The medical ethics of posthumous diagnosis of artists

The tradition of posthumous diagnosis of famous artists goes back at least to Sigmund Freud writing about Leonardo da Vinci in 1910. In his essay “Leonardo Da Vinci and a Memory of His Childhood” Freud’s psychoanalytical examination of Leonardo focused on Leonardo’s painting The Virgin and Child and St. Ann. In this examination Freud as art connoisseur and Freud as psychologist are confused and ultimately Freud’s analysis and outing of Leonardo as a “passive homosexual” is unethical.

It is not uncommon for physicians to write papers where they give a posthumous diagnosis of medical conditions in notable dead artists or other identifiable historic figures, for example, that El Greco had astigmatism. However, I would urge that both the authors and the editors of medical journals to be consider the ethics and relevance of such papers.

The publication of inaccurate posthumous diagnosis created with the authority of a physician makes for both bad art history and bad medical science. Even though there is often more information about a notable artist, due to the existence of diary, letters and their works of art, than other people the likelihood of the posthumous diagnosis being incorrect is still very high. Of course it is not just physicians who make errors in art history, everyone is going to be wrong, however, what makes the physicians errors worse is that they are not making them using anything like proper medical methodology. The only things that can be learnt from the incorrect diagnosis of breast cancer in Rembrandt’s model for Bath of Bathsheba (1654) is that paintings are not a useful diagnostic tool, something that should already be obvious.

There needs to be some guidelines for both writers and editors regarding the ethics of publishing papers containing diagnosis of famous dead artists. I propose for reasons of both accuracy and ethics that priority be given to articles that explain a diagnosis made public by the artist during their lifetime and where there is a benefit to the public in making and explaining a diagnosis. If the diagnosis was not made during the artist’s lifetime it is more than likely to be incorrect. There is the potential for a diagnosis damaging the reputation of the artist and the reputation of their art.

Is it ethical for a physician to provide an unsolicited posthumous diagnosis of medical conditions in notable artists or other identifiable historic figures that they have never examined, simply as a matter of historic conjecture, because the person is both famous and dead?

“At their strongest, confidentiality protections after death would be equal to those in force during a patient’s life. Thus, if information about a patient may be ethically disclosed during life, it likewise may be disclosed after the patient has died.” (Opinion 5.051 – Confidentiality of Medical Information Postmortem, AMA website, accessed 18/12/2015)

The AMA does lay out some ethical reasons for the disclosure of medical information postmortem. In most articles about dead artists there is a clear failure to consider both “the impact disclosure may have on the reputation of the deceased patient” and the “personal gain for the physician that may unduly influence professional obligations of confidentiality.” (Opinion 5.051) There maybe some research and educational purposes in doctors writing about famous dead artists but in examining the literature there didn’t seem to be one clear example.

As a basic guidelines for physicians writing about famous dead artists or other famous dead persons: don’t write anything that you wouldn’t write when the person was alive. Writing about a diagnosis that was made during the person’s life that the person made public themselves provided that has a public benefit. But this is not a simple matter as can be seen in “Before and After and Superman – Andy Warhol” James C. Harris, MD JAMA Psychiatry January 2014 Volume 71, Number 1 (Downloaded From: http://archpsyc.jamanetwork.com/ on 12/17/2015) Does the fact that Warhol openly discussed his childhood illness Sydenham chorea (historically known as St. Vitus dance) imply permission for further discussion of the effects of the illness on him? Is this different from an examination Warhol’s denied but widely reported use of amphetamines and cocaine? The confidence of Harris’s diagnosis that Warhol’s obsessive compulsive behaviour and hoarding an effect of Sydenham chorea ignores alternate explanations and Harris does not mention alternative explanations for Warhol’s behaviour. At what point does such discussion become inappropriate? Would making Warhol the post-child of the disease for an advertising campaign be appropriate?

These complicated cases aside lets have no more articles about El Greco’s eyesight, Richard Dadd’s mental illness or Giorgio De Chirico’s migraines. Instead let the final word be from: Bogousslavsky J “The last myth of Giorgio De Chirico: neurological art” (Front Neurol Neurosci. Epub 2010 Apr 6) who concluded that De Chirico’s art practice was “…a continuous, organized process to which organic brain dysfunction never contributed.”

(Thanks to Catherine Voutier for her assistance in the medical research.)

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Taste & Identity

Contrary to popular opinion taste is not subjective. Taste is both natural and reactive. Taste is a way that we express our identity.

It is easy to understand natural taste preferences. Liking chocolate is not a subjective, it is a natural human reaction to chocolate. If taste were subjective it would not be surprising to find an equal number of people who disliked the taste of chocolate. People who profess a dislike for chocolate are reacting to something about chocolate, perhaps they are allergic to chocolate.

Taste is also reactive. It is a reaction to a stimuli, it is a reaction to memories, it is a reaction to the tastes of others. Feedback loops can develop in tastes. Taste can also become a reaction that something is not as good as we remember. We react to our earlier tastes, we might grow tired of aspects of them. Reactive taste choices occur in response to a wide range of factors and account for much of the diversity of taste. It is an interpretation of the reaction, favourable or unfavourable or to other associated aspects.

Morrissey Edmiston suit 1993

Perhaps these example of about chocolate are not taste but an aesthetic judgements of chocolate. Perhaps taste is more about fashion and identity.

Wittgenstein wrote: “Take the case of fashions. How does fashion come about? Say, we wear lapels border than last year. Does that mean that the tailor likes them better broader? No, not necessarily. He cuts it like this and this year he makes it broader. Perhaps, this year he finds it too narrow and makes it wider. Perhaps, no expression is used at all.” Lectures on Aesthetics II.8, Wittgenstein, Lectures and Conversations on Aesthetics, Psychology & Religious Belief (Basil Blackwell, 1966,Oxford)

Wittgenstein’s  imaginary tailor might be more comfortable with hip-hop expressions like hardcore, old school (traditional) or wild style (eccentric) as these stylistic descriptions do not imply that one likes one trend or taste is better than another. Terms like ‘hardcore,’ ‘old school,’ ‘freestyle’ are useful in understanding that a culture is not a unified and timeless thing, but rather a cluster of emerging and past styles.

For taste is not just matters of aesthetics but about affinity or alienation, for example identifying with people wearing wide or narrow lapels. Taste is about identification, especially in taste in fashion.

Taste is a discourse that an individual is having with the culture that they are part of and with cultures that they are not a member. Janine Burke’s book, The Sphinx on the Table (Walker & Company, 2006, New York) is an examination Sigmund Freud’s art collection as a psychological and biographical analysis of his character. Burke uses Freud’s taste as a demonstration of both his personality as well as the way that he chooses to express it in society at the time.

Taste is the way that individuals define themselves within a culture. If taste were simply subjective then you would not be able to judge a person by their taste in music (see the Date Report “What Your Taste in Music Says About You On a Date”) any more than it you could judge them by a preference for fruit.