EDITOR’S SUMMARY: It’s not uncommon to gauge the quality of your existence by other people’s standards, and this includes your vitality. After all, you’ve likely been taught to believe the man or woman in the white coat knows all—has some sort of secret code to the inner workings of your body’s ecosystem. Salutogenesis flips this switch by taking into account the whole of who you are when assessing your well-being—what you think, how you feel, and how you respond to unwelcomed, seemingly frightful circumstances. It also invites you to be the “team captain,”—the most active player in influencing the direction of your health.
Written by Carter Trent
Edited by Nicki Steinberger, Ph.D.
What comes to mind when you evaluate your health? In an attempt to answer this question, a doctor might subject you to a battery of tests, including the obligatory blood pressure check and urine sample. Physicians frequently fail to look past physical health indicators, seldom examining your resilience toward stressors thrust upon you by the vagaries of life. “Resilience,” from the American Psychological Association (APA):
“Resilience is the process and outcome of successfully adapting to difficult or challenging life experiences, especially through mental, emotional, and behavioral flexibility and adjustment to external and internal demands.”
An assessment of primary care published in the biobehavioral medical journal, Psychosomatic Medicine, stated:
“Stress exposure and responses are rarely assessed in the primary care setting and infrequently targeted for disease prevention or treatment.”
This is unfortunate, because strengthening your resilience in the face of life’s challenges, from unexpected expenses to sudden illness, is a significant contributor to your emotional, psychological, and physical fitness, according to a concept called salutogenesis. In salutogenesis, your ability to handle the stress life throws your way, and learning from those experiences, marks a key difference between having a prosperous existence, and one that seems burdened by adversities.
Salutogenesis is a model of health that looks beyond your body’s physical state when considering how well you are. It encompasses numerous contributors to your well-being, including mental, emotional, and social factors. This concept may seem unfamiliar if you’re used to the idea that staying healthy means disease avoidance. Instead, salutogenesis espouses an expansive view of your state of health as the means to assist your body’s ability to fend off illness.
In fact, under salutogenesis, the idea of evading disease is unrealistic. According to medical sociologist Aaron Antonovsky:
“We are coming to understand health not as the absence of disease, but rather as the process by which individuals maintain their sense of coherence and the ability to function in the face of change.”
Antonovsky coined the word salutogenesis in his 1979 book “Health, Stress and Coping.” The term combines the Latin word “salus,” meaning health, and the Greek “genesis,” which means origin. Under salutogenesis, your fitness is not just a binary distinction between healthy or sick. Wellness is viewed as a continuum between total health, which Antonovsky called “ease,” and the complete absence of that health, referred to as “dis-ease.”
As you’re faced with a stressor, such as illness, your well-being shifts closer toward the dis-ease end of this continuum unless you cultivate a strong sense of coherence (SOC). SOC is what salutogenesis considers the fundamental component to your health. Antonovsky believes it’s not possible to avoid disease and stress in your life. Instead, your resilience to staving off a decline in your fitness lies in boosting your sense of coherence.
This sense of coherence concept describes your ability to cope with the various stressors in your life, whether that be in the form of a medical condition, struggles with finances, feelings of loneliness, or other factors that affect your ability to overcome challenges. The higher your sense of coherence, the greater your resilience, while the lower your SOC, the more likely you are to become susceptible to disease and a decline in health.
Antonovsky described this “sense of coherence”:
“A global orientation that expresses the extent to which one has a pervasive, enduring, though dynamic, feeling of confidence that (1) the stimuli 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.”
Antonovsky’s development of salutogenesis came after he interviewed women who survived the Holocaust. He wanted to understand why some of them lived productive lives after the end of World War II despite the horrific experience of the Nazi concentration camps. He came to realize a number of factors contributed to their well-being, which formed the basis for salutogenesis with sense of coherence (SOC) at its center.
You’ll notice the “sense of coherence” quoted above from Antonovsky involves three components. The first is called comprehensibility. This describes your ability to comprehend the problem you’re facing. Next is manageability, which is an understanding that the challenge in front of you can be overcome with the resources at your disposal. Salutogenesis refers to these resources as general resistance resources (GRRs).
The final component is meaningfulness. This is your ability to take away something meaningful from a problem you faced, so that you embrace situations as opportunities to learn and grow from, rather than circumstances to avoid. From this view, the meaningfulness component creates motivation to conquer tough times.
The GRR’s: In order to cultivate a strong sense of coherence, you need general resistance resources (GRR’s). You tap into these as a means to overcome whatever problem you’re facing. Some examples of general resistance resources are education/learning from street smarts, money/items for barter and trade, support from your loved ones/community, self-esteem, and a strong immune system. As you can see, GRRs can be any type of resource at your disposal—tangible or nonphysical.
It’s possible you may not have all the general resistance resources you wish you did. Let’s say you’d like to have more money, and waver on a continuum between melancholy and depression because you don’t. If you can relate to this, you can shift the tides by noticing your other resources, and cultivating the GRRs in your control.
For example, you might turn to strengthening your immune system to boost your sense of coherence. Feeling strong from the inside-out makes a difference! Doing so can mobilize other resources that will help you maintain or attain groundedness and resilience in the face of chaos and confusion. In other words … one positive upgrade leads to another, creating a domino effect.
Question Convention
Salutogenesis contrasts with the Western medical industry’s focus on pathogenesis, the process by which disease develops. The industry’s priority around detecting and treating illness was understandable. Since the onset of germ theory over a century ago, which states microscopic organisms are responsible for disease, the minds behind modern medicine strived to understand pathogenesis. Their aim was to prevent disease progression through treatments such as prescription drugs and surgery.
Reinforcing this approach is a collective fear of disease, seen throughout human history in epidemics such as the Black Death of the 1300s. The recent COVID-19 pandemic was an example of the widespread fear induced by “disease.” The medical response to the pandemic fueled this fear by promoting disease avoidance as a solution, emphasizing social distancing and masking.
Other factors contributed to modern medicine’s convergence around disease control and prevention. The success of antibiotics and insulin led to the notion that medications were “magic bullets” that would cure your illnesses. This idea was supported by decades of pharmaceutical advertising. As a result, the pharmaceutical industry raked in a mind-blowing $1.5 trillion in 2022.
The COVID-19 vaccine is an example of society’s reliance on medications as a panacea for disease. The societal pressures to seek salvation in the multiple vaccines (and still counting) were so intense, anyone even questioning the vaccine’s efficacy or safety was confronted with ridicule, prejudice, and blame for “spreading disease.”
But the process of pathogenicity, an organism’s ability to cause disease in another, is complex. Defining what constitutes a disease is driven by multiple factors. For instance, many signs of “sickness,” such as fever or inflammation, are the result of your body’s immune response, not the disease-causing germ, because potent chemicals, such as interferons, are released to fight off illness.
In fact, the majority of virus infections show no outward sign of disease. That’s because many viruses don’t want to kill their host. Otherwise, the virus would be stamping itself out. Antonovsky, on his way to formulating salutogenesis, came to realize that attempting to control disease was a futile exercise, given the myriad of factors and complexity involved. Instead, he became interested in what was required for a person to thrive in life.
As Professor Ilona Kickbusch, founder of the Global Health Centre at the Geneva Graduate Institute, stated in a tribute to Antonovsky:
“…there is nothing more practical and efficient than asking the right question… Aaron Antonovsky consistently had the courage to ask the right question: how is health created?”
New Paradigm Fosters Empowerment
Research supports salutogenesis. Studies have shown your sense of coherence to be a predictor of health outcomes. One study revealed people who already possessed a strong SOC were capable of making life choices that led to a 28% lower likelihood of smoking, 36% indication of being more physically active, and consuming whole, fresh food. Other studies showed the risk of death from all causes went up in people with a weak sense of coherence.
From the Journal of Epidemiology & Community Health, “Healthy lifestyle choices: could sense of coherence aid health promotion?”:
“Individual differences in SOC are associated with healthy lifestyle choices independently of social class and education, and may therefore aid the design of future health promotion interventions.”
A research study applying the salutogenic model to people with type 2 diabetes illustrated how salutogenesis works. The study was comprised of participants who had disadvantaged childhoods, such as victims of neglect or abuse, but possessed high senses of coherence. Thanks to access to general resistance resources in the form of coping strategies and social support, they tended to move toward healthier eating to combat their condition.
These coping strategies involved a flexible and creative mindset. For instance, study participants focused on what they could and should eat instead of what they could not. And rather than restricting their eating, they shifted to higher-quality foods. They replaced processed food snacks with healthy alternatives, and experimented with new recipes that encouraged metabolic stability.
From the International Journal for Equity in Health, “Salutogenic model of health to identify turning points and coping styles for eating practices in type 2 diabetes mellitus”:
“All participants experienced turning points for healthier eating that caused eating to become a priority in their life. Yet, the fact that not all were able to eat as they intended, advocates for nutritional guidance for people with T2DM, with a greater emphasis on reflexivity, psycho-social well-being and social support.”
On the contrary, those with disadvantaged childhoods, combined with an inability to handle stress associated with their childhood traumas, resulted in lower senses of coherence. They tended to eat unhealthy foods despite their medical conditions. This study illustrated how outcomes such as making healthy or poor food choices can be influenced.
Another example is weight loss. A study out of Sweden, “Who succeeds in maintaining weight loss? A conceptual review of factors associated with weight loss maintenance and weight regain,” examined participants who successfully lost weight and maintained their new weight. It showed they possessed a higher sense of coherence as a result of general resistance resources, such as motivation to lose weight and social support. Those who regained their weight exhibited a lower SOC, resulting in binge eating, and consuming food in response to negative emotions and stress.
Salutogenesis transforms the current medical model where the doctor is at the epicenter of your health—responsible for lab tests, prescriptions, and treating disease—to a model where you’re at the center. As a co-participant in all your medical decisions, you make intuitive-led choices alongside your naturopath, herbalist, M.D., psychotherapist, chiropractor, nutritionist, or any other trusted (and vetted) health practitioner.
The salutogenic approach is slowly gaining traction in the medical community. For instance, according to the constitution adopted by the World Health Organization (WHO), “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.”
If the salutogenic shift toward a more encompassing view of your health sounds appealing, here is how you can incorporate this model into your life. It starts with a focus on improving your sense of coherence. To do that, ask yourself three questions, grading each with a score of one to three, with three indicating you’re closer to the “ease” side of the health spectrum, and one meaning you’re closer to the dis-ease side, and hence, revealing an area to target for improvement.
One: Comprehensibility. Do you usually find the things that happen to you in everyday life are difficult to understand? If you’re able to make sense of a tough or chaotic situation, it’s easier to find a solution. For instance, let’s say you decide to take piano lessons. After the first lesson, you feel like you don’t know what you’re doing in the class. This feeling indicates a struggle with the comprehension component of SOC, and can make subsequent lessons more frustrating if not addressed. To reverse this, you can ask the teacher questions to clarify any confusion. In the opposite scenario, if you feel like you understood the lesson, you become more confident in your ability to eventually play the piano.
Two: Manageability. Do you tend to find solutions to problems and difficulties that others see as hopeless? For example, in the diabetes study mentioned above, participants who possessed a strong SOC were able to manage what foods they ate, or in turn, went to a dietician for guidance. In this way, they found solutions that improved their health. Those with a low sense of coherence did not seek help, and struggled to manage their diabetes. They became frustrated with eating “healthy,” which hindered their ability to improve their metabolic flexibility.
Three: Meaningfulness. Do you typically experience your daily life with a sense of personal satisfaction? When you feel your life experiences are meaningful and worthwhile, you invest energy into conquering various tasks and challenges. For example, if you work at a job where your ability to make decisions is limited, you may feel less enthusiastic about working, than if co-workers or your boss consulted with you for your suggestions.
Assessing your sense of coherence should give you insight to take steps to improve it. The next course of action is to begin strengthening your general resistance resources (GRR’s). One way to do this is through physical activities, such as swimming, dance, yoga, or taking walks on a regular basis. Another is to find community activities to participate in, since improving social ties helps boost SOC.
Look for the positives in your life, especially in the face of adversity. One research study looking at the impact of positive thinking on quality of life identified a correlation between the two. Positive thinking was found to increase life satisfaction and resilience to stress in the participants. Some of the exercises they performed to shift toward positive thinking included writing letters of forgiveness to themselves and others, and noting three good events that happened each day. From the study, “The effect of positive thinking on resilience and life satisfaction of older adults: a randomized controlled trial”:
“In conclusion, the current study findings revealed a relationship between resilience and positive thinking. Positive thinking and interventions can increase older adults’ resilience, and thereby improve their quality of life. High quality of life can lead to greater life satisfaction. In addition, positive psychological training can directly contribute to positive and healthy thinking, ultimately leading to a better dynamic life for older adults.”
Granted, cultivating a salutogenic way of thinking can prove challenging. This is especially true if you’re committed “hook, line, and sinker” into society’s disease-centric, insidious narrative. If this is you, it can take time (and patience) to transition to the salutogenic model—health improving or declining based on your resilience to coping with stressors—and includes everyday actions, such as navigating the thoughts you choose to think.
If you find the concept difficult to adopt, consider this shift-in-thinking example from Mother Teresa, who once declared, “I will never attend an anti-war rally. If you have a peace rally, invite me.” In the same way, salutogenesis flips modern medicine’s paradigm of battling disease to one where the emphasis is on examining what it takes to create wellness. This is a shift you may find worth embracing.
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Published on December 21, 2023.
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