Hektoen International

A Journal of Medical Humanities

The madness of hunger

Sylvia Karasu
New York City, New York, USA


Erysichthon felling a tree in grove of Ceres,
16 century. Photo by CM Dixon/Print Collector/
Getty Images. Used with permission1
Erysichthon Selling his Daughter, oil
by Jan Steen, between 1650 and 1660, Rijksmuseum, Amsterdam.2
Tantalus by 16th century Swiss artist
Joseph Heintz 
the Elder, 1535. Wikimedia Commons/Public Domain3


Erysichthon was arrogant and contemptuous of the gods, so Ovid tells us in Book VIII of his Metamorphoses.1 Despite clear warnings, and acting with “pure malice,”2 he chopped down Ceres’ beloved oak. The enormous tree, closely identified with Ceres herself, groaned aloud as blood gushed from its “wounded bark.”3 Angered by such defiance, Ceres contacted Famine to bestow upon Erysichthon a ravenous, devouring, wild hunger. The more Erysichthon ate, the more he wanted, and his belly became a “bottomless abyss.”4 Now impoverished by his insatiability, he even willingly sold his own daughter. “At last when his disease became so virulent, the wretched Erysichthon then began to rend his own flesh, to bite his limbs, to feed on his own body.”5 In resorting to autophagy, he suffered the ultimate intense madness of hunger. His saga has been depicted on a sixteenth century Italian earthenware plate and in a painting by Dutch artist Jan Steen.

  Tantalus, oil painting by 17th century Italian painter Gioacchino Assereto, 1630s-1640s, Auckland Art Gallery, New Zealand.
Wikimedia Commons/Public Domain4

A more well-known Greek myth about hunger is that of Tantalus, also punished by the gods for his impudence and immortalized in Homer’s Odyssey.6 In one account, he kills his own son and serves him to the gods to test whether they can recognize human flesh. Eternal punishment in Hades follows: Tantalus becomes a tormented and starving man as the alluring fruit that dangles seductively just above his head perpetually remains beyond his grasp. Images of Tantalus have also captured the imagination of artists such as Joseph Heintz the Elder and Gioacchino Assereto, among others.

French sculptor Jean-Baptiste Carpeaux portrayed the image of a distraught man made mad by hunger in his iconic Ugolino and his Sons. Count Ugolino, an actual historical figure from Pisa whose story is told in Dante’s Inferno,7 engaged in political treachery for which he was condemned to eternal damnation. Sealed with his sons and grandsons within a tower, his sons, seeing him bite his own hands, say, “Father, it will be far less painful to us if you eat us instead of yourself.”8 Eventually, all are found dead. In Dante’s Hell we find Ugolino, in a particularly gruesome description, cannibalizing the head of the archbishop who betrayed him.9 His agony has been portrayed by Delacroix, William Blake, and Rodin as well as by Carpeaux.

A hunger artist, in Kafka’s unsettling story,10 also suffers from his own form of madness. In different times, writes Kafka, “the hunger artist engaged the attention of the whole town.”11 He sat on a bed of straw within a cage for the entertainment of paying audiences. Sometimes guards stationed around him would avert their eyes and busy themselves with their card games, but “the honor of his art” prevented the hunger artist from consuming “even the tiniest morsel.”12 When his forty days of hungering were up, the crowd would celebrate with garlands of flowers and a marching band. He lived this way for years, as he traveled with his impresario from city to city. Alas, things changed over time, perhaps when food itself actually became scarce, and there was less interest in the performance of a hunger artist. In fact, “an outright revulsion”13 against the spectacle had developed. “Too fanatically devoted to hungering,”14 and too old to consider a new profession, he took a job with a circus. His cage, though, was placed near the stables, and even he noticed that his audiences seemed more interested in making their way to observe the circus animals than to see him. Eventually, the sign on his cage was no longer legible, and no one changed the numbers on a board that once registered his days of hungering. One day, a supervisor noticed a “perfectly good cage with its rotten straw.”15 Opening the door, he found the hunger artist, pathetic and almost near death, amidst the rotten straw. “I always wanted you to admire my hungering . . . I have to hunger; I cannot do otherwise.”16

Jean-Baptiste Carpeaux’s 19th century marble statue, Ugolino and His Sons. Metropolitan Museum of Art, New York City, 1865-67.5

As in Kafka’s story, in the context of hunger, people become irrational and despairing. “All human deaths are hard to bear, but starving is the most miserable of all,” says Eurylochus in Homer’s Odyssey.17 “I would prefer to drink the sea and die at once, than perish slowly, shriveled up here . . .” he says.18 Once their food supplies run out, Odysseus’ men foolishly kill and eat the cattle of the Sun God while Odysseus sleeps. Accordingly, they are severely punished: their ship, hit by Zeus’s lightning, sinks, and all of the men drown. The gods permit only Odysseus his eventual homecoming.

Our relationship to hunger is a complex one. Metaphorically, there can be hunger for love, revenge, or even spiritual sustenance.19 Awareness of hunger can develop accurately or distortedly, and some fail to distinguish hunger from other bodily feelings of discomfort.20 Further, hunger can be “a form of communication:” when people fast for health, there is a “conversation” with the body; when they fast for religious motives, their conversation is with God; and when people participate in hunger strikes, their conversation becomes “loud, public,” and even theatrical.21

Hunger can be used for self-initiated punishment, as seen in Kafka’s hunger artist, or more specifically, in those afflicted with the potentially deadly disorder anorexia nervosa, who severely restrict their food intake, damage every organ in their body, and often deny experiencing their own hunger. It can also be used as punishment of countless millions, as when it is weaponized within totalitarian regimes. Historically, Stalin and Mao, and most recently, Kim Jong Un, have initiated deliberate policies that have led to mass starvation of their own people.22 “Hunger can be ideologically exploited, politically and ritually, as a potent symbolic idiom,” even though there may not be a “universal, cross-cultural definition of hunger . . .”23 There is, though, a universal agreement among documents asserting basic human rights, that there is a right to food and a right not to starve, but unfortunately, these are neither legally binding nor enforceable by any universal law.24

William Blake’s painting, Count Ugolino and His Sons in Prison, circa 1826, Fitzwilliam Museum, an arts and antiquities museum at the University of Cambridge, England. Count Ugolino’s fate was described in Dante’s Inferno, Canto XXXIII. Wikimedia Commons/Public Domain6

There is a continuum from hunger to malnutrition to starvation to famine. Hunger, which can occur seasonally or chronically, is a recurrent, involuntary lack of access to food.25 Starvation results when there is long-term suffering from chronic and often extreme worsening of hunger. Rarely, though, does a food supply disappear suddenly. Almost always, there occurs an initial, sustained period of decreased caloric intake that results in malnutrition and semi-starvation.26 Famine occurs when there are severe food shortages that lead to a total societal breakdown: high mortality, due to persistent starvation and the opportunistic diseases that take advantage of the body’s total debilitation, occurs.27

The effects of prolonged hunger on the body and psyche are overwhelming. Food restriction, particularly without sufficient nutrition, is more difficult to endure psychologically than abstinence from food entirely, at least for a period of time. With total fasting, there is ketosis (though not in semi-starvation), and within days hunger sensations lessen considerably, while they become “progressively accentuated with prolonged undernutrition.”28 Most people can tolerate weight losses of 5 to 10% “with little functional disorganization,” but with a weight loss of 35 to 40%, humans rarely survive.29

During the Nazi Occupation, Jewish physicians, themselves confined to the Warsaw ghetto and “condemned to die of the same disease they were studying,”30 kept detailed, surreptitious records eventually smuggled out and published much later, of the effects of the systematic mass starvation —the “gross organ changes”31 that resulted in 43,000 deaths prior to the deportations and ultimate liquidation of the ghetto.32

Eugène Delacroix, Ugolino and his Sons in the TowerOrdrupgaard Collection, Copenhagen, Denmark,1856-1860, Public Domain,
Photograph by Silvio Rogério7

Ancel Keys and colleagues, as well, meticulously documented the psychological and physical effects of food restriction in their classic Minnesota Starvation Experiment conducted during World War II.33 They found that their conscientious objectors, specifically pre-selected for their physical and psychological health, all developed a “diffuse psychoneurosis,” including “emotional instability” and depression, as they lost, on average, 24% of their body weight over a six-month period,34 despite “starving under the best possible conditions” and even knowing exactly when their “torture” would end.35 Constantly hungry, they all became obsessively preoccupied with food. Several men withdrew due to overt psychological breakdowns.36 One man, in desperation, attempted self-mutilation, including “accidentally” amputating three fingers.37

Even a preoccupation with the possibility of hunger can result in, at least in the eyes of Western civilization, its own form of madness. The Kalauna of Papua suffer from food anxiety due to historical periods of famine and drought. This small population, though, is particularly intolerant to gluttony and has an inordinate fear of a “sorcery-inflicted disease,” considered the “worst disease” of insatiable hunger, not only on individuals, but on its entire community.38

“. . . The history of man is in large part a chronicle of his quest for food,” wrote Ancel Keys and his collaborators, in the first paragraph of their two-volume opus detailing their findings on semi-starvation.39 “Hunger, or the fear of it, has always played a major role in determining the actions and attitudes of man,”40 they added. Chronic hunger, though, because of its ultimate destructive effects on mind and body, is considered the leading cause of death worldwide.41 It is a “disease of wretchedness” because starving leads to “physical degradation” and a potential for “bestial metamorphosis.”42 Just the sentiment Eurylochus had voiced in The Odyssey,43 hunger brings the “cruelest end of all deaths.”44 “Hunger is a disease that torments with slowness, a pain that endures . . . the torment of hunger forces many to cross the limits of nature, that is, to feed (even) on the bodies of people related by blood or friendship . . .”45 The madness of hunger is profound and unrelenting, and hunger’s devastating images have both repelled and fascinated us as they reverberate through art, literature, and life.



  1. Ovid. The Metamorphoses of Ovid, Book VIII, “Erysichthon.” Allen Mandelbaum, trans. (San Diego: A Harvest Book, Harcourt, Inc., 1993), pp. 277-283.
  2. Griffin, Alan H.F. “Erysichthon—Ovid’s Giant?” Greece & Rome 1986. 33(1): 55-63.
  3. Ovid, The Metamorphoses, Ibid, p. 278.
  4. Ibid, p. 281.
  5. Ibid, p. 283.
  6. Homer, The Odyssey, Book 11, “The Dead.” Emily Wilson, trans. (New York:  W.W. Norton & Company, Inc., 2018), p. 298.
  7. Alighieri, Dante. The Divine Comedy of Dante Alighieri. Charles Eliot Norton, trans. In: Great Books Edition, Volume 21, Dante, Hell, Canto XXXIII. Robert Maynard Hutchins, ed. (Chicago: Encyclopedia Britannica, Inc., 1952), pp. 49-51.
  8. Ibid, p. 50.
  9. Ibid, p. 49.
  10. Kafka, Franz. A Hunger Artist and Other Stories. “A Hunger Artist.” Joyce Crick, trans.  (Oxford: Oxford University Press, 2012), pp. 56-65.
  11. Ibid, p. 57.
  12. Idem.
  13. Ibid, p. 61.
  14. Ibid, p. 62.
  15. Ibid, p. 64.
  16. Idem.
  17. Homer, The Odyssey, Book 12, “Difficult Choices,” Emily Wilson, trans. (New York: W.W. Norton & Company, Inc., 2018), p. 312.
  18. Idem.
  19. Young, Michael W., “‘The Worst Disease:’ The Cultural Definition of Hunger in Kalauna,” pp. 111-126.  In: Shared Wealth and Symbol: Food, Culture, and Society in Oceania and Southeast Asia. Lenore Manderson, ed. (New York:  Cambridge University Press, 2010), p. 112.
  20. Bruch, Hilde. “Hunger and Instinct.” Journal of Nervous and Mental Disorders. 1969. 149(2): 91-124.
  21. Russell, Sharman Apt. Hunger:  An Unnatural History, (New York: Basic Books, A member of the Perseus Books Group, 2006), p. 73.
  22. Butterly, John R. and Jack Shepherd, Hunger:  The Biology and Politics of Starvation. (Hanover, New Hampshire: Dartmouth College Press, Published by University Press of New England, 2010), p. 4.
  23. Young, ‘The Worse Disease,” Ibid, p. 126.
  24. Butterly and Shepherd, Ibid, pp. 254; 257.
  25. Ibid, p. 28.
  26. Ibid, p. 58.
  27. Ibid, pp. 29-30.
  28. Keys Ancel; Josef Brozek; Austin Henschel; Olaf Mickelsen; Henry Longstreet Taylor. The Biology of Human Starvation. Volumes I and II. (Minneapolis:  The University of Minnesota Press, 1950), p. 29.
  29. Ibid, p. 18.
  30. Winick, Myron (ed.); Martha Osnos, trans. Hunger Disease: Studies by the Jewish Physicians in the Warsaw Ghetto. (New York: John Wiley & Sons, Inc. A Wiley-Interscience Publication, 1979.) vii.
  31. Ibid, p. xi.
  32. Ibid, p. 5.
  33. Keys et al, Ibid, Volumes I and II.
  34. Keys et al, Ibid, pp. 906-907.
  35. Kalm, Leah M. and Richard D. Semba. “They Starved So That Others Be Better Fed:  Remembering Ancel Keys and the Minnesota Experiment.” Journal of Nutrition 2005. 135(6): 1347-52.
  36. Keys et al, Ibid, pp. 880-918.
  37. Keys et al, Ibid, pp. 892-898.
  38. Young, “The Worst Disease,” Ibid, pp. 122-126.
  39. Keys et al, Ibid, p. 3.
  40. Keys et al, Idem.
  41. Butterly and Shepherd, Ibid, p. 5.
  42. Camporesi, Piero, Bread of Dreams:  Food and Fantasy in Early Modern Europe. David Gentilcore, trans. (Chicago: University of Chicago Press, 1996), p. 33.
  43. Homer, The Odyssey, Book 12, “Difficult Choices,” Ibid, p. 312.
  44. Camporesi, Ibid, (Quoting J.P. Migne, ed, Patrologia Greca, Paris, 1845), p. 27.
  45. Camporesi, Idem.


Image credits

  1. Italian earthenware plate, Erysichthon felling a tree in grove of Ceres, 16th century. Photo by CM Dixon/Print Collector/Getty Images.  https://www.gettyimages.fr/detail/photo-d’actualit%C3%A9/depiction-of-erysichthon-felling-a-tree-in-the-photo-dactualit%C3%A9/501577941#/depiction-of-erysichthon-felling-a-tree-in-the-sacred-grove-of-ceres-picture-id501577941 Used with permission. (Paid Getty Images to use image.)
  2. Erysichthon Selling his Daughter, oil painting by Jan Steen, between 1650 and 1660, Rijksmuseum, Amsterdam. Erysichthon’s hunger became so insatiable that he would do anything for food, including selling his own daughter. Wikimedia Commons/Public Domain: https://upload.wikimedia.org/wikipedia/commons/thumb/4/49/Erysichthon_verkoopt_zijn_dochter_Mestra_Rijksmuseum_SK-A-2572.jpeg/1024px-Erysichthon_verkoopt_zijn_dochter_Mestra_Rijksmuseum_SK-A-2572.jpeg
  3. Tantalus by 16th century Swiss artist Joseph Heintz the Elder, 1535. Wikimedia Commons/Public Domain: https://upload.wikimedia.org/wikipedia/commons/7/7f/Tantalus_by_J.Heintz_the_Elder%2C_1535.jpg
  4. Tantalus, oil painting by 17th century Italian painter Gioacchino Assereto, 1630s-1640s, Auckland Art Gallery, New Zealand. Tantalus was the mythological figure, with food just beyond his grasp, doomed to suffer the eternal torment of starvation. Wikimedia Commons/Public Domain: https://upload.wikimedia.org/wikipedia/commons/thumb/2/2c/Tantalus_Gioacchino_Assereto_circa1640s.jpg/1024px-Tantalus_Gioacchino_Assereto_circa1640s.jpg
  5. Jean-Baptiste Carpeaux’s 19th century marble statue, Ugolino and His Sons. Metropolitan Museum of Art, New York City, 1865-67. Public Domain: Credit line: Purchase, Josephine Bay Paul and C. Michael Paul Foundation Inc. Gift. Charles Ulrick and Josephine Bay Foundation Inc. Gift, and Fletcher Fund, 1967. Here treasonous Ugolino is seen with his hands in his mouth that prompts his children to suggest that he eat them rather than himself as they are all about to starve to death in a locked tower. https://upload.wikimedia.org/wikipedia/commons/thumb/c/cd/Ugolino_and_His_Sons_MET_DP247545.jpg/1024px-Ugolino_and_His_Sons_MET_DP247545.jpg
  6. William Blake’s painting, Count Ugolino and His Sons in Prison, circa 1826, Fitzwilliam Museum, an arts and antiquities museum at the University of Cambridge, England. Count Ugolino’s fate was described in Dante’s Inferno, Canto XXXIII. Wikimedia Commons/Public Domain: https://upload.wikimedia.org/wikipedia/commons/1/1d/William_Blake_-_Count_Ugolino_and_his_sons_in_prision.jpg
  7. Eugène Delacroix, Ugolino and his Sons in the Tower. Ordrupgaard Collection, Copenhagen, Denmark,1856-1860, Public Domain, Photograph by Silvio Rogério: http://warburg.chaa-unicamp.com.br/img/obras/display_image-(6)-9.jpg



SYLVIA R. KARASU, MD, is a Clinical Professor of Psychiatry at Weill Cornell Medicine and a member of the Institutional Review Board of The Rockefeller University. The senior author of The Gravity of Weight (2010) and The Art of Marriage Maintenance (2005), Dr. Karasu is a cum laude graduate of the University of Pennsylvania and has her M.D. degree from Einstein College of Medicine. She is a Distinguished Life Fellow of the American Psychiatric Association, a graduate of the New York Psychoanalytic Institute, an elected Fellow of the New York Academy of Medicine, and in private psychiatric practice in NYC.


Highlighted in Frontispiece Volume 11, Issue 1– Winter 2019

Summer 2018  |  Sections  |  Food

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