Paul Gachet, born in Lille in 1828, had studied for a BA at the University of Paris and earned his medical degree for his thesis 'Etude sur le Melancolie' in 1858 after working in two mental institutions at Bicêtre and the Hôpital Salpetrière, The famous French physician Philippe Pinel (1745-1826) had been medical director at both hospitals where he had introduced what became known as ‘moral treatment or therapy’ based on a psychological interpretation of the patient’s symptoms. This enlightened approach to the mentally ill led to the removal of restraints such as chains and straitjackets that had been commonly used in the asylums. Also banished were the dubious practices of bleeding, purging and blistering. In their place, Pinel recommended a therapeutic relationship that involved close contact with and constant observation of patients. He visited them every day, took extensive notes and tried to determine the natural history of their condition. Previously, the understanding of mental health problems was very limited. Anyone deemed to be insane or a threat to society was likely to be locked up in an asylum built at some distance from the city centre.
The topic of Gachet’s thesis on ‘melancolie’ suggests that he had already developed an interest in nervous disorders as a young doctor, perhaps influenced by Pinel’s humanitarian approach. However, he also worked as a front line doctor with the National Guard during the Prussian siege of Paris in 1870, a brave and risky enterprise in which his surgical skills would have been tested. Gachet moved to Auvers-sur-Oise from Paris in 1872 in the hope that the country air would benefit his wife who was suffering from tuberculosis, a common and often fatal disease at the time. Sadly she died in 1885, a major loss that Van Gogh suggested had partly caused his friend’s low mood and sad demeanour, evident in both of his portraits of Gachet.
It is not clear when Gachet developed an interest in homeopathy, but this would not have been uncommon in the late nineteenth century when there were very few effective remedies available to treat common diseases. In Auvers, he apparently grew several medicinal herbs in his garden. An amateur artist, painting under the pseudonym Paul van Ryssel, he met and treated several famous impressionist artists including Renoir, Pissarro, and Cezanne, even teaching anatomical drawing to a young Georges Seurat.