By ANTHONY COSTELLO and EMMA STORR.

One of the most striking aspects of the ‘Portrait of Doctor Gachet’ is the resemblance of the subject with the artist. Paul Gachet’s aquiline nose, pointed face, his yellow hair tinged with red, the heavy moustache with the beginnings of a goatee, the slumped body posture and melancholic expression could be Vincent van Gogh. It is as if the close and intense relationship they shared in the three months leading up to Van Gogh’s death and the wavy, expressionist paintbrush technique allowed the two to merge into one.

Gachet’s and Van Gogh’s relationship was borne out of medical need and the intercession of mutual friends. Van Gogh’s brother, Theo, had become increasingly concerned about Vincent’s mental health following the former’s voluntary admission to Saint Paul asylum near Saint Rémy-de-Provence in May 1889. Dr Paul Gachet moved in literary and medical circles and had gained a reputation for a sympathetic understanding of the maladies affecting artists. It was Pissarro who recommended to Theo that his brother travel north to Auvers-sur-Oise in May 1890 and be treated and cared for by Dr Gachet.

A close and complex friendship developed over the three months of their acquaintance that culminated in them living in close proximity and often together in Gachet’s house. It was a home that doubled as a studio for Gachet. He was an amateur painter, engraver, art collector and the owner of a printing press where both Cezanne and Van Gogh produced their first etchings. Gachet and Van Gogh both completed portraits of each other, Van Gogh also painting two portraits of Gachet’s daughter, Marguerite, and one of the doctor’s homeopathic garden. They developed an intense friendship involving mutual respect and a vested interest in each other’s fields of medicine and art.

Both men are now linked in art history, the best known portrait of Dr Gachet fetching a record £82.5 million at an auction in New York in 1990 and now held in a private collection. The other portrait of the doctor (below) is in the Musée d’Orsay in Paris and was donated by Paul and Marguerite, Dr Gachet’s children, in 1949.

Van Gogh recognised an emotional connection with the physician as soon as he met Dr Gachet. He wrote the following to his sister Willemien in June 1890 soon after arriving in Auvers-sur-Oise:

For me the journey and the rest up to now have gone well, and coming back to the north distracts me a lot. Then I’ve found in Doctor Gachet a ready-made friend and something like a new brother would be — so much do we resemble each other physically, and morally too. He’s very nervous and very bizarre himself, and has rendered much friendship and many services to the artists of the new school, as much as was in his power.’ (Letter 879)

Dr Gachet greatly admired Van Gogh’s self-portrait of 1889 with a blue background and wanted to have one done of himself in exactly the same style. The painter worked quickly and described the first canvas in another letter to Willemien:

I’ve done the portrait of Doctor Gachet with an expression of melancholy which might often appear to be a grimace to those looking at the canvas. And yet that’s what should be painted, because then one can realize, compared to the calm ancient portraits, how much expression there is in our present-day heads, and passion and something like waiting and a shout. Sad but gentle but clear and intelligent, that’s how many portraits should be done, that would still have a certain effect on people at times.’ (Letter 886)

Paul Gachet, born in Lille, had studied for a BA at the University of Paris and earned his medical degree for his thesis ‘Etude sur le Melancolie‘ in 1858 after working in two mental institutions at Bicêtre and the Hôpital Salpetrière, The famous French physician Philippe Pinel (1745-1826) had been medical director at both hospitals where he had introduced what became known as ‘moral treatment or therapy’ based on a psychological interpretation of the patient’s symptoms. This enlightened approach to the mentally ill led to the removal of restraints such as chains and straitjackets that had been commonly used in the asylums. Also banished were the dubious practices of bleeding, purging and blistering. In their place, Pinel recommended a therapeutic relationship that involved close contact with and constant observation of patients. He visited them every day, took extensive notes and tried to determine the natural history of their condition. Previously, the understanding of mental health problems was very limited. Anyone deemed to be insane or a threat to society was likely to be locked up in an asylum built at some distance from the city centre.

The topic of Gachet’s thesis on ‘melancolie’ suggests that he had already developed an interest in ‘nervous disorders’ as a young doctor, perhaps influenced by Pinel’s humanitarian approach. However, he also worked as a front line doctor with the National Guard during the Prussian siege of Paris in 1870, a brave and risky enterprise in which his surgical skills would have been tested. Gachet moved to Auvers-sur-Oise from Paris in 1872 in the hope that the country air would benefit his wife who was suffering from tuberculosis, a common and often fatal disease at the time. Sadly she died in 1885, a major loss that Van Gogh suggested had partly caused his friend’s low mood and sad demeanour, evident in both of his portraits of Gachet.

It is not clear when Gachet developed an interest in homeopathy, popular in the late nineteenth century when there were very few effective remedies available to treat common diseases. In Auvers, he apparently grew several medicinal herbs in his garden. An amateur artist, painting under the pseudonym Paul van Ryssel, he met and treated several famous impressionist artists including Renoir, Pissarro, and Cezanne, even teaching anatomical drawing to a young Georges Seurat.

In 1888, two years before he met Gachet, Van Gogh was treated by two other doctors while living in Arles. These were the ‘yellow house’ years, the fields of wheat and the ‘sunflowers’ years and the alcohol-fuelled arguments over artistic difference with Gauguin. It was also the time of the harmful threats to Gauguin’s life with a razor, and self-harm with the self-same razor which resulted in the famous portrait of Vincent with his bandaged ear. Vincent van Gogh’s subsequent periods in the St Paul de Mausole asylum near Saint-Rémy included treatment by Doctor Felix Rey (subject of another portrait by Van Gogh), who diagnosed periodic epilepsy, although some have suggested that Van Gogh’s disabling attacks of vertigo and collapse were actually due to Ménière’s disease, not seizures (Arenberg et al. 1990). Another possible cause of his symptoms was absinthe poisoning. Toxic substances known as turpenes in absinthe are damaging to the nervous system and can lead to convulsion-like attacks (Mermann 1992). Van Gogh drank absinthe and alcohol regularly in the years prior to his voluntary admission to the asylum. While there, he also underwent an assessment by Doctor Peyron, who treated his melancholia and addictions. Both doctors were sympathetic to Van Gogh’s need to paint, providing ancillary studio space and a guardian to accompany his sojourns outdoors.

In the portrait of Gachet, the purple foxglove plant sits next to two yellow books on the table. Foxglove (digitalis) had been known as an effective medicine to treat heart failure (dropsy) for many years. It was also used at this time as a remedy for epilepsy (on which it had no effect) and melancholia. It is possible that Gachet was using minute doses to treat van Gogh’s mania and depression but this seems unlikely given that the artist never mentioned any medication prescribed by Gachet in his frequent letters to his family. It is true that the doctor did not remove the bullet that was lodged in van Gogh’s chest after his botched suicide attempt, but that could have been because Gachet recognised that it was safer to leave it there than risk surgery and the complications of bleeding and infection. (Gachet had frontline experience of treating trauma during the Prussian siege of Paris in 1870) He did inform Van Gogh’s brother, Theo, immediately, and was one of only a few mourners at Vincent’s funeral. According to a letter from the artist Emile Bernard to Albert Aurier, Gachet was crying so much at the graveside that he found it difficult to say anything about his famous patient.

Dr. Gachet (who is a great lover of art and possesses one of the best collections of impressionist painting of the present day) wanted to say a few words of homage about Vincent and his life, but he too was crying so much that he could only stammer a very confused farewell. . . (the most beautiful way, perhaps). He briefly outlined Vincent’s achievements, stating how sublime his goal was and how great an admiration he felt for him (though he had only known him a short time). He was, Gachet said, an honest man and a great artist, he had only two aims, humanity and art. It was art that he prized above everything and which will make his name. (Bernard to Aurier 1890)

IN MANY WAYS, Gachet and Van Gogh’s time together in Auvers-sur-Oise was fruitful in terms of friendship and art. Van Gogh painted 70 paintings in the last 70 days of his life, an output that could have been partly due to the dynamism of his interactions with Gachet. The doctor was passionate about art, his own attempts, Van Gogh’s and many other impressionists, building a collection for his family that included seven of Van Gogh’s paintings and works by Cezanne, Pissarro and Guillaumin. Sixty years later, these were donated to the Musée d’Orsay and provided inspiration for a retrospective at the Metropolitan museum in New York in 1999 entitled Cezanne to Van Gogh: The collection of Doctor Gachet.

A letter from Van Gogh to friends a few weeks before his death suggests that he was feeling the benefit of working hard and abstaining from alcohol (and absinthe):

. . . the pleasure of seeing my brother, his family and our painter friends again has done me good up till now, and I feel absolutely calm and in a normal state. The doctor here says that one must throw oneself fully into work and distract oneself in that way. The latter knows a lot about painting, and likes mine very much, he encourages me a great deal, and two three times a week he comes to spend a few hours with me to see what I’m doing. It’s anyway certain that since I stopped drinking. I’ve done better work than before, there’s still that which has been gained. (Letter 883)

Van Gogh’s and Gachet’s relationship was complex and nuanced. Predicated on illness and an intriguing doctor-patient dynamic, part of its vital essence was art. We can see this in Van Gogh’s stunning late period (from ‘Starry Night’ to ‘The Church at Auvers’) and Gachet’s amateurish canvasses, his fakes and plagiarisms, and his opportunistic and critical collecting. This relationship was physically embodied in the expression of their personalities and states of mind that we see applied to the canvases they both left behind. One can almost smell the paint.

It may be also that in the paintings and the discussions around them we are seeing a form of transference occur, a projective identification, a merging of personalities or a temporary swapping of selves. In Melanie Klein’s theory, projective identification is a process whereby unconscious fantasies of the self are attributed to another, these projections (at here most intense) allowing one person to rid themselves of aspects of their psyche and seemingly enter the mind of another. One could argue that Gachet and Van Gogh’s personality types and their close doctor-patient relationship gives this psychological theory credence. At times Gachet is in the role of artist and art critic, and Van Gogh is the sympathetic doctor to Gachet’s malaise.

Van Gogh wrote to Theo often about his impressions and concerns for his own doctor:

I’ve seen Dr Gachet, who gave me the impression of being rather eccentric, but his doctor’s experience must keep him balanced himself while combating the nervous ailment from which it seems to me he’s certainly suffering at least as seriously as I am . . . (Letter 873) Today I saw Dr Gachet again, and I’m going to paint at his place on Tuesday morning, then I’m going to lunch with him and afterwards he’ll come to see my painting. He seems very reasonable to me, but is as discouraged in his profession of country doctor as I with my painting. So I told him that I would, however, gladly swap profession for profession. Anyway, I readily think that I’ll end up being friends with him. He told me, besides, that if melancholy or something else were to become too strong for me to bear, he could well do something again to lessen its intensity, and that I mustn’t be embarrassed to be open with him. (Letter 875) He certainly appears to me as ill and confused as you or I, and he’s older and a few years ago he lost his wife, but he’s very much a doctor, and his profession and his faith keep him going however. We’re already firm friends . . . (Letter 877)

For his part, Gachet’s tendency to give himself to another is evident in an earlier relationship with Cezanne:

I am at heart and soul Paul Cezanne’s student.’

One interpretation of the relationship between artist and doctor is that Gachet’s life-long interest in art manifested itself in the wish fulfilment to be Vincent van Gogh, so he dressed like his patient, he tried to paint like his patient and he made a second ‘fake’ copy of the eponymous painting. He also collected his patient’s paintings, painted a deathbed scene so that his painting became synonymous with the great Vincent van Gogh in death and he became custodian of a cache of Van Gogh paintings. His son, Paul, later spent a lifetime writing a biography about those last days when his father and Van Gogh become inextricably bound in posterity.

Several of Van Gogh’s letters mention paying Dr Gachet in kind with paintings because of his inability to pay his fees. While Gachet clearly valued these works of art by his patient very highly, Van Gogh suggested the doctor was not always a discriminating collector and had a tendency to hoard:

. . . his house, you will see, is full, full like an antique dealer’s, of things that aren’t always interesting, it’s terrible, even. But in all of this there’s this good aspect, that there would always be what I need there for arranging flowers or still lifes. I’ve done studies for him, to show him that should he not be paid in money we’ll nevertheless still compensate him for what he does for us. (Letter 877) It’s cripplingly expensive in the village here, but Gachet, the doctor, tells me it’s just the same in all the villages around here, and he’s really feeling the pinch himself compared with before. And to start with I need to stay close to a doctor whom I know. And I can pay him in paintings, and I wouldn’t be able to do that with somebody else, should something happened so that I needed his help. (Letter 878)

IT SEEMS UNFAIR, given Van Gogh’s history of mental illness, to blame Gachet for Van Gogh’s death as some have done. Antonin Artaud, famously, accused Gachet and society generally of being complicit in Van Gogh’s death. In Van Gogh ou le suicide de la société, Artaud’s thesis is promulgated on the basis that the lesser minds of people/society could not tolerate Van Gogh’s modus operandi, his unspeakable truths and his lucid genius, evident in his work and letters. Gachet, is viewed as a ‘sorcerer’, a person jealous of Van Gogh’s talent and wanting to see his genius at work at close quarters, so that there would be a transmutation of talent (if not souls). Artaud justifies this view by reasoning that Gachet put Van Gogh under intolerable pressure to work exhaustingly in the last two months of his life. However, Van Gogh’s letters to his family at this time suggest that Gachet simply recognised the value of work, particularly creative work, as distraction and good for Van Gogh’s mental health.

The doctor here has been very kind to me; I can go to his home as often as I like, and he’s very well informed about what’s going on among painters these days. He’s very nervous himself; most probably that hasn’t improved since his wife’s death. He has two children, a girl of 19 and a boy of 16. He tells me that in my case working is still the best way to keep on top of it. (Letter 878)

Artaud’s belief came from first-hand knowledge of how society often treated mental illness, having spent practically half his short life in and out of institutions and, at one point, nine consecutive years in asylums. Artaud was treated for, amongst other ‘psychological’ symptoms, ‘mystical delusions’ and received repeated electrical convulsive therapies. It seems a miracle that Artaud survived and was lucid enough to write (he actually dictated) what was to become a prize-winning essay on Van Gogh in 1947. The writing was commissioned to accompany an unique retrospective of Van Gogh’s work which included 40 paintings with poems and illustrations by Artaud himself.

Artaud wrote, ’I am like poor Van Gogh’ and clearly saw him as a kindred spirit or brother which may have fuelled his fierce attack on Gachet. However, Artaud had his own experience of doctor/patient relationships and not all were derisory. In 1945, Gaston Ferdière, the director of psychiatry at Rodez, a proponent of art therapy, encouraged Artaud to draw and paint as a way to find some unity in mind and body after years of ECT.

While the unenlightened society of nineteenth-century France may have been complicit in Van Gogh’s demise, given Van Gogh’s history of depression and anxiety and extreme behaviour, Gachet cannot be entirely blamed for his death. It is possible that the doctor was jealous of Van Gogh’s talent, as Artaud suggests. Whether this fact might have led to medical negligence or deliberate maleficence on the part of the doctor seems unlikely, given the evident mutual admiration between Van Gogh and Gachet and the devastation he experienced at the suicide of his extraordinary and fascinating patient.

The doctor-patient relationship of Gachet and Van Gogh went far beyond the deployment of medicine, existed outside the terms laid down by the Hippocratic Oath. For Gachet, his patient invoked in him his frustrated inner artist, and in recognising Van Gogh’s genius Gachet perhaps implemented a tailor made treatment of Van Gogh’s maladies, which involved Gachet immersing himself in Van Gogh’s life more than would normally be expected in a doctor-patient relationship?

For Van Gogh, projected selves passed through him wherever he went, his personality allowed and encouraged the temptation to look inside his mind (doctors, Theo, artist friends, lovers), but the essence of Van Gogh was to be found in his art. He for a long time had projected himself on to canvas. Art a substitute for life.

♦

Anthony Costello is an essayist, translator and poet. His first poetry collection, The Mask, was published by Lapwing Publications in 2014. His second, Angles & Visions, was published in 2016. He is the editor of Four American Poets published by The High Window Press and he is a co-translator of Alain-Fournier: Poems, published by Carcanet in December, 2016. Anthony is co-editor of The High Window Journal and associate publisher at The High Window Press.

Emma Storr lives in Yorkshire and has a background in medicine and medical education. She holds an honorary position as Associate Professor in Primary Care at the University of Leeds. In 2008 she edited a case-based textbook for medical students on common problems seen in general practice. She is now turning her attention to poetry and writing non-fiction. She recently completed an MPhil in Writing at the University of South Wales. She has been published in The Hippocrates Prize Anthology in 2016 and in Strix 2 in November 2017.



Note: Artists and their Physicians is a work in progress and the authors are currently seeking funding to complete it

References:

Van Gogh Letters Auvers-sur-Oise, letters 873 – 902 20 May 1890 – 23 July 1890 http://vangoghletters.org/vg/by_period.html accessed July/August 2016

See also: Cynthia Salzman: Portrait of Dr. Gachet: The Story of a Van Gogh Masterpiece, Money, Politics, Collectors, Greed, and Loss (Penguin).