When development becomes replacement

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. Still, the meaning of the statement is not especially mysterious. Reilly was describing a capacity of the human person. People act upon the world. They learn, solve problems, create, produce, adapt, and develop competence. Through purposeful action, they can influence their own health. That was the core of her statement.

Her 1961 Slagle Lecture was not a general meditation on everything humans might do. Reilly was asking whether occupational therapy was a sufficiently vital and unique service for medicine to support and society to reward. Her intent is stated directly in the lecture. Her hypothesis was meant to explain what distinctive human need occupational therapy serves and why a health profession should be organized around it.

The remainder of the lecture makes that purpose even more clear. Reilly discusses the development of the central nervous system, sensory-motor experience, problem solving, creativity, work capacity, personal biography, life roles, illness, injury, dysfunction, and treatment. Her concern is the person whose capacity for productive and creative action has been blocked - and what knowledge might be required to help that person regain it.

She also warns that occupational therapy will not recover its purpose merely by reflecting the problems of the larger society. A profession, she argues, must identify the vital human need it serves and the distinctive manner in which it serves that need.

Kronenberg’s reformulation changes every major element of Reilly’s hypothesis.

The individual human being becomes “humanity.” Using one’s hands becomes “joining hands.” Mind and will become “Ubuntu and political will.” The person’s own health becomes “society’s health.”

That is not a modest change in terminology. It changes the subject, the mechanism, the level of analysis, and the intended outcome.

Reilly’s proposition is about personal agency exercised through occupation and directed toward health. Kronenberg’s proposition shifts the focus to collective solidarity, political will, and societal health.

I believe that Kronenberg's proposition may be a legitimate philosophical project. Collective action matters. Political will affects the conditions in which people live. Ubuntu may provide a valuable account of human interdependence. These ideas can be studied, debated, and developed on their own terms.

But they do not become occupational therapy simply because they are placed into the grammatical structure of Mary Reilly’s sentence.

That is the broader issue that concerns me.

Occupational therapy should not be frozen in 1961. Foundational ideas are not sacred objects that can never be questioned, revised, or expanded. Reilly herself described criticism as necessary to professional progress. But there is a difference between developing a profession and substituting a different purpose for its original one.

Development should leave the profession recognizable.

When we take a foundational occupational therapy proposition about the person, purposeful action, health, illness, and professional service and replace it with a theory of humanity, solidarity, political will, and societal health, then we have not broadened occupational therapy. We have created something else.

That something else may be worthwhile. It may deserve a name, a literature, a body of theory, and a community of advocates. But it should be recognized as a new formulation rather than treated as the natural completion of Reilly’s thought.

A profession cannot encompass every good thing that human beings might do. It cannot claim every form of participation, every social problem, every political struggle, and every desirable collective outcome without eventually losing the ability to explain what makes it a profession at all.

Once occupational therapy becomes a vocabulary through which broad social and political aims can be expressed, its boundaries no longer expand. They disappear. We risk removing the philosophical guardrails around the profession and losing the core premise that once made occupational therapy distinctive.

We do not strengthen a profession by hollowing out its foundational premises while retaining their familiar phrases. And we do not honor an ancestor by placing a fundamentally different argument inside the structure of her most famous words.

A genuine conversation with Mary Reilly would begin by listening carefully enough that her actual argument remains recognizable.