ABSTRACT
Years ago, the psychoanalyst Roger Money-Kyrle (1971) drew attention to three uncomfortable basic facts of life: (1) we are all dependent on other people for our survival, (2) we are not the centre of the universe and consequently our exclusion is inevitable, and (3) the passage of time and ultimately death are inevitable. Such facts about human dependency and vulnerability in ourselves and others can evoke strong feelings, ranging for example from shame, fear, hatred, contempt, derision, depression and pity to concern, empathy and fellow-understanding. Behavioural responses may be similarly variegated, from the hostile and potentially lethal to the protective. Vulnerability can thus be a very uncomfortable reality, particularly when it is our
own. One common way of dealing with such psychological discomfort is to utilise processes of psychological splitting in order to disown or disavow it in ourselves and to then defensively localise it by projecting it into others (Segal, 1986). Such externalisation, when extreme, can lead to the dehumanisation and stereotyping of others and the concomitant impoverishment of the self (due to losing touch with core elements of our humanity). Such projective processes occur not only on an individual level but also in groups of all sizes: families, organisations, communities and nations. It is important to emphasise these dynamic processes at the outset because in
studying vulnerability it can be all too easy to identify individuals or populations that are supposedly at risk while overlooking our own inescapable individual human vulnerability. Thus, for example, people from ethnic minority groups, or who are very young, elderly, poor, homeless, female, or have disabilities or mental health problems are commonly clustered together as vulnerable or potentially vulnerable groups. They are seen as vulnerable to something, typically
some negative health, social, economic or moral risk. Seeking to define the characteristics of such groups based on their relative risk of harm, while relevant for policy making and service planning, potentially entails an unhelpful deficit model that stereotypes and essentialises such groups under that banner (Liamputtong, 2007). Strengths and experiential qualities of those identified as vulnerable may be overlooked, as may dynamic and wider systemic social factors, and the baseline fact that – for any and all of us – to be alive is to be vulnerable. We all face distress and ultimately death. With this as an important caution, the present chapter outlines several classic
contributions to the biopsychosocial approach to vulnerability, to psychopathology (and to a lesser extent to the wider experience of distress), offers a conceptualisation of these factors in relation to development and help-seeking, and outlines associated vulnerability-stress models. In considering different types of psychopathology (e.g. depression, anxiety, per-
sonality disorder, schizophrenia, etc), key vulnerability factors are typically seen as a necessary though not sufficient precursor to the emergence of a particular disorder, the emergence itself being triggered by other factors such as stress (for a review of the latter concept see Grant and McMahon, 2005). Vulnerabilities are thus typically regarded as predispositional causal factors that may together with other factors catalyse distress and disorder. These factors may be observed on many different though potentially interrelated levels: genetic, biological, cognitive, affective, interpersonal, attachment, etc (Hankin and Abela, 2005). Working definitions of vulnerability as a concept frequently suggest it is a rela-
tively stable, latent trait within individuals that confers a relative susceptibility to a disorder (Zubin and Spring, 1977; Ingram and Luxton, 2005). Where relatively immutable factors (such as genetic or other constitutional variables) are less significant as sources of vulnerability, other factors – such as psycho-social vulnerabilities – may be more plastic and thus more amenable to fluctuation within and between individuals over the life course, as well as more auspicious targets for intervention. Notions of vulnerability or diathesis (the terms are interchangeable) have a long
history dating back to ancient Graeco-Roman medicine, where the latter term related to the doctrine of the humours expounded by Hippocrates (c.460-c.370 BC) and Galen (AD 129-c.201). By the nineteenth century, the concept was part of the emergent psychiatric nosology and theories of aetiology. During the twentieth century, notions of vulnerability and stress were increasingly prominent in emerging conceptualisations of schizophrenia (Bleuler, 1963), as well as other forms of psychopathology. It is to a consideration of these concepts that we now turn.
