Physiologic Studies of Reaction to Stress in Anxiety
and Early Schizophrenia
ROBERT B. MALMO, Ph.D., and CHARLES SHAGASS, M.S.
NXIETY as a symptom in psychoneurosis has
A many of the characteristics of an emergency re-
action as described by Cannon (3). The distinguish-
ing feature of anxiety, however, is that the patient
reacts to ordinary everyday life situations as though
they were emergencies. In the present investigation
psychiatric patients with pathologic anxiety were
studied under conditions of stress with the aim of
observing their behavioral and physiologic reactions
and making an objective comparison of various
reacting systems.
In the field of emotion there has been a con-
centration of attention upon autonomic responses
(10). This is a natural consequence of Cannon's
extensive studies. Such a concentration upon the
autonomic system, while extremely fruitful in terms
of the experimental work which* was stimulated
thereby, was certain to leave gaps in our knowledge
concerning other response systems. For example,
the whole question of disturbances in the skeletal
muscle system in emotion is a neglected subject. The
work of Jacobson ( n ) is a notable exception in this
regard, but what appears to be urgently needed is
an investigation of several systems simultaneously
to make possible an objective comparison of react-
ing systems.
From the clinical point of view, by determining
the dimensions of greatest deviation in stress-reac-
tions of anxiety-patients, we should approach a more
complete understanding of the common physiologic
complaints associated with anxiety states. Here com-
plaints referable to the skeletal motor system bulk
large (2).
In a previous communication (13) a method for
studying striate muscle responses in anxiety was
described and results of a positive nature were
described.
The problem of selecting an appropriate stressful
situation was also dealt with in this paper. The
Allan Memorial Institute of Psychiatry, McGill University,
Montreal, Canada.
This research was assisted by a grant-in-aid from the
National Research Council of Canada.
The authors wish to acknowledge gratefully the advice
and guidance of Dr. H. H. Jasper of die Montreal Neurologi-
cal Institute.
JANUARY-FEBRUARY, 1949
situation employed consisted of a standardized series
of painful stimulations administered by means of a
Hardy-Wolff thermal stimulator. The positive
nature of results in the prior investigation led us
to retain the pain series for use in the present more
extensive study.
The study of reaction to pain in anxiety is of
some interest from the theoretical point of view.
For example Mowrer regards anxiety as "the con-
ditioned form of the pain reaction . . ." (14, p.
555) and the view stated by Freud may be inter-
preted as similar: "Anxiety, therefore, is the expecta-
tion of trauma, on the one hand, and, on the other,
an attenuated repetition of it" (7, p. 114).
The following specific purposes guided the study:
1) to determine whether degree of physiologic dis-
turbances under stress corresponds to severity of
anxiety; 2) to compare reacting systems under
stress in order to determine whether any system
appears more specifically disturbed in anxiety than
another; 3) to make an experimental test of the
view that anxiety is a reaction denoting expectation
of pain or trauma; 4) to investigate physiologic
reactivity to stress in early schizophrenia, and to
relate these findings to the question of anxiety.
Experimental Population
A total of 75 unselected patients and 11 controls
were studied. For the purpose of dividing the
patients according to degree of anxiety, it appeared
advisable to adopt a clinical criterion of anxiety
which would be as simple and straightforward as
possible. Accordingly we have defined anxiety as
a tensional state of such severity that work efficiency
was interfered with and medical advice was sought,
and which was characterized by one or more of the
following complaints: persistent feelings of tension
or strain, irritability, unremitting worry, restless-
ness, inability to concentrate, feelings of panic in
everyday life situations. In separating the patients
according to this criterion, it seemed wise, at this
stage of investigation, not to try to draw the lines
too fine. We chose to divide the total group into
two subgroups, according to the predominance of
anxiety in the symptom picture as described in the
case history.
10
Anxiety-patient group: Thirty-six patients, 8 men
and 28 women, in whom anxiety was the predomi-
nant symptom, were placed in this group. Median
age for the group was 34 years. Median duration
of illness was three and a half years.
Mixed patient group: All other patients, except
early schizophrenics, were placed in this second
group which comprised 28 mental patients, 11 men
and 17 women, with a median age of 42, and a
median duration of illness of approximately two
years.
Eight patients suffered from depression. Of
these, 3 were agitated, and 1 showed post-ECT
excitement. There was 1 manic-depressive psychosis,
with mild manic trend. The remainder of the group
was composed of 2 alcoholics, 2 patients with diag-
nosis of psychopathic personality, 5 patients with
diagnosis of hysterical personality, and finally, a
group of 7 patients characterized by organic in-
volvement with' associated and probably secondary
anxiety or depression, or both. Two of these patients
suffered from hypertensive encephalopathy. The
other 5 suffered from various organic conditions,
as follows: epilepsy, arrested tuberculosis, operated
FIG. I . Subject with head in frame ready for stimulation. Note left hand strapped
down for GSR recording, and right forefinger resting on button. In the actual ex-
periments electrodes were attached to the neck, right arm, and left leg, and a pneu-
mograph was employed.
REACTION TO STRESS
carcinoma of the bowel, possible atrophy of the
left cerebral hemisphere, and severe concussion
(one year previous to examination).
Early schizophrenic group: We examined n early
schizophrenics, 7 women and 4 men. Median age
was 26 years. Median duration of illness was one
and a half years. Auditory hallucinations were
definitely present in 3 patients, and had probably
been present in a fourth who was in a state of
remission when we examined her. One of these 4
patients also had delusions of a persecutory nature.
Three patients had clear delusions, without any evi-
dence of hallucinations. The eighth patient in this
group was a hebephrenic girl who showed marked
silliness and inappropriate affect. The ninth patient
was characterized by profound apathy, without
delusions or hallucinations, the tenth by various
somatic complaints, grimacing, negativism, com-
plaints of losing herself, and by a positive family
history (1 brother and 1 sister were schizophrenic).
The eleventh patient suffered from a severe obses-
sive-compulsive disorder, with a bizarre form of
compulsion.
Normal control group: Eleven normal controls,
VOL. XI. NO. 1
MALMO AND SHAGASS II

6 men and 5 women, were drawn from the medical was about to become painful. The subject's eyes
and nursing staffs of the Institute. Median age was remained closed throughout the test.
24 years. It should be. emphasized that these were During instructions the subject was informed
"hospital controls," and that the results obtained that the forehead would be the place stimulated.
with them are most probably not representative of He was told to expect a sensation of warmth,
an average nonpatient population. However, since mounting into heat which might suddenly swell
we were trying to study groups representative of into a stab of pain.
different degrees of anxiety, it seemed appropriate The subject was requested not to talk during the
to include a small selected group in whom the level test, except when the examiner asked him a ques-
of anxiety could confidently be expected to be at a tion. Exactly thirty seconds following each stimulus
minimum. the examiner asked the subject two questions:
Degree of anxiety in the various groups: The "How did that feel to you?" and "Did you press
groups may be arranged from greatest to least de- the button?"
gree of anxiety as follows: 1) anxiety-patient group;
2) mixed patient group; and 3) control group. No Apparatus
attempt was made to rate the early schizophrenics
with respect to degree of anxiety. All recordings were ink tracings on paper. Five
tracings were recorded by the polygraph of an
Offner electroencephalograph. Samples from two
Stress Procedure typical records are presented in Fig. 2. Respiration
The total period of examination, which lasted was recorded pneumographically. The other four
about an hour, was divided into three parts. During tracings were made by the electrograph pens.
the first part the subject was reassured, given in- 1) EEG: Right-sided parietal and frontal leads
structions, and prepared for the test (i.e., his fore- were placed 3 cm. lateral to the midline. The leads
head was blackened and electrodes were attached). were chlorided silver discs, applied with collodion.
Following this there was a seven-minute rest period 2) Muscle potentials: EMG electrodes were like
during which the subject was asked to relax. After those for EEG. Two EMG electrodes were placed
this seven-minute period the test proper commenced. on the left side of the neck. One electrode, intended
During stimulation, light from a 500-watt lamp was to be relatively indifferent, was placed in the mid-
focused on the forehead of the subject by means of line approximately over the fifth cervical spine. The
a condensing lens (see Fig. 1). Stimuli were pre- other was placed 2 in. lateral and 1 in. superior to
sented1 by means of an electronically controlled the first. A grounded electrode was attached to the
shutter, which when open permitted light to pass right side of the neck to eliminate 60-cycle inter-
to the subject's forehead. ference. 3) EKG: The third channel of the electro-
Twelve stimuli were spaced at intervals of exactly graph was used to record EKG Lead II, for the
one and a half minutes. All stimuli were three purpose of measuring heart rate. 4) The fourth
seconds in duration, except the last stimulus whose channel was used for the purpose of recording finger
duration was only one second. Intensities were movements. The pick-up employed was a rugged
varied by means of a Variac transformer which Rochelle salt crystal with a push-button resting
controlled the voltage through the lamp. The inten- upon it.
sity series expressed in watts was 500, 270, 340, 400, Both finger movement and muscle potentials were
270, 340, 400, 270, 340, 400, 500, 500. The stimulus recorded with the intention of obtaining a clear
order was arranged so as to induce the maximum record of fluctuation or change in amplitude. There-
amount of expectancy. The range of intensities for fore, in order to facilitate observation of such
the three-second stimuli was from approximately changes, the attempt was made to keep background
0.23 Gm. cal./sec./cm.2 to approximately 0.44 Gm. level of activity constant by manipulating the ampli-
cal./sec./cm.2. The most intense stimulus felt defi- tude level. Thus, in all cases, the scores for finger
nitely painful to everyone. movement and muscle potentials represented fluctua-
During the test the subject sat leaning forward tions from a background level which was approxi-
slightly with his chin in a rest. His left hand was mately the same (visually) for each subject. Figure
strapped down (palm up) for skir, ^sistance record- 2 shows records for a control subject and a patient
ing, and his right forefinger rested on a button in which it may be seen that the background level
which he was instructed to press during stimula- is the same for both, even though at times the
tion when he thought that the heat on his forehead patient's record shows marked departure from it.
JANUARY-FEBRUARY, 1949
12
GSR: The galvanic skin response (GSR) was
recorded separately, by means of an Esterline-Angus
recording milliameter. Measurements were made
from chlorided silver electrodes attached to the palm
and dorsum of the left hand. Special precautions
were taken to avoid recording any changes due
to movement of the hand (see Fig. i ) . The hand
formed one arm of a Wheatstone bridge which was
fed from a 1.5 volt cell through a potentiometer.
This was adjusted to keep the electrode current
below 5 microamperes, thus reducing disturbances
due to polarization. The output of the bridge was
fed into a DC amplifier which drove the recording
milliameter.
All recording equipment was operated in an
adjoining room. Although some of the noise inci-
dent to operation of this equipment was transmitted
through the walls to the subject's room, it was
greatly reduced and did not appear to have an
appreciable effect upon the subject's reactions.
The examiner who occupied the subject's room
managed the Variac, and put the questions to the
subject at the appropriate times. This examiner also
made behavioral notes, among them careful records
of head movement.
Treatment of Data
In the analysis of the tracings, the general prin-
ciple was followed of scoring disturbance as devia-
tions from the subject's own base line of physiologic
activity.1 Wherever possible, as with heart rate,
direct measurements were made. Where quantita-
tive measurement was not feasible, due to either
the nature of the recordings or the amount of labor
which would be involved (a single record occupied
about 150 feet of paper), standardized rating
methods were employed. All ratings were carried
out by a technician from whom the nature of the
case was concealed.
The records were divided into five time segments
for scoring purposes, each segment being contiguous
and the divisions covering the entire record for the
eighteen-minute stimulation session. These segments
were determined by the stimulus time relationships
and were as follows: 1) the three-second period
of thermal stimulation; 2) seventeen seconds im-
mediately following stimulation; 3) ten seconds
before the question; 4) the thirty-second period
starting from the first question; this included ques-
1
T h e authors wish to express their gratitude to Mr.
Murray Heslam for his part in this work, and for his help-
ful suggestions.
REACTION TO STRESS
tioning and the interval immediately after; 5)
thirty seconds preceding the next stimulus.
1. Finger Movement
This was scored on a plus-or-minus rating sys-
tem. A single rating was made for each of the five
time periods described above, thus allowing a total
of sixty ratings for the twelve stimuli. A plus rating
was scored if finger movement exceeded the base-
line level of oscillation (see Fig. 2). In addition, if
the subject pressed the button voluntarily when
stimulated, to signal pain, a plus rating was made.
2. Neck Muscle Potentials
These were rated on a plus-or-minus basis for
the same five time intervals, and in the same way
as finger movement (Fig. 2).
3. Respiration
Respiration was scored in two ways: a) Respira-
tory deviation percentage: This was obtained by
counting the number of respirations which deviated
in either rate or amplitude or both beyond certain
limits arbitrarily set from the subject's own pre-
stimulation averages.
For rate a 30 per cent deviation in either direc-
tion was set as the limit, and for amplitude a 50 per
cent deviation. Respirations were not measured dur-
ing the question period because of the uncontrolled
-i~4-J^Li'--W»-I~J~^^^
HU80U WtHTIM,
^
FtWSCT M9VEUERT
FIG. 2. Comparison of patient and control. Control—
33-year-old male physician; patient—33-year-old male chem-
ist with chronic anxiety neurosis. Note disturbances in the
respiratory, muscle potential, and finger movement tracings
of the patient. Note also anticipatory muscle responses of the
patient. These are typical findings. In this case the patient
showed relative tachycardia (rate = 100/min.).
VOL. XI, NO. 1
MALMO AND SHAGASS
Fio. 3. Tracings of pneumograph records showing four
typical respiratory irregularities (A-D) during stimulation.
For comparison one record (B) without irregularity is
shown.
variations produced by talking. A percentage was
computed by dividing the number of deviating
respirations by the total expected from the mean
rate. A similar measure has been employed by
Ruesch (16). b) A respiratory irregularity rating
was made in order to score the effect of thermal
stimulation on the contour of the respiration curve
at the time of stimulation. This measure permitted
a possible maximum score of 12. Examples of
respiration rated plus and minus are shown in
Fig- 3-
4. Heart Rate
Heart rates were determined from brief samples
(3 to 5 beats) taken immediately before, during
and after the stimulus and before and after the
question. Brief samples at these significant intervals
were employed, because it was felt that longer
samples would possibly prevent important varia-
tions from being reflected in the scoring. There
were sixty samples of heart rate for each record.
These were treated in two ways: a) Mean heart rate
was determined. Since the female pulse rate is
higher than the male (means of 96 and 88 in this
study), it was necessary to rule out the effect of
sex to permit direct comparisons. This was done
by computing a standard or T-score by means of
which the average heart rate of each group was
equated to 50 and the standard deviation to 10.
Thus heart rates were converted to a T-score scale
which ran from about 25 to 75 and which per-
mitted direct comparisons of patients regardless
of sex. b) Heart rate variability was determined
by calculating the standard deviation of the sixty
JANUARY-FEBRUARY, 1949
measured samples. This index of unsteadiness of
interference with regularity was employed by
Fleisch and Beckmann (5). The actual standard
deviations could not, however, be employed in com-
paring patients because of certain age and sex rela-
tionships. Figure 4 shows why the effect of age
required consideration. In the graph heart-rate
variability is plotted against age. The relationship
is linear: the older the patient the less unsteady the
heart rate. Since the regression equations were dif-
ferent for each sex, they were computed separately
and the standard deviations were converted into
T-scores which took both age and sex into account.
The T-scores permit direct comparisons of heart
rate variabilities, regardless of the factors of age
and sex.
5. Galvanic Skin Response
A variety of measures were employed here, a)
Response to thermal stimulation, per cent change:
The existing background level is known to influence
the magnitude of response (8). Because of this, the
change in resistance occurring from one to three
seconds after the stimulus was converted into a
percentage by dividing the preexisting background
resistance level into it. b) Number of oscillations
before and after the stimulus: For the 30 seconds
before each stimulation and 27 seconds after, a
separate count was made of the number of resistance
oscillations. If the background resistance was below
30,000 ohms, oscillations above 200 ohms were
counted. If background resistance was above 30,000,
only oscillations greater than 400 ohms were
counted, c) Intensity ratio: This ratio was deter-
mined by dividing the averaged per cent response
for the two highest intensities (500 watts) into the
average per cent change for the three lowest inten-
AOE
FIG. 4. Relationship between heart rate variability and
age in the 75 mental patients employed in the present study.

shies (270 watts). The rationale of this measure was
that relative overreaction to a mild stimulus (270
watts) would be reflected in a high ratio, d) Ohm-
meter resistance measurements: Spot readings of the
resistance between palm and dorsum of the hand
were taken before and after the test with a Weston
Industrial Circuit Tester. Time interval between
readings was about thirty-five minutes. Due to the
relatively large applied voltage (1 to 3 volts), any
resting potential of the patient would have a negli-
gible effect upon these resistance readings.
6.EEG
The records were analyzed from the standpoint
of the effect of the stimulus in producing a de-
pression or blocking of the alpha rhythm. The
effect of anticipation of the stimulus upon the
alpha rhythm was also considered. Alpha waves
were considered present only when there was a
train of at least 3 consecutive waves with a fre-
quency of 8 to 13 per second and an amplitude
exceeding 15 microvolts. All other parts of the
Tecord were measured as showing blocking. The
duration of blocking was measured: a) during the
9- 18- ZT- 36- 45- 54- 63-
17 26 35 44 53 62 71
TOTAL FINGER MOVEMENT SCORE
(MAX.* 72)
FIG. 5. Range of total finger movement scores for each
of three patient groups and the control group. Note com-
plete absence o£ overlap between controls and early
schizophrenics.
REACTION TO STRESS
FINGER MOVEMENT
CONTROL
MIXED PT.GROUP
ANXIETY- PT.
EARLY SCHIZ.
20 40 60 60 100
PERCENT CASES
SCORE OF SCORE OF
20 OR LESS 21 OR MORE
FIG. 6. Amount of disturbance in finger movement
records. The greater the disturbance the higher the score.
five-second period preceding the stimulus, and b)
during the stimulus and after, if the blocking
persisted.
Results
1. Finger Movement
a) Total disturbance score: Our use of the term
"disturbance" in this paper is restricted to an ob-
served departure of reaction from background or
resting state. We do not intend the implication of
clinical or pathologic disturbance. The total amount
of disturbance in the finger movement record may
be quantitatively expressed by adding all of the
plus ratings for movement and for voluntary button
pressure. The maximum disturbance score so ob-
tained would be 72. The mean scores found for
the four groups were as follows: controls, 15.7;
mixed patient group, 28.1; anxiety group, 40.2; early
schizophrenics, 44.6.
All intergroup differences were statistically reli-
able except that between the anxiety and early
schizophrenic groups. The per cent distributions
of scores for each group are shown in Fig. 5. The
graph shows that while the controls were grouped
at the extreme lower end of the disturbance scale,
the patient groups tended to fall more toward the
area of greater finger movement disturbance. The
order of finger movement disturbance from least
to greatest was: controls, mixed patient group,
anxiety-patient group, early schizophrenic group.
There was no overlapping at all between the score
distributions of the controls and the early schizo-
phrenic groups. Another graphic comparison of the
finger movement scores for the group is presented
in Fig. 6.
VOL. XI, NO; 1
MALMO AND SHAGASS
These data indicate that patients in whom anxiety
was predominant showed a much greater amount
of finger movement disturbance than the less anxi-
ous patients or controls. The degree of finger move-
ment disturbance appeared to correspond closely
to the degree of anxiety. In total amount of finger
movement disturbance, the early schizophrenics
resembled the anxiety group.
b) Stimulus-response relationships: Some indica-
tion of the factors contributing to the total finger
movement disturbance score may be gained from
an analysis of the individual segments of the stimula-
tion period. The mean disturbance scores for each
time segment and the mean number of button pres-
sures are plotted for each group in Fig. 7. The
curves for the different groups resemble one another
closely in general configuration even though they
are separated vertically on the disturbance scale in
the same order as one would anticipate from the
total disturbance scores. Each curve contains two
peaks, one occurring during the period imme-
diately following stimulus (point C), the other
during the period of questioning and after (point
E). These peaks indicate that the amount of finger
o he had pressed too hastily, and at other times he
o should have. If we are correct in the assumption
A B C D NO.
TIME SEGMENT PRESSURES
FIG. 7. Relation between amount of finger movement
disturbance and stimulation in the four groups. A, Thirty
seconds preceding next stimulus. B, Three-second period of
stimulation. C, Seventeen seconds immediately following
stimulation. D, Ten seconds before question. E, Thirty-
second period beginning with first question.
JANUARY-FEBRUARY, 1949
movement disturbance was increased by both pain
stimulation and questioning. The two troughs on
the curve, points A and D, represent the time
periods preceding stimulation and questioning re-
spectively. These periods were relatively remote
from stimulation and may be taken as representa-
tive of the base-line level of disturbance for each
group.
The troughs and peaks of the curves may be as-
signed a different significance. The scores at the
troughs may be considered to represent the general
level of finger movement disturbance in the stress
situation; these scores (A and D) are clearly related
to degree of anxiety. The increases above the gen-
eral level to give the peaks (C and E) represent
the finger movement reactions caused by stimula-
tion and questioning. If these increases are com-
pared for the different groups, we find that whereas
pain stimulation produced the greatest increase in
finger movement where the level of anxiety is
greatest, questioning produced the greatest change
in the mixed patient and control groups.
The response to thermal stimulation involved not
only finger movement, but also voluntary button
pressure. Figure 7 shows that the size of the first
peak (change from A to C) and the number of
button pressures were both related to degree of
anxiety. This finding may be interpreted as evidence
that anxiety is associated with poor motor control
during pain stimulation.
The disturbance effect of questioning may pos-
sibly be explained in terms of the conflict-arousing
nature of the questions. Although no deliberate at-
tempt to induce conflict by questioning was in-
tended, the first question, "How did that feel to
you?" was often interpreted by the subjects as a
request to judge the intensity of the stimulus. Some
of these stated afterwards that they had been con-
cerned about the accuracy of such judgments. Also,
the question, "Did you press the button?" some-
times caused the subject to report the feeling that
stated that he had not pressed, but thought he
that the questioning induced a certain amount of
conflict, it would appear that this conflict had a
greater disturbing effect on the finger movement
scores of the mixed patient group and the controls
than it did on those of the anxiety group.
The analysis of stimulus-response relationships
indicates the following: 1) the greater the degree
of anxiety, the higher the general level of finger
movement in the stress-situation; 2) the extent to
which increases over this general level, caused by
i6
stimulation, corresponded to degree of anxiety, was
dependent upon the type of stimulation. Pain
stimulation tended to produce greater changes
where anxiety level was high; questioning appeared
to bring about increases not clearly related to
anxiety level.
c) Voluntary signaling of pain experience:
i) ANXIETY: The ringer movement scores con-
sidered heretofore represent sudden breaks in the
level of finger activity. In most instances, they may
confidently be regarded as a reflection of involun-
tary motor activity. The button pressure, signaling
that the subject thought the heat was about to
become painful, was, on the other hand, a voluntary
response. The following analysis was made from
the standpoint of determining how well the button
pressure results support the view that anxiety is to
be regarded as an expectation of pain or trauma
(7, 14). If this view is correct, the anxiety patient
should react sooner and more vigorously to a
stimulus of anticipated painfulness. Also over a
number of stimuli, where the choice to react or
not, could be made, he would be expected to react
more frequently.
REACTION TO STRESS
brief stimulus. The figure shows that, as would be
anticipated, the number of button pressures in-
creased with the intensity of the stimulus. This
was true of all groups. However, the control group
signaled pain at the lowest intensities less frequently
than any other group, and the anxiety-patients
tended to press the button more often at every
intensity.
The difference between the control and mixed
patient groups for the three lowest intensities was
statistically reliable. The results indicate that the
greater the degree of anxiety the greater the prob-
ability that pain will be signaled at relatively low
intensities of stimulation.
These data on the voluntary signaling of pain
experience demonstrate objectively that where a
painful stimulus is anticipated, the more anxious
patient will react sooner, more vigorously and to
less intense stimuli than the less anxious patient.
90

TABLE I 60 •
NUMBER, LATENCY, AND DURATION
OF BUTTON PRESSURES

Median Median cc
Group Mean No. latency duration
(sec.) (sec.) 60
EARLY SCHIZ.
Control 2.9 2.76 0.86 a.
Mixed patient 3-7 2.61 1.12 0 no
Anxiety 6:6 1.97 1.49
Early schizophrenic 7.0 1.15 2.49 3
O

Table I presents the mean number of button

pressures, the median latency, and median duration, 2 30
of pressures for each group. These data show that
the greater the degree of anxiety, the greater the
frequency with which pain was signaled. The dif- 20
ferences between the controls and the anxiety and MIXED PT.GROU
Schizophrenic groups were statistically reliable, as
was the difference between the mixed patient group 10
and the anxiety group. The data also show that
those who pressed the button more frequently
signaled sooner and kept signaling for a longer
time. 270 340 400 500
(I
Figure 8 presents graphs in which frequency of STIMULUS (WATTS)
button pressures is plotted against intensity of stim- FIG. 8. Frequency of button pressure responses to graded
series of intensities of thermal stimuli. Duration of all
ulation. The 500-watt stimulus, lasting one second, stimuli, three seconds, except least intense stimulus (500
may be considered as the least intense of all, since watts for one second). Note relative flattening of curve for
most individuals do not experience pain with this early schizophrenics.
VOL. XI, NO. 1
MALMO AND SHAGASS
To this extent, the results support the view that
anxiety involves anticipation of pain.
ii) EARLY SCHIZOPHRENIA: There was a surprising
degree of resemblance between the involuntary
finger reactions of anxiety-patients and early schizo-
phrenics. In the case of voluntary pressure, how-
ever, there were important differences between
these two groups. Figure 8 shows that the schizo-
phrenic group appeared to respond less dis-
criminately than any other group when it came to
signaling pain. This difference may be readily ascer-
tained by comparing the relative frequencies of
reaction to the most and least intense stimuli. The
schizophrenic group reacted to the most intense
stimulus only 1.5 times as frequently as to the least
intense, whereas the ratio was 4.2 for the anxiety-
patients, 6.3 for the mixed patient group, and 72:0
for the control group. Also the data in Table I
show that the schizophrenic responses had the
shortest latency and the longest duration of any.
These findings indicate that, although the early
II
10
A B O D E immediately after was kept. Two classes of head
TIME SEGMENT
FIG. 9. Relation between amount of disturbance in muscle
potential records and stimulation in the four groups. A,
Thirty seconds preceding next stimulus. B, Three-second
period of stimulation. C. Seventeen seconds immediately
following stimulation. D, Ten seconds before question.
E, Thirty-second period beginning with first question.
JANUARY-FEBRUARY, 1949
17
schizophrenic group studied here resembled the
anxiety group closely with regard to quantitative
degree of finger movement disturbance, their volun-
tary reactions tended to bear less relation to the
physical characteristics of the stimulus. Of the 11
schizophrenics studied, there were 6 who pressed
the button on nearly every stimulus, 2 who never
pressed, and 3 who reacted normally, pressing only
on the most intense stimuli. These results fall into
line with one of the commonly accepted charac-
teristics of schizophrenia: reaction unrelated to the
reality situation.
2. Neck Muscle Potentials
The data for the neck muscle potential records
will be considered together with those from ob-
servation of head movement. These two types of
observation are closely related, because overt head
movement appears in the muscle record as a burst
of potentials.
a) Muscle potential score: The mean scores for
each time segment of the muscle potential record
are plotted in Fig. 9. This graph reveals a striking
similarity to Fig. 7 in the relationships among the
groups. An exception occurred in the time segment
which included questioning (point E), where
muscular activities associated with talking (head
movement) appeared to be responsible for the high
muscle potential scores in all groups.
In the total score for the muscle potential
record, the score for the question period was
omitted, thus allowing for a maximum possible
score of 48. The mean total scores for the groups
were as follows: 1) controls, 8.9; 2) mixed patient
group, 16.0; 3) anxiety-patient group, 21.0; 4) early
schizophrenics, 20.3. All intergroup differences, ex-
cept for those between the schizophrenics and the
other two patient groups, were statistically reliable.
These data demonstrate that the degree of neck
muscle potential disturbance in the stress situation
was related to degree of anxiety. Here, as with
finger movement, the reactions of the early schizo-
phrenic group were similar to those of the anxiety
group.
b) Head movement: A careful record of overt
head movements occurring during the three-second
period of thermal stimulation and the 12 seconds
movements were recorded: 1) the movement was
designated as Mi if the subject moved his head in
the frame; 2) if he moved his head away from
the forehead stops and lifted his chin out of the
rest, the movement was called M2. In scoring these,
1 point was assigned to Mr, and 2 points were
i8 REACTION TO STRESS
or no head movement was observed. In such cases
HEAD WITHDRAWAL the neck potentials may be attributed to an increase
CONTROL of tension with no movement or very slight move-
ment which could not be observed.
MIXED PT. GROUP
These data on neck muscle potentials and head
movement may be interpreted similarly to the finger
movement results. They show that the greater the
ANXIETY-PT.
w//////////////////. degree of anxiety, the higher the general level of
neck potential disturbance in the stress situation,
EARLY SCtflZ.
V//////////////M and the greater the reactivity to painful stimulation.
20 40 60 80 100
The increased reactivity in anxiety may also be
PERCENT CASES considered to reflect an impaired capacity to control
or inhibit motor reactions under stress. Here, as
NONE (ONE OR MORE with finger movement, the early schizophrenic
patients resembled the anxiety group.
FIG. IO. Number of head withdrawals during stimulation. 3. Respiration
a) Respiratory deviation percentage: This score
scored for M2. If M2 occurred, no Mi's were is the percentage of all respirations which deviated
scored. Thus a maximum of 2 points for each beyond certain limits of rate and amplitude.
of 12 stimuli could be scored, making a possible Respirations were scored for the twenty-second
total of 24 for the entire test. period preceding the stimulus, during the three-
The median head movement scores for the groups second stimulus and- for seventeen seconds follow-
were as follows: control group, 1.13; mixed patient ing it, and for the ten seconds preceding the ques-
group, 2.71; anxiety-patient group, 5.25; early
schizophrenic group, 3.75. Statistically reliable dif- 40
ferences between the control and each of the three
patient groups were found, also between the mixed
patient group and the anxiety group.
Figure 10 shows the percentage of cases who
withdrew the head from the frame completely at
some time during the test (M2). No M2's occurred
in the control group, whereas 39 per cent of the
mixed patient group, 61 per cent of the anxiety
cases and 55 per cent of the schizophrenics with-
drew the head at least once. This difference be-
tween patients and controls agrees with the findings
of Chapman and his co-workers (4).
Inspection of Fig. 9 reveals that the most striking
differences between the groups representing various
degrees of anxiety occurred during the period of
the stimulus and immediately after (points B and
C). This finding suggested that overt head move-
ment might be mainly responsible for the difference
in neck muscle potential scores. To check this pos-
sibility, the muscle potential scores for the time
segments during the stimulus and after were cor-
related with the head movement scores for the 75
patients. A statistically significant positive correla- A B C
tion (r^.65) was found, indicating that a con- TIME SEGMENT
siderable proportion of the neck muscle potential FIG. 11. Relation between respiratory deviation in each
disturbance may be attributed to overt head move- group and stimulation. A, Twenty-second period preceding
next stimulus. B, During three-second stimulation and for
ment. However, there were many patients with seventeen seconds following it. C, Ten seconds preceding
high neck muscle potential scores, in whom little question.
VOL. XI. NO. 1
MALMO AND SHAGASS
tion. The median respiratory deviation percentages
for the four groups were as follows: control
group, 18.9; mixed patient group, 9.3; anxiety-
patient group, 29.3; early schizophrenic group, 22.5.
Figure 11 presents the median deviation per-
centages broken down into time segments. The
greatest degree of respiratory variation was shown
by the anxiety-patient group, the least by the mixed
patient group, with the controls and schizophrenics
intermediate. The deviation scores of the anxiety
group were reliably higher than those of the control
and mixed patient groups. Also the difference be-
tween the mixed patient and the schizophrenic
groups was statistically reliable.
These data indicate that respiratory variability
was greater in the more anxious patients. However,
the degree of respiratory variability did not cor-
respond exactly to the degree of anxiety, since the
control group showed greater variability than the
mixed patient group. The respiration scores of the
early schizophrenics were intermediate between
those of anxiety-patients and controls.
b) Respiratory irregularity during stimulation:
This score represents the number of times that
thermal stimulation disturbed the contour of the
respiration curve (see Fig. 3). The median irregu-
larity scores for the groups were as follows: control
group, 1.7; mixed patient group, 3.0; anxiety-patient
group, 9.1; early schizophrenic group, 7.0. The rela-
tionship between degree of anxiety and this meas-
ure of the disturbing effect of pain stimulation is
shown in Fig. 12. The differences between the
anxiety-patient group and the control and mixed
RESPIRATORY IRREGULARITY
DURING STIMULATION
CONTROL
MIXED PT. GROUP
ANXIETY- PT.
V//////////////////S. 45.2; mixed patient group, 48.5; anxiety-patient
EARLY SCHIZ. W////////////S.
ZO 40 60 80
PERCENT CASES
17 OR LESS
FIG. 12. Respiratory irregularity during stimulation (see
Fig. 3). Score expressed in terms of number of stimulations
during which irregularities occurred. Maximum score was differential reaction for anxiety was very slight.
12 (irregularity produced by every stimulus).
JANUARY-FEBRUARY, 1949
patient groups were statistically reliable. Here also
the early schizophrenics were more similar to the
anxiety group than to any other.
The finding that the respiratory irregularity score
was more closely related to degree of anxiety than
the respiratory deviation measure may perhaps be
understood in terms of the events that these scores
represent. The deviation percentage is an index of
unsteadiness of respiration over a relatively long
period of time; it measures the extent to which
respiration was disturbed in the stress situation as
a whole. The irregularity score is a measure of the
immediate disturbing effects of pain stimulation. In
this sense, it may be considered somewhat com-
parable to head withdrawal. These considerations
prompt the interpretation that the respiratory irregu-
larity score is a measure that reflects motor control
more than does the deviation percentage. Accord-
ingly it is not surprising that it also correlated better
with degree of anxiety, since the other measures
reflecting motor control, finger movement, and neck
muscle potentials, correlated well with degree of
anxiety.
Further confirmatory data on this point are shown
graphically in Fig. 13. The results presented in
the figure indicate that the greater the degree of
anxiety, the greater the probability that respiratory
irregularity will occur at relatively low intensities
of stimulation. The graphs in Fig. 13 should be
compared with those in Fig. 8. Considering the dis-
tinct difference between voluntary finger pressure
and irregularity in breathing, it is remarkable that
there is such a close resemblance between these
two families of curves. The general conclusions
which were drawn from the data (Fig. 8) on
voluntary pressures are therefore supported by
these data on respiratory irregularity.
4. Heart Rate
a) T-score for heart rate: This score allovva tujn-
parisons of heart rates without consideration of
sex. The mean scores for the groups were: controls,
group, 51.5; early schizophrenics, 48.9. Although
there was a tendency for the faster heart rates to
occur in the more anxious patients, no statistically
100
reliable differences were found.
The actual mean heart rates were 96 and 88 for
the female and male patients respectively, and 94
and 81 for the controls. These relatively high rates
suggest that the stress situation caused some cardiac
acceleration as a general reaction. However, the
b) Change in heart rate produced by stimulation:
20
10
500 270 340 400 500
(ISEC)
STIMULUS INTENSITY (WATTS)
FIG. 13. Frequency of respiratory irregularity upon stimula-
tion, plotted against intensity of thermal stimulation. Dura-
tion of all stimuli, three seconds, except least intense stimulus
(500 watts for one second). Note relative flattening of curve
for early schizophrenics (this Fig. should be compared with
Fig. 8).
Trie changes in heart rate produced by thermal
stimulation and questioning were determined by
comparing the heart rates immediately after these
stimuli with the rates preceding them. In general
the pain stimulus appeared to produce a slight
average decrease in rate, but there was wide varia-
tion in this respect. The questioning usually pro-
duced an increase in heart rate with the mean
changes for the group ranging from 2.5 for the
mixed patient group to 5.2 beats per minute for
the controls. No statistically significant differences
between the groups were found.
c) Heart rate variability: The T-score for heart
rate unsteadiness permits comparison of subjects
without consideration of age or sex. The mean
scores for the groups were as follows: control group,
45.2; mixed patient group, 46.6; anxiety-patient
group, 51.8; early schizophrenics, 52.5. The only
REACTION TO STRESS
reliable difference between means was that between
the anxiety and mixed patient groups. Figure 14
presents a graphic comparison of the groups for
heart rate variability. It is seen that the scores are
arranged in a gradient conforming to degree of
anxiety, but that the points on this gradient are
much closer together than they were in the case
of the measures of striate muscle activity: ringer
movement, head withdrawal, and respiratory
irregularity.
d) Influence of respiration upon heart rate
variability: In order to determine the influence of
respiratory phase, the heart rates immediately pre-
ceding thermal stimulation and immediately fol-
lowing questioning were measured for 38 patients.
In each instance the rates were measured separately
for the inspiratory and expiratory phases of respira-
tion. Standard deviation of heart rate was then
correlated against the difference between the rates
for inspiration and expiration. The product-moment
correlation was 0.50, showing the importance of the
respiratory factor in increasing heart rate variability.
The only statistically reliable finding in all of
the data on heart rate was the difference in heart
rate variability between the anxiety and mixed
patient groups, which showed that greater variabil-
ity was associated with anxiety. In assessing the
heart rate results, it should be pointed out that this
is the first measure, of those so far considered,
which reflects autonomic activity alone. All of the
measures which showed consistent relationships to
degree of anxiety reflect functions which are sus-
ceptible to direct voluntary control. The data so
far seem to indicate that, for anxiety, the differential
reactions to stress may occur in those systems most
susceptible to voluntary control.
HEART RATE VARIABILITY
CONTROL
MIXED PT. GROUP
V////////////JW/,
ANXIETY-PT. W//////////////////////A
EARLY SCHIZ. V////////////////////A
20 40 60 BO 100
PERCENT CASES
46 OR MORE
FIG. 14. Heart rate variability. Score expressed in terms
of T-scores. The higher the score the greater the variability.
VOL. XI, NO. 1
MALMO AND SHAGASS
5. Galvanic Skin Response
The group averages for the various scores ob-
tained from the GSR record are presented in
Table II.
TABLE II
AVERAGE GALVANIC SKIN RESPONSE SCORES
Median Median
Median No. Os- No. Os- Median
Per- dilations dilations inten-
ceniage before after sity
Group change stimulus stimulus ratio
Control 10.9 22.3 23.5 0.69
Mixed patient 8.9 25.5 14.3 0.85
Anxiety 7 ..4 22.3 16.0 0.71
Early schizophrenic 10.6 33.0 24.8 0.55
The only statistically reliable difference between
the groups was the higher intensity ratio of the
mixed patient group as compared to the1 early schizo-
phrenics (medians of 0.85 and 0.55). This finding
is difficult to interpret because of certain methodo-
logic considerations discussed below.
Ohmmeter measurements: Before the test, resist-
ance was reliably lower for the controls than for
the entire group of patients. All groups showed
a drop in resistance from pretest values when meas-
urements were taken at the end of the test. But the
decrease was reliably greater for patients than con-
trols. The only reliable difference yielded by inter-
group comparisons showed that the mean resistance
of the anxiety group before the start of the test
was higher than that of the controls, and that the
pre-post change was greater in the anxiety group.
In a previous investigation (13), we found a re-
liable difference between patients and controls with
respect to number of anticipatory oscillations before
stimulation. The failure to confirm this finding in
the present study appears explainable largely in
terms of certain methodologic considerations.2
In the previous study the subject was grounded
at a single point, whereas in the present one an
additional ground lead was applied to the neck in
order to eliminate 60-cycle interference in the
muscle potential record. This additional ground
apparently had the effect of increasing the average
resting DC potential between palm and dorsum of
the hand. Our observations made with and without
the neck grounded, indicated that this increase could
be as much as tenfold. From such an increase, one
2
The methodologic work upon which this conclusion is
based was carried out by Mr. John F. Davis.
JANUARY-FEBRUARY. 1949
would anticipate that relatively small changes
would be more apparent in the records taken with
two grounds. Actually, more background oscilla-
tions were counted in the present study than in the
previous one, which tends to confirm this ex-
pectation.
A further technical complication in the present
study resulted from the use of a small current (4 or
5 microamperes) to avoid polarization effect. This
current would produce potentials of about 10 to 50
millivolts in the patient's circuit, and such potentials
would be of the same order of magnitude as the
patient's body potentials. The measured effect would
result from the algebraic sum of these potentials.
Since the polarity of the body potentials could
vary, one could cancel the other in certain cases,
and spuriously low background resistance readings
would be obtained.
These methodologic consideration's force extreme
caution in the interpretation of our data. However,
the generally negative findings with the GSR
method are not inconsistent with the view that
functions less under voluntary control are less dif-
ferentiative between patients and normals, or
among groups graded in terms of degree of anxiety.
6. Electroencephalogram
The poor relaxation permitted by the stress sit-
uation and the fact that certain individuals never
display much alpha rhythm caused a high propor-
tion of our records to be unusable. The criterion
of 8 out of 12 measurable responses was set in
order to make a record eligible for statistical con-
siderations. Only 4 controls, 22 anxiety-patients, 16
of the mixed group, and 3 schizophrenics met this
criterion. Consequently, the only valid comparison
could be made between the anxiety-patients and the
mixed group. This comparison revealed no statis-
tically significant differences between the blocking
times of the two groups, either when the mean
total blocking times or when the duration of block-
ing to stimuli of different intensity were considered.
Superficial scanning of the records revealed no
gross abnormalities in any case. No systematic
qualitative analysis was attempted, since only one
area was recorded from. Such an analysis had
yielded negative results in the previous study (13).
Factors of age and sex: All of the quantitative
determinations used in this study were submitted
to an analysis, designed to determine the influence
of age and sex on the findings. The effect of these
factors on the heart-rate measures was ruled out
by scoring so as to take them into account.
The sex factor may be disregarded in comparing
22
the mixed patient and anxiety groups because chi-
square determinations showed no significant dif-
ference between these two groups in respect to sex
proportions. This is important chiefly with respect
to the measures of head movement and muscle
potential because, with these, the female patients
showed significantly more disturbance than the
males.
For finger movement there was a tendency for
younger patients to show more disturbance than
older ones (correlation of -0.30). This means that
the difference between the controls and anxiety-
patients was not due to age, since the controls were
a younger group. The early schizophrenics were
about the same age as the controls. The difference
between the mixed and anxiety groups may pos-
sibly have been influenced by age, since the former
group was older. However, the influence of age
must have been slight, since the age difference was
barely reliable statistically.
For respiration there was no significant age or
sex factor operating.
Discussion
In the introductory section of this paper certain
questions were raised. With the data in hand we
are now in position to answer them, at least in part.
The answers to these questions constitute the major
findings which may be summarized as follows:
1) Patients in whom anxiety was the predominant
clinical feature displayed a generally higher level of
physiologic disturbance under stress than normal
controls or patients in whom anxiety was absent or
secondary. In general, degree of anxiety appeared to
be related to degree of physiologic disturbance.
2) The clearest correspondence between degree of
anxiety and degree of physiologic disturbance under
stress was found with measures of motor func-
tions, such as finger movement and neck muscle
potentials. It thus appears that disturbances in
stsriate muscle activity may be particularly charac-
teristic of anxiety. 3) Overreaction to pain stimula-
tion, as reflected in signaling of pain experience
with stimuli of low intensity and withdrawal of the
head from the stimulus, occurred more frequently
where the degree of anxiety was higher. This find-
ing supports the view that the pathologic anxiety
state is associated with a heightened state of ex-
pectation. 4) In most of the physiologic reactions
studied, the early schizophrenic group resembled
the most anxious group more than any other. In
voluntary signaling of pain experience, this group
differed from all other subjects, insofar as their
REACTION TO STRESS
reactions reflected less discrimination between
stimuli and were more immediate and long-lasting.
Similar findings were obtained with a dissimilar
response, that of respiratory irregularity. This poor
discrimination appears to reflect (at a simple level)
the inappropriateness of response which is gen-
erally typical of schizophrenia.
The first finding, that of correlation between
severity of anxiety and degree of physiologic dis-
turbance, is what might have been expected. Such
correlations show that the measurements were suf-
ficiendy sensitive for good differentiation, and re-
veal in an objective way the fact that anxiety is a
state of widespread physiologic disturbance.
The second finding, that disturbance in the
skeletal muscles was particularly characteristic of
anxiety (and, in our particular experiments, de-
cidedly more differentiative than heart rate, for ex-
ample) could not have been anticipated.
In order to interpret this finding, we must ex-
amine the nature of the motor reactions which were
studied. Essentially, all of these may be considered
to have served the purpose of protecting the sub-
ject from painful stimulation; they were defense
reactions. The stress situation was so structured that
the subject could respond actively to stimulation in
one or both of two ways: he could press the button
or he could draw his head away. The most appro-
priate behavior (in conformity with instructions)
was to remain quietly in position, and, when stimu-
lation reached near painful intensity, to press the
button briefly. Head withdrawal was an obvious
defense reaction, carried out in spite of instruc-
tions to the contrary. Button pressure could serve
as a "socially approved" defense reaction, in addi-
tion to its intended purpose of signaling pain ex-
perience. The defense-function attributed to button
pressure by some subjects is well illustrated by the
patient who said that he felt toward the button as
a gunner in a plane must feel toward his gun. It
was his only protection. The third type of motor
reaction characteristic of anxiety was respiratory ir-
regularity upon pain stimulation. The respiratory ef-
fects of sudden pain such as gasping, crying out,
holding the breath, are well known. To the extent
that such reactions serve a defensive purpose, the
respiratory irregularity measure may be considered
to reflect a function similar to button pressure and
head withdrawal.
Button pressure, head withdrawal, and respira-
tory irregularity may be regarded as immediate re-
sponses to pain stimulation. On the other hand,
finger movement (exclusive of voluntary pressures),
neck muscle activity, and respiratory unsteadiness,
VOL. XI. NO. 1
MALMO AND SHAGASS
would be interpreted as the "tonic" or background
activities upon which the discrete reactions were
superimposed. The distinction here is similar to the
distinction between phasic and tonic action (9).
The "phasic" motor reactions served a defensive
purpose, while the "tonic" reactions constituted the
preparatory soil, or, as Freeman (6) has termed it,
the "postural substrate" for the defense reactions.
From this standpoint, the finding that both "tonic"
and "phasic" disturbances were about equally well
related to degree of anxiety, is not surprising, since
overexcitation in the "postural substrate" may be
expected to lead to poor response adjustment (6).
By assigning a defensive function to these motor
reactions, the results, relating motor disturbances
to anxiety, may be readily understood. The stress
situation probably caused some degree of bodily
change along the lines of Cannon's emergency re-
action (3) in almost every subject, including the
controls. However, the extent to which the emer-
gency reaction remained confined to autonomic
systems, or extended into the motor response sys-
tems, appeared to depend largely upon the level of
anxiety in the subject. A high degree of anxiety
was associated with increased discharge into the
skeletal muscles concerned with response to the
stress at hand. The less anxious subjects tended to
control their motor activities and to restrict them to
appropriate responses. The more anxious subjects
tended to show an excess degree of preparatory
activity during intervals between stimulation, and
to overreact when the stimulus was applied.
These results lead to the hypothesis that one of
the distinctive characteristics of anxiety is the greater
probability that, under stress, reaction tendencies
will go directly over into action. This implies an
impairment of motor control or a reduction of the
capacity to inhibit reactions in the interests of
superior response adjustment. A similar conclusion
was drawn by Luria (12) from his studies of motor
reactions, but he did not compare patients from the
standpoint of anxiety. These observations fit the
conception of anxiety evolved by Freud and by
Mowrer. Freud stated, "Anxiety, therefore, is the
expectation of the trauma, on the one hand, and,
on the other, an attenuated repetition of it." (7, p.
114). "Expectation" and "attenuated repetition"
would be reflected both in increased preparatory
reaction and in overreaction to stimulation. Mowrer
regards anxiety as "the conditioned form of the
pain reaction" (14, p. 555). From this, one would
predict that in anxiety motor reactions of a de-
fensive nature would appear inappropriately in
some situations.
JANUARY-FEBRUARY, 1949
It follows that clinical manifestations of impaired
motor control should be found in an interference
with smooth muscular coordination, and in the de-
velopment of skeletal tensional symptoms. This ex-
pectation is borne out in the fact that psychoneu-
rotics are known to have lower performance I.Q.'s
than verbal I.Q.'s (17). It has also been found that
psyehoneurotics were unable to delay their reactions
in certain tests carried out by Luria (12).
It is of interest to note that the physiologic re-
actions which we found most significant in our
study of anxiety were those which are usually given
the least attention in accounts of the bodily changes
in emotion. The main reasons for this neglect prob-
ably lie in the difficulties of working with systems
over which so much voluntary control is possible.
It would appear, however, that the study of striatc
muscle function in emotion should receive far more
attention in this field of research.
Finally we come to the finding that the early
schizophrenic group resembled the group of anxious
neurotics in reacting to stress. Most of the physio-
logic work which has been done with schizophrenic
subjects has led to the general conclusion that the
schizophrenic is sluggish in reaction, in comparison
with normals and neurotics. Of course, such studies
have usually been conducted in institutions where
the schizophrenic population is older and composed
mainly of chronic, rather than early, schizophrenics.
Our schizophrenic group, on the contrary, was com-
posed of early cases. Consequently our finding of
high physiologic reactivity in the schizophrenic
group is not really in conflict with other findings.
Cameron (1) has described a hyperactive pattern
of nonspecific early symptoms of schizophrenia,
which includes such complaints as worry, uneasiness,
apprehension, and tenseness. Moreover the present
findings are also in line with those of Pfister (15)
who reported experimental evidence of heightened
cardiovascular response in the early stages of schi-
zophrenia. Pfister found that as schizophrenia pro-
gressed toward chronicity, reactivity became less and
less, until finally the schizophrenic was more slug-
gish than normal in his cardiovascular responses.
Our findings indicate that anxiety-level was high
in this group of early schizophrenics.
Summary and Conclusions
1. An unselected population of 75 patients was
divided into three groups: A) 36 patients in whom
anxiety was the predominant symptom; B) all other
patients, except early schizophrenics ( N = 28), and
C) 11 early schizophrenics. Eleven normal control
24
subjects were employed in order to provide a base
line.
2. A standardized series of pain stimulations
were presented by a Hardy-Wolff stimulator. Phy-
siologic recordings were taken continuously
throughout the test. Quantitative data obtained
from analysis of records were compared with the
clinical status of the case.
3. The results and major conclusions may be
summarized as follows: A) In general, severity of
anxiety appeared to be related to degree of physio-
logic disturbance. B) The clearest correspondence
between degree of anxiety and degree of physiologic
disturbance under stress was found with measure-
ments reflecting striate muscle activity such as finger
movement and neck muscle potentials. C) In gen-
eral, the more severe the anxiety, the greater was
the overreaction to pain stimulation. D ) In terms
of general level of responsiveness, the early schizo-
phrenic group resembled the most anxious group
more than any other. But in two quite different
types of reaction, the schizophrenic group showed
a relative lack of discrimination among the various
intensities. This poor discrimination appeared to
reflect (at a simple level) the inappropriateness of
response, which is generally typical of schizophrenia.
4. Current theories of action and of anxiety were
discussed in the light of present findings.
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VOL. XI, NO. 1