In one sense all psychiatry is already evolutionary - vulnerability to mental disorder arose through the same processes as everything else about us. To me the question is whether we refocus a little, so as to make that reasoning explicit, or leave it implicit and unexamined.

The centrality of evolution to the human question always seemed logical to me - we like sweet food, we like sex, we largely agree these are evolved. Why ever stop the evolutionary analysis there?

A satisfying feature of the field: it repeatedly turns "this makes no sense" into "this makes sense under conditions that no longer hold".

Medicine has a proximate and an ultimate register. How does the fever work, and why do we have fevers. Most of psychiatry has been conducted almost entirely in the first. Evolutionary Psychiatry is betting there's a lot of value in exploring the second.

A nice thing about an evolutionary frame is how much it explains that you weren't previously aware needed explaining. Why anxiety and not calm all the time? Why grief at all? Questions you didn't know were questions!

Sleep problems in modern life are often framed as a discipline failure. They're just as often a mismatch failure — a system built for darkness and exhaustion, running on light and stimulants.

The line between 'personality trait' and 'disorder' in most diagnostic manuals is drawn by degree, not kind. Selection rarely produces traits that are all downside - it produces trade -offs, and therefore 'traits' have a range.

A decade of EPSIG: largest lineup yet for the 8th International Evolutionary Psychiatry Symposium - in person at the RCPsych, London, Fri 6 Nov 2026. Luminaries such as Nesse, Le Cunff, Hurst, Spikins, Keedwell, Hurst, Brüne all giving talks! Registration link in tweet below:

We did not evolve to be well. We evolved to leave descendants, and selection was perfectly willing to trade your comfort for their existence. Psychiatry is in some sense, the quintessential study of that trade.

Low mood is not always a fault to be corrected. Sometimes it is information — a signal that the current pursuit is not paying, delivered by a system with no gentler way to say so.

There is a difference between a system that is broken and a system doing exactly what it was built to do under conditions it was never built for. Mistaking the second for the first might have cost patients a great deal.

The reframe people find healing isn't "you're fine." It's "what you're feeling makes sense, given what this system was built to do." Sense-making is half of recovery. Evolution happens to be very good at supplying it.

Half of psychiatry is built on the idea of "normal" - and almost none of it specifies normal for what. Statistically normal? Normal for a hunter-gatherer band? Normal for a system that's overshooting because the threat it's calibrated for no longer exists? These are different sentences.

We keep looking for the lesion. A century of looking for the lesion. The uncomfortable possibility is that for much of what we treat, there is often no lesion: there's a working system meeting a world it was never shaped for.

Mainstream psychiatry asks "how is this brain different from a healthy one." Evolutionary psychiatry asks "what is this brain doing, and what was it built to do." The first question has produced a century of correlations. The second is where the explanations live.

TODAY: Samir Okasha's webinar on "methodological creationism" - a concept that reorganises a whole psychiatric debate. The uncomfortable point: you can do most of modern psychiatry without ever assuming humans evolved — and largely, we do. Worth sitting with. Webinar 25 June, 6pm BST. Link below:

10 years of EPSIG. To mark it, we've booked our biggest lineup yet for the 8th International Evolutionary Psychiatry Symposium — in person at the RCPsych, London, Fri 6 Nov 2026. Nesse, Brüne, Le Cunff, Hurst, Spikins, Keedwell. Registration link below:

Every emotion you'd like to delete was load-bearing for someone who shared your genes. That's why you still have it. The off-switch existed at various points in our history. The lineages that pressed it aren't here to discuss the matter.

Most of psychiatry proceeds as if humans weren't the product of evolution at all. Samir Okasha has a name for this: "methodological creationism." Once you see it, you can't unsee how deep it runs. Join us 25 June, 6pm BST. Link below:

The brain is the most metabolically expensive organ we have. Evolution does not build and maintain expensive things that produce only malfunction. Whatever depression, anxiety, and the rest are, "pure error" is almost certainly not the answer. Expensive systems are "doing something."

We call it "mental illness." We could call it "a brain doing its best in an environment it wasn't designed for." The second framing isn't a kind lie - It's simply more accurate. And it gestures toward completely different interventions.

New Webinar: Samir Okasha's "methodological creationism" begins by asking "how might Psychiatry look differently if we assumed human behaviour was not produced via evolution?" Coming up - 25th of June 6pm BST. Link Below:

Telling someone with depression that their brain chemistry is imbalanced is often disempowering - healing is just a matter of taking a pill and hoping it works. Telling them their system is responding to something real, and we can work out what, gives them somewhere to go.

Status anxiety is rational in a species where status determined access to mates, resources, and allies for two million years. Social media didn't create the wound! But it did remove every natural ceiling on how many people you can measure yourself against.

Disgust evolved to keep us away from pathogens and toxins. Then it got recruited for moral and social judgement — contamination, purity, the "unclean" outsider. Perhaps a lot of human cruelty runs on an emotion that started as food safety. Worth knowing where your moral intuitions come from!

We pathologise the kid who won't sit still, the adult who can't focus, the teenager who sleeps wrong, the griever who grieves too long, the worker who burns out. At some point the sheer number of "disorders" should make you suspect often the problem is the yardstick, or the environment.

What would psychiatry look like if we assumed humans weren't evolved? Samir Okasha's "methodological creationism" thought experiment is one of the most clarifying moves I've seen in this debate. Webinar coming up - 25th of June 6pm BST. Link Below:

Depression as evolved response: withdraw, conserve, reassess, signal need for support. Depression as modern trap: the withdrawal removes you from the very social and physical inputs that would lift it. The response is adaptive. The feedback loop it creates in isolation is not.

There's perhaps a reason every antidepressant trial has a huge placebo response. Belief, hope, ritual, the attention of a caring expert — these are evolved healing inputs. The studies have implicitly been demonstrating the power of the evolutionary-therapeutic relationship for decades.

Of course, some of psychiatry's "treatment-resistant" cases may just be cases where the treatment was aimed at the wrong level. You can't always pharmacologically fix a problem that lives in someone's job, marriage, or total absence of community.