Applied Psychology for Nurses

We have found that mind is entirely dependent upon the bodily organs for its existence. Is the body in the same way dependent upon the mind? Can the mind die and the body go on?

Given a perfect body with unblocked sense channels, and put the mind to sleep, paralyze the central nervous system with alcohol in sufficient quantity so that the undamaged peripheral nervous system—the senses—can obtain no response or recognition from it, and that perfect body is as useless for the time as if dead. But here comes proof of the remarkable hold of the body on life. The unconscious mind takes up the burden of directing the sympathetic nerves to stimulate the muscles of breathing. The unconscious sees to the beating of the heart. It directs the contraction of the blood-carrying vessels. It maintains certain vital processes of secretion. Thus automatically life goes on; the body still reacts to a limited field of stimuli, and consciousness recognizes it not. But when the unconscious mind ceases to function, then, indeed, does the body die. Yet the conscious mind may “die” and the body live on, so long as the unconscious continues its activity.

We might liken the mind to the boiler in which steam is generated, and the body to the engine which the steam runs. If the boiler bursts, the engine stops; but it may not be otherwise damaged. It simply cannot carry out its main function of motion any longer. The fires under the boiler are still burning and can be kept burning so long as fuel is provided, but the connection is broken and the great bulk of iron is a useless thing in that it can no longer fulfil its purpose.

In just such a way may the mind be paralyzed; but the spark of life, which has through all the years kindled the now lost mind to action, may still remain—a useless thing, which would die away if not tended from without by other bodies whose minds are still intact.

When body is dead, mind, so far as its reactions to the world we know are concerned, ceases to act. But when the conscious mind is “dead” the body may yet live as a vegetable lives, with all its distinctively human functions lost. Motionless, save for the beating of the heart and the reaction of the lungs to air, the body may still be alive, though the mind long since has ceased all earthly activity.

So we discover that an organ of mind is an essential, here, to life of mind, and that mind only can induce this organ to any action above the vegetative stage. But, on the other hand, we find that life can exist without conscious mind, even if untended by others, for a limited time.

The brain’s varied and intricate nerve connections with all parts of the body, through nerves branching from the main trunks in the spinal cord, we shall not discuss, for you know them through your study of anatomy. For the purpose of our psychology we need consider only two of the main divisions of the brain—the cerebrum, which includes what we call the right and left hemispheres, and the cerebellum.

For convenience the various lobes of the cerebrum are known as frontal, temporal, parietal, and occipital, according to the parts of the brain referred to: as forehead, temples, crown, or occiput. The cerebellum, or hind brain, is also divided into two hemispheres, and is situated behind and below the hemispheres of the cerebrum.

From these experiments it seems proved that consciousness belongs only to the cortex or surface of the upper brain, and that the vast realm of the unconscious belongs to the lower brain centers. Hence the cortex is the organ of consciousness, and the lower centers are the repository of the unconscious until it again becomes conscious.

The motor zone of the cortex we now know to be situated in the convolutions bordering the fissure of Rolando. Vision is evidently excited from the occipital lobes, though not yet conclusively proved. Smell, presumably, is located in the temporal lobes. Considered action is directed from the upper hemispheres only. It is significant that the hemispheres of the cerebrum are also accepted as the seat of memory for man—that intellectual quality which makes him capable of acting from absent stimuli, stimuli only present to memory; which makes it possible for him to reason the present from the experiences of the past.

But of what use to man, then, are the lower brain centers?

In man, as in lower animals, they care for the vegetative functions of life, so that our blood continues to circulate, the air enters and leaves our lungs, digestion is carried on, with no assistance from the upper centers, the hemispheres of the cerebrum being thus left free for concentration on the external world of matter, which it can transform into a world of thought.

It is the lower or vegetative brain that may still exist and keep life intact when the functions of the cerebrum are destroyed. We can say, then, of the brain as a whole that it is the organ of the mind, the sine qua non of the mind, the apparatus for the registration of sense impressions. The senses themselves are the rudiments of mind, are the means by which stimuli alighting on sense organs enter consciousness; for the nerves of special sense immediately carry the impetus to the brain, where it is recognized as the “not me,” the something definitely affecting the me, and demanding reaction from the me.

Mind, we found, is born in the form of consciousness when the outside world impresses itself upon the brain-cells by way of the senses. This consciousness, observation and experiment prove, is first a feeling one, later a feeling-thinking-willing one. The mind, then, is really the activity of the brain as it feels, as it thinks, as it wills. We express this in descriptive terms when we speak of mind as the flow of consciousness, the sum of all mental associations, conscious and unconscious. For mind is never a final thing. Looking within at our own mental processes we find that always our thought is just becoming something else. We reach a conclusion, but it is not a resting place, only a starting place for another. My thought was that a moment ago, but while it was that it was becoming this, and even now it is becoming something else.

And so it is with the mind. If it is thinking and feeling and willing only for the sake of exercising these mental powers, it might better not be. But what end do we actually find these functions serving?

Mind, with its powers of thinking, feeling, and willing, gives an external world of matter; an internal world of thought, and so relates them to each other as to make them serve man’s purposes. Thus these functions exist for accomplishment.

The mind, then, is an instrument of achievement. It fulfils its purpose when it makes matter serve useful ends.

Emotion or feeling is the function of the mind which associates a sense of pleasure or pain with every thought or act.

Feeling is the affective state of mind. By this we mean that it has the power to move us. And this emotion primarily does; for our feeling of pleasure or pain moves us to action, as well as precedes and accompanies and follows action. The word emotion is usually employed to denote an acute feeling state, while the word mood denotes a prolonged feeling condition, i. e., a less acute emotional state. The word feeling, however, is used to cover both; for in each case the sensational element manifests itself in a definite physical affect, pleasurable or painful in some degree.

Thinking is a conscious mental activity exercised to evolve ideas from perceptions, and to combine and compare these ideas to form judgments.

Volition or will is the function of the mind which compels the expression of thought or feeling in action.

For clarity we might indicate the mind and its functions in the following diagram:

Sensation is the uninterpreted response of the mind to stimuli brought by sense organs.

Sensation may arouse instinct and cause reflex action, or start a feeling state, or a train of thought.

Perception is the conscious recognition of the cause of a given sensation.

Percept is a word often used to denote the mind’s immediate image of the thing perceived.

Percepts are of two kinds: object and quality.

Memory is the mind’s faculty of retaining, recognizing, and reproducing sensations, percepts, and concepts.

Organic memory is the mind’s reproduction of past bodily sensations.

Example: I recall the physical sensations of a chill, and live it over in my mind, so that I can accurately describe how a chill feels to me, though I can but surmise how one feels to you.

Example: Myself having a chill, how I acted; what I thought and my emotions during that chill.

Ideation is the mind’s grouping of percepts by the aid of memory, to form concepts.

Example: I perceive color, form, mouth, eyes, nose, chin, etc. These percepts I combine as a result of past experience (memory) to form my concept, face; and the process of combining is ideation.

Concepts are mental representations of things or qualities, i. e., of object or quality percepts.

We might say that the percept is the mind’s immediate image of a thing or quality, and the concept is the result of the storing up and grouping and recombining of percepts. Thus a lasting mental picture is secured; and my idea of horse, for instance, is so clear and definite a thing in my mind that if I should never again see a particular horse, I should yet always be able to think accurately of a horse.

Concepts are of two kinds—concrete and abstract.

A concrete concept, or concrete idea (for concept and idea are interchangeably used), is an idea of a particular object or quality.

Abstract ideas are of two kinds. We speak of them as abstract object concepts and as abstract quality concepts. An abstract object concept we might call a generalized idea, an idea comprehending all objects having certain things in common.

Example: My idea of animal includes many scores of very different individual animals, but they all have bodies and heads and extremities. They all have some kind of digestive apparatus; they breathe, and can move.

An abstract quality concept is easier to think than to explain. It is as though the mind in considering a multitude of different objects found a certain quality common to many of them, and it “abstracted,” i. e., drew this particular quality, and only this, from them all, and then imagined it as a something in itself which it calls redness, or whiteness, or goodness. Thereafter, whenever it finds something like it anywhere else again it says, “That is like my redness.” So I call it “red.” In other words, consciousness thereafter can determine in a newly discovered object something it knows well merely because that something corresponds to a representation which experience and memory have already formed.

I speak of goodness, or purity, of benevolence; or of fulness, emptiness, scantiness. There is no object or quality in the outside world I can say is goodness, or fulness. But I do see things in the external world through my ideas of goodness or fulness that correspond to these ideas. They have some of the qualities the ideas embrace; and so I point them out and say, “This represents purity; that, impurity”; or, “This is full, that is empty.” One satisfies my concept of purity, while the other does not. One fulfils my concept of fulness; the other does not. And because we can never point out any one quality in the outside world and say “This is purity, and all of purity; this is goodness; or this good plus this good plus this makes all of goodness”; because of this impossibility we speak of these concepts as having reality somewhere. They are absolutes, universals, abstract quality concepts—the unfound all of which the things we call pure and good are but the part.

Apperception is the process of comparing the new with all that is in the mind, and of classifying it by its likeness to something already there.

Example: In walking through the field, along the bank of the brook, I glimpse under the low-hanging branches of the weeping willow a restlessly moving hoof. I see a certain kind of hoof and only that. Or I hear a lowing sound. And I say “cow.” I have not seen a cow, but only a part which tells me a cow is there; for all the cows I ever saw had hoofs of that general description, and so it fits into my concept cow, and into no others. Or I have heard cows, only, give that lowing sound before. From my perception, then, of hoof or sound I apperceive cow. Memory relates that hoof or that lowing sound to a certain kind of animal known in the past; and constructive imagination draws in all the rest of the picture that belongs with it.

In apperception, then, we construct from the known actually perceived by the senses, the unknown. How does the child realize that the moving speck on the distant hillside is his father? There is nothing to indicate it except that it is black and moves in this direction. But experience tells Johnny that father comes home that way just about this time. Moreover, it says that father looks so when at that distance. When Johnny is as sure it is his father as if he could see his face close beside him he has apperceived him. The speck on the hill is the newly arriving stimulus. Johnny compares it with what corresponds to it in his mind’s experience and proclaims, as a fact, that he sees his father.

Reason is the mind’s comparison and grouping of concepts to form judgments, and its association of judgments to form new judgments.

Example: My concept man includes the eventual certainty of his death. My concept mortal means “subject to death.” Therefore my judgment is, “Man is mortal.” Reason has compared the concepts and found that the second includes the first.

Judgment is the mind’s decision arrived at through comparing concepts or other judgments.

We may assume personal consciousness even as we recognize an individual body. Psychology does not deal with any awareness separated from a person. It knows no central mind of which you partake or I partake, and which is the same for us both. A universal consciousness would simply mean one which is the sum of yours and mine and everybody’s who lives today, or who has ever lived. So by personal consciousness the psychologist means his consciousness, or yours, or mine. But they can never be the same; for mine is determined by my entire past and by how things and facts and qualities affect me; and yours, by your past, and by things and facts and qualities, and by how they affect you.

Personal consciousness is the mind’s recognition of self; and as the self changes with every added experience, so personal consciousness is modified.

Imagination is the combining by the mind, in a new way, things already known.

This may be either into fantastic groupings divorced from reality, or into new, possible, rational groupings not yet experienced. So imagination is of two kinds, the fantastic and the constructive. Fantastic imagination, or fantasy, gives us gnomes, fairies, giants, and flying horses, and all the delights of fairy tales. Constructive imagination is the basis for invention, for literature, and the arts and sciences.

The word thinking, defined early in this chapter, is broadly used to denote the sum of all the intellectual faculties. Thinking is really the stream of thought.

We have found that the mind’s chief end is action, of itself, or of its body. But what are its incentives to action?

We see the very young baby giving evidences of an emotional life, living in an affective, or feeling environment, leading a pleasure-pain existence, from the first. He acts as desire indicates. But from the very moment of his birth he performs actions with which he cannot as yet have a sense-memory connection, because he is doing them for the first time. How can he know how to respond to stimuli from the very beginning?

The pugnacious instinct—the desire to fight—is the natural reaction of every human being of sane mind to attack. The inner necessity of avenging is so strong in the child or man of untrained mind or soul that he acts before he thinks. He strikes back, or shoots, or plots against his enemies. Only rare development of spirit or the cautious warning of reason which foresees ill consequences, or a will trained to force control, can later make the instinct inactive.

Where instinct ends and sense memory, imitation, and desire step in is difficult to determine. Later in life probably most of what we consider instinctive action is simply so-called reflex action, depending on sense memory, action learned so young that it is difficult to distinguish it from the true reflex action, which is due only to race memory.

James, in his Talk to Teachers, gives us a partial list of the instincts. Thus:

To this partial list we would add self-preservation, reproduction, etc.

But instincts conflict with each other, and man carries about with him in babyhood many of them which may have been very useful to his prehistoric ancestors, but which only complicate things for him. Fear and curiosity urge opposite lines of conduct. Love of approbation and shyness are opposed. Love and pugnacity are apt to be at odds. So, gradually, as intelligence increases, the child refuses to allow such impulses to lead him to action. When fear-instinct and love-instinct are at war, reason is provided to come to the rescue.

Instincts are racial tendencies of sensational or emotional states to determine action.

Instincts are the germs of habit, and when instinct would give rise to a reaction no longer useful, reason, abetted by new habit formation, in the normal mind, weakens instinct’s force; and the habit is discarded and the instinct gradually declines.

Do you know how to skate? and if so, do you remember just how you did it the first time? Probably all you recall is that you fell again and again because your feet would slip away from where you meant them to be. When you glide over the ice now it is as natural as walking, and as easy. You cannot remember in detail at all how you first “struck out,” nor the position of your feet and arms and legs, which you felt forced to assume. At the time there was very real difficulty with every stroke—each one was an accomplishment to be attempted circumspectly, in a certain definite way. All you remember now is, vaguely, a tumble or two, soreness, and lots of fun.

But what of the things we must use frequently and cannot find in our minds? What of absent-mindedness and faulty memory? In such cases our minds might be compared to a cluttered room full of things we need and want to use every day, but in confusion. We know where many of them are, the ones we care most about; but we have to rummage wildly to find the rest. We have no proper system of arrangement of our belongings. You laid down that book somewhere, absent-mindedly, and now you cannot tell where. You were thinking of something else at the time, and inattention proves a most common cause of poor memory. Perhaps you simply have more books than the room can hold in an orderly way, and so you crowded that one in some corner, and now have no recollection of where you put it.

Or I have more to do than I can possibly accomplish in the next six hours. You ask me to buy the ribbon. I attend accurately for the moment, think distractedly, “How can I do it all?—but I will”—and crowd the intention into an already overburdened corner of my mind, fail to associate it with the other thoughts already there, and return six hours later without the ribbon. My sense of hurry, of stress, of the more important thing to be done, or a reaction of impatience at the request, forced back the ribbon thought and allowed it to be hidden by others. I was really giving you only partial attention, or an emotion interfered with attention; and I forgot.

Hence we find that a faulty memory may exist in an otherwise normal mind when poor attention, or divided attention due to emotional stress or to an overcrowded mind, which makes it impossible to properly assort its material, interferes.

We shall consider this question of memory in more detail in a later chapter of practical suggestions for the nurse.

Feeling Cannot Be Separated from Thinking.—Emotion we found the constant accompaniment of every other mental activity. It is first on the stage of consciousness and, in the normal mind, last to withdraw.

Feeling Cannot Be Separated from Will.—I cannot will without a feeling accompaniment, pleasant or unpleasant. I may be using my will only in carrying out what intellect advises. But we found that intellect’s operations are always affective, i. e., have some feeling of pleasure or pain. And the very act of will itself is a pleasant one and much easier if it is making me do what I want to do; it is a vaguely or actively unpleasant one if it is making me act against desire. In the end, however, if I act against desire in pursuance of reason or a sense of duty, the feeling of pleasure in the victory of my better self is asserted. And feeling cannot be separated from will.

Thus we find by experiment that there is no thought we have, no single conscious movement or action, nor any expression of the will, but is accompanied with what the psychologist broadly terms pleasure or pain. So emotion, the first expression of mentality, is never absent from any mental or physical act. It permeates all we do, as well as all we think and will, with the partial exception of automatic action, above indicated.

Later still, when the child is older, we may have somewhat the following mechanism: “Sweets, good, want, taste; spank, hurt; don’t care, spank not hurt much, maybe never found put, sweets very good.”

The conclusion or decision that reason has reached we call a judgment. The youth who decides against the sweet between meals, we say, has good judgment. And we base our commendation on the proved fact that sweets are real fuel, giving abundantly of heat and energy, and are not to be eaten as mere pastime when the body is already fully supplied with high calorie food not yet burned up; that if sweets are eaten at irregular intervals and at the call of appetite, and not earned by an adequate output of physical work, the digestive apparatus may become clogged, and an overacid condition of the entire intestinal tract threaten. We call judgment good, then, when it is the result of reasoning with correct or logical premises which correspond with the facts of life. We call it bad when it is the conclusion of incorrect or partial or illogic premises.

A premise “is a proposition laid down, proved, supposed, or assumed, that serves as a ground for argument or for a conclusion; a judgment leading to another judgment as a conclusion” (Standard Dictionary).

Let us illustrate good and bad judgment by following out two lines of reasoning, each quite accurate as such.

So I have sweets when I want them. The judgment to take the sweets as desire indicates is entirely logical if we accept all the premises as correct. And they are, so far as they go; but they are partial; and so cannot altogether correspond with the facts of life. Sweets are good for people who expend much physical energy. They prove injurious in more than limited amounts to the bed-ridden, the inactive, or the sluggish. Hence this premise is partial and so far incorrect. Sweets do give heat and energy, true. I am chilly and tired, also true. But why? Because I am already toxic from the sweets and meats I have had throughout my sedentary years. The question is, Do I need any more energy-producing food when I am not burning up what I have? So again the premise is partial. I do need heat and energy, but I already have the material for it, and my mode of life has disorganized my system’s capacity to utilize these foods normally. So now sweets have become a detriment to my well-being. The judgment which determines me to the habit of eating sweets between meals is the result of logic, but of logic spent on tying up premises which do not fit the facts of the case.

The other judgment illustrates the logic of correct, provable premises.

“No, I shall wait until dinner-time. I have no need of so rich a food, for I had an adequate meal at the usual time and have not worked hard enough to justify adding this burden to my digestive apparatus; besides only hard workers with their muscles can afford to eat many sweets. They cause an overacid condition when taken in excess; and any except at mealtimes would be excess for me, with my moderate physical exercise.”

This judgment we call good. Its premises correspond to scientific facts.

But much reasoning must always be done with probable premises, ones which seem to correspond to the facts, but which have yet to be proved. And our judgment from such suppositions cannot be final until we see if it works.

Their logic was perfect. If the earth was flat, and Asia lay east of Europe, it was madness to sail west to reach it. But they argued from a wrong premise, so their judgment was imperfect—for they did not yet know the facts.

The result of all reasoning is judgment. And judgment is good as the materials of the reasoning process correspond to facts, or are in line with the most probable of the yet unknown. It is poor as the reasoning material fails to meet the facts, or is out of harmony with the most probable of the yet unproved.

It is of no avail, then, to attempt to improve our final judgments as such. We must examine the materials we reason with, then learn to group and compare them logically. And in the very separating of true premises from false, we use and train the judgment we would improve. And this the normal mind can do.

Joy naturally follows some stimuli; sorrow others. Disappointment or loss, shock, failure, death of loved ones, illness in ourselves or others, do not normally bring joy. A keen sense of suffering, temporarily, perhaps, of numbness; the inability to grasp the calamity; or flowing tears, an aching heart, or the stress of willed endurance, are natural, and normal reactions to such stimuli.

A developed will may refuse indulgence in the outward expression of the normal feeling of shock, grief, and loss; and this may be normal. But normal volition does not force us to laugh and dance and be wildly merry in the face of grief and loss and pain. It only suggests the adequate, reasonable acceptance of the facts that cannot be changed—the acceptance of love, faith, and hope that sees in present suffering a means of consecration to service; it does not convert the emotion of sorrow and loss into a pleasurable one. Normal reason does not suggest that will force the reactions to loss and suffering that belong by nature to attainment and success.

Nor does reason suggest the long face, the bitter tears, a storm of anger, in response to comedy and farce, in the face of a good joke, or to meet success; and normal will puts reason’s counsel into effect.

Some emotions, that seem exaggerated at first thought, may be normal under the circumstances. For no one can know the whole background for emotional response in the life of another. After being long shut up in a darkened room, with bandaged eyes and aching head and sick body, the first visit to the bit of woods back of the house—when all the pains have gone—may bring almost delirious joy. The green of the foliage, the blue of the sky, the arousing tang of the air, the birds, the sense of freedom—all go to the head like new wine. The abandon of joy is a normal response under the circumstances, now. It would hardly be normal to one whose habit it is to visit this same bit of woods every day, to one who loved it, but for whom it had lost the force of newness.

To the child, who has never in all his little life had a wish not gratified, the denial of a desired stick of candy is as great a calamity as is the loss of a fortune to the grown man. And the child reacts to feeling equally intense. These are normal reactions to stimuli—normal, under the circumstances.

But man only approximates the normal. The perfectly balanced man or woman is so rare as to be a marked person. The average intelligent individual only in general approximates this standard. He goes beyond it in spurts of untrammeled genius, to wrench lightning from the heavens, and to send his trains through the air; or he allows his feelings to dictate to his reason, and much of the time so exaggerates or depreciates the simple facts of life that the results of his reasoning no longer conform sufficiently to reality as to be thoroughly dependable.

In the use of its functions the mind manifests certain powers and certain modes of expression which can act as powerful allies or as damaging enemies of health. We speak of man as adaptable, but also as a being of habits. We speak of him as “feeling” when we wish to express the fact that his emotions influence his body. We expect of the average man a certain amount of suggestibility. We say that he is tremendously affected by his environment, which simply means that his attention, naturally centered chiefly on the things at hand, largely determines what he is. But we recognize that a man of trained mind can choose and will to substitute for his present surroundings thoughts upon more constructive things from past experience, or from future possibilities, or from within the mind’s own storehouse. His ability to largely modify his life by his will, we recognize as man’s greatest power. Adaptability, emotional response, suggestibility, attention, thought-substitution, habit-formation, and will can minister vitally to health, or can prove damaging avenues of disease.

Adaptability is as essential to life of mind as to life of body; and health of mind as well as health of body is determined by the individual ability to adjust himself to environment.

The practically adaptable man can dream dreams, but always recognizes them as dreams, and can stop at will; can vision a beautiful ideal, but comprehends that it is not yet reality, though it may some time become so if he learns and fulfils the laws leading to its realization. The adaptable man or woman recognizes the real as fact, desirable or otherwise, the fantastic as unreal and only to be indulged in as a pastime, and the ideal as the possible, a thing for which to work and sacrifice. So perfect adaptability would mean perfect mental poise.

There Can Be No Neurosis Without a Psychosis.—If the brain is the organ of the mind, then what affects the brain must perforce be at least registered by mind. So every physical shock, accident, toxic condition, infection—even the ordinary cold—rouses the mind at least to awareness, usually to discomfort. For the nerve-cells and fibers—those inseparable parts of the body mechanism—speedily report the fact that they are being tampered with. In the toxicity of the infections these very delicate tissues are nourished by toxic fluids; in accidents they carry all the messages from the injured part. Then the brain—that center of all man’s reactions and the organ of all his consciousness—receives the report of the disturbance and translates it into terms of more or less disability. The neurosis has become a psychosis. The physical condition has become a mental discomfort. Normally this ensuing mind state should be in accordance with the extent of the injury to the nerve-cells and fibers. But under long-continued discipline, or influenced by emotion, the conscious mind may not recognize the neurosis; whereas, in the hypersuggestible, consciousness will translate it into entirely disproportionate suffering.

One almost universal condition found in illness is hypersuggestability. Here is the nurse’s despair and her hope. Suggestion may come from without or from within. When from within, we call it autosuggestion.

Many of the sick are temporarily resting their reasoning faculties and their judgment. The sick body is causing a feeling of “jangling nerves,” and the mind, too, is strongly tempted to be sick. So every harsh sound, every jolt, almost every sentence spoken in their hearing suggests immediate nervous reactions. The mind does not wait to weigh them. The nervous system reacts to them the second the impression is registered. The whole self is oversensitive, and the very inflection of a voice has enormous significance. Let the nurse remember that her way of giving a treatment, her expression, or her very presence becomes a potent stimulus on the second, one to which the patient’s mind responds like a flash-light when the button is pressed.

Many suggestions come to the patient from within. Discomfort in the right side may suggest appendicitis. A slight indigestion, often purely nervous, may be interpreted as inability to care for certain diet, etc. The wise nurse will displace as many of these as she can by casual suggestions on her own part. She will demand of herself that her very presence be quieting, calming, happy; that her conversation with her patient shall vibrate with a certain something that gives him courage and strengthens the desire and the will to health; that her care of him shall prove confidence-breeding. The patient’s attitude, when he is at all suggestible, is largely in the nurse’s hands, and she can make his illness a calamity by dishonest, fear-breeding, or suspicion-forming suggestion. After all, the whole question here is one of the normality of the nurse’s own outlook on life and people. The happier, truer, and more wholesome it is, the more really can she help her patient to both bodily and mental health. Of one thing let the overzealous nurse beware. Do not irritate your patient by a patent, blatant, hollow cheerfulness that any one of any sense knows is assumed for his benefit. Personally I know of no more aggravating stimulus.

Attending to the unhappy, the painful, the boring without looking beyond makes life unhappy, painful, and a bore. Not that the nurse should ignore these realities, but she can accept them whole-souledly herself as not the final things, as merely the rocks that can be used to stand upon and get a view of the something better for everybody. When they are thus used by the wholesome mind, facts, the very barest and meanest of them, can be made useful as stepping-stones to the happier facts beyond them.

If the nurse can direct or tactfully lead the patient’s attention away from himself and his illness, she has found a big reinforcement to his treatment. This question is so vital in the care of patients that it will be discussed at greater length later on.

If we control attention we control thought, and with the suggestible patient this principle depends upon the one just now considered. Hope and courage-breeding thoughts can replace despairing and fearful ones, but it will be only when attention is directed through interest or by will to new material. There is no blank in waking consciousness. The last thought or feeling or perception, through association of ideas, brings up a related one, and so on indefinitely. We may start with a pebble on the road and go on logically, smoothly, until in five minutes we are thinking of the coronation of King George, with no sense of anything at all unusual in the succession. It may be a very roundabout process, from “pebble” through “rough way,” “ways that hurt,” “dangerous ways,” “brigands,” “uncertainties of life.” “Uncertain lies the head that wears a crown,” “King George and his crown,” “coronation.” But this constant stream of thought can be broken into at any point by a spoken word, a passing vehicle, which diverts the mind’s trend. So the nurse can take advantage of the mind’s very suggestibility, and substitute for the unhappy and sickness breeding by turning attention to anything else of a happier color, and may divert the entire stream of thought in that direction. She who knows these simple laws of the mind, and who at all knows people, is a therapeutic agent of unlimited value.