Chapter

A brief evolutionary account of medical care

Fabrizio Benedetti

in The Patient's Brain

Published on behalf of Oxford University Press

Published in print October 2010 | ISBN: 9780199579518
Published online February 2013 | e-ISBN: 9780191754661 | DOI: http://dx.doi.org/10.1093/med/9780199579518.003.0001
A brief evolutionary account of medical care

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1) In this chapter, medical care is approached from an evolutionary perspective. It represents a complex form of social behaviour that is aimed at taking care of the weak, the sick, the elderly and, more in general, the individual who needs help. 2) This evolutionary account starts from unicellular organisms. These simple forms of life are capable of taking care of themselves through a variety of mechanisms, which are often aimed at tackling harsh environments. Mechanisms of self-care and self-protection then evolved in more complex forms, such as the withdrawal reflex, the wiping reflex, and the scratch reflex. All these simple behaviours allow a noxious stimulus to be removed from one's own body. The spinal cord neuronal circuits are sufficient to warrant the correct functioning of these reflexes. 3) Grooming is somehow more complex than these simple reflexes, and involves scratching, rubbing, licking, and the like. It is not triggered by peripheral stimuli on the skin, but rather it is generated in the central nervous system through a complex concertation of neural, hormonal, and genetic events, which take place mainly in subcortical areas. There is however a similarity between grooming and the simple scratch reflex: both are directed towards one's own body. 4) The big evolutionary step that is relevant to the mechanisms of the doctor–patient relationship occurred when animals started grooming others rather than themselves. Grooming others, the so-called social grooming or allogrooming, is one of the first examples of social interaction. It represents a very elementary form of medical care, whereby the groomer takes care of the groomee. The neocortex and some hormones, e.g. oxytocin, are involved in this social behaviour. 5) Social grooming in apes and early hominids was likely to pave the road to altruistic behaviour. In real altruism, the conscious intentions to help other individuals are critical, the so-called psychological altruism. There are many examples of supposed altruistic behaviour in Homo erectus and in Neanderthal's men. 6) Whereas the very early forms of altruism and medical care in a social group relied on the involvement of many members of the group, in the course of evolution a single individual started taking care of the sick: the shaman. Shamanistic practices are common in prehistoric, historic, and modern medicine, and help us understand how medical care may have emerged among early hominids. Shamans have then been replaced with doctors, e.g. in Ancient Greece, but a real scientific medicine has emerged only very recently. 7) It is important to look at the doctor–patient relationship from an evolutionary perspective because it reminds us that it is a sort of social interaction aimed at taking care of the members of a social group, and thus at protecting both the single individual and the social group from possible dangers and damages. Medical care must also be considered within the context of self-care in unicellular organisms, invertebrates, and vertebrates, and within the context of social care in apes and humans. Therefore, the doctor–patient relationship is a product of the evolution of the nervous system and behaviour and can be studied with a neuroscientific and evolutionary approach.

Chapter.  8023 words.  Illustrated.

Subjects: Psychiatry

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