The lessons of salutogenesis: How to stay well when life gets hard
For most of modern medicine, the central question has been what makes people sick? And answering that question well has produced enormous gains including antibiotics, vaccines, surgical interventions, and all aspects of public health. But it has left another question almost entirely outside the scope of medicine: what keeps people well? Especially when life is hard and the whole world seems to conspire to stress us out at every turn.
In the late 1970s, the medical sociologist Aaron Antonovsky began asking exactly that question. He called the approach salutogenesis — from the Latin salus (health) and the Greek genesis (origin). It was the study of where health comes from, rather than why we get sick.
This may sound like a small distinction, but it is not. Salutogenesis does not ignore the difficulties of life. Antonovsky developed this framework while studying women who had survived the Holocaust, not people in comfortable circumstances. He simply asked a different question. Given that loss, uncertainty, and difficulty are part of being human, what are the conditions inside a person that allow them to stay well anyway?
His answer was built over decades of research and culminated in a framework he called the Sense of Coherence. He identified three main qualities that allow a human being to weather stressful and difficult periods of life and not succumb to despair and disease.
We have walked through these one at a time over the past five weeks. As a reminder, these pillars are:
- Comprehensibility — the sense that what is happening can be understood. The world, even when difficult, has patterns we can read.
- Manageability — the sense that we have what we need to cope. Not that life is easy, but that we have enough resources to meet what comes.
- Meaningfulness — the sense that engagement is worth the effort. That our lives, our struggles, and our actions matter.
The pillars are not three separate things. Comprehensibility makes manageability possible: it is hard to cope with what we do not understand. Manageability makes meaningfulness sustainable: meaning collapses when we are constantly drowning. And meaningfulness gives the other two a reason to exist — without it, comprehensibility is just a mental exercise and manageability is just efficient coping. Antonovsky considered meaningfulness the most important of the three. But all three need each other and support the Sense of Coherence together.
All three pillars live in the body before they live anywhere else
The yoga tradition teaches us that to make big changes in the world, we can start with what is closest to us, which is our body. A careful embodied practice
- Gives the nervous system an opportunity to make sense of our movements and sensations and gain comfort from knowing what comes next (comprehensibility).
- Empowers us to take action through movement and other yogic techniques and allows us to observe the result of that action within the body after an hour or less (manageability).
- Touches the levels where vitality lives, the wells of meaning (chakras) that have always been available even when we forgot them (meaningfulness).
Our yoga practice does all three at once, in the same hour, without our having to manage which is which. This is part of what body-based traditions have always understood. Not that the body was the only place to work with, but that the body was the place of connection, where the work of staying well could happen in an integrated way. The body did not have to choose between making sense of things, having what it needs to cope, and finding meaning. It could do all three in the same breath.
And once we become comfortable and consistent in taking care of what’s close to us, the body, we can take that confidence and sense of coherence to other areas of our lives — first our immediate family and household, then our neighborhood, then our community, then the country, then the world. Making any kind of difference requires constantly cultivating the qualities of comprehensibility, manageability, and meaningfulness, and one of the best places to find them is your yoga mat.
References
- Aaron Antonovsky, Health, Stress and Coping (1979)
- Aaron Antonovsky, Unraveling the Mystery of Health (1987)
