Background to my interest in teaching children with autism

PSYCHOTHERAPY BEYOND THE FRINGE, continued

A Delusional Illusion

But panic can come about in another way. It can come about as a result of learning an idea or meaning. Quinsey was referred to Felicity for treatment of his ‘cardiac neurosis’. What this means is that he was terrified that at every moment he was dying of a heart attack. In Quinsey, as in most people who develop cardiac neurosis, the problem developed as a result of two things happening at the same time. The two things are usually hyperventilation or chest breathing and ‘palpitations’. The ‘palpitations’ are interpreted by the person as his heart ‘acting up’ – a heart attack. And the tightness of the chest and the difficulty in breathing, from fatiguing of the chest wall muscles after a time of chest breathing (hyperventilation), are interpreted as further verification that a heart attack is in progress.

In fact, ‘palpitations’ rarely involve an experience of the heart working. Except occasionally in some very skinny people, nobody can feel his or her heart beating in his chest. As far as one can tell, essentially all ‘palpitations’ (although people call them ‘heart palpitations’) are muscle spasms of the muscles of the chest wall. Very occasionally, the speed of the muscle spasms may mimic the person’s pulse rate, so that the following test doesn’t always work. But in almost every instance, when one has ‘palpitations’, it is easy to prove that it is not the heart beating by taking one’s own pulse. Since the rate of the ‘palpitations’ will usually be different from the pulse rate, they are NOT heart activity being experienced. They are insignificant muscle spasms.

The way that tightness and pain in the chest can happen in chest breathing has already been explained in Queeny’s case. But chest breathing and palpitations occurring together can be pretty scary to the person experiencing them, and once the expectation is established the habit of becoming scared is hard to shake off.

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