Crazy as mudbugs on a hot griddle. Or was he?
What if that famous incident actually had more to do with hunger and malnutrition than with mental illness?
“Great art is not made on a full stomach,” proclaimed British journalist Jonathan Jones in his May 17, 2003 article in The Guardian, “Painting on Empty.” Jones takes his readers on a tour through history, visiting artists like Paul Gauguin, Joan Miró, and—of course—Vincent van Gogh. Miró frankly admitted that hunger was his muse: “Hunger was a great source of hallucinations. I would sit for long periods looking at the bare walls of my studio trying to capture these shapes on paper or burlap.”
As popular myth has it, many are the starving artists and writers throughout history whose odd personalities made them appear possessed, ridden by demons and riven by nightmares.
The timeless stereotype of the mad artist persists. For example, Norwegian writer Knut Hamsun’s novel, Hunger, the myth lives on in his tormented protagonist, a starving writer.
As with all stereotypes, a certain degree of truth lurks behind the generalization.
What many people don’t realize is that Vincent van Gogh, who died a suicide in 1890, spent most of his adult life in a state of semi-starvation. This is obvious from his countless letters to his brother, Theo, an art dealer in Paris, working for Goupils & Co. The majority of Vincent’s letters catalog his illnesses and his hunger—both physical and mental—in painful, even excruciating detail.
Today, most psychiatrists would diagnose van Gogh’s mental illness as a probable form of epilepsy—specifically temporal lobe epilepsy. Others might suggest that Vincent’s illness falls more into the diagnosis of a bipolar disorder, as Kathleen Powers Erickson and others suggest. In general, analyses of his erratic behavior focus very little, if at all, on his starved state as a possible trigger for his epileptic attacks and depressions or simply as an underlying causative factor for his somewhat unusual behavior between attacks. Few experts discuss specifically the effects of long-term starvation in relationship to van Gogh’s behavior and his art. Only one expert, Wilfred Arnold, in his Vincent van Gogh: Chemicals, Crises, and Creativity, examines van Gogh’s life from a rigorous all-encompassing medical point of view. Arnold concluded, among other things, that van Gogh’s habit of licking his brushes clean might have caused lead poisoning, since he used lead-based paints.
Looking at van Gogh’s character through the prism of hunger is intriguing. Beneath van Gogh’s sheer, overwhelming poverty was an underlying text of religious asceticism, associated with fasting, similar to that which he practiced during his time as an evangelical lay preacher in the Borinage mining area of central Belgium. There, he gave away most of his clothes, his belongings, and much of his food to the poor miners of the area.
Vincent told Theo in 1880, “You must not imagine that I live richly here [Brussels], for my chief food is dry bread or some potatoes or chestnuts which people sell here on the street corners, but by having a somewhat better room and by occasionally taking a somewhat better meal in a restaurant whenever I can afford it, I shall get on very well. But for almost two years I have had a hard time in the Borinage – it was no pleasure trip, I assure you.”
Examining starvation in an individual is not an easy task, for without body measurements, food recall questionnaires, or any of the other standard tools that nutritionists use to measure nutritional status, accuracy may not be attainable. However, enough tantalizing clues exist in van Gogh’s letters and in contemporary accounts to suggest that his near-chronic state of semi-starvation affected him more than has been recognized.
According to a classic study of human starvation, performed by Ancel Keys at the University of Minnesota in the 1940s, food deprivation impacts greatly on human behavior, beyond the usual marker of weight loss. A careful examination of van Gogh’s comments in his letters and a comparison of these with the results of Keys’s controlled study, and other commentaries on starvation and behavior, prove eye opening.
Just what is starvation? How do doctors and nutritionists define the process?
Starvation is the lengthy and continuous deprivation of food, a condition in which the absence of food forces the body to feed on itself. Causes of starvation include famine or other food shortages, war, fasting, systemic illness, or abnormalities of the mucosal lining of the digestive system.
No matter where in the world—or when in history—the human body needs at least two things in order to survive, to prevent and surmount starvation. Those two things are adequate nutrient intake—protein, vitamins, minerals—and sufficient energy to spare the protein in the diet and to make sure that the brain, which uses only glucose, is well supplied without metabolizing any protein intake. [Without enough calories in the diet, the body begins to catabolize—or break down—muscle mass into the energy necessary for the body to function. If enough calories exist in the diet, this breaking down of protein does not occur.]
In the 1940s, when Ancel Keys studied the effects of starvation on 36 young men, all completely healthy both mentally and physically, he worked with subjects registered as conscientious objectors during World War II, providing them with a diet very low in calories. It is unlikely that any such study could ethically be carried out today, because of restrictions on the use of human subjects in medical research. For that reason, Keys’s study is all the more important. The Keys study allows scientists and others to learn about starvation in a controlled situation, rather than by extrapolating data from the so-called “natural” starvation that results during conditions of famine and war. And since the mental health of Keys’s potential subjects was also tested via standard tools, with only the most mentally stable men allowed into the study, psychological testing eliminated the potential variable of pre-existing mental illness.
Exactly what happens physiologically in starvation, other than the expected weight loss?
First to be lost are fat deposits and large quantities of water. The liver, spleen, and muscle tissue then sustain the greatest loss of weight. The heart and brain show little loss proportionately. The starving person becomes weak and lethargic. Body temperature, pulse rate, blood pressure, and basal metabolism continue to fall as starvation progresses, and death eventually ensues, unless feeding resumes.
Essentially a starving person moves from what medical jargon terms “positive nitrogen balance” to “negative nitrogen balance.” In other words, the body begins to catabolize, or break down, protein in the muscles, as mentioned above. Then, as the body seeks an energy source for the nervous system, primarily the brain, the body begins to burn fat. Although body fat cannot be broken down to glucose and thus provide a source of “food” for the brain, by breaking down fatty acids, which make up body fat, the body can, however, convert glycerol (with its three carbons) to glucose. But this is a very insufficient and inefficient source of energy. A starving person then goes into ketosis, which essentially means that an excessive amount of ketone bodies are circulating in the blood and present in the urine. Negative aspects of long-term ketosis include kidney damage, among others. (Ketone bodies result from the breakdown of fats.) This scenario accounts for the continuing craze for low-carbohydrate diets; people go into ketosis, after losing a large amount of weight at the beginning—chiefly water weight and lean tissue mass, which is rapidly regained when re-feeding occurs, as Keys discovered in the post-starvation part his study.
In the beginning, some of the typical physical symptoms of the starving subjects in Keys’s study included fatigue, muscle soreness, and hunger pangs. Then the following symptoms appeared with regularity:gastrointestinal discomfort, dizziness, decreased need for sleep, hypersensitivity to light and noise, headaches, fainting, hair loss, poor motor control/clumsiness, decreased cold tolerance, visual disturbances (inability to focus, eye aches, “spots”), auditory disturbances (ringing in the ears, one reason many give for van Gogh cutting off his ear), and paresthesia or tingling in the hands and feet. According to Keys, one of the most noticeable symptoms turned out to be extreme emaciation in the face. Keys emphasized that these symptoms illustrate the extremes to which the body will go to preserve and produce energy for the brain’s continued functioning.
A close reading of van Gogh’s letters reveals that van Gogh, at various times, endured almost exactly the same physical symptoms as did Keys’s subjects.
For example, Van Gogh suffered from dizziness, usually while out in the open painting, a symptom that could likely been a result of his hunger and excessive intake of caffeine. And in examining van Gogh’s self-portraits, 37 paintings and four drawings, facial emaciation is quite apparent 
How do the adaptive processes described by Keys affect human behavior? In other words, how does a person living with an inadequate amount of food, or in a state of outright starvation, relate to his or her world?
Keys’s subjects displayed irritability and frequent outbursts of anger, consistent with behavior demonstrated by van Gogh. Three months into the study, Keys’s subjects experienced a lack of ambition and self-discipline; poor concentration; moodiness and depression, followed by periods of elation; diminished ability to laugh, sneeze, or blush; and decrease in muscle tone and strength. Reduced alertness and increased clumsiness, together with impaired comprehension and judgment, tended to be problems among Keys’s subjects. Van Gogh encountered problems of this sort, too.
But on tests of mental agility and intellectual ability, Keys’s subjects did not exhibit any changes. This could account for van Gogh’s continued ability to write and paint as well as he did, even when he committed himself to the insane asylum in Saint-Rémy in 1889.
Preoccupation with food is another common characteristic of people deprived of food over a long period of time. Keys’s subjects spent much time collecting recipes, reading cookbooks, and buying kitchen equipment.
And van Gogh’s paintings and drawings often took on the subject of starvation indirectly, attesting to his ongoing preoccupation with food. His painting, The Potato Eaters , is only one example of food as a “model” for him. Other van Gogh paintings, chiefly of the cafés and bars of the places he lived, still lifes with food—such as the Japanese-print-inspired still life of quinces, lemons, and grapes—coffee, and even people tilling the soil suggest that food and eating never strayed very far from his consciousness.
Anxiety, such as their preoccupation with food, and general apathy became problems among Keys’s subjects. Van Gogh’s doctor, Dr. Peyron, wrote that van Gogh was “a victim of terrible anxieties.” And Vincent remarked in many of his letters to Theo that anxiety seemed to be a constant companion to him.
Isolationist and withdrawal proclivities, as well as anxiety, emerged as the men in Keys’s study moved further into starvation mode. Van Gogh manifested an inclination toward isolationism and withdrawal throughout his life, as he wrote to Theo: “Except for Sien [a prostitute with whom he lived for a while], her mother, and for Father, I have not seen anybody, which is indeed for the best, though the days are rather lonesome and melancholy. Involuntarily I often think how much more gloomy and lonesome things are now than, for instance, when I went to Mauve [a cousin, another artist] for the first time this winter. It stabs me to the heart and depresses me whenever I think of it, though I try to throw the whole thought overboard like useless ballast.” And another time, Vincent said, “Often whole days pass without my speaking to anyone, except to ask for dinner or coffee. And it has been like that from the beginning. … But up to now the loneliness has not worried me much because I have found the brighter sun and its effect on nature so absorbing.”
In addition to isolationist leanings, sleeplessness tormented the subjects of Keys’s study. Van Gogh also apparently wrestled with insomnia, we may conjecture, as so many of his paintings depict starry skies and the nightlife of various cafés. Often he must have painted or, at the least, observed his subjects at night. In a letter from 1889, he told Theo, “What is to be feared most is insomnia, and the doctor has not spoken about it to me, nor have I spoken of it to him either. But I am fighting it myself.” 
Fatigue, and not just insomnia, plagued Keys’s subjects during the entire period of the study. Like them, Van Gogh constantly complained of fatigue and a lack of strength in his letters to Theo. Considering that he was a relatively young man, in his 30s at the time of his death, these complaints suggest more than just hypochondria.
Besides insomnia and fatigue, several of Keys’s subjects experienced periods of sulking, unpredictable fits of anger, and petty attacks of pique. Two of Keys’s subject even committed acts of self-mutilation. One young man deliberately let a car he was working on fall on his hand, severing three of his fingers in the process. This young man tested psychologically normal prior to the study. Such behavior raises provoking questions about van Gogh’s own self-mutilation tendencies, similar to the outburst that led van Gogh to quarrel with Paul Gauguin and then slash off his own ear.
Moodiness and depression pepper van Gogh’s letters, too. At age 28 he had this to say about his propensity toward depression: “But I am so angry with myself now because I cannot do what I should like to do, and at such a moment one feels as if one were lying bound hand and foot at the bottom of a deep, dark well, utterly helpless.”
One particularly interesting observation was the tremendous increase in coffee and tea consumption among Keys’s study subjects, something they did to keep their stomachs full. Similarly, van Gogh consumed vast amounts of coffee. At one point, he wrote that he’d had only a few crusts of dry bread and 23 cups of coffee over a four day period. Perhaps the coffee drinking played dual roles. Firstly, as in the high Andes, where the people use coca—a substance with stimulatory properties—to keep themselves working despite chronic hunger, van Gogh used coffee for the same reason. And for van Gogh, another role for coffee may have been the effect of the caffeine on his imagination, a hint of the visionary, almost mystical, state that his caffeine addiction stimulated in him.
Like the subjects in Keys’s study, van Gogh often complained of stomach problems, including nausea. One of the side effects of starvation is the breakdown of fats (resulting in ketosis, as explained above), which produces nausea. He blamed “filthy wine and greasy steaks” in Paris for some of his stomach problems. [Excess coffee drinking and alcohol intake, in the case of his addiction to absinthe, might also have caused his stomach problems.]
Just how starved were the men in Keys’s study? The Keys study diet strove to reproduce the dietary conditions prevalent in war-torn Europe at that time. The total number of calories provided to the men in Keys’s study was 1,570 per day. Two meals a day—consisting primarily of whole-wheat bread, potatoes, grains, turnips, and cabbage—provided their only food. Meat and dairy products rarely graced their table. The subjects continued their normal daily activities, including work.
Typical meals for van Gogh included much the same types of food, with bread and coffee predominating, and with perhaps an occasional onion or small piece of meat. Vincent remarked on eating bread and drinking coffee many times in his letters. Depending upon just how much bread he actually ate, on many days van Gogh was not even close to reaching his nutritional requirements. One pound of black bread provides approximately 1,160 calories, depending upon the type and composition of the flour and other additions to the dough. Van Gogh mentioned eating black bread, so using that as a model, on a typical “bread” day, van Gogh’s caloric intake might have reached 1,160 calories or less. A so-called normal man between the ages of 31 and 50—with an average activity level—requires 2,800 calories, in addition to a number of essential micronutrients, found primarily in vegetables, grains, nuts, and dairy products.
Van Gogh’s other major source of nourishment seems to have been wine or absinthe, which respectively provide 75 calories per 3.5 ounces and 103 calories per ounce. Ship’s biscuits, each probably yielding 25 calories and mixed with milk and eggs, which don’t provide many micronutrients, apparently formed the bulk of van Gogh’s diet from time to time. Gifts of olives from his friends, the Ginoux family, no doubt provided him with much nourishment when he lived in Arles; he made many comments concerning Provence’s olive trees and their beauty in his letters to Theo. For example, Vincent wrote, “Oh, my dear Theo, if you saw the olives just now…The leaves, old silver and silver turning to green against the blue. And the orange-coloured ploughed earth. It is something quite different from your idea of it in the North, the tender beauty, the distinction!” [Olives, rich in fat, generate about 225 calories per1/2 cup or nearly 15-20 olives.]
A surprising aftereffect of starvation surfaced once the state of starvation ended and hunger was no longer a problem for the subjects in Keys’s study. The subjects still faced problems with eating and with food in general. Van Gogh alludes to his difficulties with this problem in a letter to Theo on December 28, 1888, when he said, “I’ve discovered that my appetite has been held in check a bit too long and when I received your money I couldn’t stomach any food.” For months after the study ended, Keys’s subjects continued to horde food and suffersome physical discomfort after eating, including stomach cramping.
Van Gogh constantly spiced his letters with comments about food. As he said in one of his last letters to Theo, “I feel so strongly that it is the same with people as it is with wheat, if you are not sown in the earth to germinate there, what does it matter? –in the end you are ground between the millstones to become bread.”
In Arles, especially after he committed himself to the insane asylum in Saint-Rémy in 1888, Van Gogh grew more aware of the symbiotic relationship existing between good diet and good health, or “sanity,” as he called it. At Mme. Venissac’s restaurant in Arles, he willingly paid 1 franc a day for better food, so great was his desire to avoid another nervous attack. Absinthe (la fée verte—with its seductive greenness— and alcoholism possibly played a role in Vincent’s bizarre behavior, so toward the end of his life, he tried to limit his drinking. He said, “I am coming to believe more and more that the cuisine has something to do with our ability to think and to make pictures; as for me, when my stomach bothers me it is not conducive to the success of my work.” 
During the last 70 days of his life, in Auvers-sur-Oise, 20 miles north of Paris, van Gogh ate well at the Auberge Ravoux. And at Dr. Gachet’s house, also in Auvers, he enjoyed weekly four-to-five-course meals with his homeopathic physician. Along with art, Vincent discussed good nutrition with Dr. Gachet, a specialist in nervous disorders and an amateur artist.
Vincent van Gogh was indeed the stereotypical starving artist. Clearly his poor eating habits contributed a great deal to his physical and mental suffering. We can’t be absolutely sure of anything without having access to Vincent himself, in the flesh, but the evidence suggests very strongly that starvation, or at least chronic hunger, played a huge role in guiding Vincent’s life. He bought paint and canvases and brushes before he bought food, so his hunger for art taking precedence over his hunger for food.
Vincent himself knew this, for he constantly commented about the choice he had to make between food and art supplies. In one of his last letters he revealed to Theo that, “I am risking my life for it [his art] and my reason has half-foundered because of it … .”
And the world is a better place for his making that choice.
 W. W. Meissner, Vincent’s Religion: The Search for Meaning (New York: Peter Lang, 1997), 33.
 Kathleen Powers Erickson, At Eternity’s Gate: The Spiritual Vision of Vincent van Gogh (Grand Rapids, Mich.: William B. Eerdmans Publishing Company, 2003), 144-146; D. Blumer, “The illness of Vincent van Gogh.” American Journal of Psychiatry 159, no. 4 (2002): 519-26.
 Ibid., p. 129.
 Letter 138 (All van Gogh letters documenting this article exist online at: http://webexhibits.org/vangogh/)
 Ancel Keys et al, The Biology of Human Starvation, 2 vols. (Minneapolis: The University of Minnesota Press,1950).
 Richard H. Williams and Thomas Lathrop Stedman, Stedman’s Medical Dictionary, 25th edition (Baltimore: Williams & Wilkins, 1990).
 Thomson Corporation, “Starvation.” http://www.chclibrary.org/micromed/00066230.html
 Other side effects of ketosis include heart palpitations, kidney stones, osteoporosis, calcium depletion, depleted glycogen stores, electrolyte imbalances, gout, dehydration, dizziness, constipation, irritability, light-headedness, fatigue, depleted mineral stores, acidosis, coma, and death.
 George F. Cahill, Jr., “Survival in starvation,” American Journal of Clinical Nutrition 68 (1998): 1-2.; “The Biology of Malnutrition (an online summary of the Keys study).”
http://www.nutrisci.wisc.edu/NS350/PP; and David M. Garner, “Starvation symptoms: The effects of starvation on behavior: implications for eating disorders.” http://river-centre.org/StarvSymt.html (1997).
 Albert J. Lubin, Stranger on the Earth: A Psychological Biography of Vincent van Gogh (New York: Da Capo Press, 1996), 199.
 Self-portraits, in The Works of Van Gogh, an online exhibit. http://atara.net/vangogh/self-portraits/
[12 Letter 336
 Erickson, 137; Letters 216, W11
[16 Letter 208
 Letter 508
 Letter 570
 Garner, 1997. (See also note 7)
[20 Letters 304, 306
 Letter 173
 Letter 546
 Erickson, 129. Letter W04
 Letter B17
 United States Department of Agriculture, Nutritive Value of Foods (Washington, DC: U.S. Government Printing Office, 1981).
 Letter 520
 Letter 587, Letter to Ginoux family, December 30 or 31, 1889
 Letter 442
 Letter 607
 Letter 521
 Letter B17
 Alexandra Leaf and Fred Leeman, Van Gogh’s Table at the Auberge Ravoux: Recipes From the Artist’s Last Home and Paintings of Cafe Life (New York: Artisan, 2001).
 Letter 638
 Letters 308, 310
 Letter 652
© 2008, 2011 C. Bertelsen