Hektoen International

A Journal of Medical Humanities

Mental illness in art

JMS Pearce
Hull, England

Corridor in the Asylum. Vincent can Gogh. 1889. Metropolitan Museum of Art.

It is often said that creative art is linked to eccentricity, sometimes bordering on madness. Examples abound of great musicians, writers, and artists who at some time in their lives were deranged and often committed to institutions for mental illness. Some ended their lives in suicide.

To what extent is art inspired by a naturally extraordinarily imaginative mind, by mental illness, or both?1 This subject has spawned many texts and views. But many of them obscure the issue with cognitive jargon and attempts to artificially fit concepts of art into existing socio-philosophical categories. One of the best definitions of the word “art” ignores any mental aberrations of the artist: “The expression or application of creative skill and imagination, typically in a visual form . . . producing works to be appreciated primarily for their beauty or emotional power.” (Oxford English Dictionary)

Plato’s Phaedrus, however, tells us that artists were bestowed with a divine madness. Aristotle related creativity to depression. Virginia Woolf and Sylvia Plath were both plagued by depression; both killed themselves. Vincent van Gogh chopped off his ear, and later shot himself—though whether he suffered from depression, epilepsy, or schizophrenia is debatable. Louis Wain, known for his illustrations of humanoid huge-eyed cats was labelled schizophrenic and confined to mental hospitals. Francisco de Goya (1746-1828) after serious illness (allegedly syphilitic) in 1792 became deaf, depressed, and prone to hallucinations and delirium. This may be reflected in his subsequent paintings of monsters, witches, violence, gloom, and fantasy.

Richard Dadd’s art was largely forgotten until the 1960s when The Fairy Feller’s Master-Stroke was considered a masterpiece.2 It is generally accepted that he suffered from schizophrenia, and was afflicted by hallucinations, delusions of reference, and homicidal violence. Confined to Bethlem Royal Hospital, his minutely detailed paintings were filled with fantastical figures, many based on mythology, classical literature, and vivid drama. In his enforced seclusion he was painting in a visionary way that had echoes of Blake and the Romantic artist Philipp Otto Runge.3 Schizophrenia, first described as dementia praecox, had not been recognized in Dadd’s time.

There are countless other examples of artistic creations of those affected by mental illnesses.

Sir Charles Bell (1774-1842), celebrated anatomist and artist, published in 1806 Essays on the Anatomy of Expression in Painting, revealing differing physiognomies of human emotions.4 Darwin had made similar observations across species.5 Sir Alexander Morison (1779–1866), who was in charge of Richard Dadd at the Bethlem hospital, had himself in 1840 published The Physiognomy of Mental Diseases, believing it was possible to diagnose certain mental illness by inspecting patients’ faces. As diagnostic indicators of madness they have largely been disregarded.

It seems probable that the hallucinations and illusions of the psychotic mind can on occasion find expression, which influences, if not causes, the artistic content of those afflicted. The artist Jean Dubuffet believed that the art of the mentally ill severed constraints of tradition and convention: “Madness unburdens a person, giving him wings and helping his clairvoyance, ‘art brut’.”6 This was founded on his collection in Lausanne of a large assembly of patients’ artwork from asylums throughout Europe.

Self-portrait with bandaged ear. Vincent van Gogh. 1889. Courtauld Institute of Art. Photo by Yelkrokoyade.

A causal relationship is often inferred by comparing works painted before and after the onset of a psychiatric illness for hints of madness. But such inference is always speculative.7 Furthermore, such cleverisms as Psychiatric Art, Art Therapy, and Outsider Art may be vulnerable to abuse, denying the aspirations of artists with mental illnesses to live and work freely.8

Is artistic genius akin to madness? Cesare Lombroso collected the work of 108 patients whom he considered to show artistic tendencies. Insanity, he said, was able “to transform into painters persons who have never been accustomed to handle a brush.” He also stated that artistic genius was a type of insanity, “a degenerative psychosis,”9 an assertion that would not apply to the many whose creative works, whether in science or art, are unhampered by mental illness.

An alternative opinion points to the irony that mentally ill patients’ work, initially considered worthless, is later held to be of artistic value—a process that MacGregor has called “the discovery of the art of the insane.”10 Benjamin Rush wrote that the development of insanity could sometimes unearth hidden artistic talents: it could “throw upon its surface precious and splendid fossils, the existence of which was unknown to the proprietors of the soil in which they were buried.”11 This implied that insanity could serve to germinate the pre-existing seed of latent artistic talents.

William Alexander Francis Browne (1805–1885), esteemed superintendent of the Crichton Royal Asylum in Dumfries and father of Sir James Crichton-Browne (1840-1938), initiated one of the earliest collections of artistic work by patients in a psychiatric hospital. He believed that their art was no different from that of healthy people.12 In a similar vein, Hans Prinzhorn, a psychiatrist at Heidelberg, published the classic Artistry of the Mentally Ill in which he too found no diagnostic clues in the art of the mad. Art, he thought, was individualistic rather than evidence of insanity. Prinzhorn’s book appraised the work of ten “schizophrenic masters” whose work he characterized only as providing a “disquieting feeling of strangeness.”13

The artist’s principal tools are imagination and particularly observation, which often aims to show faithfully or figuratively interpret scenes with creative license to tell their story.14 Whether creative art is the result of natural vivid imagination, of psychosis, or both remains an insoluble dilemma.1 We must be wary of so-called experts’ interpretations of pictures that too often are portentous displays of their authors’ assumed depth of artistic knowledge.14 Paintings, like music, have been interpreted as “metaphors for human feelings . . . they are non-literal symbols of the inner life.” If that inner life is exaggerated or distorted by psychotic ideas and imagery then the resulting art can be seen as its product.15

Dadd’s expressed idea that “picture-making, like all human activity, is at least partly directed by spirits” is persuasive.2 Similarly, when depressed and burdened by alcoholism and anxiety, Edvard Munch (1863-1944) claimed that art could depend on mental illness: “. . . I can not get rid of my illnesses, for there is a lot in my art that exists only because of them.”


  1. Beveridge A.  A disquieting feeling of strangeness: the art of the mentally ill. J R Soc Med 2001;94:595-599.
  2. Tromans, N., Richard Dadd: The Artist and the Asylum (London: Tate Publishing, 2011). [the first comprehensive, illustrated biography since the Tate Gallery’s 1974 exhibition catalogue]
  3. Jones J. Locked up in Bedlam, artist Richard Dadd was set free by fairies. The Guardian, Wed 17 Jun 2015
  4. Pearce JMS. Sir Charles Bell. Journal of the Royal Society of Medicine 1993;86: 353
  5. Darwin, C. The expression of the emotions in man and animals. London: John Murray, 1872.
  6. Glimcher M. Jean Dubuffet. Towards an Alternative Reality. New York: Abbeville Press. 1987
  7. Emery AEH.  Medicine, artists and their art.  J R Coll Physicians Lond. 1997; 31(4): 450–455.
  8. Rosen A. Return from the vanishing point: A clinician’s perspective on art and mental illness, and particularly schizophrenia. Epidemiologia e psichiatria sociale 2007;16:126-32.
  9. Lombroso C. The Man of Genius. London: Walter Scott, 1891
  10. MacGregor J. The Discovery of the Art of the Insane. Princeton: Princeton University Press, 1989
  11. Rush B. Medical Enquiries and Observations upon the Diseases of the Mind. Philadelphia: Kimber & Richardson, 1812
  12. Anon. Mad artists. J Psychol Med Ment Pathol 1880;5:33-75 attributed to W A F Browne, Superintendent of the Crichton Royal Asylum, Dumfries.
  13. Prinzhorn H. Artistry of the Mentally Ill. (transl. E von Brocdorff). New York: Springer Verlag, 1972
  14. Pearce JMS. Art and Medicine. Hektoen International Winter 2016  |  Hektorama  |  Art Essays.
  15. Feinstein H. Reading Images: Meaning and Metaphor. National Art Education Association 1996; 45-55.

JMS PEARCE, MD, FRCP, is an emeritus consultant neurologist in the Department of Neurology at the Hull Royal Infirmary, England.

Summer 2019



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