What sort of factors lead to psychopathology? This is the central question that the
authors of this book attempt to answer.
The first half of the book consists of seven chapters that consider various
stressors that seem to leave an individual vulnerable to mental problems. Here the authors discuss individual
emotional makeup, biological variables, genetic factors, personality types,
cognitive arrangements, interpersonal factors, and personality traits as
possible catalysts to psychopathology.
In the second half, the essays deal with a number of disorders that are
believed to be the consequences of the stressors discussed in the first part,
including life-long depression, anxiety disorders, eating disorders, substance
abuse, behavioral problems, and the more nebulous afflictions termed
This book takes a developmental
approach, in that discussion focuses on how psychopathology may arise in early
childhood and then intensify over a lifetime, given two separate elements: the individual's initial level of
vulnerability to potential psychological problems, and the types and amount of
stress experienced by that individual.
Discussion includes external stressors over which a child has no
control--such as its biological makeup, the household environment, and economic
level of the family--and stressors which are precipitated by the individual's
own actions, such as conflict within personal relationships due to the
individual's lack of inter-personal or social skills. The word "stress" is also used to suggest biological
stressors, and as such it raises the difficult issue for the therapist of how
to distinguish between those psychopathologies which can be treated with simple
talk therapy and those requiring powerful psychotropic medication. But this book's aim is not to suggest
treatments; its aim is an attempt to
explain how psychopathology develops over an individual's lifespan.
Despite an admitted shortage of
empirical data, the discussions in this book are at least thought-provoking and
at best very informative. The authors
of the chapters in this book use the scientific approach to separate and
isolate various inter-connecting issues and overlapping elements that are
believed to lead to mental distress and illnesses. There are a number of graphs that help to somewhat simplify the
research information presented by the authors.
The ones I found most fascinating (although at the same time disturbing)
are the graphs in chapter 15, which deal with personality disorders. The authors offer ten charts detailing how
various childhood adversities--such as physical and sexual abuse, emotional and
cognitive neglect and maltreatment, and even the level of parental
education--correlate with the development of various psychopathologies
classified as personality disorders.
Their conclusion, that
"childhood abuse contributes to elevated risk for the development
of PD's (personality disorders)" (455), will not be a startling revelation
to most practitioners, but the way in which the research data is organized and
presented makes it easy to comprehend the authors' claims regarding the
etiology of those so-called personality disorders.
As mentioned above, many of the
authors admit that there is a significant lack of clinical research data
spanning individual life spans, therefore most of the conclusions reached are
tenuously theoretical, and many of the authors acknowledge that their claims
require support from additional empirical information. Inherent in this book is also the common
chicken-and-egg problem, found in most texts on psychopathology, in which
authors find themselves unable to clearly articulate where so-called mental
problems end and biological brain problems begin. In one chapter the authors simply surrender to biology when they
declare that "emotions ultimately
have biological substrates"
(97). This raises the
interesting question, Does an emotion cause a change in the biological
substrate or does a change in the biological substrate cause an emotion? The answer to this question has an enormous
impact on the ultimate definition of "psychopathology." Happily, this book does not promote a purely
biological description of psychopathology.
I was glad to see the authors of chapter seven, dealing with genetics,
clearly state in their conclusion that
"genetic influences are probabilistic, and we should guard against
explaining psychopathology in a reductionsitic 'genetic engineering'
manner. Quantitative genetic
liabilities to a specific temperament, disorder, or disease alter risk but
rarely determine outcome"
(187). This thesis--biology is
important but it's not the ultimate causal factor-- is presented as the common
thread in the development of psychopathology.
The essays in this book have
clearly been written and compiled for an academic or professional
audience. The language is clinical and
references to other, previously published papers are plentiful. In other words there is an assumption held
by the authors and editors that the reader is somewhat familiar with
developments in the research and discussion of psychopathology. But having said that, I think this book is
also accessible to the average lay reader with an interest in clinical
psychology. While the language is
technical in places it is not unintelligibly arcane.
This book has both an author and
subject index--two valued resources not often found in a volume of collected
2006 Peter B. Raabe
Peter B. Raabe teaches
philosophy and has a private practice in philosophical counseling in North Vancouver, Canada. He is the author
of the books Philosophical
Counseling: Theory and Practice (Praeger, 2001) and Issues
in Philosophical Counseling (Praeger, 2002).