Calling All Nurses

How to Deal With Irrational Patients and Family Members

Mark Goulston


When you’re in love, smoke gets in your eyes;

When you’re afraid, really afraid, hijack gets in your brain

This is not meant to be a put down to scared patients and their families. What happens to their brains on fear is that their amygdala, the mind’s sentinel in their middle emotional brain, hijacks them away from being able to hear and listen clearly, then assess what they hear to consider options. Instead they get hijacked to reacting to the present situation based on how they reacted to prior situations. Those reactions often do not fit the current reality they are facing and in many instances make what they are dealing with worse.

What do you do when you’re a nurse, doctor or health care provider and you run into this reaction in your patient or one of their family members?

And avoiding it is not an option.

Wanting to avoid it is so tempting, and the last thing you psychologically want to do is lean into that fear. However, that is actually the first thing you should do.

In my book Talking to Crazy: How to Deal with the Irrational and Impossible People in Your Life, I explain how the best strategy to use if a dog has bitten into your arm is to not try to pull your arm from the dog’s grasp. That will only cause it to dig its teeth in deeper. What you need to do is push your arm deeper into his mouth, which will cause him to release it as he starts to choke..

That is exactly the strategy to use when you find that patients or their family members are yelling, demanding and pushing you to do something now.

There is a well-known adage (author unknown) that says, “If you can name it, you can tame it.” UCLA psychologist Matthew Lieberman, PhD, explains that when you name an emotion accurately — what he refers to as affect labeling — it lessens amygdala activation. By doing that, you decrease the possibility that a person’s amygdala — the mind’s emotional sentinel — will hijack commandeer the brain, preventing it from being rational, and forcing it into a pre-wired “fight or flight” reaction.

The correct moniker(s) to use when dealing with frightened patients or their…



Mark Goulston

Dr. Goulston is the world's #1 listening coach and author of "Just Listen" which became the top book on listening in the world