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Narrative Healing, Salutogenesis and the Wellness Paradigm

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November 9, 2015

By Dr. Joel Kreisberg, DC, ACC

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.

ImprovementIn 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, 1979, p. 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 Sense of Coherence model has been empirically shown to be a clear predictor of clinical healing outcomes. A brief synopsis ensues.

The SOC model includes three primary foci:

Comprehensibility – the extent to which both internal or psychological stimuli and external or environmental stimuli make sense.
Manageability – the extent to which available resources are adequate.
Meaningfulness – the extent to which challenging events are seen as worthy of being engaged emotionally (Levin, 2008).
In integrative health coaching, the coach has the opportunity to increase coherence and predictability by facilitating life experiences that support consistency and participation in shaping outcome. Without significant control over life’s circumstances, the Sense of Coherence model postulates that a healthy balance of stress in one’s can, to a degree, support experiences that are predictable and rewarding. In other words, there can be positive value for some measure of frustration and punishment. When faced with challenges, barring individual or community issues of survival, activation of individual defense mechanisms foster an increase in overall resilience and an increase in resistance to illness.Woman Improving Circumstances

Rather than focusing on reducing stressors or stress, the salutogenic model accepts stressful stimuli as ongoing elements in life experiences. Stressors repeatedly put tension on the organism. These tensions can mobilize both general and specific resources in order to resolve the tension and overcome the stressor, thus generating an increased Sense of Coherence. Individuals with a strong SOC integrate stressors as a means for stimulating health and healing.

In Antovosky’s model, the three functions of these coping responses are 1) to modify situations, 2) to engage meaningfully in the situations, or 3) to control the stress. By resolving these tensions we learn consistency and increase our participation in successful outcomes, strengthening our Sense of Coherence. As an approach differentiated from conventional biomedicine, coaching utilizes these coping responses to support positive change, increase healing resources, decrease physical, emotional and mental illness or limitation, and support increased wellness.

One of the key techniques for engaging salutogenesis is through the healing narrative. As discussed in previous blogs, the healing narrative offers an individual the opportunity to meaningfully engage in the salutogenic process. Using storytelling, we can distinguish and comprehend subtler dimensions of our healing resources. In this way, our story facilitates narrative healing. One of the most direct ways to truly understand how story provides meaning is to directly work with the salutogenic properties of healing.

Teleosis is offering two upcoming opportunities. First, Dr. Lewis Mehl-Madrona, author of Narrative Medicine will be sharing his wisdom this Wednesday at 7 pm EST as part of our Vital Conversations Community calls. And in March of 2016, we’ll be offering a 12-hour online course in Narrative Healing. These powerful opportunities will let you explore your own access to stories that heal. You don’t want to miss these events!

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