Schizophrenia, psychiatric genetics, and Darwinian psychiatry: an evolutionary framework

The evolutionary origins of one of the most dramatic and seemingly deleterious behavioral phenotypes, the syndrome known as schizophrenia, are mysterious. Schizophrenia occurs in all cultures and is inherited. Although most phenotypes are said to be "selected for" based on adaptive qualities, it is difficult to understand how the genetic basis of schizophrenia could have operated under a similar framework. This has lead several theorists analyzing the proposed evolutionary origins of other disease states to that of schizophrenia. To date, several models have been applied. We have tried to conceptualize schizophrenia in a compensatory advantage framework whereby incomplete penetrance of the full disorder, or alternatively, the inheritance of risk alleles insufficient in number to manifest as the classic clinical syndrome, may manifest as a behavioral phenotype with adaptive advantages (eg, creative behavior or novel illuminating ideas). The idea that even full penetrance can also be advantageous has been offered as applied to religious experience and ancient social standing, but is unlikely. Can complex behavioral phenotypes such as schizophrenia, and particularly those that seem purely deleterious, be explained by mechanisms of Darwinian psychiatry? Can models from other disease classes be applied successfully to schizophrenia? Such ideas have generated intense speculation, but often in the absence of testable models. In this article, we will examine some of these proposed ideas and offer suggestions for future research.