An Evolutionary Neurotheology Approach to Depression:
What are the evolutionary psychology links between spirituality
and depression?
Marco Narajos
Background
Depression grips us, an epidemic. At an estimated 350 million people 1 with depression
worldwide, it is 10 times more common than the 35 million people 2 who are HIV positive. If
it were cancer, it would dominate Daily Mail headlines every day, and most worryingly, one
of its symptoms, suicide, is the largest cause of death 3 in men and women aged 20-34 years
old in the UK. One of the salient features of depression is that it appears across all ethnicities
and cultures4, albeit with varying presentations.
Spirituality shares this feature of striking ubiquity 5. In part due to its qualitative experience
and countless manifestations, spirituality is ill defined. The Spirituality and Psychiatry Special
Interest Group Executive Committee of the Royal College of Psychiatrists provides a working
definition 6.
“Spirituality is something everyone can experience that helps us to find
meaning and purpose in the things we value. It can bring hope and healing
in times of suffering and loss. It encourages us to seek the best relationship
with ourselves, others, and what lies beyond.”
While this comprehensive explanation is straightforward to understand, it is difficult to use in
rigorous scientific study, as several elements within this description require individual
definitions that do not vary from study to study. It is no wonder that many psychiatry trainees
feel that they do not have sufficient knowledge or training to discuss spirituality with their
patients, despite a broad acceptance of spirituality as clinically relevant 7.
1
(World Health Organization, 2012)
(World Health Organization, 2014)
3
(Office for National Statistics, 2013)
4
(Kleinman, 2004)
5
(Association of American Medical Colleges, 1999)
6
(Royal College of Psychiatrists, 2014)
7
(Kattan & Talwar, 2013)
2
1
Despite centuries of clashing, science and spirituality are not incompatible. It is worthy of note
that even the agnostic Albert Einstein, who was a part-time philosopher alongside his
theoretical physics career, experienced spirituality. Translated from the German, Einstein’s
philosophical work Mein Glaubensbekenntnis talks about his being religious 8, or probably
what we would today define as ‘spiritual but not religious’. For the remainder of this piece, I
will consider religion or religiousness as a type of spiritual practice.
“The most beautiful and deepest experience a man can have is the sense of
the mysterious. It is the underlying principle of religion as well as of all
serious endeavour in art and science. He who never had this experience
seems to me, if not dead, then at least blind. To sense that behind anything
that can be experienced there is a something that our minds cannot grasp,
whose beauty and sublimity reaches us only indirectly: this is religiousness.
In this sense, I am religious.”
A profound statement, and yet – spirituality is described as a mystery. I disagree that there is
satisfaction in the unknown. We must understand this phenomenon in all its manifestations
and from as many viewpoints as possible in order to understand its relationship with
humanity and, in clinical practice, its links with mental illness.
There are three core discussion topics of this essay in a drive to understand three fundamental
questions.
1. Why do depression and spirituality exist in our society?
2. How do depression and spirituality interact?
3. How can we use our understanding of the interactions between depression and
spirituality in order to reduce incidence of and to treat depression?
I will discuss the evidence in the literature that examines evolutionary theories of depression
and spirituality.
On the face of it, depression (and especially its lethal weapon, suicide) appears to shy away
from evolutionary congruence. Various theories abound discuss the rationale (or lack of)
behind the existence of depression. Likewise, various theories explain spirituality in the
context of evolutionary psychology. I believe that in examining the evolutionary foundations
of these two phenomena, we can approach depression in a novel way, through an
evolutionary neurotheology approach.
Neurotheology is the study of the neural correlates of spirituality 9. It encompasses how the
brain produces the spiritual experience (the qualia that Einstein and many others find so
difficult to define) as well as the behaviours or spiritual practices involved in spirituality. The
evolutionary neurotheology approach will combine the evolutionary psychology of both
8
9
(Einstein, 1932)
(Newberg, 2010)
2
spirituality and depression with our understanding of the neural correlates of spirituality to
produce a model of how spirituality and depression have interacted over time, and its
implications for further research, clinical practice, and the education of psychiatry trainees.
Depression – definition
Depression is a condition with several components. While it is primarily considered a mood
disorder and commonly understood by the public to be solely a feeling of sadness (an
unfortunate deficiency of the English language), it has physiological, cognitive, affective,
behavioural, and social elements that interact with one another. As there are many types of
major depressive illness, I will limit this discussion to a form that includes the cardinal signs10:
•
•
•
•
Anhedonia: loss of interest or pleasure
Depressed mood: rumination, negative cognitive bias, guilt, and low self-esteem
Psychomotor retardation 11: behavioural inactivity, and fatigue or loss of energy
Impaired social functioning: self-harm, withdrawn and decreased socialising
We may explain the above depressive symptoms through two main theories of depression:
adaptive and maladaptive.
Evolutionary Psychology
An adaptationist perspective states that depression is a functional adaptation 12. That is, our
brains have evolved to become depressed in response to certain stimuli (see Table 1), and
that our body is responding in evolved defence mechanisms. This hypothesis holds that most
depression is caused by changes in one’s circumstances, and that the body has adapted to
these by entering behaviours that would increase the likelihood of survival. This perspective
suggests that these mechanisms cause the social impairment, even if the body is
appropriately functioning.
Table 1: Adaptationist Explanations of Depression
Symptom
Anhedonia
Adaptive Function
Conservation of
energy 13
Rumination
Promotes analysis
of situations
Description
The individual mimics behaviours that are
produced during an infection; this sickness
behaviour ensures a focus on recovery.
The individual spends time thinking about one’s
complex problems or social situation to ensure
better decision-making.
10
(American Psychiatric Association, 2013)
Agitation is also a diagnostic criterion, but it is less well-characterised and may be more closely linked to
anxiety (Day, 1999).
12
(Durisko, et al., 2015)
13
(Anders, et al., 2013)
11
3
Negative cognitive
bias
Depressed mood
Avoiding risky
situations 14
Minimising social
loss 15
Psychomotor
retardation
Fatigue
Recovery from
sickness
Abandonment of
unrealistic goals
Signals social
defeat to others
Takes on the ‘sick
role’ 16
Withdrawn
Self-harm and
suicidality
The individual assesses situations as threats,
ensuring that risky behaviours are not conducted.
The individual is perceived to be of low social
burden, as they take less of the group resources,
increasing their social value.
The individual focuses energy and resources on
recovery, instead of physical activity.
The individual abandons goals that are unrealistic
(and therefore not beneficial to achieve).
The individual submits to dominant members of a
group, reducing risky behaviour.
The individual manipulates (either intentionally or
subconsciously) others to obtain group resources.
However, many disagree. The leading maladaptive theory of depression is the mismatch
account 17. This holds that the environment from when modern humans evolved during the
Pleistocene is sufficiently different to that of the modern world to cause depression. There
have been many changes since then: greater population densities, social class hierarchies
based on socioeconomic status and employment grades, and in some cultures, a trend
towards individualist (rather than collectivist) ideals. Thus, we respond to life stressors in a
maladaptive way.
Whilst in the past, the behaviours may have been adaptive (as shown in Figure 1), in the
modern day, the collective experience results in the impaired social function and negative
qualia that we know as depression. The mismatch account suggests that the body is
malfunctioning and over-activating these behavioural mechanisms in response to stressors
that the human brain and body has not seen before in its evolutionary history.
An alternative hypothesis is the breakdown account 18, which states that depression is the
failure of the mind and brain to regulate mood. However, given the prevalence of the
condition, and especially its sharp peak in late adolescence and early adulthood, it is perhaps
a lesser accepted theory in evolutionary psychology.
Given that early stressors in life 19 and even maternal stress prenatally 20 is correlated with a
dysregulated hypothalamic-pituitary-adrenal (HPA) axis, there is reason to believe that a form
of reprogramming occurs, perhaps at the epigenetic level 21. This is reason to believe that
depressive behaviours evolved (either in an adaptive or maladaptive sense) to deal with a
14
(Gilbert, 2000)
(Allen & Badcock, 2003)
16
Also known as the ‘bargaining hypothesis’ (Aubin, et al., 2013), this could also be explained through an
evolutionary theory of attachment (Bettmann, 2006), where one manifests symptoms to achieve proximity to
one’s attachment figure(s).
17
(Varga, 2012)
18
(Murphy, 2005)
19
(Maniam, et al., 2014)
20
(Glovera, et al., 2010)
21
(Schraut, et al., 2014)
15
4
dynamic and potentially stressful social environment, rather than occurring because of faulty
affective regulatory mechanisms.
Spirituality
It would be impossible to describe all the ways in which spirituality can mean to various
people, so I would like to categorise elements of spirituality into psychological, social, and
cultural dimensions.
Psychological
One aspect of spirituality is that it is a psychological experience. This experience is intrinsically
subjective and can involve a feeling of interconnectedness with those around them. Like
Einstein’s idea of spirituality, it may also reflect a sense of wonder or awe at the mysterious.
For others, a spiritual experience is an altered state of consciousness that may even involve
hallucinations. Any of these psychological experiences may endow one with a sense of
purpose or meaning to one’s life, especially during a stressful time.
Neuroscience
The first forays of the medical and neuroscientific community into this discussion has been in
the context of two ‘natural’ phenomena: temporal lobe epilepsy and entheogens. These
phenomena form an idea of a biological basis to the psychological experience of spirituality.
In patients with temporal epilepsy, the neurologist Norman Geschwind described a group of
symptoms, which became known as Geschwind Syndrome 22. One of these symptoms
included hyper-religiosity (intense feelings of spirituality), hyper-graphia (intense desire to
write), hyposexuality (decreased sexual desire), and an intensified mental life (greater
cognitive and affective responses). This intensified mental life also manifests in people who
take certain psychoactive drugs known as entheogens 23, like psilocybin.
Based from these two phenomena and other studies that discuss the precipitating factors for
spiritual experience, Michael Persinger hypothesised that religious and spiritual experiences
are products of the temporal lobe function 24. Of course, this was during a period of time when
psychologists still considered the brain and the mind to be modular. Persinger is famous and
infamous in the field of neurotheology as he applied weak magnetic fields transcranially to
healthy volunteers’ temporal lobes25, and reported that the subjects felt a presence. While
this provides credibility to the temporal lobe hypothesis of religious experience, a Swedish
22
(Geschwind, 1979)
(Godlaski, 2011)
24
(Persinger, 1983)
25
(Ruttan, et al., 1990)
23
5
group attempted to replicate Persinger’s experiment and failed to obtain the same results26,
leading many to question Persinger’s hypothesis.
The neuroscientific phenomenon of religiosity seemed to remain a mystery. In the last 10
years, however, a resurgence in this research has led to new hypotheses not based on
temporal lobe function. One group proposed neural correlates of religious belief based on
fMRI evidence 27 that pre-existing neural networks involved in the Theory of Mind regarding
intent and emotion, abstract semantics, and imagery are used in religious belief. Part of this
group’s hypothesis involved the idea that a Theory of Mind is necessary to understand a deity
as an independent identity with independent intentions and emotions; abstract semantics
and imagery28 are required to understand religious information such as doctrine, perhaps due
to the use of symbolism in religion. Not only does this hypothesis support an evolutionary
psychology perspective, it is also an interesting proposal given that there is evidence that a
faulty Theory of Mind reduces religious belief 29.
Evolutionary Psychology
We can look at the evolutionary psychology of psychological spirituality, in two main ways 30.
1. Spirituality is an evolutionary by-product 31 of existing neural circuits that we have
evolved separately.
2. Spirituality and its neural correlates were selected for; we evolved to become spiritual.
The three neural circuits (Theory of Mind, abstract semantics, and imagery) could fit in either
the ‘by-product’ or the ‘adaptation’ hypothesis.
There are some further points towards an adaptationist perspective. Psychological
experiences of spirituality may act as a strong motivating impulse to carry out certain spiritual
practices that may be beneficial to the group (see The Dual-Inheritance Theory below). This
may be a positive impulse, such as motivating someone to do good deeds for a reward (e.g.
heaven, jannah, samsara, and moksha), or preventing someone from doing bad deeds for
there will be punishment (e.g. hell, jahannam, and sheol).
Furthermore, the psychological experience of spirituality may also allow an individual to cope
with stressful events 32 (positive spiritual coping), although it is noteworthy to state here that
negative spiritual coping can also occur, when spiritual beliefs perpetuate negative patterns
of thinking.
26
(Granqvist, et al., 2005)
(Kapogiannis, et al., 2009)
28
(Kapogiannis, et al., 2014)
29
(Norenzayan, et al., 2012)
30
(Pyysiäinen & Hauser, 2010)
31
(Boyer, 2003)
32
(Young, et al., 2000)
27
6
Social
Spirituality also has a social dimension; it involves a systematic way of interacting with others.
This is perhaps best described in the realm of religion. We may define religion as a form of
spiritual practice. Therefore it is possible to be ‘spiritual but not religious’, estimated to be
applicable to 19% of the population in the UK 33, but not possible to be ‘religious but not
spiritual’. The social experience of spirituality includes public practices such as the attendance
of religious services or festivals and performing rituals (e.g. group prayer, funerals, and
marriages).
Within these behaviours and interactions, we especially find behaviours that may be
considered altruistic 34, especially reciprocal altruism, such as the sharing of monetary
resources in the Islamic mandatory alms-giving zakat, and the social support through stressful
periods in the Judaic period of mourning, shiva. Sociologist Émile Durkheim described religion
as intrinsically social 35 in his magnum opus, published shortly before his death, and that the
social or communal nature of religion is what distinguishes it from other forms of spirituality
such as secular forms of meditation, most commonly demonstrated in mindfulness and yoga.
Cultural
Culture collects these social aspects of spirituality and links them together through a
specialised form of communication: the medium of symbolism to represent complex or
unknown concepts. The symbolisms may take the form of art (literature, visual arts,
performing arts, etc.), traditions, festivals or celebrations, mythology and folklore, and even
language itself. Durkheim thought that religion was a social construct that employed
symbolism as a foundation; the only real concept that Durkheim found common to all
religions was the idea of a separation between objects and behaviours that are either sacred
or spiritual and those that are not (the profane). This separation leads to a sense of morality
(what is right and what is wrong), and consequently, a specific way of behaving. This specific
way of behaving forms doctrines and, in many cases, those who are in the moral authority
pass judgement on behaviours; ethologists may call this a dominance hierarchy, whereas we
are more familiar with this as the role of clergy and religious institutions.
The Dual-Inheritance Theory
The interactions between the psychological, social, and cultural aspects of spirituality are
complex, and as a result we have evolved many forms of spirituality and religion. Is it possible
that there are biological bases for the evolution of such complex behaviours? Do we have
33
(King, et al., 2013)
(Dawkins, 1989)
35
(Durkheim, 2008)
34
7
evolutionary explanations for why spirituality is the way it is today similar to evolutionary
theories for depression? The answer is yes and no.
The psychosocial aspects of spirituality could potentially have undergone a period of natural
selection. Genes, of course, determine the psychological aspects of our brain that allow us to
adapt to our environment and the people around us. This includes the development of a
linguistic ability and opposable thumbs (important in the use of tools).
More importantly, however, we also learn how to adapt to our environment. Genes could
also determine what we pay attention to in our environment, and what we filter out. We may
have genetically evolved innate biases, for example, towards not eating certain nonsalutogenic substances, like faecal matter and, indeed by extension, animals that eat faecal
matter – like pigs. Alternatively, we may have a genetic bias towards eating high-protein
foods. We may also have a bias towards learning from individuals higher up in the dominance
hierarchy, such as clerics or parental figures. Furthermore, we may also have evolved an
innate bias to conform to societal norms. Thus, identical twins born and raised separately –
one in a meat-eating, secular English household, the other in a Halal-abiding, Muslim home
in Saudi Arabia – will likely have differing taste preferences for bacon. Perhaps such an
experiment would provide much insight into evolutionary psychology – given that it is
ethically approved and grant-funded, of course!
Thus, sociocultural aspects of spirituality are determined more than genetic evolution;
cultural evolution also determines it. A cultural evolution would suggest changes in spirituality
over time that are independent of any genetic changes. However, there is a middle ground –
the social aspects of spirituality – which can be influenced by both genetic evolution and
cultural evolution.
Both of these forms of evolution could influence each other. Take for instance the possibility
that cooking was genetically and culturally evolved. A genetic adaptation to using tools may
have led to the discovery of fire. As a chemical concept, proto-human beings may not have
understood the properties of fire, but instead may have developed a culture, through cultural
evolution, of the worship of fire and the use of fire to cook food. Consequently, a group with
a genetic adaptation for using tools and a cultural understanding of fire would have the
advantage of being exposed to fewer bacterial infections. Among those selected groups, a
genetic adaptation for finding salty food delicious may be advantageous, given that salt is
important physiologically. In those groups with such a salt-loving predisposition, those that
develop a culture of curing meat with salt and those groups may be selected for, by natural
selection. This could then form groups that ‘worship’ or revere salt so much, that salt was
almost considered payment for work – perhaps, the first salary, as we know it 36. Such is the
importance of salt to our physiology and the exaltation of salt in cultural history, that in the
Christian Bible, Jesus described his followers as the ‘salt of the earth’. It is therefore almost
ironic that the same genetic and cultural evolutions for a salt-preference has become
associated with a pandemic hypertension.
Etymology of salary: Latin salārium, originally money allowed to Roman soldiers for the purchase of salt,
hence, their pay; subst. use of neuter singular of salārius pertaining to salt (Oxford University Press, 2014).
36
8
Of course, this is all hypothetical, but it is not implausible or too radical to understand, that
cultural evolution could influence genetic evolution, and vice versa. Indeed, evolutionary
biologists do criticise group selection theory, but it may be of merit as a selection mechanism
for cultural evolution.
The above can be summarised by the following statements that constitute the dualinheritance theory37.
1. Genetic evolution influences cultural learning, or the way in which we learn cultural
elements.
2. Cultural evolution occurs due to changes in the way we do things, such as due to new
information, independent of genetic changes. Cultural evolution has a fundamentally
different mechanism of transmission than genetic evolution.
3. Cultural evolution and genetic evolution can play a part in changing culture and
society. This is known as culture-gene coevolution.
Sociocultural Evolution
Through a combined dual-inheritance model of sociocultural evolution, we could consider
many of the positive contributions of religion towards human culture and survival, but
Durkheim says it best 38.
“Religious representations are collective representations which express
collective realities; the rites are a manner of acting which take rise in the
midst of assembled groups and which are destined to excite, maintain, or
recreate certain mental states in these groups.”
I assure you, it sounded better in the original French!
In other words, religion may well be all about social support and group cohesion. To expand
this list, we may look towards comparative biology and our shared characteristics with other
social beings 39.
“The following characteristics appear to be shared by humans and other
mammals, including and especially the apes, monkeys, dolphins, and
whales: attachment and bonding, cooperation and mutual aid, sympathy
and empathy, direct and indirect reciprocity, altruism and reciprocal
altruism, conflict resolution and peacemaking, deception and deception
37
(Henrich & McElreath, 2007)
(Durkheim, 2008)
39
(Shermer & McFarland, 2004)
38
9
detection, community concern and caring about what others think about
you, and awareness of and response to the social rules of the group.”
Many theorise that the great leap between other animals and human beings, the features
that have allowed us to take over the planet, are high intelligence and the capacity for
language. But perhaps it is actually the development of religion that has allowed us to develop
these attributes listed to such a high degree. This sentiment that it is the social brain that has
moulded the human brain into what it is now has been discussed in psychiatry for decades 40,
but it is a theory that has only really been developed in the last few years. New ideas41 suggest
that religious rituals that invest much resource, such as sacrifice, capital punishment, fasting,
and even circumcision serve to strengthen commitment to the group or community, and that
the existence of other groups with different beliefs actually reinforce group cohesion.
Depression and Spirituality
Epidemiology
One large meta-analysis of 147 primarily North American studies covering over 98,000
participants (of mainly Christian faith) found that there was a small but statistically significant
inverse correlation between religiousness and depressive symptoms, with this correlation
being greater at higher levels of stress. This led the investigators to hypothesise that
religiousness may buffer the effects of stress and thereby reduce depressive symptoms.
A systematic review 42 compared the results from this study in the context of others and found
that across 444 observational studies and clinical trials (1962-2010) across the globe, 61% of
studies showed a decrease in depressive symptoms with increased religiosity/spirituality,
whilst only 6% showed that religiosity/spirituality is linked with a worse outcome for
depression. The remaining show no association.
A more recent cross-sectional study in England categorised its 7,400 participants into three
groups (religious, spiritual but not religious, and neither spiritual nor religious) and found that
the spiritual but not religious group that most vulnerable to mental disorders43. Despite the
contrasting evidence, NICE guidelines still recommend mindfulness-cognitive therapy to
prevent relapse of a major depressive episode 44.
40
(McGuire & Essock-Vitale, 1981)
(Atran & Henrich, 2010)
42
(Bonelli, et al., 2012)
43
(King, et al., 2013)
44
(National Institute for Health and Clinical Excellence, 2009)
41
10
Evolutionary Neurotheology
The past sections on depression and spirituality have focused on individual evolutionary
theories for how they came about, separately (see Figure 1). I would like to propose two novel
approaches (Figures 2-3) to approaching depression, through evolutionary neurotheology.
Both of these approaches assume that a minimally-social brain is at least required to develop
either one or both spirituality and depression; however, I accept that it is plausible for
psychological elements of spirituality to drive a brain to become social over evolutionary time.
Traditional Model
The traditional model of spirituality and depression (Figure 1) states that spirituality and
depression both arose in human beings independently. Spirituality arose through a dualinheritance model; it may have begun as an evolutionary adaptation or a by-product of preexisting neural networks, but the sociocultural evolution of religion allowed behaviours to
become more complex.
Depression arose as a by-product of the neural networks that the social brain evolved.
Depression’s evolutionary origins may be considered as one of three main accounts:
(biopsychosocial) stressors cause a breakdown of adaptive mood regulatory mechanisms;
stressors elicit adaptive behaviours, which we consider psychopathological; or stressors elicit
behaviours that are maladaptive in modern humans.
Figure 1: Traditional Model of Spirituality and Depression
Social
Depression
Spirituality
The two novel approaches to depression are as follows.
11
1) Spirituality as a Coping Mechanism
This model (Figure 2) proposes that spirituality developed in human beings as an adaptive
evolutionary response to depression. In this model, depression arose as a by-product of the
neural networks that the social brain evolved, through three accounts (breakdown, adaptive,
or maladaptive/mismatch).
Spirituality then arose either through stochastic genetic changes or social behaviours that led
to greater social support and group cohesion, which was selected for due to the prevalence
of depression. A dual-inheritance model allowed the honing of the behavioural responses,
forming a rich culture that we now know today as religion. The same model also allowed the
honing of behavioural responses through genetic and psychosocial means, modifying
previously-existing social neural networks to elicit the psychological experience of spirituality.
Figure 2: Spirituality as a Coping Mechanism Model
Social Brain
Spirituality
Depression
For this model to be true, depression must cause such significant dysfunction that it would
lead to the selection (genetic or otherwise) of social coping behaviours, that which we
collectively call ‘spirituality’, to provide either protective or therapeutic effects against
depression. A perhaps extreme and unlikely example, but one that would increase the validity
of this model, is that spirituality prevents suicide 45, thereby increasing reproductive fitness.
Research into this model would lend insight into the related Terror Management Theory of
religion as a coping mechanism for death anxiety. Further research would include detailing
the psychological coping mechanisms that made spirituality an effective coping mechanism
to adapt and propagate throughout the human species. For example, is the main coping
mechanism of a psychological basis? If so, a possible research avenue would be to activate
the neural networks found in spirituality in depressed patients, through physical,
45
(Kalmár, 2013)
12
pharmacological 46, or psychosocial means (e.g. spirituality-informed therapies). If the main
coping mechanism were sociocultural, then this would lend to the growing body of evidence
that religion or a social spirituality may ease depression 47. Thus, there may be greater role for
religious institutions, even including ‘secular religions’ like the British Humanist Association,
in the treatment or prevention of major depression 48. Potentially those who identify as
‘spiritual but not religious’ may be an at-risk group for depression.
Ultimately, research into a clearer view of the protective and/or therapeutic effects of
spirituality in major depression would provide better inform clinical care, public health
schemes, and the education of healthcare providers.
2) Depression as a by-product of spirituality
This model (Figure 3) suggests that depression developed in humans following the
development of spirituality. Spirituality arose through a dual-inheritance model. Depression
may arise from three separate accounts.
1. Breakdown. Spirituality acts as a stressor, which directly contributes to or causes the
breakdown of adaptive mood regulatory mechanisms.
2. Adaptive. Spirituality acts as a stressor. To deal with this stressor, we evolved to adapt
behaviours that we consider psychopathological, and label as depression.
3. Mismatch. Spirituality acts as a stressor. To deal with this stressor, we adapted
behaviours that were adaptive in our ancestral environment, but are now maladaptive
in modern humans.
4.
Figure 3: Depression as a By-Product of Spirituality Model
Social Brain
Spirituality
Depression
46
(Baumeister, et al., 2014)
(Bennett & Shepherd, 2013)
48
(Kidwai, et al., 2014)
47
13
All three of these accounts assume that spirituality may act as a stressor that could lead to
depression. Thus, further research into this model would include forming a detailed
description of the potential predisposing, precipitating, and perpetuating factors that could
lead to depression through the various accounts (see Table 2). There is evidence that religious
beliefs increase the risk of major depression 49.
Table 2: A Formulation inclusive of religion/spirituality
Biological
Psychological
Predisposing
Vegan-only diet has caused
an iron-deficiency anaemia.
Conflict between sexual
orientation and religious
doctrine.
Social
Reduced circle of friends to
those of the same faith.
Cultural
Collectivist culture and
being low in the social
hierarchy.
Precipitating
Extended periods
of fasting.
Negative spiritual
coping.
Recent
immigration to a
country of a
different faith.
Religious war.
Perpetuating
Addiction to psychedelic
drugs.
Self-destructive coping
behaviour, like self-harm, due
to an ascetic tradition.
Chronic marital discord
between parents due to an
inability to divorce.
Sex-negative cultural values.
In the first account of this model (breakdown), a person who experiences any of the elements
of spirituality (psychological, social, and cultural) receives a certain ‘dose’ of stressors, leading
to the breakdown of adaptive brain functions. This would mean that depression is not
‘hardwired’ into our brains; it is not intrinsic to our genome. Cases of depression under this
account would be directly resulting from spirituality acting as a stressor. With further
research, this dose could be assessed into its components as part of a psychiatric formulation.
The second and third accounts are less plausible because depression is likely to have evolved
earlier than spirituality, as the regulation of mood has roles evolutionarily before cultural and
behavioural modernity of modern human beings. Furthermore, the most popular models of
mood suggest that mood is regulated at the level of evolutionarily older parts of the brain,
such as the limbic system 50; this is in comparison to many aspects of the spiritual experience
that require evolutionarily newer neural circuits, such as the Theory of Mind network.
49
50
(Leurent, et al., 2013)
(Bekoff, 2000)
14
Conclusion
There will be no one answer as to one perfect model out of the three models of an
evolutionary neurotheology approach to depression (as summarised in Figures 1-3). All three
of these probably bear some merit, each to different extents. The task now is to examine the
concepts and mechanistic pathways that conspire on the one hand to create a source of social
support, and on the other, a potentially deadly illness.
My focus in this piece may have been on depression, but there is no doubt that an
evolutionary neurotheology approach to other mental health conditions may lead to greater
insight into serious illnesses. An evolutionary theory of depression almost seemingly
romanticises an illness, but I wish to do no such thing. An evolutionary theory of depression
may mean that we cannot completely solve or ‘eradicate’ the depression pandemic; at least,
it would be difficult to tamper with the fabric of society itself. At the same time, curing
depression for good would make significant positive changes to society.
For a very scientific and rational man, Albert Einstein concluded his work Mein
Glaubensbekenntnis on a perhaps surprisingly spiritual or mystical note 51.
“To me it suffices to wonder at these secrets and to attempt humbly to
grasp with my mind a mere image of the lofty structure of all there is.”
Einstein may have been an influential brain in the 20th century, but he was still no doubt at
the hands of his biology, psychological, and sociocultural predispositions. The flaw in his belief
is that there is a dichotomy between science and the unknown – that the unknown mystery
could be ‘the most beautiful and deepest experience a man can have’. I beg to differ. There is
no dichotomy. Science is all about delving through the unknown and digging for answers to
age-old questions. Depression and spirituality raise many of those questions.
Throughout this essay, I have discussed various mechanisms by which depression and
spirituality exist in our society from evolutionary psychology viewpoints, the ways in which
they interact, and how we can use this knowledge to make an impact in education, research
focuses, public health schemes, and clinical practices. The real joy of psychiatry is that we can
take all of that wondering at the wondering of mysteries – and apply it to the real world.
51
(Einstein, 1932)
15
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© Marco Narajos 2015
This paper was awarded the Royal College of Psychiatrists’ Spirituality and Psychiatry
Special Interest Group prize for 2014.
Marco Narajos is currently a medical student at Oxford University.
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