Dr. Currier is a graduate of the University of Nebraska College of Medicine. He took five years of post-graduate training in the field of his specialty, Ear, Nose and Throat. He is a member of the American Academy of Otolaryngology, is a member of the American Board of Otolaryngology and a Fellow of the American College of Surgeons. Dr. Currier taught at Harvard Medical School before moving to Pasadena fourteen years ago, where he has since been practicing his specialty. During the past fourteen years he also has been teaching at the University of Southern California College of Medicine. He served for five years as national secretary of the American Academy of Nutrition and now serves on the Board of Directors. In 1949 he was commissioned by the Surgeon General of the United States as a civilian consultant where he served as inspector of military and public health facilities throughout the Orient. A year later he served the Indian government in India in a similar capacity. He has a master of science degree in his specialty and has written numerous papers reporting research work done in the fields of Ear, Nose and Throat and nutrition.
Up to a few years ago stress meant to the physician little more than it does to the lay person as best expressed in the phrase “stress and strain.” In medical dictionaries there was only a reference to the use of the word stress in dentistry, where it has strictly mechanical connotation’, as for instance, in engineering the term “tortional stress.”
All this has changed within the last decade, mainly due to two interrelated facts: the recognition of the important role of the hormones particularly cortisone, and still more so the thought-provoking theory of Hans Selye, which is essentially an attempt to evaluate the significance of various hormonal substances in health and disease.
The new concept of stress might well prove to be one of the greatest medical discoveries of all times. It establishes a common factor responsible for sickness of all kinds, bodily and mental alike. In the words of Selye: “Stress is essentially the rate of wear and tear in the body. Anyone who feels that whatever he is doing or whatever is being done to him is strenuous and wearing, knows vaguely what we mean by stress.” Or to give one of Selye’s more technical definitions: “Stress is the common denominator of all adaptive reactions in the body . . . It is a state manifested by a special syndrome which consists of all the non-specifically induced changes within a biologic system.”
There are infinite numbers and kinds of stressful situations which we encounter in our daily lives. These stressors act upon our bodies, setting up a chain of responses, both local and general. Only a few of them are understood at the present time. As a result of stress an “alarm reaction” is initiated, which affects especially the adrenal cortex and the pituitary gland. These glands are called upon for immediate secretion of protective vital hormones, and as long as they are not worn out, malnourished or depleted, they can prevent lasting damage. The interplay of glandular activity and hormonal output is shown in a diagram (Figure 1) taken from Selye.
It will be noted that the pituitary gland secretes an adrenocortico-trophic hormone, abbreviated as ACTH. This acts upon the adrenal cortex, causing it to secrete both an anti-inflammatory and a pro-inflammatory hormone. It seems contradictory that one and the same organ should be called upon to secrete simultaneously hormones with opposite functions. The defense against a stressful invader, through output of potent hormonal substances must in turn be kept in check, so that the body in the process of defending itself does not suffer permanent damage.
It would lead too far to trace the intricate actions of these opposing hormones in detail. But one point is of great importance: it was formerly believed that bacteria and viruses secrete an unknown substance which causes the body to react with local inflammation, general malaise, fever, and leukocytosis. However, the same signs and symptoms can be produced by injection of hormones. Bacteria, viruses, injuries, etc., all act as “stressors” and induce secretion of hormonal substances which in turn produce the various symptoms of “feeling sick.”
As stated previously, there exists an infinite number and variety of stressors. Any kind of tissue injury will produce stress; local or general infections are damaging and stressful; excessive fatigue produces stress; so does exposure to heat or cold; an operation, anesthesia, or any medication also acts as a stressor.
In addition, the biochemical and, in particular, the hormonal balance of the organism is so frequently upset by common stresses and strains that until recently they have passed unsuspected. Emotional stress may produce bodily signs and symptoms, and even serious diseases, which formerly were thought to be due to infectious agents alone. A particularly harmful source of stress is chronic malnutrition, which as a rule develops imperceptibly over a period of time and results in increasing impairment of bodily and mental health.
Stressful situations to the body, however, need not always be unpleasant. According to Selye, even a passionate kiss produces stress. Strenuous physical exercise, like a game of football or tennis, may be “fun,” and yet it is a stress on the organism.
Nervous and mental stress is so common in our time that it deserves particular attention. All of us are subject to nervous and emotional tensions and when they become sufficiently severe over a period of time they lead to physiological and biochemical deterioration. But what are the causes of these nervous and emotional tensions? Volumes, nay, whole libraries have been written on the cause of mental disease. Yet no other book goes more directly to the source of emotional disturbances than Bergler’s “Basic Neurosis.” According to that book, neurosis is the psychological consequence of emotional hurts and injuries in childhood. They result in a subconscious need and desire to hurt and punish ourselves or to use a technical term in an attitude of masochism. Of course, there are many degrees of neurotic conflicts and symptoms, but on the whole everyone suffers from inevitable traumatic experiences during infancy and childhood.
We all have eaten of the fruit of sin we all labor under unconscious emotional stresses which impede our bodily and mental functions; what then can we do in order to rid ourselves of frustrations and lead happier and more productive lives.? There are a number of possible avenues which will be briefly discussed in the following:
Insight by Conscious Endeavor
It has been said that he who understands all, forgives all. Hence, conscious efforts resulting in deeper understanding are the first steps to lessen emotional tensions. We can learn much about ourselves through studying, reading books, and listening. Such a chance to catch up with ourselves calls for leisure; to use the words of a great English surgeon: “Only leisure can rehabilitate the overstressed mechanism of the mind.”‘ The blunt advice to “stop worrying,” “take it easy,” “relax” is much easier said than done. Religion helps many people.’ But all need additional assistance in their quest for equanimity.
Various types of medications will quiet strained nerves. In prescribing, the physician has the choice between the barbituates, the rauwolfia products, Thorazine, Milltown, and others. They all have their place, but some of them are habit-forming, others harmful. At best they alleviate the symptoms for the time being, but will never get at the underlying cause.
It is the aim of psychotherapy to lead the patient beyond a merely intellectual grasp of stressful situations. In order to achieve therapeutic results it is necessary to arrive at a true understanding and emotional acceptance of the underlying problem. According to Kubie psychotherapy is a form of reorienting education. It consists primarily of efforts to alter the patient’s habitual attitudes of guilt, fear, hate and depression, by educating him to tolerate his own conscious and unconscious needs and cravings, his instinctual hungers, his familial jealousies and hates. The goal is an adult level of maturity manifested in a balanced perspective regarding one’s self, one’s life and work in relation to others. ” Psychotherapy, however, is not a panacea. Many people cannot afford it; others are too hostile and resistant, or too withdrawn to accept psychological consultation. Like any other type of therapy, furthermore, it is not effective in all cases.
Exercise and Work
“Man is still basically a muscular and motor animal. Habitual denial of this fact is sedentary living . . . produces ill health or, at least, malaise.” Wholesome exercise will relieve much stress. To quote Selye: “Simple rest is no cure-all. Activity and rest must be judiciously balanced, and every person has his own characteristic requirements for rest and activity.”” The more fortunate ones may find such productive activity in their daily work, while to others it is merely exhausting and increases resistance and stress. Even such simple physical exercise as hiking, swimming or gardening may be nothing but a burden for a deeply disturbed or very depleted individual.
There is no more direct approach to the relief of mental and emotional stress than nutritional replacement. Without detracting from any of the other treatment methods, none of them goes so straight to the heart of the matter as nutritional supplementation. Of course, the various approaches are mutually supportive. But it should be self-evident that an organism deprived of essential nutritional elements is ill-equipped to deal with the normal demands of life, let alone with extraordinary nervous and mental stress. While overt deficiency diseases are comparatively rare, a sub-optimal nutrition status is much more frequent than commonly assumed. This was clearly brought out by a comprehensive study of 610 male industrial workers employed in four chemical and pharmaceutical plants in central New Jersey. About one-fourth of them gave evidence of sub-optimal nutrition with respect to one or more nutrients. This figure is, if anything, too low, as the study was limited to men who were physically fit to work and had steady employment; furthermore, each company provided a cafeteria, and the services of one or more full-time physicians.
All medicine is based on the fact that there is no better way of dealing with a disease than to treat its cause. It has been conclusively demonstrated that nutritional deficiencies can bring on various kinds of bodily and mental illness. Earlier evidence to this effect has been presented by Peterman and Goodhart, in a paper on the current status of vitamin therapy in nervous and mental disease. More recently Miller stated that disturbances of nutrition may be the cause of any form of psychiatric disorder, from transient neurosis to deep-seated and long-standing psychosis; he goes on to say: “It is not surprising to find that disorders of feeding are, as it were, first cousins to nervous disturbance.”” Maybe the most important observations have been made by Joseph Brozek, who is associated with the Laboratory of Physiological Hygiene of the University of Minnesota School of Public Health. He created a new descriptive name for the study of the psychological impact of diet and nutrition: “experimental psycho-dietetics.”” Brozek, who worked with Ancel Keys and others on the monumental study of human starvation “presented a most impressive description of the behavioral changes observed during experimental semi-starvation and nutritional rehabilitation.” The report should be read in its entirety in order to appreciate fully how closely nutrition and psychology are linked together. Don, the volunteer subject whose behavior during the experiment is described in detail, started out by being a pleasant, cheerful, active young man, full of initiative, cooperative and sociable, highly altruistic, sensitive to the world’s social problems, and eager to play his part in the rehabilitation of a war-torn world. After twenty weeks of semi-starvation he was nothing but a shadow of his former self: weak and edematous, lacking physician endurance and mental initiative, grouchy and self-centered, without interest in female companionship, a childish slave of food, primarily concerned with individual security rather than with the larger issues. There was regression to old nervous patterns, for instance finger-nail biting; hearing was disturbed, capacity for concentration reduced, self-confidence had markedly declined, and interest in personal appearance and hygiene was gone. Don became petty, aggressive, hesitant and inexact in speech and thinking, and was mentally depressed. This ,”semi-starvation neurosis” was reversed through nutritional rehabilitation. After 33 weeks of normal feeding Don had largely returned to his former personality pattern, except for a somewhat less cheerful outlook an a heightened concern with matters of health. In other words, the experiment left its imprint even in a subject who voluntarily and knowingly underwent the ordeal. How much more devastating must be the impact of long-continued nutritional deficiency on people who are unaware of the cause of their troubles and unable to account for their mental and emotional deterioration.
Malnutrition thus produces emotional stress and strain. But the reverse is just as true. The various nutritional elements are burned up in prodigious amounts under conditions of emotional tension. Klenner has pointed out that one severe fit of anger burns up between 3000 and 4000 milligrams of vitamin C in a matter of minutes. The normal daily minimum requirement of vitamin C is given as 75 mgs. Obviously one single fit of anger consumes many times the daily intake and causes vitamin C depletion. We must assume that similar devastating changes occur with respect to other vital elements. A violent emotional outburst, as nuclear physicists tell us, creates enough electrical energy to light a 30 watt bulb for a number of years. It is not difficult to imagine how much vital energy is being wasted in balancing such an emotional tempest as well as the day-today stresses and tensions.
How can we break the vicious circle of emotions depleting bodily stores of energy, and depletion of these stores in turn creating new mental and emotional stress and strain? The answer is simple: we have to supply our bodies with sufficient amounts of nutritional building materials to guarantee normal tissue metabolism throughout life. Literally, we are what we eat. We must be ever so selective in the foods we eat, and see to it that the calories taken are not empty, but full of nutritional elements.
Watson, in testing the clinical value of nutritional replacement therapy of patients with various types of mental illness, used a more complex basic formula,* which in addition to large doses of all the known vitamins and minerals also contains enzymes, amino acids, natural concentrates, etc. Over the years, fifty subjects were treated. All but six of them showed clinical improvement which was confirmed by the Minnesota Multiphasic Personality Inventory test. Prior to replacement therapy patients were placed on placebos in order to weed out those easily suggestible people who feel better when they receive a pill containing nothing more potent than sugar and starch. Watson” summarizes his findings as follows: “Some states which are psychologically diagnosed as functional mental illness may be relieved by appropriate nutritional therapy.” Intrapsychic conflicts manifesting themselves in morbid concern with health, depressions interspersed with manic episodes, extreme emotionalism, obsessive-compulsive drives, delusions, unpredictable behavior, and withdrawal, were resolved or at least reduced. After a few months the subjects became emotionally stable, arrived at a correct appraisal of themselves, paid attention to their physical appearance, were again able to work, and made rational plans for the future.
The psychological effects of nutritional replacement therapy are so amazing that two representative case histories from Watson’s most recent paper are reported in the following.
A young man, 19 years of age, suffered from facial dermatitis, which was believed to be at least partly of psychogenic origin. He was withdrawn, very depressed, and afraid to meet people. He would not eat his meals with the family, and had not talked with his father for more than two years. He secluded himself in his room and confided only in his mother. In the initial interview he hardly opened his mouth. After one month on placebos he felt slightly worse, and the total score of the Minnesota Multiphasic Personality Inventory rated ten points worse. At the end of one month of substitutional therapy he was considerably more at ease and talked quite freely. Improvement continued steadily and at the end of four months the boy’s mother reported: “He is coming out of it. He cut the lawn voluntarily for the first time in years; he has come out of his room and watched television in the living room with the family. He also has had several long, confidential talks with his father for the first time in several years. His recovery, frankly, is more than we had hoped for.” After several months of therapy he had improved considerably, but was still not fully recovered. However, on the Minnesota Multiphasic Personality Inventory his profile had returned to normal. Treatment is being continued, and the boy seems to be making further progress.
A woman, 44 years of age. There was no organic disease; a former alcoholic, she had been helped by Alcoholics Anonymous. She scored extremely high on both the psychopathological deviation and the schizophrenia scales of the Minnesota Multiphastic Personality Inventory test. In the initial interview she broke down and sobbed, and said that she was feeling on the verge of a complete collapse. She was hysterical, hostile and excitable. After one month on placebos she reported: “They may have helped me; I didn’t expect any amazing results and I didn’t get any.” After being switched to nutritional supplementation without her knowledge, she stated: “I experienced a tremendous improvement this past month. Previously I had a perpetual lump in my throat, but this month I felt it only a couple of times. I have also felt happier, and my outlook is somewhat different. Frankly, I’ve never amounted to anything in my life, but now I’d like to go on and learn something.” At the end of four months of nutritional therapy, when asked why she had not completed her final Minnesota Multiphasic Personality Inventory test, she said: “I know this sounds funny, but I have felt so wonderful that I didn’t want to lose time by sitting down to answer the test.” Her total Minnesota Multiphasic Personality Inventory score had improved 128 points, and she had made a complete clinical recovery.
It is too early to evaluate the significance of this continuing research project. Watson himself states: “The available data on the relation of sub-clinical nutritional factors to emotional disturbance appears to support the view that psychological stress causes nutritional displacement, and nutritional displacement causes mental illness.”
When Selye formulated the basic theory of stress and its effect on human health and disease, he was mainly concerned with one particular aspect of metabolism, i.e., the interplay between various hormones. Selye’s theory proved so stimulating to research in different fields because it drew attention to the well-known but all too frequently neglected fact that man is a unit consisting of many functions. What we call “fitness” is nothing else but harmony between these various functions. On the other hand, psychological conflict and related bodily disturbances are expressions of defective integration of the organism. Recent research in biochemistry and in psychiatry has independently arrived at this same conclusion.
It may be true that nutritional stress has only the effect of amplifying weaknesses in the personality structure, thus bringing them to the surface. Or personality defects may be the result of nutritional deficiencies. At any rate, nutritional stress is definitely a fact to be reckoned with under all circumstances. It is a gratifying development that in nutritional replacement therapy we now possess a means of relieving nutritional stress and to lay the foundation for a happier and more productive life.
It is not generally recognized that there may be a nutritional basis for the stress reaction which complicates and may even cause both functional and organic pathological conditions.
Correcting the nutritional deficiency is essential in any therapeutic management of the stress reaction.