Basic vs. applied science: The ongoing OT and OS debate

 Over the course of the last several years an important professional debate about social justice has been occurring in the occupational therapy profession.

That actual debate started innocently by a student who posted a question in the Public Forums on OT Connections who was interested in conversation about an RA motion to remove Social Justice from the AOTA Code of Ethics.  That student disagreed, stating that she did not think that Social Justice represented a single political philosophy and that it should not be removed.

Some leaders in the occupational therapy community voiced their support of the student's position, stating that social justice is not reflective of a singular political ideology and should not be re-framed as such.  There was near immediate disagreement, with other AOTA members expressing that it does represent a single political ideology.

The basis of the eventual RA vote that supported inclusion of Social Justice was made on the questionable premise that Social Justice does not represent a single political ideology.  In the ensuing years of debate a lot of evidence has been provided to counter that premise.  The new draft of the AOTA Code of Ethics removes the term 'social justice' but many of the constructs remain embedded within the document.  That document remains in revision and feedback is still being collected.

I am prompted to write this reflective summary because I believe that a new level of evidence about the nature of Social Justice has been revealed, although it is unfortunate that this evidence is not in the public OT Connections forum where the debate has continued for several years.  The evidence about the political nature of Social Justice as it relates to occupational therapy is evident in a discussion thread of the International Society of Occupational Science.

The ISOS group is an essentially open membership organization that is virtually organized and focused on enabling international communication between people who are interested in occupational science.  Many of the members and leaders within the ISOS organization are occupational therapists, but certainly not all of them are.  Many of the members and leaders of the ISOS organization are also members of the Society for the Study of Occupation: USA.  As such, many of the ISOS participants are leading academics for American-based occupational therapy.

Unfortunately, while the debate about Social Justice occurred on the open OT Connections forum, there was not broad participation by the OT Academic community or the membership itself, for that matter.  Underlying the OT Connections debate there have been several themes.  Some who opposed Social Justice did so more from a basis of political opposition to the concept.  Some did so more from a basis of concern about applicability of the Social Justice and other occupational science concepts to the applied field.   Some had a combination of concerns.

The challenge in the debate has been a lack of participation and most certainly not a lack of substance.

In August 2014, the ISOS group started a discussion thread entitled "Developing occupational science as a critical and socially responsive discipline: challenges and opportunities." The following information is available on their website and is quoted directly:

"Occupational science appears in a crucial moment of its development, characterized by an increasing awareness of issues of inequity and injustice, and calls to further embrace diversity, situatedness and critical reflexivity. Overall, there appears to be a call for occupational science to become a more critical and socially responsive discipline, and increased attention has been focused on topics such as: how certain occupations are promoted by social policy discourses that reinforce structures of domination, how ideologies underlying certain occupations create and perpetuate occupational injustices, and whether occupational science has a responsibility to address social justice, humanitarism and human rights."

Certainly, occupational science is NOT occupational therapy, but one of the expressed purposes of the science was to inform the occupational therapy profession.   However, we now have a basic science that is interested in "expand[ing] the understanding of occupation and enhance the social relevance of the discipline, particularly as issues of occupational inequity and injustice are increasingly fore- fronted in local to global socio- political contexts."

The content of the discussion is based on the a priori assumption of "how can occupational science move forward in its development as a socially and politically engaged discipline?"  Responses from forum participants in the ISOS context are entirely political, including open embrace of Marxism, promotion of Nussbaum's Capabilities Approach, and a strong interest in interpretation of occupation through the lens of socialistic political interpretations of economies and power distribution.  In short, the ISOS discussions represent a unidimensional political agenda.

It is unfortunate that the proponents of occupational science were not willing to commit to a public and open conversation about this on the OT Connections website.  A lot of discussion about the political aims of Social Justice could have been avoided if we had more participation from those Academics who were proponents of this politicization.

So the facts are very clear, and those facts are that Social Justice does reflect a particular political ideology and represents a unidimensional world view on the political nature of occupations.

This leaves some members who stated that Social Justice is apolitical in a position where they need to explain their statements.  It may be very possible that some of those members were simply unaware of the political nature of the Social Justice construct.  Even a cursory review of the ISOS discussion will provide evidence to refute those claims.

As a final point, the occupational therapy profession needs to move forward.  There are several important issues that are on the table:

1. Will we re-affirm our Core Values or will we follow a handful of international Academics into a New Model of justice-based and rights-based ethics?

2. Will we take steps to revise our Code of Ethics to reflect pragmatic concerns of practice?

3. Will we expend occupational therapy resources on a basic occupational science that is not responsive to actual practice concerns and seems focused on promoting a political philosophy?

4. Will we create, nurture, and promote conversations where we have HONEST DIALOGUE about the very nature of these concerns?

The OT Connections forum and the ISOS forum should serve as a reflection point for those who wish to identify as 'occupational scientists' and those who wish to identify as 'occupational therapists.'  It is evident in these conversations that the concern about basic vs. applied science is far from over.

I would like to close this with a quote from Dr. Gary Kielhofner, who I believe presciently identified our current problem and explained his concerns when discussing the purpose of some of his final work:

This current volume was inspired by my increasing concern  that the pendulum has swung too far in the opposite direction.  It was greatly influenced by a concern that the field, in its eagerness to develop a science of occupation, may be leaving behind or forgetting the "therapy" in occupational therapy.

References:

(direct links above)

Kielhofner, G. (2009). Conceptual Foundations of Occupational Therapy Practice, 4th ed.  F.A. Davis: Philadephia.



Background reading:

 The 2011 Social Justice Debates in Occupational Therapy
Social Justice Follow Up: Brass Tacks for the Occupational Therapy Profession
Social Justice: What Would Dr. Kielhofner Say?
Emmanuelism Provided the Core Values to the Developing Occupational Therapy Profession
Patient vs. Client - What Could Go Wrong?  Look Around and See...