Salutogenesis

Salutogenesis (pronounced suh-loo-toe-je-nuh-sis) is a primarily psychological approach to healing that focuses on the origins of health rather than the causes of disease. This model of health was first proposed by Israeli-American medical sociologist Aaron Antonovsky (1923–1994) in his 1979 book Health, Stress and Coping. He coined the word "salutogenesis" (from the Latin salus, meaning "health," and genesis, meaning "origins") to establish a new branch of health management. Antonovsky intended the idea to serve in contrast to pathogenesis, which focuses on diseases as the cause of illness. He argued that the origins of good health may differ from the causes of poor health, which is the focus of pathogenic studies. As such, salutogenesis is related to such fields as health promotion, preventative medicine, and other forms of medical care that seek to promote health before illness strikes. Salutogenesis tries to channel patients into focusing on mental behaviors that encourage better health, even during times of good health, to prevent later episodes of sickness.

Background

Antonovsky was born December 19, 1923 in the United States to a family of Russian immigrants in Brooklyn, New York. In his early life, he was exposed to a variety of other immigrants to the United States, particularly Jews and Italians. His family owned a laundry in which everyone was expected to work long hours, an attitude that helped the business to survive the Great Depression (1929–1939). His family also prioritized education, and Antonovsky was resultingly educated at an elite New York high school and then sent to college, where he gained a sociology degree. During World War II, he was drafted into the military and served in the Pacific.

All of these elements helped drive his curiosity about how people react to stressors; immigrating to a foreign country, surviving the Depression, and fighting in a war were all among the most stressful activities a person could endure. Antonovsky wondered why some people coped better than others. After being released from the military, Antonovsky emigrated to the new state of Israel, where he helped found a kibbutz, a form of Israeli communal society. Upon his return to the United States, he enrolled at Yale University in the early 1950s, where he earned a doctorate in sociology. Early in his career he focused on studying the links between social classes, ethnic minorities, immigration, discrimination, and inequality.

Eventually, Antonovsky began to center his research on the sociology of health. In particular, he began to reconsider how coping mechanisms allow some people to maintain their mental health, and by extension, physical health. A study of female Jewish Holocaust survivors helped Antonovsky to create the foundation of salutogenesis, as his findings demonstrated that despite the horrors inflicted upon them, many of these survivors had successfully managed to adapt to the normal world. His focus moved from understanding why some people get sick to seeking an understanding of why some people stay well. It was a simple question, but it marked a major shift of study for Antonovsky. In 1972, he helped to found a medical school at the Ben-Gurion University of the Negev in Beersheba, Israel, which served as the center of his subsequent studies.

The release of Health, Stress and Coping offered the total of Antonovsky's original ideas on the subject. Over the next fifteen years, his thinking on the subject altered somewhat as he explored the implementation of his theories in real-world settings, although he remained convinced about the core ideas upon which salutogenesis had been founded. In 2019, the Merriam-Webster Dictionary included salutogenesis as one of its new additions to upcoming editions, a sign of the growing acceptance of the salutogenic perspective in the medical world. Such schools as the University of Zurich and the University of Bergen have established departments dedicated to the study of salutogenesis.

Overview

Antonovsky's model centered on what he termed the sense of coherence. This idea is meant to examine the relationship between health, stress, and coping. Antonovsky broke down this sense of coherence as the sum of three factors: a sense of comprehensibility, a sense of manageability, and a sense of meaningfulness.

A sense of comprehensibility refers to people's ability to comprehend the world around them. Comprehensibility allows people to maintain routines and move forward on a daily basis with an understanding of their role in life. The sense of manageability provides people with the ability to maintain a feeling of control over their surroundings, even during times of crisis. Managing crises does not mean necessarily handling problems alone; a person with a strong sense of manageability often believes that there are resources or people that offer assistance to relieve problems. Finally, and perhaps most importantly, a sense of meaningfulness refers to a person's investment in the activities of their life. People with a high sense of meaningfulness take pleasure in most daily activities. They believe that they serve an important role in the world or that there is purpose to their activities. For some people, this sense of purpose or pleasure may come from family, work, hobbies, or some other aspect of their lives.

While a sense of meaningfulness may bring the greatest satisfaction, all three aspects are important in promoting a healthy mindset. Understanding and anticipating problems without having a sense of joy or purpose can lead to the adoption of negative mindsets, just as having a clear sense of purpose and ability to predict events are less healthy if a person is unable to properly deal with problems that arise.

An increasing number of studies have borne out the value of a salutogenic model of health management. For instance, having a clear and driven sense of coherence, the primary goal of salutogenesis, has been linked to the self-promotion of healthy behaviors like proper sleep habits and a good diet among college students. Further, patients with a demonstrated sense of coherence were more likely to have lower rates of social impairment and cognitive problems when undergoing physical rehabilitation. Finally, salutogenic studies of family caregivers of people with dementia showed that a healthy sense of coherence enabled them to more successfully navigate problems with isolation and stress than those who lacked some aspect of a coherent model of thinking.

Bibliography

Andrews, Linda Wasmer. “Why Salutogenesis Is the Best New Word in the Dictionary.” Psychology Today, 26 Apr. 2019, https://www.psychologytoday.com/us/blog/minding-the-body/201904/why-salutogenesis-is-the-best-new-word-in-the-dictionary. Accessed 29 Apr. 2019.

Antonovsky, Aaron. Health, Stress, and Coping. Jossey-Bass, 1979.

Antonovsky, Aaron. “The Salutogenic Model as a Theory to Guide Health Promotion.” Health Promotion International, 11 (1996): 11–18.

Benz, C., Bull, T., Mittelmark, M., et al. “Culture in Salutogenesis: The Scholarship of Aaron Antonovsky.” Global Health Promotion, 21, no. 4 (2014): 16–23.

Friedman, H.S. “Personality and Health.” In International Encyclopedia of the Social and Behavioral Sciences, eds, Neil J. Smelser and Paul B. Baltes, ScienceDirect, 2001, 11264-70.

Mattiuzzi, Paul G. “The Sense of Coherence.” Everyday Psychology, 18 Apr. 2007, https://www.everydaypsychology.com/2007/04/sense-of-coherence.html#.XMjDyfZFyUk. Accessed 29 Apr. 2019.

Mittelmark M.B., Sagy S., Eriksson M., et al., eds.

The Handbook of Salutogenesis, Springer; 2017. https://www.ncbi.nlm.nih.gov/books/NBK435831/. Accessed 29 Apr. 2019.

Sagy, S. (2015). “Coping, Conflict and Culture: The Salutogenic Approach in the Study of Resiliency.” In: Resiliency: Enhancing Coping with Crisis and Terrorism, D. Ajdukovic, S. Kimhi, and M. Lahad, Ios, 2015, 41–48.