Breathing or respiration is controlled by the autonomic nervous system. According the Wikipedia the Autonomic Nervous System currently states:
The autonomic nervous system (ANS or visceral nervous system or involuntary nervous system) is the part of the peripheral nervous system that acts as a control system, functioning largely below the level of consciousness, and controls visceral functions. The ANS affects heart rate, digestion, respiratory rate, salivation, perspiration, pupillary dilation, micturition (urination), and sexual arousal. Most autonomous functions are involuntary but a number of ANS actions can work alongside some degree of conscious control. Everyday examples include breathing, swallowing, and sexual arousal, and in some cases functions such as heart rate.
Your body breathes without you thinking about breathing or telling it when to breathe. For a short time you can tell you body not to breathe but not for long. It isn’t the kind of thing that normally produces a lot of anxiety for people but it always has for me. I have always been afraid that I wouldn’t be able to breathe. When I read a story about someone being tied up and gagged I thought about whether I would die if that happened to me because I breathe through my mouth most of the time. I don’t like anything close to my face or around my neck no matter how cold it gets. I don’t have any reason for my fear of not being able to breathe that I can remember. I didn’t have asthma attacks as a child or being suffocated in fights with my peers.
In my mid-thirties I was diagnosed with asthma. I was surprised because I had never had a typical asthma attack where I struggled to breathe. I was tested because I had a history of environmental allergies, repeated episodes of bronchitis in the previous 10 years, and a fairly chronic dry cough since my third child was born (about six months earlier). The cough went completely away after a couple of weeks on Symbicort (a combined maintenance and short acting inhaler). For the last 8 years I haven’t thought about my asthma at all. It was well-controlled on half the dose prescribed by the doctor and I went in once a year to have my lung function tested. This summer during my regular check up my doctor told me that my lung capacity was slightly reduced but I felt fine and my chest sounded clear so I didn’t worry about it. About six weeks after the appointment I felt like the Symbicort just didn’t work as well anymore. I felt like there was something heavy resting on my chest, like I was getting an infection and I started coughing more. A few weeks later a different doctor was so concerned when he listened to my chest while I was breathing that he sent me for a chest X-ray to check for pneumonia (which I didn’t have) and got me an emergency appointment with my asthma specialist. At that visit, my lung capacity was lower and I had signs of inflammation. He told me that my asthma was getting worse. He prescribed a week of Prednisone and a follow-up visit in two months.
I had the follow-up last week. The Prednisone was amazing and in three days I felt much better. My breathing was easier and all the aches and pains in my joints went away. About a week ago my chest started to feel tighter even though I was taking my medicine at the full prescribed dose. It corresponded with a drop in temperature where I lived and I wondered if I was getting sick but I never got any worse. At my appointment my doctor told me that I didn’t have the signs of inflammation I had two months ago and my chest sounded clearer when he listened to it but my lung capacity was even lower. My normal lung capacity had been 2.5 litres for years and now it had dropped to 1.86 litres. I asked him if he thought I had something other than asthma because I have been worried that I had COPD and he told me I couldn’t have COPD because I have never smoked. He said he didn’t want to talk about any other possibilities until after I had a more sophisticated breathing test which I couldn’t schedule until the middle of January.
Since then I’ve spent a lot of time reading about asthma and COPD. Asthma is a completely reversible obstructive lung disease usually diagnosed in children and young adults. COPD is a chronic, deteriorating obstructive lung disease usually diagnosed in smokers or ex-smokers in middle-aged or older adults. People with COPD die because they can’t get enough oxygen from their breathing. It sounds like my worst nightmare. It isn’t rational but I keep thinking that I have developed COPD and that is why my medications don’t work as well as they did initially. I am thinking about my breathing.
I have never enjoyed sleeping. As a young child (before 6) my sleep was plagued with nightmares. I remember being running though the basement of our house trying to escape a man who always stood in the shadows. Whenever I thought I was going to get away I would suddenly be back where are started in the back corner farthest from the stairs. Over and over I would have the dream and wake up as the man walked closer to me and into the light. I can only remember one time when the light hit the man’s face and it was my father. I remember shaking and crying in my bed after I woke up. I used to dream that there were snakes writhing under the blankets. When I woke up I could only leave the room if the closet door was closed (and I always closed it before I went to bed). Sometimes (it feels like usually) I would wake up and discover the door was half-open and I would strain my eyes to see if there was anyone or anything in there. If I wanted to get to my parents I would have to run by the open closets. I never called out for them. I don’t know if that is because I thought they wouldn’t respond or if I was afraid that it would make whatever was in the closet come out. Often if I did make a run to my parents they would tell me I was having a dream and I should go back to bed. I would sit in the corner of their bedroom afraid to try another run by the closet. Sometimes I didn’t even run I just watched the closet.
As I grew older I learned how to direct my dreams at times. I remember having dreams where I was being chased and I pretended to be dead or hid to save my life. It worked although I felt guilty that I was a coward even though nobody but me knew it. As an adult I didn’t seem to dream very often but when I did the dreams were always about being sexually assaulted. I have had dreams about being attacked in my home, at work, on the street outside of M’s office, at my son’s Karate dojo, in our neighbourhood park. The list is endless. The dreams have a common theme in that even though I can see people they don’t help me. Sometimes I am yelling for help and they walk by me like I am invisible. Other times I know they can’t help so I don’t even yell but they are always within sight and they can’t or won’t do anything to help me. After I had kids I started having nightmares about them being in danger and I can’t save them. It is awful and luckily it doesn’t happen very often. I used to call myself a night owl. I said I needed very little sleep. I could stay up into the early hours of the morning reading or studying and then get up after 4 or 5 hours and feel completely rested. I never had any trouble falling asleep but I never got into bed until I was exhausted. Then I had children and got older and things changed.
Now I’m in my mid-40’s and I am always tired. I still can’t fall asleep before the early hours of the morning however. If I get into bed at 11pm or midnight, I can’t seem to fall asleep. My thoughts are racing, I toss and turn, I can’t get comfortable, I watch the clock or read something for hours. I have discovered something over the last couple of years. If I get into bed anytime between noon and early evening I can fall asleep easily. I usually don’t let myself because I don’t want a nap to interfere with my ability to sleep at night. Everything feels different then. My bed feels warm and soft and comforting. I like to curl up in the blankets and just feel comforted by being in bed. My bed feels safe. Lately I’ve been wondering why my bed never feels that way at night. I’m not actually feeling scared at night while I wait to go to sleep but I always feel tense and wound up. I fall asleep at night like I’ve been hit over the head. One moment I’m thinking I’m never going to be able to sleep and the next I’m waking up. During the day I lean into rest and relaxation even if I don’t fall asleep. I hate that my bed feels so different at night.
I’ve been feeling oddly disconnected from M and therapy. It is so difficult to talk about anything I do and am ashamed of doing. When I talk about things going on in my life that aren’t shameful I feel like I am wasting time. I am working on my marriage in couples therapy. I am a better parent to my children that I used to be and I only talk about parenting when I am dealing with a new issue or situation (which happens semi-regularly since I have three children). After talking about how I wished that M would remember and acknowledge my birthday which I discussed in 10 minute intervals at the end of about six sessions. I still had a list of questions I wanted to ask M. They were questions like “Doesn’t it bother you that I’ve asked you to do something that you don’t usually do?” or “Why didn’t you ask me about what it was like in my family to give or get presents?” and “How come you don’t react when I say things like I don’t believe you can do things differently or I don’t think you are telling the truth?”
Last week I sat in my session holding a piece of paper with about six questions and tried to ask them. When I didn’t then I tried to talk about why it was difficult to ask him questions. I started to feel so stupid because I know that M isn’t going to get angry if I ask questions. Then so much time has passed without me asking the questions I feel like I can’t ask them because he’ll realize how minor the questions are and that I was all twisted up and stuck over nothing. I try to explain that to him saying something like too much time has passed. I’ve made such a big deal about the questions that when I ask them and they aren’t really a big deal it will just be weird. I’ve made a big deal out of them and I didn’t need to. Then I started to cry and the session got worse and worse. I wasn’t completely silent and we talked about one of the questions. “how come M doesn’t get angry if I say I don’t believe him?” I asked him if it was because he thought I was the crazy one in the room so he didn’t have to take what I say seriously. He said no and went into a long explanation including how my feeling that I can’t believe is made up of many different parts, some to do with him, how he speaks, our history, and some to do with my own history and he is focused on my experience and not on what it feels like for him. I didn’t feel a lot better. Days later when I listened to the session I realized that after I said I made the questions into a big deal and asking them now would feel weird, M said yes but what prevents you from backtracking and saying I wanted to ask you…. Hearing it again made me feel awful because I didn’t like M agreeing with me. I thought he was saying “you are making a big deal out of nothing so just ask the questions”. M and I talked about what he really meant during Monday’s session. He told me all my experiences were important and he didn’t mean I was making a big deal out of nothing. I believed him but when he tried to bring up the questions I told him I didn’t care anymore.
I don’t care enough to talk about them. It doesn’t matter that I’m numbing myself because I felt hurt. I really can’t be in the room with him and hear him talk and respond to what he is saying at that moment. Either I don’t realize why I am upset like last week until days after a session or I can’t feel like issues are important enough to discuss. I am disconnected from my feelings and reactions while I sit with M. It is like I am so scared I can’t think and I don’t really understand why because I am not aware of being scared of M. I can’t do therapy without being able to react though. I can’t work through things. I have spent five years in therapy and I still can’t do it.
I am angry at M. I went to both my sessions with M to discuss what happened last week when I hid under a blanket. During the first one I talked about the transcript. I told him I could hear him take big audible breaths at several points during the session. He told me he used a deliberate breath to bring awareness to what was happening in him and in the room. We talked about what he did say and how I felt alone and abandoned. He told me that he was trying so intently to be present to what I was feeling that at times he was shutting his eyes. I told him I couldn’t tell he was with me and I didn’t think he could think about me for 7 minutes so I imagined he was thinking about other things (like maybe why the session wasn’t over yet). He asked me if I felt alone and abandoned at this moment and I said no but I believed that if I got so upset and couldn’t talk then he would abandon me again. I told him that after almost every one of these sessions where I have been overwhelmed and then stuck in silence that lasted until the session ended that I have promised myself that I would keep talking because I knew he couldn’t respond to my silence. Now I have to admit to myself and to him that I can’t keep that promise because I don’t know why I get silent and stuck but it happens.
I’ve gone into the sessions knowing that M cares about me and is trying to help but I’ve been frustrated because he doesn’t seem concerned about these episodes. During the first session he told me that he thought we were making progress discussing what happened and these things wouldn’t have to keep happening. It feels to me like wishful thinking though. He has no plan for what we can do different. Over the years we’ve talked about different things to try to break through my stuckness, things like moving around the room, changing where we sit so he is closer to me, talking about how I feel in my body instead of asking me to explain what I’m feeling, asking me to describe the room or the things I can see. I’ve asked if he can reassure me by telling me that he isn’t angry at me or that he wants to help me because at the time I don’t feel like he cares and is trying help me out of the hole I”ve fallen into. I’ve told him I thought some of that could be communicated by touch such as putting his hand on my shoulder and being there. He has tried some of these things once and other we’ve only discussed but what happens is that he keeps coming back to silently waiting for me to explain how and why I feel stuck. I told him it doesn’t help to discuss what he could try differently because he didn’t do the things we discussed anyway. He told me he tried some things once and they didn’t seem to help so of course he wouldn’t try them again. I said that was odd because the silence didn’t work but he kept trying that.
Since my last session I’ve been busy with my children and work and today is the first time I’ve spent a lot of time thinking about therapy and M and I got angry. It bothers me that he is trying to be with me in my stuck state instead of trying to help me out of it. We’ve discussed it often enough that I am sure he knows that I don’t think being stuck for the rest of the session helps me. I end up writing about my feelings, talking to others, processing the session without M. I often learn a lot but I don’t get to do that with M and I don’t have the experience of M and I being able to contain and work with my feelings. Instead I learn that if I get too upset I’ll be on my own to deal with my feelings and that is just like my childhood. My parents sent me away when I was upset or punished me until I stopped being upset (which is impossible) but really it drove the pain into hiding and taught me that being in pain was wrong, people wouldn’t like it if you hurt, and therefore you should never be upset. In so many ways M taught me that I was allowed to be pain when painful things happened to me and that it wasn’t my fault that my parents couldn’t deal with it. I hate that it feels like M has reached a point where he can’t help me with my pain. He hasn’t sent me away yet but… and that is how I get to it is time to quit therapy with M. I haven’t told him that but I feel like it is true.