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- Herausgeber: John Wiley & Sons
- Kategorie: Fachliteratur
- Sprache: Englisch
At last, a book about the little pieces of occupation which make up life' s real situations and experiences and form a basis for therapy. Offered in the form of stories about practice previously published in the popular US publication Advance for Occupational Therapy Practitioners, this enjoyable book presents occupational therapists as "masters of the mundane." Therapists, students and educators will find this easy to read text a useful tool in guiding clinical approaches to therapy.
Accompanied by theoretical papers by Dr. Estelle Breines and colleagues previously published in refereed international journals, these stories will aid the reader in understanding principles of active occupation that guide practice and shed light on how these ideas can be applied to the education of therapists.
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Seitenzahl: 370
Veröffentlichungsjahr: 2013
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Contents
Foreword
Preface
What goes round comes round
1 Introduction
Understanding ‘occupation’ as the founders did
Rabbi Emil Gustave Hirsch: ethical philosopher and founding figure of occupational therapy
Pragmatism as a foundation for occupational therapy curricula
2 Thinking Deep Thoughts
Occupational genesis: how activity, individual connect
What do you know about spatial orientation?
The end of occupational therapy? We have a choice
Never mind who we are – what do we do?
It’s what you don’t have to think about that counts
The thinker and the sower
Consider cultural influences when teaching patients activities of daily living
The origin of adaptation
We need to talk the talk
Genesis of occupation: a philosophical model for therapy and theory
3 The Magic of Healing
Engaging the mind to help the body overcome illness
Students are amazed to see the arts at work in the clinic
In times of bereavement
Don’t overlook some handcrafts for your rheumatoid patients
How activity affects your patient’s recovery process
A patient loves to do the teaching
A hard look at reality
Don’t ‘learn’ occupational therapy from unfriendly systems
4 Old Crafts – New Ideas
If you haven’t got any steel, try using some papier maché
Chasing Belgian lace
If Martha has them doing crafts …
Paint can be all-purpose medium in the occupational therapy clinic
With knitting, you can be teacher or student
Buying craft supplies tells something about the users
Quick! Find the knitting needles!
Crafts were the basis of the trades we still practice
An attempt to define purposeful activity
5 Toys and Games
That perfect task may be in the cards
Cards are well-suited to therapy goals
It’s all in the cards
How about getting all ‘dolled’ up?
The ‘puzzle’ behind the fun and fascination of activities
6 Saving the Environment:
Hey, don’t throw away all those six-pack rings yet!
No budget: what do we do now?
The case for recycling ‘stuff’
Putting out the challenge to find what’s cost effective
7 Home, Garden and Beyond
Culture cooking makes fox great occupational therapy
Fall: it’s finally in the air
Water, water, everywhere, so have some fun
There’s no end to what you can do with summer plants
Planting the seeds of accessible activity
There’s lots of things to do ‘lookin’ out my back door’
Considering public education and the kitchen cabinet
Bread: it can be the staff of your staff’s life in the clinic
The key to self-worth may be right at your fingertips
If you play with your food, do it right
Isaac S. Friedman:guest author
Yes, Virginia, there is activity-based occupational therapy
The therapy that’s in your office
Water sport in retirement
Did you ever want to be a ’90s Johnny Appleseed?
8 Pets and People
Try some activities with man’s best friend
Are pets the therapy tool your practice is missing?
9 Occupational Technology and Occupational Therapy
Occupational technology, past, present and future
Estelle B. Breines, Tamara Avi-Itzhak, Meryl M. Picard and Elizabeth Torcivia
The new art of videography
Chasing the perfect button
CSU’s creative links to human health
What could you do in the clinic with a ‘peace’ of paper?
10 Teaching and Learning through Activity
Students’ appreciation of crafts is not universal
Will occupational therapists who use crafts please stand
Learning to value active occupation
Where have all the trained occupational therapists gone?
Writing and teaching about activity
Moving into the occupation mode
Where do we go from here?
Media education based on the philosophy of pragmatism
Occupational therapy education in a technological world
Notes
References
Index
© 2004 Whurr Publishers Ltd
First published 2004 byWhurr Publishers Ltd19b Compton Terrace, London N1 2UN, England325 Chestnut Street, Philadelphia PA19106, USA
All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of Whurr Publishers Limited.
This publication is sold subject to the conditions that it shall not, by way of trade or otherwise, be lent, resold, hired out, or otherwise circulated without the Publisher’s prior consent, in any form of binding or cover other than that in which it is published, and without a similar condition including this condition being imposed upon any subsequent purchaser.
British Library Cataloguing in Publication Data
A catalogue record for this book is available from the British Library.
ISBN 1 86156 393 0
Foreword
The profession of occupational therapy is less than a hundred years old, if a meeting in Clifton Springs, in the USA, is seen as the beginning, yet it is expanding and flourishing all over the world. In 1917, a small group of interested people met at Clifton Springs to found the National Society for the Promotion of Occupational Therapy. Today, the World Federation of Occupational Therapists has fifty-seven member countries and the number is rising steadily.
If success can be measured in terms of growth and expansion, then occupational therapy is a successful profession. This is surely due to the pragmatic value of a professional group whose main concern is to promote and maintain people’s ability to function effectively in the world. What could be more useful?
And yet, occupational therapists sometimes appear to doubt our own worth. Perhaps this is because we work in areas of life that everyone takes for granted until something goes wrong. When Mrs Smith wants to regain her ability to get dressed after a stroke, she needs an occupational therapist. When Mr Brown returns to work after an acute psychotic episode, he may depend on the support of an occupational therapist. However, getting dressed and going to work are ordinary, everyday activities. Not everyone is able to recognise the skills that go into performing these activities and that are required for teaching or maintaining them
The skills of the occupational therapist, although crucial to those clients who receive occupational therapy, are mostly invisible to the rest of the world. Occupational therapists are not invited to address the important health issues of the day on national radio. Our interventions do not make great television drama. Some therapists find it difficult to sustain a commitment to working with activity in the face of the puzzlement or indifference of their colleagues.
What the occupational therapist does looks so simple that the observer might think it is just based on common sense. But this practical approach to addressing the ordinary activities of everyday life is underpinned by a coherent philosophy of practice that is the envy of other professions. It is also supported by an impressive body of theory that is being expanded and refined all the time.
In the past, the occupational therapist’s professional self-doubt has perhaps been exacerbated by an incongruity between the grand theories that we have tried to adapt to our practice and our focus on small gains with individual clients. When everyone around us is using medical terminology, it can be hard to take pride in talking about mundane matters such as cooking and childcare. This situation is improving as we develop a specialised vocabulary with which to articulate our concerns, our goals and our methods.
In this book, Estelle Breines has succeeded in capturing both the importance of small gains and the complexity of our apparently simple methods, in language that is appropriate to occupational therapy. She describes her collection of meditations on the therapeutic use and value of activity as ‘often warm and fuzzy simple stories’. This phrase does not do justice to the wealth of knowledge, understanding and experience that have made it possible to write in such a way. For example, in describing activities that might be appropriate for autumn (Fall: it’s finally in the air) Estelle has drawn on her understanding of activity analysis, cultural appropriateness, individual motivation, activity sequencing, accessible environments, group dynamics, risk management and occupational justice. This apparently unsophisticated description of things to do in the autumn is based, like occupational therapy itself, on complex, high level theories.
The book also incorporates some of Estelle’s more overtly philosophical and theoretical papers, reproduced with the permission of the original publishers. These enable the reader to explore in more depth some of the concepts that are touched on in the papers that describe aspects of practice. For example, in the story of Elizabeth (Engaging the mind to help the body overcome illness), Estelle describes how being able to carry out two small activities independently made a major difference to the quality of life of a lady living with severe pain and deformity. In the paper on Understanding ‘occupation’ as the founders did, she gives us a theoretical framework for understanding how these small achievements could have such a great effect.
Occupational therapists are concerned with the modest, daily activities of ordinary people but we should take care not to confuse modesty with insignificance. For someone with a serious, long-term incapacity, small achievements can be very significant. This important truth permeates the writings in Estelle’s book All the papers have appeared in other publications but it is a joy to see them together in a single collection where they form a coherent account of the interaction between theory and practice in occupational therapy.
Jennifer Creek,Freelance occupational therapist,North Yorkshire
Preface
In 1994, E.J. Brown of Merion Publications of Philadelphia, Pennsylvania, invited me to write a series of columns on activity for Advance for Occupational Therapy, a small weekly, later monthly, newsprint publication whose primary purpose is classified advertising, but which attracts a large readership for its interesting and up-to-date, sometimes controversial articles on occupational therapy. EJ and I talked about the nature of the columns she wanted from me so I could better understand what she had in mind.
To my way of thinking, occupational therapists have a clear idea of what active occupation entails, and how to use it in practice. Certainly my own education had been full of activities and activity analysis, and my years as a practitioner had given me ample experience. And the colleagues I worked with had this knowledge as well, some from their own education and some perhaps from us having worked together over time.
On the other hand, EJ had observed that in the United States, there seemed to be a shift away from using crafts and other activities in practice, and many younger therapists were uninformed as to how to use them effectively as clinical tools. It was apparent that curricula had changed, as many schools had eliminated crafts from their courses. So as schools changed, and clinics changed, therapy had changed as well.
As I had written a text called Occupational Therapy Activities from Clay to Computers, which focused on the use of activities in practice, she thought I might be interested in writing some columns that gave examples of how activity could be used effectively. I agreed to try, and the name ‘Activity Notebook’ became the title of the column, which still continues to this day.
When I began to write these articles, I never envisioned that I would be writing more than a few columns at best. After all, how many topics were there to write about? But I found myself still writing these often warm and fuzzy simple stories some eight years later. Oddly enough, they obtained a broad readership among US therapists, judging by the many emails and letters I have gotten over the years. In some instances, faculties have contacted me asking for permission to distribute some of the articles to students, which I was pleased to do, given that I use them regularly myself in various classes I teach. Students tend to accept the messages in simple stories more readily than dealing with the abstractions of complex texts.
Now that the number of articles I have written has reached a sizable mass, it seemed a good idea to make them available in one text. I hope you will find them enjoyable reading, and can use them to help to explain to the uninitiated the mysteries of occupation and its applications to health and learning.
What goes round comes round
Originally published in Advance for Occupational Therapy, Dec. 12,1994
Several weeks ago, ADVANCE ran a story by assistant editor Claudia Stahl on the Arts in Medicine program at Shands Hospital in Gainesville, FL. It detailed the story of a Florida oncologist’s move toward using creative activities with almost all his patients because he believed they are therapeutic. In this issue, I understand, Ms. Stahl will take a closer look at the AIM program, which involves everything from ceramics to weaving in the way of crafts. The program is being hailed and publicized as something ‘new’ and ‘innovative’ for a hospital setting. Occupational therapists are not providing the crafts; they are being provided on a volunteer basis by unpaid artists in residence.
Do you know that Mary Reilly once stated that if OT were to disappear as a profession, a new profession would soon emerge with the same characteristics? She never predicted, however, that our profession would be reinvented before its demise. Why is it that other disciplines would see value in the tools that OTs traditionally have held dear, while many OTs have lost their reverence for these same tools?
When I was an undergraduate student at NYU in 1957, it was expected that students would come to the program with a strong interest in handcrafts. In fact, one of the reasons students were attracted to OT was the opportunity to hone their skills in crafts while learning to use them in therapy. The curriculum included courses in ceramics, woodworking, metal crafts, weaving and other crafts. At the same time, we took anatomy, physiology, kinesiology, neurology, psychology, physical and mental conditions, and courses which taught us to splint, adapt equipment, analyze activities and use them in treatment.
Crafts were our tools; we learned to understand the world through them; we learned to use them with patients of all sorts; we had the skills we needed — and we knew who we were. I can remember as a student marching the halls of New York Hospital with a huge picnic hamper on my arm, filled with a selection of items I might need as I went from patient to patient. Whether I was dealing with patients with Hodgkins disease, poliomyelitis, lupus erythematosis, or brachial plexus injury, there was always something appropriate in that basket: spools of leather lacing, needles, yarns, scissors, glue, and doubtless many other things. I can remember better how heavy the basket was.
From that time to this we have seen many changes in health care. Some conditions we treated in the past are no longer seen, while new ones have taken their place; but I suspect the changes in occupational therapy modalities are more related to our unwillingness to identify with mundane things. We sought to characterize ourselves as scientists, while the arts that were special to us diminished in importance.
Peloquin recently suggested we return to the definition we used to use, highlighting ‘the art and science’ of occupational therapy. Not only is practice an art, but we have tools that are arts, and it is to these arts that we must return, or others will come to use them.
In January I will begin a monthly column in ADVANCE, dedicated to resurfacing issues about the use of creative activities in practice. For many young therapists, such activities remain a mystery. Beyond the skills needed to use them competently, therapists need to come to value these activities and perform them with pride. If other professions can see the value in our toots, we, too, must recognize that value. It’s time to bring our skills and our identity back together by initiating a dialogue about these ideas of such fundamental importance to our profession.
The Activity Notebook will deal with the use of activities in practice. I plan to discuss the integration of mind and body in purposeful activity; activity analysis and grading of activity; case studies in all areas of practice; teaching methods; purchasing, budgeting and billing issues; cultural relevance and regional preferences; and others.
If you are experienced, please share your ideas with me: if you are not let me know what you want to learn, and I’ll try to meet your needs. Growing a dialogue can help us save this important part of our professional repertoire for ourselves.
Times have certainly changed, but they appear to be changing back. It seems that true concepts are timeless.
Introduction
This book is divided into ten chapters which cover a series of topics of interest to occupational therapists. The articles were written, however, in a random order and the organization was undertaken much later. The disorganized approach to the writing is reflective of a problem the profession has in explaining itself as we move back and forth, to and from reductionistic and holistic conceptualizations. These articles were written in an attempt to simplify some complex notions that arose from a study of the underlying philosophical principles that influenced the development of the profession, in order to make them more palatable for readers who would rather focus on less abstract thoughts.
I write with an American bias that I request the reader to forgive. Aside from the fact that the articles originally were written by an American for an American audience, my bias comes from my belief that our profession was instigated by strong influences from the mental hygiene movement which in turn was influenced by the American pragmatists John Dewey, William James, Charles Peirce and George Herbert Mead. In turn, their ideas were driven by the relational notions of Hegel in conjunction with the evolutionary precepts of Charles Darwin.
The pragmatists adopted the notions of time, development and evolution as concepts of change evident in human behavior and experience. They departed from a prevailing notion of truth as absolute, affirming the relevance of objectivity and subjectivity in understanding human endeavor. Each of these scholars applied these ideas to their own specialized areas of study. Peirce’s notions, the most abstract, were applied by James to the study of psychology, by Mead to the study of sociology and by Dewey to the study of education, in which he advanced the notion of learning by doing.
These ideas were promulgated widely at the University of Chicago and elsewhere in the United States and influenced members of the Illinois and National Mental Hygiene Societies, whose names may be familiar to readers. Among these persons of prominence were Adolf Meyer, Eleanor Clarke Slagle, Rabbi Emil Gustave Hirsch, Julia Lathrop and Jane Addams, all foundational figures for American occupational therapy. Hirsch and Lathrop founded the Chicago School for Civics and Philanthropy, the first occupational therapy school, at Addams’ Hull House where Slagle and Mary Potter Brooks Meyer (Adolf Meyer’s wife) studied occupational therapy. It was here that learning through doing was adopted as the professions foundational belief.
Drawing on evolutionary themes, pragmatism, which is a phenomenological philosophical movement, advanced the concept of adaptation that was also adopted by occupational therapy. The pragmatists focused on the ideas that mind and body are inseparable and that the individual contributes to society, just as society contributes to the individual. Occupational therapy established its belief in bringing people to their highest levels of functioning so they could become contributing members of society. The founders of the National Society for the Promotion of Occupational Therapy, later the American Occupational Therapy Association, demonstrated the application of these ideas across the various disorders of mind and body.
In time, these abstract ideas were set aside by the occupational therapy profession. Attention was largely focused on the mundane, practical aspects of living as occupational therapists opened the door to the acceptance of common sense as a guide for behavior. Yet, in time, the profession again looked for philosophical explanations for what we inherently know and experience.
In an attempt to meet this need, I, along with others, began to study and analyze our profession’s origins and organizing beliefs. As I studied the ideas of the pragmatists, I tried to formulat e a comprehensive model that featured ideas held by occupational therapists, describing this model as occupational genesis. Occupational genesis describes the interactions among egocentric elements (mind and body), exocentric elements (time and space) and consensual elements (social factors such as relationships, language, roles, regulations), and the changes in these interactions over the course of time. For example, infants move randomly with primitive cognitive abilities (egocentric), surrounded by cribs and mobile toys (exocentric), relating to caretakers in dependent roles (consensual). As development progresses, physical and mental skills develop (egocentric), the toys and environments of childhood (exocentric) alter and relationships with siblings, friends and family grow (consensual). As aging progresses, each of these elements and their interactions change.
This model also applies to the understanding of cultural development.
Drawing from Dewey’s work in the Laboratory School at the University of Chicago, we can observe that the knowledge base and skills of individuals and the artifacts of cultures change over time, influencing and being influenced by social relationships and the activities in which one engages.
Human evolution is driven by the relationships among egocentric, exocentric and consensual elements. In each time period and in each geographic environment, humans drew upon their physical and mental capacities, in conjunction with the tangible features of their environments, in collaboration with those in their society. From this idea, the model of occupational technology emerged. Occupational technology is based on the premise that human beings have been technological creatures from the beginning of pre-history to the modern era, in the same way that occupational therapists have been technologists from their inception to today.
Occupational genesis focuses on the relational and developmental nature of humans. Occupational technology focuses on the technological features of that development. Both are derivatives of the pragmatists’ beliefs, organized to create models for occupational therapists to use in clinical practice, education and research.
The reader is urged to read original and interpretive texts to better understand than I can explain what the pragmatists offered. Toward this end, I suggest a list of papers and books to help guide your reading. And in keeping with the ordinary things that ordinary people express themselves through, I offer the simple articles that follow.
Suggested additional readings
Breines EB (1986) Origins and Adaptations: A Philosophy of Practice. Lebanon, NJ: Geri-Rehab.
Breines EB (1992) Rabbi Emil G. Hirsch: ethical philosopher and founding figure of occupational therapy. Israel Journal of Occupational Therapy 1: E1–E10.
Breines EB (1995) Occupational Therapy Activities from Clay to Computers: Theory and Practice. Philadelphia: EA. Davis.
Dewey J (1916) Democracy and Education: An Introduction to the Philosophy of Education. Toronto: Collier Macmillan.
Dewey J (1929) The Quest for Certainty: A Study of the Relation of Knowledge and Action. New York: Minton, Balch & Co.
Mayhew KC, Edwards AC (1936) The Dewey School: the Lab School of the University of Chicago. 1896–1903. New York: Appleton-Century.
Serrett KD (1985) Another look at occupational therapy’s history: paradigm or pair of hands? Occupational Therapy in Mental Health 5(3): 1–31.
Understanding ‘occupation’ as the founders did
Originally published in British journal of Occupational Therapy, Nov. 1995,58(11): 4.58–60
Abstract
The term ‘occupation’ is both ambiguous and encompassing. This term was adopted by the founders of the profession as a means of incorporating a variety of perspectives on the profession. Interrelating concepts deriving from pragmatism and the mental hygiene movement offer a rationale for understanding occupation. Terms used to describe occupation are egocentricity (mind/body elements), exocentricity (time/space elements) and consensuality (social elements). The integration of these aspects in occupation offers an explanation for the holism advanced by the profession at its outset and today.
Introduction
The literature of occupational therapy repeatedly calls for the definition and accurate use of terms. Darnell and Heater (1994) reiterate this call, in this case urging the explicit use of the term ‘occupation’ in lieu of terms such as activity. They ground their argument in Nelson’s (1988) work, which defines occupation as ‘the relationship between occupational form and occupational performance’ (p. 633).
Defining occupation, just like defining occupational therapy, seems to be a process in which occupational therapists repeatedly engage (Christiansen, 1994; Mosey, 1981). Although the Representative Assembly of the American Occupational Therapy Association (AOTA) has recently adopted new and comprehensive definitions of various terms essential to the profession, including occupation (Position Paper on Occupation, 1995, unpublished), there is no reason to believe that the last word has been written about this topic of critical concern to the profession. Therefore, new perspectives on this word of such importance to the profession may be useful for helping therapists to explain themselves and their work to patients and colleagues, and may serve as a basis for study and research.
The term occupation has been used to describe various models and concepts. These include occupational behaviour (Reilly, 1974), human occupation (Kielhofner and Burke, 1980), occupational performance (Llorens, 1979; Mosey, 1981), occupational genesis (Breines, 1990), occupational science (Clark et al., 1991) and occupational adaptation (Schkade and Schultz, 1992).
Certainly, the term occupation is used freely to describe various conceptual organizations, and appears to mean many different things. Darnell and Heater (1994) are correct to suggest the clarification of the term occupation, and to invite the expanded use of this term to characterize the profession which carries its name. In response, this article frames the discussion in terms deriving from foundation philosophical and historical sources.
At the outset
This author believes that, at the outset of the profession, the term occupation was deliberately selected because of both its ambiguity and its comprehensiveness. An attempt is made to demonstrate this through extrapolation from historical and philosophical evidence, because one is limited to post hoc interpretation when the original sources neglected to offer explicit answers to questions that emerge long after the witnesses are gone.
At the outset, there was considerable discussion about naming the profession. After numerous suggestions, such as ‘reeducation’ and ‘reconstruction’, were rejected by one or another of the founders in vigorous debate, the term occupational therapy was selected (Barton, c. 1914–17; Dunton, c. 1916–17; Licht, 1967; Slagle, c. 1916–17). Occupation appears to have been a word that the founders could agree upon, possibly because it held various meanings and could serve as a mediating term. To find a common word for a profession that synthesized many views was critical, because the profession was founded by a number of individuals who saw the value of occupation in different arenas of practice. Among these were Barton (1919) in sheltered work and physical rehabilitation; Dunton (1918) and Slagle (1914) in mental health; Kidner (c. 1917) in tuberculosis; and Tracy (1918) in medical illness.
Many of these individuals were influenced by the mental hygiene movement. This movement, which originated in the USA around the turn of the century, was recognized for its efforts in social activism (Cohen, 1983). The mental hygiene movement had many members in common with the Arts and Crafts movement, and had many principles in common. Many of the foundational figures of occupation therapy, including Adolf Meyer and Eleanor Clarke Slagle, were affiliated with the National Mental Hygiene Society or the Illinois Mental Hygiene Society (Breines, 1986a).
The mental hygiene movement was influenced by the philosophy of pragmatism expounded at the University of Chicago. Pragmatism is a phenomenological philosophy which focuses on the relationships among individuals, their artifacts and environments and their societies, as represented by their actions in personal and interpersonal well-being. John Dewey, a principal proponent of pragmatism, is recognized for the concept widely known as ‘learning through doing’.
Both the Chicago School for Civics and Philanthropy, where Slagle studied occupational therapy, and the Henry B Faville School of Occupational Therapy, where she later taught, were located at Hull House in Chicago, where pragmatism was taught by John Dewey and Julia Lathrop (Addams, 1910). The Faville School functioned under the sponsorship of the Illinois Mental Hygiene Society. And it was at the University of Chicago that Adolf Meyer (1950) taught and had collegial relationships with John Dewey and George Herbert Mead, foundational philosophers of pragmatism. Here, social activism and pragmatism were united, and built foundations for occupational therapy (Breines, 1986a; Serrett, 1985a, 1985b).
Pragmatism speaks to the interaction of the mind and body of individuals with their tangible and social environments by means of active occupation (Dewey, 1916; Mead, 1932, 1938). This relational belief system, structured in concepts of time, evolution, history and development, can serve as a model for understanding the term occupation and other terms stemming from the same root.
Three distinct concepts
‘Occupation’ can be described according to three distinct but interrelating concepts; egocentric, exocentric and consensual. These three concepts derive from the model of occupational genesis (see Figure 1; Breines, 1990, 1995), and are grounded in pragmatism. Occupational genesis defines egocentric as all aspects of mind and body; exocentric as all aspects of time and space; and consensual as all social phenomena such as roles, rules and language. Consistent with the relational aspects of pragmatism, these three concepts, egocentricity, exocentricity and consensuality, and their components – mind, body, time, space and others such as social influences – are in constant flux and interact throughout life in the performance of life’s tasks.
Figure 1: Egocentric (E), exocentric (X), and consensual (C) elements influence one another. The relationships among these elements are represented by the lines. Occupational therapy changes these relationships by influencing (adapting) any or all of these elements: mind/body, time/space, or social interactions.
Source: Breines (1995). Copyright © 1995, FA Davis.
Three major concepts are revealed when analyzing the term occupation. These concepts are:
Addressing the meaning of occupational therapy
These three uses of the term occupation together address the meaning of occupational therapy as suggested by our founders, and as understood today. The human being engages all these elements – mind, body, time, space and others – in performing life’s tasks, and practice considers them all, using each element to affect each other element in the pursuit of health. These fundamental concepts prevail regardless of clinical population, but different areas of practice emphasize different elements. ‘Psych. OTs’ may emphasize the mind while ‘phys.dis. OTs’ may emphasize the body, but both consider each other element as it applies to their patients. All therapists use the physical and social environments to effect change.
The diverse ways in which occupation can be defined suggests that this term is extraordinarily comprehensive. Moreover, precisely because of this comprehensiveness, occupation has evaded unique definition.
The founders’ selection of the term occupation to describe the profession was not incidental. Considerable argument was entered into before the name of our profession was selected (Barton, c. 1914–17; Licht, 1967; Slagle, c. 1916–17). Rather, this author believes that the term ‘occupation’ was ultimately decided upon to mean all of the elements described above, in part and in whole, if not explicitly, then in terms of its compatibility with the various beliefs of the founders. Furthermore, this holistic interpretation may be the reason that the term has been retained as the profession’s identity, despite recurring reports of discomfort with it (Marmer, 1994; ADVANCE Staff, 1994)·
Were the profession to dissociate itself from any of the three elements of occupation cited above, it would no longer be the profession it has aspired to be. In the absence of any one element – mind, body, time, space and others – we could not be who we are, nor practice as we do in the holistic breadth of practice. The term occupation encapsulates all aspects of who we are as a profession because it represent the comprehensiveness that identifies us. What brilliance the founders demonstrated in arriving at this identity for the profession!
Conclusion
This analysis is consistent with the profession’s foundational philosophy, and is consistent with practice in all its elements, at our origin as well as today. This interpretation may help therapists better to comprehend diverse features of their profession that have sometimes appeared to be in conflict, while recognizing the position of these separate elements in regard to the holism of the profession. Furthermore, this analysis, in addition to other descriptions and uses of the term occupation, affirms the comprehensiveness with which this holistic profession and its philosophy hold.
Rabbi Emil Gustave Hirsch: ethical philosopher and founding figure of occupational therapy
Originally published in Israel journal of Occupational Therapy 1992 1(1): E1–E9
Abstract
Rabbi Hirsch is identified in several sources as a founder of the Chicago School of Civics and Philanthropy, the first school of Occupational Therapy. Hirsch’s relations are traced to the Chicago School of Civics and Philanthropy and Addams, Julia Lathrop, John Dewey, George Herbert Mead, Adolf Meyer, and the Baltimore community. Hirsch’s religious and ethical philosophy are analyzed and correlated with principles of pragmatism and occupational therapy, in which enablement is advanced as being of mutual benefit to the individual and society.
Introduction
Julia Lathrop and Rabbi Hirsch founded the first school of Occupational Therapy at the Chicago School for Civics and Philanthropy. (Dunton, 1915)
This statement was made in 1915 in a book by Dr William Rush Dunton, Jr., one of the founders of the National Society for the Promotion of Occupational Therapy (NSPOT), the forerunner of the American Occupational Therapy Association (AOTA). Dunton’s statement is repeated in several secondary sources (Brunyate, 1958; Licht, 1967), but is not elaborated on, and does not reveal Lathrop and Hirsch’s reasons for establishing the school. This brief statement is the only indication that Hirsch was an individual of significance to Occupational Therapy. No other mention of Hirsch appears in Occupational Therapy literature, and no mention of Occupational Therapy appears in Hirsch’s papers.
Historical associations
While there is no direct reference, either in archival material or secondary sources as to Hirsch’s specific purpose with regard to Occupational Therapy, the literature reveals an abundance of sources from which his ideals can be extrapolated, and the case can be made that he held similar beliefs to those of his colleagues and contemporaries.
At the turn of the century, the faculty at the University of Chicago included: John Dewey (1916) and George Herbert Mead (1932), the famous pragmatist philosophers; Hirsch, himself a philosopher, educator and religious leader; Jane Addams (1910), the great social activist of Hull House; Oscar Triggs (1902), a founder of the Arts and Crafts Movement in the United States; and Adolf Meyer (1922), the renowned neurologist and psychiatrist.
The philosophy of pragmatism, based upon Darwin’s theme of evolution and Hegel’s theme of relationship or dialectic, was prevalent here. Hirsch’s biographer and son (Hirsch, 1968) reports that Hirsch, as well as Dewey, were students of Hegel’s dialectics, as was Hirsch’s father before him. Pragmatism’s philosophy of time, also expressed as evolution and history, was a critical theme of the University. This theme found its application in many veins of thought and action. These concepts were analyzed from many perspectives, each scholar particularizing these ideas to their own interests.
The universal theme to which these scholars ascribed was the relationship of the individual to society and the benefit of each to the other as a phenomenon needed for growth, change and adaptation in a positive direction. They recognized this relationship as significant to health. They believed that society’s health is dependent upon the welfare of the individual, and the health of the individual relates to the welfare of society. The mental hygiene movement took its purpose from this premise. Asserting these beliefs, the mental hygiene movement counted Dewey, James, Addams, Lathrop, Meyer, and Hirsch as members (Cohen, 1983; Slagle, c. 1917). For them, education and health were one.
The relationship between these individuals and Occupational Therapy’s founding figures has been neglected until recent times (Breines, 1986b, 1989a), but the relationship existed (Lidz, 1985; Serrett, 1985c). However, the position of Hirsch is most obscure, since the only reference to him is the brief and repeated statement by Dunton in 1915. This paper will review Emil Hirsch’s history, analyze selected writings of Hirsch for their correlation with the pragmatic perspective, and attempt to demonstrate Hirsch’s influence upon Occupational Therapy.
Emil Gustave Hirsch
Dr Emil Gustave Hirsch, rabbi at Congregation Sinai in Chicago, was a prominent leader of American Reform Judaism during the period surrounding the turn of the century (Encyclopedia Judaica, 1978). Hirsch lived from 1851 to 1923. Coming from a family of renowned rabbis, he Followed his father and uncle in that calling, and was ordained as a Reform rabbi. Rejecting an Orthodox heritage, as did his father before him, Hirsch was described as a militant (Hirsch, 1968; GLB, 1935).
White a brilliant scholar (Hirsch was conversant in 17 languages, and acknowledged leader in the Chicago and national religious and social communities), few of Hirsch’s personal paoers remain for us. Hirsch’s principles can be discerned from the small collection of items held at the American Jewish Archives – Jewish Institute of Religion in Cincinnati. While these papers contain no direct references to Occupational Therapy, they reveal Hirsch’s concern for the community’s health and welfare, his interest in active occupation, and his role in developing a manual training school for disadvantaged youngsters in the Chicago community (Hirsch, 1968), and his relationship with other foundational figures of the profession. Addams’ (1935) book, My Friend Julia Lathrop, confirms Hirsch’s involvement with Lathrop in a number of social projects. Their concern for the disadvantaged is revealed by their active involvement with numerous agencies devoted to the care of children, the elderly and the handicapped. From these and other limited sources, Hirsch’s guiding principles are revealed, and from these sources one can extrapolate his persuasions.
He reminds ‘the mighty of their obligations to the weak and stirs the weak to efforts to conquer their weakness’, demanding not only attention from those who are able, but effort from the afflicted in resolving their dysfunction. He speaks of the ‘healthy realism’ of dealing with ‘actualities’ (Hirsch, 1892, p. 2962) toward meeting society’s needs, thereby addressing the reality of daily life.
It is in the theme of ‘tzedakah’ that Hirsch’s view of ethics is revealed. He characterizes ‘tzedakah’ in terms of enablement, as opposed to ‘giving’. This principle of enablement, viewed by Hirsch as a religious theme, was described by Dewey and Addams as a social obligation. It was adopted through Hirsch’s and Lathrop’s offices as the Occupational Therapy premise at the Chicago School of Civics and Philanthropy, the first school to teach such principles. The Chicago School of Civics and Philanthropy, Hull House, and Dewey’s Laboratory School were concurrent entities, and were each based on uniform principles (Breines, 1986a, 1986b).
Hirsch had other perspectives from which he viewed adaptation and occupation. Hirsch felt that God mandated one day of rest every seventh day, and the specific day of rest was not the pertinent issue of the commandment. Rather, Hirsch viewed six days of labor as mankind’s vital and obligatory contribution to society, so it was the active, albeit unmentioned aspect of the commandment which was significant. Work was a religious commitment. The relationship between work and rest, principles also addressed by Meyer, were foundational concepts for Hirsch. Hirsch adapted the pragmatic premises of adaptation and active occupation in accord with current social needs and welfare, demonstrating this principle for modern religion and society.
Hirsch’s beliefs melded well with the Quaker principles advanced by Jane Addams. The health of the individual and the community through action in collaborative benefit was long a principle of Quakers and Jews alike.
Hirsch and Addams shared the podium many times and at many places. They were allied in their beliefs and were frequently invited to speak on social issues which concerned them both. It was at Addam’s Hull House that the Chicago School of Civics and Philanthropy flowered. The principles of active occupation and adaptation promoted by Dewey and adopted by Hirsch, Lathrop and Addams were taught there to its students Eleanor Clarke Slagle and Mary Potter Brooks Meyer. It was at Hull House that the Faville School of Occupational Therapy was established, and Slagle later taught, a school founded and supported by the Chicago Mental Hygiene Society (Breines, 1986a, 1986b; Slagle, c. 1917).
The memorial document published by the Chicago Council of Jewish Women upon Hirsch’s death ascribes four distinct principles to him (Cowen, 1923). These are identified as Religion, Education, Civic Cooperation and Philanthropy. While no mention was made of the Chicago School of Civics and Philanthropy, it too advanced these latter themes. The underlying principle of the first school for Occupational Therapy was to benefit society by enabling individuals to take their role in contributing to that society. Emil Gustave Hirsch was undoubtedly instrumental in establishing these concepts there, the ancient Judaic traditions of education and study in the pursuit of knowledge, of adaptation to a changing world, of tzedakah, and of strong concern for community and individual, enabling growth through activity, contributed to the development of a profession which retains these principles. For Hirsch, grading of abilities in a constant striving for heightened knowledge and heightened contribution to society, by improving the ability of individuals to perform in their own and their society’s behalf, was an ethical and religious issue. His interests in issues fundamental to Occupational Therapy appear to indicate Hirsch’s motives in regard to founding Occupational Therapy’s first school (Breines, 1989a).
Hirsch’s heritage
More remarkable than the connections between this remarkable man and a profession that has not acknowledged his role in its founding, nor can be certain of that role, is that despite the dearth of documentation regarding Hirsch’s influences upon the profession, his principles guide Occupational Therapists to this day. They retain the principles of adaptation and development in a theme of occupational genesis (Breines, 1990), advancing the ability of individuals to contribute actively to their own needs and those of their society in work, play and leisure, in every era. Occupational Therapists continue to apply the principles to which Hirsch ascribed, in a practice based on ethics which have meaning in the real world, even as it changes. If Hirsch is right in stipulating that, ‘Genesis is a divine poem whose last has not yet been written’ (Hirsch, 1892, p. 2960), occupational therapy’s role in that transition is clear.
Acknowledgements
Appreciation is extended to Rabbi Edward J. Sukol for identifying Rabbi Emil G. Hirsch’s connections to the Chicago community; and to Fannie Zelcher, American Jewish Archives – Jewish Institute of Religion, Cincinnati, Ohio for her assistance with the Hirsch papers.
Pragmatism as a foundation for occupational therapy curricula
Originally published in American Journal of Occupational Therapy Aug. 1987, 41(8): 522–5)
Abstract
This paper shows that the founders of occupational therapy adhered to the philosophy of pragmatism. A structure for curriculum design based on this philosophy is presented. It is proposed that clarifying our foundational philosophy to students by means of this structure would enhance their synthesis of occupational therapy concepts.
