Are There Good Reasons for Bad Feelings?

“Why does depression exist at all?” “Why are mental disorders so confusing?”

I wasn’t expecting these types of questions from the keynote speaker. Actually, I was expecting answers as I got my requirements for continuing education in the most interesting way I know— at the annual UofL Depression Center conference.

I was expecting to hear the usual stuff — how drugs disrupt mood mechanisms in ways that relieve symptoms of depression and anxiety.

Randolph Nesse, MD, one of the founders of evolutionary medicine

I didn’t realize I was listening to one of the founders of evolutionary medicine, Randolph Nesse, MD, share his insights about how studying the origins of mood might enhance our ability to find ways to feel much better, much faster.

You’d think as we evolve as a species, there would be less mental illness, right? From an evolutionary standpoint, our brains are wired to maximize reproduction and the transmission of our genes. So why would the process of natural selection find any useful purpose for anxiety and depression, especially in excessive amounts?

In the meantime, many Americans urgently need to feel better. One in ten of us experiences a depressive episode in any given year. Some states are sadder than others; Kentucky is one of them. We’re the 15th saddest state in the nation, according to the latest data from the Substance Abuse and Mental Health Services Administration.

Depression isn’t just a sad thing. It’s a costly thing. Depression hits our nation in the pocketbook in many ways, including being the leading cause of disability for Americans 15–44 years old.

So discovering how the brain influences mood and how drugs influence the brain sounds like a pretty good way to spend our research dollars — especially since the United States’ investment in depression research is less than ten percent of what we spend on cancer research.

But aren’t mood disorders caused by chemical imbalances anyway? So why the focus on evolutionary psychiatry?

Not Your Ordinary Darwinian

“There are good reasons for bad feelings. Anxiety and depression are often excessive because they benefit genes at our expense,” Nesse explains. In other words, your startle response is worth it, just in case that funny noise you heard really is an intruder.

If your personal “moodostat” is broken and you suffer with panic disorder, this evolutionary explanation isn’t much comfort, is it?

However, I realized Nesse isn’t your ordinary Darwinian. “How can the mindless selection that maximizes only reproductive success have shaped brains that make committed loving relationships and meaningful happy lives possible?” he asked. “Most people’s lives are nothing like the selfish competition for money and sex imagined by naïve Darwinians. People meditate, pray, cooperate, love, and care for others, even strangers. Our species is remarkably endowed, not only intellectually but also socially, morally, and emotionally. Understanding the origins of love and morality is a crucial foundation for understanding social anxiety and grief and the deep relationships they make possible.”

I wasn’t expecting that.

Jesse Wright, MD, founding director of the UofL Depression Center

When Jesse Wright, MD, and his colleagues at the Depression Center came up with the conference theme “Is There A Better Way? Explorations in Mental Health Treatment” I guess they really meant it.

Not Your Ordinary Psychiatrist

Evidently, Nesse is not your ordinary psychiatrist, either. In his book Good Reasons for Bad Feelings: Insights from the Frontier of Evolutionary Psychiatry, he’s attempting to disrupt current thinking in three big ways:

1. Stop viewing symptoms as diseases

In other words, don’t assume everything is caused by a brain disorder or a chemical imbalance.

“No specific brain or genetic abnormality that causes depression has been found. Most patients get some benefit, but many are ‘treatment resistant’ or experience intolerable side effects. Only a minority of patients gets enduring complete relief.”

That kind of puts things in perspective, doesn’t it?

2. Stop treating symptoms without paying attention to what is arousing them

I think he’s suggesting something I encounter every day: Recognize low mood and anxiety as potentially appropriate, adaptive responses to difficult life situations — situations that are complex, extremely uncomfortable and for which it’s not so much about finding a solution, but rather finding resolution.

With the pressure we feel to provide relief for our clients’ suffering, it’s no wonder we’re tempted to fall back on simple, quick fixes for complex problems.

3. Figure out how to treat abnormal responses by studying normal responses.

In other words, make sense of mood disorders in the context of normal mood. The way Nesse puts it, “The rest of medicine uses its understanding of normal functioning as a foundation for understanding pathology. This allows it to distinguish symptoms from diseases and to recognize syndromes such as heart failure that can have many causes.”

He’s not saying we should let up on our pragmatic focus on the immediate, proximate causes of our suffering and ways to relieve it as quickly and completely as possible.

It’s just that if we’re really smart, we’ll take a two-pronged approach that includes recognizing that our environments are changing faster than we can adapt to them. It’s not hard to see how our high-calorie Western diet and lack of exercise are examples of a “gene-environment misfit” that we’re living every day.

Sometimes there are good reasons for bad feelings. Recognizing that reality without being shattered by it is how we’re going to manage to get to the other side.

Fortunately, there’s also another side to the story, as Nesse points out, “Perhaps most profound of all, evolution explains the origins of our amazing capacity for love and goodness and why they carry the price of grief, guilt, and thank goodness, caring inordinately about what others think about us.”