm Letter 506] ] and a month later when he wrote to Bernard it seemed to still be very much on his mind. [See [http://webexhibits.org/vangogh/letter/18/B14.htm Letter B14] ] Towards the end of Van Gogh's life he had thoughts of suicide. [See letters 588, 602a, 605]

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 [ [http://www.arthistoryarchive.com/arthistory/expressionism/Vincent-Van-Gogh.html Vincent Van Gogh - Biography, Quotes & Paintings] , retrieved June 14th 2007.] . 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 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?" [ [http://webexhibits.org/vangogh/letter/20/T23.htm Letter T23] ] 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." [ [http://webexhibits.org/vangogh/letter/20/T24.htm Letter T24] ]

Diagnoses

Epilepsy

Epilepsy has been a popular diagnosis. Van Gogh himself thought that he might be an epileptic [Van Gogh wrote from Arles that the townspeople regarded him "a madman or an epileptic" — [http://webexhibits.org/vangogh/letter/19/589.htm letter 589] ] and his doctor Felix Rey 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, [http://webexhibits.org/vangogh/letter/20/592.htm 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" — [http://webexhibits.org/vangogh/letter/20/etc-from-Peyron.htm letter from Dr. T. Peyron to Theo van Gogh] ] A diagnosis of temporal lobe epilepsy was originally put forward in 1928 by Leroy and Doiteau [Doiteau, 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.Arnold, page 172] 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." [Perry, I. 'Vincent van Gogh's illness: a case record' in "Bulletin of the History of Medicine," 1947, Volume 21, pages 146-172.] It fits well with the well documented periods of intense activity interspersed with periods of exhaustion and possible depression. ['My brain is still feeling tired and dried up' in [http://webexhibits.org/vangogh/letter/18/558b.htm 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. [Hemphill, R.E. 'The illness of Vincent van Gogh', in "The Proceedings of the Royal Society of Medicine," 1961, Volume 54, pages 1083-1088.]

unstroke

The idea 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." [ [http://webexhibits.org/vangogh/letter/18/B15.htm letter B15] to Emile Bernard, c. 18 August 1888] 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." [ [http://webexhibits.org/vangogh/letter/18/512.htm letter 512] c. 19 July 1888] 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," [Beer, J. 'Van Gogh: diagnosis of the tragedy', in "Art News Annual," 1950, Volume 19, special number, pages 82-90.] but attempts to confirm this attribution have failed. [Arnold, page 181]

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. [Yasuda, K. 'Was van Gogh suffering from Ménière's disease?' "Otologia Fukuoka," (1979) 25: 1427 - 1439.] This idea then reappeared in 1990 in the Journal of the American Medical Association (JAMA). [I. K. Arenberg, L. F. Countryman, L. H. Bernstein and G. E. Shambaugh Jr, [http://jama.ama-assn.org/cgi/content/abstract/264/4/491 'Van Gogh had Meniere's disease and not epilepsy'] , Journal of the American Medical Association, Vol. 264 No. 4, July 25, 1990] 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.Arnold, page 185] 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 tinnitis has been regarded as far-fetched.

Lead poisoning

Vincent was reported to nibble at his paints at times; this could account for various forms of metal poisoning. Of the various metals contained in paints, poisoning by lead most closely matches van Gogh's symptoms. Symptoms of lead poisoning include abdominal pain, constipation, vomiting, paralysis or paresis. [Arnold, page 191]

Acute intermittent porphyria

Arnold and Loftus put forward the diagnosis of Acute Intermittent Porphyria (often referred to as simply "AIP"). [Loftus, L.S., Arnold, W.N. 1991. Vincent van Gogh's illness: acute intermittent porphyria. "British Medical Journal" 303: 1589-1591.] Arnold suggests the AIP was exacerbated by malnutrition and absinthe abuse. [Arnold, pages 139-164] 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 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, Kathleen Powers. "At Eternity's Gate: The Spiritual Vision of Vincent van Gogh", 1998, ISBN 0-8028-4978-4, pages 120 - 123] 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.

Other diagnoses

Van Gogh's primary complaints have also been variously attributed to syphilis [ [http://www.pubmedcentral.nih.gov/articlerender.fcgi?artid=535989 The fine art of patient-doctor relationships ] ] [Loftus LS, Arnold WN. Vincent van Gogh's illness: acute intermittent porphyria? BMJ 1991;303: 1589-91.] [Jamison KR, Wyatt RJ. Vincent van Gogh's illness. BMJ 1992;304: 577.] and absinthe intoxication.

References

* Arnold, Wilfred N. "Vincent van Gogh: Chemicals, Crises, and Creativity," Birkhãuser, Boston, 1992. ISBN 0-8176-3616-1.
* Hayden, Deborah "Pox: Genius, Madness, and the Mysteries of Syphilis," Basic Books, 2003, ISBN 0-465-02882-9.

Notes

External links

* [http://www.med.wayne.edu/elab/vangogh2/vangoghindex.htm Wayne State University Medical School course notes on Van Gogh's illness]