Occupational Therapy: A New Frontier in Healthcare

by B. Lana Guggenheim

Occupational therapy is often confused for other therapies, such as physical therapy. But while occupational therapy does sometimes make use of medical and physical therapies, its practice encompasses a much wider series of activities and healthcare prerogatives.

Physical therapy is a highly specific medical profession and series of practices focusing on a patient’s abilities to move and perform functions. Occupational therapy can and does encompass this, but its focus is on the daily work and life skills of a patient. As such, it covers not just physical capabilities, but mental and cognitive disorders, and other barriers, both physical and environmental, to a patient’s independence. Occupational therapy is inherently interdisciplinary, drawing from psychology, medical science, and social work.

Both physical and occupational therapies have their roots in ancient medical practices like massage and hydrotherapy advocated by physicians including Hippocrates and Galen. But the earliest evidence of using occupations as a therapy method (occupations meaning activities that occupy a person’s time, rather than paid labor) was by the Greek physician Asclepiades in 100 BCE, who advocated humane treatment of patients with mental illness using baths, massages, exercise and music - practices which had been dropped by medieval times, only to be revived in the past two centuries.

Modern physical therapy was established as a discipline towards the end of the 19th century in response to polio and World War I, which increased global demand for such aid. However, occupational therapy began as part of an 18th century hospital reform by French revolutionaries Philippe Pinel and Johann Christian Reil, using work and leisure activities as part of patient therapies. This was part of something called “Moral Treatment,” an Enlightenment-era philosophy that approached mental illness with humane care, derived both from the emerging science of psychology, as well as moral and religious mores. This led to the rise of asylums, which only declined in use in the 20th century. The Arts and Crafts movement of the late 19th and early 20th century also impacted occupational therapy, as it emerged as a form of human occupation and creativity in the face of loss of autonomy and monotony found in increasingly common factory work, as well as staving off boredom for those confined to long hospital stays, whether that was due to mental illness or physical malady. By the early 1900s, occupational therapy was becoming professionalized, challenging the mainstream views of scientific medicine by being inherently interdisciplinary, incorporating social and economic understandings with medical principles.

Reconstruction aides, an umbrella term for both occupational and physical therapists during World War I, most of whom were women, were very successful. Post-war, in order to keep people interested in the profession, emphasis shifted from war-time altruism to the financial and professional satisfaction of being a therapist, and practice and curriculum were standardized, and the profession obtained medical legitimacy in the 1920s. Today, one requires a minimum of a Master’s degree to practice in the field, but increasingly there are doctorate programs and research avenues opening up as well. Occupational therapy is increasingly focused on a patient’s mental health and in treating mental illness.

Ultimately, the two core principles underlying occupation therapy are the centrality of occupations as a basic human need, bringing meaning to life culturally and personally, and thus is therapeutic, and the concept of holism, indicating that a person and their health can only be properly understood in concept of their larger social environment. Occupational therapy grew out of practical applications of psychology and healthcare practice, but there is an increasing emphasis on research, and occupational science, the study of people as occupational beings, was founded in 1989 as a way to provide evidence-based research to support and advance occupational therapy. Occupational science underlines the ability of people to pursue occupations, specific activities that give their lives structure and meaning. While still young, there are increasing numbers of programs offering doctoral degrees in this emerging social science.

Occupational science understands occupations as an antidote to psychological pain, offering structure and means to find meaning in people’s lives. It influences patients’ health, self-respect, and sense of dignity. It is not so much the specific activities undertaken, so much as that the activities chosen are laden with symbolic meaning, thus making occupation a uniquely human enterprise, a point of human experience mostly ignored by other social sciences, and critically important particularly to the development of occupational therapy. Only once the place and potency of a given occupation, defined as culturally and personally meaningful human activity, in a person’s life is understood can therapies be tailored to their needs.

Occupation therefore encompasses much more than just paid labour, but hobbies, habits, personal rituals, or cultural activities as well. Many occupations are not productive, but primarily pleasurable, as their purpose is to imbue meaning and carry some sort of symbolism rather than material benefit. And research has indicated that mundane, daily activities affect psychological well-being far greater than major life events, meaning that the ramifications of a person orchestrating and organizing their daily lives and engaging in occupations are significant, particularly because unlike animals, human activity requires self-awareness, memory, planning, and engaging in layers of personal and cultural meanings.

Occupational science however addresses both these, as well as neurobiology and physical health. The USC Department of Occupational Therapy developed a Model of Human Subsystems that Influence Occupation to provide a conceptual framework by which all these factors interact and influence a person’s development. The model depicts a human as an occupational being, seen as an open system in interaction with their environment over the course of their life. The use of the systems model, here consisting of six substrates, explain developmental changes in a person over the course of their life is consistent with developmental psychology, of which in this case, a chosen occupation is the output.

These systems allow occupational scientists to examine how a person makes sense of their life via their chosen activities, within the context in which they function and its significance to the individual in question, which in turn requires a synthesis of knowledge from the biological and social sciences. This model allows it to function as a blueprint to organize the research and findings of faculty, students, and practitioners into a unified corpus of knowledge. The applications of this new science, while born from occupational therapy, will apply far beyond it to other disciplines, though both are empowered by the same values, namely the central role that occupation plays in health and life happiness, and viewing a person as an active agent in their own life.

This is important for keeping occupational therapy practices on track, as some worry that it was becoming over-focused on acute care instead of helping patients, especially the disabled or those with chronic disease, improve life opportunities and ability. Instead, therapists are seen as “treatment machines” and patients as “products” to be displayed on a balance sheet. If one’s identity isn’t taken into account except superficially, any therapies are not going to be as effective as they might, especially because many patients are navigating a transition from their old lives to a life with new parameters and limitations. One’s occupations allow a patient to bridge that gap and provide a framework for adaptation and recovery. Occupational science can help occupational therapists aid patients in internalizing this aspect into their clinical reasoning and therapies, helping nurture the human spirit as well as the human body.

Works Cited

Clark, Florence A., Diane Parham, Michael E. Carson, Gelya Frank, Jeanne Jackson, Doris Pierce, Robert J. Wolfe, and Ruth Zemke. "Occupational Science: Academic Innovation in the Service of Occupational Therapy's Future." The American Journal of Occupational Therapy 45.4 (1991): 300-10. Web. 21 Apr. 2016.

Clark, Florence. "Occupation Embedded in a Real Life: Interweaving Occupational Science and Occupational Therapy." American Journal of Occupational Therapy 47 (1993): 1067-078. Web.

"The History Of Occupational Therapy." The History Of Occupational Therapy. N.p., n.d. Web. 21 Apr. 2016.

Jackson, Linda. "The New Research Climate Surrounding Occupational Therapy." The Guardian. Guardian News and Media, 27 Jan. 2015. Web. 21 Apr. 2016.