Life is change. For most of history, change was transmitted only through birth. Looking at the natural world, then, Darwin and his followers upheld the survival of our genes as the compulsion that drives our every behavior. In the mental health world, Freud also flirted with that view (everything is about sex).

But humanity has subdued the natural world with our ideas. Corn, cows and cars wouldn’t exist if ideas weren’t transmissible from person to person after birth. That exchange of ideas is also an adaptive process, but it’s not Darwinian. It’s closer to the evolution proposed by Lamarck, which is thousands of times faster than Darwin’s evolution through gene transmission.

As human beings, then, we are a combination of Darwinian (sexual) impulses and Lamarckian (intellectual) impulses. Sadly, just as our relationship with the natural world is out-of-balance, the tension between genes and ideas also drives us out of balance in our relationship with the self. Our mind changes far faster than our body. Worse, improving the mind occurs through experiences that often limit the body (and visce-versa). To keep this competition under control, the mind divides into two: the conscious mind that learns and adapts to a changing world, and the subconscious mind that manages our well-being and “automatic” behaviors.

Hypnotherapy is helpful in maintaining or restoring balance between the conscious and subconscious parts of our mind. Often that means negotiating alternatives to genetically inherited behaviors – most commonly the “fight or flight” response, but also lowered mood (sadness or depression) or pain. It’s important to understand those foundations of the personality as the basis for our work.

It was this need that stimulated my interest in Randolph Nesse’s new work “Good Reasons for Bad Feelings.” Nesse is an advocate of Evolutionary Psychiatry – a discipline that holds that we can understand the cause of mental disease as imbalances or extreme cases of behaviors that ensure that our genes are passed on. Explicit in the Nesse’s framing of the issue is that those genes cause defects in our brains that predispose us to the disease.

The book considers, chapter by chapter, our major mental health problems. In each case, Nesse proposes explanations for why more primitive species would have benefited from the behavior. The fear response triggers fight or flight, which in the right balance ensures that we mate as frequently as possible. Depression pushes us to abandon unattainable goals. Altruistic behaviors imply loyalty to sexual partners that depend upon that loyalty to ensure the survival of children over the decade preceding self-sufficiency. These are all plausible explanations for why genes that code for those traits would continue to be passed on, despite making us susceptible (respectively) to irrational phobias, suicide, and sexual manipulation.

As documented in detail by Nesse (I have to admire his integrity), the defect in this proposition is that no study has been able to identify consistent genetic differences between those that suffer from mental illness and those that don’t. The doubt generated by this observation is reinforced by clinical studies that demonstrate the importance of individual life experience in determining who suffers from mental illness. Unfortunately, the administration of determinative assessments takes hours – far more than is possible in a busy clinical setting.

Of course, life experience is not predictable. As with medicine, the preventative utility of genomic markers is seductive, perhaps leading Nesse to flog a proposition that appears to have a limited future.

In specific sections of the book, the blurry boundary between genomics and culture is evident. Child rearing doesn’t require a commitment from the male – in fact some feminist authors assert that agriculture was invented by women in part because they stayed in camp to share those duties while the men went out to hunt. So Nesse’s explanation for cooperation is arguably cultural. A more direct descent from genomics might be grooming to remove pests, which is manifested even among fish.

Nesse sets his observations against the backdrop of his clinical and professional development. All are set as heroic outcomes – illustrations of clinical innovations, or transformative insights that puncture professional myopia. As a hypnotherapist, however, some of the clinical innovations seem barbaric – exposure therapy for those suffering severe phobias is one illustration. And the primacy of evolutionary psychiatry seems overblown when outcomes depend upon life experience.

Both matters are dealt with more elegantly in practices (such as hypnotherapy) that recognize the division of the mind between conscious and subconscious realms. I was surprised when I encountered psychologists that disputed that division, and Nesse is defensive in the sections in which he recognizes its importance. His hesitancy indicates that the dispute is more widely entrenched than I knew.

This is an omission that I find indefensible. The tension between biological and social imperatives explains so much regarding our behavior – and mental vulnerabilities.  Even more, those insights inform powerful therapeutic strategies that are known to be gentler and more efficacious than the alternatives described by Nesse.

To conclude, “Good Reasons for Bad Feelings” is an excellent survey of mental health issues, and in relating those pathologies to behavioral benefits, Nesse reduces the stigma that burdens sufferers. I am concerned, however, that his focus on genetics will delay recognition that the genome specifies an architecture for the brain that is vulnerable to cultural pathologies. In both the formation of synapses and the allocation of blood flow, the brain is wonderfully plastic. That faculty facilitates the spread of ideas, but also the insinuation of contradictions that manifest as pathological behavior. Evolutionary psychiatry only sets the table – it doesn’t determine the contents of life’s meal.