It is helpful to consider the original evolutionary purpose of a condition, in order to understand it and to treat it.
There are 4 classes of mental disorders. The first is the group that is characterized by excessive energy. This would include anxiety, panic attacks, obsessive compulsive disorder, insomnia and phobias. These conditions exhibit the fear network. Inability to relax, raised heart rate, obsessive thinking, ritualized behavior and superstitious thinking.
The second is its opposite, this group of conditions is characterized by too little energy. This includes depression, excessive sleep and lack of motivation and interest. This is the atavistic remnant of hibernation. The body slows down as if there is nothing to be gained from being alert.
These are not useful or adaptive ways to live in the 21st century. Fear is appropriate when there is an actual present danger. But with anxiety you experience illusionary threat as real. It is not just painful because it makes it difficult to experience pleasure, but also compels you to act inappropriately which cause unwanted consequences.
Slowing down and not trying makes sense for wild animals in the middle of winter, but it is not adaptive for modern life. Facing a lack of food and hostile environment, it makes sense to sleep and hibernate. Humans do not literally put our bodies in suspension, but we can become numb and unresponsive to the world during a bout of depression. At this time we experience our own powerlessness in a cold unfriendly world.
How do we find a centered place where we find enough motivation to do what we need without getting overly agitated; and where we slow down enough to relax without sinking into inactivity?
The third group is characterized by excessive self involvement. This include pathological narcissism and selfishness, lack of empathy for others and bullying. This is an extreme version of our drive for personal survival. The motto for people afflicted is “ always, me first”.
This is an important drive, but when it is not tempered by concern for others it becomes poison. It is a turn off for others and eventually you will find yourself alone. In addition the more you focus on your own needs the more unfulfilled you will feel. This is because you put your awareness on what you don’t have and don’t notice what you do have.
The fourth group is characterized by too much attention on others. This includes, co dependency, martyrdom and self sacrifice. This is a perversion of our need to take care of babies and children in order for the species to survive. Human babies are helpless for many years (20?) and in order for us to survive we have developed a desire to take care of them. Those that did not have this capacity did further their blood line. This is very important trait for the survival of the group.
This very human tendency towards altruism is destructive when it is not tempered by a healthy concern for yourself. Too much self sacrifice becomes resentment, which can turn into passive aggressive behavior. Another way in which it manifests is pathological codependency and a need to control others.
How do we learn to balance the need for self fulfillment with our care for others? How do we know that too much giving is too much? When is a lack of fulfillment a symptom of not getting enough and when it is a symptom of getting too much and not appreciating?
So how is knowing the evolutionary purpose of these conditions helpful in finding ways to manage them?
The most important way is that it takes some of the blame away. We are designed to survive 50,000 years ago and are driven in ways that do not necessarily benefit modern life. Mental health disorders are often due to a perversion of a drive taken out of context.
For the first group, the excessive energy is generated in order to respond to a perceived danger and lack of control. Modern mental health tends to to decrease the sense of danger by deflating the threat and to decrease personal reactivity. Some of the strategies include: desensitization, examining beliefs and ways of thinking, exercise, discovering the origins of the reactions, and medication.
The evolutionary approach to manage this class of conditions is to increase experiences of safety through experiencing a sense of control over your circumstances.
In other words, to encourage activities that create order out of chaos. We have very little influence over the most of that factors that have a huge influence over our lives, but we can take control over a small portion in order to experience a sense of control and thus a sense of safety. Some examples of what work for people are: cooking, puzzles, video games, cleaning. Making a list and then completing items on the list also creates a feeling of control over one’s circumstances. An exercise regime is also very useful because not only does it create a sense of control over your body, it also dispels some of the excess energy.
Modern mental health and the evolutionary approach offer complementary strategies that work well together.
The second group of disorders all involve a lack of energy because of a lack of hope and a sense of personal ineffectiveness. Modern mental health treatment is about attacking the lack of energy with medication and dispelling the hopelessness by changing one’s way of habitually thinking and responding. This includes: cognitive behavioral therapy, exercise and medication management.
The evolutionary approach is to encourage experiences of personal efficacy and to increase hope by increasing self confidence. When you feel effective you no longer at the mercy of unfortunate life circumstances.The overriding strategy is to encourage the making of a do able goal and then the celebration of its accomplishment. It is irrelevant how small the goal is, the importance is in its achievement Some of the strategies that have worked for others include: making a list of past accomplishments in order to remember what it felt like to be capable. Making a very simple “to do “ list for the pleasure of crossing things off. Tackling tasks in 15 minute increments is also effective in fighting the sense of powerlessness. A structured, mild, exercise program is also very useful because it naturally increases energy and by making a plan and following through self confidence is increased.
Modern mental health treatment and the evolutionary approach work well together.
The third and fourth groups of mental disorders are due a mis use of the drive to survive. One originates in the drive towards personal survival, the other in the drive for the species to survive.
The key to managing the dysfunctional behavior which originate from these is to realize that they are both extremely compelling, lead to highly desirable albeit opposite goals. We want personal pleasure, we want to win AND we also want our loved ones to do well, and are willing to sacrifice for their wellbeing.
The evolutionary approach recognizes that in their extremes these drives become destructive and accomplish the opposite of their intended outcomes. When you indulge yourself too much you no longer appreciate or savor what you have been given. You become a “hungry ghost”, a being with a huge body but a little tiny mouth who can never get enough food to satisfy himself. There comes a point that the more you satisfy desires, the more desire you feel. As such, you are the opposite of satisfied and you want more and more. This continues the unpleasant cycle. It is extremely hard to step away from it. But in order to feel better you must.
The remedy is to move your focus away from yourself and do something for someone else. Some of the activities that have worked for people include: volunteering, donating time or energy to a campaign or cause you care about, taking care of an animal, doing an anonymous act of kindness.
The other drive is to take care of those we love and that are dependent on us. It feels inherently good to nurture others. However when you give and give and get little in return, resentment builds. When you give with an open heart, you get back more than you give, but when resent creeps in, it no longer easy to keep giving. If you persist in sacrificing your own needs for those of others your resentment undermines any pleasure that you might have felt, the relationship with your loved ones start to crumble. You become over involved, they resent your attempts to help because they feel controlled and manipulated. The outcome is opposite of the intent.
The remedy is to do more for your self, for instance to set limits and distance yourself from those that are taking advantage of you. It is very hard to do because it feels unnatural to to “abandon those in need”. But if you deep down inside actually thought that there was a dire need that only you could fulfill, you would not feel resentment. In order to feel better and to preserve the relationship you must step away to a more manageable distance.
Managing these behaviors and the underlying conditions are dependent on them becoming unpleasant and unwanted. Unfortunately, pathological narcissists, bullies, and sociopaths do not experience their behavior to be a problem. They are not motivated to change or manage their condition until society steps in and demands it. At that point, the success rate is predictably not high.