In this Papers Podcast, evolutionary anthropologist Dr. Nikhil Chaudhary and consultant child and adolescent psychiatrist Dr. Annie Swanepoel discuss their co-authored JCPP paper ‘Editorial Perspective: What can we learn from hunter-gatherers about children’s mental health? An evolutionary perspective’ (doi.org/10.1111/jcpp.13773).
The paper explores a possibility that some common aspects of hunter-gatherer childhoods could help families in economically developed countries.
There is an overview of the paper, methodology, key findings and implications for practice.
Discussion points include;
- The importance of comparing hunter-gatherer childhoods to the childhoods we see in economically developed countries (referred to as WEIRD countries).
- What the acronym WEIRD stands for.
- The caveats to be aware of when comparing hunter-gather childhoods to WEIRD childhoods.
- The types of different approaches to childcare that emerge from comparing hunter-gatherer childhoods to WEIRD childhoods.
- The potential implications of the different approached to childcare on child and adolescent mental health.
- The implications on education systems in WEIRD countries.
- The potential policy implications and implications for CAMH professionals.
In this series, we speak to authors of papers published in one of ACAMH’s three journals. These are The Journal of Child Psychology and Psychiatry (JCPP); The Child and Adolescent Mental Health (CAMH) journal; and JCPP Advances.
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Dr. Nikhil Chaudhary is an Assistant Professor in Evolutionary Anthropology at the University of Cambridge. He completed his PhD at University College London as part of the Hunter-Gatherer Resilience Project which examined the genetic, behavioural and cultural adaptations of African and Asian hunter-gatherers. His research thus far has focussed on the evolution of human social behaviour and our hyper-cooperative tendencies. He is currently interested in how evolutionary thinking can help us understand the risk factors for, and prevalence of, different mental disorders; and is an executive committee member of the Evolutionary Psychiatry Special Interest Group at the Royal College of Psychiatrists.
Dr. Annie Swanepoel is a Consultant Child and Adolescent Psychiatrist in NELFT, in a team that works with children with severe to profound intellectual disability across Essex. She is the Newsletter Editor for the Evolutionary Psychiatry Special Interest Group (EPSIG) at the Royal College of Psychiatrists. She is interested in neurodevelopmental disorders, developmental trauma and how a knowledge of evolutionary science can help us understand and manage these better.
- Featured paper ‘Editorial Perspective: What can we learn from hunter-gatherers about children’s mental health? An evolutionary perspective’, (2023). Nikhil Chaudhary, Annie Swanepoel
- Blog ‘Hunter-gatherer childhoods may offer clues to improving education and wellbeing in developed countries, Cambridge study argues’ by Dr. Nikhil Chaudhary and Dr. Annie Swanepoel
[00:00:01.390] Mark Tebbs: Hello and welcome to the Papers Podcast series for the Association for Child and Adolescent Mental Health, or ACAMH for short. I’m Mark Tebbs, Mental Health Commissioner, Leadership Coach and Freelance Consultant. In this series we speak to authors of papers published in one of ACAMH’s three journals. These are the Journal of Child Psychology and Psychiatry, commonly known as JCPP, the Child and Adolescent Mental Health, known as CAMH, and JCPP Advances.
Today I’m interviewing Dr Nikhil Chaudhary, an Evolutionary Anthropologist at the University of Cambridge and Dr Annie Swanepoel, a Child and Adolescent Psychiatrist at North East London Foundation Trust. They’re authors of a paper entitled “What We Can Learn From Hunter-gatherers About Children’s Mental Health? An Evolutionary Perspective,” which was recently published in the Journal of Child Psychology and Psychiatry. The paper explores the possibility that some common aspects of hunter-gatherer childhoods could help families in economically developed countries.
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If we start with some instructions. Could you maybe say who you are and what you’re currently doing?
[00:01:14.650] Dr Nikhil Chaudhary: I’m Nikhil Chaudhary and I am an Assistant Professor in Evolutionary Anthropology at the University of Cambridge. My work has generally been conducted with hunter-gatherer societies, principally the Bayaka Pygmies from the Republic of Congo, and in the past, it’s mainly been focused around trying to understand how human social behaviour evolved in the benefits of social relationships over our evolutionary history.
[00:01:44.909] Dr Annie Swanepoel: And I’m Annie Swanepoel, I’m a Consultant Child and Adolescent Psychiatrist. I work full-time in NELFT, in the NHS, currently in Essex, with a fantastic team, and we look after children with severe learning disability. And I’m also a member of the Evolutionary Psychiatry Special Interest Group and the Newsletter Editor there.
[00:02:09.590] Mark Tebbs: The paper’s fascinating, I have to say. I’m just wondering what brought you together to produce the paper?
[00:02:16.450] Dr Annie Swanepoel: Well, Nikhil joined the Evolutionary Psychiatry Special Interest Group because we realised that we needed Anthropologists onboard to give it credibility and to make sure that we were on the right track. And Nikhil then, at one stage, mentioned that he had done this research with the pygmies in the rainforest, and he was looking for a Child Psychiatrist to join him, so I jumped at the opportunity.
[00:02:42.370] Mark Tebbs: Could you start by just giving us a overview of the paper?
[00:02:46.780] Dr Nikhil Chaudhary: So, I ought to mention that in this paper, although me and Annie have been working on data I collected with the Bayaka, who reside in Congo, here, we’re just discussing aspects of other hunter-gatherer groups, not just the Bayaka, and we’re mainly focusing on comparing hunter-gatherer childhoods with those childhoods that we see in economically developed countries. We actually refer to them as “WEIRD countries” which is an acronym that many Anthropologists use, and that stands for Western Educated, Industrialised, Rich and Democratic. It’s an apt name, because the way we live in WEIRD societies is very distant from the way our species has lived across time and space in our pre-history, our history and in other parts of the world.
So, the reason we thought it’d be important to compare hunter-gatherer and WEIRD childhoods is because we lived as hunter-gatherers, for the vast majority of our species’ evolutionary history, more than 95%. And there’s this concept in evolutionary biology of evolutionary mismatch, which is if certain systems or traits that have evolved in a species, they will always have evolved to function in a particular environment. And if an organism then faces environmental conditions, if they’re really different to those conditions where certain aspects of their biology or psychology evolved to function in, then there’s this possibility for maladaptation, or in the case of when we’re thinking about psychiatry, of mental disorder.
The focus here was comparing the childcare systems and the education systems with how hunter-gatherer childcare happens and how hunter-gatherer children learn and then, thinking about the implications of this for children’s mental health in WEIRD societies.
[00:04:50.669] Mark Tebbs: I’m just wondering, are there any, kind of, caveats that we need to be aware of when we think about these types of study?
[00:04:58.770] Dr Nikhil Chaudhary: Yes, there are a few things I’d like to start, which all listeners should bear in mind. First and foremost, of course, because our paper is on evolutionary mismatch, we’ll be thinking about aspects of WEIRD societies that may potentially be partially responsible for various psychological problems in children. But from that, we shouldn’t extrapolate and assume that all aspects of hunter-gatherer societies are ideal and, of course, children in these societies face many difficulties that children in WEIRD societies don’t face.
And then, when we’re thinking about hunter-gatherers, couple of important things to note. One is although I’m going to be referring to hunter-gatherer societies, there is so much variability, just as there is amongst WEIRD societies. So, we don’t want to treat all hunter-gatherer societies as having some uniform lifestyle, but there are general trends we see, which are shared amongst hunter-gatherer societies, when we consider them in contrast to WEIRD societies. And also, it’s important to note that hunter-gatherer societies aren’t living fossils, so to speak. They are modern populations, just as we are a modern population, and they have their own history. It’s simply the fact that their subsistence relies on hunting and gathering, just in the way that ancestral populations relied on hunting and gathering, that allows us to get some insight into human evolutionary history.
And then, the final caveat I’d like to give is that although we are discussing potential evolutionary mismatches, these are really just hypotheses that require testing at this stage. Because one of the things that is so special about our species is the level of flexibility and plasticity we have, which means that our neurology, our endocrine system, our psychological mechanisms and ultimately, our behaviour, can respond very flexibly to the environment. There’s a lot of phenotypic plasticity and as such, in many cases, we may not encounter evolutionary mismatch, just ‘cause the environment has changed a lot. But there are certainly traits where we do see evolutionary mismatch and that’s why it’s important to actually test these ideas and identify the level of plasticity and whether mismatches actually exist.
[00:07:34.630] Mark Tebbs: That’s really, really helpful. Thank you for that. So, could you go on and describe your methodology?
[00:07:41.330] Dr Nikhil Chaudhary: As I say, they’re – I’m talking about hunter-gatherer studies in general here, of which our – I’ve conducted one with the Bayaka. But when we’re studying childcare, the most typical method employed is Altmann 1964 method. It’s referred to, based on a previous study, which is quite soul destroying for the Researcher. You’ve, basically, got headphones on and for 20 second – the audio will say ‘observe’ and then they’ll be a 20 second interval and then they’ll say ‘record’ and there’ll be a ten second interval. So, you’re listening to that, while watching the focal child and then, every 20 seconds, you watch everything that happens in that child’s world, who they interact with, what sort of interactions are happening, are they asleep, are they crying? And then, for the other ten seconds, you make notes of all of this, and then, you do that for 12 hours for each child and you even split that 12 hours across three different days, to avoid biases that might arise from atypical days.
So, you get this really high-resolution insight into what’s going on in a given child’s world and then, you put all this data together, for many different children, and can work out the average type of day that a child, in a given society, encounters.
[00:09:07.019] Mark Tebbs: So, one of the themes that have, kind of, come from the study, and different approaches to childcare. So, what were some of those main differences and what’s the potential implication for children’s mental health?
[00:09:18.260] Dr Nikhil Chaudhary: Often, the hunter-gatherer childcare is described as ‘indulgent’ or using terms that we might use in Western psychology, is ‘child-centred’. And as I say, their variation both between societies and within societies in both WEIRD context and the hunter-gatherers, but let’s just identify some of the differences in what the average child experiences.
Firstly, hunter-gatherer children, or if we’re talking about infants at this point, are virtually never alone. They’re living in these camp settings, there may be 50 odd people in a camp and a hunter-gatherer child is always within close proximity to a caregiver. They breastfeed on-demand, a lot of variation across hunter-gatherer societies, but usually, they’re weaned somewhere between the ages of two to four. Levels of physical contact are extremely high, and an infant will be touching a caregiver for almost all of the day and a lot of this, given the attire, is skin-to-skin contact. When a caregiver’s on the move, the infant or young child will be carried in a sling.
And then, the final thing to mention is the level of responsiveness. A few studies have considered responsiveness to distress or crying, and we see that the vast majority of instances of crying are responded to. So, babies and young children are very rarely left to cry it out. Those responses happen very quickly, usually within half a minute and they’re again, very child centred. Those responses aren’t scolding or restricting the child’s behaviour. Rather, they are attending to the child’s need.
And when we contrast all of these features with WEIRD societies, WEIRD infants and young children will probably be alone for more of the day than hunter-gatherer children. They’ll probably experience not so much physical contact in contrast to the hunter-gatherer children, certainly less skin-to-skin contact and levels of responsiveness are much more variable. So, you may have some WEIRD children who receive really rapid and consistent responses and other WEIRD children who are left to cry it out.
[00:11:35.940] Dr Annie Swanepoel: And for me, as a Child Psychiatrist, I found this information really interesting when I first heard about it, because the children are carried literally for hours every day. Some of the research shows that infants under 18 months are being carried for seven hours per day. So, these are really numbers which, in WEIRD societies, are unthinkable. We just don’t tend to do that. The difference, of course, is that in WEIRD societies, if babies are put down to sleep, they are, objectively, safe. We’re not leaving them in a jungle. We’re leaving them in a bedroom and in a cot.
These differences and the objective safety make that children aren’t getting what they might be predisposed to expect, from an evolutionary perspective, and there are things which we can do which might help, because also, thinking about the amount of touch that children in hunter-gatherer societies get. If we are aware of that, we can make an effort to do more holding of infants and touching, and there are things like infant massage, carrying babies in a sling, which would be, actually, cheaper than buying fancy pushchairs and might improve the amount of children who have a secure attachment, and that has benefits as well on their future cognitive and emotional development.
[00:13:12.980] Dr Nikhil Chaudhary: One more thing to say is that, well, particularly the infant massage, as Annie points out, has been associated with positive attachment outcomes, but interestingly, it’s also been associated with a reduced maternal depression, as well. So, it seems that these potential predispositions are not just for the baby, but also for the mother.
[00:13:36.710] Mark Tebbs: In hunter-gatherer societies, there would be, kind of, more caregivers involved in bringing up a child, compared to WEIRD societies. Could you describe that difference and what that could mean for more Western parenting?
[00:13:52.139] Dr Nikhil Chaudhary: Evolutionary Biologists and Zoologists consider species where individuals other than the mother, or in some cases, other than the parents, when they are important in raising children, so we call these individuals allomothers or alloparents, those species are referred to as “co-operative breeders.” As the name suggests, it means that raising children is very much a shared activity and it doesn’t just fall upon the mother. It’s almost certain that humans have been co-operative breeders over our evolutionary history. This is considered a really core adaptation of our species and that’s reflected in contemporary hunter-gatherer studies, as well.
Usually, across hunter-gatherer societies, somewhere in the region of 40-50% of care will be provided by someone other than the mother. So, this misconception that it’s natural, so to speak, for a mother to have maternal instincts and do all the caretaking herself could not be further from the truth in terms of what has been the human condition. As I mentioned, hunter-gatherers are living in these camps of somewhere in the region of 35-70 individuals. As such, there’s plenty of opportunity for other caregivers to get involved, beyond the mother, in raising children.
And I always like to draw on an example of the Efé, who are another hunter-gatherer society, I believe from the Democratic Republic of Congo. It’s quite an extreme example, but it’s a nice demonstration of how important co-operation and allomothering can be amongst hunter-gatherers. So, Efé infants, at around four-months-of-age, they will have 14 allomothers. They will be passed amongst caregivers eight times an hour and they’ll be in physical contact with an allomother for 60-70% of the day. So, that really encapsulates how key non-maternal individuals are in raising children.
I ought to also mention that in many hunter-gatherer societies we see that young children get involved in childrearing. So, one of my colleagues worked with a Developmental Psychologist, where she was showing videos of young babies and caregiving by children and that Psychologist determined that amongst the Bayaka, a young four-year-old boy was capable of what we think of as sensitive caregiving. That boy was able to read the infant’s signals, understand the infant’s needs and attend to those needs. Four is really the lower bound and in many hunter-gatherer societies, children aren’t reported to get involved in childcare ‘til around the ages of five or six. But certainly, children are involved from a much younger age and…
[00:16:57.579] Dr Annie Swanepoel: And when I first heard about the level that – of care that alloparents give, I was absolutely astounded, because I knew, from my training in child and adolescent psychiatry, I knew about attachment theory. I knew that children need sensitive and responsive care. I’m a mother myself and I know how exhausting that can be to really provide for 100% of the needs that a baby has. And I was dumbstruck to hear that in hunter-gatherer societies, almost half of that care is provided by a person other than the mother and it’s divided amongst lots of different people.
So, that is so good for the baby, because it means that the baby’s needs can be fulfilled and it also is so good for the mother, because the mother isn’t exhausted and isn’t overwhelmed. And that is where I think this is really important research, because we’re not telling parents they’re not doing enough. We’re actually pointing out that parents in WEIRD societies are doing a lot more than a mother would in a hunter-gatherer society just because the mother in a hunter-gatherer society has got a lot more help, if we think in terms of the percentage of care that is given to a particular child. So, that has real implications for maternal depression, and it has implications for postnatal depression in reducing that and it has implications, once again, for children, in terms of developing a secure attachment and first giving them roots, before you let them fly.
[00:18:46.210] Mark Tebbs: Yeah, the difference is really stark, and I’m just struck by how parenting in WEIRD societies can feel very lonely, and that contrast to hunter-gatherer societies is very stark. I’ll move us on a little bit to the education system, as well, ‘cause the paper points out that instructive teaching is rare in hunter-gatherer societies and that infants primarily learn by our observation and imitation. So, could you unpack that for us and, again, sort of, tell us a little bit about what some of the potential implications are for the education system?
[00:19:20.669] Dr Nikhil Chaudhary: So, just like the allomothering and co-operative breeding, again, the way hunter-gatherer children learn is really key to understanding human adaptation, because actually, in the fact that we have these really long childhoods, when we compare our species compared to other great apes, other great apes reach maturity much earlier in adulthood and start reproducing much earlier. So, that Evolutionary Anthropologists and Biologists were interested in why humans have this long childhood and adolescent period, and one of the key theories is that hunter-gatherer subsistence are – our niche is so complex, so we’re not just relying on collecting grasses and leaves or searching for fruit. We’re extracting nuts, we’re hunting game, etc., and that led to the selection of this long developmental period, where we need to learn these skills. So, understanding learning is really key to understanding our species’ success.
I mentioned I’ve got a colleague who worked with the Psychologist on looking at those videos of sensitive caregiving by children. Her name’s Deniz Salali, and she’s also been really key in these studies of learning amongst hunter-gatherers and in my understanding of all of this. Generally, we see that, as you mention, instructive teaching is very rare in hunter-gatherer societies. When teaching does occur, it’s mainly feedback based or very subtle, like scaffolding, creating the situation for a child to pick up a skill. But principally, we see that infants learn through imitation and observation. Where I work, you can see children who – infants who have just started to walk, around one-years-old, experimenting with machetes. So, they’re giving them a lot of freedom to explore and learn by themselves, but also through copying others.
And generally, as they become a bit older and less reliant on their mother’s milk, they start spending most of the day with other children in these mixed age playgroups. We call them playgroups, but there’s no adult supervision, at least a lot of the time, there’s no adult supervision, and these playgroups can consist of children as young as two, right up to late adolescence. And in those playgroups, although they’re playing, they’re also picking up a lot of skills. So, the games they play, like hunting insects, are, of course, developing some of those skills they’ll need for real life hunting of game or climbing trees, then developing the skills required for certain foraging activities like collecting honey. And the games they play are very collaborative, rather than competitive.
And to contrast that with WEIRD education systems, on the one hand, we’ve got hunter-gatherer learning, which is peer-to-peer, rather than Teacher led and instructive. The hunter-gatherer is there learning in the context of these mixed aged playgroups, whereas in WEIRD schools, children are separated by age and ability. The learning is extremely active and exploratory, rather than a classroom setting, which is passive and sedentary, and fundamentally, play and learning are two sides of the same coin amongst hunter-gatherers. Whereas in Western classrooms, we’ve got this dichotomy of playtime and lesson time, where play and learning are strictly separated. So, those are the key differences.
[00:23:05.020] Dr Annie Swanepoel: Yes, and those have got tremendous implications, because our modern-day schools in WEIRD societies are perfect for children who are able to sit still and concentrate for hours every day, and it is no wonder that so many children struggle, because it’s not an evolutionary adaptation to be able to sit still and concentrate for hours every day. It’s an unreasonable expectation.
The other thing, which I think is really important, is the multi-age playgroups in hunter-gatherers, because as Nikhil mentioned earlier, even very young children can learn how to care for babies. So, it’s not just the younger ones who benefit from the older ones modelling what they are trying to learn. It’s also the older ones who are benefitting from having younger ones in their care, because they are learning to parent, and that will stand them in good stead when they have their own children.
So, if we think about the implications for our schools, what we need is for schools to allow children to be a lot more active and to bring in experiential learning, and I know of one school which has multi-age playgroups, which they called a “friendship group,” where they had two children from each form, this is a primary school, meeting each other once a week. And that had a very good impact on the school, because the younger children knew they had older children who were on their side and who would protect them, and the older children felt really responsible, and they felt they were young adults by having the younger ones to look after.
So, there are things, which can be done, which are cheap, which don’t cost any money and which could potentially help children across the board, as well as Teachers, of course. If you have happier children in the class, you have happier Teachers, too.
[00:24:58.840] Mark Tebbs: From that policy perspective, like, what are the potential policy implications of the work?
[00:25:04.340] Dr Annie Swanepoel: Well, I think if we think about the alloparents and how hun – in hunter-gatherer societies there are many more adults per child, looking after children is a family and a social responsibility, rather than just a parental responsibility. So, we need to be aware of that, because when parents are struggling, rather than blaming them for individual failure, we should be seeing that what is needed is more help, more input from other people. And there have been some fantastic initiatives, like the Sure Start Centres, which, in my view, should be restarted, and there’s plenty of evidence showing how effective they have been.
It would also be helpful for single mothers. If you think about those ratios, of our one person caring for several children, and also people working in nurseries, rather than the other way round. So, we really need to think about funding early childcare properly. I know in Germany they also have initiatives of placing nurseries next to old age homes, which can improve the pool of people who can help look after young people and which is also good for the older people, who then feel they have a purpose and whose lives are brightened by having young children around them.
And as I mentioned before, increasing the involvement of older children in learning to parent will be helpful for them, too. So, it’s not just a question of them babysitting. It’s a question of creating the opportunities for the younger ones to thrive, and it’s not necessarily direct instructional teaching which is needed. It’s more modelling and playing that allows younger children to thrive, and in schools, of course, as I’ve mentioned, multi-age playgroups, exercise, learning by doing and letting the older ones show the younger ones is really important. I have previously also spoken about ADHD and how that can be seen as an evolutionary mismatch, and we know that children with ADHD, if they are allowed to get exercise, that has positive implications on various different executive functions and their ability to concentrate. And if you think about the childhood obesity, as well, which is a significant problem, allowing all children to get more physical exercise in schools would be very important.
[00:27:41.270] Dr Nikhil Chaudhary: Something just occurred to me. When Annie was talking about placing nurseries next to old-age homes, just briefly to mention, one of the, sort of, paradoxes, or big questions, Evolutionary Biologists have tried to understand is the fact that humans have this really long post-reproductive lifespan. From an evolutionary perspective, the question is, “Why be alive if you can’t reproduce?” to put it bluntly, and we don’t see that in many other species. We do see it in some other mammals, for example, in orcas, but it’s rare.
And one of the key answers is focused around the fact that elderly individuals, particularly grandmothers, may have been able to increase their, what we call evolutionary fitness, their number of surviving descendants, because they can help so much in the rearing of their grandchildren. Again, it may be that elderly individuals looking after children and their grandchildren and other young children, has been so key over our evolutionary history, that that’s something we may have really lost in our society.
[00:28:54.480] Mark Tebbs: I’m just wondering whether you have any follow-up research or any other research that’s happening, in the pipeline?
[00:29:02.170] Dr Nikhil Chaudhary: A lot of these things we’re talking about are just ideas at the moment and they’re hypotheses that require testing, and I know we’ve mentioned a lot of potential solutions along the way, but they have to be taken with a grain of salt. Of course, there are certain aspects of hunter-gatherer childhoods that just wouldn’t be feasible to implement in this social and economic context we find ourselves here.
I think one of the first steps is to try and actually directly examine children’s wellbeing and psychological health in hunter-gatherer societies. We talked about some evidence that more skin-to-skin contact, or baby carrying, can have positive attachment outcomes or reduce maternal depression. Let’s actually go and try and examine attachment outcomes and rates of maternal depression in hunter-gatherer societies. And if we find that certain aspects of children’s mental health are better there, or you’ve got lower prevalence of psychological problems, then we really need to try and focus on identifying the key drivers of these differences and perhaps conducting experimental trials here.
As Annie said, there are all these potentially great applications in WEIRD schools, but again, the skills children need to learn are quite different here from foraging skills. So, it’s about identifying all those suggestions that we’ve made earlier, how practical, actually, are they? How much can we implement them in a way that still has positive learning outcomes and has positive outcomes for the children’s mental health?
[00:30:45.970] Mark Tebbs: Thank you, and are there any final messages, maybe, to CAMHS professionals who are working in the mental health system, or for ours – or for our listeners more generally?
[00:30:56.140] Dr Annie Swanepoel: I think there’s a very important quote from Dobzhansky, which says, “Nothing in biology makes sense without evolution.” Now, that is definitely also true for child mental health, and something which I learnt is that evolution is not about survival of the fittest. It’s rather about the goodness of fit between an individual and their environment. So, those who fit well in their environment have a better chance to survive and to reproduce. And if we think about our WEIRD societies, there are evolutionary mismatches, and by becoming aware of these, we can reduce it by being more aware of how things used to be and what we might be adapted to, keeping in mind all the caveats that Nikhil has mentioned.
So, what I would like to do is to invite all listeners to join the Evolutionary Psychiatry Special Interest Group, it’s EPSIG. It’s open to all professions, not just Psychiatrists, and if you are interested in this and want to see a bit more, you can look at videos on EPSIG.org. EPSIG is spelt E-P-S-I-G and you can join EPSIG by emailing email@example.com. I just wanted to say finally, evolutionary psychiatry is not different to normal psychiatry. It’s just keeping in mind evolution and gives us a more holistic view.
[00:32:27.760] Mark Tebbs: Brilliant. Thank you so much for such an interesting conversation. For more details on Dr Nikhil Chaudhary and Dr Annie Swanepoel, please visit the ACAMH website, www.acamh.org and at Twitter @acamh, ACAMH is spelt A-C-A-M-H. And don’t forget to follow us on your preferred streaming platform. Let us know if you enjoy the podcast, with a rating or review, and do share with friends and colleagues.