Keywords

Introduction

Two articles by Aaron Antonovsky published in German have stimulated salutogenesis in a widening circle of health professionals and health activists in Germany. One was published in the Swiss Journal Meducs in 1989 (Antonovsky, 1989) and the other appeared in the German Yearbook of Critical Medicine (Antonovsky, 1992). The salutogenesis approach is particularly resonant in the medical sub-disciplines of medical sociology and psychosomatic medicine for different reasons.

Medical sociologists and related health activists (the health movement in Germany) have been very much attracted by the salutogenic perspective in contrast to the dominant pathogenesis approach, as an innovative and promising concept of health and inspiration for new approaches in prevention and health promotion (in line with the Ottawa Charter for Health Promotion). The term salutogenesis itself, created by Antonovsky, gained a very attractive and metaphorical function in the debates about new perspectives, sometimes without a clear understanding of the concept as outlined by Antonovsky (1987).

Siegfried Geyer, a German medical sociologist and disciple of the Swiss medical sociologist Johannes Siegrist, formulated influential German ideas about the sense of coherence (Geyer, 1997). His main point was methodological—that it is not very clear if the sense of coherence scale measures what is claimed. Yet in German medical sociology, the attraction of the salutogenic concept of health has been mainly its paradigmatic potential vis-a-vis pathogenesis, and it has not been a significant stimulus to further sociological research.

An emphasis on research has been more evident in the fields of psychosomatic medicine, medical psychology and psychotherapy. Alexa Franke, Professor of Rehabilitation Psychology at the University of Dortmund, published an extended German version of Antonovsky’s book Unravelling the Mystery of Health (Antonovsky, 1997). In the German title, she used the term ‘demystification’ as equivalent for ‘unravelling’. Franke led several research projects for the further development of the salutogenic concept of health and developed a constitutive health promotion rehab-training programme called HEDE-Training® , a stress-management programme based on Antonovsky’s theoretical approach.

A recent online search (Thieme Connect, 21 Oct 2014) resulted in 21 articles published in the last 14 years which were more or less patient-oriented and/or related to coping mechanisms in the contexts of specific diseases, for example prevention and the concept of empirical healing (Erfahrungsheilkunde), and self-care and salutogenesis as a model for midwifery.

In the 1990s, The Federal Centre for Health Education commissioned a scientific analysis of the state of discussion and the relevance of the salutogenic model of health in Germany. The analysis was conducted by Jürgen Bengel, Regine Strittmatter and Hildegard Willmann from the Psychological Institute of the University of Freiburg, Department of Rehabilitation Psychology. The results have been published German (Bengel et al., 1998) and in English (Bengel et al., 1999). In their summary evaluation the authors conclude:

“Antonovsky does not stop at a scientific analysis of health, but goes on to formulate consequences for public health and the health sciences. His concept of the health ease/disease continuum animates the discussion on the concept of disease and health. He makes an appeal for interdisciplinary research on health and disease and reinforces behavioural as well as behaviourally-oriented prevention. He thus stimulates a discussion on the importance of health care and the societal value of health.

The construct of the SOC as a dimension of therapeutic and preventive measures has not been established and researched to a sufficient extent. From a scientific view, it is doubtful whether this construct can or will ever assert itself. The interest in the salutogenic model can be explained by the criticism of current research, the criticism of the pure pathological perspective, and the need for a theory of action, especially for health promotion and prevention.” (Bengel et al., 1999, p. 87)

In German-speaking countries , in addition to Alexa Franke’s German expanded edition of Antonovsky’s Unravelling the Mystery of Health (Salutogenese: Zur Entmystifizierung der Gesundheit), two other volumes were published on the subject in 1997:

  • H. Bartsch & J. Bengel (Eds.), Salutogenesis in Oncology (Salutogenese in der Onkologie)

  • F. Lamprecht & R. Johnen (Eds.) ‘Salutogenesis—a New Concept in Psychosomatics?’ (Salutogenese—Ein neues Konzept in der Psychosomatik?)

In 1998, two additional books followed:

  • W. Schüffel et al. (Eds.) Handbook of Salutogenesis. Concepts and Application (Handbuch der Salutogenese. Konzept und Praxis).

  • J. Margraf, J. Siegrist & S. Neumer (Eds.), Health or Disease Theory? (Gesundheits- oder Krankheitstheorie?).

In the year 2000, a book about the principles, empirical evidence and practice of salutogenesis as a scientific health concept was published (Wydler et al., 2000).

On Wikipedia in the link ‘salutogenese’ (last accessed 30 Oct 2014), five groups in Germany are listed that are engaged with and focused on different aspect of the salutogenic concept of health:

  • The group around Wolfram Schüffel (Professor emeritus and head of the University Hospital of Psychosomatic in Marburg). He initiated 1995 the annual Wartburggespräche that resulted in (among other achievements) the Handbuch der Salutogenese (Schüffel, 1998). Their particular foci are the connecting links between Balint work (physicians reflecting on their wok and relations with their patients), philosophy and psychoanalysis.

  • In the anthropological medicine and pedagogy, there is a group around Michaela Glöckler (Goetheanum, Dornach, Switzerland) and Peter Matthiessen, co-founder of the private University Witten/Herdecke. They try to connect the salutogenic orientation with the anthropological medicine and Waldorf (Rudolf Steiner’s humanistic) education.

  • Together, the umbrella association Dachverband Salutogenese (formerly the Academy for Patient-Centred Medicine) and Ottomar Bahrs (Medicine, Psychology and Sociology at the University of Göttingen; Society of Medical Communication) develop research concepts to explore the salutogenic orientation in general medical practice. The board of the Dachverband Salutogenese e.V. (Theodor Dierk Petzold and Ottmar Bahrs) edit the first Journal of Salutogenese Der Mensch.

  • The Zentrum für Salutogenese has organised the annual Symposium of Salutogenesis since 2005. Coordinated by Theodor Dierk Petzold (general practitioner and lecturer in general medicine at the Medical School in Hannover), the symposium aims to advance salutogenic theory and practice (Salutogene Kommunikation SalKom). This has up to now resulted in four thematic edited volumes.

  • The Health Academy (GesundheitsAkademie) in Bielefeld around Eberhard Göpel (Professor emeritus and Chairman of Hochschulen für Gesundheit e.V.), Alexa Franke (University Dortmund) and Günther Hölling (Patient-Information Centre) have been particularly interested in salutogenic concepts for health promotion, and some summer academies have been organised at the University of Applied Sciences in Magdeburg.

In summary, the salutogenic concept of health have been mainly adopted and adapted in Germany as a disease-oriented medical sector model, shifting from the risk orientation towards a patient/client-centred model that is more focused on health resources and the health potentials of people. Additionally, there have been some efforts, particularly initiated by medical sociologists and health activists, to apply the concept of salutogenesis to health promotion, quality of life and the assets model of health.