Defining occupational therapy

The World Federation of Occupational Therapidefines occupational therapy as a profession concerned with promoting health and well-being through occupation. The primary goal of occupational therapy is to enable people to participate in the activities of everyday life. Occupational therapists achieve this outcome by enhancing the individual's ability to participate, by modifying the environment, or by adapting the activity to better support participation.

Another way of thinking about the ideas contained in these definitions could be: occupational therapy is about understanding the importance of an activity to an individual, being able to analyze the physical, mental and social components of the activity and then adapting the activity, the environment and/or the person to enable them to resume the activity. Occupational therapists would ask, "Why does this person have difficulties managing his or her daily activities (or occupations), and what can we adapt to make it possible for him or her to manage better and how will this then impact his or her health and well-being?”

Occupational therapy gives people the "skills for the job of living" necessary for "living life to its fullest."

The College of Occupational Therapists (2004) describes OT as follows: Occupational Therapy enables people to achieve health, well-being and life satisfaction through participation in occupation.

Occupational Therapy draws from the field of occupational science to provide an evidence base to practice and develop academic and practice links to other related disciplines such as social science and anthropology, and also utilizes a range of generic models to guide the practice of OT.

History of occupational therapy

The earliest evidence of using occupations as a therapeutic modality can be found in ancient times. One-hundred years before the birth of Christ, Greek physician Asclepiades initiated humane treatment of patients with mental illness via the use of therapeutic baths, massage, exercise, and music. Later, the Roman Celsus prescribed music, travel, conversation and exercise to his patients. Unfortunately, by medieval times, the concept of humane treatment of people considered to be insane was rare, if not nonexistent (Quiroga, 1995).

In eighteenth century Europe, revolutionaries such as Philippe Pinel and Johann Christian Reil reformed the hospital system. Instead of the use of metal chains and restraint, their institutions utilized rigorous work and leisure activities in the late 1700s. Although it was thriving abroad, interest in the reform movement waxed and waned in the United States throughout the nineteenth century. At the turn of the 20th century, as physicians became increasingly interested in chronic disease, enthusiasm for the reform of the mental healthcare system was revived in the states. Work therapy found its way to America (Quiroga, 1995).

The health profession of occupational therapy as we know it was conceived in the early 1910s. Focus was on promoting health in “invalids.” Early professionals merged highly valued ideals, such as having a strong work ethic and the importance of crafting with one’s own hands, with scientific and medical principles. Early adversaries viewed wood carving and crafting by ill patients trivial (Quiroga, 1995).

The emergence of occupational therapy challenged the views of mainstream scientific medicine. Instead of focusing on purely physical etiologies, they argued that a complex combination of social, economic, and biological reasons cause dysfunction. Principles and techniques were borrowed from many disciplines—including but not limited to nursing, psychiatry, rehabilitation, self-help, orthopedics, and social work—to enrich the profession’s scope. Between 1900 and 1930, the founders defined the realm of practice and developed theories of practice. In a short 20-year span, they successfully convinced the public and medical world of the value of occupational therapy and established standards for the profession (Quiroga, 1995).

A substantial lack of primary sources of information has left today’s occupational therapists with many questions concerning the founders of the field. Information is collected from early training institutions and hospitals, professional writings of practitioners, World War I records from government agencies, newspaper articles, and personal testimonials (Quiroga, 1995).

One of the most notable figures in the infancy of occupational therapy was Eleanor Clark Slagle. Slagle was part of the generation of women who challenged women’s “rightful” place as a volunteer and strived for females to have a place in the professional world. At age forty, she was trained in curative occupations and recreations at the Chicago School of Civics and Philanthropy and later took a position at Hull House, where crafts were used to promote mental health (Quiroga, 1995).

It is speculated that Slagle’s interest in healthcare stemmed from her personal life, as her father, brother, and nephew all suffered from various disabilities. Seeing the daily struggles of people with disabilities and illnesses may have sparked Slagle to enroll in the Chicago School in 1911. In 1912, renowned psychiatrist Adolph Meyer appointed Slagle to direct a new department of occupational therapy at John Hopkins Hospital. There, she learned habit training—a method of re-educating patients on decent habits of living via substituting healthful habits for bad habits (Quiroga, 1995).

Another psychiatrist, William Rush Dunton, Jr., worked diligently to raise the status of psychiatry in medicine in the first decades of the 20th century. He viewed occupational therapy as complementary to psychiatry, as it had the promise of meshing humanitarian values with science. Dunton became interested in the work of European moral therapy advocates. He accepted a position at the Sheppard Asylum, where it was standard practice in the early 1900s for patients to participate in activities such as bowling, gymnastics, art, etc. Dunton and his contemporaries called for the development of a theory to underlie the treatment known as “moral therapy” and “diversional occupation,” among other names. He called for therapists to devise outcome measures so that the neophyte profession would be given the attention and respect he felt it deserved (Quiroga, 1995).

Another important figure in the early days of occupational therapy was Susan Tracy, a nurse by trade, who organized activity-oriented classes for nurses at the Adams Nervine Asylum. In 1910, she published a textbook that was widely used for over 30 years. She is credited with expanding the realm of occupational therapy from psychiatric institutions to the homes of patients, which is an important setting in which today’s occupational therapists work. Upon breaking ties with the asylum, she set up her own institution, entitled the Experiment Station for the Study of Invalid Occupations. This training center educated nurses so they could gain control over their practice and not default to being dominated by physicians. By practicing privately in patients’ homes, this batch of occupational therapists expanded the domain of occupational therapy and began using OT to treat physical ailments as well as mental illness (Quiroga, 1995).

Herbert J. Hall was a physician with a strong work ethic and practical vision. He believed we could retract social ills by adapting the arts and crafts movement for medical purposes. A graduate of Harvard Medical School, he advised the government on wartime standards for occupational therapy during WWI. He introduced the concept of grading activities—now a hallmark of occupational therapy—to avoid exacerbating patient’s frustration and fatigue (Quiroga, 1995).

George Edward Barton, an architect, also aided in promoting the occupational therapy profession. Diagnosed with tuberculosis in 1901, Barton later contracted gangrene and had a partial amputation, after which he was left paralyzed on his left side. He opened Consolation House, a sanctuary for people with physical disabilities, in 1914. There, intensive self-administered occupational therapy “cured” his ailments. He played an integral part in gathering the profession’s leaders and forming the first national society (Quiroga, 1995).

The first meeting of the National Society for the Promotion of Occupational Therapy was held in March 1917. Barton (along with his secretary), Eleanor Clark Slagle, William Rush Dunton Jr., Thomas B. Kinder, and Susan Cox Johnson were the only six in attendance. In the fall of 1919, at the third meeting, 300 attendees participated. In 1921, the name of the organization was changed to the American Occupational Therapy Association and the Archives of Occupational Therapy, the first professional journal, began publication (Quiroga, 1995).

World War I forced the new profession to clarify its role in the medical domain and to standardize training and practice. In addition to clarifying its public image, OT also established clinics, workshops, and training schools nationwide. Due to the overwhelming number of wartime injuries, “reconstruction aides” (an umbrella term for physical therapists and occupational therapists) were recruited by the Surgeon General. Between 1917 and 1920, nearly 148,000 wounded men were placed in hospitals upon their return to the states. This number does not account for those wounded abroad. The success of the reconstruction aides, largely made up of women trying to “do their bit” to help with the war effort, was a great accomplishment. Post-war, however, there was a struggle to keep people in the profession. Emphasis was shifted from the altruistic war-time mentality to the financial, professional, and personal satisfaction that comes with being a therapist. To make the profession more appealing, practice was standardized, as was the curriculum. Entry and exit criterion were established, and AOTA advocated for steady employment, decent wages, and fair working conditions. Via these methods, occupational therapy sought and obtained medical legitimacy in the 1920s. By the time Slagle retired from the profession in 1937, the profession’s medical identity was well on its way to being established (Quiroga, 1995).