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+Wise men study the sciences which deal with the origins and development
+of animal life, with the structure of the cells, with the effect of
+various diseases upon the tissues and fluids of the body; they study the
+causes of the reactions of the body cells to disease germs, and search
+for the origin and means of extermination of these enemies to health.
+They study the laws of physical well-being. They seek for the chemical
+principles governing the reactions of digestive fluids to the foods they
+must transform into heat and energy. So the doctor learns to combat
+disease with science, and at the same time to apply scientific laws of
+health that he may fortify the human body against the invasion of
+harmful germs. Thus, eventually, he makes medicine itself less
+necessary.
+
+But another science must walk hand in hand today with that of medicine;
+for doctors and nurses are realizing as never before the power of mind
+over body, and the hopelessness of trying to cure the one without
+considering the other. Hence psychology has come into her own as a
+recognized science of the mind, just as biology, histology, chemistry,
+pathology, and medicine are recognized sciences governing the body. As
+these are concerned with the "how" and "why" of life, and of the body
+reactions, so psychology is concerned with the "how" and "why" of
+conduct and of thinking. For as truly as every infectious disease is
+caused by a definite germ, just as truly has every action of man its
+adequate explanation, and every thought its definite origin. As we would
+know the laws of the sciences governing man's physical well-being that
+we might have body health, so we would know the laws of the mind and of
+its response to its world in order to attain and hold fast to mind
+health. Experience with patients soon proves to us nurses that the weal
+and woe of the one vitally affects the other.
+
+"Psychology is the science of mental life, both of its phenomena and
+their conditions."
+
+So William James took up the burden of proof some thirty years ago, and
+assured a doubting world of men and women that there were laws in the
+realm of mind as certain and dependable as those applying to the world
+of matter--men and women who were not at all sure they had any right to
+get near enough the center of things to see the wheels go round. But
+today thousands of people are trying to find out something of the way
+the mind is conceived, and to understand its workings. And many of us
+have in our impatient, hasty investigation, self-analytically taken our
+mental machines all to pieces and are trying effortfully to put them
+together again. Some of us have made a pretty bad mess of it, for we
+tore out the screws and pulled apart the adjustments so hastily and
+carelessly that we cannot now find how they fit. And millions of other
+machines are working wrong because the engineers do not know how to keep
+them in order, put them in repair, or even what levers operate them. So
+books must be written--books of directions.
+
+If you can glibly recite the definition above, know and explain the
+meaning of "mental life," describe "its phenomena and their conditions,"
+illustrating from real life; if you can do this, and prove that
+psychology is a science, _i. e._, an organized system of knowledge on
+the workings of the mind--not mere speculation or plausible theory--then
+you are a psychologist, and can make your own definitions. Indeed, the
+test of the value of a course such as this should be your ability, at
+its end, to tell clearly, in a few words of your own, what psychology
+is.
+
+The word _science_ comes from a Latin root, _scir_, the infinitive form,
+_scire_, meaning to know. So a science is simply the accumulated, tested
+knowledge, the proved group of facts about a subject, all that is known
+of that subject to date. Hence, if psychology is a _science_, it is no
+longer a thing of guesses or theories, but is a grouping of confirmed
+facts about the mind, facts proved in the psychology laboratory even as
+chemical facts are demonstrated in the chemical laboratory. Wherein
+psychology departs from facts which can be proved by actual experience
+or by accurate tests, it becomes metaphysics, and is beyond the realm of
+science; for metaphysics deals with the realities of the supermind, or
+the soul, and its relations to life, and death, and God. Physics,
+chemistry, biology have all in their day been merely speculative. They
+were bodies of theory which might prove true or might not. When they
+_worked_, by actually being tried out, they became bodies of accepted
+facts, and are today called sciences. In the same way the laws of the
+working of the mind have been tested, and a body of assured facts about
+it has taken its place with other sciences.
+
+It must be admitted that no psychologist is willing to stop with the
+_known_ and _proved_, but, when he has presented that, dips into the
+fascinations of the yet unknown, and works with promising theory, which
+tomorrow may prove to be science also. But we will first find what they
+have verified, and make that the safe foundation for our own
+understanding of ourselves and others.
+
+What do we mean by "mental life"?--or, we might say, the science of the
+life of the mind. And what is _mind_?
+
+But let us start our quest by asking first what reasons we have for
+being sure mind exists. We find the proof of it in consciousness,
+although we shall learn later that the activities of the mind may at
+times be unconscious. So where consciousness is, we know there is mind;
+but where consciousness is not, we must find whether it has been, and is
+only temporarily withdrawn, before we say "Mind is not here." And
+_consciousness_ we might call _awareness_, or our personal recognition
+of being--awareness of me, and thee, and it. So we recognize _mind_ by
+its evidences of awareness, _i. e._, by the body's reaction to stimuli;
+and we find mind at the very dawn of animal life.
+
+Consciousness is evidenced in the protozoön, the simplest form in which
+animal life is known to exist, by what we call its response to stimuli.
+The protozoön has a limited power of self-movement, and will accept or
+reject certain environments. But while we see that mind expresses itself
+in consciousness as vague, as dubious as that of the protozoön, we find
+it also as clear, as definite, as far reaching as that of the statesman,
+the chemist, the philosopher. Hence, the "phenomena of mental life"
+embrace the entire realms of feeling, knowing, willing--not of man
+alone, but of all creatures.
+
+In our study, however, we shall limit ourselves to the psychology of the
+human mind, since that concerns us vitally as nurses. Animal psychology,
+race psychology, comparative psychology are not within the realm of our
+practical needs in hospital life. We would know the workings of man's
+mind in disease and health. What are the instinctive responses to fear,
+as shown by babies and children and primitive races? What are the normal
+expressions of joy, of anger, or desire? What external conditions call
+forth these evidences? What are the acquired responses to the things
+which originally caused fear, or joy, or anger? How do grown-ups differ
+in their reactions to the same stimuli? Why do they differ? Why does one
+man walk firmly, with stern, set face, to meet danger? Why does another
+quake and run? Why does a third man approach it with a swagger, face it
+with a confident, reckless smile of defiance?
+
+All these are legitimate questions for the psychologist. He will
+approach the study of man's mind by finding how his body acts--that is,
+by watching the phenomena of mental life--under various conditions; then
+he will seek for the "why" of the action. For we can only conclude what
+is in the mind of another by interpreting his expression of his thinking
+and feeling. We cannot see within his mind. But experience with
+ourselves and others has taught us that certain attitudes of body,
+certain shades of countenance, certain gestures, tones of voice,
+spontaneous or willed actions, represent anger or joy, impatience or
+irritability, stern control or poise of mind. We realize that the
+average man has learned to conceal his mental reactions from the casual
+observer at will. But if we see him at an unguarded moment, we can very
+often get a fair idea of his mental attitude. Through these outward
+expressions we are able to judge to some extent of the phenomena of his
+mental life. But let us list them from our own minds as they occur to us
+this work-a-day moment, then, later on, find what elements go to make up
+the present consciousness.
+
+As I turn my thoughts inward at this instant I am aware of these mental
+impressions passing in review:
+
+You nurses for whom I am writing.
+
+The hospitals you represent.
+
+What you already know or do not know along these lines.
+
+A child calling on the street some distance away.
+
+A brilliant sunshine bringing out the sheen of the green grass.
+
+The unmelodious call of a flicker in the pine-tree, and a towhee singing
+in the distance.
+
+A whistling wind bending the pines.
+
+A desire to throw work aside and go for a long tramp.
+
+A patient moving about overhead (she is supposed to be out for her walk,
+and I'm wondering why she is not).
+
+The face and voice of an old friend whom I was just now called from my
+work to see.
+
+The plan and details of my writing.
+
+The face and gestures of my old psychology professor and the assembled
+class engaged in a tangling metaphysic discussion.
+
+A cramped position.
+
+Some loose hair about my face distracting me.
+
+An engagement at 7.30.
+
+A sharp resolve to stop wool-gathering and finish this chapter.
+
+And yet, until I stopped to examine my consciousness, I was keenly aware
+_only_ of the thoughts on psychology I was trying to put on paper.
+
+But how shall we classify these various contents?
+
+Some are _emotion_, _i. e._, feelings; others are _intellect_, _i. e._,
+thoughts; still others represent _determination_, _i. e._, volition or
+will.
+
+There is nothing in this varied consciousness that will not be included
+in one or another of these headings. Let us group the contents for
+ourselves.
+
+The nurses for whom I am writing:
+
+A result of memory and of imagination (both intellect). A sense of
+kinship and interest in them (emotion). A determination that they must
+have my best (will, volition).
+
+And so of the hospitals:
+
+My memory of hospitals I have known, and my mental picture of yours made
+up from piecing together the memories of various ones, the recollection
+of the feelings I had in them, etc. (intellect).
+
+What you already know.
+
+Speculation (intellect), the speculation based on my knowledge of other
+schools (memory which is intellect). A desire (emotion) that all nurses
+should know psychology.
+
+Child calling on street.
+
+Recognition of sound (intellect) and pleasant perception of his voice
+(emotion).
+
+Desire to throw work aside and go for a tramp on this gorgeous day.
+
+Emotion, restrained by stronger emotion of interest in work at hand, and
+_intellect_, which tells me that this is a work hour--and _will_, which
+orders me to pay attention to duties at hand.
+
+So all the phenomena of mental life are included in feelings, thoughts,
+and volitions which accompany every minute of my waking life, and
+probably invade secretly every second of my sleeping life.
+
+The conditions of mental life--what are they?
+1. In man and the higher animals the central nervous system, which,
+anatomy teaches us, consists of the brain and spinal cord. (In the
+lowest forms of animal life, a diffused nervous system located
+throughout the protoplasm.)
+2. An external world.
+3. A peripheral nervous system connecting the central nervous system
+with the outside world.
+4. The sympathetic nervous system, provided to assure automatic workings
+of the vital functions of the body. These organs of the mind will be
+discussed in a later chapter.
+
+
+
+
+CHAPTER II
+
+CONSCIOUSNESS
+
+
+We took a glimpse at random into the mental life of an adult
+consciousness, and found it very complicated, constantly changing. We
+found it packed with shifting material, which, on the surface, seemed to
+bear very little relation. We found reason, feeling, and will all
+interacting. We found nothing to indicate that a consciousness as simple
+as mere _awareness_ might exist. We believe there might be such in the
+newborn babe, perhaps even in the baby a month old; but can we prove it?
+Let us look within again and see if there are not times of mere, bare
+consciousness in our own experience that give us the proof we need.
+
+I have slept deeply all night. It is my usual waking time. Something
+from within or from without forces an impression upon my mind, and I
+stir, and slowly open my eyes. As yet I have really not seen anything.
+With my eyes open my mind still sleeps--but in a few seconds comes a
+possessing sense of well-being. Obeying some stimulus, not recognized by
+the senses as yet, I begin to stretch and yawn, then close my eyes and
+settle down into my pillows as for another nap. I am not aware that I
+am I, that I am awake, that I have yawned and stretched. I have a
+pleasant, half-dreamy feeling, but could not give it a name. For those
+few seconds this is all my world--a pleasant drowsiness, a being
+possessed by comfort. My consciousness is mere awareness--a pleasant
+awareness of uncomplicated existence. In another moment or two it is a
+consciousness of a day's work or pleasure ahead, the necessity of
+rising, dressing, planning the day, the alert reaction of pleasure or
+displeasure to what it is to bring, the effort to recall the dreams of
+sleep--the complicated consciousness of the mature man or woman. But I
+started the day with a mental condition close to pure sensation, a vague
+feeling of something different than what was just before.
+
+Or this bare consciousness may come in the moment of acute shock, when
+the sense of suffering, quite disconnected from its cause, pervades my
+entire being; or at the second when I am first "coming back" after a
+faint, or at the first stepping out from an anesthetic. In these
+experiences most of us can recall a very simple mental content, and can
+prove to our own satisfaction that there is such a thing as mere
+awareness, a consciousness probably close akin to that of the lower
+levels of animal life, or to that of the newborn babe when he first
+opens his eyes to life.
+
+_Consciousness_, then, in its elements, is the simplest mental reaction
+to what the senses bring.
+
+How shall we determine when consciousness exists? What are its tests?
+
+The response of the mind to stimuli, made evident by the body's
+reaction, gives the proof of consciousness in man or lower animal.
+
+But what do we mean by a stimulus?
+
+Light stimulates me to close my eyes when first entering its glare from
+a dark room, or to open them when it plays upon my eyelids as I sleep
+and the morning sun reaches me. It is a stimulus from without.
+
+The fear-thought, which makes my body tremble, my pupils grow wide, and
+whitens my cheeks, is a stimulus from within.
+
+An unexpected shot in the woods near-by, which changes the whole trend
+of my thinking and startles me into investigating its cause, is a
+stimulus from without causing a change within.
+
+A _stimulus_, then, is anything within or without the body that arouses
+awareness; and this is usually evidenced by some physical change,
+however slight--perhaps only by dilated pupils or an expression of
+relief. When we see the reaction of the body to the stimulus we know
+there is consciousness. On the other hand, we cannot say that
+consciousness is always absent when the usual response does not occur;
+for there may be injury to organs accounting for the lack of visible
+reaction, while the mind itself may respond. But with due care, in even
+such cases, some external symptoms of response can usually be found if
+consciousness exists.
+
+We have already realized how complex, intricate, and changing is fully
+developed consciousness.
+
+
+THE UNCONSCIOUS
+
+But the mind of man knows two distinct conditions of activity--the
+conscious and the unconscious. Mind is not always wide awake. We
+recognize what we call the _conscious_ mind as the ruling force in our
+lives. But how many things I do without conscious attention; how often I
+find myself deep in an unexplainable mood; how the fragrance of a flower
+will sometimes turn the tide of a day for me and make me square my
+shoulders and go at my task with renewed vigor; or a casual glimpse of a
+face in the street turn my attention away from my errand and settle my
+mind into a brown study. Usually I am alert enough to control these
+errant reactions, but I am keenly aware of their demands upon my mind,
+and frequently it is only with conscious effort that I am kept upon my
+way unswerved by them, though not unmoved.
+
+When we realize that nothing that has ever happened in our experience is
+forgotten; that nothing once in consciousness altogether drops out, but
+is stored away waiting to be used some day--waiting for a voice from the
+conscious world to recall it from oblivion--then we grasp the fact that
+the quality of present thought or reaction is largely determined by the
+sum of all past thinking and acting. Just as my body is the result of
+the heritage of many ancestors plus the food I give it and the use to
+which I subject it, so my mind's capacity is determined by my
+inheritance plus the mental food I give it, plus everything to which I
+have subjected it since the day I was born. For it forgets absolutely
+nothing.
+
+"That is not true," you say, "for I have tried desperately to remember
+certain incidents, certain lessons learned--and they are _gone_.
+Moreover, I cannot remember what happened back there in my babyhood."
+
+Ah, but you are mistaken, my friend. For you react to your task today
+differently because of the thing which you learned and have "forgotten."
+Your mind works differently because of what you disregarded then. "You"
+have forgotten it, but your brain-cells, your nerve-cells have not; and
+you are not quite the same person you would be without that forgotten
+experience, or that pressing stimulus, which you never consciously
+recognized, but allowed your subconsciousness to accept. Some night you
+have a strange, incomprehensible dream. You cannot find its source, but
+it is merely the re-enacting of some past sensation or experience of
+your own, fantastically arrayed. Some day you stop short in your hurried
+walk with a feeling of compulsion which you cannot resist. You know no
+reason for it, but some association with this particular spot, or some
+vague resemblance, haunts you. You cannot "place" it. One day you hit
+the tennis-ball at a little different angle than you planned because a
+queer thought came unbidden and directed your attention aside. Again,
+under terrific stress, with sick body and aching nerves, you go on and
+do your stint almost mechanically. You do not know where the strength or
+the skill is derived. But your unconscious or subconscious--as you
+will--has asserted itself, has usurped the place of the sick conscious,
+and enabled you automatically to go on. For we react to the storehouse
+of the unconscious even as we do to the conscious.
+
+Remember that the unconscious is simply the latent conscious--what once
+was conscious and may be again, but is now buried out of sight.
+
+The mind may be likened to a great sea upon which there are visible a
+few islands. The islands represent the conscious thoughts--that
+consciousness we use to calculate, to map out our plans, to form our
+judgments. This is the mind that for centuries was accepted as all the
+mind. But we know that the islands are merely the tops of huge
+mountain-ranges formed by the floor of the sea in mighty, permanent
+upheaval; that as this sea-floor rises high above its customary level
+and thrusts its bulk above the waters into the atmosphere, is the island
+possible.
+
+Just so there can be no consciousness except as that which is already in
+the mind--the vast subconscious material of all experience--rises into
+view and relates itself through the senses to an outside world. We speak
+very glibly of motion, of force, of power. We say "The car is moving
+now." But how do we know? Away back there in our babyhood there were
+some things that always remained in the same place, while others changed
+position. The _changing_ gave our baby minds a queer sensation; it made
+a definite impression; and sometimes we heard people say "move," when
+that impression came. Finally, we call the feeling of that change
+"move," or "movement," or "motion." The word thereafter always brings to
+our minds a picture of a change from one place to another. The
+process--the slow comprehending of the baby mind--was buried in
+forgetfulness even at the time. But had not the subconscious been
+imprinted with the incident and all its succeeding associations, that
+particular phenomenon we could not name today. It would be an entirely
+unique experience. So our recognition of the impression is merely the
+rising into consciousness of the subconscious material in response to a
+stimulus from the outside world which appeals through the sense of
+sight. We can get no response whatever except as the stimulus asking our
+attention is related by "like" or "not like" something already
+experienced; that is, it must bear some relation to the known--and
+perhaps forgotten--just as the island cannot be, except as, from far
+down below, the sea-floor leaves its bed and raises itself through the
+deeps. The visible island is but a symbol of the submarine mountain.
+The present mental impression is but proof of a great bulk of past
+experiences.
+
+And so we might carry on the figure and compare the birth of
+consciousness to the instant of appearance of the mountain top above the
+water's surface. It is not a new bit of land. It is only emerging into a
+new world.
+
+"But," you ask, "do you mean to assert that the baby's mind is a
+finished product at birth; that coming into life is simply the last
+stage of its growth? How unconvincing your theory is."
+
+No, we only now have the soil for consciousness. The island and the
+submarine mountain are different things. The sea-floor is transformed
+when it enters into the new element. An entirely different vegetation
+takes place on this visible island than took place on the floor of the
+sea before it emerged. But the only new elements added to the hitherto
+submerged land come from the new atmosphere, and the sea-floor
+immediately begins to become a very different thing. Nevertheless, what
+it is as an island is now, and forever will be due, primarily, to its
+structure as a submarine mountain. In the new atmosphere the soil is
+changed, new chemical elements enter in, seeds are brought to it by the
+four winds--and it is changed. But it is still the sea-floor
+transformed.
+
+Just so the baby brain, complete in parts and mechanism at birth, is a
+different brain with every day of growth in its new environment, with
+every contact with the external world. But it is, primarily and in its
+elements, the brain evolved through thousands of centuries of pushing up
+to man's level through the sea of animal life, and hundreds of centuries
+more of the development of man's brain to its present complete mechanism
+through experience with constantly changing environment.
+
+Hence, when the baby sees light and responds by tightly shutting his
+eyes, then later by opening them to investigate, his sensation is what
+it is because through the aëons of the past man has established a
+certain relation to light through experiencing it. To go further than
+this, and to find the very beginning, how the first created life came to
+respond to environment at all, is to go beyond the realm of the actually
+known. But that he did once _first_ experience his environment, and
+establish a reaction that is now racial, we know.
+
+So our baby soon shows certain "instinctive" reactions. He reaches out
+to grasp. He sucks, he cries, he looks at light and bright objects in
+preference to dark, he is carrying out the history of his race, but is
+making it personal. He has evolved a new life, but all his ancestors
+make its foundation. The personal element, added to his heritage, has
+made him different from any and all of his forebears. But he can have no
+consciousness except as a bit from the vast inherited accumulation of
+the past of his ancestors, of all the race, steps forth to meet a new
+environment.
+
+And again you ask, "How came the first consciousness?"
+
+And again I answer, "It is as far back as the first created or evolved
+organism which could respond in any way to a material world; and only
+metaphysics and the God behind metaphysics can say."
+
+We only know that careful laboratory work in psychology--experiments on
+the unconscious--today prove that our conscious life is what it is,
+because of: _first_, what is stored away in the unconscious (_i. e._,
+what all our past life and the past life of the race has put there);
+_second_, because of what we have accepted from our environment; and
+this comprises our material, intellectual, social, and spiritual
+environment.
+
+
+CONSCIOUSNESS IS COMPLEX
+
+The one fact we want at this stage of our inquiry is simply this: that
+consciousness, awaking at birth, very soon becomes complex. However
+single and simple in content immediate consciousness may be, it is so
+intimately linked with all preceding experience that a pure sensation is
+probably never known after the first second of life. As the sensation is
+registered it becomes a basis for comparison. That first sensation,
+perhaps, was just a feeling of _something_. The next is a feeling of
+something that is the same, or is not the same, as the first. So
+immediately perception is established. The baby consciousness recognizes
+that the vague feeling is, or is not, _that same thing_. And from
+perception to a complex consciousness of perceptions, of ideas, of
+memories and relations, and judgments, is so short a step that we cannot
+use our measuring rods to span it.
+
+Thus through the various stages of life, from infancy to maturity, the
+conscious is passing into the unconscious, only to help form later a new
+conscious thought. Hence the conscious thought is determined by the
+great mass of the unconscious, plus the external world.
+
+But every thought, relegated to the unconscious, through its association
+there--for it is plastic by nature--comes back to consciousness never
+quite the same, and meets never quite the same stimulus. And as a result
+a repeated mental experience is never twice exactly the same. So the
+conscious becomes the unconscious and the unconscious the conscious, and
+neither can be without the other.
+
+Our problem is to understand the workings of the mind as it exists
+today, and to try to find some of its most constructive uses; and on
+that we shall focus attention. To that end we must first examine the
+various ways in which consciousness expresses itself.
+
+We have recognized two distinct mental states--the conscious and the
+unconscious--and have found them constantly pressing each on the other's
+domain. Our study of consciousness reveals the normal in the aspects of
+sleeping and waking, also various abnormal states. Consciousness may
+become excited, depressed, confused, delirious, or insane. We shall
+consider later some of the mental workings that account for these
+abnormal expressions. At present let us examine the mind's activities in
+sleep and in delirium.
+
+
+CONSCIOUSNESS IN SLEEP
+
+Sleep seldom, if ever, is a condition of utter unconsciousness. We so
+frequently have at least a vague recollection, when we wake, of
+dreaming--whether or not we remember the dream material--that we are
+inclined to accept sleep as always a state of some kind of mental
+activity, though waking so often wipes the slate clean. A new word which
+serves our purpose well has come into common use these last years, and
+we describe sleep as a state of rest of the conscious mind made possible
+as weariness overpowers the _censor_, and this guard at the gate naps.
+The censor is merely that mental activity which forces the mind to keen,
+alert, constructive attention during our waking hours, a guard who
+_censors_ whatever enters the conscious mind and compares it with
+reality, forcing back all that is not of immediate use, or that is
+undesirable, or that contradicts established modes of life or thought.
+In sleep we might say that the censor, wearied by long vigilance,
+presses all the material--constantly surging from the unconscious into
+consciousness, there to meet and establish relations with matter--back
+into the unconscious realms, and locks the door, and lies and slumbers.
+Then the half-thoughts, the disregarded material, the unfit, the
+unexpressed longings or fears, the forbidden thoughts; in fact, the
+whole accumulation of the disregarded or forgotten, good, bad, and
+indifferent--for the unconscious has no moral sense--seize their
+opportunity. The guard has refused to let them pass. He is now asleep.
+And the more insistent of them pick the lock and slip by, masquerading
+in false characters, and flit about the realms of the sleeping
+consciousness as ghosts in the shelter of darkness. If the guard
+half-wakes he sleepily sees only legitimate forms; for the dreams are
+well disguised. His waking makes them scurry back, sometimes leaving no
+trace of their lawless wanderings. So the unconscious thoughts of the
+day have become sleep-consciousness by play acting.
+
+
+CONSCIOUSNESS IN DELIRIUM
+
+At this time of our study it will suffice to say that in delirium and in
+insanity, which we might very broadly call a prolonged delirium, the
+toxic brain becomes a house in disorder. The censor is sick, and
+sequence and coherence are lost as the thronging thoughts of the
+unconscious mind press beyond the portals into consciousness, disordered
+and confused. We shall later find, however, that this very disorder
+falls into a sort of order of its own, and a dominant emotion of pain or
+ecstasy, of depression or fear, of exaltation or depreciation calls
+steadily upon the stored away incidents and remembered, related
+feelings of the past and interprets them as present reality. The censor
+of the sick brain is stupefied by toxins, shock, or exhaustion, and the
+citadel he is supposed to guard is thronged with besiegers from every
+side. The strongest--_i. e._, those equipped with most associations
+pertinent to the emotional status at the time--win out, occupy the brain
+by force, and demand recognition and expression from all the senses,
+deluding them by their guise of the reality of external matter.
+
+We find consciousness, then, determined by all past experience, by an
+external world, and by its organ of expression--the _brain_.
+
+Consequently, our psychology leads us into anatomy and physiology,
+which, probably, we have already fairly mastered. In rapid review, only,
+in the following chapter we shall consider the organs of man's
+consciousness, the brain, spinal cord, and the senses, and try to
+establish some relation between the material body and its mighty
+propelling force--the _mind_.
+
+
+
+
+CHAPTER III
+
+ORGANS OF CONSCIOUSNESS
+
+
+Nothing is known to us until it has been transmitted to the mind by
+the senses. The nerves of special sense, of sight, hearing, smell,
+taste, touch, the temperature sense ("hot or cold" sense), the
+muscular sense (sense of weight and position), these, and the nerves
+controlling voluntary motion, form the peripheral, or surface, nervous
+system. This acts as a connecting medium between the outside world and
+the central nervous system, which is composed of the brain and spinal
+cord. We might liken the nerves, singly, to wires, and all of them
+together to a system of wires. The things of the external world tap at
+the switchboard by using the organs of special sense; the nerves,
+acting as wires, transmit their messages; at the switchboard is the
+operator--consciousness--accepting and interpreting the jangle of
+calls.
+
+The recognition by the brain of the appeals coming by way of the
+transmitting sense, and its interpretation of these appeals, is the
+mind's function of consciousness, whether expressed by thinking,
+feeling, or willing.
+
+
+THE CENTRAL AND PERIPHERAL NERVOUS SYSTEMS IN ACTION
+
+I am passing the open door of a bake-shop, and a pervading odor fills
+the air. I think "hot rolls," because my organ of smell--the nose--has
+received a stimulus which it transmits along my olfactory nerves to the
+brain; and there the odor is given a name--"hot rolls." The recognition
+of the stimulus as an odor and of that odor as "hot rolls" is
+consciousness in the form of thinking. But the odor arouses desire to
+eat--hunger; and this is consciousness in the form of feeling. The
+something which makes me walk into the shop and buy the rolls is
+consciousness in the form of willing. The sensory appeal from the
+outside world gained admission through the sense of smell; this
+transmitted the message, and consciousness recognized the stimulus,
+which immediately appealed to my hunger and incited action to satisfy
+that hunger.
+
+The ear of the operator in the telegraph office, again, might illustrate
+consciousness. It must be able to interpret mere clickings into terms of
+sense. To the operator the sounds say words, and the words are the
+expression of the object at the other end of the wire. The brain is the
+receiving operator for all the senses, which bring their messages in
+code, and which it interprets first as sound, vision, taste, touch,
+feel, smell, temperature; then more accurately as words, trees, sweet,
+soft, round, acrid, hot.
+
+The mind can know nothing except as the stimulus is transmitted by
+sense-channels over the nerves of sense, and received by a conscious
+brain. A baby born without sight, hearing, taste, smell, or touch would
+remain a mere bit of clay. He could have no awareness. But so long as
+any one sense channel remains open the mind may acquire some knowledge.
+
+Suppose I am paralyzed, blind, and deaf, and you put a tennis-ball into
+my hand. I cannot tell you what it is, not even what it is like. It
+means nothing whatever to me, for the sense channels of touch, sight,
+and hearing, through which alone it could be impressed upon my brain,
+are gone. Suppose I am blind and deaf, but have my sense of touch
+intact; that I never saw or touched or heard of a tennis-ball before,
+but I know "apple" and "orange." I can judge that the object is round,
+that it is about the size of a small orange or apple. It is very light,
+and has a feel of cloth. I know it to be something new in my experience.
+You tell me in the language of touch that it is "tennis-ball"; and
+thereafter I recognize it by its combination of size, feel, and weight,
+and can soon name it as quickly as you, who see it.
+
+Suppose I am blind and my hands are paralyzed, but I have my hearing.
+You tell me this is a tennis-ball, and if I have known "tennis-ball" in
+the past, I can describe it to you. It has been impressed upon my brain
+through my sense of hearing; and memory immediately supplies the
+qualities that go with "tennis-ball."
+
+But if none of the senses has ever developed, my brain can receive no
+impression whatever; it cannot have even the stimulus of memory. Hence
+conscious mind cannot be, except as some sense-channel or channels have
+been opened to carry thought material to the brain. So far as we know
+today, in this world, mind is absolutely dependent upon the sense organs
+and the brain--upon matter--for existence.
+
+
+THE SYMPATHETIC NERVOUS SYSTEM
+
+Associated with the central nervous system by connecting nerves--but
+located outside of it in various parts of the body--are groups of
+nerve-cells (gray matter) and their fibers, forming what we call the
+_sympathetic nervous system_--the direct connecting link between mind
+and body.
+
+The _central nervous system_ is the director of all conscious action of
+the body; the _sympathetic_ orders all unconscious action.
+
+The beating of the heart, the contraction of the blood-vessels, hence
+the flowing of the blood, the processes of digestion, the functioning of
+the glands, are all directed by the sympathetic. In other words, the
+_central nervous system_ normally controls the movements of the
+voluntary muscles; the _sympathetic_ controls those of the involuntary
+muscles.
+
+The quick blush, the sudden paling of the cheeks, the start of fear, the
+dilated pupils of fright are the direct result of the action of
+involuntary muscles under control of the sympathetic system. The
+stimulus is received by the central nervous system; the fibers
+connecting the central and the sympathetic systems carry the message
+quickly to the latter, which immediately respond by ordering contraction
+or expansion of involuntary muscles. So tears flow, we breathe freely
+again or we quake and tremble, our pupils widen or contract, the heart
+beats suffocatingly, or seems almost to stop.
+
+The _sympathetic system_, as the name implies, is influenced by
+suggestions from the emotions rather than from the intellect. We might
+say that it is controlled by the "feeling mind" rather than the thinking
+mind, for intellect cannot influence it in the least.
+
+The wise nurse, who knows something of the laws of the mind, soon
+realizes that the _sympathetic nervous system_, rather than physical
+disability, causes many indigestions, headaches, diarrheas, dry mouths,
+chills; is responsible for much nausea, much "exhaustion," etc. When she
+has had wider experience she finds that almost any known physical
+disorder can be unconsciously imitated by the suggestible patient, whose
+sympathetic nervous system causes physical reactions to respond to the
+feelings of a sick mind. Let the nurse remember, however, that is it not
+for her to decide whether the disorders from which her patient suffers
+are of physical or nervous origin. It is for her, on the other hand, to
+study her patient's mentality and reactions, and to become expert in
+reporting symptoms of nervous as well as of physical significance.
+
+
+
+
+CHAPTER IV
+
+RELATION OF MIND AND BODY
+
+
+We have found that mind is entirely dependent upon the bodily organs for
+its existence. Is the body in the same way dependent upon the mind? Can
+the mind die and the body go on?
+
+Given a perfect body with unblocked sense channels, and put the mind to
+sleep, paralyze the _central nervous system_ with alcohol in sufficient
+quantity so that the undamaged _peripheral nervous system_--the
+senses--can obtain no response or recognition from it, and that perfect
+body is as useless for the time as if dead. But here comes proof of the
+remarkable hold of the body on life. The unconscious mind takes up the
+burden of directing the sympathetic nerves to stimulate the muscles of
+breathing. The unconscious sees to the beating of the heart. It directs
+the contraction of the blood-carrying vessels. It maintains certain
+vital processes of secretion. Thus automatically life goes on; the body
+still reacts to a limited field of stimuli, and consciousness recognizes
+it not. But when the unconscious mind ceases to function, then, indeed,
+does the body die. Yet the conscious mind may "die" and the body live
+on, so long as the unconscious continues its activity.
+
+It is possible for the human body to live for years, utterly paralyzed,
+with many of the senses gone, with no consciousness of being--if cared
+for by other persons--a merely vegetable existence. The current of power
+is broken; but the spark is still glowing, though utterly useless
+because connected with nothing. And it may continue to glow for some
+time while properly stimulated from outside sources.
+
+We might liken the mind to the boiler in which steam is generated, and
+the body to the engine which the steam runs. If the boiler bursts, the
+engine stops; but it may not be otherwise damaged. It simply cannot
+carry out its main function of motion any longer. The fires under the
+boiler are still burning and can be kept burning so long as fuel is
+provided, but the connection is broken and the great bulk of iron is a
+useless thing in that it can no longer fulfil its purpose.
+
+In just such a way may the mind be paralyzed; but the spark of life,
+which has through all the years kindled the now lost mind to action, may
+still remain--a useless thing, which would die away if not tended from
+without by other bodies whose minds are still intact.
+
+But in the demented mind consciousness still remains, the awareness of
+the young child or baby stage of life. The connection between the upper
+or conscious brain centers and the body has been tampered with; it no
+longer is direct, but breaks off into switch-lines. But the contact
+still holds between the lower or unconscious mind and the body; so the
+automatic body functions go on, directed as they were in babyhood before
+the independent mind assumed control. Hence, when all acute
+consciousness is finally gone, the unconscious mind, a perfect
+automaton, may still carry out the simplest vegetative activities of
+existence.
+
+When body is dead, mind, so far as its reactions to the world we know
+are concerned, ceases to act. But when the conscious mind is "dead" the
+body may yet live as a vegetable lives, with all its distinctively human
+functions lost. Motionless, save for the beating of the heart and the
+reaction of the lungs to air, the body may still be alive, though the
+mind long since has ceased all earthly activity.
+
+So we discover that an organ of mind is an essential, here, to life of
+mind, and that mind only can induce this organ to any action above the
+vegetative stage. But, on the other hand, we find that life can exist
+without conscious mind, even if untended by others, for a limited time.
+
+If the direct nerve connections between the brain and the hand, the
+brain and the foot, or the brain and the trunk are cut off, the mind
+henceforth realizes nothing of that part except as the sense of sight
+reports upon it; for the optic nerves relate the hand and mind, through
+this sense, as truly as the motor nerves which carry the mind's message
+for motion to the hand, and the sensory nerves which carry back to the
+mind the hand's pain. But let the optic nerve be inert, the sensory and
+motor connections broken between brain and hand, or foot and trunk, or
+brain and trunk, and the hand or foot may be amputated and the mind
+never sense the fact; the trunk may be severely injured and the mind be
+serenely unconscious. So the brain in man is "the one immediate bodily
+condition of the mental operations." Take away all the brain and man's
+body is a useless mass of protoplasm.
+
+The brain's varied and intricate nerve connections with all parts of the
+body, through nerves branching from the main trunks in the spinal cord,
+we shall not discuss, for you know them through your study of anatomy.
+For the purpose of our psychology we need consider only two of the main
+divisions of the brain--the _cerebrum_, which includes what we call the
+right and left hemispheres, and the _cerebellum_.
+
+
+THE CEREBRUM OR FOREBRAIN
+
+For convenience the various lobes of the cerebrum are known as frontal,
+temporal, parietal, and occipital, according to the parts of the brain
+referred to: as forehead, temples, crown, or occiput. The cerebellum, or
+hind brain, is also divided into two hemispheres, and is situated behind
+and below the hemispheres of the cerebrum.
+
+A system of localization has been roughly mapped out, the result of
+careful laboratory work on animals and of studying the loss of various
+functions in human beings as related to the location of brain injuries.
+
+From these experiments it seems proved that consciousness belongs only
+to the cortex or surface of the upper brain, and that the vast realm of
+the unconscious belongs to the lower brain centers. Hence the cortex is
+the organ of consciousness, and the lower centers are the repository of
+the unconscious until it again becomes conscious.
+
+The motor zone of the cortex we now know to be situated in the
+convolutions bordering the fissure of Rolando. Vision is evidently
+excited from the occipital lobes, though not yet conclusively proved.
+Smell, presumably, is located in the temporal lobes. Considered action
+is directed from the upper hemispheres only. It is significant that the
+hemispheres of the cerebrum are also accepted as the seat of memory for
+man--that intellectual quality which makes him capable of acting from
+absent stimuli, stimuli only present to memory; which makes it possible
+for him to reason the present from the experiences of the past.
+
+But in all animal life, except the higher forms, the control of action
+is from the lower brain centers, centers which respond only to present
+objects. With them memory, as man knows it, is lacking; but the
+reactions of the past are indelibly imprinted upon motor nerves and
+muscles, so that when the present object presses the button, as it
+were, calling forth the experience of the race, the animal instinctively
+reacts.
+
+But of what use to man, then, are the lower brain centers?
+
+In man, as in lower animals, they care for the vegetative functions of
+life, so that our blood continues to circulate, the air enters and
+leaves our lungs, digestion is carried on, with no assistance from the
+upper centers, the hemispheres of the cerebrum being thus left free for
+concentration on the external world of matter, which it can transform
+into a world of thought.
+
+It is the lower or vegetative brain that may still exist and keep life
+intact when the functions of the cerebrum are destroyed. We can say,
+then, of the brain as a whole that it is the organ of the mind, the
+_sine qua non_ of the mind, the apparatus for the registration of sense
+impressions. The senses themselves are the rudiments of mind, are the
+means by which stimuli alighting on sense organs enter consciousness;
+for the nerves of special sense immediately carry the impetus to the
+brain, where it is recognized as the "not me," the _something_
+definitely affecting the _me_, and demanding reaction from the _me_.
+
+The functions of the cerebrum we find grouping themselves in three
+classes: _intellect_, _emotion_, and _volition_, more simply, thinking,
+feeling, and willing; and we find no mental activity of the normal or
+abnormal mind which will not fall into one of these groupings. This
+does not mean that one part of the brain thinks, another part wills,
+another part feels; for in the performance of any one of these functions
+the mind acts as a whole. Our thinking or our willing may be permeated
+with feeling, but the entire mind is simply reacting simultaneously upon
+various stimuli.
+
+
+
+
+CHAPTER V
+
+THE NORMAL MIND
+
+
+Mind, we found, is born in the form of consciousness when the outside
+world impresses itself upon the brain-cells by way of the senses. This
+consciousness, observation and experiment prove, is first a feeling one,
+later a feeling-thinking-willing one. The mind, then, is really the
+activity of the brain as it feels, as it thinks, as it wills. We express
+this in descriptive terms when we speak of mind as the _flow of
+consciousness_, the sum of all mental associations, conscious and
+unconscious. For mind is never a final thing. Looking within at our own
+mental processes we find that always our thought is just becoming
+something else. We reach a conclusion, but it is not a resting place,
+only a starting place for another. My thought was _that_ a moment ago,
+but while it was _that_ it was becoming _this_, and even now it is
+becoming something else.
+
+Thinking is mind. Feeling is mind. Willing is mind. But for the sake of
+clearness we speak of feeling, thinking, and willing as being functions
+of mind. Mind acts by using these powers. But to what end does it act?
+What purpose does it serve? For these functions are not the reasons of
+being for the mind, even as motion--while the immediate purpose of the
+locomotive--is not its chief end. The steam engine may stand in the same
+spot while its wheels revolve madly; it may move along the tracks alone,
+and accomplish nothing; or it may transport a great train of loaded
+cars. Unless it moves to some definite point and carries merchandise or
+people there, it is a useless, indeed, a dangerous invention. We find,
+in fact, that it functions to the very definite end of taking man and
+his chattels to specified places.
+
+And so it is with the mind. If it is thinking and feeling and willing
+only for the sake of exercising these mental powers, it might better not
+be. But what end do we actually find these functions serving?
+
+Mind, with its powers of thinking, feeling, and willing, gives an
+external world of matter; an internal world of thought, and so relates
+them to each other as to make them serve man's purposes. Thus these
+functions exist for accomplishment.
+
+In the solving of a problem, for instance, the mind thinks, primarily;
+in the enjoyment of music it feels, primarily, though its feeling may be
+determined by the intellectual verdict on the music; in forcing its
+owner to sit at the piano and practice in the face of strong desire to
+attend the theater, it wills, primarily. Now one of its functions
+predominates; now another. But the whole mind, not a feeling section, or
+a thinking section, or a willing section, operates together to produce
+action. When I play the piano it calls on all my mind. I think the
+music. I feel it. I make my fingers play it. But the thinking, the
+feeling, and the willing act together to result in the fingers playing.
+
+The mind, then, is an instrument of achievement. It fulfils its purpose
+when it makes matter serve useful ends.
+
+_Emotion_ or _feeling_ is the function of the mind which associates a
+sense of pleasure or pain with every thought or act.
+
+Feeling is the affective state of mind. By this we mean that it has the
+power to move us. And this emotion primarily does; for our feeling of
+pleasure or pain moves us to action, as well as precedes and accompanies
+and follows action. The word _emotion_ is usually employed to denote an
+acute feeling state, while the word _mood_ denotes a prolonged feeling
+condition, _i. e._, a less acute emotional state. The word _feeling_,
+however, is used to cover both; for in each case the sensational element
+manifests itself in a definite physical affect, pleasurable or painful
+in some degree.
+
+_Thinking_ is a conscious mental activity exercised to evolve ideas from
+perceptions, and to combine and compare these ideas to form judgments.
+
+Intellection, or thinking, might be explained as the mental process
+which converts sensation into percepts, groups percepts to form concepts
+or ideas, stores away ideas and sensations for future use, and recalls
+them when needed--the recalling being memory--and by reason combines,
+compares, and associates ideas to form judgments, then compares
+judgments to form new judgments. The process of intellect we name by
+terms denoting activity, such as intellection, thinking, the _stream of
+thought_, and the latter describes it most truly.
+
+_Volition_ or _will_ is the function of the mind which compels the
+expression of thought or feeling in action.
+
+For clarity we might indicate the mind and its functions in the
+following diagram:
+
+The following terms are ones constantly used in psychology, and are
+briefly defined that there may be no haziness in their application.
+
+_Sensation_ is the uninterpreted response of the mind to stimuli brought
+by sense organs.
+
+Sensation may arouse instinct and cause reflex action, or start a
+feeling state, or a train of thought.
+
+_Perception_ is the conscious recognition of the cause of a given
+sensation.
+
+_Percept_ is a word often used to denote the mind's immediate image of
+the thing perceived.
+
+Percepts are of two kinds: object and quality.
+
+_Memory_ is the mind's faculty of retaining, recognizing, and
+reproducing sensations, percepts, and concepts.
+
+_Organic memory_ is the mind's reproduction of past bodily sensations.
+
+Example: I recall the physical sensations of a chill, and live it over
+in my mind, so that I can accurately describe how a chill feels to me,
+though I can but surmise how one feels to you.
+
+_Inorganic memory_ is the mind's reproduction of its own reactions in
+the past.
+
+Example: Myself having a chill, how I acted; what I thought and my
+emotions during that chill.
+
+_Ideation_ is the mind's grouping of percepts by the aid of memory, to
+form concepts.
+
+Example: I perceive color, form, mouth, eyes, nose, chin, etc. These
+percepts I combine as a result of past experience (memory) to form my
+concept, _face_; and the process of combining is ideation.
+
+_Concepts_ are mental representations of things or qualities,
+_i. e._, of object or quality percepts.
+
+We might say that the percept is the mind's immediate image of a thing
+or quality, and the concept is the result of the storing up and grouping
+and recombining of percepts. Thus a lasting mental picture is secured;
+and my idea of horse, for instance, is so clear and definite a thing in
+my mind that if I should never again see a particular horse, I should
+yet always be able to think accurately of a horse.
+
+Concepts are of two kinds--concrete and abstract.
+
+A _concrete concept_, or concrete idea (for concept and idea are
+interchangeably used), is an idea of a particular object or quality.
+
+  Examples: This wine-sap apple (object concept).
+            This sweet orange (quality concept).
+
+An _abstract concept_, or abstract idea, is a mental reproduction of a
+quality or an object dissociated from any particular setting or
+particular experience.
+
+Abstract ideas are of two kinds. We speak of them as _abstract object
+concepts_ and as _abstract quality concepts_. An _abstract object
+concept_ we might call a generalized idea, an idea comprehending all
+objects having certain things in common.
+
+Example: My idea of animal includes many scores of very different
+individual animals, but they all have bodies and heads and extremities.
+They all have some kind of digestive apparatus; they breathe, and can
+move.
+
+An _abstract quality concept_ is easier to think than to explain. It is
+as though the mind in considering a multitude of different objects found
+a certain quality common to many of them, and it "abstracted," _i. e._,
+drew this particular quality, and only this, from them all, and then
+imagined it as a something in itself which it calls _redness_, or
+_whiteness_, or _goodness_. Thereafter, whenever it finds something like
+it anywhere else again it says, "That is like my redness." So I call it
+"red." In other words, consciousness thereafter can determine in a newly
+discovered object something it knows well merely because that something
+corresponds to a representation which experience and memory have already
+formed.
+
+These comprehensive concepts, or _universals_, as some psychologists
+term them, the mind, having pieced together from experience and memory,
+holds as independent realities, not primarily belonging to _this_ or
+_that_, but lending themselves to this or that. For example: My mind
+says "white," and sees white in some object. But I see the white only
+because my mind has a quality concept, _whiteness_. This outside object
+corresponds to my concept. I recognize the likeness and call it "white."
+
+I speak of goodness, or purity, of benevolence; or of fulness,
+emptiness, scantiness. There is no object or quality in the outside
+world I can say is goodness, or fulness. But I do see things in the
+external world through my ideas of goodness or fulness that correspond
+to these ideas. They have some of the qualities the ideas embrace; and
+so I point them out and say, "This represents purity; that, impurity";
+or, "This is full, that is empty." One satisfies my concept of purity,
+while the other does not. One fulfils my concept of fulness; the other
+does not. And because we can never point out any one quality in the
+outside world and say "This is purity, and all of purity; this is
+goodness; or this good plus this good plus this makes all of goodness";
+because of this impossibility we speak of these concepts as having
+reality somewhere. They are _absolutes_, _universals_, _abstract quality
+concepts_--the unfound all of which the things we call pure and good are
+but the part.
+
+_Apperception_ is the process of comparing the new with all that is in
+the mind, and of classifying it by its likeness to something already
+there.
+
+With an abstract idea of an object in mind we very deftly, through the
+use of memory and constructive imagination, deduce the whole from the
+part recognized as familiar.
+
+Example: In walking through the field, along the bank of the brook, I
+glimpse under the low-hanging branches of the weeping willow a
+restlessly moving hoof. I see a certain kind of hoof and only that. Or I
+hear a lowing sound. And I say "cow." I have not seen a cow, but only a
+part which tells me a cow is there; for all the cows I ever saw had
+hoofs of that general description, and so it fits into my concept _cow_,
+and into no others. Or I have heard cows, only, give that lowing sound
+before. From my perception, then, of hoof or sound I apperceive _cow_.
+Memory relates that hoof or that lowing sound to a certain kind of
+animal known in the past; and constructive imagination draws in all the
+rest of the picture that belongs with it.
+
+Again, we may apperceive an object or quality from our recognition of
+something which in our experience has been associated, under those
+particular circumstances, with only that object or quality. I see smoke
+on the ocean's far horizon, and I decide instantly, "a steamer." I have
+not perceived any steamer, but only something that "goes with it," as it
+were. I see the ship with my mind, not with my eyes; for I know that a
+cloud of smoke out there always has, in my past experience, represented
+just that. I compare the newly appearing stimulus--smoke in that
+particular location--with all that is associated with it in my mind,
+and classify it with the known. I apperceive "steamer."
+
+In apperception, then, we construct from the known actually perceived by
+the senses, the unknown. How does the child realize that the moving
+speck on the distant hillside is his father? There is nothing to
+indicate it except that it is black and moves in this direction. But
+experience tells Johnny that father comes home that way just about this
+time. Moreover, it says that father looks so when at that distance. When
+Johnny is as sure it is his father as if he could see his face close
+beside him he has apperceived him. The speck on the hill is the newly
+arriving stimulus. Johnny compares it with what corresponds to it in his
+mind's experience and proclaims, as a fact, that he sees his father.
+
+_Reason_ is the mind's comparison and grouping of concepts to form
+judgments, and its association of judgments to form new judgments.
+
+Example: My concept _man_ includes the eventual certainty of his death.
+My concept mortal means "subject to death." Therefore my judgment is,
+"Man is mortal." Reason has compared the concepts and found that the
+second includes the first.
+
+_Judgment_ is the mind's decision arrived at through comparing concepts
+or other judgments.
+
+Example: _Man is mortal_ is my decision after comparing the concepts
+_man_ and _mortal_ and finding that the latter really includes the
+former. Judgment at the same time says that "Mortals are men," is not a
+true conclusion. For in this case the first concept is not all included
+in the second. Mortals are all life that is subject to death.
+
+We may assume personal consciousness even as we recognize an individual
+body. Psychology does not deal with any awareness separated from a
+person. It knows no central mind of which you partake or I partake, and
+which is the same for us both. A universal consciousness would simply
+mean one which is the sum of yours and mine and everybody's who lives
+today, or who has ever lived. So by _personal consciousness_ the
+psychologist means his consciousness, or yours, or mine. But they can
+never be the same; for mine is determined by my entire past and by how
+things and facts and qualities affect me; and yours, by your past, and
+by things and facts and qualities, and by how they affect you.
+
+_Personal consciousness_ is the mind's recognition of self; and as the
+self changes with every added experience, so personal consciousness is
+modified.
+
+_Stream of thought_ is a term _James_ has brought into common usage to
+illustrate the fact, already stressed, that thinking, as we know it, is
+never static, is never one thing, one percept, one concept, one
+judgment; but is a lot of these all together, just beginning to be or
+just beginning to change into something else. We never know a concept,
+for instance, except as it is a part of our entire consciousness,
+related to all the rest; just as we do not know the drop of water in the
+brook as it flows with the stream. We can take up one on our
+finger-tips, however, and separate it from all the rest. But analyzed in
+the laboratory, this drop will contain all the elements that a pint or
+gallon or a barrel of the same water contains. The drop is what it is
+because the stream has a certain composition. We only have a brook as
+drops of rain combine to make it, but we also have only the drops as we
+separate them from the steam.
+
+_Imagination_ is the combining by the mind, in a new way, things already
+known.
+
+This may be either into fantastic groupings divorced from reality, or
+into new, possible, rational groupings not yet experienced. So
+imagination is of two kinds, the fantastic and the constructive.
+Fantastic imagination, or fantasy, gives us gnomes, fairies, giants, and
+flying horses, and all the delights of fairy tales. Constructive
+imagination is the basis for invention, for literature, and the arts and
+sciences.
+
+The word _thinking_, defined early in this chapter, is broadly used to
+denote the sum of all the intellectual faculties. Thinking is really the
+stream of thought.
+
+
+
+
+CHAPTER VI
+
+THE NORMAL MIND (Continued)
+
+
+INSTINCT
+
+We have found that the mind's chief end is action, of itself, or of its
+body. But what are its incentives to action?
+
+We see the very young baby giving evidences of an emotional life, living
+in an affective, or feeling environment, leading a pleasure-pain
+existence, from the first. He acts as desire indicates. But from the
+very moment of his birth he performs actions with which he cannot as yet
+have a sense-memory connection, because he is doing them for the first
+time. How can he know how to respond to stimuli from the very beginning?
+
+No other possible explanation offers itself than that he is born with
+certain tendencies to definite action. These we call instincts--man's
+provision to keep him going, as it were, till reason develops. Instincts
+are handed down from all the past. Definite tendencies, they are, to
+certain specific reflex actions in response to certain sensations. These
+responses, from the very beginning of animal life, have been toward
+avoiding pain, and toward receiving pleasure. It is as though the
+stimulus presses the trigger--instinct--and the muscle responds
+instantly with reflex action. This mechanism is the means of protection
+and advancement, and takes largely the place of intelligence in all
+animal life. It is what makes the baby suck and cry, clutch and pull,
+until a sense memory is established. So instinct is really race memory.
+We call instinctive those immediate, unthought reactions which are the
+same with all mankind.
+
+The pugnacious instinct--the desire to fight--is the natural reaction of
+every human being of sane mind to attack. The inner necessity of
+avenging is so strong in the child or man of untrained mind or soul that
+he acts before he thinks. He strikes back, or shoots, or plots against
+his enemies. Only rare development of spirit or the cautious warning of
+reason which foresees ill consequences, or a will trained to force
+control, can later make the instinct inactive.
+
+Where instinct ends and sense memory, imitation, and desire step in is
+difficult to determine. Later in life probably most of what we consider
+instinctive action is simply so-called reflex action, depending on sense
+memory, action learned so young that it is difficult to distinguish it
+from the true reflex action, which is due only to race memory.
+
+James, in his _Talk to Teachers_, gives us a partial list of the
+instincts. Thus:
+
+To this partial list we would add self-preservation, reproduction, etc.
+
+But instincts conflict with each other, and man carries about with him
+in babyhood many of them which may have been very useful to his
+prehistoric ancestors, but which only complicate things for him. Fear
+and curiosity urge opposite lines of conduct. Love of approbation and
+shyness are opposed. Love and pugnacity are apt to be at odds. So,
+gradually, as intelligence increases, the child refuses to allow such
+impulses to lead him to action. When fear-instinct and love-instinct are
+at war, reason is provided to come to the rescue.
+
+_Instincts_ are racial tendencies of sensational or emotional states to
+determine action.
+
+Instincts are the germs of habit, and when instinct would give rise to a
+reaction no longer useful, reason, abetted by new habit formation, in
+the normal mind, weakens instinct's force; and the habit is discarded
+and the instinct gradually declines.
+
+In prehistoric times when food was scarce, and man had not learned the
+art of tilling the soil, hunger forced him to fight for what he got to
+eat. As there was often not enough to go around, he maimed or killed
+his fellow-man that he might have all he wanted, obeying the instinct to
+survive. So, now, the baby instinctively clutches for all that appeals
+to him. But an abundance of food for all, or the intelligent realization
+that co-operation brings more to the individual than does fighting, and
+a developed sense of responsibility toward others; or merely the fear of
+the scorn of fellow beings, or the desire to be protected by the love of
+his kind; perhaps a genuine love of people, acquired by spiritual
+development, puts the primitive habit of food-grabbing into the discard.
+Finally, the very instinct of self-preservation may be transformed into
+desire to serve others. No better illustration of this can ever be
+offered than the sacrifices of the World War.
+
+
+MEMORY
+
+No mind retains consciously everything that has ever impressed it. It is
+necessary that it put aside what ceases to be of importance or value and
+make way for new impressions. We found early in our study that the
+subconscious never forgets, but harbors the apparently forgotten
+throughout the years, allowing it to modify our thinking, our reactions.
+But the conscious mind cannot be cluttered with the things of little
+importance when the more essential is clamoring. So there is a
+forgetting that is very normal. We forget numberless incidents of our
+childhood and youth; we may forget the details of much that we have
+learned to do automatically; but the subconscious mind is attending to
+them for us.
+
+Do you know how to skate? and if so, do you remember just how you did it
+the first time? Probably all you recall is that you fell again and again
+because your feet would slip away from where you meant them to be. When
+you glide over the ice now it is as natural as walking, and as easy. You
+cannot remember in detail at all how you first "struck out," nor the
+position of your feet and arms and legs, which you felt forced to
+assume. At the time there was very real difficulty with every
+stroke--each one was an accomplishment to be attempted circumspectly, in
+a certain definite way. All you remember now is, vaguely, a tumble or
+two, soreness, and lots of fun.
+
+We forget details we have intrusted to others as not a part of our
+responsibility. We forget the things which in no way concern us, in
+which we have no interest and about which we have no curiosity. And it
+is well that we do so. If it were not for the ability to forget, our
+minds would be like a room in which we have lived a lifetime, where we
+have left everything that has been brought into it since our birth. It
+would be piled ceiling high, with no room for us, and with difficulty
+only could we find what we want. As we grow from babyhood to childhood,
+from childhood to youth, from youth to maturity the room changes with
+us. We put off childish things. They are stored away somewhere, in an
+attic or basement, or destroyed. And day after day something new is
+added, displacing something else. In the case of the mind all these
+things are stored and cataloged in the subconscious, and forgotten,
+until some need causes us to look into our catalog-index and see the
+experience again, or some association calls it back, relating it to
+something new. So our discussion of the subconscious involved also a
+discussion of memory.
+
+But what of the things we must use frequently and cannot find in our
+minds? What of absent-mindedness and faulty memory? In such cases our
+minds might be compared to a cluttered room full of things we need and
+want to use every day, but in confusion. We know where many of them are,
+the ones we care most about; but we have to rummage wildly to find the
+rest. We have no proper system of arrangement of our belongings. You
+laid down that book somewhere, absent-mindedly, and now you cannot tell
+where. You were thinking of something else at the time, and inattention
+proves a most common cause of poor memory. Perhaps you simply have more
+books than the room can hold in an orderly way, and so you crowded that
+one in some corner, and now have no recollection of where you put it.
+
+Poor memory is the result of lack of attention, or divided attention at
+the time the particular attention-stimulus knocked. You asked me to buy
+a ribbon of a certain shade and a certain width when I went to town. I
+was thinking of my dentist appointment. However, I heard your request,
+answered it graciously, took the money you offered, still wondering if
+the dentist would have to draw that tooth. And the chances are that I
+forgot your ribbon. I was giving you only a passive and divided
+attention.
+
+Or I have more to do than I can possibly accomplish in the next six
+hours. You ask me to buy the ribbon. I attend accurately for the moment,
+think distractedly, "How can I do it all?--but I will"--and crowd the
+intention into an already overburdened corner of my mind, fail to
+associate it with the other thoughts already there, and return six hours
+later without the ribbon. My sense of hurry, of stress, of the more
+important thing to be done, or a reaction of impatience at the request,
+forced back the ribbon thought and allowed it to be hidden by others. I
+was really giving you only partial attention, or an emotion interfered
+with attention; and I forgot.
+
+Hence we find that a faulty memory may exist in an otherwise normal mind
+when poor attention, or divided attention due to emotional stress or to
+an overcrowded mind, which makes it impossible to properly assort its
+material, interferes.
+
+Again, we forget many things because they are unpleasant to remember. We
+have no desire, no emotional stimulus to make us remember; or because
+some of the associations with the forgotten incident are undesirable.
+We forget many things because if we remembered them we would feel called
+upon to do some unpleasant duty. You forgot your tennis engagement with
+B, perhaps, because you were so engrossed in a pleasure at hand, or in
+your work, that anything which interrupted was, under the circumstances,
+undesirable. You may have wanted very much to play with him, but some
+more pressing desire--to care well for your patient, or to continue the
+present amusement--was stronger. Or you forgot because you did not want
+to play with him and had no excuse to offer at the time. You wished to
+forget. Perhaps he does not play a good game, or you do not like him, or
+at least you like some one else much more, and he happened along; so you
+forgot B. The unconscious mind saw to it that something else was kept so
+prominently before your attention that it could not return to the less
+desired.
+
+Thus a forgetting may be purely the result of an emotional interference
+which makes it, all in all, more pleasant to forget than to remember. If
+we would help ourselves or our patients whose memories are faulty, and
+who make them worse by their continual fretting over their disability,
+we must train ourselves to be willing to forget all that does not in the
+least concern our interests or those of the people about us, and does
+not add anything desirable to our knowledge. Thus we may avoid
+overcrowding the mind. But when we would remember let us give our whole
+active attention at the moment of presentation of the new stimulus, and
+immediately tie it up with something in past experience; let us
+recognize what it is that we should remember, and call the reinforcement
+of will, which demands that we remember whether we want to or not.
+Sincere desire to remember will inspire early and frequent recalling,
+with various associations, or hooks, until the impression becomes
+permanent. The average patient's poor memory is made worse by his
+agitation and attention to it, and his conviction that he cannot
+remember. The fear of forgetting often wastes mental energy which might
+otherwise provide keenness of memory. If the nurse ties up some pleasant
+association with the things she wants the sick man to remember, and
+disregards his painful effort to recall other things, then--unless the
+mind is disordered--he will often find normal memory reasserting itself.
+
+We shall consider this question of memory in more detail in a later
+chapter of practical suggestions for the nurse.
+
+
+THE PLACE OF EMOTION
+
+_Feeling Cannot Be Separated from Thinking._--Emotion we found the
+constant accompaniment of every other mental activity. It is first on
+the stage of consciousness and, in the normal mind, last to withdraw.
+
+When I am working at a problem in doses or solutions, trying to learn my
+_materia medica_, or wrestling with the causes of disease in my
+_medical nursing_, or thinking how I can eke out my last ten dollars
+till I get some more, I am pursued with some vague or well-defined
+feeling of annoyance or satisfaction, of displeasure or pleasure. If all
+goes well, the latter; if not, the former.
+
+_Feeling Cannot Be Separated from Will._--I cannot _will_ without a
+feeling accompaniment, pleasant or unpleasant. I may be using my will
+only in carrying out what intellect advises. But we found that
+intellect's operations are always affective, _i. e._, have some feeling
+of pleasure or pain. And the very act of will itself is a pleasant one
+and much easier if it is making me do what I want to do; it is a vaguely
+or actively unpleasant one if it is making me act against desire. In the
+end, however, if I act against desire in pursuance of reason or a sense
+of duty, the feeling of pleasure in the victory of my better self is
+asserted. And feeling cannot be separated from will.
+
+_Feeling Cannot Be Separated from Action._--I cannot do anything without
+a feeling of comfort or discomfort, happiness or unhappiness. Try it for
+yourself when you are feeding a patient, making a bed, giving a bath or
+massage, preparing a hypodermic. Other things being normal, if you are
+performing the task perfectly, the feeling of satisfaction, of pleasure,
+of the very ability to work effectively, with speed and accuracy and
+nicety, comes with the doing. If you are bungling, there is a pervading
+sense of dissatisfaction, of unpleasantness. In the automatic or
+semi-automatic action a great economy of nature has conservatively put
+feeling at the absolute minimum; but it has not eradicated it. As you
+walk across the ward, though your predominating thought and feeling may
+be elsewhere, there is a sense of pleasure or displeasure in the very
+movement. If your body is fresh and you are of an energetic type and in
+happy frame of mind, a pervasive feeling of satisfaction is experienced.
+If tired or discouraged or sore from unaccustomed exercise, every step
+registers protest.
+
+Thus we find by experiment that there is no thought we have, no single
+conscious movement or action, nor any expression of the will, but is
+accompanied with what the psychologist broadly terms _pleasure_ or
+_pain_. So _emotion_, the first expression of mentality, is never absent
+from any mental or physical act. It permeates all we do, as well as all
+we think and will, with the partial exception of automatic action, above
+indicated.
+
+
+THE BEGINNING OF REASON
+
+We found feeling by far the strongest factor in producing action in
+babyhood and childhood. Our instinctive doing, we learned, is the result
+of a race impulse. Will acts chiefly at emotion's bidding. But very
+early the baby's experience operates as a partial check to feeling's
+exclusive sway. It keeps him from touching the fire, no matter how its
+brightness attracts. It may be merely the sense memory of _hurt_ when
+fingers and that bright thing came together; and one such impression
+will probably prevent him from ever again touching it. Or it may be the
+brain-cell's retention of the painful feeling of slapped hands when the
+fingers reaching out to the flame had not yet quite touched. These
+punishment experiences are only effective in many children after more or
+less repetition has set up an automatic prohibition from brain to motor
+nerves; but right here intellect begins to assert itself in the form of
+sense memory. The baby does not reason about the matter. His nerve-cells
+simply remember pain, and that particular brightness and glow, and
+finger touch--or that reaching out to the glow--and slapped hands, as
+occurring together. In the same way he early connects pleasure with the
+taste of certain forbidden things. He does not know they are sweet. He
+only knows "I want." Even here his desire to taste may be checked in
+action by a vivid memory of what happened when he tasted that other
+time, and was spanked or put in his little room all alone with only milk
+and bread to eat for a long time.
+
+Later on the child may think, from cause to effect, thus: "Sweet, good,
+want, taste, spank, hurt (or no dinner, all by self, lonely), spank hurt
+more than sweets good. Not taste." But long before he can work this out,
+consciously, two distinct memories, one of pleasure and one of pain, are
+aroused by the sight of the sweet. And what he will do with it depends
+upon which memory is stronger. In other words, his action is governed
+altogether by his feeling, though memory, which is an intellectual
+factor, supplies the material for feeling.
+
+
+DEVELOPMENT OF REASON AND WILL
+
+Later still, when the child is older, we may have somewhat the following
+mechanism: "Sweets, good, want, taste; spank, hurt; don't care, spank
+not hurt much, maybe never found put, sweets very good."
+
+Now the child is reasoning and choosing between two courses of action,
+_don't_ and _do_. His decision will depend upon whether immediate
+satisfaction of desire is stronger than the deferred satisfaction of
+being good, and the fear of punishment. He probably prefers to take a
+chance, and even if the worst comes, weighs it with the other worst, not
+having the sweet--and takes the "bird in the hand." He has reasoned, and
+has chosen between two emotions the one which his judgment says is the
+more desirable; and his will carries out the decision of his reasoning.
+His chief end in life is still to get the most immediate pleasure. Still
+later in child-life, much later, perhaps, his decision about the jam is
+based on neither love of it nor fear of punishment, but--despite his
+still sweet tooth--on a reasoned conclusion that if he eats jam now he
+may be sick, or he may spoil his appetite for dinner; or on a
+consideration that sweets between meals are not best on dietetic
+principles; and _will_ very readily backs up the result of his
+reasoning. Though his determination is largely based upon feeling,
+reason has chosen between feelings, between immediate desire to have,
+and desire to avoid future discomfort. Reason is triumphant over present
+desire.
+
+
+JUDGMENT
+
+The conclusion or decision that reason has reached we call a judgment.
+The youth who decides against the sweet between meals, we say, has good
+judgment. And we base our commendation on the proved fact that sweets
+are real fuel, giving abundantly of heat and energy, and are not to be
+eaten as mere pastime when the body is already fully supplied with
+high calorie food not yet burned up; that if sweets are eaten at
+irregular intervals and at the call of appetite, and not earned by an
+adequate output of physical work, the digestive apparatus may become
+clogged, and an overacid condition of the entire intestinal tract
+threaten. We call judgment good, then, when it is the result of
+reasoning with correct or logical premises which correspond with the
+facts of life. We call it bad when it is the conclusion of incorrect or
+partial or illogic premises.
+
+A _premise_ "is a proposition laid down, proved, supposed, or assumed,
+that serves as a ground for argument or for a conclusion; a judgment
+leading to another judgment as a conclusion" (Standard Dictionary).
+
+Let us illustrate good and bad judgment by following out two lines of
+reasoning, each quite accurate as such.
+
+I want sweets. Sweets are good for people. They give heat and energy,
+and I need that, for I am chilly and tired. People say "Don't eat sweets
+between meals." But why? They contain just what I need and the sooner I
+get them the better.
+
+So I have sweets when I want them. The judgment to take the sweets as
+desire indicates is entirely logical if we accept all the premises as
+correct. And they are, so far as they go; but they are partial; and so
+cannot altogether correspond with the facts of life. Sweets are good for
+people who expend much physical energy. They prove injurious in more
+than limited amounts to the bed-ridden, the inactive, or the sluggish.
+Hence this premise is partial and so far incorrect. Sweets do give heat
+and energy, true. I am chilly and tired, also true. But why? Because I
+am already toxic from the sweets and meats I have had throughout my
+sedentary years. The question is, Do I need any more energy-producing
+food when I am not burning up what I have? So again the premise is
+partial. I do need heat and energy, but I already have the material for
+it, and my mode of life has disorganized my system's capacity to utilize
+these foods normally. So now sweets have become a detriment to my
+well-being. The judgment which determines me to the habit of eating
+sweets between meals is the result of logic, but of logic spent on tying
+up premises which do not fit the facts of the case.
+
+One of the most prevalent defects of judgment is illustrated in this
+common disability to select premises which fit the facts. Ignorance,
+emotional reasoning, and a defective critical sense probably explain
+most poor judgments.
+
+The other judgment illustrates the logic of correct, provable premises.
+
+"No, I shall wait until dinner-time. I have no need of so rich a food,
+for I had an adequate meal at the usual time and have not worked hard
+enough to justify adding this burden to my digestive apparatus; besides
+only hard workers with their muscles can afford to eat many sweets. They
+cause an overacid condition when taken in excess; and any except at
+mealtimes would be excess for me, with my moderate physical exercise."
+
+This judgment we call good. Its premises correspond to scientific facts.
+
+But much reasoning must always be done with probable premises, ones
+which seem to correspond to the facts, but which have yet to be proved.
+And our judgment from such suppositions cannot be final until we see if
+it works.
+
+Some few centuries ago supposedly wise men called Christopher Columbus a
+fool. Of course the world was flat. If it were round man would fall off.
+It was all spread out and the oceans were its limits. If it should be
+round, like a ball, as that mad man claimed, then the waters must reach
+from Europe 'round the sphere and touch Asia; or there might be land
+out there beyond the ocean's curve. But it wasn't round, and the idea of
+finding a new way to Asia by sailing in the opposite direction was a
+fool's delusion.
+
+Their logic was perfect. If the earth was flat, and Asia lay east of
+Europe, it was madness to sail west to reach it. But they argued from a
+wrong premise, so their judgment was imperfect--for they did not yet
+know the facts.
+
+The result of all reasoning is judgment. And judgment is good as the
+materials of the reasoning process correspond to facts, or are in line
+with the most probable of the yet unknown. It is poor as the reasoning
+material fails to meet the facts, or is out of harmony with the most
+probable of the yet unproved.
+
+It is of no avail, then, to attempt to improve our final judgments as
+such. We must examine the materials we reason with, then learn to group
+and compare them logically. And in the very separating of true premises
+from false, we use and train the judgment we would improve. And this the
+normal mind can do.
+
+
+REACTION PROPORTIONED TO STIMULI
+
+In the normal mind the emotional or feeling accompaniment of thought and
+action is proportionate and adequate to the circumstances, _i. e._,
+there is a certain feeling, of a certain strength, natural to every
+thought and act; and when only that strength, not more or less,
+accompanies the thought or the act, we say, "That man is emotionally
+stable. His mind is normally balanced."
+
+Joy naturally follows some stimuli; sorrow others. Disappointment or
+loss, shock, failure, death of loved ones, illness in ourselves or
+others, do not normally bring joy. A keen sense of suffering,
+temporarily, perhaps, of numbness; the inability to grasp the calamity;
+or flowing tears, an aching heart, or the stress of willed endurance,
+are natural, and normal reactions to such stimuli.
+
+A developed will may refuse indulgence in the outward expression of the
+normal feeling of shock, grief, and loss; and this may be normal. But
+normal volition does not force us to laugh and dance and be wildly merry
+in the face of grief and loss and pain. It only suggests the adequate,
+reasonable acceptance of the facts that cannot be changed--the
+acceptance of love, faith, and hope that sees in present suffering a
+means of consecration to service; it does not convert the emotion of
+sorrow and loss into a pleasurable one. Normal reason does not suggest
+that _will_ force the reactions to loss and suffering that belong by
+nature to attainment and success.
+
+Nor does reason suggest the long face, the bitter tears, a storm of
+anger, in response to comedy and farce, in the face of a good joke, or
+to meet success; and normal will puts reason's counsel into effect.
+
+
+NORMAL EMOTIONAL REACTIONS
+
+Some emotions, that seem exaggerated at first thought, may be normal
+under the circumstances. For no one can know the whole background for
+emotional response in the life of another. After being long shut up in a
+darkened room, with bandaged eyes and aching head and sick body, the
+first visit to the bit of woods back of the house--when all the pains
+have gone--may bring almost delirious joy. The green of the foliage, the
+blue of the sky, the arousing tang of the air, the birds, the sense of
+freedom--all go to the head like new wine. The abandon of joy is a
+normal response under the circumstances, now. It would hardly be normal
+to one whose habit it is to visit this same bit of woods every day, to
+one who loved it, but for whom it had lost the force of newness.
+
+To the child, who has never in all his little life had a wish not
+gratified, the denial of a desired stick of candy is as great a calamity
+as is the loss of a fortune to the grown man. And the child reacts to
+feeling equally intense. These are normal reactions to stimuli--normal,
+under the circumstances.
+
+
+THE NORMAL MIND
+
+The normal mind reasons clearly with the best data at hand to results
+that will stand the test of conformity to reality; the normal mind uses
+reason and feeling, guided by reasonable attitude; in the normal mind
+_reason_ advises action and _will_ brings it about; in the normal mind
+_feeling_ proportionate to the circumstances accompanies every thought
+and every action. And in the well-balanced man or woman every function
+of the mind leads to action as its final end.
+
+But man only approximates the normal. The perfectly balanced man or
+woman is so rare as to be a marked person. The average intelligent
+individual only in general approximates this standard. He goes beyond it
+in spurts of untrammeled genius, to wrench lightning from the heavens,
+and to send his trains through the air; or he allows his feelings to
+dictate to his reason, and much of the time so exaggerates or
+depreciates the simple facts of life that the results of his reasoning
+no longer conform sufficiently to reality as to be thoroughly
+dependable.
+
+
+
+
+CHAPTER VII
+
+PSYCHOLOGY AND HEALTH
+
+
+In the use of its functions the mind manifests certain powers and
+certain modes of expression which can act as powerful allies or as
+damaging enemies of health. We speak of man as adaptable, but also as a
+being of habits. We speak of him as "feeling" when we wish to express
+the fact that his emotions influence his body. We expect of the average
+man a certain amount of suggestibility. We say that he is tremendously
+affected by his environment, which simply means that his attention,
+naturally centered chiefly on the things at hand, largely determines
+what he is. But we recognize that a man of trained mind can choose and
+will to substitute for his present surroundings thoughts upon more
+constructive things from past experience, or from future possibilities,
+or from within the mind's own storehouse. His ability to largely modify
+his life by his will, we recognize as man's greatest power.
+_Adaptability_, emotional response, _suggestibility_, _attention_,
+_thought-substitution_, _habit-formation_, and _will_ can minister
+vitally to health, or can prove damaging avenues of disease.
+
+
+NECESSITY OF ADAPTABILITY
+
+Adaptability is as essential to life of mind as to life of body; and
+health of mind as well as health of body is determined by the individual
+ability to adjust himself to environment.
+
+There are dreamers who have lived in their ideal world so long that they
+cannot meet the stern realities of life when they come. The shock is too
+great for the mind that has accepted only the fantastic, the real as the
+dreamer would have it; and he lets go altogether his hold on the actual,
+accepting the would-be world as present fact. And we call him insane.
+Other visionaries wakened rudely to life as it is, accept it as
+unchangeable fate, lose all their true ideals and become cynical, or
+victims of utter depression for whom life holds nothing that matters.
+Still others go on through the years self-satisfied and serene because
+they simply refuse to believe unpleasant truths; they "pretend" that
+their wishes are realities, and acknowledge as facts only the pleasant
+things of existence. The first two groups have failed to adapt self to
+life as it is, and the mind is lost or so damaged as to no longer serve
+its body properly. The "pretenders" have adjusted themselves, and so
+long as they can remain happily self-deceived all goes well for them,
+though they complicate living for others. However, they have made an
+adaptation, a defective one, it is true, but one through which the mind
+may survive. Some of this class, however, finally build up a more and
+more elaborate system of self-deception until they, too, are insane.
+
+The practically adaptable man can dream dreams, but always recognizes
+them as dreams, and can stop at will; can vision a beautiful ideal, but
+comprehends that it is not yet reality, though it may some time become
+so if he learns and fulfils the laws leading to its realization. The
+adaptable man or woman recognizes the real as fact, desirable or
+otherwise, the fantastic as unreal and only to be indulged in as a
+pastime, and the ideal as the possible, a thing for which to work and
+sacrifice. So perfect adaptability would mean perfect mental poise.
+
+It is for the nurse to realize that the greater number of her patients
+do not belong to any of these classes absolutely, but that some of them
+have tendencies leading in these various directions. And it is her
+privilege to recognize the trend of her sick patient's mental workings,
+and to so deftly and unobtrusively encourage the recognition of facts as
+things which are to be used--not as stumbling-blocks--that her mental
+nursing, as her physical, shall be directed toward health. She can
+help her patient to accept illness and suffering as realities to be
+faced, and treatment as a means, whether pleasant or not, of making it
+possible for health to replace them. The understanding nurse can
+actively help her charge one step at a time toward adaptation to the new
+environment, remembering that many of the sick, particularly the
+depressed, cannot be encouraged or incited to effort by having future
+health held out to them. They are capable only of living in the present
+and doubting all the future.
+
+_There Can Be No Neurosis Without a Psychosis._--If the brain is the
+organ of the mind, then what affects the brain must perforce be at
+least registered by mind. So every physical shock, accident, toxic
+condition, infection--even the ordinary cold--rouses the mind at least
+to awareness, usually to discomfort. For the nerve-cells and
+fibers--those inseparable parts of the body mechanism--speedily report
+the fact that they are being tampered with. In the toxicity of the
+infections these very delicate tissues are nourished by toxic fluids;
+in accidents they carry all the messages from the injured part. Then
+the brain--that center of all man's reactions and the organ of all his
+consciousness--receives the report of the disturbance and translates
+it into terms of more or less disability. The neurosis has become a
+psychosis. The physical condition has become a mental discomfort.
+Normally this ensuing mind state should be in accordance with the
+extent of the injury to the nerve-cells and fibers. But under
+long-continued discipline, or influenced by emotion, the conscious
+mind may not recognize the neurosis; whereas, in the hypersuggestible,
+consciousness will translate it into entirely disproportionate
+suffering.
+
+A great problem of nervous education is what the mind will do with
+discomfort or pain. Will it put all its attention there and respond with
+nervousness, irritability, demand for sympathy; or will it relegate all
+the minor pains to their own little places, accepted as facts but to be
+disregarded except in so far as actual treatment is needed? Will it turn
+to attend to the host of other more desirable objects? Or in case of
+acute suffering, will it take it as a challenge to endurance? Will it
+use it as a means to strengthen volition, as a stepping-stone to
+self-mastery?
+
+Realizing the force of the law--no neurosis without a psychosis--the
+nurse will try to eliminate unnecessary irritations to physical comfort,
+while she helps the patient to adjust himself to the ones which are
+inevitable. It is the doctor's problem rather than hers, except as she
+carefully fulfils orders, to eliminate the toxic causes of psychosis. It
+is hers to help the patient to meet adequately the effects of the
+infections or toxins, and to prevent as far as possible the surrender to
+uncontrolled nervousness. Her object is to have him face the psychosis
+as one of the simple facts of science, then turn the sick mind's
+attention to more important things; she would encourage _will_ to force
+endurance; she would stimulate the feeling life to the forward look of
+confidence and faith, or to acceptance of life's suffering as a
+challenge. The nurse knows that pains beyond the power of endurance the
+doctor will lighten. And the patient's reaction to discomfort and
+suffering, the understanding nurse, without any preaching, can very
+largely influence.
+
+
+THE POWER OF SUGGESTION
+
+One almost universal condition found in illness is
+_hypersuggestability_. Here is the nurse's despair and her hope.
+Suggestion may come from without or from within. When from within, we
+call it autosuggestion.
+
+Many of the sick are temporarily resting their reasoning faculties and
+their judgment. The sick body is causing a feeling of "jangling nerves,"
+and the mind, too, is strongly tempted to be sick. So every harsh sound,
+every jolt, almost every sentence spoken in their hearing suggests
+immediate nervous reactions. The mind does not wait to weigh them. The
+nervous system reacts to them the second the impression is registered.
+The whole self is oversensitive, and the very inflection of a voice has
+enormous significance. Let the nurse remember that her way of giving a
+treatment, her expression, or her very presence becomes a potent
+stimulus on the second, one to which the patient's mind responds like a
+flash-light when the button is pressed.
+
+The nurse must comprehend the principle of the nervous effect on the
+patient of all that is done and said, and realize her tremendous
+privilege in making those stimuli wholesome. The nurse who has a
+sympathetic insight, with unswerving loyalty to orders, can carry them
+out with the average patient, unpleasant though they may be to him, in
+such a way that his wholesome emotional response will be called forth, a
+response of co-operation, or of faith or of good breeding, or of
+"downing" the impulse to indulgence; or a response directed toward
+holding the nurse's interest and attention, and so keeping her in the
+room; such a response as will gain some privilege, etc.
+
+But there are some patients in whose cases ordinary persuasion,
+suggestion or requests fail. They are too nervously or mentally sick to
+be moved by logic, or to respond with customary grace to a request which
+their reason is not awake to answer. All usual suggestions may fail of
+effect. And for these few, in order that health may be at all assured,
+even the discipline of force may be necessary. But the nurse must use
+this only as a last resort, of course, and in accordance with the
+doctor's orders, and then solely as treatment leading toward the ways of
+health. Before turning to this final method she should clearly, firmly,
+and kindly explain the principle of the discipline if the patient's mind
+is at all capable of grasping it. In any case, force should be used only
+as the surgeon uses his knife. It hurts, but only to help and to save;
+and it is not called upon when other methods can secure the needed
+results. But force, thus limited in its application, may prove the only
+suggestion which will bring about the action necessary to health on the
+part of the patient. Force unwisely and unkindly used proves a damaging
+suggestion, causing reactions of fear or anger; or it may lead to
+delusions of persecution and to strengthened resistance.
+
+Many suggestions come to the patient from within. Discomfort in the
+right side may suggest appendicitis. A slight indigestion, often purely
+nervous, may be interpreted as inability to care for certain diet, etc.
+The wise nurse will displace as many of these as she can by casual
+suggestions on her own part. She will demand of herself that her very
+presence be quieting, calming, happy; that her conversation with her
+patient shall vibrate with a certain something that gives him courage
+and strengthens the desire and the will to health; that her care of him
+shall prove confidence-breeding. The patient's attitude, when he is at
+all suggestible, is largely in the nurse's hands, and she can make his
+illness a calamity by dishonest, fear-breeding, or suspicion-forming
+suggestion. After all, the whole question here is one of the normality
+of the nurse's own outlook on life and people. The happier, truer, and
+more wholesome it is, the more really can she help her patient to both
+bodily and mental health. Of one thing let the overzealous nurse beware.
+Do not irritate your patient by a patent, blatant, hollow cheerfulness
+that any one of any sense knows is assumed for his benefit. Personally I
+know of no more aggravating stimulus.
+
+_What We Attend To Determines What We Are._--This is one of the first
+laws of education. If the child's attention from birth could be
+controlled, his future would be absolutely assured. But attention is a
+thing of free will and cannot be forced by others. It can be won through
+interest or self-directed by will. The child's attention is entirely
+determined by interest, interest in the morbid and painful as truly as
+in the bright and happy. Punishment interests him tremendously because
+it affects him, it interferes with his plan of life, it holds his entire
+immediate attention to his injured self. But something more impelling
+quickly makes him forget his hurt feelings and he is happy again. The
+average sick person is emotionally very much like the child. His will at
+the time, as we noted before, is tempted to take a rest, and his
+interest is ready to follow bodily feeling unless something more
+impelling is offered. The nurse who can direct attention to other
+people, to analyzing the sounds of the street, to understanding
+something of the new life of a hospital or sick room, to planning a
+house, or choosing its furniture or equipping a library, or supplying a
+store; to intelligent references to books or current events; or to
+redecorating the room--all in his mind; to an appetizing tray, a dainty
+flower, a bit of sunshine, a picture, etc., is fixing the patient's
+attention on something constructive, helping him to get well by
+forgetting to think of himself.
+
+Thus the nurse, knowing the laws of attention, can keep herself alert to
+divert and direct her patient's thought to wholesome interests. Knowing
+the possibility of thought substitution, she can open up new channels
+of thinking. Knowing the power of the will to assist in health bringing
+and health keeping, she can sometimes stimulate long-dormant
+determination. Let her beware, however, of making the convalescent too
+dependent upon help from without, but prick his pride to gradually
+increasing doing for himself. Arouse his reasonable ambition, but let
+him realize that life must be taken up again a step at a time; and that
+he _can_ do it. If limitations must be accepted, try to inspire the
+feeling of pride in accomplishing the utmost possible within a
+limitation, and an acceptance of the inevitable without bitterness.
+
+Attending to the unhappy, the painful, the boring without looking beyond
+makes life unhappy, painful, and a bore. Not that the nurse should
+ignore these realities, but she can accept them whole-souledly herself
+as not the final things, as merely the rocks that can be used to stand
+upon and get a view of the something better for everybody. When they are
+thus used by the wholesome mind, facts, the very barest and meanest of
+them, can be made useful as stepping-stones to the happier facts beyond
+them.
+
+If the nurse can direct or tactfully lead the patient's attention away
+from himself and his illness, she has found a big reinforcement to his
+treatment. This question is so vital in the care of patients that it
+will be discussed at greater length later on.
+
+
+ONE THOUGHT CAN BE REPLACED BY ANOTHER
+
+If we control attention we control thought, and with the suggestible
+patient this principle depends upon the one just now considered. Hope
+and courage-breeding thoughts can replace despairing and fearful ones,
+but it will be only when attention is directed through interest or by
+will to new material. There is no blank in waking consciousness. The
+last thought or feeling or perception, through association of ideas,
+brings up a related one, and so on indefinitely. We may start with a
+pebble on the road and go on logically, smoothly, until in five minutes
+we are thinking of the coronation of King George, with no sense of
+anything at all unusual in the succession. It may be a very roundabout
+process, from "pebble" through "rough way," "ways that hurt," "dangerous
+ways," "brigands," "uncertainties of life." "Uncertain lies the head
+that wears a crown," "King George and his crown," "coronation." But this
+constant stream of thought can be broken into at any point by a spoken
+word, a passing vehicle, which diverts the mind's trend. So the nurse
+can take advantage of the mind's very suggestibility, and substitute for
+the unhappy and sickness breeding by turning attention to anything else
+of a happier color, and may divert the entire stream of thought in that
+direction. She who knows these simple laws of the mind, and who at all
+knows people, is a therapeutic agent of unlimited value.
+
+
+HABIT IS A CONSERVER OF EFFORT
+
+It is always easier to follow a beaten path than to break one's way
+through untrodden forests. It is easier to walk after we "learn how,"
+and learning how is simply doing it over and over until the legs and
+feet have acquired habits of motion and accommodation to distances and
+to what is underfoot. It is easy to do anything after we have done it
+again and again, so that it has become second-nature, and
+"second-nature" is habit. The wise man early forms certain habits of
+personal care, of eating, sleeping, exercising; of study, of meeting the
+usual occurrences of life. The first day he spent at anything new was a
+hard one. Nothing was done naturally. Active attention had to be keenly
+held to each detail. He had to learn where things belonged, how to do
+this and that for the first time, how to work with his associates.
+
+Do you remember the first hospital bed you ever made, the first bed-bath
+you gave, the first massage? You had to be taught bit by bit, detail by
+detail. You did not look upon the finished whole, but gave almost
+painful attention to each step that led to the made bed, the completed
+bath, or the given massage. Your fingers were probably all thumbs unless
+you had experience in such things before you came to the hospital. Your
+mind was tired from the strain of trying to remember each suggestion of
+your instructor. The second time, or certainly the third or fourth time,
+it went better. After a week of daily experience you gave the bath or
+massage or made the bed with much less effort. A month later the work
+was practically automatic and accomplished in a fraction of the time you
+spent on it that first day. Now you can do it quickly and well with
+little conscious thought; and at the same time carry on a brisk
+conversation with your patient or think out your work for the day. Your
+mind is free for other thoughts while you perform the task easily and
+perfectly. Your method of doing the work has finally become a habit
+which saves the effort of conscious attention. The details of your
+routine work are directed by the subconscious. The habit will be energy
+and time saving in proportion to the accuracy of your first conscious
+efforts spent on the new undertaking. Thus, useful habit is the result
+of active effort.
+
+We can acquire habits of thinking and habits of feeling as well as
+habits of doing.
+
+But the other habits, the bad ones, are not acquired with effort. We
+fall into them. Hazy thinking is easier than clear thinking. Suppose you
+are by nature rather oversanguine or overdespondent, and you make no
+genuine attempt to evolve that nature into poise. Directing _will_ to do
+what _desire_ opposes is too difficult, and you go the way of least
+resistance. So easily are the bad habits formed; but only with
+tremendous effort of will and persistence in refusing their insistent
+demands can they be broken or replaced by helpful ones.
+
+But habits can be learned; and bad habits can be broken when an
+overpowering emotion is aroused against them, possesses the mind, and
+controls the will; or when reason weighs them in the balance and
+judgment finds them wanting, and volition directs the mind to displace
+them by others.
+
+The nurse meets in her patients numberless habits which retard recovery
+of body and make for an unwholesome mental attitude. Some patients have
+the complaint habit, some the irritation habit, some the self-protection
+habit, some the habit of impatience, some of reckless expression of
+despair, some of loss of control, some of incessant self-attention. The
+nurse who can arouse an incentive to habits of cheer expression when the
+least cause of cheer appears, who can by reason, or if that is not
+possible, by suggestion; by holding out incentives, or by making some
+privilege depend upon control--this nurse can help her patient to
+displace habits of an illness-accepting mind by habits of a
+health-accepting one. Above all, let her beware of opening the way to
+habits of invalidism. Some people acquire the "hospital habit" because
+it is easier to give way to ill-feeling, however slight, and to be cared
+for with comfort, than to encourage themselves to build up endurance by
+giving little attention to minor ailments.
+
+
+THE SAVING POWER OF WILL
+
+It is not uncommon to hear a doctor say, "Nothing but his will pulled
+him through that time." It does not mean quite what it says, for the
+patient's will would have been helpless to cure him without the medicine
+and the treatment. But it does mean that in some cases when life is
+hovering on the brink, even the most skilful treatment cannot hold it
+back if the _will to live_ is gone. The chances may be half and half.
+Lack of desire to live may drop the balance on the death side.
+Determination and hope and confidence may overweigh the life side. For
+the influence of will in refusing to surrender to depression may throw
+the needed hair's weight in favor of more normal circulation. Depression
+and emotion may so effect the sympathetic nervous system as to cause a
+lowered circulatory activity. Determination, based on volition, may
+stimulate a response from the sympathetic system which will increase
+heart activity. And certainly, when it is not a matter of life and
+death, but a prolonged recovery, will is a saving grace. The patient who
+sets all his sick energies to the task of winning health reaches his
+goal quicker than the hopeless and depressed. Perhaps his will merely
+brings utter relaxation for the time, forces acceptance of present
+helplessness only for the sake of giving the body a better chance to
+recuperate; but the very fact that it is acting to hopefully carry out
+orders lightens by half the nurse's task of getting him well; and she
+can encourage this will to co-operate with the doctor's efforts by
+suggestion, by her directness and honesty, by the quiet assurance that
+at least a reasonable degree of health is won by effort.
+
+We have touched upon only a few of the laws of the mind. The nurse can
+help develop saving mental habits and wholesome attitudes while she
+helps to strengthen sick bodies; she can make a cure a little more
+certainly lasting who will remember that:
+1. Adaptability is essential to life and health.
+2. There is no neurosis without a psychosis.
+3. Suggestion may be a powerful factor for health.
+4. What we attend to determines what we are.
+5. Thought substitution is possible.
+6. Habit is a conserver of effort.
+7. Will is a saving power.
+
+
+
+
+CHAPTER VIII
+
+VARIATIONS FROM NORMAL MENTAL PROCESSES
+
+
+DISORDERS AND PERVERSIONS
+
+Life would be a very simple proposition if the mental machinery always
+worked right. But this is peculiarly subject to damage both from without
+and from within. From without it may be damaged by the toxins of food,
+as in the acute toxic psychoses; by the poison of drink, as in the
+alcohol-produced psychoses, such as acute alcoholic hallucinosis; by
+lack of muscular exercise, resulting in a deficient supply of oxygen to
+burn up the accumulated toxins from energy-producing foods; by the
+infections, which may result in the infection-exhaustion psychoses;
+by wrong methods of education, and by surroundings which demand too
+severe a mental strain in the struggle toward adjustment. These damages
+from without we class roughly as environmental.
+
+From within the mental workings may be injured by emotional dominance;
+by bad habits of thinking and feeling and doing--often the result of
+wrong methods of education; by defective heredity; by undeveloped will;
+by the insanities. These danger sources from within we might classify as
+self-produced and hereditary.
+
+There may be disorders of any or every function of the intellect,
+disorders of feeling, and perversions of will. Some of the most commonly
+met we list below.
+
+From this limited survey of the mind's disorders we realize that every
+departure from the normal mental attitude tends to associate itself with
+one of the following five _states of mental disability_. Depression, Exaltation, Perversion, Enfeeblement, and Deficiency.
+
+CHAPTER IX
+
+VARIATIONS FROM NORMAL MENTAL PROCESSES (Continued)
+
+
+_Hyperesthesia_ is abnormal sensitiveness to stimulation.
+
+_Anesthesia_ is loss, either temporary or permanent, of any of the
+senses.
+
+_Perversion_ is morbid alteration of function which may occur in
+emotional, intellectual, or volitional fields.
+
+Example: The odor of a rose causing an acute sense of physical pain.
+
+An _illusion_ is a false interpretation of a perception.
+
+The normal mind is quite subject to illusions, either due to a faulty
+sense organ, or to a preconceived state of mind which so strongly
+expects or presages something else than reality as to misinterpret what
+the senses bring.
+
+
+An _hallucination_ is a perception without an object.
+
+The hallucinated individual projects, as it were, the things of his
+mind's creation into the outer world, and accepts them as reality. He
+sees snakes where there is nothing to suggest them; sees a ghost where
+there is no shadow; believes that the taste of blood is constantly in
+his mouth.
+
+There are possible hallucinations of every sense. Nonexistent objects
+are seen, touched, tasted, heard, or smelled.
+
+_Hypochondriasis_ is a state characterized by persistent ideas of
+non-existent physical disabilities.
+
+The hypochondriac has every known symptom of indigestion, or of heart
+disease, or is threatened with tuberculosis--all in his mind; and
+whatever the disorder he seizes upon, his attention hovers there, while
+the ideas of that particular disability persist and strengthen.
+
+A _flight of ideas_ is an abnormal rapidity of the _stream of thought_.
+
+Every perception so immediately is linked with some association of
+experience that expression is swift and often incoherent. One word will
+follow another with amazing rapidity, words suggested by sound
+association, usually, rather than by that of meaning.
+
+Example: "Made a rhyme, had a dime, did a crime, got the time, bring
+some lime." This association by rhyme is quite common. But the
+associations of meaning are not uncommon.
+
+Example: "Made a rhyme. Mary was a poet. Mary had a little lamb. Where's
+Mary?--Mary!--No Jim--Jim, all my children--calling, calling, calling,"
+etc.
+
+A _fixed idea_ is one which morbidly stays in the mind and cannot be
+changed by reason.
+
+Example: In hypochondriasis, as given above.
+
+_Ideogenous pains_ are either pains born of an erroneous idea, or mental
+reproductions of pains now having no physical cause.
+
+A suggestible person, learning that his grandfather died of an organic
+heart, conceives the idea that he has inherited the trouble, and begins
+to suffer cardiac pains; and as long as the idea persists the pain is
+felt.
+
+_Compulsive ideas_ are ideas which intrude, recur, and persist despite
+reason and will.
+
+Example: The compulsive idea of contamination may lead its victim to
+wash and rewash his hands at every contact with matter, until finally,
+though they are raw and sore, he is incapable of resisting the act.
+
+_Disorientation_ is a state of mental confusion as to time, place, or
+identity.
+
+_Amnesia_ is pathologic forgetfulness.
+
+Example: As sometimes found in the infection-exhaustion psychoses, when
+the entire past of the patient may be wiped out for the time. Cases of
+permanent amnesia are known.
+
+_Aphasia_ is a defect in the interpretation or production of language.
+
+There may be motor aphasia, auditory aphasia, vocal aphasia, sight
+aphasia; and with disability to produce words, they may yet be
+recognized when seen; or when they can be spoken they may not be
+recognized when heard; or with inability to speak them, they are
+accurately sensed by hearing; or though understood when heard, they are
+incomprehensible when read.
+
+A _delusion_ is a false belief which cannot be corrected by reason.
+
+A _somatic delusion_ is one centering upon alterations in the organs or
+their functions.
+
+Example: Absence of a stomach, inability to swallow.
+
+A _nihilistic delusion_ is one which denies existence in whole or part.
+
+Example: Mother denies the existence of her child.
+
+A _delusion of reference_ is one in which the deluded individual
+believes himself an object of written, spoken, or implied comment.
+
+Example: The actors on the stage are directing their remarks directly
+against the victim in the box.
+
+A _shut-in personality_ is one that habitually responds inadequately to
+normal social appeal.
+
+_Sense of unreality_ is one of the commonest psychic alterations through
+which customary sensation states are displaced by unnatural and usually
+distressing ones.
+
+Examples: The breakfast table appears undefinably altered. Laughter is accompanied by strange, rather than by normal, sensations.
+
+_Morbid inhibition_ is an abnormal, negative activity of the will.
+
+Sometimes a patient will try pitifully to express some thought or
+feeling; the desire to explain is there, but will is blocked in action.
+Or the patient attempts to dress, makes repeated new beginnings, but
+cannot succeed. We say, "He is inhibited."
+
+An _obsession_ is an idea which morbidly dominates the mind, constantly
+suggesting irrational action.
+
+Obsessed patients may consistently step in such a way as to avoid the
+juncture of the flagstones on the pavement; may insist on removing their
+shoes in church; may hail each person met on the street and tap him on
+the arm; may refuse to ever leave the house without an open umbrella; or
+may try to attack every man they see, not because they want to hurt or
+kill, but because they are obsessed to the performance of the action.
+
+A _tic_ is a useless, habitual spasm of a muscle imitating a once
+purposeful action.
+
+Motor tics, such as habitual jerking of the arms, shrugging the
+shoulder, contorting the face, shaking or nodding the head, snapping the
+fingers, etc., are very common among nervous children, and even in many
+otherwise normal grown-ups.
+
+_Distractibility_ is an abnormal variation of attention.
+
+The common inability of the hypomanic patient to hold his attention to
+any subject when another is open, is very like the distractibility of
+the child who turns to every new interest as it is presented.
+
+_Negativism_ is a state of persistent compulsion to contrary response to
+suggestion.
+
+It is with these patients as though not only initiative were lost but
+also the power to follow another's lead. But their independence asserts
+itself in opposing every suggestion and in acting so far as possible
+contrary to it.
+
+_Mutism_, as used in psychiatry, is an abnormal inhibition to speech.
+
+Patients sometimes speak no word in many months. To all appearance they
+are true mutes. Then suddenly something may remove the mental blockade
+and they talk.
+
+_Compulsive acts_ are acts contrary to reason, which the will cannot
+prevent.
+
+A seemingly quite normal patient will sometimes grab a vase from a stand
+in passing, and dash it to the floor. Something "urged" him to do it,
+and he could not resist. Others will tear their clothes to shreds, not
+in anger, but because they "could not help it."
+
+_Psychomotor overactivity_ is abnormal activity of both mind and body,
+contrary to reason and uncontrolled by will.
+
+_Psychomotor retardation_ is an underactivity of both mind and body in
+which consciousness is dulled and the body sluggish.
+
+A _neurosis_ is a disorder of the nerves, which may be functional or
+organic.
+
+_Nervousness_ is properly termed a _psychoneurosis_--for we have
+learned that there can be no neurosis without an accompanying psychosis.
+
+_Psychosis_ is the technical synonym for insanity.
+
+_Borderland_ disorders constitute a group in which mental perversions do
+not yet so dominate reactions as to make them irrational.
+
+Twilight is neither night nor day; the feelings of the hysteric are not
+insane, but the actions may be.
+
+_Insanity_ is a prolonged departure from the individual's normal
+standard of thinking, feeling, and acting.
+
+_Mania_ is insane excitement.
+
+_Melancholia_ is the inability of the mind to react to any stimulus with
+other than gloom and depression.
+
+Melancholia may be of the intellectual type or of the emotional type.
+The patient who tells you constantly that he has murdered all his
+children, that he is a criminal beyond the power of God to redeem, who
+seems chained to his delusions, yet shows no adequate feeling reaction,
+no genuine sorrow, we call a case of the intellectual type of
+melancholia. Another patient misinterprets every normal reason for
+happiness until it becomes a cause of settled foreboding. The mother,
+whose son fought safely through the war and is now returning to her,
+feels that his coming forecasts calamity for him. He had better have
+died in France. She is of the emotional type of melancholia.
+
+_Hysteria_ is a nervous disorder based upon suggestibility, and capable
+of imitating most known diseases.
+
+_Insane impulses_ are morbid demands for reckless action beyond the
+control of the will.
+
+Example: The impulse to kill, quite regardless of who may be the victim.
+
+_Psychopathic personality_ is a term much used today to designate an
+hereditary tendency on the part of the individual to mental disorder.
+
+The _neuropath_ is the individual with an inborn tendency to the
+neurosis.
+
+_Neurotic_ is a term broadly employed for the nervous in whom emotions
+predominate over reason.
+
+_Neurasthenia_ is a nervous disorder characterized by undue
+fatiguability.
+
+_Psychasthenia_ is a nervous disorder characterized by a sense of
+unreality, weakness of will, self-accusation, and usually by phobias and
+obsessions, all subject to temporary correction by reason or influence
+from without.
+
+_Hypochondriasis_ is a disorder characterized by morbid attention to
+bodily sensations, and insistent ideas of bodily disorder.
+
+_Phobia_ is a morbid fear or dread.
+
+
+FACTORS CAUSING VARIATIONS FROM NORMAL MENTAL PROCESSES
+
+HEREDITY
+
+When we consider the accumulated possibilities for disorder which the
+family tree of almost any one of us can show, the wonder is not that
+there are so many nervous or insane, but rather that any come within
+hailing distance of the normal. For multitudes are born of parents whose
+bodies were food poisoned or alcohol or drug poisoned, and whose nervous
+systems were tense and irritable, oversensitive, and suffering from the
+effect of these same toxins on the brain. Others are of manic-depressive
+parentage; some are possibly even of paranoic or dementia præcox
+lineage; while many of our finest and best had psychopathic or
+neuropathic heredity. Syphilis, itself, and the underpower bodies of
+tuberculosis are heritages of many.
+
+When we realize, too, that we are born with certain inherent tendencies
+of temperament, which are too often of the melancholic or overcholeric
+type, our wonder grows that we are not doomed to defeat at birth. Were
+it not for the possibilities in the germ-plasm of choosing the much of
+good also in our heredity, often enough to overbalance the bad, and for
+the proved power of environment and training to modify or even
+altogether overcome the harmful parts of our birthright, there would be
+little hope for many.
+
+
+ENVIRONMENT
+
+While environment may prove the saving grace from poor heredity, it may
+itself add heavily to the debit side. With the very best of health
+backgrounds, environment may damage body and mind beyond repair. Under
+environment we include everything that touches life from
+without--people, things, work, play, home, school, social life, business
+life, college-life, etc. Among factors of environment damaging to mental
+health are overemotional family life, overstrict home discipline or the
+lack of needed discipline; overfeeding, underfeeding, wrong diet, lack
+of proper exercise, stimulants, drugs, overstimulation, overprotection,
+too much hardship and privation, loneliness, poor educational methods,
+immorality, etc.
+
+
+PERSONAL REACTIONS
+
+What will decide whether a human being can resist, successfully, bad
+tendencies in heredity, or in environment, or in both, and keep a
+reasonably balanced mind? It demands insight, ambition, will; and if
+these remain the body can be forced to saving ways of health, and body
+and mind can largely make their own environment. But with heavy
+handicaps of heredity or environment, or both, and poor insight, or lack
+of desire, or weak will, nothing can save the mind from neurotic taint
+or worse--nothing but obedience to some one strong enough to control the
+habits of that life, until self-control is born. And there is a hope
+that it _can_ be born in the most neurotic or neurasthenic, so long as
+the mind is sane.
+
+But after all, a large number of people whose mental processes are not
+normal, have only themselves, their poor emotions, their lazy wills,
+their hazy thinking to blame. We except what are called the heredity
+insanities--_dementia præcox_ and the other dementias and the
+_manic-depressive_ groups and _paranoia_ and _psychasthenia_--for in
+these cases, possibly with the exception of the _manic depressives_,
+even the most perfect environment could probably not prevent the
+disorder from asserting itself. Many neurotics, neurasthenics, and
+hysterics are curable if they will seriously undertake to fulfil the
+laws of physical and mental health--simple laws, but ones which demand a
+strengthened will to carry out.
+
+
+
+
+CHAPTER X
+
+ATTENTION THE ROOT OF DISEASE OR HEALTH ATTITUDE
+
+
+THE ATTENTION OF INTEREST
+
+Attention naturally follows interest. It can, however, be held by will
+to the unappealing, with the usual result of transforming it into a
+thing of interest.
+
+One of the laws of the mind we have already stressed is that what we
+attend to largely determines what we are, or shall be. The interests
+which secure our consideration may be the passive result of emotional
+life, the things which naturally appeal, which give us sensations that
+the mind normally heeds; or they may be the active result of our will
+which has forced application upon the things which reason advised as
+worth acquiring.
+
+We found that the beginning of health of mind consists in the directing
+of thought toward the health-bringing attitude. We have seen how quickly
+the normal mind can be diverted from the undesirable by a new or
+stronger emotional stimulus. We found that the sole appeal to attention
+in the baby-life is through the emotions, and that it is natural
+throughout life for the mind to heed and follow the interesting; which
+is only another way of saying that thinking follows where emotion leads,
+unless volition steps in to prevent. The supreme test of the will's
+power is its ability to hold the train of thought in the line that
+reason directs, when feeling would draw it elsewhere. This ability marks
+the man who does big things; while the inability to ever turn attention
+away from the interests proposed by feeling assures weakness.
+
+Some of the most charming people we shall ever know are those
+temperamental children of happiness whose interests are naturally
+wholesome and externalized, whose natures are spontaneous and joyous,
+and who live as they feel, seemingly never knowing the stress of forced
+concentration. With them attention follows feeling, feeling is sweet and
+true, and volition simply carries out what feeling dictates. And life
+may not be complicated.
+
+But there is another class whose attention also follows in the ways of
+least resistance; and life for them is a wallowing in the morbid and
+unwholesome. In them feeling is perverted, they seem to see life
+habitually through dark glasses; they passively attend to the sad, the
+distressing, sometimes the gruesome and the horrible with a sort of
+pallid joy in their own discolored images. The first group puts joy in
+all they see, because they are brimming full of joy themselves. These
+others find only the unwholesome in life because their minds are
+storehouses of it. We say that each type has projected himself, that is,
+has thrust himself out into the external world, and is standing back,
+looking at his own nature and calling that the universe.
+
+But neither of these two groups can long withstand the stress of a world
+they only feel and have never attempted to comprehend. The irresponsibly
+happy ones are too often crushed and broken when life proves to bring
+loss and failure and disappointment; the morbid probably will cease some
+day to enjoy their melancholic moods, and be unable to find their way
+out of them. If both had learned to control attention, they might have
+been saved. The happy, care-free child of the light is at desperate loss
+when the sun he loves is obscured, if he has not learned to look upon
+the far side of the clouds to find that there they glow golden with the
+rays temporarily shut from him. Because clouds were not interesting to
+him he never attended to them--and now he cannot. If the pessimistic,
+morbid one had looked away from the shadow to the sun it hid he, too, in
+the end might have seen with sane eyes and lived so wholesomely as to
+find all the good there was in life. Willed attention, rather than
+spineless feeling distractibility, might have saved him.
+
+When thinking can be forced to follow where trained reason directs, and
+can be kept in that direction, the greatest problem of physical and
+nervous well being is solved. To the nurse there is no other principle
+of psychology so important. But no child ever had his attention
+diverted by reasoning alone. The object at which you wish him to look
+must be made more impelling than the one he already sees, or he must
+want much to please you, else he only with his eyes will follow your
+command while his mind returns to his real interest; and the second you
+cease to command that eye service, he looks back to the thing that was
+holding him before. The beginning of all education is in arousing a
+_want to know_; in turning desire in the direction of knowledge.
+
+I am an undisciplined child and I want only candy for my lunch. It is
+not good for me. Milk is what I should have. I don't want it. You may
+deprive me of the candy and force me to drink the milk, and I can do
+nothing but submit. But I rebel within, and I am only more convinced
+that I "hate" it and want candy, and that you are my natural enemy
+because you force the one upon me and deprive me of the other. If I were
+insane and so, of course, could not be reasoned with, this might be
+inevitable. But it would be unfortunate. In that case, if possible, do
+not let me see the candy; let only the food it is best for me to have be
+put before me, and perhaps eventually I shall come to want the more
+wholesome thing--for it is better than the hunger.
+
+But as it happens I am a perfectly normal person, only I am sick. I am
+tired of bed, and want to sit up--and it does seem that I should have my
+desire. The nurse, wise in her knowledge of sick "grown-ups," who are,
+after all, very like children, will find a way to divert my mind from
+the immediate "I want" to something which I also can be led to want. I
+may agree that I want more the better feeling an hour from now. Perhaps
+her humorous picture of the effects of too early freedom on my
+condition, or of my body's urgent demand for rest, regardless of my
+mind's wish; perhaps only a joke which diverts me; perchance the
+"take-for-granted you want to help us out" air; mayhap the story to be
+read or told; or simply the poise and quiet assurance of the nurse who
+never questions my reasonableness and acquiescence; perhaps her
+confidence that this will serve as a means to the end I covet--will
+result in my gladly taking her advice, and my perfect willingness to
+wait for new orders, while I indulge in beautiful plans I shall carry
+out when they finally arrive.
+
+In other words, with the sick as with children, attention naturally
+follows interest. And the good nurse realizes that it is not wise to
+force co-operation when she can secure it by diverting her patient's
+thoughts to another interest than the one now holding him. Very often,
+merely by chatting quietly about something she has learned has an
+appeal, she can make the patient forget his weariness and boredom, or
+his resistance to details of treatment. The very milk he is refusing to
+drink may be down before he realizes it. But right here lies a hidden
+reef which may cause wreckage in the future. It is good therapy to
+divert attention by appealing to another interest when the patient is
+too sick or too stubborn or not clear enough mentally to be reasoned
+with. But if this becomes a principle, and his reason and active
+co-operation are never secured to make him choose the way of health for
+himself, the hour he is out of the nurse's hands he reverts to the
+things that now happen to appeal to him. Then unless some wise friend is
+near to continue her method of making the reasonable interesting, the
+advice of reason can "go to smash."
+
+There has been a very constant illustration throughout the past of the
+unwisdom of relying upon diverted attention alone as an effective
+therapeutic agent. We hope this will not illustrate our point so clearly
+in the future. The drunkard, who is just recovering from a big spree,
+and feels sick and disgusted with himself, and sore and ashamed, is
+appealed to in glowing terms of the wellness and strength and buoyancy
+of the man who never drinks. He has no "mornings after." The Lord is
+just waiting to save this dejected victim of alcohol from his hateful
+enemy who has made him what he is at this hour, and will forgive all his
+sottishness, his sins. He will be respected; he can command the love of
+his family again. He will no longer be a slave, but a free man. Right
+now, respect of the world and love of family and friends, and cleanness,
+and the forgiveness of a good God are infinitely more interesting than
+this splitting headache, this horrible sick feeling. And attention may
+be very readily diverted. This promised new life is more attractive than
+the present. It is easy to keep attention there. And he reforms. He
+swears off "for keeps." He is a happy man, a free man. For a few days or
+weeks, perhaps even longer, he glories in his new self-respect. It is a
+strange and enticing sensation. Then one day something goes wrong. He
+loses some money, or he is awfully tired, or the wife and children bore
+him, and all of a sudden the one greatest interest in the world is a
+drink. And because his thinking can always be led by his feeling;
+because he has never learned to force it to go elsewhere, he has his
+drink. Appealing to his emotions did not and cannot save him unless that
+appeal is followed at the right moment by awakened reason, which will
+look at the whole proposition when the mind is at its normal best, and
+choose to follow where rational feeling directs. Nor will reason save
+unless volition comes to its support and strongly backs it up and
+enforces what it advises.
+
+
+THE ATTENTION OF REASON AND WILL
+
+So the good nurse will not consider her work done when she has diverted
+mental processes into channels of co-operation. When the patient, who is
+capable of reasoning, knows the why of his treatment, and realizes that
+he can only keep well as he himself takes over the job and puts his mind
+on things outside of his feelings, and carries out the doctor's
+instructions for the sake of securing a certain end--then he has been
+under a good nurse. This wise helper never "preaches," but makes the
+healthy goal very desirable, stirs up an ambition to attain it, and
+prods the will to keep on after it despite anything feeling may say.
+
+This attitude on the part of the nurse presupposes that her own
+attention, while with her patient, is upon him and upon securing his
+health, and not upon her tiredness, or boredom, or headache, or the
+party tonight, or the man who has asked her to go to the theater with
+him tomorrow. She, surely, must learn to direct her thoughts where
+reason suggests, and to gain new interests through willed attention, or
+as a nurse she is less than second rate. Nor can she get the best
+results until she can turn with a single mind to the patient at hand as
+the immediate problem to be solved. And probably neither nurse nor
+doctor does any better service, except in saving life itself, than in
+keeping the patient from thinking constantly of himself and his ills.
+For it seems of little use to have made some people physically well, if
+they are to carry through prolonged years the curse of constant
+self-attention, self-centeredness, an ingrowing ego.
+
+There are a few simple laws of the mind hinging upon attention which are
+today being impressed upon teachers in every department, in
+kindergarten, public school, college, and university. And they are as
+necessary to the nurse as to the teacher. Three of them we have already
+discussed:
+1. Attention naturally follows interest.
+2. Attention may be held by will where reason directs.
+3. New interests grow out of willed attention.
+A fourth we shall stress before considering the use the nurse can make
+of them:
+4. The thing to which our chief attention is given becomes the most
+important thing.
+
+Do not contradict this too quickly. Don't say that nursing gets your
+chief consideration because it is, of necessity, your profession; but
+that you love your music infinitely more, and look forward to that
+through all your hours on duty. If this merely proves that music is
+distracting your attention, you are doing your nursing as a means, and
+not as an end; you give it probably all the attention necessary for good
+work, but your real desire is music. Your chief attention is directed
+toward that goal. Hence music is to you the most important thing. If
+your will is sufficiently trained to keep you from consciously thinking
+of it, still you are dreaming of it and working for it. You may make a
+very good nurse, but you will never be as excellent a one as the woman
+from whom nursing demands first and chief attention.
+
+We sometimes speak of one woman as a born nurse, and say of another,
+"She's a good nurse, thoroughly conscientious, but not a natural one
+like Miss X." It only means that Miss X's main purpose in life has
+always been caring for the sick, while Miss Y's secondary concern is
+that. There is a third, however, who may be sidetracked into nursing,
+but whose chiefest interest and attention in life has not been so much a
+certain profession or accomplishment, but a passion for people, with an
+ability to enter into their lives understandingly. She may not care for
+nursing in itself. It is only accidental that her thoughts were turned
+to it. But her liking for people makes it easier for her to concentrate
+attention on the details of nursing, as thereby she is fulfilling her
+life's ambition in studying and serving human beings. She may be a real
+success if she can only convince herself that this is her forte. If not,
+and she dreams of other fields of service, her concentration on the
+thing at hand is not perfect enough for her to compete successfully with
+the "born nurse."
+
+Whatever it is, the thing that gets our chief attention is the most
+important to us. It may be lack of appetite, or pain in the side,
+indigestion, general disability, discomfort, the mistreatment we once
+received, the mistake we once made, or the sin we committed--whatever it
+is that holds our attention, it is the most absorbing and interesting
+thing in the universe, though it may be an utterly morbid interest, an
+unhappy attention. But it blots out for the time the rest of the world.
+A big hint for the nurse exists therein. Let her try in every lawful way
+to divert her patient's attention from the disease-breeding stimuli
+toward the happy and wholesome ones.
+
+For the nurse herself in the care of patients let us draw some
+conclusions from these laws of the mind's working:
+1. Have a goal in view for the patient's health of both body and mind.
+2. Work toward instilling in your patient a health ambition--a pride in
+health.
+3. Remember that overcrowding the mind defeats your purpose of making
+one clear impression.
+4. Win interest by any legitimate means to the next step toward the
+goal, and only the next.
+5. Work for attention to hopeful, courageous, and happy things.
+
+Let us as nurses remember always that it is for the patient's sake and
+not for our own that certain results must be obtained. Our work is
+usually in helping the doctor to get the best possibilities out of the
+material at hand, and we cannot hope to change the fabric. But we can
+help to repair it; we can sometimes influence the color and suggest some
+details of the pattern, or assist in the "making over" process; and when
+the fabric is substantial and beautiful we may assist in preventing its
+marring. So we may help to evolve a body-health and mind-health attitude
+from what seemed the wreckage of a disease-accepting mind; or we may
+have the great privilege of warding off the disease-accepting attitude.
+But always, in all our care of patients, let us not neglect or fail to
+use wisely this central fact of psychology; that anything that gains
+attention, even for a moment, leaves its impress on the mind; that the
+direction of attention determines our general reaction to life.
+
+
+
+
+CHAPTER XI
+
+WHAT DETERMINES THE POINT OF VIEW
+
+The point of view of any individual depends upon temperament, present
+conditions--mental and physical--and the aim of the life. That is, it
+depends upon his inherited tendencies plus a unique personal something,
+plus all the facts of his environment and experience, plus what he lives
+for.
+
+Richard and Jim both live in Philadelphia, Richard on Walnut Street and
+Jim on Sansom Street. Richard's father is of the best Quaker stock, with
+hundreds of years of gentle and aristocratic ancestry behind him. He
+followed his father and his grandfather into the profession of medicine,
+and is a well-known specialist, alert, keen, expert, and deservedly
+honored. He is at home in Greek and Latin, French, and the sciences. He
+selects at a glance only the conservative best in art and music and
+literature. His world is a gentleman's world, a scholar's world, and the
+world of a scientist and a humanitarian. And Richard, his son, is true
+to type.
+
+Jim's father is the ash man. His world is in the alleys and basements.
+His pastime, cheap movies, and the park on Sundays. When he is not
+working he is too "dead tired" for anything heavier than the Sunday
+Supplement or perhaps the socialist club-rooms, where he talks about the
+down-trodden working man and learns to hate the "idle" rich. He spends
+his money on food and cheap shows and showy clothes. He talks loudly,
+eats ravenously, works hard, is honest, and wants something better for
+his children than he and the "old woman" have had. His music is the
+street-organ, the movie piano, and the band--some of it excellent
+too--but none of your dreamy stuff--good and lively. And his son, Jim,
+is true to type.
+
+After the Armistice Jim and Richard, who have fought for months side by
+side, go to Paris together. Richard may "have a fling" at Jim's
+amusements for the sake of playing the game and "seeing how the other
+half lives" and all that--but before long we shall find him in the
+high-class theaters and restaurants, visiting the wonderful art
+collections and libraries, riding in luxurious automobiles, and staying
+in the best hotels he can find. And even though Jim may have saved
+Richard's life and Richard is eternally grateful, and loves Jim as a
+"dandy good scout," their ways will inevitably drift apart when the one
+big common interest of fighting together for a free world is over. They
+will always remember each other. Jim will decide that a "highbrow" can
+be a real man, and Richard will ever after have a fellow-feeling for the
+"other half" and think of them now as "folks." But Jim is not at home in
+Richard's neighborhood and circle; and Richard is a fish out of water in
+Jim's. The point of view of each has been largely determined by his
+heredity and his environment.
+
+But suppose Jim isn't true to type. From the time he was a mere
+youngster the ash-man life did not appeal to him. In school he liked the
+highbrow crowd; he "took to" Latin and literature. He has a feeling of
+vague disgust when he sees a vulgar picture, a shudder when the
+street-organ grinds. There is something in Jim different. He isn't in
+tune with either his immediate heredity or his environment. The
+contribution from some remote ancestor has overbalanced the rest, and
+Jim becomes a professional man.
+
+Or perhaps Richard breaks his father's heart. Instead of following the
+trail already made, he cuts loose, frequents vulgar resorts, hates his
+school work, becomes a loafer and a bum--and, finally, a second-rate day
+laborer. Again, what he is himself, his "vital spark" has been stronger
+than immediate heredity and environment, and has broken through.
+
+
+GETTING THE OTHER MAN'S POINT OF VIEW
+
+Our points of view are very frequently merely hereditary or acquired
+prejudices, hence altogether emotional rather than rational. We only
+with great difficulty see things through another man's eyes. It
+necessitates comprehending his background fully, and standing exactly
+where he stands, so mind and eyes can both look out from the same
+conditions that confront him. And this is only possible for the man or
+woman possessed of a vicarious imagination. Such an imagination,
+however, can be cultivated.
+
+You hate my father. He injured yours--unjustly, to your mind, of course,
+for yours can do no wrong. From my point of view this father of mine is
+a great, good man. From your point of view he is wicked and cruel. We
+are both honest in our emotion-directed opinions. Until you can know my
+father as I know him, and I can know yours as you know him, we shall
+never agree about them. But I _can_ learn to understand _why_ you feel
+as you do, and you _can_ learn to understand _why_ I feel as I do. I can
+put myself, in imagination, in your place, and see that other man as my
+father, and pretty well grasp your point of view, and you can likewise
+get mine.
+
+After all, the law is very simple. Each man is the result of the things
+he puts his attention chiefly upon; and he puts it naturally upon the
+things which his forebears and his surroundings have held before him.
+The rare person and the trained person can assert the "vital spark" of
+his own personality and tear attention away from the easy direction and
+force, and hold it somewhere else. So he can change his points of view
+by learning that there are other vantage grounds which direct to better
+results. With some one else to lead the way and give a bit of help, or
+with the urge of desire to understand the new viewpoint, or by the drive
+of his will, he can change his own.
+
+Let us not forget that what we see depends on whether or not our eyes
+are normal, on where we look, or on what kind of spectacles we wear. Two
+things we can change--where we look, and the spectacles. If our eyes
+were made wrong we probably cannot change that, but we can often correct
+poor vision by right artificial lenses. There are people doomed to live
+in most unattractive, crowded surroundings who make a flower-garden of
+charm and sweetness there, or, without grounds, keep a window-box of
+fragrance. The normal person can pretty largely either make the most
+impossible environment serve his ends or get into a better one. So we
+can usually look to something constructive, helpful, attractive, or
+beautiful; and we can refuse to wear blue spectacles.
+
+We nurses soon realize that there are just about as many points of view
+as there are people, and that if we would help cure attitudes as well as
+bodies, and so lessen the tendency to sickness, it behooves us to learn
+to see what the other man sees through his eyes or by the use of his
+glasses, from where he stands.
+
+Let us try just a few experiments. Hold your pain and suffering from
+your appendix operation, and disappointment because you can't be
+bridesmaid at your chum's wedding, up close to your eyes, and you cannot
+see anything else. They crowd the whole field of vision. Look at the
+world from the eyes of a spoiled woman of wealth who for twenty years
+has had husband, friends, and servants obedient to her every whim. She
+has grown selfish and demanding. What she has asked for, hitherto, has
+been immediately forthcoming. Now she is ill, and she naturally
+considers the doctors and nurses mere agents to secure her relief from
+discomfort. She is willing to pay any price for that--and still she is
+allowed to suffer. From her point of view it is utterly unreasonable,
+inexcusable. What are hospitals and nurses for, anyway? And she is
+carping, critical, and disagreeable. Her attitude is as sick as her
+body. How could it be otherwise?
+
+Look about you from an aching mind and body, after days of suffering and
+sleeplessness, and unless you are a rare person and have a soul that
+sees the sunshine back of everything--you will find the world a place of
+torture. Look out from despair and loss of the ones you love best, or
+from failure of will to meet disaster, and everybody may be involved in
+bringing about your suffering, or in effecting your disgrace.
+
+Look out on the world from the eyes of the immigrant who has lost all
+his illusions of the land where dollars grow on the street and where
+everyone has an equal chance to be president, and if you do not cringe
+in abject humility, you are not unlikely to be insufferably
+self-asserting, considering that the world has robbed you and that now
+it is your turn to get all that is coming to you. So you make loud
+demands in a rude, ordering voice. The nurse is there to wait upon
+you--and finally you will have your innings.
+
+Look out from the resentful eyes and smarting mind of the negro who is
+just beginning in a northern city to realize that his boasted "equality"
+is a farce, and you will try to prove to the white nurse that you are as
+good as anybody. You are impossible; but back of all your bravado and
+swagger and rudeness and complaint of neglect because of your color, you
+realize that you cannot measure up. You know you belong to a different
+race, most of whose members are daily giving evidences of inferiority;
+and you are sure that the nurse is thinking that.
+
+Look from the eyes of the "new rich," or the very economical, and you
+are going to get your money's worth out of your nurses.
+
+The nurse who can get back of her patient's forehead and put her mind
+there and let it work from the patient's point of view, will learn a
+saving sense of humor, will be strict without antagonizing, will clear
+away a lot of mental clouds and help to make permanent the cure the
+treatment brings.
+
+One can often judge very truly a patient's real character by his
+reaction to his sickness. On the other hand, frequently it only
+indicates that he has not yet properly adapted himself to a new
+experience and a trying one. We hear so often, "Why, she's a different
+person these days, since she's feeling better. It's a joy to do things
+for her." She was the same person a while back, but had not learned to
+accept discomfort. Any of the following list of adjectives we hear
+applied to our patient again and again by the nurses:
+
+Unpleasant terms they are, and condemning ones if accepted as final.
+When the nurse realizes that under the same conditions she would
+probably merit them herself, she becomes more anxious to remove the
+conditions, and less bent upon blame.
+
+We must admit that the highest type person, when sick of any physical
+illness, does not deserve such descriptive terms as these. But they are
+the rare folks, few and far between; while the great mass of us have not
+acquired more than enough self-control and thoughtfulness for the
+ordinary routine of life. We are weakly upset by the unexpected. If it
+is a pleasant unexpected, we are plus in our enthusiasm, and people
+applaud; if the unpleasant unexpected, we fall short, and people deplore
+our weakness. If we learn our lesson of self-control and adaptability,
+and gain in beauty of character through experience, it has served a
+purpose. But the nurse deals with the average of human nature, and she
+finds their reaction faulty. Very often, if she is observant, she will
+discover that a patient responds in a very different way to some other
+nurse, who somehow finds that "trying" sick woman charming or
+thoughtful, likable or sweet. Of course, it may be because the other
+nurse weakens discipline and caters to the patient's whims; but it is
+just as likely to be because she has tempered her care and her
+strictness with understanding. She has grasped the patient's point of
+view; and with that start, the chances are 50 per cent. more in favor of
+the patient grasping and acceding to the wise nurse's point of view.
+
+Shall we not remember that our trying, cranky, stubborn patient is a
+sick person, and learn to treat that stubbornness or crankiness as a
+symptom indicating her need, just as we would a rising temperature?
+
+When we can meet her attitude with comprehension, and, if necessary,
+with quietly firm disregard, then we are beginning to be good nurses.
+
+Some of the most common of these sick reactions with which the nurse
+must deal are enhanced suggestibility, repression, oversensitiveness,
+stubbornness, fear, depression, and irritability. And each one demands
+a different method of approach if real help is to be given.
+
+Old Isaac Walton wrote a book many, many years ago called "The Complete
+Angler." He was a famous amateur fisherman, and he says there are only
+three rules to be observed and they will bring sure success:
+1. Study your fish.
+2. Study your fish.
+3. Study your fish.
+
+If the angler follows these directions, he is not apt to offer the wrong
+bait. When he knows all their little peculiarities, he will know how to
+catch his fish. The "complete angler" has an unlimited patience and an
+infinite sense of repose and calm. He never hurries the fish, lest they
+become suspicious of his bait. And he proves that these three rules
+work.
+
+The nurse who accepts every patient as like every other, and treats him
+accordingly, will never be a great success. The nurse who "studies her
+fish" and learns their psychology, will be a therapeutic force. She will
+know the _why_ of the way that patient acts.
+
+
+THE DELUDED PATIENT
+
+If the patient's mind is temporarily clouded through infection or
+suffering, he may be reacting to a delusion, an obsession, a fixed idea
+of disability, a terrifying fear. Sometimes he persistently refuses
+food, and gives no reason for it. The unthinking nurse is tried,
+puzzled, and irritated. In other ways, perhaps, the patient seems quite
+normal. But, after all, the explanation is very simple. He probably is
+as confident that the food is poisoned as you are that it is as it
+should be. No arguing would convince him, for, to his mind, the nurse is
+either a complete dupe or an agent of the people whom he knows are
+plotting his death. And urging him only strengthens his conviction.
+
+The writer recalls one such case of a patient who had to be tube fed
+through many months, though a tray was set before her three times a
+day--and as regularly refused. Then one day she was seen slipping food
+from off another patient's tray and eating it greedily, not knowing she
+was observed. When questioned, though she had never before given a
+reason for refusing food served to her, she said that "they" had nothing
+against Mrs. B., so wouldn't try to poison her. Her reasoning was
+excellent when one accepted her premises. She had bitter enemies. They
+were not enemies of Mrs. B. and would not harm Mrs. B. Therefore she
+dare not touch her own food, but could eat Mrs. B.'s if no one knew.
+
+These deluded patients live in a world we often do not sense, a world
+whose reality we do not appreciate. The nurse, after much experience,
+finds that there is a key to every resistance, to every lack of
+co-operation, to abnormal attitudes and actions. She realizes that a
+powerful emotion of desire or fear, of love or hate, of ambition or
+self-depreciation, of hope or despair, of faith or distrust, unchecked
+by reason or judgment through the years, has provided a soil upon which
+emotional thinking alone can grow. The patient is a mere puppet of the
+suggestions of emotions which may not be at all pertinent to the facts.
+
+
+NURSING THE DELUDED PATIENT
+
+The nurse soon realizes the uselessness of attempting to argue a patient
+out of his delusions, of trying to convince him that the things he sees
+and hears and perhaps tastes and feels, are but hallucinations. Her very
+insistence only fastens his attention more firmly upon the false
+conclusion or makes him more convinced that his mind is giving him a
+true report from the senses of sight and hearing and taste and feeling.
+But often a quiet disregard of the delusions while the nurse goes on her
+way and holds her patient to his routine, consistently and confidently,
+as she would in case they were not true, will eventually cause him to
+question their reality just because no calamity results. The nurse acts
+as if these delusions and hallucinations were non-existent in reality,
+and when the occasion arises, through the patient's questioning, she
+urges him to exert his will to act also as if they were not true; to try
+it and see what happens. Arguing, also, she finds, usually antagonizes
+or makes the patient stubborn. He cannot prove by her logic his point,
+but he "knows" from inner experience that he sees what he sees, hears
+what he hears, and knows what he knows. The fact that the nurse does
+not is merely annoying evidence that she is blind, deaf, or stupid to
+these things of his reality. He knows he is lost and damned, or tainted;
+that he is King George, Cæsar, or the Lord, as the case may be; or that
+his internal organs are all wrong. He "feels" it and the nurse
+can't--therefore, he alone has true knowledge of it. In the end, the
+wise nurse who never disputes with him, but leads him on to action which
+utterly disregards these things, may bring about a gradual conviction in
+the patient's mind that a man couldn't do what he does if all these
+things were true; and the delusion slowly may lose its force or the
+hallucination fade away. Many patients drop them from their lives
+entirely. Many others in whom dementia is not indicated, or in whose
+cases it is indefinitely delayed, can come to an intellectual
+realization that all these things are fantasies, and do not represent
+reality; that despite their continued, frequent, or occasional demands
+upon feeling life, they can be consistently ignored. These psychopathic
+individuals may act as they would if the delusions never came henceforth
+to their consciousness, and so be enabled to live a comparatively normal
+life.
+
+
+THE OBSESSED PATIENT
+
+A patient who is suffering from obsessions must carry out certain
+abnormal actions, or be wretched. She cannot do otherwise. It is as
+though she were forced by some outside agent, though the forcing is
+actually from within. When the nurse realizes this, and the more
+essential fact--that many patients, who have not true obsessions, yet
+have a tendency toward obsessed ways of thinking and doing--when she
+comprehends it almost as she would if she were the victim, then she is
+ready to help the patient by gently making the action impossible, and at
+the same time diverting attention.
+
+
+THE MIND A PREY TO FALSE ASSOCIATIONS
+
+Sometimes a nurse reminds a patient of some one in the past who has
+complicated her life in an unhappy way, so she distrusts or dreads her
+or is made constantly uncomfortable in her presence. In such a case, if
+the nurse reports her patient as resistive, or fearful or cringing, or
+distrustful, she is really misrepresenting her; for under another's care
+that patient may show an entirely opposite reaction.
+
+The nurse can only sense the strength of the influence of heredity and
+environment and habit of thought, which would give the explanation of
+many things in her patient's attitude. Nor can she realize just what
+shade of meaning certain phrases and words have for her charge. To the
+nervously overwrought person the most innocent reference--father,
+sister, wife, home--may bring concepts that are unbearable. The
+association of the word may make for deep unhappiness, of which the
+nurse knows nothing. But she _can_ learn that all these things _do_
+influence attitude, can appreciate the difficulty of her patient's
+effort at adjustment, and do all in her power to make that adjustment
+possible. If the patient is reasonable she can appeal to her reason. If
+she is too sick for that, the nurse can use happy suggestions. If the
+mind is deluded and obsessed she can use firm kindness. She can learn
+what loss of privileges will affect the rude and unco-operative patient,
+and may be allowed to try that. She can sometimes help the patient to
+self-control by making her realize that after each outburst she will be
+constructively ignored.
+
+But the point we wish to make is this: There are some sick reactions
+which the nurse, if she recognizes as such, can help the patient to
+transform into wholesome ones. At the very least the wise nurse can
+learn to simplify her own difficulties by accepting the unpleasant
+patient as possibly the result of her illness, and refusing to allow her
+trying attitude to get on her nerves. The patient may be reacting
+normally to the stimulus her untrained and toxic brain received. And
+when the nurse can see into the other's mental workings, get her point
+of view, she is ready to give fundamental help.
+
+
+
+
+CHAPTER XII
+
+THE PSYCHOLOGY OF THE NURSE
+
+
+The mind can be as definitely developed and strengthened as the body.
+The man who has suffered for years an organic disease will never have
+the same force as he who has never been seriously ill; but his
+constitution can be built up and made as efficient as possible within
+its limitations. Many a man or woman who has an organic heart disorder,
+through treatment and the proper exercises gradually increased, can very
+often approximate through many years the output of a normally strong
+person. The individual weakened by a tuberculous infection can
+frequently, by following a prescribed regimen for a time, by wise,
+scientific diet and rest treatment and the help of the out-of-doors,
+then by carefully increased physical activity, finally live the useful,
+average life. But it takes scientific care to evolve the weak body into
+a strong one; and in some cases, at best, it can never stand the same
+strain that the uninjured one carries with ease. However, even damaged
+bodies can be made very productive within their limited spheres. Also
+the naturally perfect physique can quickly become unfit through neglect
+or infections or misuse.
+
+In the same way, and just as definitely, can the mind be developed and
+strengthened. Some are by nature keen, alert, brilliant. They may
+develop into masterfulness; or they, too, may degenerate, through abuse,
+or from the effect of body infections, into uselessness. The germ-plasm
+has foreordained some individuals to psychic disorders; but training and
+mode of life can modify many of these defects. And the average mind,
+like the average physical organs, can be made more efficient through
+partaking of the proper mental food, through careful training and wise
+use.
+
+No more urgent necessity faces the professional woman than this of
+training her mind to its highest productiveness. Argument is not needed
+to convince intelligent people today that the accomplishment of life
+depends upon mentality.
+
+Let us look into the very A, B, C's of mind development, and as nurses
+undertake to equip ourselves to master our profession from the ground
+up. The first essential is ability to think clearly.
+
+_Steps to Clear Thinking_:
+1. Accurate perception, with attention to the thing that reason chooses.
+2. Association of ideas.
+3. Concentration, acquired by the help of emotion and will.
+4. Emotional equilibrium, which refuses to allow feeling to obscure
+judgment by leading reason astray.
+5. Self-correction.
+6. Automatic habits, which free the mind of all unnecessary crowding.
+
+
+ACCURACY OF PERCEPTION
+
+The beginning of learning is perception. Keen, accurate perception at
+the time of first introduction of a new fact or thought, and the linking
+up of that new material with something already in consciousness, insures
+in the normal mind the ability to remember and use that fact or thought
+again. The things casually perceived and not definitely tied up with
+something else are soon forgotten by the conscious mind.
+
+You pass a florist shop where a score of different flowers and plants
+are displayed. If your thoughts are intently on your errand you may
+glance in, see flowers, color, perhaps a riot of colors only--and
+beauty; and you feel a glow of pleasure from the sight. But a moment
+later you cannot name the blooms in the window. Perhaps roses come to
+mind because you have very special feeling for them; or carnations, or
+sweet peas. But the window as a whole you perceive only as flowers, and
+color, and beauty. You cannot describe it in detail, for you gave it
+only passive attention.
+
+But if you went to that window to know its contents; to find out what
+the florist had in his shop, because you are very interested in all
+flowers and plants, then you can tell minutely what is there. You had a
+purpose in perceiving the window; your will held attention upon each
+object in turn; and your love of flowers (an emotion) eased the effort
+of volition when it might have tired.
+
+Perception, then, is of three kinds: passive, incited by interest, and
+directed by will. And the perception which is the basis of accurate
+knowledge is one of keen interest, or of will, or of interest plus will.
+
+
+TRAINING PERCEPTION
+
+The nurse who demands of herself that she perceive accurately paves the
+way for accurate, deft service in her profession. There are constant
+means at hand for training in the art. Suppose you try to get so
+definite a picture of each ward or room you enter, in a swift but
+attentive examination of its furnishings and their locations, and of the
+patients, that you can reproduce it to yourself or a friend some days
+later.
+
+You come into a large ward, with a row of beds on either side of the
+door, and a wide central space between. How many beds in each row? There
+is a table at the far end of the room, opposite the door, and a nurse in
+white is writing there. Why does she wear white? What is her name? To
+your right is a closet-like room opening from the ward. That is a
+medicine-room, you are told. How many windows has the ward? You glance
+from bed to bed with a rapid passing in review of the patients. Which
+ones seem to you very ill? There is a large white screen about one. You
+are told that when treatments are given the screen is put there, or that
+when a patient is dying the bed is screened. You look for the
+ventilators, and see how many are open and how they work. You see a
+room-thermometer, and ask at what temperature it is kept. The nurse
+explains that a certain degree is ordered, and that, so far as possible,
+the ventilators are operated to insure that.
+
+If your attention has followed all these details with careful, accurate
+perception; if you have grasped them clearly, one by one, at the time,
+you will be able to answer quickly next day when some one asks how many
+patients the wards accommodate, and how many beds are vacant. You can
+describe the lighting and ventilation, the room temperature, etc. And
+later on you will quickly see to it that a screen is properly placed
+when you know treatments are to be given.
+
+
+ASSOCIATION OF IDEAS
+
+After the first few years of life practically nothing enters
+consciousness that cannot by some likeness or contrast or kinship be
+connected with something already there. Were it not for this saving
+economy memory would be helpless. So the nurse who is in earnest and
+eager to master her new work will not only perceive carefully each
+detail of arrangement, but in two or three days at most will know each
+patient there; she will have worked out a system of associations,
+remembering not a meaningless name, but an individual with certain
+characteristics which she ties up with her name, and so gives it a
+definite personality. She thereafter recalls not merely a patient, but a
+very special patient; and as she comes to mind she brings a title with
+her, which is her symbol. Likewise when her name is spoken or thought,
+she herself comes into the nurse's immediate consciousness. A bed in a
+certain part of the room will be no longer merely a bed, but
+Mrs. Brown's bed. Remembering can be made easy by using some such method
+as this:
+
+The first bed to the right as you enter is Mrs. Meade's. She is the
+woman with the broken hip. The next is Mrs. Blake's, that blonde, big
+woman who wants more attention than any one else. The third is
+Mrs. Bunting's. She has wonderful, curling black hair, and a nice
+response to everything done for her. The next beyond is Mrs. O'Neil's.
+She looks as Irish as her name sounds, and you will remember her by
+that. So each bed comes to mean a certain patient, and each patient
+comes to suggest the ones on either side of her--her neighbors.
+Blondeness and bigness together call Mrs. Blake to mind. Broken hip
+means Mrs. Meade, etc. Each individual on that side of the ward becomes
+associated with a name which stands for definite characteristics.
+
+Then you begin at the left bed nearest the door and follow the occupants
+back on that side. You may remember better by jotting them down in
+order of the beds, with names and a brief comment on each patient. Keep
+that list on a small card in your pocket for reference for a day or two,
+then depend on memory entirely. I have personally found this an
+excellent method.
+
+You are expected to be able to turn quickly to any medicines needed in
+emergency, and you soon learn to remember them and where they are placed
+by the arrangement into classes or kinds, which most hospitals require.
+Cathartics are together, hypnotics together, etc. So when you want
+_cascara_ you associate it with cathartic and turn to that shelf. You
+learn very soon that poison medicines are kept apart from the others,
+and quickly associate the _poison_ label with danger to patients,
+necessity of locking safely away and hiding the key from any but those
+responsible for the care of the sick.
+
+Learning to look closely at the patient's face, instead of casually
+glancing at her when you care for her, makes it possible for you to note
+changes of expression, heightened color, dilated pupils, a trace of
+strain, etc. Then try to find the exact word that will express what you
+see. Such experiments in perception and attention, association and
+memory, repeatedly demanded of yourself--_i. e._, the being able to
+recall and describe in detail the room- or ward-arrangements and to
+place the patients accurately, as we have just described--will prove
+invaluable practice, helping you to attend to every change in your
+patient's demeanor and expression, which may prove significant symptoms.
+And remember that while the mind can only contain so many isolated
+facts, yet there is no limit to its possibilities when the power of
+association of ideas is employed.
+
+Your first step to clear thinking is accuracy of perception, with
+attention to the thing reason chooses; your second is association of the
+things perceived, a grouping of them to fit in with each other, and with
+what is already in the mind. And both imply the third--concentration,
+aided by emotion and will. For passive attention and haphazard
+associations assure the opposite of clear thinking.
+
+
+CONCENTRATION
+
+_How to Study._--You learn sooner or later from experience that the
+quickest and best way to learn anything new is to give it your undivided
+attention at the moment; to perceive one thing at a time and to perceive
+it as something that is definite, or as some quality that is unblurred.
+One of you will spend three hours on an anatomy lesson, another two
+hours, while a third nurse may give it a half-hour of concentrated study
+and know it better than either of you, if you have been day-dreaming, or
+talking, or rebelling at the "luck" which keeps you indoors learning
+about bones, when the tennis-court is so inviting. True, some minds have
+better natural equipment and some have better previous training than
+others. But the average mind could learn a lesson well in much less time
+than is spent upon learning it poorly. Few people hold their attention
+strictly to the task at hand if something more interesting beckons, or
+if they feel tired, or "blue." But you can learn to do it.
+
+Put aside a certain amount of time today for study; hold your undivided
+attention on your lesson, regardless of how many pleasanter things
+appeal. When your eyes or your thoughts wander from your note-book,
+bring them back forcibly, if need be. Your first task is to keep your
+eyes there, instead of letting them follow your roommate's movements, or
+resting them by watching the street below. But it is easier to do this
+than to make your mind grasp the meaning of the things you see. You may
+read two or three pages, and not receive one idea, not even be able to
+recall any words from the context. Your eyes are obeying your will and
+seeing the words, but your mind is "wool-gathering." Now take yourself
+in hand firmly. If you are really a bit fagged, try some deep-breathing
+exercises before the open window, bathe your face in cold water. Then
+read a paragraph, close your book, and write, if you are not alone, or
+repeat to yourself aloud, if your roommate is out, what that paragraph
+says--its meaning. If you cannot do it, read it again with that end in
+view. Repeat the process, and hold yourself to it day after day, if
+necessary, until finally will has won the battle, or, better still,
+your will to learn has been reinforced by an interest in the very
+competition with yourself, if not yet in the contest. Then, as you learn
+some facts from your notes, use your imagination to apply them in real
+life.
+
+The triceps muscle. What is it for? Your notes inform you, and then it
+is really interesting to see how it performs its function. What origins
+and attachments must the triceps have to make it extend the arm? Your
+notes say that a muscle tends to draw the part to which it is attached
+toward its origin. This triceps muscle straightens the arm. In that case
+it must oppose the flexion at the elbow. How is that likely to be done?
+The triceps must start somewhere above the elbow, and quite far above,
+too, to be able to make a straight angle of an acute one; it must start
+toward the back in order to draw back the forearm; and be attached to
+the back of the bone below. Also it must be quite a long muscle. So much
+reason tells you. Now let me see how it is done, in fact. And you find
+that the triceps has three origins high above its one attachment as a
+tendon, to give it a good strong pull. These are in the outside of the
+humerus and in the scapula. That is logical, and you will remember it.
+
+Now how does the arm bend? What pulls against the triceps? And you are
+interested before you know it.
+
+There is nothing, good, bad, or indifferent, but has some points of
+interest if the mind turns its entire attention to it. But our tendency
+is to grow tired of calling back our wandering thoughts again and again
+to the thing that is hard, dry, or stupid. And we need more incentive
+than just the doing of the duty because it is to be done. We need a
+compelling interest in the goal to encourage our wills to concentration
+on the less interesting. Let us first think out the _why_ of knowing
+anatomy if we are to be nurses. And if the profession of nursing is the
+goal, let anatomy become just the next stretch of the road that leads to
+it.
+
+Concentration can be acquired. It may require three hours at first to
+learn your lesson; but later on you will do it in two, then in one, and
+perhaps in less. And when you can sit down with your notes and learn
+them with voices about you--perhaps; with some one else in the room;
+with a party an hour ahead; when you can disregard all but the work at
+hand, then you can concentrate, and the big battle of your life as a
+student is won. Study is no longer drudgery. Lessons occupy much less of
+your time and leave you more free hours. Because you give them your
+whole mind you learn them in a fraction of the hours hitherto wasted
+upon them, when you studied with divided attention. When you are doing
+clear thinking on the thing at hand, satisfactory results are assured.
+
+
+SELF-TRAINING IN MEMORY
+
+Hand in hand with clear thinking goes reliable memory. But so many of us
+have it not, and feel its need so strongly that we shall consider for a
+moment some means of training it.
+
+William James holds that brain-paths cannot be deepened; that memory is
+not strengthened in that way. There is a natural retentiveness with
+which some of us are born--the men of colossal intellect--and they
+remember and are able to use infinitely more things acquired in the
+past, because they have a brain substance of greater tenacity in holding
+impressions than others possess. James compares some brains to wax in
+which the mark left by the seal is permanent; and others he compares to
+jelly which vibrates at every touch, but retains no dent made in it.
+From our study of the subconscious we know that the dent did leave an
+impression on the brain; but it was in the subconscious. So we beg to
+change the figure and liken, in all mankind, that part of the brain that
+handles the subconscious to wax, while granting that in some rare cases
+parts handling the conscious material also hold impressions, as does the
+wax.
+
+Consequently, according to this theory, we do not strengthen our
+memories by repetition of facts, lines, or phrases. We cannot grave any
+deeper the memory paths which nature has provided at birth. But the
+attention to the thing to be remembered, which repetition has required,
+has made a larger number of connections of the words with each other, of
+thought with thought, and of the new with the old. So we have tied the
+new together with the old by that many more strings, as it were; and any
+bit of the new tugs at other bits; and the old to which it is tied
+brings the new with it when it comes to the fore. In other words,
+careful attention, at the time, to the new stimulus, and its association
+with the already known, together with repetition, will form a whole
+system of relations in the mind, and the newly entered material soon
+become so well-known that it will be difficult to disregard it.
+
+When, in spite of determined effort to remember, the thing is forgotten,
+especially in the nurse's case, it is usually because the emotional
+reaction to weariness or to some like obstacle has interfered with
+proper attention. James advises us if we would improve memory, to
+improve our thinking processes; to pay more and keener attention, so
+that we will link things closely together. This in itself will help to
+arouse interest in the thing to be remembered; and keen interest alone,
+or careful attention at the time of introduction of the new, and
+repetition of the thing to be retained, with a will which holds the
+attention fast, will assure a good, workable memory in any normal mind.
+
+Suppose that when you first enter the ward you are wishing with all your
+heart you had never decided to become a probationer. Perhaps the white
+screen and its possible meaning has so frightened you that your thoughts
+refuse to go beyond it. Suppose the very sight of so much sickness has
+agitated you instead of strengthening your determination to help nurse
+it. That is, suppose your emotions, your feelings, so fill your mind
+that perception is necessarily inaccurate and blurred. Then tomorrow
+your account of the ward will be hazy, and your desire will probably be
+against returning to a place where so many unpleasant feelings were
+aroused.
+
+The emotional balance which refuses to allow feelings to obscure
+judgment by leading reason astray is a necessary safeguard for the work
+of the nurse. There is little place in the profession for the woman who
+is "all sentiment," but perhaps there is less for the one without
+sentiment.
+
+Feeling, we found, is the first expression of mind--feeling which in the
+early months is entirely selfish. The happiest baby you know is not
+sweet and winning to please you, but because he feels comfortable and
+happy and cannot keep from expressing it. His universe is his own little
+self and you exist only in your relation to him. If you give him
+pleasure he likes you; if pain, he does not want you. His mother often
+fails to please him, but satisfies him so much more frequently than
+anybody else that he loves her best. Then comes nurse or father--if he
+proves the satisfactory kind of father, or she a nurse he can love. To
+the baby whatever he happens to want is good. What is not desirable is
+bad. And such emotional responses are altogether normal in early months,
+yes, even until the child is old enough to use reason to choose between
+two desires the one that will in the end prove more satisfying. But they
+are defects in adult life.
+
+The nurse who would always act as her first feeling dictates would not
+be in training many days. Unpleasant sights and sounds, the fear of
+making a mistake which might harm a patient, the undesirability of long
+hours of hard work in caring for patients who frequently only find fault
+with her best efforts, would early decide her in favor of another
+life-work. Comparatively few so-called "grown-ups" are guided only by
+feeling; and most of those are in institutions that are well
+safeguarded. But a great many mature men and women allow feeling to
+unduly influence their thinking. The sentimental nurse, for instance,
+may find it very difficult to give an ordered hypodermic. The patient
+dreads the pain and the nurse fears hurting her. Suppose she were to
+fail to give it on such grounds. This is an almost unthinkable case. But
+the very nurse who agrees that such an emotional weakling should not be
+allowed to train, will help her patient, even when recuperating nicely,
+to grow inexcusably self-centered, by sympathizing with every complaint,
+warning her at every turn, by allowing her and even encouraging her,
+perhaps, to discuss her illness and suffering in the minutest detail.
+This nurse is more damaging than the sentimentalist who fails to give
+the hypodermic; for that slip is easily discovered, and the transgressor
+must immediately reform and obey orders, or be dismissed. But the second
+nurse may take perfect care of the sick body, and the doctor never
+realize that she is developing the sickness idea in her patient's mind.
+
+In both of these instances reason has followed the leadings of feeling.
+It is unpleasant to hurt the patient, and she is disagreeable, too, when
+you insist on carrying out the orders. It is easier to agree with her
+ideas and sympathize with her troubles, much easier than to find some
+other avenue for her thinking, or to search for feeling substitutes. It
+is pleasanter right now to allow her mind to slip unmolested into sick
+reactions than to lead her, unwilling as she is, into the ways of
+health. Reason follows feeling's logic, which suggests that it is much
+better for the patient to talk of her ills than to keep them pent up
+inside; and judgment is sadly obscured.
+
+The emotionally balanced nurse hears the story once, that she may have
+the material for helping the need. Feeling, perhaps deep and genuine
+sympathy with a real trouble, is aroused, and rightly. But this brings a
+keen desire to help the situation. Reason insists that talking of
+sufferings, real or fancied, only makes them more insistently felt; that
+there must be some better way to meet them. It suggests various methods
+to divert the patient's attention, to change the train of thought until
+she is able herself to direct it into healthful channels; judgment
+weighs the propositions and decides upon the one which will lead toward
+establishing a health attitude.
+
+The nurse is continually meeting the necessity of acting contrary to
+fear and discouragement and weariness of spirit. How can she secure
+emotional equilibrium for herself?
+
+Keep in mind the fact that most sick people are very suggestible; that
+you have a definite responsibility to make your suggestions to your
+patient wholesome; and that your mood is a constant suggestion to him.
+Remember that he needs your best. Then, if your own trouble seems too
+great to bear, determine that, so long as you remain on duty, you will
+not let it show. Try an experiment. See if you can go through the day
+carrying your load of sorrow, or disappointment or chagrin, with so
+serene a face that the sick for whom you are caring will not suspect
+that you have a burden at all. That is a triumph worth the striving.
+Then--if you can let it make you a little more comprehending of others'
+pain, a little more gentle with the sickest ones, a bit more patient
+with the trying ones, more kindly firm with the unco-operative,
+realizing that each one of them all has his burden too--you have not
+choked feeling, but you have fulfilled reason's counsel: that sick
+people are not the ones to help you in your stress; that a good nurse
+should rise above personal trouble to the duty at hand. Your judgment
+has compared your reasons, and decided that you should act before your
+patients as you would if all were well. And _will_ holds you to
+emotional equilibrium. Such a thing can be done in a very large measure;
+and no better opportunity for emotional control will ever be offered
+than the necessity of being calm and serene before your patients, no
+matter how you feel.
+
+But, while reason and judgment teach us to control the expression of
+certain feelings, they urge that this control be exercised in
+transforming those feelings into helpful ones and giving them an
+adequate outlet. Such a substitution has been suggested above. Let us
+not forget that nothing in existence is of personal value until it gives
+some one an emotion; that feeling is the beauty of life; that living,
+without the happy, wholesome affective glow, would not be worth the
+effort; that beauty and strength and sweetness of feeling make for a
+worthy self. Remember, too, that feeling is the curse of life. It is
+feeling that would make us give up the whole struggle; and ugliness and
+weakness and bitterness of feeling make for a despicable self.
+
+Hope lies for us all in the realization that we can choose our feelings,
+our responses. We can be utterly discouraged, and bitter and depressed
+at failure; or we can recognize it as a sign-board telling us that the
+other way than the one we just followed leads to the goal. And we can
+follow its pointing finger with faith in a new attempt because, now, we
+know at least how _not_ to go. We can learn despair from all the bitter
+and the hateful and the mean; or we can learn that they never could be
+called so if there were not the sweet, the lovable, and the generous
+with which to compare them. You can learn to search as with a microscope
+for all the undesirable traits of your patients, or you can calmly
+accept all that assert themselves as undeniable facts, but use your
+microscope to find their desirable characteristics which offer
+possibilities of being brought to the foreground.
+
+You cannot constructively help yourself or your patient by denying the
+existence of the less worthy traits; but you can resolve to call out the
+something better. And if you do not find it, as may rarely be the case,
+you can refuse to let it make you skeptical of finding it in others. Let
+us remember always that, "It is not things or conditions or people that
+harm us; it is only the way we respond to them that can hurt." This one
+great truth, if really believed and made a part of all our thinking,
+would save scores of people from nervous wreckage. It is a favorite
+saying of a wise man who has helped a great many people to endure and
+take new courage when life seemed too hard to meet.
+
+That big, broken-arm case on the ward cursed you yesterday because you
+would not loosen his splints. And you rushed from the room angry and
+humiliated, wishing you could quit nursing forever, and asked to be
+moved because you had been insulted. But that man cannot harm you. He
+has never known a real lady in his life before. His training from
+childhood has been to regard women as chattels to do man's bidding; his
+experience in life is that they usually do what he asks--women of his
+kind. Moreover, he has never had a serious pain before, and it is not to
+be endured.
+
+Of course, the man must be dealt with and made to realize the
+distinction between his new surroundings and the old. Probably the
+intern or the doctor is the one to do it. Also he must be brought to
+apologize, or leave the hospital, perhaps. But he did not hurt you. Your
+own reaction did that. For outside things or people cannot damage what
+we are in ourselves. The way we respond to them does the harm. When you
+can control your expression of anger and humiliation, and substitute
+for your intense feeling a desire that such a patient may learn that
+pain is often the gateway to healing; that some respect for women may be
+kindled in him, so that eventually such an outburst in the ward may be
+impossible for him or for anyone who heard it; then you are choosing
+between emotions the one of helpfulness, for the one of justified
+indignation; and feeling has followed reason, rather than leading reason
+astray. The judgment which decides you to try methods which will shame
+or inspire some manliness into the patient was one influenced by a
+well-balanced emotional life.
+
+If we would really acquire emotional poise, there are a few practical,
+proved methods we might adopt for ourselves.
+
+When we can hold back the expression of the almost overpowering impulse
+or passion of anger and resentment and hurt; absolutely shut tight our
+lips until we can think; then wait until we can think without the strain
+of intense feeling, we will not only keep ourselves out of trouble, but
+will be able to calmly state our position, right the wrong done us if
+wrong there was, or recognize that we ourselves were wrong. For we
+seldom analyze the situation properly under the influence of strong
+feeling. If we want to accomplish anything with our words, let us wait
+until we can speak them without having to choke down our sobs or cram
+back our hot anger, or forcibly restrain ourselves from tearing things
+or slamming doors. After all that "wild fire" of emotion is gone,
+judgment will lead us to wisely reasoned action.
+
+
+SELF-CORRECTION
+
+Accuracy in work, a primary essential to the nurse, can become automatic
+if she will demand of herself accuracy of perception, and concentrate on
+learning and doing until details almost take care of themselves; if she
+will correct her own work by the standards taught her, and recognize
+just why and wherein she falls short. Not that she can always do things
+with the nicety in which they were taught. She cannot give eighteen ward
+patients in eight hours the same detailed care her private patients
+would receive if she had only two of them for the same length of time.
+In such a case she must often sacrifice refinements of detail in
+service; but there is no excuse for sacrificing accuracy in the
+necessary treatments of her charges. The nurse merely chooses between
+the multitude of things which can be done for her ward, the important
+ones which must be done. Because she is rushed is no excuse for giving a
+poor hypodermic injection or a careless bed-bath. Accuracy in doing the
+essential things should be so automatic that it takes not a whit more
+time than inaccurate doing; and such accuracy is chiefly dependent on
+constant self-correction when the task is still new, and on never
+letting up in practice until the details of the doing become practically
+automatic.
+
+
+TRAINING THE WILL
+
+There is no better opportunity for will-training than the hospital
+affords the nurse. The constant necessity of acting against desire, of
+doing tasks which in themselves cannot be agreeable, calls for a
+developed will, while it gives it constant exercise. Moods of
+discouragement and depression cannot be indulged. The nurse must do her
+work no matter how tired or blue or "frazzled" she feels, if she is not
+too sick to be on duty; for all time lost, she knows, is to be made up
+to the hospital before training is completed.
+
+Can this _will to do_, despite strong desire to the contrary, this mood
+control and the ability to disregard physical discomfort, be acquired;
+and if so, how?
+
+It is a law of the mind and of the body that any task becomes easier by
+repetition. We found that automatic habit eases much of the strain of
+action. What seemed repulsive service to the probationer on her first
+day in the hospital, she forced herself to do because she wanted to be a
+nurse. She may go on through her three years unreconciled to these
+particular duties, yet holding herself to them because she likes other
+features of her work, or because she must earn her living and this seems
+the best avenue open to her, or because her will to become a nurse is
+strong enough to make her act continually against desire. And finally,
+for almost every nurse, the interest in the end to be attained
+overshadows the unpleasant incidents in its way. The tasks are actually
+easier by their constant repetition, and her feeling of repugnance
+becomes only a mild dislike. She has strengthened her will by continuing
+to act against desire. But there is a better way to the same goal.
+
+The woman who has thought out the reasons for and against taking
+training; who has considered it carefully as a profession, and has
+chosen to put up with any obstacles in the way of becoming a graduate
+nurse, can find a happy adjustment to the disagreeable incidents it
+involves. Realizing that the paths of learning are seldom thoroughly
+smooth, she can resolve to use their very roughness for firmer
+footholds, as a means to self-control, as a fitting for the sterner
+hardships of self-support, of nursing the dangerously ill, alone, of
+meeting suffering and death in her patients with quiet courage and
+faith. In other words, she can meet the thousand and one personal
+services which in themselves might be disagreeable and prove pure
+drudgery, not merely with the stern will to do them because they are a
+necessary part of obtaining a desired end, but also for the sake of
+adding to the comfort and well-being of each patient in her care. The
+emotion of interest and kindly desire will ease the strain which will
+undergoes in demanding that she not shirk the disagreeable. For there is
+little stress in doing what we wish to do.
+
+It is psychologically possible to find genuine pleasure in the meanest
+tasks if the doing is backed up by a strong desire to make life count as
+much for others as possible. The nurse who comes to realize the waste
+involved in carrying out against desire what _reason_ proposes and
+volition dictates, will try to secure the co-operation of desire, and
+save will-force for more worthy accomplishment.
+
+A constant opportunity for will-strengthening comes to many a nurse
+during the early weeks and months of training in the necessity of going
+on despite the sheer tiredness, the weary backs and swollen, tender,
+aching feet. The one who means to "see it through" disregards them as
+far as possible on duty, gets all the out-of-doors her time permits,
+takes special exercises to strengthen weak spots, and relaxes her body
+while she reads or studies or visits in her off-duty time. In the end,
+not only does her body adjust itself to the new work, but her will has
+become a better ally for the next demands upon it; her endurance is
+remarkably increased.
+
+When she can accept hardship, drudgery, weariness of mind and body and
+perhaps of soul, the nagging of unco-operative patients, and the demands
+on her sympathies of the suffering; when she can meet these as
+challenges to develop a strong will--a will not only to endure, but to
+find happiness and give service through it all--then the nurse has
+learned the art of making every circumstance a stepping-stone to mastery
+and achievement.
+
+
+
+
+CHAPTER XIV
+
+THE NURSE OF THE FUTURE
+
+
+The student of life and of the sciences which deal with the origin and
+development of the human race, and with the relations of man to man and
+nation to nation--such sciences as biology and anthropology, sociology
+and ethics and history--comes to the conclusion that life exists for the
+development of mind. And mind is not merely intellect, but the only
+gateway we know to character, to soul. The deepest students of human
+science see no reason for life except as it "evolves" a perfect
+mind--man's goal, his ideal. And this visioned perfect mind is one
+which adjusts itself without friction to the body, making it fulfil the
+laws of health that it may help and not hinder mind's progress; one
+which adjusts itself to people and things, co-operating with other minds
+to develop manners and customs and laws of the most satisfactory
+community living; one which forces things to be servants of its will;
+one which makes harmony of life by fulfilling the laws of the soul as
+well as of the intellect and of the body.
+
+If we believe that life exists for the development of mind into a force
+of intellect and character and soul, then we need not ask why a nurse
+should know something of the laws of mind. She does not ask why she
+should know anatomy or pathology. Her work is dependent upon such
+knowledge. But if the center of life, the thing which makes the body a
+living, moving, acting agent instead of a clod, is mind; if the one
+thing which makes a difference between animal life and mineral and
+vegetable life is consciousness, _i. e._, mind; and if everything that
+affects that body, its organ, affects mind also--then surely no nurse
+can afford to learn only the rules of repair or of keeping in order the
+instrument of consciousness, without knowing what effect her efforts
+have on the mind itself. It is as though an ignorant maid accepted a
+piano as merely a piece of furniture to be kept clean and shining, and
+in her zeal to that end scrubbed the keyboard with soap and water which,
+dripping down into the body of the instrument, swells and damages its
+felts, rusts and corrodes its keys, and ruins its notes. When she knows
+that she may thus make impossible the beautiful sounds she has heard it
+give, and that the more carefully the keyboard is handled the more sure
+is the beauty resulting, her care is to keep it as free as possible of
+dust, to see that the top is down and the keyboard covered when she
+sweeps--and to clean it hereafter in such a way as to never injure its
+tone.
+
+The nurse has a much greater function than merely to help in saving the
+body and keeping its machinery in order. If the aim of life is the
+strengthening and perfecting of the mind--that "urge" of life, then
+surely the nurse's big aim will be to help establish such health of body
+as leads toward health of mind. In the average man or woman this vital
+urge becomes temporarily blocked by the very weakness of the body it
+urges. The body _must_ give the life-flame some fuel, or it dies out;
+but with very little fuel it flickers on, waiting, hoping for the more
+that it may burn strongly again. In the cases the nurse handles very
+often the "vital spark" has been poorly fed by the disabled body, and so
+discouragement or depression, or "loss of grip" results, or the flame
+continues to shine brightly with whatever little sustenance it receives,
+and so encourages the body to greater effort for it; or sinks into
+embers, glowing steadily though dully; or it burns wildly,
+recklessly--it becomes what we call "wild fire," that has no direction
+and no purpose save to burn up everything it can find.
+
+In other words, the nurse deals with those in whom the "urge" is
+weakened--the depressed and discouraged; with those whose spirits never
+flag in their steady shining--those brave souls we could almost worship;
+and those others who hold grimly on with quiet grit and courage, but
+with no cheer; and with the unstable ones of neuropathic or psychopathic
+tendency who become hysteric or maniacal.
+
+What will the nurse do for them all? Will not an understanding of how to
+recall the ambition to live, the will to get well, and the grit to see
+the thing through, be an incalculable asset.
+
+
+THE NURSE OF THE FUTURE
+
+The nurse of the future will not be merely a handmaiden to care for the
+sick body by deftly carrying out the doctor's orders. She will do this
+almost automatically as a matter of course, and skilfully; but it will
+be the merest beginning of her mission. That mission itself will be to
+eliminate the causes of disease; to teach the ways of health, to
+supervise the sanitary conditions of city, town, and country. Practical
+ways and the wise means to this end will be taught in her hospital,
+which will become a community center with clinics, teaching through its
+doctors and nurses the way to health, instead of merely treating and
+advising the cases as they come. But the greatest contribution of the
+nurse of the future will be a wide-spread _desire for health_ and _will
+to health_, rather than a desire and will to avoid discomfort and pain
+and danger of death. This _will to health_ will doom in the sane mind
+the disease-accepting attitude. It will do all that common sense and
+applied medical science can do to strengthen the body; then it will take
+what life brings in the way of unavoidable disease and weakness and
+inability, with an uncringing mind. It will hold the mind's attitude to
+serenity and poise and accomplishment within the necessary limits of its
+disordered body. It will be master of its dwelling and make the most of
+the little the body can give, and force all bearable weakness and pain
+to be stepping-stones to endurance and will-strength and cheer. It will
+not accept physical limitations as final things. If life must be lived
+in a prison-house it will be its own jailer, and fill the rooms with
+flowers, music, friends, and happiness.
+
+No nurse is competent to help her patient to overcome any curable
+physical weakness, and keep the mind serene in the face of the
+incurable, until she herself has learned that the will to health is
+capable of transforming disease of body, from disaster, into health of
+mind and soul.
+
+The nurse of the future will know the laws of mind as she knows the
+course of disease; she will be dedicated to such wise care of existing
+disease as will lead to prevention of future disease; and she will be a
+sworn, trained ally of the health-accepting mind.
+
+It is, in effect, a condensation of the four volumes of the larger
+_History of Nursing_, prepared by Miss Dock in collaboration with
+Miss Nutting, a work which has been considered standard on the subject,
+but which, by its very nature, was too elaborate for class use. This
+condition has now been overcome by condensation into this single,
+comprehensive, inexpensive volume of all the salient facts of the larger
+work.
+
+It is generally believed that the best place in the nursing curriculum
+for the History of Nursing is in the early part of the first year, when
+the student is just beginning to form her conception of nursing, and is
+being initiated into its traditions.
+
+will inevitably bring it into use in a very great number of Hospital
+Training Schools; it should, of course, be in the library of every
+Hospital which does not maintain a Training School. It is believed that
+it will be found to be