The Wing of Madness: The Illness of Vincent van Gogh*

J.C.A. MORRANT, M.B.B.S. 1

This paper. briefly describes some aspects of Vincent van work. He later suffered from three psychotic episodes at Arles
Gogh's life and attitudes. It discusses absinthe and several - during the first he cut off his ear. At Saint Remy, he later
psychodynamic factors that may have contributed to his had a series of seizure-like attacks which sound different from
psychotic episodes at Aries, when he cut off his ear. It dis- his psychoses. His illnesses appear as clouded clinical pic-
cusses Vincent's descriptions ofhis illness, especially at Saint tures because of the various physical and psychological
Rem» de Provence and concludes that he probably suffered assaults affecting him at those times. Unfortunately, we have
from partial complex seizures (temporal lobe epilepsy) with little more to go on in making retrospective diagnoses than
manic depressive mood swings aggravated by absinthe, Vincent's vast correspondence to his brother Theo. This
brandy, nicotine and turpentine. paper briefly describes some aspects of Vincent's personality
and his illnesses, which seem to be woven together.

V incent van Gogh saw himself as a rough peasant painter

and wanted his work to hang in every kitchen. He sold
only one painting but became the greatest Dutch painter of
Vincent's Boyhood
the 19th century. On July 27, 1890 he staggered to the Vincent van Gogh was born in Groot Zundert in southern
Ravoux' Cafe in Auvers-sur-Oise where he had a room. "I Holland in 1853. His brother, also named Vincent, had been
shot myself," he told M. Ravoux, "I only hope I haven't still-born one year before, and the new Vincent was thus a
botched it." Dr. Paul-Ferdinand Gachet and his village col- "replacement baby," who was then displaced in tum by his
league could not remove the bullet. Vincent shrugged, lit his siblings Anne, Theo, Elizabeth, Wilhelmina and Cornelius.
pipe and said, "I will do it allover again, don't cry. I did it for Their mother was a placid soul of magnificent incomprehen-
the good of us all." He died two days later in the arms of his sion. Their father was an earnest, humourless, selfsacrificing
brother, Theo, murmuring, "La tristesse durera" (sorrow pastor in the Dutch Reformed Church - actually, quite like
never ends) (1). Vincent had been mentally ill for some time. Vincent in personality. Rev. and Mrs. van Gogh sound sensi-
The French Impressionist painter Camille Pissaro referred ble, kindly and harmless enough, but several of their children
him to Dr. Gachet, an elderly widower and homeopath, who became mentally ill. Theo suffered from depression and
had written a treatise on melancholia and was an amateur attacks of severe anxiety and died from "dementia paralytica"
artist. "He seems very sensible; but he is as discouraged about in the Medical Institute for the Insane in Utrecht (5). Wilhel-
his job as a doctor as I am about my painting," wrote Vincent mina suffered from a "schizophrenia" and spent 40 years in
to Theo (2). Vincent's "Portrait of Dr. Gaehet" sold recently the same asylum. Cornelius committed suicide at the age of
for 82 million dollars, a price which would have mortified the 33. Every week, the family marched to chapel past the grave
young artist with his depressive self-hatred and humility. His of Vincent's namesake, with whom the young "replacement"
"Irises", which sold for 49 million dollars, made Monet was invidiously compared. Small wonder he grew up possess-
exclaim, "How, ah! how did a man who loved flowers and ing little self-esteem and a sharp awareness ofdeath. Symbols
light to such an extent, and who rendered them so well, how of death recur in his paintings, as do symbols of birth and
then did he manage to be so unhappy?" (3). How indeed? rebirth (6).
Well, as "AE" wrote (4):
In ancient shadows and twilights Vincent had mixed attitudes toward his father and, by
Where childhood had strayed, extension, toward God. He was deeply religious, attended
The world's great sorrows were born three different churches on Sunday, slaved in the Borinage as
And its heros were made. an evangelist and translated the gospels into several
In the lost boyhood of Judas languages. Later, when his boyish idealization of his father
Christ was betray'd. crumbled, he began to think of God as a mother and dropped
Vincent's troubled personality and depressive tempera- his patronymic, calling himself simply "Vincent". Vincent's
ment drove him to a life of punitive self-sacrifice and over- ambivalence about the death of his father showed in his
painting of Zola's book,Joie de Vivre, which his father hated,
set next to the Bible open at Isaiah.
'Manuscript received October 1991, revised December 1992.
I Consultant Psychiatrist, Private Practice, Vancouver, Be.
Vincent, who considered himself ugly and coarse, identi-
Address reprint requests to: J.C.A. Morrant, 210 - 2025 West 42nd Avenue, fied with Isaiah's description of the Messiah: "He shall grow
Vancouver, British Columbia V6M 2B5 up as a root of dry ground: he hath no comeliness. He is
despised and rejected of men; a man of sorrows and
Can. J. Psychiatry Vol. 38, September 1993 acquainted with grief' (7).

480
September, 1993 THE WING OF MADNESS 481

Vincent and Women plant which grows about five feet tall. Its English name,
wormwood, comes from its woody stems and its use as an
Vincent had a troubled personality and seemed depressed anti-helminthic which paralyses intestinal round worms. The
for most of his life. "A man of sorrows acquainted with grief' French troops in Algeria in 1840 added absinthe to their wine,
is hardly champagne to the average woman. He never painted believing it was a tonic and febrifuge.
an attractive woman or had a happy relationship with one. Absinthe became popular in Paris. Several cafes and res-
Vincent may have fallen in love for several reasons: to taurants featured it in a special "heure verte" (the green hour).
appease his longing for a mother; to pump up self-esteem; as Absinthe is one of the bitterest plants known, except for rue,
a salve for self-hatred - but to avoid intimacy. When he was and drinkers enjoyed pouring water into the liqueur through
20, he proposed to Eugenie Loyer, his landlady's daughter. a lump of sugar suspended above the glass on a silver sieve.
His proposal may have been a sign of depression and a need Water diluted the liqueur, causing terpene colloids to form,
for help. He characteristically chose someone who was un- which changed the green drink into a cloudy yellow (8,9).
able to relate to him; Eugenie was already engaged. Vincent Artemisia absinthium contains a toxin called thujone in
was predictably rejected and blamed her for his deepening common with sage, tansy and the thuja tree or white cedar.
gloom and "years of humiliation." In his longing for a mother, Vincent painted many thuja trees. Absinthe drinkers were in
he repeated the painful choreography with Eugenie with his danger of a double intoxication, from alcohol and from
cousin, Kee Vos-Stricker, who was literally a mother with a thujone (8,9).
little boy. Kee's husband had recently died, so she was not
Artists relished absinthe because it sharpened perceptions
ready for another relationship and fled from Vincent's
and induced a cheerful mood. Absinthe could also cause
advances.
hallucinations of vision and hearing, morbid suspiciousness,
Vincent next chose another mother, Clasina Maria angry excitement, impulsive violence and an abstinence
Hoomik or "Sien", a pregnant prostitute who had a little delirium lasting far longer than it would from alcohol.
daughter and who was the model for his famous drawing Verlaine, who was addicted to absinthe, was cruel to his wife
"Sorrow". They could not forge a warm relationship, and and shot and wounded his lover, the poet Rimbaud. The drink
Vincent likely found the time he spent receiving a painful was eventually banned in France in 1915 although it lives on
treatment for gonorrhea to be a welcome diversion from the as Pemod, which now contains anise but is devoid of absinthe.
poisonous atmosphere at home. Eventually he left her and
went to Drenth to paint in an ambiance of rain and loneliness
cognate with his inner landscape. An older woman fell in love
Vincent in Aries
with Vincent, but she became demoralized by her family's
disapproval of him and by his procrastination in consummat- Vincent travelled to Aries in 1886 in a good mood. He was
ing the relationship. She took strychnine, somewhat to looking forward to founding an artists' colony with Paul
Vincent's relief, and was sent to the same asylum in Utrecht Gauguin. He may have had a spell of hypomania, for he said
where his brother and sister were later housed. ideas came to him "in swarms" and that he was in a continuous
fever of work, even pegging his easel down or kneeling on it
Vincent, Theo and Absinthe against "the devil mistral." He could not sleep and neglected
himself badly. For years he had taken a flask of brandy on his
During this time, Theo became Vincent's greatest friend painting expeditions and wrote, "if the storm within gets too
and confidant, although Theo was four years younger. Each loud, I take a glass too much to stun myself' (2).
man became a father-figure to the other. Vincent called Theo His dear friend, Signac, visited him and wrote, "Never did
"boy", but Theo paid Vincent a reasonable allowance in he give me the impression of being a madman. Though he ate
exchange for Vincent's paintings, which he hoped to sell and, hardly anything, what he drank was always too much ...the
afterward, divide the money between them. Vincent wrote absinthes and brandies would follow each other in quick
700 letters to Theo which are so crisp, clear and devoid of succession.... He was charm personified. He loved life
thought disorder that a concurrent diagnosis of schizophrenia passionately. He was ardent and good." People noted how
is impossible to defend. charming and affectionate Vincent could be, but several
In 1886, Vincent stayed with Theo for two years in Paris. events may have temporarily changed this. Signac once
He met the Impressionists, whose work stunned him. He gave stopped Vincent from gulping turpentine, and Vincent was
up his drab and muddy palette forever and tried their gay, bold seen to do this again. Turpentine gives a pleasant feeling of
colours. Toulouse-Lautrec, who was addicted to drink, prob- warmth in the stomach, later followed by a mood of exhila-
ably introduced Vincent to absinthe and painted him with a ration and mental changes before going on to damage the
glass of it. lungs, kidneys and liver. Turpentine can also be absorbed
Absinthe was a clear emerald green liqueur named after through the skin. Vincent was a notoriously messy worker
the absinthe daisy, Artemisia absinthium. It was an alcoholic who attacked his paintings as ifhe were armed with a Gatling
brew containing the absinthe daisy and approximately gun. The paint on his brush and thumb became so thick that
14 other herbs, such as fennel, star anise, hyssop, melissa, it trickled off the canvas. Vincent may have taken turpentine
veronica and angelica. Artemisia absinthium is a perennial occasionally for self-destructive reasons or for its psycholog-
482 CANADIAN JOURNAL OF PSYCHIATRY Vol. 38, No.7

ical effects. He described his treatment for sleeplessness: "I right eye offend thee, pluck it out.... And if thy right hand
fight this insomnia with avery, very strong dose of camphor offend thee, cut if off and cast [it] from thee...." (Matthew 5:
in my pillow and mattress, and if ever you can't sleep, I 29-30).
recommend this to you" (2). Both camphor and thujone, The ear is an erotic organ (the Dutch for ear lobe "lel"
found in absinthe, are ketone-terpenes with the same empiri- sounds like "lul", the Dutch slang for penis), and Arles is a
cal formula, have similar pharmacodynamics and are both bull-fighting town where the victorious matador parades
convulsants. Von Meduna in Budapest used to inject camphor around the ring and gives the dead bull's ear to his lover.
as a convulsant treatment for schizophrenia (9). Nicotine Vincent's present to Gaby may have been a token of love and
lowers the convulsive threshold for thujone and Vincent was an acknowledgement of having been defeated by the virile,
also a heavy pipe smoker. competitive Gauguin, of whom he wrote: "With Gauguin,
When Paul Gauguin arrived in Arles, things began to sour. blood and sex triumph over ambition" (2). Perhaps he was
Vincent could not tolerate closeness and the ebullient influenced by newspaper accounts of the Whitechapel
Gauguin tended to criticize his work, which was anathema to murders by Jack the Ripper, who cut off his victims' ears.
a man whose art was his sole raison d' etre. Gauguin also However, Vincent did not know why he did it.
enjoyed Vincent's girl, Gaby, at the local "maison de Vincent made light of the episode and reassured himself
tolerance n.l,' where they went for "hygienic purposes," as and his friends that he was completely well when he wrote,
Vincent called them. Vincent was ever ready to counsel "I hope I have just had simply an artist's freak..." (2). But he
others against sexual release but he may have been making a had felt the wind of the wing of madness pass over him and
virtue of a waning sexual appetite and hoping unspent energy he had a "fear and horror of madness ..." (2). Dr. Felix Rey, a
would improve his painting. young resident physician, looked after Vincent for two weeks
Winter imprisoned the pair in the "yellow house" that at Arles Hospital. The attack lasted for seven days and
Vincent had rented. Several things happened at once which Vincent muttered confusedly about religion and philosophy
combined to cause a tragedy. First, Theo became engaged and and thought compulsively about Degas (2). In February 1889,
planned to spend Christmas with his fiancee, Jo. Vincent thus Vincent was readmitted for ten days, two weeks after Joseph
had to face spending Christmas alone and risked, through his Roulin left for Marseilles. Vincent was shortly discharged,
brother's forthcoming marriage, losing his allowance and his but 80 citizens, whom he had accused of poisoning him,
confidant. Then the postal office agent Joseph Roulin, petitioned for his readmission. He ranted at them for their
Vincent's dear friend and father-figure, was to be transferred cowardice and wished he had a revolver to protect himself.
to Marseilles. Last but not least, Gauguin decided to return to Vincent's psychotic episodes may have been complex
Paris. All hopes for an artists' colony collapsed. Vincent partial seizures, which are also called temporal lobe or psy-
weathered his abandonment very badly. Gauguin painted chomotor epilepsy. They may have been brought on by ab-
Vincent's picture, about which Vincent said, "It's me all right, sinthe, turpentine and camphor and the illness aggravated and
but me gone mad." He sat for hours glumly glaring into space prolonged by alcohol, nicotine, insomnia, anxiety and over-
and noted, "arguments are terribly electric" (2). work. Vincent described no loss of consciousness but noted
two symptoms which are experienced in some partial
Vincent and the Mutilation complex seizures. One is compulsive thinking; he thought
compulsively about Degas. The second is "compulsive-
Gauguin woke up a couple of times, saw Vincent standing reminiscence." He wrote: "During my illness I saw again
by his bed and sent him away. On December 23, 1888 at every room in the house at Zundert, every path, every plant
11:30 pm, Vincent threw absinthe in Gauguin's face, stag- in the garden, the views in the fields outside, the neighbours,
gered to the "maison de tolerance n.l" and gave Gaby the the graveyard, the church, out-kitchen at the back - down to
lower half of his left ear wrapped in drawing paper. "Keep a mag-pie's nest in a tall acacia in the graveyard" (2).
this object carefully," he said. She fainted. The police found He slid into a deep depression from loss of blood and
Vincent at home, his head wrapped in blood-soaked sheets, brooding about his attacks. Depression and suicide are com-
and at first arrested Gauguin for murder. "I would not wish a mon among patients with epilepsy. In March 1889, Vincent
moment like that on anyone," said Gauguin. ate oil paints and drank turpentine again - probably in
I suspect he visited Gaby less from lust than loneliness unacknowledged rage at Theo who was to marry Jo a month
and, like Jesus Christ, preferred her to priests and princes: later, in April, at which time Vincent wrote to his sister
"Yes, and I tell you that tax-collectors and prostitutes are Wilhelmina: "Every day I take the remedy which the incom-
going into the kingdom of God in front of you" (Matthew 21: parable Dickens prescribes against suicide. It consists of a
31). When he later apologized to Gaby for making a scene, glass of wine, a piece of bread with cheese and a pipe of
she endearingly responded that such things were not out of tobacco ...this is the limit to which melancholy will take me;
the ordinary in Arles, all the same, at some moments - oh dear me..." (2).
Several people have thought of reasons why Vincent cut He could stand it no longer. In May 1889, Vincent went to
off his ear (10). Vincent was deeply religious and believed the private asylum of Sainte-Paul-de-Mausole at Saint Remy
that hallucinations of hearing come from disease of the audi- de Provence. Three months later he was so ill, probably from
tory nerve. He may have obeyed Jesus' teaching: "And if thy a severe depression, that he could not work for 45 days. Dr.
September, 1993 THE WING OF MADNESS 483

Peyron, a retired eye specialist, looked after him. His notes Vincent tired of St. Remy after a year and wrote: "The
are poor, but Vincent's letters describe many symptoms treatment of patients in this hospital is certainly simple...for
which resemble those of partial complex seizures. the authorities do absolutely nothing; they leave us to vegetate
Complex partial seizures may start with an aura or an in idleness and feed us with slightly spoiled food" (2). He left
aura-like change in mood or consciousness, occasionally in May 1890, and Theo arranged for him to stay near Dr.
lasting for hours or days before a sudden onset of confusion. Gachet at Auvers-sur-Oise.
There may be perceptual distortions, including hallucinations Vincent was cheerful and productive at first and painted
of vision and hearing. A patient may experience delusions, two portraits of Dr. Gachet including a sprig of foxglove,
changes in mood and then a sudden recovery sometimes which was prescribed for depression. Suggestions that it
followed by a mood of guilt and despair (11). If Vincent aggravated Vincent's mental problems and made him paint
suffered from partial complex seizures at Arles, some of them things yellow from xanthopsia seem unconvincing. After all,
underwent secondary generalization with a loss ofconscious- sunflowers and corn are yellow and the paint was thickly
ness in the asylum at Saint Remy. applied because the pigment was of poor quality and Vincent
Vincent suffered from a prodrome of morose irritability feared it would fade. Dr. Gachet, a homeopath, would only
before an abrupt onset: "My work was going well ... And then have prescribed tiny doses of foxglove, if he prescribed it at
next day, down like a brute..." (2) Often he lost consciousness: all. Soon, however, Vincent's melancholy returned.
"But during the attacks it is terrible - and then I lose
consciousness of everything" (2); and later: "I dropped The End
unconscious three times without any recognizable reason ..."
(2). Or he became confused: "For many days my mind has Vincent visited Theo and Jo on July 6, 1889. He had been
been absolutely wandering" (2). He suffered from perceptual further displaced from Theo by their baby, who was discon-
changes: "However the unbearable hallucinations have certingly named Vincent. He quarrelled furiously with Theo
ceased, and are now getting reduced to a simple nightmare, about money, causing Vincent to leave in anger: "My life is
in consequence of my taking bromide of potassium I think" threatened at the very root." Later, as had happened at Arles,
(2) and: "[other patients] have also heard strange sounds and Vincent was rejected when Theo refused to spend a holiday
voices ...in their eyes too things seemed to be changing" (2). with him. This time Vincent bought his revolver.
Memory can be disturbed by partial complex seizures. On July 27, 1890 he was overheard muttering, "It's impos-
Strangers looked to Vincent like people he had known in the sible, it's impossible," as he strode to work. Later that day he
past (2) and some paintings showed a mixture of past and shot himself. The bullet entered his chest at the level of the
present scenes. axillary line. Dr. Gachet and Dr. Mazery could not remove it.
His mood changed: "inner seizures of despair." Then he
had a sudden remission: "the whole horrible attack has disap- Conclusion
peared like a thunderstorm" with amnesia for the attack: "I
have completely lost the recollection of those days," then a Drs. Rey and Peyron diagnosed Vincent as having suffered
recovery with mental fogginess: "I'm terribly dazed in the from epilepsy complicated by sun-stroke and turpentine poi-
head" (2). soning. They would probably have been familiar with turpen-
A recent paper has claimed Vincent had Meniere's disease tine as a medicine, since it was used until the end of the
(12). It was soundly criticized by Freedman for "misquota- century, but they never mentioned absinthism, although it was
tions, misleading and intentionally incomplete quotations, five times more common in Arles than in the rest of France.
quotations out of context, cavalier editing of van Gogh's Arnold makes a convincing case for absinthe poisoning (8).
letters (for example, 'attacks' being juxtaposed to 'vertige'), It is hard to blame their childhood for the serious mental
and twisting of symptoms to fit the proposed diagnosis illnesses afflicting Vincent, Theo, Wilhelmina and Cornelius.
(Meniere's disease)" (13). Monroe also criticized the paper A genetic (biochemical) contribution was at work. Vincent
and believes Vincent suffered from subcortical (focal) certainly had several severe and long-lasting episodes of
seizures (14,15). depressive illness and at least two ofa condition that sounds
There are some points against Vincent having Meniere's like hypomania that occurred during his early weeks with
disease. Vincent never complained of hearing loss. He never Sien and at Arles, where he also had his psychotic episodes.
complained of tinnitus but of, "sounds and voices." Nor did I believe Vincent suffered from a personality disorder asso-
he cut off his ear because of unbearable tinnitus. He did not ciated with a cyclothymic temperament or even manic-
know why he did it. Dr. Peyron, an eye specialist, never noted depressive illness, later complicated by complex partial
nystagmus, and Vincent's complaint that objects changed seizures. In Arles, his psychotic episodes were probably
shape is not a feature of nystagmus. He never complained of complex partial seizures, partly brought on and aggravated by
nausea and vomiting but of a "weak stomach," doubtlessly absinthe (containing the convulsant thujone), turpentine and
the result of gastritis from alcohol, coffee, tobacco, and heavy smoking, which lowers the convulsant threshold for
probably turpentine. It is rare to lose consciousness with thujone. The clinical picture was further muddled by insom-
Meniere's disease: "I dropped unconscious three times with- nia, overwork, worry and his deficient diet, which could have
out any recognizable reason" (2). caused subclinical scurvy. At Saint Remy, his complex partial
484 CANADIAN JOURNAL OF PSYCHIATRY Vol. 38, No.7

seizures probably underwent a secondary generalization with 11. Lishman WA. Organic psychiatry. London: Blackwell Scien-
loss of consciousness. We do not know if syphilis contributed tific Publications, 1987.
to his mental state (8). Dr. Gachet and Marguerite, his heart- 12. Arenberg K, Countryman LF, Bernstein LH, et al. Van Gogh
broken daughter, planted sunflowers over Vincent's grave had Meniere's disease and not epilepsy. JAMA 1990; 264:
and later, with unintended irony, a thuja tree, which still 491-493.
stands today. 13. Freedman AL. Letter. JAMA 1991; 265: 723.
14. Monroe RR. The episodic psychosis of Vincent van Gogh. J
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