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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. |