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(For the first section of this article go to Darwinian Medicine)

Section 2 - Stress and Adaptation: an individual perspective  

Stress, Cortisol and the HPA Axis

Adrenal Insufficiency and Adrenal Fatigue

The General Adaptation Syndrome

Variations in Individual Adaptive Capacity: causes and consequences

Over Adaptation

Adaptability, Darwinian Medicine, and Mental Illness

Links and References

So far this discussion has been concerned predominantly with viewing adaptation from a general rather than an individual perspective. This after all is the nature of Darwinism which is concerned with natural selection and survival of the species rather than the adaptability of individuals. In this regard there appears to be a fundamental disagreement between Darwinism and Darwinian medicine. Although Darwinian medicine, like Darwinism, frequently claims to be completely unconcerned about individuals, in reality the reverse is true. Those diseases which are explained by Darwinian medicine on an "evolutionary" basis are frequently characterised by a remarkable individual susceptibility. Although some factors which may explain this individual susceptibility are known, on the whole this is a very grey area indeed. In spite of the various claims made by Darwinian medicine linking modern diseases to our (ie the human race) failure to adapt to our modern environment, there remains little or no formal acknowledgement of the significance of individual differences in our capacity to adapt. The entire human race, as far as adaptability is concerned, is viewed as one.

While Darwinism is more concerned with the adaptability and evolution of the human species, in this section we will deal more with the (43) "type of evolution which takes place in every person during his own lifetime." In this regard Selye (43) has emphasised the similarity "between the means employed by Nature in evolving species and individuals." Selye further emphasises the importance of research into adaptive hormones in the study of human diseases (43): 

There is absolutely no doubt that there is a massive variation in the capacity of different people to adapt to the various stresses and challenges which confront us. Whether we consider emotional stressors, physical stressors, or even chemical stressors, the individual variation in adaptive capacity is considerable. While some people can cope with an enormous amount of work stress, and also personal stress, others cannot cope with a fraction as much. Even our ability to adapt to climate changes or changes in altitude varies significantly. The same is true of our ability to cope with illnesses or infections. When it comes to our adaptive capacity, we are far from being equal.

As man, individually and collectively, becomes less adaptable (ie. less tolerant of stressors) he will be compelled to artificially alter or adapt his environment to suit his needs.

There is an absolutely crucial question which modern scientists and doctors seem determined to avoid: what is the anatomical, physiological, and biochemical difference between the person who can successfully adapt to a wide variety of stressors and the person who lacks this capacity? 

Beginning with a brief consideration of the nature of our adaptive machinery, the following discussion will consider some of the possible reasons for, and implications of, this variation in our adaptive capacity.  

In order to cope with, and adapt to, the various challenges which confront us throughout life the human body is equipped with an elaborate adaptive system controlled by both the nervous system and the hormonal system. The operation of our adaptive process begins with the release of Corticotropin Releasing Hormone (CRH) by the Hypothalamus in the brain (52, 53,54,64). CRH then stimulates the pituitary gland (65) to release Adrenocorticotrophic hormone (ACTH) (66) which in turn stimulates the adrenal glands to secrete the anti-stress hormone cortisol (60,67). This complete regulatory system is referred to as the Hypothalamic Pituitary Adrenal axis or simply the HPA axis (52, 53,60). 

The part played by the adrenal glands in enabling a person to cope with stress is well established. According to Hartman and Brownell ( 57 ), "every type of stress, if of sufficient magnitude and duration, can be shown to affect the adrenal cortex". These authors continue; "exercise of the muscles, exposure to cold, to heat, to intense light, to reduced atmospheric pressure and anoxia, trauma and shock, burns, infections and poisons are examples".

As is noted by Hartman and Brownell, the poisons combated less efficiently in adrenal cortical deficiency include, bacterial toxins, histamine, drugs and venoms. In fact, even substances which are considered completely non-toxic may become so. It is also well known that deficiency of adrenal cortical hormones causes hypersensitivity to other hormones such as insulin and thyroxine. According to Tintera (58), persons who suffer from "reactive hypoglycemia" and are therefore hypersensitive to sugars, may merely be lacking in adrenal hormones, and may not be , as is commonly believed, hypersensitive to, or over-secreting, insulin.

Our ability to cope with stress is determined by our adaptive capacity (43,44). Lack of adaptive capacity implies a lack of the normal reserves necessary to permit the process of adaptation to occur. In other words, these reserves are normally employed by the body to enable internal adjustments to occur that will enable us to cope with these stresses with little or no discomfort. If this adaptive capacity is insufficient even normal stresses (exercises, weather changes, etc.) will result in some kind of discomfort or disease (see CFS page ).

It is clear from these facts that it is necessary to have a sufficient reserve capacity in the adrenal glands that can be called upon in emergency situations. It should be emphasised, that although adrenal reserve capacity cannot be determined by commonly utilised tests to determine blood cortisol levels, stimulation tests to assess the amount of reserve capacity available are not commonly performed. This is in spite of the fact that the adrenal gland requires a large reserve capacity to successfully meet the demands of various stresses. In fact, although minimal stress levels require very little adrenal capacity to maintain health, according to Hartman and Brownell, "with a major stress the demand may become extremely large" (57). It is therefore clear that the measurement of random blood cortisol levels is a very unreliable indicator of adrenal gland function.

The concept of adrenal reserve capacity is of fundamental importance when it comes to our capacity to cope with and adapt to the various stresses which may confront us. It determines our adaptability. Adaptability is of such importance that our health and vitality is claimed by Selye to be proportional to our adaptive capacity (45): "many common diseases are largely due to errors in our adaptive response to stress rather than to direct damage by germs, poisons, or life experience" . Selye points out that many modern diseases are in fact diseases of adaptation (43), that is they are the result of maladaptation to the various stresses which confront us throughout life. The term maladaptation includes diseases characterised by both an insufficient adrenal response, as well as those which are caused by over adaptation or an excessive adrenal response.

Of crucial importance in determining our adaptability and our constitutional strengths and weaknesses are the sizes of the various endocrine glands. The significance of the variation in the sizes of adrenal glands reported by Williams (61) is highlighted by the fact that Hartman and Brownell (57) reported that adrenal reserve capacity, or in other words, the capacity to cope with stress, is directly proportional to the amount or size of adrenal tissue. A diminished amount of adrenal tissue can sustain life and health as long as stresses are avoided, although there will be a proportionate reduction in work or exercise capacity (57). As is noted by Tintera (59), some people are born with "undersized or weak adrenals". According to Tintera, such persons will have reduced reserves and will therefore be susceptible to various stresses such as allergies. 

The possible effects of reduced adrenal size and capacity are perhaps best illustrated by the many and varied symptoms of Chronic Fatigue Syndrome. This disorder, which is characterised by adrenal fatigue (68) and reduced tolerance of numerous different stressors, and has been called "Functional Hypoadrenia" (62) or the "Adrenal Syndrome" (62), has now been found in some patients to be associated with a reduction in the size of the adrenal glands (63,85: see also CFS page ). This is a highly significant discovery which provides further scientific evidence of the possible effect of the size of the adrenal glands on our constitution and glandular type ( see CFS page ). 

a) Adrenal Insufficiency and Adrenal Fatigue
The end result of insufficient adrenal capacity is an inability to cope with, and adapt to, stressors, due to insufficient secretion of adaptive hormones such as cortisol. The importance of the adrenal gland in enabling the body to cope with a diverse range of stressors is probably best illustrated by the effects of a deficiency of adrenal cortical hormones such as occurs in victims of Addison's disease. Adrenal deficient patients are remarkably intolerant of all forms of stress, and therefore cannot adapt to exercise, chemicals, allergens, temperature changes, drugs, surgery, or emotional stress. Exposure to such stresses may cause what has been termed adrenal exhaustion or adrenal fatigue, or even worse, complete adrenal failure. It has been claimed that adrenal fatigue, which is still largely unrecognised and under diagnosed (68), affects 80% of Americans at some stage of their lives (68).

According to Murray and Pizzorno (47), symptoms of adrenal exhaustion or underactive adrenal glands include, being "stressed out", "tired", and "prone to allergies", or, according to Hadady (48), symptoms such as "mental fuzziness, poor memory, sexual problems, low immune strength and global overweight". Additionally, Cabot (49) states that underactive adrenal glands may also cause, "morning fatigue and depression, general achiness, poor resistance to infections, inability to cope with stress, low blood pressure, low blood sugar levels, allergies, inflammatory problems, poor libido and dizziness".

According to Hanley and Deville (56), adrenal exhaustion or "burnout", which they claim has now reached epidemic proportions, is characterised by five stages, namely, "driven", "dragging", "losing it", "hitting the wall", and finally, "burned out". Hanley and Deville claim that this final stage is characterised by exhaustion of adrenal reserves with symptoms ranging from anxiety, insomnia and recurrent infections, through to CFS, autoimmune diseases and heart disease. Wilson, in his classic book on adrenal fatigue (68), notes the many and varied symptoms and signs of this disorder including, stress intolerance, hypoglycemia, fatigue, salt craving, delayed and difficult recovery from illness or trauma, depression, symptoms aggravated by skipped meals, memory loss, allergies, asthma, CFS, frequent colds and respiratory infections. Not only do asthmatic and allergic people frequently have a reduction in adrenal reserve capacity (see Asthma page), but furthermore, low birth weight has been associated with adrenal insufficiency and chronic lung disease (168, 169; see also Hypophobia).

b) The General Adaptation Syndrome
When we are exposed to a non-fatal stress of sufficient intensity and duration then the body manifests its attempt to adapt by the commencement of the adrenal dependent General Adaptation Syndrome or GAS (43,44). The GAS, which describes only those common symptoms and physiological changes caused by a multitude of different stressors, became evident as a result of research into the physiological effects of many diverse stressors such as infections, surgery, trauma, burns and exposure to excessive cold (43, 44 ). All these stressors, if of significant magnitude and duration, produce various physiological changes, as the body attempts to adapt, which together constitute the GAS. In its complete form, the GAS is comprised of three stages, namely, the Alarm Stage, the Stage of Resistance, and the Stage of Exhaustion (50, 43, 44, 55, 68, 94).

Upon exposure to a sufficiently severe and prolonged (systemic) stressor, the body commences its attempt to adapt by suddenly increasing the output of adrenal cortical hormones. This is the Alarm Stage (46, 43, 44, 30). In the case of exposure to a very sudden and severe stress, the Alarm Stage may be characterised by an initial "shock phase", followed by a "counter-shock phase"(5).

Continued exposure to a non-fatal stressor results in commencement of the second stage, the Stage of Resistance. This stage is the one in which adaptation occurs and, according to Selye (44), "is characterised by an increased resistance to the particular agent to which the body is exposed and a decreased resistance to other types of stress". Even though specific adaptation has been acquired during the Stage of Resistance, there is a limit to just how long this adaptive response may be maintained. Continued exposure to a stressor will eventually result, if adaptation is unsuccessful, in a loss of adaptive capacity and the commencement of the final stage, the Stage of Exhaustion. According to Selye (43, 44), the adaptive capacity is dependent upon the amount of available adaptive energy, and therefore, when, in the Stage of Exhaustion, this energy becomes totally depleted, further adaptation becomes impossible.

The GAS is characterised by numerous physiological changes including altered blood volume, blood sugar levels, and fluid metabolism, changes in blood circulation, body temperature, kidney function, blood pressure, metabolic rate, metabolism of carbohydrates, proteins, and fats, changes in the thyroid gland, enlarged adrenal glands and "shrunken" (51) immune system (thymus and lymph) (43, 44). It should also be noted that the process of adaptation, especially when this process results from exposure to severe or chronic stress, may involve the mobilisation of bodily reserves from the liver, muscles and bones. 

Although stress ( ie. activation of the adrenal anti-stress system ) is commonly thought of as resulting exclusively from emotional or psychological causes, this popular misconception could not be further from the truth. As has been noted by Wilson (68), "one of the commonly overlooked causes of stress and resistant adrenal fatigue is chronic or severe infection." The ability of certain infections to cause severe unremitting internal biochemical stress is fundamental to diseases such as CFS. Transient emotional stress is inconsequential when compared with the type of chronic unremitting stress that may result from infections or the persistence of microbial toxins.

It is clear that an adequate adaptive capacity creates a condition of tolerance - an ability to adjust to a wide variety of circumstances or stressors. It is also clear that this capacity varies considerably from person to person. So what are the causes and consequences of this variation?

The constitutional causes of this variation in adaptive capacity, as we have considered above, seem to be largely related to our adrenal capacity, or more specifically perhaps, the size of our adrenal glands. Our effective adaptive capacity at any particular stage of our lives is determined by the interaction of our genetic or constitutional capacity and our exposure to stressful life events or illnesses which may serve to reduce our effective adaptive capacity. The ability of illnesses to modify our adaptive capacity, although highly significant, is often unrecognised.

As has been noted by Goode (69), "the problems with stress result from a complicated interaction between the demands of the outside world and the body's capacity to manage potential threats." Similarly, according to Nesse and Young (88), stress is a "mismatch between the demands made on an individual and the individual's ability to meet those demands."

Wilson (68) points out that our total adrenal capacity, or capacity to adapt to stressors, is the result of the interaction of various factors including lifestyle factors, illnesses, surgery, trauma, diet, and genetic factors. According to Wilson(68) congenital factors play a big part in "adrenal resiliency". Wilson continues:

The consequences of our genetic variation in stress tolerance or adaptive capacity, although numerous, may be divided into two fundamental categories, namely, those which result from under adaptation or an insufficient response to stress, and those that result from over adaptation or an excessive response to stress. As has been noted by Selye (43), "sometimes our responses (to stress) are too weak, so that they do not offer adequate protection; at other times they are too strong, so that we actually hurt ourselves by our own excessive reactions to stress." 

Since the features of under adaptation are generally due to adrenal insufficiency and are therefore well known (see above), the following discussion will be confined to the less well recognised over adaptive reactions. It should be borne in mind however, that the distinction between under adaptation and over adaptation may in reality be somewhat blurred since reduced adaptive capacity may actually lead to over adaptation. Conversely, over adaptation may eventually lead to under adaptation. Rather than being mutually exclusive it appears that there may be a considerable degree of interaction and overlap of these conditions.

Over Adaptation
Over adaptation refers to the development of inappropriate adrenal overactivity as a result of exposure to one or more stressors, whether such stressors are physical, emotional, chemical, or are the result of an illness. It is important to realise that this type of adrenal overactivity may not always be sufficiently severe to be readily detected by routine pathology tests. Individuality in hormone levels and constitutional factors, fluctuations in "normal ranges", and disturbances in circadian rhythm ensure that the reliability of routine laboratory tests is confined predominantly to detecting more extreme hormonal variations.

The individuality of the tendency to over adaptation or hyperactivity of the HPA axis is highly significant. Exposure to a certain stressor will produce no inappropriate adaptive response in one person while another person who has less adaptive capacity may experience an exaggerated response to the same stressor. The anti-stress system of such a person simply overcompensates or overreacts. In other words, our adaptive system appears to have a highly individualised "set point" which determines the degree of stress we can endure before our emergency anti-stress system is activated. This point seems to be determined by the interaction of our genetic adrenal capacity and our exposure to significant stressors. Exposure to such stressors will tend to reduce our effective adaptive capacity and therefore lower the point at which an emergency hormonal response becomes necessary ( ie. lower our stress tolerance to the point at which adrenal overactivity and over adaptation ensue).

I should emphasise here that the term "emergency" refers not necessarily to the presence of a serious threat to life or safety but rather to the fact that these hormonal responses draw on bodily reserves and are ultimately very damaging to the body and are therefore unsustainable (3, 4, 88). The adaptive system has been described by Nesse and Williams (3) as an "emergency kit that is opened only when the benefits of using the tools are likely to exceed the costs." Nesse and Williams point out that (3) "some components are kept sealed in the emergency kit precisely because they cause bodily damage." The body clearly only resorts to such potentially injurious responses when its normal capacity to cope has been exceeded. This point is of absolutely vital importance since it suggests that maximising normal adaptive capacity (ie. reserves) will tend to reduce, or raise the threshold for the occurrence of, damaging maladaptive reactions.

As has been pointed out by Arem (183), the difference between those people who cope more effectively with stress and those who do not is that the former have the capacity to cope with stress and adapt without excessive production of cortisol. Those who have difficulty coping on the other hand, tend to overproduce cortisol. Paradoxically, people who are hypersensitive to stress are often also hypersensitive to a broad range of chemicals and drugs, including cortisol.

The tendency of the body's anti-stress system to overreact or over adapt is increasingly being recognised as playing a part in various mood disorders (69, 70, 71, 72, 73, 74, 75, 76, 77, 87). Hypersensitivity of the HPA axis is now considered to be the underlying mechanism behind post traumatic stress disorder or PTSD (71, 73, 74, 76, 77). In such cases exposure to significant stress or trauma results in a "supersensitive state" (71) and a "persistently hypersensitive stress response system" (71). This phenomena has been particularly well documented in relation to child abuse (70, 71, 73, 74, 75, 76) which may cause "a hypersensitive stress response system which overreacts to all forms of stress in adults, including mild stress or daily life events" (71). It is now believed that this over adaptive state may result in mood disorders, depression, anxiety, suicide, obesity, memory loss, dementia, and diabetes (69, 70, 71, 72, 78). Mood disorders have also been linked to heart disease as has been demonstrated from the consequences of the Type A personality (81, 82, 83, 84), although strangely, there seems little concern about the underlying causes of the various personality types. Considering the numerous well known ill effects of excess cortisol (see Body Typing) the full effects of over adaptation have yet to be fully realised.

Recently evidence has begun to emerge that CFS (62, 85; see also CFS page), schizophrenia (181), and abdominal obesity (182) may also involve hyperactivity of the HPA axis . Poesnecker notes, in his classical publication on CFS (62), that this disorder is characterised either by exposure to excessive stress or by genetically reduced adrenal capacity, or by the interaction of these factors. According to Poesnecker (62) the weak adrenal glands of many CFS patients results in hyperactivity of the HPA axis as the body attempts to stimulate the failing adrenal glands. Poesnecker claims that this produces the simultaneous occurrence of fatigue and exhaustion with insomnia, anxiety and restlessness (see CFS page).

In addition to all the recently emerging evidence of the importance of HPA hypersensitivity it has been known for more than 50 years, thanks to the brilliant work of Hans Selye (44), that the resistance phase of the GAS is characterised by a general hypersensitivity to stress. Once this stage of the GAS is commenced the body apparently focuses its coping ability upon the initial stressor with the result that there is a diminished ability to cope with, and an exaggerated response to, all other forms of stress.

It should be pointed out that the occurrence of adrenal hyperfunction in various mood disorders does not preclude the possibility that such disorders may also be caused by adrenal hypofunction (92, 93, 119). Insomnia too has been linked to both high (135, 136) and low (142) cortisol levels. Although, from a symptomatic reductionist perspective, adrenal hypofunction and adrenal hyperfunction would be considered as opposite and unrelated types of disorders, from a holistic perspective these disorders may both be regarded as disorders of adaptation. It is the consequences of adrenal hyperfunction or excessive amounts of cortisol however, which is of major concern to public health and the reduction of many age related diseases such as osteoporosis.

While concerns about the risks of osteoporosis and other complications has resulted in doctors becoming very cautious about the use of cortisone treatments, they nevertheless seem rather less concerned about the consequences of those stresses, diseases, non-steroidal drugs, and toxins which may cause elevated levels of endogenous cortisol. Elevated endogenous cortisol levels may result from exposure to any significant stress including infections such as HIV, hepatitis or other infections (43, 68,128, 129, 130, 131, 139, 140), work stress (68, 118,138), excessive noise (137), exercise or physical stress (88,150), caring for the chronically ill (86, 91), certain drugs (177, 178, 179), chronic illnesses or pain (153), bereavement (176), and the stress of dying (143). Other stresses which may elevate cortisol levels include (153) hypoglycemia, inflammation, surgery, trauma, and toxins. Elevated cortisol levels resulting from any of these stressors may in turn cause Alzheimer's disease (140,143,144), diabetes (140, 151, 152), insomnia (135,136), heart disease (140, 141,151), hypertension (180), depression (100, 101, 102, 103,104,105, 106,107, 154), impaired immunity (145,146,152), obesity and abdominal fat (145, 148, 149,151,152), osteoporosis (145,147,151,152, 154), and irritable bowel syndrome (132,133, 134). 

It is remarkable, in spite of the consequences of elevated cortisol levels, that medicine continues to display a level of concern which is proportional to the origin of the cortisol (ie. endogenous or exogenous) rather than its level per se. Yet, as far as the damaging effects of cortisol are concerned, the abovementioned conditions are cause for major concern. Given the fact that even trained hospital workers (68, 118), or in fact many people who care for the chronically ill (86, 91), may have significantly increased cortisol levels the extent of this problem is obviously enormous. Although many carers display symptoms of stress such as irritability, insomnia, depression, restlessness and anxiety (90), doctors generally seem to prefer to avoid confronting the underlying cause of these symptoms. Typically doctors seem satisfied to utilise symptomatic drug treatments while the well known consequences of stress and elevated cortisol levels are frequently ignored. Especially since resolution of the stress underlying adrenal hyperfunction may result in an adrenal "crash" as the body attempts to return to normal, would not patients be better served if they received reassurance about the underlying cause of these rather disturbing effects? If symptoms are being caused by excess cortisol then natural supplements could also be used in an attempt to control these ill effects (see Body Types). Unlike the use of toxic symptom suppressing drugs for which there appears little or no scientific justification, there seems considerable scientific justification for the use of natural anti-cortisol treatments in those who are suffering from stress induced adrenal overactivity. 

As medical science continues its absolute obsession with symptom suppressing drugs, those disorders which are associated with elevated cortisol levels are continuing to spiral out of control.

Although the damaging effects of excess endogenous cortisol are slowly being realised there remains a considerable degree of confusion as to the precise reason/s why so many people are overproducing stress hormones. Why is modern society so incredibly difficult to adapt to (without the secretion of emergency adaptive hormones) especially given the view of many that we have never had it so easy? The point made by Poesnecker in regard to CFS patients (62) that genetically reduced adrenal capacity may lead to excessive compensatory adrenal activity is probably still not yet generally accepted in mainstream medicine (there is nothing unusual about alternative medicine leading the way - it is simply a matter of determining by how long, years, decades, or centuries). However, it is now well known that exposure to a significant trauma or stress may produce a sustained, or perhaps even permanent, state of HPA hyperactivity and excessive production of stress hormones. The common factor here of course, is that our effective adaptive capacity may be significantly reduced by both reduced genetic adrenal capacity and exposure to severe stress. HPA hypersensitivity in other words, is preceded by diseases, events, or circumstances which diminish our effective adaptive capacity.

Evolutionists argue that our stress system is geared to save us from physical threats such as were faced by our ancestors and therefore such a system is not appropriate for the type of stress we face today (88,89). From this perspective our stress system has quite simply failed to adapt to the requirements of modern life. Like black and white TV's, it is simply outdated. However, this approach again fails to acknowledge individual differences in our capacity to cope with stress and adapt. Why is it that some people are much more stress tolerant and do not suffer from adaptive diseases? If Darwinian medicine is to be taken seriously, and if it is to have any hope of filling the current void in modern medicine, it must be able to explain individual differences. Medical science frequently claims that we are becoming healthier and healthier and living longer and longer (see Health Trends) but yet others claim we have not, as a species, adapted to modern life. 

Unfortunately, in a medical world which has traditionally been obsessed with fictitious statistical averages, the subject of individuality continues to be somewhat of a scientific taboo. Even more frowned upon is the suggestion that individuality is related to our genetic glandular make up ( see Body Types). While medical science readily acknowledges the physiological and biochemical complexities of our stress system, they nevertheless continue to pretend that this system is identical in everyone, even in spite of the voluminous scientific evidence to the contrary. There is such sensitivity towards this topic that authorities may even seek to distance themselves from any such suggestion. According to Nesse for instance (89):

 
While no one would seriously suggest that "individual learning" has no effect upon behaviour, as has been noted by Selye (43), Nesse (95) and also Nesse and Williams(3), behaviour may also be influenced dramatically by the body's hormones and brain chemicals. Nesse refers to research which shows that, in monkeys, the dominant animal is determined by its serotonin levels (3,95,96). The dominant monkey will become subordinate when its serotonin level is lowered while a subordinate monkey will become dominant when its serotonin level is increased (3,95). In fact, when randomly selected males were treated with antidepressants to increase their serotonin levels they would become the new dominant male "in every instance" (3). Similarly, Selye (43) found that dominant monkeys had the highest levels of cortisol as compared to subordinate members of the community. It should be noted in this regard, since serotonin may control and enhance cortisol secretion (120, 121, 124), the effects attributed to serotonin by Nesse may actually have been due to changes in cortisol metabolism.

It is clear from this research that diseases which affect our hormones or brain chemicals may significantly alter not only our disposition, but also our relative standing in society. As has been pointed out by Nesse and Williams (3) we "cannot help but wonder what would happen in large corporations as more and more depressed employees start taking antidepressants." In other words, what will happen when large numbers of males all become the dominant male or boss? This is clearly a matter of absolutely vital importance and these workers are to be commended for their attempts to draw attention to it ( see Hypophobia page).

Although many proponents of Darwinian medicine deny the importance of individuality, this is not universally agreed. The importance of individuality, as I have indicated previously, has been emphasised by Lewis (19): "one important task that Darwinian medicine might achieve is to direct the attention of Western medicine and related sciences away from the white, 70kg adult (non-pregnant by definition) male as the representative human entity to a more individualised approach." As has been pointed out elsewhere (see Nutrition and Megavitamins), the fictitious statistically average man with average height, average weight, average job, average wife, average appetite etc, etc, simply does not exist. Unless medicine concerns itself with real individuals the truth will never be revealed.

Unfortunately, modern medicine's view of the types of disorders I have considered above continues to be very seriously disadvantaged by the limitations of their reductionist symptomatic perspective. Rather than confine ourselves to the molecular intricacies of the HPA axis and fictitious statistical averages, as is the habit of modern medicine, it is the purpose of this discussion to adopt a more holistic constitutional approach. I am more concerned with the causes and consequences of maladaptation and the implications of these matters from a constitutional perspective. Although medicine of course, would view disorders such as CFS and PTSD as being totally unrelated, from a holistic perspective these disorders, and also disorders such as (43) high blood pressure, allergies, mental disease, migraines, diabetes, infections, some types of asthma, hypersensitivity diseases, obesity, and heart disease, may be considered to be  (mal)adaptive in nature. Such diseases of adaptation are "the maladies in which imperfections in the GAS play a major role" (43). These are the "stress diseases" (43) which are the result of "our defective bodily or mental reactions to the stressors encountered in daily life" (43).

It is indeed disappointing to note that although these diseases were reported to be diseases of (individual rather than species) adaptation more than 50 years ago (43), modern medicine appears to have abandoned this perspective in favour of their much preferred symptomatic reductionist approach. Recent attempts by Darwinian medicine to explain some of these diseases from an evolutionary perspective seem to conspicuously avoid any consideration of the possible contribution of individual maladaptation. Darwinian medicine instead, suggests that the current proliferation of "stress diseases" is due to evolution and the failure of the human stress system to adapt to modern life (88). According to Darwinian medicine stress diseases are caused by a defect in fundamental human design affecting the entire human race and not a malfunction of the anti-stress apparatus in particular individuals.

Interestingly, whether we consider the approach of mainstream medicine or the approach of Selye, the medical solution to these stress diseases involves the development of  drugs to block or modify the stress response, although Selye also points out that we should (43) "combat disease by strengthening the body's own defences against stress." However, while Selye acknowledges the possible role of individual weaknesses in our stress system in causing these stress diseases (43), Darwinian medicine on the other hand fails to acknowledge any individual glandular weaknesses, preferring instead to lay the blame on evolution.

Given the importance of the body's adaptive machinery it is disappointing that alternative medicine has also been slow to embrace the importance of adaptation and endorse the use of natural therapies which would support this process or counteract it if there is a tendency towards over adaptation. While alternative medicine, to its credit, has endorsed the use of natural treatments to assist in coping with adrenal exhaustion or stress, the wider perspective involving the implications of the GAS and over adaptation have been practically ignored. This is a direct result of alternative medicine's abandonment (particularly in the West) of holistic constitutional balancing which seeks to restore optimum health by rectifying any metabolic imbalance.

Since the sensation of 'stress' may be caused by adrenal overactivity as well as adrenal underactivity the inappropriate use of cortisol increasing drugs or herbal adrenal tonics such as liquorice, ginseng and evening primrose oil is cause for considerable concern. The ill effects of excess cortisol necessitates that all cortisol increasing supplements should be strictly avoided in cases of adrenal overactivity. The marketing of herbal adrenal tonics as "anti-stress" supplements is misleading since such products may aggravate stress in cases of adrenal overactivity. 

It does appear, from the facts we have considered, that both under adaptation and over adaptation may be opposite sides of the same coin. Both may be associated with diminished adaptive (adrenal) capacity. Poesnecker (62) has pointed out that in the case of CFS the cause stems from an "adaptive system weakness" caused by genetically reduced adrenal capacity. As I have indicated above, Wilson (68) also emphasises the critical importance of genetic adrenal capacity when it comes to adrenal fatigue.

It is these individual constitutional differences in our capacity to cope with stress and adapt which are of fundamental importance to any discussion of human adaptability. Even when it comes to child abuse it seems it is only those with higher cortisol levels that go on to develop PTSD (71,76). In other words, those abuse victims who cope more effectively do not produce such sustained high cortisol levels and do not go on to develop PTSD. It appears that those persons who possess optimum adrenal capacity will be least likely to develop disorders of maladaptation. Adequate adrenal capacity seems to offer protection from such maladaptive responses.

In spite of all the available evidence modern medicine is still unable to positively determine whether the current epidemic of hypercortisolemic conditions is caused by internal metabolic factors or external environmental factors. Has science created an environment which is impossible to adapt to without the excessive secretion of emergency adaptive hormones? Or, on the other hand, is man's adaptive capacity diminishing due to internal metabolic problems? Is intrinsic human adaptability, or man's capacity to cope, increasing or decreasing?

The answer to these questions will become clearer with the passage of time, especially since tolerance is the fundamental hallmark of health and adaptability.

As is also the case with heart disease, diabetes, asthma, and obesity, modern medicine is desperate to obtain an explanation for the current epidemic of mental diseases. With the incidence of depression doubling every ten years (3) as it becomes more prevalent in succeeding generations (3, 95), Nesse (95) has commented that "an extraordinary epidemic of depression may be upon us." In Australia too the number of prescriptions for antidepressants has tripled in only seven years (99). In addition, the much heralded new generation of antidepressants have recently been reported to be only slightly more effective than "sugar pills" (97, 98, 99). According to recent trials placebos can "produce 80% of the effects of antidepressants" (99). Drug companies have overstated the effectiveness of antidepressants (184) and both drug companies and regulators such as the FDA have concealed the adverse effects of these drugs (184,185). The "proximate solutions" to this epidemic which have been offered by modern medical science have clearly been a dismal failure.

Under the influence of Darwinian medicine the traditional view of mainstream medicine that all symptoms are diseases is rapidly changing to all symptoms are defences or adaptations. The pendulum is swinging from one extreme to the other even though the truth undoubtedly lies somewhere in between. To Darwinian medicine most mental diseases, including depression and anxiety, may be explained as inappropriate or outdated (species) defences or adaptations, a kind of evolutionary baggage from times gone by, something akin to what was formerly believed about tonsils and appendixes. According to Nesse in this respect (95), "depression and anxiety are not defects like schizophrenia, but defences whose regulation has gone awry." 

Since depression is regarded as a defence it must convey a definite evolutionary advantage. Such a view however, has been called into question by Feder (170) who points out that suicide, with which depression is associated, could hardly be considered to benefit the process of natural selection. According to Feder in this regard (170): "it is hard to imagine a behaviour that is less likely to maximise an individual's contribution to his or her gene pool than suicide. There is no way that suicidal thoughts or behaviours can lead to a person's surviving any situation." Notwithstanding these concerns however, Nesse has responded by pointing out the possible advantages of suicide (171): "suicide could be an adaptation that has been shaped to benefit kin when resources are scarce." Strangely, in this era of abundant resources, and in affluent countries in particular, more and more people seem to be resorting to this means of "benefiting kin when resources are scarce."

Even though schizophrenia, unlike depression, is regarded as a defect rather than a defence, from the perspective of Darwinian medicine it is believed that the persistence of the genes which cause this disorder indicates that it must also produce an evolutionary advantage (3), even in spite of the fact that schizophrenia is known to have a significantly negative effect upon reproductive success (116). Similarly, according to Darwinian medicine the gene responsible for manic depression will spread because this disorder causes sexual aggression and therefore provides an evolutionary advantage (3) although it is difficult to imagine that the stone age manic depressive or schizophrenic would have had enhanced survival rates and transmission of genes. In spite of these facts however, attempts to identify the specific genes which cause manic depression and schizophrenia have failed (95).

On the other hand, in stark contrast to the vague and uncertain theories of evolutionary medicine, we are now beginning to realise the enormous importance of optimum nutrition which I have discussed previously and elsewhere (see B vitamins, Nutrition and Megavitamins). Contrary to the view of Darwinian medicine that we are suffering from nutritional excesses rather than deficiencies there is an increasing amount of scientific evidence that nutritional deficiencies are extremely common in modern society ( see B vitamins, Nutrition and Megavitamins, Nutrition is for the Birds). Nutritional surveys in America have revealed that (117) "not a single person consumed 100% of the RDA" for ten vital nutrients. Furthermore, as I have mentioned elsewhere (see Nutrition and Megavitamins) consumption of RDA levels of nutrients is most definitely not an indicator of optimum nutritional status. There is also a huge amount of scientific evidence showing that nutritional deficiencies may cause various mental diseases (see B vitamins, Nutrition and Megavitamins ).

We also know of the critical importance of optimal nutrition during pregnancy and the ability of nutritional deficiencies during this vitally important stage of life to damage DNA and cause genetic diseases (32, 33, 34, 35). In view of the 1950's medical practice of advising women to practice semi-starvation during pregnancy which I referred to previously, it would be expected that there would be many people today who would still be suffering from various physical or mental aberrations as a result of this iatrogenic foetal malnutrition (see Hypophobia page). It seems even excessive stress during pregnancy may result in underdeveloped adrenal glands and a permanent predisposition to adaptive diseases (68).

One of the problems with Darwinian medicine is that it overlooks all those facts which when combined determine the stress tolerance and adaptability of the individual person. For instance, if a person were to suffer from mental illness and stress diseases because of foetal malnutrition then Darwinian medicine would probably opt for an evolutionary explanation and claim that this was just another instance of failure of the human species to adapt to the requirements of modern society. Darwinian medicine, being exclusively concerned with adaptability of the entire human species rather than individuals, completely overlooks the part played by genetic differences in our individual adaptive machinery in determining our stress tolerance, even though it is well known that "vulnerability to the severe mood disorders is mediated substantially by genetic factors" (95). Darwinian medicine seeks to provide an evolutionary excuse for the failures of medicine. Clearly, if a given disease is "cured" by the "proximate" strategies of modern medicine it will cease being of major concern to Darwinian medicine. Darwinian medicine it seems, is for those "left over" diseases for which medicine has no answers.

While the influence of maladaptation at an evolutionary or species level seems somewhat vague and uncertain, this is certainly not the case for maladaptation at the individual level. As has been pointed out by Selye three decades ago (43): "it is common knowledge that maladaptation plays an important part in nervous and mental diseases." Selye points out that the type of hormonal changes which occur during the GAS are quite capable of causing or aggravating various mental diseases. Cortisol for instance, may cause euphoria, excitement, and insomnia followed later by depression (43). Selye further points out that physical stressors have long been known to produce this type of biphasic response in humans. Certain infectious illnesses for instance, have repeatedly been observed to cause excitement followed subsequently by depression (43). According to Selye these types of endogenous hormonal effects often go unrecognised (43): "we are on guard against external toxicants, but hormones are parts of our bodies; it takes more wisdom to recognise and overcome the foe which fights from within."

Given all these facts it is indeed interesting to note that scientific evidence is increasingly confirming the fact that both depression and also manic depression are related to elevated cortisol levels (71, 100, 101,102, 103,104, 105,106, 107,125,126). Although it has long been argued that elevated cortisol levels in depression may be a result of this disorder rather than a cause of it, this is not consistent with the available scientific evidence. Increasing evidence, including the effects of Cushing's syndrome as well as the effects of exogenous cortisol administration, all confirm the possible depressive effects of this hormone (186, 187, 188). Depression however, which is associated with metabolic diseases such as osteoporosis, heart disease, cancer, infectious diseases, and premature ageing (108, 122,123), is now known to be a systemic metabolic illness and not simply a mental disease (108, 122, 123). All these diseases are well known consequences of excess cortisol (see Body Types). Additionally, initial trials with drugs to lower cortisol levels are proving to have a significant antidepressant effect (108, 109).

The connection between osteoporosis and depression creates a very serious problem for Darwinian medicine. One of the fundamental beliefs of evolutionists is that today we are suffering from nutritional excesses rather than nutritional deficiencies. Yet, in spite of this, one of the most rapidly increasing diseases in modern society is osteoporosis, a deficiency disease which science has clearly linked to depression. Psychiatrists also seem reluctant to acknowledge the increasing scientific evidence that depression is just one symptom of a broader metabolic disorder which may lead to serious consequences, such as heart disease, osteoporosis, and premature ageing. The strong relationship between depression, elevated cortisol levels, and osteoporosis, clearly suggests that depression should be treated by endocrinologists rather than psychiatrists but yet this does not seem to be happening. The reductionist approach of modern science permits doctors to pretend that single symptoms such as depression are in fact single diseases which occur in total isolation from the remainder of the body. According to this attitude, the brain is affected neither by the nutrients and toxins absorbed by the intestine nor the numerous hormones circulating in the body. In spite of the lessons repeatedly learned from diseases like hypothyroidism, which was once thought to be a mental disease and still frequently receives this erroneous diagnosis (see Thyroid page), this fundamental diagnostic error of medical perception continues to be perpetuated. The survival of psychiatry depends upon the complete isolation of the brain from the remainder of the body.

If in fact depression is a defence which provides an evolutionary advantage, does this also apply to osteoporosis and heart disease with which depression is associated? Additionally, since heart disease is claimed by Darwinian medicine to be the result of our failure to adapt to modern fatty diets, does this mean that depression and osteoporosis are also caused by this same mechanism? Then there is the obvious question, if depression is just one symptom of a serious metabolic disease should not scientists and evolutionists be asking "what is the evolutionary advantage of this underlying disease?" rather than "what is the evolutionary advantage of one symptom (ie. depression) of this metabolic disease?" Does the metabolic disease, of which depression is but one symptom, offer a selective advantage? If scientists do not ask the correct question, how can they ever hope to obtain the correct answer? For all its much publicised concern about the increasing diseases of modern society, Darwinian medicine seems conspicuously silent on these issues.

The bottom line when it comes to depression is, why are some people so susceptible to this disorder while others are not? What is the reason for this individual susceptibility? Contrary to popular opinion, exposure to stressful life events is NOT necessarily the deciding factor when it comes to depression. Although Nesse and Young (88) claim that "most stresses in modern life arise not from physical dangers or deficiencies, but from our tendency to commit ourselves to personal goals that are too many and too high", according to evidence cited by Nesse (115) on the other hand, depression is caused not so much by exposure to stressful events but rather by our individual capacity to cope. In this regard Nesse states (115): "while about 80% of first episodes (of depression) in women are preceded by a severe life event, only about one sixth of previously well women develop a depression after a severe life event." In other words, most healthy people, around 83%, will tend to adapt to and cope adequately with, most stressful life events, a fact which is hardly surprising.

While some may doubt the evolutionary usefulness of depression there is little doubt that anxiety on the other hand, may be a defensive emotion which is essential for survival (2, 3,17, 95, 114,127). Selye (43) has pointed out that excessive or inappropriate anxiety may be a sign of maladaptation or inability to cope with a stressor. As has been pointed out by Nesse and Williams (3), "maladaptive extremes of anxiety, sadness and other emotions make more sense when we understand their evolutionary origins and normal, adaptive functions." Panic disorder for instance, is said to be the result of the "fight or flight" system being triggered inappropriately (2, 3, 95, 114, 127). When it comes to panic attacks or anxiety it is probably the first stage of the fight or flight system which is primarily involved. This first or immediate stage, which precedes any significant increase in cortisol, is characterised by secretion of adrenalin and stimulation of the sympathetic nervous system (88).

The usefulness of anxiety as a defensive emotion is amply demonstrated by the consequences of having too little anxiety, a condition which has been termed "hypophobia" (2, 3,17,127). As I have indicated elsewhere (for a more complete discussion of hypophobia refer to the Hypophobia page of this web site), the hypophobic person or person with too little anxiety is much more likely to experience the consequences of excessive risk taking (2, 3,17, 127). While this is serious enough, the hypophobe who rises to a position of power in society may inflict the consequences of this excessive risk taking upon the wider community (see Hypophobia page) .

In spite of the evolutionary usefulness of anxiety and depression, modern science still has no explanation for the current epidemic of mental diseases. Darwinian medicine tends to distract our attention away from well know reversible "proximate" causes of both anxiety and depression such as hyper and hypothyroidism (see Thyroid page), elevated cortisol levels, and nutritional deficiencies (see B vitamins, Nutrition and Megavitamins). In fact, Darwinian medicine continues mainstream medicine's obsession with symptoms rather than causes. From a Darwinian perspective we should be asking, 'what is the evolutionary usefulness of hypothyroidism and nutritional deficiencies' rather than 'what is the evolutionary usefulness of anxiety and depression?' Apparently the (undiagnosed) hypothyroid person with depression or anxiety would be seen as suffering from some kind of evolutionary maladaptation. Darwinian medicine encourages doctors to conveniently blame evolution for all those disorders for which they have no better explanation. Even suicide and child abuse it seems, may be explained on evolutionary grounds. The dangers and lack of scientific justification for such an approach are obvious.

Conclusion

It must be conceded that Darwinian medicine offers very little that is new. Recognition of the existence of defensive or adaptive symptoms and distinguishing such symptoms from disease symptoms, far from being new, has formed a fundamental part of holistic medicine for thousands of years. The same is true of the importance of vital energy and metabolic balancing. Equally, recognition of the vital importance of the natural foods and "natural" dietary requirements of man has also long been of fundamental importance to holistic medicine. What Darwinian medicine has achieved is to make these concepts scientifically acceptable and utilisable by mainstream medicine. Darwinian medicine has been used as a means of legitimising some of the fundamental concepts of holistic medicine and then attempting to incorporate these concepts into the reductionist framework of modern medicine as "new" scientific discoveries.

The most significant aspect of Darwinian medicine to modern science however, is its considerable capacity to offer an excuse for many of the major failings of mainstream medicine. This is clearly the most popular use for Darwinian medicine. The so called "diseases of civilisation" which modern science has been at a complete loss to explain or successfully treat, can now be easily dismissed as examples of a failure of the evolutionary process. Most significantly, according to this belief it is man's failure to adapt which is at fault and NOT the scientifically developed environmental, technological, and social changes which have exceeded or obstructed man's capacity to adapt. The blame, according to Darwinian medicine, must be placed squarely upon man's evolutionary capacity to adapt rather than the scientifically developed hazards which have challenged this adaptive capacity. This is an absolutely vital point which is central to Darwinian medicine. Otherwise Darwinian medicine would be recommending an abandonment of all those changes (ie. deviations from nature) which challenge man's adaptive capacity such as food processing and adulteration, unnatural agricultural practices, and the use of toxic drugs and chemicals. Darwinian medicine would be recommending natural organic foods, nutrition, and herbal medicine in order to minimise adaptive stresses. In fact, Darwinian medicine does not support such natural reforms but endorses any change which challenges our adaptive capacity as long as it is based upon what is described as being "scientific" at that particular point in human history.

The point cannot be overemphasised that Darwinian medicine has no definite application in regard to human diseases other than those created by the failings of medicine. Darwinian medicine is an outgrowth of medical failure that has no existence in its own right. One hundred years ago diseases like hypothyroidism would have had an evolutionary basis. Today the function of the thyroid is understood. The more medicine fails, the more important Darwinian medicine will become. When scientific explanations fail, it will offer a highly flexible and accommodating explanation of convenience.

Darwinian medicine has enabled science to be redefined to embrace some of the basic principles of holistic medicine. Because of Darwin and his theory of evolution and natural selection, science has now suddenly discovered that the natural food diet of our ancestors was optimum for our needs. Nature in other words, according to Darwinian medicine, was designed exquisitely to satisfy our dietary requirements. The artificial environment constructed by science on the other hand, has left us unable to adapt and has caused the current epidemic of "diseases of civilisation". These now are the scientific facts. But what are we to do with these newly discovered scientific facts? Where to from here?

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