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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 confident 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.

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