The Evolution of Occupational Therapy

1
The Evolution of Occupational Therapy

• Concepts of Occupational Therapy
• OCCT 6511
• Fall 2005
• Judith C. Vestal, PhD, LOTR

2
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.

3
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)

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Quaker Influence

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

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Moral Treatment

• Dr. Philipe Pinel, late 18th 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

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Moral Treatment (cond)

• 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

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Moral Treatment (cond)

• 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

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Moral Treatment (cond)

• 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.

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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

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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

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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

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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.

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Adolph Meyer, MD

• 1866-1950
• Late 1800s, 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.

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Meyer (cond)

• 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

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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

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Herbert J. Hall

• Physician
• Prescribed occupation to regulate patients lives
• Awarded grant by Harvard to study use of
  occupation

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20th 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)

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• 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

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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.

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Dunton (cond)

• Classified work into 3 types
• Invalid occupation
• Occupational therapy
• Vocational training

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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

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Slagle (cond)

• 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.

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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

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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

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Life in 1917

• First time in history for US to be engaged in
  World War
• Stenographers 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)

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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

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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

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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)
• OTs role became exercise for disabled part in
  course of constructive procedure

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Coming Attractions

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