Paula’s normal breathing is abnormal

So no one notices. Paula does not even know. Paula thinks that she is breathing normally. She is breathing comfortably. Paula looks like she is breathing normally. She does not complain of any breathing problems, because she thinks she has none. Paula seems very healthy.

It is unbelievable and inconceivable that she has very depressed breathing at rest and is fine. It is astonishing that she uses her abdominal muscles to achieve every breath she takes; this takes extra work; only people in respiratory distress do this. Yet she feels no distress. She needs her abdominal muscles to push air out of her lungs. Her lungs do not seem to passively let the air out as is the case in people whose breathing is normal. She seems not to interpret this as distress. For her, this is normal breathing. If asked Paula will say that breathing for her does take work. She thinks that it is normal for breathing to be a little difficult. She doesn’t know that this is not normal for most people.

The motor act of breathing is run by the autonomic nervous system, especially the brain stem and the peripheral nerves, ganglions, nervous fibres and the respiratory muscles.

Paula does not have to think about breathing in and out, it is automatic. this is true for all of us.

If Paula thinks that her breathing is normal and if she does not look like she is in respiratory distress, how can we know if Paula’s breathing is normal or not?

We can’t.

Unless we carefully check her rate, volume and pattern of breathing, preferably using a stopwatch. This is remarkably easy to do at rest.

When is it important to know if her breathing is normal or not?

It is important if and when Paula has onset of a serious depression, the kind with psychomotor retardation and mental confusion.

Paula’s abnormal breathing rate and pattern in health suggests that she has less flexibility in responding to and recovering from health challenges which could affect homeostasis and the elimination of waste metabolic gases in the blood.

Exhaling is a motor act. Exhaling seems to be the only way to eliminate excess metabolic gas, which needs to be carefully kept in check for us to function normally.

Eating and breathing creates energy . Your body use the oxygen you breathe to get energy from the food you eat. This process is called cellular respiration. During this process the cell uses oxygen to break down sugar. Breaking down sugar produces the energy your body needs. And it also produces carbon dioxide in excess amounts which must be exhaled in the correct amount. Too much or too little will affect brain function. C02 is a cerebral vasodilator and serves an important function and it is carefully controlled through breathing rate, depth, pattern and locomotor activity.

One would think that doctors and scientists would have a little more respect for the motor act of breathing since it relates to homeostasis, pH and a key cerebral vasodilator and can cause all kinds of problems for the function of the body and the mind if a mechanical problem occurs throughout one’s life but this is not the case.

It is not the case because the autonomic nervous system operates these things under the radar and we are not aware when the body is having difficulty managing these internal substances, including gases [oxygen, C02, etc… that we cannot see.

Paula is a good example of a potential disaster waiting to happen. It is easy to see that, given her abnormal respiration in health, that physical challenges [illness, injury, blood loss [especially important in menstruating females], nutrient deficiency, etc..] might create unique issues for her and these issues will most likely affect mood, cognition and motor activity when her body is in crisis.

So the brain and the function of the mind is completely dependent on the motor function of the body, in particular, the function of the motor ventilatory system – independent of the lungs.

Emotions are intimately linked to the motor act of breathing, all stresses are. Stress is a physical or mental response to an external cause. “Many stressors, including emotions, cause an increase in ventilation in humans.…….. It is widely reported that ‘breathing’ or minute ventilation (𝑉˙E, l min−1) increases in response to a variety of external and internal stressors. In this context, ‘stress’ is defined as adverse or demanding physiological, pathophysiological or psychological stimuli that perturb the respiratory system………..The initial response to various stressors includes an increase in the activity of the sympathetic nervous system. This is changed in a global fashion, leading to an increase in cardiovascular function and a release of adrenal catecholamines (Homma & Masaoka, 2008). Since the seminal work of Cannon (1929), the human ventilatory response to external and internal stressors has also been recognised as an important part of the body’s preparation during the ‘fight or flight’ response, the prototypic human response to stress (Jansen et al. 1995; Taylor et al. 2000). Hyperventilation is often considered part of this response (Van Diest et al. 2001),  Tipton MJ, Harper A, Paton JFR, Costello JT. The human ventilatory response to stress: rate or depth? J Physiol. 2017 Sep 1;595(17):5729-5752. doi: 10.1113/JP274596. Epub 2017 Jul 27. PMID: 28650070; PMCID: PMC5577533.

When Paula became ill with bipolar depression, she looked depressed from the outside, but internally she was experiencing huge distress and fear and a sense of stiffness. She could not talk much or explain her symptoms because 1] she was too out of breath to speak more than a few words 2] her face felt stiff and she had difficulty forming the words but with effort no one could really tell. 3] her breathing remained depressed [one would expect her breathing to increase given her internal state of arousal and fear and distress] and as usual, she was not aware of this and as usual, no one noticed because her distress was internal and private and 4] her memory was affected in that she could not remember what she was thinking or what she wanted to say long enough to express herself and 5] she would forget that her memory was diminished so she did not mention it, although she was upset every time she experienced difficulty.

This is what Dr Emile Kraepelin reported in bipolar states of unmedicated depression.

One has to suspect these signs and symptoms in order to investigate whether they are present. The patient cannot tell you or help you to understand what you should be looking for.

These are very serious and debilitating signs and symptoms and they are completely reversible [at least with the first few attacks] no matter how long the attack lasts. too much or too little C02 is also completely reversible unless and until it kills you.

So it is very important to explore respiratory rate, rhythm and pattern in order to understand the best way to treat the patient and restore their baseline brain function and that of their mind.

No treatments, wrong treatments, and the patient might stay mentally confused for years, decades even…possibly forever if they are given the wrong treatments.

Since current treatments concentrate on mood rather than restoring baseline memory and cognition and since current treatments are hit or miss, trial and error……the chances of “curing” this kind of patient are not good.

Paula was very lucky. She had me and we had both read Kraepelin so we had him. Whatever medication she was given, she only continued it if it began to restore her mind- her baseline cognition and memory. When her cognition and her memory were fully restored, her fear disappeared.

It took over a year. Progress was intermittent and gradual [we tested her every single day], but we learnt which medication [s] restored her mind.

Without this medication, she looses her mind again and again, so she is taking it for life.

Her respiratory rate and pattern remain unchanged; this motor function seems to be permanently damaged, hence the need for chemical supplementation not needed by normal people.

Because Paula lost and then found her mind, despite motor damage to her breathing, we have been able to learn a lot about bipolar illness thanks, in part, to the studies of Dr Kraepelin, over a hundred years ago.

Maybe scientists in this century will look into this hypothesis.

Maybe finally we can cure bipolar illness.


still editing ……………..

to be continued……


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