Salutogenesis and ACEs, Part 2

Last week, we dove into the concept of  ‘salutogenesis’, coined by medical sociologist Aaron Antonovsky. In it, the central question is what we need in life to remain healthy. We are all exposed to stress factors of many sorts, which makes it important to have resources that can refresh us, people with whom we feel safe and secure, heard and seen. Antonovsky called these Generalised Resistance Resources (GRR’s), to indicate that they contribute to our ability to cope with life’s challenges.
If we have such resources available, Antonovsky stated, they will support our health through the ‘Sense of Coherence’ (SoC), a sense of consistency in life, also described as psychological resilience. The SoC is the confidence that our internal and external environments are predictable to a certain extent and that all will be well in life. He saw three core elements that together constitute the SoC: comprehensibility, manageability, and meaningfulness. These three mutually influence one another and the physical, psychological, and social are always interwoven. Let us take a closer look at all three.

Clear messages and communication and a certain order and predictability feed comprehensibility in life. This is the cognitive element of the SoC. For comprehensibility, a perception of security in a culture or a specific setting is key. If you are in a war situation, in a violent neighbourhood, somewhere where you do not understand the language, or in the middle of a disaster or a crisis, your sense of security and predictability are seriously affected. You will no longer know what to count on and this can make life feel incomprehensible.
For children, if they cannot count on their primary attachment figures, such situations can lead to forms of insecure attachment.

Balance between experiencing under- and overload (with regard to obligations and expectations) and between challenges and resources in life (the previously discussed GRR’s) creates manageability, the behavioural component of the SoC. When you do not have enough to do and are not encouraged and challenged, you may lose your lust for life. On the other hand, being constantly overburdened is also problematic, because it may lead to a lurking burn-out.
For children, being overasked on a structural basis can mean that they can hardly be themselves and are continuously trying to meet other people’s expectations. This way, the child’s authenticity may get under (serious) pressure.

The extent to which life feels emotionally valuable and satisfying and to which people consider life worth living and worth dedicating energy to, forms the meaningfulness of one’s existence, the motivational element of the SoC. Antonovsky saw this as the most important element of the SoC. When you get the impression that what you do is useless, you can start feeling useless yourself. It can damage your self-confidence and make you feel depressed. Because humans are intensely social beings, ‘hardwired for connection’, especially the lack of meaningful contact with others can create a sense of meaninglessness – an aspect painfully made visible for many by the present lockdown measures.
For children, the lack of contact with others can have really severe consequences. We know the stories of children in Romanian orphanages, who were fed and clothed, but had hardly any interpersonal contact – they withered away. Harry Harlow’s experiments in the middle of the previous century (with monkeys separated from their mothers) also showed how deep the urge for connection is and how babies perish without loving connection.

How people experience and describe their health, has a lot to do with how they experience their SoC. If one of the elements of the SoC is threatened, the perception of how ‘healthy’ you are, can change very suddenly.
As we discussed last week, Antonovsky mainly looked at factors in life that support health and wellbeing, that help you to adjust to changing circumstances, and that offer social resources. He did not look at life as a river full of dangers that you should not fall into, but as a stream in which all of us inevitably located. What we need to do is learn to swim. We have to learn to acquire resources and use them if necessary, so that we do not feel engulfed and drown. In all of that, Antonovsky saw an important role for the surrounding culture and social environment. Those can either support the SoC or rather throw up barriers. Have a look at the framework above; you see the important place of cultural factors. In his writings, Antonovsky mentioned social position, gender, age, innate characteristics, parenting methods, ethnicity, work situation and good or bad luck as illustrations of these cultural factors influencing the SoC.

What we see is that Antonovsky chose a very holistic approach: health and wellbeing are not individual phenomena, but are embedded in all kinds of physical, mental, and social mechanisms. This is called a biopsychosocial approach. Anything around ACEs is based on such a biopsychosocial approach. The science related to ACEs repeatedly emphasises that disease and social problems have a history with roots in the social environment. It is counterproductive to judge people’s behaviour without paying attention to that environment; shame and guilt are the biggest barriers to growth and development. They do not make us flourish, but nips us in the bud. They push us under water in the river.
A society that dares to courageously, vulnerably and compassionately examine her own history, habits, and institutions, offers her children the most fertile soil for a healthy adult life.

Did these two blogs make you curious about salutogenesis and how you can apply this concept in your own life or work setting? If so, have a look at this wonderful, freely downloadable resource: The Handbook of Salutogenesis, a publication from 2017, written by Mittelmark et al., and a real treasure trove for information and ideas.

Posted in Theory.