Saturday, August 14, 2010

Theory of Mind and Evolutionary Psychiatry

We are human because we are social.  There is some debate as to why we became quite so social, but the predominant theory is that when we left the forests for the savanna, a larger group offered better protection from predators.  Living in large groups (on Facebook and elsewhere we tend to have 150 people we keep fairly decent track of) required many changes in our brains that no primate had needed before.  We were required to understand from another person's point of view, not just empathy, which is understanding how another feels and is common to all primates and many animals, but actually be able to picture ourselves in someone else's dirty bare feet and figure out what he or she would do, and why.  Understanding the intentions and dispositions of others and reflecting upon our own mental state is vital for survival in a large group.  We developed moral codes, social rules, and language.  Language is most interesting because quite a bit of our speech is not plain, but metaphor, requiring years of learning to understand the context and the culture.

The size of the neocortex relative to body size in primates is directly related to the usual size of the family group or tribe of that kind of primate.  We have the biggest neocortex, and the biggest tribes.  The only exception to this rule is gorillas, who live in relatively small groups, but have rather large brains.   The size of the neocortex is also directly proportional to the lifespan of primates - we have the longest.  The size of the social group of primates is also directly correlated with the length of time we are considered "juvenile," and in humans, that extended period of youth means that we are also selected for longevity, with a post-reproductive lifespan of several decades (1).

Deception requires understanding the "theory of mind" in another.  Self-deception may be the most advanced trait of all (right up until it becomes a little too much self-deception) - as someone who has no understanding of their own unacceptable wishes will appear to be more trustworthy and sincere.  

Evolutionary Psychiatry was born because I want to figure out how to heal.  I know how to make symptoms better.  I spent eight years in medical school and residency learning how to make symptoms better.  But the population is getting sicker and sicker, and the only reasonable theoretical paradigm I could find to explain the core dietary and psychological problems was an evolutionary one.  I have no interest in self-deception, however temporarily adaptive it may be.

There is an excellent evidence-based textbook for Diet and Western Disease (Food and Western Disease: Health and nutrition from an evolutionary perspective), but Dr. Lindeberg makes no reference to psychiatric issues in his book that I recall.  Most evolutionary psychiatry texts (such as Textbook of Evolutionary Psychiatry: The origins of psychopathology) have quite a bit of biology, but are, frankly, more psychologically oriented. 

One cannot ignore psychology.  It can outflank biology sometimes, it takes years to master, decades to perfect, and I use it every single day at work.  But biology usually has the upper hand.  And what are we doing, anyway, merely sending people off to get coping skills when their neurons are starving for cholesterol or omega 3 fatty acids or zinc or magnesium or serotonin or dopamine?  The growing biological evidence is that much of mental illness is autoimmune in nature.  I noted in a previous post that therapy is anti-inflammatory, but we have so much knowledge and so many tools.  No one gets to my office without going through a great deal of suffering - would you ever seek out the help of a psychiatrist if you didn't absolutely have to?  Everyone deserves a full-spectrum approach.

I looked at a number of popular press "food and mood" type books out there.  Check out the top ten on Amazon, and I assure you, I have read them all.  While many have some interesting information, they all have serious limitations and are, for the most part, scarcely evidenced-based.  The best two are Primal Body-Primal Mind: Empower Your Total Health The Way Evolution Intended (...And Didn't)and Depression-Free, Naturally: 7 Weeks to Eliminating Anxiety, Despair, Fatigue, and Anger from Your Life, but both leave you with the feeling you need 20-40 supplement pills a day just to make it through, and the latter has a whole section on the ridiculous "blood-typing" diet that has been thoroughly debunked, seriously straining the credibility of the entire book.  That's not good enough for me, or for my patients.  My goal is to present credible, practical, evidenced-based information day after day.

Our ancestors ate food, not supplements.  On a public health level, I'm trying to get away from supplements as much as I am trying to decrease the need for prescription medications.  I blog about interesting medicines and supplements because it teaches me the biochemistry and the connection to dietary vitamin deficiency or inflammation.  On a personal level, supplements and medications may be efficacious.  But understanding supplements is not my mission. 

Five years ago I could not have done this.  I have a toe in academia, but scarcely a toe.  I have a busy practice, the responsibilities of a business, two very young children and a husband and no ability to visit the physical medical library more than a few times a year.  I have no research assistants other than you, the blogging community.  And yet there is no moral excuse for not writing this blog.  I need to know how to heal, and I've trained for too long and know too much to be satisfied with merely mitigating the symptoms.  A wonderful therapist is an invaluable person, but his or her special gift is to allow and to facilitate others to figure out their own path - "don't just do something, sit there."  I have only a limited capacity to do therapy, as I am always trying to "do."  Perhaps it is youth, hubris, or naivete, but I would really like to heal. 

We are human because we are social.  Online access and a wonderful, worldwide educated community actually interested in this ridiculous little niche of evolutionary psychiatry has made this blog far better than it would have been with my own resources and knowledge.

Please, keep commenting.  Please challenge and question.  Being social makes us human.  Knowledge and education may save our humanity.

And for my weekly conceit - Delibes, the Flower Duet from Lakme....

11 comments:

  1. Lovely Post. I'm from New Zealand, and if I ever need a shrink, the first thing I'll do is save for the airfare to Massachusetts. Jayne

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  2. Hi Emily

    Some interesting things in this paper if you haven't already seen it:

    http://www.scielo.br/pdf/bjmbr/v31n12/3323c.pdf

    Food, Mood, & Health: A neurobiologic outlook

    Jamie :)

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  3. i frikin loved this....especially the part about food...we need food, good food...and life usually falls into place a little easier. good food* that is!!!

    until i took down copious amounts of downright paleo mass quantity food i had no desire to be social, no desire to state my opinion, no desire to LIVE...theres SO MUCH to debate about to talk about and to love about its amazinG!!!!!

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  4. "The growing biological evidence is that much of mental illness is autoimmune in nature. "

    I'm interested in hearing more about this.

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  5. Hi Jamie - thanks for the link! I read it and there is a post brewing - also left a comment on your site.

    Hi malpaz - yeah, life is crazy interesting, no? I'm so gad you are able to enjoy it now.

    Hi Jin. Autoimmune = unwelcome and out of whack inflammatory response, and it has turned out to be a major theme in my blog ( as it would with any paleo blog). Some of my posts that talk about the actual biochem include Depression crashed your party and Lithium and inflammation. A bunch of others also talk about it. Thanks for the comment!

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  6. Hunter.family - I'm sure there are many fantastic psychiatrists in New Zealand. But thanks for the vote of confidence!

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  7. Hey Emily

    This such a huge endeavour - by which I mean trying to construct a paleolithic psychology, never mind a pathology of same. Do you SERIOUS want to get involved in the new War of the Roses vs Pinker, Tooby & Cosminides !!! ? ? ?

    Now the use of Diet, along the lines of what Jamie Scott's contributions is much more realistic, and can do a lot of good.

    Some 15 years, as part of a Health Screen, I took a quick Psych Profile, which did have 2 major depressive symptoms. Treatment was some Weekly Talk Therapy, good ol' Prozac, PLUS my own extra, which was to start serious jogging. My simple conclusion was: Talk Therapy - Blah, tell me something I dont know; SSRI, noticed NOTHING; but after a month of running, reaching about 30 miles/week, my physical condition was great, and mood was excellent. I concluded the new paradigm should be Somato-Psychic rather than Psycho-Somatic. Upregulation via physical activity rather than other way round!

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  8. Hi Leon. I'm not exactly sure what you mean, but my exploratory contributions will, I hope, be primarily dietary. As for exercise, my number one recommendation and cure! But have you ever tried to get a bunch of deeply depressed and fatigued individuals to exercise?

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  9. Emily, I found this passage particularly interesting: "And what are we doing, anyway, merely sending people off to get coping skills when their neurons are starving for cholesterol or omega 3 fatty acids or zinc or magnesium or serotonin or dopamine?"

    I have been trying a supplement called ZMA recently which contains Zinc, Magnesium, and B6. Like most users of ZMA report, I have experienced markedly more vivid dreams and the ability to recall them very clearly after waking. As well, my sleep seems to be much deeper.

    Could you possibly elucidate on this Zn/Mg brain connection?

    Thanks!

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  10. Hi David - sleep is a huge and mysterious subspecialty. I'm very interested though and will look into it.

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  11. Count me in your group of supporters. I am 70 years old with a history of IBS (extreme) and a 15 year tour of psychotherapy. Also carbon dioxide therapy, electro shock, LSD, magic mushrooms, all of the early psychoactive drugs, marijuana, allergy shots, B-12 shots, peyote, and more. My troubles started with a ruptured appendix (unattended for 2 days), (a near death experience) at age 15. My life and body (immune system) changed forever. I developed psoriasis, ankylosing spondylitis, food and chemical sensitive's, along with a strong aggressive behavior, (jailed a few times), alcohol over use and depression. I assumed I would not live to 30 years old. Yet I am still here, after retiring, started reading health blogs 2 years ago. Most of what I found that helped me survive and grow over the years was by trial and error. The school of very hard knocks.

    I have been grain free for decades, low carb, (high saturated fat) for 10 years, and supplementing D3 for 3 years. I hope I can share what has worked for me as I work my way through your blog from start to current. So far you seem spot on, as far as what has worked for me. You are on to something very big, a cure which I mostly have found for myself, is possible, but it takes a guide or a very strong personality to find the right path. A path that I call, a "Path with Heart". Keep up the good work.

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