Vulnerability to Psychopathology
A Biosocial Model
by Marvin Zuckerman
Review by Keith
S. Harris, Ph.D. on 1 Jul 2000.
American
Psychological Association; 1999 (ISBN: 1557985944)
As both an encyclopedic review and an
integration of research related to the etiology of psychological
conditions, Vulnerability to Psychopathology will be of
significant interest to practitioners as well as professors and students.
Zuckerman's writing style is clear and readable, and the use of technical
and professional jargon is kept to a minimum. However, the lay reader will
likely find this book useful more as a reference volume rather than as a
book to be read from cover to cover.
The foundation that this book is based on is
the diathesis-stress model of psychopathology initially developed by Paul
Meehl, which Zuckerman uses to extend his former work on the biological
basis of personality (1991) to include some of the major Diagnostic
and Statistical Manual (DSM) diagnostic categories.
The first chapter of Vulnerability
introduces the diathesis-stress model and illustrates how vulnerabilities
derived from genetics and early environment can lead to mental disorders
under stressful conditions. The term diathesis is defined as a
constitutional disposition or predisposition, "biological traits
produced by the genetic disposition" (p. 3). It is worth noting,
however, that in mental disorders diathesis does not produce a consistent
effect, as illustrated by the fact that even identical twins do not show a
perfect concordance rate in any disorder in the DSM.
The next chapter provides an historical review
of the concept and uses of diagnostic categories, beginning as far back as
ancient Greece. Besides their observations of major mental conditions such
as mania and depression, these early efforts are also interesting for
their consideration of personality types and traits. The evolution of the
DSM is presented, and strengths and weaknesses of each edition are
discussed. The latest explication of the DSM was much more influenced by
scientific data than previous editions, and Zuckerman provides a very
extensive and interesting overview of the reliability and validity of the
DSM's categories of disorders. His discussions of diagnostic comorbidity,
the attempts to lay groundwork for future laboratory testing, and the
theoretical issues surrounding diagnosis of mental conditions provide
especially important reading for the mental health practitioner.
Chapters 3 through 7 deal with many of the
major types of psychological conditions, i.e., anxiety and mood disorders,
antisocial personality disorder, addictive disorders, and schizophrenia.
In each chapter Zuckerman provides interesting and useful data about
prevalence, comorbidity, genetics and familial factors, personality traits
or issues, common stress triggers or risk factors, and possible or
supported neuropsychological pathways for the disorder or condition being
considered.
The last chapter presents Zuckerman's views of
the future of psychopathology research and also offers a framework for the
development of psychotherapeutic models based on the growing knowledge of
how predisposing factors (the diatheses) and environmental
stressors interact. Especially important to therapists (and clients!) are
the early identification of vulnerabilities and the development of
therapies to provide resilience in the face of those potential stressors
most basic to human nature, e.g., family, intimate relationships and work.
Zuckerman intentionally avoids discussion of
current treatments for mental conditions in this book. However, in the
last chapter he notes that the diathesis-stress model may hold potential
for a bright future for psychotherapists. "My prognosis is that
psychotherapies will become smarter, by addressing the specific problems
producing the stress that provokes the disorders" (p. 429). In light
of the current debate about the significant factors in psychotherapy, an
understanding of the etiology of psychopathology is particularly useful,
and this book provides it.
