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