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.
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.