The book reviewed here is the ‘Textbook of Evolutionary Psychiatry. The Origins of Psychopathology’ by Martin Brune. As the title suggests, Brune in this book is introducing the beginnings of an ambitious framework for reformulating psychiatric illnesses in evolutionary terms. In the introductory chapter, Brune argues that
‘the epistemiological foundations of modern psychiatry (and psychotherapy) are clearly rooted in naturalism‘
Brune discusses some of the important historical developments in psychiatry with figures such as Griesenger, Kahlbaum and Kraeplin and along the way there is the following quote from James Crichton-Browne
‘It seemed not improbable that the cortical centres which are last organised, which are most highly evolved and voluntary, and which are located on the left side of the brain might suffer first in insanity‘
While the term insanity is redundant, a modern parallel might be drawn with Crow’s theory of psychosis which invokes differential gender based neurodevelopmental patterns (and which is reviewed here and here). What I found profoundly interesting here was Brune’s observations of the ICD and DSM manuals
‘These manuals improve the reliability of diagnosis, but at the cost of reducing the complexity of clinical phenomena. Although claiming to be largely ‘atheoretical’ they represent compromises between various ‘schools’ of psychiatry‘
In chapter 1 on the definition of evolution, Brune provides an overview of evolutionary theory explaining natural, group and sexual selection, inclusive fitness theory and reciprocal altruism. He also looks at some of the factors in reproductive success across species (see also Mean Genes for a more detailed exploration of this area – reviewed here) and principles of evolutionary psychology including methods for testing the theories. There is also coverage of genetics and again a look at how the role of genetics in psychopathology can be tested experimentally. In the chapter on brain anatomy, evolution and function, Brune looks at various relevant issues including the Triune brain and allometric growth curves
He also considers ‘mind reading’ as an important adaptive trait. In the chapter on human life history, Brune considers Bowlby’s attachment theory as a useful paradigm for considering issues from an evolutionary perspective. In the 4th chapter, Brune writes about the causes of psychopathology. In this chapter there are some necessary generalisations including protective and risk factors associated with mental illnesses as well as problems or phases associated with different age groupings. There is then a chapter on the psychiatric assessment covering signs and symptoms before Brune concludes
‘computer-based ethological analysis of nonverbal behaviour is of little use in everyday clinical practice, but the ability to recognise non-verbal behavioural elements during interactions can be achieved through training and a standardised scale for rating patients’ non-verbal behaviour is direly needed‘
Brune looks at autism and other pervasive developmental disorders in Chapter 6. Given the heterogeneity of autism, this is a particularly difficult area to draw conclusions from an evolutionary perspective and attachment behaviours and mirron neurons are invoked (although mirror neurons are not without their controversy).
In Chapter 7, he looks at Attention-Deficit/Hyperactivity Disorder and although suggesting this may even be a culture-bound syndrome quite speculatively earlier in the book looks closely at the neurobiology. Perhaps it is too early to make convincing arguments for the role of the DRD4 gene and there is much conjecture that leads to the novelty seeking function of the gene and the adaptive utility in fast changing environments. However it can also be argued that society today is fast changing, unstable and therefore ADHD should be an advantage, so I found this less convincing. In chapter 8, Brune looks at dementia and considers the issue of senesence and the balance between selecting for fertility in early life and health in adulthood. He also looks at some of the features of neuoranatomy – the Entorhinal Cortex, hippocampus and Anterior Cingulate Cortex as well as the APOE4 gene. In chapter 9, he looks at substance misuse and alcohol dependence discussing the Opiate, Dopamine and Oxytocin systems although it will be interesting to see developments in this area (see also this review of an article on social buffering which involves a discussion of the Opiate and Oxytocin systems).
In the chapter on Schizophrenia he considers this to be a heterogenous condition and favours the importance of sexual selection for extremes of traits such as intelligence and language. He makes some interesting comments on Erotomania, linking it with patterns of female fertility. A number of constructs including mental state attribution and insight are discussed. The 11th chapter on affective disorders is interesting and consideration is given to mood disorders relating to submission and dominance within a social hierarchy. The reality is most likely considerably more complex however and if as suggested there is a continuum between mood disorders and psychosis, then there should be some overlap in the evolutionary explanations. There is an interesting discussion of affective disorders and the triune brain although there is considerable speculation (although biologically plausible). Of all the chapters, I thought that the one on anxiety disorders was the most convincing particularly in the discussion of panic disorder, PTSD and OCD and there is already a well established literature in this area.
In a discussion of eating disorders, Brune considers the role of subordinate behaviour, resource allocation and reproductive delay in constructing an evolutionary explanation. The discussion of personality disorders is difficult given the complexity of the personality construct and this is acknowledged. Cluster B personality disorders are discussed with regards to resources and MAO-A activity. Cluster C personality disorders are discussed briefly and with regards to defensive strategies although it is interesting to note that there has been considerable debate about their relation to the anxiety disroders. Thus it does not seem unreasonable to suppose that there should be an overlap between the corresponding evolutionary explanations. Finally there is a consideration give to a number of different areas including forensic psychiatry, psychotherapy and then an epilogue in which Brune suggests a new way of formulating the diagnosis and management based partly on the 4 W questions discussed earlier in the book.
This is an interesting and at times speculative account of evolutionary psychiatry. Although there is much speculation, at this stage with this being such a young discipline, such speculative foundations are a necessary first-step in the establishment of a theoretical framework. Brune has accomplished a considerable amount within the pages of this book and has managed to integrate a number of complex subject areas. This is an important area within psychiatry which may offer valuable insights into the nature of mental illnesses.
Martin Brune. Textbook of Evolutionary Psychiatry. The Origins of Psychopathology. Oxford University Press. 2008.
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