Mind and control of breathing are physiologically joined “at the hip” metaphorically speaking. Mind and control of breathing are two sides of the same coin. It is obvious, really. Control of breathing does not only involve the respiratory neutrons of the brain or brain stem, the entire autonomic nervous system is involved, including the skeletal respiratory muscles and the entire ventilatory system helping to move air in and out of the body. Looking at isolated respiratory neutrons of the brain will tell you nothing. The peripheral nerve fibres, ganglions, skeletal respiratory muscles, and chest wall, bone and cartilage geometry, all will affect the brain’s ability to “control” breathing rate, depth and pattern at rest and during exercise, illness and other stimuli. Control of breathing involves much more than the brain, much more than the lungs, Control of breathing involves the entire body and all organ systems and the thermodynamics involved. Yes it is complex. Yet damage to any system affecting “control of breathing” is easy to detect if one knows how. The answer lies in the normal or abnormal workings of basic physiology; the answer is OBVIOUS when one evaluates the vital signs [Respiratory rate, Blood Pressure, Heart Rate and body temperature].
It seems that control of breathing mechanisms are endlessly adaptive and varied. This is obvious when one examines the case of my friend Paula. When she suffered a long episode of altered mental status with abnormal mood, she suffered silently [she could barely speak] and though everyone noted the changes in her demeanour, no one thought about to check out her general physical condition. This is easily done by checking the vital signs; had anyone done this they would have noted that her vital signs were very abnormal and thus, the acid base of the blood must have been affected, thus accounting for her [silent] mental confusion and suffering.
Not only was her respiratory rate impossibly low at 3 breaths per minute, but during illness it got even lower [2.5 breaths per minute]. This explains the sympathetic activation response [blood pressure and heart rate rising, catecholamine release, etc… ] to what we assume to be an exacerbation of her baseline state of ventilatory failure [which no one knew about] most likely causing hypercapnia and a confusional state or chronic delirium , a quiet motor subtype of delirium which would not lift easily without supportive medical care.
Why does a quiet delirium occur? Most likely because the patient cannot breath yet show no visible shortness of breath because they are breathing so so slowly and with invisible effort of the abdominal muscles for active exhaling.
Paula’s ventilatory system is broken. Her physiology is abnormal. During health. Under some adverse physical conditions, it fails to fully control endogenous acids formed by cell metabolism from rising, in the blood.
No one can explain this.
No one is even aware this can happen.
Because patients are not aware of this ventilatory system defect, in health and are no wiser during periods of hypercapnic ventilatory failure.
And doctors never count respiratory rate during routine appointments. So obvious problems with control of breathing go unnoticed and the increased risk of hypercapnic respiratory failure and its hypercapnic encephalopathy are ignored. Prevention of hypercapnia is possible, with careful monitoring of the patient and their 4 vital signs, but how can doctors prevent something they do not even know exists, despite the best efforts of Dr Emile Kraepelin to tell them based on thousands of patients with this very problem.
Remember, ASSUMPTIONS need to be checked out, because your assumptions may be wrong and the result sometimes is chronic illness, suffering and disability, such as we see in potentially reversible attacks of bipolar illness.