I’m more interested in psychological and psychiatric therapy than I am in theory (since that’s what I’m in school to do), so I’ll restrict my discussion of this largely to that context.

Have you ever been in a situation where there was just soo many ways to attack a position that you didn’t know where to start? Kind of like your first visit to Disneyland where you spent so much time trying to decide what to ride, that you wasted too much time to actually do any of the rides? Well, that’s kind of how I feel about psych. There are just so many objections to the current state of affairs that I never know which one to bring up first; and even worse, I’ll sometimes drop one halfway through to move on to the next one. The last time I attempted to put all my thoughts on psych into a single coherent series of essays, I ended up with a laughable result (which you can see in the earliest days of this blog). But, I’m going to try again.

The problem with psych is that it operates in a vacuum.

What I mean by this is that often times psychological theory seems to be pulled out of thin air, with little regard for other disciplines that also study the brain and behavior. A perfect example of this is Maslow’s Heirarchy. Personal experience, as well as stories handed down through the ages would seem to contradict Maslow’s supposition; self-actualization tends to be driven by a desire to achieve such things as esteem, belonging/love, and safety. Indeed, those that have all 4 of the ‘lower’ needs often show very little in the way of self-actualization (think trust-fund kiddies, etc).

As you peruse the vast array of psychological schools, you see they are founded on everything from ‘progressivism’ (Critical Psychology) to, well, nothing (Radical Behaviorism). Which brings me to my main contention: Psychology has failed to harmonize itself with what is known about the origin and development of brain and behavior.

While perusing Moti Ben-Ari’s excellent Just A Theory: Exploring The Nature Of Science, I caught a diagram he’d based off of the famous The Structure of Scientific Revolutions by Thomas Kuhn. Ben-Ari’s work is an excellent treatise on how science is done. Something that all psychologists and psychiatrists would do well to read. Anyway, here’s the diagram (click to see a larger one).

Maslow’s heirarchy, Piaget’s theory of child development, the psychiatric ‘chemical imbalance’ theory of depression(click on my psych or medicine categories to see more of my rants about the unscientific nature of psych), all of these are still at the pre-science stage. Their original paradigm has been assaulted by anomalies regarding the purpose of the brain (they evolved for a reason that probably had nothing to do with helping us to ‘achieve happiness and harmony’), the environment the brain operates best in (the traditional classroom is not an environment in which we’d expect what when all is said is done is basically a hairless monkey to thrive in), as well as the constancy and adaptability of the brain (unlike your computer’s circuit board, the brain regularly and constantly rewires itself).

Only problem is, these blatant anomalies have failed to result in a crisis. It’s as if all this evidence simply didn’t exist in the world of psychoogical theory and therapy. So what we’re continually stuck with is a pre-science paradigm that–because it has insulated itself from the fields which speak to the biological origins and nature of the brain and behavior–will not acknowledge a need to develop a new paradigm. Operating in a vacuum.

All theories are based on assumptions. These assumptions are usually based on observation of some sort. Over time, as our perception increases in accuracy and complexity, the observations themselves change. And with that comes a change in assumption…which will either lead to refinement or destruction of the old theory. The long-held theory that the sun revolved around the earth made sense given our observation that the sun seemed to go from east to west from dusk until dawn, only to end up on the east at dawn the next day. There was no reason to suspect that the earth either rotated on its axis or revolved around anything. With the dawn of modern astronomy, it became clear that the Earth was rotating, and–given the precession of the stars–was orbiting the sun as well. Which led to Copernicus’ famous pronouncement that the planets orbited the sun…in circular orbits. Keppler and his lapdog, Brahe, using increasingly accurate astronomical data, found that rather than being perfectly circular, their orbits were elliptical (basically take two ends of a circle and pull on them). The new observations led to new facts (elliptical orbits) which changed the assumptions and modified the theory rather than abolished it.

The psych establishment has consistently failed to take into account the new observations, assumptions, and theories developed through bioanthropology (paleoanthropology + primatology), behavioral ecology, and neurobiology; in the remainder of this initial essay, I’ll try to briefly discuss some of the more glaring omissions from psychological theory.

Darwinism:
1. The variability of traits in populations - Before (and sadly even after) Darwin there remained the idea of the ‘type specimen’ for a species of animal. If the ‘type’ happened to have mottled orange and black fur, then the ’species’ had mottled orange and black fur. Individuals who had more orange or more black were ‘imperfect’. As Darwin postulated (which makes more sense), there is actually a ‘range of normal’; rather than a species standing 27″ at the shoulder it would be characterized by the range of 24-29″. Psych currently has little or nothing in the way of established guidelines to determine what lies in the normal range and what lies outside it; the current trend seems to be that if a teacher/parent/lover makes the decision that your behavior is ‘abnormal’ then it is, and that if you don’t feel as good as you want, then you’re ‘abnormal’. (Are socially anxious people really that abherrant? Or do they merely lie at one end of ‘normal’ in a social anxiety spectrum?) Are we doing the mental health equivalent of declaring that being a 5′6″ tall male is a disease?

2. The sheer pervasivenes of ‘mental illness’ in the states must give one pause. The lifetime incidence of psychiatric illness is round about 47% if we listen to the dominant perspective. That’s sicker than dalmatians for crying out loud (for those who’ve never known one, they’re some of the most inbred, problem-filled dogs in the world due to pedigree/breeder issues). How did we get that sick? In the evolutionary struggle, those traits which make one individual less able to survive and reproduce than others will usually result in that individual’s elimination. By all accounts, depression, anxiety, and the like are not fun and substantially affect one’s ability to act in a normal fashion. They can’t have been good things to have for a hunter gatherer living in a Puma filled jungle. If depression, OCD, Bipolar, any of those ‘fairly common’ disorders are idiopathic–not due to outside factors–in nature, then how did they become so high in frequency, given their devastating effects? While natural selection can overlook more ‘minor’ faults (like the presence of an appendix, or flat feet), such large effects in such large portions of the population would not likely last. We are left with the proposition that in all but a handful of cases (I’ve only read about one family in eastern europe that is absolutely 100% depressed due to a serotonin receptor defect), these diseases are either developmental in nature, or are not diseases at all but *injuries* (I’ll come back to that later). And, while susceptibility has been shown to be heritable, see point number 1.

Bioanthropology:
1. Big brains evolved long before modern society did. Fully anatomically modern humans were around between 160,000 and 200,000 years ago. This means that the human brain was not designed to operate in modern society. And this is an important point. While it may function well enough, there will inevitably be friction when a brain designed to interact with 50-100 people intimately is suddenly plunged into a world where only the most reclusive interact with that many, to mention just one of the original ‘design parameters’ at odds with our current situation.

Why this is important is because of the ready use of the word ‘adaptive’ and ‘maladaptive’ to describe behavior in a modern setting by mental health professionals. They show a willingness to declare that a normal human behavior is ‘maladaptive’ in a certain setting and therefore must be changed. This is equivalent to saying that the response of high blood pressure, atherosclerosis, and heart disease to a junk-food-filled modern life is ‘maladaptive’ and therefore the physiological response should be changed. Yet, few doctors would say that nothing is wrong with eating copious amounts of big macs and whoppers. The way we’ve constructed our environment should be under scrutiny, but rarely finds itself there.

2. As TH Huxley–Darwin’s famous ‘bulldog’–was known to remark, he was unable to find a difference in the gross brain anatomy of humans and other primates; finding differences of degree, rather than kind. Aside from language centers, (which some argue chimps have as well), Huxley’s contention remains largely true today, at much smaller levels of resolution than were available to him. There is no part of the ‘emotional’ and ‘learning’ systems of the human brain that isn’t present in apes, monkeys, and indeed most social mammals. Studies of these parts in humans then must be grounded in their origination and purpose in ‘lower’ animals.

The conception of ‘Attention’ is one of the most lucid examples of the differences between psychological schools and evolutionary schools. Attention in animals is goal-directed. Perceive a stimulus, identify the stimulus, categorize the stimulus, act in response to the stimulus. If the stimulus is a blade of grass, it’s irrelevant. If it’s a banana, make screeching noises and run up the tree to grab it before everyone else. If it’s a leopard, make screeching noises and band together to ‘mob’ it by throwing sticks and stones until it leaves for less annoying prey. Compare this to children, who are told they are ’sick’ and then given meth in pill form if they can’t hold their attention on a non-goal-oriented stimulus. Sitting in lecture in med school, it’s hard to find anyone who can sit still or pay attention for an entire hour; and yet we expect that from our children?

Neurobiology:
1. Unlike most of the organs in our body, the brain regularly and dramatically reorganizes and rewires itself in response to outside stimulus. Most other tissues simply respond. About the only tissue that even comes close is muscle tissue. In response to type and amount (or lack thereof) of exercise, muscles can increase the size of their fibers, the metabolic type of fibers (anaerobic or aerobic), the emphasis on structural type (slow-twitch and fast-twitch), and the size of attachments to bone. The brain can and does all that regularly (see Hebbian and Anti-Hebbian synapses), but it can also change how it connects to other cells in the same lobe and other parts of the brain entirely. This would be like your muscles able to change which bones and ligaments they attach to from exercise alone.

However, the brain is largely treated as a computer. The PC on which the ’software of your mind’ is run. Plasticity and Hebbian synapses are never mentioned in the psych literature. No mention of the fact that the brain functions on a positive feedback system rather than a negative feedback system (again unlike most other tissues). Indeed the way we approach treatment to issues with the brain is much as we’d approach treating a broken negative feedback system. The brain is both software and hardware.

2. Although there is much we do not know about brain circuitry, we do know enough to begin to form a paradigm of brain function. We do know which parts of the brain do what, in a general fashion. And we know how they connect to each other, for the most part. Tying back in to my example of attention, the current psych perspective on learning and attention can be shown to be flawed through basic neurobiology as well. In most mammals, the ‘attention areas’ of the brain are connected to the emotional centers of the brain. Furthermore, in all ‘higher’ primates (humans included), the attention areas are also hardwired into the visual centers. The result is that attention is inextricably linked with emotion, in addition to which one’s attention will automatically and without conscious will be redirected to new visual stimuli. The human brain is not an attention maintaining machine, but an emotional-context-dependent goal-oriented attention switching machine.

3. Neurotransmitters, Pathways, and Treatment. As I pointed out in my earlier link, even the way we treat depression doesn’t harmonize with what is happening. In the very simple circuit I illustrated in that post, we have a ‘presynaptic’ nerve and a ‘postsynaptic’ nerve. The ‘presynaptic’ nerve fires in response to the external and internal situation (roughly speaking, firing=situation good, not firing=situation bad). The postsynaptic nerve responds to this by inducing a mood change through firing in response. This is an extreme oversimplification, but it’s a fairly accurate one. So what we have is:

situation good–>presynaptic response–>postsynaptic response–>feel good.
situation bad–>no presynaptic response–>no postsynaptic response–>feel like crap.

We medicate by changing the behavior of the postsyanptic cell. Making it fire no matter what the presynaptic cell is doing. Because the postsynaptic cell still responds just fine, this means the problem wasn’t with the postsynaptic in the first place. The problem was either in our perception of the situation, or in the presynaptic cell. Both of which continue to be ignored by most researchers, due to the fact that depression is ‘clearly idiopathic’. It fixes the symptom, but completely ignores the cause.

Putting It All Together
What we’re left with are a series of facts that the psych establishment has more or less ignored completely. They give us a clearer and more grounded picture of how the mind came to be and what it was designed to do. With this information we can proceed on a clearer footing, both in successful treatment of mental health problems (by an accurate assessment of symptom versus cause) and avoidance (by determining the ways in which the modern environment doesn’t harmonize so well with the big monkey brain on our shoulders).

The human brain is simultaneously more limited and more plastic than the psych establishment has given it credit for. The goals it was designed to reach, the way it was designed to achieve those goals, and the environment in which it was designed to function cannot be inferred by looking at humans in the modern context as it bears no relation on our origin. Only by looking at the evolution of the brain and behavior can we understand how to effectively treat the human brain.

Most importantly we need to redefine mental health problems in a more concrete heirarchy. Being a mere student myself, I have no business weighing in quite this far into the discussion, but since this is just a blog I’d establish the following three categories and definitions:

1. ‘Idiopathic Illness’–This would be the bonafide, headscratching ‘we have no clue what’s going on here’ kinda thing. Schizophrenia, that Eastern European family I mentioned, some forms of bipolar, and the like.
2. ‘ Illness’–Mental illness as a result of a definable environmental or developmental insult. In some cases it’s an event. In others it’s not learning to think in a certain way. Depending on the age of the person and how long/severe their mental health problems were, these may or may not be reversible.
3. ‘Mental Injury’–This category is the novel one, and I could see it encompassing the majority of people who have depressive episodes, anxiety problems, body image disorders, and the like. As I mentioned earlier, the only tissue that is all that similar to the brain are muscles. And muscles can get injured, partially because they, like the nervous system, also in some ways operate on a positive feedback mechanism. In other cases they get injured because we abuse them in ways they weren’t meant to be used (my mom is glaring at me and my weights when I say this one). The longer you don’t lift weights the harder it is when you start again. The bigger you get, the faster you run, the more awkward a position you get into, the more likely you are to get hurt once you leave the design parameters of the human body. It can be much the same case for humans. The horrors of war and post traumatic stress. Peer ridicule, desire to belong, and starvinve oneself. Or the basic neurobiological principle that the more you think sad thoughts the harder it is not to think sad thoughts (Hebbian synapse). With these injuries a combination of medication and therapy (depending on severity one emphasized more than other) could be used to get people back on their feet.

Conclusion:
I’m no Thomas Szasz. And I’m certainly no Cosmides or Tooby (wh0 in my opinion make the mistake of thinking that science can say MORE than it really can). And I don’t believe that people with the ’softer’ mental health problems are ‘weak’. But I don’t think they’re diseased either. There’s little evidence to support that contention. And as a person who’s suffered more than his fair share of physical ailments, there is nothing worse than a doctor who tells you that you won’t ever be fixed and will need to keep taking this medicine for the rest of your life to feel normal.

I prefer to see these mental health ailments as injuries because we’ve not shown an irreversibility that I consider the hallmark of an illness. Although some claim otherwise, my searches through everything from Ovid to Google Scholar do seem to indicate that cognitive behavioral therapy and interpersonal therapy are as or more effective than drugs. And like I said, the drugs do have a purpose, but I’d contend that purpose is to alleviate symptoms long enough to get the work of ‘fixing’ them done.

Currently it seems that every differentiation from the norm, every abherrant behavior, is an illness or a disorder. That pills are the only ‘treatment’ in sight. And that apparently 47% of us have a brain disease of one sort of the other. This is a perspective that makes little sense given the reality of our origins and the flexibility of the brain. By being honest about what is known about the brain and what really is illness and what isn’t, we can look for the origins of mental health problems and ruthlessly eliminate them. I will be happy man on the day when as few of my patients as possible are on long-term psychoactive medication, none are in my office because of mismatch between man and environment, and most come in eager to work through their injuries, aware that with a little hard work we’ll end our relationship with them free of trouble and stronger people besides.