When the external motor behaviour is different from the internal state

During Paula’s attack she acted zombie like; she did not move much, she had few facial expressions, she managed only stereotyped responses, she slouched when sitting, she looked unkept, …….psychomotor retardation is a very good term for how she behaved. If Paula had explained that she was sick, with nausea, loss of appetite, loss of weight [involuntary], dyspnea [sensation of difficulty breathing], mental fogginess, fatigue, lethargy, during or after a recent minor infection, everyone would have understood.

If Paula could have explained what was wrong, she would have gotten lots of support.

But Paula had no idea what was wrong, she woke up in this strange state. She was too short of breath to put together more than 2-3 words at a time because she was short of breath but did not recognize that she was short of breath because of her slow breathing. She could not identify the sensation, beyond that it felt distressing. Paula felt immense fear.

Rhythmic respiratory breathing continuously adapts to the organism’s posture, activity level, speech, and can reveal whether someone is calm, agitated, or scared.[12] Plasticity of the mechanisms involved in respiratory behavior is modulated in part by the pre-Bötzinger complex. Disruption causes irreversible loss or major disruption of breathing in vivo. The frequency and amplitude change according to the behavioral and metabolic demands of the organism it controls. Breathing is thus extremely sensitive to the internal state of the organism.  Pre-Bötzinger complex From Wikipedia, the free encyclopedia June 2021

Fear usually results in a quickening of breathing rate, blood pressure, heart rate and release of catecholamines, usually known as the Fight or Flight Response. Paula’s breathing rate was abnormally low…..her breathing was super slow and mostly deep, even through her fear. This was NOT fight or flight. This was something else. Something that needed investigating. Something that was not good.

So Paula’s emotional state [indescribable, and unbearable fear, distress] and her breathing responses [depressed] seem to be uncoupled. How can that be?

“Breathing is an unconscious, involuntary process controlled by neural networks in the central and peripheral nervous system. These neural networks continuously regulate breathing to ensure optimal tissue oxygen delivery and carbon dioxide elimination.Inspiratory Off-Switch Mediated by Optogenetic Activation of Inhibitory Neurons in the preBötzinger Complex In Vivo Swen Hülsmann,1,*Liya Hagos,1Volker Eulenburg,2 and  Johannes Hirrlinger3,4 Int J Mol Sci. 2021 Feb; 22(4): 2019. Published online 2021 Feb 18. doi: 10.3390/ijms22042019

Paula, if asked, will tell you that breathing in is more difficult for her than breathing out, even though, she has to use a lot of strength to exhale actively, squeezing all the air out of her body with the help of her abdominal muscles. It is not a normal way to breath and it takes more time to take breaths this way, yet it feels normal to her. She even thought that everyone breathed this way. [she was wrong].

So what is wrong with Paula?

No one knows.

No one measures vital signs in modern times, especially respiratory rate at rest. During health or during illness. She had to find out by accident in a first aid class. There were a bunch or others with respiratory rates that were too high or too low. They were unaware of this, same as Paula.

So breathing IS an unconscious, involuntary process controlled by neural networks in the central and peripheral nervous system.

And it can break without the person knowing.

It seems especially important to understand this in the time of COV-ID. Perhaps Paula should wear a medical alert bracelet with her normal [abnormal] respiratory rate, tidal volume and minute ventilation at rest.

Or they might set the mechanical ventilation machine for people with “normal ventilatory parameters and accidentally kill her with ignorance.

That wouldn’t be good. 😦

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