Art in Science—Goya to Dr. Arrieta: An Illustration of Patient-Physician Trust

While traveling in Seville, Spain in 1792, renowned Spanish painter Francisco de Goya y Lucientes (1746-1828) contracted a febrile illness, from which he never fully recovered. Although his vision and balance improved, muscle weakness and deafness plagued him for the rest of his life. Medical historians have disagreed about the possible cause of Goya’s serious illness. Was it syphilis? Mercury encephalopathy? Lead poisoning from paint? Speculation has run from those to still-more exotic causes, like Susac’s syndrome or Vogt-Koyanagi-Harada disease [2, 3]. From correspondence with his friend, Martin Zapatero [3], we know that ongoing symptoms profoundly impaired Goya’s quality of life, and he became socially withdrawn.

In 1819, Goya experienced another serious illness of uncertain diagnosis that inspired the painting Autorretrato con el doctor Arrieta (Self-portrait with Dr. Arrieta; Fig. 1). As Goya’s illnesses worsened over the remainder of his career, the artist’s oeuvre became darker in emotional content, likely reflecting his poor health [3]. His gruesome image of Saturn Devouring his Son (1819-1823) or his bleak depiction of an older woman in Monk Talking to an Old Woman (Fig. 2) both serve as a compelling example of this psychological evolution and a stark contrast with Self-portrait, which appears to be rooted in gratitide and reverence.

Fig. 1.

Francisco José de Goya y Lucientes, Self-portrait with Dr. Arrieta, c. 1820, oil on canvas, Minneapolis Institute of Art, Minneapolis, MN USA.

Fig. 2.

Francisco José de Goya y Lucientes (Spanish, 1746–1828), Monk Talking to an Old Woman. Watercolor, 5.7 x 5.4 cm; 22.9 x 22.9 cm (frame). Museum purchase, Fowler McCormick, Class of 1921, Fund (y1985-6). Princeton University Art Museum.

Self-portrait with Dr. Arrieta is an homage to Goya’s physician, Dr. Eugenio Garcia Arrieta, who is depicted in this scene ministering to his gravely ill patient. The text at the bottom of the painting reads: “Goya, thankful to his friend Arrieta: for the skill and care with which he saved his life during his short and dangerous illness, endured at the end of 1819, at 73 years of age.”

In this self-portrait, Goya’s upper torso occupies the center forground, his face sharing the spotlight with Dr. Arrieta’s head. The doctor’s intent stare travels past a cup of liquid that he holds near the mouth of his patient. Goya’s circumstances appear desparate, his face pale, eyes shut, head rolled back, and clutching his bed sheets. He is depicted as feeble and despondent, and portrayed with a faded, ghost-like appearance. Goya’s unfocused gaze is consistent with a state of febrile delirium; his unsaturated skin tone emphasizes how close he was to death. He rests against his doctor’s body, one of the physician’s arms on his shoulder and the other completing the embrace and offering the cup of medicine, the cup of hope. Goya has completely ceded to his caregiver’s support.

We know little about the personal and professional history of Dr. Arrieta, other than the fact that he traveled to Africa in the 1820s, presumably to study infectious diseases [1]. This limited information, along with the inscription beneath the painting that describes an acute and perilous illness, suggests that the physician was sought out because of his scientific interests and expertise. The doctor’s gentle embrace conveys empathy and his intentions appear deliberate and with therapeutic intent. Judging by the manner in which Dr. Arrieta is portrayed, then, as now, the value of steadfast compassionate care was a crucial dimension of the patient-physician relationship.

Emerging from the dark background of the portrait, at least three in number, are faces, shadowy and ambiguous. The physician’s illuminated body blocks these ill-defined figures from coming into the light. They have been variously conjectured to be assistants to the doctor, priests and servants [9], Goya’s comrades [6], or demons [7], perhaps waiting to guide the patient, in death, to his final destination. Whomever they may be, Dr. Arrieta keeps them from his patient, his body serving as a barrier between darkness and light, standing between the unknown and reality. We find solice in the physician’s presence, not only as a hopeful source of medical knowledge, but also as a comforting and committed protector.

It is common for artists to pay tribute to their physicians and those who nurse them back to health. Some of the more well-known artists so inclined include Vincent Van Gogh (Dr. Paul Gachet), Edvard Munch (Dr. Daniel Jacobsen), and Frida Kahlo (Drs. Leo Eloesser and Juan Farill) [9]. Artists choose to depict their healers through art for many reasons: Personal catharsis, on commission, or as a gesture of gratitude [9]. Goya’s piece may be considered as an ex voto [11], a type of religious offering (often artwork) that expresses appreciation for divine healing from catastrophe. Such tokens of appreciation or fulfillments of a vow were traditionally left for religious leaders, saints, or divine figures in churches. Indeed, the positioning of Goya’s body, collapsed within Dr. Arrieta’s support, is reminiscent of another empathic embrace, Michelangelo Buonarroti’s Pietà (1498-1499), where the Virgin Mary tenderly holds the body of Jesus (Fig. 3). There are other parallels between the two works—the composed and peaceful looks on both Mary’s and Dr. Arrieta’s faces (the protecters), a sense of their inner strength, the vulnerable poses of both Jesus and Goya, and the draping cloths that fall from their limp bodies.

Fig 3.

Michelangelo Buonarroti, Pietà, c.1498-1499, Marble, St. Peter’s Basilica, Vatican City. (Photo credit: Stanislav Traykov).

As an artist, Goya’s decision to represent Dr. Arrieta in such a reverent manner can be interpreted as a positive commentary on his trust in his physician and an acknowledgment of the value of compassion and professionalism. This is particularly meaningful in the context of this work being painted when doctors and medicine were generally distrusted [10]. This attitude was exacerbated during this same period of time by the reinstatement of the Spanish Inquisition under abolitionist king, Ferdinand VII [8]. Goya himself did not always warm to physicians. Years earlier, in his scathing series of sketches commenting on Spanish society, titled Los Caprichos, Goya portrayed a doctor as an ass (De que mal morira?) [5], a seemingly contradictory perspective when viewed along side the reverent Self-portrait. Still, this painting depicts Dr. Arrieta as capable, a savior, and ultimately, the one who returned Goya to health, allowing him to live for nearly another decade.

We should also consider that at the time of this painting (early 19^th century), the molecular basis of disease was unknown and the Western pharmacopeia was meager. It would be nearly another 40 years before Louis Pasteur established the field of bacteriology and several more before history-altering pathogens such as Cholera vibrio, Poxviridae, and Mycobacterium tuberculosis would be identified, isolated, and effective therapies pursued. Yet, in this painting, our eyes are drawn to the cup of (what we presume is) medicine in the center of the canvas that Dr. Arrieta tenderly, but firmly, holds to Goya’s lips. Regardless of the hesitations Goya might have harbored towards physicians and their medicines or potions—hesitations that may have been shared by society at large—the painting highlights the personal conflict that may arise among desparately sick patients, otherwise skeptical but in urgent need of help.

This painting ultimately highlights an encounter of mutual respect and reliance between patient and doctor. For the medical profession to fulfill its missions to heal and to care, there must be trust between the ill and their providers. The sick patient must have confidence that his or her physician will do all within his power to care for him. The physician must return this trust with skillful and compassionate care. The relationship can be a delicate balance, indeed, a union. The blurred edges (sfumato) between Dr. Arietta’s hands and Goya’s feeble body in this portrait symbolize their shared battle against disease.

Empathy, commitment, integrity, and a selfless investment in the patient’s physical and emotional circumstances earns the physician respect, then as now. Recall Luke Fildes’ The Doctor [4]. Despite society’s frequent skepticism over the centuries about the knowledge and skills of physicians in general—skepticisim that often has been well-founded patients in crisis repeatedly turn to their doctors with hope and in search of compassion and professionalism [4].

Goya depicted this as well in Self-portrait with Dr. Arrieta.