The only clue is a sudden sensation of dysphoria [or unease or distress or , if severe- a sense of anguish] and a sudden inability to perform at baseline level [which results in shame and guilt due to failure to do things like one used to, due to a sudden unspoken amnesia for the task.
Paula was only able to mention her sudden unease and anguish because it was so unbearable, overwhelming and inexplicable. As for her suddenly vacant mind, she had no words to explain it so she simply was silent as much as possible, beyond superficial and polite short phrases.
Paula’s unease and dysphoria was palpable and intense. Some people could sense it off her, it was that palpable, but they could only make incorrect guesses about what was wrong, without her input. .Unfortunately, she could not offer any input. Her mind was strangely blank, except for the unease about her sudden loss of autobiographic mind. Paula knew she no longer was able to think or speak or function as she had before. She simply could not remember how. And so she tried her best with the abilities, thought and words that remained and tried to get through the days, and nights as best she could.
No one could possibly know what was happening inside her; unless they thought to count her baseline respiratory rate at rest.
Everybody’s baseline respiratory rate at rest is undetectable. The system is run seamlessly by the autonomic nervous system, much like the other physical signs we take for granted. The brain and the skeletal respiratory muscles and nerve fibres will move air in and out of the body, in and out of the lungs, in and out of the blood, in and out of the tissues, in and out of the cells, in and out of the neurons, and will do so automatically – in the correct ratios for each cell of the body.
Like a thermostat, a baseline rate is set [by the brain and the blood], and compensatory mechanisms kick in when adjustments are needed. And respiratory rate and depth is one of these compensatory mechanisms. Respiratory rate is especially important because cell metabolism continually produces carbon dioxide in the body and the brain continually monitors this endogenous respiratory gas in order to keep it in check. When levels of carbon dioxide from cell metabolism gets too high respiration rate becomes faster and deeper to keep the levels in the blood and tissues constant for each organ system.
It is likely that the disturbed cognitive function that Paula experienced and the inhibited motor behaviour , including speech, she presented were linked to the impaired motor feedback systems shown by the investigation of the motor ventilatory act and its impairment.
Although viewed as separate functions historically, it can be argued that complex motricity and cognition are functionally connected………and both evolved in parallel, interdependently. According to Llinás (10), oscillations of neural activities can represent both motor and cognitive processes, suggesting that both processes may share similar evolutionary roots. This is supported by a recent review on shared evolution of motor and cognitive processes (11) as well as by data and analysis by Vallortigara et al. (12), arguing that evolution of attention serves successful motor processes. Along these lines, Carruthers (13) argue that working memory has developed to serve motor control in animals. It has been argued that episodic memory evolved from place cells in the hippocampus (14). Similarly, it has been argued that the basal ganglia have similar anatomical corticostriatal loops that serve both motor and cognitive processes (15). …….……Both cognitive and motor function are controlled by brain areas such as frontal lobes, cerebellum, and basal ganglia that collectively interact to exert governance and control over executive function and intentionality of movements that require anticipation and the prediction of movement of others. ……………… disorders of executive function and judgment, either inhibited or facilitated, ………can all be attributed to dysfunction of this network and its control of motor and non-motor cognitive behavior. Thinking, Walking, Talking: Integratory Motor and Cognitive Brain Function Gerry Leisman,1,2,*Ahmed A. Moustafa,3 and Tal Shafir4 Front Public Health. 2016; 4: 94. Published online 2016 May 25. doi: 10.3389/fpubh.2016.00094
The disruption of executive function underlying Paula’s change of mood, personality and behavior may be a result of the inhibition or excitement of neuronal networks of parts of the frontal lobes, cerebellum and the basal ganglia that work collectively. And neurons, are very sensitive to changes in carbon dioxide production, carbon dioxide balance in the cell, and impairments in the feedback systems maintaining that balance, one key feedback system being the motor control of breathing.
Yet no one tested Paula’s motor control of breathing when she became quietly confused and amnesic for self.
No one thought to. No one made the link between the physiological effects of carbon dioxide produced by human cell metabolism, impaired feedback correction mechanisms [as shown by counting respiratory rate per minute], and the effects of rising endogenous C02 on neuronal function affecting the mind.
Because doctors and scientists do not count respiration rate to check for problems with the motor control of breathing. [this is part of first aid, it is not a medical act].
Because doctors and scientists have not figured out the link between the motor act of breathing and and mental imagery and mind.
Lets think about this further………in the next blog….
Of Sound Mind 