The United States Supreme Court is, in the words of today’s New York Times headline, up against a “momentous test.”  As most Americans are aware, the justices are hearing arguments about the constitutionality of requiring citizens to obtain health care: the “mandate” that is one of the central components of what is frequently referred to as “Obamacare,” President Obama’s healthcare overhaul plan.  Media coverage of the plan and of the Supreme Court proceedings has been understandably intense, as many Americans envision a scenario in which their lives might be directly affected by the decisions in the offing.  These imaginary scenarios frequently invoke the possibility of unexpected illness and hospitalization.

When one Yale University Press author recently turned his thoughts to hospitals and the critical moments of sickness and healing that occur in them, his focus was trained on the extraordinary richness of art in hospitals.  This unique focus was unsurprising, given that the author in question is the distinguished art historian Richard Cork.  The book that resulted from this critical examination, The Healing Presence of Art: A History of Western Art in Hospitals, discovers the astonishing variety of images found in medical settings, ranging from dramatic confrontations with suffering (Matthias Grünewald at Isenheim) to the most sublime celebrations of heavenly ecstasy (Giovanni Battista Tiepolo in Venice).  By examining the art both present in hospitals and made by some of history’s greatest artists during hospitalizations, Cork reveals art’s ability to humanize our hospitals.  In the short essay below, Cork discusses some of the artwork made by Vincent van Gogh during his time in an asylum.  (Serendipitously, “Irises,” pictured below, and a number of the other paintings that van Gogh made at the asylum are also featured in another recent YUP release, the spectacular catalogue Van Gogh: Up Close edited by Cecilia Homburg.)

“Stricken by Acute Mental Derangement”

Richard Cork—

Although my new book is filled with outstanding masterpieces of western art made in hospitals, perhaps the most miraculous are the paintings produced by Vincent Van Gogh during his turbulent time in an asylum. Even today, when Van Gogh’s international reputation is higher and wider than ever, we have intense difficulty understanding how he managed to paint such a sustained series of masterpieces. After mutilating his ear and struggling to retain his sanity, this vulnerable young Dutchman dreaded the sudden onset of each new bout of epileptic seizure. But somehow, he carried on painting for another turbulent year and — against all odds — produced his finest work before succumbing to suicide.

The eloquent letters written to his brother Theo reveal just how dramatically Vincent veered from panic and hopelessness to incisive, stubborn resolve and back again. As early as September 1883, seven years before he killed himself, Van Gogh confessed to Theo that, “because I have a need to speak frankly, I can’t hide from you that I’m overcome by a feeling of great anxiety, dejection, a ‘je ne sais quoi’ of discouragement and even despair, too much to express. And that if I can find no consolation for it, it might all too easily overwhelm me unbearably.”

These words proved sadly prophetic. But Vincent, having wisely abandoned his doomed attempts to become an art dealer and a priest, developed as a painter with astonishing courage, inventiveness and flair. Although unable to sell his work, Van Gogh was sustained by its momentum even when, in May 1889, he was admitted to a mental home near the village of Saint-Remy-en-Provence. The attending physician, Dr. Theophile Peyron, recorded on the certificate of entry that his 36-year-old patient had been “stricken by acute mental derangement, with hallucinations of his sight and hearing, which led him to mutilate himself by cutting off his ear.” The affliction was terrible enough to make Vincent remain in the asylum for an entire year. Even so, this illness did not prevent him from pursuing his art with a remarkable sense of discipline, concentration, audacity and, above all, passionate commitment.

Van Gogh, fortified by medicine, hoped that his mind would never again succumb to what he described as moods of “indescribable mental anguish when the veil of time and inevitability seemed for the twinkling of an eye to be parted.” Although Dr. Peyron came to the hesitant conclusion that Vincent was suffering from “a state of epilepsy”, and warned Theo that “if this should be confirmed one should be concerned about the future”, he was encouraged by his patient’s initial progress. After recurrent painful nightmares during the first few weeks of his stay, Van Gogh’s sleep improved along with his appetite. Despite his distress, he seemed adept at discovering continual inspiration in whatever surroundings confronted him. A few weeks earlier, he had bravely asserted that “if I had to stay for good in an asylum, I should make up my mind to it and I think I could find subjects for painting there as well.” The prophecy was borne out to spectacular effect at Saint-Remy, where he painted many of his most vibrant canvases.

Within a week of arriving at the asylum he was hard at work on paintings of the garden, one of which turned into a superlative image called Irises. At first sight it appears a festive work, revelling in the piercing clarity of the violet-blue flowers as they thrust and wave with an exuberance worthy of a Hokusai print. After a while, though, more disturbing elements demand attention. The irises and their blaring green leaves fill the canvas with insistent movement, as if jostling for room in the confined picture-space. They crowd round the solitary white flower in their midst, provoking the suspicion that Vincent equated their clamorous behaviour with the more disturbed patients confined inside the asylum’s walls.

In one letter, he described life in the asylum and informed Theo that “there is someone here who has been shouting and talking like me all the time for a fortnight; he thinks he hears voices and words in the echoes of the corridors, probably because the nerves of the ear are diseased and too sensitive.” Vincent explained to Theo that, “as there are more than thirty empty rooms” at the asylum, he had been given “one to work in.” He lost little time in hanging on its walls his unframed works, one of which can be seen in a gouache study of this new studio. He longed to animate the whole asylum with his art, telling Theo that “it would be splendid to hold an exhibition in all the empty rooms, the large corridors.”

Van Gogh was irrepressible as an artist for much of his stay in the asylum. Towards the end of May 1889 he described his excitement over the view from his bedroom, where “through an iron-barred window I see a square field of wheat in an enclosure, a perspective like van Goyen, above which I see the morning sun rising in all its glory.” Soon after Dr. Peyron allowed him to work in the field, he began an extended sequence of views which amount to the finest series of paintings he produced at Saint-Remy. The first canvas, Mountainous Landscape Behind the Asylum, is one of the most outspoken in its desire to use nature as a metaphor for his own emotional condition. The turbulence of the wheat, heaving in its enclosure like an angry sea, surely refers to Van Gogh’s view of his plight within the institution’s walls. He described the painting to Theo on 9th June, explaining that the foreground contained “a field of wheat ruined and hurled to the ground after a storm.” Vincent must have been conscious of the fact that he, too, was trying to recover his shattered composure “after a storm.”

Towards the end of June he started work on a painting called The Reaper, and brought it to virtual completion before suffering a serious breakdown for several weeks. The choice of theme may well have reflected an awareness that a mental crisis was imminent, for when Van Gogh resumed work on the “terribly thickly painted” picture in early September he informed Theo that “I see in this reaper — a vague figure fighting like the devil in the midst of the heat to get to the end of his task — I see in him the image of death, in the sense that humanity might be the wheat he is reaping.” The toiling peasant could embody Van Gogh’s realisation that he was engaged in a struggle against mental illness to complete the task he had set himself as an artist. But he insisted that “there’s nothing sad in this death, it goes its way in broad daylight with a sun flooding everything with a light of pure gold.”

In one mood, Vincent transformed a view of the Hospital at Saint-Remy (Trees in front of the Entrance to the Asylum) into an ecstatic image, rejoicing in the vigour of trunks and foliage as they soared high above the buildings. “I tried to reconstruct the thing as it might have been”, he explained, “simplifying and accentuating the haughty, unchanging character of the pines and cedar clumps against the blue.” During the first few months of his stay in the asylum, he recovered from the initial shock of other inmates yelling and screaming in nearby rooms, at night as well as in the day. He started talking to them, even though they were incapable of coherent replies. And he reported in a letter to his sister that, “though there are some seriously ill here, the fear of madness that I felt has already largely disappeared. Although one is always hearing howls and cries like beasts in a zoo, the people here understand each other very well and help each other when they fall into a fit.”

This optimism did not prove well-founded. Soon afterwards, Van Gogh suffered a gruelling attack while at work in the foothills near the asylum. The onset of a mistral, blowing a half-finished painting off its perch, seems to have precipitated his collapse. A protracted fit of yelling left his swollen throat acutely painful for days, and he even attempted suicide by gulping down his own paints. Nightmares and hallucinations dogged Vincent. Hidden away in his room, where he struggled to cope with this alienation by working harder than ever on self-portraits filled with an unbearable sense of strain, Van Gogh felt tormented. “If one could resign oneself to suffering and death, surrender one’s will and love and self!” he wrote. “But I love to paint, to meet people, to see nature.”

Eventually, in April 1890, he announced to Theo that his period at the asylum should now be terminated. But his sense of regret was intense. He could not bear the thought of leaving the South, with all its fertile inspiration, and going north to live with Dr. Gachet, an avid collector of Impressionist art. Auvers-sur-Oise, where Gachet had a house, was only an hour from Paris, and at first Van Gogh managed to paint some outstanding images under the doctor’s care. But this final burst of blazing productivity could not be sustained for long. Just over two months after he left Saint-Remy in May 1890, he wrote a letter to Theo describing his new paintings. It sounds purposeful enough, but one passage is sadly revealing: “I’d like to write to you about many things, but first the desire has passed to such a degree, then I sense the pointlessness of it all.”

Four days later, Vincent went out into the summer fields and clumsily shot himself in the chest with a revolver. His brave and arduous attempts to recover mental stability with medical help had all failed, and he died two days later. On his death-bed, when the distraught Theo asked him why he had decided to commit suicide, Van Gogh only managed to reply with another, equally anguished question: “Who would imagine that life could be so sad?”

Richard Cork is an award-winning art critic, historian, broadcaster, exhibition curator, and former Professor of Fine Art at Cambridge University and Senior Fellow at the Courtauld Institute of Art in London. The Healing Presence of Art is now available from Yale University Press.