Bodily changes in pain, hunger, fear, and rage

THE EFFECT OF THE EMOTIONS ON DIGESTION

The doctrine of human development from subhuman antecedents has done much to unravel the complex nature of man. As a means of interpretation this doctrine has been directed chiefly toward the solving of puzzles in the peculiarities of anatomical structure. Thus arrangements in the human body, which are without obvious utility, receive rational explanation as being vestiges of parts useful in or characteristic of remote ancestors—parts retained in man because of age-long racial inheritance. This mode of interpretation has proved applicable also in accounting for functional peculiarities. Expressive actions and gestures—the facial appearance in anger, for example—observed in children and in widely distinct races, are found to be innate, and are best explained as the retention in human beings of responses which are similar in character in lower animals.

From this point of view biology has contributed much to clarify our ideas regarding the motives of human behavior. The social philosophies which prevailed during the past century either assumed that conduct was determined by a calculated search for pleasure and avoidance of pain or they ascribed it to a vague and undefined faculty named the conscience or the moral sense. Comparative study of the behavior of men and of lower animals under various circumstances, however, especially with the purpose of learning the source of prevailing impulses, is revealing the inadequacy of the theories of the older psychologists. More and more it is appearing that in men of all races and in most of the higher animals, the springs of action are to be found in the influence of certain emotions which express themselves in characteristic instinctive acts.

The rôle which these fundamental responses in the higher organisms play in the bodily economy has received little attention. As a realm for investigation the bodily changes in emotional excitement have been left by the physiologists to the philosophers and psychologists and to the students of natural history. These students, however, have usually had too slight experience in the detailed examination of bodily functions to permit them to follow the clues which superficial observation might present. In consequence our knowledge of emotional states has been meager.

There are, of course, many surface manifestations of excitement. The contraction of blood vessels with resulting pallor, the pouring out of “cold sweat,” the stopping of saliva-flow so that the “tongue cleaves to the roof of the mouth,” the dilation of the pupils, the rising of the hairs, the rapid beating of the heart, the hurried respiration, the trembling and twitching of the muscles, especially those about the lips—all these bodily changes are well recognized accompaniments of pain and great emotional disturbance, such as fear, horror and deep disgust. But these disturbances of the even routine of life, which have been commonly noted, are mainly superficial and therefore readily observable. Even the increased rapidity of the heart beat is noted at the surface in the pulsing of the arteries. There are, however, other organs, hidden deep in the body, which do not reveal so obviously as the structures near or in the skin, the disturbances of action which attend states of intense feeling. Special methods must be used to determine whether these deep-lying organs also are included in the complex of an emotional[*] agitation.

Among the organs that are affected to an important degree by feelings are those concerned with digestion. And the relations of feelings to the activities of the alimentary canal are of particular interest, because recent investigations have shown that not only are the first stages of the digestive process normally started by the pleasurable taste and smell and sight of food, but also that pain and great emotional excitement can seriously interfere with the starting of the process or its continuation after it has been started. Thus there may be a conflict of feelings and of their bodily accompaniments—a conflict the interesting bearing of which we shall consider later.

Emotions Favorable to Normal Secretion of the Digestive Juices

The feelings or affective states favorable to the digestive functions have been studied fruitfully by Pawlow,[1] of Petrograd, through ingenious experiments on dogs. By the use of careful surgical methods he was able to make a side pouch of a part of the stomach, the cavity of which was wholly separate from the main cavity in which the food was received. This pouch was supplied in a normal manner with nerves and blood vessels, and as it opened to the surface of the body, the amount and character of the gastric juice secreted by it under various conditions could be accurately determined. Secretion by that part of the stomach wall which was included in the pouch was representative of the secretory activities of the entire stomach. The arrangement was particularly advantageous in providing the gastric juice unmixed with food. In some of the animals thus operated upon an opening was also made in the esophagus so that when the food was swallowed, it did not pass to the stomach but dropped out on the way. All the pleasures of eating were thus experienced, and there was no necessity of stopping because of a sense of fulness. This process was called “sham feeding.” The well-being of these animals was carefully attended to, they lived the normal life of dogs, and in the course of months and years became the pets of the laboratory.

By means of sham feeding Pawlow showed that the chewing and swallowing of food which the dogs relished resulted, after a delay of about five minutes, in a flow of natural gastric juice from the side pouch of the stomach—a flow which persisted as long as the dog chewed and swallowed the food, and continued for some time after eating ceased. Evidently the presence of food in the stomach is not a prime condition for gastric secretion. And since the flow occurred only when the dogs had an appetite, and the material presented to them was agreeable, the conclusion was justified that this was a true psychic secretion.

The mere sight or smell of a favorite food may start the pouring out of gastric juice, as was noted many years ago by Bidder and Schmidt[2] in a hungry dog which had a fistulous opening through the body wall into the stomach. This observation, reported in 1852, was confirmed later by Schiff and also still later by Pawlow. That the mouth “waters” with a flow of saliva when palatable food is seen or smelled has long been such common knowledge that the expression, “It makes my mouth water,” is at once recognized as the highest testimony to the attractiveness of an appetizing dish. That the stomach also “waters” in preparation for digesting the food which is to be taken is clearly proved by the above cited observations on the dog.

The importance of the initial psychic secretion of saliva for further digestion is indicated when, in estimating the function of taste for the pleasures of appetite, we realize that materials can be tasted only when dissolved in the mouth and thereby brought into relation with the taste organs. The saliva which “waters” the mouth assures the dissolving of dry but soluble food even when it is taken in large amount.

The importance of the initial psychic secretion of gastric juice is made clear by the fact that continuance of the flow of this juice during digestion is provided by the action of its acid or its digestive products on the mucous membrane of the pyloric end of the stomach, and that secretion of the pancreatic juice and bile are called forth by the action of this same acid on the mucous membrane of the duodenum. The proper starting of the digestive process, therefore, is conditioned by the satisfactions of the palate, and the consequent flow of the first digestive fluids.

The facts brought out experimentally in studies on lower animals are doubtless true also of man. Not very infrequently, because of the accidental swallowing of corrosive substances, the esophagus is so injured that, when it heals, the sides grow together and the tube is closed. Under these circumstances an opening has to be made into the stomach through the side of the body and then the individual chews his food in the usual manner, but ejects it from his mouth into a tube which is passed through the gastric opening. The food thus goes from mouth to stomach through a tube outside the chest instead of inside the chest. As long ago as 1878, Richet,[3] who had occasion to study a girl whose esophagus was closed and who was fed through a gastric fistula, reported that whenever the girl chewed or tasted a highly sapid substance, such as sugar or lemon juice, while the stomach was empty, there flowed from the fistula a considerable quantity of gastric juice. A number of later observers[4] have had similar cases in human beings, especially in children, and have reported in detail results which correspond remarkably with those obtained in the laboratory. Hornborg[4] found that when the little boy whom he studied chewed agreeable food a more or less active secretion of gastric juice invariably started, whereas the chewing of an indifferent substance, as gutta-percha, was followed by no secretion. All these observations clearly demonstrate that the normal flow of the first digestive fluids, the saliva and the gastric juice, is favored by the pleasurable feelings which accompany the taste and smell of food during mastication, or which are roused in anticipation of eating when choice morsels are seen or smelled.

These facts are of fundamental importance in the serving of food, especially when, through illness, the appetite is fickle. The degree of daintiness with which nourishment is served, the little attentions to esthetic details—the arrangement of the dishes, the small portions of food, the flower beside the plate—all may help to render food pleasing to the eye and savory to the nostrils and may be the deciding factors in determining whether the restoration of strength is to begin or not.

Emotions Unfavorable to the Normal Secretion of the Digestive Juices

The conditions favorable to proper digestion are wholly abolished when unpleasant feelings such as vexation and worry and anxiety, or great emotions such as anger and fear, are allowed to prevail. This fact, so far as the salivary secretion is concerned, has long been known. The dry mouth of the anxious person called upon to speak in public is a common instance; and the “ordeal of rice,” as employed in India, was a practical utilization of the knowledge that excitement is capable of inhibiting the salivary flow. When several persons were suspected of crime, the consecrated rice was given to them all to chew, and after a short time it was spit out upon the leaf of the sacred fig tree. If anyone ejected it dry, that was taken as proof that fear of being discovered had stopped the secretion, and consequently he was adjudged guilty.[5]

What has long been recognized as true of the secretion of saliva has been proved true also of the secretion of gastric juice. For example, Hornborg was unable to confirm in his little patient with a gastric fistula the observation by Pawlow that when hunger is present the mere seeing of food results in a flow of gastric juice. Hornborg explained the difference between his and Pawlow’s results by the different ways in which the boy and the dogs faced the situation. When food was shown, but withheld, the hungry dogs were all eagerness to secure it, and the juice very soon began to flow. The boy, on the contrary, became vexed when he could not eat at once, and began to cry; then no secretion appeared. Bogen also has reported the instance of a child with closed esophagus and gastric fistula, who sometimes fell into such a passion in consequence of vain hoping for food that the giving of the food, after the child was calmed, was not followed by any flow of the secretion.

The inhibitory influence of excitement has also been seen in lower animals under laboratory conditions. Le Conte[6] declares that in studying gastric secretion it is necessary to avoid all circumstances likely to provoke emotional reactions. In the fear which dogs manifest when first brought into strange surroundings he found that activity of the gastric glands may be completely suppressed. The suppression occurred even if the dog had eaten freely and was then disturbed—as, for example, by being tied to a table. When the animals became accustomed to the experimental procedure, it no longer had an inhibitory effect. The studies of Bickel and Sasaki[7] confirm and define more precisely this inhibitory effect of strong emotion on gastric secretion. They observed the inhibition on a dog with an esophageal fistula, and with a side pouch of the stomach, which, as in Pawlow’s experiments, opened only to the exterior. In this dog Bickel and Sasaki noted, as Pawlow had, that sham feeding was attended by a copious flow of gastric juice, a true psychic secretion, resulting from the pleasurable taste of the food. In a typical instance the sham feeding lasted five minutes, and the secretion continued for twenty minutes, during which time 66.7 cubic centimeters of pure gastric juice were produced.

On another day a cat was brought into the presence of the dog, whereupon the dog flew into a great fury. The cat was soon removed, and the dog pacified. Now the dog was again given the sham feeding for five minutes. In spite of the fact that the animal was hungry and ate eagerly, there was no secretion worthy of mention. During a period of twenty minutes, corresponding to the previous observation, only 9 cubic centimeters of acid fluid were produced, and this was rich in mucus. It is evident that in the dog, as in the boy observed by Bogen, strong emotions can so profoundly disarrange the mechanisms of secretion that the pleasurable excitation which accompanies the taking of food cannot cause the normal flow.

On another occasion Bickel and Sasaki started gastric secretion in the dog by sham feeding, and when the flow of gastric juice had reached a certain height, the dog was infuriated for five minutes by the presence of the cat. During the next fifteen minutes there appeared only a few drops of a very mucous secretion. Evidently in this instance a physiological process, started as an accompaniment of a psychic state quietly pleasurable in character, was almost entirely stopped after another psychic state violent in character.

It is noteworthy that in both the favorable and unfavorable results of the emotional excitement illustrated in Bickel and Sasaki’s dog the effects persisted long after the removal of the exciting condition. This fact, in its favorable aspect, Bickel[8] was able to confirm in a girl with esophageal and gastric fistulas; the gastric secretion long outlasted the period of eating, although no food entered the stomach. The influences unfavorable to digestion, however, are stronger than those which promote it. And evidently, if the digestive process, because of emotional disturbance, is for some time inhibited, the swallowing of food which must lie stagnant in the stomach is a most irrational procedure. If a child has experienced an outburst of passion, it is well not to urge the taking of nourishment soon afterwards. Macbeth’s advice that “good digestion wait on appetite and health on both,” is now well-founded physiology.

Other digestive glands than the salivary and the gastric may be checked in emotional excitement. Recently Oechsler[9] has reported that in such psychic disturbances as were shown by Bickel and Sasaki to be accompanied by suppressed secretion of the gastric juice, the secretion of pancreatic juice may be stopped, and the flow of bile definitely checked. All the means of bringing about chemical changes in the food may be thus temporarily abolished.

Emotions Favorable and Unfavorable to the Contractions of the Stomach and Intestines

The secretions of the digestive glands and the chemical changes wrought by them are of little worth unless the food is carried onward through the alimentary canal into fresh regions of digestion and is thoroughly exposed to the intestinal wall for absorption. In studying these mechanical aspects of digestion I was led to infer[10] that just as there is a psychic secretion, so likewise there is probably a “psychic tone” or “psychic contraction” of the gastro-intestinal muscles as a result of taking food. For if the vagus nerve supply to the stomach is cut immediately before an animal takes food, the usual contractions of the gastric wall, as seen by the Röntgen rays, do not occur; but if these nerves are cut after food has been eaten with relish, the contractions which have started continue without cessation. The nerves in both conditions were severed under anesthesia, so that no element of pain entered into the experiments. In the absence of hunger, which in itself provides a contracted stomach,[11] the pleasurable taking of food may, therefore, be a primary condition for the appearance of natural contractions of the gastro-intestinal canal.

Again just as the secretory activities of the stomach are unfavorably influenced by strong emotions, so also are the movements of the stomach; and, indeed, the movements of almost the entire alimentary canal are wholly stopped during great excitement. In my earliest observations on the movements of the stomach[12] I had difficulty because in some animals the waves of contraction were perfectly evident, while in others there was no sign of activity. Several weeks passed before I discovered that this difference was associated with a difference of sex. In order to be observed with Röntgen rays the animals were restrained in a holder. Although the holder was comfortable, the male cats, particularly the young males, were restive and excited on being fastened to it, and under these circumstances gastric peristaltic waves were absent; the female cats, especially if elderly, usually submitted with calmness to the restraint, and in them the waves had their normal occurrence. Once a female with kittens turned from her state of quiet contentment to one of apparent restless anxiety. The movements of the stomach immediately stopped, the gastric wall became wholly relaxed, and only after the animal had been petted and began to purr did the moving waves start again on their course. By covering the cat’s mouth and nose with the fingers until a slight distress of breathing is produced, the stomach contractions can be stopped at will. In the cat, therefore, any sign of rage or fear, such as was seen in dogs by Le Conte and by Bickel and Sasaki, was accompanied by a total abolition of the movements of the stomach. Even indications of slight anxiety may be attended by complete absence of the churning waves. In a vigorous young male cat I have watched the stomach for more than an hour by means of the Röntgen rays, and during that time not the slightest beginning of peristaltic activity appeared; yet the only visible indication of excitement in the animal was a continued quick twitching of the tail to and fro. What is true of the cat I have found true also of the rabbit, dog and guinea-pig[13]—very mild emotional disturbances are attended by abolition of peristalsis. The observations on the rabbit have been confirmed by Auer,[14] who found that the handling of the animal incidental to fastening it gently to a holder stopped gastric peristalsis for a variable length of time. And if the animal was startled for any reason, or struggled excitedly, peristalsis was again abolished. The observations on the dog also have been confirmed; Lommel[15] found that small dogs in strange surroundings might have no contractions of the stomach for two or three hours. And whenever the animals showed any indications of being uncomfortable or distressed, the contractions were inhibited and the discharge of contents from the stomach checked.

Like the peristaltic waves in the stomach, the peristalsis and the kneading movements (segmentation) in the small intestine, and the reversed peristalsis in the large intestine all cease whenever the observed animal shows signs of emotional excitement.

There is no doubt that just as the secretory activity of the stomach is affected in a similar fashion in man and in lower animals, so likewise gastric and intestinal peristaltic waves are stopped in man as they are stopped in lower animals, by worry and anxiety and the stronger affective states. The conditions of mental discord may thus give rise to a sense of gastric inertia. For example, a patient described by Müller[16] testified that anxiety was always accompanied by a feeling of weight, as if the food remained in the stomach. Every addition of food caused an increase of the trouble. Strong emotional states in this instance led almost always to gastric distress, which persisted, according to the grade and the duration of the psychic disturbance, between a half-hour and several days. The patient was not hysterical or neurasthenic, but was a very sensitive woman deeply affected by moods.

The feeling of heaviness in the stomach, mentioned in the foregoing case, is not uncommonly complained of by nervous persons, and may be due to stagnation of the contents. That such stagnation occurs is shown by the following instance. A refined and sensitive woman, who had had digestive difficulties, came with her husband to Boston to be examined. They went to a hotel for the night. The next morning the woman appeared at the consultant’s office an hour after having eaten a test meal. An examination of the gastric contents revealed no free acid, no digestion of the test breakfast, and the presence of a considerable amount of the supper of the previous evening. The explanation of this stagnation of the food in the stomach came from the family doctor, who reported that the husband had made the visit to the city an occasion for becoming uncontrollably drunk, and that he had by his escapades given his wife a night of turbulent anxiety. The second morning, after the woman had had a good rest, the gastric contents were again examined; the proper acidity was found, and the test breakfast had been normally digested and discharged.

These cases are merely illustrative and doubtless can be many times duplicated in the experience of any physician concerned largely with digestive disorders. Indeed, the opinion has been expressed that a great majority of the cases of gastric indigestion that come for treatment are functional in character and of nervous origin. It is the emotional element that seems most characteristic of these cases. To so great an extent is this true that Rosenbach has suggested that as a term to characterize the cause of the disturbances, “emotional” dyspepsia is better than “nervous” dyspepsia.[17]

The Disturbing Effect of Pain on Digestion

The advocates of the theory of organic evolution early pointed out the similarity between the bodily disturbances in pain and in the major emotions. The alterations of function of internal organs they could not know about. The general statement, however, that pain evokes the same changes that are evoked by emotion, is true also of these deep-lying structures. Wertheimer[18] proved many years since that stimulation of a sensory nerve in an anesthetized animal—such stimulation as in a conscious animal would induce pain—quickly abolished the contractions of the stomach. And Netschaiev, working in Pawlow’s[19] laboratory, showed that excitation of the sensory fibres in the sciatic nerve for two or three minutes resulted in an inhibition of the secretion of gastric juice that lasted for several hours. Similar effects from painful experience have been not uncommonly noted in human beings. Mantegazza,[20] in his account of the physiology of pain, has cited a number of such examples, and from them he has concluded that pain interferes with digestion by lessening appetite and by producing various forms of dyspepsia, with arrest of gastric digestion, and with vomiting and diarrhea. The expression, “sickening pain” is testimony to the power of strong sensory stimulation to upset the digestive processes profoundly. Vomiting is as likely to follow violent pain as it is to follow strong emotion. A “sick headache” may be, indeed, a sequence of events in which the pain from the headache is primary, and the nausea and other evidences of digestive disorder are secondary.

As the foregoing account has shown, emotional conditions or “feelings” may be accompanied by quite opposite effects in the alimentary canal, some highly favorable to good digestion, some highly disturbing. It is an interesting fact that the feelings having these antagonistic actions are typically expressed through nerve supplies which are correspondingly opposed in their influence on the digestive organs. The antagonism between these nerve supplies is of fundamental importance in understanding not only the operation of conditions favorable or unfavorable to digestion but also in obtaining insight into the conflicts of emotional states. Since a consideration of the arrangement and mode of action of these nerves will establish a firm basis for later analysis and conclusions, they will next be considered.

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