The Origin of Angst:How Anxiety and Depression Evolved From Ancient Herd Instincts –And Became Painful to So Many of Us

Jeffrey P. Kahn, M.D.Weill-Cornell Medical CollegeNew York, NY

UCLA Psychiatry Grand RoundsFebruary 2015

VIDEO LINK: psychiatrygrandrounds.com/GR15/JKahn.html

Jeffrey P. Kahn, M.D.

Disclosures:Author:

“Angst: Origins of Anxiety and Depression”

Oxford University Press

No other disclosures

Why Is There Angst?

Anxiety/Depression Must Have a Reason

A Theory on The Origin of Angst

Five specific syndromes reflect five corresponding social instincts - that try to coax us back to more herd-like behaviors

Our Anxiety and Depressive Disorders Are Modern Expressions of Ancient Herd Instincts

Simplistic nutshell: five core anxiety and depressive subtypes emerge when our rational and civilized behavior arouses our sociobiological instincts

Humans Wonder - and Wander

Humans Think Like This, Not Cows

Sheep Can Recognize Humans

And When We Wander From the Herd…

…Social Instincts Coax Us Back

Lions and Tigers and Bears are Not Why:Angst is the Modern Echo of

Evolved Social Instincts

Primeval Lions Evoked Fear - Not Angst

Most Important to People is: Other People Even Thoreau

The Central Social Core of Human Existence: Tribal/Herd Behavior Instincts

Social Emotion

A Social Focus for Evolution

Evolutionary Selection

Survival of the Fit Individual The Fittest Individuals Pass On Their Own DNA

Survival of the Socially Fit Herd The Fittest Social Behaviors Pass On Group DNA

Sterile Worker Bees Protect Species DNA

A Brave and Childless Mouse Protects Family DNA

Altruism!

Natural Selection: 2 Complementary Processes

Evolutionary PsychiatryIs Not A Brand New Idea

DarwinExpression of Emotions in Man and Animals

FreudA Phylogenetic Fantasy

Hyperaggressive “Ice Age Man”Das Unbehagen in der Kultur

Civilization and Its Discontents“The Discomfort in Culture”

JungCollective Unconscious

Many Others

Evolutionary Psychiatry:A Newer View of Psychopathology

DSM

Validated and Specific Psychiatric Diagnoses

But Some Diagnoses May Be Overly Broad

Major Depressive Disorder

Generalized Anxiety Disorder

Bipolar II Disorder

Five Specific Syndrome Subtypes

Panic AnxietySocial AnxietyOCDAtypical DepressionMelancholic Depression

Evolutionary Psychiatry:A Novel Sociobiological Synthesis

These Five Core Syndrome Subtypes Are Our AngstEach One Matches a Specific Social Instinct

Instinct Matches Syndromal Core Cognitions

Corresponding Behaviors Even in Us Civilized Types

Ethology and Animal Behavior

Specific Angsts from Specific Aroused Instincts

Each Syndrome Includes Related Syndromes

Humans Have Further Evolved These Instincts Intensification

Counter-Instinctive Adaptation

For Each Syndromal Instinct:Real Scientific Support

Science (More Than 600 References)Genetics and Epigenetics

Social Psychology

Animal Ethology

Psychopharmacology

Neurosciences

Clinical, Biological, Workplace Psychiatry

#1: Panic Anxiety: Stay Near Home Social Purpose:

Kept us close enough to home and group that we could safely find our way back.

An alarm to warn of geographic or emotional distance

Counterinstinctive BehaviorExample: Challenging Fear of Flying

Motto: “Catastrophes await if you can’t find your way home.”

Animals: Infant Separation Anxiety

Don’t Stray Far From Family, Home or Safety:Panic Anxiety

#2: Social Anxiety: Social Hierarchy Social Purpose:

Kept us in line in tribal social hierarchies to keep the peace at home.

Shy embarrassment from gratifying attention

Counter-Instinctive CopingExample: Performers Challenging Their Fears

Motto: “Shame and embarrassment come from not

knowing your primeval rank.”

Animals: Dominance Hierarchy – Alpha Dogs & Baboons

Follow the Leader of the Pack:Social Anxiety

“Too Many Cooks Spoil the Broth” – Old English Proverb

#3: OCD – Nesting Behavior Social Purpose:

Impels the work needed for groups to live together safely.

Motto: “Clean, arrange, save and behave for a sure and tidy

nest.”

The Four OCD Factors by Factor Analyses

Para-Instinctive CopingExample: Numbers and Technical Work

Animals: Nesting (and Grooming)

Clean, Arrange, Save, Behave

#4: Atypical Depression: Social Harmony Social Purpose:

Kept us well-enough behaved for a cooperative society.

Rejection Sensitivity Leads To More Polite Behavior

Counter-Instinctive Coping Example: Detached Workaholism to Succeed and Remain

Motto: “Behave yourself to avoid rejection, remorse and exile.”

Animals: Canine Apologies

Winter Hibernation Earlier Evolutionary Instinct, With Similar Symptoms

Go Along to Get Along:Atypical Depression

“Nature, when she formed man for society, endowed him with an original desire to please, and an original aversion to offend his brethren.” - Adam Smith

#5: Melancholic Depression: Preserving Herd Resources

Social Purpose: Death kept us from using scarce resources when we

no longer felt useful to the herd.

Eskimo Ice Floe Myth

Counter-Instinctive Coping Example: Counter Fatalism with Reason

Motto: “Take one for the team if you are too old or too ill.”

Animals: “Illness Behavior”

Salmon, Mice - and the Human DST

Apes and Dogs

Feeling So Useless You Could Die:Melancholic Depression

“How do we, humans know when it is time to move on? As with the migrant birds, so surely with us, there is a voice within if only we would listen to it, that tells us certainly when to go forth into the unknown.”

- Elisabeth Kubler-Ross

#6: Consciousness: Social Awareness

Social Purpose: Keep Us Responsive To Our Companions And Environment.

Allows Counter-instinctive And Repurposed Behavior

Moderates Ancient Instinctive Fears Except When Diminished by “Hypofrontality”

Motto: “Thoughtful Understanding Leads To Better Solutions.”

Animals: Dolphins, Apes, Crows And Dogs Have Some

But Human Consciousness They Have Not!

Positive Psychotic Symptoms Not Clearly Known In Animals

Consciousness Lost & Instinct Run Amok:Schizophrenia and Psychosis

“The very essence of instinct is that it is followed independently of reason.”

- Charles Darwin

Psychosis/Schizophrenia: Syndromes

Five Syndromes: Five Psychotic Subtypes

Aroused Instincts Override ReasonHypofrontality

The Missing Think

Decreased Conscious Mediation

Dopamine

The Provocative Power of Appetite

Increased Instinctive Arousal

Five Human Syndromes:Instinct Becomes Psychotic Perception

Panic Anxiety Classical Paranoid Schizophrenia: Alone against predators

Social Anxiety Paranoid Delusional Disorder: Authorities will punish you

OCD Schizo-Obsessive: Catastrophe from ignoring the nest

Atypical Depression Mania: From social harmony to saving the world

Melancholic Depression Psychotic Depression: The purposeless must die, rot away

Happy in the Herd:Instinctive Herds & Primeval Ignorance

“The security of Society lies in custom and unconscious instinct, and the basis of the stability of Society, as a healthy organism, is the complete absence of any intelligence amongst its members.”- Oscar Wilde

Assembling the Herd

From Bacteria to Herd to Homo sapiens

The Same Six Instincts Everywhere (Maybe not Melancholia)

Boids: Computer simulation of bird flocks

The Big Five Personality Traits (OCEAN)

All I Really Need to Know I Learned in Kindergarten

Varieties of Moral Experience: Political Herds

Instincts & Specialized Social Group Roles

Climbing To Civilization:The Rise of Reason & the Ascent of Angst

“It is impossible to overlook the extent to which civilization is built upon a renunciation of instinct.” - Sigmund Freud

Cogito Ergo Vincere Instinctu:Quelling Angst & Rethinking Herds

Beer and Civilization Consciousness and Everyman

The Origin of Psychopharmacology and Beer

Alcohol Free Societies Today

The Deliberate Herd A Higher Authority

Government

Civilization and Societal Advance Counter-Instinctive Coping

Consciousness, Teams and Technology

Illness and Instinct: Consciousness Has

Consequences

“Man is the only creature that refuses to be what he is.”

- Albert Camus

Mere Civilized ConsciousnessDoes Not Blissfulness Buy

Triggered Psychiatric Syndromes Coax us Back to the Herd

Stigma

Suicide

Alcohol and Substance Abuse

Crime

Heart Diseases “Stress” of Counter-instinctive Behavior

Free to Choose:How to Balance Your Reason & Instinct

“Nothing in biology makes sense, except in the light of evolution”- Theodosius Dobzhansky

“The final mystery is oneself.”- Oscar Wilde

Who Are You?

Consciousness or Biology?

Endure Suffering or Seek Succorance? You’ve Gotta Ask Yourself One Question:

Do You Feel Yucky? Do Ya?

Unexpected Risks of Treatment The Helmet Effect

Shiny Happy People?

The Vital Importance of Psychotherapy

Where Are We Headed Now?

Are We Still In the Same Place?

“The past is never dead. It’s not even past.”

- William Faulkner

To a greater extent than we have imagined, we may still live today in an emotional world designed on that ancient African savannah.

Angst: Origins of Anxiety and DepressionOxford University Press

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Jeffrey P. Kahn, M.D.Weill-Cornell Medical College