Sense of Coherence:

Antonovsky:

"The time has now come for a formal definition of the concept that integrates all the foregoing details, implicit and explicit, and that is a crucial variable in explaining movement on the health ease/disease continuum. The sense of coherence is 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. Almost invariably when I have presented this concept, people have had an immediate, intuitive response of “I know very well what you’re talking about.” In the particular cultural context in which the concept has been presented, it is often taken to mean “I am in control” and associated with the concept of an internal locus of control. This cultural bias is discussed in detail below. Once this misinterpretation is clarified, I have found that the concept makes important sense to people. One of the reasons it does is that people can identify in their personal experience—both in their own lives and in their reading of literature—individuals with a strong sense of coherence as well as individuals with a markedly weak sense of coherence. Thomas Mann’s vivid portrayal of Mynheer Peeperkom in The Magic Mountcun illustrates a strong sense of coherence. In The Brothers Karamazov, Fedor Dostoevsky has given us a masterly contrast of the two extremes: Ivan and Dmitri Karamazov, each of whose sense of coherence is, in its own way, minimal compared with that of Alyosha. Perhaps the supreme example in literature, particularly appropriate because one individual moves from one extreme to the other, is that of Job. Intuitive approval of a concept that is intended as an explanatory and hypothesis-generating tool, however, is only a starting point. It is crucial to analyze all the facets of the definition and to clarify possible misunderstanding and the precise implications of each of the terms."

"As defined, the sense of coherence' explicitly and unequivocally is a generalized, long-lasting way of seeing the world and one’s life in it. It is perceptual, with both cognitive and affective components. Its referent is not this or that area of life, this or that problem or situation, this or that time, or, in our terms, this or that stressor. It is, I suggest, a crucial element in the basic personality structure of an individual and in the ambiance of a subculture, culture, or historical period. This does not mean that there are no ups and downs. A particular experience, a specific situation, a detailed success or failure can effect a temporary and minor shift in one’s sense of coherence. (In fact, being impervious to particular changes in one’s environment is one indication of what I subsequently call a fake sense of coherence.) But such changes occur around a stable location on the continuum. The term dynamic in the definition takes us much beyond such minor fluctuations. Its meaning will become fully clear, I hope, in the discussion below of the sources of the sense of coherence. I certainly am not committed to understanding the sense of coherence as being determined forever and anon by genes or early childhood experience. It is shaped and tested, reinforced and modified not only in childhood but throughout one’s life. To take an example. The pathogenic orientation, particularly in the hands of clinicians, clarifies the dynamic pattern of a deteriorating sense of coherence. Thus the psychotherapist seeks to point out to the neurotic patient how he or she continually gets involved in endeavors that by definition are doomed to failure; the psychotherapist then focuses on the sources of this neurotic pattern. He or she may even note how such continued experiences weaken the sense of coherence. A salutogenic orientation, however, can lead to working with the patient to engage in goal-oriented behavior that promises success, thereby strengthening the sense of coherence. Similarly, a radical change in one’s structural situation—in marital status, occupation, place of residence—can lead to a significant modification in one’s sense of coherence. But in addition one’s sense of coherence, strong or weak, plays a significant role in determining one’s choice of remaining in or changing one’s structural situation. Thus, to stick to the above example, the neurotic, with a weak sense of coherence, may choose to avoid the “danger” of entering psychotherapy. In this sense, one tends to choose situations that reinforce the level of one’s sense of coherence. The same dynamic approach can be applied to different areas of life. If experience in one area tends to weaken while experience in another area tends to strengthen one’s sense of coherence, the person with a stronger sense will seek to change the area that weakens it, while the person with a weaker sense will gravitate toward that area. In this way, there is a constant albeit dynamic tendency toward consistency and generalization, stability and continuity. Stability and continuity bring us to the crux of the matter. A strong sense of coherence involves a perception of one’s environments, inner and outer, as predictable and comprehensible. In the image that has been and will be used often, it means that the  stimuli that impinge on one are meaningful, as information or as music. Even more important than the immediate response, however, is the overall expectation that stimuli will continue to be meaningful. This is what one’s world is seen to be like. Receiving stimuli is only one side of one’s transactional relationship with one’s world, however. No less important is the confidence that the stimuli one sends will be received without undue distortion. Thus, one’s world has form and structure, is choate and comprehensible. We should take note of one frequent situation. We receive stimuli that are perceived as noise. The person with a strong sense of coherence locates the trouble outside himself; the stimuli are nonsensical. But in the case of the stranger or the migrant, people all around speak a language that makes no sense, but one knows very well that the impediment is in oneself. If one understands what is going on, however, and if the world is seen as predictable, outcomes may still not fulfill needs. And a person with a weaker sense of coherence will indeed tend to anticipate that things are likely to go wrong. When things make no sense and are not predictable, it is difficult to expect that needs will be fulfilled, except by sheer luck or blind chance. One can clutch at straws; one can engage in privatized (not culturally routinized and ritualized) magic. But one remains without much hope. The person with a stronger sense of coherence is quite able to see reality, to judge the likelihood of desirable outcomes in view of the countervailing forces operative in all of life. One is not blinded by confidence. It is in this context that the phrase as well as can reasonably be expected has been included in the definition of the concept. Malinowski’s (1931) Trobriander fishermen, even after having engaged in all the proper rituals prior to fishing in the open sea, know full well that the rituals are no guarantee against drowning or a poor catch. To put the matter another way: A strong sense of coherence is not at all equivalent to feeling that everything in life is handed to one on a silver platter or that one has the Midas touch. Quite the contrary may even be true. Life may well be seen as full of complexities, conflicts, and complications—which one understands. Goal achievement may be seen as contingent on immense investment of effort. Moreover, one may be fully aware that life involves failure and frustration. The important thing is that one has a sense of confidence, of faith, that, by and large, things will work out well. Not that things will have a Hollywood happy ending. This is why the proviso “as can reasonably be expected” is added. A strong sense of coherence includes a solid capacity to judge reality. What makes frustration, failure, and pain tolerable without vitiating a strong sense of coherence is, to introduce another crucial term, the perception of lawfulness. Job was shattered not because of his terrible suffering, not because almost all that he had was taken from him. When fate is capricious, when events are arbitrary, when there is no lawfulness—and not at all when there is no omnipotence—the sense of coherence is shattered. In this lies the terrible brilliance of modem totalitarianism, foreshadowed in Franz Kafka’s Castle. One never knows when the doorbell will ring or for what reason. The ideas of predictability and lawfulness may suggest too great an emphasis on the cognitive aspect of the sense of coherence. A belief in lawfulness does not necessitate intellectual understanding of the logic of the laws. An orthodox Jew even regards such an attempt as apostasy—a view that led to the excommunication of Spinoza. The intellectual task, as well as the emotional aspiration, is to know God’s laws; the behavioral task is to obey them. The rank-and-file party member need not understand the laws of history; this is the realm of the leadership. It is enough to maintain one’s faith in God or in the party in order to maintain a strong sense of coherence. Such faith makes everything comprehensible, at least affectively. It is when faith collapses that the sense of coherence dissipates. The Holocaust, violating all previously known lawfulness, thus posed a most torturing problem for believing Jews. An approximation of their problem is found in Crossman (1950), in which six well-known ex-Communists analyze their break with the party. We can now take the final step in clarifying the definition of sense of coherence. It is of the utmost importance that I did not choose the more familiar phrase sense of control, which clearly implies and is overwhelmingly used as meaning “I am in control.” This conceptualization reflects a superfluous cultural bias, an discussed below. A sense of coherence, as I trust has become clear, does not at all imply that one is in control. It does involve one as a participant in the processes shaping one’s destiny as well as one’s daily experience. The orthodox Jew, striving with all his might to obey the 613 commandments, is not at all passive. The Calvinist on whom signs of grace have been bestowed in response to his utmost effort has been extremely active. But this docs not mean that it is they who are decisive in the outcome. The crucial issue is not whether power to determine such outcomes lies in our own hands or elsewhere. What is important is that the location of power is where it is legitimately supposed to be. This may be within oneself; it may be in the hands of the head of the family, patriarchs, leaders, formal authorities, the party, history, or a deity. The element of legitimacy assures one that issues will, in the long run, be resolved by such authority in one’s own interests. Thus a strong sense of coherence is not at all endangered by not being in control oneself."

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Verstehbarkeit, Handhabbarkeit, Sinnhaftigkeit

Comprehensibility, Manageability, Meaningfulness