Seminar Paper, 2003, 20 Pages
Definition of health
Biography of Aaron Antonovsky
Antonovsky’s Model of Salutogenesis
What are the applications of this concept?
Basic message of the model of salutogenesis
Comparison of salutogenesis and pathogenesis
The salutogenic model
1. Life experiences
2. The sense of coherence (SOC)
3. Generalized resistance resources, GRR
5. State of tension
6. Coping with tension
7. The health-disease-continuum
8. The questionnaire
How do I increase joy of life – several approaches
Typically, a person is not preoccupied with his/her health until getting sick. The state of wellbeing is so natural for most of us, that it barely enters the level of our consciousness. Consequently it is not surprising, that there is by far more literature about diseases, their symptoms and the course of a disease, than about the subject of health. Does the term “symptoms of health” exist at all?
Aaron Antonovsky did focus on the interesting subject of how an individual can stay healthy. He developed the model of salutogenesis, which he put in contrast to pathogenesis. Despite of his criticism of the latter concept used by the medical community, it was important for him to stress, that salutogenesis was supposed to serve as an addition to and not a replacement for pathogenesis. This model is presented here.
At the end, I will discuss the subject of joy of life.
Health is a very broad term that is difficult to describe, since it can be perceived rather subjectively. Nevertheless, I have found a few definitions that shall be mentioned briefly.
The WHO describes the ideal standard of health in 1948 as a “state of complete psychological and physical wellbeing.” This seems, however, far from reality, because nobody can be absolutely healthy and this state is therefore constantly out of reach. 1
Hans-Georg Gadamer even speaks of “elusiveness of health”. It is only noticed when sick. Especially in an affluent society, where the flu does not mean certain death as it might in Third World countries, health is nothing special, but the normal human condition. Gadamer opposes the WHO definition and sees the human being in a constant imbalance between health and disease. 2
Heinz Hartmann again sees health as a subjective matter. Some people always feel sick, others rarely, although they show the same symptoms. Health also depends on the environment of each person. 3
The sociologist Talcott Parsons defines a person as being healthy, when he or she can appropriately perform the expected roles and tasks within society. 4
The American-Israeli medical sociologist Aaron Antonovsky is born in Brooklyn, USA, in 1923. He studies sociology graduating with a PhD. In 1960 he immigrates to Jerusalem, Israel, where he participates, respectively conducts various research projects at the Institute for Applied Social Research. Among other research areas, he focuses on stress factors and the topic of health and disease. After a baffling study on women, who had survived a concentration camp and who despite of it were physically and mentally very healthy 5, he develops a new stress concept in 1966, arguing that stressors not always make sick, but can also be beneficial to health. His two most important publications about exploring health are first released in 1979 and 1987, “Health, Stress and Coping (1979)” and “Unraveling the Mystery of Health (1987)”. 1994 he dies at the age of 71.6
Definition of terms:
Salus – Lat. wellbeing, integrity, happiness
Genesis – Greek origin
Salutogenesis = genesis of health
Antonovsky’s model mainly finds application in the areas of psychosomatics, psychotherapy and rehabilitation, but also in health promotion and preventive medicine. 7 Nowadays, many people use the term salutogenesis incorrectly and in a way that is not exactly in accordance with Antonovsky’s concept. 8
This concept was developed as a supplement, not a replacement of the pathogenetic approach. It is about maintaining and promoting health. Antonovsky introduces the sense of coherence as a measure that allows determining how healthy or sick a person is.
Alone the terms salutogenesis and pathogenesis express opposites, the former meaning formation of health, while the latter deals with the development of disease.
Antonovsky here does not ask the pathogenetic question “How do I get healthy again?”, but rather “How do I stay healthy?” Maintaining health and an individual’s personal life story are pivotal. Antonovsky sees the human organism constantly under attack from various stimuli. The issue is, how to deal with it. 9
Another important question for him is, why some people stay healthy, although their environment and life style predisposes them to fall sick. So he asks, why many smokers do not develop lung cancer, while the medical community is only interested, how many smokers are affected by cancer and the reason why, and how it can be prevented. 10
For Antonovsky, health is something unstable, not omnipresent. We have to spend energy to maintain and to foster it. Disease is yet nothing bad. Sometimes it can even be beneficial and protect the body. When a person is under too much stress, the immune system is weakened and the likelihood is higher to, for example, get the flu. Consequently the person is confined to the bed, cannot tend to his or her tasks for some time anymore, and thus not relieve the stress and draw new energy. 11
However, with his concept of salutogenesis, Antonovsky did not postulate any definition of health and the maintenance thereof, since every being copes in an individual way.
The salutogenic model consists of several parts with varying impacts on each other. I am going to consecutively explain those and point out the links. As an overview, the entire model is simplified and presented in illustration 1.
Illustration 1, see BENGEL, p. 36
On a daily basis, each human being is confronted with new situations. These create our personal attitude towards life, which means, the way we deal with our experiences.
Antonovsky’s river metaphor is a fitting example. He suggests that every human being is swimming in a river from birth till death. This river can have different features. At some spots there are rapids, waterfalls, or currents. You have to pay attention, fight against it, and mobilize all your resources, in order to be able to continue carefree.
At other times, the river is calm and you can peacefully take in the scenery and replenish new energy. These stretches increase your quality of life and help you to overcome difficult times.
Now it is important to understand when to relax and when it is necessary to fight. To a certain degree, you have to adapt to your environment.
The better an individual can cope with different situations and can classify them correctly, the more pleasure he or she will have in life.12
The sense of coherence, short SOC, is the core of the salutogenic model. Coherence means cohesion or consistence.13 Consequently, the SOC is a measure, how ‘consistent in self’ a person perceives his or her environment. Or, in Antonovsky’s own words: The sense of coherence is “a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that the stimuli deriving from one’s internal and external environments in the course of living are structured, predictable and explicable, as can be expected within reason.” 14 („eine allgemeine Einstellung, die das Ausmaß eines umfassenden, dauerhaften, zugleich aber dynamischen Vertrauens beschreibt, dass die innere und äußere Umwelt vorhersagbar und überschaubar ist, und dass die Dinge so gut entwickelt werden, wie vernünftigerweise erwartet werden kann.“) Hence, it is about a person’s basic attitude towards his or her fellow beings and environment.15 It is determined through social, historic, cultural, but also individual circumstances.16
Due to different life experiences, every person develops a different SOC. In turn, this reflects on future experiences and the attitude of coping with them. If one experiences many similar situations, a learning process takes place on how to cope well, leading to specific behavior patterns.17
Piaget was already emphasizing that outer changes impact the inner attitude.18 The SOC mainly refers to stressful and unforeseeable situations of daily life. Depending on the strength of the SOC, we are more or less prepared to cope.
The SOC has three components, including comprehensibility, manageability, and meaningfulness.
Comprehensibility is a cognitive coping mechanism. It reflects, how a person understands his or her environment. We can classify stimuli well that we receive in unexpected situations, since we are familiar with them due to previous exposure.19 We manage our tasks well, be it at work, in our circle of friends or family. We grasp the greater context of our being. So a laborer might see his occupation as small and unimportant, but without it the company would not function properly. One has an understanding that the own doing is important too.
Manageability indicates, to what degree we can solve problems, or deem them solvable. An individual can realistically assess, how well a problem can be dealt with, or if it is necessary to ask for help.20 Whereby it is not a bad thing to get help! We have control over our lives and know when and how we need to act. Moreover, a balanced exposure is important; a temporary excessive demand with a subsequent recovery phase is better than being continually under-challenged.
Meaningfulness is the emotional component. Therein we see the purpose of our lives. We perceive new situations as a challenge, not a burden.21 This attitude has great impact on managing the situation and ultimately solving it. A person reacts more self-confident, when the experience is a challenge. When life, our work, our being-there for family and friends is filled with purpose, then we experience a reduced number of stressful situations. For Antonovsky this component is most important.
The three components as described above, portray a person with a strong SOC. By that I mean that this person has an intrinsic understanding of the world around, can control and deal with situations, and sees a purpose in the whole. This person will more likely seek help and does not perceive everything as a burden, like someone with a low SOC would. Also, the person’s own emotions are better predictable and discernable. Consequently, he or she is less intimidating and great to interact with.22
For a person with a strong SOC, every situation is new and can be handled flexibly. A low SOC often has people frozen within a construct of rigid rules, which are not always advantageous.23
1 See BENGEL, p. 15
2 See LAMPRECHT, p. 22
3 See OPPERMANN, p. 197
4 See SCHIFFER, p. 39
5 See BENGEL, p. 20
6 See BENGEL, p. 20
7 See BENGEL, p. 100
8 See BENGEL, p. 9
9 See BENGEL, p. 24 ff
10 See BENGEL, p. 27
11 See LAMPRECHT, p. 31
12 See WELBRINK, p. 49
13 See BENGEL, p. 28
14 See LAMPRECHT, p. 23
15 See BENGEL, p. 28
16 See SCHÜFFEL, p. 69
17 See ANTONOVSKY, p. 166 f
18 See BENGEL, p. 31
19 See BENGEL, p. 29
20 See BENGEL, p. 29
21 See BENGEL, p. 30
22 See ANTONOVSKY, p. 139
23 See ANTONOVSKY, p. 166 f
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