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5/13/2013

Aaron Antonovsky's insight on observing Holocaust survivors.

An interview I gave to the Sacramento Bee was published this morning.  I was asked about the escape of Amanda Berry with her child, and the rescue of two other women after years being caged in a house in Cleveland by a sadist.

When interviewed,  I discussed an observation about Holocaust survivors that was made by the late Aaron Antonovsky,  an American-born medical sociologist (doctorate from Yale) who made his career at the Israel Institute for Applied Social Research in Jerusalem.

Antonovsky is not as well known as he should be.  To the extent that he is known,  it is for "a theory" that he called the sense of coherence and a term he coined:  salutogenesis.  

Antonovsky's first book was titled "Health, Stress and Coping: new perspectives on mental and physical well-being,"  (1979).  His second was "Unraveling the Mystery of Health:  how people manage stress and stay well,  (1987).  

Antonovsky described the observation I referred to as "a fundamental turning point in my work as a medical sociologist."  

The starting point looks different after you have read the entire work,  and also after the passage of time.  In the interview with the Bee,  I conveyed the import and bungled the details.

The study I had in mind was not specifically about Holocaust survival.  It was a 1970 study of "adaptation to climacterium of women in different ethnic groups in Israel"  (i.e.,  health adaptation to either menopause or aging).

Across the groups,  most women (more than half) displayed good emotional health.  Among those who had been in concentration camps,  it was only 29%.  More than two-thirds of the survivors were still troubled.  It made sense that they would be troubled,  given their experience.

What did not make sense to Antonovsky was that  29% were psychologically healthy:
"To have gone through the most unimaginable horror of the camp,  followed by years of being a displaced person,  and then to have reestablished one's life in a country which witnessed three wars ... and still be in reasonable health?"  
Antonovosky began searching for the roots of human resilience - whatever it is that enables us to cope with life,  however life comes at us.  What he realized is that you cannot find the answer by looking at how people get sick or how to prevent illness.  He said you have to look at it from the perspective of how people become healthy or how they create health (the salutogenic model of health).  

Central to Antonovsky's theory is the observation that healthy adaptation to life requires a sense of meaning.  In simple terms,  you cannot achieve physical or psychological health if you do not have an enduring belief that life is worth living.  It is a theory that explains why faith and hope can be life sustaining in a medical crisis,  and in ordinary life,  and in all types of extraordinary circumstances.

Viktor Frankl, the influential Austrian existentialist, neurologist, psychotherapist and concentration camp survivor made the same point in the title of his seminal book:  "Man's Search for Meaning" (1959).

Describing his own survival,  Frankl said (in part) that he was sustained by an awareness of the meaning of love and his understanding of the phrase:  "the angels are lost in perpetual contemplation of an infinite glory."

The difficultly in discussing how people survive trauma (aside from getting the research details correct) is that if you refer to any type of "triumph of the human spirit," it could imply that some did not have enough faith, will, strength or determination.

If you contemplate why some do not survive,  you can come dangerously close to blaming or inducing guilt in victims of all types.  Why didn't the rape victim fight harder?  Why did the abused woman return to her man?  How come everybody else got over it and you didn't?  Those questions lead us to the wrong answers.

The human spirit and psyche can in fact be broken by trauma and terror,  no matter what the character strength of the individual.  We know this with certainty because everyday in America right now,  22 of our most capable, disciplined, honored and well-trained young men and women commit suicide.  Right now, 22 Veterans per day are committing suicide, and it cannot possibly be their fault.

By referring to Antonovsky's turning point observation,  what I was hoping to convey is that we should always be amazed by those who survive any adversity in life,  and that theoretically and empirically,  we know what is at the root of how they do it.



Copyright, Paul G. Mattiuzzi, Ph.D.