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Title: Applied Psychology for Nurses
Author: Porter, Mary F.
Language: English
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Copyright Status: Not copyrighted in the United States. If you live elsewhere check the laws of your country before downloading this ebook. See comments about copyright issues at end of book.

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       *       *       *       *       *



      +----------------------------------------------------------+
      |                                                          |
      |                    Applied Psychology                    |
      |                                                          |
      |                        for Nurses                        |
      |                                                          |
      |                                                          |
      |                            By                            |
      |                                                          |
      |                  Mary F. Porter, A. B.                   |
      |                                                          |
      |     _Graduate Nurse; Teacher of Applied Psychology,      |
      |           Highland Hospital, Asheville, N. C._           |
      |                                                          |
      |                                                          |
      |                                                          |
      |                                                          |
      |                                                          |
      |                 Philadelphia and London                  |
      |                  W. B. Saunders Company                  |
      |                           1921                           |
      |                                                          |
      |                                                          |
      +----------------------------------------------------------+


               Copyright, 1921, by W. B. Saunders Company



                           PRINTED IN AMERICA
                                PRESS OF
                         W. B. SAUNDERS COMPANY
                              PHILADELPHIA



                            TO THE MEMORY OF
                               MY FATHER



FOREWORD


This little book is the outgrowth of a conviction, strengthened by some
years of experience with hundreds of supposedly normal young people in
schools and colleges, confirmed by my years of training in a
neurological hospital and months of work in a big city general hospital,
that it is of little value to help some people back to physical health
if they are to carry with them through a prolonged life the miseries of
a sick attitude. As nurses I believe it is our privilege and our duty to
work for health of body and health of mind as inseparable. Experience
has proved that too often the physically ill patient (hitherto nervously
well) returns from hospital care addicted to the illness-accepting
attitude for which the nurse must be held responsible.

I conceive of it as possible that every well trained nurse in our
country shall consider it an essential to her professional success to
leave her patient imbued with the will to health and better equipped to
attain it because the sick attitude has been averted, or if already
present, has been treated as really and intelligently as the sick body.
To this end I have dealt with the simple principles of psychology only
as the nurse can immediately apply them.

The writer wishes to acknowledge her indebtedness for criticism of this
work and for several definitions better than her own, in the chapters
_The Normal Mind_ and _Variations From Normal Mental Processes_, to
Dr. Robert S. Carroll, who through the years of hospital training helped
her to translate her collegiate psychology from fascinating abstract
principles into the sustaining bread of daily life.

                                                         MARY F. PORTER.

  ASHEVILLE, N. C.,
    _August, 1921_.



CONTENTS


                                                            PAGE
  CHAPTER I

  WHAT IS PSYCHOLOGY?                                         11


  CHAPTER II

  CONSCIOUSNESS                                               20
    The Unconscious                                           23
    Consciousness is Complex                                  29
    Consciousness in Sleep                                    31
    Consciousness in Delirium                                 32


  CHAPTER III

  ORGANS OF CONSCIOUSNESS                                     34
    The Central and Peripheral Nervous Systems in Action      35
    The Sympathetic Nervous System                            37


  CHAPTER IV

  RELATION OF MIND AND BODY                                   40
    The Cerebrum or Forebrain                                 43


  CHAPTER V

  THE NORMAL MIND                                             47


  CHAPTER VI

  THE NORMAL MIND (Continued)                                 59
    Instinct                                                  59
    Memory                                                    62
    The Place of Emotion                                      67
    The Beginning of Reason                                   69
    Development of Reason and Will                            71
    Judgment                                                  72
    Reaction Proportioned to Stimuli                          75
    Normal Emotional Reactions                                77
    The Normal Mind                                           77


  CHAPTER VII

  PSYCHOLOGY AND HEALTH                                       79
    Necessity of Adaptability                                 80
    The Power of Suggestion                                   84
    One Thought Can Be Replaced by Another                    89
    Habit is a Conserver of Effort                            90
    The Saving Power of Will                                  93


  CHAPTER VIII

  VARIATIONS FROM NORMAL MENTAL PROCESSES                     95
    Disorders and Perversions                                 95


  CHAPTER IX

  VARIATIONS FROM NORMAL MENTAL PROCESSES (Continued)        101
    Factors Causing Variations from Normal Mental Processes  108
      Heredity                                               108
      Environment                                            109
      Personal Reactions                                     110


  CHAPTER X

  ATTENTION THE ROOT OF DISEASE OR HEALTH ATTITUDE           112
    The Attention of Interest                                112
    The Attention of Reason and Will                         118


  CHAPTER XI

  GETTING THE PATIENT'S POINT OF VIEW                        124
    What Determines the Point of View                        124
    Getting the Other Man's Point of View                    126
    The Deluded Patient                                      133
    Nursing the Deluded Patient                              135
    The Obsessed Patient                                     136
    The Mind a Prey to False Associations                    137


  CHAPTER XII

  THE PSYCHOLOGY OF THE NURSE                                139
    Accuracy of Perception                                   141
    Training Perception                                      142
    Association of Ideas                                     143
    Concentration                                            146
    Self-training in Memory                                  150


  CHAPTER XIII

  THE PSYCHOLOGY OF THE NURSE (Continued)                    152
    Emotional Equilibrium                                    152
    Self-correction                                          160
    Training the Will                                        161


  CHAPTER XIV

  THE NURSE OF THE FUTURE                                    164

         *       *       *       *       *

  INDEX                                                      169



Applied Psychology for Nurses



CHAPTER I

WHAT IS PSYCHOLOGY?


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:

        / Emotion        { Pleasure                                \
        {                { Pain                                    }
        {                                   / Eye                  }
        {                                   { Ear                  }
        {                / Sensation        / Nose                 }
        {                {   (impression   <  Mouth                }
        {                {   on mind from   \ Skin                 }
        {                {   some organs)   { Muscles              }
        {                {                  { Viscera              }
        {                {                  \ General sensation    }
        {                {                                         }
        {                {  Perception            }                }
        {                {    (recognition of      > of object     }
        /                {    cause of sensation) }  of quality    \
 Mind <   Intellect, or  /                                           > Mind
        \   the Stream <              { Self                       /
        {   of Thought   \            { Organic                    }
        {                {  Memory   <  Inorganic                  }
        {                {            { Percept                    }
        {                {            { Concept                    }
        {                {                                         }
        {                {            { Abstract                   }
        {                {  Ideation <  Concrete                   }
        {                {            { Imaginative { Fanciful     }
        {                {                          { Constructive }
        {                {  Reason                                 }
        {                \  Judgment                               }
        \ Will                                                     /

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.

                        { hot.
  Examples: Feeling of  { cold.
                        { pain.

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.

           { fluid--water.
  Example: { cold--snow.
           { pain--cut.

_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.

  Example: { object, as water.
           { quality, as fluid.

_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:

  Fear         Ownership              Shyness
  Love         Constructiveness       Secretiveness
  Curiosity    Love of approbation    The ambitious impulses:
                                            Imitation,
                                            Emulation,
                                            Pride,
                                            Ambition,
                                            Pugnacity

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.


Disorders of the _Functions_ of _Intellect_.

                / Hyperesthesia (exaggeration of sensation)
                {   as found in neurasthenia, or in mania.
                { Anesthesia (absence of sensation)
                {   as in the numbness of hysteria; in sensory
                {   paralysis.
  Disorders     / Retardation
     of       <     as in dementia and melancholia.
  Sensation     \ "Clouding" or dulness
                {   as in simple depression.
                { Perversion
                {   as in dementia and melancholia. Sweet may taste
                \   sour; fresh food may smell decayed.


                / Hyperesthesia (exaggeration)
                {   as in neurasthenia or mania.
                { Anesthesia
  Disorders     {   as in hysteria or paralysis.
     of         { Retardation
  Perception    {   as in dementia and melancholia.
                / "Clouding" or dulness
  (being      <     as in simple depression.
  dependent     \ Illusion
  on sensation  {   found in normal mind--easily corrected;
  is always     {   found in many insanities.
  disturbed     { Hallucinations
  with it).     {   frequently met in the infection-exhaustion psychoses,
                {   in dementia, in paranoia, in acute
                \   hallucinosis of alcoholism.


                / Hypochondriasis
                {   found in many of the hypersuggestible, frequent
                {   in the mild depressions and in all victims of
                {   self-attention.
                { Retardation
                {   found in most depressions.
                { Deficiency
                {   as in idiocy--the inability to form new concepts.
                { Acceleration
                {   as in hypo-mania.
                { Poverty
                {   as in the abnormally self-centered;
                {   as in melancholia.
                { Rambling ideas
                {   as in chronic insanity.
                { Flight of ideas
                {   as in manias, hysterias, and acute deliriums.
  Disorders     / Fixed ideas
     of       <   as in paranoia.
  Ideation      \ Perversions (concepts change their meaning altogether)
                {   as in dementia.
                { Ideogenous pains
                {   as in hysteria.
                { Compulsive ideas
                {   common in borderland states;
                {   in psychasthenia, or hysteria.
                { Disorientation
                {                  { thing,
                {   (wrong idea of { place, or
                {                  { person);
                {   found in confused conditions;
                {   in delirium from infections;
                {   in insanities.
                { Confusion
                {   as in the infection-exhaustion psychoses;
                \   in insanities.


                / Absent-mindedness.
                { Amnesia (morbid forgetfulness).
                {         { temporary,
  Disorders     / Aphasia { prolonged,
     of       <           {permanent (see later explanation).
   Memory       \ Perversion
                {   as fabrications, due to memory-confusion or
                {   inaccuracy; also due to excessive ideation and
                \   defective judgment.


                /                  / Somatic
                {                  {   as in hypochondriasis.
                {                  { Persecutory
                {                  {   as in paranoia.
                {                  { Unworthiness
                {                  {   as in simple depression or
                {                  {   melancholia.
                { Delusions        { Grandeur
                {   Systematized   /   as in mania or paranoia.
  Disorders     /   Transient    <   Nihilistic
     of       <     Fixed          \   often found in melancholia.
   Reason       \                  { Reference
                {                  {   as in paranoia.
                {                  { Altered personality
                {                  {   as in hysteria.
                {                  { Perverted personality
                {                  {   (patient may believe he is a dog);
                {                  \   as in dementia.
                { Emotional thinking.
                { Shut-in personality
                {   as seen in the deficient social capacity of potential
                \   dementia præcox.


                / Defective judgment
                {   in all insanities;
                {   in hysteria.
                {    _Ex._: Patient who accepts mental suggestion
                {    of disability as reality.
                { Perverted judgment
  Disorders     /   in severe dementias--as influenced by unreasonable
     of       <     fear, hatred, etc.;
  Judgment      \   in all acute insanities--as manifested in inability
                {   of patient to rid himself of his delusions.
                { Absence of judgment
                {   in all acute insanities;
                {   in later dementias.
                { Limitations
                \   in many so-called normal and in all the abnormal.


                / Suggestibility
                {   in hysteria.
                { Excitement
                {   in mania.
                { Depression
                {   in melancholia.
  Disorders     / Phobias
     of       <     as found in psychasthenia.
  Emotion       \ Deficiency
                {   as in the apathy of depression.
                { Perversion
                {   in mania, in depression, in catatonia.
                { Deterioration
                {   in dementia.
                { Sense of unreality
                \   found in all borderland cases.


                / Wilfulness
                {   in many "normal." Very common in hypomania.
                { Willessness (aboulia or paralysis of will)
                {   often found in psychasthenia; and in depressive
                {   states.
                { Morbid inhibition
                {   as in depressive states.
                { Indecision
                {   as in psychasthenia;
                {   as in simple depression.
                { Obsessions
                {   found pre-eminently in psychasthenia.
                { Tics
  Disorders     /   in many borderland cases;
     of       <     in the hypersensitive as often the only expression
    Will        \   of any neuropathic tendency.
                { Distractibility
                {   as in hypomania and frequently in hysteria.
                { Negativism
                {   as in catatonia.
                { Mutism
                {   as in catatonia.
                { Compulsive acts
                {   as in psychasthenia, hysteria, etc.
                { Psychomotor overactivity (volition unable to check)
                {   as in mania.
                { Psychomotor retardation (volition unable to energize)
                \   as in depression.


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,
  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.

  Examples: The crooked stick as a snake.
            A ghost created from shadow.
            An ordinary ringing in the ears as sleigh-bells.
            Milk tasting like blood.

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

GETTING THE PATIENT'S POINT OF VIEW


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:

  unreasonable     stubborn      lazy               deluded
  cranky           resistive     unco-operative     will-less
  hipped           obsessed      hypocritical       of mean disposition
  excitable        fearful       exacting           dissatisfied
  undecided        wilful        self-centered      morbid
  doubtful         demanding     retarded           abusive
  depressed        spineless     self-satisfied

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.



CHAPTER XIII

THE PSYCHOLOGY OF THE NURSE (Continued)


EMOTIONAL EQUILIBRIUM

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.



INDEX


  Absent-mindedness, 64

  Absolutes, 54

  Abstract concept, 52
    object concepts, 53
    quality concepts, 53

  Accuracy of perception, 141

  Action cannot be separated from feeling, 68

  Acts, compulsive, 106

  Adaptability, 79
    necessity of, 80

  Amnesia, 103

  Anesthesia, 101

  Aphasia, 103

  Apperception, 54

  Association of ideas, 143

  Attention, 79
    of interest, 112
    of reason and will, 118
    root of disease or health attitude, 112

  Autosuggestion, 84

  Awareness, 15


  Bad habits, 91

  Beginning of reason, 69

  Body and mind, relation of, 40

  Borderland disorders, 107

  Brain, 33
    hind, 43


  Censor, 31

  Central and peripheral nervous systems in action, 35

  Cerebellum, 43

  Cerebrum, 43
    functions of, 45

  Clear thinking, steps to, 140

  Compulsive acts, 106
    ideas, 103

  Concentration, 146

  Concepts, 52
    abstract, 52
      object, 53
      quality, 53
    concrete, 52

  Concrete concepts, 52

  Consciousness, 15, 20, 21
    definition, 15
    flow of, 47
    in delirium, 32
    in sleep, 31
    is complex, 29
    organs of, 34
    personal, 57


  Delirium, consciousness in, 32

  Deluded patient, 133
    nursing of, 135

  Delusion, 104
    nihilistic, 104
    of reference, 104
    somatic, 104

  Determination, 18

  Development of reason and will, 71

  Disease attitude, attention, root of, 112

  Disorders, 95
    borderland, 107
    of emotion, 99
    of functions of intellect, 96
    of ideation, 97
    of judgment, 99
    of memory, 98
    of perception, 96
    of reason, 98
    of sensation, 96
    of will, 99

  Disorientation, 103

  Distractibility, 105


  Effort, habit a conserver of, 90

  Emotion, 18, 45, 49
    disorders of, 99
    the place of, 67

  Emotional equilibrium, 152
    reaction, normal, 77

  Environment as cause of variation from normal mental processes, 109

  Equilibrium, emotional, 152


  False associations, mind a prey to, 137

  Feeling, 49
    cannot be separated from action, 68
      from thinking, 67
      from will, 68

  Fixed idea, 103

  Flight of ideas, 102

  Forebrain, 43

  Future, the nurse of the, 164


  Getting other man's point of view, 126
    patient's point of view, 124


  Habit a conserver of effort, 90
    bad, 91
    hospital, 92

  Habit-formation, 79

  Hallucination, 101

  Health and psychology, 79
    attitude, attention, root of, 112

  Heredity as course of variation from normal mental processes, 108

  Hind brain, 43

  Hospital habit, 92

  How to study, 146

  Hurt, 70

  Hyperesthesia, 101

  Hypersuggestability, 84

  Hypochondriasis, 102, 108

  Hysteria, 107


  Idea, compulsive, 103
    fixed, 103

  Ideas, association of, 143
    flight of, 102

  Ideation, 52
    disorders of, 97

  Ideogenous pains, 103

  Illusion, 101

  Imagination, 58

  Impulses, insane, 108

  Inhibition, morbid, 104

  Inorganic memory, 52

  Insane impulses, 108

  Insanity, 107

  Instinct, 59

  Instincts, list of, 61

  Intellect, 18, 45
    functions of, disorders of, 96

  Interest, attention of, 112


  Judgment, 56, 72
    disorders of, 99


  Life, mental, 14
    conditions of, 19
    phenomena of, 15


  Mania, 107

  Melancholia, 107

  Memory, 51, 62
    disorders of, 98
    inorganic, 52
    organic, 51
    self-training in, 150

  Mental disability, states of, 100
    life, 14
      conditions of, 19
      phenomena of, 15
    processes, normal, variations from, 95, 101
      factors causing, 108

  Mind, 14, 33
    a prey to false associations, 137
    and body, relation of, 40
    functions of, 50
    normal, 47, 77

  Mood, 49

  Morbid inhibition, 104

  Motion, 26

  Movement, 26

  Mutism, 106


  Necessity of adaptability, 80

  Negativism, 106

  Nervous systems, central and peripheral, in action, 35
    sympathetic, 37

  Nervousness, 106

  Neurasthenia, 108

  Neuropath, 108

  Neurosis, 106
    from psychosis, 82

  Neurotic, 108

  Nihilistic delusion, 104

  Normal emotional reactions, 77

  Normal mental processes, variations from, 95, 101
      factors causing, 108
    mind, 47, 77

  Nurse of the future, 164
    psychology of, 139

  Nursing deluded patient, 135


  Obsessed patient, 136

  Obsession, 105

  One thought replaced by another, 89

  Organic memory, 51

  Organs of consciousness, 34

  Overactivity, psychomotor, 106


  Pain, 69
    ideogenous, 103

  Patient, deluded, 133
      nursing of, 135
    obsessed, 136

  Patient's point of view, getting, 124
    what determines it, 124

  Percept, 51, 52

  Perception, 51
    accuracy of, 141
    disorders of, 96
    training of, 142

  Peripheral and central nervous systems in action, 35

  Personal consciousness, 57
    reactions as cause of variation from normal mental processes, 110

  Personality, psychopathic, 108
    shut-in, 104

  Perversions, 95, 101

  Phenomena of mental life, 15

  Phobia, 108

  Place of emotion, 67

  Pleasure, 69

  Point of view, getting other man's, 126
    patient's, getting, 124
    what determines it, 124

  Poor memory, 64

  Power of suggestion, 84

  Premise, 72

  Protozoön, consciousness in, 15

  Psychasthenia, 108

  Psychology and health, 79
    definition, 12
    of the nurse, 139

  Psychomotor overactivity, 106
    retardation, 106

  Psychoneurosis, 106

  Psychopathic personality, 108

  Psychosis, 107
    neurosis from, 82

  Pugnacious instinct, 60


  Reactions, normal emotional, 77
    proportioned to stimuli, 75

  Reason, 56
    and will, attention of, 118
      development of, 71
    beginning of, 69
    disorders of, 98

  Reference, delusion of, 104

  Relation of mind and body, 40

  Retardation, psychomotor, 106


  Saving power of will, 93

  Science, 13

  Second-nature, 90

  Self-correction, 160

  Self-training in memory, 150

  Sensation, 51
    disorders of, 96

  Sense of unreality, 104

  Shut-in personality, 104

  Sleep, consciousness in, 31

  Somatic delusion, 104

  Steps to clear thinking, 140

  Stimuli, reaction proportioned to, 75

  Stimulus, definition, 22

  Stream of thought, 50, 57

  Study, how to, 146

  Suggestibility, 79

  Suggestion, power of, 84

  Sympathetic nervous system, 37


  The unconscious, 23

  Thinking, 49, 58
    cannot be separated from feeling, 67
    clear, steps to, 140

  Thought, stream of, 50, 57

  Thought-substitution, 79

  Tic, 105

  Training perception, 142
    the will, 161


  Unconscious, the, 23

  Universals, 53

  Unreality, sense of, 104


  Variations from normal mental processes, 95, 101
    factors causing, 108

  Volition, 45, 50


  What determines patient's point of view, 124
    we attend to determines what we are, 86

  Will, 50, 79
    and reason, attention of, 118
    development of, 71
    cannot be separated from feeling, 68
    disorders of, 100
    saving power of, 93
    training of, 161



                           =A Short History=

                              =of Nursing=

               From the Earliest Times to the Present Day

                                   By
                        =Lavinia L. Dock, R.N.=
               Secretary, International Council of Nurses

                         In Collaboration with
                 =Isabel Maitland Stewart, A.M., R.N.=
         Assistant Professor, Department of Nursing and Health,
            Teachers College, Columbia University, New York

                          _12^o. Price, $3.00_

             =This New Volume Has Been Prepared Especially=
                    =for the Use of Student Nurses=


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.

                 =The Many Excellent Features of this=
                      =_Short History of Nursing_=

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

               =The Best Volume on This Important Subject=

                                                                  (_Over_)



                              =Some of the=

                         =Putnam Nursing Books=


=Maxwell and Pope's Practical Nursing=
  Price $2.50.

=Cadmus' Manual of Obstetrical Nursing=
  Approximate price $1.50.

=Dock's Materia Medica for Nurses=
  Price $2.25.

=Higgins' Psychology of Nursing=
  Price $2.50.

=Pope's Manual of Nursing Procedure=
  Price $2.40.

=Pope's Essentials of Anatomy and Physiology for Nurses=
  600 pages. Price $2.90.

=Pope's Quiz Book for Nurses=
  485 pages. Price $2.50.

=Dock and Nutting's History of Nursing=
  In four volumes. Illustrated volumes 1 and 2, price $7.50. Volumes 3
  and 4, price $7.50.

=Dock and Stewart's Short History of Nursing=
  One volume, 400 pages. Price $3.00.

=Pope's Physics and Chemistry for Nurses=
  450 pages. Price $2.50.

                             Arthur W. Isca
                        Medical and Nurse Books
                             Besse Building
                         Minneapolis, Minnesota



       *       *       *       *       *

Transcriber's Note: Here is a list of corrected errors. Line numbers
count from the start of the book itself not including the Transcriber's
Note. Alternatively, use the HTML version, in which the errors are
marked.

  l780:  ecstacy changed to ecstasy
  l1258: Missing full-stop in i. e.
  l1665: or changed to of
  l1766: pasttime changed to pastime
  l1867: strees changed to stress
  l1883: council changed to counsel
  l1994: , changed to .
  l2324: em-dash changed to hyphen
  l2588: hypochondrasis changed to hypochondriasis
  l2817: successfuly changed to successfully
  l3334: stubborness changed to stubbornness
  l4120: in changed to is
  l4198: weakenss changed to weakness

The inconsistent hyphenation of hypo-mania is as in the original.





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