Randy Nesse Profile picture
Feb 12 18 tweets 7 min read
On #DarwinDay it is wonderful to anticipate the fast progress coming to psychiatry as it discovers its missing foundation in evolutionary biology.
@isemph @HumBehEvoSoc @AllenFrancesMD @mentaldaily_com @Got_Anxiety @sse_evolution @eshb @RiadhAbed1 @PFinuras @APAPsychiatric
The day between #DarwinDay and #ValentinesDay gives an opportunity to respond to questions about
what #evolution offers to #psychiatry and
why I think it will bring fast progress.
Painful emotions, especially anxiety & depression, are by far the most common reasons people seek help. An evolutionary perspective recognizes emotions as special states shaped by natural selection along with control systems that express them in situations where they are useful.
But evolved control systems often give rise to useless bad feelings because:
- false alarms are normal given the smoke detector principle
-natural selection maximizes reproduction at the expense of health, and
-we live in environments very different from our ancestors.
Recognizing that emotions are usually symptoms, not diseases, will make psychiatry more like the rest of medicine. This should resolve some controversies that have made psychiatry look silly, and it should lead to new research approaches and better treatments.
Out of control behaviors such as addiction and eating disorders are the next most common reasons people seek help. Instead of just asking what is wrong with individual patients, an evolutionary framework asks why we all have brains that make us vulnerable.
Novel aspects of modern environments — readily available food, alcohol, drugs and mass media — initiate vicious cycles in control systems that evolved in very different environments. This is only the beginnings of a full explanation for our shared vulnerability.
Severe disorders such as schizophrenia, autism and bipolar disorder are highly heritable. When the genome was first sequenced we hoped to find a few specific genetic culprits. But most of the heritability results from thousands of common alleles, each with only a tiny effect.
We also hoped that finding genetic causes would lead to better diagnostic categories. But the genetic variants that cause one disorder turn out to also cause other disorders. What a disappointment!
Evolution-minded researchers have speculated that disease-associated alleles might persist because they offer advantages. But evidence against this hypothesis is growing, with the possible exception of bipolar disease.
It is increasingly clear that psychiatry’s dominant paradigm is wrong. We hoped to find specific genes causing specific brain abnormalities that would define and account for specific mental disorders. But a growing mountain of evidence is inconsistent with this model.
I suspect that some systems may be intrinsically vulnerable to failure because of their complexity, their interdependency on other systems, or because selection acting strongly on path-dependent massively pleiotropic systems creates new problems. But this is just my speculation.
Why be optimistic that psychiatry will make fast progress as it brings in evolutionary biology? One reason is the history of animal behavior research. It was transformed by the adoption of an evolutionary framework.
Another reason is the growing number of researchers working to understand why natural selection left us vulnerable. I describe much of their work in my book on evolutionary psychiatry.
goodreasons.info
Another reason is the pending June, 2022 publication of a Cambridge University Press book on evolutionary psychiatry edited by @RiadhAbed1 and Paul St. John Smith for the Royal College of Psychiatrists. It will be a landmark.

cambridge.org/core/books/evo…
In summary, there are good reasons to think that putting psychiatry on the same evolutionary foundation as the rest of medicine and ethology will lead to rapid progress.
But patience will be necessary. Physiology and genetics worked for decades to explain diseases before they became useful for prevention and treatment. Also, new fields are prone to excess enthusiasm and premature clinical applications.
Goodwill and good humor from those with different areas of expertise will be crucial. Global praise or condemnation of the entire enterprise is an obstacle to be avoided. Progress will come from assessing specific hypotheses one by one.

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More from @RandyNesse

Jan 19, 2021
#Antidepressants seem effective in the clinic but not in controlled studies. Why? Let’s consider all possibilities. @PeterDKramer @AllenFrancesMD @DrHowardLiu @DalackMd @blackdoginst @NAMICommunicate @Got_Anxiety @EikoFried @PsychTimes @matthewckeller @RiadhAbed1 @APAPsychiatric
Most of us who have prescribed antidepressants for thousands of patients have heard hundreds of them report transformed lives. “It is as if I walked out of a dark room into sunlight” “All of a sudden I can experience pleasure again”
But perhaps the effectiveness is an illusion. The improvement of patients taking #placebo is barely better than that for those taking antidepressants.
Here are 10 reasons why antidepressants
->Could seem effective when they are not, or
->Could seem ineffective when they are
Read 18 tweets
May 20, 2020
The flood of articles offering “Quick tips for controlling your Covid anxiety” makes me nervous. After 30 years treating patients in one of the first specialty clinics devoted to anxiety disorders, I should have super advice, right? Not really, but here are 6 observations. Image
Quick tips can help but they can be worse than useless. Exercise, eat right, get sleep, talk with friends, and challenge negative thoughts. Like diet suggestions, they can help, but they can be hard to follow, ineffective, or prone to make some people feel like failures.
Some articles advise readers they MUST control their anxiety to avoid heart disease and cancer. There is hardly any evidence that anxiety directly causes medical illness but worry about that can initiate a vicious cycle that turns ordinary anxiety into a serious problem. Image
Read 8 tweets
May 31, 2019
Starting June 1, I will tweet a chapter each day from my new book goodreasons.info about how the light of evolutionary biology can dissolve the mists that swirl around mental disorders. Well, some mists for some disorders. @DuttonBooks @hbes2019 @LondonEvolution @ISEMPH
From the Preface: I wanted to write this book as soon as I realized that evolution could explain why bodies are vulnerable to disease. But the rest of medicine had to come first. Why We Get Sick stirred lots of interest. The new book is about why mental illness exists at all.
For each chapter I address the question, "So what?" Saying what is true changes only views unless it also changes what people do. Mental health clinicians who understand evolution do their work differently and better. For all others, self-understanding is valuable in itself.
Read 87 tweets

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