From domestication to imperial patronage: Deconstructing the biomedicalisation of occupational therapy

Occupational therapy knowledge emerged in the 19th century as reformist movements responded to the industrialisation of society and capitalist expansion. In the Global North, it was institutionalised by State apparatuses during the First and Second World Wars. Although biomedicine contributed to the rapid expansion and establishment of occupational therapy as a health discipline, its domestication by the biomedical model led to an overly regulated profession that betrays its reformist ideals. Drawing on the work of Deleuze and Guattari, our aim in this article is to deconstruct the biomedicalisation of occupational therapy and demonstrate how resistance to this process is critical for the future of this discipline. The use of arts and crafts in occupational therapy may be conceptualised as a 'nomad science' aesthetically resisting the domination of industrialism and medical reductionism. Through the war efforts, a coalition of progressive nurses, social workers, teachers, artisans and activists metamorphosed into occupational therapists. As it did with nursing, biomedicine proceeded to domesticate occupational therapy through a form of 'imperial' patronage subsequently embodied in the evidence-based movement. 'Occupational' jargon is widely used today and may be viewed as the product of a profession trying to establish itself as an autonomous discipline that imposes its own regime of truth. Given the symbolic violence underlying this patronage, the future of occupational therapy should not mean behaving according to biomedicine's terms. As a discipline, occupational therapy must resist the appropriation of its 'war machine' and craft its own terms through the release of new creative energy.

Eamon O'Sullivan: 20th-century Irish psychiatrist and occupational therapy patron

The profession of occupational therapy was formalized in the USA in 1917. Many of its earliest proponents were psychiatrists, yet their role in the development of the profession has received limited attention. This paper addresses this gap by considering one of the earliest Irish psychiatrist patrons of occupational therapy: Dr Eamon O'Sullivan (1897-1966) of Killarney Mental Hospital, Co Kerry, who developed an occupational therapy department in 1934. A textbook written by O'Sullivan reflects core philosophies articulated by occupational therapy's founders, and these philosophies were evident in practice at his hospital. Some inconsistencies between O'Sullivan's writings and practice are identified. In the absence of patient testimonies, it is not possible to resolve questions about the potential exploitation of patients through work as therapy.

A Historical Cross-Professional Perspective on the Fellowship in Occupational Therapy

Health professions education is increasingly creating learning experiences after one's entry-level practice degree. Such experiences include residency and fellowship experiences for health professions practitioners. This review of residency and fellowship programs across several health professions includes the development of residency programs and the implications these developments have on occupational therapy. The analysis across health professions includes medicine, pharmacy, physical therapy, speech-language pathology, and occupational therapy. This thorough analysis can help guide the development of occupational therapy fellowships. This background provides a foundation to focus on the implications for emerging fellowships within occupational therapy. The findings can be utilized to assist in the development of new successful fellowship programs.

The Kirkbride buildings in contemporary culture (1850-2015): from 'moral management' to horror films

The so-called 'Kirkbride Plan' is a type of mental institution designed by the American psychiatrist Thomas Story Kirkbride. The Kirkbride-design asylums were built from 1848 to the end of the nineteenth century. Their structural characteristics were subordinated to a certain approach to moral management: exposure to natural light, beautiful views and good air circulation. These hospitals used several architectural styles, but they all had a similar general plan. The popularity of the model decreased for theoretical and economic reasons, so many were demolished or reused, but at least 25 of the original buildings became protected places. Over the years, surrounded by a legendary aura, these buildings have become a leitmotif of contemporary popular culture: 'the asylum of terror'.

The Pioneer Schools of Occupation: Reflections for Current Practice

The Pioneer Schools of Occupation: Can They Teach Us Anything Today? This study reviews the development of the pioneer schools of occupation and their curriculum or program design between 1906 and 1923. The purposes are to document the existence of the schools, to explore the issues in establishing the schools, and to compare and contrast concepts stated in early curriculum models with those in current models of practice. The dates were selected to examine ideas before the passage of the Minimum Standards for Courses of Training in Occupational Therapy by the American Occupational Therapy Association (AOTA) outlining a consensus course of study.

Eleanor Clarke Slagle: Facts and Myths

Although the name, Eleanor Clarke Slagle, is well known to occupational therapy practitioners, her personal history is less known and published accounts vary in the degree of accuracy. This article is based on a historical research technique known as source criticism that focuses on using accounts published during the individual's lifetime that can be verified, when possible, through more than one source. The purpose is to present an accurate history of Mrs. Slagle as a person who influenced the history and development of occupational therapy practice in the United States.

The intermingled history of occupational therapy and anatomical education: A retrospective exploration

Few research articles have addressed the anatomical needs of entry-level occupational therapy students. Given this paucity of empirical evidence, there is a lack of knowledge regarding anatomical education in occupational therapy. This article will primarily serve as a retrospective look at the inclusion of anatomical education in the occupational therapy curriculum. Focusing on the historical inclusion is the first step to address the gap in existing knowledge. Examining the history of anatomy in occupational therapy provides an educational context for curricular developments and helps current anatomical educators understand the evolution of occupational therapy as a profession. Exploring the educational history also offers anatomy educators an identity, as significant contributors, in the training and preparedness of entry-level professionals while focusing on the ideals of occupational therapy. However, there is a critical need for empirical evidence of best teaching practices in occupational therapy and anatomical education. This manuscript provides a foundation and a starting point for further investigation into the anatomical competencies for entry-level occupational therapists.

[Inside and outside the asylum. On the dynamics of work as therapy in Weimar Germany]

In the 1920s patients of mental hospitals were more and more treated with work therapy, as the paper will show using the example of the Staatskrankenanstalt Hamburg-Langenhorn that had been founded in 1893 as Irren-Colonie. Based on a qualitative analysis of administration records and patient files the paper poses the question after the effects that work therapy had inside and outside the hospital and examines the interactions between psychiatric acting and economic as well as welfare state needs.

The psychiatrist as administrator: the career of W.F. Theunissen in the Dutch East Indies

W. F. Theunissen (1882-1961) was a leading psychiatrist in the Dutch East Indies. He was the medical director of several large mental hospitals after which he became director of the Dutch East Indies Public Health Service. Theunissen was not known for his research into the causes of mental illness. Instead, he made his mark as an administrator greatly reducing the expenses of the Lawang mental hospital by expanding occupational therapy in new and innovative ways. His accomplishments earned him the position of director of the Indies Public Health Department, where he oversaw the decentralisation of health services and the development of public health initiatives.

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

Despite the long history of beliefs about the therapeutic properties of work for people with mental ill health, rarely has therapeutic work itself been a focus for historical analysis. In this article, the development of a therapeutic work ethic (1813-1979) is presented, drawing particular attention to the changing character and quality of beliefs about therapeutic work throughout time. From hospital factories to radical "anti-psychiatric" communities, the article reveals the myriad forms of activities that have variously been considered fit work for people with mental health problems. While popular stereotypes of basket-weaving paint a hapless portrait of institutional work, a more nuanced reading of therapeutic work and its political and philosophical commitments is advanced. The article concludes by arguing that the non-linear and inherently contested development of therapeutic work is less the effect of paradigmatic shifts within the therapeutic professions, but rather evidence of a broader human struggle with work.

What is a "health" professional? The changing relationship of occupational therapists and social workers to therapy and healthcare in Quebec, 1940-1985

Studies regarding the medicalization process generally focus on the way various physical and psychological conditions have been identified as "health" problems, within specific historical contexts. Less well known is how the therapeutic roles of certain "health" professionals were also a result of the confluence of particular historical events. By comparing the professional trajectories of Quebec's occupational therapists and hospital social workers from 1940 to 1985, this article demonstrates how professionals originally outside of the world of health care created new therapeutic roles for themselves within the constantly expanding institutional health care system.

["Or should we be cured just to [..] be constantly confronted with the fact that we have to stay here forever [..]?" The view of psychiatric patients between illness, normalization and normality (1921-1937)]

In German psychiatry, a distinct change occurred in the 1920s with regard to types of treatment. By introducing work therapy, early releases and psychiatric support outside the asylums the number of in-patients was to be reduced. As a consequence social approaches began to dominate psychiatric discourse. These approaches aimed at normalizing everyday life in the institutions and at implementing treatments that would allow patients to be reintegrated into society. Based on numerous documents on a patient who had spent the 1920s and early 1930s in a mental institution, the article adds a patient's view to the psychiatrists' perspective that has so far dominated the history of psychiatry of the Weimar Republic. The documents allow for an in-depth investigation of both the potential and the limitations of the approaches to psychiatric reform prevalent at the time. They illustrate, from a micro-perspective, the field of tension between psychiatric diagnosis, life in the asylum and integration into society that, in the case of this patient, became especially poignant with the patient's release at the time of the Third Reich sterilization laws.

Visiting the mentally ill: volunteer visitors at Saskatchewan hospital, Weyburn 1950-1965

This article offers a glimpse into the lives and activities of some of the patients, volunteers and staff in the Saskatchewan mental health system during the period of deinstitutionalization. Drawing on her own experience as a patient in psychiatric wards as well as ongoing research in the history of mental health, it features the role of Regina Volunteer Visitors in Saskatchewan Hospital, Weyburn and examines the importance of occupational and recreational therapies and activities in improving the lives of the patients in that institution. It emphasizes the perspectives of patients and volunteers who actively worked to develop recreational activities, with the intention of helping individuals connect with the surrounding communities. The views and perspectives presented here are drawn from a variety of historical and oral interview sources, including views from visitors to the asylum and patients who lived within its walls. The author has also been a consumer of mental health services, and spent time in the Provincial Mental Hospital in North Battleford. The article therefore makes an important contribution to enhancing our understanding of the social history of deinstitutionalization, not only for its unique source base, but also because those sources have been examined and explained to readers through the perspectives of a former patient herself. This article draws significant attention to the changing opportunities for patients as they interacted with the women's volunteer groups, as well as to how the changes brought about by the encroaching deinstitutionalization, care in the community, and decisions from "above" affected the individuals on the ground.

[A pioneer in occupational therapy at mental hospitals in local cities (approaches at Shichiyama Hospital at the beginning of Taisho Era)]

Occupational therapy at mental hospitals in Japan began in 1901, when Shuzo Kure created two sewing rooms in the female section of Sugamo Hospital and allowed patients to sew pillowcases and hospital gowns for use at the hospital. In 1904, Sugamo Hospital added a work section, and occupational therapy became an official part of the hospital. In addition, Kure stated in The Complete Book of Japanese Internal Medicine (Nihon Naika Zensho), published in 1916, that occupational therapy had also become popular at other mental hospitals; however, he did not refer to specifics, such as information on what kind of occupational therapy was being carried out at which hospital. Shichiyama Hospital is a private facility located in Kumatori-cho, Sennan-gun, Osaka. In 1599, some 200 years before Philippe Pinel released lunatics from their chains, Sanai Honda established Soshindo at Jokenji Temple for the treatment of mental disorders using Chinese herbal remedies. Treatment using these remedies was practiced until the 1950's. Evidence suggests that Chinese herbal remedies were being used in combination with occupational therapy, such as farm work and raising poultry, from the end of the Meiji Era. Plans of the hospital in 1913 included descriptions of a farm, and entertainment and recreational areas for patients, confirming this evidence. It also supported Kure's statement about occupational therapy having become popular at mental hospitals at the beginning of the Taisho Era. In Summary, occupational therapy was practiced at mental hospitals in local cities at the beginning of the Taisho Era, and such occupational therapy in this period was significantly influenced by Shuzo Kure; therefore, I pay my respects to this great pioneer of psychiatric medicine.

History of ergonomics and occupational therapy

Ergonomics is commonly known as "the scientific study of human work" [14, p. 3] and "the application of scientific information concerning human beings to the design of objects, systems, and environments" (p. 4). The American Occupational Therapy Association defines occupational therapy as "skilled treatment that helps individuals achieve independence in all facets of their lives. It gives people the 'skills for the job of living' necessary for independent and satisfying lives [1]." Both professions share common backgrounds. Occupational therapy has been involved in health care and ergonomics is looking for its place in the health care field.

Exploring the mental health roots of occupational therapy in Canada: a historical review of primary texts from 1925-1950

PURPOSE

This historical study focused on understanding the influence of mental health concepts and practices on the profession of occupational therapy in Canada during the first part of the 20th century.

METHODS

The authors examined early editions of the Canadian Journal of Occupational Therapy (CJOT) and other primary works from 1925-1950 to identify key events and themes.

RESULTS

Analysis of these key historical documents revealed four themes: (1) Idle hands, emotional mischief, social unrest; (2) The grand vision; (3) Practical reality: Disparity between theory and practice; and (4) Understanding occupation: Approaches and methods to promote mental health. A timeline of key events related to occupational therapy practice and mental health also emerged.

IMPLICATIONS

Reflecting on the history of a profession can assist its members to understand current practices and future possibilities.

[The origins of occupational therapy in Spain]

INTRODUCTION

Occupational therapy is a young discipline in many aspects, but since ancient times an important number of reports have appeared in the health sciences literature and in the early days of neurology and psychiatry that can shed light on the origins and the fundamental principles that underlie this profession today. We have gathered examples that show how the philosophy and the clinical practice of the procedures used in occupational therapy stem from the process of humanising medical care.

AIMS

After analysing the information currently available to us on the history of the influence of humanism on the development of medicine in Spain, the authors believe they have found enough evidence to identify the precursors of occupational therapy at that point in history.

DEVELOPMENT

Our study examines facts that appear to situate the earliest evidence of occupational therapy at the origins of Spanish neurology and psychiatry in the 15th century, and which were later to have such a powerful influence on the birth of certain aspects of Pinel's moral treatment.

CONCLUSIONS

If we accept 'moral treatment' as being one of the main forerunners of occupational therapy, and if we take into account that the humanitarian way patients were dealt with in Spanish neurological and psychiatric institutions and hospitals in the 15th century had a notable influence on the principles that regulated that 'moral treatment', then it is reasonable to state that the earliest evidence of occupational therapy is to be found in the development of humanisation within Spanish medical care.

From Education to Occupation: The Story of Thomas Bessell Kidner

Background. Thomas Bessell Kidner is well-known in the United States as a great contributor to occupational therapy. He is not well-known in Canada despite the fact that his first contributions to the profession were made here between 1900 and 1918. Purpose. To tell the story of Thomas Bessell Kidner and his impact on occupational therapy. Methods. Interpretive biography research methods using archival materials, published papers and family papers. Results. Kidner's work as an organizer of manual training in elementary schools in Nova Scotia and New Brunswick and as Director of Technical Education for Calgary prepared him for his work as Vocational Secretary of the Military Hospitals Commission during World War I. Kidner developed, implemented and oversaw the reeducation program for injured soldiers across Canada. It included bedside occupations, off-ward and curative workshop activities provided by ward aides, as well as industrial training and apprenticeships in the workplace. Practice Implications. Kidner's story stimulates us to revisit our profession's early emphasis on return-to-work. Knowing about our past helps occupational therapists to build a stronger identity.

The growth of the profession of occupational therapy

Occupational therapy is a frequently unknown and misunderstood profession. However, occupational therapy practitioners have a rich history in the US Army, from the inception of the profession to current challenges. The article is a chronicle of historical highlights of occupational therapy which discusses how this history is harmonious with that of occupational therapy in the US Army. In researching this topic, several concepts emerged: (1) occupational therapy grew from a belief that people need occupation, or activity, to remain healthy; (2) people learn the best through purposeful activity; (3) the number of occupational therapists in the US Army decreases during peacetime, but in time of war the benefit of this profession is recognized and its numbers increase; (4) although models of health care change, the primary focus of occupational therapy remains constant; and (5) there is a direct correlation between the philosophy of occupational therapy and the philosophy of treating Soldiers with combat stress reactions, a "go-to-war" mission of Army occupational therapy practitioners. As such, the management of these Soldiers is enhanced by the unique skills offered by this profession.

[Professionalization of occupational therapists--based on interviews with the psychiatric nurses and instructors before legislation on occupational therapists was passed]

This article aims to clarify the historical background regarding why psychiatric occupational therapists pointed out the ambiguity of their professional roles in the 1990's after over 25 years of legislation on occupational therapists. Findings regarding their social background and interviews with the nurses and instructors who were engaged in occupational therapy before the legislation are as follows: (1) Actual conditions of the nurses and instructors were not fully reflected in the clauses. This seems to create a separation between old and new people in this field. (2) Although social prejudice against the patients and chronic shortages of manpower existed, the objectives of treating the patients as human beings and collaborating with them (not having them work) were regarded as being important. This seems to have been one of the "guidelines" of Doctor Shuzo Kure in the Meiji Era.

[Labour, silence and order: visualizing modern psychiatry--strategies for legitimizing Swiss asylum psychiatry in the context of occupational therapy in the interwar period]

In the 1930s Swiss psychiatrists were engaged in a singular public campaign to promote a new image of their profession. The result of this campaign was a series of booklets about psychiatric institutions. These asylum-monographs, as they were called, encompassed a large number of photographic illustrations, most of which showed patients at work. Taking the visual omnipresence of patients' work in the asylum-monographs as a starting point, this contribution examines the status of occupational therapy in psychiatric discourse and practice in Switzerland at the beginning of the 1930s. The first part of the contribution describes and outlines the development of patients' work in several psychiatric institutions after World War I. Then it turns to the discussion about the introduction of a new and more active form of occupational therapy ("aktivere Therapie") in this period. The second part of the contribution analyzes the meanings of therapeutic work in psychiatric discourse. It shows that the enthusiasm occupational therapy produced among Swiss psychiatrists was mainly due to its ability to change the visual appearance of the asylums. Furthermore it points to several traits of Eugen Bleuler's concept of schizophrenia, especially the assumption of different ranks of primary and secondary symptoms and the notion of autism, which were both crucial to the contemporary understanding and handling of occupational therapy. Finally, it argues that a medical interpretation of patients' work, which identified therapy with working discipline, was a necessary precondition for the omnipresence of patients' work in Swiss psychiatry's public campaign in the 1930s.

Welfare state and women's work: the professional projects of nurses and occupational therapists in Sweden

In this article we explore how Swedish welfare politics within health-care and rehabilitation has opened up a space for nurses' and occupational therapists' professional projects. Using historical data, an analysis of the policy-making process behind welfare programs central to the professionalization of nursing and occupational therapy is presented. The time period covered is, in the case of nurses, the larger part of the twentieth century, while the modern history of occupational therapists first began in the 1940s. Special emphasis is placed on the corporative nature of the Swedish welfare state and the professional strategies utilized by nurses and occupational therapists in their struggle for jurisdiction. In the article, politicization is identified as a core strategy by which female-dominated welfare state occupations in Sweden have tried to gain influence over the welfare policy-making process and their occupations' jurisdiction.

Embracing Our Ethos, Reclaiming Our Heart

A profession’s ethos is an interlacing of sentiment, value, and thought that describes its character, conveys its genius, and manifests its spirit. The ethos endures over time, serving as touchstone against which individuals may strike their actions to know their worth. As a profession’s inner voice, the ethos inspires individuals and calls them back if they stray too far.

This discussion of the occupational therapy profession’s ethos has two discernable parts. The first invites deliberation, given its historical ground. The second is a blend of ideas and images, a clutch of reflections inviting affect and will to join in thought. My hope is to illuminate the ethos of the profession in such a way that a new perspective on current challenges is possible. I set before you this idea: To advance into the future with the ethos that has characterized occupational therapy since its inception is a reclamation of the profession’s heart.

Canadian occupational therapists' contributions to prisoners of war in World War II

BACKGROUND

A small number of Canadian occupational therapists provided materials to prisoners of war who were experiencing occupational deprivation in German camps during World War II. Although the occupational therapy contribution was relatively minor relative to the overall efforts of assistance to prisoners of war, it represented dedication, commitment and further sacrifice at a time when occupational therapists faced difficult choices.

METHOD

An historical research method approach was employed to gather information from primary sources found in the Canadian Association of Occupational Therapy archives. Secondary sources were also consulted to provide additional background information. This paper outlines the need and context for the response, method of organization, materials sent, challenges experienced, and impact that this effort had on both POWs and the occupational therapists themselves.

PRACTICE IMPLICATIONS

This account may inform and inspire current day occupational therapists who are considering the implications of occupational deprivation within frameworks of social and occupational justice.

Helen Primrose LeVesconte: occupational therapy clinician, educator, and maker of history

BACKGROUND

The Canadian history of our profession is not well known and our identity is thought to suffer as a result. Helen Primrose LeVesconte (7896-1982) is one pioneer in our development whose story has not been told.

PURPOSE

Our purpose is to explore LeVesconte's life and work in order to expand knowledge of our roots and thereby strengthen our identity.

METHOD

Using interpretive biography methods we draw on LeVesconte's own writings, articles written about her, and archival documents to describe turning point moments in her life and to display meaningful patterns in her work.

RESULTS

LeVesconte's work as a clinician and her role and reputation as an educator, show her to have been a strong and visionary leader. Her views on the client's role, the importance of the therapist-client relationship, prevention, community-based programs, and vocational rehabilitation are of particular interest.

PRACTICE IMPLICATIONS

Because LeVesconte educated over 1,850 students while director of the occupational therapy program at the University of Toronto, her influence has been felt throughout the country. Her perspective is compared to current practice; and questions are raised as to aspects of her legacy and philosophy that might now be reconsidered.

Chaotic Occupational Therapy: Collective Wisdom for a Complex Profession

In the tradition of Mosey’s (1985) Eleanor Clarke Slagle lecture (p. 504) as a road map to where this presentation is going, I will present a short preface andfirst, talk about herstory and our professional identity;second, use chaos theory as a way to look at occupation;third, introduce you to Charlotte’s Web of Chaos;fourth, make some conclusions about chaos and occupational therapy;fifth, do an ending to this telling, and;sixth, do a summary and closing.

[Housing and work as criteria of the "Social Integration" of the mentally ill - development in Germany between 1900 and 2000]

AIM

This paper analyses, in what way psychiatrists considered housing and work as criteria of social integration of mentally ill people and what models of care were suggested in Germany throughout the 20th century.

METHOD

Publications in 29 German professional and scientific psychiatric journals through the complete period from 1900 to 2000 and monographs were searched for papers on the above issues.

RESULTS

Until the second half of the century, integrative initiatives related to housing and work generated in asylums without the aim of a full social integration of the patients. In the activistic concept of NS-psychiatry, work became an obligation for patients and a criterion for selection that decided on life and death. Not until the late 1950s, there again was an orientation towards integration in psychiatric care in both German states. Whilst already in 1963 the "Rodewisch Theses" outlined recommendations for the rehabilitation of the mentally ill already in the GDR (East Germany), a similar mark of reform ideas was published in the "enquete" in the FRG (West Germany) in 1975. In the GDR initiatives were limited to a small number of locations. In the FRG and the re-unified Germany various forms of sheltered housing and work were established - also with significant regional variation. However, a clear discussion of underlying aims and implications for the structure of mental health care was not found in the psychiatric literature.

CONCLUSIONS

In the 20th century a tradition of psychiatric ideas related to housing and work did not develop in Germany. Particularly, there were only sporadic contributions from university psychiatry. Work was more frequently explicit subject of discussions than housing. Both areas were - slowly and in discontinuity - established as criteria of integration of people with mental illnesses, which was increasingly accepted as an aim of mental health care.

Occupational therapy's dance with diversity

As the demographics of the United States continue to change and we become a more pluralistic society, the increased diversity of the occupational therapy workforce and our consumers calls for an examination of the profession's stance on multiculturalism and diversity. Using the metaphor of dance, this article identifies the dance partners as the organization's leaders and its members. A historical review of the profession from the 1940s to the present traces the partners' steps to determine which led the dance of diversity during the profession's development. In this review, I discovered that the period when the profession most effectively and productively explored issues of diversity was during the early- to mid-1990s--a time when the organization and its members worked in harmony. At that time, occupational therapy's dance with diversity flowed with rhythm and synchronicity.

Hanwell Lunatic Asylum 1831-1844: the golden years

The achievements at Hanwell Lunatic Asylum were widely praised in their time. The ideals of the physicians were dependent on the attendants for their success. A variety of documentation, including patient case-books, manuals of staff duties, matron's daily report books and visitors reports, are examined to assess the reality behind the public image.

The evolution of our occupational perspective: the journey from diversion through therapeutic use to enablement

Occupational Therapy, in the broad sense of the term, has become the most serious problem before the statesmen of every nation in the world at the present time. All over the civilized globe, the widespread disease of unemployment (lack of occupation) is monopolizing the attention of national parliaments and world conferences. Everywhere the effort is being made to remedy human dissatisfaction and mental unrest by providing daily tasks so that minds may be occupied, bodies may be healthy, and the means of sustenance may be found (Howland, 1993, p. 4).

The history of occupational therapy assistants in Canada: a comparison with the United States

In the middle of the twentieth century, the role of occupational therapy assistant was introduced in North America. Although the role, utilization and training of assistant personnel have raised much controversy and debate within the profession, Canada and the United States have taken very different paths in terms of dealing with these issues. This paper focuses on the history of occupational therapy assistants in Canada, using the experience in the United States for comparison purposes. The occupational therapy literature and official documents of the professional associations are used to present a chronology of major historical events in both countries. Similarities and differences emerge in relation to historical roots; training model and standards of education; certification, regulation, and standards of practice; career laddering and career mobility; and professional affiliation. The paper concludes with a summary of issues which require further exploration, debate and resolution if the profession is to move forward in Canada.

Authenticity in occupational therapy leadership: a case study of a servant leader

OBJECTIVE

The purpose of this qualitative study was to examine the leadership of occupational therapy educator Sr. Genevieve Cummings at the College of St. Catherine in St. Paul, Minnesota, from 1960 to 1994.

METHOD

In-depth interviews were conducted with faculty, staff, administrators, and friends who knew her work intimately. Themes regarding her leadership were synthesized from the interview data and compared with trends in the leadership literature.

RESULTS

The predominant themes representing the major elements of her success as a leader were enabling others, focusing on the greater good, collaborative visioning, and leadership through caring and service. The findings indicate that Sr. Genevieve led in uniquely authentic manner by serving the needs of students, faculty members, and the profession.

CONCLUSION

Sr. Genevieve was an effective, authentic, and accomplished leader throughout her career. Her contributions had a significant impact on the field of occupational therapy and occupational therapy education. The legacy of her leadership serves as a model for others in occupational therapy who must balance multiple challenges, pressures, or roles and be able to work effectively with others.

COTA education and professional development: a historical review

This article provides a historical review of certified occupational therapy assistant (COTA) education, professional roles, career mobility, and professional development. The evolution of COTA education from 2 hospital-based, 12-week training programs to the current 162 accredited 2-year college degree or professional certificate programs is examined. The expansion of the COTA role from well-delineated direct service provider to advanced practitioner able to assume leadership roles within the profession is explored. Historic and current programs and methods supportive of COTA career mobility and professional development goals, including the Career Mobility Program, continuing education, career laddering, and the Advanced Practitioner program are described.

Mania pre-lithium

The changes that lithium brought are most fully understood when we grasp the difficulties for management that acute mania presented. Restraint in canvas camisoles, padded cells, paraldehyde, water-baths and salts-Epsom, not Lithium-met mania in echos of Bedlam still heard in the early 1950s. It is a part of psychiatric history important to remember.

A historical cross-disciplinary perspective on the professional doctorate in occupational therapy

Clinical doctorates are emerging in occupational therapy. By examining the development of clinical doctorates in medicine, dentistry, psychology, pharmacy, nursing, and physical therapy, implications can be drawn for the future of occupational therapy education. These histories offer us a sense of the distinct purpose and curricular structure of the professional doctorate, its successes and problems, its general sequence of unfolding, the political dynamics surrounding it, and the potential it holds for supporting the profession's capacity for service to patients.

Tracing research methodology in occupational therapy

As a profession, occupational therapy has been repeatedly confronted with the challenge to prove the value of occupation as a therapeutic medium. The types of research pursued by occupational therapists have evolved in response to societal trends, external pressures, and the priorities of individual practitioners. Although many therapists have reconciled the pursuit of research with the roots of occupational therapy through an adherence to naturalistic methods, others continue to value experimental research designs. This article explores the rise of qualitative research methods in occupational therapy and addresses the current dilemma between naturalistic and positivistic designs.

Occupational therapy and rehabilitation: an awkward alliance

This article argues that although occupational therapy and rehabilitation are often considered synonymous, the latter is but one aspect of the former. Early influences on occupational therapy are briefly reviewed, and some philosophical ideas about activity are described. The rationale for the use of occupations as treatment in the early part of this century, both in Canada and in the United States, is examined and contrasted with the development of physical medicine and rehabilitation after World War II. This discussion demonstrates that the origins of occupational therapy and rehabilitation in North America had little in common. As occupational therapy became incorporated into rehabilitation, the profession's core values eroded, and although current definitions of rehabilitation offer a more appropriate fit for occupational therapy, rehabilitation continues to see engagement in occupations as a separate and subsequent step. The article concludes by considering future directions and the tasks that lie ahead.

Occupational therapy's link to vocational reeducation, 1910-1925

The development of occupational therapy is rooted in early 20th century medical reform. During the early 1910s, several members of the medical profession, human service workers, and the larger American society were increasingly disturbed by medical practices that did not consider the individual's personal experience of disability. Occupational therapy was developed, in part, out of this desire to provide persons with treatment that helped them to function in their communities despite their disability. Early occupational therapy leaders envisioned the fledgling profession as a societal service capable of assisting persons with disabilities to return to both work and community life. Vocational reeducation was initially considered to be an integral component of occupational therapy in the years from 1910 to 1920. However, the profession's early link to vocational reduction was challenged by vocational technical trainers during World War I. To prevent occupational therapy from being subsumed by vocational technical training, the early occupational therapy leaders implemented several strategies: adoption of physician prescription for all occupational therapy services, delivery of occupational therapy services primarily within hospital settings, and dissociation from vocational reeducation services. Reasons accounting for why the early occupational therapy leaders abandoned their initial commitment to vocational reeducation are explored. Suggestions about how this decision has affected present-day practice are also offered.