When in late May 1944, only ten days before the D-day, a brochure asking for volunteers in a medical experiment was distributed through the work camps across the USA where conscientious objectors had found an option to serve their country, little could the over 400 young men who applied and the 36 finally selected suspect the immense influence their decision would imply to the study and understanding of human behavior under starvation, and of eating disorders in particular. The leaflet, entitled “Will you starve that they be better fed?” alluded to the European population suffering from war food shortage and malnourishment, and asked young men to go through a controlled starvation period followed by refeeding, in preparation for the immense task expected to be found in released countries. By this stage of the Second World War victory was turning towards the Allies, and the US government was concerned about having to feed the thousands of people in concentration camps or those who simply were going through harsh times, when food was too often unavailable. With the Normandy landing just around the corner (June 6, 1944) the problem of a refeeding 2 strategy became more important. In fact that winter would be one of the hardest in some countries, like the half-liberated Netherlands where it would be known as the Hongerwinter and thousands of people died of starvation, Allied relief not reaching part of the nazi-controlled land.
The experiment was to be held at the Laboratory of Physiological Hygiene at the University of Minnesota, and was the idea of his founder, Dr. Ancel Keys, a physiologist who had left the Mayo Foundation, preferring practical field work in Minnesota. A couple of years earlier, in 1941-2, he had developed the extremely popular (if not specially loved) ready-to-eat & pocket-portable K-ration, and a decade later would also become famous for his contribution to the study of cardiovascular risk factors and the Mediterranean diet. He probably followed his own advice, as he lived over one hundred. Many people would first knew about the Minnesota experiment through the article published in Life magazine on July 1945.
Keys and his team selected 36 men from over 400 petitioners and designed a semi-starvation program for six months (the experiment took place between February 1945 to October 1946) consisting of a diet similar to that of war-ridden countries based on cabbage, potatoes, turnip, beans or a small amount of pasta and brown bread in a twice-a-day 1.500 calories cut to-half-normal meal regime, to achieve a 25 % loss of body weight. During the first three months diets for all men were standardized, antropometric measures taken for each one and psychological tests given. Then a six-month starvation period began during 3 which regular threadmill walking was added to diminishing caloric intake, while coordination and other psychological tests were performed. The men were allowed to keep their college studies if they wished, and to go out (in pairs, to avoid cheating). This was followed by a three-month refeeding stage, with four different regimes, designed relying on the belief of the times that vitamine supplements would quicken the improvement -which wasn´t so, nor with protein content, while plain caloric intake proved to be determinant. The men were under medical follow-up, and were even offered physical shelter al the Laboratory after release from the experiment, as the team was conscious of eventual both physical and mental sequels. The results of the Starvation experiment produced in 1946 a short guidance book, Men and Hunger, for staff aiding war-starved population, and later a two-volume complete report entitled The Biology of Human Starvation (1950) still available from the University of Minnesota Press.
Alas, and this is the sad paradox, it took too long for the experiment to complete to apply its findings to the liberated countries, starvation taking place between 1945 and 1946 and refeeding completed on October 1946, more than a year after peace had been reached in Europe on V-day May 8th., 1945. Yet, what´s more impressive than the facts are the boys themselves, their testimonials, as they kept personal diaries during the experiment. When it was finished they carried on with their lives and personal goals; not unsurprisingly many of them would take war relief posts and afterwards met careers as teachers, religious or diplomats. They never forgot the experiment -nor it seems their ideals-, when they were once and again interviewed about those months, 4 leaving us invaluable information, personal details and even recordings that help us understand not only what they went through with modesty and honesty alike, but also why did they did it for : starving so that other could be better fed. “I wanted to do something that had a little more punch to it. I wanted to risk my life in some way and be of service”, told volunteer Marshall Sutton. “The difference between us and the people we were trying to serve (...) : we knew the exact day on which our torture was going to end”, stated Sam Legg. “I am proud of what I did. My protuding ribs were my battle scars” said Henry Scholberg. As starvation advanced, belts were adjusted and ankles swollen, they were also aware of the psychological changes it was also conveying : “... food became the one central and only thing really in one´s life. And life is pretty dull if that´s the only thing” (Harold Blickenstaff). “It changed our personalities. We were always apologizing to each other for something we didn´t mean to do. (...) We had periods of elation. Periods of deep depression. And our difficult traits came to the surface” (Marshall Sutton).
Volunteers Gerald Wilsnack, Marshall Sutton, and Jasper Garner relax in the sun during their daily routine as participants in the Ancel Keys starvation experiment, c.1944. Minneapolis Newspaper Collection, Hennepin County Library Special Collections. Similarities and differences with eating disorders Quetelet´s Body Mass Index (BMI) was the measure relating weight to height that Keys and others favored and is nowadays in common use for monitoring weight changes. It dropped during starvation to a range of 14.9 to 18.6 (mean 16.4), compared to 18.4 to 25.4 (mean 21,9) previous range. Aside from the well-known physical effects (weakness, decreased heart rate, coldness, swollen joints, hair loss, dizziness, constipation -hearing being the 6 only improved measure), the main mental changes the volunteers suffered also occur in eating disordered patients. E.g. depression, obsessivity with food, weight and related activities, food crumbling and ruminating, bad dreams, decreased concentration, loss of sexual drive, chewing gum addiction, kleptomania, viewing normal weight people as obese, some men not viewing themselves as severely underweight but acknowledging others were (perceptual distortion), even a case of psychoses and another one of self-mutilation.
Also during refeeding seven men reported a concern for the body areas where fat was relocating. All these symptoms are to be found in eating-disordered patients, specially in restrictive-type anorexia nervosa. The above mental crises resulted in some drop-outs including transient psychiatric hospitalization. 32 out of 36 men completed the experiment. After 8 months of rehabilitation their normal previous weight was restored for the 21 participants followed, five showing overweight at the time if not obesity (considered as BMI > 30, now 24). When regaining free access to food many of them lost their control over eating and their sense of satiety at first, having to eat continuously, not stopping despite feeling full, and always having to carry some food with them; six of them (32 %) reported binging and two vomited involuntarily during the refeeding phase; some asked to stay in the Laboratory premises for some time as a safety measure before returning home. Many anorectic patients have a similar course over time, evolving to purgative-type anorexia and eventually to bulimia nervosa over the years. As for the psychometric measurements, it is worth noticing that although the perceived psychological performance of the men worsened, “no objective loss in intellectual ability and no faults in memory or logic were observed”.
The 7 Minnesota Multiphasic Personality Inventory (MMPI) which had just been issued a year before the study started and is still in widespread use among Psychiatrists and Psychologists today, showed increased scores of what became known as the “neurotic triad” or “semistarvation neurosis”, namely Hypocondriasis, Hysteria and Depression, while the psychotic subscales remained within normal limits except for the above commented case (the MMPI didn´t include by then validity scales or corrections). For three out of the four non-completers the MMPI showed increases in the psychopathic subscale congruent with increased anger, aggressiveness and impulsivity, and in the psychotic subscales though not reaching abnormal values, consistant with pre-psychotic clinical features in the two men who had to be hospitalized. Female bulimia nervosa patients show an MMPI impulsive/compulsive profile similar to these worst cases.
We have written a lot about the similarities between the Starvation Experiment and eating disorders. Now, which are the differences? First and obviously, the gender. Sex could account for different basis personality traits and physical endurance. Second, the idealistic basis with all men being conscientious objectors, most having pacifist and religious ideals (many of them affiliated to pacifist churches, three quakers). Age might have some effect too, as the volunteers age range was 22 to 33, while eating disorders more commonly beguin at younger ages, and are increasing in prepubertal boys and girls. Then there´s the personality basis : the men were checked and considered mentally healthy to be selected to enter the study, while in most eating disordered patients there are obsessive, avoidant and/or 8 impulsive personality traits that facilitate the disclosure of the disorder, remain over time and can also be found in relatives. Although the self-sacrifice drive may be shared to some extent, these men didn´t wish to starve per se, but for helping others; so when they could avoid extra physical activity like climbing stairs all of them gladly stayed away from it; they felt “hungry all the time” and when they were given access to food they willfully took it; they didn´t fight against their natural instincts regarding food and exercise as soon as they were allowed to act freely. They wanted to show their commitment and shared persistence with patients, but were not deeply unsatisfied with their bodies as patients are. While eating disordered patients develop the need of the dietary symptoms from previous inner self-esteem and developmental conflicts, and fight to deny their natural hunger feeling, often becoming both physically and mentally hyperactivated to attenuate self-consciousness and suffering. The Minnesota volunteers laid on the campus grass as soon as they were released from the treadmill routine, the anorectic and bulimic patients seek extra physical activities, especially after an imposed meal arousing guilt feelings and self-depreciating thoughts. The Keys volunteers were not previously specially critic about their own bodies, nor had fear to regain weight, a key diagnostic feature for anorectic patients, eating disordered patients being highly critical about both their physical and characterial qualities. the lack of previous obsessive trais, deep self-unsatisfaction (other than feeling different for having chosen not to use weapons) and/or impulsive-aggressive drives (in a sample made of pacifist and often religious men) make a crucial difference and explains such different outcomes (prognosis).
Finally, a difference is also established regarding psychopharmacological treatment, as nowadays it´s common to use 9 antidepressants and benzodiazepines, and eventually antipsychotic medication, to control anxiety or insomnia and help diminish dysphoric and depressive mood and obsessive thinking. The experiment ended and the volunteers then came back to their lives. For many it took months to return to their normal eating patterns, for some it took years. To a minority it took up to five years to fully recover their normal eating behavior and control weight previous to the experiment. Ten of them reported that “their perceptions and perspectives regarding food were permanently altered by the study experience”.
The comradeness feeling and good-nature of the men were restored when they were refed. The survivers kept meetings for fifty! years; and a 57-year follow-up has been recently published. And even at 95 volunteer Daniel Peacock said he would undergo it all again (providing he was young again). Because those men believed in helping others as long as they didn´t have to kill.
The Minnesota experiment showed among many other issues that starvation causes mental changes and that refeeding is mandatory to revert them and achieve psychological improvement. Last and not least, let´s not forget that the ethics underlying the experiment were only acceptable in those hard times with a world war going on, but would not be allowed at present. Let´s take it as an advance on human rights and remember the Minnesota experiment as something that really helped others and the understanding of the physical and mental process of starvation and the development of an eating disorder.