Chapter

Defence mechanisms of the body in the course of evolution: from cellular to social responses

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/9780199579518.003.0008
Defence mechanisms of the body in the course of evolution: from cellular to social responses

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1) This chapter is aimed at drawing some conclusions on the basis of all the mechanisms that have been described throughout this volume. Following the evolutionary and neuroscientific approach to the doctor–patient relationship, this special social interaction can be viewed as a defence mechanism which is capable of suppressing the patient's discomfort and influencing the course of illness. 2) The basic concept of defence mechanisms is that the body can protect itself from invaders, as the immune system does, and from damage, as the wound healing processes do. Likewise, simple reflexes, like the withdrawal reflex, or more complex behaviours, like the fight-or-flight response, are aimed at protecting the body against environmental dangers. 3) Complex cultural factors can also represent an important mechanism of defence. For example, cultural thermoregulation is a way to protect the body against extreme temperatures, which the normal thermoregulatory mechanisms are not able to tackle. With cultural thermoregulation, mankind was capable of making clothes and building heating machines to tackle extreme low temperatures. 4) Social and cultural factors are also important to promote health and well-being. Living in a social group is advantageous to health. For example, the social interaction with members of the same ethnic group may be beneficial to one's own health. 5) Within the context of body defence mechanisms and social interactions, the doctor–patient relationship represents a special case of beneficial social interaction which can be conceptualized as a true defence mechanism. This evolved to guarantee suppression of discomfort by a mere social event, that is, meeting the healer. For example, a person whose brain is capable of shutting down pain when the presence of medical help is detected may have an advantage over someone whose brain lacks this capacity. 6) The central point is that the system ‘patient–therapist’ is at work regardless of whether the therapy is effective or ineffective. Even if the therapy is totally ineffective, i.e. it has no specific effects, expectation of benefit (the placebo response) may be sufficient to inhibit discomfort and eventually to influence the course of illness. Therefore, the whole system is capable of suppressing discomfort through the mere social interaction between patient and therapist. 7) Health professionals represent environmental variables that act on the patient's brain by inducing expectancies of benefit and hope. Health professionals are the crucial point in this process, for they promise good treatments and induce expectations and hope for the patient's future well-being. The patient's personal expectations play a key role here. If he wants to consult a healer, be he a shaman or a modern doctor, this is because of his personal beliefs about the healer's therapeutic capabilities. Therefore, the healer is the environmental variable that triggers those endogenous mechanisms of self-cure, e.g. the release of endogenous opioid painkillers.

Chapter.  5637 words.  Illustrated.

Subjects: Psychiatry

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