The Ant Mill of Occupational Therapy: A Profession Trapped in Its Own Spiral
Ethics in occupational therapy can feel distant or overly academic—something shaped by committees and frameworks rather than day-to-day practice. I’m someone who has worn both hats—a street-level OT who’s spent too much time in academia—and that gives me a particular vantage point for reflecting on where we’ve been and where we might be headed. I’m writing this for the lunch-bucket practitioners out there—the ones grounded in clinical realities—who have sensed that something in our professional dialogue feels increasingly unfamiliar or prescribed. But I think we need to bring these conversations down to earth. We need to pull chairs into a circle, metaphorically speaking, and talk through what these changes mean for us—not just as professionals, but as people trying to do meaningful work.
And those who hold influence in academic and leadership roles—especially those involved in shaping documents like the Code of Ethics—need to be listening closely to the voices of those grounded in direct clinical practice. Some already are, and I’m grateful for the thoughtful responses I’ve received from colleagues in academia who share these concerns and want to help chart a better path forward. That means making the conversation both safe and accessible, while still respecting the complexity of the issues at hand.
+++
While taking a break from program development work and scrolling through Facebook reels, I came across a short video that caught my attention—army ants caught in what’s called a "death spiral." They moved in a relentless, tightening circle, each ant following the one ahead, unaware that the path led nowhere. The caption explained it was a phenomenon known as an "ant mill," where ants, having lost track of the colony, begin following each other in a loop until they collapse from exhaustion.
I couldn’t stop thinking about it. As absurd and sad as it was to watch, it immediately struck me as an uncanny metaphor for what’s happening not just in society at large, but more specifically within certain sectors of the occupational therapy profession—beginning in academic environments and increasingly influencing students and practice settings alike.
The ant mill is not driven by malice or ignorance. Each ant is simply following a rule that works most of the time: follow the one in front of you. The tragedy emerges when this once-reliable rule is followed reflexively, without re-evaluation or recognition that the context has changed. Occupational therapy, in some of its institutional and academic domains, is caught in such a loop.
This pattern began with what seemed like a well-intentioned shift. In 2010, the AOTA Code of Ethics introduced social justice as an ethical principle. At the time, it was framed as an aspirational value, consistent with broader cultural trends and the increasing influence of identity politics and postmodern frameworks in academia. But what began as an appeal to inclusivity quickly morphed into an enforceable standard of professional behavior.
By 2020, the revised Code of Ethics had doubled down on this trajectory. Language around diversity, equity, and inclusion (DEI) was embedded throughout the document, reflecting not only a commitment to representation but also a narrowing ideological worldview. The code began to conflate political advocacy with ethical obligation. Practitioners were no longer simply expected to treat patients with dignity and respect but to adopt specific sociopolitical interpretations of justice, equity, and power.
This change has had cascading effects. Accreditation standards (ACOTE), education models, hiring practices, and even research funding mechanisms are now shaped by a near-unquestioned DEI orthodoxy. Alternative perspectives, or even reasonable critiques, are increasingly marginalized. The profession—once rooted in pragmatic, person-centered problem solving—now orbits tightly around concepts and commitments that, while perhaps morally appealing, are often ideologically rigid and epistemologically unchallenged.
We are deep in the spiral.
One only has to glance at the recent March/April 2025 issue of the American Journal of Occupational Therapy to see how deeply embedded these frameworks have become. From article titles to positionality statements to thematic framing, the journal now reflects a profession steeped in equity-centered ideology and postmodern critique. While these approaches can bring valuable insight, they also risk reinforcing a singular lens—one that sidelines pluralism and limits inquiry. The scholarly voice of occupational therapy is increasingly becoming the echo chamber of its most institutionally empowered perspectives.
This is also why I publish these thoughts in a blog. Perspectives like this weren't included in AJOT's diversity issue. They're rarely reflected in conference programming. And while online discussion forums are open in theory, proponents of the dominant frameworks rarely engage in meaningful dialogue. That absence is telling. So this piece appears here - simply because there are so few spaces left for alternative perspectives to be explored openly.
Perhaps this narrowing of discourse helps explain why so many clinical practitioners feel disconnected from the professional association today.
The intellectual roots of this spiral are multifaceted. Some trace back to the occupational science literature, where postmodernism and critical theory began to gain popularity. I remember taking my own initial steps into that content—engaging with postmodern thinkers like Foucault, whose ideas about power and knowledge seemed provocative, and Derrida, whose deconstructive lens raised new questions about meaning and interpretation. I approached their work with curiosity more than conviction. It felt exploratory at the time, even invigorating. But hindsight has made it clearer: many of us didn’t realize the cliff we were slowly approaching. What started as a good-faith effort to broaden perspective quickly evolved into a dominant framework with consequences that weren’t always anticipated or tested in practice.
This "fourth paradigm" was not just a domestic academic trend. Its global diffusion was propelled by increasing internationalism, particularly through countries whose healthcare and academic systems were already more ideologically aligned with collectivist principles. Critical theories resonated in those contexts, but little effort was made to evaluate their translatability into environments like the U.S., where systems are less centralized and more pluralistic. We are not all socialized countries with universal care models. Yet this context is often ignored. Instead, the dominant discourse seems increasingly focused on deconstructing anything associated with Northern or Western paradigms—without pausing to assess whether these imported frameworks truly serve our patients, our students, or our systems. I dedicated a full chapter on this topic in my textbook, "Clinically oriented theory for occupational therapy."
I've previously written about this "fourth paradigm" in occupational therapy—one that elevates narrative population level perspectives, standpoint theory, and identity-based knowledge over empiricism, pragmatism, and systems thinking. (See: "Pushing back against a 'Fourth Paradigm' in the occupational therapy profession.") While this paradigm shift was billed as an expansion of our epistemology, it has in practice constrained it. We are no longer curious ants exploring terrain. We are circling each other, each convinced that the ant in front knows the way.
This evolution set the stage for the widespread adoption of equity frameworks, and this is not an exclusive critique of DEI as a principle—respect, representation, and inclusivity do matter. But when these values are framed as enforceable ethical mandates without space for dissent, we trade open inquiry for conformity. Worse, we begin to equate ethical integrity with ideological allegiance. This does not unify the profession; it atomizes it into fearful compliance.
I’ve heard from many colleagues—privately—who share these concerns. But few are willing to say so publicly. The risks are too high. The career consequences too real. And perhaps, the language to express dissent within a DEI-dominated framework feels unavailable. And so the spiral continues. I suspect that many occupational therapy practitioners don’t agree with the direction the profession is taking but don’t know how—or whether—they’re even allowed—to object.
We must ask: what are we building if all our professional dialogue is shaped by fear of stepping out of line? What happens when no one dares to question the direction because they’re too busy following the trail in front of them?
In biology, the only way out of an ant mill is disruption. Something must break the pattern—a gust of wind, an obstacle, a shift in terrain. Ironically, some of the most vocal proponents of the current trajectory in occupational therapy refer to themselves as 'OT disruptors.' But it may be time to disrupt the disruptors—to question whether the direction they’ve championed is leading us toward innovation or entrenchment. Not all disruption is progress; sometimes, it's just another tightening turn in the spiral. In occupational therapy, we need the intellectual equivalent: open forums, pluralistic ethics, and leadership willing to invite critique rather than silence it.
We cannot afford to circle until collapse. The trail we are on is not destiny. It is a choice. Disruption, in this sense, doesn’t mean rejection—it means re-centering. It means asking whether our professional frameworks still serve real-world practice, whether they foster innovation or constrain it, and whether they include room for intellectual diversity. The question is—are we brave enough to pause, look up, and take a different path together?
If you’ve felt this tension and haven’t known how to express it, you’re not alone. I welcome thoughtful responses—public or private—as we all try to find better footing in this evolving landscape.
Comments