Evolution and psychiatry

If evolution is the missing half of a ‘truly biological psychiatry’, ¹ the other half being biological reductionism, then value is out of the picture. But this cannot be. We do not deny the gains from biology or those that are to come (millions of people manage to live because of advances in this field). Nor are we pessimistic about the potential gains that evolution claims for mental healthcare. However, these two ‘halves’ do not make a whole. We understand the aspiration for a truly biological psychiatry: life would be easier. Biology (although a big part, or the major part of the picture) cannot (alas!) be the whole, and evolutionary theoretical considerations of disorder, natural function, design and the like cannot fill what is missing. The reason is that even if we accept a value-free account of naturally selected mechanisms, physical as well as mental, these must be considered within the spectrum of individual and social values. Fulford ² explains why values are so feared. Other theorists who have considered evolution in terms of disorder also accept the indisputable place of values in psychiatry. Psychiatry is conceptually and empirically more complex than the rest of medicine. Every now and then a claim is made for a concept that will push psychiatry to an exclusively biological future. But psychiatry must be the avant-garde of science, rather than the runner-up of medicine, for perspectives which truly add to those complexities (empirical as well as philosophical) to do justice to themselves. ³

Psychiatry's interest in evolutionary theory is not new. The authors will be familiar with the views of Scadding, Kendell and Boorse, who all attempted to define disease in evolutionary terms. Accounts of disorder based on evolutionary theory allegedly offered the epistemological background for a value-free conceptualisation of disease. This is one way out of psychiatry's embarrassment when comparing itself against the scientific status of the rest of medicine and the medical model. However, this seems to be a misuse of natural selection, dressed in the colours of realism in order to enhance a ‘scientific’ psychiatry.

We do not argue that evolutionary theory has no role to play. Evolutionary psychology may offer new significant ways of approaching mental disease. But let us hope that this interest in Darwin will not be a pretext for blind reductionism and a return to a fact/value dichotomy. Britain is in the front line of value-based and evolution-based considerations with the work of Fulford, Thornton, ⁴ Bolton ⁵ and others. Great heritage, greater present.