Why We Get Sad: How Evolution Makes Sense of Emotional Disorders.Professor Randolph Nesse, EPSIG

so I'm especially glad to be here today because you may not have a sense like I do of what an amazing occasion this is there is no other group of psychiatrists in the world certainly not sponsored by a reputable and very distinguished organization that has gotten itself together to try to bring evolutionary biology to psychiatry and I think what you are hearing today is the beginning of what will likely become the world center for evolution and psychiatry and I hope helping to save our profession from itself and and having it move forward I thought maybe I could just skip my talk Paul presented my ideas in such exquisite clear accurate way I thought maybe I just take the afternoon off but there are a few other things to say but then after I heard your talk I thought well I need to add an extra hour to talk bring in the social dimension that will be for some other time the title here is the title of my forthcoming book which I must finish by April 30th and I've been gotten lots of good ideas from you and it's a lot of good ideas floating here that are wonderful it's a very small part of evolution and psychiatry not usually I've given talks about all of evolutionary medicine and all of evolutionary psychiatry and it doesn't work so I'm just going to talk to you about one small part of evolution and notice what I'm saying evolutionary psychiatry I've pleaded with your organizers to change their name because as soon as you call it evolutionary psychiatry it makes it sound like it's some special alternative weirdo kind of treatment I think what we should be saying is evolutionary foundations for psychiatry just like there are genetic foundations and cognitive foundations I don't know if but if I slip you'll forgive me so our grand vision that I think we share and that's growing is that what I call a genuinely medical model for psychiatry which strongly implies that the current model is a bogus medical model for psychiatry I think evolution provides as Paul said so well what physio for psychiatry what physiology provides for the rest of Medicine and some people think evolution reduction court rare it's the exact opposite we have to offer the antidote to mindless reductionism and bringing the person and the mind and the life and social relationships back into the equation in a scientific way I begin however with how effective we are psychiatrists and just how deep the problems are in our profession this is no secret to most of you diagnosis of course is in desperate disarray of the u.s. you know the very first page of Kaplan and Sanok and the second paragraph says there is no reason to trust these diagnostic categories they're not based in science whatsoever what in our leading textbook massive comorbidity no one knows really what to do about that huge prevalence of these disorders to the extent that actually Ron Kessler is a friend and you can kind of adjust the standard so that you stay below the 50% it seems more realistic to people if it's below 50% of the population who has a disorder 15 years ago we all thought now that we had scans that we would find brain lesions we haven't found them what does that mean we also haven't found the genes that we thought we would find I was even confident we have not found them and worse yet no breakthroughs in causes the treatments we're muddling along doing a little bit some better better better and we're effective as a profession but the foundations are very shaky and it makes us look bad and makes our professional lives less satisfying because we don't we we do it effectively but we don't know what it is we're doing really I got into this in part in fact the whole reason evolutionary medicine exists because I was so frustrated at the conclusion of my training all my friends were becoming brain doctors and giving drugs and not talking to their patients or they were not giving drugs and only talking to their patients and talking about their patients early lines or we've got cognitive behavioral therapy going in the anxiety clinic that I helped to run for 40 years or doing behavior thing but it's all fragmented isn't it and then we have these fights amongst ourselves and it makes us all look kind of silly is there some way we can find a solid foundation that we can all stand around and talk continually and pulling it all together this is too long a text right you're not specialists but this is brilliant I'm just going to read it a recent conference on psychiatric did education many psychiatrist seem to be saying to medicine please take us back and we'll never again deviate from the medical model for its one critical psychiatrist put it psychiatry has become a hodgepodge of unscientific opinions the sort of philosophies and schools of thought mixed metaphors real diffusion propaganda and politic into mental health and other esoteric goals and contrast the rest of Medicine appears neat and tidy he has a firm basis in the biological sciences enormous technological resources at its command and a record of astonishing achievements and elucidating mechanisms of disease and devised new treatments would seem that psychiatry would do well to emulate its sister medical disciplines by finally embracing once and for all the medical model of disease I'm not sure how many of you recognize the source of this this is George Engle in science in 1961 this first paragraph of course did become the mantra for our field for the past 50 years and where did it end up Tom Insel has recently retired as a director of the National Institutes of mental health United States and he said a few years ago whatever we've been doing for the five decades it ain't working when I look at the numbers number of suicides disabilities mortality data it's abysmal and it's not getting any better maybe we just need to rethink this whole approach with no validated biomarkers and too little in the way of novel medical treatment since 1980 it's time to rethink mental disorders now he's not really serious about that his idea rethinking mental disorders is to look still harder for the genes and the spots in the brain but now I take you back to what else George Engle said in 1961 he gave that first paragraph and then he says but I do not accept the premise that we should follow this pseudo medical model rather I contend all medicine is in crisis and further to medical as crisis derives from the same basic Fault in psychiatry's namely adherence to a model of disease no longer adequate for the scientific task of social responsibilities so this is where I was when I was frustrated and I realized that there was no trying to bring evolution to psychiatry without actually doing for medicine first and we're now to that phase and you know you mentioned a bit about me being in medicine as well I confess I've conceals my background as a psychiatrist because I wanted to be taken seriously as a physician and doing all of my work but my last the chapter I just finished is on evolution and cancer and now I finally feel the time is right for me to come back and become a psychiatrist evolutionist full-time and I'm glad to join you again by the psychosocial model is what George Engle advocated everybody's advocated it is wonderful we all should do it nobody does it they'll talk about it no one actually does it the medical model has proved to be much more profitable and simple and what human minds want most is something simple a few diseases each with specific causes as for evolutionary medicine it's not a special kind of treatment it's used in the basic science of evolutionary biology as Paul said so clearly to illuminate and improve medical treatment it's the intersection of the basic science and the clinical profession the core mystery that George Williams and I tried to promote and it has really engaged my whole career and button interested so many people is why the body isn't better why do we have an appendix and a narrow birth canal and wisdom teeth and inability to control cancer and affection any better than we do you'd think natural selection could have done better I'm gonna save you that part of an evolutionary medicine lecture there's lots of them on the web and elsewhere we're going to go right on specifically to emotional disorders I would love to talk with you about schizophrenia and eating disorders an ADHD now there are good evolutionary ideas about each of these but I'm going to limit myself today just to emotional disorders because that's half of what we do the burden is gigantic this is data from World Health showing that unipolar depression for women of reproductive age in modern societies is one-third of all medical problems in terms of disability and early death this includes all medical problems then you get schizophrenia bipolar disorder another mood disorder traffic accidents mostly from alcohol OCD clearly emotion two-thirds of the medical mirdon for women in modern societies is burdened from mental disorders and most of that is emotional disorders Schopenhauer is the great pessimist and I'm afraid I identify with the man he notes that it's immediate and direct purpose of our life is not suffering than our existence is the most ill adapted to its purpose in the world doesn't it seem like that time sometimes when you come back after a hard day in clinic it says who designed this thing couldn't they have done a better job please and this hat this is the question we've been asking in evolutionary medicine why are we vulnerable to disease this applies to cancer in atherosclerosis and Alzheimer's disease I also spent most of last summer in Alzheimer's disease I'd love to tell you about that another time but it also hides the schizophrenia anorexia anxiety and depression why did the system get designed in a way that's so vulnerable to these kinds of disorders the thing my students always do and everybody does and you must help me stop this is try to people say oh the evolution benefit of cancer is and I'll tell you that when George Williams and I first did our work we asked each other that question for a month until we realize it's the wrong question natural selection does not shape diseases if you hear somebody saying the evolutionary reason benefit of some disease say stop no evolution does not shape diseases evolution shapes things that make you vulnerable to diseases and that's very very different you hear that please stop people if you don't our whole field is going to go down the drain 10 burgers 4 questions I'd be the third person to talk about this and I added this slide in because I had a wonderful sabbatical at UCL in 2002 I spent the entire first month staring at a brick wall and listening to the Welsh steamfitters replacing the main steamed thing right beneath beneath me and thinking about tin bergen's for questions and I finally put them into a way that organizes them and helps me understand them there's two of them that are about the mechanism one about development within the individual and the other about how the mechanism works in a cross-section and time the other two questions are evolutionary questions one is transition over time phylogeny and the other is selective advantage and actually I put this on the web and within a year it was on a Wikipedia and finally I published it in intrigue in honor of the Centennial or the 50th anniversary of the publication a quick anecdote actually Tinbergen published this to honor Lauren was because Lorenz was getting quite old the wrens was 60 years old and of course the other irony here is that in honoring his mentor Tinbergen the single paper who it's conceptual paper really transformed and improved the whole way we think and this is a lot of what we have to offer to our colleagues it's several different kinds of conceptual clarifications that are as powerful as this for improving how we can think about mental disorders we don't have a new way of treatment there's no such thing as evolutionary psychiatry is a kind of treatment I don't think but there is evolutionary foundations that are missing that can help us all understand what we're doing so there's six reasons for vulnerability have caught on quite nicely in they're used very widely now these are the things that George and I came up with after working for a number of years together reasons why the body isn't better the first is something selection can't do like to start over again and redesign something or eliminate all mutations to yes we're in modern environments and a lot of diseases are present now but they were never present much before pathogens evolve faster than we do the amazing thing is that we can exist at all and con avoid infection trade-offs nothing can be perfect some people say evolutionary medicine says the body's perfect excuse me it says nothing can be perfect because anything can be better only at the cost of something else being worse reproductive success at the cost of health is one of the deepest most disturbing things and I have a whole separate lecture about that have you noticed that some of your patients do things that are not in their interests and that very often those are sexual things and it's not only our patients either it's like all of us it's fascinating actually to think about what proportion of difficulties in people's lives come from them being pushed by their genes to do things good for genes that are not actually good for their health or happiness the last one is what we're going to focus on exclusively today defenses that is these are not actually reasons for vulnerability but they're often confused with diseases in particular there are two kinds of things physicians in general medicine distinguish almost intuitively they're doing it better yet now that evolution is coming to bear these are things that are just a machine that working right seizures cancer paralysis jaundice there's no function to those things they just happen then indicate something's not right in the machine but it didn't have these things fever cough pain fatigue and anxiety those are mechanisms shaped by natural selection to go off when they're needed because they're useful in those situations you can see where this is going emotions are not diseases there are defenses that is the negative ones are the positive emotions you wouldn't want to call it defenses but they're all responses shaped by natural selection because they're useful in a certain situation and I'm calling this the fundamental mistake in failure to recognize negative emotions as things that can be useful is such a fundamental mistake again Paul said it earlier today it's like you know treating cough is the disorder cough isn't the disorder Coffee is a symptom of the disorder and the emotions that we see are symptoms of bad things happening in people's lives diagonal psychology most research on evolution and mental disorder or on mental disorders in general has been about negative effect depression anxiety this is what people come complaining about and has justifiably been the right focus for most research in the last 15 years a number of psychologists have pointed out that we really neglecting the other half of effect we should also be talking about the benefits of positive effect and they've gone whole hog telling us all we should try as hard as we can to be happy right now because it's good for our health well it is good but neither there's something missing here right if you take an evolutionary view of these capacities you notice that we should be also talking about the benefits of negative effect at least for our genes if not us and we should even be talking about the costs of excessive positive effects so for every single response in the body whether it's emotion or cough or fever or whatever you can have too little and you can have too much and it's these dis regulations that form the focus of most of our work we need diagonal psychology to address these neglected boxes so I think we all would recognize that emotions theory is crucial for understanding emotional disorders but psychiatrists and psychologists have not paid much attention to emotions theory they just go right for depression is bad let's get rid of it why have more attention been paid I decided in about 1988 that I was going to if I was gonna treat emotions for the rest of my life I was gonna try to understand them so I gave myself a solid year to read everything I could find about emotions what I found was interminable debates about what they are how many aspects they are or this dimensional model better is the basic emotions model better how are they regulated are they really an age where the cultural does each emotion I was really confused by the time I finished my one year reading what is an emotion I love this article 92 definitions in 1981 and that was a long time ago every new paper has a new definition including mine then all these books why do we need books like what is an emotion what is emotion why Italy if all these books really suggest that we're missing something if we don't even know what it is we're talking about here are aspects of emotions there's so many articles about which comes first the physiology or the thought or the motor or the consciousness the answer to this one is that they all influence each other in somewhat integrated states and we really don't need to revisit the james-lange difficulty anymore dimensional models remain popular and the people who advocate them on unpleasant to Pleasant and mild to intense things do fit there very nicely and you can elaborate dimensional models but then you have to get into a tussle with the people who have basic emotion models and the piece of people with basic emotion of models fight amongst themselves about how many basic emotions there are and what they are and you're not supposed to read this slide you're just supposed to look at it to see that every expert has a different list of basic emotions and there's no way for figuring out which ones are the real basic emotions are you confused yet I finally paused in the midst of all of this literature I'd been swimming in for a year and I recognized that I was having emotions they were arousing emotions in me and the emotions were frustration and confusion and by the end of it all hopelessness I decided I just wasted a year trying to understand it and give it up basically I just couldn't get out of it anything concrete and then finally I went back to the master I should have read him before I went back to William James and all William James you can just he was really brilliant he says as far as a scientific psychology of the emotions goes I may have been survived by too much reading of classic works on the subject but I should as lief read verbal descriptions of the shape of the rocks on a New Hampshire farm as toil through them again they give one nowhere a central point of view or deduction or general principle they distinguish and refine and specify in infinitum without ever getting on to another logical level isn't it marvelous and it doesn't exactly solve the problem but at least you're in good company if you feel confused I went then to evolution approaches to evolution to emotion and everybody told me read Darwin he's done it evolutionary motions or MacLaine's triune brain or M psyche I'm sorry I tried them all and they didn't answer what I wanted answered finally I found it vertical by fiddling about why I was too satisfied with Darwin's work I mean yes he dudes get credit for talking about the emotions but he restricted himself enormous ly to the expression of emotions and how humans and animals are similar instead of talking about difference amongst animals and the actual motivational other kind of functions that's led to why natural selection shape them and fiddlin argues quite convincingly that Darwin is anti-darwinian in that book McLane's triune brain was very useful in getting people to think about emotions at least in terms of phylogeny in different parts of the brain but the idea that each different component of the brain has a very fixed relationship to a certain kind of thinking or emotions it's not helpful all that much evolutionary psychologists tried very hard to argue that there's a radical modularity in the brain and that emotions are separate states that are except that's and what not what section natural selection does natural selection does not make things in nice tidy little categories with little boundaries around them it makes something that works but it's quite messy actually and finally many if you look up on Wikipedia or Google what's the evolutionary function of anger you'll get six or ten different answers the evolutionary function is to protect yourself against attack to keep groups intact the truth is that all the different emotions share and overlap different functions and they all serve different functions that's not a route that's going to take us forward so now what what do we do next again think we need to get away from this art idea that it's more of an English garden it's more of an Italian garden this is more like a wild bank Darwin's tangled bank I mean and it's not the kind of clear crisp simple structure that we really want we have to accept that natural selection shapes things that are messy that get the job done and Wilson hugely influential paragraph I read this when I was on call one night reading late at night I bought the book as soon as it came out love joins hate regression fear this withdrawal and so on and lens design not to promote the happiness of the individual but the favor to maximum transmission of the controlling genes that gobsmacked me oh my god I've had a misunderstanding about human behavior and emotions my entire career if you have a mutation that makes you have more children that makes you unhappy all your life it's going to spread it's very disturbing idea I'd note that it took this paragraph out of his book as he's gone down the slippery stoat - mistaken thinking about group selection don't follow him down that slope please so what would your real evolutionary approach to this be it's really applying behavioral ecology modern behavioral ecology to the emotions and I'm going to quickly go through my best answers to five questions how do emotions increase fitness how did different emotions evolve how are their regulation mechanisms shaped why are negative emotions so often excessive and I think they usually are excessive which is why we can get away with treating them and not rooting people and finally why are so many emotions so irrational first how do emotions increase fitness individuals get an advantage if they have a special mode of operation that they go into in certain situations it's just like sweating shivering and pain these are things shaped by natural selection to respond in certain situations and they give a selective advantage number two how did different emotions evolve well they were partially differentiated from precursor emotions across phylogenetic time to cope with ever more specialized kinds of situations and as for whether we should be thinking in dimensional terms or basic emotion terms an evolutionary perspective makes it clear that that whole debate is really not biologically informed what we need to look at is the situation in which each emotion is useful and those situations overlap with each other some examples sweating is a situation that evolved or a response that evolved to cope with excess heat Koff to foreign matter in your bronchi inflammation infection pain - tissue damage anxiety - a threat of loss sadness - loss jealousy - the threat of a loss of a mate you see how they get more specific - but not completely separate from one another the situations that have shaped the different emotions are those that have recurred over evolutionary time and influence fitness so that individuals who have a capacity to enter a special state where our cognition and motivation in physiology and memory and facial expression all change they get a selective advantage and this is a diagram that I drew that's been very helpful we published a number of times now all the way back to bacteria and bacteria respond to their environments when things are really tough take form spores I would say that no conceptually is really quite the same as an emotional response they also swim forwards or in random ways to get to good places I give a whole lecture about mood mood and bacteria but that we're not going to do that today but notice that right at back the beginning there's two basic circumstances that organisms face opportunities or threats positive emotions and negative emotions and the real point of this is to notice that these clusters of leaves on the tree are overlapping with each other we don't have to argue about how many basic separate emotions there are because they're not separate they've all come from each other in an evolutionary process that gradually differentiates them emotions correspond to situations not functions not brain low sign they're overlapping functional boundaries and there's no distinct set of basic emotions when people talk about this a rigid thing okay there's a lion coming towards you yes but at least for we humans that's not the real thing that arouses emotions mostly and I wish I had another hour to go in Robin - how this social you what kind of suffering do we have these days physical most people that we encounter have enough food to eat and they're not in pain and they're not hungry I mean it's it's wonderful the kinds of suffering they experience our social emotions they feel jealous and angry lonely and depressed and anxious about what other people think about them this is right at the core of the biggest problems we face now and we need to try to get at it so I decided to look at it in terms of goal pursuit because in fact it's pursuing goals especially social goals like getting certain people who love us or accept us in their group or think well of us there are two kinds of kinds of goals opportunities and avoiding bad things back to that diagram I just showed you ahead of time we experience hope and desire anxiety or fear after a success happiness pleasure or relief after a failure disappointment sadness or pain I was so proud of this and this really helped me to understand I started looking at my own life and my patients you've got to figure out what a person is trying to do in life and how it's going before you can understand their emotions and then I started asking people this has got to be familiar right and most of my psychologist friend said no no then I talked to some older people who had read more widely and classically and they pointed out what I should have known all the time that this is pretty much exactly what Plato the Stoics Cicero and Hume had been saying all the time except we have forgotten it and made it all into fancy neuroscience this is well known ancient stuff most psychiatrists aren't aware of it and I think we need to bring this kind of basic thinking back into the picture 3 how to selection shape the regulation mechanisms and emotions no good if it's there all the time it's only good if there's a mechanism to detect whether the situations present and express the emotion in that situation and preferably not in other situations how does it detect the situation and the answer here is again it's messy natural selection works to identify these situations any way it can with little tiny cues this business of social attention for instance people not looking at you and now we're back to Robin's work if people just don't look at you and don't pay attention to it that feels really bad probably because that stimulus has been a fairly reliable cue that there's something wrong between you and the group or you and other people if in fact that's what you're experiencing it's not a specific module it's just something that's wired on the brain that way next why does motivation vary there are people whose motivation doesn't vary they have the exact same level of effort and interest and enthusiasm at all times I don't think they do as well in life as people whose motivation varies depending on good times and bad times if someone tells you you can get a grant if you can get it in in 48 hours and we guarantee you'll get a hundred thousand pounds to do your research most of us would not bother sleeping for 48 hours and do it and be quite enthusiastic all the time those people who couldn't generate the enthusiasm to stay up all night I'm not going to do as well mood enthusiasm initiative and risk-taking increase when the payoff is high or temporary but it decreases from a specific activity when the when it's not working and from all activity when all the options available have costs that are greater than benefits now this doesn't happen that often these days usually these days because we have heat and electric lights and food in the refrigerator but for our ancestors there were many times when anything you would do would just be wasting calories because there's no food out there to get your best thing to do would be nothing picking raspberries is I think an exemplar to help us understand mood it's simple but it gets the idea across about how mood can be helpful this is Charles famous marginal value theorem how many people are familiar with it only one so so this is one of the most fundamental principles regulating all behavior and all psychiatrists in my opinion should spend a couple of hours with this because this is what regulates our behavior animals go from patch to patch looking for food and they have to stay at the right length of time in each patch for now we're gonna pretend we're going from raspberry bush to raspberry bush and it takes this much time to find a new raspberry bush no raspberries coming in during that time once you find a bush isn't it kind of exciting you get a whole lot of raspberries ready at once and you feel excited and enthusiastic and you get a lot of raspberries and then you pick most of them and then you picked all of them and there comes a point when you just kind of get bored with that raspberry bush and disappointed and you start thinking know what this isn't working I think I better look for another one it's not just us every animal the forages has to have this mechanism working pretty well and it turns out that ladybug bird beetles foraging for athens follow exactly this and they follow it very well not because they can do the calculus I'll tell you the secret in just a moment here it is this is my wife's way of their foraging for raspberries she thinks it's wasteful to leave a raspberry on the bush I'm exaggerating a bit but and forgive me Margot if you watch this this is the number of raspberries you get and the time it takes to get them right so this is the number the slope is the number of raspberries per minute you want that slope to be steeper but sometimes I actually go too quickly between different raspberry bushes being saw the ADHD and impatient so I am actually likely get a lot of raspberries from one bush and then go looking for another one so I spend most of my time looking for new bushes she spends most of her time now trying to get the last rare raspberry off the bush the optimal strategy mathematically and I'll spare you the calculus is to take the tangent then you get the maximum number of berries per time that you possibly can this is what mood is in initiatives for I mean at a certain point working on a paper you decided I'm not going to make any more progress on this tonight and you quit and that's a good thing there are people who work all night and waste their time that's not good there are people who work on their paper for 10 minutes and quit that's no good the right amount of time invested on everything you do this also applies to relationships that's a whole nother story and good times you spend some time finding a new bush you get a big payoff another time paying a bush get a big the longer you stay the more calories you get wonderful time these are good times and most of people's lives these days are like this but sometimes for some people unfortunately it's more like this a long time to find a new bush a small payoff this is I call this dating in New York you know it is it's really hard so initiative in this situation just leads to waste of time and effort when is it best to knew nothing or at least not pursue what you're doing when costs are greater than benefits for all available actions it's best not to do anything a lot oh for unpropitious times don't just do something stand there and this is not intuitive I mean the idea the cultural norm is we're all supposed to be enthusiastic and positive been doing things at all times but I'm not sure that's right especially for people's close personal lives because for many times things are just not going well and I also think the Semite have something quite deep to do with depression in relationships I mean if your spouse is mean to you for a week you could just say enough of this I'm leaving but it's probably better to stick out stick it out for a while and if in fact you feel low mood like you know what probably nobody else would have me that's probably good because it keeps you from making a premature jump out to something that's probably even worse and this brings us to the depressogenic situation ask yourself the question if you wanted to make someone depressed how would you do it you put them trapped in pursuing an unreachable goal and our society creates those situations for many people these days in particular for graduate students because their graduate students who have spent several years getting a degree and at some point they realize that they're never going to get a job that uses their too green they've already invested and sorry if there's any graduate students here you may leave before there's an exploit but I've seen many such students and what a con quandary to have invested a whole lot of life and money and interest trying to do something and realizing at the end of it all you're probably not going to actually get the payoff that you wanted you quit and drive a taxicab what do you do or it's the same in certain marriages you've been in a marriage for a number of years and you realize it's really working but you made a huge investment you just you can't just leave you can't just stay be trapped pursuing and unreachable it might be the unreachable of trying to get your mother to love you which is a really big one for a lot of people and that also can be equally hopeless my first half of my career I spent all my time with my depressed patients saying let's figure out what you're trying to get there's a way don't let your depression get in the way we can do it together it was so young and naive gradually I started realizing that many things people want to do in life they're not going to succeed at and it's and it's and some people have taken this idea and said oh so we should just tell people to quit no what we should do is try to talk with our patients about why it is they can't quit their pursuit of an unreachable goal and that takes I think deep clinical intuition and knowledge and closest to the patient and understanding and empathy William Blake if any could desire what he's incapable of possessing despair must be his eternal lot no new ideas Under the Sun this was all well known by poets and philosophers graduate student of mine Matt Keller did a wonderful study looking at whether different situations caused different symptoms and depression and other graduate student has gone on to prove that using rating scales that take a sum score of different symptoms for depression like the hamilton in the back it ignores all the actual data about the specific symptoms of depression which are actually as closely attuned to the personal situation as our different symptoms of a cold are to whether your cold is in your nose or your throat or your lungs crucial question in my residents ask now is is there something very important you're trying to do in life you can't give up despite knowing you're unlikely to succeed and this question is opened up the lives of so many patients to me I'm gonna go through a few things here just talking so I have time for discussion a very important thing is to say that this isn't the whole answer I think about half of my patients have an unreachable goal at the center of their problem about half don't some of them have unfortunate genes or toxic drugs or inflammation causing your depression the whole idea that depression has one cause comes from this misunderstanding of thinking that emotions are diseases they're not the responses that can be aroused by many different things we need to understand them top-down how motivational structures influence the brain and how the brain influences our thinking this is how all organisms work they take resources and they make offspring seems simple doesn't it but the reality is more like this resources material resources that gets really complicated this is why we have big brains to figure out these things and even thinking through them all night we can't figure them out the reality is that actually no wonder everything is so complicated I propose that we need the equivalent of a review of systems but for psychiatry and the rest of Medicine they go through each different bodily system and they say is anything wrong there we need to do the same thing with people's social lives and I've imitated the Apgar which is Virginia apgar's wave as you all know for coding a newborn baby about its health and then the same thing for the resources behavior the ecological resources social resources occupational resources children family income abilities and love those are really the six big things that people are striving for in life and I have a standardized inventory where we began filling it out in the clinic and boy did it open our eyes we had some patients who had obsessive-compulsive disorder but very severe illnesses and they were taking showers for two hours a day and had trouble working but they had a job and and a spouse and interests and appear that they were functioning in luck we had other patients who had much milder syndromes but who didn't have any income or partner or kin or occupation or social support completely different cases you know these cases they're the ones that are so hard-to-treat and we shouldn't just pretend to have a more severe kind of OCD know they have a social system they have a life situation that is not functional and the complexities there last is why our negative emotion is so common and I'd like to emphasize that I do not believe that most negative emotions are useful I think most of them are not useful and it's because of how natural selection shapes the regulation mechanisms it's a smoke detector principle who some of you have heard before the idea is that a normal system will Express the protective response whenever the cost is less than the benefit and if the cost is relatively low like a smoke detector going off its going to go off when there's even a small chance that the danger is actually present but to make it concrete we imagine that you hear a noise behind a rock should you run away and not bother getting water for your family that night well it depends the cost of fleeing we're going to say is 100 calories the cost of not fleeing if it does turn out to be a line behind that rock is more like a hundred thousand calories which is how many calories a lion would get if it ate you so how loud would the noise have to be before it would be wise to flee you should see whenever the noise is loud enough that the probability is anything greater than one in the thousand which means that 999 times out of a thousand the panic attack experienced will be unnecessary but perfectly normal this applies to all defenses this applies to pain fever cough nausea and all the rest this is why general medicine is possible without hurting people too much because most of these responses go off many many times when they're not actually needed so we can use drugs to block them but a senator just blocking them willy-nilly we should be teaching doctors and ourselves to think about this particular person this is personalized medicine without the genes trying to make good clinical decisions about when we use drugs to block a defensive response very applicable in panic disorder where you can talk to patients I used to tell them oh it's your brain that's doing this it's a real psychiatric disorder and over and over again they'd say to me but doctor I know it's physical can you refer me to a good cardiologist please and finally I changed my tune and I said what you're experiencing is a false alarm at a useful panic response that would save your life of a line we're chasing you they said oh that makes sense why is it a false alarm I explained a little bit and fully one out of four would say to me that makes perfect sense I don't think I need to worry about this anymore I don't think I need another appointment thank you very much let's come back if you need me but how satisfying it is to use theoretical understanding to change what you do in the clinic in a way that has immediate tangible benefits to your patients lastly why are emotion so emotional why do people get so irrational especially with anger and jealousy people we see people in our clinic all the time and they're irrational and sometimes we try to help them be rational which is a good idea I think but I think they're good evolutionary reasons why emotions should not be rational I wrote a whole book or edited a whole book on the strategies of commitment which is game theory nuclear mutually assured destruction is the foundation of it being irrational is essential to having social manipulation capacities people who are completely objective can be easily manipulated as many of us know and then there psychodynamic defenses I've been fascinated by the psychodynamic defenses I don't think they're there by accident they're not just glitches in the system we are actively unable to get in touch with some of our motives and it's probably a good thing because at first of all protects us from some of the things we can't have that we're striving for and the whole world there of exploration of psychodynamics biologically in terms of the benefits of being unaware of some of our impulses and here's the lecture I'll give another time maybe Robin and I can do it together about all of the social emotion disorders a whole other realm combining what I've just said we're trying to understand how relationships work and the specialized emotions that get aroused in relationships and then there's a neglected emotional disorders why they weren't anxiety and depression get all of the interest why not all the disorders of too much anger or too little anger or too much love or too little or too much jealousy or too little Envy even is useful some people don't have enough of it to take benefits other people have way too much and it makes them and everybody around them miserable so practical bottom line for every clinician if you see an emotion and we see them all the time what should you do should you try to kill it off the way so many doctors do no and that was our attitude towards bacteria they're all bad kill them off turns out we have a microbiome and we should recognize that those microbes are useful likewise for emotions when you see an emotion that you should first of all think like a doctor and try to figure out what might be arousing this emotion and then you take it to the second stage and say is this emotion excessive given this circumstance for this person and then you make a separate decision about how to relieve suffering irrespective in a thoughtful way but instead of just willy-nilly blocking the emotions saying it's a depressive disorder you try to understand that person's life situation and trying to fix the situation if you can not very often you can or the person would have done it trying to change the view in a situation and cognitive therapy works very well and changing the brain mechanisms if necessary and using all of your therapeutic skills to try to help that individual so the goal here is to try to bridge the gap between evolution and psychiatry a couple of websites that might be helpful and I'd like to invite you all to the big evolution and medicine meeting in the Netherlands August 2017 oh but we're open for abstracts quite soon and a number of you here I think would offer presentations that everybody would be very interested in thanks very much okay so first an SE occasionally somebody presents an incredibly complex subject in such a way that it all makes sense in about 45 minutes and that induces a sense of mild euphoria for many obviously I think you probably just managed to do that okay so there's a thick thicket of raspberries out there I guess I imagine there are some questions you they think there's no furry micro microphone you know who the furry microphone you I thank you very much indeed for your presentation and just three brief comments john Alderdice psychiatrist who's involved in applying psychological ideas to communal conflicts in various parts of the world the first thing that you did was point us back to the things that get forgotten about and people who have said some of the things that we've only to rediscover William James and back as far as Plato I mentioned two names one from this city healings Jackson who is hugely important in understanding not just neurology but in his Korean lectures pointing towards meditation and even societal developments and the other is only some of the earlier on mentioned that there were no already why and somebody mentioned earlier on that there were no journals on the evolutionary psychiatry for decades there has been a journal in France called evolution psychiatric which was promoted by malinovski and/or EE and their developments particularly his development of Organo dynamic psychiatry is a very interesting development it doesn't answer everything but it's an interesting contribution to thought one of the things that he pointed out and is rather important for us is the development of our capacity to reflect on things and reflect on ourselves we're not just emotions or behavior or cognition we have a capacity for imagination and that's one of the things that becomes disturbed whenever we become disturbed psychologically and the third thing is that evolution is not only about natural selection that's a very important part of the of the notion of evolution but evolution is more than simply natural selection and I just wanted to flag that so I'll just come in the last part absolutely that there's drift and there's migration and mutation the other three components of evolution and we should pay close attention to them again I think one of the things that's been most thrilling to me being here today and I read I've been reading the IPSec newsletter I hope everybody read the article what was the title of the article about trying to do it right trying to avoid mistakes it's just so stories or something like that I mean the great danger for this whole enterprise is that people are going to take it and run with it and say I've got a new kind of therapy or or they're gonna use wrong ideas because there's a lot of evolutionary theory that it's quite subtle actually and I think here we have a really solid good start in a critical approach to this application of theory and it's going to be a comment on those of you who are organizing this group to keep trying to be inclusive into bringing people in but also encouraging a continual critical thinking about the proposals people make and that will mean the slightest hint of a weirdness and other psychiatrists are going to say they don't want anything to do with this they've had enough weird things already they're already embarrassed of being psychiatrists so I think it's very I'm very encouraged by that that direction from this group to that that rillette Annie and myself have put together some articles a group of three trying to explain some of these issues and sorry I've just got a mental block of what we used as the titles now but two of them are out and the third ones coming and please put them on the web otherwise they don't really exist I wouldn't know how to I'm afraid I'm still sort of right on our pages so we'll talk later to make sure we they happen yeah but there should be some way so also characteris interested can take advantage of the work that you all are developing and the point is we come from a scientific angle but not only science and the other thing is to mention the not only science is the cultural evolution the dual inheritance that we find important and is partly we don't want to be left just discussing genes that there are other things in culture which are equally important to look at how they've moved and some of this is it with the work of Richard Dawkins and so on in means although I think you know there's a lot of controversy about that but it's in that that area that we also have to look at the evolution and how things have changed over the last well 10,000 years or whatever that one of the reasons I moved to Arizona State is because two wonderful scientists and friends Rob Boyd and Joan silk are there and Rob in particular has done a wonderful job of developing what's called cultural group selection group selection does work at the level of culture and it's very important to try to be thinking in these ways about how cultures evolve and don't evolve as a guide to trying to understand our human behavior in society's vast differences in different cultures but everything from grief to anxiety to jealousy and we can't just pretending that they're rigid systems that profoundly influenced by culture this is not not positions that in any way I'm a nice worn apollomon child psychiatrist what I find most useful with having an evolutionary perspective for psychiatry is that it brings ethical questions to the fore for example if I see a child who is depressed and I explore the family situation and it's because they're being emotionally abused by their parents but it doesn't reach the Children's Services threshold because it needs to be quite severe especially nowadays with the austerity cuts it means that Children Services won't intervene well just close the case but we stuck with the child being in the home where they are being exposed to constant criticism and they depressed and that brings up the question as a psychiatrist what what do we do do we treat with antidepressants in order to help the individual withstand the situation they in when we're unable to change the situation and I think there are many such situations that especially in child psychiatry and I think the evolutionary view is helpful to make us think about do we adapt the individual to fit into the environment or do we adapt the environment to suit the individual sorry so there are so many really good studies that you think of when you think from an evolutionary point of view that you never thought of otherwise you never ever in my opinion use your evolutionary theory to do something clinically all by yourself you try to think up the study you need to do to give clinical evidence for clinical recommendations in this case I think both for those kids and for abused women who are depressed I want to see the study you can take women in a shelter and give half the manor depressants and half of them not and see how antidepressants actually work do they actually help the women to accept the situation and go back and not feel so bad about being abused or does it give them a certain kind of courage and something else to get out of that situation I don't know the answer I do think in terms of thinking how antidepressants work an evolutionary view gives us a different perspective instead of a normalizing some homeland from the brain it's much more the way astronaut on pain you know it disrupts the system that ordinarily regulates low mood and makes it so isn't cranking up the low mood the way it was so much anymore a very different perspective on what these drugs are doing a perspective that might help us to find new and better drugs because it's good to block pain and depression thank you um I'm kind of long Gitana I'm a consultant forensic artist and I'm fascinated by this day today and I guess my question to you is in order to link up violence with mental disorder and evolution I think a good place to start is anger and emotion anger or even rage what are your thoughts on that it's fascinating to me that people who don't get angry lose a lot of social influence and people who do get angry and it's very much it's it's a game theory thing you know if it's if someone's so angry you don't know if they're gonna kill you or not they have a lot of influence senseless for them to kill you it's just not worth it but if you're worried that they might that that means that you really have to treat them very differently than you would otherwise and that kind of emotional influence is very powerful and again some of our patients don't have access to that in particular are neurotic patients fear that they will be left alone and no one else will have them so they don't dare get angry in their relationship with their partner and because of not being able to signal via anger when anger really signals is you better straight not or I'm out of this relationship I mean that's what it really signals had a certain level but if you don't dare leave your relationship ever then you can't signal the anger I mean all the stuff about the relationship of anger to depression it starts to make sense once you put it in this kind of context with evolutionary game theory and there's a whole world to be developed there still Bundy I'm really sorry I'm forgive me I I I think we have to stop the flow of the conversation which is a real shame just too little observation if I may just really really become what one thought I've got is that as a as a clinician was a skytruss when I see patients with severe depression then what people invariably say is that there's something qualitatively quite different about their emotional experience of depression compared to normal sadness now there's one thought about you know what's going on is that you know the juncture between the two and another thought is when we give patients SSRIs in particular they'll frequently say well you know what's happened is I've lost that intensity of depression and actually what I've got is not much feeling at all but hey you know I'll I'll buy that because I couldn't kind of cope like this but presumably living in a sort of hypo emotional state in some sense you know works for that individual see through a lot of wheels within wheels here on them but and there are a large question some of our patients are hyper emotional and we should also attend a summer hypo emotional and there are advantages and disadvantages to both of those and much more to be studied there thank you so much thank you

Channel: EPSIG UK

Views: 12,755

Keywords: Evolution, Psychiatry, Evolutionary Psychiatry, Psychology, Evolutionary psychology, EPSIG, Emotions, Royal College of Psychiatrists

Id: w4Nng7aIt44

Length: 56min 56sec (3416 seconds)

Published: Thu Oct 13 2016