There is a third way in which the word hunger is used, namely, as a symbolic expression of a state of need in general, or as a simile for want in other areas. This usage, too, has led to confusion, though one that is more readily recognized. Problems of similar complexity exist in the concept of pain, and they have been widely discussed by biologists and neurologists. Susanne Langer, in Mind: An Essay on Human Feeling, 24 brings the various observations together. She points out that this problem involves semantic as well as philosophical considerations. Confusion has arisen from the tendency of mixing the two "logical languages" that refer to the description of physical and psychical phenomena. Freud made a clear-cut distinction when he defined instinct as "a borderland concept between the mental and the physical, being both the mental representative of the stimuli emanating from within the organism and penetrating to the mind, and at the same time a measure of the demand made upon the energy of the latter in consequence of its connection with the body." 14 .
Kubie, in a series of papers, emphasized the need to recognize the complexity of instinctual development through a proper understanding of the function of the symbolic processes and their influence on instinctual processes. 21, 22 He expressed misgivings about the use of the word libido. 23 I wish to offer here the hypothesis that hunger awareness is not innate biological wisdom, and that learning is necessary for this biological need to become organized into recognizable patterns.
Clinical Observations.
The need to examine the tacit assumptions about hunger forced itself upon me during the psychiatric and psychoanalytic study and treatment of a large group of patients suffering from anorexia nervosa or developmental obesity. Quite a few of them were borderline or frankly schizophrenic. 1, 8.
Psychoanalytic inquiry has facilitated recognition of the manifold unconscious and symbolic meaning of food, both in voracious uncontrolled intake and rigid refusal to eat.