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....