Randolph Nesse. Good Reasons for Bad Feelings:

Insights from the Frontiers of Evolutionary Psychology (2019)

In a paragraph

Evolutionary psychology considers why natural selection left us vulnerable to mental disorders and aims to use this knowledge to improve treatments.  Some conditions like excessive anxiety evolved for evolutionary fitness, while others such as obesity are due to the effects of modern environments on our ancient minds.

Key points

• Evolutionary psychology asks: ‘Why has natural selection left us vulnerable to mental disorders?’ It aims to use insights from evolutionary biology to understand the origins of psychiatric problems and to improve treatments.

• Evolution explains the origins of our amazing capacities for love and goodness and why they carry the price of grief, guilt, and caring inordinately about what others think about us. The mind’s vulnerabilities are as extraordinary as its abilities. It goes awry so often in so many ways that any hosannas for the designer would soon be transformed into fury and lawsuits.

• Evolution represents the second half of biology. The usual approach describes the body’s mechanisms and how they work – proximate explanations. The other kind of explanation describes how those mechanisms came to be the way they are – evolutionary or ultimate explanations. Mechanic’s and engineer’s perspective.

• Outside psychiatry, medicine recognizes symptoms, such as pain and cough, as protective defences, distinct from the disorders that arouse them. By contrast, extremes of emotions, such as anxiety and low mood, are categorized as disorders, irrespective of any situation that might be arousing them. This error is so basic and pervasive that it deserves a name: Viewing Symptoms As Diseases (VSAD).

• Six evolutionary reasons explain vulnerability to diseases:
  1. Mismatch: our bodies are unprepared to cope with modern environments.
  2. Infection: bacteria and viruses evolve faster than we do.
  3. Constraints: there are some things that natural selection just can’t do.
  4. Trade-offs: everything in the body has advantages and disadvantages.
  5. Reproduction: natural selection maximizes reproduction, not health.
  6. Defensive responses: responses such as pain and anxiety are useful in the face of threats.

• The Smoke Detector Principle. Most of the responses that cause human suffering are unnecessary in the individual instance but still perfectly normal because they have low costs but protect against huge possible losses. Anxiety is like false alarms from smoke detectors.

• The general human tendency to ignore the effects of situations and to attribute problems to characteristics of individuals is so pervasive that social psychologists have a name for it: “The fundamental attribution error.”

• Emotions adjust physiology, cognition, subjective experience, facial expressions, and behaviour to better deal with situations.

• Emotions arise from the “appraisals” people make about the personal significance of information. Predicting what emotion will be aroused by new information requires knowing an individual’s values, goals, projects, and strategies.

• Women on average have about the right amount of anxiety for their own welfare; men have the right amount to maximize transmission of their genes, at a huge risk to their health.

• Mood adjusts behaviour to the propitiousness of the situation. High mood to take advantage of opportunities, low mood to withdraw and reset when effort not worthwhile. Relative to the motivational structure of the person’s inner life. Unrealistic goals and hope can lead to depression.

• Low mood is psychic pain and depression is chronic psychic pain. One third of depression caused by life events, third unrelated to life events, a third a combination. Our strategies for relieving psychic pain are about as effective as our strategies for relieving physical pain—modestly to moderately effective, usually with side effects, often with risks on withdrawal, but still an enormous boon to humankind.

• Psychology strives to be a nomothetic discipline, but a psychology of the individual would essentially be idiographic. An individual’s emotions and actions make sense only in the context of that person’s idiosyncratic life goals and projects.

• Do a Review Of Social Systems (ROSS) to look systematically at the individual’s situation. Problems arise when a potentially vulnerable person encounters a stressful situation.

• Our recent understanding of the origins of altruism represent a fundamental advance in human knowledge. Sexual selection for moral partners may be an important aspect, encouraging morality despite its costs, as with a peacock tail. The belief from Dawkins that we are selected for selfishness is a social corrosive.

• Repression and cognitive distortions can be useful.

• Sexual problems are common as natural selection shaped us not for happiness but to maximize reproduction. Romantic infatuation superbly demonstrates the value of subjectivity. “Love is a gross exaggeration of the difference between one person and everybody else.” “Love is a temporary insanity curable by marriage.”

• The systems that regulate body weight now fail more often than not. Trying to control their weight makes millions of people feel terrible, not only about their bodies but also about their lack of self-control. Dieting adjusts the weight set point higher: when food supplies are unreliable, extra stores are worthwhile. Eating disorders are but one example of how modern environments set up our ancient minds for trouble. Social resources are now as abundant as food, creating new kinds of social connections that are, to human relationships, what candy is to food. Drugs that imitate dopamine hijack subtle mechanisms.

• Specific alleles have not been found for most diseases. Genes for schizophrenia and autism may persist due to natural selection stabilizing traits at the point close to a cliff edge that maximizes genetic fitness despite the dire outcomes for a few individuals. Like racehorse legs bred to the point where they are light but risk breaking.

• This book follows on from “Why We Get Sick: The New Science of Darwinian Medicine,” written with evolutionary biologist George Williams in 1996.

Comments

The book’s purpose is to illustrate the better understanding and better psychiatric practices that can come from taking an evolutionary perspective, but many fascinating and important subjects are touched on along the way.  Among these my favourites were the interesting idea that emotions and depression depend on the motivational structure of a person’s inner life, and the fine examination of the origins of altruism.  There are good discussions of the nature of psychology, and well told stories from the author’s experiences as a practicing psychologist. The book is among the best models I have seen of clear, warm and engaging non-fiction writing, and the author comes across as exceptionally learned and wise.

Links

The book on Amazon UK

Author’s website

Appearance on 80,000 Hours Podcast

Extracts

Preface

The aim of this book is to show that asking why natural selection has left us vulnerable can help make sense of mental illness and make treatment more effective.

Nearly everyone has wondered why human life is so full of suffering. Part of an answer is that natural selection shaped emotions such as anxiety, low mood, and grief because they are useful.

Evolution explains the origins of our amazing capacities for love and goodness and why they carry the price of grief, guilt, and caring inordinately about what others think about us.

PART ONE.  Why Are Mental Disorders So Confusing 

1. A New Question

Why has natural selection left us so vulnerable to mental disorders?

A patient: “Your whole field is confused. You know that, right?”

Practicing psychiatry based on only one perspective is like living within the walls of a medieval town. Trying to understand different perspectives is like visiting a series of walled towns. To see the whole landscape of mental illness requires a view from a mile high using special glasses that show changes across evolutionary as well as historical time.

Doctors who look for hereditary factors and brain disorders recommend drugs. Therapists who blame early experience and mental conflicts recommend psychotherapy. Clinicians who focus on learning suggest behaviour therapy. Those who focus on distorted thinking recommend cognitive therapy. Therapists with a religious orientation suggest meditation and prayer. And therapists who believe most problems arise from family dynamics usually recommend, predictably, family therapy.

Diagnostic and Statistical Manual of Mental Disorders (DSM).

A 1957 paper by the evolutionary biologist George Williams.

The usual approach describes the body’s mechanisms and how they work; biologists call these proximate explanations. The other kind of explanation describes how those mechanisms came to be the way they are; biologists call these evolutionary or ultimate explanations. Mechanic’s and engineer’s perspective.  Only half of biology. Evolutionary explanations are essential complements to proximate explanations.

“Tinbergen’s Four Questions”: What is the mechanism? How does the mechanism develop in an individual? What is its adaptive significance? And what is its evolutionary history?

Shifting the focus from diseases to traits that make bodies vulnerable to diseases was the crucial insight that became a cornerstone for evolutionary medicine.

George saw the implications more clearly than I did and insisted on giving our article the grand title “The Dawn of Darwinian Medicine.” Our book, “Why We Get Sick: The New Science of Darwinian Medicine,” reached a wider audience and encouraged the growth of what is now called evolutionary medicine.

In its general form, the new question asks, “Why did natural selection leave our bodies with traits that make us vulnerable to disease?”

An evolutionary view explains why we have desires, why we can’t satisfy them, and why it is so hard to set them aside: our brains were shaped to benefit our genes, not us.

Our species is remarkably endowed, not only intellectually but also socially, morally, and emotionally.

2. Are Mental Disorders Diseases?

Psychiatric diagnosis is confused because it doesn’t distinguish symptoms from diseases, and it incorrectly assumes that each disorder has a specific cause.

As a solution to the diagnostic unreliability crisis of the 1970s, DSM-III succeeded beyond all expectations.But many patients with one DSM disorder also qualify for several other diagnoses. DSM-5 was finally published in 2013.

We have been trying to map the landscape of mental disorders by drawing lines around clusters of symptoms as if they were islands, but mental disorders are more like ecosystems that blend into one another, defying crisp boundaries.

Mental disorders are characterized by “harmful dysfunction.”

The rest of medicine recognizes symptoms, such as pain and cough, as protective defences and carefully distinguishes them from the disorders that arouse them. In psychiatry, by contrast, extremes of emotions, such as anxiety and low mood, are categorized as disorders, irrespective of any situation that might be arousing them. This error is so basic and pervasive that it deserves a name: Viewing Symptoms As Diseases (VSAD).

3. Why are Minds so Vulnerable?

The mind’s emotional abilities are astounding. They connect us to our partners, flooding us with love when with them, longing when they are away, sympathy when they suffer, and grief when they die. When they betray us, the mind fires us with rage. When we betray them, it racks us with guilt and motivates reparations. The mind works day and night, planning, ruminating, fantasizing, dreaming. Was Joe’s apparently friendly josh really a subtle insult? Could I really have great sex with … Who was that in my dream? The mind is the most extraordinary device that we know of in the universe.

The mind’s vulnerabilities are as extraordinary as its abilities. It goes awry so often in so many ways that any hosannas for the designer would soon be transformed into fury and lawsuits.

Six evolutionary reasons explain vulnerability to diseases:

1. Mismatch: our bodies are unprepared to cope with modern environments.
2. Infection: bacteria and viruses evolve faster than we do.
3. Constraints: there are some things that natural selection just can’t do.
4. Trade-offs: everything in the body has advantages and disadvantages.
5. Reproduction: natural selection maximizes reproduction, not health.
6. Defensive responses: responses such as pain and anxiety are useful in the face of threats.

If pneumonia is already under control, taking an antibiotic longer increases selection for resistant strains without shortening a person’s illness.

The Smoke Detector Principle. Most of the responses that cause human suffering are unnecessary in the individual instance but still perfectly normal because they have low costs but protect against huge possible losses. They are like false alarms from smoke detectors.

The correct question is Why did natural selection shape traits that make us vulnerable to disease?

PART TWO.  Reasons for Feelings

4. Good Reasons for Bad Feelings

Emotions were shaped to cope with situations.

The general human tendency to ignore the effects of situations and to attribute problems to characteristics of individuals is so pervasive that social psychologists have a name for it: “The fundamental attribution error.”

Emotions are specialized states that adjust physiology, cognition, subjective experience, facial expressions, and behaviour in ways that increase the ability to meet the adaptive challenges of situations that have recurred over the evolutionary history of a species.

Our minds make models of the world and project alternative futures across months and years.

The outcomes of different possible actions play out in our minds. As we plan, fantasize, dream, and imagine, emotions nudge us toward some paths and away from others.

Human values and identities are gloriously diverse, so predicting what emotion will be aroused by new information requires knowing an individual’s values, goals, projects, and strategies. The big news in emotions research is that emotions arise from the “appraisals” people make about the personal significance of information.

Idiosyncratic strategies. The most common and effective strategy: just wait.

5. Anxiety and Smoke Detectors

Useless anxiety can be normal, as the Smoke Detector Principle reveals.

Women on average have about the right amount of anxiety for their own welfare; men have the right amount to maximize transmission of their genes, at a huge risk to their health.

6. Low Mood and the Art of Giving Up

Mood adjusts behaviour to the propitiousness of the situation.

The cause is in the motivational structure of a person’s inner life.

Mood usually refers to a long-term pervasive state, akin to climate, while affect is the expression of a current emotional state,

They interpret diverse stressful life events as a loss of status, and they observe that many patients recover when they give up an unwinnable status competition.

High and low moods were shaped to cope with propitious and unpropitious situations.

Individuals whose mood rises in propitious situations can take full advantage of opportunities. Individuals whose mood goes down in unpropitious situations can avoid risks and wasted effort and can shift to different strategies or different goals. The capacity to vary mood with changes in propitiousness gives a selective advantage.

Chimpanzees and humans make foraging decisions well. No calculation is needed; motivation flags at the optimal time to make a switch.

Hope is often at the root of depression.

Baseline mood is remarkably stable for most people, and variations reflect mainly the rate of progress toward a goal.

Depressive realism.

We must not let new understanding of the utility of low mood interfere with our efforts to relieve mental pain.

7. Bad Feelings for No Good Reasons: When the Moodostat Fails

Moodostat failures cause serious diseases.

The first principle of social psychology, laid out by the field’s founder, Kurt Lewin, in a simple formula: B = f(P, E): Behaviour is a function of a Person in his or her Environment.

In about a third the onset of depression was unconnected to any life event, another third had a vulnerability to depression that had magnified the effect of a negative experience, and the final third had depression caused by a specific event.

Even the actors and actresses can’t live up to the expectations aroused by the characters they play.

The biggest rewards in mass societies go to those who pursue grand goals single-mindedly.

Ninety percent of height variation is caused by genetic variation, but there are no “height genes” with large effects.

The mechanism that adjusts depression so it becomes more likely after bad times may be a feature, not a flaw.

Who gets bipolar disorder is explained almost entirely by genetic variations; they account for more than 80 percent of the variation in vulnerability.  However, as is the case for so many other genetic diseases, no common alleles have a substantial influence on bipolar disorder.

Low mood is psychic pain. Depression is chronic psychic pain. This should guide how we evaluate and treat it. The first step is to try to figure out if something specific is arousing the pain. Investigation often reveals the inability to give up an unreachable goal. Many such problems are caused by “social traps,”

Our strategies for relieving psychic pain are about as effective as our strategies for relieving physical pain—modestly to moderately effective, usually with side effects, often with risks on withdrawal, but still an enormous boon to humankind.

PART THREE. The Pleasures and Perils of Social Life

8. How to Understand an Individual Human Being

An individual’s emotions and actions make sense only in the context of that person’s idiosyncratic life goals and projects.

Nomothetic and idiographic. Psychology has been striving to make of itself a completely nomothetic discipline. The idiographic sciences, such as history, biography and literature … endeavour to understand some particular event in nature or in society. A psychology of the individual would essentially be idiographic.

Emotions don’t arise from events; they arise from a person’s appraisal of what events mean to his or her ability to reach personal goals.

Doctors conduct what is called a “review of systems” by asking a standard set of about thirty questions.  Extend this to a Review Of Social Systems (ROSS).

Most problems arise when a potentially vulnerable person encounters a stressful situation.

They can create the situations that torment them.

9. Guilt and Grief: The Price of Goodness and Love

Explaining altruism.  George Williams argued against group selection, taken up in The Selfih Gene.

The idea that our brains were shaped to get us to behave in the interests of our genes is deeply disturbing. On first grasping it, I lay awake for nights wondering if my moral impulses were just manipulations at the behest of my genes. The core idea seemed necessarily true, but it was at odds with the guilt, social sensitivity, and genuine goodness I thought I saw in patients, friends, and myself. The belief that we are selected for selfishness is a social corrosive.

A brief executive summary of the origins of cooperation. (1) Benefits to groups of unrelated individuals cannot explain the evolution of extreme human social abilities. (2) Benefits to kin who share the same genes explain most altruistic behaviour. (3) Much apparent cooperation among nonrelatives is just individuals doing things that help themselves and that also happen to help others. (4) Extensive cooperation among nonrelatives is explained mostly by reciprocal favour trading. (5) Reciprocity systems shape costly traits for establishing a good reputation. (6) The previous five explanations explain most social behavior in most organisms, but not quite all. They represent a spectacular fundamental advance in human knowledge even though they cannot fully explain human capacities for commitment and moral behaviour. Important additional explanations are offered by cultural group selection, commitment, and social selection.

Trees put most of their life effort into competing to be taller. But Aspen trees are clones that create tight groves of modest height. The cells in our bodies are like 40 trillion identical twins.

Altruists who associate selectively with other altruists reap advantages compared to others who merely trade favours with random others. Sexual selection for altruistic partners (you want a kind man). The resulting prosocial traits are as expensive and dramatic as a peacock’s tail.

We care about our pets because they care about us—as well they should after thousands of years of domestication by social selection.

Sociopaths probably due to variants at cliff edge not exploiting niche. Sociopaths corrode trust.

10. Know Thyself – NOT!

Repression and cognitive distortions can be useful.

The capacity to create internal models of the external world can be useful. Mental manipulation of such models allows comparing the likely outcomes of alternative strategies without the risks of actually doing things.

The idea that repression and lack of self-knowledge can be beneficial is disturbing. Ever since the Enlightenment, hope for progress has been pinned on reason, respect for facts, and critical independent judgment. This is threatened by the idea that our tendencies to deny facts and distort reality may be useful adaptations.

PART FOUR. Out-of-Control Actions and Dire Disorders

11. Bad Sex Can Be God – For Our Genes

Sexual problems are common for good evolutionary reasons.

Our question is, as usual, not why some people have problems; it is why sexual problems exist at all. Why are they so amazingly and unfortunately common? The most important answer is simple: natural selection shaped us not for happiness or pleasure but to maximize

reproduction.

In a hunter-gatherer society with only half a dozen possible mates within walking distance, hopes for a spectacular partner could be kept within bounds.

Romantic infatuation superbly demonstrates the value of subjectivity. As George Bernard Shaw put it, “Love is a gross exaggeration of the difference between one person and everybody else.” “Love is a temporary insanity curable by marriage.”

The market for erectile dysfunction drugs is now about $ 4 billion a year. Pharmacology has changed the sexual world, to the pleasure of many men and women—and the dismay of some women, who had thought they were done with all that.

12. Primal Appetites

Dieting spirals famine protection mechanisms into anorexia nervosa and bulimia.

“They are as sick that surfeit with too much as they that starve with nothing.” The Merchant of Venice.

The systems that regulate body weight now fail more often than not.

Trying to control their weight makes millions of people feel terrible, not only about their bodies but also about their lack of self-control.

Even in modern societies, death rates rise faster for every pound underweight than they do for every pound overweight. So, the brain mechanisms that protect against obesity are weaker than those that protect against starvation.

Our task is different; it is to figure out why we all have eating regulation mechanisms that are so vulnerable to dysregulation. The starting point is recognizing that selection has shaped powerful mechanisms to protect against starvation.

Like nearsightedness, smoking, substance abuse, and obesity, anorexia is a disorder of modern environments, and most alleles that influence it are harmless variations in the natural environment.

Predictive adaptive response – poor pregnancy nutrition leads to later weight gain.

Dieting adjusts the weight set point higher: when food supplies are unreliable, extra stores are worthwhile.

Eating disorders are but one example of how modern environments set up our ancient minds for trouble. As resources of diverse kinds become more readily available, we all face multiple predicaments like that of Tantalus. Social resources are now as abundant as food. Facebook, Twitter, and Snapchat create new kinds of social connections that are, to human relationships, what candy is to food.

13. God Feelings for Bad Reasons

Substances hijack learning to create zombies.

Drugs that increase or imitate dopamine hijack these subtle mechanisms. The pursuit of normal rewards is automatically regulated. Most chemicals that give humans a buzz evolved to disrupt insect nervous systems.

My colleague the psychologist Kent Berridge has shown that this “wanting” system tends to overwhelm and outlast the “liking” system, so that some chronic users desperately want drugs that no longer provide much pleasure.

Understanding the brain mechanisms that cause addiction should lead to new drugs to block those mechanisms.

14. Minds Unbalanced on Fitness Cliffs

Genes for schizophrenia and autism may persist because of cliff edges in the fitness landscape.

We thought we would find specific genetic flaws causing specific diseases. What we found is organic complexity beyond our imagining. Some genetic disorders are caused by specific genetic mutations with big effects. Huntington’s chorea (aka Woody Guthrie’s disease) is a good example: if you have the allele, you get the disease. For diseases such as cystic fibrosis caused by recessive genes, you get the disease if you have two copies of a defective allele. However, most common genetic diseases are very different. Instead of a few identifiable genetic variations with big effects, they are caused by thousands of variations spread across the genome, each with only a tiny effect. This is the case not only for schizophrenia, autism, and bipolar disease but also for type II diabetes, high blood pressure, coronary artery disease, migraine headaches, and obesity.

The inability to find specific alleles that cause genetic diseases is called the problem of “missing heritability.” The heritability is not really missing; solid studies document strong effects of genes. What is missing is identification of the specific alleles that account for the heritability. Natural selection tends to eliminate alleles that cause dire illnesses.

Even for rats, females are better at social tasks and males are better at systematizing.

These disorders are not diseases like eating disorders and substance abuse that are mainly products of modern environments.

Successive generations of racehorses have become faster and faster but also more and more vulnerable to breaking a leg, something that now happens about once every thousand times a racehorse starts a race.

Diseases resulting from cliff-edged fitness functions should be highly heritable, observed in a few percent of the population, and the risk will be influenced by the complex interactions of many normal alleles that all have about the same small influence on disease risk. This matches the data for many diseases.

These diseases all may result from natural selection stabilizing traits at the point close to a cliff edge that maximizes genetic fitness despite the dire outcomes for a few individuals.

In his profound book Cybernetics, Norbert Wiener, the father of information theory, suggested that dysregulated feedback control systems might be responsible for some mental disorders.

Epilogue: Evolutionary Psychiatry: A Bridge, Not An Island

How using all of biology can integrate psychiatry and make sense of mental illness.

Instead of being appalled at life’s suffering, we should be astounded and awed by the miracle of mental health for so many.