By Alison Escalante
What if mental disorders like anxiety, depression or post-traumatic stress disorder aren’t mental disorders at all? In a compelling new paper, biological anthropologists call on the scientific community to rethink mental illness. With a thorough review of the evidence, they show good reasons to think of depression or PTSD as responses to adversity rather than chemical imbalances. And ADHD could be a way of functioning that evolved in an ancestral environment, but doesn’t match the way we live today.
Adaptive responses to adversity
Mental disorders are routinely treated by medication under the medical model. So why are the anthropologists who wrote this study claiming that these disorders might not be medical at all? They point to a few key points. First, that medical science has never been able to prove that anxiety, depression or post-traumatic stress disorder (PTSD) are inherited conditions.
Second, the study authors note that despite widespread and increasing use of antidepressants, rates of anxiety and depression do not seem to be improving. From 1990-2010 the global prevalence of major depressive disorder and anxiety disorders held at 4.4% and 4%. At the same time, evidence has continued to show that antidepressants perform no better than placebo.
Third, worldwide rates of these disorders remain stable at 1 in 14 people. Yet “in conflict‐affected countries, an estimated one in five people suffers from depression, PTSD, anxiety disorders, and other disorders,” they write.
Taken together, the authors posit that anxiety, depression and PTSD may be adaptive responses to adversity. “Defense systems are adaptations that reliably activate in fitness‐threatening situations in order to minimize fitness loss,” they write. It’s not hard to see how that could be true for anxiety; worry helps us avoid danger. But how can that be true for depression? They argue that the “psychic pain” of depression helps us “focus attention on adverse events… so as to mitigate the current adversity and avoid future such adversities.”
If that sounds unlikely, then consider that neuroscientists have increasingly mapped these three disorders to branches of the threat detection system. Anxiety may be due to chronic activation of the fight or flight system. PTSD may occur when trauma triggers the freeze response which helps animals disconnect from pain before they die, and depression may be a chronic activation of that same freeze response.
Labels are something we internalize to define who we are and what we are capable of. All too often, labels limit us. And that’s why reconsidering how we label anxiety, depression or ADHD is important. Does someone have depression, a medical disorder of their brain, or are they having a depressed adaptive response to adversity? Adversity is something we can overcome, whereas a mental disorder is something to be managed. The labels imply very different possibilities.
Consider how we label ADHD. A generation ago boys with ADHD were labelled as “bad boys” and were given penalties or detentions. Now we help kids with ADHD understand that they have a “learning difference.” Instead of detention, we try to provide support in a variety of modalities. When we do, the behavior problems often disappear. That label change to learning difference is vital, because it gives space for kids with ADHD to be “good kids” and to succeed. Yet ADHD is still “attention deficit and hyperactivity disorder.”