The Comfort of Lies

We humans are exceptional at self-deceit. This isn’t terribly surprising if you brave the neuroscientific literature about how we think. But before we are mired in academic mud trying to get purchase on our psychological frailties, let’s talk Vincent Van Gogh.

Van Gogh is the stuff of legend. Something in the heady mix of tortured genius, miraculous skill, and a cracking life story makes him irresistible to us in our armchairs. We’ve all at least appreciated, if not swooned in front of a Van Gogh swirl or painterly gesture. And we all know his story. It’s passed down. Truth.

Three aspects of his history are fascinating.

The ear gift is celebratory. Sliced off with a razor by his own hand then wrapped in rags and presented to a prostitute from the local brothel, this has been the by-line that has proven Van Gogh’s delusional mania.  The incident occurred whilst Vincent was living at the Yellow House in Arles with Gaugin. More of that colour and less of Paul (the rampant syphilitic Post-Impressionist we’ve met in a previous column) in a moment.

His death is also apocryphal. Widely accepted as fact, Van Gogh shot himself in a lonely wheat field in Auvers at the age of thirty-seven; his suicide a result of internal demons and external commercial failure.

The third tidbit is our emergency medicine connection, where it is written that the yellow preponderance in Van Gogh’s later works was a result of xanthopsia – the golden chromatic lens on the world arising from over-digitalisation. It is thought that digitalis was prescribed by his doctor, Dr Gachet, whose portrait in front of the foxglove plant you see here.

But are these fabulous snippets any more than half-truths, embellished by time and written legacy; simply titillating fractions of a story stuck in our memory?

Medicine has more than its fair share of heirloom knowledge handed down from generation to generation. Some of it is intermittently challenged, but often it flows without ripple or rethink. We could fill a hundred columns with examples; axioms and dogma that have us hooked. Epinephrine in cardiac arrest, stents and metalwork, the crutch of crystalloids, kneejerk antibiotics, kneejerk anything.

Medical reversal is a hulking, cumbersome thing. Knowledge, once ingrained in the collective consciousness, can be titanically difficult to turn around. And this applies to behaviour too; the doing of things. Of anything, as elegantly dissected in this think-piece (Emerg Med Australas 2018;30[2]:273). The lure of intervention bias, making us order tests, give drugs, do stuff, is a trap for our busy worker brains. In our time pressured, outcome driven departments, sometimes our higher brains are unable, or unwilling, to challenge this conduct.

This takes us back to the peculiar world of cognitive theory. Once an idea is woven into our cortex, it can be devilishly hard to unpick. We in medicine often do an admirable enough job of it – we need to, with truth being updated at blistering pace – but still, we aren’t perfect. Human stubbornness is probably fallout from the way consciousness evolved; we construct elaborate universes from nothing more than hallucinations (after all, what else are our cortical interpretations of sensory data?), and these worlds play out as stories inside our silent skulls. Having a narrative brain may have helped us develop as social beings; seeing the people around us as arcs, with pasts and futures, may have made our neighbours easier to understand. This meant we could manipulate them into liking and helping us. A win! But for all that, we are still the heroes of our own stories. We make the outside world work for our inside one. And thus, the main point: our internal cosmos is more valid than everyone else’s. Any new information is moulded to our own actuality, rather than the other way around.

There are many who have not had our advantages when it comes to understanding the scientific process (the process of discarding theories that do not stand up to the highest level of scrutiny). In this light, difficult to comprehend ideologies can be, if not supported, at least forgiven. For example, anti-vaxxers don’t hold their belief systems out of malice; it is simply that these ideas feed an already manufactured reality. The internet, sadly, is not always an ally – what should have been the age of information is sometimes the opposite; the Monsanto of the digital landscape, propagating fallacious information like manipulated weeds. A well-curated social media conversation, however, can sometimes do the reverse. For much of the population though, once something is believed, it takes a good deal to unbelieve it – the key for us is being open enough to unbelieve.

This much I know from abundant experience. It is tough to admit one’s wrongness; to recognise that one’s unassailable truths may not have the foundations first thought. Busting open our prejudices is considerably harder than reclining in pleasant fiction.

And thus we return to the life of Vincent Van Gogh. How many of the accepted, repeatedly told stories of his life are true?

The ear? Probably.

The suicide? Unlikely. Historical sleuths have put together a far more plausible string of events; an outcast accident, a cover-up, a borrowed gun.

The xanthopsia? Almost definitely not. A great retrospective laundering, a fabulous tale made up to suit a world hungry for a reductive explanation of genius. Van Gogh was probably simply partial to yellow.