It is said that “those who cannot remember the past are condemned to repeat it” (Santayana, 1905, p284). This statement tells us that history will be relived and we can reflect on the past; learn from our mistakes and progress. To understand occupational therapy fully as a profession, we must consider the past; acknowledge the roots and how they contributed to development of occupational therapy as it is today. This account considers key parts of occupational therapy history and sets it in the context of how knowledge of the past informs contemporary practice.
Although many believe occupational therapy is a relatively new profession, occupational therapy principles and practice go back to the late eighteenth, early nineteenth century (Tuner 2002). At that time, new ways of thinking changed the treatment of mental asylum inmates from isolation and torture to a moral treatment (Friedland 2007; Turner 2002). For occupational therapy, treating individuals morally, with dignity and respect, is still a vital concept, reflected in the code of ethics which outlines treating patients with individuality, self-respect and dignity (College of Occupational Therapists 2010). Philippe Pinel and William Tuke introduced this new humane way of thinking (Bing 1981). Noting faster recovery in those participating, Pinel believed exercise and manual work should be prescribed as an act of treatment; thus introducing occupations for treatment which, to this day, is a key concept of occupational therapy practice (Mayers 2002; Turner 2002; Cara & MacRae 2005; Paterson 2007; 2010). This was the start of the link between occupation and health which today is a strong concept. The development of such treatments spread and influenced practice in many different countries. An example of this can be seen in the introduction of occupational therapy to Scotland. David K Henderson, worked closely with the founders of Occupational Therapy in America, Eleanor Clarke and Adolf Meyer, and they influenced his understanding and principles of Occupational Therapy (Paterson 2007).
The twentieth century saw introduction of education and training as a method of developing occupation as therapy in practice. Training courses were introduced for student nurses in the treatment of psychiatric conditions (Tuner 2002). World War One, in particular, contributed hugely to the development and establishment of a new avenue of occupational therapy – physical disabilities (Jelic & Eldar 2003). In the British Empire alone there were over 2 million injured, due to development and battlefield use of new destructive weapons leading to large numbers of ex-military with physical disabilities needing treatment post-World War One (Public Broadcasting Service 2010). The concept already developed in previous century for those with mental health problems – humane treatment through use of occupation – was applied to physically disabled ex-combatants. Thus, occupational therapists adapted their lessons to a different setting. For example, the concept of occupation as a means of treatment is reinforced when Sir Robert Jones, an Inspector of Military Orthopaedics in World War One, sets up workshops in hospitals. Emphasising learning from other countries as an aspect of development of occupation therapy, Jones was influenced by work done in America to provide rehabilitation and move injured soldiers back into a work place (Yakobina, Yakobina & Harrison-Weaver 2008; Friedland 2007). Common principles were developing, directing the development of occupational therapy – occupation and treating individuals as individuals with respect and dignity. However, this steady march of progress of occupational therapy in physical settings was interrupted by Great Depression of the 1920s and 30s (Paterson 2010). Low budgets and staff cuts meant occupational therapy in physical settings being cut and occupational therapy returning to its roots in mental health settings. Despite these drawbacks the development of education in occupational therapy took a large step forward. Gartnavel Royal Asylum, Glasgow, introduced the term ‘occupational therapy’ in 1922 and within Aberdeen Royal Asylum there was the first allocation of an occupational therapy post in 1925 to Margaret Barr Fulton (Paterson 2010). After experiencing occupational therapy within Gartnavel Hospital, Glasgow, and, in a further example of knowledge from one country informing practice of another, in American Occupational Therapy centres, Elizabeth Casson opened the first Occupational Therapy school – Dorset House – in 1930 (Fraser-Holland 1990; Tuner, Foster & Johnson 2002; Friedland 2007; Paterson 2007).
In 1939, war again provided impetus for occupational therapy development. World War Two brought a surge in the need for occupational therapists to rehabilitate men injured in the war (Paterson 2007). The concept of rehabilitation grew in World War Two, with the requirement of professionals working together as a team (Paterson 2010). The success of multidisciplinary team working has been carried on as a successful way of working, still happening today. Today, professionals working together and using each other’s strengths promotes successful team working within care settings. The word rehabilitation is a buzz word today, with principles of rehabilitating people to maintain independence in their daily life. Occupational therapy education also took a step forward. Emergency courses were run to meet the demand for occupational therapy in rehabilitation (Yakobina, Yakobina & Harrison-Weaver, 2008). In 1939 Elizabeth Casson opened a curative workshop in Bristol which also aided education as students studying at Dorest House would now experience physical and mental occupational therapy in practice (Paterson 2010). This is a major step for occupational therapy education influencing the role of occupational therapy today with treating the patient holistically which includes mental and physical wellbeing. This also was a step forward for occupational therapy as a profession, enhancing the role and evidence of occupational therapy in physical settings.
Many of the foundations of current occupational therapy practice were laid at this time. Use of arts and crafts was further explored and employed by Occupational Therapists as a form of treatment (Friedland 2007). Theory was also being developed to inform practice. William Morris discussed the outcomes of developing a product from start to finish which was to build on physical difficulties but also the sense in pride of doing this (Paterson 2010). John Colson, a physiotherapist and occupational therapist explored theory relating to the use of occupations. Therapists adapted and graded craft activities to suit each individual (Paterson 1998; Paterson 2010). The developments introduced the basic occupational therapy skills- activity analysis and graded activity to enable successful outcomes for individuals which are the basis of current practice.
Due to the increase in the mining within the UK in the 1930’s, physical injuries related to mining were becoming increasingly common (Paterson 1998). Occupational Therapists adapted their knowledge and treatment of injuries related to the war to accommodate rehabilitation of miners. Occupational therapists extended the use of treating individuals as individuals and through the use of occupation into a setting out with mental health and military; a move which has been happening ever since. Theory development also continued with two professional bodies being set up in Britain- the Scottish Association of Occupational Therapists, formed in 1932 and the Association of Occupational Therapists, formed 1935. The Association of Occupational Therapists launched the first British occupational therapy journal in 1938 (Paterson, 1998) and articles were produced to acknowledge the concepts of Occupational Therapy and the rise in Occupational Therapy as a treatment for physical and mental health issues. Spreading knowledge was always part of occupational therapy development and articles and journals, helped build a body of theory and evidence widely available. Co-operative learning, so influential in the early occupational therapy development, continued, new teaching courses were established and, along with journals and articles, the principles and concepts of occupational therapy developed from the beginning were formalised and taken forward to today’s practice.
Concepts and principles that were introduced from the start included acknowledging the link between occupations, health and wellbeing; the use of occupation as a form of treatment; exploring the balance in people’s life and client centred practice (Mayers 2000; Paterson 2010). These concepts have provided a foundation for occupational therapy principles. These principles have informed contemporary practice through the development of models within occupational therapy which link aspects of how different occupations can affect health.
A concept used within occupational therapy treatment historically, acknowledged by the moral treatment era, is the treatment of the patient as an individual. Occupational Science when coupled with psychology and sociology gave occupational therapists a greater understanding of the importance of individualised treatment as occupational science explores humans as occupational beings (Wilcock 2001; Clark 1997). This development has influenced occupational therapy code of ethics as individualised treatment – client centred practice – is today the centre of occupational therapy practice and key to our code of ethics (Hammell 2001; College of Occupational Therapists 2010). Through the identification of a person as an individual, therapists now work in conjunction with patients to direct a treatment plan and select occupations meaningful to them.
Throughout occupational therapy as a profession, their knowledge and core skills, although remain the same, are adapted to meet the requirements of the current population’s needs. Initially, introducing physical occupational therapy during war times with the rise in tuberculosis and amputations and later when the increase in the mining population in the 1930’s required occupational therapists to discover new avenues. Within today’s society, in the UK, there is an increasing aging population, problems relating to inequality such as depression and alcohol drug dependency and obesity all which have potential for occupational therapy input through our transferrable skills (Hanlon et al, 2011).
Another strand in the history of development of occupational therapy is the role of government. Government policies and funding for, future health of key groups have often influenced direction taken by occupational therapy. When the National Health Service was set up, their vision was to treat people within the community. This vision appears still to be present with a move to community rehabilitation as health is created in the community. The change from the past to present is that the government are trying avoiding people coming into hospital through prevention strategies prior to illness whereas, in the past, individuals would have been admitted are help received if they were ill. Currently, re-ablement – maintaining individuals at home instead of care homes or hospitals – is shaping current practice (Department of Health 2011). A large population of re-ablement customers will be elderly. Occupational Therapy posts are now being created within re-ablement teams which influence a new avenue of practice. This has been the case for occupation therapy practice today with ever evolving populations in need. The change in society shapes current practice in occupational therapy however; foundations set back in the 19th century still are core.
Occupational therapy can be said to have done a full loop. The war in Iraq and Afghanistan requires occupational therapists to explore this area again decades on from the initial occupational therapy in physical disabilities (Clark et al 2007; Canadian Association of Occupational Therapists 2009). Issues are much the same with occupational therapists looking at moving veterans back to the community and back into a workplace (Canadian Association of Occupational Therapists 2009). The concepts of rehabilitating people back into a workplace developed through the curative workshops has similar strands in a new concept of occupational therapy – vocational rehabilitation- which not only relates to veterans but those suffering from long term sick, ex- offenders and substance misuse – to name a few.
In conclusion, occupational therapy, although having developed greatly over the centuries, still has the same key foundation of occupational therapy principles – use of occupation, client centred practice and the link between occupation and health. Occupational therapists have the skills to adapt to the needs of society and provide services to meet expectations. This again has been shown in the move from mental health to physical health in the war, to mining injuries and now today to meet the needs of the aging population, mental illness, obesity, alcohol and drugs. Therefore, acknowledgement of occupational therapy in the past has provided occupational therapy with solid foundation of principles that remain today and contribute to the ever changing societal needs.
Hope you have enjoyed reading this months blog. We would welcome any discussion on the above and how OTs past has shaped present practice on the blog or view our discussion forum http://www.arrowsconnect.com.
NB: Views as of my own.