Trapped!

Things close in. I need to get out. Mental illness is simple, really. We get overwhelmed, overloaded. Too much of one thing, too much of everything. Too much thought, too much emotion, too much sensory input. Too much of nothing, even. Think of a fire in your brain or of being trapped deep underground, unable to breathe. There is no way the brain can respond rationally.

The brain copes, instead, by flipping out or shutting down.

Nearly 20 years ago, in a hot tub, I relived one of these experiences with a New Age practitioner. I felt myself in some dark cavern of hell, struggling, desperate to get out. Oddly, I found myself humming a tune from Offenbach's "Orpheus in the Underworld." Thankfully, my practitioner stayed with me and helped me effect my escape. Light, fresh air, deliverance. I flopped onto the deck of the tub, spent, exhausted.

Slowly, I collected my wits and speculated out loud that this is what it must have been like when I was born. Not that my mom was about to corroborate my account, of course. Funny thing, though, next time I saw her, with no prompting, she started talking about my birth.

It was a very quick delivery, she informed me. I was out instantly, practically born in the elevator. This did not square with my hot tub experience. Then, as an afterthought, my mom happened to say: "The doctor told me to hold my legs together."

Holy crap!

Let me attempt a reconstruction, from the baby's point of view: Here I was, venturing out from the security of the womb, in some biological equivalent of an extremely confining crawl space. There was no going back, but I could take some comfort in my forward progress. Things were closing in, it was a scary situation, but I was ready. I made my big push, and ...

I couldn't get out!

Talk about a fetus with attitude, I literally forced my way to the surface, where I entered the world kicking and screaming in unsanitary conditions. Instantly, I was whisked away into an isolated ward, where my mother jokes I bonded with a nun. I have no reason to doubt her.

Please don't tell anyone about this ...

Darwin and the Psychiatric Advantage

Happy birthday, Charles! You're looking great at 200.

Also happy anniversary of "On the Origin of the Species," which was published 150 years ago today.

Here's an interesting fact: Peacock tails drove Darwin crazy. The sight of one "makes me sick," he wrote. These feathered accessories played havoc with his work-in-progress theory of natural selection. Surely, any bird stupid enough to flaunt their colors in the wild wouldn't live long enough to mate.

Darwin's solution seems obvious enough today, but back in the nineteenth century it was a scientific breakthrough, a work of genius. The showy tails, he figured out, were chick magnets. The flashier, the better. The well-endowed cock, so to speak, won the right to make a deposit. The bird's genes would live on, even if its owners' days were numbered.

Evolutionary biologists refer to this as a trade-off. The sickle cell gene, for instance, helps confer immunity against malaria.

Fine. But how does Darwin apply to mental illness? According to evolutionary biologist Randolph Nesse MD of the University of Michigan: "Psychiatrists still act as if all anxiety, sadness, and jealousy is abnormal and they don't yet look for the selective advantages of genes that predispose to schizophrenia and bipolar disorder."

I heard Dr Nesse at the American Psychiatric Association annual meeting a few years back talk about the selective advantage in anxiety. Obviously, sufficiently anxious cave men were able to steer clear of saber toothed tigers long enough to find an opportunity to pass on their genes to the next generation.

Anxiety traits are no mere artifacts of an earlier age. It is crucial to marshaling our wits. We could never survive one day in traffic without it, let alone the full range of personal interactions.

Dr Nesse compared the brain's limbic system to a smoke detector that is programmed to deliver 100 false alarms for every genuine alert. The false alarms are the price of survival. Better to be too anxious. The seriously anxious, it turns out, have hyper-sensitive smoke detectors. The false alarms and the hyper-sensitive in our midst tend to blind us to the fact that a certain degree of anxiety is good, that we would fail to exist as a species without it.

Similarly, you can make a Darwinian case for bipolar. Highly energetic and productive and creative types certainly had a selective advantage over their more mundane kinfolk. Think of mania lite. Passing on the risk of more serious manifestations was an acceptable trade-off.

But what is the advantage to depression? For one, depression is when the rose-colored glasses come off, when reality sets in. If mania is all about daring, depression is about caution. The daring have an advantage in life's ultimate prize, the opportunity to mate. So do the cautious.

Depression also provides an opportunity for regrouping and recouping, not to mention a time of introspection and reflection. Think of depression as an enforced time-out. In its own perverse way, depression may set the stage for needed psychic healing.

As with anxiety and mania, we are talking more benign manifestations. The more virulent versions of depression, it seems, are part of the price we have to pay.

For the longest time, I could see no selective advantage to schizophrenia. There are those who claim that those with schizophrenia would have made perfect shamans and seers back in the old days - a romantic notion of serious mental illness totally without merit, as I see it.

Then I picked up "A Beautiful Mind" by Silvia Nasar. The book chronicles the life of John Nash, the Nobel Laureate who lost some 25 years of his life to schizophrenia. As the book makes clear, John Nash was a social and intellectual oddball well before his schizophrenia erupted. We tend to think of mental illness as a complete break with reality or rationality, but these breaks don't just happen overnight. Subtle symptoms may manifest many years earlier, what the experts describe as "prodromal" states.

And there may be certain advantages. Nancy Andreasen MD, PhD of the University of Iowa mentions that Newton, Einstein, and Watson all had schizotypal tendencies or schizophrenia running in the family. Newton, in fact, had a full-blown psychotic episode later in life.

John Nash confided to a friend that he took his psychotic delusions seriously because they came to him the same way his mathematical ideas did. As the title says, "A Beautiful Mind."

Darwin made no attempt to reconcile his discoveries with religion, but that doesn't mean the two are mutually exclusive. Nevertheless, because one cannot witness evolution in action the way one can observe gravity or thermodynamics in action, Darwin is still a hard sell for most of the population. For many of us, evolution is an act of faith, even though science is virtually unanimous on its general points.

Evolutionary psychiatry, though, is still a speculative endeavor. A legitimate argument can be made that we are retrofitting psychiatry to conform to evolutionary precepts. Then again, a very strong case can be made that our behavior makes no sense without taking evolution into account. Instead of viewing all mental illness as solely destructive, we are forced to consider its advantages. And in looking at the advantages, we find potential in our own worth.

Happy birthday, Darwin, from a big fan of yours.