Dialoguri între artă și psihiatrie (I) – cazul Expresionismului american

Introduction

Approaching any form of art using a psychological interpretative model is a difficult task due to the risk of methodological fallacies that can occur virtually at any step along the way, and analyzing the lives and artworks of famous artists from a psychiatric perspective implies more or less the same perils. However, the history of the relationship between art and psychopathology is a long one, and there are some famous cases of individual artworks (The Moses by Michelangelo) or artists (Leonardo da Vinci and a Memory of His Childhood) thoroughly explored by Sigmund Freud⁽¹⁾. Analyzing art and artists from the perspective of a mental health specialist is not at all an eccentric endeavor, because art perception is based on a dialogue between the artist, the audience, and the cultural tradition, allowing for new interpretations to be constructed and new meanings to be extracted from the same topic⁽²⁾. Clinical psychology and psychiatry are assumed to possess adequate hermeneutics for interpreting the meanings of virtually any artwork because they are sciences operating in the same realm of significant verbal and nonverbal communication. When creating art, the artists interact with their own internalized objects, therefore externalizing a bit of their personal history and perspective on the self and world⁽²⁾. As Selikowitz (2020) explicitly states, both psychiatry and art are concerned with “the visual embodiment of abstract internal states” and involve a similar epistemological approach – i.e., the deconstruction of the appearance to find the deeper meaning⁽³⁾.

As can be observed, the interaction between psychiatry and art involves more than one level of analysis. On a large scale, two major aspects could be explored in this domain: (1) the impact of psychiatric disorders on the life of famous artists and the possible influence of psychopathology on their creativity, and (2) the use of art therapy in the understanding of and coping with psychiatric symptoms⁽⁴⁾. Another interesting – also less well-explored – aspect of this interaction is “the artwork produced by the psychotherapist with the emotional experience of the client as the subject”, which is a new but promising field of research⁽⁴⁾. Also, several projective tests invite the patients to explore their unconscious minds through the self-production or interpretation of visual art objects. Even more, the visual art created by individuals may be an important means to support a diagnosis, or to monitor the evolution of a patient during therapy, as can be the case in the Jungian analysis.

This review focuses on the first aspect and attempts to delineate the presumed impact of psychiatric disorders on the life and art of several famous representatives of American Abstract Expressionism. The second aspect, although apparently outside the purpose of this review, is very provocative, and it should be mentioned due to its significant, both social and scientific consequences. Also, it is relevant to the need for psychiatrists to have basic knowledge about art when trying to understand the creativity of their patients, which is an important resource that could be integrated into any therapeutic plan. The importance of art therapy in improving the outcomes of patients diagnosed with depressive disorders, anxiety disorders, cognitive disorders, schizophrenia and autism has been supported by multiple investigations^(5,6). This positive effect is related to the opportunity offered to the patients to open up and share their feelings, memories and experiences⁽⁵⁾. Art therapy has quite a long history, since the founders of this method as a formal intervention are considered to be Adrian Hill (1942) in the UK and Margaret Naumburg (1940) in the USA⁽⁷⁾. In this context, the pioneering work of Prof. Dr. Aurel Romila, at the “Alexandru Obregia” Clinical Hospital of Psychiatry, Bucharest, to promote social reinsertion through art therapy, is considered, first of all, an essential effort in the de-stigmatization of patients with mental health illnesses⁽⁸⁾. Art therapy includes a large repertoire of techniques, from drawing, painting and modeling to dance therapy, music therapy and theatre therapy, contributing fundamentally to improving the outcome of mental health conditions and responding to emotional, social and spiritual needs that cannot be covered by other treatments⁽⁶⁾. In the same direction of analysis, it should be reminded that the artworks of a few patients have gained the attention of art historians, and Jean Dubuffet called these works “Art Brut” (“rough art”), while Roger Cardinal named them “Outsider Art”^(4,9,10). This art is defined by a lack of abiding by any rules or norms that may restrain conventional or traditional art⁽⁹⁾.

Focusing on the aim of this review, a few cautionary statements are in order prior to beginning the psychopathological analysis of some of the most famous creators in the world of visual arts. First of all, this approach is based on multiple biographical sources that could be retrieved online, but it was not conceived as a systematic review. Therefore, the possibility that relevant reports on the chosen topic to be missed exists. Secondly, this review is not intended to foster a reductionistic interpretation of quintessential artworks or artists by limiting their complexity to a psychopathological context. On the contrary, this approach aims to support a complex hermeneutics of the artworks and a very nuanced approach to the relationship between individual creativity and psychiatric illnesses. As a corollary to this assertion, it must be noted the richness of creative geniuses’ personalities is impossible to define using the currently available psychological or psychiatric means, and those interested in finding more about the life and work of these art pioneers are invited to consult the biographies mentioned in the references list. Thirdly, the current article is not, by any means, focused on retrospectively making psychiatric diagnoses. Analyzing the biography and indirect reports on public features, such as artists, is a tricky undertaking, as it is any psychiatric evaluation when the individual is not inside the consulting room⁽¹¹⁾. Therefore, no diagnosis inferences have been attempted outside the framework defined by the cited references in order to avoid any stigmatization by rash judgments. Fourthly, in case multiple sources indicating contradictory data about a certain biographic event were found, since authorized sources are quite few in rapport with the unauthorized ones, this fact was stated in the review, or the most credible source was selected. Therefore, a certain selection bias cannot be eliminated and needs to be acknowledged by the reader.

Methodology and objectives

Three electronic databases were selected (i.e., PubMed, Google Scholar and Medline), but due to the non-medical features intricated with the topic, the search was extended by including all relevant references that could be found in the retrieved articles. The search paradigm included “Abstract Expressionism”, “New York School”, individual names of all the major representatives of this artistic movement, AND “mental disorders”, “psychopathology”, OR “anxiety”, “depression”, “psychosis”, “suicide”, “alcohol”, “drugs”. Grey literature was also searched for data about the core keywords previously mentioned. All the relevant articles published since the inception of those databases up to February 2025 were included in the analysis. No restriction was applied to the language of the explored published sources.

All significant data in the literature regarding the potential interpretations of the artwork and personality of the famous painters representing American Expressionism have been explored with the purpose of highlighting the aspects of interest from a psychiatrist’s perspective.

Results

Essential features of the American Expressionism

American Expressionists were a group of artists who valued the free expression of unconscious elements, and their distinctive feature was the combination of emotional intensity with an anti-figurative abstract style⁽¹²⁾. As Clement Greenberg postulated, Abstractionism was characterized by the fact that the content in painting was no longer relevant, and only the formal surface and technical aspects of the painting mattered, as could be directly experienced by the viewer⁽¹³⁾. “Let painting confine itself to the disposition pure and simple of color and line, and not intrigue us by associations with things we can experience more authentically elsewhere”, wrote Greenberg⁽¹⁴⁾. This artistic movement emerged in the 1940s, but no formal association was founded. The movement was also called “The New York School” because those loosely affiliated artists were primarily from this city and their main place of creative debate was Cedar Tavern in New York City^(12,15). One of the first public statements associated with this school is a letter from Rothko and Gottlieb, who wrote: “To us, art is an adventure into an unknown world of the imagination which is fancy-free and violently opposed to common sense”⁽¹⁵⁾.

The two main currents in Abstract Expressionism are considered “action painting” and “color field painting.” The first term was coined by Harold Rosenberg in 1952 and is a style represented by Jackson Pollock, William de Kooning and Franz Kline, defined by the perspective of art as a dynamic creative act^(16,17). The second term was characterized by Clement Greenberg as reflecting the use of large expanses of flatly applied color, and this trend was exemplified by artists like Mark Rothko, Clyfford Still, and Barnett Newman^(14,17).

Arshile Gorky

The painter Arshile Gorky (Vostanig Adrian by his real name), born in Armenia in 1904 (which is an estimate since no official records survived), played an important role in the Abstract Expressionism movement. He is considered an essential liaison between European Surrealism and American Abstractionism since Gorky’s vividly colored, abstract, dancing biomorphs contributed to the shaping of the new artistic movement⁽¹⁸⁾. Although he initially adopted such forms from Surrealists, he actively transformed and essentialized them, finally offering something new that represents a personal, unique approach to form and colors, by integrating his own traumatic experiences into the Abstractionism concepts⁽¹⁹⁾. Gorky was the first Abstractionist painter who named his works with titles referring to particular objects and places as a means to fusion reality and the subjective world⁽¹⁹⁾. Some scholars argue that Arshile Gorky is, in fact, a precursor of Abstract Expressionists and not a pure expressionist due to his eclectic combinations of styles that incorporated post-impressionism, cubism, surrealism, and abstractionism⁽¹⁹⁾. However, the evolution of his style, but also his social life closely intertwined with the destinies of his colleagues from the New York School, as well as his influence on Pollock’s and De Koonig’s styles⁽¹⁸⁾, are important arguments to see him as part of this movement.

Gorky had a very traumatic childhood, as his father abandoned the family when he was only 6 years old, his mother died of starvation while he was a teenager, and he witnessed during his childhood the persecution of his people by Ottoman Turks that culminated with genocide on the Armenians in northeastern Turkey (with an estimate of 1,500,000 victims of massacres and forced deportations)^(20,21). Although Gorky finally succeeded in fleeing to the United States later in his adolescence, all these early traumas are considered vulnerability factors that may have led to his death by suicide in 1948⁽²¹⁾. As pointed out by the very engaging article authored by Alexandra Pitman (2018), added to this vulnerable psychological terrain, acute stressors like financial problems, somatic diseases, and also a history of depression are all invoked as potential triggers of Arshile Gorky’s premature death by suicide⁽²¹⁾.

The tragic loss of his mother inspired Gorky to create two painted versions of The Artist and His Mother, possibly as an attempt to symbolically regain the loss of his primary love object⁽²¹⁾ and to compensate for the grief related to this tragic event. The enduring effort to repeatedly paint and adjust his mother figure in these works is revelatory for the importance Gorky placed on her memory and the somber serenity reflected by the face and posture of her character⁽²¹⁾. These paintings suggest, through their imbued melancholy, the persistence of early trauma-related feelings and memories and their possible influence on Gorky’s life decisions.

An interesting aspect of this artist’s biography is that he can be considered a case of completely falsified personal history, as Gorky was able to invent every detail of his life as he went along^(20,22). He assumed a new name, which may reflect insecurity about his identity, and pretended to be a nephew or a cousin of Maxim Gorky, the exiled Soviet writer; also, the first name, Arshile, is supposed to be derived from Homer’s hero Achilles^(19,21,23), maybe as a means to present himself as a fierce personality. The artist continuously created an entirely new biography for himself (a “false persona” or “as-if” personality) throughout his life – i.e., he allegedly graduated from an elite French education institute and received professional artistic training when, in fact, he was a self-teach painter; he also pretended to be a Russian, as can be observed from the choice of his name, or a Georgian, thus negating his Armenian origins (and his traumatic childhood, implicitly)^(18,21,22). The first biography, written by his friend Ethel Schwabacher, was based on information obtained from the artist, therefore it is a non-reliable source of data regarding his life⁽²⁰⁾. It should also be noted that his relatives and friends were, voluntarily or involuntarily, part of this story fabrication and, at the end of his life, his wife was not aware of Arshile Gorky’s original name, while his best friends were also ignorant of this original identity⁽²⁰⁾. 

Regarding his medical history, Gorky’s health began gradually to deteriorate in the second part of his life, as he underwent surgical intervention for rectal cancer, remaining with a permanent colostomy, but also with erectile dysfunction⁽¹⁸⁾. These consequences have led him to consider he was betrayed by his own body, and he was, for the most part, dependent on the help of his wife, another fact he resented⁽¹⁸⁾. Even more, a car injury that led to the temporary paralysis of his painting arm added more suffering to his life⁽²¹⁾.

Gorky’s mental health was affected by recurrent depression, with severe episodes during which he started to talk about suicide; possibly, psychotic features were associated with some of these episodes^(21,22). On multiple occasions, his wife saw him going into the woods with a rope, and she succeeded in interrupting his attempts⁽²¹⁾. Financial disappointments, the accidental incineration of his studio with much of his art in it, and some harsh critics of his work have accentuated the depression⁽²⁰⁾. Also, narcissistic and/or borderline personality features have been collated into Gorky’s profile as possible explanations for his isolation and pride, but also for several episodes of disintegration of his self, which may have further predisposed him to depression when confronted with significant losses⁽²²⁾. Gorky also had moments when he was unable to paint, when his depression was at its worst, and his self cohesion was threatened⁽²²⁾. Outbursts of verbal and physical violence towards his wife were witnessed by his children, and this, together with the episode of his wife’s affair, led to the couple’s separation on the eve of the artist’s suicide⁽²¹⁾.

Gorky killed himself by hanging at 44 years old (or 46, as the exact date of his birth is undocumented) after writing “Goodbye My Loveds” on a wooden crate^(21,24,25). Some preparatory behavior has been noted; for example, he started giving away his collection of artist’s materials, although the ultimate significance of these gestures escaped to his close ones⁽²²⁾. There are authors who consider that, in this case, suicide was chosen by the artist as the only way he perceived to preserve some control, but also as a form of self-sacrifice for a culture that contributed to his demise⁽¹⁸⁾. After his death, the success of his works increased exponentially, and his fame finally came, with a tragic delay^(18,24,25).

Hints of his tormented life, with physical and psychological traumas, can be seen in his paintings. In one of his last works (Agony, 1947), some scholars suggested the representation of his studio fire, cancer operation, overall emotional disequilibrium, and the appearance, even symbolic, of a suspended image of Gorky himself⁽¹⁹⁾.

From the psychiatrist’s perspective, the history of Arshile Gorky illustrates the importance of the long-term consequences of child trauma, as these may be vulnerabilities for depression and suicide (Figure 1). The pseudologia fantastica may be seen in this case as a component of a narcissistic personality who had to cope with multiple stressors throughout his life and save a fragile self from disintegration. Also, the multiple narcissistic injuries he suffered toward the end of his life (colostomy, erectile dysfunction, temporarily paralyzed painting arm, his wife’s affair, loss of many of his paintings in an accidental fire) overimposed on a fragile personality structure and a long history of depression should have been raised the indication for psychiatric care. Also, the importance of aborted or interrupted suicide attempts (as those reported by his wife) needs to be highlighted in any patient with vulnerability factors for self-harm.

Jackson Pollock

Considered by many critics one of the most influential figures of the American Abstractionism movement, Jackson Pollock (1912-1956) had a relatively short but extremely intense period of creative work, during which he completely reinvented the technique of painting. After a tumultuous life during which he only partially got to enjoy his success, he died prematurely in a car accident on an empty road at only 44 years old while driving under the influence of alcohol, killing his girlfriend and severely injuring her acquaintance at the same time^(12,26). Pollock created a new composition method – i.e., the “drip technique”, and produced paintings that are nowadays evaluated among the most expensive works in art history^(12,26). As Spence (1999) noted, when looking at his masterpieces in an exhibition hall, “the complexity of synapses floods” the space, and you may witness “an abstract language seared with emotion”⁽²⁶⁾. The excitement and inner creative effervescence of Jackson Pollock are reflected in the movie documentaries, which expose the real rhythm of his work. Throughout his life, alcohol dependence, depression and suicidal impulses appear to constantly accompany the artist⁽²⁾. Some scholars consider that his genius is based on his ability to sublimate these impulses, “to express his internal chaos on the canvas before him”, and others simply state that Pollock’s unconscious mind spilled over, completely uncontrolled, into his action painting^(2,27). Or, as the artist framed it himself: “The source of my painting is the unconscious” (cited in Leja, 2023⁽²³⁾).

There are several aspects that could be of interest to both psychiatrists and art historians when exploring the work and life of Jackson Pollock. First, he spent some time in Jungian analysis, which seemed to have helped him temporarily because then he was at peace with himself and very creative at that time⁽²⁶⁾. A series of drawings that Pollock made during the Jungian analysis are known as “psychoanalytic drawings”, and they were produced between 1939 and 1940⁽²⁹⁾. These were a substitute for verbal communication, as the therapist observed Pollock had difficulties in expressing himself verbally, so he invited the artist to free-associate using drawings⁽²⁹⁾. These drawings suggest Pollock may have worked with Jungian concepts, like “individuation” or “anima”⁽²⁹⁾. Also, some interpreters have seen problems with the archetype of “anima” in these drawings (e.g., Bird and Moon Woman Cuts the Circle), which was conflicted and could explain the problems with women in his life⁽²⁷⁾.

Secondly, after periods when his creativity could be considered at its peak, he relapsed into heavy drinking⁽²⁶⁾, suggesting a form of mental and physical exhaustion that triggered the alcohol abuse or a way to sabotage his own creativity. Another interpretation, supported by the data mentioned below, was the succession of elation periods, where his creativity burst, and depression episodes when he found refuge in alcohol.

Thirdly, the artist’s father’s lifestyle included violence and alcoholism⁽²⁶⁾, suggesting a possible genetic component for his substance abuse disorder.

Lastly, the artist’s young adulthood included heavy drinking, physical altercations and a rather promiscuous lifestyle, with elements indicating Pollock’s desire to prove his own masculinity⁽²⁶⁾. Supporting this desire, the painter’s image is that of an athletic man dressed in a white T-shirt and faded jeans, embodying the American macho ideal, which is immortalized in iconic portraits⁽²⁶⁾.

Some authors consider this desire a characteristic of the young adulthood of the artist, as well as the attachment to a series of father figures (fellow artists, art critics) who exert an influence on his creative career⁽²⁶⁾.

Regarding his medical history, Pollock had significant mood swings, late speech and truancy during his childhood, and social anxiety, besides the already mentioned alcohol binges during his adolescence^(29,30). He underwent psychoanalysis in an outpatient regimen since he was 23, but was also hospitalized several times and received psychopharmacological treatment^(29,30). His hospitalizations were due to manic or psychotic symptoms added to alcoholic intoxications, and he was discharged with various diagnoses, according to the nosographic systems of that time⁽³⁰⁾. One of these hospitalizations in 1938 lasted about four months⁽³¹⁾. According to Stahl et al. (2025), he would most probably receive a diagnosis of bipolar disorder according to the current systems of diagnosis, because the symptomatology was mainly affective⁽³⁰⁾.

The question about the influence of mental health problems on the creation of his unique style has been raised, and the fact that Pollock was more creative when he was overactive and possibly manic enhances the relevance of this question⁽³⁰⁾. There are experts who attributed the drip technique to pareidolia (thus equating Pollock’s painting with huge Rorschach planches), and questions exist about the possibility of visual hallucinations and hyperesthesia in relation to the tendency of camouflaging images under successive layers of paint⁽³⁰⁾.

In order to find scientific answers to at least some of these questions, advanced analyzing techniques have been applied to Pollock’s paintings. Fractals are useful in describing the visual complexity of many natural patterns, and the patterns of Pollock’s layers of dripping paint are also fractal, according to a team of researchers (Taylor et al., 2011)⁽³²⁾. This team conducted a series of scientific experiments to test how such fractals impact the neurophysiological condition of the viewer and differentiated two models of fractals in Pollock’s works: the early model, with low dimension (D), corresponding to smooth, sparse shapes, and the late model, with high D fractals – which indicated more intricated, detailed shapes⁽³²⁾. The discussion about pareidolia was further enriched by the possibility of “polloglyphs” (a term created by Stahl et al., 2025) being inserted into Pollock’s paintings, which are voluntarily created images that the painter has hidden into his works and then added drippings⁽³⁰⁾. Because the artist was acquainted with the Rorschach test when treated with psychoanalysis, it is possible that he was later inspired to include fuzzy edges in his technique that may recall images in the viewer⁽³⁰⁾. Stahl et al. (2025) showed that, in Pollock’s paintings, like Troubled Queen, #34, Untitled, 1949, or Untitled, 1938-1941, hidden images can be found under layers of drippings⁽³⁰⁾. However, this discovery would contradict the mainstream art critics, who consider that Pollock’s work was based on unconscious images and impulses and movement, not on durable reflection and conscious planning⁽³⁰⁾. Also, these results would contradict the artist himself, who, as previously mentioned, stated his art was based on the unconscious⁽²⁸⁾.

Another aspect of the art creation – psychopathology interaction is the fact that, during his final years (1951-1956), when alcoholism was at its peak, Pollock was drawn into dark, mostly oily black, semi-figurative, and rather monotonous paintings⁽³³⁾. Some critics consider this phenomenon as directly driven by alcoholism, psychological pain and self-pity⁽³³⁾. For example, in the Portrait and a Dream, Pollock apparently represented his own face contemplating the violence, inner threats, and sufferance within his dream, suggesting a passive rapport to the turmoil of his own life⁽³³⁾.

Also, the mother complex seemed to have returned in his final paintings, where female figures with motherly physical features reappear⁽²⁷⁾.

In conclusion, there are several aspects of Pollock’s history that could attract the attention of a mental health specialist: vulnerability factors for self-aggressive behaviors, such as a genetic component for alcohol use disorder, bipolar disorder with possible psychotic features, long periods of heavy drinking, personal insecurity during adolescence probably related to the problems with the paternal figure; the intermingling of psychoanalytic concepts into his art, some of them being certain (like the drawings he performed during his Jungian analysis), while others requiring more explorations (like the “polloglyphs”, pareidolia, visual hallucinations, and hyperesthesia-driven artworks); the self-aggressive behavior itself, as heavy alcohol use and driving under the influence of alcohol may be considered equivalents of suicidal acts or parasuicidal gestures (Figure 2).

Willem de Kooning

Born in Rotterdam, The Netherlands, in 1904, de Kooning proved artistic skills early in his adolescence, being a talented designer, architect, carpenter and portraitist^(34-36). His parents divorced when he was 5 years old, and although they later re-married, his mother (who worked in a bar) raised him mostly on her own⁽³⁴⁾. In a biography authored by Stevens and Swan (2004), it is suggested that the early years of his life may have contributed to some of his personality features, such as indecisiveness, feelings of being marginalized, or addictive tendencies⁽³⁶⁾. De Kooning succeeded in migrating to the USA in 1926, after a few failed attempts^(34,35). He married Elaine Fried, the model of his painting Seated Woman (1940), and their relationship was passionate but also marked by heavy alcohol use^(34,35).

In the first phase of his development, he had a very aggressive style of painting, leaving heavy traces on partially destroyed canvas and pieces of paper magazines on his paintings⁽³⁴⁾. He used semi-figurative representations, the female figures being more symbolic than real portraits, but still preserved elements of figurative art, unlike other colleagues in the Abstract Expressionist movement⁽³⁴⁾. In the second phase (1950s – early 1960s), he switched to the abstractions of landscape, using softer colors and being less aggressive⁽³⁴⁾. In the 1960s, he returned to painting females, then, later, he made clay sculptures and lithographs under the influence of Japanese drawings and calligraphy⁽³⁴⁾.

Of medical relevance are the anxiety, violent mood swings and prolonged periods of depression, combined with heavy drinking, on a background of financial difficulties and the need to find his own creative identity starting from the 1930s⁽³⁶⁾. However, he succeeded in being creatively productive and gaining some control over his mood swings, but in the 1960s his drinking problems worsened, a phenomenon which continued in the 1970s, with periods of leaving his home and sleeping intoxicated wherever he could find a place to rest⁽³⁶⁾.

In the late 1970s, cognitive problems started to appear, most likely due to heavy alcohol use, and he withdrew from the art scene⁽³⁴⁾. In that period, de Kooning presented insomnia, panic and anxiety, and signs of self-neglect⁽³⁴⁾. He was hospitalized repeatedly and succeeded finally to quit drinking⁽³⁴⁾. In the 1980s, he restarted painting by combining figurative art with abstract features, and he was even very productive, in spite of disorientation periods with short-term memory losses^(34,37). His style evolved to a purely abstract style, producing more than 300 paintings in this last period⁽³⁷⁾. However, that change in style and speed raised an intensive debate among art critics – i.e., whether it was a voluntary change or one dictated by the limitations due to his neurocognitive disorder⁽³⁷⁾. The debate was fueled by the fact that de Kooning’s late artistic creations appeared after the New York State Supreme Court declared de Kooning as lacking mental capacity and when he was already impaired in conducting independent activities of daily living, although no neurological diagnosis was explicitly formulated at that time⁽³⁴⁾. Finally, de Kooning received an official diagnosis of Alzheimer’s disease (AD) in 1989⁽³⁸⁾. Some art critics viewed the change in his style as a reflection of Abstract Expressionism to communicate through emotional and spiritual means, leaving aside irrelevant elements that could be observed in de Kooning’s early works⁽³⁴⁾. Also, there are critics who consider the art produced by de Kooning in the second part of his life as the most sensitive artistic achievement in contemporary art⁽³⁹⁾.

More specifically, in his last phase, he painted on top of earlier produced models and used different techniques⁽³⁷⁾. The switch from figures of women, multicolored prints and rich in oil canvases to ribbon-like abstractions seems a direct consequence of de Kooning’s case of progressive neurological impairments, while the duration for finishing a painting decreased from months to weeks^(38,40,41). He forgot people’s names and dates of recent events, he was temporally and spatially disoriented, had confabulations, rage bursts and anterograde amnesia while still abusing alcohol and having episodes of depression^(39,41). Regarding the etiology of de Kooning’s dementia, stating it was a case of AD is an oversimplification, since other multiple causes have been invoked – e.g., arteriosclerosis, alcoholism, nutrition imbalances, or abused drugs⁽⁴¹⁾.

Neuroesthetics is based on the result of studies that explore the relationship between artistic works and brain functioning, and a solid body of reports is derived from well-known visual artists, de Kooning included⁽³⁴⁾. As a counterargument to the fact that high intellectual capacities are prerequisites for abstract art creation, de Kooning succeeded in finishing his last paintings while fighting dementia due to Alzheimer’s disease⁽³⁷⁾. According to Espinel (2007), who analyzed the paintings created by the artist prior to and after the onset of AD, a syndrome called “creating in the midst of dementia” is responsible for these rather surprising results of de Kooning⁽³⁷⁾. This syndrome is characterized by a combination of preservation of the working, procedural and episodic memory, while the semantic memory system is impaired, and a response to precise stimuli that is able to reactivate specific cerebral areas⁽³⁷⁾. Other scientists compared the ability of de Kooning to create even in advanced phases of his dementia by the preservation of hand-to-eye coordination when he was put in the front of the canvas with a projection of early work, even though he was severely impaired in the activities of daily living⁽³⁴⁾.

In a fractal analysis of several painters’ works, artists who were diagnosed with neurodegenerative disorders versus normal aging visual artists, it was shown that a gradual decline in fractal dimension (FD) started in the case of de Kooning from 40 years of age, and a greater variance was observed in FD across time versus controls⁽³⁸⁾. Therefore, the fractal analysis may be explored as a way to measure the neurological impairment derived from one artist’s works⁽³⁸⁾.

A similar phenomenon of neurocognitive disease’s impact on the life and creativity of a visual artist was described by Holmbon Larsen and Londos (2024) when exploring the case of the well-known Swedish artist diagnosed with an AD, Peter Tillberg⁽⁴²⁾. Through a retrospective analysis, the authors, based on evaluations from independent art critics, observed that his paintings became different, with the involvement of other feelings and sensations than before, deteriorating from diffuse and vague to repetitive and monotonous⁽⁴²⁾. This artist was still able to create artistic works even when his Mini-Mental State Examination scores were below 10, suggesting the low validity of such instruments to assess the correlation between brain dysfunctions and artistic capacity⁽⁴²⁾. The authors concluded that there is a need for a multidisciplinary approach to the cases where the impact of neurodegenerative disorders is evaluated in artists⁽⁴²⁾.

The capacity of art to act epigenetically as a protective factor in neurodegenerative disorders has been invoked by several authors⁽⁴³⁾. While interesting, this hypothesis requires further exploration with a large group, long-term design, and biological markers.

The correlation between neurodegenerative disorders and visual creativity in individuals without special artistic abilities was explored in a quasi-experimental design study that included 11 patients with AD involved in art therapy and monitored for 31 months⁽⁴⁴⁾. According to this study, the selection of drawings or modeling was significantly associated with the severity of cognitive deficits, and the type of material and quality of the artwork was similarly associated with the deficit severity⁽⁴⁴⁾. The authors of the study draw attention to the fact that visuospatial impairments can influence the quality of drawing and modeling, inducing changes in the perception of depth, distance, shape, shape consistency, and background⁽⁴⁴⁾. Patients who developed or maintained artistic abilities were more probably diagnosed with frontotemporal dementia than with Alzheimer’s disease⁽⁴⁴⁾.

De Kooning’s case is illustrative for multiple reasons: (1) the importance of conjugation of toxic and biological factors in the onset of dementias; (2) the analysis of creativity, as a product of interacting, multiple psychological functions, some of them resisting for a long time even during the course of the most devastating neuropsychiatric disorders; (3) art-based therapy can be a useful resource in patients with AD or other neurocognitive disorders, but the interindividual variance in residual cognitive abilities is important (Figure 3).

Mark Rothko

Although Mark Rothko (1903-1970) resented the label “abstractionist” that was attributed to him by critics, his life and work are tightly related to the American Abstractionism movement. He abandoned the surrealist technique he approached initially and switched to a more direct style connected to “human drama”, reaching a fully abstract style in 1949⁽²⁷⁾. He is also the pioneer of color-field painting, which is one of the two currents of the Abstractionism school, as stated in a previous section. His priority was, as he put it, not on any conceptualization or scholar principles but “only in expressing basic human emotions – tragedy, ecstasy, doom, and so on – and the fact that lots of people break down and cry when confronted with my pictures shows that I communicate those basic emotions”⁽⁴⁵⁾. Rothko is best known for his wide-scale paintings that invite observers to plunge into their own unconscious, his works presenting significant merging and immersive properties⁽⁴⁶⁾.

Rothko was inspired by Mozart (“Mozart sings like a bird”, he wrote⁽⁴⁵⁾) and tried to create a form of harmony between his painting (including the scale of his work – “large pictures take you into them”⁽⁴⁵⁾) and the music of the famous Austrian composer (“feelings have different weights; I prefer the weight of Mozart (…) and I like his scale”⁽⁴⁵⁾). Thomas Messer observed: “Rothko shares with composers of music an absence of explicit imagery and a correspondingly developed capacity to evoke content by association (…) he is a creator of melodic surfaces rendered vital and sonorous”⁽¹³⁾. From a psychological perspective, this could indicate Rothko’s ability to have synesthesia by converting musical sounds into visual imagery. Also, the preoccupation with transforming emotions into paintings is a constant element of his creation, and the sublimation of his own negative, destructive impulses can be detected in the artist’s statements. In a lecture Rothko gave in 1958, he stated that a meaningful work of art must be based on a clear preoccupation with death and an understanding of mortality and, as a complement, sensuality, a relationship of desire with reality⁽¹³⁾. The large color field paintings of Rothko are able to trigger feelings of depression, discomfort or uneasiness in the viewers, as they were probably triggering in the artist himself⁽⁴⁾.

Like Pollock, Rothko was familiar with Jungian concepts and analysis⁽²⁷⁾. However, unlike Pollock, he was unconcerned about working with his own unconscious and he was more intimate with philosophy and mythology⁽²⁷⁾. Rothko was interested in Nietzsche, Aeschylus, Sir George Frazer, Freud and Jung, and he used symbols in a conscious manner in his work, but never explored his own impulses in a professionally guided manner⁽²⁷⁾. His painting Slow Swirl reflects the presence of multiple mythological symbols possibly inspired by Jungian theory, which the artist deliberately seemed to have placed there⁽²⁷⁾.

As in the case of Arshile Gorky, Rothko was very attached to his mother, who was a strong and powerful figure^(11,18). Another similarity with Gorky was the fact that one of his parents died early (his father, in this case, died of colon cancer when Gorky was 11), and he also passed through the stress of exile⁽¹⁸⁾. Rothko was born Marcus Rothkowitz in Dvinsk, which is today in Latvia, and migrated with his family to America in 1913. They arrived in America with no knowledge of English⁽¹¹⁾, which must have made their adjustment difficult, as the artist himself declared; this was added to the fact that he felt marginalized as a Jewish child among native Americans, although he made all the possible efforts to integrate himself into the local society and culture^(11,47,48). He confessed to one of his friends: “You don’t know what it is to be a Jewish kid dressed in a suit that is a Dvinsk, not an American idea of a suit, traveling across America and not able to speak English”^(47,48).

Rothko was described by his sister as very fragile and frequently sick⁽¹¹⁾. He sought refuge in alcohol and had periods of heavy drinking, leading to severe liver disease, a fact that presumably interfered with the possibility of surgeons intervening for an aortic aneurysm detected in 1968⁽¹³⁾. He divorced his first wife in 1944, and he became severely depressed⁽¹¹⁾. The death of his mother in 1948 accentuated again his depression. He separated in 1969 from his second wife, and again, the depression worsened in the context of both social and health-related aspects⁽⁴⁶⁾. As he gradually aged, his creativity did not suffer, but he became worried and demoralized over his physical diseases⁽⁴⁶⁾. He was fighting depression all his adult life and received pharmacological treatment while refusing psychotherapy, although this was offered to him.

He killed himself at the age of 66 years old, still at the peak of his career, by severing both brachial arteries with a razor blade^(4,11,13). The autopsy report confirmed the presence of high doses of doxepin hydrochloride and sedatives, but also acute gastritis, severe emphysema and severe heart impairment^(46,49). No suicide note was found, although the gesture was apparently carefully planned, based on the level of detail he took care of when arranging the set of his death⁽⁴⁶⁾. The decision to kill himself was considered by Breslin (1993), his biographer, a desperate gesture to preserve a sense of “dignity and control” in the context of multiple physical and mental threats⁽⁴⁷⁾. 

Some authors consider that his paintings are, in fact, his true suicidal notes⁽⁵⁰⁾. Mark Rothko himself stated that his artwork reflected the depressed mood he had⁽⁴⁾. In this respective, by the end of the 1960s, the colors Rothko used became darker, with black, blues and purples dominating the paintings (as can be seen in his last masterpiece, the 14-dark colored paintings in the Rothko Chapel at the University of St. Thomas in Houston where he used dark red), a fact some critics have correlated with the change of his mood⁽²⁷⁾. Although dark, these paintings are radiant and invite mostly contemplation and meditation⁽⁴⁶⁾. As the artist’s daughter, Kate Rothko Prizel, declared: “There was a terrible tendency for me to see the paintings darkening, becoming less accessible emotionally, more hard-edged. I had a hard time separating them from his depression”⁽⁵¹⁾.

In a very thoroughly conducted analysis based on the biography of Rothko, Hartman (2018) showed that the general risk factors for suicide in the case of Rothko were early object loss (his father), recurrent major depressive depression and substance abuse; the trigger might be the diagnosis of the aortic aneurysm (a severe narcissistic wound), that led to marital conflicts, increased alcohol intake and social isolation; restriction on his paintings imposed by the treating physician due to his overall health status, but also the onset of erectile dysfunction may also have contributed to the severe depression (other narcissistic wounds); the addictive behaviors can be conceptualized as the results of a self-representation splitting and an attack toward own body which betrayed him; the suicide may have been fantasized by Rothko as a way to accomplish a fusional reunion with his departed mother⁽¹¹⁾. This perspective on early losses as a predisposing factor to suicide in the case of Rothko’s tragic death is supported by other authors, who correlate this aspect with his difficulty in forming intimate relationships and presenting bouts of eating, anger crises, and episodes of depression⁽⁴⁹⁾. The same predisposing factor was correlated with Rothko’s lack of interest in psychology and psychoanalysis as a means to avoid confrontation with past, early traumas⁽⁴⁹⁾. As mentioned before, Rothko refused any form of psychotherapy and accepted only antidepressants and sedatives, which he combined with high doses of alcohol⁽⁴⁹⁾.

Regarding his legacy, an interesting experiment, based on the reaction of observers to Rothko’s art, was conducted by Pelowski (2015), who intended to study the relationship between cognitive models of crying, insight and “esthetic experience”; such experiences are expected to trigger changes in one’s self-image or worldview, leading to intense emotions⁽⁵²⁾. The author explored the reaction of observers in a cross-cultural approach (UK, Japan and US museums), and abstract paintings were chosen because of their austerity or opacity, which puzzles the observers and invites them to reflect and revise their own perspectives about the significance of art⁽⁵²⁾. The Rothko Chapel, a Rothko room in the Kawamura Museum in Japan, and a room for Mark Rothko’s late paintings in Tate Modern were included in this experiment due to their “particular notoriety for tear elicitation”⁽⁵²⁾. The results showed that, when confronted with the art stimulus (the monumentality of Rothko’s creations), observers had high rates of confusion, anxiety, self-awareness, epiphany, triggering (“Painting watching me”, “Awareness of others watching me”) and happiness, all of these being in some cases associated with confusion or cry⁽⁵²⁾. In total, 43% of the viewers in the Houston Chapel, 36% in the Kawamura Museum in Japan and 36% in London’s Tate Modern reported intense emotions, described as “feelings like crying” as part of their art experiences⁽⁵²⁾. Crying was mostly related to confusion, self-awareness and epiphany⁽⁵²⁾. The author of the study interprets these “feelings like crying” as a salient indicator of the esthetic experience⁽⁵²⁾.

Another study observed the reaction of viewers (N=678 primary and 335 secondary students) to Rothko’s Untitled (1969), and monitored four perceptual dimensions: sensory, emotional, cognitive and spiritual, on a proposed Rothko Experience Scale⁽⁵³⁾. The results showed an intense perception of Rothko’s art by awareness of modifications of its colors and other sensory features, while the borders between Self and temporal and spatial coordinates tend to vanish⁽⁵³⁾. Also, the authors extended the study by including not only contemplative tasks but also creative tasks, which involved the participants, enhancing the educational objective of this experiment⁽⁵³⁾. The authors of this study suggest the utility of engaging the audience in the experience of modern art by using Rothko’s paintings because these can create an undefined and extemporal atmosphere, triggering vivid emotional experiences, thus being adequate for meditation and reflection^(53,54).

In conclusion, for psychiatrists, the exploration of Rothko’s biography illustrates the intricacy between vulnerability factors, lack of protective elements and triggers for suicide (Figure 4). Rothko’s art offers an extreme richness of directions for psychological research since his paintings are powerful elicitors of intense emotions through activation of unconscious elements, and their use for educational purposes has already begun to be explored, as previously shown.

Conclusions

The analysis of biographical data partially explaining the tragic deaths of Jackson Pollock, Mark Rothko and Arshile Gorky is relevant from a psychiatric perspective, because it reflects the importance of (a) vulnerability factors such as early trauma, alcohol use disorder, untreated or poorly treated major depression or bipolar disorder, and (b) the role of psychosocial factors and somatic invalidating diseases as triggers for suicidal behaviors. The case of Willem de Kooning is more complicated because, besides the impact of alcohol use disorder in the genesis of his neurocognitive disorder, poorly treated depression and anxiety, and the negative social consequences of Alzheimer’s disease, there is a luminous aspect of his fight with dementia. More specifically, the analysis of his biography highlights the fact that he was able to stay creative for a long time after the Alzheimer’s disease diagnosis by using residual cognitive capacities. The importance of art therapy to patients with neurocognitive disorders by exploiting the residual executive functions^(55-58) is illustrated successfully by such life stories.

Also, it can be inferred from these biographies that using alcohol as a means to increase creativity exposes the artist to the risk of developing severe mental disorders or even death, the subject walking on a narrow line between sublimation of unconscious impulses and disastrous surrender before them⁽¹²⁾. As a hypothesis for further research, it remains to be explored if artists who voluntarily let their unconscious manifest freely during their periods of creative work, as part of their programmatic statements about the art, have a more difficult time differentiating and controlling self-aggressive impulses. A retrospective analysis of the long-term consequences of comorbid depression and substance use disorder on creativity in professional artists versus controls is another topic to be further researched.

The analysis of the Abstract Expressionism artworks led the scientists to apply new techniques in the field of art investigation, such as fractal analysis (for Pollock and de Kooning’s works) or scales for measuring the effects of exposure to an artwork (Rothko Experience Scale), the creation of new art terms (“polloglyphs”⁽³⁰⁾), and the enrichment of nosography with new syndromes, such as “creating in the midst of dementia”⁽³⁷⁾, inspired by Kooning’s last phase paintings. But maybe, more importantly, is the alarm signal within these biographical analyses about the need for mental health specialists to be aware of the vulnerability factors for self-aggressive behavior, to screen for potential triggers of these behaviors that can be ignored by a superficial evaluation, and for the preparatory signs for suicide.

Autor corespondent: Octavian Vasiliu E-mail: octavvasiliu@yahoo.com

CONFLICT OF INTEREST: none declared.

FINANCIAL SUPPORT: none declared.

This work is permanently accessible online free of charge and published under the CC-BY.