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Nursing The Deluded Patient

The nurse soon realizes the uselessness of attempting to argue a patient
out of his delusions, of trying to convince him that the things he sees
and hears and perhaps tastes and feels, are but hallucinations. Her very
insistence only fastens his attention more firmly upon the false
conclusion or makes him more convinced that his mind is giving him a
true report from the senses of sight and hearing and taste and feeling.
But often a quiet disregard of the delusions while the nurse goes on her
way and holds her patient to his routine, consistently and confidently,
as she would in case they were not true, will eventually cause him to
question their reality just because no calamity results. The nurse acts
as if these delusions and hallucinations were non-existent in reality,
and when the occasion arises, through the patient's questioning, she
urges him to exert his will to act also as if they were not true; to try
it and see what happens. Arguing, also, she finds, usually antagonizes
or makes the patient stubborn. He cannot prove by her logic his point,
but he "knows" from inner experience that he sees what he sees, hears
what he hears, and knows what he knows. The fact that the nurse does
not is merely annoying evidence that she is blind, deaf, or stupid to
these things of his reality. He knows he is lost and damned, or tainted;
that he is King George, Caesar, or the Lord, as the case may be; or that
his internal organs are all wrong. He "feels" it and the nurse
can't--therefore, he alone has true knowledge of it. In the end, the
wise nurse who never disputes with him, but leads him on to action which
utterly disregards these things, may bring about a gradual conviction in
the patient's mind that a man couldn't do what he does if all these
things were true; and the delusion slowly may lose its force or the
hallucination fade away. Many patients drop them from their lives
entirely. Many others in whom dementia is not indicated, or in whose
cases it is indefinitely delayed, can come to an intellectual
realization that all these things are fantasies, and do not represent
reality; that despite their continued, frequent, or occasional demands
upon feeling life, they can be consistently ignored. These psychopathic
individuals may act as they would if the delusions never came henceforth
to their consciousness, and so be enabled to live a comparatively normal

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