Welcome to the next part of The mental health workers' guide

Today’s topic is the Stress & Vulnerability model of mental health and disorder

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History is replete with different and conflicting theories about the causes and effective treatments of people whom we would now describe as suffering from psychosis and other mental health problems. From the divine guidance enjoyed by the Ancient Greeks and the demonic possessions of both the Bible’s Old and New Testaments to more modern assumptions about social pressures and genetic loading there seems to be no shortage of explanations. 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 to despair and social isolation.

Fortunately there is a way to make sense of this situation and even include elements of all the other conflicting theories (even though many of the more primitive explanations such as possession tend to be seen as psychological rather than spiritual influences). The ‘Stress & Vulnerability’ model of mental health and disorder is a way of thinking about mental health problems, including psychosis in a way that makes sense to people from a range of backgrounds and beliefs. There really is something here for everybody.      

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.

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.

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?

Biology

Evidence from family studies, particularly studies involving twins seem to show a strong genetic element. It seems that one aspect of a person’s vulnerability is related to their genetic make-up. However this is not the whole story. Other biological factors (stressors) include poor diet, overwork, exhaustion and sleep deprivation, the use of substances (illicit and prescribed), infection and other illnesses, inadequate oxygen supply and even constipation. We are biological organisms and as such we are extremely vulnerable to stressors that interfere with the normal functioning of the body.                                                                                                   

Coping style

I remember as a teenager my preferred method of dealing with life’s problems was to fly into a rage and attack (physically as well as verbally) whoever or whatever was nearest. I’m happy to say that those days are far behind me now but for a few years in my adolescence I was much more likely to punch people than talk to them. That was how I dealt with life’s problems then – my coping strategy.

The only problem was, it wasn’t nearly so effective as I’d hoped it would be. I was a big adolescent (I reached 6’ in height by the age of about 13) and so I could easily defeat most of my peers in fights but that didn’t really solve anything. Instead it made my problems worse.

I developed a reputation as a thug and a bully. I soon found myself with significantly fewer friends than I used to have. I wasn’t always violent. I changed very dramatically following a traumatic family bereavement. That change cost me a large part of my social group. It also cost me the support of most of the teachers at school and it definitely made it harder for those who were interested enough to try to help me.

The cumulative effect of all this was a powerful vicious circle. The worse my behaviour became the smaller my support networks became. The smaller my support networks the worse my behaviour because I had fewer and fewer chances to learn better coping strategies. It’s as though every attempt to cope with life’s difficulties moves our mental health either forwards or backwards and although it’s easy to set off on the wrong path it’s much harder to turn back when we’ve made a mistake.

Good coping, effective coping involves maintaining supportive friends, not driving them away. It also involves being open to experience and learning how best to deal with situations as they arise.

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). We will cover some of the principles around thinking style as this series progresses but there’s much more detail in my earlier series and free PDF, ‘Emotional Management’ which is available for free download here.

Environment

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

This is true even at the most basic level.

For example, I’m a bit of a hoarder. I don’t necessarily hoard junk, as such, but information. I hang on to old journals ‘in case they might be useful’ for years – long after the information they contain has become obsolete. My study regularly becomes so full of paper that it is difficult even to find a chair to sit on.

One way I know that I need to do something about it is I periodically find it very difficult to relax enough to concentrate on the course I’m writing or the blog post I’m researching. When that happens I have a clear out, my environment becomes more ordered and less frenetic. As it does so my concentration improves too.

That’s a small point of course but it does illustrate a wider principle. More serious environmental problems relate to inadequate housing, inherently dangerous or violent surroundings, overcrowding or isolation. The environment in which we live has a huge impact upon our mental health and can certainly contribute to psychosis as well as a range of other psychological problems.

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. 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. These things can help people to move away from high vulnerability to low vulnerability.

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.

We will examine some of these potential changes as the series progresses but for the most part it’s not rocket science. Common sense principles about diet and rest, exercise and relaxation, problem-solving and social interaction can be massively beneficial. Additionally, working to develop improved mental habits and a realistic (not necessarliy positive) attitude is extremely powerful. There is more to mental health management than medication (although that has a place).

References

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

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

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