His early career was devoted to directing television commercials in the Pacific Northwest. In his films, he has dealt with themes concerning homosexuality and other marginalized subcultures.
His filmography as writer and director includes an adaptation of Tom Robbins' novel Even Cowgirls Get the Blues, which features a diverse cast (Keanu Reeves, Roseanne Barr, Uma Thurman, and k.d. lang, with cameos by William S. Burroughs and Heather Graham, among others); and My Own Private Idaho, also starring Reeves as well as River Phoenix (Van Sant also planned to direct a biographical film about Andy Warhol with Phoenix in the lead role, but canceled the project after Phoenix's death).
He wrote the screenplays for most of his early movies, and wrote one novel, Pink. A book of his photography has also been published, called 108 Portraits.
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