Vincent Van Gogh: A Negative Result from his Modern Suicidal Profile Assessment

Goals

Consistent with this KVP history of providing a contemporary perspective of critical issues regarding the life and death of Vincent van Gogh, the goals of this article are as follows:

1. To create a suicide profile assessment of Van Gogh for the period between December 1888 to July 1890 while living in Arles, Saint-Remy-de-Provence, and comparing it to the Auvers-sur-Oise period by utilizing the C-SSRS (Columbia – Suicide Severity Rating Scale).
2. To establish a distinct and determinative difference between the mental status of Van Gogh during the Arles/ Saint-Remy period and that of Auvers-sur-Oise.
3. To argue that the Auvers-sur-Oise period not only does not provide evidence of suicidal ideation, let alone gestures or a definitive plan with a time frame but that it was a time when Van Gogh finally calmed down, found love, achieved some of his most sublime masterpieces, and realized the most productive and creative period of Van Gogh’s ten-year artistic career.
4. To definitively challenge the false suicide narrative that has remained prevalent in many academic discussions despite the forensic evidence indicating murder, not a suicide.
5. To conclude that  the traditionally accepted suicide narrative as the cause of Van Gogh’s death is a false narrative and brilliant coverup story for a homicide to protect the perpetrators! It is simply unsubstantiated conjecture, lacking critical data and analysis to now support a lucrative Van Gogh market mania. Suicide is no longer a viable perspective regarding the death of Vincent van Gogh.

Autism Spectrum Disorder & Suicide Risk

South, Costa and McMorris have documented that among individuals with ASD there is three times higher rate of suicide attempts and deaths compared with the general population across all age ranges, beginning from age ten years. Furthermore, there is a higher incidence among autistic girls and women than among boys and men. Of further concern for our clinical understanding of Van Gogh is that the risk for suicide attempts and deaths is higher for those individuals diagnosed with additional mental health issues, particularly anxiety and affective disorders [1].

Addressing Van Gogh’s ASD and suicidal risk is essential to his twenty-first century mental health profile and therapeutic intervention. To assist in this analysis, the C-SSRS (Columbia – Suicide Severity Rating Scale) is utilized. This tool is commonly used by emergency personnel and clinicians in more controlled environments. It has a simple format, a set of questions to guide intervention.

C-SSRS Evaluation Questions

• Question #1: Wish to be Dead Have you thought about being dead or what it would be like to be dead? Have you wished you were dead or wished you could go to sleep and never wake up? Do you wish you weren’t alive anymore?
• Question #2: Non-Specific Active Suicidal Thoughts Have you thought about doing something to make yourself not alive anymore? Have you had any thoughts about killing yourself?
• Question #3: Active Suicidal Ideation with Any Methods (Not Plan) without Intent to Act Have you thought about how you would do that or how you would make yourself not alive anymore (kill yourself)? What did you think about?
• Question #4: Active Suicidal with Some Intent to Act, without Specific Plan When you thought about making yourself not alive anymore (or killing yourself), did you think that this was something you might actually do? This is different from (as opposed to) having the thoughts but knowing you wouldn’t do anything about it.
• Question #5: Active Suicidal Ideation with Specific Plan and Intent Have you decided how or when you would make yourself not alive anymore/kill yourself? Have you planned out (worked out the details of) how you would do it? What was your plan? When you made this plan (or worked out these details), was any part of you thinking about actually doing it?

These questions offer a critical context for evaluating Van Gogh’s suicidal risk factors during the final two years of his life as studied above. This assessment will be dependent upon his letters, both written and received, eyewitnesses, and medical professionals of his time.

Question #1: Wish to be Dead Have you thought about being dead or what it would be like to be dead? Have you wished you were dead or wished you could go to sleep and never wake up? Do you wish you weren’t alive anymore?

On December 23, 1888, Vincent van Gogh (subsequently referred to the more personable “Vincent”) had an extremely volatile encounter with Paul Gauguin which resulted in the mutilation of Vincent’s left ear. There is a legitimate issue as to whether Paul Gauguin was the cause of this mutilation [2].

Regardless, it raises the questions: what was the degree of intent for self-harm? Was this a latent suicide gesture? Was it a symbolic wish to be dead? Therefore, a clinician must evaluate not only the implications of this violent gesture but the contextual circumstances as well. To what extent was his abuse of alcohol, especially absinthe, causing neurological impairment and its behavioral consequences? Was this mutilation associated with his subsequent nineteenth century diagnosis of epilepsy or his twentieth century diagnosis of Meniere’s [3]? These issues raise the question as to whether it was a rational, thoughtful, deliberate act with possible latent suicidal ideation with accompanying gesture or whether it was a strictly impulsive act subsequent to a volatile emotional situation exacerbated by alcohol abuse. This evaluation leans in the direction of an unplanned, emotional, and irrational act exacerbated by alcohol abuse. Unless, it was Gauguin who did the mutilation as an expert swordsman when they were both inebriated prior to Christmas 1888.

In March 1889, his friend, Paul Signac, visited Vincent in Arles. Signac wrote to Theo of this visit. It has an ironic twist to it, namely, how normal and healthy he perceived Vincent to be, and yet, refers to Vincent’s bizarre desire to drink turpentine. Does not this speak to Vincent’s alcohol abuse, indeed, addiction. His alcohol use was restricted, given his subsequent readmissions to the Old Hospital of Arles (Hôtel-Dieu-Saint-Espirit). Certainly, these clinicians were monitoring him quite closely for dangerous behavior, even if it was bizarre. Signac wrote as follows:

That is also the wish of your brother, who would like to be taken away as soon as possible from this hospital, where he must indeed be suffering – from this constant surveillance that must often be petty-minded. In short, I found him, I assure you, in the most perfect state of health and reason. He wishes for one thing only, to be able to work undisturbed. Therefore, act so as to provide him with that happiness.

How sad this life must be for him!’ He talked to me all day about painting, literature, and socialism. He was a little tired by the evening. There was a terrible mistral blowing, which might have irritated him. He wanted to drink a litre of turpentine that was standing on the table in the room. It was time to return to the hospital [4].

In his letter to Theo (March 24, 1889), Vincent acknowledges his alcohol abuse: Mr. Rey says that instead of eating enough and regularly I have been particularly sustaining myself with coffee and alcohol. I admit all that, but it will still be true that I had to key myself up a bit to reach the high yellow note I reached this summer. That, after all, the artist is a man at work, and that it’s not for the first passer-by who comes along to vanquish him once and for all [5].

Doesn’t this sound like Vincent is needing to get high on booze to paint as he so desired? This reinforces the role alcohol played in his ear mutilation episode.

When Vincent became a voluntary patient at the St. Remy Asylum, Dr. Peyron, his physician, documented (May 8, 1889) that Vincent tried to poison himself by eating paint as he had done during the previous attack [6].

However, on January 1, 1890, Vincent wrote to Theo: “Odd that I’d worked perfectly calmly on canvases that you’ll soon see, and that all at once, without any reason, the confusion took hold of me again” [7].

Vincent had a total of three attacks in Arles and four while at St. Remy Asylum. This informative comment by Vincent, “confusion took hold of me again,” leads to a viewpoint that his self-harming behaviors are not premeditated but occurred inexplicably, randomly, unpredictably and that self-harming behavior was not suicidally intended but confused efforts to free himself from the consequences of these attacks.

Vincent never had such an attack while he lived in Auvers-sur-Oise, although he was aware and apprehensive that they could occur again.

To conclude the response to this first question, Vincent never had such an emotionally devastating trauma than being rejected by Kee Vos Stricker when he proposed marriage. She responded: “Never, No, Never.” Vincent wrote an extended letter to Theo which he asked to be kept confidential; it is well worth reading this lengthy and rambling narration in its entirety to get an understanding of how Vincent was coping with the rejection. In reference to the question of suicide, this excerpt from that letter to Theo on November 7, 1881, is insightful: I suppose far from astonishing you, this will seem very natural and reasonable. For love is something so positive, so strong, so real that it is as impossible for one who loves to take back that feeling as it is to take his own life. If you reply to this by saying, “But there are people who put an end to their own life,” I simply answer, “I really do not think I am a man with such inclinations.” Life has become very dear to me, and I am very glad that I love it. My life and my love are one [8].

Such a declaration quite forcefully undermines the suicide narrative and points to murder as the cause of Vincent’s death. This is not to say that Vincent did not realize his vulnerability, given his attacks. With a touch of humor, on January 13, 1890, Vincent comments to Theo: “And I even have hopes that it (the attacks) will be dispelled even more if I return to the north. Just mustn’t forget that a broken pitcher is a broken pitcher (emphasis added), and so I have no right at all to entertain pretensions” [9].

While in and out of the hospital in Arles, Vincent writes to his sister, Wil, about not wanting to be a “martyr” for his art. Ironically, Theo wrote to his sister, Lies, of Vincent (posthumously) being “among the martyrs who have died with a smile on their face” [10].

However, on May 2, 1889, Vincent dismisses this “martyr” label in a letter to his sister, Willemien: I read a little so as to think about it more. It’s very likely that I have a lot more to suffer. And that doesn’t suit me at all, to tell you the truth, for I wouldn’t wish for a martyr’s career in any circumstances.

For I’ve always sought something other than the heroism I don’t have, which I certainly admire in others but which, I repeat, I do not believe to be my duty or my ideal [11].

On January 20, 1890, Vincent writes to the Ginoux’s who live in Arles regarding Madame Ginoux’s illness and does acknowledge the struggle of one’s existence.

I’ve very often told myself that I’d prefer that there be nothing more and that it was over. Well, yes – we’re not the master of that – of our existence, and it’s a matter, seemingly, of learning to want to live on, even when suffering. Ah, I feel so cowardly in that respect, even as my health returns. I still fear. So, who am I to encourage others, you’ll rightly say to me, it hardly suits me [12].

Although this may imply struggling with suicidal ideation, is it relevant to Question 1 - ‘Wish to be Dead’? Possibly! But with Vincent, there is ambiguity in this comment to the Ginoux’s.

Another controversial situation was the communication between Theo and Vincent (and Theo and Jo, his wife) in July 1890 regarding Vincent’s misunderstanding of Theo’s family responsibilities, his financial situation, his employer, Boussod, Valadon & Cie,, whether to start his own art dealership, and his health issues. In these last letters, there wasn’t any mention of wanting to be dead [13].

Is a comment made in 1881 (re: Kee Vos Stricker) relevant to comments written in 1889/1890? Yes! It serves as valuable background, but the suicidal profile focuses on the here-and-now, namely, Vincent’s life in Auvers-sur-Oise. Consequently, in response to Question 1, ‘Wish to be Dead,’ the clinician cannot give a simple “Yes” or “No.” It depends upon the situation. If the question is raised in Arles between December 1888 and May 1890 and in St. Remy between July 1889 (his first attack at St. Remy) and April 1890 (his last recorded attack) there might have been a qualified “Yes.” Regarding his stay in Auvers-sur-Oise, however, the answer would be a definitive “No.” This “No” is directly relevant to the false tradition that Vincent committed suicide.

Following C-SSRS protocol, the evaluation must move onto Question 2:

• Question #2: Non-Specific Active Suicidal Thoughts Have you thought about doing something to make yourself not alive anymore? Have you had any thoughts about killing yourself? Addressing these questions, once again, depends on Vincent’s circumstances. Consuming paint and turpentine were a significant concern during his St. Remy confinement. On August 4, 1889, Theo expresses his concern about Vincent’s mental status in a letter to Vincent: In your last letter you wrote that we are brothers for more than one reason. I feel that too, and even if my heart isn’t as sensitive as yours, I can sometimes imagine the distress that you feel because of so many thoughts that aren’t resolved. Don’t lose heart and remember that I need you so much [14].

Dr. Peyron also raised the issue of Vincent’s mental status with Theo.

On August 3, Peyron had sent Theo a telegram about Vincent, which  Jo van Gogh-Bonger  wrote about to her sister Mien on August 9, 1889: ‘Bad news from Vincent. On Saturday at 6 o’clock we got a telegram from the doctor – Vincent ill, letter follows. We worried all day Sunday, but fortunately a letter arrived around 4 o’clock; he’s having another crisis and tried to poison himself with his brush and paints. After that letter, nothing – you can imagine how upset Theo is – he’s coughing again and looks worse than he did before – tomorrow he has to see Rivet [Paris doctor] again’ [15].

Previously, Van Gogh tried to drink turpentine; later, paint will again prove a threat to Van Gogh’s health [16].

On January 3, 1890, Theo wrote to Vincent: It’s curious that this has taken hold of you again, precisely a year after the first attack, and it proves that you must remain on your guard. So, if you know that it’s dangerous at times to have paints near you, why not set them aside for a while by making drawings? Like the other times, this crisis may be followed by another, although much less violent. I think that at such moments you’ll do better not to want to work with color. In a while from now nothing will prevent you from starting again [17].

On January 8, 1890, Theo wrote an important clarification: When I last wrote to you it was under the impression of Dr Peyron’s first letter. I’m very, very glad that it isn’t as bad as that letter made me assume, and he himself wrote to me again to say that it had taken a quite different turn than he had thought at first. In his first letter he gave me to understand that it was dangerous for you to continue to paint, as the paints were a poison, but he got a little carried away, perhaps through simply relying on hearsay, being ill himself. Let’s hope, then, that you may continue to work as you intend to [18].

When Vincent had an attack, eating paint and drinking turpentine were a documented concern. However, these risk-behaviors occurred when his normal mental status was disrupted by his intermittent and unpredictable violent and frustrating inner ear vertigo attacks diagnosed as Meniere’s. The Meniere’s disease diagnosis, replacing the old epilepsy diagnosis, has not been disputed in the 30+ years since it was published to worldwide acclaim. Importantly, there is no documented evidence of such self-injurious behavior or any vertigo attacks while living in Auvers-sur-Oise.

Therefore, the answers to Question 2 are a highly problematic “Yes” for St. Remy but a definitive “No” for Auvers-sur-Oise.

The conclusion, at this point, is that the Vincent’s C-SSRS profile for Arles and St. Remy are to be considered as significant, as background, especially given the medical circumstances that have been addressed for those two periods in Vincent’s life, but irrelevant and moot in terms of his murder, not suicide.

Vincent arrived in Auvers-sur-Oise on May 20, 1890, was fatally injured on July 27, and died on July 29. The primary focus for evaluating his suicide profile must focus on his mental status for the Auvers-sur-Oise period to confirm that suicide was not in his clinical differential diagnosis. According to what has been evaluated as stated above, the answers to Questions 1 & 2 for the Auvers-sur-Oise period are both “No.” According to C-SSRS, if the answer to these two questions is “No,” (as indicated), then the evaluation skips Questions 3, 4, and 5 and proceeds to SUICIDAL BEHAVIOR. (If his death had occurred at Arles or St. Remy under similar questionable circumstances as it did in Auvers-sur-Oise, then it would be necessary to address questions 3, 4, and 5). This section of the evaluation must focus on his physical and mental status from May 20 to July 27 (prior to the occurrence of the fatal injury on July 27, given how this injury occurred is forensically contested as to whether the wound was self-inflicted or inflicted by another) [19].

The period of May 17 to May 20 when Vincent visited Paris is also considered.

After Vincent was officially discharged from St. Remy Asylum on May 16, he went to visit Theo, his wife, Jo, and their child, Vincent-Willem, arriving on May 17. He stayed for 3 days.

Theo and Jo were surprised how healthy Vincent looked.

Theo also wrote to Willemien about this visit:

‘Oh Wil, you would be as happy as we were to see Vincent back like he is. He has never looked as healthy as he does now, and he also talks quite normally. Still, he feels that the attacks could come back, and is afraid of that. It seems that it takes him unawares and that nothing can be done about it, at least in St Remy, but rest [20].

Recalling this visit, Jo also wrote of Vincent’s better- than-ever healthy appearance: Before me was a sturdy, broad-shouldered man with a healthy color, a cheerful look in his eyes and something very resolute in his appearance. ‘He looks much stronger than Theo,’ was my first thought. He charged out into the arrondissement to buy olives he loved and came back insisting that they taste them. He stood before the canvases he had sent and studied each with great intensity. Theo led him to the room where the baby lay sleeping, and Jo watched as the brothers gazed into the crib. They both had tears in their eyes [21].

Vincent’s physical and mental status upon arriving in Auvers-sur-Oise had a normality to it, albeit what one might term, “Vincent’s Normality.” On June 5, 1890, Theo wrote Vincent: Yesterday Dr Gachet came to see me, and unfortunately there were people there, which prevented me from talking with him much, but what he said to me was that he thought you are cured and that he saw no need at all for it to recur [22].

Keeping in mind the evaluation for Questions 1 and 2 and now focusing on Vincent’s life in Auvers-sur-Oise, the evaluation of SUICIDAL BEHAVIOR is as follows. Actual Attempt, Self-Injurious Behavior, Aborted Attempt or Self-Interrupted Attempt There is no actual suicide attempt/gesture documented, even discussed, by Vincent or any of his correspondents. There is no involvement from the local police prior to July 27 implementing a suicidal intervention (ideation, attempts, self-injurious behavior) nor explicit public concern for such intervention to be done. There is no documentation by Dr. Gachet of Vincent making any such attempts on his life or even of non-suicidal self-injurious behaviors, discussions, or letters. Accordingly, it is concluded that the response to this criterion is “No” - there were no actual attempts, no aborted attempts interrupted by Vincent himself or another person(s) and no self-injurious behavior.

Although Vincent, as well as Theo, were concerned that another vertigo attack might occur, Vincent was putting his exuberant energy into his paintings. He was doing a painting a day with his ongoing creativity and dedication.

In his very last letter to Theo, July 23, 1890, Vincent wrote:

As for myself, I’m applying myself to my canvases with all my attention, I’m trying to do as well as certain painters whom I’ve liked and admired a great deal [23].