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Experimental Neurosis Resulting from Semistarvation in Man

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					               'Experimental Neurosis" Resulting from
                       Semistarvation in Man
                          BURTRUM C. SCHIELE, M.D. AND JOSEF BROZEK, PH.D.




I  N SPEAKING of "experimental neurosis" one
    has in mind, as a rule, the type of behavior
change studied in animals by the method of the
                                                              versed by diet therapy, and can be considered, there-
                                                              fore, as a type of "experimental neurosis."
                                                                 The current psychiatric terminology does not con-
conditioned responses, developed by Pavlov (17)               tain terms which would precisely denote the changes
and utilized in this country by Gantt, Liddell,               observed in experimental semistarvation. We had a
Maier, Masserman, and others (see, for example,               choice of either attempting to coin new categories
 [16], p. 122 fl.). In such experiments the "stress"          or of using the available terms and specifying their
consists classically in the inability of the animal to        meanings. We propose to use the term "semi-
discriminate between two conditioned stimuli, such            starvation neurosis" to refer to those changes pro-
as auditory tones of decreasing difference in fre-            duced by the experimental regimen and reduced
quency, making it impossible to anticipate the                during the course of the nutritional rehabilitation
"correct" response and resulting in a conflict be-            which were common to all the subjects and have
tween the excitatory and inhibitory processes. The            a parallel in natural starvation (5, 14, 18). These
behavior manifested by the animal is similar to               changes were described in detail elsewhere (8). In
human behavior under conditions of severe frustra-            addition to the commonly occurring reactions some
tion and anxiety.                                             of the subjects developed unusual or severe person-
   Behavior disturbances may be produced also by              ality and neurologic disturbances. In this paper we
alterations in the internal environment of the organ-         shall present case studies of these individuals.
ism (15). The changes in behavior resulting from
toxic factors have long been of interest to psychia-           PURPOSE OF THE EXPERIMENT—EXPERI-
trists, but it is rare that one has the opportunity to                  MENTAL DESIGN
study this type of stress under controlled conditions
in human beings. We have earlier reported the                    The starvation-rehabilitation experiment was car-
profound effects of severe vitamin B complex restric-         ried out at the Laboratory of Physiological Hygiene,
tion on personality in normal young men (3). More             University of Minnesota, in 1944 and 1945, with
recently we had an opportunity to study changes               follow-up studies extending through 1946 (13). The
resulting from a prolonged, severe semistarvation.            primary purpose of the experiment was to investi-
The resultant personality alterations in the majority         gate, under controlled conditions, the relative effec-
of instances could be classified as "psychoneurotic."         tiveness of different types of diet in bringing about
They were induced by the starvation regimen, re-              recovery from prolonged inanition. The experi-
                                                              mental subjects were 36 healthy young male volun-
   From the Department of Psychiatry, (Dr. Schiele), and      teers who represented, within normal limits, a wide
the Laboratory of Physiological Hygiene, (Dr. Brozek), Uni-
                                                              range of individual differences in body build, physi-
versity of Minnesota, Minneapolis, Minnesota.
   This work was sponsored by the Brethren Service Com-       cal fitness, and personality. The men were recruited
mittee, the American Friends Service Committee, the Uni-      among conscientious objectors who prior to the
tarian Service Committee, the Mennonite Central Committee,    experiment had participated in various projects of
the Sugar Research Foundation, New York, the National         national importance under the program of the
Dairy Council operating on behalf of the American Dairy
Association, and the John and Mary R. Markle Foundation,
                                                              Civilian Public Service (C.P.S.) (7).
New York. Beginning July 1, 1945, the work was sup-              The experiment proper lasted for approximately
ported in part under a contract, recommended by the           a year. Control observations were made during
Committee on Medical Research, between the University of      three months (November, 1944-February, 1945), in
Minnesota and the Office of Scientific Research and Devel-
opment. On November 1, 1945, the responsibility for this      which the subjects were maintained on a "good"
contract was assumed by the Office of the Surgeon General,    diet which provided an average of 3492 calories
U. S. Army.                                                   per day. Six months of semistarvation followed
JANUARY, 1948
32                                                                         EXPERIMENTAL NEUROSIS
(February-July, 1945) when the average daily in-            be noted. The profiles illustrate graphically the
take was reduced to 1570 calories. The diet was             personality patterns of the individuals, the changes
planned to simulate food available in Western and           in semistarvation, and, in cases followed during the
Central Europe under the conditions of food short-          nutritional rehabilitation, the return to prestarvation
age during the Second World War. The semi-                  values. For present purposes, the profiles may be
starvation period was followed by three months of           interpreted by considering a rise on the left side
controlled nutritional rehabilitation; this ended in        (Hs, D, and Hy) as indicating a "neurotic" type
October, 1945. During this period the caloric intake        of reaction and a rise on the right side as indicating
was increased for all subjects. The men were                a more severe personality disorganization suggest-
divided into four groups, receiving an additional           ing "psychotic" conditions.
supplement of 0, 400, 800, and 1200 Cal.
                                                               SEMISTARVATION CHANGES COM-
                     METHODS                                        MON TO THE GROUP
   In the control period, the semistarvation, and the         The striking anatomic and physiologic changes
rehabilitation phases of the experiment a large array       resulting from semistarvation such as weight loss,
of methods was used to study personality and                weakness, low pulse, and reduced BMR are well
behavior. In addition to standardized tests and in-         known and easily understood. The psychologic
ventories (1, 2) these included autobiographies,
diaries kept by the subjects, formal interviews, and
a variety of informal contacts. The case studies to
follow are based, for technical reasons, on only a
fraction of the quantitative information available.
The Minnesota Multiphasic Personality Inventory
(abbreviated as MMPI) is the only psychometric
instrument utilized in this paper.
   The Inventory is fully described elsewhere (10)
but a brief comment may be useful to orient those
not familiar with it. The scales were developed by
contrasting the responses of patients exhibiting rela-
tively well defined psychiatric syndromes (Hypo-
                                                                                 Hy   Pd
chondriasis—Hs, Depression—D , Hysteria—Hy,
                                                               FIG. 1. Minnesota MultiphasicPersonality Inventory, aver-
Psychopathic deviation—Pd, Paranoid reaction—Pa,
                                                            age values for 32 subjects who completed the experiment.
Psychasthenia—Pt, Schizophrenia—Sc, Mania—Ma)               The scores for individual subjects were obtained as the
with the responses obtained for a "normal" popula-          average of two administrations during the control period
tion. The femininity-masculinity of interests is            (C), at the end of the semistarvation period (S24), and
measured by the Mf scale. The scores on this scale          after twelve weeks of controlled rehabilitation (R12). The
                                                            R33 values were obtained for 20 subjects during a follow-up
were high for most subjects included in our group,          examination made after twelve weeks of controlled rehabili-
indicating a high degree of "femininity" of interests.      tation plus twenty-one weeks of unrestricted diet.
This fact may be interpreted as a result of selective
factors related to the subjects' rich cultural interests;   changes, although more complicated and more diffi-
the elevated Mf score did not appear to have specific       cult to measure, are just as characteristic as are the
clinical significance and was not incorporated in           physical changes. The chief psychologic manifesta-
drawing the personality profiles.                           tions which were found characteristically in all sub-
   It should be noted that "normal average" scores          jects are intense preoccupation with thoughts of
for the MMPI scale are 50 and the standard devia-           food, emotional change tending toward irritability
tion in the normal population is equal to 10. The           and depression, decrease in self-initiated activity,
scores are reasonably reliable on tests repeated under      loss of sexual drive, and social introversion.
standard conditions and the inventory is provided              The composite MMPI profile for the 32 men who
with internal checks to indicate whether the subject        completed the entire experiment will serve as a
cooperated and answered with care the 550 items             general frame of reference for the individual case
making up the inventory. In the present experi-             studies. Scores on the validating scales ("?," L,
ment the validating scores were well within normal          and F ) were normal throughout, varying between
limits except for rare cases in which these facts will      50 and 55. The profile obtained during the control
                                                                                                       VOL. X, NO. 1
SCHIELE AND BROZEK                                                                                                33
period is also completely normal, except for the               psychosis. The case history of one subject (No. 130)
elevated femininity-masculinity (Mf) score, a fact             is of interest in view of the fact that he successfully
which was discussed above. The elevation of the                completed the experiment in spite of a history of
neurotic end of the profile (Hs, D, and Hy) during             cyclothymic personality difficulties. Two men (Nos.
semistarvation gives a quantitative and graphic indi-          29, 101) had neurologic disturbances (paresthesias).
cation of the personality changes observed clinically.         One (No. 5) exhibited neurologic symptoms of
In rehabilitation these changes were reversed, al-             probable hysterical origin. One (No. 20) developed
though the profile obtained at the end of controlled           an hysteroid neurotic reaction which led to self-
rehabilitation is still above the normal. In this              muldlation. The case of subject No. 2 who made
connection it may be pointed out that the first                an optimal adjustment to the semistarvation stress
twelve weeks of rehabilitation were in reality a               is included to provide a contrast to those who de-
continuation of the stress. This was especially true           veloped more severe symptoms.
of the first six weeks and of the men in the lower
caloric groups. It was only some time after release
from the controlled diet that complete rehabilitation          Case No. 2
was effected. Profiles on 20 subjects obtained after              This subject is an example of the men who
thirty-three weeks of refeeding had returned to the            showed the least psychologic deterioration.
"normal," semistarvation level.
                                                                  The subject was a 24-year-old law student with
   The average score on the Pd scale was initially             strong interest and experience in the labor move-
low and there was little change during semistarva-             ment. The home provided adequate economic and
tion. This indicates an absence of a tendency to               emotional security, and the subject had a happy
devolop aggressive, antisocial reactions or "char-             childhood. In college and law school he became a
acter neuroses." It is of interest that 3 of the 4             social and professional leader. He wrote a column
subjects who failed to complete the experiment (and            in the college paper, organized a successful society,
were not included in the group profile) did show               was its president for several years, and was active
significant elevation in Pd score. The moderate                in campus politics. He was given a number of
elevation of the scores on the Pa, Pt, Sc, and Ma              honors and repeatedly demonstrated his ability in
scales was entirely within "normal" limits and is              many areas. This successful pattern continued in
further evidence of the absence of "psychotic" types           various Civilian Public Service assignments.
of reaction in the average subject. This was not                  Neurotic traits in this individual were minimal.
true of a few individuals who showed more severe               In his youth he had been shy and self-conscious
or unusual symptomatology. The mean score on                   with girls, was slow to learn to dance, and worried
femininity-masculinity interest scale (Mf) changes             for some time over severe facial acne. The subject's
but little; the slight drop is consistent with a clinical      sex drive was moderate. He had been interested in
impression that the Mf tends to go down as neurotic            a number of girls but usually kept these relation-
reactions develop.                                             ships secondary to his work and professional ambi-
                                                               tion. Observations during standardization confirmed
                    CASE STUDIES                               the impression that the subject was capable, success-
                                                               ful, and well integrated. He was adaptable, had a
   In any severe and prolonged stress situation in-            workable philosophy of life and definite goals, both
volving as many as 36 subjects, one would expect a             immediate and future. He was well poised and
certain percentage of frankly psychopathologic re-             accepted by both the staff and the members of the
sponses. Although many of the subjects had periods             group.
during which their distress was quite severe, there               He suffered a full share of the consequences of
were only 9 whose symptoms went beyond the usual               semistarvation. His physical symptoms were of
range of the semistarvation deterioration. There               average severity except for a relatively large amount
were 4 cases 1 (Nos. 234, 235, 232, 233) whose reac-           of edema in the last weeks of the semistarvation
tion took the form of a character neurosis; they               period. His weight at the beginning of semistarva-
were unable to stay on the semistarvation diet. In             tion was 73.5 Kg., at the end of semistarvation 55.9
one of these cases (No. 234) the response to the               Kg. with a low of 54.6 Kg. five weeks earlier; the
stress was particularly violent and bordered on a              gain was due to accumulated edema. His psycho-
  1
                                                               logic symptoms were likewise typical of semistar-
    The cases are identified by their code numbers which
have no reference to the total of the subjects participating
                                                               vation. He was lethargic, mildly depressed, and
in the experiment.                                             somewhat irritable. The latter two symptoms were
JANUARY, 1948
34                                                                        EXPERIMENTAL NEUROSIS
less marked in this subject than in many. He                 were normal. At the end of semistarvation the pro-
suffered from hunger pains and was preoccupied               file shows a moderate elevation of the neurotic triad
with thoughts of food as were all the other subjects,        (Hs, D, and Hy), the rise of the scores on all the
although he seldom talked about it. Sexual interests         three scales being of about the same magnitude.
dropped off severely in the early part of semistar-          The profile fits in with the clinical picture of a mild
vation. At the beginning of the experiment he                neurosis.
became interested in a girl and was greatly sur-                In summary, the neurosis in this case was mini-
prised to note the degree to which his depression            mal yet was definitely present. Its experimental
and loss of sexual feeling reduced his interest in           character is demonstrated by the fact that it devel-
their friendship.                                            oped as a result of the semistarvation stress and
    On the positive side it may be said that he had          disappeared on rehabilitation. This case will serve
little or no temptation to break the diet, and that          as a contrast to those who had more severe and
he complained less than the average subject in spite         complex symptomatology.
of showing the same amount of physical deterior-
ation. When he entered the experiment, he set                Case No. 234
about to complete the last semester of his law school            This subject found himself unable to stay on the
studies. On obtaining an L. B. degree he began               semistarvation diet in spite of his strong desire to
                                                             do so, and the ensuing conflict precipitated a border-
                                                             line psychotic episode which necessitated his re-
                                                             moval from the experiment.
                                                                During standardization this 24-year-old man ap-
                                                             peared to have everything that would make the
                                                             sailing smooth. The subject was charming, hand-
                                                             some, artistic, and had a gift of gab. His standing
                                                             in the group was high, and he taught with success
                                                             a class in German which was a part of the educa-
                                                             tional program developed to prepare the men for
                                                             relief service in Europe. He held a salaried position
                                                             as a church organist while serving in the experi-
                                                             ment. The obvious assets gave the false impression
                                                             that the subject was more mature than was actually
   Fic. 2. Scores on the Minnesota Multiphasic Personality
Inventory for subject No. 2 in the control period (C), at
                                                             the case.
the end of semistarvation (S24), and after twelve and            Upon further investigation of his background we
thirty-three weeks of rehabilitation (R12 and R33).          find that he came from a comfortable urban home
                                                             in which servants carried the major burden of rais-
taking courses in political science, completing most         ing the 6 children. It appears that the subject was
of the requirement toward an M. A. in that field.            never very close to his parents and that, particularly
He was able to do this in spite of the distressing           in his youth, he was not well accepted by those of
symptoms. He showed his maturity of judgment                 his own age. However, he enjoyed school, was a
by anticipating that the early part of rehabilitation        capable student, and obtained a university degree.
would be a continuation of the stress.                       Being talented musically, he planned to follow
  During rehabilitation he was in the experimental           music as a vocation. Throughout life he had more
group receiving a supplement of 800 calories. In             interest in boys than in girls and for several years
spite of this he felt little or no progress for the first    he carried on a "beautiful friendship" which gave
three and a half weeks of the rehabilitation period;         evidence of a personality inversion.
actually his body weight decreased from the average              The development of the unusual response to the
of 56.9 Kg. for the first week to an average of               experimental stress may be oudined as follows: In
55.5 Kg. for the third week of rehabilitation due            the first few weeks, while suffering the usual symp-
to loss of edema fluid. However, the satisfactory             toms resulting from reduced food intake, he was
completion of the starvation period did offer him             troubled by strange dreams of "eating senile and
some mental relief and tangible evidences of re-              insane people." During the eighth week he impul-
covery gradually became manifest.                             sively broke the diet, eating several sundaes and
  The Minnesota Multiphasic Personality Inventory             malted milks, and stealing some penny candies.
profiles for standardization and for R33 (Fig. 1)             He promptly confessed this episode, became self-
                                                                                                     VOL. X, NO. 1
SCHIELE AND BROZEK                                                                                            35
depreciatory, and felt he was not good enough to            At this time he presented the picture of a hypo-
be retained in the experiment.                           maniac; he was overly talkative, emotionally un-
   "Judging from the content of his diary, he was        stable, and somewhat elated. Within a few days'
clearly aware of the conflict between his desire to      time, however, his symptoms subsided. Though he
save face and the desire to leave. In an apparent        ate large amounts of food, he did not stuff himself
attempt to strengthen himself, he listed his reasons     to the point of becoming sick, and at the time of
for sticking to the experiment: a desire for the         his release from the hospital he showed little gross
personal satisfaction of completing it; the admoni-      evidence of personality disturbance.
tion of his buddies; the approbation of the church,         The MMPI (Fig. 3), taken during standardiza-
family, and friends; and the desire to do service to     tion, is normal; the profile secured in the tenth
starving Europe and to uphold the ideals of the          week of semistarvation (just before his release from
C.P.S. program. This may have been partially effec-
tive, for his next diet violation was half-hearted; he
stole and ate a few raw rutabagas (cooked ones
being one of the main articles of the diet).
   Early in the ninth week, as the conflict became
more intense, he spoke of being unable to stop the
whirling ideas going through his mind about "food,
food, food." In the next few weeks he began to
display serious personality disturbances. He became
overwrought and began to write voluminously in
his diary. His writing tended to ramble, with sug-
gestions of flight of ideas. Next he turned to God
in an attempt to solve his conflicts and for a few
days he felt a new strength. He vowed to get a job
in a grocery store to test himself. However, he            FIG. 3. Scores on the Minnesota Multiphasic Personality
                                                         Inventory for subject No. 234 during the control period
developed insomnia and concluded, "I'm not the
                                                         (C) and after ten weeks of semistarvation (S10).
strong-willed egg that people seem to think I am."
A minor spree of shoplifting, stealing trinkets which
had little or no intrinsic value for him, may have       the experiment) is clearly pathologic. The elevation
served as substitutive behavior. Next he began a         of the Pd scale and of the entire right of the profile
series of frank dietary violations which he concealed    is indicative of a serious type of personality dis-
for a time by falsely recording his weight.              organization, these changes are in a marked contrast
   Since it now was plain that he was unable to          with those obtained in subject No. 2. There was
control himself, he attempted to save face with a        also a rise in the score on the " F " scale, from 50 in
number of rationalizations: he was an individualist      the control period to 73 in the tenth week of semi-
and was not meant for regimentation; the whole           starvation. In this case the elevation cannot be
experiment was a failure, and he should persuade         interpreted in the sense of " F " being a "validation"
                                                         scale but as an indication of severe personality dis-
the other men to quit with him; and finally, he had
                                                         turbance. Responses yielding a high " F " score were
done a great deal for the group already and might
                                                         previously found to reflect a clinically established
as well quit. There were threads of self-deprecia-
                                                         presence of psychiatric disturbances (12).
tion and guilt, but these became less evident as time
went on.                                                    In summary, the subject is a bisexual individual
    After discussions with the Laboratory staff he       with poor personality integration and weak self-
once more attempted to get back in line; he volun-       control, although he appears to have sufficient assets
teered to give up his money and checkbook, and           to adjust to ordinary circumstances of life without
he even asked for a "buddy" to constantly supervise      much difficulty. He first slipped on impulse; this
him. When this failed utterly, and it became neces-      resulted in remorse and guilt, though he received
                                                         some relief on confession. He tried to obtain sup-
 sary to place further restriction upon him, he devel-
                                                         port from his religious beliefs but slipped again.
oped a violent emotional outburst with flight of
                                                         The mechanism of substitution, expressed in such
ideas, weeping, talk of suicide, and threats of vio-
                                                         acts as stealing trinkets, was ineffective. When
lence. Because of the alarming nature of his symp-
                                                         threatened with forceful restrictions he "blew up."
toms he was released from the experiment and
                                                         This is the only instance in which the experimental
admitted to the Psychiatric Ward of the University
                                                         stress precipitated a reaction pattern which could
 Hospitals.
 JANUARY, 1948
36                                                                      EXPERIMENTAL NEUROSIS
be considered "psychotic." In spite of the short           He immediately suffered a severe emotional upset,
duration of the psychotic symptoms it had many             with nausea, and upon returning to the laboratory
features of a manic psychosis. Many clinicians, on         he vomited. He promptly made a complete con-
the other hand, would prefer to classify this disorder     fession to the staff, making at first an attempt to
as a borderline psychotic episode in a psychopathic        save face by referring to his loss of control as a
personality.                                               "mental blackout."
                                                              In the next few days his pattern of defense began
Case No 235.                                               to reassert itself: he was sure that he had learned
   This subject, age 25, is another man who failed         his lesson, that he would be alert to the possibility
to adhere to the diet. He exhibited a mild clinical        of temptation. A few days later he stated that he
neurosis and, in addition, developed hematuria.            was "serene and secure" with a feeling of "complete
   There appeared to be nothing unusual in his back-       control." The only evidence of his underlying un-
ground. He and his 7 siblings were raised on a             certainty was found in his pressure to talk and write
farm, and had a happy home life. After completing          about his "little difficulty." On the surface all went
high school the subject worked for a time in an            well for the next few weeks. However, his weight
automobile factory and later attended college. This        failed to go down in spite of drastic cuts in the
man appeared to be a perfectly satisfactory member         diet—a strong indication that he was again taking
of the group: He was well met, friendly, and               food. As this became evident, signs of a definite
enthusiastic. He had entered the experiment be-            though mild clinical neurosis began to appear. The
cause of a sincere and long standing interest in           subject became increasingly restless and uneasy. He
nutrition and in foreign relief. He had definite           was self-depreciatory, expressed disgust and self-
plans for the future, intending to make rural co-          criticism. He made vague and ambiguous remarks
operative farming his life work. He had a healthy          about additional dietary irregularities, but was un-
interest in the opposite sex and during the experi-        able to face the issue squarely. -
ment he corresponded regularly with the girl he               In midstarvation he began to experience hema-
hoped to marry. He was a hard worker and spent             turia, a disorder which he had had some years
much of his free time as a bookkeeper in a cooper-         previously; the urologist reported inflamatory
ative grocery store.                                       changes of obscure etiology in the posterior urethra.
   On further observation, however, it became evi-         Because of the discrepancies in the weight curve
dent that the subject had many hysteroid mecha-            and because of the urologic complications the pa-
nisms and other signs of a neurotic temperament.           tient was released from the starvation diet during
In interviews, he was good natured and easy going          the eighteenth week. He wrote later:
but showed an immature "Pollyanna" attitude. He               I received the news with mixed emotions, having
wrote copiously in his diary and ended every other         sincerely desired to see the experiment through and
sentence with an exclamation point. He always              yet realizing that my violations of diet would make
expressed great self-righteousness and optimism; this      results inaccurate! Sense of failure was almost pre-
                                                           dominant! Mentally, emotionally and physically I was
attitude is illustrated by his declared purpose in life:   a mess. My first thought was escape from it all! Try
"to do that which is right in the sight of God our         and forget it as just a bad dream! The transfer to
Maker, trying always to advance His Kingdom on             another unit didn't go through, and when asked to
earth. Truly life is worthwhile!"                          stay on 'til Oct. 20th and help out in the kitchen, I
                                                           felt honor bound to do just that and to do the best
   This subject's particular pattern of response began     job I knew how. And again, it was no doubt the best
to show itself in the first few weeks of semistar-         thing that could have happened. Leaving here when
vation. Though he had no outward difficulty, he            I came off diet would have been purely an escape.
talked excessively about how well he was taking            Staying here, while difficult to adjust to, has helped
                                                           me to recover the assurance, the interest in others,
the stress: he suffered little or no food craving; he      and the will to go forward, that has always driven me.
had no temptations even when handling food in              While sincerely regretting my failures here, it [the ex-
the grocery store; his adjustment to the routine           periment] has taught me a lesson in humility and
was complete.                                              understanding that will be priceless to me. And per-
                                                           haps in other areas I can, with God's help, make my
   During the seventh week of the semistarvation           contribution to the society in which I live.
period he became unsettled and restless. One eve-
ning while working in the grocery store he suffered          On the neurotic end of the MMPI the peak is
a sudden "complete loss of will power" and ate             on Hy (Fig. 4). This elevation is moderate and,
several cookies, a sack of popcorn, and two overripe       taken by itself, would hardly be considered as
bananas before he could "regain control" of himself.       having clinical significance. However in view of
                                                                                                   VOL. X, NO. 1
SCHIELE AND BROZEK                                                                                                37
the very high scores on one of the validating scales          stances. The family was large, congenial, and
(L scale), ranging from 68 to 78, the elevation in            upheld strong moral principles. The subject at-
Hy assumes added significance and indicates a                 tended college for two years. There were many
hysteroid temperament. In terms of the items which            evidences of latent neurotic characteristics in his
constitute the L scale of the MMPI, the subject               personality make-up. He was a friendly, boyish type
appeared to himself as a "perfect" person who                 of individual, with a strong tendency to try to
always tells the truth (item J42), likes everyone he          appear as he thought one should. His past history
knows (J47), never feels like swearing (J51), and             is full of episodes during which he was indecisive
has table manners just as good at home as when he             and unable to formulate his goals clearly. His
is out in company (J54). Such an individual must              struggle with the problem of pacifism is typical.
be singularly resistant to self-revelation.                   He was imbued with pacifistic principles from child-
                                                              hood and finally became a conscientious objector
                                                              although he was never completely sure of his stand.
                                                              In his autobiography he says, "With a somewhat
                                                              melodramatic feeling I finally committed myself
                                                              to it."
                                                                 In the first few weeks of starvation the subject
                                                              showed the usual reactions of hunger and loss of
                                                              energy. However, by the ninth week it became
                                                              apparent that he was tense and worrying con-
                                                              siderably. After the story of subject No. 234 became
                                                              known, he confessed minor irregularities of diet
                                                              such as eating a crust of bread; these appeared to
                                                              trouble him gready. At this time, along with two
                                                              or three others, he began to chew gum in enormous
  FIG. 4. Scores on the Minnesota Multiphasic Personality
Inventory for subject No. 235 during the control period (C)   quantities (up to 40 to 60 packages per day). By
and after twelve weeks of semistarvation (S12).               the middle of the starvation period (S12) the pa-
                                                              tient was in a sorry state. His finances would not
   In summary, the restlessness, self-depreciation,           stand his heavy expenditures for chewing gum, his
and the eating off diet followed by an emotional              mouth became sore, and though he made valiant ef-
reaction and vomiting may be considered as evi-               forts to control the gum chewing, it only became
dence of a clinical neurosis. That the neurosis was           worse; on one occasion he was known to have stolen
mild is accounted for by the fact that the stress was         a package of gum. This compulsive behavior ap-
terminated early, that it was mitigated by taking             peared to be aimed at the alleviation of hunger sen-
the extra food, and that the hematuria provided a             sations, to allay nervousness, and to reduce the temp-
ready-made face-saving device and source of ration-           tation to eat off the diet, but little beneficial effect
alization. Since the neurosis developed out of the            was obtained.
conflict between his hunger drive and his personal               During the last six weeks of the starvation period
standards and ideals, and since it disappeared when           his resdessness, sense of guilt, and general nervous-
he was released, it may be considered as an "experi-          ness increased decidedly. In spite of having very
mental neurosis." His ability to dissociate himself           little money he bought an old suit for f 10.00 which
from reality (e.g. eating when in a "mental black-            was evidently of little use to him. Later he wailed,
out") and to rationalize served as a psychologic              "Nobody in his right mind would do a thing like
protection and allowed him to reduce his suffering            that." In interviews it was noted that his character-
by breaking the diet without very severe feelings             istic indecisiveness had become markedly exag-
of guilt.                                                     gerated. He was disgusted because of his inability
                                                              to control his gum chewing. Many ambiguous ref-
Case No. 232                                                  erences were made to his previous minor dietary
  This case is presented because of the subject's             irregularities, and he talked a great deal about how
incapacity to adhere to the diet and the development          awful it would be to break the diet. However, he
of a frank personality disorder, psychoneurotic in            was unable to face the issue squarely and did not
type.                                                         make a clean confession. Instead he talked a great
  The subject, age 25, was a husky athletic indi-             deal about a compulsive fascination for refuse and
vidual. His parents were farmers in modest circum-            a strong, almost impelling, desire to root in garbage
JANUARY, 1948
38                                                                             EXPERIMENTAL NEUROSIS
cans. Information obtained in post experimental                   subsided over a period of weeks and that the subject
interviews revealed that some of his behavior was                eventually made a satisfactory adjustment.
self-punishing: he had not bought good food but                     In the MMPI the profile (Fig. 5) indicates a
actually ate garbage, a sandwich which he found                  definite neurotic pattern at the twelfth week of
on the ground, and a student's lunch which he                    starvation, which was accentuated still further to-
had stolen.                                                      ward the end of the semistarvation period. In addi-
   Since his weight failed to go down in spite of                tion to the elevation on the "neurotic" end of the
drastic cuts in his diet, he was dropped from the                profile there was also a significant rise in the scores
experiment at the end of the starvation period. This             on the "psychotic" scales, even though without
meant that the subject left the Laboratory and was               control values the semistarvation scores would not
completely relieved of all restrictions. However, his            be considered as definitely abnormal. The score on
neurotic manifestations continued in full force and              the F scale rose from 52 during the control period
even increased for a while. He repeatedly went                   to 64 at the twenty-fourth week of semistarvation.
through the cycle of eating tremendous quantities                   In summary, this subject's latent personality weak-
of food, becoming sick, and then starting all over               nesses were amplified and brought to the surface by
                                                                 the stress. He did not have the strength to carry
                                                                 out the program nor the capacity to decide unequi-
                                                                 vocally to get out of the unpleasant situation. Thus
                                                                 he developed an experimentally induced neurosis
                                                                 characterized by such symptoms as indecisiveness,
                                                                 self-depreciation, feeling of guilt, restlessness, ner-
                                                                 vous tension, compulsive gum chewing, and eating
                                                                 off diet.

                                                                 Case No. 233
                                                                    This case is somewhat similar to the preceding
                                                                 one (No. 232). The central feature is the probable
                                                                 eating off the diet.
  FIG. 5.     Scores on the Minnesota Multiphasic Personality       The two subjects were close friends. Both were
Inventory   for subject No. 232 during the control period (C),
and after    twelve and twenty-four weeks of semistarvation      athletic, less intellectual, and less cultured than the
(S12 and    S24).                                                average members of the group. This man was also
                                                                 addicted to excessive gum chewing, and he failed
again. He sought interviews, complaining that he                 to lose weight in spite of drastic reductions in his
needed psychologic rehabilitation. He was emo-                   diet. Because of this his data were not used in the
tionally disturbed enough to voluntarily seek ad-                final group analysis although the subject remained
mission to the Psychiatric Ward of the University                in the experiment and was used for independent
Hospitals. He eloped within twenty-four hours,                   short-term biochemical observations.
giving as his reason that he must find a job. After                 There was only indirect evidence that this man's
a few days he again returned asking for further                  failure to lose weight was due to dietary violations.
psychiatric help. During the subsequent interviews               He denied eating any unauthorized food-although
he was self-depreciatory, and felt confused and de-              he admitted that he was unable to control his gum
feated. On one occasion he cried freely and became               chewing because of his nervousness. He appeared
so agitated that he kicked over a table and broke                very depressed but was inarticulate in both the
his glasses. With characteristic inconsistency he                interviews and the diary in which he generally
attempted to relieve his conscience by making                    wrote much less than the average subject. Despite
partial revelations but still avoiding a painful com-            the fact that there was no surface evidence of mal-
plete confession. He appeared to derive little benefit           adjustment on entering the experiment, his back-
from the psychiatric contacts, and was unable to                 ground shows ample evidence of difficulty. The
make plans or decisions, still attempting to cling to            subject had feelings of inferiority and lacked self-
impossible solutions and face-saving devices. It took            confidence; he described himself as disorganized,
him several weeks to liquidate a few items of                    lacking in planning, and a procrastinator; he wet
personal business and depart for home. Follow-up                 the bed until the age of 15, was shy and poorly
information indicates that the problem gradually                 socialized until much later.
                                                                                                        VOL. X, NO. 1
SCHIELE AND BROZEK                                                                                               39
   The MMPI showed a striking rise early in the               Just prior to his admission to the experiment he
semistarvation period (Fig. 6); the control profile            worked as an orderly in a mental hospital. At first
was normal. In this case the changes in the MMPI               he was in an up swing; he enjoyed his work; he
profile present a more correct picture of the semi-           founded and edited an institutional publication.
starvation neurosis than would have been obtained             Some of the articles which he wrote contained such
on the basis of diaries and interviews in which the           "scorching invectives" that he was nearly dismissed
subject was hopelessly inarticulate.                          from his job. The elated phase was soon followed
                                                              by a depression which lasted several months and
                                                              was more severe than the preceding ones.
Case No. 1 30
                                                                 The history of this cyclothymic disorder nearly
   The subject had a history of personality difficul-         caused his nonacceptance for the experiment. It was
ties when he entered the experiment; these became             finally decided to include him because of his assets.
aggravated during the stress. The final result, how-          He had insight into his problem, gave evidence of
ever, appears to have been a net gain.                        strength of character, had a good record of accomp-
   This 24-year-old pretheological student was born           lishment in spite of his personality handicaps. He
and largely raised in India where his parents were            gave the clinical impression that he woud be able
missionaries. Part of his childhood and later adoles-         to complete what he started.
                                                                 Objectively, the patient did very well during the
                                                              entire experiment. He had the usual physical symp-
                                              "233            toms and slightly more than his share of irritability
   80
                    /    \                                    and hostility, the latter being expressed especially
   70           /               \ \                           toward one of the generally unpopular men (No.
            4                         *
                                                              29). The subject experienced a number of periods
   60
                                                              in which his spirits were definitely high; he asso-
 S 50                                                         ciated this with discovering that he could "take" the
            o-~~
                                                              stress of the experiment better than many of the
  40                                                          men toward whom he had previously felt inferior.
                    o- c
  30                         S 24                             These elated periods alternated with times in which
                                                        -
                    «•       S 12                             he suffered "a deep, dark depression." None of
                                                              these mood swings, either up or down, lasted more
                                                              than a few days.
  FIG. 6.   Scores on the Minnesota Multiphasic Personality
Inventory   for subject No. 233 in the control period (C)        Toward the end of the starvation stress the sub-
and after   twelve and twenty-four weeks of semistarvation    ject felt that he had reached the end of his rope.
(S12 and    S24).                                             He expressed the fear that he was going "crazy"
                                                              (subject No. 20 was the only other subject to express
cence was spent in the United States. His back-               this fear). He felt that he was losing his inhibitions.
ground history is filled with evidence of adjustment          He looked pained and depressed much of the time.
difficulties which led him to change schools many             On many occasions during the last three or four
times. In childhood the subject suffered from terri-          weeks of semistarvation he had impelling desires
ble nightmares: "To this day [they] send shivers              to smash or break things. At no time, however,
down my back just to think of them." He struggled             were these impulses carried into action. In rehabili-
with autoeroticism and feared that he had stronger            tation he was in the lowest caloric group (the other
sex desire than most people. While in college he              groups receiving from 400 to 1200 more calories).
was told by the school psychiatrist that he was               He carried on in spite of the resulting slow rate of
"a mess." Yet in spite of marked neurotic qualities           rehabilitation. As time went on, his mood swings
the subject has a good record of accomplishment.              lessened in intensity and frequency.
   He describes himself as having few close friends,             After the experiment was all over, the subject felt
being shy, submissive, and having a marked in-                he had been personally strengthened by the ordeal.
feriority complex. "I am conceited, self-centered,            "It undressed us. Those who we had thought would
inconsiderate, tactless, and blunt. I have a lousy            be strong were weak; those who we surely thought
personality even though I know how to get along               would take a beating held up best." The personal
with most people and can hold down friends." In               satisfaction which he obtained from the suffering
recent years he has had several periods of mild               and the successful completion of the experiment is
depression alternating with periods of mild elation.          clearly indicated by his diary: "I am proud of what
JANUARY, 1948
40                                                                            EXPERIMENTAL NEUROSIS
I did. My protruding ribs were my battle scars. My                 This 33-year-old professional actor came from an
abnormal conduct in society also was where I was                economically secure urban background. His mother
hit. I am proud of these. I am glad I acted like a              dominated the family and tended to favor the sub-
fool, that I became so weak I could hardly turn over            ject over his older sister. In speaking of his child-
in bed, that I thought with my stomach instead of               hood and adolescence he referred to himself as
my head. It was something great, something                      "mother's little helper." He played with dolls dur-
incomprehensible."                                              ing much of his childhood and always heartily dis-
  Four profiles of the MMPI are presented (Fig. 7).             liked fighting. He had many fears, and recalls
The prestarvation profile shows an elevation on the             vividly that his mother warned him that if he
"psychotic" end. This is consistent with his cyclo-             masturbated his children would be deformed. He
thymic pattern. At the end of semistarvation the                believes that he had some romantic interest in girls
                                                                before the age of 11; from 12 to 13 he went through
                                                                a period of hero worship and from the age of 13 he
                                                »I3O            had definite bisexual leanings. After finishing ele-
                                                                mentary school he overcame his earlier traits suffi-
                 A                                              ciently to play football for eight years, yet he claims


     -J,
                                                                to have been afraid of physical contact in spite of
                                O
                                                                successfully holding a position on the varsity team.
                                                                In college he was successful at numerous activities
                                s       /                       but was not very popular in spite of strong efforts
                                        ^           \       .
                                                                to become so. He did graduate work in drama and
     •       /                          -»—«r                   took up the theater as his profession.
                                                                   When this man entered the experiment he was
                                                            _   pleasant, polished, and well poised. During stand-
            o•   c
              • S 24                                            ardization he was well accepted in spite of his
            9 • R 12                                        -
            C - R 33                                            theatrical manners. He was confident of his ability
                            1   1   1       i   i       i
                       Hy
                                                                to withstand the semistarvation stress; his diary
   Fic. 7. Scores on the Minnesota Multiphasic Personality
                                                                contains comments concerning his "beautiful ath-
Inventory for subject No. 130 in the control period (C),        letic body" and his fitness: "Bring on the diet!"
at the end of semistarvation (S24), and after twelve and        This subject began to show his semistarvation neu-
thirty-three weeks of rehabilitation (R12 and R33).             rosis in the early weeks. He lost his composure, and
                                                                developed marked irritability and egocentricity. He
profile shows an added neurotic response of con-                continually dramatized his suffering even when
siderable severity. In other words, the whole per-              out in public, much to the annoyance and embar-
sonality was involved. By the twelfth week of                   rassment of the other subjects. He became easily
controlled refeeding there is a noticeable improve-             the most unpopular member of the group, a fact
ment in those symptoms which were brought out                   which many of the men showed openly. This un-
by the semistarvation stress. By the thirty-third               doubtedly increased his stress since he was sensitive
week of rehabilitation, that is after twenty-one                to the feelings of others. However, he appeared
weeks of complete freedom, his scores on the psycho-            unable to control himself in spite of his efforts
neurotic scales of the MMPI are as good or better               to do so.
than his prestarvation values. In addition, there is
                                                                   His personality deterioration was more severe
a striking improvement in the scores obtained on
                                                                than in the majority of the cases. The D score on
the psychotic scales of the inventory. This suggests
                                                                the MMPI went up over three standard deviations
that the experience of having gone through the
                                                                from the mean and there was an elevation in the
experiment had significant therapeutic value for the
                                                                "psychotic" scales of the inventory (Fig. 8).
subject, although the permanency of this improve-
ment cannot be predicted on the basis of the infor-                During the thirteenth week the subject began to
mation available.                                               experience tingling and burning sensations in the
                                                                anterior aspects of both thighs. These were more
                                                                disturbing at night. For a few weeks he had a simi-
Case No. 29                                                     lar but less definite "dry" sensation on the under-
  In this case the experimental neurosis took the               neath area of the penis. These abnormal sensations
form of severe social deterioration. The subject also           gradually increased in area and intensity throughout
suffered from moderately severe paresthesias.                   the remainder of the twenty-four weeks of semi-
                                                                                                       VOL. X, NO. 1
SCHIELE AND BROZEK                                                                                              41
starvation. At their height the burning pain on the           interests in the opposite sex. His history gave little
thighs was very distressing.                                  evidence of neurotic traits in his personality make-
   Neurologic examinations revealed no positive               up. His home background was congenial and
findings aside from abnormal response to superficial          happy. After completing high school, he took up
sensory stimuli in the anterior and lateral aspects           the printing trade and followed this occupation for
of both thighs. Testing with the pin and cotton elic-         several years. He entered college at the age of 24
ited "burning" sensations which were much more                and graduated at 28.
intense in the very center of the disturbed areas.               In semistarvation he suffered a marked physical
                                                              deterioration. During the last weeks of semistarva-
                                                              tion his weight picture was complicated by the de-
                                                              velopment of edema. His gross body weight was
                                                              decreasing too slowly and his diet was cut drasti-
                                                              cally. He was acutely unhappy and felt sure that
                                                              the Laboratory was making a mistake and that he
                                                              was in physical danger. He became extremely de-
                                                              pressed and worried about himself. For example,
                                                              now that sexual urges were absent, he was free of
                                                              his long-standing habit of masturbation; he feared
                                                              that the habit would return when he was rehabili-
                                                              tated. Although he showed a considerable strength
                                                              of character throughout and never once wavered in
                                                              his cooperation or in his intentions, he apparently
                                                              had about all he could take at the end of the
                                                              semistarvation period.
                                                                 During the twenty-second week of semistarvation
                                                              he began to experience burning and tingling in the
                                                              left thigh. This difficulty gradually increased and
                                                              for a time involved the right thigh also. It gradu-
   FIG. 8. Scores on the Minnesota Multiphasic Personality    ally subsided during rehabilitation. (He was in the
Inventory for subject No. 29 during the control period (C),   top group receiving a 1200 Cal. supplement.)
at the end of semistarvation (S24), and after twelve and         Neurologic examinations were entirely negative
thirty-three weeks of rehabilitation (R12 and R33).
                                                              except for paresthetic areas on the anterior aspects
                                                              of each thigh. These areas, which covered approxi-
tation there was a marked diminution in the in-               mately one-third of the anterior aspect of the thigh,
tensity of the paresthesias. By the twelfth week of           were irregular in outline and the boundaries shaded
rehabilitation they were still further reduced al-            gradually into normal skin. The subject was readily
though the area remained about the same.                      able to distinguish sharp from dull. The intensity
   The sensory disturbances in this case are some-            of his subjective sensations varied greatly from time
what suggestive of meralgia paresthetica except for           to time. The routine recheck toward the end of
the more widespread distribution. The personality             controlled rehabilitation revealed a return to normal
deterioration was very marked and the emotional               except for small vaguely outlined areas which were
distress may have played a role in the importance             slightly "dull" to touch, and these were not noticed
assigned to these symptoms by the subject.                    spontaneously.
                                                                 The MMPI during control was normal. The
Case No. 101                                                  semistarvation profile indicates the typical semi-
   This man developed mild paresthesias in addition           starvation neurosis; the relatively high D (72) and
to the usual semistarvation changes.                          the low Hy (56) adds weight to our clinical impres-
   The subject, age 30, gave the impression of being          sion that the paresthesias were not hysterical (con-
a stable, mature, well-integrated individual with a           trast with profile on subject No. 5).
sense of dry humor and matter-of-fact outlook on                 In summary, thir., subject suffered severely; he
life. He had been an active church worker and had             developed a full-blown neurosis which was charac-
held a number of positions of leadership in the               terized especially by irritability, impatience, and
Boy Scouts and church groups. This work occupied              concern over previous masturbation. The distur-
his attention almost to the complete exclusion of             bance in skin sensation appears to have had a physio-
JANUARY, 1948
42                                                                          EXPERIMENTAL NEUROSIS
logic basis and constituted an additional source of               The subject was overweight and was required to
stress. Although the paresthesias were more dis-               lose weight during standardization (from 83.6 Kg.
turbing and less well tolerated during periods of              to 80.8 Kg.). Since he was still above normal
depression and irritability, they did not appear to            weight for his age and height, his weight loss was
have the characteristics of a psychogenic disturbance.         placed at 29 per cent as compared with 24 per cent
                                                               for the group average. During the first half of semi-
                                                               starvation he developed the characteristic physical
                                                               symptoms common to the group, but he suffered
                                                               less psychologically. He was so elated over the
                                                               happy progress of a new and promising love affair
                                                               that he thought and talked of little else.
                                                                   Midway through semistarvation the girl broke off
                                                               their engagement. Not only was this in itself a
                                                               severe blow, but he now became fully aware for
                                                               the first time of the disquieting effects of the
                                                               starvation stress. His dreams about food became
                                                               more intense. His depression and irritability were
                                                               marked. He was impatient and strongly resented
                                                               the restrictions incidental to the experiment.
  FIG. 9. Scores on the Minnesota Multiphasic Personality          During the next four weeks he continued to be
Inventory for subject No. 101 during the control period (C),
                                                               in a turmoil over his unhappy romance. He met
at the end of semistarvation (S24), and after twelve weeks
of controlled rehabilitation (R12).                             his ex-fiancee on several occasions in an attempt to
                                                                straighten out their affairs. These experiences were
                                                               not very satisfactory, and he continued to feel
Case No. 5                                                      bitter over "what might have been." Although he
   This subject developed neurologic symptoms,                  made the decision to "wash things up, clean, neat
probably hysterical in origin.                                  and final," he continued to see her at every
   This 29-year-old man came from a rugged back-                opportunity.
ground. His parents were mill-hands who lived in                   Since he considered himself a sophisticated and
poverty most of their lives. The subject was raised             worldly individual, he was dismayed to find that
in the slums and was often placed in boarding                   he suffered emotional tension and peculiar feelings
homes while his mother worked. There was no                     every time he met the girl. They saw each other
religion in the family. The father showed no in-                often since they both participated in the activities
terest in the home and the brother had many traits              of the University Theatre where they had met
of a psychopath. The subject was ashamed of his                 originally. He was particularly alarmed and fright-
father and had no close feelings for his brother.               ened over the fact that on several occasions he found
    As the patient matured, he appears to have made             himself on the verge of tears. These emotional ex-
a fairly good adjustment to life, emancipating him-             periences were nearly overpowering, came unexpec-
self from home influence. After some deliberation               tedly, and always occurred in the theatre or other
and conflict he chose the ministry as his vocational            situations associated with the romance. As time
goal. In temperament he appeared extroverted. He                went on, the subject became better able to control
was highly intelligent and had ability as an actor.             his outward behavior and feelings, and he found
On the surface he appeared easy going and good                  some solace in the company of his ex-fiancee's sister.
natured, but he was restless and often became tense.               In the eighteenth week he reports in his diary
 Most of his Civilian Public Service experience was              that his spirits were much improved but that he
 in the mental hospitals where he served as an                  began to experience some difficulty in walking:
 attendant. This contact stimulated his interest in              "My right foot seems unhinged at the ankle. When
 psychiatric disturbances and led him to an unceas-              I step on my heel, the toe comes down with a slap
 ing psychologic analysis of himself and of others.              as if I had no control of the muscles." At the same
 He was a person who had strong feelings and who                 time he noted a transient numbness of the right
 developed strong likes and dislikes. Although he
                                                                 thumb. Two days later he noted for the first time
 tried to be objective, his personal antipathy toward
                                                                 that he was able to converse with his ex-fiancee
 the interviewer to whom he was first assigned was
                                                                 without emotional distress. "No feeling aroused at
 so intense that a change was necessary.
                                                                                                       VOL. X, NO 1
SCHIELE AND BROZEK                                                                                              43
all. She might just as well have been any one of a            considered the condition as probably hysterical al-
dozen other girls I know fairly well."                        though he was puzzled as to how one so wordly and
   This same day he reported to the Staff his                 sophisticated as himself could have hysteria.
new physical complaints. The symptoms included                   The MMPI was normal during control (Fig. 10).
"numbness" near the base of the index finger of               The semistarvation profile, obtained after he had
the right hand, and hypesthesia on the anterior               had symptoms about five weeks, shows the typical
aspects of both legs, extending from below the                elevation on the neurotic end of the curve with the
knee to the toes. He also complained of a peculiar            peak on Hy of 78.
weakness of the right ankle which "gave way"                     Although it seems unlikely, it can be argued that
unexpectedly. All of these symptoms recurred                  there may have been neurologic, nutritional, or other
intermittently.                                               physiologic factors responsible for the development
   Neurologically, the subject's condition was objec-         of the sensory complaints. Even if this were so, it
tively normal on all three occasions at which the             is our opinion that these became the focus for the
subject was examined. He was able to distinguish              hysterical conversion that still plays an important
sharp from dull and to recognize light touch at all           role in the production of the final clinical picture.
times. The hypesthetic area on the hand and the
                                                              Case No. 20
                                                                 This subject suffered a pronounced personality
                                                              deterioration culminating in two attempts at self-
                                                              mutilation. The complex psychogenesis of these
                                                              "accidents" justifies the presentation of this case in
                                                              considerable detail.
                                                                 The subject was 28 years of age; he came from a
                                                              wealthy urban home. His father died when the
                                                              subject was 14 years of age, but he left a consider-
                                                              able fortune. Although our subject is the youngest
                                                              of the three children, he assumed the leadership in
                                                              family matters. His mother exerted a dominating
                                                              influence over her children. Her second marriage
   FIG. 10. Scores on the Minnesota Multiphasic Personality   turned out unhappily, ending in divorce but only
Inventory for subject No. 5 during the control period (C),
after twenty-four weeks of semistarvation (S24), and twelve   after the stepfather had wasted the family fortune.
weeks of controlled rehabilitation (R12).                     The brother, age 31, has been a long-standing prob-
                                                              lem whose academic, occupational, and marital
sensory disturbance of the left leg disappeared per-          ventures were failures. The sister, age 30, has
manently in a few days while the other symptoms               remained at home in order to be a companion to
gradually faded out over a period of ten weeks. The           her mother. The subject was quite concerned about
record of the routine neurologic examination made             her, and feared that she was wasting her life. It is
during the fourth week of rehabilitation indicates            important to note that the subject's family matters
that though the hypesthesic area on the right leg             remained complicated, unsettled, and distressing to
was still reported as present, the subject stated that        him during the time that he was participating in
it no longer attracted his attention. At no time did          the experiment.
any of these symptoms cause real discomfort to the               He graduated from college at the age of 23. He
subject, and he did not show concern over them.               was an able student, especially proficient in lan-
He reported their presence in a matter-of-fact way            guages which he taught for a period of time prior
as a part of the experimental routine.                        to induction into C.P.S. However, his vocational
   That the neurologic symptoms experienced by                plans were confused. The subject was highly intelli-
this subject were hysterical in nature is supported           gent, engaging, extroverted, and had a capacity for
by the negative objective neurologic findings, and            becoming well-liked. He was conscientious, deter-
the vague outline, indefinite localizations, and inter-       mined, and a hard worker with notable humani-
mittent character of the sensory disturbances. They           tarian and social-welfare interests, and he would be
were preceded by a period of relative emotional               a leader in most groups. In spite of these assets he
calm in reference to his love affair. The subject,            showed a peculiar immaturity for his age and back-
who had studied abnormal psychology in college,               ground, expressed in exaggerated standards of him-
JANUARY, 1948
44                                                                    EXPERIMENTAL NEUROSIS
self, vocational indecision, underdeveloped sex life,    formance as I was then, but had completely let go
dependence on his family, and restlessness. Fre-         of myself and couldn't do anything but go on
quently he worked and drove himself to complete          sobbing . . . . ever since I felt like a quitter and I
a task, following which he felt compelled to go to       hate quitters. That wonderful last day has been
bed at home for an extended period of recuperation.      spoiled. I only hope a return of strength will help
The mother also reacts in this manner whenever           me look a little less tragically on today's flop."
forced to confront a difficult situation.                  While the subject was making such a struggle to
   The subject developed the semistarvation neurosis     appear strong during the semistarvation stress, he
in marked degree. He suffered considerably from          had failed to anticipate that the twelve-week re-
hunger, weakness, irritability, and moroseness. His      habilitation period might be little better than the
eating habits became annoying to others because he       preceding starvation. It was his bad luck that he
spent hours in making "God-awful" concoctions            was assigned to the next to the lowest caloric group.
and odierwise dawdling over his food. Since he           The going was tough for him and the thoughts of
had appeared at the start as the strong man who          continued participation in the experiment were be-
could "take it," the personality changes were espe-      coming unbearable.
cially distressing to him. He was hurt by his drop          At the end of the first week of rehabilitation he
in popularity. However, he continued to take a           injured his left hand when his automobile slipped
strong stand until the fourteenth week when doubts       off the jack. One finger was torn three-fourths off
began to creep in.                                       at the distal phalanx and required outpatient surgi-
   "My philosophy of pushing mentally and physi-         cal care. He made it appear that this was an acci-
cally is quite obviously breaking down." He felt         dent but confided the trudi to one Staff member.
that he had had about all he could take. Only the        In order to get out of the experiment he had
approaching end of semistarvation some ten weeks         attempted to mutilate himself; he had done an in-
away enabled die subject to hold together. Yet his       complete job because he lost his nerve at the last
strength of character was being shaken by the temp-      moment. The injury was not serious enough to
tation to escape from the stressful situation. He        warrant his release from the experiment. His
wrote, "I have had a horrible thought today. My          psychologic tension was not relieved after the acci-
cold has settled into an annoying cough, and I got       dent nor following his confession.
to thinking how pleasant it would be to contract            The next week his diary indicated that he was
tuberculosis, merely for the rest and food involved      painfully aware of the fact that he no longer could
in its treatment. I am terribly ashamed of die           hold up during this unexpected continuation of the
thought, but it came so here it is on paper. This        stress, let alone appear as a strong man. "This has
awful week has undoubtedly contributed to its            been my worst week of the entire experiment. It
development. I hope more awful weeks don't pro-          has been caused probably by the realization that I
duce more ghastly ideas."                                have been subconsciously setting my sights at the
   For a time his determination rallied. He wrote        end of starvation, considering getting through that
that even if he developed tuberculosis he would          stress as the job before me and expecting a letdown
insist on remaining in the experiment for the benefit    and rest after it. Of course such a letdown was not
of medical science. Shortly thereafter he attempted      possible; in fact, the most important part of the
to burn the bridges by committing himself to an          experiment is the present one, and the job won't be
extra two-month period of furdier experimentation        completed until October [ten weeks away]. Unfor-
after the end of twelve weeks of controlled refeeding.   tunately, I wasn't ready for the strain of rehabilita-
   On the last day of semistarvation he collapsed on     tion and when it came I almost cracked under it.
the treadmill. Although this should not have been        I have had grave doubts recently about my physical
considered unusual in view of the subject's physical     and mental ability to continue the experiment.
weakness, he suffered an acute emotional upset be-       Since quitting is so obviously contrary to my basic
cause he felt diat he had failed to live up to the       desires and common sense, I have run into an awful
standards which he set for himself. ". . . . I've        conflict that has been intense enough to make me
been miserable all day because I fell down on the        wonder whether I am losing my mind. I can't
job. To have held out this long and then on the          promise that I won't blow up in some manner,
last day to fold is more than discouraging. I feel as    letting off the steam that is still within me."
though I had failed in someone's trust. I started           Two days later he writes, "God grant us no more
 bawling like a baby and kept it up for a long, long     weeks like this one. Physically I have felt much as
 time. I have never been so ashamed of any per-          at the end of the starvation period. Mentally I have
                                                                                                VOL. X, NO. 1
SCHIELE AND BROZEK                                                                                                45
been more depressed than ever in my life. I have            all I could do was think of home. I had so little
decided to will some cheerfulness and pep into              control over my mind that I was afraid I would lose it.
                                                            One morning at breakfast I came closer to an act of
myself. We shall see how that makes out. Unless             violence that I ever had before. Someone across the
I force myself to be cheerful, I feel sure that I'll sink   table—I can't remember who—will never know how
into hopeless slough of despondency which could             close he came to having a tray smash down on his
lead into a complete mental and physical break-             head. He'd done nothing. I just wanted to be at my
                                                            mother's and not at the breakfast table in Shevlin
down. I am scared of such a thing and am deter-             Hall. It was all going on in my mind. I just felt
mined to avoid it if possible. I think the only way         that I had cracked. Finally, in bed at night I tried
to avoid it is to make myself do things I don't feel        to be as objective as I could and I've managed to
like doing, keeping busy at something, anything at          force myself to stick until July 29 [end of semistarva-
all, so long as I am busy. Inactivity will drive            tion]. On the last day of semistarvation, well, I didn't
                                                            finish it . . . I only lasted ten seconds on the treadmill
me nuts."                                                   and that upset me and I bawled for a half hour and
   While he was in this unhappy state of mind, his          then more. I was so disappointed to flop at the last
sister came to visit him. Their visit started off badly     test . . . As for this [referring to the lost of the
                                                            fingers], I don't know. I had made up my mind to
as there were many troublesome family affairs to be         stick it through to October 20. I felt I'd be demobilized
discussed. The next day, in spite of this additional        by the end of my leave. I felt there'd be no point
stress, his spirits lifted remarkably. That evening         in this at this time when the war is over. How silly
he and his sister went to the home of a friend.             it had been to drop a car on my fingers, I thought.
                                                            I certainly had no idea I'd do this [sic!]. I am now
While his sister had dinner with their hosts, the           back at the place I was; that is, I'd like to get a 4-F
subject went into the yard to chop wood as he had           and go home. I'm afraid, what will I do next?
often done before. He somehow managed to chop
off three fingers of his left hand. He was given               Although the subject was kept on the same caloric
emergency surgery in the Student Health Service at          level, he did receive in the hospital a few variations
the University Hospitals where he remained for              in diet items (e.g., fruit, etc.). He appeared to
five days.                                                  enjoy the experience immensely. The bed rest,
   On the day following the accident the subject,           attention, and freedom from routine during a few
while mildly distraught, talked freely and indicated        days of hospitalization appear to have satisfied his
his partial insight into the psychodynamics involved.       immature, dependent needs and to have served as
The following is a verbatim record of an interview:         a satisfactory substitute for home and his mother.
                                                               After the release from the hospital, the subject
   I've always thrown myself into everything I did and
have done it very hard. Afterward I have reacted with       was persuaded to remain in the experiment and was
fever and collapse and have been babied by my mother.       able to carry on during the remaining two months.
I have recently had the stress of this pneumonia and        The pain suffered may have served as punishment
then the last month of semistravation was very tough,       for failing to perform up to expected standards and
especially the edema. On top of that I've had a difficult   for the desires to leave the experiment; it may have
home situation. My brother is a rotter. I owe it to
my mother and sister to spend time at home. I asked         expiated his sense of guilt.. Also, he was being
to be taken off the list of those going abroad since        slowly rehabilitated physically and was approaching
my mother's affairs are more important. Then reha-          the end of the regimentation imposed by the experi-
bilitation started. I had looked to six months of star-     ment and the C.P.S. assignment.
vation as a job to be done and I did it. But then I
had no chance to relax and rest and let down. When             In subsequent interviews he almost completely
rehabilitation started, I was still hungry. It was really   repressed the purposeful nature of the accident.
more starvation. In fact, I suffered from more hunger       Although he could not clearly explain nor describe
because I could not take food out [to make "sand-           exactly how it happened, he gave "rational" sug-
wiches"] as I had before. I was blue over the whole
thing. I was in a weird frame of mind. I thought            gestions: he was "too weak," had poor control, it
that there was only one thing that would pull me            was uncomfortable to hold the ax with both hands
out of the doldrums, that is release from C.P.S. I          because of the sore fingers on the left hand (pre-
decided to get rid of some fingers. Ten days ago            viously smashed in the auto-jack incident), the ax
I jacked up my car and let the car fall on these fingers.
It missed them all except it crushed the end of one         must have hit a branch, etc. He argued strongly
finger [same hand]. That's not normal. It was pre-          that the accident had no personal motivation, yet he
meditated. Since then I have begun to worry about           did make this comment: "I wasn't myself for two
my state of mind. I have also worried about the family;     weeks. I may be more valuable to the experiment
my brother's wacky, my sister's very worried over my
mother, and maybe there's something wrong with me           than if I hadn't done it." From this time on he
too. I've always been able to sleep, but not last week;     carefully avoided all mention of the accident, though
I tossed and turned. I tried to do some reading but         he continued to talk and write freely on everything
JANUARY, 1948
46                                                                       EXPERIMENTAL NEUROSIS
else. He was puzzled over a newly acquired aver-          severely from a conflict between the desire to escape
sion for psychology and psychologists; this appears       from the painful situation and the desire to save
to have been a defense against self-revelation.           face. The psychologic situation was further compli-
   It is of psychologic interest that the pattern of      cated by distressing home conditions. All this led
self-mutilation appears to have been suggested by         to a severe emotional conflict.
an experience two years earlier which he never once          The first attempt to solve this conflict was through
mentioned while at the Laboratory. At a previous          deliberate self-mutilation (smashing his hand).
C.P.S. assignment he give first aid to one of his close   After this abortive attempt he was disgusted with
friends who had lost several fingers in a buzz saw;       himself, miserable, and depressed. The second
this friend was subsequently given a 4-F and re-          "accident" appears to have been brought about by
leased from C.P.S.                                        more unconscious mechanisms. The action, while
    It may be relevant at this point to consider some
observations made in Japanese camps for Allied
prisoners of war (6). The malnourished men
tended to become accident-prone due to fatigue and
weakness. Some of -the accidents resulted from
faulty machinery and lack of protective equipment,
e.g., lack of goggles during work in which arc-
welding torches were used. On the other hand,
purposive accidents also occurred; the prisoners
 would intentionally injure themselves in order to
be released, at least temporarily, from work. Nutri-
 tionally they did not gain as the food received by
the sick prisoners was usually less, sometimes only
 hal'f of the ration received by men who were able
•to work. By design these "accidents" were to result
in minor injuries but sometimes the trick proved
only too successful. Thus Curtin reports that one
 prisoner had his right hand and forearm torn and
crushed by machine in a brick factory, and another           FIG. 11. Scores on the Minnesota Multiphasic Personality
su'ifeFed a traumatic amputation of two toes and          Inventory for subject No. 20 during the control period (.C)>
                                                          at the end of starvation ($24), in the second week 6i
 pa«t of his foot.                                        rehabilitation (R2), and at the end of controlled rehabili-
   The MMPI profile taken during standardization          tation (R12).
is normal, while the one taken at the end of semi-
starvation is severely neurotic in type (Fig. 11). At     not providing a solution of the underlying problems,
the second week of rehabilitation the D score has         did have a therapeutic effect which enabled the
fmrther increased by nearly one standard deviation        subject to complete the experiment.
and, more significantly, the psychotic end of the
profile has shown a marked rise. Such a profile                                DISCUSSION
indicates that the subject is under a severe stress
which he is not able to handle. This profile was          The Nature of Personality Changes in Starvation
obtained four days after his first accident and six          Except for the presence of clinical edema, the
days before his second one. The scores at the             anatomic and physiologic changes resulting from
twelfth week of rehabilitation indicate a slow re-        semistarvation were essentially similar in all sub-
turn toward normality.                                    jects. In the psychologic and social aspects the indi-
   In summary, subject No. 20 displayed in a severe       viduals varied to a greater extent, although there
•degree the usual personality changes of "semistar-       was enough similarity in the response to the stress
vation neurosis." The physical deterioration con-         that we may speak of "semistarvation. neurosis."
flicted sharply with his pattern of always being the      The greater variation of the psychologic manifesta-
strong man. By expecting rapid rehabilitation, he         tions of starvation was due to etiologic complexity
misgaged the deration of the stress; because of his       of the behavioral responses, large individual differ-
 "all or none" pattern he was particularly unpre-         ences in basic personality make-up, and, most im-
 pared for this and was unable to make the necessary      portantly, less uniformity imposed by the experi-
.psychologic adjustment. In addition he suffered          mental regimen in this area.
                                                                                                     VOL. X, NO. 1
SCHIELE AND BROZEK                                                                                         47
   The behavioral, emotional, and social manifesta-      problems of social ethics and, in particular, of
tions of starvation may be looked upon as psycho-        participation in military activities.
somatic phenomena in the broad sense; that is, they
are the results of a complex interaction between         Factors Unique to the Minnesota Experiment in
anatomic, physiologic, individual-psychologic, and
                                                            Contrast to Natural Starvation
social-psychologic factors. In view of the psycho-
pathologic effects of vitamin deficiencies it may be        There was a number of factors alleviating the
noted that the diet was fully satisfactory as far as     stress of semistarvation, incidental to the controlled
the vitamins, and especially the vitamin B complex,      conditions under which it was conducted. The sub-
are concerned.                                           jects were provided with good physical care. They
   Behavioral changes often represented useful or        had comfortable, healthful living quarters, adequate
necessary adjustments. Thus loss of strength and         clothing and sanitary facilities. They had oppor-
endurance, accompanied by irritability and general       tunity to participate in the curricular and extra-
discomfort, are partially compensated for by de-         curricular activities at the University, had their own
crease in physical activities and reduced social con-    educational program focussed on training men for
tacts. For example, attempts to participate in such      European relief, and their recreational facilities
activities as dancing resulted in painful fatigue; the   were excellent. Their food was controlled and there
subjects learned to avoid this type of experience as     was no struggle for existence. The subjects were
they became aware of their increasing physical           secure in the knowledge that their food would be
debility. A decreased body temperature was com-          served and that it would be available regularly.
pensated for by the use of more clothing and bed         More importantly, they knew that the starvation
covers, by the revelling in hot showers, and by the      phase would end after six months and that rehabili-
demand that food be very hot. Physiologic changes        tation would follow. They were given competent
affecting the hormonal system such as decreased          medical supervision and were free from the political
activity of the sex glands (and possible other           and social turmoil that commonly accompanies
glands) modified the character and intensity of the      naturally occurring starvation.
sex "drive." Compiling of receipes and poring over          On the other hand, some of the provisions and
cookbooks may be considered as one of the mecha-         restrictions imposed by the experimental regimen
nisms compensating for prolonged hunger.                 increased the severity of the stress as compared
                                                         with naturally occurring starvation. The subjects
Similarity to Natural Starvation                         voluntarily starved in the midst of plenty and were
                                                         unable to improve their nutritional condition by
   The basic picture presented by our subjects dur-      personal effort and ingenuity. The limitation of
ing semistarvation is essentially comparable to that     personal freedom required by the experimental
seen in "naturally" occurring famine (5). This was       program was in itself a hardship.
clearly evident in the anatomic and physiologic             There was a natural, strong conflict between the
effects—weight loss, emaciation, weakness, reduced       desire to continue to participate in the experiment
basal metabolism rate and pulse rdte, edema, etc.        and to gain all the satisfactions resulting from it on
The psychologic effects of starvation, such as hunger,   the one hand, and the desire to escape from the
intense preoccupation with food, irritability and
                                                         painful situation. Although the men committed
depression, and social introversion observed in the
                                                         themselves at the start, there was no other but moral
Minnesota Experiment have also their parallels in
                                                         pressure to keep them in the experiment. Actually,
famine.
                                                         the only formal penalty would have been a transfer
   This indicates that the fact that the subjects were   to another C.P.S. camp. It was a particular strain
conscientious objectors did not distort the psycho-      on the character of the subjects that a large measure
physiologic relationships between decreased food         of responsibility for conforming to the experimental
intake and behavior. We wish to emphasize that in        regimen was placed directly on them. It should be
the standardization period the subjects were clini-      noted that the subjects were allowed to go freely
cally completely normal. Their underlying char-          to the homes of friends, into restaurants for black
acter and personality were approximately those           coffee, etc. About midway in the semistarvation
which one could find in good average citizens of         period it became necesssary to establish a buddy
comparable age, intelligence, education, and social      system in order to lessen this strain. The buddy
economic background. However, there were signifi-        system in time became a powerful source of irrita-
cant differences in the area of attitudes toward         tion in itself.
JANUARY, 1948
48                                                                     EXPERIMENTAL NEUROSIS
The "Experimental       Neurosis"    Resulting    from    stresses of combat tend to reduce all individuals to
  Semistarvation                                          a common denominator, . . . the combat person-
                                                          ality. . . . There is a considerable repetition of
   To a large extent the same stresses of semistarva-     symptoms, attitudes, and experiences" (9, p. 119).
tion were shared by all the subjects. An attempt had
                                                             In addition to the commonly shared neurotic
been made to adjust the desired weight loss in such
                                                          symptomatology, some subjects manifested forms of
a way that the weight decrement would take into
                                                          behavior deviating not only from the prestarvation
account the "nutritional status" at the start of the
                                                          condition but also from the general patterns of
semistarvation period, and thus to equalize the
                                                          simple "semistarvation neurosis." A response to the
physical stress inherent in the loss of weight. The
                                                          semistarvation regimen was considered as "abnor-
subjects shared the same living quarters and were
                                                          mal" if it appeared to be inefficient, unusual, exag-
exposed to the same experimental regimen. The
                                                          gerated, or contrary to the main purpose of the
resulting behavioral changes summarized by the
                                                          experiment.
inadequate term of "semistarvation neurosis," were
necessary and universal; hence, they may be con-             Excessive gum chewing was one of the reactions
sidered as "normal" reactions under the given cir-        which may be considered as an "inefficient" mecha-
cumstances although they markedly deviated from           nism. It was started in an attempt to alleviate
the prestarvation pattern of behavior.                    hunger and nervous tension, but it was continued
                                                          compulsively in spite of the fact that it failed to give
   The term "neurosis of inanition" has been used         the desired result and, in addition, caused a sore
by Aronovitch in his description of the effects of the    mouth and an unnecessary expenditure of funds.
Russian famine of 1918-1921; speaking specifically        This symptom occurred in great intensity in 4 sub-
of children he wrote that "the neurosis of inanition      jects; 2 of these failed to adhere to the semistarva-
manifested itself . . . in a combination of unusual       tion diet.
vindictiveness, extraordinary irritability, and chronic      The subject who chopped off his fingers certainly
crying," (quoted in 18, p. 19). Yet it is with hesita-    showed a reaction which was both inefficient and
tion that we applied the term "neurosis" to those         unusual; it was a roundabout way to achieve the
changes which were common to all semistarvation           end in mind. The hysterical sensory disturbances in
subjects. In this sense we are in a position some-        subject No. 5 can be also classified as unusual.
what analogous to those who dealt with the "war              The personal antagonism created by subject No.
neuroses."                                                29 represented a reaction of the rest of the group
   The core of the difficulty lies in the fact that in    to an exaggerated irritability. Some of the manner-
psychiatric terminology no adequate provision is          isms and ritualistic eating habits, such as intermin-
made for concepts and terms differentiating various       able "souping" of food, belong also to the category
degrees of deviation, from normal to clearly patho-       of exaggerated responses.
logically abnormal. It would be incorrect to speak           Eating off the diet was contrary to the purpose of
of "subdinical" psychoneurosis as we do in cases          the experiment. A strict adherence to the dietary
where the emotional and behavior changes are not          regimen was an essential criterion of conformity to
marked enough to enable us to decide whether the          the social values of the subject group, and those who
changes are severe enough to be considered "patho-        did not adhere to the agreed restrictions exhibited a
logic." That semistarvation did provoke clearly           behavior pattern similar to ordinary antisocial ac-
observable changes in behavior, affected the mood         tivity. It should be emphasized that with one or
and sense of well being, and reduced the efficiency       two exceptions this did not consist in a rational act
of the men in their daily living, social contacts, and    of procuring food such as one might obtain in a
program of study, all indicate that there was an          resturant. On the contrary, the subjects' inefficient
unusual condition present. On clinical grounds this       and neurotic approach to the solution of the prob-
condition can be considered as a "neurosis."              lem of hunger is shown by the fact that those who
   A similar situation is present in combat. It was       broke diet ate garbage, raw rutabagas, infinitesimal
recognized that under conditions of sufficient stress     amounts of food, or in other ways attempted to
all men show to some degree a failure of "normal"         minimize their behavior discrepancies and expiate
adaptation, the failure being evidenced by "neurotic"     their guilt.
symptoms. "Such symptoms are . . . pathological              Why did some men develop these abnormal be-
only in a comparative sense, when contrasted with         havior patterns? Generally one may attempt to
the symptoms of those still making successful adap-       interpret the behavior differences in the light of
tations" (9, p. 7). As in starvation, "The universal      psychophysiologic constitution, past history, and
                                                                                                   VOL. X, NO. 1
SCHIELE AND BROZEK                                                                                           49
present situational factors. In some of our cases         tation. The men lost on the average about one-
we were able to interpret the abnormalities of be-        fourth of their original body weight, and exhibited
havior in these terms. In other instances the mecha-      profound changes in a number of physiologic
nisms were not completely clear.                          functions.
   The severity of the stress of the whole experiment        All subjects developed emotional and personality
removed the superficial facade, the "persona,"' and       symptoms of "semistarvation neurosis" varying in
brought out into a shaper relief the individual           intensity from mild to severe. In the majority of
strengths and weaknesses. The situation was essen-        cases these symptoms receded during the following
tially similar to the differential responses of an        twelve weeks of controlled rehabilitation. On fol-
apparently homogeneous population to any other            low up, after an additional period of twenty-one
stress. Thus under combat conditions the individual       weeks of unrestricted rehabilitation, the men were
personality differences become more manifest than         back to their prestarvation normal. Thus the psy-
during regular army routine; in the face of the           chologic disturbances, induced by the semistarvation
social and physiologic stressful factors involved in      regimen and relieved on refeeding, can be con-
the war-army situation, "a latent schizophrenia may       sidered as an experimental psychoneurosis.
be precipitated or a manic-depressive reaction re-           In the present paper, attention was focused on
leased; an incipient neurosis will acquire definite       9 subjects selected because they exhibited symptoms
configuration, a deep hypochondriasis may be              of special interest from the neuropsychiatric point
touched off, an old psychosomatic response revived,       of view.
and individual personality traits precipitated into          Two men suffered from paresthesias of probable
definite form," (11, p. 29).
                                                          physiologic origin. One had sensory and motor
   The fact that under the experimental stress of          disturbances, probably hysterical in nature.
semistarvation the individual differences increased          Another subject suffered a psychogenic accident.
is demonstrated also by the rise in the standard              In 4 men the reaction to the stress took the form
deviations of the individual scores on the "neurotic"      of a character neurosis. The disintegration mani-
scales of the MMPI. Thus the standard deviation            fested itself by inability to adhere consistently to the
of the Hypochondriasis scores for the 32 men who           diet. Under the moral and social pressures to con-
completed the experiment increased from 3.4 in             form to the experimental regimen, one of these 4
control to 6.6 at the end of the semistarvation period.    developed a pathologic reaction bordering on psy-
For Depression the corresponding values are 6.5 and        chosis; this cleared rapidly upon his release from
 12.1, for Hysteria 6.1 and 8.2. Similarly, in fatigue     the experiment.
resulting from intensive visual work under inade-             One subject had a history of previous personality
quate illumination it has been observed that the           difficulties, cyclothymic in character. These were
individual differences in performance tend to be-          exaggerated by the stress but clinically did not reach
 come magnified (4). The technique of applying a           clearly pathologic intensity. When nutritionally re-
 "stress" such as standardized physical work in dis-       habilitated this man appeared to have benefited
covering latent deficiencies in the cardiovascular
                                                           psychiatrically from the successful participation in
 system which escape if the subject or the patient is
                                                           the experiment.
 examined at rest is a well established procedure for
                                                              One case, exemplifying those subjects who com-
 characterization of "fitness" in man (19).
                                                           pleted the experiment with minimal personality
   Ex post facto it appeared that men with a.more          deterioration, was included to provide a contrast
stable personality make-up showed minimal deterio-         with men who developed more frank neuropsychi-
ration while those with latent personality weak-           atric symptoms.
nesses developed more severe symptoms; however,
it should be acknowledged that we would have been                       ACKNOWLEDGMENT
unable to predict, with any degree of certainty
before the start of the stress, which individuals             We wish to express sincere thanks, for cooperation
would develop "abnormal" reactions.                        and help, to the director of the Laboratory of Physi-
                                                           ological Hygiene, Dr. Ancel Keys, the senior staff
                       SUMMARY                             of the Laboratory (Drs. Austin Henschel, Olaf
                                                           Mickelsen, Henry Longstreet Taylor, and Miss
  Thirty-six men recruited from the Civilian Public        Angie Mae Sturgeon), and Messrs. Joseph C. Frank-
Service camps volunteered for an experiment on             lin and Harold Guetzkow who participated in the
semistarvation and subsequent nutritional rehabili-        project as assistant psychologists. The semistarva-
 JANUARY, 1918
50                                                                                 EXPERIMENTAL NEUROSIS
tion experiment was a cooperative venture. It would                 8. FRANKLIN, J. C ,     SCHIELE, B. C ,    BROZEK, J., and
have been impossible without the devotion of the                           KEYS, A. Observations on human behavior in ex-
                                                                           perimental semistarvation. J. Clin. Psychol. (in
men who volunteered to serve as subjects in this                           press).
rugged assignment.                                                  9. GRINKER, R. R., and SPIEGEL, J. P. Men Under Stress.
                                                                           Philadelphia, Blakiston, 1945.
                                                                   1U. HATHAWAY, S. R., and MCKINLEY, J. C.         Manual for
                      BIBLIOGRAPHY                                         the Minnesota Multiphasic Personality Inventory.
 1.   BROZEK,   J.,   FRANKLIN,   J. C ,   GUETZKOW,   H.,   and           Minneapolis, Univ. of Minn. Press, 1942.
        KEYS, A. Human behavior in prolonged experimental          11.   KARDINER, A., and SPIEGEL, H.      War Stress and Neu-
        semistarvation. Am. Psychol. 1:269, 1946. (Ab-                     rotic Illness. New York, Hoeber, 1947.
        stract.)                                                   12.   KAZAN, A. T., and SHEINEERG, I. M. Clinical note on
2.    BROZEK,   J., FRANKLIN,     J. C ,   GUETZKOW, H.,     and  the significance of the validity score (F) in the Min-
        KEYS, A. Recovery after 12 weeks of controlled re-        nesota Multiphasic Personality Inventory. Am. J.
        habilitation following experimental semistarvation in     Psychiat. 102:181, 1945.
        man. Am. Psychol. 2:329, 1947 (Abstract).           13. KEYS, A. Human starvation and its consequences.
 3. BROZEK, J., GUETZKOW, H., and KEYS, A. A study of             J. Am. Dietet. A. 22:582, 1946.
      personality of normal young men maintained on re-     14. LEYTON, G. B. Effects of slow starvation. Lancet 2:73,
      stricted intakes of vitamins of the B complex. Psy-         1946.
      chosom. Med. 8:98, 1946.                              15. MASSERMAN, J. H. Principles of Dynamic Psychiatry.
 4. BROZEK, J., SIMONSON, E., and KEYS, A. A work, test           Philadelphia, Saunders, 1946.
      for quantitative study of visual performance and      16. MCFARLAND, R. A., GELLHORN, E., ADOLPH, E. F.,
      fatigue'. J. Appl. Psychol. (in press).                     SHOCK, N. W., and RICHTER, C. P. The internal
 5. BROZEK, J., WELLS, S., and KEYS, A. Medical aspects           environment and behavior—A symposium. Repr.
      of semistarvation in Leningrad {Siege 1941-1942).           from Am. J. Psychiat. 1941.
      Amer. Rev. Soviet Med. 4:70, ;1&4'6."                 17. PAVLOV, I. P. Conditioned Reflexes and Psychiatry.
 6. CURTIN, A. P. Imprisonment undeptche Japanese. Brit.          Transl. and ed. by W. H. Gantt. New York, Inter-
      Med. J. 2:585, 19.46. •                                     national P., 1941.
 7. The Experience of the American Friends Service Com- 18. SOROKIN, P. A. Man and Society in Calamity. New
      mittee in Civilian Public Service under the Selective       York, Dutton, 1942.
      Training and Service Act of 1940 (1941-1945). Phil-   19. TAYLOR, H. L., and BROZEK, J. Evaluation of fitness.
      adelphia, Amer. Friends Service Committee, no date.         Federation Proc. 3:216 1944




                                                                                                                VOL. X, NO, 1
A N N U A L MEETING                                                                                         51



                      FIFTH ANNUAL MEETING: TENTATIVE PROGRAM
        Announcement is made by the Program Committee of the following tentative program for the
      Fifth Annual Meeting, Chalfonte-Haddon Hall, Atlantic City, New Jersey:

      Saturday, May 1, 1948

          8:30 a.m.     Registration

          9:30 a.m.    General Session.
                          Chairman: Dr. Carl Binger
                                            Six papers to be presented, the remaining ones, if acceptable
                                            to the Committee, to be read by title.

          2:30 p.m.     Psychosomatic Problems in Pediatrics.
                           Chairman: Dr. Milton J. E. Senn
                                Psychosomatic Consequences of Emotional Experiences in the First
                                Year of Life—with film.
                                    Dr. Rene A. Spitz
                                Somatic Defense Mechanisms in Ego Development.
                                   Dr. Margaret Gerard
                                The Significance of the "Emotional Climate" in Early Feeding Diffi-
                                culties.
                                     Dr. Marian C. Putnam and Dr. Gregory Roclilin
                                Physical Tension in Emotionally Disturbed Children: Contribution to
                                the Problem of Personality Integration.
                                    Dr. Emmy Sylvester
                                Psychosomatic Aspects of Diabetes in Childhood.
                                    Dr. Hilde Bruch

          8:00 p.m.    Panel Discussion on Methods.
                          Chairman: Dr. Franz Alexander

      Sunday, May 2, 1948

          9:30 a.m.    Annual Business Meeting, for members only.

         10:00 a.m.    Psychosomatic Problems on Diabetes.
                          Chairman: Dr. I. Arthur Mirsky

                                Control of Diabetes.
                                    Dr. Howard F. Root
                               Newer Concepts in the Treatment of Diabetes.
                                  Dr. Edward Tolstoi
                                (Title to be announced later)
                                     Dr. George E. Daniels
                                (Title to be announced later)
                                     Dr. Samuel Soskin
                                (Title to be announced later)
                                     Dr. Francis Lukens
                                (Title to be announced later)
                                     Dr. Sydney G. Margolin




JANUARY, 1948