Researchers used structured diagnostic interviews to investigate the likelihood of all of Vincent van Gogh’s possible psychiatric problems and disorders. Such an extensive psychiatric examination – based on his extensive correspondence and existing medical information – had never been done before. Some theories were confirmed, others were disproved. The researchers discovered that Vincent van Gogh most likely suffered twice from delirium probably caused by alcohol withdrawal after he cut off his own left ear. The research, coordinated by Emeritus Professor of Psychiatry Willem Nolen of the UMCG, was published today in the International Journal of Bipolar Disorders.
The Dutch painter Vincent van Gogh died on 29 July 1890 as a result of a suicide attempt two days earlier. Since then, many different medical and psychological theories have been put forward regarding the illnesses from which he suffered. Many of these theories used a ‘top-down’ approach, through which a disease was assumed on the basis of a limited set of arguments, without taking into account any other information that did not fit that particular picture. Emeritus Professor Willem Nolen: ‘In our research, we used a “bottom-up” approach: we investigated all possible mental symptoms using structured diagnostic interviews as well as all possible epileptological symptoms. Of course, we couldn’t interview Van Gogh himself to do that.’ To this end, the researchers interviewed three art historians who know Van Gogh well from his correspondence (902 letters, including 820 to his brother Theo) and from information from the doctors who treated him.
Van Gogh suffered from a combination of several psychiatric disorders, known as comorbidity. It is, however, impossible to diagnose any of these disorders with absolute certainty, although several frequently suggested theories are confirmed as being likely. From early adulthood, he mentioned in his letters various symptoms consistent with a – most likely bipolar – mood disorder in combination with a – most likely borderline – personality disorder. This was exacerbated by an alcohol addiction and malnutrition. Coupled with increasing psychosocial tensions (including a conflict with his friend and colleague Paul Gauguin), this led to a crisis during which he cut off his ear on 23 December 1888.
A new theory put forward by the researchers is that Van Gogh subsequently experienced two brief psychotic episodes, presumably delirium due to alcohol withdrawal, because he was forced to suddenly stop drinking alcohol following his admission to hospital after the ear incident. His condition then deteriorated further and in the last year of his life he experienced several severe depressive episodes, at least one of which had psychotic features. He was unable to make a lasting recovery, which probably led to his suicide in July 1890.
The researchers found that several other suggested diagnoses were highly improbable. For example, there were no obvious signs that he suffered from schizophrenia and they ruled out porphyria (a rare metabolic disease) and gas poisoning (due to carbon monoxide from lamps).
A remaining question as to whether Van Gogh suffered from epilepsy is still open for discussion. His own doctors established this diagnosis, most likely referring to ‘masked epilepsy’. This means that the patient does not have classic seizures, but rather a behavioural disorder based on epileptic activity in the deeper parts of the brain. Today, this diagnosis is also known as focal epilepsy, with seizures resulting in extremely variable manifestations of anxiety, delusions and hallucinations. In Van Gogh’s case, this could have been caused by brain damage as a result of his lifestyle – alcohol abuse, malnutrition, poor sleep and mental exhaustion. Since additional examinations (in particular, EEG and imaging techniques) were not available in his day, the likelihood of him having had epilepsy is, however, difficult to quantify. As a result, the researchers argue that focal epilepsy as a comorbidity in addition to his psychiatric disorders, cannot be ruled out.
Has this research finally confirmed which illnesses Vincent van Gogh suffered from? ‘We think we can safely rule out some previously suggested diagnoses and we are more or less certain about several illnesses that he suffered from, but we will never really know for sure,’ says Nolen. ‘We were not able to interview the patient personally, which means that we must exercise caution in our conclusions. And although Van Gogh’s letters contain a lot of information, we must remember that he didn’t write them to his doctors, but to his brother Theo and other family members and other relatives in order to inform them, to reassure them or to get something done. He might have downplayed or even embellished certain things. Therefore, our article certainly won’t be the last on Van Gogh’s illnesses.’
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