The integration of evolutionary theory into the medical field has undeniably contributed to our understanding of health and disease. Despite its benefits, however, it has been historically misinterpreted and misused, leading to the rise of harmful ideologies such as eugenics and social Darwinism.
Eugenics, a concept introduced by Sir Francis Galton in the late 19th century, advocated for improving the genetic composition of the human population through selective breeding. It was misguidedly interpreted as a practical application of Darwinian evolution, even though it deviated significantly from Darwin’s principles.
While Darwin’s theory emphasizes the vital role of variation and natural selection in the survival of species, eugenics erroneously asserted the notion of “fitness” as being synonymous with physical and mental perfection. Eugenic ideologies led to numerous discriminatory practices including forced sterilizations and restrictive immigration policies, predominantly targeting marginalized communities such as people with disabilities, ethnic minorities, and the economically disadvantaged.
Similarly, social Darwinism emerged as another harmful interpretation of evolutionary theory. By applying Darwin’s principle of “survival of the fittest” to social, economic, and political issues, social Darwinists justified class and racial hierarchies, colonization, and the oppression of indigenous peoples. These interpretations not only resulted in gross human rights violations but also eclipsed the potential benefits of incorporating evolutionary perspectives into medicine.
Recognizing the historical misuse of evolutionary theory is crucial for its responsible application in current and future medical practices. A more comprehensive and accurate representation of evolutionary theory in medicine should involve the concepts of cooperation, gene-environment interplay, and the role of stress in shaping our biology and behavior. The Evolutionary Stress Framework (ESF) is one such approach that incorporates these principles.
The ESF aims to shift the focus from genetic fitness and competition to the concepts of adaptive stress responses and complex ecosystems. This framework allows us to explore health and disease from an evolutionary perspective, acknowledging the role of various genetic, environmental, and physiological factors that influence human health.
The adaptive nature of stress, the principles of complex adaptive systems, and the cooperative aspect of evolution are central to this framework. They provide a more nuanced understanding of health and disease, which can lead to more personalized and effective healthcare interventions. By steering clear of harmful and reductionist ideologies, the ESF seeks to usher in a paradigm shift in healthcare that is truly inclusive and personalized.
The Science:
History: Evolutionary Theory
Let’s take a moment now to venture back into the intricate and sometimes controversial narrative of evolutionary theory’s application to medicine. Evolutionary theory has historically produced valuable insights into human health and disease, as well as instances of misuse and misinterpretation that have led to harmful and discriminatory practices. Investigating this history and recognizing its contributions and shortcomings is essential to comprehending the potential advantages and hazards associated with integrating evolutionary perspectives into medical practice.
Historically, linear interpretations of evolutionary theory allowed for or even encouraged concepts like “survival of the fittest” and natural selection to be applied to medicine, emphasizing the role of genetic fitness in health outcomes (Nesse & Williams, 1994). While these principles have indeed advanced our understanding of disease etiology, prevention, and treatment, their misinterpretation also led to problematic ideas such as eugenics, supremacy dogma, social Darwinism, and misappropriation to justify white colonization (Gould, 1981; Kevles, 1985). The misinterpretation of these concepts has had significant negative impacts on marginalized communities, particularly those with disabilities and people of color.
Eugenics, for example, was a movement that sought to improve the genetic quality of the human population by promoting the reproduction of those deemed “fit” and limiting the reproduction of those deemed “unfit” (Galton, 1883). This movement led to forced sterilization and other forms of reproductive control, particularly targeting people with disabilities and people of color (Kevles, 1985; Lombardo, 2008). This concept was later used to justify forced sterilization, immigration restrictions, and even genocide, leading to the widespread suffering and discrimination of marginalized groups, including people with disabilities, ethnic minorities, and the economically disadvantaged (Kevles, 1985; Lombardo, 2008).
Social Darwinism, another problematic idea rooted in the misinterpretation of evolutionary principles, extended the concept of natural selection to social and economic realms, suggesting that the “fittest” individuals and groups would naturally rise to the top of society (Hofstadter, 1944). This idea has been used to rationalize racial and ethnic hierarchies, as well as to justify white colonization and the oppression of indigenous peoples (Gould, 1981; Stocking, 1968).
These misguided applications have justified discriminatory policies and practices against people with disabilities, minorities, and other marginalized groups, overshadowing the potential benefits of incorporating evolutionary perspectives into medical practice. The Evolutionary Stress Framework aims to shift the focus toward a more accurate representation of evolutionary theory, encompassing cooperation and emergent stress allostasis in complex ecosystems. By doing so, it sets the stage for an emergent and dynamic view of health that is independent of harmful and reductionist ideologies.
This new perspective allows us to ask better questions and develop effective frameworks for finding solutions, ultimately leading to the creation of equitable care. By understanding health in the context of evolutionary processes, we can gain valuable insights into the complex interplay of genetic, environmental, and physiological factors that have shaped human health throughout history. This understanding enables us to recognize that individual differences in health outcomes and responses to stress are not merely deviations from a “normal” state but rather the result of purposeful and protective adaptive processes that have enabled our species to thrive in diverse and ever-changing environments.
As we transition to the Evolutionary Stress Framework, incorporating evolutionary theory into the medical model can help us identify the adaptive functions and trade-offs that underlie various health conditions, ultimately leading to personalized, and effective healthcare interventions that take into account the full spectrum of influences on human health. This approach fosters a just and equitable healthcare system that promotes the health and well-being of all individuals, regardless of their genetic fitness or other characteristics, paving the way for a future where healthcare is truly inclusive and tailored to the unique needs of every individual.
History: Stress Theories
The concept of stress also has a complex and sometimes contentious history in both medicine and public discourse. While stress is widely acknowledged as a factor influencing physical and mental health, it has often been misused and oversimplified, leading to misunderstandings and even discrimination. This section aims to address misconceptions and emphasize the importance of a nuanced understanding of stress in the context of the Evolutionary Stress Framework.
Historically, stress has been perceived as a harmful or toxic influence on health, and in some cases, it has been invoked as a catch-all explanation for various health issues when no other apparent causes are identified. This oversimplification can result in the dismissal of patients’ experiences and the neglect of underlying biological, psychological, and social factors contributing to their health problems. Further, attributing health issues solely to stress may perpetuate stigmatization and discrimination, as individuals experiencing stress-related health problems may be blamed for their own suffering or accused of having inadequate coping skills.
Numerous organizations and health institutions have emphasized the detrimental effects of stress, often referring to it as a “silent killer” or highlighting its impact on health (Govindasamy et al., 2021; Paustian-Underdahl et al., 2022; , Goodday & Friend, 2019; Cardon & Patel, 2013; Balwan, 2021; Abbasi, 2018). However, there has been an increasing focus on the issue of “toxic stress,” and several initiatives have been launched to support individuals in managing stress levels. (Reference Franke (2014) discusses the effects of toxic stress on children and the need for an integrative approach to prevention and treatment. Reference Gross et al. (2016) emphasizes the importance of reducing toxic stress associated with adverse childhood experiences. Reference George (2018) highlights the challenges faced by undocumented immigrants and advocates for solutions to mitigate the effects of toxic stress. Reference Murray (2017) explores the impact of toxic stress on the physical and mental health of child refugees. Reference Weber & Harrison (2019) discusses the need for public policies to minimize toxic stress in children. Reference Eom & Choi (2010) investigates the mechanisms of toxicity of silver nanoparticles, including oxidative stress-related endpoints, Reference Purtle et al. (2021) highlights the work of the Harvard Center on the Developing Child in disseminating information about toxic stress and advocating for solutions. Reference MacKinnon et al. (2022) mentions the involvement of the JPB Research Network on Toxic Stress at Harvard’s Center on the Developing Child in the development of a coping scale. Reference DeCandia & Guarino (2020) emphasizes the impact of toxic stress on brain development and the need for trauma-informed care. Reference Amirazizi et al. (2022) discusses the association between adverse childhood experiences (ACEs) and toxic stress, as well as the long-lasting effects on neurobiological systems. Reference Orapallo et al. (2021) mentions the integration of research on the impact of trauma and toxic stress in the Trauma Smart training program.) Research indicates that stress is not only associated with medical labels, such as ADHD and dyslexia but also with diversity and evolution itself. This connection highlights the intricate and multifaceted nature of stress and its impact on human development and functioning. (Reference Liloia et al. (2022) discusses the overlapping neuroanatomical alterations between dyslexia and ADHD, indicating a potential connection between these conditions and stress. Reference Joëls & Baram (2009) explores the impact of stress on brain function and the diversity of stress mediators. Reference Renoux et al. (2016) discusses the increasing prescription rates of ADHD medications, suggesting a link between stress and the diagnosis and treatment of ADHD. Reference Kroeger (2021) examines the association between childhood ADHD and family relationships, highlighting the role of stress in shaping these relationships. Reference Franz et al. (2021) investigates the effects of learning disorder labels on teacher expectations, indicating the influence of labels such as dyscalculia, dyslexia, and ADHD on perceptions of students. Reference Fridman et al. (2017) explores caregiver burden among children/adolescents with ADHD, indicating the multidimensional impact of ADHD on work, social/family life, and parental worry/stress. Reference Summerton et al. (2023) examines the longitudinal associations between COVID-19 stress and the mental health of children with ADHD, suggesting ongoing associations between stress and ADHD symptom severity.)
Although stress plays a significant role in understanding health, it is important to acknowledge that our current medical infrastructure may not be adequately equipped to address the complexity of stress. As a result, prioritizing funding, educational, and research initiatives to support the development of a comprehensive framework for understanding stress should become a top priority for policymakers, healthcare professionals, and researchers alike.
The impact of stress on an individual is dependent on a multitude of factors, including personal characteristics, context, and other variables. This complexity, coupled with its association with numerous medical conditions, underscores the need for a comprehensive framework that can provide insights into the dynamic nature of stress and its implications for health and well-being. By investing in initiatives aimed at developing a better understanding of stress and its role in human health, we can work towards creating a responsive and adaptive medical infrastructure. This, in turn, can lead to effective prevention strategies, tailored interventions, and ultimately, improved health outcomes for diverse populations. Furthermore, recognizing the role of trade-offs and cooperative cognitions in shaping human neurodiversity can offer valuable insights into the interplay between individual differences, environmental factors, and adaptive processes, ultimately fostering more inclusive and effective approaches to health and well-being.
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