The Evolution of Occupational Therapy Concepts of Occupational

The Evolution of Occupational Therapy Concepts of Occupational Therapy OCCT 6511 Fall 2005 Judith C. Vestal, Ph. D, LOTR

Ancient Times • origin of activity or occupation for healing or treatment • mind/body relationship • ancient Egyptians and Greeks stressed value of alternating work and play in daily life schedules • Placing equal value on work, play, self-care became an underlying philosophy of O. T.

Plato and Aristotle • …”in every man and woman there is born the instinct to to make and to do” (Plato) • “therapeutic arts” work to maintain occupational performance despite disease or disability • Well being of the soul is the end result of desirable and satisfying activity. (Aristotle)

Quaker Influence • Concern re conditions in institutions • William Tuke (1732 -1822) established asylum for the care of Quaker members, York Retreat.

Moral Treatment • Dr. Philipe Pinel, late 18 th century – Treatment for chronic, institutionalized mental patients consisted of work, exercise and ADL – Moral Treatment, based on • a respect for human individuality, • a fundamental perception that individuals have a need to engage in creative, productive activity

Moral Treatment (con’d) • Benjamin Rush, MD, began to put this concept into practice – Respect for human rights – Value of activity for creativity and productivity – Fit with values of the day; society of participation in government and in religious activities

Moral Treatment (con’d) • Samuel Tuke – Quaker in England – Special emphasis on humane treatment – Treated patients as rational human beings who had capacity for restraint – Established Friends Asylum for the Insane • Patients encouraged to “apply orderly habits” • Patients encouraged to participate in “exercise and labor”

Moral Treatment (con’d) • After 50 years interest in moral treatment declined – – – economic pressures hospitals increased in size rapidly physicians were too busy public lacked insight of therapeutic value of activity shift in the medical view of mental illness from moral-emotional basis of illness to a more organic, brain disease basis. • Increasing ethnic prejudice due to large numbers of immigrants coming to America. Immigrants made up the bulk of the increasing population in mental hospitals.

Industrial Revolution • Began in England • Government support for big industry, textiles, fuel production, etc. • Focus on mass production and machine made objects • Individualization was not important

Arts and Crafts Movement • John Ruskin advocated for more focus on individual rather than machine • Industrialized focus replaced by arts and crafts movement – Man was the creator of objects, not machines – Objects more respected, more aesthetically pleasing – William Morris (1834 -96), the British craftsman, designer, writer, typographer, and Socialist

George Edward Barton • Architect • Developed TB and experienced long term recuperation • Understood importance of activity during recovery • Established Consolation House in Clifton Springs, NY, 1914

Susan B. Tracy • Considered a “near founder” of OT • Studies in Invalid Occupations, 1913 • Noticed patients recovering from surgery seemed happier when kept occupied • Saw occupation as a means to help and care for patient; emphasized interpersonal traits without which “therapist” could not engage patient successfully.

Adolph Meyer, MD • 1866 -1950 • Late 1800’s, began to use work as a therapeutic agent in treating the emotionally disturbed. • His premise: – temporal adaptation; proper use of time in gratifying activity – rhythms of life must be kept in balance: work, play rest & sleep. – interpersonal relationships are important and should be emphasized in treatment.

Meyer (con’d) • Adolph Meyer is sometimes called the forerunner of occupational therapy. • Presented paper entitled “The Philosophy of Occupational Therapy” to Society for Promotion of Occupational Therapy • Paper published in “Archives of Occupational Therapy” • First conceptual model of occupational therapy

Settlement Houses • Modeled after Toynbee Hall in England • Designed to provide neighborhood center, social and civic focus, to maintain educational and philanthropic enterprises • Hull House in Chicago founded by Jane Addams

Herbert J. Hall • Physician • Prescribed occupation to regulate patient’s lives • Awarded grant by Harvard to study use of occupation

20 th Century • Mental hospitals began to attend to emotional and psychological factors involved in mental illness. • Individuals from Chicago to the East coast began using activity/occupation in treating the mentally ill. • Meeting in Clifton Springs, NY on March 17, 1917 to start a society (founding of the profession of Occupational Therapy)

• Moses Shepherd – Shepherd Asylum, 1891 – Used warm baths and nutrition, work and leisure • Enoch Pratt – Shepherd Enoch Pratt Hospital, 1896 – Increased rate of cure by making hospitals more like home – Activities important part of program; building for OT

William Rush Dunton, MD • Psychiatrist, joined staff of Enoch Pratt – Believed in the use of occupation for people with mental illness – Felt it important to have trained people directing activities – Wrote first textbook: Occupational Therapy: A Manual for Nurses, 1915.

Dunton (con’d) • Classified work into 3 types: – Invalid occupation – Occupational therapy – Vocational training

Eleanor Clarke Slagle • Took course from Julia Lathrop at Chicago School of Civics and Philanthropy • Taught similar course in Michigan • Went to Phipps Psychiatric Clinic at Johns Hopkins and taught 3 week courses in occupations • Director of occupational therapy department under Dr. Meyer

Slagle (con’d) • Slagle returned to Chicago in 1915 to establish Henry B. Flavill School of Occupations • Reinforced the importance of habit training through occupation • Held every office in S. P. O. T/A. O. T. A.

National Society for Promotion of Occupational Therapy • Barton, Dunton, and Tracy planned a meeting to discuss mutual interests re. occupations as treatment. Slagle and Hall were invited. • Purpose was to provide some direction for hospital workers and model for treatment using occupation. • Susan Cox Johnson

NSPOT • Meeting took place 1917 at Consolation House in Clifton Springs • Attended by Barton, Dunton, Slagle, Kidner, Johnson, Newton – Drew up objectives for organization – Goals included recruitment of members, develop teaching modules, research. • Name changed in 1921 to AOTA

Life in 1917 • • • First time in history for US to be engaged in World War Stenographer’s salary was $12/week Cigarettes 20 for 15 cents (no tax, no filters, no talk of cancer) 3 children in Fatima, Portugal saw visions of Virgin Mary Ford touring car cost $360 Loaf of bread cost 5 cents; quart of milk 10 cents Toast made on top of stove Postage was one penny for postcard and two pennies for a letter No communist countries anywhere in the world Woodrow Wilson proposed League of Nations (later became United Nations)

Pragmatism and OT • Major assumption – ideas are interpreted through their consequences • John Dewey (1859 -1952) proponent of pragmatism in education • Knowledge and truth relate to practice, action and doing • Knowledge should be used to solve problems and help people adapt to environment • Basis for concept “learning by doing” • View humans as holistic

Reconstruction Aides • 1918 – 4 women sent to France to help soldiers recuperate from “shell shock” and “war neurosis” • Surgeon General Pershing sent for 1000 more aides • War ended and reconstruction aides served in Army hospitals across country

OT and Rehabilitation • WW II shifted focus of OT to enhancing medical outcomes of injury and trauma • Hospitals developed departments of “physical medicine and rehabilitation” headed by physiatrists (physical therapy physicians) • OT’s role became exercise for disabled part in course of constructive procedure

Coming Attractions • • • Influences on practice areas Search for identity Evidence based practice Emerging area of practice Tri-alliance collaboration