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Digital psychiatry has become increasingly important and understanding of certain aspects is essential for practising clinicians. This article discusses electronic patient records (EPRs), from their origins to current and future use, the growth and embedding of outcome measurements, the use of social media, and learning and research in virtual arenas.
This chapter explores some of the opportunities and challenges that technology and social media have brought to medical education, teaching, and practice. Finally, guidelines on doctors’ use of social media are highlighted.
Our immediate ancestry remains uncertain at this time, but what is clear is that we are all African. This chapter will start with the current debates on the emergence of Homo sapiens and the changes we see in the subsequent 200,000 years in terms of our behavioural and cultural development. We have already shown that the ‘march of progress’ image – so culturally famous from t-shirts to posters – of a line of ever more upright and ‘civilised’ walking ape-to-man creatures is wrong. There has never been a single line, and we are not the apotheosis of evolution. A second myth is that ‘we evolved’ 200,000–300,000 years ago and since then have been static, with only technology progressing. However, humans have continued to change with time. The third conceit is the focus on ‘our’ move ‘out of Africa’ 50,000–60,000 years ago. This idea is problematic: it culturally assumes a non-African terminus as our destiny and is a very Eurocentric view of the world. It is true that a subpopulation of hunter-gather sapiens, most likely Yoruba peoples from around what is now Tanzania, left that continent at around that time, and from that group the rest of the world’s populations emerge. But this is to downplay the fact that for 80% of our species’ existence we have all been entirely African, and a genetically small subgroup left for the last 20% of that time. History is written by the ‘victors’, and much anthropology has been written by Western academia. In 2020, it was estimated that fewer than 2% of whole sequenced genomes have as yet come from Africa (Maxmen, ), and we lack ancient DNA from Africa greater than 15,000 years old (partially due to climactic reasons). However, the tide has begun to turn, and the next 10 years look very exciting in this regard.
Just over 50,000 years ago – a blink in evolutionary time – there were at least six, possibly seven, human species alive: sapiens, neanderthal, denisova, floresiensis, luzonensis, remnants of erectus and, perhaps, the last of Homo naledi. This is similar to contemporary primates, with chimpanzees, gorillas, baboons and so forth all living side by side. It underlines the important fact that sapiens is one hominin species among many and that it is firmly part of nature and does not stand apart from it. However, we are used to occupying a unique solo position as the only humans, though such a situation accounts for less than 1% of the time since we separated from our last common ancestor with chimpanzees. This has led to the conceit and falsehood that evolution is a linear trail, marked through ever greater brain growth, leading to us. It also adds to the challenge when looking at the fossil record to determine whether some ancient species were indeed our ancestors or just side chains in a rich hominin tree. A further difficulty is that taxonomic descriptions imply clean leaps from species to species, such as between Homo habilis and Homo erectus. However, each child is a close genetic variant of its parents, and there are no hard borders as changes accrue across millennia. Late Australopithecus looks closer to the genus Homo than to early Australopithecines. Determining ‘when is a species a species’ is difficult (Barraclough, ). Adding to the uncertainty, interbreeding between different human species appears to be the rule rather than the exception, with there being complex flows of genetic material. It is a jigsaw for which we do not know how many pieces there are, nor how they might interlink. Further, the pieces are often found in fragments of single bones, and they can be so rare that many finds remain known by their ‘site name’. The last 10 years have seen enormous leaps in palaeoanthropology, from the discovery of previously unknown (and entirely unexpected) human species, to advances in molecular biology that have allowed us to sequence the Neanderthal genome and better estimate temporal links between fossils. Genetic data tell us that there are several other hominin species as yet undiscovered, whose ghostly footprints are currently seen only through a unique genetic imprint across some human populations.