Suffering and Salutogenesis: A Conceptual Analysis of Lessons for Psychiatry From Existential Positive Psychology (PP2.0) in the Setting of the COVID-19 Pandemic

Abstract

The COVID-19 pandemic has had a widespread effect on the thoughts, emotions and behavior of millions of people all around the world. In this context, a large body of scientific literature examining the mental health impact of this global crisis has emerged. The majority of these studies have framed this impact in terms of pre-defined categories derived from psychiatric nosology, such as anxiety disorders, depression or post-traumatic stress disorder. These constructs often fail to capture the complexity of the actual experiences of the individuals being studied; more specifically, they describe these experiences exclusively in terms of disease, while neglecting their potentially adaptive or “salutogenic” aspects. Similarly, discussion of psychological assistance for these individuals has largely been confined to a reiteration of “evidence-based” psychological or pharmacological techniques which can be delivered using remote access technology. In the context of the COVID-19 pandemic, these approaches are likely to be of mixed efficacy. Conversely, “negative emotions” or distressing psychological experiences may actually be functional in the setting of a disaster or crisis, serving to minimize harm, maximize social coherence and compliance, and facilitate adherence to safety measures. The limitations of the “conventional” approach are, to a certain degree, inherent to the prevailing medical model of mental health. Beyond these considerations lies the concept of “salutogenesis,” a term which refers to the innate capacity of individuals to create and maintain health and well-being in the face of adversity. Using principles derived from the second wave of positive psychology (PP2.0), particularly its emphasis on the totality of human experience and the possibility of deriving meaning and character growth from suffering, this paper conceptually analyses the relevant aspects of salutogenesis and PP2.0, and proposes an alternate approach for addressing mental health concerns during the COVID-19 pandemic. Such an approach, while acknowledging the utility of the conventional medical-psychotherapeutic model in specific cases, reduces the risk of medicalizing human experience, and provides individuals and communities with opportunities for growth and adaptation. The benefits of this proposal could potentially extend far beyond the current crisis, offering an opportunity for the field of psychiatry and mental health research to move away from a purely “disease-centered” model.

Sense of Coherence and Burnout in Healthcare Professionals in the COVID-19 Era

“…In line with previous studies ( 28 , 30 , 33 ), we have identified GRR in relevant vulnerable groups as a critical premise in designing mental health intervention programs. The concept of SOC can influence some psychotherapeutic modalities and psychological counseling approaches.…”

“…We expected a substantial association and prognosis of SOC both in line with burnout and in line with personal accomplishment as an aspect to mental health. The need for proactive research to identify GRR in this group is outlined ( 28 , 30 , 32 , 33 ).…”

“…Rajkumar ( 28 ) has outlined a conceptual salutogenic framework for a mental health approach that can integrate the principles of existential positive psychology and salutogenesis, which has been based on thoroughly reviewed previous experience and a critical analysis. The highlights of this approach are assessing the psychological distress in terms of the risk for auto- or allo-aggression, comprehending suffering outside of the conventional diagnostic criteria, interpreting the “story of the person,” determining the individual's current SOC, and deriving therapeutic meaning from suffering.…”

‘Brain fog’, guilt, and gratitude: experiences of symptoms and life changes in older survivors 6 months after hospitalisation for COVID-19

“…Sense of coherence is described as one’s ability to holistically comprehend a stressful experience, the capacity to use the available resources, and the enduring and dynamic feeling of confidence that the experiences in life are comprehensible, manageable, and meaningful [ 17 ]. The concept called ‘salutogenesis’ focuses on our innate capacity to create and maintain health and well-being in the face of adversity [ 18 ], and more on people’s resources than on pathogenesis [ 19 ]. Our internal healing resources and potential for active adaptation to new circumstances is emphasised in the salutogenic model [ 19 ].…”

Mental Wellbeing and Boosting Resilience to Mitigate the Adverse Consequences of the COVID-19 Pandemic: A Critical Narrative Review

“…Facing some adversity as opposed to none or extreme levels of adversity actually appears to improve coping ability, functioning, and happiness (Seery et al, 2010). Positive Psychology 2.0 (Wong, 2011), Existential Positive Psychology (Wong, 2020; Wong et al, 2021) and salutogenesis (Antonovsky, 1979; Rajkumar, 2021) may all contribute to boosting resiliency, positive wellbeing, and possibly even flourishing during these times of ongoing adversity. In fact, proactive coping with “suffering can enhance our resilience” (Wong et al, 2021, para.…”