Book Review

Vincent van Gogh: Chemicals, Crises, and Creativity

N Engl J Med 1993; 329:1133October 7, 1993

Article

Vincent van Gogh: Chemicals, Crises, and Creativity
By Wilfred N. Arnold. 332 pp., illustrated. Boston, Birkhauser, 1992. $49.50. ISBN: 0-8176-3616-1

During Vincent van Gogh's last and most creative years he suffered from an unusual disease with attacks of horrible anxiety, confusion, and aggression, sometimes brought on by absinthe abuse. Once, during a delirious phase, after threatening to kill his friend Paul Gauguin, he cut off a lobe of his ear and presented it to a prostitute. His artistic powers were not diminished. On the contrary, between the attacks he engaged in exuberant artistic activity. It is to this period that we owe an impressive number of brilliant paintings, some of them created in a single day. Van Gogh himself felt there was something the matter: “I toil like one possessed, in a mute frenzy -- I fight with all my strength to master my art and tell myself that success would be the best lightning rod for my disease.”

One would think that van Gogh's eloquent description of his symptoms would have produced a clear conception of his disease, yet for no other historical person have so many diagnoses been proposed; it is said that more than 100 have been forwarded since van Gogh's death, from syphilis to Meniere's disease. Now another, acute intermittent porphyria, has been added to the list, and it is by far the best grounded and may be the definitive one. This diagnosis has been advocated and magnificently presented by the American biochemist Wilfred Arnold. The disease, a hereditary metabolic disorder, produces compounds with toxic constituents, precursors of porphyrin, which cause attacks, manifested by various neurologic problems that range from gastrointestinal pains to fits of confusion with hallucinations. The diagnosis was proposed by Loretta Loftus, an associate of Arnold's.

The two have collected an overwhelming amount of evidence supporting their hypothesis. They started by making a thorough analysis of all of van Gogh's letters and combined what they learned with information from his contemporaries to establish a most accurate picture of his disease. They then collected the dozen proposed diagnoses most worthy of merit and gave a detailed account of the symptoms of each. These were compared with those of van Gogh to determine which coincided and which did not. Some of the hypotheses are treated rather curtly, and the proposal that Meniere's disease could be the cause of his symptoms is dismissed without mercy: “The presentation exemplifies all of the worst aspects of selective embrace of symptoms and misconstruing of quotations in order to shore up an idea.”

With the profound knowledge thus acquired, Arnold and Loftus concluded that van Gogh's illness was most likely a toxic psychosis. Consequently, they paid special attention to the possibility of alcoholism or lead poisoning. After consideration of the effect of the toxic products of absinthe, the related disease acute intermittent porphyria was found to be a unifying hypothesis that accounted for all of van Gogh's symptoms. The diagnosis is particularly fitting given his manic-depressive tendency and his occasional absinthe abuse: “Periods of incapacitating depression and physical discomfort were severe and grave enough to provoke self-mutilation and eventual suicide.”

Increased evidence for this hereditary disorder is supplied by the fact that similar symptoms had occurred in some of van Gogh's close relatives, including his brother and his sister. An expert in the subject, Jan Waldenstrom, is somewhat skeptical about the diagnosis, however, as one of the decisive signs is missing. Red coloration of the urine, typical of the condition, was never mentioned in van Gogh's correspondence.

A good example of the author's thoroughness and care in handling his subject is the chapter entitled “The Yellow Palette.” Not only does Arnold give a detailed account of physical and physiologic theories of color perception and rendition, but he also carried out an experiment, letting his students describe how they saw the colors of pictures through yellow goggles. His treatment of the various hypotheses is likened to “erecting straw men and then knocking them over with the data.” When he has knocked them all over, he arrives at the satisfying conclusion that “artistic preference remains the best working hypothesis to explain the yellow dominance in Vincent van Gogh's palette.”

The author's reluctance to withhold any of his extensive knowledge in the field occasionally makes for tedious, though always informative, reading. The book is handsomely produced, with 14 color reproductions of high quality. It definitely proves that even a highly specialized medical author may make an unquestionably valuable contribution to the history of art.

The broad range of information in this book and the erudition of the author are impressive. Even if the diagnosis should prove to be incorrect, which seems unlikely, the material Arnold has collected will remain an unsurpassable fund of knowledge about one of the greatest artists of all time.

Philip Sandblom
University of Lund, Lund, Sweden