When Linnaeus named us Homo sapiens, he recognized that we are a type of animal. The conversation beyond the pandemic may run from this core fact, but it cannot hide. Birds fly, turtles crawl, and insects breed prodigiously. Each has a fundamental nature that facilitates certain behaviors and impedes others.
If we are to find our way to a new order that better meets our own deep needs, and also the planet’s, we need to grasp what is fundamental to our biological nature. To get from here to a better place unavoidably requires that we speculate—project beyond what is known. But we should try to launch from solid ground. So here are points offered from a professional biologist as beacons to steer by.
Consider our basic biochemistry. The enzymatic machinery that replicates our DNA, reads our genes into proteins, and governs our cellular energy metabolism was inherited from microbes and their descendant, “eukaryotic” cells, which are larger, better structured, and better energized. These fundamental aspects of our animal nature were optimized—perfected to the point of un-improvability—by half a billion years ago.
Of course, with changing conditions, evolution added new genes and modified others. But the core of our stunningly intricate intracellular machinery has long been “settled law.” We study cellular processes in “model” organisms, such as the nematode worm and the fruit fly, because our cellular processes are deeply similar, having been inherited from the same common ancestor.
So what? Well, much of our biomedical enterprise—physicians, medical schools, hospitals, federal and private biomedical research institutes, plus Big Pharma—focuses on trying to understand this molecular machinery in order to control it. Newly discovered genes, proteins, and “signaling” molecules are often reported as potentially “druggable” targets for control of some disorder or condition. This vast enterprise, engaging many of our best and brightest scientists, has achieved innumerable, immense successes. This was my career for half a century.
But now we should reflect that 70 years of basic and clinical research directed at cellular machinery has not solved the major causes of death in today’s modern society. These include hypertension, obesity, type 2 diabetes, coronary heart disease, suicide, and addictions to drugs, alcohol, and tobacco. Moreover, these causes are coupled: obesity contributes to hypertension and type 2 diabetes; smoking contributes to heart disease; and so on.
Together these causes are four-fold greater than the next important cause of death, cancer. But, if we move to the “addictions” column and include the 50% of all primary liver cancers that are caused by alcoholism and the 90% of lung cancers that are caused by smoking, then the sum exceeds the remaining cancers by nearly five-fold.
Molecular treatment has been ineffective for these leading causes of death because they arise from chronic stress and despair—caused by societal dysfunctions. Failures of human interaction trigger cascades of diverse pathologies that ultimately filter down to disrupt the cellular machinery. But since there’s nothing wrong with the cellular machinery, except as it is abused, efforts to “fix” it with a panoply of drugs are doomed.
Give one drug, and both brain and body compensate. Add a second one, and they compensate further. Eventually, some control may be achieved; however, each drug has multiple (“side”) effects—mostly predictable. Those require additional drugs, and the result is a basically sick person stabilized precariously by “polypharmacy.” Such medically unstable individuals are the most vulnerable to COVID-19. Meanwhile, this direction for the bio-medical enterprise grows ever more expensive: US health care now consumes nearly 20% of the GDP, whereas in 1960 it was 5%.
What needs to change?
After COVID, such wasteful misdirection of bio-medical R&D will be unaffordable. Ditto for Big Pharma’s commercial products derived from this enterprise. Furthermore, stress and despair will be rising and will remain high for perhaps decades. The consequent mortalities will also rise and persist until we manage to relieve ourselves from chronic strain.
Here is bio-medicine’s perfect storm: rising deaths from societal dysfunctions that cannot be cured by polypharmacy will overwhelm a vast bio-medical complex based on a quasi-religious faith in druggable molecular targets and in search of profits.
The bio-medical complex will continue to expand molecular therapies for socially caused conditions. Consequently lots more people will die prematurely, having lived in poor health for years before they succumb. Furthermore, attempts to fund this “health” behemoth will create a crisis of budgetary resources on a scale formerly occupied by the “defense” behemoth.
Based on these fundamental considerations, we should steer hard toward massively reducing stress and despair by meeting the deepest needs of our species. If we were to manage this, and also resume physical exercise, then we’d transition from a chronically ill population to a healthy one and roughly 90% of the current medical costs would be unnecessary.
Our species’ deepest needs
Our fundamental need is for intermittent, brief satisfactions. We inherited this requirement from our earliest bilateral ancestor, a marine worm. The worm found food, mates, comfort, and safety directed by a brain that continuously prioritized these quotidian hungers and learned when and where to find them.
One brain circuit drove seeking, and when a need was unexpectedly met, another circuit triggered a reward signal that delivered a pulse of satisfaction that allowed a pause in seeking. The worm’s circuit for reward learning was so efficient that, one-half billion years later, all brains, including the nematode, the fruit fly, and our own, still rely on it.
The reward signal is a pulse of the neurochemical dopamine, and, so long as we received a few surprises over a day that provided a few dopamine pulses, we were fine. But modern life grew highly predictable, thereby reducing surprises about where and when to find food or comfort. So the daily dopamine pulses, which we need more acutely than vitamins, diminished—and we grew uneasy and restless.
This dis-ease we treat with various molecules, including alcohol, nicotine, and every drug of abuse, because they all trigger the reward circuit to release dopamine in large surges.
The drugs temporarily relieve our discomfort, but soon the brain compensates and demands a higher dose. Here is another perfect storm: our core circuits for physiological regulation and learning rely on intermittent small pulses of dopamine, but now these circuits encounter great surges of dopamine caused by a special sort: polypharmacy. Now our persistent cravings for these surges are served by Big Pharma, Big Tobacco, Big Alcohol, and Big Narco.
The design of our brain reward circuit, like that of our cellular metabolic circuits, was perfected in the worm. Computational scientists recognize the worm’s reward rule as mathematically optimal—so it, too, has also been “settled law” for half a billion years.
Yet, the bio-medical enterprise studies the reward circuit intensively—a whole division of NIH (NIDA) funds and coordinates the search for molecular solutions to our existential problems. They seek an opioid molecule to treat your “physical” pain but not get you high. They seek molecules to reduce your cravings for alcohol, tobacco, opioids, and food.
There’s not the slightest chance that this will work. No drug will free us from the necessity to meet our species’ deepest cognitive and emotional needs.
At the origin of our species, about 200,000 years ago, the size and prolonged development of our brain were “settled law.” The package included:
- A profound drive to wander—reflected in our rapid migrations across the globe.
- An immense capacity for social learning—that allowed us to manufacture stone tools and use them to build boats that crossed the Pacific Ocean 40,000 years ago from the Indonesian archipelago to Australia.
- Tremendous neural diversity that gifts each brain with circuits supporting a unique bundle of behavioral traits. These innate “talents,” when practiced, imbue each person with a unique skill set. A community where all brains are different immensely amplifies what can be invented, executed, and transmitted compared to a community where all brains are the same.
- Prolonged development of circuits over decades as the brain acquires knowledge and revises its programs. The frontal and temporal tracts—key pathways for cognitive and emotional processing—do not mature finally until our late 40s. Consistent with this, foragers greatly improve their skills and productivity between ages 20-45, and well past 60 they still contribute to a three-generation family.
In short, evolution imbued our species with the capacity for lives of adventure and invention. It gave individual humans the capacity for diverse practical skills, plus the social skills needed to share them communally. Finally, evolution gave us the capacity to grow our skills over decades. Our species core need is to fulfill these capacities.
Yet, beginning 250 years ago—a mere 0.1% of our species’ existence—the industrial system began to erase for most of humanity the chance to fulfill these deep needs of our life cycle. We evolved to explore the planet, but now multitudes punch a ticket or scan a bar code. “Jobs” learned in minutes or days present neither challenge nor surprise. This profound mismatch between our abilities and our opportunities to exercise them causes chronic stress and despair.
Challenges that engage our deep intelligence across the life span must not be reserved just for a wealthy minority. We must all exercise these capacities or suffer the mortal consequences of stress and despair—whose annual death rate will likely exceed that of COVID-19 by tenfold—and for which there will be no vaccine.
We must reorganize so that all of us can live closer to who we deeply are. This would immensely reduce the need for Big Pharma and Big Narco. Post-COVID, we’re going to need those resources elsewhere.
These considerations suggest a definite program. First, we must restructure “work.” Challenge and sociality must trump “efficiency.” Second, we must reduce inequality. Monkeys, upon seeing another better rewarded for the same effort, refuse to work. The monkeys’ labor strike suggests that our own sense of fairness was already present 20 million years ago in our last shared ancestor.
Third, we must restructure education. Instead of cramming kids into classrooms to “teach” one curriculum, we must help each child explore natural talents and develop programs to optimize individual growth. Guide education by a conclusion from neuroscience: what we practice, we become.
Editor’s Note: A version of this piece originally appeared in a discussion for the Great Transition Initiative.
Mad in America hosts blogs by a diverse group of writers. These posts are designed to serve as a public forum for a discussion—broadly speaking—of psychiatry and its treatments. The opinions expressed are the writers’ own.