Ep 24: Mental Smoke Detectors (Randy Nesse)
Why hasn’t natural selection eliminated human diseases? Are bad feelings like anxiety and depression adaptive? Can we use evolutionary biology to improve medicine?
Randy Nesse is a doctor and a scientist at Arizona State University who uses evolutionary biology to inform the practice of medicine. In his latest book, “Good Reasons for Bad Feelings,” he discusses how natural and sexual selection may have shaped our psychological and emotional lives. On this episode Art and Marty talk to Randy about evolutionary psychiatry.
Want more info on evolutionary medicine? Go to the International Society for Evolution, Medicine &Public Health’s website: www.isemph.org
Follow Randy on Twitter: @RandyNesse
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Marty Martin 00:00
Support for this episode of Big Biology comes from Sable Systems.
Art Woods 00:03
There's basically no other company that has had such a big impact on my research. I started using some of their products to do insect respirometry when I was a postdoc. I fell in love with their modular, intuitive, easy-to-use machines, and when I got my next job I bought a whole respirometry system based on their gear.
Marty Martin 00:19
You know, I was always surprised by the way they encouraged me to modify their devices myself. Most companies ominously tell you that opening the device voids a warranty.
Art Woods 00:27
Sable Systems gear is designed by working scientists who understand that every experimental setup is unique and that systems must be highly customizable. The devices are unfussy, robust, and easy to set up.
Marty Martin 00:40
You can find their products at sablesys.com. That’s s-a-b-l-e-s-y-s dot com. For early humans, the world was a dangerous place. They worked hard to find enough food while avoiding danger from predators and humans they didn’t know.
Art Woods 01:00
But perhaps the single most important thing for our ancestors was navigating the complexities of living in groups with humans they did know.
Marty Martin 01:07
Evolutionary psychiatrist Randy Nesse argues that all of those ancient pressures profoundly shaped how our minds work today.
Art Woods 01:13
Randy is one of the founders of the field of evolutionary medicine and a Professor at Arizona State University where he applies evolutionary biology to the practice of medicine and particularly psychiatry.
Marty Martin 01:23
Instead of asking how someone became depressed or anxious and could get better with drugs or therapy, Randy wants to know why our minds are so fragile in the first place. Why are we vulnerable at all to mental problems? His recent book, Good Reasons for Bad Feelings, considers evolutionary explanations for our emotions and behaviors.
Art Woods 01:40
For instance, anxiety is one of the most common mental illnesses in the US, affecting about one in five people. In his book, Nesse argues that some of us experience extreme anxiety today because under many circumstances, a little of it was good for our ancestors.
Marty Martin 01:56
It was good to be anxious about prowling lions. People who weren't got eaten, so fewer of their genes are still around. But why should the genes that remain cause anxiety? Randy says that we've been asking the wrong question. It's not that anxiety represents an overly sensitive alarm system, it's that the cost of a false alarm is far smaller than the cost of no response at all. So some diseases might just be a consequence of keeping that alarm system on the razor's edge of sensitivity. Such a finely balanced system is prone to malfunction.
Randy Nesse 02:24
The right question to ask about emotions is not what they're for, the right question is, in what situation has this particular suite of changes given advantages? And once you ask that question, anxiety becomes much easier. In situations of danger, anxiety helps you get the heck out of there, and prevents you from going back to situations that are dangerous.
Art Woods 02:49
Anxiety can feel terrible, but unfortunately, our genes don't care about our happiness. If they want to make it into the next generation, their best bet is with a hair trigger lion detector. Since the early 1990s, the evolutionary psychologists Leda Cosmides and John Tooby have been studying a similar set of questions at the University of California, Santa Barbara. They and Paul Ewald, Peter Gluckman, and others have been infusing medicine with foundational evolutionary ideas.
Marty Martin 03:17
According to Randy, many of our good and bad feelings have some adaptive functions. He thinks of them like coughing, or vomiting, or even diarrhea. They're often not fun, and sometimes they're outright gross, but they can be incredibly useful.
Art Woods 03:30
On this episode of Big Biology, we talk with Randy about how he and other psychiatrists use evolutionary biology to understand the origins of the fragile mind and to come up with new ways to treat affected people with more creativity and compassion.
Marty Martin 03:44
The fields of evolutionary medicine and particularly evolutionary psychiatry are relatively new, and Randy hopes that his ideas will become a normal part of medicine in the future.
Art Woods 03:52
I'm Art Woods.
Marty Martin 03:53
And I'm Marty Martin.
Art Woods 03:54
You're listening to Big Biology.
Marty Martin 04:07
Let's start with just a big picture, what is evolutionary psychiatry? Maybe give us a brief history of the field, and we don't necessarily need to talk about its biggest successes so far. But just where did it come from? And what is it?
Randy Nesse 04:22
Evolutionary psychiatry is just a subset of evolutionary medicine, a field that really got going with George Williams and me about 30 years ago now, where we asked a different question about disease. I mean, everybody tries to figure out why do some people get sick and why do other people not get sick, and it's some combination of genes and environment. But we stepped back from all of that and instead asked this other question of why do any of us get sick? Why didn't natural selection just do a better job of protecting us? Why do we have wisdom teeth and why do we have a blind spot in the eye? And why is the birth canal so narrow, and why can't we do better getting rid of cancer and infection? And why do we have acne and hemorrhoids? You'd think natural selection would have done a better job, and once we started asking that seriously, we realized that it was a fundamentally new question. Everyone had assumed that natural selection makes things work well, and nobody previously had really paused to ask, so why does it goof up? And we came up with several categories that have inspired lots of people to do wonderful science, really trying to ask this new question. So evolutionary psychiatry and evolutionary medicine, they're not fields of practice. A lot of people think, oh, it's like alternative, something or another? No, there's nothing alternative about it. It's like genetic medicine or genetic psychiatry, it's just applying a basic science. But it does give you a pretty fundamentally different view of what disease is, and that makes it just deeply interesting to everybody. So so how did you end up linking forces with George Williams and, and developing these initial ideas? How did you guys get together? So I read George Williams 1957, where he offered an evolutionary explanation for aging. And that led me to a couple years of research on trying to gather data from animals in the wild about their rates of death at different ages. And I very quickly was able to show that there was strong support for George Williams's ideas. So it turns out when I finally met him, he had been looking for a doctor to work on evolutionary medicine, and I've been looking for evolutionary biologist, to try to take an evolutionary view, not only of psychiatry, but of medicine in general. And so we wrote a paper and then we wrote another paper, and then we wrote a book, and that gave rise to the whole field. Evolutionary psychiatry is much later, really. Now I can say, I think, that I've been a little quiet about being a psychiatrist. I've been an evolutionary doctor, because a lot of people don't take psychiatrists all that seriously. So so I've been writing papers about evolution in cancer, evolution in infection, evolution in Alzheimer's disease, things like that. But now it's time to really bring the whole thing full circle, and to see just how much progress psychiatry can make, if we actually put it on the same foundation that we do for animal behavior. And other studies of behavior.
Art Woods 07:02
So I feel like there's been a lot of excitement about these ideas among, you know, the sort of tribe that I'm part of, so organismal biologists, evolutionary biologists, you know, people doing basic biology research. How much headway have you made with psychiatrists?
Randy Nesse 07:17
You know, it depends on where you are. In England, the Royal College of Psychiatry has a special interest group called the Evolutionary Psychiatry Special Interest Group with over 1000 members. It's just, and they have meetings every few months, and they're fabulous. And Italy next month, there's going to be a big confab for evolution, and psychiatry. In the United States, everybody I've talked to is interested, but not many of them know about my book yet. Publicity has been great in Europe, but not so great in the United States. Once they hear about it, they say, wow, this is kind of what we've been looking for. But they really don't know much about it. So I can't see it as much progress really.
Marty Martin 07:57
Do you have any ideas about why the difference is in the US?
Randy Nesse 08:02
Well, you know, we're a backwards country, in terms of evolutionary biology, and half of the population doesn't really get it. And people imagine it's political or something, which is really too bad. I mean, I must say, I have sympathy for people who find the ideas disturbing. You know, it's a very disturbing idea to recognize that, it's bad enough that our bodies were, you know, a product of natural selection. That our minds were to? There was a really big, wonderful meeting on evolution and medicine in Spoleto, the annual Italian Science Festival with 1000s of people. And I was thrilled that the Vatican paper said all the talks were really wonderful and excellent, except for the talk by Randolph Nesse. Because all the other talks were about, you know, bodily kind of things, and my talk was about the mind. And they said, well, that just goes one step too far.
Art Woods 08:58
Just too close to home for them.
Randy Nesse 09:00
Yeah.
Marty Martin 09:01
Interesting. So let's get into the details of evolutionary psychiatry. What is the problem in your mind about considering brain disorders, mental diseases? And how does evolutionary psychiatry approach the concept?
Randy Nesse 09:16
This only makes sense in a bit of historical context, but the big picture is that there's huge controversy still swirling around psychiatry, and it's confusing, it's contentious. It's a debating point to me. The New York Times every week or so has some article by somebody with some strong opinion about psychiatry in general. Well, that doesn't sound like a proper scientific field. We're supposed to make steady progress, you know. And so there's something called the Diagnostic and Statistical Manual that was revised.
Marty Martin 09:44
The DSM.
Randy Nesse 09:45
Yeah, the DSM-II was kind of cool. DSM-II you said, did a person have bad feelings, for no good reason? Yep. Okay, that's depression. And that, it was anybody's opinion. But DSM-III made it properly objective, so you had to count the number of symptoms and how long they had had them. And, and with that, all of a sudden you could do reliable diagnosis. And at the time that this was created in the 70s, everybody thought, this is a temporary system until we can find the brain abnormalities. Because what we're going to do is just like the rest of medicine, we're going to use microscopes and genetics, and scans and diagrams, and autopsy results, we're going to find out what's wrong in the brain, for depression, schizophrenia, autism, everything. And that hope has persisted. But the deeply frustrating, disturbing, shocking thing is that we have not been able to find specific brain abnormalities for any of the major mental disorders. Most people see these.
Art Woods 10:43
That's really astonishing.
Randy Nesse 10:44
You know everybody, you see these pretty pictures with brain scans and light up pixels, and and you hear about a new gene for this new gene for that. Yes, but none of them reached the standard of evidence of saying, yep, if you got this, you got the disorder. It just just hasn't worked. So here's the most fundamental problem for a whole field. Why is it that we haven't been able to find, I mean, there must be differences in the brains of people with autism and schizophrenia from other people? But why can't we find them? And one good answer that I hope is right is, we got to just keep looking. You know, I really hope this will work. I'm not one of these guys who says, you know, forget about, you know, reductionist research. I think we need to keep looking really hard. But the studies for genes, wow, I mean, at the turn of the millennium, it was really clear that whether you get schizophrenia, or autism or bipolar disorder or not depends almost entirely on what genes you have. It doesn't matter what happens to you are what your parents did to you. If you get an identical twin with one of those disorders, you're probably going to get it. So it seemed really obvious, we're going to find the genes and find the cause. But thanks to cheap genome sequencing, we've now been able to run 10s of hundreds of 1000s of people, and it's really clear that there are no common alleles, genetic variations, that strongly predict any of these disorders, they all influenced the risk by 1% or less. There are a few copy number variations, a few exceptions of really rare things that have bigger effects. But this has been a shock to everybody. Likewise, with brain scans, we thought we were going to in the decade of the brain, find the spots in the brain that were wrong in schizophrenia, autism, bipolar, no, no such thing. There are some generalizations. I mean, you can show that brains of people who are depressed are somewhat different from other brains, but not enough to make a diagnosis, and certainly not enough to identify any specific abnormality. So everybody's wondering, okay, what do we do next? And, you know, I'm a big advocate for don't complain too much unless you have something else to offer.
Marty Martin 12:53
Good mantra.
Randy Nesse 12:54
Yeah. And, you know, so and I do think evolutionary biology has something fundamentally new to offer. I mean, the large picture is that, first of all, you distinguish diseases from symptoms, like the rest of medicine does. People say, oh, are you trying to take psychiatry away from medicine? I said, no, I'm trying to take psychiatry to medicine, and show how it really can be done in the same way we do the rest of medicine. Other doctors carefully distinguish symptoms from diseases. You come in with a cough, the doctor doesn't say, oh, you've got cough disorder, take this cough syrup, it'll make it go away. You go into your doctor with anxiety, the doctor says oh you got too much anxiety, you take this drug, it'll make it go away. But anxiety is a useful response, you know, just like cough or fever or vomiting or pain. So once you start thinking that way, you realize that, first of all, you got to look to see if something might be arousing that symptom, just like pneumonia might arouse cough, what might be arousing anxiety. And second of all, you have to ask about whether for this individual patient, the amount of that symptom they're having is about right and useful, or maybe it's normal, but not useful in that instance, or maybe the whole system that regulates that defensive response is not working right. So it really helps you think more deeply about things.
Art Woods 14:08
I want to come back to this stuff you were just saying about the utility of anxiety and depression. And I want to spend some serious time on that. But before we do that, let's circle back to your comments about about genetics and the genetic underpinnings of of these conditions. And it's this sort of funny spot, right? Because the claim is that our mental architecture and our mental states are products of evolution. And so of course, that implies that there are heritable traits in there that have genetic influences, and that there are alleles that affect these states and so so is the claim that there's no genes of large effect that are determining these mental states, and it's, it's a collection of very small effects from very many genes, and it's much more of a statistical thing. Is that is that where the heritability comes from?
Randy Nesse 14:59
You know, this is my current project Art, is to try to ask the question about why would genetic variations that are associated with disease persist? And the easy answer is that mutations happen, and it takes a while to get rid of them. That's called mutation selection balance. A lot of people have speculated that these genetic variations that are associated with disease actually are useful. I don't think there's much evidence for that, actually, although it deserves consideration. I've been looking much more at other possibilities. And I could go into those if you want to, it's a bit technical, to try to figure it out. But, you know, everybody just kind of assumes that, you know, if you have a genetic abnormality, that abnormality is gonna cause a problem. But that's not how natural selection has shaped the body. Almost all traits are not product of one or two, or 10 genes, they're products of like 50, or 100. In fact, if you look at height, height is the best example of all. How tall you are, depends mostly on what genes you have, how tall your parents were. So you'd think that we could go in and find the genes for it. Not so, it's just like with with these disorders, it's 1000s of genes, each of which influences things by less than 1%. Even if you take the top 50 genes for height, together, they explain something like 10% of the variation in height. I think we're dealing with the same kind of situation for things like anxiety and depression, and other disorders. But you know, the whole, this is why I say, an evolutionary view gives you a fundamentally different view of the body and disease. I think there's a tacit creationism, often, in a lot of medical research, as if the body is consisted of these genes and boxes and arrows, and they go together in simple ways, kind of the way we force our students to memorize things for their tests. But you know, whether it's the clotting system or the immune system, they're not so simple as those simple boxes and arrows, almost everything influences almost everything. I love that leptin was supposed to be the hormone that controls body weight. And there's a great book by Jay Shulkin and a colleague about this, they pointed out that leptin has at least 40 different functions, sometimes serving different functions in the same cell. We're thinking about the body as if it's a machine, and once you take a deeply evolutionary view, you realize that all of these genes are interacting in enormously complex ways to create traits and things that work pretty well. Quite well, actually. Yeah, a sort of giant network in pleiotropy. That's right. It's all networks in pleiotropy.
Marty Martin 17:47
Correct me if I've got your your words or your sentiment wrong, but towards the end of the book, I think you mentioned that you see value in considering life more as a process than a thing.
Randy Nesse 17:57
I mean, it's certainly right. But I would talk about, you know, bodies as systems, you know, that that comes very close to my current thinking. And really, what's, what bodies are, are bundles of things that regulate things to replicate the information into a new generation. So it's all homeostasis, and adjusting as a function of the environment. So what's disease? Disease is when those stabilizing systems go wrong, for any kind of reason. And this means that I'm thinking more and more in terms of control theory, a somewhat technical mathematical treatment of things, but everything from how much RNA a particular gene makes, to how nauseated you get when you smell something foul, I mean, everything is shaped by control systems. And I think most diseases and especially psychiatric ones, can be understood as control systems not working right. We could talk about eating disorders now if you'd like to and drug abuse, those are dramatic examples that, they're genetic factors, but they're not genetically abnormal. What's wrong in those disorders is that a normal regulatory process was spiraling off into a vicious cycle, where the more you do the worse it gets and the worse it gets, the worse it gets. I think that's probably true for,
Marty Martin 19:19
How much is this, sort of percolating through the medical and psychiatric fields? Are there people taking this mindset and running with it research wise? Or are you the sort of outlier right now?
Randy Nesse 19:28
Um, there are a few of us. But I, I wish I could say there were hundreds of us actually doing research in this area. We need funding to study some of these things. And later in the program, we might talk about where I'd like to see those funds put to do specific things. But if you go to the National Institutes of Mental Health and you say, I'd like to understand the fundamental reason why low mood exists in the first place, how it's regulated and how it's useful, they'll say what? They're so fixed on the idea that we are going to find these specific brain abnormalities to account for these disorders, that taking the larger, more deep scientific picture of trying to understand how things actually work, it's just not on their radar. On the other hand, if you really want to be like, that's what medicine has done, I mean, doctors who understand kidney disease, they don't just go looking for the cause of kidney disease, they first understand how kidneys work, and how they're how they're regulated and how they get dysregulated. And I think once we start doing the same thing for thinking and emotion, and the like, we're going to make progress the way the rest of medicine has.
Art Woods 20:38
So let's talk about that with respect to anxiety and depression. And I'll say, I had a sort of stunning revelation when I was reading your book. And so here's my favorite line in the whole book, which maybe is an odd one to pick. But you said, the standard way to tell if a drug will be an effective antidepressant is to see if it makes an animal persist in useless effort. That feels like somehow a revelation to me. So what do you mean by tha, and what are the uses of anxiety?
Randy Nesse 21:09
Let's work our way from emotions to anxiety to depression, okay? Because we've got to just to say a little word about that, because back in 1990, I wrote what's probably one of my most important papers, called an evolutionary approach to emotions. And I spent a couple of years trying to understand emotions, because heck, I was treating people with emotional problems all day long, you think I should learn something about it? And oh, man did it, did that whole business spur emotions in me. It was so frustrating, you know, I kept reading these things about how many different emotions are there? And are there basic emotions? Are there dimensions of emotions? Where can we find them in the brain? Can you have emotions without being aware of them? I'm just, gave me a headache. And then finally, I read William James, who said, you know, oh, I'd hate to go through all of that emotions literature again, I'd rather move rocks on a New Hampshire farm. And I thought, Okay, I'm at least in good company here, you know, with my frustration, but I think most people who have taken an evolutionary view of emotions have tried to figure out what each specific emotion is for. And that seems like a natural evolutionary approach, hey, it's got to be useful. What's it for? And this is, again, thinking of things like machines. This is a hammer, oh, there's hammers for something, a hammer is for something. But anxiety has all kinds of functions, it communicates with others, and it motivates action to protect you, and it spurs your physiology system, the right question to ask about emotions is not what they're for. The right question is, in what situation has this particular suite of changes given advantages? And once you ask that question, anxiety becomes much easier. In situations of danger, anxiety helps you get the heck out of there, and prevents you from going back to situations that are dangerous, either physically or socially. And that takes us to think, oh wow, anxiety is actually useful. And I specialize in treating anxiety disorders at one of the world's first anxiety disorders clinics. And it was more than 10, 15 years I was into that work before I finally took really seriously my own ideas, and said, wait a second, these are useful responses. And I started talking with my patients about that and saying, you know what, you're suffering terribly, you can hardly go out of the house. But there are people who have a worse problem. They never experience anxiety at anything. And they die. And all of a sudden, my patient's eyes lit up, and they said, oh, gosh, so I'm not just completely an abnormal person? So there's something useful about this? And that helped them quite a lot. And it also helped me, the next advance for me was something called the Smoke Detector Principle. I kept asking myself, so why does this system go off way more than it should? It's, you know, I was frustrated with my patients, I'd do behavior therapy, and the person would go to the grocery store five times and run out each time because they had a panic attack. And I would say to them, nothing bad has happened, why are you still feeling anxious, and they would say Doctor Nesse, I just, it just happens. But finally, it dawned on me that smoke detectors give us false alarms. And we put up with them because we know, we want that smoke detector to go off every single time that there is a real fire. And so then I started doing the math. And if you do something called signal detection theory, you quickly realized that if the cost of a response is kind of low, like even a panic attack costs like 100 calories, but not having that response might be disastrous, like the lion actually gets you. Then natural selection is going to shape that response to go off every time there's even a small chance that the lion is present, and those panic attacks are going to be perfectly normal, although useless in the individual instance. Once I started explaining that to my patients, about a quarter of them said, oh, wow, that makes sense. I'm going to quit worrying about this, thank you very much, I'll call you if I need you. It was such a revelation to have, that's probably the most practical impact. The other three quarters of patients, they needed medications and behavior therapy and psychodynamic therapy, they needed all kinds of help to get past it. But just the fundamental understanding of what we're dealing with, and why there are false alarms, it was just a revelation to everybody.
Marty Martin 21:13
Ooh, emotions, okay.
Randy Nesse 21:39
So it seems like, you know, any individual anxiety attack or panic attack is going to have a very low cost, and you framed it in terms of 100 calories spent. But a lifetime of anxiety and panic attacks add up to a lot of health problems, right, physically and mentally. And so is the issue just that, you know, those accumulate over such long periods of time that most people throughout our evolutionary history didn't even live to be that old anyway. And so is it a function of us living to old age? So let's pause about this the health problem business, you know, every few months, there's an article about how anxiety is going to kill you, because it's stress. But there's a huge bias in that whole literature. Nobody writes articles about how not having enough anxiety is more likely to kill you much quicker.
Art Woods 26:21
Yeah.
Randy Nesse 26:23
And there's a lot of people who want to sell drugs, who would like you to, you know, think that your anxiety is going to be fatal in physical ways as well. Yes, there is evidence that people who have chronic really bad anxiety are likely to have more other problems, physically, but you know, that just makes people with anxiety feel more anxious about being anxious. Thank you very much, Doctor.
Art Woods 26:47
Meta anxiety.
Randy Nesse 26:49
Yeah, right. Right. And that's a classic example of these kinds of positive feedback cycles that I was talking about a minute ago. And in fact, maybe we should talk about that with panic disorder while we're on it. Because the essence of the problem for many people with panic attacks is that they fear the symptoms of panic itself. And it's often caused by doctors. I mean, someone suddenly gets an episode of rapid pounding heart rate, and shortness of breath, and sweating, and a terrible feeling, and they're rushed to the emergency room, and the doctor examines them carefully and says, you know, I don't find any specific problems. I don't think you're having a heart attack right now. But you should be very careful. And if it keeps happening, come on back. Wow, that's like a perfect way to create,
Art Woods 27:34
That's gonna raise your heart rate right there.
Randy Nesse 27:35
So then the person starts monitoring themselves, and they're out mowing the lawn, and their heart rate goes up. Uh oh, is it happening? And of course, once they think, uh oh, is it happening, that causes anxiety, that causes more heart rate, that causes more anxiety, and they're off to the races with a full blown panic attack all over again. So this is another simple idea that I think helps doctors and patients, to better understand what this is and to deal with it. It doesn't completely solve it, you got, the key to treatment for panic disorder is to get the person to go into the situation where they're likely to have panic attacks and just stay there until the panic attack comes and it goes. When it goes away, that actually signals to the brain that you don't really need to have a panic attack, thank you. So doing that repeatedly is really effective as therapy, but it's hard as heck to get people to do that, because it feels awful.
Marty Martin 28:40
So Randy, one of the criticisms, devil's advocate here, one of the criticisms of evolutionary medicine, probably will always be that it's hard to do the experiments. So, is there evidence in light of what we're talking about specifically, that some form of anxiety, I mean, is helpful in the traditional influencing fitness sense? Or could you think about ways to look at the data that exists to get some footing on that?
Randy Nesse 29:05
Not much, actually, this, there are a few people who have tried to look for instance, at people who have more anxiety than usual, and see if they have fewer car accidents or something like that. And that does not pan out very well. But again, these are so different from things in the natural environment. Just can't do that.
Marty Martin 29:25
Okay. So let's do a little bit more with emotions. I'm sorry, I gotta be a little bit selfish here, because I was telling Art earlier today, that part of the reason that I became a scientist is that my grandfather challenged me, it must have been, I think I was eight years old, 10 years old. He challenged me at some point in my life to explain emotions, because he loved Darwin, and he loved Darwin's book on emotions. So let me just channel him and ask you the question, why are some people so much more emotional than others? Will that get you any grounding on this sort of emotion as adaptation perspective?
Randy Nesse 29:59
Yeah. You know, that is a profound, unanswered question. And isn't it?
Marty Martin 30:04
He was a smart guy.
Randy Nesse 30:05
Isn't it fascinating, though? I mean, some people you say, what about your emotions? And they say, what do you mean about these emotions things? You know, they just don't get it. And other people, you know, you look at them wrong, and they collapse in tears, they start yelling at you. It's such a huge range. I mean, I think my answer is that, you know, there's not a big fitness difference between people with somewhat more and somewhat less emotional tendency than others. But this is so important for psychiatry. And with borderline personality disorder, for instance, one of the most serious chronic problems we deal with, most of those people are extraordinarily socially sensitive. And they have huge emotional responses to small things. So somebody looks at them wrong, and they say, why are you against me? And then the person starts oh, well, I wasn't before, but now I am, you know. So they're, so it really causes terrible problems. In fact, stepping back from this whole thing, emotions cause most of our problems. What we want is to feel good and happy, and not too many of us can for very long at a time, because we're always worrying about something or angry about something or bored about something or depressed about something, and our mind keeps wandering back to the problems, instead of the positive things in our lives. It's kind of like your tongue keeps going to the little sore spot in your mouth, you know, it just can't quite help it. I think there's a good evolutionary reason for that. I mean, the mind has all this processing power, and it spends it, trying to solve problems and, and get us to get more resources and find more mates and have more babies. So we're kind of trapped in that cycle that's been shaped for us. But I find it fascinating that, and knowing these things about emotions and evolution, it doesn't cure them. I mean, we all have bad feelings. I had a little bout of bad feelings other day. And it was a little bit helpful to say, oh, I know what that's happening. Yeah, my mind is trying to get me to do this, which might be good for my genes, but not good for me. It didn't make it go away, but it gives you a little sense of humor, you know about, about bad feelings, I wish it could make them go away, because it's such a problem and depression and anxiety together, cause more disability adjusted lost years than all other medical disorders. These are worse, even than chronic pain, on chronic pain is worse. It's worse than cancer, worse than heart disease, I mean people suffering with bad emotions. Part of it is due to the Smoke Detector Principle. Part of it's due to the fact that life is tough, and other people want the same things that we do. And they're not always honest, and sometimes they're mean. Sometimes it's because the system is broken, either genetically or because of the modern environment kind of things. But it's just, once you see, like, 1000s of patients whose emotions are really crippling their lives and making them awfully miserable, you just have to wonder who designed this thing? You know, it's just like, you know, is this all a cosmic joke or something? And I'm sympathetic with all the folks who want to know go find people who have depression, anxiety, it's mostly drug company supported stuff. I wish the drugs worked better, they work some. But so I'm sympathetic with that, but stepping back again, it's just horrible that so many people suffer so much with these emotions to so little purpose. Can I get one more in here about emotions? I lied, we can't move on yet. Randy, do other animals have emotions? And how would we know? Well sure they do have, I mean the feeling part of an emotion is only one part, right? I mean, and other parts include your physiology and your behavior, or your memories and your learning and your, there's all these other things that are part of an emotion. No, you can't really tell whether another animal is actually feeling things in the same way we are. But they certainly do have behavioral control mechanisms that make them behave differently. Even bacteria behave differently in different circumstances. When things dry up, they've got a special mechanism that turns them into spores, so they can survive till another time. That's pretty dramatically different from being in your cave in the winter with no food and curling up in the back corner until it's spring, and not eating because if you go out to try to eat, get stuff to eat, you're gonna die. But it's the same general idea.
Marty Martin 34:26
I like your, I think this is your definition from the book for emotion, specialized states that adjust physiology, cognition, subjective experience, and I think there was more to the list, to meet the challenges of situations that have occurred to a species. So that captures all of those different things that totally different organisms are doing that all sort of fall up under that emotion, and below.
Randy Nesse 34:44
So you might also recall that, I think, everybody writes a paper to define emotions. There are like 50 different definitions and papers written about all the definitions. I think an evolutionary approach really does solve this because instead of just thinking of some brilliant person's ideas about emotions, you say, wait a second, these are products of natural selection. So how can we understand what they are in terms of how they were shaped from their precursors and how they give advantages. So I think that simple definition, that they are specialized states that coordinate all kinds of things together to increase your ability to cope with situations, that actually provides a solid foundation of going forward with emotions research.
Art Woods 35:28
I'd like to ask a question to you with your, maybe with your psychiatry hat on, but, so if I talk with my colleagues at different campuses, I think I think the general sense is that we see maybe more emotional suffering and mental illness among students on campus than we feel like we used to. And I don't know if that's actually the case. So I guess the question is, do you think there are changes among students in sort of mental illness? Or is it that it's the same as it's always been, and somehow it's now more out in the open than it has been?
Randy Nesse 36:06
It's a profound question, but one that needs data. And I try to be a proper epidemiologist, and not just go off saying stuff about these things. There's pretty good evidence that mental disorders are not dramatically more common now than they were 30 years ago. An article just came out last week, looking at worldwide data of incidence and prevalence rates. There's no good evidence that things are dramatically worse mental health wise. There is some evidence that for young people in the United Kingdom, over the past 10 years, there has been an increase in measurable anxiety and depression. And that's interesting, and it needs to be replicated. But there's a huge bias here as well, because if you want to do something about these problems, you document that it's a really, really bad problem. And you're trying to show it's increasing. And who wants to say no, it's not that big a problem? You can't, you don't say that. Yeah, so it's sort of like a publication bias. Low mood feels less medical somehow than depression, right. Yeah, right. So everybody well meaningly, wants to really emphasize how big it is, and how bad it's getting and how much worse it's getting. Even as I say this I pause and I say, well, you know, the pressures on students today, because of our social system, are just horrendous. I mean, I'm so glad I'm old, and don't have to be applying for college and doing all the fussing and, and pretending and the stuff, it's just, the pressures on young people are just brutal, to get into the right school to get good scores to get into the right postgraduate school to get the right job. It's just a brutal, winner take all kind of competition, all the while people running universities say, oh, we're trying to make a more nice environment. But please apply for Fulbright, you know? So the idea of just actually getting an education getting a job and living your life, it's almost like that's not acceptable anymore. I mean, everybody's supposed to be great, you know, and if you don't do it through an established pathway, you have to make it in rap music, or on Instagram or someplace. And I think those those pressures are just huge. So I'm contradicting what I said before, it might be that these new things of social media and brutal competition have increased anxiety and depression. But it needs a different kind of research. I don't think just going out and asking people, how anxious are you? how depressed are, even if the fancy ways of asking, I don't think those really get to it? What we need to be doing is talking with people individually for an hour saying, so let's talk about your bad feelings. Let's talk about your anxiety. Let's talk about your depression. What are the main things you're trying to do in life? I mean, how's it going? What are the obstacles? What are the risks? What are the frustrations? Are you hitting a dead end anyplace? If you are, can you give up and change, or are you kind of trapped, pursuing that unreachable goal? And we've finally gotten to your point Art, that you started us off with, which is what I think is probably the most useful thing I've come up with for low mood and depression. The residents I've trained tell me the most valuable thing I've taught them is ask your patients, is there something terribly important you're trying to do that you just can't succeed at, but you can't give up? And asking that question often reveals what's going on, even after you're talking to the person for an hour previously. They might say, oh, actually, I feel like I'm supposed to be home taking care of my mother with Alzheimer's disease because she's in a really cruddy home. But that would mean giving up my job. And I feel guilty about that every minute or, you know, I spend every minute worrying about my daughter, who is addicted to heroin. So I call her and she won't even answer the phone and then I cry, and I try to figure out what to do. And then there's a person who says, you know, what I really need to do is stop drinking, but I can't and I'm depressed. And I think I should just kill myself. So I mean, people are often trapped, trying to do something that they can't succeed at and can't quit. And as you know, some very short podcast types asked me so Doctor Nesse, you think everybody should just give up? No. I mean, if it were, if it was easy as that people would, people would do that, you know. But a lot of these things some people think people can give up. I mean, there was some guy who's trying to become city manager, and he doesn't get the job. And he spent five years feeling awful every day about himself. Okay, well, you know, either quit aiming at that or do something else. You don't want the rest of your life feeling bad about something that just is never going to happen. And then there's unrequited love, go back to the poets of the ages, and it all comes back to sex and reproduction and trying to get that very special one to do it with you. And of course, that doesn't happen nearly as often as we would like, because everybody else is very picky. So are we? So, because I think all of life is a matter of trying to do things and seeing what works. And I think one of the deepest things to know about people is, how do they cope when they're not succeeding? I mean, some people just give up fast. Some people blame themselves. Some people blame other people, there's a big body of psychological literature about those two kinds of people. And some people just keep trying no matter what. And those people I think, are especially prone to great success. And they're prone to deep depression. I need to make a quick distinction here. I try to be very careful distinguishing low mood from depression. Because as soon as you say depression, people think I've been depressed, you don't know what you're talking about? Yes, I do. Depression is a really serious illness when it's bad. It's not normal mood. So I use the phrase low mood to describe the same kinds of feelings and responses that aren't as bad and might be products of what's going on in a person's life. So low mood is, Yeah, well as soon as you make it depression, you start counting the symptoms and trying to find causes. But this, this helps bring this little discussion to a conclusion though, because very often ordinary low mood gets aroused when you're trying to do something that's not succeeding. And if you keep pursuing it and pursuing it and pursuing it, the low mood escalates and escalates and escalates until it becomes full fledged depression. Actually, there's about a dozen psychologists who have done wonderful research about this. Carver and Shire have all kinds of experimental studies, demonstrating that it's not reaching a goal that influences your mood, it's your rate of progress towards a goal, that's really relevant research for this, but none of that research has made it to psychiatry. And I'm hoping my book and podcasts like this can encourage people to bridge these two fields.
Marty Martin 42:56
This, if you can connect the dots for us, Art and my probably our favorite section overall, was the self deceit section, would you say, Art?
Art Woods 43:02
Yeah.
Marty Martin 43:03
How does that fit in here? I mean, what's the relationship between people that are really adept at deceiving themselves and things like depression?
Randy Nesse 43:10
Yeah. So I grew up thinking know thyself is the ultimate maximum, right? So let's follow the Greek philosophers and get deep knowledge about ourselves. And that made me especially interested in psychodynamics, because psychodynamic is a way of getting to know your inner impulses that you otherwise can't really get in touch with. So it really does give you a certain deeper kind of understanding of your own motives and the rest. But then, gradually, from this evolutionary perspective, I started asking myself, so how come there's a whole system in there to keep us from knowing stuff that we otherwise could know? What's going on there? Is it just that the mind isn't capable of it, that doesn't seem to be the case. Because, you know, sometimes somebody will say, that person just hates me. And you say, well, what's the evidence for that? And the person will say, I can just tell. And then you say, can we talk about your feelings for that person? Oh, I really want them to like me, I think they're great. But then you dig, dig deeper and do free associations for a few hours, and you quickly discover that the person you're talking with hates the other person. And they're doing what's called projection, and they're attributing their hatred to the other person. And of course, this is a toxic business because once you start thinking that people that you don't like don't like you, then you act as if they don't like you, and then soon enough, they don't like you. It's yet another, yet another positive feedback kind of thing. So I asked myself this question about why the psychodynamic defenses and why the ability for the unconscious exists at all. I mean, somebody unconscious is just the mind can't do stuff. You don't notice when you're gallbladder contracts, because there's no reason for you to, but that is not the right explanation for these kinds of defenses and unconscious. There's something else going on. And there was a very specific idea about this that's been promulgated by some famous evolutionary biologists. Bob Trivers, in particular, and Dick Alexander, suggested that if you weren't really aware of your own motives, then maybe you could better deceive other people, because all of life is a bunch of deception anyhow. And I thought that was an interesting idea. But then I started going to meetings and talking with people, and they said, oh, that's the explanation. I said, whoa, can we pause here a second, and see if that's really, that's like a really cynical view of life. And after I wrote a few papers about that, that got me in trouble, because there were psychoanalytic kind of papers, and you weren't supposed to do that. And I concluded they're probably right, in part. But I think the exact opposite is probably even more important. That is the ability to just completely overlook our friend's transgressions, and forget about them. I mean, that's a very important part of having friends, is just not remembering when they dissed you or something. And I think that that helps a lot. Furthermore, we come back to what you were saying a few minutes ago about pursuing goals, and the like, I don't know how you test this, but it seems to me so useful to decide that you never wanted something anyhow. You know, you're trying and trying and trying to get into graduate school, and then you don't get in, and you say to yourself, you know what, that would have been six years of really hard work for nothing at low pay, and after that, I probably wouldn't get a job. I'm really glad.
Art Woods 43:10
Thank God I didn't get into grad school.
Randy Nesse 46:22
And, and that's really good. You know, that's a very healthy way of thinking and going on with things and just ruminating objectively about failures, that doesn't do any good. So I think subjectivity, and I was very surprised to discover this, being kind of dedicated to objectivity, but I was very I mean subjectivity is good stuff for getting us through life and having us have better relationships. Maybe it's better for helping us better deceive other people also, but I really take issue with the super cynical view that some evolutionary people take about human nature.
Art Woods 47:11
So the capacity for sort of moral behavior and altruism, so where does that come from?
Randy Nesse 47:17
So I think one of the most challenging and problematic things about evolutionary approaches to human behavior has been the tendency to assume that everybody is out to get maximum matings at all moments, however they can, by deception, and subterfuge and, and all the rest. Yeah, that does happen a lot, as anybody who's ever been in the dating scene knows. But, but people have a capacity for genuine morality. And you know, as a psychiatrist working in an anxiety disorders clinic, you see people who are tossing and turning in bed all night long, wondering if they accidentally insulted the person at the checkout counter at the grocery store. You know, they're just so sensitive, and it's not just the people tossing and turning who have anxiety disorders, I think most people are extraordinarily socially sensitive. We really care what other people think about us. And you know, back in the 60s, it was I'm okay, you're okay, I'm not going to worry so much. And I had people coming to me saying, you know, I care too much about what people think about me. And I said, yeah, we'll try to fix that. No, once I started actually living life more, and meeting more people who didn't care what people thought about them, who were really obnoxious very often, I realized that, you know, there might be something evolutionary going on here, I was treating hundreds of people with social anxiety. They're just so worried about what other people think about them. And it dawned on me that, gosh, there must be reason for this. And that goes back to this question about how can morality exist, and a deep problem that really was brought up most profoundly by George Williams and others, when they discovered that group selection doesn't work. The old idea about things like this is natural selection shapes all kinds of traits that are good for the species, like, you know, doing what's right for your group. And we won't go into all the details here, but the bottom line is any genetic variation that makes an individual do things that are good for the group that makes that individual have fewer offspring, that's gonna go away pretty quickly, because that individual has fewer offspring. There are very rare exceptions, so it's not an all or none thing. But a lot of people have said, because we can observe morality in humans, and generosity and loyalty, that proves that group selection must work. So I put my mind to the task of saying, I think there must be some other explanation. And I finally found in the work of Mary Jane West-Eberheard and others this principle called social selection, and you know, being a moral person, that's a really big deal expensive thing. That's like a peacock's tail, you know, it's, it's like really huge. If you do the right thing, you're gonna pay penalties for that a lot, but a lot of us do. So this this is an evolutionary mystery. The peacock's tail is easy. The male, the male peahen, peacocks, who have a big tail, are more desirable as mates. And so they have more offspring, and that explains why the tail gets so big. One person, Jeffrey Miller, has suggested that actual sexual choices, it might be that people choose sexual partners who are nice. And I think that's a plausible idea that has not been developed far enough. But Mary Jane West-Eberheard points out that any social choice, not just of mates, but of people you want to associate with, when that gives advantages to that person who is chosen, it gives advantages to you. And so what you get is a sorting system, where those people who are most desirable as social partners, even aside from sexual partners, those people who are most desirable, they get the best other partners, which is kind of a brutal business too. The people, people who are the nicest and has most to offer and do offer the most, get the other partners who are best, but this creates by pure selfish choices, really strong selection, for being good, and for caring what other people think about you, which leads directly to one of the worst psychiatric problems, which is social anxiety. And this provides the explanation for why we are so sensitive. And I think this is helpful for people with social anxiety to realize it's not all just you're a weak, shy person, it is that your social sensitivity has been shaped by the benefits of being appreciated by other people and being a better partner. So if I can just rephrase a little bit what you said, it sounds like that moral behavior is a kind of, you know, emotional mental peacock's tail, and it leads to assorted mating among people that that have this, this tendency to begin with. Yeah that's close, but leave the mating part out. It just is, we're all looking for partners in life, aside from sexual partners, we're looking for podcasting partners, you guys seem to have a good time working together. And I'm guessing, I'm guessing, except for certain days, you know, you both kind of trust each other and admire each other and work well together with each other. And you know, it's so good. And, you were kind of careful about choosing who you were going to do this with. And that's a good thing. And those other poor people who weren't quite loyal and trusting and, generous, they didn't get the ability to work with you on this great project. And they lost out. So it's not just mates. It's choosing people, when we choose people to join us in a sorority, or fraternity, or at a job, or, or wherever we choose people, we're trying to choose people who are nice and generous and loyal, and honest, and kind and generous. And it's, this also addresses a really profound question in philosophy. What is moral? What do we mean by moral? And I think that's too deep and complicated to go into here, but. We'll solve that in five minutes. It's like porn, we know it when you see it, but it's hard to define. But if you can tell where it comes from, what you know, I think a lot of what we mean by what's moral, is how we want other people to behave. And it's because of these things of choosing partners that, and this, this is why, I mean, social media now is so mean, you know, some people do something that's a violation of something or another and everybody piles on, you know, to shame them, and all the rest without even knowing much of anything, and forming a social group. And everybody can say, oh, we're better than other people, because we jumped on that person who is a bad person, and the out group. That gets complicated.
Marty Martin 53:47
So Randy, I've got to ask. I'm a fan of this Netflix show, Mindhunter. And, I mean, where do psychopaths and sociopaths fit in there? Is there any way to see them as some sort of, you know, advantageous genotype in a particular context? Or what would be your explanation for those types?
Randy Nesse 54:08
So this is another unanswered question. I've never, you know, some of my psychiatrist friends went into forensic psychiatry, and they spent their entire careers dealing with sociopaths, murderers and con men and all the rest. I did the exact opposite. I worked with people who were anxious and basically good people. And I think I think that's biased my view of human nature. And I think my friends have also gotten biased views of human nature because of who you spend time with. But the problem with how there can be some people who are sociopaths is a profound one, Linda Mealey was a profound evolutionary psychologist back about 20 years ago who wrote an article suggesting that this is what's called frequency dependent. And she suggested that, you know, in a society where most people are good, a sociopath can make hay because they're all suckers out there, while, if there are too many sociopaths, then you don't have anybody to take advantage of and the trait goes away. And so it maintains itself at a certain level of stability. I've never bought that, partly because of my bias, but also because a lot of sociopaths have evidence for minor brain abnormalities, and minor neurologic abnormalities. It's highly heritable, I mean, who is a sociopath is determined profoundly by genes. But I think many of them can be interpreted as having a brain abnormality. I mean, there's even little reflex abnormalities that are characteristic of some people with sociopathy. And it's probably not one thing either, you know, I mean, some people just don't experience emotion. And some people have special drives that I don't think it's just one thing. But another possibility that I think is more disturbing is that natural selection continues to work on this. And that, you know, the advantages of being socially sensitive and of having a moral compass, they're not they haven't been around for that long, really, you know, 100,000, few 100,000 years maybe. And it might be very different in different social kind of circumstances. It might be if you're in a complex kind of society, there's one kind of selection acting and that kind of thing, and if you're in a smaller group, it's different. So I think there's a lot to be done on that. But my basic view is that I mean, I see it as a strategy that works for some people, but I wouldn't want to call it a strategy that has been selected for, I think I might call it a strategy that's been left over. But I might well, I might be well wrong about this. I don't know anything about sociopaths, I haven't seen a thousand of them. Well, and the difficulty is when it comes to anything scientific, when something is rare, it's hard to study. So there, it's 1% of the population is a really serious sociopath. And you know, 4 or 5%, who are not quite sure what you're talking about when you're talking about guilt, and these other things. So it's not that rare. But it certainly is overrepresented in our prisons. And interestingly, on our newspaper front pages.
Marty Martin 57:07
These are all fascinating sorts of things. But where do you see psychiatry going? And how do you expect evolutionary perspectives to help?
Randy Nesse 57:16
Right, you know, every time I do an interview, especially shorter ones where people haven't read my book, they say, so how, Doctor, is this going to make therapy better today? And I say, well, you know, it's not. That's like saying, how is genetics going to make medicine better today? You know, it's a basic science. But I do think in contrast to something like brain scans, it gives us a fundamental, solid theoretical framework for making sense of things that otherwise don't make too much sense. I mean, this distinction between emotions and behavioral disorders, that's fundamental. And we need to start thinking about emotions in terms of their functions in terms of how they're regulated, and all the rest. This transforms how we do research in psychiatry. I think you mentioned before the rats swimming in a vat of water to see how long they swim as the best test for what's an antidepressant? Well, most of those studies have been done on the assumption that continuing to swim is a good thing. And giving up is a bad thing. Stop, think evolutionarily, rats that keep swimming drown. And in fact, the rats that get Prozac and are thrown into a bucket of water, they're more likely to drown than the rats that just float with their nose above the water. So it just it changes your perspective in such fundamental ways. Likewise, in talking about genetics of these disorders, I mean, the idea that we're going to find the genes, people keep trying for that, but it's increasingly clear that they don't exist. So what do you do, an evolutionary approach says that instead of looking for the genes, we should be looking for the traits that are pushed to what I call a cliff edge, where natural selection shapes the whole system to be right up there at the peak, where everything is maximum, and really cranking along perfect, except one more step takes you off the cliff edge to the whole system collapsing. So that is another fundamentally different way of thinking about genetics. In the clinic, I think there are, you know I keep saying this is not a method of treatment, this is not supposed to cure anybody tomorrow, but boy, it makes you a better therapist and psychiatrist, once you understand these things. I mean most, one of the crucial things in all therapeutic relationships is to distance, I mean, usually patients want to get closer, and have, you know, a close personal relationship. And if you go too far down that road, you're in a big mess, because you're promising things you can't deliver. But if you step back and say sorry, I'm just your shrink, and you just pay me and I just give you advice, that doesn't work very well. Yeah, so thinking about how these relationships work, in terms of social selection, and evolution of relationships, I think that changes our understanding of the therapeutic relationship. Likewise, as I said about anxiety, helping people to realize that there is a system that natural selection has shaped to downregulate anxiety, if you put yourself in the situation, and let the anxiety happen, and come and go, that helps people quite a lot. And then when I talked about depression, trying to look very carefully with a person at what I call the review of social systems, and look at every aspect of the person's life and try to understand where a problem might be, that changes how you do therapy, too. So it's not a quick, do this new kind of evolutionary therapy. Some of my friends say we should do that, I'm against it. I think evolution should inform every kind of therapy. But as more and more people get the big picture, I think it's going to go a long ways towards getting rid of the stigma and the confusion and the controversy, that swirl around psychiatry. Diagnosis, everybody argues about diagnosis, there's no need to really, I mean the clinical syndromes we see are there, and they're useful to talk about. The fact that we can't find specific genes or specific brain lesions, that's just too bad. The disorders are still there, and we need to, we need to accept the science. A lot of times the people who are most big about we gotta get scientific about it, they're not paying attention to the findings for the past 30 years, which is that we have not found genes or brain lesions.
Art Woods 1:01:15
So if you had to turn these ideas into a, you know, a sort of more full fledged research program, so, you know, if you had to tell NIH what to do and how to spend their money to start to get at these questions, what what would you advise them to do?
Randy Nesse 1:01:28
I have pneumonia six, yeah. So there might be 20 specific projects, plus a giant educational initiative, I mean, scientists who study animal behavior, all based it on evolution. Scientists who study medical mental disorders, hardly any even know about evolution and behavioral ecology. So part one is, let's educate everybody. And it's not up to me, this should be a giant campaign to bring the same kind of basic science to bear on mental disorders, as we do for animal behavior. But part two are a whole bunch of very specific projects. For instance, you know, when you go to the doctor, he does a or she does a review of systems to check, do you have any, you know, blurry vision, or dizziness or rapid, they ask you all kinds of questions that seem unrelated to your problem, to see what might be going on. And I have a fairly systematic review of social systems that does the same thing for a person's social life. So it investigates the possible origins of different emotions. And you can't just do a checklist of life stress or life events. That's very objective, and it's a good start, but that's not where the causal you know, things for emotions comes from. Emotions come from a person's appraisal of what events mean for their ability to reach their personal goals. So I think an evolutionary framework offers a way of bringing in this personalized approach to emotions in a framework where instead of just giving your opinion, you can be scientific about measuring these kinds of things. I think there are opportunities to change how we do our brain scanning studies. Instead of just using diagnoses of the sorts that are usually used, I think we should be using the products of a review of social systems to try to figure out which patients have always had depression because their parents and grandparents had it, which patients are in the midst right now of a really messy marriage they want to get out of but they can't, which people are impoverished and can't even get enough money to get on the bus to get their job. You know, there are all these different kinds of situations that can lead to depression. And I think once we start separating them out functionally in evolutionary frameworks, we will see better findings from our brain studies. And likewise, for genetics. Right now we're doing the genetics of depression, as if it's one thing, not even paying attention to the fact that low mood is useful. I mean, I think we can back up and start looking instead at specific symptoms. And one of my former graduate students, Eiko Fried, has really a dozen wonderful articles showing that why do we, summing up all the different symptoms you have of depression into a score? That's nonsense. That's like summing all the symptoms you have for pneumonia and saying how bad your pneumonia is, by how often you, you know, could we please look at the X-ray, you know? Right, right. So he's made great progress showing that if you use specific symptoms, you can make more progress. But I think, you know, I did work early on the dexamethasone suppression test, which is an endocrine abnormality that occurs in some people with depression. I'm pretty sure if we were to look at the details of which, of categories of people based on a review of social systems, we would be able to find out which people have that neuroendocrine abnormality and which ones don't. And I just published an article last week in Dialogues in Clinical Neuroscience with another colleague, Dan Stein, from South Africa, about how an evolutionary perspective might help us find better drugs in psychiatry. Instead of this assumption that we're finding drugs that normalize something or replace some missing hormone or something, we need to recognize that what we're doing with antidepressants, mostly, is blocking a normal system, just the way pain blocks normal pain systems. And the fact that we have antidepressants that work in numerous different places in the system, it's no surprise, you can block pain many different places in the normal pain system. So I think that gives great opportunities for trying to look for drugs that influence emotions by recognizing their utility, instead of just assuming that they're abnormal states. There's so many things ready to be done. And but every one of these projects is a few $100,000 to a few million. And first, we got to get people educated.
Marty Martin 1:05:41
So on that front, I've been a fan of the concept of evolutionary medicine, we contacted, I contacted you a long time ago about advice in putting together a class, and as I've seen the field develop from afar, it seems like there are there's some progress being made on the educational side that there are more programs and institutes I mean, what, is the ship turning? What's your feeling on that now?
Randy Nesse 1:06:03
So we're really doing great. One of our postdocs here at Arizona State University, who studies educational things, has just done a survey and finds that more than half of all research universities in the States have specific courses on evolutionary medicine. So that's going to change the world. Those kids are going to go to medical school grow up and become deans, and finally put evolution in the curriculum. But speaking of pursuing unreachable goals, I basically spent my entire career trying to bring evolutionary principles as a basic science to medicine. And I gotta say, I failed so far. There is no medical school that teaches hardly any evolutionary biology. Most deans say, what do you mean? Some even say, hasn't evolution been disproven? That's only one dean. But but you know, there's just, I think we're getting there. But what I want to do now that I think we're making good progress with undergraduates, is turn my efforts to finding collaborators in medical schools, and try to create online resources that any person who's teaching a medical school class or nursing class or veterinary medicine class, or public health class, they can slip it into the curriculum, and they can have a 20 minute module that I've narrated about aging, or 20 minute module about evolution and pain, or 20 minute module about evolution and emotions, or one about why cancer exists at all, or one about why we can't find antibiotics that the bugs don't develop resistance to, I mean that's my goal for the coming years. And we'll see if I can find medical schools that are interested in going along with that. Another thing that's been great has been the International Society for Evolution, Medicine and Public Health. That was made possible by the wonderful folks here at Arizona State University. I was invited here to start this program in the Center for Evolution and Medicine and higher faculty. And they allowed me to organize a big international meeting. And that led to the society which has just had its fifth annual meeting in Zurich. Next year, we're meeting in Athens, Georgia, the year after that we're meeting in Portugal. And finally, we're bringing together the scientists, the doctors, the researchers, all together to talk about the scientific progress and specific studies. And it's just so interesting, we have such a good time. And some of the things are turning out to be very practical. There's something called the Gil Omenn Prize that is offered by Gilbert Omenn, former president of AAAS, for the best paper in the field. This year, the paper was one about a strategy for preventing antibiotic resistance. Profoundly important, another is the Williams prize for the best paper published in our journal, which is Evolution, Medicine and Public Health, $5,000 went to the authors of the paper about aging, showing that George's original theory back from 1957 now has strong scientific support. That already has transformed gerontology most gerontologists recognize that aging is shaped by natural selection. So that's an area of real progress. We're getting there. People say aren't you frustrated, aren't you know, don't you get mad? No. Well sometimes I do. But I try to realize that, you know, you have to do what works. And maybe I'm going on a limb now and putting my efforts towards medical education. I might not succeed at that, but I think I want to do that while I can, and to see, there must be some deans out there who, I mean, I swear you can better understand and memorize the 10,000 facts in a medical education with an evolutionary framework.
Marty Martin 1:09:31
Completely.
Randy Nesse 1:09:32
Oh, yeah. I mean,
Marty Martin 1:09:34
That's the hook. I always get the undergrads on, I say I'm gonna give you the coat rack where you can hang onto all the facts. Everybody totally goes for it. Oh, what's that?
Randy Nesse 1:09:41
Right? But you know, you gotta get deans on board, you need a few hours with them to get that. I mean, I hated biochemistry, because it was all this memorization of stuff. But now I read books on biochemistry for fun. I mean, not too seriously. But once you realize how these systems got there and what they're for, it's fascinating.
Marty Martin 1:10:14
Randy was the founding director of the Center for Evolutionary Medicine at Arizona State, as well as the founding president of the International Society for Evolution, Medicine and Public Health, whose goal is to facilitate communication among scientists, students, clinicians and public health officials using evolutionary biology as a backbone.
Art Woods 1:10:29
And these ideas are starting to catch on. In Episode 12, we interviewed Joel Brown, an evolutionary ecologist working at the Moffitt Cancer Center in Tampa, Florida, about using evolutionary theory to treat cancers. He and his colleagues have had phenomenal success with some prostate cancer cases and are planning new trials now with other conditions.
Marty Martin 1:10:49
So far, though, evolutionary medicine remains outside the mainstream. No medical school requires evolution of their students and very few med schools even have evolutionary biologists on their faculty. The International Society for Evolution, Medicine and Public Health hopes to change that. The society has a database of resources about evolutionary medicine on their website, including materials for people interested to teach the discipline, and the society publishes a peer reviewed journal.
Art Woods 1:11:12
You can find out more on their website isemph.org. You can also find out more about evolutionary psychiatry and medicine in Randy's books at his website, RandolphNessie.com. We'll link to those resources on our website.
Marty Martin 1:11:26
Thanks for listening to Episode 24. In two weeks, we're back with an interview with the neuroscientist and philosopher Patricia Churchland. We talked with Pat about her new book Conscience which covers the neurobiological origins of our moral intuitions.
Patricia Churchland 1:11:38
And I thought, this is it. This really shows us that not only are our mental states brain states, but that we can learn totally unpredictable things about ourselves from neuroscience. And that motivated me to go down to the medical school one fine fall day and said, you know, I'm a philosopher, but I realized I need to know neuroscience and to know anything in neuroscience, I have to know the anatomy.
Art Woods 1:12:10
That episode drops on September 26. If you like it and the podcast overall, please support us on Patreon. Patrons get access to extra content, plus, they feel great about themselves for supporting independent science communication. Visit www.patreon.com/bigbio to donate. Well known to relieve anxiety and crush depression.
Marty Martin 1:12:32
Thanks to Matt Blois for producing this episode. Haley Hansen, Chloe Ramsey, Sarah Guzinski and Lexi Sauser manage our social media channels. Michael Levin helps with social media and especially Patreon, and as always, thanks to Steve Lane who manages our website.
Art Woods 1:12:45
This podcast also gets generous support from the University of South Florida College of Public Health and the College of Humanities and Sciences at the University of Montana.
Marty Martin 1:12:54
Music on the episode is from Podington Bear.