A Fourth of July Reflection: Faith in Persons
Looking back, I think I was observing a real phenomenon. But I don't think I had yet identified the central issue. Over the past decade I have come to believe that the debate was less about public health or occupational science than I originally thought. Those are manifestations of something deeper. Today I am framing the question differently and in a more fundamental way:
Who, exactly, is the recipient of occupational therapy?
For most of our history, the answer was obvious. It was the human being sitting in front of us. Everything else flowed from that simple proposition.
Perhaps that is why this question seems appropriate for Independence Day.
The Fourth of July is a celebration of political independence, but at its heart is a much older and much more demanding idea: that human beings are capable of governing themselves. The American experiment has long been animated by the belief that individuals possess both dignity and moral agency, and that free societies are built upon those assumptions. Like every philosophical principle, autonomy has limits and responsibilities. It has never been absolute. Yet respect for the capacity of individuals to direct their own lives remains one of the defining ideas of our political tradition.
I think that the same faith in human beings is also one of the defining ideas of occupational therapy.
Mary Reilly's famous Slagle Lecture is often reduced to a single sentence about occupation and health. We quote it so frequently that I wonder whether we have stopped reading the lecture itself. Immediately after the famous quotation, Reilly wrote that occupational therapy rests upon one of those great ideas capable of advancing civilization. She described that idea this way:
"...that man, through the use of his hands, can creatively deploy his thinking, feelings and purposes to make himself at home in the world and to make the world his home."
What has always fascinated me about this statement is the extraordinary faith in human beings that lies beneath it. Reilly was not describing people as passive recipients of care or products of circumstance. She believed that people possess the capacity to act upon the world, to create meaning, and ultimately to participate in shaping their own lives.
Elizabeth Yerxa expanded that vision only a few years later. Her conception of authentic occupational therapy was built upon respect for the individual's search for meaning, and she argued that therapists should not impose their own values but instead expose clients to possibilities and trust them to make choices for themselves. She acknowledged that dependency sometimes requires temporary limits on choice, but she insisted that those moments are exceptions rather than the philosophical foundation of practice.
One of my favorite observations from Yerxa is that helping people discover their own choices requires more knowledge, more skill, more sensitivity, and more faith in the individual than simply telling them what is good for them.
That sentence has become more meaningful to me over the years.
Respecting autonomy is difficult precisely because it requires faith that another human being is capable of becoming more than he or she is today. Paternalism asks much less of us. It assumes that the professional already knows the destination.
Somewhere along the way, however, our understanding of intervention began to change.
Over time, as occupational science expanded internationally and public health perspectives became more influential, the object of intervention subtly began to move. The OTPF III reflected this change when it described clients as persons, groups, and populations. That shift had relatively little impact on the daily work of clinicians, but it profoundly influenced the academic conversation about what occupational therapy ought to become.
As I have asked repeatedly, once your "client" becomes an institution, what exactly is an occupational therapist supposed to do?
Our licenses authorize us to evaluate, educate, fabricate, adapt, rehabilitate, coach, collaborate, and solve problems with real human beings. Those are remarkably powerful things. They simply operate at a different level than politics.
I have always figured that if I wanted to become a political activist, I would have become a political activist. If I wanted to become a legislator, I would have become a legislator.
Instead, I became an occupational therapist because I believe that societies are ultimately built through individual acts of competence, compassion, creativity, and responsibility.
That may sound naïve to some people. I do not think it is.
This idea is not new. In Self-Reliance, Emerson was not arguing that people exist apart from one another or that communities do not matter. He was arguing that societies become stronger when individuals develop the courage to think, choose, create, and act rather than simply conform. That is not a rejection of community. It is a recognition that communities are ultimately composed of persons capable of moral action.
Some readers, particularly within contemporary occupational science, will undoubtedly recognize echoes of Emerson, or America's long tradition of emphasizing individual liberty, and conclude that I am making an ideological argument. I do not think that is quite right. Respect for human agency did not originate with modern politics, and it was woven into occupational therapy long before today's political vocabulary entered our professional discourse. Reilly and Yerxa were writing decades before terms such as neoliberalism became common shorthand for dismissing arguments about autonomy. The question is not whether autonomy belongs to the political left or the political right. The question is whether faith in the individual's capacity to act remains one of the defining philosophical commitments of occupational therapy.
There is an old story about a child throwing stranded starfish back into the ocean. It has become something of a cliché, but clichés often survive because they capture enduring truths. Someone tells the child that the effort is meaningless because thousands remain on the beach. The child throws another starfish into the water and replies, "It mattered to that one."
George Eliot expressed the same idea much more beautifully at the conclusion of Middlemarch, writing that "the growing good of the world is partly dependent on unhistoric acts." She reminds us that civilization depends upon countless people whose faithful lives will never appear in history books.
Occupational therapists rarely change civilization in dramatic ways. We help one child discover a new way to play. We help one older adult remain in his own home. We help one person recovering from injury return to work. We help one family imagine a future that yesterday seemed impossible. Professions contribute to civilization through the faithful exercise of their craft. Occupational therapy is no different.
Those moments rarely make headlines. Yet accumulated across thousands of therapists and millions of lives, I think that they quietly become civilization itself.
As we built the new occupational therapy program at RIT, I found myself returning to these ideas repeatedly. People often assume that our emphasis on technology means devices, artificial intelligence, robotics, or virtual reality. Those things certainly matter. But they are not the philosophical center of what we are building.
Technology, in its oldest sense, is the craft of making. Occupational therapy is also a craft of making. We help people make routines, adaptations, identities, relationships, confidence, and meaning. Ultimately, we help people remake their lives. That work begins not with faith in systems, but with faith in persons.
Perhaps that is what Mary Reilly was asking us to test all along.
On this Fourth of July, I continue to believe that respect for human agency is one of those ideas capable of advancing not only a profession, but a civilization.
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