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What Lies Beneath

What Lies Beneath

The Comfort of Lies

Johnston, Michelle MBBS

doi: 10.1097/01.EEM.0000578600.70604.6f
    self-deception, admitting errors:
    self-deception, admitting errors

    We humans are exceptional at self-deceit. This isn't terribly surprising if you brave the neuroscientific literature about how we think. But before we are mired in academic mud trying to get purchase on our psychological frailties, let's talk Vincent Van Gogh.

    Van Gogh is the stuff of legend. Something in the heady mix of tortured genius, miraculous skill, and a cracking life story makes him irresistible to us in our armchairs. We've all at least appreciated, if not swooned in front of, a Van Gogh swirl or painterly gesture. And we all know his story. It's passed down. Truth.

    Three aspects of his history are fascinating.

    The ear gift is celebratory. Sliced off with a razor by his own hand then wrapped in rags and presented to a prostitute at the local brothel, this has been the byline that has proven Van Gogh's delusional mania. The incident occurred while he was living at the Yellow House in Arles with Gaugin. More of that color and less of Paul (the rampant syphilitic post-impressionist we met in a previous column) in a moment.

    His death was also apocryphal. Widely accepted as fact, Van Gogh shot himself in a lonely wheat field in Auvers at the age of 37, his suicide a result of internal demons and external commercial failure.

    A Story Stuck in Memory

    The third tidbit is our emergency medicine connection, where it is written that the yellow preponderance in Van Gogh's later works was a result of xanthopsia, the golden chromatic lens on the world arising from over-digitalization. It is thought that digitalis was prescribed by his doctor, Dr. Paul-Ferdinand Gachet, whose portrait in front of the foxglove plant you see here.

    But are these fabulous snippets any more than half-truths, embellished by time and written legacy, simply titillating fractions of a story stuck in our memory?

    Medicine has more than its fair share of heirloom knowledge handed down from generation to generation. Some of it is intermittently challenged, but often it flows without ripple or rethink. We could fill a hundred columns with examples, axioms, and dogma that have us hooked. Epinephrine in cardiac arrest, stents and metalwork, the crutch of crystalloids, kneejerk antibiotics, kneejerk anything.

    Medical reversal is a hulking, cumbersome thing. Knowledge, once ingrained in the collective consciousness, can be titanically difficult to turn around. And this applies to behavior too—the doing of things. Of anything, as elegantly dissected in this think piece. (Emerg Med Australas 2018;30[2]:273;

    The lure of intervention bias, making us order tests, give drugs, do stuff is a trap for our busy worker brains. In our time-pressured, outcome-driven departments, sometimes our higher brains are unable, or unwilling, to challenge this conduct.

    Universes from Hallucinations

    This takes us back to the peculiar world of cognitive theory. Once an idea is woven into our cortex, it can be devilishly hard to unpick. We in medicine often do an admirable enough job of it—we need to, with truth being updated at blistering pace—but still, we aren't perfect. Human stubbornness is probably fallout from the way consciousness evolved; we construct elaborate universes from nothing more than hallucinations (after all, what else are our cortical interpretations of sensory data?), and these worlds play out as stories inside our silent skulls.

    Having a narrative brain may have helped us develop as social beings; seeing the people around us as arcs, with pasts and futures, may have made our neighbors easier to understand. This meant we could manipulate them into liking and helping us. A win! But for all that, we are still the heroes of our own stories. We make the outside world work for our inside one. And thus, the main point: Our internal cosmos is more valid than everyone else's. Any new information is molded to our own actuality, rather than the other way around.

    There are many who have not had our advantages when it comes to understanding the scientific process (the process of discarding theories that do not stand up to the highest level of scrutiny). In this light, difficult-to-comprehend ideologies can be, if not supported, at least forgiven. Anti-vaxxers don't hold their belief systems out of malice; it is simply that these ideas feed an already manufactured reality.

    The internet, sadly, is not always an ally. What should have been the age of information is sometimes the opposite, the Monsanto of the digital landscape propagating fallacious information like manipulated weeds. A well-curated social media conversation, however, can sometimes do the reverse. For much of the population, once something is believed, it takes a good deal to unbelieve it; the key for us is being open enough to unbelieve.

    This much I know from abundant experience. It is tough to admit one's wrongness, to recognise that one's unassailable truths may not have the foundations first thought. Busting open our prejudices is considerably harder than reclining in pleasant fiction.

    So we return to the life of Vincent Van Gogh. How many of the accepted, repeatedly told stories of his life are true? The ear? Probably.

    The suicide? Unlikely. Historical sleuths have put together a far more plausible string of events, an outcast accident, a cover-up, a borrowed gun.

    The xanthopsia? Almost definitely not. A great retrospective laundering, a fabulous tale made up to suit a world hungry for a reductive explanation of genius. Van Gogh was probably simply partial to yellow.

    Dr. Johnstonis a board-certified emergency physician, thus the same as you but with a weird accent. She works in a trauma center situated down the unfashionable end of Perth, Western Australia. She is the author of the novel Dustfall, available on her website, She also contributes regularly to the blog, Life in the Fast Lane, Follow her on Twitter@Eleytherius, and read her past columns at

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