满目疮痍的精神病学：春天还会远吗？-聚才发

摘要 / Abstract

疾病的病菌理论及相应的公共卫生方案（包括卫生、疫苗接种和抗生素治疗）使得全球预期寿命大幅提高。随着传染病发病率的下降，精神障碍一跃成为全球疾病负担的主要来源。然而，科学家们对精神障碍的病因知之甚少，许多目前流行的精神药理学治疗方法，如抗抑郁药和抗精神病药，在治疗症状方面仅有中等到微弱的疗效，也未能对具有各类精神病综合征的病人生理系统提出明晰且可信的见解。其实，自从人们开始精确记录以来，虽然精神障碍的治疗投入大幅增加，但大多数精神障碍的患病率并没有下降。因此，许多研究人员正尝试重新思考精神病学。

引言

在20世纪，生物医学的发展迅速降低了全球传染病的负担，大幅增加了人们的预期寿命（Murray et al, 2015）。进入21世纪后，慢性非传染性疾病一跃成为当前全球疾病负担的主要原因（Benziger, Roth, & Moran, 2016），而精神障碍在其中“功不可没”（Whiteford et al, 2013）。然而，大多数精神障碍的病因仍未可知，且精神障碍疾病的患病率也居高不下。

在此，本文将对当前精神障碍的主流研究进行全面的评判（critique）（图1）。首先，本文将回顾精神障碍对全球疾病负担的贡献。继而，探讨生物精神病学（包括精神药理学、成像和其他生物标志物研究）以及遗传和表观遗传方法之成败。最后，对不同精神病学分类的理论基础作评判。希望让生物人类学家（biological anthropologist）看清这一点：在心理健康研究中，存在着真实且被广泛承认的理论危机。

图1：每个点都代表《美国精神疾病诊断分类手册》（DSM-IV）中所列举的一种症状，并用其最常出现的DSM章节来标示，同一疾病中出现的症状彼此连接。

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Borsboom & Cramer（2013）

精神障碍与全球疾病负担

虽然病原体是推动人类进化最为重要的选择压力之一，但它们在疾病发生中的作用直到19世纪末才被发现，并使人类健康水平得到空前改善。在20世纪，疫苗接种、卫生项目以及有效抗生素的研发大大降低了高收入人群的传染病发病率和死亡率（Logan, 1950；Roser, 2018）。在美国，1900年约有半数的死亡由传染病导致，但到世纪末就几乎不再有人死于传染病。尽管高收入国家更受惠于生物医学的进步，但自20世纪40年代以来，所有国家的平均预期寿命都有所增加（Roser, 2018）。在1893年对路易斯•巴斯德（Lois Pasteur）的公开演讲中，同为微生物学家的约瑟夫•李斯特（Joseph Lister）说道：“几个世纪以来，传染病仿佛一直笼罩在黑暗的幕布之下。在发现疾病的微生物起源过程中，您掀起了那道黑幕”（Schwartz, 2001）。

图2：美国所有原因、非感染性原因和感染性疾病原因的粗略死亡率。

—

Armstrong，Conn，and Pinner (1999)

相比之下，公共心理健康却只有极为有限的改善，精神障碍仍笼罩在黑色幕布之下。1990年至2010年间，世界范围内的精神、神经和药物滥用障碍（迄今为止的所有精神疾病）的流行率总体保持稳定。疾病负担以DALYs*（伤残调整生命年）来衡量（Whiteford et al, 2013）。目前，精神障碍位列全球DALYs排行榜的第五席（7.4%），仅次于心血管和循环系统疾病（11.9%）、常见传染病（11.4%）、新生儿疾病（8.1%）和癌症（7.6%）（Whiteford et al, 2013；图3）。在可归因于精神障碍和药物滥用障碍的7.4%的DALYs中，抑郁症（40.5%）高居榜首，紧随其后的则是焦虑症（14.6%）、药物使用障碍（10.9%）、酒精使用障碍（9.6%）、精神分裂症（7.4%）、双相情感障碍（7.0%）、广泛性发育障碍（4.2%）、儿童行为障碍（3.4%）和饮食障碍（1.2%）（Whiteford et al，2013）。抑郁症和焦虑症的大部分疾病负担受累在年轻人和中年人身上（图4）。

*译者注

伤残调整生命年（Disability Adjusted of Life Years）：是衡量整体疾病负担的一种方法。最初是由世界卫生组织所开发，现在则渐渐地在公共卫生和健康影响评估等方面变得普遍。失能调整生命年“扩展了因过早死亡而损失的潜在寿命这一概念，将因为健康状况不佳或失能而损失的‘健康’年岁也包括进去。”这么做，即可以将死亡率和发病率合并成单一的、共同的度量。

图3：2017年，在社会经济指数低、中、高的国家，四类疾病造成的疾病负担比例中自我伤害已从伤害组重新归类到心理健康组。（数据来自全球疾病负担GBD； http://www.healthdata.org，2019年4月4日获取）。社会人口指数（SDI）：确定国家或其他地理区域在发展谱系中的位置的概括性度量。SDI以0-1范围表示，是GBD研究中所有地区的人均收入、平均教育程度和生育率排名的综合平均值。

图4：2010年，按年龄划分每种精神和药物使用障碍的残疾调整生命年（DALYs）

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Whiteford等（2013年）

一项近期研究将精神障碍的定义扩大至自杀、自残和痴呆症（dementias），并进行了其他相应的调整，结果显示精神障碍实际上应占DALYs的13%，与排名第一的心血管和循环系统疾病相当（Vigo, Thornicroft, & Atun, 2016）。在一项相关的研究中，Ferrari等人（2014）估计三分之二的自杀DALYs可归因于精神障碍，尤其是抑郁症。如是观之，自杀的人数将比所有战争和凶杀案的逝者总和还要多得多（Lozano et al, 2013）。

DALYs结合了死亡率和残疾负担（disability burden）。精神障碍对疾病负担的影响主要在于其对残疾负担的影响，而非死亡率。残疾负担是以YLDs（残疾生活年数，years lived with disability）来衡量的。精神障碍是导致各种残疾的主因，占全球YLDs的22.9%，紧随其后的是肌肉骨骼疾病（占YLDs的21.3%），而诸如癌症和心血管疾病等其他非传染性疾病，仅排在第三（占YLDs的11.1%）（Whiteford et al, 2013）。Vigo等（2016）的重新分析认为精神疾病的残疾负担甚至更高，占YLDs的32.4%。

大多数研究发现，情绪障碍和焦虑障碍的发病率并不因时间推移而有所变化（Bretschneider et al, 2018; Patten et al, 2016）。举例而言，从1990年到2010年，重度抑郁症（major depressive disorder, MDD）的全球患病率维持在4.4%左右，焦虑症则为4%（Baxter et al, 2014）。几乎没有证据表明治疗率的提高可以降低自杀率（Nock et al, 2008），且跨国自杀率*并无明显下降，不同国家和地区的自杀率差异也很大（Lee, Roser, & Ortiz-Ospina, 2018）。同时，在一些西方人群中，神经发育障碍，如注意力缺陷多动障碍（ADHD）和自闭症谱系障碍（ASD）的诊断和治疗有所增加，可能反映了诊断趋势的转变和公众意识的增强（Myers et al, 2018；Olfson, Gameroff, Marcus, & Jensen, 2003; Russell, Collishaw, Golding, Kelly, & Ford, 2015; Visser et al, 2014; Xu, Strathearn, Liu, Yang, & Bao, 2018）。

*译者注

跨国自杀率（cross-national suicide rate）：即自杀率的跨国趋势。

– Hao Hao –

对生物精神病学的评判

大脑是人体中最复杂的生物学器官，生物学拥趸们认为，精神障碍也理应被视为和其他疾病一样的生理疾病，并援引大量证据来支持这一观点，如精神药物的有效性以及精神障碍与激素、影像、基因和表观遗传等生物标志物的关联（例如，Kirsch, 2015）。毋庸置疑，心理健康现象确有其生物学基础，多数（但并非全部）都应被归为生物功能障碍。生物精神病学（biological psychiatry）作为一个研究精神障碍的神经生理和遗传基础的领域，主要目标是开发用于诊断的测试方法及有效的治疗手段。然而，受限于当前技术，目前仅能评估大脑部分组织层次的物理变化。所以到目前为止，还未能有用于诊断的测试方法，各类治疗疗效也差强人意。

精神药物疗效有限

21世纪初，许多善意的社会运动希望通过强调抑郁症、精神分裂症和其他心理疾病“与其他疾病一样”来减少精神疾病的污名化（Pescosolido et al, 2010），而制药企业则热切地以“化学失衡”（chemical imbalance）这一精神疾病的解释模型，来作为推广的关键策略。然而，这些运动最终都失败了，原因如下：首先，一篇系统回顾发现，对精神障碍的生物遗传原因的认可非但不能减少精神疾病的污名，反而可能加重心理健康专业人士和精神病患者本身的污名化态度（Larkings & Brown, 2018）；其次，几乎没有证据表明精神药物可以纠正特定的化学失衡或神经生物学缺陷。

举例而言，抑郁症的“化学失衡”理论来自对第一代抗抑郁药化学作用的推断，也被称为儿茶酚胺、单胺或5-羟色胺的神经递质缺乏假说。这些药物被偶然发现，能够作用于单胺（monoamine）途径而增加单胺浓度（López-Muñoz & Alamo, 2009）。但现在我们知道，抑郁症的“化学失衡”假说是错误的：

首先，增加单胺浓度的药物也能减少抑郁症状（O’Donnell, 2011），这是对抑郁症的单胺类物质缺乏说的有力反驳，就像阿司匹林可以缓解头痛症状，但头痛并非由阿司匹林的缺乏引起的；

其次，抗抑郁药物几乎立即（几分钟内）增加单胺浓度，但其抗抑郁效果却在几周后才出现（Frazer & Benmansour, 2002; Harmer, Goodwin, & Cowen, 2009）；

第三，诸如可卡因之类的其他药物，也会增加单胺类物质浓度（Kalsner & Nickerson, 1969；Kuhar, Ritz, & Boja, 1991），但其却不是有效的抗抑郁药；

第四，一些抗抑郁药物，如噻奈普汀，反而会减少单胺浓度（Baune & Renger, 2014；McEwen et al, 2010）；

第五，单胺类物质的耗损不会诱发非抑郁症患者的抑郁症（Ruhé, Mason, & Schene, 2007）。

总之，尽管单胺类物质可能在抑郁症中发挥一些作用，但没有证据表明抑郁症是由5-羟色胺、去甲肾上腺素或任何其他神经递质或生化物质简单的不平衡引起的（Kendler, 2008; Lacasse & Leo, 2015, 以及其中的参考文献）。

– Thomas Rouzière –

尽管缺乏证据，“化学失衡”模式却被制药业通过直接面向消费者的广告成功传播（Lacasse & Leo, 2005, 2015），渗透到美国大众意识中，催生了寻求帮助和诊断的文化（Angell, 2009; France, Lysaker, & Robinson, 2007）。长此以往，加之具有较少不良副作用的抗抑郁药（如选择性5-羟色胺再摄取抑制剂）的发展，使得许多国家的抗抑郁药处方量激增数倍。例如，在澳大利亚，抑郁药的使用从1990年到2002年增加了352%，从2000年到2011年又增加了95%。在加拿大、英国和美国，抗抑郁药和其他治疗方法也出现了类似的增长。心理治疗虽然也有大幅增加，然而在这些国家中都没有观察到情绪、焦虑或药物滥用障碍的发病率的下降（Jorm, Patten, Brugha, & Mojtabai, 2017）。

至少这二十年来，人们已认识到常用抗抑药的有限疗效（如Kirsch & Sapirstein, 1998）。Kirsch（2008）和Turner、Matthews、Linardatos、Tell和Rosenthal（2008）分析了从美国食品和药物管理局获得的已发表和未发表的抗抑郁药试验报告，发现已发表的数据中存在着有利于积极治疗效果的强烈偏见。在对未报告的研究进行调整后，他们发现作用范围Cohen’s d=0.31至0.32，表明治疗相对于安慰剂的优势不大。这相当于汉密尔顿抑郁量表（HAM-D，其范围从0到52）中的2分不到，而HAM-D的3分差异才能达到抑郁症治疗的临床意义标准（Kirsch, 2015；国家临床优化研究所，2004）。近期一项对已发表和未发表的抗抑郁药试验进行的荟萃分析发现，抗抑郁药的效果与安慰剂相比相差无几（Cipriani et al, 2018；关于活性安慰剂的讨论，也见Kirsch, 2015）。

精神药物可导致多种副作用，因此也需要进行严格的风险—效益分析。例如，抗抑郁药会引起失眠、性功能障碍（如性欲下降、勃起功能障碍）和体重变化等。研究者们发现（Cartwright、Gibson、Read、Cowan & Dehar et al, 2016），在180名长期抗抑郁药使用者的样本中，73.5%报告了戒断症状，43%报告了对药物的成瘾感。近期一项效果甚佳的新证据表明，NMDA受体拮抗剂氯胺酮可以快速有效地改善抑郁症症状，但遗憾的是，疗效的改善稍纵即逝，且氯胺酮还是一种滥用药物（McGirr et al, 2015；Duman, 2018）。服用抗精神病药物的相关风险包括：运动障碍，如帕金森症，甚至不可逆的脑损伤，如迟发性运动障碍（重复的、不自主的、无目的的运动，Bagnall et al, 2003；Muench & Hamer, 2010），脑组织体积损失（Dorph-Petersen et al。2005；Ho, Andreasen, Ziebell, Pierson, & Magnotta, 2011; Moncrieff & Leo, 2010; Vita, De Peri, Deste, Barlati, & Sacchetti, 2015），代谢综合征（如腹部肥胖、高血压、高血糖）（de Hert, Schreurs, Vancampfort, & Winkel, 2009），以及心脏猝死（Ray, Chung, Murray, Hall, & Stein, 2009）等。抗精神病药物的短期副作用太过煮鹤焚琴，会导致主观感受上智力和创造力的下降（Moncrieff, Cohen, & Mason, 2009），且服用此类药物的患者有近半数不服从医嘱（Lacro, Dunn, Dolder, Leckband, & Jeste, 2002），当然，他们也得为此埋单（Haad, Brain, & Scott, 2014）。最后，症状的改善并不一定等同于生物功能障碍的纠正。

伦理缺失：逾越科学的营销

一些研究者预估，2013年有16.7%的美国成年人至少拿到过一次精神病药物的处方（Moore & Mattison, 2017）。抗抑郁药位居榜首，占12%（另见Pratt，Brody & Gu, 2017），其次是抗焦虑/镇静/安眠类药物（8.3%）及抗精神病药物（1.6%）。这些药物带来的巨额利润（Lindsley, 2012），对心理健康的研究和治疗产生了非常恶劣的影响（Angell, 2005）。正如《新英格兰医学杂志》前主编Marcia Angell所言：

现在，许多已发表的临床研究根本不能相信，以往那些值得信赖的医生的判断或权威的医疗指南，也不再让人信服。20多年的编辑经历，使我不情愿地得出这一结论，而我为此感到难过……（Angell, 2009）。

医生等医疗专业人士经常会负责临床药物试验或招募病人参加，或者在公司资助的讲座上为产品背书，以得到数万美元的报酬，其中许多人都隶属于著名的研究型大学，这些行为存在着严重的利益冲突（Angell, 2009; Callaway, 2010）。Perlis等（2005）仔细查阅了2001年到2003年间发表在精神病学高质量期刊上的397项精神药物临床试验后，发现47%的文章报告了至少一名作者的经济利益冲突，这与接受业界支持的研究倾向于报道正向的药物结果有关（另见Lexchin, Bero, Djulbegovic, & Clark, 2003; Lundh, Lexchin, Mintzes, Schroll, & Bero, 2017）。此外，一些来自顶级大学并接受NIH资助的精神病学家也违反了联邦规定，没有上报药物公司的财务支持（Harris, 2008; Kaise, 2009）。

另一方面，药物公司会采取不道德的营销行为，如用钱收买医生，使其在讲座中宣传标示外使用，或是让其在公司雇佣的影子写手（ghostwriter）所写文章中挂名，以及其他不道德的活动（Petersen, 2002, 2003；关于影子写手和制药业的进一步讨论，见Angell, 2009; Sismondo, 2007; Fugh-Berman, 2010）。在1991年至2015年间，有373项和解协议涉及制药企业、美国联邦政府和州政府，行业总罚款高达357亿美元（Almashat, Wolfe, & Carome, 2016）。

总而言之，大多数精神药物的疗效都不是很好，并且有着大量的副作用，却被那些有倾向性的科学出版和广告活动过分夸大。至于它们真正起效的部分，无论是针对哪种精神障碍，其病因学研究提供的证据尚没有足够的说服力。

– Björn Öberg –

精神障碍的成像及其他生物标志物

目前还没有用于诊断精神障碍的生物检测。在上世纪七八十年代，地塞米松抑制试验曾被视作抑郁症的生物标志物，可预测药物反应，但随后的大样本研究发现，其特异性和敏感性为低至中等，临床效用也很有限（Kapur, Phillips, & Insel, 2012）。神经影像学测量也有潜力可挖。功能性MRI和PET可以分辨小至1mm³体素的血流（神经活动的指标），大量研究显示患者和对照组的神经活动存在统计学差异。不过，这些差异还不够敏感可靠，并不能作为诊断工具（Abi-Dargham & Horga, 2016），毕竟1mm³脑组织包含了6-7万个神经元和数千万至数亿个突触连接的复杂网络（Azevedo et al, 2009），而当前的技术条件难以检测如此微小的网络结构。

基因、环境与表观遗传学：精神障碍的表型遗传力

焦虑症、重度抑郁症和创伤后应激障碍（PTSD）的遗传力*（heritability）很低（例如，重度抑郁症的遗传力约为0.38），表明困境、不幸这类环境因素，在其中起着非常重要的作用（Kendler & Baker, 2007；Kendler & Gardner, 2016；Kendler, Gatz, Gardner, & Pedersen, 2006）。不过，仍有许多精神疾病有着很高的遗传力，这表明在一定程度上，它们由神经受体、神经肽、神经递质运输载体和其他参与神经功能的蛋白质等发生的遗传变异，和相关调节序列的变异所引起。人类基因组包含的全部基因中，约有一半在大脑中表达（Naumova, Lee, Rychkov, Vlasova, & Grigorenko, 2013），其中许多基因都有变体，目前普遍认为其中一些变体：（a）在精神疾病中发挥重要作用，（b）作用于行为，进而影响健康（Keller, 2018）。精神分裂症的遗传力约为0.8，与身高的遗传力差不多（Cannon, Kaprio, Lönnqvist, Huttunen, & Koskenvuo, 1998; Hilker et al, 2018; Sullivan, Kendler, & Neale, 2003）。孤独症谱系（Colvert et al, 2015; Tick, Bolton, Happé, Rutter & Rijsdijk, 2016）、双相情感障碍（Wray和Gottesman, 2012）和强迫症（Taylor, 2011）也具有高度遗传性，这意味着相比环境因素，遗传因素更能解释疾病风险的变化（Sullivan, Daly & O’donovan, 2012）。许多精神障碍对健康有害却能遗传，听起来是一个进化悖论，毕竟有害的等位基因理应被净化选择（purifying selection）淘汰（Keller, 2018; Keller和Miller, 2006），这一问题我们之后会进一步讨论。

*译者注

遗传力，又称遗传度，是育种学和遗传学使用的一种统计量，用来估计某一性状在群体中有多大比例的变异是遗传因素决定的，测得变异也因环境因素效应变化（含测量误差）。根据是否是受到成长家庭影响，人类的环境因素常分为“共享环境因素”和“非共享环境因素”。

在早期的精神疾病遗传学研究中，大多数都集中于“候选”基因的功能影响，而如何选择这些基因通常是基于对基因功能已有的了解（Johnson et al, 2017）。Caspi等人（2003）发现5-羟色胺转运体相关区多态性（5-HTTLPR）的短等位基因，能调节压力性生活事件和抑郁症之间的联系，该基因出现频率为0.08至0.44，并与种群相关（Haberstick et al, 2015）。当时普遍认为这个方向很可能取得突破性进展，这篇有影响力的论文开启了一系列关于人类和其他动物（包括非人灵长类动物）5-HTTLPR的后续研究（如Shattuck et al, 2014）。可惜的是，最近一项研究对包括38802名欧洲血统被试的31个数据集进行综合荟萃分析后发现，其结论并不支持基因环境相互作用的假说，研究者在论文中总结，“……如果说，5-HTTLPR短等位基因只在有压力的个体中增加抑郁症的风险，那这种相互作用就不能大范围应用，其效应值必须仅为中度，并且只能在有限的情况下被观察到”（Culverhouse et al, 2018）。另一项研究对多个重度抑郁症的大样本数据进行了分析，结果显示多个候选基因，或候选基因与环境相互作用的假说，与疾病均无确切关联（Border et al, 2019）。由于候选基因研究的可重复性很差，精神病遗传学研究正在转向其他遗传学方法（Keller, 2018）。

– Tianhua Mao –

目前人们借助基因定位研究（gene-mapping studies），如全基因组关联研究（GWAS）和全基因组测序研究，来检测DNA序列变异和表型结果之间的关联（Timpson, Greenwood, Soranzo, Lawson, & Richards, 2018）。随着GWAS检测大量样本的成本降低，这些技术在很大程度上取代了候选基因研究。GWAS研究发现任一单核苷酸多态性（SNP）对精神疾病的影响都很小，此外，GWAS也解释了为何候选基因研究没有在精神障碍病因研究中取得突破（Keller, 2018; McCarroll, Feng, & Hyman, 2014）。因为在有抑郁症和精神分裂症风险的基因变异中，单一SNP比例还不到0.05%（如Culverhouse, 2018; Keller, 2018）。

然而，基因定位研究表明了，在精神障碍中存在很多的突变靶点，这些靶点可能会解决精神疾病具有高遗传力的悖论。例如，尽管每个单独的等位基因突变只有很小的影响，但是据估计，分布在全基因组中的8300个常见遗传突变占精神分裂症遗传风险的50%（阿尔茨海默病是个例外，少数几个影响大的位点导致了大多数变异）。在许多疾病的遗传力中，常见的SNPs占三分之一到二分之一。但与罕见的SNPs相比，人们对常见的SNPs了解更多，因为前者需要更大的样本量来检测显著性。目前认为常见突变与罕见突变（包括新的SNPs和拷贝数变异）的某些组合，可以导致精神障碍，但作用机制尚不清楚（Gratten, Wray, Keller, & Visscher, 2014）。有一些研究证明，多个独特的罕见结构突变带来了精神分裂症的风险（国际精神分裂症联盟和其他, 2008; Walsh et al, 2008）。一种可能性是罕见的结构突变能够破坏其他基因，进而诱发疾病（Walsh et al, 2008）。另外，轻微有害的等位基因也可能随时间推移而累积，在偶然超过某个阈值后，出现易罹患行为或认知功能障碍的表型（Gratten et al, 2014; “复杂疾病的全基因模型”见Boyle, Li, & Pritchard, 2017）。

此外，还有其他一些复杂情况，包括精神障碍的遗传学既证明了异参同效（equifinality），即不同的基因突变可导致同一种精神障碍（Keller, 2018），也证明了多元定局（multifinality），即单个基因突变或同一种基因突变是多种精神障碍的共同风险因素（国际精神分裂症联盟和其他, 2009）。一些特定疾病（包括精神分裂症、双相情感障碍和抑郁症；Lee et al, 2013）具有共同的遗传突变，也许能由基因多效性、表观遗传因素、特定环境因素暴露的变化、表观分型方法有效性的缺陷或以上因素的某种组合来解释。

因此，“突变—选择—漂移”是一个很好的零模型（null model），可以用它来测试遗传突变的其他假设，例如平衡选择（Keller, 2018）。此外，如果多基因性状是正态分布的，目前精神障碍的建构就会捕捉到“正常”行为的极端变化，从而支持精神病理学是多维的，而非二元论的观点（Plomin, DeFries, Knopik, & Neiderhiser, 2016）。总而言之，即使基因测序技术已有很大进展，我们对影响行为、心理和其他表型结局的遗传结构依然所知甚少（Gratten et al, 2014）。此外，正如几位研究者（Sullivan, Allen et al, 2007）所提醒的，尽管精神分裂症和其他精神障碍在不同人群中有相似的症状，目前我们对这些症状的理解，仍是严重偏向于西方、受教育、工业化、富裕和民主（Western, Educated, Industrialized, Rich, and Democratic, WEIRD）的人群（Henrich, Heine, & Norenzayan, 2010）。

环境因素亦可遗传

精神障碍是基因与环境相互作用的结果。它和其他心理特质（包括人格）的变化可分为两大类：源自遗传突变和源自环境变异（Plomin et al, 2016）。例如，在有抑郁经历的人中，约38%归于遗传突变，62%归属环境变异，如经历离婚或其他逆境。然而，事实证明，许多被当作环境变异的因素（如离婚），也像基因突变一样可以遗传（Plomin, 2018; Plomin & Bergeman, 1991; Plomin, Lichtenstein, Pedersen, McClearn, & Nesselroade, 1990），这些可遗传的环境包括家庭、邻居、工作和学校环境（Plomin et al，2016）。在对调查“环境量”遗传力的研究进行系统性回顾后，Kendler和Baker（2007）估算了所有已明确的环境量（共35项，包括具体的生活事件、家庭环境和婚姻质量等）的加权遗传力为27%。离婚是抑郁症的一个风险因素，而离婚的风险可以遗传，所以抑郁症的遗传力包括了环境因素的遗传力，离婚便是其中之一。抑郁症的一部分遗传力可能也属于人格风险因素，如神经质（Fanous, Neale, Aggen, & Kendler, 2007）。

众多研究表明，即使是成长于相同的家庭环境中的兄弟姐妹，他们的心理特征并不会受到同等的环境影响。也就是说，对成年期结局（adult outcomes）产生影响的环境因素，很可能是高度随机且特异性的事件，很难通过方法论来捕捉（Turkheimer, 2000）。正如Plomin等（2016）观察到的，心理特征是通过许多影响微小的基因共同遗传的，“非共享环境”则是无数经验的集合体，其中大多数可能也只有极微小的影响。

– Hao Hao –

生物精神病学

生物精神病学带来了有关精神障碍的知识爆炸，涵括激素、神经解剖学、遗传和表观遗传因素等多个方面，这些来之不易的成果却未能转化成更好的诊断和治疗手段。事实上，它对目前主流的精神障碍概念和分类方法提出了疑问。家庭和双胞胎研究表明，遗传因素对精神障碍的作用并未映射到主流的诊断分类。借用Smoller等人（2019, p. 4）的话来说，“我们的基因好像没读过DSM”。

尽管神经科学家们已经解开了许多关于解剖学、神经化学组织和神经系统回路的谜团，在最新版的重要教科书《精神疾病的神经生物学》（Neurobiology of Mental Illness）中，几位编辑闷闷不乐地承认：

……无论是对大多数主要精神病综合征的病理生理学的了解、或基于其基础生物学机制的诊断方法，还是精神疾病的治疗和预防手段，那些关于大脑的海量知识都没有带来根本性的进展（Charney, Buxbaum, Sklar, & Nestler, 2013, p. ix）。

主流精神病学研究范式理论的基础

来自医学、精神病学和相关领域的众多学者们，都在批判精神病学研究在改善公共健康方面的失败，并呼吁人们对此多加关注。许多人认为，这一失败很大程度上源自基于DSM的精神疾病分类的根本缺陷，且精神病分类（psychiatric nosology）正在经历一场信任危机（评论见Zachar & Kendler, 2017）。

DSM对研究和政策的束缚

DSM旨在改善研究，但如今医疗和法律体系对它的限制十分根深蒂固，虽然权威性得以增强，却也因此很难基于科学理由做出实质性的改变。为了保证基本的治疗，科学上存疑的诊断类别也被保留下来（见4.2）。DSM不仅影响了美国国内的精神疾病诊断与治疗，也为国际疾病分类（International Classification of Diseases，ICD-11）提供了参考（见Tio, Epskamp, Noordhof, & Borsboom, 2016）。DSM-IV工作组主席、精神病学家艾伦-弗朗西斯（Allen Frances）认为：

“……（DSM的）现实影响或许太大了：它决定了什么人会接收到什么治疗，以及能不能报销治疗费用；谁有资格获得残疾福利、退伍军人福利、学校和心理健康服务；谁有资格获得人身保险、收养孩子、驾驶飞机或购WS@#@买枪支（Frances, 2013a）。”

现在很多人认为，DSM在阻碍研究。原因包括DSM/ICD所定义的障碍之间的过度共病性、机制的异质性和障碍的物化。那些遗传学、系统神经科学和行为科学中的新发现，DSM/ICD的分类不能与之很好地匹配，使得人们开始怀疑这些所谓的疾病类别是否真正正确、有效。因此，很难将基础的动物模型或人类研究转化为对病理的系统性理解或针对机制的治疗（Cuthbert & Insel, 2013, and references therein）。

生物医学的诊断依赖于可识别的功能障碍，但精神病学目前的诊断基础却是症状的数量和类型。在科学革命的黎明阶段，学者们旨在找到“自然”的分类并发现其根本原因，例如植物、动物和无机物的分类。皮内尔（Pinel）、克雷佩林（Kraepelin）、布莱勒（Bleuler）和许多其他人开发了精神疾病的各个分类系统。这些理论家们所创造的体系就是DSM的前身，并且他们认为只要成功地找到了精神疾病的自然分类，就能理解它们的成因。这种策略的确在许多其他自然现象中都取得了成功，例如从元素周期表中拾取理解物质本质的灵感，以及植物和动物分类法对达尔文的进化理论的影响。然而，Kraepelin在其职业生涯接近尾声时承认，他的许多分类法中可能并不蕴含这种“自然”的疾病类别（Zachar & Kendler, 2017）。

到20世纪50年代时，美国早期的精神疾病诊断体系已经部分被精神分析所取代，它在对精神疾病的分类时，所采用的是基于因果的精神分析理论。这一理论纳入了对强烈情绪的压抑（repression），尤其是在婴儿期经历的情绪。DSM-I和II（美国精神病学协会, 1952a, 1952b）的创建者们采用了这种基于原因推论的方法（Shorter, 2015），只划定了两个宽泛的诊断类别：第一类涉及有器质性病因的严重精神障碍，第二类则包含不太严重的情况，例如“精神神经症”（psychoneurosis），一种被认为由社会和环境压力引起的状况（Kawa & Giordano, 2012）。在20世纪70年代，当政府机构和私人保险公司等第三方开始支付治疗费用时，这一体系下明确诊断界限的缺乏和诊断的低可靠性越来越多地被用来批判精神病学（Eaton, South, Krueger, Millon, & Simonsen, 2010）。

– Hao Hao –

1980年出版的DSM-III预示了一种范式转换*（paradigm shift），并奠定了现代诊断的基础。其中基于症状的诊断策略在Kraepelin和其他18、19世纪理论家的分类系统中有明确的先例（例如，Compton & Guze, 1995）。该策略取代了DSM-I和II中基于因果的精神分析方法，因为后者缺乏实际证明（Mayes & Horwitz, 2005；Cooper & Blashfield, 2016）。这一策略提高了诊断的可靠性，安抚了第三方支付者，并提高了精神病学的声誉。

*译者注

范式转换用来描述在科学范畴里，一种在基本理论上从根本假设的改变。这种改变，后来亦被应用于各种其他学科方面的巨大转变。库恩在书中阐释，每一项科学研究的重大突破，几乎都是先打破道统，打破旧思惟，而后才成功的。

普遍认为，提高可靠性是提高有效性的重要一步（Skodol & Spitzer, 1982；也见Horwitz & Wakefield, 2007）。然而，到目前为止，尚没有迹象表明DSM改善了精神疾病诊断的有效性。DSM-III工作的领导者Robert Spitzer和DSM-IV的编辑Michael First都承认：

尽管精神病学研究取得了相当大的进展，但令人失望的是，在理解精神障碍的病理生理过程和原因方面，我们几乎没有进展。如果硬要说有的话，研究表明情况比最初想象的还要复杂，而且我们认为，要理清如何根据病因学分类精神障碍，我们了解的还不够多（Spitzer & First, 2005）。

有些人甚至认为，诊断可靠性的提升是通过牺牲诊断有效性达成的（Horwitz & Wakefield, 2007； Kendell, 1989）。DSM-III中的诊断标准以对临床人群的研究为基础而制定，但这些临床人群通常是住院病人，也就是说，他们已经确诊有严重的精神问题了。这项研究的目的是为了可靠地区分不同类型的疾病，而不是区分健康人和病人（Horwitz & Wakefield, 2007）。当由此得来的DSM-III诊断标准被首次（错误地）应用于具有全国代表性的社区人群（绝大多数没有精神疾病）时，出现了离谱的结果：超过四分之一的人口（28.5%）被认为在过去一年内患有精神疾病，而近一半的人口（48%）在其一生中患有过精神疾病（Regier et al, 1998）。这些过高的比例引起了Spitzer和其他人对假阳性诊断的担忧（Horwitz & Wakefield, 2007；Regier et al, 1998; Spitzer & Wakefield, 1999）。后来主持DSM-5工作的Regier及其同事也指出了此问题（Regier et al, 1998）。

所有这些在社区人群中诊断出的障碍有可能只是临床精神障碍的更温和版本，但也有其他的可能性。基于在流行病学责任区（ECA，Epidemiological Catchment Area）数据库和全国并发症调查问卷（NCS，National Comorbidity Survey）中发现的高患病率，我们有理由假设，社区中的一些综合症表现了人们对内部或外部刺激的暂时反应，仅仅是为了自我稳定，而非真正的精神病理学障碍。人类机体对各种物理、生物和情感压力的反应模式是有限的。血压、脉搏、体温、焦虑或情绪的短暂变化不一定代表疾病，而是合理的适应性反应。对于许多体现出符合当前精神综合症（特别是情感和焦虑障碍）定义的症状的人，可能他们没有被临床确诊的原因在于，他们只是在合理自我调节，既非病态也无需治疗。例如，有些悲伤反应（grief reaction，通常出现于丧亲一类事件之后）虽符合临床标准，但如果只是短暂出现，就不会被认为是病态。

现在，科学文献中已经几乎找不到这种对社区人口中“病例”显然合理的解释了。人们已经可以面不改色地报道高到令人难以置信的流行率。例如，美国政府在2017年报道，每五个青春期女性中就有一位在过去一年中患有重度抑郁症（National Institute of Mental Health, 2019a），也就是一种严重的精神疾病。

– Hao Hao –

在DSM-III出版30多年后，时任国立精神卫生研究所（NIMH）及其成人转化研究与治疗发展部主任的Insel和Cuthbert特别称其“阻碍进步”（Cuthbert & Insel, 2013）。神经生物学家和国立精神卫生研究所的前主任Steven Hyman认为，DSM作为一种启发式或思维捷径（heuristic）是有用的，因为它为临床医生和临床研究人员提供了一种“共同的语言”。他同意DSM诊断结果的评分者间信度（inter-rater reliability）普遍较好，但他并不认可这种把精神疾病“当作真实独立存在的自然种类，不受特定评分者影响”的处理方式（Hyman, 2010）。Hyman还观察到，神经生物学的复杂性是有效诊断的最大障碍，而且DSM本身也使问题更加复杂化。例如，他曾指出，“比起‘归纳’症状，（DSM）更偏向于‘区分’症状，这本是一个相当随意的决定，却因此滋生出大量的疾病名称”（Hyman, 2007）。

诊断类别的数量随着DSM的每个后续版本而激增。第一版本有128个类别，而最新的DSM-5编列了541种（Blashfield, Keeley, Flanagan, & Miles, 2014）。DSM-4的主席Frances不满于过多的诊断标签，因为这越来越多地将他认为的“正常行为的严重变体”医学化。他补充道，最近注意缺陷障碍（ADHD，俗称多动症）、双相情感障碍和自闭症谱系障碍（ASD）确诊率增加的原因是“市场驱动的诊断风潮”（Frances, 2013a）。据他说，DSM-5将导致大规模的过度诊断和有害的过度药物治疗（Frances, 2013b）。

DSM-5中作出的所有改变都放宽了诊断标准（除了自闭症相关的），并有可能将目前的“诊断膨胀”变成“超级诊断膨胀”。旧版DSM的惨痛经验告诉我们，但凡诊断系统中的任何东西有可能被滥用并变得流行，那么它就会无可避免地被滥用。许多人只是正常地有悲伤情绪、贪吃、分心、忧虑、压力应激、童年的耍脾气、老年的健忘或者“行为成瘾”，但他们很快就会被误标为精神病患者，并接受不当治疗。

而真正饱受精神问题困扰的人明明可以接受可靠的诊断和有效的治疗，却被严重怠慢了。DSM-5将使情况变得更糟，因为它将注意力和稀缺的资源从真正需要帮助的人身上转移到仅仅在日常生活中有些烦恼的人身上。把他们误标为精神病人并不能帮助他们，反而会伤害他们。

对于植物、动物、传染病和无机物，他们的自然分类在发现潜在的因果原则方面都发挥了关键作用，例如进化论、物质的原子理论和疾病的细菌理论。但迄今为止，精神障碍的各种分类都未能发现它们的根本原因。目前的诊断系统远不够格说自己是一个“自然”的分类系统，而是深深地依赖于精神病学特有的历史。正如精神病学的领军人物肯德勒所说，“如果我们在一个埃米尔·克雷佩林、欧根·布莱勒、库尔特-施奈德和罗伯特·斯皮策从未生活过的平行宇宙中，那么DSM-IV肯定会在许多重要的方面有所不同”（Kendler, 2009）。

建构主义与自然主义“疾病”观点之对比

精神病学在揭示精神障碍的原因并改善公共卫生方面的失败，很大程度上是因为其羸弱的理论基础——首当其冲的便是“疾病”概念。讨论疾病概念的文献盈多，通常分为两大阵营：自然主义，强调生理机制和功能；建构主义，强调规范性和具有文化特异性的健康和疾病相关概念（综述见Murphy, 2015）。

或许对疾病最有影响力的自然主义解释来自哲学家Christopher Boorse。他认为疾病是内部状态，将某种功能能力抑制在该物种的平均水平以下，因此疾病不受主观影响（非建构主义），就像关于生理功能的陈述一样（Boorse, 1977）。关于DSM，Spitzer赞同自然主义疾病的概念，并说道：“我们的方法明确了所有关于疾病或失调讨论中存在的一个基本假设，即有机体功能障碍（organismic dysfunction）”（Spitzer, Endicott, & Franchi, 2018, p. 37；转引自Wakefield, 1992a, p. 235）。不过，生理功能障碍的概念其实没有看起来这么简单。一种直观看法是，生理功能障碍指与正常功能相比的统计学上的偏差（如，Caplan, Engelhardt Jr, & McCartney, 1981； Scaing, 1967； Taylor, 1971）。

统计偏差固然可以作为疾病的诊断标准之一，但并非所有的统计偏差都是疾病，因为器官或系统的结构及功能异常可能是良性的（Wakefield, 1992a, 1992b）。例如，脚底的厚茧在穿鞋的人群中是统计学上的偏差，但在赤脚的人群中却是普遍特征。又例如，心脏位于身体的反面（situs invertus，心脏逆位），是一种罕见但通常无症状的疾病（Wakefield, 1992b）。故而，仅仅偏离某种标准并不等于疾病。对于许多身高和体重之类的特征来说，当其太偏离平均值，落入分布的左右尾内时是有害的，但对于智力这样的特征，在低极端有害，却在高极端十分有益。再如体温，超过37.8℃在统计学上也是不正常的，但如果发生在感染期间（即发热；Kluger, Kozak, Conn, Leon, & Soszynski, 1998）就是功能性的正常表现了。此外，在老年人中，白内障是统计学上“正常”（80岁为止的发病率大于50%）的现象，却仍被认为是一种视力障碍。

– Donghyun Lim –

塞奇威克倾向于建构主义立场，并写到：“本质上，所有的疾病都是从某种更理想的状态的偏离……” （Sedgwick, 1982；转引自Wakefield, 1992b）。在某些情况下，对生理功能的威胁很大程度上决定了条件的合意性。我们不想要蛀牙，因为它会侵蚀牙齿组织，不仅让我们牙疼，也会损害咀嚼功能，因此阻碍我们摄取营养。在其他情况下，社会规范和态度决定了某些被“医疗化”的状况的价值。剖腹产往往是不必要的，但人们错误地认为阴道分娩没那么安全（Cecilia De Mello, 1994; Rosenberg & Trevathan, 2018； Rosenberg & Veile, 2019）。审美标准因地而异，所以各国的整容趋势也各不相同（Holliday & Elfving-Hwang, 2012; Tranter & Hanson, 2015），许多人会有选择性地整容，以此“纠正”处于正常（和健康）差异范围内，但会被认为畸形的部位（Honigman, Phillips, & Castle, 2004），以此提升他们在各自文化背景下的社会价值（Haas, Champion, & Secor, 2008）。

建构主义对精神病学中疾病概念的批评由来已久，将精神病学贬为一个执行社会规范而非治疗生理功能障碍的社会制度。精神病学家托马斯•萨兹（Thomas Szasz）说：“精神病的‘真正’存在和女巫的‘真正’存在意义完全相同”（萨兹，1960）。而福柯（Foucault, 1965, 1990）和谢夫（Scheff, 1971）这样的社会学家则把精神病患者框定为被强迫赋予社会角色和条件的社会异类。这些角色和条件使他们更加被边缘化，并使其合法化。许多精神病学的诊治似乎不是为了治疗功能障碍，而是为了压制不被社会所接受的异常行为。

对于社会价值在塑造精神病学诊断方面的作用，一个常被引用的例子就是，DSM的前两个版本都将同性恋视为精神疾病。其他不再被视为障碍的精神状况或医学上存疑的障碍类别包括道德性精神错乱（Augstein, 1996）、儿童自慰症（Engelhardt, 1974；Foucault, 1990）和癔症（Veith, 1965）。

性别认同障碍（gender identity disorder）最近才被重新归类为性别焦虑的一种（gender dysphoria），以消除性别错位是一种“疾病”的暗示（美国心理学会，2015）。然而，即使是这个新标签也与DSM-V提供的精神障碍定义不一致，因为该定义要求症状反映出从根本上影响心理功能的心理、生理或发育功能障碍……社会偏差行为（如政治、宗教或性相关）和（主要是）个人与社会之间的冲突不是精神障碍，除非该偏差或冲突是由个体的某种上述功能障碍造成的（美国精神病学协会，2013）。

如果它本身不是一种疾病，那么为何恰好是性别错位，而非其他来源的焦虑（如丧亲、失业、性侵）会被拎出来送诊，特别是在被判别为“（主要是）个人与社会之间的冲突”的背景下更显奇怪（美国精神病学协会，2013）。尽管仍存争议，DSM-V中还是保留了这个疾病标签，部分原因是对保险范围和护理机会的考量，因为性别错位与同性恋一样，可能会增加焦虑、抑郁、自我伤害和自杀行为的风险（Haas et al, 2010; Marshal et al, 2011; Hughto, Reisner, & Pachankis, 2015; Reisner et al, 2016; Zucker, Lawrence, & Kreukels, 2016）。

精神病学的批评者们强调了一个基本观点：精神障碍由特定的症状所定义——这些症状代表了社会上被贬低的状况，例如不讲卫生、强迫性思维、不恰当的性行为、妄想、多动、持续性低落情绪、冲动、怪异思维、过度自尊自大、强迫性撒谎、寻求关注、情感淡漠和不合群等。目前，这些症状虽然被编入“障碍”类别，但却没有明确的病理证据。

尽管如此，对于精神疾病只反映文化特定的价值或角色的观点，并没有很多证据支持。例如，精神分裂症具有很高的遗传性，在不同的人口中亦具有相似的症状、流行率和同样不良的社会结果（Jablensky et al, 1992; Saha, Chant, Welham, & McGrath, 2005; Sullivan, Allen et al, 2007; Whiteford et al, 2013）。

小结：对DSM理论基础的批判

由克雷佩林和其他十九世纪的精神病学领袖们所创建，这种基于症状的分类系统未能揭示精神疾病的根本原因。并且，至少在美国，这种分类方法被精神分析方法部分取代了。DSM-III中对疾病分类的再思考，是对DSM-I和DSM-II中精神分析派系因果理论的彻底摒弃。DSM-III工作组的领导者们对这些理论嗤之以鼻，并回归了以症状为准的诊断系统（Shorter, 2015; Cooper & Blashfield, 2016），同时结合了对新生物标志物的调查和新药物的研发。但是，尽管它为研究人员提供了对于（越来越多的）疾病的可靠诊断，这种现象心理学式的（neo-Kraepelinian）项目在发现疾病原因或开发有效的治疗方法上，并不比它19世纪的先辈们做得更好，而且许多DSM“疾病”的真实有效性依然存疑。尽管人们尚未就更好的方法达成共识，但许多研究人员已经觉察到，学界范式的“气象”变化已经临近。

参考文献

Abi-Dargham, A., & Horga, G. (2016). The search for imaging biomarkers in psychiatric disorders. Nature Medicine, 22, 1248.

Adair, L. S., Popkin, B. M., Akin, J. S., Guilkey, D. K., Gultiano, S., Borja, J., … Hindin, M. J. (2010). Cohort profile: The Cebu longitudinal health and nutrition survey. International Journal of Epidemiology, 40, 619-625.

Allen, J. S. (1997). Are traditional societies schizophrenogenic? Schizophrenia Bulletin, 23, 357-364.

Almashat, S., Wolfe, S. M., & Carome, M. (2016). Twenty-five years of pharmaceutical industry criminal and civil penalties: 1991 through 2015. Washington D.C: Public Citizen.

American Psychiatric Association. (1952a). Diagnostic and statistical manual of mental disorders. 1st edition: American Psychiatric Association.

American Psychiatric Association. (1952b). Diagnostic and statistical manual of mental disorders. 2nd edition: American Psychiatric Association.

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders. 5th edition: American Psychiatric Association.

American Psychological Association. (2015). Guidelines for psychological practice with transgender and gender nonconforming people. American Psychologist, 70, 832-864.

Anders, S., Tanaka, M., & Kinney, D. K. (2013). Depression as an evolutionary strategy for defense against infection. Brain, Beha-v-ior, and Immunity, 31, 9-22.

Andrews, P. W., & Durisko, Z. (2017). The evolution of depressive phenotypes. In The Oxford Handbook of Mood Disorders (pp. 24-36). New York: Oxford University Press.

Andrews, P. W., & Thomson, J. A., Jr. (2009). The bright side of being blue: Depression as an adaptation for analyzing complex problems. Psychological Review, 116, 620.

Angell, M. (2005). The truth about the drug companies: How they deceive us and what to do about it. Random House Incorporated. New York: Random House.

Angell, M. (2009). Drug companies & doctors: A story of corruption. The New York Review of Books, 56, 8-12.

Angermeyer, M. C., & Kühnz, L. (1988). Gender differences in age at onset of schizophrenia. European Archives of Psychiatry and Neurological Sciences, 237, 351-364.

Armstrong, G. L., Conn, L. A., & Pinner, R. W. (1999). Trends in infectious disease mortality in the United States during the 20th century. Journal of the American Medical Association, 281, 61-66.

Arnedo, J., Sv-rakic, D. M., Del Val, C., Romero-Zaliz, R., Hernández-Cuervo, H., Schizophrenia Consortium MG of, et al. (2015). Uncovering the hien risk architecture of the schizophrenias: Confirmation in three independent genome-wide association studies. American Journal of Psychiatry, 172, 139-153.

Arnett, A. B., Pennington, B. F., Willcutt, E. G., DeFries, J. C., & Olson, R. K. (2015). Sex differences in adhd symptom severity. Journal of Child Psychology and Psychiatry, 56, 632-639.

Au, T. M., Dickstein, B. D., Comer, J. S., Salters-Pedneault, K., & Litz, B. T. (2013). Co-occurring posttraumatic stress and depression symptoms after sexual assault: A latent profile analysis. Journal of Affective Disorders, 149, 209-216.

Augstein, H. F. (1996). JC Prichard’s concept of moral insanity-A medical theory of the corruption of human nature. Medical History, 40, 311-343.

Azevedo, F. A., Carvalho, L. R., Grinberg, L. T., Farfel, J. M., Ferretti, R. E., Leite, R. E., … Herculano-Houzel, S. (2009). Equal numbers of neuronal and nonneuronal cells make the human brain an isometrically scaled-up primate brain. Journal of Comparative Neurology, 513, 532-541.

Bagnall, A.-M., Jones, L., Ginnelly, L., Lewis, R., Glanville, J., Gilbody, S., … Kleijnen, J. (2003). A systematic review of atypical antipsychotic drugs in schizophrenia. In In: NIHR health technology assessment programme: Executive summaries. Southampton: NIHR Journals Library.

Baio, J. (2012). Prevalence of autism spectrum disorders: Autism and developmental disabilities monitoring network, 14 sites, united states, 2008 (Vol. 61, no. 3). Morbidity and mortality weekly report. Surveillance summaries. Centers for Disease Control and Prevention.

Baron-Cohen, S. (2000). Theory of mind and autism: A fifteen year review. In S. Baron-Cohen, H. Tager-Flusberg, & D. J. Cohen (Eds.), Understanding other minds: Perspectives from developmental cognitive neuroscience (Vol. 2, pp. 3-20). Oxford: Oxford University Press.

Baron-Cohen, S. (2002). The extreme male brain theory of autism. Trends in Cognitive Sciences, 6, 248-254.

Baron-Cohen, S., & Hammer, J. (1997). Is autism an extreme form of the “male brain”? Advances in Infancy Research, 11, 193-218.

Baron-Cohen, S., Knickmeyer, R. C., & Belmonte, M. K. (2005). Sex differences in the brain: Implications for explaining autism. Science, 310, 819-823.

Baron-Cohen, S., Leslie, A. M., & Frith, U. (1985). Does the autistic child ha-v-e a “theory of mind”? Cognition, 21, 37-46.

Baune, B. T., & Renger, L. (2014). Pharmacological and non-pharmacological interventions to improve cognitive dysfunction and functional ability in clinical depression-A systematic review. Psychiatry Research, 219, 25-50.

Baxter, A. J., Scott, K. M., Ferrari, A. J., Norman, R. E., Vos, T., & Whiteford, H. A. (2014). Challenging the myth of an “epidemic” of common mental disorders: Trends in the global prevalence of anxiety and depression between 1990 and 2010. Depression and Anxiety, 31, 506-516.

Beer, C. (2019). Niko Tinbergen and questions of instinct. Animal Beha-v-iour. https://doi.org/10.1016/j.anbeha-v-.2019.08.005

Belsky, J., & Pluess, M. (2009). Beyond diathesis stress: Differential susceptibility to environmental influences. Psychological Bulletin, 135, 885.

Belsky, J., Schlomer, G. L., & Ellis, B. J. (2012). Beyond cumulative risk: Distinguishing harshness and unpredictability as determinants of parenting and early life history strategy. Developmental Psychology, 48, 662.

Benedict, R. (1934a). Anthropology and the abnormal. The Journal of General Psychology, 10, 59-82.

Benedict, R. (1934b). Patterns of culture. Boston, MA; New York, NY: Houghton Mifflin Company.

Benziger, C. P., Roth, G. A., & Moran, A. E. (2016). The global burden of disease study and the preventable burden of NCD. Global Heart, 11, 393-397.

Bertera, E. M. (2005). Mental health in US adults: The role of positive social support and social negativity in personal relationships. Journal of Social and Personal Relationships, 22, 33-48.

Bhardwaj, A., Bourey, C., Rai, S., Adhikari, R. P., Worthman, C. M., & Kohrt, B. A. (2018). Interpersonal violence and suicidality among former child soldiers and war-exposed civilian children in Nepal. Global Mental Health, 5, e9.

Blashfield, R. K., Keeley, J. W., Flanagan, E. H., & Miles, S. R. (2014). The cycle of classification: DSM-I through DSM-5. Annual Review of Clinical Psychology, 10, 25-51.

Blevins, S. M., & Bronze, M. S. (2010). Robert Koch and the ‘golden age’of bacteriology. International Journal of Infectious Diseases, 14, e744-e751.

Bogin, B. (1999). Patterns of human growth. Cambridge, UK: Cambridge University Press.

Bogin, B., Varea, C., Hermanussen, M., & Scheffler, C. (2018). Human life course biology: A centennial perspective of scholarship on the human pattern of physical growth and its place in human biocultural evolution. American Journal of Physical Anthropology, 164, 834-854.

Boorse, C. (1977). Health as a theoretical concept. Philosophy of Science, 44, 542-573.

Border, R., Johnson, E. C., Evans, L. M., Smolen, A., Berley, N., Sullivan, P. F., & Keller, M. C. (2019). No support for historical candidate gene or candidate gene-by-interaction hypotheses for major depression across multiple large samples. American Journal of Psychiatry, 176, 376-387.

Borsboom, D., & Cramer, A. O. (2013). Network analysis: An integrative approach to the structure of psychopathology. Annual Review of Clinical Psychology, 9, 91-121.

Borsboom, D., Cramer, A. O., & Kalis, A. (2019). Brain disorders? Not really: Why network structures block reductionism in psychopathology research. Beha-v-ioral and Brain Sciences, 24, 1-54.

Bowers, M. E., & Yehuda, R. (2016). Intergenerational transmission of stress in humans. Neuropsychopharmacology, 41, 232.

Boyle, E. A., Li, Y. I., & Pritchard, J. K. (2017). An expanded view of complex traits: From polygenic to omnigenic. Cell, 169, 1177-1186.

Brainstorm Consortium, Anttila, V., Bulik-Sullivan, B., Finucane, H. K., Walters, R. K., Bras, J., et al. (2018). Analysis of shared heritability in common disorders of the brain. Science, 360, eaap8757.

Bretschneider, J., Janitza, S., Jacobi, F., Thom, J., Hapke, U., Kurth, T., & Maske, U. E. (2018). Time trends in depression prevalence and health-related correlates: Results from population-based surveys in Germany 1997-1999 vs. 2009-2012. BMC Psychiatry, 18, 394.

Bringmann, L. F., & Eronen, M. I. (2018). Don’t blame the model: Reconsidering the network approach to psychopathology. Psychological Review, 125, 606-615.

Brown, G. W., & Harris, T. O. (1978). The social origins of depression: A study of psychiatric disorder in women. New York. NY: Free Press.

Brüne, M. (2005). “Theory of mind” in schizophrenia: A review of the literature. Schizophrenia Bulletin, 31, 21-42.

Brüne, M. (2015). Textbook of evolutionary psychiatry and psychosomatic medicine: The origins of psychopathology. New York: Oxford University Press.

Burns, J. K. (2004). An evolutionary theory of schizophrenia: Cortical connectivity, metarepresentation, and the social brain. Beha-v-ioral and Brain Sciences, 27, 831-855.

Byrne, R. W., & Whiten, A. (1990). Machia-v-ellian intelligence: Social expertise and the evolution of intellect in monkeys, apes, and humans. Beha-v-ior and Philosophy, 18, 73-75.

Callaway, E. (2010). Questions over ghostwriting in drug industry. Nature.accessed August 22, 2018. http://www.nature.com/news/2010/100907/full/news.2010.453.html

Cannon, T. D., Kaprio, J., Lönnqvist, J., Huttunen, M., & Koskenvuo, M. (1998). The genetic epidemiology of schizophrenia in a Finnish twin cohort: A population-based modeling study. Archives of General Psychiatry, 55, 67-74.

Caplan, A. L., Engelhardt, H. T., Jr., & McCartney, J. J. (1981). Concepts of health and disease: Interdisciplinary perspectives. Reading, MA: Aison-Wesley, Advanced Book Program.

Cartwright, C., Gibson, K., Read, J., Cowan, O., & Dehar, T. (2016). Long-term antidepressant use: Patient perspectives of benefits and adverse effects. Patient Preference and Adherence, 10, 1401.

Caspi, A., & Moffitt, T. E. (2018). All for one and one for all: Mental disorders in one dimension. American Journal of Psychiatry, 175, 831-844.

Caspi, A., Sugden, K., Moffitt, T. E., Taylor, A., Craig, I. W., Harrington, H., et al. (2003). Influence of life stress on depression: Moderation by a polymorphism in the 5-HTT gene. Science, 301, 386-389.

Caye, A., Petresco, S., de Barros, A. J. D., Bressan, R. A., Gadelha, A., Gonçalves, H., et al. (2019). Relative age and attention-deficit/hyperactivity disorder: Data from three epidemiological cohorts and a meta-analysis. Journal of the American Academy of Child & Adolescent Psychiatry, pii, S0890-8567(19)31432-7.

Cecilia De Mello, E. S. (1994). C-sections as ideal births: The cultural constructions of beneficence and patients’ rights in Brazil. Cambridge Quarterly of Healthcare Ethics, 3, 358-366.

Charlson, F., van, O. M., Flaxman, A., Cornett, J., Whiteford, H., & Saxena, S. (2019). New who prevalence estimates of mental disorders in conflict settings: A systematic review and meta-analysis. The Lancet, 394(10194), P240-P248.

Charney, D. S., Buxbaum, J. D., Sklar, P., & Nestler, E. J. (2013). Neurobiology of mental illness. New York: Oxford University Press.

Cipriani, A., Furukawa, T. A., Salanti, G., Chaimani, A., Atkinson, L. Z., Ogawa, Y., et al. (2018). Comparative efficacy and acceptability of 21 antidepressant drugs for the acute treatment of adults with major depressive disorder: A systematic review and network meta-analysis. The Lancet, 391, 1357-1366.

Clark, L. A. (1999). Introduction to the special section on the concept of disorder. Journal of Abnormal Psychology, 108, 371.

CLHNS. (2019). Cebu longitudinal health and nutrition survey. Retrieved from https://www.cpc.unc.edu/projects/cebu

Clukay, C. J., Hughes, D. A., Rodney, N. C., Kertes, D. A., & Mulligan, C. J. (2018). DNA methylation of methylation complex genes in relation to stress and genome-wide methylation in mother-newborn dyads. American Journal of Physical Anthropology, 165, 173-182.

Colvert, E., Tick, B., McEwen, F., Stewart, C., Curran, S. R., Woodhouse, E., et al. (2015). Heritability of autism spectrum disorder in a UK population-based twin sample. JAMA Psychiatry, 72, 415-423.

Compton, W. M., & Guze, S. B. (1995). The neo-Kraepelinian revolution in psychiatric diagnosis. European Archives of Psychiatry and Clinical Neuroscience, 245, 196-201.

Cooper, R., & Blashfield, R. K. (2016). Re-evaluating DSM-I. Psychological Medicine, 46, 449-456.

Cosmides, L., & Tooby, J. (1999). Toward an evolutionary taxonomy of treatable conditions. Journal of Abnormal Psychology, 108, 453-464.

Culverhouse, R. C., Saccone, N. L., Horton, A. C., Ma, Y., Anstey, K. J., Banaschewski, T., et al. (2018). Collaborative meta-analysis finds no evidence of a strong interaction between stress and 5-HTTLPR genotype contributing to the development of depression. Molecular Psychiatry, 23, 133.

Cuthbert, B. N., & Insel, T. R. (2013). Toward the future of psychiatric diagnosis: The seven pillars of RDoC. BMC Medicine, 11, 126.

Darwin, C. (1859). The origin of species. London, England: John Murray.

de Hert, M., Schreurs, V., Vancampfort, D., & Winkel, R. (2009). Metabolic syndrome in people with schizophrenia: A review. World Psychiatry, 8, 15-22.

Dev-ries, K., Watts, C., Yoshihama, M., Kiss, L., Schraiber, L. B., Deyessa, N., et al. (2011). Violence against women is strongly associated with suicide attempts: Evidence from the WHO multi-country study on women’s health and domestic violence against women. Social Science & Medicine, 73, 79-86.

Dorph-Petersen, K.-A., Pierri, J. N., Perel, J. M., Sun, Z., Sampson, A. R., & Lewis, D. A. (2005). The influence of chronic exposure to antipsychotic medications on brain size before and after tissue fixation: A comparison of haloperidol and olanzapine in macaque monkeys. Neuropsychopharmacology, 30, 1649.

Duman, R. S. (2018). Ketamine and rapid-acting antidepressants: A new era in the battle against depression and suicide. F1000Research, 7, F1000.

Dworkin, E. R., Menon, S. V., Bystrynski, J., & Allen, N. E. (2017). Sexual assault victimization and psychopathology: A review and meta-analysis. Clinical Psychology Review, 56, 65-81.

Eaton, N., South, S., Krueger, R., Millon, T., & Simonsen, E. 2010. Contemporary directions in psychopathology. New York: Guilford.

Eccleston, C., & Crombez, G. (1999). Pain demands attention: A cognitive-affective model of the interruptive function of pain. Psychological Bulletin, 125, 356.

Ellis, B. J., & Bjorklund, D. F. (2012). Beyond mental health: An evolutionary analysis of development under risky and supportive environmental conditions: An introduction to the special section. Developmental Psychology, 48, 591.

Engelhardt, H. T. (1974). The disease of masturbation: Values and the concept of disease. Bulletin of the History of Medicine, 48, 234-248.

Evans-Campbell, T. (2008). Historical trauma in American Indian/Native Alaska communities: A multilevel framework for exploring impacts on individuals, families, and communities. Journal of Interpersonal Violence, 23, 316-338.

Evans-Lacko, S., & Knapp, M. (2016). Global patterns of workplace productivity for people with depression: Absenteeism and presenteeism costs across eight diverse countries. Social Psychiatry and Psychiatric Epidemiology, 51, 1525-1537.

Fairburn, C. G., & Bohn, K. (2005). Eating disorder NOS (EDNOS): An example of the troublesome “not otherwise specified”(NOS) category in DSM-IV. Beha-v-iour Research and Therapy, 43, 691-701.

Fanous, A. H., Neale, M. C., Aggen, S. H., & Kendler, K. S. (2007). A longitudinal study of personality and major depression in a population-based sample of male twins. Psychological Medicine, 37, 1163-1172.

Ferrari, A. J., Norman, R. E., Freedman, G., Baxter, A. J., Pirkis, J. E., Harris, M. G., et al. (2014). The burden attributable to mental and substance use disorders as risk factors for suicide: Findings from the global burden of disease study 2010. PloS One, 9, e91936.

Field, N. P., Om, C., Kim, T., & Vorn, S. (2011). Parental styles in second generation effects of genocide stemming from the Khmer Rouge regime in Cambodia. Attachment & Human Development, 13, 611-628.

Fiske, A. P., & Haslam, N. (1997). Is obsessive-compulsive disorder a pathology of the human disposition to perform socially meaningful rituals? Evidence of similar content. The Journal of Nervous and Mental Disease, 185, 211-222.

Flinn, M. V., Nepomnaschy, P. A., Muehlenbein, M. P., & Ponzi, D. (2011). Evolutionary functions of early social modulation of hypothalamic-pituitary-adrenal axis development in humans. Neuroscience & Biobeha-v-ioral Reviews, 35, 1611-1629.

Flinn, M. V., Quinlan, R. J., Decker, S. A., Turner, M. T., & England, B. G. (1996). Male-female differences in effects of parental absence on glucocorticoid stress response. Human Nature, 7, 125-162.

Foucault, M. (1965). Madness and civilization. 1961. Trans Richard Howard. New York, NY: Random House.

Foucault, M. (1990). The history of sexuality: An introduction, volume i. R. Hurley (Trans.). New York, NY: Vintage.

Fox, M. (2018). “Evolutionary medicine” perspectives on Alzheimer’s disease: Review and new directions. Ageing Research Reviews, 47, 140-148.

France, C. M., Lysaker, P. H., & Robinson, R. P. (2007). The” chemical imbalance” explanation for depression: Origins, lay endorsement, and clinical implications. Professional Psychology: Research and Practice, 38, 411.

Frances, A. (2013a). The past, present and future of psychiatric diagnosis. World Psychiatry, 12, 111-112.

Frances, A. (2013b). DSM-5 is a guide, not a bible: Simply ignore its 10 worst changes. Retrieved from https://www.huffpost.com/entry/dsm-5_b_2227626

Frazer, A., & Benmansour, S. (2002). Delayed pharmacological effects of antidepressants. Molecular Psychiatry, 7, S23.

Friston, K. J., Redish, A. D., & Gordon, J. A. (2017). Computational nosology and precision psychiatry. Computational Psychiatry, 1, 2-23.

Frith, C. D. (2004). Schizophrenia and theory of mind. Psychological Medicine, 34, 385-389.

Fugh-Berman, A. J. (2010). The haunting of medical journals: How ghostwriting sold “HRT”. PLoS Medicine, 7, e1000335.

Fuller, K. C., Mccarty, C., Gra-v-lee, C. C., & Mulligan, C. J. (2018). Depression in African Americans: Using genetic and social network data to investigate variation in symptoms of depression. American Journal of Physical Anthropology, 165, 91.

Gilbert, P., Gilbert, J., & Irons, C. (2004). Life events, entrapments and arrested anger in depression. Journal of Affective Disorders, 79, 149-160.

Ginzburg, K., Ein-Dor, T., & Solomon, Z. (2010). Comorbidity of posttraumatic stress disorder, anxiety and depression: A 20-year longitudinal study of war veterans. Journal of Affective Disorders, 123, 249-257.

Godfray, H., & Parker, G. (1992). Sibling competition, parent-offspring conflict and clutch size. Animal Beha-v-iour, 43, 473-490.

Gratten, J., Wray, N. R., Keller, M. C., & Visscher, P. M. (2014). Large-scale genomics unveils the genetic architecture of psychiatric disorders. Nature Neuroscience, 17, 782.

Grove, J., Ripke, S., Als, T. D., Mattheisen, M., Walters, R. K., Won, H., et al. (2019). Identification of common genetic risk variants for autism spectrum disorder. Nature genetics, 51, 431.

Gurven, M., Stieglitz, J., Trumble, B., Blackwell, A. D., Beheim, B., Da-v-is, H., … Kaplan, H. (2017). The Tsimane health and life history project: Integrating anthropology and biomedicine. Evolutionary Anthropology: Issues, News, and Reviews, 26, 54-73.

Haas, A. P., Eliason, M., Mays, V. M., Mathy, R. M., Cochran, S. D., D’Augelli, A. R., et al. (2010). Suicide and suicide risk in lesbian, gay, bisexual, and transgender populations: Review and recommendations. Journal of Homosexuality, 58, 10-51.

Haas, C. F., Champion, A., & Secor, D. (2008). Motivating factors for seeking cosmetic surgery: A synthesis of the literature. Plastic Surgical Nursing, 28, 177-182.

Haberstick, B. C., Smolen, A., Williams, R. B., Bishop, G. D., Foshee, V. A., Thornberry, T. P., et al. (2015). Population frequencies of the triallelic 5HTTLPR in six ethnicially diverse samples from north america, southeast asia, and africa. Beha-v-ior Genetics, 45, 255-261.

Haad, P. M., Brain, C., & Scott, J. (2014). Nonadherence with antipsychotic medication in schizophrenia: Challenges and management strategies. Patient Related Outcome Measures, 5, 43.

Hadley, C., & Crooks, D. L. (2012). Coping and the biosocial consequences of food insecurity in the 21st century. American Journal of Physical Anthropology, 149, 72-94.

Hadley, C., & Patil, C. L. (2006). Food insecurity in rural Tanzania is associated with maternal anxiety and depression. American Journal of Human Biology: The Official Journal of the Human Biology Association, 18, 359-368.

Hadley, C., & Patil, C. L. (2008). Seasonal changes in household food insecurity and symptoms of anxiety and depression. American Journal of Physical Anthropology: The Official Publication of the American Association of Physical Anthropologists, 135, 225-232.

Hagen, E. H. (1999). The functions of postpartum depression. Evolution and Human Beha-v-ior, 20, 325-359.

Hagen, E. H. (2003). The bargaining model of depression. In P. Hammerstein (Ed.), Genetic and cultural evolution of cooperation (pp. 95-123). Cambridge, MA: MIT Press.

Hagen, E. H., & Barrett, H. C. (2007). Perinatal sadness among Shuar women: Support for an evolutionary theory of psychic pain. Medical Anthropology Quarterly, 21, 22-40.

Hagen, E. H., & Rosenström, T. (2016). Explaining the sex difference in depression with a unified bargaining model of anger and depression. Evolution, Medicine, and Public Health, 2016, 117-132.

Hagen, E. H., Roulette, C. J., & Sullivan, R. J. (2013). Explaining human recreational use of “pesticides”: The neurotoxin regulation model of substance use vs. the hijack model and implications for age and sex differences in drug consumption. Frontiers in Psychiatry, 4, 142.

Hagen, E. H., & Sullivan, R. J. (2018). The evolutionary significance of drug toxicity over reward. In S. Ahmed & H. Pickard (Eds.), Routledge handbook of philosophy and science of aiction. London: Routledge.

Hagen, E. H., Sullivan, R. J., Schmidt, R., Morris, G., Kempter, R., & Hammerstein, P. (2009). Ecology and neurobiology of toxin a-v-oidance and the paradox of drug reward. Neuroscience, 160, 69-84.

Hagen, E. H., & Thornhill, R. (2017). Testing the psychological pain hypothesis for postnatal depression: Reproductive success versus evidence of design. Evolution, Medicine, and Public Health, 2017, 17-23.

Hagen, E. H., & Tushingham, S. (2019). The prehistory of psychoactive drug use. In T. B. Henley, M. Rossano, & E. Kardas (Eds.), Cognitive archaeology: Psychology in prehistory. New York: Routledge.

Hagen, E. H., Watson, P. J., & Hammerstein, P. (2008). Gestures of despair and hope: A view on deliberate self-harm from economics and evolutionary biology. Biological Theory, 3, 123-138.

Haig, D. (1997). Parental antagonism, relatedness asymmetries, and genomic imprinting. Proceedings of the Royal Society of London B: Biological Sciences, 264, 1657-1662.

Hallett, M. (2015). Tourette syndrome: Update. Brain and Development, 37, 651-655.

Hamilton, W. D. (1966). The moulding of senescence by natural selection. Journal of Theoretical Biology, 12, 12-45.

Harmer, C. J., Goodwin, G. M., & Cowen, P. J. (2009). Why do antidepressants take so long to work? A cognitive neuropsychological model of antidepressant drug action. The British Journal of Psychiatry, 195, 102-108.

Harrington, A. (2019). Mind fixers. W.W. New York: Norton.

Harris, G. (2008). Top psychiatrist didn’t report drug makers’ pay. The New York Times, A4.

Hay, P., Girosi, F., & Mond, J. (2015). Prevalence and sociodemographic correlates of dsm-5 eating disorders in the australian population. Journal of Eating Disorders, 3, 19.

Helzer, J., Wittchen, H.-U., & Krueger, R. (2008). Dimensional options for DSM-V: The way forward. In J. Helzer, H. Kraemer, & R. Krueger (Eds.), Dimensional approaches in diagnostic classification – Refining the research agenda for DSM-V (pp. 115-127). Virginia: American Psychiatric Association.

Henrich, J., Heine, S. J., & Norenzayan, A. (2010). Beyond weird: Towards a broad-based beha-v-ioral science. Beha-v-ioral and Brain Sciences, 33, 111-135.

Herbert, T. B., & Cohen, S. (1993). Stress and immunity in humans: A meta-analytic review. Psychosomatic Medicine, 55, 364-379.

Herpertz-Dahlmann, B., Wille, N., Hölling, H., Vloet, T. D., Ra-v-ens-Sieberer, U., & BELLA Study Group (2008). Disordered eating beha-v-iour and attitudes, associated psychopathology and health-related quality of life: Results of the bella study. European Child & Adolescent Psychiatry, 17, 82-91.

Hilker, R., Helenius, D., Fagerlund, B., Skytthe, A., Christensen, K., Werge, T. M., … Glenthøj, B. (2018). Heritability of schizophrenia and schizophrenia spectrum based on the nationwide Danish twin register. Biological Psychiatry, 83, 492-498.

Hill, K., & Hurtado, A. M. (1996). Ache life history: The ecology and demography of a foraging people. New York: Routledge.

Ho, B.-C., Andreasen, N. C., Ziebell, S., Pierson, R., & Magnotta, V. (2011). Long-term antipsychotic treatment and brain volumes: A longitudinal study of first-episode schizophrenia. Archives of General Psychiatry, 68, 128-137.

Holliday, R., & Elfving-Hwang, J. (2012). Gender, globalization and aesthetic surgery in South Korea. Body & Society, 18, 58-81.

Honigman, R. J., Phillips, K. A., & Castle, D. J. (2004). A review of psychosocial outcomes for patients seeking cosmetic surgery. Plastic and Reconstructive Surgery, 113, 1229.

Horwitz, A. V., & Wakefield, J. C. (2007). The loss of sadness: How psychiatry transformed normal sorrow into depressive disorder. New York: Oxford University Press.

Hughto, J. M. W., Reisner, S. L., & Pachankis, J. E. (2015). Transgender stigma and health: A critical review of stigma determinants, mechanisms, and interventions. Social Science & Medicine, 147, 222-231.

Husky, M. M., Guignard, R., Beck, F., & Michel, G. (2013). Risk beha-v-iors, suicidal ideation and suicide attempts in a nationally representative French sample. Journal of Affective Disorders, 151, 1059-1065.

Hyman, S. E. (2005). Aiction: A disease of learning and memory. American Journal of Psychiatry, 162, 1414-1422.

Hyman, S. E. (2007). Can neuroscience be integrated into the dsm-v? Nature Reviews Neuroscience, 8, 725.

Hyman, S. E. (2010). The diagnosis of mental disorders: The problem of reification. Annual Review of Clinical Psychology, 6, 155-179.

International Schizophrenia Consortium and others. (2008). Rare chromosomal deletions and duplications increase risk of schizophrenia. Nature, 455, 237.

International Schizophrenia Consortium and others. (2009). Common polygenic variation contributes to risk of schizophrenia and bipolar disorder. Nature, 460, 748.

Jablensky, A., Sartorius, N., Ernberg, G., Anker, M., Korten, A., Cooper, J. E., … Bertelsen, A. (1992). Schizophrenia: Manifestations, incidence and course in different cultures a world health organization ten-country study. Psychological Medicine Monograph Supplement, 20, 1-97.

Jasieńska, G., & Ellison, P. T. (1998). Physical work causes suppression of ovarian function in women. Proceedings of the Royal Society of London Series B: Biological Sciences, 265, 1847-1851.

Jenkins, J. H. (2015). Extraordinary conditions: Culture and experience in mental illness. Berkeley: University of California Press.

Jensen, P. S., Mrazek, D., Knapp, P. K., Steinberg, L., Pfeffer, C., Schowalter, J., & Shapiro, T. (1997). Evolution and revolution in child psychiatry: ADHD as a disorder of adaptation. Journal of the American Academy of Child & Adolescent Psychiatry, 36, 1672-1681.

Johnson, E. C., Border, R., Melroy-Greif, W. E., de, L. C. A., Ehringer, M. A., & Keller, M. C. (2017). No evidence that schizophrenia candidate genes are more associated with schizophrenia than noncandidate genes. Biological Psychiatry, 82, 702-708.

Jorm, A. F., Patten, S. B., Brugha, T. S., & Mojtabai, R. (2017). Has increased provision of treatment reduced the prevalence of common mental disorders? Review of the evidence from four countries. World Psychiatry, 16, 90-99.

Kaiser J. 2009. Senate probe of research psychiatrists, 325, 30.

Kalsner, S., & Nickerson, M. (1969). Mechanism of cocaine potentiation of responses to amines. British Journal of Pharmacology, 35, 428-439.

Kapur, S., Phillips, A. G., & Insel, T. R. (2012). Why has it taken so long for biological psychiatry to develop clinical tests and what to do about it? Molecular Psychiatry, 17, 1174.

Karlstad, Ø., Furu, K., Stoltenberg, C., Håberg, S. E., & Bakken, I. J. (2017). ADHD treatment and diagnosis in relation to children’s birth month: Nationwide cohort study from norway. Scandina-v-ian Journal of Public Health, 45(4), 343-349.

Kaufman, J., & Charney, D. (2000). Comorbidity of mood and anxiety disorders. Depression and Anxiety, 12, 69-76.

Kawa, S., & Giordano, J. (2012). A brief historicity of the Diagnostic and Statistical Manual of Mental Disorders: Issues and implications for the future of psychiatric canon and practice. Philosophy, Ethics, and Humanities in Medicine, 7, 2.

Keller, M. C. (2018). Evolutionary perspectives on genetic and environmental risk factors for psychiatric disorders. Annual Review of Clinical Psychology, 14, 471-493.

Keller, M. C., & Miller, G. (2006). Resolving the paradox of common, harmful, heritable mental disorders: Which evolutionary genetic models work best? Beha-v-ioral and Brain Sciences, 29, 385-404.

Kelley, A. E., & Berridge, K. C. (2002). The neuroscience of natural rewards: Relevance to aictive drugs. Journal of Neuroscience, 22, 3306-3311.

Kendell, R. (1989). Clinical validity. Psychological Medicine, 19, 45-55.

Kendler, K., & Gardner, C. (2016). Depressive vulnerability, stressful life events and episode onset of major depression: A longitudinal model. Psychological Medicine, 46, 1865-1874.

Kendler, K. S. (2008). Explanatory models for psychiatric illness. American Journal of Psychiatry, 165, 695-702.

Kendler, K. S. (2009). An historical framework for psychiatric nosology. Psychological Medicine, 39, 1935-1941.

Kendler, K. S., & Baker, J. H. (2007). Genetic influences on measures of the environment: A systematic review. Psychological Medicine, 37, 615-626.

Kendler, K. S., Gatz, M., Gardner, C. O., & Pedersen, N. L. (2006). A Swedish national twin study of lifetime major depression. American Journal of Psychiatry, 163, 109-114.

Kendler, K. S., Karkowski, L. M., & Prescott, C. A. (1998). Stressful life events and major depression: Risk period, long-term contextual threat, and diagnostic specificity. The Journal of Nervous and Mental Disease, 186, 661-669.

Kendler, K. S., Karkowski, L. M., & Prescott, C. A. (1999). Causal relationship between stressful life events and the onset of major depression. American Journal of Psychiatry, 156, 837-841.

Kendler, K. S., Kessler, R. C., Walters, E. E., MacLean, C., Neale, M. C., Heath, A. C., & Ea-v-es, L. J. (1995). Stressful life events, genetic liability, and onset of an episode of major depression in women. The American Journal of Psychiatry, 152, 833-842.

Kendler, K. S., Myers, J., & Zisook, S. (2008). Does berea-v-ement-related major depression differ from major depression associated with other stressful life events? American Journal of Psychiatry, 165, 1449-1455.

Kertes, D. A., Kamin, H. S., Hughes, D. A., Rodney, N. C., Bhatt, S., & Mulligan, C. J. (2016). Prenatal maternal stress predicts methylation of genes regulating the hypothalamic-pituitary-adrenocortical system in mothers and newborns in the Democratic Republic of Congo. Child Development, 87, 61-72.

Kessler, R. C., & Üstün, T. B. (2004). The world mental health (WMH) survey initiative version of the world health organization (WHO) composite international diagnostic interview (CIDI). International Journal of Methods in Psychiatric Research, 13, 93-121.

Kiecolt-Glaser, J. K., Gouin, J.-P., & Hantsoo, L. (2010). Close relationships, inflammation, and health. Neuroscience & Biobeha-v-ioral Reviews, 35, 33-38.

Kinney, D. K., & Tanaka, M. (2009). An evolutionary hypothesis of depression and its symptoms, adaptive value, and risk factors. The Journal of Nervous and Mental Disease, 197, 561.

Kirkwood, T. B. (1977). Evolution of ageing. Nature, 270, 301.

Kirkwood, T. B., & Rose, M. R. (1991). Evolution of senescence: Late survival sacrificed for reproduction. Philosophical transactions of the Royal Society of London series B. Biological Sciences, 332, 15-24.

Kirsch, I. (2008). Challenging received wisdom: Antidepressants and the placebo effect. McGill Journal of Medicine: MJM, 11, 219.

Kirsch, I. (2015). Antidepressants and the placebo effect. Zeitschrift für Psychologie, 222, 128-134.

Kirsch, I., & Sapirstein, G. (1998). Listening to prozac but hearing placebo: A meta-analysis of antidepressant medication. Prevention & Treatment, 1, 2a.

Kleinman, A. (1980). Patients and healers in the context of culture: An exploration of the borderland between anthropology, medicine, and psychiatry.Berkeley: University of California Press.

Kleinman, A. (1982). Neurasthenia and depression: A study of somatization and culture in China. Culture, Medicine and Psychiatry, 6, 117-190.

Kluger, M. J., Kozak, W., Conn, C. A., Leon, L. R., & Soszynski, D. (1998). Role of fever in disease. Annals of the new York Academy of Sciences, 856, 224-233.

Koch, R., Pinner, B. R., & Pinner, M. (1932). The aetiology of tuberculosis. New York, NY: National Tuberculosis Association.

Kohrt, B. A., Hruschka, D. J., Worthman, C. M., Kunz, R. D., Baldwin, J. L., Upadhaya, N., et al. (2012). Political violence and mental health in nepal: Prospective study. The British Journal of Psychiatry, 201, 268-275.

Kohrt, B. A., Jordans, M. J., Tol, W. A., Speckman, R. A., Maharjan, S. M., Worthman, C. M., & Komproe, I. H. (2008). Comparison of mental health between former child soldiers and children never conscripted by armed groups in Nepal. Jama, 300, 691-702.

Kohrt, B. A., & Mendenhall, E. (2016). Global mental health: Anthropological perspectives. New York: Routledge.

Kohrt, B. A., Speckman, R. A., Kunz, R. D., Baldwin, J. L., Upadhaya, N., Acharya, N. R., … Worthman, C. M. (2009). Culture in psychiatric epidemiology: Using ethnography and multiple mediator models to assess the relationship of caste with depression and anxiety in Nepal. Annals of Human Biology, 36, 261-280.

Kotov, R., Krueger, R. F., Watson, D., Achenbach, T. M., Althoff, R. R., Bagby, R. M., et al. (2017). The hierarchical taxonomy of psychopathology (hitop): A dimensional alternative to traditional nosologies. Journal of Abnormal Psychology, 126, 454.

Kuhar, M., Ritz, M., & Boja, J. (1991). The dopamine hypothesis of the reinforcing properties of cocaine. Trends in Neurosciences, 14, 299-302.

Lacasse, J. R., & Leo, J. (2005). Serotonin and depression: A disconnect between the advertisements and the scientific literature. PLoS Medicine, 2, e392.

Lacasse, J. R., & Leo, J. (2015). Antidepressants and the chemical imbalance theory of depression. The Beha-v-ior Therapist, 38, 206-213.

Lacro, J. P., Dunn, L. B., Dolder, C. R., Leckband, S. G., & Jeste, D. V. (2002). Prevalence of and risk factors for medication nonadherence in patients with schizophrenia: A comprehensive review of recent literature. The Journal of Clinical Psychiatry, 63, 892-909.

Larkings, J. S., & Brown, P. M. (2018). Do biogenetic causal beliefs reduce mental illness stigma in people with mental illness and in mental health professionals? A systematic review. International Journal of Mental Health Nursing, 27, 928-941.

Le Grange, D., Swanson, S. A., Crow, S. J., & Merikangas, K. R. (2012). Eating disorder not otherwise specified presentation in the us population. International Journal of Eating Disorders, 45, 711-718.

Leboyer, M., Henry, C., Paillere-Martinot, M.-L., & Bellivier, F. (2005). Age at onset in bipolar affective disorders: A review. Bipolar Disorders, 7, 111-118.

Lee, L., Roser, M., & Ortiz-Ospina, E. (2018). Suicide. Retrieved from https://ourworldindata.org/suicide

Lee, S. H., Ripke, S., Neale, B. M., Faraone, S. V., Purcell, S. M., Perlis, R. H., et al. (2013). Genetic relationship between five psychiatric disorders estimated from genome-wide snps. Nature Genetics, 45, 984.

Lehrner, A., Bierer, L. M., Passarelli, V., Pratchett, L. C., Flory, J. D., Bader, H. N., et al. (2014). Maternal PTSD associates with greater glucocorticoid sensitivity in offspring of Holocaust survivors. Psychoneuroendocrinology, 40, 213-220.

Lemaître, J.-F., Berger, V., Bonenfant, C., Douhard, M., Gamelon, M., Plard, F., & Gaillard, J.-M. (2015). Early-late life trade-offs and the evolution of ageing in the wild. Proceedings of the Royal Society B: Biological Sciences, 282, 20150209.

Leonard, W. R., & Godoy, R. (2008). Tsimane’ Amazonian panel study (TAPS): The first 5 years (2002-2006) of socioeconomic, demographic, and anthropometric data a-v-ailable to the public. Economics & Human Biology, 6, 299-301.

Lexchin, J., Bero, L. A., Djulbegovic, B., & Clark, O. (2003). Pharmaceutical industry sponsorship and research outcome and quality: Systematic review. BMJ, 326, 1167-1170.

Lindsley, C. W. (2012). The top prescription drugs of 2011 in the United States: Antipsychotics and antidepressants once again lead CNS therapeutics. ACS Chemical Neuroscience, 3(8), 630-631.

Little, M. A. (1989). Human biology of african pastoralists. American Journal of Physical Anthropology, 32, 215-247.

Logan, W. P. D. (1950). Mortality in England and Wales from 1848 to 1947: A survey of the changing causes of death during the past hundred years. Population Studies, 4, 132-178.

López-Muñoz, F., & Alamo, C. (2009). Monoaminergic neurotransmission: The history of the discovery of antidepressants from 1950s until today. Current Pharmaceutical Design, 15, 1563-1586.

Lozano, R., Nagha-v-i, M., Foreman, K., Lim, S., Shibuya, K., Aboyans, V., et al. (2013). Global and regional mortality from 235 causes of death for 20 age groups in 1990 and 2010: A systematic analysis for the global burden of disease study 2010. The Lancet, 380, 2095-2128.

Lundh, A., Lexchin, J., Mintzes, B., Schroll, J. B., & Bero, L. (2017). Industry sponsorship and research outcome. Cochrane Database of Systematic Reviews, 2, MR000033.

Maes, M. (1995). Evidence for an immune response in major depression: A review and hypothesis. Progress in Neuro-Psychopharmacology and Biological Psychiatry, 19, 11-38.

Marshal, M. P., Dietz, L. J., Friedman, M. S., Stall, R., Smith, H. A., McGinley, J., … Brent, D. A. (2011). Suicidality and depression disparities between sexual minority and heterosexual youth: A meta-analytic review. Journal of Adolescent Health, 49, 115-123.

Mayes, R., & Horwitz, A. V. (2005). DSM-III and the revolution in the classification of mental illness. Journal of the History of the Beha-v-ioral Sciences, 41, 249-267.

Mayr, E. (1961). Cause and effect in biology. Science, 134, 1501-1506.

McCarroll, S. A., Feng, G., & Hyman, S. E. (2014). Genome-scale neurogenetics: Methodology and meaning. Nature Neuroscience, 17, 756.

McDade, T. W. (2002). Status incongruity in samoan youth: A biocultural analysis of culture change, stress, and immune function. Medical Anthropology Quarterly, 16, 123-150.

McEwen, B. S., Chattarji, S., Diamond, D. M., Jay, T. M., Reagan, L. P., Svenningsson, P., & Fuchs, E. (2010). The neurobiological properties of tianeptine (stablon): From monoamine hypothesis to glutamatergic modulation. Molecular Psychiatry, 15, 237.

McGirr, A., Berlim, M., Bond, D., Fleck, M., Yatham, L., & Lam, R. (2015). A systematic review and meta-analysis of randomized, double-blind, placebo-controlled trials of ketamine in the rapid treatment of major depressive episodes. Psychological Medicine, 45, 693-704.

Mead, M. (1928). Coming of age in Samoa. New York, NY: Morrow.

Medawar, P. B. (1952). An unsolved problem of biology. London: University College.

Merikangas, K. R., Jin, R., He, J.-P., Kessler, R. C., Lee, S., Sampson, N. A., et al. (2011). Prevalence and correlates of bipolar spectrum disorder in the world mental health survey initiative. Archives of general psychiatry, 68, 241-251.

Merskey, H. E. (1986). Classification of chronic pain: Descriptions of chronic pain syndromes and definitions of pain terms. Pain.

Milaneschi, Y., Lamers, F., Peyrot, W. J., Abdellaoui, A., Willemsen, G., Hottenga, J. J., et al. (2016). Polygenic dissection of major depression clinical heterogeneity. Molecular Psychiatry, 21, 516.

Moncrieff, J., Cohen, D., & Mason, J. (2009). The subjective experience of taking antipsychotic medication: A content analysis of internet data. Acta Psychiatrica Scandina-v-ica, 120, 102-111.

Moncrieff, J., & Leo, J. (2010). A systematic review of the effects of antipsychotic drugs on brain volume. Psychological Medicine, 40, 1409-1422.

Moore, T. J., & Mattison, D. R. (2017). Adult utilization of psychiatric drugs and differences by sex, age, and race. JAMA Internal Medicine, 177, 274-275.

Muench, J., & Hamer, A. M. (2010). Adverse effects of antipsychotic medications. American Family Physician, 81, 617-622.

Mulligan, C., D’Errico, N., Stees, J., & Hughes, D. (2012). Methylation changes at nr3c1 in newborns associate with maternal prenatal stress exposure and newborn birth weight. Epigenetics, 7, 853-857.

Mulligan, C. J. (2016). Early environments, stress, and the epigenetics of human health. Annual Review of Anthropology, 45, 233-249.

Murphy, D. (2015). Concepts of disease and health. In E. N. Zalta (Ed.), The stanford encyclopedia of philosophy. Stanford, CA: Spring. Retrieved from https://plato.stanford.edu/archives/spr2015/entries/health-disease/

Murray, C. J., Barber, R. M., Foreman, K. J., Ozgoren, A. A., Abd-Allah, F., Abera, S. F., et al. (2015). Global, regional, and national disability-adjusted life years (dalys) for 306 diseases and injuries and healthy life expectancy (hale) for 188 countries, 1990-2013: Quantifying the epidemiological transition. The Lancet, 386, 2145-2191.

Myers, S. M., Voigt, R. G., Colligan, R. C., Wea-v-er, A. L., Storlie, C. B., Stoeckel, R. E., … Katusic, S. K. (2018). Autism spectrum disorder: Incidence and time trends over two decades in a population-based birth cohort. Journal of Autism and Developmental Disorders, 49, 1-20.

Nagl, M., Jacobi, C., Paul, M., Beesdo-Baum, K., Höfler, M., Lieb, R., & Wittchen, H.-U. (2016). Prevalence, incidence, and natural course of anorexia and bulimia nervosa among adolescents and young adults. European Child & Adolescent Psychiatry, 25, 903-918.

National Institute for Clinical Excellence. (2004). Depression: Management of depression in primary and secondary care. National Institute for clinical excellence. www.nice.org.uk/CG023NICEguideline

National Institute of Mental Health. (2019a). Major depression statistics. Retrieved from https://www.nimh.nih.gov/health/statistics/major-depression.shtml

National Institute of Mental Health. (2019b). Research domain criteria (RDoC). Retrieved from https://www.nimh.nih.gov/research/research-funded-by-nimh/rdoc/index.shtml

Naumova, O. Y., Lee, M., Rychkov, S. Y., Vlasova, N. V., & Grigorenko, E. L. (2013). Gene expression in the human brain: The current state of the study of specificity and spatiotemporal dynamics. Child Development, 84, 76-88.

Nesse, R. M., Bergstrom, C. T., Ellison, P. T., Flier, J. S., Gluckman, P., Govindaraju, D. R., et al. (2010). Making evolutionary biology a basic science for medicine. Proceedings of the National Academy of Sciences, 107, 1800-1807.

Nesse, R. M., & Ellsworth, P. C. (2009). Evolution, emotions, and emotional disorders. American Psychologist, 64, 129.

Nesse, R. M., & Williams, G. C. (1994). Why we get sick: The new science of darwinian medicine. New York Times.

Nettersheim, J., Gerlach, G., Herpertz, S., Abed, R., Figueredo, A. J., & Brüne, M. (2018). Evolutionary psychology of eating disorders: An explorative study in patients with anorexia nervosa and bulimia nervosa. Frontiers in Psychology, 9.

Nettle, D. (2010). Dying young and living fast: Variation in life history across english neighborhoods. Beha-v-ioral Ecology, 21, 387-395.

Nock, M. K., Borges, G., Bromet, E. J., Cha, C. B., Kessler, R. C., & Lee, S. (2008). Suicide and suicidal beha-v-ior. Epidemiologic Reviews, 30, 133-154.

Nowrouzi, B., McIntyre, R. S., MacQueen, G., Kennedy, S. H., Kennedy, J. L., Ra-v-indran, A., … De Luca, V. (2016). Admixture analysis of age at onset in first episode bipolar disorder. Journal of Affective Disorders, 201, 88-94.

O’Donnell, JF., Shelton, RD. (2011) Drug therapy of depression and anxiety disorders. In: Brunton LL, Chabner BA, Knollmann BC, eds. Goodman & Gilman’s the pharmacological basis of therapeutics. 12th ed. New York: McGraw-Hill.

Olfson, M., Gameroff, M. J., Marcus, S. C., & Jensen, P. S. (2003). National trends in the treatment of attention deficit hyperactivity disorder. American Journal of Psychiatry, 160, 1071-1077.

Pagel, M. D., & Harvey, M. H. (2002). Evolution of the juvenile period in mammals. In M. E. Pereira & L. A. Fairbanks (Eds.), Juvenile primates: Life history, development, and beha-v-ior (pp. 27-37). New York: Oxford University Press.

Panksepp, J. (2004). Affective neuroscience: The foundations of human and animal emotions. Oxford: Oxford University Press.

Patil, C., & Hadley, C. (2008). Symptoms of anxiety and depression and mother’s marital status: An exploratory analysis of polygyny and psychosocial stress. American Journal of Human Biology, 20, 475-477.

Patil, C. L., Maripuu, T., Hadley, C., & Sellen, D. W. (2015). Identifying gaps in health research among refugees resettled in Canada. International Migration, 53, 204-225.

Patten, S. B., Williams, J. V., La-v-orato, D. H., Wang, J. L., McDonald, K., & Bulloch, A. G. (2016). Major depression in Canada: What has changed over the past 10 years? The Canadian Journal of Psychiatry, 61, 80-85.

Pepper, G. V., & Nettle, D. (2017). The beha-v-ioural constellation of deprivation: Causes and consequences. Beha-v-ioral and Brain Sciences, 40, 1-72.

Perlis, R. H., Perlis, C. S., Wu, Y., Hwang, C., Joseph, M., & Nierenberg, A. A. (2005). Industry sponsorship and financial conflict of interest in the reporting of clinical trials in psychiatry. American Journal of Psychiatry, 162, 1957-1960.

Perner, J., & Roessler, J. (2012). From infants’ to children’s appreciation of belief. Trends in Cognitive Sciences, 16, 519-525.

Pescosolido, B. A., Martin, J. K., Long, J. S., Medina, T. R., Phelan, J. C., & Link, B. G. (2010). “A disease like any other”? A decade of change in public reactions to schizophrenia, depression, and alcohol dependence. American Journal of Psychiatry, 167, 1321-1330.

Petersen, M. (2002). Whistle-blower says marketers broke the rules to push a drug. The New York Times. Retrieved from https://www.nytimes.com/2002/03/14/business/whistle-blower-says-marketer…

Petersen, M. (2003). Court papers suggest scale of drug’s use: Lawsuit says doctors were paid endorsers. The New York Times. Retrieved from https://www.nytimes.com/2003/05/30/business/court-papers-suggest-scale-o…

Pinares-Garcia, P., Stratikopoulos, M., Zagato, A., Loke, H., & Lee, J. (2018). Sex: A significant risk factor for neurodevelopmental and neurodegenerative disorders. Brain Sciences, 8, 154.

Plomin, R. (2018). Blueprint: How DNA makes us who we are. Cambridge, MA: MIT Press.

Plomin, R., & Bergeman, C. S. (1991). The nature of nurture: Genetic influence on “environmental” measures. Beha-v-ioral and Brain Sciences, 14, 373-386.

Plomin, R., DeFries, J. C., Knopik, V. S., & Neiderhiser, J. M. (2016). Top 10 replicated findings from beha-v-ioral genetics. Perspectives on Psychological Science, 11, 3-23.

Plomin, R., Lichtenstein, P., Pedersen, N. L., McClearn, G. E., & Nesselroade, J. R. (1990). Genetic influence on life events during the last half of the life span. Psychology and Aging, 5, 25.

Power, R. A., Kyaga, S., Uher, R., MacCabe, J. H., Långström, N., Landen, M., … Svensson, A. C. (2013). Fecundity of patients with schizophrenia, autism, bipolar disorder, depression, anorexia nervosa, or substance abuse vs their unaffected siblings. JAMA Psychiatry, 70, 22-30.

Prata, D. P., Costa-Neves, B., Cosme, G., & Vassos, E. (2019). Unra-v-elling the genetic basis of schizophrenia and bipolar disorder with gwas: A systematic review. Journal of Psychiatric Research, 114, 178-207.

Pratt, L., Brody, D., & Gu, Q. (2017). Antidepressant use among persons aged 12 and over: United States, 2011-2014. NCHS Data Brief, 283, 1-8.

Premack, D., & Woodruff, G. (1978). Does the chimpanzee ha-v-e a theory of mind? Beha-v-ioral and Brain Sciences, 1, 515-526.

Quinlan, R. J., Dira, S. J., Caudell, M., & Quinlan, M. (2016). Culture and psychological responses to environmental shocks. Current Anthropology, 57, 0.

Radtke, K. M., Ruf, M., Gunter, H. M., Dohrmann, K., Schauer, M., Meyer, A., & Elbert, T. (2011). Transgenerational impact of intimate partner violence on methylation in the promoter of the glucocorticoid receptor. Translational Psychiatry, 1, e21.

Raison, C. L., Capuron, L., & Miller, A. H. (2006). Cytokines sing the blues: Inflammation and the pathogenesis of depression. Trends in Immunology, 27, 24-31.

Raison, C. L., & Miller, A. H. (2013). Malaise, melancholia and madness: The evolutionary legacy of an inflammatory bias. Brain, Beha-v-ior, and Immunity, 31, 1-8.

Raison, C. L., & Miller, A. H. (2017). Pathogen-host defense in the evolution of depression: Insights into epidemiology, genetics, bioregional differences and female preponderance. Neuropsychopharmacology, 42, 5-27.

Rantala, M. J., Luoto, S., & Krams, I. (2019). Eating disorders: An evolutionary psychoneuroimmunological approach. Frontiers in Psychology, 10, 2200.

Ray, W. A., Chung, C. P., Murray, K. T., Hall, K., & Stein, C. M. (2009). Atypical antipsychotic drugs and the risk of suen cardiac death. New England Journal of Medicine, 360, 225-235.

Rebeiz, M., Patel, N. H., & Hinman, V. F. (2015). Unra-v-eling the tangled skein: The evolution of transcriptional regulatory networks in development. Annual Review of Genomics and Human Genetics, 16, 103-131.

Regier, D. A., Kaelber, C. T., Rae, D. S., Farmer, M. E., Knauper, B., Kessler, R. C., & Norquist, G. S. (1998). Limitations of diagnostic criteria and assessment instruments for mental disorders: Implications for research and policy. Archives of General Psychiatry, 55, 109-115.

Reisner, S. L., White Hughto, J. M., Gamarel, K. E., Keuroghlian, A. S., Mizock, L., & Pachankis, J. E. (2016). Discriminatory experiences associated with posttraumatic stress disorder symptoms among transgender adults. Journal of Counseling Psychology, 63, 509.

Renoux, C., Shin, J.-Y., Dell’Aniello, S., Fergusson, E., & Suissa, S. (2016). Prescribing trends of attention-deficit hyperactivity disorder (ADHD) medications in UK primary care, 1995-2015. British Journal of Clinical Pharmacology, 82, 858-868.

Reyes-Garcı’a, V., Gra-v-lee, C. C., McDade, T. W., Huanca, T., Leonard, W. R., & Tanner, S. (2010). Cultural consonance and psychological well-being. Estimates using longitudinal data from an amazonian society. Culture, Medicine, and Psychiatry, 34, 186-203.

Riley, W. T., Treiber, F. A., & Woods, M. G. (1989). Anger and hostility in depression. Journal of Nervous and Mental Disease, 177, 668-674.

Rodney, N. C., & Mulligan, C. J. (2014). A biocultural study of the effects of maternal stress on mother and newborn health in the Democratic Republic of Congo. American Journal of Physical Anthropology, 155, 200-209.

Root, A., Brown, J. P., Forbes, H. J., Bhaskaran, K., Hayes, J., Smeeth, L., & Douglas, I. J. (2019). Association of relative age in the school year with diagnosis of intellectual disability, attention-deficit/hyperactivity disorder, and depression. JAMA Pediatrics, 173, 1068-1075.

Rosenberg, K. R., & Trevathan, W. R. (2018). Evolutionary perspectives on cesarean section. Evolution, Medicine, and Public Health, 2018, 67-81.

Rosenberg, K. R., & Veile, A. (2019). Introduction: The evolutionary and biocultural causes and consequences of rising cesarean birth rates. American Journal of Human Biology, 31, e23230.

Rosenström, T., Fawcett, T. W., Higginson, A. D., Metsä-Simola, N., Hagen, E. H., Houston, A. I., & Martikainen, P. (2017). Adaptive and non-adaptive models of depression: A comparison using register data on antidepressant medication during divorce. PLoS One, 12, e0179495.

Rosenström, T., Gjerde, L. C., Krueger, R. F., Aggen, S. H., Czajkowski, N. O., Gillespie, N. A., … Ystrom, E. (2018). Joint factorial structure of psychopathology and personality. Psychological Medicine, 49, 1-10.

Roser, M. (2018). Life expectancy. Retrieved from https://ourworldindata.org/life-expectancy

Rudahindwa, S., Mutesa, L., Rutembesa, E., Mutabaruka, J., Qu, A., Wildman, D. E., … Uin, M. (2018). Transgenerational effects of the genocide against the Tutsi in Rwanda: A post-traumatic stress disorder symptom domain analysis. AAS Open Research, 1, 334-345.

Ruhé, H. G., Mason, N. S., & Schene, A. H. (2007). Mood is indirectly related to serotonin, norepinephrine and dopamine levels in humans: A meta-analysis of monoamine depletion studies. Molecular Psychiatry, 12, 331.

Ruscio, A. M., Stein, D. J., Chiu, W. T., & Kessler, R. C. (2010). The epidemiology of obsessive-compulsive disorder in the national comorbidity survey replication. Molecular Psychiatry, 15, 53.

Russell, G., Collishaw, S., Golding, J., Kelly, S. E., & Ford, T. (2015). Changes in diagnosis rates and beha-v-ioural traits of autism spectrum disorder over time. BJPsych Open, 1, 110-115.

Sachdev, P. S., Blacker, D., Blazer, D. G., Ganguli, M., Jeste, D. V., Paulsen, J. S., & Petersen, R. C. (2014). Classifying neurocognitive disorders: The DSM-5 approach. Nature Reviews Neurology, 10, 634.

Saha, S., Chant, D., Welham, J., & McGrath, J. (2005). A systematic review of the prevalence of schizophrenia. PLoS Medicine, 2, e141.

Sapolsky, R. (2018). Double-edged swords in the biology of conflict. Frontiers in Psychology, 9, 2625.

Scaing, J. G. (1967). Diagnosis: The clinician and the computer. The Lancet, 290, 877-882.

Scheff, T. J. (1971). Being mentally ill: A sociological theory. New York: Transaction Publishers.

Scheper-Hughes, N. (2001). Saints, scholars, and schizophrenics: Mental illness in rural Ireland, updated and expanded. Berkeley: University of California Press.

Scheper-Hughes, N., & Lock, M. M. (1986). Speaking “truth” to illness 1: Metaphors, reification, and a pedagogy for patients. Medical Anthropology Quarterly, 17, 137-140.

Schwartz, M. (2001). The life and works of louis pasteur. Journal of Applied Microbiology, 91, 597-601.

Sedgwick, P. (1982). Psycho politics. London, England: Pluto Press.

Segerstrom, S. C., & Miller, G. E. (2004). Psychological stress and the human immune system: A meta-analytic study of 30 years of inquiry. Psychological Bulletin, 130, 601.

Sellen, D. W., & Mace, R. (1997). Fertility and mode of subsistence: A phylogenetic analysis. Current Anthropology, 38, 878-889.

Shattuck, M. R., Satkoski-Trask, J., Deinard, A., Tito, R. Y., Smith, D. G., & Malhi, R. S. (2014). The evolutionary history of slc6a4 and the role of plasticity in macaca. American Journal of Physical Anthropology, 153, 605-616.

Shorter, E. (1997). A history of psychiatry: From the era of the asylum to the age of Prozac. Chichester, NY: John Wiley & Sons.

Shorter, E. (2015). The history of nosology and the rise of the diagnostic and statistical manual of mental disorders. Dialogues in Clinical Neuroscience, 17, 59.

Simon, R. W., & Lively, K. (2010). Sex, anger and depression. Social Forces, 88, 1543-1568.

Sismondo, S. (2007). Ghost management: How much of the medical literature is shaped behind the scenes by the pharmaceutical industry? PLoS Medicine, 4, e286.

Skodol, A., & Spitzer, R. (1982). The development of reliable diagnostic criteria in psychiatry. Annual Review of Medicine, 33, 317-326.

Sla-v-ich, G. M., & Irwin, M. R. (2014). From stress to inflammation and major depressive disorder: A social signal transduction theory of depression. Psychological Bulletin, 140, 774.

Smetana, J. G., & Villalobos, M. (2009). Social Cognitive Development in Adolescence. In R. M. Lerner & L. Steinberg (Eds.), Handbook of adolescent psychology. Vol. 1: Individual bases of adolescent development (3rd ed., pp. 187-228). John Wiley & Sons.

Smith, R. S. (1991). The macrophage theory of depression. Medical Hypotheses, 35, 298-306.

Smoller, J. W., Andreassen, O. A., Edenberg, H. J., Faraone, S. V., Glatt, S. J., & Kendler, K. S. (2019). Psychiatric genetics and the structure of psychopathology. Molecular Psychiatry, 24, 409.

Spitzer, R. L., Endicott, J., & Franchi, J.-A. M. (2018). Medical and mental disorder: Proposed definition and criteria. In Annales médico-psychologiques, revue psychiatrique (Vol. 176, pp. 1-665). New York: Elsevier.

Spitzer, R. L., & First, M. B. (2005). Classification of psychiatric disorders. Journal of the American Medical Association, 294, 1898-1900.

Spitzer, R. L., & Wakefield, J. C. (1999). DSM-IV diagnostic criterion for clinical significance: Does it help solve the false positives problem? American Journal of Psychiatry, 156, 1856-1864.

Stein, D. J., Chiu, W. T., Hwang, I., Kessler, R. C., Sampson, N., Alonso, J., et al. (2010). Cross-national analysis of the associations between traumatic events and suicidal beha-v-ior: Findings from the who world mental health surveys. PloS One, 5, e10574.

Stieglitz, J., Kaplan, H., Gurven, M., Winking, J., & Tayo, B. V. (2011). Spousal violence and paternal disinvestment among tsimane’forager-horticulturalists. American Journal of Human Biology, 23, 445-457.

Stieglitz, J., Schniter, E., von Rueden, C., Kaplan, H., & Gurven, M. (2014). Functional disability and social conflict increase risk of depression in older adulthood among bolivian forager-farmers. Journals of Gerontology Series B: Psychological Sciences and Social Sciences, 70, 948-956.

Stieglitz, J., Trumble, B. C., Thompson, M. E., Blackwell, A. D., Kaplan, H., & Gurven, M. (2015). Depression as sickness beha-v-ior? A test of the host defense hypothesis in a high pathogen population. Brain, Beha-v-ior, and Immunity, 49, 130-139.

Sugiyama, L., Snodgrass, J. (2019). The Shuar health and life history project. Retrieved from http://www.bonesandbeha-v-ior.org/shuar/

Sullivan, P. F., Daly, M. J., & O’donovan, M. (2012). Genetic architectures of psychiatric disorders: The emerging picture and its implications. Nature Reviews Genetics, 13, 537.

Sullivan, P. F., Kendler, K. S., & Neale, M. C. (2003). Schizophrenia as a complex trait: Evidence from a meta-analysis of twin studies. Archives of General Psychiatry, 60, 1187-1192.

Sullivan, R. J., & Allen, J. (1999). Social deficits associated with schizophrenia defined in terms of interpersonal machia-v-ellianism. Acta Psychiatrica Scandina-v-ica, 99, 148-154.

Sullivan, R. J., Allen, J. S., Nero, K. L., Barrett, R., Harland, R., Hezel, F. X., et al. (2007). Schizophrenia in Palau: A biocultural analysis. Current Anthropology, 48, 189-213.

Sullivan, R. J., Allen, J. S., Otto, C., Tiobech, J., & Nero, K. (2000). Effects of chewing betel nut (Areca catechu) on the symptoms of people with schizophrenia in Palau, Micronesia. The British Journal of Psychiatry, 177, 174-178.

Sullivan, R. J., Andres, S., Otto, C., Miles, W., & Ky, R. (2007). The effects of an indigenous muscarinic drug, betel nut (Areca catechu), on the symptoms of schizophrenia: A longitudinal study in Palau, Micronesia. American Journal of Psychiatry, 164, 670-673.

Sullivan, R. J., & Hagen, E. H. (2002). Psychotropic substance-seeking: Evolutionary pathology or adaptation? Aiction, 97, 389-400.

Sullivan, R. J., Hagen, E. H., & Hammerstein, P. (2008). Revealing the paradox of drug reward in human evolution. Proceedings of the Royal Society B: Biological Sciences, 275, 1231-1241.

Syme, K. L., Garfield, Z. H., & Hagen, E. H. (2016). Testing the bargaining vs. inclusive fitness models of suicidal beha-v-ior against the ethnographic record. Evolution and Human Beha-v-ior, 37, 179-192.

Syme, K. L., & Hagen, E. H. (2018). When saying “sorry” isn’t enough: Is some suicidal beha-v-ior a costly signal of apology? Human Nature, 30, 1-25.

Szasz, T. S. (1960). The myth of mental illness. American Psychologist, 15, 113.

Taylor, F. K. (1971). Part 1. A logical analysis of the medico-psychological concept of disease. Psychological Medicine, 1, 356-364.

Taylor, S. (2011). Etiology of obsessions and compulsions: A meta-analysis and narrative review of twin studies. Clinical Psychology Review, 31, 1361-1372.

Ten Ha-v-e, M., De Graaf, R., Van Dorsselaer, S., Tuithof, M., Kleinjan, M., & Penninx, B. (2018). Recurrence and chronicity of major depressive disorder and their risk indicators in a population cohort. Acta Psychiatrica Scandina-v-ica, 137, 503-515.

Ten Ha-v-e, M., Penninx, B., Tuithof, M., van, D. S., Kleinjan, M., Spijker, J., & de, G. R. (2017). Duration of major and minor depressive episodes and associated risk indicators in a psychiatric epidemiological cohort study of the general population. Acta Psychiatrica Scandina-v-ica, 136, 300-312.

Thapar, A., Cooper, M., & Rutter, M. (2017). Neurodevelopmental disorders. The Lancet Psychiatry, 4, 339-346.

Theorell, T., Hammarström, A., Aronsson, G., Träskman Bendz, L., Grape, T., Hogstedt, C., … Hall, C. (2015). A systematic review including meta-analysis of work environment and depressive symptoms. BMC Public Health, 15, 738.

Thomas, R., Sanders, S., Doust, J., Beller, E., & Glasziou, P. (2015). Prevalence of attention-deficit/hyperactivity disorder: A systematic review and meta-analysis. Pediatrics, 135, e994-e1001.

Thomsen, P. (1996). Schizophrenia with childhood and adolescent onset-A nationwide register-based study. Acta Psychiatrica Scandina-v-ica, 94, 187-193.

Thornhill, R., & Thornhill, N. W. (1989). The evolution of psychological pain. In R. Bell & N. Bell (Eds.), Sociobiology and the social sciences. Lubbock: Texas Tech University Press.

Tick, B., Bolton, P., Happé, F., Rutter, M., & Rijsdijk, F. (2016). Heritability of autism spectrum disorders: A meta-analysis of twin studies. Journal of Child Psychology and Psychiatry, 57, 585-595.

Timpson, N. J., Greenwood, C. M., Soranzo, N., Lawson, D. J., & Richards, J. B. (2018). Genetic architecture: The shape of the genetic contribution to human traits and disease. Nature Reviews Genetics, 19, 110.

Tio, P., Epskamp, S., Noordhof, A., & Borsboom, D. (2016). Mapping the manuals of madness: Comparing the ICD-10 and DSM-IV-TR using a network approach. International Journal of Methods in Psychiatric Research, 25, 267-276.

Tooby, J., & Cosmides, L. (1990). The past explains the present: Emotional adaptations and the structure of ancestral environments. Ethology and Sociobiology, 11, 375-424.

Tranter, B., & Hanson, D. (2015). The social bases of cosmetic surgery in Australia. Journal of Sociology, 51, 189-206.

Trevathan, W. R. (2007). Evolutionary medicine. Annual Review of Anthropology, 36, 139-154.

Trivers, R. L. (1974). Parent-offspring conflict. Integrative and Comparative Biology, 14, 249-264.

Turkheimer, E. (2000). Three laws of beha-v-ior genetics and what they mean. Current Directions in Psychological Science, 9, 160-164.

Turner, E. H., Matthews, A. M., Linardatos, E., Tell, R. A., & Rosenthal, R. (2008). Selective publication of antidepressant trials and its influence on apparent efficacy. New England Journal of Medicine, 358, 252-260.

Tushingham, S., Snyder, C. M., Brownstein, K. J., Damitio, W. J., & Gang, D. R. (2018). Biomolecular archaeology reveals ancient origins of indigenous tobacco smoking in North American Plateau. Proceedings of the National Academy of Sciences, 115, 11742-11747.

Valeggia, C. R., & Snodgrass, J. J. (2015). Health of indigenous peoples. Annual Review of Anthropology, 44, 117-135.

Valenstein, E. (2002). Blaming the brain: The truth about drugs and mental health. New York: Simon & Schuster.

Veith, I. (1965). Hysteria: The history of a disease. London, England: The University of Chicago Press Chicago.

Vigo, D., Thornicroft, G., & Atun, R. (2016). Estimating the true global burden of mental illness. The Lancet Psychiatry, 3, 171-178.

Visser, S. N., Danielson, M. L., Bitsko, R. H., Holbrook, J. R., Kogan, M. D., Ghandour, R. M., … Blumberg, S. J. (2014). Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003-2011. Journal of the American Academy of Child & Adolescent Psychiatry, 53, 34-46.

Vita, A., De Peri, L., Deste, G., Barlati, S., & Sacchetti, E. (2015). The effect of antipsychotic treatment on cortical gray matter changes in schizophrenia: Does the class matter? A meta-analysis and meta-regression of longitudinal magnetic resonance imaging studies. Biological Psychiatry, 78, 403-412.

Vitzthum, V. J., & Wiley, A. S. (2003). The proximate determinants of fertility in populations exposed to chronic hypoxia. High Altitude Medicine & Biology, 4, 125-139.

Wakefield, J. C. (1992a). Disorder as harmful dysfunction: A conceptual critique of DSM-III-R’s definition of mental disorder. Psychological Review, 99, 232.

Wakefield, J. C. (1992b). The concept of mental disorder: On the boundary between biological facts and social values. American Psychologist, 47, 373.

Wakefield, J. C. (1995). Dysfunction as a value-free concept: A reply to Sadler and Agich. Philosophy, Psychiatry, & Psychology, 2, 233-246.

Wakefield, J. C. (2000). Spandrels, vestigial organs, and such: Reply to murphy and woolfolk’s “the harmful dysfunction analysis of mental disorder”. Philosophy, Psychiatry, & Psychology, 7, 253-269.

Wakefield, J. C. (2014). Wittgenstein’s nightmare: Why the RDoC grid needs a conceptual dimension. World Psychiatry, 13, 38-40.

Walsh, T., McClellan, J. M., McCarthy, S. E., Aington, A. M., Pierce, S. B., Cooper, G. M., et al. (2008). Rare structural variants disrupt multiple genes in neurodevelopmental pathways in schizophrenia. Science, 320, 539-543.

Warrier, V., Toro, R., Won, H., Leblond, C. S., Cliquet, F., Delorme, R., et al. (2019). Social and non-social autism symptoms and trait domains are genetically dissociable. Communications Biology, 2, 1-13.

Wells, J., Haroun, D., Williams, J., Nicholls, D., Darch, T., Eaton, S., & Fewtrell, M. (2015). Body composition in young female eating-disorder patients with severe weight loss and controls: Evidence from the four-component model and evaluation of dxa. European Journal of Clinical Nutrition, 69, 1330.

Whisman, M. A., & Uebelacker, L. A. (2009). Prospective associations between marital discord and depressive symptoms in mile-aged and older adults. Psychology and Aging, 24, 184.

Whiteford, H. A., Degenhardt, L., Rehm, J., Baxter, A. J., Ferrari, A. J., Erskine, H. E., et al. (2013). Global burden of disease attributable to mental and substance use disorders: Findings from the global burden of disease study 2010. The Lancet, 382, 1575-1586.

Willcutt, E. G. (2012). The prevalence of dsm-iv attention-deficit/hyperactivity disorder: A meta-analytic review. Neurotherapeutics, 9, 490-499.

Williams, G. (1966). Adaptation and natural selection. Princeton, NJ: Princeton University Press.

Williams, G. C. (1957). Pleiotropy, natural selection, and the evolution of senescence. Evolution, 11, 398-411.

Wise, R. A. (1996). Aictive drugs and brain stimulation reward. Annual Review of Neuroscience, 19, 319-340.

Wray, N. R., & Gottesman, I. I. (2012). Using summary data from the danish national registers to estimate heritabilities for schizophrenia, bipolar disorder, and major depressive disorder. Frontiers in Genetics, 3, 118.

Xu, G., Strathearn, L., Liu, B., Yang, B., & Bao, W. (2018). Twenty-year trends in diagnosed attention-deficit/hyperactivity disorder among US children and adolescents, 1997-2016. JAMA Network Open, 1, e181471.

Yehuda, R., Schmeidler, J., Wainberg, M., Binder-Brynes, K., & Duvdevani, T. (1998). Vulnerability to posttraumatic stress disorder in adult offspring of holocaust survivors. American Journal of Psychiatry, 155, 1163-1171.

Yurgelun-To, D. (2007). Emotional and cognitive changes during adolescence. Current Opinion in Neurobiology, 17, 251-257.

Zachar, P., & Kendler, K. S. (2007). Psychiatric disorders: A conceptual taxonomy. American Journal of Psychiatry, 164, 557-565.

Zachar, P., & Kendler, K. S. (2017). The philosophy of nosology. Annual Review of Clinical Psychology, 13, 49-71.

Zucker, K. J., Lawrence, A. A., & Kreukels, B. P. (2016). Gender dysphoria in adults. Annual Review of Clinical Psychology, 12, 217-247.

作者：Kristen L. Syme、Edward H. Hagen

译者：刘凯、李楠 | 审校：Lemona、Leon、Nevaeh

编辑：Nevaeh | 封面：Hao Hao | 排版：光影

本文节选自：

https://onlinelibrary.wiley.com/doi/10.1002/ajpa.23965

Syme, Kristen L., and Edward H. Hagen. “Mental health is biological health: Why tackling “diseases of the mind” is an imperative for biological anthropology in the 21st century.” American journal of physical anthropology 171 (2020): 87-117.

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