Sonntag, 8. März 2015

Why do some people stay healthy and others become ill?



Why some people are able to cope with adverse conditions and others fail?
And ultimately: How does health develop respectively what keeps oneself healthy?

These were the questions which were posed by Aaron Antonovsky (1923-1994), a Israeli-American sociologist, especially after he found out that about a third of the group of concentration camp-survivors evaluated by him was in an unexpected good mental condition. Thereof he developed in the 1970ies the concept of salutogenesis.
He vindicated the point of view that you are never completely healthy or completely ill, but you move all your life in the health-ease-continuum and oscillate between the extremes. To achieve a condition as balanced as possible, several factors come into effect:

One factor are the stressors, with that he means all stimuli that generate stress. For him that are mainly the chronic stressors (like war, poverty, poor hygienic or nutritional conditions, physical restrictions, permanently mental over- or underload), at the sidelines even mundane stressors (like time pressure, complexity of everyday life, physical and psychical strain) and critical life events (like death of a kin, relocation or other grave changes of the social environment). These stressors rock the boat, and if unbalanced, they can gain the upper hand and sicken you.

To prevent that it needs as a second balancing factor the resistance resources. Those are on the one hand individual resistance resources (like physical resources, coping strategies, and intelligence), on the other hand even social and cultural resources (like cultural stability, social support and financial possibilities).

These two factors oscillate your circumstance like a perpetuum mobile on the health-ease-continuum back and forth.

This back-and-forth-oscillating gains stability only through the third factor: the sense of coherence (SOC). You can name this sense of coherence even as worldview or basic attitude to life, a basic attitude, with which the world is experienced as interrelated and meaningful. This consists of three components:
At first of the sense of comprehensibility: That means that people are able to understand their surroundings, so to array and process incoming stimuli resp. already facing them with the corresponding expectation. The opposite would be a world that seems to be haphazardly, unpredictable, chaotic and inexplicable.
The second component is the sense of manageability: That is the basic attitude, that incoming difficulties are solvable. That is not only about your own expedient acting, but also about the confidence that other people or a higher power help with the coping with obstacles. People who lack of this creed see oneself to be delivered to the odds of life, and are under the impression that they can undertake nothing to change their situation. They think they are simply on the shady side of life.
The third component is the sense of meaningfulness. That means how far life is perceived as meaningful, that the challenges of life are worth to engage for them and to search for solutions. People who lack of this component perceive life as a torture and every further challenge is a further load for them.
The more the sense of coherence is developed, the more flexible you can react to challenges and you can activate the appropriate resources and coping strategies.

Antonovsky considered that the SOC had the biggest impact to physical health – that couldn’t be proved by empiric research. However it could verify that considerable impacts on psychic health are to report, though Antonovsky deemed it improbable.
So Lundberg could verify in 1997 that people with a high SOC-value have a substantial lower risk to suffer from psychic diseases. Other studies prove that inclination, likewise the cohesion between low SOC-value and anxiety resp. depressiveness.
The SOC seems to have a considerably larger impact on the coping with stress: It facilitates the fitting with hard living conditions like disability or the tendency for a sick relative (Dangoor/ Florian 1994, Rena et. al. 1996) and correlates positively with active coping strategies in trying situations. On the other hand low SOC-values are associated with depressive coping behaviour (Backer et. al. 1996), helplessness (Callahan/ Pincus 1995) and resignation (Rimann/ Udris 1998).
Evidence is found for the correlation between the SOC and social environment, too: The higher the SOC-value, the higher the number of friends (Larsson/ Kallenberg 1996), a high SOC-value is associated with high matrimonial happiness of paralysed patients (Rene et. al. 1996) and a positive correlation is found between the SOC and social support (Becker et. al. 1996).
The manifestation of the SOC is independent of culture; there are different studies concerning gender, age, educational background and socioeconomic status – but the results don’t admit a plain interpretation in the one or the other direction.

I like this concept, because it shows the multifacetedness of health. There is not the one and only factor (like a virus that catches you, an accident, a personal crisis) that decides about health or ease, but there is a multitude of factors that ultimately decides on our health condition: a critical incident as trigger in combination with other stressors, the resistance resources and the fundamentally sense of coherence. It is not really surprising that the sense of coherence is associated with psychic health, is it? If I have the strong conviction that a situation will come to a good end and if I expect that my problem can be solved, I am calmer and less stressed. But if I take the view that it is yet a catastrophe if I cannot pursue my job for two or three days, that puts me under pressure and can cause immense stress.
The sense of coherence is mostly understood as a psychological variable which is as well investigated in psychological settings. To date, especially in the German-speaking area, the spiritual dimension of the salutogenesis is rarely attached value, here furthermore persists need for research.


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