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Art and Images in Psychiatry
April 2005


Author Affiliations


Arch Gen Psychiatry. 2005;62(4):359-360. doi:10.1001/archpsyc.62.4.359

Willem de Kooning’s (1904-1997) reputation as a leading Abstract Expressionist was established in the 1940s.1 He had an exceptionally long career and, despite the onset of Alzheimer disease, continued to paint into the 1980s.2 He studied art in Holland and Belgium before stowing away on a ship and coming to the United States in 1926. He initially supported himself as a house painter and commercial artist, only devoting himself to art full time after joining the Work Projects Administration Federal Art Project, part of Franklin Roosevelt’s New Deal in 1935. He borrowed techniques from the old masters and was influenced by Arshile Gorky, Pablo Picasso, Piet Mondrian, Henri Matisse, and the Surrealists, moving figures and landscapes into abstraction and developing a powerful abstract style. Fundamental themes and motifs in his work bear striking parallels to those of the Dutch painters Hieronymus Bosch and Pieter Bruegel.3

Willem de Kooning 
(1904-1997), American. Cover: Excavation, 1950. Oil on canvas, 206.2 × 257.3 cm, Mr and Mrs Frank G. Logan Purchase Prize; gift of Mr and Mrs Noah Goldowsky and Edgar Kaufmann, Jr, 1952. Reproduction, The Art Institute of Chicago. Figure appearing in the “Arts and Images in Psychiatry” article: Untitled XIII, 1985. Oil on canvas, 203.2 × 177.8 cm.© The Cleveland Museum of Art, 2003. Leonard C. Hanna, Jr, Fund, 1987. Copyright 2005 The Willem de Kooning Foundation/Artists Rights Society (ARS), New York, NY.

(1904-1997), American. Cover: Excavation, 1950. Oil on canvas, 206.2 × 257.3 cm, Mr and Mrs Frank G. Logan Purchase Prize; gift of Mr and Mrs Noah Goldowsky and Edgar Kaufmann, Jr, 1952. Reproduction, The Art Institute of Chicago. Figure appearing in the “Arts and Images in Psychiatry” article: Untitled XIII, 1985. Oil on canvas, 203.2 × 177.8 cm.© The Cleveland Museum of Art, 2003. Leonard C. Hanna, Jr, Fund, 1987. Copyright 2005 The Willem de Kooning Foundation/Artists Rights Society (ARS), New York, NY.

The ideas and forms that are intrinsic to Abstract Expressionism are fully represented in his work, perhaps more so than that of any other artist. He explored all aspects of Abstract Expressionism and defined its limits. Yet unlike others in this movement, de Kooning insisted that he had no specific style,1(p15)and he did not follow an absolute or an aesthetic belief, as did many other Abstract Expressionists. After World War II when there was an emphasis in philosophy on Existentialism, he came to personify the angst of the artist as he examined the absurdity and precariousness of human existence through his work. Stating that he did not want to conform, only to be inspired, he developed an aesthetic of uniting various antitheses: abstract and figurative, beautiful and repulsive, space and ground, mastery of craft and subjective expression.

In his early work, he did not fully abandon representation as exemplified in works of the early 1950s. His Woman series, especially Woman I, with its snarling ferocity, is perhaps the best known of his early paintings, and it brought him considerable attention. His abstract action painting Excavation, winner of first prize in an exhibition at the Art Institute of Chicago (Chicago, Ill) in 1951, established de Kooning as a leading Abstract Expressionist. It is considered a masterpiece and has been described as “a synthesis of the contrary passions animating painting during the first half of the twentieth century.”4(p293)de Kooning was fascinated by the interfaces of water and earth. Restless, he wandered the streets of New York at night to calm himself, gazing at the glistening wet pavement. He was entranced by excavations taking place in New York City in the boom years following World War II as foundations were created for new buildings. Through holes cut in wooden boards around construction sites, he caught glimpses of the excavations into the earth and the rising new buildings.

Excavation, he said, was inspired by a scene from the 1949 Italian neorealist film Bitter Rice that showed women working in the rice fields of the Po Valley, stooping over water-soaked rice paddies to harvest rice.4(p294)To de Kooning, these women embodied an earthy femininity, a sense of yearning, and a powerful sensuality. He was reminded of his youth in Holland when he was struck by images of peasants turning over the rich earth with spades. In the damp lowlands of Holland, digging a building foundation or a grave might unexpectedly bring up water. Dipping his brush into wet paint, de Kooning mirrored the excavations that intrigued him. He used white and black enamel house paint and the last of his color paints; with his palate knife, he unearthed patterns of color from rich fields of black and white. His painting was a form of excavating as he built up the surface with paint and scraped it down to produce contours and surfaces on the canvas. The yellow monochrome “lit by flashes of bright red and blue, is like a sea of jarred rock.”1(p222)This painting has been proposed as a metaphor of de Kooning’s engagement with America. Its ceaseless movement seems “to capture the dissonant social rhythms of the twentieth century, encompassing a time of displacement, movement, dislocation, exile, and longing.”4(p295)He seems to be integrating “the rigorous detachment of cubist structure with the personal drive and spontaneity of surrealism.”4(p296)The painting reveals the syncopation of the city; the eye stops and starts as it moves over the surface of the painting, making quick turns, gliding over open spaces, catching glimpses of a fast-moving train and shapes suggestive of the elements of faces, eyes, birds, and fish. A door, left ajar at the bottom center of the painting, invites the viewer to enter deeper into the excavation.

During the 1960s, de Kooning produced nonfigurative work, paintings of women, and works with landscape elements. In 1964, he received the Presidential Medal of Freedom for his lifetime work from Lyndon Johnson. His huge, improvisational canvases continued to be charged with energy. But the mid to late 1970s saw the floundering of his work; the number of paintings diminished, and he finally stopped working. By the late 1970s, he had memory lapses that were thought linked to his alcohol abuse. de Kooning had difficulty handling his success; chronically anxious, he abused alcohol to allay his anxiety and had recurrent hospitalizations for binge drinking. Alcohol, prescription drugs (Valium), and depression were taking their toll. At this point, his estranged wife, Elaine de Kooning, who had separated from him in the 1950s, returned to care for him. Therapy and participation in Alcoholics Anonymous was initiated; surreptitiously, she gave him Antabuse. By 1980 after he stopped drinking, de Kooning experienced a severe episode of depression. Surprisingly, he emerged from his depression and began a new productive period of work. In the early 1980s, he completed a painting almost every week, producing 341 paintings in that decade.

During the 1980s, de Kooning was diagnosed with Alzheimer disease. The impact of his diagnosis on his work is widely debated and has sparked controversy. The elements of his late work (1980-1990) were pared down to a limited range of colors that formed sinuously intertwining ribbons (Figure). He no longer produced the density and layered complexity (shown in Excavation) that had put him at the forefront of Abstract Expressionism. His final work was allusive rather than expository. Yet to many, de Kooning’s art seemed beautifully simplified. In his early years, he was notorious for destroying his paintings and for his slowness in completing those he released for exhibit. Now, his approach had changed; no longer did he ruminate over his work, nor was he so unwilling to release a painting as he had been earlier.

de Kooning, Untitled XIII, 1985.

de Kooning, Untitled XIII, 1985.

With the care of assistants and a structured daily routine, he was generally fully focused at his easel even though he forgot people’s names and recent events. His conversations contained protracted silences, and he confabulated and joked to cover up his confusion, reminiscent of his famously clever humor. Sometimes he became enraged by the realization of his cognitive decline. Yet he remembered details of his training in Rotterdam, his illegal immigration to the United States, his jobs as a housepainter, and the struggles in developing his art in New York. Avoiding alcohol, improving his nutrition, getting adequate sleep, and following a daily routine allowed him to work and may have improved reversible components of his dementia.

When it became apparent that de Kooning was in mental decline, suspicions arose in art circles that family members and studio assistants were conniving in his increased productivity. To reduce these concerns, his assistants photographed the stage-by-stage evolution of his paintings, and in 1988, he was videotaped at work. Recycling images had been his practice in the past, and he had often painted with a “flash card” in hand, holding a reproduction of an earlier work that he integrated into a new painting. Now his assistants projected his earlier images onto the canvas to help him begin his workday and to provide the skeletal structure of new paintings.2(p47)Thus, his older work could serve as a stimulus to initiate new paintings. de Kooning finally stopped painting in the mid 1990s.

Artistic production involves various cognitive processes; the pattern of dementia leads to predictable changes in art.5-9 The degenerative dementias show differences in neuroanatomy and affect only specific brain regions.5 Individuals with Alzheimer disease initially show involvement of the temporoparietal lobes, and deficits appear in the processing of perceptual and spatial information.7 They are less likely to initiate or complete projects. When they do continue to paint or draw, they tend to simplify, and the range of topics becomes more restricted; images tend to become more schematic. Rather than a sign of creativity, increasing abstraction may come from the loss of ability to recognize relationships between structures and shapes. Although with sufficient structure and prompting an accomplished artist may continue to paint during the initial phases of the illness, there is no evidence to suggest that new art habits emerge after the onset of Alzheimer disease. This is not the case for other types of dementia. With frontotemporal dementia, a subset of patients develops artistic skill after the onset of their illness.5,8,9 Although socially impaired and cognitively compromised, they may show a preoccupation with the fine details of faces, objects, and shapes.5,8 Even though most artists with frontotemporal dementia have been aphasic, they have spared functions in the posterior parietotemporal regions, especially in the nondominant hemisphere, in contrast to those with Alzheimer disease. In semantic dementia, a subtype of frontotemporal dementia, hypometabolism of the left anterior temporal lobe might release the visually oriented right hemisphere,8 which is consistent with proposals of paradoxical functional facilitation. Paradoxical functional facilitation might enhance sensory and perceptual functions as a result of changes in inhibition (competitive opponent-processing) and brain plasticity, with compensatory augmentation of function.10

Willem de Kooning may be the best-known artist with Alzheimer disease.2,6,11,12 Although friends described him as inert and forgetful, his demeanor changed when he entered his studio. Elaine de Kooning and his assistants provided the structure, context, and setting for him to continue to work, and he continued to do so regularly into the late 1980s. By the end of the 1980s, he painted for only short intervals and his concentration span was brief. There is agreement among art critics that his late period revealed a new approach2 that may be related to his illness12 but still remains significant. In his final period, he may have turned to the example of Matisse by emphasizing line, color, and form. Using primary colors (red and blue on white), the paintings were simpler yet are described by some critics as lyrical. Others are more critical of the work, but all agree that continuing to paint was essential to his vitality. As an artist with dementia, he may have been sustained by the momentum of routines and patterns that had developed over his lifetime. His resurgence in his last years is a testament to human fortitude when faced with cognitive decline.

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