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by Simon Baron-Cohen (Editor)
Psychology Press, 1997
Review by David J. Mullen, M.D. on Dec 3rd 2000

The Maladapted Mind

The Maladapted Mind: Classic Readings in Evolutionary Psychopathology, edited by Simon Baron Cohen, is an excellent compilation of articles exploring novel perspectives on abnormal psychology derived from the relatively new sub-discipline of evolutionary psychology-- evolutionary psychopathology. The contributors are well known in the discipline and several are clinicians--a fact that is clearly reflected in an appreciation of the "real world" complexities encountered in the treatment of psychiatric disorders.  This was refreshing, as I have at times found other works in evolutionary psychology to be guilty of an excess of "oversimplification".  Although, according to the cover, the book is aimed at "advanced students and researchers in the fields of psychiatry, evolutionary biology, biological anthropology, and cognitive science", most of the chapters are probably accessible to an intelligent and educated lay reader who is willing to make an effort.  Some previous familiarity with evolutionary psychology as well as the terminology of psychopathology is helpful however.      

The structure of the book, as does the title, echoes one of the truly major works in evolutionary psychology--The Adapted Mind: Evolutionary Psychology and the Generation of Culture edited by Jerome Barkow, Leda Cosmides and John Tooby. Except that while The Adapted Mind focused on elucidating the evolutionary origins of normal psychological mechanisms, The Maladapted Mind explores the potential implications of a Darwinian perspective for the understanding as well as the treatment of psychopathological deviance. At 12 chapters and 286 pages, The Maladapted Mind does not provide an exhaustive survey of evolutionary psychopathology but it does offer an excellent sampling of concepts within this burgeoning perspective.

The first 3 chapters provide an overview of the potential value of an evolutionary/functional approach to the understanding of human psychology generally, especially the psychology of emotions, and for abnormal psychology in particular. This functional approach—emphasizing an understanding of the purpose or function of psychological features such as anxiety or sadness in terms of Darwinian fitness—is contrasted with the currently dominant descriptive approach in psychiatry that categorizes disorders in terms of collections of symptoms. In chapter 2, McGuire et. al. describe at length the weaknesses of the purely descriptive method by utilizing it to describe a patient presenting with the complaint of cough, a symptom.  The cough is described without reference to the known functional purpose of a cough to clear the airway of obstruction.  The resulting description of cough quality and associated features clearly falls short of a satisfying understanding of disease etiology and treatment whereas an understanding of the purpose of a cough readily suggests a search for airway irritants or causes of obstruction and associated treatments.  As the current diagnostic system dominant in psychiatry emphasizes qualities and associated features of psychiatric symptoms such as anxiety and depression without any reference to the potential functionality of symptoms themselves or their relationship to a functional system, it (the diagnostic system) is also notably deficient with regard to generating a satisfying understanding of illness etiology and/or treatment.  While the authors readily admit that much work needs to be done for a Darwinian approach to gain secure footing in the clarification of psychiatric diagnoses, they do make an excellent case for a significant potential contribution from an evolutionary perspective on psychopathology. 

The third chapter in the volume, “Evolutionary epidemiology: Darwinian theory in the service of medicine and psychiatry” by Daniel Wilson addresses another feature of the current “medical model” so dominant in psychiatry, namely, the assumption that psychiatric syndromes represent specific defects in the individual.  This, as opposed to what may be either potentially adaptive efforts that have gone awry due to contextual mismatch (modern environments rather than evolutionary relevant environments) or an inappropriate activation of otherwise adaptive responses (similar to allergies representing a miss-targeted immune system response).  The author makes an excellent case that psychiatric syndromes, and therefore the genes associated with them, appear far to frequently in the population for them to represent only the results of mutation.  Therefore, the Wilson argues, the genes must have been, by at least some mechanism, of adaptive value to their carriers.  Of course, the beneficial effect may have been gleaned through a variety of potential mechanisms such as differential effect of genes at different doses or ages. An excellent example of a known differential effect of dose is the sickle cell gene that, if an individual is heterozygous (carries only one copy derived from one parent),  they benefit through resistance to malaria.  However, if a person is homozygous (carries two copies, one from each parent) they will develop sickle cell anemia. The author concludes that it behooves researchers in psychiatric genetics to attempt to identify potential benefits of carrying genes associated with psychiatric illnesses. 

After the general overview of the Darwinian approach to psychopathology, the remaining chapters explore application of the perspective to specific areas of abnormal psychology.  Chapters 4 and 5 focus on a functional understanding and analysis of anxiety disorders from the assumption that anxiety represents a normal “defensive” response to cues that suggest the threat of a potentially significant loss.  Both the common features of anxiety as well as the features of specific disorders—panic disorder, obsessive compulsive disorder, and simple phobias may be understood with respect to both a generalized component of preparation for defensive behavior (increased heart rate, sweating, increased respiration) as well as by features suggesting reactions to specific threats (freezing in fear of heights, running/fleeing in animal phobias, and hand washing in the contamination fears of obsessive compulsives).  Chapter 5 by Randolph Nesse presents an analysis of panic disorder and agoraphobia as a potential atavistic response to being caught far away from one’s home territory and support—a potentially mortal danger to our Pleistocene ancestors. 

Chapters 6 through 9 describe the application of evolutionary psychological concepts to anti-social behavior and psychopathy.  I particularly enjoyed chapter 8 by Linda Mealy, “The sociobiology of sociopathy: An integrated evolutionary model,” in which she develops the thesis that there are two principal routes to the development of the sociopath: one she describes the “primary sociopath” and the other of course as the “secondary” type.  The primary sociopath is describes as being of a substantially genetic pre-disposition resulting in severe defects in the “social emotions” of empathy, guilt and remorse.  The secondary sociopath is believed to represent a more environmentally reactive type with anti-social behaviors developing in an environment that was more conducive to the development of such behavior.  The primary type is described as being essentially inevitable in a social species capable of more than one behavioral strategy existing in equilibrium with each other.  The secondary type is felt to be more amenable to alterations in social conditions.  Overall her contribution appeared to be a well balanced treatment of a complex and controversial area. 

The tenth chapter is by editor Simon Baron-Cohen and appropriately deals with his well known ideas related to the role of “Theory of Mind” in autism and explores some putative cognitive mechanisms that may support this superficially mundane, but on closer examination, remarkable human feat—the development of states of mind as motivators of complex behaviors.  The concepts are well defined and both theoretical as well as empirical issues are explored.  Finally, the last two chapters—11 and 12—address some of the most common but complex of the mental disorders—the depressive conditions.  I felt these two chapters did very well in considering the extremely complex nature of depressive conditions in a highly lucid and systematic fashion.  There was no hint of simple-minded “genetic reductionism” and due weight was given to the problems and limitations of variously evolutionarily based theories.  I particularly appreciated the McGuire, Troisi, and Raliegh chapter (12) for its balanced perspective.

On the whole, I highly recommend The Maladapted Mind: Classic Readings in Evolutionary Psychopathology as an excellent compilation of quality contributions to a new approach to psychopathology that, while clearly controversial, holds considerable promise for the refining, integrating, and extending of our understanding and potential treatment of a source of significant human suffering.     

 

Dr. Mullen is an Associate Professor of Child and Adolescent Psychiatry in the University of New Mexico School of Medicine. He is the Deputy Medical Director of the UNM Children's Psychiatric Hospital and attending physician in that facility's adolescent inpatient unit. His interests include the application of evolutionary psychological principles to the understanding of child and adolescent psychopathology, especially the disruptive behavior disorders.