Idiocy or Impulsivity? Breaking the Spiral Behind My Fall

Last night I fell.

Amongst many other things.

If you know anything about Progressive Supranuclear Palsy (PSP), your first reaction is probably, “Well, that’s what PSP does.”

Normally, I would agree.

This morning, after a few hours’ sleep, a hot shower and a much-needed espresso, my first reaction was much simpler.

What an idiot.

Then I replayed the night.

The more I thought about it, the less convinced I became. Was it really idiocy? Or was it impulsivity? They sound similar, but they are not the same. Idiocy is making a foolish decision for no reason. Impulsivity is what happens when pain, uncertainty, exhaustion and anxiety gradually overwhelm good judgement.

That distinction matters because calling myself an idiot teaches me nothing. Understanding how I became impulsive might stop me making the same mistake again.

So what actually happened?

It started with breathlessness, something that has been bothering me for the past couple of weeks. I couldn’t lie flat, but sitting upright meant I couldn’t sleep. My lower back was hurting for reasons I still don’t understand. I found myself endlessly moving between the bed, the wheelchair and the bathroom despite taking three medications intended to reduce exactly that problem. My eyes were too tired to read, I didn’t want another screen, and I knew I was disturbing my wife.

None of those things would have defeated me on their own.

Together, though, they became something much bigger than the sum of their parts.

Pain became frustration.

Frustration became anxiety.

Anxiety became impatience.

Without really noticing it, I had stopped making careful decisions and had become impulsive.

On about my third journey back towards the chair, with my wife, who I’d woken up for the third time, I abandoned the careful transfer and simply launched myself towards it from far too great a distance.

I slipped. I fell.

My wife and our live-in carer picked me up. Thankfully, apart from a bruised ego and an even sorer back, the damage was limited.

Lying there, it would have been very easy to blame PSP.

This morning, I don’t think that tells the whole story.

The breathlessness itself remains a mystery.

The honest medical answer is that nobody knows exactly what is causing it. It could be the asthma I’ve had since university. It could be one of my medications. It could be PSP itself, although breathlessness appears only occasionally in the medical literature. It could be something else entirely.

But if you ask me – and this is not a medical opinion, just one patient’s honest reading of his own body – I suspect anxiety is doing much of the work. Perhaps not all of it, but enough to create a cruel circle in which anxiety produces breathlessness, and breathlessness feeds even more anxiety.

That uncertainty is one of the hardest parts of living with PSP. Beyond the hallmark symptoms, every new problem raises the same impossible questions. Is it the disease? Is it a side effect? Is it anxiety? Is it something else entirely? Sometimes there simply isn’t an answer.

Working out the cause is my doctors’ job. Mine is simply to describe honestly what living with that uncertainty feels like.

Looking back now, I think I can finally see the chain.

PSP created the environment. The breathlessness lit the fuse. Pain, uncertainty and lack of sleep fanned the flames. Eventually, judgement gave way to impulsivity. The final decision, though, was still mine.

That is why I no longer think this article is really about a fall.

It’s about a spiral.

Last night, everything I tried was simply another version of the same failing plan. Bed. Chair. Bed again. Another trip to the bathroom. Music far too late. Another attempt to force sleep that clearly wasn’t coming. I wasn’t solving the problem. I was simply running another lap of the same circuit, hoping the outcome would somehow be different.

That, I now think, was the real mistake.

The answer is not to keep playing the same game. The answer is to change the game completely.

If the spiral starts again, perhaps I should stop trying to sleep altogether. Perhaps I should move straight to the recliner, put on calming music immediately, do some breathing exercises, stretch gently within what my body allows or even have a shower if I can manage it safely. The specific solution almost matters less than the principle.

Interrupt the spiral. Sleep can come later.

The spiral cannot.

The smaller changes still matter. Fewer transfers mean fewer opportunities to fall. But those are defensive tactics. The real strategy is recognising the spiral before impulsivity takes over.

The breathlessness is still here this morning. So is the mild back pain and, if I’m honest, a little of the frustration.

What has changed is not the symptom.

It is my understanding of the night.

The breathlessness may return full-on tonight, or it may disappear completely. I genuinely don’t know.

But if it does return, I hope I do something different.

Not because I expect to eliminate the breathlessness, but because I now recognise the spiral. The objective is no longer to win the battle for sleep. It is to interrupt the spiral before it reaches impulsivity.

Living with PSP means accepting that much is outside my control. Nights like this remind me that not everything is. Sometimes the biggest victory is not preventing every symptom. It is recognising the moment when you can still change the direction of the night.

And in a disease that gradually takes choices away, I have learnt never to underestimate the value of the ones that remain.