A reformulation of the social brain theory for schizophrenia: the case for out-group intolerance.

This article proposes a reformulation of the social brain theory of schizophrenia. Contrary to those who consider schizophrenia to be an inherently human condition, we suggest that it is a relatively recent phenomenon, and that the vulnerability to it remained hidden among our hunter-gatherer ancestors. Hence, we contend that schizophrenia is the result of a mismatch between the post-Neolithic human social environment and the design of the social brain. We review the evidence from human evolutionary history of the importance of the distinction between ingroup and out-group membership that lies at the heart of intergroup conflict, violence, and xenophobia. We then review the evidence for the disparities in schizophrenia incidence around the world and for the higher risk of this condition among immigrants and city dwellers. Our hypothesis explains a range of epidemiological findings on schizophrenia related to the risk of migration and urbanization, the improved prognosis in underdeveloped countries, and variations in the prevalence of the disorder. However, although this hypothesis may identify the ultimate causation of schizophrenia, it does not specify the proximate mechanisms that lead to it. We conclude with a number of testable and refutable predictions for future research.