The healing powers of optimism are well attested. Over the years innumerable medical studies have shown that a positive outlook has beneficial effects on health, not just in general terms but for specific complaints too. According to the Harvard Medical School, for example, a 2008 study of 2,873 healthy men and women found that a positive outlook on life was linked to lower levels of the stress hormone cortisol and had favourable effects on cardiovascular illness. More pertinently, perhaps, a 2006 study explored the link between emotions and respiratory tract infections. A sample group of 193 volunteers were given a common respiratory virus and it was discovered that subjects with an upbeat personality were less likely to develop symptoms than their more miserable peers. Science, though, has only confirmed what was already widely understood, which is why the art found in hospitals – vivid land- and seascapes, animals and flowers, bright abstracts – is so relentlessly cheery.
But the bland chirpiness that now characterises the art hung in medical centres has a more complex history – one in which the concepts of the soul and sin were thought more important than stimulating the release of endorphins. Indeed, precisely because they understood that the art of healing needed to minister to the spiritual as well as the physical, it was an area that fascinated some of the greatest of painters, from Piero della Francesca, Rogier van der Weyden and Leonardo da Vinci, to Rembrandt, Francisco Goya and Vincent van Gogh. For them, St Paul’s words on the interconnectedness of body and soul were an invitation to paint: “A body is not a single organ, but many… The eye cannot say to the hand, ‘I do not need you’… If one organ suffers, they all suffer together.” The spirit was one such organ.
This holistic attitude came about in part because, in the Middle Ages, hospitals did more than simply treat the sick; they were centres for assorted charitable enterprises, doubling as dormitories for travellers and pilgrims, asylums, almshouses and havens for foundling children. A fresco of 1444 at the Spedale di Santa Maria della Scala in Siena, Italy, includes a cartouche bearing the legend: “Here is an image of the Blessed Virgin Mary. Under your mantle the Christian populace is protected.”
This message of shelter and succour was given its most perfect early expression in the central panel of Piero della Francesca’s Polyptych of the Misericordia, which was commissioned in 1445 by the Compagnia della Misericordia, a charitable confraternity in the painter’s home town of Borgo San-Sepolcro. Piero gave the word misericordia – mercy – physical form in the standing figure of the Virgin opening her mantle to cover the kneeling figures of eight townspeople. The look on her face may be one of solemn detachment but the message of aid given and received is unequivocal. Mary, the embodiment of grace, is painted against an unadorned gold background so the panel reads like a signboard: here, at Mary’s feet and in her shadow, is where mercy and relief can be found.
At the same time, however, at Beaune in Burgundy, 1,000km away, the Flemish artist Rogier van der Weyden offered a sharply contrasting vision of redemption. His 1443-51 Last Judgement for the Hôtel-Dieu hospital shows Christ and his saints in majesty but beneath them, tellingly closer to eye level, is a harrowing portrayal of the damned descending in stumbling procession to Hell. The multi-panel altarpiece was commissioned by Nicolas Rolin, chancellor of Burgundy, for a town that had been devastated by outbreaks of the plague just a few years earlier. It was nevertheless hung in the patients’ ward rather than in the chapel and during the week its hinged wings would be closed, showing the rear panels carrying portraits of the donor and his wife and trompe l’oeil statues, presenting to the sufferers a conventional image of piety. On Sundays, however, the panels were opened to reveal a brilliantly coloured panorama offering a straight binary choice: sin and mortality or redemption. For bodies and minds already in distress this living scene of their potential fate – whether imminent or distant – must have been startling. Van der Weyden’s extraordinary invocation of the end of days was meant, quite literally, to put the fear of God into them.
A detail from Rogier van der Weyden’s Beaune Altarpiece, 1443-51
This tough love stance reached its apogee some 60 years later, not far from Beaune at the Monastery of St Anthony in Isenheim, near Colmar on the Franco-German border. There, between 1505 and 1515, the German painter Matthias Grünewald created one of art’s greatest and most distressing paintings, the Isenheim Altarpiece. The monks at the monastery specialised in treating both the plague and various skin diseases and, given the prominence of St Anthony in the paintings’ iconography, one of those ailments was likely to have been the flaming rashes of erysipelas, also known as St Anthony’s Fire. The central panel shows the crucifixion but Christ’s body is anything but noble or sacred – it is scarified and covered with boils and pustules. Christ is haggard, oozing and agonised, just like the hospital’s patients. The picture is, coincidentally, the largest crucifixion scene in European painting of the time.
The donor believed that this extreme example of identification with Christ – a saviour who suffered just as they suffered – was an essential part of any cure and insisted that patients should be taken to see the painting as the first stage of healing. It was, he was convinced, the means by which their minds could be opened to the possibility of a miracle. Christ’s broken body was nonetheless an insistent reminder of just how badly that miracle was needed and how potent it would need to be. The sense of despair was poignantly recognised in another of the panels showing St Anthony himself, which contains a piece of paper inscribed with the words: “Where were you, good Jesus, where were you? And why did you not come and dress my wounds?”
In 1905, the novelist and critic Joris-Karl Huysmans saw the altarpiece and was awestruck. The figures, he said, “were obviously modelled on the corpses in the hospital mortuary”, making the painting “the hosanna of gangrene, the song of triumph of decay”. Nevertheless, Grünewald’s “pestiferous Christ”, his body “moulded in greasy white soap mottled with blue, and mamillated with boils and carbuncles”, represented a balm that “could only be understood by the sick, the unhappy and the monks”.
If Piero, Van der Weyden and Grünewald’s works were for the edification of the sick, the grandest series of all illness paintings was essentially an epic piece of virtue signalling. Between 1564 and 1587 Jacopo Tintoretto painted 38 huge pictures for the walls and ceilings of the Scuola Grande di San Rocco in Venice. The Scuola was the sumptuous headquarters for another of the charitable confraternities that were such a feature of medieval and Renaissance civic life; this one dedicated to St Roch, patron saint of plague sufferers, whose remains were buried in the church next door. As a port city with a high proportion of trade from the East, Venice was not only particularly vulnerable to new outbreaks of bubonic plague but was also the place where the system of quarantine – named after the 40 (quaranta) days ships’ crews were made to spend at an outlying island before being allowed to unload their cargoes – was first developed.
Tintoretto’s huge scheme reflected the confraternity’s sense of its own importance and depicted numerous episodes from the Old and New Testaments. It culminated, however, in a series of allegorical paintings, one of the most imposing of which, at 22ft wide, shows St Roch in the Hospital, in which the holy man is represented as a hands-on medic ministering to plague sufferers. In a ward dramatically sliced by light and shade, the sick gaze dazedly at the buboes under their arms or in their groin, as the saint touches one bed-bound sufferer, encouraging him to rise. His gesture is a reflection of the tradition of the Royal Touch, or thaumaturgic touch, by which French and English kings, courtesy of being ordained by God, would cure the sick by the laying on of hands, most notably those with “the King’s Evil” – scrofula.
Self-portrait with Dr Arrieta, 1820
During the 17th and 18th centuries several hospitals were built with the same grandeur the San Rocco confraternity granted themselves. These resembled palaces more than spartan institutes of health and the grandest, such as the Invalides in Paris and, in London, the Royal Hospital for Seamen at Greenwich and the Royal Hospital at Chelsea, were for wounded servicemen. As befitted the respect nations showed their soldiers and sailors – “the hardy maimed veterans of our country’s honour” as one contemporary Irish writer put it – their design and decoration was entrusted to the finest architects and painters of the age.
Jules Hardouin-Mansart’s Church of the Dome at the Invalides had frescoes by Charles de la Fosse and sculptures by Antoine Coysevox; Christopher Wren designed the buildings at Chelsea and Greenwich, while Sir James Thornhill masterminded the vast decorative scheme of the seamen’s “Painted Hall”. This last, to the delight of the veterans, included a portrait of John Worley, a sailor who had spent 70 years at sea and whose behaviour on land remained salty: the hospital Council minutes record that he had been “very drunk in his ward… abusing his ward fellows and cursing and swearing saying he was better than any in the house”. Nevertheless, to see their boisterous companion immortalised on the ceiling was a fillip.
William Hogarth, who was coincidentally Thornhill’s son-in-law, was a painter who brought something of Worley’s combative spirit to the task of providing pictures for St Bartholomew’s – his local hospital, having been born almost in its shadow in 1697. Between 1719 and 1745 five new London hospitals were founded – Guy’s, Westminster, the Royal London, St George’s and the Middlesex – while Barts was substantially extended. In 1734 Hogarth won the commission to decorate the grand staircase of the building’s new wing by offering to work for free. His motivation was hardly altruistic: a Venetian history painter called Jacopo Amigoni was on the point of signing a contract for the scheme and the nationalistic Hogarth was determined to break foreign painters’ grip on public art in the country.
Hogarth’s more disinterested side came to the fore as a founding governor of the Foundling Hospital, initially sited at Hatton Garden in London. Although the hospital was committed to protecting children from smallpox, dysentery and the like, the childless Hogarth played his part not only by fostering foundlings himself but designing their uniforms and the hospital’s coat of arms, and donating several of his paintings to seed a permanent art collection. With additional works by artists such as Thomas Gainsborough and Joshua Reynolds, the gallery raised the hospital’s profile to the point that it became a fashionable cause.
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A group of other artists had even more personal links to hospitals, including Frida Kahlo, a long-term invalid, and Edvard Munch, who was shot in the hand by a deranged lover, leaving mental injuries that never really healed. An earlier painter with reasons of his own to be fascinated with hospitals was Frans Hals, who in 1642 painted a vivid group portrait showing the Regents of the St Elizabeth Hospital of Haarlem. These civic grandees, caught in the middle of a board meeting, were not just devout Christian souls but the men who funded the care of the painter’s own “imbecile” son. In 1664 he would also paint pendant group portraits of the Regents and Regentesses of Haarlem’s Old Men’s Almshouse, where, having fallen on hard times, Hals himself may have been a resident. Such close-to-home connections are one reason perhaps that Hals depicted these men and women with such a sympathetic eye, emphasising their humanity above their status.
Richard Dadd, Vincent van Gogh and Théodore Géricault meanwhile were among the various significant painters who had personal experience of the madhouse. Dadd (1817-86), convinced his father was the Devil in disguise, killed him with a rusty penknife and was confined to Bethlem (Bedlam) Hospital for the insane. Two of the most arresting works he painted in confinement are not his celebrated fairy pictures but portraits of sympathetic physicians, Sir Alexander Morison and William Charles Hood. These men, set against backgrounds of haunting detail and natural fecundity, stare at the painter/viewer with calm equanimity. They are sitting to a man, not a lunatic.
The most unsettling pictures reflecting mental illness were, however, painted by the French Romantic artist Géricault. In the years around 1820 he produced a series of ten portraits of the insane for a pioneering psychiatric physician named Dr Étienne-Jean Georget. Five of them remain, and in their intensity and sympathy of observation they represent some of the most extraordinary portraits ever painted. Géricault himself had suffered bouts of mental illness and had possibly been treated by Georget: the portraits may indeed have been of fellow inmates at either the Pitié-Salpêtrière teaching hospital in Paris or Georget’s private asylum in Ivry. They may also have been made as teaching aids for the physician, to demonstrate the physiognomic appearance of a variety of mental states, such as obsessive envy, kleptomania and delusions of military rank.
During a trip to England, Géricault met with Charles Cockerell, the architect responsible for Seckford Hospital in Woodbridge, Suffolk, as well as the Ashmolean and Fitzwilliam museums, who recalled the painter’s troubled state: “Lying torpid days and weeks then rising to violent exertions. Riding tearing driving exposing himself to heat cold violence of all sorts.” However poignantly but frankly he looked at his fellow sufferers, Géricault left no self-portrait of himself at the time.
The two World Wars necessarily led to a great increase in medical art. And among its most notable examples were the pastel portraits of facially disfigured First World War soldiers drawn by Henry Tonks. Tonks was a rarity in that he was initially a surgeon himself, working with, among others, Sir Frederick Treves, the doctor who treated and befriended Joseph Merrick, the “Elephant Man”. He left the operating room for the studio and both before and after the war Tonks was the most influential teacher at the Slade School. During the war, however, he returned to medicine and his pastels were not made as works of art – although they certainly are – but as aids for pioneering reconstructive surgery.
Nowhere, though, was the doctor-patient relationship more tenderly shown than in Goya’s Self-portrait with Dr Arrieta of 1820. Goya was afflicted not just with deafness but likely with an autoimmune disease that made his life precarious. In this double portrait he shows himself, at 73, in the grip of one such bout of extremity, ageing and drained, in bed and limp with exhaustion. Dr Arrieta is propping him up and offering him a drink – a cordial or medicine – with a sacramental gesture and a look of the utmost solicitude, even though the patient is too weak even to look back at him. In the dark behind the pair is a cluster of spectral figures; worried onlookers perhaps or waiting ghosts. Arrieta’s care saved Goya’s life and this remarkably intimate and emotionally open painting is his tribute of thanks.
The picture though has a tragic coda: in the year it was painted, Arrieta was sent by the Spanish government to Africa to study a recent outbreak of the plague. While there, it seems he contracted the disease and died, far from home. Goya’s painting is therefore more than a private gift of gratitude; it stands not just as a profound and deeply heartfelt memorial to an individual man, but to a profession.
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This article appears in the 24 Mar 2021 issue of the New Statesman, Spring special 2021