Evolutionary Psychiatry

A new beginning

Anthony Stevens, John Price

• Publisher: Routledge
• Year: 2015
• ISBN:
  9781317580485
• Edition: 1
• Topic: Psychology
• Subtopic: History & Theory in Psychology
• Index: Psychology

Evolutionary Psychiatry was first published in 1996, the second edition followed in 2000. This ground breaking book challenged the medical model which supplied few effective answers to long-standing conundrums. A comprehensive introduction to the science of Darwinian Psychiatry, the second edition included important fresh material on a number of disorders, along with a chapter on research.

Anthony Stevens and John Price argue that psychiatric symptoms are manifestations of ancient adaptive strategies which are no longer necessarily appropriate but which can best be understood and treated in an evolutionary and developmental context. Particularly important are the theories Stevens and Price propose to account for the worldwide existence of mood disorders and schizophrenia, as well as offering solutions for such puzzles as paedophilia, sado-masochism and the function of dreams.

Readily accessible to both the specialist and non-specialist reader, Evolutionary Psychiatry describes in detail the disorders and conditions commonly encountered in psychiatric practice and shows how evolutionary theory can account for their biological origins and functional nature.

This Classic Edition of the book includes a new preface by Anthony Stevens and a foreword by Paul Gilbert.

Part I
Evolutionary Psychiatry: an Introduction

1
Historical Background

The Medical Model in Psychiatry

All psychiatrists are doctors. Their long and arduous training conditions them to base their work on the medical model – namely, the idea that it is the doctor’s function to examine, to diagnose, and to treat. A psychiatric examination, like any medical examination, is designed to elicit signs and symptoms and to establish the history and course of a diagnosable disease. Once a diagnosis is made, a course of treatment is prescribed, and the patient followed up to assess progress, or otherwise, as the case may be.

The grubby, unemployed youth, who thinks people are staring at him and laughing at him and who hears accusing voices coming out of other passengers’ Walkmans on the tube, is diagnosed as schizophrenic and put on phenothiazine drugs. The lonely, divorced woman, who wakes early in the morning, wishing she were dead, and is too frightened to go out and do the shopping in case she breaks down in public, is diagnosed as suffering from depression associated with agoraphobia and put on antidepressant and anxiolytic medication.

In this way, psychiatrists emulate the clinical precision of their medical and surgical colleagues, persuading themselves that they are dealing with clinical entities, which, like diabetes and myxoedema, possess a known origin, a definable course, and a definite cure. Unfortunately, this is largely an illusion. For although psychiatrists may define and classify mental illnesses such as schizophrenia, depression, and obsessive-compulsive disorder, they have little or no idea of what these conditions could be or why human beings should suffer from them.

This does not mean, however, that examining patients and classifying their mental symptoms are futile activities. Observation, differentiation, and classification are natural modes of intellectual progression: they are the means by which our cognitive faculties seek to impose order on chaos. Phenomena have to be recognized and distinguished before they can be explained. Carl Linnaeus had described nearly a million different plant and animal species before Darwin came along and cut through this vast complexity with his tremendous insight that all species are related, and that the more complex evolved out of simpler forms by the twin processes of genetic mutation and natural selection occurring in an environment with finite resources. If the labour of description, annotation, and classification had not continued throughout the eighteenth and early nineteenth centuries the necessary data would not have existed for Darwin’s genius to work on.

In medical science this procedure started with Hippocrates and his disciples. They carefully studied their patients, recording the signs and symptoms of their disease. When certain of these indices were found to recur in conjunction with one another, the physician was in the position to recognize (and diagnose) a typical clinical syndrome. We also owe to Hippocrates the idea that diseases have a course through time: they have a natural history. The physician must not only make a careful physical examination in the here and now, but he must elucidate details of the illness’s first manifestation and its history since the onset. Then the patient must be followed carefully, noting what changes occur, either spontaneously or as a result of therapeutic intervention. In this way, knowledge could be acquired which might make it possible to distinguish one disease entity from another and to make a realistic assessment of the likely prognosis. In this manner the basis of sound medical practice was laid. Where Hippocrates fell short of the modern physician was in the aetiological system he used to account for the afflictions he was able to diagnose. He attributed madness, for example, to increased humidity of the brain.

In the seventeenth century, the English physician Thomas Sydenham applied the Hippocratic approach to demonstrate that, when one illness can be distinguished from another on the basis of careful clinical examination, it becomes possible to move beyond ancient humoural theories to establish actual pathological changes which underlie each disease. In this way he was able to describe such conditions as malaria, scarlet fever, and gout. Only when the underlying pathology has been described does it become feasible to devise scientifically validated treatments likely to produce a cure – though for the conditions Sydenham described, the cure was a long time in coming. However, his was a decisively important argument. The description of the clinical characteristics of myxoedema and Grave’s disease preceded the discovery that they were due respectively to under-and over-activity of the thyroid gland. Once this was established, it became possible to cure myxoedema by administering thyroid extract and Grave’s disease by removing part of the thyroid tissue. Interestingly, Sydenham saw his approach as analogous to that employed by the botanists of his time. The physician, he said, should be able to describe physical diseases ‘with the same exactness as we see it done by botanic writers in their treatises on plants.’

The psychiatrists of the eighteenth and nineteenth centuries were inspired by a similar sense of mission. By making systematic observations of the mentally ill, they were able to describe their symptoms and behaviour with a precision that other psychiatrists were able to understand and replicate. This prepared the way for Emil Kraepelin to perform his great work of synthesis and to publish his conclusion in the 1890s that there existed two major functional psychotic disorders, which he called dementia praecox and manic-depression.

Medical science has historically progressed through five stages:

• 1 Recognition of specific symptoms
• ↓
• 2Definition of syndromes
• ↓
• 3 Identification of tissue pathology
• ↓
• 4 Demonstration of the causes of tissue pathology
• ↓
• 5 Establishment of an appropriate cure.

All five stages have been completed with regard to a number of medical conditions, but with psychiatric disorders the story has been less encouraging. There has been considerable progress in accomplishing the first two stages, but the last three have been marked with only variable and often disappointing success. The descriptive classification of mental illnesses introduced by Kraepelin certainly brought order into a previously chaotic back ward of psychiatric practice, but it offered no definite indications as to the aetiology or treatment of the illnesses it defined. Since then the search for structural lesions in the brain and for biochemical disturbances of cerebral functioning has yielded some progress towards establishing a genetic and neurophysiological basis for the major psychoses. The role of psychological and social factors influencing the onset of psychiatric illness is now better appreciated than hitherto, and powerful psychoactive drugs have been developed which go some way to remove symptoms and relieve suffering. However, it is widely acknowledged that as a branch of medicine psychiatry has failed to achieve the scientific status confidently predicted for it by such pioneers as Kraepelin, Bleuler, and Maudsley at the beginning of the twentieth century.

In this failure, psychiatry has been no more culpable than its sister disciplines psychology and sociology. Outstanding figures in the history of these areas of enquiry – men like J.B. Watson, B.F. Skinner, Karl Marx, Emile Durkheim, Sigmund Freud, and C.G. Jung – achieved eminence primarily because they proposed theoretical models capable of guiding the clinical, experimental, and field work of those who subscribed to them. But none of these has achieved the degree of general acceptance enjoyed by paradigms in physics (the Newtonian and Einsteinian paradigms), biology (the Darwinian paradigm of evolution through natural selection), or astronomy (the Copernican paradigm).

In the course of this book we shall argue that the main reason for the paradigmatic failure of psychiatry and the behavioural sciences generally is attributable to their persistent reluctance to come to terms with the scientific revolution wrought in biology by Charles Darwin. Their formulations are still tinged with special creationism, their findings lack the unifying cohesion of a conceptual framework linking the basic features of human life with the natural history of our own and other animal species. There are powerful religious and political reasons why this has been so in the past, but these have now lost their salience, and developments in ethology, behavioural ecology, and sociobiology have at last made it possible, we believe, to bring psychology and psychiatry into the mainstream of contemporary biological science.

The Phylogenetic Dimension

The first systematic attempt to place human psychopathology on a biological footing was that of Sigmund Freud. That it failed was because of his dogmatic insistence on the central motivating importance of sex, his obsolete conceptions of the functioning of the central nervous system acquired working in Brücke’s laboratory in the 1880s, and because, throughout his life, his evolutionary formulations remained unashamedly Lamarckian. A significant, but less appreciated, contribution, was made by Freud’s dissident colleague, Alfred Adler, who annexed Nietzsche’s ‘will to power’ in order to introduce the notions of self-esteem, feelings of inferiority, and the need to compensate for them, into the aetiology of neurosis. In this he anticipated the importance attributed to social ranking behaviour by modern behavioural biology. That Adler’s formulations have been neglected by evolutionary psychologists is because he was by nature an educationalist and politician rather than a biologist.

A major breakthrough in the early decades of this century was the hypothesis proposed by C.G. Jung of archetypes functioning as dynamic units of the phylogenetic psyche, which Jung misleadingly termed the ‘collective unconscious’. Archetypes are conceived as neuropsychic units which evolved through natural selection and which are responsible for determining the behavioural characteristics as well as the affective and cognitive experiences typical of human beings.

Unlike Freud, who maintained that the crucial events of human developmental psychology were confined to childhood and adolescence, Jung took the view that development proceeds throughout the life-cycle as a whole. The archetypal endowment with which each of us is born prepares us for the natural life-cycle of our species in the natural world in which we evolved. A programmed sequence of stages, each mediated by a new set of archetypal imperatives, seeks fulfilment in the development of characteristic patterns of personality and behaviour. Each set of imperatives makes its own demands on the environment. Should the environment fail to meet them, then the consequent ‘frustration of archetypal intent’ (Stevens, 1982) may result in psychopathology. For example, the infant–mother archetypal system will achieve fulfilment only if activated by the presence and behaviour of a maternal figure; and the heterosexual archetypal system can achieve fulfilment only through the presence of a suitable mate. Should any of these figures be absent, then the archetypal system concerned will remain dormant and development may be arrested or follow an aberrant course.

In the Jungian view, the purpose of life is the fullest possible realization of the archetypal programme that is compatible with ethical responsibility. Psychopathology results, on the other hand, when the environment fails, either partially or totally, to meet one (or more) basic archetypal need(s) in the developing individual. This view is in close agreement with that developed by the British psychiatrist, John Bowlby, in the 1950s. Before then, Jung’s ideas had for the most part been neglected or derided because they subverted the prevailing academic consensus which was deeply hostile to the notion that innate structures could have any part to play in human psychology or human social behaviour.

Until Bowlby’s arrival on the scene, it had been generally accepted that infant attachment behaviour, like practically all other forms of human behaviour, was learned through a form of ‘operant conditioning’ associated with natural rewards and punishments, the caretaker’s presence and nurturing behaviour being experienced as rewarding, and her absence or lack of maternal attention being experienced as punishing. As with most theories espoused by academic psychologists at that time, the primary reward held to be responsible for eliciting infant attachment was food, and, as a consequence, it came to be known as the ‘cupboard love’ theory. Practically all psychologists, psychiatrists, and psychoanalysts accepted the cupboard love theory as accounting for the facts, and it went unquestioned for decades.

Then, in 1958, Bowlby published his now famous paper entitled ‘The nature of the child’s tie to his mother’, in which he attacked the cupboard love theory and suggested instead that infants become attached to their mothers, and mothers to their infants, not so much through learning as by instinct. Mothers and infants had no need to learn to love one another: they were innately programmed to do so from birth. The formation of mother– infant attachment bonds, Bowlby maintained, is a direct expression of the genetic heritage of our species.

The initial reaction to Bowlby’s paper was one of widespread condemnation, particularly from social scientists. What upset them was Bowlby’s use of the term ‘instinct’ and the readiness with which he borrowed concepts from the relatively new science of ethology (the study of behaviour patterns in organisms living in their natural environments) and applied them to human psychology. But he remained adamant that such comparisons between different species were biologically justifiable; and in attacking the cupboard love theory he was able to cite many examples from the ethological literature of the existence of strong infant–mother bonds which had been formed through mechanisms bearing no relation to feeding gratification and which developed in the absence of any conventional rewards such as those postulated by the learning theorists. This was corroborated by Stevens (1982) who, in a study of Greek children raised in an orphanage, found that a substantial proportion of them became primarily attached to nurses who had cuddled and played with them but seldom fed them.

One of the most influential ethological texts, The Study of Instinct by Niko Tinbergen, was published in 1951. In it Tinbergen proposed that every animal species possesses a repertoire of behaviours. This behavioural repertoire is dependent upon structures evolution has built into the central nervous system of the species. Tinbergen called these structures innate releasing mechanisms, or IRMs. Each IRM is primed to become active when an appropriate stimulus – called a sign stimulus – is encountered in the environment. When such a stimulus appears, the innate mechanism is released, and the animal responds with a characteristic pattern of behaviour which is adapted through evolution to the situation.

Although no one made the connection at the time, Tinbergen’s position was very close to Jung’s view of the nature of archetypes and their mode of activation. A mallard duck becomes amorous at the sight of a mallard drake (the green head being the sign stimulus that releases in her central nervous system the innate mechanism responsible for the characteristic patterns of behaviour associated with courtship in the duck), and a ewe becomes attached to her lamb as she licks the birth membranes from its snout. In the same way, Bowlby argued, a human mother presented with her newborn infant perceives its helplessness and its need for her care, and during the hours and days that follow is overwhelmed by feelings of love, attachment, and responsibility. Bowlby, like Jung, held that such patterns of response had been prepared for by nature. As Jung himself insisted, the archetype ‘is not meant to denote an inherited idea, but rather an inherited mode of functioning, corresponding to the inborn way in which the chick emerges from the egg, th...

Table of contents

• Cover
• Title
• Copyright
• Dedication
• Contents
• List of illustrations
• Preface to the classic edition
• Foreword to the classic edition
• Preface to the first edition
• Preface to the second edition
• Acknowledgements
• PART I Evolutionary psychiatry: an introduction
• PART II Disorders of attachment and rank
• PART III Borderline states
• PART IV Spacing disorders
• PART V Reproductive disorders
• PART VI Dreams, treatment, research, and the future
• Glossary
• Bibliography
• Index