that is, human consciousness [in my opinion] , is a product of how human’s process air and food [ie energy] in the body, in the blood, and in the brain to provide energy for movement and for consciousness [to guide movement]. Human consciousness is a complex physical thing. A good metaphor to explain human consciousness is the concept and application of electricity. Electricity is a physical process that involves knowledge of physics and chemistry. You can only get so far by examining the inside of a radio or a television set. or computer., without understanding how electricity works through them. Understanding the magic of how these work involves understanding energy and how energy works to power these devices. It is the same for the brain. In order to understand what happens in consciousness and in states of altered consciousness , one must look beyond the brain and understand how energy is generated and utilized by the nervous system of the entire body.
” Energy, in physics, the capacity for doing work. It may exist in potential, kinetic, thermal, electrical, chemical, nuclear, or other various forms. There are, moreover, heat and work—i.e., energy in the process of transfer from one body to another. After it has been transferred, energy is always designated according to its nature. Hence, heat transferred may become thermal energy, while work done may manifest itself in the form of mechanical energy.” Britannica, The Editors of Encyclopaedia. “Energy”. Encyclopedia Britannica, 16 Nov. 2021, https://www.britannica.com/science/energy. Accessed 20 September 2022.
Energy is needed by our bodies to do everything from moving to thinking to growing. Chemical reactions in our cells change the food we eat into energy [ with the help of oxygen that we breathe]. This complex process is called metabolism. Specific proteins in the body control the chemical reactions of metabolism. Thousands of metabolic reactions happen at the same time — all regulated by the body — to keep our cells healthy and working.https://kidshealth.org/en/teens/metabolism.html
Respiratory rate, heart rate, blood pressure and body temperature are easy to measure at rest and if normal, will suggest that all is fairly well at that moment. The vital signs work as a system to regulate circulation and metabolic processes like pH, 02 and PCO2 [explained in other blogs as the partial pressure of carbon dioxide in the blood]. This system is managed by the autonomic nervous system and is involuntary. What I describe in the case of Paula is only one type of systems failure, there are many others. I’ll discuss this more in my next blog.…
All the more reason to check these vital signs if someone is unwell or acting unlike their usual selves. The behaviour they present may be compensation for a condition that they are unaware of.
For example, adopting a slumber posture when sitting and propping up the head with one’s arms is known to help a person having difficulty breathing to breathe. Having difficulty breathing will tend to affect a person’s mood and they will probably not feel jolly. They might show behavioural signs of being depressed and these signs are exactly the same as those of having difficulty breathing. Their difficulty breathing may be visible but subject to misinterpretation as depression. The person may not be aware of having difficulty breathing and may not mention it-ever.
This is what happened to Paula.
Many mistakes were made in her care.
Mistakes that could be avoided by simply checking and measuring breathing rate, heart rate, blood pressure and body temperature at rest. At rest, all are involuntary and are co-ordinated together in order to maintain adequate metabolism. All, at rest, are co-ordinated by the autonomic nervous system and, if measured together, will give us a pretty good idea of how the autonomic nervous system is doing; because the autonomic nervous system can not talk or give any indication of a problem, except through behavior change , mood change or through careful measurement.
When Paula’s behavior changed suddenly, and when she did not recover her usual self for days and then weeks, a quick assessment of her vital signs would have been all it took to realize that she had a problem with her breathing that she was unaware of; her respiratory rate was depressed [3 breaths per minute], and the other vital signs showed sympathetic activation [high blood pressure and heart rate] yet her body temperature was lower than normal and her hands, feet and lips were pale, She did not look bad enough to be in severe respiratory failure but she was perhaps in mild respiratory failure.
In any case, Paula needed a more complete physical and medical investigation to see if her acid base of her blood was normal and if her PC02 was OK. Her ventilation was very depressed and this would more than explain the changes to her behavior. Ventilatory failure would also explain her behavior [depressed locomotor activity, difficulty sleeping, lack of energy for speaking, changes to her voice, feeling of distress [common when one cannot breathe], lack of appetite, mental confusion and partial amnesia] . Normal consciousness and normal behavior and normal body temperature, all require adequate exchange of air.
This was 20+ years ago.
And still, no one is looking at possible altered ventilation in neurological and neuro-psychiatric conditions generally ; and particularly in bipolar depressed states.
Even though Dr Emile Kraepelin found abnormal ventilation [including depressed ventilation] in bipolar depression and in manic states. He thought that pH changes dictated the changes of altered ventilation he saw in depressed versus manic states. [chapter 3, bodily states, manic depressive insanity, 1926].
I think that the same might be true of the motor types of delirium, especially chronic delirium [which might be misdiagnosed as dementia].
But doctors do not measure ventilatory rates at rest and seem not to be interested in the function of the autonomic nervous system and the vital signs. Even though these are easy to measure [including ventilatory rate] and can be measured again and again and again for accuracy.
I think that doctors are scared and that they are misinformed about the motor act of breathing, pH and PC02 and behavior and thought and mood.
I know how they feel. I am scared every time I measure Paula’s ventilatory rate. It is really low. It is not shallow. There is nothing in the medical literature that describes her chronically altered breathing.
And no one seems curious about the link between her breathing and her thinking. And even more puzzling, no one is curious about how Paula is able to compensate for her altered breathing in order to regulate the pH of the blood. pH is key to chemical reactions and functions of enzymes. pH, chemical reactions, enzyme function and altered ventilation and consciousness/cognitive function…..these are all related.
And yet only Kraepelin and I are curious about how metabolism is affected in the face of physical injury limiting and/or altering the ventilatory system? And only Kraepelin and I have bothered to discover that some of us have altered ventilatory systems and do not know it.
Now that is crazy!
To be continued