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Counselling Psychology Quarterly

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Evolution, depression and counselling

Tony J. Carey
a
Living Life Centre , Bray, Co. , Wicklow, Ireland
Published online: 22 Oct 2010.

To cite this article: Tony J. Carey (2005) Evolution, depression and counselling, Counselling
Psychology Quarterly, 18:3, 215-222, DOI: 10.1080/09515070500304508

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 Counselling Psychology Quarterly,
September 2005; 18(3): 215–222

THEORY AND PRACTICE

Evolution, depression and counselling

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TONY J. CAREY

Living Life Centre, Bray, Co. Wicklow, Ireland

Abstract
In this paper a framework of evolutionary psychology is used to develop a model of depression. In this
model depression is seen as not normally a biochemical illness or disorder, but instead as usually due
to the person becoming trapped within a psychologically activated but unwanted and inappropriate
suite of natural emotions, with the activation coming from a perception of a major decline in personal
usefulness that can include failure, guilt, shame or perceived rejection. A neuropsychological observa-
tion that supports this model is described. The implications of the model for counselling with
depressed clients are outlined in terms of a multi-dimensional approach, oriented around perceived
usefulness. It is predicted that clients receiving such counselling will recover more rapidly and be
less likely to suffer a relapse than those receiving just drugs or a form of counselling that covers
fewer dimensions.

Keywords: evolution, depression, counselling, suicide

Introduction
Could depression be due in most cases to the activation of a commonly inherited suite of
emotional systems, or ‘‘programmes’’, and not to some maladaptive mental illness? Is it,
as Randolph Nesse (2000) puts it, ‘‘a state shaped to cope with unpropitious situations’’?
If this is indeed the case, how did such ‘‘programmes’’ evolve? What is their activation
mechanism? How could such a framework lead to the prevalence and risk factors for depres-
sion that we see today? What are the implications of all of this for counselling and the
treatment and prevention of depression? This paper attempts to address these questions.

Evolutionary psychology
Darwin’s theory of evolution was founded on the physical structures that organisms inherit
from their parents. Relatively recently, over the last 10–15 years, researchers have been
laying the foundations of a parallel theory, known as evolutionary psychology, about the

Correspondence: Tony J. Carey, Counselling Psychologist, Ganymede, Glencree Road, Enniskerry, Co. Wicklow,
Ireland. E-mail: careytj@eircom.net

ISSN 0951-5070 print/ISSN 1469-3674 online ß 2005 Taylor & Francis

DOI: 10.1080/09515070500304508
 216 T. J. Carey

psychological systems and tendencies including emotions that we inherit. When Darwin put
forward his theory, it was way ahead of our understanding of genetics and how a DNA code
can be translated to construct the ‘‘bricks-and-mortar’’ of bodies. However, this lack of
knowledge in Darwin’s time of the underlying mechanisms did not invalidate his theory.
Likewise, the fact that we do not yet understand the physical or genetic basis of psycholo-
gical systems does not undermine the evolutionary approach to psychology that Darwin
himself initiated. Indeed our very existence is proof that our ancestors danced to the tune
of their evolved psychological systems.
An important foundation stone in evolutionary psychology is that, for most of the very
long period when our ancestors were making tools, the social conditions under which
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they lived and under which our psychological systems evolved were very different to
today’s world. They were hunter-gatherers living in small bands of 20–150 individuals,
all quite closely related and highly dependent on each other for survival.
To get some idea of the timescales involved, suppose you were able to walk backwards in
time with each step taking you back by one generation of 25 years. Consider going on a
four-day trek backwards in time, covering 15 miles per day by walking for 6 hours each
day at a steady speed of 2½ mph. Only 6 minutes after starting you would pass through
the agricultural era and into the era of hunter-gatherers. After just a further 26 minutes,
you would pass through a ‘‘bottleneck’’ of evolution that includes the ancestral father of
all humans. At the end of the four days of trekking, after 1 440 minutes of walking time,
you would arrive at the start of the era of stone tools some 100 000 generations (2.5 million
years) ago. This was the point in evolution when the brain size of our bipedal ancestors
started to accelerate away from that of our close cousins the chimps and gorillas. So
99.6% of our tool-making ancestry was in the pre-agricultural era.

Evolution and severe depression

Despite this long period of hunter-gatherer evolution, it is not obvious how something as
potentially crippling and life threatening as severe depression could have been selected as
adaptive. How could something that ‘‘lessens the power of action’’ be ‘‘well adapted’’,
as Darwin (1887) put it in a specific reference to depression? Nesse (2000) suggests that
it could be useful in two ways:
. To inhibit further action on some major life enterprise that was going wrong, and:
. To prevent premature pursuit of alternatives.
This seems to be a good explanation for the mild-to-moderate depression that can be
experienced after some major failure or loss in our lives. For example, a woman whose
husband’s return from a hunting expedition was overdue would probably have been
better off feeling depressed than prematurely seeking another mate. However, Nesse’s
(2000) hypothesis does not explain how severe depression, with its slowing of mental func-
tions, terrible psychic pain that one client described as three times worse than childbirth,
loss of appetite, social withdrawal and suicidal thoughts, could be adaptive.
The first step towards explaining how severe depression could evolve was taken by
Haldane (1955) when he said that, biologically speaking, he would sacrifice his life for
two brothers or eight cousins. Hamilton (1963) elaborated this in a paper that showed
how altruistic behaviour could evolve. De Catanzaro (1981) subsequently set out a math-
ematical model of suicide and life-threatening behaviour, based on the objective costs to
the individual and the benefits to relatives of an individual ending his life or accelerating
his death. More recently Robert Mashman (1997) summarized the case for the evolution
 Evolution, depression and counselling 217

of what he calls ‘‘psychic misery’’ and its associated suicidal tendencies. But could an
individual really have weighed up these costs and benefits? What would be a suitable
mechanism for triggering such a potentially devastating emotional state?
One answer to this question is that the step that has evolved for triggering severe
depression may be a self-assessment of personal uselessness to close relatives, to important
roles or to the perceived extended family or tribe, that includes feelings of uselessness linked
to guilt, shame or perceived rejection. Re-assurance by close relatives or significant
members of the tribe of the individual’s usefulness would have been the escape route.
The absence of such re-assurance would lead to a deepening of depression. An example
may help to illustrate this.
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Imagine a 55 year-old male in a hunter-gatherer tribe who finds himself unable keep up
any longer with the hunt at a time of food shortage in the winter, with few opportunities to
switch to gathering. He is therefore a drain on his supporting relatives and sees himself as
such. The rest of the tribe, including his close relatives, can also see this and are unable to
offer re-assurance to him of his usefulness. Feelings of uselessness eat into his self–worth,
moderate depression deepens and a sub-programme of severe depression is triggered
whose symptoms actually make him less useful, reinforcing his view of his uselessness
and locking him in to his depressed state. His appetite falls, his weakened immune
system is unable to resist an infection and he dies to the general benefit of the relatives
who had been supporting him.
Of course, if our ageing hunter had been in error in assessing himself as of no further use
to the tribe, his comrades would probably have quickly responded to his mood and
inappropriate perception with reassurance and possibly a suggestion of a modified role
compatible with his physical abilities, thereby nipping his depression in the bud before it
had reached deeper stages. It is in this sense that Edward Hagen (2003) sees depression
as having evolved to stimulate this sort of social response. His bargaining model may be
part of the story. However, its view of suicidal tendencies, as only of value as a threat,
ignores their potential benefit to relatives that would have existed in the case of individuals
who, through age, injury or disease, were no longer able to contribute meaningfully to group
survival.
In today’s world, it is all too easy for individuals, isolated from the supportive network of
an extended family, to become locked into a distorted and undeserved sense of uselessness
or rejection. A student whose sense of self-worth has been built on perceived parental
wishes and appreciation for academic success could well consider exam failure as grounds
for viewing themselves as useless. An arrested person with no previous experience of prison,
flooded with guilt and shame, may feel the same way. Lacking corrective re-assurance of
their value to significant others, the triggering of severe depression in such circumstances
becomes a significant risk.

A ‘‘programme’’ for depression?

One fascinating piece of evidence that depression can arise from a discrete ‘‘programme’’ is
described by Antonio Damasio (2003). The story concerns a 65-year-old woman with no
history of depression or recent sadness whose symptoms of Parkinson’s disease were no
longer responding to drug treatment. Surgeons were attempting to give her some relief
through a reasonably standard procedure that involves tests with electrodes at various
positions in the brain to locate a site for a permanently implanted electrode. One of the
positions surprisingly initiated the following emotional sequence.
 218 T. J. Carey

First, she stopped talking and started to look sad. Next, after a few seconds she began to
cry and seemed totally miserable. Then she started to talk about how deeply sad she felt
and, as is a common component of depression, how exhausted and lacking in energy she
felt. She went on to describe, in words that could have been lifted from a textbook descrip-
tion of clinical depression, how worthless and useless she felt, how she no longer wished to
continue living. This reaction was totally unexpected and obviously distressful to the
woman. So the current was switched off. Within two minutes her demeanour and behaviour
abruptly returned to their previous relaxed state. She reported that she had felt awful but
did not know why.
If depression is a ‘‘programme’’ that can be switched on with electrodes, then it can
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probably be switched off in a similar way. This could be the explanation for the benefits
of ECT. Of course this procedure has the negative side effect of some memory loss.
However, the experience described by Damasio (2003) suggests that a more delicate switch-
ing mechanism may well exist. Of considerable interest therefore is the recent discovery
(Harrison, 2004) that a 20-minute brain scan using magnetic resonance imaging lifted
depression in 23 out of 30 bipolar patients, whilst healthy individuals were not affected.
This evolutionary view of depression, as a suite of ‘‘programmes’’ from mild blues to
severe, clinical depression that were selected as adaptive in very different circumstances,
can explain a number of features of its incidence today. In a society where money is seen
as the main route to self-worth and where the extended family is often absent, high rates
of depression particularly amongst the poor and isolated are easy to understand. Other fac-
tors in today’s world liable to have an adverse effect on self-assessed value are: mating and
reproductive role problems, associated with higher divorce rates, more single parenthood
and rising infertility, unfavourable comparisons with super-successful media personalities,
and advertisements for things that cannot be afforded.
Within industrial societies it is probably fair to say that the social structure of companies
has quite a few features in common with the male hunting-band. In contrast, women today
who look after children at home often lack the cooperative framework of an extended family
or its equivalent. It is not therefore surprising that, in our so-called developed economies,
rates of depression for women are often double those of men and rates of attempted suicide
show a similar pattern. However, when it comes to completed suicides the ratio is the other
way round.
How can the evolutionary approach explain this difference in the gender ratio for
attempted suicide compared to that for completed suicide? A superficial explanation pro-
vides the clue. Male attempts at suicide are more likely to result in death because men
choose methods such as shooting, jumping or hanging that tend to inflict irreversible
physical damage. On the other hand, women tend to use pills, poisons and gas that
have ‘‘a greater possibility of discovery and rescue’’ (Group for the Advancement of
Psychiatry, 1989). The evolution of an inhibition against serious physical self-harm would
make sense for women because it could be fatal, not just for them, but also for their
unborn and their young infants dependent on them for breast milk. In this regard, it may
be significant that the only country in the world where the female suicide rate exceeds
the male one is the People’s Republic of China (WHO Statistics, 2003), which has had
very severe programmes to restrict births, although ready access to toxic pesticides in
rural areas has certainly contributed to this sad statistic.
Rates of depression for women at home with babies or young infants are particularly high
(Swendsen & Mazure, 2000; Cryan et al., 2001; Carey et al., 2003). Without a supportive
network as a reality check, it is all too easy for young mothers with difficult babies to come
to regard themselves as failures in motherhood. So postnatal depression, but not the brief
 Evolution, depression and counselling 219

birth-linked maternity blues, can be seen as just another example of the inappropriate trig-
gering of a depression programme. This is consistent with the evidence (Evans et al., 2001)
that antenatal depression is as common as postnatal depression.

An evolutionary model for depression

Therefore an evolutionary approach yields a model of depression as:
A species-wide evolved suite of emotional programmes that are mostly activated by a perception, almost always
over-negative, of a major decline in personal usefulness, that can sometimes be linked to guilt, shame or
perceived rejection.
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This model seems to provide a potentially helpful explanation for the rising incidence of
depression in developed societies and for the present higher incidence of depression in
women. It allows us also to predict that, as the bread-winner (hunter) role of men is increas-
ingly undermined by the growing earning power of women, rates of male depression will
probably start to catch up. It also enables us to understand the above average rates of
depression associated with unemployment, redundancy – particularly where there has
been long term employment with a supportive institution, serious illness, and old age.
Some people consider that having an inherited behavioural tendency or ‘‘programme’’,
involving an emotional push in a certain direction, implies a deterministic outcome. In
fact such dispositions are very open to being inhibited or modified through experience,
training or free will. For example, although nature has almost certainly arranged for
sweet things to be preferred by most humans and probably to stimulate our appetites, we
are not all condemned to be obese because of the ready availability of sweet foods.
Furthermore, in the case of the above model of depression, the ‘‘programme’’ is activated
and probably de-activated, by how we perceive our world and the priorities that we put
on events or outcomes. This gives huge scope for interventions that help us to change
our perceptions or priorities.
How does this evolutionary model of depression sit with the conventional view of depres-
sion as a form of mental illness? The term ‘‘mental illness’’ implies that there is something
wrong physically with someone’s brain – something that can under certain circumstances
produce the psychological symptoms of depression. This disease view of depression leads
naturally to the concept of drugs to counterbalance the inner neurobiological disorder.
It also helps to maintain the stigma associated with clinical depression – sufferers are
seen as mentally ill. Whereas the evolutionary model described above is totally at odds
with this conception of depression. It would admit a role for anti-depressants, but only in
most cases as temporary ‘‘water-wings’’ to suppress the pain and other symptoms of depres-
sion until the individual has been enabled to regain his or her sense of usefulness. It allows
severe depression to be viewed as usually due to the inappropriate activation of an inherited
emotional condition. Hagen’s (2003) model points to the same conclusion. As he puts it:
‘‘the Western conceptualisation of depression as a mental illness is largely incorrect’’.
For some time psychiatrists and general practitioners have relied largely on drugs to treat
depression. However, a presentation at the 2004 annual meeting of the American
Psychiatric Association suggests that psychiatry may be starting to swing away from this
position (American Psychiatric Association, 2004). The presentation at this meeting by
Dr Michael Thase reviewed research that found a combination of anti-depressants and
psychotherapy to be the best treatment for severe depression. At the same session there
was reference to studies that show psychotherapy can produce similar changes in brain
functioning to medication. Furthermore, the US National Institute for Mental Health
 220 T. J. Carey

(2004), mentions that, for mild-to-moderate depression, combining drugs and psychother-
apy is no better than psychotherapy on its own, whilst here in Ireland one psychiatrist
(Corry, 2004) has recently suggested that depression should be seen as an emotion not
a disease.

Implications of the evolutionary model of depression

What then are the overall implications of the evolutionary model outlined above? A small
minority of cases of depression are caused by organic factors such as thyroid dysfunction.
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However, for most occurrences the model suggests:

. That depression should be regarded, not as a mental illness or disorder, but as a
situation of being trapped in an unwanted and inappropriately activated suite of natural
emotions,
. That these emotions are activated by a perception of a major decline in usefulness to
the people, organizations, communities, roles or endeavours that are or were import-
ant to us, with this perceived decline often linked to perceived failure, guilt, shame
or rejection. This is in line with Beck’s (1996) model of depression as arising from
over negative self-assessments,
. That there is an intrinsic ‘‘lock-in’’ property at the deeper end of this suite of emo-
tions, in that the symptoms of depression tend to make someone less useful. It also
becomes very hard for the affected individual to switch off depression by internal
thought alone, requiring counselling or external inputs from events or significant
people, communities or organizations to reverse the feeling of uselessness or
perceived rejection,
. That it is the psychological activation of this suite of emotions that causes changes in
brain biochemistry, such as altered levels of neurotransmitters – changes that are an
intrinsic part of these emotions and are not due to some biological illness,
. That therefore counselling/therapy should be the intervention of choice for depres-
sion, with drugs being considered as temporary ‘‘buoyancy aids’’ until clients can
‘‘swim’’ with confidence on their own, or as painkillers whilst psychological healing
takes place,
. That the differences between individuals in their susceptibility to depression are
mainly due to differences in their psychological make up, arising from the interplay
of nature and nurture on personal development, including prior experience of
depression that may facilitate the initiation of future depression,
. That individual susceptibility to depression can be greatly reduced through appro-
priate counselling/therapy,
. That counselling for depression should, in addition to following the so-called
‘‘Common Factors’’ (see Hubble et al., 1999), be focussed on enabling the client:
(1) To regain a feeling of usefulness, and:
(2) To be more resilient to future setbacks, with some or all of the following
dimensions contributing to these processes:
(a) Relationship. As always in counselling, a relationship that can facilitate
the client in talking about sensitive or difficult issues is so important.
In particular, the appreciation of the client’s positive qualities by their
therapist, as someone they have come to respect and trust, can be very
beneficial to a depressed client.
 Evolution, depression and counselling 221

(b) Purpose and meaning. Facilitating the client in improving their sense of
purpose in life and coming to terms with its realities – the existential
dimension of counselling that Irvin Yalom (1999) writes so well about,
e.g. Momma and the Meaning of Life.
(c) Spiritual dimension. Helping the client to regain or achieve a sense of the
positives in themselves that intuitively seem to transcend this world.
(d) Self-esteem. Enabling the client to both improve their external sources
of self-esteem and to achieve a degree of self-generated self-esteem –
David Burns (1993) book 10 Days to Great Self-Esteem can be useful for
some clients.
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(e) Connectedness. Empowering the client to enhance their social connected-

ness, lessen isolation and improve existing relationships.
(f) Cognitive insight. Allowing clients to achieve cognitive insight into their
depression and the common ways of negative thinking – of unrealistically
negative appraisals of events and how to combat these. This may include,
as John Teasdale (2002) points out, clients becoming able to see their
‘‘negative thoughts/feelings as mental events, rather than as self ’’.
Models ultimately stand or fall on their predictions. The evolutionary model of depression
presented here predicts that those receiving multi-dimensional counselling along the above
lines will recover more rapidly and be less likely to suffer a relapse than those receiving drugs
or a form of counselling that covers fewer dimensions.

Conclusions
In conclusion, we have seen how an evolutionary approach yields a model in which depres-
sion is seen as not normally a biochemical illness or disorder, but as usually due to becoming
trapped within a psychologically activated but unwanted and inappropriate suite of natural
emotions, with the activation coming from a perception of a major decline in personal
usefulness that can include failure, guilt, shame or perceived rejection. It is predicted that
clients receiving multi-dimensional counselling that is oriented around their perceived
usefulness will recover more rapidly and be less likely to suffer a relapse than those receiving
just drugs or a form of counselling/therapy that covers fewer dimensions.

Acknowledgement
Comments by Professor Randolph Nesse at the draft stage of this paper were most helpful
and are gratefully acknowledged.

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