In this, the third and final part of the series, I want to continue the study of fine art, asking how paintings might be used effectively in a medical education, and how they might serve as the starting point for conversations about health, healthcare and what it means to be a doctor or a patient. This time, I wish to look at images created by artists who’s own ill-health has affected their work and finally at what I have called “conversation pieces”.
Self Portrait, Vincent van Gogh (1890)
In part II, I ended with van Gogh’s portrait of his doctor, Paul Gachet. Let us look another of van Gogh’s works. Painted in 1890, as was the portrait of Dr Gachet, this is one of almost forty self-portraits that Vincent completed in his brief artistic career. It was described by those who knew him as the best likeness of them all.
Intense and brooding – the artist portrays himself against a background of swirling turmoil. This painting almost shakes with rage, with frustration, if you stand before it in the Musée d’Orsay in Paris.
Van Gogh’s genius as an artist is often inextricably linked to his mental illness. “My pictures are almost a cry of anguish,” he wrote, but despite many contemporary reports of his clinical state, the exact nature of his illness remains elusive. Was he suffering from manic-depressive psychosis, as his family history might support? Was he suffering from petit-mal epilepsy, as some of his doctors thought? Was it turpentine poisoning, as Gachet suggested? Was he simply an alcoholic or was it the more hallucinogenic and mind-numbing effects of absinthe – a favoured drink in 19th century France?
We are unlikely ever to know. But, our legacy from van Gogh’s, albeit disturbed, genius not only comprises his immense portfolio of masterpieces, but also his words:
“I should like to paint portraits,” he wrote, “which would appear after a century to the people living then as apparitions.”
A wish surely fulfilled.
Despite the lyrics of the song – van Gogh did not take his life on a starry, starry night, but in the heat of a July afternoon in Auvers-sur-Oise. He shot himself, aiming at his heart, but the bullet was deflected by the fifth rib. It took him almost two days to die of his septicaemia. It was a shabby end.
Dr Gachet eased his last hours and when Vincent finally escaped the world he found so difficult, he did not escape art. Even on his deathbed this artist, who had been obsessed with confronting his own image, was the subject of yet another portrait, not this time by his own hand but by that of his doctor.
Portrait of Vincent van Gogh, Paul Gachet (1890)
Dr Gachet drew several portraits of the dying Vincent and one charcoal drawing can be seen in the Musée d’Orsay .
Van Gogh’s words as well as his paintings and his thoughts about the very nature of art resonate with anyone who studies medicine. He wrote:
I know no better definition of the word Art than this, ‘Art is man added to nature’, nature, reality, truth, but with a meaning, with an interpretation, with a character that the artist brings out and to which he gives expression, which he sets free, which he unravels, releases, elucidates.”
Some years later he added:
I feel like a fool going and asking doctors permission to paint”
Van Gogh was an artist in whose paintings, in whose words, and I believe even in whose eyes we are afforded one of the best examples of how art and medicine may come together and find greater meaning in each other.
Les Cocquelicots, Claude Monet (1874)
The second of my Artist-as-Patient case histories is that of Claude Monet. The title of one of Monet’s early works (Impression, Sunrise) gave the Impressionist movement its name, and this painting – Les Cocquelicots – was exhibited along with it at the first impressionist exhibition in 1874 and can now be enjoyed at the Musée d’Orsay in Paris.
Painted when the artist was 33, Les Cocquelicots, or the Poppyfield is a masterpiece, yet perhaps a masterpiece somewhat cheapened by over-reproduction.
Much has rightly been made of Monet’s talent and his genius. Much has also been made of his theories and perception of light and colour, but less is written on what may have been an important reason for the changes that took place in his palette and on his canvasses over the years.
Let’s go forward some 20 years to examine these changes.
Rouen Cathedral, Claude Monet (1892)
Painted in the artist’s middle years this is one snapshot from the great Rouen Cathedral series and can be seen in the National Museum of Serbia in Belgrade. It is indicative of the changing style and colouration, which Monet was adopting in this period.
The blue end of the spectrum begins to dominate and his canvasses drift slowly from impressionism to abstraction. Only two years after this painting was completed, the neo-impressionist Paul Signac was moved to write:
But, no M. Monet, you are not a naturalist…Trees in nature are not blue, people are not violet, and your great merit is precisely that you painted them like this, as you feel them and not just as they are.”
Waterlilies, Claude Monet (1910)
By the time the artist was in his 70s he had moved almost exclusively to the study of his garden at Giverny and particularly his waterlily pools. He painted around 250 versions of his beloved water lilies and they can now be seen in galleries the world over, but perhaps the most striking versions hang in the specially build oval rooms of the Musée de l’Orangerie in Paris.
In this example from around 1910, there is intense violet-blue and almost abstract brushwork. What could account for this? A maturing artistic talent? A developing colour theory? Yes, but also consider what was taking place in Monet’s eyes.
His vision had been failing for years, and in the summer of 1912 bilateral cataracts were diagnosed which continued to grow over the decade until in February 1923, at the age of 83 he had surgery on one eye, which was considered at least partly successful.
Cataracts, or opacities of the lens of the eye are well known to slowly deteriorate vision, but they can also cause alterations in the way we see colour.
Such changes both in acuity and colour vision could go a long way towards explaining the apparent changes in style we can now, retrospectively, observe in Monet’s work.
The physician-cum-amateur art historian can meet with many difficulties trying to venture into the ivory towered city of fine art, but I think this particular story demonstrates clearly that the professional art historian may sometimes learn from the physician.
Lastly, I would like to discuss three more complex images. These are images that do not fall easily into a category, and images that from the point of view of medical education may be called conversation pieces.
Roses in a Champagne Glass, Edouard Manet (c1882)
What could be complex about a small vase of flowers hanging in the Burrell Collection in Glasgow? And, what could the medical significance of such a painting be?
Nothing, at face value – for some paintings to achieve their significance, medical, historical or otherwise, you have to understand their background, perhaps the conditions in which they were painted – why, when and for whom they were painted.
When Edouard Manet, who painted these flowers, was a young man, he dazzled and scandalised the art world with his huge studio compositions such as Déjeuner sur l’herbe or Olympia. But, this small canvas – and that’s the key, its size – this small canvas only about 20 by 30 cm was painted in the year before the painter’s death at the age of 51.
The reason he had to revert to such small scale work, being no longer able to stand at his easel, was not because of his frailty – remember he was only 50 – no, the reason was syphilis. Loss of proprioception and therefore loss of balance is a late feature of syphilis and this painting would not only be a useful conversation piece for the interaction of art and medicine but also an attractive mnemonic for the neurological effects of tertiary syphilis.
Experiment with an Air-Pump, Joseph Wright of Derby (1768)
The second of my conversation pieces is an earlier work and this time from England and hangs in the National Gallery in London. When Joseph Wright of Derby painted his Experiment with an air-pump in the 18th century, scientific research was clearly a collaborative effort, and more than 200 years later little has changed. Little has also changed regarding our diverse views on medical research from profession and public alike, and in particular on the use of animals in research.
Here the cockatoo is being used to demonstrate that air is required for life – a demonstration that, of course, will cost the bird its life. The faces of those present show a range of attitudes from eager anticipation, through disinterest, to revulsion.
This painting, while being a masterpiece of technique (Wright specialised in unusual lighting effects in his work) is also a masterpiece of observation and as such would be an excellent resource for the discussion of modern medical research.
This brings us to my third and final conversation piece.
Bathsheba holding King David’s letter, Rembrandt van Rijn (1654)
In 1654 Rembrandt painted this portrait of his mistress Hendrickje Stoffels as “Bathsheba holding King David’s letter” which now hangs in the Musée du Louvre in Paris.
After the death of his wife, Hendrickje was Rembrandt’s maid and nanny to his son Titus, but soon she became his lover and later bore him a daughter, Cornelia. She died a young woman of 37, probably from breast cancer, but the reason I highlight this painting is only partly because it shows the swelling in Hendrickje’s left armpit and the discolouration of the underside of her breast that some have characterised as features of such a malignancy. No, the main reason – the poignancy of this painting – is that Rembrandt took such care to record the details of her tumour. Whatever the cause of Hendrickje’s premature death, she died defenceless against her disease. Medical science could offer her no real help, nor any hope of recovery. Today, however, a woman in her place should expect both.
The acceptance by patients and their relatives of a serious diagnosis, and indeed its discussion with them is an area fraught with difficulty. Should all patients be told their diagnosis, however painful this may be? Should their relatives be involved in this decision, or should they be entirely secondary? Like all ethical problems there are no easy answers. Suffice to say, however, the problem is illuminated, if not solved, by discussion and I can think of worse and less interesting ways of starting that discussion with students than by looking at this masterpiece by Rembrandt.
I began the first of this series of essays with a quotation from Marie Therese Southgate, who served as the cover editor for the Journal of the American Medical Association for over 30 years. Each week she would choose a work of art to reproduce on the cover of that medical journal and write a short but enlightened piece on its meaning and significance. It is to Dr Southgate that I return to give the last words.
Medicine is itself an art. It is an art of doing, and if that is so, it must employ the finest tools available — not just the finest in science and technology, but the finest in the knowledge, skills, and character of the physician. Truly, medicine, like art, is a calling. And so I return to the question I asked at the beginning. What has medicine to do with art?
I answer: Everything.”
© Allan Gaw 2020
SlideEasy and The Business of Discovery are now published and available on kindle and they’re free to download if you’re on Kindle Unlimited.
What can we learn from the past that may be relevant to modern drug research?
“I cannot recommend it highly enough: even if you read nothing else about the origins of drug research and what it can (should?) teach us, read this….This is a ‘buy’.” Madhu Davis review in Pharmaceutical Physician
Also available on kindle: