Mental health articles

Resilience theories

There are a number of references to resilience in mental health promotion writing. For example, Joubert and Raeburn place considerable emphasis on ‘resilience’ which they see as ‘a dynamic and human concept’ (p.16) and central to their model of mental health. In the UK the then Health Education Authority’s (HEA) treatment of mental health also had a heavy emphasis on resilience: ‘Mental health … is the emotional resilience which enables us to enjoy life and to survive pain, disappointment and sadness. It is a positive sense of well-being and an underlying belief in our own, and others’ dignity and worth’ (HEA 1996: 2). One of the problems with this is that although Joubert and Raeburn emphasize ‘supportive environments’ which are needed to enhance and develop individual resilience, they also leave unmentioned the social and ecological factors for which such resilience is often needed. This omission was also made by the HEA and Orley and Birrell Weisen.

Although some of life’s disappointments and sadness, such as bereavement and loss, are going to happen to everyone, many of life’s ‘ups and downs’ are not inevitable but rather they are socially created, and things could be constructed differently. Many of the ‘downs’ are the result of social injustices, inequalities and health-demoting policies that need to be challenged and improved – not just accepted – if we are to improve mental health. Another related point about resilience is that there are some people in the world who have a great deal more resilience than most of us will ever have or need. They would simply not survive without it. For them, it is not a ‘requisite capacity’ or ‘latent resourcefulness’ in need of awakening. Instead it is something they would rather not have to use quite so routinely. The appropriate argument may be less about ‘awakening’ and more about social justice. So although Joubert and Raeburn are right to place their faith in ‘the human spirit’ and the potential this has for things to be done, there is a problem with such a single emphasis. They ignore the meso and macro-ecological systems and structures which are there in society, which cannot be neutral in their propensity for promoting or demoting health, and which in many cases need addressing.

Antonovsky’s sense of coherence theory

As we have seen, the pathogenic view sees health as being the absence of disease and sees treatment, such as pharmaceutical drugs, as an allopathic system of opposite forces to correct the sickness. This is reductionist and mechanistic, reducing the problem down to pathogens or risk factors. A theory that turns the argument around is called salutogenesis. This suggests that we need to look at those who stay well despite being high on risk factors. What is different about them? How do they cope? What helps the person to cope? Why do some people cope better than others do? Salutogenesis sees health as a continuum ‘We are all terminal cases. And we are all, so long as there is a breath of life in us, in some measure healthy’. Salutogenesis sees treatment as enhancing the coping mechanisms not just to one specific illness but in general, helping people to move towards the healthy end of the health–illness continuum.

A salutogenic theory of health starts from the assumption that the human and living systems are subject to unavoidable entropic processes (the damage and deterioration caused by life and aging), and unavoidable death. In reading the work of Antonovsky, you will find a metaphor of health based on the idea of a river.

From his research, Antonovsky identified a range of factors that seemed to play a role in helping the people cope and survive. He called these generalized resistive resources. These are the properties of a person, (or a collective) which have facilitated successful coping with the inherent stressors of human existence.

Seedhouse’s Foundation Theory

Seedhouse seems to be right about a good many things to do with mental health promotion: right about the shortcomings of replacing ‘mental health’ with equally unclear terms like ‘well-being’; right to flag up that health promotion has limits; right that mental health promotion should not be a separate health promotion activity; and right to acknowledge that practice is necessarily based more on values and ‘untestable beliefs’ than on evidence (Seedhouse 1998: 8). His basic idea is that health requires various foundations which include:

1 The basic needs of food, drink, shelter, warmth and purpose in life.

2 Access to the widest possible information about all factors which have an influence on a person’s life.

3 The skill and confidence to assimilate this information.

4 The recognition that an individual is never totally isolated from other people and the external world.

Tags: Health, mental, Mental health