Ingram RE, Miranda J, Segal ZV
New York: The Guilford Press; 1998. 330 pp with index
ISBN 1-57230-304-2 (cloth)
What does it mean to be vulnerable to a mental disorder such as major depression? While 20% of women and 12% of men can provide first-hand knowledge about this ubiquitous disorder, it may be assumed that even more people are vulnerable to depression. Treatments, whether psychopharmacological or psychotherapeutic, may be effective; however, the challenge to the field is to identify individuals who may need more than a universal intervention (e.g., building children’s self-esteem) to prevent episodes and the recurrence of episodes. Ingram and colleagues have set out to define and review this area from a fundamentally psychological perspective, while being mindful of other factors (e.g., genetic, neurochemical, social / interpersonal, economic and political).
Cognitive vulnerability refers to “an internal and stable feature of the person that predisposes him or her to the development of psycho-pathology under specified conditions such as the occurrence of stressful life events” (page 87). The internal and stable feature is cognitive, meaning a broad meta-construct composed of mental structure propositions, operations and products related to perception, thinking and memory. These authors wisely choose to be all-inclusive and go to great pains to put these constructs in the context of cognitive models (e.g., information-processing, social-cognitive and behavioural-cognitive). They also acknowledge that there is relatively little that is unique across other related psychopathological domains such as anxiety, schizophrenia and depression, at the level of these broad constructs. The authors are, after all, concerned with how people perceive, think about (whether consciously or not), and remember, themselves and their lives. The book serves as an excellent primer for those readers curious about the concepts of cognitive psychology and models in this field, while remaining close to the experimental literature of depressive disorders. The authors readily acknowledge the limitations of both the measurement of cognition (e.g., latent or not easily observed cognitive structures that have to be primed or elicited in some way) and research methodology (e.g., the challenge and expense of conducting longitudinal follow-up studies). They provide an excellent review of the extant literature, while gently guiding the reader through the terminology and jargon of the field. As experienced clinicians and researchers, aware of the limitations of any single model of risk and recovery, they are skilful at placing this work in broader scientific contexts including: classification, psychobiology and the “war of words and perspective” between social psychologists, primarily James Coyne, and the cognitive theorists. Furthermore, the authors methodological sophistication is outstanding, and the reader can be well-assured that the book is brilliant in its elucidation of the currently known methods to observe cognitive vulnerability in the absence of emerging technologies such as functional magnetic resonance imaging.
While the authors acknowledge the necessity for integration into the cognitive vulnerability field, they do little to advance the paradigms or the methods to achieve this end (or is it a beginning?). They do make some interesting observations, however, and before lamenting the relative stagnation of a field that is more than 20 years old, a summary of some of these gems is in order. Risk for a mental disorder such as major depression, and vulnerability to the disorder, are not the same. Using the original work by Zubin and Spring, the authors remind us that concepts such as a limitation in skills/competence and coping are risk, but not vulnerability, factors. Risk factors for major depression include being female, having a previous history of depression, and being divorced or separated. Vulnerability, on the other hand, encompasses the interactive notion of a stable characteristic in concert with life events or other environmental stimuli. Vulnerability then, is fundamentally endogenous, but not in the way the term was originally used in the dichotomy between reactive and endogenous depression. Instead the authors adopt a stress diathesis model in which stress is defined as any event either external (e.g., job loss) or internal (e.g., unrelated personal standards for success). Vulnerability may not be obvious or even measurable at present, but it does help us to understand how some people who are living in risky conditions (e.g., poverty, a positive family history, 3 or more children under age 10) do not become depressed. Interestingly, while accepting that lowered emotional resilience, coping, and social support are vulnerability factors that are integrated with stress, the authors tend to ignore the potentially malignant interaction between these variables and the previously mentioned risk factors.
The issue of measuring a latent vulnerability is addressed with a discussion of a methodology (Stroop test, priming). I was disappointed in the relative lack of innovation in this methodology, which has produced few significant results. It is extremely difficult to measure a vulnerable, latent state. In addition, this book does not really help to answer the burning question, “Why do some people living in adverse conditions and having many risk factors for major depression get depressed while others do not.” It does, however, help the reader to understand the direction of the research and the base for this fascinating field of inquiry. Hats off to the authors for giving us such a secure base from which to operate.
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