Presentation on Evolutionary Psychiatry, autism and neurodiversity at ASI Forum 2020 (w/transcript)
On Saturday I had the opportunity to present at the Adam Smith Institute's annual 'Forum', giving a fifteen minute presentation with a Q & A afterwards. To make this accessible (and because my 'umming' makes it somewhat painful to listen to- to me at least) a transcript of the presentation with the relevant slides is attached below.
The Facebook video of the morning's talks and Q&A is available here.
Timestamp: 5:06 *Presenter introduction*
Timestamp: 6:33 *Adam Begins*
Slide One: Alt-Text: A map of the world but the countries are different people. Text reads "Evolutionary Psychiatry: Explaining the ultimate cause of mental disorders in a bizarre modern world. Adam Hunt." Logos for the RCPsych, EPSIG and University of Zurich's Institute of Evolutionary Medicine are below.
Thank you very much. Great. Thanks Matt. Yeah, so as Matt mentioned my background was in philosophy and perhaps it will become apparent today why I was drawn to evolutionary psychiatry and especially coming from evolutionary biology and philosophy of biology background. So, Yeah I mean I guess that none of you have ever heard of evolutionary psychiatry. I think that will change very soon as part of my work. I'm currently a PhD student in the University of Zurich and I've been working on this for about four years actually basically since I finished my masters, I've been working on a book on evolutionary psychiatry which I am now converting into a PhD I've also worked closely with the Royal College of Psychiatrists, they have an evolutionary psychiatry special interest group, which I'm a part of. It's a really interesting field and I hope that you'll learn something today about thinking
about mental disorders, which has been kind of missing from the conversation.
Slide Two: Alt-Text: The cover of a book, 'The Reindeer People: Living with animals and spirits in siberia by Piers Vitebsky'. A picture of a reindeer herder standing in the snow amongst a crowd of about eighty reindeer, with a forest in the background.
So. I'm gonna start with a story. It was a story told by an anthropologist Piers Vitebsky in this book, he was travelling across Siberia living with reindeer herders and he came across one particular reindeer herder who caught his attention because he was very weird. This is a picture of the Evenky, the group he was travelling with and the figure that old grandfather came across was called old grandfather Nikitin, sorry Vitebsky came across, was called old grandfather Nikitin. Old grandfather Nikitin was very strange.
He moved with a group of reindeer herders and they have a herd of 2,600 reindeer and he moved with a group of about 20 guys caring for these reindeer, but he didn't socialize with the rest of the herders. He camped away from them, he didn't share meals in the evening, he didn't drink and gossip, but even though he didn't socialize them this way, he wasn't normal - just very strange in this kind of community - he was one of the most important persons, person, to the Avenkey.
The reason was that old grandfather's mind was incredible. This is about 80 reindeer you can see on the slide and the Evenki have 2,600 reindeer. Old grandfather could look at any single one of these reindeer point of them and tell you that parentage their family history and their medical history.
He could tell you whether one got stuck in a fence four years ago. You knew their dynamics he knew which males had been losing competitions this year and so which ones had to be bred and which ones had to be eaten. It's hard to underestimate how important this was to the Evenki.
The reindeer are their transport, their clothing, used to be their clothing and their food and so old grandfather even though he was antisocial was an incredibly important figure. The reason I'm telling you this story is because old grandfather has been picked up as an example of someone who is probably on the autism spectrum, living in a life closer to that of our ancestors.
Slide Three: Alt-Text: Text saying 'Presentation Outline: The huge problem of mental disorders; evolutionary psychiatry versus current psychiatry; key concept: mismatch; autism spectrum disorder; consequences of evolutionary psychiatry.'
So that's going to kind of frame the discussion that I want to have today just to outline very quickly the huge problem of mental disorders. Why evolutionary psychiatry differs from current psychiatry a key concept which is found in evolutionary psychiatry- mismatch. I'm going to talk a bit more about autism spectrum disorder. And then I'm going to think about the consequences of this evolutionary analysis.
Slide Four: Alt-Text: The Huge Problem of Mental Disorders. A clip saying 'global impact of mental disorders in terms of lost economic output will amount to 16,000 billion over the next 20 years.' Two graphs, one showing neuropsychiatric disorders contribute the most to disability adjusted life years of any medical condition, the other showing that mental and substance abuse disorders cause the highest proportion of years lived with disability compared with other medical conditions between ages 15 and 40.
So the huge problem of mental disorders, we all know the names depression anxiety ADHD dyslexia, um, maybe we don't know that over 20 years the world economic forum estimate that 16 trillion would be lost in terms of economic output.
This is mainly depression but it's also the individuals who, like schizophrenics, autistics, bipolar, who can't work in normal jobs. This is huge. I mean, I don't need to say that but clearly it's huge not only in monetary terms but also in terms of daily-disability adjusted life years psychiatric disorders often come talk, um, they they ‘outperform’- really terrible language- but they really are worse than most physical conditions.
One of the reasons for that is because this as this yellow bar here depicts, how different disorders affect people at different ages and mental disorders are here from basically birth- autism is here from birth- old grandfather was probably a strange child. Didn't fit in at the time on no doubt, and but yeah, this is, this is obviously huge in terms of economic impact but also in terms of affecting our life. And it needs to be explained.
Slide Five: Alt-Text: Evolutionary Psychiatry versus current psychiatry. Recognising proximate and ultimate causation. An image of a cross section model of brain, and an image of different morphs as an ape stands up, holds tools, and becomes a human.
So current psychiatry is basically something like this. It's it's about brains, right? I guess that most of you come into this thinking that psychiatric disorders are something going wrong in your brain. You have heard things about chemical imbalances, which by the way have been pretty roundly disproven as like the most ridiculous oversimplifications, I mean because of the audience today, I'll say this - it's kind of like saying that economics is just about money. There's there's so much more than chemicals... This is interesting because obviously psychiatry looks at brains and things okay minds are brains fine, yeah sure obviously minds are brains - no no one's denying that but an evolutionary psychiatrist wants to ask well, why are the brain differences which inevitably underlie mental disorders, in the same way that brain differences in have to be underlying creativity and anger, we want to understand what this brain difference means where it came from we, want to look at it through the evolutionary past because no matter if you find some difference in the brain which causes autism you haven't really explained anything you've looked at what is a ‘proximate’ cause you haven't really ultimately explained it.
Slide Six: Alt-Text: Key concept: mismatch. Old minds in new lives. An image of four nearly naked men walking through a savannah with spears and bows and arrows. An image of a sillhoutted man standing in a dark room alone. An image of an iphone. An image of several people sitting in cubicles in an office, with white computers and white facemasks.
So this is a key concept in evolutionary psychiatry which I hope will be quite intuitive to you so this is what you're meant to be doing right now basically this is a group of South African hunter gatherers, they're going out on their day to hunt and try and kill some meat they got their spears they've got the bone arrows that's life every day you get up you hunt you get food that's basically what all your genes are meant to be doing and instead we got this...
We have rooms where you can be isolated, it it sounds strange but for almost a little evolutionary history you were never alone. I mean being alone is a very rare thing it's basically like when you go to the toilet, you're alone all the rest of the time in your entire life, you're not alone.
I don't need to talk about how weird smartphones are everyone kind of thinks about this and and then just just this workplace of the bottom which looks extremely dystopian, partly the masks, thanks Corona virus, but also just even if there weren't masks here. I mean compare the lives of these adults on their daily activity, right? I mean, something's going on here and I hope it's kind of obvious that we need to understand psychiatry by recognizing that okay, well, you know the bodies and brains that we grow up in are more like this situation - we're meant to be living in the situation the left and they've ended up in the situation on the right, so what's going on here?
Slide Seven: Alt-Text: Autism spectrum disorder. A quote "autism spectrum disorder is a construct used to describe individuals with a specific combination of impairments in social communication and repetitive behaviors, highly restricted interests and or sensory behaviors beginning early in life". Below it, text reading 'Facts which don't make sense: strengths and weaknesses; no clear pathology found in brains & genes; early onset, lifelong; common: 1-2% of people, spectrum 5%" next to that, text reading "Autism & neurodiversity as evolved cognitive specialisation?" Below, an image of 100 figures, with about thirty half coloured in, and ten coloured in completely, in five different colours. Next to that, a book cover, 'The Pattern Seekers: How Autism Drives Human Invention' by Simon Baron Cohen
So now to autism. You've all heard of it, you all heard it's spectrum and this is a recent description of autism from a 2020 paper by Catherine Lord so I'll just read it out for you so “autism spectrum disorder is a construct used to describe individuals with a specific combination of impairments in social communication and repetitive behaviors, highly restricted interests and or sensory behaviors beginning early in life”.
There are a few interesting points to pick up here firstly obviously the spectrum now these these labels social communication, especially, are pretty broad so autistic individuals to to qualify as socially impaired could either not understand irony or not enjoy eye contact, or they could be completely unable to speak. The spectrum is extremely broad and the other thing that I want to point out is that the the language here of a construct is pretty new this is like a development in mainstream psychiatry five years ago, we'd have said it's a severe neurodevelopmental disorder that's kind of changing - the reason they still use disorder is because that's what it is in the leading psychiatric manuals but there's a there's a movement to recognize that actually that's maybe not the best term, so I'm going to talk a little bit about some facts about autism which just don't make sense of this disorder label.
So as we saw in the example of Old grandfather and as I'm sure you were all aware from popular media, autism involves strengths and weaknesses. That's weird. Diseases shouldn't give you some kind of ability in another area. We don't get coronavirus and you know suddenly like able to jump 10 meters in the air, right? Like it's it's it's it doesn't it doesn't make sense and at the moment it's kind of seen like these weaknesses are the things that really are important and the strengths are kind of like, oh that's just like an accident. But it's still it's still super confusing.
Secondly, there's been decades of research billions of dollars spent thousands and thousands of very intelligent lives, technologies built and grants given to try and understand what the pathology of autism is. And we've basically found nothing, we've found no clear pathology in almost all cases. Now you should be noted that because autism is a spectrum some of the individuals can be classified as autistic because they have actually had some kind of early life trauma. I mean, like physical trauma like foetal alcohol syndrome or indeed they might have some rare genetic mutations. Often these cases are associated with intellectual disability. But that's not the case for most of the autism spectrum something like 80% to autistics don't have this clear pathology. Another interesting fact that really is kind of been missed as as paradoxical unless you look at the from an evolutionary perspective is that this is an early onset lifelong disorder... condition.
So these genes are constantly affecting your reproductive success and there's no paradox when there are genes which predispose you to dementia because dementia arrives when you're 70 and by that time you've already had children the genes are already in the gene pool and your children are going to get dementia when they're older and that's that's kind of a curse, selection basically can't see the genes and get rid of them from the gene pool. That's not the case with autism. And indeed with many mental disorders. They are affecting all of your time when you should be reproducing. So they should be able to be reduced from the population-selected out.
Okay, so. Here finally this is a hundred people/figures and within a hundred people you're going to find one person on the spectrum - sorry one person who would classify as fully autistic and indeed five percent of people who would classify as on the spectrum and this number is significant because every single one of your ancestors knew at least a hundred people they moved in groups of twenty or thirty usually but all those groups of twenty and thirty were kind of part of larger collections.
This is very confusing. Why are why why are so many people autistic - why would every single group have had autistic individuals within them? Now Simon Baron Cohen who is a leading autism researcher and just came out the book saying that he thinks autism is linked to human invention. I think memory is probably more of a feature but it's interesting to note that one of the leading thinkers in the field was recognized that the autistic strengths really probably explain the persistence of autistic genes in the gene pool.
And also I'd like to point out that these facts on the left here don't just apply to autism they apply to all sorts of conditions the conditions which we think of as neurodiversities at the moment and I don't know if you know the neurodiversity movement, it's a social movement basically claiming that people with ADHD dyslexia dyspraxia, tourettes, autism, especially, shouldn't be considered as disorderly they should be considered as just different. Their strengths counteract their weaknesses and really evolutionary psychiatry can come in and say, well it makes a lot of sense. I mean none of this evidence points to true disease in a normal normal framing of the term and it kind of makes sense for us to think in different ways to have like cognitive specializations and it also makes sense that there are weaknesses associated with every strength no one can do everything, you know, so so this this concept of trade-offs is really important and the fact that the human population is so full of these differences, I think is just huge important think about.
Slide Eight: Alt-Text: Consequences of Evolutionary Psychiatry: Images with text above. The first reads 'reduce stigma' and the image below has four cartoons with speech bubbles, one is talking, one with microphone, one with megaphone, one listening. The second reads 'Improve outcomes' and the image below is of a book, 'The New CBT: Clinical Evolutionary Psychology' by Mike Abrams. The third reads 'Change the world' and has two images below, one of an empty classroom, the other of the same office as in slide six, workers at white computers wearing white masks.
So what does this mean? I think very intuitively and hopefully even in the last 10 15 minutes you'll have seen that this can reduce stigma because you’ll have recognized that you might conceive of these conditions in a different way, we know that the way that we explain conditions really does affect the stigma if you say that a person depression’s is caused by a broken brain-like a chemical imbalance, it's actually depressing it makes them less likely to have hope about their outcome it makes other people see them as more hopeless it makes them unable to kind of seek help so really just explaining something in a different way really does actually change how we affect stigma. We could also improve outcomes this is a new book by a clinical psychologist who thinks that if we explain these things, explain these tendencies, these disorders more generally, not maybe not autism but other disorders through evolution through an evolutionary lens, then we can really get encourage people to seek help and actually improve how they respond to treatment.
And lastly slightly tongue in cheek change the world I mean it's quite literally I mean look at this world right this is this is not a savannah in Africa and we're not the same we're not built to be in classrooms some of us do well in that environment right but people with ADHD and dyslexia and autism really don't and by forcing everyone to take one interview process to go through through one school system, you're really kind of selecting for their weaknesses of these individuals and probably missing their strengths so I think there's a lot of potential in thinking about how we can be flexible with people's individual differences. Also just making this world more less depressing, you know, like giving us giving us a little bit of what we've lost we never gonna be hunters again but maybe we can revisit a time where you know that we have some more of these natural stimuli which our brains are kind of built for. When when we think about those trillions of dollars, it can't be that hard to just move us a little bit closer and towards what we're meant to be doing.
Slide Nine: Alt-Text: Thanks, links to socials and website and email, affiliation logos, the cover of a book, 'Good Reasons for Bad Feelings: Insights from the Frontier of Evolutionary Medicine' by Randolph Nesse.
So with that I I want to thank you, point you to my socials if you want to check my website some details there on my work and if you want a good book to get into evolutionary psychiatry, I can really recommend Randolph Nesse's good reasons for bad feelings, there's a few videos shout out to EPSIG and go on the YouTube channel, watch some of those videos and yeah, thank you for that.
I'm not going to transcript the Q&A for now; I might do this later.
*END Q&A* Timestamp 1:33:47