With 900+ letters... why no diagnosis?

As I dive deeper into the life and works of Vincent van Gogh, one question continues to hound me: with more than 900 letters and personal accounts of Vincent's life, why are we no closer to an actual diagnosis? Perhaps we're not asking the right questions.

Even a five-minute scan of the internet will reveal a list of more than 150 possible diagnoses that sound more like a pharmaceutical disclaimer: manic-depressive, schizophrenia, bipolar disorder, toxin exposure, and so on.

I could understand this lack of a definitive diagnosis if we were talking about the artist Johannes Vermeer. Despite the vast popularity of his work (Girl with the Pearl Earring, The Milkmaid, etc.), very little is known about his life. There is scant documentation, letters, writings, or personal records. But we're talking about the ubiquitous Vincent van Gogh.

I suppose I can understand the challenge of what the experts call a "postmortem psychiatric diagnosis" based solely on historical documents. But we're talking about 900+ letters, to say nothing of all the firsthand personal accounts of interactions with the tortured artist.

After all, haven't they used these "pathography" and "retrospective diagnosis" tools to nail down the specifics of Abraham Lincoln, Virginia Woolf, Isaac Newton, and Ludwig van Beethoven? Perhaps those results were also listed as "likely" issues. Despite our immense technological and knowledge growth, the uncertainty of it all is truly confounding.

Maybe we're focusing on the wrong area, or asking the wrong questions.

The real and perceived rejection Vincent faced in his life would challenge anyone. And it started from the beginning of his life - he isn't the first Vincent Willem van Gogh born to his parents. A child by the exact same name was stillborn exactly one year earlier. And throughout his entire life, his parents and family often struggled to understand or embrace Vincent's moods, interests, relationships, and career decisions.

Beyond the disapproving parents, Vincent was rejected by romantic pursuits, dismissed from a rural lay pastor position, dismissed from jobs with previous employers, lost friendships, panned by art critics, and saw little financial reward for his artistic work.

His frequent gruff, argumentative, and inflexible communication style led to his challenges in maintaining relationships, which ultimately led to isolation and self- (and involuntary) commitment to psychiatric care.

"Almond Blossom" (1890) was a gift from Vincent to his brother, Theo, and his sister-in-law, Jo Anne, on the birth of their child, named in Vincent's honor.

Was the ultimate reason for Vincent's demise his perception of losing the one constant in his life, Theo? The brothers had an uncommonly close relationship - some call it symbiotic. As a kid brother, Theo looked up to and admired Vincent, and was a constant source of support (financial, artistic, philosophical, spiritual) to him as an adult. Theo was the one person to whom Vincent could pour out his soul. And he did, in letter after letter.

While there are no signs that Theo actually withdrew his support - financial or otherwise, Vincent had reason to believe change was afoot. Theo wrote about his own family's expenses (especially after the birth of Theo's and Jo Anne's baby); they had an argument in Paris regarding money and Theo's future; and on July 23, 1890, less than a week before his death, Vincent wrote to Theo, "I’d perhaps like to write to you about many things, but first the desire has passed to such a degree, then I sense the pointlessness of it."

Is it possible Vincent saw his last ember of support fading and had reached the end of his rope? What must Vincent have thought to lose the one person who truly understood him?

Sometimes, even the most rigorous of efforts in science and technology can't answer the unknown. But maybe this wasn’t about a medical or psychological diagnosis; maybe it was always about losing Theo.