Wednesday, February 11, 2009

Issues with occupational science and the developing lexicon related to occupational or social justice.

The concept of occupational justice is in its infancy, still struggling with definition and identity. Although many of the concepts associated with occupational justice are not new, they are being evolved and reaffirmed, representing another step in the scientific (r)evolution of occupational therapy. Clarification of salient issues has to include definitions of assumptions, concepts, taxonomies, and subsequent research orientation; these are all critical for the evolution of concepts.

The primary challenge in developing a lexicon for occupational science is one of linguistics. Some linguists argue that a concept must be encodable in order for it to be stable. This is important so that the 'hearer' can understand and form a mental concept of the message. However, other linguists argue that there are more concepts than there are encodable forms. Additionally, it takes time for words to stabilize within language. This seems to be the state of affairs in occupational science, which is understandable given the nascent development of the field. Specifically, this is why there has been considerable debate and difference amongst scholars, even in providing basic definitions for the concept of ‘occupation.’ This is acceptable for scholarly discourse, but is not acceptable for conducting research or explaining occupation to the public, or for application to practice.

Prior to trying to frame the nature of occupation for research purposes, occupational scientists still need to clarify concepts amongst stakeholders within the evolving science. This is important because as Kuhn (1962, p.5) states, research is "a strenuous and devoted attempt to force nature into the conceptual boxes supplied by professional education." Unless the professional education is consistent and sound, the research that is conducted will be in danger of having serious flaws. This fact underscores the importance of having a well-developed lexicon; research will hold more value once definitions are broadly accepted.

The logical question that follows is this: are occupational therapists adequately prepared to develop the lexicon of this evolving science? The evidence to date shows that there will likely be periods of confusion as the profession begins to move toward a consensus opinion on the meaning and definition of its central concepts. Yerxa (1999) was concerned that “some might use such a lexicon to oversimplify and/or reduce rich, complex concepts…lead[ing] to premature closure of what should be a generative theory.”

Occupational science is identified as an interdisciplinary endeavor, and this creates inherent opportunities and dangers when inviting broad diversity of input into the creation of the science. In simplistic terms, occupational science is like a bandwagon: new ideas are generated and they ‘jump aboard’ the bandwagon where they are able to conduct tests of congruency against the developing set of ideas. Some of these ideas fit better than others.

In addition to the above problem, many occupational scientists were initially schooled as occupational therapists. Since most occupational therapists were educated within a medical model, how does this same group transfer its collective knowledge into post-positivistic models like occupational science? The creation of taxonomies by positivistic-thinking individuals can create a very shaky foundation for the entire science. In this regard, classification systems must be understood as being arbitrary conveniences that are subject to revision and debate. The developing taxonomies of occupational science should be considered a temporary and convenient filing system, not a set of fixed rules. This is particularly important until the evolving field develops enough points of triangulation to eliminate spurious ideas.

The logical corollary to this is that the lexicon developed by occupational scientists might not fit well within the constraints of practice models for occupational therapy. So, it is possible that occupational science may inform occupational therapy, but caution must be exercised before we can state that an occupational science lexicon will consistently make sense for practice.

As a discipline, occupational science is still in its infancy. The current professional discourse on definition of terminology serves as the necessary precursor to scholarly research, which can than be presented to the public. Occupational science is another step within a long revolution in the field of occupational therapy. Theory-testing will demonstrate its ultimate worth and determine its place within practice.

The most recent issue of the American Journal of Occupational Therapy (January February 2009) is the first special issue dedicated to “social justice and health disparities,” which are central constructs within occupational science. After reading the journal I was left wondering “how does this relate to how an occupational therapist engages in practice?”

I decided to conduct a small study using a convenience sample with an N of 1 (self). In other words, this is my opinion.

I spend a fair amount of time blogging about power inequities in systems and how they negatively impact people who have disabilities. A smattering of these entries can be found under ‘OT Stories’ and ‘Disability Rights’ in this blog. As this blog theoretically represents practice it seemed to be a reasonable data set from which to test the presence and applicability of the occupational and social justice concepts discussed in the journal.

While reading through these blog entries I found that I did not use words like “occupational injustice,” “occupational apartheid,” “occupational deprivation,” or “occupational marginalization” despite my strong familiarity with the concepts. Considering the recent attention to these concepts in the occupational therapy literature, as recently summarized by Braveman and Bass-Haugen (2009) I began wondering why these words haven’t been inculcated into my lexicon and practice.

As evidenced in the blog entries herein, my practice is strongly focused on navigating systems and functionally advocating for patients. Additionally, there is a strong focus on narrative construction of meaning with the individuals who are living a disability experience.

Specifically, I find that my own practice, as related in the narratives on this site, was highly influenced by Mattingly and her concepts related to narrative construction of meaning. In blog entries on this site therapeutic ‘storytelling’ is used as a primary technique that helps to guide the outcome of intervention – and it is also used to explain the intervention for the blog readers. Sometimes the storytelling is purposefully manipulated for the patient’s and reader’s benefit. This benefit and interaction has often been unwittingly embedded within the banal form of this blog.

Mattingly draws upon the Heideggerian expectation that current meaning is strongly dependent on a future conceptualization of hope. She provides detailed analyses of therapeutic interactions, providing examples of how therapists struggle against the notion that their patients who have disabilities might experience time as a brute sequence of events. She shows that therapists work with patients to develop a shared vision for the future and of life after recovery from illness or disease.

Mattingly explains that the process of narrative within the context of therapeutic exchange may be construed as imitating the patient’s life that is actually being lived, or it may be that the patient’s life is imitating the narrative that is being constructed between the therapist and patient. She also proposes a third interpretation, suggesting that narrative imitates experience because of the therapeutic ‘sense-making’ of the occupational therapist. All of these elements are embedded within this blog.

Another significant influence on my practice is the work of Jerome Bruner, who describes the concept of ‘folk psychology’ as a model of empiricism. Folk psychology is a system that people use to organize their experiences and to make sense of them. Folk psychology is based on narrative, which is a sequential, factually indifferent, navigational method that has dramatic quality and is accessible to anyone who has mastered the (shared) language. Bruner diverts criticisms that this is a relativistic model by suggesting that since language is a shared expression of culture, meaning-making takes on a larger sense than as simple individual interpretations of reality.

Bruner advances his own philosophy of experience that can be contrasted to Husserl’s phenomenology. Where Husserl proposes that all un-provable assumptions be discarded when describing what is given in experience, Bruner expresses that culture, as mediated through narrative discourse, is the foundation for interpretive meaning. Bruner’s interpretation of ‘zu den sachen selbst’ is that the ‘things’ that matter most are the communal cultural experiences that are acquired through language acquisition.

This blog, much like Bruner’s book, provides an autobiography as a sample illustration, demonstrating the strong linkages between personal experience, historicity, and cultural foundation.

This blog, which reflects my practice, follows a constructed design of storymaking, storytelling, and narrative folk psychology. The emphasis is on making and finding meaning, navigating systems, and is reflected in the plodding efforts and struggles of the people whose stories are contained herein.

This can be rather strongly contrasted to the concepts outlined by Braveman and Bass-Haugen (2009) and as reflected in many of the articles in the referenced AJOT. I have some rather strong concerns that the concepts associated with social or occupational justice might inadvertently contribute to ‘linguistic determinism’ and subsequent victimization.

This brings the conversation full circle back to issues related to lexicon. I don’t doubt that “occupational injustice,” “occupational apartheid,” “occupational deprivation,” or “occupational marginalization” exist – but when we frame the problems with this language it is possible that we are creating a new liberation politic, and that the advancement of the ‘cause’ becomes dependent on the continued subjugation of people’s ‘occupational rights.’

In other words, the terms may be helpful for explaining the sociology of power differentials, but they may not provide a functional springboard for providing an intervention. Here, Mattingly’s focus on hope and Bruner’s focus on meaning-making are a much more functional model for helping people move forward. If we spend too much time talking about “occupational injustice,” “occupational apartheid,” “occupational deprivation,” or “occupational marginalization” I am afraid that all we will create is a bunch of really angry people – or even worse – we run the risk of beginning to think that the proper point of intervention is in picket lines and protest rallies as described by Blakeney and Marshall (2009).

Albert Camus is often quoted as saying, “Don't walk in front of me; I may not follow. Don't walk behind me; I may not lead. Just walk beside me and be my friend” This is a model of shared narrative construction between therapist and patient that is used as a therapeutic tool for return to daily occupations (whatever the disability may be). This model of therapist-patient interaction is starkly contrasted to a fist-pumping anger-fest that is stoked by using an inflammatory lexicon of rights-denial.

The presence or absence of rights-denial is factual and independent of our opinions. What matters is how we help people get past those barriers. We are a pragmatic profession that helps people. We are not community activists and rabble rousers.

In summary, I am not sure who is going to pay for OTs to attend protest rallies about water quality in Kentucky. However, if lack of potable water causes disruption and stress in caregiving routines for parents of children who have disabilities I am relatively certain that there are ways to help them cope, adapt, and make meaning out of their experiences.

This difference in intervention alone can serve to represent the crux of the problem in how we make social or occupational justice fit into an occupational therapy practice model.


Blakeney, A.B. and Marshall, A. (2009). Water quality, health, and human occupations. American Journal of Occupational Therapy, 63, 46-57.

Braveman, B. and Bass-Haugen, J.D. (2009). Social justice and health disparities: An evolving discourse in occupational therapy research and intervention. American Journal of Occupational Therapy, 63, 7-12.

Kuhn, T.S. The Structure of Scientific Revolutions, 3rd ed. Chicago: The University of Chicago Press

Yerxa, E. (1999). Occupational terminology interactive dialogue. Journal of Occupational Science, 6, 75-79.

Background reading:

Bruner, J. (1990). Act of meaning. Cambridge: Harvard University Press.

Mattingly, C. (1995). Healing dramas and clinical plots: The narrative structure of experience. Cambridge: Cambridge University Press.

Sperber, D. & Wilson, D. (1998). The mapping between the mental and the public lexicon, In Carruthers, P. & Boucher, J. (eds.) Thought and language. Cambridge: Cambridge University Press

1 comment:

Buckeyebrit said...

Hey Chris - great post, will digest it properly this evening! Just wanted to let you know about the new OT blog carnival and invite you to submit a post, would you be interested in hosting the next ed? More info here