BJPsych Kaleidoscope July 2020

magazine-coverTell me your story…a challenging prospect for some, perhaps especially if you are a vulnerable refugee.

Sadly, there are an estimated 68 million people worldwide who have been forcibly displaced by war and persecution. Rates of post-traumatic stress disorder (PTSD) are notably high in refugee groups, but rates of seeking and obtaining care are low. Various factors contribute to this: from stigma about mental illness and fear of authority figures, through cultural and linguistic barriers, to suffering direct and indirect discrimination and racism.

July’s Kaleidoscope looked at a randomised controlled trial aimed at reducing stigma and enhance help-seeking, in over 100 men seeking asylum in Australia, all of whom had PTSD symptoms. Participants either undertook an online 11-module ‘Tell your story’ (TYS) intervention, or stayed on a waiting list. All undertook assessments on stigma, PTSD symptoms and help-seeking intentions at the beginning, on completion of the intervention (or control), and one month subsequently. The 11 modules took participants through a stepped process about their personal journey, in topics such as ‘surviving stress’ and ‘how can talking help?’ Those in the TYS group showed significant reductions in stigma and increases in help-seeking behaviour, doing much better than refugees with PTSD just ‘left alone’. The whole principle is remarkably simple, and – dare I say it - obvious; the point is doing it and showing it can be done – so kudos to the research team.

The online nature of the TYS programme makes it easily scalable to reach large numbers of folk. This narrative approach shows good promise in helping provide an accessible avenue to assist some of society’s most vulnerable individuals to access the care they need and deserve.

What is the point of dads? Cheesy jokes, bad dancing, cringe-worthy speeches. Surely evolution should have got rid of them by now? Certainly other primates do not have fatherhood in the same way. Evolutionary theory had previously worked on a model of a ‘hired gun’ who could provide protection and food to a female vulnerable with a young child (known as paternal provisioning) – but in exchange for sex. A problem with this model, known as the ‘social dilemma’, is that competing with dads are…cads.

A cad, who focuses on promiscuous mating and then leaving (you know the type), is likely at an evolutionary advantage as he should sire more children, thus continuing his rogue genes. The counter was that females would reward long-term male care provision with sexual fidelity, denying this to cads. Nice theory, but it has problems, including the obvious fact that well, dad could end up looking after cad’s children, so-called ‘paternity theft’. And a quick comparison with promiscuous polygynous chimpanzee society shows none of this works there: rank and aggression, not providing bananas, are what get the ladies in chimp-town.

Kaleidoscope reviews a paper that used game theory to propose a new solution – ‘complementarities’. This is the division of labour and pooling of resources that create synergies between a couple, and which cannot occur when each operates alone, including in hunter–gathering food accumulation. The fit that occurs in such partnerships optimises the strengths of each in providing for each other, far stronger than can occur in other modelled couplings. The foods obtained by the hunting male were nutritionally different (and complementary) to those captured by the gathering female; each could begin to specialise, but could not succeed without its mate.

This appears to have begun between five and eight million years ago in our early ancestors, likely coinciding with ecological changes in Africa. At that time a drying of the landscape made sourcing energetically rich food more challenging, supporting adaptations that maximised resources – including long-term pair partnerships. What is perhaps strongest about this model is that it simultaneously allows cads to exist (a phenomenon that will surprise none), but they do not become dominant over dads. A tipping point is reached where dads’ synergistic partnerships with mums lead to more offspring surviving to have their own children, and thus retention of the helpful dad genes. So here’s to plaid trousers, barbeque chefs, and lost drivers who will not ask for directions – hurray for dads.

Quiz

  1. Research has shown that poor ‘mood homeostasis’ – the ability stabilise one’s mood via relevant activities (e.g. sports to enhance, reading to ‘calm’) – is associated with worse prognosis in depression.
  2. An online psychoeducational programme to increase help-seeking in refugees with PTSD failed, suggesting fear of authority figures remains a core problem in this group.
  3. Recent evolutionary research suggests the unique success of fatherhood in the human species was the early emergence of ‘complementaries’ whereby each gender adopted unique and reciprocal food-gathering roles, something not seen in other primates.

Answers

  1. True, and it is thus argued to be a putative therapeutic target.
  2. False, the programme worked very well, suggesting helping demystify mental illness is key.
  3. True.
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