Every so often we come across a piece which takes conventional wisdom and then turns it on its head so logically that we end up asking ourselves “why didn’t I think of that?”. This piece by Justin Garson – professor of philosophy at Hunter College and the Graduate Center, City University of New York – falls in that category. Garson says that the public at large and the medical profession misunderstands and misdiagnoses “mental illness”.

Garson takes us back to when he first realised that the medical profession has not quite figured out mental illness: “…as a grad student in philosophy, I stumbled upon the book Why We Get Sick: The New Science of Darwinian Medicine (1994) by Randolph Nesse, a physician, and George C Williams, an evolutionary biologist. They argued that real progress in medicine won’t happen until we look at health and disease in terms of the big picture of evolution. When we do that, conditions that we’ve long considered to be diseases can turn out to be adaptations. That is, we can see them as shaped by natural selection because of an advantage they gave to our ancestors. They’re functional, not dysfunctional.
Think about fever. From ancient Greek times through to the Middle Ages, many doctors ‘knew’ fever was a disease – a ‘heat contrary to nature’ as Galen put it. The only question was how to destroy it before it destroys you. But then in the 18th century, the German chemist Georg Stahl advanced a brilliant insight that is universally accepted today. Rather than being a disease, what if fever is actually the body’s healing response to infection?

Seeing fever as functional, not dysfunctional, didn’t mean you stopped treating it. Rather, it transformed the character of treatment. Fever was no longer the thing you’re trying to attack, to stifle, to pummel with medications. Instead, you recognise that the fever has a role to play in the healing process. The purpose of medicine is to comfort the patient and curb fever’s excessive manifestations.”
After explaining how doctors mistreats people like his father (who had bipolar disorder) with hospitalisation, antipsychotic medication, blood tests, etc, Garson explains how Nesee & Williams’ Darwinian insights helped him see mental disorders in new light: “In their book, Nesse and Williams advanced the hypothesis that some mental disorders, such as depression, also have an evolved function, just as fever evolved to fight infection, or calluses evolved to protect the skin from friction. But what could possibly be the evolved function of depression? From extremely low moods, to lack of sleep, to chronic feelings of worthlessness or guilt, all the way to thoughts of, or attempts at, suicide, depression seems to fall clearly on the dysfunction side of the fence.

In later work, Nesse argued that depression is sometimes the brain’s evolved signal that something in a person’s life needs to change, such as a harmful relationship, an unrealistic career plan or a goal that needs to be re-evaluated. What that means in practice is that it’s not always best to bombard depression with medication. Sometimes, it’s better to figure out what depression is trying to say. The theory that depression is an evolved signal doesn’t ignore the fact that depression often has a tragic outcome. Nesse and Williams’s core point was that we can no longer take the dysfunction paradigm as the silent default when treating depression.”

This insight helps Garson not only re-interpret Sigmund Freud’s work more positively (“his most important idea wasn’t the Oedipus complex (which nobody believes in anyway), infant sexuality, or the death drive. Rather, it was the idea, which drove his life’s work, that each form of what he called ‘madness’ has a special function, just like fever or calluses”), it also helps Garson explain why in the current time the field of Darwinian medicine has exploded: “In the nearly 30 years since the publication of Why We Get Sick, the field of Darwinian medicine has exploded. Today, there are numerous textbooks, university courses and scholarly articles on the topic. Evolutionary psychiatry in particular is witnessing a flurry of interest. In the past eight years, three textbooks on the subject have been published, each drawing on hundreds of scholarly articles…

Evolutionary psychiatry doesn’t insist that all mental disorders have evolved functions. For instance, Lewy body dementia, which affected the actor Robin Williams, can lead to depression and personality change, which can be traced to a build-up of misfolded proteins in the brain. But the evolutionary approach has revealed at least three ways that various mental health ‘disorders’ might actually be functional: some represent evolved responses to current crises; others, evolved responses to past crises; and still others, evolved cognitive styles. The real value of thinking of mental illness in terms of function isn’t to destroy the dysfunction paradigm, but to show why it can no longer serve as the default starting point for all psychiatric thinking and practice….
…trend in evolutionary psychiatry is to see certain disorders, such as dyslexia, as evolved cognitive styles, rather than dysfunctions. The conventional biomedical perspective sees dyslexia as a disorder of reading and writing that stems from a brain dysfunction that hurts our ability to match sounds and shapes. However, emerging evidence from archaeology, neuroscience and cognitive psychology suggests that dyslexia is actually a distinct cognitive style in its own right, with its own strengths and benefits.

Consistent with the evolutionary perspective, people with dyslexia often have a ‘big picture’ grasp of their environment. For example, they’re quicker to notice when a work of art represents an impossible figure, such as M C Escher’s Waterfall (1961). They also excel at ‘divergent thinking’, the ability to come up with multiple solutions to the same problem.”

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