Doctoring with Darwinian medicineDoctoring with Darwinian medicine
All In The Mind
Look in your doctor's kitbag, and you'll probably find a stethoscope, a thermometer, a first-aid kit. But a copy of Charles Darwin's Origin of Species too? 'Darwinian Medicine' asks: why do we get sick, and why didn't the body evolve to be better? Psychiatrist Randolph Nesse argues physicians ignore evolutionary theories at the peril of their patients. All in the Mind continues Radio National's celebrations of Darwin's 200th birthday...
29:56•21 Mar 2009
Why Evolution Belongs in Your Doctor’s Bag
Episode Overview
- Darwinian medicine asks why natural selection left humans vulnerable to disease rather than assuming the body is perfectly designed.
- Many anatomical quirks, such as the appendix or the eye’s blind spot, can be better understood through evolutionary history.
- Most mental disorders involve emotions, yet medical training has not fully covered the evolutionary origins and functions of emotional states.
- Persistent, severe depression is described as pathological, while milder low mood may sometimes have evolved to help people reassess or abandon unreachable goals.
- The smoke detector principle suggests that systems like pain, anxiety and cough are set to overreact because the cost of a false alarm is usually far lower than missing real danger.
“"Most mental disorders are emotional disorders."”
What insights can doctors gain by asking why our bodies and minds are so vulnerable? This episode of All In The Mind heads straight for that question with psychiatrist and evolutionary medicine pioneer Professor Randolph Nesse. Rather than stuffing a doctor’s bag with yet another gadget, Nesse argues it should also carry Charles Darwin. He suggests that medicine usually asks *how* disease works, but rarely *why* the body was left so prone to it.
That shift leads to surprisingly practical questions: "Why did natural selection leave the appendix there, given that so many people die of appendicitis?" or "Why are the coronary arteries so narrow?" You’ll hear how seemingly "botched" features – from our blind spot to fragile wrists – can make sense once evolution is taken into account. The episode also spends time on mental health, especially anxiety and depression.
Nesse points out that "most mental disorders are emotional disorders" yet psychiatrists haven’t been thoroughly trained in the "origins, functions, and regulations of emotion". He separates crippling, chronic depression from milder low mood that might once have helped our ancestors back off from impossible goals. Using examples from his clinical work, he describes how asking whether someone is "pursuing a goal that they can't reach and they can't give up" suddenly made "about half" of his patients’ struggles clearer.
You’ll get a feel for Darwinian medicine as a way of asking better questions rather than a new treatment fad. Nesse even jokes about "Darwinian doctors" who claim to treat everyone by evolution, replying, "What on earth are you doing?" For anyone curious about why emotions hurt, why bodies break, and how evolutionary thinking might reshape future research, this conversation offers a thoughtful blend of science, clinical experience, and a few delightfully odd anatomical detours.
It might leave you wondering: if low mood and anxiety act like smoke alarms, when is yours warning you, and when is it just over-sensitive wiring?
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