Maladaptive Medical Memes and the Cultural Evolution of Sickness and Healing

The constructive use of medical memes by sick persons is understandable and unproblematic: The negative valence of sickness can be undone or neutralized by the implementation of medical memes. What needs to be appreciated, however, is that what amounts to a positive valence of sickness can also be enhanced through the use of medical memes. Thus there exist exploitative and deceitful ways in which medical memes can be used by persons motivated by, vulnerable to, or actually in conditions of sickness. For example, medical memes consisting of new insights into the way sickness manifests, or disease* processes operate, can be appropriated by the sick person to enable him or her to more effectively make use of sickness for selfish purposes. Conversely, healers can use and promote medical memes (i.e., those that are idiosyncratic to them) for selfish purposes, in the process gaining advantages for themselves and their genetic relatives. The first of these exploitative uses of medical memes will be considered in greater detail below.

One must realize that the benefits, dispensations, and resources made available to the sick person by significant others can be better appropriated the more closely conditions of sickness conform to models of illness and disease* prevalent in the community. In brief, individuals wanting to effectively model a condition of sickness are likely to be motivated to make effective use of the understandings of sickness, illness, and disease* that are part of that community's traditions of medicine. By these mechanisms and motivations, then, medical memes are appropriated and learned by persons for purposes of "real" and "fictive" sickness and healing. The exploitation of the sick role may of course benefit the individual, even contribute to his or her inclusive fitness. On the other hand, such use of a medical meme may work to the detriment of other evolutionary "units" (e.g., the society, culture).

It can be appreciated that social sanctions can be brought to bear on sick persons so as to thwart exploitative uses of sickness or the sick role that unduly

penalize others. Sickness, however, has prove a difficult social category and condition to invalidate. Developments of biomedical technology have proven of great value in refining diagnosis so as to validate conditions of sickness and illness. Researchers who study pain, as an example, have documented facial display patterns that correlate with "faked" pain (Craig, Hyden, and Patrick 1991). Generalizing from this, one can view all contemporary biomedical disciplines as partly engaged in positive healing and partly engaged in negative healing, that is, in helping to undo authentic conditions of sickness and invalidating conditions of unauthentic sickness that involve exploitation of knowledge of medical memes and of the sick role more generally. Quite obviously, in exercising a function of "negative healing" biomedical disciplines are acting on behalf of the society and thwarting the individual. This discrepancy in aims and functions underscores the differences between biologic and cultural evolution of sickness and healing. (With respect to deceptive healers or charlatans, who benefit themselves selfishly by fictive uses of medical memes, it is fellow community residents, fellow healers, or the state that bring sanctions to bear, depending on the type of society.)

In this light, psychiatry during its heyday in the modern European era can be visualized as a discipline, indeed a socially evolved institution, which among other things, in developing a science about the mental and its effects on the body, has prominently appropriated the function of validating conditions of sickness that eluded the capacities of healers of earlier societies and of specialists of postmodern societies. Psychiatrists, in other words, are the healers who in many ways are called on to authenticate the potentially exploitative uses of sickness in modern and postmodern societies. What is termed "malingering" in psychiatry constitutes an intentional presentation of false or grossly exaggerated physical or psychological symptoms. Such a "condition" essentially invalidates in a formal way a claim of illness (by resourse to "expert" determination as to a fictive sickness state). By contrast, in many ways one can view the concept of somatization as an invention that validates sickness pictures that in general medicine do not meet criteria of disease. The irony is that in this instance, validation takes place by medicalization of a psychiatric disorder, a process that can be stigmatizing.

Another example of the maladaptive use of medical memes is that involving the abuse of clinically efficacious substances. Issues considered in the chapter on habits and disorders of habituation are examples of this. Such disorders illustrate the maladaptive consequences of medical memes. From the standpoint of evolution, abuse of sedatives, analgesics, stimulants, and other "mind altering" drugs can be analyzed as developments taking place at a group (i.e., social, cultural) level. Effective medical memes such as drugs are objects that are linked to healing and that when mass produced and made available to members of the population under conditions of poor regulation prove deleterious to the population and society. Maladaptive use of medical memes can also be

analyzed from the standpoint of the individual. At this level, it could be said that social and cultural conditions of modern and postmodern societies have created an assortment of new sicknesses of demoralization, depression, or spiritual emptiness. For these new sicknesses and illnesses, whether or not the outcome of unmet (conscious or unconscious) needs, mental regeneration through drugs is palliative. Persons will be "naturally" motivated to seek healing and healers. However, because the drugs in question mobilize powerful genetically based neurobiological mechanisms, they can undermine adaptive behavior.

In addition to exploitative uses of sickness, forms of social maladaptation created by the process of (medical) social evolution, there exist exploitative uses of healing, which are related types of social maladaptation made possible by the social evolution of healing. In earlier chapters some of these were considered. They included the reinforcement and perpetuation of sickness, exploitation of the human motivation for sickness, and economic exploitation for personal gain. Unorthodox or "quack" healers have traditionally elicited sanctions from sick persons and other healers. In modern and postmodern societies, the state has intervened to regulate the practice of healing and the punishment of unauthorized healers.