STIGMA of Serious Bipolar Illness.
Dr Kraepelin noticed that thousands of his unmedicated patients with depressive insanity had too slow breathing rates at rest. This alone would make these patients unhealthy and would imply respiratory acid base problems in the blood. This explains the very unpleasant state of depressive insanity. This state is almost unbearable to experience. The patient is unaware of his own abnormal breathing rate and is equally unaware of the not so good state of his blood. This alone would explain the change in mood, cognition [diminished] and locomotor activity [also diminished]. An arterial blood gas test is the only test to give results of PCO2 in the blood. An abnormal minute volume would suggest the need for an Arterial Blood Gas Test.
It is my experience that doctors do not know that attacks of bipolar depression are due to physical illness affecting the brain and the mind. . Doctors misinterpret this metabolic illness as psychiatric illness. Kraepelin obtained careful assessment of vital signs and what he found in depressive episodes is especially telling.He found too slow breathing in bipolar depression. Too slow breathing is very bad.
And in patients will normal lungs, too slow breathing will affect their overall health, especially when breathing conditions are found wanting or when patients suffer from infections affecting their breathing.
This is the stigma that prevents these patients from getting proper care.. This is a metabolic disease of the blood due to respiratory pump muscle failure NOT a psychiatric disease.
These patients are mentally confused and so sick, as to be near death while almost never dying, this is also true of other organ failures, before they are finally diagnosed [if ever] once the person begins the active process of dying or commits suicide because organ failure is too unpleasant a sensation.
Organ failure of any kind is often hard to detect because the function of organs are internal, and organs can fail and cause serious hidden problems that the patient cannot explain, before any disturbances in the blood can be found.
I have seen doctors miss obvious syndrome of heart failure, kidney failure, and obvious syndrome of brain failure causing altered mood, altered mind and altered locomotor activity. They miss these syndromes because the symptoms are often nonspecific for long periods. It is difficult doctors and, indeed, all humans to know the difference between healthy and not healthy individuals . It is the same with depressive insanity and bipolar illness. The stigma is that they do not get timely physical care which would clear their mental confusion and their sensations of anguish-a form of dyspnea].
This situation results in huge STIGMA , especially with the serious and disabling syndromes of bipolar depressive syndrome and mania.
To ELIMINATE stigma, the assessment of physical health and the health of the brain must be approached in a way that is radically different. This is what Kraepelin thought.
Healthy people breath normally at rest . Unhealthy people will have abnormal breathing at rest. Breathing rate at rest is involuntary; it is set by the brain stem in order to maintain pH of the blood. Adequate breathing requires healthy lungs and on a functioning respiratory muscle pump system to move air in and out with minimal effort at rest.
Dr Kraepelin noticed that thousands of his unmedicated patients with depressive insanity had too slow breathing rates at rest. This alone would make these patients unhealthy and would imply respiratory acid base problems in the blood. This explains the very unpleasant state of depressive insanity. This state is almost unbearable to experience.
The patient is unaware of his own abnormal breathing rate and is equally unaware of the not so good state of his blood. This alone would explain the change in mood, cognition [diminished] and locomotor activity [also diminished].
So the first thing doctors and health providers must do is to simply count respirations at rest for one minute with a stopwatch. Paula [who had a bad episode of bipolar depression] was astonished to find that her breathing rate was 3 breaths per minute. Doctors never measure breathing rate at rest. No one knows why. It is stupid. They should. Breathing is key to being healthy!
It is easy to see that with physical illness or blood loss or infection etc…Paula is much nearer to respiratory acidosis of the blood [type 2] than other people. And mental confusion and sensations of anguish [a form of dyspnea] would result.
That is why Paula got sick.
1] So to eliminate stigma in bipolar depressive states or any seriously disabling depressive state…simply measure respiratory rate at rest for one minute with a stopwatch.
2] to check for the mental confusion accompanying the metabolic dysfunction of the blood, ask a person something they should know, like their address [if they have had a stable residence for a number of years.] Paula discovered that when ill, she did not know that she did not remember her address.
The stigma Paula suffered was that people assumed she was physically healthy when she was not. This led to bad treatments, loss of time, bad decisions on the part of caretakers etc….
She could not make her doctors listen. She knew something was very physically wrong. She had read Kraepelin and knew of the bodily signs of bipolar depression especially and she understood that her doctors had to help her to get her normal mental status back and that they had to check her breathing.
They did none of that.
THAT IS STIGMA!!!!!