The Sense of Coherence II:

Antonovsky:

"The Sense of Coherence" Concept

"If, in emphasizing the importance of the salutogenic question, I have seemed diffident about my particular answer to the question, this has been unintentional. I am quite persuaded, until data compel me to modify or change my position, that the sense of coherence is a very major determinant of maintaining one's position on the health ease/dis-ease continuum and of movement toward the healthy end. True, neither I nor others have as yet directly submitted the model to empirical test, a subject to which I shall returm. At the same time, both related empirical studies and the responses of many colleagues to the book that appeared in 1979 have reinforced my conviction. Over and over again, I have been told, "Your sense of coherence theory makes sense." Then why on earth has it not yet been tested? I must admit that part of the answer lies in my envy of the division of labor found in physics. I have been tempted to say, "I am the theoretician; now you experimentalists do the testing." (Which, of course, would allow me to say, should ugly facts not conform to theory, that the test was not well done.) And part lies in the burden of work in a consuming medical school in Beersheba. But the major part of the answer is to be located in the sense that before I could embark on empirical work, there were several crucial conceptual issues to be clarified. That this has taken me longer than expected is hardly surprising. It is to the conceptual progress that I believe has been made that I now tum. Five issues will be discussed: (1) the three now-identified components of the SOC, (2) the relations among the three components, (3) the concept of boundaries, (4) the strong and the rigid SOC, and (5) stressors as generalized resistance deficits. Comprehensibility, Manageability, and Meaningfulness Consideration of the definition of the SOC (1979, p. 123) and the discussion that follows it highlights the concept's essentially cognitive character as originally conceived. Influenced by information theory, I divided the perception of stimuli into seeing them as information or noise. I wrote of a "way of seeing the world... as predictable and comprehensible," of "form and structure," of "lawfulness." Although the concept was tentatively satisfying, I did not feel ready to operationalize it without further clarification. A series of in-depth, largely unstructured interviews with a wide variety of persons, fifty-one in number, was initiated. All had two characteristics in common: they had experienced major trauma, and they were reported to be coping amazingly well. The question that guided the interviews was how they saw their lives. Analysis of the protocols led us to classify sixteen persons the as having a strong SOC and eleven as being at the other end of scale. I then searched the protocols of these two extreme groups, looking for themes consistently found in one group and markedly absent in the other. Repeatedly, I was able to identify three such themes, which I now see as the three core components of the SOC. I call these comprehensibility, manageability, and meaningfulness. The persons we had identified as having a strong SOC were high on these components, in stark contrast to those we had identified as having a weak SOC. ... Comprehensibility is indeed the well-defined, explicit core of the original definition. It refers to the extent to which one perceives the stimuli that confront one, deriving from the internal and external environments, as making cognitive sense ... As a sociologist, I have been pleased by the attention given in the to both the micro and the macro social-environment as information that is ordered, consistent, structured, and clear, rather than as noise-chaotic, disordered, random, accidental, inexplicable. The person high on the sense of comprehensibility expects that stimuli he or she will encounter in the future will be predictable or, at the very least, when they do come as surprises, that they will be orderable and explicable. It is important to note that nothing is implied about the desirability of stimuli. Death, war, and failure can occur, but such a person can make sense of them. Given the original definition as the basis for classifying respondents, it came as no surprise that the comprehensibility theme was so clearly identified. The second theme was at least foreshadowed in the phrase "a high probability that things will work out as well as can reasonably be expected" (1979, р. 123). Yet the emphasis remained cognitive, expressed in the phrase "a solid capacity to judge reality" (p. 127), rather than in the more emotional, confidence-expressing term "things will work out." But in the interviews, the most striking theme that emerged, at least in terms of frequency, sounded consistently by those who had been classified as having a weak SOC and never noted by the strong-SOC respondents, was that of the sad sack, the shlimazl (the one on whom the soup gets spilled), or, in the occasional extreme version, a touch of paranoia. Things happened to one, invariably unfortunate things, and this will continue to be the case in life. At the other extreme, events in life are seen as experiences that can be coped with, challenges that can be met. At worst-and recall that these are people who have undergone very difficult experiences-the event or its consequences are bearable. I came to call this second component manageability and formally define it as the extent to which one perceives that resources are at one's disposal which are adequate to meet the demands posed by the stimuli that bombard one, "At one's disposal" may refer to resources under one's own control or to resources controlled by legitimate others-one's spouse, friends, sources of stressors and coping resources. Yet I have been amazed, in recent years, that many seem to have forgotten that a man by the name of Freud ever lived and that internal stimuli and conflict are omnipresent.  colleagues, God, history, the party leader, a physician-whom one feels one can count on, whom one trusts. To the extent that one has a high sense of manageability, one will not feel victimized by events or feel that life treats one unfairly. Untoward things do happen in life, but when they do occur, one will be able to cope and not grieve endlessly. The third component, meaningfulness, was also foreshadowed in the original discussion, when I warned against "too great an emphasis on the cognitive aspect of the sense of coherence" (1979, p. 127) and referred to the importance of being involved "as a participant in the processes shaping one's destiny as well as one's daily experience" (p. 128). But it was not until the interview protocols were studied that the significance of this component became apparent. I now see it as representing the motivational element. Those classified as having a strong SOC always spoke of areas of life that were important to them, that they very much cared about, that "made sense" to them in the emotional and not only the cognitive meaning of the term. Events that went on in these areas tended to be viewed as challenges, as worthy of emotional investment and commitment. Frankl's (1975) work had come to my attention only after my book name was written and undoubtedly influenced the choice of the of this component. By contrast, those whom we had classified as having a weak SOC, at the extreme, gave little indication that anything in life seemed to matter particularly to them. Short of this, they grudgingly granted that this or that life area was important, but only in the sense that it imposed wearisome burdens, unwelcome demands they would much rather do without.  Formally, the meaningfulness component of the SOC refers the extent to which one feels that life makes sense ... that at least some of the problems and demands posed by are worth investing energy in, are worthy of commitment and engagement, are challenges that are "welcome" rather than burdens that one would much rather do without. This does not mean that someone high on meaningfulness is happy about the death of a loved one, the need to undergo a serious operation, or being fired. But when these unhappy experiences are imposed on such a person, he or she will willingly take up the challenge, will be determined to seek meaning in it, and will do his or her best to overcome it with dignity. I can now formally redefine the SOC as follows: 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 (1) the stimuli deriving from one's internal and external environments in the course of living are structured, predictable, and explicable: (2) the resources are available to one to meet the demands posed by these stimuli; and (3) these demands are challenges, worthy of investment and engagement."