Evolutionary and narrative medicine: are they compatible?

Abstract

Evolutionary medicine and narrative medicine are two powerful frameworks for approaching medical practice that have emerged in the past thirty years. One is based on biological science and the ideas of Charles Darwin, along with his more recent followers. The other has come out of the social sciences. It draws on ideas that are familiar in philosophy and the humanities about the central role of storytelling across all human cultures. At first sight, the two frameworks and the movements associated with them may seem to stand in opposition to each other as ways of thinking about medicine, or even to be incompatible. How can a framework that rests on the acceptance of biological truth be harmonised with one rooted in subjectivity and relativism? As someone with an allegiance to both schools of thought, who has tried to contribute to each of them, 2 I want to argue that they are in fact complementary and have the potential to enrich each other. Evolutionary medicine follows the famous dictum laid down by the geneticist Theodosius Dobzhansky: ‘Nothing in biology makes sense except in the light of evolution.’ Since medicine is so thoroughly anchored in biology, scholars in evolutionary medicine argue that doctors should extend their curiosity from familiar questions like ‘what has caused this disease?’ or ‘how should we treat it?’ to more fundamental ones like ‘could this condition have arisen in humans because it conferred benefits in some circumstances?’ and ‘is it possible that treatments may have damaging effects by countering those benefits?’ Such questions invite us to take a perspective based in deep time and on other kinds of societies than our own. The questions can also be unsettling because they suggest that medical mindsets based on proximate explanations and linear solutions might have utility in the short term, but may be far too limited in their intellectual and ecological scope. Evolutionary medicine has now influenced thinking and practice in a wide range of areas including antibiotic resistance, congestive heart failure and depression. Indeed, there is a persuasive argument for teaching evolutionary biology in medical schools, in order to underpin an adequate understanding of the other basic sciences.