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Vulnerability to PsychopathologyReview - Vulnerability to Psychopathology
A Biosocial Model
by Marvin Zuckerman
American Psychological Association, 1999
Review by Keith S. Harris, Ph.D.
Jun 30th 2000 (Volume 4, Issue 26)

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.

Keith Harris, PhD, is a clinical psychologist and supervisor of Victor Valley Behavioral Health Center in San Bernardino county, California. Hisinterests include clinical supervision, the empirical basis forpsychotherapy research (and its design), human decision-making processes,and the shaping of human nature by evolutionary forces.


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