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Maybe People Aren’t Buying What AOTA Is Selling

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AOTA held its annual business meeting this week. There were the expected reports about advocacy wins, strategic priorities, publications, communities of practice, and the upcoming conference. There was also a rather substantial financial problem. AOTA finished fiscal year 2026 with an operating deficit of approximately $3.4 million . Investment income covered nearly all of that amount, leaving a comparatively small overall loss of about $100,000. That sounds reassuring until you separate investment performance from regular operations. AOTA did not come close to paying its operating expenses with the money it generated through membership, conferences, accreditation, continuing education, publications, and other routine activities. The investment portfolio rescued the income statement. That is fortunate, but it is not a business model. The budget was balanced with assumptions the Board already doubted The most remarkable disclosure came from Treasurer Bryant Edwards. He described the...
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When development becomes replacement

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Subtitled: What a Facebook meme gets wrong about Mary Reilly - and why it matters. I was scrolling through Facebook when I came across a meme described as “in conversation with an ancestor.” It placed Mary Reilly’s famous occupational therapy hypothesis beside a contemporary reformulation by Frank Kronenberg.  I am re-posting the meme here for purposes of commentary and professional criticism. Source: Frank Kronenberg, posted to social media July 21, 2026 At first glance, it looked like a respectful update - perhaps an effort to carry a foundational idea forward into a more socially conscious age. But the longer I looked at it, the more concerned I became. This was not just a modernization of Reilly’s language. It was a replacement of her premise. Reilly wrote: “Man, through the use of his hands, as they are energized by mind and will, can influence the state of his own health.” The generic use of “man” is dated, and at first I thought that might be the subject of the meme. S...
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Everything Is an Occupation. Not Everything Is Occupational Therapy.

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Subtitled: Pornography, professional scope, and the missing clinical threshold. Last month I wrote about an article examining drag as an occupation . My objection was not that drag could not be studied as an occupation. Occupational science can study almost anything people do, including activities that are unfamiliar, controversial, highly personal, culturally specific, or socially contested. That descriptive work can help us understand meaning, identity, habits, routines, context, and participation. That is not occupational therapy, per se, but it might sometimes be additive. The additional leap into occupational therapy practice remains my persistent concern. Once an occupation has been described, authors sometimes attach a few sentences explaining its supposed clinical relevance. The occupational therapist is then asked to acknowledge it, assess it, support it, or incorporate it into practice, even when no particular patient population, health condition, intervention, competency, or...
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When the Definition of “Critical” Becomes Critical for Occupational Therapy

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  Apparently, the definition of critical is critical. A recent mixed-methods study in the Australian Occupational Therapy Journal examines how occupational therapy educators across different countries think about and define critical thinking. The authors found something I have long suspected and have previously documented: occupational therapy educators do not all mean the same thing when they use the term 'critical.' Some define critical thinking in concrete, clinical, pragmatic terms: reasoning, evidence appraisal, decision-making, and reflective practice. Others define it in broader sociopolitical terms: questioning knowledge production, identifying oppressive structures, pursuing social transformation, and taking “critical action.” There is a wide chasm between these definitions. It matters because “critical thinking” is not a minor curricular phrase. The term 'critical' appears everywhere in higher education, accreditation language, learning outcomes, rubrics,...
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A Fourth of July Reflection: Faith in Persons

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Thirteen years ago, on the Fourth of July, I wrote about autonomy. At the time, I was trying to understand what I believed was a subtle but important shift occurring within occupational therapy. I argued that our profession was moving away from one of its deepest philosophical commitments: respect for the autonomy and agency of individual human beings. 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 Inde...
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Occupational Science With a Progress Note Attached

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A recent article in The Open Journal of Occupational Therapy caught my attention: “ Doing Drag: Exploring the Experiences of Drag as an Occupation for Performers in California. ” I want to start with a point of clarity: I do not object to anyone studying drag. It can definitely be studied as an occupation. It involves preparation, performance, costume, makeup, role construction, social interaction, community participation, identity expression, skill, and meaning. There is no serious argument that drag is not something people do, or that it cannot be examined through an occupational lens. But I still scratch my head a little at the topics that seem to get elevated for study. There is no reliable national estimate of drag performers, in part because drag often occurs outside formal occupational categories. But by any reasonable comparison, drag is a niche performance occupation, while ordinary occupations involve hundreds of thousands or millions of people. That raises a question: wh...
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Welcome to the Crisis Conversation

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I read the recent AJOT article, “ Occupational Therapy in Crisis, ” with interest and some frustration. Interest, because I agree with the basic premise. Occupational therapy is in a period of identity instability. The profession is struggling with questions about its theoretical base, its view of humans, its scope of practice, and its methods of creating change. Those are not small questions - they are the questions that define a profession. Frustration, because this crisis did not suddenly appear in 2026. I have been writing and presenting about these same tensions for years, often in less formal spaces and often without the kind of protective language that makes professional journals comfortable. So, welcome to the crisis conversation. I actually mean that sincerely. I am glad the issue is being named in AJOT. I am glad the word “crisis” is being used. I am glad there is some recognition that occupational therapy may not have a shared understanding of what it is, what it does, or ho...
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