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Psychiatric Times
Evolution of Mental Health Disorders: An Alternative Perspective
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In Angst: Origins of Anxiety and Depression, Dr Jeffrey Kahn offers an alternative perspective on the evolution of common mental health disorders by considering the adaptive nature of symptoms that modern clinicians deem pathological.
Angst: Origins of Anxiety and DepressionBy Jeffrey P. Kahn, MD; New York, Oxford University Press, 2013312 pages • $34.95 (hardcover)
In Angst: Origins of Anxiety and Depression, Dr Jeffrey Kahn offers an alternative perspective on the evolution of common mental health disorders by considering the adaptive nature of symptoms that modern clinicians deem pathological.
By providing a wealth of anthropological case studies, Dr Kahn proposes his theory of the “herd instinct” in an often comical yet educational manner that is not overly clinical. This makes the book a valuable read for both psychiatrists and those without a medical background who are interested in learning more about the etiology of mental illness and potential treatment.
The first part of the book is dedicated to an exploration of the “usual suspects” of anxiety and depressive disorders on an individual level to illustrate that certain forms of distress can be seen as vestigial social instincts that have persisted into the modern world. For example, Dr Kahn illustrates the historical utility of panic anxiety. By keeping members close to the tribe, our ancestors could avoid real dangers, such as hyenas and dehydration.
The shame and embarrassment of social phobia functioned to maintain a social hierarchy, protecting groups from internal conflict and vulnerability to attack from stronger groups. Melancholic sentiments of uselessness and worthlessness with corresponding weight loss allow for a redistribution of scarce resources to the fittest, most capable individuals of the group. Common “symptoms” are redefined as social instincts meant to maintain structures and behaviors that benefit the survival of the species.
The idea unfolds in the second part of the book, where the “herd instinct,” the collective group of social instincts, is postulated to be the driving force behind the common goals and sense of purpose that allowed groups and civilizations to thrive. In the modern era, reason and a more sophisticated consciousness have evolved to protect humans from succumbing to overwhelming angst by forming “counter-instinctive behavior” directly opposite those social instincts, resulting in heterogeneous personalities and possibly leading to some challenges of today’s society, such as alcoholism and even coronary heart disease. The idea of “counter-instinctive behavior” shares similarities with freudian defense mechanisms, and Dr Kahn is quick to acknowledge and appreciate this.
In the last chapter, Dr Kahn leaves readers with a glimmer of hope that humans have some control over their experiences and are not just tokens in evolution’s game of survival, and he offers practical strategies to balance primeval instinct and contemporary reason. Thoughtful self-exploration with the possibility of medication and psychotherapy may relieve suffering for the individual while hopefully maintaining social harmony.
Disclosures:
Dr Kastenschmidt is a geriatric psychiatrist at Long Island Jewish Medical Center, Department of Emergency Medicine, New Hyde Park, New York. She also provides therapy with a group private practice in New York City. Dr Kastenschmidt is a graduate of the adult psychiatry residency and geriatric psychiatry fellowship training programs at Montefiore Medical Center/Albert Einstein College of Medicine in Bronx, New York and is in the process of completing a Psychodynamic Psychotherapy Training Program at the Institute for Psychoanalytic Education in Manhattan.
