Transcriber's Note: Italics have been rendered using _underscores_ andbold using =equals signs=. A number of printer's errors have beencorrected, and are listed at the end. * * * * * +----------------------------------------------------------+ | | | 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 someyears of experience with hundreds of supposedly normal young people inschools and colleges, confirmed by my years of training in aneurological hospital and months of work in a big city general hospital, that it is of little value to help some people back to physical healthif they are to carry with them through a prolonged life the miseries ofa sick attitude. As nurses I believe it is our privilege and our duty towork for health of body and health of mind as inseparable. Experiencehas proved that too often the physically ill patient (hitherto nervouslywell) returns from hospital care addicted to the illness-acceptingattitude for which the nurse must be held responsible. I conceive of it as possible that every well trained nurse in ourcountry shall consider it an essential to her professional success toleave her patient imbued with the will to health and better equipped toattain it because the sick attitude has been averted, or if alreadypresent, has been treated as really and intelligently as the sick body. To this end I have dealt with the simple principles of psychology onlyas the nurse can immediately apply them. The writer wishes to acknowledge her indebtedness for criticism of thiswork and for several definitions better than her own, in the chapters_The Normal Mind_ and _Variations From Normal Mental Processes_, toDr.  Robert S. Carroll, who through the years of hospital training helpedher to translate her collegiate psychology from fascinating abstractprinciples 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 developmentof animal life, with the structure of the cells, with the effect ofvarious diseases upon the tissues and fluids of the body; they study thecauses of the reactions of the body cells to disease germs, and searchfor the origin and means of extermination of these enemies to health. They study the laws of physical well-being. They seek for the chemicalprinciples governing the reactions of digestive fluids to the foods theymust transform into heat and energy. So the doctor learns to combatdisease with science, and at the same time to apply scientific laws ofhealth that he may fortify the human body against the invasion ofharmful germs. Thus, eventually, he makes medicine itself lessnecessary. 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 mindover body, and the hopelessness of trying to cure the one withoutconsidering the other. Hence psychology has come into her own as arecognized science of the mind, just as biology, histology, chemistry, pathology, and medicine are recognized sciences governing the body. Asthese are concerned with the "how" and "why" of life, and of the bodyreactions, so psychology is concerned with the "how" and "why" ofconduct and of thinking. For as truly as every infectious disease iscaused by a definite germ, just as truly has every action of man itsadequate explanation, and every thought its definite origin. As we wouldknow the laws of the sciences governing man's physical well-being thatwe might have body health, so we would know the laws of the mind and ofits response to its world in order to attain and hold fast to mindhealth. Experience with patients soon proves to us nurses that the wealand woe of the one vitally affects the other. "Psychology is the science of mental life, both of its phenomena andtheir conditions. " So William James took up the burden of proof some thirty years ago, andassured a doubting world of men and women that there were laws in therealm of mind as certain and dependable as those applying to the worldof matter--men and women who were not at all sure they had any right toget near enough the center of things to see the wheels go round. Buttoday thousands of people are trying to find out something of the waythe mind is conceived, and to understand its workings. And many of ushave in our impatient, hasty investigation, self-analytically taken ourmental machines all to pieces and are trying effortfully to put themtogether again. Some of us have made a pretty bad mess of it, for wetore out the screws and pulled apart the adjustments so hastily andcarelessly that we cannot now find how they fit. And millions of othermachines are working wrong because the engineers do not know how to keepthem in order, put them in repair, or even what levers operate them. Sobooks must be written--books of directions. If you can glibly recite the definition above, know and explain themeaning of "mental life, " describe "its phenomena and their conditions, "illustrating from real life; if you can do this, and prove thatpsychology is a science, _i.  e. _, an organized system of knowledge onthe workings of the mind--not mere speculation or plausible theory--thenyou are a psychologist, and can make your own definitions. Indeed, thetest of the value of a course such as this should be your ability, atits end, to tell clearly, in a few words of your own, what psychologyis. The word _science_ comes from a Latin root, _scir_, the infinitive form, _scire_, meaning to know. So a science is simply the accumulated, testedknowledge, the proved group of facts about a subject, all that is knownof that subject to date. Hence, if psychology is a _science_, it is nolonger a thing of guesses or theories, but is a grouping of confirmedfacts about the mind, facts proved in the psychology laboratory even aschemical facts are demonstrated in the chemical laboratory. Whereinpsychology departs from facts which can be proved by actual experienceor by accurate tests, it becomes metaphysics, and is beyond the realm ofscience; for metaphysics deals with the realities of the supermind, orthe soul, and its relations to life, and death, and God. Physics, chemistry, biology have all in their day been merely speculative. Theywere bodies of theory which might prove true or might not. When they_worked_, by actually being tried out, they became bodies of acceptedfacts, and are today called sciences. In the same way the laws of theworking of the mind have been tested, and a body of assured facts aboutit 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 thefascinations of the yet unknown, and works with promising theory, whichtomorrow may prove to be science also. But we will first find what theyhave verified, and make that the safe foundation for our ownunderstanding of ourselves and others. What do we mean by "mental life"?--or, we might say, the science of thelife of the mind. And what is _mind_? But let us start our quest by asking first what reasons we have forbeing sure mind exists. We find the proof of it in consciousness, although we shall learn later that the activities of the mind may attimes be unconscious. So where consciousness is, we know there is mind;but where consciousness is not, we must find whether it has been, and isonly temporarily withdrawn, before we say "Mind is not here. " And_consciousness_ we might call _awareness_, or our personal recognitionof being--awareness of me, and thee, and it. So we recognize _mind_ byits 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 whichanimal 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 orreject certain environments. But while we see that mind expresses itselfin consciousness as vague, as dubious as that of the protozoön, we findit 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 manalone, but of all creatures. In our study, however, we shall limit ourselves to the psychology of thehuman mind, since that concerns us vitally as nurses. Animal psychology, race psychology, comparative psychology are not within the realm of ourpractical needs in hospital life. We would know the workings of man'smind in disease and health. What are the instinctive responses to fear, as shown by babies and children and primitive races? What are the normalexpressions of joy, of anger, or desire? What external conditions callforth these evidences? What are the acquired responses to the thingswhich originally caused fear, or joy, or anger? How do grown-ups differin their reactions to the same stimuli? Why do they differ? Why does oneman walk firmly, with stern, set face, to meet danger? Why does anotherquake and run? Why does a third man approach it with a swagger, face itwith a confident, reckless smile of defiance? All these are legitimate questions for the psychologist. He willapproach the study of man's mind by finding how his body acts--that is, by watching the phenomena of mental life--under various conditions; thenhe will seek for the "why" of the action. For we can only conclude whatis in the mind of another by interpreting his expression of his thinkingand feeling. We cannot see within his mind. But experience withourselves 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 orirritability, stern control or poise of mind. We realize that theaverage man has learned to conceal his mental reactions from the casualobserver at will. But if we see him at an unguarded moment, we can veryoften get a fair idea of his mental attitude. Through these outwardexpressions we are able to judge to some extent of the phenomena of hismental life. But let us list them from our own minds as they occur to usthis work-a-day moment, then, later on, find what elements go to make upthe present consciousness. As I turn my thoughts inward at this instant I am aware of these mentalimpressions 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 singingin 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 mywork to see. The plan and details of my writing. The face and gestures of my old psychology professor and the assembledclass 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 orwill. There is nothing in this varied consciousness that will not be includedin one or another of these headings. Let us group the contents forourselves. The nurses for whom I am writing: A result of memory and of imagination (both intellect). A sense ofkinship and interest in them (emotion). A determination that they musthave my best (will, volition). And so of the hospitals: My memory of hospitals I have known, and my mental picture of yours madeup from piecing together the memories of various ones, the recollectionof the feelings I had in them, etc. (intellect). What you already know. Speculation (intellect), the speculation based on my knowledge of otherschools (memory which is intellect). A desire (emotion) that all nursesshould 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_, whichorders 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, andprobably 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 thelowest forms of animal life, a diffused nervous system locatedthroughout the protoplasm. ) 2. An external world. 3. A peripheral nervous system connecting the central nervous systemwith the outside world. 4. The sympathetic nervous system, provided to assure automatic workingsof the vital functions of the body. These organs of the mind will bediscussed in a later chapter. CHAPTER II CONSCIOUSNESS We took a glimpse at random into the mental life of an adultconsciousness, and found it very complicated, constantly changing. Wefound it packed with shifting material, which, on the surface, seemed tobear very little relation. We found reason, feeling, and will allinteracting. We found nothing to indicate that a consciousness as simpleas mere _awareness_ might exist. We believe there might be such in thenewborn 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, bareconsciousness in our own experience that give us the proof we need. I have slept deeply all night. It is my usual waking time. Somethingfrom within or from without forces an impression upon my mind, and Istir, 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 apossessing sense of well-being. Obeying some stimulus, not recognized bythe senses as yet, I begin to stretch and yawn, then close my eyes andsettle down into my pillows as for another nap. I am not aware that Iam I, that I am awake, that I have yawned and stretched. I have apleasant, half-dreamy feeling, but could not give it a name. For thosefew seconds this is all my world--a pleasant drowsiness, a beingpossessed by comfort. My consciousness is mere awareness--a pleasantawareness of uncomplicated existence. In another moment or two it is aconsciousness of a day's work or pleasure ahead, the necessity ofrising, dressing, planning the day, the alert reaction of pleasure ordispleasure to what it is to bring, the effort to recall the dreams ofsleep--the complicated consciousness of the mature man or woman. But Istarted the day with a mental condition close to pure sensation, a vaguefeeling of something different than what was just before. Or this bare consciousness may come in the moment of acute shock, whenthe sense of suffering, quite disconnected from its cause, pervades myentire being; or at the second when I am first "coming back" after afaint, or at the first stepping out from an anesthetic. In theseexperiences most of us can recall a very simple mental content, and canprove to our own satisfaction that there is such a thing as mereawareness, a consciousness probably close akin to that of the lowerlevels of animal life, or to that of the newborn babe when he firstopens his eyes to life. _Consciousness_, then, in its elements, is the simplest mental reactionto 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'sreaction, 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 froma dark room, or to open them when it plays upon my eyelids as I sleepand the morning sun reaches me. It is a stimulus from without. The fear-thought, which makes my body tremble, my pupils grow wide, andwhitens my cheeks, is a stimulus from within. An unexpected shot in the woods near-by, which changes the whole trendof my thinking and startles me into investigating its cause, is astimulus from without causing a change within. A _stimulus_, then, is anything within or without the body that arousesawareness; and this is usually evidenced by some physical change, however slight--perhaps only by dilated pupils or an expression ofrelief. When we see the reaction of the body to the stimulus we knowthere is consciousness. On the other hand, we cannot say thatconsciousness is always absent when the usual response does not occur;for there may be injury to organs accounting for the lack of visiblereaction, while the mind itself may respond. But with due care, in evensuch cases, some external symptoms of response can usually be found ifconsciousness exists. We have already realized how complex, intricate, and changing is fullydeveloped consciousness. THE UNCONSCIOUS But the mind of man knows two distinct conditions of activity--theconscious and the unconscious. Mind is not always wide awake. Werecognize what we call the _conscious_ mind as the ruling force in ourlives. But how many things I do without conscious attention; how often Ifind myself deep in an unexplainable mood; how the fragrance of a flowerwill sometimes turn the tide of a day for me and make me square myshoulders and go at my task with renewed vigor; or a casual glimpse of aface in the street turn my attention away from my errand and settle mymind into a brown study. Usually I am alert enough to control theseerrant 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 myway unswerved by them, though not unmoved. When we realize that nothing that has ever happened in our experience isforgotten; that nothing once in consciousness altogether drops out, butis stored away waiting to be used some day--waiting for a voice from theconscious world to recall it from oblivion--then we grasp the fact thatthe quality of present thought or reaction is largely determined by thesum of all past thinking and acting. Just as my body is the result ofthe heritage of many ancestors plus the food I give it and the use towhich I subject it, so my mind's capacity is determined by myinheritance plus the mental food I give it, plus everything to which Ihave subjected it since the day I was born. For it forgets absolutelynothing. "That is not true, " you say, "for I have tried desperately to remembercertain 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 todaydifferently 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; andyou are not quite the same person you would be without that forgottenexperience, or that pressing stimulus, which you never consciouslyrecognized, but allowed your subconsciousness to accept. Some night youhave a strange, incomprehensible dream. You cannot find its source, butit is merely the re-enacting of some past sensation or experience ofyour own, fantastically arrayed. Some day you stop short in your hurriedwalk with a feeling of compulsion which you cannot resist. You know noreason for it, but some association with this particular spot, or somevague resemblance, haunts you. You cannot "place" it. One day you hitthe tennis-ball at a little different angle than you planned because aqueer thought came unbidden and directed your attention aside. Again, under terrific stress, with sick body and aching nerves, you go on anddo your stint almost mechanically. You do not know where the strength orthe skill is derived. But your unconscious or subconscious--as youwill--has asserted itself, has usurped the place of the sick conscious, and enabled you automatically to go on. For we react to the storehouseof the unconscious even as we do to the conscious. Remember that the unconscious is simply the latent conscious--what oncewas 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 afew islands. The islands represent the conscious thoughts--thatconsciousness we use to calculate, to map out our plans, to form ourjudgments. This is the mind that for centuries was accepted as all themind. But we know that the islands are merely the tops of hugemountain-ranges formed by the floor of the sea in mighty, permanentupheaval; that as this sea-floor rises high above its customary leveland thrusts its bulk above the waters into the atmosphere, is the islandpossible. Just so there can be no consciousness except as that which is already inthe mind--the vast subconscious material of all experience--rises intoview and relates itself through the senses to an outside world. We speakvery glibly of motion, of force, of power. We say "The car is movingnow. " But how do we know? Away back there in our babyhood there weresome things that always remained in the same place, while others changedposition. The _changing_ gave our baby minds a queer sensation; it madea definite impression; and sometimes we heard people say "move, " whenthat impression came. Finally, we call the feeling of that change"move, " or "movement, " or "motion. " The word thereafter always brings toour minds a picture of a change from one place to another. Theprocess--the slow comprehending of the baby mind--was buried inforgetfulness even at the time. But had not the subconscious beenimprinted with the incident and all its succeeding associations, thatparticular phenomenon we could not name today. It would be an entirelyunique experience. So our recognition of the impression is merely therising into consciousness of the subconscious material in response to astimulus from the outside world which appeals through the sense ofsight. We can get no response whatever except as the stimulus asking ourattention is related by "like" or "not like" something alreadyexperienced; that is, it must bear some relation to the known--andperhaps forgotten--just as the island cannot be, except as, from fardown below, the sea-floor leaves its bed and raises itself through thedeeps. The visible island is but a symbol of the submarine mountain. The present mental impression is but proof of a great bulk of pastexperiences. And so we might carry on the figure and compare the birth ofconsciousness to the instant of appearance of the mountain top above thewater's surface. It is not a new bit of land. It is only emerging into anew world. "But, " you ask, "do you mean to assert that the baby's mind is afinished product at birth; that coming into life is simply the laststage of its growth? How unconvincing your theory is. " No, we only now have the soil for consciousness. The island and thesubmarine mountain are different things. The sea-floor is transformedwhen it enters into the new element. An entirely different vegetationtakes place on this visible island than took place on the floor of thesea before it emerged. But the only new elements added to the hithertosubmerged land come from the new atmosphere, and the sea-floorimmediately begins to become a very different thing. Nevertheless, whatit is as an island is now, and forever will be due, primarily, to itsstructure as a submarine mountain. In the new atmosphere the soil ischanged, new chemical elements enter in, seeds are brought to it by thefour winds--and it is changed. But it is still the sea-floortransformed. Just so the baby brain, complete in parts and mechanism at birth, is adifferent brain with every day of growth in its new environment, withevery contact with the external world. But it is, primarily and in itselements, the brain evolved through thousands of centuries of pushing upto man's level through the sea of animal life, and hundreds of centuriesmore of the development of man's brain to its present complete mechanismthrough experience with constantly changing environment. Hence, when the baby sees light and responds by tightly shutting hiseyes, then later by opening them to investigate, his sensation is whatit is because through the aëons of the past man has established acertain relation to light through experiencing it. To go further thanthis, and to find the very beginning, how the first created life came torespond to environment at all, is to go beyond the realm of the actuallyknown. But that he did once _first_ experience his environment, andestablish a reaction that is now racial, we know. So our baby soon shows certain "instinctive" reactions. He reaches outto grasp. He sucks, he cries, he looks at light and bright objects inpreference to dark, he is carrying out the history of his race, but ismaking it personal. He has evolved a new life, but all his ancestorsmake its foundation. The personal element, added to his heritage, hasmade him different from any and all of his forebears. But he can have noconsciousness except as a bit from the vast inherited accumulation ofthe past of his ancestors, of all the race, steps forth to meet a newenvironment. And again you ask, "How came the first consciousness?" And again I answer, "It is as far back as the first created or evolvedorganism which could respond in any way to a material world; and onlymetaphysics and the God behind metaphysics can say. " We only know that careful laboratory work in psychology--experiments onthe 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; andthis comprises our material, intellectual, social, and spiritualenvironment. CONSCIOUSNESS IS COMPLEX The one fact we want at this stage of our inquiry is simply this: thatconsciousness, awaking at birth, very soon becomes complex. Howeversingle and simple in content immediate consciousness may be, it is sointimately linked with all preceding experience that a pure sensation isprobably never known after the first second of life. As the sensation isregistered it becomes a basis for comparison. That first sensation, perhaps, was just a feeling of _something_. The next is a feeling ofsomething that is the same, or is not the same, as the first. Soimmediately perception is established. The baby consciousness recognizesthat the vague feeling is, or is not, _that same thing_. And fromperception to a complex consciousness of perceptions, of ideas, ofmemories and relations, and judgments, is so short a step that we cannotuse our measuring rods to span it. Thus through the various stages of life, from infancy to maturity, theconscious is passing into the unconscious, only to help form later a newconscious thought. Hence the conscious thought is determined by thegreat mass of the unconscious, plus the external world. But every thought, relegated to the unconscious, through its associationthere--for it is plastic by nature--comes back to consciousness neverquite the same, and meets never quite the same stimulus. And as a resulta repeated mental experience is never twice exactly the same. So theconscious becomes the unconscious and the unconscious the conscious, andneither can be without the other. Our problem is to understand the workings of the mind as it existstoday, and to try to find some of its most constructive uses; and onthat we shall focus attention. To that end we must first examine thevarious ways in which consciousness expresses itself. We have recognized two distinct mental states--the conscious and theunconscious--and have found them constantly pressing each on the other'sdomain. Our study of consciousness reveals the normal in the aspects ofsleeping and waking, also various abnormal states. Consciousness maybecome excited, depressed, confused, delirious, or insane. We shallconsider later some of the mental workings that account for theseabnormal expressions. At present let us examine the mind's activities insleep and in delirium. CONSCIOUSNESS IN SLEEP Sleep seldom, if ever, is a condition of utter unconsciousness. We sofrequently have at least a vague recollection, when we wake, ofdreaming--whether or not we remember the dream material--that we areinclined to accept sleep as always a state of some kind of mentalactivity, though waking so often wipes the slate clean. A new word whichserves our purpose well has come into common use these last years, andwe describe sleep as a state of rest of the conscious mind made possibleas 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 withreality, forcing back all that is not of immediate use, or that isundesirable, 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 intoconsciousness, there to meet and establish relations with matter--backinto the unconscious realms, and locks the door, and lies and slumbers. Then the half-thoughts, the disregarded material, the unfit, theunexpressed longings or fears, the forbidden thoughts; in fact, thewhole accumulation of the disregarded or forgotten, good, bad, andindifferent--for the unconscious has no moral sense--seize theiropportunity. The guard has refused to let them pass. He is now asleep. And the more insistent of them pick the lock and slip by, masqueradingin false characters, and flit about the realms of the sleepingconsciousness as ghosts in the shelter of darkness. If the guardhalf-wakes he sleepily sees only legitimate forms; for the dreams arewell disguised. His waking makes them scurry back, sometimes leaving notrace of their lawless wanderings. So the unconscious thoughts of theday 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 ininsanity, which we might very broadly call a prolonged delirium, thetoxic brain becomes a house in disorder. The censor is sick, andsequence and coherence are lost as the thronging thoughts of theunconscious mind press beyond the portals into consciousness, disorderedand confused. We shall later find, however, that this very disorderfalls into a sort of order of its own, and a dominant emotion of pain orecstasy, of depression or fear, of exaltation or depreciation callssteadily upon the stored away incidents and remembered, relatedfeelings of the past and interprets them as present reality. The censorof the sick brain is stupefied by toxins, shock, or exhaustion, and thecitadel he is supposed to guard is thronged with besiegers from everyside. The strongest--_i.  e. _, those equipped with most associationspertinent to the emotional status at the time--win out, occupy the brainby 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 anexternal 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'sconsciousness, the brain, spinal cord, and the senses, and try toestablish some relation between the material body and its mightypropelling force--the _mind_. CHAPTER III ORGANS OF CONSCIOUSNESS Nothing is known to us until it has been transmitted to the mind bythe senses. The nerves of special sense, of sight, hearing, smell, taste, touch, the temperature sense ("hot or cold" sense), themuscular sense (sense of weight and position), these, and the nervescontrolling voluntary motion, form the peripheral, or surface, nervoussystem. This acts as a connecting medium between the outside world andthe central nervous system, which is composed of the brain and spinalcord. We might liken the nerves, singly, to wires, and all of themtogether to a system of wires. The things of the external world tap atthe switchboard by using the organs of special sense; the nerves, acting as wires, transmit their messages; at the switchboard is theoperator--consciousness--accepting and interpreting the jangle ofcalls. The recognition by the brain of the appeals coming by way of thetransmitting sense, and its interpretation of these appeals, is themind'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 fillsthe air. I think "hot rolls, " because my organ of smell--the nose--hasreceived a stimulus which it transmits along my olfactory nerves to thebrain; and there the odor is given a name--"hot rolls. " The recognitionof the stimulus as an odor and of that odor as "hot rolls" isconsciousness in the form of thinking. But the odor arouses desire toeat--hunger; and this is consciousness in the form of feeling. Thesomething which makes me walk into the shop and buy the rolls isconsciousness in the form of willing. The sensory appeal from theoutside world gained admission through the sense of smell; thistransmitted the message, and consciousness recognized the stimulus, which immediately appealed to my hunger and incited action to satisfythat hunger. The ear of the operator in the telegraph office, again, might illustrateconsciousness. It must be able to interpret mere clickings into terms ofsense. To the operator the sounds say words, and the words are theexpression of the object at the other end of the wire. The brain is thereceiving operator for all the senses, which bring their messages incode, 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 bysense-channels over the nerves of sense, and received by a consciousbrain. A baby born without sight, hearing, taste, smell, or touch wouldremain a mere bit of clay. He could have no awareness. But so long asany one sense channel remains open the mind may acquire some knowledge. Suppose I am paralyzed, blind, and deaf, and you put a tennis-ball intomy hand. I cannot tell you what it is, not even what it is like. Itmeans 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 touchintact; 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"; andthereafter 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" inthe past, I can describe it to you. It has been impressed upon my brainthrough my sense of hearing; and memory immediately supplies thequalities that go with "tennis-ball. " But if none of the senses has ever developed, my brain can receive noimpression whatever; it cannot have even the stimulus of memory. Henceconscious mind cannot be, except as some sense-channel or channels havebeen opened to carry thought material to the brain. So far as we knowtoday, in this world, mind is absolutely dependent upon the sense organsand the brain--upon matter--for existence. THE SYMPATHETIC NERVOUS SYSTEM Associated with the central nervous system by connecting nerves--butlocated outside of it in various parts of the body--are groups ofnerve-cells (gray matter) and their fibers, forming what we call the_sympathetic nervous system_--the direct connecting link between mindand body. The _central nervous system_ is the director of all conscious action ofthe body; the _sympathetic_ orders all unconscious action. The beating of the heart, the contraction of the blood-vessels, hencethe flowing of the blood, the processes of digestion, the functioning ofthe glands, are all directed by the sympathetic. In other words, the_central nervous system_ normally controls the movements of thevoluntary muscles; the _sympathetic_ controls those of the involuntarymuscles. The quick blush, the sudden paling of the cheeks, the start of fear, thedilated pupils of fright are the direct result of the action ofinvoluntary muscles under control of the sympathetic system. Thestimulus is received by the central nervous system; the fibersconnecting the central and the sympathetic systems carry the messagequickly to the latter, which immediately respond by ordering contractionor expansion of involuntary muscles. So tears flow, we breathe freelyagain or we quake and tremble, our pupils widen or contract, the heartbeats suffocatingly, or seems almost to stop. The _sympathetic system_, as the name implies, is influenced bysuggestions from the emotions rather than from the intellect. We mightsay that it is controlled by the "feeling mind" rather than the thinkingmind, for intellect cannot influence it in the least. The wise nurse, who knows something of the laws of the mind, soonrealizes that the _sympathetic nervous system_, rather than physicaldisability, causes many indigestions, headaches, diarrheas, dry mouths, chills; is responsible for much nausea, much "exhaustion, " etc. When shehas had wider experience she finds that almost any known physicaldisorder can be unconsciously imitated by the suggestible patient, whosesympathetic nervous system causes physical reactions to respond to thefeelings of a sick mind. Let the nurse remember, however, that is it notfor her to decide whether the disorders from which her patient suffersare of physical or nervous origin. It is for her, on the other hand, tostudy her patient's mentality and reactions, and to become expert inreporting 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 forits existence. Is the body in the same way dependent upon the mind? Canthe mind die and the body go on? Given a perfect body with unblocked sense channels, and put the mind tosleep, paralyze the _central nervous system_ with alcohol in sufficientquantity so that the undamaged _peripheral nervous system_--thesenses--can obtain no response or recognition from it, and that perfectbody is as useless for the time as if dead. But here comes proof of theremarkable hold of the body on life. The unconscious mind takes up theburden of directing the sympathetic nerves to stimulate the muscles ofbreathing. The unconscious sees to the beating of the heart. It directsthe contraction of the blood-carrying vessels. It maintains certainvital processes of secretion. Thus automatically life goes on; the bodystill reacts to a limited field of stimuli, and consciousness recognizesit not. But when the unconscious mind ceases to function, then, indeed, does the body die. Yet the conscious mind may "die" and the body liveon, 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 caredfor by other persons--a merely vegetable existence. The current of poweris broken; but the spark is still glowing, though utterly uselessbecause connected with nothing. And it may continue to glow for sometime while properly stimulated from outside sources. We might liken the mind to the boiler in which steam is generated, andthe body to the engine which the steam runs. If the boiler bursts, theengine stops; but it may not be otherwise damaged. It simply cannotcarry out its main function of motion any longer. The fires under theboiler are still burning and can be kept burning so long as fuel isprovided, but the connection is broken and the great bulk of iron is auseless 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, maystill remain--a useless thing, which would die away if not tended fromwithout by other bodies whose minds are still intact. But in the demented mind consciousness still remains, the awareness ofthe young child or baby stage of life. The connection between the upperor conscious brain centers and the body has been tampered with; it nolonger is direct, but breaks off into switch-lines. But the contactstill holds between the lower or unconscious mind and the body; so theautomatic body functions go on, directed as they were in babyhood beforethe independent mind assumed control. Hence, when all acuteconsciousness is finally gone, the unconscious mind, a perfectautomaton, may still carry out the simplest vegetative activities ofexistence. When body is dead, mind, so far as its reactions to the world we knoware concerned, ceases to act. But when the conscious mind is "dead" thebody may yet live as a vegetable lives, with all its distinctively humanfunctions lost. Motionless, save for the beating of the heart and thereaction of the lungs to air, the body may still be alive, though themind long since has ceased all earthly activity. So we discover that an organ of mind is an essential, here, to life ofmind, and that mind only can induce this organ to any action above thevegetative stage. But, on the other hand, we find that life can existwithout conscious mind, even if untended by others, for a limited time. If the direct nerve connections between the brain and the hand, thebrain and the foot, or the brain and the trunk are cut off, the mindhenceforth realizes nothing of that part except as the sense of sightreports upon it; for the optic nerves relate the hand and mind, throughthis sense, as truly as the motor nerves which carry the mind's messagefor motion to the hand, and the sensory nerves which carry back to themind the hand's pain. But let the optic nerve be inert, the sensory andmotor connections broken between brain and hand, or foot and trunk, orbrain and trunk, and the hand or foot may be amputated and the mindnever sense the fact; the trunk may be severely injured and the mind beserenely unconscious. So the brain in man is "the one immediate bodilycondition of the mental operations. " Take away all the brain and man'sbody is a useless mass of protoplasm. The brain's varied and intricate nerve connections with all parts of thebody, 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 maindivisions of the brain--the _cerebrum_, which includes what we call theright 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 brainreferred to: as forehead, temples, crown, or occiput. The cerebellum, orhind brain, is also divided into two hemispheres, and is situated behindand below the hemispheres of the cerebrum. A system of localization has been roughly mapped out, the result ofcareful laboratory work on animals and of studying the loss of variousfunctions in human beings as related to the location of brain injuries. From these experiments it seems proved that consciousness belongs onlyto the cortex or surface of the upper brain, and that the vast realm ofthe unconscious belongs to the lower brain centers. Hence the cortex isthe organ of consciousness, and the lower centers are the repository ofthe unconscious until it again becomes conscious. The motor zone of the cortex we now know to be situated in theconvolutions bordering the fissure of Rolando. Vision is evidentlyexcited from the occipital lobes, though not yet conclusively proved. Smell, presumably, is located in the temporal lobes. Considered actionis directed from the upper hemispheres only. It is significant that thehemispheres of the cerebrum are also accepted as the seat of memory forman--that intellectual quality which makes him capable of acting fromabsent stimuli, stimuli only present to memory; which makes it possiblefor him to reason the present from the experiences of the past. But in all animal life, except the higher forms, the control of actionis from the lower brain centers, centers which respond only to presentobjects. With them memory, as man knows it, is lacking; but thereactions of the past are indelibly imprinted upon motor nerves andmuscles, so that when the present object presses the button, as itwere, calling forth the experience of the race, the animal instinctivelyreacts. But of what use to man, then, are the lower brain centers? In man, as in lower animals, they care for the vegetative functions oflife, so that our blood continues to circulate, the air enters andleaves our lungs, digestion is carried on, with no assistance from theupper centers, the hemispheres of the cerebrum being thus left free forconcentration on the external world of matter, which it can transforminto a world of thought. It is the lower or vegetative brain that may still exist and keep lifeintact 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 senseimpressions. The senses themselves are the rudiments of mind, are themeans by which stimuli alighting on sense organs enter consciousness;for the nerves of special sense immediately carry the impetus to thebrain, 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 threeclasses: _intellect_, _emotion_, and _volition_, more simply, thinking, feeling, and willing; and we find no mental activity of the normal orabnormal mind which will not fall into one of these groupings. Thisdoes not mean that one part of the brain thinks, another part wills, another part feels; for in the performance of any one of these functionsthe mind acts as a whole. Our thinking or our willing may be permeatedwith feeling, but the entire mind is simply reacting simultaneously uponvarious stimuli. CHAPTER V THE NORMAL MIND Mind, we found, is born in the form of consciousness when the outsideworld impresses itself upon the brain-cells by way of the senses. Thisconsciousness, observation and experiment prove, is first a feeling one, later a feeling-thinking-willing one. The mind, then, is really theactivity of the brain as it feels, as it thinks, as it wills. We expressthis in descriptive terms when we speak of mind as the _flow ofconsciousness_, the sum of all mental associations, conscious andunconscious. For mind is never a final thing. Looking within at our ownmental processes we find that always our thought is just becomingsomething 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 isbecoming something else. Thinking is mind. Feeling is mind. Willing is mind. But for the sake ofclearness we speak of feeling, thinking, and willing as being functionsof 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 ofbeing for the mind, even as motion--while the immediate purpose of thelocomotive--is not its chief end. The steam engine may stand in the samespot while its wheels revolve madly; it may move along the tracks alone, and accomplish nothing; or it may transport a great train of loadedcars. Unless it moves to some definite point and carries merchandise orpeople there, it is a useless, indeed, a dangerous invention. We find, in fact, that it functions to the very definite end of taking man andhis chattels to specified places. And so it is with the mind. If it is thinking and feeling and willingonly for the sake of exercising these mental powers, it might better notbe. But what end do we actually find these functions serving? Mind, with its powers of thinking, feeling, and willing, gives anexternal world of matter; an internal world of thought, and so relatesthem to each other as to make them serve man's purposes. Thus thesefunctions 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 bedetermined by the intellectual verdict on the music; in forcing itsowner to sit at the piano and practice in the face of strong desire toattend the theater, it wills, primarily. Now one of its functionspredominates; now another. But the whole mind, not a feeling section, ora thinking section, or a willing section, operates together to produceaction. When I play the piano it calls on all my mind. I think themusic. I feel it. I make my fingers play it. But the thinking, thefeeling, and the willing act together to result in the fingers playing. The mind, then, is an instrument of achievement. It fulfils its purposewhen it makes matter serve useful ends. _Emotion_ or _feeling_ is the function of the mind which associates asense of pleasure or pain with every thought or act. Feeling is the affective state of mind. By this we mean that it has thepower to move us. And this emotion primarily does; for our feeling ofpleasure or pain moves us to action, as well as precedes and accompaniesand follows action. The word _emotion_ is usually employed to denote anacute feeling state, while the word _mood_ denotes a prolonged feelingcondition, _i.  e. _, a less acute emotional state. The word _feeling_, however, is used to cover both; for in each case the sensational elementmanifests itself in a definite physical affect, pleasurable or painfulin some degree. _Thinking_ is a conscious mental activity exercised to evolve ideas fromperceptions, and to combine and compare these ideas to form judgments. Intellection, or thinking, might be explained as the mental processwhich converts sensation into percepts, groups percepts to form conceptsor ideas, stores away ideas and sensations for future use, and recallsthem when needed--the recalling being memory--and by reason combines, compares, and associates ideas to form judgments, then comparesjudgments to form new judgments. The process of intellect we name byterms denoting activity, such as intellection, thinking, the _stream ofthought_, and the latter describes it most truly. _Volition_ or _will_ is the function of the mind which compels theexpression of thought or feeling in action. For clarity we might indicate the mind and its functions in thefollowing 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 arebriefly defined that there may be no haziness in their application. _Sensation_ is the uninterpreted response of the mind to stimuli broughtby sense organs. { hot. Examples: Feeling of { cold. { pain. Sensation may arouse instinct and cause reflex action, or start afeeling state, or a train of thought. _Perception_ is the conscious recognition of the cause of a givensensation. { fluid--water. Example: { cold--snow. { pain--cut. _Percept_ is a word often used to denote the mind's immediate image ofthe 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, andreproducing 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 overin 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 inthe past. Example: Myself having a chill, how I acted; what I thought and myemotions during that chill. _Ideation_ is the mind's grouping of percepts by the aid of memory, toform concepts. Example: I perceive color, form, mouth, eyes, nose, chin, etc. Thesepercepts I combine as a result of past experience (memory) to form myconcept, _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 thingor quality, and the concept is the result of the storing up and groupingand recombining of percepts. Thus a lasting mental picture is secured;and my idea of horse, for instance, is so clear and definite a thing inmy mind that if I should never again see a particular horse, I shouldyet 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 areinterchangeably 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 aquality or an object dissociated from any particular setting orparticular experience. Abstract ideas are of two kinds. We speak of them as _abstract objectconcepts_ and as _abstract quality concepts_. An _abstract objectconcept_ we might call a generalized idea, an idea comprehending allobjects having certain things in common. Example: My idea of animal includes many scores of very differentindividual animals, but they all have bodies and heads and extremities. They all have some kind of digestive apparatus; they breathe, and canmove. An _abstract quality concept_ is easier to think than to explain. It isas though the mind in considering a multitude of different objects founda certain quality common to many of them, and it "abstracted, " _i.  e. _, drew this particular quality, and only this, from them all, and thenimagined it as a something in itself which it calls _redness_, or_whiteness_, or _goodness_. Thereafter, whenever it finds something likeit anywhere else again it says, "That is like my redness. " So I call it"red. " In other words, consciousness thereafter can determine in a newlydiscovered object something it knows well merely because that somethingcorresponds to a representation which experience and memory have alreadyformed. These comprehensive concepts, or _universals_, as some psychologiststerm 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 mindsays "white, " and sees white in some object. But I see the white onlybecause my mind has a quality concept, _whiteness_. This outside objectcorresponds 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 outsideworld I can say is goodness, or fulness. But I do see things in theexternal world through my ideas of goodness or fulness that correspondto these ideas. They have some of the qualities the ideas embrace; andso 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 otherdoes not. And because we can never point out any one quality in theoutside world and say "This is purity, and all of purity; this isgoodness; or this good plus this good plus this makes all of goodness";because of this impossibility we speak of these concepts as havingreality somewhere. They are _absolutes_, _universals_, _abstract qualityconcepts_--the unfound all of which the things we call pure and good arebut the part. _Apperception_ is the process of comparing the new with all that is inthe mind, and of classifying it by its likeness to something alreadythere. With an abstract idea of an object in mind we very deftly, through theuse of memory and constructive imagination, deduce the whole from thepart recognized as familiar. Example: In walking through the field, along the bank of the brook, Iglimpse under the low-hanging branches of the weeping willow arestlessly moving hoof. I see a certain kind of hoof and only that. Or Ihear a lowing sound. And I say "cow. " I have not seen a cow, but only apart which tells me a cow is there; for all the cows I ever saw hadhoofs 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 soundbefore. From my perception, then, of hoof or sound I apperceive _cow_. Memory relates that hoof or that lowing sound to a certain kind ofanimal known in the past; and constructive imagination draws in all therest of the picture that belongs with it. Again, we may apperceive an object or quality from our recognition ofsomething which in our experience has been associated, under thoseparticular circumstances, with only that object or quality. I see smokeon the ocean's far horizon, and I decide instantly, "a steamer. " I havenot perceived any steamer, but only something that "goes with it, " as itwere. I see the ship with my mind, not with my eyes; for I know that acloud of smoke out there always has, in my past experience, representedjust that. I compare the newly appearing stimulus--smoke in thatparticular 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 bythe senses, the unknown. How does the child realize that the movingspeck on the distant hillside is his father? There is nothing toindicate it except that it is black and moves in this direction. Butexperience tells Johnny that father comes home that way just about thistime. Moreover, it says that father looks so when at that distance. WhenJohnny is as sure it is his father as if he could see his face closebeside him he has apperceived him. The speck on the hill is the newlyarriving stimulus. Johnny compares it with what corresponds to it in hismind's experience and proclaims, as a fact, that he sees his father. _Reason_ is the mind's comparison and grouping of concepts to formjudgments, 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 thesecond includes the first. _Judgment_ is the mind's decision arrived at through comparing conceptsor other judgments. Example: _Man is mortal_ is my decision after comparing the concepts_man_ and _mortal_ and finding that the latter really includes theformer. Judgment at the same time says that "Mortals are men, " is not atrue conclusion. For in this case the first concept is not all includedin the second. Mortals are all life that is subject to death. We may assume personal consciousness even as we recognize an individualbody. Psychology does not deal with any awareness separated from aperson. It knows no central mind of which you partake or I partake, andwhich is the same for us both. A universal consciousness would simplymean one which is the sum of yours and mine and everybody's who livestoday, or who has ever lived. So by _personal consciousness_ thepsychologist means his consciousness, or yours, or mine. But they cannever be the same; for mine is determined by my entire past and by howthings and facts and qualities affect me; and yours, by your past, andby things and facts and qualities, and by how they affect you. _Personal consciousness_ is the mind's recognition of self; and as theself changes with every added experience, so personal consciousness ismodified. _Stream of thought_ is a term _James_ has brought into common usage toillustrate the fact, already stressed, that thinking, as we know it, isnever static, is never one thing, one percept, one concept, onejudgment; but is a lot of these all together, just beginning to be orjust 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 thebrook as it flows with the stream. We can take up one on ourfinger-tips, however, and separate it from all the rest. But analyzed inthe laboratory, this drop will contain all the elements that a pint orgallon or a barrel of the same water contains. The drop is what it isbecause the stream has a certain composition. We only have a brook asdrops of rain combine to make it, but we also have only the drops as weseparate them from the steam. _Imagination_ is the combining by the mind, in a new way, things alreadyknown. This may be either into fantastic groupings divorced from reality, orinto new, possible, rational groupings not yet experienced. Soimagination is of two kinds, the fantastic and the constructive. Fantastic imagination, or fantasy, gives us gnomes, fairies, giants, andflying horses, and all the delights of fairy tales. Constructiveimagination is the basis for invention, for literature, and the arts andsciences. The word _thinking_, defined early in this chapter, is broadly used todenote the sum of all the intellectual faculties. Thinking is really thestream of thought. CHAPTER VI THE NORMAL MIND (Continued) INSTINCT We have found that the mind's chief end is action, of itself, or of itsbody. But what are its incentives to action? We see the very young baby giving evidences of an emotional life, livingin an affective, or feeling environment, leading a pleasure-painexistence, from the first. He acts as desire indicates. But from thevery moment of his birth he performs actions with which he cannot as yethave a sense-memory connection, because he is doing them for the firsttime. How can he know how to respond to stimuli from the very beginning? No other possible explanation offers itself than that he is born withcertain tendencies to definite action. These we call instincts--man'sprovision to keep him going, as it were, till reason develops. Instinctsare handed down from all the past. Definite tendencies, they are, tocertain specific reflex actions in response to certain sensations. Theseresponses, from the very beginning of animal life, have been towardavoiding pain, and toward receiving pleasure. It is as though thestimulus presses the trigger--instinct--and the muscle respondsinstantly with reflex action. This mechanism is the means of protectionand advancement, and takes largely the place of intelligence in allanimal 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 thesame with all mankind. The pugnacious instinct--the desire to fight--is the natural reaction ofevery human being of sane mind to attack. The inner necessity ofavenging is so strong in the child or man of untrained mind or soul thathe acts before he thinks. He strikes back, or shoots, or plots againsthis enemies. Only rare development of spirit or the cautious warning ofreason which foresees ill consequences, or a will trained to forcecontrol, can later make the instinct inactive. Where instinct ends and sense memory, imitation, and desire step in isdifficult to determine. Later in life probably most of what we considerinstinctive action is simply so-called reflex action, depending on sensememory, action learned so young that it is difficult to distinguish itfrom the true reflex action, which is due only to race memory. James, in his _Talk to Teachers_, gives us a partial list of theinstincts. 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 himin babyhood many of them which may have been very useful to hisprehistoric ancestors, but which only complicate things for him. Fearand curiosity urge opposite lines of conduct. Love of approbation andshyness are opposed. Love and pugnacity are apt to be at odds. So, gradually, as intelligence increases, the child refuses to allow suchimpulses to lead him to action. When fear-instinct and love-instinct areat war, reason is provided to come to the rescue. _Instincts_ are racial tendencies of sensational or emotional states todetermine action. Instincts are the germs of habit, and when instinct would give rise to areaction no longer useful, reason, abetted by new habit formation, inthe normal mind, weakens instinct's force; and the habit is discardedand the instinct gradually declines. In prehistoric times when food was scarce, and man had not learned theart of tilling the soil, hunger forced him to fight for what he got toeat. As there was often not enough to go around, he maimed or killedhis fellow-man that he might have all he wanted, obeying the instinct tosurvive. So, now, the baby instinctively clutches for all that appealsto him. But an abundance of food for all, or the intelligent realizationthat co-operation brings more to the individual than does fighting, anda developed sense of responsibility toward others; or merely the fear ofthe scorn of fellow beings, or the desire to be protected by the love ofhis kind; perhaps a genuine love of people, acquired by spiritualdevelopment, puts the primitive habit of food-grabbing into the discard. Finally, the very instinct of self-preservation may be transformed intodesire to serve others. No better illustration of this can ever beoffered than the sacrifices of the World War. MEMORY No mind retains consciously everything that has ever impressed it. It isnecessary that it put aside what ceases to be of importance or value andmake way for new impressions. We found early in our study that thesubconscious never forgets, but harbors the apparently forgottenthroughout the years, allowing it to modify our thinking, our reactions. But the conscious mind cannot be cluttered with the things of littleimportance when the more essential is clamoring. So there is aforgetting that is very normal. We forget numberless incidents of ourchildhood and youth; we may forget the details of much that we havelearned to do automatically; but the subconscious mind is attending tothem for us. Do you know how to skate? and if so, do you remember just how you did itthe first time? Probably all you recall is that you fell again and againbecause your feet would slip away from where you meant them to be. Whenyou glide over the ice now it is as natural as walking, and as easy. Youcannot remember in detail at all how you first "struck out, " nor theposition of your feet and arms and legs, which you felt forced toassume. At the time there was very real difficulty with everystroke--each one was an accomplishment to be attempted circumspectly, ina certain definite way. All you remember now is, vaguely, a tumble ortwo, soreness, and lots of fun. We forget details we have intrusted to others as not a part of ourresponsibility. We forget the things which in no way concern us, inwhich we have no interest and about which we have no curiosity. And itis well that we do so. If it were not for the ability to forget, ourminds would be like a room in which we have lived a lifetime, where wehave left everything that has been brought into it since our birth. Itwould be piled ceiling high, with no room for us, and with difficultyonly could we find what we want. As we grow from babyhood to childhood, from childhood to youth, from youth to maturity the room changes withus. We put off childish things. They are stored away somewhere, in anattic or basement, or destroyed. And day after day something new isadded, displacing something else. In the case of the mind all thesethings are stored and cataloged in the subconscious, and forgotten, until some need causes us to look into our catalog-index and see theexperience again, or some association calls it back, relating it tosomething new. So our discussion of the subconscious involved also adiscussion of memory. But what of the things we must use frequently and cannot find in ourminds? What of absent-mindedness and faulty memory? In such cases ourminds might be compared to a cluttered room full of things we need andwant 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 therest. We have no proper system of arrangement of our belongings. Youlaid down that book somewhere, absent-mindedly, and now you cannot tellwhere. You were thinking of something else at the time, and inattentionproves a most common cause of poor memory. Perhaps you simply have morebooks than the room can hold in an orderly way, and so you crowded thatone 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 atthe time the particular attention-stimulus knocked. You asked me to buya ribbon of a certain shade and a certain width when I went to town. Iwas thinking of my dentist appointment. However, I heard your request, answered it graciously, took the money you offered, still wondering ifthe dentist would have to draw that tooth. And the chances are that Iforgot your ribbon. I was giving you only a passive and dividedattention. Or I have more to do than I can possibly accomplish in the next sixhours. 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 theintention into an already overburdened corner of my mind, fail toassociate it with the other thoughts already there, and return six hourslater without the ribbon. My sense of hurry, of stress, of the moreimportant 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. Iwas really giving you only partial attention, or an emotion interferedwith attention; and I forgot. Hence we find that a faulty memory may exist in an otherwise normal mindwhen poor attention, or divided attention due to emotional stress or toan overcrowded mind, which makes it impossible to properly assort itsmaterial, interferes. Again, we forget many things because they are unpleasant to remember. Wehave no desire, no emotional stimulus to make us remember; or becausesome of the associations with the forgotten incident are undesirable. We forget many things because if we remembered them we would feel calledupon to do some unpleasant duty. You forgot your tennis engagement withB, perhaps, because you were so engrossed in a pleasure at hand, or inyour work, that anything which interrupted was, under the circumstances, undesirable. You may have wanted very much to play with him, but somemore pressing desire--to care well for your patient, or to continue thepresent amusement--was stronger. Or you forgot because you did not wantto play with him and had no excuse to offer at the time. You wished toforget. Perhaps he does not play a good game, or you do not like him, orat least you like some one else much more, and he happened along; so youforgot B. The unconscious mind saw to it that something else was kept soprominently before your attention that it could not return to the lessdesired. Thus a forgetting may be purely the result of an emotional interferencewhich makes it, all in all, more pleasant to forget than to remember. Ifwe would help ourselves or our patients whose memories are faulty, andwho make them worse by their continual fretting over their disability, we must train ourselves to be willing to forget all that does not in theleast concern our interests or those of the people about us, and doesnot add anything desirable to our knowledge. Thus we may avoidovercrowding the mind. But when we would remember let us give our wholeactive attention at the moment of presentation of the new stimulus, andimmediately tie it up with something in past experience; let usrecognize what it is that we should remember, and call the reinforcementof 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 becomespermanent. The average patient's poor memory is made worse by hisagitation and attention to it, and his conviction that he cannotremember. The fear of forgetting often wastes mental energy which mightotherwise provide keenness of memory. If the nurse ties up some pleasantassociation with the things she wants the sick man to remember, anddisregards his painful effort to recall other things, then--unless themind is disordered--he will often find normal memory reasserting itself. We shall consider this question of memory in more detail in a laterchapter of practical suggestions for the nurse. THE PLACE OF EMOTION _Feeling Cannot Be Separated from Thinking. _--Emotion we found theconstant accompaniment of every other mental activity. It is first onthe 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 dollarstill I get some more, I am pursued with some vague or well-definedfeeling of annoyance or satisfaction, of displeasure or pleasure. If allgoes well, the latter; if not, the former. _Feeling Cannot Be Separated from Will. _--I cannot _will_ without afeeling accompaniment, pleasant or unpleasant. I may be using my willonly in carrying out what intellect advises. But we found thatintellect's operations are always affective, _i.  e. _, have some feelingof pleasure or pain. And the very act of will itself is a pleasant oneand much easier if it is making me do what I want to do; it is a vaguelyor actively unpleasant one if it is making me act against desire. In theend, however, if I act against desire in pursuance of reason or a senseof duty, the feeling of pleasure in the victory of my better self isasserted. And feeling cannot be separated from will. _Feeling Cannot Be Separated from Action. _--I cannot do anything withouta feeling of comfort or discomfort, happiness or unhappiness. Try it foryourself when you are feeding a patient, making a bed, giving a bath ormassage, preparing a hypodermic. Other things being normal, if you areperforming the task perfectly, the feeling of satisfaction, of pleasure, of the very ability to work effectively, with speed and accuracy andnicety, comes with the doing. If you are bungling, there is a pervadingsense of dissatisfaction, of unpleasantness. In the automatic orsemi-automatic action a great economy of nature has conservatively putfeeling at the absolute minimum; but it has not eradicated it. As youwalk across the ward, though your predominating thought and feeling maybe elsewhere, there is a sense of pleasure or displeasure in the verymovement. If your body is fresh and you are of an energetic type and inhappy frame of mind, a pervasive feeling of satisfaction is experienced. If tired or discouraged or sore from unaccustomed exercise, every stepregisters protest. Thus we find by experiment that there is no thought we have, no singleconscious movement or action, nor any expression of the will, but isaccompanied with what the psychologist broadly terms _pleasure_ or_pain_. So _emotion_, the first expression of mentality, is never absentfrom any mental or physical act. It permeates all we do, as well as allwe think and will, with the partial exception of automatic action, aboveindicated. THE BEGINNING OF REASON We found feeling by far the strongest factor in producing action inbabyhood and childhood. Our instinctive doing, we learned, is the resultof a race impulse. Will acts chiefly at emotion's bidding. But veryearly the baby's experience operates as a partial check to feeling'sexclusive sway. It keeps him from touching the fire, no matter how itsbrightness attracts. It may be merely the sense memory of _hurt_ whenfingers and that bright thing came together; and one such impressionwill probably prevent him from ever again touching it. Or it may be thebrain-cell's retention of the painful feeling of slapped hands when thefingers reaching out to the flame had not yet quite touched. Thesepunishment experiences are only effective in many children after more orless repetition has set up an automatic prohibition from brain to motornerves; but right here intellect begins to assert itself in the form ofsense memory. The baby does not reason about the matter. His nerve-cellssimply remember pain, and that particular brightness and glow, andfinger touch--or that reaching out to the glow--and slapped hands, asoccurring together. In the same way he early connects pleasure with thetaste of certain forbidden things. He does not know they are sweet. Heonly knows "I want. " Even here his desire to taste may be checked inaction by a vivid memory of what happened when he tasted that othertime, and was spanked or put in his little room all alone with only milkand 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 hurtmore than sweets good. Not taste. " But long before he can work this out, consciously, two distinct memories, one of pleasure and one of pain, arearoused by the sight of the sweet. And what he will do with it dependsupon which memory is stronger. In other words, his action is governedaltogether by his feeling, though memory, which is an intellectualfactor, supplies the material for feeling. DEVELOPMENT OF REASON AND WILL Later still, when the child is older, we may have somewhat the followingmechanism: "Sweets, good, want, taste; spank, hurt; don't care, spanknot 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 immediatesatisfaction of desire is stronger than the deferred satisfaction ofbeing good, and the fear of punishment. He probably prefers to take achance, and even if the worst comes, weighs it with the other worst, nothaving the sweet--and takes the "bird in the hand. " He has reasoned, andhas chosen between two emotions the one which his judgment says is themore desirable; and his will carries out the decision of his reasoning. His chief end in life is still to get the most immediate pleasure. Stilllater in child-life, much later, perhaps, his decision about the jam isbased on neither love of it nor fear of punishment, but--despite hisstill sweet tooth--on a reasoned conclusion that if he eats jam now hemay be sick, or he may spoil his appetite for dinner; or on aconsideration that sweets between meals are not best on dieteticprinciples; and _will_ very readily backs up the result of hisreasoning. 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 presentdesire. 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 goodjudgment. And we base our commendation on the proved fact that sweetsare real fuel, giving abundantly of heat and energy, and are not to beeaten as mere pastime when the body is already fully supplied withhigh calorie food not yet burned up; that if sweets are eaten atirregular intervals and at the call of appetite, and not earned by anadequate output of physical work, the digestive apparatus may becomeclogged, and an overacid condition of the entire intestinal tractthreaten. We call judgment good, then, when it is the result ofreasoning with correct or logical premises which correspond with thefacts of life. We call it bad when it is the conclusion of incorrect orpartial 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 judgmentleading to another judgment as a conclusion" (Standard Dictionary). Let us illustrate good and bad judgment by following out two lines ofreasoning, 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 sweetsbetween meals. " But why? They contain just what I need and the sooner Iget them the better. So I have sweets when I want them. The judgment to take the sweets asdesire indicates is entirely logical if we accept all the premises ascorrect. And they are, so far as they go; but they are partial; and socannot altogether correspond with the facts of life. Sweets are good forpeople who expend much physical energy. They prove injurious in morethan limited amounts to the bed-ridden, the inactive, or the sluggish. Hence this premise is partial and so far incorrect. Sweets do give heatand energy, true. I am chilly and tired, also true. But why? Because Iam already toxic from the sweets and meats I have had throughout mysedentary years. The question is, Do I need any more energy-producingfood when I am not burning up what I have? So again the premise ispartial. I do need heat and energy, but I already have the material forit, and my mode of life has disorganized my system's capacity to utilizethese foods normally. So now sweets have become a detriment to mywell-being. The judgment which determines me to the habit of eatingsweets between meals is the result of logic, but of logic spent on tyingup premises which do not fit the facts of the case. One of the most prevalent defects of judgment is illustrated in thiscommon disability to select premises which fit the facts. Ignorance, emotional reasoning, and a defective critical sense probably explainmost 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 hardenough to justify adding this burden to my digestive apparatus; besidesonly hard workers with their muscles can afford to eat many sweets. Theycause an overacid condition when taken in excess; and any except atmealtimes 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, oneswhich 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 ifit works. Some few centuries ago supposedly wise men called Christopher Columbus afool. 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 beround, like a ball, as that mad man claimed, then the waters must reachfrom Europe 'round the sphere and touch Asia; or there might be landout there beyond the ocean's curve. But it wasn't round, and the idea offinding a new way to Asia by sailing in the opposite direction was afool's delusion. Their logic was perfect. If the earth was flat, and Asia lay east ofEurope, it was madness to sail west to reach it. But they argued from awrong premise, so their judgment was imperfect--for they did not yetknow the facts. The result of all reasoning is judgment. And judgment is good as thematerials of the reasoning process correspond to facts, or are in linewith the most probable of the yet unknown. It is poor as the reasoningmaterial fails to meet the facts, or is out of harmony with the mostprobable of the yet unproved. It is of no avail, then, to attempt to improve our final judgments assuch. We must examine the materials we reason with, then learn to groupand compare them logically. And in the very separating of true premisesfrom false, we use and train the judgment we would improve. And this thenormal mind can do. REACTION PROPORTIONED TO STIMULI In the normal mind the emotional or feeling accompaniment of thought andaction is proportionate and adequate to the circumstances, _i.  e. _, there is a certain feeling, of a certain strength, natural to everythought and act; and when only that strength, not more or less, accompanies the thought or the act, we say, "That man is emotionallystable. His mind is normally balanced. " Joy naturally follows some stimuli; sorrow others. Disappointment orloss, shock, failure, death of loved ones, illness in ourselves orothers, 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 thenormal feeling of shock, grief, and loss; and this may be normal. Butnormal volition does not force us to laugh and dance and be wildly merryin the face of grief and loss and pain. It only suggests the adequate, reasonable acceptance of the facts that cannot be changed--theacceptance of love, faith, and hope that sees in present suffering ameans of consecration to service; it does not convert the emotion ofsorrow and loss into a pleasurable one. Normal reason does not suggestthat _will_ force the reactions to loss and suffering that belong bynature to attainment and success. Nor does reason suggest the long face, the bitter tears, a storm ofanger, in response to comedy and farce, in the face of a good joke, orto meet success; and normal will puts reason's counsel into effect. NORMAL EMOTIONAL REACTIONS Some emotions, that seem exaggerated at first thought, may be normalunder the circumstances. For no one can know the whole background foremotional response in the life of another. After being long shut up in adarkened room, with bandaged eyes and aching head and sick body, thefirst visit to the bit of woods back of the house--when all the painshave gone--may bring almost delirious joy. The green of the foliage, theblue of the sky, the arousing tang of the air, the birds, the sense offreedom--all go to the head like new wine. The abandon of joy is anormal response under the circumstances, now. It would hardly be normalto one whose habit it is to visit this same bit of woods every day, toone 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 notgratified, the denial of a desired stick of candy is as great a calamityas is the loss of a fortune to the grown man. And the child reacts tofeeling 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 resultsthat will stand the test of conformity to reality; the normal mind usesreason 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 thoughtand every action. And in the well-balanced man or woman every functionof the mind leads to action as its final end. But man only approximates the normal. The perfectly balanced man orwoman is so rare as to be a marked person. The average intelligentindividual only in general approximates this standard. He goes beyond itin spurts of untrammeled genius, to wrench lightning from the heavens, and to send his trains through the air; or he allows his feelings todictate to his reason, and much of the time so exaggerates ordepreciates the simple facts of life that the results of his reasoningno longer conform sufficiently to reality as to be thoroughlydependable. CHAPTER VII PSYCHOLOGY AND HEALTH In the use of its functions the mind manifests certain powers andcertain modes of expression which can act as powerful allies or asdamaging enemies of health. We speak of man as adaptable, but also as abeing of habits. We speak of him as "feeling" when we wish to expressthe fact that his emotions influence his body. We expect of the averageman a certain amount of suggestibility. We say that he is tremendouslyaffected by his environment, which simply means that his attention, naturally centered chiefly on the things at hand, largely determineswhat he is. But we recognize that a man of trained mind can choose andwill to substitute for his present surroundings thoughts upon moreconstructive things from past experience, or from future possibilities, or from within the mind's own storehouse. His ability to largely modifyhis life by his will, we recognize as man's greatest power. _Adaptability_, emotional response, _suggestibility_, _attention_, _thought-substitution_, _habit-formation_, and _will_ can ministervitally 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; andhealth of mind as well as health of body is determined by the individualability to adjust himself to environment. There are dreamers who have lived in their ideal world so long that theycannot meet the stern realities of life when they come. The shock is toogreat for the mind that has accepted only the fantastic, the real as thedreamer 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 asunchangeable fate, lose all their true ideals and become cynical, orvictims of utter depression for whom life holds nothing that matters. Still others go on through the years self-satisfied and serene becausethey simply refuse to believe unpleasant truths; they "pretend" thattheir wishes are realities, and acknowledge as facts only the pleasantthings of existence. The first two groups have failed to adapt self tolife as it is, and the mind is lost or so damaged as to no longer serveits body properly. The "pretenders" have adjusted themselves, and solong as they can remain happily self-deceived all goes well for them, though they complicate living for others. However, they have made anadaptation, a defective one, it is true, but one through which the mindmay survive. Some of this class, however, finally build up a more andmore elaborate system of self-deception until they, too, are insane. The practically adaptable man can dream dreams, but always recognizesthem as dreams, and can stop at will; can vision a beautiful ideal, butcomprehends that it is not yet reality, though it may some time becomeso if he learns and fulfils the laws leading to its realization. Theadaptable man or woman recognizes the real as fact, desirable orotherwise, the fantastic as unreal and only to be indulged in as apastime, and the ideal as the possible, a thing for which to work andsacrifice. So perfect adaptability would mean perfect mental poise. It is for the nurse to realize that the greater number of her patientsdo not belong to any of these classes absolutely, but that some of themhave tendencies leading in these various directions. And it is herprivilege to recognize the trend of her sick patient's mental workings, and to so deftly and unobtrusively encourage the recognition of facts asthings which are to be used--not as stumbling-blocks--that her mentalnursing, as her physical, shall be directed toward health. She canhelp her patient to accept illness and suffering as realities to befaced, and treatment as a means, whether pleasant or not, of making itpossible for health to replace them. The understanding nurse canactively help her charge one step at a time toward adaptation to the newenvironment, remembering that many of the sick, particularly thedepressed, cannot be encouraged or incited to effort by having futurehealth held out to them. They are capable only of living in the presentand doubting all the future. _There Can Be No Neurosis Without a Psychosis. _--If the brain is theorgan of the mind, then what affects the brain must perforce be atleast registered by mind. So every physical shock, accident, toxiccondition, infection--even the ordinary cold--rouses the mind at leastto awareness, usually to discomfort. For the nerve-cells andfibers--those inseparable parts of the body mechanism--speedily reportthe fact that they are being tampered with. In the toxicity of theinfections these very delicate tissues are nourished by toxic fluids;in accidents they carry all the messages from the injured part. Thenthe brain--that center of all man's reactions and the organ of all hisconsciousness--receives the report of the disturbance and translatesit into terms of more or less disability. The neurosis has become apsychosis. The physical condition has become a mental discomfort. Normally this ensuing mind state should be in accordance with theextent of the injury to the nerve-cells and fibers. But underlong-continued discipline, or influenced by emotion, the consciousmind may not recognize the neurosis; whereas, in the hypersuggestible, consciousness will translate it into entirely disproportionatesuffering. A great problem of nervous education is what the mind will do withdiscomfort or pain. Will it put all its attention there and respond withnervousness, irritability, demand for sympathy; or will it relegate allthe minor pains to their own little places, accepted as facts but to bedisregarded except in so far as actual treatment is needed? Will it turnto attend to the host of other more desirable objects? Or in case ofacute suffering, will it take it as a challenge to endurance? Will ituse it as a means to strengthen volition, as a stepping-stone toself-mastery? Realizing the force of the law--no neurosis without a psychosis--thenurse will try to eliminate unnecessary irritations to physical comfort, while she helps the patient to adjust himself to the ones which areinevitable. It is the doctor's problem rather than hers, except as shecarefully fulfils orders, to eliminate the toxic causes of psychosis. Itis hers to help the patient to meet adequately the effects of theinfections or toxins, and to prevent as far as possible the surrender touncontrolled nervousness. Her object is to have him face the psychosisas one of the simple facts of science, then turn the sick mind'sattention to more important things; she would encourage _will_ to forceendurance; she would stimulate the feeling life to the forward look ofconfidence and faith, or to acceptance of life's suffering as achallenge. The nurse knows that pains beyond the power of endurance thedoctor will lighten. And the patient's reaction to discomfort andsuffering, the understanding nurse, without any preaching, can verylargely 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, wecall it autosuggestion. Many of the sick are temporarily resting their reasoning faculties andtheir 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 suggestsimmediate nervous reactions. The mind does not wait to weigh them. Thenervous system reacts to them the second the impression is registered. The whole self is oversensitive, and the very inflection of a voice hasenormous significance. Let the nurse remember that her way of giving atreatment, her expression, or her very presence becomes a potentstimulus on the second, one to which the patient's mind responds like aflash-light when the button is pressed. The nurse must comprehend the principle of the nervous effect on thepatient of all that is done and said, and realize her tremendousprivilege in making those stimuli wholesome. The nurse who has asympathetic insight, with unswerving loyalty to orders, can carry themout with the average patient, unpleasant though they may be to him, insuch a way that his wholesome emotional response will be called forth, aresponse of co-operation, or of faith or of good breeding, or of"downing" the impulse to indulgence; or a response directed towardholding the nurse's interest and attention, and so keeping her in theroom; 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 tobe moved by logic, or to respond with customary grace to a request whichtheir reason is not awake to answer. All usual suggestions may fail ofeffect. 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 usethis only as a last resort, of course, and in accordance with thedoctor's orders, and then solely as treatment leading toward the ways ofhealth. Before turning to this final method she should clearly, firmly, and kindly explain the principle of the discipline if the patient's mindis at all capable of grasping it. In any case, force should be used onlyas 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 neededresults. But force, thus limited in its application, may prove the onlysuggestion which will bring about the action necessary to health on thepart of the patient. Force unwisely and unkindly used proves a damagingsuggestion, causing reactions of fear or anger; or it may lead todelusions of persecution and to strengthened resistance. Many suggestions come to the patient from within. Discomfort in theright side may suggest appendicitis. A slight indigestion, often purelynervous, may be interpreted as inability to care for certain diet, etc. The wise nurse will displace as many of these as she can by casualsuggestions on her own part. She will demand of herself that her verypresence be quieting, calming, happy; that her conversation with herpatient shall vibrate with a certain something that gives him courageand strengthens the desire and the will to health; that her care of himshall prove confidence-breeding. The patient's attitude, when he is atall suggestible, is largely in the nurse's hands, and she can make hisillness a calamity by dishonest, fear-breeding, or suspicion-formingsuggestion. After all, the whole question here is one of the normalityof the nurse's own outlook on life and people. The happier, truer, andmore wholesome it is, the more really can she help her patient to bothbodily and mental health. Of one thing let the overzealous nurse beware. Do not irritate your patient by a patent, blatant, hollow cheerfulnessthat any one of any sense knows is assumed for his benefit. Personally Iknow of no more aggravating stimulus. _What We Attend To Determines What We Are. _--This is one of the firstlaws of education. If the child's attention from birth could becontrolled, his future would be absolutely assured. But attention is athing of free will and cannot be forced by others. It can be won throughinterest or self-directed by will. The child's attention is entirelydetermined by interest, interest in the morbid and painful as truly asin the bright and happy. Punishment interests him tremendously becauseit affects him, it interferes with his plan of life, it holds his entireimmediate attention to his injured self. But something more impellingquickly makes him forget his hurt feelings and he is happy again. Theaverage sick person is emotionally very much like the child. His will atthe time, as we noted before, is tempted to take a rest, and hisinterest is ready to follow bodily feeling unless something moreimpelling is offered. The nurse who can direct attention to otherpeople, to analyzing the sounds of the street, to understandingsomething of the new life of a hospital or sick room, to planning ahouse, or choosing its furniture or equipping a library, or supplying astore; to intelligent references to books or current events; or toredecorating the room--all in his mind; to an appetizing tray, a daintyflower, a bit of sunshine, a picture, etc. , is fixing the patient'sattention on something constructive, helping him to get well byforgetting to think of himself. Thus the nurse, knowing the laws of attention, can keep herself alert todivert and direct her patient's thought to wholesome interests. Knowingthe possibility of thought substitution, she can open up new channelsof thinking. Knowing the power of the will to assist in health bringingand health keeping, she can sometimes stimulate long-dormantdetermination. Let her beware, however, of making the convalescent toodependent upon help from without, but prick his pride to graduallyincreasing doing for himself. Arouse his reasonable ambition, but lethim realize that life must be taken up again a step at a time; and thathe _can_ do it. If limitations must be accepted, try to inspire thefeeling of pride in accomplishing the utmost possible within alimitation, and an acceptance of the inevitable without bitterness. Attending to the unhappy, the painful, the boring without looking beyondmakes life unhappy, painful, and a bore. Not that the nurse shouldignore these realities, but she can accept them whole-souledly herselfas not the final things, as merely the rocks that can be used to standupon and get a view of the something better for everybody. When they arethus used by the wholesome mind, facts, the very barest and meanest ofthem, can be made useful as stepping-stones to the happier facts beyondthem. If the nurse can direct or tactfully lead the patient's attention awayfrom himself and his illness, she has found a big reinforcement to histreatment. This question is so vital in the care of patients that itwill be discussed at greater length later on. ONE THOUGHT CAN BE REPLACED BY ANOTHER If we control attention we control thought, and with the suggestiblepatient this principle depends upon the one just now considered. Hopeand courage-breeding thoughts can replace despairing and fearful ones, but it will be only when attention is directed through interest or bywill to new material. There is no blank in waking consciousness. Thelast thought or feeling or perception, through association of ideas, brings up a related one, and so on indefinitely. We may start with apebble on the road and go on logically, smoothly, until in five minuteswe are thinking of the coronation of King George, with no sense ofanything at all unusual in the succession. It may be a very roundaboutprocess, from "pebble" through "rough way, " "ways that hurt, " "dangerousways, " "brigands, " "uncertainties of life. " "Uncertain lies the headthat wears a crown, " "King George and his crown, " "coronation. " But thisconstant stream of thought can be broken into at any point by a spokenword, a passing vehicle, which diverts the mind's trend. So the nursecan take advantage of the mind's very suggestibility, and substitute forthe unhappy and sickness breeding by turning attention to anything elseof a happier color, and may divert the entire stream of thought in thatdirection. She who knows these simple laws of the mind, and who at allknows 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 waythrough untrodden forests. It is easier to walk after we "learn how, "and learning how is simply doing it over and over until the legs andfeet have acquired habits of motion and accommodation to distances andto what is underfoot. It is easy to do anything after we have done itagain and again, so that it has become second-nature, and"second-nature" is habit. The wise man early forms certain habits ofpersonal care, of eating, sleeping, exercising; of study, of meeting theusual occurrences of life. The first day he spent at anything new was ahard one. Nothing was done naturally. Active attention had to be keenlyheld to each detail. He had to learn where things belonged, how to dothis 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-bathyou gave, the first massage? You had to be taught bit by bit, detail bydetail. You did not look upon the finished whole, but gave almostpainful attention to each step that led to the made bed, the completedbath, or the given massage. Your fingers were probably all thumbs unlessyou had experience in such things before you came to the hospital. Yourmind was tired from the strain of trying to remember each suggestion ofyour instructor. The second time, or certainly the third or fourth time, it went better. After a week of daily experience you gave the bath ormassage or made the bed with much less effort. A month later the workwas practically automatic and accomplished in a fraction of the time youspent on it that first day. Now you can do it quickly and well withlittle conscious thought; and at the same time carry on a briskconversation with your patient or think out your work for the day. Yourmind is free for other thoughts while you perform the task easily andperfectly. Your method of doing the work has finally become a habitwhich saves the effort of conscious attention. The details of yourroutine work are directed by the subconscious. The habit will be energyand time saving in proportion to the accuracy of your first consciousefforts spent on the new undertaking. Thus, useful habit is the resultof active effort. We can acquire habits of thinking and habits of feeling as well ashabits of doing. But the other habits, the bad ones, are not acquired with effort. Wefall into them. Hazy thinking is easier than clear thinking. Suppose youare by nature rather oversanguine or overdespondent, and you make nogenuine attempt to evolve that nature into poise. Directing _will_ to dowhat _desire_ opposes is too difficult, and you go the way of leastresistance. So easily are the bad habits formed; but only withtremendous effort of will and persistence in refusing their insistentdemands can they be broken or replaced by helpful ones. But habits can be learned; and bad habits can be broken when anoverpowering emotion is aroused against them, possesses the mind, andcontrols the will; or when reason weighs them in the balance andjudgment finds them wanting, and volition directs the mind to displacethem by others. The nurse meets in her patients numberless habits which retard recoveryof body and make for an unwholesome mental attitude. Some patients havethe complaint habit, some the irritation habit, some the self-protectionhabit, some the habit of impatience, some of reckless expression ofdespair, some of loss of control, some of incessant self-attention. Thenurse who can arouse an incentive to habits of cheer expression when theleast cause of cheer appears, who can by reason, or if that is notpossible, by suggestion; by holding out incentives, or by making someprivilege depend upon control--this nurse can help her patient todisplace habits of an illness-accepting mind by habits of ahealth-accepting one. Above all, let her beware of opening the way tohabits of invalidism. Some people acquire the "hospital habit" becauseit is easier to give way to ill-feeling, however slight, and to be caredfor with comfort, than to encourage themselves to build up endurance bygiving little attention to minor ailments. THE SAVING POWER OF WILL It is not uncommon to hear a doctor say, "Nothing but his will pulledhim through that time. " It does not mean quite what it says, for thepatient's will would have been helpless to cure him without the medicineand the treatment. But it does mean that in some cases when life ishovering on the brink, even the most skilful treatment cannot hold itback 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. Forthe influence of will in refusing to surrender to depression may throwthe needed hair's weight in favor of more normal circulation. Depressionand emotion may so effect the sympathetic nervous system as to cause alowered circulatory activity. Determination, based on volition, maystimulate a response from the sympathetic system which will increaseheart activity. And certainly, when it is not a matter of life anddeath, but a prolonged recovery, will is a saving grace. The patient whosets all his sick energies to the task of winning health reaches hisgoal quicker than the hopeless and depressed. Perhaps his will merelybrings utter relaxation for the time, forces acceptance of presenthelplessness only for the sake of giving the body a better chance torecuperate; but the very fact that it is acting to hopefully carry outorders lightens by half the nurse's task of getting him well; and shecan encourage this will to co-operate with the doctor's efforts bysuggestion, by her directness and honesty, by the quiet assurance thatat 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 canhelp develop saving mental habits and wholesome attitudes while shehelps to strengthen sick bodies; she can make a cure a little morecertainly 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 alwaysworked right. But this is peculiarly subject to damage both from withoutand 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 thealcohol-produced psychoses, such as acute alcoholic hallucinosis; bylack of muscular exercise, resulting in a deficient supply of oxygen toburn up the accumulated toxins from energy-producing foods; by theinfections, which may result in the infection-exhaustion psychoses;by wrong methods of education, and by surroundings which demand toosevere a mental strain in the struggle toward adjustment. These damagesfrom 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 ofwrong methods of education; by defective heredity; by undeveloped will;by the insanities. These danger sources from within we might classify asself-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 commonlymet 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 everydeparture from the normal mental attitude tends to associate itself withone 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 thesenses. _Perversion_ is morbid alteration of function which may occur inemotional, 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 faultysense organ, or to a preconceived state of mind which so stronglyexpects or presages something else than reality as to misinterpret whatthe 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 hismind's creation into the outer world, and accepts them as reality. Hesees snakes where there is nothing to suggest them; sees a ghost wherethere is no shadow; believes that the taste of blood is constantly inhis mouth. There are possible hallucinations of every sense. Nonexistent objectsare seen, touched, tasted, heard, or smelled. _Hypochondriasis_ is a state characterized by persistent ideas ofnon-existent physical disabilities. The hypochondriac has every known symptom of indigestion, or of heartdisease, or is threatened with tuberculosis--all in his mind; andwhatever the disorder he seizes upon, his attention hovers there, whilethe 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 ofexperience that expression is swift and often incoherent. One word willfollow another with amazing rapidity, words suggested by soundassociation, usually, rather than by that of meaning. Example: "Made a rhyme, had a dime, did a crime, got the time, bringsome lime. " This association by rhyme is quite common. But theassociations of meaning are not uncommon. Example: "Made a rhyme. Mary was a poet. Mary had a little lamb. Where'sMary?--Mary!--No Jim--Jim, all my children--calling, calling, calling, "etc. A _fixed idea_ is one which morbidly stays in the mind and cannot bechanged by reason. Example: In hypochondriasis, as given above. _Ideogenous pains_ are either pains born of an erroneous idea, or mentalreproductions of pains now having no physical cause. A suggestible person, learning that his grandfather died of an organicheart, conceives the idea that he has inherited the trouble, and beginsto suffer cardiac pains; and as long as the idea persists the pain isfelt. _Compulsive ideas_ are ideas which intrude, recur, and persist despitereason and will. Example: The compulsive idea of contamination may lead its victim towash 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, oridentity. _Amnesia_ is pathologic forgetfulness. Example: As sometimes found in the infection-exhaustion psychoses, whenthe entire past of the patient may be wiped out for the time. Cases ofpermanent amnesia are known. _Aphasia_ is a defect in the interpretation or production of language. There may be motor aphasia, auditory aphasia, vocal aphasia, sightaphasia; and with disability to produce words, they may yet berecognized when seen; or when they can be spoken they may not berecognized when heard; or with inability to speak them, they areaccurately sensed by hearing; or though understood when heard, they areincomprehensible 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 ortheir 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 individualbelieves himself an object of written, spoken, or implied comment. Example: The actors on the stage are directing their remarks directlyagainst the victim in the box. A _shut-in personality_ is one that habitually responds inadequately tonormal social appeal. _Sense of unreality_ is one of the commonest psychic alterations throughwhich customary sensation states are displaced by unnatural and usuallydistressing 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 orfeeling; the desire to explain is there, but will is blocked in action. Or the patient attempts to dress, makes repeated new beginnings, butcannot succeed. We say, "He is inhibited. " An _obsession_ is an idea which morbidly dominates the mind, constantlysuggesting irrational action. Obsessed patients may consistently step in such a way as to avoid thejuncture of the flagstones on the pavement; may insist on removing theirshoes in church; may hail each person met on the street and tap him onthe arm; may refuse to ever leave the house without an open umbrella; ormay try to attack every man they see, not because they want to hurt orkill, but because they are obsessed to the performance of the action. A _tic_ is a useless, habitual spasm of a muscle imitating a oncepurposeful action. Motor tics, such as habitual jerking of the arms, shrugging theshoulder, contorting the face, shaking or nodding the head, snapping thefingers, etc. , are very common among nervous children, and even in manyotherwise normal grown-ups. _Distractibility_ is an abnormal variation of attention. The common inability of the hypomanic patient to hold his attention toany subject when another is open, is very like the distractibility ofthe child who turns to every new interest as it is presented. _Negativism_ is a state of persistent compulsion to contrary response tosuggestion. It is with these patients as though not only initiative were lost butalso the power to follow another's lead. But their independence assertsitself in opposing every suggestion and in acting so far as possiblecontrary to it. _Mutism_, as used in psychiatry, is an abnormal inhibition to speech. Patients sometimes speak no word in many months. To all appearance theyare true mutes. Then suddenly something may remove the mental blockadeand they talk. _Compulsive acts_ are acts contrary to reason, which the will cannotprevent. A seemingly quite normal patient will sometimes grab a vase from a standin 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, notin 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 inwhich consciousness is dulled and the body sluggish. A _neurosis_ is a disorder of the nerves, which may be functional ororganic. _Nervousness_ is properly termed a _psychoneurosis_--for we havelearned 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 donot yet so dominate reactions as to make them irrational. Twilight is neither night nor day; the feelings of the hysteric are notinsane, but the actions may be. _Insanity_ is a prolonged departure from the individual's normalstandard of thinking, feeling, and acting. _Mania_ is insane excitement. _Melancholia_ is the inability of the mind to react to any stimulus withother 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 hischildren, that he is a criminal beyond the power of God to redeem, whoseems chained to his delusions, yet shows no adequate feeling reaction, no genuine sorrow, we call a case of the intellectual type ofmelancholia. Another patient misinterprets every normal reason forhappiness 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 havedied in France. She is of the emotional type of melancholia. _Hysteria_ is a nervous disorder based upon suggestibility, and capableof imitating most known diseases. _Insane impulses_ are morbid demands for reckless action beyond thecontrol 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 anhereditary tendency on the part of the individual to mental disorder. The _neuropath_ is the individual with an inborn tendency to theneurosis. _Neurotic_ is a term broadly employed for the nervous in whom emotionspredominate over reason. _Neurasthenia_ is a nervous disorder characterized by unduefatiguability. _Psychasthenia_ is a nervous disorder characterized by a sense ofunreality, weakness of will, self-accusation, and usually by phobias andobsessions, all subject to temporary correction by reason or influencefrom without. _Hypochondriasis_ is a disorder characterized by morbid attention tobodily 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 thefamily tree of almost any one of us can show, the wonder is not thatthere are so many nervous or insane, but rather that any come withinhailing distance of the normal. For multitudes are born of parents whosebodies were food poisoned or alcohol or drug poisoned, and whose nervoussystems were tense and irritable, oversensitive, and suffering from theeffect of these same toxins on the brain. Others are of manic-depressiveparentage; some are possibly even of paranoic or dementia præcoxlineage; while many of our finest and best had psychopathic orneuropathic heredity. Syphilis, itself, and the underpower bodies oftuberculosis are heritages of many. When we realize, too, that we are born with certain inherent tendenciesof temperament, which are too often of the melancholic or overcholerictype, our wonder grows that we are not doomed to defeat at birth. Wereit not for the possibilities in the germ-plasm of choosing the much ofgood also in our heredity, often enough to overbalance the bad, and forthe proved power of environment and training to modify or evenaltogether overcome the harmful parts of our birthright, there would belittle hope for many. ENVIRONMENT While environment may prove the saving grace from poor heredity, it mayitself add heavily to the debit side. With the very best of healthbackgrounds, environment may damage body and mind beyond repair. Underenvironment we include everything that touches life fromwithout--people, things, work, play, home, school, social life, businesslife, college-life, etc. Among factors of environment damaging to mentalhealth are overemotional family life, overstrict home discipline or thelack of needed discipline; overfeeding, underfeeding, wrong diet, lackof 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, badtendencies in heredity, or in environment, or in both, and keep areasonably balanced mind? It demands insight, ambition, will; and ifthese remain the body can be forced to saving ways of health, and bodyand mind can largely make their own environment. But with heavyhandicaps of heredity or environment, or both, and poor insight, or lackof desire, or weak will, nothing can save the mind from neurotic taintor worse--nothing but obedience to some one strong enough to control thehabits of that life, until self-control is born. And there is a hopethat it _can_ be born in the most neurotic or neurasthenic, so long asthe mind is sane. But after all, a large number of people whose mental processes are notnormal, have only themselves, their poor emotions, their lazy wills, their hazy thinking to blame. We except what are called the heredityinsanities--_dementia præcox_ and the other dementias and the_manic-depressive_ groups and _paranoia_ and _psychasthenia_--for inthese cases, possibly with the exception of the _manic depressives_, even the most perfect environment could probably not prevent thedisorder from asserting itself. Many neurotics, neurasthenics, andhysterics are curable if they will seriously undertake to fulfil thelaws of physical and mental health--simple laws, but ones which demand astrengthened 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 willto the unappealing, with the usual result of transforming it into athing of interest. One of the laws of the mind we have already stressed is that what weattend to largely determines what we are, or shall be. The interestswhich secure our consideration may be the passive result of emotionallife, the things which naturally appeal, which give us sensations thatthe mind normally heeds; or they may be the active result of our willwhich has forced application upon the things which reason advised asworth acquiring. We found that the beginning of health of mind consists in the directingof thought toward the health-bringing attitude. We have seen how quicklythe normal mind can be diverted from the undesirable by a new orstronger emotional stimulus. We found that the sole appeal to attentionin the baby-life is through the emotions, and that it is naturalthroughout life for the mind to heed and follow the interesting; whichis only another way of saying that thinking follows where emotion leads, unless volition steps in to prevent. The supreme test of the will'spower is its ability to hold the train of thought in the line thatreason directs, when feeling would draw it elsewhere. This ability marksthe man who does big things; while the inability to ever turn attentionaway from the interests proposed by feeling assures weakness. Some of the most charming people we shall ever know are thosetemperamental children of happiness whose interests are naturallywholesome and externalized, whose natures are spontaneous and joyous, and who live as they feel, seemingly never knowing the stress of forcedconcentration. With them attention follows feeling, feeling is sweet andtrue, and volition simply carries out what feeling dictates. And lifemay not be complicated. But there is another class whose attention also follows in the ways ofleast resistance; and life for them is a wallowing in the morbid andunwholesome. In them feeling is perverted, they seem to see lifehabitually through dark glasses; they passively attend to the sad, thedistressing, sometimes the gruesome and the horrible with a sort ofpallid joy in their own discolored images. The first group puts joy inall they see, because they are brimming full of joy themselves. Theseothers find only the unwholesome in life because their minds arestorehouses 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 worldthey only feel and have never attempted to comprehend. The irresponsiblyhappy ones are too often crushed and broken when life proves to bringloss and failure and disappointment; the morbid probably will cease someday to enjoy their melancholic moods, and be unable to find their wayout of them. If both had learned to control attention, they might havebeen saved. The happy, care-free child of the light is at desperate losswhen the sun he loves is obscured, if he has not learned to look uponthe far side of the clouds to find that there they glow golden with therays temporarily shut from him. Because clouds were not interesting tohim 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, inthe end might have seen with sane eyes and lived so wholesomely as tofind all the good there was in life. Willed attention, rather thanspineless feeling distractibility, might have saved him. When thinking can be forced to follow where trained reason directs, andcan be kept in that direction, the greatest problem of physical andnervous well being is solved. To the nurse there is no other principleof psychology so important. But no child ever had his attentiondiverted by reasoning alone. The object at which you wish him to lookmust be made more impelling than the one he already sees, or he mustwant much to please you, else he only with his eyes will follow yourcommand while his mind returns to his real interest; and the second youcease to command that eye service, he looks back to the thing that washolding 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 isnot good for me. Milk is what I should have. I don't want it. You maydeprive me of the candy and force me to drink the milk, and I can donothing but submit. But I rebel within, and I am only more convincedthat I "hate" it and want candy, and that you are my natural enemybecause you force the one upon me and deprive me of the other. If I wereinsane and so, of course, could not be reasoned with, this might beinevitable. But it would be unfortunate. In that case, if possible, donot let me see the candy; let only the food it is best for me to have beput before me, and perhaps eventually I shall come to want the morewholesome thing--for it is better than the hunger. But as it happens I am a perfectly normal person, only I am sick. I amtired of bed, and want to sit up--and it does seem that I should have mydesire. 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 fromthe immediate "I want" to something which I also can be led to want. Imay agree that I want more the better feeling an hour from now. Perhapsher humorous picture of the effects of too early freedom on mycondition, or of my body's urgent demand for rest, regardless of mymind'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 beread or told; or simply the poise and quiet assurance of the nurse whonever questions my reasonableness and acquiescence; perhaps herconfidence that this will serve as a means to the end I covet--willresult in my gladly taking her advice, and my perfect willingness towait for new orders, while I indulge in beautiful plans I shall carryout when they finally arrive. In other words, with the sick as with children, attention naturallyfollows interest. And the good nurse realizes that it is not wise toforce co-operation when she can secure it by diverting her patient'sthoughts to another interest than the one now holding him. Very often, merely by chatting quietly about something she has learned has anappeal, she can make the patient forget his weariness and boredom, orhis resistance to details of treatment. The very milk he is refusing todrink may be down before he realizes it. But right here lies a hiddenreef which may cause wreckage in the future. It is good therapy todivert attention by appealing to another interest when the patient istoo sick or too stubborn or not clear enough mentally to be reasonedwith. But if this becomes a principle, and his reason and activeco-operation are never secured to make him choose the way of health forhimself, the hour he is out of the nurse's hands he reverts to thethings that now happen to appeal to him. Then unless some wise friend isnear to continue her method of making the reasonable interesting, theadvice of reason can "go to smash. " There has been a very constant illustration throughout the past of theunwisdom of relying upon diverted attention alone as an effectivetherapeutic agent. We hope this will not illustrate our point so clearlyin the future. The drunkard, who is just recovering from a big spree, and feels sick and disgusted with himself, and sore and ashamed, isappealed to in glowing terms of the wellness and strength and buoyancyof the man who never drinks. He has no "mornings after. " The Lord isjust waiting to save this dejected victim of alcohol from his hatefulenemy who has made him what he is at this hour, and will forgive all hissottishness, his sins. He will be respected; he can command the love ofhis family again. He will no longer be a slave, but a free man. Rightnow, respect of the world and love of family and friends, and cleanness, and the forgiveness of a good God are infinitely more interesting thanthis splitting headache, this horrible sick feeling. And attention maybe very readily diverted. This promised new life is more attractive thanthe present. It is easy to keep attention there. And he reforms. Heswears off "for keeps. " He is a happy man, a free man. For a few days orweeks, perhaps even longer, he glories in his new self-respect. It is astrange and enticing sensation. Then one day something goes wrong. Heloses some money, or he is awfully tired, or the wife and children borehim, and all of a sudden the one greatest interest in the world is adrink. And because his thinking can always be led by his feeling;because he has never learned to force it to go elsewhere, he has hisdrink. Appealing to his emotions did not and cannot save him unless thatappeal is followed at the right moment by awakened reason, which willlook at the whole proposition when the mind is at its normal best, andchoose to follow where rational feeling directs. Nor will reason saveunless volition comes to its support and strongly backs it up andenforces what it advises. THE ATTENTION OF REASON AND WILL So the good nurse will not consider her work done when she has divertedmental processes into channels of co-operation. When the patient, who iscapable of reasoning, knows the why of his treatment, and realizes thathe can only keep well as he himself takes over the job and puts his mindon things outside of his feelings, and carries out the doctor'sinstructions for the sake of securing a certain end--then he has beenunder a good nurse. This wise helper never "preaches, " but makes thehealthy goal very desirable, stirs up an ambition to attain it, andprods the will to keep on after it despite anything feeling may say. This attitude on the part of the nurse presupposes that her ownattention, while with her patient, is upon him and upon securing hishealth, and not upon her tiredness, or boredom, or headache, or theparty tonight, or the man who has asked her to go to the theater withhim tomorrow. She, surely, must learn to direct her thoughts wherereason suggests, and to gain new interests through willed attention, oras a nurse she is less than second rate. Nor can she get the bestresults until she can turn with a single mind to the patient at hand asthe immediate problem to be solved. And probably neither nurse nordoctor does any better service, except in saving life itself, than inkeeping the patient from thinking constantly of himself and his ills. For it seems of little use to have made some people physically well, ifthey are to carry through prolonged years the curse of constantself-attention, self-centeredness, an ingrowing ego. There are a few simple laws of the mind hinging upon attention which aretoday being impressed upon teachers in every department, inkindergarten, public school, college, and university. And they are asnecessary to the nurse as to the teacher. Three of them we have alreadydiscussed: 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 makeof them: 4. The thing to which our chief attention is given becomes the mostimportant thing. Do not contradict this too quickly. Don't say that nursing gets yourchief consideration because it is, of necessity, your profession; butthat you love your music infinitely more, and look forward to thatthrough all your hours on duty. If this merely proves that music isdistracting your attention, you are doing your nursing as a means, andnot as an end; you give it probably all the attention necessary for goodwork, but your real desire is music. Your chief attention is directedtoward that goal. Hence music is to you the most important thing. Ifyour will is sufficiently trained to keep you from consciously thinkingof it, still you are dreaming of it and working for it. You may make avery good nurse, but you will never be as excellent a one as the womanfrom 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 onelike Miss X. " It only means that Miss X's main purpose in life hasalways been caring for the sick, while Miss Y's secondary concern isthat. There is a third, however, who may be sidetracked into nursing, but whose chiefest interest and attention in life has not been so much acertain profession or accomplishment, but a passion for people, with anability to enter into their lives understandingly. She may not care fornursing in itself. It is only accidental that her thoughts were turnedto it. But her liking for people makes it easier for her to concentrateattention on the details of nursing, as thereby she is fulfilling herlife's ambition in studying and serving human beings. She may be a realsuccess if she can only convince herself that this is her forte. If not, and she dreams of other fields of service, her concentration on thething at hand is not perfect enough for her to compete successfully withthe "born nurse. " Whatever it is, the thing that gets our chief attention is the mostimportant to us. It may be lack of appetite, or pain in the side, indigestion, general disability, discomfort, the mistreatment we oncereceived, the mistake we once made, or the sin we committed--whatever itis that holds our attention, it is the most absorbing and interestingthing in the universe, though it may be an utterly morbid interest, anunhappy 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 wayto divert her patient's attention from the disease-breeding stimulitoward the happy and wholesome ones. For the nurse herself in the care of patients let us draw someconclusions 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 inhealth. 3. Remember that overcrowding the mind defeats your purpose of makingone clear impression. 4. Win interest by any legitimate means to the next step toward thegoal, 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 andnot for our own that certain results must be obtained. Our work isusually in helping the doctor to get the best possibilities out of thematerial at hand, and we cannot hope to change the fabric. But we canhelp to repair it; we can sometimes influence the color and suggest somedetails of the pattern, or assist in the "making over" process; and whenthe fabric is substantial and beautiful we may assist in preventing itsmarring. So we may help to evolve a body-health and mind-health attitudefrom what seemed the wreckage of a disease-accepting mind; or we mayhave the great privilege of warding off the disease-accepting attitude. But always, in all our care of patients, let us not neglect or fail touse wisely this central fact of psychology; that anything that gainsattention, even for a moment, leaves its impress on the mind; that thedirection 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, presentconditions--mental and physical--and the aim of the life. That is, itdepends upon his inherited tendencies plus a unique personal something, plus all the facts of his environment and experience, plus what he livesfor. Richard and Jim both live in Philadelphia, Richard on Walnut Street andJim on Sansom Street. Richard's father is of the best Quaker stock, withhundreds of years of gentle and aristocratic ancestry behind him. Hefollowed his father and his grandfather into the profession of medicine, and is a well-known specialist, alert, keen, expert, and deservedlyhonored. He is at home in Greek and Latin, French, and the sciences. Heselects at a glance only the conservative best in art and music andliterature. His world is a gentleman's world, a scholar's world, and theworld of a scientist and a humanitarian. And Richard, his son, is trueto 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 notworking he is too "dead tired" for anything heavier than the SundaySupplement or perhaps the socialist club-rooms, where he talks about thedown-trodden working man and learns to hate the "idle" rich. He spendshis money on food and cheap shows and showy clothes. He talks loudly, eats ravenously, works hard, is honest, and wants something better forhis children than he and the "old woman" have had. His music is thestreet-organ, the movie piano, and the band--some of it excellenttoo--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 byside, go to Paris together. Richard may "have a fling" at Jim'samusements for the sake of playing the game and "seeing how the otherhalf lives" and all that--but before long we shall find him in thehigh-class theaters and restaurants, visiting the wonderful artcollections and libraries, riding in luxurious automobiles, and stayingin the best hotels he can find. And even though Jim may have savedRichard's life and Richard is eternally grateful, and loves Jim as a"dandy good scout, " their ways will inevitably drift apart when the onebig common interest of fighting together for a free world is over. Theywill always remember each other. Jim will decide that a "highbrow" canbe 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 inRichard's neighborhood and circle; and Richard is a fish out of water inJim's. The point of view of each has been largely determined by hisheredity and his environment. But suppose Jim isn't true to type. From the time he was a mereyoungster the ash-man life did not appeal to him. In school he liked thehighbrow crowd; he "took to" Latin and literature. He has a feeling ofvague disgust when he sees a vulgar picture, a shudder when thestreet-organ grinds. There is something in Jim different. He isn't intune with either his immediate heredity or his environment. Thecontribution from some remote ancestor has overbalanced the rest, andJim becomes a professional man. Or perhaps Richard breaks his father's heart. Instead of following thetrail already made, he cuts loose, frequents vulgar resorts, hates hisschool work, becomes a loafer and a bum--and, finally, a second-rate daylaborer. Again, what he is himself, his "vital spark" has been strongerthan 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 acquiredprejudices, hence altogether emotional rather than rational. We onlywith great difficulty see things through another man's eyes. Itnecessitates comprehending his background fully, and standing exactlywhere he stands, so mind and eyes can both look out from the sameconditions that confront him. And this is only possible for the man orwoman 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 isa great, good man. From your point of view he is wicked and cruel. Weare both honest in our emotion-directed opinions. Until you can know myfather as I know him, and I can know yours as you know him, we shallnever agree about them. But I _can_ learn to understand _why_ you feelas you do, and you _can_ learn to understand _why_ I feel as I do. I canput myself, in imagination, in your place, and see that other man as myfather, and pretty well grasp your point of view, and you can likewiseget mine. After all, the law is very simple. Each man is the result of the thingshe puts his attention chiefly upon; and he puts it naturally upon thethings which his forebears and his surroundings have held before him. The rare person and the trained person can assert the "vital spark" ofhis own personality and tear attention away from the easy direction andforce, and hold it somewhere else. So he can change his points of viewby learning that there are other vantage grounds which direct to betterresults. With some one else to lead the way and give a bit of help, orwith the urge of desire to understand the new viewpoint, or by the driveof his will, he can change his own. Let us not forget that what we see depends on whether or not our eyesare normal, on where we look, or on what kind of spectacles we wear. Twothings we can change--where we look, and the spectacles. If our eyeswere made wrong we probably cannot change that, but we can often correctpoor vision by right artificial lenses. There are people doomed to livein most unattractive, crowded surroundings who make a flower-garden ofcharm and sweetness there, or, without grounds, keep a window-box offragrance. The normal person can pretty largely either make the mostimpossible environment serve his ends or get into a better one. So wecan usually look to something constructive, helpful, attractive, orbeautiful; and we can refuse to wear blue spectacles. We nurses soon realize that there are just about as many points of viewas there are people, and that if we would help cure attitudes as well asbodies, and so lessen the tendency to sickness, it behooves us to learnto see what the other man sees through his eyes or by the use of hisglasses, from where he stands. Let us try just a few experiments. Hold your pain and suffering fromyour appendix operation, and disappointment because you can't bebridesmaid at your chum's wedding, up close to your eyes, and you cannotsee anything else. They crowd the whole field of vision. Look at theworld from the eyes of a spoiled woman of wealth who for twenty yearshas had husband, friends, and servants obedient to her every whim. Shehas grown selfish and demanding. What she has asked for, hitherto, hasbeen immediately forthcoming. Now she is ill, and she naturallyconsiders the doctors and nurses mere agents to secure her relief fromdiscomfort. She is willing to pay any price for that--and still she isallowed to suffer. From her point of view it is utterly unreasonable, inexcusable. What are hospitals and nurses for, anyway? And she iscarping, critical, and disagreeable. Her attitude is as sick as herbody. How could it be otherwise? Look about you from an aching mind and body, after days of suffering andsleeplessness, and unless you are a rare person and have a soul thatsees the sunshine back of everything--you will find the world a place oftorture. Look out from despair and loss of the ones you love best, orfrom failure of will to meet disaster, and everybody may be involved inbringing about your suffering, or in effecting your disgrace. Look out on the world from the eyes of the immigrant who has lost allhis illusions of the land where dollars grow on the street and whereeveryone has an equal chance to be president, and if you do not cringein abject humility, you are not unlikely to be insufferablyself-asserting, considering that the world has robbed you and that nowit is your turn to get all that is coming to you. So you make louddemands in a rude, ordering voice. The nurse is there to wait uponyou--and finally you will have your innings. Look out from the resentful eyes and smarting mind of the negro who isjust 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 asgood as anybody. You are impossible; but back of all your bravado andswagger and rudeness and complaint of neglect because of your color, yourealize that you cannot measure up. You know you belong to a differentrace, 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 youare 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 mindthere and let it work from the patient's point of view, will learn asaving sense of humor, will be strict without antagonizing, will clearaway a lot of mental clouds and help to make permanent the cure thetreatment brings. One can often judge very truly a patient's real character by hisreaction to his sickness. On the other hand, frequently it onlyindicates that he has not yet properly adapted himself to a newexperience and a trying one. We hear so often, "Why, she's a differentperson these days, since she's feeling better. It's a joy to do thingsfor her. " She was the same person a while back, but had not learned toaccept discomfort. Any of the following list of adjectives we hearapplied 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 wouldprobably merit them herself, she becomes more anxious to remove theconditions, and less bent upon blame. We must admit that the highest type person, when sick of any physicalillness, does not deserve such descriptive terms as these. But they arethe rare folks, few and far between; while the great mass of us have notacquired more than enough self-control and thoughtfulness for theordinary routine of life. We are weakly upset by the unexpected. If itis a pleasant unexpected, we are plus in our enthusiasm, and peopleapplaud; if the unpleasant unexpected, we fall short, and people deploreour weakness. If we learn our lesson of self-control and adaptability, and gain in beauty of character through experience, it has served apurpose. But the nurse deals with the average of human nature, and shefinds their reaction faulty. Very often, if she is observant, she willdiscover that a patient responds in a very different way to some othernurse, who somehow finds that "trying" sick woman charming orthoughtful, likable or sweet. Of course, it may be because the othernurse weakens discipline and caters to the patient's whims; but it isjust as likely to be because she has tempered her care and herstrictness with understanding. She has grasped the patient's point ofview; and with that start, the chances are 50 per cent. More in favor ofthe patient grasping and acceding to the wise nurse's point of view. Shall we not remember that our trying, cranky, stubborn patient is asick person, and learn to treat that stubbornness or crankiness as asymptom 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 nursemust deal are enhanced suggestibility, repression, oversensitiveness, stubbornness, fear, depression, and irritability. And each one demandsa different method of approach if real help is to be given. Old Isaac Walton wrote a book many, many years ago called "The CompleteAngler. " He was a famous amateur fisherman, and he says there are onlythree 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 wrongbait. When he knows all their little peculiarities, he will know how tocatch his fish. The "complete angler" has an unlimited patience and aninfinite sense of repose and calm. He never hurries the fish, lest theybecome suspicious of his bait. And he proves that these three ruleswork. The nurse who accepts every patient as like every other, and treats himaccordingly, will never be a great success. The nurse who "studies herfish" and learns their psychology, will be a therapeutic force. She willknow the _why_ of the way that patient acts. THE DELUDED PATIENT If the patient's mind is temporarily clouded through infection orsuffering, he may be reacting to a delusion, an obsession, a fixed ideaof disability, a terrifying fear. Sometimes he persistently refusesfood, and gives no reason for it. The unthinking nurse is tried, puzzled, and irritated. In other ways, perhaps, the patient seems quitenormal. But, after all, the explanation is very simple. He probably isas confident that the food is poisoned as you are that it is as itshould be. No arguing would convince him, for, to his mind, the nurse iseither a complete dupe or an agent of the people whom he knows areplotting his death. And urging him only strengthens his conviction. The writer recalls one such case of a patient who had to be tube fedthrough many months, though a tray was set before her three times aday--and as regularly refused. Then one day she was seen slipping foodfrom off another patient's tray and eating it greedily, not knowing shewas observed. When questioned, though she had never before given areason for refusing food served to her, she said that "they" had nothingagainst Mrs.  B. , so wouldn't try to poison her. Her reasoning wasexcellent when one accepted her premises. She had bitter enemies. Theywere not enemies of Mrs.  B. And would not harm Mrs.  B. Therefore shedare 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 worldwhose reality we do not appreciate. The nurse, after much experience, finds that there is a key to every resistance, to every lack ofco-operation, to abnormal attitudes and actions. She realizes that apowerful emotion of desire or fear, of love or hate, of ambition orself-depreciation, of hope or despair, of faith or distrust, uncheckedby reason or judgment through the years, has provided a soil upon whichemotional thinking alone can grow. The patient is a mere puppet of thesuggestions 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 patientout of his delusions, of trying to convince him that the things he seesand hears and perhaps tastes and feels, are but hallucinations. Her veryinsistence only fastens his attention more firmly upon the falseconclusion or makes him more convinced that his mind is giving him atrue 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 herway and holds her patient to his routine, consistently and confidently, as she would in case they were not true, will eventually cause him toquestion their reality just because no calamity results. The nurse actsas if these delusions and hallucinations were non-existent in reality, and when the occasion arises, through the patient's questioning, sheurges him to exert his will to act also as if they were not true; to tryit and see what happens. Arguing, also, she finds, usually antagonizesor makes the patient stubborn. He cannot prove by her logic his point, but he "knows" from inner experience that he sees what he sees, hearswhat he hears, and knows what he knows. The fact that the nurse doesnot is merely annoying evidence that she is blind, deaf, or stupid tothese 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 thathis internal organs are all wrong. He "feels" it and the nursecan't--therefore, he alone has true knowledge of it. In the end, thewise nurse who never disputes with him, but leads him on to action whichutterly disregards these things, may bring about a gradual conviction inthe patient's mind that a man couldn't do what he does if all thesethings were true; and the delusion slowly may lose its force or thehallucination fade away. Many patients drop them from their livesentirely. Many others in whom dementia is not indicated, or in whosecases it is indefinitely delayed, can come to an intellectualrealization that all these things are fantasies, and do not representreality; that despite their continued, frequent, or occasional demandsupon feeling life, they can be consistently ignored. These psychopathicindividuals may act as they would if the delusions never came henceforthto their consciousness, and so be enabled to live a comparatively normallife. THE OBSESSED PATIENT A patient who is suffering from obsessions must carry out certainabnormal actions, or be wretched. She cannot do otherwise. It is asthough she were forced by some outside agent, though the forcing isactually from within. When the nurse realizes this, and the moreessential fact--that many patients, who have not true obsessions, yethave a tendency toward obsessed ways of thinking and doing--when shecomprehends it almost as she would if she were the victim, then she isready to help the patient by gently making the action impossible, and atthe same time diverting attention. THE MIND A PREY TO FALSE ASSOCIATIONS Sometimes a nurse reminds a patient of some one in the past who hascomplicated her life in an unhappy way, so she distrusts or dreads heror is made constantly uncomfortable in her presence. In such a case, ifthe nurse reports her patient as resistive, or fearful or cringing, ordistrustful, she is really misrepresenting her; for under another's carethat patient may show an entirely opposite reaction. The nurse can only sense the strength of the influence of heredity andenvironment and habit of thought, which would give the explanation ofmany things in her patient's attitude. Nor can she realize just whatshade of meaning certain phrases and words have for her charge. To thenervously overwrought person the most innocent reference--father, sister, wife, home--may bring concepts that are unbearable. Theassociation of the word may make for deep unhappiness, of which thenurse knows nothing. But she _can_ learn that all these things _do_influence attitude, can appreciate the difficulty of her patient'seffort at adjustment, and do all in her power to make that adjustmentpossible. If the patient is reasonable she can appeal to her reason. Ifshe is too sick for that, the nurse can use happy suggestions. If themind is deluded and obsessed she can use firm kindness. She can learnwhat loss of privileges will affect the rude and unco-operative patient, and may be allowed to try that. She can sometimes help the patient toself-control by making her realize that after each outburst she will beconstructively ignored. But the point we wish to make is this: There are some sick reactionswhich the nurse, if she recognizes as such, can help the patient totransform into wholesome ones. At the very least the wise nurse canlearn to simplify her own difficulties by accepting the unpleasantpatient as possibly the result of her illness, and refusing to allow hertrying attitude to get on her nerves. The patient may be reactingnormally to the stimulus her untrained and toxic brain received. Andwhen the nurse can see into the other's mental workings, get her pointof 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 havethe same force as he who has never been seriously ill; but hisconstitution can be built up and made as efficient as possible withinits limitations. Many a man or woman who has an organic heart disorder, through treatment and the proper exercises gradually increased, can veryoften approximate through many years the output of a normally strongperson. The individual weakened by a tuberculous infection canfrequently, 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 intoa strong one; and in some cases, at best, it can never stand the samestrain that the uninjured one carries with ease. However, even damagedbodies can be made very productive within their limited spheres. Alsothe naturally perfect physique can quickly become unfit through neglector infections or misuse. In the same way, and just as definitely, can the mind be developed andstrengthened. Some are by nature keen, alert, brilliant. They maydevelop into masterfulness; or they, too, may degenerate, through abuse, or from the effect of body infections, into uselessness. The germ-plasmhas foreordained some individuals to psychic disorders; but training andmode of life can modify many of these defects. And the average mind, like the average physical organs, can be made more efficient throughpartaking of the proper mental food, through careful training and wiseuse. No more urgent necessity faces the professional woman than this oftraining her mind to its highest productiveness. Argument is not neededto convince intelligent people today that the accomplishment of lifedepends upon mentality. Let us look into the very A, B, C's of mind development, and as nursesundertake to equip ourselves to master our profession from the groundup. 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 obscurejudgment 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 atthe time of first introduction of a new fact or thought, and the linkingup of that new material with something already in consciousness, insuresin the normal mind the ability to remember and use that fact or thoughtagain. The things casually perceived and not definitely tied up withsomething else are soon forgotten by the conscious mind. You pass a florist shop where a score of different flowers and plantsare displayed. If your thoughts are intently on your errand you mayglance in, see flowers, color, perhaps a riot of colors only--andbeauty; and you feel a glow of pleasure from the sight. But a momentlater you cannot name the blooms in the window. Perhaps roses come tomind because you have very special feeling for them; or carnations, orsweet peas. But the window as a whole you perceive only as flowers, andcolor, and beauty. You cannot describe it in detail, for you gave itonly passive attention. But if you went to that window to know its contents; to find out whatthe florist had in his shop, because you are very interested in allflowers and plants, then you can tell minutely what is there. You had apurpose in perceiving the window; your will held attention upon eachobject in turn; and your love of flowers (an emotion) eased the effortof volition when it might have tired. Perception, then, is of three kinds: passive, incited by interest, anddirected by will. And the perception which is the basis of accurateknowledge 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 theway for accurate, deft service in her profession. There are constantmeans at hand for training in the art. Suppose you try to get sodefinite a picture of each ward or room you enter, in a swift butattentive examination of its furnishings and their locations, and of thepatients, that you can reproduce it to yourself or a friend some dayslater. You come into a large ward, with a row of beds on either side of thedoor, and a wide central space between. How many beds in each row? Thereis a table at the far end of the room, opposite the door, and a nurse inwhite is writing there. Why does she wear white? What is her name? Toyour right is a closet-like room opening from the ward. That is amedicine-room, you are told. How many windows has the ward? You glancefrom bed to bed with a rapid passing in review of the patients. Whichones seem to you very ill? There is a large white screen about one. Youare told that when treatments are given the screen is put there, or thatwhen a patient is dying the bed is screened. You look for theventilators, and see how many are open and how they work. You see aroom-thermometer, and ask at what temperature it is kept. The nurseexplains 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, accurateperception; 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 manypatients the wards accommodate, and how many beds are vacant. You candescribe the lighting and ventilation, the room temperature, etc. Andlater on you will quickly see to it that a screen is properly placedwhen you know treatments are to be given. ASSOCIATION OF IDEAS After the first few years of life practically nothing entersconsciousness that cannot by some likeness or contrast or kinship beconnected with something already there. Were it not for this savingeconomy memory would be helpless. So the nurse who is in earnest andeager to master her new work will not only perceive carefully eachdetail of arrangement, but in two or three days at most will know eachpatient there; she will have worked out a system of associations, remembering not a meaningless name, but an individual with certaincharacteristics which she ties up with her name, and so gives it adefinite personality. She thereafter recalls not merely a patient, but avery special patient; and as she comes to mind she brings a title withher, which is her symbol. Likewise when her name is spoken or thought, she herself comes into the nurse's immediate consciousness. A bed in acertain part of the room will be no longer merely a bed, butMrs.  Brown's bed. Remembering can be made easy by using some such methodas this: The first bed to the right as you enter is Mrs.  Meade's. She is thewoman with the broken hip. The next is Mrs.  Blake's, that blonde, bigwoman who wants more attention than any one else. The third isMrs.  Bunting's. She has wonderful, curling black hair, and a niceresponse 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 bythat. So each bed comes to mean a certain patient, and each patientcomes to suggest the ones on either side of her--her neighbors. Blondeness and bigness together call Mrs.  Blake to mind. Broken hipmeans Mrs.  Meade, etc. Each individual on that side of the ward becomesassociated with a name which stands for definite characteristics. Then you begin at the left bed nearest the door and follow the occupantsback on that side. You may remember better by jotting them down inorder of the beds, with names and a brief comment on each patient. Keepthat 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 anexcellent method. You are expected to be able to turn quickly to any medicines needed inemergency, and you soon learn to remember them and where they are placedby 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. Youlearn 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 thoseresponsible for the care of the sick. Learning to look closely at the patient's face, instead of casuallyglancing at her when you care for her, makes it possible for you to notechanges of expression, heightened color, dilated pupils, a trace ofstrain, etc. Then try to find the exact word that will express what yousee. Such experiments in perception and attention, association andmemory, repeatedly demanded of yourself--_i.  e. _, the being able torecall and describe in detail the room- or ward-arrangements and toplace the patients accurately, as we have just described--will proveinvaluable practice, helping you to attend to every change in yourpatient's demeanor and expression, which may prove significant symptoms. And remember that while the mind can only contain so many isolatedfacts, yet there is no limit to its possibilities when the power ofassociation of ideas is employed. Your first step to clear thinking is accuracy of perception, withattention to the thing reason chooses; your second is association of thethings perceived, a grouping of them to fit in with each other, and withwhat is already in the mind. And both imply the third--concentration, aided by emotion and will. For passive attention and haphazardassociations assure the opposite of clear thinking. CONCENTRATION _How to Study. _--You learn sooner or later from experience that thequickest and best way to learn anything new is to give it your undividedattention at the moment; to perceive one thing at a time and to perceiveit as something that is definite, or as some quality that is unblurred. One of you will spend three hours on an anatomy lesson, another twohours, while a third nurse may give it a half-hour of concentrated studyand know it better than either of you, if you have been day-dreaming, ortalking, or rebelling at the "luck" which keeps you indoors learningabout bones, when the tennis-court is so inviting. True, some minds havebetter natural equipment and some have better previous training thanothers. But the average mind could learn a lesson well in much less timethan is spent upon learning it poorly. Few people hold their attentionstrictly to the task at hand if something more interesting beckons, orif they feel tired, or "blue. " But you can learn to do it. Put aside a certain amount of time today for study; hold your undividedattention on your lesson, regardless of how many pleasanter thingsappeal. When your eyes or your thoughts wander from your note-book, bring them back forcibly, if need be. Your first task is to keep youreyes there, instead of letting them follow your roommate's movements, orresting them by watching the street below. But it is easier to do thisthan to make your mind grasp the meaning of the things you see. You mayread two or three pages, and not receive one idea, not even be able torecall any words from the context. Your eyes are obeying your will andseeing the words, but your mind is "wool-gathering. " Now take yourselfin hand firmly. If you are really a bit fagged, try some deep-breathingexercises before the open window, bathe your face in cold water. Thenread a paragraph, close your book, and write, if you are not alone, orrepeat to yourself aloud, if your roommate is out, what that paragraphsays--its meaning. If you cannot do it, read it again with that end inview. Repeat the process, and hold yourself to it day after day, ifnecessary, until finally will has won the battle, or, better still, your will to learn has been reinforced by an interest in the verycompetition with yourself, if not yet in the contest. Then, as you learnsome facts from your notes, use your imagination to apply them in reallife. The triceps muscle. What is it for? Your notes inform you, and then itis really interesting to see how it performs its function. What originsand attachments must the triceps have to make it extend the arm? Yournotes say that a muscle tends to draw the part to which it is attachedtoward its origin. This triceps muscle straightens the arm. In that caseit 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 starttoward the back in order to draw back the forearm; and be attached tothe back of the bone below. Also it must be quite a long muscle. So muchreason tells you. Now let me see how it is done, in fact. And you findthat the triceps has three origins high above its one attachment as atendon, to give it a good strong pull. These are in the outside of thehumerus 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 areinterested before you know it. There is nothing, good, bad, or indifferent, but has some points ofinterest if the mind turns its entire attention to it. But our tendencyis to grow tired of calling back our wandering thoughts again and againto the thing that is hard, dry, or stupid. And we need more incentivethan just the doing of the duty because it is to be done. We need acompelling interest in the goal to encourage our wills to concentrationon the less interesting. Let us first think out the _why_ of knowinganatomy if we are to be nurses. And if the profession of nursing is thegoal, let anatomy become just the next stretch of the road that leads toit. Concentration can be acquired. It may require three hours at first tolearn your lesson; but later on you will do it in two, then in one, andperhaps in less. And when you can sit down with your notes and learnthem 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 athand, then you can concentrate, and the big battle of your life as astudent is won. Study is no longer drudgery. Lessons occupy much less ofyour time and leave you more free hours. Because you give them yourwhole mind you learn them in a fraction of the hours hitherto wastedupon them, when you studied with divided attention. When you are doingclear 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 ushave it not, and feel its need so strongly that we shall consider for amoment some means of training it. William James holds that brain-paths cannot be deepened; that memory isnot strengthened in that way. There is a natural retentiveness withwhich some of us are born--the men of colossal intellect--and theyremember and are able to use infinitely more things acquired in thepast, because they have a brain substance of greater tenacity in holdingimpressions than others possess. James compares some brains to wax inwhich the mark left by the seal is permanent; and others he compares tojelly 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 animpression on the brain; but it was in the subconscious. So we beg tochange the figure and liken, in all mankind, that part of the brain thathandles the subconscious to wax, while granting that in some rare casesparts handling the conscious material also hold impressions, as does thewax. Consequently, according to this theory, we do not strengthen ourmemories by repetition of facts, lines, or phrases. We cannot grave anydeeper the memory paths which nature has provided at birth. But theattention to the thing to be remembered, which repetition has required, has made a larger number of connections of the words with each other, ofthought with thought, and of the new with the old. So we have tied thenew together with the old by that many more strings, as it were; and anybit of the new tugs at other bits; and the old to which it is tiedbrings the new with it when it comes to the fore. In other words, careful attention, at the time, to the new stimulus, and its associationwith the already known, together with repetition, will form a wholesystem of relations in the mind, and the newly entered material soonbecome 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 emotionalreaction to weariness or to some like obstacle has interfered withproper attention. James advises us if we would improve memory, toimprove our thinking processes; to pay more and keener attention, sothat we will link things closely together. This in itself will help toarouse interest in the thing to be remembered; and keen interest alone, or careful attention at the time of introduction of the new, andrepetition of the thing to be retained, with a will which holds theattention 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 yourheart you had never decided to become a probationer. Perhaps the whitescreen and its possible meaning has so frightened you that your thoughtsrefuse to go beyond it. Suppose the very sight of so much sickness hasagitated you instead of strengthening your determination to help nurseit. That is, suppose your emotions, your feelings, so fill your mindthat perception is necessarily inaccurate and blurred. Then tomorrowyour account of the ward will be hazy, and your desire will probably beagainst returning to a place where so many unpleasant feelings werearoused. The emotional balance which refuses to allow feelings to obscurejudgment by leading reason astray is a necessary safeguard for the workof the nurse. There is little place in the profession for the woman whois "all sentiment, " but perhaps there is less for the one withoutsentiment. Feeling, we found, is the first expression of mind--feeling which in theearly months is entirely selfish. The happiest baby you know is notsweet and winning to please you, but because he feels comfortable andhappy and cannot keep from expressing it. His universe is his own littleself and you exist only in your relation to him. If you give himpleasure he likes you; if pain, he does not want you. His mother oftenfails to please him, but satisfies him so much more frequently thananybody else that he loves her best. Then comes nurse or father--if heproves the satisfactory kind of father, or she a nurse he can love. Tothe baby whatever he happens to want is good. What is not desirable isbad. And such emotional responses are altogether normal in early months, yes, even until the child is old enough to use reason to choose betweentwo desires the one that will in the end prove more satisfying. But theyare defects in adult life. The nurse who would always act as her first feeling dictates would notbe in training many days. Unpleasant sights and sounds, the fear ofmaking a mistake which might harm a patient, the undesirability of longhours of hard work in caring for patients who frequently only find faultwith her best efforts, would early decide her in favor of anotherlife-work. Comparatively few so-called "grown-ups" are guided only byfeeling; and most of those are in institutions that are wellsafeguarded. But a great many mature men and women allow feeling tounduly influence their thinking. The sentimental nurse, for instance, may find it very difficult to give an ordered hypodermic. The patientdreads the pain and the nurse fears hurting her. Suppose she were tofail to give it on such grounds. This is an almost unthinkable case. Butthe very nurse who agrees that such an emotional weakling should not beallowed 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 givethe hypodermic; for that slip is easily discovered, and the transgressormust immediately reform and obey orders, or be dismissed. But the secondnurse may take perfect care of the sick body, and the doctor neverrealize 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, whenyou insist on carrying out the orders. It is easier to agree with herideas and sympathize with her troubles, much easier than to find someother avenue for her thinking, or to search for feeling substitutes. Itis pleasanter right now to allow her mind to slip unmolested into sickreactions than to lead her, unwilling as she is, into the ways ofhealth. Reason follows feeling's logic, which suggests that it is muchbetter for the patient to talk of her ills than to keep them pent upinside; and judgment is sadly obscured. The emotionally balanced nurse hears the story once, that she may havethe material for helping the need. Feeling, perhaps deep and genuinesympathy with a real trouble, is aroused, and rightly. But this brings akeen desire to help the situation. Reason insists that talking ofsufferings, real or fancied, only makes them more insistently felt; thatthere must be some better way to meet them. It suggests various methodsto divert the patient's attention, to change the train of thought untilshe is able herself to direct it into healthful channels; judgmentweighs the propositions and decides upon the one which will lead towardestablishing a health attitude. The nurse is continually meeting the necessity of acting contrary tofear and discouragement and weariness of spirit. How can she secureemotional equilibrium for herself? Keep in mind the fact that most sick people are very suggestible; thatyou have a definite responsibility to make your suggestions to yourpatient wholesome; and that your mood is a constant suggestion to him. Remember that he needs your best. Then, if your own trouble seems toogreat to bear, determine that, so long as you remain on duty, you willnot let it show. Try an experiment. See if you can go through the daycarrying your load of sorrow, or disappointment or chagrin, with soserene a face that the sick for whom you are caring will not suspectthat 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 patientwith the trying ones, more kindly firm with the unco-operative, realizing that each one of them all has his burden too--you have notchoked feeling, but you have fulfilled reason's counsel: that sickpeople are not the ones to help you in your stress; that a good nurseshould rise above personal trouble to the duty at hand. Your judgmenthas compared your reasons, and decided that you should act before yourpatients as you would if all were well. And _will_ holds you toemotional equilibrium. Such a thing can be done in a very large measure;and no better opportunity for emotional control will ever be offeredthan the necessity of being calm and serene before your patients, nomatter how you feel. But, while reason and judgment teach us to control the expression ofcertain feelings, they urge that this control be exercised intransforming those feelings into helpful ones and giving them anadequate outlet. Such a substitution has been suggested above. Let usnot forget that nothing in existence is of personal value until it givessome one an emotion; that feeling is the beauty of life; that living, without the happy, wholesome affective glow, would not be worth theeffort; that beauty and strength and sweetness of feeling make for aworthy self. Remember, too, that feeling is the curse of life. It isfeeling that would make us give up the whole struggle; and ugliness andweakness 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 depressedat failure; or we can recognize it as a sign-board telling us that theother way than the one we just followed leads to the goal. And we canfollow its pointing finger with faith in a new attempt because, now, weknow at least how _not_ to go. We can learn despair from all the bitterand the hateful and the mean; or we can learn that they never could becalled so if there were not the sweet, the lovable, and the generouswith which to compare them. You can learn to search as with a microscopefor all the undesirable traits of your patients, or you can calmlyaccept all that assert themselves as undeniable facts, but use yourmicroscope to find their desirable characteristics which offerpossibilities of being brought to the foreground. You cannot constructively help yourself or your patient by denying theexistence of the less worthy traits; but you can resolve to call out thesomething 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. Letus remember always that, "It is not things or conditions or people thatharm us; it is only the way we respond to them that can hurt. " This onegreat truth, if really believed and made a part of all our thinking, would save scores of people from nervous wreckage. It is a favoritesaying of a wise man who has helped a great many people to endure andtake new courage when life seemed too hard to meet. That big, broken-arm case on the ward cursed you yesterday because youwould not loosen his splints. And you rushed from the room angry andhumiliated, wishing you could quit nursing forever, and asked to bemoved because you had been insulted. But that man cannot harm you. Hehas never known a real lady in his life before. His training fromchildhood has been to regard women as chattels to do man's bidding; hisexperience in life is that they usually do what he asks--women of hiskind. Moreover, he has never had a serious pain before, and it is not tobe endured. Of course, the man must be dealt with and made to realize thedistinction between his new surroundings and the old. Probably theintern or the doctor is the one to do it. Also he must be brought toapologize, or leave the hospital, perhaps. But he did not hurt you. Yourown reaction did that. For outside things or people cannot damage whatwe are in ourselves. The way we respond to them does the harm. When youcan control your expression of anger and humiliation, and substitutefor your intense feeling a desire that such a patient may learn thatpain is often the gateway to healing; that some respect for women may bekindled in him, so that eventually such an outburst in the ward may beimpossible for him or for anyone who heard it; then you are choosingbetween emotions the one of helpfulness, for the one of justifiedindignation; and feeling has followed reason, rather than leading reasonastray. The judgment which decides you to try methods which will shameor inspire some manliness into the patient was one influenced by awell-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 impulseor passion of anger and resentment and hurt; absolutely shut tight ourlips until we can think; then wait until we can think without the strainof intense feeling, we will not only keep ourselves out of trouble, butwill be able to calmly state our position, right the wrong done us ifwrong there was, or recognize that we ourselves were wrong. For weseldom analyze the situation properly under the influence of strongfeeling. If we want to accomplish anything with our words, let us waituntil we can speak them without having to choke down our sobs or cramback our hot anger, or forcibly restrain ourselves from tearing thingsor 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 automaticif she will demand of herself accuracy of perception, and concentrate onlearning and doing until details almost take care of themselves; if shewill correct her own work by the standards taught her, and recognizejust why and wherein she falls short. Not that she can always do thingswith the nicety in which they were taught. She cannot give eighteen wardpatients in eight hours the same detailed care her private patientswould 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 inservice; but there is no excuse for sacrificing accuracy in thenecessary treatments of her charges. The nurse merely chooses betweenthe multitude of things which can be done for her ward, the importantones which must be done. Because she is rushed is no excuse for giving apoor hypodermic injection or a careless bed-bath. Accuracy in doing theessential things should be so automatic that it takes not a whit moretime than inaccurate doing; and such accuracy is chiefly dependent onconstant self-correction when the task is still new, and on neverletting up in practice until the details of the doing become practicallyautomatic. TRAINING THE WILL There is no better opportunity for will-training than the hospitalaffords the nurse. The constant necessity of acting against desire, ofdoing tasks which in themselves cannot be agreeable, calls for adeveloped will, while it gives it constant exercise. Moods ofdiscouragement and depression cannot be indulged. The nurse must do herwork no matter how tired or blue or "frazzled" she feels, if she is nottoo sick to be on duty; for all time lost, she knows, is to be made upto the hospital before training is completed. Can this _will to do_, despite strong desire to the contrary, this moodcontrol 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 byrepetition. We found that automatic habit eases much of the strain ofaction. What seemed repulsive service to the probationer on her firstday in the hospital, she forced herself to do because she wanted to be anurse. She may go on through her three years unreconciled to theseparticular duties, yet holding herself to them because she likes otherfeatures of her work, or because she must earn her living and this seemsthe best avenue open to her, or because her will to become a nurse isstrong enough to make her act continually against desire. And finally, for almost every nurse, the interest in the end to be attainedovershadows the unpleasant incidents in its way. The tasks are actuallyeasier by their constant repetition, and her feeling of repugnancebecomes only a mild dislike. She has strengthened her will by continuingto act against desire. But there is a better way to the same goal. The woman who has thought out the reasons for and against takingtraining; who has considered it carefully as a profession, and haschosen to put up with any obstacles in the way of becoming a graduatenurse, can find a happy adjustment to the disagreeable incidents itinvolves. Realizing that the paths of learning are seldom thoroughlysmooth, she can resolve to use their very roughness for firmerfootholds, as a means to self-control, as a fitting for the sternerhardships of self-support, of nursing the dangerously ill, alone, ofmeeting suffering and death in her patients with quiet courage andfaith. In other words, she can meet the thousand and one personalservices which in themselves might be disagreeable and prove puredrudgery, not merely with the stern will to do them because they are anecessary part of obtaining a desired end, but also for the sake ofadding to the comfort and well-being of each patient in her care. Theemotion of interest and kindly desire will ease the strain which willundergoes in demanding that she not shirk the disagreeable. For there islittle stress in doing what we wish to do. It is psychologically possible to find genuine pleasure in the meanesttasks if the doing is backed up by a strong desire to make life count asmuch for others as possible. The nurse who comes to realize the wasteinvolved in carrying out against desire what _reason_ proposes andvolition dictates, will try to secure the co-operation of desire, andsave will-force for more worthy accomplishment. A constant opportunity for will-strengthening comes to many a nurseduring the early weeks and months of training in the necessity of goingon despite the sheer tiredness, the weary backs and swollen, tender, aching feet. The one who means to "see it through" disregards them asfar as possible on duty, gets all the out-of-doors her time permits, takes special exercises to strengthen weak spots, and relaxes her bodywhile 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 hasbecome a better ally for the next demands upon it; her endurance isremarkably increased. When she can accept hardship, drudgery, weariness of mind and body andperhaps of soul, the nagging of unco-operative patients, and the demandson her sympathies of the suffering; when she can meet these aschallenges to develop a strong will--a will not only to endure, but tofind happiness and give service through it all--then the nurse haslearned the art of making every circumstance a stepping-stone to masteryand achievement. CHAPTER XIV THE NURSE OF THE FUTURE The student of life and of the sciences which deal with the origin anddevelopment of the human race, and with the relations of man to man andnation to nation--such sciences as biology and anthropology, sociologyand ethics and history--comes to the conclusion that life exists for thedevelopment of mind. And mind is not merely intellect, but the onlygateway we know to character, to soul. The deepest students of humanscience see no reason for life except as it "evolves" a perfectmind--man's goal, his ideal. And this visioned perfect mind is onewhich adjusts itself without friction to the body, making it fulfil thelaws of health that it may help and not hinder mind's progress; onewhich adjusts itself to people and things, co-operating with other mindsto develop manners and customs and laws of the most satisfactorycommunity living; one which forces things to be servants of its will;one which makes harmony of life by fulfilling the laws of the soul aswell as of the intellect and of the body. If we believe that life exists for the development of mind into a forceof intellect and character and soul, then we need not ask why a nurseshould know something of the laws of mind. She does not ask why sheshould know anatomy or pathology. Her work is dependent upon suchknowledge. But if the center of life, the thing which makes the body aliving, moving, acting agent instead of a clod, is mind; if the onething which makes a difference between animal life and mineral andvegetable life is consciousness, _i.  e. _, mind; and if everything thataffects that body, its organ, affects mind also--then surely no nursecan afford to learn only the rules of repair or of keeping in order theinstrument of consciousness, without knowing what effect her effortshave on the mind itself. It is as though an ignorant maid accepted apiano as merely a piece of furniture to be kept clean and shining, andin her zeal to that end scrubbed the keyboard with soap and water which, dripping down into the body of the instrument, swells and damages itsfelts, rusts and corrodes its keys, and ruins its notes. When she knowsthat she may thus make impossible the beautiful sounds she has heard itgive, and that the more carefully the keyboard is handled the more sureis the beauty resulting, her care is to keep it as free as possible ofdust, to see that the top is down and the keyboard covered when shesweeps--and to clean it hereafter in such a way as to never injure itstone. The nurse has a much greater function than merely to help in saving thebody and keeping its machinery in order. If the aim of life is thestrengthening and perfecting of the mind--that "urge" of life, thensurely the nurse's big aim will be to help establish such health of bodyas leads toward health of mind. In the average man or woman this vitalurge becomes temporarily blocked by the very weakness of the body iturges. 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 morethat it may burn strongly again. In the cases the nurse handles veryoften the "vital spark" has been poorly fed by the disabled body, and sodiscouragement or depression, or "loss of grip" results, or the flamecontinues to shine brightly with whatever little sustenance it receives, and so encourages the body to greater effort for it; or sinks intoembers, glowing steadily though dully; or it burns wildly, recklessly--it becomes what we call "wild fire, " that has no directionand no purpose save to burn up everything it can find. In other words, the nurse deals with those in whom the "urge" isweakened--the depressed and discouraged; with those whose spirits neverflag in their steady shining--those brave souls we could almost worship;and those others who hold grimly on with quiet grit and courage, butwith no cheer; and with the unstable ones of neuropathic or psychopathictendency who become hysteric or maniacal. What will the nurse do for them all? Will not an understanding of how torecall the ambition to live, the will to get well, and the grit to seethe 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 thesick body by deftly carrying out the doctor's orders. She will do thisalmost automatically as a matter of course, and skilfully; but it willbe the merest beginning of her mission. That mission itself will be toeliminate the causes of disease; to teach the ways of health, tosupervise the sanitary conditions of city, town, and country. Practicalways and the wise means to this end will be taught in her hospital, which will become a community center with clinics, teaching through itsdoctors and nurses the way to health, instead of merely treating andadvising the cases as they come. But the greatest contribution of thenurse of the future will be a wide-spread _desire for health_ and _willto health_, rather than a desire and will to avoid discomfort and painand danger of death. This _will to health_ will doom in the sane mindthe disease-accepting attitude. It will do all that common sense andapplied medical science can do to strengthen the body; then it will takewhat life brings in the way of unavoidable disease and weakness andinability, with an uncringing mind. It will hold the mind's attitude toserenity and poise and accomplishment within the necessary limits of itsdisordered body. It will be master of its dwelling and make the most ofthe little the body can give, and force all bearable weakness and painto be stepping-stones to endurance and will-strength and cheer. It willnot accept physical limitations as final things. If life must be livedin a prison-house it will be its own jailer, and fill the rooms withflowers, music, friends, and happiness. No nurse is competent to help her patient to overcome any curablephysical weakness, and keep the mind serene in the face of theincurable, until she herself has learned that the will to health iscapable of transforming disease of body, from disaster, into health ofmind and soul. The nurse of the future will know the laws of mind as she knows thecourse of disease; she will be dedicated to such wise care of existingdisease as will lead to prevention of future disease; and she will be asworn, 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 withMiss Nutting, a work which has been considered standard on the subject, but which, by its very nature, was too elaborate for class use. Thiscondition has now been overcome by condensation into this single, comprehensive, inexpensive volume of all the salient facts of the largerwork. It is generally believed that the best place in the nursing curriculumfor the History of Nursing is in the early part of the first year, whenthe student is just beginning to form her conception of nursing, and isbeing 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 HospitalTraining Schools; it should, of course, be in the library of everyHospital which does not maintain a Training School. It is believed thatit 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 numberscount from the start of the book itself not including the Transcriber'sNote. Alternatively, use the HTML version, in which the errors aremarked. 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.