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When Occupational Therapy Forgets What it Knows: Professional Memory, Epistemic Authority, and Repeated Rediscovery

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OTs are historically nomadic Occupational therapists are historically nomadic. I don’t mean that we are naturally restless, or that moving from one setting to another is a professional virtue or even a standard. I mean that OT work has repeatedly been built inside systems that change – systems that contract, close, or lose the funding and institutional commitment that made the work possible. The occupational therapist may move on. The service may disappear. The knowledge developed there often has no durable home. I saw this in a community rehabilitation system where I once worked. When I arrived in 1989, the agency had no occupational therapists and had recently been cited by the state for failing to provide skilled services in its day program for adults who had developmental disabilities. I hired a COTA (later became my wife!), added staff, and built OT across adult day habilitation, an outpatient clinic, children’s educational programming, residential services, and consultation t...
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The Thinker, the Maker, and the Machine: Revisiting 3D Printing Eleven Years Later

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One of the perils of longitudinal blogging is that the internet preserves my earlier certainty long after my thinking has evolved. I have learned over time to stop being so certain about things. Ideas written in response to a particular moment remain sitting in this blog exactly where I left them, waiting to be rediscovered without the benefit of everything I learned afterward. If I am fortunate, I rediscover them myself before someone else does. Ahem. I recently revisited a post I wrote in March 2015 titled “On 3D printing technologies and The Nature of Gothic .” Because I am now helping to build an occupational therapy program where digital fabrication is one of its defining capabilities, there is a reasonable possibility that one of my students will eventually find it too. I figured I had better clean up the mess on aisle three before a student or collaborator asks why the person promoting Measure. Design. Make. once dismissed 3D printing as a fad. The original post isn't enti...
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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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