by Annie Swanepoel, Henry O’Connell, and Paul St John Smith

Abstract

Overmedicalisation in the treatment of mental health problems occurs when normal emotional responses are inappropriately framed as disorders requiring primarily pharmacological intervention, or when social and environmental contributors to distress are overlooked in favour of a narrowly biological model. Critically, this risk is not confined to biological psychiatry: psychotherapeutic models are equally capable of framing ordinary human distress as requiring professional intervention. Evolutionary psychiatry (EP) broadens the scope of the standard biopsychosocial model to consider both individual level (ontogenetic) and species level (phylogenetic) development of emotional and psychological phenomena and associated behaviours. By understanding that many psychiatric symptoms, such as anxiety, low mood and hypervigilance, have phylogenetic roots as adaptive responses to ancestral environments, clinicians can better distinguish between normal variation and disabling or disorder-level pathology. EP also illuminates how mismatches between evolved psychological mechanisms and modern environments contribute to distress, suggesting non-pharmacological interventions may often be more effective. At the same time, the evolutionary criterion for distinguishing disorder from normal variation – while scientifically grounded – has limited utility in clinical practice, where cultural trends can push judgement towards either overmedicalisation or diagnostic nihilism. In this paper, we outline how an evolution-informed perspective can inform clinical reasoning, promote diagnostic discernment, and support a holistic, evobiopsychosocial approach to the prevention and treatment of psychiatric illness.

Key words: evolutionary psychiatry, overmedicalisation, adaptive responses, evolutionary mismatch, biopsychosocial model