Conceptions of vulnerability in mental disorders

Despite intensive research in recent decades, the search for the aetiopatho genesis of psychiatric diseases is just as relevant as ever. In recent year s, ideas of the aetiopathogenesis of psychotic diseases based on the concep t of "vulnerability" in its diverse variations and developments have been g ained increasingly ground. The publications of Zubin and associates above a ll have contributed to a "vulnerability model". According to this descripti ve model, schizophrenic disturbances develop as a result of stimuli/irritan ts or stress factors under modulation of the social and physical environmen t as well as dependent on the premorbid personality. The increased vulnerab ility which gives rise to this is perceived as a threshold descensus of the individual towards stimuli/irritants (with a deficit counter - irritants i mpulses). Apart from that, multi-causality of vulnerability is assumed as t he starting point, whereby there is the possibility of several therapy appr oaches. Moreover, contrary to the prevailing pessimistic view that schizoph renia is a process-type progressive disease, an episodic nature of schizoph renic psychoses is postulated with a prognosis that is indeed positive in t he long term. In recent years, although often not explicitly stated, Zubin' s concept of vulnerability was also indubitably subjected to various furthe r developments (the vulnerability stress model by Nuechterlein and associat es as also the integrative psycho-biological schizophrenia model by Ciompi may serve as examples). Worth mentioning are also various new concepts from system sciences (such as those from cybernetics, synergetics, the chaos th eory, the communication theory, structure determinism etc.), which endeavou r to clarify the problem of psychosis. The evaluation of central neurophysi ological function deviations with schizophrenics and their relations has so far been oriented above all towards the vulnerability model of Zubin and N uechterlein, which differentiates temporarily relatively stable trait marke rs with generally unaltered expressivity at the pre-, intra-, and post-psyc hotic stages as well as episode markers and intermediate markers. However, specific factors contributing to the pathogenesis of schizophrenic disturba nces have not as yet been found, in addition, there is still a multitude of methodological problems and distinctive features to fulfil the expectation of a comprehensive concept with which the whole complexity of the occurren ce, the progress, and the outcome of psychoses can be explained. Reintroduc tion of the concept of vulnerability experienced, as Schmidt-Degenhardt put it, "a renaissance in use that appeared almost inflationary and a complete ly dubious popularisation... without reference to its historical implicatio ns...... Consequently, a critical view of the use of this term would appear to be necessary.