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Cited by 18Mental Health and PsychiatryPsychology and Mental HealthHistorical Psychiatry and Medical Practices

The Vulnerability-Stress-Model—Holding Up the Construct of the Faulty Individual in the Light of Challenges to the Medical Model of Mental Distress

Open access
Demke, Elena·2022·Frontiers in Sociology
DOI 10.3389/fsoc.2022.833987PMC PMC9168073
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Abstract

In the late 1970s, the course seemed to be set for a reconciliation of the controversy around the somatic vs. the social nature of mental distress. The biopsychosocial model and the vulnerability-stress-model were influential agents in this move, but a medicalized somatic view on mental distress persisted nonetheless. The reasons for this persistence are complex, and naturally include questions of structural power. However, the adherence to a certain fundamental framing of a problem may continue to be transmitted not only out of conviction, but also unwittingly. The vulnerability-stress-model allowed those who used it to effectively stick to the implications of a medicalized somatic view of the faulty individual who falls ill, while also allowing them to believe they integrated the social dimensions of the problem. A close reading and hermeneutical interpretation of the text by Zubin and Spring (1977) and an analysis of its use in psychoeducation serve as a case study in this respect. The vulnerability-stress-model (simply called “vulnerability model” by Zubin and Spring; more often “stress-vulnerability model” by English speaking recipients, and “vulnerability-stress-model” by German authors) seems to have been a success story: since its publication by Zubin and Spring (1977), it has been the point of reference for numerous scholarly and popular (“psychoeducational”) adaptations. It was soon extended from the diagnosis of schizophrenia to various psychiatric diagnoses, understanding mental distress as the result of a trait/state-interaction in the shape of “deviant coping patterns” (Zubin and Spring, p. 112). Recipients appraised the integration of environmental and dispositional factors, some of them opposing the supposed originally integrative intention of the VSM to reduced applications of it (Schmidt, 2012). However, it can be argued that this integration is a matter of rhetorics rather than argumentative essence. Their argument which significantly depends on the use of metaphors, as well as their referencing amounts to a confirmation of a medicalized view on mental distress and a dismissal of the role played by societal factors. Applied to psychoeducation, this paradoxical combination reinforced a view of the persons in question as individually vulnerable, rather than socially wounded. The consequences in terms of what appears as remedy are significant and contribute to turning individual difference into disability.

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  • The stress-vulnerability model posits that psychotic disorders emerge when underlying vulnerabilities interact with environmental stressors that exceed an individual's capacity for adaptation.

    “It posits that psychotic disorders emerge when underlying vulnerabilities (such as genetic predisposition, neurodevelopmental anomalies, early trauma, or maladaptive cognitive styles) interact with environmental stressors that exceed an individual’s capacity for adaptation.”

    From Delusional Experiences Emerging From AI Chatbot Interactions or “AI Psychosis” (2025) · cites this paper as [16]

    The Introduction describes the model as an interaction between enduring vulnerability and stressful events, with higher vulnerability lowering the stress level at which episodes occur. The Close Reading section also discusses coping abilities and mentions trauma and perinatal complications, but our copy does not identify maladaptive cognitive styles as an underlying vulnerability in the model. It therefore supports the sentence’s central account, but not its full list of examples. (LLM, conf=0.84)

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Research works printed but not linked: 4

  1. Bäuml J. Pitschl-Walz G. (eds.). (2007). Psychoedukation bei schizophrenen Erkrankungen. Konsensuspapier der Arbeitsgruppe Psychoedukation bei schizophrenen Erkrankungen. Zürich: Schattauer.
  2. Cooper D. (1971). The Death of the Family. London: Penguin Books.
  3. Gallagher M. (2017). From mental patient to service user: deinstitutionalisation and the emergence of the Mental Health Service User Movement in Scotland, 1971-2006 (PhD thesis). University of Glasgow, Glasgow, Scotland. Available online at: https://theses.gla.ac.uk/8078/ (accessed January 31, 2022).
  4. Landwehr A. (2002). Einführung in die Historische Diskursanalyse,” in Geschichte des Sagbaren (Tübingen: edition diskord).

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Authors
Demke, E.
Corresponding author
Demke, Elena
Venue
Frontiers in Sociology
Publisher
Frontiers Media SA
Published
2022-05-23
Volume
7
Pages
833987-833987
ISSN
2297-7775 (ISSN-L)
DOI
10.3389/fsoc.2022.833987
PMC
PMC9168073
OpenAlex
W4281298289
Cited by
18
References
30
Citations by year
2026: 8 · 2025: 6 · 2024: 3 · 2023: 1
FWCI
4.62
Type
journal article
Language
en
Open access
Licence
Locations
  • Frontiers in Sociology (publishedVersion, cc-by)
  • PubMed Central (publishedVersion, cc-by)
  • PubMed (publishedVersion)
  • DOAJ (DOAJ: Directory of Open Access Journals) (submittedVersion)
Funders
Deutsche Forschungsgemeinschaft
Topics
  • Social Sciences › Arts and Humanities › Philosophy › Mental Health and Psychiatry
  • Social Sciences › Psychology › Clinical Psychology › Psychology and Mental Health
  • Social Sciences › Psychology › Clinical Psychology › Historical Psychiatry and Medical Practices
Keywords
vulnerability-stress model, biopsychosocial model, medicalization of mental illness, psychoeducation, structural power, disability, schizophrenia

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