Cultural awareness and occupational therapy

Here is an excellent email question I got from a gentleman in India who is considering a career change and would like to practice OT in an English-speaking country.

My question is: Even if I got good command over English, would indigenous people prefer a foreign therapist and would I be able enough to know their problems?

I had this exact same question when I was completing my fieldwork in a mental health setting in an inner-city environment. I grew up in a suburban mostly middle-class world and when I came into my new worksite I looked around and could not recognize the culture around me.

I understood that poverty existed in the world, but I had not seen people trying to get admitted into the psychiatric unit until the monthly governmental check came.

I understood that some people were on drugs, and I had even seen some of my friends try drugs, but I never saw anyone needing to be strapped down to a gurney after a bad PCP trip because they thought that they could see the devil if they looked closely into people’s eyes.

I heard about people trying to commit suicide, but I never met so many of them who actually tried.

I recall seeing the movie One Flew Over the Cuckoo’s Nest, and imagined that mental health was advancing so much because I saw that electroshock therapy was being conducted on anesthetized patients in an operating room. But it still didn’t fit in with my cultural reality.

My point here is that I had absolutely no basis to understand the sociological morass around me. When I reached for a life preserver I looked for Mary Reilly who had never before failed me – but I found that she spoke about occupational roles and at that time I couldn’t understand how to bridge the divide between the reality of street level mental illness and the need to help people return to normal role behavior where ‘normal’ was nothing that they had ever even approached previously. The model just didn’t seem to fit, and perhaps I was not sophisticated enough at that time to understand.

Since then we have conceptually refined our terminology and we are better able to articulate concepts of occupation and context so that we have models that can help us. I think that Reilly and role theory are still extremely relevant – but perhaps from a broader economic and social perspective that is perhaps beyond the point of this emailer’s question.

Anyway, I think that there are ways to ‘bridge’ these divides – and of course the first step is to be aware of the gap. Once you are aware of the gap you can take active steps to help people in relevant ways. But that is true for all of OT – not just when the gap is represented by language barrier and cultural barrier.

OTs need to have a meta-awareness regarding the interaction between the therapist’s cultural perspective and the cultural perspective of the person receiving services. Without this meta-awareness you will not be able to be maximally effective. It sounds like the emailer is already well on his way to being a good OT.

In the alternative, you can forget about all this cultural meta-awareness diatribe and you can just stack cones, but your patients will leave the encounter unfulfilled and unhelped.

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