In May 1889, Vincent left Arles for an asylum in St. Remy of his own accord, accompanied by Reverend Salles from Arles. He was given a studio there in addition to his room, and he was allowed to paint outdoors, where he worked on pictures of the wheat fields, cypress trees, and olive orchards. Over the course of the first summer months in St. Remy, van Gogh completed two of his most famous masterpieces, Irises and the complex stylistic departure of the preternatural atmospheric landscape The Starry Night. Vincent spent his time at the asylum (almost exactly one year) painting landscapes of the hospital grounds (Window of van Gogh's Studio in the Asylum) and portraits of patients and attendants (notable is his powerful portrait of the head attendant, Portrait of Trabuc, from the fall), hoping to achieve a cure for his condition. He suffered periodic episodes of hallucination, breakdown, and seizure, with increasingly debilitating attacks in July, December, January, and February, during which times he was confined indoors. At least two of these episodes were triggered by supervised visits to Arles to see his friend Madame Ginoux. Vincent occasionally ate his paint during his fits, which only made him sicker and resulted in the temporary confiscation of his materials. It sometimes took up to a month to fully recover and regain the frenetic momentum of his work, which of course only led to another breakdown, but he seemed to have accepted the reality and the inexorability of his disorder, claiming that he was "losing the fear of the thing" (L 591).
In September, his work was requested for the "Les XX" ("The Twenty") exhibition of post-Impressionist artists in Paris, and although his Irises and Starry Sky were well received at the fifth Artistes Independents show, his interest in refining his portraits grew. In the fall he wrote Theo that he was "working like one actually possessed... in a dumb fury of work" (L 604), and during this period he was working on some of his most famous and most revealing self-portraits, including Self-Portrait, September 1889, Self-Portrait with Clean-Shaven Face, 1889, and Self- Portrait, 1889–90, in which his neurotic patterning and texturing reached its mature pinnacle. He was quickly arriving at his goal of portrait- making as icon or apparition, the spiritual or emotional ghost of the subject and the painter alike. His landscapes were also attaining a kind of transcendent, supernatural presence through their nervous, angular graphic energy and their increasingly potent colors, as in The Road Menders, Rain, Entrance to a Quarry, and Road with Cypress and Star.
Vincent was strangely outraged by his first taste of publicity–a quite positive mention of his work at the Paris World Fair in October 1889–and in December he had suffered a serious relapse and had begun to mention thoughts of suicide to his attendants. His work at the "Les XX" exhibit in Brussels aroused much interest from the public, and one painting even sold in February 1890 for four hundred francs. The same month a glowing review of Van Gogh's work alone by Albert Aurier was published, and Vincent was overwhelmed with gratitude and hopefulness, but after a return visit to Madame Ginoux in Arles he was once again incapacitated. In March 1890, ten of his paintings were exhibited at the next Artistes Independents show, and Monet claimed that Vincent's work was the finest in the entire exhibition. During the final weeks in St. Remy, Vincent made spiritually-charged copies of Rembrandt's The Raising of Lazarus and of Delacroix's Pieta. He was excited to leave, but conscious that he had "more ideas in [his] head than [he] could ever carry out, but without it clouding [his] mind" (L 630). In May 1890, Vincent finally left the St. Remy asylum and visited Theo and his new wife and baby son, named Vincent Willem, for whom Vincent had painted the celebratory Blossoming Almond Tree. He had desired to leave the asylum for months, but the move was contingent on Theo making arrangements with a Dr. Gachet to supervise Vincent while he stayed at the Auberge Ravoux inn in Auvers-sur-Oise, a town north of Paris.