To be healthy and happy is sometimes to be mad

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The Independent Online
'UNLIKE many of my colleagues, particularly Americans, I do not equate what is good for the health with what is good.' When I heard those words, I nearly fell off my seat with delight. I heard them, moreover, in one of those Brooklyn accents which can rip open a can of worms at 20 paces.

Professor Aaron Antonovsky, who teaches 'the sociology of health' in Israel, was addressing the Families at Risk European conference at Wembley this summer. Perhaps it takes a Brooklyn-born Israeli to aim so accurately at the American solar plexus. But I was unexpectedly reminded of Pope John Paul II. Whatever his failings in many other areas, the Pope earned glory as the man who told Americans that the fact that most of them wanted something did not automatically mean that they ought to have it.

Professor Antonovsky punctured one of those enormous sealed systems so dear to religion, psychology and politics. As he said, it is an especially American orthodoxy that the cult of health - whether of the body, that apparatus you have to keep sleek and nurtured, or of the psyche - must also be the cult of virtue. Even in this country, many of us have come gradually to assume that paunchy, unaesthetic people are less moral than those who 'care for their bodies', and that muddled, inconsistent personalities are an offensive contrast to those who have 'got it together'.

Oh, really? How did we come to forget all those flat-tummied young men and maidens, with their rosy tans and rippling deltoids, who put on black uniforms and beat the hell out of the 'racially and politically challenged' in the 1930s? And how can we overlook the fact, obvious in every estate agency or senior common room, that you can be a happy, together, well-integrated shit?

Professor Antonovsky, who is also a great concept-coiner, was lecturing on what he calls 'SOC - the sense of coherence'. He explains SOC as 'a way of seeing the world as comprehensible, manageable and meaningful'. Without the irony in his voice, it would have been hard to listen to him. For the world outside the conference centre was on fire.

The Families at Risk conference had been called to discuss what happens to families in Europe when their worlds cease to make sense. As the days of presentations and debate passed, Sarajevo was burning. A new generation of European families was learning what it means to flee from a home, to lose a father killed or fighting on some unknown front, to travel the roads with bags and bundles and hungry children, to be the prey of armed bands who beat, steal, rape and sometimes kill, to be at best refugees in a foreign land without possessions or hopes. For this generation, like that of its grandparents in the 1940s, the world reveals itself as incomprehensible, unmanageable and meaningless. No 'sense of coherence' for them.

But what is the real moral value of that SOC? As Antonovsky said, 'the stronger the SOC, the more adequately is one likely to cope with changes'. The mental world of Communists and fundamentalist Christians, to take extreme examples, included the possibility of the hell on earth represented by Nazi concentration camps. In Buchenwald and Ravensbruck, the Communist cells among the prisoners retained some sense of coherence: things might not be manageable, for the moment, but for a trained anti-Fascist they were all too comprehensible and meaningful. In the same way, ideological mass movements like Communism or Fascism have provided their members with a highly satisfactory SOC. Everything makes sense; nothing happens by chance; if you are not for us you are against us; the inner enemy is being unearthed by heightened vigilance and liquidated - and tomorrow, as the SS song went, the whole world will be ours: '. . . und morgen die ganze Welt]'

So you can be a fit, happy, well-adjusted monster. As Antonovsky went on, I began to hear fewer echoes of the Pope and many more of such novelists as Joseph Heller or Kurt Vonnegut or the Polish writer Witold Gombrowicz. From Brooklyn and the University of the Negev, another prophet of absurdism was speaking.

'The SOC construct,' he said, straight-faced, 'was formulated as the core construct of a salutogenic model, that is, one which is designed to explain successful coping with stressors and health enhancement.' Salutogenic? But mercifully Antonovsky was using jargon as a satirical weapon. He explained that, unlike everyone else in the world, he regards health and not illness as the great mystery. So how do people fall healthy? 'Salutogenesis' is his word, and a deliberately horrible one, for this strange tendency of human beings to collapse into good health from causes which still defy medical research.

It follows that acquiring an SOC - sense of coherence - is a grave symptom of psychic healthiness. There are various ways in which a patient may have picked up SOC: by exposure to the 'healthy thinking' of some absolutely fulfilled and balanced group, like Stalinists or Nazis, or by the individual process (probably assisted by Freudian or Jungian therapists) of thinking him- or herself through to a state of personal balance, peace and fulfilment. SOC can be caught by infection in a crowd, like pneumonic plague, or inherited as a lonely gene from ancestors who made sense of their own worlds.

Here Joseph Heller and his 'Catch 22' become relevant. Who has a high SOC in Bosnia if not the Serbian militiamen, jumping up every morning all bright-eyed at the prospect of cleansing another village of Muslims? The lowest score lies with the refugee women and children stuck in the mud and rain between the frontiers of Bosnia and Croatia. Their sense of coherence is zero. On the other hand, it is also true that in order to retain a strong SOC in Bosnia - to be happy and healthy amid ethnic cleansing and the bombing of market- places - you have to be sick. The more sense of coherence you have, the crazier you must be.

This is not just about war in the Balkans. All over post-Communist Europe, certainties have given way. Family incomes have vanished, as industries are privatised or closed; marriages break up as a parent leaves home to seek work; mothers unable to afford contraceptives face new laws criminalising abortion. There are some groups who find this coherent: the free-market fanatics in the finance ministries, or the missionaries of the International Monetary Fund who think people have to suffer to deserve capitalism, or even the skinhead gangs in Germany who believe that foreign refugees are the sole cause of unemployment. But, broadly speaking, you have to be mad to experience such chaos and stay sane.

What we need is a Sense of Incoherence. We live in turmoil as we have always lived, and the Golden Ages people love to mourn - Edwardian England, or even Brezhnevite Russia - were turbulent and meaningless to those living through them. Accepting chaos is a step to real maturity.

The grown-ups in Communist Europe were not the pitifully few believers, but the masses who voted as they were told, disbelieved everything they read and bribed or stole to get what their children needed. They lived a life of mild criminality spiced by humanity. In the madhouse, only those who don't add up make sense.