What is Evolutionary Psychiatry
On keeping the frontal lobe firing or "when dreams go, life is a barren field frozen with snow"*
Things have been slow and relatively easy with my new quiet job and my new quieter life, but occasionally an opportunity to teach or go on a podcast does come up, and this fall has afforded me both. While most people are curious about food and mood, on the academic side there is some interest in the idea of Evolutionary Psychiatry in general, so every once in a while I like to sit down and gather my thoughts about it.
Most people don’t really understand what psychiatry is, it’s mysterious even to other doctors and sometimes psychologists too. Then you add a modifier like “evolutionary” and you sound like a hack, but really, it’s just one more way of looking at the medical science and art of the practice of psychiatry, which is a field that uses medical and psychological training to address the problems of mental health and substance abuse in the population.
When I began my psychiatry training after four years of college and another four of medical school, it was an exciting time. New medications promised major advances and new understanding of the brain meant it was only a matter of time between better therapy and new meds and technology before we could tune and tweak and solve the problem of refractory depression and intractable psychosis.
Perhaps this is a trajectory common to all starry-eyed optimists launching in their profession, but I was destined for disappointment in the efficacy of our treatments. Moreover, after mastering the basics of ruling out medical problems and ably prescribing and getting a few years of practice being a therapist under my belt, I was also busy but bored. Psychiatrists can go into academics and answer more in depth questions and dig to their hearts desire, or enter analytic institutes and explore the philosophy of therapy and sit in deep thought, but that never appealed much to me either. I’d used a paleo diet to lose weight after my second child was born and found it cleared up my skin as a side benefit, and I began to read about ancestral health and evolutionary medicine. Then I read some lay books (like Primal Body, Primal Mind) and found them to be interesting, but over-generalized, and poorly representing the science of the referenced articles, which were usually of poor quality anyway.
Ultimately we are the primates that can’t stand to be bored, which is why we built all of this (gestures all around)…boredom is a defense, too, against more powerful driving emotions like anger and sadness and pursuing an intellectual interest. (See, I did pay attention to those lectures on Vaillant and Bowlby). If we don’t have something to interest us, we lose motivation and languish. I had lived my entire life through age 30 in a furnace of learning, no breaks along the way and I didn’t know how to exist without thinking intensely about something and, well, everything. I wanted to address ancestral health and psychiatry, but in a responsible way, as fairly as possible investigating the science even with my humble abilities at reviewing The Literature. I did it for me, really, not for anyone else, except perhaps my patients, but writing about it attracted other interest and people wanted talks and more writing at Psychology Today and…well. Here I am, for better or worse.
Back to Evolutionary Psychiatry, which has two parts:
1) Risk for mental illness comes from a combination of inherited risk genes and environmental stress (the latter can mean anything from acute trauma and disaster, chronic violence, exposure to viruses, autoimmune disease, social stress, air pollution). Major mental health disorders like schizophrenia and severe depression are relatively common, often strike fairly young and have an obvious survivor disadvantage for the person affected and their offspring, is there some reason the risk genes persist in the population? Is there some sort of adaptive advantage to having the genes? This is a question made much more complicated by the fact that very few psychiatric disorders in the population seem to be caused by a single gene (exceptions may be rare disorders like periodic catatonia and some families with unusual triplet repeats in certain chromosomes leading to schizophrenia). Psychiatric risk genes could number in the hundreds or thousands, and it’s the combination of genes and environmental stress that cause the problems. Some of the research into this includes a large Swedish study linking families with mental illness to more creativity in their first degree relatives.
2) The second aspect of Evolutionary Psychiatry is more applicable to everyday life and clinical practice. This piece is a more general view of ancestral health, exploring how the mismatch between our evolved mostly hunter-gatherer bodies and brains and our modern environment. One can have a lot of fun and get into a lot of trouble with these questions. Partly because it is very easy to fall for a naturalistic fallacy that everything paleo is better for us (spoiler, the major advances extending modern lifespan and human health are water sanitation, vaccines, and antibiotics). But if one has some common sense you can start to think about how modern life does contribute to diseases of civilization, and how that is related to mental health, without unnecessarily dying of tetanus or rabies because you won’t get a shot at the emergency room after tangling with a rusty bit of metal or an angry racoon. Evolutionary Psychiatry is just a way of generating hypotheses that need to be answered with study. Does managing light exposure at night help improve sleep quality? Does daily exercise and movement improve physical and mental health? Some of these questions are safe to answer yes for most people and go forward with adjustments. We mostly drank springwater in our evolutionary history, does it make sense to go into the woods and drink raw water? At least in the US, probably not a great idea. Better to get those added minerals we might be missing from our home water with some (treated and bottled) mineral water or supplements. Giardia is no fun for anyone, except maybe the wee parasite itself.
These are the questions I’ve pondered, then, over the years, back at Psychology Today.
This substack is something different, perhaps something disappointing. More personal, less academic, as I figure out the next steps. The pandemic took over that driving intellectual interest for a while, and I couldn’t really think or write about anything else. Now I’m not sure quite what to do, but I don’t intend to languish. There are just so many things to wonder about.
*Langston Hughes
"I had lived my entire life through age 30 in a furnace of learning, no breaks along the way and I didn’t know how to exist without thinking intensely about something and, well, everything."
Great summation of our formative years.