Model of salutogenesis

As we think about the world, it will reveal itself to us. If we take life as a game, we will gladly accept challenges; if we view our life as fate, we will act accordingly – or not, because fate is known to be predetermined.

Aaron Antonovsky (1923–1994), an American medical sociologist who emigrated to Israel in 1960, dealt with the question of why some people do not get sick despite extreme stress. To this end, he studied former inmates of concentration camps during World War II and subsequently developed the model of salutogenesis.

“Why do people remain healthy – despite many potentially health-threatening influences? How do they manage to recover from illnesses? What is special about people who do not get sick despite extreme stress?” These are the central questions that Antonovsky posed.

He developed the concept of salutogenesis (from Latin salus: health, happiness; and Greek genesis: origin). Antonovsky saw this as a counterpoint to pathogenesis, focusing on the emergence and treatment of diseases. Salutogenesis means viewing people as simultaneously more or less healthy and more or less sick.

For the comparison between the thinking of traditional medicine and his approach, Antonovsky used a metaphor:

“The pathogenetic approach wants to rescue people from a raging river at great expense, without considering how they got in and why they cannot swim better. From the perspective of health education, however, people do not voluntarily jump into the river and simultaneously refuse to learn to swim.”

And Antonovsky further wrote:

“My fundamental assumption is that the river is the stream of life. No one walks safely along the shore. A large part of the river is polluted, and there are currents, rapids, and whirlpools. My work is dedicated to the question: How does one become – wherever one is in the river – a good swimmer?”

Whether a person is pulled from the river, the river is calmed, or they are taught to swim, depends on individual conditions. The ability to "swim" is what Antonovsky refers to as the sense of coherence – the so-called Sense of Coherence (SOC).

The three components of the sense of coherence

The Sense of Coherence describe a fundamental attitude towards life that is based on three components:

• Comprehensibility: To what extent one perceives internal and external events as ordered, explainable, and predictable – instead of chaotic and arbitrary.
• Manageability: The conviction that sufficient resources are available to cope with challenges – either from within oneself or with the help of others.
• Meaningfulness: The assessment that the tasks of life are worth mastering. Meaningfulness provides motivation and is considered the most important component of the SOC.

How does a strong SOC emerge?

The cultural, social, familial, and personal background – as well as chance – create so-called generalized resistance resources: such as material security, knowledge, intelligence, self-confidence, coping strategies, cultural stability, worldview, faith, social integration, and a healthy lifestyle. From these arise life experiences characterized by consistency, co-creation, and balance between over- and under-demanding situations. These experiences are crucial for the strength of the sense of coherence.

If these resources are lacking, Antonovsky speaks of generalized resistance deficits. They impair both life experiences and the development of a strong SOC.

In summary: An attitude that views the world as understandable, manageable, and meaningful provides the cognitive and motivational basis to successfully cope with stressors. People with a strong SOC are less prone to health-damaging behaviors such as smoking or excessive alcohol consumption, as they suffer less from stress and are more motivated to take care of their health.

However, Antonovsky also emphasized that stress itself has a direct impact on the organism. The brain, immune system, and other body systems are closely interconnected. Intense or prolonged stressors can disrupt this balance and thus impair health.