Therapist´s Manifesto: Salutogenesis and Broader Perspectives

The motivations for this post are numerous, however there is a singularity in it´s relevance. It effectively summarizes what I have come to believe is a fundamental understanding within the domain of rehabilitation.  In truth, it is a much broader understanding that extends into medicine itself...and even into our daily lives, I dare say.

Although this central philosophy has always been understood intrinsically, I was never completely sure of what to make of it or how to verbalize it. 

There is a well-established, well-entrenched dichotomy between health and illness that essentially dilutes the potential reach and effectiveness of the healthcare provider.  Moreover, this dichotomy extends into the very mind of the healthSEEKER!  Health and illness (or health and disease, to be precise) are seen as two completely distinct states and therefore exist in their own reality.  This is an intuitive understanding...however, when you examine this from a broader perspective, they are manifestations of a singular state.  It is a continuum which is characterized, at one extreme, by perfect health and at the other extreme by disease. Therefore it can even be considered, not as a ¨health-disease¨ dichotomy, rather varying states of health.  This is likely to resonate to some as simple semantics, but the general philosophy was termed Salutogenesis by sociologist Aaron Antonovsky.  The term describes an approach focusing on factors that support human health and well-being, rather than on factors that cause disease.  The most popular and intuitive Pathogenetic approach is the most familiar...the focused efforts on disease-fighting.

Although this general central philosophy is not difficult to understand, it is a rarity within the healthcare system...in fact, it is sometimes viewed as ¨alternative¨.  But the unfortunate reality is that we have been conditioned to exist within the pathogenetic paradigm...where health needs to deteriorate to a preset level before it is ¨worthy¨ of being labelled as an illness and therefore worthy of intervention.  This is observed in respect to all of the so-called ¨health standards¨...blood pressure, weight, cholesterol levels, etc.  They are all considered ok until they reach a critical level...at which time they morph into a specific pathology and so begins a Pathogenetic intervention.

The Salutogenetic approach does not dismiss or conflict with the Pathogenetic one...it effectively BONDS with it and forms a much larger singularity.  Within this singularity, both exist as equally powerful and valid factors that work to contribute to systemic homeostasis.  Therefore, one does not need to ¨wait¨ for a specific pathology or condition to appear.  Whether in times of health or illness, a focus on salutory factors always contributes to the establishment and maintenance of a homeostatic state.

If I extend this general philosophy to a more specific narrative (CP, MS, Fibromyalgia, Autism, etc...), the overall understanding and framework hold up quite nicely.  With respect to the conditions listed above, the physical, environmental, chemical, and psychological stressors are amplified to various degrees compared to the healthy population.  The critical factor for consideration, when approached from the Salutogenetic perspective, is whether these stresses are received by the system as pathogenic, neutral, or salutory.  This is determined by what Antonovsky termed as Generalized Resistance Resources (GRR´s).  Therefore, the more GGR´s available to the system, the better chance the varying stressors will manifest as neutral or salutory.  In the CP, MS, FMS, etc...community, these GRR´s are characterized by respiratory mechanics, immune system function, lymphatic competence, interstitial fluid flow, and others.

Therefore we arrive to the overall message and intention of this post: The most fundamental, successful, and reliable therapeutic interventions are the Salutogenetic ones.  Even within specific, well-identified diseased states, the salutory stresses serve to develop and support progress and improvement.  Not only does it contribute to a homeostatic state, it effectively defines the ability to adapt to additional stressors by the building up of GRR´s.   The most glaring example of the salutogenetic approach is massage therapy...it is essentially effective for EVERYONE and EVERYTHING.  Why?...because it is a Salutogenetic stimulus (hypothalamic tuning results in automatic muscular relaxation, improving interstitial fluid flow increases fluid drainage and lymphatic performance, improved circulation contributes to better O2 delivery and metabolic performance, etc..)

In summary, the broader perspective does not suggest a continued ¨cleaving¨and ¨compartmentalization¨ for the sake of ease.  Although from a macro level (State, Provincial, Institutional) this may serve a greater good, the micro management (care-seeker to care-giver) should always consider the systemic singularity of the person and implement the appropriate balance of salutogenetic and pathogenetic strategies.