DIAGNOSING THE CANVAS: VAN GOGH DID NOT HAVE EPILEPSY

Diagnosing the canvas is an exercise that certain aesthetically minded doctors engage in either for mental sport, or for understanding of the natural history of diseases. It includes two different approaches: the first is identifying an artist's illness through his works, and the second is studying the subjects shown in works of art and attempting to explain anomalous figures by making a medical diagnosis.

In the first, the evolution of the Water Lilly series of Monet (Fig. 1) is concomitant with the events of his near blinding cataract and eventual eye surgery. Monet was diagnosed as having cataract in 1912 (when he was 72 years of age) when ". . a general fuzziness and muddiness. . loss of details" became apparent, in addition to increasing use of ". . yellow-brown color cast, which is the color range that people with cataract see, with loss of ability to see a violet and blue". Monet himself described his visual changes: "I no longer painted light with the same accuracy. . . red appeared muddy to me, pink insipid, and the intermediate or lower tones escaped me".

By 1922, Monet was legally blind, able to see only light but almost no forms or colors. Later he had a cataract surgery after which he completed in his last four years of life (known as the "blue period") his Water Lilly cycle. Some of those later paintings glow with soft, lush blue and purple.

Yet, mistakes can be made, because temptation to assign a syndrome or a disease to an artist, whom the doctor has never met, may lead to harmful notions about that specific artist. A historical example of such mistakes is that of a Parisian doctor who in 1913 suggested that El-Greco painted his remarkably elongated figures because he may have had astigmatism (fig. 2). Virtually, all the hallmarks of this would disappear if the pictures are viewed through a 189 1. 0D astigmatic lens which is turned 15 degrees with respect to the horizontal axis. However, Doctor James Ravin who studied entirely El-Greco's case pointed out that, without correction lenses, astigmatics view the world as blue even though the color could not be affected as in the case of myopia and hypermetropia. And as there is no evidence of the existence of lenses that could correct astigmatism in the 16th century, when El-Greco lived, the diagnosis of astigmatism is to be ruled out. Moreover, X-Ray images taken of El-Greco's paintings showing beneath the painted figures drawings of a more naturalistic composition add support to this view. El-Greco was beyond reality and had a supply of mystical and miraculous spirit of the event which stands correctly in comparing the spiritual mystery in the hands of Christ in his "Christ On The Cross With Landscape" (fig. 3), to the physical reality of the hands of Jesus Christ in Ruben's "Christ on the Cross" (fig. 4), both painted at about the same period. Thus, Ravin corrects a famous mistake turning a sickness into a style.

Another interesting case is that of Van Gogh (fig. 5) who has been subject until now to at least 152 post-humous diagnoses. The case of his ear cut had alone thirteen explanations. Each diagnosis imposed on Van Gogh is brought through tell tale details of his paintings. One of these diagnoses is epilepsy which was deduced by the brilliant yellows in his paintings (cover picture). They associate that to a digitalis toxicity - a drug which was given to him by his doctor Paul-Ferdinand Gachet as a treatment for epilepsy - causing the yellow vision. In two of his paintings Van Gogh showed doctor Gachet holding digitalis plant in his hand (fig. 6). Every year, doctors pour in the literature new diagnoses. One of the most recent is that Van Gogh did not have epilepsy but had Meniere's disease. Doctor Kaufman Arenberg et al reviewed letters and paintings of Van Gogh. Based on these reviews, Dr. Arenberg concluded that Van Gogh must have suffered from frightening attacks of disabling, recurrent vertigo, with nausea and auditory and visual disturbances that were described as hallucinations. All of these, according to Dr. Arenberg, are compelling evidence for a diagnosis of Meniere's disease and not epilepsy. This becomes the 14th explanation for Van Gogh's slicing off part of his ear. Yet the cycle continues; doctors at University of Kansas Medical Center have submitted another paper to the Journal of the American Medical Association (JAMA) proposing that Van Gogh had a congenital metabolic disorder. However, they won't name the disease until the report is accepted and published.

The second approach is diagnosing the models of the canvas; an example of this is the famous Corot's "Girl with Mandolin" (fig 7). The distinctly gnarled hand of the musician called the attention of two physicians and an art student to diagnose on the lady rheumatoid arthritis condition (fig 8). They went further to explain the twisted manner in which Corot had painted the hand: he himself suffered of gout.

The rheumatoid arthritis diagnosis won't stop here, as rheumatologists are trying to deduce the natural history of the disease through the ample number of paintings present at hand. Before 1800, such a disease was rare in concordance with its absence in paintings of that time, and so it could have been brought to Europe on a wide scale at one time.

Another example is the Doctor of "St. Luke's Fildes"; showing the doctor observing a sick child in bed. Dr. Southgate also by observation of the painting concluded that it is probably a childhood infection like Scarlet fever or lobar pneumonia.

Doctors reached Michelangelo's Pieta in Rome (fig 9). They criticized the engorged veins of hands and arms of dead Christ while everybody knows that the peripheral veins flatten when the heart stops. "Michelangelo was not with it as far as anatomy is concerned".

Ghassan Abou-Alfa
Med. IV

REFERENCES

Angier, N. . 1990. Studying Art With The Eye of a Physician. The New York Times. Cl

Bates, B.. 1987. A Guide To Physical Examination and History Taking. Philadelphia: J. B. Lippincott Co .

Canaday, J. . 1980. What Is Art?. New York: Alfred A. Knopf Inc. .

Eigar, F. . 1958. Van Gogh. London: Thames and Hudson.

House, J. Monet. 1981, Oxford: Phaidon.

Hoonakker, EW. . 1990. Painting What one Sees. Organorama. 27: 15-18

Jasper'.s, K. . 1977. Strindberg and Van Gogh. Tucson: The University of Arizona.

Kaufman, Arenberg 1. et al. 1990. Van Gogh Had Meniere's Disease And Not Epilepsy. JAMA. 264:491-493.

PapaFava, F. . 1986. Michelangelo In The Vatican. Florence: Scala.

Runyan, W. 1981. Why Did Van Gogh Cut Off His Ear? The Problem Of Alternative Explanations In Psychobiography. Journal Of Personality And Social Psychology. 40:1070-1077.