Newswise — Vincent Van Gogh is often credited as "the mad painter," best known for his use of bold colors and brush strokes, an uncommon style during his time. His struggles with mental illness are commonly highlighted as the root of his artistic genius, but a psychiatrist with The University of Texas Health Science Center at Houston (UTHealth) shares that it was just one of the factors influencing the artwork of the world-renowned painter. 

Marshal Sanches, MD, PhD, an associate professor of psychiatry at McGovern Medical School at UTHealth, has analyzed Van Gogh's work, aiming to determine what diagnoses might have been the root causes of his bouts of depression, mania, and mood swings. Sanches has also drawn parallels between his art and what was happening in his life to determine if his mental state had a direct correlation to his work as a painter. He recently presented to his colleagues during Grand Rounds for the Louis A. Faillace, MD, Department of Psychiatry and Behavioral Sciences at McGovern Medical School. 

Sanches considered several possible diagnoses for Van Gogh before ultimately concluding that his mental state cannot be attributed to a single, solitary diagnosis, but instead is a combination of several factors that made up his personality and view of the world. 

"Of course, this is just an academic exercise," Sanches said. "It is not possible to know for sure what Van Gogh's diagnosis was - these are just hypotheses, based on information assessed retrospectively, and any conclusions should be seen in light of the limitations inherent to this kind of method." 

In his analysis of Van Gogh's work, Sanches evaluated the research of other mental health experts, including Willem Nolen, MD, PhD, a professor of psychiatry at the University of Groningen in the Netherlands. 

Nolen analyzed self-reported symptoms the artist mentioned in his letters to friends and family, as well as other sources including notes from his doctors, to explore all possible diagnoses. 

"Using Nolen's approach, there is strong evidence to support a diagnosis of bipolar disorder," Sanches said. "But this cannot be offered as a full explanation and no single disorder likely explains all of his mental health problems. He most likely suffered from several comorbid disorders."

While Van Gogh was always considered an emotional child, much more so than his siblings, his first documented depressive episode did not occur until he was 22 years old. After losing his job as an art dealer and moving to Paris with his younger brother to pursure a career as a painter, he continued to have clear episodes of depression and manic behavior. 

"His paintings during this period clearly reflect a shift in his mood," Sanches said. This timeline would match up with the first manifestation of what was probably bipolar disorder. Symptoms of bipolar disorder include intense feelings of emotion and changes to a person's sleep patterns and activity levels, and typically start to emerge during the late teen to early adult years, according to the National Institute of Mental Health. 

After living in Paris for a couple of years, Van Gogh moved to Arles. It was during this time that he seems to have developed a fixation on the color yellow. "The Yellow House" and "Sunflowers" both were painted during this time. 

"There is no unique answer for the reason of his fixation with the color yellow," Sanches said. "Some researchers believe that might have been the result of medical or neurological conditions able to cause a predominance of yellow in vision (xanthopsia). Another hypothesis is that one of the componenets of absinthe, which we know Van Gogh used heavily, might have caused him to develop a 'yellow vision.'"

During the time Van Gogh lived in Arles he cut off his ear on Dec. 23, 1888. It is at this time he was admitted to the hospital for the first time and diagnosed with epilepsy. 

He voluntarily put himself in the hospital again for one year in 1889. It was a period full of ups and downs but also very busy professionally for Van Gogh as he completed more than 300 pieces during this time, including the famous "Starry Night." At the end of this year-long hospital stay, Van Gogh's doctors claimed he was cured of his depression, hallucinations, and delusions. However, over the next 10 weeks, he apparently continued to deal with feelings of sadness and lonliness, and dove into his work completing 70 more pieces. On July 29, 1890, he died by suicide. Van Gogh's last words, according to his brother, were, "The sadness will last forever."

Several authors, including Shelley Carson, PhD, whom Sanches also cites in his analysis, have extensively studied the relationship between psychopathology and creativity. Carson, a professor of psychology at Harvard University, has proposed a model, according to which certain shared neurobiological elements could predispose individuals to both creativity and mental illness. 

While some studies do suggest that individuals in creative professions are at higher risk of suffering from a mental disorder, that relationship cannot be generalized. "There are many highly successful artists who show no signs of mental illness, as well as patients with psychiatric disorders who are not artists," Sanches said. 

The biggest evidence for Van Gogh's mental state not being exclusively tied to his art is the fact that his low self-esteem throughout his life does not seem to have affected his art at all. "He always believed in his art and continued to believe that art was his niche in the world," Sanches said. "It wasn't simply Van Gogh's mental state that was influencing his artistic style. Those influences might have played a small role, but his painting style is also a reflection of the outside influences on his life - where he was living and the other artists he was interacting with at the time. He was a genius of a painter, and he might have had a touch of mental illness, but he wasn't simply 'the mad painter.'"