What happened to Paula’s mind when she woke up that night feeling anguish and distress is easy and hard to explain. She found out at breakfast with her husband, that she was not herself, she was suddenly strange. Lucky for her part of the strangeness was being silent and non talkative and quiet and reserved, a magnification of her normal personality, so it took a long time for people to notice the changes.
Her husband did not notice, because it turns out that Paula is usually quiet at breakfast time, but Paula did not know this anymore. So Paula sat there and worried instead of enjoying the shared silence. Instead of reading the newspaper while her husband did crosswords, Paula sat in front of her newspaper and wondered what she usually did. She had no idea. She was perfectly fine the morning before but now she’d lost her sense of self. She was lost. She wondered why she did not know what to do, what to say. Her husband was oblivious. To him, she was the same as always.
No one really noticed much difference in her behavior unless she spoke or did work. When she spoke she said little. When she performed any task, she was inept cognitively.
From the point of view of her friends, as with her husband, she looked like a quieter version of her usual self. Internally though, Paula no longer knew what to do or what to say in any situation, every minute, every hour, every day, from the day she woke up strange till this strangeness lifted; after over a year. It was like she superficially looked and moved [or didn’t] like Paula but her memory for being Paula was gone.
Paula was vaguely aware that she had once been fine, but without her usual “self” she was left to stumble in her world, without her thoughts, without her words, without her opinions, without her ideas, without content, without her accumulated knowledge, without anything in her mind except surprise and dismay at how this could possibly be.
Paula did not know what to do and so did little. When she did do anything, [her usual work, chores, hobbies], she found out that she did not remember much. This was frightening. And embarrassing. It felt very bad to perform poorly, especially if it involved one of her usual responsibilities.
How to explain? What to say? No idea. Especially without knowledge, words, opinions, or thoughts. No idea. She was lost. She was still Paula, in a sense. She looked like Paula. She spoke like Paula. She went to work as Paula. She returned home as Paula. She retained a sense of where she was supposed to be, and who other people were, but other than that, the details and the content of Paula were impaired. Paula was not completely gone, since no one really noticed [until she spoke or acted]. Even her close associates and friends did not notice for a while, but Paula knew. And Paula noticed. She noticed that she was impaired. She knew that she did not know. She noticed that her thoughts were gone. She felt like a zombie because she was so impaired. . Her body was simultaneously alert for threat and very aroused [high heart rate and blood pressure] and alarmed, yet at the same time, mentally dull, amnesic. This put her at at a tremendous disadvantage. Paula had woken up terrified – knowing something was very wrong, even before she realized that she was amnesic and mentally dull and newly socially and cognitively inept. What happened to Paula?
Paula worried every time she realized she’d lost the ability to think, remember, decide, react, converse, perform [eg. her work, chores, hobbies], in her usual way. And she realized this every time she did or did not do any little thing. Every minute was filled with things she usually encountered and every minute brought surprise, worry, uncertainty, amnesia, failure, and distress. Every minute was then filled with worry., worry with a capital W; Worry! ….And her panic was accompanied by a strange inhibition of her movements, inhibition of her facial expressions, of her voice, of her ability to speak. She did not behave like a person who was worried enough to the point of hysterics. If anything, if you really looked at her closely, she seemed wooden, stiff. And she felt strangely stiff , ever since she woke up that day. And Paula’s movements, reactions, and facial expressions were inhibited, as if her muscles were indeed stiff, making her look a little “zombie-like” but only a little. And yet she was in a chronic silent state of panic, even before she understood her usual “self” to be inhibited or gone. Paula was panicked, her motor functions muted, she’d lost her mind, she’d lost her “self. She’d lost her mind. Who could possibly understand?
Her mind was not completely blank, in fact, her body and mind was hyper aroused and her remaining continual thoughts, hyper active. The content of her thoughts appropriately revolved every second around the missing content. Paula racked her brains all day long, searching for what she used to say or do. She did not even know if or when to eat. She had no appetite. Hunger pangs, thirst..these sensations had disappeared too. She was loosing weight and starting to look unwell.
Paula’s mind was blank, yet she never stopped thinking; she thought about her loss of knowledge, her loss of social markers, her loss of ideas, her loss of a roadmap of self….it is so hard for her to describe.
Paula thought furiously and silently all day long: When well, she’d always had a running commentary in her head. But now her thoughts were bound up around her inability to think. No wonder no one could tell but her. Her face, usually so expressive, was expressionless.
Here is a sample of her new running commentary of thoughts ” I don’t know what to do. Why is that? It is close to suppertime. I have to make supper. What do I usually make? I don’t know. Why don’t I know? I make the same thing all the time. How is it I don’t know. I don’t remember the recipe. How much water do I add to rice? I just made it yesterday. Why don’t I know how much water to add? Where did I put the recipe for rice ? Should I ask someone? Who would I ask? What would I say? I don’t remember the phone number. Where did I put the phone book? I am running out of time. How much water do I put in the rice? Why don’t I know? etc… In the end, Paula somehow is able to make the rice and she forgets to add salt and the rice is tasteless and supper is ruined.. And she feels guilty because she ruined supper, which she did [although everyone was very gracious and forgiving]. And she can’t explain any of this. What would she say? Who would “get” what was happening to her?
Paula had lots and lots of thoughts, so many, she was preoccupied with them much of the time. Paula was preoccupied with good reason. She was partially cognitively inept and incompetent and had a great deal of difficulty doing anything. She had lost part of her mind. She knew she wanted to make supper but beyond that, she’d lost so many details regarding this task, she was brought to a near standstill, trying to figure out what to do, this even for routine things [making supper is only one example]. Her entire day was like this. So was most of her night. Her internal arousal [fright, anguish] was such that she couldn’t get to sleep.
Paula was preoccupied every minute, every hour, every day..She was in this state for over a year, trying to figure out what to do, how to respond, why she no longer remembered, and how to respond without her knowledge and memory, without her compass and how embarrassing it is to be like this, how she is letting everybody down [she was so inept her employer finally noticed and came very close to firing her] ….It as like being lost at sea, having lost one’s compass and being left to drift aimlessly and ineptly, in circles and worrying day and night about drifting about in circles, accomplishing nothing and going nowhere.
And no one knew. And no one understood. And Paula could not explain. Explaining requires an intact mind, and cognition it seems. Which is why Paula can explain and remember now, long after she recovered.
She finally was able to recall when well what she couldn’t recall when she was strange. How is that possible? Her mind, her skills, her intellect, her memory, her “self” , was merely inhibited and was retrievable once this syndrome lifted.
She recovered herself and she also recovered the experience of her then amnesic and disabled self.
How?
This suggests a reversible long lasting involuntary chemical or drug-like unpleasant experience affecting the brain. Chemical effects affecting more than the brain. Chemical effects affecting the whole body. A long period of a spontaneously occurring awake “black-out”. [no recreational drugs or alcohol and completely involuntary- kind of like a stroke.
Endogenous chemical effects altering normal physiology and resulting in observable, nonspecific and abnormal physical signs, including vital signs; [such as the heart rate, respiratory rate [and depth], blood pressure, body temperature] and possibly affecting the chemical composition of organic and inorganic molecules of the blood nurturing the blood and tissues of the body.
If anyone thought to measure these vital signs, especially respiratory rate which is closely monitored and regulated by the brain. [if possible]. Respiratory rate is too slow or too fast at rest is often not obvious without careful measurement. Yet abnormal respiratory rate will suggest possible physical problems affecting carbon dioxide transport. The brain usually regulates Carbon Dioxide in the blood by changing respiratory rate and depth. Why would the brain arrange for too slow or too fast or poorly responsive breathing? The brain closely monitors carbon dioxide [and not oxygen] to react to and minimize changes to acid base levels of the blood. It seems that normal acid base [pH] levels in the blood is necessary for being alive and also for normal intracranial pressure and for normal brain function of the mind.
Did you know that the fluids of the body such as blood follow non Newtonian physics? Thus means that normal physics does not apply to blood. Now the brain deals with the non Newtonian properties and manages everything fine usually.; for the brain it is concrete, physical and customary. The brain tracks pH and carbon dioxide in the blood, to keep us alive
For humans, the behavior of blood is a difficult branch of physics and mostly different than what we would expect of other materials. For the brain and the circulation, it is just the way blood works.
The behavior of gases we breath are also very complex, especially when utilized by our bodily tissues to produce energy to be alive.. Our cells produce other gases and these gases are regulated by our skeletal muscles, assuming our lungs are healthy partners.
To be continued……
Of Sound Mind 