Chapter 22

ATTENTION THE ROOT OF DISEASE OR HEALTH ATTITUDE

THE ATTENTION OF INTEREST

Attention naturally follows interest. It can, however, be held by will to the unappealing, with the usual result of transforming it into a thing of interest.

One of the laws of the mind we have already stressed is that what we attend to largely determines what we are, or shall be. The interests which secure our consideration may be the passive result of emotional life, the things which naturally appeal, which give us sensations that the mind normally heeds; or they may be the active result of our will which has forced application upon the things which reason advised as worth acquiring.

We found that the beginning of health of mind consists in the directing of thought toward the health-bringing attitude. We have seen how quickly the normal mind can be diverted from the undesirable by a new or stronger emotional stimulus. We found that the sole appeal to attention in the baby-life is through the emotions, and that it is natural throughout life for the mind to heed and follow the interesting; which is only another way of saying that thinking follows where emotion leads, unless volition steps in to prevent. The supreme test of the will's power is its ability to hold the train of thought in the line that reason directs, when feeling would draw it elsewhere. This ability marks the man who does big things; while the inability to ever turn attention away from the interests proposed by feeling assures weakness.

Some of the most charming people we shall ever know are those temperamental children of happiness whose interests are naturally wholesome and externalized, whose natures are spontaneous and joyous, and who live as they feel, seemingly never knowing the stress of forced concentration. With them attention follows feeling, feeling is sweet and true, and volition simply carries out what feeling dictates. And life may not be complicated.

But there is another class whose attention also follows in the ways of least resistance; and life for them is a wallowing in the morbid and unwholesome. In them feeling is perverted, they seem to see life habitually through dark glasses; they passively attend to the sad, the distressing, sometimes the gruesome and the horrible with a sort of pallid joy in their own discolored images. The first group puts joy in all they see, because they are brimming full of joy themselves. These others find only the unwholesome in life because their minds are storehouses of it. We say that each type has projected himself, that is, has thrust himself out into the external world, and is standing back, looking at his own nature and calling that the universe.

But neither of these two groups can long withstand the stress of a world they only feel and have never attempted to comprehend. The irresponsibly happy ones are too often crushed and broken when life proves to bring loss and failure and disappointment; the morbid probably will cease some day to enjoy their melancholic moods, and be unable to find their way out of them. If both had learned to control attention, they might have been saved. The happy, care-free child of the light is at desperate loss when the sun he loves is obscured, if he has not learned to look upon the far side of the clouds to find that there they glow golden with the rays temporarily shut from him. Because clouds were not interesting to him he never attended to them--and now he cannot. If the pessimistic, morbid one had looked away from the shadow to the sun it hid he, too, in the end might have seen with sane eyes and lived so wholesomely as to find all the good there was in life. Willed attention, rather than spineless feeling distractibility, might have saved him.

When thinking can be forced to follow where trained reason directs, and can be kept in that direction, the greatest problem of physical and nervous well being is solved. To the nurse there is no other principle of psychology so important. But no child ever had his attention diverted by reasoning alone. The object at which you wish him to look must be made more impelling than the one he already sees, or he must want much to please you, else he only with his eyes will follow your command while his mind returns to his real interest; and the second you cease to command that eye service, he looks back to the thing that was holding him before. The beginning of all education is in arousing a _want to know_; in turning desire in the direction of knowledge.

I am an undisciplined child and I want only candy for my lunch. It is not good for me. Milk is what I should have. I don't want it. You may deprive me of the candy and force me to drink the milk, and I can do nothing but submit. But I rebel within, and I am only more convinced that I "hate" it and want candy, and that you are my natural enemy because you force the one upon me and deprive me of the other. If I were insane and so, of course, could not be reasoned with, this might be inevitable. But it would be unfortunate. In that case, if possible, do not let me see the candy; let only the food it is best for me to have be put before me, and perhaps eventually I shall come to want the more wholesome thing--for it is better than the hunger.

But as it happens I am a perfectly normal person, only I am sick. I am tired of bed, and want to sit up--and it does seem that I should have my desire. The nurse, wise in her knowledge of sick "grown-ups," who are, after all, very like children, will find a way to divert my mind from the immediate "I want" to something which I also can be led to want. I may agree that I want more the better feeling an hour from now. Perhaps her humorous picture of the effects of too early freedom on my condition, or of my body's urgent demand for rest, regardless of my mind's wish; perhaps only a joke which diverts me; perchance the "take-for-granted you want to help us out" air; mayhap the story to be read or told; or simply the poise and quiet assurance of the nurse who never questions my reasonableness and acquiescence; perhaps her confidence that this will serve as a means to the end I covet--will result in my gladly taking her advice, and my perfect willingness to wait for new orders, while I indulge in beautiful plans I shall carry out when they finally arrive.

In other words, with the sick as with children, attention naturally follows interest. And the good nurse realizes that it is not wise to force co-operation when she can secure it by diverting her patient's thoughts to another interest than the one now holding him. Very often, merely by chatting quietly about something she has learned has an appeal, she can make the patient forget his weariness and boredom, or his resistance to details of treatment. The very milk he is refusing to drink may be down before he realizes it. But right here lies a hidden reef which may cause wreckage in the future. It is good therapy to divert attention by appealing to another interest when the patient is too sick or too stubborn or not clear enough mentally to be reasoned with. But if this becomes a principle, and his reason and active co-operation are never secured to make him choose the way of health for himself, the hour he is out of the nurse's hands he reverts to the things that now happen to appeal to him. Then unless some wise friend is near to continue her method of making the reasonable interesting, the advice of reason can "go to smash."

There has been a very constant illustration throughout the past of the unwisdom of relying upon diverted attention alone as an effective therapeutic agent. We hope this will not illustrate our point so clearly in the future. The drunkard, who is just recovering from a big spree, and feels sick and disgusted with himself, and sore and ashamed, is appealed to in glowing terms of the wellness and strength and buoyancy of the man who never drinks. He has no "mornings after." The Lord is just waiting to save this dejected victim of alcohol from his hateful enemy who has made him what he is at this hour, and will forgive all his sottishness, his sins. He will be respected; he can command the love of his family again. He will no longer be a slave, but a free man. Right now, respect of the world and love of family and friends, and cleanness, and the forgiveness of a good God are infinitely more interesting than this splitting headache, this horrible sick feeling. And attention may be very readily diverted. This promised new life is more attractive than the present. It is easy to keep attention there. And he reforms. He swears off "for keeps." He is a happy man, a free man. For a few days or weeks, perhaps even longer, he glories in his new self-respect. It is a strange and enticing sensation. Then one day something goes wrong. He loses some money, or he is awfully tired, or the wife and children bore him, and all of a sudden the one greatest interest in the world is a drink. And because his thinking can always be led by his feeling; because he has never learned to force it to go elsewhere, he has his drink. Appealing to his emotions did not and cannot save him unless that appeal is followed at the right moment by awakened reason, which will look at the whole proposition when the mind is at its normal best, and choose to follow where rational feeling directs. Nor will reason save unless volition comes to its support and strongly backs it up and enforces what it advises.

THE ATTENTION OF REASON AND WILL

So the good nurse will not consider her work done when she has diverted mental processes into channels of co-operation. When the patient, who is capable of reasoning, knows the why of his treatment, and realizes that he can only keep well as he himself takes over the job and puts his mind on things outside of his feelings, and carries out the doctor's instructions for the sake of securing a certain end--then he has been under a good nurse. This wise helper never "preaches," but makes the healthy goal very desirable, stirs up an ambition to attain it, and prods the will to keep on after it despite anything feeling may say.

This attitude on the part of the nurse presupposes that her own attention, while with her patient, is upon him and upon securing his health, and not upon her tiredness, or boredom, or headache, or the party tonight, or the man who has asked her to go to the theater with him tomorrow. She, surely, must learn to direct her thoughts where reason suggests, and to gain new interests through willed attention, or as a nurse she is less than second rate. Nor can she get the best results until she can turn with a single mind to the patient at hand as the immediate problem to be solved. And probably neither nurse nor doctor does any better service, except in saving life itself, than in keeping the patient from thinking constantly of himself and his ills. For it seems of little use to have made some people physically well, if they are to carry through prolonged years the curse of constant self-attention, self-centeredness, an ingrowing ego.

There are a few simple laws of the mind hinging upon attention which are today being impressed upon teachers in every department, in kindergarten, public school, college, and university. And they are as necessary to the nurse as to the teacher. Three of them we have already discussed:

1. Attention naturally follows interest.

2. Attention may be held by will where reason directs.

3. New interests grow out of willed attention.

A fourth we shall stress before considering the use the nurse can make of them:

4. The thing to which our chief attention is given becomes the most important thing.

Do not contradict this too quickly. Don't say that nursing gets your chief consideration because it is, of necessity, your profession; but that you love your music infinitely more, and look forward to that through all your hours on duty. If this merely proves that music is distracting your attention, you are doing your nursing as a means, and not as an end; you give it probably all the attention necessary for good work, but your real desire is music. Your chief attention is directed toward that goal. Hence music is to you the most important thing. If your will is sufficiently trained to keep you from consciously thinking of it, still you are dreaming of it and working for it. You may make a very good nurse, but you will never be as excellent a one as the woman from whom nursing demands first and chief attention.

We sometimes speak of one woman as a born nurse, and say of another, "She's a good nurse, thoroughly conscientious, but not a natural one like Miss X." It only means that Miss X's main purpose in life has always been caring for the sick, while Miss Y's secondary concern is that. There is a third, however, who may be sidetracked into nursing, but whose chiefest interest and attention in life has not been so much a certain profession or accomplishment, but a passion for people, with an ability to enter into their lives understandingly. She may not care for nursing in itself. It is only accidental that her thoughts were turned to it. But her liking for people makes it easier for her to concentrate attention on the details of nursing, as thereby she is fulfilling her life's ambition in studying and serving human beings. She may be a real success if she can only convince herself that this is her forte. If not, and she dreams of other fields of service, her concentration on the thing at hand is not perfect enough for her to compete successfully with the "born nurse."

Whatever it is, the thing that gets our chief attention is the most important to us. It may be lack of appetite, or pain in the side, indigestion, general disability, discomfort, the mistreatment we once received, the mistake we once made, or the sin we committed--whatever it is that holds our attention, it is the most absorbing and interesting thing in the universe, though it may be an utterly morbid interest, an unhappy attention. But it blots out for the time the rest of the world. A big hint for the nurse exists therein. Let her try in every lawful way to divert her patient's attention from the disease-breeding stimuli toward the happy and wholesome ones.

For the nurse herself in the care of patients let us draw some conclusions from these laws of the mind's working:

1. Have a goal in view for the patient's health of both body and mind.

2. Work toward instilling in your patient a health ambition--a pride in health.

3. Remember that overcrowding the mind defeats your purpose of making one clear impression.

4. Win interest by any legitimate means to the next step toward the goal, and only the next.

5. Work for attention to hopeful, courageous, and happy things.

Let us as nurses remember always that it is for the patient's sake and not for our own that certain results must be obtained. Our work is usually in helping the doctor to get the best possibilities out of the material at hand, and we cannot hope to change the fabric. But we can help to repair it; we can sometimes influence the color and suggest some details of the pattern, or assist in the "making over" process; and when the fabric is substantial and beautiful we may assist in preventing its marring. So we may help to evolve a body-health and mind-health attitude from what seemed the wreckage of a disease-accepting mind; or we may have the great privilege of warding off the disease-accepting attitude. But always, in all our care of patients, let us not neglect or fail to use wisely this central fact of psychology; that anything that gains attention, even for a moment, leaves its impress on the mind; that the direction of attention determines our general reaction to life.