UA-10331854-1
≡ Menu

If you are new to this site, Questions and Answers about Recovery can be a good place to start!

Mental “disorder” or evolved mental strategy?

In the mental health field currently, when people experience intense anxiety and depression, and when they experience mania and/or psychosis, the experience is understood to be a “disorder” or a “biological dysfunction” that is of no use and should “corrected” by any means that might be effective in doing so.  The most straightforward way of doing this is conceived to be a drug that might directly reverse the theorized “biochemical imbalance” though other methods are tried, particularly when drugs don’t work.

The primary opposition to this point of view in our culture comes from those who deny the existence of mental disorders at all:  they see “diagnosis” in the mental health field as being an illegitimate enterprise, and the DSM as a work of quackery designed to make money for drug companies and for “mental health professionals.”  It is noted that there is no physical test for any sort of “mental disorder” and no objective way of determining what should be called a disorder.  It is then imagined that people would do fine if saved from those in the mental health field who attempt to diagnose and then “help” them.

A middle ground between these two extreme views is however emerging.  In this view, the mental states that get diagnosed as “disorders” tend to be specialized states of mind which do tend to cause trouble for people, but which can also be seen as part of an evolved, problem solving strategy used by the mind.  That is, while these mental states may not be consciously chosen by the person and may cause problems, they also may solve important problems, and so in any given case it may be unclear whether they are doing more harm than good.

An example of a “biological” evolved problem solving strategy that both causes problems but also potentially solves problems is that of a fever.  Fevers cause many problems, and if quite high may cause brain damage or even death, yet we have evolved to have fevers because they often help solve the problem of infections.

“Anxiety” can be seen as an evolved mental/emotional strategy that can also both cause and solve problems.  Anxiety can disrupt our life and narrow our focus, making us hyper-vigilant for certain stimuli while oblivious to others; yet under some circumstances, such hyper-vigilance and narrow focus can be life saving.  People who tend to be more anxious than others may have many problems due to the anxiety, but they are also less likely for example to die in accidents.  So while there is a particular biological way anxiety manifests in our bodies and brains, this biological process itself cannot be called a “dysfunction.”  Instead, to determine whether a given level and type of anxiety is doing more harm than good, one would need to analyze the exact level and type of threat in the person’s life.  And since no one’s viewpoint on this is completely objective, no clear line can be drawn between “helpful” anxiety and “disorder.”

While many people would recognize anxiety as evolutionarily important, it is much less common in our culture to recognize the potential value of depression, or depressed mood.  This partly accounts for the high rate of use of anti-depressants, thought by our culture to be useful in eliminating a pesky “bio-chemical imbalance.  Yet, a great deal of evidence suggests that depressed mood is objectively helpful to people in carefully reviewing complex problems, and that our ability to be depressed, just like our ability to be anxious, has evolved for a purpose.   That is, just like fever or anxiety, depression has high costs to an individual, but despite this it is often more helpful than not, and so the biological process that gets activated in depression cannot in itself be called a “dysfunction.”  (For a brief review of the evidence for this, see http://www.scientificamerican.com/article.cfm?id=depressions-evolutionary  For online access to a more in depth look at the subject, see http://sites.google.com/site/paulwandrewsphd/home/andrews_pr_2009-1)

Again, since no one’s viewpoint is completely objective, no clear line can be drawn between a potentially “helpful” depression, and one that is in excess of that which might be helpful in a given circumstance, and so might deserve to be called a “disorder.” 

If we really “get it” that anxiety and depression should not automatically be thought of as disorders, then we might instead talk to people in a more open-minded way about what is going on.  We might help them identify the original problem that prompted their anxious and/or depressed mental states, and perhaps help them as best we can find solutions to those problems, or at least ways to work around the problems, so that further anxiety or depression is less likely to be triggered and is also less necessary.   We might do this all without ever being able to clearly define whether any amounts of anxiety or depression the person might have been experiencing were in “excess” of that which was helpful in the situation; rather, this would be an open question during the discussion, a question to explore rather than one to answer with a formula or a DSM.

But what about other serious mental health issues, such as mania and psychosis?  What possible use might exist for mental states that cause these sorts of problems?

The story at this point becomes more complex. 

Let’s start with mania.  Richard Bentall, in his excellent summary of a lot of mental health research titled Madness Explained  discusses evidence that mania is a way of defending against depression.  It is interesting to note that most of the strategies used to fight depression, if used to excess or if used by people over-sensitive to the methods, can result in mania.  For example, even a simple strategy like avoiding thinking critical thoughts about oneself can contribute to mania, and anti-depressant medications also frequently cause mania.

So, if depression is evolutionarily useful, why might we, or at least some people, have evolved a tendency to fight depression by becoming manic?  I would suggest that, just as depression is a way to address complex problems by slowing down and thinking through problems in a slow and analytical way, mania is a way to experiment with the opposite strategy, to shut out negative information, to speed up & play around with creative possibilities that might not be seen when looking at a problem in an analytical way.  Also, experimenting with mania might allow a person to escape from some life problems caused by depressed mood itself.

While mania may at times result in solutions to life problems, it is clearly a high-risk strategy.  Many people have no inclination to try it at all.  This may be because they don’t have the right genes for it, or just because they have not yet become desperate enough for it to seem, to their deeper self if not their conscious self, to be a strategy worth attempting.  To other people however such a strategy seems a natural inclination for them.  Again, rather than define it as clearly a “disorder” we might take a less certain stance, helping people look at their place in life and at how various strategies they may be inclined to try may be helping in some ways but also causing destruction in other ways, and then helping people explore options about what to do next and how to do it.

So, what about psychosis?  Does it have an evolved role in solving life problems, and if so, what sorts of problems is it meant to solve?  The answer in that case is even more complex.

“Psychosis” may be loosely defined as being out of touch with reality and/or disorganized in a way that causes serious problems, and it can occur both as part of an extreme mood state such as depression or mania, and apparently independently of a mood state or when a person appears to be in a neutral mood.  When it appears as part of a mood state, it is often just an extreme manifestation of that mood state, as in the manic person who believes he or she has been given special powers by God, or the depressed person who feels that his or her flesh may be rotting. 

When psychosis appears outside of a specific mood state, it is often thought by psychiatry to be independent of mood, or  to be a “thought disorder” rather than a “mood disorder.”  But this notion is contradicted by an extensive body of evidence showing close inter-relationships between “bipolar disorder” which is seen to be a mood disorder, and “schizophrenia” which is seen to be a “thought disorder.”  To the extent there is a genetic vulnerability, for example, the vulnerability seems to be to both of these disorders, and many people experience a mix of both. 

A practical way of understanding why some people may have “psychotic” experiences and perceptions independently of extreme mood states, may be the notion that these experiences and perceptions are often developed to defend against extreme mood states, and so while they are active, the person’s mood state becomes neutral.  Evidence for this notion comes from the fact that when people become aware that they have been deluded or psychotic, they often become depressed.  Al Galves, in a recent blog post, explores some of the ways psychotic experience may protect people from the sorts of extreme emotional states they might otherwise experience would they face their world more directly.  (For example, a person who feels depressed and useless may develop a belief that he or she has been chosen by the president to carry out a special mission:  protected by such a belief, the person’s mood may become neutral.)

I believe the story may be even more complex than Al suggests however.  Evidence exists that when it seems important to a person to control a particular situation, and yet the person has no definite idea about how to control it, that person is much more likely to begin thinking in ways that break conventional rules, in ways which consider less likely possibilities.  This results in increased perceptions of patterns where no patterns exist, belief in conspiracies, etc.  It also would appear that this sort of thinking, despite its risks, would be more likely to result in thinking “outside the box” and in perceiving patterns which others, due to their more conventional thinking, might have missed.  Some people may be genetically more prone to this sort of thinking than others (which might help explain why the risk for psychosis, and creativity, appear to run in the same families.)  But others may be prone to this sort of thinking only because the circumstances of their lives caused them to focus on trying to control more situations that could not be controlled in any straightforward way, and so they consciously or unconsciously shifted into a style of thinking more likely to result in psychotic experiences, yet also more likely to result in creative solutions.

I was recently reading how in people diagnosed with schizophrenia, there is often a very serious loss of a sense of context, or a loss of the “common sense” of the culture of the person.  This is often seen as just a “biological deficit” of the person, part of the “disease process.”  Yet, thinking creatively, as well as spiritual opening, often involves dumping what we think we know, so we can think of things in a fresh way.  People who do this to an extreme, and especially people who do it instinctively without making a conscious decision to do so, may be at risk of making a mess of their lives, and of getting diagnosed, and of getting stuck in this style of thinking, but that doesn’t mean that there isn’t also possible benefits to that style of thinking or reasons why we have evolved to be capable of thinking that way.

According to this line of thinking, there is a biological process (much more complex than the formerly hypothesized “excess of dopamine” which appears not to exist in reality) that underlies psychotic thinking – however, like anxiety and depression etc., it is a biological capacity that has evolved for a reason, and so it is sometimes helpful despite the high risks associated with the process.  If the capacity to shift into such “outside the box” thinking has evolved for a reason, then this suggests that a culture that managed to chemically suppress all manifestations of such states of mind would ultimately be crippling itself, rather than becoming more “healthy.”  It might lose the capacity to think outside of its own usual assumptions, and so lose the flexibility necessary to meet new evolutionary challenges.

A better approach would be to approach individuals experiencing “psychotic” states in a more open-minded kind of way, being unsure of what might be helpful or not, and being open to exploring that with the person.  Such an approach would include being curious about the life dilemma that originally triggered the psychotic thinking, and being open to the notion that the psychotic thinking may actually be helpful at some stage in coming up with solutions to that dilemma, rather than just being an “illness.”  This doesn’t mean failing to recognize the high risks associated with psychosis, or refusing to ever do things that might directly reduce the psychosis if that seems necessary, because after all, recognizing the potential benefits of a fever does not mean that we would never take direct action to control it if it seems to be “too much.”  However, it does mean that mental health care for psychosis should become much more collaborative, much more “pro-person” and less “anti-psychotic” since after all the psychosis may actually in some ways be serving the person, even while hurting the person in other ways. 

One reason I am a proponent of cognitive therapy for psychosis is that, at least for those in its more humanistic wing, there is recognition that work with psychosis should be “radically collaborative” and should recognize that there may be value in psychotic experiences, even ones which otherwise cause problems.  Such therapists approach their work with an open mind, and can help clients invent their own approaches to the future, seeing that they have options to take elements of their own visionary experience while also having the capacity to step back from this visionary or psychotic experience and back into more conventional views when that makes sense. 

I believe that people experiencing psychosis deserve to be helped, both because the experiences which drove them to psychosis were often very difficult and confusing, and because the experience of being psychotic in itself can be very destructive and confusing.  Yet, I also believe that those who tend to get diagnosed with psychosis have the capacity to help the rest of us as well, because they are the ones who tend to think outside of our cultural “box.”  Ideally, we will find a way of interacting with these people which helps both them, and us, have both the capacity to think in a conventional way when that is helpful, yet also experiment with thinking outside of conventions so we can make progress as a culture in dealing with our blind spots.

12 comments… add one
  • An excellent article and really gets to the heart of things. May I put it as a link on my website which is for people who I am enouraging not to go to their GP without good advice first!
    Cheers

    Hilary

  • Sure, feel free to put this up on your website! I would like to see as broad a spread for this perspective as possible.

  • I already jumped the gun and put a link to today’s post on my site. Your article is an excellent disection of what is really going on with psychosis. Now, the question is, since agreement seems to be converging and will continue to converge around the idea that psychosis is an understandable and creative solution to a deep personal problem, how are we going to convince medical schools to stop teaching the disease model of mental illness? As soon as someone has a psychotic break or a depression and enters hospital, their problems rapidly escalate in ways that have nothing to do with the reason they were there in the first place.

  • Rossa, I think it is still a small minority who see any purpose behind psychosis (and I would describe psychosis as an attempt at a creative solution, since not oncommonly the attempted solution makes things worse. Of course, if the person is protected from his or her worst impulses, and given a chance to work through the bad ideas to get to something better, the eventual end state is more likely to be that creative solution.)

    I have little idea how to stop medical schools from teaching a disease model, nor how to get hospitals to less frequently traumatize and alienate people they attempt to treat: but I know a beginning is to get more of us talking about the problem, talking about possible solutions, and forming alliances with each other.

  • Sigh. I came to the same observations about psychosis that you do after really paying attention to the environment around my son and the possible reasons why he couldn’t cope. Psychosis doesn’t just “happen.” Hopefully, the Internet will provoke exchanges of ideas that were previously not given the light of day.

  • You are lucky that you were able to defy such odds. I find the schizophrenia paradox terrifying. or a terrifying paradox Now I take small doses of abilify to keep me writing because I can’t stand reality. Reality sucks. I like the pills. The pills make me happy to escape. They tell me (repeatedly) to take this pill that does absolutely nothing (I think? or that I know of?) regardless of whether I’m on or off it. I stopped for two months and didn’t hear voices or anything, but I was dealing with itchy eyes…probably from smoking (it’s the whole self-medicating thing) I’ve been brought up to do this but I don’t care. I really don’t care no one can help me and I’m slipping away…oh well. That’s insanity for you. At least I’m not suicidal and feeling like I am fake….since the real me does not exist in reality just the illusion of a medicated me. Of course, it’s a battle. An endless good and evil game….take the blue pill or the red pill. Life falls apart when you take the red pill, slowly gradually swiftly crumbles into nothing. And maybe that’s good. It’s all metaphorical…amazing poetry written by none other than me.
    I wrote a story when I was 14 about a girl who was brainwashed and stuck in a room…and a government that had people circling highways for oil…ironic it all comes true. Ironic how dreams can manifest…ironic how I feel I hate myself. Well they won I guess. Because I dont know anymore. I dont know….anythting I cant tell if I’m here or there or if I’m me or just complaining. Well this is life. live and find the shiny silver lining. Ignore the truth I guess.

    Good luck and I hope you dont take this personal. I try not to say things…but then it all comes out. the sad part is I wanted to experience my madness without ‘them’…that’s why it hurt. I defied…I stood up and said I didn’t want to take the pills and look how I benefited!

  • It’s with mixed feelings I see this line of thought rising again. I love the work of John Weir Perry as much as anyone else, don’t get me wrong. I believe in a spirituality of ceremony–the honoring of air, fire, water and earth–and in many SZ “delusions” there is a hunger toward transformation through immersion in ancient mythic patterns. And yet: here we are, today.

    We know so much more about the effect of environmental toxins such as heavy metals, food additives, and the ubiquitous synthetic poisons that are rife in the tissues of everyone on this planet. We accept that they cause cancer, diabetes, whacked hormones and obesity to the body–but find the high flying mind immune. But is it so, and if not, how relevant is this information? See Dr. Sherry Roger’s DEPRESSION: CURED AT LAST. She cites only primary sources of research: articles from toxiciological journals, allergy MDs, etc. All of this poison truly does affect mood and behavior. Hence, it seems cruel to ignore these incredible findings, to insist that the mind must toil on finding alternate “defenses” when in fact, gasp, it could become truly well.

    But the root of your romantic argument–for I’ve found that people like Al Galves won’t even look into the nutritional/environmental causes–is the mistaken notion of the Brain Disembodied. We think ultimately our minds, our will, our holy spirits can rise above it all. I too believe strongly in the human spirit. But to downplay the serious dismantling of the health of the body (which, yoo hoo, includes the brain) by the Industrial Revolution through post-modern techno culture…this really chagrins me.

    I keep waiting for more mental health activists to catch on, but understand that to embrace the work of the likes of Mark Hyman, MD or Harvard’s Martha Herbert is scary. It takes courage to accept we’re all in this together because we’ve all poisoned the planet/ourselves/our minds. If “mental” as a separate category goes away, whither our advocacy, our blogs, our adversaries, our identities? We need the vision to see what we can become instead: warriors for wholeness, within and without.

  • Ron,

    I am so happy and proud of you for what you’re doing and writing these days! It seems to me, even in the short time I’ve known you (via the Net) that you’ve matured and developed so much. I hope you keep on writing and talking and trying to inject a little common sense into our benighted “helping” professions. Do you have a book in the works?? I hope so!! Mary

  • Hi Sue,

    I see myself as a person pretty much like Al Galves (he’s a friend) but I don’t deny the effect of stuff like toxins on creating mental health problems, or good nutrition in helping to solve them. Certainly, one of the fastest ways to create psychosis is to use a toxin like meth for an extended period of time.

    What I am saying is that I think psychosis is an evolved response to stressful situations where it seems urgent to gain control yet one sees no clear way to do so. Using this understanding, it is clear that toxins can trigger this response, both by increasing stress and by reducing mental clarity, making it harder to see how to gain control and/or when one could just as well let go. And conversely, getting good nutrition, just like getting good sleep etc., can reduce stress and improve clarity, making it less likely that this response will be triggered.

    What I don’t accept is the notion that psychosis always results from stuff like toxins or failure to meet physical health needs. I think the real picture is much more complex than that. If you see psychosis as strictly physical, then if your physical correction doesn’t work, you have no alternatives but hopelessness. (Just as, if you see it as a “biochemical imbalance” and then your drugs don’t work, you are hopeless.) But if you see it in this more complex way, you will still support physical health, but then additionally have a perspective from which you can address the psychological and even spiritual angles, which are I believe the primary factors in a great many cases.

  • Anonymous,
    I believe your comments were directed to me. I’ve been thinking about what you said about getting off meds and look what happened, meaning you were no better off, so it sounds like you are feeling punished for doing what you thought would work and it didn’t. There is no quick fix here. You will work it through for yourself eventually, and if you hate yourself, you are in good company. To me, self-doubt and self-loathing is at the bottom of most of our problems. Comedians come to mind. They will admit that the reason they are funny is because they really don’t like themselves, but they’ve found a way out in humor. Self-doubt fuels a lot of artistic endeavors. You can make it work for you.

    Sue – I am all in favor of vitamin therapy, too, but I feel that, that like medications, it is still restricting madness to faulty biochemistry. Many people are disappointed when they change their diet and add vitamins, and they still have problems. A lot of people, including my son’s holistic psychiatrist, seem to think that it was all about balancing the biochemistry. Even I was amazed when my son went “bonkers” again after he had been taking vitamin supplements and restricting his diet. I had to do a “re-think” in his case and I concluded that he had issues he was continuing to resolve. We could give him all the vitamins in the world, and he still wanted an escape hatch (psychosis). You also mention that we accept that certain cancers and other diseases have a link to toxins, etc. so shouldn’t we apply that thinking to mental health conditions as well? That is a valid question. I actually go further. If we say that mental health has a psychospiritual dimension, then why not also apply the psychospiritual dimentions to physical conditions? Here, I reference people like Bert Hellinger, a former Jesuit priest who has popularized Family Constellation Therapy in Germany and Anne Ancelin Schutzenberger, a French psychologist (The Ancestor Sydrome). Most of us have a hard time accepting the idea that a child’s illness can be a response to the family situation, because it seems to unfair and let’s face it, spooky. It’s also not very North American in its outlook. Both Hellinger and Schutzenberger make these links, and for both physical ailments and mental illness.

    I am saddened to read about people who say they tried vitamins, etc. and it didn’t work. What then do they do? They are still mentally ill, unfortunately. Dr. Dietrich Klinghart has what he calls a healing pyramid. He says, pump everything you can into Level 1 (vitamins and meds) and if that doesn’t work, then your problems are at Level 4, psychospiritual, and other interventions are needed.

  • RonUnger,

    I think this article makes a lot of important points on what we face when diagnosed with thought disorders. I think it’s important that no one is grouped or categorized, and it’s easy for the mental health system to fall into that trap. Hopefully healthcare reform might change this sometime in the future.
    I liked what you wrote about human coping mechanisms. Like soldiers who return who are also suddenly afflicted with mental illness, there are a lot of factors.

    Perhaps “thinking outside the box” is an evolutionary trait…in fact I would say humans wouldn’t be humans or “conscious” above the other animals if we didn’t think outside the box. That’s what makes us who we are. So of course if someone was faced with an impossible situation they would go into overdrive and think too creatively or out there…of course there are many different kinds of people with different responses to the world. We should learn to recognize the individual not the label or group we associate them with.

    Rossa Forbes,
    Thanks for the reply you are right. Though that wasn’t directed at anyone in particular. Something I’ve noticed is that I’m a very multi-faceted person, and I am very sensitive to people’s thoughts and the environment. This sensitivity could also play a role. When we have an ego breakdown or grow up from our shells we have to face that nothing always goes our way, and sometimes this leads to crisis.

    I agree with the author that it can be detrimental to always think you should take medication. I’ve noticed I don’t get the same effects from something if I don’t need it. Like food, you don’t feel as good if you eat when you aren’t hungry. With meds, they don’t do anything when I don’t need them but meds are difficult to gauge with how they’re working.

    I was off meds for three months and I learned to cope and the auditory hallucinations stopped, but the uncertainty led me to start again….and I became conflicted because the chemical change actually made my symptoms come back. Then, when I am in a different place or state of mind and I think I need them it works..

    Then I look at my mother who is suffering right now from mania and delusions. I think she would be using the denial mechanism to cope. But what with? We’re all being so nice to her and she’s just so upset and out of touch. That’s where it’s hard to know where to draw the line.

    I know what you mean about vitamins not really working all the time. I started taking a vitamin for depression and it has helped though. Sam-E. I’m pretty logical, down to earth, etc. when I’m stable. Though this comes and goes with or without meds. The depersonalization feelings off of meds is one reason I stay on them, and another reason why I worry about them being a psychological response not a chemical one. But I’m probably wrong, I’ve probably been helped in the long run.

UA-10331854-1