10 ideas from Good Reasons for Bad Feelings – Insights from the Frontier of Evolutionary Psychiatry

Good Reasons for Bad Feelings by Randy Nesse examines emotions and mental illness from an evolutionary psychology perspective. I was really excited about reading this book because Nesse’s Why We Get Sick had a huge impact on me when I read it as an undergrad, encouraging me to think of the intersection between health psychology and evolutionary psychology. Here is a good primer on Darwinian Medicine from around that time.

Last month I had this discussion on free will versus determinism with Gena Gorlin, a clinical psychologist who expressed a great deal of skepticism about an evolutionary approach to clinical psychology and mental health in our conversation. I was reminded that, in the therapeutic community, an evolutionary perspective is often considered wrongheaded, counterproductive and offensive to human dignity.

Good Reasons for Bad Feelings is essential reading for anyone interested in how an evolutionary perspective improves our thinking about mental health. And skeptics will appreciate that it’s honest about stuff we really don’t understand.

Here are 10 ideas from Good Reasons for Bad Feelings.

1- Psychiatrists are as depressingly removed from biological explanations for depression as you might expect.

Nesse relates a meeting of psychiatrists he attended:

At lunch I asked other psychiatrists why they thought the capacity for low mood existed at all. Their answers were miles away from biology. “Depression is what makes us human.” “Depression is essential for relationships to be meaningful.” “I never even thought of that. Does there have to be a reason?” “Depression is a brain disorder, there is nothing useful about it.” When I suggested that there must be some reason evolution shaped a capacity for mood, their comments ranged from the shocking to the perplexing. “Hasn’t evolution been disproven?” “I think it is learning and culture, not biology.” “That sounds like one of those just-so stories.” “Mood is caused by chemical imbalances, not evolution.” Hearing those comments from friendly, well-educated doctors forced me to recognize that psychiatrists were not even thinking about the utility of mood, much less its evolutionary origins.

Evolutionary psychiatry and evolutionary clinical psychology has some proponents, but it’s still relatively rare. Scott Alexander (who was in the news in the past couple of months), Nando Pelusi and Emily Deans come to mind as practitioners who deeply understand evolution. As far as I know there hasn’t been a survey of how well psychiatrists and practitioners understand evolution- but I don’t imagine it would look that good.

2- Viewing Diseases as adaptations is a major pitfall in Darwinian Medicine

When I took evolutionary psychology as an undergraduate at LSE we often speculated about the adaptive value of various psychological phenomena in seminars. Some of the ideas we spitballed were, for example that schizophrenia is a frequency dependent strategy that enables belief in one’s supernatural powers (e.g. sorcery or shamanism) or suicide is a kin selection adaptation for reducing the burden on family. We were more likely to speculate that a disease was directly adaptive than to speculate that it was the byproduct of some other psychological mechanism. That’s because you have to have a deeper understanding of how other psychological systems work before you can consider their vulnerabilities.

Nesse calls this VDAA or “Viewing Diseases As Adaptations”:

The error of thinking that most everything is an adaptation comes naturally to human minds.

VDAA is a serious error that remains common in evolutionary medicine. But diseases are not adaptations. They do not have evolutionary explanations. They were not shaped by natural selection. However, aspects of the body that make us vulnerable to diseases do have evolutionary explanations. Shifting the focus from diseases to traits that make bodies vulnerable to diseases was the crucial insight that became a cornerstone for evolutionary medicine.

One good example Nesse uses is racehorses breaking their legs. We wouldn’t say that a racehorse breaking his leg is an adaptation, rather it is a byproduct of selective breeding. Racehorse speed, like human intelligence is an extraordinary quality that may be more vulnerable from an engineering perspective.

Breeding only the fastest horses made their leg bones longer and longer, thinner and thinner, and lighter and lighter. 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.

Because all racehorses have been selected for speed, horses that break their legs and their relatives will not be much faster than other horses. Strong selection for extreme mental capacities may have given us all minds like the legs of racehorses, fast but vulnerable to catastrophic failures.

3- Viewing symptoms as diseases is a major lapse of psychiatry

If viewing diseases as adaptations is the major sin of an evolutionary approach, viewing symptoms as diseases is ever present. In psychiatry, depression and anxiety are treated as disorders even if they are preceded by a terrible event.

4- Hope is often the root of depression

Nesse relates the results of this study by Heckhausen et al. which looks at the emotional distress of women who are hoping to have children before and after menopause as an example of how distress tracks goal pursuit.

When people are making progress toward their main life goals, they feel fine. Inability to make progress toward a goal causes demoralization and temporary withdrawal….When the unreachable goal is truly given up, low mood is replaced by temporary sadness aroused by the loss, and the person moves on to pursue other more reachable goals. Sometimes, however, the goal is something the person cannot give up, such as finding a job or a partner or a cure for a fatal condition. In such a situation, people can get trapped pursuing an unreachable goal, and ordinary low mood escalates into severe depression.

The German psychologist Jutta Heckhausen… studied a group of childless middle-aged women who were still hoping to have a baby. As they approached menopause, their emotional distress became more and more intense. But after menopause those who gave up their hope for pregnancy lost their depression symptoms. The irony is deep: hope is often at the root of depression.

5- We don’t usually consider deficits of negative feelings as disorder

I’m pretty sure I’m hyperthymic– I’ll write a blog about it sometime but I am almost always happy. Sometimes hyperthymia is associated with bipolar disorder but my mood hovers around one pole. I experience some negative emotions like jealousy and envy. I’ve been sad, for short periods of time (e.g. 3 days after major life events) but I’ve never experienced depression or grief (lack of grief is common, in this study Nesse conducted, 17% of widows and widowers reported “never” experiencing grief “at any time”). There are pros and cons of hyperthymia. Being happy is wonderful, and I’m very lucky. But it’s sometimes difficult for me to empathize others and because of this I can behave irreverently or inappropriately. As Nesse says “Milder versions of unjustified positive emotion are great for those who experience them, but some perky people can be insufferable”- guilty as charged. Hyperthymia is considered a personality type but would never be considered a mental illness or personality disorder. Similarly, other people don’t experience other normal negative emotions, like jealousy or anxiety. Nesse explains here that having insufficient negative emotions can be seriously detrimental.

Negative emotions can be deficient. Few complain, but these are serious diseases. Hypophobia, insufficient anxiety, can be fatal. Lack of jealousy reduces reproductive success. Lack of sadness can result in doing the same stupid things over and over. Positive psychology and negative psychology get all the attention. An evolutionary perspective highlights the neglect of “diagonal psychology,” that is, excess positive emotions and deficient negative emotions. Excesses and deficiencies of anxiety, low mood, embarrassment, disgust, surprise, guilt, pride, envy, jealousy, and love all deserve attention….Emotions have meaning. We should try to understand their messages. They are usually trying to get us to do or stop doing something. Sometimes they are wise and we should heed them. But not always.

Lack of low mood is rarely recognized except when people are unmoved by events that would shake others. In our study of bereavement, a remarkable number of people reported no grief symptoms after the death of their spouse, but no diagnosis applies to them. Deficiencies of high mood are finally getting more attention thanks to positive psychology.

6- We don’t care if you’re not scared

I liked this point about deficits of negative emotions so much it’s taking up two of the 10 points here.

On hypophobia, the lack of a normal fear response:

We all know reckless people who lack the usual fear of dangerous animals, social criticism, driving fast, taking drugs, and death-defying stunts. At California ski resorts, young daredevils ski down (actually, jump off) slopes (actually, cliffs) that others fear. These men—they are nearly all men—are admired for their skill and courage, especially by women. Every year, several die.

Hypophobia is serious and potentially fatal but underrecognized and rarely treated. Hypophobics don’t come to anxiety clinics. Instead, they are found in experimental aircraft, on creative frontiers, and on the front lines of battlegrounds and political movements. They are also found in prisons, hospitals, unemployment lines, bankruptcy courts, and morgues. Pharmaceutical companies have not rushed to provide treatment for hypophobia, but several drugs would likely be effective. …Starting a clinic for hypophobics could improve health and prevent injuries, but it doesn’t seem like a good business proposition.

7- Disney is responsible for the pervasive myth about lemmings committing suicide

Disney is responsible for the pervasive myth about lemmings that you’ll hear many people reference when they make group selection arguments. Thanks Disney.

The idea that selection works to benefit groups was illustrated in the 1958 Walt Disney film White Wilderness. It showed scores of lemmings jumping into a fjord, as a mellifluous narrator explains that the self-sacrifice by some is necessary to ensure that there is enough food that the species can survive. A 1962 book by the zoologist V. C. Wynne-Edwards described examples of animals that stopped breeding when food supplies were short, to support his thesis that such tendencies evolve to prevent the demise of the entire group. Williams pointed out that this makes no sense. Genetic variations that induced an individual to stop breeding would be selected out, even if they benefited the group, even if they could save the species from extinction. Individuals that stop breeding for the good of the group will have fewer offspring than those that carry on, so such sacrifices must have other explanations. As for the lemmings, the Disney film crew could not find any lemmings jumping into fjords. So they bought brooms, paid locals to trap lemmings, then secretly but literally swept them into the sea.

8- Courage can be defined by where you’re at

I really appreciated this point, as I have close friends and family who suffer from phobia, OCD and PTSD.

Fearless individuals are often admired, but their challenges are small compared to the gritty resolve many anxiety patients demonstrate by giving a talk, going to the dentist, flying on a plane, leaving the house, or coming for anxiety treatment. Treatment can reduce their suffering, and evolutionarily informed treatment can do that faster. In the meanwhile, people with anxiety disorders deserve recognition for their courage and daily determination to live full lives despite their symptoms.

9 – Young people are sexually maturing earlier- but their minds may not be

I don’t think we know much about how pubertal sex hormones are tied to brain maturation or sexual decision making. Anecdotally, transwomen, who go through something similar to women’s puberty when they start taking estrogen often report changes to their psychology and sexual decision making, above and beyond the comfort and confidence of feeling more feminine. So too, there could be aspects of mental development that are spurred on by puberty in cis girls who have naturally occuring estrogen when they hit menarche (have their first period). If there are now several more years when girls can accidentally get pregnant and the teen pregnancy rate is falling anyway, we might be doing something right in terms of education, or maybe it was just MTV’s 16 and pregnant . There is now, as always, panic about the sexuality of young people. An interesting point from Nesse nonetheless:

Another dramatic change is the earlier age at menarche, declining from an average age of sixteen to twelve. The brain, however, doesn’t mature any faster, so many people are wanting and having sex years before brains are ready to provide guidance.

10- When it comes to fields of science, There is a baby in every bathtub

Evolutionary psychologists get a bad rap, often because there are some very funny and salacious claims made by evolutionary psychologists. Evolutionary psychology is also very popular among some communities, like pickup artists and incels, who apply it with, let’s charitably say, mixed legitimacy. For my non native English speaking friends, there is a famous idiom in English that says, “don’t throw the baby out with the bathwater”. Here Nesse makes a point I strongly agree with. Every field had its valuable insights; There is a baby in every bathtub:

Psychoanalysis is ridiculed, and those who practice it are held in contempt by many academic psychiatrists. It’s a bit dangerous even to acknowledge, as I am doing here, that some psychoanalytic ideas are valuable. It is easy enough to find psychoanalytic ideas ripe for ridicule….Preposterous extremes are easy to find in every field. Some learning theorists try to explain and treat every psychiatric disorder, even psychosis. Some neuroscientists make grand claims that all mental problems are caused by something broken in the brain. Some family therapists think most disorders are caused by family dynamics. Some evolutionary psychologists propose wild sexy ideas that get lots of attention. And some evolutionary psychiatrists make preposterous claims about the adaptive significance of mental disorders. Every perspective gets pushed to extremes that dirty the water. But there is a baby in every bathtub. The baby, for psychoanalysis, is the fact of repression.