Hollon Steven D, Andrews Paul W, Thomson J Anderson
Department of Psychology, Vanderbilt University, Nashville, TN, United States.
Department of Psychology, Neuroscience and Behaviour, McMaster University, Hamilton, ON, Canada.
Front Psychiatry. 2021 Jul 5;12:667592. doi: 10.3389/fpsyt.2021.667592. eCollection 2021.
Evolutionary medicine attempts to solve a problem with which traditional medicine has struggled historically; how do we distinguish between diseased states and "healthy" responses to disease states? Fever and diarrhea represent classic examples of evolved adaptations that increase the likelihood of survival in response to the presence of pathogens in the body. Whereas, the severe mental disorders like psychotic mania or the schizophrenias may involve true "disease" states best treated pharmacologically, most non-psychotic "disorders" that revolve around negative affects like depression or anxiety are likely adaptations that evolved to serve a function that increased inclusive fitness in our ancestral past. What this likely means is that the proximal mechanisms underlying the non-psychotic "disorders" are "species typical" and neither diseases nor disorders. Rather, they are coordinated "whole body" responses that prepare the individual to respond in a maximally functional fashion to the variety of different challenges that our ancestors faced. A case can be made that depression evolved to facilitate a deliberate cognitive style (rumination) in response to complex (often social) problems. What this further suggests is that those interventions that best facilitate the functions that those adaptations evolved to serve (such as rumination) are likely to be preferred over those like medications that simply anesthetize the distress. We consider the mechanisms that evolved to generate depression and the processes utilized in cognitive behavior therapy to facilitate those functions from an adaptationist evolutionary perspective.
我们如何区分疾病状态和对疾病状态的“健康”反应？发烧和腹泻是进化适应的典型例子，它们会在体内存在病原体时提高生存几率。然而，像精神分裂症或精神躁狂症这样的严重精神障碍可能涉及真正的“疾病”状态，最好通过药物治疗，而大多数围绕抑郁或焦虑等负面影响的非精神病性“障碍”可能是进化而来的适应机制，其作用是在我们祖先的过去提高广义适合度。这可能意味着，非精神病性“障碍”背后的近端机制是“物种典型的”，既不是疾病也不是障碍。相反，它们是协调一致的“全身”反应，使个体能够以最大功能化的方式应对我们祖先所面临的各种不同挑战。可以说，抑郁的进化是为了在面对复杂（通常是社会）问题时促进一种深思熟虑的认知方式（沉思）。这进一步表明，那些最能促进这些适应机制所服务功能（如沉思）的干预措施，可能比那些仅仅麻醉痛苦的药物更受青睐。我们从适应主义进化的角度来考虑导致抑郁的进化机制以及认知行为疗法中用于促进这些功能的过程。
