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Behavior of young children in a situation simulating entrapment in refrigerators was studied in order to develop standards for inside releasing devices, in accordance with Public Law 930 of the 84th Congress. Using a specially designed enclosure, 201 children 2 to 5 years of age took part in tests in which six devices were used, including two developed in the course of this experiment as the result of observation of behavior. Success in escaping was dependent on the device, a child's age and size and his behavior. It was also influenced by the educational level of the parents, a higher rate of success being associated with fewer years of education attained by mother and father combined. Three major types of behavior were observed: (1) inaction, with no effort or only slight effort to get out (24%); (2) purposeful effort to escape (39%); (3) violent action both directed toward escape and undirected (37%). Some of the children made no outcry (6% of the 2-year-olds and 50% of the 5-year-olds). Not all children pushed. When tested with devices where pushing was appropriate, 61% used this technique. Some children had curious twisting and twining movements of the fingers or clenching of the hands. When presented with a gadget that could be grasped, some (18%) pulled, a few (9%) pushed, but 40% tried to turn it like a doorknob. Time of confinement in the enclosure was short for most children. Three-fourths released themselves or were released in less than 3 minutes; one-fourth in less than 10 seconds. Of those who let themselves out, one-half did so in less than 10 seconds. One-third of the children emerged unruffled, about half were upset but could be comforted easily, and a small group (11%) required some help to become calm. Forces exerted in any horizontal direction by the children for whom such records were obtained ranged up to 29 pounds. The average was about 10 pounds for 3-year-olds and about 21 pounds for 5-year-olds. For reasons not known, the 2-year-old group exerted a slightly greater average force than did the 3-year-old group. More than one-fourth of the children exerted in excess of 18 pounds and almost two-thirds in excess of 12 pounds. Data from these experiments proved valuable in developing standards for release devices (as required by Public Law 930), which are expected to be effective for self-release by a large percentage of, but not all, entrapped children. An important result of the behavior study was the finding that, when entrapped, children most often try to escape either by pushing on the door through which they entered the enclosure, or by manipulating a knob release as they would a doorknob. Relatively few children pushed against the back, sides or ceiling of the enclosure. A follow-up study of 96 test subjects, 8 months after the tests, by interviews with the mothers showed very little obvious residual effect. Reversion to infantile behavior was not found. A number of children still talked about the tests, some with pleasure, a few with resentment. Mothers were not aware of more than ephemeral emotional upset in any of the children. Reasons for the low level of anxiety engendered by the tests may lie in the precautions taken and in factors inherent in the situation; the parents were not involved in the incident, which enabled them to be calm and casual with the children.

The purpose of this paper is to indicate that many psychoneuroses are essentially upsets of the autonomic nervous system, that in many cases we are not dealing with an emotional upset, but with the secondary autonomic disorder caused by that upset, and that this autonomic disorder is to the patient the essential part of his or her illness and the suffering from which he or she desires relief. Accordingly in such cases therapy should be pharmacological by drugs specific for the type of upset present. Such therapy gives excellent results, especially in early cases. Toxic or psychological factors which are still operating must, of course, be dealt with by appropriate measures, but even in such cases pharmacological therapy proves a useful auxiliary. If, after elimination of those causal factors the resultant autonomic upset persists. pharmacological therapy is essential to bring about a complete cure. This has been proved to us by observation of the failure of persistence in psychotherapy in such cases with subsequent relief by pharmacological therapy.

We report below the occurrence of congenital intermittent vertical nystagmus in a father and son who were in all other respects normal. So far as we can determine, such a case has never been previously reported. Report of Case Case 1. —A 28-year-old male graduate student at the University of California had suffered from attacks of vertical nystagmus since the age of 7 months. These attacks which were usually precipitated by fatigue or emotional upset, occurred at least once a day, were sudden in onset, lasted 20 to 30 minutes, and subsided spontaneously. No aura preceded these spells, but the patient recognized their onset by experiencing blurred vision and rapid vertical oscillation of the environment (oscillopsia). During an attack he could minimize the blurring by looking down and tilting his head back. He had never experienced any alteration in consciousness before, during, or after these attacks. No nausea, vomiting, tongue-biting

School-phobic youngsters have sometimes been described as wilful and stubborn in the family situation (Hersov, 1960), and this tendency has been invoked to explain the particular occurrence of school phobia in early adolescence (Leventhal and Sills, 1964). The emotional upset shown by these young people when faced with the prospect of going to school (Berg, Nichols and Pritchard, 1969), may occasionally appear to be more in the nature of anger, defiance and temper than either fearfulness or misery (Smith, 1970). The fact that in the general population dislike of school is reflected in actual absence only during the secondary school years (Mitchell and Shepherd, 1967) supports the view that assertiveness, which presumably becomes more effective as the child reaches the teens, plays some part in school refusal.

Summary Emotional disturbances in children often develop in the setting of physicalillness. An understanding of the meaning of the illness to the child is helpful in the prevention of lasting emotional upset. To many children illness comes as punishment. A common psychologic reaction is a regression to an immature level of social and emotional adaptation. While many children react to illness in a constructive way, others may respond with persistent dependency patterns, rebellion, or chronic invalid reactions. Attention to the psychologic needs of the child during the convalescent period is also important in the over-all care of the sick child.

Within the framework of Hebb's dissonance theory (Hebb, 1949) marked discrepancies between expected and observed perceptual experience result in an unpleasant affective state. This emotional upset is characterized by disorganization and stereotyping of thinking and/or behavior patterns and the organism is motivated to reduce the state. Rats have been shown reliably to display more defecation and less ambulation when exposed to a strange environment and both of these responses may be considered indices of emotional upset in the animal (Hall, 1934, 1936; Broadhurst, 1957). Recent research (Grumpelt, et al., 1969) suggested that intense inter-sense perceprual dissonance was one of the factors responsible for the emotional upset usually contingent upon a new experience with a particular kind of motion. In an attempt to replicate these findings and further explore their implications, 180 female rats (Holtzman strain), approximately 130 days old, were randomly assigned to 12 groups of 15 rats each in a 3 by 4 design. Drug type was one variable (10 mg/kg diazepam, 0.4 mg/kg meclizine hydrochloride or mammalian saline solution, all orally administered 90 min. prior to testing) and motion-dissonance condition was the second. A previously described (Grumpelt, et al., 1969) acetate test cage and surrounding display, which could be rotated independently, allowed design of the following groups: motion-dissonance, M-D, motion alone, M, dissonance alone, D, and no-motion-no-dissonance control, C. It was hypothesized that diazepam, a tranquilizer, might reduce emotional upset effects on D groups while meclizine hydrochloride, an anti-motion sickness agent, might reduce these effects on M groups. Diazepam was chosen because it has no demonstrated peripheral autonomic blocking action or extrapyramidal side effects (Randall, et dl., 1961) while meclizine has no known effects except on the vestibular nuclei. The specific meclizine dosage Level was established after pilot work but it appeared that an appropriate dosage level of diazepam could be estimated from the literature. Measures of ambulation and defecation were used (cf. Grumpelt, et al., 1969) to assess emotional upset. A factorial analysis of variance on ambulation scores yielded a significant main effect of motion-dissonance treatment (P = 6.71, df = 3/168, p < ,005); however, the drug treatment (P = 2.21, df = 21168) and the interaction (F = 0.91, df = 6/168) were nonsignificant. A similar analysis of defecation scores also indicated that motion-disso

I N a previous report’ I discussed the subject of emotional disturbance as a cause of an acute cardiac insult. I presented some of the possible physiologic and pathologic changes responsible for such an insult under emotional strain. The following case, which was sent to me for review by a physician from Los Angeles, further illustrates the causal relationship between a severe emotional upset and an acute myocardial infarction. The case is of interest because the condition occurred in an apparently perfectly healthy person, forty-two years of age, an airplane pilot who usually is not easily disturbed by danger or by an exciting event. It also illustrates the intermittency of subjective manifestations as the pathologic process progressed for about two days before the diagnosis was established. During this interval there were periods when he felt quite well, and even piloted his plane over a stretch from the West Coast to Hawaii without discomfort. It is hoped that more cases illustrating the effect of emotion and strain upon the heart will be brought to our attention.

THE RELATION of emotion to elevation of arterial pressure has been discussed in the medical literature since essential hypertension was first recognized. Although ample evidence exists that an emotional upset may cause temporary elevation of arterial pressure, there are differences of opinion concerning its importance as the cause of essential hypertension. Among the findings in patients with essential hypertension, as well as in some of their normotensive siblings, is an excessive rise in arterial pressure when carbon dioxide accumulates in the blood during voluntary suspension of breathing. 1 It was therefore considered desirable to study the effect of breath holding on arterial pressure in patients with emotional disturbances. The study also afforded information concerning the reactivity of the vasomotor system in the psychoses studied. MATERIAL AND METHODS Seventy-nine patients, of whom 51 were women, were studied by the method of Ayman and Goldshine. 1 The patients were at rest during

MEN electing vasectomy for contraception and their wives were studied with interviews, psychological tests, and questionnaires over a four-year period beginning prior to surgery. They were compared to ovulation-suppression-using couples. After four years, the two groups did not differ significantly in frequency of intercourse or other sexual behavior, changes in sexual problems, emotional adjustment, or changes in marital satisfaction. Consistent with earlier evaluations, the vasectomy men showed evidence of a counteractive reaction to threats to masculinity with an increase in masculinity-confirming behavior. The study procedures probably attenuated adverse psychological reactions. Other men not interviewed showed psychological test evidence of emotional upset following vasectomy. Suggestions are made concerning selection of appropriate subjects for the operation, and for other contraception methods, and concerning appropriate procedures to reduce risk of negative postvasectomy emotional reactions. Voluntary male sterilization, vasectomy, has not been an unusual method of contraception

Surgical operations, although necessary for the patient's life and health, are frightening and upsetting. The adult recovers from this emotional upset in a reasonably short time and does not necessarily show in his later emotional reactions the effects of the operation. This is not so true of the child. His emotional development, that is, his capacity to handle his emotional reactions, is still incomplete. His ego has not acquired a very stable ability to test reality. His knowledge of his own physiology and anatomy is meager and is confused with weird speculations about the inside of his body, and he is reticent about discussing these weird ideas with adults lest he be laughed at, as has happened so often. When he has to have an operation, he is seldom told what is going to happen to him and may even not be told that there is to be an operation