No one knows. No one has thought of it. Especially when the mood disorder is so visible, so recognizable, so “in your face” but the breathing disorder is not.
Part of the stigma of a chronic mood disorder involves being so overwhelmed with the mood disorder the we forget to keep searching for possible physical disorders that might be generating the disturbed mood. Physical disorders that are easily overlooked. Physical disorders that we do not really wish to see. Physical disorders that terrify us on a visceral level, even if we are not fully conscious of it. Physical disorders we wish to avoid seeing.
Breathing and the possibility of damage to the motor apparatus that keeps us breathing is very frightening to most of us. Not breathing suggests something final, something ominous, something we cannot control, something we cannot do anything about.
Not being able to breathe and not knowing this has never crossed anyone’s mind.
The very idea is horrifying…..a slow unseen torturous syndrome which can linger for decades, for most of one’s lifetime…….without disclosing the possibility of impaired mechanical ability to breath.
Paula lives with this knowledge every day now, even as no one can tell. It is a nightmare really, especially when it results in * pH problems of the blood circulating inside of her.
* In chemistry, pH (/piːˈeɪtʃ/, denoting ‘potential of hydrogen’ or ‘power of hydrogen’) is a scale used to specify the acidity or basicity of an aqueous solution , ” “pH Wikipedia“
It is completely normal not to think of pH of the blood when talking to a person with a mood disorder, especially if they have suffered difficult circumstances in their life. It is much easier to focus on their sad narrative than to focus on the sad pH of their blood.
Yet, abnormal breathing due to physical injury and subsequent pH problems are central to some, if not many mood disorders, such as some, if not many cases of major depression with significant cognitive impairments, and cases of bipolar illness with significant cognitive impairments. The significant cognitive impairments will impede communication of the significant impairment [because communication requires intact level of cognition] and so the patient may not be able to signal this.
pH of the blood and the role of moving air in and out of the body is a “hard” problem in the field of consciousness and mood research in that it is hard for most of us to grasp. It involves knowledge of biochemistry and thermodynamics and is extremely complicated even for scientists and even for doctors.
Yet problems are easier to detect than we realize. Counting respiratory rate to see if it falls in the range of normal is not objectively hard to do. All it takes is counting baseline breathing rate for one minute , using a stopwatch watch. However, it seems that counting respiratory rates is emotionally hard to do. No one wants to do it. No one wants to know about it. Not even a doctor. Breathing is a very emotional issue , it seems, because everyone knows how vital the physical motor act of breathing is to being alive.
I do not think that everyone knows how vital breathing is to mood. Unseen, unfelt, undiagnosed mechanical difficulty moving air in and out of the body is horribly unpleasant, unless it becomes horribly involuntarily euphoric…..both out of one’s control, both wrecking one’s life, unless the mechanical breathing difficulty is uncovered, which is unlikely if one does not move past the mood to examine respiratory rate.
Examining respiratory rate and other vital signs in response to chronic mood and cognitive and behavioural change is not a logical response for human beings. It must become a routine part of medical care of chronic debilitating mood disorders.
And this is scary. Everyone who knows Paula and Paula’s broken breathing tries to ignore and forget it. Same with the thousands of patients uncovered by Kraepelin in the asylums.
This is not only a stigma involving mood disorders, it is a stigma related to our collective fear of death.
We cannot live on this planet if we cannot properly and mechanically move air in and out of our lungs; it is just that simple.
Yet it is much more complicated than we know.
we know this, in part , from other hypoxia tolerant animals, and from the scientific puzzle the Paula represents right now, not only to her doctors but to all of us.
And accepting this and exploring it, despite our visceral fear, will uncover effective treatments to allow people to live quality lives despite their ventilatory injury.
Paula herself is proof of this.
To be continued………………