PSYCHOLOGY AND HEALTH
In the use of its functions the mind manifests certain powers and
certain modes of expression which can act as powerful allies or as
damaging enemies of health. We speak of man as adaptable, but also as a
being of habits. We speak of him as "feeling" when we wish to express
the fact that his emotions influence his body. We expect of the average
man a certain amount of suggestibility. We say that he is tremendously
affected by his environment, which simply means that his attention,
naturally centered chiefly on the things at hand, largely determines
what he is. But we recognize that a man of trained mind can choose and
will to substitute for his present surroundings thoughts upon more
constructive things from past experience, or from future possibilities,
or from within the mind's own storehouse. His ability to largely modify
his life by his will, we recognize as man's greatest power.
_Adaptability_, emotional response, _suggestibility_, _attention_,
_thought-substitution_, _habit-formation_, and _will_ can minister
vitally to health, or can prove damaging avenues of disease.
NECESSITY OF ADAPTABILITY
Adaptability is as essential to life of mind as to life of body; and
health of mind as well as health of body is determined by the individual
ability to adjust himself to environment.
There are dreamers who have lived in their ideal world so long that they
cannot meet the stern realities of life when they come. The shock is too
great for the mind that has accepted only the fantastic, the real as the
dreamer would have it; and he lets go altogether his hold on the actual,
accepting the would-be world as present fact. And we call him insane.
Other visionaries wakened rudely to life as it is, accept it as
unchangeable fate, lose all their true ideals and become cynical, or
victims of utter depression for whom life holds nothing that matters.
Still others go on through the years self-satisfied and serene because
they simply refuse to believe unpleasant truths; they "pretend" that
their wishes are realities, and acknowledge as facts only the pleasant
things of existence. The first two groups have failed to adapt self to
life as it is, and the mind is lost or so damaged as to no longer serve
its body properly. The "pretenders" have adjusted themselves, and so
long as they can remain happily self-deceived all goes well for them,
though they complicate living for others. However, they have made an
adaptation, a defective one, it is true, but one through which the mind
may survive. Some of this class, however, finally build up a more and
more elaborate system of self-deception until they, too, are insane.
The practically adaptable man can dream dreams, but always recognizes
them as dreams, and can stop at will; can vision a beautiful ideal, but
comprehends that it is not yet reality, though it may some time become
so if he learns and fulfils the laws leading to its realization. The
adaptable man or woman recognizes the real as fact, desirable or
otherwise, the fantastic as unreal and only to be indulged in as a
pastime, and the ideal as the possible, a thing for which to work and
sacrifice. So perfect adaptability would mean perfect mental poise.
It is for the nurse to realize that the greater number of her patients
do not belong to any of these classes absolutely, but that some of them
have tendencies leading in these various directions. And it is her
privilege to recognize the trend of her sick patient's mental workings,
and to so deftly and unobtrusively encourage the recognition of facts as
things which are to be used--not as stumbling-blocks--that her mental
nursing, as her physical, shall be directed toward health. She can
help her patient to accept illness and suffering as realities to be
faced, and treatment as a means, whether pleasant or not, of making it
possible for health to replace them. The understanding nurse can
actively help her charge one step at a time toward adaptation to the new
environment, remembering that many of the sick, particularly the
depressed, cannot be encouraged or incited to effort by having future
health held out to them. They are capable only of living in the present
and doubting all the future.
_There Can Be No Neurosis Without a Psychosis._--If the brain is the
organ of the mind, then what affects the brain must perforce be at
least registered by mind. So every physical shock, accident, toxic
condition, infection--even the ordinary cold--rouses the mind at least
to awareness, usually to discomfort. For the nerve-cells and
fibers--those inseparable parts of the body mechanism--speedily report
the fact that they are being tampered with. In the toxicity of the
infections these very delicate tissues are nourished by toxic fluids;
in accidents they carry all the messages from the injured part. Then
the brain--that center of all man's reactions and the organ of all his
consciousness--receives the report of the disturbance and translates
it into terms of more or less disability. The neurosis has become a
psychosis. The physical condition has become a mental discomfort.
Normally this ensuing mind state should be in accordance with the
extent of the injury to the nerve-cells and fibers. But under
long-continued discipline, or influenced by emotion, the conscious
mind may not recognize the neurosis; whereas, in the hypersuggestible,
consciousness will translate it into entirely disproportionate
suffering.
A great problem of nervous education is what the mind will do with
discomfort or pain. Will it put all its attention there and respond with
nervousness, irritability, demand for sympathy; or will it relegate all
the minor pains to their own little places, accepted as facts but to be
disregarded except in so far as actual treatment is needed? Will it turn
to attend to the host of other more desirable objects? Or in case of
acute suffering, will it take it as a challenge to endurance? Will it
use it as a means to strengthen volition, as a stepping-stone to
self-mastery?
Realizing the force of the law--no neurosis without a psychosis--the
nurse will try to eliminate unnecessary irritations to physical comfort,
while she helps the patient to adjust himself to the ones which are
inevitable. It is the doctor's problem rather than hers, except as she
carefully fulfils orders, to eliminate the toxic causes of psychosis. It
is hers to help the patient to meet adequately the effects of the
infections or toxins, and to prevent as far as possible the surrender to
uncontrolled nervousness. Her object is to have him face the psychosis
as one of the simple facts of science, then turn the sick mind's
attention to more important things; she would encourage _will_ to force
endurance; she would stimulate the feeling life to the forward look of
confidence and faith, or to acceptance of life's suffering as a
challenge. The nurse knows that pains beyond the power of endurance the
doctor will lighten. And the patient's reaction to discomfort and
suffering, the understanding nurse, without any preaching, can very
largely influence.
THE POWER OF SUGGESTION
One almost universal condition found in illness is
_hypersuggestability_. Here is the nurse's despair and her hope.
Suggestion may come from without or from within. When from within, we
call it autosuggestion.
Many of the sick are temporarily resting their reasoning faculties and
their judgment. The sick body is causing a feeling of "jangling nerves,"
and the mind, too, is strongly tempted to be sick. So every harsh sound,
every jolt, almost every sentence spoken in their hearing suggests
immediate nervous reactions. The mind does not wait to weigh them. The
nervous system reacts to them the second the impression is registered.
The whole self is oversensitive, and the very inflection of a voice has
enormous significance. Let the nurse remember that her way of giving a
treatment, her expression, or her very presence becomes a potent
stimulus on the second, one to which the patient's mind responds like a
flash-light when the button is pressed.
The nurse must comprehend the principle of the nervous effect on the
patient of all that is done and said, and realize her tremendous
privilege in making those stimuli wholesome. The nurse who has a
sympathetic insight, with unswerving loyalty to orders, can carry them
out with the average patient, unpleasant though they may be to him, in
such a way that his wholesome emotional response will be called forth, a
response of co-operation, or of faith or of good breeding, or of
"downing" the impulse to indulgence; or a response directed toward
holding the nurse's interest and attention, and so keeping her in the
room; such a response as will gain some privilege, etc.
But there are some patients in whose cases ordinary persuasion,
suggestion or requests fail. They are too nervously or mentally sick to
be moved by logic, or to respond with customary grace to a request which
their reason is not awake to answer. All usual suggestions may fail of
effect. And for these few, in order that health may be at all assured,
even the discipline of force may be necessary. But the nurse must use
this only as a last resort, of course, and in accordance with the
doctor's orders, and then solely as treatment leading toward the ways of
health. Before turning to this final method she should clearly, firmly,
and kindly explain the principle of the discipline if the patient's mind
is at all capable of grasping it. In any case, force should be used only
as the surgeon uses his knife. It hurts, but only to help and to save;
and it is not called upon when other methods can secure the needed
results. But force, thus limited in its application, may prove the only
suggestion which will bring about the action necessary to health on the
part of the patient. Force unwisely and unkindly used proves a damaging
suggestion, causing reactions of fear or anger; or it may lead to
delusions of persecution and to strengthened resistance.
Many suggestions come to the patient from within. Discomfort in the
right side may suggest appendicitis. A slight indigestion, often purely
nervous, may be interpreted as inability to care for certain diet, etc.
The wise nurse will displace as many of these as she can by casual
suggestions on her own part. She will demand of herself that her very
presence be quieting, calming, happy; that her conversation with her
patient shall vibrate with a certain something that gives him courage
and strengthens the desire and the will to health; that her care of him
shall prove confidence-breeding. The patient's attitude, when he is at
all suggestible, is largely in the nurse's hands, and she can make his
illness a calamity by dishonest, fear-breeding, or suspicion-forming
suggestion. After all, the whole question here is one of the normality
of the nurse's own outlook on life and people. The happier, truer, and
more wholesome it is, the more really can she help her patient to both
bodily and mental health. Of one thing let the overzealous nurse beware.
Do not irritate your patient by a patent, blatant, hollow cheerfulness
that any one of any sense knows is assumed for his benefit. Personally I
know of no more aggravating stimulus.
_What We Attend To Determines What We Are._--This is one of the first
laws of education. If the child's attention from birth could be
controlled, his future would be absolutely assured. But attention is a
thing of free will and cannot be forced by others. It can be won through
interest or self-directed by will. The child's attention is entirely
determined by interest, interest in the morbid and painful as truly as
in the bright and happy. Punishment interests him tremendously because
it affects him, it interferes with his plan of life, it holds his entire
immediate attention to his injured self. But something more impelling
quickly makes him forget his hurt feelings and he is happy again. The
average sick person is emotionally very much like the child. His will at
the time, as we noted before, is tempted to take a rest, and his
interest is ready to follow bodily feeling unless something more
impelling is offered. The nurse who can direct attention to other
people, to analyzing the sounds of the street, to understanding
something of the new life of a hospital or sick room, to planning a
house, or choosing its furniture or equipping a library, or supplying a
store; to intelligent references to books or current events; or to
redecorating the room--all in his mind; to an appetizing tray, a dainty
flower, a bit of sunshine, a picture, etc., is fixing the patient's
attention on something constructive, helping him to get well by
forgetting to think of himself.
Thus the nurse, knowing the laws of attention, can keep herself alert to
divert and direct her patient's thought to wholesome interests. Knowing
the possibility of thought substitution, she can open up new channels
of thinking. Knowing the power of the will to assist in health bringing
and health keeping, she can sometimes stimulate long-dormant
determination. Let her beware, however, of making the convalescent too
dependent upon help from without, but prick his pride to gradually
increasing doing for himself. Arouse his reasonable ambition, but let
him realize that life must be taken up again a step at a time; and that
he _can_ do it. If limitations must be accepted, try to inspire the
feeling of pride in accomplishing the utmost possible within a
limitation, and an acceptance of the inevitable without bitterness.
Attending to the unhappy, the painful, the boring without looking beyond
makes life unhappy, painful, and a bore. Not that the nurse should
ignore these realities, but she can accept them whole-souledly herself
as not the final things, as merely the rocks that can be used to stand
upon and get a view of the something better for everybody. When they are
thus used by the wholesome mind, facts, the very barest and meanest of
them, can be made useful as stepping-stones to the happier facts beyond
them.
If the nurse can direct or tactfully lead the patient's attention away
from himself and his illness, she has found a big reinforcement to his
treatment. This question is so vital in the care of patients that it
will be discussed at greater length later on.
ONE THOUGHT CAN BE REPLACED BY ANOTHER
If we control attention we control thought, and with the suggestible
patient this principle depends upon the one just now considered. Hope
and courage-breeding thoughts can replace despairing and fearful ones,
but it will be only when attention is directed through interest or by
will to new material. There is no blank in waking consciousness. The
last thought or feeling or perception, through association of ideas,
brings up a related one, and so on indefinitely. We may start with a
pebble on the road and go on logically, smoothly, until in five minutes
we are thinking of the coronation of King George, with no sense of
anything at all unusual in the succession. It may be a very roundabout
process, from "pebble" through "rough way," "ways that hurt," "dangerous
ways," "brigands," "uncertainties of life." "Uncertain lies the head
that wears a crown," "King George and his crown," "coronation." But this
constant stream of thought can be broken into at any point by a spoken
word, a passing vehicle, which diverts the mind's trend. So the nurse
can take advantage of the mind's very suggestibility, and substitute for
the unhappy and sickness breeding by turning attention to anything else
of a happier color, and may divert the entire stream of thought in that
direction. She who knows these simple laws of the mind, and who at all
knows people, is a therapeutic agent of unlimited value.
HABIT IS A CONSERVER OF EFFORT
It is always easier to follow a beaten path than to break one's way
through untrodden forests. It is easier to walk after we "learn how,"
and learning how is simply doing it over and over until the legs and
feet have acquired habits of motion and accommodation to distances and
to what is underfoot. It is easy to do anything after we have done it
again and again, so that it has become second-nature, and
"second-nature" is habit. The wise man early forms certain habits of
personal care, of eating, sleeping, exercising; of study, of meeting the
usual occurrences of life. The first day he spent at anything new was a
hard one. Nothing was done naturally. Active attention had to be keenly
held to each detail. He had to learn where things belonged, how to do
this and that for the first time, how to work with his associates.
Do you remember the first hospital bed you ever made, the first bed-bath
you gave, the first massage? You had to be taught bit by bit, detail by
detail. You did not look upon the finished whole, but gave almost
painful attention to each step that led to the made bed, the completed
bath, or the given massage. Your fingers were probably all thumbs unless
you had experience in such things before you came to the hospital. Your
mind was tired from the strain of trying to remember each suggestion of
your instructor. The second time, or certainly the third or fourth time,
it went better. After a week of daily experience you gave the bath or
massage or made the bed with much less effort. A month later the work
was practically automatic and accomplished in a fraction of the time you
spent on it that first day. Now you can do it quickly and well with
little conscious thought; and at the same time carry on a brisk
conversation with your patient or think out your work for the day. Your
mind is free for other thoughts while you perform the task easily and
perfectly. Your method of doing the work has finally become a habit
which saves the effort of conscious attention. The details of your
routine work are directed by the subconscious. The habit will be energy
and time saving in proportion to the accuracy of your first conscious
efforts spent on the new undertaking. Thus, useful habit is the result
of active effort.
We can acquire habits of thinking and habits of feeling as well as
habits of doing.
But the other habits, the bad ones, are not acquired with effort. We
fall into them. Hazy thinking is easier than clear thinking. Suppose you
are by nature rather oversanguine or overdespondent, and you make no
genuine attempt to evolve that nature into poise. Directing _will_ to do
what _desire_ opposes is too difficult, and you go the way of least
resistance. So easily are the bad habits formed; but only with
tremendous effort of will and persistence in refusing their insistent
demands can they be broken or replaced by helpful ones.
But habits can be learned; and bad habits can be broken when an
overpowering emotion is aroused against them, possesses the mind, and
controls the will; or when reason weighs them in the balance and
judgment finds them wanting, and volition directs the mind to displace
them by others.
The nurse meets in her patients numberless habits which retard recovery
of body and make for an unwholesome mental attitude. Some patients have
the complaint habit, some the irritation habit, some the self-protection
habit, some the habit of impatience, some of reckless expression of
despair, some of loss of control, some of incessant self-attention. The
nurse who can arouse an incentive to habits of cheer expression when the
least cause of cheer appears, who can by reason, or if that is not
possible, by suggestion; by holding out incentives, or by making some
privilege depend upon control--this nurse can help her patient to
displace habits of an illness-accepting mind by habits of a
health-accepting one. Above all, let her beware of opening the way to
habits of invalidism. Some people acquire the "hospital habit" because
it is easier to give way to ill-feeling, however slight, and to be cared
for with comfort, than to encourage themselves to build up endurance by
giving little attention to minor ailments.
THE SAVING POWER OF WILL
It is not uncommon to hear a doctor say, "Nothing but his will pulled
him through that time." It does not mean quite what it says, for the
patient's will would have been helpless to cure him without the medicine
and the treatment. But it does mean that in some cases when life is
hovering on the brink, even the most skilful treatment cannot hold it
back if the _will to live_ is gone. The chances may be half and half.
Lack of desire to live may drop the balance on the death side.
Determination and hope and confidence may overweigh the life side. For
the influence of will in refusing to surrender to depression may throw
the needed hair's weight in favor of more normal circulation. Depression
and emotion may so effect the sympathetic nervous system as to cause a
lowered circulatory activity. Determination, based on volition, may
stimulate a response from the sympathetic system which will increase
heart activity. And certainly, when it is not a matter of life and
death, but a prolonged recovery, will is a saving grace. The patient who
sets all his sick energies to the task of winning health reaches his
goal quicker than the hopeless and depressed. Perhaps his will merely
brings utter relaxation for the time, forces acceptance of present
helplessness only for the sake of giving the body a better chance to
recuperate; but the very fact that it is acting to hopefully carry out
orders lightens by half the nurse's task of getting him well; and she
can encourage this will to co-operate with the doctor's efforts by
suggestion, by her directness and honesty, by the quiet assurance that
at least a reasonable degree of health is won by effort.
We have touched upon only a few of the laws of the mind. The nurse can
help develop saving mental habits and wholesome attitudes while she
helps to strengthen sick bodies; she can make a cure a little more
certainly lasting who will remember that:
1. Adaptability is essential to life and health.
2. There is no neurosis without a psychosis.
3. Suggestion may be a powerful factor for health.
4. What we attend to determines what we are.
5. Thought substitution is possible.
6. Habit is a conserver of effort.
7. Will is a saving power.