This paper presents a posthumous psychological evaluation and diagnosis of the Dutch artist Vincent Van Gogh (1853–1890), drawing on his biographical history, letters to his brother Theo, and secondary research. Using DSM-IV-TR multi-axial criteria, the paper formulates a case history detailing Van Gogh's erratic moods, psychotic episodes, seizures, and suicidal behavior. The evaluation procedure, case formulation, and cultural context are each addressed in turn. The paper concludes that Van Gogh met the diagnostic criteria for Bipolar I Disorder with mixed, recurrent psychotic features, accompanied by paranoid personality disorder, temporal lobe epilepsy, and polydrug abuse. A recommended treatment plan including mood stabilizers, antipsychotics, cognitive therapy, and electroconvulsive therapy is also proposed.
Vincent Van Gogh was a Dutch artist born in 1853 in a village in the Netherlands to the family of Theodorus Van Gogh, a minister of the Dutch Reformed Church. Van Gogh was the oldest among five siblings, including two brothers and three sisters. He belonged to a family of art dealers, artisans, and religious preachers, while Vincent himself was keen to draw and sketch from childhood. As time passed, he decided to become an artist. Even at a very young age, Vincent was moody, self-willed, and irritable (Blumer, 2002). Later in life, his personality became more eccentric and he suffered from unstable moods and recurrent psychotic episodes. Van Gogh experienced immense highs and lows throughout his short life, most of which revolved around his struggle with mental illnesses whose symptoms and diagnosis became recognizable only later.
Vincent Van Gogh completed his formal education after considerable fluctuations and was employed at the Hague Gallery ("Vincent van Gogh: Early Years," 2012) at the young age of 16. In 1873 he was relocated to London and then to Paris in 1875. During the two years Vincent spent in London, he fell in love but took his infatuation too seriously, which led him toward depression. The disappointment in love made Vincent sad, gloomy, and anti-social; he barely interacted with his family during this period (Blumer, 2002). His desire to become a professional art dealer had died by then, and he chose to devote his life to preaching and evangelization like his father, although he still nurtured his passion for art. Vincent studied theology in a formal school but failed to complete his program and rejected Latin as a proper language for preaching religion to the poor. He abandoned his theology lessons and stepped up to work practically with peasants and miners in a very poor area of Belgium. Due to his overly charitable behavior and impropriety as a church preacher, Vincent was expelled from the church, with whose brethren he had shared all his belongings. He was left disappointed and robbed of trust once again. After this episode, Vincent once more went through severe depression (Blumer, 2002). His progress as a preacher stopped, but his fascination with the miners inspired the artist in him to emerge in full force. Vincent turned 27 in 1880, at which time he enrolled in an arts school in Brussels, Belgium, and painted his first acknowledged work, The Potato Eaters, in 1885 ("Vincent van Gogh: Overview," 2011). However, during that period Vincent failed to make his art popular and also lost his trust in people and in love.
Vincent moved to Paris in 1886 to live with his brother Theo. He lived frugally, studied color theory, and chose to paint simple paintings of peasants. Paris and the sound advice of his brother brought positive changes in Vincent. He moved on from earthy tones to brighter colors and painted everything around him. It was during this period of his life that mental ailment began to show itself in distinct forms. He started to suffer from sudden terror attacks, epigastric sensations, and episodes of unconsciousness. Some people reported spasms and a blank stare, after which he often did not remember what had happened. His brother's letters (Hulsker, 1977) to their sister indicate that Vincent's situation worsened with time; he tended to be unhygienic, irritable, and always ready to start a fight. As time passed, Vincent developed both physical and mental ailments, but ironically his development as an artist continued to flourish.
Vincent left Paris and his brother Theo to move to Arles in 1888. By this time he had quite perfected his art and produced the most intense paintings of his life. His psychotic episodes kept worsening as his art flourished. His letters from that era indicate that he suffered from despair and fatigue at all times (Blumer, 2002). His life was turbulent, and vehement artistic creativity alternated with episodes of listlessness and exhaustion. Dysphoria, euphoria, and anguish attacked him in turns. Violence, anger, and lack of sexual desire were also present. Vincent complained of a troubled stomach and poor blood circulation. His letters indicated that he was unable to understand his own situation when he suddenly underwent fits of anxiety without any visible cause, or felt blankness in his mind; there were times when he felt severe remorse over the most trivial things in his past (Blumer, 2002).
At the persuasion of Theo, Gauguin — an artist friend — joined Vincent, but the visit proved a hopeless disaster and ended in catastrophe due to Vincent's utter lack of tolerance and uncontrolled temper (Blumer, 2002). When Gauguin left the house, Vincent followed him, and upon being turned away, he returned home and cut off the lower half of his own left ear, presenting it to a favorite prostitute. Afterward, he descended into an extreme psychotic state of agitation, hallucinations, and delusions lasting three days. When he became stable he had no recollection of the events of the preceding days. Vincent spent several weeks in hospital, where epilepsy was diagnosed; he was under treatment while experiencing psychotic relapses and prominent amnesia.
Vincent's condition worsened toward the end of his life; he drank increasingly heavily, especially when Theo became engaged and married. For Vincent, his relationship with his brother felt threatened. Among all his other disturbing symptoms, Vincent now suffered from suicidal ideation, and in unsuccessful attempts he ingested lamp oil, turpentine, and paint (Blumer, 2002). In May 1890, Vincent was discharged from hospital and declared cured. He moved to Auvers, where he spent the last few weeks of his life. Fortunately, he suffered fewer fits and seizures and also abstained from drinking. By this time, Vincent's art had begun to gain recognition, but Theo's failing health prevented him from providing further financial support. A heated exchange of words with his brother left Vincent terribly depressed. His paintings, rather than showing luminous heavenly bodies, now depicted fields and endless paths beneath stormy skies (Blumer, 2002). Some days later, Vincent Van Gogh shot himself and died two days later with Theo by his side.
In the ten years he spent painting intensively, Vincent produced 900 paintings that received little attention during his lifetime. He sold only one painting before his death. Many years later, his work is universally acknowledged and serves as a source of inspiration for artists around the world ("Vincent van Gogh: Overview," 2011).
A psychological evaluation procedure is intended to determine whether a person is suffering from a mental disorder and, if so, to identify the exact diagnosis (Hirsch, n.d.). Usually, several procedures must be carried out that focus on obtaining maximum information. In the case of Vincent Van Gogh, most of the study regarding his mental health was conducted posthumously by examining his biographies and letters to his siblings.
General psychological evaluation procedures may include questionnaires given to the family regarding the behavior, activities, and associations of the person under consideration, along with review of previous medical records. When carrying out a psychological evaluation of a deceased person, such activities are not possible. However, what is required for a thorough evaluation is the family, cultural, medical, and psychosocial history of the patient (Hirsch, n.d.). The information needed for a posthumous evaluation of mental health includes the following:
All impediments, difficulties, and major stressors that the family faced should be considered when evaluating mental health status. Personal issues such as relationships with friends and family, behavior in society, and domestic responsibilities and their timing must be studied. Accidents that could be causal agents of brain injuries or other major injuries should be taken into account. For a posthumous psychological evaluation, information regarding the modes of expression of the individual is gathered — for example, an artist may be evaluated on the basis of what he painted while alive, and a writer on the basis of the intensity of his writing. Any information about suicidal ideation, hallucinations, anxiety, depression, unusual thoughts, or behavioral disturbances must be gathered from journal entries, accounts of people who were in contact with the subject, books, letters, and research articles (in cases involving a famous personality).
When such material is available, studies are rendered more reliable and easier to conduct. For this evaluation of the mental health of Vincent Van Gogh, detailed information about his life was obtained from research articles and reputable websites. Most significantly, the major details of Van Gogh's life are well documented thanks to the letters he exchanged with his brother Theo (Van Gogh and Van Gogh-Bonger, 1914) and other relatives and friends (Van Gogh and Van Gogh, 1958).
A detailed review of his birth, early life, and later life — especially his progress as an artist — was discussed in the preceding section. All of this information forms the basis on which the case was formulated and evaluated in the sections that follow.
This patient, Vincent Van Gogh, is a 37-year-old, single, Dutch male artist. He is the second-eldest of six siblings, the first having been stillborn. Vincent voluntarily admitted himself for the first time to the Saint-Paul asylum in Saint-Rémy, France, in 1889. The patient described himself as a moody, solitary child, often disobedient and with few friends. His early interests included flowers, birds, and insects, though he preferred to play alone.
The patient entered the city hospital at Brouwersgracht in The Hague, Netherlands, in 1882 with a gonorrheal infection and was admitted for 25 days. After 14 days he complained by letter of a "dreadful weakness." At the time of his initial hospitalization he displayed suicidal behavior. These acts were carried out while he was in a confused state of mind, during which he described his thoughts as increasingly jumbled, to the point that "the noise inside has become unbearable." First indications of neurosis and psychosis occurred at age 27. On Christmas Eve of 1888, he became physically and emotionally exhausted due to conflict with fellow artist Paul Gauguin. He reportedly chased Gauguin with a razor and cut off the lower half of his own left ear.
His life history indicates that his illness revolved around episodes of critical mental derangement and disability, separated by intervals of sanity and creativity. Vincent had an extremely unconventional personality with frequent unstable moods and dramatic character swings. He suffered from recurrent psychotic episodes. He experienced two very distinct episodes of reactive depression in his life, and there is clear bipolar evidence in his mental history. Both episodes of depression were followed by sustained periods of high energy and enthusiasm — first as an evangelist and then as an artist.
"Dutch cultural and social background of the patient"
"DSM-IV-TR multi-axial diagnosis and supporting evidence"
Based on the diagnosis, it can be said that Vincent Van Gogh displays prevailing signs and core symptoms of Bipolar I Disorder with recurrent mixed episodes of psychotic features (Table 2) (Tan, 2011). The manic phase is typically followed by two to four depressive episodes. Features of both phases, as well as associated psychotic features, are summarized below.
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