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Review of Development and Psychopathology: A Vulnerability-Stress

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DOI: 10.1037/cp2007_2_143

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CP 47-2 4/21/06 9:22 PM Page 143
appartenant à des disciplines variées. Quelle que soit la
forme d’intervention offerte, la thèse centrale que
Wolf défend dans cet essai est qu’il est capital pour l’in-
tervenant d’allier une attitude réflexive et analytique à
une ouverture aux émotions vivantes de la relation,
pour qu’un réel dialogue puisse prendre place avec le
sujet psychotique.
Dans la troisième partie de l’essai, l’auteur se
penche justement sur des notions et un vocabulaire
qui forment un lexique à partir duquel appréhender
la relation que l’on aspire à établir avec la personne
psychotique. Il se concentre sur la pensée de deux
philosophes, Martin Buber et Emmanuel Levinas. De
Martin Buber, il rapporte la distinction entre la ren-
contre Je-Tu indissociable du dialogue véritable et le
Je-Cela qui s’intéresse à l’autre davantage comme à
une chose. La totalité de l’être, l’immédiateté de la
relation, la présence et la réciprocité qui qualifient la
rencontre Je-Tu sont exposées pour aborder leurs par-
ticularités lorsque le sujet est psychotique. De
Emmanuel Levinas, Wolf reprend les notions de trau-
matisme de l’autre et d’«incondition d’otage», oppo-
sées à celles du tiers et de la parole en mouvement du
Dire. Il en vient ensuite à mettre en évidence l’impuis-
sance de la raison face au message du psychotique et
enfin, comment s’exprime l’asymétrie de la relation à
celui-ci.
La lecture de cet ouvrage est ardue non pas à cause
de l’écriture qui est à la fois précise, esthétique et raf-
finée, mais plutôt parce que la complexité des idées
présentées et la nature des objectifs visés, sont en soi
exigeantes. Le lecteur qui y investira l’attention re-
quise sera par contre bien récompensé, il s’en trou-
vera enrichi d’une façon de voir qui lui servira.
L’auteur s’adresse explicitement à ses collègues psy-
chiatres mais l’essai mérite d’être lu par quiconque
entreprend d’accompagner des personnes psycho-
tiques.
Marc-Alain Wolf est psychiatre et docteur en philoso-
phie. Dans son travail de clinicien et de chercheur, il s’in-
téresse à la psychose, aux obstacles et aux défis du dia-
logue avec les malades, mais aussi aux phénomènes
religieux et à leur interprétation psychologique. Il a publié
un livre sur les relations entre la mystique et la psychiatrie,
Quand le mysticisme mène à la folie (MNH, 1998) et un livre
proposant une lecture psychologique de quelques récits
bibliques, Quand Dieu parlait aux hommes (Triptyque,
2004).
Hélène Dymetryszyn est co-directrice et coordonnatrice
des internats et de l’enseignement clinique pour la
Division de la psychologie de l’Hôpital Général Juif à
Montréal. Elle compte plusieurs années d’intervention
clinique auprès d’une population de patients adultes
Comptes rendus de lecture 143
atteints de maladies mentales variées, dans le cadre du
programme de l’Hôpital psychiatrique de jour à l’Hôpital
Général Juif. Elle agit également comme superviseure
auprès des étudiants de niveau doctorat au département
de psychologie de l’Université de Montréal.
BENJAMIN L. HANKIN and JOHN R. Z. ABELA (Eds.)
Development and Psychopathology: A Vulnerability-Stress
Perspective
Thousand Oaks, CA: Sage Publications, 2005,
520 pages
(ISBN 1-41290-490-0, CDN$72.95 Paperback)
Reviewed by PAUL D. HASTINGS and JACOB N.
NUSELOVICI
In this edited volume, Hankin and Abela seek to
advance perspectives on the development of various
psychopathologies by calling attention to the joint
contributions of individual susceptibilities – vulnera-
bilities – and adverse environmental circumstances –
stressors. Vulnerability-stress models of psychopatholo-
gy are rooted in such early work as Beck’s diathesis-
stress model of depression, and Sameroff’s transac-
tional model of development. The interactions of dis-
positional and environmental influences together lead
to the unfolding, maintenance, or change of individ-
ual competencies over time. Cicchetti, Luthar, Rutter,
and others have led efforts to incorporate the interde-
pendencies of nature and nurture, with the implica-
tions this has for continually re-directed growth and
change throughout the life-course, firmly into the
tenets of developmental psychopathology. Despite
these theoretical advances to our understanding of
developmental processes, few researchers have empiri-
cally evaluated vulnerability-stress models. One limit-
ing factor in the progression of the science of develop-
mental psychopathology has been the absence of a
thoughtfully articulated and integrative summary of
the relevant vulnerabilities and stressors affecting chil-
dren and adolescents. This book begins to fill that
void. There is a disclaimer in the preface of the vol-
ume, though, as the editors confide that more ques-
tions are posed than answers given.
The volume starts with one chapter on stress, fol-
lowed by one chapter on vulnerability-stress models.
Part II follows with seven chapters on specific areas of
vulnerability. Herein lies a shortcoming of the book,
and arguably of the field of developmental psy-
chopathology: Stress is not given the same degree of
careful and detailed consideration as vulnerability.
Many chapters refer broadly to “negative events” as if
CP 47-2 4/21/06 9:22 PM Page 144
144 Book Reviews
they were all created equal. As Grant and McMahon
argue in the first chapter, the field needs new and
complete taxonomies of stress. For research on the
development of psychopathology to progress, as much
attention needs to be given to identifying the circum-
stances that objectively qualify as stressors as has been
devoted to identifying vulnerabilities and symptoms.
In the second chapter, Ingram and Luxton intro-
duce a number of models of how stress and vulnera-
bility factors might interact to affect functioning and
development. In so doing, they illuminate the poten-
tial for vulnerabilities to generate new stressors in a
person’s life, and for stressors to introduce or exacer-
bate vulnerabilities. The interdependence of stress
and vulnerability, therefore, may call into question the
extent to which they truly can be meaningfully distin-
guished, particularly in early development. Consider
the contributions of parental care for infants and
young children. Soothing and regulation of infant
arousal occurs through the relationship with a sensi-
tive and effective caregiver. Thus, should an abusive or
neglectful parent of an infant be considered a vulner-
ability, or a stressor? As both Davila and colleagues
(Chapter 9) and Johnson and colleagues (Chapter
15) indicate, this may be a meaningless distinction.
One cannot accurately extend adult-based perspec-
tives on psychopathology into a developmental frame-
work without necessarily acknowledging that the rules
of the game have changed. Factors or processes that
may be clearly distinguishable in adulthood as inter-
nal (vulnerability) or external (stress) break down
when one seeks to understand the initial origins and
etiology of any aspect of functioning in the earliest
periods of childhood.
The chapters in Part II describe genetic, neuro-
physiological, affective, cognitive, attachment, social
cognitive (interpersonal), and personality vulnerabili-
ties. These detailed considerations of “internal” fac-
tors that might form the germs of future psy-
chopathology will be useful for many students and
researchers. In particular, the chapters by Lemery and
Doelger on genetics, and Gibb and Coles on cognitive
vulnerabilities, stand as impressive and developmen-
tally informed syntheses of current literatures and will
serve as valuable references. Lemery and Doelger
explain how it is possible for behavioural genetics
research to produce heritability indices of psy-
chopathologies that change with age, and vary across
reporters. Their evaluation of developmental and
methodological issues in behavioural genetics will sup-
port more careful considerations of the implications
of this research. Gibb and Coles evaluate the extent to
which cognitive biases for psychopathology are evi-
dent and associated with functioning in children and
youth. Importantly, they suggest how the roles of cog-
nitive biases in psychopathology, as well as the biases
themselves, can change developmentally.
Some of the vulnerability chapters deal with devel-
opmental issues in less clear or consistent ways. Pihl
and Nantel-Vivier present comprehensive models of
the connections between aspects of neurophysiology
and distinct psychopathologies that are impressively
thoughtful and novel. However, they are based almost
exclusively on the biological correlates of psy-
chopathology in adults, which could be products of
the impacts of early environmental experiences on
young children’s developing neurophysiology.
Although it is a truism to state that there is no behav-
iour without biology, it is equally important to recog-
nize that biology requires an environment in order to
develop and function. Even gene expression and neu-
rophysiological regulation are subject to environmen-
tal shaping. The multiple impinging influences that
affect trajectories of development preclude the possi-
bility of biological determinism for psychological dis-
orders.
Tackett and Krueger’s discussion of personality as a
vulnerability for the development of problems,
although a laudable effort, most clearly demonstrates
a second shortcoming. Developmentalists interested
in both maladaptive and normative functioning, and
clinical scientists interested in the problems of chil-
dren and youth, tend to approach the study of devel-
opmental psychopathology from different perspec-
tives. Despite repeated acknowledgements in this vol-
ume that downward-extensions of models of adult psy-
chopathology cannot be presumed to be valid
accounts of psychopathology of childhood, several
chapters concentrate on just that: evaluating the
extent to which theories of adult functioning can be
applied to children with a minimum of re-formula-
tion. A team from the developmentalists’ camp proba-
bly would have included a chapter on temperament as
a vulnerability. Instead, Tackett and Krueger attempt
to re-interpret several decades of temperament
research as fitting neatly within adult personality mod-
els. It is a valiant effort. However, with so few longitu-
dinal studies evaluating the links between childhood
temperament and adult personality, there is only limit-
ed understanding of the developmental processes by
which early dimensions of temperament form the
bases of future healthy adult personality, let alone how
temperament, personality, and psychopathology are
united. For example, these authors suggest that inhib-
ited, disinhibited, and difficult temperament might all
be elements of neuroticism. This disregards an exten-
sive literature distinguishing the etiology, manifesta-
tion and development of these aspects of tempera-
 CP 47-2 4/21/06 9:22 PM Page 145
ment. Further, it does not provide a firm footing for
identifying any specificity between individual differ-
ences in temperament, and individual propensities to
develop different kinds of emotional and behavioural
problems.
In Part III, the volume concludes with six chapters
on specific kinds of psychopathology: depression, anx-
iety, disruptive behaviour, substance use, eating disor-
ders, and personality disorders. As well as briefly
reviewing symptoms, prevalence rates, and ages of
onset, all six chapters provide detailed and useful
summaries of the many vulnerabilities linked with
these problems areas. The two chapters contributed
by the volume’s editors, on depression and disruptive
behaviours, most closely consider the seven vulnerabil-
ities described in Part II. The six chapters offer less
insightful or detailed treatments of stress, however.
With the exception of the chapter on depression,
none effectively presents convincing models of the
interactions between stress and vulnerability in the
development of psychopathology. Main effect rela-
tions linking stress with psychopathology, and linking
vulnerabilities for psychopathology, are reviewed. But
across most of these areas of disordered functioning,
it remains unclear how and why a given stressor is like-
ly to affect two children differently.
The disclaimer in the preface rings true. One fin-
ishes this book with the sense that it is a good start,
but also the hope that it is the first part of a two-vol-
ume series! It begins to provide the necessary informa-
tion for generating new models of the development of
psychopathology based on vulnerability-stress interac-
tions. Obviously, a more comprehensive consideration
of stress is needed, but this book also calls for
researchers to address a number of exciting questions.
1) How do vulnerabilities change with age? It seems
unlikely that most would be static or immutable.
2) Are there sensitive or critical periods for vulnerabil-
ities to be impacted by stressors?
3) Are there matches between specific vulnerabilities
and specific stressors that make particular psy-
chopathologies more likely to develop?
4) How do early caregiver-infant relationships develop
into “internal” vulnerabilities and “external” stres-
sors later in childhood?
5) Are biological, emotional, cognitive, and social cog-
nitive vulnerabilities just different faces of a com-
mon, core susceptibility to psychopathology, or are
they meaningfully distinct?
6) What are the roles of resilience and protective fac-
tors in the development of well-being? Is the good
mental health of children and youth supported by
anything other than the absence of vulnerability
View publication stats
Comptes rendus de lecture 145
and stress?
7) Do any of these models pertain to the majority of
the world’s children and youth, who live outside
the generally privileged conditions of most families
in North America and western Europe? Culture
provides context and meaning to stress, vulnerabili-
ty, and psychopathology. For hundreds of millions
of children in developing countries, stress means
living in conditions of war, poverty, hunger, malnu-
trition, overcrowding, homelessness, and lack of
education and health care. When we look beyond
our own borders, what do we know about the devel-
opment of psychopathology?
Benjamin L. Hankin is Assistant Professor and Clinical
Psychologist at the University of South Carolina. His
research is aimed at applying cognitive risk factors to pre-
dict depression and anxiety during adolescence and young
adulthood and in understanding the developmental ori-
gins or cognitive vulnerability to depression. He has pub-
lished articles in such journals as Journal of Abnormal
Psychology, Cognitive Therapy and Research, and Psychological
Bulletin.
John R. Z. Abela is Associate Professor of Psychology at
McGill University and Director of the Cognitive Behaviour
Therapy Clinic at Montreal Children’s Hospital. He stud-
ies vulnerability to depression in children and adolescents.
His recent work has appeared in British Journal of Clinical
Psychology, Cognitive Therapy and Research, and Canadian
Psychology.
Paul D. Hastings is Associate Professor in the
Department of Psychology at Concordia University, where
he directs the Affective and Behavioural Competence
Development (ABCD) Laboratory in the Centre for
Research in Human Development. His research program
is centred on examining the transactional contributions of
children’s physiological reactivity and experiences of
parental socialization to trajectories of adaptive and mal-
adaptive development.
Jacob N. Nuselovici is masters candidate in the
Department of Psychology at Concordia University, where
he is studying with Dr. Hastings.
JON MILLS
Treating Attachment Pathology
Lanham, MD: Jason Aronson, 2005, 388 pages
(ISBN 0-7657-0132-4, CDN$40.02 Paper, 0-7657-0130-8,
CDN$89.31 Cloth)
Reviewed by TREVOR R. OLSON and MICHAEL Wm.
MACGREGOR