Control of the behavior of schizophrenic patients by food.

Operant-conditioning principles using food as a reinforcer were applied to control the behavior of 45 chronic schizophrenic patients. The investigation was conducted in a psychiatric ward in which there was 24-hr environmental control. In order to use food as a reinforcer for controlling psychotic behavior, it was necessary first to deal with the eating deficits in the patients. Approximately 50% of the ward population was selected because of a history of refusal to eat. Their refusal to eat had remained relatively unaffected by one or more of these treatments: spoonfeeding, tubefeeding, intravaneous feeding, and electroshock. These treatments were discontinued, and the patients were left alone at mealtimes. The results show that social reinforcement in such forms as coaxing, persuading, and feeding the patient tend to shape patients into eating problems so they are conditioned to eat only with assistance. When refusal to eat was no longer followed by social reinforcement, the patients soon started eating unassisted. When access to the dining room was made dependent upon a chain of responses including a motor and social component, all patients learned these responses.