With the Glascow Coma Score [for head injury], the higher the number the more awake the patient. If you are awake you are assumed to have “normal” wakefulness. But what if you have abnormal wakefulness? Patients with bipolar depression look passive externally but internally they are hugely distressed and super upset. If anything, they are too awake internally; too stimulated yet unable to respond or even understand what is going on. There is no test for being “TOO AWAKE” , in a continual state of fear. Agitation, restlessness, confusion are all parts of this internal unpleasant awareness. The pattern of the vital signs will give clues that something is physically very very wrong. The vital signs will suggest sympathetic activation; being too awake will probably be evident in the very high blood pressure and heart rate and the fear evident in the eyes. Respiratory rate should also be elevated.
If the patient shows signs of fear and sympathetic activation but the respiratory rate is too slow. or minute volume is too low……..you will have found the cause of the patient” fear. They are physically unable to raise their breathing frequency as all the textbooks describe. This means the patient is not breathing enough air at rest and is suffering from some level of asphyxiation and doesn’t know it. Asphyxiation is a silent process. I expect that the kind of ventilatory injury that Paula and others have, body heat is lost fairly quickly, despite the reflex sympathetic activation and the reflex compensatory measures that are still intact. We think that the systemic vasoconstriction and lowered body temperature and other reflex chemical reactions that occur put Paula into a restless state of fear [signaling how close she was to dying] and a state of reflex suspended animation [made possible by the fixed yet slow deep breathing.
Mild fixed a sphyxiation would certainly gain one’s attention! And it would also mess with one’s ability to think or speak or eat or sleep. And that is exactly what happened to Paula and to Kraepelin’s patients. Suspended animation states would explain their spontaneous recovery when internal conditions were slowly healed and restored, by feed forward biological mechanisms.
Asphyxiation, it seems , is a complex thing. And the brain.body have mechanisms to cope.
And we just beginning to learn about these mechanisms as we understand more about the mitochondria……..
To be continued…..