- Email: [email protected]
Sense of coherence and sociology of emotions
The six Cs-comments
978
Antonovsky’s image of chaos. But what are the options for thoughtful people who consider their own circumstances in South Central L.A.? Extensive research has shown that opportunities for education, employment, health-care, and housing have remained the same or have worsened since the riots of the mid-1960s. Reforms, service programs, and economic assistance aimed at people in these areas consistently have increased following periods of civil unrest, only to decline later through cutbacks in public spending [S]. Pessimism about civility within capitalist society, given such a dismal history of unresponsiveness to the basic human needs of the growing ‘underclass’ [6], is not an irrational response to the evidence. Likewise, violent tactics-predicated on a belief that basic change is unlikely to emerge from peaceful political processes-are not necessarily chaotic or incoherent responses to the unresponsiveness of policy to the grimmest of social conditions. Closer to Professor Antonovsky’s home, there is the Palestinian situation. Again, the image of young people with guns fills our consciousness. Although Israel has enacted a national health program that aims to assure universal access to needed care, Israel’s Palestinian population has encountered numerous obstacles to both preventive and curative services [7,8]. These barriers go beyond those experienced by ethnic minorities within the Jewish population. Further, efforts to organize health care programs targeting Palestinian people have suffered from interference and intermittent government repression. Given the Israeli government’s intransigent position on the Palestinian problem and the brutality of repression that Antonovsky cites regarding the invasion of Lebanon, the option of using a gun becomes neither exactly a chaotic nor incoherent way to change an intolerable situation.
To sum up, Professor Antonovsky’s troubling overview of current conditions and his utopian vision of a salutogenic future raise many issues to ponder. One of the main questions raised by his admirable work has do with the viability of nonviolent means to achieve the laudable goal of civility within a salutogenie society. Looking clearsightedly at our recent history, one might say, with both respect and regret, a good word for the “young man [or woman] with a gun.” HOWARD WAITZKIN
University of California, Irvine North Orange County Community Clinic 300 W. Romneya Drive Anaheim, CA 92801, U.S.A. REFERENCES 1. Guevara C. Venceremos! The Speeches and Writings of Che Guevara (Edited by Gerassi J.), p. 29. Simon and Schuster, New York, 1968. 2. Waitzkin H. The Second Sickness: Contradictions of Capitalist Health Care. Free Press, New York, 1983. 3. Waitzkin H. The Politics of Medical Encounters: How Patients and Dociors Deal-with Social Problems. Yale University Press, New Haven, 1991. 4. Goldberg C. Architect of Soviet reform denies CIA ties while in Kremlin. Los Angeles Times, February 25, 1993, p. A12. 5. Piven F. F. and Cloward R. A. Regulating the Poor: The Functions of Public Welfare. Vintage, New York, 1971. 6. Wilson W.-J. The Truly Disadvantaged: The Inner City, the Underclass, and Public Policy. University of Chicago Press, Chicago, 1990. Gordon J., Fine J., Geiger H. J., Leaning J., Shapiro L. A.. Simon B.. Marton R., Barahouthi M. and Pressberg G. Medical rights abuses in the West Bank and Gaza Strip. Hlrh/PAC Bull. 19, (3), 1, 1989. Punamaki R. L. and Suleiman R. Predictors and effectiveness of coping with political violence among Palestinian children. Br. J. Sot. Psychol. 29, 67, 1990.
COMMENTS SENSE
OF COHERENCE
AND
With his emphasis on salutogenesis, with his conceptual and empirical work on “Sense of Coherence” (SOC) Aaron Antonovsky must be credited as one of the outstanding, truly innovative scientists in the field of health sociology. This judgment is further substantiated by the present paper which summarizes three more recent developments in his conceptualization of “Sense of Coherence” [l]. First, the paper aims at integrating the SOC concept into a general model of information processing of living systems where five stages of health-damaging conflicts are specified: (a) linkage vs isolation, (b) information vs noise, (c) integration, (d) availability of resources, and
SOCIOLOGY
OF EMOTIONS
(e) feedback. Secondly, the paper describes differences between SOC and some major psychological concepts of coping. Finally, it emphasizes the sociostructural contexts of SOC as exemplified by two ‘ideal types’ of social organization: coercion and civility. The paper, thus, presents new insights into the dynamics of salutogenesis in an eloquent and lucid way. However, in my view, these dynamics could be elaborated even more successfully if the author had dealt with the following two problems in a systematic way: first, with the problem of integrating emotional experience into the SOC concept, and secondly with the problem of linking sociological and
979
The six Cs-comments variables with relevance to SOC within a theoretical model. In defining SOC Antonovsky puts his sole emphasis on cognition (“dispositional orientation”, “Weltanschauung” [1, p.91) rather than combining cognition with emotion. Yet, any concept which aims at explaining physical health should deal with efferent autonomic nervous and endocrine system pathways activated by emotional experience [2,3]. The three components of SOC ‘Comprehensibility’, ‘Meaningfulness’, and ‘Managability’ do not define the specific affective quality of the experience of coherence. Antonovsky probably would argue that SOC acts as a cognitive buffer against aversive socio-environmental stimuli thus preventing stressful experience. However, this argument does not take into account recent developments in neuroscience and stress research indicating that stressful socio-environmental information often bypasses or overrides cognitive appraisal processes [4 51. A second shortcoming of the SOC concept concerns the lack of explicit statements on the way social factors may initiate or modulate the experience of coherence. Clearly, a responsive microsocial environment is needed to enhance a sense of coherence. But the interaction between these two types of variables, socio-environmental and person characteristics, needs to be specified in a theoretical model. For instance, what is the effect of SOC after adjusting for social support? Are these two variables acting in additive or interactive ways on health indicators? Is SOC mediating health-related effects only in conjunction with stressful socio-environmental conditions, or is it a predictor on its own? The absence of such a theoretical model must be considered a major shortcoming of Antonovsky’s approach. One approach towards developing further the salutogenic concept was elaborated and tested in our group. Although originally this approach was restricted to the explanation of cardiovascular health its implications may be more general [6]. Our model puts its emphasis on a widely recognized human need to match favourable self-experience with a responsive social environment. Three relevant aspects of selfregulation are distinguished in this respect: selfefficacy, that is the sense of purposeful and successful realization of one’s aspirations and goals; self-esteem, that is the sense of worth, continuous identity and uniqueness experienced by an individual self, and self-integration, that is the sense of belonging to, of being connected with significant others, especially so in primary groups. Three patterns of socio-emotional motivations correspond to these aspects of self-regulation: first, the motivation to perform, to achieve and to contribute to one’s relevant social environment; secondly the motivation of being esteemed and rewarded, of getting positive feedback from significant others, and thirdly the motivation to belong to and to be connected with primary groups. Selfpsychological
SSM 37,8--8
efficacy can be experienced to the extent only that the social structure offers opportunities of contributing, of performing, e.g. through occupational roles. Favourable self-esteem is contingent upon reward opportunities, that is a society’s capacity to meet the socio-emotional motivation of being esteemed. Feelings of self-integration are contingent upon social networks which provide options for the experience of belonging and connectedness. According to this approach, salutogenic functioning is mediated by positive emotions resulting from successful selfregulation. Successful self-regulation in turn is contingent upon matching between socio-emotional motivations of the individual and the societal opportunity structure. We have tested a relevant part of this concept in predicting cardiovascular health. Our hypothesis stated that a balance between high extrinsic or intrinsic effort at work (a structural prerequisite of experiencing favourable self-efficacy) and adequate reward (a structural prerequisite of experiencing favourable self-esteem) promotes cardiovascular health. Conversely, the continuous experience of an imbalance between high effort and low reward at work is associated with negative emotions such as irritation, anger and hostility. These emotions in turn trigger sustained autonomic arousal which in the long run impairs cardiovascular functioning and health. In prospective and cross-sectional studies we explained prevalence of or change in cardiovascular risk factors by components of this model [7l. Moreover, it was possible to improve the prediction of new cardiovascular events [8]. In conclusion, the salutogenic approach developed by Antonovsky proves to be fruitful beyond the concept “Sense of Coherence” which, as argued, needs further elaboration. JOHANNES SIEGRIST
Dtisseldorf, Germany RJWERENCRS
1.
Antonovsky A. Complexity, conflict, chaos, coherence,
coercion and civility. Sot. Sci. Med. 37,969-974, 1993. 2. Henry J. P. and Stephens P. M. Stress, Health and the Social Environment. Springer, Berlin, 1977. 3. Weiner H. Perturbing the Organism. The Biology of Stressful Experience. The University of Chicago Press, Chicago, 1992. Buck R. Human Motivation and Emotion. Wiley, New York, 1988 LeDoux J. E. Sensory systems and emotion:a model of affective processing. Integr. Psychiat. 4, 237, 1986.
Siegrist J. Soxiale Krisen und Gesundheit (Social Crises Hogrefe, Grittingen. In press. Siegrist J. Peter R., Georg W., Cremer P. and Seidel D. Psychosocial and biobehavioral characteristics of hypertensive men with elevated atherogenic lipids. Atherosclerosis 86, 211, 1991. 8. Siegrist J., Peter R., Junge A., Cremer P. and Seidel D. Low status control, high effort at work and ischemic heart disease:prospective evidence from blue-collar men. Sot. Sci. Med. 31, 1127, 1990. and Health).
978
Antonovsky’s image of chaos. But what are the options for thoughtful people who consider their own circumstances in South Central L.A.? Extensive research has shown that opportunities for education, employment, health-care, and housing have remained the same or have worsened since the riots of the mid-1960s. Reforms, service programs, and economic assistance aimed at people in these areas consistently have increased following periods of civil unrest, only to decline later through cutbacks in public spending [S]. Pessimism about civility within capitalist society, given such a dismal history of unresponsiveness to the basic human needs of the growing ‘underclass’ [6], is not an irrational response to the evidence. Likewise, violent tactics-predicated on a belief that basic change is unlikely to emerge from peaceful political processes-are not necessarily chaotic or incoherent responses to the unresponsiveness of policy to the grimmest of social conditions. Closer to Professor Antonovsky’s home, there is the Palestinian situation. Again, the image of young people with guns fills our consciousness. Although Israel has enacted a national health program that aims to assure universal access to needed care, Israel’s Palestinian population has encountered numerous obstacles to both preventive and curative services [7,8]. These barriers go beyond those experienced by ethnic minorities within the Jewish population. Further, efforts to organize health care programs targeting Palestinian people have suffered from interference and intermittent government repression. Given the Israeli government’s intransigent position on the Palestinian problem and the brutality of repression that Antonovsky cites regarding the invasion of Lebanon, the option of using a gun becomes neither exactly a chaotic nor incoherent way to change an intolerable situation.
To sum up, Professor Antonovsky’s troubling overview of current conditions and his utopian vision of a salutogenic future raise many issues to ponder. One of the main questions raised by his admirable work has do with the viability of nonviolent means to achieve the laudable goal of civility within a salutogenie society. Looking clearsightedly at our recent history, one might say, with both respect and regret, a good word for the “young man [or woman] with a gun.” HOWARD WAITZKIN
University of California, Irvine North Orange County Community Clinic 300 W. Romneya Drive Anaheim, CA 92801, U.S.A. REFERENCES 1. Guevara C. Venceremos! The Speeches and Writings of Che Guevara (Edited by Gerassi J.), p. 29. Simon and Schuster, New York, 1968. 2. Waitzkin H. The Second Sickness: Contradictions of Capitalist Health Care. Free Press, New York, 1983. 3. Waitzkin H. The Politics of Medical Encounters: How Patients and Dociors Deal-with Social Problems. Yale University Press, New Haven, 1991. 4. Goldberg C. Architect of Soviet reform denies CIA ties while in Kremlin. Los Angeles Times, February 25, 1993, p. A12. 5. Piven F. F. and Cloward R. A. Regulating the Poor: The Functions of Public Welfare. Vintage, New York, 1971. 6. Wilson W.-J. The Truly Disadvantaged: The Inner City, the Underclass, and Public Policy. University of Chicago Press, Chicago, 1990. Gordon J., Fine J., Geiger H. J., Leaning J., Shapiro L. A.. Simon B.. Marton R., Barahouthi M. and Pressberg G. Medical rights abuses in the West Bank and Gaza Strip. Hlrh/PAC Bull. 19, (3), 1, 1989. Punamaki R. L. and Suleiman R. Predictors and effectiveness of coping with political violence among Palestinian children. Br. J. Sot. Psychol. 29, 67, 1990.
COMMENTS SENSE
OF COHERENCE
AND
With his emphasis on salutogenesis, with his conceptual and empirical work on “Sense of Coherence” (SOC) Aaron Antonovsky must be credited as one of the outstanding, truly innovative scientists in the field of health sociology. This judgment is further substantiated by the present paper which summarizes three more recent developments in his conceptualization of “Sense of Coherence” [l]. First, the paper aims at integrating the SOC concept into a general model of information processing of living systems where five stages of health-damaging conflicts are specified: (a) linkage vs isolation, (b) information vs noise, (c) integration, (d) availability of resources, and
SOCIOLOGY
OF EMOTIONS
(e) feedback. Secondly, the paper describes differences between SOC and some major psychological concepts of coping. Finally, it emphasizes the sociostructural contexts of SOC as exemplified by two ‘ideal types’ of social organization: coercion and civility. The paper, thus, presents new insights into the dynamics of salutogenesis in an eloquent and lucid way. However, in my view, these dynamics could be elaborated even more successfully if the author had dealt with the following two problems in a systematic way: first, with the problem of integrating emotional experience into the SOC concept, and secondly with the problem of linking sociological and
979
The six Cs-comments variables with relevance to SOC within a theoretical model. In defining SOC Antonovsky puts his sole emphasis on cognition (“dispositional orientation”, “Weltanschauung” [1, p.91) rather than combining cognition with emotion. Yet, any concept which aims at explaining physical health should deal with efferent autonomic nervous and endocrine system pathways activated by emotional experience [2,3]. The three components of SOC ‘Comprehensibility’, ‘Meaningfulness’, and ‘Managability’ do not define the specific affective quality of the experience of coherence. Antonovsky probably would argue that SOC acts as a cognitive buffer against aversive socio-environmental stimuli thus preventing stressful experience. However, this argument does not take into account recent developments in neuroscience and stress research indicating that stressful socio-environmental information often bypasses or overrides cognitive appraisal processes [4 51. A second shortcoming of the SOC concept concerns the lack of explicit statements on the way social factors may initiate or modulate the experience of coherence. Clearly, a responsive microsocial environment is needed to enhance a sense of coherence. But the interaction between these two types of variables, socio-environmental and person characteristics, needs to be specified in a theoretical model. For instance, what is the effect of SOC after adjusting for social support? Are these two variables acting in additive or interactive ways on health indicators? Is SOC mediating health-related effects only in conjunction with stressful socio-environmental conditions, or is it a predictor on its own? The absence of such a theoretical model must be considered a major shortcoming of Antonovsky’s approach. One approach towards developing further the salutogenic concept was elaborated and tested in our group. Although originally this approach was restricted to the explanation of cardiovascular health its implications may be more general [6]. Our model puts its emphasis on a widely recognized human need to match favourable self-experience with a responsive social environment. Three relevant aspects of selfregulation are distinguished in this respect: selfefficacy, that is the sense of purposeful and successful realization of one’s aspirations and goals; self-esteem, that is the sense of worth, continuous identity and uniqueness experienced by an individual self, and self-integration, that is the sense of belonging to, of being connected with significant others, especially so in primary groups. Three patterns of socio-emotional motivations correspond to these aspects of self-regulation: first, the motivation to perform, to achieve and to contribute to one’s relevant social environment; secondly the motivation of being esteemed and rewarded, of getting positive feedback from significant others, and thirdly the motivation to belong to and to be connected with primary groups. Selfpsychological
SSM 37,8--8
efficacy can be experienced to the extent only that the social structure offers opportunities of contributing, of performing, e.g. through occupational roles. Favourable self-esteem is contingent upon reward opportunities, that is a society’s capacity to meet the socio-emotional motivation of being esteemed. Feelings of self-integration are contingent upon social networks which provide options for the experience of belonging and connectedness. According to this approach, salutogenic functioning is mediated by positive emotions resulting from successful selfregulation. Successful self-regulation in turn is contingent upon matching between socio-emotional motivations of the individual and the societal opportunity structure. We have tested a relevant part of this concept in predicting cardiovascular health. Our hypothesis stated that a balance between high extrinsic or intrinsic effort at work (a structural prerequisite of experiencing favourable self-efficacy) and adequate reward (a structural prerequisite of experiencing favourable self-esteem) promotes cardiovascular health. Conversely, the continuous experience of an imbalance between high effort and low reward at work is associated with negative emotions such as irritation, anger and hostility. These emotions in turn trigger sustained autonomic arousal which in the long run impairs cardiovascular functioning and health. In prospective and cross-sectional studies we explained prevalence of or change in cardiovascular risk factors by components of this model [7l. Moreover, it was possible to improve the prediction of new cardiovascular events [8]. In conclusion, the salutogenic approach developed by Antonovsky proves to be fruitful beyond the concept “Sense of Coherence” which, as argued, needs further elaboration. JOHANNES SIEGRIST
Dtisseldorf, Germany RJWERENCRS
1.
Antonovsky A. Complexity, conflict, chaos, coherence,
coercion and civility. Sot. Sci. Med. 37,969-974, 1993. 2. Henry J. P. and Stephens P. M. Stress, Health and the Social Environment. Springer, Berlin, 1977. 3. Weiner H. Perturbing the Organism. The Biology of Stressful Experience. The University of Chicago Press, Chicago, 1992. Buck R. Human Motivation and Emotion. Wiley, New York, 1988 LeDoux J. E. Sensory systems and emotion:a model of affective processing. Integr. Psychiat. 4, 237, 1986.
Siegrist J. Soxiale Krisen und Gesundheit (Social Crises Hogrefe, Grittingen. In press. Siegrist J. Peter R., Georg W., Cremer P. and Seidel D. Psychosocial and biobehavioral characteristics of hypertensive men with elevated atherogenic lipids. Atherosclerosis 86, 211, 1991. 8. Siegrist J., Peter R., Junge A., Cremer P. and Seidel D. Low status control, high effort at work and ischemic heart disease:prospective evidence from blue-collar men. Sot. Sci. Med. 31, 1127, 1990. and Health).