Hektoen International

A Journal of Medical Humanities

Letters from the asylum

Nicholas Kang
Auckland, New Zealand

Asylum of Saint-Paul-de-Mausol, Provence, France.

After cutting off his ear, Vincent van Gogh spent a year in Saint-Rémy-de-Provence confined to a mental asylum. Despite several major relapses during his stay, he continued to work prolifically, completing more than 140 paintings including masterpieces such as Starry Night, Irises, and Almond Blossom. Three months after leaving, he was dead.

What was his state of mind and how did he produce this vast quantity of work? What was the inspiration for these iconic pieces, conceived in the most unlikely of studios? The answers lie in Vincent’s own words. Published a century ago, his letters have long been admired for their poetic ardor as well as the riveting chronicle they provide of his life and work. The eloquent, lucid, and heartbreaking narrative from Saint-Rémy is the penultimate chapter in this epistolary tale and speaks to universal themes of hope, suffering, fate, and renewal.

Spring 1889

Irises. May 1889. J Paul Getty Museum, Los Angeles.

Vincent arrives at Saint-Paul-de-Mausole at the foot of the Alpilles in southern France. This ancient monastery in the remote mountain valley of Saint-Rémy-de-Provence is now a private sanatorium offering cloistered sanctuary for troubled minds—an asylum for the insane.

Vincent’s mood is despondent but calm. Of the “terrible attack” five months ago, he recalls, “Now the shock had been such that it disgusted me even to move, and nothing would have been so agreeable to me as never to wake up again.” He takes succor in his new surroundings, where he is free to work at his easel and afforded the use of a studio. Soon he begins a series of paintings of the asylum gardens, finding solace amongst its roses, lilacs, ivy, and irises. “When you receive the canvases I’ve done in the garden,” he writes, “you’ll see that I’m not too melancholy here.”

The society of his fellow residents is met with a mixture of pity and trepidation, the “vague dread” gradually dissipating: “Little by little I can come to consider madness as being an illness like any other.” These “poor unfortunates” howl like “animals in a menagerie” or “vegetate in idleness;” one new arrival “breaks everything and shouts day and night . . . tears the straitjackets and . . . scarcely calms down.”

Summer 1889

Starry Night. June 1889. Museum of Modern Art, New York.

Life in this remote alpine landscape brings respite to Vincent’s infirm spirit. “Never have I been so tranquil as here,” he states. Recovery, he hopes, will be “a matter of time and patience.” He is left undisturbed to finish canvas after canvas, believing that “work will preserve” him. Free to roam the olive groves and wheat fields by day, his vivid imagination is evident in everything he sees:

“At the end of the field a little pink house with a tall and dark cypress tree that stands out against the distant purplish and bluish hills, and against a forget-me-not blue sky streaked with pink whose pure tones contrast with the already heavy, scorched ears [of wheat], whose tones are as warm as the crust of a loaf of bread.”

One composition has been of particular interest for some time. “When will I do the starry sky, then, that painting that’s always on my mind?” he asked a year earlier, exploring night effects in Starry Night over the Rhône and Café Terrace at Night. But far from the street lanterns and gas lamps of Arles, there is nothing to illuminate Vincent’s nights in the asylum other than the “great starry firmament.” Through the iron bars of his window, as if imagined in some hallucinatory dream of giant citron moon and “stars too big,” he conceives the fabled nocturne that becomes his most well recognized opus from Saint-Rémy—“a new study of a starry sky.”

This intense period of creativity is short-lived. Memories of recent events intrude on Vincent’s thoughts and presage his first serious relapse:

“Every time I try to reason with myself in order to get a clear picture of things – why I came here, and that after all it’s only an accident like any other – a terrible terror and horror seizes me and prevents me from thinking. It’s true that it tends vaguely to diminish, but it also seems to me to prove that there is indeed something, I don’t know what, disturbed in my brain.”

Vincent’s illness is now punctuated by a series of “crises” separated by interludes of lucid and rational thinking. The psychotic episodes are distinguished by their abrupt onset, which his physicians report as “attacks of epilepsy” and “acute mania with visual and auditory hallucinations.” Paranoid, incoherent, and terrified, he attempts to poison himself, ingesting paint and other inedible items. “For many days I’ve been absolutely distraught . . . it is abominable,” he exclaims. “It appears that I pick up filthy things and eat them, although my memories of these bad moments are vague.”

Autumn 1889

Self Portrait. September 1889.
Musee d’Orsay, Paris.

Recovery is slow and difficult. Unable to venture outside for weeks at a time and barred from his studio during attacks, Vincent endures protracted intervals of inactivity. Immured in stupor and loneliness, he becomes “demoralized by the certainty of unhappiness.” In perhaps the most moving passage from all the letters, he writes:

“And yet it might be possible, yet one glimpses even a vague probability that on the other side of life we’ll glimpse justifications for pain, which seen from here sometimes takes up the whole horizon so much that it takes on the despairing proportions of a deluge.”

Vincent gradually comes to accept his fate, resigned to “this inevitability of suffering and despair.” He longs to move back north to be with his brother Theo—his chief correspondent—but when the opportunity first arises he hesitates, fearing what might happen. “Leaving now would perhaps be unwise,” he concludes, “when I consider a new crisis likely in the winter.” He develops a sense of security in this mental infirmary with his “companions in misfortune,” safe from the real world, his strength slowly returning. Painting become his “remedy,” the asylum his refuge.

Throughout the course of this relapsing and remitting mental breakdown, Vincent’s unshakeable belief is that work will sustain his tenuous grip on sanity. He walks for hours in search of fresh landscapes to paint, produces copies of old masters, and executes several new self-portraits—constantly imploring Theo to send him ever more canvas, paint, and brushes. His misguided optimism is all too apparent:

“I’m ploughing on like a man possessed, more than ever I have a pent-up fury for work, and I think that this will contribute to curing me.”

Winter 1889

The looming anniversary of Vincent’s first crisis—the episode that culminated in his self-mutilation the previous Christmas—threatens to disturb his fragile mind once more. Fear of an impending attack “leaves the mind in a latent state of sensitivity.” Fate determines that his presentiment is realized, resulting in a “quite violent attack of exaltation.”

But winter passes and so too does Vincent’s latest delirium. His spirits are lifted upon learning of the birth of Theo’s son and he immediately begins a new and ambitious work, a gift for the newborn child. He announces, “I started right away to make a painting for him, to hang in their bedroom. Large branches of white almond blossom against a blue sky.”

Almond Blossom epitomizes Vincent’s artistic depiction of nature—the cycle of life and seasons, of death and rebirth, of loss and renewal. The blossoms seem almost to flower directly off the canvas—symbols of new life but also reminders of the ephemeral nature of existence. Vincent considers the new piece “the most patiently worked, best thing I had done, painted with calm and a greater sureness of touch.” He yearns to visit his brother’s new family just as soon as he “can bear the journey and ordinary life.” But before the canvas has even dried he suffers another attack, his worst yet, and is “done for like a brute.”

Spring 1890

Final letter from Saint-Remy. May 13th, 1890.
Almond Blossom. February 1890. Van Gogh Museum, Amsterdam (Vincent van Gogh Foundation).

Reflecting on events of the past eighteen months, Vincent expresses his sense of failure: “I consider this a shipwreck, this journey.” The force of destiny weighs heavily on his thoughts, presenting no alternative but to end his self-imposed incarceration. “My desire to leave here is now absolute,” he affirms, explaining:

“It was almost impossible to bear my fate here . . . the surroundings are starting to weigh on me more than I could express – my word, I’ve waited patiently for over a year – I need air, I feel damaged by boredom and grief.”

Arrangements are finally made for a return to Paris to sojourn in the village of Auvers-sur-Oise, the final crisis having “disappeared like a thunderstorm.” Yet on the eve of departure, Vincent is filled with a bittersweet mixture of anticipation and regret, pondering the little world that has been his home:

“This morning, as I’d been to have my trunk stamped, I saw the countryside again – very fresh after the rain and covered in flowers – how many more things I would have done.”


  1. All excerpts of letters are quoted from the van Gogh Letters Project: Leo Jansen, Hans Luijten, Nienke Bakker (eds.) (2009), Vincent van Gogh – The Letters. Version: December 2010. Amsterdam & The Hague: Van Gogh Museum & Huygens ING. http://vangoghletters.org

NICHOLAS KANG, FRACS, studied medicine at the University of Sydney. He has contributed one previous article to Hektoen International.

Highlighted in Frontispiece Volume 10, Issue 3– Summer 2018 & Volume 10, Issue 4– Fall 2018

Winter 2018 



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