The origins of psychopathology is a topic approached in mainstream psychiatry by examining genetic factors, pathophysiology and the developmental factors (ontogeny). Martin Brüne, like other evolutionary psychiatrists, finds this approach incomplete and proposes that these proximate causes of psychopathology should be complemented by ultimate causation ones (phylogeny and adaptive functions). By doing that, the four ‘why’ questions suggested by Tinbergen (function or adaptation, phylogeny, mechanism and ontogeny) would be covered. This is possibly the main theme of this book and has influenced the structure of its chapters.
The book therefore is not a list of evolutionary theories of psychopathology. Instead, it is largely written using a standard psychiatric textbook layout. Clinical chapters are divided into sections similar to any other introductory textbook of psychiatry, such as symptomatology, epidemiology, risk factors, pathophysiology, differential diagnosis, course and outcome, and treatment, in addition to a section which provides an evolutionary synthesis. Part one of the book, which provides the theoretical background, covers evolutionary principles, human life history in addition to causes of psychopathology, the human brain and psychiatric assessment in line with the approach described above.
In sections called ‘Afterthought’, added to chapters in part 1 and 3, Brüne outlines concepts, impressions and insights which provide a different dimension to the content of the chapter and sometimes clarify difficult ideas. Examples of these afterthoughts include ‘genetic determinism’, ‘the possibility to prevent mental illness’, ‘what non-verbal behaviour can tell us’ and ‘the social brain hypotheses’. The last is one of many examples in this book used to highlight the importance of the social context in the origin of psychopathology. This is used to dispel a common misconception that the evolutionary approach is a reductionist enterprise that aims to explain psychopathology in purely genetic or molecular terms. Another example is a new addition to chapter 1 in this second edition, ‘the differential genetics of susceptibility’ – the concept that genetic variation can promote vulnerability or protection depending on the nature of early life experiences. Although the clinical chapters in part 2 follow a DSM-5 approach to categorisation, the author takes pains to underline the dimensional nature of psychiatric conditions, which is another important theme of this book. He explained that a different approach to categorisation based on evolutionary themes would have been too radical and would defy the purpose of this book as an introductory textbook of psychiatry.
I would personally recommend this book to psychiatrists, researchers and interested medical students. I think it would be of special importance for psychiatric trainees, because in addition to the classic knowledge base necessary for their training and exams, it will also provide them with a more coherent theoretical formulation and context than they can find in current mainstream texts.
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