Leaving Van Gogh

One





WHEN THEO VAN GOGH first approached me about caring for his brother, I was in my sixties and I had been practicing medicine for thirty-one years. I was well established. My patients were a varied group, but for years I had specialized in diseases of the nerves and mental maladies. A handful of other men in Paris had similar qualifications, but it was my connection to the art world that brought Theo van Gogh to me in the spring of 1890. In fact, it was Camille Pissarro who sent him.

As a boy in Lille, I had studied painting, and through those lessons I came to know Amand Gautier. He was a little younger than I and significantly more talented, so it was no surprise to me that he was accepted to the École des Beaux-Arts in Paris. I had already spent two years at the Faculté de Médecine when he arrived in Paris in 1852, and my life was much livelier from that day. Gautier was an open, affable man, handsome and eager to make friends. What’s more, his fellow painting students were far more entertaining than my fellow medical students. I cared deeply about medical problems, but what I wanted to talk about was art, so I often went with Gautier to the artists’ cafés. And thus over the years I came to know them all—Courbet and Manet, Pissarro and Cézanne, Monet and Renoir, Sisley and Guillaumin.

In 1855 I was accepted as an extern under Dr. Jean-Pierre Falret at what was officially called the Hospice de la Vieillesse-Femmes at the Salpêtrière. Most of the patients were elderly, as the institution’s name would suggest, but Falret was famous for his innovative treatment of women of all ages who had lost their minds. My wife, Blanche, used to tease me, in the gentlest possible way, that the first women I ever knew were mad, pretending that this was why I found her so delightful. She may have been right. When we finally met, in 1868, I had known plenty of sane ladies, but none seemed to see the world in such a clear light as the woman who became my wife. I always relied on her generous but sensible perception of people and their emotions. It is precisely those points that the mad get wrong. You could even say that the definition of madness is a flawed understanding of the world around you. By that standard, Blanche was the sanest person I ever knew. Perhaps my years working in the asylum had made me especially grateful for her soundness.

Despite its reputation for modernity, the Salpêtrière, which had been built largely in the seventeenth century, looked like an old provincial town. The entire hospital was surrounded by a wall and formally laid out around the domed chapel. Parts of the grounds were beautiful: there were old trees, long, symmetrical walkways, and buildings constructed from the golden stone typical of Paris. But its history came with drawbacks. A warehouse for saltpeter, erected on a damp and isolated tract of riverbank, cannot easily be transformed into a rational, modern hospital building. Nor, when many of its patients are mentally fragile, can it be helpful that one of its most prominent wards is housed in what was once known as La Force, France’s most notorious women’s prison. Fear and grief still lingered in those walls.

Only sixty years before I arrived, the great Dr. Philippe Pinel had released the patients from their chains. This was a revolutionary action, for until that point the mad had been thought to be possessed by malevolent spirits. They could not be treated, it was supposed, but must be restrained. Pinel and others believed that madness was rather a kind of alienation from the true self (which is why we used to refer to the mentally ill as “aliénés”). The new “moral treatment,” by appealing to what was left of the patients’ reason, could bring them back to themselves. As a young doctor, I found Dr. Pinel’s theories thrilling. The merciful and humane attempt to guide a mad person back to his or her senses is not a simple task, and it is not always successful. Even now, in a new century, we do not know what keeps some of us tethered to reality while others go astray. We still do not know exactly how to diagnose the various forms of madness, and we certainly do not know how to cure them. This I have learned to my cost. But in those days, I still believed we could. I thought that kindness and regular hours, good, plain meals, fresh air, and moderate distraction—even work for the most capable—could relieve the mad.

Once I finished my medical training, I began to build an independent practice. I am not a man for committees and meetings. I could never have run a division of a hospital the way Falret did. Instead I worked in the city’s clinics, offered free consultations to the poor, and served as the medical officer of a spa for a few summers. I was even, for a spell, the doctor for a comic theater, soothing sore throats and wrapping twisted ankles so that actors could go back onstage. It was a hand-to-mouth existence, but I was a rich man compared to my artist friends. At least everyone recognizes the need for doctors.

Those were the days, in the 1850s and ’60s, when academic art was slowly giving way to something more individual. Courbet and Cézanne and their friends painted not flattering, fashionable portraits or gigantic mythology paintings but rather their own responses to the life that we all lived. These revolutionary canvases were not well received at first, so my friends were often in desperate straits. I owe several of my loveliest paintings to the fact that I helped them from time to time. I loaned Monet money, I took care of one of Renoir’s favorite models. They gave me canvases as payment. It was a satisfactory arrangement for everyone.

Though Cézanne and I became quite friendly, it was Camille Pissarro I knew best. At times he could barely feed his wife and their children. Of course I helped when the little ones became ill, when Madame Pissarro grew exhausted, when the painter’s eyes began giving him trouble. When he was living north of Paris, in Pontoise, and I bought a house for my family in the neighboring village of Auvers, we saw each other a great deal. Once Cézanne, Pissarro, and I made etchings together, using the little press I had in my attic studio. Pissarro, too, gave me paintings in exchange for medical care.

Over the years, some of these attachments faded, as the bonds of young men do. Cézanne moved to the South and rarely visited Paris. Gautier and I had a falling-out over money he owed me, Monet became rich and grand, and Pissarro bought a house south of Paris where he could live cheaply. Or perhaps it was my own fault—it was true that after Blanche died I became somewhat withdrawn. Yet I kept up with the art world through the 1870s and ’80s. I went to the Salons and other exhibitions, I visited dealers, I read the art criticism in the newspapers. I knew from Pissarro that his dealer was a Dutchman named Theo van Gogh, who worked for Boussod and Valadon. I had occasionally visited their premises on Boulevard Montmartre, but most of what I saw there was dull and conventional. Yet Pissarro claimed that this Van Gogh worked hard for him, trying to sell his beautiful landscapes. Over the years I had heard snippets of gossip about Theo van Gogh’s painter brother. He had lived with Theo for a year or two in Paris in the late 1880s, but our paths did not cross and I had no clear idea of what his pictures looked like.

In his letter proposing that I meet Theo van Gogh, Pissarro explained further. Apparently this brother, Vincent, had a history of mental troubles. He had spent a year in an asylum in Provence, having committed himself voluntarily. He felt that he was better now, but that the company of his fellow patients was hindering any further progress. He wanted to come north to be near Theo, but he did not want to live in Paris. The city, he felt, would be too busy, too jarring to his nervous state. He also felt it important that he be under the care of a doctor. At first Theo van Gogh had hoped that his brother could board with the Pissarro family, but Madame Pissarro did not care to receive a recovering mental patient into a home full of small children.

Pissarro then thought of me, his former neighbor. I practiced medicine in Paris, seeing patients four days a week. On Sunday, Monday, and Tuesday, I was a rural family man in Auvers, where Pissarro thought Vincent could find inexpensive lodgings and paint in the country. I had a great deal of experience with nervous ailments, I knew painters, and voilà—I was the solution to Theo van Gogh’s difficulty. I replied to Pissarro, saying that I would be happy to meet with Theo.

But I heard no more from Pissarro for several months. I had put the matter out of my mind when, one day in March of 1890, an extremely courteous young man arrived at my Paris premises on the rue du Faubourg St. Denis, a busy street between the Gare de l’Est and the Gare du Nord. My consulting room was dark and formal, with tobacco-colored velvet curtains and many framed prints on the wall. I had long since grown accustomed to the noise from the street—carriages, wagons, hawkers, even the omnibus—but new patients were sometimes distracted by it.

At first I thought this was the case with my new visitor, Theo van Gogh. He was well dressed and well groomed, in a frock coat and silk hat, a conventional bourgeois like thousands of others you would pass in the street. He was no taller than I, and pale-skinned, with short russet hair and a sandy mustache. He spoke flawless but faintly accented French and exhibited the highly attentive air of a man who sold things for a living. Yet he seemed to lose the thread of his tale from time to time. Now, as I think back, I realize that he may simply have been selecting what to tell me—and what, strategically, to leave out.

Vincent, Theo told me, was his elder brother by four years, not the firstborn but the first surviving son of a Protestant pastor in the Netherlands. Several uncles of the family were art dealers like Theo, and Vincent himself had originally worked in the Hague branch of Goupil, a gallery with Parisian roots. It was a kind of apprenticeship, I gathered. He did well, Theo said, and was transferred to another branch.

“And did he always demonstrate interest in painting?” I asked. “Painting, for himself?” I had been sitting near Theo in an armchair, but now I stood and moved to my desk. I began taking notes as Theo spoke.

“Not until about ten years ago, when he was twenty-seven,” Theo answered. “He had made a few drawings at home, but that was all.”

“Was he gifted?” I asked.

Theo hesitated. He was evidently torn between honesty and affection. He shrugged slightly, indicating to me that Vincent’s talent had not been visibly overwhelming but that Theo’s fraternal loyalty forbade him to say so.

Vincent’s career as an art dealer came to an end when the young man took it into his head to be a teacher instead, but after a brief spell at a small boarding school in England, he abandoned that career. “He decided to become a minister,” Theo said. “Mind, I am telling you everything. It would be very painful for him to talk about these things, but you should know them. Earlier there had been a situation with a young woman, a cousin of ours. Vincent …” He fell silent again, eyes on a rather gloomy etching of a Dutch landscape. Apparently there was no way to tell the tale that reflected well on his brother. “Vincent could not believe she did not have feelings for him. He, his fervor—it alarmed her. Then there was another young woman in England, and another unhappy outcome. So, the church.”

“Like his father. A familiar way of life, perhaps,” I suggested, trying to make the decision seem rational.

But Theo could not quite accept my reasoning. “Yes and no. He went to the Borinage as a missionary to the coal miners. I don’t know if you know anything about that part of the country—perhaps you’ve read Zola’s Germinal?” I nodded, recalling the bleak account of unremitting labor, poverty, and violence. “Zola spares nothing. It is as he portrays it, a terribly harsh way of life. Vincent became ill. He gave away all of his food, all of his furniture.”

I thought of the women at the Salpêtrière. The wards had been full of monomaniacs, patients fixed on one dominating fantasy. Many of them refused food for one reason or another. “Yes. I see,” I said. “Did he know who he was? Was he emulating Christ? Or did he believe he was Christ?” Such a delusion was common among the mad.

“He knew at all times who he was,” Theo answered. “He had by then lost his faith. I brought him to our parents’ house to recover. That was when he decided to be an artist.” There was another pause. “You must understand, Dr. Gachet, that Vincent’s goal is to help people. He thinks that somehow, with his art, he can express important truths about the nature of life. He believes that it is his absolute duty to do so. At any cost.”

We were silent for a moment. Theo’s last words seemed to echo in the suddenly hushed room. One had to wonder, then: was it the art itself that had attracted Van Gogh? Or was it the chance for self-sacrifice? Monomaniacs are capable of harming themselves in the most preposterous ways. When you question them, however, their thinking—you could not call it reasoning—has a certain coherence. Apparently this Vincent saw himself as some kind of savior. Theo did not appear to grasp how grandiose the delusion was.

“And why was he in the asylum?”

Theo did not answer right away. He looked down at his knees. I waited.

“It was a complex incident.” He paused again, then raised his head and made as if to rise. “I realize that these are your consulting hours, Monsieur le docteur, and I don’t want to trespass on them.”

I gestured to the empty chairs. “Do you see any other patients?” I asked. “I am at your disposal. And if I am to be of any help to your brother, I really must know his whole history. Surely you understand.”

“Yes, of course,” Theo said and folded his hands somewhat formally in his lap. He looked unseeing at the wall for a moment, clearly seeking to frame his tale. “Vincent lived at home in the Netherlands for a while, teaching himself how to paint. It was difficult for our parents. In a big city like Paris, it might not matter so much if the pastor’s son roams around bareheaded in near rags. But in a Dutch village, I assure you, such behavior prompts talk. My mother loves Vincent very much, but the neighbors were cruel.” He stopped, apparently lost in the painful memory for a moment, before flapping his hand dismissively. “In any event—I need not go into detail. Vincent came to Paris. He lived with me. He made great strides in his painting, great strides. But he is … a very difficult person to live with. His energy is frightening. He needs little sleep. He can be very argumentative. Intense. And he paints so quickly! The paintings, Doctor—they piled up. It’s not a large flat I live in. There are paintings everywhere: under beds, rolled into wardrobes. My wife is remarkably tolerant.” He took a deep breath, as if to calm himself. “We were not yet married when Vincent lived with me, and she has not yet met him, but she lives with his work.”

He abruptly changed the subject. “Do you know Gauguin?” I wanted to ask more about this ferocious energy. I saw that, too, sometimes in the hospital wards. We call it “mania,” and it is sometimes found in combination with another form of derangement. Yet I decided to follow Theo’s lead for the moment.

“I’ve heard the name. Somewhat farouche, I understand? Bold, swashbuckling?”

“Yes. Enormously talented. As impossible as—no, actually more impossible than my brother. Vincent, at least, is full of gentleness and loving-kindness. His intentions are pure. Gauguin is ambitious and guileful. I think he’s quite capable of malice, but Vincent admires him very much. My brother conceived an idea that he wanted to go paint in the South. Paris was too crowded, too busy. He felt he could live cheaply and simply somewhere in Provence, and he found a house in Arles. He was going to form a ‘Studio of the South,’ and he wanted Gauguin to join him.” Theo fell silent again, now staring at his thumbs. Then he looked up at me.

“Before he went to the asylum, I made Vincent an allowance of 150 francs a month, and I have always supplied him with painting materials. I expect to do the same once he leaves St.-Rémy, where he is now. It’s not much, but I can’t afford more; my wife will have a baby soon. I agreed to send money to Gauguin as well if he joined Vincent in Arles. Gauguin was there for only two months. I did not hear this directly from either of them, but the visit was not a success. Their temperaments … Vincent gets so set on an idea, but nothing lives up to his visions.” He took a deep breath and smiled at me. “You are very patient, Doctor, I am almost at the end.”

“Not at all. In fact, you have mentioned …” I looked down at what I had written: Mania? Argumentative. “Studio of the South”—delusions? Delusions about women. “You have mentioned several characteristics that are familiar to me from other patients. Do go on.”

“Well, Gauguin and Vincent quarreled. To this day I do not know exactly what happened. Gauguin says Vincent threatened him with a knife. After their argument, my brother appeared at the local brothel, covered in blood. He gave one of the whores …” Theo visibly gathered himself for the effort. “He gave her a section of his ear.” His left hand flew to his own ear and touched the lobe, as if to ensure that it was still there. “He had cut it off.”

“So he was put under a doctor’s care?” I interjected. This was familiar territory, unfortunately. A patient’s family could often tolerate delusions or melancholy without calling upon a physician’s expertise. Self-mutilation, however, was going too far.

“Yes. Taken to the asylum in Arles. And then released back to his little house. But the townsfolk had turned against him. Vincent is, I must tell you, a spectacle. The boys of the town took to chasing after him. He threatened them. He was considered a menace to public safety. They put him in the asylum again.” He stopped again and took a deep breath. “And then, because he did not feel safe alone, he went to the asylum at St.-Rémy. His doctor in Arles recommended it. They have been good to him there. He paints. They allow him to leave with an attendant. He says it is quite beautiful. From what his letters say, they are fond of him.”

“Yet he wishes to leave,” I prompted.

“Yes. He is finding it more and more difficult to be around the other patients. He feels they make him worse.”

“This is a good sign,” I pointed out. “It is not unlike the fever patient who becomes contentious and difficult once he is on the mend. If Vincent chafes at his surroundings, that is progress.”

It is a strange kind of comfort to offer. In fact, I suppose it is a paradox of sorts: that those patients who are sufficiently in command of themselves to be unhappy are better off than those whose minds have simply taken flight from the world. Theo stood up, apparently unaware of what he was doing, and went to the window. He peered out, unseeing. “Vincent is afraid that staying at St.-Rémy will have a bad effect on him. He is insistent about this.”

“Does he say what it is that he fears?” I asked. “Has he ever mentioned visions or hallucinations? Many patients find these terrifying.”

“I think he feels he cannot paint as he would like,” Theo answered, still looking out the window. “With Vincent, that is always the concern.”

“And he is at the asylum voluntarily? He was not committed?”

“No,” Theo confirmed, turning back to face me. “I believe he signed something to that effect.”

“Then there will be no problem with his leaving,” I stated.

“But—he cannot be completely alone,” Theo said. “This is what I have come to ask, Doctor. Pissarro indicated that you were open to the idea. Would you be willing to supervise Vincent? He knows that he is too fragile to live in complete independence. If you were willing to meet with him, keep track of him, warn him …” He was now looking at me directly. “He is a difficult man, Doctor, but a good man. He is kind. He wants so much to be of some service to the world. His art is everything to him.” He gestured at the walls of the salon. “I can see that you are sensitive to artists, Doctor. You have known all of the Impressionists. Pissarro cannot praise you enough, as a doctor and as a connoisseur—”

I cut him off. “Monsieur van Gogh, there is no need to go on. I would be happy to supervise your brother, as you put it. I think Auvers would be a very good place for him. I have a great deal of experience with mental maladies. I will know what to watch for, and how to help your brother. Very often, a patient’s circumstances contribute significantly to his illness. Auvers is a peaceful village. We will find your brother an inexpensive inn, where he can have a room and his meals. As you may know, I myself paint and etch. There is a studio in the house, and I am always delighted to have company. I have a son and daughter, and we share a quiet family existence, regular and modest. Does your brother neglect his meals?”

Theo nodded. “I’m afraid so. Ever since the terrible episode in the Borinage, he has seen food as an interruption. Even when I tell him that he must eat to keep his strength up, he gobbles a few mouthfuls and then forgets.” He seemed to have finished but drew a breath and spoke again. “I should mention that in Arles he drank a great deal of absinthe. He used it as a way to … I think he said ‘stun’ himself. To quiet his agitation. But since he has been at St.-Rémy, he has not been drinking. He even says he feels better for it.”

“You see, he is already on the path to better health,” I answered. “If we can persuade Monsieur Vincent to lead a wholesome life, with plenty of work to distract him from his troubles, I think he will do very well. And I would certainly be glad to help him, in any way I can. You do understand, I hope, that I am not the doctor for the town of Auvers. I practice here in Paris, so I will not be able to offer him official medical care.”

“But what kind of medical care is there for cases like my brother’s?” Theo asked, standing again. There was bitterness in his voice. He slipped his watch from his pocket and frowned at it. “I am sorry, Doctor, to have taken up so much of your time. I must get back to the gallery.” He stepped forward and held out his hand. “I am very grateful. I will write to Vincent immediately. We will let you know when to expect him.”

I had no doubt at all that I could help this Vincent van Gogh. I could not—and to this day I cannot—imagine who would be better suited to the task. There were not so many physicians in those days who had studied and practiced mental medicine. Of those, the “mad doctors,” how many were acquainted with the new painting and those who produced it? I knew all too well that artists put a great strain on their nerves. Their perception of the world is as important as their touch with a brush or their color sense, and it is very easy to overtax this faculty. At the same time, many of them live in terrible conditions, as Vincent had evidently done. Vincent van Gogh felt he could help the world with his painting. That seemed unlikely. It was probably this very conviction that was driving him mad. I had written my doctoral thesis on the topic of melancholy, and I knew how closely linked it was with the artistic temperament.

If you are a doctor—indeed, if you are a man of science—another man’s suffering may become your project. I cannot deny that, as Theo van Gogh trotted down my stairs, I felt a surge of excitement. This Vincent, this mad artist, sounded fascinating, like a case study of my keenest interests. It was a fortunate thing for both of us that Pissarro had sent Theo van Gogh to me. I still believe that. I do.