Research paper contemporary psychology

Research paper contemporary psychology

write a 5 pages essay on the following topic. In addition to your require outside sources, you must reference the short story “The Yellow Wallpapers” in your paper.

* write a clear thesis
*your introduction should explain why this subject is worthy of the reader’s attention and any background information.
*incorporate outside information as support- remember to paraphrase more often than you quote in order.

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Department of Anthropology, University of Vienna, Austria

Author for correspondence: Univ. Prof. Dr. Sylvia Kirchengast, Department of Anthropology, University of Vienna, Althanstrasse 14,
A-1090 Vienna, Austria; Phone: 0043-1-4277-54712; Fax: 0043-1-4277-9547; email: Sylvia.kirchengast@univie.ac.at
The insane woman-mental disorders and female life
history-a Darwinian approach
Sylvia Kirchengast1,†
ABSTRACT
Gender based differences in the prevalence rate of mental disorders are described since ancient
times. In particular a strong association between female reproductive events such as sexual
maturity, pregnancy, postpartum period or menopause and mental illness was described
and mainly used to describe the female sex as the weak and emotionally instable one. In this
review mental disorders associated with specific stages of female life history are analyzed and
interpreted from the viewpoint of evolutionary medicine. In particular the association between
female adolescence and eating disorders, reproductive phase and postpartum depression and
depression during post menopause are focused on using an evolutionary approach. From that
viewpoint mental disorders associated with female life history events seem to be adaptive to some
degree, but mental disorders may also be interpreted as a result of the mismatch between recent
life circumstances and the environment in which our ancestors evolved.
Keywords
Eating disorders, Postpartum depression, Depression, Female life history, Evolutionary
medicine
Introduction
Mental disorders are among the most important
health problems at the beginning 21rst century
[1,2]. According to the Global Burden of
Disease (GBD) study published in 2007 mental
disorders account for more than 25% of all
health loss due to disability. This is more than
eight times more than coronary heart disease and
more than twenty times more than even cancer
[3]. A systematic review of 174 studies published
between 1980 and 2013 indicated that about
17.6% of adults experienced a common mental
disorder within the past 12 months and 29.2%
across their lifetime [4]. Mental disorders are
found worldwide, although there is evidence
of some regional variation, which may be due
to cultural factors but also due to the fact that
nationally representative data for incidence of
mental disorders were sparse across most of the
world [5]. Beside regional differences, mental
disorder prevalence vary characteristically
according to gender [6,7]. Although gender
differences in rates of overall mental disorders,
including rare disorders such as schizophrenia and
bipolar disorders, are negligible, women suffer
more frequently from mood disorders such as
depression, anxiety and somatic complaints [8].
On the other hand the lifetime prevalence rate
of substance abuse such as alcohol dependence
is more than twice as high in men compared to
women and men are more than three times as
likely to be diagnosed with antisocial personality
disorders [8]. Mental disorders reduce not only
health related quality of life of affected persons; it
represents also an economic and social challenge
for societies. In an interview with the Guardian”
at September 12th 2005, Lord Richard Layard, an
emeritus professor in economics and Downing
Street advisor pointed out that “Mental health
287 Neuropsychiatry (London) (2016) 6(5)
Review Kirchengast
between proximate or physiological and ultimate
or evolutionary explanations of biological
phenomena [36] Proximate factors are devoted
to illuminate the how of human functioning
based on the sum of all the biological processes
such as genetic, epigenetic or physiological
factors. Ultimate explanations, in contrast,
try to answer the question why considering an
evolutionary viewpoint and try to understand
the contribution of a trait to the reproductive
fitness of an organism in its natural environment.
[22,37].
Disease itself was not the central target of
evolutionary explanations, but Williams and
Nesse tried to understand why natural selection
has left the human body so vulnerable to diseases
[32]. Consequently the focus of evolutionary
medicine lays not on the disease but on
the susceptibility to diseases. Evolutionary
explanations for the vulnerabilities that make
humans susceptible to disease are design tradeoffs
that offer an advantage overall, but leave us
vulnerable to diseases such as genes that cause
pathologies but give a net fitness advantage. On
the other hand there are constraints, that is, limits
on what natural selection can do because of its
stochastic nature. Other possibilities are accidents
that cause disease that are too rare to shape
defenses. Furthermore evolved defenses may be
interpreted as defects or diseases today. Somatic
examples are fever, cough, vomiting diarrhea but
also adverse emotions such as anxiety or sadness
[17]. Of particular importance is the mismatch
hypothesis. According to this idea there are novel
environmental factors that change faster than our
bodies evolve. Consequently a mismatch between
our recent environmental conditions and the
environment in which our ancestors evolved
may result in various pathological conditions
today [38,39]. The best example of this point
of view are so called diseases of civilization or
Western diseases comprising mainly metabolic
and cardiovascular disturbances such as diabetes,
obesity, hypertensions and arteriosclerosis [40].
According to the mismatch hypothesis Homo
sapiens is adapted to a high mobile lifestyle
and frequent food shortages and therefore to a
very efficient energy storage. This adaptation to
hunger and malnutrition does not work in an
environment of food abundance and reduced
physical activity levels [41,42]. During the
last 20 years after Williams and Nesses initial
publication [32] the concept and applications
of Evolutionary medicine experienced their
own evolution and was critically discussed in a
is now our biggest social problem-bigger than
unemployment and bigger than poverty” [9].
Consequently understanding the etiology and
identifying risk factors of mental disorders
remain a substantial ongoing challenge for
psychiatric epidemiology. Beside genetic factors,
ontogenetic influences and environmental stress
factors, the application of evolutionary theory
in order to understand causes and expression of
mental disorders was introduced about 25 years
ago [10]. Although a large number of evolutionary
psychiatric texts have been published during
the last two decades [11-21], an evolutionary
perspective of mental disorders remain largely
ignored by mainstream psychiatry and the
medical community [22]. Recently however the
concept of evolutionary or Darwinian medicine
has been included in some medical curricula
[23,24] and consequently this evolutionary
approach to diseases may gain in importance in
future, although Darwinian medicine does not
offer treatments but explanations. In the present
review mental disorders associated with female
life history patterns are discussed from viewpoint
of Evolutionary medicine.
The concept of evolutionary or Darwinian
medicine
Evolutionary theory is above all associated with
the name of Charles Darwin (1809-1882),
who introduced the terms biological evolution,
natural and sexual selection in science, but also
considered evolutionary explanations for behavior
and disease more than 150 years ago [25,26].
During the twentieth century evolutionary
theory became an unquestionable part of
natural science and consequently Theodosius
Dobzhansky declared that “Nothing in biology
makes sense except in the light of evolution” [27].
Since about 25 years an evolutionary approach is
increasingly used to explain and to understand
various medical conditions and eventually to
allow a better understanding of current health
care issues [28-31]. The concept of Darwinian
or better evolutionary medicine in a recent
sense was formalized in the early 1990ties most
notably by the evolutionary biologists George
C. Williams and psychiatrist Randolph Nesse
[32], at least three main monographs have
initiated evolutionary medicine [33-35]. To
clarify how evolutionary theory can be used in
medical science the different levels of causality
in evolutionary biology have to be considered.
Evolutionary theory makes a clear distinction
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The insane woman-mental disorders and female life history-a Darwinian approach Review
large number of publications [30]. Today the
aim of evolutionary medicine is to investigate
evolutionary causes of vulnerability to disease,
malfunctions and design failures but also the
investigation of the history of diseases in order to
understand how changing living conditions but
also processes of modernization and acculturation
influenced health and disease. Consequently
evolutionary medicine tries to explain diseases in
terms of adaptation to environment. During the
last years evolutionary medicine has increasingly
focused on certain mental disorders. The so
called Darwinian or evolutionary psychiatry
have provided numerous new insights [12-
14,19,21,43,44]. Nevertheless the evolutionary
interpretation of mental disorders is still
considered controversial [15-20,40,45-52].
Recently a framework for the evolutionary
analysis of mental disorders based on a special
conception of life history theory was presented
by Del Guidice [53] and critically discussed
[37,54-57]. Life history theory is a branch
of evolutionary biology focusing on the
way organisms allocate time and energy to
growth and reproduction. The fundamental
assumption of life history theory is that tradeoff
exists between energy expended on growth
and factors influencing survival on the one
hand and reproduction on the other hand. Each
species has evolved specific life cycles which
enhance reproductive success [58] Specific
traits of human life history are an exceptionally
long life span, an extended period of juvenile
dependence, late reproductive maturity, a low
number of offspring, cooperative breeding,
all mothering i.e. support of reproduction,
female menopause and long post reproductive
span [59]. Female Homo sapiens life history
is characterized in particular by a limited
reproductive span of about 30 to 40 years and
an extended postreproductive period [60,61].
The beginning and the end of reproductive
span is additionally characterized by a high
frequency of ovulatory cycles which reduce
potentially reproductive span even more [62-
64]. These different stages of life history may
be associated with distinct mental disorders.
Mental disorders across female life span
The focus of this review is the analysis of mental
disorders across female reproductive span from
an evolutionary viewpoint. The assumption of a
specific relationship between female reproductive
function and mental disorders is nothing new.
„ Female reproductive function and
mental disorders-a historical perspective
Since ancient times a strong association between
female sex, female reproduction and mental
illness or insanity was postulated. The first
mental disorder attributable to women and for
which an accurate description exist since the
second millennium BC is without any doubt
hysteria. Hysteria was mentioned in the Kahun
Papyrus (1900 BC) and the Eber Papyrus (1600
BC) in ancient Egypt but also in ancient Greece
[65]. Hippocrates (5th century BC) introduced
the term hysteria named after the uterus (from
the Greek ὑστέρα “hystera” = uterus) because
he believed that the cause of this mood disorder
lies in the movement of the uterus “hysteron”.
Hysteria was thought to be caused by a wandering
womb or uterus and consequently the Greek
physicians tried to cure hysteria by fumigation
of the vagina to lure the uterus back into proper
position. Hysteria as a typical female mental
disorder was focused on by Roman physicians
too. Aulus Cornelius Celsus (1rst century BC)
provided an accurate clinical description of
hysteria, but also by Claudius Galen (2nd century
AD) mentioned hysteria and Soranus (2nd
century AD) finally revolutionized hysterical
cures [65]. The association between female
reproductive organs but also female reproductive
function and mental diseases dominated medical
research through middle ages and renaissance up
to modern age [65].
Since the 18th and 19th century, women
outnumbered men in diagnosis of madness. For
example in the Edinburgh infirmary 98% of
hysteria cases were women in the late eighteenth
century. Charcot who has been described as
heralding the epidemic of hysteria in the late
19th century treated 90 male hysterics while in
the same time approximately 900 women were
diagnosed [66]. Thomas Laycock described
hysteria as a woman´s natural state (1840).
Increasingly female reproductive function was
thought to promote female mental problems
and cause female insanity by many psychiatrists,
psychologists and antifeminists during 19th and
early 20th century. Otto Weininger in 1903
declared that “hysteria is the organic crisis of the
organic mendacity of women”. The still most
dubious fame in this respect goes to the German
psychiatrist Paul Julius Möbius who published
“On the physiological idiocy of women”.
According to these authors mental illness in
women was increasingly seen as a result of female
reproductive function. This connection between
289 Neuropsychiatry (London) (2016) 6(5)
Review Kirchengast
female reproductive function and mental illness
was used as an argument against political
or feministic demands such as admission of
women to universities or women´s right to
vote. In 1869 James Mac Grigor Allan held a
lecture concerning menstruation at the London
Anthropological society. He stated: “At such
times women are unfit for any great mental and
physical labor. They suffer under a languor and
depression which disqualify them for thought
or action and render it extremely doubtful
how they can be considered responsible beings,
while the crisis lasts. Much of the inconsequent
conduct of women, their petulance, caprice and
irritability may be traced directly to this cause.
It is not improbable that instances of feminine
cruelty (which startle us as so inconsistent with
the normal gentleness of the sex) are attributable
to menstrual excitement caused by this periodical
illness….”
Additionally a new view of female personality
and mental illness emerged in the 19th century:
women were perceived as passive, weak
highly vulnerable to stress in particular during
menstruation, pregnancy, postpartum and after
menopause. In 1851 two women were found
innocent of murder charges because they were
found to have acted with temporary insanity as
a consequence of suppression of menstruation or
problems with their uterus [67,68].
Cesare Lombroso one of the fathers of criminology
and criminological anthropology stated that
most female criminals were menstruating at
the time of crime. At the same time Richard
von Krafft-Ebbing, a leading psychiatrist of this
time, demanded that the courts should give
special consideration to women whose menstrual
problems or pregnancies are complicated by
emotional influences beyond their control.
Women were increasingly seen as victims
of their reproductive function, in particular
menstruation, childbearing, postpartum period
and menopause which lead to deviant behavior
or mental illness [67]. „ Mental disorders associated with
female life history events
Although the theories of Weininger, Möbius or
Lombroso are clearly obsolete today, some mental
disorders are associated with particular stages
of female life history. The prevalence of one of
the most common mood disorders, depression,
increases with reproductive developmental
events such as puberty, pregnancy, postpartum
phase, peri- and post menopause [69-71]. From
a proximate viewpoint this observation suggests
that sex hormones associated with female
reproduction play a key role in depression [72].
Furthermore irregular cycles, late menarche and
being in the first year post menarche were found
to be differentially associated with depression,
obsessive-compulsive disorder and eating
disorders among high school girls [73]. Early
menopause on the other hand is also associated
with increased prevalence of depression [69].
In this review eating disorders mainly associated
with female adolescence, postpartum depression,
as well as depression during post menopause and
old age are focused on and discussed from the
viewpoint of evolutionary medicine. „ Adolescence and eating disorders
The life history stage of adolescence marks the
metamorphosis of the child into the adult.
It starts with the onset of puberty and ends
with the completion of the growth spurt, the
attainment of adult stature height and the
achievement of reproductive maturity [74].
Consequently adolescence is the entry in female
reproductive life. Adolescence however is also a
sensible phase of life when body image and body
image dissatisfaction gain in importance [75]. In
Industrialized countries an increasing number
of adolescent girls are extremely concerned with
their body weight and body shape [76]. Although
only few of them suffer from a pathological eating
disorder fulfilling all diagnostic criterions to
DSM-IV [77] disturbances in eating behavior are
increasingly common among female adolescents.
Consequently eating disorders such as Anorexia
nervosa or bulimia nervosa are among the most
common mental disorders of adolescent girls
and young females in First World countries
and in case of Anorexia nervosa an increase in
the incidence among 15 to 19 year old girls was
observed over the past decades [78]. This trend
and the mainly discussed the proximate causes
of these disorders i.e. interacting psychological,
social and biological factors [79] led to the
assumption that Anorexia nervosa is mainly
caused be environmental factors typical of
postmodern Industrialized countries. Anorexia
nervosa however, was described as early as
17th century. Eating disorders among female
adolescents were already reported in the 19th
century and interpreted in the framework of
hysteria at that time. Today it is estimated that
10% of school-aged adolescent girls show partial
anorectic or bulimic symptoms [80], but much
more adolescent girls are worried about the
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The insane woman-mental disorders and female life history-a Darwinian approach Review
body weight, diet frequently and step on scale
very often. But why adolescent girls strive for
thinness? And why eating disorders or restricted
eating behavior affects much more girls than
adolescent boys? In a recent study carried among
677 Viennese adolescents aging between 10
and 18 years significant gender differences in
body image, eating behavior and dieting could
be observed. Body image, in particular the
subjective description of weight status, differed
significantly between boys and girls. Although
overweight and obesity were rare among boys
and girls of this sample more than 50% of
girls during late adolescence, i.e. 15 to 18 years
described themselves as overweight. This was
true of less than 20% of the boys only. Regarding
weight controlling practices it turned out, that
significantly more girls than boys tried to reduce
their body weight by dieting and stepped more
often on a scale to control their body weight
[81].
The association between extensive dieting
and the stage of reproductive maturity seems
paradox because the physiological consequence
of intensive dieting and a longtime negative
energy balance lead in prepubertal girls to a
delay of sexual maturation and during later
adolescence to a marked reduction of ovulatory
cycles, anovulation and as worst case to
secondary amenorrhoea. Extremely dieting girls
reduce in this way their reproductive capability
dramatically. Consequently eating disorders
during adolescence reduce reproductive
capability and in this way reproductive fitness.
From an evolutionary viewpoint eating disorders
are clearly maladaptive. During the last 30
years various evolutionary interpretations of
the phenomenon eating disorders have been
published. Voland et al. [82] pointed out the
kin selection hypothesis interpreting restricted
eating behavior and resulting anovulation as a
helper at the nest phenomenon. Guisinger [83]
introduced the “flee from famine hypothesis”.
He suggests that anorectic symptoms, including
restricted food intake are manifestations of
adaptive mechanisms to the conditions of
famine that in our past facilitated migration
from the famine in the depleted environment
to a better one. But the key feature of restricted
eating behavior or manifest eating disorders is
reduced reproductive capability. This idea was
first pointed out by Wasser and Barash [84],
who introduced the reproductive suppression
hypothesis in the early 1980ties. According
to this idea human females can optimize their
life time reproductive success by suppressing
reproduction when future conditions for survival
of the offspring are likely to be sufficiently
better. Our ancestors did clearly not live in
the Garden of Eden, and food shortages were
a common experience. Gestation and lactation
however are energetically costly and a too low
fat amount would increase complications during
pregnancy and increase the risk of pregnancy
loss and neonatal mortality. For our ancestors
the reduction of fertility potential during
times of food shortage was clearly a positive
adaptation. Adolescent girls in contemporary
First world countries suffer extremely seldom
from food shortages despite the refuse to eat
enough or diet intensively. But extreme dieting
postpone adolescent development and in recent
First world countries sexual maturation takes
place extremely early in comparison to former
times but also in comparison to contemporary
traditional societies. During the last 170 years
age at menarche had decreased significantly from
about 16.2 years in 1840 to about 12.2 years in
2000 [85]. Furthermore the period of frequent
ovulatory cycles in first years after menarche
had decrease markedly. Additionally first sexual
intercourse occurs earlier. Early reproduction
however, which is now physiologically possible,
is not social desired in our postmodern society.
Modern living condition in an affluent society
have led to an increase of reproductive span, the
society however does not support this biological
change. Restricted eating behavior therefore may
be interpreted as a strategy to postpone sexual
maturation and enhance reproductive success
through delaying reproduction until social
circumstances increase the potential reproductive
success. „ Reproductive age-postpartum
depression
Pregnancy and the postpartum period are
associated not only with physical but also profound
emotional changes [86,87]. Postpartum period is
a particular vulnerable phase in female life cycle.
After giving birth women in many cultures are
subject to various postnatal rituals. They often
follow certain dietary rules and other taboos
and are cared for mainly by other women. This
period of rest and seclusion usually lasts between
20 and 40 days. In Chinese culture this phase
is called “Doing- the-month”. During this time
the mother will be confined to home and observe
ritual practices which are thought to bring the
postnatal condition back to a normal state of
health. These behaviors should support mothers
291 Neuropsychiatry (London) (2016) 6(5)
Review Kirchengast
and help them to cope with the new situation.
Worldwide a significant number of mothers,
however, experience a period of depression
during postpartum phase. There are several forms
of postpartum emotional disorders-from the
so called baby or maternity blues which occurs
typically for a short period of few days following
delivery to postpartum depression which is
later more prolonged and serious condition
[87-89]. Symptoms include anxiety, guilt,
negative maternal attitudes, and poor parenting
self-efficacy and can have immediate ill effects
on the offspring [87,90-92]. Internationally,
the prevalence of postpartum depression is
considered to be 10 to 15%, however prevalence
rates ranges from almost 0% in Singapore to
nearly 57% in Brazil [89]. In western societies
approximately 10 to 15% of all mothers are
affected by postpartum depression. Similar
rates are found for various other societies such
as 11.2% among Chinese women, 17% among
Japanese women, and 16% for Arab women
[93]. Higher rates are found among Indian
women in Goa (23%) [89]. The exhaustion
of a new mother, due to the demands of labor
and the new situation with a new-born baby
will often progress to postpartum depression.
Negative feelings of a mother towards her
newborn child associated with anxiety, feelings
of guilt, and the impossibility to care for the
newborn child have clearly adverse effects on the
child and its chance to stay healthy and survive
the critical period of neonatal phase and early
infancy. Consequently from an evolutionary
viewpoint postpartum depression seems to be
maladaptive. Hagen [94,95] however provided
an evolutionary interpretation of postpartum
depressive disorders. At first we have to consider
that rearing a child requires an extremely high
maternal investment [96]. Human newborns are
quit large at birth however they are extremely
helpless in comparison to the social mammals
such as non-human primates [57]. This feature
is typical of humans and is the result of two
counteracting evolutionary trends: bipedy
i.e. upright locomotion and encephalization.
Bipedy requires a narrow pelvis, which allows
the legs to be close together in order to optimize
biomechanics of biped locomotion. On the other
hand the trend of encephalization resulted in
larger brains and consequently larger fetal heads.
This antagonistic interaction of bipedalism and
encephalization makes childbirth consequently
complicated and leads to the birth of premature
helpless newborns [57,97]. Bringing up a human
infant and child is a very costly experience
requiring large amounts of time, resources and
energy. In order to cope with these challenges
Homo sapiens has evolved cooperative breeding
and allomothering i.e. help provided by other
women or sometimes the father. A lack of support
may result in newborn death. Evolutionary
theory predicts that a mother neither does
automatically invest in every child and that the
mother constantly evaluates the fitness costs
and benefits of investing in her offspring [98].
Under adverse conditions the mother may defect
her care and consider investing in other fitness
enhancing behaviors. Hagen hypothesized that a
lack of support by the father, poor environmental
conditions, problems during pregnancy and
birth or indicators that the offspring is unlikely to
survive to reproductive age would have an impact
of whether or not to invest in the offspring.
Postpartum depression may give the mother
the tool to defect from raising the child. Hagen
called this evolutionary approach to postpartum
depression the defection hypothesis [94,95].
The lack of support and adverse environmental
conditions seem to be strongly associated with
postpartum depression especially in recent times.
In former times when large family units live close
together family members were able to help the
young mother. If insufficient care had been given
initially the onset of postnatal depression would
have resulted in immediate response. Family or
other group members with a wealth of parenting
experience would support the young mother.
Baby blues or post-partum depression would
increase the investment of their social network,
by making themselves unable to care for their
child. In this sense postpartum depression
may be adaptive and fitness enhancing. Today
the situation has completely changed only few
people were born, raised, works and die in their
local communities. The nuclear family and
single moms have replaced the extended family
and social isolation especially of young mothers
is on increase. This situation may increase the
prevalence of postpartum depression. „ Menopause and post menopause
Human menopause is unique in nature and only
few social mammals experienced an extended
post reproductive phase, which is however not
comparable to that of human females [60].
Menopause and extended post reproductive
phase might have been favored by natural
selection in various ways: menopause ensures
that mothers are young enough to have a real
chance to survive pregnancy, birth and early
childhood of their offspring and ensures that
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The insane woman-mental disorders and female life history-a Darwinian approach Review
old oocytes are not fertilized [60]. Additionally
post reproductive phase enables women to
invest in the grandchildren generation and
enhance reproductive fitness in this way [96-
99]. Physiologically Menopausal transition is
characterized by marked hormonal changes
first of all a decline of estrogens and a rise
of gonadotropins [60,61]. But menopause
is also characterized by marked social and
culture dependent changes of life. Furthermore
menopausal transition or climacteric is related
to an increased prevalence of psychological
symptoms, depressive disorders and a loss of
quality of life. As early as 1830 one physician
notes” There is a predisposition to many diseases,
and these are often of a melancholy character”
(Joseph Ralph 1830). 1893 the French scientist
Regis de Bordeaux used ovarian extract to treat
a female patient for menopausal insanity. Even
today it is well described that menopausal women
often complain a depressive mood and population
based studies showed that psychological disorders
peaks during menopausal transition. Proximate
or physiologically these symptoms are explained
by estrogen deficiency, but also social factors
may increase depressive symptomatic. In a recent
study focusing on the situation of menopausal
women with a background of migration in
Vienna an extraordinary high prevalence
of psychic symptoms, mainly depression
was observed [100]. Depression scores were
significantly higher among Turkish immigrant
women in comparison to Austrian women. The
Turkish immigrant women suffered markedly
also from cultural isolation and a loss of their
extended family.
A special risk factor for depression during post
reproductive phase seems to be childlessness and
the relationship between parents and offspring
[101-103]. Childless post reproductive women
experienced significantly higher depression scores
than childless men or mothers of comparable age
[104]. The increased risk of mental disorders in
particular depression during post reproductive
phase can be interpreted in a Darwinian sense.
According to Watson and Andrews [45] so
called social – navigation hypothesis depression
is an evolved strategy to cope with unpropitious
social circumstances. It signals the need for
help and more investment from partners,
or the social network [18]. Furthermore the
association between reproductive history and
depression during post reproductive phase may
be interpreted as a result of a mismatch or the
dysregulation hypothesis according to Wilson
[105]. The recent situation of many posts
reproductive may be childless women without
a well working social network was completely
uncommon in the environment where Homo
sapiens evolved. At this time older individuals
survived only in well working social networks.
In the industrialized countries and postmodern
societies however, many social networks do
not longer exist. Postmodern societies are
characterized by increased rates of divorce,
single living arrangements, but also voluntary
childlessness and the decline of the family as
social institution [103]. The increasing number
of ageing post reproductive women, who are
childless, lonesome and suffer from a lack
social support, is completely new in our long
evolutionary history. The result of this trend may
be a dysregulation according to Wilson [105]
and as follows an increased rate of depression
which also may be interpreted as an adaptation
to this unfavorable living circumstances during
post reproductive phase.
Discussion
This short review focused on mental disorders
associated with female life history events such
as adolescence, postpartum period, and post
menopause from a viewpoint quite different
from that of clinical medicine. During the
last four decades psychiatry has accumulated
an enormous base of knowledge and several
effective new treatments [17]. The main goal
of a clinical approach to mental disorders is to
provide an effective treatment, which increase
the patient´s the health related quality of life.
The evolutionary approach discussed in this
review however does not offer any treatment;
the main goal is to understand the evolutionary
basis of mental disorders. As already pointed out
in the introduction section mental disorders are
among the most important health problems at
the beginning 21rst century. The World Health
Organization has estimated that by 2020 major
depressive disorders would constitute the second
largest component of the burden of disease
worldwide [2]. According to Lord Richard
Layard we are confronted with an epidemic of
mental disorders at the moment [9]. Mental
diseases however are clearly not new disorders of
the 20th or 21rst century only. Earliest attempts
to treat mental illness are evidenced by the
discovery of trepanned skulls dating 5000 BC
[68]. Early man widely believed that mental
illness were the result of supernatural phenomena
such as demonic possession or the evil eye.
293 Neuropsychiatry (London) (2016) 6(5)
Review Kirchengast
Trepanations have been carried out in order to
allow the demon to get out of the head of the
affected person. Trepanations as treatments of
mental disorders were performed for thousands
of years. Roger of Parma wrote in his Practica
Chirurgiae in 1170 “For mania or melancholy
a cruciate incision is made in the top of the
head and the cranium is penetrated to permit
the noxious material to exhale to the outside…”
From the 15th century onwards asylums were
established in order to accommodate mental ill
individuals in Europe however the goal of these
institutions was not treatment. Asylums were
merely inhumane institutions where mentally
ills persons were abandoned by relatives or
city authorities. Mental disorders are described
throughout human history and throughout
different cultures [67].
The evolutionary approach to analyze mental
illness – the so called Darwinian psychiatry – tries
to find answers on the following question: “Why
has natural selection left the body vulnerable
to mental disorders?” As pointed out in the
introduction section Darwinian psychiatry tries
to explain the existence of particular mental
disorders as an evolutionary adaptation
[15,16,106]. In evolutionary terms there is a
selection pressure towards the development
of adaptations. Adaptations however, are not
endpoints they must confer benefit to individuals
and increase their reproductive success [106].
Within the framework of the concepts of
evolutionary medicine mental disorders may be
interpreted as defenses or results of a mismatch
between our recent living conditions and the
environment in which our ancestors evolved.
The environment in which our ancestors of the
genus Homo and in particular Homo sapiens
evolved in Paleolithic times has been called
the environment of evolutionary adaptedness
(EEA) [107] or more recently the adaptively
relevant environment [38,108]. According to
these concepts human biology has adapted
through the process of natural selection to the
environmental conditions during Paleolithic.
This view is summarized by the notion that
“Human biology is designed for Stone Age
conditions” as Williams and Nesse pointed out
[32,42]. The adaptively relevant environment
was characterized by a foraging subsistence
based on hunting and gathering, the use of stone
and wooden tools, a highly mobile (nomadic)
life style, small multi-aged egalitarian groups
consisting of 20 to 30 group members. There was
a lack of domesticated animals with the exception
of the dog [108]. Ethnographic analyses of the
few remaining contemporary forager populations
such as the Hadza in Tanzania, the !Kung of
Namibia and Botswana, Ache of Paraguay or
Efe of central Africa provided information about
life style in a foraging economy [109,110].
About 20 000 years ago the process of Neolithic
transition started resulting in the emergence of
agriculture and a complete change in subsistence
economy and life circumstances about 10 000
years ago in the area of the fertile crescent [111].
Domestication of animals and plants allowed the
production of a surplus of food. Consequently
humans developed semi-permanent settlements
and gave up their mobile lifestyle. The production
of food allowed a considerable population
growth because more people could be supported
on the food grown. Neolithic transition changed
human lifestyle dramatically [111,112]. This was
in start of urbanization-a process still continuing
today [113].
99% of our evolutionary histories we have
spent as hunter gatherers following a nomadic
life style in small groups consisting of 20 to
50 group members. Our recent environment
is completely different from that in which our
species evolved. An increasing number of people
live in urban environments, many of them in
so-called mega cities of more than 10 million
inhabitants. Recent urban Homo sapiens live
alone without family members as singles or in
small nuclear families in a quite anonymous
society. This habitat and these living conditions
are completely different from that environment
we are adapted for. Loneliness, social isolation,
occupational stress may lead to rising rates of
burnout syndrome or depressive disorders.
Consequently we are faced with a dramatic
mismatch between current environment and a
human body evolved in the environment of our
evolutionary adaptedness [38]. This mismatch
between our evolutionary heritage and recent
living conditions may enhance the prevalence
of mental disorders through our life span. As
pointed out eating disorders which mainly
result in postponement of sexual development,
cycle irregularities, anovulation and amenorrhea
may be interpret as a reaction of earlier sexual
development according to secular trends [85]
and the social refusal of early pregnancies. In this
way eating disorders may be interpreted within
the framework of the mismatch hypothesis.
The evolutionary basis of depression is still
considered controversial [15-20,40, 45-50].
It was hypothesized that low mood may be an
294
The insane woman-mental disorders and female life history-a Darwinian approach Review
adaptation to circumstances where a life goal
cannot be achieved and should be disengaged
from [18]. Furthermore it was mentioned that
the mechanism activated in depression is one
designed to cope with threatening circumstance
where flight is impossible [114]. According to
Wilson [105] depression may be the result of
dysregulation which might occur because the
environment of recent Homo sapiens is so different
from that in which our ancestors evolved. Hagen
[94,95] in contrast, interpreted depression as
an adaptation by itself. Postpartum depression,
for example, is a mechanism by mothers to
increase the investment of their partners but also
of their social network, by making themselves
unable to care for their child [94,95]. This
adaptation in case of postpartum depression
may be explained by increased investment of
the partners and other relatives which may
result in increased reproductive success of the
depressive women. But is this adaptation model
applicable to all kinds of depressive disorders,
especially to geriatric depression? Watson and
Andrews [45] generalized the adaptation model
to all cases of depressive disorders. In their –
so called social – navigation hypothesis they
characterized depression as an evolved strategy
to cope with unpropitious social circumstances
[45]. Depression enhances not only the
individual fitness it has also the function of social
motivation. It signals the need for help and more
investment from partners, or the social network.
This hypothesis may be applicable to postpartum
depression as well as post reproductive
depression. It signals the need of help to social
networks, this is especially true among new
mothers but also childless elderly. On the other
hand the association between female life history
events and depression may be interpreted as
a result of a mismatch or the dysregulation
hypothesis according to Wilson [105]. In case
of childless post reproductive women the recent
situation characterized by being childless without
a well working social network was completely
uncommon in the environment where Homo
sapiens evolved. Only few members of social
groups survived until post reproductive age
and these individuals survived in well working
social networks. In many developing countries
and traditional societies offspring and close
relatives are still recognized as an old age security
in an economic and are essential for surviving.
In recent postmodern societies however, we
are confronted with increased rates of divorce,
single living arrangements, but also voluntary
childlessness, and the transition to of family
systems towards nucleation and the decline of
the family as social institution [103,115]. This
trend of a growing number of post reproductive
people, who are lonesome and suffer from a lack
social support, is new in our long evolutionary
history. The result of this trend may be a
dysregulation according to Wilson [105] and
as follows an increased rate of depression which
also may be interpreted as an adaptation to this
unfavorable living circumstances during old age.
Additionally to the evolutionary approach to
mental disorders across female life history we
should not forget the cultural dimension. As
pointed out above mental disorders have been
associated with female reproductive function
since ancient times. Although also a great
number of males was and is affected by mental
disorders, mental disorders have been especially
stigmatizing for girls and women. The strong
association between reproductive function
and mental disorders was clearly related to
gender discrimination and misogyny. Typical
examples are the statements of Otto Weininger
and Paul Julius Möbius who published “On
the physiological idiocy of women”. A cultural
environment which is characterized by a
low social status of women increases stigma
–discrimination and may increase mental
disorders. On the other hand the association
between female gender and mental disorders
represents a stigmatization and discrimination
too. Stigmatization and discrimination however
can also be interpreted within the framework of
evolutionary theory [116].
Conclusions
What can we conclude from these three examples
of psychic disorders through female reproductive
life span? Female reproductive life span is limited
and energy imbalance and other stress factors may
affect female reproductive success negatively.
Mental disorders across female reproductive
phase have ever existed, and are not the result of
menstruation per se as thought by 19th century
scientists but distinct mental disorders or what
recently is classified as mental disorders may
increase life time reproductive success of women.
As pointed out female reproduction requires high
costs in energy during and after pregnancy and
an intensive investment to bring up the offspring
to reproductive age. Under less favorable
conditions women may not be able to meet these
affords. Eating disorders during adolescence or
young reproductive age may postpone sexual
295 Neuropsychiatry (London) (2016) 6(5)
Review Kirchengast
development during adolescence or interrupt
reproductive capability during young reproductive
age. In this way unsafe early teenage pregnancies
are avoided, and reproduction is postponed to
better conditions. Postpartum depression may
enhance reproductive success as mood disorders
of the mother may increase social support from
relatives or society. Depressive disorders during
post reproductive phase may be explained by a
mismatch between present social environment of
aging people and the adaption to stop reproducing
early and invest in existing dependent children,
grandchildren or the offspring of genetically related
relatives. Voluntary and involuntary childlessness,
social isolation and the awareness that reproductive
capability has ceased irreversible may enhance
depressive disorders during this stage of life.
Consequently mental disorders associated with
female life history stages may be interpreted in an
evolutionary sense.
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