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Book Forum: Cultural Psychiatry   |    
Origins of Psychopathology: The Phylogenetic and Cultural Basis of Mental Illness
WILLIAM R. FLYNN, M.D.
Am J Psychiatry 2003;160:1364-1364. doi:10.1176/appi.ajp.160.7.1364
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By Horacio Fábrega, Jr., M.D. New Brunswick, N.J., Rutgers University Press, 2002, 411 pp., $60.00.

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Dr. Fábrega is a professor of psychiatry and anthropology at the University of Pittsburgh. He contends that psychiatry and psychiatric education have neglected knowledge of anthropology that would allow us to have a deeper, comprehensive understanding of psychopathology. This book addresses that deficiency, the questions of how what we know as mental illness today was expressed at earlier stages of human evolution and how evolution has influenced psychopathology and vice versa. Evolutionary psychiatry tries to understand and treat mental illness using the findings of evolutionary biology and psychology. Dr. Fábrega’s scholarship is impressive; he cites the literature hundreds of times, including 21 of his own publications, many of which deal with contributions of anthropology to psychiatry. The majority of his sources were published in the last two decades. He compares and contrasts the views of other theorists in the field with each other and with his own. He quotes many of them at some length.

At the outset Dr. Fábrega acknowledges that examining the behavior of animals by extrapolating from our knowledge of human behavior runs the risk of anthropomorphism. For that reason, he focuses on what is known about "the last common ancestor" in the human chain of evolution, as exemplified by the chimpanzee. The effort to understand psychopathology in an evolutionary context is similar to doing so in a cross-cultural context. He compares the ways that clinicians, biologists, and social scientists conceive of psychopathology.

Dr. Fábrega discusses the clinical versus the evolutionary perspectives on psychopathology and why they are compatible and complementary. He speaks of the active role that psychopathology plays in evolution and addresses the question of how and why psychiatric disorders have been positively selected. Fitness to survive and reproduce was the basic requirement over the eons of evolution. He provides examples of the adaptive value during evolution of traits and states that we view and treat as pathological today in human beings. The cultural context of any deviation of thinking, feeling, or behaving determines whether it is pathological. Our ancestors, as they evolved toward modern man beginning about five million years ago, had physical and cognitive characteristics that interacted with the larger physical environment of their time.

There are several chapters on the descriptions of psychopathology during evolution. Studies of higher primates such as monkeys, chimpanzees, and baboons have demonstrated behavior and personality traits suggestive of human psychopathology. Dr. Fábrega marshals the findings of comparative and evolutionary biology and paleoecology to hypothesize about the conditions that existed at stages of evolution, i.e., the ethological, precultural, protocultural, and early cultural phases of cognitive and language development. He theorizes about the external conditions such as the physical environment, social relations, and group relations and how they interacted with language and cognitive development during different time periods. With the development of culture came emotions such as shame, guilt, and pride, which changed the character of psychopathology in time.

The foregoing is but a sample of the content of this volume, which is a masterful piece of erudition and scholarship. Dr. Fábrega analyzes an astonishing number of combinations of circumstances in which our ancestors lived in prehistoric times. He traces the parallel lines of physical, cultural, cognitive, and language development and speculates on the expression of psychopathology by individuals and their society’s responses to it. This work is valuable for its meticulous exposition of what anthropologists, cultural anthropologists, paleoanthropologists, archeologists, ecologists, biologists, evolutionary biologists, comparative and evolutionary psychologists, and cognitive scientists have to say about evolution even without regard to psychopathology. My only cavil is that Dr. Fábrega uses anthropological terms freely but is a bit parsimonious about explaining them. I would have welcomed a glossary.

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