Austin M. Hopkins //

In her critically-acclaimed Netflix special Nanette, comic Hannah Gadsby begins her first show for a mainstream American audience with the playful autobiographical content which founded her home career in Australia. She makes self-deprecating but inherently uncomfortable jokes concerned with her identity as a lesbian woman. But as she continues into territory framed by her childhood spent in Tasmania, where homosexuality was viewed as criminal, and experiences of violence precipitated by her being mistaken as a man and by being noticed as a homosexual, Nanette quickly transitions from the realm of stand-up comedy into a space where Gadsby’s anecdotes cease to be jokes, and where Nanette “transforms into a commentary on comedy itself—on what it conceals, and on how it can force the marginalized to partake in their own humiliation” (Donegan 2018). Nanette drew critical acclaim and fury for how powerfully Gadsby implicates her audience in the tension that fuels comedy, and Gadsby leaves her audience to reconcile that tension within themselves, declaring “that tension? It’s yours…I am not helping you anymore.” Gadsby proceeds in a serious exploration of her experiences of physical and sexual violence, refusing to partake in the longstanding tradition of transforming her personal traumas into truncated joke form with dispersible entertainment value. Most importantly, Gadsby implicates her audience in the telling of her story, refusing those who participate in the moment the privilege of being able to walk away unburdened by ethical responsibility.

In the hour-long special, Gadsby also shares a story of an interaction with a former audience member, identified as a man, following a show in which she shared that she was taking an antidepressant medication. This audience member told Gadsby that as an artist, “you shouldn’t take medication” because “it’s important that you feel” (Gadsby 2018, emphasis added). Furthering his case, he claimed that “if Vincent van Gogh had have taken medication, we wouldn’t have the sunflowers.” He insisted the critical acclaim and inherent quality of van Gogh’s art was inherently contingent on the unmedicated nature of the mental illness from which he suffered. If Gadsby mitigated her capacity to feel or the intensity of what she felt, then her art would lose critical and entertainment value in the public’s mind.

Gadsby, who holds an art history degree, was able to quickly eviscerate his proposition, describing how van Gogh self-medicated throughout his artistic career, painting not only during and following hospital admissions, but also depicting the very psychiatrists who were treating him. Gadsby references one particular painting in which van Gogh depicts one of his psychiatrists holding a foxglove plant, from which one of van Gogh’s medications was derived. Gadsby counters this audience member’s demand that she be unmedicated to preserve the quality of her own art by proposing that “we have the sunflowers precisely because…van Gogh medicated. What do you honestly think, mate? … That creativity means you must suffer? That is the burden of creativity? Just so you can enjoy it?”

Gadsby refutes the notion that van Gogh’s unmedicated mental illness was the driving force behind his art—notably, his renowned painting Sunflowers, as referenced in the audience member’s comment. She calls attention to the perversity of the man’s suggestion that artists must suffer in order to create great works. This is not to say that suffering does not inspire art—one does not have to look far to find such evidence. Frida Kahlo’s diverse artistic portfolio, from her numerous self-portraits to her surrealist works inspired by nature, is grounded in Kahlo’s lifelong experience of debilitating chronic pain (Courtney et al. 2017). Edvard Munch, a Norwegian painter acknowledged as a leader of the expressionist movement and painter of the infamous Skrik (The Scream), was well-known to have struggled with chronic mental illness (Steinberg and Weiss 1954). Although illness and suffering can inspire and drive artistic expression, it is not the crux of the value inherent to the artwork itself. We must question why these works are prized and held to critical acclaim: is it due to the technical aspects of the work, or for the context in which it was created? If more the latter, is there an implied expectation that the art is valuable precisely because the artist suffered, or because they were able to express their suffering? What happens when someone views or experiences the art without knowledge of the context in which it was created—what is lost, and is anything gained? What happens when someone like Gadsby’s audience member, who knows of the suffering behind the work, places value on the work primarily because the artist suffered?

 Gadsby’s rebuttal begets the questions of for whom art is intended and for what purpose(s) it is created. These questions are complicated by the inclusion of an artist’s personal experiences into the work and how these intimate experiences can become transactional in the entertainment value of any given work of art. Looking back on the interaction between Gadsby and the audience member, we can ponder the effects of the recognition that a work of art is rooted in illness or suffering on the audience’s reception of the work and expectations for future works. We can also consider the root of a painting’s contextual information that is often tied to an artist’s illness and suffering: why it was painted. In the commentary to come, van Gogh’s Sunflowers will be brought forward from its reference in Nanette as an example of an artwork that can allow two starkly different viewings: one produced by a uncontextualized viewing and one rooted in the narrative of van Gogh’s life at the time of its painting. I will consider the implications on the naïve viewer who learns of van Gogh’s experiences of illness tied to the painting—how does it change the way the viewer is engaged, how the art is remembered and valued, and how the viewer is implicated? From this reading, I will briefly consider the ethical relations of an audience to art created from mental illness and the role of audiences in providing beneficial witnessing to the artist. Placing ourselves in the role of a viewer who lacks any historical and orienting information about van Gogh, we can explore this revelation for ourselves.

The work is painted in a variety of yellow hues, with the color scheme only deviating in small bursts of green from the flower stems and cream on the bottom of the vase. We see a bundle of vibrant, voluptuous sunflowers in various stages of bloom; some have their petals spread widely while others have yet to open. They are all oriented in different positions, creating a sense of movement, life, and natural chaos. The absence of other accompanying objects forces the viewer’s attention upon the seemingly commonplace vase of fresh flowers. The use of almost all mustard yellow shades gives off a soft warmth, leaving the viewer with an aesthetically pleasing sense of calm. The vase might be situated within the kitchen of a country cottage or on a side table in a living room of a summer home. The vase of flowers could represent a gift between lovers or stand for the fruits of a person’s springtime efforts and labor in their backyard garden. The image, as seen for the first time, exudes a sense of growth and purity, of glowing serenity, of natural comfort, of blossoming life, of radiant warmth.

Van Gogh painted five canvasses as part of Sunflowers in Arles, a small town on the southern French coast, just west of Marseille. These canvasses are amongst his most famous works, critically appraised for demonstrating the possibility of creating an entire artistic image using primarily variations of a single color without losing any sense of eloquence or visual power. Whether or not the almost exclusive use of yellow hues is related to xanthopsia, a particularly rare side effect of the medication digoxin in which a yellow tint hazes one’s vision, can only be speculated, as van Gogh was suggested to have been taking this medication for his epilepsy (Harkup 2017). But there is more to the story of Sunflowers beyond these technical feats. In a letter to his friend Arnold Koning, van Gogh wrote that Sunflowers was painted following psychiatric hospitalization with a deliberate nod to simplicity and gratitude. For what, we may never truly know, but we can guess that it relates to his gratitude to his doctors and inner circle for caring for him through his “attack of the brain or some other fever” (van Gogh 1889). But with this new knowledge, the painting takes on a very different connotation. We see it through a new perspective, one of survival and recovery, of having been through something that threatened the painter’s sense of self and sanity and possibly redefined his entire worldview. We can imagine the vase of flowers present on a side table in a hospital room, a gift to a suffering patient from concerned family or friends. The bouquet could be the one source of hope in a place shaped by the tribulations of physical disease, relentless corporeal suffering, challenges to faith, and the shock and trauma of an untimely or gruesome death. The flowers, arranged intricately, will eventually wilt and die, cut from their stems and source of continued nutrition and life. The eminence of the flower’s short shelf life could reflect the patient’s own engagement with mortality, of knowing that the life that radiates from his own body will eventually falter, wilt, and cease to exist. This is all conjecture, but the interpretative possibilities of Sunflowers widely expand with the knowledge of when and why it was painted.

However, there is a danger present in this knowledge. Seeing the aesthetically beautiful painting, partnered with the notion that, to some degree, mental illness inspired its creation, the viewer’s mind can create (consciously or not) an association between psychic suffering and aesthetic beauty. Is there beauty to be found and recognized within experiences of illness? Absolutely. But should we then take this idea of beauty in suffering and hold artists to the expectation that we prize and applaud their suffering? That we would be remiss if they no longer suffered (with the implication that their art could potentially suffer in quality)? That art is not only for the purposes of the artist’s self-expression and therapeutic endeavor, that the audience must also be appeased, entertained, and fulfilled? These are difficult questions, ones that are not entirely theoretical. We look to popular media to see how mental illness is romanticized for emotionally intriguing storylines and narrative click bait that then fail to represent people with mental illness judiciously, a disservice not only to the misrepresented but also to those encountering stories of mental illness through media.

Media portrayals of people with mental illness have consistently and unabashedly created dramatic and distorted images of mental illness emphasizing the dangerousness, criminality, and unpredictability of people with mental illness. Stigmatizing media imagery perpetuates negative reactions to the mentally ill within the audience, including reactions of fear, rejection, derision, and ridicule (Stuart 2006). In 2000’s Wonderland, audiences are horrified to witness a man with untreated schizophrenia go on a shooting spree in Times Square and later stab a pregnant physician in her abdomen (Tartakovsky 2019). The 2019 film Joker, the origin story for DC Comics’ notorious villain The Joker, uses Arthur Fleck’s mental illness as a causal trajectory for his transformation into an unstable, unpredictable, consciously violent villain. Other recent problematic media portrayals of mental health include the depiction of teenage suicide on Netflix’s 13 Reasons Why. Notably, these portrayals almost exclusively focus on the characters’ descents into madness and the widespread damage and hurt that accompany that descent. Critical components of the mental health narrative are lost in this stereotype: resilience and recovery, survival and balance. If current media depictions are skewed toward detrimental representation, how can viewers ethically engage with mental illness that inspires artistry? Gadsby asks her audiences to take on a sense of responsibility as participants in her art form:

“All I can ask is just please help me take care of my story. Do you know why we have the sunflowers? It’s not because Vincent van Gogh suffered. It’s because Vincent van Gogh had a brother who loved him. Through all the pain, he had a tether, a connection to the world. And that…is the focus of the story we need. Connection.”

As Gadsby notes in her heartfelt conclusion to Nanette, recognition that art can arise from suffering and illness is enough to inspire ethical engagement between art and audience. Much like the man who condemned Hannah Gadsby for medicating the illness that could potentially inspire further art for his and others’ future entertainment and consumption, audiences can easily find themselves in unethical territory when engaging with art born from suffering. To return to the earlier question of the purpose of art related to an artist’s mental illness: the point is not to privilege the audience’s enjoyment, reception, and fulfillment. Audiences are secondary in this relationship, but they are indubitably important as art allows experiences to be seen. This act of seeing, of an external audience’s witnessing of an artist’s suffering—maybe this is the point of art rooted in mental illness. The power of having one’s story and experiences witnessed, along with the subsequent validation, can be instrumentally powerful for the artist. But for audiences, maybe the limit of ethical participation is simply to see the work of art. This is not seeing in a strictly literal sense but also a deeply metaphorical one that ties to Gadsby’s call for responsibility. The duty accompanying the literal seeing of the artwork implicates the audience in carrying forward a more complete story: an artist, who lived or lives with mental illness, has found a way of rendering that suffering expressively and publicly as a declaration of survival and existence. As with van Gogh’s Sunflowers, an audience can see the hope inherent to the support he had through his own mental illness experience, support that helped him to recover. Gadsby’s very public testimony to her own experiences of illness and violence force audiences to confront a world in which these things can happen and to implicate themselves in the larger systems at work. Audiences should not place demands or expectations upon the artist, for it is not their lives and vulnerabilities at stake. Rather, the stories, emotions, and humanity of the artist are implicated.

The industry surrounding art furthers the ethical complexity of how audiences engage with art tied to mental illness. As Gadsby said, “Artists are not these incredible, you know, mythical creatures that exist outside of the world. No, artists have always been very much part of the world, and very… very firmly attached to power. Always. Power and money, art is always there.” When systems of power are created in art, certain experiences, artists, and modes of expression are inevitably privileged, by design, at the expense of others. Systems of power foster right and wrong means of expression and reception. Systems of power led to the widely popularized stereotypical depiction of people with mental illness as dangerous, unruly, and unpredictable, as these characteristics were not only entertaining but hooked audiences by preying upon long-established fears and stigmas. Nanette was controversial for challenging these very systems of power, ones that historically and contemporaneously dictate the self-deprecation and self-sacrifice of artists of marginalized identities for the comfort and fulfillment of an audience. Maybe this was because of the artistic form of Nanette, in comparison to art such as Sunflowers. Van Gogh’s voice and mental illness story are less easily accessible, and thus more likely avoidable. When Gadsby was speaking her truth in real time, looking her audience in the eye, she commanded that they connect the ethical implications of comedy with their participation in her art. Eradicating the unscathed ignorance from which some of her audience may have benefited, Gadsby created space for art expressing experiences of mental illness to escape stereotyped narrative trajectories and deprecating effects on the artist and to instead create connections between artist and audience that can inspire productive change.


Gadsby, Hannah. 2018. Nanette. Netflix.

Harkup, Kathryn. “It Was All Yellow: Did Digitalis Affect the Way Van Gogh Saw the World?” The Guardian. Guardian News and Media, August 10, 2017.

Steinberg, Stanley & Joseph Weiss. 1954. “The Art of Edvard Munch and Its Function in his Mental Life.” The Psychoanalytic Quarterly 23:3, 409-423, DOI: 10.1080/21674086.1954.11925955

Stuart, Heather. 2006. “Media Portrayal of Mental Illness and its Treatments: What Effect does it have on People with Mental Illness?” CNS Drugs 20 (2): 99-106.

Tartakovsky, Margarita. “Media’s Damaging Depictions of Mental Illness.” Psych Central, March 18, 2019.

van Gogh, Vincent. Vincent van Gogh to Arnold Koning, 22 January 1889. In The Vincent van Gogh Letters, The van Gogh Museum (Amsterdam).

Author: Austin M. Hopkins is an M.D. Candidate (Class of 2021) at the University of North Carolina School of Medicine in Chapel Hill, North Carolina, and is pursuing a dual M.A. in English, concentration in Literature, Medicine, and Culture. His interests include psychiatry, incarcerated health, trauma, LGBTQ+ health, and clinical ethics. 

Image: Vincent van Gogh, Sunflowers (1888). Courtesy of The van Gogh Museum, Amsterdam, NL.

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