Analytic Perspectives on "Rocky"

Introduction

In collaboration with Pesi® Inc., I provide a full-day psychopharmacology seminar that is case-based. The twist is that the selected case is a film that we flip as a fictional case study of mental illness. Like other pop culture-based curricula I direct, the purpose of this seminar is not to render diagnoses per se, as it would run the risk of stigmatizing individuals with mental illness (films too often provide inaccurate portrayals of mental disorders). Instead, the selected film serves to stimulate discussion about a class of psychotropic medication.

At our medical school, personality disorders have been taught through the genre of American “fighting films.” Participating students view four films: The Matrix (1999), Kill Bill Vol 1 and Vol 2 (2003, 2004), and Rocky (1976). For example, The Matrix showcases Cluster A, Kill Bill demonstrates Cluster B, and characters in Rocky provide evidence of Cluster C personalities.

While our manuscript on The Matrix has been previously published, this blog will look at the Rocky franchise and merge one of its characters with Pesi’s mission to provide continuing education on the topic of psychopharmacology. Specifically, we’ll look past Adrian’s avoidant personality and instead focus on another character, Mickey Goldmill. In doing so, we will introduce medications used to treat Major Neurocognitive Disorder (MNCD) through analysis of Sylvester Stallone’s Rocky (1976).

Synopsis

Rocky (1976) is a sports drama written by and starring Sylvester Stallone that tells the rags to riches story of a heavyweight boxer, Rocky Balboa. The film won Best Picture and was selected for preservation in the United States National Film Registry by the Library of Congress as being “culturally, historically or aesthetically significant.” The film has spawned seven sequels to date, and the original holds a rating of 8.1 on IMDb and a 93% Tomatometer rating on Rotten Tomatoes.

How it relates to the field of psychiatry

The Leap of Faith

Case-based learning (CBL) is currently employed at many medical schools to promote lifelong learning and has been found to be preferred over more traditional methods of teaching⁽¹⁾. When using films to teach mental disorders such as depression, anxiety, and psychosis, movies are selected that demonstrate signs and symptoms that support the etiology, manifestation, and course of illness.

However, when the script becomes the foundation for a discussion about medications, learners need to be more amenable to the proposed mental disorder. That is, the rigorous discussion about the signs and symptoms reaching the diagnostic threshold of a mental disorder is replaced by an equally rigorous discussion about evidence the character is taking medication. For this reason, I submit that Mickey Goldmill is afflicted with MNCD. Evidence, albeit scant, that supports this diagnosis includes Coach M having a history of traumatic brain injury (r/o Chronic Traumatic Encephalopathy).

Table 1. Medications used to treat MNCD

Source: Anthony Tobia, MD

Available Medications

FDA-approved medications for the treatment of MNCD of the Alzheimer’s type (Alzheimer’s disease) slow the worsening of symptoms by either: a) inhibiting the enzyme that degrades acetylcholine and/or b) lowering CNS glutamate by blocking NMDA receptors. The combination pill, Namzaric®, combines an acetylcholinesterase inhibitor (Aricept®) and Memantine, an NMDA receptor blocker.

By including some off-label medications and rearranging the classes of medications, learners can remember the psychopharmacology used to treat MNCD of the Alzheimer’s type by the acronym COACH M (Table 1).

Goals of Therapy

The above medications may delay or slow the worsening of MNCD and lead to temporarily improved functioning. What if any had been prescribed to Coach M, and did he have better cognitive functioning in this scene (Rocky actually calls him “crazy”) where he tries to convince Rocky Balboa not to get in the ring with Clubber Lang?

It’s fun to consider what beneficial effects a medication like Namzaric® (unfortunately a generic name is not available) would have had for Mickey and the people’s lives he touched. Examples include Rocky not getting in the ring with Clubber, Mickey not suffering an acute myocardial infarction and dying, Apollo Creed not coming out of retirement to train Rocky and therefore not being killed by Ivan Drago in 1985, and “Donnie” Johnson not struggling to grow in his father’s shadow.

Psychopharmacology Essential Reads

Long-Term Use of Benzodiazepines and Dementia Risk

Does Antipsychotic Medication Work?

Of course, these characters being spared the above morbidity and mortality would come at the cost of millions of movie-goers being deprived of the Rocky franchise.