Personal and professional reflections on the power of an evolutionary perspective
Essay Series #1 - Dr Silva Vartukapteine summarises her winning essay from the 2023 inaugural essay competition from the CPsychI* Evolution and Psychiatry Special Interest Group.
*College of Psychiatrists of Ireland
Edited by Dr Gurjot Brar & Prof. Henry O’Connell.
Combining both personal and professional insights, Dr Silva discusses how evolutionary insights may be beneficial to reconceptualising the mother-infant relationship, anxiety disorders and ADHD diagnosis and management. As with much of the literature in the field, the evolutionary perspective is discussed as complementary and additive to current practice.
For the longest time our ancestors lived within small hunting and gathering groups, switching from a nomadic lifestyle to permanent settlements and farming only around 12000 years ago[1]. Our current modern world, which is all we know and which we see as the norm, has actually existed only for a tiny moment if we consider the context of the millions of years of human evolution.
In this article I explore questions such as: Since our bodies and brains have evolved in a completely different context, what does it mean for us, humans, who are living now? How does it affect us? Can awareness of an evolutionary perspective offer any tangible benefits for us, both in our personal and/or professional lives?
Babies and Evolution
I first came across a practical application of evolutionary principles to my life by sheer serendipity. After becoming a mother of my firstborn child, I found myself overwhelmed and sleep deprived during the early months of adjusting to parenthood, as well as confused by the enormous amount of conflicting advice around childcare, particularly infant sleep. Some of the information sources portrayed the night awakenings and the infant’s preference for sleeping close to their primary caregiver as an unhealthy habit and a ‘problem to be fixed’. Luckily, I happened to stumble across a book by R.Fitz-Desorgher, an experienced midwife and parenting consultant, who wrote:
“To me it has always seemed so obvious that if a certain baby behaviour is universal, there must be a good protective evolutionary reason for its existence. [..]Our twenty-first-century baby has exactly the same instinctive, evolutionary drives to survive and takes no account of the modern, noisy world he has entered[2].”
This really made sense to me and made me realise that our current societal expectations – that our young should happily self-soothe and enjoy an uninterrupted sleep in their own separate rooms – have not always been the norm and actually are in conflict with evolutionary survival strategies. Imagine a baby being left alone overnight in the hunter-gatherer society - it would likely have spelt a death sentence due to hypothermia or attack by a predatory animal. Thus, those babies who protested and cried when put down or left alone, were the ones who survived and passed on their genes.
This new-found understanding and shift in my thinking did not miraculously stop my baby from waking up every 2 hours at night or wanting to be held constantly, but what it did was much more important: I could finally stop worrying that something may be wrong with my baby or my parenting approach, and I could allow myself to relax and accept this as a normal (albeit difficult) behaviour in this developmental stage especially when viewed in evolutionary context. This serves as a personal testimony of how simple awareness of evolutionary principles can shift the way a person feels and functions and help tolerate a difficult situation for which a quick solution is unrealistic. Below, I further explore how this principle may apply to Psychiatry.
“I could finally stop worrying that something may be wrong with my baby or my parenting approach, and I could allow myself to relax and accept this as a normal (albeit difficult) behaviour in this developmental stage especially when viewed in evolutionary context.”
Evolutionary perspectives on anxiety disorders
In an attempt to demonstrate the value of integrating evolutionary approaches to Psychiatry, I will first look at anxiety disorders as an example where some elements of evolution are already being acknowledged, although not necessarily specifically named as such. For example, we know that cognitive distortions/ biases are common treatment targets in Cognitive Behavioural Therapy for anxiety disorders. One of them is known as “negativity bias”, meaning that negative stimuli (which can be represented as “sticks”) are more readily noticed and have a greater impact than positive ones (represented by “carrots”). There is an evolutionary explanation to why we are prone to such thinking bias which has been eloquently articulated by the psychologist Rick Hanson:
“[..]in the tough environments in which our ancestors lived – if they missed out on a carrot, they usually had a shot at another one later on. But if they failed to avoid a stick – a predator, a natural hazard, or aggression from others of their species – WHAM, no more chances to pass on their genes. [..]in evolution, Mother Nature only cares about passing on genes – by any means necessary. She doesn’t care if we happen to suffer along the way[..][3]
Therefore, anxiety served a protective purpose for our brains– to scan for potential danger and focus on what might go wrong – because historically it enhanced our chances of survival. This also meant that people were more likely to hand down the genes that made them more attentive to danger.
Moreover, at its core, fear and anxiety are completely normal and protective reactions to perceived threats – our sympathetic nervous system becomes activated, releasing adrenaline in our bloodstream and prepares us to deal with the hazard, e.g. by escaping, fighting or freezing, which is an ancient and nearly universal response in the animal kingdom. However, the type of threats that we typically encounter nowadays are significantly different from those in the past: instead of living in harsh surroundings with frequent physical threats to our survival, in the modern world we are more likely to have to deal with situations such as presenting in front of other people, work-related, relationship and financial stress, exams, traffic jams, cyberbullying etc.
Our bodies still react in the same way to these modern stressors (as if they were a potential life or death situations) by preparing to “fight or flight”. However, escaping or attacking is typically not very helpful or useful when dealing with modern world stressors, therefore often there is no opportunity to implement this strategy or to “discharge” the built-up tension and we can end up getting stuck in a chronically elevated state of stress[4]. As a solution to this problem, several ways have been suggested that can help us return our bodies back to a parasympathetic state of rest and relaxation – be it physical activity, breathing and relaxation techniques, social supports - these approaches have been widely acknowledged and endorsed as part of the treatment plan for anxiety disorders.
So, overall, when dealing with anxiety disorders, it is helpful to be aware of and accept that our brains have evolved under much different circumstances with the main priority being survival and reproduction. This allows us to normalise the cognitive biases and automatic physiological reactions in our bodies and helps us creatively solve problems of how to manage these reactions in our current contexts.
Potential benefits of viewing ADHD through an evolutionary lens
The second psychiatric diagnosis I want to explore is Attention Deficit Hyperactivity Disorder (ADHD) because in my opinion an evolutionary perspective in regards to this condition could be pivotal but is currently not widely acknowledged in the mainstream psychiatric setting. ADHD is a common neurodevelopmental disorder and has been increasingly more diagnosed over the recent decades[5] with multiple proposed explanations for this trend (e.g. changes in diagnostic criteria, changes in methodology of the studies and in clinical practice etc.). I will try to explore this trend from a different perspective.
As we know, ADHD is commonly diagnosed during childhood and, although receiving a diagnosis can be very valuable as it gives access to highly effective treatment options, at the same time there is a risk of possible negative long-term effects on the child’s sense of identity, self-esteem and their hopes and beliefs about their future opportunities (or lack thereof). As written by Dr Sanah Ahsan, Clinical Psychologist:
“[..]suggesting we have a broken brain for life increases stigma and disempowerment[6].”
Children, whose sense of self and identity is only developing, could be especially susceptible to this. It can be demoralising to believe that there is something wrong with you, that you’re not “normal”. But again, if we actually look at society’s expectations of what is “normal” and dissect how they have changed over time, it may offer us a different perspective on the problem. We can easily imagine how ADHD traits would have been pertinent and highly valuable in the ancient environment, but nowadays, when our environment looks completely different, these same traits can become a disadvantage and are considered maladaptive. This is called “mismatch theory”.
For example, hyperactivity, presenting as tirelessness and a high need for movement, would have had plenty of opportunity for utilisation as the hunter-gatherer lifestyle was constantly “on the go” with significant physical elements to many of their daily tasks. Secondly – distractibility – or, more specifically, the tendency for attention to easily shift towards things happening in the periphery (e.g., noises, movements) instead of focusing on a single main task and “drowning out” other competing stimuli, could have been protective while hunting, allowing hunters to rapidly scan their surroundings to avoid being unexpectedly attacked. And the third symptom of the triad – impulsivity – likely supported hunters’ response-readiness and ability to change their strategy quickly which might have been beneficial in harsh ancestral environments[7].
I think that one of the biggest areas of this mismatch is in the educational setting, making it increasingly difficult for people with ADHD traits to succeed (and I wonder if this could be one of the reasons why ADHD diagnosis has been rising). Needless to say, there were no schools, classrooms and examinations in the hunter-gatherer societies. “In relation to the biological history of our species, schools are very recent institutions,” writes Peter Gray, an evolutionary psychologist and a research professor, who takes interest in studying children's natural ways of learning, “Children in hunter-gatherer cultures learned what they needed to know to become effective adults through their own play and exploration.
[..]With the rise of agriculture, and later of industry, children became forced labourers. Play and exploration were suppressed[8].” According to Dr Gray’s research, what we currently recognise as conventional schooling, gradually evolved in the 19th and 20th century. However, even in the recent decades, the school systems have continued to change considerably:
“The length of the school year has increased (it now averages 5 weeks longer than in the 1950s). The number of years of required attendance has increased. The amount of homework has increased immensely, especially in elementary schools. Recesses have been reduced[..]. Fun activities, such as art and music, have regularly been dropped from curricula in favor of more time for worksheets and test preparation. [..]and ever-greater pressure has been placed on children to score high on standardized tests[9].”
If we carefully consider the above information, we will realise that what we now know as “normal”, actually isn’t natural from an evolutionary perspective – the modern environment and requirements are unprecedented and vastly different to what human brains and bodies have adapted to. School can be challenging even for a typically developing child, but if you add an “ADHD brain” to the mix, no wonder these children are struggling in the current education system.
What’s next?
So, what can we do about it? I am not suggesting that we should discard our current evidence-based interventions for ADHD – they have their place and they have helped many. But if we could simply broaden our understanding of ADHD to include an evolutionary explanation, if we could see the ADHD traits as adaptive in certain contexts/environments and a liability in some other contexts, rather just simply as an overarching deficit, I think it would do 2 things:
1) It would help normalise and validate some of our common human experiences and reduce the stigma associated with this diagnosis;
2) It would potentially open up new opportunities for interventions and supports by also addressing the environmental and societal factors, rather than seeing a person’s mental health struggles solely as their individual “failure”.
I believe that we, humans, are more than capable of inventing creative strategies on how to tweak our current educational and employment systems in order to offer more individualised approaches for the benefit of many. Just look at all the inventions humans have already come up with!
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