Had Vincent van Gogh a bipolar disorder?

Wheat field with crowsVincent Van Gogh (1853–1890) imparted in his art a deep essence of life, and in such a unique way, that many would say it is possible to experience it vicariously by looking at his paintings even once. In 10 years, while exerting mental and physical efforts that may well contributed to his premature death, he produced an impressive number of masterpieces.
However, the specific neurological disorder Van Gogh suffered and how this may have influenced his art is still not clear.
The combination of his eccentric personality, irascible temper, unstable moods and prolific creativity makes the understanding of his illness a very complex endeavor and therefore poses a great challenge to those who investigate the relationship between the ‘artistic mind’ the brain and illness. In fact, most of the neurologic and medical diagnoses (nearly 30) proposed for Van Gogh, during the last century, are not based on medical evidence but are ascertainable from analyses of his paintings and biographical data.
My opinion is that according to DSM-IV criteria and findings extrapolated from his letters to his brother Teo, Van Gogh is most likely to have suffered a bipolar disorder, affective or schizoaffective, which caused his death by suicide.
Before 1886, Van Gogh presented major and minor depressive episodes alternating with hypomanic or manic phases, often with rapid switching. Durable depressive episodes occurred in London after a love rejection, when he was expelled from the church, and at the moment of his separation from the prostitute Sien and her son. Durable hypomanic or manic phases were concomitant to his beginnings as an evangelist, as well as an artist.
In Arles (1888) he experienced anxiety, melancholia, remorse, insomnia and physical exhaustion, which he related to his insalubrious behavior. On Christmas Eve in 1888, during what was probably his first psychotic crisis (of which he remained amnesic) he cut off part of his left ear. After two brief psychotic crises he voluntarily entered the Saint-Rémy asylum in May.
In Saint-Rémy, during the following year, he experienced severe depressive episodes and three psychotic crises, of which at least two were concomitant with his temporary visits in Arles. The last of these crises, characterized by religious and paranoid delusions and auditory hallucinations, persisted over 3 months (February–April 1890) and left some vivid memories. Discharged from the asylum in May 1890 as being cured, he moved to Auvers-sur-Oise, where he manifested rapid switching between manic and depressive symptoms. On July 27, he shot himself in the chest and subsequently died two days later, July 29, 1890.
Between 10% and 19% of individuals with bipolar disorder attempt suicide, and 80% of suicidal actions of bipolar individuals occur during a depressed phase of the illness. Van Gogh committed suicide at the age of 37 during a depressive crisis following a manic-psychotic phase. The transition between the two phases of the bipolar disease may be perceived for Vincent in the Wheat field with crows, one of the last if not the last painting he completed before his death.
We will never know the effect that pharmacological treatments (antidepressants, lithium, valproate, carbamazepine, lamotrigine, olanzapine) and psychotherapies available today might have had on Van Gogh’s life and art. The artistic creation is a mysterious and individual process that is inseparable from personal experiences and we are inclined to believe and accept that the disease and its related artistic dimensions co-existed in Van Gogh.
Through his paintings Van Gogh wanted to express authentic forces that deeply live in nature. These forces were symbolized not only in skies, stars, trees, flowers, portraits, but also in buildings, chairs, and rooms. By such symbolism he used the force of colors to enhance emotions. The experience of manic and depressive states may have guided him into a deeper insight of nature’s spiritualism. In every period of his life, he probably used the processes of the artistic creation to convert his suffering due to the bipolar disease into positive paths.

From Carota A. et al. Understanding Van Gogh’s Night: Bipolar Disorder. Bogousslavsky J., Boller F (eds): Neurological disorders in Famous Artists. Front Neurol Neurosci. Basel, Karger, June 2005, vol 19, pp 121-131

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