Stone Age brains in 21st century skulls - Transcript

The original interview was conducted at ABC radio in Melbourne in November 2007, after Natasha Mitchell approached G Galambos and D Wilson after their lectures at a Symposium (they were Co-Chairing) entitled "Evolutionary Psychiatry: Finding the Future in the Past", at the World Psychiatric Association International Congress 2007, Melbourne (Delivered 29/11/2007)

Natasha Mitchell: Front up to your shrink, and you bring a menagerie of hunter gatherers, anteaters and reptiles from your ancestral past with you. Or so Professor Daniel Wilson and Dr Gary Galambos believe. Both clinical psychiatrists, they provocatively challenge their profession to look to the Darwinian roots of human neuroses, and the evolutionary battleground that is our stone-age brain.

You're with All in the Mind on ABC Radio National, thanks for tuning in. I'm Natasha Mitchell and here's a big idea as the nation debates the 2020 Summit this week. How would you take it if I suggested you are but a Stone Age mind in a 21st century skull?

Daniel Wilson: Our genome was adapted, over 50 million years as primates, to living in small groups, very small groups, maybe 20 to perhaps 200 individuals, very closely related genetically, lifelong interaction in those small groups.

All of that has changed instantaneously, in genetic terms, over the last 10,000 years with the rise of agriculture at the end of the last Ice Age, the rise of urban complex economies, migration all over the world, the population explosion. So people don't fully appreciate how dramatically different the environment is today than the environment to which we adapted since before India was attached to Asia. That's how long we were living in these very small groups of closely related individuals.

Gary Galambos: So you could consider us as having Stone Age brains in modern skulls.

Natasha Mitchell: These are both pragmatic, coal-face clinical psychiatrists with daily experience of working with people in emotional need. Daniel Wilson is Head of Psychiatry and Professor of Anthropology - an interesting combination - at Creighton University in Omaha, Nebraska. Dr Gary Galambos is a consultant psychiatrist and Medical Director at St John of God Health Services in Sydney, but theirs, they say, is a profession facing an existential crisis itself and patients are losing out. Their provocative challenge to colleagues and to all of us is to look to the Darwinian roots of human neuroses and disorders like manic depression to the evolutionary battle ground that is our Stone Age brain.

Gary Galambos: I think mainstream psychiatry simply looks at manic depression as a biological disorder, as a malfunction and there's a great search out there for the genes and for the neurochemical disturbance, but the problem that I and colleagues like Dan have is that there's been a failure to go one step backwards if you like and say well let's try and understand why there is this incredible vulnerability and potential within humanity to have these disorders.

Daniel Wilson: The pure medical model has many virtues, but to tell people with certain intrinsic capacities that they have a disease that needs purely to be treated, like diabetes or something which is commonly used as a metaphor in psychiatry, is unbalanced. And patients respond, they say yes, you're right I knew there was something worthwhile underneath all of the suffering.

Natasha Mitchell: Well let's climb inside that experience for a moment, the much beloved Australia actor and comedian Garry McDonald knows a thing or two about internal suffering and he's spoken publicly about his own plight.

Gary MacDonald: In '93 everything was going really well, I mean I'm just going to pat myself on the back here for a little while, I won a Sydney Film Critics award for a movie I'd done, been to the West End with a David Williamson play, had 11 years of Mother and Son, or 10 years of Mother and Son, which was extremely successful, I'd won a silver Logie for my performance in that show and Ruth and I had, Ruth Cracknell who was the star of Mother and Son, we had a very successful series of soap powder commercials, so, this is important, dirt is good, and I'd had Norman Gunston before that, so I had a very, very strong career and you know a good family life etc. etc. But then something in my brain said I wanted to be top dog again, I didn't want to share it with Ruth, I wanted to go back and experience what I'd experienced with Norman Gunston, so I went back to doing Norman again and you know because he was so much fun, I used to get you know really we'd be in fits of laughter sometimes after a very successful interview. And so much fun that after a couple of weeks on air I had a nervous breakdown.

It runs through my family, my grandfather had a nervous breakdown at about the same age, he was in his 40s, he never did a heavy stroke of work again from that day on. And my mother is riddled with anxiety, so I really didn't have much of a hope in a way and I hadn't realised this, but I had been experiencing anxiety for over 20 years. I'd thought it was nerves, I thought it was something that every other actor experiences and I should be able to manage it. I thought it was just a little bit of stage fright and really it wasn't until a couple of, about a year after the nervous breakdown of major depression, someone said to me you've got anxiety, that's your problem - and it was. And that's when I started to do something about it. It's like you've woken up in the middle of the night and you can hear a burglar downstairs and not knowing whether to confront the burglar or to just keep still and hope he'll go away. I mean awful, awful, you are absolutely consumed with it. I struggled with this and they were giving me things like Xanax and Xanax is a really powerful benzodiazepine, it's kind of like kryptonite, really and it slows you down, takes the edge off everything, so that for an actor the only work you can get is probably in a theatre company in far north Queensland.

Natasha Mitchell: Of course Garry McDonald has gone on to become an advocate with the Depression Awareness Initiative in Australia called Beyond Blue.

So what compels psychiatrist Daniel Wilson and Gary Galambos to consider that many of today's mental disorders could in fact mask useful traits from when our ancestral heads walked the savanna. Daniel can I start with you, you are both a Professor of Anthropology and a Professor of Psychiatry and a clinician, why bring evolution into psychiatry at all?

Daniel Wilson: First of all as Dobzh-ansky, the great 20th century biologist said, nothing in biology makes sense without evolution and I think the same is true for psychiatry. Psychiatry has been suffering an identity crisis in the last generation. The Freudian project which contained much of psychiatry through the 20th century collapsed and we don't have a defining framework. Evolution provides that beautifully, because it actually ranges from the most proximal molecular aspects of biology and behaviour up through social and cultural dimensions and on into evolutionary genetics.

Natasha Mitchell: Gary Galambos you're 100% a clinician by day, but by night what compels you to turn to evolutionary ideas in thinking about your own clinical work as a psychiatrist?

Gary Galambos: I would say my patients got me thinking beyond the text books and beyond the current paradigms, because at least when Freud was around there was a theory to help patients gain understanding into their symptoms, into their human experiences. Whilst we've made evolutionary leaps in the areas of medication and neuroscientific understanding, the chemical imbalance metaphor has become the predominant one and I discovered many of my colleagues telling patients, as an explanation, that their chemical imbalance was the cause of their symptoms. And that's been a source of great dissatisfaction for patients and has led to I think a great dissatisfaction subliminally amongst my colleagues as well, who give this explanation but don't feel it in their bones. And I didn't feel it in my bones.

Natasha Mitchell: But people often who have been diagnosed with a mental illness also derive a great sense of relief that it's not their fault, that it's the result of the chemistry in their brain, potentially.

Gary Galambos: What's crucial here is not a dissatisfaction with my capacity to treat patients and to make use of the various models that have come into psychiatry and through psychiatry up to now and still persist. We still use Freudian analytic theories, there are patients that really do benefit from lying on the couch and talking about their life histories and there's other patients who really benefit from being told look, there is a real disturbance within your brain and without medication it's going to be very hard for you to live a functional life. However I think a great majority of patients lie somewhere in between that and they need a model that bridges the gap between understanding and treatment that can give them a sense of meaning to their conditions. And only then are they going to be able to walk out feeling that they are in good hands and in understanding hands.

Natasha Mitchell: Are you suggesting that psychiatrists have got rather good at describing the what and the why of mental illness or mental disorders but no so much the how, how they came to be?

Gary Galambos: Absolutely, psychiatrists have tried to move back in the domain of medicine, there has been a separation of psychiatry from medicine for a long period, there has been a very valid and noble attempt to help patients feel like they've got medical conditions, can benefit from medicine and the 'why?' question has been missing. And I think that's part of the reason that so many patients, not even just in psychiatry but in medicine generally, turn to alternative practitioners.

Natasha Mitchell: Daniel Wilson one of your colleagues, John Price, has put it like this: that evolutionary approaches to psychiatry recognise that the patient also brings the hunter/gatherers, the ant eaters, the reptiles from their ancestral past and by the end of a consultation the room is crammed with this menagerie, each member of which has the right to be listened to and, if possible, have his needs fulfilled. What on earth is evolutionary psychiatry, this sounds like chaos in the clinic?

Daniel Wilson: There's a quite simple underlying theme in this and that is that the brain is an accumulation, as is the body, of a very deep evolutionary history. The brain evolved starting about 500 million years ago and we still retain elements of each advance in the course of neural evolution. It actually goes back to Plato, who spoke about the logical brain struggling, like a chariot driver, to control the wild horses of the earlier parts of the brain. And in some respects psycho-pathology appears to be a conflict between mammalian sediments and reptilian drives and trying to get those into proper alignment, like a chariot driver would manage the reins of the horses, so that all of this wild animal power can be directed skillfully, is a big part of the underlying purpose of thinking in evolutionary terms.

Natasha Mitchell: Let's unpack that and how do you turn to the evolution of the social brain and its components in this discussion?

Daniel Wilson: I'm greatly influenced by the work of Paul McLean, who was long a researcher at the National Institute of Mental Health in the United States html — a psychiatrist, who looked at komodo dragons, reptiles and formulated a nice way of organising an understanding of the brain, which is otherwise just hideously complicated. He basically came up with three assemblages: the reptilian brain, the early mammalian brain and then the primate brain. And each of those they solved different behavioural environmental problems. The reptilian brain solved the problem of how do animals within a species interact without violence and that was through social dominance displays done by the autonomic nervous system. A classic human example would be blushing, social blushing. Dinosaurs were the first to really interact with one another in a way, besides sex and violence; they developed dominance displays. The reptilian brain classically as organised in dinosaurs and we carry that around with us largely unchanged. It's the mid brain and it's unconscious and it controls an enormous range of bodily reactions, including sentiments that we're not necessarily aware of.

Natasha Mitchell: We all have a reptilian brain whether we like it or not.

Daniel Wilson: We do indeed html — some perhaps more than others, but that's a clinical observation. On top of that is the early mammalian brain, the old limbic system, which arose in the transition from reptiles to mammals about 120 million years ago, which occurred as mothers and their offspring began to attach to one another. Reptiles basically laid eggs and there wasn't a great deal of maternal/child interaction, but about 120 million years ago internal live birth of children or offspring occurred and the earliest part of the limbic system is called the thalamus singular gyrus and it's thought actually to have mediated, and still mediates, the cry of an offspring so that the mother could recognise that.

Natasha Mitchell: And the limbic system of our brains they produce our rich emotional life.

Daniel Wilson: Absolutely, the limbic system is wonderfully complex and very little chartered, open territory in terms of neurology and psychiatry. A lot goes on there; it's generally thought to be semi conscious, almost more of an intuitive and not linguistically based, it's a different level of awareness than our conscious brain, which evolved later in primates over the last 40 to 50 million years.

Natasha Mitchell: And then we have our higher brain, as it's often called, the part of the brain that most defines us as humans.

Daniel Wilson: Yes, the neo cortex, which evolved over the last 60 million years or so, most notably in primates and in humans, with a great deal of potential for rational, abstract thinking, as well as a lot of new talents like music and language and expanded memory as well. But the attempt to become more rational and to think things through, as opposed to having reptilian automatic responses or even the earlier mammalian, very emotional responses.

Natasha Mitchell: Ancient history revealed in the anatomy of your brain. Professor Daniel Wilson, psychiatrist and anthropologist at Creighton University. Stone Age brains and modern neuroses on All in the Mind, here on ABC Radio National with me, Natasha Mitchell, reaching the world of Radio Australia and as podcast. Let's head then to the clinic now with Dr Gary Galambos in Sydney - Gary, what does all this thinking about the evolution of our brain and its various stages of evolution got to do with psychiatry?

Gary Galambos: Many psychiatrists would ask the same question, but in the consulting room when a patient comes to me who is having a social hierarchy problem. For example, they are doing a good job but they have a boss who finds their success or their skills intimidating and conducts a dominance display, lets them know who's boss, constantly, and this employee can't make sense of this, not going to let the boss get away with it, keeps coming to work and he keeps taking it, he or she in some ways lets the boss know that they don't appreciate it, sometimes even in quite passive ways like turning up late, or not doing the work as well as they should. And their reptilian brain eventually gets sick of the situation and turns into submissive mode, appeasement mode, which is another way of saying depression in that particular context. So the individual is then referred by the GP to the psychiatrist, so the scenario is one of a problem and it's an evolutionary problem. One part of the brain, that reptilian core, is not in synchrony with the other two levels, so that's a very interesting situation where some would argue the individual needs some problem solving to get out of that situation using an evolutionary model what's happening here - and in a way that gives them permission to make a hard decision, change departments. Their reptilian brain is signalling to them that it's not happening in that situation, it's not going to let them function normally until they find a better environment.

Natasha Mitchell: Very interesting. Daniel what does it mean to say a behaviour has an evolutionary basis, or that it might have been adaptive at some point in our ancestral past?

Daniel Wilson: Everything has an evolutionary foundation, adaptation is more specific, adaptation suggests that there's a useful quality to a particular trait, in this case, behaviour.

Natasha Mitchell: So you actually think that manic depression has an evolutionary basis?

Daniel Wilson: Oh unquestionably, it quite plainly does. I say that because it's so genetically inheritable, that is, it runs in families so strongly and it is so common that we know from basic Darwinian science that something that's genetic and very common was selected for.

Natasha Mitchell: Does that mean that it might have actually had a benefit at some point in our ancestral past in a different environment?

Daniel Wilson: Absolutely, not necessarily depression and mania per se, but what we might today call a manic would have been an alpha. If you look at an alpha gorilla they are very dominating creatures, they are not running around manic. Likewise the subordinate animals are submissive but they are not depressed. There's a great value in having a relatively small number of persons in a population who have particular talents. You wouldn't want a population that's entirely made up of hyper dominant individuals; you need more Indians than you do chiefs so as to say. I think the disruption is in the modern environment. Submission in depression becomes excessive; in mania the tendency to dominate becomes excessive and part of that I think is the loss of the cocooning of the small social group that regulates behaviour very tightly. In today's environment a person like Hitler can try to take over the world. In a hunter/gatherer society you can try to dominate 30 or 50 individuals - a completely different scale of magnitude.

Natasha Mitchell: So you think the ancestors of people who have been diagnosed with manic depression today were the leaders of small hunter/gatherer societies, the creatives?

Daniel Wilson: Yes, take a look at Wolrd War Two, some of the main characters: Churchill a classic manic depressive, family history some say that he treated his depression with Davidoff cigars and Paul Roget champagne - I don't recommend that. Roosevelt: what we would call today bipolar too, not prone to severe depression but at base line very energetic, hyper active. Then you look at Adolf Hitler a text book of all sorts of psycho pathology, probably including some fundamental disorder such as mania depression, obsessive compulsive disorder, he was clearly not a picture of health. And the same is true of Tojo, although not as well known by some accounts, was thought to have had an affective disorder and some obsessive traits. So the four world leaders of Wolrd War Two all were affected by mania or depression - remarkable. Artists, the Ohio Writers Workshop classic study by Nancy Andreason, my teacher when I was a medical student when that was being done, these were eminent writers, overall 60% had psycho pathology — depression, mania or alcoholism.

Natasha Mitchell: Isn't this romanticising what can be a very tragic difficult illness with very difficult extremes?

Daniel Wilson: Well it is and it isn't. I'm not romanticising it I'm just recounting some of the evidence that there is an abundance of advantageous aspects to this. The psycho-pathology is real, the very disturbed lives and families, a much higher suicide rate. I'm not romanticising it but balancing the picture. The pure medical model has many virtues, but to tell people with intrinsic capacities that they have a disease that needs purely to be treated like diabetes or something is unbalanced and patients respond. They say yes, I knew there was something worthwhile underneath all of the suffering.

Gary Galambos: WHO have been for years now emphasising the fact that psychiatric disorders have the largest rates of disability compared with any other disorder so living with a lifetime of potential to have a manic episode or a depressive episode, or a psychotic episode or chronic symptoms, it has very substantial levels of disability and suffering out there.

Natasha Mitchell: Gary Galambos, which is why it's hard to fathom that there might be some sort of genetic benefit, adaptive benefit in evolutionary history to something like manic depression, or schizophrenia, or depression, or mania, or personality disorder?

Gary Galambos: Absolutely and I think that it's extremely important not to be over simplistic, using evolutionary models, just as it's important not to be over simplistic with reductionistic neuroscience models or analytic models that only look at the individual life history. Where evolutionary models can bridge that gap is by having an over-arching theory linking the gene, environment and behaviour. There are disorders that can be explained in evolutionary terms that are malfunctions of the development of the brain and cause vulnerabilities. It can be akin to medical disorders like diabetes, certain types of very severe depression, which we call melancholy depression or psychotic depression that respond very well to anti-depressants and ECT for example you know are examples of that. But I would say that by and large a majority of mood disorders for example.........

Natasha Mitchell: So for example anxiety, depression .............

Gary Galambos: Absolutely, probably fit in a category of what we call technically, genome lag, evolutionary models, which mean that we truly have this Stone Age mind that's not responding well to the modern environment. Urbanisation has had great benefits for humanity, but huge costs in terms of our emotional health and the rising levels of depression, very high levels of anxiety, many of us think can be attributed to the fact that our brain is working in normal ways but to, if you like, a very stressful environment, an environment that we did not particularly evolve for and therefore you could argue there's a bit of a mutiny occurring. You know our biological systems are overwhelmed with the environments around us. I mean a classic example is panic disorder; it's probably the most common disorder out there after phobias. There's a large number of people out there that have such severe panic symptoms that they don't want to leave their houses. You'll find that this is a lot more common in city environments than rural environments. To live in a densely populated city with millions of people is literally terrifying for our reptilian brains and probably our mammalian brains as well. So our brains go into shut down mode, they say get out of there, get back home where it's nice and safe, keep away from all these non-family strangers, they're probably dangerous, they might drag you away to another tribe or worse. There's an example of our biology acting as it should have a couple of hundred thousand years ago perhaps.

Natasha Mitchell: So that's a creative theory but is there any basis to it? In fact is there any basis to any of these evolutionary ideas about human behaviour?

Gary Galambos: I tell my patients this is a preliminary model, but this helps to give some level of explanation, why there might be an adaptive capacity here that's gone off track.

Natasha Mitchell: Well I'm interested that both of you take these ideas into your clinical work. Isn't it a little bit too early to be doing that and how do you take them into the clinic? Daniel.

Daniel Wilson: Well I don't think it's too early. I think this has more substance in terms of the body of data that's available from anthropology and evolution about how humans are and how they develop. To my way of thinking, it's simply common sense inference from very well-documented science.

Natasha Mitchell: So what are the implications for psycho-therapy?

Gary Galambos: That we need to acknowledge we are an adaptive but vulnerable species and that our evolutionary past, not just our personal historical past, can help to explain why we're a vulnerable species to mental disorders. And I actually think that gives great reassurance. People with mental illness and disorders it gives them a sense of belonging as opposed to being different. It gives them a sense of being part of the human race and you know mental disorders are a normal part of the human race. It doesn't mean that we have to accept them and not treat them but it helps satisfy a deep need in us and I would argue it's an evolutionarily-derived need to have a model.

Natasha Mitchell: But reassurance is one thing Gary but Daniel you think that this whole set of ideas might lead to more sophisticated psychotherapies?

Daniel Wilson: I think it does and I think it already has helped us to understand how psychotherapy works and it works, not just through language and mental events occurring in a vacuum, it actually changes the brain. Psychotherapy appears to allow people to take sentiments not fully known to them, particularly in the limbic system area.

Natasha Mitchell: So that's our emotional brain?

Daniel Wilson: Our emotional brain, the late reptiles early mammals, and turn it into conscious, abstract language-based understanding. Basically to move from being captive to one's feelings to achieve, in some cases, achieve insight to live differently in the world, or at least to understand the struggles that they are dealing with.

Natasha Mitchell: Just to come back to this idea of the brain in battle with itself and its history. I mean one suggestion is our higher brain, our neo mammalian brain, doesn't always have full control over our lower brains, our reptilian and our ..............

Gary Galambos: Sometimes the horses bolt, absolutely, and psychotherapy is about reining the horses in and getting the different parts in synchrony, it's getting them working together rather than against each other.

Natasha Mitchell: There is a lot of frustration though from many people who feel most concerned that we're looking to evolutionary answers for our behaviour, but that somehow this constrains us to think of our behaviour and our mind only in evolutionary terms.

Daniel Wilson: A criticism of evolutionary psychiatry and psychology has been that we have been trying to explain everything as beneficial, that's not true. I don't know of anyone who would argue that every single aspect of human behaviour good, bad and ugly was adaptive.

Gary Galambos: Any new way of thinking, adoption of any new model, can be used in different ways, positive ways, negative ways. I think there have been some cautionary tales of the past that we need to learn from, but I don't think that that should stop us from looking for good science, good models that are going to help us find a theoretical framework that can help psychiatrists treat their patients more effectively. Research is going in the right directions and ask the right questions.

Natasha Mitchell: Well seductive narratives for our tripartite brain to wrestle with. Daniel Wilson and Gary Galambos, thank you for joining me on the show this week.

Daniel Wilson: Thank you.

Gary Galambos: A pleasure.

Natasha Mitchell: A research challenge if ever there was one. My guests today Dr Gary Galambos, Medical Director at St John of God Health Services in Sydney, speaking personally today though about his own passions. Daniel Wilson, Head of Psychiatry and Professor of Anthropology at Creighton University in Nebraska and Darwinian models of the mind always provoke a response, so get writing. Our email is on the website. Even better blog your thoughts at my All in the Mind blog: Audio links, including the website that Gary Galambos has set up on these themes, all there to explore. My thanks to Anita Barraud and Tim Symonds today, as Stone Age Natasha Mitchell is signing off until next week - last words go to actor Gary McDonald with lessons from his own demons.

Gary MacDonald: I think the trouble is most people want a simple solution. The unexamined life is not worth living, Socrates said, and it hasn't changed. So there isn't really an easy solution, I think most people want a pill and it's not as simple as that, you really have to do a little bit of work and I think every day I meditate and if you're feeling bad, I don't do it every day, but that walk in the morning is fantastic advice. It doesn't have to be a power walk, it's just a walk, you don't dawdle, you walk and if you're feeling a bit low, about 20 minutes into the walk the endorphins kick in, it's really interesting. But also just taking a moment, especially if you're stressed and if you can come back to the moment and just listen. Kids are the great lesson, you see a kid when they go into that zone, they just zone out and you can't get through to them, let them go there, that's what they are doing, they are just replenishing their stock.


Daniel R. Wilson Professor & chair of psychiatry Professor of anthropology School of Medicine Creighton University Omaha, Nebraska, USA

Dr Gary A. Galambos Consultant Psychiatrist Medical Director St John of God Health Services

Founder of the Evolutionary Psychiatry Interest Group (New South Wales, Australia).

Gary Macdonald Australian actor and comedian