The great Mexican painter Frida Kahlo (1907-1954) is without doubt one of the most intense and emotive artists of the twentieth century. Frida's life changed dramatically at the age of 18, when she was involved in a terrible accident. A streetcar violently impacted the bus in which she was riding. She suffered multiple bone fractures, including the third and fourth lumbar vertebrae, and had a deep abdominal wound inflicted by a metal rod. She was confined for several months in a plaster corset. From that time on, Frida suffered severe, widespread pain and profound fatigue. Generalized pain and exhaustion lingered with her for the remainder of her life (1-5).

Through the years, a variety of diagnoses were offered to explain her chronic illness, such as tuberculosis and syphilis, that were later ruled out. She received diverse types of treatments, including medications and long periods of confinement in a metal or plaster corset. In efforts to relieve her pain, she underwent several orthopedic operations on her spine, both in Mexico and in the United States, without improvement in her symptoms.

Despite her debilitating illness, Frida was engaged in an active social life. She had a tempestuous marriage to the famous Mexican muralist Diego Rivera. She traveled extensively and had relationships with the world leaders and artistic personalities of her time. Frida began painting after her accident. During periods of immobilization in a plaster corset, she used a special easel, and a mirror was attached to the canopy of her bed so that she could focus on herself. Although her painting skills were largely self-taught, she was also acquainted with the traditional schools of painting. Both in her oeuvre and in her customs, she looked back with devotion to her Mexican roots. The Surrealists claimed her as one of their own. The stillness of her self-portraits reflects the influence of her father, who was a photographer (3).

Frida used to describe her own paintings as "the most frank expression of myself" (1). Her self-portraits are impassioned. Anguish and pain are the common themes of her work. These emotions are dramatically expressed in her oil painting, "The Broken Column (see picture on left). As Hayden Herrera observed, Frida's determined impassivity creates an almost unbearable tension. Pain is made vivid by nails driven into her naked body. A gap resembling an earthquake fissure splits her torso. The opened body suggests surgery. Inside her torso, we see a cracked ionic column. The corset's white straps accentuate her beautiful body. Her hips are wrapped in a cloth suggestive of Christian martyrdom. She stares straight ahead with dignity. Tears dot her cheeks, but her features refuse to cry. An immense and barren plain in the background conveys physical and emotional suffering (1).

To explain Frida's chronic illness, we offer an alternative diagnosis. Our opinion is that she suffered posttraumatic fibromyalgia. This prevalent syndrome is characterized by persistent widespread pain, chronic fatigue, sleep disorders, and vegetative symptoms, and by the presence of tender points in well-defined anatomic areas (6,7). The concept of fibromyalgia as a clinical entity as we know it today was probably unknown to most physicians of the early twentieth century. Our diagnosis explains her chronic, severe, widespread pain accompanied by profound fatigue. It also explains the lack of response to diverse forms of treatment. The onset of fibromyalgia after physical trauma is well-recognized (8).

A drawing in Frida's diary reinforces our diagnostic impression (9). She depicts herself in pain, and 11 arrows point to anatomic sites that are near the conventional fibromyalgia tender points (6). Of course, because fibromyalgia is an illness without anatomic sequelae, our contention cannot be proven or disproven. What appears certain is that Frida's self-portraits convey widespread pain and anguish with the emotional overtones that fibromyalgia patients frequently use to describe their illness.

We are indebted to Dr. Leonardo Zamudio, who allowed us to have access to Frida Kahlo's medical records, to Ms Dolores Olmedo, who gave permission to reproduce "The Broken Column," and to Dr. Robert Kalish, who kindly reviewed the manuscript.

Manuel Martinez-Lavin, MD, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico

Mary-Carmen Amigo, MD, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico

Javier Coindreau, MD, Instituto Nacional de Cardiologia Ignacio Chavez, Mexico City, Mexico

Juan Canoso, MD, American British Cowdray Hospital, Mexico City, Mexico

REFERENCES
 

1. Herrera H. Frida: a biography of Frida Kahlo. New York: Harper Row; 1983.

2. Tibol R. Frida Kahlo: una vida abierta. Mexico City: Universidad Nacional Autonoma de Mexico; 1998.

3. Zamora M. Frida Kahlo: the brush of anguish. San Francisco: Chronicle Books; 1990.

4. Monsivais C. Vazquez-Bayod R. Frida Kahlo: una vida, una obra. Mexico City: Conaculta; 1992.

5. Del Conde T. Frida Kahlo: la pintora y el mito. Mexico City: Universidad Nacional Autonoma de Mexico; 1992.

6. Wolfe F, Smythe HA, Yunus MB, Bennett RM, Bombardier C, Goldenberg DL, et al. The American College of Rheumatology 1990 criteria for the classification of fibromyalgia: report of the multicenter criteria committee. Arthritis Rheum 1990; 33:160-72.

7. Martinez-Lavin M, Hermosillo AG, Rosas M, Soto M-E. Circadian studies of autonomic nervous balance in patients with fibromyalgia: a heart rate variability analysis. Arthritis Rheum 1998; 41:1966-71.

8. Buskila D, Neumann L, Vaisberg G, Alkalay D, Wolfe F. Increased rate of fibromyalgia following cervical spine injury: a controlled study of 161 cases of traumatic injury. Arthritis Rheum 1997; 40:446-52.

9. Freeman P. Frida Kahlo: Diario: autorretrato intimo. Mexico City: La Vaca Independiente; 1995.