Rethinking sense of coherence: Perceptions of comprehensibility, manageability, and meaningfulness in a group of Palestinian health care providers operating in the West Bank and Israel

Drawing on a salutogenic perspective, we explored sense of coherence (SOC) in a group of Palestinian mental health care providers living and working in Israel and the occupied Palestinian territories (West Bank). Specifically, we conducted a qualitative exploration of the cultural characteristics of SOC and its components (comprehensibility, manageability, and meaningfulness) in two groups of Palestinian Muslim helpers. We found that context-specific features of SOC can mobilize generalized resistance resources for coping with traumatic and stressful experiences, even in an environment characterized by political instability, military violence, and social trauma. Ten main themes emerged from the thematic content analysis: acceptance, reacting to adversity, acknowledging human insecurity (comprehensibility), self-control, talking to family, education as a resource for survival, connecting to the severity of the event, responsibility as a source of control (manageability), religiosity, and sense of belonging (meaningfulness). The Islamic faith, as expressed through the concepts of Sumud and Taslim, seemed to permeate individuals’ ability to attribute meaning to historical and transgenerational trauma, as well as to their ongoing traumatic conditions, thus acting as their ultimate source of health and wellbeing. A holistic, spiritual, and collectivist outlook helped respondents to approach their lives with optimism. We discuss the implications for mental health care providers and future research directions.