Occupational Therapy: A Profession Born from Liberation and Empowerment

 Asclepiades

As discussed earlier, the American Dream was an influential factor in the formation of the United States Culture we know today. A focus on working as a moral obligation shaped the way US citizens viewed their everyday lives and activities. Occupational therapy however, or at least the founding concepts, have been used for ages in places like Greece and Rome. In 100BCE activities like "therapeutic baths, massage, exercises, and music" were prescribed by the Greek physician Asclepiades to treat human patients considered to be "insane" while 100 years later, Roman Celsus prescribed music, travel, conversation, light, and exhausting exercise for those he treated (Quiroga). Regardless of historic examples, humans have been engaging in everyday activities to fulfill their lives and enrich their lived experience for much longer than documented history. It is a natural instinct for humans to seek out activities that provide them with pleasure and fulfillment. It was only in the beginning of the 20th century that therapists professionally began to use this instinct to influence health and wellness. The origins of the occupational therapy profession are deeply shaped by three national and global occurrences that very much encapsulate the ideology that fuels the occupational therapist's perspective: 1) the Arts and Crafts movement in reaction to the industrial revolution, 2) the return of veterans  from World War I, and 3) the women's rights and suffrage movement

In the early part of the 1900s, two very important changes within our world were occurring that would ultimately affect the development and formation of occupational therapy. First, the industrial revolution was in full swing, increasing factory jobs but at the same time drastically altering what "work" looked like. Assembly line factories quickly overtook the job market and countless citizens found themselves completing only a portion of the work to create a product, sometimes never actually seeing the finished product. The creativity had been removed from craftsmanship, effectively degrading the individual to a single repetitive tool in a long line of tools to create interchangeable products. The Arts and Crafts movement, present in both Europe and the United States and usually only participated in by middle- and upper-class citizens, sought to counteract this distancing of the hand from creative work by studying and continuing various craft forms. Hand-made textiles, woodworking, metalworking, basketry, weaving, and sewing all became more than simple hobbies, but methods of liberation from the "tyranny of the machine" and grasping a more "productive and meaningful" lifestyle by working in the traditional manner.  They sought to maintain a moral work ethic that did not demoralize the human into the tool of the machine, but rather abide by the cultural norms that had already been deeply rooted in the Protestant Work Ethic. From this movement occupational therapists, or reconstruction aides as they were called at that time, usually middle- and upper-class,  found inspiration in how to provide treatment for their patients. By providing their patients with the opportunity to successfully complete the entire process of a craft, the therapists were able to provide a moral experience of satisfaction, self-worth, accomplishment, and learning while also possibly improving other aspects of the patient's quality of life in the same moment. This flavor can still be tasted in therapy sessions today, as craftsmanship are still used to evaluate, remediate, and support participation.

WWI Amputees 1919

Secondly, the United States entered World War II in 1917, creating an influx of veterans suffering from physical disabilities, mental disabilities, and what WWI veterans called "combat neurosis" or "shell shock" (what we call today Post Traumatic Stress Disorder). The combination of this population as well as the already present needs for Mental Health services sparked an increased awareness of the need for "mental hygiene" services throughout the United States. Psychology, psychiatry, nursing, and doctors began to seek out methods to facilitate the rehabilitation or "reconstruction" of veterans with both mental and physical disabilities. Many men returned home, unable to work in the traditional manner, unable to provide financial resources to their family. There was a desperate need for a treatment that could effectively improve the mental status of these veterans and return them to their roles as breadwinner as quickly as possible. In a culture where idle hands were immoral and dependency on others was pitiful, these individuals needed to discover a way to regain their independence. Occupational therapy seemed to fill that need. After therapists formed their first professional association in 1917 called the National Society for the Promotion of Occupational Therapy (NSPOT), one of the first tasks they undertook "was to convince the U.S. Army and the commander of the Allied Expeditionary Force in World War I, General John Pershing, to order the hiring of 5,000 reconstruction aides to provide occupational therapy to the war’s wounded."[Source] In fact, one of the founders of NSPOT had seen occupational therapy as the solution to the difficulty of unemployment and disabled veterans previously and had already created a workshop for the chronically unemployed.

Slagle

Addams

 Eleanor Clark Slagle was one of the most influential founders of the occupational therapy profession. She set the stage for the growth and development of a new profession for young women in a time when the movement for women's suffrage was slowly emerging within US culture. Born into a family of abolitionists, she was surrounded by the ideas of liberation and advocacy from an early age. When Slagle traveled to Chicago in 1911, while most women were ascribing to the traditional ideologies of domesticity, purity, piety, and submissiveness, Slagle was surrounded by the women of the Hull House, notably Jane Addams and Ellen Gates Starr,  who were actively involved in politics, pushing for the rights of women, and crossing social barriers not yet crossed by women in the US. Through her interaction with many who experienced social oppression and deprivation as well as the women of the Hull house, Slagle recognized her interest in the "unfair social attitude toward the dependency of the mentally and physically handicapped" by realizing the parallel between this social marginalization and that of the women of the time. Her experience working with people with mental illness specifically led her, in 1914, to found a workshop for the chronically unemployed called the Experimental Station. Once the high demand for this type of workshop for more individuals than simply those with mental illness was realized, Slagle began to accept individuals who were being limited by disabilities of all sorts. Because therapists had begun to use arts and crafts as a therapeutic method, she was able to work with both veterans and others who could no longer participate in the jobs they once had, to support themselves financially. They were able to sell their products and thereby at least somewhat reconstruct their roles within their everyday lives as a breadwinner and independent individual. She believed that not only could occupations provide effective rehabilitation for some illnesses, but it could also provide job training for those who might otherwise not have access, an ideology later employed by Herbert James Hall to support the Devereux Workshops.

But Eleanor Clark Slagle was not the only one concerned with liberation and empowerment; in the early 1900s, William Rush Dunton, Jr., the "father of occupational therapy" was forming the Sheppard-Pratt Hospital, a hospital that encouraged patients to take active roles in their own care. After being influenced by William Tuke of the York Retreat, a Quaker-run home in England for those who experience mental illness, Dunton sought to incorporate a "judicious regimen of activities" into the care within his hospital. This "moral therapy" was meant to provide "habit training" for the patients, a method of replacing unhealthy habits by practicing new ones repeatedly, also allowing a more engaged participation in their own rehabilitation. At this point various institutions, mostly mental health facilities, were incorporating the idea of "occupations" into their everyday treatment by using crafts such as weaving, woodworking, metalworking, basketry, leather craft, and bookbinding. Patients were beginning to take an active role in their health and wellness instead of simply being the subject of treatments and surgeries by hospital staff. "Occupational therapy" began to be seen as a norm rather than an experiment and was largely recognized as an integral part in the betterment of patients' well-being, especially those within the mental health setting. Therapists and hospital staff were now able to provide services that surpassed mere "custodialism" and moved more towards a team effort between the doctor, nurse, therapist, and patient.

First Meeting of NSPOT

And so began the germination of the profession we know today as occupational therapy. From its roots, occupational therapy is a profession that seeks liberation and independence. It seeks methods to empower the human person to achieve meaningful participation. From liberating ourselves from the tyranny of the machine, to reconstructing our roles after combat experiences, to claiming the rights of all humans, male, female, physically disabled, mentally disabled, doctor, or patient, occupational therapy has worked to empower men and women to claim their right to participation through the work of their hands. Today, we continue to teach, support, and encourage all those who are deemed atypical to rebel and liberate themselves from the idea of normal by walking with them as they take an active role in working toward accomplishing meaningful occupations.

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But has occupational therapy ceased growing; has it become all that it can be? No. As a profession we are still learning and continue to reevaluate our perspectives and assumptions. Through globalization and cross-cultural interaction, we have begun to realize that many of the assumptions that stem from our roots in US culture may not apply in all situations.


Quiroga, V. A. M. (1995). Occupational therapy: The first 30 years 1900 to 1930. Bethesda, MD: The American Occupational Therapy Association.

www.aota.org