I Really Need To Lighten Up

Reading back over my last few blog posts, I realize I’ve done absolutely nothing to make psychiatry fun or interesting.  In fact, dear reader, you might think I’m a pretentious pedant, obsessed with irrelevant details that have nothing to do with what my patients really need.  And you know what?  You might be correct.  Treatment of depression by family practice docs?  BORING!!  A possible biomarker for cocaine relapseWho cares????  A new insomnia medication?  A real sleeper…

I realized today that I’m doing it all WRONG.  Not only can psychiatry be fascinating, but it can be cool.  As cool as a rap video.  Because that‘s what matters nowadays, right?  Don’t believe me?  Take a look at Steve Stahl’s DLPFC Rap:

No wonder I find psychopharmacology so dry.  It’s because I don’t realize how BADASS it can be!!!  I’m sitting here in my office, questioning antidepressant mechanisms, poring over datasets and p-values, and reading up on esoteric new interventions like concreteness therapy for mood disorders.  In the meantime, Steve Stahl and his NEI Global crew are partying on the beach in San Diego, rapping about the DLPFC.  It’s true.  I’m a loser.  Lame.  A real D-bag.

The DLPFC, for those “in the know,” is the dorsolateral prefrontal cortex.  I used to know it as Brodmann area 46, a cortical area responsible for executive function, planning, organization, and working memory.  But that’s boring sh*t for old farts like me, I guess.  After watching the NEI Global clip, I now know it as “all I need to know.”  That’s pretty tight.  It’s also “where the money is,” which is even more badass.  Dollar bill, y’all.

Why are those old, gray-haired APA dinosaurs spending all their time writing the new DSM-5???  Why do the guys in the journals recommend brain scans and genetic screens and personality tests and long-ass interviews???  Yo, get it together, Steve Stahl has already figured out that the DLPFC is responsible for “executive function, attention, concentration, impulses, emotions, obsessions, compulsions, motor [?], fatigue, ruminations, worry, pain, negative symptoms, guilt, and suicidality.”  What more do you need to know, bro???

So now, when a psych resident asks me what causes obsessions or suicidality, I can just answer, “Yo, homeboy, it’s the DLPFC.”  Then I can tell him to find a drug that acts on the DLPFC and say, “prescribe that sh*t!”  Even better, when a patient comes to my office and complains of pain or guilt or concentration problems, I can just whip out one of Stahl’s epic pix and say, “Chill out, sister, homey’s got yo back” and write a script for something that works on the DLPFC.  As the video says, “most of the symptoms are in the PFC!!!!”  Bitchin’!  Another satisfied customer!

Of course, I am kinda pissed off now because my med school profs and residency mentors made me study all that stuff about brain development, cognition, behavior, PLUS all that neuroanatomy sh*t not involving the DLPFC.  WTF???!!!!  Major waste of time, LOL!!!!!  ‘Cuz the DLPFC seems to be where it’s at (where’s this Beck Depression Inventory?).  All I need to do now is grab Stahl’s book or attend an NEI Global conference—or, better yet, look for drugs that affect the DLPFC—and I’m good to go!

Hey, mental illness is no laughing matter.  But learning about the part of the brain that causes mental illness can be LMFAO, can’t it??

[Thanks to the Neurocritic blog for the link to the DLPFC rap.]

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11 Responses to I Really Need To Lighten Up

  1. C.J.Brenner says:

    Very Funny. I am glad that they did not become neurologists as this might be a series of many rap videos so much that they might have had to go into country and classic rock and even folk music to talk about the rest of the brain. But I did learn something that I do not recall from Medical School! Great job.

  2. Iatrogenia says:

    Prefrontal cortex, seat of sin. Stick an icepick in, nice and thin, if they’re illin’, get on pillin’.

  3. Dazed and Confused says:

    Video is terrible. Someone needs to lock them up as they are clearly lacking insight into their behavior.

  4. AJ says:

    brilliant! the whole post was greatly amusing. We definitely need to lighten up from time to time :)

  5. Carol Levy says:

    Iatrogenia, Had a doc, William Sweet, one of the ‘fathers of neurosurgery’ tell me he wanted to do a ‘mesencephalic tractotomy’ to help with my chronic intractable facial pain. Turns out he wanted to do a mini frontal lobotomy – ‘you’ll still have the pain, you just won;t care that you do.” I hightailed it out of there!

  6. Dr. D says:

    Wow. I’m sure glad I went into psychiatry long before that video came out, because if I’d seen it while I was a med student, I might’ve too embarrassed to join Dr. Stahl’s profession. Lovely commentary though…a good sense of humor is definitely needed when confronted with something this ridiculous.

    • stevebMD says:

      Dr. D,

      Thanks. I almost wrote an entirely different post, about how I was frankly embarrassed by the video, and how it cheapens and demeans (rather than demystifies and clarifies) what we do. But then I figured I’d come off as a nit-picky purist or, worse, a party pooper, so I decided to put a more humorous spin on my remarks.

      What’s not funny, however, is that this is how some students and doctors learn their neurobiology.

      • Mara says:

        Why was it embarrassing? I thought it was a cute way for them to learn about psychiatry. I remember learning all the state capitals through a song. And everyone, including you and Dr. D, learned the ABCs through song right? Everyone learns different. I usually don’t like science stuff, and was never a great science student, but I liked it. I now have DLPFC ingrained into my memory.

      • Barbara says:

        Stumbled across video on YouTube and then someone directed me to your blog post about it –
        The comments on YouTube provide frightening insight into how Stahl is revered by students and patients –
        I think the video claimed that he knows the mechanisms by which the drugs work – maybe he should let the manufacturers and FDA in on that since most of the labeling still says ‘mechanism of action uncertain …’ unless something has changed recently -

      • stevebMD says:

        Thanks Barbara. As I wrote my post, I felt that the only way to contain my disgust was to write it from a tongue-in-cheek point of view.

        My “disgust” is not necessarily directed at Steve Stahl or NEI Global– everyone deserves to have some fun every once in a while– but rather at the viewers who use Stahl’s videos & cartoons as their sole source of information about psychopharmacology. To paraphrase the video, many psychiatrists truly DID enter this field instead of neurology because, in many ways, neurobiology IS more complicated. We fail to realize, however, that when we prescribe medications with potent and widespread effects based simply on a cartoon diagram from a drug-company-sponsored Stahl talk, we ask the patient to take a huge risk.

  7. Daniela says:

    Ha. Awesome rant! There’s nothing a little humor won’t help. Especially a bad case of the cringes.

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