The thinking brain versus everything else
Psychiatry deals with the supratentorial. Supratentorial? you’re wondering.
A quick anatomy lesson: there’s a thick sheet of tissue that stretches horizontally through the brain, dividing it into
The thinking brain versus everything else
Psychiatry deals with the supratentorial. Supratentorial? you’re wondering.
A quick anatomy lesson: there’s a thick sheet of tissue that stretches horizontally through the brain, dividing it into a top and a bottom. The sheet is called the tentorium.
The part of the brain below the tentorium handles the basics, like breathing, hunger, hormones, and heartbeat. That’s called the infratentorium. It’s not the interesting part. Forget about it.
Now if you’re looking for thought and emotion and language, the top section of the brain is where you put your money. This part is called the cerebrum or supratentorium, and it should be splashed in neon colors or dipped in gold, or both. This is where we find the human soul. This is the land of dreams, passions, goals, and imagination. Here you find movies like the Matrix and Avatar and the English Patient. This is where Martin Luther King found his speech and started a movement. Herein lies the Italian Renaissance.
If you’re going to be a psychiatrist, you must swear an allegiance to the supratentorium.
In medicine, the joke goes like this: “The patient presented with a sore toe.” It can be a cough, burning sensation across the abdomen, problem walking, rash,anything. All you need is an unexplained symptom. “Upon examination the toe is fine. The problem isn’t physical. The problem is supratentorial. Therefore, the plan is to refer to psychiatry.”
What? you’re thinking. How can a sore toe be above the tentorium?
A toe can’t be supratentorial. Thar’s the rub, mate! A supratentorial toe means the sore toe isn’t real. The patient is imagining it. No, no, they’re not faking the pain. They really feel it, but there’s no physical reason for the toe to hurt. Since the pain is felt and thought about but not real, it’s supratentorial. It lies in the realm of movies and art (and psychiatry), not physical medicine.
There are other words to describe a “symptom without a cause,” like functional and idiopathic. “His inability to walk is functional,” or “she’s struggling with idiopathic pain behind the right ear.” We doctors like to use big words to hide the truth. Sometimes we don’t know what’s causing the problem. It’s easier to imagine it’s not real.
I’ll let you in on a few clues:
- When faced with a set of symptoms the doctor doesn’t recognize, something outside our circle of knowledge or that doesn’t exist in our textbooks, we often call it supratentorial (or functional or idiopathic).
- If a doctor says your problem is supratentorial, consider seeking a second opinion.
- If you’re a psychiatrist with a supratentorial problem… oh, never mind.
Psychiatry, Tentorium, and Contradiction
So psychiatry deals with the supratentorial. What is psychiatry but the realm of thought, emotion, behaviors, memory, and speech? What is humanity but t