Role of salutogenesis in healthcare communication
Disclaimer: This is an extract from Professor Ananda’s chapter on “Salutogenesis Approach to Communication” that has appeared in the excellent book “Effective Medical Communication” edited by Professor SC Parija and Professor BV Adkoli and published by Springer, Singapore. This except is used only for educational and promotional purposes and doesn't seek to infringe on any copyright claims. The full chapter and book can be purchased from https://doi.org/10.1007/978-981-15-3409-6_23
In modern times, healthcare professionals in general and medical doctors in particular are being increasingly targeted by the general public for lacking a ‘humanistic’ approach to their patients. While this perception may not be completely true, it cannot be wished away as on a whole there has been an overreliance on a pathogenic disease-modifying focus rather than a salutogenic health-promoting focus on wellness. It often seems to me that we as a profession have lost sight of the woods for the trees, limiting our search towards the manifestation of diseases and illness, forgetting that we as health care providers are meant to help ‘health’ manifest in the first place.
“What then is the way out of this?” may well be your question and that is where salutogenesis, an emphasis on patient care that identifies and addresses the causes of health and well-being, comes into the picture. It also encompasses interventions focused on health promotion and those that help optimize wellness. This shift in perspective is required in both our mental process and manifest communication with patients and their caregivers if we are to make any lasting difference in their lives.
As healthcare providers we must always remember that our role is to provide “care” in the most loving, compassionate and competent manner as possible by us at that point of time. This is the humanistic angle, the one with the heart that makes medicine an art. As said so well in the most amazing movie Patch Adams[1], “You treat a disease, you win, or you lose. If you treat a person, I guarantee you’ll win, no matter what the outcome”. This is further reiterated by another quote from the same movie where we are reminded, “Our job is to improve the quality of life, not just delay death”. A very philosophical and heart touching statement is then made when he says, “Why can’t we treat death with a certain amount of humanity and dignity, and decency, and God forbid, maybe even humor. Death is not the enemy gentlemen. If we’re going to fight a disease, let’s fight one of the most terrible diseases of all, indifference”.
Healing in a holistic sense has faded from medical attention and is rarely discussed in modern medicine especially in therapeutics. However, other disciplines like medical anthropology, sociology, alternate systems of medicine, and medical philosophy have continued an active contemplation of holistic healing. To heal is to achieve or acquire wholeness as a person. The wholeness of personhood involves physical, emotional, intellectual, social, and spiritual aspects of human experience.[2]
The Indian tradition of healing on the other hand understands health and well being as a dynamic continuum of human nature and not a mere ‘state’ to be attained and maintained. The lowest point on the continuum may be understood as having the lowest speed of vibration and manifests as death whereas the highest point with the highest vibration is that of health, wellbeing and even a conceptual awareness of immortality. In between the extremes of this continuum lie the states of normal health and disease. For many, their state of health is defined as that ‘state’ in which they are able to function without hindrance whereas in reality, health is part of our evolutionary process towards Divinity.
This is in tune with the concept of eudemonia described by Aristotle as a “well-lived” life that fulfills a person’s ultimate purpose and gives them meaning. Eudemonic happiness is a steadfast, abiding contentment marked by flourishing vs. a short-term pleasure or comfort. This may related also to the concepts of self-actualization of Abraham Maslow[3] and to the meaning/purpose of life known in the Japanese culture as Ikigai[4] and as self-responsibility (Swadharma[5]) in Indian tradition that enables the individual to attain a sense of coherence that is essential for salutogenic wellbeing[6].
Everyone loves to be loved, valued and feel respected as an individual. Such support from the healthcare providers creates a positive sense of self esteem that enables healing to manifest in a natural manner. Patients of cancer and survivors have identified social support as a crucial element for coping with illness and for achieving adequate quality of life. This is also positively associated with promotion of survival in both early as well as the late stages of cancer as emotional and social support helps them learn to cope with psychological stress. This in turn can reduce levels of depression, anxiety, disease and treatment-related symptoms. Suggested approaches include training in relaxation, meditation, or stress management, counselling or talk therapy, healthcare education sessions, social support in a group setting, and exercise.
The great Austrian psychiatrist and Holocaust survivor Viktor Frankl (1905–1997) is best-known for his indispensable 1946 psychological memoir Man’s Search for Meaning which is a meditation on what the gruesome experience of Auschwitz taught him about the primary purpose of life: the quest for meaning, which sustained those who survived. He tells us so very clearly, ““Everything can be taken from a man but one thing: the last of the human freedoms — to choose one’s attitude in any given set of circumstances, to choose one’s own way.” He also gives us hope when he says, “If there is a meaning in life at all, then there must be a meaning in suffering. Suffering is an ineradicable part of life, even as fate and death. Without suffering and death human life cannot be complete”. [7]
For those interested in communication with fellow suffering human beings he says, “Love is the only way to grasp another human being in the innermost core of his personality. No one can become fully aware of the very essence of another human being unless he loves him. By his love he is enabled to see the essential traits and features in the beloved person; and even more, he sees that which is potential in him, which is not yet actualized but yet ought to be actualized. Furthermore, by his love, the loving person enables the beloved person to actualize these potentialities. By making him aware of what he can be and of what he should become, he makes these potentialities come true”. This is where empathy and compassion come into our medical profession as the guiding lights. Without such qualities we become mere machines and lose the humanistic aspects of medicine. It is these aspects that have elevated our profession to the status of being a noble and divine one and we owe it to ourselves, to our profession and to our fellow human brethren to do the best we can to become true healers and providers of health care.
[1] https://en.wikiquote.org/wiki/Patch_Adams_(film)
[2] Egnew TR. The meaning of healing: transcending suffering. Ann Fam Med 2005;3(3):255–262.
[3]www.psychologytoday.com/intl/blog/theory-and-psychopathology/201308/the-theory-self-actualization
[4] https://en.wikipedia.org/wiki/Ikigai
[5] https://moayush.wordpress.com/2017/05/09/the-yoga-of-responsibility
[6] www.ncbi.nlm.nih.gov/books/NBK435839
[7] Viktor E. Frankl Quotes (Author of Man’s Search for Meaning) [Internet]. Goodreads.com. 2019 [cited 6 September 2019]. Available from: https://www.goodreads.com/author/quotes/2782.Viktor_E_Frankl
