Evolutionary symptom analysis of schizophrenia reveals disabled functions for rehabilitation

Introduction

Eugen Bleuler established schizophrenia as a mental disorder by describing the structure of the symptoms in the mental psychic sphere. However, after analyzing over a million genomes, the BrainSTORM consortium (2018) could not distinguish schizophrenia from any other major mental illness and concluded that it “underscores the need to refine psychiatric diagnostics.” It is proposed that a principal reason for difficulties in distinguishing the genetics of psychiatric diagnostic symptoms is that they reflect the normal emotional function that is disrupted and not the biological pathology, which diffusely overlaps among the major mental illnesses.

In evolutionary symptom analysis (ESA), core subjective symptoms in each mental illness are viewed as the breakdown of a discreet segment of emotional function evolved within a specific time-period during the human evolutionary narrative. An evolutionary understanding of the normal function that is disabled is a powerful heuristic for practitioners schooled in cognitive and behavioral treatment (CBT) to devise novel functional approaches, such as those suggested at the end of the paper.

This view of schizophrenia as the breakdown of an evolved emotional function introduces an approach to the disorder that brings to bear a vibrant century-and-a-half of progress in evolutionary biology with well-developed theories. ESA supplements a microbiological, genomic view of schizophrenia with a macrobiological, evolutionary view of the normal functions that are disabled by the disorder. As well as providing a functional theoretical framework for CBTs, this approach offers mental health providers with a humanistic, yet biologically based context with which to understand the inner mental life of people living with schizophrenia.

Biological vs. experiential levels

In the BrainStorm Consortium study cited above, the core symptoms of neurological disorders could be distinguished by their genomes because they reflect pathology that occurs predominantly at the biological brain level. Much of the functioning of emotion at the biological level, such as neurotransmitters and the like, evolved to modulate emotions that operate at the experiential level. So in schizophrenia, the experienced symptoms of hallucinations and delusions are not merely a refraction of pathology at the biological level, but rather both levels actively participate in the pathology.

ESA proposes that the base condition of the major mental illnesses involves abnormal development of the processes which have evolved to generate emotional responses and/or damage to those underlying biological processes which support feelings and behavior. The extent to which inborn genetically based etiologies vs environmental factors are at play remains an open question. Whatever the etiology of abnormal biological processes, the way an individual responds to and experiences events is impaired. A major way in which such impairment leads to dysfunction is manifest under conditions of stress when biological modulation failure (“broken brakes”) releases an inappropriate over response (psychic intensity) which can quickly escalate into frank pathology. Evidence for this model emerges from the fact that helpful medications are now appreciated to augment modulatory functions at the biological level (“brake fluid”). But the key to understanding the ESA view is a description of the pathogenic mechanism that breaks down at the experiential level.

Pathological positive feedback (PPF)

Like heard sounds, felt emotions vary in amplitude (volume), experienced as the intensity of feelings.  If sound is taken into a microphone, amplified, put out through a speaker, then reenters the microphone, is further amplified, and again exits the speaker, a positively reinforced feedback loop can be established building to a screech in an instant and persisting until the volume is turned down (i.e., bidirectional modulation by an amplifier). The felt experience of emotion can similarly be conceived as divided into an input function, and an output function which can be modulated at many levels.

The word “emotion” is derived from the French word émouvoir, which means “to stir up.” The emotions stirred (and stirring) up in mental illness are most notably emotions pertaining to social interactions which are especially affected in schizophrenia. Social emotions exist in two dimensions distinguished by their complementary functions, 1) an input-perceptive function and 2) an output-motive function. The normal arc of minute-to-minute input–output function is an afferent limb taking in felt perceptions which elicit feelings that then, in an efferent limb, stimulate behavior toward the circumstances.

As the emotional intensity along this input–output arc increases, it progressively folds in on itself to form an internal, positively-reinforcing feedback circuit as described above. As the perceptual input and motive output dimensions of an emotion enter into this self-potentiating feedback interaction, the feeling generated (and also generating the process) is alarming escalation of a sense of hyperawareness of the perception-action cycle,[1] which is dynamically held in check by regulatory mechanisms at the biological level as stated. Schizophrenia involves disturbances in processes allowing for a smoothly working relationship of the individual to the social ecology of groups.

The proposed pathological psychic mechanism of all major mental illnesses is as follows: when the intensity of experienced symptoms reaches a critical threshold, determined by constraints on, or deficiencies of, regulation at biological levels, the input-output functions escalate into unrestrained pathological positive feedback (PPF) at the experiential, symptomatic level. The hyperintensity of the experience of PPF dominates and paralyzes all mental function. This general view has been called the “broken brakes” theory highlighting that biochemical abnormalities relate to the modulation of PPF; however, ESA emphasizes that the actual pathology operates at the experiential level where psychotherapies can be applied. In addition, with the insight that pathology in mental illnesses exists as hyperactivity, manifest states of lethargy and lack of initiative in the major depressions, and the “negative” symptoms of schizophrenia are compensatory to the active pathology.

Atypical depression, which is associated with separation sensitivity, can be used as an introductory example of an evolutionary symptom analysis (ESA). The function of the fear of separation is to aversively cohere personal relationships and is experienced in the mind as the result of diffusively complex physiological processes at the brain level. However, the actual pathological feedback occurs at the mind level. A frequent presentation of atypical depression following the loss of a love relationship is the subjective experience of separation fear (input) motivating repetitive escape into memories of the relational experience (output), which then bids back progressively more hyperawareness of the fear, the back-and-forth process then escalating into pathological positive feedback (PPF). As stated, while ESA views the primary pathological mechanism of PPF to occur at the experiential level, other mechanisms occurring at the biological level determine the onset and persistence of the disorder, for which modulatory drug treatments are effective. So, the patient is taken “off the hook” by regarding the PPF, itself, as a medical illness best treated by an antidepressant while casting the pathology in easily understood human terms providing a framework for CBT approaches that make sense to the patient.

In ESA theory, the distinctive character of each of the serious mental illnesses is not found in the pathology, which is always PPF, but in the antecedent segment of normal emotional function that breaks down into the illness. This normal functional segment, from which each illness is derived, emerged during a designated stage in our evolutionary history and then persisted to integrate with other segments of emotional function evolved thereafter. It is reasonable to assume that separation fear played a key role in primate group formation since it first began to occur some 52 million years ago (Shultz, Opie, Atkinson, 2011), and that the quality and dynamics of its sentience remains unchanged today.

Furthermore, a fundamental aspect of PPF, illustrated by atypical depression, is that only the intensity (volume) of the normally functioning emotion is affected, but not its other properties. Indeed, the intensity of PPF is produced by a state of pathological hyperawareness of antecedent emotional states, which normally are all but invisible while silently performing their everyday integrated functions. These pathologically hyperaware states serve to magnify their respective antecedent emotional states without distorting the integrity of their dynamic structure.

In atypical depression, the obsessive escaping from separation fear into a remembered relational realm serves as a stark inner caricature of its antecedent task of cohering personal relationships throughout our evolution with the same aversive feeling. In the same manner, the antecedent functional segment that is disrupted by schizophrenia is revealed by the transparent intentionality of the delusions and hallucinations, coupled with the patient’s pathologically intense belief in them.

 

Intentionality

In attempting to fathom schizophrenia in the evolutionary context, there must be a firm grasp on the concept and evolutionary dimensions of intentionality. Intentionality, which everyone intuitively understands, is derived from the verb, intend, which is related to will or motivate; but these latter two verbs are transitive needing an object: you must will or motivate yourself to do something, whereas you are the subject that intends to act. Intentionality has two dimensions: 1) the capacity to initiate and be the ongoing source or agent of an intention (will or motivation) and 2) it must be directed at, or be about, someone or something. When I pick up a spoon, the source of intentionality is me, and it is directed at the spoon. Intentionality is an important concept because the emblem of schizophrenia is the experience of thoughts and voices communicating to patients from an external intentionality in the social sphere.

Can intentionality evolve to emit from the social sphere?

In 2019, developmental psychologist Michael Tomasello published Becoming Human: A Theory of Ontogeny (which won the American Psychological Association’s prestigious William James Book Award). Tomasello recognizes that the mystery of how the ape mind evolved into the human mind cannot be directly studied because “collaboration, communication, and thinking do not fossilize” (Tomasello, 2014). He approaches the problem by studying comparatively the minds of apes and developing children to ascertain what is exclusively human in human nature. He proposes that collective intentionality in communication is unique to humans, and that it has genetic roots and is not merely a by-product of culture. He has come to this conclusion based on the predictable timing across cultures of the unfolding of 1) shared intentionality arising at nine months old (“Let’s both look at that pretty bird”) and 2) collective intentionality starting around three years old (“That’s the right way we ought to do it”).

Tomasello assumes that collective intentionality was evolved for the benefits of coordinating divided labor and that therefore teamwork is the unique human adaptation.  Tomasello vastly expands the scope of the process he describes:

As a final attempt to characterize the monumental transformation of human ontogeny that shared intentionality has effected, let us invoke the grand evolutionary scheme of Maynard Smith and Szathmáry (1995). They identified eight major transitions in the evolution of complexity of living things on planet Earth, including everything from the emergence of chromosomes, to the emergence of multicellular organisms, to the emergence of human culture (see also Wilson 2012). Remarkably, in each case the transition was characterized by the same two fundamental processes: (1) a new form of cooperation with almost total interdependence among individuals (be they cells or humans) that creates a new functional entity, and (2) a concomitant new form of communication to support this cooperation (Tomasello, 2019).

Going beyond Maynard Smith and Szathmáry above, Tomasello pointedly claims that the human transition evolved considerably prior to the onset of culture (when practical knowledge was broadly enough sustained across generations to itself undergo natural selection) about 45,000 years ago, and thus stands as a biological transition tantamount to the Cambrian explosion of multicellular organisms some 500-million years ago.  Adopting this deep-time perspective emphasizes the magnitude of the qualitative transformation in becoming human, accompanied by 1) interdependence and 2) a new communication system. With the perspective that this monumental shift occurred, not in the cognitive domain but that of emotional intentions, an epic dimension of human evolution emerges for which schizophrenia is both a reflection and a beacon. Before describing this new human narrative, the evolutionary aspect of intentionality needs to be discussed.

Imagine a lifeless collection of amino acids first acquiring the rudiment of life, which is to replicate. In the process of replication, mutations are naturally selected for traits that enhance the survival of succeeding generations of the new organism. Because all these newly acquired traits enhance the capacity of this burgeoning organism to survive, they transform the organism into a subject with the intention to survive. Now turning to the Cambrian Explosion: in contemplating the wholesale shift in the benefactor of natural selection from individual cells to groups of cells, it naturally follows that intentionality would also shift from cells to the new group-organisms. In a major biological transition, the translocation of intentionality from the individual to the collective group-organism is the result of the underlying shift in natural selection from individuals to groups of individuals, and it is this epic shift in natural selection that is directly reflected in the core symptoms of schizophrenia.

Becoming human

Because schizophrenia is a sickness of that which makes us human, a clear understanding of how we became human is essential. Just as individual cells assembled into organically coordinated groups of cells, ape individuals assembled into organically coordinated groups of humans. The key is to draw the distinction between cooperation, in which each party co-opts something from the other in a win-win transaction, and coordination, in which the synchronized engagement of divided labor leaves no room for individual–group trade-offs, and everyone rises and falls together. This watershed was crossed in both the Cambrian and human transitions when the benefits to the individual cell or ape of pursuing its own goals were overtaken by the benefits to each of coordinating their behavior as a group.

At a tipping point, disruptive competitive inclinations of individuals begin to be suppressed by natural selection for the coordination of each individual’s labor into a harmonious team effort. Once past this tipping point, there is an exponential growth in the productivity of teamwork, and natural selection for benefits to the individual, even as a stealthy predator, is quickly overwhelmed by natural selection driven by benefits to relationships among individuals. In this process, a unique communication system (language) emerged to mediate a collective intentionality to coordinate groups of individuals as if single organisms. Language is characterized by continuous-and-simultaneous signaling-and-receiving-signals, i.e., humans decide what to do as a group by constantly collaborating with each other.

Believing

In schizophrenia, it is natural to dismiss the intransigence of patients’ belief in the reality of their delusions as a mere semantic side-effect of their riveting experience. Indeed, a premise in much of cognitive therapy is that the patient suffers from false beliefs about the “basic” disorder occurring at experiential/biological levels. In sharp contrast, ESA proposes that the delusions in schizophrenia reflect the PPF breakdown of the process of believing itself.  An obvious implication of such an approach is that to focus on a false belief as something to change fails to address the real problem of the working of processes underlying generation of beliefs.

Whereas transactional dominance–submission relationships crystalize ape groups into hierarchies (sole function: protection from predation), collective authority–belief relationships coordinate human groups into open-ended functioning organisms. The evolution of neurological systems in physical organisms is a process of progressively establishing neural connections between perceptions of common circumstances and successful responses to them. The recognition of such circumstances is neurologically linked to evolved responses. In human groups, a unique system of collective communication (language) serves the role of a neurological system. The collective recognition-and-response to circumstances occurs through a process of sustained group communication.

The uniquely human instinct is to mutually seek immersion with one another into the sentient “harmonic” of group authority-and-belief. This group sentience, like the neurological systems of organisms, has been hard-wired by evolution to link, minute-by-minute, the fleeting narrative of circumstances with successful collective responses. The principal thrust of the vast majority of human evolution has been the progressive refinement of branching algorithms for coordinating groups’ sequential perceptions-and-responses, all mediated by the constant flux and flow of collective authority-belief feelings (instead of neurons). However, in our own species, this relational intentionality to coordinate productive behavior has been harnessed to the fitness of groups involved in waging chronic war. Because the symptoms of schizophrenia derive from the breakdown of our current process of believing, they should reflect this shift in the function of the belief-feeling during the last 300,000 years of our Homo sapiens species.

Although the perceived source of delusions and hallucinations are not necessarily collective entities like the government and often are nondescript individuals, they are all considered to emanate from the “public” social sphere. We shift into the public sphere when we speak about our beliefs. Our voice has evolved to drop an octave to signal that we are now speaking with the serious collective authority of our group (even as we usurp the intonation for our own benefit). Normal intercourse between individuals integrates communication emanating from the belief systems of the various groups with which we identify, for example the Republican Party or the scientific community. When our species engages in conversation, there is an emotional backdrop of strategic transaction among belief systems, and it is this sensibility that is disabled in schizophrenia.

The psychic process of believing functions in the background of our language where groups communicate to their individual constituents. These belief systems do not exist as logical trains of thought but consist of diffuse signaling in the background intonation (“dog-whistles”), communicating firm emotional attachments to certain values (rules) associated with cultural groups; pathological hyperawareness of receiving these fragmented antecedent social cues (“dog-whistle downpours”) could explain the illogical loose associations characteristic of thinking in schizophrenia, in association with utter belief that the meaning of this thinking is transparently obvious.

Psychologist Jonathan Haidt, in his book The Righteous Mind: Why Good People Are Divided by Politics and Religion (2012), offers evidence that the differences between conservatives and liberals involve the dissimilar emphasis each group places in six belief categories: important issues to liberals are care/harm, liberty/oppression, and fairness/cheating, whereas for conservatives the most important issues are loyalty/betrayal, authority/subversion, and sanctity/degradation. In the thinking process, one is in constant communication with various nested groups (via watching a favorite cable news channel, for example). We “civilians”[2] who do not have schizophrenia, remain oblivious of believing in a particular value system because our human instincts immerse us into our beliefs in the same manner that fish swim together in water (“civilian-groupthink”).

In the thought-provoking book Far from the Tree: Parents, Children, and the Search for Identity (2012), about parents and their exceptional children, author Andrew Solomon writes, “The rich culture of Deafness, the LPA [Little People of America]-centered empowerment of dwarfism, … the self-actualization of the autism rights brigade—none of this is really present in the world of schizophrenia.” The reason for this lack of group identity is that, in schizophrenia, the very process by which individuals believe in group identities is itself disrupted.

William Cantwell Smith points out in his Belief and History (1977) that the original meaning of (the feeling of) belief referred to competitive loyalty and identity as in believing in a sports team or your country. It has only been since the Enlightenment era, when knowledge became more theoretical, that the belief-feeling started to imply acceptance of (submission to) a theoretical proposition, such as natural selection, based on scientific evidence. This very recently appended requirement of evidence-in-pursuit-of-truth to the meaning of “belief” is a reconnection with core human instincts evolved for relational productivity in our ancestral species. Now with our divided politics, we are witnessing an unfortunate reversion to its root Homo sapiens meaning.

In addressing the natural history of how competitive group identities evolved to emerge in our species, Darwin’s own conception of group selection becomes relevant; note the word, “victorious”:

There can be no doubt that a tribe including many members who, from possessing in a high degree the spirit of patriotism, fidelity, obedience, courage, and sympathy, were always ready to give aid to each other and to sacrifice themselves for the common good, would be victorious over most other tribes; and this would be natural selection (Darwin, Descent of Man, 1871).

This idea that prosocial instincts have evolved as the result of groups waging chronic war is tainted due to Hitler’s related notion of the superiority of the warlike Germanic peoples. Nevertheless, Darwin is right that there can be “no doubt” about the evolutionary effects on human nature of chronic war in our own Homo sapiens species; war has been directly documented for 10,000 years (Keeley, 1996) and there is disparate evidence for group violence for up to 120,000 years (Bowles, 2006). Suffused into the positive traits that Darwin lists above has been group selection for warlike instincts for group dominance so prominent today. However, this us-versus-them mentality is rare in schizophrenia.

For example, in the Washington DC Navy Yard shootings in 2013, everyone initially assumed that the perpetrator was a terrorist motivated by hostile group beliefs. It turned out he was living with schizophrenia. In an email recovered by the FBI, he expressed his motive: “Ultra-low frequency [microwave] attack is what I’ve been subject[ed] to for the last 3 months, and to be perfectly honest that is what has driven me to this.” In schizophrenia, the internal emotional mechanism, itself, whereby the authority of groups normally communicate with their believers, collapses into an intensely hyperaware state.

Language

The principal function of group identities in modern times is to bind together large groups, e.g., countries, religions, ethnic groups, etc., in competition with each other. Because schizophrenia is such a crippling, evenly distributed, and widespread disorder, and because it leaves spoken language ability largely intact, the aspect of communication function that it disables, which operates in the background, must derive from a process far more central to prior species of humans (hominins). In other words, this one facet of modern communication that serves to transmit group beliefs and competitive loyalty had been the only form of language communication at one time and therefore essential to hominin survival.

ESA proposes that, prior to modern humans and our complex, multifaceted vocal language, communication was solely motivated by obedience to (belief in) the evolved authority of groups. The goal of communication for the members of a group was to ascertain from one another how together they should coordinate their behavior as a group. This would be analogous to a group of believers discussing how to behave in a manner consistent with their shared beliefs. It is likely that this ancient core of our modern language, which has receded into the background of our communication, is disabled in schizophrenia. This collective-immersive quality continues to be the hallmark of human language, and it is important to be aware of how unique it is.

To appreciate the limitations of communication between animals selected at the level of individuals, as opposed to at the level of relationships as in humans, it is enlightening to read the abstract from a classic paper on the subject by Robert Seyfarth and Dorothy Cheney (2003) titled “Signalers and Receivers in Animal Communication”:

In animal communication natural selection favors callers who vocalize to affect [i.e., manipulate] the behavior of listeners and listeners who [are selected to] acquire information from vocalizations. The [motivational] mechanisms that cause a signaler to vocalize do not limit a listener’s ability to extract information from the call. Whereas signalers may vocalize to change a listener’s behavior, they do not call to inform others. Listeners acquire information from signalers who do not, in the human sense, intend to provide it.

In other words, in animals evolved for the fitness of individuals, expressions are always manipulative, and understanding expressions is the equivalent of eavesdropping. These characteristics are opposite of the immersive-transparency intrinsic to collective expressions, and, indeed, we modern humans are shameless blabbermouths, competing to bend each other’s ears.

Upright posture

The most fundamental fact about human evolution is that upright posture is a categorical requirement for a fossil to be designated a hominin. In the oldest hominin skull fossils, the extent of upright posture is determined by the forward position of the foramen magnum in the skull through which the spinal cord exits. Because any orthopedic surgeon can tell you that upright posture produces vulnerability for injuries to the lower back, perennially among the top ER visits (Weiss, 2011), and to joints in the lower limbs, it is reasonable to conclude that the evolutionary advantages of such a costly adaptation must have been central to the functioning of even the earliest hominins. Upright posture enabled the face and upper body to become the publicly viewed instruments for the sustained-and-simultaneous signaling-and-receiving-signals necessary to coordinate minute-to-minute teamwork.[3] The connection between the categorical status of upright posture and its collective communication function leads to the conclusion that a rapid, “punctuated” (Eldridge and Gould, 1972) shift from the individual intentionality of apes to the collective intentionality of humans occurred six million years ago and initiated our hominin tribe.

The evolved objective of communication for the members of a group was to ascertain from one another how together they should behave in such a way as to optimize their function as a group. Because a central goal of this therapy is to identify schizophrenia with this core of being human, I will reproduce from my book a flight of imagination into the experience of our ancestral hominin species knapping essentially the same hand ax for an astonishing 1.5 million years:

Crouching in a circle, we are all glancing back and forth, not merely imitating one another’s work, but watching for strokes made with the authority of how it should be and always had been done. We all instinctively know the familiar rectitude of wisdom flashing alternatively among us, making small adjustments with constant mutual recognition until general specifications are satisfied: the precise technique of striking, the proper size and shape.

Whether it be from one day, week, or century on into the next, the memory of what to do and when to do it was not stored in any individual brain. Rather, this knowledge was mixed into and among a given group—and all groups—in bits and pieces, which, when the moment arose, fell together in collective animation. Diffusing through time and space and linked by long repeating chains of unbroken mutual experience, this hallowed ritual, the emblem of a sacred tribe, scattered far and wide out into their diaspora from Africa out and across the vastness of Eurasia. Although individuals drifted from one group to another, small bands dissolved, and new ones reconstituted, these diurnal chains of communal functioning wove an unbroken fabric for 50 thousand generations across the expanse of entire continents.

Identity

Just as human collective intentionality has been naturally selected through the ages to coordinate behavior most productively, so too have our deepest human instincts evolved to permit the thoroughgoing engagement required for teamwork. The productivity of relationships increases with the number of individuals in a given group, up to the limit of the need for everyone to see and hear everyone else in the continuous “public” sending-and-receiving of signals (language). In our own species’ history, population amalgamation[4] caused collective intentionality (authority) to become subject to top-down (hierarchical), group-level (in contrast to relational-level), competitive, win-lose selection for the fitness of groups chronically at war, as has been discussed.

The result is that the evolved human intentionality of authority and belief that had previously resided within each-and-every human relationship was adapted for the competitive benefit of groups at war with each other. The superimposition of this Darwinian dimension of Malthusian competition shifted what the human collective intentionality (authority) was about—from the productivity of relationships to the fitness of groups. The long-evolved human emotional structure of authority-and-belief has been commandeered to promote the multiple factional group identities so apparent in recorded human history. Modern group identities orient the individual as to how to act in the social context of one’s nested groups (a “social GPS”), each guided by competing belief systems—and this is the function disabled by schizophrenia coupled with diminishment in the root capacity to coordinate productive behavior with others.

Narrative truth

Evolutionary symptom analysis is based on what Johns Hopkins psychiatrist Peter Rabins in the The Why of Things (2013) calls narrative truth: “Causal narratives seek to knit together disparate observations, facts, and events into a coherent and inclusive whole that convincingly links later events to prior events.” Just as Freudian psychoanalysis is based on a developmental narrative, ESA is based on an evolutionary narrative. This narrative is consistent with the science of human evolution, and in addition, you the reader can judge whether it empathically resonates with you (mindful that our capacity for empathy itself is a legacy of the same collective communication functions that are disrupted in schizophrenia).

The following outline contains evidence for the hypothesis that the emergence of hominins six million years ago represented a major biological transition in the history of life. At the end of the outline, the evolution of cultural identities in our own species is omitted as unnecessary because its malfunction in schizophrenia is treated by fostering a passionate identity with our antecedent, core human capacity for teamwork.

In bold-type below, the known facts of human evolution are reinterpreted to be primarily influenced by the emergence in evolution of the novel social structure of individuals assembling into group-organisms with linguistic capacity to coordinate their divided labor into teamwork.

EARLY HUMANS (6→2.5 million years ago)

 

 

GENUS HOMO (2.5 million→300,000 years ago)

This new human narrative consists of an initial sea-change conversion to collective intentionality, followed by 3.5 million years of consolidation in collaborative linguistic function, and then 2.5 million years (prior to modern humans) in which these new multi-individual organisms spread their cognitive wings to colonize Eurasia.[5]  So, during the first ninety-seven percent of the six million years of our becoming human upon this earth, we lived our lives immersed with one another in the communal coordination of our mutual survival. Minute by minute, millennium after millennium, our ancestral species sought relentlessly and passionately to fathom from one another—in the language of emotion—the intentions of their groups: what would be the most righteous and correct alternative that they, together as a single creature, should follow next? Schizophrenia is a sickness of this venerable core human legacy and it is by embracing it and rehabilitating it that this most human of all maladies can be healed.

 

Treatment

Existing psychosocial treatments for schizophrenia suffer from fragmentation due to lack of theoretical grounding. As Dixon, et al. (2009) wrote in their Schizophrenia Patient Outcomes Research Team (PORT) report:

. . . our field has no consistent method to categorize psychosocial treatments. Some psychosocial treatments are organized around the outcome or problem being addressed (eg, alcohol or other drug use, medication adherence). Others are organized around the strategy being used (eg, CBT). Still others are organized around care processes (eg, family psychoeducation, ACT [assertive community treatment]) or phase of illness (early-onset interventions). The lack of a standardized method to organize treatments and approaches can lead to confusion and mask the fact that different interventions and treatments may share common elements.

The basic problem is the focus on cognitive or behavioral dimensions instead of the functional emotional deficits that both underlie them now and have underlain their evolution. A step in the direction of tailoring treatment to an emotional deficit—motivation—is the demonstration that socialization therapy sequentially causes improvement in motivation which then causes improvement in employment (Fulford et al., 2010). Core Human Instincts Therapy organizes diverse treatment modalities around the rehabilitation of the macrobiological (evolutionary) functions of emotions disabled in schizophrenia.

From Moral Treatment to Core Human Instinct Therapy

Modern psychiatry was founded by Phillippe Pinel in Europe, and Benjamin Rush in America on the principles of humane treatment and moral discipline known collectively as the moral treatment movement. Dorothea Lynde Dix was the legendary 19th Century reformer who was appointed head of Civil War nurses in her 60s. Early on, she became an advocate of the moral treatment philosophy when she herself was treated at the York Institute in England founded by Quaker William Tuke. Although beginning as a secular movement in Europe, it absorbed the religious fervor of the Second Great Awakening in America which included a strong work ethic leading to the founding principles of occupational therapy (Ikiugu, 2007). Besides the obvious benefits of humane treatment, moral training recognized the need to impose a system of values in the context of occupational training.

Core Human Instincts Occupational Therapy (CHI-OT) informed by ESA provides a new theoretical framework for an occupational therapy that harkens back this founding of American psychiatry two hundred years ago. In place of training in religious morals based on the biblical narrative, CHI-OT provides patients with schizophrenia training in core human instincts based on the human evolutionary narrative. The following is meant merely as a heuristic to give a sense of possible directions CHI-OT might take.

 

CHI-OT (pronounced “coyote”) Theory

1) Those recently evolved for the fitness of groups involved in chronic war.

2) Those evolved over millions of years for the productive coordination of work, called Core Human Instincts (CHI, pronounced, “ky”).

CHI-OT: Practice

Grice’s Maxims, (1975) truth-seeking

Overall: Be cooperative. Be informative.

  1. Maxims of Quantity:
    1. Make your contributions as informative as is required.
    2. Do not make your contributions more informative than required.
  2. Maxims of Quality:

Supermaxim: Try to make your contribution one that is true.
1. Do not say what you believe is false.
2. Do not say that for which you lack evidence.

III. Maxims of Relation: Be relevant.

  1. Maxims of manner: Supermaxim: Be perspicuous [transparent].
    1. Avoid obscurity of expression.
    2. Avoid ambiguity.
    3. Be brief
    4. Be orderly.

Seeley’s Bee Lessons (2010) decision-making

Lesson 1. Compose the Decision-Making Group of Individ­uals with Shared Interests and Mutual Respect.

Lesson 2. Minimize the Leader’s Influence on the Group’s Thinking.

Lesson 3. Seek Diverse Solutions to the Problem.

Lesson 4. Aggregate the Group’s Knowledge Through Debate.

Lesson 5. Use Quorum Responses [as opposed to consensus] for Cohesion, Accuracy, and Speed.

Takes place in parallel with addressing task: “walking and chewing gum”

Teamwork talking CBT

Semantic Intonation Therapy (SIT): addresses “flat affect”

 

Conclusion

Evolutionary symptom analysis of schizophrenia reveals schizophrenia as a sickness of our unique human capacity for collective intentionality evolved throughout human evolution for the benefits of teamwork, but recently co-opted for modern group identities. Core Human Instincts Occupational Therapy endorses Gentle Good Riddance to the competitive and divisive aspects of cultural identities while embracing an identity with, and rehabilitation of, teamwork. Theoretical principles are proposed, along with practice directions for teamwork CBTs and new semantic intonation therapies.

 

 

 

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[1] The psychic amplifier that sustains PPF is hyper-self-awareness, most evident in panic disorder: “As I begin to feel anxious, I am sucked into focusing on my anxiety, which makes me more anxious,” a process that rapidly ricochets with increasing intensity into pathological panic. A description of the natural history of self-awareness in PPF is beyond the scope of this paper and can be found in Wylie (2020).

 

[2] As will be outlined in the therapy section, to foster identity and humor, the accretion of a colloquial vocabulary relevant to schizophrenia is encouraged like that which has grown up around Alcoholics Anonymous (AA).

[3] This hypothesis for upright posture satisfies Darwin’s insistence that evolution must proceed by small increments, which hypotheses that invoke (eventual) superiority in long-range mobility do not.

[4] Comparative genome sequencing on Neanderthals from about 60,000 years ago (Prüfer, 2017) demonstrated that they were “highly inbred, . . . lived in small groups, and had lower genetic diversity.” This is compared to the genomes of four 34,000-year-oldHomo sapiens from Eastern Russia (Sikora, 2017). Although from the same kinship

group, their genomes . . . “were not very closely related. Thus, these people may represent a single social group that was part of a larger mating network, similar to contemporary hunter-gatherers. The lack of close inbreeding might help to explain the survival advantage of anatomically modern humans.”

[5] Both a proposed evolutionary mechanism of the initial human biological transition, and the inner evolutionary story of our own species as revealed by the manic phase of bipolar disorder can be found in Wylie (2020).