Before Evolution: Our First Report and Videos

Today we are publishing two things at once: the inaugural report of the Foundation for Evolution and Mental Health, Before Evolution: The State of Mental Health (link here) and a series of filmed interviews with leading members of our advisory board and founding team, as well as an edited trailer to introduce the field (all available on our newYouTube channel).

Together they form our first major campaign — and a statement of where the field stands, what it could become, and the road we believe it is now ready to travel.

This is the most substantial body of work the Foundation has produced to date. It has been built, like the field of evolutionary psychiatry in general, almost entirely out of goodwill, by trustees, advisory board members and volunteers giving their time because they believe the work matters.

The Report: A Diagnosis of the Field

Over one billion people worldwide live with a mental health condition. Global costs are estimated at $2.5 trillion per year and projected to reach $16 trillion by 2030. In low- and middle-income countries, more than 75% of those affected receive no treatment at all. Among young people, prevalence is rising sharply across every region for which data exist.

And yet — despite decades of investment and genuine effort by extraordinary scientists and clinicians — the dominant paradigms have stalled. Most major classes of psychiatric medication still derive from accidental discoveries made in the 1950s. Around 82% of the antidepressant response in mild-to-moderate depression is duplicated by placebo. Therapy response rates have been flat for decades. The $20 billion of US neuroscience investment over the Insel era was acknowledged, by Insel himself, to have "not moved the needle" on outcomes. Polygenic risk scores remain clinically non-actionable for any psychiatric disorder.

Our report argues that this is not because the people doing the work aren't excellent. It's because they are working without the foundational framework that grounds the rest of biology: evolution. Mental health clinicians are, in effect, trained in half of biology. Evolutionary science is absent from the MRCPsych syllabus, the ACGME psychiatry requirements, and clinical psychology curricula worldwide.

The report walks through eleven sections, covering the mental health crisis, the gap in education, the state of psychotherapy and pharmacology, the limits of contemporary neuroscience and genetics, environmental factors and mismatch, the potential to inform workplace, school and community interventions and the state of the field in terms of progress and institutions. Each section ends with concrete, evolution-informed recommendations.

The headline message is that the intellectual work needed to respond to this crisis has, to a remarkable degree, already been done. The fruit in the tree of evolution is hanging low for picking.

The Interviews: The People Behind the Roadmap

Alongside the report, we are releasing a series of filmed interviews — and an edited trailer — with members of our team and advisory board. We have been recording and editing these for months, and we are deeply grateful to the contributors, all of whom gave their time freely.

Prof. Randolph Nesse, founding father of evolutionary medicine and evolutionary psychiatry, makes the case that psychiatry has spent fifty years trying to act like the rest of medicine while skipping the foundation that grounds the rest of medicine in biology — and reflects on the moment in his own clinic when he realised that anxiety was there for good evolutionary reasons, and dysregulated for good evolutionary reasons too.

Prof. Robin Dunbar, originator of "Dunbar's number" and the social-brain hypothesis, argues that we are running stone-age minds in a space-age world, that even modern villages are too big for the social architecture humans evolved for, and that the universal "social toolkit" of laughter, singing, dancing, ritual and shared meals — by triggering the endorphin system — represents the best antidepressant we have: free, effective, and non-addictive.

Prof. Paul Gilbert, founder of Compassion Focused Therapy, explains how an evolutionary understanding of motivation, attachment and rank reshapes what good therapy looks like — and shares striking findings from his work with bipolar patients who, simply by understanding mood instability through the lens of the evolved rank/status system, gained a transformative new way of tracking and managing their condition.

Dr. Nikhil Chaudhary draws on years of fieldwork with hunter-gatherer communities to argue that the lack of community in modern life may be the single biggest driver of both mental and physical ill health — and presents a project, conducted with mothers in a UK perinatal psychiatry unit, in which simply learning that humans evolved as cooperative child-rearers produced powerful emotional shifts and led to a co-designed leaflet that psychiatrists are now actively asking for.

Dr. Deniz Gül Salali brings us into the Congolese rainforest and the world of the Mbendjele BaYaka — small groups, extensive sharing, mixed-age peer learning, present-focused living — and contrasts that world with the hierarchical, status-driven, future-oriented one that 80% of biomedical research participants come from, despite that population representing only ~11% of humanity.

And our Chair, Dr. Adam Hunt, closes the series with a direct call to action: it is time to move past the simple broken-brain models that have dominated psychiatry for decades and borne almost no useful fruit. Mental disorders are not infections to be cleared. They are products of hundreds of thousands of years of human evolution colliding with a very strange modern world — and the right explanations, his research is beginning to show, genuinely change how people see themselves and how others treat them.

Why This Matters Now

Taken together, the report and the interviews are our roadmap. They describe where the science is, what it could become, and what is required to get there.

What is most striking — and what we want supporters of the Foundation to hold on to — is how much has already been achieved with essentially no money. The Royal College of Psychiatrists' Evolutionary Psychiatry Special Interest Group has grown to nearly 4,000 members. Landmark publications have appeared in World Psychiatry, the British Journal of Psychiatry, and Kaplan & Sadock's Comprehensive Textbook of Psychiatry. Evolution-informed therapies — Compassion Focused Therapy, Cognitive Evolutionary Therapy, mismatch-reduction approaches — have produced encouraging early evidence. Pilot hunter-gatherer fieldwork in the Congo and the Bolivian Amazon is generating insights that perinatal psychiatrists in the NHS are asking to use. Promising young researchers are ready to launch RCTs and PhD projects right now, and are looking for relatively modest funding to do so.

In the context of global mental health spending — a $2.5 trillion-a-year problem — the sums required to move evolutionary psychiatry from a growing movement into an established discipline are extraordinarily small. Curriculum development, clinical piloting, public communication, the coordinating infrastructure of the Foundation itself: this is not the kind of work that needs billions. It needs catalytic, well-directed funding, applied to a field whose intellectual foundations are already in place, and ready to translate.

We believe that once a science finds the right theory, progress can happen very quickly. Evolutionary theory has reorganised the rest of biology over the last century. It is the right theory for understanding the human mind too. That is why we expect — and intend — to see rapid, meaningful progress across explanation, prevention, and treatment in the years ahead.

Looking Forward

This first campaign represents a snapshot of where we are: a field rich in ideas, expertise and goodwill, but light on infrastructure and funding. We look forward to a future in which the reports we publish are not only of ideas and possibilities, but of findings, completed studies, scaled interventions, and lives changed. We hope that one day we will be able to look back at this moment — this campaign, this report, these interviews — as the roadmap that we set out, and then steadily, perhaps even quickly, drove down.

If you can see the potential of this work, we would love your help.

Read the report, watch the series, and support our work by donating.

The Foundation for Evolution and Mental Health is a UK-registered charity (No. 1211344). We fund research and education at the intersection of evolution and mental health — including evolution-informed psychotherapy and interventions, cross-cultural studies of mental health in non-industrialised societies, work on the strengths and functions associated with diagnosable disorders, and accessible educational resources for clinicians, patients, families, and the public. We exist to help change the paradigm of mental health understanding and care.

FEMH is Gift Aid certified, meaning eligible UK donations from UK taxpayers receive a 25% boost from the UK government. For significant donations, it is often possible to arrange for overseas donors to receive tax benefits via their national charitable donation system e.g. US donors will be able to make donations to a 501(c)(3). Please contact FEMH directly via our website to arrange this.