See discussions, stats, and author profiles for this publication at: https://www.researchgate.

net/publication/331230653

Good Reasons for Bad Feelings: Insights from the Frontier of Evolutionary
Psychiatry

Book · February 2019

CITATIONS READS

48 9,177

1 author:

Randolph M Nesse
Arizona State University,
259 PUBLICATIONS   19,665 CITATIONS   

SEE PROFILE

Some of the authors of this publication are also working on these related projects:

Evolutionary Psychiatry View project

All content following this page was uploaded by Randolph M Nesse on 20 February 2019.

The user has requested enhancement of the downloaded file.

 GOOD REASONS for
 BAD FEELINGS
{
Insights from the Frontier of
Evolutionary Psychiatry

RANDOLPH M. NESSE, M.D.

DUTTON

9781101985663_GoodReasons_TX.indd iii 10/13/18  3:03 PM

 CONTENTS

PREFACE xi

PA RT O N E
Why Are Mental Disorders So Confusing?
1. A New Question
Why has natural selection left us so vulnerable
to mental disorders? 3

2. Are Mental Disorders Diseases?

Psychiatric diagnosis is confused because it doesn’t
distinguish symptoms from diseases, and it incorrectly
assumes that each disorder has a specific cause. 17

3. Why Are Minds So Vulnerable?

Six evolutionary reasons explain vulnerability to diseases. 29

PA RT T WO
Reasons for Feelings
4. Good Reasons for Bad Feelings
Emotions were shaped to cope with situations. 45

5. Anxiety and Smoke Detectors

Useless anxiety can be normal, as
the Smoke Detector Principle reveals. 67

8  3:03 PM 9781101985663_GoodReasons_TX.indd vii 10/13/18  3:03 PM

 viii C o n te n ts

6. Low Mood and the Art of Giving Up

Mood adjusts behavior to the propitiousness of the situation. 84

7. Bad Feelings for No Good Reason: When the Moodostat Fails

Moodostat failures cause serious diseases. 112

PA RT T HR EE
The Pleasures and Perils of Social Life
8. How to Understand an Individual Human Being
An individual’s emotions and actions make sense only in the
context of that person’s idiosyncratic life goals and projects. 141

9. Guilt and Grief: The Price of Goodness and Love

Preferred partners get advantages that make morality possible. 160

10. Know Thyself—­NOT   !

Repression and cognitive distortions can be useful. 183

PA RT FOU R
Out-­o f-­C ontrol Actions and Dire Disorders
11. Bad Sex Can Be Good—­for Our Genes
Sexual problems are common for good evolutionary reasons. 201

12. Primal Appetites

Dieting spirals famine protection mechanisms
into anorexia nervosa and bulimia. 219

13. Good Feelings for Bad Reasons

Substances hijack learning to create zombies. 234

9781101985663_GoodReasons_TX.indd viii 10/13/18  3:03 PM

 Cont ent s ix

14. Minds Unbalanced on Fitness Cliffs

Genes for schizophrenia and autism may persist
because of cliff edges in the fitness landscape. 245

Epilogue: Evolutionary Psychiatry: A Bridge, Not an Island

How using all of biology can integrate psychiatry
and make sense of mental illness. 262

FURTHER READING 271

NOTES 273

ACKNOWLEDGMENTS 351

INDEX 355

ABOUT THE AUTHOR 365

8  3:03 PM 9781101985663_GoodReasons_TX.indd ix 10/13/18  3:03 PM

 P R E FAC E

When I first realized that evolutionary biology could provide a new kind
of explanation for mental disorders, I immediately wanted to write this
book. It was soon clear, however, that understanding why bodies are vul-
nerable to diseases in general had to come first. That project was the focus
of my collaboration with the great evolutionary biologist George C. Wi­
lliams. We wrote a series of technical papers and Why We Get Sick: The New
Science of Darwinian Medicine, a popular book that helped inspire much
new work in what is now the thriving field of evolutionary medicine. Ever
since then, my career has been committed equally to bringing evolutionary
biology to medicine and to helping my patients with mental disorders. The
two missions are connected deeply.
Practicing psychiatry is enormously satisfying. Patients are grateful for
effective treatment. Providing it is intellectually interesting as well as emo-
tionally fulfilling. Each patient poses a puzzle. Why did this individual get
these symptoms now? What treatment will work best? However, sometimes
looking out the window from my cozy office, I have visions of a tsunami
sweeping millions of people with mental disorders to oblivion, with no
help or high ground in sight. Such dark apparitions inspire asking different
larger questions: Why do mental disorders exist at all? Why are there so
many? Why are they so common? Natural selection could have eliminated
anxiety, depression, addiction, anorexia, and the genes that cause autism,
schizophrenia, and manic-­depressive illness. But it didn’t. Why not? These
are good questions. The aim of this book is to show that asking why

xi

9781101985663_GoodReasons_TX.indd xi 10/13/18  3:03 PM

 xii P reface

natural selection has left us vulnerable can help make sense of mental illness
and make treatment more effective.
The possible answers suggested here are examples, not conclusions;
some will turn out to be wrong. That should not be discouraging at an
early stage in a new field so long as ideas are tested. As Darwin put it,
“False views, if supported by some evidence, do little harm, for every one
takes a salutary pleasure in proving their falseness: and, when this is done,
one path towards error is closed and the road to truth is often at the same
time opened.”1
Continuing controversies and slow progress in psychiatry have inspired
many calls for new approaches to mental disorders. Evolutionary biology is
not new; it is the well-­established scientific foundation for understanding
normal behavior, but its relevance for abnormal behavior is finally being
recognized. Evolutionary medicine is providing new explanations for why
our bodies are vulnerable to diseases and is now being applied systematically
to mental disorders. The time is ripe to explore the frontier of evolutionary
psychiatry.
I wish the field could have some other name. Evolutionary psychiatry
is not a special method of treatment, and professionals in other mental
health fields will also appreciate an evolutionary perspective. A more ac-
curate descriptor would be “Using the principles of evolutionary biology
to improve understanding and treatment of mental disorders in psychiatry,
clinical psychology, social work, nursing, and other professions.” But that
is unwieldy, so this book is a report from the frontier of evolutionary psy-
chiatry, viewed broadly.
Mental disorders are such a plague on our species that we all want
solutions right now. Evolutionary psychiatry offers some practical benefits
now, but the big payoffs will come as researchers, clinicians, and patients
ask and answer new questions inspired by a fundamentally new perspective.
In the meanwhile, evolutionary psychiatry offers philosophical insights.
Nearly everyone has wondered why human life is so full of suffering. Part
of an answer is that natural selection shaped emotions such as anxiety, low
mood, and grief because they are useful. More of an answer comes from
recognizing that our suffering often benefits our genes. Sometimes painful
emotions are normal but unnecessary because the costs of not having the

9781101985663_GoodReasons_TX.indd xii 10/13/18  3:03 PM

 P reface xiii

emotion could be huge. There are also good evolutionary reasons why we
have desires we cannot fulfill, impulses we cannot control, and relationships
full of conflict. Perhaps most profound of all, however, evolution explains
the origins of our amazing capacities for love and goodness and why they
carry the price of grief, guilt, and, thank goodness, caring inordinately about
what others think about us.

July 2018

8  3:03 PM 9781101985663_GoodReasons_TX.indd xiii
View publication stats 10/13/18  3:03 PM