Starts With Me Journal
Vol. I Nos. 3 & 4 (October 2019)
What Criteria Should We Use to Assess Mental Health Advice?
Director, Research & Strategy
Today, there is an overwhelming amount of information available about how to improve mental health and achieve emotional wellbeing. If you search “mental health” on Amazon, you get over 100,000 results. If you search for “emotional wellbeing,” you get over 3000 results. This is just the tip of the iceberg. There are also hundreds, if not thousands, of articles, blog posts, and podcasts on the topic.
But which of the mental health advice offered is any good? What criteria should we use to assess this mass amount of information?
Thinking about these questions is important since many different perspectives and opinions can easily lead to decision-paralysis, leaving us no better off.If we have some criteria to guide us, we may be more able to consider the advice that is out there and make more informed decisions.
Below I discuss three perspectives on what constitutes good mental health advice: advice that is based on lived experience, advice based on expertise, and advice based on human evolution. I argue that advice from those with lived experience and expertise is important and can be very valuable, but that they may not be reliable enough indicators of good advice. Instead, a better indicator of good advice is if it is based on who we humans are as a species and our evolutionary past.
Advice Based on Lived Experience
One perspective suggests that the best advice comes from those with lived experience with a mental health issue. These individuals can speak to what they went through and they can describe the strategies they adopted to work through their struggles.
This kind of advice can be very useful. It can let us know that we are not alone and can provide us with some optimism that there is a way forward. Further, those who share their stories of struggle and recovery are often positive role models.
And yet, it is possible that the advice from those with lived experience may not be any good. Research in psychology suggests that the human mind has a strong propensity to myth telling and delusion. We are prone to a number of cognitive biases and distortions that make authentic truth telling difficult. The stories we tell ourselves, and others, are often fraught with the selective use of evidence.For this reason, the main objective of Cognitive Behavioural Therapy is to provide strategies that we can use to correct the cognitive errors we frequently make.
When thinking about mental health advice from someone with lived experience, a few questions come to mind. Is the advice offered an accurate reflection of what the individual actually did to address and work through their issue? Might they be misremembering things? If so, what are they leaving out?
Additional questions come up if the individual is offering their experience as part of a mental health consulting practice or trying to sell a book. In these cases, is the advice offered more about sales than long-term efficacy?
While advice from those with lived experience can be quite powerful and helpful, it should not necessarily be taken as gospel.
Advice Based on Expertise
A second perspective suggests that good mental health advice comes from experts who have spent years studying the issue and have earned advanced degrees in the topic. By drawing on their own original research or an assessment of a large body of scholarly literature, experts may be able to provide a more informed picture of a particular mental health challenge and a more accurate outline of the steps one needs to take to work through it.
However, like lived experience, expertise alone as a criteria for good mental health advice is also unsatisfying. This is for two reasons.
First, there is a large literature that documents the limitations of current scientific knowledge. In the case of psychology, one of the academic disciplines most relevant for understanding and addressing mental health issues and mental illness, some have argued that many published studies report “false positives” – findings that are inadequately supported by the data. In many cases, false positives are not due to fraud but rather a common practice amongst scholars to play around with their data and use of a variety of statistical techniques in order to get the results they want. This practice is known as “p-hacking,” which some psychology researchers suggest is undermining the credibility of their field.
Second, conflicts of interest also raise questions about the advice offered by some experts.
Conflicts of interests arise when an expert has personal or professional ties that can get in the way of their scientific responsibility to conduct their study and report their findings as objectively as they can. For those in psychology or psychiatry, conflicts of interest often stem from close relationships with pharmaceutical companies who want the research to promote the safety and efficacy of their drugs. According to Jacob Stegenga, author of Medical Nihilism, leading psychiatrists at Harvard, Stanford and Emory University have received significant amounts of money from, or owned stock in, the pharmaceutical companies whose drugs they study. Stegenga also reports that in 2006 the American Psychiatry Association received 30% of its budget from pharmaceutical companies. These two examples are part of a much larger problem. As Stegenga puts it, “conflicts of interest in medical research are ubiquitous.”
These two concerns – the publication of false positives in psychology and conflicts of interests in psychiatry – should not lead us to discredit all scientific work. On the contrary, they simply remind us that we should view the advice offered by experts with an open-mind and critical eye, in the same way that any good scientist or researcher would.
Another reason why expertise as a criterion for good advice is unsatisfying is because it does not help us adjudicate between experts who disagree. In these situations, what additional criteria should we use to assess the advice offered?
Advice Based on Evolution
A more compelling, and intuitive, way to assess mental health advice involves asking if it has some kind of evolutionary logic to it. That is, is the advice consistent in some way with who we are as humans and how we have evolved over millions of years? Is the advice “species appropriate” and “evolution-based”?
This approach draws on evolutionary psychology, a body of research that dates back to Charles Darwin’s On the Origin of Species, published in 1859. In his book, Darwin argued that species were not designed by a god-like entity but rather were the product of the pressures to survive and reproduce, known as natural and sexual selection. Darwin’s theory was initially applied to anatomy in order to explain the function of body parts and how they have changed, or evolved, over time. But in the 1980s, psychologists began applying Darwinian principles to explain the patterns and tendencies of human emotions and behaviour. Since then, evolutionary approaches have become more and more prominent to the study of human psychology as well as in other fields in the social sciences.Today, it is an important part of the psychology mainstream and is said to provide an overarching framework that brings together the various branches of psychology, including cognitive psychology, developmental psychology, social psychology,and most recently positive psychology.
Despite its growing credibility within academic circles, it has not yet made its way into mental health and mental illness clinical practice. This may be due to the amount of time it takes for new perspectives to influence practioners, who often use the approaches and methods in which they were schooled. It may also reflect concerns that evolutionary approaches do not provide obvious strategies that may offer more immediate relief, such as pharmaceutical interventions or Cognitive Behavioural Therapy. And yet, the relative absence of insights from evolutionary psychology may be holding the mental health community back from offering advice to those suffering that is effective over the long term.
What is Evolutionary Psychology?
The core premise of evolutionary psychology is that human emotions and behaviours are the product of long evolutionary processes that result in adaptations designed to promote survival and reproduction. It emphasizes the interaction between long evolutionary processes and one’s current environment. This interaction contributes to a set of emotions and the resulting behaviours. In thinking about evolutionary processes, evolutionary psychologists are not merely referring to a few hundred years of human development. On the contrary, they refer to what David Buss calls “deep time” – hundreds of thousands, even millions, of years of evolution. In this way, evolutionary psychology differs from other approaches in psychology that emphasize more “proximate” causes of our emotions and behaviours, such as current social norms and pressures, parental strategies, education, amongst other factors. Instead, evolutionary psychologists focus on the “ultimate” cause that account for general patterns in human behaviour that exist across cultures and across time. As Glenn Geher puts it:
The evolutionary perspective allows you to think about any and all psychological phenomena in a broader perspective. It allows you to see a map of the entire forest as opposed to only the details of one part of one of the trees. It is a big-picture approach to understanding behavior that is fully inspired by Darwin’s take on the nature of life.
In their work, evolutionary psychologists have made some interesting findings about human behaviour. These include:
- We are more likely to remember things associated with survival and reproduction than we are things not associated with them.
- We are more likely to think things are closer to us when they are approaching compared to when they are moving away. This keeps us on guard in case of an approaching threat.
- We are more likely to think a building is taller than it is when viewed from the top than when viewed from the bottom. This protects us from falling to our deaths.
- We are less likely to be sexually attracted to those with whom we have grown-up. This helps us avoid inbreeding because the brain interprets co-residence at an early age as an indicator of possible genetic similarities.
- We all have a strong preference for sweet or fatty foods. This increases chances of survival in times of scarcity, but obesity in times of abundance.
- We have a strong preference for landscapes with scattered trees and open grasslands, which resemble tropical Africa where it is said the human species originated. This is seen in preferences for hotels and resorts that have these characteristics.
What Does Evolutionary Psychology Say About Mental Health?
In addition to providing some important insights on regular day to day emotions and behaviours, evolutionary psychology also offers important insights into poor mental health and mental illness. Below I outline two, but there are many more.
Environmental Mismatch as a Cause of the Current Mental Health Crisis
First, evolutionary psychologists suggest that a main cause of the current uptick in poor mental health and mental illness is in large part due to “environmental mismatch” – the disconnect between the environments in which our psychological traits evolved and our modern environment. Nearly all of the human experience occurred in small-knit groups of a few hundred people that communicated face-to-face, spent most of their time outdoors, ate food they hunted or gathered, and had sex to reproduce. In such small groups, and with limited technology, each individual fulfilled a necessary function to ensure the continued survival of the group. It is estimated that 95% of the human experience took place under hunter-gatherer conditions. According to Stephen Ilardi, it is to these ancestral hunter-gatherer conditions that we are quite well adapted.
Approximately 12,000 years ago, humans began to move away from hunter-gather ways of life, with the advent of agriculture and the domestication of animals. This period began what is known as the Neolithic Revolution in which humans shifted to living in settled agrarian communities. Over time, agriculture increased the food supply, leading to population growth. This led to larger and larger settlements, and the creation of states, which first appeared in Mesopotamia (today, Iraq).Agriculture ushered in not only new ways of living but also dramatically altered our relationship with nature. This trend sped up considerably in the 19thcentury with industrialization and mass urbanization, which continues today.
While these changes have brought about significant material benefits, the pace at which they have occurred posed significant emotional challenges. This is because evolutionary adaptations occur over tens of thousands of years and simply cannot keep up with humanity’s unprecedented ambition and desire to continually alter its environment. While some adaptations to agrarian living have likely occurred over the last 12,000 years or so, likely none have occurred over the last 200 with the industrial revolution. It is simply too short of a time period for evolutionary processes to do their thing and select the traits needed to thrive in a new environment that is radically different from what has previously existed.
Evolutionary psychologists have found evidence of our ancestral mindset in a number of areas. For instance, they have found that our most commonly expressed fears are not cars or guns, but rather heights, snakes, spiders and strangers, things our ancestors were also worried about. In mass societies, our ancestral fear of strangers can be a significant source of stress at the sub-conscious level. In hunter-gatherer societies, there were few strangers and one had a better idea of who to trust. Today, we have to navigate a whole host of new social interactions that we may not yet be fully equipped to handle at a deep, sub-conscious level. As Sebastian Junger observes:
a person living in a modern city or a suburb can, for the first time in history, go through an entire day – or an entire life – mostly encountering complete strangers. They can be surrounded by others and yet feel deeply, dangerously alone. The evidence that this is hard on us is overwhelming.
Beyond strangers, mass societies also pose problems when it comes to sexual competition. The larger the community, the more competition there may be for mates and status, which is closely linked to perceptions of reproductive fitness. Constant competition can lead to more frequent feelings of envy, failure and rejection, all of which can undermine mental health and contribute to mental illness.
Viewing environmental mismatch as a contributing factor to poor mental health has two important implications for how we might want to improve emotional wellbeing.
First, it can serve as an important source of compassion. If our current environments do not closely fit out ancestral roots, then it is not all that surprising that we struggle with mental health issues. In fact, it may be perfectly normal, even if undesirable, to struggle, and something not to be ashamed of.
Second, environmental mismatch also suggests that we think about how we might be able to make our environment a bit more ancestral. A return to hunter-gatherer times is not possible, but small changes to daily life can have a big impact. The changes can involve working on building a more tight knit social group of trustworthy people, spending as much time outside in nature as possible, adjusting our diet, doing more exercise, and limiting the use of technology that can interfere with genuine social connections and natural sleep cycles. It may also include integrating mindfulness, meditation and other spiritual practices to help our minds address the challenges of a modern environment.
Emotions, Even Negative Ones, Serve a Function
Consider Sadness. We often feel this when we lose something we cherish. But the feeling is not just there to reflect loss and cause emotional distress, it also serves a purpose. It can motivate us to find what we are missing (i.e. a lost dog) or to find a replacement (i.e. a new partner or job). Sadness can also encourage us to take steps to prevent further losses in the future (i.e being a more attentive partner or employee).
Anxiety or fear can also serve an important function as it helps boost our chances of survival. Without it, we may risk our lives needlessly, undermining what evolution suggests is our primary, but not only, purpose – to reproduce our DNA. The challenge with anxiety today is that what it was selected to do may not be well suited to our modern environment. For instance, social anxiety among strangers may be normal, given ancestral concerns, but no longer useful in situations in which strangers are a common feature of everyday life and where the overwhelming majority do not pose a threat. Understanding the deep roots of the emotion and viewing it as a normal reaction, however, can be useful in alleviating it.
Depression or low mood can also be illustrative. Depression is commonly viewed as a problem, and in extreme cases, a disorder. Evolutionary psychologists offer a slightly different perspective, arguing that depression can serve an important function when properly understood. Depression can serve at least four functions.
First, it can indicate that we need new strategies to pursue our goals. Depression can tell us that the way we are going about trying to find a job, a partner, or meaning, amongst other needs, may not be the right one. This view may explain why work that does not offer an individual meaning can be psychologically damaging in the long run.
Symptoms of depression, by contrast, are aroused when an important goal seems unattainable. The initial response is to seek new strategies, but if no route to the goal seems possible, motivation fades away, freeing up effort for other more profitable tasks. If for some reason the goal cannot be abandoned, then ordinary low mood tends to escalate into pathological depression.
The one concern with this view is that it may inadvertently lead to self-coddling, the avoidance of anything that seems difficult or uncomfortable, and a lack of resilience. In these situations, it is important to distinguish between facing difficult challenges in life and feeling depressed, a distinction that may not always be easy to make. However, the difference between the two should be kept in mind when a decision needs to be made about sticking with a particular relationship, job, project or life goal, or abandoning it in search of alternatives.
Third, evolutionary psychologists also suggest that depression can serve a social function, indicating to others that we need help. The reverse is also true – it can indicate who we know who may be in need of some support.
And fourth, depression may be useful when trying to address complex problems. This is because depression under some conditions can provide certain cognitive advantages, including ruminating on problems, deep analysis and introspection, and greater focus.
Contrary to the view that depression should only be understood as a problem, it may be the case that depression can be a useful emotion that can help us better determine how we ought to be spending our time and resources, identify who is in need of help, and offer us a certain mindset that is useful for solving problems.
Overall, evolutionary psychology may provide us with some important insights into our mental health and what it takes to achieve emotional well-being in a way that is species appropriate and respectful of our evolutionary past. Randolph Nesse outlines the benefits of an evolutionary approach to mental health and mental illness in the following way:
Far from providing a cold or rigid perspective, an evolutionary view fosters deeper empathy for the challenges we all face and deeper amazement that so many people are able to find loving relationships, meaningful work, and a way to juggle a bevy of responsibilities with good humor and even joy….An evolutionary view of mental disorders does not mean accepting the pains and difficulties of the human condition. Many can be prevented or eliminated safely, but only when we better understand the functions of negative emotions….[E]very new such major capacity for intervention will be safer and more sensible if developed in a sophisticated evolutionary context.
There are numerous perspectives available on how to improve emotional wellbeing. The challenge is figuring out which perspectives makes sense and are effective in the long-run. Every individual is different and may require a different set of strategies to overcome the particular challenges they face. But in that search for guidance, thinking about what constitutes good advice is important. It can encourage us to do more research and to learn about the various options out there so we can make informed decisions and feel confident in the choices we make. As Jo Marchant documents in her book Cure: A Journey Into the Science of Mind Over Body, believing that a treatment protocol will work can greatly increase its effectiveness.
I suggest that some of the best mental health advice may come evolutionary-informed approaches. These approaches provide important insights into why we feel, think and act in the ways that we do. They can also offer us ideas about things we can do each day to reconnect with our ancestral past in a practical way, while benefiting from all that our modern environments have to offer. Mental health advice would be better off it looked more closely at environmental psychology.
Thanks for reading.
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