Control of the behavior of schizophrenic patients by food.
Stop spoon-feeding: withdraw social attention for food refusal and require a simple response chain to access meals—chronic eating problems reversed quickly.
01Research in Context
What this study did
The team worked with three adult men in a state hospital. All had refused food for months and were spoon-fed by staff.
Doctors used two simple rules. First, staff stopped talking or looking when food was spit out. Second, the men had to walk to the dining room, sit down, and pick up a spoon before the tray arrived.
What they found
Food refusal stopped in every patient within nine days. Each man began feeding himself with no prompts.
Weight went up. Staff no longer had to sit beside them for hours. The ward ran smoother and quieter.
How this fits with other research
Kahng et al. (1999) later added remote prompts and rewards to a habit-reversal plan for nail-biting. Their idea is the same: give a clear chain of steps plus consequences.
Wilkins et al. (2009) used chaining to teach children with autism to retell stories. The 1962 meal chain is the grandparent of that story chain.
Delamater et al. (1986) replaced echolalia with correct answers using prompts and fading. Both studies show that old, stuck behavior can flip fast when the environment changes.
Why it matters
You can copy the two rules today. Remove attention for food refusal and require a simple response chain before the meal starts. The change can be quick, even with years of tube or hand feeding. Start small: one walk to the table, one self-scoop, one bite.
Want CEUs on This Topic?
The ABA Clubhouse has 60+ free CEUs — live every Wednesday. Ethics, supervision & clinical topics.
Join Free →Place the client’s tray on the table only after they walk to the chair, sit, and hold the spoon—ignore every spit or turn-away.
02At a glance
03Original abstract
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.
Journal of the experimental analysis of behavior, 1962 · doi:10.1901/jeab.1962.5-343