A clinical look behind the self-portraits of Antonio Ligabue

Art lovers, historians, and mental health professionals have endlessly speculated about what psychiatric disorders famous painters might be diagnosed with today and how their mental dis-tress seems to have influenced their life and career. However, very limited analysis is available about the Italian painter Antonio Ligabue (1899-1965). This “psychological autopsy” has been based on the review of his biography, paintings, exhibitions, and personal scripts. It reconstructed a hypothetical illness trajectory originating from an autism spectrum disorder, possibly exacerbated by comorbid health conditions, social exclusion, poor caregiver support, and stressful life events, culminating in multiple hospitalizations for affective dysregulation and aberrant behavior. The present “cold” case report suggests that Antonio Ligabue’s mental difficulties may need to be looked at under a neurodevelopmental perspective encompassing autism, a condition very much underrecognized during his lifetime.

Article

No one would argue that the Italian painter Antonio Ligabue suffered from a severe mental disorder, possibly exacerbated by unmatched traumatic events. At 18, a few years after her mother and stepsiblings’ death, according to him at the hands of his adoptive father, he started getting in and out of psychiatric hospitals, first in Switzerland and later in Italy. His life was dotted with abandonments, from people – his adoptive mother denounced his wanderings – to institutions – the Swiss Confederation expelled him. As a young adult sent to Italy, he was escorted by law enforcement to a beggars’ hospice and later found living in the woods like a savage. In less than 10 years, he was admitted to a psychiatric hospital three times, the last time for three years. He got some recognition for his artistic work only in the last years of life and died at 65 at the same hospice where he was welcomed as a teen, after being stricken by a paralysis (https://museorevoltella.it/antonio-ligabue/).

Seventy years after his last discharge from the Italian psychiatric hospital, his medical records have been made public, revealing a first diagnosis of depressive syndrome (1937) and a second diagnosis of manic-depressive psychosis (1940 and 1945), today known as bipolar disorder. Even though some evidence of agitation and logorrhea occurred during the second admission, and aggressive behavior led to the third one, psychiatrists examining his medical records found some symptoms conflicting with such a diagnosis, including being considered mentally deficient, presenting with persecutory ideas, and self-mutilating his nose (https://www.gazzettadireggio.it/video/locale/reggio-emilia-le-cartelle-cliniche-di-antonio-ligabue-ecco-perche-il-pittore-finiva-in-manicomio/105297/105789). Some authors have suggested that his impossibility to integrate into society and his aberrant behavior as well as his aggressiveness and self-harm would orient to a diagnosis of borderline personality disorder ¹.

Acknowledging the difficulty of making a correct post-hoc diagnosis, especially based on partial clinical information, we believe that paying a visit to one of the art exhibitions dedicated to his work and his life (https://museorevoltella.it/antonio-ligabue/) may help reaching a different conclusion, that is a diagnosis of autism spectrum disorder (ASD), whose diagnostic construct would have become clearer only much later ². In terms of DSM-5 diagnostic criteria ³, for criterion A, it is almost sure that his social approach was atypical, that he struggled to share interests, emotions, and affect, that lived isolated, without having friends or romantic relationships, showing aggressiveness and possibly inefficient communicative behavior leading to hospital admissions. He enjoyed animal companionship more than human beings, possibly reflecting his difficulty in developing, maintaining, and understanding relationships. Coming to criterion B, he had a highly restricted and fixated interest that made him a “painter of animals”, with all his initial activity devoted to this subject. He insisted on sameness, with 123 self-portraits, very similar to each other, documented in almost 40 years of activity. Despite being very poor, he owned 11 motorcycles of the same brand and, possibly, color, for which he had rituals and preoccupations, bringing along red paint to meticulously cover scratches; he intensely focused on Beethoven’s fifth symphony; he was intolerant of coughing, perceiving a total blockage making him perform strange exorcising rites, sounds, and screams, possibly denoting stereotypies (https://museorevoltella.it/antonio-ligabue/). ASD is associated with significant healthcare expenditures and a greater utilization of psychiatric health services, especially in those with depression (his first diagnosis), comorbid health conditions (he suffered from rickets and difficult growth), issues with adaptive functioning (he was socially excluded) and caregiver support (absent in his case), and exposed to stressful life events (as he was) ^4-6, thus being entirely consistent with Ligabue’s history of multiple hospitalizations.

Did his autistic traits enabled him to function as a painter as well as he did, in the face of the tremendous life events that happened to him? Like Antonio Ligabue, we all try to play with the cards that life hands us. Some “symptoms” or ways of being in the world would let us result dysfunctional in one context, but very adaptive and appropriate in another. This is one of the lessons that Ligabue is still teaching us.

Conflict of interest statement

The authors declare no conflict of interest.

Funding

This research received no external funding.

Ethical consideration

Not applicable.

Authors contributions

Conceptualization, M.C. and R.C.; methodology, M.C. and R.C.; validation, M.C. and R.C.; investigation, M.C. and R.C.; resources, M.C. and R.C.; writing—original draft preparation, M.C. and R.C.; writing—review and editing, M.C. and R.C.; visualization, M.C. and R.C.; supervision, M.C.; project administration, M.C. Both authors have read and agreed to the published version of the manuscript.