Salutogenesis

Salutogenesis is a term coined by Aaron Antonovsky,[1] a professor of medical sociology. The term describes an approach focusing on factors that support human health and well-being, rather than on factors that cause disease (pathogenesis). More specifically, the "salutogenic model" is concerned with the relationship between health, stress, and coping.

Antonovsky's theories reject the "traditional medical-model dichotomy separating health and illness". He described the relationship as a continuous variable, what he called the "health-ease versus dis-ease continuum".[1]

Derivation

The word "salutogenesis" comes from the Latin salus = health and the Greek genesis = origin. Antonovsky developed the term from his studies of "how people manage stress and stay well"[2] (unlike pathogenesis which studies the causes of diseases). He observed that stress is ubiquitous, but not all individuals have negative health outcomes in response to stress. Instead, some people achieve health despite their exposure to potentially disabling stress factors.

In his 1979 book, Health, Stress and Coping, Antonovsky described a variety of influences that led him to the question of how people survive, adapt, and overcome in the face of even the most punishing life-stress experiences. In his 1987 book, Unraveling the Mysteries of Health, he focused more specifically on a study of women and aging; he found that 29% of women who had survived Nazi concentration camps had positive emotional health, compared to 51% of a control group. His insight was that 29% of the survivors were not emotionally impaired by the stress. Antonovsky wrote: "this for me was the dramatic experience that consciously set me on the road to formulating what I came to call the 'salutogenic model'."[2]

In salutogenic theory, people continually battle with the effects of hardship. These ubiquitous forces are called generalized resource deficits (GRDs). On the other hand, there are generalized resistance resources (GRRs), which are all of the resources that help a person cope and are effective in avoiding or combating a range of psychosocial stressors. Examples are resources such as money, ego-strength, and social support.

Generalized resource deficits will cause the coping mechanisms to fail whenever the sense of coherence is not robust to weather the current situation. This causes illness and possibly even death. However, if the sense of coherence is high, a stressor will not necessarily be harmful. But it is the balance between generalized resource deficits and resources that determines whether a factor will be pathogenic, neutral, or salutary.[1][3]

Antonovsky's formulation was that the generalized resistance resources enabled individuals to make sense of and manage events. He argued that over time, in response to positive experiences provided by successful use of different resources, an individual would develop an attitude that was "in itself the essential tool for coping".[1]

Sense of coherence

The "sense of coherence" is a theoretical formulation that provides a central explanation for the role of stress in human functioning. "Beyond the specific stress factors that one might encounter in life, and beyond your perception and response to those events, what determines whether stress will cause you harm is whether or not the stress violates your sense of coherence." [4] Antonovsky defined Sense of Coherence as:[2][5]

"a global orientation that expresses the extent to which one has a pervasive, enduring though dynamic feeling of confidence that (1) the stimuli deriving from one's internal and external environments in the course of living are structured, predictable and explicable; (2) the resources are available to one to meet the demands posed by these stimuli; and (3) these demands are challenges, worthy of investment and engagement." [6]

In his formulation, the sense of coherence has three components:

According to Antonovsky, the third element is the most important. If a person believes there is no reason to persist and survive and confront challenges, if they have no sense of meaning, then they will have no motivation to comprehend and manage events. His essential argument is that "salutogenesis" depends on experiencing a strong "sense of coherence." His research demonstrated that the sense of coherence predicts positive health outcomes.

Fields of application

Antonovsky viewed his work as primarily addressed to the fields of health psychology, behavioral medicine, and the sociology of health.[2] The term has been adopted in the medical fields of healthcare and preventive medicine. It has also been adopted as a term to describe contemporary approaches to nursing,[7] psychiatry,[8] and healthcare architecture.[9][10] The salutogenic framework has also been adapted as a method for decision making on the fly; the method has been applied for emergency care[11][12] and for healthcare architecture.[10][13][14][15]

References

  1. 1 2 3 4 Antonovsky, A. "Health, Stress and Coping" San Francisco: Jossey-Bass Publishers, 1979
  2. 1 2 3 4 Antonovsky, A. Unraveling The Mystery of Health - How People Manage Stress and Stay Well, San Francisco: Jossey-Bass Publishers, 1987
  3. ↑ Antonovsky, Aaron (1987). Unravelling the Mystery of Health. San Francisco: Jossey-Bass Inc.
  4. ↑ At everydaypsychology.com: The Sense of Coherence
  5. ↑ Antonovsky, Aaron. Studying Health vs. Studying Disease, Lecture at the Congress for Clinical Psychology and Psychotherapy, Berlin, 19 February 1990. available online from the Universidade Nova de Lisboa
  6. ↑ Antonovsky, Aaron (1987). Unravelling the mystery of health. Josey Bass Publishers. p. 19. ISBN 1-55542-028-1.
  7. ↑ England, M., & Artinian, B. (1996). Salutogenic Psychosocial Nursing Practice. Journal of Holistic Nursing, 14(3), 147-195.
  8. ↑ Bergstein, M., Weizman, A., & Solomon, Z. (2008). Sense of Coherence Among Delusional Patients: Prediction of Remission and Risk of Relapse. Comprehensive Psychiatry, 49, 288-296.
  9. ↑ Dilani, A. P. D. (2008). Psychosocially supportive design: A salutogenic approach to the design of the physical environment. Design and Health Scientific Review, 1(2), 47-55.
  10. 1 2 Golembiewski, J. (2010). Start making sense; Applying a salutogenic model to architectural design for psychiatric care. Facilities, 28(3).
  11. ↑ Golembiewski, J. (2009). Moving from theory to praxis on the fly; Introducing a salutogenic method to expedite mental healthcare provision. Paper presented at the Australian Rural and Remote Mental Health Symposium.
  12. ↑ Golembiewski, J A (June 2012). "Moving from theory to praxis on the fly; Introducing a salutogenic method to expedite mental healthcare provision.". The Australian Journal of Emergency Management. 27 (2): 42–47.
  13. ↑ Golembiewski, J A (5 March 2010). "Start making sense; Applying a salutogenic model to architectural design for psychiatric care.". Facilities. 28 (3/4): 100–117. doi:10.1108/02632771011023096.
  14. ↑ Golembiewski, Jan A (April 2012). "Psychiatric design: Using a salutogenic model for the development and management of mental health facilities". World Health Design Scientific Review. 5 (2): 74–79.
  15. ↑ Golembiewski, Jan A (2012). "Salutogenic design: The neural basis for health promoting environments". World Health Design Scientific Review. 5 (4): 62–68.

See also

Further reading


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