Episode Transcript
[00:00:08] Speaker A: Hello there, I'm John Ryan and you're very welcome to the 21st episode of the Work Healthy podcast, our last in 2023. If you're unaware of the concepts of salutogenesis, our sense of coherence, today's podcast could be truly life changing.
If Aaron Antonofsky, the man who coined both phrases, had lived, he would have been celebrating his hundredth birthday this very day. Our birthday gift today is actually time with his son Avishai, who gives us a great insight into the man and the development of those concepts that have truly transformed how we think about health, stress and anxiety and indeed how we can cope successfully in our fast changing world. I started our interview by asking Avishai to describe his father Aaron, and how he developed the concept of salutogenesis.
[00:01:06] Speaker B: In 1960, he and my mother, his wife, emigrated to Israel.
They lived in Jerusalem where he worked at the Hebrew University. And then in 1972, he was asked to move to town city of Beersheva, which is in southern Israel, and to be one of the five founders of the new medical school which was going to be established then. And he became the chair of the admissions committee, which was unheard of, someone who is not a medical doctor chairing the admissions committee.
And the whole medical school was set up in what was termed later the Beersheba spirit because it brought something new, it brought a view of medicine and healthcare as something that should be centered on a human being and not on a case of, you know, this or that disease and people. Students were sent from their first year already to community clinics in development towns to meet the people, to sit in with, with the family doctors and learn not only about someone who has a headache or a kidney infection or, or sore throat, but also about this person's family, this person's.
[00:02:57] Speaker A: Context, I suppose.
[00:02:58] Speaker B: Yeah, giving the context because viewing the, the patient as a, as a whole human being.
And in those years, my father was involved in a study, he ran a study, a very large scale study about how women adjust to menopause.
And that was in the early 1970s.
And in that study, in that large sample, there were two groups of women, that was in the 1970s, and women, a sample were in their 50s.
So they were, that means they were born in the 1920s. So he had two groups of women who were born in Germany in the 1920s. One of those groups left Germany before World War II and came to what would later become the state of Israel. And the other group went through the war in concentration camps and survived the most, you know, horrible experience one can think of in the concentration camps and, and then came to Israel.
And when one of the things that was measured in that study was the satisfaction with life.
And it was found that in the group of women who did not go through the concentration camps, women who came to Israel before the war, a little over 50% were generally satisfied with life. Satisfied with life means we have a job, we have friends, we read books, we go out, we take vacations, life is okay.
And in the other group of women who went through the concentration camps, about 29, only 29 said they were satisfied with life.
Now those 29% said, you know, they, they have dreams, they have memories, but in general, life is okay.
And my father was looking at the data, and I remember, I remember a lecture of his that, that he gave telling this story. He said, I was looking at the data and I was asking myself, well, what's new here? I mean, this is trivial. Of course, women who went through the most excruciating experience will be much less satisfied with life even 30 years later than women who did not. So, you know, what's, what's the big issue here? And then he said to himself, you idiot, you're not looking in the right place.
It doesn't matter. The difference between these two groups of women doesn't matter. What's important is those 29% of the women who were in concentration camps and still say life is okay.
I would, this would be true even if it were 9%, not 29%.
How, how do these, how did these women get by? What, what did they have that enabled them to go through this horrible part of life? And it's not that after they came to Israel, life was, it wasn't the Garden of Eden. You know, there were wars in Israel and, and all kinds of things that they had to go through adjusting to a new country. And still these women say life is okay. And this is when it occurred to him that no one before has ever in, in the, the health system system. No one has ever asked systematically and scientifically the question, what creates health?
What helps people maintain or move towards health?
The medical establishment in the Western world for hundreds of years has been thinking and teaching and practicing the pathogenic model, which is, which asks what, what's create? What creates illness? Why do people get sick? How do we, how do we treat sickness?
And later on, how do we prevent sickness?
And if so, so this is when this new way of thinking, this new, this paradigmatic shift came along.
[00:07:53] Speaker C: Some of the resources you talk about, and maybe you'll Share later where I've gone on to those websites and read more. And one of the things that stood out for was where somebody was asking students in a university, have you ever had a diagnosis of health?
And it was really kind of interesting that I had never considered that like, so that this, this concept that health isn't just the normative, it's not just the given, it's something, it's a state to be achieved.
And, and I think that's an interesting difference and a different way of looking upon it. So, yeah, I mean, if you could share more about that salutogenic model, that would be great.
[00:08:41] Speaker B: I think. Well, before giving a little metaphorical explanation about the difference between the pathogenic, the traditional medical pathogenic model and the solutogenic model, I'll tell a story of when I was a young child, when we moved to the town of Beersheva where the new medical school was established.
We hadn't, we moved into a new home. We had a garden and my father had planted bushes and flowers in the garden and he would love to work in the garden, although he was no gardener.
And that was in the southern part of Israel where there is a desert, hot desert climate.
And I remember one day going out to the garden with him and he was looking at all those plants and he said something like, no, he was, he said something like, I. It's very easy to understand why several plants will not make it. They won't survive this desert heat. They'll die soon. The real mystery is how some plants will grow and blossom and be give beautiful flowers. How. That's the real mystery.
And that is actually the salutogenic question before the term salute of Genesis was coined.
So the metaphor which was, has been published in several places, is the metaphor of the river of life.
Now imagine, imagine you're walking along the river. You know, the sun is shining, the birds are singing, the trees are blossoming, and.
And then suddenly you fall into the river. You fall into the river. That means you become sick.
And inside the river there are doctors waiting there and they jump and try to help you and save you and keep you from drowning. Sometimes they succeed, sometimes they do not. In other words, sometimes there is a cure, sometimes there is no cure. So that's the curative medicine. You fall into the water or become sick and then doctors try to help you. Later chronologically came along preventive medicine. The preventive medicine is those people who are standing outside the river trying to help you to prevent you from falling into the river. They say if you don't Want diabetes, don't eat sugar if you don't want a heart attack, don't eat fat and so on. They try to prevent you from falling into the river.
Now preventive medicine is also focused on disease because the question there is how to prevent disease X or disease Y.
According to the pseudogenic model, we are in the river. All of us are in the river to begin with.
And it's not a matter of either you're sick or healthy. The, the classical medical models dichotomy between health and sickness.
We're talking about a continuum, what my father called ease dis ease continuum. And we're in the water all the time in the river.
And our mission is to try to swim upstream to move towards the health pole on this ease dis. Ease continuum. So all of us at any given moment in time are somewhere along this, this continuum because we. Now, why are we always in the river? Because there's always, always something we have to face, some kind of challenge. I'm not talking only about health challenges, physical or mental health. I'm talking about.
I was on my way to an important meeting and my car broke down on the way.
I had a fight with my wife or my husband this morning.
My boss yelled at me. I have an overdraft in my bank account.
[00:12:52] Speaker C: The normal stresses of life.
[00:12:54] Speaker B: Exactly. The normal stresses of life. There's always something we have to deal with.
So that's why we're always in the water. And our mission is to swim upstream towards the health pole on this ease disease continuum.
So to summarize this point, we first of all, according to the salutogenic model, health and disease are a continuum. They are not. It's not a dichotomy.
And second, the solitude. Genesis says look at the whole person, not only at a specific type of sickness, and the third thing is look for health resources or salutary factors rather than, rather than pathogenic factors and causes for illness. That's. Yeah.
[00:13:57] Speaker C: And I mean, I think the, the river of life is such a wonderful metaphor for what, what we face as individuals. And, you know, there's so many things about a river that, you know, number one, it can be beautiful, but like with water, it can also provide a danger.
So there's a. There's a balance. And it depends whether you respect it or not. So sometimes we can respect our own bodies and sometimes we can disrespect them with what we do. But equally, you know, there's, there's tides and currents that are currently are. That are trying to pull us in A particular way and sometimes we have to work hard to try and fight against those. And sometimes, you know, there can be a particular rocky patch that we go through and it can be like white water rafting through difficulties.
[00:14:49] Speaker B: Right.
[00:14:50] Speaker C: And then, then the likes of COVID along and that's just a pure tsunami coming at us. So in the case that we're on this continuum from ease to dis ease and sometimes we hit those harder points where it's kind of maybe chronic stress which isn't easy to get over, what then is the solutogenic model proposing as the best way to deal with those situations?
[00:15:19] Speaker B: Okay, so I'll take this, the tsunami example of COVID 19 which hit us.
The principles we talked about were actually derived from the components of the core concept of the solutogenic model, namely sense of coherence.
Because if I, if I take a step backward just to mention the sense of coherence.
[00:15:51] Speaker C: Yeah.
[00:15:52] Speaker B: The solute to genic question is how do people move towards health?
And sense of coherence is actually the answer to this question. It's, it's the, it comprises, you know, it's similar to, other concepts of, you know, self efficacy and hardiness and resilience. They are all under this solutionic umbrella. And the concept of sense of coherence is.
Well, it is not a trait you're born with. It is not a state you're in at a given on a given day.
It's an orientation towards life. It's perceiving life and the challenges that life poses as comprehensible. Meaning I can understand what's going on and I am able to predict what will come next and as manageable. Meaning I have, I perceive that I have the relevant resources to cope with whatever challenges I'm facing. And these can be physical fitness, this can be money in the bank, this can be social support. This can be anything that is relevant for coping and meaningful. We're viewing these challenges as meaningful as, as worthy of engagement. This is a motivational component. So this is what we talked with doctors and, and hospital personnel about.
They and their patients as much as.
As much as they can. They should stress the importance of knowledge about this disease, which in March or April of 2020 was not much, but trying to have as much knowledge and convey knowledge to the patients as well.
The importance of resources, coping resources such as social support from within for medical staff and from families around and sharing things. Well, this is going more into like therapeutic interventions, but the importance of sharing and feeling that they're not alone and.
[00:18:34] Speaker C: What'S your sense using that word again in terms of seeing people who have a high sense of coherence or a low sense of coherence, what are the contributory factors to that? And is it something that we, once we know conceptually about, that we can actually go on a journey to increase our sense of coherence?
[00:18:57] Speaker B: Well, if you would ask my father, he would say that the sense of coherence develops and stabilizes around age 30 once we are more or less have a stable life. We have, we completed our education, we have steady job and so on and beyond that.
Sense of coherence can change following very major life events, positive or negatives, but, but if not so it's sort of fluctuations, but it's more or less stable today. Today that is not as rigid. Today, several theorists and scientists believe that it can be changed, it can be strengthened. And what contributes to a strong sense of coherence over the life course and from childhood is a sense of stability providing the component of comprehensibility. Stability in childhood. I know what will happen if I do A or if I do B. I can predict what will happen tomorrow, next week, a year from now. I'm not talking about a four year old predicting what will happen a year from now, but a sense of, you know, if, even if the, my father or mother will come home from work and go to the playground. Yeah, that's, that's one thing. Now for, for comprehensibility, information is not, is not enough. The information has to make sense and reduce uncertainty. For example, if I switch to Hebrew now and I completed my answer, this would be giving you the same kind of information but in a mode which would be, you couldn't understand, you couldn't make sense out of it. Yeah, okay, so this is comprehensibility.
What can strengthen manageability is first of all, you know, the perception of I have, I have tools, I have resources to get along and this an example of this or I'll say before that.
My father spoke about an overload, underload balance, which can give you experiences of successful coping in which you do have to invest resources, but it's not overwhelming.
For example, my older grandchild asked me a while ago to help him with homework in mathematics.
And I said, well, what kind of help do you need? He said, I want you to do my homework for me.
And I said, well, I did or tried to do my own homework when I went to school and I helped your dad do his homework. I'm not going to do your homework for you.
And he insisted And I insisted, but I didn't say it's your homework, you do it. I suggested that we look at it together and try to understand what needs to be done and do one or two exercises together and once he understands he should do all the rest. Well, he tried to negotiate, but, but that's what happened. And, and he was, later on he was very proud of himself.
[00:22:42] Speaker C: Good.
[00:22:43] Speaker B: Now I, if, if I would have told him at the beginning, I don't want to have anything to do with it, it's your homework. He probably, it wouldn't get done and he would, he would experience a sense of failure. If I did it, if I did all of his homework for him, it would be a success, but it wouldn't be his. Yeah, that's assuming I wouldn't make mistakes, which is not a very, I'm not sure.
But this way he had this sense of succeeding. He got helped with what he got help from, from a relevant coping resource, which was his grandfather in this example.
So, so experiences of overload, underload, balance, which can contribute to what we call manageability or a sense of control over our resources. And finally, meaningfulness is the main thing, according to Aaron Antonovsky, is the experience of contributing to your society or contributing to your community, which can express your, your, your main values in life or, or bringing your values into reality, into implementing what you believe in.
[00:24:09] Speaker C: Yeah.
[00:24:10] Speaker B: So that gives a sense of, of meaningfulness. And this can be done in, in not, not half day workshops, but with more prolonged work, it can strengthen people's sense of coherence.
[00:24:24] Speaker C: It's fascinating because utilizing that model, it's working with leaders and trying to get them to understand that if you just leave an organization alone, that's a dangerous thing. Whereas if you actually intervene and support people at the right way. And so for example, with comprehensibility, as a leader of an organization, you have more information about the future and you can, by sharing that information with people, reduce the anxiety that they're facing because uncertainty obviously leads to anxiety. So that's one area you can, number two, you can get information back from the organization as to how are people doing, so that you can actually target resources to help people manage at the moments that they're struggling to cope. And that can make all the difference. And the final area then is that idea of actually sometimes life can be tough and we sometimes lose sense of why we're bothering to do stuff. And if a good leader could inspire people to the mission and the purpose as to why they're doing what they're doing. And I mean, you talk very eloquently about those people who were frontline medical workers during COVID who like, put their lives on, on the line to go and help other people. I mean, it's stunning. And I don't, I don't think we found a way to thank them enough for, for what they did. So I think that's been wonderful. I mean, I'm interested too, just the shift in terms of salutogenic rather than pathogenic, you know, the, the world of work. People are talking hugely about sort of people struggling from a mental health perspective. And, you know, at the start of our conversation, before we started to record, you were talking about the shift to talking about mental fitness. So to me, that's a, that's a really important shift in mentality away from something that can perspective be perceived as a weakness or a challenge to something saying, actually, hold on a second, I'm going to become much better at this area of my life. And I think it's something that really, we haven't been trained or educated to do. So could, could you talk a little bit about sort of developing a sense of mental fitness within people so that they can cope with the world we're living in today?
[00:26:44] Speaker B: Mental fitness, which is a. It's a broad term and it encompasses social and behavioral and mental and even physiological components.
I'll center on one of the important things we do, which is increase the feeling of social support and social cohesion. For example, if there's a workplace with hundreds of people in that workplace, one of the things we do is randomly assign two workers more or less at the same level in the organization, but randomly assign them to pairs and once a week during work hours so it wouldn't be at their own expense, have them sit with each other for 20 or 30 minutes and give them some leading questions about, you know, to talk to each other about the workplace, about the management, about. About the relations in the workplace. But very, very quickly it may shift to talking about Manchester United losing 1 nil to Byron Minton last night. Yeah, that's okay. Whatever, whatever they talk about, they get to know each other. They get the feeling that their problems are not their. They're not the only ones who have these problems of, of feeling this way or that way in the workplace and, and the feeling that other people share my problems in the workplace and may know sometimes personal problems from, from that at home.
This can, this can help a.
Create a feeling of cohesion, which could, by the way, a way to measure this is using. Using measurements of, of social networks or social. The strength of social networks. How many, how many ties does each one of the employees have with others within the organization and at what levels? And we found that this, this activity which goes on for 12 or 14 weeks, once a week, talking to another employee each. By the way, each week it's a, it's a different pair. I mean, we.
[00:29:25] Speaker C: Okay.
[00:29:25] Speaker B: Reassign them randomly each week. So it's not the same guy I talk to every week for 14 weeks.
[00:29:31] Speaker C: Yeah, okay.
[00:29:32] Speaker B: Each one. Each time it's someone else.
And we did some empirical measurements of social networks and self efficacy, general self efficacy or job self efficacy.
A sense of coherence.
Burnout. Burnout went down.
So we have data on the improvement in general well being.
[00:30:01] Speaker C: Okay.
[00:30:03] Speaker B: So this increases sense of coherence and increases other things as well.
[00:30:07] Speaker C: So it's like speed dating for the organization.
[00:30:12] Speaker B: Yeah, kind of speed dating. Exactly.
[00:30:16] Speaker C: But it's great. It makes an awful lot of sense because, you know, that is normally left up to random events for people to kind of get to know each other, whereas you're actually saying, you know something, this is a really important practice, so we should actually, at the expense of the company from a time perspective, we should sort of, you know, put some practice in place to make that happen. I love that. I think that's, that's really good. I mean, like, you know, thank you so much for explaining the salute of Genesis and giving us insight into your dad and the sense of coherence. I'm, I'm interested from a broad perspective. I mean, the, the concept. I think once you get to understand it, it's a different orientation and I think it can be really, really helpful.
And I know when I first came upon it it was random and I thought I was the last to find out about it, but I've actually realized that actually this is new news to a lot of people and then suddenly when they use it, it can be wonderful and life changing. So I'm just wondering about the development broadly of the concept of salutogenesis. And there's a couple of resources you were talking about that maybe you can talk a little bit about.
What will, what will success look like when, when do you know your work is done and you've arrived and your dad would be looking on and sort of saying, that's great, we've got there finally.
[00:31:48] Speaker B: Well, I think a short answer would be when more and more people think salutogenically because it is a paradigm shift. A longer. The answer would be, you know, we will never reach it, it's like the river of life. We're trying to swim towards the ease or health pole. But this, this pole is, you know, there's always a way to swim.
But I do think that I'll use a short example in a study done among police operation headquarters workers about what makes them, what helps them feel or increase their mental well being and their operational functioning.
And there were interviews and focus groups and people said there, the workers said, well, when we feel that we understand our missions better and when we feel that we have the help of resources like training and like our commanders giving us positive feedback, and when we understand why we're doing this, this helps us operate better and feel better.
And this was a study that I was not involved in, but I was asked to help someone sum up the findings and start to write an article which was not unpublished yet.
And he was telling me about these results. And I said, well, you're talking about, or what they were talking about was comprehensibility, manageability and meaningfulness. In other words, what the people were saying, when we have higher sense of coherence, we feel better. And he said, sense of what?
And I explained it. So when, when people stop saying, asking when I, when I give feedback and say, and say, well, what. Actually what you're talking about is sense of coherence. And they do not have to ask sense of what? Because they know the term. Yeah, that would be, that would be a success.
[00:34:09] Speaker C: So a website that people can go to then is. Yes, yes.
[00:34:15] Speaker B: First, I would like to mention the two books of Aaron Antonovsky, 1979. The first book called Health, Stress and coping, and the second book in 1987, Unraveling the Mystery of Health.
And then about five, six years ago already came out the first edition of the Handbook of Salutogenesis.
Second edition came out last year in 2022. Handbook of Salutogenesis, which has dozens of chapters by researchers all around the world about theoretical and empirical developments of salutogenesis in many fields, not only in the field of health, but work organizations and education and urban planning, you name it, and these can be downloaded freely. Aaron Antonovsky's books as well as the handbooks can be found or downloaded freely on the website of the Society for Theory and Research on Salutogenesis. The acronym is stars.
If you look that up, you can find it on the web. But I mean, the, the, the address is easy to remember. It's stars hyphen society.org yeah, and I.
[00:35:49] Speaker C: Have to say I. It's incredibly generous of you and your family to to actually make both of Aaron's books available. And the work that all of the group who were involved in the development of the Handbook of Salutogenesis, it's just a credit to each and every one of them.
And I know you guys have conferences and the like, and there's a center of salutogenesis in Zurich, and Dr. Bauer is part of that, who's interviewed in the Make Work Healthy book that we published. So, like, it is fantastic. And I think that whole concept of coherence was something that was new to me.
And, you know, I think every day I'm getting a better understanding of what that actually means in reality. And at the time I operate best as an individual is when I have a greater sense of coherence. So if that is the case, I've got to hopefully teach my children what this is all about so that they can actually accelerate their opportunity to get there. Because the reality is that life is tough. And for some people, it's a lot tougher than for others. So they're in a different part of the river.
But regardless of where you are, the ability to know how to swim is essential. And to me, the knowledge that you guys have provided and that your father inspired us all to do, we owe you a huge debt of gratitude. So thank you. Thank you so much.
[00:37:27] Speaker B: Thank you very much. I would just like to add one note of thanks to. Well, I'm not going to name all the peoples, but there are so many people who have led this or continued. Like, I think Bernie Toppin, the songwriter for Elton John and song Candle in the Wind. There's a line there.
His candle burned out long before his legend ever did. Yeah, that's it. His candle burned out long before his legend ever did. And there are so many people who have kept this legend alive. You mentioned Professor Georg Bauer, who is the head of the center of Slutogenesis in Zurich and who is specializes in workplaces, and he is the head of the Global Working Group on Saluto Genesis. And there's so many other people, and I'm not gonna name them because I don't want to forget anyone, but they can all be found in the Handbook of Salutogenesis. So thanks. Great thanks goes to all of them.
[00:38:31] Speaker C: Absolutely.
[00:38:32] Speaker B: I'm glad to have been here today.
[00:38:34] Speaker C: And to us at Healthy Place to Work, your dad was a legend and is a legend.
So thank you very much. And if there's anything that we can do in our work to. To help support everybody involved in salutogenesis and taking that to the world, just. Just ask the question and we'll be there.
We've kind of converted it slightly. We talk about stronger. So what we want to do is make both individuals and organizations stronger and that, that's the, the essence of that sense of coherence. So thank you, thank you again for your generosity in the intention interview today and continued success and stay safe and healthy.
[00:39:15] Speaker B: Thank you. Thank you very much, John.
[00:39:18] Speaker A: Happy birthday, Aaron Antonofsky. And thanks for bringing those two concepts into our lexicon and for shaping how we think about coping. Indeed, my thanks to Avishai and the team for bringing Salutogenesis to the world. And indeed, thank you for, for listening to the Work healthy podcast in 2023 we'll be kicking off 2024 with insights from Richard Ryan who developed the self determination theory with his colleague DC and we'll be learning about life at Dubai Police along with how mental health is delivered at Unilever.
Have a safe, happy and healthy Christmas from all a healthy place to work.
