Van Gogh’s Madness: A Modern Medical Investigation

Van Gogh’s Haunted Mind: Alcohol, Absinthe, and the Madness That Consumed Him

The colors swirled and pulsed before his eyes: electric blues, starburst yellows, deep, bottomless blacks. The world did not stand still for Vincent van Gogh; it flickered, danced, and whispered in a language only he could hear. But in the final years of his life, those whispers turned into voices: mocking, accusing, commanding. The walls spoke, the night sky moved, and unseen figures lurked just beyond his vision.

Was it genius or madness? Perhaps a mind poisoned by chronic alcohol use and absinthe-induced psychosis? Let's make a differential diagnosis.

The Green Devil: Alcohol and Absinthe as Triggers of Psychosis

In the dimly lit cafés of 19th-century France, absinthe was more than a drink; it was an obsession. Artists, poets, and dreamers chased its otherworldly effects, believing it unlocked creativity. But what many did not realize was that this emerald-green liquor carried a hidden neurotoxic secret: Absinthe contained thujone, a compound known to cause seizures, hallucinations, and disordered thinking. The more van Gogh drank, the more he saw things that were not there. Neurologists like Henri Gastaut (1956) later theorized that absinthe, combined with his likely epilepsy, triggered a storm of psychotic episodes​. The American Journal of Psychiatry (Blumer, 2002) reviewed van Gogh’s medical history and found striking similarities between his symptoms and alcohol-induced psychotic disorder—a condition marked by auditory and visual hallucinations, paranoia, and violent agitation​.

Van Gogh himself sensed the danger, writing in one of his final letters: "I risk ruining myself mentally. If only I could be rid of this terrible need for drink."

Yet he could not stop, drinking even more to soothe his emotions: “If the storm within gets too loud, I take a glass more to stun myself.”

The Final Breakdown: A Mind Beyond Repair

Blumer (2002) leans toward a combination of temporal lobe epilepsy, bipolar disorder, and alcohol-induced psychosis as the most likely explanation for van Gogh’s symptoms. However, thiamine deficiency (Wernicke-Korsakoff syndrome), absinthe toxicity, and lead poisoning may have significantly worsened his condition. By mid-1890, van Gogh’s symptoms worsened. He was now experiencing paranoia and deep depression, common in chronic cases of untreated alcohol-induced psychosis. On July 27, 1890, he walked into a wheat field and shot himself in the chest. His brother Theo rushed to his side, but Vincent was already fading. He died two days later, whispering, “The sadness will last forever.”

Final Thoughts: What We Would Likely Diagnose Today

If Vincent van Gogh presented in a modern psychiatric emergency room, his history of mood instability, hallucinations, self-harm, and substance use would lead to a differential diagnosis of:

1. Alcohol-Induced Psychosis (Alcoholic Hallucinosis) / Wernicke’s Encephalopathy
2. Temporal Lobe Epilepsy with Hallucinatory Phenomena
3. Bipolar Disorder with Psychotic Features vs. Schizoaffective Disorder
4. Lead Toxicity (from prolonged exposure to paints)
5. Absinthe (Thujone) Neurotoxicity Compounding Epilepsy
6. Possible unstable personality traits

Had he received modern care, he would have been hospitalized, treated with IV thiamine, benzodiazepines for alcohol withdrawal, antiseizure therapy (if TLE confirmed), and possible low-dose antipsychotics. Doctors would perform an MRI of the brain, an electroencephalogram (EEG), a drug toxicology screen, CBC, CMP, U/A, syphilis screening, thyroid tests, and measure his blood alcohol level and lead level. With proper management, his hallucinations and paranoia may have resolved, allowing treatment of any underlying mood disorder (perhaps with anticonvulsants and antipsychotics). He would be admitted to an inpatient psychiatric unit (if beds were available) to hopefully prevent the tragic decline that led to his suicide.