It so happens that our whole state and social system is geared towards studying and treating illness, both physical and psychological in nature. I, for my part, want to introduce you to a field, and to people, who looked in the direction of health and asked: "What keeps us healthy, whatever happens?" The aim of this article is to change your beliefs, to find your resources and to turn the focus of your attention to health rather than to illness (pathology).
Salutogenesis is the science that studies the factors which help to maintain physical and mental health despite the negative influences of the environment. It was developed by the sociologist Aaron Antonovsky.
How do you stay healthy?
Salutogenesis does not ask why people fall ill, but why they stay healthy despite an enormous amount of harmful influence. What strengthens us so far that we can withstand heavy strain without harmful consequences?
As a woman with a medical background and as a counsellor, it matters to me not only to help my clients when they are already ill, but also to find in people the personal resources that carry them and help them grow – the so-called resilience.
A definition of resilience
Resilience (from the Latin resilire: to spring back, to bounce off) means a person's capacity to withstand psychological crises, social conflicts and possible triggers of illness.
The decisive factors here are individual resources, both genetically anchored and learned, such as
- attachment,
- self-confidence and
- stress tolerance.
Resilience therefore has a large influence on the level of health a person can reach.
How does resilience develop?
If, from the very beginning, people
- develop the feeling that they can do something and achieve something themselves (self-efficacy),
- if they can recognise a meaning in what they do and if they feel connected to the world around them,
then they can achieve more and cope with the unfavourable circumstances that affect their physical and mental health, and this makes them more resilient.
People who were not given the chance to develop this from childhood on can still – under difficult conditions – mature through
- trusting relationships with other people and/or
- psychotherapy later in life ("earned security").
That, however, is possible only at a far greater cost in energy, time and effort.
Salutogenesis according to Aaron Antonovsky (1923–1994)
So there are three conditions that have a substantial influence on a person's health. They were worked out by the sociologist Aaron Antonovsky. He formulated his theory after medical-sociological studies of people who had survived the Holocaust – survivors of the Second World War concentration camps who, contrary to all expectation, remained mentally and physically healthy – and then tested these astonishing findings on people from a wide range of social and sociocultural circles. Antonovsky's aim was to work out the binding preconditions that healthy and contented people apparently have, so that these qualities could be used to maintain or restore health.
Antonovsky therefore summed up the three conditions that influence a person's health – conditions, or abilities, that make up an important health-related resource – under the term sense of coherence (SOC; in German, Kohärenzgefühl).
A sense of coherence arises in people when they perceive their world as:
- comprehensible,
- manageable,
- meaningful.
The salutogenic model states that these three points determine how far a person can cope with the strains in their surroundings and how much freedom that person has in their thinking, feeling and acting.
In the salutogenic model, health and illness are two poles of an unstable balance. The findings of scientific research into salutogenesis show how we can move further towards health, that is, become more resilient.
A definition of salutogenesis
Salutogenesis is a scientific model that examines how health comes about and how it is maintained. The concept of salutogenesis was developed by the medical sociologist Aaron Antonovsky (1923–1994). Research in salutogenesis is positively oriented and pursues the following questions:
- Where does health come from?
- How can I strengthen my health?
- Why have I stayed healthy while everyone around me is ill?
The salutogenic orientation calls into question the idea that a person is either healthy or ill and that illness means a deviation from the normal state. What is characteristic of human life is health rather than illness.
It is therefore not enough to steer clear of difficult life processes or of disease-causing microorganisms. Quite often that is simply impossible. On the contrary, we gain good protection and reasonable stability,
- in dealing with the "ever-present stranger",
- with conflicts and
- with stress factors.
They help us to get to know and to widen the limits of our mental and physical resilience.
Instead of a miracle weapon against illness, we should look for the sources that make it easier for our organism to adapt actively to the demands of the environment. Life, learning and growth cannot be had without our own active effort and participation. In fact, you could even say that stress and harmful environmental influences do us some good, to a certain degree, in the development of physical health and personal maturity.
Paracelsus (1493–1541) put forward the thesis that the size of the dose alone decides whether something is a poison or a remedy.
This is also confirmed by modern research into resistance, also known as hormesis.
Salutogenesis and pathogenesis – two sides of one coin
Salutogenesis is the counterpart, the opposite pole, of pathogenesis, which describes how a disease develops. From the "downstream perspective", conventional medicine tries to rescue drowning people from a raging river, as the sociologist Aaron Antonovsky describes it. Wholly taken up with this task, eye and mind are never focused on what is happening further upstream – on who or what is pushing all these people into the river.
This picture may help you further: pathogenesis deals with the question "What helps in case of illness?". Salutogenesis, by contrast, with "What can we do so as not to end up in the current at all?"
A definition of pathogenesis
Pathogenesis describes how a physical or mental illness develops (pathology = disease / genesis = development). The starting point of this pathological process is the so-called aetiology, that is, the cause of the disease. Clarifying the aetiology of a disease is therefore the precondition for saying anything reliable about its pathogenesis.
Pathogenesis concentrates on the illness. A problem that can arise from this is the following: fixated on the problem, the eye often loses sight of those positive, meaningful and life-serving qualities of life that ought to be encouraged. The pathogenic paradigm, for instance, dominated medicine for centuries and produced a great many experts on disease who often have not the faintest idea of the individual health of their patients. The question is what makes you ill, and how prevention and therapy help.
So what is looked for is the pathogen, the antibiotic or the preventive vaccination. This piece of advice is typical of the pathogenic principle:
get yourself vaccinated against every possible pathogen, avoid all stress and excitement, allow yourself a spell of sick leave or take a tablet at every hint of feeling unwell)))).
A pathogenic hallmark
The limits of modern medicine
With this way of thinking, and with the consequences that follow from it, medicine has, however, reached its limits. On the one hand people are growing older, yet at the same time they suffer from chronic illness to an unprecedented degree and so are in fact no healthier than in earlier times.
What most people lack for their health is the feeling that they are finding their way in this rapidly changing world, that they are at ease and that they can see a human meaning in all the ever more impersonal activities of everyday life. On the other hand, the rising costs in the health sector can no longer be financed the way they used to be. This makes it necessary to rethink the methods and the justification of modern medicine and to examine other approaches.
Pathogenesis (what makes you ill?) and salutogenesis (what makes you healthy?) are both justified in medical examinations, but the importance of pathogenic research for living organisms has been considerably overrated all along. To come back once more to the words of Aaron Antonovsky:
The decisive salutogenic question is how to become a good swimmer, wherever you may be in the river whose nature is determined by historical, sociocultural and physical conditions of the environment.
Aaron Antonovsky
Try to answer three important questions:
- What helps me to swim by myself in the stream of life?
- What increases my ability to adapt to conditions of life that are not always pleasant?
- What leads to a health that also meets the demands of life in the medium and long term?
For me, as a woman with a medical education and experience and as a counsellor, health means being healthy in the sense of wholeness. That includes being in harmony with yourself and with your surroundings and feeling connected to everything that is. Illness is always the result of a discord between individual processes and functions in the body, and at the same time an "imprint" of inner psychological processes.
Natallia Nechai
Against this background, Aaron Antonovsky's research findings are of great importance. He was, by the way, not the only person to turn his attention precisely to the healthy human being. The second prominent thinker was Abraham Maslow.
Abraham Maslow (1908–1970)
The psychologist Abraham Maslow asked why the view of healthy people is so neglected. Perhaps, he said, one could learn from them and so become healthier oneself.
He therefore began a study lasting many years to explore the nature of health in healthy people: "When I began to study mental health, I selected the most outstanding and healthiest people (...) and studied their qualities. They differed greatly from one another and, in some respects, astonishingly from the average." His findings are impressive, and according to his research healthy people have the following characteristics:
- They perceive reality more clearly and are therefore able to judge people and facts correctly.
- They can accept themselves, other people and nature; they reject artificiality, boasting and hypocrisy.
- They have naturalness, spontaneity, simplicity and modesty.
- They are oriented towards the problem, the matter and the subject, not towards their own self.
- They need their "personal space" and can feel entirely at ease on their own.
- They are autonomous, active, oriented towards achievement and growth and therefore relatively independent of their physical and social surroundings.
- They pass no judgement (they evaluate nothing), but simply value everything they have, with awe, joy and wonder.
- They were "shaped" by mystical experiences; many have known a loss of self and transcendence through the so-called "peak experiences".
- They have a sense of community, that is, a deep feeling of identification, sympathy and affection towards others.
- They can cross the boundary of the ego and enter into intense interpersonal relationships.
- They have a democratic character structure and are friendly in their dealings with people, regardless of class, race, upbringing or beliefs.
- They have a strong moral bearing, that is, firm moral standards and no chronic uncertainty between right and wrong.
- Their humour is philosophical; they do not laugh at hostile or hurtful jokes, or at jokes about superiority
- Healthy people are creative without exception; they can withstand pressure and stay flexible.
Personal responsibility as the foundation of health
These research findings are a first step towards a healthier future, in which health is more than merely the absence of illness and which, above all, has to be shaped by a large measure of personal responsibility. Responsibility that we carry in bringing up ourselves and our children.
Health thus no longer looks like an illusion but like an inner task: to realise our human potential. A principle that can be applied to practically every area of human life.
Many people, however, find it hard to take on this responsibility and to find their bearings for the next steps towards stable health. As a counsellor with a medical background and many years of experience in salutogenesis, I would be glad to accompany you on your way. I wish you peace and health!
If you have questions or would like to know more, write to me.
