In order to make room for oxygen, you need to clear out the carbon dioxide. You do this with your Respiratory Pump, the system for moving air in and out of the body all day and all night. This is key to life! So simple, so mechanical, so automatic….we don’t even have to think about it…yet the whole body participates.
Taking out the garbage, though, can be hard work, physical work. Yet it is not hard work for most.. Exhaling waste gases is effortless for normal people. It is like letting the air out of a balloon…..it happens naturally and quickly. [try it and see].
For Paula and for Kraepelin’s patients getting rid of waste gas is hard, it takes great effort and work. Extra muscle power is needed with every breath. When Paula was sick. it seemed that she had no energy to do much more than work to exhale, to take out the waste gas garbage in order to leave room for fresher air.
This is fine when one is well, but help might be required when one is sick. Accessory muscle work is virtually invisible without taking a closer look. Accessory muscle work is different from shortness of breath.
Of Sound Mind 