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Rare case report of Van Gogh syndrome in a patient with paranoid schizophrenia
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    'Van Gogh' syndrome - a term to approach with caution

    Dear Sir / Madam - many thanks to Mudgal et al for their interesting and comprehensive case report. I wonder, however, how useful the term 'Van Gogh' syndrome is compared with simply 'self - mutilation'? The term is commonly used to refer to self-mutilation in the context of psychosis, but my contribution to a similar case caused me to research Van Gogh's medical history (1). Although it is commonly assumed Van Gogh suffered psychosis, evidence for this is scant: his behaviour was always variably aggressive and unpredictable but there were no clear 'episodes' with a 'well' Van Gogh in between, and overt delusions and hallucinations were conspicuous by their absence. Sometimes his style of painting is suggested as 'proof' of psychosis but this belies his creative genius. In fact, it seems the traits of aggression and unpredictable behaviour, coupled with a desire to punish himself or others in the context of unstable relations, were longstanding and suggest an emotionally unstable personality disorder. A bull's ear was traditionally given as a prize to victorious bull fighters in Arles, where Van Gogh was trying to set up an artistic community with Gaugain. Van Gogh's 'gift' of his ear to a maid in a brothel , Rachel, (she was not a sex worker) could be seen as a symbolic rather than psychotic act: he and Gaugain were vying for her affections and it is in this context that he gave his ear as a...

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