Weiner H
Neuropsychiatric Institute, University of California, Los Angeles 90024, USA.
Psychosom Med. 1998 Jul-Aug;60(4):510-20. doi: 10.1097/00006842-199807000-00020.
Medicine does not have a comprehensive theory of health, ill-health, and disease. Its explanations of disease are firmly rooted in pathological anatomy brought about by infection, intoxication, trauma, and mutations in genes. Because medical concepts have been influenced mainly by classical physics, it is mechanistic, materialistic, deterministic, reductionistic, linear-causal, and strongly biased toward proximate explanations of disease. Of late, many thoughtful persons have attempted to provide medicine with a more comprehensive theory that integrates the documented roles of physical, social, environmental, and psychological factors in the etiology and pathogenesis of ill-health and disease (eg, Refs. 1-3).
Until very recently (4), no one has clearly pointed out that such a comprehensive theory should be guided by the concepts of evolutionary and organismic biology. Darwin's great theory states that evolution is "driven," but not exclusively so, by natural and sexual selection. Natural selection acts on variants that differ in adaptive capacities. Those capable of adaptation survive to reproduce. Failure to adapt reduces reproductive fitness and success, and leads to injury or death. But this formulation could be expanded to regard ill-health and disease as adaptive failures, whereas health usually may be conceived of as equivalent to adaptive success. Adaptations are determined by many factors-genetic, morphological, physiological, and behavioral. Selective pressures are many and varied. However, social primates are at a selective advantage, and are among the most successful species and varieties. Social behavior (eg, support) seems to enhance the chances of survival and reproductive fitness. Physiological (immunological, metabolic, cardiovascular) and behavioral adaptations are geared specifically for interactions with the environment. Emotions have evolved as ways of matching physiological responses with environmental demands and signaling the organism's state.
This study will review aspects of evolutionary theory that would lead to a unified, integrated theory of health, illness, and disease, and to a clearer taxonomy in medicine.
医学没有关于健康、不良健康状况和疾病的全面理论。其对疾病的解释主要基于由感染、中毒、创伤和基因突变导致的病理解剖学。由于医学概念主要受到经典物理学的影响，它是机械论的、唯物主义的、决定论的、还原论的、线性因果的，并且强烈倾向于对疾病进行直接解释。近来，许多有识之士试图为医学提供一个更全面的理论，该理论整合了身体、社会、环境和心理因素在不良健康状况和疾病的病因及发病机制中已被记录的作用（例如，参考文献1 - 3）。
直到最近（参考文献4），才有人明确指出这样一个全面的理论应以进化生物学和机体生物学的概念为指导。达尔文的伟大理论指出，进化“由”自然选择和性选择“驱动”，但并非完全如此。自然选择作用于具有不同适应能力的变异体。那些能够适应的变异体得以存活并繁殖。无法适应则会降低繁殖适应性和成功率，并导致损伤或死亡。但这个表述可以扩展，将不良健康状况和疾病视为适应失败，而健康通常可被理解为等同于适应成功。适应由许多因素决定——遗传、形态、生理和行为因素。选择压力多种多样。然而，社会性灵长类动物具有选择优势，是最成功的物种和变种之一。社会行为（例如支持）似乎能提高生存和繁殖适应性的机会。生理（免疫、代谢、心血管）和行为适应专门针对与环境的相互作用。情感已经进化为使生理反应与环境需求相匹配并表明机体状态的方式。
本研究将回顾进化理论的各个方面，这些方面将导向一个关于健康、疾病和病症的统一、综合理论，并在医学中形成更清晰的分类法。
