At face value, medicine appears to work on a relatively simple model. You gather information through history taking, clinical examination and investigations such as lab tests and imaging. Then, you narrow down the differential diagnosis to the single most likely diagnosis. Lastly, you treat the diagnosis as per the recommended treatment guidelines.
But if you ask anyone who works in healthcare, they will all know that is not the whole truth. There are so many other factors and variables that play in to the management of a patient that the model above does not address.
For example, you may diagnose a skin infection and prescribe antibiotics, but the person may not have enough disposable income to pay for the medications. You may come up with a plan for the patient to come in to clinic in a week’s time for a review, but they may not have transport or someone to look after their children so that they can come in. You may diagnose that there is nothing medically wrong with the patient, but they may still be worried that they have a serious condition that killed their father.
In medicine, you do not treat the disease; you treat the patient. It is easy to get so focussed on the clinical picture that the overall context is lost. This leads to incomplete care, which causes a variety of issues ranging from patient dissatisfaction to recurrent presentations.
Although it may seem difficult and time-consuming to pay attention to these extra details, it almost always pays off in one way or another. Addressing a patient’s troubled social situation may reduce the number of times they present to hospital, saving significant costs. The doctor taking the time to reassure the patient that their symptom is not concerning for a significant illness may let the patient sleep comfortably at night. Talking through the patient or their family’s concerns and questions might make the worst day of their lives slightly more tolerable.
This approach is useful outside of the hospital too. When you face a problem, regardless of the type, instead of trying to come up with a quick fix to patch it up, try to consider the context of the problem. You may discover that there is a deeper, more fundamental cause of the problem that needs fixing.
Whether we’d admit it or not, we all have someone in our lives that we consider a best friend. A best friend is someone who you enjoy spending time with, trust with your deepest secrets and talk openly and honestly with when something is troubling you.
For some, this may be a childhood friend with whom they had endured the hardships of life together. For others, it may be their parents, sibling or significant other. In some cases, a person who was a stranger to you less than a year ago may quickly develop in to your most valuable friend. Many of us will even have multiple “best friends” who we can call upon in times of need, or if we just need to rant over a drink.
These friendships do not happen without effort. Sure, it requires basic chemistryand connection. But to build a great friendship, it requires both parties to invest time, care and empathy. Loyalty is built on acts of kindness. You need to actively listen to delve deeper into the emotions and thoughts that drive your friend’s worries. We improve each other over time by calling out bad behaviours, while offering endless support and love when the other person feels worthless or unattractive. We take for granted the sheer amount of emotional energy invested in cultivating a true friendship.
When we forget this fact, we become terrible friends. We can be selfish, becoming angry with our friend that they aren’t giving us the support that we need. If this ever happens, consider the fact that your friend is also human and that they might be in exactly the same position as you. To parody John F. Kennedy:
“Ask not what your friend can do for you – ask what you can do for your friend”.
There is also one other friendship we must discuss – the friendship between you and yourself. This sounds strange, but you should be your own best friend. You are the person that has truly lived your life with you. You know of all the dramas, thoughts and feelings you have experienced. Yet when we are in a time of need, we neglect to support ourselves as a friend. Instead of support and love, we criticise ourselves, neglect ourselves and drive ourselves to stress and fatigue.
Be generous with your kindness to yourself and don’t forget to treat yourself. If you are having a bad day, take a break so that you can be there for yourself. Watch a movie, go for a walk, introspect and have a deep and meaningful chat with yourself. If you feel like a failure, remind yourself that you are being stupid and remind yourself of how amazing you are.
No matter how many great friends we have, we cannot truly be happy if we treat ourselves like an enemy.
How many friends can a person have? Believe it or not, science has solved this question. An anthropologist called Robin Dunbar studied various societies, tribes and primate groups to determine how many members a group can have to maintain stability. He discovered that the ideal size for a group of humans was about 150.
What happens if there are more than 150 people in a group? This is easily explained by the following thought experiment. Imagine that you have a friend called Mr. White. Add a personality to him – flesh him out as a person. Next, you make another friend called Mr. Red. Then Mr. Blue, Mr. Green, Mr. Maroon… At a certain point, you will no longer remember the name or personality of your “friend” and not even care about that person. This is the limit set by our brains – known as Dunbar’s number, or more colloquially the Monkeysphere.
Any person outside of this Monkeysphere is not of your concern. Once you saturate your brain with 150 relationships, the brain ceases to care about other people. Interestingly, the Monkeysphere is directly related to the size of the neocortex (the part of the brain responsible for higher order thinking). For example, most monkeys can only operate in troupes of 50 or so.
The Monkeysphere can be defined as the group of people that you conceptualise as “people”. Because of this limitation, we are physiologically incapable of caring about everyone in the world. For example, we are highly unlikely to be concerned about the welfare of the janitor at work compared to a loved one. As politically incorrect it may be, the brain sees the janitor as “the object that cleans the building” rather than a human being. You may “care” about the janitor in the sense that you greet him in the corridor, but there is a limit to this. This effect actually explains quite well why society is dysfunctional in general.
Because we do not see people outside the Monkeysphere as “people”, they mean less to us. Stalin once said that “one death is a tragedy; a million deaths is a statistic”. Similarly, the death of a family member is devastating but 10,000 people dying in a foreign country from war does not have the same emotional effect. Furthermore, if a stranger was to die in front of your eyes, you would still not be nearly as devastated as the death of someone you are close to.
Also, as we do not feel connected to these “outsiders”, we are much more prone to act rude or aggressively. For example, one may insult other drivers with the most colourful words on the road, but would (hopefully) never say those words to a friend.
This expands to a greater scale in the context of survival. We are wired to put the need of the members of our Monkeysphere ahead of those outside of it. Thus, we would not steal from our friends but openly evade taxes as we see the government and others as a cold, faceless body. It does not occur to us that through our actions, we are harming other human beings. The same applies to our view of corporations; despite being made up of real people, we only see them as heartless machines actively conspiring against us.
What if the scale was then expanded to countries? If we do not see a person on the other side of the road as a human being, it is extremely unlikely we would register a foreigner as one. This explains why racism and stereotyping is so common in human societies. Although liberal-minded people would like to believe that we should treat every human being like we treat our mothers, our brain is incapable of it. In fact, it is much more likely we would see those people as acting against our interests by “stealing jobs” and so forth. Thus, racism is a hard-wired behaviour to protect the best interest of our Monkeysphere.
We have established that it is impossible to worry about the seven billion strangers in this world. This brings us to an important point: it is just as impossible to make “them” interested in “you”. It is a cold, hard fact that if you are outside of their Monkeysphere, people will not care about you. Ergo, they treat you badly, put you down, steal from you and downright ignore you. In fact, cognitive dissonance means you are even less likely to care for people outside the Monkeysphere as your brain actively rejects people from getting closer to your Monkeysphere, exceeding the preset limit of 150 people. This is why propaganda always focusses on dehumanising the enemy and why people seeking votes and attention pull at sympathy strings – to try get as close to your Monkeysphere as possible.
Many people will lament how we are not monkeys and the Monkeysphere does not apply to us. We have laws, ethics and “humanity”. However, we cannot escape our primitive psychological behaviours and this is reflected in societies filled with crime, unhappiness and a general disinterest in people not related to yourself. This is why city-dwellers tend to be less friendly than villagers, as there are too many people to fit in one, happy Monkeysphere. In fact, monkeys may have more functional societies than us because they hardly ever exceed their own Monkeyspheres (which may also explain why they rarely have wars). The same can be said of tribes and villages of the past.
Ironically, the development of society has been based around working around the limitations of the Monkeysphere – a theoretically ideal society. By living in larger groups, humans can achieve greater feats such as industries and large-scale economies. Although we suffer the consequences of racism and crime, we have become very effective in survival.
Economics is based on the Monkeysphere too. As we only care about our Monkeysphere, there is no reason for us to be concerned about the needs of others. So when a system such as communism forces us to share our bananas, we become infuriated that we have to give up our bananas to people we do not know. But in capitalism, every individual can pick bananas for just ourselves and those we care about. The system thrives as each Monkeysphere acts dynamically and everyone is happy. This is the concept of the invisible hand that is the foundation of modern economics.
But still, the concept of countries means that we have to share the burden of millions of people we do not care about in the form of taxes and civil duties. This makes us unhappy. So what can we do?
Firstly, realise that you are to others what others are to you. If you find a certain person on television as annoying and irrational, chances are that someone else sees you in that light. You are limited to your Monkeysphere of 150 people and people outside of it are in their own Monkeyspheres.
Secondly, understand that no one is special. There are no heroes or perfect beings. Everyone is a human being and prone to making mistakes and acting “human”. Therefore, we cannot idolise people and be disappointed by their actions. This also means that you cannot judge another person and consider their words and actions as insignificant, as they are just as human as you.
Lastly, never simplify things. The world is not simple. It cannot be generalised as one happy village with everyone living happily in harmony. It is a composite of a massive number of different Monkeyspheres, all concerned with their own well-being and not caring about anything else.
Remember the words that Charles Darwin spoke to his assistant, Jeje Santiago: “Jeje, we are the monkeys”. As much as we would like to think that we are higher-order beings, we are simple creatures of habit and behaviour limited by our Monkeysphere.
Some people are known to overreact regarding their health, such as a hypochondriac thinking that she has kidney failure because her urine looks slightly frothier. However, some people far surpass the level of hypochondrias to the level of psychiatric disease. Münchausen’s syndrome patients are known to exaggerate or create symptoms so that the doctor would pay attention to them. When the doctor investigates, treats and sympathises with the patient they gain satisfaction from all the attention they are receiving.
Although this may sound like hypochondrias, Münchausen’s is far more serious.
A Münchausen’s patients are known to cause symptoms just to get attention from others. For example, a common manoeuvre used is the injection of insulin to induce a hypoglycaemic seizure. When their symptoms are “treated”, the patient will most likely invent another factitious disease to be treated for a longer time. They will also seek out many different doctors when the attending doctor catches on to their act. In fact, a Münchausen’s patient will do almost anything to prolong medical care, even accepting unnecessary and risky procedures such as surgeries.
The key difference between Münchausen’s syndrome and hypochondriasis is that the patient is aware that they are not actually sick (hypochondriacs actually believe they are sick). The fundamental basis for Münchausen’s syndrome is the desire for attention. Thus, the main risk factor for developing Münchausen’s is childhood experience of seeing someone close (typically a family member) suffering a debilitating disease. For example, if a girl sees her sister suffering from leukaemia and receiving all the attention of everyone around her, she may develop feelings of jealousy and later try to duplicate the scenario. As a patient, the person feels safe and comfortable and this feeds their addiction to medical care.
As Münchausen’s patients are very proficient liars and act completely like an actual patient, doctors must rule out any diseases before suspecting that their patients have a psychiatric problem. However, some signs such as the patient being overly keen on receiving procedures such as biopsies or continuously developing random symptoms may indicate Münchausen’s.
Interestingly, a similar condition called Münchausen’s syndrome by proxy also exists, where a caregiver (e.g. mother) convinces a doctor that the person they are caring for (e.g. child) are sick. Unfortunately, as these patients actually cause illness in the child, it is considered a form of child abuse. Common “symptoms” include: growth problems, asthma, allergies, vomiting, diarrhoea, seizures and infections. This may lead to the child developing Münchausen’s syndrome in the future.
In the year 914 (during the Later Three Kingdoms period of Korea), a general named Wang Geon was on his way to strike the kingdom of Later Baekje. He noticed a strange, colourful cloud in the sky and when he went there to investigate, he found a maiden washing clothes by a well. He approached her and asked for some water. The maiden politely accepted and went to fetch a gourd of water, placed a willow tree leaf in it then handed it to Wang Geon. Curiously, he asked:
“What is the reason for putting a leaf in the water?” “You appeared to be very thirsty so I was worried that you would gulp down the water too quickly and upset your stomach.”
He was touched by her consideration and wisdom and fell in love with her, so he asked her hand in marriage before leaving the town.
In 918, Wang Geon became the first king of Goryeo after successfully unifying the three kingdoms of the Korean peninsula. The maiden is now known as Empress Janghwa; that is the story of how a girl became an empress from a simple act of kindness and tenderness.
The word cute is used in many different contexts: a girl saying a guy is “cute” could mean that she finds him attractive, while a guy saying a girl is “cute” may imply that they find them lovable but not in an attractive way. But essentially, cuteness can be described using the concept of neoteny.
What is neoteny? This is a concept in evolution where adults of a species preserve traits of youth. The end result is a mature organism that appears to be immature. A good example of this is the axolotl, which preserves its juvenile aquatic form (e.g. gills and overall look) in adulthood, even when they are living amphibiously. It has been hypothesised that human beings originate from neotenised chimpanzees, as a baby chimp has striking resemblance to a human.
Cuteness and neoteny have an extremely intricate relationship. It is common knowledge that the most powerful attractors of care from an adult is cuteness. Almost every infant organisms have “cute” appearances that make people instantly feel warm and fuzzy. Ergo, being cute (i.e. neoteny) is a survival advantage as the young are cared for more until they are mature. This simple concept has led to the lengthening of childhood in humans, as children require a long time under the care of adults while they absorb knowledge and learn how to function in society. This also solved the problem of babies being born with immature brains (as the head is already too large to fit through the birth canal) and still having a chance at survival.
It has been scientifically proven that people with cuter faces are seen in a more positive light, more likely to be hired and less likely to provoke aggression in violent people (the human brain is wired to inhibit aggressiveness when faced with cuteness, presumably an effort to reduce child abuse and improve survival). In short, cuteness invokes maternal or paternal love and causes a sudden want to protect the cute thing.
This leads to another advantage of cuteness: attractiveness. Although beauty and cuteness are almost diametrically opposed, many men (and women) find “cuteness” to be appealing in the opposite sex. This is likely related to the brain confusing parental love with romantic love. A youthful look is also associated with fertility, which greatly influences a man’s subconscious choice of a partner. However, it is also true that because of this effect a man may see a cute girl only as a “little sister” figure they need to protect, rather than a potential love interest.
So what makes for a cute person? As stated above, these are traits of neoteny, or in other words:
large eyes
small nose
small jaw and teeth
flattened and rounded face
large brain/forehead (causing the eyes/nose/mouth to be lower on the face)
hairless face and body
limbs shorter than torso length
legs longer than arms
upright posture
These characteristics are commonly used in animations and cartoons to boost the audience’s affection towards the character. This is especially the case in Japan where the a cultural obsession with cuteness is clearly evident.
