Every schoolchild knows that Vincent Van Gogh cut off his ear. The bloody event occurred on Dec. 23, 1888. But how much he sliced away (the entire ear, a chunk of his earlobe, or a mutilation in between) and why has been argued about ever since. An even hotter debate exists among medical sleuths: what was the cause of Van Gogh’s mental health breakdowns, especially during the last few years of his life? And the corollary query: did his madness contribute to his magnificent artistic vision?

One is reminded of all these contretemps today because it is Vincent Van Gogh’s 164th birthday.

Let’s begin with the most famous ear in all of art history.

Doctors and historians have sparred over the “ear lobe vs. entire ear” question for more than a century. An art historian named Bernadette Murphy recently found a long lost diagram penned by one of Van Gogh’s doctors, Felix Rey, which shows the mangled ear after the fact and demonstrates that the artist did lop off the entire ear with a razor. Yet the clinical notes of another doctor, Paul-Ferdinand Gachet (whose portrait Van Gogh famously painted in 1890) state that only the earlobe was gone. The injury was probably somewhere in between.

Doctors and historians have sparred over the “ear lobe vs. entire ear” question for more than a century.

Less a topic for schoolchildren but certainly one that fascinates adults was Van Gogh’s presentation of his bloody ear to a local prostitute. According to one contemporary local newspaper report, Van Gogh must have had visions of immortality in mind when he was said to have uttered, “Keep this object carefully.” The prostitute (others have argued she was only a maid at the brothel) promptly fainted. The following day, the artist Paul Gauguin, who was living with Van Gogh at the time, but spent the previous night in a hotel to avoid his roommate’s odd behavior, found the artist in bed, passed out and covered in blood. Gauguin took him to the hospital and telegraphed Van Gogh’s brother, Theo, to come down from Paris immediately. The ever-loyal Theo was at Van Gogh’s bedside by nightfall.

Even before this act of madness—one that resulted in being committed to an insane asylum—many people considered Van Gogh to be off the beam. As a young man, he was prone to spells of depression and obsession, especially on issues related to his religious faith, and may have exhibited a nervous tic. At 27, his parents practically begged him to seek mental health treatment, but he rejected this request—no doubt a response rooted in the denial of his problems and the sorry state of both psychiatry and asylums in the late 19th century.

Throughout his young adulthood, Van Gogh abused alcohol and other neurotoxic substances, such as absinthe. Ever the struggling artist, he also lived a chaotic and less than healthy life. Moreover, Van Gogh was a frequent customer at both the Parisian brothels and similar houses of ill repute in Arles, where he might have easily contracted syphilis. The sexually transmitted disease attacks the central nervous system in its end stages and can make one quite mad.

From July 15 to September 25, 2016, the Van Gogh Museum in Amsterdam mounted an exhibit entitled “On the Verge of Insanity: Van Gogh and His Illness.” As part of the background materials for the exhibit, a researcher named Laura Prins collected the various armchair diagnoses offered by a slew of physicians in the medical literature. They range widely from epilepsy, schizophrenia, and bipolar disease to neurosyphilis, cycloid psychosis (a mixed bag of anxiety, elation, depression, hallucinations and schizophrenic and bipolar symptoms), and borderline personality. Because there is no way of proving any of these diagnoses, the “What Made Vincent Mad” industry is unlikely to end any time soon.

Another “medical argument” among Van Gogh aficionados concerns how Vincent actually died.

The long-held belief is that Van Gogh shot himself in the chest on July 27, 1890. After dragging himself back to the hotel he was living at in Auvers, he was treated by a local doctor named Felix Mazery and, later, his physician Paul-Ferdinand Gachet. The bullet, which deflected off of one of Vincent’s ribs, was simply too deep for the medicos to remove. Van Gogh died of the wound two days later, on July 29, with his beloved brother Theo by his side. He was only 37.

In a superb, 2011 biography of Vincent Van Gogh, the Pulitzer Prize-winning authors Steven Naifeh and Gregory White Smith, raised several doubts of the conventional wisdom that the artist killed himself. “No physical evidence of the shooting was ever produced,” the authors wrote. “No gun was ever found.” The biographers insist that Van Gogh had no personal experience handling a gun, he left no suicide note, and the bullet entered his upper abdomen “from an unusual, oblique angle,” rather than a straight-on path as one might expect when a person shoots himself.

Naifeh and Smith theorize that Vincent was accidentally shot by a friend’s 16-year-old brother who carried a gun and often teased the artist to distraction, resulting in explosive episodes of anger on Van Gogh’s part. The biographers further speculate that Van Gogh made “hesitant, halfhearted, and oddly hedged confessions” of an attempted suicide because he was depressed, eager to die, and did not want to incriminate the young man who did the deed.

Caught in the maelstrom of all these speculations, diagnoses, mental health mayhem, and, perhaps murder, we must appreciate that they all framed the stunning art we now treasure and adore. Madness, creativity, and masterpieces are all part of Vincent Van Gogh’s legacy.

Perhaps, on this day of Vincent’s birth, we might seek solace by quoting (or better still, singing) the final lines of Don McLean’s 1971 hit ballad, “Starry, Starry Night”: