Picasso’s migraine: Illusory cubist splitting or illusion?

Introduction

Everybody knows that the famous Spanish painter Pablo Diego José Francisco de Paula Juan Nepomuceno María de los Remedios Cipriano de la Santísima Trinidad Ruiz y Picasso (1881–1973) suffered from migraine. His name is after all included in numerous lists of ‘famous migraine sufferers’ on the internet, as well as in many books and scientific articles (1–3). A Google search half way through 2010 with the key words ‘Picasso’ and ‘migraine’ resulted in 41,900 hits. Other famous migraine sufferers include Sigmund Freud, Friedrich Wilhelm Nietzsche, Julius Caesar, Joan of Arc, Karl Marx, Robert E. Lee, Ulysses S Grant, Lewis Carroll, Stephen King, Gustav Mahler, Elvis Presley and Cristiano Ronaldo, the latter obviously suffering from ‘footballer’s migraine’.

Is such information relevant or just tabloid-like voyeurism? Can it improve our insight in historical medical knowledge and practices (4,5)? Do artists, intentionally or unintentionally, reveal in their work evidence of their own medical defects, and do these diseases act as possible sources of inspiration (4)? Whatever the answers are, an additional problem arises when the celebrity has died some time ago and medical records are absent or incomplete (5). For example, is it true that Wolfgang Amadeus Mozart and Vincent van Gogh each suffered from at least 10 different diseases (4,6)? Likewise, the approach to famous people with headache is fraught with controversy, and physicians have repeatedly been cautioned against trying to diagnose headache syndromes without directly interviewing and examining patients (7). This is especially so because many patients had a tendency to obscure their headache and headache-related complaints, as these were thought to be psychological in origin (7). So, is all that has been written about headache in the famous to be taken seriously? What about Picasso’s migraine?

Picasso’s aura

In 2000, Podoll and Robinson described a peculiar phenomenon in paintings of migraine patients (8). They studied 562 paintings of patients who participated in a ‘Migraine Art Competition’ and found so-called ‘illusory splitting’ in six of the drawings. In this type of illusion, ‘objects or persons appear to be split, along fractured lines of varying form and orientation, into two or more parts that may be displaced and separated from each other’ (8). By invitation, we wrote an editorial comment on this article, praising its originality and importance (9). In our comment, we went a little bit further by pointing at similar forms of vertical facial splitting in works of Pablo Picasso, for example ‘La femme qui pleure’ (from 1937) and ‘Portrait de femme au chapeau’(1938). We concluded our contribution as follows: ‘Besides, we think that illusory splitting as a part of bizarre visual migraine auras might have inspired Picasso to paint female faces with the characteristic vertical splitting and shift of the eyes.’ In the same year, one of us (MDF) went further on this theme in a lecture given at the Headache World Congress in London (10). The presentation contained the statement ‘… although there is no official account of Picasso suffering from migraine, this could easily have been overlooked if he only suffered from migraine aura without headache.’ The lecture was livened up by a ‘Migraine Picasso Quiz’, which showed that ‘participants of the congress repeatedly had great difficulties in distinguishing between several of Picasso’s paintings and paintings of migraine patients, who had depicted their own visual auras’ (10). Since then, the name of Picasso has been irrevocably associated with migraine.

Inspired by masks?

Vertical facial splitting is an important aspect of the cubist representation of the face (11). Cubism was originally pioneered by Picasso and Georges Braque, and is considered as a new reality in visual representation in which the objective subject of the paintings was simplified, fragmented, reassembled, and viewed simultaneously from different angles (12). Primary among the techniques was a rejection of the fixed-point perspective. Repeatedly, art historians have mentioned African masks as the most likely source of inspiration for Picasso’s drawing of split faces, but this is disputed (13,14). Picasso himself has even claimed not to have seen the African masks circulating in Paris before completing his first cubist painting (15).

The Portrait of Gertrude Stein (1906) was Picasso’s first painting with a mask-like, nearly abstract face, resembling facial splitting (12). It is considered as a transitional work that anticipates cubism. The construction (or deconstruction) of Gertrude Stein’s face resembles the facial construction, eyes, angular appearance, and physiognomy of later works, especially Les Demoiselles d’ Avignon, the work that is considered the beginning of cubism. Picasso’s own comment on these (facial) disfigurations was: ‘Why should I try to imitate nature?’ and ‘If you give a meaning to certain things in my paintings, it may be very true, but it was not my idea to give this meaning’ (11). In a detailed and richly illustrated analysis of the paintings of Picasso, Cohen (1991) discusses the origins of Picasso’s work, and from a medical point of view he focuses on the distorted bodies and faces (11). There is no mention at all of migraine.

The technique of vertical splitting of the face was also used by other cubists, such as Georges Braque and Juan Gris. For example, in his Portrait of Picasso, Gris depicts even Picasso himself with a split face. The question arises why Gris did so. In any case, it is unlikely that Picasso’s migraine auras were the source of this, as auras cannot be seen from the outside. So, could it be possible that Gris had migraine auras himself? There, however, is no proof of this. George Braque did suffer from myopia (and for him there is also no indication that he had migraine) (4). Could in his case eye disease instead of migraine be the cause of the splitting of faces?

Eye diseases have often influenced and inspired artists (4,16). For example, the whole Impressionist group was called ‘a conspiracy of people with poor eyesight’ (16). Cézanne, Renoir, and Degas were myopes, Monet had nuclear cataract, Pissaro corneal ulcers. There are stories that they deliberately rejected wearing spectacles and painted at a distance at which the painting was out of focal range in order to make the picture impressionistic (16). It is, however, likely that a painter with visual problems will paint distorted images only on purpose. If an artist with – for example – astigmatism sees an elongated world, the likeness of it that he or she paints, in order to appear equally elongated, will be in fact compensated and the normal dimensions restored (4). With migraine, however, this is not possible. Where eye disease allows one to see things at a distance and sight can be manipulated, a brain disease such as migraine is a more subjective ‘part of the self’ that cannot be influenced. Besides, in contrast to poor sight due to eye disease, the aura of migraine is a transient phenomenon, so to reproduce it one has to rely on memory. In most patients, the aura warns of the occurrence of the horror of headache, and therefore is not often seen as something ‘beautiful’. There will always be a difference between representations caused by eye diseases and those caused by cerebral disease.

It seems that splitting of the face is intrinsic to cubism as a synthesis of analytic cubism and African art that is not restricted to a certain artist, and certainly is not an expression of a (cerebral) disease. So, is this the end of Picasso’s migraine?

As if.  .  .

We admit that our suggestion that Picasso could have suffered from migraine auras without headache was, at that time, not based on research of biographies, letters or memoirs of Picasso or one of his contemporaries. After 2000, our (limited) search using key words such as ‘headache’, ‘migraine’, ‘aura’, ‘attacks’, ‘visual phenomena’, or ‘facial splitting’ in PubMed, Project Muse, a couple of biographies of Picasso and in the letters of Picasso to the avant-garde artist Guillaume Apollinaire did not give any information suggestive of migraine. What we did find was an article about Le repas de l’aveugle (1903), a painting by Picasso of a blind man at a table (17). To paint this, Picasso was probably inspired by the deteriorating vision of his father or by ‘what he most feared in life’ (turning into a blind painter). No actual (permanent or temporary) visual disturbances of himself were mentioned.

Our remark that Picasso ‘could have been inspired by migraine auras’ must be placed in the context of other unproven suggestions about physical or psychological influences on Picasso’s work, such as ‘fear of disease, disfigurement, and death from syphilis is believed to have played a role in motivating Picasso’s painting’ (18), or ‘there is incipient psychic dissociation and even schizophrenia in Picasso’s paintings’ (17). Just like these, our statement can be seen as an explanation of what could have been, but even more as an example of the peculiarity of migraine auras. What the migraine patient experiences is necessarily inaccessible to others (19). Careful analysis of drawings of migraine patients, however, can give insight in processes that generate these hallucinations (19). It is said that the similarity of the drawings of migraine patients probably confirms the organic nature of the migraine aura (20). In the case of Picasso we have turned this around. He painted something that could have been an aura, and that can serve as an example of how auras can be experienced.

Another artist suffering from probable migraine

A remarkable historical parallel exists between Picasso’s ‘migraine’ and that of Hildegard of Bingen. This German abbess and mystic lived from 1098 to 1179, and some of her works have been preserved, including several books describing her visions and miniature drawings illustrating the visionary works. In 1917, Charles Singer, a well known British medical historian, suggested that Hildegard could have suffered from migraine (21). He based this theory on some of Hildegard’s descriptions of her visions and some of her illustrations. For example, he ‘easily recognized’ a description of a scintillating scotoma in her words: ‘I saw a great star splendid and beautiful, and with it an exceeding multitude of falling sparks which with the star followed southward’. After some of her visions Hildegard ‘…cast into the abyss that I could see them no more.’ She also repeatedly mentioned ‘painful disease’ in her writings.

Although there was no scientific or historic proof of Singer’s statement, subsequent authors – including the well known neurologist Oliver Sacks – included Hildegard’s name in lists of migraine sufferers (3,20,22–25). Podoll and Robinson (2002) compared her miniatures with some drawings in the ‘Migraine Art Competition’, and concluded that Hildegard’s visions closely resemble ‘elementary geometric hallucinations occurring as visual migraine aura phenomena’ (26). They also pointed to descriptions in her texts of ‘episodes of complete amaurosis’, ‘bilateral paresis of the legs’ and speech difficulties’ as proof of her migraine.

In several of her drawings Hildegard depicts repeating square forms, such as the ramparts of a castle or walled city. Singer describes these as fortification spectra, but that is not correct as that term is commonly used for zigzag shapes seen on the plan of a fortress, and not the square appearance of the fortress wall itself (26,27). Oliver Sacks echoes Singer as he calls Hildegard’s figures ‘fortifications’, which obviously is an error (27). So, although crenellations do sometimes occur, the drawings of Hildegard are not typical for migraine. This opinion is supported by Schott (2007) after his systematic analysis of drawings of migraine auras (19). Concerning Hildegard’s drawings he states that ‘…even cursory inspection of the illustrations shows they reveal features entirely different from those characteristic of migraine’ (19), an opinion that had already been expressed by previous authors (27,28). Furthermore, Schott does not consider the descriptions of Hildegard suggestive of migraine aura, but concludes that ‘her illustration has been instrumental in discriminating fact from fiction’ (19). Obviously the latter statement parallels the situation concerning Picasso’s migraine: someone makes an ‘as-if’ statement, some others repeat this, and suddenly it becomes the ‘scientific’ reality.

Unfortunately, doctors can be misled, just as any other human being. When a medical ‘expert’ makes a statement, there are not many who doubt its truth and investigate the sources. Remarkable examples of this are the ‘guitar nipple’ and the ‘cello scrotum’. These were presented as credible diseases (29,30), and quickly were established in the spectrum of health problems associated with making music (31). However, both appeared to be an invention by the authors (32).

Pigeons and Picasso

At the 2000 Headache World Congress in London where Picasso’s migraine was ‘launched’ there were several press conferences. Here, MDF had to answer more questions about Picasso’s auras than about the latest scientific discoveries in the field of migraine. Several American, English, Spanish, Japanese and Dutch newspapers reported on this important ‘news’, and it even was the opening item of several television news shows (for example BBC News, 4 September 2000).

A couple of years later, in September 2009 at the 14th Congress of the International Headache Society in Philadelphia, JH presented a lecture on ‘Migraine and Painting’. When the audience was asked ‘Did Picasso suffer from migraine?’ 50% answered ‘yes’, 25% ‘no’, and 25% ‘don’t know.

As mentioned before, the audience of a scientific meeting could not distinguish paintings of Picasso from those by migraine patients (10). It has been shown, however, that even pigeons can learn to recognize Picasso’s paintings (33). When confronted with paintings of Monet (who suffered from eye disease) and Picasso (from migraine?), the pigeons had no problems distinguishing them. They even showed a generalization from Monet’s to Cezanne’s and Renoir’s paintings or from Picasso’s to Braque’s and Matisse’s paintings. Showing Monet’s paintings upside down disrupted the discrimination, whereas showing those of Picasso upside down did not. So there was no need to write the present article for pigeons, as they are not to be fooled.

Did Hildegard suffer from migraine? Does cello playing cause pain in the scrotum? Do pigeons like Picasso’s paintings? We do not know. Picasso’s migraine is a wonderful hypothesis, but without evidence. It is impossible to choose between an inspiration for illusory splitting or just an illusion.