Chapter 6

It is probably in Christian Renaissance works that the negative perceptions of epilepsy are most clearly expressed. Such preoccupations centred upon demonic possession and the need to ‘cast out’ the demon and make the possessed person ‘clean.’ This was illustrated by using symbolism, and required skill in depicting a twisted torso or face. The challenge to pictorial art was in representing an evolving process, namely the seizure, in a static form, namely the painting. Ladino and her colleagues conducted a comprehensive search of articles and reviews focusing on artistic depictions of epilepsy.[1] They classified these within the following periods: Greek, Early Christian, Renaissance, early Latin American, modern, and contemporary. The methodology used by Ladino and her colleagues to search Western medical databases inevitably resulted in a cultural bias, with an overemphasis on Western Christian religious art and an under-representation of the depiction of epilepsy in Eastern pictorial art. Here we shall explore the presentation of epilepsy in pictorial art using Ladino’s epochs, but we shall aim to spread our net a little more widely. Inevitably, however, far from being a systematic review, the following account must be viewed as a personal and highly selective appreciation of the depiction of epilepsy in art.

Below is an extract:

“The question of whether or not Van Gogh had epilepsy certainly merits a discussion of the evidence available. However, here again caution is needed, as over 150 physicians have suggested a total of 30 different diagnoses for the artist’s various health problems. His name also appears on most of lists of famous people with epilepsy.

“Vincent Van Gogh (1853–1890), the Dutch Post-Impressionist painter, was born into an upper-middle-class family at Groot-Zundert in southern Holland. His father was the pastor of a Dutch Reformed church in a particularly Catholic part of the country. Vincent was one of five surviving children, and his youngest sister, Wilhelmina, was incarcerated for much of her life with a diagnosis of schizophrenia. His brother Theo, who supported him throughout his life, suffered from depression, and another brother, Cornelius, committed suicide. During the last decade of his life, Van Gogh produced over 800 oil paintings (landscape, still life, portraits, and self-portraits), many of them characterized by the use of bold colours and frenetic brushwork. His suicide at the age of 37 was the culmination of years of mental turmoil, illness, and poverty.

Vincent did not complete a formal education, but instead left school at the age of 15 to work for a firm of art dealers in the Hague. He was transferred by his firm to London, where he remained for about two years before leaving his position, probably due to a combination of factors, including a failed romantic infatuation, an inability to address the financial aspects of his occupation, and a tendency to argue with clients about the merit of their purchases. I think we can safely assume that he was fired. There followed a period of profound religiosity in the artist’s early twenties, which has been outlined by Dietrich Blumer.[2] During this period Van Gogh became a social recluse and was increasingly concerned with religion. After failing his theological studies he became an unqualified evangelist in a poverty-stricken mining town in Belgium, but was eventually dismissed because of his dishevelled appearance, his demeanour, and his inappropriate and excessive charitable acts. At the age of 27, only 10 years before his death, he decided to become a painter and applied to art school, only to be rejected. By this stage he was an agnostic and entirely supported by his faithful brother Theo. The only hint that something might be amiss was his somewhat unusual personality. Indeed his mother, with whom he was now living, said that she was ‘so afraid that wherever he goes and whatever he does, he will spoil everything by his peculiar behavior and queer ideas.’[3] Van Gogh then went to Paris to stay with his brother Theo, who was now working as a successful art dealer, and it is around this time that the first indications of epilepsy symptoms begin to emerge. Van Gogh was in his early thirties and was experiencing episodes of sudden fear and loss of consciousness. He was also drinking absinthe (a distilled highly alcoholic drink made from medicinal herbs, and regularly consumed by Bohemian writers and artists) and smoking to excess, and becoming increasingly unkempt and argumentative. Absinthe was known to induce hallucinations, and it was also thought to provoke seizures.

In 1888, just two years before his death, Van Gogh moved to the warmer climate of the ancient Roman town of Arles in the south of France. Here he was to produce over 300 oil paintings at a frantic pace. He rented the now famous ‘Yellow House’, and invited other artists such as Paul Gauguin to stay with him as guests and help to set up his somewhat grandiose vision of a ‘Studio of the South.’ Gauguin’s stay was to find a permanent place in Van Gogh’s history. An absinthe-fuelled argument led to Gauguin leaving, pursued by Van Gogh holding an open razor. Giving up the chase, Van Gogh returned to the Yellow House, where he cut off the lower part of his ear, wrapped a scarf around his head, and set off for the nearest brothel. Eventually the local inhabitants of Arles became so disturbed by his behaviour that a petition was successfully raised to have him committed to the Saint Paul de Mausole asylum for epilepsy and mental disorders, on the outskirts of Saint Rémy-de-Provence. It was here that the somewhat uncertain diagnosis of epilepsy was made by the asylum director, an elderly semi-retired clinician called Dr Peyton. On the basis of this diagnosis, Van Gogh was prescribed potassium bromide. He returned to the asylum voluntarily the following year in a psychotic state, experiencing religious and paranoid delusions and auditory hallucinations. By now he was swinging between manic and depressive modes indicative of a bipolar disorder. At this point he may also have started to receive treatment with digitalis.

Van Gogh was a prodigious letter writer, and it is in his personal correspondence, especially his letters to his brother, Theo, that the strongest evidence for a diagnosis of epilepsy can be found. A six-volume edition of his correspondence was published recently,[4] and the Swiss neurologist Fabienne Picard has identified within this work evidence that he feels ‘makes the diagnosis of epilepsy indisputable’, from 1888 (when Vincent was 35 years old) onward.[5] Picard cites letters written not only by Van Gogh but also by the clinicians. There are references within the correspondence to the episodic nature of attacks, concern about tongue biting, fatigue and sore throat on recovery, and Van Gogh’s fear of having an attack, falling into the hands of the police, and being ‘forcibly carried off into an asylum.’ Nowhere, however, is there a clear description of what an epileptologist would unequivocally recognize as a seizure. In May 1890, Theo wrote to his brother, advising him not to travel alone, and commenting that ‘in any event on the day you have decided to come here you absolutely must be accompanied during the entire journey by someone you trust.’ Picard also quotes from the admission notes of the asylum director, Dr Peyton, which state that Van Gogh ‘is suffering from acute mania with hallucinations of sight and hearing, which may have caused him to mutilate himself by cutting off his ear … based on all the above I consider Mr Van Gogh is subject to attacks of epilepsy, separated by long intervals.’ The published correspondence also reveals for the first time a family history of epilepsy.

Although Picard is convinced by the evidence, others are less so, and over the years many alternative physical and mental diagnoses have been suggested to explain Van Gogh’s tragic life experiences. Possible psychiatric explanations have included borderline personality disorder and bipolar disorder, and suggested physical causes have ranged from fainting during episodes of near starvation to lead poisoning and the ‘royal illness’ of porphyria. To this author, epilepsy seems to be the most likely diagnosis, and many of Van Gogh’s personality traits could be explained by Geschwind’s controversial epileptic personality syndrome, including his emotional volatility, depression, hyposexuality, religiosity, and hypergraphia (as evidenced by six volumes of correspondence). It was the great French neurologist and epileptologist Henri Gastaut who first raised the question of whether Van Gogh had epilepsy,[6] so perhaps he should have the last word here. He was convinced that epilepsy was indeed the correct diagnosis, and he suggested that the seizures had initially been triggered by alcohol.

Van Gogh’s death had just as much pathos as his life. He had been discharged from the asylum in May 1890, and was abstaining from alcohol, free from the presumed seizures, and working furiously. On 27 July 1890 he went out into the fields with his paints and a revolver and shot himself in the lower chest. He then staggered back to an inn, where he told friends that he could not bear life any longer. The decision was made not to remove the bullet, and he died two days later. If it is accepted that Van Gogh indeed had epilepsy, he is yet another tragic statistic demonstrating the high risk of suicide in those who have the condition.

In an article entitled ‘The science of art’, V.S. Ramachandran proposes the following theory: ‘Van Gogh’s epileptic seizures in his temporal lobes may have actually strengthened neural connections between his visual object and face area and the amygdala, nucleus accumbens and other brain regions involved in gauging the emotional significance of what’s being viewed. Such a heightened attention and emotional response to visual images may have made him a more accomplished artist – his seizures enabling him to “attend” to certain critical dimensions more than you or I.’[7]This in-depth analysis, which claims that the disorder gave the painter some sort of advantage compared with other people, assumes that the diagnosis of epilepsy is correct, as does the observation made by other writers that Van Gogh’s unusual perception and use of colour can be explained scientifically by the possibility that he was taking the drug digitalis, which was often given to patients with epilepsy. Studies have shown red-green visual impairment in approximately a quarter to a third of people taking digitalis, with a quarter also showing colour blindness due to severe tritan deficiency, which results in their confusing blue with green, and yellow with violet. This might possibly therefore have given Van Gogh yet another artistic advantage resulting from his epilepsy. However, the evidence that he was ever treated with digitalis is based on the fact that it was used to treat mental conditions, and that he painted one of his doctors (the above-mentioned Dr Peyton) holding a foxglove, from which the drug is derived. Finally, even if Van Gogh was taking digitalis, this would only have been for the last year or so of his life, and so would have had little effect on his artistic output as a whole”.

[1] Ladino D, Rizvi S and Téllez-Zenteno JF (2016) Epilepsy through the ages: an artistic point of view. Epilepsy & Behavior 57, 255–264.

[2] Blumer D (2002) The illness of Vincent Van Gogh. American Journal of Psychiatry 159, 519–526.

[3] Hughes JR (2005) A reappraisal of the possible seizures of Vincent Van Gogh. Epilepsy & Behavior 6, 504–510.

[4] Jansen L, Luijten H and Bakker N (2009) Vincent Van Gogh: The Letters. Thames and Hudson (in association with the Van Gogh Museum and the Huygens Institute), London.

[5] Picard F (2011) Vincent van Gogh’s epilepsy. Epilepsy & Behavior 22, 414–415.

[6] Gastaut H (1956) Vincent van Gogh’s disease seen in the light of new concepts of psychomotor epilepsy [article in French]. Annales Medico-Psychologiques 114, 196–238.

[7] Ramachandran VS and Hirstein W (1999) The science of art: a neurological theory of aesthetic experience. Journal of Consciousness Studies 6, 15–51.