Good Reasons for Bad Feelings - Randolph M. Nesse

Part One: Why Are Mental Disorders So Confusing?

1. A New Question

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

• Field of psychiatry → narrowing to perspective that “mental disorders are brain diseases,” but need to also consider insights from behaviorism, psychoanalysis, cognitive therapy, family dynamics, public health, social psych
  • Cannot diagnose by neurological of genetic factors
• When considering evolutionary explanations, important to address four questions: What is the mechanism? What is its adaptive significance? How does it develop in an individual? What is its evolutionary history?
• Diseases are not adaptations, but our vulnerabilities to disease have evolutionary explanations
• New question about how natural selection leads to things like mental illness → similar to the classic question of why life is so full of suffering
  • Usually because sources of mental pain (anxiety, depression, etc.) are useful in some situations
  • Leads to similar question of how we can experience things like love and morality if we are only driven by natural selection?

2. Are Mental Disorders Diseases?

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

• Mental disorders more like clusters of symptoms
• Many people with same diagnoses → different symptoms; one person with a set of symptoms → diagnoses… do our definitions of disorders even correspond to “real” things?
• Benefits of moving towards truly medical model of disease in psychiatry → 1) not viewing symptoms (ex. negative emotions) as disease) 2) recognizing that many syndromes have dozens of cause (ex. heart failure, autism), 3) diagnosing conditions with no specific tissue pathology, but rather a dysregulated control system (ex. eating/mood disorders)

3. Why Are Minds So Vulnerable?

• Natural selection shapes us to maximize number of offspring who survive to reproduce themselves— not necessarily health, longevity, mating
  • Genetic variation that decrease a n individual’s fitness can still become more common if it benefits relatives with the same genes → kin selection explains some altruistic behavior

Six evolutionary reasons to explain vulnerability to diseases:

1. Mismatch: our bodies are unprepared to cope with modern envt (esp availability of plentiful food)
2. Infection: bacteria and viruses evolve faster than we do
   • Well-intended practices like taking full antibiotic course can actually promote resistance
3. Constraints: natural selection can only act on existing variation, cannot shift to new strategy once a path is chosen
4. Trade-offs: everything in the body has pros and cons
5. Reproduction: natural selection maximizes reproduction, not health (ex. testosterone → males have more success at reproduction but also die sooner than females)
6. Defensive responses: responses like pain and anxiety are useful when facing threats
   • Can summarize as: 1 & 2 → our bodies evolve too slowly to keep up with changing envt; 3 & 4 → natural selection just can’t do certain things; 5 & 6 → misunderstandings about what natural selection shapes
   • Key question: why did natural selection shape traits that make us vulnerable to diseases?

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Part Two: Reasons for Feelings

4. Good Reasons for Bad Feelings

Emotions were shaped to cope with situations (not for distinct functions).

• More like modes of operation or programs that increase our ability to cope in situations, rather than parts of a machine or system
  • Specialized states that adjust physiology, cognition, subjective experience, facial expressions, behavior
  • Emotion don’t have to involve subjective feeling → assuming so can lead to missed diagnoses (ex. someone who’s tired, unmotivated, but doesn’t report feeling sad may be having the emotional experience of depression)
• Work of Lisa Feldman Barrett → psychological construction view of emotions is consistent w evolutionary view
• Mapping emotions to categories of situations/goals (which are extremely complex for humans!):
• Lots of focus on excess negative emotions and absence of positive ones, but also important to study the other diagonal cases

5. Anxiety and Smoke Detectors

Useless anxiety can be normal (Smoke Detector Principle).

• Smoke Detector Principle: systems regulating protective responses like vomiting, anxiety → turn on response whenever benefit > cost, even if that leads to false alarms
• Reason we have anxiety → more likely to escape dangerous situations and avoid them in the future
• People with too much anxiety are common… what about too little (hypophobia)? Often found in extreme sports, on creative frontiers, battlegrounds, political movements… and prisons, unemployment lines, etc. (but rarely anxiety clinics)
• Predisposed to have phobias of certain things (heights, animals, injury, etc.)
• Panic disorder, PTSD, GAD, etc. can be thought of as excessive panic responses
• Evolutionary perspective can improve how we treat and understand anxiety disorders
  • Use personalized assessment of causes of individual’s anxiety to guide tx (genetic & physiological causes → psychological tx, life situations → meds)
  • Insights into how different tx work— affecting systens

6. Low Mood and the Art of Giving Up

Mood adjusts behavior to the propitiousness of the situation → reallocated investments of time, effort, resources, risk-taking to maximize Darwinian fitness

• How to distinguish pathological from normal depression? When is grief from a loved one’s passing considered too much?
• When/how is low mood useful?
  • Signaling for attention, as in mother/child relationship
  • Signal submission after status loss to yourself and others → avoid attack
  • Think more deeply about your problems
  • Adjust energy to potential gain from a situation (propitiousness)— helps you make decision of how much effort to put into an activity, when to stop, and when to move on
  • Immune responses → depression to help conserve resources
  • Depressive realism → low mood makes ppl more realistic
• Low mood/depression often signals a deep recognition that you’re pursuing a major goal that will never work; if you can’t give it up, can get trapped in cycle of severe depression
  • Irony = hope is often at the root of depression
  • Animal models of depression (and antidepressants) = rat giving up on swimming, learned helplessness in dogs being shocked → actually might be a more adaptive choice to “give up” when faced with persistent challenge to conserve energy
• Similarly, tendency from of high mood = to “broaden and build,” invest more resources
• Mood is influenced most by rate of progress towards a goal, not success or failure → remarkably stable for most people
• Why does low mood feel so bad? Perhaps to motivate us to avoid similar situations in the future (like physical pain)
  • Also as with pain: all this doesn’t mean depression shouldn’t be treated; rather that the cause should also be sought while relieving suffering

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

Moodostat failures cause serious diseases.

• Critical to understand origins and fx of normal mood to understand mood disorders
  • Research and tx on mood disorders often ignore role of life situations, prone to fundamental attribution error
• Why is viewing symptoms as disease (VSAD) so common in psychiatry?
  • Many serious disorders do result directly from broken regulatory mechanisms (bipolar)
  • Patients often wrongly attribute symptoms to life events → over correct for this
  • Sometimes important events not disclosed by patients off easy to miss
• Why has natural selection left mood regulation so vulnerable to dysregulation?
  • Fitness advantages of ambition (not just for money, but for acceptance, etc.)
• Impossible to attribute mood disorders to just genetics, life events, or personality → must consider complex intx btw them all
  • Likewise: tx can change the situation, the view of the situation, and the brain → need to address all three
  • (Not addressed here but important to learn more about = role of past events/early experiences in mood disorders)

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Part Three: The Pleasures and Perils of Social Life

8. How to Understand an Individual Human Being

An individual’s emotions and actions only make sense in context of their life goals and projects.

• Nomothetic (generalizations) and idiographic (narratives) explanations— how to incorporate them both?
  • One framework = Review of Social Systems (ROSS) to identify sources of emotional symptoms: briefly evaluate each realm of SOCIAL resources: social, occupation, children/family, income, abilities/appearance/health/time, love/sex
  • Different people → different patterns of resource allocation (can graph as network)

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

Preferred partners get advantages → morality is possible and adaptive → social emotions like guilt and sadness have reasons

• View of human nature most promising for psychological health = “people can be good or bad, depends on the situation”
  • Whatever a person’s beliefs are, they are very self-sustaining
• How to explain altruism and moral behavior in the context of natural selection and evolution?
  • Most altruistic behavior → benefits kin with same genes, just happens to help the individual along with others, supports reciprocal favor trading
  • Additional explanations offered by 1) cultural group selection, 2) commitment, 3) social selection
  • (Note on group selection: not much evidence that this occurs, except for cases where the “individuals” are genetic clones, like aspen trees… or cells in a human body)
  • Social emotions → help us deal with situations involving cooperation (symbiotic or mutualistic exchanges)
  • Still, these factors don’t explain more extreme examples of prosocial behavior in humans (committed relationships, worrying about pleasing others, sacrificing yourself for a cause)
  • Commitment → stronger relationships than those built just on reciprocity, bc provides help at times when you may have less to give
  • Partner selection and rejection → may select for actual altruism— a display trait like a peacock’s feathers; non-random allocation of “altruism” genes similar to domestication of dogs
• Grief and sadness: does it serve a purpose, or is it “the price of love”?
  • Perhaps evolved as responses to people going missing, creating desire to find out what happened (thus learning about threats to avoid)
  • Explains the hyper-awareness of reminders of people that we lost— served as “search image”

10. Know Thyself—NOT!

Repression and cognitive distortions can be useful, and too much or too little can be dysfunctional.

• Repression of unwanted emotions, memories, desires is real → question is what leads to certain things being kept out of our conscience?
  • Listening to free association (your own or someone else’s) → showcases unconscious influences on our thoughts
  • Cases of implicit bias and “nudges”
• Self-deception evolved to make us beter at deceiving others → explains some but not all of case
  • Other benefits → minimize distraction from constant upsetting thoughts
  • Potentially keeping unsatisfiable desires at bay = major function of repression
• OCD = failure of repression → extreme objectivity and conscientiousness; shows how disruptive these high expectations can be to social relationships, ability to make decisions
• Central trade-off between actions that give short-term personal pleasure at long-term social cost and those that inhibit immediate selfish motives to get social benefits later
  • Humans → more able than many species to inhibit impulses via repression, making cooperation and commitment possible

  • Highlight two pathways to mental disorder, supported by genetic studies:

    1) Internalizing (inhibition, anxiety, self-blame, neurosis, social selection worked too well)

    2) Externalizing (pursuing self-interest with little inhibition → social conflict, addiction)

• Though repression served & serves evolutionary advantages in many ways, also makes us vulnerable to tribal thinking, polarization

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Part Four: Out-of-Control Actions and Dire Disorders

11. Bad Sex Can Be Good—for Our Genes

Sexual problems are common for good evolutionary reasons… ex:

• Choosiness for partners is great for natural selection, but in modern times (esp with media) leads to tons of time being taken up judging, being judged, preparing to be judged
• Tendency of men to interpret small friendly gestures as sexual invitations = extension of Smoke Detector Principle

12. Primal Appetites

Positive feedback loops underly most eating disorders

• Many genetic, societal factors leading to obesity epidemic → what is different about people that can maintain a normal weight?
  • Systems that evolved to regulate hunger, protect vs starvation much stronger than those protecting against excess body weight
• Why do we all have eating regulation mechanisms so vulnerable to dysregulation?
• Eating disorders caused by normal genes intx with abnormal envt
• Possible evolutionary benefits of eating disorders? Most possibilities (fleeing famine, sexual competition, etc. are examples of Viewing Diseases as Adaptations… they are not.)
• Living in a world rich with social resources can cause analogous problems with social media and status to eating disorders

13. Good Feelings for Bad Reasons

Substances hijack learning pathways → addiction

• Why are members of our species are so vulnerable to addiction?
  • Alternative to asking why certain people get addicted, or what brain mechanisms are implicated
  • Root causes involve capacity for learning— drugs that can imitate or increase dopamine
  • More of a problem in modern times bc availability of purified drugs, new methods of administration that make reaction stronger (ex. coca leaves vs cocaine)
• Addiction often more centered around desire than pleasure

14. Minds Unbalanced to Fitness Cliffs

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

• Schizophrenia, autism, bipolar disorder → similar class of disorders: affect ~1% population each, with milder forms affecting 2-5%
• Strong genetic components → why have these traits survived?
  • Also dependent on stochastic events during development— little evidence of link to external environment
  • Result from complex intx from thousands of genes, rather than specific pathways
  • Contribution of new mutations? (Older parents)
  • Perhaps arise from intrinsic constraints on information processing in human brain
  • Preservation of alleles that increase vulnerability due to other benefits (verbal skills, etc.); also alleles that increase fitness early in life but cause disease later (like some related to Alzheimer’s) → “another tragic example of how we were shaped for reproductive success at the cost of health”
• Could be examples of traits at the edge of a fitness cliff (ex. natural selection has pushed it to the max beneficial level, which is not a middle ground but an extreme, like thin cannon bones in racehorses) → statistically, distribution of the trait has some people beyond ideal

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Epilogue: Evolutionary Psychiatry: A Bridge, Not an Island

How using all this biology can integrate psychiatry → help make sense of mental illness

• VDAA comes naturally, but is the biggest flaw in reasoning
• Metaphor of thin string pulling stronger string pulling a rope pulling a cable to make the bridge across the Niagara (how this book is bridging the gap between evo biology and psychiatry)