The relevance of hierarchies, territories, defeat for depression in humans: hypotheses and clinical predictions.
BACKGROUND
Hierarchical and territorial behaviour are widespread in animals and humans. The consequences of defeat have been linked to depression in humans. However, hierarchical and territorial behaviours are not mentioned in ICD10 or DSM1V. I therefore investigated the coverage in relevant textbooks.


METHODS
I searched the indices of books on Animal Behaviour, General Psychology and General Psychiatry for entries on Hierarchy, Territory and Dominance.


RESULTS
A paradox is revealed. Hierarchical and territorial behaviour are widespread in both animals and humans but are neglected in textbooks of human behaviour and mental problems. Four hypotheses are put forward to explain this paradox and explore its implications. 1. That hierarchical and territorial behaviours evolved before human consciousness. They are available to consciousness but not in the forefront of awareness. 2. That human hierarchical and territorial behaviour are overlaid by a cultural veneer of manners, which conceal the true state of affairs. 3. That humans have internal, mental, hierarchical aims in addition to external physical hierarchical aims. 4. That failure to achieve internal hierarchical aims may produce diminution of well being and changes in behaviour by the same biological mechanisms that are active in external hierarchical defeat. Three testable predictions follow from these hypotheses. 1. That there are common genetic factors and similar patterns of brain activity in homologous structures during hierarchical and territorial behaviour in man, primates and lower vertebrates. 2. That brain structures involved in external hierarchical conflict, consciousness and imagery will be active during internal hierarchical conflict. 3. Defeat of internal hierarchical aims produce depressed mood and satisfying alternative hierarchical aims are protective. Case examples are given to illustrate the existence of, and the consequences of defeat on, internal hierarchies.


CONCLUSIONS
These hypotheses and predictions are theoretical and require confirmation or refutation by neuroimaging and prospective studies.


CONCLUSIONS
A neglect of human hierarchical behaviour by clinicians is suggested and discussed. The concept of internal hierarchies, if confirmed, may throw light on human striving, the emotions of defeat and the therapy of depression.
Rohde
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South Kensington and Chelsea Mental Health Centre, 1 Nightingale Place, SW10 9NG, London, UK. rohdep@doctors.org.uk
D000328:Adult; D000368:Aged; D000818:Animals; D005075:Biological Evolution; D001921:Brain / Q000503:physiopathology; D001931:Brain Mapping; D003866:Depressive Disorder / Q000503:physiopathology / Q000523:psychology*; D004291:Dominance-Subordination; D005260:Female; D006380:Helplessness, Learned; D006608:Hierarchy, Social; D006801:Humans; D007389:Internal-External Control; D008297:Male; D008875:Middle Aged; D013731:Territoriality