The Social Situation of Sickness: an Evolutionary Perspective on Therapeutic Encounters

Sickness was a crucial adaptive problem in the course of evolution, and one solution, particularly in humans, is support and care from in-group members. The social interaction between sufferers and (potential) helpers was a recurrent social situation throughout human evolution and its outcome was crucial for survival. Thus, respective selection pressures may have yielded specific behavioral adaptations for both the sufferer and the helper role. According to the present paper, it is important for the sufferer to communicate the sick state convincingly, while it is important for the helper to communicate the act of helping convincingly. Signaling strategies for the efficient pursuit of the respective goals are proposed, then the proposed strategies are substantiated with previous empirical evidence and theory. Many heterogeneous medical phenomena, such as the placebo effect, social modulation of pain, somatization, and overtreatment, are integrated in the argument. Thereby, the present paper contributes to a conceptual foundation for the evolutionary study of therapeutic encounters and the patient-practitioner relationship and thus may allow Darwinian medicine to study not only disease but also healing.