“We are coming to understand health not as the absence of disease, but rather as the process by which individuals maintain their sense of coherence and ability to function in the face of changes in themselves and their relationships with their environment.”-Aaron Antonovsky “Unraveling the Mystery of Health: How People Manage Stress and Stay Well”
Salutogenesis is a word many rarely come across, but when I stumbled onto the concept ten years ago, I couldn’t let it go. Salutogenesis literally means the creation of health, or the fostering of healing, much as pathogenesis refers to the creation or development of disease. Saluto (health) genesis (origins) offers a counterbalance to the reductionist emphasis of contemporary biomedicine, in that salutogenesis describes a set of factors that is entirely different from the medical perspective that healing is simply the reverse of getting sick.
In 2004, John Travis shared the Illness-Wellness Continuum in his seminal volume, The Wellness Book: How to Achieve Enduring Health and Vitality. Often referred to as the Wellness Paradigm, the Illness-Wellness Continuum considers individual symptoms of illness and disease and includes an orientation towards wellness. In this regard, healing is the orientation towards the healthy end of the Illness-Wellness Continuum, no matter where one begins on the continuum. The inclusion of wellness-oriented factors is not simply reversing the causes of illness; rather there is a whole set of skills and resources that can be engaged to move from illness to wellness. These were identified by Aaron Antonovsky, an Israeli sociologist, who devoted his career to researching and promoting a salutogenic approach to medicine and healing. Antonovsky’s steps to healing include enhanced coping mechanisms, increased host resistance, improved adaptive responses, an increased sense of coherence and improved resilience.
How do we characterize an individual’s health at any given time in the Wellness Paradigm? What are the factors that facilitate maintaining a current level of health or a move toward the more salutary end of the continuum? What factors push the individual towards illness and morbidity? These are the essential questions for the health coach as well as the client. This does not, however, disqualify the medical model. Rather this simply broadens the clinical potential of health coaching to include the conventional pathogenic perspective and the more salutogenic capacities. Integrative health coaching emphasizes positive psychology and motivational theory and is thus a more inclusive perspective.
Antonovsky’s key theoretical model of healing was based on what he called the “Sense of Coherence (SOC).” The SOC “is the global orientation that expresses the extent to which an individual has a pervasive, enduring, dynamic feeling of confidence that one’s internal and external environments are predictable and that there is a high probability that things will work out as well as can reasonably be expected” (Antonovsky 126). Such an orientation is extraordinarily useful for health coaching. With empirical research that reflects its use as a successful predictor for improving healing outcomes, the SOC model has been empirically shown to be a clear predictor of clinical healing outcomes. A brief synopsis ensues.