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Art and Images in Psychiatry
December 2002

Portrait of Dr Gachet

Author Affiliations

James C.HarrisMD

Arch Gen Psychiatry. 2002;59(12):1083-1084. doi:10.1001/archpsyc.59.12.1083

I have a portrait of Dr Gachet with the grief-stricken expression(expression navree) of our times. You could say somewhat like your Christ in the Garden of Olives . . .—van Gogh to Gauguin, June 18901

ON JULY 27, 1890, Vincent van Gogh (1853-1890) died in the arms of his brother Theo at 1:30 AM, poignantly saying to Theo, "if it could always be like this."2 He died 29 hours after staggering back to his hotel in Auvers, France, after shooting himself in the chest.2 He had gone out to paint immediately after breakfast2 days before, taking a gun with him that he used to keep crows away when he worked. When he returned home late, about 9 PM, the landlady's wife expressed her worries about his absence and asked if anything unfortunate had happened. He started to answer but then went directly to his room. Upstairs, the landlord heard him groaning and went to him asking if he was ill. Vincent lifted his shirt to reveal bleeding from a "dark red hole surrounded by a purplish halo3-4 cm below the left nipple"—a self-inflicted gunshot wound.3 The local physician was called, but Vincent asked for Dr Paul Gachet. When Dr Gachet arrived, he spoke of Vincent's possible recovery, but Vincent said, "then I should have to do it all over again."2

Vincent was referred to Dr Paul Gachet on the advice of the painter Pissaro, and with the encouragment of his brother, Theo, he sought him out. Vincent had settled in Auvers sur Oise after his discharge from the asylum at Saint-Remy near Arles. After a year in the asylum he was discharged as cured despite having 3 psychotic episodes in the previous 6 months and 2 suicide attempts; this information apparently was not fully conveyed to his new physician. Dr Gachet, an artist himself, had written his medical thesis on melancholy,4 and was now a semiretired homeopathic physician, chronically bereaved, and living with his son and daughter. Although he initially questioned this physician's competence, Vincent came to regard Dr Gachet as "a true friend and something like a new brother, such is the physical and moral resemblance between us. He, like me, is highly strung and extremely odd."5 Dr Gachet admired Vincent's recent self-portrait and sought to have Vincent paint him in the same manner. Vincent expressed excitement about the project, writing to his sister, Wil, that this would be the modern portrait created not by"means of photographic resemblance but by emotional expressiveness, using our modern science of and taste in color as a means of expressing and ennobling character."1 He wrote, "sad yet gentle, but clear and intelligent—that is how one might paint many portraits."5 He wished to convey "something of the eternal which the halo used to symbolize, and which we seek to convey by the actual radiance of our coloring."5

Vincent van Gogh (1853-1890), Portrait of Dr Gachet, 1890, French. Oil on canvas. Courtesy of the Musee d'Orsay, Paris, France.

Vincent van Gogh (1853-1890), Portrait of Dr Gachet, 1890, French. Oil on canvas. Courtesy of the Musee d'Orsay, Paris, France.

Vincent described the painting to his sister in the following way:

Dr Gachet's face is the color of an overheated brick, and scorched by the sun; he has reddish hair and a white cap set against a landscape of blue hills, his coat is ultramarine . . . this makes his face stand out and look pale despite its reddish-brown color. His hands are those of a midwife and are paler than his face . . . My portrait of myself is done almost exactly the same way; the blue is a delicate blue of the sky in late afternoon and I am wearing pale lilac.5

Dr Gachet leans against a red garden table with his closed fist against his face. There is a purple foxglove plant, a source for digitalis and emblematic of his role as physician, on the table. Dr Gachet completed his medical thesis, A Study of Melancholia, in 1858.4 Vincent's painting shows features of melancholy that the thesis describes:

The patient's posture is very characteristic. The body stoops, the head hangs down and leans to one side . . . The ridges of the eyebrows protrude and two or three vertical creases separate the two eyebrows. The mouth is closed in a straight line. The gaze is staring, anxious, and averted.4

Vincent chose the pose of Saturn, Homo melancholicus, shown in classic images from antiquity with a slanted body with the head resting on a closed fist. Melancholia was the cold, dry humor, which, in certain manifestations, was the hallmark of the philosopher, poet, and scholar. Starobinski1 proposes that, in this painting of Dr Gachet, "we are confronted with Melancholy itself." Vincent chose to illustrate not clinical depression, but a world-weary physician contemplating the depth of human suffering and his own.6 This effect is achieved not only by the facial expression and posture, but also by perspective and composition. The perspective is foreshortened, drawing the viewer closer and heightening its intensity. The subject and the background are shown in different spatial planes, resulting in a sense of alienation of the figure from the surrounding environment. There were 2 essentially identical portraits of Dr Gachet — the one shown on the cover is the second, which Dr Gachet kept for himself.2

His friend, Emile Bernard, made this moving diary entry at Vincent's burial:

On the walls of the room where the body lay all his last canvasses were nailed, forming a sort of halo around him, and rendering his death all the more painful to the artists who were present by the splendor of his genius which radiated from them. On the coffin a simple white linen, masses of flowers, the sunflowers he loved so much, yellow dahlias, yellow flowers everywhere.

Dr Gachet was initially too grief-stricken to speak, but managed to utter a farewell: "he was an honest man," he said, "and a great artist. He had only two goals, humanity and art. It is the art, which he cherished above all else, that will make him live on."2

Starobinski  J A modern melancholia: Van Gogh's portrait of Dr Gachet.  Psychol Med. 1993;23565- 568Google ScholarCrossref
Hulsker  J The suicide.  Vincent and Theo Van Gogh: A Dual Biography Ann Arbor Mich Fuller Publications1990- 440Google Scholar
Gachet  P Les 70 Jours de van Gogh a Auvers. Macksey  Rtrans. Saint-Ouen-l'Aumône, France Editions duValhermeil1994;247- 248
Gachet  PF Etude sur la Melancolie.  Montpellier, France Editeur de Montpellier Medical1858;
 The Complete Letters of Vincent van Gogh.  Boston, Mass Little Brown2000;
Saltzman  C Portrait of Dr Gachet: The Story of a Van Gogh Masterpiece.  New York, NY Penguin Books1998;40- 40