3.3  Human Instincts and Culture; Psychiatric Problems   last revised/edited 7/2015, 6/2018

3.3.0 Summary
3.3.1 Early developments: gathering and hunting
3.3.2 Evolving of agriculture and of sophisticated ancient cultures
3.3.3 Human behaviors: inborn and cultural factors
3.3.4 Character of people: inborn and cultural factors
3.3.5 Development of customs and traditions; negative aspects of cultural developments
3.3.6 Beneficial traditions in primitive and higher cultures; loss of valuable traditions
3.3.7 Examples of factors contributing to the development of ethical behavior and acculturation
3.3.8 Specific factors leading to unethical behaviors
3.3.9 Conflict, anxiety and stress; culture and mental disorders
3.3.10 Resilience versus posttraumatic stress symptoms
3.3.11 Posttraumatic stress and related mental health problems
3.3.12 Abuse-addiction
3.3.13 Prevention of anxiety and mood disorder, quality of life
3.3 Appendix  Position of women, biology and cultures

3.3.0 Summary
Humans had relatively large brains for over a million years but they progressed extremely slowly. Eventually progress accelerated slightly through multiple developmental stages. Only in the last few millennia have most human groups abandoned the gathering-hunting small-group living, to which our instincts are adapted. Gathering-hunting bands have been quite egalitarian, but they have not lived peacefully in harmony with nature; and homicides have been frequent.
At some stage within the last 150,000-50,000 years, people developed by language enhanced social interactions and storytelling, and people became more imaginative, occasionally expressing themselves artistically. Homo sapiens bands also started new migrations out of Africa. On their ways they hunted almost all large animals to extinction. Agriculture evolved probably more accidentally than as an invention, allowing much higher population density; it lead to a windfall for the evolving upper classes. Inventions appeared to be rare and their benefits were rarely recognized; technological progress remained very slow. Generally people relied on traditional wisdom, believing that the past was better than the present. Only around 1500 did Europeans start to recognize the possibility of progress based on sciences and technologies.
Interactions of gathering-hunting bands were largely guided by social instincts, but sympathy, compassion and sense of fairness were essentially limited to people within small groups. Cultures evolved; they helped people adapt to climate fluctuations and changing environments when they migrated. Cultures also made people feel as if they became a more evolved species and they saw others as subhuman. Evolving customary practices exaggerated, suppressed and modified the expression of instincts and also of people’s characteristics. Masculinity and femininity were sometimes exaggerated in grotesque and cruel ways; leaders were often seen as god-like. Most instinct-based behaviors, such as eating and courting, have been shaped and often enhanced by cultures. Storytelling, joking and gossiping, dancing and other artistic expressions alleviated the hardships of life.
Religions, local myths and notions such as patriotism evolved and helped anonymous large groups to have a sense of unity, belonging together as clans or states. While previously the formation of families was the main source of meaning in life, cultures added a broader range of activities and perceptions that gave people a sense of meaning. Religions spread forms of morality; however they often incorporated inhumane practices, even justifying wars, and they usually supported hierarchies with cruel class systems rather than encouraging progress towards more humane institutions. By cultural morals adapted instinctive expressions appear to unite people. However, failing to comply with cultural morals leads to shame, guilt and, in victims, also disgust; perpetrators or victims were often killed or exiled; if surviving, victimizations have often led to posttraumatic symptoms, including inability to trust, anxiety and depression.
Because of the anonymity of societies and the lack of compassion for people who are considered as “others,” even within the same society, the drive to rise in rank became dangerous: there has no longer been a simple goal of becoming the group leader, multiple steps and ways of increasing one’s power and property have become available and consequently the pursuit of a higher rank has become addictive and has often led to crimes. As people no longer lived a nomadic life style and grains and animals could be accumulated as property, materialism or greed and other addictions have become widespread, partly because people had more difficulties establishing friendships and personal goals and finding meaning in life. Progress appeared erratic, sometimes even random and up to the present, influential people generally like to maintain the status quo unless technological progress enriches them. In many countries, institutions have hardly been efficient in accomplishing true progress towards humane conditions for all.
Obviously, human life changed much during our evolving. The development of cultures had typically very mixed results, creating seemingly beneficial goods and adding ways for people to find meaning in life but also creating new problems and causing much suffering. In recent history, at least physical suffering has been greatly reduced: medicine made extraordinary progress; slavery and colonialism ended; the beating of children and women is no longer considered acceptable and a private matter; and particular cruelties in legal systems and warfare have been widely outlawed. Grieving prematurely deceased close family members and friends has become relatively rare. Still, many people question whether overall happiness improved when comparing modern people of highly industrialized countries with ‘primitive’ societies and our early ancestors.
Three major trends predominated in the last few thousand years.
1. Economic and sociopolitical units gradually increased to interacting large clans, feudal estates, kingdoms, empires and the present worldwide culture with much trade and a theoretical belief in human rights and international law.
2. With the evolving of agriculture and animal husbandry, people started to live densely in hierarchical systems of specialists; while people always had a propensity to cruelties and were likely to die prematurely due to illnesses, accidents and homicides, the introduction of agriculture led to much worse conditions for low cast people, particularly women: exploitation and cruel treatments were used systematically, slavery or slave-like conditions of servants and workers, and genocidal war fare became ‘normal’; primarily due to infectious diseases and malnutrition, life expectancy plummeted and stayed very low for thousands of years.
3. Homicides and other crimes gradually decreased. Retribution, enforcing some form of ‘justice,’ warfare and the right to execute humans became, according to cultural beliefs, a monopoly of states, even though there always were areas of lawlessness, subcultures of people who assumed a right to take the law into their own hands, and organizations with ‘private’ armies.

3.3.1 Early developments: gathering and hunting
Gathering-hunting bands appear to have consisted of usually 30 to 50 people (occasionally <20 to >100?); availability of food and population density has influenced group size; however, larger groups tend to break up due to lack of familiarity between members and consequent mistrust and fear. In present indigenous populations without agriculture and herding, cultures with their own language typically consist of many small groups in a geographically demarcated area with a population of only about 500 people.1 Cohesiveness may be based on intermittent intergroup trade and meetings, informal contacts and family ties as members of different bands intermarried; neighboring bands may also form temporary alliances.
Primitive tribes have not lived peacefully in harmony with nature. Social instincts are adapted to interactions within small groups without sophisticated tools and weapons. Otherwise humans are opportunistic and often act shortsightedly. With minor improvements in their weapons, they hunted many animals to extinction. Indigenous people worldwide appear to have frequently deceived or exploited outsiders and/or they raided neighbors’ encampments, usually attacking while people slept, when the men of the group had left, and/or when attackers had the advantage in numbers. They have been steeling women and stored goods, or they may have terrorized neighbors to drive them away; revenge homicides have also been frequent. Sometimes humans fought courageously, mostly in defense of the immediate family or group and sometimes when impulsively retaliating.
Gathering-hunting societies were quite egalitarian. Even though group members may have accumulated more food than needed for their immediate families, excess food was usually distributed. Leaders, healers, artisans and artists obtained their own food, and there were hardly inherited positions of power. Men and women had different functions, but both were appreciated. However, women lost status when brides traditionally moved to their husbands’ groups where they did not have allies and the support of their families of origin.
Naturally young people tend to be monogamous, however, particularly successful males may want multiple wives and both, men and women tend to have affairs. Although affairs generally cause severe harm to families, in terms of evolutionary biology they make sense: for women it is risky to have all children with one partner whose genes may be problematic in case of certain epidemics or forms of environmental stress. For propagating genes of males it is obviously advantageous to have more children than one women can bear including children that the male does not help raising.
Among chimpanzees, the female usually leaves the group to find a mate that is not closely related. In human gathering-hunting tribes, groups intermittently met; whether girls or boys usually left their group seemed to vary; later girls were generally compelled to leave the settlements of their family to find a partner that was not closely related, and in many cultures marriages were usually arranged with girls having no say in where they had to move. Today we still find many rural villages in which most families have the same name, not because of inbreeding, but because girls had to seek husbands in other villages and have to give up their name and identity. Boys generally inherit the family property, land, cattle, workshop, etc. while girls have to leave (the girls’ families may pay for rituals and a dowry or the husband’s family pays her family).
Jared Diamond describes that gathering-hunting and early agricultural groups of Papua New Guinea often had contact with people of neighboring cultures and children grew up multilingual. Still, as others, including Irenäus Eibl-Eibesfeldt described, there was until recent centuries little intermarriage between people of different culture and language.

3.3.2 Evolving of agriculture and of sophisticated ancient cultures
In recent millennia, most human bands added agriculture and/or herding to gathering and hunting. Small bands integrated in larger social units. Early religions, with shared superstitions and beliefs in spirits, with ancestor cult and legends concerning the origin of their tribe, gave larger, anonymous tribal groups a sense of unity, of belonging together. Violence within tribes may have decreased but remained frequent. More ‘advanced’ cultures with large sociopolitical organizations have incurred problems due to anonymity. There has been less trust, empathy and compassion and more anonymous crimes2. The sense of meaningful structure, defined by social instincts, was diminished and cultural customs gained power. The drive to rise in rank becomes dangerous when people of lower rank are no longer individually known and are perceived as strangers3.
Increased food production and population density resulted in early professions and formation of social classes. For most people, the quality of life decreased: people worked harder, food supply became less reliable, nutritional deficiencies and infectious diseases became frequent.
In small groups, interpersonal conflicts were usually alleviated by people observing social instinctive propensities, such as their sense of fairness and propensity to caring; friends or relatives may have mediated or elders arbitrated. These functions were replaced by crude judicial systems. Civilizations typically introduced heritable political leadership positions that often also fulfilled the function of high priests and chief justices. In addition there were classes of almost exclusively male clerks and bureaucrats, artisans, soldiers, priests and healers. Different types of commoners had few rights; women usually had least rights. Religions justified the social order of hierarchies and casts. Healers and priests benefitted from complex superstitions, but they also helped with rituals that promoted self-healing and giving people a sense of comfort and meaning.
Larger populations and higher population density with more people knowing each other personally enhanced the likelihood of creativity, of sharing inventions and of multiple people developing inventions further. Very gradually, sophisticated cultures developed. Factors that slowed progress included people learning routines from parents and working hard; when having reserves, people had little incentive to change and when there was near starvation, people did not dare to experiment. When dealing with behaviors that are not strictly instinctive, humans inherently remember dangers and negative outcomes more than positive experiences; even vague reports of dangers are readily believed and spread within populations. In addition, religions and superstitions often advised against making life easier, fearing that some god or spirits may be insulted. Many major changes led to much suffering and people in most cultures had myths about a much better past.
Around 1500, leading Europeans started to believe that scientific inquiry could move civilizations forward, saving labor, improving productivity, etc. Until then, the attitude was that texts from antiquity, the Bible and theological treatises contained everything people needed to know. The exploration of the world was quickly combined with colonializing it and introducing Christianity. The invention of the printing press enhanced communication over long distances, and widely distributed literature led readers to empathetically understand very different people as they were described in travel reports, novels, etc. The development of exploitative empathy, taking advantage of the empathic understanding of what others may want, helped to promote sales of consumer goods and capitalism. Compassionate empathy made people more humane.
The introduction of agriculture was in many places more coincidental than an invention. As settlements often evolved before agriculture, collected grass seeds were probably often dropped close to dwellings, and large seeds were preferred over small ones. Consequently, small fields of good seed plants grew wherever people stayed for some time. However, it is not known how in the Americas’ maize was bread from a plant with very small cobs and potatoes from a very poisonous plant. A suggestion is that the small maize plant originally had functions other than as significant source of food, e.g. medicinal, decorative or religious; potatoes may have been used to execute people and nutritious variants that did not kill the convict later became animal feed and human food.
While agriculture and domestication of animals greatly increased food production per square kilometer, agricultural work is harder, depends on regular rain, and is fraught with dangers. Nutritional deficits, animal diseases that infect humans and rampant spread of infectious diseases among the densely living peasants led to a dramatic drop in life expectancy and quality of life. In spite of high mortality, population growth was significant, partly because cooked agricultural foods are more digestible, allowing earlier weaning.
It also became apparent that humans have characteristics of animals that can readily be domesticated: humans are inherently quite docile and compliant. Extreme maltreatments rarely led them to keep fighting until killed or able to escape, and subjugation and abuses did not interfere with their fertility.
With agriculture, animal husbandry and land ownership, people accumulated property that they had to defend. Having armies, most civilizations also introduced slavery, primarily enslaving people captured in warfare. Local low-ranking people often became enslaved. Kings often claimed to own not only their land but also all ‘subjects’ and they could rape any girl of their land, make her a personal slave without rights, or claim her as one of his wives.
With the evolving class hierarchies, women generally lost in rank and were often treated like work animals. While in virtually all ‘higher cultures’, homicides decreased, abuses have been widespread at all levels. In recent times, some governments and international bodies have made efforts to rectify glaring problems but racism persists and women are still broadly discriminated against; in many cultures women are treated with little respect and they generally lack rights and protections specific to their reproductive functions.
Polygyny, which has been much more frequent than polyandry, has always been associated with wealth and power of men: men who could afford to support multiple wives often had more than one. Usually there were more marriageable women than men: young single men often died in fights and in warfare or when behaving recklessly and doing dangerous work; girls were usually coerced to marry very young. With increasing power, leaders became extremely polygynous: first they had several, later dozens, hundreds and rarely even thousands of women they controlled as their exclusive wives. Even today, very wealthy or powerful men often feel that they have the right to use women for their pleasure with little consideration for the women and their own families.
Whether virtually all modern societies are patriarchal because patriarchal chiefdoms were more aggressive and conquered more egalitarian societies, or because in larger, centralized civilizations women were less interested and less assertive in seeking leadership roles: both are probably important factors. Generally, males are more ambitious, risk taking and aggressive when pursuing high ranks. Men’s propensity to make decisions without much consideration for social consequences makes it easier for them to feel good about aggressive encounters in leadership roles. Even if a woman is assertive and fairly aggressive, the needs of her children and elderly parents are much more likely to compete with her pursuit to become a leader than a man’s family.
Until the European Middle ages, answers to what people did not know were sought in the Bible, old texts and abstract philosophical-theological discussions rather than by studying nature and experimenting. The revolutionary changes in leading thinkers’ attitude led to the accelerating development of sciences and technologies, including the printing press. Much wealth was created. The exploitations of colonies and slavery led to additional wealth. Widespread reading led individuals to understanding others better and becoming empathetic, however, understanding people was also used to exploit their vulnerabilities. Sales people empathized with potential buyers to make the best sales pitches. Today, ‘artificial empathy’ that is based on companies spying on people’s use of the Internet including their social media communications, is also politically exploited. Scientific, technological and economic progress moves forward in unpredictable fashion, largely guided by profit seeking, with little ethical consideration.

3.3.3 Human behaviors: inborn and cultural factors
Cultures developed specific ways of responding to instincts (traditions); they are transmitted through cultural learning, and cultures exert pressure to follow them. Most of these traditional behaviors feel rewarding and are reinforced like any perceptions or actions that are associated with instincts, but some traditions suppress and frustrate instinct fulfillment and often cause negative emotions. As culturally shaped behaviors are practiced, they start feeling natural, ‘right’ and/or ‘good’ as if they were inborn; they become “second nature.” Consequently conflicts between expression of raw instincts and culturally adapted behaviors are rare in mature adults. Even most behaviors that feel spontaneous are influenced by cultural learning.
Often it is hard to distinguish between a ‘raw instinct’ versus culturally refined behavior. However, while failure of an instinctive behavior primarily leads to frustration, even minor transgressions against cultural expectations lead to embarrassment, shame, guilt and/or disgust, and members of the culture may become very hostile towards the transgressor. Examples: not finding food is frustrating; but if a newly initiated hunter is not able to catch even a lizard, it is shameful; if he slept late, he probably also feels guilty. Disgust, is felt by a person who observes or is a victim of perversions of instincts that are prohibited by most cultures, e.g. a strong male mistreating a weaker female or child, or sexual acts of adults with children or among first-degree relatives. Similarly, disgust is perceived when observing transgressions against own cultural traditions and values, e.g. when observing eating habits of very different cultures. If victimized in ways considered ‘unconscionable’ in own culture, the victim will, in addition to pain, also feel disgust. Shame and embarrassment occur when failing to live up to cultural expectations, particularly if important persons observe the failure. Guilt is a consequence of failing where a choice and free will is perceived, e.g. if an unacceptable behavior was impulsively committed, if a prescribed behavior was omitted because of fatigue, or if the failure is due to inadequate preparation and efforts4.
Obviously, pain and suffering, physical and mental, are unavoidable parts of life, but cultures largely determine what is considered ‘normal’ or ‘natural’ versus ‘unacceptable’ or ‘cruel.’ Outsiders are likely to consider a culture “barbaric,” “primitive” and inferior when they observe cruel treatments of children or animals that are condoned or mandated in that culture but not in their own. Cruelties that are common in one’s own culture are usually perceived as ‘normal’ and/or justified. Being victimized in a way that is in one’s culture perceived as unconscionable, and being forced to witness and/or participate in such victimizations is closely related to lasting symptoms of posttraumatic stress disorder (PTSD), panic and other anxiety disorders, mood disorders and personality disorders5 (see below). Feeling lasting shame, guilt, and/or disgust may lead to similar psychological problems.
Humans have an instinctive sense of fairness, which is the basis of reciprocity and also vindictiveness. Humans naturally also lack sexual attraction towards persons they observed growing up from infancy, which is the natural basis of the incest taboo. Cultures added many rules and mandates, describing what people should or should not do (and think), and many natural inclinations are expanded or in some ways distorted. These rules and mandates became the essence of the cultural-religious morality. Learning of this morality may be closely related to language learning as many words already express moral judgments. We may hypothesize that there is a ‘moral center’ attached to or an extension to the language center. However, this has not been demonstrable with fMRI studies; various areas of the brain are active when talking or thinking about moral decision-making.
Disgust, shame, guilt and embarrassment occur naturally also in situations other than when failing cultural expectations. Disgust may result from smelling rotten food or food that previously caused nausea and vomiting. Shame and guilt may result from not living up to one’s own expectations (personal culture) that are usually based on social instincts; embarrassment occurs when caught not being able to do what one bragged about or exposing something one wanted to keep secret or hidden, e.g. eating unhealthy snack. Memories and associations may also cause the feeling of shame, guilt or disgust.
By nature, humans continuously judge their environment, mood and health of other human beings, health of plants and animals, etc. While assessing others mood and health is valuable, cultures teach to judge how others should behave and what we have a right to expect, which often leads to disappointments and bad feelings, including blaming, frustration, anger, vindictive feelings, and jealousy. Unreasonable expectations of one-self lead to guilt feelings that are hard to assuage.

3.3.4 Character of people: inborn and cultural factors
Cultural traditions and institutions have been considered to express the character of a people. The opposite is much more accurate: the cultures influence and largely shape the character of individuals. When people move from one culture to another, they usually adjust to the new culture, in their own lives or within one to two generations, unless they are isolated and/or make efforts to keep their cultural heritage. Many cultural institutions, religions and forms of artistic expression spread to ethnically and culturally very different people.
Researchers described and analyzed psychosocial problems in different forms of social organization, including kibbutzim, utopian experimental societies, former communist, and modern Western societies. Many problems arose when cultures and utopian experiments ignored human nature, particularly the differences between the sexes, the strong natural bonds within nuclear families, the instinctive nature of basic property, and the need for small, cohesive groups.
The development of cultural traditions and institutions has been influenced by many factors, including geography, climate, biological environment, population density, contact with other cultures, and technological innovations; and great thinkers and coincidental factors are very important. Successful cultures proved viable, they exploited human capacities, but humans often behaved unconscionably and most endured poor quality of life. To improve behavior patterns of people, their environment, particularly their cultural institutions, have to be changed.
Many aspects of cultural learning have been relevant for so long that modern humans of all cultures share them to a large extent. While musical talents vary greatly, virtually everybody is linguistically talented, dexterous, coordinated enough to be able to walk, run, climb and move rhythmically. However, learning to climb and particularly learning to swim varies greatly between people of different cultures (some children can ‘dog paddle’ if falling into deep water; many drown if not previously instructed in swimming). Ways and posture when walking and carrying heavy loads and also aspects of childcare vary in different cultures. In almost all cultures, music is important and virtually all people learn to appreciate many forms of music and move rhythmically to it.
All people are visually skillful and able to quickly guess angles and proportions, as is necessary to recognize individual faces. Healthy children are capable of quickly acquiring one or multiple languages, to use their hands experimenting and in learnable skills, and to recognize faces including indications of moods. Without these inborn abilities or ‘talents,’ a young person of a traditional society could hardly have survived, much less procreated. It thus appears that every healthy human probably has inherent abilities to draw, write and dance, and cultures should foster such forms of artistic expression.
The natural goal of humans is biological success. Cultures strive to protect themselves and to grow, in territory, power etc., often suppressing other cultures as well as people’s natural inclinations. The primary goal of modern societies is economic growth. The goal of an ethical model society is to improve the quality of life of present and future generations in all parts of the world. Model institutions intend to foster rational and ethical thinking and create
Cultures may lead to some evolutionary trends, favoring some features in future generations. East Asian children and adults may better tolerate high population density without increased aggression. Particularly males in some tribes appear unusually aggressive. Women of some African ethnicities as compared to modern Western women tend to have a pelvis that is anatomically more adapted to long-distance walking than giving birth. It is unclear how much people biologically evolved in recent centuries. Today there is hardly natural genetic selection; the large majority of people survive childhood illnesses and accidents; health and good adaptation rather decrease people’s desire to have children; technologies and ideas are spreading into areas and ethnic groups of all parts of the world; as a result most children all over the world have some common experiences.
The transfer of cultures can be swift and unexpected. Until recently, it was often assumed that all civilizations go through similar stages until they reach modern industrialization and democratic institutions. Buddhism moved early from Indo-European North India to Southern India and East Asia; Islam and Christianity spread from Semitic to African, Indo-European and South Asian civilizations; The European classical music tradition deeply penetrated East Asia and to some degree almost all cultures of the world. While Medieval Christianity had some tradition of spiritual-meditative practices, these were largely lost in the West and meditation and related practices have more recently been re-introduced from South and East Asian cultures (Buddhist meditation, Yoga, Chinese and Japanese martial arts). As Jared Diamond describes, New Guineans from very different, often hostile groups, including stone-age gathering-hunting and agriculturalist tribes with many different languages, have quickly learned to live peacefully together in their modern capital; like Americans, they drive cars, use computers and communicate in a common language, the from English derived Tok Pisin. An evolving (and in some ways degenerating) American political-economic ideology is spreading into all parts of the world.
A problem that has held humans back is lack of imagination in thinking ahead and thinking about possibilities. If people saw an unknown product being used in another culture and they consequently knew that humans could produce it, an inventor soon may reinvent it; but developments are usually delayed when, rather than evaluating the possibilities a new invention offers, only gradual small changes in existing devices are passed to later generations.
Sometimes cultural changes appear to be a natural progression: at critical times, changes are often proposed, introduced or initiated by multiple thinkers and/or enlightened leaders; people promoting similar changes around the same time may work independently and may not know each other. When a critical number of people, sometimes a small minority, reach agreement, a changed attitude easily becomes part of the culture, examples include the abolition of slavery, genocidal warfare and colonialism, the acceptance and spread of foreign practices such as yoga and martial arts, and acknowledging homosexuality and same-sex marriages. This is comparable to scientists and engineers inventing essentially the same or corresponding insights around the same time without knowing of each other’s work. In a much broader time frame, after some 300,000 years of nomadic life and at least 30,000 years of having elaborate languages and having reached all continents (except Antarctica), many groups of homo sapiens throughout the world started, in more recent millennia, to build towns, develop agriculture and advancing some sciences (e.g. astronomy).
Regarding the exceedingly slow developments of humans, Bill Bryson, in A Short History of Nearly Everything, 2003, points out how erratic and so far hardly explainable climate changes were until about 10,000 years ago (around that time, average temperatures appear to have once risen 4°C in 20 years!); Bryson speculates that the present relatively stable and mild interglacial time may have in some way helped humans to finally progress at an accelerating speed. (He also wonders about the rapid adaptations of animals and plants to climate changes and about life close to the poles where there is very little sun light, e.g. large animals, including tyrannosaurus rex having lived in forests about 1,000km from the North pole.)

3.3.5 Development of customs and traditions; negative aspects of cultural developments
Cultures modify natural behaviors. Cultural adaptation of behaviors resembles the development of instincts in disparate species (cultural pseudospeciation6).
Some traditions consist in through generations passed-down tool use; pre-human examples include a regional chimpanzee tradition of cracking nuts with rocks and techniques to ‘fish’ termites. Some cultural expectations only demand a good performance of a normal instinctive behavior. Many cultural customs were complex and became mandatory, confirming membership of the tribe. Some cultural adaptations were necessary for people to live in very different environments. People of a culture usually see themselves as superior to others. Many tribes’ names indicate that they thought of themselves as representing humankind, e.g. “Alemanni” (all men)7. The old Greek’s term “barbaric” referred to foreigners not having a real language (saying only “bar-bar”). In very early cultures, people travelled very little and were not aware of distant groups, because uninvited strangers without some personal connection were almost always assumed to be potentially dangerous. Trade was often indirect, for instance people living in a mountain valley may value sea shells without being aware of oceans and not knowing what tribes were involved in trading them.
Cultures typically exaggerate, suppress, or modify (ritualize) instinctive behaviors, giving them a cultural stamp and distinguishing their culture from others. Cultures prescribe how to eat, court, interact in different relationships, etc. Similarly, cultures tend to exaggerate and modify or suppress natural differences between groups of people, particularly age groups and the sexes. Children may be expected to behave like adults or adolescents like prepubescent children. Uniforms and corsets were designed to exaggerate male and female characteristics while “unisex” hairstyles and clothing may hide them. Female genital mutilation and foot binding may be understood as extreme ways of exaggerating the girls’ femaleness8. Conversely, natural needs of women may be ignored, e.g. in the USA, women have no or only minimal rights for pregnancy-maternity leave (and if they have rights, their husbands often have the same rights).
Cultures typically encourage overspecialization of individuals and groups, inhumane power structures, and exploitation of common people. People’s lives are rarely balanced. Mothers may be cooped up with their children or they are working and have little time with them. Young people with special talents are driven to compete, practice in most of their “free” time, and they are prevented from adequately develop other talents and aspects of their personality.
Countless labor saving inventions lead to ever higher standards of living and expectations. Rather than people working less, modern Americans tend to spend more time working, driving children to classes and events, etc. While accidents became relatively rare and young people experience painful medical treatments infrequently, there are now widespread fads, people having large tattoos and many piercings, and people seek dangers in rodeos and riding heavy motorbikes without helmets; in addition anorexia, self-injurious behaviors and suicide attempts are quite frequent in adolescents and young adults. Compared with gathering-hunting societies, most modern people have little leisure time and times they enjoy spending with their children. Since World War II, there has been much progress regarding the avoidance of wars and cruel, dictatorial governance. However, the rapid development of sciences and technologies, other than medicine, added little to the enhancement of people’s quality of life.
Cultural rituals and directives, particularly rituals of transition such as marriages with “gift” exchanges and initiation into adulthood, were probably valuable in alleviating stress with changes, but they were often complex, merciless, and expensive. Some people were unable to comply and there may have been threatened with brutal retribution for transgressions. Cultures also created conflicts, fears and traditional rituals concerning good and evil spirits, witchcraft and a presumed afterlife. Sometimes people were banished from their clan, which often lead to their death due to psychological stress.
Suffering that is considered ‘normal’ in a culture and experienced by many or most women or men is generally relatively well tolerated and later processed without causing posttraumatic stress symptoms. Being part of a group of people who feel much solidarity increases pain and frustration tolerance.
In many ‘higher’ patriarchal cultures, arranged marriages are common and particularly problematic for the woman. Beautiful rituals and celebrating her beauty and new status may help some, but it is hard for her to move to the groom’s family, and lose the support of her mother or an older sister when afraid and unhappy, when pregnant and giving birth, etc. Girls have usually been forced to marry when too young; they have been expected to know how to work but were not taught with understanding and empathy concerning adult life and good relationships, as appeared to be traditional in some ‘primitive’ societies. The young brides are often treated violently, female in-laws may be unkind, etc. In addition, some rituals, expectations and myths aggravate pain and suffering, e.g. when difficulties in childbirth are assumed to be a consequence of the woman having been unfaithful, or if women are blamed and punished for having girls rather than boys.
It appears that throughout history, there was a general development towards decreased homicides, as documented by Steven Pinker (The Better Angels in Our Nature, 2011), but there was not a gradual trend towards people becoming more humane. Most hunting-gathering people had high homicide rates with frequent warfare between groups and/or revenge killings between clans; and people with very simple natural lifestyles were at times very cruel. Herders have often protected their herds with violent measures, establishing a reputation of effectively taking the law into their own hands, even when there were functioning courts; and corresponding attitudes were passed down in families long after herding was given up. The “high cultures” of antiquity to recent times developed unprecedented, systematic, often publicly executed cruelties: cruel treatments in the initiation of boys and sometimes to ‘improve’ the bodies of girls according to their culture’s standards; efficient forms of massacres e.g. burning villages when people were trapped in them; genocidal campaigns; public, sadistic punishments and executions, and, more recently, bombing metropolitan areas rather than strategic military targets. Urbanized people of high casts sometimes invented forms of cruel treatments; such practices then may have spread into rural areas, particularly if they became associated with the dominant religion. Recent developments lead to a sharp decrease of cruel treatments but progress is not universal and there are often tragic setbacks; particularly in the USA there are signs of wide-ranging regression that may spread into other regions.

3.3.6 Beneficial traditions in primitive and higher cultures; loss of valuable traditions
In most cultures many traditions evolved that alleviate difficult times: celebrations, secular and religious rituals, storytelling, highly structured and spontaneous dancing and other forms of artistic expression, etc. Good traditional healing may include psychological support, hypnotic techniques and pharmacologically active herbs.
Many cultural activities alleviate distress, make life easier and are the source of pleasures. The refinement of instincts, e.g. in courting and eating, often includes artistic creativity. Many cultures found beautiful ways of expressing social and other instincts. Frustrations and by cultures caused negative emotions may be ameliorated by humor, literary or theatrical productions, sports, and games; conflicts may also be dealt with in symbolic ways or sublimated through artistic expression and the passive experience of art. Rules of courtesy generally smooth interactions. Rituals of passage that include instructions often help with transitions in life. Cultures may create settings that facilitate culturally adapted expression of social instincts and dealing with basic needs, for instance in their traditional markets and fairs, or, in pre-industrial cultures, fairly uniform traditions concerning collection of water and washing clothing, etc. Architecture, including the layout of huts and houses is often conducive to social interactions and relief of stress; settlements may contain a central open space and communities may include town squares; later, public baths, parks with beautiful plants, publicly displayed visual art, natural areas, etc. have often be added.
Dreams may be an important way of symbolically processing stressful events, and some cultures may have found ways to utilized dreams to improve peoples’ sense of community and quality of life. In many cultures, dreamlike fables and tales have helped people see their problems in different ways. Some spiritual religious and non-religious practices reintroduced ways to find a meditative and contemplative state of mind that includes the ability to review matters without judgment.
Modern cultures have discouraged natural ways of meditating and contemplating, mainly by rigid school and work schedules and by frequent distractions. Schools usually discourage “daydreaming”; schools also often suppressed children’s natural inclinations to spontaneously move and express themselves artistically. Even activities that include touch are often avoided for fear of being interpreted in a sexual way. For many, high population density leaves little opportunity to find quiet natural places.
A major problem of evolving civilizations is the first gradual and recently rapid loss of positive aspects of old cultures. While there is much progress in areas such as medical and psychological care, food production, transportation, indoor climate control technologies, and more democratic institutions, many old ways of relieving problems are lost. People often feel isolated; the poor have often less family and community support than in previous generations, walking daily is no longer a natural part of life and in many places it is dangerous. Profit-driven developments seem random rather than following a plan or cultural plans and directives.

3.3.7 Examples of factors contributing to the development of ethical behavior and acculturation
Behaving ethically is to some extent inborn, based on social instincts, but cultural factors are very important. Following maternal and social instincts and fighting in the defense of family or tribe are considered noble. However, people lack strong inhibitions to injure and kill, if there are major conflicts or there is no social bond. As contact between unrelated people increased and weapons became more sophisticated, cultures introduced moral teachings and laws against homicide, but allowed many exceptions.
For families and small groups to stay harmonious, cultures usually emphasize generosity as a virtue, rather than simple reciprocity or fairness; generosity is important since individuals are usually more aware of what they give and how they are hurt than what they receive and how they may be hurting others. Fortunately, good feelings last longer after giving than after receiving a gift.
In many cultures, much socialization took place in children’s groups. Older children, and particularly prepubescent girls in gender-mixed groups, taught younger children games and societal rules. These children’s groups have been largely lost in our highly industrialized civilization. Children have been far too often segregated by age and when there are more children, they spontaneously tend to segregate by sex.
Folklore and cultural teachings introduce children to religious and moral doctrines of their civilization; they influence ways children perceive the world. The taught and used language itself influences thinking and perceptions to a significant degree. Multilingual and multicultural upbringing teaches children to think in broader ways.
Laws and law enforcement are designed to positively influence peoples’ behaviors; probable punishments are a major disincentive. Making the right to punish the exclusive prerogative of the state has greatly decreased violence and homicides due to family feuds. However, the courts’ adversarial approach aggravates conflicts. Punishment of one party does not resolve the psychological problems ensuing from a crime or accident.
Economic institutions influence ethical thinking in a society. With free trade, producers and service providers may ethically consider whether filling an economic niche will help improve the quality of people’s lives or they may only consider whether it is advantageous for them.
Money and its pursuit are central to modern civilizations. Since money represents the power to purchase almost any good or service, it has an addicting quality and, if not countered by ethical considerations, strongly influences reasoning. Consumerism also inappropriately promotes a focus on brands, roles and people’s gender, which is particularly problematic for children and adolescents. Particularly for the wealthy and poor, money has an effect like tokens in a bad behavior modification program. For the wealthy, the addictive pursuit of profits encourages unethical investments9. In the poor, money fosters the overvaluation of unaffordable luxuries, makes people feel inadequate, encourages unethical buying, and leads to the loss of community resources. Introducing capitalism into essentially self-sufficient, traditional societies in ethical ways is complex. Accumulating material wealth is unethical.
In the USA, the monopoly of the state to defend potential victims and to punish criminals is weak; the Second Amendment to the Constitution, designed to prevent re-colonization or the development of a dictatorship, led to a legal right for individuals to own their own firearms; however this right and a history of widespread lawlessness also led people to assume they have a right to take laws into their own hands which is a main reason that the USA has a much higher homicide rate than Canada, Europe, Australia, etc.
When people are generous as a matter of virtue and morality, a problem that sometimes evolves is parasitic behavior or exploitation of others’ generosity. Neither party benefits: the generous person starts feeling resentment and the recipient, seemingly the winner, loses status, skills and meaning in life.
Usually, generosity is needed to maintain friendships, but how people respond to negative or positive interactions is highly culture specific. In the USA, people generally need to make up for a negative interaction with multiple positive efforts to save a friendship. In other cultures, rank higher persons feel free to criticize others many times between assurances that they value a loved family member, spouse or friend. When learning, doing well is self-rewarding and teachers may not feel that they have to congratulate a student; no criticism and sometimes signs of silent approval strengthen the friendly teacher-pupil relationship. Similarly, lower-ranking people, pupils or students, must not congratulate a teacher or elder since they are not supposed to judge them; they are expected to be respectful and modest. Rewarding  children’s learning by experimenting may lead them to actually devalue their activity and no longer perceive it as fun; much learning is and should feel like play, something natural or a privilege rather than an unpleasant task.
While childhood is economically exploited by businesses directly advertising to children, emphasizing sex specific taste and desires and sexualizing children in advertisements and movies, there is also an exaggerated fear that nudity and touching children may foster pedophilia and/or other immoral sexual inclinations. Children benefit from approving and bonding touch by adults and other children. Children probably also benefit from seeing nude older children and adults in a non-sexual way, assuaging their curiosity and letting them see human bodies as normal and maybe beautiful. When curious pubescents see only younger children nude, they may actually develop an association between sex drive and seeing naked little children. The early focus on sex specific preferences in clothes, toys and activities misses that children want to experiment with different roles: a girl may sometimes want to pretend being an animal, or she may like to play with boys in practical, gender-neutral clothing. This does not mean that children should hide their sex by dress and hair style. The constriction of sex stereotyping may lead to rebellion with children becoming sexually confused and, at least temporarily, wanting to be a child of the other sex.

3.3.8 Specific factors leading to unethical behaviors
Violent and other unethical behaviors have been decreasing in recent millennia and particularly in recent decades, however, unethical behaviors continue to be frequent for multiple reasons. Children and adolescents are often uncaring, even cruel. While some cultures foster cooperation at least in some children’s games, almost all Western games are adversarial and competitive, with winners and losers, or designed for a child to play alone. Within families and social groups unethical behaviors may be a consequence of early neglect, abuse, and/or forms of “under-socialization.” Children need to develop basic trust through loving attachments. Depending on family culture and social environment, children may or may not learn to empathize with people of different ethnicity, culture and/or socioeconomic background, and with people who are sick or handicapped. Cultures often discourage compassionate empathy with strangers and animals, other than family pets.
While children may learn to think ethically, many unethical behaviors are learned at a later time. People may be taught to ignore compassionate empathy and natural inhibitions while doing a job, when performing traditional practices, or in the military. Many cultures taught that discipline should be enforced with severe physical punishments. Gang subcultures may teach members to commit callous, violent acts. People are also often advised to heed self-interests and to ignore empathy when there are conflicts. In most cultures, cruel traditions are firmly ingrained, and many forms of erratically applied mistreatments are accepted.
Unethical behaviors often result from a lack of generosity. Some people acquire a self-centered attitude. Insecure persons may overvalue what they give, feel overly stressed by criticism, and hardly recognize how they hurt others; they then may feel treated unfairly and become depressed, hostile, resentful and cynical. Laws that specify rights for ill or handicapped person and laws that remove responsibilities from individuals may foster a self-centered, adversarial attitude. In cases of accidents, people may then sue designers and manufacturers of appliances, building owners and cities that manage parks and play grounds, rather than making efforts to change a profit-driven culture, which often penalizes ethical decision-making. It has also been shown that, if enterprises and service providers are recognized as ethical, people are less inclined to sue.
Cultures often encourage exploitative behaviors. Powerful people have little incentive to pay poor workers fairly and corporations have an obligation to earn profits for investors. Poor people are often quite generous, but sometimes they exploit others’ generosity and some may steal from each other.
Most cultures have condoned the maltreatment of a wife or of children, considering it a private matter, even if the abuse violates the culture’s moral teachings. Cultures often emphasize “family honor”: family members may be expected to illegally take revenge rather than rely on their legal system, an adolescent who behaves “immorally” may be disowned and banished, and girls who were raped may be considered a ‘disgrace’ and treated in a punitive way.
Cultures often place unreasonable expectations on individuals, and failure to live up to families’ expectations leads to conflicts, embarrassment, shame, guilt and other negative emotions. Sometimes there are severe punishments. As a result, individuals often feel they are “bad”, “inferior”, and even “immoral”; they may become depressed, and they may believe that they cannot improve. While Westerners consider it wrong to punish young women for having been raped, fundamentalist ‘Christian’ parents may force a barely mature raped daughter to carry the pregnancy to term and give the baby up for adoption, interpreting her suffering as just punishment or the will of God.
The breakdown of an earlier culture and young people broadly rebelling against their family culture may lead to a temporary increase in many forms of unethical behaviors. Postcolonial countries and countries that recently disposed of a dictator may have little structure, no clear rank order in which rules are generated and enforced, and few disincentives to steal, exploit, etc. In the 1960’s, particularly in the USA, there was broad rebellion against cultural rules with some idealism but also extensive drug abuse, glorifying unethical sex, etc. People were aware of gross ethical problems including racism and sexism, cultural rules seemed overly restrictive, and the post WWII optimism of broad rapid improvements faded. The rates of violent and nonviolent crimes greatly increased and stayed high for a few decades.
Institutions of modern civilizations frequently fail expectations and promised functions, leading to much frustration and anger. Extended families and communities may fail to adequately support nuclear families. These problems contribute to psychological disturbances, including abuse behaviors and addictions.

3.3.9 Conflict, anxiety and stress; culture and mental disorders
Cultures and subcultures (family and group cultures) contribute much to conflicts, distress and mental disorders, though genetic factors and personal fate are also significant. Undirected instinctual tension and conflicts between different instinctive and cultural inclinations are major causes of chronic anxiety and depression10. Inability to live up to cultural expectations often adds to stress and anxiety.
Biologically, a major cause of psychological conflict, stress or anxiety is novelty that is not sought, including repeated situations in which the individual still feels insecure; the person does not feel adequately prepared by instincts, culture, and/or personal learning; there does not appear to be a response that feels right and good and there is no anticipation that instincts will take over and guide. Similarly if unable to mentally accept uncertainty and likely pain, people feel conflict, they appear overwhelmed, and they may not be able to decide between multiple options.
Anxiety and novelty also occur in desired situations, for instance when falling in love, moving to a new place with positive anticipation or expecting a child; there is much uncertainty and often anticipated pain, but people usually expect that instincts, culture and personal learning will guide them, that the outcomes are meaningful, and that they will be resilient when facing dangers, pain and deprivation. People may also wish to explore, following instincts related to establishing own territory and/or higher rank, and they may accept great risks and discomfort.
Anxiety is often perceived as mixed but mostly positive, e.g. if there are conflicts on how to spend some unexpected income or inheritance. People may also like fear to enhance excitement in sports and entertainment. Fear, the anticipation of pain and danger, do not necessarily lead to lasting negative anxiety: anticipation of what is perceived as a meaningful experience such as initiation procedure, medically indicated or cosmetic surgery, getting pregnant and childbirth lead to apprehension, but the anxiety has a strong positive component. Often young people effectively distract themselves most of the time from anticipated severe pain that will be endured as something expected or unavoidable.
On the other hand, abuse and victimizations, when natural and particularly cultural expectations are violated, often lead to prolonged fear and anxiety, a sense that nobody is trustworthy, that the world is dangerous and unpredictable, and that the normal resilience to emotional and physical pain and to uncertainty is lost.
A central characteristic of mental disturbances is an individual’s inability to accept reality. In addition or as a consequence, the adaptability of the mind seems lost: the person may feel trapped with guilt feelings, fears, distrust, or temporarily over-optimism, etc. Thoughts of minor relevance may be overvalued, perceptions and memories may be distorted and instincts may be perverted. In a chronic state, the person may feel bad and unable to enjoy normal activities. Unhealthy lifestyle and poor quality of social interactions may be part cause, part result of depression. If there is no obvious solution to conflicts, people should be able to review information, then follow intuition and conscience. Instead people often find themselves in vicious cycles where conflicts interfere with decision-making, and when a decision is made, the person feels that he/she made a mistake.
While there are significant genetically determined propensities to mental disorders, expression of genetic vulnerabilities is strongly influenced by environmental factors, mainly life experiences.
There is conflict in virtually every relationship: at any age, the offspring may want more from their mother than she should and/or wants to give, siblings are always in some competition, instincts of males and females do not complement each other, and particularly outside one’s nuclear family it is often difficult to ascertain when giving helps or hurts the receiving individual. However, among loving people and people who are inclined to negotiate compromises with a generous attitude, most conflicts are resolved without undue arguing and stress, and the participants, getting to know each other better, tend to bond. Much of the perception of negative stress and anxiety is derived from internal conflicts, uncertainty how to negotiate a danger, conflicts between different instincts and conflicts between instincts and multiple incongruous cultural expectations.
In a most simplified model, mental disorder may be seen as minds being ‘stuck’ in a place without the normal ability to shift one’s consciousness and thinking, e.g. in mania, the mind cannot move out of unrealistic optimism, in depression the mind may be overwhelmed and stuck with guilt, sense of worthlessness, maybe jealousy and other negative thoughts that interfere with normal enjoyments and with mental flexibility of problem solving. Mood disorders and neurosis keep the mind from moving “sideways” when manipulating data within the higher brain centers; in psychosis, there is often also a disturbance in “vertically” moving from present perceptions of sense organs to imagined and remembered perceptions, e.g. in hallucinations, fears may lead to remembered sounds and noises that become undistinguishable from actual present sounds in the environment; some visual impression that is vaguely reminiscent of a feared object may be seen as the actual object.11 People may be inherently predisposed towards some psychiatric disorder(s) but factors in the environment lead to the decompensation: there is no psychiatric disorder that is always seen in both of a pair of identical twins even though they often grow up in comparable or very similar environments. In all psychiatric disorders, supportive, structured, humane environments are beneficial in the course of the disorder; medications may or may not be very important. We must assume that in a close to “ideal” environment, mental disorders are rare or expressed in a much ameliorated form.

3.3.10 Resilience versus posttraumatic stress symptoms
Humans frequently suffer severe pain, physical and mental, but they generally are psychologically very resilient. Although people perceive severe pain, losses and danger of death as extremely aversive, even extreme experiences are usually processed and eventually become distant memories that do not directly influence later daily life. Knowledge of uncertainty or even likelihood of further adversities are accepted. People live as if they were safe. Some pains and danger are even perceived as making life positively exciting, and people may put themselves purposely into dangerous situation.
An important aspect of mental health consists in living largely in the present, accepting oneself as what one is, enjoying what is positive and accepting what is negative. The past is understood and accepted as unsure memories, some beautiful many neutral, mixed, sad and bad. Conflicts of the past should be processed into grief over losses and lost opportunities, sorrow about having made mistakes and having hurt others, etc. Past suffering may be understood as “normal” in a very uncertain world and as contributing to the person’s growth, something that shaped the present person and sometimes a source of pride. The future is always unpredictable, but people influence it powerfully and may feel good about moving developments in a positive direction.
It appears that in the Western civilizations, people lost much of their natural resilience. This may be due to children being taught to have unreasonable expectation, children no longer learning to meditate, having little exposure to nature, no balance between artistic, academic, strenuous physical activities (including sports), etc. Children’s natural fear of injuries and pain is often reinforced, particularly in girls. Adults often emphasize how they protect children and how children ‘deserve’ acknowledgements and rewards.
Western people today appear overly focused on negatives: while experiencing positive emotions, they are much distracted by negative thoughts; while experiencing negative emotions, they tend to ‘fuse with’ and seemingly become the negative emotion, unable to add an opposing thought that may put facts into perspective. In the Third World, many poor people appear much more focused on what is perceived as positive at the moment; people seem to have mostly apprehension, not severe fear and negative stress regarding future dangers and anticipated suffering and losses.
In posttraumatic pathologies, including depressions, eating disorders, posttraumatic stress disorder (PTSD) and panic disorder12, the person’s resilience appears impaired; uncertainties and dangers encumber the perception of the present and lead to dread concerning the future. PTSD is more pre-traumatic than posttraumatic: the patient no longer tolerates the possibility or likelihood of further physical and emotional suffering.
The flood of negative news has often been blamed on Westerners frequent negative thoughts. While we know of much suffering in the world, we generally have today much more distance from others’ suffering. In contrast, most Africans, particularly women, are continuously exposed to frightening situations, personally and affecting loved ones as well as many distant relatives and friends; in addition to ‘normal’ suffering and premature deaths related to poverty and inadequate healthcare, women are frequently abused by husbands and targeted in warfare. Even if they suffer much, they may feel some compassion for distant people they assume to suffer in similar ways as they do.
Culturally, American middle-class children are taught to have unreasonable expectations and ‘rights’, and people tend to be highly sensitive to criticism. For the very poor, there is the conflict between the idea of upward mobility and equal rights versus the reality that they and their families live essentially outside the dominant civilization: economically, socially, legally and politically, the rules of the region hardly apply to them. On the other hand, research indicates that compliments, rewards and prizes for any small accomplishment spoil the enjoyment of artistic experimenting or valuable volunteer activity. One research indicated that if a friend or coworker made one insulting and/or hurtful statement, many positive statements are needed to salvage a friendly relationship. In other cultures, occasional compliments and statements such as “I love you” are all that is expected even if a relationship is in some ways abusive. A European teacher may criticize a student frequently while assuming that a good performance is self-rewarding, not needing particular praise.

3.3.11 Posttraumatic stress and related mental health problems
Chronic posttraumatic symptoms, such as a continuous underlying feelings of loneliness and insecurity, with frequent nightmares, flashback experiences, and other symptoms, seem to result from situations in which personal and cultural expectations clash with the actual events; this disparity interferes with the processing of adverse events. Even a minor trauma, if incompatible with cultural expectations, may lead to posttraumatic stress disorder (PTSD), e.g. in case of extreme humiliation or minimally violent sexual abuse; in contrast, fear of death and extreme pain rarely lead to lasting posttraumatic symptoms, if considered “normal”, e.g. in mountaineering accidents, in ritual initiation practices or during childbirth. In PTSD, there is usually some guilt, shame, and/or disgust, and there is terror or horror: the victim seems to lose basic trust in humanity, nature, spiritual-religious meaning, and/or belief in protection by God and/or other spiritual beings. A victim’s horror may include the perception that unbearable meaningless pain has no foreseeable end or may recur at any time. PTSD related symptoms may include anxiety and panic attacks, at first triggered by an unlikely danger and later for seemingly no external reason, apparently initiated by something associated with the previous trauma, some memory and/or a thought. Sometimes patients dissociate: different parts of the mind lose their associative connectedness, e.g. a women feeling like she is again the abused girl she was, the self may feel like she is leaving the body and looking down on a victimization, or parts of the body feel numb or are not felt at all. Borderline personality features, seeing everything ‘black and white’ rather than naturally nuanced and multifaceted, is a frequent consequence of traumas, with or without typical PTSD symptoms, and sometimes reinforced by the culture. Patients may try to control aspects of their lives in dysfunctional ways, leading to eating disorders and/or opioid, alcohol and other addictions. There may be a sense and/or the reality of becoming an outcast, being abandoned and rejected by family or their social group. Both, perpetrators and victims of acts violating cultural norms are often disdained.
Having felt much fear and/or pain always leads to two contradictory responses: sensitization, a sense that the pain and danger were worse than one could have imagined and that one will hardly be able to tolerate something similar another time, versus desensitization, an awareness that one survived and possibly a certain pride and feeling that the experience was in some way meaningful, maybe allowing a sense of solidarity and belonging within a new group of people who suffered the same. In PTSD, the sensitization prevails; however, after most traumas, the person eventually perceives mostly a desensitizing development, particularly if there is not a succession of traumatic events. Still, some people have long-lasting episodes of high anxiety and depression following a major trauma.
In PTSD, overwhelming negative stress, pain, horror with sense of being abandoned, shame, guilt, disgust, and associated memories stay unprocessed; dissociated memory fragments may be hard to access but are often triggered by unpredictable stimuli. Acute, temporary posttraumatic symptoms are normal in any situation of extreme pain, fear, sense of abandonment, etc., but if the experience can later be seen as purely accidental or, as “normal” within the culture, symptoms usually resolve. If the meaning of a trauma changes after it occurred, processing and healing may start or be disrupted.
People who are indirectly involved with trauma victims, e.g. working with them and trying to help, may sympathetically experience symptoms of PTSD, including horror, disgust, shame, guilt, consequent nightmares, etc.13Torture often includes helplessly observing loved ones being abused and/or hearing others screaming in pain.
Change of meaning of a traumatic event is probably frequent. Young girls were often married to a ‘proper’ husband they hardly knew, they were generally taken away from their supportive family, and they purposely were kept uninformed about sex, pregnancies and childbirth. The meaning of these traumatic experiences radically changes when women learn to see them as ‘normal,’ the ways of starting her family. Female genital mutilation and painful procedures in rites of passage of young people are usually feared and experienced as traumatic but later accepted or appreciated for making them fully accepted and respected among adults. While today fear pain is often reinforced in children, they learn to readily accept and appreciate immunizations, getting braces for tooth position corrections, etc.
Vulnerability to chronic posttraumatic symptoms may have some genetic component. Research indicates that it is increased if there was significant early life stress14 or if comparable experiences are repeated before the previous victimization was adequately processed. Reduced size of amygdale and hippocampus may be cause and/or effect of PTSD and related disorders; treatment may lead to normalizing these brain functions and increased size of these nuclei.
The desensitizing response to traumas, particularly if repeated, occasionally leads to masochistic activities, the persons becoming proud of their ability to tolerate high levels of pain. Hormonal responses, particularly an increase in endorphins probably contribute to an addictive quality of experiencing significant pain. People who perceived sympathetic trauma when observing or learning about others’ severe pain may want to test their own ability to tolerate intense and/or prolonged pain. These may be a factor in the frequent addiction to getting large tattoos, and the people may simply claim that they like the tattoos, even though they obviously can hardly see them.
Related to posttraumatic symptoms is chronic anger and despondency in persons who feel treated unjustly, by society and/or by fate. Inability to accept lack of justice in human institutions and nature interferes with the mental processing of privations and suffering.

3.3.12 Abuse-addiction
Abuse and addiction behaviors are learned but soon feel natural, like instincts or cultural rituals. Abuse behaviors consist in actions that make the person feel better, but there is some knowledge that the action cannot be justified, is harmful and/or unethical. Unless this knowledge is supported by emotions that are stronger than the emotional force of the abuse behavior, the abuse behavior cannot be stopped.
Addicting drugs rapidly lead to a good feeling, comparable to natural feelings of instinct fulfillment. Effects of tranquilizers imitate deserved rest and relaxation after good work or having achieved peace; psychostimulants feel like anticipatory excitement, as if being just about to reach a momentous goal; opiates feel like a lonely person is now accepted and nurtured by loved ones. Abusable drugs are self-reinforcing, often causing people to neglect much of their normal life. And drugs reinforce what the person felt, thought, and did shortly before and while using them, which often includes bad feelings, distorted thoughts, and unethical actions. Abuse behaviors and abuse related thoughts tend to spread like a mental cancer, invading and corrupting more and more activities of the mind, from perceptions and emotional responses to thoughts, urges and behaviors. When addiction related thoughts and urges become a first priority, abuse becomes addiction: the abuse pattern always competes with other important aspects of life. Drug abuse behaviors often include unjustifiable risks and damage to health. Addictions curtail patients’ mental development; they maintain or return individuals to adolescent conflicts, including rebelling against versus learning from previous generations, overconfidence and risk taking versus insecurity, selfishness versus idealism and compassionate empathy.
Other forms of abuse develop in similar ways as drug addictions. Inappropriate behaviors that lead to some instinctual gratification are repeatedly acted out without adequate consideration of the problems they are likely to cause. The instinct fulfillment may be direct or indirect; instincts may be perverted; and cultural learning is involved. Examples include eating calorie-dense food when anxious but not hungry; resting on cozy sofa when bored but not tired; buying to relieve tension and feel important; accumulating goods and wealth while ignoring ethics; mistreating others to relieve anger and tension; engaging in exploitative and dangerous sex; gambling with the excited expectation of imminent wealth and importance; and enjoying and vicariously participating in aggression when reading, watching movies or playing video games.
Abuse-addiction is the antithesis of sensible and above all ethical living. It competes with nature and culture and makes unethical thinking and behaving feel normal, even rewarding. Drug abuse prevention must emphasize positive motivation to live ethically, following social instincts and culture, empathetically considering consequences of one’s actions on others. Former addicts must move addiction behaviors to their personal taboos: while impulses cannot be avoided, starting to enjoy memories and thoughts should bring an immediate feeling of displeasure, shame, guilt and disgust; people must deepen an insight that abuse behaviors are outside their values, that reevaluating available information will always confirm that insight.
Drug abuse-addiction functions essentially as an artificial instinct that is acquired and becomes part of one’s personal culture. Obviously, there is no instinct that lets people find and ingest addicting drugs; like cultural ways of eating, drug seeking includes learning and planning. The language used when describing instinct fulfillment and instinct-related feelings is the same as language used when talking of drug use; and drugs compete with instinct-related behaviors with addicted persons sometimes favoring instincts, sometimes addiction patterns. Reward feelings with drug use and instinct fulfillment are essentially identical. Sometimes, drug abuse is perceived as positive for own future, facilitating ability to carry out a necessary job, avoiding a deep depression, etc., even if the abuser knows that benefits hardly outweigh long-term harm and risks.
To overcome the craving of an abuse pattern, an emotion is needed that is stronger than the urge to abuse. People often assume, wrongly, that the patient must be ready to stop the pattern for him- or herself. In reality, willpower to make difficult changes is usually derived from love for close relatives and friends and thoughts of future loved-ones. Social instincts and personal ethics provide powerful emotions to counter an undesirable instinctive or abuse-addiction behavior; people generally do best when thinking about others: loved ones, potential future partners, children not yet born, their community. In an experiment, a monkey stopped eating a banana, when a monkey in an adjacent cage was shocked every time he (or she?) wanted to take a bite. The daughter asked her mother (one of my patients) to stop smoking in place of gifts for her 11th birthday, and a little boy told his grandfather that he did not like his smoking. Both stopped and did not relapse.

3.3.13 Prevention of anxiety and mood disorder, quality of life
Many factors influence a person’s propensity towards neurotic developments. Particularly children need stable attachments. Parental figures provide functions of teaching and critically guiding play (usually same gender parent) and unconditional loving and appreciating children as human beings (often mainly function of opposite gender parent). In most societies, girls have not received adequate unconditional appreciation by parents, probably contributing to frequent anxiety and mood disorders in adolescence and adulthood (compare 2.1). Important aspects of education are often neglected, including the teaching of ethics, particularly broad empathy, avoiding us-versus-them thinking and avoiding the elaboration and enjoyment of unethical thoughts, understanding of the other sex, problem solving and mediation skills, and learning healthy lifestyle habits that include contact with nature and meditation, with or without self-suggestions. People greatly benefit from learning awareness meditation, learning to keep some distance from negative feelings, emotions and thoughts, being nonjudgmental while fully experiencing and accepting the present. While appreciating the present, people may sincerely set new goals and plan changes, recognizing that working conscientiously towards goals is more important than reaching them.
Supportive social networks and a healthy lifestyle are beneficial, generally decreasing symptoms of most psychiatric disorders, improving physical health, and increasing pain tolerance. Many forms of psychosocial, psychological, and psychiatric treatments are helpful. Behavior modification techniques, used in teaching and psychological treatments, may be problematic; they often rely on physical and psychological behaviors as rewards that may lead to abuse-addiction (e.g. eating sweets, money-like tokens). Even hugs, as rewards, may be problematic: children may start craving the friendly, warm feeling of hugs, which during adolescence may lead to misunderstandings. Particularly in children, behavior modification may also decreases their self-esteem when adults focus on results of behaviors rather than the essence of their humanness. Probably best behavior modification techniques are seemingly spontaneous, unpredictable positive reinforcements and generally ignoring undesired behaviors; when an established negative consequence is applied to spoil the pleasure of an unethical act, the parental figure should not show any emotion. Non-contingent, spontaneous giving strengthens a person’s sense of self-worth.
To feel good, people must accept realities that cannot be changed, as well as uncertainties, past, present, and future. Healthy, positive anxiety, positive excitement, and enjoyment result from wholehearted appetence behavior, that is, from looking for opportunities to express social and other instincts, and from generally ethical, culturally appropriate expression of instincts. Unhealthy lifestyles and problematic social environments contribute to unfavorable inborn propensities becoming mental health problems.
Naturally, pain and suffering do not significantly influence human behaviors, unless they lead to posttraumatic stress disorder and depression, but they are important factors in people’s quality of life. Treatment of all medical and psychological-psychiatric disorders, as well as preventive and palliative care, is very important in improving the health and quality of life in a society.
Generally, it is very difficult to assess the quality of life of a people. Reading old texts, we may perceive the great similarity between us modern people and people of previous centuries and millennia when we observe and empathize with described emotions and aspirations, conflicts, emotional suffering, etc. We easily forget about how primitive their dwellings were, how hard they worked, and mainly how they lacked any form of effective medical treatments or palliative measures when severely injured, dying of infections or cancer, etc. While we occasionally grieve the loss of a very close person, families used to continuously loose children, siblings, parental figures: virtually everybody was part of large nuclear and extended families but premature deaths at all ages were very frequent. Major and minor surgeries and many ritual scarifications and mutilations have been performed long before or purposely without anesthesia, and any infection could lead to a very painful death. Many women died in childbirth and from pregnancy complications. In all civilizations, people have often unnecessarily hurt each other emotionally and have often made others’ and their own lives physically distressing. In spite of the frequent severe physical suffering with danger of death, people often flourished, found meaning in striving to have families and/or reaching higher rank, living honorably and resolving conflicts according to the rules of their cultures, etc. A sense of meaning in life and seeing beauty in people, relationships, rituals and art may be most important.
To alleviate stress caused by cultures and inherent conflicts, meditation may be most helpful; meditation includes not judging events, other people and oneself; it may lead to practicing an accepting and forgiving attitude. Even if rationally believing that there is no reason for guilt, people often feel guilt or that others are guilty because humans are designed to reason as if there were free will. Rituals and symbolic acts of compensation may be helpful. If there is posttraumatic stress, activating the right brain hemisphere appears important: activities in nature, observing open fields, plants, birds, etc.; meditation, alternate nose breathing, and particularly the psychotherapeutic technique Eye Movement Desensitization and Reprocessing (EMDR); sometimes other alternate side stimulation help, such as looking briskly around while walking or looking out a train window and seeing objects pass from one to the other side of one’s visual field.
In short-term and long-term planning, it is also important to think in bands of first, second and third priorities, always considering first priorities, such as taking loving care of family, doing good work at a job and staying ethical, before engaging in second priority activities, such as non-professional art work or gardening or third priority pastimes. If impulsively doing lower priority behaviors, there are often no adequate resources, particularly time, for first priorities (comparison: when attempting to fill a jar, the full jar representing a full life, we cannot start putting sand and gravel into the jar, otherwise large rocks will not fit. Starting with the big rocks, gravel can then fill spaces in between and later sand can still fit between gravel.)
In the USA, many young people no longer see adolescence as a critical time to learn, grow emotionally and find meaningful goals for one’s life; instead there is the widespread idea that youth is mainly to be enjoyed by ‘hanging out’, playing video games and enjoying alcohol, drugs and ‘casual’ sex. That girls/women have twice as much anxiety and depressive disorders in much of the Western World is partly due to earlier discrimination; women had not simply different roles, they were often targeted for abuse. More recently, the ‘sexual revolution’ has been a ‘boom’ for males at the cost of women. Young girls are often pressured into premature sexual activity and may think that they are ready to be sexually active and believe that with birth control they will enjoy experimenting like boys can; however women’s emotional system does not know that there is contraception (in addition, birth control sometimes fails; since the ready availability of contraception, abortions increased in many places). Girls cannot enjoy promiscuity as men may; promiscuity in young women is usually due to pathological developments and hardly enjoyed.
Many people believe that unethical thoughts are o.k., thinking that 99.99% of people may never do what they vicariously act out in video games, but that would leave one in 10,000 who may – which means thousands of young men. People who are very tired, in extraneous circumstances or intoxicated do not invent crimes, they are likely to do what they worked out and enjoyed previously in their fantasies, be that shooting a desperate person who may want to steal, sexually assaulting some homeless person or becoming renowned as mass murderer. Obviously, unethical fantasies also damage human relationships: violent or inappropriate sexual thoughts about co-workers or in-laws interfere with empathetic understanding and with developing more than very superficial friendships. And the risk of acting out violent fantasies is increased in socially isolated angry persons and possibly also in persons with autistic features.

3.3 Appendix
Position of women, biology and cultures:
Biologically and exacerbated by cultures throughout history, girls loose independence and move into a more passive, subordinate or victim’s position when growing up. Women maintain child features, which are seen as beautiful, being generally smaller with less pronounced muscles, round head shape, soft skin with little body hair. To enhance their attractiveness, adolescent girls may emphasize child features by acting insecure and hesitant, as if seeking guidance or approval from boys; women may remove body hair and occasionally seek surgery to shorten their nose. Unless very athletically inclined, women also want to be admired for their breasts and female figure, signals of procreative functions that remind people that pregnancies and infant care decrease mothers’ ability to move freely, follow whims and live independently. Young women have no control over the fluctuations of their hormones with premenstrual psychological vulnerabilities and menses that are often painful, particularly if there is endometriosis. Girls become attracted to strong, sometimes paternal, males who could easily abuse and even kill them.
Evolution led fear and submissiveness to rather enhance girls’ sexual feelings and attraction to strong males at a time when they may not know much about sex and reproduction. In the development of humans, adolescent girls have been unique among mammals: while getting close to an attractive male felt ‘right,’ girls had some understanding that sex was probably painful and ultimately outside their control, that childbirth is dangerous and extremely painful, and that they have little control over their reproductive functions and were likely to have many children. While following their instincts feels right, girls appear largely in denial about what they actually know. Until recent decades, there was no effective contraception for women and hardly any pain relief during childbirth; the term marital rape did not exist. Today, girls have more control, but there is also much more pressure to allow and engage in sex during early dating; uninvited intercourse, often without good protection, and violent date rape are still frequent. Since availability of effective contraception and the women’s liberation movement, it has been widely assumed that the natural differences between boys and girls are minor, that differences in interests result from cultural influences, and that boys and girls should equally enjoy sexual experimenting and casual sex. Biologically, with the much larger investment in offspring, girls naturally are much more discriminating, wanting to ‘test’ a boy for some time before becoming ready to invite sex; the emotional system does not “know” of contraception.
In many cultures, girls are actually taught to fear pain as in case of small injuries, and that any form of intimacy will be embarrassing and shameful or disgusting. Sex education has often been limited to warnings about girls protecting their physical virginity. While marriage was essentially required, the freedom to choose a partner was usually restricted by cultural dictates and often by requiring parental consent.
In most animals females choose a male partner and must invite mating; males have to ‘dance,’ show strength, grow antlers or beautiful feathers, etc. to be attractive, while females tend to be inconspicuous, which is safer. Females virtually always succeed getting an apparently desirable male partner when ready for sex. In contrast, human boys may rape any girl, attractive or not, if she is alone; sometimes males abducted and raped an attractive girl, and, in many cultures, then could marry her. For this reason girls are taught to be cautious, being with relatives or friends whenever in unprotected places. More importantly, human girls greatly benefit from being beautiful rather than inconspicuous, so they are attractive to many available males and they can participate in choosing a good partner. A chosen partner is expected to help protect her and future children. Young women may not find an interested, appropriate mate, particularly in monogamous societies, which, in conservative cultures, left them few options. Women who are perceived as unattractive and/or not desirable do better in polygynous societies, becoming a second or third wife to an average male, rather than having to settle with a most unfavorable one. However, if criminals and other psychologically disturbed men marry, they generally do better, though not good enough for a functional family; still, when married, they generally benefit from the relationship and they are less dangerous for societies.
When in a relationship with a husband, he, and sometimes his family, are likely to determine where the couple will live. Even in a desired relationship, there are conflicts; in intimacy, the woman has less control and there are often misunderstandings. Naturally, intercourse leads to hormonal responses that bond partners, and in arranged marriages, love may develop after marriage, but the woman often stays in her lower position, tied to their home with small children. However, women often exert power more indirectly, by ‘manipulating,’ or thanks to influential parents; men often learn that following their wives’ wishes is usually beneficial for a harmonious family life. Generally women have been controlling aspects of life that are less important to males. A more recent problem is that young women are aware that they have to decide relatively early whether they want to be married and/or have children, while a male may procrastinate in making up his mind about a committed relationship and starting a family. Even though more women attend higher education, including medical schools, the previously predominantly male world is not adjusting to the needs of women who have or want to have children; males are hardly able to replace the mother of a small child.
1  Richard E. Leakey:  People of the Lake, 1978, p. 111ff: Tribes, consisting of small groups, contain about 500 people.
Irenäus Eibl-Eibesfeldt Die Biologie des Menschlichen Verhaltens, dritte überarbeitete Ausgabe, Piper 1997, p. 421: Local groups of hunter-gatherer populations usually contain 30-50 persons; p.149:  Even today, intact gatherer-hunter societies consist of a few hundred people (about 500) with own language and traditions. In New Stone Age Planters, at most a few thousand form a people. Larger groups usually disintegrate into factions, which develop different dialects and fight each other.
2  Science, 1997; 277: 918-924 (15 August)  “Neighborhoods and Violent Crime:  A Multilevel Study of Collective Efficacy,” by Robert J. Sampson, Stephen W. Raudenbush, and Felton Earls. There are, of course, many cultural factors that contribute to the frequency of different types of crimes. Violence within families is quite frequent in most cultures. In Scandinavia all forms of violence are relatively rare though rising.
3  Eibl-Eibesfeldt Der Mensch – das riskierte Wesen, Piper, 1991, 97, p.155-176
4  Personal observation and interpretation of anthropological literature.
5  Personal experience in treatment of psychiatric patients.
6 Irenäus Eibl-Eibesfeldt Die Biologie des Menschlichen Verhaltens, dritte überarbeitete Ausgabe, Piper 1997, p. 149, 411ff, 447ff,840ff.
7 Konrad Lorenz, in Die Rückseite des Spiegels, 1973, Behind the Mirror, 1977, Harcourt Brace Jovanovich, p. 194, talks of groups seeing their own culture as “refined” and others as “crude” .
8  Ways of overstating girls’ characteristics that were desired in their culture probably developed as forms of competing, parents wanting their daughters to be more attractive to potential future husbands. Later the procedures became essentially considered conditions to be acceptable for marriage; they may have become more extreme; not mutilated children were considered unworthy, dirty, vulgar, etc. While exaggerating the girl’s femininity in culture-specific ways, such as impractical and uncomfortable clothing, foot binding, and genital mutilations ignore the natural instincts of mothers and adults generally: of all humans, girls in the age range, in which mutilating practices were/are performed, are perceived as most vulnerable and deserving protection.
9  There is often a connection between learning through rewards and addiction since rewarding experiences are misused.
10  Depression and chronic negative anxiety (undesired anxiety and anxiety with conflicts) may be considered different  symptoms of the same disorder. They share genetic predisposition and both respond to treatment with exercise regimens, similar forms of psychotherapy, and/or antidepressant medications. Generally, people seek anxiety and exciting novelty rather than quiet monotony, but conflict-induced anxiety leads to a response of negative stress with discomfort, vague fears, etc.
11  Many mental disorders may be conceptualized as strong propensity to hold on to or feel stuck with exaggerated perceptions and thoughts, including distortions of sensory experiences. However, most mental patients still ‘harbor’ normal perceptions and thought processes: if there is a disaster, most patients seem to forget their delusions or deleterious thoughts and act temporarily ‘normal’ and even if delusional about being rich and powerful, most still seek government assistance such as social security.
12  Panic and other anxiety disorders typically start after major traumas. The patient feels generally uncertain and easily exaggerates any minor danger, such as bridges collapsing, being crushed by a crowd, or being confronted by strangers about suspicious behaviors.
13  Sympathetically experienced physical and psychological trauma, when hearing or reading reports, may lead to PTSD symptoms, e.g. in children, therapists, and journalists. Realistic and historical fiction, theater and movies may lead to PTSD symptoms.
14  Psychiatric Annals, 1/2003, 33/1, p. 18-29: Neurobiology of Early-Life Stress, by Christine Heim, et al.

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