When is Mental Anguish a Breathing Problem?

Breathing difficulty and Depression can look the same. Same body posture, same body language, yet different sources of distress. 


Many people with breathing difficulty adopt this position spontaneously without understanding why. They can’t explain it.  They just know they feel terrible.   It is easy to jump to the wrong conclusion and wrong diagnosis.

Positions to Reduce Shortness of Breath:

eg. When Sitting

  • Rest your feet flat on the floor.
  • Lean your chest forward slightly.
  • Rest your elbows on your knees or rest your chin on your hands.
  • Relax your neck and shoulder muscles.

The position shown above is helpful when you have shortness of breath for any reason. https://my.clevelandclinic.org/health/articles/9446-positions-to-reduce-shortness-of-breath

Breathing difficulty and Depression can look the same. Same body posture, same body language, yet different source of distress.

Depressed people adopt the same body language as people experiencing difficulty breathing.

Vincent van Gogh’s 1890 painting  depicting sorrow  ….. OR ….depicting the “Tripod position ” [instinctively adopted by people having trouble breathing.

A painting of an old man who sits on a chair with his head in his hands.

Sorrowing Old Man (‘At Eternity’s Gate’), 1890. Kröller-Müller Museum, Otterlo [98]

 Remember that breathing difficulty can also cause mental anguish.  The person may be conscious of the mental anguish but may not be consciously aware that their breathing is the reason.

You could try to ask the person straight out if they are experiencing any trouble breathing.   This would be a start; although they may not know.


Paula is not sure if she knew that she was having difficulty breathing; her thoughts seem to have been obliterated by the anguish she was experiencing; she had no idea what was happening.  No one [except Kraepelin] thought  of it.


The patient may not be able to think straight or even be able to understand the sensation they are experiencing but they may be able to answer ” yes or no” .  Or they may say “I don’t know”.   In both cases you should count their respirations to rule out possible respiratory acidosis and hypercapnia. 


Basic first aid -A.B.C. [with special attention to breathing rate]would have shown that Paula [ like Kraepelins bipolar depressive patients] had very abnormal breathing -of which they were unaware. All doctor’s should practice basic first aid in order to rule out medical emergencies that they and the patient are ignorant of.  Any one can learn first aid; one does’t have to be a doctor- one simply has to think of it!


A.B.C. stands for instructions to  A .CHECK THE AIRWAY:  i.e. look inside their throat. Paula’s airway may have been partially blocked with secretions from an infection and/or from allergic reactions to exposure to higher levels of indoor carbon dioxide [from overcrowding, inadequate building ventilation systems, etc]. B. CHECK BREATHING: I would add COUNT THE  NUMBER OF TIMES AIR IS EXCHANGED AT REST FOR ONE MINUTE. Continual breathing rate is controlled by the brain stem automatically. It is not voluntary.  How many times does the person breathe in and out at rest?  Doctors think they can tell by eyeballing it, but they are wrong. Especially in a person with an unknown injury to their “control of breathing” like Paula and , and, it seems Krapelin’s thousands of patients.  If you are unsure, you can always measure breathing rate over an hour with a Respiratory inductance plethysmography (RIP) like some of Kraepelin’s researchers did] – or you can use a modern electronic “HEXOSKIN MONITOR” -both will measure the movement of the chest and abdominal wall, thus counting respirations.  C.  CHECK CIRCULATION: Kraepelin described his depressive bipolar patients as lethargic, with bradypnea instead of tachypnea, tachycardic, and vasoconstricted [with cold, pale even blue feet, hands and lips]. They  looked pretty sick, in medical terminology-they were even “toxic-looking”. What does this mean?   Typically, a toxic looking patient will look either pale, gray or cyanotic and will be lethargic. They could have [bradypnea], tachycardia,tachypnea and/or poor capillary refill.If the patient looks toxic you worry about sepsis among other things [such as respiratory failure, heart failure, etc…].fromhttps://forums.studentdoctor.net/threads/what-does-toxic-mean.1083063/

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