The Psychology and Physiology of Breathing
This is Robert Fried’s third book on the crucial role of breathing and hyperventilation in our emotional and physical health. The first, The Hyperventilation Syndrome (1987), was a scholarly monograph, and the second, The Breath Connection (1990a), was a popular version for the lay reader. This book combines the best features of both and extends Dr. Fried’s seminal work to protocols for clinical psychophysiology and psychiatry. Hoping to avoid misunderstanding, he has taken systematic care to introduce relevant electrical, physiological, and psychological concepts in operational language for the widest possible professional audience.
Any clinician not thoroughly experienced in respiratory psychophysiology and biofeedback will leave these pages with profound new insight and direction into an aspect of our lives which we innocently take for granted as “common sense”—the role of breathing in health and illness. Einstein viewed such common sense as “that set of prejudices we acquired prior to the age of eighteen.” I am impressed that Dr. Fried mirrors Einstein’s uncanny genius in not accepting the obvious— breathing is not “common sense” but, rather, is a pivotal psycho-physiological mechanism underlying all aspects of life.
The “common sense” that Dr. Fried explores has deceptive roots in history. Hippocrates anticipated Dr. Fried’s focal interest some 2,500 years ago in observing that “breathing is the basic rhythm of life.” Actually, this observation was common sense since the Greeks accepted the intertwined relationship of psyche and soma in a common etymological structure of two expressions: phren was used to denote the diaphragm as well as the mind, and pneuma represented the vital essence of life as well as breath or air. Any imbalance was used as a basis to explain disease.
Virtually every philosophical system seeking to comprehend human nature since earliest recorded history views breathing as a crucial central link between mind and body. The Old Testament makes the link in describing mankind’s creation, where body precedes sustaining breath:
And God formed man of the dust of the ground and breathed into his nostrils the breath of life, and man became a living soul.
Most yogic systems, which superficially vary in theory and technique, incorporate a common underlying structural assumption that life (mind-body) is a regenerative “given” that may be altered for health or illness through proper or improper breathing.
Ancient wisdom about the importance of “proper breathing” is largely ignored in modern medical practice. We are enthralled by the technological marvels of scientific diagnosis, medication, and surgery. We treat respiratory problems with medication or mechanical assistance such as intermittent positive pressure breathing (IPPB) delivered by a machine.
We are taught to treat globus hystericus and its many variants that occur along a continuum from anxiety to panic disorders with medications and/or paper bag rebreathing to increase retention of carbon dioxide without instructing patients in the self-regulation of respiratory dynamics. Ironically, we use hyperventilation to activate and detect brain-wave abnormalities such as epilepsy.
Yet normal breathing apparently has been overlooked as a serious subject for modern medical diagnosis and therapeutics. Astute physicians, however, recognize that shallow breathing or hyperventilation is an epiphenomenon, if not an etiologic factor, in 50% to 70% of medical complaints.
Proper breathing is taught in anticipation of natural childbirth and is an important foundation in training vocalists and wind instrument players. Various modalities of biofeedback, sometimes referred to as “scientific yoga of the West,” when properly applied, probably exert their most significant nonspecific effect in normalizing breathing patterns. Dr. James Lynch, in The Language of the Heart, identified the disruption in breathing accompanying human dialogue as an incipient factor in the 90% of high blood pressure cases previously identified as idiopathic, or “cause unknown.”
Dr. Fried ingeniously ties all of these leads together with scientific rigor. He couples a scholarly and rational overview with an operational treatment procedure that satisfies patients, their physicians, and other health-care professionals. For the first time, he validates “faulty breathing” as the etiologic ‘common pathway” that may be corrected by yoga, meditation, exercise, relaxation, biofeedback, and a variety of other nonmedical techniques used to normalize health. He accomplishes this by using a perspicacious multivariate experimental design that incorporates physiological measurements (respiration rate, respiration mode and pattern, end-tidal carbon dioxide, blood oxygen concentration, cardiorespiratory synchrony, electromyography, electroencephalography, and a thermal index of peripheral vascular tone) to establish his case for the crucial role of the hyperventilation syndrome in many medical conditions. He takes heed of the following critical issues raised by Darrow (1943):
To attain significance a test of autonomic functions must circumvent the mutually antagonistic action of the two branches of the autonomic nervous system so that it may be clear whether an observed peripheral event is due to increase of activity in one branch of the autonomic system or to decrease of activity in the other. There must be no question for example whether an observed pupillary dilation is due to sympathetic excitation or to inhibition of the parasympathetically determined irido-constrictor tone. The problem is literally to determine the weight on either side of a ‘balance” when neither side is known. The mere knowledge that the balance has been upset by a given condition as afforded by many so-called tests of autonomic function, may be physiologically or clinically of little value except as indication that something has been disturbed. It does not necessarily define the foregoing events in the neural and neurohumoral systems, and in consequence may even be misleading in determining proper corrective procedures. . . . This may explain the sterility which, with few exceptions, has beset attempts to correlate measurements of peripheral autonomic changes with human behavior.”
Before this book, there were many disparate and ornamentally embellished pathways which promised to lead us to the peak of optimal health. But Dr. Fried has identified one direct “final common pathway”: stressed and distressed people hyperventilate.
Like Einstein, he has changed our frame of reference, providing a scientific rationale and treatment protocol for better understanding and for altering the increasingly stressful course of human existence.