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

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 to other community programs. We developed clinic satellites across the region. People were receiving ‘active programming’ - an organized, individualized, goal-directed program that included six hours of services. For people covered by the Willowbrook-related requirements, this language carried specific obligations. And at that time OT and PT eventually generated about $1.2 million in annual agency revenue and MANY people received skilled services that I believe improved the quality of their lives. I left in 1995.

That was a large and developed service system. The system had clinicians, supervision, ongoing programming, clinics, consultation, and ways to fund the work. Much of it later fell apart. I am told that the agency no longer employs occupational therapists on its staff – although the website states that OTs and PTs work in a monthly wheelchair clinic.

A recent Facebook post described OT students spending a week at this local community agency, learning about the program and leading activities with adults with developmental disabilities. The students seemed to do thoughtful, joyful work, and the week sounds like it mattered to everyone involved. What unsettled me was the framing: OT’s role in community programming seemed to be presented as something the students were discovering, when this community had once supported a substantial OT service system.

 

 When the structure goes, the knowledge goes with it

It is critical to understand that the habilitation and rehabilitation service did not disappear because the human need disappeared. Funding, policy, and public priorities changed; the system that had supported the work contracted. When services lose staff, reimbursement, leadership, and institutional support, the knowledge embedded in daily practice becomes vulnerable too. A familiar and even locally iconic agency name may remain while the capacity to provide the service has become a shell of what it was.

This is one reason I call OT nomadic. Our work travels with clinicians, but it is often anchored to particular institutions, funding streams, and people. When a program closes or changes direction, the work travels only as far as clinicians can carry it. The records are scattered. The clinical reasoning, adaptations, relationships, and practical know-how may never be preserved in a form the next generation can readily find.

The result is more than a gap in the archive - a whole service structure can fall out of professional memory. Later, students arrive at the community agency that remains and encounter a worthwhile learning opportunity. But if the story begins with their arrival, the earlier system disappears from view. The profession sees a new question where people once built and sustained an entire answer.

The archive was incomplete before it went online

This is not only an OT problem. Across academic fields, students and researchers encounter advice to use recent sources - often the last five or ten years. That advice can be sensible when the question depends on current evidence, technology, or policy. But it is not a universal rule of scholarship. Academic library guides vary: some describe recent-source windows as typical, while others explicitly caution that limiting a search by date can exclude seminal or foundational work. What begins as a useful prompt to assess currency can become a rubric-level filter: old means less credible, less relevant, or not admissible. I can’t tell you how many times a student will ask me, “Is it ok if I use a source that is older than ten years old?”

That filter is especially consequential when the question is historical or conceptual. Publication date is not a measure of whether an idea is new, whether it has a lineage, or whether prior practice accumulated knowledge that remains useful. If a literature review is asked to be both current and historically thin, it can mistake the rediscovery of an old question for the emergence of a new one.

And the record researchers are asked to search was never complete. Before the Internet, knowledge was distributed across print journals and books, conference proceedings, professional newsletters, agency reports, program manuals, local archives, and practitioners’ files. Some work was never formally published or indexed. Some existed only in institutional records that were lost, discarded, or made inaccessible when a program changed or closed. In many settings, the people doing consequential practice did not have the time, role, or support to turn that work into durable scholarly publications.

I could find no digital record of what OT and PT services provided to that community agency from 1990-1995.  I might as well have been staring into a black hole.

Digitization has made enormous amounts of material easier to search, but it did not create a complete record. Libraries and archives select what to digitize; copyright, funding, preservation priorities, metadata, and search interfaces shape what becomes visible. Researchers in history and information studies have shown that online collections are selective and that searching them can privilege what is digitized and easily retrieved. A searchable archive is not the same thing as a complete archive.

Access is another filter. A citation may be discoverable while the full text remains behind a paywall or outside a researcher’s library holdings. Surveys of scholars document reliance on informal routes to obtain articles and books. This does not prove that paywalls erase older work in particular. It does show that access affects what researchers can actually inspect, compare, and carry into their own accounts. When access is difficult, the most available review or familiar citation chain can become a substitute for the harder work of recovering a source’s history.

Research on scholarly citations also suggests that online availability can change what gets cited, sometimes shifting attention toward more recent work and a narrower set of sources. Other findings complicate that picture: older print sources continue to be used where collections remain accessible. The point is not that the Internet erased the past. It is that digital discovery changes which past is easiest to encounter. Recency expectations then operate on top of a record already shaped by survival, documentation, digitization, indexing, and access.

A lost lineage is more than a missing citation

I see the same pattern in other areas of practice – one that hits close to home for me is with hospice and end-of-life care. In the 1980s Kent Tigges and Bill Marcil did groundbreaking work on occupational behavior in terminal and life-threatening illness. Their work examined occupational history and roles, how illness disorganizes and reorganizes daily life, and the meanings of action, identity, and participation when time and capacity are changing.

Over the last 5-10 years I see doctoral students doing capstones on “the role of OT with the dying,” often as though the profession is encountering the question for the first time. The students are not at fault; their work may be thoughtful and useful. The loss is that the question can reach them stripped of its lineage - and with it, the richer theoretical and practical content developed by those who had already taken the question seriously. Sometimes that loss is presented as innovation. OT’s work with dying people can be recast through a fashionable identity like “death doula,” as though a new label were needed to make the contribution visible. The problem is not that students explore new roles; it is that the new label can eclipse the occupational-behavior work already done and the depth of what it understood.

I don’t mean to make this a complaint about name recognition and citation. Although I think that the name in a reference list matters. The deeper loss is intellectual: ideas become detached from the contexts, people, and practice that gave them meaning. When a generation has to rediscover the territory without knowing who mapped it before, it may repeat the question while losing the substance of the earlier answer.

Who gets to say what OT is

This is the epistemic problem I want to bring to my upcoming NYSOTA talk. The Occupational Therapy Practice Framework organizes the profession’s present account of its domain and process. Every revision also raises questions of authority: Who is in the room to say what OT is? Who is there to say what OT was? Which experiences count as evidence? Which theories and practices are carried forward, and which are left out because the people who knew them are gone, retired, undocumented, difficult to locate, or not invited into the conversation?

The same question troubles the way OT tells its founding story. If the familiar account is repeated mainly through Dunton and Slagle, while Hall and Barton were no longer alive to speak for themselves, whose version becomes the profession’s version? People with access to publication, committees, archives, and official histories can shape what later generations inherit. People who are absent cannot correct the record. Their work may be reduced to a name, an anecdote, or nothing at all.

A framework can organize knowledge. It cannot, by itself, preserve the conditions in which knowledge was developed or the people who developed it. That takes deliberate historical memory: records of programs, decisions, funding, practice, and the reasoning of clinicians and the people they served. Without that memory, a profession can retain its vocabulary while losing the substance that gave the vocabulary meaning.

The cost of starting over

I do not know how many hours, careers, or service opportunities have been lost to OT’s repeated rediscoveries. I do know what the cycle looks like. A service structure is built and then dismantled. Its work becomes hard to find. A new generation meets the same need and begins again by asking what OT might contribute. The theories that could guide the work have been detached from the people and settings that made them practical.

The result is inefficiency – but perhaps more importantly it narrows what the profession can imagine and explain. Rich, meaningful theoretical and practical knowledge is sent to the historical dustbin. Students start near the beginning. Clinicians must make old arguments again. Communities may go without services while OT rebuilds an account of its own contribution. The people who needed those services do not get the lost time back – so this is not just an argument for accurate histories.  This impacts people’s lives.

How much time is lost in rediscovery? There is no clean number. The losses are distributed across capstones that repeat old questions, programs rebuilt without their predecessors’ accumulated knowledge, and ideas that survive only in the memories of the people who did the work. That makes the cost hard to count - and easy to overlook.

My talk is titled “How Do We Know What We Know? The OTPF-5, Epistemic Authority, and the Responsibility of a Profession.” I want to ask what responsibility comes with deciding what counts as OT knowledge. If we do not keep track of our history, we will keep rediscovering theories without their roots, repeating practices without their accumulated wisdom, and losing the people who helped us understand why the work matters.

We may be fiddling while Rome burns, then trying to rebuild from whatever fragments happen to survive online. If OT’s future is to be more than another cycle of rediscovery, we have to preserve the profession’s memory - and the people, ideas, and services that memory contains.