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J R Soc Med. 2006 July; 99(7): 373–374.
PMCID: PMC1484559

The diagnosis of art: melancholy and the Portrait of Dr Gachet

Dr Paul Gachet (1828-1909), born in Lille, studied medicine in Paris and Montpellier, and wrote a thesis entitled Étude sur la mélancolie.1 In 1858, he returned to Paris to practise as a doctor and moved to Auvers-sur-Oise in 1872. There he befriended many painters, including Cézanne (who painted The House of Dr Gachet), Daubigny, Guillaumin, and Pissarro. Gachet himself became an artist, signing his works ‘P van Ryssel’.

Vincent van Gogh (1853-1890) moved to Auvers on 20 May 1890, after leaving the asylum at St-Rémy. He made three portraits of Gachet, an etching (May 1890) and two paintings (June 1890)—the second, for Gachet himself to keep, a near copy of the first.2 The best known of these, Portrait of Dr Gachet (oil on canvas, 67× 56 cm, location unknown), shows the doctor with his head propped on his right hand; his elbow rests on a table next to a purple foxglove and two books, Germinie Lacerteux (1865) and Manette Salomon (1867), both by the Goncourt brothers, Edmond and Jules.

The portrait is profoundly melancholic: the colours are mostly heavy and oppressive; the two novels are depressing in content—Germinie Lacerteux is about a young servant who lives a debauched life and dies miserably in the workhouse and Manette Salomon describes the lives of four more or less unsuccessful painters. Gachet is palpably depressed—his head-in-hand pose is classical,2 as is his facial expression. Van Gogh wrote that Gachet's face was ‘grief-hardened’; ‘... he certainly seems to be suffering [nervous trouble] as seriously as I’, and ‘he is sicker than I am’. But van Gogh saw himself going beyond the doctor's individual melancholy to a more general state. As he wrote to Gauguin, ‘I have a portrait of Dr Gachet with the heart-broken expression of our time’. And to his brother Theo: ‘I had to paint [him] like that to convey how much expression and passion there is in modern heads.. .that is how one ought to paint many portraits’.

And what is the foxglove doing in the painting? Some have suggested that it is the badge of the physician2—a role that it plays nowhere else in art. Others have suggested that Gachet treated van Gogh's seizures with digitalis. It has even been suggested that digitalis toxicity may have accounted for van Gogh's love of yellow,3 which does not bear scrutiny.4 But in the 19th century, digitalis was used to treat some psychiatric problems, including delirium tremens and mania, and it was also sometimes used to raise the spirits. According to William Withering's son: ‘... women of the poorer class in Derbyshire... drink large draughts of Foxglove tea, as a cheap means of obtaining the pleasures or the forgetfulness of intoxication’.5 Van Gogh described Gachet's foxglove as being ‘of sombre purple hue’. Perhaps he included it as another symbol of melancholy.

But why was Gachet melancholic? Was it endogenous depression? Or was it the symptom of some physical illness? In the painting, his hands are slightly pigmented, albeit paler than his sunburnt face, and his nails are completely pale. Could he have had Addison's disease? Alas for this hypothesis, van Gogh's painting is impressionistic, not realistic; a contemporary photograph of Gachet shows that he had a fuller face than van Gogh portrayed; his hands are not seen. In fact, the portrait of Gachet is more like van Gogh himself or his brother, Theo, than Gachet. And indeed Gachet had asked van Gogh to paint it in the style of one of his self portraits.

Perhaps Gachet was, like van Gogh, addicted to absinthe.6 We encourage further speculation.

Figure 1
Portrait of Dr Gachet (1890) by Vincent van Gogh (oil on canvas, 67×56 cm, location unknown) [in colour online]

References

1. Gachet P-F. Étude sur la mélancolie. Montpellier: Imprimeur de l'Academie, Editeur de Montpellier Medical, 1858
2. Saltzman C. Portrait of Dr Gachet. The Story of a van Gogh Masterpiece. New York: Viking Penguin, 1998
3. Lee TC. Van Gogh's vision. Digitalis intoxication? JAMA 1981;245: 727-9 [PubMed]
4. Aronson JK. Coloured vision? New Scientist 1990; 30 June: 80-1
5. Aronson JK. An Account of the Foxglove and its Medical Uses, 1785-1985. Oxford: Oxford University Press, 1985
6. Baker P. The Dedalus Book of Absinthe. Sawtry: Dedalus, 2001

Articles from Journal of the Royal Society of Medicine are provided here courtesy of Royal Society of Medicine Press