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Van Gogh Museum Journal 2003 (2003)

Van Gogh Museum Journal 2003

(2003)– [tijdschrift] Van Gogh Museum Journal–rechtenstatus Auteursrechtelijk beschermd

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illustratie
fig. 1
Anna van Gogh-Carbentus to Theo van Gogh, Leiden, 29 December 1888, Amsterdam, Van Gogh Museum (Vincent van Gogh Foundation)


The illness of Vincent van Gogh: a previously unknown diagnosis
Leo Jansen, Hans Luijten and Erik Fokke+

The enormous volume of writing inspired by Vincent van Gogh's illness ranges from mere speculation to serious attempts to gain insight into what he actually suffered from. His life was beset by difficulties, and he himself was well aware of his melancholic temperament, sensitive nature and nervous character, to which his extensive correspondence bears witness. There was friction in the Van Gogh family; several of his infatuations remained painfully one-sided; he never completed any course of education; the various jobs he had all came to nothing; and in 1882 he had to be treated for gonorrhoea in the ‘citizens' hospital’ in The Hague.1 Those around him also suffered from his overwrought state and high-strung nature. As evidenced by the extant letters, Van Gogh's non-conformity and obstinacy were frequently the subject of family correspondence, which reveals how often his parents voiced their anxiety and concern about him. They seldom mention his health, however, let alone his mental health. Generally they talked about how eccentric he was and what strange ideas he had. They also worried about his nervous exhaustion and his unfitness for practical life, and deplored his ‘dejected mood.’2 In March 1878 Vincent's father wrote: ‘Is it surprising that we feel pain and sorrow upon discovering that he has absolutely no joy in life? But he always just plods on, with his head bowed, while we did what we could to help him towards an honourable goal! It is as though he deliberately chooses the difficult path.’3 And a month later he wrote: ‘I fear it is an unhealthy existence he has made for himself.’4

Most of the interest in Van Gogh's case history has understandably focused on the last 18 months of his life (1888-90), the period in which he was living and working in Arles, Saint-Rémy-de-Provence and Auvers-sur-Oise. In Arles an act of self-mutilation landed him in hospital; in Saint-Rémy he had himself committed to the Saint-Paul-de-Mausole asylum, where he suffered several nervous breakdowns; and finally, on 27 July 1890, he shot himself in the chest in Auvers, where he died of his injuries two days later.

A variety of illnesses have been ascribed to Van Gogh over the years, including syphilis, dementia praecox, hallucinatory psychosis, alcoholism and turpentine poisoning.5 Théophile Peyron (1827-1895), director of the hospital at Saint-Rémy, informed Theo that he saw Vincent not as a lunatic but as someone suffering from attacks of an



illustratie
fig. 2
Anna van Gogh-Carbentus, c. 1885, Amsterdam, Van Gogh Museum Archives


epileptic nature.6 P.H.A. Voskuil arrived at a similar conclusion in his comprehensive study, which, in so far as his findings apply to the ‘attacks of an epileptic nature,’ suggests that such symptoms did not appear until 1888.7

The complaints Vincent suffered from include the following:

Spells of confusion, which included sleep-walking, a feeling of emptiness in the head, a stuporous state, the ingestion of paint and rubbish from the floor, and possibly drinking - or attempting to drink - turpentine.

Hallucinations resembling ecmnesia, such as déjà-vu déjà-vécu, in which he saw details of his native village of Zundert; paranoid delusions, in which he imagined he was being followed by the police and a crowd of people, or was afraid of being poisoned; nightmares; and a state of anxiety displaying violent agitation.

Tonic convulsions, during which he fell to the ground.

Personality disorders and hypo-sexuality, the latter manifesting itself after the attacks during the last years of his life.

Voskuil concluded that Van Gogh inhabited an interesting borderline region between neurology and psychiatry: ‘Epilepsy as we define it today was not the most probable diagnosis in Van Gogh's case. In this exceptional man his very complicated symptomatology can best be explained by complementary and not contradictory psychological and neurophysiological factors. The latter cause the psychiatric disturbance including dysfunction of the temporal lobe, partly because of, but not always at the same time as, thujone intoxication. Added to these, neurotic development, psychological stress and possible genetic traits, caused symptoms which may have been manifested as epileptic limbic activity.’8 Temporal lobe epilepsy is characterised by a complex relationship between epilepsy and depression; people suffering from this complaint are 25 times more likely to commit suicide.

 

A document only recently discovered sheds some light on the course taken by Van Gogh's illness: a letter written by his mother, Anna Cornelia van Gogh-Carbentus (1819-1907) (figs. 1 and 2) in December 1888 - an eventful month in the artist's life, when Van Gogh and the painter Paul Gauguin were living in the Yellow House in Arles. The letter dates from a few days after Vincent had cut off part of his ear, which had occurred just before Christmas. Vincent's brother and patron, Theo (fig. 3), who took the train from Paris to Arles as soon as he received Gauguin's telegram, must have informed his mother of the incident directly from Arles, since she had already replied from Leiden by 29 December. The letter is interesting for a number of reasons: not only does it offer a revealing look at the gloomy thoughts their mother had about Vincent

illustratie
fig. 3
Theo van Gogh, c. 1885, Amsterdam, Van Gogh Museum (Vincent van Gogh Foundation)


and at the close bond between the two brothers, it also betrays surprising suppositions regarding Vincent's illness. Professing her sympathy and referring to times past, she writes about a specific incident in her moving epistle, published here in full for the first time.

My dear Theo!

I was deeply moved by your letter. Oh Theo, what sorrow. Thank you for your love for the unhappy Vincent. God be with him and us. Oh, the poor boy! I had hoped things were going well and thought he could quietly devote himself to his work! I had just written him a note to tell him what Israëls and the others had said about his work, and for the New Year, because don't think I forgot him. Oh Theo, what will happen now, how will things turn out? I would almost say, if only he would become really ill, it would bring things to a head, but he already is very ill, you might say, the worst that one could imagine. My consolation is that he is a child of our heavenly Father, and He will neither fail nor forsake him. If it was for me to say, I would ask, ‘Take him unto Thee,’ but we must take things as God gives them. Oh Theo, if it is borne out, you remember what Prof. Ramaar in The Hague said - when Pa so much wanted him to go with him as a mental patient, and Vincent said he was willing to go and ask for medicine, and just when they were supposed to leave, he refused and Pa went anyway to tell him - and he said, from what I now hear something is missing or wrong in the little brain.9 Poor thing, I believe he was always ill, and that what he and we have suffered are the consequences of it. Poor brother of Vincent, sweet, dearest

illustratie
fig. 4
Johannes Nicolaas Ramaer, from Eigen Haard (1887), no. 50, p. 593, The Hague, Koninklijke Bibliotheek


Theo, you, too, have been very worried and troubled because of him. Your great love, wasn't it too heavy a burden, and now you've again done what you could, Wil10 went to The Hague today, how disappointed she will be, too, I am grievously saddened and anyway you will no doubt send me news as often as possible, honestly Theo, if things get even worse and Aix has to happen, tell me everything, otherwise I'll think even worse. What a coincidence, after your hope for happiness,11 and this deep sorrow, may she be a comfort to you, but Theo, I didn't say anything, I wrote nothing to Jo before you had your answer from Amsterdam. Write to me as soon as you know anything, although I am saddened with grief, I can however be glad about happiness and would like to tell the good news, Jo and Anna also wanted to write.12 Oh Theo, must the year end with such a disaster? Where is Aix? Such suffering for both of you, how he must feel it all, how touching about Zundert, together on one pillow. Goodbye, dear Theo, may God be near with His comfort, and if possible bring help. God bless the remedies. Thanks for your love, God bless your endeavours. Anna is also sad, Jo and Wil are not at home. A kiss from your ma.13

 

Obviously Theo had already suggested to their mother that Vincent might be admitted to a hospital in Aix-en-Provence. Theo must have talked about this possibility to Felix Rey, the assistant doctor who treated Vincent in the hospital at Arles. Indeed, Vincent later wrote to Theo: ‘There are so many times when I feel entirely normal, and it seems to me that if what I have is only an illness specific to this part of the country, I'll just have to wait here quietly until it's over. Even if it were to happen again (let's assume that won't be the case). But this is what I say once and for all to you and M. Rey. If sooner or later it would be desirable for me to go to Aix, as has already been suggested - I consent in advance and will submit to it’ [751/577].14

A completely new particular in Vincent's case history is that his father wanted to take him to a certain ‘Prof. Ramaar.’ This was Johannes Nicolaas Ramaer (1817-1887), a prominent psychiatrist in The Hague, who was one of the founders of mental health care in the Netherlands (fig. 4).15 On 26 July 1863, Ramaer was appointed physician-director of the mental hospital at Delft, where he stayed until July 1869. After this he settled in The Hague as a ‘consulting physician,’ but kept his post at the institution in Delft until 1872. On 19 July 1872 he was appointed an inspector of lunatic asylums; on 1 October 1884 he was named to the state inspectorate for lunatics, after which he could no longer practise medicine privately.

Ramaer advocated a brand of scientific psychiatry in which psychological disorders were thought to be the result of physical processes taking place in the body. The

intriguing reference to the ‘little brain’ (the cerebellum) must point to the fact that Ramaer viewed Vincent's symptoms as purely physical, and not primarily as an emotional or psychological condition. The clinical symptoms of cerebellar dysfunction are ataxia (the inability to co-ordinate voluntary movements), hypermetry (excessive, uncontrolled movement) and dysdiadochokinesis (an inability to execute rapidly alternating movements).

From what we know about Van Gogh, however, it cannot be inferred that he was suffering from one of these disorders, though he must have had certain facial tics, as we shall see below. Ramaer kept up with the medical journals, that much is certain, but in his day little was known about the cerebellum.16 Ramaer's diagnosis - made without ever having seen the patient, and therefore based solely on what Vincent's father had told him, and, moreover, passed on to us by Vincent's mother - unfortunately seems to have been a shot in the dark, and thus of mainly historical importance.

 

This leaves the question as to when the visit took place. It is unlikely that it was as early as 1868-69. In March 1868 Vincent had been removed - for reasons that remain unclear - from the Tilburg Hoogere Burgerschool (secondary school), after which he lived with his parents in Zundert until August 1869. He subsequently started work as an assistant in the firm of Goupil & Cie., art dealers in The Hague. In any case, the alleged visit could not have taken place until after Ramaer had set up practice in The Hague in July 1869. Moreover, the fact that Vincent refused to go along indicates that he was over the age of 16. It is therefore most likely that the visit to Ramaer was connected with the so-called ‘Gheel affair’ of 1880, at which time Vincent's father was planning to have his son committed to lunatic asylum in Gheel (now Geel), Belgium.17

Van Gogh experienced increasing difficulty while working as a lay preacher in the Borinage (a mining district in Belgium) from December 1878 to September 1880. Not only was he living in reduced circumstances and losing a lot of weight, he was also in no way equal to the task in hand.18 His concerned parents went to visit him, and during this period Vincent returned twice to his parents' home. (It may be inferred from his mother's letter that Vincent was at home at the time of the planned visit to Ramaer.) The first time was mid-August 1879, when he arrived in Etten unannounced. We know from his parents' letters that he was given different clothes to wear, spent whole days reading Dickens, and refused to engage in any normal conversation, giving only short answers and ‘pulling ugly faces.’19 The last remark must refer to facial tics. It is not known how long he stayed, only that his behaviour was a cause of great concern. This was also the case seven months later, in March 1880, when he again returned home; as his father wrote to Theo: ‘Vincent is still here, but oh, it's nothing but a struggle.’20

It was not until a year later that Van Gogh reflected on what had taken place in 1880. In the meantime his controversial love for his cousin Kee Vos had come to light: ‘Though it causes me much sorrow and grief, I simply cannot accept that a father who curses his son and (remember last year) wants to send him to a madhouse (which I of course resisted with all my might) and calls his son's love “untimely and improper”!!! can be right [...]. That matter of Gheel last year, when Pa wanted to have me committed to an institution against my will!!! has taught me to be on the qui vive’ [183/158, 184/159].21 It looks very much as though Vincent's father viewed Ramaer's ‘diagnosis’ as grounds for having his son committed to a lunatic asylum.

Vincent played down his psychological problems to ease his mother's mind, both in 1880-81 as a 27-year-old, and again seven years later in Arles. The only thing he wrote to her and his sister Willemien shortly after the ear incident, namely on 7 January 1889, was that he had been

slightly ‘unwell’ and that it ‘had not been worth the trouble of telling you.’ But although he assured them that there was no reason for ‘fretting’ [736/569a], we know from Theo's letters that Vincent had a clear understanding of his illness. His full awareness of the seriousness of his condition may well have prompted him to seek salvation in death, a solution his mother had envisioned 18 months earlier as the answer to her prayers.


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