In 1976, by a series of unexpected turns, I was admitted to the fourth class of a new medical school in Beer Sheva, Israel. My admissions interviewer was a medical sociologist named Aaron Antonovsky. He had spent the previous decade studying Holocaust survivors and asking a question almost no one in medicine was asking. Not what made the suffering ones sick, but what allowed some of them, against everything they had endured, to live with steadiness, purpose, and even joy. He called the field he was building salutogenesis — the study of the origins of health rather than disease. Meeting him changed the direction of my life. Forty-five years and a career in psychiatry later, I understand that now in a way I could not at twenty-two.
Antonovsky’s central finding was deceptively simple. People remain well, under conditions that should crush them, when their world feels comprehensible, when the resources to meet it are within reach, and when their effort is connected to something worth caring about. He called the combination a sense of coherence, and he showed across decades of research that it is one of the strongest predictors we have of how a human life unfolds under stress.
I spent nearly forty years sitting with patients in the aftermath of loss — of capacity, of role, of the work that had defined them. What I learned at those bedsides is what Antonovsky predicted in his lectures. People break when the world stops making sense, when their resources feel out of reach, and when the thread connecting their effort to something larger goes slack. We lose those conditions — individually and as a society — far more easily than we like to admit.
Salutogenesis asks a different question of every institution: not what is making us sick, but what would make us well.
After retirement I returned to Antonovsky’s work the way one returns to a long letter that finally makes sense. I was reawakened to it by Dr. Sir Harry Burns, the former chief medical officer of Scotland, who used the salutogenic framework to confront an opioid crisis conventional medicine could not reach. His work confirmed what I had come to suspect. Salutogenesis is not only a clinical model. It is a way of seeing families, workplaces, communities, technologies, and democracies.
The Institute for Salutogenesis is the vehicle I have built to carry that lens into public life. It is the framework beneath everything else I am working on — Moonshot Press, the People’s Commission on Technology and the American Future, and the broader civic work of this country’s 250th year. Its purpose is to bring the science of health, not the science of disease, into how we think about people and the conditions under which they thrive — and to apply that lens, with humility, to the questions of our moment, including what artificial intelligence is doing to work, attention, community, and the shared coherence a free society depends on.
I am one person, in my second-act stage of life, doing what I can with the time I have. Antonovsky taught me, more than four decades ago, that the question is never whether stress and disruption will come. They always do. The question is whether we can build the conditions under which human beings can meet what comes and remain whole.
That is the work of the Institute. I would be grateful for your company in it.