meiou 0.1.8 → 0.1.9

data/_books/Applied_Psychology_for_Nurses.txt

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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