Breathing difficulties due to respiratory pump failure can be very hard to detect. The depressive distress is an easy pattern of behavior to recognize yet very hard to treat effectively if the doctor does think about hidden silent breathing difficulties involving the respiratory pump muscles, nerves and bones. The doctor should know the importance of carefully measuring breathing rate, breathing depth and breathing pattern at rest. . The body will react internally if the brain decides that the unseen, unlooked for breathing difficulty is dangerous. The involuntary nervous system is in charge of the rate and depth of breathing. It will sound the alarm if something is seriously wrong with the body. That alarm is the sympathetic fight or flight system. It will raise Blood Pressure, mess with heart rate and rhythm, and should increase breathing. Imagine if it, for some reason the sympathetic nervous system cannot increase breathing. This is what seems to happen in depressive insanity. This is a key diagnostic sign. And doctors everywhere are missing it because they no longer know any better.
Hidden breathing difficulties from respiratory pump failure may end up being the main reversible cause of attacks of manic depressive insanity…Serious attacks of bipolar illness involve loss of one’s mind….This is mainly what Paula and I have been discussing for all these years. We have been discussing Paula’s experience during the worst of it. She remembers…..
Breathing is a complex motor act, involving much more than the lungs. Not being able to breath enough comes in many different forms. Any difficulty breathing can result in loss of mind and loss of speech and in a puzzling crushing kind of anguish [a form of intense distress] often reversible with medical support.
Doctors have forgotten how to look for hidden breathing difficulty from respiratory pump failure. The patient will feel mostly an ANGUISH which they will be unable to explain because it is a form of DYSPNEA which is impossible to describe. Patients will not be aware that are having trouble moving air into and out of their bodies because …who knows why? Breathing rate, depth and pattern is a mostly involuntary process linked to acid base of the blood. It is an unconscious function. Maintaining a constant blood pH is critical to a person’s well-being and to the normal function of their mind.
Patients who are sick seem not to be aware of anything except the sensation of anguish which blots out much of conscious awareness of self. It is like being in a lot of pain, but completely different . Both will be impossible for others to relate to or even know about – especially if the patient can no longer communicate well. These patients will barely be able to speak more than a few words at a time. Their voice will sound weak. They will not look visibly out of breath but they will be too out of breath to speak normally. They will have to push the words out and use extra energy to speak or do anything else, which is hard because of their neglected , unlooked for and unseen respiratory pump failure.
Breathing is linked to locomotor activity. Central Pattern Generators (CPGs) are known as neural circuits that generate repetitive patterns of motor behavior independent of any sensory input. They are a property of most independent integrative nervous systems. CPGs are known to underlie fifty or more rhythmic motor behaviors including walking, chewing, swimming, feeding, flying and respiration in vertebrates and invertebrates. Enteric Nervous System: Physiology, Jackie D. Wood, in Reference Module in Neuroscience and Biobehavioral Psychology, 2017, https://www.sciencedirect.com/topics/medicine-and-dentistry/central-pattern-generator.
Dr Emile Kraepelin  found that too slow breathing [in depressed insanity states] somehow is linked to too slow moving, difficulty initiating of movement and to general inactivity, mostly because the patient is only able to consciously focus on the near suffocation that they are experiencing, not having any idea what is causing it.
Dr Kraepelin also recorded that too fast breathing, in the same patient, causing euphoria, irritability, labile emotion, etc…, will also lead to faster speech, locomotor speed and level of activity and sleep will become impossible. This is because the respiratory pump failure is too severe to risk going to sleep. So you cannot sleep without risking death….when in the manic part of the attack of respiratory pump failure.
Too slow breathing and too fast breathing can occur causing respiratory acid base disturbance and mental confusion. No one knows why the breathing rate is so abnormal in these patients. Respiratory pump failure is one of the more difficult to remember causes of respiratory failure.
How do you diagnose respiratory pump failure? Again, look up previous blogs on measuring minute volume – and past blogs on looking for active exhaling [both of which requires basic first aid to detect] – and if pump failure is suspected, the PCO2 [partial pressure of carbon dioxide in the blood] can be measured by an arterial blood gas test. [look up past blogs on this too].
Carbon dioxide is a cerebral vasodilator and so is very important for circulation of blood to all parts of the brain.. Mind Failure suggests that something is physically very very wrong with a person and we owe it to them to do a careful, thorough physical examination and to keep searching until mental status is completely restored.
It is time for a paradigm shift when thinking of serious and disabling syndromes such as bipolar illness. Young adult lives are going to waste and no one is doing anything much about it. Trial and error medications used without knowing their chemical effects pertaining to breathing and mental status has not worked very well. except by accident.
We have effective MEDICAL treatments to support ventilation in respiratory pump failure. [again see past blog]. We can bring back normal baseline mental status. I am very optimistic about this. We succeeded with Paula. We did it by monitoring her mental status until whatever treatment she was given helped. [please look at the blog describing what we did].
Paula and I know from Dr Emile Kraepelin’s work that altered mental status is completely reversible. Dr Kraepelin [died 1926] showed that seriously ill patients without treatments always spontaneously got well for long periods until another attack disabled them again. Abnormal carbon dioxide levels in the blood causes serious mental confusion, but is completely reversible, if treated. Imagine how much faster we can relieve suffering of manic depressive patients with 21st century medical support.
When reading about the history of science, one finds out that new ideas such as Dr Kraepelin’s often take hundred’s of years to become obvious. The time to look at Kraepelin’s original hypothesis is NOW.
It is time to think carefully and prove or disprove this hypothesis. [There is also a past blog on how to do this scientifically].
What are you waiting for?