How To Care For The Insane Part 3

It requires an intimate a.s.sociation with the insane, and a careful study of their manner of thought and conduct, to be able to successfully guide, direct, and control them.

_The Relation of Attendants to Patients._--The position of attendants is often a trying one; they are liable to misrepresentation when they have faithfully done their duty; they must learn to receive with calmness a blow or an insult, or even so great an indignity as being spit upon; they must bear with provocations that come day after day, and are seemingly as malicious as they are ingenious and designing; they must watch over the suicidal with tireless vigilance, control the violent, and keep the unclean clean.

To do all this requires the exercise of self-control and kindness; the putting a curb upon the temper; the education of judgment and tact; faithfulness in the performance of duty, and a knowledge of what to do and what to avoid.

These trials are, however, but a part of the experience of an attendant in caring for the insane, for there is a.s.sociated in this care much that is satisfactory and pleasurable. It is a satisfaction to know that duty has been well done; to be able to care for the sick; to do something to alleviate suffering; to tenderly watch over and soothe the dying; it is a pleasure to see a patient improving, going on to recovery, and finally able to return home cured.

Many delightful friendships are formed between attendants and patients, some lasting for years within the asylum, and some for a lifetime, with those who have recovered. Most of the insane appreciate the services rendered them, and have a feeling of grat.i.tude for those who care for them.

Attendants should always treat patients with politeness and respect; it is something that is never thrown away, and exerts a good influence, however rude and disrespectful a patient may behave.

Patients should not be ridiculed, their mental weakness and peculiarities made light of, nor should they be made a show to inquisitive visitors.

It is useless for attendants to try to argue patients out of a belief in their delusions, and to do so often results in fixing them more firmly in the mind. We should not however pretend to believe them, nor humor their belief, nor allow them to carry out their delusions in their dress, conduct, and general behavior.

_The Character of an Attendant._--The insane should always be treated with kindness, and nowhere is the golden rule "thou shalt love thy neighbor as thyself" more necessary of application than in caring for them; and it is well for attendants, when tempted, to stop and think how, under like circ.u.mstances, they would want their mother or sister or brother treated.

Keeping this n.o.ble teaching and this high motive for right-doing ever in mind, an attendant cannot go far astray.

It is a development of character to care for the insane, and instead of being brutalizing, as some ignorant people say, it is elevating and humanizing.

Attendants should never gossip, either among or about themselves, or of their patients. It is a mean and degrading habit to indulge in; it will undermine a good character, and often become overpowering and malicious.

On the other hand, never be afraid to speak the truth, and never let a lie, or the semblance of a lie, pa.s.s your lips, or remain for a moment in your heart. Of all things be truthful.

Attendants must acquire a spirit of willing obedience, of cheerful execution of all commands and directions, and of faithful performance of every duty that devolves upon them. Unless they have this spirit, they will be unable to successfully a.s.sume positions where obedience is to be exacted from others.

They should preserve their own self-respect; in all things set a good example; be neat and tidy in their dress, gentlemanly or ladylike in their conduct; considerate of the wants and feelings of other attendants; they should "cherish a high sense of moral obligation; cultivate an humble, self-denying spirit; seek to be useful; and maintain at all hazards their purity, truthfulness, economy, faithfulness, and honesty" (Utica Asylum Rules and Regulations).

In their relation to the inst.i.tution, attendants should fulfil all their engagements with the same sense of right, that they expect will be observed towards them by those who employ them. It is a business contract that is a.s.sumed, and brings with it mutual legal responsibilities, rights, and obligations. Attendants should strive to so conduct themselves, that when they leave their employment they can go away with the respect of every one, and bear with them the reputation of a good character and of work well done.

_How and What to Observe in the Care of Patients._--It is important that attendants should early learn habits of close observation. The exercise of the habit increases the ability to observe, and one soon comes to see and know things he never saw, or thought of before. It is necessary to learn first the physical condition, mental symptoms, and habits of a patient, before we are able to observe and appreciate any change.

Observation, to be of value, should be systematically made, and only one thing at a time can be noticed, which must be understood before pa.s.sing to another, otherwise every thing is confused.

The condition and appearance of a single part should be looked at to see what is natural, and what is evidence of disease.

In practice, written notes taken at the time, are extremely valuable in teaching close and accurate observation, and cultivating an ability to clearly express to others the result.

For the purpose of suggestion and guidance, the following system for observation is given:

Observe the effect of medicine.

The face.--Observe if it is pale, and if the pallor is sudden, temporary or permanent; if flushed, if congested, if blue with venous blood, if there are any eruptions, bruises, or scars. Observe the expression of the face.

The tongue.--Observe if it is coated, and if so, if white, brown, red, black, glazed, dry, or cracked; if it is tremulous, or drawn to one side, or protruded with difficulty.

The lips.--Observe if pale, blue, dry and cracked, if there is tremulousness about the corners of the mouth; the teeth, if covered with sordes; the gums, if bleeding.

The breath.--Observe if sweet, sour, foul, or offensive.

The respiration.--Observe if slow or fast, quiet and natural, or loud, labored, and difficult, if puffing, wheezing, shallow, or irregular.

The eyes.--Observe if congested, the color, if any blindness; the pupils, if contracted, dilated, irregular, unequal, or if they respond readily to light.

If there is cough, observe if moist or dry, if croupy, if with pain, or if prolonged.

If any expectoration, observe if it is b.l.o.o.d.y or streaked with blood, if thin and frothy, thick and purulent, or if it sticks to the cup.

The pulse.--Observe if it is slow or rapid, full, weak and thin, if irregular or intermitting. Count it.

The temperature.--Observe by the hand or thermometer.

The body.--Observe for eruptions of the skin, for sores, bruises, or deformities, or if there is any paralysis.

The appet.i.te.--Observe if it is poor, changeable, if food is relished or disliked; if refused, if it is constantly or occasionally, and if from delusions or indifference; if there is overeating and gluttony, if food is bolted, or chewed, or if the patient has teeth to eat with.

The digestion.--Observe if natural, or painful, and if so, whether upon taking food, or if the pain is delayed; if gas is discharged from the mouth, if the stomach is sour, if the food is heavy and distressing; also observe what kinds of food give dyspepsia, and what seem to be well borne.

Of vomiting.--Observe if occasional or constant, if immediately after food, or delayed, if sour or bitter, if preceded by pain or nausea, if it contains any undigested food.

Of diarrhoea.--Observe how frequent the discharges, if with pain, and where it is situated, the color, the consistency, if there is any blood or mucus, if it alternates with constipation.

Of constipation.--Observe if alternating with diarrhoea, if habitual, the effect of medicine and food; if there are any piles.

The menses.--The quant.i.ty, if there is any pain, its cessation and reappearance, if any effect upon the mental condition.

Of pain.--Observe the character and severity, its location, and any evidence of a cause.

Of dropsy.--Observe if it is general or local, if in the chest, face, abdomen, arms, or legs; if there are any varicose veins.

Of sleep.--Observe the length of time, if quiet and natural, if restless, if deep or light, if there is great drowsiness or continued wakefulness, and the effects of medicine.

Of unconsciousness.--Observe if it comes on slowly or suddenly, if partial or complete, if the patient can be aroused.

Of convulsions.--Observe if slight or severe, if of short or long duration, if continued or interrupted, if general or of one side, or of an arm or a leg, or the face, or of a few muscles only.

Of the mental condition.--Observe if fixed or changeable, the nature of delusions, illusions, or hallucinations; dangerous attempts or threats toward himself or others; any change in the mental state.

Of habits.--Observe if fixed or changeable, how formed or how corrected.

Of the general conduct.--Observe the dress, if neat and tidy, or otherwise, private habits, care of personal wants, improvement in conduct, the influence of attendants and other patients, or the influence the patient himself exerts on others.

This by no means includes all that it is necessary to observe, but it contains much that is important, and the system, if studied and used practically, will suggest to the observer whatever may require attention.

_The Control and Influence of Attendants over Patients._--By a "smart attendant" is meant one who sees little to do beyond having a control of the ward by a rule that is close and exacting, who maintains a strict discipline, and who has a love for cleanliness, order, work, and scrubbing. But a "useful attendant" is one who tempers these mentioned traits, by striving to gain the confidence of his patients, by exerting over them a beneficial influence, who is able to bring the individual patient into accord with his surroundings in the asylum, so as to help his improvement or recovery, meet his wants, and increase his comfort and enjoyment. In order to do this it is necessary that the attendant should give careful study and attention to each patient. Such a study will soon demonstrate to, and teach the attendant the fact, that the insane are very individual in their habits, and while no two are alike, there are resemblances that in an asylum are made the basis of cla.s.sification by wards: there is the convalescent, the suicidal, the demented, the sick and feeble, and the noisy or violent wards.

Attendants must first learn that patients are not to be treated merely as a ward full of people to be kept in order, to be clothed, fed, and put to bed, but that the peculiarities of each patient are to be studied, and that it is their duty to know thoroughly the wants, and condition of each case, and how best to care for and control it. The better knowledge an attendant has of the individual, the better he can care for a ward full of individuals.