underlying the potentially reversible syndrome of manic depressive insanity, has never been seriously examined since Dr Emile Kraepelin, because it takes time, because it takes thought, because it considers connective tissues such as blood and considers autonomic nervous system indicators such as the vital signs.
A biology clinic for physical investigations of mental illness and disturbance of patterns of mood, mind and locomotor activity is what is needed in the 21st or 22nd century. It is time to include careful biological investigation of mental dysfunction, as more and more is discovered about how the human body functions, how it may become damaged over time, due to injury and/or as a result of exposure [to toxins], and how to treat such damage in order to restore vital functions including mental function.
The medical concept of “altered mental status” is important. Only in the psychiatric literature is disturbance of mind separate from the concept of “altered mental status” and the reason for this is that psychologists, psychologists, and other mental health workers do not remember or utilize their physical science knowledge or their biological knowledge in assessing “mental illness”. Mental illness is always biological in nature and the search for what is interfering with the normal function of the mind is not unlike a careful detective investigation involving knowledge of physiology and deranged physiology. It is not a sprint but can take years of collecting data till we begin to understand what is going on not only in the brain, but also in the blood and the circulation of blood. And the start of this investigation is to always look at the basics, the breathing rate and depth, [and the blood gases- if the breathing rate and minute ventilation are” off” in any way. .[regarding “Minute Ventilation and why it is important ….see many past blogs or quickly look it up]
The reason there are no organic causes for mental illness syndromes is because psychiatry and psychology do not have the skills to investigate and discover these organic causes. It is obvious that we have not yet discovered the organic causes of serious mental illness.
And who pays for psychiatry’s neglect and disinterest and their dislike of biology? Parents who “know instinctively “that their kids are physically ill and are being ignored, young adults who have become sick upon reaching adolescence and will lose their ability to function at their peak or even at all, and society at large, often loosing potentially talented and creative individuals, who instead become ill, dependant and impaired for long stretches of their lives, instead of joyfully contributing to their “proche” and to society.
If you are unlucky enough to lose your mind, like Jerry did in his 21st year, in the midst of receiving awards at his University graduation, you will fall into the psychological hands of the psychiatry department after getting minimal attention from the referring emergency department of any hospital…STILL…, today the same as 50 years ago-when he became ill,
In the 22nd century, with the help of this blog, maybe things will be different.
Let us pretend that Jerry become acutely ill in the 22nd century.
The emergency department, having judged the situation urgent [but not immediately life threatening], would now refer Jerry to a” biology clinic for mental illness”.
If Jerry had been sent to a Biology Clinic, the staff would have gotten his paediatric and medical history. Jerry, like Paula, was born not breathing and swallowed meconium and was suctioned and resuscitated. He was sickly as a child and was he and his family were exposed to many pollutants in their poorly ventilated overcrowded apartment.
Many of his childhood ailments suggested both respiratory [childhood asthma] and kidney problems. And his family history suggests neuromuscular disease.
Before he became agitated and manic, Jerry seemed very depressed for a period of a couple of years.He had lost weight and had become [accidentally] malnourished. Was his breathing depressed, as well? No one knows. No one thought to look at his vital signs, including breathing rate and depth. Yet all the vital signs contribute to the circulation and to the content of the blood, the connecting tissue that feeds all the organs, including the brain and the miind.
During Jerrry’s episode of agitation, his breathing became irregular and chaotic, his breathing depth unknown. The staff in the 22nd century would judge this to be enough to order arterial blood gas tests and maybe serial venous blood gas tests. Jerry’s temperature was elevated and his face flushed. His eyes were protruding. He kept saying that he had an immense pressure inside his head. once he calmed down, an examination of his eyes would be necessary to check for exophthalmos, a condition that’s related to Graves’ disease. and to check for papilledema …..Papilledema is swelling of the optic disk due to increased intracranial pressure exophthalmos Papilledema – Eye Disorders – Merck Manuals Professional …www.merckmanuals.com › … › Optic Nerve Disorders
Mania seems to be an extended presentation of agitation, which can be worked up medically, but never was back in the 1960’s. It is still not properly worked up, in a biological clinic, even now-in the 21st century. Even when agitation and mania become chronic, allowing for time to investigate the biological underpinnings. Why? Because of longstanding stigma and fear….of disturbances of mind, and because of deeply ingrained ideas that assume separation of the mind and brain from the body and blood and from basic vital physiological signs such as the motor act of breathing, heart rate, blood pressure and thermoregulation.
which requires participation of the muscles [voluntary-ish] to move air in and out of the lungs
We will never know what organic dysfunction led to this continual state of agitation in Jerry, but abnormal ventilation is a good possibility, given his birth. [Pulse oximeters mat not be useful in giving more information about the cause of this agitation; [Pulse oximeters do not offer information about haemoglobin concentration, cardiac output, efficiency of oxygen delivery to the tissues, oxygen consumption, sufficiency of oxygenation, or adequacy of ventilation].https://www.nursingtimes.net/clinical-archive/assessment-skills/the-correct-use-of-pulse-oximetry-in-measuring-oxygen-status-01-03-2002/
There is a good possibility that exhaling excessive air is orchestrated by the brain and requires the participation of voluntary muscles to move as much air out as possible. I had Jerry [age 65] breath into a Peak Flow Meter, one day and his exhale was so strong, so fast, almost overwhelming the green zone [the highest level on the Peak Flow Meter. Could needed to exhale as mcc air as possible explain Jerry’s overly rapid, breathy voluminous speech, full forcefully exhaled air falling out of his mouth every time he opened it to speak? Paula, who does not breath enough [see her minute ventilation in previous blogs] only reaches the average edges of the red zone of her peak flow monitor [signifying possible danger], no matter how hard she tries, even with use of her accessory abdominal muscles. And when unwell and depressed, she seems not to have enough exhaled breath to speak at all and keeps her mouth mostly shut, as if conserving air. In both stages of this syndrome, the locomotor activity matches the minute ventilation [respiratory rate times tidal volume] and we need to learn more about what is happening and why.
It seems likely that breathing and heart rate and blood pressure are “out of sync” during these periods of illness resulting in weeks to months of agitation or depression or mixtures of both.. Jerry was also heard to say that his head was exploding during the beginning of his manic episodes, suggesting perhaps high inter-cranial pressure…Hypercapnia, a key cerebral vasodilator could lead to increased inter cranial pressure. It seems likely that breathing rate and the inability to manage acidosis are the reason for this continued agitation.
A Biology clinic for mental disturbance would investigate these clues in order to try to understand what is going on biologically and to look for intelligent and effective treatments based on understanding the underlying biology. . It is true that psychiatric tranquilizers will calm an agitated person down, but it will not restore the person to a normal and functional state. And without understanding the nature of the underlying biological problems the patient has, it is likely to do physical damage over time. Jerry was managed on the antipsychotic medication of the day back then, but it made him more agitated, more crazy. After 5 years of inadequate, potentially dangerous and basically, experimental treatments, valium and lithium finally helped him calm down  but at the cost of kidney damage, and eventual damage to the blood [diabetes type 2 and damage finally to the heart] because his doctors had no idea what they were doing, but refused to admit it.
And this is still the state of psychiatric treatment for manic depressive insanity today, experimental drugs-with simplistic names [antidepressent drugs, antipsychotic drugs] without any biological knowledge, monitoring or oversight of this complex biological illness. And often, the original potential of the patient is diminished, to boot.
Abnormal breathing rates, minute ventilation, and arterial blood gases are needed to explore the nature of the pathophysiology more fully. Arterial blood gases are needed to monitor treatment and avoid further physiological damage.
to be continued….