Thursday, September 04, 2008

The power of words

There is more opportunity to follow the conversation in the Advance for Occupational Therapy magazine about early intervention service delivery. I read the magazine today and still felt uncomfortable as I kept stumbling over what Dr. Jane Sorenson wrote:

“At the end of the year, all of them were performing at maximum potential… I explained, as I do with all parents whose permanently disabled child is performing at his maximum potential within the reality of the disability, that more treatment won't mean more function right now… I believe it is our responsibility to the children to discharge them from direct service when they have reached realistic goals within the reality of their diagnoses.”

I wanted to do some self-checking to be sure that I wasn’t applying any bias to reading her based on my disappointment over her previous comments. After a lot of consideration, I think I understand the nature of my concern and discomfort.

It is the words.

As an amateur anthropologist I have some passing understanding of the Sapir–Whorf hypothesis. This hypothesis states that there is a power to words and that words frame our perspectives and understandings. This is not a discussion about political correctness which has pejorative connotations because of the way that the concept has been co-opted in American political discourse. This is about the power of words and the language we use.

Language is a medium for expression of a culture – and a culture is a shared set of beliefs and practices. In the simplest form, language transmits the beliefs and practices of people. I would be remiss if I did not also reference Jerome Bruner, who described the construction of reality through narrative. In short, words are powerful. Words reflect our beliefs that frame our narratives and support our culture.

Occupational therapists have a culture. There are variations in the culture but there are some basic beliefs that most occupational therapists hold. Perhaps the most important of those beliefs has to do with human potential.

I am not talking about human potential from some wishy-washy 1960s mind-expansion perspective. I am talking about the basics of humanistic psychology, and people’s needs, and how they experience their lives and how their needs are met. Occupational therapists, perhaps more than any other professionals, understand this dynamic nature of human need, and how needs ‘imperatively demand satisfaction’ – which I believe is an Eric Fromm quote that was recycled by Mary Reilly in her Slagle lecture. People have needs and meeting those needs is often derailed and impeded by life experiences or disability.

So what are we saying when we state that someone is performing at their maximum potential? What exactly does that mean? What is potential and how does one know when it has been maximized? Is there anyone that reads this who has ever believed that their own potential has been maximized?

For your potential to be maximized your needs must be met. To state that someone has maximized their potential is to state that they Need no more.

If you Need no more, you can not have growth. And perhaps you have no meaning. If I say that you Need no more than I have placed you in a box, de-humanized you in every way possible, and stated that your human potential is complete. To take away your Need is to take away your human-ness. You are a defined object and not a self-actualizing subject.

The words are horrifying – I can only imagine the punched-in-the-stomach feeling that a parent would feel to have someone tell them that their child has no Needs and that they are at their maximum potential within the reality of the disability.

Whose reality? The reality of the all-knowing professional who after having completed some assessments in a limited contextual understanding of that child completely and abjectly disregards the parent’s larger hopes and aspirations? Is that reality?

I can’t imagine harsher words. That is where I am getting stuck.

There is no doubt that there are times to discharge a child. There are times to change from direct to indirect interventions. There are times to make all kinds of changes in the recommended intervention program of a child. These are not real issues – everyone knows these things.

But it should never be time to use words that limit the human potential of anyone.

Here is an easy fix – how about saying that “the child has derived the maximal benefit from participating in occupational therapy at this time.” I can accept that.

I can’t accept the statement that they have achieved their maximal potential given the reality of their disability. It is just too cruel and this is not the culture of occupational therapy.

There is a difference of articulation here: is the child done and do the parents need to accept some reality? Or is the therapy done for that particular time and context?

I know they are just words – but let’s hear your opinion – isn’t there a difference?

1 comment:

Cheryl said...

I think your rewording is much better and quite appropriate. I have used a similar wording in the hospital, when a person can still benefit from outpatient or home health therapy, but has exceeded what we can offer in the acute environment. I've also had pediatrics where I told the parents that we were at a plateau, or needed a general break from therapy to let things sink in. Sometimes, a few months or a different therapist can make a big difference in a kid's treatment. I think it would be incredibly inappropriate to tell any parent of a young child that they have reached 'maximum potential'... that's like telling someone with a spinal cord injury that they'll never walk or use their hands again! Can't count out the possibilities of the future... and especially not in such a tactless manner.