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Maurice B. Mittelmark · Georg F. Bauer
Lenneke Vaandrager · Jürgen M. Pelikan
Shifra Sagy · Monica Eriksson
Bengt Lindström · Claudia Meier Magistretti

The Handbook
of Salutogenesis
Second Edition
The Handbook of Salutogenesis
 A publication of the Global Working Group on Salutogenesis
of the International Union for Health Promotion and Education,
the Society for Theory and Research on Salutogenesis, and
the Center of Salutogenesis, University of Zürich
Maurice B. Mittelmark
Georg F. Bauer • Lenneke Vaandrager
Jürgen M. Pelikan • Shifra Sagy
Monica Eriksson • Bengt Lindström
Claudia Meier Magistretti
Editors

The Handbook
of Salutogenesis
Second Edition

Foreword by Margaret M. Barry

Editors
Maurice B. Mittelmark Georg F. Bauer
Department of Health Promotion Center of Salutogenesis
and Development Division of Public and Organizational Health
Faculty of Psychology Epidemiology, Biostatistics and Prevention
University of Bergen Institute
Bergen University of Zürich
Norway Zürich
Switzerland
Lenneke Vaandrager
Department of Social Sciences, Health Jürgen M. Pelikan
and Society University of Vienna, and
Wageningen University and Research WHO-Collaborating Centre for Health Promotion
Wageningen in Hospitals and Healthcare
The Netherlands Austrian National Public Health Institute
(Gesundheit Österreich GmbH)
Shifra Sagy Vienna
Martin Springer Center for Conflict Studies Austria
Ben-Gurion University of the Negev
Be’er Sheva Monica Eriksson
Israel Department of Health Sciences
University West
Bengt Lindström Trollhättan
NTNU Center for Health Promotion Research Sweden
Norwegian University of Science and Technology
Trondheim Claudia Meier Magistretti
Norway Centre for Health Promotion and Participation,
Lucerne University of Applied Sciences and Arts
Lucerne
Switzerland

ISBN 978-3-030-79514-6    ISBN 978-3-030-79515-3 (eBook)

https://doi.org/10.1007/978-3-030-79515-3

© The Editor(s) (if applicable) and The Author(s); first edition published by Springer International Publishing, 2017, 2022
This book is an open access publication.
Open Access This book is licensed under the terms of the Creative Commons Attribution 4.0 International License
(http://creativecommons.org/licenses/by/4.0/), which permits use, sharing, adaptation, distribution and reproduction
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The registered company address is: Gewerbestrasse 11, 6330 Cham, Switzerland
Foreword

The Handbook of Salutogenesis is the second edition of a publication produced by the Global
Working Group on Salutogenesis of the International Union for Health Promotion and
Education (IUHPE) in collaboration with the Society for Theory and Research on Salutogenesis
and the Center of Salutogenesis at the University of Zürich.
This comprehensive handbook provides a definitive guide to salutogenesis from its origins
to the present day, addressing its core concepts, theory and methods and outlining its applica-
tion to health promotion and related areas of study and practice.
Health promotion is rooted in a salutogenic view of health as it is concerned with enabling
individuals and populations to increase control over and improve their health and wellbeing.
Health promotion moves the focus from individuals at risk of developing illness to systems and
environments that shape the development of good health at a population level.
In public discourse, however, health is primarily understood as relating to illness and health
services are predominantly illness services concerned with treating and caring for ill-health.
Health promotion as a concept and multidisciplinary area of practice is, therefore, often poorly
understood, which can lead to a narrow interpretation of its core purpose and of its implemen-
tation in policy and practice. An understanding of the nature of positive health, how it is cre-
ated and can be sustained at a population level, is critically important to provide a sound
theoretical base for health promotion and its implementation in practice.
The concept of salutogenesis, as articulated by Aaron Antonovsky, brings a scholarly focus
to studying the origins of health, instead of the origins of disease. Salutogenesis provides a
guiding theory for the field of health promotion as it is concerned with positive health, creating
coherent living environments, strengthening socio-ecological health resources, and strengthen-
ing the sense of coherence of individuals and groups. Antonovsky’s work on salutogenesis has
had a significant and lasting impact on health promotion globally, providing a model for
research on population health and well-being. As a theoretical framework for understanding
positive health, the salutogenic model focuses on positive well-being rather than illness and the
‘salutary’ factors that determine health rather than the pathogenic factors. The model’s core
construct of sense of coherence is vital to understanding positive mental health and well-being
as it involves the capacity to comprehend and make sense of one’s own experiences and the
ability to manage and respond flexibly to the inevitability of life stressors.
Developing the salutogenic orientation as a paradigm for health promotion research and
practise has been an important focus for IUHPE. IUHPE is an independent professional asso-
ciation of individuals and organisations whose mission is to promote global health and well-­
being and to contribute to the achievement of equity in health between and within countries of
the world. This mission is translated into practise by developing key scientific and professional
activities through a global network of members who are specialised in and committed to health
promotion. Within IUHPE, global working groups are established to provide a platform for
advancing the scientific and professional development of health promotion. The IUHPE Global
Working Group on Salutogenesis was established in 2007 with the specific aim of advancing
and promoting the science of salutogenesis within health promotion. This Global Working
Group has successfully brought together interdisciplinary members from different world
regions to advance and further develop the study of different aspects of salutogenesis. The col-

v
vi Foreword

lective efforts of the group, through conferences and publications such as this handbook, con-
tribute to the scientific base of health promotion and to the core mission of the IUHPE, further
details of which can be found at https://www.iuhpe.org/
As President of IUHPE, I welcome this second edition and applaud the efforts of the Global
Working Group on Salutogenesis in producing such a comprehensive compendium of schol-
arly work. This second edition follows on from a very successful first edition, which is listed
as the fourth most accessed book in the Springer catalogue of open access books.
I congratulate the editors and authors on this landmark publication. It makes a significant
contribution to the field of salutogenic studies and to explaining the contribution of the saluto-
genic approach to health promotion and related areas. This handbook will be a valuable
resource for all academic scholars and practitioners interested in understanding the origins of
health and advancing the field of health promotion.

Margaret M. Barry
President, International Union for Health Promotion and Education
Galway, Ireland
Preface

On behalf of the editor team, greetings! We are salutogenesis friends working in health promo-
tion, who banded together to accomplish what none of us alone could manage. Writing this
handbook has brought the editors and the chapter authors closer together, discussing and
debating every detail related to this complex project, with its 57 chapters and 88 authors.
Together, we have mustered the resources to manage the task. We have helped one another to
understand salutogenesis better, and the work has been personally, socially, and professionally
meaningful. We have become more adept academicians, and we have had fun.
With the recent establishment of the Society for Theory and Research in Salutogenesis
(STARS), we wish to expand our collaboration to other fields that are incorporating salutogen-
esis in their work, such as education, art therapy, peace studies, sustainability sciences, organi-
zational development and leadership, medicine, and architecture. The Center of Salutogenesis
at the University of Zürich in Switzerland, headed by coeditor Georg Bauer, plays the coordi-
nating and administrative role for STARS. The Center also managed to raise the open-access
fee for this handbook. For that, we are truly grateful!
Readers might wonder why a new edition of the Handbook has come so quickly following
the 2017 book. In fact, the planning and writing of this second edition commenced immedi-
ately after the publication of the first edition in 2017. Even as the first edition was hot off the
press, we were aware that theory and research in the field of salutogenesis were rapidly expand-
ing and needed renewed attention in this second edition. In the period up to and including
2016, a search revealed 7650 titles in the literature dealing with salutogenesis. In the few years
since, 3420 new titles have been published, almost a fifty percent increase in the literature on
salutogenesis.
This book was written in 2019 and 2020, with the bulk of the work being done under the
trying circumstances of the Coronavirus. Coping with the pandemic has distracted some atten-
tion away from tasks like book writing. Nevertheless, the book’s authors steadfastly held to our
plan to finish the writing in 2020, and for that, we editors are very grateful. As well, several
chapters address salutogenesis in the context of Coronavirus. Also, many of the book’s authors
have turned attention to salutogenesis research connected to the pandemic. Some of that
research has already come to publication (see Mana and Sagy, 2020).
As this book attests, salutogenesis scholarship is thriving in several disciplinary and trans-
disciplinary fields. This development would induce a broad smile and a high degree of satisfac-
tion to the field’s founding theoretician, Aaron Antonovsky (1923–1994).
In closing, I am honored to name and thank one other salutogenesis “founder”: Professor
Bengt Lindström. Bengt stepped immediately into the breach after Antonovsky’s untimely
passing. He has created and used every avenue and every opportunity – journals, books, con-
ferences, seminars, masters, and PhD training programs – to promote scholarship on saluto-
genesis. There is no doubt: without Bengt’s intellectual leadership and tireless enthusiasm,
salutogenesis would have advanced at a much more moderate pace. There are two “Professors
of Salutogenesis”: Aaron Antonovsky and Bengt Lindström.

vii
viii Preface

Aaron Antonovsky (1923–1994) (Published with permission of © Avishai Antonovsky. All

Rights Reserved).

Bengt Lindström.

Reference

Mana, A., & Sagy, S. (2020). Brief report: Can political orientation explain mental health in
the time of a global pandemic? Voting patterns, personal and national coping resources, and
mental health during the Coronavirus crisis, Journal of Social and Clinical Psychology,
39(3), 187–193. https://doi.org/10.1521/jscp.2020.39.3.165

Bergen, Norway Maurice B. Mittelmark

Acknowledgments

On behalf of readers worldwide, the editors acknowledge with gratitude the open-access finan-
cial support provided by the Center of Salutogenesis at the University of Zürich. In many parts
of the world, scholars do not have the financial resources to buy books, and academic libraries
everywhere are experiencing cutbacks in budgets for the purchase of books. Experience with
the 2017 edition of the handbook shows open access has a dramatic and positive impact on
global dissemination. In a world with mounting challenges to the dissemination of knowledge,
the advance of the open-access model is inspiring.
The 2017 Handbook of Salutogenesis and this 2nd Edition spring forth from the International
Union for Health Promotion and Education’s (IUHPE) Global Working Group on Salutogenesis
(established in 2007), of which all the editors are members. We are grateful to the leadership
of the IUHPE for providing a welcoming home for the worldwide community of salutogenesis
scholars working in health promotion and education.
We are deeply grateful for the contributions of the team at Springer, who helped us com-
plete the book during difficult times. In New York, Janet Kim has been a patient and vital col-
laborator at every step of producing the manuscript. In Tokyo, Misao Taguchi has been of great
editorial assistance during the final stages of writing. Our Production Editor in Chennai has
been Anila Vijayan, who skillfully managed the magical metamorphosis from the typewritten
to the printed page.

ix
Contents

Part I Salutogenesis from Its Origins to the Present

1 Salutogenesis From Its Origins to the Present���������������������������������������������������������   3

Maurice B. Mittelmark
2 Mileposts in the Development of Salutogenesis�������������������������������������������������������   5
Bengt Lindström
3 Salutogenesis as a Theory, as an Orientation and as the
Sense of Coherence����������������������������������������������������������������������������������������������������� 11
Maurice B. Mittelmark and Georg F. Bauer
4 Aaron Antonovsky (1923–1994): The Personal, Ideological,
and Intellectual Genesis of Salutogenesis����������������������������������������������������������������� 19
Avishai Antonovsky and Shifra Sagy
5 Aaron Antonovsky’s Development of Salutogenesis, 1979–1994 ��������������������������� 29
Hege Forbech Vinje, Eva Langeland, and Torill Bull
6 Salutogenesis Meeting Places: The Global Working
Group, the Center, and the Society on Salutogenesis ��������������������������������������������� 47
Georg F. Bauer
7 Salutogenesis Post-Graduate Education: Experience From the
European Perspective on the ETC-PHHP Health Promotion
Summer Schools (1991–2020) ����������������������������������������������������������������������������������� 51
Lenneke Vaandrager, Anna Bonmatí-Tomàs, Arnd Hofmeister,
Carlos Alvarez-­Dardet, Paolo Contu, Maria Koelen, Gaby Ortiz-Barreda,
Giuseppe Masanotti, Gwendolijn Boonekamp, Lynne Kennedy,
Giancarlo Pocetta, Dolors Juvinya Canal, Patrizia Garista,
Bengt Lindström, and Magdalena Wrzesińska

Part II Key Concepts in the Salutogenic Model of Health

8 Key Concepts in the Salutogenic Model of Health��������������������������������������������������� 59

Monica Eriksson
9 The Sense of Coherence: The Concept and Its Relationship to Health����������������� 61
Monica Eriksson
10 Stressor Appraisal on a Pathway to Health: The Role of the
Sense of Coherence����������������������������������������������������������������������������������������������������� 69
Maurice B. Mittelmark
11 The Sense of Coherence: Measurement Issues��������������������������������������������������������� 79
Monica Eriksson and Paolo Contu

xi
xii Contents

12 Generalized Resistance Resources in the Salutogenic Model of Health ��������������� 93

Orly Idan, Monica Eriksson, and Michal Al-Yagon
13 Specific Resistance Resources in the Salutogenic Model of Health����������������������� 107
Maurice B. Mittelmark, Marguerite Daniel, and Helga B. Urke

Part III The Sense of Coherence in the Life Course

14 The Sense of Coherence in the Life Course ������������������������������������������������������������� 117

Claudia Meier Magistretti
15 Salutogenesis: Sense of Coherence in Childhood and Families ����������������������������� 123
Orly Idan, Orna Braun-Lewensohn, Bengt Lindström, and Malka Margalit
16 Salutogenesis and the Sense of Coherence During the Adolescent Years�������������� 139
Orna Braun-Lewensohn, Orly Idan, Bengt Lindström, and Malka Margalit
17 Salutogenesis and the Sense of Coherence in Young Adults
Not in Education, Employment, or Training (NEET)��������������������������������������������� 151
Claudia Meier Magistretti and Beat Reichlin
18 Salutogenesis and the Sense of Coherence in Middle Adulthood��������������������������� 167
Ottomar Bahrs, Felix Deymann, and Karl-Heinz Henze
19 Older People, Sense of Coherence and Community ����������������������������������������������� 185
Maria Koelen and Monica Eriksson
20 Effectiveness of Interventions to Enhance the Sense of
Coherence in the Life Course������������������������������������������������������������������������������������� 201
Eva Langeland, Lenneke Vaandrager, Anne Britt Vika Nilsen,
Marco Schraner, and Claudia Meier Magistretti

Part IV Salutogenesis Beyond Health

21 Salutogenesis beyond Health������������������������������������������������������������������������������������� 223

Shifra Sagy
22 Salutogenesis Beyond Health: Intergroup Relations and Conflict Studies����������� 225
Shifra Sagy and Adi Mana
23 Positive Psychology and Its Relation to Salutogenesis��������������������������������������������� 233
Stephen Joseph and Shifra Sagy
24 The Application of Salutogenesis in Politics and Public Policy-Making��������������� 239
Ruca Maass, Charlotte Kiland, Geir Arild Espnes, and Monica Lillefjell
25 The Application of Salutogenesis for Social Support and
Participation: Toward Fostering Active and Engaged Aging at Home ����������������� 249
Mélanie Levasseur and Daniel Naud
26 Salutogenic Architecture ������������������������������������������������������������������������������������������� 259
Jan A. Golembiewski

Part V Salutogenesis in Health Promoting Settings: Organisations,

Communities and Environments

27 Salutogenesis in Health Promoting Settings: A Synthesis Across

Organizations, Communities, and Environments ��������������������������������������������������� 277
Georg F. Bauer
Contents xiii

28 Applying Salutogenesis in Organisations����������������������������������������������������������������� 283

Georg F. Bauer and Gregor J. Jenny
29 Applying Salutogenesis in Schools����������������������������������������������������������������������������� 295
Bjarne Bruun Jensen, Wolfgang Dür, and Goof Buijs
30 Applying Salutogenesis in Higher Education����������������������������������������������������������� 307
Mark Dooris, Sharon Doherty, and Judy Orme
31 Applying Salutogenesis in the Workplace����������������������������������������������������������������� 321
Gregor J. Jenny, Georg F. Bauer, Hege Forbech Vinje, Rebecca Brauchli,
Katharina Vogt, and Steffen Torp
32 Salutogenesis and Mental Health Promotion in Military Settings������������������������� 337
Avishai Antonovsky
33 The Application of Salutogenesis in Communities and Neighborhoods ��������������� 349
Lenneke Vaandrager and Lynne Kennedy
34 Applying Salutogenesis in Towns and Cities������������������������������������������������������������� 361
Ruca Maass, Monica Lillefjell, and Geir Arild Espnes
35 The Restorative Environment and Salutogenesis:
Complementary Concepts Revisited������������������������������������������������������������������������� 371
Eike von Lindern, Freddie Lymeus, and Terry Hartig

Part VI Applying Salutogenesis in Healthcare Settings

36 Applying Salutogenesis in Healthcare Settings ������������������������������������������������������� 389

Jürgen M. Pelikan
37 The Application of Salutogenesis in Hospitals��������������������������������������������������������� 397
Christina Dietscher, Ulrike Winter, and Jürgen M. Pelikan
38 The Application of Salutogenesis in Primary Care������������������������������������������������� 419
Daniela Rojatz, Peter Nowak, Ottomar Bahrs, and Jürgen M. Pelikan
39 Applying Salutogenesis in Mental Healthcare Settings������������������������������������������� 433
Eva Langeland and Hege Forbech Vinje
40 Applying Salutogenesis in Vocational Rehabilitation Settings������������������������������� 441
Monica Lillefjell, Ruca Maass, and Camilla Ihlebæk
41 Applying Salutogenesis in Residential Care Settings����������������������������������������������� 447
Viktoria Quehenberger and Karl Krajic
42 Applying Salutogenesis in Midwifery Practice��������������������������������������������������������� 459
Sally Muggleton and Deborah Davis
43 The Application of Salutogenesis in Birth, Neonatal, and
Infant Care Settings ��������������������������������������������������������������������������������������������������� 465
Soo Downe, Claudia Meier Magistretti, Shefaly Shorey, and Bengt Lindström
44 Applying Salutogenesis in Community-­Wide Mental Health Promotion������������� 479
Vibeke Koushede and Robert Donovan

Part VII Salutogenesis in Challenging Social Circumstances and Environments

45 Salutogenesis in Challenging Social Circumstances and Environments��������������� 493

Bengt Lindström
xiv Contents

46 The Salutogenic Approach to Childcare in Sub-Saharan Africa:

A Focus on Children Who Thrive in the Face of Adversity������������������������������������ 495
Pauline Bakibinga and Dennis J. Matanda
47 Salutogenesis and Migration������������������������������������������������������������������������������������� 503
Marguerite Daniel and Fungisai Puleng Gwanzura Ottemöller
48 Salutogenic Approaches to Dementia Care��������������������������������������������������������������� 513
Jan A. Golembiewski and John Zeisel
49 Salutogenesis as a Framework for Social Recovery After Disaster����������������������� 533
Mélissa Généreux, Mathieu Roy, Tracey O’Sullivan, and Danielle Maltais
50 Salutogenesis and the Mental Health of First Responders������������������������������������� 543
Avishai Antonovsky
51 Salutogenesis in Prison����������������������������������������������������������������������������������������������� 553
James Woodall, Nick de Viggiani, and Jane South

Part VIII Salutogenesis Theory and Methods: Developments,

Innovations and Next Steps

52 Salutogenesis Theory and Methods: Developments, Innovations and

Next Steps ������������������������������������������������������������������������������������������������������������������� 565
Lenneke Vaandrager
53 Theoretical Issues in the Further Development of the Sense of Coherence
Construct��������������������������������������������������������������������������������������������������������������������� 569
Jacek Hochwälder
54 Qualitative Approaches to the Study of the Sense of Coherence ��������������������������� 581
Avishai Antonovsky, Gillie Pragai Olswang, and Lenneke Vaandrager
55 Promoting Salutogenic Capacity in Health Professionals��������������������������������������� 611
Eva Langeland, Liv Hanson Ausland, Hrafnhildur Gunnarsdottir,
Susanna H. Arveklev, and Hege Forbech Vinje
56 The Digital Lifeworld and Salutogenesis ����������������������������������������������������������������� 625
Luis Saboga-Nunes, Uwe H. Bittlingmayer, and Pauline Bakibinga
57 Salutogenesis for Thriving Societies ������������������������������������������������������������������������� 635
Maurice B. Mittelmark, Monica Eriksson, Shifra Sagy, Jürgen M. Pelikan,
Lenneke Vaandrager, Claudia Meier Magistretti, Bengt Lindström,
and Georg F. Bauer
Index������������������������������������������������������������������������������������������������������������������������������������� 639
Editors and Contributors

Editors

Maurice B. Mittelmark Department of Health Promotion and Development, Faculty of

Psychology, University of Bergen, Bergen, Norway, maurice.mittelmark@uib.no
Georg F. Bauer Center of Salutogenesis, Division of Public and Organizational Health,
Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland,
georg.bauer@uzh.ch
Lenneke Vaandrager Department of Social Sciences, Health and Society, Wageningen
University and Research, Wageningen, The Netherlands, lenneke.vaandrager@wur.nl
Jürgen M. Pelikan University of Vienna, Vienna, Austria
WHO-Collaborating Centre for Health Promotion in Hospitals and Healthcare at the Austrian
National Public Health Institute (Gesundheit Österreich GmbH), Vienna, Austria
Institute for Sociology, University of Vienna, Vienna, Austria, juergen.pelikan@goeg.at
Shifra Sagy Martin Springer Center for Conflict Studies, Ben-Gurion University of the
Negev, Be’er Sheva, Israel, shifra@bgu.ac.il
Monica Eriksson Department of Health Sciences, Section of Health Promotion and Care
Sciences, Center on Salutogenesis, University West, Trollhättan, Sweden
Department of Health Sciences, University West, Trollhättan, Sweden, monica.eriksson@hv.se
Bengt Lindström NTNU Center for Health Promotion Research, Norwegian University of
Science and Technology, Trondheim, Norway, bengtblind@hotmail.com
Claudia Meier Magistretti Centre for Health Promotion and Participation, Lucerne University
of Applied Sciences and Arts, Lucerne, Switzerland, claudia.meiermagistretti@hslu.ch

Contributors

Carlos Alvarez-Dardet The Public Health Research Group, University of Alicante, Alicante,
Spain, Carlos.alvarez@ua.es
Michal Al-Yagon Department of School Counseling and Special Education, Constantiner
School of Education, Tel Aviv University, Tel Aviv, Israel, alyagon@tauex.tau.ac.il
Avishai Antonovsky Department of Health and Well-being, Medical Corps, Israel Defense
Forces, Ramat-Gan, Israel, antonovsky.soc@gmail.com
Susanna H. Arveklev Center for Salutogenesis, Department of Health Sciences, University
West, Trollhättan, Sweden, susanna.arveklev-hoglund@hv.se

xv
xvi Editors and Contributors

Liv Hanson Ausland Department of Health Promotion, Faculty of Health Sciences, University
of South-Eastern Norway, Vestfold, Norway, Liv.H.Ausland@usn.no
Ottomar Bahrs University of Düsseldorf, Düsseldorf, Germany
Umbrella Organization Salutogenesis, Göttingen, Germany, obahrs@gwdg.de
Pauline Bakibinga African Population and Health Research Center, Nairobi, Kenya,
pbakibinga@aphrc.org
Margaret M. Barry Discipline of Health Promotion, School of Health Sciences, and Head,
WHO Collaborating Centre for Health Promotion Research, National University of Ireland
(NUI) Galway, Galway, Ireland, margaret.barry@nuigalway.ie
Uwe H. Bittlingmayer Institute of Sociology, University of Education Freiburg, Breisgau,
Germany, uwe.bittlingmayer@ph-freiburg.de
Anna Bonmatí-Tomàs University of Girona, Faculty of Nursing, Girona, Spain,
anna.bonmati@udg.edu
Gwendolijn Boonekamp HAN University of Applied Sciences, School of Sport and Exercise,
Nijmegen, The Netherlands, gwendolijn.boonekamp@han.nl
Rebecca Brauchli Center of Salutogenesis, Division of Public and Organizational Health,
Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland,
rebecca.brauchli@uzh.ch
Orna Braun-Lewensohn Conflict Management and Resolution Program, Ben-Gurion
University of the Negev, Beer Sheva, Israel, ornabl@bgu.ac.il
Goof Buijs UNESCO Chair Global Health & Education, Paris, France, goof.buijs@unesco-
chair-ghe.org
Torill Bull Department of Health Promotion and Development, Faculty of Psychology,
University of Bergen, Bergen, Norway, torillsicloud@icloud.com
Dolors Juvinya Canal Nursing Department, Faculty of Nursing, University of Girona,
Girona, Spain, dolors.juvinya@udg.edu
Paolo Contu Department of Medical Sciences and Public Health, University of Cagliari,
Cittadella Universitaria, Monserrato-Cagliari, Italy, pcontu@unica.it
Marguerite Daniel Department of Health Promotion and Development, Faculty of
Psychology, University of Bergen, Bergen, Norway, marguerite.daniel@uib.no
Deborah Davis Faculty of Health, University of Canberra, Canberra, ACT, Australia
ACT Health, Canberra, ACT, Australia, Deborah.Davis@canberra.edu.au
Felix Deymann University of Göttingen, Göttingen, Germany, fdeymann@posteo.net
Nick de Viggiani Department of Health and Social Sciences, University of the West of
England, Bristol, UK, nick.deviggiani@uwe.ac.uk
Christina Dietscher Department of Non-Communicable Diseases, Mental Health and
Geriatric Medicine, Austrian Ministry of Health, Vienna, Austria,
christina.dietscher@gesundheitsministerium.gv.at
Sharon Doherty Preston, UK
Robert Donovan School of Human Sciences, University of Western Australia, Nedlands,
WA, Australia, robert.donovan@uwa.edu.au
Mark Dooris Healthy & Sustainable Settings Unit, School of Community Health &
Midwifery, Faculty of Health & Care, University of Central Lancashire, Preston, UK,
mtdooris@uclan.ac.uk
Editors and Contributors xvii

Soo Downe Research in Childbirth and Health (ReaCH) group, THRIVE Centre, University
of Central Lancaster, Preston, UK, sdowne@uclan.ac.uk
Wolfgang Dür Medical University of Vienna, Danube Private University and IMC University
of Applied Sciences Krems, Vienna, Austria, wolfgang.duer@univie.ac.at
Geir Arild Espnes Center for Health Promotion Research, Department of Public Health and
Nursing, Faculty of Medicine and Health Sciences, Norwegian University of Science and
Technology, Trondheim, Norway, geirae@ntnu.no
Patrizia Garista National Institute of Documentation, Innovation and Educational Research,
University of Perugia, Perugia, Italy, p.garista@indire.it
Mélissa Généreux CIUSSS de l’Estrie-CHUS; Faculté de médecine et des sciences de la
santé, University of Sherbrooke, Sherbrooke, QC, Canada, Genereux@usherbrooke.ca
Jan A. Golembiewski Psychological Design, Sydney, Australia
Interior Architecture and Environmental Design, Bilkent University, Ankara, Turkey,
jg@psychological.design
Hrafnhildur Gunnarsdottir Center for Salutogenesis, Department of Health Sciences,
University West, Trollhättan, Sweden, Hildur.gunnarsdottir@hv.se
Terry Hartig Institute for Housing and Urban Research and Department of Psychology,
Uppsala University, Uppsala, Sweden, terry.hartig@ibf.uu.se
Karl-Heinz Henze Lou Andreas-Salomé Institut for Psychoanalysis and Psychotherapy,
Göttingen, Germany, khenze@gwdg.de
Jacek Hochwälder Department of Psychology, Mälardalen University, Eskilstuna, Sweden,
jacek.hochwalder@mdh.se
Arnd Hofmeister Nexus Institute, Berlin, Germany, arnd-hofmeister@gmx.de
Orly Idan School of Psychology, Interdisciplinary Center (IDC), Herzliya, Israel,
oidan@idc.ac.il
Camilla Ihlebæk Department of Public Health Sciences, Norwegian University of Life
Sciences, Ås, Norway, camilla.ihlebak@nmbu.no
Gregor J. Jenny Center of Salutogenesis, Division of Public and Organizational Health,
Epidemiology, Biostatistics and Prevention Institute, University of Zürich, Zürich, Switzerland,
gregor.jenny@uzh.ch
Bjarne Bruun Jensen Health Promotion Research, Steno Diabetes Center Copenhagen,
Gentofte, Denmark, bjarne.bruun.jensen@regionh.dk
Stephen Joseph School of Education, University of Nottingham, Nottingham, UK,
stephen.joseph@nottingham.ac.uk
Lynne Kennedy College of Natural and Health Science, Zayed University, United Arab
Emirates, and University of Chester, Chester, UK, Lynne.Kennedy@zu.ac.ae
Charlotte Kiland Department of Political Science and Management, Faculty of Social
Sciences, University in Agder, Kristiansand, Norway, charlotte.kiland@uia.no
Maria Koelen Department of Social Sciences, Health and Society Group, Wageningen
University, Wageningen, The Netherlands, koelen@caiway.nl
Vibeke Koushede Department of Psychology, University of Copenhagen, Copenhagen,
Denmark, vjk@psy.ku.dk
xviii Editors and Contributors

Karl Krajic Department for Sociology, University of Vienna, Vienna, Austria

Working Life Research Centre, FORBA Forschungs- und Beratungsstelle Arbeitswelt, Vienna,
Austria, karl.krajic@univie.ac.at
Eva Langeland Department of Health and Caring Sciences, Faculty of Health and Social
Sciences, Western Norway University of Applied Sciences, Bergen, Norway,
eva.langeland@hvl.no
Mélanie Levasseur School of Rehabilitation, Université de Sherbrooke, Sherbrooke, Québec,
Canada, melanie.levasseur@usherbrooke.ca
Monica Lillefjell Department of Neuromedicine and Movement Science, Faculty of Medicine
and Health Science, Norwegian University of Science and Technology (NTNU), Trondheim,
Norway, monica.lillefjell@ntnu.no
Freddie Lymeus Institute for Housing and Urban Research and Department of Psychology,
Uppsala University, Uppsala, Sweden, freddie.lymeus@psyk.uu.se
Ruca Maass Department of Neuromedicine and Movement Science, Faculty of Medicine and
Health Science, Norwegian University of Science and Technology (NTNU), Trondheim,
Norway, ruca.e.maass@ntnu.no
Danielle Maltais Département des sciences humaines et sociales, Université du Québec à
Chicoutimi, Québec, QC, Canada, danielle_maltais@uqac.ca
Adi Mana School of Behavioral Science, Peres Academic Center, Rehovot, Israel,
manna.adi@gmail.com
Malka Margalit Tel Aviv University, and Peres Academic Center, Rehovot, Israel,
malka@tauex.tau.ac.il
Giuseppe Masanotti Experimental Research Centre for Health Promotion and Education
(CeSPES), University of Perugia, Perugia, Italy, giuseppe.masanotti@unipg.it
Dennis J. Matanda Population Council, Nairobi, Kenya, dmatanda@popcouncil.org
Sally Muggleton Faculty of Health, University of Canberra, Canberra, ACT, Australia,
sally.muggleton@canberra.edu.au
Daniel Naud Research Centre on Aging, Eastern Townships Integrated University Health and
Social Services Centre, Sherbrooke, Québec, Canada, daniel.naud2@usherbrooke.ca
Anne Britt Vika Nilsen Department of Health and Caring Sciences, Faculty of Health and
Social Sciences, Western Norway University of Applied Sciences, Bergen, Norway,
anne.britt.vika.nilsen@hvl.no
Peter Nowak Austrian National Public Health Institute (Gesundheit Österreich GmbH),
Vienna, Austria, peter.nowak@goeg.at
Luis Saboga-Nunes Institute of Sociology, University of Education Freiburg, Breisgau,
Germany
Coimbra Health School, PC, Coimbra, Portugal, saboga-nunes@ph-freiburg.de
Tracey O’Sullivan Faculty of Health Sciences, University of Ottawa, Ottawa, ON, Canada,
tosulliv@uottawa.ca
Gillie Pragai Olswang Conflict Management and Resolution Program, Ben-Gurion
University of the Negev, Beer Sheva, Israel
Animal Assisted Therapist Training Program, David Yellin Academic College of Education,
Jerusalem, Israel, gillie@bgu.ac.il
Editors and Contributors xix

Judy Orme Department of Health and Social Sciences, University of the West of England,
Bristol, UK, judy.orme@uwe.ac.uk
Gaby Ortiz-Barreda Department of Health Promotion and Development, Faculty of
Psychology, University of Bergen, Bergen, Norway, Gaby.Barreda@uib.no
Fungisai Puleng Gwanzura Ottemöller Department of Health Promotion and
Development, Faculty of Psychology, University of Bergen, Bergen, Norway, Fungi.
Ottemoller@uib.no
Giancarlo Pocetta Department of Medicine and Surgery and Experimental Research Centre
for Health Promotion and Education (CeSPES), University of Perugia, Perugia, Italy,
giancarlo.pocetta@unipg.it
Viktoria Quehenberger Institut für Gesundheitsförderung und Prävention, Vienna, Austria,
v.quehenberger@gmx.at
Beat Reichlin Centre for Health Promotion and Participation, Lucerne University of Applied
Sciences and Arts, Lucerne, Switzerland
Centre of Child and Adults Protection, Lucerne University of Applied Sciences and Arts,
Lucerne, Switzerland, beat.reichlin@hslu.ch
Daniela Rojatz Austrian National Public Health Institute (Gesundheit Österreich GmbH),
Vienna, Austria, daniela.rojatz@goeg.at
Mathieu Roy CIUSSS de l’Estrie-CHUS; Faculté de médecine et des sciences de la santé,
University of Sherbrooke, Sherbrooke, QC, Canada
Quebec National Institute of Public Health, Québec, QC, Canada, mathieu.roy7@usherbrooke.ca
Marco Schraner Centre for Health Promotion and Participation, Lucerne University of
Applied Sciences and Arts, Lucerne, Switzerland, marco.schraner@hslu.ch
Shefaly Shorey Alice Lee Centre for Nursing Studies, Yong Loo Lin School of Medicine,
National University of Singapore, Singapore, Singapore, nurssh@nus.edu.sg
Jane South School of Health and Community Studies, Leeds Beckett University, Leeds, UK,
J.South@leedsbeckett.ac.uk
Steffen Torp Department of Health, Social and Welfare Studies, University South-Eastern
Norway, Kongsberg, Norway, Steffen.Torp@usn.no
Helga Bjørnøy Urke Department of Health Promotion and Development, Faculty of
Psychology, University of Bergen, Bergen, Norway, helga.urke@uib.no
Hege Forbech Vinje THE FORBECH VINJE ACADEMY (www.forbechvinje.no),
Sandefjord, Norway, hfvinje@gmail.com
Katharina Vogt Helsana Insurance Company Ltd, Zurich, Switzerland, katharina.vogt@
helsana.ch
Eike von Lindern Dialog N – Research and Communication for People, Environment and
Nature, Zurich, Switzerland, eike.von.lindern@dialog-n.ch
Ulrike Winter Freelancer, Vienna, Austria, uli.winter@chello.at
James Woodall School of Health and Community Studies, Leeds Beckett University, Leeds,
UK, j.woodall@leedsbeckett.ac.uk
Magdalena Wrzesińska Department of Psychosocial Rehabilitation, Medical University of
Lodz, Lodz, Poland, magdalena.wrzesinska@umed.lodz.pl
John Zeisel Hearthstone Institute and the I’m Still Here Foundation, Winchester, MA, USA,
zeisel@thehearth.org
 Part I
Salutogenesis from Its Origins to the Present
 Salutogenesis From Its Origins
to the Present
Maurice B. Mittelmark
Part I provides an overview of the development of the field of
salutogenesis, as background for the remaining chapters in
The Handbook of Salutogenesis.
Chapter 2 by Bengt Lindström reviews mileposts in the
development of the field from the late 1990s until today. This
is a chronology of the meetings, seminars and other events
that have provided space and time for the development of
salutogenesis as an academic field. This chapter is of histori-
cal value and helps describe the global collaborative work
that has supported the network of colleagues whose work is
in the book.
Chapter 3 by Maurice Mittelmark and Georg Bauer is a
revision and expansion of a chapter in the 2017 Edition,
meant to convey some of the main ways the term ‘salutogen-
esis’ is used today. Antonovsky introduced the term saluto-
genesis in his 1979 and 1987 books on the Salutogenic
Model of Health, but salutogenesis subsequently has come to
refer to a core concept in the Model in particular; the sense
of coherence. This usage has advanced to the point that some
writers have coined the term ‘sense of coherence theory’.
The term salutogenesis is also frequently used to refer, more
generally, to an approach to health theory, research and prac-
tice emphasising resources that people may call on to
improve health.
Chapter 4 is of particular importance in this Handbook.
Written by Aaron Antonovsky’s son Avishai Antonovsky,
and by one of his closest colleagues and former PhD student,
Shifra Sagy, this revised chapter from the 2017 Edition pro-
vides the first biography of the founding father of salutogen-
esis. The authors share their insight regarding the development
of the salutogenic idea. They were very close to Aaron
Antonovsky for several decades, and their familiarity with
his background contributes to understanding the develop-
ment of salutogenesis.
M. B. Mittelmark (*)
Department of Health Promotion and Development,
Faculty of Psychology, University of Bergen, Bergen, Norway
e-mail: maurice.mittelmark@uib.no
© The Author(s) 2022
M. B. Mittelmark et al. (eds.), The Handbook of Salutogenesis, https://doi.org/10.1007/978-3-030-79515-3_1
1
Chapter 5 by Hege Forbech Vinje, Eva Langeland and
Torill Bull is reproduced from the 2017 Edition. The editors
are convinced that this summary of Antonovsky’s develop-
ment of the Salutogenic Model of Health is among the best
synopses available. While no summary can replace the value
of Antonovsky’s voluminous productivity on salutogenesis,
the reader of this chapter will receive a quite in-­depth intro-
duction to Salutogenesis’s main lines of development under
the guiding hands of its founding theoretician.
Chapter 6 by Georg Bauer provides the reader with a use-
ful description of Salutogenesis meeting places. These are
the Society for Theory and Research on Salutogenesis
(STARS) and the Global Working Group on Salutogenesis
(GWG-Sal) of the International Union for Health Promotion
and Education (IUHPE). Bauer also provides information
about the Center on Salutogenesis at the University of Zürich
in Switzerland. The center is the host organisation of both
meeting places. The reader wanting to connect more directly
to a global salutogenesis network will find this chapter to be
of great practical value.
Finally, Chapter 7 by Lenneke Vaandrager of The
Netherlands and colleagues from Spain, Germany, Italy,
Norway, the United Kingdom and Poland trace the develop-
ment of higher education in salutogenesis in Europe, span-
ning 30 years. At this time, the annual summer schools of the
European Training Consortium in Public Health and Health
Promotion have trained more than 700 participants from 60
countries. Perhaps the most distinguished member of the
summer school’s faculty – at least from the perspective of
advancing salutogenesis as a theory for health promotion – is
Aaron Antonovsky, who participated in the 1992 edition of
the course in Gothenburg, Sweden.
The chapters of Part I provide the reader with an over-
view of the entire scope of development of salutogenesis
from its start in 1979 to this day. Just over a mere 40 years,
a very rapid eye blink in social science history! Therefore,
this book is an introduction to a transdisciplinary field in
its infancy. The reader is heartily invited to join in on the
‘ground-floor’ of the research, theory building and prac-
3
4 M. B. Mittelmark

tice that we a­nticipate will advance salutogenesis to a
mature scholastic undertaking. What is the fundamental
problem that makes this audacious undertaking worth the
effort?
How may we better understand the origins of human health?
How may we advance health in a manner considerate of the con-
nectedness of health to life generally?
Not just human life, but global life.

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 Mileposts in the Development
of Salutogenesis 2
Bengt Lindström

First Encounter
It was a sunny and windy afternoon in the Spring of 1987. I was
waiting for a group of guests of Public Health Officials on the
pier of the Nordic School of Public Health. They were arriving
quite spectacularly on a 19th-century steamship, “Bohuslän,”
used at special occasions by the City of Göteborg. The sea was
quite rough, and it took a while to dock and land the old, tall, and
narrow ship. I had time to scan the many familiar faces of col-
leagues and friends on board but among them was a new face.
I greeted my friends and walked up to the new person who
looked a bit pale and shaky and relieved getting on firm land; he
said: “Hi, I am not used to the sea because I come from the
middle of the Negeb desert and the Beersheva University in
Israel, I am Aaron Antonovsky.”
This was my first encounter with Aaron Antonovsky
(Fig. 2.1), the father of salutogenesis. As a welcome, he handed
me a signed copy of his latest book, fresh from the printers, titled
“Unravelling the Mystery of Health.” It was the beginning of a Fig. 2.1 Aaron Antonovsky, teaching at the Nordic School of Public
friendship that would last until his sudden death seven years Health in 1992
later.

the hospitals. I never understood why you learnt anatomy

like reading a telephone book or why you were trained in
 y Understanding of “Salutogenesis” Before
M
understanding only the somatic growth of a child, integrating
Antonovsky
neither the mental and social nor spiritual dimensions into a
wholeness. During my specialization, I moved to Sweden,
As for so many others, the salutogenic thought was not com-
where pediatrics was more open to the community; meaning
pletely new to me as such, but we did not have the concepts
in your training, you met healthy children and their families
and words to specify what it was about until Aaron
in Child Wellbeing Clinics. Also, in Sweden, child mental
Antonovsky conceptualized his model. My salutogenic jour-
health services were provided through child and adolescent
ney started before I met with him. I trained as a physician in
psychiatry.
Finland and specialized in pediatrics; I wished and hoped
Although I loved to work with children and families and
pediatrics could have been called child health and move
was good at it, there was always that longing for a more
beyond the traditional health-disease axis, but this was the
direct approach to health. Much later, already 10 years into
late 1960s and early 1970s; in Finland, the prime time for
medicine, came the event that finally changed my profes-
“hardcore biomedical science.”
sional orientation. I was in charge of a group of children with
Our teachers were decidedly ignorant of other entry points
cystic fibrosis, a genetic disease that at that time lead to
to medicine and what went on in the community outside of
infections, malnutrition, and usually a premature death due
to severe lung infections.
B. Lindström (*) One morning I met a family well-known to me; they had
NTNU Center for Health Promotion Research, Norwegian already lost one child to the disease, and this day the younger
University of Science and Technology, Trondheim, Norway
e-mail: bengtblind@hotmail.com

© The Author(s) 2022 5

M. B. Mittelmark et al. (eds.), The Handbook of Salutogenesis, https://doi.org/10.1007/978-3-030-79515-3_2
6 B. Lindström
sister – 17-year-old Maria1 – also suffering from cystic fibro-
sis, was at my surgery. But that day, the front page of her
records had a new handwritten note: marked in red were the
letters PSEUDOMONAS!!! This meant she had the infection
everybody in the care of cystic fibrosis patients feared, an
infection we could not master, which would eventually lead
to her death. I was young at the time and not yet experienced
with death. I was thinking of what to say about her future
when she walked into the room. Coughing, wasted and frail
she came toward me. I was about to start when I realized her
eyes were shining, her cheeks blushing, and she was smiling.
I stopped myself and asked “Maria – what is it?” She looked
at me, gave me a broad smile and said: “Bengt, I am in love.
I want to get married, and I want to have children!”
Because of her sister, she knew very well where every-
thing was going but still, in the face of death, she was talking
about life, love and having a family. Eventually, she did not
make it, but it left me forever thinking of how this was pos-
sible, that what she talked about contradicted all I had learnt
in medical school; this is where my journey toward saluto-
genesis began. Antonovsky would have said, “You idiot (as
he said to himself), you were looking in the wrong
direction!”
A few years later, because of Maria, I broke out of the
Clinics, and in 1984, I went into public health research and
training at the Nordic School of Public Health (Nordic
School of Public Health), serving five countries in interdisci-
plinary postgraduate training and research. These were the
years when the World Health Organization (WHO) Health
for All Strategy was launched; WHO stepped beyond health
care into community health and launched the Ottawa Charter
for Health Promotion in 1986, which advocated a structural
approach to implement health promotion.
My years at Nordic School of Public Health were inten-
sive and rewarding. Of great significance to me, Aaron
Antonovsky was a regularly returning visiting scholar at the
school from 1987 to 1994, active and engaging in teaching
and guiding seminars. It would not take long before he was
appointed Honorary Professor at the Nordic School at the
same time as Ilona Kickbusch, the then Health Promotion
Director of WHO.
I took special care to accompany him during his visits to
the School, and I eagerly attended his lectures and seminars,
taking detailed notes. As a result, I have a collection of his
lectures spanning 7 years and several hours of his presenta-
tions on video recordings. I admired the way he presented
salutogenesis concepts in the classroom; and ever since, I
have tended to emulate his pedagogic approach and his use
of drawings to illustrate key ideas.
He was teaching at the European Training Consortium
Course at the school when he agreed to read the manuscript
1
The name has been changed to protect privacy and confidentiality.
of my first publication on salutogenesis, dealing with the
amelioration of children experiencing family breakdown.
The emphasis was on seeing divorce through the perspective
of the child and as a process, not as one point-in-time event.
Three questions are important from a salutogenic perspec-
tive: How do adverse life events affect one over time? How
do adverse events (here related to divorce) unfold from the
perspective of the target group (here the child)? What is
needed to steer a constructive process? My conclusion was
that it is not the life event of “divorce” as such that is impor-
tant. The important thing is what conditions prevail before
and after, how the whole process is managed, how does the
child perceive it, and how does it make sense to the child?
Discussing my paper, Antonovsky approved of my line of
thought. This was 1993; he mentioned he was going to par-
ticipate in an important meeting at WHO in Copenhagen,
where he was to hold a seminar attended by leading health
promotion experts, on how salutogenesis could be used as a
framework for health promotion. It was a shock when,
shortly after the Copenhagen meeting, I received a fax from
Aaron reading, “Dear Bengt, I have a malignant cancer,
going into care tomorrow, pray for me.” He died days later.
The loss of Antonovsky paralyzed his closest research net-
works for a long time. It was also the end of his Salutogenesis
Newsletters, which at the time were the primary source of
news about salutogenesis developments globally.
His WHO presentation was published in Health Promotion
International after his death (Antonovsky, 1996). This land-
mark work concluded:
With great respect for the concept of health promotion (and for
those committed to it), I have none the less been highly critical,
in emphasizing that the basic flaw of the field is that it has no
theory. The salutogenic orientation has been proposed as provid-
ing a direction and focus, allowing the field to be committed to
concern with the entire spectrum of health ease/dis-ease, to
focus on salutary rather than risk factors, and always to see the
entire person…
Within a few years, Antonovsky’s posthumously pub-
lished call to action was well heeded. It is not an exaggera-
tion to proclaim this single publication as the catalyst – the
milepost – for the burgeoning of salutogenesis scholarship.
 Chronology of Key Developments
A
After 1996
This chronology has a decidedly personal cast since I am
aware of salutogenesis developments mainly through my
involvement. My first organizational responsibility outside
the Nordic School of Public Health was as the Secretary
General of the European Society of Social Pediatrics
(ESSOP). At the same time, I took a similar position in
NOBAB (Nordic Network for Children’s rights and needs in
2 Mileposts in the Development of Salutogenesis
health care) concerned with implementing the Convention
on the Rights of the Child within Health Care.
One key member of ESSOP whom I worked with for a
long time on many health promotion projects was Concha
Colomer (1958–2011) from Valencia, Spain. Concha holds a
special place in the development of salutogenesis scholar-
ship as a cofounder of a postgraduate training summer course
in health promotion that has salutogenesis as a shaping prin-
ciple. The course is run by the European Training Consortium
in Public Health and Health Promotion – ETC-PHHP (the
founding partners were the Nordic School of Public Health,
the Valencian School of Public Health, the Andrija Stampar
School of Public Health in Croatia, and the Liverpool
Department of Public Health). Since 1991, 782 students have
been trained, coming from over 60 different countries. In a
separate chapter in this Handbook, Vaandrager and col-
leagues describe details of the history and activities of the
course.
The autumn following Antonovsky’s death, I visited the
school of Public Health in Granada, Spain, to participate in a
health promotion seminar lead by Erio Ziglio, the WHO
European Director of Health Promotion. We discussed the
need for greater emphasis on salutogenesis in health promo-
tion research and training, and in 1995, I set up courses on
health promotion and salutogenesis at the Nordic School. I
was in charge of the course on salutogenesis for over
15 years. In 2007, the salutogenesis course evolved to
become the International Seminar on Salutogenesis of the
Global Working Group on Salutogenesis – GWG-Sal –
which I chaired for a decade (more about GWG-Sal later).
I had the opportunity to introduce salutogenesis at the first
Nordic Health Promotion Research Conference at the
University of Bergen in 1996, where Maurice Mittelmark
was the host. Salutogenesis has featured on the program at
all subsequent Nordic conferences, the most recent being the
Ninth, held in 2019 at Roskilde University.
About the same time, I was invited to a Swedish Research
Council seminar on the status of research on salutogenesis.
Attending were Marianne Cederblad and Kjell Hansson,
who were among the first to research salutogenesis in
Sweden (they also hosted Antonovsky’s sabbatical in Lund
in 1987). Also participating in the seminar was Olle
Lundberg, who together with Maria Nyström Peck had
developed the three-question SOC scale. The consensus
emerging from the seminar was that research on measuring
the SOC was too meager. I wished to contribute to the needed
research and recruited Monica Eriksson to work with me on
the task. Monica had written her master’s thesis on saluto-
genesis in Finland, where Guy Bäckman had introduced
salutogenesis to Finnish academia. With me as her advisor,
Monica undertook her PhD at Åbo Akademi University Vasa
on the sense of coherence, which resulted in a series of pub-
7
lications that have become classic papers in the field
(Eriksson, 2007).
There were many other salutogenesis developments at
about the same time. Maurice Mittelmark was the President
of the International Union for Health Promotion and
Education – IUHPE. He was determined to pave the way for
salutogenesis in health promotion, and in 2007, the IUHPE
established GWG-Sal, with me as its founding Chair.
A bit earlier, I worked to infuse salutogenesis into a 6-year
European Union project to establish a framework for a
European Masters in Health promotion (EUMAHP, 1998–
2004). The project included many prominent health promo-
tion scholars from the continent, among them was Georg
Bauer, who was to succeed me as head of GWG-Sal when I
retired in 2017.
In a related EU project aiming to develop health promo-
tion indicators (the EUPHID project), Bauer led the team
that constructed an influential framework for research indi-
cators, which had an explicit salutogenesis orientation
(Bauer et al., 2006).
In 2005, I became Research Director for Health Promotion
at Folkhälsan, an old established Finish NGO that was
involved in population health and community development
practice and research. Monica Eriksson joined me on the
research team. The Folkhälsan position allowed me, for the
first time in my career, to pull my thoughts together and
focus entirely on my work on salutogenesis.
Monica and I conducted systematic reviews, with rigor-
ous inclusion and exclusion criteria, of research that had
used Antonovsky’s salutogenesis framework up to that time
(Eriksson, 2007). We also built an open-access database on
salutogenesis to serve researchers all over the globe. During
our 5 years at Folkhälsan, we helped to consolidate interna-
tional collaboration. For example, we worked closely with
two Norwegian collaborators to establish significant saluto-
genesis infrastructure in Norway. Geir Espnes was the found-
ing director of the Center for Health Promotion Research at
the Norwegian University for Science and Technology in
Trondheim, and Nina Mjosund reconfigured the Buskerud
Regional Psychiatric Services in Norway, resulting in a
unique entry point for salutogenesis in mental health care.
From 2007 on, the IUHPE became a principal arena for
salutogenesis, which has had a significant place in IUHPE
global and regional conferences ever since. This helped to
expose health promotion practitioners and researchers to
salutogenesis, but a dedicated meeting place was also needed
for people immersed in salutogenesis.
Responding to the need, we organized the First
International Seminar on Salutogenesis in Helsinki in the
Spring of 2008, with about 150 researchers and practitioners
participating from Asia, Europe, and North America. Among
them was Shifra Sagy (whose PhD advisor in Israel had been
8 B. Lindström
Antonovsky), who gave a brilliant presentation on the early
days of salutogenesis.
At the end of 2008, we organized the first meeting of
GWG-Sal at Nordic School of Public Health, with founding
members Sagy, Mittelmark, Bauer, Lindström, Eriksson,
Corey Keyes (United States), Lenneke Vaandrager (the
Netherlands), and Jürgen Pelikan (Austria).
The Second International Seminar on Salutogenesis was
held in 2009, at Folkhalsan in Helsinki. The same year, the
GWG-Sal members participated in a seminar on resilience in
London, and as a group, presented salutogenesis and its rela-
tionship to resilience to the audience. We also held our sec-
ond GWG-Sal meeting in London, and at that meeting, we
agreed to produce a handbook on salutogenesis, which was
published by Springer (Mittelmark et al., 2017).
The Third International Seminar on Salutogenesis was
arranged at the IUHPE World Conference in Geneva in 2010,
where we launched salutogenesis on a broad scale to the
global health promotion community. The same year we
introduced our work at the WHO Global Conference on
Health Promotion in Nairobi. All IUHPE World Conference
scientific programs have since had input from GWG-sal,
leading to many salutogenesis subplenary, paper, poster ses-
sions, and workshops, during the 2013, 2016, and 2019
conferences.
In 2010, we published The Hitchhiker’s Guide to
Salutogenesis: Salutogenic Pathways to Health Promotion
(Lindström & Eriksson, 2010). This was first published in
English, and at the time of writing, the book is available in
eight languages: English, Spanish, Catalan, French,
Norwegian, Italian, German, and Polish.
In 2011, the International Seminar on Salutogenesis was
arranged at University West in Trollhättan, Sweden, where
Monica Eriksson was later appointed Professor. The same
year, I was appointed Professor of Salutogenesis (the first
professorship with this title) at the Norwegian University of
Science and Technology in Trondheim, Norway (where I
continued until my retirement in 2017). The GWG-Sal oper-
ation moved with me to Trondheim, where Geir Espnes had
established a new Center for Health Promotion Research.
Geir launched a series of International Health Forum bian-
nual conferences (2012–2018), wherein a dedicated part of
the scientific program was the International Seminar on
Salutogenesis. On my retirement in 2017, Georg Bauer took
over the leadership of the GWG-Sal at the newly founded
Center on Salutogenesis at the University of Zürich in
Switzerland.
Coincident with the inauguration of the Zürich center (by
the President of the University), GWG-Sal launched the
Society for Theory and Research on Salutogenesis – STARS
(www.stars-­society.org). The society was established as a
home for academics interested in salutogenesis, reaching
beyond the health promotion discipline to welcome other
disciplines in the social science and biomedical sciences
communities. The year 2017 was a boom year for salutogen-
esis; besides the activities just mentioned, the first edition of
The Handbook of Salutogenesis was published as an open-­
access publication of Springer Nature, edited by GWG-Sal
members. In the short period since its publication, the hand-
book has risen to the top three Springer open-access publica-
tions globally, measured by the number of downloads. It was
the popularity of the first edition that gave GWG-Sal mem-
bers the motivation to start work on this second edition.
Conclusion
The first salutogenesis study was undertaken in the late
1960s and published in Antonovsky’s books in 1979 and
1987. With his background in medical sociology, he related
his salutogenic framework to the field of health, and he
wished to foment a paradigm adjustment, from pathogenesis
standing alone to pathogenesis and salutogenesis. He rea-
soned that the field of health promotion was fertile ground
for such a shift. Where are we at this point? In a practical
sense, the contents of this handbook answer the question.
There seems to be no doubt that salutogenesis is thriving in
its research, teaching and theory building.
Yet, salutogenesis is still in its infancy, a maturing con-
struct, but with many unanswered questions that are posed in
the concluding sections of many of this book’s chapters. The
final chapter of this handbook, coauthored by its GWG-Sal
editors, addresses some of the critical issues that salutogen-
esis as an academic field must address to advance as transdis-
ciplinary science, and hasten the paradigm adjustment that
Antonovsky envisioned (Bauer et al. 2020).
References
Antonovsky, A. (1996). The salutogenic model as a theory to guide
health promotion. Health Promotion International, 11(1), 11–18.
Bauer, G., Davies, J. K., Pelikan, J., & Euhpid Theory Working
Group and The Euhpid Consortium. (2006). The EUHPID Health
Development Model for the classification of public health indica-
tors. Health Promotion International, 21(2), 153–159.
Bauer, G. F., Roy, M., Bakibinga, P., Contu, P., Downe, S., Eriksson,
M., … Mana, A. (2020). Future directions for the concept of saluto-
genesis: A position article. Health Promotion International, 35(2),
187–195.
Eriksson, M. (2007). Unravelling the Mystery of Salutogenesis.
Folkhälsan Research centre, Research Report 2007:1. Helsinki.
Lindström, B., & Eriksson, M. (2010). The hitchhiker's guide to salu-
togenesis: Salutogenic pathways to health promotion. Folkhälsan
Research Center.
Mittelmark, M. B., Sagy, S., Eriksson, M., Bauer, G. F., Pelikan,
J. M., Lindström, B., & Arild Espnes, G. (2017). The handbook of
Salutogenesis. Springer Nature.
2 Mileposts in the Development of Salutogenesis 9

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 Salutogenesis as a Theory,
as an Orientation and as the Sense
of Coherence
Maurice B. Mittelmark and Georg F. Bauer
Introduction
In the health promotion field, the term salutogenesis is asso-
ciated with various meanings that Aaron Antonovsky intro-
duced in his 1979 book Health, Stress and Coping, and that
he expounded in many subsequent works. In its most thor-
oughly explicated meaning, salutogenesis refers to the salu-
togenic model of health, which posits that life experiences
help shape one’s sense of coherence—an orientation towards
life as more or less comprehensible, manageable and mean-
ingful. A strong sense of coherence helps one mobilise
resources to cope with stressors and manage tension success-
fully. Through this mechanism, the sense of coherence helps
determine one’s movement on the health ease/dis-ease
continuum.
In its narrower meaning, salutogenesis is often equated
with one part of the model, the sense of coherence, specifi-
cally defined as:
a global orientation that expresses the extent to which one has a
pervasive, enduring though 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. 123).
In its most general meaning, salutogenesis refers to a
salutogenic orientation, particularly in health promotion
research and practice, focusing attention on the origins of
This chapter is a revision and update of work published in Mittelmark,
M.B., Sagy, S., Eriksson, M., Bauer, G., Pelikan, J.M., Lindström, B.,
& Espnes, G.A. (eds). (2017). The Handbook of Salutogenesis.
Springer, Cham. DOI: https://doi.org/10.1007/978-­3-­319-­04600-­6
M. B. Mittelmark (*)
Department of Health Promotion and Development, Faculty of
Psychology, University of Bergen, Bergen, Norway
e-mail: maurice.mittelmark@uib.no
G. F. Bauer
Center of Salutogenesis, Division of Public and Organizational
Health, Epidemiology, Biostatistics and Prevention Institute,
University of Zürich, Zürich, Switzerland
e-mail: georg.bauer@uzh.ch
© The Author(s) 2022
M. B. Mittelmark et al. (eds.), The Handbook of Salutogenesis, https://doi.org/10.1007/978-3-030-79515-3_3
3
health and assets for (positive) health, contra to the origins of
disease and risk factors.
These meanings are distinct yet inextricably intertwined.
The heart of the salutogenic model is the sense of coherence,
a ‘global orientation‘easily conflated with the ‘salutogenic
orientation’ since the concept of orientation is central to
both. A helpful distinction is that ‘orientation’ in relation to
the sense of coherence has relevance for all humans’ ability
to engage resources to cope with stressors. In contrast, ‘ori-
entation’ in relation to salutogenesis refers to professionals’
interest in the study and promotion of the origins of health
and assets for health rather than tackling the origins of dis-
ease and risk factors.
This book is about salutogenesis in all these meanings—
the salutogenic model, the sense of coherence and the saluto-
genic orientation. These meanings and their reception in
research and practice are taken up in this chapter to set the
stage for the chapters that follow. We also briefly discuss
salutogenesis in relation to other concepts within and beyond
the health arena, with which salutogenesis has important
kinship.
The Salutogenic Model
By his own account, the turn in Antonovsky’s life from
pathogenesis to salutogenesis began to crystallise in the late
1960s. Having worked up to that point as a stress and coping
survey researcher with foci on multiple sclerosis, cancer and
cardiovascular diseases, he realised that his real interest did
not have its starting point in any particular disease. Instead,
the starting point was ‘the illness consequences of psychoso-
cial factors howsoever these consequences might be
expressed’ (Antonovsky, 1990, p. 75). This insight led to
research and publications on the ideas of ‘ease/dis-ease’
(breakdown) and generalised resistance resources. Still, it
did not mark the full emergence of salutogenesis in his think-
ing. At this stage of his career, Antonovsky’s focus was still
pathogenic (ibid, p. 76). Another decade would pass before
11
12
Antonovsky came to the question ‘what makes people
healthy?’ and the need to coin the term salutogenesis to con-
vey the thinking mode implied by the question. The time and
space to develop these ideas came while he was on sabbatical
at Berkeley in 1977 and 1978.
The fruition was Antonovsky’s full exposition of saluto-
genesis in Health, Stress and Coping (Antonovsky, 1979),
the publication of which completed his turn from pathogen-
esis to salutogenesis. Antonovsky’s illustration of the saluto-
genic model is reproduced in Fig. 3.1. Up until the 1979
book, no research based on the salutogenic model had been
undertaken. The model’s core construct, the sense of coher-
ence, had yet to be fully developed, operationalised and mea-
sured, and it was to this task that Antonovsky turned his
effort. As a result, his book Unraveling the Mystery of Health
(Antonovsky, 1987) focused a great deal of his attention on
the sense of coherence and its role as an independent variable
in health research (Eriksson & Lindström, 2006, 2007).
Other aspects of the salutogenic model received less atten-
tion. Antonovsky’s ambitions for further development of the
salutogenic model were cut short by his death at age 71, just
7 years following the publication of Unraveling the Mystery
of Health.
Health professions and disciplines have yet to be power-
fully touched by salutogenesis, even if Antonovsky was pro-
fessionally situated in a medical school during all the years
he developed salutogenesis. The venerated Dorland’s
Illustrated Medical Dictionary, in print since 1900 and now
in its 33rd Edition, does not even have an entry for salutogen-
esis, much less the salutogenic model (Dorland, 2020).
The salutogenic model has not yet deeply penetrated
social science or medicine; this does not mean that there is
no penetration, and the chapters of this book are evidence
that certain health-related arenas are captivated. Many schol-
ars who do refer to the salutogenic model stray far from its
main ideas. Interest in the model’s details is watered down
by the sweeping generality of the salutogenic orientation,
and by the intense interest the sense of coherence awakens.
Four aspects of the salutogenic model that require attention
are mostly neglected: (a) the origins of the sense of coher-
ence, (b) other answers to the salutogenic question than the
sense of coherence, (c) health defined as something other
than the absence of disease and (d) processes linking the
sense of coherence and health.
The sense of coherence develops from infancy.
Antonovsky wrote extensively about the roles of culture in
salutogenesis and the development of the sense of coherence
(Benz et al., 2014). His writings included attention to the role
of culture in shaping life situations, in giving rise to stressors
and resources, in contributing to life experiences of predict-
ability, in load balance and meaningful roles, in facilitating
the development of the sense of coherence and in shaping
perceptions of health and well-being (ibid). With almost the
M. B. Mittelmark and G. F. Bauer
sole exception of work by Israelis, culture is not a theme in
salutogenesis research (see, e.g. Braun-Lewensohn & Sagy,
2011; Sagy, 2015). One might protest and point to the pleth-
ora of studies that have translated sense of coherence ques-
tionnaires. Still, such research is not the study of the cultural
forces to which Antonovsky called attention.
Stepping up the salutogenic model’s ladder, cultural and
historical context is understood as a cauldron generating psy-
chosocial stressors and resistance resources. The processes
involved are little studied. Which psychosocial resources are
predictably generated by which child-rearing patterns, which
social role complexes and their interaction? Is it the case that
generalised resistance resources are of prime importance to
developing the sense of coherence as Antonovsky main-
tained, and which are of most importance during which life
stages? Do specific resistance resources (SRRs) also play a
vital role? How does the experience of stress affect the shap-
ing of resistance resources? Unaddressed questions about the
origins of the sense of coherence abound.
Moving on to the issue of other answers to the saluto-
genic question than the sense of coherence, Antonovsky
invited others to search for them, even if his interest remained
firmly with the sense of coherence. The question is this:
What factors (presumably besides the sense of coherence)
intervene between the stress/resources complex on the one
hand and the experience of health on the other hand? A con-
venient way to partition the question is with the intra-person/
extra-person differentiation. The sense of coherence is an
intra-person factor; which other intra-person factors may be
important? There are many candidates (hardiness, mastery
and so forth), but little effort to compare and contrast their
mediating and moderating roles with the sense of coherence
in the same research designs.
As to extra-person salutary factors, there is at least move-
ment in promising directions. In the work and health litera-
ture specifically, and in the settings literature more generally,
interest is growing in how physical and social environments
can enhance well-being and performance. Such research is
attentive to the sociocultural environment, not as a force in
shaping the sense of coherence, but as a mediating factor,
which may facilitate coping. In the health promotion area,
this is referred to as ‘supportive environments’. A fundamen-
tal precept is that health-enhancing social policy should cre-
ate supportive environments. An example of a salutary
extra-person factor is work and family corporate support
policy, which is an SRR related positively to job satisfaction,
job commitment and intentions to stay on the job (Butts
et al., 2013). Most interestingly, it may be that the perceived
availability of support under such policy, rather than the use
of supports, is the critical factor in good job-related out-
comes (ibid). Concerning GRRs at work, Brauchli et al.
(2015) identified key job resources relevant for health out-
comes across a broad range of diverse economic sectors,
3 Salutogenesis as a Theory, as an Orientation and as the Sense of Coherence 13

Potential Endogenic and Exogenic Stressors

F F F
A. Psychosocial Stressors

1. accidents and survivors 8. other normative

Public
2. others’ experiences crises I and
Major Psychosocial B B B 3. horrors of history, 9. conflicts in Private
Generalized direct and vicarious social relations (avoid or neutralize) Health

Souces Resistance Resources 4. intrapsychic conflicts 10. goals-means gap

Measures
5. fear of aggression
of
1. material (1) avoid J 6. immediate world change
GRRs B. Physical and Biochemical
7. phase-specific crises
A (strong) sense of coherence mobiizes GRRS and SRRs to Stressors
2. knowledge, (2) K
intelligence
D D (3) (2) define as nonstressors
M
3. ego identity L H G
E (3) manage:
child
The 4. coping strategy: a. holding action
rearing
Socio rational, flexible, D b. overcome
patterns
Sense of
Cultural farsighted stressors
Coherence
and
5. social supports, ties
Historical social- E
context role
6. commitment: continu- Life Experiences Sense of Coherence
complexes State L
ance, cohesion, Characterized by
control a global orientation that ex- of

1. consistency presses the extent to which Tension

idio- E 7. cultural stability C A one has a pervasive, enduring
syncratic 2. participation
though dynamic feeling of
factors 8. magic in shaping
confidence that one’s internal
outcome and external enviornments are Unsuccessful State Pathogens
9. religion, philosophy, Q
3. underload- predictable and that there is a Successful Tension of and
art: a stable set of N
E overload high probability that things Tension Management Stress “Weak Links”
answers G
chance balance will work out as well as can Management P
reasonable be expected
10. preventive health
orientation O
Health
G
Ease/Dis-ease
Genetic and Consti-
R Continuum
tutional Generalized R R
Resistance Resources
Other Ease/Dis-ease
Continua

Key to Figure 1

Arrow A: Life experiences shape the sense of coherence.

Arrow B: Stressors affect the generalized resistance resources at one’s disposal.
Line C: By definition, a GRR provides one with sets of meaningful, coherent life
experiences.
Arrow D: A strong sense of coherence moblllzes the GRRs and SRRs at one’s
disposal.
Arrows E: Childrearing patterns,social role complexes, idiosyncratic factors, and
chance build up GRRs.
Arrow F: The sources of GRRs also create stressors.
Arrow G: Traumatic physical and biochemical stressors affect health status di-
rectly; health status affects extent of exposure to psychosocial
stressors.
Arrow H: Physical and biochemical stressors interact with endogenic pathogens
and “weak links” and with stress to affect health status.
Arrow I: Public and private health measures avoid or neutralize stressors.
Line J: A strong sense of coherence,mobilizing GRRS and SRRs, avoids
stressors.
Line K: A strong sense of coherence,mobilizing GRRS and SRRs,defines stimuli
as nonstressors.
Arrow L: Ubiquitous stressors create a state of tension.
Arrow M: The mobilized GRRs (and SRRs) interact with the state of tension and
manage a holding action and the overcoming of stressors.
Arrow N: Successful tension management strengthens the sense of coherence.
Arrow O: Successful tension management maintains one’s place on the health
ease/dis-ease continuum.
Arrow P: lnteraction between the state of stress and pathogens and “weak
links” negatively affects health status.
Arrow Q: Stress is a general precursor that interacts with lhe existing potential
endogenic and exogenic pathogens and “weak links.”
Arrow R: Good health status facilitates the acquisition of other GRRs.
Note: The statements in bold type represent the core of the salutogenic model.

Fig. 3.1 The salutogenic model of health. (Reprinted from Antonovsky, 1979. Published with permission of © Avishai Antonovsky. All Rights
Reserved)

companies and professions. Furthermore, they showed that salutogenic path of coping but also through GRRs promoting
independent from one’s hierarchical position, gender or age, positive health outcomes.
job-related GRRs both protect from negative consequences Moving to health defined as something other than the
of work-related stressors (job demands) and directly pro- absence of disease, the definitions of health evident in the
mote positive health outcomes such as work engagement. salutogenesis literature are not as specified initially in the
The last finding points to the fact that positive health devel- salutogenic model of health (Mittelmark & Bull, 2013).
opment works not only through the originally postulated Research articles reporting on the relationship of the sense of
14
coherence to a wide range of single disease endpoints fail to
note that this is a departure from the salutogenic model’s
specifications. In contrast, Antonovsky had described the
degree of pain, functional limitation, professional prognosis
and need for treatment as four broader criteria to assess the
movement towards the ease end of the health ease/dis-ease
continuum. However, these criteria still define health in neg-
ative terms—health is the absence of those four negative
qualities. In contrast, health promotion researchers and prac-
titioners applying the salutogenic orientation focus on posi-
tive health outcomes—the presence of perceived well-being
or fulfilment.
Finally, moving to the issue of processes linking the
sense of coherence and health, the salutogenic model posits
that the sense of coherence helps a person mobilise GRRs
and SRRs in the face of psychosocial and physical stress-
ors. This may end with stressors: (1) avoided, (2) defined as
non-­stressors, (3) managed/overcome, (4) leading to a ten-
sion that is managed with success (and enhancing the sense
of coherence) or (5) leading to unsuccessfully managed
tension. These outcomes impact one’s movement on the
ease/dis-ease continuum, but what mechanisms link the
sense of coherence and movement on the continuum? The
sense of coherence is postulated as an orientation towards
the appraisal of stimuli, not as a cognitive or emotional
mechanism that converts information about stressors and
resources into coping responses. What else happens in the
brain that lies between the sense of coherence and coping
responses? This is a little-studied question, surprising since
the appraisal of stimuli plays a considerable role in the
salutogenic model.
The discussion above suggests some areas of neglected
development of the salutogenic model. Why is the model
relatively neglected? One obvious answer is its newness and
complexity; another is that Antonovsky himself did not pur-
sue the whole complex model’s empirical testing. Instead, he
focused on the sense of coherence that he considered as the
key concept, and even as the ultimate dependent variable in
salutogenic thinking. Thus, it is not surprising that many
other scholars have followed his inspiring leadership and
focused on studying the sense of coherence part of the model.
Another explanation might be that the salutogenic model is
still incomplete (Bauer et al., 2019). As mentioned above,
beyond the coping path, one would need to add a direct path
of positive health development leading from generalised pro-
moting (not resistance) resources to positive health out-
comes. In his last paper, Antonovsky (1996) introduced the
idea of ‘salutary factors that actively promote health’.
Simultaneously, such an expanded salutogenic model would
better capture the salutogenic orientation with its focus on
resources/assets and (positive) health outcomes going
beyond the absence of disease.
M. B. Mittelmark and G. F. Bauer
Salutogenesis as the Sense of Coherence
Antonovsky situated salutogenesis as a question: what are
the origins of health? His answer was the sense of coherence.
The question and this answer comprised the heart of his salu-
togenic model as just discussed. Antonovsky invited other
answers to the salutogenic question while remaining con-
vinced that his answer was fundamental. The way Antonovsky
posed and answered the question of salutogenesis was chal-
lenging. ‘Origins’—he used the plural form—signal the pos-
sibility of multiple health-generating determinants and
processes. His singular answer—the sense of coherence—
suggested a channelling of all salutogenic processes through
a particular mental orientation. This answer provides an
appealing reduction of complexity compared to the concept
of pathogenesis, with its legion of risk factors:
A salutogenic orientation , I wrote, provides the basis, the
springboard, for the development of a theory which can be
exploited by the field of health promotion […] which brings us
to the sense of coherence (Antonovsky, 1996).
He considered the sense of coherence as the fundamental
concept of the salutogenic model. We say no more about the
content of the sense of coherence idea here, referring the
reader instead to Part III of this book, which is devoted to the
topic. Instead, we focus on why the sense of coherence has
been overriding as the answer to the salutogenic question.
Why is the sense of coherence equivalent in meaning to salu-
togenesis for so many scholars?
Firstly, Antonovsky strongly signalled that of all the salu-
togenic model’s aspects, the sense of coherence deserved
special attention. In his influential 1996 paper in Health
Promotion International, Antonovsky proposed a research
agenda consisting solely of sense of coherence questions:
• ‘Does the sense of coherence act primarily as a buffer,
being particularly important for those at higher stressor
levels, or is it of importance straight down the line?
• Is there a linear relationship between sense of coherence
and health, or is having a particularly weak (or a particu-
larly strong) sense of coherence what matters?
• Does the significance of the sense of coherence vary with
age, for example, by the time the ranks have been thinned,
and those who survive generally have a relatively strong
sense of coherence, does it still matter?
• Is there a stronger and more direct relationship between
the sense of coherence and emotional well-being than
with physical well-being?
• What is the relationship between the person’s movement
toward well-being and the strength of his/her collective
sense of coherence?
• Does the sense of coherence work through attitude and
behaviour change, the emotional level, or perhaps, as sug-
3 Salutogenesis as a Theory, as an Orientation and as the Sense of Coherence
gested by the fascinating new field of PNI (psychoneuro-
immunology), from central nervous system to natural
killer cells?’ (Antonovsky, 1996, pp. 16, 17).
Notably, some of these questions focus on neglected
issues discussed in the paragraphs above on the salutogenic
model. Antonovsky’s focus on the sense of coherence was
clear, which undoubtedly influences subsequent generations
of salutogenesis researchers’ choices.
Besides the importance of Antonovsky’s lead, the sense of
coherence has the charm of relative simplicity: it suggests
that all salutogenic processes are channelled through a mea-
surable global life orientation. Thus, this single, focused
concept reduces complexity. Further, the sense of coherence
concept has high face validity for both researchers and popu-
lations to which it is applied. It makes immediate sense that
perceiving life as comprehensible, manageable and mean-
ingful is conducive to health. It is also supposedly more
complete and generalisable, and not culture bound, in con-
trast to concepts such as internal locus of control and mas-
tery. The combination of cognitive, behavioural and
motivational components positions the sense of coherence
uniquely, and they are all measurable.
This last point that the sense of coherence is appealingly
measurable may be the most significant reason for its
centre-­stage position in the salutogenesis literature. In the
prestigious journal Social Science and Medicine,
Antonovsky (1993) published a paper titled The Structure
and Properties of the Sense of Coherence Scale, cited as of
this writing by over 2500 publications, a momentous
achievement. Within just a few years, Antonovsky’s sense
of coherence scale had been used in ‘at least 33 languages
in 32 countries with at least 15 different versions of the
questionnaire’ (Eriksson & Lindström, 2005). The stream
of sense of coherence measurement papers has continued
unabated (Rajesh et al., 2015).
Thus, it is understandable that, for many, salutogenesis
is synonymous with the sense of coherence: it is
Antonovsky’s answer to the salutogenic question, it was his
sole priority for further research and sense of coherence
measurement has scientific importance. Still, several lines
for future advancement of the SOC concept have been iden-
tified (Bauer et al., 2019).
The Salutogenic Orientation
In his last paper, published posthumously, Antonovsky
(1996) wrote:
I was led to propose the conceptual neologism of salutogene-
sis—the origins of health—(Antonovsky, 1979). I urged that this
orientation would prove to be more powerful a guide for research
and practice than the pathogenic orientation.
15
Was Antonovsky predicting a paradigm shift? It is impor-
tant to note that the 1996 paper cited above was directed at
the field of health promotion, which Antonovsky felt had too
whole heartedly accepted pathogenesis thinking and disease
prevention via risk factor reduction. Expressing his hopes for
‘proponents of health promotion,’ Antonovsky wrote that the
salutogenic orientation might help them ‘carve out an auton-
omous existence—though one undoubtedly in partnership
with curative and preventive medicine’ (Antonovsky, 1996).
Not so much a complete paradigm shift from pathogenesis to
salutogenesis, Antonovsky wished to foment a shift to salu-
togenesis as a viable theory basis and an essential supple-
ment to pathogenesis in the health and social sciences
(Mittelmark & Bull, 2013). In introducing the salutogenic
orientation, Antonovsky referred explicitly to Thomas
Kuhn's (1962 and 2012) idea of paradigmatic axioms, which
need to change for a paradigm shift to emerge. His thoughts
were on:
…the axiom … which is at the basis of the pathogenic orienta-
tion which suffuses all western medical thinking: the human
organism is a splendid system, a marvel of mechanical organisa-
tion, which is now and then attacked by a pathogen and dam-
aged, acutely or chronically or fatally (Antonovsky, 1996).
Challenging this axiom, Antonovsky summarises the
essence of the salutogenic orientation in contrast to the
pathogenic orientation (Antonovsky, 1996):
• In contrast to the dichotomous classification of pathogen-
esis into healthy or not, salutogenesis conceptualises a
healthy/dis-ease continuum.
• In contrast to pathogenesis’ risk factors, salutogenesis
illuminates salutary factors that actively promote health.
• In contrast to focusing on a particular pathology, disabil-
ity or characteristic of a person, salutogenesis might work
with a community of persons and relate to all aspects of
the person.
We return to our earlier question, slightly rephrased: was
Antonovsky calling for a paradigm shift from pathogenesis
to salutogenesis? Certainly not in the sense of salutogenesis
as the usurper of pathogenesis. He repeatedly remarked that
pathogenesis would remain dominant in the ‘health’ arena.
However, he did hope that salutogenesis would achieve an
ascendant position as the theory of health promotion. This is
not yet achieved but salutogenesis is on the rise. The Health
Development Model (Bauer et al., 2006) is a prominent
framework for developing health promotion indicators, and
it explicitly incorporates aspects of both pathogenesis and
salutogenesis. If the paradigm shift concept is not too grand
to apply, we could say that the shift is to a paradigm that
incorporates pathogenesis and salutogenesis. Even if modest
so far, this shift is perhaps the most promising contribution
of the salutogenic orientation to the health and social sci-
16
ences. Compared to other concepts relevant to a search for
the origins of health, such as assets, resources, coping and
resilience, salutogenesis is in a sense a complete concept,
offering a new outlook on health outcomes, health determi-
nants and health development processes. For many health
promotion researchers, using the term ‘salutogenesis’ com-
municates at a minimum that one pursues an alternative,
complementary approach to pathogenesis.
Many health resources and assets concepts (e.g. social
support, the sense of coherence, self-efficacy, hardiness and
action competency) have kinship under the salutogenesis
umbrella (Eriksson & Lindström, 2010). The umbrella also
covers diverse positive health conceptions such as quality of
life, flourishing and well-being. In this light, salutogenesis
might be defined simply as processes wherein individuals’
and communities’ resources are engaged to further individ-
ual and collective health and well-being. Of course, this
umbrella concept is a particular view of the salutogenesis
aficionado; a self-efficacy researcher might be inclined to
place salutogenesis under the umbrella in the company of all
the other positive health concepts.
Salutogenesis in Companionship:
Comparable Concepts and Developments
The salutogenic model originated as a stress and coping
model (Antonovsky, 1979). Antonovsky referred to Selye's
(1956) and Lazarus and Cohen's (1977) work as inspira-
tional. As does the salutogenic model, Lazarus and Cohen’s
transactional model of stress assumes an interaction between
external stressors and a person who evaluates stressors based
on the resources available to cope. In the domain of working
life, the well-established job demand-control model
(Karasek, 1979; Bakker et al., 2015), the effort-reward
imbalance model (Siegrist et al., 1986; Van Vegchel et al.,
2005) and the more generic job demands-resources model
(Bakker & Demerouti, 2007) share with the salutogenic
model the basic idea of a balance between stressors and
resources, and that they have been empirically tested in rela-
tion to disease outcomes. In a recent development, an organ-
isational health model has emerged from the explicit linking
of the job demand-resource model (Bakker & Demerouti,
2007) with salutogenesis (Bauer & Jenny, 2012; Brauchli
et al., 2015).
Salutogenesis as an orientation is an idea in close concert
with a broad academic movement towards a positive per-
spective on human life. There are traces of salutogenesis in
philosophy, at least since Aristotle reflected on the hedonic
and eudaimonic qualities of (positive) health (Ryan & Deci,
2001). Three decades before Health, Stress and Coping, the
World Health Organization’s constitution pronounced that
health is more than the absence of disease. Illich (1976)
M. B. Mittelmark and G. F. Bauer
commented on the medicalisation of life. Social epidemiol-
ogy has a long tradition of considering broad social determi-
nants of health beyond the proximal disease risk factors
(Berkman et al., 2014). More recent developments include
research on positive psychology and positive organisational
behaviour in organisational psychology (Nelson & Cooper,
2007), on happiness in management research (Judge &
Kammeyer-­Mueller, 2011), on place as a resource in social
ecology (Von Lindern, Lymeus & Hartig, this volume), on
promoting strengths in educational sciences (Jensen, Dür &
Buijs, this volume) and on pre-conditions for substantially
rewarding, satisfying and fulfilling lives in the field of posi-
tive sociology (Stebbins, 2009; Thin, 2014). In health pro-
motion, the positive paradigm is evident in the recent
literature of two kinds: that which describes protective fac-
tors against untoward outcomes (e.g. Boehm & Kubzansky,
2012) and that which describes factors promoting well-
being (Eriksson & Lindström, 2014).
Conclusions
This chapter—and this handbook—introduces a broad
swath of developments that excite the present generation
of salutogenesis scholars. Some of these developments
are relevant to the salutogenic model, others are firmly
focused on the sense of coherence and yet others are
more identifiable with salutogenesis as an orientation.
The book also takes up parallel developments in positive
psychology, occupational and organisational health sci-
ences, social ecology and educational sciences that may
make little explicit reference to salutogenesis and are in
evident close kinship with salutogenesis. It is one of the
main aims of this book to invite an inclusive, bridging
dialogue meant to nourish salutogenesis in all its mean-
ings. The book also aims to introduce salutogenesis
researchers to scientific kinfolk who contemplate matters
highly relevant to salutogenesis, even if they do so in
works of literature not searchable with the keyword
‘salutogenesis’.
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 Aaron Antonovsky (1923–1994):
The Personal, Ideological,
and Intellectual Genesis
of Salutogenesis
Avishai Antonovsky and Shifra Sagy
“Your candle burned out long before your legend ever did”
(Bernie Taupin, Candle in the wind).
Introduction
In January 1945, while serving in the American army and
stationed in New Guinea, Aaron Antonovsky (hereafter
Aaron) wrote a long letter to his younger brother, Carl, who
was then 13, ongoing adolescence. Aaron, at the age of 21,
expressed two things that would later on become a signifi-
cant part of his academic character. He wrote: “You don’t
know the meaning of ‘iconoclast’—but you know the idea,
because Avraham Aveenu [Abraham, one of the fathers in the
Bible] was one. What did he do? He looked all about him,
questioned everything, rebelled against everything … and he
mercilessly destroyed everything that was false. He broke
not only the idols themselves, but the belief he himself had
once had in them. He had not yet discovered the great prin-
ciple of his life, but he had cleared the way for it.” Years later,
perhaps less dramatically, pathogenesis was “removed” from
the agenda to make way for salutogenesis. Toward the end of
the letter, Aaron wrote: “… throughout our lives, we must
never stop asking questions; but it is most important now.” A
half a century later, in a tribute to Aaron, Ilona Kickbusch
wrote “… there is nothing more practical and efficient than
asking the right question …. Aaron Antonovsky consistently
This chapter is a revision and update of work published in Mittelmark,
M.B., Sagy, S., Eriksson, M., Bauer, G., Pelikan, J.M., Lindström, B.,
& Espnes, G.A. (eds). (2017). The Handbook of Salutogenesis.
Springer, Cham. DOI: https://doi.org/10.1007/978-­3-­319-­04600-­6
A. Antonovsky (*)
Department of Health and Well-being, Medical Corps, Israel
Defense Forces, Ramat-Gan, Israel
e-mail: Antonovsky.soc@gmail.com
S. Sagy
Martin Springer Center for Conflict Studies, Ben-Gurion
University of the Negev, Be’er Sheva, Israel
© The Author(s) 2022
M. B. Mittelmark et al. (eds.), The Handbook of Salutogenesis, https://doi.org/10.1007/978-3-030-79515-3_4
4
had the courage to ask the right question: how is health cre-
ated?” (1996, p. 5).
Rebelling against the mainstream and searching for the
right questions seem to be the two most salient characteristics
that bridge between Aaron the scholar and Aaron the man.
In this chapter, we wish to share some insights we have
regarding the development of the salutogenic idea, by draw-
ing lines connecting it to the person Aaron was. Having been
very close to Aaron for several decades, we feel that a certain
degree of familiarity with his personal background would
contribute to the understanding of the development of the
salutogenic theory. Therefore, we wish to shed some light on
Aaron’s personal experiences, ideological beliefs, and pro-
fessional development throughout his life, until the crystal-
lization of the salutogenic idea. Being close to him, and
knowing what he would prefer, we shall refer to him by first
name throughout this chapter (unless quoting others).
But how does one write about Aaron the scholar, without
diving too deeply into the world of salutogenesis, which will
be discussed thoroughly throughout this book? How does
one write about Aaron the man, without becoming too bio-
graphically boring? We shall try to accomplish this task by
avoiding strict academic writing; instead, following a brief
history of his life, we will highlight a few qualities which, we
believe, are characteristic of Aaron’s scholarly work and his
personal life. In doing so, we will quote friends and col-
leagues of Aaron’s who have agreed to contribute their
­illustrative memories to this chapter.1 These will be embel-
lished with some unknown, perhaps humorous, anecdotes.
Rebellion and the Importance of Questions
Aaron was born in the United States in 1923, 5 years after
the end of World War I and 6 years before the outburst of
the Great Depression. His parents and older sister had fled
from Russia a few years earlier, arrived in Canada, traveled
1
The names of these people are marked in bold typeface.
19
20
to England, and back to Canada before they finally settled
down in Brooklyn, New York. As a child, Aaron’s social
environment consisted of immigrant families, mostly
lower-class Jews and Italians. His father owned a small
laundry shop where his wife and two older children spent
many hours helping out. Somehow, they managed to sur-
vive the difficulties of adapting to a new culture in times of
a severe economic depression. Later, in the 1930s, Aaron’s
parents—for whom education was extremely important
(having little or no formal education themselves)—sent
him to a prestigious high school, and then to college, until
he was drafted into the American army during World War II
and sent to the Pacific.
As an adolescent, Aaron was deeply involved in the
HaShomer HaTza’ir Jewish youth movement, where he first
absorbed a socialistic ideology. As his younger brother Carl
told us, “Belonging to a Jewish organization was obvious.”
Selma Rieff, a close friend, who met Aaron as a child in the
youth movement, remembers those days, of endless ideo-
logical discussions, as most important in shaping Aaron’s
orientation to life.
This was perhaps the first instance of Aaron the rebel
because unlike most movement members, he was against
Communism. At the age of 26, after the establishment of the
State of Israel in 1948, Aaron came to Israel and was a found-
ing member of a kibbutz,2 where his socialist ideology came
into practice.
Upon returning to the United States in the early 1950s,
Aaron completed his doctorate in sociology at Yale
University. By that time, he had been involved in research
and writing about social class, discrimination, inequality,
immigration, and ethnic minorities. During this period, we
believe, the seeds were planted for what would a quarter of
a century later evolve into being the salutogenic model. For
Aaron, the two decades between 1955 and 1975 were years
of transition: personally, he had married, spent a year in
Iran and then came back to Israel (this time to the city of
Jerusalem), had a child born, and ended up in the city of
Beer Sheva, helping to set up a new medical school.
Professionally, Aaron moved back and forth between the
sociological studies on immigration, culture, and social
class, and the focus on sociology of health. During this
period, he was coauthor or coeditor of four books, which
are possibly not familiar today to health promotion schol-
ars, but we see them as tied to the salutogenic revolution:
Poverty and health (1969), Hopes and fears of Israelis
2
A kibbutz (in Hebrew: collection; plural: kibbutzim) is an Israeli
unique kind of collective settlement. A person living in a kibbutz is a
kibbutznik. There are a few hundred kibbutzim; the first established in
1909. Traditionally based on agriculture, they began as utopian socialist
communities, carrying the slogan “From each according to his ability,
to each according to his need.” Today, many kibbutzim have been priva-
tized, and industry has replaced much of the agriculture.
A. Antonovsky and S. Sagy
(1972), From the golden to the promised land (1979), and A
time to reap (1981).
People suffering discrimination, or poverty, or the
struggle to adjust to a new country as immigrants (or
founding a kibbutz on bare land in the summer heat or the
winter cold), are quite obviously prone to physical or
mental sickness. Still, many such people maintain good
health and well-being. The question that began to arise in
Aaron’s mind was not why some of these people feel mis-
erable, but rather how some of them manage quite well.
This question became more salient following a study of
women Holocaust survivors, many of whom were found
to be well adapted, despite the excruciating experience in
concentration camps and poor life conditions after immi-
gration to Israel.
The answer, which Aaron has termed the sense of coher-
ence, was to follow. But it was the salutogenic question—not
why does one become sick but how does one move toward
the health pole on the ease–dis-ease continuum—that consti-
tuted the major philosophical change in thought, from the
traditional pathogenic orientation to the salutogenic view of
the mystery of health.
The emphasis on asking the right question, as a key to
relevant answers, is, we believe, crucial to the advancement
not only of the study of health and well-being but also of all
scientific endeavors. Aaron’s mantra “Ask the right ques-
tion!” has been following one of us (AA), first as a teen-
ager, later as a young student, and to these days as a
researcher in the social sciences; it is useful in the aca-
demia, but no less in solving “simple” daily problems, be it
why the TV remote control does not work or where to go on
the next vacation.
Asking questions, in itself, is a kind of rebellion. It signi-
fies resistance to blind acceptance. But Aaron wanted more.
Aaron put into deeds the words attributed to Mark Twain:
“Whenever you find yourself on the side of the majority, it’s
time to pause and reflect.”
From a personal-developmental perspective, we see the
roots of Aaron’s salutogenic theory in his concrete child-
hood and adolescence experiences, from which he derived
the tendency to question the world and rebel against what
he believed was wrong. In a recent conversation, his
younger brother Carl described him as “very idealistic,
striving for a better world, intellectually curious, full of
compassion, and having a strong feeling of how things
should be done.”
Aaron’s parents, optimistically tackling the daily
hurdles in the time of the Great Depression, served for
him as living examples of viewing life as comprehen-
sible, manageable, and meaningful. It is, therefore,
clear why he dedicated his book Unraveling the mys-
tery of health (1987b) “To my parents … from whom I
learned about the sense of coherence.” A good illus-
tration of the strong bond between Aaron and his
4 Aaron Antonovsky (1923–1994): The Personal, Ideological, and Intellectual Genesis of Salutogenesis 21

Fig. 4.1 High school essay by Aaron Antonovsky (yellow markings added by the authors)

mother, his early idealistic thoughts of social justice
and health, and his tendency toward rebellion is found
in an excerpt from an English essay he wrote in high
school at age 16. The original, in Aaron’s handwrit-
ing, was typewritten by him several years later (see
Fig. 4.1). His essay, by the way, earned him a B+
mark.
 armth and Informality Versus Strictness
W
and Academic Demands
Several colleagues and friends have pointed out two charac-
teristics of Aaron that we know very well, and—we believe—
have enabled him not only to make his way to the hearts of
other people but also to be a good researcher and health edu-
22
cator: informality, on the one hand, and uncompromising
academic demands, on the other.
In a Western professional world where it is a custom to
go to work with shoes, a jacket, and a tie, Aaron was known
for his appearance with sandals, a short-sleeved shirt, and
of course no tie. This habit may have its origin in the kib-
butz life, and it was probably very convenient to wear such
an outfit in Beer Sheva (where Aaron lived for 18 years
while at Ben Gurion University of the Negev).3 We assume
that on very formal occasions abroad (i.e., outside Israel)
he would wear a tie, but in our memories (at least for AA),
the only time Aaron wore a suit and a bow-tie was for the
ceremony in 1993, in which he received an honorary doc-
torate at the Nordic School of Public Health in Göteborg,
Sweden.
An illustration of Aaron’s openness, talkativeness, and
informality is found in an article by Suzanne C. Ouellette
(Kobasa). In 1998, a special issue of Megamot (“Trends”—
the leading Israeli behavioral sciences journal) was devoted
to “Salutogenesis and wellness: Origins of health and well-­
being.” Ouellette, who developed the concept of hardiness at
about the same time that the idea of the sense of coherence
was born (e.g., Kobasa, 1979), wrote an article for the special
issue, titled “Remembering Aaron Antonovsky: A conversa-
tion cherished and one missed.” Here are a few excerpts of
that article (Ouellette, 1998), back-translated from Hebrew
(unfortunately, we were unable to find the original English
manuscript, which was translated into Hebrew for the special
issue):
I had only one opportunity to meet Aaron Antonovsky and enjoy
a lively, open, and informal conversation about research ques-
tions that had interested us. It took place at his parents’ apart-
ment in Brooklyn, New York. It was in summer 1982, only a few
years after each one of us published, without being introduced to
each other, what we had thought were new and unique calls for
research about the things that keep people healthy under stress.
In the phone conversation we had before that meeting, Aaron
explained that he was visiting his parents and told me a bit about
them and his relationship with them. His parents lived during the
time of the Holocaust and were now in their old age. His visit
was to make sure they are alright. It was also an opportunity for
him to gain strength from two people who had been, and still
were, key figures for him; an example of how people live, in
Aaron’s words, a salutogenic life.
At the meeting itself I got the impression that Aaron’s par-
ents were full of vitality despite their age (his father was over 90
and his mother was approaching 90). They did what was needed
to make sure their son’s stay in New York would be comfortable
and that our meeting would be pleasant for me as well. Aaron
was dressed informally: an army-like khaki shirt. I have seen
this kind of shirt, but usually in films in a desert area, not in the
streets of Brooklyn or Chicago. I wore a suit, but his outfit was
more appropriate for the summer heat that day. I looked more or
less like I thought that a young lecturer should look like at a
meeting with a senior scholar. The clothes remained the only
representations of our difference in status. The conversation
3
Beer Sheva is called the “capital of the Negev.” The Negev is a dry,
desert-like region in the southern part of Israel. The temperatures range
from about 10° (centigrade) in the winter to 35–40° in the summer.
A. Antonovsky and S. Sagy
itself was a free exchange of ideas between two people who had
committed themselves to certain questions regarding human
behavior, to the search for better-developed theories and for bet-
ter means to examine such theories.
Much of Aaron’s work consisted of simultaneously present-
ing his own work and the work of others. He developed his ideas
by putting them side by side with others’ similar ideas. He has
given us a lesson on how to work; his intention was not to show
that his approach was better; instead, he demonstrated how con-
frontations between the theoretical and practical ideas of differ-
ent researchers give rise to new questions, which may bring us
closer to a better understanding of human behavior. He showed
us that a sense of coherence can be found through the loneliness
of writing.
In the same spirit, Rudolf Moos of Stanford University
has recently written to us about Aaron:
He loved to engage in discourse with me and several of my col-
leagues and was always ready and eager to review his ideas and
to learn about our comments and criticisms. We had quite a few
long conversations about his ideas, which were incisive, origi-
nal, and rather revolutionary for the time.
Our own work focused heavily on the positive (and negative)
influences of the social context on health and behavior and on
the specific ways in which individuals could confront and man-
age stressful life events and life crises.
Regarding the way Aaron related to others’ criticisms,
Shifra Sagy (second author) remembers his openness to
critical opinions of other researchers, let them be senior or
junior. “He may have not been perceived as such in the aca-
demia,” says Shifra, “but I knew this characteristic of his
very well.” She elaborates:
He always encouraged me to express my opinion and even to
argue with him. He liked to tell the story of how I became
research coordinator for his big study on sense of coherence and
retirees’ adjustment. During my first job interview with him, I
said he is very wrong, including only retirees in the study, and
that to understand their adjustment to retirement he should also
have a sample of the retirees’ spouses.
I went home and told my husband there is no chance that I
got the job. Apparently, I was wrong; and the rest is history.
Deo Strümpfer, a friend and colleague from South
Africa, added:
He was the most supportive colleague and “teacher” a person
can ever hope to have. His comments on pre-publication papers
were incisive, yet always kind and warm; an amazing aspect was
how quickly he responded. He connected persons with similar
interests with one another.
Aaron’s informality has apparently struck the memories
of several other colleagues and students. Moshe Prywes, the
first Dean of the Beer Sheva medical school (died in 1998),
said: “I first met Aaron when he was a fellow at the Guttmann
Institute of Applied Social Research at the Hebrew University
of Jerusalem. I couldn’t help but notice the man who was
wearing shorts and sandals.” (Prywes, 1996, p. ii). Asher
Shiber, a medical student and later a colleague, lately
recalled that once every week or two, Aaron (and his wife,
4 Aaron Antonovsky (1923–1994): The Personal, Ideological, and Intellectual Genesis of Salutogenesis
Helen) would invite two or three students to their house for
dinner. Ayala Yeheskel, a social worker in Beer Sheva in the
mid-1980s, told us:
A while before a meeting with Antonovsky in January 1985, I
lost my son, Eldad. At the time I was employed as a social
worker in the Department of Psychiatry and in the Department
of Family Medicine at the Soroka Medical Center in Beer Sheva,
and spent much time teaching about the biopsychosocial
approach. Besides that, I was exploring possible topics for my
doctoral dissertation at the Hebrew University of Jerusalem, in
the context of life stories of Holocaust survivors. About a month
after my personal tragedy, emotionally uneasy, I turned to
Antonovsky for counseling. With utmost patience and tender-
ness, he listened, and at the end of the meeting he asked me a
question I will never forget: “Ayala, you are now in the midst of
your own private holocaust; how will you engage in a subject
you are so personally close to? In any case, I will help you and
wish you good luck.” I felt I had received approval, from an
admired and beloved person, of my ability—in spite of my per-
sonal circumstances—to carry on with the tasks I had planned
for myself.
Aaron’s informality and warmth were expressed not only
toward his colleagues and students. Several times, while on
visits abroad, Aaron was interviewed by local newspapers.
One would expect that a serious professor, a well-known
scholar in his field, would present himself in formal dress.
However, some photos show this was not the case: he was
photographed riding a bicycle or wearing short pants because
that is what made him comfortable (unfortunately, the
authors’ attempts to contact the newspapers and obtain per-
mission to use the 30- to 40-year-old photos were
unsuccessful).
 he Establishment of the Medical School
T eral decades. His leadership, absolute integrity and idealism per-
and the “Beer Sheva Spirit”
Although not directly related to salutogenesis or to Aaron’s
personal characteristics, it seems that a short background on
the establishment of the medical school in Beer Sheva is
needed in order to put several of the quotes and stories here-
after in context. Shimon Glick, professor of internal medi-
cine and former Dean of the Faculty of Health Sciences at
Ben Gurion University of the Negev, who worked with Aaron
from the first days of the medical school in the early 1970s,
described the formation of the “Beer Sheva spirit” and
Aaron’s contribution to it:
When Professor Moshe Prywes of Hebrew University and Dr.
Haim Doron of Kupat Holim4 launched the new medical school
at Ben Gurion University of the Negev it was not to produce
another medical school, but to create an educational institution
of another type entirely. This was to be a school which would
4
Kupat Holim, literally meaning “sicks’ fund,” is the Israeli health plan
and medical insurance institution.
23
train humanistic physicians with an orientation to the needs not
only of their specific patients but to the needs of the community
in which the school is located. These physicians would be sensi-
tive to the psychosocial and cultural aspects of medicine.
Wonderful sounding words, but really neither of the two found-
ers of the school, nor hardly any of the existing staff or of the
staff recruited to begin to teach at the school had any real con-
cept of how to accomplish this great and important mission.
Prywes recruited Aaron to be the spirit and guiding light of the
project. Aaron was a scholar in sociology of health, most of it
theoretical, as sociology usually is; now here was an amazing
challenge and opportunity to apply sociology to the creation of
an institution which would train a new kind of physician to serve
his/her community in the ideal manner, sensitive to the cultural
and psychological needs of the patients and their community.
Aaron was not just one of several department heads recruited to
join the new medical school, but was perhaps the key individual
who contributed to expressing and articulating clearly the
school’s goals and direction. He was among the handful of indi-
viduals who laid the framework for the school. Among the revo-
lutionary concepts were exposure of students in their first school
year to patients not just in the hospital, but in their community
settings, teaching them how to speak to the patients, how to
understand the influence of their surroundings, economic and
social conditions on their illness and the like. But first you had to
pick the right kind of students who would be open to this kind of
educational orientation. So, one had to change the selection pro-
cess which heretofore depended only on academic
achievements.
All of these steps Aaron designed and taught us, step by step.
Speaking for me personally, who arrived as professor of internal
medicine in 1974 when the school opened, these ideas were new.
I had never heretofore read an article in medical sociology, had
never even heard of Antonovsky, but quickly became in some
way a devoted follower of his. His ideas and concepts resonated
with me and we shared fully the goals. He taught us how to inter-
view patients, how to teach students to do so. He also created the
admission process to the medical school, helped select the mem-
bers of the admission committee, trained them and set into
motion a unique process that has continued successfully for sev-
meated the process and made the admission committee a most
prestigious and respected unit in the school, trusted by all.
In reality, most physicians and basic scientists at the institu-
tion did not really fully comprehend and buy into his philosophy,
because their focus and training had been in the traditional bio-
medical model. But Aaron influenced enough of the key people
and had the full support and backing of the medical school lead-
ership. I believe that the so called “Beer Sheva spirit,” which
characterizes the school and its graduates to this day, is the spirit
instilled by Aaron. And in the spirit of salutogenesis that is what
keeps the institution on the “right” track often in the face of
adversity and administrative and bureaucratic problems.
On a more personal level, Shimon Glick mentioned that
during almost 20 years of working together with Aaron at the
medical school, himself being religious and Aaron growing
up in HaShomer Hatza’ir (encompassing great ideological
differences and conflicting outlooks), they have always
respected one another and had much in common.
Milka Sampson is secretary of the Department of
Sociology of Health at Ben-Gurion University, of which
Aaron was chairperson. She worked with Aaron from the
time she was appointed, in 1984, until he formally retired in
24
1993. She described Aaron as “an honest and fair man, from
whom I learned so much.” She was a beginner secretary in
her early 20s and remembers that “Professor Antonovsky”
insisted she call him “Aaron.” Before Milka, there was a sec-
retary who would always address him as “professor.” Ofra
Anson, who worked with Aaron in the Department of
Sociology of Health for almost 20 years, told us in a recent
interview that Aaron once said to her in despair, relating to
the secretary: “For Heaven’s sake, we work together! Why
doesn’t she stop calling me ‘the professor’?!”
Shifra Sagy (second author), who was Aaron’s doctoral
student and later a colleague in the department, mentioned
the “Friday cakes”: every Friday, it was someone else’s turn
to bring a cake to the staff meeting. Aaron had insisted that
each one must prepare a cake by him/herself (one time, on
his turn, he wanted to bake a fruit cake, but the only fruit he
had at home was a grapefruit; so he baked a grapefruit cake
…). In these matters, everyone belonged to the same social
status. For example, they would all take turns washing
dishes.
The Friday gatherings were devoted not only to profes-
sional matters. Actually, this was also an opportunity to dis-
cuss a good book someone had read, or to celebrate
someone’s birthday, or to argue about politics. However,
even though Aaron’s belief system has probably influenced
several of his career choices, he meticulously separated ide-
ology from scientific objectivity. Zeev Ben-Sira, a medical
sociologist from the Hebrew University of Jerusalem who
passed away about a year after Aaron, addressed this issue in
an obituary written a short while after Aaron’s death (1995,
unpublished):
Aaron was an idealist, believing in the future of a better and just
world. He vehemently contended against social injustice, dis-
crimination, and intolerance. However he unpromisingly sepa-
rated between his beliefs and his scholarly work. He strongly
resisted any intrusion of ideologies into scientific objectivity.
Doubtlessly, his beliefs in a better world influenced the
choice of the field of his scholarly work, yet did not contaminate
the objective, scrupulous and unbiased approach to his research.
Understandably, then, his initial steps in his scientific career
and research were devoted to the study of social discrimination,
inequality, intergroup and ethnic relations, and of the absorption
of immigrants.
Aaron’s personal affection was combined with the great
importance he ascribed to community medicine. Aya
Biderman, a family doctor, recollects her meeting with
Aaron:
In 1980 I arrived for internship at the Soroka Medical Center in
Beer Sheva, after studying medicine in Jerusalem. During that
year I came to know Dr. Aaron Antonovsky, or “Aaron” as he
insisted that we call him.
In 1981 I began to specialize in family medicine. The
Department of Family Medicine was next door to the Department
of the Sociology of Health, of which Aaron was chairperson.
A. Antonovsky and S. Sagy
Aaron had special feelings toward our profession. He said fam-
ily medicine was one of the “islands” in which the biopsychoso-
cial model should be applied.
As a young doctor, I conducted a study on the reasons why
some patients do not attend their family doctor. I hoped to have
it published and thought the data may interest Aaron. I met with
him to ask for his help, and he agreed. Thanks to him I had my
first publication in the medical literature. Aaron’s willingness to
help a young doctor, who had no experience in research or writ-
ing, was very significant and gave me the push and the enthusi-
asm toward research and academic practice.
Aaron also agreed to teach a biopsychosocial seminar in our
department. It was a great learning experience which we (the
young doctors) carried with us for years.
The duality of Aaron the man and Aaron the scholar was
also expressed in daily work. Alongside with the warm atmo-
sphere and informal relationships in the department, Aaron
was strict about work. The department was quite small (6–7
people), and it was important for Aaron that each one would
know what others were working on, as a means of mutual
fertilization. He demanded from himself what he asked of
others, even when it came to things normally done by junior
research assistants, such as counting questionnaires. Shifra
recalls that when she was beginning her doctorate, Aaron
insisted that she write in English. She then gave him her
handwritten draft of part of her work. The next day, Aaron
gave it back to her, typewritten and corrected.
Indeed, Aaron gave his students lots of hard work. For
Israeli students, most of whom have part-time jobs beside
their academic studies, spending hours and hours in the
library was not a trivial matter. Asher Shiber remembers his
basic studies in medical school with Aaron: “The first thing
he did was to send me to the library to read and read and read
…. As an enthusiastic medical student, I wanted to do medi-
cine, not read about medical research.” As the time passed,
though, students realized that hard work is productive, and
they learned to appreciate Aaron’s strictness. Asher sums this
point: “With all my appreciation toward Aaron as a profes-
sional, the first thing that comes to my mind when I think of
him is how much I loved him as a person.”
Reading and reading and reading was not only a home
work task which Aaron had given his students. Being a book-
worm himself, Aaron believed in broadening one’s educa-
tion. Joel Bernstein, a neighbor, a friend, and a colleague
from the life sciences, wrote to us:
Our professional backgrounds might not have led to any aca-
demic interaction was it not for the connection with Judy.5
However, from the beginning there were social gatherings and I
found myself in the company of a true intellectual. I do not think
a visit to the Antonovsky home passed without me reviewing the
books lying on the table or in the shelves. The collection was
5
Judy Bernstein was Aaron’s research and teaching assistant and later
became a faculty member in the Beer Sheva medical school, where she
worked until her premature death in 2001.
4 Aaron Antonovsky (1923–1994): The Personal, Ideological, and Intellectual Genesis of Salutogenesis
truly eclectic, with a scattering of Yiddish literature (in the origi-
nal), philosophy, political science (much from the liberal aca-
demics of the 1950s and 1960s), and of course sociology and
psychology. The Antonovsky abode was no more than 150
meters from ours. They moved in about a year after we did, and
like everyone had to install an irrigation system—for which,
with only the experience of having done my house, I became the
consultant, and occasionally technical assistant.6
With Joel’s help, Aaron spent several hours working in
the garden. The first author of this chapter, having spent
much time with Aaron in the garden, thinks it is possible that
the seeds Aaron planted in the desert soil around the new
house in 1973 were, to some extent, seeds of the salutogenic
idea; more than once he would look at a few plants, some
dying and some still alive, take a closer look at the green
ones, and mumble “I wonder how they survive.”
We believe that the importance Aaron saw in informal
relationships and in expanding one’s knowledge is tied to
two unique qualities of the new medical school he had helped
to establish, which we touched upon above, quoting Shimon
Glick. First, the selection process: unlike at other universi-
ties, the main criterion for accepting candidates to medical
school was not matriculation grades or psychometric scores,
but rather results of two stages of semi-structured interviews.
Taking into account criticism on an interview as a selection
instrument, it seems that in Beer Sheva they have managed to
overcome its disadvantages. As Aaron wrote, “In our case,
there has come into being a widespread belief among faculty
and students: more humane and responsible, less individual-
istic and competitive, more compassionate and concerned”
(Antonovsky, 1987a).
This quote brings back a story one of us (AA) has heard
once from Dina Ben-Yehuda, who was one of Beer Sheva’s
first graduates. Today she is chair of the Department of
Hematology at Hadassah Medical Center in Jerusalem and
Dean of the Faculty of Medicine at the Hebrew University.
The anecdote occurred when Dina was already a senior doc-
tor at Hadassah (forgive us if there are minor inaccuracies).
One evening, a senior citizen in his 80s was brought by an
ambulance to the emergency room (ER), after having experi-
enced dizziness and weakness. The doctor in charge of the
ER that evening, a senior resident, had the patient go through
blood tests, a neurological test, and an ECG. After reviewing
the results, with no significant findings, the resident doctor
ordered the nurse to discharge the guy and send him home. A
young intern, who was with the resident, then said: “if I may,
I suggest we keep him here for the night.” The resident’s
response was “he’s fine, nothing’s wrong with him, and we
need the bed.” The intern replied: “Indeed, he seems to be
okay; but he’s a widower, no one is waiting for him at home.
He would probably be happy to be around people, to have
someone make him a cup of tea. I’m sure we can find a bed
6
We mourn the sudden death of Joel Bernstein which occurred in 2019.
25
for him. Why don’t we let him spend the night here and send
him home tomorrow morning?”
Dina, who was off duty, happened to be in the ER at that
time and overheard the conversation. She later approached
the intern and said “You studied in Beer Sheva, right?” No
doubt, she knew what she was saying…
The second unique quality of the Beer Sheva medical
school was the very early stage at which students faced the
real world of treating patients. During their first year, stu-
dents visited community clinics in development towns in the
Beer Sheva region, where they met with the poor, the unem-
ployed, and the immigrants who had lost faith in the govern-
ment’s promises for good life. In addition, each student was
hospitalized for a few days, without revealing to the medical
staff the fact that they were not real patients. They learned
that beside anatomy, physiology, and chemistry, it is of
utmost importance to learn about doctor-patient
relationships.
Ascher Segall, another neighbor, friend, and colleague,
and one of the founders of the Beer Sheva medical school,
related to the link between Aaron the medical sociologist and
Aaron the person:
One of his most striking characteristics was the ability to main-
tain complete objectivity as a scholar in parallel with a consis-
tent commitment to the values in which he deeply believed. His
development of the theory and practice of salutogenesis attests
to his rigor and creativity in research while his focus on the
humanistic dimensions of medical education reflected his world
view as a human being …. His impact as a teacher at the Ben
Gurion School of Medicine went far beyond his formal
teaching.
The impact Ascher Segall referred to is also reflected in
the words of Aaron’s students. For example, in a tribute by
Moshe Prywes in a special issue of the Israel Journal of
Medical Sciences in memory of Aaron, he cited Professor
Dina Ben-Yehuda (whom we mentioned earlier), who was a
former student of Aaron. Dina was a member of the first
class of the Ben Gurion medical school, and 20 years later
was Aaron’s personal doctor at the Sharet Institute of
Oncology in Jerusalem, where he was admitted after being
diagnosed with leukemia. Prywes had asked her about Aaron,
and she replied: “For Ben Gurion graduates, Professor
Antonovsky was not just a name. He was a concept. A con-
cept that contains within it much discussion and debate, all
pertaining to the doctor-patient relationship … I took care of
Aaron when he was sick and was with him until he died.
During that time, he was in full control of all decisions con-
cerning himself. When his condition deteriorated, he called
me into his room and asked me to discontinue all treatment,
and he took leave of his family and friends. I feel that I have
lost the best of my teachers.” (Prywes, 1996, p. ii).
The influence Aaron had on students was reciprocal, and
so was the respect students and Aaron felt toward each other.
26
Aaron’s socialist ideology, and his strong belief in all people
being equal, may have played a role in the way he prepared
the draft for his first book, Health, stress, and coping
(Antonovsky, 1979), as told by Leonard Syme, a colleague
from the University of California at Berkeley:
Aaron wrote me in the spring of 1977 to ask if he could spend a
sabbatical year at Berkeley.7 I said “yes!” immediately of course.
When he arrived on campus in the fall of that year, I was able to
find him a remarkable office. The office was in the basement of
Stephens Hall at the end of a hallway that overlooked Strawberry
Creek. It was basically isolated from the rest of the building and
looked out over beautiful trees and a babbling little brook.
Then we talked. Aaron said he had this idea about writing a
book on something called “salutogenesis.” He explained what
this word meant and I was captivated. To have one of the world’s
great scholars come to Berkeley to explore a truly exciting and
original idea was one of the great moments in my life. I asked
how I could help. He said he would love to give a seminar that
fall in which he could explore his ideas. It took two days to
recruit an excited class of Social Epidemiology graduate stu-
dents for the seminar.
What happened next was one of the most amazing things I
had ever seen. Aaron welcomed them to the seminar, explained
how it would work, and assigned them to critically review a draft
chapter that he had written after arriving at Berkeley. The next
week, students discussed their assignment and, as they were
leaving the room, they were asked to review another new chapter
that Aaron had just written during the previous 7 days. This went
on for 15 weeks. After the semester ended, Aaron had finished a
complete draft of his book and was ready to send it off to a pub-
lisher. And the book, was, of course a classic.
What a mind he had! I have thought about this remarkable
Antonovsky phenomenon many years since it happened.
In 1983, Aaron returned to Berkeley for another sabbati-
cal, again in an office overlooking the creek. Guy Bäckman,
from the Åbo Akademi University in Finland, who met Aaron
in Berkeley, wrote to us about their acquaintance:
Unraveling the enigma or mystery of health was at that time a
big question and theme among the researchers in Berkeley.
Questions of frequent occurrence were “Why are only some of
us sick although all of us are, at least in some way, exposed to
risks?” and “How do we manage to stay healthy?” I had many
fruitful discussions on those themes with Aaron in his office on
the Berkeley campus, where, from the window, we could see lots
of greenery and running water, which certainly stimulated talk
about what it might be that keeps people in good condition and
health in changing and sometimes risky and chaotic
circumstances.
A Closure and New Horizons
Haim Gunner, an old friend from the days of the youth move-
ment and today a professor of environmental sciences, beauti-
fully summarized the inseparable arenas that made up Aaron’s
7
In 1977, Leonard Syme was chairman of the Department of Biomedical
and Environmental Health Sciences in the School of Public Health at
the University of California, Berkeley.
A. Antonovsky and S. Sagy
life—the quest for a just world of social equality, and the aca-
demic journey toward unraveling the mystery of health:
The engaged and enthusiastic academic of his later years slips
into the image of the devoted kibbutznik and the fields where we
shared tractor and plough. And in the evenings, on a crowded
balcony with the hills of Galilee facing us, dissected the future
with the complete confidence of youth.
Consciously or otherwise, Aaron’s life was the model for the
salutogenic principle. Two projects dominated his life: initially,
the kibbutz and the model society to be derived from it, and
always the ongoing fulfillment of the Zionist ideal. And then the
building of the medical faculty at Ben Gurion University around
the new concept of the family as the arbiter of the individual’s
health. For the kibbutz, comprehensibility was derived from the
perhaps naive, but nonetheless coherent view that Marxism pro-
vided. And not only was the project which promised equality
and security to be a local event but one which would eventually
pervade the entire social structure. Marxism with its dicta and
comprehensive weltanschauung made it eminently predictable.
Our belief in our skills and the support of the community made
it eminently manageable, and our passionate belief, buttressed
by juvenile psychoanalytic insights, that it gave meaning to our
lives make the kibbutz and its realization the perfect model for
the principles of salutogenesis: comprehensibility; manageabil-
ity and meaningfulness.
We wish we could devote a few paragraphs to the words
Aaron’s beloved wife, Helen, would have to say for this
book. Unfortunately, Helen passed away in 2007. Along the
36 years of marriage to Aaron, she was his greatest supporter,
admirer, and critic. There was probably not even one article,
lecture, or book of Aaron’s that went to press before Helen
had read and approved the manuscript. A research psycholo-
gist and scholar in her own right, Helen was an inseparable
part of the scholar and the man Aaron was.
Shifra Sagy (second author) has been engaged in saluto-
genic research throughout her academic career, specializing in
social-psychological and collective aspects of sense of coher-
ence. She introduced the salutogenic paradigm into the
Department of Education, where she headed the educational
psychology program for several years. After her retirement, she
is still heading the research center of conflict studies at Ben
Gurion University of the Negev, under the philosophical agenda
of salutogenesis. Avishai (first author) is a social psychologist
and grew up in a “salutogenic” household, but until a few years
ago salutogenesis has not been a central part of his academic
work. However, currently Avishai is leading the implementa-
tion of salutogenic thought, as well as the conduction of
research, in the Department of Health and Well-­being of the
Israeli Medical Corps. This promising line of work is described
in more detail elsewhere in this book. Aaron would probably be
surprised, and hopefully happy, to learn about this new path
salutogenesis is marching on. As it appears, salutogenesis has
gone way beyond the scope of medical sciences and health, and
has become an interdisciplinary area of research and practice.
Aaron passed away in 1994, but his salutogenic vision
continues to stimulate theory, research, and policy-making
4 Aaron Antonovsky (1923–1994): The Personal, Ideological, and Intellectual Genesis of Salutogenesis 27

worldwide. We hope students and professionals around the
world will profit from this comprehensive handbook on salu-
togenesis, and perhaps some of them will continue to develop
salutogenic research and carry it on to new horizons. After
all, salutogenesis is not limited to physical or mental health;
it is a philosophy of human existence.
References
Antonovsky, A. (1979). Health, stress, and coping. San Francisco:
Jossey-Bass.
Antonovsky, A. (1987a). Medical student selection at the Ben Gurion
University of the Negev. Israel Journal of Medical Sciences, 23,
969–975.
Antonovsky, A. (1987b). Unraveling the mystery of health. San
Francisco: Jossey-Bass.
Kickbusch, I. (1996). Tribute to Aaron Antonovsky—‘what creates
health’. Health Promotion International, 11, 5–6.
Kobasa, S. C. (1979). Stressful life events, personality, and health:
An inquiry into hardiness. Journal of Personality and Social
Psychology, 37, 1–11.
Ouellette (Kobasa), S. C. (1998). Remembering Aaron Antonovsky:
A conversation cherished and one missed. Megamot, 39, 19–30.
(Hebrew).
Prywes, M. (1996). A tribute. Israel Journal of Medical Sciences, 32,
i–ii.

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 Aaron Antonovsky’s Development
of Salutogenesis, 1979–1994
Hege Forbech Vinje, Eva Langeland, and Torill Bull
Introduction
I hope it will become clear in due course that my concern is no
mere semantic quibble and that here, as in all of science, how
one poses the question is crucial to the direction one takes in
looking for the answers (Antonovsky, 1979, p. 12).
When a person thinks seriously about a topic over a period
of about three decades, it is a sign of good thinking and per-
sonal development if, at the end of that period, he/she is no
longer in total agreement with former ideas. Adventures
along the road become the germ (to use Antonovsky’s own
expression) of new ideas and layers of understanding. So
was also the case with the development of the salutogenic
model of health (SMH), a development described by
Antonovsky himself in retrospect as a “personal odyssey”
over decades (Antonovsky, 1990). While Chap. 3 portrays
Antonovsky, the man and the researcher, this chapter por-
trays the SMH and its development along with life events of
its creator until the untimely death of Antonovsky in 1994.
The chapter is based on the authorship of Antonovsky him-
self. Papers written in his last years, in which he looks back
and comments on how his thinking developed, have been of
particular value. These papers come in addition to the publi-
This chapter is a revision and update of work published in Mittelmark,
M.B., Sagy, S., Eriksson, M., Bauer, G., Pelikan, J.M., Lindström, B.,
& Espnes, G.A. (eds). (2017). The Handbook of Salutogenesis.
Springer, Cham. DOI: https://doi.org/10.1007/978-­3-­319-­04600-­6
H. F. Vinje (*)
THE FORBECH VINJE ACADEMY (www.forbechvinje.no),
Sandefjord, Norway
E. Langeland
Department of Health and Caring Sciences, Faculty of Health and
Social Sciences, Western Norway University of Applied Sciences,
Bergen, Norway
T. Bull
Department of Health Promotion and Development, Faculty of
Psychology, University of Bergen, Bergen, Norway
© The Author(s) 2022
M. B. Mittelmark et al. (eds.), The Handbook of Salutogenesis, https://doi.org/10.1007/978-3-030-79515-3_5
5
cations in which he originally introduced his ideas. In the
SMH, there are important concepts, the development of
which we trace in this chapter: stress, breakdown, resources,
sense of coherence (SOC), and health.
Antonovsky departs, in his two major books (Antonovsky,
1979, 1987) from the traditional medical view of homeosta-
sis being the basic human condition, and introduces the fun-
damental philosophical view of “the human organism as
prototypically being in the state of heterostatic disequilib-
rium as the heart of the salutogenic orientation” (Antonovsky,
1987, p. 130). The release of Health, Stress and Coping in
1979 was a culmination of 15 years of work, during which he
came to understand that disease, illness, and entropy (decline
into disorder) are the norm rather than the exception to a rule
of otherwise self-regulated homeostatic processes occasion-
ally being disturbed with resulting pathology. He found it to
be a futile task to try to understand and control every single
factor that might lead to this or that particular disease. A
more fruitful approach would be to focus on what he found
to be the overall problem of active adaptation to an environ-
ment in which stressors are omnipresent and inevitable. He
presented the term negative entropy (Antonovsky, 1987,
p. 9) in which the goal was to search for useful inputs to the
sociocultural context, the physical environment, and into the
organism down to the cellular level to counter the normal
tendency of entropy. So, negative entropy, or negentropy as
he also termed it, is actually something positive.
In his efforts to study health instead of disease, Antonovsky
coined his famous new word: “salutogenesis—of the origins
(genesis) of health (saluto)” (Antonovsky, 1979, preface
vii), the intriguing question being: what are the origins of
health? In the course of his research, Antonovsky corre-
spondingly offered an answer to the question: “The origins
of health are to be found in a sense of coherence”
(Antonovsky, 1979, preface vii). This question and the
answer constitute the SMH, the development of which is the
focus of this chapter. In his descriptions of the model, most
importantly of the process developing it, he points to the
struggles it entailed for him, and for other researchers and
29
30
practitioners, to move from one paradigm to another: “I have
no illusions. A salutogenic orientation is not likely to take
over. Pathogenesis is too deeply entrenched in our think-
ing.…” (Antonovsky, 1996b, p. 171). Antonovsky urged,
nevertheless, researchers of different professions, and with
use of different methodologies, to work together to bring the
knowledge of the origins of health increasingly further.
Antonovsky worked on the SMH for more or less 30 years.
The first 15 years resulted in his book Health, Stress and
Coping in 1979, and the presentation of SMH in its entirety.
The next 15 years he was improving, refining, and cultivat-
ing the understanding of the model and the elements in it.
The release of his 1987 book Unravelling the Mystery of
Health represented a peak in his career. This release was
originally intended to be a revised version of Health, Stress
and Coping, but ended up being a whole new book, primarily
presenting and explaining the concept of sense of coherence,
his answer to the salutogenic question. His second book
became a huge success and is translated into several
languages.
In the preface of his first book, Antonovsky (1979) points
out that he offers no easy solutions to the salutogenic ques-
tion, and that he does not shy away from technical discus-
sions when needed. His writings are directed not only to his
colleagues in medical sociology but also to sociologists, psy-
chologists, psychiatric nurses, physicians, healthcare orga-
nizers, epidemiologists, architects, community organizers,
and even more, who professionally or personally want to
understand and enhance the adaptive capacities of human
beings (Antonovsky, 1979, preface viii). His rather wide
scope of intended audience is also reflected in the cross sec-
tion of where he finds theoretical and intellectual inspiration.
He expresses indebtedness to students, research assistants,
and colleagues, without whom he would not have reached as
far as he did. Repeatedly he points out the necessity and
value of students’ and peers’ criticism not only for the ideas
he took from them but also for the intellectual challenge in
the need to explain why. Not only throughout Health, Stress
and Coping especially but also in Unravelling the Mystery of
Health, Antonovsky specifies to whom he owes his intellec-
tual debts. He names and credits scholars such as Hans Selye,
René Dubos, George Engel, Thomas Holmes, Richard Rahe,
John Cassel, and Melvin Kohn. As he believes to have bro-
ken new ground, he also claims to see echoes of his ideas
everywhere (Antonovsky, 1987, p. 34). Although he says he
finds evidence of the influence of great thinkers in his work,
he describes a feeling of relative isolation when introducing
the concept of salutogenesis and developing the SMH. As he
narrates every other researcher of the time focused on the
need to explain pathology, his feeling of isolation intensified
with the introduction of the sense of coherence, the answer to
the salutogenic question (Antonovsky, 1987, p. 33). In devel-
oping the SMH, not only did he detach himself from his ear-
H. F. Vinje et al.
lier work but also from the work of just about everyone else
at the time. Around the time of the release of Health, Stress
and Coping, he finds, however, that the salutogenic question
is increasingly asked, and he is intrigued to notice that seri-
ous research studies at least partly congruent with the SOC
concept are being performed. He no longer feels alone as
elements, variants, and alternative understandings of health
and illness in the social sciences are surfacing (Antonovsky,
1987, p. 34). Antonovsky humbly credits this development
primarily to the serious research of colleagues, and not so
much to his own work. He dedicates a chapter in his 1987
book to convergences, discrepancies, and disagreements of
the research of Suzanne Kobasa, Thomas Boyce, Rudolf
Moos, Emmy Werner, and David Reiss and demonstrates
once more how his ideas and theories develop in interaction
with the theories of other scholars.
In all his writings about the SMH, Antonovsky gives a
somewhat personalized account of how he came to work on
the subject at hand, he presents challenges he encounters on
his way, and he clarifies and explains how he moves ahead
and reaches the point at which he stands when writing this
particular book or paper. Apparently he learnt this approach
from Oriental scholars (Antonovsky, 1979, prologue 1).
Being so detailed about his research process makes a very
interesting read, and gives the impression of a humble
scholar, on his way, inviting other researchers in on his
reflections. Antonovsky declares that the SMH is merely one
part of the conceptualization of what he finds to be one of the
greatest mysteries of the study of human beings: “How do
we manage to stay healthy?” (Antonovsky, 1979, preface
vii). On a hopeful note, in Health, Stress and Coping he
expresses a wish that the salutogenic question is convincing
enough for researchers to take up the gauntlet and develop
the model further; of which this book is a clear
demonstration.
Stress Research: The Principal Note
At the outset, Antonovsky was not particularly interested in
stress (Antonovsky, 1990). In retrospect, however, he singles
out research (Hollingshead & Redlich, 1958; Kardiner &
Ovesey, 1951; Selye, 1956) causing him to stop a little and
reflect upon questions relevant to stress during his training
years in the Yale Sumner-Keller anthropological tradition in
the 1950s. Nonetheless, at the time, he found them periph-
eral to his main interests, and he did not believe he would
spend most of his career studying the stress process. His
major interests during these formative years were in “culture
and personality, stratification and ethnic relations”
(Antonovsky, 1990, p. 71). Growing up as he did in
New York, being the son of Jewish parents, one can assume
this interest was awakened by his exposure to both Jewish
Another random document with
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been thoroughly well known in that country. Facts are facts. Where
among our painters are we to search for the artist who can decorate
our walls with imperishable colors? Ages after our pigmy buildings
will have crumbled into dust, and the cities enclosing them will
themselves have become shapeless heaps of brick and mortar, with
forgotten names—long after that will the halls of Karnak and Luxor
(El-Uxor) be still standing; and the gorgeous mural paintings of the
latter will doubtless be as bright and vivid 4,000 years hence, as they
were 4,000 years ago, and are to-day. “Embalming and fresco-
painting,” says our author, “was not a chance discovery with the
Egyptians, but brought out from definitions and maxims like any
induction of Faraday.”
Our modern Italians boast of their Etruscan vases and paintings;
the decorative borders found on Greek vases provoke the admiration
of the lovers of antiquity, and are ascribed to the Greeks, while in
fact “they were but copies from the Egyptian vases.” Their figures
can be found any day on the walls of a tomb of the age of Amunoph
I., a period at which Greece was not even in existence.
Where, in our age, can we point to anything comparable to the
rock-temples of Ipsambul in Lower Nubia? There may be seen sitting
figures seventy feet high, carved out of the living rock. The torso of
the statue of Rameses II., at Thebes, measures sixty feet around the
shoulders, and elsewhere in proportion. Beside such titanic sculpture
our own seems that of pigmies. Iron was known to the Egyptians at
least long before the construction of the first pyramid, which is over
20,000 years ago, according to Bunsen. The proof of this had
remained hidden for many thousands of years in the pyramid of
Cheops, until Colonel Howard Vyse found it in the shape of a piece
of iron, in one of the joints, where it had evidently been placed at the
time this pyramid was first built. Egyptologists adduce many
indications that the ancients were perfectly well acquainted with
metallurgy in prehistoric times. “To this day we can find at Sinai large
heaps of scoriæ, produced by smelting.”[812] Metallurgy and
chemistry, as practiced in those days, were known as alchemy, and
were at the bottom of prehistoric magic. Moreover, Moses proved his
knowledge of alchemical chemistry by pulverizing the golden calf,
and strewing the powder upon the water.
If now we turn to navigation, we will find ourselves able to prove,
on good authorities, that Necho II. fitted out a fleet on the Red Sea
and despatched it for exploration. The fleet was absent above two
years and instead of returning through the Straits of Babelmandel, as
was wont, sailed back through the Straits of Gibraltar. Herodotus
was not at all swift to concede to the Egyptians a maritime
achievement so vast as this. They had, he says, been spreading the
report that “returning homewards, they had the sunrise on their right
hands; a thing which to me is incredible.” “And yet,” remarks the
author of the heretofore-mentioned article, “this incredible assertion
is now proved incontestable, as may well be understood by any one
who has doubled the Cape of Good Hope. Thus it is proved that the
most ancient of these people performed a feat which was attributed
to Columbus many ages later. They say they anchored twice on their
way; sowed corn, reaped it and, sailing away, steered in triumph
through the Pillars of Hercules and eastward along the
Mediterranean. “There was a people,” he adds, “much more
deserving of the term ‘veteres’ than the Romans and Greeks. The
Greeks, young in their knowledge, sounded a trumpet before these
and called upon all the world to admire their ability. Old Egypt, grown
gray in her wisdom, was so secure of her acquirements that, she did
not invite admiration and cared no more for the opinion of the flippant
Greek than we do to-day for that of a Feejee islander.”
“O Solon, Solon,” said the oldest Egyptian priest to that sage. “You
Greeks are ever childish, having no ancient opinion, no discipline of
any long standing!” And very much surprised, indeed, was the great
Solon, when he was told by the priests of Egypt that so many gods
and goddesses of the Grecian Pantheon were but the disguised
gods of Egypt. Truly spoke Zonaras: “All these things came to us
from Chaldea to Egypt; and from thence were derived to the
Greeks.”
Sir David Brewster gives a glowing description of several
automata; and the eighteenth century takes pride in that masterpiece
of mechanical art, the “flute-player of Vaucanson.” The little we can
glean of positive information on that subject, from ancient writers,
warrants the belief that the learned mechanicians in the days of
Archimedes, and some of them much anterior to the great
Syracusan, were in no wise more ignorant or less ingenious than our
modern inventors. Archytas, a native of Tarentum, in Italy, the
instructor of Plato, a philosopher distinguished for his mathematical
achievements and wonderful discoveries in practical mechanics,
constructed a wooden dove. It must have been an extraordinarily
ingenious mechanism, as it flew, fluttered its wings, and sustained
itself for a considerable time in the air. This skilful man, who lived
400 years b.c., invented besides the wooden dove, the screw, the
crane, and various hydraulic machines.[813]
Egypt pressed her own grapes and made wine. Nothing
remarkable in that, so far, but she brewed her own beer, and in great
quantity—our Egyptologist goes on to say. The Ebers manuscript
proves now, beyond doubt, that the Egyptians used beer 2,000 years
b.c. Their beer must have been strong and excellent—like everything
they did. Glass was manufactured in all its varieties. In many of the
Egyptian sculptures we find scenes of glass-blowing and bottles;
occasionally, during archæological researches, glasses and
glassware are found, and very beautiful they seem to have been. Sir
Gardner Wilkinson says that the Egyptians cut, ground, and
engraved glass, and possessed the art of introducing gold between
the two surfaces of the substance. They imitated with glass, pearls,
emeralds, and all the precious stones to a great perfection.
Likewise, the most ancient Egyptians cultivated the musical arts,
and understood well the effect of musical harmony and its influence
on the human spirit. We can find on the oldest sculptures and
carvings scenes in which musicians play on various instruments.
Music was used in the Healing Department of the temples for the
cure of nervous disorders. We discover on many monuments men
playing in bands in concert; the leader beating time by clapping his
hands. Thus far we can prove that they understood the laws of
harmony. They had their sacred music, domestic and military. The
lyre, harp, and flute were used for the sacred concerts; for festive
occasions they had the guitar, the single and double pipes, and
castanets; for troops, and during military service, they had trumpets,
tambourines, drums, and cymbals. Various kinds of harps were
invented by them, such as the lyre, sambuc, ashur; some of these
had upward of twenty strings. The superiority of the Egyptian lyre
over the Grecian is an admitted fact. The material out of which were
made such instruments was often of very costly and rare wood, and
they were beautifully carved; they imported it sometimes from very
distant countries; some were painted, inlaid with mother-of-pearl,
and ornamented with colored leather. They used catgut for strings as
we do. Pythagoras learned music in Egypt and made a regular
science of it in Italy. But the Egyptians were generally considered in
antiquity as the best music-teachers in Greece. They understood
thoroughly well how to extract harmonious sounds out of an
instrument by adding strings to it, as well as the multiplication of
notes by shortening the strings upon its neck; which knowledge
shows a great progress in the musical art. Speaking of harps, in a
tomb at Thebes, Bruce remarks that, “they overturn all the accounts
hitherto given of the earliest state of music and musical instruments
in the East, and are altogether, in their form, ornaments and
compass, an incontestable proof, stronger than a thousand Greek
quotations, that geometry, drawing, mechanics, and music were at
the greatest perfection when these instruments were made; and that
the period from which we date the invention of these arts was only
the beginning of the era of their restoration.”
On the walls of the palace of Amenoph II. at Thebes, the king is
represented as playing chess with the queen. This monarch reigned
long before the Trojan war. In India the game is known to have been
played at least 5,000 years ago.
As to their knowledge in medicine, now that one of the lost Books
of Hermes has been found and translated by Ebers, the Egyptians
can speak for themselves. That they understood about the
circulation of the blood, appears certain from the healing
manipulations of the priests, who knew how to draw blood
downward, stop its circulation for awhile, etc. A more careful study of
their bas-reliefs representing scenes taking place in the healing hall
of various temples will easily demonstrate it. They had their dentists
and oculists, and no doctor was allowed to practice more than one
specialty; which certainly warrants the belief that they lost fewer
patients in those days than our physicians do now. It is also asserted
by some authorities that the Egyptians were the first people in the
world who introduced trial by jury; although we doubt this ourselves.
But the Egyptians were not the only people of remote epochs
whose achievements place them in so commanding a position
before the view of posterity. Besides others whose history is at
present shut in behind the mists of antiquity—such as the prehistoric
races of the two Americas, of Crete, of the Troäd, of the Lacustrians,
of the submerged continent of the fabled Atlantis, now classed with
myths—the deeds of the Phœnicians stamp them with almost the
character of demi-gods.
The writer in the National Quarterly Review, previously quoted,
says that the Phœnicians were the earliest navigators of the world,
founded most of the colonies of the Mediterranean, and voyaged to
whatever other regions were inhabited. They visited the Arctic
regions, whence they brought accounts of eternal days without a
night, which Homer has preserved for us in the Odyssey. From the
British Isles they imported tin into Africa, and Spain was a favorite
site for their colonies. The description of Charybdis so completely
answers to the maëlstrom that, as this writer says: “It is difficult to
imagine it to have had any other prototype.” Their explorations, it
seems, extended in every direction, their sails whitening the Indian
Ocean, as well as the Norwegian fiords. Different writers have
accorded to them the settlement of remote localities; while the entire
southern coast of the Mediterranean was occupied by their cities. A
large portion of the African territory is asserted to have been peopled
by the races expelled by Joshua and the children of Israel. At the
time when Procopius wrote, columns stood in Mauritania Tingitana,
which bore the inscription, in Phœnician characters, “We are those
who fled before the brigand Joshua, the son of Nun or Navè.”
Some suppose these hardy navigators of Arctic and Antarctic
waters have been the progenitors of the races which built the
temples and palaces of Palenque and Uxmal, of Copan and
Arica.[814] Brasseur de Bourbourg gives us much information about
the manners and customs, architecture and arts, and especially of
the magic and magicians of the ancient Mexicans. He tells us that
Votan, their fabulous hero and the greatest of their magicians,
returning from a long voyage, visited King Solomon at the time of the
building of the temple. This Votan appears to be identical with the
dreaded Quetzo-Cohuatl who appears in all the Mexican legends;
and curiously enough these legends bear a striking resemblance,
insomuch as they relate to the voyages and exploits of the Hittim,
with the Hebrew Bible accounts of the Hivites, the descendants of
Heth, son of Chanaan. The record tells us that Votan “furnished to
Solomon the most valuable particulars as to the men, animals, and
plants, the gold and precious woods of the Occident,” but refused
point-blank to afford any clew to the route he sailed, or the manner of
reaching the mysterious continent. Solomon himself gives an
account of this interview in his History of the Wonders of the
Universe, the chief Votan figuring under the allegory of the
Navigating Serpent. Stephens, indulging in the anticipation “that a
key surer than that of the Rosetta-stone will be discovered,” by which
the American hieroglyphs may be read,[815] says that the
descendants of the Caciques and the Aztec subjects are believed to
survive still in the inaccessible fastnesses of the Cordilleras
—“wildernesses, which have never yet been penetrated by a white
man, ... living as their fathers did, erecting the same buildings ... with
ornaments of sculpture and plastered; large courts, and lofty towers
with high ranges of steps, and still carving on tablets of stone the
same mysterious hieroglyphics.” He adds, “I turn to that vast and
unknown region, untraversed by a single road, wherein fancy
pictures that mysterious city seen from the topmost range of the
Cordilleras of unconquered, unvisited, and unsought aboriginal
inhabitants.”
Apart from the fact that this mysterious city has been seen from a
great distance by daring travellers, there is no intrinsic improbability
of its existence, for who can tell what became of the primitive people
who fled before the rapacious brigands of Cortez and Pizarro? Dr.
Tschuddi, in his work on Peru, tells us of an Indian legend that a train
of 10,000 llamas, laden with gold to complete the unfortunate Inca’s
ransom, was arrested in the Andes by the tidings of his death, and
the enormous treasure was so effectually concealed that not a trace
of it has ever been found. He, as well as Prescott and other writers,
informs us that the Indians to this day preserve their ancient
traditions and sacerdotal caste, and obey implicitly the orders of
rulers chosen among themselves, while at the same time nominally
Catholics and actually subject to the Peruvian authorities. Magical
ceremonies practiced by their forefathers still prevail among them,
and magical phenomena occur. So persistent are they in their loyalty
to the past, that it seems impossible but that they should be in
relations with some central source of authority which constantly
supports and strengthens their faith, keeping it alive. May it not be
that the sources of this undying faith lie in this mysterious city, with
which they are in secret communication? Or must we think that all of
the above is again but a “curious coincidence?”
The story of this mysterious city was told to Stephens by a
Spanish Padre, in 1838-9. The priest swore to him that he had seen
it with his own eyes, and gave Stephens the following details, which
the traveller firmly believed to be true. “The Padre of the little village
near the ruins of Santa Cruz del Quichè, had heard of the unknown
city at the village of Chajul.... He was then young, and climbed with
much labor to the naked summit of the topmost ridge of the sierra of
the Cordillera. When arrived at a height of ten or twelve thousand
feet, he looked over an immense plain extending to Yucatan and the
Gulf of Mexico, and saw, at a great distance, a large city spread over
a great space, and with turrets white and glittering in the sun.
Tradition says that no white man has ever reached this city; that the
inhabitants speak the Maya language, know that strangers have
conquered their whole land, and murder any white man who
attempts to enter their territory.... They have no coin; no horses,
cattle, mules, or other domestic animals except fowls, and the cocks
they keep underground to prevent their crowing being heard.”
Nearly the same was given us personally about twenty years ago,
by an old native priest, whom we met in Peru, and with whom we
happened to have business relations. He had passed all his life
vainly trying to conceal his hatred toward the conquerors
—“brigands,” he termed them; and, as he confessed, kept friends
with them and the Catholic religion for the sake of his people, but he
was as truly a sun-worshipper in his heart as ever he was. He had
travelled in his capacity of a converted native missionary, and had
been at Santa Cruz and, as he solemnly affirmed, had been also to
see some of his people by a “subterranean passage” leading into the
mysterious city. We believe his account; for a man who is about to
die, will rarely stop to invent idle stories; and this one we have found
corroborated in Stephen’s Travels. Besides, we know of two other
cities utterly unknown to European travellers; not that the inhabitants
particularly desire to hide themselves; for people from Buddhistic
countries come occasionally to visit them. But their towns are not set
down on the European or Asiatic maps; and, on account of the too
zealous and enterprising Christian missionaries, and perhaps for
more mysterious reasons of their own, the few natives of other
countries who are aware of the existence of these two cities never
mention them. Nature has provided strange nooks and hiding-places
for her favorites; and unfortunately it is but far away from so-called
civilized countries that man is free to worship the Deity in the way
that his fathers did.
Even the erudite and sober Max Müller is somehow unable to get
rid of coincidences. To him they come in the shape of the most
unexpected discoveries. These Mexicans, for instance, whose
obscure origin, according to the laws of probability, has no
connection with the Aryans of India, nevertheless, like the Hindus,
represent an eclipse of the moon as “the moon being devoured by a
dragon.”[816] And though Professor Müller admits that an historical
intercourse between the two people was suspected by Alexander
von Humboldt, and he himself considers it possible, still the
occurrence of such a fact he adds, “need not be the result of any
historical intercourse. As we have stated above, the origin of the
aborigines of America is a very vexed question for those interested
in tracing out the affiliation and migrations of peoples.”
Notwithstanding the labor of Brasseur de Bourbourg, and his
elaborate translation of the famous Popol-Vuh, alleged to be written
by Ixtlilxochitl, after weighing its contents, the antiquarian remains as
much in the dark as ever. We have read the Popol-Vuh in its original
translation, and the review of the same by Max Müller, and out of the
former find shining a light of such brightness, that it is no wonder that
the matter-of-fact, skeptical scientists should be blinded by it. But so
far as an author can be judged by his writings, Professor Max Müller
is no unfair skeptic; and, moreover, very little of importance escapes
his attention. How is it then that a man of such immense and rare
erudition, accustomed as he is to embrace at one eagle glance the
traditions, religious customs, and superstitions of a people, detecting
the slightest similarity, and taking in the smallest details, failed to
give any importance or perhaps even suspect what the humble
author of the present volume, who has neither scientific training nor
erudition, to any extent, apprehended at first view? Fallacious and
unwarranted as to many may seem this remark, it appears to us that
science loses more than she gains by neglecting the ancient and
even mediæval esoteric literature, or rather what remains of it. To
one who devotes himself to such study many a coincidence is
transformed into a natural result of demonstrable antecedent causes.
We think we can see how it is that Professor Müller confesses that
“now and then ... one imagines one sees certain periods and
landmarks, but in the next page all is chaos again.”[817] May it not be
barely possible that this chaos is intensified by the fact that most of
the scientists, directing the whole of their attention to history, skip
that which they treat as “vague, contradictory, miraculous, absurd.”
Notwithstanding the feeling that there was “a groundwork of noble
conceptions which has been covered and distorted by an aftergrowth
of fantastic nonsense,” Professor Müller cannot help comparing this
nonsense to the tales of the Arabian Nights.
Far be from us the ridiculous pretension of criticising a scientist so
worthy of admiration for his learning as Max Müller. But we cannot
help saying that even among the fantastic nonsense of the Arabian
Nights’ Entertainments anything would be worthy of attention, if it
should help toward the evolving of some historical truth. Homer’s
Odyssey surpasses in fantastic nonsense all the tales of the Arabian
Nights combined; and notwithstanding that, many of his myths are
now proved to be something else besides the creation of the old
poet’s fancy. The Læstrygonians, who devoured the companions of
Ulysses, are traced to the huge cannibal[818] race, said in primitive
days to inhabit the caves of Norway. Geology verified through her
discoveries some of the assertions of Homer, supposed for so many
ages to have been but poetical hallucinations. The perpetual daylight
enjoyed by this race of Læstrygonians indicates that they were
inhabitants of the North Cape, where, during the whole summer,
there is perpetual daylight. The Norwegian fiords are perfectly
described by Homer in his Odyssey, x. 110; and the gigantic stature
of the Læstrygonians is demonstrated by human bones of unusual
size found in caves situated near this region, and which the
geologists suppose to have belonged to a race extinct long before
the Aryan immigration. Charybdis, as we have seen, has been
recognized in the maëlstrom; and the Wandering Rocks[819] in the
enormous icebergs of the Arctic seas.
If the consecutive attempts at the creation of man described in the
Quichè Cosmogony suggests no comparison with some Apocrypha,
with the Jewish sacred books, and the kabalistic theories of creation,
it is indeed strange. Even the Book of Jasher, condemned as a gross
forgery of the twelfth century, may furnish more than one clew to
trace a relation between the population of Ur of the Kasdeans, where
Magism flourished before the days of Abraham, and those of Central
and North America. The divine beings, “brought down to the level of
human nature,” perform no feats or tricks more strange or incredible
than the miraculous performances of Moses and of Pharaoh’s
magicians, while many of these are exactly similar in their nature.
And when, moreover, in addition to this latter fact, we find so great a
resemblance between certain kabalistic terms common to both
hemispheres, there must be something else than mere accident to
account for the circumstance. Many of such feats have clearly a
common parentage. The story of the two brothers of Central
America, who, before starting on their journey to Xibalba, “plant each
a cane in the middle of their grandmother’s house, that she may
know by its flourishing or withering whether they are alive or
dead,”[820] finds its analogy in the beliefs of many other countries. In
the Popular Tales and Traditions, by Sacharoff (Russia), one can find
a similar narrative, and trace this belief in various other legends. And
yet these fairy tales were current in Russia many centuries before
America was discovered.
In recognizing in the gods of Stonehenge the divinities of Delphos
and Babylon, one need feel little surprised. Bel and the Dragon,
Apollo and Python, Osiris and Typhon, are all one under many
names, and have travelled far and wide. The Both-al of Ireland
points directly to its first parent, the Batylos of the Greeks and the
Beth-el of Chanaan. “History,” says H. de la Villemarque, “which took
no notes at those distant ages, can plead ignorance, but the science
of languages affirms. Philology, with a daily-increasing probability,
has again linked together the chain hardly broken between the
Orient and the Occident.”[821]
No more remarkable is the discovery of a like resemblance
between the Oriental myths and ancient Russian tales and traditions,
for it is entirely natural to look for a similarity between the beliefs of
the Semitic and Aryan families. But when we discover an almost
perfect identity between the character of Zarevna Militrissa, with a
moon in her forehead, who is in constant danger of being devoured
by Zmeÿ Gorenetch (the Serpent or Dragon), who plays such a
prominent part in all popular Russian tales, and similar characters in
the Mexican legends—extending to the minutest details—we may
well pause and ask ourselves whether there be not here more than a
simple coincidence.
This tradition of the Dragon and the Sun—occasionally replaced
by the Moon—has awakened echoes in the remotest parts of the
world. It may be accounted for with perfect readiness by the once
universal heliolatrous religion. There was a time when Asia, Europe,
Africa, and America were covered with the temples sacred to the sun
and the dragons. The priests assumed the names of their deities,
and thus the tradition of these spread like a net-work all over the
globe: “Bel and the Dragon being uniformly coupled together, and
the priest of the Ophite religion as uniformly assuming the name of
his god.”[822] But still, “if the original conception is natural and
intelligible ... and its occurrence need not be the result of any
historical intercourse,” as Professor Müller tells us, the details are so
strikingly similar that we cannot feel satisfied that the riddle is entirely
solved. The origin of this universal symbolical worship being
concealed in the night of time, we would have far more chance to
arrive at the truth by tracing these traditions to their very source. And
where is this source? Kircher places the origin of the Ophite and
heliolatrous worship, the shape of conical monuments and the
obelisks, with the Egyptian Hermes Trismegistus.[823] Where, then,
except in Hermetic books, are we to seek for the desired
information? Is it likely that modern authors can know more, or as
much, of ancient myths and cults as the men who taught them to
their contemporaries? Clearly two things are necessary: first, to find
the missing books of Hermes; and second, the key by which to
understand them, for reading is not sufficient. Failing in this, our
savants are abandoned to unfruitful speculations, as for a like reason
geographers waste their energies in a vain quest of the sources of
the Nile. Truly the land of Egypt is another abode of mystery!
Without stopping to discuss whether Hermes was the “Prince of
postdiluvian magic,” as des Mousseaux calls him, or the
antediluvian, which is much more likely, one thing is certain: The
authenticity, reliability, and usefulness of the Books of Hermes—or
rather of what remains of the thirty-six works attributed to the
Egyptian magician—are fully recognized by Champollion, junior, and
corroborated by Champollion-Figeac, who mentions it. Now, if by
carefully looking over the kabalistical works, which are all derived
from that universal storehouse of esoteric knowledge, we find the
fac-similes of many so-called miracles wrought by magical art,
equally reproduced by the Quichès; and if even in the fragments left
of the original Popol-Vuh, there is sufficient evidence that the
religious customs of the Mexicans, Peruvians, and other American
races are nearly identical with those of the ancient Phœnicians,
Babylonians, and Egyptians; and if, moreover, we discover that
many of their religious terms have etymologically the same origin;
how are we to avoid believing that they are the descendants of those
whose forefathers “fled before the brigand, Joshua, the son of Nun?”
“Nuñez de la Vega says that Nin, or Imos, of the Tzendales, was the
Ninus of the Babylonians.”[824]
It is possible that, so far, it may be a coincidence; as the
identification of one with the other rests but upon a poor argument.
“But it is known,” adds de Bourbourg, “that this prince, and according
to others, his father, Bel, or Baal, received, like the Nin of the
Tzendales, the homages of his subjects under the shape of a
serpent.” The latter assertion, besides being fantastic, is nowhere
corroborated in the Babylonian records. It is very true that the
Phœnicians represented the sun under the image of a dragon; but
so did all the other people who symbolized their sun-gods. Belus, the
first king of the Assyrian dynasty was, according to Castor, and
Eusebius who quotes him, deified, i. e., he was ranked among the
gods “after his death” only. Thus, neither himself nor his son, Ninus,
or Nin, could have received their subjects under the shape of a
serpent, whatever the Tzendales did. Bel, according to Christians, is
Baal; and Baal is the Devil, since the Bible prophets began so
designating every deity of their neighbors; therefore Belus, Ninus,
and the Mexican Nin are serpents and devils; and, as the Devil, or
father of evil, is one under many forms, therefore, under whatever
name the serpent appears, it is the Devil. Strange logic! Why not say
that Ninus the Assyrian, represented as husband and victim of the
ambitious Semiramis, was high priest as well as king of his country?
That as such he wore on his tiara the sacred emblems of the dragon
and the sun? Moreover, as the priest generally assumed the name of
his god, Ninus was said to receive his subject as the representative
of this serpent-god. The idea is preëminently Roman Catholic, and
amounts to very little, as all their inventions do. If Nuñez de la Vega
was so anxious to establish an affiliation between the Mexicans and
the biblical sun-and serpent-worshippers, why did he not show
another and a better similarity between them without tracing in the
Ninevites and the Tzendales the hoof and horn of the Christian
Devil?
And to begin with, he might have pointed to the Chronicles of
Fuentes, of the kingdom of Guatemala, and to the Manuscript of Don
Juan Torres, the grandson of the last king of the Quichès. This
document, which is said to have been in the possession of the
lieutenant-general appointed by Pedro de Alvarado, states that the
Toltecas themselves descended from the house of Israel, who were
released by Moses, and who, after crossing the Red Sea, fell into
idolatry. After that, having separated themselves from their
companions, and under the guidance of a chief named Tanub, they
set out wandering, and from one continent to another they came to a
place named the Seven Caverns, in the Kingdom of Mexico, where
they founded the famous town of Tula, etc.[825]
If this statement has never obtained more credit than it has, it is
simply due to the fact that it passed through the hands of Father
Francis Vasques, historian of the Order of San Francis, and this
circumstance, to use the expression employed by des Mousseaux in
connection with the work of the poor, unfrocked Abbé Huc, “is not
calculated to strengthen our confidence.” But there is another point
as important, if not more so, as it seems to have escaped
falsification by the zealous Catholic padres, and rests chiefly on
Indian tradition. A famous Toltecan king, whose name is mixed up in
the weird legends of Utatlan, the ruined capital of the great Indian
kingdom, bore the biblical appellation of Balam Acan; the first name
being preëminently Chaldean, and reminding one immediately of
Balaam and his human-voiced ass. Besides the statement of Lord
Kingsborough, who found such a striking similarity between the
language of the Aztecs (the mother tongue) and the Hebrew, many
of the figures on the bas-reliefs of Palenque and idols in terra cotta,
exhumed in Santa Cruz del Quichè, have on their heads bandelets
with a square protuberance on them, in front of the forehead, very
similar to the phylacteries worn by the Hebrew Pharisees of old,
while at prayers, and even by devotees of the present day,
particularly the Jews of Poland and Russia. But as this may be but a
fancy of ours, after all, we will not insist on the details.
Upon the testimony of the ancients, corroborated by modern
discoveries, we know that there were numerous catacombs in Egypt
and Chaldea, some of them of a very vast extent. The most
renowned of them were the subterranean crypts of Thebes and
Memphis. The former, beginning on the western side of the Nile,
extended toward the Libyan desert, and were known as the
Serpent’s catacombs, or passages. It was there that were performed
the sacred mysteries of the kúklos ànágkés, the “Unavoidable
Cycle,” more generally known as the “circle of necessity;” the
inexorable doom imposed upon every soul after the bodily death,
and when it had been judged in the Amenthian region.
In de Bourbourg’s book, Votan, the Mexican demi god, in narrating
his expedition, describes a subterranean passage, which ran
underground, and terminated at the root of the heavens, adding that
this passage was a snake’s hole, “un ahugero de colubra;” and that
he was admitted to it because he was himself “a son of the snakes,”
or a serpent.[826]
This is, indeed, very suggestive; for his description of the snake’s
hole is that of the ancient Egyptian crypt, as above mentioned. The
hierophants, moreover, of Egypt, as of Babylon, generally styled
themselves the “Sons of the Serpent-god,” or “Sons of the Dragon;”
not because—as des Mousseaux would have his readers believe—
they were the progeny of Satan-incubus, the old serpent of Eden, but
because, in the Mysteries, the serpent was the symbol of wisdom
and immortality. “The Assyrian priest bore always the name of his
god,” says Movers.[827] The Druids of the Celto-Britannic regions
also called themselves snakes. “I am a Serpent, I am a Druid!” they
exclaimed. The Egyptian Karnak is twin-brother to the Carnac of
Bretagné, the latter Carnac meaning the serpent’s mount. The
Dracontia once covered the surface of the globe, and these temples
were sacred to the dragon, only because it was the symbol of the
sun, which, in its turn, was the symbol of the highest god—the
Phœnician Elon or Elion, whom Abraham recognized as El
Elion.[828] Besides the surname of serpents, they were called the
“builders,” the “architects;” for the immense grandeur of their temples
and monuments was such, that even now the pulverized remains of
them “frighten the mathematical calculations of our modern
engineers,” says Taliesin.[829]
 De Bourbourg hints that the chiefs of the name of Votan, the
Quetzo-Cohuatl, or serpent deity of the Mexicans, are the
descendants of Ham and Canaan. “I am Hivim,” they say. “Being a
Hivim, I am of the great race of the Dragon (snake). I am a snake
myself, for I am a Hivim.”[830] And des Mousseaux, rejoicing
because he believes himself fairly on the serpent’s, or rather, devil’s
trail, hurries to explain: “According to the most learned
commentators of our sacred books, the Chivim or Hivim, or Hevites,
descend from Heth, son of Canaan, son of Ham ... the
accursed!”[831]
But modern research has demonstrated, on unimpeachable
evidence, that the whole genealogical table of the tenth chapter of
Genesis refers to imaginary heroes, and that the closing verses of
the ninth are little better than a bit of Chaldean allegory of Sisuthrus
and the mythical flood, compiled and arranged to fit the Noachian
frame. But, suppose the descendants of these Canaanites, “the
accursed,” were to resent for once the unmerited outrage? It would
be an easy matter for them to reverse the tables, and answer to this
fling, based on a fable, by a fact proved by archæologists and
symbologists—namely, that Seth, Adam’s third son, and the
forefather of all Israel, the ancestor of Noah, and the progenitor of
the “chosen people,” is but Hermes, the god of wisdom, called also
Thoth, Tat, Seth, Set, and Sat-an; and that he was, furthermore,
when viewed under his bad aspect, Typhon, the Egyptian Satan,
who was also Set. For the Jewish people, whose well-educated men,
no more than Philo, or Josephus, the historian, regard their Mosaic
books as otherwise than an allegory, such a discovery amounts to
but little. But for Christians, who, like des Mousseaux, very unwisely
accept the Bible narratives as literal history, the case stands very
different.
As far as affiliation goes, we agree with this pious writer; and we
feel every day as certain that some of the peoples of Central
America will be traced back to the Phœnicians and the Mosaic
Israelites, as we do that the latter will be proved to have as
persistently stuck to the same idolatry—if idolatry there is—of the
sun and serpent-worship, as the Mexicans. There is evidence—
biblical evidence—that two of Jacob’s sons, Levi and Dan, as well as
Judah, married Canaanite women, and followed the worship of their
wives. Of course, every Christian will protest, but the proof may be
found even in the translated Bible, pruned as it now stands. The
dying Jacob thus describes his sons: “Dan,” says he, “shall be a
serpent by the way, an adder in the path, that biteth the horse-heels,
so that his rider shall fall backward.... I have waited for thy salvation,
O Lord!” Of Simeon and Levi, the patriarch (or Israel) remarks that
they “ ... are brethren; instruments of cruelty are in their habitations.
O my soul, come not thou into their secret; unto their assembly.”[832]
Now, in the original, the words “their secret,” read—their Sod.[833]
And Sod was the name for the great Mysteries of Baal, Adonis, and
Bacchus who were all sun-gods and had serpents for symbols. The
kabalists explain the allegory of the fiery serpents by saying, that this
was the name given to the tribe of Levi, to all the Levites in short,
and that Moses was the chief of the Sodales.[834] And here is the
moment to prove our statements.
Moses is mentioned by several old historians as an Egyptian
priest; Manetho says he was a hierophant of Hieropolis, and a priest
of the sun-god Osiris, and that his name was Osarsiph. Those
moderns, who accept it as a fact that he “was learned in all the
wisdom” of the Egyptians, must also submit to the right interpretation
of the word wisdom, which was throughout the world known as a
synonym of initiation into the secret mysteries of the Magi. Did the
idea never strike the reader of the Bible, that an alien born and
brought up in a foreign country could not and would not possibly
have been admitted—we will not say to the final initiation, the
grandest mystery of all, but even to share the knowledge of the
minor priesthood, those who belonged to the lesser mysteries? In
Genesis xliii. 32, we read, that no Egyptian could seat himself to eat
bread with the brothers of Joseph, “for that is an abomination unto
the Egyptians.” But that the Egyptians ate “with him (Joseph) by
themselves.” The above proves two things: 1, that Joseph, whatever
he was in his heart, had, in appearance at least, changed his
religion, married the daughter of a priest of the “idolatrous” nation,
and become himself an Egyptian; otherwise, the natives would not
have eaten bread with him. And 2, that subsequently Moses, if not
an Egyptian by birth, became one through being admitted into the
priesthood, and thus was a Sodale. As an induction, the narrative of
the “brazen serpent” (the Caduceus of Mercury or Asclepios, the son
of the sun-god Apollo-Python) becomes logical and natural. We must
bear in mind that Pharaoh’s daughter, who saved Moses and
adopted him, is called by Josephus Thermuthis; and the latter,
according to Wilkinson, is the name of the asp sacred to Isis;[835]
moreover, Moses is said to descend from the tribe of Levi. We will
explain the kabalistic ideas as to the books of Moses and the great
prophet himself more fully in Volume II.
If Brasseur de Bourbourg and the Chevalier des Mousseaux, had
so much at heart to trace the identity of the Mexicans with the
Canaanites, they might have found far better and weightier proofs
than by showing both the “accursed” descendants of Ham. For
instance, they might have pointed to the Nargal, the Chaldean and
Assyrian chief of the Magi (Rab-Mag) and the Nagal, the chief
sorcerer of the Mexican Indians. Both derive their names from
Nergal-Sarezer, the Assyrian god, and both have the same faculties,
or powers to have an attendant dæmon with whom they identify
themselves completely. The Chaldean and Assyrian Nargal kept his
dæmon, in the shape of some animal considered sacred, inside the
temple; the Indian Nagal keeps his wherever he can—in the
neighboring lake, or wood, or in the house, under the shape of a
household animal.[836]
We find the Catholic World, newspaper, in a recent number,
bitterly complaining that the old Pagan element of the aboriginal
inhabitants of America does not seem to be utterly dead in the
United States. Even where tribes have been for long years under the
care of Christian teachers, heathen rites are practiced in secret, and
crypto-paganism, or nagualism, flourishes now, as in the days of
Montezuma. It says: “Nagualism and voodoo-worship” as it calls
these two strange sects—“are direct devil-worship. A report
addressed to the Cortes in 1812, by Don Pedro Baptista Pino, says:
‘All the pueblos have their artufas—so the natives call subterranean
rooms with only a single door, where they assemble to perform their
feasts, and hold meetings. These are impenetrable temples ... and
the doors are always closed on the Spaniards.
“‘All these pueblos, in spite of the sway which religion has had
over them, cannot forget a part of the beliefs which have been
transmitted to them, and which they are careful to transmit to their
descendants. Hence come the adoration they render the sun and
moon, and other heavenly bodies, the respect they entertain for fire,
etc.
“‘The pueblo chiefs seem to be at the same time priests; they
perform various simple rites, by which the power of the sun and of
Montezuma is recognized, as well as the power (according to some
accounts) of the Great Snake, to whom, by order of Montezuma,
they are to look for life. They also officiate in certain ceremonies with
which they pray for rain. There are painted representations of the
Great Snake, together with that of a misshapen, red-haired man,
declared to stand for Montezuma. Of this last there was also, in the
year 1845, in the pueblo of Laguna, a rude effigy or idol, intended,
apparently, to represent only the head of the deity.’”[837]
The perfect identity of the rites, ceremonies, traditions, and even
the names of the deities, among the Mexicans and ancient
Babylonians and Egyptians, are a sufficient proof of South America
being peopled by a colony which mysteriously found its way across
the Atlantic. When? at what period? History is silent on that point; but
those who consider that there is no tradition, sanctified by ages,
without a certain sediment of truth at the bottom of it, believe in the
Atlantis-legend. There are, scattered throughout the world, a handful
of thoughtful and solitary students, who pass their lives in obscurity,
far from the rumors of the world, studying the great problems of the
physical and spiritual universes. They have their secret records in
which are preserved the fruits of the scholastic labors of the long line
of recluses whose successors they are. The knowledge of their early
ancestors, the sages of India, Babylonia, Nineveh, and the imperial
Thebes; the legends and traditions commented upon by the masters
of Solon, Pythagoras, and Plato, in the marble halls of Heliopolis and
Saïs; traditions which, in their days, already seemed to hardly
glimmer from behind the foggy curtain of the past;—all this, and
much more, is recorded on indestructible parchment, and passed
with jealous care from one adept to another. These men believe the
story of the Atlantis to be no fable, but maintain that at different
epochs of the past huge islands, and even continents, existed where
now there is but a wild waste of waters. In those submerged temples
and libraries the archæologist would find, could he but explore them,
the materials for filling all the gaps that now exist in what we imagine
is history. They say that at a remote epoch a traveller could traverse
what is now the Atlantic Ocean, almost the entire distance by land,
crossing in boats from one island to another, where narrow straits
then existed.
Our suspicion as to the relationship of the cis-Atlantic and trans-
Atlantic races is strengthened upon reading about the wonders
wrought by Quetzo-Cohuatl, the Mexican magician. His wand must
be closely-related to the traditional sapphire-stick of Moses, the stick
which bloomed in the garden of Raguel-Jethro, his father-in-law, and
upon which was engraved the ineffable name. The “four men”
described as the real four ancestors of the human race, “who were
neither begotten by the gods, nor born of woman,” but whose
“creation was a wonder wrought by the Creator,” and who were
made after three attempts at manufacturing men had failed, equally
present some striking points of similarity with the esoteric
explanations of the Hermetists;[838] they also undeniably recall the
four sons of God of the Egyptian theogony. Moreover, as any one
may infer, the resemblance of this myth to the narrative related in
Genesis, will be apparent to even a superficial observer. These four
ancestors “could reason and speak, their sight was unlimited, and
they knew all things at once.”[839] When “they had rendered thanks
to their Creator for their existence, the gods were frightened, and
they breathed a cloud over the eyes of men that they might see a
certain distance only, and not be like the gods themselves.” This
bears directly upon the sentence in Genesis, “Behold, the man is
become as one of us, to know good and evil; and now, lest he put