ECOLOGIC MENTAL ILLNESS HOW INTEREST DEVELOPED 1949-1950*
by Theron G. Randolph, MD, University of Michigan Medical School; board certified in internal medicine and in allergy and immunology; author and coauthor of numerous medical articles and books; a founder and past president of the Society for Clinical Ecology, now the American Academy of Environmental Medicine and considered the father of clinical ecology; also, president of the Human Ecology Research Foundation and a founding member of NOHA's Professional Advisory Board.
Having observed the induction of acute psychotic episodes after the test feeding of given foods during the period 1945-1949, the writer was only partially prepared for the course of events to be described, which took place in late1949.
"Did you say you want to transfer her to the psychiatric floor? I can't believe it. She was fine when I saw her during dinner."
The nurse then went on to say, "She has been increasingly hyperactive, irritable, and negative to suggestion during the past half hour. She refuses to stay in bed and demands more air. We have to watch her every minute or she will stagger to the window and open it or rush to the exit door to get out of the hospital. She is ravenously hungry and drinking water excessively."
This conversation took place about 8:30 PM, interrupting a talk I was giving before a suburban parent-teachers group. I left an order for her to be given a large dose of paraldehyde and returned to my talk. I was still wondering what had happened to this patient when the telephone rang again 10 minutes later. "Doctor, it is going to take more than a sedative to handle this patient. She is kicking, screaming, rushing for the stairs and is becoming increasing hostile and belligerent. All the personnel on the medical floor are immobilized merely hanging on to her. May we tie her down?"
At this point I gave permission to obtain round-the-clock psychiatrically trained nurses on the case and to apply physical restraints on all extremities. Sending her to the psychiatric floor was out of the question because of the utter lack of dietary control there. The reasons for this decision will be apparent after a brief review of her history.
Some six months earlier, a doctor in an adjacent state had asked me to see this 32-year-old woman secretary, who in early childhood had been subject to a stuffy nose, bronchitis, mild asthma, and intermittent hives. Headaches, which had been present since the age of 15, had become continuous, increasingly severe, and associated with extreme fatigue, mental confusion, and depression. Superimposed on this predominant level of headache, fatigue, and depression were acute intermittent episodes of hyperactivity and incoordination, suggesting drunkenness. With time, these acute episodes-best described as compulsive wandering mania-were followed by depression in which she remained semi-stuperous, regressed to childhood levels, and was disoriented for two to three days at a time. Upon recovery, she was unable to recall what had transpired. Psychiatrists had diagnosed her condition variously as early schizophrenia, advanced psycho-neurosis, and hysteria.
A week earlier, when she had arrived for her initial office visit with me, she had complained of a very severe headache. She was so dopey and confused that I was unable to obtain any additional history. Indeed, she was unable to recall what she had eaten for breakfast, who had taken her to the plane, and most other recent events. As a consequence, she was admitted to the hospital and placed on an elimination diet, avoiding wheat, potato, and chocolate, preparatory to performing individual food ingestion tests. Within 24 hours, coffee and beet sugar were also avoided, based on the observation that drinking coffee with beet sugar provided temporary relief of her headache. After becoming increasingly withdrawn, irritable, confused, depressed, and achy for the next three days, these advanced withdrawal-type symptoms improved, coincident with the temporary recurrence of nasal stuffiness and itching. By the end of the fifth day all symptoms had subsided, she was adjusting normally to others and spending her time campaigning for General Eisenhower's nomination for president.
Having learned that she had been drinking approximately 45 cups of coffee daily and that each cup had contained two teaspoonfuls of beet sugar and having observed her eating beets as a vegetable in the previous evening meal-the first material of beet origin in five days-I reasoned while driving home that this acute psychotic episode was probably on the basis of a test reaction to beets. Upon arriving home I learned that all was quiet at the hospital.
I saw her early the following morning. She was pulling and tugging at her restraints. Her eyes were puffy. She recognized neither the intern nor me. Indeed, she didn't know her own name, where she was, nor what day it was. She spoke in a monotonous complaining voice with little change in facial expression. Her general behavior and vocabulary were those of an irritable, whining four-year-old child.
Curious to know what her behavior might be like without the restraints, we complied with her persistent requests, innocently, and removed them. Eluding both of us, she dashed out the door and was well on her way to the exit stairs when caught by the intern. The two of us had our hands full in placing this slight woman back on the bed and reapplying her restraints.
When resting from our exertion in the conference room, the intern inquired incredulously, "What happened to her? She was fine when I saw her early last evening." Sensing that he was at a total loss to explain what had occurred and living up to my reputation as the local food-allergy "nut," I replied simply, "Oh, something she ate, probably the beets she had for dinner." As might have been expected, the new intern burst forth into hilarious laughter. Before outlining my suggestions, I asked him for his recommendations, but none were forthcoming. I then explained how a patient is essentially addicted to a food that is eaten regularly and frequently to perpetuate the stimulatory effect immediately following each feeding, how such a food is rarely every suspected, and how the sugars and other rapidly absorbed foods are especially effective in maintaining such a process. I then pointed out her enormous intake of beet sugar, her withdrawal effects when it had been avoided, her subsequent improvement when it and certain other foods had been eliminated, and, finally, the timing of this probable, acute test-reaction to beets as a vegetable-the first material of beet origin in the past five to six days. Having no alternative program, he agreed to go along with the suggestion to say nothing to or in front of the patient about plans to follow the same diet upon which she had previously improved. I predicted that if this was a reaction to beets, she should be back in contact within two to three days and probably over the entire episode within four to five days. In such an event, she would be fed beets again to determine if the reaction could be reproduced. To the house officer's interested surprise, this is exactly what happened.
After her recovery we accustomed her to the passage of a stomach tube each morning. After beets were fed blindly by intubation on the second morning, an identical reaction developed, confirming her extreme degree of susceptibility to this food. Another time, she obtained beet sugar by error and developed a similar psychotic episode. On each occasion, her reaction required approximately five hours from the time of exposure to reach maximal intensity, see stimulatory level (++++) in the chart below. At such a point the overall speed of the reaction slowed and merged with approximately the same withdrawal level (----), from which recovery occurred during the following four to five days.
In a relatively mild reaction to wheat, which reached stimulatory level (++), her craving for "sweets" became so intense that she willfully ate beet-sugar-containing, hard candy. After a slight lag, she then went on to a (++++) (----) reaction as described.
Her test reaction to bitter chocolate sweetened with honey (to which she was not sensitive) was most interesting in that she was observed for several hours as the (+++) initial stimulatory phase merged with the (----) withdrawal phase. The chocolate was given in lieu of lunch. She was observed to eat the evening meal in intermittent stimulatory waves of approximately 20-minutes duration. For instance, she would eat for a few minutes, frequently drinking water, while walking about the room. A few minutes later, she would be nauseated and depressed, climbing back into bed and sometimes taking a short nap. Upon arousing, she would repeat this stimulatory-withdrawal sequence. During one such stimulatory period, after completion of the meal, she asked her nurse to refill her opaque water jug. Although this was done promptly, a few minutes later the patient criticized the attendant for not having brought the water, whereupon the nurse poured out a glassful.
It was then apparent for the first time in this reaction that she had been temporarily amnesic during the depths of her withdrawal phases. After this, I quizzed her during the following hour and determined that with the recurrence of each withdrawal she had become amnesic and disorientated in regard to time, place, and person for progressively longer periods until these symptoms prevailed throughout the cycle, which by now was becoming somewhat longer than initially.
After leaving the hospital this patient remained well except for several accidental exposures to beet sugar. In early 1950 she aggreed to be rehospitalized for the purpose of recording an experimentally induced acute psychotic episode by means of motion pictures and tape recordings. Mr. Arthur Siegel, a professional photographer, volunteered his time and equipment in photographing and editing this motion picture.
A stomach tupe was passed each morning. A preliminary blind intubation of milk was not followed by any evidence of reaction. The blind intubation of macerated beets and beet sugar reproduced the sequence described above. Four thousand feet of film, as cut to 1,200 feet for the edited version of the motion picture, illustrate the salient features of an experimentally induced, advanced psychotic reaction. This case report, as well as the levels of reaction, have been reported in the medical literature. During the past two decades [1950-1970] this motion picture has been shown many times in this country and abroad. As far as can be determined, it represents the first recorded instance of a food-induced, acute psychotic episode of this degree of severity.
This clear-cut demonstration of cause and effect in this advanced case, as well as the stimulatory and withdrawal levels and transitional waves, provoked interest in studying mental illness from the standpoint of the impingement of non-personal environmental exposures in susceptible persons. Observations in this case, confirmed and extended in others during the past two decades [1950-1970], led to the following classification of levels as listed in popular terms.
THE UPS AND DOWN OF ADDICTED LIFE
++++ WAY OUT
+++ DRUNK-LIKE AND BLOODY-MINDED
+ SLIGHTLY HYPER
0 NORMALCY-DEFINED AS BEHAVIOR ON AN EVEN KEEL
-- BRAINFAGGED, PUFFY, AND ACHY
--- MILDLY DEPRESSED ("NEUROTIC")
---- SEVERELY DEPRESSED ("PSYCHOTIC")
* This article was first published in the Spring 1970 issue of the Human Ecology Study Group Newsletter. Dr. Randolph has kindly given us his permission to publish it again.
Article from NOHA NEWS, Vol. XVIII, No. 2, Spring 1994, pages 3-6.