Neither the title of this book nor a casual look at its contents list will prepare you for the depth and profundity of its substance. The ambition of the author is to provide a new philosophy of medicine that will enable the re-integration of love and compassion into the science of medicine. However, this is not simply a philosophical or polemical text. The author is a psychiatrist and an evolutionary scientist, and he sets out to achieve his objective by proposing a theory that drives all matter and energy in the universe. Fricchione proposes that the phenomenon of ‘separation challenge–attachment solution’ applies not only to mammals and birds or even to all life forms, but also to the prebiotic universe. This may shock and baffle many readers but the author carefully sets out his ideas, which he bases on evolutionary theory, and to support his hypothesis marshals a formidable array of cutting-edge scientific evidence ranging from particle physics and the Big Bang theory right through to advanced neuroscience and evolutionary biology. The arguments and evidence are presented in exhaustive detail over 22 chapters (and a post-script) ranging over 550 pages of densely packed text. Some of the science is highly technical and complex, which places this book beyond the reach of the majority of the non-specialist public.

The author presents a strong case for the evolution of true altruism, primarily through the somewhat contentious process of group selection rather than through kin selection as conventional wisdom would have it. This genuine altruism then forms the basis for philanthropy and the unbounded love of the stranger, of humanity and nature preached by the major religions as well as the compassion that forms the cornerstone of healing in medical practice and in healthcare in general.

Furthermore, unlike conventional evolutionary theorists who insist that evolution has no direction or goal, Fricchione contends that evolution does have a direction and this is towards increasing complexity (the law of complexification) and that this is relentlessly driven by the process of separation challenges being met by the production of ever more complex attachment solutions. This particular aspect of Fricchione's theory is highly persuasive as is clear from comparing amphibians and reptiles with mammals and birds respectively where there is a clear increase in the complexity and intensity of the attachment solutions in the latter compared with the former. This rule appears to hold true more generally in biology in that the simpler the life form the simpler the attachment strategies and vice versa.

Mammals show the most elaborate attachment strategies exemplified by McLean's mammalian behavioural triad (mother–infant attachment, infant separation call and juvenile play). Among mammals primates have the most complex attachment strategies and humans lie at the pinnacle of the attachment complexity hierarchy. One fascinating hypothesis that Fricchione proposes is that language arose in humans as an attachment solution to the separation challenge of having a big brain and consequently being born immature, helpless and completely reliant on the mother. He proposes that language arose out of the infant's separation call that served a particularly pivotal survival function during our species’ evolution.

However, the author's hypothesis does tend to focus rather too intensely on altruism and cooperation (attachment solutions) when nature presents a mass of evidence that it is red in tooth and claw. The darker side of life, namely that much of survival is based on exploitation, predation and competition, although acknowledged by the author, does not sit entirely comfortably in his grand scheme. In addition, there are some concerns about the falsifiability of the separation challenge–attachment solution hypothesis where every piece of evidence is presented by the author as confirmatory of his hypothesis whether it is evidence of cooperation, coexistence or destruction and genocide.

Despite these concerns and whether or not one accepts them wholesale, Fricchione's claims regarding the applicability of the separation challenge–attachment solution hypothesis to the non-biological world or to non-social species, his points regarding its applicability to humans are not in doubt. In addition, the connection between this and human compassion and its role in the practice of medicine and healthcare is a message that is both worthy and profound. Furthermore, his project of uniting all knowledge (material and spiritual) using the scientific method must qualify as one of the most fundamental intellectual challenges faced by humanity. It is not possible to give justice to such a large and complex project in a short review. Suffice it to say that medics, scientists and philosophers with the stamina and the motivation to learn of a new approach to the understanding of love, compassion and spirituality and who are prepared to have their existing assumptions severely challenged and tested will find this book both enlightening and fascinating.