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Salutogenesis

January 15, 2015

Dr. Anton Antonovsky, an Israeli social scientist, coined the phrase that forms the title of this blog and described it in 1979.[i] The concept is brilliant, and what surprises me is that after 6 intense years of ACE’s informed work, I had not heard of it before today. Just to let you know that this is common in my work. As a non-formally trained (no Ph.D.) scientist basically self-teaching, I come across new concepts and theories on a regular basis. I know have another avenue of inquiry I need to go down. And I believe it’s an important one. I have already been down this path, and it’s a fundamental principle in my Restoration to Health Initiative (RtH)—combining medical, behavioral health and nutrition screening in a health care system to identify victims of developmental trauma.

I haven’t really explained the “Systems” approach I used to develop RtH. As a new Executive for a non-profit in Alaska in 2003, I was shocked by the dysfunction in our work processes. After a short conversation with a business executive who had adopted a system of management based on how Toyota managed, I was introduced to “Lean Thinking (Lean).” Lean has 2 essential principals—Respect for People and Continuous Improvement. After immersing myself in both the cultural development of Lean and learning the skills of continuous improvement, the non-profit improved considerably. I blogged about my experiences learning and implementing Lean at the non profit so you can read about it there if you have any interest.[ii]

When I became aware of ACE’s, I had been trained to think systemically and I applied that thinking to my research into trauma. At a 2010 event for our tribal members, I had put together the original concept of medical and behavioral health in one entity. We had developed a number of A 3’s[iii] addressing issues that had to be solved before merging the services. I left before we could accomplish the tasks set out in the A 3’s and I don’t believe that work has continued.

Salutogenesis describes a systems approach to health. Most babies are born “defect free.” If their upbringing follows a biologically predictable pattern, without interference by Adverse Childhood Experience, they have fewer medical and behavioral issues. That is a fundamental insight I derived from the ACE Study. As a child develops, Lean Thinking tells us that when defective parenting appears, we should intervene quickly, as a team, to address the issue and eliminate the defect. Through information (to parents about the consequences of ACE’s), teaching (of parenting skills), healing (for the negative behaviors implicated in transmission of ACE’s, such as alcoholism) and continuous improvement (for both parent and child), we achieve a health adult.

Dr. Antonovsky used his theory to study the concept of resilience. It’s a little more involved that my limited research can explain, but he observes that many people thrive despite having Adverse Experiences (including childhood derived) in their lives. I will tackle this explanation when I have more knowledge. Basically, there is a process that prepares some people to rebound from adversity. They don’t have negative health outcomes because their development process contains factors that help them cope. I believe this is what others refer to when they describe resiliency.

I want to add one more thought, also based on the concept of resiliency. It is my belief that some resilience can be attributed to the adoption of positive and neutral behaviors. I described this before in the context of successful childhood actors and singers. They do well until the praise stops, usually at age 18. Criticism sets in at the same time. As adults, they can access more coping materials: alcohol, drugs, sex and buying stuff (“retail therapy”). Lots of teens are praised for their skills and devote extraordinary amounts of time and effort to develop them. I believe for ACE’s kids, both the exercise and the praise help alleviate the feelings of stress, tension and anxiety. However, a meltdown (from the accumulated effects of substances and stress) leads to both physical and behavioral issues later in life.

It is appropriate to have trauma informed employees wherever kids spend time: schools, sporting events, juvenile justice systems and recreation centers, among others. Recognizing the infliction of ACE’s or the manifestation of ACE’s is critical to what I described in the systems approach as identification of a defect. We can then utilize a team approach to solving the problem.

I should add that the systems approach does not rely on blame or shame when fixing defects. And defects should not be used in a judgmental form. A defect is only a descriptor for occurrences that we know can lead to problems in the future.

[i] Antonovsky, A. “Health, Stress and Coping” San Francisco: Jossey-Bass Publishers, 1979

[ii] https://leaninalaska.wordpress.com

[iii] An A 3 describes an 11” x 17” document used by Toyota to write, on one page, all of the information required to improve a process.

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