Over the centuries, there have been numerous examples of fine artists creating works of art that deliberately work with and within contemporaneous medical thought, portraying people with particular ailments or diseases. But what about if we turn that concept around a little bit? What happens when those in the medical field turn to paintings or sculptures from the past and retroactively investigate the health of the individuals depicted therein? What happens when art history turns into a diagnosis?                

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Links and Further Resources

Boston Globe: Monet? Gaugin? Using Art to Make Better Doctors

New York Times: Studying Art with the Eye of a Physician

Wall Street Journal: Doctors Enlist Paintings to Hone Skills

The Guardian: The Fine Art of Medical Diagnosis

The Guardian: Did the Mona Lisa Have Syphilis?

Episode Transcript

When I was an undergraduate studying art history, I took a class that I particularly loved-- it profiled French art during the Revolution and the decades thereafter. Painting, in particular, was really fantastic during that time, as artists transitioned from the stoic paintings referencing ancient history, values, and aesthetic styles, towards the stormy, emotional themes of the romantic period. One of the artists who created some of the greatest hits of the time period was Theodore Géricault, whose masterpiece is a monumental painting of shipwrecked passengers on a makeshift pontoon which he titled The Raft of the Medusa. Géricault peaked, artistically-speaking, and created the Raft-- his most important work-- at an early age, as he was still in his late twenties when it was completed. But what I found most fascinating was what he did next. For the last three years of his life, until his early death at the age of 32 in 1824, Géricault undertook a series of 10 paintings of people diagnosed as criminally insane. Today, only five of those paintings survive, but the five that remain are powerful and strange. They portray a gambling addict, a woman driven mad by jealousy, a kleptomaniac, a man with delusions of grandeur, and a quote “child snatcher.” Little is known about the series other than it was probably commissioned by a friend of the artist, who was a doctor at an asylum in Paris. The thought behind them, though, is that perhaps there was some kind of biological or physiological way to identify someone-- or diagnose their mental ailments-- simply by looking at them. And while this question is rather problematic-- and don’t even get me started on how this type of thinking was used to discriminate by race and gender-- I do think these works are intriguing in that it is one of the examples that we have of a fine artist deliberately working with and within contemporaneous medical thought.

But what about if we turn that concept around a little bit? What happens when those in the medical field turn to paintings or sculptures from the past and retroactively investigate the health of the individuals depicted therein? What happens when art history turns into a diagnosis?                                                                                                     

Sometimes people think that visual art is dry, boring, lifeless. But sometimes, the stories behind those paintings, sculptures, drawings and photographs are weirder, crazier, or more fun than you can imagine. Art History is full of murder, intrigue, feisty women, rebellious men, crime, insanity, and so much more. And today, as part of our ongoing series of episodes called The Bigger Picture, we’re going to look at the ways that doctors and other medical professionals have turned their attention and talents towards art history and have diagnosed famous works of art. Exploring the unexpected, the slightly odd, and the strangely wonderful in Art History, this is the ArtCurious Podcast. I'm Jennifer Dasal.

At the beginning of this year I introduced a new series of episodes that look at questions or issues that aren’t specific to any artist, period, or piece. Instead, these look at bigger trends or theories in the history of art-- the bigger picture, as I am calling it. But this Bigger Picture episode actually has its roots in one of the very first episodes of the ArtCurious Podcast, and that’s episode 4, where we tackled the funny question of Michelangelo’s rather masculine-looking women. I ended that discussion with a story about a doctor who theorized that one of the Renaissance master’s strangest sculptures-- a woman with misshapen breasts called Night, in the Sacristy of the Church of San Lorenzo in Florence-- looked as odd as it did because the model was a real woman who had exhibited or had recently died from advanced breast cancer. While this theory is one of my favorites, it's by no means the only example of a doctor putting in his or her two cents about a famous work of art. In fact, articles that diagnose works of art pop up on my twitter feed with surprising regularity.

On the surface, it seems like an odd pairing, right? Art and medicine? Unfortunately these days, art--or the humanities in general-- is sometimes presented as the polar opposite to science, mathematics, or engineering. In fact, so much of art and its creation relies heavily on one of the tenets of primary importance in science, too: the power of observation. Think about it-- artists look at the world around them and have to interpret their surroundings, feelings, thoughts and questions into something concrete-- something fully visible. This is the visual arts we are talking about, after all, and the same concept applies whether or not you are an artist trying to translate the tree in front of you onto a pile of clay or if you’re a non-representational artist whose goal is to experiment with color. Looking--and, more importantly, seeing-- is paramount. And yes, there is a differentiation between the two.

For medicine, too, the power of observation is, and always has been, a key factor to curing one’s ailments. This was one of the important lessons frequently imparted by physician and author William Osler, who is frequently called the Father of Modern Medicine and was one of the doctors who first established Johns Hopkins Hospital, later the Johns Hopkins School of Medicine, in Baltimore, Maryland. Osler wrote, quote, “The whole art of medicine is in observation...Get the patient in a good light. Use your five senses. We miss more by not seeing than we do by not knowing.” And he was right. A cursory glance-- what I’d simply call “looking,” is the difference between noticing a mole on someone’s back, and observing-- really seeing-- is taking the time to get a good look around, and perhaps that’s when a doctor would catch the irregular size or shape of said mole and be able to diagnose an early case of skin cancer, for example. You get my point-- seeing, as Dr. Osler noted, is the starting point for any good physician.

Even if art and medicine haven't always been directly linked, art and biology has. For many artists, the ability to master the depiction of human anatomy is one of those major educational signposts to becoming an artist. Even today, art students across the world vie for seats in drawing classes where they have the opportunity to draw from a live (and typically nude) model. Even if your goal isn’t to paint, sculpt, or draw a naked figure, the skills of observation learned in those courses are incredibly important. In observing lines, shadows, the intricacies of color and light, artists can develop the tools needed to create stunning works of art. Art is tied into science in myriad other ways, too-- physics, chemistry, and so forth-- but that's a topic for another day. Suffice to say-- the distance between art and medicine isn't as huge and we might think, on first glance.

Diagnoses of figures in art started, probably, as an off-the-job case of observation. For most of the classic analyses that we’re going to be discussing today, the correlations began when a doctor or nurse was just strolling through an art museum, admiring some old masterpiece. This is certainly the case with James J Stark, the doctor who visited Florence on vacation and found himself face-to-face with Michelangelo’s sculpture of Night and noticed the irregularities in the artist's depiction of her left breast. That’s the thing-- even when we are off the clock, our powers of observation do not stop-- and thank goodness for that. Because sometimes we require true diligence to be able to diagnose a work of art. Unlike with a living, breathing human being, paintings cannot talk and tell us how they are feeling. They can’t tell us about the strange cough they’ve been experiencing, or blurred vision, or any hundreds of other symptoms or side effects that we hear strung together during every single commercial for Zymbalta or Restasis. All we can rely on, for works of art, is our very own eyes.

Luckily in some cases, the clues can be fairly straightforward. One of the most interesting examples of a medical diagnosis of a painting centers around a Renaissance painting by the Flemish painter Quinten Massys. His most famous work is located today in London’s National Gallery, and it is titled The Old Woman, or The Ugly Duchess. The titular woman is certainly ugly, to be sure-- she’s got a strangely masculine face, with huge ears and a very prominent philtrum-- which, I just learned, is the actual term for that space between your nose and upper lip. Philtrum. Use it in a sentence today. The old woman is wearing a very low-cut shirt that she’s used to highlight her prominent breasts-- but those ladies just aren’t that appetizing, as they are wrinkled and a little deflated. And yet the woman has a soft smile and a hopeful look in her eyes as she gazes off into the distance holding a small red rosebud in her fingertips. Traditional art historical analysis of this painting holds that it is a satirical view of a lady who is attempting to hold onto her youth for far too long and has refused to age gracefully. Instead, she is trying to doll herself up to be as attractive to a potential suitor as possible-- but the result is grotesque rather than charming. In her 1997 book, Picturing Women in Late Medieval and Renaissance Art, author Christa Grössinger notes that this painting was probably undertaken as a visualization of a work by the Dutch humanist Erasmus, who wrote his essay In Praise of Folly in 1511. In it, Erasmus lambastes women who quote "still play the coquette", "cannot tear themselves away from their mirrors" and "do not hesitate to exhibit their repulsive withered breasts.” It does seem that Quinten Massys is fairly directly depicting Erasmus’s rather unkind words here. But the real question that has dogged this painting for 500 years was this: Was this simply just a satirical character study, or did some poor lady actually look like this? Well, it turns out that we received one answer in 2008, when British cancer Expert Michael Baum announced that he had a viable explanation.

Michael Baum has engaged in so-called “medical ward rounds” at the National Gallery with his students for many years. And he had an inkling that the painting of The Ugly Duchess was more than meets the eye. So he charged one of his students, named Christopher Cook, with the task of figuring it all out, and Cook came back with a whopper. The old woman, he said, was suffering from a very rare condition called Paget’s Disease, which is a particular abnormality of the metabolism that causes one’s bones to deform over time. Cook noted that this woman’s case was particularly advanced, and that the image clearly showed her  multiple symptoms--enlarged jaw bones, sunken eyes, a pushed-up nose, and that lengthening of the philtrum, among other telltale signs. According to an article in The UK’s Guardian newspaper from 2008, Cook and Baum are convinced that the sitter of the portrait was probably a real duchess-- or at least someone of stature and power, someone who would have been able to afford to commission a painting in the first place, let alone one of such an unattractive sitter, if we’re going to be honest about it. As Baum said, quote, “I reckon the artist was paid a princely sum to do it because who is going to buy a painting like that?”  

Paget's disease is a rare condition named after a British surgeon, Sir James Paget, who diagnosed the first known cases in the 19th century. Typically, Paget’s disease affects the lower body first, especially the legs and the pelvis, but it does, on occasion, affect the skull and other upper-body locations. And in the case of the poor duchess, it looks like she may have been afflicted in a particularly malicious, all-over manner. But in the Guardian article, Baum urges readers to not feel too terribly for the woman-- after all, the condition would have only affected her outward appearance, and other than the occasional headache, it would not have pained her in any other way. Perhaps, then, the woman’s comfortable, and even serene, expression is a true reflection of a real woman’s peace of mind.

Diagnosing a subject of a painting is one thing-- but diagnosing the artist is another topic altogether, and one that is very popular, as you might imagine. For the last century, physicians have sought explanations for why an artist might paint or sculpt the way that he does. One of the most prominent examples is that of Vincent Van Gogh, an artist who had a known history of various mental and physical issues. But Van Gogh is also an artist with a rather particular visual style, too. Before we all go too nutso on the interpretation, let’s just step back for a second and say that it is entirely possible-- and in fact, probable-- that Van Gogh’s painting technique and color preferences were ones that developed naturally for him over the course of a couple of years of experimentation. But several doctors have also suggested that there might be a medical explanation for them, too.  Dr. Paul Wolf, a Clinical professor of pathology at the University of California, San Diego, has done a series of articles for The Western Journal of Medicine about the effects of chronic disease on creative individuals, ranging from Ludwig van Beethoven and Sergei Rachmaninoff to our friend Vincent. About Van Gogh, Wolf says that he was always struck by the artist’s prominent use of bright yellow. After debunking a theory linking the artist’s color predilection with his overindulgence in absinthe, Wolf goes on to suggest an alternate theory-- that the artist’s doctor, Paul Ferdinand Gachet, may have treated him with digitalis, which was then a regimen for those who suffered epileptic fits, as Van Gogh was known to have done. As Wolf writes, quote, “People receiving large and repeated doses of this drug often see the world with a yellow-green tint. They complain of seeing yellow spots surrounded by coronas, much like those in Starry Night. In one of van Gogh's three portraits of Gachet, the physician holds a stem of digitalis purpurea, the purple foxglove from which the drug is extracted.” Medically speaking, is Dr. Wolf’s explanation possible? Certainly. But I’m also going to chalk this one up more to Van Gogh’s interest in color theory and expressive experimentation than to an overabundance of epilepsy medication.

Then there is one fascinating story of a work of art that seems fairly straightforward. But bring in a doctor, give him a little time to observe, and throw in a question or two, and suddenly you have a whole new--and darker-- narrative. This one brings us back to Michael Baum, the cancer specialist who gave the diagnosis of Paget’s Disease to Quentin Massys’s old woman. He found himself quite troubled over a work by Piero di Cosimo, called A Satyr Mourning over a Nymph, because the story of the Nymph’s death didn't seem to match up with the image created by Cosimo. The story is based on the tragic tale of a nymph named Procris, which was most famously told by Ovid in his work The Art of Love, though the story itself has most certainly been around for much longer. Long story short, Procris met her fate when she was accidentally killed by her own husband via a spear wound inflicted during a deer hunt. In Cosimo’s painting, we see Procris lying dead on the ground, nude except for a wrap of fabric around her pelvis and right arm, and wearing some incredibly stylish sandals. A faithful dog mourns to her right, and a satyr-- half man, half goat-- rests his hand on Procris’s shoulder and gently touches the deceased’s brow. The funny thing, though, is that Piero di Cosimo doesn’t present viewers with a spear wound-- but he does show us plenty of other clues. As Dr. Baum says in his Guardian article, quote, "Look at her hands, for example. Both are covered with deep lacerations. There is only one way she could have got those. She has been trying to fend off an attacker who has come at her, slashing in a frenzied manner with a knife or possibly a sword. Certainly there is no way that a spear could have done that."
 

And that’s not all. Baum also points to the odd angle of Procris’s left hand is a strange one, but not one that is unfamiliar to medical professionals. The nymph’s hand is bent severely at the wrist and curled under, creating a position referred to as “the waiter’s tip,” an injury that occurs when there has been serious damage inflicted at particular points on the cervical vertebrae-- the upper part of the spinal column, in one’s neck. To be specific, when there is a severing of the nerves at points C3 and C4 on the spine, the damage that ensues causes the wrist to flex harshly and the fingers to curl under, garnering this odd position that is reminiscent of a waiter’s hand behind his back as he accepts a covert tip.

All of this adds up to a rather unaccidental death, and certainly not one inflicted by a spear. Baum sums it up thusly, saying quote, “So what we are looking at is a picture of a woman who has had her throat cut after desperately trying to defend herself from a knife-wielding killer. This is not the outcome of a romantic tragedy. This is the result of a brutal murder."

To be fair, Baum does end his interpretation of Piero di Cosimo’s work by saying that the artist was probably trying to be true to the subject matter and most likely intended to really tell the story of Procris as it was originally written, but that his own keen powers of observation led him to accidentally present otherwise. As Baum states, quote, “I think he may well have gone to a mortuary and asked to be allowed to paint the body of a young woman and got the body of one who had been murdered by knife – and so he faithfully put on to his canvas what he saw. It just happens not to accord with our modern understanding of what would have happened to a woman struck accidentally by a spear."

Startling and fascinating interpretations like these, presented by doctors and scientists, can allow us to see artwork in a curious and new way--and that’s a good thing, most of the time. But what happens when people-- trained art experts and novices alike- get out of hand with their diagnoses? This is probably the case of a recent story that hit the news in February 2017 about the Mona Lisa. If there is one thing that people like to argue about in art history, it’s this: Why is the Mona Lisa smiling like that? In reality, it’s a kind of boring question, but it is one that has been titillating people nonetheless for a couple hundred years. And now, art critic Jonathan Jones has come up with his very own theory, which he published on his blog, again with the U.K.’s Guardian newspaper. And in it, Jones noted that he’s found an explanation-- the Mona Lisa’s got a strange smile… because she was suffering from syphilis. Huh? So what’s his evidence? Jones states that even though the lives of women in the Renaissance are practically lost to history, there was a ledger that was recently discovered in a convent in Florence, which documented the sales of remedies from its adjoining apothecary. And Lisa del Giocondo, the woman usually identified as the subject of the portrait, was recorded in the ledger as having purchased ‘snail water’-- yes, you heard that correctly. It turns out that ‘snail water’ was a primary ingredient in a vile concoction that was most typically used as a cure for sexually transmitted diseases, with syphilis as its main target. And Jones notes that this type of medicine was still in use all the way into the 18th century, when it was listed in a kind of recipe book for home remedies. It’s like The People’s Pharmacy, but for the pre-modern age.

Jones further remarks that there was a major syphilis outbreak in the 16th century, around the same time period that Leonardo da Vinci was painting his masterwork. So the chances of La Joconde being afflicted with the disease is certainly a possibility. But I have to say that I find this art historical diagnosis to be less than credible. First of all, we’re talking about a diagnosis made by a newspaper art critic, not a trained medical professional. And then there’s the timing of the snail water purchase, which, to his credit, Jones does note as having been undertaken nearly 10 years after the portrait was begun by Leonardo. True, it is possible that Mona could have been suffering from syphilis or another STD far earlier, and perhaps she really did wait decades to purchase a much-hoped-for remedy, but still. It’s suspicious. And then there’s my last point of contention, which is every art historian’s favorite-- the good old “I just want to see what I want to see” quotient. Especially when we’re talking about a work of art whose manufacturer and subject are long, long dead, we simply have little recourse than to project our own ideas and interpretations onto them. After all, it’s not like Leonardo can just pop up and say, “You know what? She was having a bad day, so leave the poor woman alone!” So Jones reads his own diagnosis into the work of art, commenting upon the dark shadows around her eyes and claiming that her skin has a sickly green tint. My favorite part of the blog post is where Jones begins to analyse the famous wild landscape behind Mona-- and here he claims that it is meant to represent America, the new world, from where many STDs spread to Europe.

Which is why I found it especially hilarious when, only one month after I read Jones’s post about Mona’s secret sexual disease, I read a new story released to the press and widely disseminated throughout the world. A study was recently concluded by the University of Freiburg that stated that the secret of Mona Lisa’s smile has finally been decoded by science- yes! Science is finally giving us the answer to a mystery that has been eluding humankind for centuries! And the conclusion? Ta-da! She was… happy. Yep. You can't make this stuff up, you guys. Okay, so there's a little more to it and it involves participants interpreting her smile as either happy or sad, but… really? It's a smile. Sure, it's not the biggest grin in history, but this is your big scientific revelation about the world's most famous painting?

Jonathan Jones and his syphilitic claim just perfectly pinpoints the one big side-effect of art interpreting by those who might not be trained to proclaim judgments on it: and that’s the risk of over-interpretation. Maybe a painting’s subject had cataracts, or bipolar disorder, or drank too much wine. But sometimes a rose is a rose is a rose, and there might not be any actual symbolism, or meaning, or medical diagnosis attached to it.

Thank you for listening to this episode of the ArtCurious Podcast, a proud member of the Modest Podcast Network. This episode was written, produced, and narrated by me, Jennifer Dasal. Our production and editorial services are provided by Kaboonki Creative. Video. Content. Ideas. Learn more at K-A-B-double O-N-K-I dot com. The ArtCurious Podcast is fiscally sponsored by VAE Raleigh, a 501c3 nonprofit creativity incubator. This means that you can now donate to the show and it is fully tax-deductible! Please see our website for further details-- and you can also go there for images, information and links to our previous episodes. The site is artcuriouspodcast.com. And you can contact us via the website, email us at artcuriouspodcast@gmail.com, or find us on Twitter and Instagram at artcuriouspod.

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