Sleep deprivation

Is That Bipolar Mind Cobra In Your Face? Then What Do We Do Now?

Out in the metaphoric mind-woods? Think you have the diagnosis right? Let’s take a few more minutes to get the specific, correct identification. See what you think about this brief video, and don’t look at the info on it – in a minute I’ll tell you a personal story about this snake – and the relevance of misidentification.

OK, picture this: You already know I’m a Boy Scout, looking regularly to help old women across the street, son of a physician, looking, even in childhood, to save my fellow man from the challenges of personal catastrophe.

So as a kid, out on a Scout camping trip in southeast Missouri – out in the deep sticks – I had a run in with a big snake… but permit me first to set the scene.

A Few Notes on Southeast MO 1952-1956
I lived in Dexter, right there on Thrower St where the Union Pacific RR made a sharp turn, and we could regularly hear the whistles of the passing trains as they rounded that corner heading South. It was a small town, country life, and after the war, WWII that is, a hobo would occasionally come down Thrower, knocking on doors looking for a little cleanup work and a sandwich. I started early thinking about where they were going and how they got to our front door. They never had much to say. By that time in my life, about 12 yrs old, I had traveled over most of the western states in a 39′ Chevy Coup we called Sue, so the nomadic dreams were already well oiled from pre-school.

Cotton Picking Vacation
If you look on the map at that Dexter link and see the hill and woods on the left, and the flat square areas of farmland to the right… that flat space is what they call the Cotton Belt. We were released from school to stay home in the fall for ~ 2 weeks every year to go out and pick the cotton ['cotton picking vacation'] before the days of mechanical harvesters – in the early 50’s [more later in another post]. Those picking sacks came in two sizes: short and long, the long was about 10.’ Work all day, might make between 3-5$. Not fun.

We could look out from our back yard vantage point and see for miles across those flats and farms. That flat area and the ridge that supported Thrower was the old bank of the Mississippi River from thousands of years ago. Linnae May Wiley lived across the street on Thrower, she had no indoor plumbing, chopped cotton [weeded with a hoe] and picked it for a living, and cooked pig brains for breakfast. She was mysteriously quiet, very pleasant, and could move down that cotton row like a ghost. She hooked us up with work gigs.

The Cobra Looms in the Woods
On the occasion of this camping trip I already have a reputation with my friends having killed a pygmy rattlesnake at Scout Camp that previous year, was seriously chasing merit badges, and was a little older than some of the other kids on this trip. Interestingly, I told them on the car ride down there that I had just heard on the radio that a Cobra had escaped from the Springfield MO zoo [true reportage], and wondered privately what I would do if I came across a Cobra. Reassured, I knew that Springfield was on the other side of MO, and didn’t sweat the outing – looked forward to it.

Then in the woods, quite innocently walking along, we hear a very large hissing noise, and looked just a short distance ahead to see a hooded snake [see video] looming and hissing, ready to strike. I quickly decide – this is the Cobra! I know snakes, and know that no American snake has a hood and hisses like that. So what would be the smart thing to do? … Yes, my fiends, you guessed it – it would have been best to simply walk away. Good sense.

The Moment of Recognition
But no, I have to save humanity. So I get everybody back, work around the hissing situation, imagining what it will be like if he is faster and I get bit – break off a big stick, and proceed to kill the snake. It was a proud moment. No one of my friends and I had every seen anything like it before. Parker saves Missouri from extremely fast traveling venomous Cobra. Is there a merit badge for Cobra killing?

Hognose Humiliation
Readers, you know the rest of the story. One of our troop counselors gave me the news… the only American puff adder is the non-venomous Hognose snake, an excellent rat killer, and a friend to man. So, just what is the point?

Consider this contemporary moment of more challenging precise identification and recognition…

Looks like Bipolar, but no….
Thursday of this week I saw a 45 yo bedraggled, unemployed woman who:

1. Dropped out of high school her freshman year because she was doing so poorly – after making great grades through grade school.
2. Has had time in jail for cocaine possession and abuse, – abused alcohol, marijuana, and cocaine since early adulthood.
3. Goes to the bathroom, passing a monolithic stool once a week under great duress – this pattern for MANY YEARS!
4. Suffers with profound estrogen dominance, long history of PCOS, significant perimenopausal symptoms.
5. She thinks of suicide almost every day, but will not harm herself because of religion.
6. Has regularly failed antidepressants and distrusts doctors – SSRIs make her spaced and irritable.
7. Can’t hold down her job tending bar now that she is a felon.
8. Sleeps about 2-3 hrs/night every nite
9. Does not eat protein, no breakfast, poor lunch,
10. Hasn’t had any Vit D level taken, but is now well into her long standing pattern of seasonal affective disorder as well
11. She looks hypothyroid and hands are cold hair is thinning, and she is significantly overweight.
12. She has been severely abused by her first husband and has scars on her face to show.
13. She is totally alone and required to see a psychiatrist only to fulfill probation requirements.

And here is the punch line: She has been, as many are,  misidentified as Bipolar – the venomous, recalcitrant kind! Refractory to antidepressants means bipolar to so many. Looks like a hooded Cobra to me… and by the way, refractory to mood stabilizers.

I don’t need to say much more – except that I guessed her [typical ADHD] school history in detail before she told me, she is medically sick, markedly sleep deprived and not taken care of – and estrogen, depression and ADHD all can significantly contribute to moods, – she has been ADHD since symptoms in the 6th grade. She has been, in a very unhappy way, left for years to hang in a metaphoric tree, the way I left that harmless snake as a kid because I didn’t know the details before I walked in and killed it.

ADHD has NEVER REMOTELY been considered by anyone treating her. She has thought she had ADHD for years.

No this missive is not motivated by guilt, I got over that snake mistake long ago. But that Hognose snake did change the way I think about things – and missing the abundance of diagnoses that have been missed here, is simply catastrophic for this woman. Time for a little redefinition of what we are doing in the process of homogenized psychiatry, chasing superficial appearances, chasing labels that hiss – entirely missing the mind and the person.

Drop me a comment if you read this, your thoughts may tease out something I’m missing,

cp

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Tagged as: ADD/ADHD diagnosis, Bipolar Disorder, Boy Scout, Cocaine dependence, drug addiction, Estrogen Dom, hognose snake, Hypothyroidism, Mississippi River, Scouting, Sleep deprivation

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