Structured Psychosocial Stress and Therapeutic Intervention: Toward a Realistic Biological Medicine

Abstract

Using generalized 'language of thought' arguments appropriate to interacting cognitive modules, we explore how disease states can interact with medical treatment, including, but not limited to, drug therapy. The feedback between treatment and response creates a kind of idiotypic 'hall of mirrors' generating a pattern of 'efficacy', 'treatment failure', and 'adverse reactions' which will, from a Rate Distortion perspective, embody a distorted image of externally-imposed structured psychosocial stress. This analysis, unlike current pharmacogenetics, does not either reify 'race' or blame the victim by using genetic structure to place the locus-of-control within a group or individual. Rather, it suggests that a comparatively simple series of questions to identify longitudinal and cross-sectional stressors may provide more effective guidance for specification of individual therapy than complicated genotyping strategies of dubious meaning. These latter are likely to be both very expensive and utterly blind to the impact of structured psychosocial stress -- a euphemism for various forms of racism and ethnic cleansing -- which, we contend, is often a principal determinant of treatment outcome at both individual and community levels of organization. We propose, to effectively address 'health disparities' between populations, and in contrast to current biomedical ideology based on a simplistic genetic determinism, a richer program of biological medicine reflecting Lewontin's 'triple helix' of genes, environment, and development, a program more in concert with the realities of a basic human biology marked by hypersociality unusual in vertibrates. Aggressive social, economic, and other policies of affirmative action to redress the persisting burdens of history would be an integral component of any such project.