Evolution & Psychiatry: A Career Long Passion
A special commemorative article for our first anniversary in which I interview my mentor and the co-founder of this Substack - Prof. Henry O'Connell
It was an absolute pleasure to sit down with Henry and interview him for this very special article which commemorates the Evolution & Psychiatry Substack’s first year since its inception on May 5th, 2023 with “What is Evolutionary Psychiatry?”:
What is Evolutionary Psychiatry?
Evolutionary psychiatry seeks to blend the theory of evolution with current understanding of mental disorders. It has it primordial roots in ethology and biology, furthered by evolutionary psychology and medicine, which are gaining much traction in recent times (
Henry you have been pivotal in my academic development over the last few years and I am ever grateful for your continued mentorship. It’s a real pleasure to sit down with you and talk about your journey. So without further ado, please introduce yourself for those who don’t know you!
Thank you, Gurjot. And congratulations on the Substack and happy one year anniversary! Your Substack has been one of the most important contributions to the field of evolutionary psychiatry over the past twelve months, providing beautifully designed articles on all aspects of evolution and psychiatry that are accessible to novices, longstanding enthusiasts and experts alike.
Regarding myself, I graduated in Medicine from Trinity College Dublin in 1997 and, following my internship in St James’s Hospital, I went on directly to psychiatry training as that had been my passion and focus throughout medical school. I completed basic specialist training in the Dublin region, a research fellowship in Old Age Psychiatry in Mercer’s Institute for Successful Ageing and then returned with my wife Kathy and our young family to my home village in Tipperary to complete my higher specialist training in the Mid-West region.
Dual qualified in Old Age and General Adult Psychiatry, I took up my first consultant post in 2008 in Portlaoise, initially in Old Age Psychiatry and then, from 2013 onwards, in General Adult Psychiatry.
Some career highlights along the way have included completion of a Masters in Medical Education with the University of Galway, a Medical Doctorate on delirium research with the University of Limerick (UL) and my appointment in 2014 as a Clinical Professor with the latter institute, with which I have developed a clinical teaching programme for medical students.
I have researched and published widely on aspects of all major psychiatric conditions including dementia, delirium, schizophrenia, mood disorders and autistic spectrum disorders. With UL colleagues I co-authored ‘Problem-based psychiatry’ in 2020 and I have also published my own textbooks, ‘Becoming a psychiatrist’ (2022), ‘Evolution and Psychiatry: clinical cases’ (2022) and I am currently looking for a publisher for ‘Psychiatry: a visual guide’.
Henry, you work has been crucial in the development of Evolutionary Psychiatry, particularly in Ireland but how were you introduced to the field initially and what interests you specifically about evolutionary psychiatry?
My friend and colleague Dr Tom McMonagle takes the credit for this! After a long and busy day working together in St Patrick’s Hospital in Dublin in 1999, Tom asked if I had ever heard of the idea of ‘evolutionary psychiatry’. With the prophetic warning that it would change my life, Tom gave me my first introduction to the area in that conversation and advice on further reading. Because of the pressures involved in passing membership examinations, completing clinical training, various research projects and applying for consultant posts, the area was relegated to a background hobby of mine for many years.
Encouraged by my wife Kathy, I had my first publication on the topic in 2004, a letter on Darwin Day published in the Irish Journal of Psychological Medicine. I also made contact with the late John Price (co-author with Anthony Stevens of ‘Evolutionary Psychiatry’, the first textbook that I read on the topic) who kindly provided a bursary for me to travel to an evolutionary psychiatry meeting in Delmenhorst, Germany in 2011. There I met with John, Randolph Nesse, Martin Brune and may other important figures in the field of evolutionary psychiatry.
Thereafter, I was busy working clinically and developing a clinical teaching programme with UL, so evolutionary psychiatry remained a background hobby of mine, with a few contributions to the literature (Attachment disorders: an evolutionary perspective, 2007; 150 years of evolutionary theory, 2008; Alfred Russel Wallace (1823–1913): evolution and medicine, 2009) until 2019, when things really took off (but more on that later).
Regarding what interests me about evolutionary psychiatry, my initial answer to that question is, simply - everything! And before I proceed, I must state explicitly that evolutionary psychiatry is not some radical ‘anti-psychiatry’ school of thought. Instead, applying evolutionary principles to the study of mental health and illness compliments what we already know and do, but offers additional layers of meaning for patients, their families and for us as clinicians. The current ‘biopsychosocial’ model is somewhat jaded and philosophically limited. The development of an ‘evo-biopsychosocial’ model is much needed, a framework that views humanity as a long-evolved species (incorporating principles of phylogeny), that takes into account the importance of individual life-long development (ontogeny) and that breaks down the somewhat arbitrary divisions between the ‘bio’, the ‘psycho’ and the ‘social’.
Evolutionary psychiatry is not some radical ‘anti-psychiatry’ school of thought. Instead, applying evolutionary principles to the study of mental health and illness compliments what we already know and do, but offers additional layers of meaning for patients, their families and for us as clinicians.
Evolutionary psychiatry takes us beyond proximate or ‘how’ questions about mental health and illness to ultimate or ‘why’ questions, e.g. instead of just focussing on neurotransmitter models for mood disorders, the evolutionary perspective asks why we as a species are all so vulnerable to mood disorders in the first place and what are the normal underlying emotional mechanisms that go awry when we become unwell.
The evolutionary perspective also takes us away from the overly simplistic and unrealistic categorical approach to diagnosis and instead opens our eyes to the spectrumal nature of normal mental health and mental illness. The evolutionary perspective is therefore destigmatizing in that it encourages us to view all of humanity as sharing broadly similar characteristics, traits and vulnerabilities and thus argues against the ‘othering’ of those suffering with psychiatric symptoms and disability.
The evolutionary perspective is therefore destigmatizing in that it encourages us to view all of humanity as sharing broadly similar characteristics, traits and vulnerabilities and thus argues against the ‘othering’ of those suffering with psychiatric symptoms and disability.
There are also some direct clinical applications, such as Nesse’s ‘smoke detector principle’ that can be used in the treatment of anxiety and panic disorder. Clinical applications are my particular area of interest and the relative lack of direct clinical applications is an area of criticism of evolutionary psychiatry that I encounter all the time. This prompted me to write ‘Evolution and psychiatry: clinical cases’ which I published in 2022 and which, thanks to you Gurjot, is going through an overhaul with the chapters being edited and published again on your ‘Evolution and Psychiatry’ Substack. As you know, we are hopeful that these edited chapters will form a second edition of the textbook and that an organization such as the World Psychiatric Association may publish this. The textbook is a collection of clinical cases of hypothetical patients with various psychiatric conditions. With each case, basic principles of aetiology, epidemiology, investigations and management are outlined, followed by attempts to synthesize the information using an evolutionary framework.
Attention Deficit Hyperactivity Disorder (ADHD) - Clinical Case Series #1
Welcome to the first in a series of clinical cases, exploring common mental disorders through the lens of evolutionary psychiatry. A ‘problem-based learning’ (PBL) approach is taken with learning outcomes defined at the outset, followed by several clinical encounters with fictional scenarios, interspersed with theory r…
Delirium & Dementia - Clinical Case Series #4
Welcome to the fourth in our clinical case series, exploring common mental disorders through the lens of evolutionary psychiatry. A ‘problem-based learning’ (PBL) approach is taken with learning outcomes defined at the outset, followed by several clinical encounters with fictional scenarios, interspersed with theory respond…
The evolutionary perspective also has much to offer in how we design and interpret research findings, especially in the area of psychiatric genetics and the emerging science of epigenetics and in how we define ‘caseness’ of psychiatric disorders.
Because of the fundamental place of evolution as the bedrock science of biology, I am also very keen to raise awareness of the area generally and to introduce evolutionary teaching to schoolchildren, undergraduates and to clinical trainees in psychiatry and throughout medicine. I am working on different projects in this area at present, including the delivery of evolutionary psychiatry lectures for final year medical students at the University of Limerick. I’m also very excited to see that you Gurjot are focussing on awareness and education in evolution for your doctoral thesis at the University of Limerick, the first doctoral thesis on evolutionary psychiatry anywhere in the world, ever!
The evolutionary perspective also opens up endless opportunities for collaboration with individuals in diverse scientific areas, from palaeoanthropology to psychology and sociology, serving as a bridge between these areas of study.
Finally, adopting an evolutionary perspective has made me a much more enthusiastic, intellectually curious and energised psychiatrist and I hope that this rubs off on and helps my colleagues, trainees and, most importantly, my patients and their families.
That moves us nicely on to my next question. You were instrumental in founding the special interest group with the College of Psychiatrists of Ireland, what prompted you to found that group and how has that journey been since?
For Darwin Day (February 12th) in 2019 I gave a talk on evolutionary psychiatry to a group of psychiatry trainees in Ennis, Co. Clare. The talk went down well, with lots of audience participation, partly (I think) because I conducted a quiz on evolutionary topics throughout the talk and gave out chocolates to those who got the right answers! (chocolates because of the close proximity of Darwin Day to St Valentine’s Day).
Among the most enthusiastic attendees at that session were psychiatry trainees Dr Mara Petrut and Dr Diarmuid Boyle and we joined forces over the following two years to give a number of talks on evolutionary psychiatry, at University of Limerick and College of Psychiatrists of Ireland (CPsychI) academic meetings. One of these meetings was (virtually) attended by Randolph Nesse, the founding father of evolutionary psychiatry and medicine, and he gave extremely positive and encouraging feedback. Buoyed up by Randolph Nesse’s endorsement, and inspired and encouraged by our UK colleagues Dr Riadh Abed and Paul St John-Smith, I went on with Mara and Diarmuid to propose to the CPsychI the idea of an ‘Evolutionary and Psychiatry’ Special Interest Group (EP SIG).
The CPsychI accepted our application and we started off on what has been a really enjoyable and fruitful journey, with only the second national evolutionary psychiatry organization in the world (the UK group started in 2016). I became Founding Chair and Mara Petrut was an extremely enthusiastic and energetic Vice Chair. Because of the COVID-19 pandemic, virtual meetings online had become the norm and, starting in February 2021, we have had online EP SIG lectures (available on the CPsychI YouTube channel) two or three times per year. Our speakers have included Mike Watts, Paul St. John-Smith, Kevin Mitchell, Adam Hunt, Randolph Nesse, Annie Swanepoel, Riadh Abed and Rick Coste. These videos have been viewed well over 100,000 times and the CPsychI are currently editing and posting YouTube ‘shorts’ from them. Alfonso Troisi will honour us as our next speaker, in October 2024. The list of our speakers includes practically all of the leading lights in the world of evolutionary psychiatry.
As a group, we have also published a number of evolutionary articles over the last few years, on topics as diverse as music, religion and psychedelics (see list of publications at the end of this article).
Banging the drum: evolutionary and cultural origins of music and its implications for psychiatry
The above article was recently published by the BJPsych Bulletin. Dr Gurjot Brar & Prof. Henry O’Connell interview the co-authors: Dr Paul St John-Smith and Dr Gerry Rafferty. But first a brief summary of the article. There is growing interest in music-based therapies for mental/behavioural disorders. In the paper, we begin by reviewing the evolutionary a…
Taking the lead from our UK colleagues we also established an essay prize in 2023 and, as you know, the joint winners were Silva Vartukapteine and you Gurjot, and you both went on to present your winning papers online and this video is one of the highlights of our playlist.
In July 2022, you Gurjot started working with me as Senior Registrar in Portlaoise and we bonded over evolutionary psychiatry! We have collaborated on countless papers and projects since then including the Evolution and Psychiatry Substack. The EP SIG Vice Chair baton was passed from Mara Petrut to yourself in January 2023 and you have injected yet more enthusiasm and focus into the EP SIG, especially with the Substack and your increasingly lengthy list of publications on the topic. We have also kept in close contact with our UK colleagues, especially Riadh Abed, Paul St. John-Smith, Adam Hunt and Annie Swanepoel and collaborated at various conferences in Ireland, the UK and at WPA meetings:
A Tale of Two Meetings
A) Midlands Portlaoise Evolutionary Psychiatry Meeting Friday 13th October 2023
Evolution at Westminster Abbey & A Recent Evolutionary Psychiatry Meeting in London
Dear Readers, we have a special article today following a recent meeting on Friday March 1st where we had the second annual Trainee meeting arranged by the Trainee Committee and Riadh Abed in the Evolutionary Psychiatry Special Interest Group of the Royal College of Psychiatrists.
The EP SIG has allowed us to have a platform within the CPsychI and we value greatly the support from administrative staff (Helen Murray) and IT staff (Ian Rice) there in facilitating our meetings, developing our webpage and the YouTube playlist. The EP SIG has also allowed us to collaborate with an increasing number of colleagues in Ireland and throughout the world. Oh and (of course) we have a really interesting and active WhatsApp group!
OK let’s talk more about you, I know you have many interdisciplinary interests, can you speak to how they arose and how they might be relevant to your main interests?
Outside of evolutionary psychiatry and psychiatry generally, and aside from my wife and children (of course!), my primary interests involve sport of all types (apart from horse racing), creative writing, comedy (of most types) and collecting maps and globes (the older the better). For this discussion, I will focus on sport and creative writing.
Regarding sport, I am a passionate football fan and a lifelong supporter of Liverpool FC. I also of course support my home county of Tipperary in the Irish sport of hurling. I run at least three or four half marathons every year and a full marathon every few years so I am always in training for one event or another and I run most days in the week. The physical and psychological benefits of sport are endless, as a spectator and participant, and I have been known to talk about such topics to the point of inducing boredom!
I have also always dabbled in creative writing and in 2021 I was very glad to be able to collaborate with psychiatrist colleagues Frank McKenna and Kevin Lally in publishing our collection ‘Human Stories: 16 tales of the afflicted mind’ and we are currently working on a second collection. As with sport, the creative outlet of writing has endless benefits, especially in facilitating reflective practice and lifelong learning for doctors.
In recent years a few things have gradually dawned on me regarding my professional life as a doctor and my interests outside of medicine. Firstly, I’ve realised that, in contrast to the ‘book learning’ of my early career, much of my clinical learning now is based on deep reflection of everyday practice and, increasingly, retrospective reflection on various clinical scenarios from throughout my career. This reflective and retrospective practice is facilitated by running long distances every day and always making efforts to ‘sublimate’ the most challenging and complex clinical scenarios into some type of creative writing that helps foster longer term learning.
Another phenomenon I’ve come to realise over recent years is the importance of thinking broadly and forming connections between different interests, passions and areas of activities in one’s life, not just now but back to one’s childhood. For example (and I’m not the first to point this out), I have a strong hunch that we as a species evolved to run long distances frequently (to facilitate hunting and exploration) and so one of my fantasy papers in future will hopefully be on the evolutionary basis to long distance running, whereby I can combine insights from two of my great passions. And speaking of combining such passions, I am currently working with my UK colleague Dr Matt Butler on a fascinating paper exploring the evolutionary basis to football fandom!
What are you working on currently? And what's in store for you in the near future?
My main current evolutionary psychiatry project is the ongoing refinement with yourself of ‘Evolution and psychiatry: clinical cases’ into a second edition, with regular postings of edited chapters on the Evolution and Psychiatry Substack.
The EP SIG is going strong but only because of the input of yourself and so many other enthusiastic members, and maintaining interest and outputs in terms of published studies and papers, the Substack and the YouTube channel is a constant work in progress.
I am also working with Riadh Abed and Annie Swanepoel as an executive officer of the World Psychiatric Association Section of Evolutionary Psychiatry and raising awareness of evolutionary psychiatry through regular academic meetings and publications.
In order to properly incorporate evolutionary principles into undergraduate medical education and postgraduate clinical training for psychiatrists and other medics, I know that curricula must be modified and this is a longer-term project of mine. I am having some early success here through my lectures on evolutionary psychiatry in UL.
On the creative and sporty side, I’m running a half marathon in May and a full marathon (my first since turning fifty) in June, I am collaborating with medical colleagues on some new story collections and I’m starting to dip my toe in the area of poetry writing (I’m especially attracted to the discipline required to write a good haiku). I’ve no doubt that these ongoing activities will cross fertilize with each other and enhance the ongoing development of my ‘day job’ as a busy psychiatrist. For example, I’ve recently completed a novel based on a week in the life a long-distance running psychiatrist, along with a short story on Charles Darwin’s two years spent as a medical student in Edinburgh and a haiku on the emotional impact on fans on the start of a new football season.
Where do you see evolutionary psychiatry will go in future, what kind of barriers do you foresee?
As an unbridled and longstanding enthusiast of evolutionary psychiatry, I sometimes become frustrated and even puzzled that the area is not embraced more widely among clinical and academic colleagues.
But undoubtedly there are barriers. That said, the barriers for evolutionary psychiatry are not insurmountable.
From a curricular viewpoint, medical educators cite already bulging volumes of material to be covered and sometimes view evolution as just another topic for which they have no room. My response to this is simple, and it’s a paraphrasing of Theodosis Dhobansky’s often cited quotation – “without an evolutionary perspective, nothing in biology (or medicine or psychiatry) makes sense”. Being the ultimate meta theory, evolution pulls together and makes sense of so much in biology and medicine (Stearns et al., 2010). And a principle of medical education is that examination is the tail that wags the dog (so to speak) of learning (Petersdorf, 1986), so I’m convinced that evolution must be introduced into curricula and examinations in order for the medical profession to start considering it more seriously.
As an unbridled and longstanding enthusiast of evolutionary psychiatry, I sometimes become frustrated and even puzzled that the area is not embraced more widely among clinical and academic colleagues.
At the clinical level, colleagues frequently cite the lack of everyday clinical applications of the evolutionary perspective. I tend to argue that areas such as epidemiology, neurophysiology and biochemistry have little to offer in everyday clinical practice and yet we know that our medical education would be incomplete without the inclusion of these basic sciences. My clinical cases textbook also hopefully goes some way to addressing this area, providing evolutionary insights for everyday clinical scenarios along with the more subtle benefits for busy clinicians of having an endlessly fascinating meta theory that makes sense of so much that we see and treat every day.
At the research level, the atheoretical amassing of great mounds of data, the blind pursuit of ‘statistically significant’ findings and the largely futile search for ‘causative’ genes brings to mind the observation of Darwin himself on the futility of counting pebbles in a gravel pit and his point that ‘observation must be for or against some view if it’s to be of any service’.
At wider societal levels, there are also barriers to evolutionary thinking for a range of reasons, including religious beliefs, simple lack of awareness, knowledge and education on evolution and concerns regarding the deliberate misinterpretation and misuse of evolutionary principles for political purposes.
To extend Darwin’s metaphor, we as evolutionists must not only guide pebble counting with an overarching framework and focused theoretical questions, we must also turn on the lights of education and awareness in the gravel pit.
Thanks again Henry for your time and your dedication to the field, where can we follow your work and reach out to you? Also any links you would like to share for our readers?
Thank you Gurjot, it really has been a pleasure reflecting on the journey that has brought us to this point. I am hopeful work will continue in the field and we may develop further international and local collaboration.
I am on Twitter/X @henrypoconnell and you can also get in touch by email: hpoconnell@yahoo.ie
Below are some links that our readers may find useful:
Evolution and Psychiatry: clinical cases (on Amazon) by Henry O’Connell
Evolutionary Psychiatry: Current Perspectives on Evolution and Mental Health by Riadh Abed & Paul St John-Smith
Good Reasons for Bad Feelings by Randolph Nesse
YouTube playlist of our talks on the CPsychI YouTube channel
Evolution and Psychiatry Substack
RCPsych Evolutionary Psychiatry Special Interest Group (EPSIG)
World Psychiatric Association Section of Evolutionary Psychiatry
Randolph Nesse’s website (very useful links to everything he has written)
International Society for Evolution, Medicine and Public Health (ISEMPH)
List of articles published by this group:
Evolution and psychiatry: the formation of a special interest group by Dr Gurjot Brar and Professor Henry O’Connell, from the Irish Journal of Psychological Medicine
Book Review: How religion evolved and why it endures by Robin Dunbar, review by Dr Gurjot Brar and Professor Henry O’Connell, from the British Psychological Society
Banging the drum: evolutionary and cultural origins of music and its implications for psychiatry by Gerry Rafferty, Gurjot Brar, Mara Petrut, David Meagher, Henry O’Connell, Paul St John-Smith, from the BJPsych Bulletin.
The use of psychedelics in psychiatric treatment – evolutionary perspectives by Dr Gurjot Brar and Professor Henry O’Connell, from the Irish Journal of Psychological Medicine
WPA Review -Q4 -eNewsletter News from the Evolutionary Psychiatry Section by Dr Gurjot Brar and Dr Annie Swanepoel
Special Interest: Evolution and Psychiatry by Professor Henry O’Connell, from the CPsychI Think Tank newsletter
Book Review: Good reasons for bad feelings: insights from the frontier of evolutionary psychiatry by Randolph M. Nesse by Professor Henry O’Connell, Dr Mara Petrut & Dr Diarmuid Boyle, from the Irish Journal of Psychological Medicine*
Evolutionary theory in psychiatry and psychology by Professor Henry O’Connell, from the Irish Journal of Psychological Medicine*
Alfred Russel Wallace (1823–1913): evolution and medicine by Professor Henry O’Connell (2009), from the Journal of Medical Biography: 17(4), 214-216
150 years of evolutionary theory by Professor Henry O’Connell (2008), from British Journal of Psychiatry: 193 (3), 258-259
Attachment disorders: an evolutionary perspective by Professor Henry O’Connell (2007), from the British Journal of Psychiatry: 191, 459; author reply 459-60.
What is Evolutionary Psychiatry? by Dr Gurjot Brar & Professor Henry O’Connell, from the Evolution & Psychiatry Substack Newsletter
If you enjoyed this article and would like to discover more about Evolutionary Psychiatry please consider:
subscribing to our Substack to receive regular content updates
visiting the webpage of the Evolution and Psychiatry Special Interest Group within the College of Psychiatrists of Ireland
visiting the webpage of the Evolutionary Psychiatry Special Interest Group within the Royal College of Psychiatrists
exploring a Youtube playlist on curated presentations by the Evolution and Psychiatry Special Interest Group within the College of Psychiatrists of Ireland
exploring the Youtube page of the Evolutionary Psychiatry Special Interest Group within the Royal College of Psychiatrists
exploring the Evolving Psychiatry podcast