When a person is in distress, we can draw on deep, evolved mechanisms to calm the storm, through attention, touch and care
When I talk to my patients about emotion regulation, among the first things that come into their minds are usually deep breathing and meditation. Those who’ve gone through counselling might describe cognitive-behavioural approaches, where they follow set steps to challenge the assumptions underlying their emotional reactions. ‘
With all the added distress, anxiety and depression associated with the COVID-19 pandemic, many of my patients, friends and family members also talk about using the many relaxation and mindfulness apps now available.
As a psychiatrist, I appreciate that these techniques have the potential to be helpful. Many have been validated in well-designed research studies. But there’s another aspect of my identity that makes me doubt whether emotional regulation is something we’re really supposed to do alone. That side of me is the trained anthropologist. I’ve practised psychiatry for more than a decade, but I’ve been travelling around the world for much longer trying to understand how people face and respond to suffering.
Twenty-five years ago, I spent some months at a small concrete temple in southeastern Nepal. Families would bring their loved ones when they could no longer support them at home. The priests at the temple would listen as the families explained their problems. The person in distress would stay a few weeks, months or even longer. Every morning, the residents would worship together, chanting and rocking as they sat cross-legged or kneeling on the floor.
While I was initially captivated by what was, to my eyes, this more unusual form of healing, I began to notice the people coming by, day by day, for a conversation with one of the priests. They’d describe the worries in their hearts and their minds, and the holy man would sit with them, never in a rush. Sometimes, he would teach them a mantra or wipe their backs and shoulders with a feather brush. Then they would leave with more light in their faces. Some came back often, others I only saw once.
I’ve seen that style of interaction again and again. In northern Uganda, a village health worker sat under a tree talking to a woman who had been shunned by her neighbours because she had a child with a rare neurological disorder. In Liberia, a police officer, whose daughter lived with a mental illness, sat listening to a colleague who was explaining how distressing it was to enforce quarantine during the Ebola outbreak.
In Haiti, a houngan priest talked with a teacher about digging his way out of the rubble after buildings had crumbled around him in the 2010 earthquake. If you listen closely, these conversations aren’t limited to people in helping professions. There’s a taxi driver and a passenger talking about the stress of raising teenagers. Or a woman sharing with her spouse about anger at her coworkers after a day at the office.
Emotion regulation to reduce distress appears to be a fundamental human behaviour that doesn’t just happen within us, but between us. We’re constantly consoling others and being consoled, from instances of forgettable disappointment to life-changing traumas. Unfortunately, mainstream psychiatry and psychology, as well as the self-help movement, is burdened by the expectation that self-regulation skills must be mastered to achieve wellbeing.
In my clinical training, I’d originally thought of managing distress as a technical skill for professionals. To be effective, helping others regulate their emotions called for the training of psychologists, religious leaders or other specialists. However, observing the cross-cultural elements of emotion regulation between people makes me think that it’s actually a human universal taking on myriad manifestations. And as a ubiquitous human behaviour, arguably it should be understood from an evolutionary perspective.
With the anthropologists Catherine Panter-Brick of Yale University and Melvin Konner of Emory University, as well as with Vikram Patel, the world’s leading expert in global mental health at Harvard University, and my colleague Katherine Ottman at George Washington University, we endeavoured to identify what evolutionary theory could tell us about interpersonal healing and emotion regulation between people.
Fields such as evolutionary medicine and evolutionary psychiatry had already worked to shed light on the origins of physical and mental illnesses, uncovering mismatches between the selection pressures that shaped who we are and the current environmental, dietary, social and other factors that affect us in daily life.
However, the question of psychological healing hadn’t been explored in similar depth. Why do humans spend minutes every day, to hours and weeks of our lives, comforting others in distress, even when that’s not our profession? Why do we as humans support one another, and why does it look similar across cultures and throughout the history of our species?
If emotional processes are bound up with social rupture, it follows that they’ll play a role in social repair
These questions seem superficially like those about altruism: that is, why do we do anything nice for others at all, from an evolutionary perspective? Survival of the fittest, in popular culture, has typically been simplified to an ethos of absolute individualism.
However, beginning in the 1960s and ’70s, evolutionary biologists developed models for altruism that moved beyond helping others just because of shared DNA. Tit-for-tat dynamics and quid-pro-quo social exchanges remained prominent as explanations, but contemporary evolutionary theory also recognises how shared social behaviours are important for survival because of competition between social groups. For one thing, cooperation is helpful in procuring and protecting resources. A group member who monopolises all the resources from others might get a short-term benefit, but she’s more vulnerable to threats overall because the group as whole has been weakened.
At a certain point in our evolutionary history, other humans became a much bigger threat than other predatory animals. This intragroup competition can be seen in other social mammals too, especially nonhuman primates. Jane Goodall’s writings on chimpanzees are rich with descriptions of group formations and fissures, forced exclusion and intragroup reconciliations.