Evolution has equipped people for a world very different from the one they now inhabit
field is confused. You know that, right?” The patient who delivered this parting shot had a perpetual knot in the pit of her stomach. She had lost interest in everything, was anxious, irritable and nauseous, and struggled to sleep. Her family doctor had told her it was “nerves”. A psychotherapist asked about sexual feelings in childhood for her father. A psychiatrist offered drugs to fix what he said was a chemical imbalance in her brain.
Randolph Nesse, now of Arizona State University, cites that encounter in his fascinating book to illustrate why he has spent his career studying the evolutionary roots of mental illness. Though doctors who treat physical ailments do not routinely refer to evolution, their theories about bodies are based on the fact that humans, and the pathogens that afflict them, are the product of aeons of natural selection. Disorders are defined by comparison with normal functioning.
In Dr Nesse’s definition, “specialised states that…increase the ability to meet adaptive challenges” constitute normal emotions. They are experienced as positive or negative because only situations containing opportunities or threats affect evolutionary fitness. A negative emotion may be just as evolutionarily useful as physical pain. A depressed patient’s low mood, for example, may result from his realisation that a major life project is sure to fail.
When it comes to doctoring the body, you have to go back to the 19th century to find a time when the theories were baseless and the treatments often harmful . For doctoring the mind, as Anne Harrington’s fine history of psychiatry shows, that point is much more recent. In 1949 a Nobel prize went to the Portuguese inventor of the lobotomy, an operation intended to sever the “worry nerves” of the brain.
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