Good Reasons for Bad Feelings

by Randolph M. Nesse

  Advance Praise for Good Reasons for Bad Feelings

  “To quote a renowned geneticist, ‘Nothing in biology makes sense except in the light of evolution.’ A quarter century ago, Randolph Nesse bravely helped apply this dictum to medicine. Now, in Good Reasons for Bad Feelings, he tackles the deeper evolutionary question of why we, our minds, and our brains are so vulnerable to mental illness. He navigates the dangers of either too much or too little adaptationism, deftly handles the false dichotomy between psychological and biological perspectives, and bridges abstract intellectualizing with pressing clinical need. This is a wise, accessible, highly readable exploration of an issue that goes to the heart of human existence.”

  —Robert M. Sapolsky, author of Behave

  “Those powerful feelings that fill our day, that give us the oomph to act one way or another are the guardrails to living and this wonderful book explains all of them. Randolph Nesse has done it again.”

  —Michael S. Gazzaniga, director, Sage Center, UC Santa Barbara; author of Tales from Both Sides of the Brain

  “A masterful, groundbreaking book that persuasively challenges standard clinical wisdom and provides a road map for the transformation of our conceptually confused psychiatric nosology. With crystal clarity, Nesse reviews what we know of our biologically designed emotions and argues for unflinching acceptance of our evolved nature as a baseline for understanding both normal and disordered suffering. . . . Anyone interested in mental health—laypeople, students, clinicians, and scholars—will be grateful for the novel insights to be gained from this important book.”

  —Jerome C. Wakefield, professor of psychiatry, New York University; coauthor of The Loss of Sadness

  “What is the nature of suffering, its origin and its adaptive significance? Good Reasons for Bad Feelings may well become a legend, as it is a book about psychology, psychiatry, biology and philosophy that is also a good read, and it opens the door to deep questions in a manner that is tender, quizzical and industrious.”

  —Judith Eve Lipton, MD, coauthor of Strength Through Peace

  “Randolph Nesse’s new book vividly demonstrates how careful thinking using principles of natural selection leads to new and profound insights into why humans sometimes suffer mental disorders; the key question is why our minds are fragile. His writing style is clear and engaging, and the narrative reflects a masterful blend of history, novel ideas, and clinical experience in an insightful and coherent manner. I hope it is widely read and discussed.”

  —Eric Charnov, Distinguished Professor Emeritus of Evolutionary Ecology, University of Utah; MacArthur Fellow

  “Prompted by the distress of his patients and confusion within his own field, psychiatrist Randolph Nesse set out to combine years of clinical experience with new insights gleaned from evolutionary biology, allowing him to view the entire landscape of human obsessions, anxieties, and compulsions through the lens of deep time, placing traits that contribute to depression and mental illness into evolutionary perspective. The result is a book as wise and illuminating as it is relevant to our daily lives.”

  —Sarah Blaffer Hrdy, professor emerita of anthropology, UC Davis; author of The Woman that Never Evolved and Mother Nature

  “Nesse’s book is hugely important for the future of mental health care, and Nesse is the preeminent person to write it. It provides a personalized and lively but well-documented treatise on how we humans function as we do and on needed changes in the way psychiatry thinks about troublesome mental experiences and behavior. It draws on an impressive range of knowledge, from not only psychiatry, including extensive case descriptions, but also psychology, biology, philosophy, and humanistic literature. Many readers will find it hard to put the book down.”

  —Eric Klinger, professor emeritus of psychology, University of Minnesota

  “Two sets of ideas inform this fine book: one, the coldhearted logic of natural selection; the other, the practical wisdom of a compassionate psychiatrist. The tension is palpable. The result is riveting.”

  —Nicholas Humphrey, professor emeritus of psychology, London School of Economics; author of Soul Dust

  “Good Reasons for Bad Feelings by Randy Nesse is a delightful book. It is insightful about the human condition, sanguine and not overstated. And it is written in a straightforward and delightful manner, personal and professional, and with humor. Neese is one of the originators of the field of evolutionary medicine. This is a welcome book in evolutionary psychiatry and on the biological basis of the emotions and our cultural evolution.”

  —Jay Schulkin, research professor of neuroscience, Georgetown University

  “In Good Reasons for Bad Feelings, leading evolutionary theorist, psychiatrist Randolph Nesse, begs us to ask the right question: Why did natural selection make us so prone to mental disorders of so many kinds and intensities? It is no exaggeration to say that he opens the door to a new paradigm in thinking about human beings and their conflicted lives. A path-breaking book by a man who is truly humane and caring. A privilege to share time with him.”

  —Michael Ruse, Lucyle T. Werkmeister Professor of Philosophy, Florida State University; author of On Purpose

  “In this highly accessible, scholarly and deeply illuminating book the internationally acclaimed evolutionary psychiatrist Randolph Nesse guides us through the implications of being gene-built and contextually epigenetically fine-tuned for our states of mind. From depression to anxiety to issues of moral behavior, we are guided to new understandings of the algorithms of the human mind and the contexts in which they can play out, for better or worse. This paradigm offers fundamental, new ways of thinking about mental states and moral behaviours, illuminating new means and opportunities to gain insight to and work with some of the dark sides of our nature. This will become a treasured classic not just for clinicians but for all those interested in how to facilitate well-being and create more moral communities and societies.”

  —Professor Paul Gilbert OBE, author of The Compassionate Mind and Living like Crazy

  “How did we end up recognizing that every system in the body has a function shaped by evolutionary selection and yet thinking that systems in the mind do not? How did physical and mental health drift so far apart? Randolph Nesse explains, in this highly readable book, how ‘symptoms’ in psychiatry should be seen in their evolutionary context, and that anxiety and depression for example have functions, just as do inflammation, blood clotting, or a cough. Nesse is a pioneer of evolutionary psychiatry, which has the potential to revolutionize mental health care.”

  —Simon Baron-Cohen, professor of developmental psychopathology, Cambridge University

  “This book sets out to show how evolution underpins (or should underpin) psychiatry. In doing so, it will surely change the face of medicine—and deservedly so.”

  —Robin Dunbar, emeritus professor of evolutionary psychology, University of Oxford

  “Randy Nesse has brought a new and important synthesis to the study of illnesses that psychiatrists deal in. This engagingly accessible, pioneering book provides a wide range of answers for how something as maladaptive as bipolar disorders could have evolved. It provides a wide range of answers for why natural selection has left us vulnerable to so many mental disorders, and the ‘mystery of missing heredity’ is identified as a key problem. Nesse shows that by taking into account complex pleiotropic effects, natural selection may push some useful trait close to a fitness peak near a ‘cliff edge’ despite the disabling consequences for a few individuals who go over the edge. Thus a gene may be useful to many, but with bad luck contributes to victimizing the few. This complex problem s
urely will yield to further research.”

  —Christopher Boehm, professor of biological sciences, USC Dornsife

  ALSO BY RANDOLPH NESSE

  Why We Get Sick: The New Science of Darwinian Medicine (with George C. Williams)

  DUTTON

  An imprint of Penguin Random House LLC

  penguinrandomhouse.com

  Copyright © 2019 by Randolph M. Nesse, MD

  Penguin supports copyright. Copyright fuels creativity, encourages diverse voices, promotes free speech, and creates a vibrant culture. Thank you for buying an authorized edition of this book and for complying with copyright laws by not reproducing, scanning, or distributing any part of it in any form without permission. You are supporting writers and allowing Penguin to continue to publish books for every reader.

  DUTTON and the D colophon are registered trademarks of Penguin Random House LLC.

  LIBRARY OF CONGRESS CATALOGING-IN-PUBLICATION DATA

  Names: Nesse, Randolph M., author.

  Title: Good reasons for bad feelings : insights from the frontier of evolutionary psychiatry / Randolph M. Nesse, MD.

  Description: New York, New York : Dutton, [2019]

  Identifiers: LCCN 2018045094| ISBN 9781101985663 (hardcover) | ISBN 9781101985687 (ebook)

  Subjects: LCSH: Mental illness—Etiology. | Mental illness—Genetic aspects. | Psychiatry—History.

  Classification: LCC RC454.4 .N47 2019 | DDC 616.89—dc23

  LC record available at https://lccn.loc.gov/2018045094

  While the author has made every effort to provide accurate telephone numbers, internet addresses, and other contact information at the time of publication, neither the publisher nor the author assumes any responsibility for errors or for changes that occur after publication. Further, the publisher does not have any control over and does not assume any responsibility for author or third-party websites or their content.

  Neither the publisher nor the author is engaged in rendering professional advice or services to the individual reader. The ideas, procedures, and suggestions contained in this book are not intended as a substitute for consulting with your physician. All matters regarding your health require medical supervision. Neither the author nor the publisher shall be liable or responsible for any loss or damage allegedly arising from any information or suggestion in this book.

  Version_2

  To my patients, who have taught me so much

  CONTENTS

  ADVANCE PRAISE FOR GOOD REASONS FOR BAD FEELINGS

  ALSO BY RANDOLPH NESSE

  TITLE PAGE

  COPYRIGHT

  DEDICATION

  PREFACE

  PART ONE

  Why Are Mental Disorders So Confusing?

  1. A New Question

  Why has natural selection left us so vulnerable to mental disorders?

  2. Table-Column-HeadAre Mental Disorders Diseases?

  Psychiatric diagnosis is confused because it doesn’t distinguish symptoms from diseases, and it incorrectly assumes that each disorder has a specific cause.

  3. Why Are Minds So Vulnerable?

  Six evolutionary reasons explain vulnerability to diseases.

  PART TWO

  Reasons for Feelings

  4. Good Reasons for Bad Feelings

  Emotions were shaped to cope with situations.

  5. Anxiety and Smoke Detectors

  Useless anxiety can be normal, as the Smoke Detector Principle reveals.

  6. Low Mood and the Art of Giving Up

  Mood adjusts behavior to the propitiousness of the situation.

  7. Bad Feelings for No Good Reason: When the Moodostat Fails

  Moodostat failures cause serious diseases.

  PART THREE

  The Pleasures and Perils of Social Life

  8. How to Understand an Individual Human Being

  An individual’s emotions and actions make sense only in the context of that person’s idiosyncratic life goals and projects.

  9. Guilt and Grief: The Price of Goodness and Love

  Preferred partners get advantages that make morality possible.

  10. Know Thyself—NOT!

  Repression and cognitive distortions can be useful.

  PART FOUR

  Out-of-Control Actions and Dire Disorders

  11. Bad Sex Can Be Good—for Our Genes

  Sexual problems are common for good evolutionary reasons.

  12. Primal Appetites

  Dieting spirals famine protection mechanisms into anorexia nervosa and bulimia.

  13. Good Feelings for Bad Reasons

  Substances hijack learning to create zombies.

  14. Minds Unbalanced on Fitness Cliffs

  Genes for schizophrenia and autism may persist because of cliff edges in the fitness landscape.

  Epilogue: Evolutionary Psychiatry: A Bridge, Not an Island

  How using all of biology can integrate psychiatry and make sense of mental illness.

  FURTHER READING

  NOTES

  ACKNOWLEDGMENTS

  INDEX

  ABOUT THE AUTHOR

  PREFACE

  When I first realized that evolutionary biology could provide a new kind of explanation for mental disorders, I immediately wanted to write this book. It was soon clear, however, that understanding why bodies are vulnerable to diseases in general had to come first. That project was the focus of my collaboration with the great evolutionary biologist George C. Williams. We wrote a series of technical papers and Why We Get Sick: The New Science of Darwinian Medicine, a popular book that helped inspire much new work in what is now the thriving field of evolutionary medicine. Ever since then, my career has been committed equally to bringing evolutionary biology to medicine and to helping my patients with mental disorders. The two missions are connected deeply.

  Practicing psychiatry is enormously satisfying. Patients are grateful for effective treatment. Providing it is intellectually interesting as well as emotionally fulfilling. Each patient poses a puzzle. Why did this individual get these symptoms now? What treatment will work best? However, sometimes looking out the window from my cozy office, I have visions of a tsunami sweeping millions of people with mental disorders to oblivion, with no help or high ground in sight. Such dark apparitions inspire asking different larger questions: Why do mental disorders exist at all? Why are there so many? Why are they so common? Natural selection could have eliminated anxiety, depression, addiction, anorexia, and the genes that cause autism, schizophrenia, and manic-depressive illness. But it didn’t. Why not? These are good questions. The aim of this book is to show that asking why natural selection has left us vulnerable can help make sense of mental illness and make treatment more effective.

  The possible answers suggested here are examples, not conclusions; some will turn out to be wrong. That should not be discouraging at an early stage in a new field so long as ideas are tested. As Darwin put it, “False views, if supported by some evidence, do little harm, for every one takes a salutary pleasure in proving their falseness: and, when this is done, one path towards error is closed and the road to truth is often at the same time opened.”1

  Continuing controversies and slow progress in psychiatry have inspired many calls for new approaches to mental disorders. Evolutionary biology is not new; it is the well-established scientific foundation for understanding normal behavior, but its relevance for abnormal behavior is finally being recognized. Evolutionary medicine is providing new explanations for why our bodies are vulnerable to diseases and is now being applied systematically to mental disorders. The time is ripe to explore the frontier of evolutionary psychiatry.

  I wish the field could have some other name. Evolutionary psychiatry is not a special method of treatment, and professionals in other mental health fields will also
appreciate an evolutionary perspective. A more accurate descriptor would be “Using the principles of evolutionary biology to improve understanding and treatment of mental disorders in psychiatry, clinical psychology, social work, nursing, and other professions.” But that is unwieldy, so this book is a report from the frontier of evolutionary psychiatry, viewed broadly.

  Mental disorders are such a plague on our species that we all want solutions right now. Evolutionary psychiatry offers some practical benefits now, but the big payoffs will come as researchers, clinicians, and patients ask and answer new questions inspired by a fundamentally new perspective. In the meanwhile, evolutionary psychiatry offers philosophical insights. Nearly everyone has wondered why human life is so full of suffering. Part of an answer is that natural selection shaped emotions such as anxiety, low mood, and grief because they are useful. More of an answer comes from recognizing that our suffering often benefits our genes. Sometimes painful emotions are normal but unnecessary because the costs of not having the emotion could be huge. There are also good evolutionary reasons why we have desires we cannot fulfill, impulses we cannot control, and relationships full of conflict. Perhaps most profound of all, however, evolution explains the origins of our amazing capacities for love and goodness and why they carry the price of grief, guilt, and, thank goodness, caring inordinately about what others think about us.

  July 2018

  PART ONE

  Why Are Mental Disorders So Confusing?

  CHAPTER 1

  A NEW QUESTION

  If I had an hour to solve a problem and my life depended on the solution, I would spend the first fifty-five minutes determining the proper question to ask, for once I know the proper question, I could solve the problem in less than five minutes.

  —Albert Einstein

  I knew something was up when the psychiatry resident knocked on my office door five minutes before I was scheduled to meet with him and his new patient.