Understanding Stress and Vulnerability
 By Stuart Sorensen RMN 2002

Throughout history people have been concerned about the nature of mental disorder. There have been many different theories about the cause and effective treatment of people whom we would now describe as suffering from mental illness. At first glance it seems as though people just keep on going round and round in circles without ever getting any nearer to solving the problems which can lead so many of us to mental despair and social isolation.

However, things aren’t really as gloomy as all that. It is true that people still disagree about the exact cause of mental disorders or even if people who think differently should fairly be called ‘ill’ at all (Caplan P. J. 1995). But it is also true that most people agree about the basic nature of the problem and new approaches are being developed constantly to help people in distress (Gamble C. & Brennan G. 2000).

This handout aims to provide a brief overview of the ‘Stress:Vulnerability’ model of mental disorder. This model provides a way of thinking about mental health problems that makes a great deal of sense to many people.

Back in 1977 Zubin & Spring published their paper outlining the Stress:Vulnerability model of mental disorder (Zubin & Spring 1977). The paper is quite detailed but the principle is simple enough. Briefly put the idea is that people become ill when the stress they face becomes more than they can cope with. Also, people’s ability to deal with stress – their vulnerability – varies so problems which one person may take in their stride might be enough to cause another person to become depressed or psychotic. The graph overleaf may help to explain this more fully.

High stress

Low stress High Vulnerability
Low vulnerability

We can see from the above graph that people with low vulnerability need to experience a great deal of stress before they become distressed whereas those people with high vulnerability need only a small amount of stress to ‘tip them over the edge’ into serious mental disorder.

So what causes the differences in people’s vulnerability? What makes one person more vulnerable than another and what can we do about it?

Genetics

Evidence from family studies, particularly studies involving twins seem to show a strong genetic element (Horobin D. 2001). It seems that one aspect of a person’s vulnerability is related to their genetic make-up. However this is not the whole story.


Coping style

Some methods of coping with life’s difficulties seem to be more effective than others. People who use effective coping skills seem to deal with stress better than those who do not. They can handle much more stress before they develop symptoms of mental disorder (Warner R. 1994).

Thinking style

How a person thinks about their self or the world around them seems to make a major difference to their level of vulnerability to stress. This is more than simply being optimistic or pessimistic – there are certain thinking methods which help people to cope better than others (Thomas P. 1997) (Warner R. 2000).

Environment

The way a person deals with stress and the options they have are often related to their environment. Anything from the state of a person’s home to the neighbourhood they live in can make a difference.

Social skills

The better a person’s social skills the easier it is for them to get other people to help them when things get too tough for them to handle alone. People with lots of supportive friends tend to do better in times of crisis than people with fewer or perhaps no other people to turn to.

So what can we do about it?

There is little that can be done to alter an individual’s genetic make-up. Even if we could change that it probably wouldn’t be a good idea. There is growing evidence (Horobin 2001) that the very genes that make people susceptible to stress are also involved in making them talented in other ways. The trick probably lies in helping people to examine the other things which make them vulnerable and looking for ways to change them (Coleman R.1999). 

For example it is possible to adopt different styles of coping and thinking. Social skills can be developed just as other skills can and although sometimes a little more tricky, it is possible to change a person’s environment for the better. All these things can help people to move away from the high vulnerability to the low vulnerability end of the graph.

Additionally it’s often possible to reduce the amount of stress people find themselves under. It’s surprising how much can be achieved by making a few, relatively simple lifestyle changes. This can have a huge impact on the risk of further episodes of illness.

This has only been a very brief overview of the Stress:Vulnerability model of mental disorder. I hope you find it helpful. Other handouts in this series will aim to address specific ways in which you can reduce your own vulnerability and the amount of stress you face in your everyday life.

Please feel free to discuss this and any other handout in the series with your key worker.

References

Zubin J. & Spring B. (1977) Vulnerability - a new view of schizophrenia. Journal of Abnormal Psychology Vol.86, No.2, pp.103-124.

Caplan P. J. (1995) They Say You’re Crazy Perseus, Massachussetts

Coleman R. (1999) Recovetry – an Alien Concept Handsell, Gloucester

Gamble C. & Brennan G. (2000) Working with Serious Mental Illness Balliere Tindall, London

Horobin D. (2001) The Madness of Adam & Eve Corgi publishing, London

Thomas P. (1997) The Dialectics of Schizophrenia Free Association Books, London & New York

Warner R. (1994) Recovery From Schizophrenia Routledge, London & New York

Warner R. (2000) The Environment of Schizophrenia Brunner-Routledge, London & Philadelphia