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Vincent's bandage

BMJ 2001; 323 doi: (Published 15 December 2001) Cite this as: BMJ 2001;323:1434
  1. Philip Thomas, consultant psychiatrists,
  2. Pat Bracken, consultant psychiatrists
  1. Bradford Community Health Trust

    The art of selling a drug for bipolar disorder

    Over the past few months the British Journal of Psychiatry has contained a striking image of Vincent Van Gogh. The BMJ has also carried the image. Those who attended the annual general meeting of the Royal College of Psychiatrists in July 2001 encountered the same image in a lofty, softly lit hall, a shrine to the pharmaceutical industry. The image—consisting of renditions of one of Van Gogh's self portraits against psychedelically coloured backgrounds, echoing Andy Warhol's Marilyn—formed a devotional icon to the drug valproate semisodium. But this is a Vincent with a difference. A large dressing covers his left ear, held in place by two strips of adhesive dressing. What are we to make of this? What is really being said here?

    It is well known that Vincent Van Gogh removed part of his left ear. In October 1888 Paul Gaugin visited him in Arles. The two had previously met in Paris, and had much in common. Van Gogh hoped that together they could start a school of artists in the south, in contrast to “those decadent and rotten Parisian boulevardiers.” Things didn't work out. Gauguin was short tempered, and they quarrelled, sometimes violently, until Gauguin decided that he had had enough and returned to Paris. At this point Van Gogh became agitated, and on Sunday 23 December removed part of his left ear with a razor. He was admitted to the asylum at Saint-Remy. Although he was in and out of hospital after this, the last 18 months of his life were marked by a burst of creative energy, as he painted some of his greatest works, 60 paintings alone between May and July 1889.


    If only Van Gogh had been on valproate semisodium …

    The advert for valproate semisodium shows Van Gogh with his left ear bandaged. At least the advertising agency got its facts right, which is more than we can say for poor Vincent. In one of his most famous paintings, the Self-Portrait with Bandaged Ear of 1889, he shows himself with his right ear bandaged. He had painted himself from his image reflected in a mirror, which reversed right and left. So the first message is that we can rely on the drug company's facts, in contrast to these temperamental artists.

    But there is more. We are presented with four identical images of Vincent, each with a different coloured background, scarlet red, blue, green, and purple. Does this mean that Vincent was a fragmented human being? Perhaps he had multiple personality disorder. But no, the message becomes clear if we examine the text that accompanies these images in the medical journals: “First Line Mood Stabiliser” above the images and “Proven across a spectrum of today's bipolar patients” below. So the truth is that Vincent suffered from bipolar disorder, his extremes of mood implied by the violently clashing colour backgrounds out of which his mutilated face emerges. The adverts also have helpful little coloured bullets to guide our interpretation of this revelation, each annotated and linked to reliable drug company references, scarlet red for mania, blue for rapidly cycling bipolar disorder, purple for mixed mania (sic), green for lithium non-responders.

    Surely, then, there can be no doubt about the facts. Valproate semisodium is the best thing for fast, consistent mood stabilisation. If only Vincent had taken this he wouldn't have needed the bandage. With mood suitably stabilised he would not have hacked away at his left ear to still his tormenting voices. He would never have found his way into Saint-Remy, and the world would never have had its breath taken away by Starry Night, or any of those other great canvases in his last 18 months.

    And it can work for us too, in an age that has no use for anxiety, in which we lie etherised like Prufrock, sedated, becalmed, and tranquil, neither high nor low. No suffering, no soul, no art. Yes, if Vincent had been on valproate he might still have painted. If he were alive today and on valproate Vincent would be driving around in a white transit van, painting houses battleship grey. But then at least the bandage wouldn't be necessary. Madness is okay, as long as it's kept in its place, on the canvas, in the asylum but, either way, under drugs.

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