The film then cuts to scenes that take place in the period from 1883 through 1891, commencing with Vincent van Gogh's decision to work exclusively as an artist, and concluding with his death and that of his brother Theo a few months later.

The film is a double portrait of both men; Noel Murray has summarised this aspect, "Altman and screenwriter Julian Mitchell contrast Theo's life—which mostly consists of him guiding rich people through galleries and selling them paintings he despises—with Vincent's gradual development of his own voice and style, through hard physical labor.

Vincent & Theo also shows both men as warped by a similar madness, torn between their lusts for sex and alcohol, and their yearnings for social respectability and religious connection.

... Vincent & Theo is less concerned with stockpiling facts than canvassing an accumulation of insights through the crafting of a time, place, and mood that allows the van Goghs to leap out of history in all their ungainly glory.

Noel Murray wrote in 2015, "Altman's production-designer son Stephen—the unsung hero of his later films—could almost be credited as the co-author of Vincent & Theo for how well he recreates late-19th-century Europe in both its tactile grime and its old world quaintness.

[7] Several critics have remarked favourably on his "compulsive", "vexing" score that "finely underscores the underlying testy dynamics of living only for art.

"[18] In 2015 Noel Murray wrote, "Vincent & Theo masterfully illustrates the way artists enjoy the power to transform real life into a thing of beauty.

"[4] Reviewers have commented on the successes of Tim Roth and of Paul Rhys in their roles as Vincent and Theo van Gogh.

An unsigned review in Variety noted "Tim Roth powerfully conveys Vincent's heroic, obsessive concentration on his work, and then resultant loneliness and isolation.

"[19] The same reviewer wrote "Paul Rhys skillfully inhabits a character even more wretchedly unhappy than his brother, who at least has the consolation of his art, and Theo’s own incipient madness gives the film much of its unsettling tone."

Desson Thomson wrote, "As Vincent, Tim Roth is, without a doubt, the best thing about this movie ... presents a soft-souled, black-toothed, endearingly tormented artist, willing to take his work as far as it can go.

"[20] Roger Ebert wrote "here is Robert Altman's Vincent and Theo, another film that generates the feeling that we are in the presence of a man in the act of creation.

"[23] Roger Ebert wrote of "a remarkable scene in a field of sunflowers, where, as van Gogh paints, Altman's camera darts restlessly, aggressively, at the flowers, turning them from passive subjects into an alien hostile environment.