EPSIG Symposium 1
EPSIG Symposium 1
EPSIG Symposium 1
Evolution ?
October 4th 2016
• Aetiology
• Pathogenesis
• Diagnosis
• Treatments
• Outcomes
• The philosophy and
science of psychiatry
2
Disease model
• “People who suffer from mental disorder
suffer from a sick or broken brain, not from
weak will, laziness, bad character, or bad
upbringing” (Nancy Andreasen; The Broken
Brain: The Biological Revolution in Psychiatry”
1983)
• Past president of the American
Psychopathological Association and the
Psychiatric Research Society.
Andreasen contributed to DSM III and DSM IV
Task Forces
3
Thomas Szasz
Psychosocial and anti-psychiatry model
• Each provides only bits and pieces. There is still no consensus on the
role psychiatry should play in determining when socially unacceptable
behaviour becomes a medical problem. However, psychiatry is central to
many people’s lives.
7
Where does Evolution fit into Psychiatry?
8
Evolutionary psychiatry definitions
9
Why Evolutionary theory is relevant to psychiatry
• Evolutionary Psychiatry (EP) proposes a new conceptual framework:
a Meta-Theory for psychiatry based on Darwinian theory.
Psychosocial
models Proximate
Evolutionary Biological
Critical
Psychiatry and Psychiatry Reductionism
Hermeneutics
Sciences
11
Darwinian or Evolutionary psychiatry proposes
1. Mental processes were naturally selected and have important functions,
2. Human evolutionary heritage resulted in mental mechanisms including
cognitive, motivational, affective, hedonic, linguistic, and behavioural
dispositions and structures.
3. Some mental conditions interfere with the ability of these mental
mechanisms to perform the functions that they were selected/designed
to perform.
4. The concept of disorder in evolutionary psychiatry must also refer to
dysfunctions that harm the person in the current environment and social
circumstances.
12
Darwinian or Evolutionary psychiatry
1. EP considers a species perspective, with related interests to
Evolutionary psychology and medicine
14
What does evolutionary psychiatry do that the standard
models have not covered
• EP thereby emphasises the various implicit factors involved in
causation, assessment, diagnosis and treatment of psychiatric reactions
so not only the “Hows” but also the “Whys” become equally important
to any explanation and course of action.
15
Why should Psychiatry consider Evolution?
• EP proposes evolutionary theories to account for the widespread
existence of, substance misuse, borderline states and
schizophrenia, bipolar disorder, the dementias and affective
disorders as well as other defences, childhood and
neurodevelopmental disorders
• The new science of Darwinian Psychiatry is readily accessible to
psychiatrists integrating not replacing current scientific knowledge
• EP describes in detail the disorders and conditions commonly
encountered in psychiatric practice and show how evolutionary
theory can account for their biological origins and functional
nature.
16
Tinbergen
What does evolutionary
psychiatry do that the
standard models have
not covered ?
A complete biological
explanation of a behaviour
or response requires four
components:
(1) mechanism,
(2) Individual development,
(3) function, and
(4) phylogeny.
17
Evolutionary Psychiatry Warning!
• So while evolution suggests new ways of
viewing psychiatric phenomena
• EP complements more conventional
approaches
• EP does not displace them.
• Brains are not designed machines or
computers but products of millions of years
of natural selection that work remarkably
well, given that no trait can be perfect, and
that selection maximizes reproduction, not
health.
18
Brain circuitry and neurotransmitters
• The end products of the human mind/brain
are behaviour patterns, emotions and
cognitions which are the phenotypic
characteristics of our brains that have been
shaped by selection.
• Brain circuitry, genes and neurotransmitters
are subservient systems that have evolved to
generate those end products.
• EP does not deal in false dichotomies.
19
Pathways that mediate the influence of evolutionary
processes on disease vulnerability
20
Pathways that mediate the influence of evolutionary
processes on disease vulnerability
21
Defences: Pathways that mediate the influence of
evolutionary processes on disease vulnerability
• Evolutionary Medicine makes a distinction between defects, disorders and
protective responses.
• Evolution/nature has selected adaptations (defense mechanisms) that help
protect against injuries and infections.
• These include:
1. Pain, sickness, illness behaviour
2. Anxiety, Depression, OCD,
3. Fever, Lethargy, Fatigue
4. Nausea,
5. Itching,
6. Expulsions: Sneezing, Vomiting, Coughing,
• Much of medicine/psychiatry involves of blocking the above defense
reactions (Nesse). 22
Adaptationist and non-adaptationist conceptualizations:
criticism
• Not everything should be considered an adaptation!
• Darwinian psychiatry's main proponents endorse the adaptationist ideas
in evolutionary psychiatry.
• This is an attempt to view all evolutionary novelties as adaptations, i.e.,
classically, features that favour survival and/or reproduction.
• This position is in its own way as teleological, and anthropomorphism
plays a central role in its construction.
• Organism–environment interactions are bidirectional processes.
Bernardo Dubrovsky n.b Niche constructionism
23
Useful Evolutionary Links
• https://www.psy.ox.ac.uk/team/robin-dunbar
• https://www.autismresearchcentre.com/people_Baron-Cohen
• https://sols.asu.edu/people/randolph-nesse
• https://evmed.asu.edu
24
Part 2
Darwin’s primary theory
Darwin theorised that evolution by natural selection is a process demonstrated by the observation that more
offspring are produced than can possibly survive.
And:
1) traits vary among individuals with respect to morphology, physiology, and behaviour
(phenotypic variation),
2. When changes or mutations do occur, they cannot not be passed down through the
generations.
27
Why some psychiatrists neglect or are opposed to
Darwinism:
1. EP is not relevant and does not help our understanding of mental
disorder.
2. Because they assume EP leads to biological reductionism.
3. Or leads to the neglect of psychosocial factors.
4. Or leads to the neglect of human subjectivity, meaning and/or the
uniqueness of the individual
5. Lack of exposure to or knowledge of evolutionary ideas
6. Evolution has a tainted history e.g. eugenics (Appeal to Hitler?)
7. Religious or ideological opposition
28
A comment on Values
• Patients have complex profiles and need to be treated as unique
individuals with their own values and priorities respected .
• Whether something “Is” or can be done medically is not the same issue
as to whether it should be done.
• “Is” questions differ from “Ought” questions.
• These ethical issues are not resolved simply by science.
29
Why Darwinism is not just another ideology
30
Evolution of placebo
• “Comforting myths” remain an important mode of treatment and care for some
distressed people, albeit acting through biological or what have been called placebo
mechanisms.
• The biological substrate and instinctual underpinning of interpersonal healing is
likely to be rooted in the evolution by natural selection of mammalian attachment
instincts and related grooming (bonding) behaviours (Benedetti).
31
Evolution of placebo
• The idea that placebo, social and reproductive processes may enlist
common emotional brain systems, top down processes including
hormones and neuro-chemicals, raises many evolutionary questions.
32
Evolutionary approach
• It follows that although human behavioural strategies are biological
phenomena they can only be fully understood within their correct social
and environmental contexts.
• Hence, it becomes legitimate to speak of a biology of human social
behaviour, a biology of culture and so forth.
33
Therapy
• Therapy ought to help patients understand the bio-ecological bases
inherent and communicated through their symptoms and provide
motivations for giving up unprofitable behavioural strategies or defences.
• EP also informs what biological processes may be altered and why this
may be safe, necessary or otherwise e.g. blocking anxiety, pain or other
defences
• Alfonso Troisi
35
Summary 1
An evolutionary perspective on mental disorders (Nesse)
1. Asks new questions about why natural selection has left us all vulnerable to
mental disorders, questions with several kinds of possible answers,
2. Offers the beginnings of the kind of functional understanding for mental
health professions that physiology provides for the rest of medicine,
3. Provides a continuing framework for a deeper and more empathic
understanding of individuals,
4. Explains aspects of how relationships work, Kin selection, Parental
Investment , Attachment etc.
36
Summary 2
An evolutionary perspective on mental disorders
5. Provides a way to think clearly about development and the ways that
early experiences influence later characteristics,
6. Provides a foundation for understanding emotions and their regulation,
7. Provides a foundation for a scientific diagnostic system,
8. Provides a framework for incorporating multiple causal factors that
explain why some people get mental disorders while others do not.
37
Studying the proximate mechanisms of illness is standard in psychiatry.
Ascertaining phylogenetic requires indirect methods as we do not have time machines.
1. EP therefore uses insights from comparative animal evolution,
2. genetics, and comparative genomes
3. ethology,
4. palaeo-anthropology,
5. Studies of comparative culture,
6. philosophy & other humanities.
7. evolutionary biology,
8. epidemiology,
9. biochemistry,
10. psychotherapy & psychology.
11. psychiatry ,
12. medicine,
13. public health
38
Evolutionary approach
• Darwinian approaches may
advance the endeavour to
formulate optimal ways of
conceptualizing and explaining
psychopathology and from there
aid therapy.
• EP necessitates rigorous analyses
of how environments have and
continue to shape and constrain
adaptive behaviours, producing
different varieties of signs,
symptoms, and responses. 39
Epilogue
• This quote is apposite for
psychiatry and psychiatric
neuroscience, if not
medicine and the life
sciences in general.
• It is time not just to
rethink but to implement
such an integrative
approach in research,
clinical practice and
medical education.
40
Articles for the newsletter
• We still need articles, reviews and interviews for the
newsletter.
• Please send to me at:
• paulstjohnsmith@hotmail.com
• Any evolutionarily related or inspired ideas or topics in 100
words
• Book reviews
• Small articles are always welcome.
41
Part 3
• In EP a mental disorder can be usefully characterised as at least a two
stage process i.e. harmful dysfunction
44
Start with questions.
“Why the large brain?”
• Why and how are humans different
from other mammals ? e.g. Why do
humans have symbolic thought,
cultures, religions, learning, the
ultimate social brain etc
• What drove these attributes?
• What are the functions of universal
human behaviours e.g. the purpose
of emotions etc
• Does this predispose us to unique
disorders e.g. Schizophrenia?
45
Why do we have complex culture?
46
Evolutionary Psychiatry in 100 words
• Evolutionary psychiatry (EP) brings profound Darwinian “Why” questions
to psychiatry’s biopsychosocial “How” does psychiatric disorder arise.
• It re-evaluates psychiatric epidemiology, genetics, biochemistry &
psychology, using insights from comparative animal evolution, ethology,
palaeo-anthropology, culture, philosophy & other humanities.
• EP investigates what it means to be human from the functions or
“purpose” of the mind-brain seeking explanations for persistent heritable
traits (syndromes, defences, emotions, cognition & behaviours), shaped by
selection (Natural, sexual and social) & other evolutionary processes.
• It reviews human traits, behaviours & “disorders”, using evolutionary
history, development & psychotherapy, considering interactions with
modern environments, illuminating causation, prevention and humanistic
treatments.
47
Challenges
The conflict with special creation
and essentialism
• Victorian Creationism (teleological): Intelligent
cause (Supernaturalism) creates the designed
effects of organized complexity, orthogenesis,
teleology and order seen in diversity.
• Biological Essentialism presupposes there is an ideal
“created “ genotype or phenotype any deviation
from which is a category of disease.
• Darwinism (anti-teleological): unintelligent material
causes (Materialism/Naturalism) produce the
effects of organized complexity, and order seen in
diversity.
48
Why Darwinism is not just another ideology
49
Why Evolutionary theory is relevant to psychiatry
• First:- Psychiatry lacks a formal definition of what constitutes a mental disorder.
• The failure to set a valid distinction between mental health and mental illness
has largely undermined its scientific credibility.
• Psychiatry’s difficulty in defining mental disorder derives from its difficulty in
defining mental health.
• To identify what has gone wrong with the individual’s mental and behavioural
functioning, one should have a detailed idea of how the individual functions or
would function when nothing is going wrong.
• Evolutionary explanations of human mind and behaviour have much to offer
psychiatry.
• Evolutionary behavioural science is for psychiatry what physiology is for the rest
of medicine. Alfonso Troisi
50
Why Evolutionary theory is relevant to psychiatry
• Second, the approach of mainstream psychiatry to individual differences is
basically based on typological thinking: homogeneity in a population is the
natural state and variation is the result of some sort of interference.
• Rejecting typological thinking, evolutionary theory suggests that it may
prove useful to think about individual differences in human behaviour in
terms of adaptive within-species variation, including some of those deviant
profiles that are currently defined as psychiatric disorders or psychological
dysfunctions.
• A hallmark of modern evolutionary models is the capacity to integrate
explanations focusing on species-typical patterns with explanations
focusing on individual differences that diverge from these modal patterns.
Alfonso Troisi
51
Why Evolutionary theory is relevant to psychiatry
• Third, recent findings from molecular genetics and developmental
psychology are questioning dichotomies that have dominated psychiatric
thinking for centuries (i.e., brain vs. mind, genes vs. environment, biology
vs. psychology, nature vs. nurture).
• To integrate these new findings, we need new theoretical models that
explain why (not only how) genes interact with environments in shaping
individual phenotypes, what are the pros and cons of behavioural
plasticity, and which and when behavioral systems are more sensitive to
environmental influences.
• The development of these new models will not be possible without the
contribution of evolutionary sub-theories such as life-history theory,
attachment theory, and sexual selection theory. Alfonso Troisi
52