Crackpots and basket-cases: a history of therapeutic work and occupation

Occupational therapy's oversight: How science veiled our humanity

BACKGROUND

Occupational therapy's connection to positivist science predates the profession's formal beginning, with important contributing knowledge sources coming from mathematics, physics, psychology, and systems theory. While these sources of objective knowledge provide a rational, defendable position for practice, they can only explain a portion of what it means to exist as an occupational being.

AIMS/OBJECTIVES

This article aims to reveal some of the history of science within occupational therapy and reveal the subjective, ontological nature of doing everyday activities that the profession's preoccupation with positivist science has obscured.

METHODS

This research used a history of ideas methodology to uncover how occupational therapy perceived people and how practice was conceptualised and conducted between 1800 and 1980s, as depicted in writing of the time.

CONCLUSION

Analysis showed that, through history, people were increasingly categorised and delimited. Practice also became systematically controlled, moving occupational therapy into a theoretical, scientific, and abstract realm.

SIGNIFICANCE

The emphasis placed on objectivity diminishes the attention given to human ways of practicing, where the subjective experience is central to our thinking.

The development of a creative work rehabilitation organisation

Work as therapy has a place in mental healthcare, but there is disagreement about how and why it might be helpful, and how best to conceptualise or represent those benefits. Over the last 50 years, occupational and industrial therapy sheltered workshops have been key elements in the provision of work activities in psychiatric settings, and community-based horticultural activities and creative craft work have offered additional approaches. Using archival material, interviews, witness seminars and personal reflections, this article charts the birth and initial growth of Restore, a charity providing creative work-based services in Oxfordshire between 1977 and 1988. Although Restore might be understood as a response to national trends in mental healthcare policy and research, its trajectory reflects local contingencies.

Use of Measuring Tools in Practice Development Projects: A Critical Perspective

BACKGROUND.

Occupational therapists are generally positive towards use of measuring tools. However, such use may be problematic.

PURPOSE.

To illuminate hidden and adverse effects of using measuring tools in occupational therapy.

METHOD.

A Foucauldian inspired thematic analysis of the use of measuring tools in 13 reports of practice development projects in Denmark.

FINDINGS.

Three themes were constructed: "Categorisation of loss", "Conduct of conduct: Self-tracking and competition", and "Conforming to expected forms of everyday living". Measuring tools tended to produce generalised truths about older adults and were used to predict outcome of or access to reablement programs. The measurements guided both older people and professionals, and measurements created both motivation and resistance. The tools served as an extension of the healthcare professionals' authority.

IMPLICATIONS.

When appropriately situated, measuring tools have the potential to empower and enhance older adults' lives and should be the focus of greater clinical attention.

The experiences of veterans with mental health problems participating in an occupational therapy and resilience workshop intervention: an exploratory study

Introduction

Occupational therapy has long had a strong presence in military mental healthcare. Today’s veterans have complex needs and can face challenges reintegrating into civilian life. This exploratory study investigated whether veterans receiving mental health treatment who participated in a bespoke occupational therapy and resilience workshop intervention improved their perceived participation in everyday life.

Method

An interpretivist hermeneutic phenomenological approach was used to explore veterans’ perspectives. Ten participants took part in two semistructured focus groups. Thematic analysis was used to identify and analyse patterns within the data.

Findings

Most participants developed occupational goals and started to make lifestyle changes; participants developed an appreciation of the value of occupation; participants developed insight into their recovery journeys; and value was placed on the ‘healing power’ of the group.

Conclusion

This exploratory study provides preliminary evidence to suggest occupational therapy was influential in helping participants understand the impact of occupation on health and start making lifestyle changes. Participants also reflected on their recovery journeys. The benefits of doing this within a group environment appear to have been particularly therapeutic. Original occupational therapy research in this specialism is sparse. This novel study provides insight that can further discussion and enhance understanding about what the profession can offer this client group.

An ambivalent atmosphere: Employment training programs and mental health recovery

This article critically examines the role of employment training programs in the personal recovery of adults living with mental illness in community settings. Using Cameron Duff's (2014) notion of 'assemblages of recovery,' we explore how, and to what extent, employment training programs provide the supportive resources linked to personal recovery. Using an ethnographic case study, we describe the ambivalent atmospheres associated with one program. This ambivalence expresses the fundamental tension between the genuine aspirations of personal recovery and the realities of the capitalist labor process.

Problematizing 'productive citizenship' within rehabilitation services: insights from three studies

Background: The idea that everyone should strive to be a 'productive citizen' is a dominant societal discourse. However, critiques highlight that common definitions of productive citizenship focus on forms of participation and contribution that many people experiencing disability find difficult or impossible to realize, resulting in marginalization. Since rehabilitation services strive for enablement, social participation, and inclusiveness, it is important to question whether these things are achieved within the realities of practice. Our aim was to do this by examining specific examples of how 'productive citizenship' appears in rehabilitation services.Methods: This article draws examples from three research studies in two countries to highlight instances in which narrow understandings of productive citizenship employed in rehabilitation services can have unintended marginalizing effects. Each example is presented as a vignette.Discussion: The vignettes help us reflect on marginalization at the level of individual, community and society that arises from narrow interpretations of 'productive citizenship' in rehabilitation services. They also provide clues as to how productive citizenship could be envisaged differently. We argue that rehabilitation services, because of their influence at critical junctures in peoples' lives, could be an effective site of social change regarding how productive citizenship is understood in wider society.Implications for rehabilitation'Productive citizenship', or the interpretation of which activities count as contributions to society, has a very restrictive definition within rehabilitation services.This restrictive definition is reflected in both policy and practices, and influences what counts as 'legitimate' rehabilitation and support, marginalizing options for a 'good life' that fall outside of it.Rehabilitation can be a site for social change; one way forward involves advocating for broader understandings of what counts as 'productive citizenship'.

The art and nature of health: a study of therapeutic practice in museums

Drawing on ethnographic fieldwork and interviews at a major metropolitan art museum and botanic garden, this article considers the practical accomplishment of American museums' 'health turn' by tracing how museum staff develop therapeutic programmes for visitors with disabilities. In doing so, it considers one of medical sociology's fundamental theoretical questions - how ideologies of health order social life - in an unconventional empirical setting. Acknowledging contemporary arguments for both the relative merits and unintended consequences of this policy trend, I focus instead on the particular institutional arrangements, professional norms, and material cultures of art and nature that shape museums' therapeutic work, so as to reveal its effects. Data reveals ideological similarities, but practical differences, between museological and medical understandings of wellness. Extending a 'medical sociology of practice' to new contexts ultimately foregrounds the contingencies, and diversity, of therapeutic mechanisms and meanings, thereby broadening sociological research on healing and healthism.