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Evolution and Mental Illness:
Interview with Dr. Steven Lesk
By Carin Chea
In 2021, the National Institute of Mental Health reported that over 57.8 million adult Americans lived with mental illness, which meant one in every five individuals over the age of 18 struggled with the proverbial invisible illness.
This staggering statistic is not news to Dr. Steven Lesk, an accomplished psychiatrist who has been on the forefront of mental health treatment since 1984.
In addition to helping adults, Dr. Lesk has used his expertise and experience to mentor students while conducting imperative research.
And now, his innate knowledge and curiosity has culminated in, Footprints of Schizophrenia: The Evolutionary Roots of Mental Illness, an exploration of how and why schizophrenia came to be.
Dr. Lesk challenges the modern underpinnings of psychiatry and asks questions that stump even the most stalwart of institutions.
As brilliant a writer as he is a clinician, Dr. Lesk aims not only to inform, but to broaden our understanding of the origins of mental illness as a pathway toward providing more effective treatment.
Tell us how you landed on the profession of psychiatry.
I’ve always been interested in the mind. I received my bachelor’s and master’s degrees in psychology. After going to medical school, I got into psychiatry. I just retired this past February after practicing for 40 years.
What prompted you to write Footprints of Schizophrenia? Is this your first book?
Yes, this is my first book, though I’m working on a second book and hoping to get that published as well.
What I want is for people with psychiatric illnesses to go to their psychiatrist’s office and ask, “What is this I hear about mental illness having to do with evolution?”
That’s why I wrote the book, to spread the word.
Can you expand upon that more? Why is evolution so important in psychiatry?
I’ve never been satisfied with the explanation that psychiatrists give their patients. They use catch phrases like “genetics,” “connectivity,” and “chemical imbalances.”
About 10 years ago, I broadened my knowledge base by doing extensive reading on anthropology texts, language theory, and developmental psychology, and came up with something more meaningful and explanatory.
I started writing papers and submitting them; but, no one was interested. They thought I was being too speculative. So I decided to write a book.
You see, mental illness is due to the evolutionary moment we’re in. 50,000 years ago, there wasn’t any mental illness. In 20,000 years, we won’t have mental illness as we know it.
Why do you think we won’t have mental illness in 20,000 years?
Ten or 20,000 years from now we’ll have passed through it and far enough from this transition period, and everyone will be on board. Right now, it is so new that not everyone is on board with this way of thinking.
What is this transition period you’re referring to, and what does language have to do with it?
Language has changed our way of thinking radically. Language has only been around for 50,000 years or so and it has revolutionized how we use our minds. We’re still in this “transition” phase.
Prior to 50,000 years ago, there was no language. Humans could not participate in their thought processes. They were glorified animals who weren’t even on top of the food chain. Once we got language, we wiped out all other species like the Neanderthals.
We learn to suppress a chemical called dopamine when we have language. Once we got language, we starting learning and using this technique of dopamine suppression. Our egos expanded and our brains expanded; they’re larger on the left side than the right side in order to accommodate thinking. We went from primitive to reality-based thinking.
Take a schizophrenic, for example. A schizophrenic will learn to suppress dopamine, but sometime in late adolescence it all falls apart and they regress back to primitive thinking. The other mental illnesses (bipolar, major depression and anxiety) follow that blueprint, but on a lesser level.
We have medications that either suppress or improve dopamine. In 20,000 years, we’ll all be on board with this process that language has given us because mental illness is due to the suppression of dopamine.
Why do you think psychiatry hasn’t taken all this into consideration?
I feel psychiatry is in the dark ages because they’re ignoring all of this. These issues are so fundamental to understanding what mental illness is. We’re really off base in our research.
We don’t have a single blood test, x-ray, or CAT scan that gives us a diagnosis. All we can do is listen to our patients. Psychiatry completely ignores evolution as part of the picture in our research protocol.
I think there’s great hope we can advance. But, right now, the meds we have are primitive. They don’t work for everyone, they take a long time to work, and they have a multitude of side effects.
If we could re-focus our understanding of mental illness and take evolution into account, I think our direction of research could improve.
Why are psychiatrists afraid to entertain these new ideas?
We’re stuck in certain avenues, like genetics. A mutation or gene for schizophrenia has never been found, so if it were genetic, it would have gone extinct by now. Darwin made that very clear.
We’re stuck in these grooves and unwilling to give them up. There’s a reluctance to look at new ideas; in fact, people seem afraid of them.
My next book I think is going to be called the Abdication of Psychiatry because I think others in this field have missed the boat. You can’t put a square peg in a round hole, but we keep trying.
What do you hope readers will take away after reading your book?
I want patients and their families to go into doctors’ offices and say “You told me my family member has a chemical imbalance, but how about evolution?” That will at least motivate psychiatrists to read up on it. I’m trying to get patients to demand a better explanation than what they’ve been given.
Currently, patients are not satisfied with the treatment or medication they get. Right now, the best medication we have for schizophrenia causes several side effects, requires a weekly blood test, and can cause things like bowel obstruction.
If we go into any other doctor’s office, they examine your body and give you tests. We need more of a biological basis in the field of psychiatry in order to really understand what mental illness is about.
But, when you broach this topic to orthodox psychiatry, they get defensive. They are much too frightened of it and will not entertain it as an option until patients go into their offices demanding, “What is it with evolution?”
What was it exactly that got you started on this path of exploring evolution as a framework for psychiatry?
It was a series of things. I remember asking a schizophrenic patient, “Why does the sun come up in the morning?” He thought about it, and finally he said, “Tomorrow.” I said, “What do you mean by that?” and he replied, “Didn’t you ever see Annie? ‘The sun will come out tomorrow.’”
You see, schizophrenic thinking is a regression to a more primitive, childlike thinking. It’s a regression, just like when people take psychedelics. It makes them childlike.
As we learn language, we grow into what Freud calls The Reality Principle. We focus on what is realistic, not just what is relevant to us.
For instance, if you ask a child about something, they’ll say something like “the moon is a big fat man who’ll eat you.”
Children are dominated by words, but adults dominate words. We use language in a way that advances our minds. We can gate out these primitive mindsets that interfere with realistic thinking.
That gating process is one of the most important assets of mental health. The better you are at gating, the healthier you are. Language started this because when you use words, you need a place to park those words in order to express a sentence. First, you have a primitive thought, then you add words to it.
Language divided our minds up into these Freudian areas. You can see the progression of a child from age 5 to 15, where suddenly they’re talking in a realistic matter instead of a funny, joking, idiosyncratic way that makes sense only to them.
Right now, maybe 80% of the population does it well. When you have a mental illness, you’re slipping back into primary process thinking which is akin to daydreaming or (with schizophrenics) primitive organizational thinking which isn’t connected to reality at all.
It's disheartening learning that the field of psychiatry has been so adverse to your research.
They’re so allergic to anything that’s not in the groove of what they’re doing. It’s a shame. It’s sad. But, a lot of psychiatrists are starting to realize that genetics is not the answer to everything.
Are there any practical treatments in line with your research that can help schizophrenics?
There is something called Cognitive Restructuring where they provide mental puzzles that get them to use their executive functioning. That’s been helpful over a long period of time, but it’s not being focused on.
Of course, schizophrenics and most mentally ill patients will require medication, but we can still help them restore executive functioning. There are schizophrenics who are amazingly highly functional. All of them are engaged in educational types of opportunities, and most of them are on clozapine.
The key is: We have to understand what executive functioning is and find a way to get schizophrenics to use it more.
What is one thing you’d love to share with those struggling with mental illness?
Go to your psychiatrist and ask, “What does mental illness have to do with evolution?” That’s the greatest chance we have of changing things.
For more information, please visit StevenLeskMD.com.
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