The Deluded Patient

If the patient's mind is temporarily clouded through infection or

suffering, he may be reacting to a delusion, an obsession, a fixed idea

of disability, a terrifying fear. Sometimes he persistently refuses

food, and gives no reason for it. The unthinking nurse is tried,

puzzled, and irritated. In other ways, perhaps, the patient seems quite

normal. But, after all, the explanation is very simple. He probably is

as confi
ent that the food is poisoned as you are that it is as it

should be. No arguing would convince him, for, to his mind, the nurse is

either a complete dupe or an agent of the people whom he knows are

plotting his death. And urging him only strengthens his conviction.

The writer recalls one such case of a patient who had to be tube fed

through many months, though a tray was set before her three times a

day--and as regularly refused. Then one day she was seen slipping food

from off another patient's tray and eating it greedily, not knowing she

was observed. When questioned, though she had never before given a

reason for refusing food served to her, she said that "they" had nothing

against Mrs. B., so wouldn't try to poison her. Her reasoning was

excellent when one accepted her premises. She had bitter enemies. They

were not enemies of Mrs. B. and would not harm Mrs. B. Therefore she

dare 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 world

whose reality we do not appreciate. The nurse, after much experience,

finds that there is a key to every resistance, to every lack of

co-operation, to abnormal attitudes and actions. She realizes that a

powerful emotion of desire or fear, of love or hate, of ambition or

self-depreciation, of hope or despair, of faith or distrust, unchecked

by reason or judgment through the years, has provided a soil upon which

emotional thinking alone can grow. The patient is a mere puppet of the

suggestions of emotions which may not be at all pertinent to the facts.