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salutogenesis

salutogenesis

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Published by: hamletquiron on Oct 31, 2010
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www.salutogenesis.netA. Antonovsky . conference in Berlim
 1 
this is awww.salutogenesis.netinitiativepost your message atnetmembers@salutogenesis.net 
SALUTOGENESIS
 
EASESTUDYING DIS.STUDYING HEALTH VS
Aaron Antonovsky,Lecture at the Congress for Clinical Psychology and Psychotherapy1990February19,Berlin  
Abstract
 The paper's point of departure is the proposal that the pathogenic paradigm which at presentdominates disease research and clinical practice in the industrialized world is of decreasingpower as we try to understand and deal with the health and illness of human beings. Thelimitations of the paradigm are not resolved by preventive medicine or the biopsychosocialmodel. Five important contrasts are presented to show that the difference between thepathogenic and the salutogenic model, which posits that the great mystery is the origin of health, are fundamental. The search for the answer to the question "What explains movement toward the health end of the health/ illness continuum?" led to formulation of the sense of coherence concept and itsthree components, comprehensibility, manageability and meaningfulness. The overarchinghypothesis, then, became: the stronger the SOC, the greater the likelihood of moving towardthe health end of the continuum. The major determinants of the SOC are located in macrosocial and historical factors. Finally, itis noted that there are many roads to a strong SOC and health, and that health is not the onlyvalue in human life.
 
www.salutogenesis.netA. Antonovsky . conference in Berlim
 2STUDYING HEALTH VS. STUDYING DISEASEAaron Antonovsky*Lecture at the Congress for Clinical Psychology and Psychotherapy,Berlin, 19 February 1990SummmaryThe paper summmarizes a journey of some 15 years of research. It starts by proposing that apathogenic paradigm at present dominates disease research and clinical practice in theindustrialized world. It suggests that this paradigm, based on the assumption that disease isdeviant and puzzling, is of decreasing power as we try to understand the health and illness of human beings. The limitations of the paradigm are not resolved by preventive medicine or thebiopsychosocial model. A salutogenic paradigm is offered as an alternative. This paradigm isbased on the assumptions of inherent heterostasis and conflict in human existence. Thecontrasting answers of the pathogenic and salutogenic models to five fundamental questions arepresented to show that the differences between them are fundamental.1. How are people classified in terms of their health status?A dichotomous vs. a continuum classification2. What is to be understood and treated?A scientific diagnosis of the specific disease of the patientvs. assessment of the overall state of health/illness of persons3. What are the important etiological factors?The risk factors for the particular disease being consideredvs. the total "story" which can explain location on thecontinuum, including salutary, health-promoting resources4. How are stressors conceptualized?As somewhat unusual and pathogenic vs. as ubiquitous andopen-ended in consequences5. How is suffering to be treated?The "magic bullet" and wars against diseases vs. strengtheningcoping resourcesThe search for the answer to the question "What explains movement toward the health end of thehealth/illness continuum?" led to the study of resistance resources. Such resources areconceptualized in terms of the overall construct of the Sense of Coherence (SOC) and its threecomponents, comprehensibility, manageability and meaningfulness. The SOC is clearly not aparticular coping strategy, but a general orientation to life. The overarching hypothesis proposedis that the stronger the SOC, the greater the likelihood of moving toward the health end of thecontinuum.The important determinants of the SOC are to be found in the nature of the society in which onelives in a given historical period, and the particular social role complexes in which one isembedded. Finally, it is to be noted that there are many roads to a strong SOC and health, andthat health is not the only value in human life.
 
www.salutogenesis.netA. Antonovsky . conference in Berlim
 3STUDYING HEALTH VS. STUDYING DISEASEAaron Antonovsky1Lecture at the Congress for Clinical Psychology and Psychotherapy,Berlin, 19 February 1990When Dr. Faltermaier invited me to address you, he asked me to present a social scienceperspective on health and health research, discuss the conceptual shift from an illness to a healthorientation, characterize the current situation of the sociological and psychological research onhealth and illness, analyze the role of the health concept in international research, present myown standpoint, and discuss its consequences for health promotion. I have two alternatives: Ishall be glad to deal with the issues raised by Dr. Faltermaier -- on the condition that you agree tolisten to me the rest of today and at least all of tomorrow, cancelling everything else on theprogram. The other alternative is to limit myself to discussing my own model, leaving it to you torelate it to the broader questions. I assume that you prefer the latter alternative.My point of departure is to specify the goal of my professional endeavors, a goal which I, amedical sociologist, share with all of you, clinicians and researchers alike: We seek to advance ascientific understanding of the bodily and emotional suffering of human beings associated withillness. Please note that I exclude grief, misery, unhappiness, frustration and the like, though suchemotions involve suffering and may well lead to illness. Also note that I, as well as you, haveother goals in life. I will return to both these issues later. Because illness is universal, everyhuman society has developed a paradigm, a philosophy, a set of fundamental assumptions, a setof categories, to provide such an understanding. And every society has developed a socialinstitution, based on its understanding of illness, to deal with the problem. In modern westernindustrialized societies, what is called the biomedical model provides this paradigm. It isembodied in the complex of medical care institutions which we have created. As patients,practitioners or researchers, we have all internalized this understanding of illness.I haveproposed that this philosophy be called the pathogenic paradigm, since its base is a set of assumptions about the origins, nature, course and therapy of pathology. Its point of departure isthat specific pathogens or disease agents, or insufficiences or superfluities, come to threaten theintegrity of the organism. The resulting symptoms are diagnosed in terms of diseases, as detailedin the International Classification of Diseases, Injuries and Causes of Death, or in DSM-III. Thesocial institution of medicine, including psychiatry, is organized around the identification of thedisease and the application of chemical, physical or surgical weapons to repair or minimize thedamage to the organism wrought by the pathogen. Research is directed to identifying thepathogens and the search for their elimination.This is a paradigm which emphasizes the individual person, the material body, the mechanisticinterrelationships among the parts of the body, and the cheerful assumption that most of the time,for most of us, the machine does not break down. It would take us too far afield to discuss whythis pathogenic paradigm has emerged. But I would suggest that it is a paradigm which iscomfortable with the mode of industrial production, whether of a free market or centralizedplanning type, which has dominated the developed world.
1
Aaron Antonovsky, Ph.D. is the Kunin-Lunenfeld Professor of Medical Sociology and Chair,Department of the Sociology of Health, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beersheba, Israel.
 

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