e.

ì-14

THE RELATIONSHIP BETWEEN OCCUPATION AND HEALTH:

IMPLICATIONS FOR
OCCUPATIONAL THERAPY AND PUBLIC HEALTH

By
Ann Allart Wilcock

A thesis submitted to
The Department of Community Medicine
FACULTY OF MEDICINE
UNIVERSITY OF ADELAIDE
in fulfilment of the
requirements for the award of the
DEGREE of DOCTOR OF PHILOSOPHY
(Public Health)

APRIL, 7996.
 1l

TABLE OF CONTENTS
ABSTRACT
vll
STATEMENT OF ORIGINALITY...........
ACKNOWLEDGMENTS

CHAPTER ONE: INTRODUCTION

Aims, objectives and research questions..........
1
Auto-biographical information...............
.2
Research approach and method.........
...8
Background concepts
15
Health.....
15
Occupation.......
L7
Biological and socio-cultural integration...............
18
Outline of chapters..............
20

CHAPTER TWO: AN OCCUPATIONAL THEORY oF HUMAN NATURE

Introduction.
.29
Defining theory and theories of human nature .......2g
Defining occupation............... ......g1
Proposed occupational theory of human nature...... ...................39

Central concepts.. ..............44

Diagnosis and prescription...... .56
Three way link: survival, health, occupation
57

CHAPTER THREE: BIOLOGICAL CHARACTERISTICS AND CAPACITIES:

THE FOUNDATION FOR OCCUPATIONAL BEHAVIOUR
Defining capacity.. .61.
Evolution, structure, function of the brain.............., .62
Genetic variation in capacities............. .66
..67
69
Gender......... 72
Ontogenesis 73
Examples of particular capacities and characteristics....
74
Bipedalism 75
Hand function. ..77
 11r

Language. . ..8L
Consciousrî.ess......... 88
Creativity ,93
Sleep 99

CHAPTER FOUR: OCCUPATIONAL EVOLUTION

Introduction..........- .....106
Hunter-gathering.... 108
Agriculture. t22
Towns and city states.,..
Lrdustry.. 130
Post industry.......... L39
Functions of occupations.............. 1,46

CHAPTER FIVE: HEALTH: AN OCCUPATIONAL PERSPECTIVE

Defining health..... 1,49
Defining well-being................. 150
Physical well-being ...............154
Mental well-being L57
Social well-being 1.62
Well-being and incapacity........ 164
Well-being, occupation, brain and mind...... L65
Community and ecological well-being... t67
Holism..
Ottawa Charter for health promotion 172
Thesis definition of health. ..173
Health and occupation for hunter-gatherers....................... .174
Views of healing and health... 181
Biological needs: A mechanism for health.... 183
The concept of needs and drives.................... ...184
Three way role in health........ ...L87
Non-omnipotence.. 193
Socio-cultural determinants of health thro' occupation.... 195

CHAPTER SIX: ILL-HEAITH: OCCUPATIONAL RISK FACTORS.

Introduction............ .201.
Public health and medical science............ .202
 lv

Public health and occupational health....... .206

Occupational history of patterns of morbidity .207
Occupational structure and population size...,
Occupational irnbalance......... ............2t3
Occupational deprivation.. ............229
Occupational alienation .240
.248

CHAPTER SEVEN: THE GENESIS OF OCCUPATIONAL THERAPY

Introduction to occupational therapy.......... 252
Definitions.................. .253
Moral treatment .255
Industrialisation..... .261
Therapeutic occupations: a new start...... .263
Adolf Meyer...... .265
268
Feminism. ..269
Arts and Crafts Movement.... .270
Eleanor Clarke S1a91e.......... ,.274
Pragmatism............. ,.276
Education and philosophical base .278

CHAPTER EIGHT: OCCUPATIONAL THERAPY'S RELATIONSHIP WITH

OCCUPATION AND HEALTH
Introduction........... .28L
Medical model.. .282
.282
.286
Patronage 290
Professionalism ..291
Reductionism........... .292
Rehabilitation.......... 298
Adaptive nature 300
Occupation rediscovered........ 302
Health promotion............... 312

CHAPTER NINE: OCCUPATIONAT THERAPY AND PUBLIC HEALTH

Introduction...........
Occupational therapy examples. 327
 v

Occupational Approach. 332

Action-research approach.. 333
Exploratory phase.... 335
Education-awareness phase... 337

Social justice model...... 351

Community development model. 357
Ecological sustainability model. 360

Summative statements.... 369

LIST OF FIGURES AND TABLES

Chapter 2:
Figure 2.'l-,: Life expectancy chart 46
Figwe 2.2: Assæiation areas of the brain........ 50
Figure 2.3: Link between occupation, health and surviva1......................58

Chapter 3:
Figure 3.L: Theories of bipedal locomotion. ...................7 6
Figure 3.2: Early hominid adaptation to bipedalism........... ...................7 6
Figure 3.3: Overview of the evolution of 1anguage............ ..................85

Chapter 4:
Figure 4.L: Human evolution: positive feedback system........ ............109
Figwe 4.2: Possible significant changes affecting evolution.... ............111
Figure 4.3: Hunting and the evolution of society ............121,

Chapter 5:
Table 5.1: Comparison of 'physical fitness' and
'psychological fitness'.............. 158
Figure 5.1.: Mortality patterns of hunter gatherer populations..... L79
Figure 5.2: Needs: three way role to health.. 188
Figure 5.3: Occupational determinants of health & well-being .196
Figure 5.4: Health & well-being: occupational perspective........ 198

Chapter 6:
Figure 6.1: Determinants of ill-health. .21,4
 vl

Chapter 7:
Table7.l: Worcester State Hospital patient recovery
statistics.. 260
Figure 7.1: Outline of Dr. Neff's lectures. 264

Chapter 8:
Figure 8.L: Strengthening quadriceps.... ....296
Figure 8.2: Increasing range of movement.. ,...296
Figure 8.3: Managing uneven surface.... ....296
Figure 8.4: Work hardening ....296
Figure 8.5: Work skills... ...296
Figure 8.6: Leisure skills 296

Figure 8.7: Altemative self care skills .297

Figure 8.8: Mobility/balance practice.............. .297
Figure 8.9: Assessing potential to return to previous
employment .297
Figure 8.10: Revision of skills for new employment................... .297
Figure 8.1-1: Practicing public transport access .297
Figure 8.12: New emp1oyment............ .297

Chapter 9:
Table 9.1,: Overview of health models...... 343
Figure 9.L: World population trends.. 363
Figure 9.2: Feedback loop showing environmental
destruction via technological progress... 363

APPENDIX I: Well-being study.... ....373

APPENDIX II: Occupational Therapists views: health and occupation..........382
APPENDIX III: Occupational balance and health....... ........383
APPENDIX IV: Occupational Therapists views: health promotion..................392
BIBLIOGRAPHY 404
 vll

Abstract

This thesis proposes an occupational theory of human nature based on the

observation that all humans engage in occupation to survive, be safe, and meet
their needs for social approval and self actualisation. The core idea under
investigation is that engagement in occupation is, in evolutionary terms, a

central mechanism for health. In order to test the theory, the thesis scrutinises

ideas held about human biological capacities, occupational histov, and health.

The scrutiny supports the notion that health and engagement in occupation
are inextricably linked: however occupation is so much a part of everyday life
that this relationship is hardly acknowledged. In addition, it is difficult to
consider the purpose and meaning of occupation, or it's relationship to health,

in an holistic way because occupation has been arbitrarily divided into work,
pIay, leisure and rest, particularly within post-industrial societies. The

exploration, using a history of ideas approach, reveals that health outcomes,

either good or bad, can be traced to occupational determinants such as the type

of economy, governmental policies, and societal values such as the 'work

ethic'.

Following an exploration of health and illness from an occupational

perspective, the position of occupational therapists as agents for promoting
health according to their view of occupation is considered. An account of the
profession's genesis makes it clear that its basic philosophical stance is

congruent with World Health Organisation and 'New Public Health'

ideologies. Despite pressures throughout its development to conform with the
medical model, occupational therapy has emerged with a strong commitment
to research and practice based on it's distinctive view of occupation and it's
centrality to health and well-being.
 vrll

An occupational therapy approach to public health is postulated based on

action-research. Five models of health promotion, 'wellness', 'preventive
medicine', 'social justice', 'community development' and 'ecological
sustainability', are discussed to illustrate the breadth of an occupational
approach to 'public health'. Strong recommendations are made for
occupational therapists to implement an occupational approach within public
health.
 x

Acknowledgements.

My sincerest thanks go to

Dr Neville Hicks, Reader, University of Adelaide, for patient persistence in

developing my scholarship, for enrichirg -y ways of thinking, and for
ongoing interest and support as my supervisor,

My husband, Derek, for his care, encouragement, time and practical help in
lay out and presentation,

]an Heath, Library Liaison Officer, University of South Australia, for years
of help in finding material, and tracing references, and Peter Newnham,
Librarian, University of Adelaide,

Bob Hall, Senior Lecturer in Mathematics, University of South Australia for

his assistance and advice in statistical matters, Dr Matt Gaughwin, for his
advice on'evolution', and Dr A.D. Hunt for his clarification of theological
history,

Professional colleagues, from throughout my career, who have contributed

(in many ways) to my work and ideas, particularly, |anet Crowe, Mary S
|ones, P.ggy lay, Betty Maclntyre, Rosemary Donald, Howard Johnson,
]osephine Moore, Betty Yerxa, Florence Clark, Joyce McKinnon, Helene
Polatajko, Loretta do Rozario, Gail Whiteford, and Kerry Thomas,

Cecilie Bearup, for her caring support and for proof reading,

Work colleagues at the University of South Australia who have shared my

ongoing struggles, enthusiasms, frustrations and development, P"ggy
Farrow Bradley, Christina Boerema, Chris Chittleborough, Pam Dean,
Catherine Delin, Maureen Foale-Towell, Sue Hunt, Brenton Kortman,
Esther May, Beth McMillen, Susan Pettifer, Netta Russell, Mandy Stanley
and Penny Westhorp,

Students at the University of South Australia who have worked with me

on research projects, and those who have shared my interest in the
development of occupational science.
 Chapter L

Introduction

This thesis explores the relationship between occupation and health, how
this relationship is addressed by occupational therapists, and its importance to
public health. Throughout the thesis the word 'occupation' is used to mean
'all purposeful human activity'.

Four particular questions are addressed; namely the importance of

occupation in human life, occupation as a positive influence on health, the
potential of occupational therapy to be a health promoting profession, and the
compatibility of occupational therapy with current public health and World
Health Organisation (W.H.O.) objectives. The beneft,:li greater emphasis on
the relationship between occupation and health may yield are discussed, with
the recommendations that there should be greater recognition of the potential
role of occupational therapists in programs initiated by primary health care

and public health organisations.

The exploration, which has led to the development of an occupational view

of human nature and health, was prompted by documents from the W.H.O.
and the Better Health Commission of Australia which called for an acceptable
level of health for all by the year 20001. These documents stressed the need
for the reorientation of all health professions towards the pursuit of health.

For each profession particular perspectives of health and illness are somewhat
different, and for each professional there are also slight differences according
to underlying beliefs, values and experiences. Nevertheless, there is scant

lWorld Health Organisation. Primary health care. Repoft of the intemational conference on
primary health care. ALma Ata. 1978; Better Health Commission of Australia. Looking
fortoard to better henltlt. Canberra: Australian Govemment Publishing Service, 1.986.
Chapter 1: Introduction ,

acknowledgment that basic ideas about what health is may not be constant
between professions or within the general population. There is therefore

little appreciation that, in order to meet professional, community and

individual goals, health care workers, including occupational therapists need
to be able to define clearly what they, their clients, and the communities they

serve understand by health and illness

This in no way implies that a standard definition is required by health

professionals. In fact, because ideas about 'health and well-being' do differ
between individuals, communities, professions, societies and cultures, it is

important to search for factors common to the experience of 'health', and for
those which may have been overlooked. It is also necessary that occupational

therapists, along with other disciplines, should be able to describe clearly their

profession's particular views, and their own underlying views and values.
Such clarification is also necessary for the researcher, so, a brief history of my

own personal and professional orientation is included, (as is common practice

in qualitative research), prior to discussion about the focus of the thesis.

I trained as an occupational therapist in England between 1958-6'J,, where

training was based on physical and mental health care concepts according to
the medical model2. A commitment to and interest in rehabilitation,
established during the second world war, was still dominant w-ithin this
model. Students leamed about anatomy, physiology, psychology, medical,

surgical and psychiatric disorders, along with practical training in numerous

occupations such as woodwork, weaving, recreation, dance, household,

2 An e^ample of the influence of the medical model on occupational therapy at that time is
provided by the following quote:
"Ocatpational therapy is the term giaen to the use of actiaities of many kinds, medically
prescribed, for the distinct purpose of contributing to recoaery from disease or ínjury, or for
the maintenance of fimction when complete recoany is not possible. lt is directed to ultimate
re-establishment of the patient in home and employment, or in uork or recrention under
sheltered conditions"
MacDonald EM, editor. Occupational therapy in rehabilitation 2nd ed. London: Bailliere,
Tindall and Cassell, 7964, p.2. (1st edition, L960).
Chanter 1: Introduction 3

gardening and process work to a level of competence enabling graduates to

teach or use these in the treatment of patients. The relationship between
these occupations and health was hardly considered in philosophical terms,
and theoretical considerations were directed to the prescriptive use of
occupation to remedy physical, mental and, occasionally social, disorders. In
common with educational practices of the time, information sharing was
didactic and authoritarian, rather than participatory, so that the teaching and

learning environment did not, on the whole, encourage questioning or self

directed study. The result of this mix was an occupational therapist
competent to practice within a wide range of medical services, with a strong
belief in the efficacy of occupation to influence health status, but little ability
to articulate a rationale for this belief. This latter factor made it difficult to
defend the value of occupation to health when medicine adopted an
increasingly reductionist, 'scientific', and technological stance from the late
nineteen sixties onwards.

This difficulty did not result, in my case, in a decrease of belief in the

efficacy of occupation's influence on health because experience had provided

strong empirical evidence that this was the case. Experience had also

broadened of health to incorporate the notion of maximising

concept
^y
individual potential and well-being. Four case histories which I experienced
illustrate the point.

In \96t, Harriet was a forty five year old lady who had been
disabled with rheumatoid arthritis from her late teens. She was
unable to sit at all, spending her time lying in bed, or standing for
brief periods, having reached this upright position with the
mechanical aid of a tilting mechanism. She had minimal
shoulder, elbow and finger movement, to the extent that she
could not touch her face, feed herself without aids, or attend to
even simple self care. Because of this restricted mobility, and
tremendous pain, throughout her adult life she had suffered
gross occupational deprivation. During the course of our
professional association she mentioned, by chance, that she
envied those who could paint, and by inference that this, for her,
Chapter 1: Introduction 4

was beyond the realms of possibility. As this was before the days
of rehabilitation and education aid catalogu€s, much to her
surprise a 'Heath Robinson' device , which enabled her to paint
tiny areas of a pre-drawn canvas, was concocted and set up across
her bed. With a master painting to follow for colour, she
completed piece by painful piece, a small landscape, which to her
was the equivalent of a 'Constable'. There is no way to describe
her joy as she went on to her next masterpiece, or the
disappointment she expressed in a letter she wrote after a move
to another treatment facility where she was unable to continue
her new found occupation.

Two men, in their thirties, lived, more or less permanently, in

hospital following spinal injuries which left them quadriplegic.
The first, Peter, it was reported, had had an unusual and
deprived childhood, brought up in an institution with
intellectually handicapped children following abandonment as
an infant. As a result he had experienced minimal education,
and poor job opportunities. Following his accident Peter was
taught by an occupational therapist to do tapestry embroidery, in
which he became very interested, and skilled. He entered and
won competitions in local shows, and became a local celebrity as
a result. He regularly glowed with well-being following his
occupational achievements being recognised and applauded. The
other man, David, supplemented his pension by making simple
carpentry objects on commission. He was introduced to wood
turning, on an electric lathe, which was initially a challenge but
which became an ongoing and absorbing occupation. Many years
later I was able to visit David, unexpectedly, and thought he
didn't remember me. His response -"How could I forget the
person who introduced me to wood turning. Now look under
the bed and pull out the box. I am working on clock faces at the
moment!"

Sharon was seventeen when her nightdress caught fire. She was
badly burned over her face, neck, chest, arms and hands.
Ultimately she lost several fingers, and suffered facial
disfigurement. At first meeting, early in the medical and
functional restoration process, it was obvious to her that she
would be unable to follow her previous long term plan which
was to join the armed forces. To provide greatest choice for her
future it was suggested that she could, if she wished, use the
years of treatment as a time to rebuild her future. She chose to
undertake external matriculation studies between bouts of
surgery. It was hard work, and took a long time, but resulted in
entry to university, and successful graduation into a profession.
This course of action facilitated a new way of life and enabled
Sharon, despite physical loss to utilise capacities which had
previously been untapped.
Chapter 1: Introduction 5

These examples of people, who despite residual disability, were enabled to

reach higher levels of well-being through maximising untapped potential led

me to a belief in 'growth models of health' advocated by psychologists such as

Maslow. Ideas based on this belief are central to the notions about occupation
and health discussed in this thesis.

I became aware of other important health related functions of occupation

through four years experience in a small acute psychiatric unit as the sixties
gave way to the seventies. This unit was run as a therapeutic community
which used the community's social processes as treatment for those admitted.
The strategies included group therapy, in which feedback was given on

individual behaviour by others in the group; encouragement of frank

expressions of thoughts and feelings about the here and now, and peer group

pressurd. Group therapy was not restricted to discussion, but included action
and community occupation4. The idea upon which the seven day a week
occupational therapy sessions was based was that when people are 'well', and

are together in a group, they formulate plans quite quickly for how they will
spend their time together, and having decided on a course of action will
engage in what they have chosen to doÞ. Therefore the program planners
held a positive and stated expectation that members of the group would spend
two to three hours each morning together in what was known as 'the
practical relationship room', and that they would engage in group activity of

their choice. The staff's role was to encourage such activity but not to initiate
ir.

3 L"r'y BS. Therapeutic Community. ln: Kuper A, Kuper J, editors. The social science
encyclopedia. revised ed. London: Routledge, 1989.
4 For interest, see: Friedland J, Murphy M. A group approach in psychiatric occupational
therapy. Canadían journnl of ocaryntionnl therapy 7965;32:109-118; ShannonPD,SnortumJR.
An activity group's role in intensive psychotherapy. The American journnl of ocatpntional
therapy 1,965;20l-68-71; Mumford MS, A comparison of interpersonal skills in verbal and
activity groups. The Anterican journal of occupational therapy 7974;28:287-283.
5 ¡ohnson H. Psychiatrist, Shortland Clinic, Royal Newcastle Hospital, professional
communication, 1968.
Chapter 1: Introduction 6

What happened in these sessiolìs was, of course, a major topic for

consideration in other parts of the program. What did happen for sometimes

days, weeks even stretching, occasionally, into rnonths, was often very little in
the way of group occupation but a great deal in terms of difficulties

experiencedby members of the group in initiating occupation. Staff

discovered many ways to encourage activity, often tapping unexpected
capacities in themselves in their efforts to overcome occupational deprivation

resulting from the patients' lack of mental health. It was a difficult role for
staff who tended, erroneously, to equate the patients' reduced engagement in
purposeful occupation as a reflection of their own techniques being
ineffective, and themselves had to contend regularly with their own
frustration as well as the extremely demanding work of helping the patients
explore what was happening. As this challenging process was worked
through the patients eventually arrived at a state in which their drive for
occupation was restored. It usually occurred for most of the group at about
the same time, and resulted in some dynamic, exciting and different activity.
We held art shows, made movies, built brick barbecues, and even 'group'
knitted with 'group'-turned ten foot long knitting needles. Completion of a

major community occupation was almost a signal for discharge: health, well-
being and occupation appearing to be inseparable, just as lack of health had
resulted in poverty of occupational engagement6.

These experiences made me reflect about the purpose of occupation in

human life, and on the apparent close association between mental health and
occupation.
My more recent experience has concentrated firstly on neurological

rehabilitatior{, with some time spent undertaking post graduate study in

6 Wilcock AA. Shortland clinic memoirs. Unpublished document written at the time of transfer
to another post, 1972
Twilcock AA.Ocaryational therapy approaches to sfroke. Melboume: Churchill Livingstone,
7986.
Chapter 1: Introduction 7

neuropsychology at Flinders University with Professor Genna Geffen, whose

work on dichotic listening is well knowns, and Dr Mike Wood, whom I was
able to observe using a wide range of neuropsychological tools to assess clients

with central nervous system damage. A principle text recommended by these

authorities was Kolb and Whishaw's Fundamentøls of Human
Neuropsychology, which still contains material relevant to many of the

issues addressed heree. úrterest in neuro-sciencehas led to an appreciation of

the role of the central nervous system in all aspects of human life, including
the promotion of health, and in understanding humans as occupational

beings, because as Edelman ProPoses

"ln the course of eaolution, bodies cøme to høae minds. But rt is

not enough to say that the mind is embodied: one must say hoztt. To
d o that we haae to take a look øt the brain and the neraous system
and at the stntctural ønd functionøl problems they present"\0

A second major interest has been in public health and health promotion,

influenced by studies undertaken towards a masters degree in public health at

the University of Adelaide, which introduced me to the concepts of social

medicine and social health.

My interest in studying the occupational nature of humans was precipitated

by the emergence of a new generic discipline - namely occupational science.
This sparked, for me, a professional 'revelation' of the need to understand,
more fully, the apparent human need for occupation as a basis for the practice

8See, for example: Geffen G, Traub E. The effects of duration of stimulation, preferred hand and
familial sinistrality in dichotic monitoring. Cortex 1980; 16 (1): 83-94; Geffen G. Reliability
and validity of the dichotic monitoring test for language laterality. Neuropsychologia 198L;
I9(3):4ß-a23; Geffen G, Reynolds M. Pure-tone perception and ear advantages in dichotic
listening. Perception and psychophysics 7982;31 (1): 68-74; GefÍen G, Quinn K. Hemisheric
specialiiation and ear advantages in processing speech. Psychological bulletin I98a; 96(2):
ùg-Zgt; Geffen G. The effects of orientation and maintenance of attention on hemispheric
asymmetry for speech perception. Cortex 1988; 2a(4: 255-265.
9 folb B, Whishaw lQ.Fundamentals of human neuropsychology.Srd ed. San Franscico: W.H.
Freeman and CompanY, 7990.
10 Ed"I*ut G.Bright air, brilliant fire: On tlrc matter of the mind.London:PenguinBooks,l.992,
p.15.
Chapter L: Introduction I

of occupational therapy. Occupation, to date, has received little attention

within the conventions of medical scientific inquiry. Those who have
considered it have usually regarded aspects of occupation as observable
human behaviour which can be used as a surrogate measure for other criteria
they wish to research. In recent years occupational therapists, prompted by
the work of Mary Reilly at the University of Southern Califomia(USC) in the

I960s, have begun to develop an interest in the study of human occupation in

a holistic sensell, but Dr Elizabeth Yerxa from USC was most responsible for
the 'naming and 'framing'of occupational science as the study of humans as

occupational beingsl2. Lrterest in this new science has culminated for me in

the bringing together of a history of ideas surrounding the relationship
between occupation, health, public health and occupational therapy.

This thesis therefore has the character of an exploration based on

observations and reflections of professional experience in clinical practice and
education in occupational therapy and the health care system over three
decades. The rationale for this approach is an appreciation that every Person

holds a view of human nature formed as a result of life experiences and

extensive and on-going contact with people, cultures and communities. This

provides an often unacknowledged source from which to draw a theoretical

model.

Flowever, developing a perspective centred on humans as occupational

beings is particularly difficult because occupation is such an integral part of

life, and of already accepted, but different, perspectives on life. To rethink
issues from this different, yet familiar, focus demands that "the ways of

11 See, for example: Reilly M. The education process. The American journal of occupational
therapyLg6g; 23:299-307; Kielhofner G, editor. A model of human occupation.Baltimore:
Williams and Wilkins, 1985; Christiansen C, Baum C, editors. Occr.ryational therapy:
oaercoming human perþrmance deficits. New fersey; Slack lnc., 1991.
12 Ye.xa EJ. Occupational science: A source of power for participants in occupational therapy
lournal of occupationnl science: Australia,1993; 1(1): 3-10.
Chaoter 1: Introduction 9

thinking which seem so natural and inevitable that they are not (usually)
scrutinised with the eye of logical self consciousness" be identified and
analysed, and following scrutiny, re-synthesisedl3. Even a background in
occupational therapy has not foreshortened, for me, the development of a

sense of competence in processing problems from an occupational viewpoint.

Despite the difficulty, at a global and political level, in rehabilitation, in health

care general|y, in education, and for 'social' problems, tentative ideas from

this perspective have broadened my ways of looking at vexed problems such

as ecological degradation, paid employment, resource allocation, 'street kids',
or the destructive behaviour of youth gangs, which appear to be unresponsive
to present initiatives formulated within the context of primarily 'market

economy' or'social' perspectives.

Another difficulty encountered when trying to formulate approaches to

study this perspective is the prevailing reductionism of traditional scientific

methods. Human engagement in occupation is complex and varied and

almost impossible to measure according to methods which are essentially

reductionist and contextually controlled. To reduce engagement to

component parts would, on the whole, diminish its study as it is the
integrated complexities of engagement which require the most rigorous
explorationla. Indeed, the complexities of human characteristics and the

variety of occupational environments are often seen by traditional

experimental researchers as contaminants to research designls. Gergen, a
social psychologist, is one of many who criticise using traditional science
methodology for studying human beings, because techniques do

13 Love¡oy AO. The study of the history of ideas. 1936. In: King P, editor. The history of idens.
London and Canberra: Croom Helm. 7983'p.182.
14Yer^a EJ, Clark F, Frank G, Jackson J, Parham D, Pierce D, Stein C, Zemke R. An introduction to
occupational science: A foundation for occupational therapy in the 21st century. Occupational
therapy in health cnre 7989;6@):1-17.
15 Y"rru EJ. A Mind is a Precious Thiog. The Austrnlian ocarpational therapy journal 1990;37
(4):170-777.
Chapter 1: Introduction 10

decontextualise, are atemporal and deterministic and lead to inadequate and

distorted findingsts. Open minded consideration of different research
methodologies, such as those used in developmental and social psychology,

anthropology, sociology,history and evolutionary biology which study people

contextually, view their activities diachronically, and recognise individual
will, are more suitable as a means of buildit g a knowledge base for a science
of occupationlT. Additionally, methods advocated by critical social scientists
as appropriate for interdisciplinary research about the "conditions which
make possible the reproduction and transformation of society, the meaning of

culture, and the relationship between the individual, society and nature" are
valuable to consider as tools in understanding the occupational nature of

humans18. This thesis asserts that a synthesis of ideas from a wide range of
disciplines is required for the broad issues being explored, therefore the

exploration takes the form of a history of ideasle. The next few pages discuss
the research approach.

The term 'history of ideas' was advanced by Arthur Lovejoy in the 1920's to

cover study approaches which centre on concepts, and how changes in their
meaning and associations alter according to history2o. Lovejoy proposed that
the task of the history of ideas is to

"attempt to understønd how neu) beliefs and intellectualfashions are

introduced and diffused, to help to elucidate the psychological
character of the processes by which changes in aogue ønd influence
of ideas haae come øbout; to make clear, if possible, how conceptions
dominant, or extensiaely preaalent, in one generation lose their
hotd upon men's minds and giae place to others"2r-

l6c"tg"trK.Touards trnnsþrmation in social knowledge. New York: Springer-Yerlag,L982.

17 y.truEJ, et al. An introduction to occupational science, A foundation for occupational therapy
in the 21st century...
18 n"ld D. Frankfurt School. ln: Bottomore T, editor. A dictionnry of Marxist thought. 2nd ed.
Oxford: Blackwell Publishers, 1997, p209.
19 Lovejoy AO.Essays in thc history of idens. Baltimore: The fohns Hopkins Press, 1948.
20 Burke P. History of ideas. ln: Bullock A, Stalleybrass O, Trombley S, editors. Tfte Fontana
dictionnry of modern thottght. London: Fontana Press, 1988, p.388.
zlLoveioy AO. The study of the history of ideas... pp.779-194.
Chapter 1: Introduction 11

He described, as a maior part of this research method, the viewing of ideas

"fronì. the standpoint of a particular pu{pose", made possible by considering

and dividi.g "i. great part...the same material as the other branches of the
history of thought", so that "new groupings and relations" emerge. He
argued for the history to be concerned with "ideas which attain a wide

cliffusion, which become part of the stock of many minds", which "disregard
national and linguistic boundary lines", and cross barriers between different
disciplines and thinking, so demonstrating that ideas which emerge at any
one time usually manifest themselves in more than one direction.

The particular purpose of this thesis is the exploration of the meaning and
associations between concepts of and health, within the
occupation
framework of an occupational theory of human nature and in relation to

occupational therapy and public health. It does so by grouping and relating

already 'known' thoughts and facts in a different way, contending that the
concept and meaning of occupation and of health has changed with
occupational technology and subsequent socio-cultural evolution, ideas and
expectations. This thesis reviews material from other disciplines, from
several cultures, and from ideas and artefacts of 'the people', as well as known
'experts' in a new light from the standpoint of the proposed occupational
theory. Like other histories of ideas it "aims at interpretation and unification

and seeks to correlate things" which in our present structures and

reductionist ways of thinking may appear unconnected. "At first glance" it

may appear, as other historical inquiry sometimes does, to be "a strange
combination of incongruences: general but detailed; straight forward but

intricate; pragmatic but abstract", and because it tells a story, the rigour of the
research effort is easily overlooked22.

22 Hamilton DB. The idea of the history and the history of ideas. lmnge: lournal of nursing
scholarship 7993;25 (1): 5-a8.
Chapter 1: Introduction 72

The history of ideas approach taken here can be viewed as both critical
research, and as a method of developing theory, in a way similar to grounded
research23. Immersion and saturation in relevant, but broad ranging,

literature, is a valid method of discovering how others have viewed the

issues which are the subject of this inquiry. Literature is the major source of
data. Analysis occurs as critical reading and reflection trigger understanding
of the data. Hypotheses, definitions, and new ideas emerge as the research
progresses, so that the direction of the study is a dynamic and changing
process. For example I presumed quite early in the exploration that humans

have always engaged in occupation, then realised that I had to discover if this

was generally held to be so. to a voyage of discovery through

This led
evolutionary texts, to anthropology, sociology and philosophy, to ethology,
socio-biology, genetics, labour studies, psychology, ecology and Neural
Darwinism, and in no place did I find a direct answer to my queIy.
Engagement in occupation is so fundamental it is taken for granted. As I
ploughed backwards and forwards through these, as well as texts from other
disciplines, issues emerged and fresh connections were made. Ideas

disregarded at one stage became important at a later stage. As immersion led

to saturation, themes and, eventually, hypotheses developed. For Íl€, the

history of ideas process also facilitated a'critical' viewpoint because it enabled

me to look at the world through a different lens. It generated a belief in the

need for political and social change to improve occupational experience,

health and well-being, along with sustaining the ecologY, and the need for
occupational therapists to become social activists has become an unexpected
focus of parts of the thesis.

23clut". B, Strauss A. The discoaery of grounded theory: strategies for qualitatiue research.
New York Aldine,7967.
Nof a Different researche¡s have suggested several stages of analysis in grounded theory
which include category development and saturation, formulating abstract definitions, and
using definitions and categories, by linking, testing and connecting them with existing theory;
See, ior example: Field P, Morse I.Nursing research: The application of qualitatiae
approaches. Rockville, Maryland: Aspen, 1985, pp.109-1.13; memoing, sorting and coding
memos to produce an outline and discovering overriding analytic schemes . See, for example:
Wilson ¡lS.Resenrch in nursing. Menlo Park, Califomia: Addison Wesley,1985, pp.415422.
Chapter 1: Introduction 13

The writing was also an essential aspect of the research process. As Laurel
Richardson suggests, writing can be "a way of 'knowing' - a method of
discovery and analysis". She argues that even within qualitative research the
scientific paradigm has blanketed creative and expressive writing which is a

part of the act of discovery. This has led to boring texts about riveting topics,
and to important research being little read. Historical research, il:t contrast to
most other forms of qualitative work, depends upon the quality of a reasoned
argument or interpretive dialogue, which is considered of more importance
than particular methodological steps or stages which are in accord with

scientific conventions24. Learning this art even to my current novice level,

has been the most difficult part of this exploration'

Histories of ideas carry another risk apart from misunderstanding of the

nature, depth and rigour of the exploration and analysis:

"Because the historian of an idea is compelled by the nature of his

enterprise to gather materiøl from seaeral fields of knowledge, he is
ineuitably, in at leøst some parts of his synthesis, Iiable to the errors
which lie in wait for the non-specialist"25.
For this reason I have made use of secondary and tertiary sources of

information as well as referring to primary works. Primary sources of

literature are generally considered preferable, but secondary sources which are
accounts "reacting to the ideas of a primary author" can further illuminate
the original ideas and point the novice towards new or different sources of
evidence. Tertiary sources, such as current books and articles, are also useful
for suggesting lines of inquiry, and acquaint the researcher with other

historians viewpoints. The story, which emerges from this process, though,

24 Richardson L. Writing: A method of inquiry. pp.576-529. In: Denzin N, Lincoln Y, editors.

Handbook qunlitatiae research. London: Sage,7994'p.522.
"f
25Love¡oyAO.Essays in the history of idens..'p.795.
 '1,4
Chapter 1: Introduction

must open up "new avenues of investigation, criticism and reflection not

simply recreate another authors interpretation of the past"26.

Relevant material for this research is wide ranging, from works pertaining

to those disciplines noted earlier, as well as human anatomy and physiology,

public health and health promotion, archaeology, occupational evolution,
philosophy, economics, and research which considers occupation or relates to
the human need for occupation. The latter required an extensive 'meta-
review' of occupational therapy joumals and texts, viewing historically and
collectively, rather than in the a-historical, sequentialist way in which journal
articles are necessarity published. For enquiry outside the health field I found
specialist dictionaries and encyclopaedia, such asThe Cambridge Encyclopedia

tf Human EuolutionzT, Tom Bottomore's A Dictionary of Marxist Thought2s

and Kuper and Kuper'sThe Social Science Encyclopediaze,to be useful as first

ports of call for new lines of inquiry as they emerged. Electronic searches were
used for particular topics such as sleep, alienation, well-being, community
development, bipedalism, deprivation and so on, although only a fraction of
the available material could be used to illustrate the arguments being

pursued. Choice was made according to my interpretation of their relevance

to the questions being explored and to the importance given to a particular
point of view by other historians, scientists, time or culture, all within the
confines imposed by u huge amount of material - so vast a topic has this

proved to be.

26Humilton DB. The idea of the history and the history of ideas...
27¡ones S, Martin R, Pilbeam D.The Cambridge encyclopedin of human a¡ohttion. Cambridge:
Cambridge UniversitY Press, 1992.
2SBotto*o.e T, editor. A dictionnry of Marxist thought. 2nd ed. Oxford: Blackwell Publishers,
\997.
29Krrp"r A, Kuper |, editors. The social science encyclopedia. revised ed. London & NewYork:
Routledge, 1989.
Chanter 1: Introduction 15

Because the topic is so broad ranging, mention is made of many issues or

themes which, to do them justice, could be expanded. Flowever, I have had to

be content with raising them as relevant, and choosing to provide some
lengthier, but still brief, discussion on a few outstanding examples, as in
chapter 4, where a number of particular human characteristics or capacities

are examined, or the several times the ideas of Konrad Lorenz or Karl Marx
are raised. I did not set out expecting to include Marx as I knew little of his

work. I have been continually surprised to find how similar are many of his
concepts, particularly of his early humanist period, to those of occupational

scientists and therapists.

I have also supported some of the central or emerging concePts with ideas
which arose out of many small empirical studies which I conducted, mainly
utilising questionnaires, employed with a variety of people from the
community, as well as occupational therapists and students. The sampling
employed in these differed. One study used random sampling, others cluster
sampling, and still others, total populations in particular situations, such as

students or participants at a seminar or conference. Questionnaires were also

used in a pilot study which accessed a convenience samPle of people known

to the group of students taking part in the research. All of these studies were
exploratory in nature, seeking to expand understanding of the relationships
between health and occupation, and beliefs, values, perceptions and ideas that
people, including occupational therapists, hold about this relationship. Some
of these studies are reported concisely in the appendices.

Having discussed the way in which this research was conducted, a few
important concepts need to be introduced about health, about occupation and
about biological and socio-cultural approaches to studying health and
occupation, which provide a backdrop to the study: all are revisited later in
the text.
Chapter 1: Introduction t6

Firstly, in seeking to clarify people's beliefs, values, PercePtions and ideas

about the relationships between health and occupation/ it is important to

recall that in present times, in post-industrialised societies, health care,

including public health, is dominated by medical science. This is based, in the
main, on contemporary understanding of physiology, biochemistr/, pathology
and bio-statistics, and societal acceptance of modern technological surgical and
pharmaceutical advances. Medical science values are so integral to post-
industrial culture's thinking it is difficult for those brought uP in such a
society to perceive health from other than a medical science perspective. To
some extent this limits the study of health to ideas, beliefs and approaches
which are valued, advocated and deemed important by medical science.

Even the growing behavioural-health, social-health and health science

professions, different and distinct from medicine, are still influenced by

medical science values and perspectives, in that they challenge or utilise

medical science categories and theories, accept many medical science priorities
and are concerned with strategies to diagnose or analyse, reduce or prevent
illness resulting from physical, behavioural or social factors. Because of this

emphasis the major preoccupation in health research is to uncover the causes

of ill-health and disease. Notwithstanding the holistic philosophy of the

Ottawa Charter for Health Promotion which has been adopted by the'new
public health' movement30, health research remains preoccupied with
reducing the incidence of ill-health at the expense of detailed exploration of
the of good-health and well-being. Recent interest in social
causes
d,eterminants of health, health promotion and 'wellness' has centred to a
large extent on the prevention of illness, many people using the terms

30 World Health Organization, Health and Welfare Canada, Canadian Public Health
Association.The Ottnzua Charter for Health Promotion. Ottawa, Canada:1986. For insight
into the 'new public health' see, for example: Ashton f, Seymour H. The new public health:
The Liaerpool experience. Milton Keynes: open university Press. 1988
ChapterL: Introduction 7.7

'prevention' and'health promotion'synonymously. Preventive aPProaches,

which dominate health promotion just as medicine dominates health care,
generally take for granted a medical science explanation of the cause of disease
and the mechanisms for prevention.

The 'new public health' is also influenced by a post-industrial debate

between the values of economic rationalism and social equality. Caught
between the presumptions of medical science and the debate about social
values, public health has largety failed to consider how basic human needs
relate to health, unless the 'needs' can be reduced to obvious physiological

functioning or monetary terms. Rather like 'instinct theory', the idea of

human needs is unfashionable and to a large extent ignored, being associated
with "naturalistic fallacy"3l and out of step with the dominant notions of
behaviourism and cultural relativism. This stance ignores the needs and
potential of humans which are part of their 'hard-wired' neuronal structure,
and. as Doyal and Gough maintain in their award winning book A theory tf
human need,even if, as is their view, needs are notidentical with drives or a

"motivational force instigated by u state of disequilibrium...neither are they

disconnected from'human nature"'.
,'To ørgue
for such disconnection would be to identifu humanity
with no more than human reason ønd to bifurcate human existence
from thøt of the rest of the ønimal world."3z
It is argued here that health is related to the meeting of biological needs and
potential; to learning "how nature intended human beings to live" S3; and
that the needs of any living organism are related to health from the point of
view of "how a specimen" of that kind of organism "can be recognised as

flourishin g"34 .

31 Wutt, ED. Human Needs. In: Kuper A, Kuper j, editors. T/re social science encyclopedia'.'
p.367.
32 DoyuLL, Gough I. A
theory of lutmøn need. London: MacMillan, 7997, pp.35-36.
33 CoonCS. The hunting peoples.London: fonathan Cape Ltd, 7972, p.393.
34 Wuttr ED. Human needs. lnl The socinl science encyclopedia.'. p.368.
Chaoter 1: Introduction 18

Secondly, this thesis holds that humans have 'occuPational needs' which
go beyond the instinctive patterned behaviours of many other animals, and
that these needs are related to health. In fact, they are the species' primary
health mechanism, motivating the provision of other basic requirements as

well as enabling individuals to utilise their biological capacities and potential,

meet socio-cultural expectations and thereby flourish. The adaptive capacity
of the human brain allows the innate drive for purposeful activity to respond
to cultural forces and values which add a social dimension to the relationship
between occupation and health. The thesis explores health from an
occupational perspective by considering how biological and socio-cultural
needs influence each other.

Although in recent times occupation, in it's own right, has not been a focal
point of study, socialist reformers, in England and Europe who recognised the
value of human labour, and pragmatist philosophers in the United States of
America in the late Lgth and early 20th Centuries, did recognise the centrality
of to life. Since then sociology, economics, technology and
occupation
medical science have so dominated thinking that occupation has been
considered from these perspectives rather than in its own right. It is
interesting to note that socialist and pragmatist recognition of the importance
of occupation in life grew from the results of huge social change from a

technology of human labour based on agriculture to one based on industry,

and that occupational therapy originated as a result of this occupational
interest. The current resurgence of interest in occupation by occupational
therapists may well be a response to a particular need to re-consider human

occupational requirements afresh at another time of change.

Thirdly, in order to understand health and occupation both biological and

cultural issues require exploration. This history of ideas focuses on
Chapter 1: Introduction t9

combining two different approaches - an evolutionary, biological aPProach

and a modern culture concept approach. This is not an unusual combination
for occupational therapists, although it is uncommon for biological and socic
cultural determinants of human behaviour to be studied in tandem in the
present day.

This exploration of the innate evolutionary aspects of health and

occupational behaviour and those determined by experience, learning and
cultural evolution, involves ideas similar to those of modem ethologists
seeking to discover, amongst other ideas, the survival function of the
behaviour under study. Ethology has emerged over a period of around 75

years, the term having been initially applied in a variety of contexts,

overlapping at one extreme with ecology and at the other with psychology3s.
The current view of ethology that behaviour demonstrates the interactions
between the inborn, natural aspects of behaviour and those determined by
experience and learning, contrasts with the 'ultra-environmentalism' of

modern anthropology and sociology36. Durant argues that the "idea of innate
character in animals (and man) was central to the work" of Konrad Lorenz37.

Lorenz (L903-89), an Austrian zoologist, who explained ethology as the Process

of examining:
"animøl and human behaaiour as the function of øsystem owing its
existence, as well øs it's special form, to a deaelopment process thøt
has taken place in the history of the species, in the deaelopment tf
the indiaidual nnd, in man, in culturøl history" 3e.

In line with Lorenz's perspective I consider prehistoric occupational traits

alongside 'natural' health behaviours of early hominids, before they were

35 Durant JR. Innate character in animals and man: A perspective on the origins of etholog/,
Chapter 4 . ln: Webster C, editor. Biology, ntedicine and society L840-1'940. Cambridge:
Cambridge UniversitY Press, 1981.
36 W"brt"r C. Biology, nrcdicine and society L840-1'940...p.3.
37 Durant JR. Innate character in animals and man... pp-76a-765.
38 Lorun, K. Ciuilized man's eight deadly sfus. translated by Latzke M. London: Methuen & Co
Ltd.,7974, P.7.
Chaoter 1: Introduction 20

affected by millions of years of acquired health and occupational values, the

assumption being that human traits resulting from biological evolution will
have affected occupational evolution, just as changes in social values and
occupational technology will have affected 'natural' health behaviours.

However making inferences about occupational behaviour and health by

considering early human lifestyles is difficult because of the lack of written
records. Historians, anthropologists and the like, have had to make do with
hypotheses about human evolution informed by archaeological fragments
and by inference from twentieth century cultures which aPPear similar to
those of early humans. This thesis uses accounts of such work in order to

pursue the evolution of occupation and its relationship to health.

The thesis has four main sections which address the particular questions
explored; chapter two proposes a theory of human nature and chapters three

and four consider the importance of occupation in human life according to

that theor/; chapters five and six suggest the positive influence of occupation
on health, and the negative effects of occupational alienation, deprivation
and imbalance; chapters seven and eight inquire into the potential of
occupational therapy to be a health promoting profession, and the last chapter

explores a role for occupational therapy with current World Health

Organisation and public health objectives. Each chapter will now be outlined.

Chapter two of the thesis defines occupation as a central aspect of the

human experience because it covers the whole range of purposeful human

activity whether work, play or rest, obligatory or chosen, biological or socio-

cultural in origin. Occupation is so much a part of the ordinary fabric of life
that it is taken for granted, despite the fact that it provides the mechanism to
fulfil basic human needs essential for survival, and to enable people to adapt
to biological, social and environmental changes. A theory of human nature
based on the human need to engage in occupation is proposed. It takes an
evolutionary, and humanist view, which has the incidental advantage of
Chapter l.: Introduction 2l

bringing reductionist presumptions under question3e. It also advocates for

ecological sustainability, because, although the humanist / ecological mix may

seem somewhat incompatible, a line taken argues that because of our

occupational natures humans now dominate the ecological chain yet tend to
see themselves as separate from it. They degrade the environment, in part, in

response to the materialism resulting from occupational 'progress', and in

part, because they do not appreciate the consequences of meeting their
occupational needs.

Many existing views of human nature have influenced, or are integral to

the theory that humans are occupational beings. For example, from Plato,
comes the notion that humans are fitted by nature for different activities
because of their particular aptitudes and interests; from Freud and the
psychoanalysts, agreement that all mental entities have some physiological
basis, but that we are not aware or conscious of them all; from existentialist
theories the concept of the uniqueness of individuals, and that meaning,
purpose and choice in human life is as important as scientific or metaphysical

truths; and from outside the Occidental tradition, the need for balance, which
is central to many Eastem views, is seen as important to occupational well-
being. well as modern biology, sociology, behavioural and
These as
neuropsychology offer a variety of views which, collectively, sustain an
occupational view of the nature of humans.

Chapter three, based mainly on biological and neurosciences, explores, from

an occupational perspective, the particular mix of human characteristics and

capacities which have enabled us to survive healthily and successfully as a

species. In the latter half of the twentieth century evolutionary theories

regarding biological determinants of behaviour have been dominated by
sociological postulates that human actions are determined by socio-cultural

39 St"uer,sonL. Seuen theories of lumun nature. 2nd ed. New York Oxford University Press,
7987, p.I43.
Chapter 1: Introduction 22

envirorunents, rather than inherited characteristics. Human capacities are

indeed developed according to individual utilisation, experience and socie
cultural environments, as sociologists postulate. However, it is also true that
there are particular neuronal systems genetically endowed with the capacity
for particular behaviours such as bipedalism, dexterity, sPeech and language,
body image, or visual perception4O . This chapter provides a basis for the later

arguement that the human drive for purposeful use of capacities, through
occupation, is a biological endowment, but that the PurPose is the result of
socio-cultural values and forces.

To understand the relationship between occupation and the socio-cultural

environment, chapter four traces 'occupational evolution', comParing the
lifestyles of early and modem humans in order to discover basic occupational
drives, and how engagement in occupation has changed throughout time.
Human occupation has become extremely complex because of the never-
ending development of occupational technology, and the social structures and
values which accompany it. People's occupational nature is evidenced by the

diversity of activities which are culturally valued, as well as the diversity of

values given to the many ways of dividing and classifying occupation.

The exploration covered by chapters two to four leads me to propose that

the evolutionary functions of occupation are integral to survival and health,
but that the basic occupational needs of people are now obscured by the values
imposed by the cultures and societies in which they live, and by prevalent
philosophies. This leads naturally to chapter five, which explores positive
health from an occupational perspective. I argue that there is an integrated
biological and socio-cultural construct of health which relates to survival of
the species, enables individuals and communities to flourish, and which has
inbuilt flexibility in that it can change according to context. The chapter is
40 rolb B, Whishaw IQ.Fundamentals of human neuropsychology..'
Chapter 1r Introduction 23

founded on the W.H.O.'s 1946 definition of health and well-being and how
the Ottawa Charter for Health Promotion describes health.

úr the search for links between occupation and health the biologically

endowed relationship between needs of humans and health is considered by

focussing on health issues for hunter-gatherer peoples, and views held about
'natural' health. just as concepts of occupation have changed throughout

history, so have changes to major occupational structures and foci distorted

early health behaviours so that they no longer serve their original purpose
effectively. The importance to health of balanced utilisation of capacities
through engagement in occupation, according to individual need, emerges as
a primary consideration from this exploration of an occupational perspective
of health.

This thesis makes an unexamined assumption that aiming health care

towards good-health and well-being is a laudable and desirable objective. As

part of this aim it recognises the need to prevent ilhress. This being so,

chapter six discusses the relationship between occupational structures and

illness at population levels, and goes on to consider evidence, from existing
studies, about ill-heatth resulting from occupational deprivation, alienation
and imbalance. I argue that there is inadequate consideration of underlying
socio-cultural determinants which lead to occupational deprivation,

alienation, or the need for balanced utilisation of capacities, in health care,

education or social and political policies, strategies and Programs. This
should be a concern for public health.

Current fascination with health, driven both by personal vitalism and by

economic doctrines, is associated with much rhetoric published by health

professionals and political authorities about the importance of developing

health promotion programs. There may be some health professionals who do
Chapter 1: Introduction 24

not perceive good-health as their concern. Whether or not this is the case,

there are few opportunities available for established health services to either
evaluate services or to undertake major program changes towards facilitating
good health and well-being. Indeed for one of occupational therapy's

traditional client groups, the chronically disabled, Programs with that aim
appear to be disapPearing.

To address these issues, and others, an original exploration of occupational

therapy's role and potential in promoting health is offered. Occupational
therapy has not been thoroughly reviewed from a perspective of the

relationship between occupation and heatth. The profession developed from

ideas generated by the work of 19th Century social reformers and
philosophers as mentioned earlier, and has been one health profession
intimately concerned with occupation. Despite a common assumPtion that it
is, similar to other medically accepted health sciences, most applicable to the
remediation of ill-health, occupational therapy's philosophical base relates to
the facilitation of good-health and well-being through engagement in
purposeful occupation. Occupational therapists have long held a belief that
health can be enhanced by occupation which is beneficial to human well-

being. However, present social and political thinking fails to acknowled$e a

human need for occupation for its own sake, apart from paid employment for
monetary reasons. Occupational therapy's appreciation of a basic value of
occupation is therefore out of step with dominant values. The next two
chapters ask how occupational therapy's focus on occuPation and on health
has changed, historically as a result of both external and internal pressures.

Chapter seven describes and analyses the origins of occupational therapy in

North America at the beginning of the twentieth century. Notions about

occupation and the development of human potential surfaced then as themes

common to philosophies and policies proposed by industrialists, educators,
Chapter 1: Introduction 25

philosophers, social and health workers. This melange of themes

culminated, in the health arena, in the formation of occuPational therapy.

Occupational therapy is, in fact, different from many other health professions

in that it began with a philosophy that is not based on physical science: its
growth was a response to social problems stemming from wide spread
industrialisation, to a growing appreciation of the value of human labour,
and to ideas central to 'moral treatment' of mental ilhress in the L9th century.
This difference has made it hard for others to understand. Occupational
therapists tried to reduce the difference by conforming to physical science
presumptions of other health professions. The conformity achieved some
useful outcomes, but at the cost of devaluing and almost losing many of
occupational therapy's distinctive features. Because of the uncertainties
caused by a shifting foundation and by medical science directives which
encouraged reductionist rather than holistic approaches, occupational

therapists have experienced many difficulties in explaining their contribution

to health care and have suffered some loss of overall direction of professional
aspirations.

Chapter eight analyses the historical relationship between occupational

therapy and occupation. Although the twentieth century has been an era of
rapid change in occupational technology, occupational issues have on the
whole been addressed through legislation and procedures aimed at social

equity or the economy. In response to these forces, plus advances in medical

science and, frequently, in the organisation of health care services,
occupational therapists have altered substantially, if temporarily, the value
and importance given to occupation. This led eventually to serious

consideration being given by the profession to re-identifying it's ideological

foundation and theory base. An exploration of this theoretical soul-searching

in recent years demonstrates that occupational therapists are developing a

Chapterl: Introduction 26

greater appreciation of their profession's original philosophy, with most now

identifying occupation as their particular focus in health care.

The chapter also considers the relationship between occupational therapy

and health promotion. Occupational therapy's philosophical base, even
when aimed at remediating ill-health, relates to the promotion of health.
Practice is founded on the notion that health can be improved by people being

enabled to potential. However occupational

reach their 'occupational'
therapy's contribution to health promotion is not recognised for many
reasons, including its long association with the medical model which, to an

extent, deflected some of occupational therapy's initial PurPose. Other

important factors in the lack of recognition are the poorly understood
relationship between occupation and health; the differing views of health and
the promotion of health between health care workers; differing models of
practice within professions; and the fact that views of occupational therapists
do not necessarily agree with changing cultural values of the most influential
health care workers and policy makers. The chapter explores these issues as

well as occupational therapy's particular contributions to health promotion.

Key concepts important in health promotion rhetoric are integral to the aims
of occupational therapy, such as being primarily responsive to client

participation and goals, facilitating quality of life, and enabling people to

maximise potential, independence, self growth and actualisation. Current
difficulties and problems which prevent the achievement of these aims are

identified. One source of empirical data for the exploration is a national

survey of occupational therapists undertaken to evaluate their interest and
current professional direction towards and in health promotion.

Although the thesis concentrates on exploring health from an occupational

perspective, in the process it also attempts to clarify different approaches to

health. Such clarification is required to provide a foundation for considering

Chapter 1: Introduction 27

the actual and potential relationship between public health and occuPational
therapy. Based on the assumption that occupation is important to the health
of individuals and communities, the last chapter ProPoses an actual and
potential role for occupational therapy in public health. It structures this
proposal around five different health approaches which, together, form an
integrated view of health promotion. The approaches span wellness within
conventional medicine, preventive medicine, social justice, community
development, and ecological sustainability. This view, should it be

implemented, would enable systematic and logical integration of the W.H.O.

health into health care. Priority health strategies could be
objectives

encouraged and reinforced, and non-comPetitive recognition and

encouragement of different values, approaches and conlributions may be
more possible than at present. The current, non-integrated, structure of
in terms of acute versus long
health care is arbitrarily divided, for example,
term, individual versus community, or medical versus social health. The
'new public health' direction towards 'health for all' is relevant to all aspects

of health care from illness to wellness and cannot be seen to start where
conventional medicine, for example, is assumed to leave off.

Within these approaches, occupational therapists, attending to the

relationship between occupation and health, can make special and particular
contributions towards public health. The chapter outlines a new synthesis of
occupational therapy using action-research approaches compatible with it's

philosophical and theoretical base as well as subsequent development. It is

proposed that an occupational perspective on health would allow

occupational needs to be integrated with medical science approaches.

preventive medicine and health and wellness education would expand to

address issues such as the importance of balancing and making use of human
capacities, and community development and social justice initiatives would
cast occupational deprivation issues and inequalities in a new light. In all
Chapter 1: Introduction 28

approaches a stronger focus on the development of services aimed at

disadvantaged people is required. Finally I propose that an occupational

perspective of health will assist ecologists in a better understanding of how to

harness or adapt human occupational traits to sustain rather than destroy the

earth.
 Chapter 2

An occupational theory of human nature

This chapter introduces occupation as a central aspect of the human
experience, defining it by using descriptions formulated by occupational

therapists and others. The discussion in the chapter leads to the proposition
that, from an evolutionary perspective, there is a three-way link between

survival, health and occupation, in that occupation provides the mechanism

for people to fulfil basic human needs essential for survival, to adapt to

environmental changes, and to develop and exercise genetic capacities in

order to maintain health.

As a particular focus for the history of ideas explored in the thesis a theory
of human nature is proposed, based on the idea which defines the emerging
discipline of occupational science, that humans are occupational beingsl.
This chapter sets out the main direction of the theory, but the details are

explored in chapters 3 to 6. A theory, in the sense it is used here, is a system

of ideas held to explain a group of facts or phenomena. It includes a "related

set of principles" which "tie two or more concepts together, usually in a

correlational or causal way" such as those in the paragraph above relating to

survival, health and occupation2. According to Lewin's three stages of theory
development - the speculative, the descriptive and the constructive, this
theory is at the second stage of development, the descriptive, which is a time
for testing. In this case, throughout the thesis the concepts, relationships and

1ye.ra EJ, Clark F, Frank G, Jackson J, Parham D, Pierce D, Stein C, Zemke R. An introduction to
o"",rpuiior,"l science, A foundation for occupational therapy in the 21st century. Ocuryational
therapy in health cnre 7989;6@):l-17.
2 Du,ldt BW, Giffin K. Theoretical perspectiaes for rurrsing. Boston: Little, Brown & Co., 1985,
p.47. See also: Miller BRf. What is theory, and why does it matter? ln: Miller BRJ, Sieg KW,
Ludwig FM, Shortridge SD, Van Deusen l. Six perspectioes on theory for the practice of
occtrpniionol therapy. Rockville, Maryland: An Aspen Publication, 1988.
Chapter 2: An occupational theory of human nature 30

principles will be measured against a broad range of ideas and against known

research from other theories3.

That the theory is concerned with human nature is ambitious, but I have

chosen to address it in this way to emphasise the extent of the complexity and
of the influence engagement in occupation has had uPon cultural evolution,
upon our present circumstances and upon the health of individuals and
communities. "The notion of human nature involves the belief that all
human individuals share some common features" and characteristics that are
innatel. Accepted by many Marxist theorists, this is a concept central to
humanist and critical theorists, with whom I identify strongly, in that it
provides the grounds for aiming towards growth models of health, and for
critical analysis of social which inhibit human
or health environments

potential. Although Marx made valuable contributions to a social and

occupational view of human nature the notion is, however, dismissed in the

official ideology of socialist countries, and by Marxist structuralisms.

Well articulated examples of differing views of human nature range as

widely as those proposed by Marx, Plato, Freud or Sartre as well as those

embraced in creeds as diverse as Christianity or Taoism. In addition, I argue/

that each person thinks and acts according to a personal view of human
nature, but seldom attempts to articulate or to test this view, preferring,
instead to profess allegiance to one or other socio-culturally accepted view.
These diverse theories about human nature provide the context for beliefs

3 Lewin K.Principles of topological psyclnlogy. New York McGraw HjIl' 7947

4 Markovic M. Human nature. In: Bottomore T, editor. A dictionary of Marxist thought. 2nd ed.
Oxford: Blackwell Publishers, L997, p209; See also Venable Y. Human nature: The Marxian
aiew. 1945, reprinted Gloucester, Mass.: P. Smith, 1975.
SAlthrrrset L.For Marx Paris: F. Maspero, 1965; translated by Brewster B. London: Allen Lane,
1969.
Chapter 2: An occupational theory of human nature 31

about the meaning and purpose of life, about visions of the future, and about
what humans should or should not do6.

This thesis proposes a theory of human nature based on the idea that we

!ey9-31 .T1.3_!g ry,ed t"a .e.¡g189 in occupalion.-. This need has, on the whole,
been overlooked in scientific inquiry and in most theories of human nature
because it is so mundane. That engagement in occupation is innate, inborn 6

or natural, is indicated by the fact that people spend their lives almost

constantly engaged in purposeful 'doing' even when free of obligation or

necessity. Th"y 'do' daily tasks including things they feel they must do, and
others that they want to. Hqgr'gn evolution has been filled with ongoing and
progressive 'doings', which, apart from enabling the species to survive, has

stimulated, entertained and excited some people and bored or stressed others
according to what was done. Doing is so much a part of everyday life, that a
within Western cultures people frequently identify themselves and each
other by what they do. For example, common forms of introduction name
occupational pursuits, such âS, "May I introduce Fred Jones? He is a
computer operator". Many family names from England and Europe reflect
long past occupations of their members, such as Smith and Barber.

Frequently children are asked "\Alhat are you planning to do when you grow
up?" or "what have you been doing?". It is as if the occupational background,
present or future of people is a major reflection of every individual, that what

they do, in some ways, is what, or who, they are. The things people do are
described as occuPations.

As occupation is a central theme of this thesis it is necessary to clarify, as far

as is possible, what is meant by the word in this particular context. It will be

used. here as occupational therapists use it, in the generic sense, perhaps
reflecting common usage of the word when their profession was developing

6 St"u"r,ror, L. Seaen theories of humnn nature. 2nd ed. Oxford: Oxford University Press, 1987
Chapter 2: An occupational theory of human nature 32

in the first decades of this century. In The Concise Oxford Dictionary of 1911,
occupation was defined as "occupying or being occupied; what occupies one/
means of fitling up ones time, temporary or regular employment, business,
calling, pursuit'7. In Websters Revised, Unabridged Dictionary of the English
Language of I9t9 the definition includes "that which occuPies or engages the

time and attention"S .

'Occupation' has several meanings in contemporary dictionaries, also. The

1989 Oxford English Dictionary defines the aspect of occupation central to this
thesis as "being occuPied or emPloyed with, or engaged in something'e.

Despite this generic meaning, occupation is currently commonly used to refer

to paid employment, specifically. The adjective 'occupational' is particularly

used in this way, as in 'occupational health and safety' and 'occupational

diseases'. The use of occupation to refer, as it does in this thesis, to ull
human activi is sometimes misunderstood. It may therefore be Û
useful to consider other words with similar meaning in order to justify the

continued generic usage. These are - 'praxis', which is used in various ways
in scholarly or academic circumstances, but seldom as part of common usage/
and words in common use such as 'work', 'labour', 'leisure' and 'activity'.

for 'of action', according to Lobkowicz "refers to

Praxis, from the Greek
almost any kind of activity which a free man is likely to perform; in
particular, all kinds of business and political activity"10. InRoget'sThesaurus
praxis is given as a synonym for actionl1, but it is such a specialised word that
it does not appear in all dictionaries. In the Oxford English Dictionary where

TThe concise Oxford dictionary of urrent English. Oxford: Clarendon Press, 1911'
Sryebrtrr't rsTrised unnbridged dictionary of the English Innguage. London:G Bell & Sons Ltd,
and Springfield: G & C Merriam Company, 1919.
9flrt OrforA Engtish dictìonary.2nd ed. Vol.XIL Oxford: Clarendon Press, 1989.
lOlobkowiczN. Tlrcory nnd practice: History of concept from Aristotle to Marx. Notre Dame,
Ill. and London: University of Notre Dame Ptess,1967, p-9'
11 Roget pM. Rogef 's tlrcsaunts of synonynts nnd antonyms. London: The Number Nine Publishing
Company,7972.
Chapter 2: An occupational theory of human nature 33

it does appear, it is defined as "doing, acting, action, Practice", yet in another

dictionary it is defined as 'accePted Practice or custom'12. In neuro-

rehabilitation, apraxia (no action) is a not uncommon sequelae of stroke or

head injury13. Lr that instance it refers to a lack of ability to carry out
purposeful activity or skilled movement when there is no physical, cognitive
or emotional reason for difficulty. In the same vein 'praxiology' - the science
of efficient action, is a discipline "dealing with methods of doing anything in
any way...from the point of view of its effectiveness"l4

Marx's use of 'praxis' is, perhaps the most similar to occupation as it is used
in this thesis. To him praxis was "the free, universal, creative and self-
creative activity through which man creates (makes, produces) and changes
(shapes) his historical, human world and himself"15. Marx usually oPPoses
'labour' to 'praxis', but in Economic ønd Philosophical Manuscripts is

sometimes inconsistent, using 'labour' Synonymously with 'praxis'16. Praxis,

as action, is used in the present day as a descriptor for many tyPes of action-

research, such as critical praxis research or critical feminist praxis17. Its many
different meanings, and its obscurity, despite increased usage since the 1960s
following translation and availability of Marx's early writings, preclude
'praxis' as the most appropriate word for all purposeful activity.

lTThe Oxford Englistt dictionary, Vol XI[... p.297;The standard English desk dictionary...
p.663;
13Thir d.isorder was first defined by Hughlings Jackson in the 1860's, named by Steinthal in 1871,
but detailed analysis is attributed to Leipmann from 1900 onwards, and described in:
Leipmann H. Drei Attfsatze nus dem Aptaxiegebiel. Berlin: springer, 1908.
l4Kotarbinski T. The goal of an act and the task of the agent. In: Gasparski W, Pszczolowski T,
editors. praxiological studies: Polish contributions to the science of efficient nction.
Dordrecht, Holland: D Reidel Publishing Company, \983' p'22'
15 petrovic G. Praxis. In: Bottomore T, editor. A dictionary of Mnrxist thought.'. p'435
16 Marx K. Economic and philosophical manuscripts ,1844. In: Livingstone R, Benton G,
translators. I(arl Mnrx: Enrly writings. Penguin Classics, l'992'
17 5.", for example: Comstock D. A method of critical research. Chapter 18. In: Bredo E,
Feinberg W, õditors. Knowledge and aalues in social nnd educntional research.
philadeíphia, Pennsylvania: Temple University Press, 7982, pp 370-390; Lather P. Research
as praxis. Haranrd educntionnl reuictu 7986;56 (3):257-277'
Chapter 2: An occupational theory of human nature 34

Dictionary definitions of 'work' describe it as "action involving effort or

exertion, especially as a means of gaining livelfüood"l8. Work derives from
an old English word "Weorc" and is described by Williams as the most
general word for "doing something and for something done", however its
current predominant use iS, like 'occupation', for "regular paid
employment"lg. It's usage in this way is even more specialised than
'occupation'. Williams notes that "the specialisation of work to paid
employment is the result of the development of capitalist productive
relations" which in part shifted the meaning "from the productive effort
itself to the predominant social relationship". "Work (in its widest sense/

including labour)", observes Parker, is "independent of any particular form of

society". It "is a basic condition of the existence and continuation of human

Iife"2o. It is also the antithesis of play,leisure, rest and recreation, implying

an element of compulsion or necessary toil, so eaming a description as

"everything we do to keep body and soul together"2l.

'Labour', like work, is used for activities which are for some reason

necessary or enforced. Williams suggests it has a "strong medieval sense of

pain and toil", and that it is a harder word than work, with manual workers
being described as labourers from the thirteenth centurys. Labour is described
by Marx as

"ø process in which both man and Nature participate, and in which
ma'n of his o'wn accord starts, regulates, and controls the material
reøcfiôns between himself and Nature. He opposes himself to
Nature as one of her own forces, setting in motion arms and legs,
heød ønd hands, the natural forces tf his body in order to
øppropriate Natures productions in a form adapted to his own
wants.22

18 Work. The standard English desk dictionary...p.975.

19 Willia^s R.Keywords' London: Fontana, 1983'
20 Parker S.Leisure and work. London: George Allen & Unwin, 1983, p'13'
21 S*itL R.Unemployment and health: A disaster and a challenge. Oxford: Oxford University
Press, 1987.
22MutrK.Capitnl, Volume 1. Hamburg: OttoMeissner, 1'867'
Chaoter 2: An occupational theory of human nature 35

Ruskin, English nineteenth century socialist, described it as the "contest of the

life of man with an opposite; - the term 'life' including his intellect, soul, and
physical power, contending with question, difficulty, trial or material force."23
Harry Braverman, a contemporary socialist, in his 1974 book addressing the

degradation of work in the twentieth centur/, writes that labour "represents

the sole resource of humanity in confronting nature...whether directly

exercised or stored in such products as tools, machinery, or domesticated

animals", and cites Aristotle's description of labour being "intelligent

action'24.

Despite these very broad concepts, 'labour' like 'work' is not used for
activities which are restful or playful, and although neither means only paid
employment, like 'occupation', they are used frequently in this way. Both

describe an agPect of what can be meant by 'occupation', that is, work and

labour are an integral part of 'occupation'.

Time other than that spent in paid employment is described as 'leisure'

from the Latin "licere" meaning permit and from the L4th century meaning
of opportunity or free time. An altemative is a "holiday, the old word for
religious festival"2s, although this has implications of a contained time, such

as a 'day' or 'week' and, "in countries affected by the Hebrew tradition", the

Sabbath "is not so much a day of leisure as a day of ceremonial inactivity, a

duy of restraint"26. Leisure, holiday and religious pursuits are also
occupations.

23 Ruskin J. preface. 1862. In: Yarker PM, editor. Ruskin: Unto this /asf. London: Collins
Publishers, 1970.
24 Bru,u"r*an]H.Labor and monopoly cnpital: The degradation of zuork in the twentieth century
New York: Monthly Review Press,7974.
25 wiuiu^s R. Keywords.. -

26 Parker S.Leisre and zuork..' p.17.

Chapter 2: An occupational theory of human nature 36

'Activity' is defined as "the state of being active; the exertion of energy,

action"Z7, and, like occupation, describes specific deeds or action It is often
used interchangeably, even by occupational therapists, but unlike it is seldom
used to imply paid employment, despite its derivation from Latin "agere", to
do28. Of these choices, despite its frequent limited use, occupation remains

the only word which can be used for all types of activity, and is therefore the
most appropriate word to use.

Occupation is so much a part of everyday life that it is reasonable to make

empirical statements about it. It can be said, therefore, IþgJ h34çtaßs-engage.-in..

occupation, with individuality qf Purpoqe; lþ"y think about the effects,
conceptualise and plan before undertaking activity; and they are able to reflect
and mentally alter future behaviour as a result of outcomes. Occupations
d.emonstrate an individual's culturally sanctioned intellectual, moral and

physical attributes. It is only by their activities that people can demonstrate

what they are,or what they hope to be. Accolades for individual
achievement are often surrounded with ritualised activities, such as
graduations, ticker-tape parades and initiation ceremonies. Awards and
rituals are highly valued as demonstrations of the appreciation of
occupational achievement.

In order to satisfy their need to exercise their capacities, humans seek out
various and sometimes novel ways to pass the time. Without occupation
time appears to pass extremely slowly, as any long distance air traveller can
attest, even with the frequent meals, drinks and movies. Occupation is a
@,

natural user of time which provides a sense of purpose, and without which
humans are apt to be bored, depressed and sometimes destructive. Even the
stylite, the eremite or the monk pass the time in a way purposeful to him or

27The Oxford English Dictionary, Vol I... p.130.

23Worct
finder, The Austrolinn thesatrus. Sydney: Reader's Digest, 1'983.
Chapter 2: An occupational thegry q! human nature 37

her, despite the PurPose PerhaPs aPPearing obscure to others. People so

commonly express a need to 'do something to pass the time', that we have a
word for this in the English language - Pastime. Exploring how and why
people use time the way they do provides a rich source of data on many
different socio-cultural and health related issues and, so, this perspective of
occupation has been subject to scrutiny. Time-use surveys originated early
this century, with most studying large population grouPs for comparative
purposes, to inform social planners at National and Intemational levels2e.

Adolf Meyer, an American psychiatrist, eminent in the first half of this

century, and credited with providing a philosophy to occupational therapy,
also proposed that how people use time is very important. He asserted that in
order to maintain and balance the organism that is a person, there is a need to

act in time with bodily and natural rhythms, and that timely activity and rest

are vital components of healthy living. He observed to an historic meeting of

occupational therapists in 1922 that
,,Human ideøls høae unfortunøtely ønd
usually been steeped in
dreams tf timeless eternity, and they
haoe neaer included an
equølly religious aøluation tf øctual time and íts m9aning in
u¡holesome ihythms.
-wonder
The øwakening to a full meøning of time as-
the biggest ønd asset tf our liaes and the aaluation, tf
opportinity and perþrmance as the greøtest measure of time; those-
ir:, the beacon lights tf the philosophy ,f the occupational
worker"3o.

29 S"" for example: Castles I.How Australians use their time, Catalogue No 4153.0. Australian
Bureau of Statistics, L992 (embargoed to 1994); Harvey AS. Quality of life and the use of time
theory and measurernent. loutnal of ocuryational science: Australin 199
C, Milroy BM, editors. Lfe spnces: Gender, household, employment' Ya
vancouver Press, 1988; Robinson JP. How Americans use time: A socia
of eaerydny behaaiour. New York: Praeger Publishers 1977; Szalai A. The use of time:
bnity actiaities of urban and sttburban populations in twelae countries. The Hague: Mouton,
7972.
30 M"y", A. The phitosophy of occupational therapy. Archioes of ocuryational therapy,1922:7:
1-1ó. In: The Anrcrican journal of ocuryational tlrcrapy,|977; 37(10):639-642.
Meyer is the subject of a brief biographical note included in Chapter 7.
Chapter 2: An occupational theory of human nature 38

Despite this early pointer, it was not until about the nineteen seventies that

occupational therapists began, seriously, to recognise the value of time-use

research and the study of human temporality3l.

Occupation also provides the mechanism for social interactiory and societal
a
development and growth, forming the foundation stone of community, local
and national identity, because individuals not only engage in separate
pursuits, they are able to plan and execute grouP activity to the extent of
national government or to achieve intemational goals, for individual,

mutual and community purposes. Anthropologists describe this unique

human trait as 'culture' and suggest

"It is the unique blend of biology and culture that møkes the species
Homo sapiens' a truly unique kind tf animal...Humflns are
different, not so much for what loe do...but rather the fact thøt. we
,a, do more or less what we wønt. That is what haaing a highly
deaeloped culture reaIIY means."32

Statements by occupational therapists suggest a view within the profession

that occupation is central to the human experience. In the professional

literature occupation has been described as a natural human phenomenon

31 S"" for example: Mackinnon ], Avison W, McCain G. Rheumatoid arthritis, occupational

profiles and þsychological
-
adjustment. lournal of occupatíonnl science: Australia 7994;7(4): 3'
iO. Stanley Vf. e" investigation into the relationship between engagement in valued
occupations and life satisfãction for elderly South Australians. Jotrnal of occupational
scienie: Australia 1995;2(3): 100-11.4. Yerxa E], Locker SB. Quality of time used by adults
withspinalcordinjuries.The American journal of occupational therapy7990;4:318-326.
Pentland W, McCoi MA, Harvey A, do Rozario L, Neimi I, Barker l. The relationship
between time use and health, well-being, and quality of lrf, . Proceedings of a
multidisciplinary research meeting. Kingston, Canada: Queens University, 1993; Kielhofner
G. The temporát dimension in the lives of retarded adults. The American iournal of
occupationai therapy 1979; 33: 161-768; Neville Application with
shoiçterm psychiaiiic patients. The American erapy 1980;34:328-
331; Rosenti-tui te, Howi MC. Activity pattems mparison of
temporal adaptation among day versus night shift workers,. Ocutpational therapy in mental
hea'I th l9S4; 4:59-78; Weeder TC: Comparison of temporal Pattems and meaningfulness of
daily activities of schizophrenics and nórmal adults. Ocuryational therapy in mental health
!986;62 27-45'
32LeakeyR,LewinR.People of tlrc Inke: Man: His origins, nature, and fúure'PenguinBooks,
1978, pP.38-39.
Chapter 2: An occupational theorv of human nature 39

which is taken for granted because it forms the fabric of everyday lives33,
more specifically, as purposeful use of time, energy, interest and attention3a
in work, leisure, family, cultural, self-care and rest activities. It includes

activities that are playful, restful, serious and productive which are carried
out by individuals in their own unique ways based on societal influences,
their own needs, beliefs and preferences, the kinds of experiences they have
had, their environments and the patterns of behaviour they acquire over
time3S. Occupation which is culturally sanctioned is seen by some as a

primary organiser of time and resources, enabling humans to survive,

control and adapt to their world, be economically self sufficient36 and to

experience social relationships and approval, as well as Personal growth37.
This view of occupation is applicable to communities at local to global levels,
and should not be seen as referring only to individuals.

All of this description will be integral to the meaning given to

aspects

occupation throughout this text and provides a base for the occupational
theory I propose. This theory meets the criteria of empirical accuracy and
predictive capacity required by contemporary cannons of science being based
upon few arbitrary elements derived from multiple and ongoing
observations3s. It can also definitely predict that people will in the future

33 Cyntin S, Robinson,\NI. Occupational therapy and nctiaities health: Towards health

tttiough actiuities. Boston: Little, Brown and Company,l99O'
34 Occupational therapy; its definitions and functions. American journal of ocaryational
therapy ,1972;26:204.
35 Ki"Iroftrer G, editor . A model of human ocatpation, theory and application. Baltimore:
Williams and Wilkins, 1985
36 Yer*a Ef, et al. An introduction to occupational science"'p'3'
37 Wilcock AA.Ocuryntional therapy appronches to stroke. Melbourne: Churchill Livingstone,
1986.
38 For example, Stephen W Hawking nA brief lústory of time (Toronto: Bantam Books, 1988)
suggests that
,Ïn"throry is a good theory if it it must acutrately describe a large
satisfies two requirements;
class of íbseruatlons on th-e tnsis of a model tlnt contnins only a few arbitrary elements, and it
mtÉ înke definite predictions about the results of future obserantions." (p.10).
Chapter 2: An occupational theory of human nature 40

continue to engage in occupation, although the form of the occupations will

change according to socio-cultural evolution.

The occupational theory I have set out also meets Stevenson's

requirements for a theory of human nature3e. It is set within generally
accepted scientific theories of the evolution of the universe and the sPecies
that inhabit it. Its basic concept of the nature of humans is that as a result of
their biological evolution and enculturation humans are occuPational beings.
That is, the need to engage in occupation forms an integral part of innate
biological systems aimed at survival and health; that the varying potential of
individuals for different occupations is a result of their genetically inherited
capacities; and that the expression and execution of occupation is learnt and
modified by the ecology and socio-cultural environments40. The theory
provides a simple diagnosis and prescription Namely, that humans have
not seriously considered the implications or requirements of their

occupational nature; that this has caused deleterious effects to individual,

community and ecological health; and that addressing this lack of awareness
has the potential to result in major and beneficial changes to social, political,
economic, ecological and health policies.

The background to my occupational theory of human nature can be seen in

the following brief account of biological and cultural evolutionary theory.

Current scientific thought generally accepts that living matter evolved

39LeslieStevenson inSeoen theories of httman nature (p.9), setshisrequirementsas

"(1) a backgrormd theory of the nahtre of the uniaerse; (2) a basic theory of the nature of man;
(3) a diagnolis of zuhat is wrong with mnn; and G) a prescription for putting it right" .
4t, As'natirat seleLtion acts on phenotypes, not genotypes, and as phenotypes always include an
enafuonmental component, it is of course fallaciotts to oppose genes and enoironment"(Berghe
pL van den. Sociobiology. I¡The sociat science encyclopedia... p.797). This concept is in accord
with the Csikszentmihãiyi's view that human action is shaped by genetic, cultural and self
teleonomies (Csikszentmihalyi M, Csikszentmihalyi IS. Optimal experience: Psychological
sttdies of flow in consciottsn¿ss. Cambridge: Cambridge University Press, 1988;
CsikszeÁtmihalyi M, Massimini F. On the psychological selection of bicultural information.
-psychology.1985;3(2):
New idens in 115-38.), and is supported by Snell's proposal that the
making of 'humans' is aLout 50% genetics and 50% culture (Snell GD. Senrch for a rntional
ethic. New York: Springer Verlag, 1988, p.140)'
Chapter 2: An occupational theory of human nature 41,

naturally from non-living matter in the form of single-celled creatures. Over

a period of perhaps a billion years some electrons, protons and neutrons

combined to form atoms which formed molecules. Some of these became

"more or less well-organised aggregates", one class of which is organic matter-
In türfr, some original micro-organisms went through a "comparable

hierarchical evolution" to primitive plant forms to invertebrates to

vertebrates, and, in the last 60 million years, to mammalsal.

Against a background of geologist and naturalist speculation, interest and
theories which were out of step with dominant Christian beliefsa2, Darwin's
Origin of the Species by Means of Natural Selectiona3 and The Descent tf
Man44 are recognised as the works which brought theories of evolution to
public debate and inquiry in the Occidentas. Dawkins suggests that although
it is difficult to explain "how even a simple universe began", Darwin's theory

of evolution by natural selection demonstrates a way in which "simplicity

could change into complexity" and how collections of stable molecules could
eventually, through "high longevity/fecundity/copying-fidelity", evolve into
complex living beingsa6. Darwin's theory is based on the empirical

observations that there is a tendency for parental traits to be passed to their

41 Stavrianos LS. The world to 7500: A global history.4th ed. New Jersey: Prentice Hall 1988,
o.4.
ït must be bome in mind that 'evolutionary trees ('dendrograms') are greatly oversimplified,
even when depicted as bushes with many shoots side by side, and many branches.
42 Speculation, interest and theory is demonstrated n'sTheory of the
eärth published nI79S; Clergyman, T.R.Malth principle of
populaiion,published nlT98; French naturalist, Jea theory of organic
lrrãt.rtio.r, Systeme des Animaur published in 1801; and Charles Lyell's Ptinciples of geology
published bãtween 1830-1833. See: Campbell BG. Humankind emerging. pp.8-t7.
43Darwin C.Origin of the species by means of natural selection.London,lS59.Cambridge,Mass:
Harvard UniversitY Press, 1964.
44 Darwin C.The descent of man and selection in relation to sex. London, 1891. New York:
Appleton, 1.930.
a5 Oäi*itr's evidence did not come from human-beings, and only his conclusion suggested that his
theory would shed light on the origin of man (Darwin C.Origin of the species...)'
Noneiheless his theories were received with moral shock, fear and derision in the lay
community although accepted rapidly in biological science, at least until the retum of the
creationists(Ridley M. Creãtionism. In Bullock A, Stallybrass O, Trombley S, editors-The
Fontana dictionary of modern thotrght.2nd ed' London: Fontana Press, 1988.)
46 Dawkins R. The replicators. chapter 2 of The selfish gene.7976.In: Dixon B, editor.From
creation to chaos: Clnssíc writings in science, Oxford: Basil Blackwood Ltd,7989,pp.39-44.
Chapter 2: An occupational theory of human nature 42

offspring; that despite this, there are considerable and noticeable variations
between individuals; and that species are capable of a rate of generation which

cannot be supported by available natLrral resources. That is, more are born

than can survive, requiring a struggle for existence. This leads to survival by
natural selection of those with "certain inherited variants which increase the
chances of their carriers surviving and reproducing"4T. Spencer termed this
"survival of the fittest', in an often-quoted phrase which is frequently

misconstrued to mean survival of those physical fit and strong, rather than

those with 'expected reproductive success', because it is taken literally, and

out of context4S. Natural selection results in the accumulation of favoured
variants which will effect gradual adaptive change in every generation and,
over extended periods, produces new forms of life. Diversity and individual

uniqueness is the consistent message of evolutionary studies from Darwin's

time to the presentae. Individual uniqueness, particularly in relation to
biological characteristics and capacities influencing engagement in occupation

is a focal concern of occupational therapists, but not of political, social or

health planners for whom population and grouP similarities rather than
individual diversity are the focus. Humans, because their biological capacities
enable flexible, adaptable and wide ranging occupations, are fitted for almost

any environment and are dispersed across the globe. Cultural and

occupational evolution such as tool use, agriculture and modern medicine

have broken through natural population restraints which maintained
population size of species more or less constant over long periods of time,
and as a result have reached a point where humans dominate ecological

47¡ones S. The nature of evolution. Lr Jones S, Martin R, Pilbeam D, edilors.The Cambridge

encyclopedia of human eaolution. Cambridge: Cambridge University Press,7992,p.9.
48 Sp"n.", H.Principles of
biology.New York Appleton, 1864, Vol. I, p M4; See also: Sterelny
K. Evolutionary explanations of human behavior. Australian journal of philosophy 7992;70
(2): 156-772.
49¡or,esS. Thenabureof evolution.In The Cambridge encyclopedia of human eaolution... p.9.
 2: An occu pational theory of human nature 43
Chapter

systems, many believe, to the extent of natural resources not being sufficient
to maintain predicted population growthsO.

Working at almost the same time as Darwin, the Austrian monk Gregor
Mendel studied, and experimented with plant sPecies which led to his

formulation of biological laws of heredity. Virtually ignored at the time, his

work was rediscovered in L900 by three scientists working separately, De
Vries, Correns and Tschermak, remarkably, all within a three month period.
Mendel's work provided the answer to the "causes of the variations on which
natural selection acts"Sl. Darwin's theory, modified in the light of Mendelian

geneticsS2 is now known as neo-Darwinisms3 or synthetic evolutions4. In

recent times "the discovery of the structure and function of DNA has made

clear the nature of the hereditary variations uPon which natural selection
operates"ss. It is now acknowledged that humans are mammals with much
in common with other animals, and that like other species humans have "a
certain genetic constitution that causally explains not only the anatomical
features...but also our distinctive...behaviour"56. As Bronowski explains so

succinctly

"the eaolution of the brain, of the hand, of the eyes, of the feet, the
teeth, the whole human frøme, møde a special gift of man...faster in
eaolution, and richer and more flexible in behaaiour...he has what
no other animal possesses, ø jigsaw of faculties which alone, oaer
three thousand million years of ttfe, make him creatk¡e"S7.

501ones S.ibid p.9; Campbell BG' Httmankind emerging." p'17'

51 Campbell BG. Humankind emerging.' - pp.60-69.
52 St"^ C, Sherwood ER, editors.Tlrc origin of genetics. SanFrancisco: W.H. Freeman, 1966.
53 M"duwar P. Darwinism. In: TIrc Fontana dictionary of modern thottght...
54 McHenry HM. Evolution' In: Tåe socinl science encyclopedia"'
55 Dyro. F. The argument from design. From: Disturbing the universe 1979.1n: Dixon B. editor,
Fiom creation to clnos: Clnssic uritings in stience. Oxford: BasilBlackwoodLtd, 1989'p.49.
56st"'u"*ot L.Seaen tlrcories of htmnn nature... p.'].,37.
STBronowskil.The nscent of man. London: British Broadcasting Corporation, 7973, p.42-
 2: An occupational theory of human nature 44
Chapter

Bronowski's description of human difference is a useful bridge between

Darwinist theories of evolution and the next stage of my central interest - the
occupational nature of humans - which will be introduced here and explored
more fully in the next 2 chaPters.

The next stage of my argument relies upon three related sets of principles.
I propose that all people (unless prevented by congenital or acquired
First,
dysfunction such as brain damage) engage in complex and self initiated
occupational behaviour because of their species common combination of
biological features, such as consciousness, cognitive capacity, and language.
Although it is higher cortical adaptations, such as these, which have
generated and made possible the complex occupational behaviour which sets

humans apart from other animals, anatomical and physiological

characteristics of the body, such as bipedalism, upright posture and hand
dexterity are vital instruments in the execution of occupation. Because of the
integrated function of each, the mind and body are not seen as separate
entities but, "simply one and the same"58. Lorenz contends that this is the
only possible view "tenable for the evolutionary epistemologist" and that
"the razor-edge demarcation" Seen aS existing between them by some
disciplines is only for the purpose of understanding themse. Certainly, since
Descartes, in the seventeenth century, seParated the body from the mind

epistemologically, generations of scientists, up to the present day, have fed the

assumption that mind and body can and should be considered separately60.
This separation has hindered the growth and understanding of humans as

occupational beings who because of mind-body unity are able to engage in

occupation.

58lo.".r, K. The waning of humanen¿ss,. Munich: R Piper & Co Verlag, 1983. Translated USA:
Little Brown and Company, 1987, p.93.
S9Lot"n K. The waning of humaneness... p.93'
60 Consider, for example, how the treatment of people with mental disorders is separated from
those with PhYsical disorder.
Chapter 2: An occupational theory of human nature 45

Second, I hypothesise that engagement in occuPation is indispensable to

survival, as well as being an integral part of comPlex health maintenance

mechanisms. The latter point will be explored further in chapters 5 and 6.

This hypothesis is in line with another of Lorenz's suggestions, that the

principal purpose of both anatomical characteristics and behaviour patterns is
survival6l, and with Ornstein and Sobel's proposition that "the major role of
the brain is to mind the body and maintain health"62. My theory of
occupation combines these views, maintaining that a primary function of
human anatomical characteristics and particularly of the brain is to facilitate
healthy survival, and that occupation is a primary mechanism for this

function. To this end the whole of the brain is involved in survival and in
health and the whole of the brain is involved in engagement in occupation.
This notion is complementary to a predominant view that genomic
reproduction is the principle goal of evolution, contending that, as
reproduction can only occur during a particular stage of the life cycle, to reach
reproductive age individuals have to survive and resist disease and death,
and that positive health enhances survival and reproductive success. After
reproduction offspring require nurture and education so that they too can
eventually reproduce. Engagement in occupation is not only required for
survival to the point of reproduction, but also for a long time after to provide
support for the immature of the species. Views held about 'kin selection' or
'gene selection' which develop the concept of Darwinian 'fitness'to include

reproductive success of individuals who share genes63, accounts, at least in

part, for social and altruistic behaviours and occupations. Given the short life
expectancy of humans until fairly recently, support, beyond that provided by

biological parents, was often necessary because human young have lengthy

61l-o.er,z K.The waning of hunnneness'.. p.21.

62 Omstein R, Sobel D. The healing brain: a radical nav qpproach to lrcalth cnre . London:
MacMillan, 1988, PP'11-12 .
63 Campbel| BG.Humnnkind enrerging-.. pp.90-91'
Chapter 2: An occu pational theory of human natule 46

childhoods. See Figure 2.1, on thrs page, for a diagrammatic

representation of human life expectancy during evolution.

Third, the theory recognises as important that, in large Part/ genetic traits or
capacities are inherited and that there is considerable variation between

individuals because of genetic recombination which "theoretically ...can

create nearly an infinite number of different organisms simPly by reshuffling

the
immense amount of genetic differences between the DNA of any two
pâr€nte"64. The differences between humans are discussed further in the next
chapter, and the importance of considering the exercise of the particular range

of capacities of each individual is also raised in later chapters as an important

issue in terms of positive health and well-being, and in preventing illness.

lt20

Fig. 2.L: since the time of the Cro-Magnons, life expectancies

hñe doubled in countries with modern medicine and

64McHenry HM. Evolution. In: The social science encyclopedia...p.280

65Fig. 2.1: is from Campbell Bl.Hwnankind emerging"'p'521'
Chapter 2: An oc cupational theory of human nature 47

Integral to the principles are ideas about the biological and socio-cultural
bases of behaviour, the haphazard nature of evolution, the similarities and

differences between sPecies, brain size and caPacities, and the impact of
occupational humarìs upon cultural change. Whilst accePtance of a biological

basis for occupational behaviour may be criticised by those who claim that
human behaviour depends on culture rather than genetics, modern
sociobiologists and ethologists contend that

"rpithin tal gene-enaironmental action model, cultltre can be seen as the

man-made pait tf the enaironment, preselected by the specifically human
genome...Cuiture cøn haae no empiricøl reþrent outside of the humøn
"organisms inaent and transmit it, and, thereþre, its eoolution is
that
inioitably intertwined with the biotogical eaolution of our species"66.

Such contention provides "a factual background for a middle view"67 which

is in accord with the theory of human nature proposed here because it

"d.emonstrates the importance of evolutionary origins in the behaviour of
the species"68, but also maintains that, because of their biology, humans'
occupational behaviour, as sociologists claim, is, in large part, socio-culturally
determined.

I in common with evolutionary biologists, that the origin of the

also hold,

human species was not inevitable but a consequence of "a long series of
events, each depending on the other, and each unpredictable and ünique"69.

As Lorenz explains, species have evolved in "unforeseeable ways" not

"predetermined and directed toward some purpose"7O. This notion is
fundamental to a humanist approach which recognises freedom of choice and
self responsibilify. Because humans are goal-directed and committed by their
nature to purposeful occupation, it is difficult to appreciate that evolution
66Berghe pL van den. Sociobiology. In:The social science encyclopedia'.. p.797' See also: Wilson
E. On htman nature. cambric ge Mass.: Harvard university Press, 1978.
6TSnell GD.Search t'or n rational ethic... p.140'
68Edet^ar, G.Bright air, brilliant fire: On the matter of the mind. London: PenguinBooks,l99Z
P.40
69pitb"u^ D. What makes us human. In:The Cambridge encyclopedia of human euolution..' p.t.
70 Lor"ntK. Tlrc waning of humaneness... p.5.
Chaoter 2: An occupational theory of human nafure 4 I

may not have an ultimate purpose. This notion of pre-destination has led
many theories of human nature, such as Marxism, to maintain that advances
in cultural evolution must progress to the enhancement of human nature.

I¡r fact the occupational nature of humans may not be Progressive in terms of
ultimate 'good' for the species. It may lead to less desirable outcomes for

health and well-being, with occupational technology, for example, having the
potential to destroy the earth's environment and the species.

In this theory the need to 'do' is not species-specific, since all living things
carry out survival activities. For example, birds build nests, decorate bowers
to attract mates, and dive from great heights for fish or small Prcy, and
domesticated dogs can learn that certain activities will be rewarded by food or

praise, or will run or play with a ball for no apparent reason except for fun,
but which coincidentally maintains their level of physical fitness and acuity.
What animals do and how much freedom they have in the choice of
occupations depends upon the size, structure and capacities of their nervous

systems, as well as upon environmental opportunities and constraints. In the

evolution of the human brain, through the processes of natural selection,

many pathways and connections remain from earlier developmental stages,

and few structures have been discarded, although there may be alterations in
size and function. Current evidence suggests that new brain functions are
the result of "systematic reorganisation, elaboration or reduction of existing
structures or shifts in proportions of existing connections"Tl. In fact, except
for the neocortex, all cerebral regions have a rudimentary equivalent in
reptilian brains7l. Bronowski observes that, whilst "every human action goes

back in some part" to animal origins, an important distinction remains:

71D"u.o.rTW. Thehumanbrain. In:The Cnmbridge encyclopedia of human eaoltttion...p.723.

72Ror" S.The consciorts brnin. revised ed. England: Penguin Books, 1976.
Chapter 2: An occupational theorv of human nature 49

"lVhat are the physical gifts that man must share with the animals, and what
are the gifts that make him different?"73.

All animals appear to have some special attributes which are Paramount to
their survival and which influence their regular occupations. This varies
between and within species. For some it is speed, for others the ability to

camouflage, and for yet others, highly developed visual or auditory caPacities.

Many animals possess qualities and characteristics once thought unique to

humans, which is not surprising as all mammalian brains have neuronal

circuitry and systems which enable them to receive, attend to, interpret,
communicate with, and act upon information from the environment. Il:r

fact, "there is no strong evidence of unique brain-behaviour relationships in

any species within the class Mammalia"74. The gifts that make humans
different are particular adaptations which evolved with increased brain size
and, more specifically, association areas of the cortex.

The degree of difference is manifest in the size of the human brain which is
"the largest primate brain that has ever existed"75. It is 6.3 times larger than
expected for mammals of the same body size76. Deacon suggests that the

structure, configuration and architecture is typical of other primates despite

unique anatomy and functions for special human adaptations such as
"symbolic communication, speech, tool usage and culture", and that
"comparative size of brain may not be as important as its intemal

T3Bronowski I.The ascent of man'..p.37-

74 trolb B, Whishaw I Q. Fundamentals of human neuropsychology. 3rd ed. San Franscico: W H
Freeman and ComPanY,L990, P.106.
Cf Campbell,
"Otti brain is not so much different from other brains, it is bigger. We are not ø whole new
experiment in the eooltrtionnry process, but a superprimate. A quantitatiae change in the
eiolaing humnn brain, howeaer, has produced a qualitatiae chnnge of extraordinary
sígnificancd'
(Campbell BG. Humnnkind emerging... p.366')
75D"uco.r TW. The human brain. In: Tlrc Cnmbridge encyclopedia of human eaolution... p'1'15.
76 ¡erison ¡lj.l. Euoltrtion of tlrc brnin nnd intelligence. New York: Academic Press, 1973.
Chapter 2: An occupational theory of human 50

organisation". He puts a case that "language abilities may be the 'sPecial

intelligence' of humans", that the "brain has been shaped by evolutionary
processes that elaborated the capacities needed for language, and not just by a

general demand for greater intelligence", and that "when all such species

specific biases are taken into account, 'general intelligence' will be found to be

less variable among species than once thought"TT Others attribute the
difference to an increase in association areas of the cortex. This difference is
clearly indicated in Figure 2.2 ftom Rose.

Rat Cat Monkey Human

E Motor area

Sensory areas
Association areas

Figure 2.2: Dlfferences in size of association areas of the brain between

humans and other mammals (from Rose (p.170))78

The association areas are responsible for complex communication and

emotional tone, language, thinking, humour, forward planning, problem
solving, analysis, judgement and adaptation, and Lorenz has noted that
,,ømong humnns...perceptions of deplh and direction, ø central
neraous representa.tion of space, ( estølt perception ønd the capacity
fo, øbstraction, insight and learning, aoluntary moTsement, curiosity
77D"u"onTW. The human brain. In: TIrc Cambridge encyclopedia of human eaolution.
pp.1.15,779,L23
78 Rose S.The conscious brain. revised ed. England: Penguin Books, 1976
Chapter 2: An occupational tlreory of human nature 51

..exploratory behaaiour (and) imitøtion...are more strongly-

dezteloped than any tf them is aftxong an animal species, ea:n -if
.represent
they for those animals a fulfilment of the ffiost aital, Iife-
7e.
furthering functions'
These highly developed capacities, along with consciousness and particular

physicat characteristics, such as bipedalism, are the sPecial survival

mechanisms of humans, in that they endow unPrecedented flexibility,
enabling them to adapt to and meet the challenge of many different
environments and dangers. The "intelligence and skills of our forebears do
not only manifest themselves in the evolutionary transformations of the

brain: they can also be seen in the results of their activity"8O,

The differences in degree of caPacity, which frees people from the

of most animals, are central to the

instinctive and functional constraints
particular occuPational nature of humans, giving them their apparently
strong drive to engage in daily, new or adventurous occupations and to
undertake unwelcome or unenjoyable activities according to socio-cultural
expectations. Lrdeed, popular writers such as Desmond Morris, and Lyall
Watson contend that most people enjoy a challenge and are neophilic in that

they "actively pursue the new and different"8l. Bruner suggests it is only
human adults who 'introduce' their offspring to challenging and sometimes
frightening new experiencessz, whilst amongst both birds and other
mammals the presence of mothers is required to reduce fear of novel stimuli
to enable their offspring to explores3, If Bruner's suggestion is true, perhaps
such learning experiences are a necessary precursor for people to take risks to

create environments in which they feel comfortable, and to brave exploration

of the unknown.

79 Lor.n"K. The waning of humaneness... pp.57-58'

80
¡e[nek J.Primitive httnters. London: Hamlyn, 1989'
Sl Morris D.Ttrc lutmnn zoo. London: Jonathan Cape,1969; Watson L.Neophilia: The tradition
of the new. Great Britain: Hodder and Stoughton Ltd, 1989'
82 Br.^"rJS. Nature and uses of immaturity.Americøn psychologist.tgT2; AugusL 687-708.
83King DL. A review and interpretation of some aspects of the infant-mother relationship in
mammals and birds. Psychological bulletin. 7966; 65: 143-155'
Chapter 2: An occupational theory of human nature 52

Some suggest that humans appear to go beyond survival needs in their

pursuit of occupationsa" The range of capacities available to humans certainly

allows them to pursue many oPtions which may not aPPear to have an
obvious relationship to survival, but much deliberation about this point has
led me to the position taken in my theory, that this extended ability is an
integral part of healthy survival mechanisms, h that engagement in wide
ranging occupations enables people to hone their skills, their caPacities and
their flexibility so that they are competent to deal with novel situations as
they occur, as well as providing exercise to maintain the "well working of the
organism as a whole"85. This freedom and flexibility has, along with genetic
and biological variability, resulted in humans from different regions of the
world appearing 'different'. A large part of the difference can be attributed to
the occupations in which their forebears have engaged over time, and the
value given to them by the culture in which they live, because, as Richard
Leakey, the anthropologist, observes

the most pronounced differences are the wøy in which people do

things: theit dress, their architecture, their myths, their songs, their
ideøIá and so on...The earth is populøted by one people liaing many
different styles of ltfe because of aunique cultural capacity. f"d the
*¡na thøi expresses this unique cøpøcity is the one that also
uniaersally seeiks beyond itselffor explanations of man himself and
the natuie of the world around him." 86
Indeed, from birth children, through their predominant occupation of play,
seek beyond themselves for explanations of the world and their place within
it. As they do this they develop their innate capacities through learnt
behaviours, through practising skills, and using their minds and bodies to
enable them to survive, to interact with others, and to choose future roles. In

going beyond obvious survival needs in their pursuit of occupation people

evolve and adapt as occupational beings according to their environment and

S4Morris D.The human animal England: BBC TV Production,1994.

85Kass LR. Regarding the end of medicine and the pursuit of health. In: Caplan AL, Englehardt
HT, McCarÈrey fl,"editors. Concepts of health and disease: lnterdisciplinary perspectiaes.
Massachusetts: Addison Wesley Publishing Co', l'981'
86 Leakey R.Tlrc making of mankind, London: Michael Joseph Ltd.,7987, p.248.
 2: An occu pational theorv of human nature 53
Chapter

cultural values. The brain's capacity to adapt to social environs different

from those in which humans evolved has led to "culture itself" creating
"norms of human behaviour that, in a certain sense, can steP in as substitutes

for innate behaviour Programs"87.

The ability of humans for socio-culftrral adaptation enables infants at a very

to assimilate and retain information from the environment, before
early age

a conscious appreciation of meaning or significance is possible. This early

absorption of observed behaviours enables ontogenetic development to be in
step with socio-cultural expectations. In fact, the complexity of the human
brain as the species survival mechanism means that human babies are not
able to reach a stage where they can take care of themselves before birth, and

they require social support for many years to assume 'full humanness'. As

part of this process, attitudes, as well as occupational behaviours are absorbed

and. adopted, and it is those formed before intellectual capacities are
sufficiently advanced to allow for adequate understanding or refuting, that
have the strongest, albeit 'unconscious', hold on individuals. This

mechanism was central to early humans healthy survival because it allowed

essential learning to occur from birth, and stimulated the development of

capacities. Their view of the strength of such learnt attitudes and behaviours
led founding behavioural psychologists Watson and Skinner to argue that

only physiological reflexes are inherited, Watson going as far as to claim

" gilse me a dozen healthY infants,
world to bring them uP in ønd
random ønd trøin him to become i
doctor, Iawyer, artist, merchant
thief regørdless of his tølents, penchants, øbilities, aocations, ønd røce
of his ancestors" 88.

87 Lor.nrK. The waning of humaneness... p.124'

88wutro., lB.Behauiottrísm,1924, revised 1930. New York: W.W' Norton,797O, p104; Skinner
BE.Science and hunnn behaaiour. New York: Macmillan, 1953.
Chapter 2: An occupational theory of human nature 54

Sociologists might not accept Watson's exaggerated language but a similar

understanding by them has led to one of sociology's fundamental Postulates,
that human actions are limited or determined by Past and Present
environments, and that humans are the products and the victims of their

societySg. Sociologists, in contrast to socio-biologists, also reason that "human

beingS are made, not born" because, "even if someone argues that human
endowments such as soul and rationality are innate, these gifts are not
sufficient to ensure that an infant will become a truly functional human

being, capable of ethical and cultural responsibility", and that "the infant has

to be learned...in short, we enact, rehearse, work, and play our way into the
human condition"e0. However this implies that people have the genetic and
biological capacity to learn which is also part of being human. My
occupational theory of human nature holds that, because of humans'
particular mix of biological characteristics and capacities they are receptive to
the process of enculturation and socialisation to the extent that they can

indeed be considered products of their particular culture.

It is also held in my theory that societies are the product of humans acting
on their environment. As people engage in occupation the physical and

social environment is altered. Often, the more sophisticated the occupation

the greater the change to the environment which in tum causes further
change to and development of people. Karl Marx suggests that "by thus acting

on the external world and changing it, [man] at the same time changes his
own nature'91, and Braverman, in the same vein, proPoses that people are
the special product of purposeful action. He argues that occupation which
"transcends mere instinctual activity is the force which created human kind

and. the force by which humankind created the world as we know it"e2. Neff,

89shil, E. Sociology. In: The social science encyclopedia... pp.799-810.

g0Drivur T.The magic of ritual. SanFrancisco: Harper Collins Publishers, 7997' p.16.
91Mur* K.Capital. Volume 1...pp 179-180.
92Bruu"t** H.Labor and monopoly cnpital...
Chapter 2: An occupational theory of human nature 55

who is not a Marxist, agrees that the most revoiutionary force in human
history is technological change associated with the way PeoPle "wrest their
living from nature"93. He argues that social institutions are merely mirrors
of technological levels. This idea, apparently well accePted in archaeological
circles, as well as Marxist sociology, supports the theory that humans are
occupational beings, that occupation has the potential to change the world or
the species, and that it provides the mechanism to enable people to survive,
and to adapt to biological, sociological and environmental demands. This
view points to the need to consider human's occupational nature from an

ecological as well as sociological perspective.

The many models of cultural evolution based on occuPational technology

are sometimes said not to address sufficiently the influences of other

variables such as local environments, ecology and climate, war and conquest,
spiritual beliefs and social struggles, or the complexities of the interactions
between theme4. From my standpoint, there is some truth in the criticisms
because such views have been limited to economic 'work' or 'labour'

perspectives, neglecting an holistic view of occupation which of necessity

integrates many factors. Other criticisms have been levelled at the notion of
cultural evolution itself, particularly as postulated by Victorian

anthropologists such as Tyleres and Morgane6, in that it seems to imply

progress in the sense that advanced technological societies are someho'¡¡

'better' or 'higher up the evolutionary ladder' than older cultures with less
technical economieseT. However, the notion of cultural superiority is called
into question by the argument that cultures can vary independently of race,

93N"ff WS.Work and human behaaior.3rd ed. New York Aldine Publishing Company, 1985,
P.20.
94N"ff WS.Work and lutman behnuior'..
95Tylo, EB. Antfuopotogy: An introchtction to tlæ stttdy of man nnd ciailizntion. 1881'. University
of Michigan Press, 1960.
96Morgur, L:i^.Ancient society.1877. \,Vhite LA, editor. Cambridge, Mass.: Belknap, 1964.
97 N"ff WS.Work and human behaaior...
Chapter 2: An occupational theory of human nature 56

and that no one culture is superior to another9s. Similarly the occupational

nature of humans is not seen to be more evolved in technologically advanced
societies in contrast to hunter-gatherer or agrarian societies but, rather,

expressed differently according to each culture's history, and technological

development.

Having outlined the main concepts of this occupational theory of human

nature,I turn to considering the last two points of Stevenson's notion - that
any such theory has to include a diagnosis of 'what is wrong with humans',
and a prescription of how to 'right the wrongs' from it's particular
perspective.

As to diagnosis, I maintain that, although the occupational behaviour of

early humans was in tune with self-sustaining 'natural'health and ecological
balance, the current direction of occupational behaviour is out of step with
human's animal heritage, natural behaviours and the ecology. This echoes a
sentiment expressed by Alexis Carrel, in 1935, that modem civilisation "does
not suit us", being "born from the whims of scientific discoveries, from the
appetites of men, their illusions, their theories, and their desires" but
"without any knowledge of our real nature". He argued for a science of
human individuals which views them as "arÌ indivisible whole of extreme
complexity"ee. It could be suggested that in the present day knowledge of

human nature remains rudimentary, and that Carrell's science is still

necessary despite an avalanche of research in various disciplines in recent
decades. The knowledge is certainly fragmentary and, without a real
appreciation of the human need to engage in occupation, it is incomplete.

98Hut"h E. Culture. In:Tlrc social science encyclopedia... p 779'

99carrel A. Man tlrc unknown London: Burns and Oates, 7935'p'1'4'
Chapter 2: An occu pational theorv of human nature s7

As for a prescription of how to 'right the wrongs', addressing the lack of

awareness of our occupational natures has the potential to influence social,
political, economic ancl health policies so that they are more in tune with our
occupational nafllres, self-sustaining 'natural'health and ecological balance.
More concrete solutions do not seem advisable, as theories of human nature
which are pfescriPtive, such as 'Marxist Communism', do not allow
sufficient flexibility to allow solutions to be resPonsive to contextual and

evolutionary change.

Gaining an increased understanding of this perspective of human nature is

worthy of further extensive inquiry as it appears aPPropriate to many of the
problems the world faces today and in the future, namely how to maintain
health and ensure human survival in an economic and self sustaining way,
which meets the biological, sociocultural and occupational needs of people as
well as redressing ecological degradation. Because of the nature of the
approach taken in the thesis, the exploration which follows can only touch on

these wide ranging issues, although it is acknowledged that each requires

study in their own right.

In summary, the central core of this occupational theory of human nature

is the proposal that the superprimate brain of the human species has 'healthy
survival' as its primary role. It is a brain which continually activates
human's particular mix of characteristics and capacities through engagement
in occupation. It is an occupational brain and a healing brain. Our
occupational nature is the result of evolution/phylogen|, genetics, ontogeny,

ecological and socio-cultural environments, and opportunity all of which are

centred or integrated in the brain. Engagement in occupation forms a three

way link with health and survival which is illustrated by Figure 2.3.
Chapter 2: An occupational theory of human nature 58

Health
Biological needs
met

SURVTVAT
PRIMARY HUMAN
DRIVE

Occupation
Provides
Protects
Maintains
Nurtures

Figure 2.3: Three-way link between occuPation, health and survival.

Survival is recognised as the primary drive of humans, as of all other

animals. Survival of individuals is the outcome of the use of capacities
through occupations which provide for essential needs of the organism,
including supportive social, ecological and material environments. The
extent and quality of survival for individuals, communities and societies

depends on their health and physical, mental and social well-being, and
health is the outcome of each organism having all essential sustenance and
safety needs met, and of having physical, mental and social capacities
is achieved through occupation.
maintained, exercised and in balance. This
Engagement in occupation depends, in turn, on a level of health, and its

specific components, which are able to provide the energy, drive and
functional attributes necessary for engagement'

Additionally, the survival of healthy species depends on the human's

capacity to live in harmony within an environment which can continue to
Chaoter 2: An occuoational theorv of human nature 59

provide basic requirements; to ensure the continued acquisition of these

requirements; and to provide safety and education for the next generation.

The integrative functions of the central nervous system which Process

external and internal information, activated by engagement in occupation,
are focal to survival, the maintenance of homeostasis, and in facilitating

health and well-being. The next four chapters, which consider biological
characteristics and capacities, occupational evolution, health and well-being,
and the prevention of illness explore the ideas behind this view of human
nature.
 Chapter 3

Biological characteristics and capacities:

The foundation for occuPational behaviour

In ord,er to substantiate one aspect of the theory, this chapter explores ideas
concerning biological'characteristics' and 'capacities' which aPPear to make
considerable contributions to occupational behaviour. Some capacities and
characteristics which have been identified as important by evolutionary
scientists, archaeologists and anthropologists will be discussed, because they
are adaptations which set humans apart from other mammals. As these are
explored ideas about the potential role of these capacities in survival, health
and well-being, and how they can be used in occupation for self maintenance,
development and growth, will also be considered'

The chapter focuses mainly on the central nervous system (CNS), because it

is the brain which coordinates and controls human's engagement in

occupation. Flowever, it is important to recall that, according to this theory,
the CNS cannot be studied in isolation because, for example, "the shape of an
animal's body is as important to the functioning and evolution of its brain as
the shape and functioning of the brain are to the behaviour of that body", and
inevolutionary terms "the shape of cells, tissues, organs, and finally the
whole animal - is the largest single basis for behaviour"l. Sources for much
of the material comes from the neurosciences, along with that from

archaeologists and anthropologists who explore the biological development of

humans through brain size and structure, physiological capacities such as

l Edulrnun G.Bright air, brilliant fire: On tlrc matter of the mind'London:Penguin,1992,pp.51'

48.
Gerald Edelman's work, centred on his theory called 'Neural Dnnuinism,'has been
described
;,f," first biological theory of individuality and autonomy' by Oliver Sachs in the New York
",
Review of Books, and as such is very relevant to the themes in this thesis'
Chapter 3: Biol oqrca I characteristics and 61,

bipedal locomotion and hand function, and evidence of intellectual function

such as language, all of which are prerequisite to complex occuPational
behaviour such as tool manufacture.

To consider the links between use of capacities/ engagement in occuPatÍon,

health and, survival it is necessary to first define what is meant by'capacity'.

Texts and articles reviewed in the course of exploration of 'capacity', use

words such as 'genetic potential', 'characteristic', 'trait', 'talents'and 'ability'

interchangeabty. Both academic and popular dictionaries and thesauruses use
words such as faculty, capability and trait to describe capacity. These in turn
extend our understanding, with capability defined as "power of undeveloped
faculty", and faculty as "aptitude for any special kind of action; Power
inherent in the body or an organ; (and) mental Power"2' 'Trait' has
synonyms such as 'characteristic quality', 'distinguishing mark', 'attribute',
'feature', 'peculiarity', 'speciality' and 'idiosyncrasy'3, but in most instances
implies an observable rather than a potential aptitude. Capacity, then, in this

context, is used to mean the innate and perhaps undeveloped potential,

aptitude, ability, talent, trait or power with which each individual is endowed.

Species characteristics and range of capacities express the essential difference

of one species of animal from another. Complex occupational behaviour
differentiates humans from others and allows humans to adapt to, and
survive healthily in, many different environments, and it is "expansion of a
standard primate brain" which has provided humans with

behaaioural possibilities undreamed tf in other even closely

relnted, species. This brøin,..giaes us the humøn potential fo,

2 Th, standard English desk dictionary, Znd ed. @ Oxford University Press, 1'975; published for
sale in Australia and New Zealand only, Sydney: Bay Books,1976
3 Roget pM. Rogef 's tlæsaurus of synonyms and antonyms. London: The Number Nine Publishing
Coäpur,y. tgiZ; Word ; The Austrnlian Thesaurus. Sydney: Reader's Digest,1983.
finder'
 Bioloeical characteristics and capacities: 62
Chapter 3

making tools, talking, planníng, dreaming tf the future, and

creatiig an entirely iew ennironment for ourselues"

This point leads us, naturally, to consideration of the evolution, structure and
function of the brain.

The "rather haphazard and seemingly disorganised set of structures"S in the

brain evolved in 'archaeological' layers as animals adapted to different

habitats, climates and subsistence demands. Each layer maintained stability
and health of the organism as conditions changed, and each layer added a new

dimension to occupational behaviour. Herbert Spencer, an evolutionist

social philosopher, (L820-L903), was the first to argue that "the brain evolved
in a series of steps, each of which brought animals the capacity to engage in a

constellation of new behaviours", and John Hughlings-|ackson(L835-L911), an

English neurologist, who based his work on Spencer's theory, recognised that
the cortex has a special role in purposeful behaviour which is supported by
subcortical areas concerned with more elementary forms of the same
behaviouÉ.

Although in the 1.990s it is generally accepted that the brain is organised

according to 'systems', some neuro-scientists still refer to the human brain's
functional hierarchy based on phylogenic evolution. The brain stem is the
oldest part of the brain which developed before the advent of mammals. It
controls the simplest life support systems such as breathing, heart rate and
general alerting to predators oÍ prey. The limbic system evolved to ensure

stability of the organism on 'land', which called for structures to maintain, for
example, intemal temperatures, fluid levels and emotional reactions such as

4 Campbell BG.Humankind emerging.Sth ed. New York: Harper Collins Publishers, 1988,
pp36a-365.
5 Omstein R, Sobel D.The healing brain: A rndical naþ ßWronch to health care. London:
Macmillan, 1988, P.36.
6Kolb B, Whishaw lQ. Fundamentnls of human neuropsychology. 3rd ed. San Franscico: W H
Freeman and ComPanY, 1990, P.123-
 63
Chapter 3: Biolosical characteristics and capacities:

those concerned with self protection. The cerebellum was Probably the first
area to specialise in sensory-motor coordination, and is integral to efficiency
of skilled movement. The cerebral cortex is the most recent layer. It is here
that the processes occur which make humans most different from other
animals, Such as their capacity to analyse, organise, understand, Produce,

judge, plan, activate, sense, formulate and execute occupatiod. Some of these
processes, such as "the perceptual systems of seeing, hearing and language

comprehension" are more structured than others such as "thinking and

imagining, learning and judging" so although "we can Perceive the world
only in certain modes, we can think about the finished products of perception,
embellish them and manipulate them in many different ways". Such cortical
functions give humans the "capacity to adapt culturally...enabling (them) to
insulate themselves from the environment and to exploit the

environment"S.

The growing knowledge about the relation of brain strucfure to behaviour

demonstrates "...enormously intricate brain systems at...molecular levels,
cellular levels, organismic levels (the whole creature), and transorganismic
levels (that is, communication of some sort or other)", all of which inter-
connect. In the cerebral cortex alone it has been estimated that there are
between twenty to a hundred billion neurones, and about one million billion
connections all of which are capable of many combinations so that "the sheer
number and density of neuronal networks in the brain" reaches

"hyperastronomical" figures, and "the brain might be said to be in touch more

with itself than with anything else". Indeed "the kinds of unique
individuality in our brain networks makes that of fingerprints or facial

7 Kolb B, \rVhishaw I Q. Fundømentals of human neuropsychology. Omstein & Sobel D.The

healing brain.
8 Campbell BG.Humankind emerging. "'PP'55, 374-378'
Chapter 3: Bioloeical characteristi cs and caoacities: 64

features appear gross and simple by comParison'g. Many neurones, each of

which is "unusual in three respects: its varied shape, its electrical and
chemical function, and its connectivity", have specific potentiallo. In fact
"very specific patterns of behaviour are determined by very sPecific brain
areas", 1r,ith "each behavioural system probably (having) its own underlying
neurophysiological mechanisms"ll. Different brain areas have different cell
formations which have been described in functional and cytoarchitectonic

maps12. "Mapping is an important principle in complex brains" and the fibres

that connect maps with each other "are the most numerous of all those in the
brain"13

Mapped areas of the brain which have been identified with specific

functions do relate to occupational behaviour, although the "complexity of

the brain's structure makes it incredibly difficult to relate it's components to

individual capacities"l4. This is also because capacities themselves are

incredibly complex systems. In fact the complexity of brain organisation, as it

relates to occupation and to capacities, is one factor in the difficulty
experienced throughout history in understanding what happens where. For
example, Kolb and Whishaw report in a history of neuroPsychology that

whilst Alcmaeon of Croton (c. 5008C), Hippocrates (430-3798C) and Plato (42G
g47BC) subscribed to a view that located mental processes in the brain,
Empedocles (c. 490-4308C) and Aristotle (384-3228C) believed the heart to be

the source of mental functionsls. Galen (129-199AD), refuted Aristotle's view

9.Sp"rry R. 1982. Some effects of disconnecting the cerebral hemispheres. Les Prix Nobel l'981'

pp.209-2L9'
10 Ed"l^"r, G.Bright air, brilliant fire'..pp.7, 16-19.
ll Snell GD.Search for a rational ethic. New York: Springer Verlag, 7988,pp.147,765.
12 penfield W, Boldrey E. Somatic motor and sensory representation in the cerebral cortex as
studied by electricäl stimulation. Brain, 1958;60: 389-443; Brodmann K. Vergleichended
Iokalisatións lehre der Grosshirnrinde in prinzipien dargestellt auf grund des zellenbaues.
Liepzig: JA Barth, 1909.
13 Ed"t*ur, G.Bright air, brilliant fire ... p.19.
14 Kolb B, Whishaw I Q. Fundamentals of humnn neuropsychology...P'4'
15 rolb B, Whishaw I Q. Fundamentals of human neuropsychology"'
 65
Chapter 3: Biological characteristics and caPacities:

following experiments in which he applied light pressure to heart and brain,

and found pressure to the brain stopped voluntary behaviour. Eighteenth
century anatomists Franz Joseph Gall and Johann Casper Spurzheim are
credited with originating the localisation of function argument' Th"y
cleveloped a theory of phrenology, in which specific caPacities of the brain
were attributed according to the bumps and depressions aPParent on the
surface of individual skulls. However, in large part, because they assigned
capacities derived from a value laden philosophical view, such as

'veneration' and 'secretiveness' rather than from observable behaviours,

their contribution was rejected. In recent years localisation theories have

been substantiated with the proviso that any area with a specific function does

not work in isolation. hr fact, the complexities of the interactive nature of

specific areas of the brain has been demonstrated by the 'zenon 133' studies of
brain activity in which a two dimensional measure of regional blood flow was
taken during performance of tasks as compared to a 'resting state'. It was
found that the frontal lobes were relatively active bilaterally even at rest, and
that just simple movement of the fingers involved activity of many different
areas16. Such complexity has been confirmed by three dimensional 'positron
emission topography'which has been used to image the neuronal activiV of
both hemispheres and deeper brain structures during use17.

Complex and integrative neuronal activity at many levels and the notion of
localisation of function are not incompatible, and if the former is kept very
much in mind it is possible to accept that:

Larr"r, NA, lngvar DH, Skinhoj E. Brain function and blood flow.scientific American
16 L978;

239: 62-71.; Roland PE. Applications of brain blood flow imaging in behavioral
neurophysiology: Corticaf iield activation hypothesis. In: Sokoloff L, editot' Brain imaging
and biaii fmclion. New York: Raven Press, 1985, pp'87-L04'
l7Kety SS. Disorders o American7979;241:202-274; MazziottalC,
nhálps ME. Human studies of local brain metabolism: Strategies
and iesults. ln:Brain fion; Restak R'The brain' New York: Bantam
Books, 1984.
 66
Chapter 3: Biological characteristics and capacities:

"Inside the cortex lie separate centers 'u)ith specific functions, which
we like to caII talents. Mathematical ability is a sepørate talent from
the ability to mol)e Sracefully; aerbal agility is distinct from ,, the
preaious iwo. There is a range o! dffiryt functions, for smell.ing,
'þr thinking,
for ffioainç, for calculating that the brain possesse5."78
However, talents "are not given equally to all of us; PeoPle are not aS
consistent as we might have imagined", and recognising this, Ornstein and

Sobel contend that in order to understand the brain's operation, as well as its
concern with health, it is necessary to study the 'collage' of "specialised neural
systems each of which possesses a rich concentration of certain abilities"

which are talents of a specific nature, or of generic organisation or tendencylg.

One such study led Gagne to propose a 'differentiated model of giftedness and

talent', which identifies giftedness as 'aptitude' and talent as 'fulfilment or

activity performance', with aptitude being translated into talent via
environmental and. intrapersonal catalysts. Gagne grouPs aptitudes and
talents into aptitude domains, such as intellectual, creative, socio-affective
and sensorimotor, and fields of talents such as, academic, technical, artistic,
interpersonal and athletic2O. As well as primary capacities such as seeing,
standing, perceiving colour or touching, which are complex physiological

processes in their own right, there are other more complex capacities such as

problem solving, exploration, consciousness, creativity, and So on. These

more complex capacities do not appear to be based on specific maPS but are
examples of the integrative workings of many independent and inter-
dependent systems.

In order to corroborate the idea that individual variation in capacities is

genetically endowed, the next few pages will consider ideas and evidence
from studies relating to genetics, including those on twins, race, gender and
ontogenesis.

18 Omstein R, Sobel D.TIrc healing brain.'.p.39.

19 Ornstein R, Sobel D.TIrc healing brain.-.pp.39,57'
20 Gugr," F. Toward a differentiated model of giftedness and talent. In: Colabango N, Davis G,
editors. Hnndbook of grfted education. Massachusetts: Allyn and Bacon, 1991.
 Biolosical characteristics and caPacities: 67
Chapter 3:

Although, in common with other animals, the range of human caPacities

is, on the whole, common to the species, individual variation is the rule' For
example, in an early classic experiment on fowls, JBS Haldane (1892-7964)'
who is credited with the first case of genetic linkages in mammals, found that
when he mated fowls weighing an average 1300 grams, with bantams
averaging 750 grams there was a tendency for the weight of their hybrid
offspring to split the difference between their parents weight. \,ltrhen hybrid
mated hybrid the variations that ensued produced birds with a range of
weights from much greater to much smaller than the grandparents.
Inheritance is 'cooperative' in that genes as part of a 'gene complex' combine
or interact, and it is usually more than one gene that produces a single trait.
Haldane estimated, in his experiment, that if ten genes had an effect on
weight they could produce 59,049 variations2l. In the present time, as
geneticists and biologists have come closer to understanding the structure and

function of genes by using biochemical technology, ranging from

electrophoresis of proteins to very sophisticated analysis of DNA structures,
,'they have uncovered inherited variation, or polymorphism, at almost every

level of organisation" to the extent that "it is certain that every human being
who has lived or ever will live is genetically ünique"22. The biological
processes that have increased genetic variability throughout evolution are

"mutation, sexual recombination, genetic drift, gene flow, and increase in

population size"Z3, so that except for identical twins every individual carries
different genetic material.

Despite some methodological flaws which discredited early findings in

some 'twin studies' which sought to explore the relative roles of nature and

21 Haldan" JBS.The c(utses of anoltttion Longmans, Green 1932. Reprinted Ithaca, New York:
Comell UniversitY Press, 1966.
Martin R, Pilbeam D, editors. Th¿ Cambridge
22
¡on"rS. Genetic diversity in humans. In: fones S,
Lniyclopedia of human eaolution. Cambridge: Cambridge University Press,7992,pp-264'267.
23 Campbell BG. Hurnnnkind emetging...pp'86-87.
 3: Biological characteristics and capacities: 68
Chapter

nurture in behaviour, there is now abundant evidence from these that

capacities are part of our genetic inheritance. In studies of genetically identical

twins compared with fraternal or non-identical twins, Plomin, DeFries and

McClearn found that the general cognitive ability of identical twins was more
alike than those of fraternal twins n
of L8 studies, which included over
17

6,000 identical and non-identical twin pairs.2a Other traits such as

schizophrenia, drinking habits, homosexuallty,criminal tendencies, Prosocial
behaviour and personality characteristics have consistently been found more
similar in identical twins2s. Following study of 850 pairs of twins Loehlin and
Nichols concluded. that "genes and environment carry roughly equal weight
in accounting for individual variation in personality"26, although

Vandenberg suggests that the relativity of heredity and environment varies

according to specific capacities2T.

With regard to variation in neurophysiological Processes, not even

identical twins have "the exact pattern of nerve cells..'at the same time and
placs"z8. Nor have they exactly corresponding numbers of branches of any
one neuron because of "the stochastic nature" of the 'topobiological'29 and

24 ptornir, R, DeFries ]C, McCleam. Behaaior genetics. A primer' San Francisco: W.H. Freeman,
1980.
25Snell GD.Search for n rationnl ethic....
26LoehlinJC, Nichols RC.Heredity, enaironment and personality: A study of 850 sets of twins.
Austin: Texas University Printets, 1976'
27 Vandenberg SG. Hereditary factors in psychological variables in man, with special emphasis
Aldine,
on cognitioã. In: Spuhler þÍ, editor. Genitíc diaersity and human behnaior- Chicago:
1967, pP.99-133.
28 Ed"lttut G.Bright air, brilliant fire...p-64.
2gTopobiology ('topos' meaning place) is a term used by Edelman in his theories about brain
evolution because rnany trañsãctions between cells leading to'shape' are place dependent.
See: Edelman G[.Topobiology: An intrcduction to moleatlnr
embryology' New York: Basic
Books, 1988.
 Biological characteristics and capacities: 69
Chapter 3:

'epigenetic'30 "developmental driving forces provided by cellular processes

such a cell division, movement and death"31.

Ilt evolutionary terms factors which increase or decrease individual

variability include contentious issues relating to race and gender. These will
be briefly considered because central to this thesis is the notion that increased

awareness, and encouragement, of the unique potential of individuals is

important and, if there are differences according to race or gender, apart from
individual genetic inheritance or cultural learning, this should not be
overlooked in 'socially just' research or intervention aimed at individual or
community health and well-being through engagement in occupation.

The biological processes in question for race are those that decrease
variability within particular groups, such as when "natural selection and
reduction in population size" results in the 'founder effect' in which different
gene frequencies are perpetuated in isolated communities32. Examples of this

type lead to speculation that some differences in capacities may well be found
in people of different races, who, particularly because of geographical isolation
over a long period of time, inherit variations fitted to their environment
through the processes of natural selection33.

Whilst the "overwhelming majority of genes of homo sapiens are shared

by all mankind, a relatively small percentage is believed to control those

30Epigenesis is the "development of an organism from an undifferentiated cell, consisting in the _

successive formation and development óf organs and parts that do not preexist in the
fertilised
oott'
-Þo
lÃlOorland's illlstratecl medical dictionnry.25th edition. Philadelphia: W B Saunders, 1974,
p.530.
31 Edelmat G.Bright air, brilliant fire...p.25'
32 Campbell BG. Humankind emerging...p'86-87'
33S"", fàr example: Coon CS. Rncial adaptations: A stttdy of the origins, nsfite and significance
of rncial anriations in \utmans. Chicago: Nelson Hall,1982; Mellars P, Stringer C, editors.
ih, lrr,,non reao¡ttion: Behaaiotral anã biologicnl perspectiacs on the origins of modern
humans. Edinburgh: Edinburgh University Press, 1989'
 3: Biolo eical characteristics and capacities: 70
Chapter

features which differentiate the races from each other"34 Anatomical

differences which are adaptations to past or Present environments, such as

hair, eyelid, breast or iip form, pigmentation, frequencies of balding and body
build are easily demonstrated. There are also physiological differences such as
in blood groups, basal metabolic rate, bone growth, age and order of tooth
eruption, and subtle variations which give rise to diseases like 'sickle cell
anaemia', 'phenylketonuria', 'favism'or 'familial Mediterranean fever'35. It
is possible, of course, that such differences may, in the future, be found to
result from environmental factors, such as nutrition. Anatomical and
physiological differences may account for some particular skills more
prevalentin one racial group than another, such as in athletics, as evidenced
by particular negroid groups. As well, differences in the occupational
behaviours characterising some cultures may result, in part, from particular
genetic inheritance. Despite suggestions that there may be racial differences in
Ie, mechanical and abstract reasoning, form discrimination, colour sense and

tonal memory36, some investigators stress that race is based on genetic

physical traits rather than mental traits.

Indeed, the race concept itself has been challenged37. Littlefield, Lieberman

and Reynolds found that of 58 texts that appeared between 1932 and 1979 only

twenty-five accepted the race concept, whilst seventeen did not' The
remaining sixteen were non-committal, said there was no consensus or did
not mention the subject. There was, in fact, an evident swing away from the
concept of race in more recent texts38. Whilst this may reflect data from new

stud.ies it may also reflect changes of ideas and values about racial differences

34Tobias PV. Race. ln: The social science encyclopedin"' p'681'

35 Campbell BG. Humnnkind emerging...
36 GarnSM .Human races .3rd, ed. Springfield, Ill.: Thomas, 197t; Garn SM, editor. Readings on
race .2nd ed. Springfield, Ill.: Thomas, 1968'
3Tlewontin RC. The apportionment of human diversity. Eaolutionary Biology 1972;6:381-398'
38Littl"fi"ld A, Lieberman L, Reynolds LT. Redefining race: the potential demise of a concept in
physical anthropology. Cttrrent Anthropologl¡ 7982; 23(6): 641'647.
Chapter 3: Biological characteristics and capacities: 7l

and concerns about discrimination. Many scientists working in this area

express concern about differences being viewed as evidence of suPeriority or
inferiority. To counter possible racism some investigators have developed an

environmental hypothesis which suggests that differences, particularly

concerning IQ scores, are attributable to cultural factors39, and Tobias observes
that "at this stage of our ignorance it is unjustified to include intelligence,
however tested, among the validly demonstrated, genetically determined
differences among the races of mankind"40.

As IQ tests measure ideas and intelligence values of the societies who

devise them, they are only valid in that environment. What is deemed
intelligent and valued by other cultures may not be the same capacities. One
capacity is not more valuable than another outside a particular context, they
are just 'different', and the notion of difference in capacities due to racial

'fitness' does not imply racial superiority or inferiority but rather a cause for

celebration and pride of particular capacities and human adaptability to

environmental circumstances. However aS world travel, migration,

multiculturalism and inter-racial marriage increase, what differences there
are between racial groups will decrease, as gene flow decreases variation

between populations but increases variation within themal. Appreciating

possible differences in capacities between individuals from different racial

backgrounds may be as important to health and well-being as recognising
species similarities and cultural diversity, if it assists in recognising and

enabling expression of the unique range of capacities of each individual that

will enhance individual and community experiences of health and well-
being.

39scu.r S. Røce,social class and indiaidunl differences. New fersey: Hillsdale, 1980; Scarr-
Salapatek S. Race, social class and IQ' Science1977;174:.
40 toUiu, pV. Race. ln: Kuyper A, Kuyper |, editors, TIrc social science encyclopedia. London &
NewYork: Routledge, 1985, P'682'
41 Campbell BG' Humankind emerging"'
 3: Biological characteristics and capacities: 72
Chapter

Similarly there may be differences in capacities between genders because of

the evolutionary pressures of natural selection and hormonal differences,
which are under the control of genetic influences Not only do levels of
testosterone, estrogenic hormone and progesterone account for differences in

male and female behaviour, btrt, in addition, Kolb and Whishaw report,
following an examination of behavioural, anatomical and neurological

studies, that there are significant gender differences in cerebral organisation

including cerebral maturation rates, cerebral laterality, language and spatial

capacitiesa2. For example it is thought that the gene for spatial ability is
recessive on the X (femate) chromosome, that males require only one X
chromosome but that females require both X chromosomes to carry the gene
before spatial ability is demonstrated. With this model it is possible to predict

that while fifty percent of males would possess the trait only twenty-five
percent of females would, although some females would demonstrate greater
ability than average malesa3. As well it seems that differences in cerebral

maturation rate can result in different capacities. It has been proposed that
males generally mature physically and mentally more slowly than females,
and that maturation rate is a critical determinant of cerebral asymmetry.

Although there must be, or have been, some adaptive advantage in laterality,
such as more storage space with the subsequent potential for a greater range of

skilled capacities, there are no compelling theories as to PurPose to this date,

and, indeed, theories of laterality, as they \ rere proposed, twenty or so years
ago, arebeing challenged by some neuro-scientists in the 1990s44. Waber has

demonstrated that regardless of gender, adolescents who mature early

4?Kolb B, Whishaw rQ. Fundamentals of humnn neuropsychology"'

43Harris L|. Sex differences in spatial ability: possible environmental, genetic and neurological
factors. In: Kinsboume M, edilor. Asynnretricat fimction of the brain. Cambridge: Cambridge
UniversitY Press, 1978.
44xolb B, Whishaw I Q. Fundamentals of lumnn neuropsychology"'
 IJ
Chapter 3: Biological characteristics and capacities:

perform better in verbal tasks and those who mature later Perform better on
spatial tasksas

Waber's material supports the idea that just as caPacities can differ between

individuals, races and genders so are there differences because of age as

discrete neurophysiological mechanisms start functioning at specific times
during ontogenesis. This can be observed when infants become responsive,
often quite suddenly, to specific external stimuli"46. Il1 fact because
"connections among the cells are...not precisely prespecified in the genes",
epigenetic processes start in embryo when "key events occur only if certain

previous events have taken place"47. After birth, apart from obvious physical
capacities, such as crawling, walking and talking, whose aPPearance are well

documented, "at a certain point in ontogenesis, each individual begins to

realise his or her own powers to direct attention, to think, to feel, to will, and
to remember. At that point a new agency develops within awareness. This is
the self"48 . With knowledge of the self comes an increased need to conform

with others of the species, and to demonstrate particular skills and capacities
which are socio-culturally valued. Capacities, therefore, also vary between
individuals as theY

change in aariorts zaays as an indiaidual Srows ttp, since eaery

competence need not høae appeared fu-Ily formed øt birth. Some
com.petencies improae with leørning old prnctice during childhood
ønd youth, ancl aII do not improae at the same rate, or necessørily are
perfeèted during a lifetime"4e.

Capacities are the building blocks of unique occuPational natures and

personalities, despite the remarkable sameness in the range of capacities

4swub"r Dp. Sex differences in cognition: A function of maturation rate? Science,1976;192]. 572-
573
46Campbel|l.Winston Churchill's aftcrnoon nap. London: Palladin Grafton Books, t986,p.766.
47Ed"I^ut G.Bright air, brilliant fire...p.23.
4Scrikr""rrrr,ihalyi M, Csikszenmihalyi IS, editors. Optimal experience:Psychological studies
of flow in coniciottsr?ess. Cambridge:Cambridge University Press, 1988,
p.20.
49 CampbellJ.Winston Clntrchill's afternoon nap"'p'290'
Chapter 3: Bioloeical characteristics and capacities: 74

available to human beings. Subtle variations between humans lead to

amazing differences in occupational interest, comPetence and satisfaction
which grow or diminish according to envirorunental demands, enculturation
and individual opportunity. "No two mixes of the inner and outer factors are
just alike"SO. The external variables increase individual differences in
capacity, in part, because of structural change which results from the neuronal
demand.s of activity, so it is not surprising that the "brains of individuals vary
in features just as the faces of individüâls vary"51.

purposeful use of time is also part of our biological heritage, as Selye

observes: "our braiÍì. slips into chaos and confusion unless we constantly use

it for work that seems worthwhile to us" however much "the average Person
thinks he works for economic security or social status"52, and the human
need to make use of capacities is evident from very early in evolution. (This

need. will be discussed further in chapter 5). Because the type of purpose and

nature of occupation depends upon humans particular capacities, the chapter

will now turn to consider some of those capacities which are critical to

complex, self-initiated occupational behaviour, and which are also focal

points in debates about evolution and about humanness. The human

capacities of upright walking, hand dexterity, stereoscopic vision, language

and social nature are prime examples. Campbell suggests that these particular
capacities have "overwhelming significance" and when "added together
separate all humans from all other animals"53. The first four of these will be

discussed now, and the social nature of humans in the next chapter'

S0snell GD.Search for n rational ethic."'p' 740'

51Kolb B, Whishaw I Q. Fundømentals of humøn neuropsycholow."P.4'
52selye H, Monat A, Lazarus RS. Súress and coping: nn anthology. 2nd ed. New York: Columbia
UniversitY Press, 1985, P.28.
S3Campbell BG. Hnnnnkind emerging"'p'47'
 : Biological characteristics and caoacities: 75
Chapter 3

Upright posture seems to be one of the most ancient of the sPecies

particular features "associated with the ecological adaptations of early
hominids"S4. Evidence such as fragments of a four million year old thigh
bone found in Ethiopia, and the discovery in Laetoli of a trail of footprints left

by three hominids in volcanic ash more than 3.5 million years ago, Ieads to
anthropological opinion that hominids stood like humans before they could
think like humans. Lewin suggests that the explanation of bipedalism which
currently enjoys the most scientific support is that upright walking was a
biological adaptive response to accessing traditional foods in a changing

environment; that a more energy efficient mode of walking was required

because food sources became dispersed with climatic and subsequent
environmental changesss. Another explanation is based on the fact that
human young, who take a long time to mature, are dependent on their
parents to carry them, unlike other primate offspring who are able to cling to
their parent's long body hair. Erect standing and bipedal locomotion enabled
mothers to move about whilst using arms and hands to support their
child,rens6. However these are only two of several plausible explanations, all
of which may have influenced bipedal evolution, and some of which are
illustrated in Figure 3.1 and 3.2 on the next PagesT'

Although other animals have the ability to walk upright, humans have
developed bipedalism into an adaptation as specialised as flight in a hovering

S4Fleagle JG. primate locomotion and posture. In:The Cambridge encyclopediø of human
eaolution..'P.79 '
55 Lewin R. Ii the of Mankind: A Smithsoninn Book of Human Eaolution. Washington,
Age
D.C.: Smithsonian Books, 1988'
Hamlyn,1989'
56
¡ennek l.Primitiae hunters. London:
57 figrrr" 3.1 is taken from Fleagle fG. Primate locomotion and posture. In: TJte Cambridge
Humankind
,n\yclopeaø of httmøn *oírtion..*.79; Figve 3.2 is taken from Campbell BG'
emerging...P.259
 76
Chapter 3: Biological characteristics and capacities:

,rlþN lb
1 Carrying 1a Weapons and tools Vegetable foods,
water amd infants

I
a
al ¡ \ t
-.,*,.%Ê-.,-. t

tl
{lJ
,tl t-
I

2 Travelling between food trees 3 Feeding from bushes

.aÑut I \r irl t

4 Feeding on grass seeds 5 Provisioning family

Figure 3.1. some theories of the origin of bipedal locomotion

Need for
better infant
care
Male. help. in
Provrsronrng
Reduced
mobiliW of
f emale
Diverse male-female
feeding strategies
Infant BIPEDALISM
helplessness
Male-f emale
food sharing

Pair bonding and

rate of sexual
interdependence
Better infant
care and
socialization
Loss of estrus and
development of male and
femald secondary sexual
features

Figure 3.2: Pliocene adaptations of early hominids according to

Lovejoy, drawn as a feedback system.
 Biolosical characteristics and caPacities: 77
Chapter 3:

hawk, whilst also developing versatilityss. Humans can run, jump, dance,
climb, swim, and cope with almost any terrain, and the health advantages of
bipedal occupations such as running, walking and swimming, particularly
with regard to the cardio-vascular system are well researched and applauded,
even if not all epidemiologists agree about which form of activity is most
valuable. Skilled use of bipedal locomotion varies between all humans, as
evidenced by the number of sports and athletic pastimes which are based on

different aspects of it. Not everyone can triple jumP, dance like Fonte)m/ or
run a four minute mile, and whilst many climb, only a few pursue this
occupation to the ultimate achievement of climbing to the summit of Mount
Everest. However, despite the fact that bipedal locomotion is slower than

quadrupedal, humans have thrived from the occupational advantages of

having the forelimbs free.

Hand dexterity is also so characteristic that Benjamin Franklin is reputed to

have observed that 'man is a tool-making animal'. Although other primates

are known to use 'tools'59, the homo genus is said to have begun with the
ancestors who are credited as being the first manufacturers of stone tools.
They lived about 2.5 to 1..6 million years ago, and are known as 'homo
habilis' ('handy man')60 and although it is believed their tools were meagre,
"statistical studies of these tools have shown that their makers...had a concept

of symmetry...and...a plarured technique". Homo habilis is also credited with

building the first known stone shelters in Olduvai, and of carrying food to

58 Fo, an interesting view of early human locomotion pattems based on analysis of hunter

r
RMcN. Characteristics and advantages of hu
Wootton R, editors' Biomechanics in saolutio
59
¡ane Goodall demonstrated with slides how
C and
skill, use grasses to extract termites from their
Caliiomia] April 4th, 1995. See also: Goodall e' Ma':
Harvard/Beli<.nap, 1986; Brewer SM, McGrew
honey'
Fotia primntologicn !990;54: 100-104'
60 So named u;.7g64by Leakey L, Napier j' and Tobias P'
 78
Chapter 3: Biolosical characteristics and capacities:

such camp sites for processing and sharing6l. These occuPations were

facilitated by a hand. structure similar to our own, with a thumb positioned

for opposition, essential for tool handling and manufacture, facilitated by u
wrist joint which pronated and supinated62'

The anatomical advantage of hands capable of many types of prehension

enabled them to be used as tools in their own right. This endowed early

humans with the capacity for manipulative skill which was facilitated by u
refinement of specialised brain centres within the primary sensory and motor
areas of the cortex, coordinatedwith other brain centres such as the basal
ganglia and the cerebellum63. As Sir Charles Bell observed, in his 1833
'Bridgewater Treatise'64 on 'The Hand' which related the hand's structure
and function to environment,
,'this dffirence in the length of the finger thousand
purposes',' adapting the hand and fingers, as a rod, ø
'switch,
ø sword,-a hammer, ø pen, or pencil, ol €tc', in
all which a secure hold and freedom tf ødmirøbly
combined" 65.

Such a hand structure, along with the capacity to walk upright thus freeing

the hands for activity, is one of the special human attributes important to the
unique occupational history of the species. Jelinek suggests this attribute was
pre-adaptive to tool use, and it is probable that this pre-adaptive period was

characterised to sorne extent by playful occupation66. Jerome Bruner, the

psychologist, for example, argues that "play...can produce the flexibility that

61
¡ehnek J.Primitiue Hunters..-p 24.
62 Almquist EE. Evolution of the distal radioulnar iont. Ctinical orthopedics 1992;Feb (275):5'
13.
63 Brodmanrr K.Vergleiclrcneled loknlisations lehre der Grosshirnrinde in
prinzipien datgestellt
nr¡ gr""a des zillenbattes. Liepzig: JA Barth 1909; PenfieldW, Boldrey E. Somatic motor and
by eletrical stimulation. Brnin,1958;
,"rõry representation in the lerãbrat cortex as studied
60: 389443.
64 The Right Honorable Francis Henry, EarI of Bridgewater teft €7000 to the Royal Society to
sponsor a number of treatises
65 ôi. Charles Bell. Tlr hand: lts nrcchanism and aital endouments ns eaincing design.l¡ndon:
william Pickering 1833. Brentwood: The Pilgrims Press, 1979, p.1,08.
66 !.Primitiue lumters...
¡elinek
 Biological characteristics and capacities: 79
Chapter 3:

makes tool using possible", citing the laboratory studies of Birch and of Schiller

which indicate that play with materials is necessary Prior to using it for
"instrumental ends"67.

The use of upper limbs and hands have developed into a very sPecialised
adaptation, so that the unique movements, the sense of touch, the balance
function, the reaching out, the gesturing and fine manipulative capacities can
be used separately or combined in infinitely varied ways to enable culturally
derived occupations, unique to humans, to be carried out. Yet all humans are
not able to use their upper limbs and hands with the grace of a Balinese
dancer, the skill of an artist or the strength of arm wrestler. Although the
capacity to use hands is "one of the dominant aspects of our biological and

cultural adaptation"6s, there are differences between individuals which is

recognised in commonplace acceptance of particular attributes of individuals,

and which needs to be borne in mind when strategies for occupational justice
are enacted.

Upright posture and skilled hand use work in cooperation with vision.
Because of human's upright posture and height, and eyes positioned at the

front rather than the side of the head, they are able to see for relatively long
distances. As well as enjoying the benefits of long sight, stereoscopic vision
helps people to focus on objects that are close, and to see these in three
d.imensional form. This capacity has made it possible for humans to
manipulate and appreciate the structure of materials, to become tool-makers
and, with practice, to produce objects of great variety and complexity which, in

turn, have assisted human adaptation to different environments. Coupled

678*rr", Nature and uses of immaturity. American psychotogist August 7972,p.695; Birch HG'
J.
The.elation of previous experience to insightful problgl_solvrng.lournal of co,mpatatiae
and
pltysiologicnl þsychologyiO+S;38:.367-383; Schiller PH. Innate constituents of complex
r"rpo.tãt in primàtes. Psychologicnl eaiew 7952; 49: 777-791'
68 ti'.tu.', E. Evolution of human manipulation. tn: The Cambridge cncyclopedia of human
eaoltttion.'.P'349.
 Biolosical characteristics and capacities: 80
Chapter 3:

with visual perception, humans are able to identify objects by colour, hue,
brightness and form, in different orientations, and with sufficient clarity to
pick out objects from their background whether they are still or moving. This
range of visual capacity has been instrumental in the variety of occupations
which can be undertaken, and gives humans an evolutionary advantage over
other animals despite them, perhaps, having better visual faculties of a

particular kind.

Humans know about their world through their senses, and it is "the
limitations of (human) senses (which) set the boundaries of...conscious
existence"69. To many, vision is the most important of our senses and it has
been estimated that between seventy-five and ninety percent of the
information stored in the brain is derived from visual sources. Ninety-eight
peopleof a group of one hundred and four subjects surveyed by first year
occupational therapy students about their perceptions of sensory capacities
identified vision as the sense they most used70. Despite this, loss of vision
d.oes not necessarily impair health or well-being, but the effects differ between
people, perhaps according to how and to what extent they use it in valued
occupations, and how much they are able to compensate for the loss by using

other senses.

"Since the world is constantly changing, the brain is flooded with

information", even though "the eye (only) takes in a trillionth of the energy
which reaches it"71. Lr fact the visual system and the brain selects, simplifies
and organises so that what humans see "is not so much a replication of the
real world as a calculated and very selective abstraction of it"72. This capacity

69cor"r, Ward Lly'''. Sensation nncl perception. 2nd ed. Orlando: Academic Press, 1984'
S, porac C,
70 Research carried out as part of 'Occupation and health', Wilcock AA, University of South
Australia, Adelaide, 1993.
71 omstein R, Sobel D.Tlrc healing brnin-'. pp'105-106'
T2wutron L.Neophilia: Ttrc trndition of the new. Great Britain: Hodder and Stoughton Ltd,
7989, p.67.
 81
Chapter 3: Bioloeical characteristics and

prevents people from being overwhelmed by extraneous information, helps

them make sense of what they see, and choose what it is necessary to attend to

so that appropriate, or even fast, action can occur as necessary for survival and

safety. For example, instead of 'seeing' each colour, shape, texture and form
of parts of a room as separate, people perceive the room as a whole coherent

structure in which they can move and act; or a glimPse of part of an animal,
or another human, who may threaten will be perceived and understood as a

whole. In order to do this "the brain constantly needs stimulation to develop,

grow and maintain its organisation"T3, and vision, like all other capacities, is
dependent, to a large extent, uPon use and uPon what we learn through
experience. Indeed, sensory systems are often especially tuned in to

communication sYstems of the same species, because the activities of

conspecifics often affect survival, health and well-beingT+.

This leads to consideration of language, which, because of the weight given

to this capacity, its complexity, and its centrality in occupational evolution,
merits an extended discourseT5. Chomsky, along with many others, argues
that complex human language is unique to humans as no other animal
learns anything which resembles it76. Indeed, it is held by some that human
language is so different from communication of other animals that

comparison need not be made77. However, the more traditional view argues
that language has evolved through a series of adaptive changes within

73 Ornstein R, Sobel D'TIæ healing brain"' p'218'

74Hopki,.., CD. Sensory mechanisms in animal communication. In: Dewsbury DA, Slater PJB,
1983; Leger DW.
editors. Animal behaaior. VoL 2: Commtmication. New York: Freeman,
øiitogirot fotmdations for behnaior: An integratiae approach. New York Harper
Collins
Publishers, 1992
75 Th" importance of the topic is characterised by nurnerous texts. Some in the last decade
include: Bickerton D. Langnge and species. chicago: university of Chicago
Press, 1990;
Chomsky N. The origin o| Inigtnge: lts nature origin and ltse. NewYork: Praeger,t986;
Liebermån p. Llniquily ir,rtoit ihe eaolution of speech, thottght and selfless
behaaior'

Cambridge, Ma: Harvard University Press, 1991'

76 Chomsky N.Lnngtnge nncl Mind. NewYork Harcourt Brace Jovanovich,1972.
77 New York Wiley, 1967; John-Steiner V'
-genetic Processes in verbal communication'
onsciousness: Integratiue leaels. Hillsdale,
Nj: Erlbaum,7987'
 3: Biological characteristics and caPacities: 82
Chapter

mammalian communication systemsTS, and "^uy rest on neural

mechanisms that are present in reduced form in other living sPecies and that

wefe elaborated quite early during hominid evolution"Te.

Edelman argues that humans had the capacity to "produce and act on
concepts" and to ascribe meaning prior to language acquisition. Then, at
about the same time as the speech areas named after Broca and Wernicke
emerged in the brain, changes occurred in the base of the skull as a result of

bipedalism.
"This prouided a basi
morphological of"'the
suprataryngeal tract...As parl tf this ent, the
aocal ,orlt emerged ønd the tongue, selected
to øIlow fuller cõntrol of air flow )Trer in turn
allowed' for the production of coarticulated sounds, the
phoneme5"8o.

According to Ed.elman's theory of neuronal group selection, and following

the prior evolution of the specific brain structures mentioned above, the
capacity for language was first linked by "learning with concepts and
gestures", followed by semantics and then syntax81,

Although early language was, undoubtedly, based on gesture, body signals,

grunts, growls, cries or even perhaps markers on trees for directional
information in the hunt for food, speech is thought by some to have
developed as people became tool users, because, amongst the more obvious
social advantages, speech would have facilitated complex thinking abilities

78li"b"r*"r, P.The biology and soolution of language. Cambridge: Harvard University Press'
1984.
79li"b"r-"r, p . Human speech and language. In:The Cambridge encyclopedia of human
eaolution... P.137.
80Ed"I^ut G.Bright air, brilliant fire"' p'L26'
;
and of hominid fossils suggests that the
tract probably...was not completed until the
'
patterns of human speech seem to haue
" and " there seems to be a link bettueen the
control and those responsible for syntax" '
(Lieberman P. Evolution of the speech apparatus. In:The Cantbridge encyclopedia of human
ea o ltt ti o n...PP.736 and 137")
81Edul*u.t G.Bright nir, brilliant fire"' p'129'
 3: B ioloeical characteristics and capacities: 83
Chapter

necessary for the manufacture of tools, and the transfer of tool making skills
as they occurred. Such claims are supported by the fact that the brain of homo

habilis was larger than other hominid sPecies of the same Period, and, a
habilis skull, estimated to be two million years old, was found to possess a
Broca's speech area, although not as prominent a feature as that of modern
humans82. Earlier ancestors' remains have not revealed this feature and
there is considerable debate from studies of ape brain structure and behaviour

as to whether Broca or Wernicke areas, important for human speech, are

presents3. Even though chimpanzees are excellent communicators, and

"appear to have concepts and thought and...simple semantics,...they have no

brain bases for the complex sequencing of articulated sounds, (and)...lack an

elaborated s/ntax"84. The sounds produced by them mainly originate in the

limbic system (as does the human scream) and are not commensurate with
human spoken language which originates in the cortex8s. Their gestures,
however, are generated in the cortex, and the greatest success in teaching
primates to communicate has not been achieved through speech, but by sign
language such as 'Ameslam', symbols, and using a computer keyboardS6' In
infancy children rely on "the workings of the timbic system to call attention to
their needs...They find temper tantrums, whimpering, or crying a much

easier way...to express (emotions) than to explain" This is despite being able

to use simple speech, such as two word sentences, to communicate effectively

about less emotional issues. Human speech is thought, by some, to have

S2leakey R. The Making of mankind. London: Michael Joseph Ltd., 198L'

83rotb B, Whishaw IQ. Fundamentals of human neuropsychology"'
84Ed"t*un G.Bright air, briUiant fire...p.13O. Seealso: PremackD.Language and intelligence
in op, and mai. Hillsdale, NJ.: Lawrence Erlbaum Associates, 1976; Patterson R, Linden E.
The eclucation of Koko. New York Holt, Rinehart and winston, 1981.
85 Campbell BG. Humnnkind emerging"'
86premack Af, premack D. Teaching language to an ape. Scientific American 7972;227:92'99;
AM,
Gardner Bi, Gardner RA. Two *ãy.o*m,tnication with an infant chimpanzee. In: Schrier
Stolinitz F, editors. Behauior of nonhuman primates. Vol4. New York: Academic Press 1971;
ill TV. Lana'i aquisition of language skills. In: Rumbaugh DM, editor.
by a ctúmpaniee.New York: Academic Press L977;Savage-Rumbaugh ES.
oiup"t. ln:Tlrc Cnnfuridge encyclopedia of hunnn eaolution'
 and capacities: 84
Chapter 3:

evolved in a similar fashionsT. For an overview of the evolution of language

see Fig. 3.3:88 on the next Page.

Although most pre-historians seem to agree that some form of verbal

language arose as long as two and a half million years ago, and that by about

30,000 years ago humans would have developed "modern language caPacity,

including the ability to articulate complex abstract ideas"8e, not all agree with
the tool technology hypothesis. However a link between language and some
type of occupational behaviour is favoured by many. Hewes emphasises the
role of gesture in the evolution of language and suggests that as tool usage
occupied hands they became less available for communication leading to

increased use of facial gesture and soundeo. Kimura agrees that speech is
related to gesturing and tool usage and argues that it follows that evolution of

speech occurred later than lateralisation of brain function which was

instrumental in control of complex movementel. This theory is supported by

observations that hand gestures still accomPany speech, and when there are

difficulties in verbal communication, such as people conversing in different

languages, hand and facial gestures increase. Theories about lateralisation

flourished in the 1g60's and 70's, although much of the research was carried
out with male subjects, and often those with some 'abnormality' of brain
function. More recent evidence points to both hemispheres being involved
in most activities (even though they may perform different parts of the task).

It is also evident that the "complexity of neural networks involved are all

87 CampbellBG.Humnnkind emerging"' p'360'

88Fig. 3.3: is taken from Campbell BG. Humnnkùtd emerging... p.367.
89 tãakey R. The Making of Mankind. London: Michael foseph Ltd., 1'981, p.139'
90 H"*", GW. Language origin theories. In: Rumbaugh DM, editor. Lnnguage learning by a

chimpnnzee. New York Academic Press, 1977'

91fi*.rra D. Neuromotor mechanisms in the evolution of human communications. ln: Steklis HD,
Raleigh M|, editors.Nettrobiology of social comnutnication in primates: An eaolutionary
perspectiae. New York: Academic Press, 1979'
 3: Biolog ical characteristics and 85
Chapter

Holocene
10,000
AGE IJôÀtl.ì CÂPfFNlÇ ¡. ne
-:tt;,.^ n
Birth to 6 weeks Tongue immobile during cries and larynx high in throat
300,000 :

6 weeks to 3 months Base of tongue and larynx have begun to descent in the throat
Babbling

1 to ltl 2 yeafs Cranial capacity of about 750 cc.

Begins speaking
7l/ 2toZyears Us€s two word sentences

3 to 4 years Begins to express feelings in rvords

ml on
Adult Cranial capacity of 1,000 to 2,000 cc.

Larynx low in the throat, enlarging the pharyngeal region.

Through speech normally able to convey thought at least ten times
faster ttran would be possible by any other form of signaling

1 500000

750 cc.

modem

Fig.3.3: Overview of the evolution of language. (From Campbell, P'360')

 Biological characteristics and capacities: 86
Chapter 3:

highly dependent upon individual differences, talents and learning,

including one's sex and genetic endowmert!"gz

Bruner hypothesises that language is "virtually an outgrowth of the

mastery of skilled action and perceptual discrimination" basing this claim on
observations of ontogenetic development. From this beginning, he asserts
Ianguage is progressively freed from its original dependence on action and
experienceg3. Others name hunter-gatherer activities, or complex social

relationships as the driving force in the evolution of language, with de

Laguna suggesting that the most likely explanation lies in the need for help
associated with a socio-technical way of life9a, It would seem that as all these
were occurring at about the same time a combination of causes is probable,
and, I favour the theory that development of language followed similar stages

to those apparent in ontogenesis. This seems to make sense of the evidence

from archaeology and other primates. Simple tool usage and communication
similar to that of chimpanzees increased in complexity as bipedalism freed the
hands and led to structural anatomical and physiological change in the base of
the skull an¿ head, all of which facilitated more complex occupational

behaviour, social structures, speech and language'

is the foundation of culture âs, without language,

Spoken language
complex technology and social structures would be impossible.
Reminiscence, singing and the telling of stories, myths and legends is central

in handing down to the next generation occupational 'know how', culturally

sanctioned behaviours, taboos and spiritual beliefs, all of which are intimately

related to survival, health and well-beinges. Without language, individuals

92Moor" lC. Sennl dimorphism and brain ftmctions, Material prepared for a7996 Conference
paper . Personal communication 1'996'
93g*r,", JS. Nature and uses of immaturi ty. American Psychologist. 1972; August: 687 -708 (p 700)'
94lugr-o GA de. Speech: Its ftmction ønd deuelopment. (origrnally published 1927) Bloomington,
háiana: lndiana University Press, 1963'
95 No material record or proof of these aspects of technical, cultural and spiribual occupations are
available as, before Ure fairty recent advent of writing, human discourse and song simply
vanished.
Chapter 3: Biolosical characteristics and capacities: 87

are peripheral to society and devalued, and as a consequence well-being

would be hard to experience in cultures, such as our own, which value
language related occuPations.

The capacity to communicate is not the only benefit of language. As Percy

Bysshe Shelley observed in'Prometheus Llnbound', "He gave man speech,

and speech created thought, which is a measure of the universe"96. Although
piaget argues that "language is not enough to explain thought, because the

structures that characterise thought have their roots in action and in

sensorimotor mechanisms that are deeper than linguistics"97, language

allows individuals to explore ideas, to think in abstract as well as concrete

terms, and to bring to their occupational pursuits, concepts based on their
unique life experience and ways of thinking. Lewin suggests

"mankind's exaggerøted intellectual power focuses on the need to

buíld a better mental construct of reøIity....It may hape required a
complex propositionøI lønguage, 1o.t
,orrrræ witi others, but sõ we could think better"es'

Thinking about, and searching for truths about life and it's meaning must
have developed along with language. It is probable that intellectual activities

of the type now called phitosophy first emerged as wonder at the natural
world, and that early belief systems were based on animals and
environmental forces important in survival terms. This speculation is

founded. on the types of images humans left behind in cave drawings and in
ornamentation, and the fact that the earliest monumental buildings, of for
example Uruk and Ur in Mesopotamia, had religious significance, frequently
associated with natural phenomenon. Early Greek philosophy which
emerged in Miletus, with Thales, (around 600 BC), also reflects this dual
interest in matters natural and spiritual. Thales is reported as saying that "all

gíPercy Bysshe Shelley. 'Prometlrcus l-Inbound',II,[V. London: C' & ]' Ollier,1820'
gZpiaget S¡* psychological sttdies, (edited by D Elkind) New York: Random House, 1967, p'98'
I.
98 Lewin R. In the Age of Msnkind... p.174.
 3: Biolosical characteristics and capacities: 88
Chapter

things are full of gods"99. It was not until the Sophists came into prominence,
shortly before Socrates, that philosophy became interested in Mankind apart

from Nature, and in 'reasoning per se'. This interest led to a recurring theme
in philosophy and psychology - the debate about the nature of consciousness,
which is the next human characteristic to be considered, but from the
perspective of its role in the occupational nature of humans rather than in

philosophical history.

Consciousness is an example of a 'super-caPacity', which is a combination

of many other capacities and is integral to the use of other capacities.
Capacities seldom work in isolation, but combine with others according to the

environment and experience. They are multi-functional and the combining

of specific capacities with others increases the potential variability that
individuals witl demonstrate through their occupations. Capacities can be
used. in an insular focussed way, or act as an integrated part of several

capacities, being utilised in different ways at any one time' Th"y are
responsive to inner needs and external variables as well as being capable of
rapid reaction to emergency. Each capacity is "relatively independent of the

others", but they may "work in concert. This means that the faculty itself,
seen as a whole, is bound to vary from one Person to anotþs¡"100' A similar

theme in modern psychology is that a single mental capacity may rePresent a

"family' of competencies". Harvard psychologist, Howard Gardner, calls these

'frames of mind'101'

Consciousness is defined in the 1.981. Macquarie dictionary as "the state of

being conscious; inward sensibility of something; knowledge of one's own
existence, sensations, cognitions etc'; and the thoughts and feelings,

99 Hamlyn DW. A
history of western philosophy. England: Viking, 1987,p'\5.
100çutnp6sll l.Winston ChurclúIl's nfternoon nrry"'
1016ur¿¡s¡H.Frames of rúnd.The tlrcory of ruultiple intelligences. NewYork: Basic Books,
7983, P.290.'
 characteristics and caPacities: 89
Chapter J:

collectively, of an individual, or of an aggregate of p€opls"102' It has been

described as "the tool of the social anima1"103, and by Watson as "the caPacity
to see ourselves and to put ourselves in someone else's place. We are not

only self aware, but conscious of being so". It is "the key'..(and)...the Power
which motivates and drives all human affairs"lO4. Consciousness enables us
to know what we know and to experience our own feelings and the outcomes
of what we do. It "is a kind of continuous apprehension of an inner reality,
the reality of one's mental states and activi1is5"L05, providing us with a model
of the world, "based on sense and body information, expectations, fantasy and
crazy hopes, and other cognitive processes"l06. Consciousness is deemed
by

many writers to demonstrate the difference between humans and other

species, in that humans alone can "examine all options in advance...look

inward upon themselves, and...observe the processes of their own 1¡i¡d5"107.

There is, however, evidence that some other primates have some degree of
consciousness, and for example "can recognise themselves on television, and
even determine whether an image is taped or 1ive"108'

Edelman has proposed a biological model of the evolution of consciousness

according to his theory of neuronal group selection. The processes of natural

selectiongave rise to form and tissue pattems which are the basis of
,behaviour'. From this developed a "primary repertoire of variant neuronal

groups in the brain". which are involved in selection. Selection "assumes

that, during behaviour, synaPtic connections in the anatomy are selectively
by specific biochemical processes", 'carving out' a
strengthened or weakened.

L027¡, Macquarie dictionary. NSW: Macquarie Library Pty., Ltd', 1981.

103 ¡su/in R. In the Age of Mankind"'pp'179-780'
1041Y¿156¡ L. N e o p h ili a.'.P.43.
L05 6¡.,¡ç¡land pM. Matter and consciousness, revised ed. Cambridge, Ma: A Bradford Book,
1988, P.73.
106g¡¡s16¡¡ R. The eaolution of consciottsness: The origins of the way we think. New York:
Touchstone, 7991', P.228.
1076u*O6"ll BG. Humankind emerging"' p'52'
108p.u^u"¡ D, Woodruff G. Does the chimpanzee have a theory of mind? Behnuioral and brain
sciences 1978;4:515; Savage-Rumbaugir ES' Language training
of apes' In:The Cambridge

encyclopedia of hwnan euoltttion"'p'141'

 Biolosical characteristics and caPacities: 90
Chapter 3:

variety of functioning circuits. "Correlation and coordination of...selection

events are achieved by 're-entrant' signalling and by strengthening of

interconnections between the maps" in the brain. This selection Process

linked, during evolution, the older areas of the brain (brain stem and limbic
system) which take care of bodily functions, intemal states and values, and
the thalamo-cortical system which perceives and categorises world events.
Together, through 'value-category' memory, they enable perceptual
categorisation, and the subsequent development of primary consciousness/
which, in conjunction with changes to the structure of the brain, such as
Broca and Wemicke areas (mentioned with regard to language) in quite a
short time span evolved higher order conscious¡ss5109'

In considering the evolutionary purpose of consciousness it would seem

that awareness of the possible consequences of action is necessary for an

organism with freewill. Such a capacity can act as a guard to ensure continued

well-being and survival. Without it the organism can use its other capacities
in ways, and for occupations, which wilt be detrimental to itself, to the species
and the ecologies uPon which it is dependent'

One of the reasons I have chosen to discuss the capacity for consciousness, is

that complex occupational behaviour would be impossible without

consciousness, and apart from it being a prerequisite consciousness plays an

important part in choice and execution of occupation. Omstein hypothesises

that, although individuals are generally unaware of it, consciousness vetos or
permits every action which is initiated at an unconscious level from the
,many different kinds of minds'(responsible for human resPonses to the

world, talents, capacities and characteristics) within the brain organisationll0.

Additionally, states of consciousness can be affected by the types of
occupations in which individuals choose to engage. Csikszentmihalyi has

109g¿"¡n* G.Bright nir, brilliant fire... pp'83-85,117-179,734'

1109¡¡s¡g¡ R. The anohttion of consciousness"'
 9l
Chapter 3: Biolosical characteristics and capacities:

found that "when high and Personal skills are used to the
challenges are

utmost, we experience a rare state of consciousness" which he calls'Flow'.

'Flow' is enjoyable, narrows attention to a clearly defined goal, Provides a
sense of control over actions although awareness of time disappears, and
people are absorbed and involved. "The activity can be wildly different, but
when people are deeply involved meeting a manageable challenge, the state
of mind they report is the same the world 6vsr"111. Csikszentmihalyi, who
embraces a 'personal growth' view of health recognises that 'Flow'
experiences resulting from "growth enhancing occupations" are an important

aspect of positivs þs¿11þ112.

In an argument similar to Edelman's argument that consciousness depends

upon perceptual and conceptual categorisation, semantics, syntax and

phonology, all of which allow learning to occur, Csikszentmihalyi ProPoses
that consciousness depends particularly on three other capacities. He believes
,,attention, awareness and memory...act as a buffer between genetic and

cultural instructions on the one hand, and behaviour on the other"' His
view that "consciousness frees the organism from its dependence on the
forces that createdit, and provides a certain (if precarious) control over our
behaviour" is similar to my own view, as stated above. Consciousness, in
fact, negates the need for a multitude of separate genetic Programs to link
stimuli and responses, and "increases the possibilities" between

,,programmed instructions and adaptive behaviours". The "self system" has a

main goal to "ensure its own survival. To this effect, attention, awareness
and memory are directed to replicate those states of consciousness that are

Toward a science of occupation.lournal of

38-42,(p.39); Sato I. Bosozuko: Flow in Japanese
sikszenmihalYi IS, eds. OPtimal
consciousness' Cambridge:Cambridge University
dernization and the changing context of flow in
work and leisure. In: Csikszenmihalyi M, Csikszenmihalyi IS, eds' Optimal experience:
Psychological studies of flow in consciousness"'
uzgriksr.nmihalyi M. Activity and happiness:Toward a science of occupation.Journal of
ocutpational science:Austrqlia 1993;1(1): 38-42'
 Biological characteristics and capacities: 92
Chapter 3:

congenial to self, and to eliminate those that threaten its existence". On the
down side, consciousness has given humans enormous independence and
power, with the potential to destroy the environment from which they
evolved and on which they depend, and "it is by no means certain that (this)
choice and control...will serve us better than the blind instructions of our
genes"113.

Whilst consciousness is an essential capacity for the forward planning and

execution of occupational behaviour it has the unenviable role of prompting
humans to consider the consequences of their actions. It is central in the
balancing act between occupational achievement, health and well-being, in
both the short and long 1s¡rn114. Its watch-dog role is made complex by its
susceptibility, just as other capacities, to enculturation. For example, raising
the of people about lifestyle issues relating to ill-health, can be
consciousness

viewed as both a cause and. effect of 'health education' initiatives, and this
important matter is discussed in some detail in the last chapter. It is an
integral part of other agendas such as those aimed at cultural awareness, social
justice or sustainable ecology. Consciousness raising also emerged in the
1960's as part of the feminist movement to enable women "to express and

explore themselves", to understand the effects of patriarchal societies, and to

valid.ate "women's knowledge and experience" from a Personal and political
viewpoint. Similar groups are emerging for men.11s. This broader

consciousness raising is important as part of an holistic view of health and

well being116. For example, advocates of transpersonal psychology recognise

113 6ri¡52snmihalyi M, Csikszenmfüalyi IS, editors. optimal experience: Psychological studies

of flow in consciottsness... pp.20-23'
114S;e. Dossey L. Consciousness and health: what's it all about. Topics in clinical nursing 1982;
3(Jan): t-61 Newman MA. Newman's theory of health as praxis. Nursing
Science quarterly
fðSO;S1r¡, 37-47; Burch S. Consciousness: How does it relate to health? lournal of holistic
nursing 7994; 12(7): 101-1 16.
1156r¡¡¡5f,¿w A. Consciousness raising. In: Bullock A, Stalleybrass O, Trombley S, editors. Th¿
Fontana dictionary of moelern thottght. 2nd ed. Great Britain: Fontana Press, 1988, pp.166'
116 g"", for example: Thomas B. Challenges for teachers of women's health. Nrtrse education
799t2;17(5):10-L4; Ford-Gilboe MV. A comparison of two nursing models: Allen's
Chapte¡ 3: Bi characteristics and caPacities: 93

that an 'optimal state of consciousness' is a central Process in the

achievement of positive health. Optimal states of consciousness, they believe,

enable people "to achieve deep states of relaxation,...(to experience)...increased

inner awareness,...bodymind self awareness and (make) effective

choices...more accessible"l17. Th"y link psychological and physiological states,

incorporating notions from many Asian religions including the 'Patanjali'

concept that "all the body is in the mind, though not all of the mind is in the
body"11a. h a way similar to Ornstein's and Sobel's pragmatic view that the

brain minds the body, the 'psychophysiological principle' claims that every
conscious or unconscious change in either physiologic or mental-emotional

state is accompanied by an appropriate change in the other, and that health

can be facilitated by awareness and self regulation of normally unconscious
processesl 19.

Consciousness is one of the most complex, poorly understood of human's

mental capacities. Similarly complex and subject to many different

interpretations is the last capacity which will be discussed in this chapter -
creativity. This capacity is not a prerequisite of occupational behaviour, but
results from the amalgam of the rich variety of capacities available; as such is
important to an occupational perspective. It has, in the minds of many, been
closely associatedwith occupational therapy, though often in a limited, craft-
oriented way, rather than in the holistic way creativity is used here. Just as
occupation is used. to refer to all purposeful activity, so is creativity used in

theory of health as expanding consciousness.

; Koemer JG, Bunkers SS. The healing web: An
wtrsing7994;72 (1): 51-63; Smith-Campbell B'
ualitative study on coming to public judgement.

1.17posssy BM. The transpersonal self and states of consciousness. ln: Dossey BM, Keegan L,
Kolknrier LG, Guzzeita CE. Holistic lrcalth promotion. A guide for practice. Rockville:
Aspen publications, 1989, P.32.
118ç.in E, Gre"n A. Biofeedback and transformation. In: Kunz D, editor. Spiritual aspects of the
henling arús. Wheaton Ill.: The Theosophical Publishing House, 1'985, pp'L45-62'
119çr"gn E, Green A. Biofeedback and transformation. In: Spiritual aspects of the lrcaling arts..'
 Biolosical characteristics and capacities: 94
Chapter 3:

relationshipto all WPes of activities, Products or ideas; and just as

consciousness is seen as combining other caPacities so does creativity.
Creativity is both a capacity in it's own right, and a'super-caPacity' integrating
or involving almost every other human capacity. Gordon suggests that "to

create is one of man's most basic impulses"l2O, Iung classified it as one of five
major instinctive forces in humansl21, and Sinnott argues that it is in
"inherent creativeness' of the ordinary affairs of people that the "ultimate
source" of creativeness is to be found122.

Creativity derives from the Greek word 'krainein' meaning to fulfil, and
the Latin word 'creare' meaning ¡6 ¡1¿ks123. Dictionaries describe it as the
'ability to bring into existence or being, to originate, to beget, to shape, to bring
about, to invest with new character, and to be inventive'124. William Morris
suggested that creativity is an integral part of the human contest with nature
describing his percePtion thus:

"Br.tt ø tnøn, making something ushich he feels will exist because he ís

ing the energies of his mind ønd soul as
imøginøtion help him øs he works. Nof
ghts of the men of past ages guide his
race, he çygq¡¿g"125.

Creativity requires the ability to conceptualise outcomes from actions.

Some describe such abstract conceptualisation as the ultimate human gift, and

Lewin suggests that the creation of paintings, carvings and engravings

represents a true abstraction of thought and mind, and traces examples back

perhaps 300,000 years.126. However, john Halverson of the University of

L20çor¿on R. The creative process. In: Jennings S, editor. Creatiae thetapy. London: Pitman
Publishing, !975' P.l.
121Ju¡ìgCG. Collected uorks. Princeton, NJ: Princeton University Press, 1959.
122 g¡r.,r.,o¡¡ EW. The creativeness of life. In: Vemon PE, editor. Creatiuity' [,ondon: Penguin
Books, 7970, P.715.
L23yo.r¡g JG.What is creativity?lournnl of creatiae behnuiout7985;19(2):77'87.
!24y¡, itandqrd Englistr desk dictionary, 2nded. The concise Oxford dictionary of artent
English. Oxford: Clarendon Press, L911'
125¡y1orri, W. 1884, In: Morton AL, editor. Political writings of William Morris ' London:
Lawrence and Wishart, t973'
12691¡"¿ inLewin R.In the Age of Mankind"'
Chapter 3: Biological characteristics and caPacities: 95

California argues that early creative images were "unmediated by cognitive

reflection" but rather were clear, representational and rePeated for their own
sake. The extent oÍ early human's creativity has been hard to assess because
although they appeared to possess very little in the form of creative artefacts
this may be a consequence of an "inescapable conflict between mobility and
material ssl¡sss"127. For example, the lKung, when they travel, carry only
about L2 kilograms each, so most of their culture is carried in their heads.
This is also true of the Australian aboriginal following a traditional lifestyle,
and reminds us that creativity is much more than the manufacture of

material artefacts. It includes those intellectual and abstract reasoning skills

so dear to philosophers and academics, and the evidences of culture which are
carried in the minds and recreated regularly throughout history. Sinnott

suggests that the biological basis for creativity is the "organising, pattern
forming, questing quality" of 'life' itself which, when applied to behaviour
and. the complexity of the human brain, results in an almost infinite number

of new mental Pâttern5"128

Marx, as noted earlier, suggested that labour is the collective creative

activity of mankind; certainly it was the creative abstract occupations which,
integrated with tool technology, evolved eventually into high technology
activities through cultural evolution. High technology is the epitome of
human creativity, yet the products of the industrial and technological age
have had a serious effect on individual creativity. For example, although not
true of all peopte, many no longer make products that they need, preferring to
buy; seldom create their own entertainment, preferring to watch and listen to
pre-packaged material. Similarly, the creative behaviour of many children
has changed with the advent of television, as, hours are spent in viewing

images rather than experimenting, playing, or creating their own.

127ç7¡¿¿ in Leakey R. TIrc Making of Mnnkind.'.pp'101-103'

128 5i¡¡1e¡¡ EW. The creativeness of life' In Creatiaity"'p'775
 96
Chaoter 3: Biolosical characteristics and capacities:

Creativity is a capacity which has excited much interest and discussion, yet
sources seld.om agree on a definition, with one paPer written in 1953 offering

no less than tweny fivetzs. Many psychologists, from behaviourist to social

psychologists, have offered theories ¿þeq1 i1130. For example, it has been
suggested that psychoanalytic theorists, such as Freud and Adler, accepted the

view of creativity held early this century which limited the concept to 'the
arts'131. 'The arts' were held to be socially acceptable activities which were an

outlet for sublimation of libidal energy and other unconscious conflicts,

drives and needs. Creativity was seen as stemming from neurotic tendencies,
offering the resolution of guilt feelings, and comPensation for feelings of

inferiorityl3z Despite this Freud recognised parallels between the creative

nature of children's play and the creative artist, and also, along with others of
the psychoanalytical school, suggested that creative people were subject to
better health as well as more sickness than the average133.

It is not surprising that humanist and gestalt psychologists have linked

creativity with the experience of health and with individual potential, as I do.
They hold the view that creativity is much more than innate talent or genius
exemplified by exceptional individuals in 'the arts' and is evident in all

aspects of life as the potential to self actualise is given to all human beings at

L29¡4o.rur, DN. Creativity today. lournal of aesthetics 7953;12:1'24.

130 g¡¡f¡s¡ BF.The science of behaaiour. New York MacMillan, 1953; Maslow A}{. Toward a
psgctntogY of w York TM' The
Zoíø iíyrnã New Y ating
minds: An an seen th
Straainsky, Eliot, Graham, and Gnndhi'
BorgB'
Frames ói reference in psychosocinl occtr
Slack'
1987;Gordon R. The creative process' In:
1313rrr." MA, Borg B. Frantes of reþrence in ylor IA'
Getzels fW, eãitors.Perspeciiues' in creati
any'1975'
732 Freud
Freud
he
,1958;
of the
Hogarth Press, 1959, PP.143-144'
1333u¡ien F. Creatiae person nnd crentizte process. New York: Holt, Rinehart and Winston,
1969;Tay|or IA, Getzels JW, editors. Perspectiaes in creatiaity,..
 97
Chapter 3: Biological characteristics and capacities:

þl¡1þr34. Humanists, such as Maslow and Rogers, have ProPosed that self
growth motivates creativity, and that creativity and the achievement of
individual potential are synonymous with health. Rogers describes "man's
tendency to actualise himself, to become his potentialities" as the mainspring

of creativityras, and Maslow observes:

"thøt the concept of creativeness ønd the concept of the healtlty, self-
øctuøIising, frlly human Person seem to be coming
"onâ
closer
,.1ryd closer
together, *oy perhøps turn out to be the same thing"'130

Maslow reached this conclusion following a study of self fulfilled people,

whom he saw as mentally healthy, in order to discover how people are
enabled towards growth and self actualisation, and to determine the attributes

and components of a basically healthy intrinsic nature. He described the

healthiest and most effective people as 'transcenders'. Such people are
responsive to beauty, holisticin their perceptions of humanity, motivated by
the satisfaction of 'being' and 'service values', able to adjust well to conflict
situations and. more likely to accept others with an unconditional positive
regard. Th"y are less attracted by the rewards of money and objects, and work

whole-heartedly toward.s goals and purposes. They tend to fuse work and play
and have more peak or creative experiences.

There are definite similarities between traits of Maslow's 'transcendors'and

traits believed to characterise creative people as identified by The Institute of

personality Assessment at the University of California. The latter are

described as intuitive, oPen, spontaneous and expressive, independent, self

accepting, flexible not authoritarian, and autonomous, functioning best when

working independently on their interests. Th.y are relatively free from fear,
are not interested in detail but in meaning and implications, with the
ability

to synthesise and integrate material and experiences. They have well

134 ¡4ur1o* A]H. Motiaation nnd personality. New York: Harper & Row, 1954.
135 ¡1ogs¡s CR. Towards a theory of creativity. (1954). In: Vemon PE, editor. Cteatiuity..'p'140
136¡4ur1ey¿ A. The frther reaches of htnnnn nature. New York Viking Press,797l.
 Biological characteristics and capacities: 98
Chapter 3:

developed intrinsic values and are goal direc¡sd137. Indeed, the links between
creativity (and by inference, occupation) and mental health aPPear strong and
for example, high creativity has been found to correlate with a high degree of
normal mature positive self esteem138. This discussiorfhould be held in
mind when mental well-being is discussed in chapter 5'

Making the assumption that creativity is closely related to occupation, from

low levels observed in solving the problems of daily life to significant levels
in terms of contributions to advances in technology, intellectual or socio

cultural activity, there appear to be strong links between individuals and

particular forms of creative occupation. This supports the notion of inherent
capacities, which emerge or peak at different parts of the life cycle, as discussed

earlier in the chapterl3r. It also appears that, for most people, potential
requires incubation, education, diligence, nurture and opportunity, despite
some evidence of particular individuals having the ability to overcome
detrimental circumstances in order to actualise their occupational

creativitylao

These examples from the range of capacities with which humans are

endowed demonstrate how anatomical structures and physiology focus on

occupational behaviour. The incredible flexibility of specific parts of the body
for different functions such as those noted in the hands, bipedalism, and

L37 purr.," WA, Hahn DB. lJnderstanding Your Health. 2nd ed. St Louis: Times Mirror/Mosby
College Publishing, 1989.
138 gs16¡1en R. Creativity and normal narcissism. lournal of creatitte behaoiourlgSí;19(1): 47-
55.
139 4*u6i1eTw.The social psychology of crentiaity...; FeldmanD.Beyond uniaersals in
cognitiae deaeloPntent Norwood,
be"tween the ages of 20 and 80 years H' Age
and achieaement Princeton, N]: Princeton
Sociocultural context of individual creativity: A transhistorical time-series analysis.
|ournal of personality and social psycltology 7975;32:
7779-7.]'33.
1404*u6¡1e-TM^.The social psyclnlogy of creatiuity...; Stein M,.r. Stimulating creatiaity (vols
1 and 2) New york: Academic preli, piAE and 1975; Feldman D. Beyond uniuersals in
cojnitiíe deaelopment..; Gardner H. Creating nind*..; Golann SE. Psychological study of
creativity. Psychological bulletin 1963; 60:548-565'
Chapter 3: Bioloeical characteristics and capacities: 99

vision, coupled with the extensive range of higher cortical caPacities which
are central to consciousness and creativitl, for example, prompts, motivates
and enables an infinite variety of occupational exPloration, exPerimentation,

interest, choice and skill, as well as imbuing people with the need for Pu{Pose

and meaning. Additionally, every other physiological characteristic

influences, promotes or supports human's occupational behaviour. The next

section considers 'sleep' and 'homeostasis' from this perspective'

Most animals appear to need a balance between activity and rest, the two
seeming to be opposites of the same system. Kleitman explored and then
d.escribed the day / night sequence as the 'basic rest activit/ cycls'141. He saw
sleep as complementary to wakefulness in that "the one related to the other as

the trough of a wave is to the g¡ss1"1'42.

Over the last forty years, sleep patterns have been the subject of intense
scrutiny, and sleep is recognised as an important aspect of health and well-
being, relaxation and sleep providing the natural mechanism to prevent

over-use, and a time for repair. Additional understanding is now emerging

about the complex relationship between it and occupation carried out during

waking states. Theories about this relationship centre around 'recuperation',

,information processing', 'energy conservation', and 'self preservati6¡'143.

As sleep deprivation results in symptoms such as decreased coordination and

reaction times, irritability and blurred vision144 which affect occupational
performance, sleep can be viewed as necessary to engagement in occupation.

Together they form part of the complex neural system aimed at maintenance

of health.

L41ç1"¡¡^r., N.Slery and wakefttlness. Chicago: University of Chicago Press, L963, p.188'
142çu*p6sll l.Winston Churchill's afternoon nap"'
143¡"gsr Drv.Biotogical foundations of behaoior: An integratirse approach- New York: Harper
Collins Publishers lnc., 1992.
144¡1o*" JA. A review of the biological effects of total sleep deprivation in man.Biological
PsychologY 1978; (7): 55-102'
 3: Biolosical characteristics and capacities: 100
Chapter

Leger suggests that "just as musicians' pauses are a comPonent of the

performance, pauses from the stream of behaviour are a comPonent of the
repertoire. The organism 'doing nothing' is doing something"14s. All sleep
stages have a homeostatic function, although the system does not operate on

feed.back principles but on intrinsic timing mechanismsl46. These

mechanisms differ slightly for each individual and change throughout

lifespan. In evolutionary terms the oldest form of sleep known as 'non rapid
eye movement' sleep, or slow wave sleep (SWS) shows different patterns of
EEGs for several different stages. SWS is responsible for replenishing the
body, and maintaining physiological and metabolic fitness' After a day of
strenuous physical occupation SWS increases, and it is only during SWS that

growth hormone, essential for restoring damaged tissue, is releasedl47.

Following sleep deprivation sws sleep takes priority in 'catching uP'. For
example, studies, such as that conducted by Shapiro and others, on ultra-
marathon rurìners demonstrated an increase in SWS sleep as well as total

sleeping time over four nights following the run148. This effect appears most
developed amongst people who are physically fi¡14e, suggesting a close
relationship between sleep patterns and regular occuPations.

As the of the neocortex expanded during evolution

association areas

additional 'servicing' was required for the maintenance of structures

specialising in mental and social functions. This is provided by rapid eye
movement (REM) sleep when circuits are tested and neuro transmitters are
replenished by being rested selectivelyls0. During this stage the brain is very

145¡"gs¡ DtN.Biotogical foundations tf belnuiour"'p'374'

146çu*O5"lI J.Winston Cfutchill's afternoon nap"'
147g"rr¡ JF, parker DC, Mace IW, Gotlin RW, ]ohnson LC, Rossman LG. Human growth hormone
release:Relation to slow wave sleep and. sleep waking cycles. science 7969;165:513-515,
148g¡upi¡6 CM, Bortz R, Mitchell D, Bartel P, Jooste P. Slow wave sleep: A recovery period
after exercise.Science 1987;214: 1253-7254 '
149po."¡ |. To what extent can sleep be influenced by diurnal activity? Experientia 1984;40: 422-
424.
1506u*p6sll l.Winston Churchill's afternoon nnp"'
Cha 3: characteristics and ca

active and "actually consumes more oxygen than it does during intense

physical or mental activity when one is awake"1sl. Speculations about other

functions of REM sleep include the integration of knowledge acquired during
the day, consolidation of information, assistance in dealing with emotionally
charged, material, and the taying down of long term memoryls2. (However,

some claim that SWS sleep also assists memory formation and recall1s3).
Experiments, using EEGs, on rats, rabbits and cats have demonstrated that
theta rhythms exhibited during important species specific occupations such as

exploring, burrowing or pouncing are also present during REM sleep. Fox
speculates that "current information, blocked from the hippocampus and the
limbic circuit during waking, is allowed in there during sleep to be 'matched'
against those wired-in survival behaviours that are the species'ethogram". If
the it is processed "for at least three years in
information is deemed relevant
some form or other" during dreams before being 'stamped in' to long term
memory and eventually stored in the neocortex1s4. This process enables the
neocortex to assess experience towards future goal directed action. Although

REM sleep may serve a similar PurPose in humans, Fox suggests that
dreaming has been freed, to some extent, from phylogenetic ties and species
specific experience, allowing the 'matching' to relate to prenatal and

chitdhood exPerience.

There are'gating mechanisms' which facilitate Passage between sleep and

awake s1¿¡ss155. REM sleep, which usually occurs four to five times a night is

seen as the easiest exit point from sleep, and possibly evolved in part as
a

15L¡4oor"¡6.The lifespan in relation to the neruotts system. Melboume:Australian Association of

Occupational Therapists, ]une 1994 , p'188'
152p"ur¡nun CA. R.E.M. sleep and information processing: Evidence from animal studies.
and
Nerroscience and neuribehaaioural reaiewi...3,57-68,7979; Smith C. Sleep states
leaming: A review of the animal literature. Netroscience and biobehauioural reuiews .

ßg5; 9:757_16g; Campbelll.winston Churchill's nfternoon nap...

153po*1", MJ, SullivanMj, Ekstrand BR. Sleep and memory.science 7973;779:302-304-
154po* R.The search for society. New Brunswick: Rutgers University Press, L989, p.179;
155y¿¡r',ss¡ l.Brnin anel psyche: the biology of the unconsciotts' Garden City, NY: Anchor
Press/DoubledaY, 1985, ChaPter 8'
 3: Bi ological characteristics and capacities: 702
Chapter

"sentinel device, a monitor in case of danger"156. At rhythmical times during

wakefulness there are 'sleepability gates' when it is easier to sleep. The most
obvious of these is the biological slump occurring in the afternoon which is
taken as 'siesta time' in many traditional cultures157. Bi-phasic activity peaks
are part of our biological heritage; are evident in behaviours of other
primates; and are probably an adaptation resulting from the need to reduce
occupation during the hottest part of the day. However, whilst duration of
sleep, which need differs from person to person, is hard to change, ultradian
rhythms of arousal and non-arousal concerned with placement of sleep are
easily overruled by socio-cultural demands such as social, and family
routines, obligatory and freely chosen occupationslss. For example, in a study
of 64 child.ren, L0 and L4 years of. age, weekly changes of sleep patterns during

the school year disappeared during vacations when sleep increased

considerablyrsl. Studies using EEGs have demonstrated differences in brain
waves throughout sleep and awake states. Particularly in the awake states
these seem to relate to when the organism is best fitted for different types of

occupation or rest, although these are flexible and can be overridden, as

happens in 'post-industrial' working days and twenty-four hour working

shifts which enable humans to behave as nocturnal rather than diurnal

animals. The sleep systems are therefore facilitatory to immense occuPational
flexibility, as well as servicing all systems so they can be used as required in
occupational behaviour.

The last physiological characteristic to be explored is 'homeostasis' which is

defined as "a tendency to stability in the normal body states (internal

156 çu^OS"ltl.Winston Churchill's afternoon nnp"' p'794
1571y¡r¡otr Churchill is quoted as saying
"Yo, mlst sleep sometit brt*rrn hmch-ancl diruter, and no half mensures' Take off your clotlrcs
i
onA get into bed. Tlnt's what I always do"(Quoted in Graebner W.My dear Mr Churchill'
London: Michael |osePh, 1965, P.55)'
1.586u*O6"ll SS. Duration and placement of sleep in a 'disentrained environment'.
P syòhophy siology 1984: 21(1): 106-113'
7593riryrç7ak jt, ¡asinstca M, Pawlak E, Zwienykowskl M' Annual and weekly changes in the
sláep-wake rhythm of school children. Sleep 7993;16 (5):433-435.
Chapter 3: Bioloeical characteristics and caPacities: 103

environment) of the orgânism."l60. It "is an evolutionary strategy for

preserving internal sameness by resisting and smoothing out the changes"

and variations frorn the extemal environment

Homeostasis is especiølly necessary for the Proper functioning of the
central neruolts system tf animals on the higher rungs tf the
eaolutionnry ladder. Beþre intelligent life could aPpeør, and Toell
beþre the culminøting eaent tf consciousness, the mechanism to
eisure the sameness of the internal milieu had to be in placsTsr.

It was Claude Bernard, a nineteenth century French physiologist, who

developed the concept that the internal environment - the 'milieu interieur'
- of a tiving organism must maintain reasonable constancy despite external
circumstances. He reco8nised that humans despite their apparent

indifference to the environment are "on the contrary in a close and wise
relationship with it, so that its equilibrium results from a continuous and
delicate compensation established as if by the most sensitive balances" and
that animals able to maintain 'inner sameness' have greater freedom to live
in many different environments, and are less vulnerable to ecological change.
This perhaps results in their apparent indifference to the environmsn1.162

The term homeostasis was suggested by Walter Cannon, an American

physiologist in 1926163. He recognised that homeostasis is a system working

L60por¡nn¿5 ntedical dictionary, p.720.

1616u*O6"ll J. Winston Chttrclill' s nfternoon nap...pp.44,54'
162 3"rn¿¡¿ C. Lectures on the phenomena of life common to animals and vegetables' (1'878-
1829). Second Lecture. ln: Langley LL, editor. Homeostasis, origins of the concept.
Stroudsburg, Pennsylvania: Hutchinson and Ross, Inc', pp'729-1'47'
"Lectures
Bemard's first recorded use of the term was in the first lecture of a series entitled
on the physiological and the Pathological Alterations of the Liquids of the Organism",
University of Paiis on December 9,7857. In this lecture Bernard said that in living beings
to
there is a spontaneous organic evolution which although it needs the extemal environment
independent of that environment in its course because "in the
manifest itielf, is neverthãless
are, in reaúty, direct extemal influences and protected
nment (miliett tly constituted by fluids circulating in
s, Origins of 85.
out Bemard, se ltot' Clatde Bernnrd and the internal
enaironment, A memorial symposiu rz. New York Marcel Dekker, Inc.7979; Olmstead MD,
Olmstead E;g.. Clnude Bernørd nnd tlrc experimental method in medicine. New York:
Collier Books, 1961'.
163go*1e¡ W. physiological regulation of normal states: Some tentatiae postulations concerning
biological !rcmeostatics. Paris: Charles Richet, 1926, pp'91-93'
 Bioloeical characte ristics and 104
Chapter 3:

cooperativeiy with brain and body, and found that at "critical times" of
environmental stress "economy is secondary to stability" itt that important

or salt are eliminated in order to maintain

substances such as water, sugar

constancyl&. Cannon researched and described the way a fluid matrix

provides a stable context for highly specialised cells, which, by themselves/ can
only survive in specific conditions, to enact their part in complex, flexible and
versatile activities. He postulated that homeostasis leaves humans free to do
new occupations, to be adventurous, and to seek beyond survival to the

'unessentials'which are part and parcel of civilisation165,

Homeostasis is a successful adaptation which is central to human's

l

occupational nature, because not only is the need for 'sameness' used to

maintain constancy in body physiology but in mental Processes as well. In

order to make sense of the world, psychological mechanisms seek 'sameness'
in what is received and perceived. This is facilitated by an "internal milieu
(which) seems to be more constant for the cells of the brain than for other
parts of the body"166. L:r 1890, William James claimed in The Principles tf
psychotogy that the capacity to recognise sameness is a prerequisite for the

existence of a sense of self, and "the very keel and backbone of our thinking"

as it is central to recognition, of giving meaning, and of appreciating contrast

and differencel.6T. This capacity is also central to occupational behaviour.
Without it, every time engagement in occupation occurred it would aPPear as
a new experience, take longer, be in the nature of trial and error, and no
ongoing learning could occur. The occupational evolution of the species
would indeed be different.

164çu*lon W. Ttrc uisdom of the body.New York: W.W.Norton and Co',lnc',7939, p'3L7'
L65çu*lot W. TIrc wisdom of the b0dy...p.323.
166çu¡.p6sll l. Winston Clntrchill's afternoon nap"'p'54'
Jam;s W. The principles of psychology.
767 Vol. 1. New York Dover Publications ,1890, p.239
 105
Chapter 3: Biological characteristics and

This chapter has found that biological 'characteristics' and 'caPacities'

which have been identified as important by evolutionary scientists,
archaeologists, anthropologists, neuro-scientists and other disciplines form
the basis of the occupational nature of humans. Such characteristics have
allowed humans to learn and to adapt culturally to many different natural
an¿ social environments. A super primate brain capable of the whole range

of sociocultural adaptations which have characterised occupational evolution

is common to humankind but is also unique in each individual. During the
exploration the role of human capacities in survival, health and well-being

began to emerge, setting the scene for later consideration. Occupational

behaviour is a result of the processes of natural selection throughout
evolution as organisms have adapted to their environment, on genetic
inheritance, on individual biologicat structure and form, on epigenetic
processes, on ontogenesis, and on learning. The next chapter will explore the
evolution of occupational behaviour which has resulted from this biological
inheritance.
 Chapter 4

Occupational evolution

The last chapter established that humans have the biological capacity for
occupation. This chapter explores the history of human engagement in
occupation from the time of the earliest known hominids between two and

three million years ago, in order to discover whether this too supports an
evolutionary theory of human nature based on occuPation' 'Homo sapiens
sapiens' - modern humans - are thought to be little more than L00,000 years

old1, and evidence of complex, cultural and technological occupational

behaviour is increasingly apparent from this time on, but this is founded on
behaviour of earlier members of the species.

I have used archeological and anthropological texts as the source for much
of the material aboutearly humans occupations. Along withThe Cømbridge
Encyclopediø tf Eaolutionz, several texts have been particularly useful' such

as Jacob Bronowski'sThe Ascent of Man3, Bernard Campbell's Humankind

Emerging!, which has also been the source of several explanatory figures
throughout the thesis, The First Humans edited by Goran Buranhults, and a
range of texts by Leakey and Lewin6. All take a common evolutionary view
of

human history in which occupational development is considered in

1 Pilbeam D. What makes us human? ln: fones S, Martin R, Pilbeam D, editors' T1æ Cambridge
encyclopedia of hunun euohttion. Cambridge: Cambridge university Press,
1992'
2
¡or,", S, Martin R, Pilbeam D, editors. The Cambridge encyclopedia
of human anolution"'
3 Bronowski !.The ascent of man. London: British Broadcasting Corporation,\973'
4 Campbell BG.Hununkind emerging.Sth ed. New York Harper Collins Publishers, 1988'
5' B.r.anh.rlt G, editor. The frst humans: Human origins and history to 10,0008C' Australia:
University of Queensland Press, 1993.
6 Leakey i, t"*itt R. People of the lake: Man: His origins, nalure, and future' Penguin Books'
7978;'LeakeyR.The mnking of mankind. London:MichaelJosephLtd,1981; LewinR'Th¿
Age of Mankind' Washington DC: Smithsonian Books, 1988'
ñichard Leakey's interest in pre-history grew from early exPosure
famous parents, Mary and Louis Leakey, responsible for many imp
Africa. Later, he becáme Director of the Kenya National Museum.
a
in Washington DC, was a consultant' with
bio-chemist, and currently a writer for 'Scienóe'
of mankind''
Leakey, to the BBC during the production of the television series 'The making
Chapter 4: Occuoational evolution to7

conjunction with the biological and cultural development of the human

species. Most debate similar topics which are aPParently important in
archeological and anthroPogical research, yet, aPart from detail, there aPPears

to be remarkable agreement between them. The scholarshiP exhibited within

the texts, and others of similar nature used throughout this chapter/ rest uPon
a range of hypotheses founded on the study of archeological finds and their
context, the subjecting of these to scientific analysis and archeological
reconstruction, and from ethnographic studies of modern people still
engaging in early lifestYles.

Throughout this thesis I avoid using terms such as 'developed' or

'undevelop€d', or 'first' or 'third world' countries as these suggest suPeriority

of one occupational form over another. To describe the differences these

terms seek to define,I have used the occupational form itself, such as hunter-
gatherer or post-industrial societies. This follows a trend in archeology and
anthropology in which the eras of mankind's history are frequently described
in occupational terms, that is, hunter-gatherer, agriculfural and industrial
eras

Occupation is so central to the study of the origins and development of

humans in society that much of the evolution of the human species, from
pre-homo sapiens, is traced by studying occuPations such as tool usage, food
production, creativity, and domestic and communal activitiesT' In fact'
Roland Fletcher uses occupational behaviours to define what is meant by
'human'. Along with bipedalism and toolmaking, he lists "the capacity to
control fire, to interact socially with their dead, and to represent the universe
in art" as marks of humanness in evolutionary termsS. Archaeologists and

7See,Íor example: Foley R, ed.itor. Hominid eaolution and community ecology' Ifndon:
Academic Press, rsg¿;'Klein RG. The humnn cateer: Hunnn biological and cultural
origins'
Chicago: University of Chicago Press, 1989.
8 fl"t.h", R. The evolution of human behaviour. In: Buranhult G, editot'The first humans:
Humøn origins and history to L0,0008C..'P'I7'
 108
Chaoter 4: Occuoational evolution

anthropologists recognise strong links between human occuPation and

biological evolution. These two avenues of study are interdePendent because
"the tangled triple influence of bipedalism, brain development, and the

manipulation of objects cannot (easily) be separated'e. Clearly, this chapter is

buitt upon, and extends, the discussion of those matters in the Previous

chapter.

The first section explores the probable tifestyles and occupations of early
humans until agriculture became the dominant economy' It considers'

briefly, ideas held about occupations ranging from the practical matters of tool
technology, food acquisition, division of labour and education of the young
to

social occupations and those of an abstract nature'

Interest in differences between humans and other animals because of the

tools they used for their various occuPations has been central to the
evolutionary debate, with some pre-historians arguing that tool technology
was the driving force of the evolution of the human brainl0 and others, such

as Blumenburg, opposing the hypothesis that tool technology of any other

activities were solely, or in combination, responsible for the advanced
hominid brain, despite their importance in survival or social behaviourll'
Another, recent, controversial view based on temperature regulation of the
brain following ecological change in the African Savannah, and known as the
'radiator theory', points to bipedalism preceding increased brain capacity and
complex tool technology following itt2. Flowever, there is general agreement
as a
that changes in tools over the millenia reflect changes that affect culture

9 Campbell BG.Humankind emerging-'. p'230'

10 Lancaster The dynamics of tool using behav iour. American anthtopologist L967;70:56'66;
J.
of man in Àf¡ca and beyond . Philosophical transactions "f
the
Tobias pV. The
Royal "*"ri"rr."43-56.
Society 7981;292:
1983;24
11 gti*"nu".g Ë. t evolution of the advanced hominid brain. Current anthropology
(5): 589-623. "
12ruit D. As it happened: some liked it hot. Television documentary, U{' SBS(Adelaide)
8.0Opm, March 21', L9g6. See: Falk D. Cerebral cortices of East
Afrián early hominids' Science
7983;221 7072-7074
 109
Chapter 4: Occupational evolution

whole, and Gowlett suggests that stone tools "provide a framework for
mapping out human activities from the distant past to recent times"13, The
interactive nature of the evolution of toolmaking is shown in figure 4'1'

below. Throughout history, people have sought methods and tools to make
tasks less arduous which, in some instances, has made new occupations
possible well into the future. Indeed, as Jelinek ProPoses, adaptation through

experimentation is the driving force of technological evolution, just as

adaptatio n per se is a central tenet of evolutionary theory, and
"a new

discovery (does) not have to find it's relevance immediately" but can Provide
"a new solution" to some future need14.

Small Increased brain size

canine teeth and comPlexitY

Carrvine weapons,
tool's, fõod, bäbies

Fig. 4.1: Numerous feedback systems occur in nature and are often
intãrlocking. Negative maintains stability, but positive feedback
that constitute evolution' Shown
e feedback sYstem that has been

l3Gowlett ]Af. Tools - the palaeolithic record ' In:The Cambidge encyclopedia of luman
eoolution... p.350'
1989,p'42'
¡elinek J.Primitiae htmters. Hamlyn, London,
14
15Éig ¿.r i" tuk"tt from Campbell BG. Humankind emerging"' p' 237
 110
Chapter 4: Occuoational evolution

Debate about the daily occuPations of our early ancestors however, is

it is on skeletal remains, the environment in which they

speculative, based as

were found, and fossils and tools found adjacent. Like all large Primates'
hominids almost certainly subsisted principally on Plant foods, and homo
habilis was probably an oPPortunistic omnivore, occuPied by scavenging,
rather than hunting, with "...animal products Such as birds' e88s, larvae'
lizard.s and small game (playing) a much more important role than big game"

in the same way that they constitute "...an important Part of the diet of
present day hunter-gatherers"16. "...Scavenging requires no division of labor

and does not imply sharing or any other social behaviour aPProaching our
own", although habilines probably lived in small grouPs with a structure

similar to that chimpanzeeslT. This very gradualty developed into a

of
systematic food sharing economy based on co-oPefative foraging of
meat and

plant foods, and possibly some d.ivision of labour18' This led eventually to
"some turning point in our history (when) the primitive homo males began
to take a serious interest in hunting as another way of providing meat"19'
It

may well have started through self protective behaviours, such as stone
throwing, required because of human's physical vulnerability in comparison
to many other animals. Barbara Isaac suggests that stone throwing' as
observed in the Hottentots in South West Africa, and the Australian
Aboriginal in the Musgrave Ranges and the northern Kimberleys, was a
possible early method, of attacking Prey for food2o. Recent debate
has

suggested no clear cut distinctions between hunting and herding2l, and

16 Buranhult G, editor. TIæ first humans: Human origins and history to 1'0'0008C"' P'59'
17 Rowley-Conway P. Mighty hunter or marginal scavenger? In: The first htnnans: Human
origins and history to 1'0,0008C.'- p'67-62'
18r,uri der Merve Nf Reconstructing prehistoric diet. In: The Cambridge encyclopedin of lutman

eaolution...pp.369-372;
- 'foodways.
Wing ES, Brown AG' Paleonutrit
prehistoric New York Academic press, 1978; g

tehaviour of protohuman hominids' Scientific American

19 Leakey R, Lewin R.PeopIe of the lake: Man: His origins'
20lsua.B.Throwing.In:The Cambtidge encyclopedia of human eaolution"' p'358'
21 lngota T.Htmtersl pnsturnlists and ranclrcrs. Cambridge: Cambridge University Press' 1980
 111
Chapter 4z Occupational evolution

between hunter gatherers per se and horticulturalists who also hunt and

gatherzz, but rather between'immediate return economies', characterised as

'hand to mouth' existence, such as that lived by the Hadza, a hunter-gatherer

people who live in Tanzania23, and 'delayed retum economies' in which a

time investment for the future is part of daily ltfeza. Figure 4.2 provides a
sequence for some of these behaviours based on knowledge of living primates

and archeological and fossil records.

How occupation was divided according to gender, in the early days of

human evolution, has long been a point of debate in archeology and
anthropology. The extent of sexual dimorphism, and the maturation rates of
early humans set some parameters to the debate26, and others reflect concerns
of the modern societies from which the ideas emanate, such as about Power
relations, monogam/, and the nucleat familyzT- Most recent opinion seems
to favour the idea that as hunting became an important aspect of subsistence'
females, along with their child-bearing and care roles, engaged in the
fabrication of household implements and clothing and continued with the

Throwing objects) Seenin living Primates and therefore

Tooluse probably ancient
Bipedalism ) Evident by 3.75 million Years B.P
Reduced canines
Evident about 2.5 B.P
T
ftavmging Evident by 1,.75 million Years B.P
Increasing brain size )

Fig.4.2-. Possible sequence of significant change affecting human evolution2S'

22 E[en flR.Enaþonment, subsistence and system,' Cambridge: Cambridge University Press'

L982
23 Foley R. Studying human evolution by analogy. In;The Cambridge encyclopedia of humøn

eoolution... P.336.
E' editor
24 Woodbu* ¡. Hrrrtt"rs and gatherers today and reconstructio-n of the past' ln: Gellner
Soaiet and zuestern anthropology. London: Duckworth, 1980'
25Campbell BG. Humankind emerging-.. P'234'
26pott, n. The hominid way of life. In;The Cambridge encyclopedia of htman eaolution"'
27 LamplM. Sex roles in prehistory' ln: Buranhult G, editor' The first humans: Human origins
and history to '1.0,0008C..' pp.30-31.
 7.7.2
Chapter 4: Occupational evolution

foraging-gathering role, sharing their finds, as the hunters shared their

meat28. In fact it has been estimated that women contributed more than half

the required subsistence calories29. The necessity for women to assume

responsibility for tasks in a sequential order of those closer to home to those
farthest afield was due to the need for women to undertake occupations close

to camp because of child-rearing restraints3O. For men the opposite is true3l'

Although, by about 100,000 years ago dimorphism was similar to that found
in modem humans32, evidence from primate ethology and ethnology of
foragers demonstrates that male specialisation in hunting and defence gives
a

"selective advantage to larger males" with resultant sexual dimorphism33'

There may well have been a selective advantage for females who

demonstrated child-rearing, food gathering and PreParing, and fine

manipulative skills.

Herskovits observes there would be no exemptions from some kind of

labour except for the very young, and that everyone would be primarily
a

hunter or gatherer and tool/household-implement-maker, even those with

extra-curricula activity as Shamans, chiefsor warriors34 In similar vein'
Coon, the Harvard anthropologist, infers from his study of modern
hunter-

gatherer societies that most individuals would be'jacks of all ttades',

living

284 recurring motif in rock paintings and engraving shows women with digging sticks weighted
with perforated round stones.
encyclopedia of human
van der Merve NJ. Reconstructing prehistoric diet' In: The Cambridge
eaolution... p.369
}9L""RB, Devore r.Man the hunter.Chicago: Aldine Pubtishing Co.1968; Dalberg F, editor'
Womanthegatherer'NewHaven,CT:YaleUniversityPress,l9E]..
Diets were u"ry"dirr"rre which increased the likelihood of balanced nutrition'
30Bro*r, fK. A note on the division of labor by sex. Americøn anthropologist. 1970;72(5): 1073-
7078.
31 Burton ML, Brudner LA, white DR. A model of the sexual division of labor. American
e thn oI o gis t, t977 ; a(2): 227 -251"
32 umpl it. S.* roles in prehistory. In: Buranhult G, editor' The frst humans: Humnn ongffis
and history to L0,0008C'.. pp30-31'
33Burton tuti, Wtrit" DR. Division of labour by sex' ln: Kuper A, Kuper ], editors' Tfte social

science encyclopedia. London & NewYork: Routledge' L985' p'206'

34 Herskovits M. Economic anthropology' New York Knopl 1952'
 113
Chap ter 4: Occupational evolution

and working mostly out of doors, their senses acute and, like their bodies'
well exercised. Their schedules and routines would be seldom monotonous,
and often adventurous3S. Many anthropologists argue that this simple, but
obviously effective economy provided a very successful and persistent quality
of life, with Marshall Sahlins of the University of Chicago naming it
'the

original affluent society...in which all the peoples wants are easily satisfied"36'
and
Coon suggests there is a closeness of fit between hunter-gathering people

their environments. "Such PeoPle" he writes

"haue had the enerry, hardihood, and ingenuity to -Iiae and lirsewell
in eaery climøtic ,"tgion of the world nit coaered by _icecaps. Thty
harte done so with stone tools and no firearms. In eaery well-
documented instance, cases tf hnrdship may be traced to the
interuention rf modern intruders"37.

Hunter-gatherers, like most primates, and modem humans, lived in social

groups. In Ethiopia, ]ohanson found numerous bones ascertained to be over

three million years old., and to have come from at least thirteen individuals,
perhaps killed together in some kind of natural catastrophe3s' Social

psychologists and sociobiologists offer various reasons for humans having

lived in social groups throughout their evolution, including the need to meet
biological 'drives' through grouP activity, dependency, affiliation, dominance,
sex,self esteem39, nepotismaO, coercion+l, and reciprocitya2' Jerome Bruner
,,there is no known human culture that is not marked by reciprocal
observes

35 Coon CS. The hunting peoples' London: Jonathan CapeLtd,I972'

36 Cit"d in: Lewin R.In the age of mankind: A Smithsonian book of human euolution'
Washington DC.: Smithsonian Books, 1988, p'1'90'
37coot CS. The Hunting Peoples... pp.388-389'
lrurankind. New York Simon & Schuster' 1981'
¡ohanson D, Edey M.fucy, Tlrc biginnings of
38
39ergyt" M.The psychology of interperconal beluaiour. Harmondsworth: Penguin Books' 1967'
40 Rtexat ¿er RD. Darutinism and human ss'

7979; Chagnon N,Irons W, editors. Eool

n
North Scitúate, Massachuseth Duxbury
sexuality. New Yo¡k Oxford University Press,1979'
41 uur, den Berghe PL. Sociobiology.In:The socinl science ancyclopedia-..
42 Trirre.s RL. The evolution of reciprocal altruism. Qtnrterly reuiew of biology 7971;46(7):
35-57.
Chapter 4: Occuoational evolution 744

help in times of danger and trouble, by food sharing, by communal

nurturance for the young or disabled, and by the sharing of knowledge and
implements for expressing skil1"43. This, as well as other theories, such as

"the hunting band was an effective, adaptive solution to the survival and

development of a partly carnivorous species"+4, and that social groups offered

some protection against predators, imply occupational behaviour of a social

nature

Because of the way evolution and natural selection work, it is argued ry

anthropologists that social structures are not only determined by what is best
for individuals in terms of sexual success4s, but that the kinds of social grouPs

found in higher primates are facilitatory to 'kin selection" As was noted in

chapter 2, this extends the Darwinian notion of individual 'fitness' to include
'social fitness', thereby increasing the survival, well-being and reproductive
success of all individuals in a social grouP who carry an individual's genes46'

Within modern hunter-gatherer societies, such as those of Australian

aborigines, Kalahari Bushmen and the Birhhor of northern India, survival

needs and peaceful coexistence are major determinants of grouP size which

ethnographic studies demonstrate are usually made up of between 20 lo 70

peopleaT. "A lone individual rarely survives for more than a year' whereas a

group of five can continue for up to a generation (about 30 years)' A group of

to
about 25 has a good chance of surviving for perhaps 500 years" and appears

be compatible with minimal conflict. To avoid inbreeding, these grouPs

usually form part of larger 'tribes' of about five hundred to eight hundred

43 Br,rne, American Psychologist'1972;Augush 687-708'

]S. Nature and uses of immaturity'
p.690.
44 Morris D, Marsh P.Ttibes'London: Pyramid Books,1988, p'9'
45 Leakey R, Lewin R'People of the lake... pp'32-33'
46Campbell BG. Humankind emerging-.-
aZ l-itjugF"r, R. Animals of ice age Europe. In: The first humans: Human origins and history to
1_0,0008c...
 115
Chapter 4: evolution

people48. It is possible to argue from these studies of modem traditional

societies that from early in human evolution there aPPears to have been
a

preference for small grouPs in everyday life, and for the larger social get-
togethers to be occasional, and for social gatherings to be PurPosive rather
than accidental. Humans grouP together for the PurPoses of achieving large
scale occupations, and for the enjoyment that can be experienced from being
with and doing things with others. People with like occuPational interests
find pleasure and challenge in discussing and sharing their enthusiasm'

Stimulation from social and grouP occuPational interests will often lead
to

profound personal exploration of id.eas and to individual occupations which

lead towards self growth and actualisation'

The evolution of the role of societies in education of the young of the

nature
species is an important aspect in understanding how the occupational

of humans can be developed or inhibited: after all learning, which occurs in

the first formative years of life, has significant lifelong effects. In fact, because
what is best for the safety and' development of offspring is of vital importance
to the species, education of the young is one of the strongest arguments given
for people living in social grouPs: it provides children with role models for
their own future survival, as well as the protection and guidance of adults
a lot to
before being burdened with their responsibilities. Primate young have

learn and compared with other animals, a long childhood' Leaming by

observation and imitation combined with the imaginative creativity of Play,
for human young to learn about self care, safety and
provid.es education
survival occupations. It also provides the experience of fun and the
d,evelopmentof skilts and self worth, which are potential motivators for
continued engagement in occupation. As humans evolved into
more

of childhood, play and education extended and

complex animals, the years

48 Buranhr.,lt G, editor. TIrc first humans: Human origins and history to L0,000P,C"' P'93'
Chaoter 4: ô¡¡rrnr tional evolution 116

changed. For example, until recent times play and education was an integral
part of the day to day occupations of adults and children, taking Place in an
environment relevant to the families' work and leisure activities. Today, in
post industrial societies, children, and often young infants, are separated from
their family for much of their 'waking' day, and education is Provided
according to social and politically devised criteria. The effects of this change

have not been assessed in terms of adult engagement in, or value given to,
occupation.

There are some who challenge the present segregation of education from
parents. Coon, for example, compares unfavourably the contact and guidance
"through the puberty ordeals" of the young provided by parents in urban
societies n,ith that possible in hunting societies. He suggests that "the secrecy

that once formed a part of puberty rites is transferred to the parents, to whom
they (the adolescents) will not reveal what they are doing"4e' In contrast'
Lorenz tn On Aggression discusses ethological causes of what he describes as

"war betr,r,een the generations" which he asserts is part of a "species-

preserving function to eliminate obsolete elements hindering new

developments"S0. In puberty young people go through a stage of
"physiological neophilia" in which everything new is attractive' When
somewhat older they experience a revival of love of tradition or "late
obedience". In occupational terms, Lorenz'S explanation has Some merit, in
that physiological neophilia at an age when physical and mental capacities are
will facilitate experimentation and exPloration across a wide spectrum
acute,

of activities which may well provide survival and health advantages'

Additionaüy later development, growth and adaptation may be based on
successful experiences and individual interest so enhancing personal
capacities, health and well-being.

49 Coo., CS.The hunting peoples..- p.392'

50 Lot"t, K.On aggression. London: Methuen,I966,p'52'
Chapter 4: Occu national
rt7

Some authorities suggest that the demands of survival in harsh

environments made the occupations of traditional societies necessarily very

arduous and virtually continuous despite time spent in social activitysl'

Waechter and others argue that "the struggle for existence over nearly four
million years by a creature with few weapons other than his developing brain
allowed little time for activities not immediately concerned with survival"S2'
However others, basing their argument on evaluation of modem hunter-
gatherer lifestyles, have Posited that the mixecl economy of hunting and
gathering brought with it time for leisure in the sense of occupation apart from

labour concerned with survivals3. Indeed, Marshall Sahlins in Stone Age

Economics argued that more time is available for leisure in hunter-gatherer

societies than in agrarian or industrial societiessa. Providing evidence of this
are the findings of Richard Lee and' Patricia Draperss who, as part of a group
of

investigators, mainly based at Harvard University, studied the hunter-gatherer

lifestyle of the lKung san who live on the northern fringe of the Kalahari
Desert56. Daily,adults, from L5 to 60 years of age, only spend about two and a

half hours in providing their necessities of life. These measurements were

taken at a time of drought, and it may well be that in more plentiful times the
57. The lKung are
lKung would have had. even more time available for leisure
not unique amongst hunter-gatherer societies in having time for leisure' In
the 1840's Edward fohn Eyre remarked on the few hours it took, "without
fatigue or labour" for Australian Aborigines to procure sufficient food to last
the daYss
rNS'Work and
51 Waechter I.Man Oxford: Elsevier-Phaidon, 1976; Neff
before history.
L985'
human behazsiour. grd eaition. New York Aldine Publishing company,
52 Waechter !.Man before history. Oxford: Elsevier-Phaidon, L976 (lntroduction)'
53 S"nUr," ¡¡.. Stone age economics. Chicago: Aldine-Atherton,7972; Leakey R, Lewin R'
people of tlrc Lake: "Man: His Origins, Ñature, and Future...; Leakey R.ltt Y?Y"S of
lvtai.nkiia...; van der Merve NJ. Rãconstructing prehistoric diet. ln The Cømbridge
encyclopedia of human eaolution.-. p.369.
54 Sunur,r M. Stone age economics-..
55 Leakey R. The Making of Mankind'.-
56fni" Iiiestyle has been erod.ed, and, now, only a few continue in traditional ways'
Chapter 4z Occupational evolution 118

Labour, in the sense of procuring the physical needs of survival, is only one

aspect of the occuPational behaviour necessary for the well-being of the

organism, and other forms of occupation serve an inbuilt need to exercise,

maintain and develop the capacities inherent to each individual. In fact, as
long as the second need is met by goal directed, meaningful occupation, and it
is possible for material needs to be provided by other means, then the
occupational nature of humans can be satisfied. Leisure, for example,
frequently serves as a mechanism for children and adults to exercise their
bodies, to be social, to develop their creativity, to fulfil "wishes at the fantasy

level", and to sort out problems as well as having a crucial role in teaching and
maintaining "fluency with roles and conventions"Sg. It's difference from
work in meeting basic human needs is related directly to how it is valued by
societies

Hunter-gatherer societies left a legacy of more than stone tools to

d,emonstrate the range of occupations valued by them. Deep in caves they

drew and coloured images, usually depicting creatures and humans who were
a part of their world. They carved throwing sticks and other implements'
along with creating "new and stylistically more complex tools" and there is
archeological evid.ence of "a rich ceremonial tife based on complex concePts
and rituals"60. However it is difficult to determine if there existed any formal
differentiation and value loading between labour, self care and leisure in the
lives of early hominids. From study of hunter-gatherer people of recent times
it is possible to suggest that early in human history no distinction did exist
between labour and leisure occupations. Wax observes "I do not believe that
of
any Bushman could tell us - or would be interested in telling us - which part

STl.eakey R, Lewin R. People of tIrc Lake:Man: His Origins, Nature, and Future"' P'88'
58Eyr" yi.¡ournats of erpeditions of discoaery into Central Australia and operland'London:T&
W Boone,1845.
59 Br.rr,"r
|S. Nature and uses of immaturi ty. American psychologist 1972; Augu'slr.687-708'
pp.698-699.
60¡.rr"rtrrrtt G, editor. The first lnnnans: Human origins nnd history to L0,0008C"' pp'98-99'
 119
Chapter 4: Occuoational evolution

(his) activity was work and which wâs play"61. The separation of leisure from

work appears to have occurred fairly recently, early societies seeming to have
operated in such a way that a natural balance between work, leisure, self care

and rest was an accePted Part of their occupational lives' Their 'economic'
activities had inbuilt leisure comPonents such as "singing and telling stories at
work"62. Indeed in hunter-gatherer societies such as that of the eskimos63 or
Australian aboriginals64, there is no generic word for 'work' or 'doing' but
many for specific occupations such as 'hunting'. Such a lack of distinction is
ad.vantageous to health and well-being, in that individuals would be
able to

develop their own traits and capacities according to need and opportunity'
without subjugating their choice of activity to economic efficiencies or without
regard to the kinds of socio-cultural values imbued in work, self care or
leisurqthat have mad.e occupational choice so complex in present times'
I

This does not imply that socio-cultural values did not exist or were not
important to early humans. In fact the simplistic notions held until recently
that the hunter-gatherer lifestyle was essentially nomadic, and that small
band.s of families would be unencumbered by material goods or social
hierarchy, are changing. Many of the complex features of our own way of
life'

such as social inequality, occupational specialisation, long-distance exchange/

and technological innovation originated with hunter gatherers6s' These
suggestions are suPPorted by finds such as "the remains of magnificently
adorned children...buried with high honors before they are old enough
to do

anything outstanding raises the possibility of status by heredity rather than

achievement',66; and Mediterranean shells used as paleolithic decoration,
as

to
61 Wu* RH. Free time in other cultu¡es. In Donahue W, et al', editors' Free time: Challenge
Iater maturity. Ann Arbor, Michigan: university of Michigan Press, 1958, pp'3-16'
62 parker S.Leistre and work.London: George Allen and Unvsin, 1983, p.1'9.
63 Bous F. Ttu mind of primitiae nrcn. New York: Macmillan, 1911.
64 Neff WS. Work and humnn behaoiour."
65Bro*r,and.Price,citedinlewin R.ln tlrc age of mankind: A Sntitlrconian book of human
eaolution... p.195.
66 Buranhult G, editor. The first httmans: Httman origins and ltistory to L0'0008C"' P'95'
 720
Chapter 4: O evolution

far inland as the Ukraine giving reason to suPPose that trade was an
occupation long before the establishment of agriculture or towns' King'
anthropologist of the Historic Preservation Advisory Council, when discussing
early Californian societies, observed' they had "economic systems utilising
shell-bead currencies and validated by ritual exchange obligations" which
"facilitated sharing of subsistence resources over broad areas"67 ' The

possibility of complex lifestyles is also supported by evidence in the Central

Russian Plains of semi-permanent dwellings with vaults, arches and

of mammoth bones from about 30,000 years ago' Such

buttresses, constructed

constructions can be said to "represent the foundations of architecture"6S'

Such dwellings also ind.icate that fixed habitation and some domestication

of crops probably occurred in some regions for thousands of years before the
rapid spread of agriculture through most of the world from about 10,000 years
ago and, indeed, "many archeological sequences also show that
knowledge of

agriculture and domesticated plants existed long before there was a real shift
from hunting and gathering"6g' For an overview of how hunting is believed
to have contributed to the evolution of society see figure 4'3 on the next

Page70.

The impact of the agrarian revolution on human occupation merits

discussion, as it was the first major, rapid occupational change that

we know
still
of, is one which set the scene for increasing occupational complexity' and
impacts uPon the daily tife of many people'
why agriculture occurred at all has been a topic of debate over decades'
although it is generally accepted that the advent of permanent settlements

6TlewinF..ln tlu age of nnnkind: A Smithsonian book of humnn ettolution."p'204'

68
¡eünek l.Prinútiae hunters... p.66- of human
6gBinford LR. Subsistence - a key to the past. 365-368 Ín:The Canrbridge encyclopedin
eaolution... P.368.
z0 Fig. 4.3 is taken from Campbell BG, p'342'
 1,21,
Chapter 4: Occu oational evolution

HOLOCENE
1 0,000

HOMO ERECTUS (c. 1.G05 million B.P.)

Bcijing fossils
Physical Males over and lemales between 4 feet 6 ¡nches ând 5leet tall
Torralba /Ambrona characteristics Cranial capac¡ty from 775 to 1225cc; heavily built skull
and Terra Amate More sweat glands and less hair than previous hominids
Olorgesailie Heavier and lhicker bones than most modern humans
Hearths at Escale

Günz glaciation Scavenged, loraged, and gathered lood

Subsistence
Java fossils
prevlous
Hunted larger an¡mals, such as anc¡snt el€phants. than d¡d
lmillion- pLEISTOCENE hominids
gett¡ng
A. robuslus and ùoisei At least in northem arêas, probably hunted as a maior means ol
food, €speciallY in winter
extinct
Used spears and posslbly spherolds as weapons, and ùe technlques
Ea¡liest Acheulian tools of ambirsh and p€trs¡stence hunting

llrmly
Division ol labour'betw€en the s€xes and interdepênd€nce more
Social
establishect than among previous hominlds
organization
Édended kinship t¡es, incest taboos, and exogaÍry probably appearÊd
Established,temporary and permanent homes
Probably lived in bands of 20 to 50 indiv¡duals

Fig.4.3: Hunting and the evolution of society

of
The evolution of human society resulted to a great extent from development
and the
gathering and huntirg to increäse food resou;ces, the division of labour'
expansion into the north temperate zones'
 1,22
Chapter 4: Occupational evolution

was closely associated with environmental and climatic conditions which

adequate food and
prevailed. in different locations. Those which provided
reducing to a
shelter all year round probably suPPorted resident populations,
extent nomad.ic ways of life. Maior theories about the rapid
increase of
great
is not well
permanent settlement range through ideas that hunter-gathering
adapted to support large numbers of people, and a rise in
populations forced
ice age
more intensive means of food production; that when the pleistocene
ended a major ciimate change occurred which produced environments
resulted in a
conducive to agriculture; and' that increasing social complexity
need for more formalised food production because the food
procuring system

of smail nomadic communities became inadequate. It is also possible

that the

developing occupational capacity of humans was instrumental

in the change'

That is, as humans experimented. with material resources as their

skills

expanded, they began to challenge the environment

and adapt it to to meet
and
their own needs and comfort, and they changed their social structures
is supported by the fact
behaviours to accommodate such change. This theory
that as agriculture developed so did the diversity of occupations
in which
services regarded
humans engaged along with an expansion of goods and
as

necessarYTl.

when agriculture became the d.ominant economy it was the men

who
done by women'
changed their occupation from hunting to that previously
Flowever, the shift to male farming heralded a change
in role for many
occupationsT2' For
women, who increasingly became engaged in household
according to the
women, as for men, the roles they undertook differed
societies and cultures in which they lived. Ester Boserup found sexual
but no common
division of labour in all the traditional societies she studied,

71 Parker S-Leisure and work"'

72 E^b", CR. The relative decline in women's contribution to agriculturg w-ith intensification'
Sexual division of
Antericnn anttrropologist, 1983; 85(2): 285- ì04.; Burton ML, \',l/hite DR'
workinagriculture.A-mericgnnntltopologist,tg}4;86(3):568-583.
 4: O ccup ational evolution
t23
Chapter

pattern; what was considered 'natural' occuPation for women was seemingly
d.etermined by the fact that they had "undergone little or no change for

generations"T3. Variability was particularly evident with regard to food

production and care of domesticated animalsTa'

Agriculture did not necessarily mean the cessation of communal life. In

many instances it gave a focus for some combined activity for both individual
and communal good., as well as time for celebration and fun. For example

Ashton reports that among the Basuto, working parties, which "are 9aY,

are a part of
sociable affairs comprising about 10-50 participants of both sexes",

all aspects of agricultural activitiesTs. Work structures which mix labour and
leisure lessen d,rud.gery and enable workers to meet their social and
psychological needs, although, from a capitalist view in which labour is seen

as separable from other types of occupation, and as merely one asPect

of the

production ProceSS, in most instances, combining work and leisure is

considered inefficient and uneconomical. In Western agricultural societies
also, Ieisure, as well as work, was long associated with seasonal tasks which

included, communal participation. When Christianity became the dominant

religion, seasonal celebrations of an occupational and social nature were
adapted to its religious observances'

some peoples did not adopt an agrarian lifestyle. Coon argues that
surviving hunters do not lack the intellectual capacity to progress, pointing,
as evidence, to their ingenious methods of obtaining foodstuffs, and
to their
complex social organisationsT6. The successful survival of Australian
aboriginals in a relatively inhospitable environment and their unusually

73 Bor"*p E.Women's role in economic deoelopnrent. New York St. Martin's Press,1970, p15'
74 g,rrton tutl, White DR. Division of labour by sex .ln The social science encyclopedia... p.206'
75 Arhtor, H. The Basuto. 1967.Ln: Parker S.Leisure and uork...p.131"
76coon CS.TIrc hunting PeoPles...
 L24
Chapter 4: Occupational evolution

complex structure of kinship relationships is a case in point77. Three Possible

reasons for the retention of a hunter-gathering way of life are; firstly,
isolation; secondly, climatic conditions not conducive to profitable
agriculture; and thirdly, that they did not want to change78. Coon suggests
that they had an eminently satisfactory way of living together in small grouPs/
free from tedious routine, and all the food they needed, and he argues that
adopting agriculture would have imposed a "whole new system of human
relationships that offer no easily understood advantages, and disturbs an age
old balance between man and nature and among the people who live
together"79.

is supported by observations made of hunter-gatherer

Coon's argument
communities currently in the Process of adopting a sedentary, agrarian
lifestyle. For example, some of the lKung are undergoing transition from a
hunter gatherer lifestyle to agriculture, under Pressule from the government'
A major source of apparent conflict and difficulty arises from differences
between community life based on 'sharing', central to hunter-gatherers, and
,saving', that is, the husbandry of resources, central to agriculture. Another

consequence for the lKung is an apparent decrease in both social and sexual

egalitarianism, and a more rigid defining of male and female roles, obvious
also in changed play behaviours of the children. There has been a tendency
for individuals to accumulate material goods, as well as a marked rise in birth

rate. The dispersion of shelters from villages clustered around a central, and
publicly shared, space to more isolated shelters 'owning' the land around
them has changed the complex support mechanism of the older tyPe of
communitiesso. All of these changes are manifest in occupational behaviour'

77
¡ehnek l. Primitiae hunters...
78Coor,CS. The hunting peoples..'
79 Coon CS. The hunting peoples-.- p.3'
80 Leakey R. The making of nmnkind"' pp'226-229
 a2s
Chapter 4: Occupational evolution

With the ad.vent of agriculture a more stable Provision of food, for those

who adopted agrarian Practices, led to greater PoPulation density, an aPParent

need. for territorial defence, and the ever recurring occupation
of war81.
Leakey Suggests that "man is not Programmed to kill and make war, nor even

to hunt: his ability to do so is learned from his elders and his Peers when
society demands it"82. His argument is based on no evidence of inflicted
death and warfare being found before the advent of temple towns making
"this...too recent an event to have had any influence on the evolution of
human nature". This cultural view of human aggression is one aspect of the
ongoing d.ebate about whether or not humans are innately aggressive and
wars inevitable. In contrast Lorenz argues that, in common with other
animals, humans are innately aggressive in order to maintain sufficient
sPace

for existence, to ensure the strongest males father offspring, and to establish a
'pecking order'83. Others ProPose that an inevitable consequence of tribal
bonding is hostility to other tribessa. It is true that people have expended vast
amounts of mental and physical effort as well as resources on the
development and accumulation of weaPons. These may be seen as an
expression of a human need to feel safe, of innate aggression Of,
as a

consequence of either, an occupational need to develop tool

technology

without adequate consideration of the possible consequences of the

technology so produced. The weapons of war are only one aspect of tool
technology developing beyond and perhaps to the detriment of human
rvell-

being. This may be a reflection of the planlessness of evolution, that

adaptation to one set of environmental conditions millions of years
a8o may

prove to be a handicap in another type of environmentss' Lr particular'

the

expression of capacities through ongoing experimentation and

technological

Sl Lewin R.In the age of mankind: A Smithsonian book of human eaolution.-.

82 Leakey R. The making of ntankind"' p'242'
83 Lo."n K. On aggression' London: Methuen' l'966'
84 Morris D, Marsh P.Tribes,. London: Pyramid Books' 1988
85 Lor"* K.The waning of luunanene.ss. London: Unwin Paperbacks, 1983'
 evolution 126
Chapter 4:

development is a strong force, esPecially when valued highly by society. The

brain's ability to overide biological needs with a highly developed cognitive
capacity responsive to socio-cultural influences, has disadvantages as well as

advantages.

Another disadvantage of the human capacity for occupational

experimentation is that agriculture changed the earth as a result of
d.eforestation, land. clearing and ploughing, and irrigation schemes, such as

blocking or moving river bedss6. As part of the agricultural Process,

domestication of animals "involved an accelerating process of elimination of

the great diversity of wild animals and plants to replace them with a few
also resulted in
species that could. be easily managed and manipulated". It has

the proliferation of some, such as the rabbit87. "Erosion and the alteration of
the balance of species became inevitable"ss'

with the fairly recent formation of cities, at l¿asL 6,000 years à8o, more

elements of modern occupational behaviour began. Lewin considers

that it is
possible from this time to trace occupational developments in architecture,
art, writing, commerce, religion, increased technological innovation and

social administration. Administrative functions, organisation and control of

cities in those early days, often combined with religious activity and
monumental architecture, developed to help communities cope with socio-
environmental stress, uncertainty and unpredictabilityas. The stressors arose
from within communities living in much larger, specialised populations
than they had been used to, and also in response to possible dangers to the
community from outside. Neff observes that during this period occupation

F. origins of agriculture. ln: The Cambridge encyclopedia of human etsohttion...

86 Hole pp.373'
379
STclutton-Brock J. Domestication of animals. pp.380-385. tn: The Cambridge encyclopedia "f
human euolution.-. P.385.
88Hotu F. origins of agricultute.-. p'379'
89 Lewin R.In the age of nnnkind: A Smithsonian book of human eaolution..'p'224'
 1.27
Chapter 4: Occupational evolution

began acquire distinctions and qualifications, and an increasingly

to
complicated infrastructure of evaluative meanings, including a distinction
between labour and leisure9o '

It is, perhaps, in early Greek culture that the greatest distinction between
labour and leisure is made. The Greek city states were established by conquest
during the third and second millenia BC, when the Greek citizen "managed
to divest himself of all need to labour" leaving this to slaves, free peasants,
artisans and craftsmen who were usually the indigenous people of conquered

d.omainsel. Labour and work were regarded as "brutalising the mind, making
man unfit for thinking of truth or for practising virtue; it was a necessary evil
which the visionary elite should avoid"e2. In contrast,leisure, which was the
domain of the elite, was concerned with occupations worthy of free men, such
as those of an intellectual, political and social nature, and warlike
pursuits,

alongwith "a conscious abstention from all activities connected with merely
being alive"93. Aristotle argued, in concurrence with the cultural norms of
his day, that without labour it is not possible to provide all the necessities of
is
life, but that to master slaves is the human way to master necessity and thus
not against naturee4. He supposed that the suPreme end for human
endeavour is happiness, that the function of 'man' is reasoning,
and that

happiness for 'man' is the good performance of reasoninges. Hannah Arendt

(1906-19T5), who is considered an authority on concePts of work and labour in

the Greco-Roman world came to agree, in large part, with the classical
views

of which she wrote, regarding labour and work as degrading and less than
human, and that the leisure pursuits of Athenian gentlemen demonstrated

90N"ff WS. Work and lntman behaaiour"'

91 N"ff WS. Work and httman behaaiour"' p'33'
92 Parker S.Leinre and zuork... p'14'
93 Parker S.Leisure and uork... p.L7'
94 Arirtotle. politics. ln: Barnes J, editor. The complete works of Aristotle. Revised oxford
translation. UK.: Princeton Univerity Press, 1984'
95 Arirtotl". Nicomachean Ethics. ln; The complete works of Aristotle"'
 128
Chapter 4: Occrrpational evolution

the true human conditione6. This view is challenged by Neff who argues that
although Arendt's views probably correctly reflect ideas held about occupation
in Classical Greece and Rome "it is not work itself that is degrading but the

power relationships and social structure which surround it"; that it takes on a
,servile' nature when subjugation of one people to another is part of the

equation; and that to the dominant grouP it may aPPear "degrading to

perform certain kinds of work, since to do so is to be akin to a slave or an

alien"e7. Similarly, this occupational theory holds that no occupation of itself
is degrading; that socio-cultural structures and values which force people into
restricted. occupational choice is counter to our occuPational nature and to
,occupational justice'; that humans need to recognise and accept, as part of

the human condition, their similarities with as well as their differences to

other animals; and that if, in the future, other means are found to provide
humans with the necessities of life without work or labour humans will not
suffer deleterious affects to their heatth and well-being so long as the whole
range of each individuals physical, mental and social capacities have the
opportunity for exercise and growth in a socio-cultural environment which

values such activity (occupational justice)'

The notion of the elite having a choice of occupational pursuits, to the

extent that choice is equated to this day with leisure, continued in feudal and

agricultural societies. However, the idea that leisure is superior to work was
challenged in Christian societies partly by a reformed monastic rule which
saw occupation as one honourable way of serving God, as well as being
necessary for the material well-being of monastic communities. For example

rule XLVII of the Benedictine order ordained that "idleness is the enemy of
the soul and therefore, at fixed times, the brothers ought to be occupied in

g6Arendt H.The human condition.Chicago, Ill.: University of Chicago Press, 1958.

Arendtrecognis utanimnl laborans (the labour of the
body) andhõno she found surprising because_of the
pr"r".,t day glor as"the soutce of nll aalues"(pp'83-85)'
97 N"ff WS. Work and human behnuiour... p'35'
 129
Chapter 4: Occupational evolution

manual labour, and again at fixed times, in sacred r€ading"98. Such views
were based, in part, on the Hebrew notion of God as one who works, and the

command.ment of six days labour followed by a day of rest on the Sabbathee.

Although much earlier than the Reformation, some argue that such ideas can
be considered pre-cursors of what is usually called the 'Protestant work ethic'.

The 'work ethic', a concept originating with Max Weber, who sought to
understand the religious and idealistic roots of modern caPitalismloo, is
usually reserved. for reference to the Reformers' doctrine of salvation, and is
particularly relevant to Calvinism. Salvation was God's gift in response to
faith, and work was a 'fruit' of faith. A life of obedience which included hard
work and thrift were deemed necessary for those 'elected' to serve God' and to
be 'saved' by God,, and which He could 'favour' with prosperity. Perhaps
because the notion of predestination, central to Calvinist doctrine, was

difficult to accept, worldly success following methodical labour gradually

came to be equated with being of the 'chosen few'101. Such Reformation
ideas

appealed to the masses who, by necessity, laboured, and benefited growing

numbers of merchants and artisans, living in cities, who were able to mix
their opportunities for prosperity on earth with hope for preferment in
heaven, although Protestant creed did stress that it was the work rather than
its fruits which were imPortant.

The ennobling of one aspect of occupation over others may have done
disservice to the occupational nature of humans. It has the potential to
deprive individuals of a balanced use of their innate capacities, of using some
and not others to the detriment of overall well-being. Closer to the view held
in my occupational theory is the more holistic notion of occupation followed

98B"tt".,ron HS, editor. Documents of the Christian Chttrch. New York Springer,t963'
99 Exodus 20: verses 9-ll.The Hoty Bible. Authorised King James version. London: Oxford
UniversitY Press, 1972.
100y¡"6". M.The protestant ethic and the spirit of capitalism. (1922). Translated by Parsons
T. London: G. Allen & unwin Ltd., 1930. (Original German edition 1922)
101.çu16s¡g S. Weber, Max. ln: Tlrc social science encyclopedia... pp 892-896'
 130
Chapter 4: Occupational evolution

by the pre-industrial society of the Baluchi of Western Pakistan, that

occupation can be divided into the sphere of obligatory duty and the sphere of

one,s own will, with the latter being the valued domain in which individuals
choose to spend energy and creativitylO2. However it was the work ethic

rather than freely chosen occupation which continued in ascendence as

agriculture gave way to industrialisation, and discussion of ideas which grew
from this time on will be the focus of the last part of the chapter'

From the turn of the eighteenth century in the occident, the occupational
nature of humans was subjected to perhaps its greatest challenge. With
remarkable speed occupation as a valued part of life became focussed on paid

employment, increasingly within capitalist forms of industry. Indeed, in

England, which led the change to industry, there was a "steady assimilation of

small professional and business families", "diverse in point of both wealth

and activity" on whom "primarily, depended the viability and growth of
the

national economy...social flexibility and stability..."los. This new

'middle

class,, "frequently self-made and always dependent on aggressive use of

their

talents,...were genuine 'capitalists'in terms of the investment of their labour

and their profits in entrepeneurial activity, whether commercial or

professional", dominated, work, education, Play and diversionl04' Their

fascination with pragmatics and applied technology lingers today, along with
one of the most influential forces on occupation in our own times,
economics, which also developed at this time'

102yyu* RH. Free time in other cultures"'

103 ¡ur.,g¡e¡d P, Harvie C. The eighteenth century and te 18".olindustry. ln: Morgan KO,
The Oxford history ol nritoir, Vohtme IV. Oxford: oxford University
Press,1992,
"aitîr.
P.42
104¡ur,t¡o.¿ P, Harvie C.ln:The Oxford history of Britain. Volume V'.. PP.a4-45
 131
Chapter 4: Occupational evolution

Adam Smith (1723-1790), whose An inquiry into the nature and causes tf
the wealth tf ns¡isn5r}S is considered the foundation of classical economics,

proposed that the key to increasing a nation's wealth was by the accumulation

of capital and, the division of labour, both of which would increase with the
freeing of trade. He held that the division of labour would enhance workers'

specialist skitls because "the difference of natural talents...is not...so much the

cause, as the effect of labour. The difference...seems to arise not so much from

nature, as from habit, custom, and education". However he also recognised

that the division of labour could decrease the quality of work106. In the broad
sense, division of labour has led to modern exchange economy, that is,
specialisation followed by exchange between specialists, which is a
fund,amental aspect of all modern economies1o7. Whilst it appears that the
vast majority of the population have accepted that material wealth provided

by occupational specialisation is logical and acceptable, one could raise the

basic question of whether division of labour and specialisation is conducive to

well-being, not withstanding material wealth. This is not a straight-forward
question as there are many dimensions to specialisation, from that resulting

from the d,evelopment of personal and professional skills, to specialisation

which is imposed by a system. In the former strengths and capacities can be
developed but in the latter there may be a minimalising of individual
development except for minute and meaningless actions, as in some
industrial processes and for the majority of workers little opportunity to
explore a wide range of occupations and discover their individual potential.

There has been a persistent stream of questioning of the ill-effects that

accompany the goods proclaimed by classical economics. Professor of

An inqtüry into the nnture anil causes of the wealth of nntions' 126. (Campbell
105 grr.l¡¡., A.
RH, Skinner es, rð¿a wB, editors), chicago: university of Chicago Prcss,7976'
106 ¡¡u'¡u"l DD.Adam Smith.Oxford: Oxford University Press, l'985, Vol'l; p'17'
107 gu¡¡6ç¡ G, Baxter RE, Rees R. The Penguin ctictionary of economics,2nd ed, Penguin Books,
1978.
 1,32
Chapter 4: Occupational evolution

Economics at Chicago University, Frank Knight, for example, argued that "the

values of life are not, in the main, reducible to satisfactions obtained from the

consumption of exchangeable goods and servisss"108' John Kenneth Galbraith

argued inThe Afftuent Societyroe that classical economics developed at a time
when 'wants' were chasing 'goods'and is inappropriate when the opposite is
true as in modern industrial nations where the "production machine has
become an end in itself"lr0; and even Lionel Robbins, an economist of the

English neo-Classical School suggested that economists "have nothing to say

on the true ends of life: and that their propositions concerning what is or
what can be involve in themselves no propositions conceming what ought to
be"111. post-Ricard.ian economics have also been critised for defending and

rationalising the interests of capitalism at the cost of impartialityrrz, *t,n

Marxist writers describing as 'vulgar economics' that which concentrates on
,,surface phenonena" such as "demand and supply to the neglect of structural

value relationships" and the "class relationships underiying commodity

transactions"l l3.

The extreme dichotomy, at the time of the industrial revolution, of

economic, social conditions and the nature of occupations versus the values
of employers and their employees, led intellectuals as various as Karl Marx'
the effects of the industrial era
John Ruskin and William Morris to consider
on the occupational nature of mankind. some of their ideas were similar to
a source
those expressed. by Renaissance Utopians, that what people do can be

108 p.¡r6¡ FH. Some fallacies in the interpretation of social cost. 1924. Reprinted
in Arrow K],
scitãvsky T. Readings in welfare Economics' London: Allen and unwin,
1969'pp'226-227'
109 çu16¡6itt- lK. The nffluent society. London: Hamish,1958.
110 ¡qo11 E. A history of economic thottght. 4th ed. London: Faber and Faber, 7973' p'600'
1.11 go66ir.,s L. politics ancl econontics, pnpers in political econoftty, London: MacMillan, 1'963,
p.7.
112 pu,nl¿ Ricardo was an English political economist (1772-\823) In his work such as Principles
"taxation,
of political economy nnd (7817), the antagonism of class interests remains central'
113 p"s¿¡ M. Vulgar economics. ln; Bottomore T. A Dictionary of Mnrxist thought.2nd ed.
Oxford: Blackwell Ltd., 7997, P'574'
 evolution 133
Chapter 4:

of joy if it is creative and Provides pleasure in the exercise of a range of

skills114. A brief account of the views of Marx, Ruskin and Morris follows.

Karl Marx, in his early works, such as Economic and Philosophical

Mønuscripts, The HoIy Family and The German Ideology formulated
a

'materialistic theory of history' arguing that it is social and economic

conditions, rather than metaphysical or religious ideas, which drives human
history and determines how people live11s. Influenced by Hegel who saw
,,labour as man's act of self creatien"l'16, he founded much of his philosophy
on the idea that "free conscious activity constitutes the species character of
6¿n,'117. particularly in Economic ønd philosophicøl manuscripts he
discusses 'praxis' as the free, universal, creative and self creative activity
which differentiates humans from other animals and by which they make
and change themseives and their world118. This implies that it is natural
for

all people to be involved in productive activity to provide for their

subsistence but that such occupation should also enable them to achieve

fulfillment, dignity and weil-being. Marx argued that when labour is not
a

creative activity by which humans make and mould themselves'

but is

simply a process to earn a wage for subsistence, it is a contradiction of the

¡4o." T.utopia. (1516) Translated with an

1'1'4
ndsworth:
Þ"r,g.rir,, reås; iampanella T.City 0f the
D|' Berkeley:
University of Califomia Press, 1981'
1L5 ¡4u.* K. Economic and philosophical manu Penguin Classics
7992.
Marx had not intended these PaPers for publication , but from 1932(Soviet
as it provided new insights on
translation)onwards the work cråated enõrmous interest
and the self creation of humanity through material
Marx's concepts of alienation
labour.
Seealso: BottomoreT.A Dictionary of Marxist thought"';
Lawrence and Wishart ' 1964'
Marx K, Engels F.The German iaeobg|' 1845-46 .L:".9:":.
a work of self clarification of their idea about a
Marx descriU"¿ tLrir manuscript as
labour'-
materialist concept ing the division-of.
e and Wishart'1957'
Marx K.The holy
rn","earlyworksableinEnglishuntilthel.950's.
in words.London: ane The Penguin Press, L970, p'31'
116 ¡¡r.¡". E. Marx his own
117¡4¿¡¡ K. ln Early uritings..'p'328'
118¡4ur* K. ln:Early writings...p.3z-8. Petrovic argues tnA Dictionary of Marxist thottght."
that Praxis is thã central concept of Marxism @'a3Q '
 evolution 134
Chapter 4:

nature of mankind, economic conditions having become more Powerful than

individuals. Fischer, in his comments on Marx's work, adds "the reduction
of labour to empt)' wage earning is now accepted without Qu€sti6¡"119'
Additiona¡y Marx recognised that when work is destructive to people's
physical and intellectual potential "the worker feels himself only when he is
not working"12o. Marx criticised the capitalist industrial society of the time
because it prevented individuals from being able to cultivate their unique
talents and alienated them from their species need to be an active, productive
being, and in fact, led to misery, exhaustion and mental debasement. This

idea of alienation, which will be considered in greater depth later, was a major

theme of Marx's theories. These early humanist ideas of Marx are remarkably

similarto the central focus of this thesis, that humans are occupational beings
and. that compulsion and subservience can act against the biological
function

of this species characteristic.

Ruskin and Morris differed from Marx in that they came to social criticism
from the viewpoint of creative artists. Ruskin (1819 - 1900) as a well known art
critic challenged the traditional view between manual labour and intellsç¡121,
and in 1860 tumed to political economy, writing four essays which appeared
in

Cornhill Magazine and were published as Llnto this Last in 1862122' From this

time he added considerably to the challenge offered by Coleridge in The

Friendtzg and, Carlyle in Sartor Resartusl24, to classical political economists

whom they characterised as ignoring the human factor in economics'

119 ¡is.¡"¡ in his own words"'p'49'

E. Marx
120 ¡4¿¡a K. In Early zc'ritings'-.P.326'
127"y¡, want one man to be always thinking, and nnother to be always working, and.we call one
o gritlr*on, and the other øi operatial; uhereas the workmnn ought often to
be thinking'
and tlrc thinker often to be working, nnd both should be gentlemen, in the best sense." Ruskin
Co'' 1853'
l. The stones of Venice.Vol2, London: Smith, Elder and
122 ¡rrr¡¡r, I.Iì6l,preface. ln: Yarker PM, editor. Rttskin: llnto this lasf' London: Collins
Publishers, 1970.
L23 ço1".i¿ge sT. The friend. 1g09. New York: Freeport,1971.
L24 çuryry"-y. Sartor Resartus 1833-4. I¡: Sartor Resartus, and on heroes and hero worship.
York: Dutton,t973'
tntrod. by Hudson wH. London: Dent, 1908, reprinted New
 135
Chapter 4: Occupational evolution

Ruskin's central theme was that the quality of life citizens enjoy is the true
measure of a nation's prosperity, rather than the accumulation of wealth for

its own sake. He attacked the boredom and monotony of the Victorian
industrial system, the disconnection between leisure and work, and advocated
that training schools should be established at government exPense for all
childrenl2s. These schools should teach the laws of health, habits of gentleness
and justice, and the 'calling' by which each would live. Il:r conjunction with
these proposed that the government should establish factories and
he
workshops, producing high standard goods, to run in competition with private
business. Any person out of employment should be admitted immediately to
a goverrunent school, trained and given work for wages. For those unable to
work he proposed special training schemes, or 'tending' in the case of
sickness. For those who objected to work he suggested they be compelled to
work in less desirable jobs, their wages retained until each learned to respect
the laws of emPloYment.

William Morris, who was a member of the small Marxist Social Democratic
Federation organised by Henry M.Hyndman, founded the Socialist League
in

England in 1884. He was the most notable of Ruskin's followers and,

although abandoning Ruskin's elitism, amongst his many endeavours

attempted to establish a working community on Ruskin's principles' Morris

(1834-1896) was a Poet, architect, painter, printer, craftsman and social
reformer (known to some today for a revival in the popularity of his
decorative fabrics and wallpapers)126. As a craftsman he too deplored
the

machine age and the fact that commerce had become a 'sacred religion',

turning work from a solace into a burden, and for the majority a mere

drudgery:

125¡4¿sq¿¡1hy F. Wiltinm Morris: A tiþ for orr time. London: Faber&Faber,7994,pp'70-77

126 giog¡vphical detail from Cole GDH. ln : selgman ERA, editor , Encyclopaedia tf social
sciince. NewYork: Macmillan, 1933'
 4: Occupational evolution 136
Chapter

The wonderful ffiachines...haae driaen aII men into mere frantic

høste and hirry, thereby destroying pleasure...they haue instead tf
lightening the labour tf the workmen, intensified it, and thereby
added more weariness Yet to the burden which the poor haae to
carry rz7.

He supported the destruction of social and economic inequalities, hoping that

the manual arts could be restored as an integral part of peoples lives. He
accepted that "the race of man must either labouror perish þecause) 'Nature'
does not give us our livelihood gratis; we must win it by toil of some sort
or

degree" but he also believed that, under socialist conditions, the necessary
work of society could be accomplished without overstrain or difficulty.
Morris argued against the "stifling oveforganisation common to both
capitalist and socialist versions of modern industrial society"128. Additionally
he suggested that most work could be done with actual pleasure in the doing
,,Since certainly other matters ('Nature') takes care to make the acts
in
necessary for the continuance of life in the individual and race not only
end.urable but even pleasurabls"l2e. In Nezus from Nowhere he described a

fictional communist utopia based on his ideas about the pleasures inherent in
work when people are free and independent, and where poverty, exploitation,
competition and money all disappearl30'

Marx, Ruskin, and Morris believed that purposeful, creative labour, which
but
is close to what this thesis is calling occupation, is basic to human nature,
they saw that the industrial and commercial use of this innate characteristic
was destructive both to individuals, and to mankind, in the long term'
The

challenges aimed at changing the values of industry and commerce led by

127 ¡4er¡¡s W. Art and socialism. 1884. In: Morton AL, editor. Politicnl writings of WiIIiam
Morris. London: Lawrence & Wishart, 1973' pp'Il}-LlL'
1.28¡ackson Lears Tf. No place of grace: Antimodernism and the transþrmation of American
culture 1.880-1'920. NewYork: Pantheon Books, l98lr p'63'
l.29 ¡46rr¡, W. Useful work versus useless toil. 1884. ln Political writings of WiIIiam Monis"'
130 ¡4e¡¡¡s W. News from nowhere. 1890. In: Morton AL, editor. Three worl<s by WiIIinm Morris:
ñrr, ¡o* nowhere, The pilgrims of hope, A drenm of lohn Ball. London: Lawrence &
Wishart, 7968(1974)'
 Occupational evolution 737
Chapter 4:

such socialist comment and mounted by the organised labour movement

achieved some success but social inequities and conditions of work have
remained the major focus of debate and action. In contention over the

exploitation of the workforce, the basic ideological arguments about the

nature of occupation and the human need for purposeful creative activity
were, on the whole, overlooked. Mainstream socialism "became enmeshed
in the 'quasi-socialist machinery' of party politics", and followed the Fabian
vision of a technocratic society with enlightened leadership, in preference to
the anti-modern revolutionârY stance of Ruskin and Morris13l' Workers
continued, in better conditions, to be servants of machines and, for many

people, there was little opportunity for creativity or even the chance to be

involved in a total Process of production'

In early industrial society even social and celebratory customs, as an integral
part of work, diminished and the division between work and leisure became
clearer. This division was not absolute or the same for each individuall32,
and in many traditional workshops ritual patterns of fellowship and
celebration continued133. However the change was so evident that it
encouraged entrepreneurs to recognise the commercial potential of separated
entertainment, which has led to one of the most powerful industries of the
present day13a. The separation of work from leisure is also demonstrated
in

the way leisure was deplored by Victorian explorers, who perceived, in their
encounters with hunter-gatherer peoples, that their 'non-work ethic' was a

major reason for 'lack of progress'. This prejudice or bias remains today, with
post-ind.ustrial nations encouraging mole traditional peoples to change to an
occupational way of life similar to their own without reference to the

131¡ackson Lears TJ. No place of grace: An_tintodernism and the transformation of American
c,lt,re 1.880-1.920... p.OA; Vtaikenzie N, Mackenzie |. The Fabians. NewYork Weidenfeld
and Nicolson,7977.
132¡o*"oonJ,MyerscoughJ. Time to spare in Victorian England. Hassocks: Harvester Press,
7977.
133goi¡sy p. Leisure antl class in Victorian England. London: Routledge & Kegan PauL1978.
134ç-*¡r.,rham H. Leisure in tlrc inclttstrial reattltttion. London: Croom Helrn, 1980.
 138
Chapter 4:O evolution

personal satisfaction, community well-being or ecological sustainability of

traditional occupational behaviour'

that because modern

]enkins and. sherman afgue, in The Leisure shock,
society iS "work-oriented in a systematic, non-seasonal way, as it
has been

since the industrial revolution", it does not consider leisure seriouslyl3s.

Leisure, they say is often confused with pleasure, making it sound "vaguely

sinful and hedonistic and. frivolous enough to be frowned upon"' Despite

this they observe that modem technology creates a situation in which all
goods and services can be prod.uced by fewer people leading to a
reduction in

the availabilityof paid employment. This leaves many people with up to

'progress' and the
rc}% leisure time, in a society that values technological
material rewards of paid employment above all other forms of occupation
and
including those that are people or skills centred. Eventually, ]enkins
Sherman argue, societies are going to have to come to terms with
the idea

that the 'work ethic' is fast becoming redundant and that the boundaries
between work and. leisure must be blurred. This need to blur
work and

leisure is a constant theme of writers concerned with their study136'

Throughout this century the need for people to be seen to pass time
usefully, to provide by ones own efforts for the necessities of life, sometimes
despite unfulfilling, unsatisfying employment has been a strongly held
social

value. Jahoda found, from study of the unemployed in the 1930s, that
employment offered, more than financial reward. It allowed PurPose,
a sense

of achievement, a daily time structure, social contact outside the family,

and

sftock. London: Eyre Methuen Ltd', 1981, p'1'

135
¡enkins C, Sherman B. The leisure
136 ç"r.,¡516r., K. Social change and youth in America. Daedalus 7962; Wnler: 745-177;
Friedlander F. Importance of work versus
stratified grouPs. lournal of applied psy
Leisure asãn American and Soviet value'
Leisure and work...;Robertson l'Fttttte uor
fer
am?
S. Leisure ur.o*fánrution for'unemploymer
lottrnal of ocatpntional science: Australia 7993; 1(2):20-26'
 evolution 139
4|

Social status, and it's lack caused boredom, mental despair, aPathy and
deteriorationl3T. In the late 1gg0's she remained convinced about these
negative sffss¡s138. Similarly, Warr found that employment offers scoPe for
developing new skills and decision making, but that on the down side,
the

value given to emPloyment causes the unemployed to suffer frequent

humiliations and loss of social statusl3e. smith goes so far as to suggest that
paid employment has become the central institution mattering more to
individuals than "govemment, education, religion, defence, or health"' He
believes being unemployed may be worse than "being excommunicated'
disenfranchised, illiterate, conquered, and diseased", with many people
without paid employment feeling unwanted, as if they no longer belong to

society, their impoverished days having neither structure nor PurPosel40'

In the late twentieth century, in post-industrial cultures, employment for

remuneration still enjoys the greatest status amongst occupations for
both

men and women. People in the nineties, though, have shifted their ideas

from expecting to work to provide for their own needs towards an expectation
that they have a right to work to provide themselves with status and
material

comforts. However for many people paid employment is not intrinsically

satisfyinglal. For example, winefield and his colleagues, in a prospective
longitudinal study of over three thousand young Australians, found that

people dissatisfied with their employment were no better off in

terms of self

esteem, levels of depression or lack of psychological well-being

than the

unemployed who were, as could be expected, significantly worse

off than

Cambridge: Cambridge University Press' 1982'

137
¡ahoda M. Employment and unemploymenf'
ra8 ianoda M. Economic recession and mental health: some concePtual issues. lournal of social
is sues, 1988; 44 (4): 73-23'
1391,y¡¡¡ p. Twelve questions about unemployment and health. fn: Roberts R, Finnegan R, Gallie
D, editors. Nru approaches to economic Iiþ' Manchester: Manchester
University Press'
1985.
140 groi¡¡ R.lJnemploynrcnt and health; A clisaster and a challenge. oxford: oxford
UniversitY Press, 1987'
1416*.,11", SB, purke, SR. Work, organisntions and clnnge: Themes nnd perspectiaes in
Attltralia' Sydney: Allen ar d Unwin, 1988'
 140
Chapter 4: Occu pational evolution

those satisfied *ith their employmsn¡142. The theme of the last two
paragraphs, which begins to relate unemPloyment or unsatisfactory

employment with ilihealth, will be developed in chapter 6.

Becausepaid employment has assumed such high status, unless other

forms of occupation assume a mârket status on a par with it, they have
subject to
become devalued. This has resulted in leisure activities becoming

high technological development and over regulation' An examPle is the

preoccupation with product development rather than sailing skill in the

much publicised Americas Crp. In this we see the value once given solely to

human occupational achievement taken over by the achievement of

occupational technology. Effectively, this values material goods
at the
expense of people and process, and devalues skills as
well as the goods people

can produce bY their own efforts'

Although not always linked with capitalist gain, technological

experimentation and. d.evelopment have been strong characteristics
of the
occupational nature of humans throughout history because our
'genetic

need to
constitution' is organised, in such a way that all people experience the
behaviour
engage in exploratory, adaptive and productive occuPational
occuPations in
seemingly for the purpose of reducing time spent on necessary

favour of time for self chosen occupations. The effort to save time in order to

use it in some other way demonstrates how individuals unconsciously seek

to use the range of their capacities. For some people the range of obligatory
needs for
activities concerned with their work may meet their biotogical
this may be far
physical, mental and social stimulation and exercise; for others
from the truth. Industrial Processes and capitalist structures narrowed
the

1.421y¡"¡i"1d AH, Tiggerman M, Goldney RD. Psychological concomitants of satisfactory

Social psychiatry and psychiatric
"Ãjfoy*".,tandäemploymentinyoungpeopie.
epidemiologY ' 7988;23:7' 9-57'
 evolution 141
Chapter 4:

range of activity of many individuals to those which were economically

efficient and. viable, reducing many of the peripheral occupations, often of a

social or problem scllving nature, which in earlier economies had given
exercise to a wide range of capacities'

Industrialisation certainly signalled an enormous change from a long

period of human occupation based, in the main, on natural processes through

either hunting and gathering or agriculture to occupations which were man-
made, and in some cases many steps removed from Nature and natural needs

or processes. As early as 1935, Carrel, a Nobel púze winning medical scientist,

in a call for the scientific study of man, suggested that

"it is dfficult...to know exøctly how the substitution of y artifcial- mode

of existíice fo,
'haae
the naturøl one and a complet-e . mod-ificøtion tf their
ínaironment ciailised humøn beings" r4s
acted upon

This question remains as people seem to accept that technological change is

necessarily an improvement, and that the development of machines to
reduce

occupational effort is inevitable and desirable. Just as from the L920's on,
most

people continue to joyfully welcome "modef'n civilisation" adopting new

mod,es of life and "ways of acting and thinking", laying aside "old habits",

because these "demand a greater sffe¡¡"144. In this way new technology

leads

to new cultural adaptations, which, in turn, lead to further technological

change, and so on. This can be constructive or destructive,
and depending on

the viewpoint taken can be either or both'

In technically advanced societies the industrial era has evolved rapidly into
a new electronic era. Arthur Penty, a follower of Morris, is credited
with

coining the phrase 'post-industrial society' at the turn of the centu1y145,

but

143 çu¡¡s1 A.Mnn the ttnknown London: Bums and Oates, 7935, pp.24'25.
14 Carrel A.Man tlrc unknown.'. P'25'
145 grr¡o.¡ ALC. post industrial society. In: Bullock A, Stalleybrass O, Trombley S, editors'
Press, 1988, p'670'
Tlrc Fontana dictionnry of nroclern tlnught.2nd. ed. London: Fontana
 evolution 142
Chapter 4:

social commentator's as diverse as Daniel Bell, Alain Touraine and Barry

To them post-industrial society is
Jones give us contemporary descriptionsla6.
characterised by a change from production to service industries, from
manual

to professional and technical workers, and to decision making based on

information technology. Toffler observes that these economic changes are
part of "a crisis that is simultaneously tearing uP our energy base, our value
systems, our Sense of sPace and time, our epistemology aS well as our
economy,, and will result in a "wholly new and drastically different social

order',147. In fact, the social forms and values which developed and prevailed
during industrial domination of human choice in labour and leisure

occupation remain. The tension between traditional social forms and

modern industrial arrangements has been responsible for a period of

unprecedented uncertainty and loss of direction for many people' Jones
suggests that, despite 'universal literacy, an omnipresent media and
a vast

information industry", post-industrial society is threatened by it's

,,preoccupation with materialism, a conviction that national and

international salvation is to be found in economic growth alone, and

emphasis on externalised (consumption based) value slsteme"l48. Similarly,

the American futurologist, Richard Louv, ín Working in America 1-'l',

commenting on the speed of change in the 'information age', observes that:

Euen the Post-industrials haae a gnawing feeling that the

transþrming economy is like ø blizzard or tornado.:unpredictable,
-more
Ueyoíta coitrol, or, preciselT controlling us'r4e '

Both Jones's and Louv's concerns can be seen as a criticism of the

complacent, confident pred.ictions of the futurologists of the fifties
and sixties

York:
146 g"¡ D.The coming of post indttstríal society. A penture_in social forecasting,.New
Basic Books ,lg73i tánraine A. Posf Inclustrktt Society. London:
Wildwood House,7974;
and the of work.Melbourne: oxford university
|ones B. Sleepers, wake! Technology future
Press, 1982.
147 yo¡ç¡s¡ A.The eco-spasflt report. New York : Bantam Book Inc., 7975' p'3'
148Jones B.Sleepers, unke! Teclmology and the future of zuork"'p' 1'
149 ¡6rrv R.Working in Anrcricn 1I' New York: Penguin' 1983'
 evolution 143
Chapter 4: Occu

in which "the fruits of applied science...were seen able to Produce...an era of

leisure and abundancs"L50. Following the economic recessions of the late
seventies and eighties a more cautionary note has appeared in futurological

speculation often in reference to social limits of growthtsl, and frequently

allied with ecological theory. However many people do appear to experience
the difficulties alluded to by Louv, such as feeling loss of control, or that the
world is changing too rapidly for comfort, despite these feelings, in some

measure, being countered by excitement as technological development sweePs

all before it.

The value given to technology has also caused a devaluation of older
members of society. Many are confused by the rapid social and technical
changes occurring around them; whereas in agricultural societies they were

often viewed as wise counsellors and spiritual leaders, in post-industrial

societies they have been effectively displaced because their early
life

experiences are no longer seen aS relevant, but are viewed as being part
of a
,,Stagnant, marginal social Category"152. The Same attitude is evident in

dealings with non-modern technology based societies. In large part, the lack
of understanding and recognition of the human need for occupation has
contributed to humans allowing technological development to drive them
rather than the other way around, and in accepting that the driving force of
such d.evelopment, at present, is based on economic theory rather than on
human nature and needs.

of
Countering this could be possible if all people had a better understanding
the purpose and meaning of 'occupation' in a generic sense' Such
understanding demands 'a sociological imagination that reminds us of the

150
¡urrgk R, Galtung J. London:
editors. Mankind 2000' E'
'frrîrrotogrnl OE
flrecasting in perspectiae'Paris Research

Confereice, Osto' tn: B"ell D, editor' 'Towards the nwin'

1,968; Kumar K. Futurology' ln:.The social science
1.51g¡.r"1., F.Socínl limits to growth.London: Routledge & Kegan PauL,7977.
152¡1ur*rH. Gerontology, social. In: The socíal science encyclopedia... p'337'
 144
Chapter 4: Occupational evolution

real range of social behaviour...necessary so that we can collectively decide

which kinds of work and which kinds of leisure are aPPropriate to a good life
and create the oppùrtunities for these to be realised"ls3. In fact, from the
industrial era on, occupation for its own sake seems to have lost its efficacy
and value, perhaps because it is no longer obviously associated with 'Nature'.

The major changes in ways in which people have met the physiological
requirements of food, shelter and safety, whilst nurturing their social and
mental needs, have evolved from being an integral part of a self sustaining
ecological lifestyle to one which is superimposed on and destructive to
natural resources. This can be seen to have obscurred some biological needs
which are germain to species survival. Meeting the needs of long term
species survival is not, for most people in post-industrial societies, a day
to

day concern, and, in fact, human occupation, its technology, and the social
structure and values that surround it, are now so complex that they are
almost unrecognisable as d.eveloping from the simple survival occupations of
our ancestors. The need to use human capacities in a creative, problem
solving, inventive or adaptive way has led to the domination of occupational

technology over the ecolog/, survival of the species in the long term, and

ironically to the detriment of present and future use of personal skills. This
thesis agrees with Lorenz'S viewpoint that such domination can be

considered a "disorder(s) of certain special behaviour mechanisms originally

possessing surviva] Y¿1ss"154.

Some commentators argue that when the humans become sufficiently

focussed on these culturally created problems the same drive which created

them will be able to counteract the ill effects. This could already be in train.
Indeed, Toynbee suggested in the 1.960's that even though "in making"'tools

153 pu¡¡gt S.Leisure and work--- p.719.

154 ¡o¡s¡2 K. Ciailized møn's eight dendy sins. Translated by Latzke M. London: Methuen &
Co Ltd, 7974, P'2'
 4z OccuPational evolution 145
Chapter

progressively more effective" and the "misuse of them Progressively more

dangerous" the "World's most powerful nations and goverrlrnents have

shown an uncustomary self restraint on some critical occasions"

demonstrating an "advance in social justice" and an increase in

humanitariunisrr¡1SS. In present times, there is widespread questioning of the

wisdom of continuing with economic policies which place technological
development and the expansion of trade before human well-being and
diminishing natural resources. Robertson, for examPle, in 'Future work',
calls for people to reject a future of technological determinism in which

technology rather than value systems dictate choice; and Jones suggests that
"the most appropriate analogies for economic Processes are to be found in
biology -with growth, maturation, nourishment, excretion and decline
rather than physics"1s6. Despite this, at the recent United Nations Conference
on Environment and Development the government delegates appeared to
support maintaining the status quo and trans-national corporations by
arguing for "promoting sustainable development through trade
liberalisation"lsT. A reluctance by industrialists and world leaders to pay
more than lip service to ecological or pre-industrial society's issues points to a

bias towards maintaining the first, or possibly the second of three possible
scenarios for the future -'business as usual', in which development continues
similar to the present; 'hyper-expansionism' based on super-industrial
development of science and technology; or a 'sane, humane, ecological'

vision which focuses on human development and ecological

sustainabilityrsa. Future health and well-being depends on the latter vision,

with all human beings utilising their occupational nature through activities

1551or¡6ss Af. A study of history, vol XII. Reconsiderations. oxford: oxford University Press,
fgOf.fn: KohnH,áditor.The Modern World.NewYork:MacMillan, 1963,pp'303-304'
1563o6"r1rorlJ.Ftúure work,...; jonesB. Sleepers, wake! Technology and the future of work"'
P.44.
157 korten D, editor. Economy, ecology and spirittmtity. The Asian NGO Coalition, Manila,
IRED Asia, Columbo, rfrã neoptã-Centred Development Forum, New York, 7993,
p'2'
L58 ¡1o6s¡¡5enl. F rtture uork...
 L46
Chapter 4: ()ccunetional evolution

which sustain the ecological balance and which enable Personal growth and
potential. This issue will be picked uP in the final chapter.

The exploration of biological and cultural occuPational evolution in

chapters three and four, has established the force of the idea that the biological
need to engage in occupation is a major characteristic of humans aimed at

enabling species survival and individual health. Four major functions of

occupation have been identified. They are; to provide for immediate bodily
r
I

needs of sustenance, self care and shelter; to develop skills, social structures

and technology aimed at safety and superiority over predators and the
environment; to maintain health by balanced exercise of personal capacities;
and to enable individual development so that each person and the species

will flourish. However, because of the strength of the occupational needs

which are prerequisite to meeting those four functions, imbalance is possible,

and the needs may be counter to survival, particularly if they are not
recognised for what theY are.

Whilst it is relatively easy to see that there is a correlation between obvious

survival occupations and health, because what people do has direct bearing
on their type of shelter, their access to food, clean air and water, which have
been well researched, the correlation between health and the innate
need of

humans to engage in other types of occupations is obscure, complex and

poorly researched. Because of the complexity of occupation, teasing out its
positive or negative attributes is difficult. Engagement in occupation cannot
easily be separated from the other basic requirements of life, and the
complexities of these interactions need much more inquiry' The interaction
of mind, body and spirit, obligatory and choice issues, differences in genetic
capacities, the nature of and need for occupational mastery, risk taking
and

challenge, optimum levels of personal satisfaction, or the relationship to

 147
Chap ter 4: Occupational evolution

sociocultural values of any occupation are just a few of the variables which
may make a difference to how occuPation affects health.

In conclusion, it may seem that, in comparing early and Present forms of

occupations which have continued throughout evolution, this chapter has
condemned current practices. To some extent the comment may be justified
âs, exploring the differences between natural and culturally acquired
in
occupational behaviours, it would seem that people living in post-industrial
countries do not aPPear huPPy or satisfied. Despite many apparent material
and social welfare advantages people carurot be described as experiencing well-
being, but rather a "drifting dissatisfaction" which, according to
anthropological studies, does not occur in the "more primitive social
groupings nor, indeed, in the less developed seu¡¡¡1s5"159' Some of the

in the chapter include - the division of occupation

probable causes alluded to

for gender, economic and. age reasons; limitations, restrictions and

impositions due to dominant philosophies and policies of societies; conflict
between technological development, individual need and the ecology; and
the problem of achieving balance between occupations of choice and necessity.
The literature reviewed in this chapter also suggests that the basic
occupational needs of people have been obscured by the current complexity of

occupational technology and economy, and the socio-political structures,

divisions, and values which have been established progressively. This leads
to the notion that cultural views of occupation dominate biological needs for
occupation and that this may be a cause for less than healthy survival'
Because the origins and nature of occupations have become obscure we have

failed to recognise them as a basic need, accepting instead the materialistic,

value loaded results of occupation as the central focus of modem life and
occupations purpose. This poses many questions for the future, not least,

¡enkins C, Sherman B. The Leisure Slnck...

159 p'5
 148
Chapter 4: Occupational evolution

from the perspective of this thesis, is the question of what these changes
mean to the occupational nature of people, and to their health. The next
chapter will explore ideas about health and well-being from this occupational

view of human nature.

 Chapter 5

Health: An Occupational Perspective

Ideas about what is health differ according to cultural and spiritual

philosophies, socially dominant and individual views, the type of

economy
view
and the health technology available. This chapter discusses a particular
of health from the perspective of humans as occupational beings' focussing
on what makes and keeps people well, rather than what causes
or prevents

them from being ilt. It starts by exploring definitions and concepts held about
health, well-being, holism and w.H.O. directives to promote health'
From

this exploration, and building upon the ideas about occupation which
have

thesis is described'
emerged in earlier chapters, the view of health held in this
This relates to survival of the species, to how individuals and communities
flourish and to ecological sustainability. In order to support the central
notion that engagement in occupation is a biological mechanism for
health,

of
the chapter goes on to explore how the 'natural'occupational behaviours
early hunter-gatherers related to their health status.

There are many definitions of health, but the world Health organization
well-
definition of health as "a state of complete physical, mental and social
being not merely the absence of disease or infirmitlr" has survived
fifty years

of rapid social change, and is one which a significant body of health

writers

have kept in mind1, despite some criticism aboutthe definition from

medical

and difficult
scientists that it is 'idealistic', 'unattainable', 'largely irrelevant',

to measureP. The focus of western medical efforts on illness rather than

1 World Health Organizatio n. Constitution of the World Health Organisation' International

Health Conference, New York, 1946'
2 see for example: Nutbeam D. Health promotion glossary. Health promotion7986;1' (1): 113;
Addison-Wesley,1981 parts 1
èãpru. A. et'al. C";;"p;t of health ord ditrntu. ñ'eading, Mass:
&5.
 150
Chapter 5: Health: An occupational perspective

health might also appear to gainsay the broader intent of the definition.
This

focus is not surprising as, on the whole, in countries with advanced

medical
illness in
technology, people have been socialised to think about health and
terms of med.ical and physical sciences and their commodities, to
the extent

that Newman, a nursing theorist, observes that the view of health as the
absence of disease has pervaded most of our thinking
from very early in tifd.

Health as 'more than the absence of illness' is particularly difficult to

explicate, although there have been many attempts. For example,
Blaxter

and Lifestyles, some of the many ways health may be

discusses, tn Health

conceptualiseda. Her monograph, based on a survey undertaken

in the
united Kingdom with a sample of 9000 adults, found that, as well as
the

as: having a reserve to

absence of disease and illness, people described health

combat problems; behaviour aimed at healthy lifestyle; physical fitness;

energy and vitality; social relationships; being able to function;

and psycho

social wellbeing. The sulvey outcomes support the belief that

views of health

differ over the life course, have clear gender differences, and are, for most,
a

multidimensional concept. The view of health presented in this chapter

accepts these conclusions, and I use some of Blaxter's results to illustrate
well-being
particular points. Blaxter's findings also appear to link health and
in accord with the W.H.O. definition. Understanding what is meant by
well-
depth in the
being appears to be a key issue, so this will be explored in some
next pages.

and a
As early as 490-429 BC Pericles made the connection between health
feeling of well-being. More recently well-being has been
defined within the

health promotion fraternitY as:-

Healttt ns expanding consciortsness' St Louis: The C'V' Mosby Company'

1986'
3 N"**un ]rirA.
4 Blaxter lvi. Heatth and lifestytes. London and New York: Tavistock/Routledge,799O'
 151
Chapter 5: Health: An occupational perspective

a subjectiae assessment of lealjh- which is less concerned with

biolog'ical fmction than utnn feelings suclt 1: self esteem
and a
sense" of telonging through social integration"s '

In the Thesaurus, 'well-being' stands with words like happiness and

prosperity, as well as health6. Whilst happiness and health have

an intuitive

fit, prosperity may be linked with well-being, in so far as people with no

monetary concerns are able to make most use of health promoting
for
opportunities. They are more easily able to meet the basic requirements
health than poorer people, as well as having none of the stress or worries
money in
attributed to poverty. In addition, the high social value accorded to
the present day increases its potential effect on health status' Standardised
mortality and morbidity statistics support the association of people with
limited resources experiencing poorer health (and, it can be argued,
less well-

workers in
being)7. For example, it has been found that children of unskilled
of
Britain are twice as likely to d,ie in their first year of life as are those
professional peopld, and numerous other studies support the
notion that

well being is related to income, financial status, and employmente'

Despite these acknowledged 'material' associations the feeling

of well-being

as intangible and amorphous a concept as

'charm' or 'style'' Subiectively,
is

5 N.rtb"u* D. Health promotion glossary"'p'726'

6American Heritage Dictionary, editors. Roget's new tlrcsnunls' Boston: Houghton Mifflin
CompanY,1980.
7 ¿norrgl, ío *ok yort sick: How income and enaironment affect heatth.
Australian National
i""äf, ilesearch paper, No 1, Sept L1 92, offers a detailed summary.
Strategy
8 VVhit"h"ud. M.The heatth diuide' Penguin,7988'p'229'
Muhlin GL, Peck HB. Community stressors,

tlu"t,

nal of occttpational psychology 1990;63 (4):193-

210.
 An occupational 752
Chapter 5: Health:

well-being can be described as a pleasant and desirable physiological sensation

which can differ from person to person. Some people describe well-being as
'being on top of the world', or in conjunction with 'being in love', others

when they indulge in a favourite hobby or relax in a special place, and some
even experience it in pursuit of their paid occupation or vocation. Jotu.r

Hersey, for example, admitted to "feeling nourished and transformed" as a

result of his literary work10. Other feelings include happiness, contentment,
peace, joy in simple aspects of the environment or being with others, energy
and anticipation, confidence and concentration, satisfaction with ongoing

achievement, or a sense of timelessness and 'flow'11. Csikszentmihalyi

found
'flow' at
that ,,the typical working adult in the United States" experiences
work "three times (54%) as often as in free time (L7"/o)", and during the
experience of flow feels "very significantly more huPPy, strong, satisfied'
creative, and concentrated"l2. Blaxter's study found that for women
who

defined heatth in terms of energy they described it in a similar way as

,,'feeling like conquering the world', 'being keen and interested', 'lots of get
up and go,,, and "'properly alive"'13. At times of absorbing interest, when
physical, social and mental capacities are able to meet the challenge'
people

are said to be able to resist disease and seem impervious to many problems

and difficulties that beset them'

Fragments of other empirical research point in the same direction. when

Pybus and Thomson asked 444 New Zealanders in 1979 what, in their

experience, was being well the answers included replies like being 'able to do

10 Hersey ). Time,s winged chariot. In: Fadiman C, editor. Liaing philosophies: The teflections
of some eminent menánd women of our time. New York: Doubleday,1990.
11 êrikszentmihalyi M. FIow: The psychotoU of optimal experience. New York Harper and
Row,1990.
12 Crikrr"r,tmihalyi M. Activ ds a science of occupation' lournal of
ocarpational science: Aust
rience in work and leisure' lournnl of
see also: csikszentmihalyi M
personality and socinl psychology' 1989:56 (58): 5-22'
13 Blaxter M. Health nnd lifestyles"'p'26'
 153
Chapter 5: Health: An occupational perspective

'being full of
what I want to and enioy it' and 'energy and interest', as well as
life, and 'feeling alive' and 'vital', with 'energy for things extra'l4' An
Adelaide survey of seven convenience cluster samples selected from
high

school students, an elderly citizens village, family units, a suburban

neighbourhood, the city shopping centre, churchgoers, and fourth
year

concept of
occupational therapy stud.ents, which asked subjects to define their

well-being, how it felt to them and how often they experienced

the feeling,

discovered that the three most common resPonses related to

having a sound

mind, a healthy body and. being huPPy. Ninety-five percent of 138

respond.ents agreed they had experienced a feeling they would describe as

well-being, percent admitting they experienced this feeling

with fifty
frequently. Fifty-two percent described the feeling associated with well-being
with
as happiness, thirty-five percent with Peace, and twenty-two percent
confidence. Subjects were asked with what situation or environment
they

associated a feeling of well-being, and of the two most common

resPonses/

fifty-six percent concerned. relationships, and thirty-seven percent

surroundings. The majority of subjects were female, singie, fit and young
which may well have given a particular cast to the resPonses' Details of
the

study witl be found in appendix I. In other studies well-being has been related

to social supports, community cohesion, marital state, education and religious

attitudes, beliefs and activitiesls'

In ord,er to explore positive health and well-being in more depth physical'

and social well-being need to be considered separately, and linked
to
mental

14pyb.r, MW, Thomson MC. Health awareness and health actions of parents'
Henlth : Perspectiaes and practices'
ANZERCH/APHAConference, 1979. ln: BodtìyJ,editor.
New Zealand: The Dunmore Press, l'985'
15coh"r, p, et al. Community stressors, mediating conditions and wellbeing in urban
instument to measure self-responsibility
neighborhoods... ; McCoíatha jT. McConattrip. An
1985;11: 295-308; Argyle M' The
for wellness in older adults. Eiucational gerontology
eial' Religion and-well-beitg it later life"';
/sychology tf hoppinr,,"'; 59:"ig.H, illness: A psychometric study.'.;
Burckardt C, et all'Quality of life o-f adults with chronic
of children. Socral indicators
Homel R, Bums e. Ènrrirónmental quality ancl the well-being
r e s e a r ch 1989 ; 27: 133-158'
 154
Chapter 5: Health: An occupational perspective

engagement in occuPation. Physical well-being is, perhaps, the asPect of

health which has received most attention, and is the easiest to understand.
The experience of phvsical well-being is often recognised when body function

is challenged beyond the norm, and the challenge is met, such as the relaxing
after-effects of exercise. Indeed, Maslow suggests that muscular PeoPle
have

to use their muscles to "'feel good' and to achieve the subjective feeling of

harmonious, successful,uninhibited functioning"l6. According to Blaxter,

young people, and men in particular, associate health with physical fitness,
with strength, energy and, athletic prowess and, in line with this, identify
sportsmen as their idea of health in others. Women tend to relate physical
fitness and energy in terms of outward appearance and work related activity
rather than sports or particular leisure pursuitslT. Small scale studies carried
out with students in Adelaide tend to confirm that young people view
physical fitness and well-being as synonymous but that there are differences
in how men or women perceive physical fitness, often in accord with how
health and well-being are reported in the medials'

Popular media regularly encourage people to experience well-being and

health by physical means such as exercise and diet' The results of medical
in Australia in
research, aimed mainly at physical welt-bein}, are reported

abbreviated form in popular magazines such as'Well-being' and

'Women'S

Weekly', in medical columns of newsPaPers, on radio and television, and

form much of the foundation for the current interest in the pursuit of health'
The number of joggers or aerobic devotees are testament to the effectiveness
of this type of promotion to the extent that 'Health', in this popularized
sense

has become a marketable product over recent years, with

health farms, foods,

D van Nostrand Company,

16 Maslow A1.Tozuard a psyclnlogy of being.2nd ed. New York
1968,pP.207 -

17 BlaxterM. Heakh and liþstyles"'pp'24-26'

t8 Wilcock AA. Research carried out as part of student leaming about the relationship between
occupationandhealth.UniversityofsouthAustralia,T99l'7995.
 155
Chapter 5: Health: An occupational perspective

centres and shops springing uP throughout metropolitan areas. For example,

listings of health and fitness centres in the Adelaide Yellow Pages increased by
50% in a d.ecade, from SL in L983 to 120 in the L993 directory. In L983 there

were only L03 health food manufacturers / wholesalers / retailers listings,

compared with i.g9 in 1993. The apparent rise of interest in feeling well along

with defeating disease has also been associated with a growth of alternative

health services for those unhappy with the solutions provided by

were
conventional medicine. No 'alternative health services'(so described)
listed in the 1gg3 directory compared with 5g in rgg3, and the listings of
a

group of different services including acuPuncture, herbalism, homeopathy'

naturopathy, massage, and relaxation therapy grew in the 10 years
from 379 to

600

Lr some ways, such interest could be seen as resurgent rather than

novel as

earlier societies have also perceived benefits of physical fitness.

For example,

in the first half of the 20th century initiatives were taken in several countries
to encourage and almost glorify health and fitness. These initiatives in the
most part had patriotic national flavours and are most typified
by the Nazi

youth movement in Germany. In Australia less fervent Programs towards a

healthy and strong white race were advocated by progressives such
as

decades of
Cumpston, Elkington, and Cilentole. Powles describes those early
this century as the 'national' period in the public hygiene movement in
purity
Australia when physical fitness, eugenics, efficiency, vitality and race
were focal values2o.

19Ro" M. NlÍe Australianprogressiaes: Vitalism in bottrgeois social thought 1890 -

1'960'

University of Queenslar'tã P"."rr, 1984; Cilento R. Btueprint for the health of a Nation'
Sydney: Scotow Press, 1944'
20 po*f", J. Professional hygienists and the health of the nation' Chapter
13' In: lvfacleod J'

editor. The contmon uentíll of science. Melboume: Oxford University Press, 1988'
 perspective 156
Chapter 5: Health: An

In contrast to those 'national' and 'physical' themes, Present views are

based to some extent on more holistic notions influenced by traditional Asian

philosophies, and associated with increasing acknowledgement that physical

well being is related to spiritual, social and behavioural factors, such as where
and how people live and what they betieve, their self care practices, the
amounts and, types of activity they pursue, and a balance between rest
and

work, ,being' and 'doing'21. Subsequently, it is being recognised that physical

well-being, achieved through use of physical capacities, has an effect
on

general-well-being, for example, mental functioning benefits through

increased blood supply to the brain and aerobic power and social interactions
provided
benefit through shared activityzl. Examples of such recognition are
by a review of the relationship between physical training and mental health
in which Folkins and Syme found evidence of a positive relationship
between exercise, well-being, self concept and work abilityz3, by
Chamove's

study, which found that mod,erate physical exercise by people

with psychiatric

disorders decreased their depression, anxiety, disruptive and psychotic

behaviour, increased self-concept and social well-being, and aided sleep
and

relaxation2a, by Morgan's suggestion that non-specific aspects of

exercise such

as social contact may be instrumental in improved mental

health and well-

being2s and by Oliver's report that improved play and social interaction are
benefits of physical education activity along with growth, fitness,
agility and

coordination26.

21 HetzelBS, Mc Michael T. L S fnctor: Liþsyte and health. Ringwood, Victoria: Penguin, 1987'
Z2sydn"y KH, Shephard R]. Activity patterns of elderly men and women' loutnal of getontology
role of activity: Myth or reality -
1977;32 (7):25-32; Also see: Kirchman MM. The prwentive
A review of the literature. ptrysicnt and ocutpaional therapy in geriatrics
1983;2(4):39-47'
23 Foki* CH, Syme WE. physical fitness training and mental health. American psychologist

798L;36:37T389.
24 Chu^orre A. Exercise improves behaviour: A ratonale for occupational therapy ' Btitish
journal of ocaryatíonal therapy'1986; 49: 83-86'
25'tutorgu^ Wr. nry.nological effects of exercise. Behaaioral medicine update 1982;42 25-30'
26 oti,nã, |. physical activity and the psychological development of the handicapped' In:
Kane
psychologicnl aípects of fhysical education and sport' London: Routledge & Kegan
l, "ait"i.
P aul, 1972, PP -L87 -20a'
 157
Chapter 5: Health: An occupational perspective

The theory of human nature which I am devetoping in this thesis leads me

to propose that people need to make use of their physical capacities to enioy
physical well-being; that this can be through engagement in individually
motivating and ongoing occupations. If they are able, or encouraged'
to

to enhance
pufsue self chosen occupations, as well as those that are obligatory,
their physical caPabilities, they will enhance their health, apart from
supplying sustenance for survival and safety: "the best sort of exercise
in
'exercise'...the best
terms of retaining one's powers is the kind you don't call
exercise is work"27. Indeed, studies have demonstrated
that older people who

lead active lives following a wide range of occupations tend to

feel better and

to require less med.ical attention than isolated and sedentary elderly

peoplez8.

The total range of an individual's purposeful and fulfilling occupations

can

provide sufficient exercise to maintain homeostasis, and to keep body

parts

functioning at peak efficiency. For example, occupations can maintain

and

enhance joint stability and range, muscle tone, cardiovascular fitness and
respiratory capacity. A range of occupations can provide balance
between

physical challenges and relaxation which prevent over-use,

and allow time

for repair. when people are able to experience occuPational well-being,

in a
need or wish to do
physical sense, they wilt be able to carry out activities they

without undue consideration of body functionin$, and their physical status

will enable effective utilisation of mental and social capacities'

This leads to consideration of mental well-being which, in this theory,

alludes to spiritual as well as cognitive and affective factors.
Blaxter found

that psychological 'fitness' (well-being) was a popular concept of health across

described health
all the age grouPs, and for both men and women when they
for themselves rather than for others. Whilst it tended to be used more
by

27 Comfort A. A goocl age.Melboume: MacMillan Co Pty Ltd, 1977, p.82'

28 Corbin HD. Brighter vistas for senior citizens: Salient thoughts' lournal of physical

edttcation and recreation 1977; October: 52-53'

 occuP ational perspective 158
Chapter 5: Health: An

women and those with 'better' education, "'health is a state of mind' or

,health is a mental thing more than physical' were common statements"29.

For a comparison between resPonses of subjects from her study, concerning

physical fitness and psychological fitness see table 5.1.

Males Females

18-39 40-59 60+ 18-39 40-59 60+

27% 72% 4r% 32% 167"

fi 39%

31% 40% %% 48% 52% 44%

Psychological fitness

Table 5.L: Comparison of concepts of _'physical .fitness' and Plr¡ho^l^ogical

fitness, for describing what it is to be healthyoneself . N-
9,000 = 100%.30

The National Mental Health Association of America describes mentally

healthy peoPle as those who:

"Feel comfortable about themselues...are not oaerrþhelmed by

their own emotions...can øccept many ofliþ's disappointments in
their stride'..experience øtt of the'#,*rr:#:lîlfr/;i
{;:*'"ri!ri
ble with others'..are able to
about the interests of other
t are satisfYing and løsting. Are
tife...respond to their Problems,
øccept responsibility, pløn øhead without fear tf the future, and
øre able to estnbliih r:ealistic $oø15"3L

Mental health is described in these or similar terms in many popular

texts

addressing healthy living, including, The Good Health

Guide3T, Health

throughDiscoaery,33and.IJnderstandingYourHealth3a.Thepopulartexts

29 Blaxter M. Hentth and lifestyles"'p'29'

30 Tubl" 5.1. compiled from data contained in Table 3.2 Blaxter
M. Heakh and líþstyles"'p '18'
31 Puyr," wA, H;hn DB. Llnderstanding your y
'1995'p'26'
d the Scottish
gZ
Th" Open University in association-with the
Health Education Unit' Tlre good lrcaltlt gtt
33 Dit ti^ur, GB, Greenberg ]S' Henlth throtryh
Random House'
7986.
34Puy.r" WA, Hahn DB. I'Jnderstanding Your Hcaltlt"'
 159
Chapter 5: Health: An occuPationa I perspective

usually refer to the well-working and coping ability of both emotional and
intellectLral capacities, and sometimes include sPiritual caPacities, all of
which, in combination, enable individuals to find meaning in their lives,
interact effectively with others, be reflective, Process and act on information,
solve problems, develop skills for making decisions, clarify values and beliefs,
cope with stress, and be flexible and adaptable to changes in life circumstances

and, d.emands. According to this conception, whilst these varied capacities

may not amount to 'well-being' in themselves, and the need to use them
differs between people and at different life stages, they are seen as
prerequisites to the experience of well-being3s. They are also capacities,

integral to engagement in occupation. If individuals are under or over

of emotional, intellectual or spiritual capacities because of

stressed in the use

physiological, environmental or social factors, or because of occupational

deprivation, alienation or imbalance, health and well-being may be
und.ermined36. From Antonovsky's theory linking health with
a 'sense of
coherence' comes the idea that one difference between
who stay well and who

do not is an individual's level of coping within their 'own boundaries''

These boundaries, which enclose what is most important to each

individual,

may be narrow for some and broad for others' That iS, "one need not
necessarily feel that all of life is highty comprehensible, manageable' and

meaningful in order to have a strong 'sense of coherelìce"', but those with

this sense will be better able to coPe and to experience 'behavioral

immunology', and to experience mental well-being37.

35 Kuor,", AD, Coyne fC, Schaefer C, Lazarus RS. Comparison-of two modes of stress
;;õ;;t, óuJi r,orrt", and uplifts versus life events. lournal of behaaioral medicine

L981';4:1'-39.
365"" fo, example: Ho1mes T, Rahe R. Schedule of recent events and social readjustment rating
between Person and environment'
,"åf"r, Lazar,rs RS, Launier R. Stress related transactions
chaptersin:PervinLA,LewisM,editors.Perspectiaesininteractionalpsychology'New
York: Plenum7978'
37 a'sense of coherence'as:
to whiclt one has a peruasiue, en-during though.
n tltat expresses the extent
conficlencL that e) tlæ stimrli deriaingfrom one's -in.ternal.
and external
,oriræ of tiaing nre stntctured, predictnble nnd explícit; Q) the resourses
 160
Chapter 5: Health: An occupational perspective

Some psychologists have pursued the study of mental well-being

particularly, focussing on specific attributes, and measuring satisfaction in
various aspects of life38. Social psychotogists - Strack, Argyle and Schartz,
for
Maslow,
example - equate the concept of mental well-being with happiness3e.

whose work based on the study of people he considered mentally healthy

has

alreadybeen noted, is discussed in most books addressing the subject of

mental well-being. He regard.s it as 'full humanness', which he describes as

the highest level of personal development enabling individuals to recognise

their potentials and life-roles, and to fully utilise their personal strengths,
without selfishnessao. Maslow stands in a tradition of humanist Psychology,
based on existentialism4l, which extends from Bumham's
'wholesome

personali ty'42, through Fromm'S 'productive character'43, to Rogers

descriptions of the 'fully functioning person'44. This humanist tradition
can

be said to stem from the 'mental hygiene movement', founded in America

in

tg1g, which was influential in the growth and development of

mental health

servicesof the first half of the century, including the birth of occupational
therapy. The rhetoric of this approach became "equated with productiveness,

are aaailable to meet the demands posed by these stimuli; and @ these demands are

also: White RW. Sense of interpersonal compe

38see for example: Bradbum NM'

1969; Andrews FM, WitheY SB' ;

Diener E. Subjective wellieing bulletin¡9S4;95:542-575.

3gstrack F, Argyle M, Schartz N, editors. Subje tiae well-being: an interdisciplinary
perspectiae. Oxford: Pergamon Press, 199L'
4otuturio* A.The farther reaches of human natute.VikingPress,1971"
41 B,rllock A.The humanist tradition in the West.LondonandNewYork Norton,1985'
42 Bu*hu* WH.The wholesome personality. New York: Appleton-Century, 1932-

43 Fro*^ E. Man for himself. New York Holt, Rinehart & Winston,7947-
44 Rog"r, C. On becoming n person' Boston: Houghton Mifflin' 1961'
 Health: An occupational perspective
76\
Chapter 5¡

social adjustment, and contentment - 'the good life' itself'as. In turn the

,mental hygiene movement' can be seen to uphold the Renaissance tradition

of human achievement, and the ideals of the 'uge of enlightenment"

However, humanist approaches have not, in a real sense, sought to integrate
their perspective of mentat well-being with physical and social well-being.
Taken to extremes, that is, considering "achievement of one's goals" as the

criterion for health is as focussed and narrow as a bio-mechanical approach to

health which only considers physical factors. Despite this criticism Boddy,
a

nurse educator, commends the approach as being "one of the few models
which acknowledges the individuality of people and their creativity in
defining their goa1s"46. The central concept of these approaches, that well-
being depends upon the meeting of individual potential is also central to
the

theory of humans as occuPational beings'

Occupationally, mental well-being embraces the belief that the potential

range of individuals' occupations will allow each of them to be creative
and

adventurous aS they experience alt human emotions, explore and adapt

appropriately, and without undue disruption meet their life needs. If mental

well-beingis to be attained, occupations need to provide self esteem'

motivation, socialisation, meaning and PurPose as weil as sufficient
intellectual challenge to stimulate neuronal physiology, and encourage
efficient or enhanced problem solving, sensory integration, perception'
attention, concentration, reflection, language and memoryaT' Additionally,
a

balance of occupations between intellectual challenges, spiritual

experiences,

does not imply

emotional highs and lows, and relaxation is required. This

ngteuy D. Mental health. ln: Kuper A, Kuper f, editors. The

45 social science encyclopedia'

Lo-ndon & NewYork: Routledl e, 1985'

46 noddy |, editor. Healt¡ : Perspectiaes and practices...p.48.
47 S.u,ft, Lilley J, fackson L. The value of activities: Establishing a foundation for cost
A review of the literature. Actiaities, adaptation and ageing 1990;14(4):12'
"*urr,pt":
effectiveness.
long term care resident'
13; Foster P. Activities: A necessity for total health care of the
Actiuities, adaptation and ageing 1983;3(3): 77-23'
 Health: An occu pational L62
Chapter 5:

constant high powered mental 'doing' or 'feeling', rather that this should be
interwoven with time for simply 'being' or 'becoming'48. Mental well-being
wilt be enhanced if people choose their occuPations so that they are able to
develop spiritual, cognitive and emotive caPacities, to exPerience
timelessness and 'higher-order meaning'4e, and to adjust their activities to
achieve a balanced combination of mental, physical and social use'

Many of the characteristics of mental well-being include asPects of social

interactions and relationships which leads naturally to the consideration of
social well-being. Nutbeam suggests that well-being in its entirety belongs

within the broad context of the social model of health as he considers its focus
is on "social integration", "social support" and "social coherence for
belonging"so. This suggests that physical and mental well-being are

dependent on the co-existence of social well-beings1. Social well-being is

usually described as resulting from satisfying interpersonal relationships,
which depend on the ability to interact happily and effectiveiy with people,
within cultural and social parameters, without fear to challenge or develop

id,eas deemed of benefit to society. Social ease is acquired, and often

associated

with, socially sanctioned (moral) and respected occupational behaviour.

The previous chapter showed that throughout time, people have displayed

a need to be part of a co-operative social group. Some theorists even argue

that there is a correlation between the size of the neocortex and the size of
to
social groups amongst primates, humans having the largest brain relative
size, and the largest and most complex societiess2. It is, therefore, hardly

48 do Roru.io L. Ritual, meaning and transcendence: The role of occupation in modem life' Journal
of ocuryational science: Atrctrnlia 1994; 1'(3): 46-53'
49 RuppuportR. Ecology, meaning, and religion Richmond: North Atlantic Books, 1979'
50 N.rtb""* D. Health promotion"'p'726'
51 See, for example: Kirkpatrick R, Trew K. Lifestyle and psychological well-being_among
unemployed åen in Nårthem Ireland. lournal of ocuryational
psycltology 1985; 58: 207-276'
52 o.r.,uur ti. *t gossip is good for you. Neiu Scientist, 21st. November, 1992; Vo1.136,
No' 1848:
28-37.
 perspective 163
Chapter 5: Health: An

surprising that reports of welt-being are often associated with social

interactions. Some empirical research supports this association. For example,

Argyle's study of the psychology of happiness rePorts several social factors
which have been linked with health. He found that relationshiPs, such as
marriage and other close, confiding and suPPortive relationships enhance
health by both preserving the immune system and encouraging good health
habitss3. He also reports that socially valued activities, including paid
employment (if it is satisfying) and 'religion' aPPear to have a positive
correlation with both health and happiness. Blaxter's findings also support
this view, in that "not only socio-economic circumstances and the external
environment, but also the individual's psycho-social environment - carry
rather more weight, as determinants of health, than healthy or unhealthy
54
behaviours"

From the occupational perspective held here, social well-being occurs when
the range of each individual's occupations and roles enables maintenance and
development of satisfying and stimulating social relationships between
family members, with associates and within the community in which they
live, and when engagement in occupation is balanced between social
situations and time for quiet and reflection. Occupations which will have
most obvious effects on health are those which are socially sanctioned,
approved and valued, even if only by a sub-culture with which people choose
to associate, and which endows individuals with social stafus enabling them
freedom to effectively utilise physical and mental capacities in combination
with social activityss. Doyal and Gough go so far as to suggest that "to be
denied the capacity for potentialty successful social participation is to be

53 Atgyle M' The psychology of lnppiness"'

54 Blaxter M. Health nnd liþstyles... p'233'
55 S"" for example; Maguire G. An exploratory study of relationship of valued activities to
-the
the life satisfaction olelderly pe.ror,r. Occupntional thernpy
journal of resenrchl9S3;3:1'64-
777.
 764
Chapter 5: Health: An occuPational perspective

d.enied one's humanity"So. Social well-being wilt be enhanced if people are

able to develop their potential through Practice in a range of socially valued

occupations and to balance their social health needs because of increased

health.
awareness of the relationship of social activity and

With these ideas in mind it becomes necessary to ask if health and well-
being is possible despite some incapacity. One obvious answer is that,
because

no two individuals will Possess the same fange of capacities, nor have the
same experiences which impact uPon their growth, in a sense, anyone can be

seen as incapacitated to some extent. Some people can sing, others are tone
from
deaf; some are athletic, others are clumsy. Such capacities endowed
of
birth, or the lack of them, are generally accepted as within the normal range
human differences, yet when these relate to a fundamental capacity, such
as

is lost
bipedalism, vision, intellect, or fluid movement, or when such capacity
in later life, individuals so afflicted are described by others as incapacitated or

disabled and are frequently classified as unhealthy.

without
This thesis argues that people can experience health and well-being
already
use of all possible capacities, and that this is the norm. The arguments

cited concerning individual d.ifferences provide empirical evidence of

the

truth of this claim. At a 1991 seminar on stroke, held in NewZealand,

opinions about the potential for people to experience health
and well-being

following stroke were canvassed. Most of those who had had a stroke,
and

their relatives and carers, agreed it is possible for people following stroke,
with subsequent loss of capacity, to experience health and well-being, but not
all health workers agreed. In fact during the seminar one physician
expressed

not be
very vehemently his opinion that any Person with hemiplegia could
considered healthYsT.

p'184
56Doyul L, Gough l. A tlrcory of hunnn need. Houndmills, Hampshire: MacMillan, L991,
57 Wilcock AA. WorksÃrlp,"uoiitti, Henkh Care, ocatpational Therapy and Stroke'
Seminar
November 1991.
on Stroke, National Heart Foundation, Auckland, New Zealand:
 165
Chapter 5: Health: An occuoational PersPective

physical, mental and. social well-being, cannot easily be separated. They are

part of an integrated system which warns, maintains and rewards through

people's awareness of how they feel. This witl be discussed in greater detail
later in the chapter. Yet much of our health care system focusses on one or
other aspect of these, usually acording to which one is seen as dysfunctional;
which one is diseased. This has led to recent health and wellness initiatives
concentrating on particular aspects of fitness for their own sake, and
failing to

make use of the potential health-giving properties to be found in every day

engagement in life's occupations. contrasting markedly with initiatives
of

that type, occupational therapists have focussed to a great extent on the

'doing' and
integration of physiological, psychological and social well-being,
brain/body functioningss. similar integrative notions of health have been
the subject of study from a variety of perspectives, but despite popular
and

have
scientific interest, neither these nor occupational therapists' concepts
been well integrated into mainstream health care practicesSe'

One of the similar concepts, proposed by Ornstein and Sobel, that the
principle function of the human brain is to maintain health, was introduced
in chapter two. They claim that their view, which aPPears more logical than
some of the lofty purposes attributed to the brain by those seeking
to

"escaped the
differentiate humans from their animal heritage, has largely
attention of the mainstream of medicar practice and psychological thought".
"the body as a mindless machine"
Med.icine, they suggest, has largely regarded

and. psychology has been restricted by "u view

that the main PurPose of the

58 A survey of 15 South Australian

occupation and health, illustrates
n

A guide forpractice. Rockville: Aspen

wñoleness handbook: Care of body, mind and
ntinuum Publishing comPany, 1991; Pelletier KR'
d Schuster, 1994.
 p 166
Chapter 5: Health: An

human brain was to pfod.uce rational thought. Never mind that the"'neuron
thought or reason" 60. This idea is a recent
[does] not for the most part, serve
the attention of
contribution to the study of the mind which has occupied
probably for
philosophers, psychologists, medical scientists and many others,
as long as humans have had the capacity for abstract thought.
A brief
diversion to review the changing concepts held about the mind
is warranted
to
to illustrate how concepts of health and well-being can change according
influences
dominant views of societies, and how occupational development
concePt formation.

Mind is derived from the old German word "'gamundi' meaning

to think,

remember, intend", but in Classical Greece the concept of

mind was
Plato, for example
interwoven with concepts about the soul and spirit6l with
proposing that the "mind is the attribute of the gods and
of very few men"'
however,
and. that it is "separate and independent of the body"62' Aristotle,
viewed. the soul as inseparable from the body, and
"the mind."(the thinking

soul)...an independent substance implanted within

the soul...incapable of
relationship between
being destroyed"63. The evolution of the ideas about the
contexts of the age
bod.y, brain, soul and. mind tends to reflect the occupational
view of
in which they were made. It is possible to speculate that an holistic
the relationship was held by early humans who, because of their
close

not seek to distinguish

relationship with the rand and other living things, did
special characteristics of the species. Rose argues
that in medieval times in a
fixed to revolving
world in which it was believed "the stars and planets were
glass spheres drawn by angel Power, the body was the natural home of the

60 Omstein R, Sobel D. Ttrc healing brain: a raclical new appronch to health care ' London:
MacMillan, 1988, P'1'1'
$lValentine ER. Mind. In:The social science encyclopedia.
62 pluto. 'Timaeus'(51d) and 'Phaedrus' (67a) In: Hamilton E, Cairns H' editors'
The collected
dinlogrræ of Plaìto. New York Pantheon
Books' 1961'
63 Rrirîotl" (4I3 a 4) and (408 b 18). In: Barnes j, editor' The conrylete ruorks of-
Aristotle'
princeton university Press, t984, pp.657,658'
Revised oxford translaiion. uK.:
 Health: An occupational pers
t67
Chapter 5:

soul and there was no incompatibility between them". Following discoveries

which demystified the universe, such as those of Copemicus, Galileo and
Newton, Descartes reconciled his own mechanistic view with Catholic
rhetoric. He separated the soul or mind (which he placed in the pineal gland)
"sort of hydraulic
from the body and, brain (which he viewed as operating as a
system") proposing that, theoretically, minds and souls can exist apart from
the body, and can withstand it's corruption and death6a. This Cartesian
dualism has dominated ideas throughout the recent evolution of
explanations of the relationships between body, brain, soul and mind65.
These explanations have been progressively expressed in terms of clockwork

models, electrical and magnetic models, phrenology, telephone and factory

management models to cybernetic and computer based models66. Although

integrated systems theories predominate today the effects of dualism remain

with disorders of mind and body being treated by different medical specialists
in different locations, and the alleviation of social and ecological disorders
being the province of totally separate agencies. Dualism is contrary to the
holistic notion of health and occupation resulting from all parts of brain and
body working in harmony with the environment'

From the holistic point of view of my theory the previous division of

physical, mental and social well-being was for the PurPose of discussion
only'

So too is the fact that well-being was considered only from an individualistic

perspective. Within capitalist societies it is easy to disregard broader concepts

of health which relate to families, communities, and to the ecology' Some
other societies, such as the Australian aboriginals, place more value
on kin

and community than individuality. This value is reflected in the way

in

@ Ros" S.The Harmondsworth: Penguin Books' 1976'p'39'

consciotts brain. revised ed.
65 Descartes R.Discourse on tlrc metlrcd of righth¡ condttcting the reason, IV', \637'Translated
with lntroduction by Lafleur LJ. New York: The Liberal Arts
Press, 1954'
66 Rote S.The conscious brnin"'
 168
Chapter 5: Health: An occupational perspective

which the Australian Aboriginal Health Organisation defines health as

referring to:

the social, emotional, spirituøl and cultural well being tf the

whole community. Health seraices should striae to øchieae thøt
state where ,räry indiaiduat cøn achieae their full potential øs
human beings (aúoriginals) ønd t\us bring about total well being
of their communitY as a whole" 67'

This might remind people from cultures dominated by individualistic

are fairly
values that such values are closely associated with materialism and
recent68. Communities were originally a source of protection and succour to

individuals, and were small enough to reflect their basic needs but, because
of

their protective function, the good of 'tribe' was Seen as of more importance
than individual survival. In societies in which individual goals and
needs

have assumed dominance over communal need people commonly

talk, with

some degree of regret, about loss of community spirit, yet still seek to

influence the way of life of other existing cultures who hold

to community
and extended family values much more in tune with the ecology' Indeed'
people from post-industrial societies are so imbued with the values
of

material and technological, economic growth, and have given such

to ouf seParate nature that we have become alienated from the
,,prominence

most fundamental truth of our nature, our spiritual oneness with the living
universe", and our dependence on maintaining it's physical health69

My occupational view of health encompasses the relationship between all

life from cellular to global factors, from biological to socio-cultural, and

microscopic to macroscopic levels. For example, human
occupational

Barclay J' Zollo j' editors'

67 Agi.r, T. Aboriginal health in Aboriginal hands' ln: Fuller f, Painters
M'ultiatlt,rat heatth care in South Australia. Conference proceedings Adelaide:
Prints, L993, P'23.
68 Lrrk", S.lndiuidualism. Oxford: Basil Blackwell' 1973'
69 Th" Asian NGO Coalition, IRED Asia, The people centreddevelopment forum'-Economy'
of^s-ustainnblity'1993; Potter VR'
;;;lW and spiritrtality: ioward a _t.heory àncl- prnctice 74t 727-153'
Bioe"tñics, the science-of survival. Biotogy ønd medicinel971;
 1,69
Chapter 5: Health: An occupational perspective

behavior affects health and well-being on an individual basis through

the

integrative systems of the organism; on a social level through shared activity,

the continuous growtlì of occupational technology and socio-political activity;
and on a global level through occupational development affecting the natural
resources and eco systems. Any or alr of these can have negative or
positive

effects on health, and atl are inextricably tinked. This implies that
practitioners focussing on promoting the health giving relationship of
occupation cannot do so only at an individual level. All levels have
to be

considered. or explored by focussing on education, behavioural, social and

environmental issues.

Widening the idea of health to include individual, community and

ecological well-being brings theories such as 'holism' and

'general systems

theory, into consideration. 'Holism', from the greek 'holos' meaning whole,
was first used by Smuts in 1928 to describe philosophies which considered
"a
whole systems rather than parts of systems (reductionism)70' He observed
basic tendency of nature and, evolution to produce novel, irreducible
wholes",

and that living systems are more than the sum of their partsTl' Also
subscribing to this view, Bertalanffy, who sought to discover general
patterns,

trends and structures in natural, social and technological systems, developed

,general systems theory'zz which proved to be "a major source of impetus

towards a more holistic approach" in the biological sciences and health care,
including occupational therapyT3. The view that people are more than
a

70 #f,: î"ï:f'#ïrffîl'iï:ä",Ë,iil"å:ii::i"ï'äi.
elaborated on his philosophy of holism and published
London: MacMillan&Co'
Holism ønd euolution tn\928. (SmutsJC. Holism and eaolution.
lia,., tOZø.¡For Smut's place in the history ecology see Golley FB'A
ttistory of the eco systeti concept in ecology: e parts' New haven: Yale
UniversitY Press, 1993, chaPter 2'
71fop"t*ur, L, Moskop f. Theholistic.health m critique' lournal of
*rdirirt and philosophy' 1981;6(2):209-35, p 221'
72 Bertlarrnfy L von. Problems of Lft'NewYork: Wíley' 7952'
T3wilkirrror., P. General systems theory. In: Bullock A, Stalleybrass O, Trombley S, editors' The
Fontana Press, 1988'
Fontnnn dictionary of ítrodern thought .2nd ed. London:
 persPective 770
Chapter 5: Health: An

collection of cells, tissues and organ systems encoufages the study of health
based on the integrated nature of human beings as part of their socio-cultural

and natural environment and draws on systems theory for its explanationsT4.
In some ways this may be considered a retum to older values when it is
'haelth'
appreciated that the word. 'health' is derived from the old English
from ,hal' meaning whole7s. Current dictionaries give 'wholeness' as one of

the slmonyms of health76, so that the need to talk about holistic health is
perhaps evidence of the term 'health' having come to mean
"something less

than wholeness"77. The concentration on reductionist research in the

twentieth century has, however, provided evidence which has enabled people
to recognise the holistic nature of living systems'

Although holism was first mooted, in this century, in the nineteen

twenties, it did not gain prominence in the health debate until interest in

altemative lifestyles and approaches to improve health and quality of life

escalated from the early 1960's in many parts of the world.
Many of those

adopting alternative lifestyles rejected, to some extent, westem cultures in

favour of eastern philosophies and religions, particularly those such as
Hinduism which embodies 'oneness with the universe'78. However, holistic
health labels have been applied to many approaches and disciplines, from
which Kopelman and Moskop, have identified five major common

characteristicsTe. They are: health being viewed from a positive perspective;

the use of natural rather than invasive or high technology solutions in the

management of ill-health; self responsibility for health, rather than

professional responsibility which should focus on health education;
and

74 pietroni pC. Holistic medicine. ln:The Fontana dictionary of modern thought..'

Inc. 1984, Volume
Wagnalt's Standard Desk Dictionary. Harper and Row Publishers
1
75 Ftmk û
p.296.
T'TheAustralian Concise Oxford Dictionary of Current English, 1987
77 ¡,oady J, editor. Henlth: Perspectiues and prnctices...p.1'13.
78 goddy J, editor. Health: Perspectiaes and practices"'
79 tcop.í*un L, Moskop I rn9_rrolltic health movement: A survey and critique. lournal of
,,,rdirin" and philosoplry-799|; 6(2): 209-35'
 pefspecti ve 1.77
Chapter 5: Health: An

change of emphasis within health services towards behavioural, social and

environmental issues. These characteristics, which are also central to my
occupational view of health, do not aPPear to differ in any great degree to

ideas central in the Ottawa Charter for Health Promotion. This states
that

,,health is a positive concept", that "health promotion supports personal and

social development through providing information, education for

health and

enhancing life skills" to enable people to "keep themselves, their

families and
"towards the
friends healthy", and that health services should be reoriented
promotion of health"8O. Perhaps the similarities are merely figures of speech,
as it can be argued that few health services or resource allocations for health
purposes have been shifted in an holistic direction. The rhetoric may, in fact,

be being used by heaith authorities to counter the criticisms leveled at

the

pragmatic technological approach of medical scientists. Lack of action

in

reorienting services towards holistic approaches may be due, in part, to the

lack of empirical research supporting their benefits, or because of the
impossibility of comprehending the whole of the biological mechanism, even
if all it's elements were known81. Boddy suggests that exponents of holism
have failed to justify much of its logic, and need to take a more critical
approach, similar to that expected of western medical science'
Within the
,holistic health' movement there is a common, unwritten assumption that

health defined in holistic terms is good per se. she argues that
if health is
regarded as a "sufficient goal in it's own right, (and as) the highest
good rather

than a means to achievement of some other higher good", then the active
pursuit of health should be the primary goal of us all. such a direction could
be as limiting as a 'bio-mechanical', or an 'achievement of goals' model of
health82.

80 World Health Organization, Health and Welfare Canada, Canadian Public Health
Canada, 1986'
Association . Ottawí Clnrter for Heatth Prontotion. Ottawa,
81 Pott". VR. Bioethics, the science of survival"'
82 Soddy j, editor. Henlth Perspcctiaes and Practices...p.776-
 172
Chapter 5: Heal th: An

It is important to consider further the Ottawa Charter for Health Promotion

because this document is a Primary soufce of contemPorary
health Promotion

directions. The Charter was developed and adopted by delegates from,

mainly, post-ind,ustrial societies, IePresenting 38 countries at the first
international conference on health Promotion jointly organised by
Canadian

and World Health Organisations. It proposes that action is required

in five
major directions - buitding healthy public policy, creating supportive
environments, strengtheningcommunity action, developing personal
skills

and. reorienting health services beyond the provision of clinical

and curative

services towards the pursuit of health'

The Charter, which can be seen as developing the World Health

organisation definition and the ideas embodied in the Declaration
of Alma

Ata83, has been influenced by the concepts and views ProPounded by social
in it's intent as
health activists of the last twenty years. The charter is holistic
it recognises "the inextricable links between people and their
environment
approach to health'" It
[which] constitute the basis for a socio-ecological
argues for "the conservation of natural resources throughout
the world"'the

need to encourage reciprocal maintenance, to take care of each

other' our
one lives in
communities and our natural environment...[so] that the society
conditions that allow the attainment of health by all it's members."
It
creates
issue of our way
also calls for a commitment to "address the overall ecological

of living,, and to "counteract the Pressures towards harmful products,

In
resource depletion, unhealthy living conditions and environments'"
acknowledging that urgent consideration needs to be given
to factors
can be seen to
detrimentai to the natural and social environment, the Charter
structures and
recognise the adverse results of many current occupational
technology. However, it also recognises the benefits of occupation'
Although

83 World Health Organisatio n. Primnry Henlth Care' Report of the Intemational Conference
on Primary Health Care, Alma-Ata, USSR' ' 1'97&
 ve L73
Chapter 5: Health: An occu

not formally acknowledged within the document, its

'occupational' emphasis

recognises that what people do affects their health. Health,

it is stated,
,,cannot be separate,l from other goals" because it "is created and lived by
leam, work, play
people within the settings of their everyday life; where they
and love". The Charter encourages communities and individuals to
participate actively in tife by the prescription that:
\

well-being,
to reach ø state of complete physical, mental znd social
an indioiduat oí group must be øble to identifu and to realize i
aspirations, to -s,øiisfy
needs, and to chønge or cope with the I

enair onment "84

argument of this
This encapsulates, in large measure, a theme central to the
chapter, that there are primary links between health
and occupation; that

occupation is the fund.amental mechanism by which people realise

aspirations, satisfy needs and coPe with the environment; and that

engagement in occupation to meet needs and aspirations provides the

and social
mechanism for the maintenance and growth of physical, mental
mechanism effectively
capacities. These are central to hearth. To utilise this

humans need to develop or maintain natural and social environments in

which the species will be able to sustain life and which provide
sufficient

challenge to exercise individual's capacities and community

potential' By this
integrated part of the
means individuals and the species will flourish as an
ecology.

Following this review of ideas about health and well-being,

holism' and
point of
w.H.o. directives towards health promotion from an occupational
'health' in this thesis as:
view, it is possible to summarize what is meant by

. the absence of illness, but not necessarily clisability

o attained through
a balance of physical, mental and social well-being

socially valued and individually meaningful occupation

S4ottn ra Clnrter for Hcnltlt Promotion'

 774
5: Health: An occupational

O enhancement of capacities and oPPortunity to strive for individual

potential
o community cohesion and oPPortunity
a social integration, suPPort and justice "
a all within, and as Part of, a sustainable ecology

Having established what I mean by heatth, the next section of this chapter

explores, from this conception, the occupational behaviours

of hunter-
gatherers and views about the health enhancing consequences
of natural
rifestyles. It does so in the berief that the basic biorogical health mechanisms
of early humans will have been largely unaffected by culturally acquired

their health will

knowledge, values and behaviour, and that examination of
sustain the view that engagement in 'naturally' driven
occupation can be

health promoting. This will be considered along with early

hunter-gatherer's

likety experience of morbidity and mortality

In previous chapters it has been argued that within hunter-gatherer

shelter, safety,
cultures provision to meet the needs of sustenance, self care,
serf esteem and life satisfaction was similar for the total population. All able
with the
bodied people were involved first hand in occupations concerned
getting and preparing of food and water, with finding or
devising adequate

shelter for safety and temperature control, and with

the care and education of
the privilege' of not
off-spring. Few would have suffered the fate, or enjoyed
being able or eligible (for whatever reason) to participate
in providing for
themselves and others. Occupations were communal
with on the job
training, and only limited division of labour' Such simple occupational

structures did not obscure innate physiological needs,

but catered for them'

Unlike many other animals, humans "exploit almost every

link in the food

chain", a characteristic which supported flexibility of

habitat, and provided
 175
Chapter 5: Health: An oerspective

motivation for hunter-gatherer PeoPles to move from "one resource to

reduced the
another,'8s. Such a nomadic lifestyle assisted physical fitness,
probability of illness due to unhygienic waste disposal, provided
adventure'

prevented boredom, and promoted bonding of fellow nomads'

In common
"practice of moving
with other nomad,ic PeoPles, the Australian aboriginal
camp as they iourneyed throughout the tribal land
ensured that many of the

health problems associated with permanent settlement sites could not

develop", is a case in point86. Indeed, the daily occuPations of hunter-

being re-discovered as
gatherers provided them with the type of exercise now

advantageous to cardiovascular fitness, and 'tacked on'

to today's occupations'

as providing opportunity to think ahead, plan and use ingenuity

and
as well
creativity to furnish their personal, kin and community requirements.
Communities were small enou not to require restrictive rules and
eras' the groups
regulations and probably, more so than in later occupational
who lived together on a regular basis were stable and supportive'
Survival

group in
would often have depended on the strength created by u cohesive
imposed by u nomadic
combined. activity. úa fact, because of the constraints
the moveable
way of life, the people making up each social 'band' constituted
assets of the group, that is, the people rather
than material assets were valued

as central to survival. This would have influenced the

development of a

communal rather than an individual view of the world

and of health'

spiritual or playful
Obligatory occupations, and many others of a creative,
were carried out as an integral part of the day-by-day business
of
kind,
constrained to balance
wresting a living from nature. Hunter-gatherers were
as, at least until they
physical exertion with sedentary and rest occupations
wouid have been
learnt to create and control fire to their advantage, they

85 Stephenson W. Tlte man' Sydney: Angus and Robertson'1972'p'26'

ecological dnelopntent of
Book
86rioã-noyes MJE. Patterns of aboriginal uilttue: then and nozu' Sydney: McGraw-Hill
ComPanY, 1977, PP'754-155'
 176
Chapter 5: Health: An

diurnal, so following basic circadian Patterns of sleeping and waking'

belief the
Additionally, and as noted in an earlier chapter, contrary to popular
obligatory occupations of providing for immediate needs
was not as time

consuming as the 'modern eight-hour day"

The development of individual potential by participation in occupations,

many of which were directly related to maintenance of the
organism and
was ensured by
survival of individuals, their communities and the species'
the development of a technology which was in tune
with the natural world'

Many consider that the occupational pursuits of the hunter-gatherer era

would, generally, not have disturbed the environmental balance.

At least, as
"influence their biotope in
Lorenz suggests, human hunter-gatherer cultures
a way no different from that of animal populations"ST' Further, despite his
need as modern
suspicion that pre-historic people had the same characteristic
humans to "over exploit every resource they can luy their hands ofl"'
does not aPPeaf to have
stephenson observes that the Australian aboriginal
of Australia produced
done so, perhaps because their long, isolated, occuPancy
',a stable relationship between man and his resources"88. King-Boyes
agrees

that ,,in full tribal life the Aborigines presented an excellent example of a

society working in rhythm with it's environment". This tyPe of lifestyle

a real test
which was followed for probably at least two million years provided
health and well-
of the effectiveness of engaSement in occupations to sustain
being of PeoPle and the ecologY'

There have been many speculations and comments

about the health status

humans from a rich variety of sources. Professor of zoology

at
of early
in The Ecological Deaelopment tÍ
Queensland University, Bill Stephenson,
Mønobserves "we know that people living a culturally
primitive life (with

87 Lor"nrK. Ciailized nnn's eight deadty si¿s. Translated by M' Latzke' London: Methuen & Co
Ltd.,1974, PP.I2-13'
SSstephenson W. Tfte ecologicnl deoelopntent of nan"'p'94'
 177
Chapter 5: Health: An occupational perspective

less medical care) are generally more physically perfect than those
from

affluent societies"se, and McNeill in Plagues and People suPPoses that

,,ancient hunters of the temperate zone were most probably healthy folk"

despite short lifespans compared with modem humanse0' Such

views are

supported by reports from explorers in their initial contacts with people of

primitive cultures which suggest that they appeared both happy and healthy'

For example, Nicholas Tunnes observed in 1656 that Eskimos in west

Greenland who directed. "all their efforts...toward acquiring,
without too
much trouble, what is absolutely necessary in the way of clothing
and food"

believed themselves 'happy' and 'favoured'e1' and Captain James Cook

record,ed in his ]oumal, 1768-177t, that he found the natives
of the Pacific
Islands he visited, happy, heatthy and futl of vigour. of
the Australian

aborigines he wrote "they are far happier than we Europeans,"'they

live in

tranquility,, and "they think themselves provided with all the

necessarys of

Life, and that they have no Superfluities"e2' It was of course, a

popular
the ideal
opinion at the time of Cook's voyages, that, 'a state of nature' was
1755 theories of
state to create health and happiness, based on Rousseau's
corrupted by civilisation93. These theories were So
man aS a 'noble Savage'
which
popular, Dubos observes, that they "fostered an intellectual climate"
influenced philosophers of the 'age of reason' and
'practical sanitarians"

contributing eventually to social reforms and improvement in healthea'

For

example, Thomas Beddoes, British poet-physician hypothesized

that the

blessed original state of health could only be recaptured

by abiding by the

The ecologica! deaelopment of man"'p'217'

SgStephenson W.
goVtÑeiU WH.PIagtes and peopte. London: Penguin Books, 1979,p'39 (first published by
DoubledaY, IJSA, 197 6')
91T,rrrnesN.1656. Citedin: Dubos R.Mirage of health: lJtopias, progress and b.iological
change'
of
New york: Harper and Row Publishers,"795b, p.¡l;
see-also:. Fortuine R' The health the
Bultetin of tlrc history of medicine
Eskimos as portrayed, in the earliest written accounts'
L977;45:97-1L4-
g2Wharton WJL, editor. Captain Cook's lotrnal during his fitst aoyage around the world made
in H M Baik Endeaaorrr, i76g-'1.771, London: Eliotstock,1893,p.323.
In: Mason
93 Rorrssea., f]. Discourse on the origin and foundations of inequity amongst men' 1754'
jrl,. in, iittispensaøte Roussenu' London: Quartet Books' 1979'
94Dtrbot k Mirnge tf lrcalth:""p'744'
 1.78
Cha Health: An

simple order and purity of naturees. Julien Joseph Virey, the nineteenth
century French physician-philosopher, asserted in L'Hygiene Philosophique'
that humans in a state of nature are endowed with an instinct for health
which permits biological adaptation, and which civilised humans have 1oste6,
and Ed.ward Jenner observed that "the deviation of Man from the state
in

which he was originally placed by Nature seems to have proved to him

a

prolific source of disease"9T'

Earlier oriental examples demonstrate that Rousseau'S theory was not

original. InTheYellow Emperor's classic tf lnternal Medicine, published
in

china in the fourth Century BC it was supposed that in the remote past
,,people lived to a hundred years, and yet remained active and did not become

decrepit in their activities"es. similarly Lao-tzu and chuang-tzu eulogise

"the ancient men lived in
about a golden age, the latter suggesting that when

a world of primitive simplicity...was a time when the yin and the yang
worked harmoniously,...all creation was unharmed, and the people did not
"Man in the morning
die young"99. Pao Ching-yen, at a later date, observed
went forth to his labour on his own accord and rested in the evening.
People

were free and uninhibited and at peace...Contagious diseases did

not spread,

and long life was followed by natural ds¿1þ'"100

Despite these supposed advantages of the lifestyle, a high

level of mortality

at all ages is beiieved to have been the common experience

containing the

95B"ddo", T.Hygeia, or essays moral and-medicnl on the causes affecting the personal state of
iä *¡dau"g"ånd affhtent classes.3 vols. Bristol R. Phillips, 1802-1803'
chard, 1828.
aariolae uaccine: A disease discoaered

itiÍiÍ'í"í"'î;"ouffffl;iú,1åi"*r
of internal nrcdicine'
ÌlruVeith. Huang Ti Nei Ching Su Wen. The yellow emperor's
gS classic
Baltimore: Williams and Wilkins, 1949' p'253'
99 Lao-tzu.Tao Te C/ring (The Way) Circe 5008C: Chuang-tzu' ln: Dubos R' Mirage of health:
'biologirit'
lJtopias, progress nnld ,t n gt. New York: Harper and Row Publishers, 1'959' p'10'
100 pue Ching-yen. ln: Needham J.science and cioilisation in Chinn,Yol2,History of scientific
t it i gn t," Cambridge: Cambrid
ge University Press' 1956'
"
 179
Chapter 5: Heal th: An occu pational rrerspective

human population at the level at which their interaction with ecology could
be maintained. Those who survived and Procfeated were those most able to
live and adapt effectively to life's demands, and in fact could be designated
healthy. In this wàlt Coon observed "natural selection is not thwarted, and in
their breeding populations they do not build up increasing loads of disabling
genes"lO1. See figure 5.1 for an illustration of mortality patterns of hunter
gatherer PoPulations.

Figure 5.L: Mortality patterns__of

hunter gatherer poPulationslo2
Survival
(%) Survival patterns in three extinct and one
modem hunter-gatherer populations:
100
A, Cariston-Annis, Kentucky, USA (4000-
2500 BC);
90 B, Libben, Ohio USA (AD 750-1000);
C, Yanomami, males only; and
80 E D,'Maghreb'-Afaslou-bou-Rhummel and
Taforalt, North Africa (10,000 years
ago)'
70 (A,22.4 yearsi B,19.9 Years; C,21.5
A years; D, 2'l'.! years).
60 B
c Curve E shows the survival profile of a
modem post-industrial population, the
50 D USA in 1960. The average life expectancy
of the recent US population of nearly 70
40 years contrasts sharply with the values
for the other populations.
30

20 Early mortality and morbiditY

10 resulted from ecological forces

acting on the PoPulation, for
0 10 20 30 40 50 60 70
example "Parasites with high
Age (Years)
transmission rates and little or

no induced immunitY" such as

worms, lice and ticks, Pathogens such as salmonella and tryPanosoma

101çoor., CS.The hunting peoples. London: fonathan Cape Ltd., 1972,p'390'

102¡4"¡r.,¿"1RS. Human f,opulations before agriculture. ln:Tlrc Canfuridge encyclopedia of
human nolution..-P'408'
 180
Chapter 5: Health: An occupational perspective

(sleeping sickness), climate ("older PeoPle suffer gradual loss of the ability to
buffer temperature extremes"103), and availability of food and water.
'occupational' accidents, aggression and infanticide are also suggested

causesl04.

Such demographic and epidemiologic deductions do not contradict the

claims that hunter-gatherers exPerienced general well-being, but rather, in
common with modem humans they experienced ill-health and accidents,
the

different nature of which, coupled with lack of specialist knowledge, led to

the
early death for many of the population. Nor do these deductions negate
notion that occupation, survival and health are inextricably linked' In fact
they support this notion. Because of their occupational nature and potential,
humans were able to strive to improve these survival odds and decrease
the

experience of illhealth. Their technology, in the main, addressed the

potential risk factors of a world in which people are not the fastest, strongest,
'fight or
largest or best camouflaged of animals. Much has been written about

flight' behaviour, and it's appropriateness for the natural dangers facing early
humans, since Walter Cannon's description, in the nineteen twenties,
of the

single automatic pattern of response of the organism to any challenge

to

equilibriuml0s. Flowever appropriate, the resPonse would have been

unpleasant to experience, and provided strong motivation to develop

artefacts and sociar structures to overcome fear-producing situations. social

cohesion and education were used by hunter-gatherers, along

with tool
predators in the
technology, as vehicles to improve superiorityover prey and
longterm.So,survivalPressuresprovidedmeaning' motivation and
opportunity for engagement in a variety of individual and
communitY

103 poSse¡ A. people and disease .In:The Cambridge encyclopedia of human euolution"' pp'411-
4I2.
104¡4"1r.,¿"1RS. Human populations before agriculture. ln:The Cambridge encyclopedia "f
humnn eaohttion... P'410'
105 çu,.,¡6n tNB. Bodily clnnges in pain, Iumger, fear and rnge. Boston: c. T. Branford,
1929 &'

1953
 181
Chapter 5: Health: An occupational

occupations which addressed the obvious health risks

of the day' In pursuit

of this hunter-gatherers developed caPacities, talents and Potentials' and a

with rest in tune with

satisfying balance of physical, mental and social exercise
well-being'
nature which at the same time promoted their health and

It is not known whether early humans made any conscious efforts to

maintain health and Prevent illness apart from shelter, sustenance and the

seeking out of substances they instinctively craved

when sick, in a way similar

to other "r,i*u1s106. Stephenson has suggested that the 'animal' ability of

primitive humans developed, into a commonsense approach to

health and

illness, and "that with his omnivorous feeding habits and

experimental

of a wide range
frame of mind, primitive men established the curative values
products, many of which are still in medicinal use"107' King
Boyes
of plant
notes of Australian Aborigines that "many records exist of the remarkable
healing capacity exhibited by their bodies subsequent to
injury; and the

knowledge of homeopathic medicine held by the women

was considerable"'

These practices co-existed with the use of shamans

at times of ill-health, but
"an inalienable right of
without the expectation that 'good health' was
life"108

At least from the time of recorded history humans aPPear to have valued
riving. Dubos cites the history of
hearing science more than naturarly hearthy

the Greek gods Hygeia and Asclepius as symbolising the

never ending

oscillation between these different points of view.

Hygeia was the goddess
the "virtues of
who once watched over the health of Athens. she symbolized
a Sane life in a pleasant environment", and probably
personified reason' She

106 gir"¡¡s¡ HE. A History of Medicine, VoI. 1, Primitiae nnd Archnic Medicine. New York:
Oiford UniversitY Press, 1955'
1'0751"0¡"nron W. The ecological deaelopment of man"'p'736'
Book
108 çir.,g-geyes MlE. Patterni of Abotiginal atlttte: Tlrcn and now' Sydney: McGraw-Hill
ComPanY, 7977, PP'754-755'
 182
Chapter 5: Health: An occu

was not involved in the treatment of the sick, but closely associated with

mental health. For followers of Hygeia, health was the natural order of
things: they saw the most important function of medicine as the discovery
and teaching of natural laws which ensured health of mind and body. From

the 5th Century BC on, her cult progressively gave way to the god of healing,
Asclepius, who before his creation as a Deity lived as a physician in the L2th
Century BC. Followers of Asclepius believe that the chief role of medicine
is

to treat disease. In mythotogy Hygeia became relegated to being either a

member of his retinue, or his daughter, along with Panakeia' In most
histories of medicine she is mentioned briefly as subservient to Asclepius.
Hippocrates attempted to marry the approaches of Asclepius and Hygeia,

providing students of public health with a classical philosophy about the

relationship between external and internal determinants of health' He
observed that a physician "was to be skilled in Nature and must
strive to

know what man is in relation to food, drink, occupation and which effect

each of these has on 1þs 61þs¡"109'

Medical science is dominant in current thinking about health, and it is

medical experts who, on the whole, define for the general public what
health

is. yet, it could be said that the meeting of biological needs, 'with the weapons
of Hygeia', seems to have tittle in common with modern medicine'

Medicine's interest in healing may account for the large number of people
who do equate health with the absence of illness. In fact, whether people
can

health of mind
achieve health through meeting 'natural laws which ensure

and body' is, in many respects, socio-culturally determined' Cultures and

societies provide the occupational structure and value systems which
determine which, how and why particular needs can be met.

1.09p¡r6s5 k Mirage of health: lJtopias, progress nnd biological clnnge"'p'139

 183
Chapter 5: Health: An

Yet, from "ancient times the theory that most of the ills of mankind
arise

from failure to follow the laws of nature" has been reasserted time
and time

again110. Ideas and health practices purported to be based on

natural lifestyles

have resurfaced in this century with the counter-cultural movements of the

sixties, the growth of holistic and natural health approaches, the ecological

,greenies' of the present time, and in this thesis. \ trhilst it is beyond the

return
bounds of practicability to suggest that post-industrial societies should
a 'natural' lifestyle based on hunter-gatherer occupations in the
cause of
to
health and happiness, the repeated' interest in the topic suggests that keeping
in touch with humans' innate needs as evidenced by their early behaviours is
important in refocussing attention on matters relating to healthy survival
of

the species.

to
Biological mechanisms aimed at ensuring survival and health are basic
all animals, and ad,aptation occurs in response to long term environmental
conditions during a period of change. Such adaptations are not neccesarily
fitted to healthy living in future environments and, as some basic biological
needs of humans are now obscured by millions of years of acquired values,
and probably
present day health awareness may not reflect needs which were,

still are, fundamental to heattþ survival'

The chapter now considers health and well-being by exploring the

biologically-based needs responsible for the maintenance of
health and well-

being through occupation. But, first, it is necessary to discuss

the concept of

biological needs, because, on the whole, and in a way similar

to 'instincts'' the
the human quest
study of biological needs has been neglected of late' Perhaps
remarked on
for the new and different is partly to blame for this. As Allport
fashion in scientific enquiry "'we never seem to solve our problems
or

110ps6or k ibid.. p.9

 perspecti ve 184
Chapter 5: Health: An

exhaust our concepts; we only grow tired of ¡þsnì"111. Alternatively,

the false

dichotomy between disciplines concerned with the long running nature

versus nurture d.ebate, and the recent emPhasis on nurture, may have
resulted. in need being more commonly exPlored from a socio-cultural

PersPective.

There aÍe, however numerous need theories which attemPt to identify

from a 'natural' perspective what motivates human behaviour112. Doyal and
Gough, for example, of HumønNeed, recently called in question
inÁ Theory

fashionable subjective and relativist aPProaches, arguing that health and

autonomy are basic needs, the meeting of which are essential Preconditions
for participation in social lifel13. Maslow's 'needs hierarchy theory' is

probably the best known and most widely used needs theory, particularly
in

health texts. It is founded on the premise that individuals have innate needs
which act as motivating forceslla. He identified five basic need levels related
to one another in a prepotent hierarchy. At the first level are needs, such as
for food, which relate to the physiological function of the human organism,

followed progressively by needs for safety and security, then belonging, love
and social activity, with the need for esteem and respect at the fourth level,
and at the top of the hierarchy, self actualisation. The Process of self
nature of
actualising he saw as the "development of the biologically based
man, (empiricaliy) normative of the whole species conforming to biological

1114110or¡ GW. The open system in personality theory./ournal of abnormal and social
p sy cholo gY 1960; 6t: 301-311'
112¡aipo,rg;'liw.The energies of men.London: Methuen,Lg32,andsocial psychology.23rdrev'
ed.Methuen,1936; tewï K. A dynamic theory of personality.
NewYork1935;.Murray
ølify. Ne 'ork 1938; Hull C' Principles tf beh.aaior' New
fts, 7943; and PersonalitY' 2nd ed'
954 and tf motiaation' 4th ed'
Press, L9 relatedness and growth:
Human needs in organizational seffings' N
972'
113poy¿1L, Gough r. A theory of human,need"'
propose-and my own' One
There are some similaride; bLtween the model Doyal and Gough
I a nãeds theory in terms of positive health and
basic difference is that whilst concephralise
(See footnote 140)'
well-being, they argue from a negative health perspective
114 ¡4ur1o* A]H. Motiantion and personnlity"'
 perspective 185
Chapter 5: Health: An

destiny, rather than to historically-arbitrary, culturally-local value models

as

the terms 'health' and 'illness' often do"115. His theory is that more basic
higher
needs must be largely, but not necessarily comPletely, satisfied before

levelneeds are activated and motivating. A similar three level hierarchy

(ERG) as the
proposed by Atderfer identifies existence, relatedness and growth
need 1evels116.

Both Maslow's and Alderfer's theories are compatible with notions about
but
innate 'drives' common in psychology for the greater part of the century'
in disuse at present117. Based on physiological discoveries such as those
pertainingtohomeostasis,'.drives'wereSeenaSpersistentmotivations,
and animal
organic in origin, which "arouse, sustain, and regulate human
such as
behaviour" and are distinct from external determinants of behaviour
,,social goals, interests, values, attitudes and personality 1¡¿i15"118' Dashiell, in

'Fundamentals of objective Psychology' illustrated this view:

"The primary driaes persistent forrys tf animal and human

to
conduct are" tissue conditions within the organism giaing rise to
stimulations exciting the organism to oaert actiaity. A møn's
interest ønd desir"es may become e'Uer so eløborate, refined'
socialized, sublimøted, ideø[isüc; but the raw basis ftom which^
they
I7e
are deaeloped is found in the phenomenø of tiaing v76lls7"

Eysenck, Arnold, and Meili, in the Encyclopedia tf Psychology report that

the word 'need', meaning a "central motivating variable" made its

debut into

academic psychology in the early nineteen thirties' The concept

of need' they

1.15 ¡4ur1eq¡ A:H. Toward a psychology of being. 2nd ed. New York: D van Nostrand Company,
1968. p.vi.
11641¿"r¡", Cp. Existence, relatedness and growth: Human needs in organiutional settings"'
117poru1 and Gough recognise biological motivations or drives, but they separate from these
,unirärsal needs"' founded on human reason. Part of thei¡ stated reason for
thei¡ discourse of
result from extemal sources' as in
this separation is thìt physiological drives and needs can
'needing' a fix. In such cases this is obviously not a
the case of someone *ho iak"s ã.,tgt
of human need"'p'36'37)'
universalneed,butanabnormalolie.(Doyali,GoughI.A theory
118y6s¡g pT. Drives. In: Sills DL, editor. lnternational encyclopedia of the social scienc¿s' The
Macrãilhn Co & The Free Press, 1968,pp'275-276'
L19pur¡¡u11 JF. Fundanrcntals of objectiue psychology. Boston: Houghton Mifflin, 7928, pp'233'
234.
 186
Chapter 5: Heal th: An occuPational

instinct, an innate
say, eventually replaced the notion of instinct but, unlike
need, though undeniably goal-oriented, does not have a "repertoire of
inherited, unlearned action pâtterne"l2'. snell bemoans the
fact that "the

term instinct has gone out of fashion", but thinks it

"tempting to revive the

term and to say we can now relate instinct to detailed brain etsç1q¡s"121.
h:l

"long, self-
accord with this Lorenz observes that although humans lack
contained chains of innate behavior patterns" they have more "genuinely
'instinctive impulses'
instinctive impulses than any other animal"122. These
'biological need'.
are close to what I am terming the experience of

'Need' is described in the Dictionary of Behavioral Science as:

,,the
condition ,f lacking, wanting or ,requiri.ng something . which
if present woulâ benefit the orgønism by føcilitøting behaaiour or
âøtisfYing a tension."

and also as
,,ø construct representing a force in the brain whichdirects and
o,rgønises the' indiaiduat's perc-eption, thinking^^ønd action, so as
lo' ,hong, an existing, unsatisfying situation"rz3

The word 'need', despite diverse common, conceptual usage,

is employed

in this section of the thesis, to describe the mechanism by which

unconscious

concerned in
biological requirements are communicated to neuronal systems
engagement with the external world, or which alerts
the conscious state to the

existence of kind of disequilibrium. This view conforms with the

some

suggestion made by Anscombe that 'needs', which are a matter of obiective

fact, relate to what is required for living organisms - plants, animals or

1206rr"r.,"¡ HS, Amold w, Meili R. Encyclopedia tf psychology. New York: Continuum Books,
füe SeaburY Ptess, 7979, Pç'705-706'
121 gr.,"11 GD.Steørch for a rational ethic. New York Springer Verlag, 1988,p'747
biologjcal needs is found in
It is interestit g'tã ,.rát" that almost all of the mateiial ãbout
the references used here.
pylt or,oji.ut anä sociat science texts pre 1980. This is reflected in
!2}yor.nrK. Cipilized nnn's eight deadly sins"'pp'3-S
123y¿o¡¡¿¡ B, editor. Dictionary tf beluaioral science. New York: Van Nostand' ReiriBtd Co'
- . k. . ^
1973, P.250.
 L87
5: Health: An occupational perspective

infused with
humans to fulfit potential and flourish124. Anscombes ideas are
new life some thirty yeafs later by ornstein and sobel's account of how
the

brain makes ',countless adjustments" to maintain stabitity between "social

worlds, our mental and emotional lives, and our intemal physiology", each
neuron producing "hundreds of chemicals" ...which..."for the most part"
are

responsible for "keeping the body out of trouble, from commonplace

problems like not falling over or walking into a wall to the myriad
of tasks
From
involved in maintaining the stability and health of the organism"125.
my viewpoint biotogical 'needs' are activated by this process and positive
health and well-being is experienced when conditions allow humans to

flourish because they are able to meet their needs and potential, usually
through occuPation.

According to this view, biological needs are homeostatically valuable

'whole in interaction
inborn health agents which recognise the organism as a
with the environment' as part of an oPen system. They do not differentiate
in the way in which modem society
between physical, mental or social issues
'a
and medical or psychological practice do, but work as part of flow
of
They
processes' within biological systems relating structures and functionl26

are integral to the collaboration between biological rhythms and homeostasis.

Needs, from my homeostatic perspective, have a three way role

in

maintaining the stability and health of the organism through occupation

prompted by a specific feeling experiencedl2T. Th"y serve to warn when a
problem occufs, to protect and prevent potential disorder, and
to prompt and

1.24g5çe¡¡¡þe GEM. Modern moral philosophy, Philosophy. 1958; 33(724): L-19; see also Watts
ED. Humanneeds. In: The social science encyclopedia"'
125g¡¡s¡gin R, Sobel D. The heating brain: a radical neu approach to health carc .London:
MacMillan, 1988, PP.11-12'
L26 gs¡¡¿1¿¡ffyL von. General systems theory. New York George Baziller. 1968'p'27'
L27 1yi1.o"¡ AA. A theory of the human need for occupation. lournnl of ocutpational science:
Au st r ali a 1993; 1(7): 77 -24'
 188
Chapter 5: Health: An

reward use of caPacities so that the organism will flourish' and Ieach

potential. These three categories of needs Provide both motivation and

feedback. See Figure 5'2'

PROTECT AND PREVENT PROMPT AND REWARD

WARN OF PROBLEM

discomfort calling for energy surge to use pu{pose, satisfaction,

acities fulfilment, leasure

action

feedback link feedback link

Figure 5.2: Needs: three way role in health'

Each of these categories will now be discussed briefly

Firstly, to warn and protect, needs are experienced as a form

of discomfort
the need' Examples of
which calls for some kind of action to satisfy or assuage
these experiences are pain, fatigue, hunger, cold,
feat, boredom, tension,

d.epression, anxiety, anger or loneliness. Many

studies have researched these

experiences as separate emotions128. Cziksentmihalyi,

who has spent much

of his professional life, using a variety of methods such as

questionnaires'

d.iaries, interviews and an 'experience sampling

method', to research the

effects of occupation on individua\sl'zs, uses the term 'psychic entropy' to

"integrated resPonse to the self
describe these states13O, He sees them as an

system," with a main goal to "ensure its own

survival", a view also held in

this thesis.There is debate about whether actions provoked by such

experiences can be considered purposive; indeed not atl occupational

. NewYork Plenum, 1977' lzatd CE, Kagan |,

r. New York: Cambridge University Press, 19&['
ridge UniversitY Press, 1986.
itors.Optimal experience: Psychological studies
dge University Press, 7988, pp'22'23'
s:Toward a science of occupation'lournal of
38-42.
 ve 189
Chapter 5: Heal th: An pational

therapists concede that activity which has unconscious,

rather than socially

valued, purpose can be described as occuPation. Irr psychology

literature it is

in texts contemporary with those discussing'biological needs' and

'drives'

that we find general acceptance of the notion of innate, biologically-driven

activity. Rex and Margaret Knight's, A modern introduction to psychology
is

a case in point, which suggests that activities which do not

involve PurPosive

'foresight', 'distant ends' or even, in some cases, 'ideas or images' should be

described as 'conative', after the work of McDouga11131.
McDougall, the most

famous advocate of the 'Hormic' school of psychology argued that the

humans to act or
conative and emotional aspects of innate tendencies incline
to experience an impulse toward. action which is conducive to biological
well-

beingl3z'

In the second category, which involves preventing disorder and prompting

such as, a need
the use of capacities, needs are experienced in a positive sense,

to spend extra energy, walk, explore, create, understand or make sense

of,

utilize ideas, exPless thoughts, talk, listen or look, meditate or worship'

spend

time alone or with others, and so on. This mechanism, in interaction

with

the first, acts to balance over or under-use. If capacities are over

used people

susceptibility to
feel fatigue, stress and burnout which can lead to increased
accident and illness. If capacities are under-used they will atrophy' cause
disturbance to equilbrium and produce a decline in
health. The balanced
of personal capacities to enable maintenance and development
of the
exercise
is perhaps the most primary and least appreciated function of
organism,
time to time
human occupation, although it has been commented on, from
by well-respected authorities from health science disciplines' Notable

of which have already

examples, from throughout this century, some authors

131 16.,¡9¡1 R, Knight M. A modern introdtrction to psycholo3y' London: University

Tutorial Press
Ltd,7957, PP.56-57'
132 ¡4.porrgati W. Socinl psychology. 23rd rev. ed. London: Methuen' 1936'
 ve 190
Chapter 5: Health: An occu

been mentioned, aÍe risted below in order to demonstrate the striking

Meyer proposed:
similarities of their ideas. InIg22 the psychiatrist, Adolph
,,lt is the use tlnt we make of oursekses that giaes the ultimate stamp to
our eaery organ"r33
In 1935 Carrel, in analogous comment observed:

eraøtion that PhYsiological and

by work. Also, that tffor! is
deaelopment of the indiaidual.
nce and morøl sense become
the phYsiologicøI ønd mental
on his functional actirtitY and
lack of use of our
.ln order to reach
t actualize all his

In L955 Sigerist, the medical historian comments:

,,work in itself is not harmfut to health; it .is, on the contrary,
essential n iís maintenøncei:, becattse it determines the chief
,iytü tf our life, b-alønces it, ønd gktes meaning and
themind
significance. An orgøn that does not u¡ork atrophies and
tiat' does not zuork becomes dumb"l3s'

echoes these earlier thoughts in his

And in !968, the psychologist, Maslow
observation that:

d cease their clamor onlY when

ities are also needs. Not onIY is it
is also necessary for growth' The
can become a disease centre or
else atrophy or disappeør, thus diminishing the person"'r36

The third category of needs considered to be integral to

the occupational
that reward use of
nature of humans and. their healthy survival are those
capacities, such as the need meaning, PurPose, satisfaction, fulfillment'
for
happiness and pleasure. Pleasure and happiness,
including laughter, have

133 ¡4sts¡ A. The philosophy of occupational therapy"'

1%curr"t A.Man, the tmknown London: Bums and oates, 1935,pp.178-179.
'l',
135j¡g"¡is¡ HE. A ltistory of medicine, VoI. Primitiae and archaic medicine"'pp'254-255'
136 ¡4ur1o* A]H. Touad a psychology of being"'
 t9L
Chapter 5: Health: An

been recognised as Powerful human needs by many writers' from Aristotle

is particularly
twenty three hunded years ago to current writers, whose work
and sobel,
relevant to an occuPational PersPective, such as Argyle, omstein
related to
and csikszentmfüalyi. They maintain that pleasure is biologically
health Promoting-activityl37' This does not mean that pleasure is the
part of health
ultimate drive of humans, but rather that it forms an integral
maintenance. In this vein, and picking uP on some of Doyal's
and Gough's

concems about needs and drives, Csikszentmihalyi notes that

d the Pleøsure PrinciPle miSht

enetic teleonomY athose cøuse it
phys Guch as
es q to be under
gene and begins
to foltow the teleonomy of the self"lza '

carried out in
That pleasure is indeed irurate is supported by experiments
the 1950,s, in which rats could self-deliver a stimulus
to the hypothalamus,
'discovered' what
and from which James olds and Peter Milner
has

subsequently been called the 'pleasure centre'.

since then other areas of the

system have also been found to elicit a pleasure resPonse'

similar
limbic
experiments from the 1960s have been reported
from America on humans'

mostly inmates of mental hospitals. The subjects descriptions

of the
such as 'feeling good'' which they
experiences were vague, but included terms

apparently did experience, to the extent that they were prepared to seif

stimulate several hundred shocks an hour139'

ve. Elementary school guidance and counselling

lyi
to

M. The use of humour as a technique for

1990;7 (3):77-8a; Buxman K' Make room for
1,(12):46-57; Mallett f. Use of humour and
ttr sing. 1993; 2(93): 172-17 5'
ilors.Optimal experience: Psychological studies

of flotu in consciottsness"'pp'24-25'
139 qoss S.The conscious brain"'pp'292-293'
 perspective 192
Chapter 5: Health: An occu

Together, the second and the third category of needs serve to establish a

of individ.ual identity and autonomy, the latter being identified by

sense
Doyal and Gough as one of two universal needs, the other being physical
health. In the 'negative' terms of their concept autonomy includes
minimisation of 'mental illness', 'cognitive deprivation', and restricted

opportunifise'.140-

In order to test the proposal about biological needs having a three way role
in maintaining stability and, health, first year occupational therapy students,
as part of a survey about health, occupation and capacities, each administered
they had
a questionnaire to three peopte known to them to ascertain whether
ages ranging from
experienced such needs. Approximately L50 subjects with
were questioned'
six to ninety-eight years, and a mean age of thirty five years,
discomfort
Approximately ninety-nine percent admitted they had experienced
which called for action, and almost all of these had acted in some
way to
admitted to
alleviate the discomfort. Between eighty and ninety nine percent
experiencing a need to use their capacities in various ways.
Of these ninety-
to this lype
nine percent had, responded to such needs. If they did not respond
the type
of need approximately eighty seven percent admitted to experiencing
and ninety-nine
of discomfort described in the first category. Between ninety
percent agreed they had experienced a need for PurPose,
satisfaction,

action in
fulfilment, and pleasure, with ninety-five percent usually taking
response to these needs. When subjects did not respond to these needs
lack of resPonse resulted
approximately eighty seven percent agreed that this
that they
in discomfort. Additionally, the majority of those surveyed reported

negatiaelyas tlte ninimalisation of death,

oely as the minintnlisation of mental
d opportunifies"l considenngf"tlmt these ftuo
 ve 193
Chapter 5: Health: An

affects their mental,

consider the satisfaction of these three categories of needs
physical and social health in a positive way'

to discussion of how socio-cultural influences fit into this

This brings us
scheme. Needs afe not omnipotent, and even ultradian rhythms of
is, needs are
sleepability or wakeability can be overriden by the cortex141. That
subject to scrutiny of, and adaptation by, the highly developed
cognitive and

intellectual capacities of humans, so that

"primitiae instinctiae enery, cøn be directed from its nøturøl 8?11

t'owards alternøtiae ends-ihat are ø greøter ualue" ' h is this
pr:orr6 of redirection which enøbles the "highest achieaements tf
humanitY"l42'

This capacity for redirection and adaptation differentiates between biological

and non-biological 'needs' and allows individuals to make choices
according

to the particular circumstances in which they find themselves, with the

future in mind. In this way all impulses concemed with state of
mind or

action, whether deriving from "phylogenic or from cultural sources"'(are)

a

link in a well ordered., harmonious working system and, as such, (are)

Marcuse, Bay and
ind,ispensible"143. Even political theorists such as Fromm,

Macpherson recognise that needs and wants differ, that needs are not

dependent upon wants, and that cognitive and intellectual capacities

not only

formulate wants, they interpret needs14a. The two work in partnership,

needs

identifying biological requirements, and wants, in many instances,

formulating ways that individual biological requirements can be
achieved'

141g1çu¿iun rhythms are those with a frequency of less ftg ?9 hours. The term was coined by
a
Halberg
chronobiologist at the University of Minnesota' Franz
1421ç.,¡r¡¡ R, Knight M.A modern introdt¿ction to psychology..'p'777'
143¡e¡snz K. Ciailized nun's eight deadly sins"'pp'3-5'
14 Frorr,^ E. TIte Sane Societ17. New York: Rineh att, 7955i Marc.tse H' -One Dimensional Mnn'
London: Routledge uttJ fågu" Paul,1964;Wolff RP'
e of Pure
Tolerance. t or,aoi' ëup", ioes;Bay C' Politics and
tical

Science Rsuiew. tsOSiSs; Bay C' Ñeeds, wants an iournal of

Oxford:
political sciencelg6S;L:Z+1'-í60; Macpherson CB' -. r^^^..^ ;.^ retreiaal'
-^t--;.,^tOxford:
Essnys in
Clarendon Press, l966;MacPherson CB. Democratic Tlrcory:
Clarendon Press, 1973'
 perspective 194
Cha 5: Health: An

Our intellectual and cognitive capacity, freed by the mechanism of choice,

has enabled humans, r.lespite diverse challenges, to satisfy, in
large measure/
earlier. In post-industrial countries, action to
the biological needs described
satisfy of assuage discomfort, such as, food production, the
regulation of

temperature, and measures to reduce pain, have reached a level of

sophistication far beyond the simple methods used by all other
animals living

in natural habitats. To prevent disorder humans have developed ways of

using their capacities in adaptive, inventive and exploratory fashions to
the

extent that they can provide purpose, reward and the pursuit of
happiness'

In fact, the biological mechanism of needs has focussed human energies

towards developing both occupations and socio-cultural structures to
meet

those needs. Because of this humans have been successful survivors - to the
point of over-population - although the occupations and socio-cultural
structures, in some instances, whilst answering one need, may defeat another'
"act in
There are 'downsides' to the mechanism of choice, in that humans can
had built
ways that (go) against the millenial wisdom that natural selection
into the biological fabric of the species", as was discussed in the section on
'consciousness' in chapter 1þ¡ss145' Because of the caPacitY to ignore
biological needs, people may develop socio-political structures, or make

lifestyle choices, that result in detrimental health consequences'

Clear

in this century at women's

examples of this are starvation diets aimed, early

suffrage, or currently at a fashionable aPPearance, which

may lead to

conditions such as anorexia nervosa or to untimely death'

Unless asked to consid,er such factors, or some Process or part of the

mechanism goes amiss, people are not usually conscious of survival and
health maintaining functions. These, rather like the autonomic
nervous

14Sçr¡¡52s¡tmihalyi M, Csikszentmihalyi IS' editors' Optimal experience: PsYchological

sttdies of flozu in consciottsness"'pp'20-21'
 ve 195
Chapter 5: Health: An occupational

working. of this we
system, are built into the organism to just go on
Because

are able to utilize oul caPacities for our own PurPoses,

to explain the purpose

of life in abstract rather than biological ways, and to

attribute meaning to our

activity based on socio-cultural influences. It follows that, in Present

their biological
circumstances, many individuals are not able to distinguish
needs, which ultimately impact on their health, from wants
or preferencesl46'
evolution
This is hetd to be partly because the complexity of socio-curtural
makes d.ifferentiation ciifficult, so that "even phylogenetically
evolved

programs of...behavior are adjusted to the Presence of

a cuiture" which alters

the significance of biotogical needsl47'

These latter points lead naturally to the final items to

be proffered in this

chapter - the socio-cultural determinants underlying the experience of

positive health and well-being through occupation, and the

link between
these and biologically based determinants. These provide
what can be

regarded as a paradigm of the complex relationship between occupation'

health and well-being.

The ideas about occupation and health which have been

explored in this
'occupational indicators of
chapter, sustain the view that there are not only
health and wellness', but also underlying factors which can positively
influence health. Figure 5.3, on the next PaBe, encapsulates
the concept'

There are three distinct categories of underlying factors of

a socio-cultural

nature: firstly, the type of econom/, such as whether

it is nomadic' agrarian'

146 çi¡rr"ruld R, editor. Htmtan needs and politics' Sydney: Petmagon,l977'

Great
L47 yor"n K. The uaning of hrmrnneness, Munich: R Piper & Co Verlag,1983' Translated
Britain: Unwin Paperbacks, 7989' p'lTa'
 Occupational Positive influences Occupational Health
Underlying
on well-being indicators of health outcome qr
occupational factors institutions and
activities status

þpe of econolny/ eg:

Nomadic Technology in daily Occupational
Agrarian living . satisfaction lcreanvrly I Energy/ alertness
Division of labour 'meaning'/ 'purPose' Able to sleep/rest
Industrial
Employment oPPortunities oPportunity/choice Trme for others
Post-industrial '. Range of activities o
Capitalist/ socialist balance (physical,
mental, social, rest); Open to new challenges ¡¡
choice / obligatory; Commitment
nutrition/ activitY Flexibility
Nationnl policies ønd pnon- Ongoing challenges to Happiness / contentment /
ties, eg: meet individual/
serenity/flow
Legislation J absenteeism
War or peace community needs and t!
Fiscal regulations
Economic growth or potential
Commercial and Positive health
sustainable ecology Belonging/ sharing/
materialistic infl uences Wellbeing
Wealth/power multi- contributing
Ecology and Absence of illness
nationals or Involvement in sociallY
environmental management
self generated valued occupation
community develoPment Community and familY
coherence/ stability/ suP- Appropriate height/ weight
port/ growth ratio
Occupational freedom and Normal
Media equity
Culturalaalues, eg: blood pressure
Local regulations Ecological balance / rights
Occupational justice / equitY blood cholesterol
Dole/social services of all living organisms
Views of occupation lung function
Job creation schemes Unpolluted environment
Work ethic
Individual/ communal
Education Environmental comfort /
Health care systems space/beauty
conventions
Sports/ recreational
Health or healing opportunities

FIGURE 5.3: DETERMINANTS OF FIEAXTHAND WELL BEING THROUGH OCCUPAIION \9

(ñ
 perspective r97
Chapter 5: Health: An occu

industrial, post-industrial, capitalist or socialist for examPle; secondly,

national policies and priorities, such as towards war or Peace, economic
growth or sustainatle ecology, wealth and Power of multinational
organisations or self generated community development; and finally,
dominant cultural values about such ideas as social justice and equity as
it

relates to occupation, how different aSPectS of occupation are Perceived'

the

work ethic, individualistic or communal conventions, and resPect

for health

or healing. These underlying factors give rise to particular occupational

institutions and activities in any given society' For example, the type of
economy has d.irect influence on the amount and type of technology
in daily

living, how labour is divided between classes, genders and age groups, and
employment opportunities; national priorities have direct influence
on

legislative and fiscal institutions which provide rules by which people

live,

commercial and material activities, and management of the

environment

and the ecology; and cultural values will impact uPon the media,
local

regulations, Social Services, job creation schemes, education and

health care

systems, for examPle.

These activities and institutions can be positive influences uPon

community, family or individ.ual health by providing equitable opportunity

to develop potential, creativity and balanced use of capacities, to experience

belonging and
satisfaction, meaning and. PurPose, stability and support,
sharing, and being able to contribute in a way which
is socially valued' yet

maintains natural resottrces and recognises the rights of

all living organisms'
for all communities'
The effects of the underlying factors may not be the same
as a necessity
or for all individuals. For example, although peace is advocated
by many
for health by the ottawa charter, a view that is currently supported
people, it may be that some communities and individuals
find war to be a

health-enhancing occupation. Although to the

'green lobby' ecological

sustainability appears to be the healthy way for all to survive,

to Power-
 ve 198
Chapter 5: Health: An

HEALTH, WELLNESS J TLLNESS

Phvsiolosical indicators
BÉ, cholËsterol, weight

Agelgender tice, choice,

appropriate sa tivitY, growth.

Occupational Institutions/Activities

Occupational Evolution National

Sociocultural
Huntergatherers, Agrarians Policies values
Industrial, Post industrial

Relationship with Communal/familY

ecosystem

Biological needs
Use capacities
Safery / Response / ActivitY / Reward

Other requirements for

Reproduction survival/comfort

SPECIES SURVIVAL
INDIVIDUAL HEALTH
AND SURVIVAL

EVOLUTIOI'l/GENETICS

Figure 5.4: Factors underlying health and well being from occuPatíonal
PefsPective.
 ve 7.99
Chapter 5: Health: An occupational

broking economists and Politicians the opposite may be conducive

to their
well-being1a8. What the young Perceive as dangerous risk-taking
behaviours

by the more mature may Produce haPPiness, exhilaration and physical

fitness'

Occupational indicators of health status include energy and alertness' a

range of activities, flexibility, interest, contentment, commitment,

the ability
to relax and sleep, time for others, oPenness to new challenges and
reduced

absenteeism. These are likely to be comPatible with more conventional

health status indicators such as appropriate height/weight ratio,

and normal

blood pressures, cholesterol and lung function. Figure 5'4 on the

previous

page displays the interactive links between biological needs

and socio-cultural
of
factors d.iscussed throughout the chapter, as occuPational determinants
the figure in
health and well-being. only the most direct links are shown in
the interest of clariv, and it is especially important to note the link
from the
,health and well-being outcome' back to the underlying determinants, as the

Processisnotlinear,butinteractiveatalllevels.

Illsummary, health and well-being result from being in tune with our
,occupational' species nature. Being responsive to biologically-driven needs

and utilizing capacities has, in the past, been central to maintaining

homeostasis, and promoting physical, mental and social well-being.
Because

physiological,and innate biological mechanisms are informed, stimulated'

become very
influenced and adapted by conscious social Processes, these too
influential determinants of human occupation and of health. For health
and

in
well-being to be experienced, by individuals and communities, engagement
occupation needs to have meaning and be balanced befween
capacities,

provide optimal opportunity for desired growth in individuals or

groups, be

choice, and be
flexible enough to develop and change according to context and
compatible with sustaining the ecology. Such engagement,
if it is in accord
opposite values'
L48 ¡e1s; Both war-mongers and power-brokers may pay lip service to
 perspective 200
Chapter 5: Health: An

with socio-culhrral values, will enable individuals, families and communities

to flourish and. the species to survive. The complexity of the interaction
of

socio-cultural processes with biological needs, along with lack of

awareness

about hearth's dependence on engagement in balanced and satisfying

occupation can lead to unheatthy consequences. These are discussed

in the

next chaPter.
 Chapter 6

Ill-health: Occupational risk factors.

odds and
Early humans used. occupational behaviour to improve survival
decreasethe experience of in-health. Atthough this is still the case in many
instances, the current complexity of occupational behaviour may conceal

focuses on identifying
detrimental effects of human occupation. This chapter
'occupational' risk factors to health and well-being' In doing so it
is in line

with public hearth conventions aimed. at the 'absence of illness' through

can be regarded as a first
preventive approaches based on known risks. As this
step in the promotion of health, it is appropriate
to consider whether
occupational risk factors can be prevented even
though they are very complex'
deprivation and
The chapter focuses particularly on occupational imbalance,

alienation as risks to health, so I analyse studies not only in health care

fields which address these

riterature but also from education and socio-political
issues. I follow this course because there is inadequate
understanding and
occupation as it relates to
consideration, as well as a lack of research, about
illness, or the prevention of occupational risk factors,
in an holistic sense'

researchers' given their

The chapter begins by exploring why public health
to
particularinterest in the prevention of illness, have paid scant attention
benefits of engagement
either the illness prevention or the health promoting
health can result
in occupation, despite the fact that a variety of risk factors to
from less than optimal balance, use, choice or opportunity
in occupation'

these, noted in chapter one'

There are, perhaps, two major reasons. The first of

is that throughout most of its recent history pubtic health has been tied'

conceptually, to medical science. The second is

that the notion of occupation

has been associated with paid employment,

rather than with the human need
 risk factors 202
Chapter 6: Ill-health: Occu

for purposeful activity as a requirement for health. These two issues

- public

health's close association with medical science, and

the limitations of the
discussed briefly'
specialty of occupational health and safety wilt be

public health,s close association with medical science is illustrated by the

,absence of ilhress' view of hearth in public health and health
emphasis on the

education texts. The topics which are most frequently addressed - cigarette
smoking, alcohol and drugs, eating habits, exercise
and fitness, stress control'

safe sex and occupational(paid employment)

hazards are clearly identified as

risk factors in illnessl. Such topics, along with issues of social

justice and

The medical view of illness

equity, are also prominent in social health texts.
is the idea which prevails'
is so pervasive that the pursuit of a disease-free state
and the difference between hetping people to be
healthy and stopping them

from being unhealthy, which are different operations, based on different

premises, is poorly appreciated. Indeed, from
my own exPerience, even most

health cafe workers concerned with social or community health appear to

as the promotion of health2' so
assume that prevention of illness is the same

dominant is this idea that 'health' is used as the

identifying descriptor for

services aimed at ill-health, such as health care,

health science' health

professionals, and even public health'

also support the

Current research priorities and health resource expenditure
with
claim that health care is dominated by medical science's PreoccuPation
illness; and that preventing
illness; that healing takes priority over Preventing

iå,,o. o,
Michael, in
of these topics but barely relates them to
Mc
economic and ocåupational environments' (Hetzel BS'
surround.ing contexbual features such as
Victoria: Penguin, 1987).
Michael r. L S f";t;;, Lifestyte and health, Ri: gwood,
all health promotion centres I have seen in
the same
2 Fo,
of information u, tî," texts noted above. Additiona
health care
type""u*ple,
they comm their field of
workers involved * p."""",i..,, I huu" found
endeavour is health Promotion'
 risk factors 203
Chapter 6: Ill-heal th:

illness takes precedence over maintaining and enhancing wellness'

For

example, there is substantial criticism that curative

and technological health
aimed at health despite
programs receive too great a Percentage of resoufces
evidence of highly developed, industrialised societies
having a decreasing

margin of return on continued. investments in conventional,

curative medical

care against the improvement of health status3. That

criticism is oftenlevelled
and
from the perspective of preventive medicine. Katz, Hermalin
Hess

suggest that

"heølth proþssionøIs andinstit lfr" iustly. ui

deaoting too much attention to curatiae
while down-playing or
-and poticy
preaentiae a

Goaernment ptannõrs aII leaels

-at relatiae neglect tf
treøtment ihteruention progro*t to the
preaentiae ffirts "4'

aPProaches to
Whilst clearly differentiating between curative and preventive
shared if those
health this suggests that health resources would be equitably
approaches were the only recipients. such a suggestion ignores other than
'absence of ilbress' approaches, and maintains public health's long time
association with reductionist, as opposed to holistic, concepts of health'
Because pubtic hearth tend.s to consider risks at population levers, it is easy to

beseducedintothinkingthatitsapproachisholistic.

The pervasiveness of 'absence of illness' approaches, exemplified by the

modern phenomena of med.ical science, such as orSan
transplants, have

created a myth that all illness can be overcome'

In fact, the Better Health
Commission of Australia suggests that we live
in a society which continues to
we can control our
foster the belief that, with the aid of modem technolog|,
wellness as our rights' The
bodies and the environment and expect health and

. ln: Oxford textbook of public heøIth' Vol' 2'

1985.
ention and health: Direction for policy and
to Better Health, Volwnes 7,2, and 3, Canberra:
86.
 risk factors 204
Chapter 6: Ill-heai th: Occu

Better Health Commission, itsetrf, has been criticised for fostering

the same
have reinforced 'healing'
belief in its detailed reccommendations. Such beliefs
,hearth' i.deologies, and confused curative medicine with health.
rather than
with such beliefs, the most logical way to promote health would be a regimen

of following medical rules such as regular medical check ups' a balanced

nutritional d.iet, adequate exercise, an appropriate amount of sleep,
and

obeying as far as possibre those mandates which

are said to decrease risk of ill-

health. In many ways the majority of public health initiatives, and how they
in the media, support the message that this is, indeed' the case'
are reported
that if whatever is
For example, the emphasis given to 'screening' suggests
it can be fixed. \¡vhilst these are important adjuncts to
wrong can be found
health, even if such rules are followed illness is not necessarily avoided, and
'health', nor, indeed, well-being, are not the inevitable reward' Although'life

style' and 'bad habits' such as smoking are blamed

for many of today's chronic

diseases6,withapparentsupportfromnumerouspublichealthstudiessuchas
insufficient to explain
the twenty year Framingham Cohort studyT, they are
on why people
who gets sick and. who stays healthy. Research concentrating
succumb to unhealthy lifestyles and habits is necessary but is rare'

at population level
Additionally, health is so complex that studies carried out
can only establish probable links. There are as yet
many unknown

determinants of illness, and even fewer of wellness'

possibilities, and the

clearly, not all risk factors have been established. other
und.erlying determinants of risk factors, need
to be studied with the rigour

applied to the study of risks already known

about' The occupational nature of

health consequences of smoking: Cancer 1982,

uilar disease!9ï3,T\rc health consequences of
. Rockville, Maryland: A report of the surgeon
ary heart diseaseatherotfuombotic brain
iaíe anatysis of some factors relnted to tlrcir
U.S. Department of Health, Education and
o. 1740-0320,1971'.
 factors 205
Chapter 6: Ill-health:

humans is one example which merits closer scrutiny, and can be seen as

having many of the same requirements as inquiry into the social nature of ill-

health. In recent vears public health has recovered the notions of

'social

beings and their

medicine, which studies the "social behaviour of human
"work and Play" in
external environment" and, occasionally, how people
some' but not
many different cultures. Whilst this type of research embraces
all, notions about occupation and' health, at least it is
now accepted that there

are "associations between much of this human behaviour and human health

trained pioneer of social

and disease"s. Douglas Gordon, who was a medically
medicine includes
medicine in Australia, suggests that the practice of social
and structures
coming to understand the motives, values, social organisations
mysteries of
of different cultures as well as the "philosophies and essential
humanbehavioursinsofarastheseaffecthealth''9.

research' This
Public health maintains a long tradition of epidemiological
type of exploration, viewed as normative by the research establishment,
empirical nature and greatly influenced by positivism, is appealing to
in
funding bod.ies. Epidemiology does not embrace the
most suitable research

methods to explore complex interactive determinants

of health, such as
motives, values, social organisations and structures of
different cultures' and
and health from
which can be applied to the relationship between occupation
individual to global perspectives. This necessitates qualitative,
as valid research tools in
phenomenological, methodologies being recognised
conjunctionwith conventional quantitative epidemiology' Qualitative
aspects from this
methodologies are well suited to exploring the occupational
restricted perspective of the
wid.er view of public health, as well as the more

relationshipbetween illness and occupational hazards' using qualitative

SGordon D.Healtlt, sickness, society: Theoretical concepts in social and preaentioe medicine'
and
Press' 1976' p'5'
éi i.,.iu,Queensland: University of Queensland
gGordon D.Healtlt, sickness, and socicty"'p'5'
 206
Chapter 6: Ill-health: Occupational risk factors

methodologies, along with critical research approaches, it is

possible to extend

both the direction and the range of exPloration to include underlying

determinants based on lon8 held occuPational beliefs and
structures'

of pertinent methods recent tendencies in the

Rather than using the variety
the limited
public hearth speciarty of 'occupationar hearth and safety' indicate
focus of public health in matters pertaining to health and occupationlO'
'occupational medicine' is, perhaps older than public health, with at
least two

and classical
texts on 'mining'diseases being pubtished in the L6th century,
texts on occupational diseases being published by Ramazzini
in 1700' and
Thackrah in r.g3r.11. The focus has historicaly been on
il-health, and the
in the BBC
current public health interest reflects this emphasis' For example'
documentary "skeletons of Spitalfields" occupational health experts
expressed

their surprise at finding that the skeletal remains of hands belonging

to

nineteenth century weavers did not display evidence of undue

degeneration as

variety of hand
a result of overuse. The altemative point of view, that the
exercise inherent in the activity may be a health benefit,
was not even

mentionedl2.

The present emphasis in occupational health also mirrors the current

societal, political and economic value given to paid
employment above other
attention in relation
occupations. whilst leisure and recreation is given some
'Life Be In It Campaign', the
to ,healthy lifestyle' through Programs such as the

3rd
lOparmeggiani L, editor. ILO encyclopedia of occupational health and safety' 2 vols'
reviseã-ed. Geneve: Intemational Labour organisation,
1983'
llAgricola (George Bauer) De re
by Hoover HC, Hoover HL' N
iheophrastus aon Hohenheim
Temkin CL, Rosen G,Zîlbootg

1.
n DocumentarY, circa 1990'
 207
Chapter 6: Ill-health: risk factors

relegates it to a much
amount of research and resources allocated to this topic
asPects of occupation are effectively
lesser status than paid emPloyment. Other
aPProaches is that
ignored or studied in isolation. The major Problem in such
paid
if the phenomenon of occuPation is not studied as an entity broader than
work the likelihood of understanding the true relationship between
is iust as reductionist aPProaches within
occupation and health lessened,

preventive medicine lessens the likelihood of appreciating interactive and

compounding factors in disease Processes'

The public health preoccuPation with risk factors of

ill-health suggest that it

may be necessary to the linkages between engagement in

demonstrate
pertaining to these are to
occupation and the prevention of illness if research
be valued and resourced by public health authorities.
A broad, contextual
might begin with
picture of the interaction between occupation and ill-health
can be seen as central
the changing occupational behaviours of humans which
next few Pages review
to changes in morbidity and mortality. To this end the
briefly the occupational history of patterns of morbidity'

fitted into a self

MacNeill explains how early hominids, as other animais,
on other forms of life' as
balancing, self regulating ecological system, preying
theywerepreyeduPonbylargebodiedorganisms,parasitesandmicro.
organisms. They were, in fact, "caught in a precarious equilibrium between

of large
the microparasitism of disease organisms and the macroParasitism
provoke acute
bodied predators". In a natural state some microparasites
achieve a
disease, killing the host; some provoke immunity reactions; others
experiences continuous' low
stable relationship with the host who perhaps
host and are the cause of disease
level malady; and yet others are carried by the
hominids' apart
in others. Yet, as was intimated in the last chapter, for early
from occasional disturbances such as drought,
fire and floods which set limits
be supposed' such as
to population imbalance, "a tolerable state of health can
 I risk factors 208
Chapter 6z Ill-health:

exists among wild primates of the forest today". within this natural scenario
genetic or behavioural
any change to one living creature is compensated for by
change in co-organisnìs. 'Undisturbed' biological evolution is a slow Process'
as well as adapt to'
but when humans began to evolve culturally, and to adapt,
the balance
different habitats by changes in their occupation they transformed
of nature and patterns of disease altered along with this occuPational
transformation. As human hunter-gatherers began to dominate the food

chain, populations increased; as they became able to overcome

cold through

use of clothing, shelter and fire they were able to expand

into colder environs

leaving behind many of the parasites and disease organisms' In new

This was
environments popurations escarated and occupations proriferatedl3-
aided by the cirumstance that in nomadic life
"the small collections of human

beings were too scattered to sustain micro-organisms which do not readily

achieve a carrier state"14'

It would seem, however, that the world's resources can suPPort only
limited

numbers of hunter-gatherers and that social strategies

to control population
probably were used15'
numbers, such as abandonment of unwanted infants
The modern assumption that life must be preserved at all
costs sits

uncomfortably with a natural ecological point of view.

In contrast, although
stability, better access to food, and' improved shelters
during the agricultural
due to starvation' as well
era reduced comparatively morbidity and mortality
as providing better facilities to nurture and care
for infants, the sick and the

aged.,low life expectancy remained the common experience because of the

increased incidence of infectious diseasesl6'
The continual development of

by
l3McNeill W]H.Plagues and people.London: Penguin Books, 1979,pp'\3'25' (first published
DoubledaY, IJSA, 7976)'
14 Dorrglas people's' Brit.ßh j.ournal of sociology 1966;77:263'
M. nopulation control in primitive
in genératzed hunting and collecting populations'
273; Birdsell JB. On population structure
Ea ol tt t ion 1958; 12t 789 -205'
15 Do.rglus M. Population control in primitive peoples"'
1987
l6Hetzel BS, Mc Michael T. L S fnctor: Liþstyle and health, Ringwood' Victoria: Penguin'
 risk factors 209
Chapter 6: Ill-health:

along
agriculture which prevented the re-establishment of natural ecosystems,
with the rise of villages, towns and cities, Provided ideal conditions for
hyperinfestations of various potential disease organisms. Throughout the

world diseases such as diphtheria, scarlet fever, malaria, typhus, smallpox'

syphilis, leprosy and tuberculosis caused ongoing morbidity, along
with

various plagues which caused periodic but devastating toll. Indeed,

the

bubonic plague, at its peaks, kilted l'0,000 people daily in Constantinople

a few
during the 6th and 7th centurylT, and in the 14th century, within only
years, between a third and a half of the population
in Europe and Britainls'

such epidemics and infectious diseases occurred because with increased

population density as well as more travel and contact from trade
diseases

leases of life.
which had been checked by generations of adaptation gained new
so did
As occupations such as oceanic exploration, trading and conquest grew,
For example,
the spread of disease sometimes with disastrous consequences.
in 1520 smallpox arrived in Mexico along with the relief expedition for Cortez,
and played a major role in the outcome of the spanish conquestle, and in
Australia, aborigines having "no racial experience with diseases such as

measles, mumPs, smallpox, chickenpox and influenza"

were devastated when

exposed to these disorders along with white settlement2O'

During most of human existence the population increase has only

been

giobal increase of
about 0.1 per cent per annum, compared with a present
approxim ate\y 2o/o per annum21. Based on what occurs in modern primitive
can be attributed to factors
economies, the small growth of human populations

lTprocopius. persian wars 23:1. History of ttrc wnrs. 5 volumes. English translation by Dewing
'Cambridge, Mass': Harvard University Press' 1914'
HB.
lSMumford L. The condition of Man, London: Heinemann, 19M and1963'
19M"N"iu w]H.Plagtes and people""p'192
2OGordon D.Health, sickness, and society"'
2lCipotla C.i.i^. Tlrc economic tristory of ruorld populations' 5th ed' Harmondsworth: Penguin'
7970.
 210
6: Ill-health: I risk factors

such as primitive forms of birth control, disease, famine,

war and high
infectious diseases did
mortality rates in infantsand childrerLzz, particularly as
not cease to be the major threat to hearth until this century.
The industrial

revolution initially provid,ed' few health benefits for the

vast majority of

people who moved to towns and cities in order

to find paid employment' In

1.780only 15% of the population in the United Kingdom, 0%

in Australia' and

5% in the united states lived in towns or cities. This had risen to 50% in the
United Kingdom by 185L, in Australia by 1'870, and
in the United States by
about \g10z3. perhaps the most obvious result of
this urban population

explosion was over-crowding in environments not

constructed for

comfortable and sanitary living, which, aggravated

by industrially-polluted
working conditions led to a widespread increase in ill-health. Eversley

suggests:

"We who liae in the trttentie

significance of Pøin, disfigurem
as a constant factor in eoery
infected and sttPPurøted -for . we
iírftations tike toothache

nsumption tf rotten foodstffi-,

as those Proaided bY bød teeth
.24

Many factors have brought about an improvement

in this state of affairs
L9th century, particularly the
including public health initiatives from the mid
improvement of sanitary conditions, water supply and housing' other social
and economic changes such as improved nutrition, smailer families' less
overcrowding and improved education, along
with maior advances in medical

22Gordon D Healtlt, sickness, and society"'p'157 '

.

23¡ones B. sleepers, wake! Technology and the futtre

of work. Melboume: oxford university
Press, t982, P'16-
24Eversley DEC. Epidemiology as soc.ial^history' [n: Creighton CA' editor'
History of epidemics

1" Briínin. znd ;d' London: ( assell' 7965' 1:35

 risk factors 217
Chapter 6: Ill-health: Occu

and pharmaceutical science have also contributed to

a decrease in disease?s'
in
Indeed,it is possible to aPPreciate Gordon's suggestion that medicine's role
and for this it
making life more bearable "is probably its major achievement
receives little credit"26'

structures
This overview of the interaction between changing occupational
a window onto a variety of
and behaviours and morbidity and mortality oPens
recurring themes. one which emerges as important
in terms of occupational

structure is population size, so it is pertinent

to consider the present trend
towards urbanisation for economic reasons associated
with paid emPloyment

aSanexamPleofapotentialunderlyingriskfactortohealth.

Although only 3% of the world's population lived in

cities as late as 1800,

centralisation of occupational efforts started

with the acquisition and
possession of land, following the adoption of agriculture' However' only a

and cities for the thousands of

small proportion of people have lived in towns
years since then, and these urban centres were
much smaller than modern
people living in them' The
cities which usually have in excess of a million
Greeks "mistrusted aggregations of rnore than 10,000 people since they
considered anything larger hard to govern and' keep healthy"' Medieval and

Renaissance cities were also small, yet are said to have been "architecturally'
satisfying social entities even
economically, and intellectually satisfactory and
mortalitY high"z7 ' This picture
though their hygiene was poor and their infant
from famity life and home
changed as paid employment became seSregated
during the past two hundred
base and urbanisation escalated dramatically
years. From roughly 1730 until the turn of this century, urban conditions were

(Ctba
25Doll R.Preaentiae nrcdicine: The objectiues in'tlrc aaltte of preuentiue medicine"
Foundation Symposium 10) London: Pitrnan'
1985
26GordonD. Healtlt, sickness, and society"'p't64
2Tcordon D.Henlth, sickness, and societr¡"'p'311 '
 21,2
6: Ill-health: Occu risk factors

appalling2s. Urbanisation has continued to rise, and

by 1980 reached' 80% in

the United Kingdom, 3l:/o in Australia, and 76%

n the United States2e'

as deleterious to health:
overcrowding itserf has been described by Lorenz
people subjected to the over-PoPulation of city
life, experience "exhaustion of
lose sight of the innate
interhuman relationships" which causes them to
friendliness and. social nature of humans which
is apparent "when their
capacity for social contact is not continually overstrained"' He argues that
"superabundance of social contacts, forces every one of us
to shut himself off
crowding of many
in an essentially 'inhuman' wàf , and which, because of the
individuals into a small sPace, elicits aggression"30.

In some cities, the inhabitants deem it wise to restrict some occupations

on a recent visit to Los Angeles I was advised that
because of such aggression.
would be a
it is unsafe to wark in the city, and that the preferred arternative
did not meet the
walking track in the university grounds. The altemative
same interest, value or PurPose as a walk to
the city which would not only

stretch my legs, but enable me to become familiar

with the environment'
its difference. The lack
a'ow me to soak up the atmosphere and to experience
of freedom to such a simple occupation was frustrating for
Pursue
t1l€'

stimulation and change

although it may be that, for many people, the constant
accompanies city living compensates for the
disadvantages3l' There
which
"provokes to activity those
may also be some truth in the claim that city living
namely the capacity to
attributes of the brain which are essentially human'
devote major resources of human endeavour
to pursuits and goals that are not

28Mumford L.The culture of cities. New York: Harcourt, Brace, 1938.

29
Jones B. Slerpers,
unke!"'p'16'
'eight & Co
3Oloren, K. Cit:ilized man's deadty sirs. Translated by Latzke M' London: Methuen
Ltd.,1974, PP.8-9,76'

e70).
 273
Chapter 6: Ill-health: risk factors

attachment to
material"32. People tend to exPress strong feelings about their
city living, or their desire to 'get away from it all', yet whether
or how changes

in the size of population grouPings affect health has not been the topic of

intensive inquiry, and I ProPose may be a major, largely unrecognised factor in

occupational imbalance, deprivation and alienation.

The next section of the chapter discusses occupational imbalance,

as a result of underlying
deprivation and alienation as risk factors which occur
determinants described in chapter five. The tyPe
of economy, national
institutions and
priorities and policies, and cultural values create occupational
but can also lead
activities which may not only promote health and well-being
to risk factors such aS overcrowdit g, loneliness, substance abuse, lack of
opportunity to develop potential, imbalance between
diet and activity' and

ecological breakdown. They can also result

in ongoing unresolved stress from
occupational imbalance, deprivation or alienation, which are risk factors in
lead to the development of
themselves, may result from other risk factors, or

health risk behaviours. These risk factors can lead to early, pre-clinical health
fitness' brain or
disorders such as bored'om, burnout, depression, decreased
liver function, increased blood Pressure, and changes in sleep patterns'
body

disability or death'
weight and emotional state, and ultimately to disease,
Figure6.1.(onthenextPage)encapsulatesthisoverview.

The first of the risk factors to be considered is occupational

imbalance'

urge to use
Balance, asa result of 'heeding' physiological messages such as the

physical, mental, social capacities or rest is seldom,

if ever, the primary concern
and within intrinsic and
of socio-cultural structures, let a balance between
achieving health and well-being'
extrinsic factors aPPears to be a key concept in
"muy
In fact, Friedman suggests that Cannon's ideas about homeostasis

32 GordonD.Health, sickness, nnd society"' p'337

 ô
Ð
É
Occupational Risk factors Early (pre-clinical) Health ID

Underlying health disorders outcome ct\

institutions and impinging on
occupational factors
activities the individual I

o
Þ

Type oJ economy, eg: Technology in dailY

Nomadic living
Agrarian Division of labour â
Industrial Employment oPPor- Ongoing, unre nla d s tr ess
e
Boredom Þ
Post-industrial tunities
from: Burnout o
Capitalist/ socialist
Occupational Depression
Þ
alienation
N ational policies ønd Priorities, deprivation
f Body weight o
î
e8:
Legislation
Fiscal regulations imbalance
J Fitness Ð

War or peace Commercial and Lack of opportunitY to

f Bloodpressure Disease o
Ë
Economic growth or materialistic infl uences develop potential
t Blood cholesterol Disability Ø

sustainable ecologY Ecology and environmen- Ecological breakdortm

J Lung function Death
Wealth/power multi- tal management (smoking)
nationals or Occupational and
self generated environmental Pollut- J Liver & Brain
function (alcohol)
communitY develoPment ants
Sleep disturbance
Overcrowding
Anxiety states
Media Loneliness
Culturaloalues, eg: Other metabolic
Occupational j ustice / equitY Local regulations Imbalance between
Dole/social services
disturbance
Views of occuPation diet and activitY
Work ethic Job creation schemes
Education Substance abuse
Individual/communal
conventions Health care sYstems
Sports / recreational
Health or healing
opportunities

FIGURE 6.1.: DETERMINANTS OF ILL'HEAXTH THROUGH OCCUPATION

N
È
 risk factors 2ts
Chapter 6: Ill-health:

well come to dominate medical thinking in the twenty-first century...as the

and as the role of

interdependence of the internal bodily systems is revealed,
harmony between t\e person and the environment is documented"33'

The idea of balance was central to the Greek view of health. Th"y believed

that illness resulted from imbalance of the four humours and that a

physician's job was to advise on due proportion, to "restore a healthy balance"

and to aid "the natural healing Powers believed to exist in every human
being"34. This was recognised in Hippocratic writings3s, and
by Plato who
espoused balance of mind and body by avoiding "exercising either body or
mind without the other, and thus preserv(ing) an equal and healtþ balance
between them". He advocated that those engaged in
'strenuous intellectual

pursuit' must also exercise the body, and those interested in physical fitness
should, develop 'cultural and intellectual interests'36. Il1
the same way,
engagement in occupations must be 'properly proportioned' so that a balance

in the exercise of individual human capacities. To this end, imbalance,

exists

in occupational therapy terms, is often taken to refer specifically to a lack of

balance between work, rest and Pluy37. (See Appendix
IV). Defining what this
is a social rather than
is is no easy task because what is considered work or play

a biological construct, and because what people

feel about, or do in, their work'

33 Friud*an HS, editor. personality and New York ]ohn Wiley & Sons, 7990, pp'7,7L'
disease.
34 Risse GB. History of Western medicine from Hippocrates-to germ thggry.-t_n: Kipl.e KF,
editor'
Cambridge university Press,
The cambridge zuorld history of httmnn disease. Cambridge:
7993, P.l1'.
35 nippã"ratesRegimen. ln: Hippocratic Writings: on .Ancien.t Medicine. William Benton,
Britannica, lnc'' 1952' This
Publisher, Great Books of the Western Worlð Encyclopaedia
conducive to health
contains a prescription of diet and lifestyle
36 pluto. Timaeus.Translated with an intoduction by Lee HDP. Penguin Classics L965, pp'116-
117.
's view of balance see: Meyer A' The philosophy
tional therapy !922;L:7-10. In:The American
639-642; Levin HL' Occupational and
ryational therapy and rehabilitation 1938;77:
ment and indiviàual. The American iournal of
work and leisure in
occupntional therapy 1984; 38: 29-.34;Marlno-Schom JA. Morale,
retirement, ehysiiaí"and ocuryntionnl tlrcrapy in geriatricslgS6;4:49-59; SpencerEA'
of héalth and welhress' Ocutpationnl thernpy
Toward a balance of work and play: promotiõn
in henlth cnre 1989;5:87-99'
 2a6
ch 6: tll-health: Occupational risk factors

rest or play differs for everyone. The evolutionary PersPective and health
focus of my theory suggest that imbalance involves a state
which occurs
meet their unique Physical'
because people's en8agement in occuPation fails to

social, mental or rest needs, and allows insufficient time for their own
for the occuPations each feels
occupational interests and growth as well as
obliged to undertake in order to meet family, social and community
commitments.

follows, from the standPoint of my theory, that imbalance will

therefore
It
differ for each ind,ividual, just as their capacities, interests and
responsibilities

d,iffer, and, that imbalance can be viewed as a factor in disease Processes' For

example, in terms of infectious diseases, when "our responses to problems in

life are excessive or deficient,...the balance is upset between us and

our resident

pathogens" because "the central nervous system and

hormones act on our
abet diseat""38; and
immune defences in such a way that the microbes aid and
imbalance can be
in terms of the so called lifestyle disorders of the present day,
a cause of the production of "excessive stress hormones - cortisol and

catecholamines, which can lead to artery damage, cholesterol buildup and

and ill-
heart disease"3e. From this point of view, physiological imbalance
with, the vicissitudes
health, result from individual responses to, and coping
of everyd. ay \ife, which are closely tied to people's engagement in occupations'

Contemporary occupational structures, and the social

environment and
provide people with
political agendas which support these structures,may not
use of capacities'
opportunities for health enhancing, balanced yet stimulating
because occupational value in post-industrial cultures (and many other

cultures striving to emulate post-industrialism) usually centres around paid

See also:
38
¡ustice gets sick: Thinking and healt¡. Texas: Peak Press' 1987' pp'28-29;
B.Wo
Wolf S, Goodell H. Beluaioural lcience in ctinical
medicine' Springfield,Ill.: Charles C'

Thomas, 1976'
39]ustice B.Who gets sick...pp'3L-32; See-also Price VA' Type A behaaiottr pattern:
A model for
Press' 1982'
resenrclt and þractice' Nãw York: Academic
 2t7
Cha 6: Ill-heal th: Occupational risk factors

employment. Within Paid emPloynÌent there is little commonality in

physical, mental, social and obligatory requirements or oPPortunities
for

choice, so, for the majority of people, engagement in other occuPations is

necessary, in most instances, to ensure that all caPacities are exercised
and

balanced to a point equating to health and well-being' However'

a limited
understanding of this concept of balance suggests that it is chance, rather than
design, which leads to balanced lifestyles'

In part, this is because massive and rapid changes in society result in

people are
ongoing alterations to use of capacities' For example, on the whole,
no longer required to undertake either sustained or substantial physical
exercise. Th"y undertake it at will rather than for necessity. This contrasts

marked,ly with the situation which existed until fairly recent times a0' Very

few mod.ern people would run or walk for several hours every day,
as early

humans did, despite considerable media exPosure to the claims

that exercise of

sufficient vigour and regularity is protective of cardio-vascular disease

and

conducive to general well-being. Lack of physical activity

and coronary heart

disease is as strong a risk factor as increased blood Pressure,

smoking and high

levels of cholesterol, and adults who are 'inactive' are twice as likely to die
from cardio-vascular disease than those who are 'very active'41' Commonly
accepted standards about what this protective level of
fitness entails is

vigorous, repetitive, rhythmical activity such as walking, running,

swimming

or cycling, for at least 20 minutes, 3-4 times a week42' In Britain,

the United

States of America and Australia, less than half the adult population meet that

40Hetzel BS, McMichael T.L nd health"'p'186'

,,aigororts physicnt actiuity w ¡fe for moit people, at home, at zuork and in
transit betuteen them. Eaen hrr*nn mttscles proaided ,up t9 ^9ne-thitd of the
is less than 1'/o; tlrc human
energy ttsed by ,o,rk hipr, fnctories and farms.
Tolay
.tlrc fig,ure
workplace", w\th physical activity
body is becoming redundant as n source'of energy.in-th.e
i-,"íi"gVecomel'Uiiily a recreationat option lather ttnn a suraianl
necessity"'

4lpowell KE, Thompson pD, Caspersen C], Kendrick jS. Physical activity and the incidence of
.áro^ury ireart disease. Annuit rsuieu of prblic health7987;8:253-287.
42 American College of Sports Medicine. Gtúdelines for exercise testing and prescripfion '
4th ed'

PhiladelPhia: Lea & Febiger, 1991'

 218
Cha 6: Ill-health: O risk factors

standard, with women less likely to engage in physical activity than

men4144,4s,46. Whilst the Australian goverrunent is implementing Programs

within schools which actively encourage women to ParticiPate in spotÚ7,

Green, Hebron and Woodward suggests that women give a different

meaning

and structureto leisure which rePresents to them time for relaxation and a
physical and mental rechargit #8. As meaning and structure can be leamt, a

change of societal emphasis, values and opportunities may result in women

becoming more interested in sport as a leisure or work occupation'
In fact,

Boutilier and sanGiovanni report a dramatic increase of women's

as a result
participation in sport in America since the seventies, which they see
emphasis on
of both the feminist movement and "the emergent mid-century

physical fitness"4e.

'occupational' health
The protective effect of vigorous activity is part of the

mechanism of biological evolution. The protective effects include

43Hetzel BS, Mc Michael T. LS factor: Liþstyle and health.... pp.186-I87',

aged 25-64' hßIf of the men
In a 1983 Australian survey of.'ínpproximottty aooo study subje.cts
the leael xfficient to maintain
7nd- two thirds of the women iirely or nlaner exercised.'.at
heart-lung endurance fitness"
44curp"rr"n CJ, Christensen GM, Pollard RA' S rse

objåctives - Evidence from NHIS 7985' Public of the

In the 1985 American National Health lntervi icine'
men exercised according to a level recommen
45Blaxter M. Health and Lifestyles""
solely as a leisure time
In the Blaxter study in the'united Kingdom which defined exercise
reported no vigorous activity'
*li"iry, 63% ofrr,ui"r, and'69% of females
46

leisure pursuits, such as spor! than females

reading and craftwork as well as some sPor
47o"purår"nt of Sport, Recreation and Tourism, Annual Report, L985/86. Canberra: Australian
Góvemment Publishing Service, 1986'
4gcr""r,E,HebronS,Woodward.D.Women's leisrtre in Shffield: A research report' sheffield
odward D' Womens
ó"!urt*"nt of Afplied Social Studjes' ]'987;
Ieiiure. What leisure? London: MacMillan
4gBoutilier M, SanGiovanni L. Women and spo nd policy' In: Lewin E'
olesen V, editors. Wo nten, lrcnltlt nnd healing: Toward
a neu perspectiae. New York:
Tavistock Publications, \985, p'209'
 risk factors 219
Chapter 6: Ill-health:

strengthening of heart musclesO, increased production of Protective HDL

cholesterolsl , reduction in triglyceridess2, reduced blood Pressures3, improved

glucose metabolisms4, increased resting metabolic rate, maintenance of
weight

loss55, and reduction of fibrin stickiness (and therefore the formation of blood
clots)s6. Apart from cardio vascular disease several studies have shown
the

protective effect of physical activity against osteoPorosis, some cancerssT,

anxiety and d,epressionss. However, as Kaplan, Sallis and Patterson suggest
',the study of physical activity as it relates to health is in its infancy" and it is

difficult to estimate and measure as most studies use different criteria to define
physical activity, or describe and quantify it's many variationsse. Apart
from

gend.er, many studies have also found differences between

grouPs according to

age, ethnicity, socio-cultural status, education and paid employment60'

50Bhi. SN, Kohl HW, bons LW' Physical fitness

women' lournnl of the
and. all-cause mortal
Haskell wL' |ohnson fL'
American Medical
wrrut"y FS, criqui MH, Sheps DS. Physical fitness as a predictor of cardiovascular mortality
journal of medicine 1988; 319: 1379-1384'
in asyirptomatiË North Ameiican men. Neø England
S1uurt"tt i,trl. Ex"rcise induced changes in plasma lipids and lipoproteins. P-reaentiae
pp]Uastätt V\trL, Blair SN, Williams PI, Krauss RM' Lindren
medicine 1984; L3:23-36; Wood
fi, etU"., JJ, Ho PH, Farquhar ]W. lncreased exercise level and plasma lipoprotein
concentratio.,rr I o.á-y"ar'randtmised study in sedentary middle-aged men' Metabolism
\983;32:31-39.
S2rupur, RM, Sallis ]F, patterso¡TL. Health and human behaaior. New York: McGraw-Hill
Inc, 1993.
-Davis K. Study of coronary risk factors
medical iournal 1975; 5982: 507-509; Siegel
e prevention and treabment of hypertension'
0.
S4vranic M, Wasserman D. Exercise, fitness and diabetes. In: Bouchard C, Shephard RJ,
and lrcaltlt: A concensus of
stephens T, SuttonlR, McPherson GD, editors. Exercise, fitness
Human Kinetics, L990, pp.467-490.
cuåent knowledge. Champaign, Ill.:
The
SsEpstein LH, Win; RR, Thompson ]K Griffin W. Attendance and fitness in aerobic exercise:
4: 465-479'
effects of contract ur,á lott"ty procedures. Behaoior
modification 1980;

56 Haskell WL, Leon AS, Caspersen CJ, Froelicher VF, Hagberg VF, Harlan lM,
¡t.al
benefits unã urr"rr*ent of physical activity and fitness in adults' Medicine
Cardiovascular
and science in sports nnd exercise!992;24:5207-220'
S7culub."r" LH. Exercise, immunity, cancer and. infection. ln: Exercise, fitness and health: A
consenslß of current knowledge' 'pp'567-579'
S8st"ph"ns T. nhysicat activity and mental health in the United States and Canada: Evidence
f.o.., ¿ population surveys' Preaentiae medicine L988;77:'
35-47 '

59 fuptur, Rlut, Sulli, JF, PattersonTL. Heolth and lutmnn behnuiour"'p'350'

science in
60 s"e for example, Gilliam TB, Freedson PS, Geenen DL, Shahraray B. Medicine and
CC' A descriptive
;i;r;t and eiercise 1981; 13: 65-67; Stephens T' 11t9!.D\'White
Ptfulic IrcaIt¡ reports 1985; 100: 147-158;
.ipiá"*iof"gy of leisure time physicaf activity'
 risk factors 220
Chapter 6: Ill-health:

All of these factors relate to differences in occuPational behaviour: simply

recommend.ing an exercise regime which meets Pre-determined health

criteria

is not effective for everybody. Physical activity in the Past met many other
occupational needs and societal values: what is recommended to
replace

'superseded' occupations in the present age has also got to meet the ever

changing needs and values of humans occuPational nature in the future'

Instead, in a reductionist way, and counter to the notion of 'balance', the

expenditure of physical energy, its components, and the specificity

of each to

perceived health functions, have been put under the microscoPe,

and people

are now given reductionist advise on aspects of physical activity

which are

deemed to be 'good' or 'bad'for selected issues' For example,

the American

College of Sports Med.icine makes a distinction between physical activity for

'fitness' or for 'health61, and 'fitness' has been similarly divided by the
Dance, into
American Alliance for Health, Physical Education, Recreation, and
,,motor skill related, fitness" and "health related fitness". In the latter:

"components appear to be deaelopment of,

heøI
cardioaøscular-ie'spiratory of a!
- .-.optimal
body weight, nnd the deaelo flexibility
musculør strength and endura the preaention of
62
low back injury and Pain"

Whilst the research which provides the basis for such division is valuable,
it's presentation in both professional and popular media leads to the
assumption that other types of physical activity are of less vaiue'
It is hardly
the physical
surprising that people hearing this type of rhetoric do not equate
with their
activities of daily iiving, nor more general occupational behaviours
people over the
health. In a retrospective study conducted in Adelaide on L00

shea s, Basche cE, Lantigua R, weschrer H'

-ffiiäåîT:l#::ti,llTJi,X1,åï:'lt
aentiae medicinelgg|;27:201-217 King AC'
, Marcus PM, Oldridge MD, Paffenbarger RS,
ysical activity and interventions in adults'
992;24: 5221-5237.
6lArnerican College of Sports Medicine. Gttidelincs for exercise testing and prescription""
62wiiliams M:H. Lifetim; fitness and zuellness: A personal cltoice' 2nd ed' Dubuque: Wm' C'
Brown Publishers, 1990, P'9'
 22'L
Chapter 6: Ill-health: Occupational risk factors

age of sixty, it was found that the maiority of the samPle did not associate their
of
life,s occupations with their health63. This finding aPPears to be indicative
a 'medicalised' understanding of health by the general public' which is'
and the
perhaps inadvertently, being reinforced by health education strategies,

media.

This modern reductionism can be contrasted with the holistic nature

of
were part of
hunter-gatherer lifestyles in which physical activity and nutrition
an ecological healthy 'whole'64. In the present day weight gain and obesity
are

common health concerns in post-industrial societies and many

widely

differing circumstances associated with occupation affect the prevalence

of
diets there is
weight disord.ers, yet in the multitude of articles and texts about
as closely related'
scant reference to the need to consider diet and occupation
For example, although it has been estimated that an individual, Per t21
pounds of body weight, will expend. approximately 1"5 calories Per minute
employed as a typist, in contrast to 3.5 if engaged in domestic
work, nutritional

intake seldom varies when occupations change, with a resultant

imbalance

between energy input and output'6s'

It is often the small percentage of people who are committed to physical

of how their food
exercise regimes, and 'physical health' who are very aware
to breakdown
intake affects their occupation. Flowever, even these are subject
reported that
of health because of imbalance. For example, it has recently been
fitness and well-
arthough athletes generally experience a high rever of physical

63 wilcock AA, et ar. Retrospectiae sttñy of elderly peoples'- perceptions o! t\e relationship
"htoíth.
between their lifes àri,,pLrø"t ona Univeisity of South Australia: Unpublished'
1990.
64King-goyes MlE. patterns of aboriginal cttlture: then and now. Sydney: McGraw-Hill Book
CompanY, 7977. PP' 17,755'
Human nutrition and
65 S"", io, á*u*pt", Þurr*o." R, Eastwood ly''A. Dauidson and Passmore,
are according to the obesity index
dietetics. Edinburgh: Churchill Livingstone ,7986; Grades
obesity seriously'^Edinburgh:
based on the u,r" .iio w /f, devised by Garrow lS.Trent qnd obesity: Causes' fallacies'
Churchill Livingstone , 1987; Hafen BQ, editor' ouerweiglrt
treatment' Umñ: Brigham Young University Press' 1975'
 222
Chapter 6: Ill-health: OccuPational risk factors

being, they frequentry suffer some form of breakdown of health at

the time of

major competition. Evidence about the cause of pathophysiology of such

overtraining syndrome is limited, but it has been suggested that the stress of

training can cause depression and decreased immune function66' This

gives

performance in
rise to the notion that too much exercise, taken to reach peak
lead to
this case, is detrimental to health as is too little exercise, which can
with
atrophy of body tissue and organs. Kenneth Cooper, who is credited
trigger the
coining the term 'aerobics', now suggests that ovef-exercising can
many life style
over production of free radicals which could be linked with
disorders, and even d.eath67. Indeed, from a study of cases of
sudden death

d.uring exercise, siscovick, weiss, Fletcher and Lasky found that

the risks of

death during exercise are increased by 700o/o, despite men who exercise having

half the death rate of those who do not exercise6s. Moderate, rather
than

strenuous exercise is now being seen, by some, as a more

sensible physical

fitness regime, and this recommendation fits in well with notions about

occupational balance.

Despite this changing view, another aspect of balance between

activity and
'sleep' research discussed in
rest, is also poorly und,erstood, even though th"e
when the
chapter three points to them being part of the same continuum.
,natural, balance between active and rest occupations is considered (apparent

from studies of more primitive cultures) it would seem that artificial

constructs such as the eight hour duy or five duy week
have little to

recommend them. Within these constructs people are engaging in activity for
'temporal' reasons. There is a lack of
socially, economically or potitically based
understanding of how biologically based temporal rhythms impact uPon
occupation, and on occupation's relationship to ilþhealth, despite studies

66 BudgettR. overtrainingsyndrome. British jotrnal of sports medicine799\; 24(4):237-236'

67 cooã". K.Dr Kenneth Coopers antioxidant reaolution. Melboume: Bookman,1994'
68 Siscovick DS, weiss NS, Fletcher RH, Lasky T. The incidence of primary cardiac arrest
311: 874-877'
duringvigorous exercise. New England journal of medicine1984;
 223
Chapter 6: Ill-health: Occupational risk factors a

which have found that shift work which disrupts sleep-wake Patterns, can lead
to irritability, malaise, fatigue, stomach comPlaints, diminished concentration,
diminished functional capabilities, mood changes and increased suscePtibility
to accidents69.

evolutionary terms rest between actions aPPearS an early survival

In
mechanism. From personal, close and ongoing observations of habitual rest /
activity patterns of domestic animals, I note that much of their time is sPent
in

rest and. watchfubress. This is contrasted with periods of intense activityT0.

I

suggest that this biological balancing function serves a survival purpose

whereby energy is conserved and stored during resting, whilst the

watchfulness informs, so that the animal is ready for action should

a need

arise. The watchfulness remains as a dominant behaviour, although it's

original survival function is obscured under the social-cultural guise of

entertainment or 'sticky-beaking'7t. Whilst assuming that humans retain
vestiges of the resting mechanism, Hetzel and McMichael suggest that,
for
although contemporary western society "has largely eliminated" the need
a natural means of resting tired limbs or
"recreational inactivity (as)
conserving hard won energy...the instinct for it remains"72. This
may, in

some way account for the often expressed desire of people 'to stop working''
'to
'to go for a holiday', 'to have a rest', 'to retire if they could afford to do so',
be anywhere other than at work", and that society's arbitrary temporal
constructs and constraints are counter to biological activity pattems'

169-
69 with

ork
and stress 7988; 2: 139-153'
70ð,r.n our"rvation has, during my adult life, included six dogs, a cat, two goats, four lambs, a
bantam hens'
cow, three calves, about 100 fan tail pigeons and innumerable
71 AnAustralian slang term for minding other people's business'
72 ljetzel BS, Mc Michael T. L S factor: Lifestyle and health...p.186.
 224
Chapter 6: Ill-health: Occupational risk factors

Late in the evolutionary chain, as human caPacities increased, the need

to

keep more diverse 'intellectual' capacities exercised for when they were
required, demanded changed, increased and more flexible activity Patterns'
These activity patterns were superimposed on, and integrated
with the older

activity rest rhythms. These Patterns often comPete, and inactivity or

/
'top of the hierarchy'
passive activity, which seldom provides for the newer
needsfor satisfaction, PurPose and meaning, can become the easier oPtion'
For example, watching television is one of the most common
'resting'

occupations of present times, and Kubey and Csikszentmihalyi

found that it is

universally reported as involving practically no challenges and no skills, and

the low level
does not provide 'flow' experiencesT3. Csikszentmihalyi suggests

of energy expenditure may be a factor in it's popularity, along

with the notion
,,a mismatch between opportunities and abilities leads to a progressive
that
atrophy of the desire for new challenges"T4. I suggest that it is modern
'watchfulness' during which time people learn about and reflect on
their

world for similar survival reasons to earlier times. In combination

with this,

choice passive, 'unsatisfying' and what are frequently described as

of
for those
unhealthy pursuits may be a particular, but unconscious, problem
do not
who, because of early deprivation, or lack of learning and opportunity,
develop their innate capacities and potential, and need to
be more watchful'

As well, in present occupational structures, the amount of time

people have
needs in terms of
available for restful occupations may not meet their overall
are obliged to
biological balance, because amongst other factors, many people
That is' there is
utilize their mental capacities differently than in earlier times'
probably a decrease of time and opportunity for intellectual
or spiritual
routine, but demanding
reflection, and much more time required to attend to

73 Kubey R, csiksentmihalyi M. Telsaision and the qual Erlbaum, 1990'

See also Csiksentmihutyi fU, Larson R, Prescott S' The ivity and
experience. ¡ournni- if'youth nnet- adolescence 1977;6:2 Television and
*"ãiu in adolescentlife- Yottt¡ and society 1983;15:13-31'
music: Contrasting
T4csiksentmihalyi M. Activity and happiness: Towards a science of occupation. lournal of
ocuryational science: Austrnlin7993;l(1):38-a2'
 225
6: Ill-health: Occupational risk factors

paperwork which has to be fitled in for work, social security and taxation

purposes. For many, this is stressful and a common comPlaint

is that PeoPle

lack energy and. are tired by the mental and social demands of
their

occupations. So spite of widespread dissemination of information that

in
many people still
sedentary lifestyles jeopardise long term health and survival
imbalance between
choose sedentary occupations for their leisure time, and
physical, mental, social and Iest occupations is an ongoing
occurrence'

I,,-tggz,with a small grouP of student researchers from the Adelaide

School

of
of Occupational Therapy, I undertook a pilot study to explore perceptions
occupational balance and its relationship to health. using
a cluster sampling

method and with 146 respondents the results indicated that,

for many, ideal

occupational balance is approximately equal involvement

in physical' mental'
was found between the
social and rest occupations. A significant relationship
perceived by the respondent
closeness of current occupational patterns to those
IV)
to be ideal, and their reported health' (See appendix

awareness of the
The arbitrary dividing of occupation impedes the conscious
and obligatory occupations
need to balance mental, physical, social, rest, chosen

as integral aspects of health. For many people,

lack of such balance results in

boredom or burnout. Boredom is the most common emotional response to

emotional response to
lack of occupation and. burnout is the widely reported
and burnout are
over stimulation, and too much occupation. Both boredom
forms of stress which have been tinked with ill health.
whilst overload has
aS a cause of illness' if
received more attention than insufficient occupation
"highly conditioned
enefgy systems are not used they deteriorate. Both
detraining" and people who
endurance athletes who go through a period of
are bedridden experience huge "decreases in the oxygen
energy system in
 226
Chapter 6: Ill-health: Occu pational ns k factors

immune
relatively short periods of time"75. This phenomenon can decrease
responses, and increase susceptibitity to i[-hearthz6.
In parallel, and probably

associated with the opposite of boredom, more than ten studies have
demonstrated that physical activity has a protective effect
against certain

cancersTT

Sobel and Omstein assert that "the brains mechanism

for adaptation can be

overwhelmed and britzed by too much change and chall€nge"78

but that "a
"to maintain its
certain amount of stimulation and information" is needed
organisation. TheY observe that:
"øs the brøin eaolaed, its nbility to
høndle the usorld became
increøsingly comprehensitte. ...The pøradox that øs the humøn is
brain matures ànd dettelops it
both enormously. increases it's
olitity to out new things ond,-..2! the søme time' deaelops øn
find
enormous capacity for getting bored"Te'

that "it is the

Ardell claims that "boredom is the arch-enemy of wellness" and
leading cause of low level worseness"' He argues that
it can be held
responsible for health-risk behaviours, such âs, smoking,
drug and alcohol
associated with potent
abuse, and "a failure to take the positive initiatives

lifestyles"so.

and bumout
There are many reasons for the apparent increase in boredom
societal Pressure to pursue
caused by occupational imbalance. This includes
the apparent need
particular occupations which may impose uPon individuals

T5Williams MH. Lifetime fitness and wellness:"'p'27

editors. Biotogical foundations of cerebtal
ress, 1984 ; Andervont HB. Influence of
Na 579-587;
ork: erberg J,
mental
, ßs-îå;.
77culubr"r.LH. Exercise, immunity, cancer and infection' ln:Exercise, fitness and health: A
consenslß of utrent knowledge"'pp'567-579'
78 Omstein R, Sobel D. The healing brain, a radical new approach to health cnr¿ '
I-ondon:

MacMillan, 1988, P'207'

TgOrnstein R, Sobel D. Ttrc heating brain"" pp'207' 214'
80 Ard"u DB. High leael uellness. 2nd ed. Berkeley, ca.: Ten speed Press, 1986.
 risk factors 227
Chapter 6: Ill-health:

to d.o more than they are caPable of, or to do less than they achieve Personal
satisfaction from. ornstein and sobel suggest there is an optimal set point for
stimulation "in the middle of an organism's resPonse level" maintained
,,through feedback processes similar to the homeostatic mechanisms of the
body',, and that when there is either "too much or too
little, instability results

and disease may follow"81. Similarly Csikszentmihalyi has found

that an

optimal state relating to health and well-being occurs when

individuals are

challengedby their occupations, and have the personal capacities to meet the
challenges2. If this does not occur ill-health may be a consequence'
These

views support the 'needs construct' described in the last chapter'

until the industrial revolution, as Jones observed, "labour/time-absorbing

emproyment was the norm in human experience"s3. In earlier times many

people grew or made most of the products they required

by virtue of both
and mastering skills
physical exercise and creative endeavour. By practising
from beginning to end they were able to utilise their capacities
to the extent
a sense of
that each felt comfortable and as a consequence benefited from
achievement, satisfaction and well-being, which assisted
their resistance to

disease and illness. This allowed a more cohesive

perspective of occupation

which, it is argued, enabled greater awareness of too much

or too little exercise

of capacities. However at times of environmental crisis or

ecological change

when the challenges became too demanding, despite this more

holistic

As sigerist suggests:
awareness, susceptibitity to disease would have increased.
maY become a chief cause
it, when it is too hard,
when it is not ProPerIY
or when it is Performed under

D. The lrcaling brain"' pp'213-217'

81 Ornstein R, Sobel
82 Crik"""nhihalyi M. Flow: The Psyclrclou ()f optimal experience' New York: Harper and
Row,1990.
83
Jones B.Sleepers, wnke!-.- P.83
g4iig"rirt HE. ¿ ltistory of medkine,.v:!,. ,, primitiae and nrchaic medicine. NewYork:
Ox'ford University Press, 1955, p'254-255'
 228
Chapter 6: Ill-health: Occupational risk factors

Apart from individual experience of imbalance, there is an imbalance in

health opportunities through occupation throughout the community, between
the haves and the have nots; between the rich and the Poor; between the
informed and the illiterate; and between the employed and the unemPloyed'
This imbalance is becoming a cause for concem to the extent that it is a
common topic of conversation in many community venues, and is being

ad.dressed in popular med,ia. For example 'The Weekend Australian'

newspaper, dated April 8-9th, 1995, devoted more than a page to an article

addressin gThe øge tf oaefwork. This presented evidence from several major

post-industrial nations to suggest that many people in paid emPloyment

are

now expected. to take on increased duties, to spend longer hours on

work tasks

without extra rewards, and that health breakdowns from this cause are

a double
increasingss. Women are particularly at risk as they often undertake
role of domestic and paid emPloyment occuPations.

This is the case not only in post industrial societies. Barrett and Browne
assert that African women have a triple workload, as
biological, social and

economic producers, which is deleterious to their health86, and Ferguson

found, that women in a marginal area of Kenya experience stress-related ill-

health because of the demands of their many occupations, as
well as poor

nutrition, high fertility rates and limited access to health care87'

At the other

end of the spectrum is the rising numbers of unemployed with

decreased

Inequities of
opportunity for engagement in satisfying and valued occupation'
this type cause not only individual illness but community disease'
This

disease is compounded by the present day need

to adapt and cope with an ever

If individuals need
changing social, occupational and ecological environment'

overwork. Tfte Weekend Austrnlian reuiew' April 8-9' 1995' pp'2-3;

see
85 Gure S. The age of
decline of leisure' New York: Basic
also schor J.TIrc ouenuorked American: The unexpected
Books, 1991.
86 Barrett HR, Browne A. Workloads of rural African women: The impact of economic adjustment
1993;1'(2):3'1I'
in Sub-Saha.ur, Atico. lorrnal of ocuryntionnl science: Attstralin, November
87 F"rgUron A. Women's health in a marginal area of Kenya' Social science nnd medicine 7986;

23 17-29.
 229
Cha 62 Ill-health: Occupational risk factors

to have some degree of stability for the human system to remain healthy, there
could come a time when maintaining the balance between development,
particularly occupational development, and physiological processes
is a major

issue in health.

Despite affluent societies having an abundance of occupational choices

which

offer opportunity for the exercise and development of physical, mental and
social skills, the structures, material costs and values placed
uPon different

aspects of occupation may well affect how successfully

individuals access these

opportunities. People may also be restricted in their choice by factors

as

because the
various as time, lack of resources, lack of awareness or, perhaPs,
focus of their occupations aPPeaf irrelevant to survival, health or well-being'
such obstacles can cause occupational imbalance because of occuPational
deprivation which I will now consider as another major risk
factor'

that
Deprivation implies the influence of an extemal agency or circumstance
The external
keeps a person from "acquiring, using or enjoying something"sS'

agency or circumstance which causes occupational deprivation may be

technolog/, the division of labour, lack of emPloyment opportunities' poverty
imposed by
or affluence, cultural values, local regulations, and limitations
sociar services and education systems, as werl as
ill-health and disability.

Familiar examples spring to mind, such as the person confined

to bed and

wheel-chair because of physical handicap, the reluctant

retiree' numerous

individuals engaged. in 'carer' duties, the school leaver or middle

aged process

worker unabre to find paid emproyment or the ronely, battered

child with little

access to toYs or stimulus'

doing because of
Infants deprived of the opportunity of learning through
lack of sensory stimulation within their environment, fail
to develop

88 D"prirr". Ftmk €t Wagnall's Stnndatd Desk Dictionary,Yol1A-M USA: Harper & Row,
Publisher Inc., 1984, P'772
 230
Chapter 6: Ill-health: Occupational risk factors

normally or to all types of biological and social

thrive8e,e0,e1' Indeed'

d.eprivation have been associated with failure to make use of occuPational

with dysfunction in adolescencee4' Il:l
opportunitiesg2, poor healthe3, and
extreme examples where children have been left alone in almost
emPty

have failed to
rooms, and Provided with only food and a place to sleep they
develop even basic occupational skills of walking and self care. The
classic

example of child deprivation is the 'wild boy of Aveyron'

who appeared from
probably' at
the woods of Caune, in France, in the late eighteenth century, after,
least seven of his twelve years living alone. Despite five years
of experimental

education by Jean ltard. he never attained normal language

or robust health'
is provided
although he did develop in many wayses. A more recent example
by the prolonged deprivation experienced by children in Romanian

orphanages, in which "every child who has been in these institutions for six
months or longer has significant developmental delays"e6. ln a
pilot study

exploring the effects of sensory deprivation, and the changes

that can occur
to be
following enrichment of the environment, infants were initially found
'deficiency' categories of the
functioning at a level between the 'at risk' and

GilfoYle EM' GradY

89 Literature w
Short MA' Vestibular
AP, Moore I
stimulation mplications ' Physical
:135-152'
and occuPat
90 So*" institrrtions provide a depr r D' Failure to
ln: Drotar D'
thrive and prevenúve mental hãa
editor. Niu directions in faittre \\i;t ¿i.'ovence

ther aPY 7959;26 123-127 '

92 Mackie A. Social deprivation and the role of psychological services' Educational
and child
psy chologY 1992; 9(3): 84-89'
93 To*rrr"r,d P, Simpson D, Tibbs N. lnequalities in health.inthe city of Bristol: A.preliminary
Internafiànal journal of heatth seraices 1985;15(4): 637- 663'
review of statistical evidence.
94 Mechanic D. Adolescents at risk: New direc;i ons. lournal of adolescent health 199'l';12(8):
638-643.
problem of
95 ltard |. Thewild boy of Aveyron. In: Malson L, editor. WoIf chitdren nnd the
lutmai natttre. New York: Monthly Review I ress' 7972'
g6 ln: Brooke Foundation Anrutal Report'
Bur.orr, B. program suÍunary, projects and descriptions.
Washington, DC: Brooke Foundation' t993' ç'12'
 risk factors 237
Chapter 6: Ill-health: Oc

total 'Test of Sensory FunctionseT' Following a six month Program within an

enriched environment children improved in all but 'adaptive motor

functions'98.

Another group of people who experience extreme occupational deprivation

are prisoners of war. The importance of finding meaning
through occupation

is one factor in the survival odds of prisoners' For example, Dimsdale

in a
identified
study of the coping behaviour of Nazi concentration camp survivors
purpose as essential to those who survived. One of his subjects
focussed on

"whefe I could find a blanket, something to chew, to eat, to repair, a tom shoe'
an additional glov""ee, and Frankl, an existential psychiatrist, about his own
concentration camp experiences, observed that mortality rates
were highest

amongst those unable to find purpose1O0. Prisoners in

jails often face similar,

if not so extreme, states of occupational deprivation which has been linked

with both community and individual disorders such as prison riots101 and

schizophrenialo2, as well as suicide whilst in custodyl03' Supporting

the link

between lack of purposeful occupation and ill-health is

a longitudinal study of
over a period
long term prisoners which found. the opposite to be the case as,
in a
of seven years, the prisoners being studied became increasingly involved
variety of occupations which led to decreases of dysphoric emotional
states,

incidentsloa'
stress related medical problems and disciplinary

infants (TSFI) Manual. Los Angeles:

9T D"gangrGA, Greenspon_Sl. Test of ^sensory functions in
Western Psychological Services, L989'
98 Haradon G, Bascom B, Dragomir C, Scipcaru V' Sensory functions of institutionalized
Romanian infants: A pilot"study. occiryatioul therapy
internationallgg4;1:250-260.
99Di*rdul", jE. The coping behavior of Nazi concentration camP survivors' Amerícnn journal of
p s y ch i a t r Y 797 a; ß1(7): P'795'
f00i.ur,¡1 yU. ¡ønn's search for menning. Boston: Beacon Press, 1962'
101 gr""* B. Disorganization and the New Mexico prison riot of 7980' American
sociological

reaiew 1985; 50(5): 6n-688'

102g¿¡1s HN. L'isolement carceral (Isolation in prison) English abstract of Perspectiaes-
p sy chia t r i q u e s 1989 ; 28(19): 252-255'
1993; 77(5):381-409'
roe ¡1"61¡9 Suicides in young prisoners: A summary.Death studies'
A.
104 2u*61" E. Behavior and adaptation in lon; term prison inmates: descriptive longitudinal
."r.rttr.Criminalirtsticeandbelnaiorlgg2;19(a):409-425'
 232
Chapter 6: Ill-health: Occup ational risk factors

Many people experience reduced occupational oPtions because they are

deprived of paid employment and may, as a result, have reduced oPPortunity

in
to use physical, mental or social caPacities and may thereby suffer a decrease
health. However it would aPPear that there may be more than this simple

explanation to consider. one important characteristic of paid

employment at

present, noted in the chapter on occuPational evolution, is the

value placed

upon it by society, which is probably as great as skill in obtaining the

In
requirements for sustenance would have been among hunter-gatherers'
other words, significant work will be more conducive to mental
and social

health and, well-being if it involves both meeting a primary urge and

complying with societal values. Lack of significant work
may cause mental
because of the
and social ill-health, which can result in physical illness as well
integrative nature of the nervous system. Research data seems
to support that

decreased health status is linked with unemployment.

Richard Smith's summary account suggests that unemployment

and poor

health are strongly associated, that unemployment itself causes

some illness'

and that health problems are compounded by unemployment; that the

povefty, low socio-economic status, poor education, and housing
conditions'

cause difficulties
associated frequently with both ill heaith and unemployment

in clarifying the strength of the associations; and that unemployment is also

associated with high divorce rates, child and sPouse abuse, unwanted

perinatal and
pregnancies, abortions, reduced birthweight and childgrowth,
for none of the
infant mortality, and increased morbidity in families, though
associations can it be assumed, that unemployment itself is the causelOs'

smith is supported by many detailed studies. About a fifth

of the
since being out of
unemployed report a deterioration in their mental health

105g-i¡¡ R.LlnenryIoyntcnt and health: A clisnster nncl ct challenge' Oxford: Oxford University
Press, 1'987.
 233
6: Ill-health: Occuoational risk factors

work106 . Studies using standardised questionnaires consistently

show that the

mentar hearth of the unemproyed is poorer than those with

q¡e¡lç107, and that

thereis a tink between unemployment, suicide and deliberate self-injurytoa.

There is less evidence associating unemployment with psychoseslOe.
Fryer and

reported an
Payne, found that 5 per cent of the unemployed they studied
improvement in their mental health - some because they escaped from jobs

they disliked, while others had found positive aspects to unemploymentll0'

The studies linking unemployment with physical illness are limited'
rates of
However the British Regional Heart Study has shown higher
bronchitis, chronic obstructive 1*g disease, and ischaemic
heart disease
Beale and Nethercott
among the unemployed than among the employed111.
found. a statistically significant 20 per cent increase in
medical consultation

rates for families of g0 men and 49 women who lost

their jobs when a local

factory closed, compared with controls who did not lose

their jobsltz' A 60 per

cent increase in referrals to hospital out-patients was also

found' In a 1992

Australian paper, unemployed men were reported as experiencing

a 66 per

cent higher prevalence of disability, 2l per cent of recent illnesses, L0L percent
more days of reduced activity because of illness, and of diabetes
and respiratory

disorders as a cause of death, than employed men' Women

followed the same

106 ço¡"¿re M, Bartholomew R. A study of the long ter-m unemployed' London: Manpower
services commission, 19g0; Jackson ÞR, wut. PÈ.
unemployment and psycho^logical ill
and age. Psycholog-ical medicine 7984;1'4:605-74;
health: 1'ne mo¿Lratitg tot" of duration
Unemployment and Health' In: Roberts R, Finnegan R'
Warr P. Twelve Questiäns about
to Economic Lfe' Manchester: Manchester University
Gallie D, editors] New Approaches
Press, 1985.
P], De Cieri H'
1071y¿¡¡ P. Twelve Questions about Unemployment and Health"'; Dowling
An Australian case sbudy' lournal
Griffin G, Brownìú. psychological aspeäts ôf redundancy:
of industtial relntions 1987; 29 (4): 519-531'
108pi¿¡¡ S. Unemployment and suicidal behaviour: A review of the literature' Socrøl science
me dicine 1984; 19 93-11'5'
109 ¡aco EG. The socinl epidemiology .of mental disorders. New York: Russell Sage Foundation'
and health'
ígOO, Wur. P. Twelve questions about unemployment
110¡rr"¡ D, Payne R. Proactive behaviour in unemploymenh Findings and implications' Leisure
s t u die s t984; 3: 273-95'
111g6o¡ DG, Cummins RO, Bartley MJ, Shaper AG. Health of unemployed middle aged men in
Great Britain, Lancet 1982; i:7290-4'
of
112g"u1" N, Nethercott S. Job loss and family morbidity: A study of factory closure, lournal
1985; 280: 510-4'
Roynt Coltege Genernl Practicioncts
 234
Chapter 6: Ill-health: Occupational risk factors

at Johns Hopkins
trends but not to the same extent113. Brenner, a Professor
fluctuations in the
University, found a relationship between downward
physical and emotional
American economy between 1940 and 1973, and
illnesslla. He calculated that an unemployment increase
of about a million

people(L% of the population) sustained for 6 years, could be linked with

increases of 36,gg7 in total d.eaths, 4227 n mental hospital admissions, and 3340
to subtle
in prison admissions. His study indicated that health is vulnerable
fluctuations and that it improves and declines with the
economy'
economic
scott-samuel, and Moser, found unemployment
may also be associated with
that this is the case116'
premature death115, however Gravelle is unconvinced

deprivation
other people who are at risk of ill-health from occupational
such as the poor' the
include disadvantaged groups within the community,
in the
minority ethnic grouPs and the aged' There are differences
d.isabled,
and othersl17, and it is argued
risks of i1-health between such social groupings
this equation' For example'
here that occupational deprivation plays a part in
areas, disturbed by "self-
Australian aboriginal eld.ers, particularly from remote
poor health, along
destructive activities such as drinking, (and) violence",
'sit-down' money be replaced
with loss of traditional occupations, "asked that
by money for work done by those who were unemployed"lls'
The

National
713¿rorrr¡ to make yott sick: How income and enoitonment ffict health' Australian
FI"uí,n strategy Research PaPer No 1' Sept L992'
journal of lrcalth ,
114gr"*.,"¡ MH. Health costs and benefits of economic policy' International
tnéNational economy: A review, and
seraices 1977;T:igf-g3; Brenner MH. MortaUty
ana
t 1979;i2568-73.
. Lancet 1984; ii: 7464'5;Moser KA, Fox AJ' Jones

1166.uu"11" H. Does tmemployment kill? oxfotd,: Nuffield Provincial Hospitals

Trust, 1985'
Social/medical
1L7g¿¡¡ |T. The inverse care law' LnncettgTL;Febtuary 27:405'412; Martin
GS'

aspectsofpoaertyinAtlstralia.Aus.tralianGovemmentinquiryintopoverty.Canberra:
opitl-J. Èconomic policy and health care:
Australian cou"ä*"^iÞ"uiirniitrg service, t976;
The inverse care law' Neu Doctor 1983'
Employment
11g¡ensen H. What it means to get off sit-down money: Community Development
'fropcts (CDEP). lotrnal oi occupational science: Australial993;1(2):72-79'
 235
Cha 6: Ill-health: risk factors

came into being

Community DeveloPment Employment Project Scheme
,,an increase in the health of communities.'.more PeoPle involved
providing
active tasks, a d,ecrease in alcohol consumPtion, an increase
in
in physically
rare example of an'occupational'
cleanliness and better nutrition"l19. This is a

initiative being implemented for combined health, social and economic

benefits.

very few initiatives are being implemented for those with ongoing
health

aimed at promoting their

problems, such as the disabled. In fact, Programmes

health through opportunities to encourage growth of

occupational potential

become Scarce' even though

are the first to be axed when 'health' resources

such programs are not expensive when compared

with 'technologically
brilliant life-saving procedures which may condemn a
'brain injured' victim
future' Hodges asks:
to an unfesourced., unsatisfying and unhealthy life in the
,,Are service need.s for the promotion of health among the disabled different
met?" He identifies the lack
than for the non-disabled, and are they adequately
void and suggests that
of development of strategies for the disabled as a major
for this "significant portion of society."'the concept of health
promotion and

disease prevention takes on added dimensions

and heightened need"'120

Women,too,havegenerallysufferedoccupationaldeprivationforhundreds
but the industrial revolution brought the differences
and divisions of
of years

labour between men and women to a point seen

by Mackie and Pattullo as

destroying the vitality of women121. Equality

of occupational opportunity
between males and females had. declined
from the Palaeolithic era on' yet
respite' For example' in the
during particular eras Some women enioyed some
a nufìnery (usually uPPer
medieval period it was possible for women entering

L1966o¡irL.,al and Torres strait Islander commission' No reaerse gear: A

National reuiew of the

1993'
Comrítrnity Deaelopnrcnt Projects Scheme'
120¡1o¿gss A. Health þromotion and disease prevention for the disabled' loutnøl
of allied
health1986; Nov'
12L¡4u"¡¡" L, pattullo P.Women at zuork,Londorr: Tavistock Publications, 192
 risk factors 236
Chapter 6: Ill-health:

merchant classes) to receive a

class, unmarried females, and later from the
better education and the chance to engage in a greater range
of occupations
able to engage in many
than those who married, and women in towns were
equality, and were
trades122. Women did not however have political
subservient to their fathers or their husbands. Although accepted as of less
which were often
value than the roles men undertook, women's occupations
"gruelling and virtually unending", were also productive, rich in variety'
self

expression and responsibility, achievement and satisfaction, and not

,,compartmentalised, isolated or solitary"12a. Not all women were engaged in

paid employment but the restricted occupational role of affluent women was
in a different way. Their physicar activity was slight, the
hazardous to hearth
"social usefulness was never
use of their mental capacities restricted, and their

recognized or recompensed. Instead their dependence

on the male bread
and their work in the famity reduced their capacity to
organise"124'
winner
Florence Nightingaleat the age of 26 observed that "women don't consider
themselves as human beings at all" and that she
knew of some who had gone
Garrett Anderson suggests
mad for lack of things ¡e ds125. similarry Elizabeth
that:
"there nois
happiness, ønd
the døys drøg
dreary shøm

122 5¡¿y¡i¿¡os LS. Tlrc world to 7500: A globat history,4th ed' Englewood Cliffs' NJ': Prentice
Hall, 1988, P.273-275
No words ending in'ste-r' o.r 'ess" as inbrewster (woman beer
or
), baxter(worian baker), seamstress (woman sewer)'
ìth century Liare Metiets(Book of Trades)' which lists the
de
86 of ihese guilds; Power l. Jh" position of
rules of 100 paris Guilds. women *"r" *o.tit
g in
iígacy of the .øadt' ages' Clarendon
women. fr,, Cru*-p Cõ ]acob EF, editors. The -Oxford:
press,I916,pp.+Oí-+3+;'Gro* SH, Bingham ¡vtõl- Wo*rn in medieaal -Rennissance Europe'

St Louis Parl , Vn': Glenhurst' 1983'

123¡4u"¡i" L, Pattullo P.Women at work"' p'10
Press'1973'p'58'
L24 ¡o*6o¡ham S. Hidden from history' London: Pluto
125 y¡ee¿¡am-Smith C, Florrræ Nightingnle' London: The Reprint
Society' t952'p'71'
126 Anderson EG. Fortnightly reaiewl'JS, xv: London: 7874, p'590'
 risk factors 237
Chapter 6: Ill-health:

The sftong preference for women to follow domestic and

child raising

occupations in the home, in victorian times,

was linked with infant health. It

was thought by manv that if married women undertook

paid employment

outsid,e thehome this wourd be at the sacrifice of

infant rivesr27,128, although

this was found, by u u8g3-g4 Royal Commission on Labour' not to be the

s¿gg129.

women's occupations
The inequality of opportunity that has characterised
and dominant
for thousands of years as a result of the type of economy,
cultural id.eas such as about social justice and equity,
humanism,

individualism and familism, is still evident today, although

in post-industrial

societiesit has improved greatly. Even so as recently as t976' Douglas Gordon'

gender bias in
in his book Heølth, Sickness ønd Society exPresses occupational
observing:
,,lt is said that a man's iob proaides him with a tneans to satisfy
bY maint.aining
,ønd
's occuPøtion is more
side occuPøtion to a
wiþ and mother and from her

¡1"*i¡¡, M., wiues and mothers in victorian industry,

727 London: Rockcliff,1958.
1.28 ¡.,¿is.1ive of the period, Dr H' jones, in an essay'The perils and protection of infant Iiþ'

Society 7894;
lottrnal of the Roynl Statistical

f Dr ]ones' PaPer, by the Royal Statistical

clusion, such as; that statistics linking women
mortality rates provided conflicting evidence;
s were more crucial variables; that some children
vided bY mother's wages'
ality in bngland, 1895-1974, lournal of

bearing on the extent and

129ço11"¡¡ CE. The collection and utilization of official statistics
effects of the industrial employment of
women' lottrnal of the Roynl Statistical society

Labou work'
indttst and the
tween Y were

imPrecise and imPressionistic'

 238
Chapter 6: Ill-health: O ccu risk factors

home. ..Some Tþomen need to work oLttside: a lot do not zoish to

do so , At least that is what theY søY"'730

The remarkable improvements in women's morbidity and mortality

since

reduced birth
the nineteenth century aPPears to be multi-factoral, including
rate, greater und.erstanding of obstetric and gynaecological
disorders'

emancipation, a change of attitudes, and it is argued here, the increased

develop potentials' Indeed a
opportunity for women to exercise capacities and
few stud,iespoint to this being the case131. However despite the growing
work, the study of the
numbers of women participating in other than domestic
relationship between women's occupations and
health are limited' on the

whole, to job stress132, reproductive hazards133, and the threat to family

function and. maternal responsibilitiesl3a '

variable and' genercIly'

Occupational deprivation and imbalance have been
adaptation to challenge'
gradual as occupation evolved in the course of human
a rapidly increasing rate
It has been noted that adaptation is being called for at
the technological possibility of
at present, and Omstein and. Sobel suggest that

130 neSS and society ...,p.378; see also: Frumkin RM. Occupation and
s. In: Rose AM, edifor. Mental health and mental disorder.I-ondon:
Paul,1956.
131 ense of well-being' and use of professional
one-
Stress

cio-
lP.
azards. ln Beckerman CL, edttor' The eaolaing
980; Haw MA. Women, work and stress: A
health and socinl behaaior L982;23: 132-IM;
women: the case of clerical work' ln: Lewin' E'
g: ...

lations for women in the workplace, Feminist

ory of women workers and hazards in the
PetchekY, R' Workers, reProductive
duction. F¿minisf studies 1979; 5: 233'245;
tective' discrimination. Feminist studies 7979;
ional health and women: the case of clerical work'
Ith and Healing....
134per¿¡¡y Mp, Rapoport R, Rapoport RN. sex, cnreer, nnd fanúIy, Beverly
Hills: sage

Publications, 1977'
 239
Chapter 6: Ill-health: Occupational risk factors

more rad.ical changes in occuPation could result in serious health

consequences. Th"y say that because Parts of the brain are
rooted in earlier

species inheritance peopre are only able to respond with

biological reactions

which are either "obsolete" or "inappropriately illicited"l3s Similarly,

Dubos

their
warns that although humans may aPPear to adapt to new environments
biological inheritance only enables adaptation up to a point and
that chronic
are an echo of Some
disease states can develoP over 1ims136. These wamings

of Dunn's anxiety as to whether individuals and families can "attain and

and Maslow's
maintain wellness while riding the crest of a social millrace"r37,
that has ever
concems that mankind is "at a point in history unlike anything
been before" with "huge acceleration in the growth of facts, of knowledge, of
suggested that
techniques, of inventions, of advances in technology"' Maslow

the rapidity of the changing world calls for "a different kind of human
being...who is comfortable with change," because "societies that cannot turn
that there are
out such people will die"138. The Ottawa Charter also recognises
health concerns associated with socio-ecological change and calls
for a
"systematic assessment of the health impact of a rapidly changing
environment, particularly in areas of technology, work, energy
production and

urbanisation"l.3g. Such an assessment would need to take into

account the

concept of alienation or 'estrangement' which is the third occupational risk

factor to be considered.l4o

1359¡¡51sin R, Sobel D. TIrc healing brain"' p'206

136pu6es R. Changing pattems of disease. In: Brown RG, Whyte HM, editors ' Medical
practice

,o**r,nii'iyi itoceedings of a confertncy ynuyl! the Australian National

nnd the
'iiio,ersity, .by 1968 (p 59)'
Canierrn. Canbeira: Austraiian National University Press,
137D*m tlt. Uigh Isoet wellness. Arlington, Va.: RW Beatty, 1961.
138¡4ur1o* ¿,. itte farther reaches of human nature' Viking Press' L97L'
1391yo.1¿ Health Organization, Health and
Association. Ottaiua Charter for Healtlt
14041i"rlu¡ion. defined as "estrangemenu tran
ent

ourDose". rt, ,ioidi'd Engtish clesk cti

7975;
and New
þ.ruiitn"a for sale in Australia
 240
Chapter 6: lll-health: OccuPational risk factors

Since the time when PeoPle lived in harmony with the natulal

enviforunent earlyin the sPecies history, with only the simplest of technology
to assist them to meet their needs, mankind has sought to challenge and
technology
master nature by the development of more and more sophisticated
death by
tomeet their occupational wants, and, to conquer ill-health and delay
change is
ever increasing sophisticated medicar science. such technological
seen, by some, as alienating. Alienation is a term
much debated by twentieth

century Marxists, as it is a theme which surfaced as important in the early

humanist period of Marx's work since first being published in English in

1932141.

As a central concept of his philosophy, alienation is intimately connected

with Marx',s views about activity and human nature142. Lrdividual, grouP,
institutional or societal activity can result in alienation when it is not in
accordance with our species nature. Marx saw our species nature as a unity of
naturalism and humanism; that is, he viewed humans in evolutionary
terms'

as part of nature and,, in humanist terms, as

praxic beings who both change
any
nature and create themselves. He regarded as potentially alienating
productive, economic, social or spiritual activity, as well as
the products of

activity such aS philosophies, morals, money, commodities, laws

or social
'capitalist' history such
institutionsl43. He argues that because of 'cultural' and
'creativity' of
activities and products have become estranged from the natural
human's species natufe, resulting in feelings of alienation towards self and

others, and the activities and products themselves.

These alienating activities,

along with division of labour are "forced uPon individuals by the society

G,
141¡4u.* K. Economic ancl phitosoptúcat manrtscripts,ls4 (7972)- In: Livingstone R,-Benton
' Penguin classics, 1992, andGrundisse, 1857 (first
translators. KnrI Mnrx:'Enrly zuritings.
English version 1939); Penguin Classics' 1970'
142p"¡roui. G. Alienation. In: Bottomore T, editor. A dictionary of Marxist tlrought' 2nd ed'
Oxford: Blackwell, 7991' pp'l1-1'6'
143¡4u¡¡ K. Economic and philosophical manuscripts, 1844' ln: KnrI Marx Early zuritings""
Penguin Classics, 1992'
 Occu risk factors 24\
Chapter 6:

which they themselves s¡s¿fs"144 and as long as "activity is not

voluntary...man'S own deed becomes an alien Power oPPoSed

to him, which

enslaves him instearl of being controlled by him"14s'

To illustrate this concePt of alienation, consider the analogy

of an animal
a world of a
born in captivity - a lion, for example, who has only ever known
cage,of other animals tiving solitary lives in their own cages, and of people
who feed and care for him, but who demand particular
activity and behaviour

from time to time. It is possible to understand that the lion

will experience
needs anrd instincts which relate to the natural environment in which he
would have lived in the wild but with no means of really
appreciating or

satisfying them. He is estranged or alienated from

his species nature, from his

activities and from other animals but because he has

never known a natural
frustrated, or the need to
lifestyle does not understand why he feels unhappy,
escape to something different. Humans because of their occupational species

The bars are the products

nature have constructed, over time, their own cages'
and results of their occupations, such as the social values
of any culture or

society, its laws and rules, its political direction and its economic structure

demands on each
including the day by day occupational opportunities and
individual. Like the lion, humans afe estranged from their species
nature'

from others, from what they 'do' and from the results of
their activities'

Daniel Miller even suggests that the status given to

the medical profession'

and it's 'scientific' values, can be alienating factors

in the way that they exert

control over the procedures aimed at rapid repair of

body parts

decontextualised from the recipients mental or social

needs146

L44¡4o¡-.,S.Divisionof labour. ln: A dictionary of Marxist thought"'p'155'

1.45 ¡4u.* K, Engels F.TIte German ldeology.7845-46. London: Lawrence
& wishart, 1964'
care system'
L46 ¡4¡1", p. Dissociation in medical practice: Social distress and the health
of social distress and the ltonrcIesslgg3;2(4):243-267.
i'"-"*rt
 Occuoational risk factors 242
6: Ill-health:

Marx particularly linked feelings of alienation with the restrictions imposed

upon the ordinary worker by capitalism and industrial processes' He Pondered
on the contrast between the craftsmen who worked skilfully with tools
which

themselves wefe often hand made, and the factory worker

who in many

instances were subservient to their tools - the machines. He wrote that far
from freeing humans from toil "the lightening of the labour, even, becomes
a

sort of torture, since the machine does not free the labourer
from work, but

deprives the work of all l¡¡s¡s51"147. He envisaged that factory

workers

,'robbed thus of all real life-content, have become abstract individuals,..'the

only which still links them with the productive forces and with
connection

their own existence - labour - has lost all semblance of self-activity

and only

sustains life by stunting l¡"148. Marx perceived

this 'stunting' outcome as less
associated with
than health-giving and suggested a direct illness connection
the processes of industrialisation because:
,,factory work exhausts the neraorts system to the uttermost, it
does au)ay utith the møny sided. \oy. o! lhe muscles'-
and
confiscates eaery øtom of freedom, both in bodily nnd
intellectual
actiaitY"

smith suggests inlJnemployment and Health that, for many, these problems

people has since the

continue to the present, as "most employment for most
and' as
industrial revolution been hard, exhausting, boring, dirty, degrading'
during
Marx said, alienâting"149. These alienating changes were compounded,
values", with
the industrial revolution, by "the terrific destruction of human
Dubos suggesting that if ever people "lived under conditions completely

removed from the state of nature dreamed of by the philosophers

of the

enlightenment, it was the English proletariat of the

1830s"1s0'

147 ¡¡ur* K Capita I (1867) "'pp'a22-424

L48 Pir.¡".,L970...pP 43-M'
1495*¡¿., R. Llnemployment and Health: A disaster nnd a challenge' Oxford: oxford university
Press, 1987,P.2-
150ps6es k Miiage of health: Lltopins, progress and biological chnnge' New York: Harper and
Row Publishets, 1959, P'L47'
 risk factors 243
Cha 6: Ill-health: Occu

Those conditions are now regarded as so unhealthy that it

is difficult to

understand why made the mass exodus from country to town' until it
PeoPle
is appreciated that "the move from farm to factory was based on Social
trends

that it was
that the individual could not control", and "it is far from clear
need1sl. It
ind.ividual preference...that led to urban migrations", but economic
is also worth noting that the conditions of most people in
the eighteenth

century wefe far from idyllic, with labourers working

from dawn to dark in
,poverty and darkness'1s2. Huge numbers of the population changed not only

their habitats but the structure of their social networks,

from small cohesive

groupings, which worked and played. together, to large

populations where
that a "new
individuals know or aIe close to few people. ]ones observes
concept of 'going to work"' emerged as "employment based at or near home"
and
was ,'replaced by work at central locations such as factories
shop5"153'

Centralisation separated males and females, altering

the value of their
well-being; it separated
occupations, and experiences of social and mental
roles; and children' unless
adults from children, altering teaching and learning
observed or participated with
engaged in 'child labour' with them, no longer
valued roles and
their parents as they engaged in the daily round of socially
skills. Instead they leamed from strangers'

may well have gradually

such changes to basic human relationship patterns
alienation problems
impacted on some of the family, loneliness and social
common in the modern world, and which lead
directly or indirectly to ill-

health. Misjuskovic puts a case that aiienation, and individual

loneliness are

such as America, (and

mofe pronounced and prevalent in 'atomistic societies',
I would argue, other post-industrial societies), than in'organic communities'
and
in which natural functions, role perspectives, mutual interdependence
1511.i01s¡¡ T. Hebrides women: A philos r'
Wright BD, Ferree MM, Mellow GO'
Woñen, uork and teclmologY' USÃ:
152g.orlo*rkíl.The Ascettt of Man' London:
153
¡ones B. SleePers, wake! " '
 244
Chapter 6| Ill-health: Occupational risk factors

intrinsic relations are stressed in contrast to individual freedom, external

connections, causal and reductionistic explanations, rule orientation and

artificial frameworksls4. His view has some merit when

it is observed how
structures, language,
current post-industrial values and changing occupational
and technologies can restrict freed.om of action by ever
increasing rules'
endeavour with labour
regulations and bureaucracy; rePlace ongoing human
mundane variety; reduce the
saving technology which often creates work of a
availability of paid employment which has interest, meaning or meets

way of life out

individual needs for growth and challenge; create a materialistic
are part' All of
of step with sustaining the natural world of which humans
those changes have the potential to create environments which are alienating

enough to spawn discontent and dis-ease'

since Marcuse renewed attention to Marx's theme

of alienation in t932'
such as Fromm, have continued widespread and
intense discussion
others,
which links the notions of alienation with 'sickness'
oI ill health for

ind,ivid.uals and for societies155. In numerous

recent studies' alienation

associated with unsatisfactory occupational factors has been found to be

implicated in ill-health and 'risk' behaviours, particularly for people already

disadvantagedls6. Whilst technological change in itself (unless toxic) is

loneliness' lournal of sociology

154 ¡4i¡rrs¡evic B. Organic communities, atomistic societies, and
nnd social welfare 7992; L9(2):1'47-'l'64'
1'55prot¡n E.The sane society ' New York Rinehart' 1955'
L56 5"" for example: Yates A' Current status
lndian ctltti. American ioutnal of psych
ts

cing chronically mentally ill elders receiving

for"residentialservices' Adr¡if residential care
vice delivery for Korean
PsychotheraPY during social
isis. GrouP analYsis 1993;
of youth unemplovment: Review from a
;38(5): 699-709; Rodenhauser P'
c
 245
Cha 6: Ill-health: Occupational risk factors

unlikely to cause ilhress, the effects on People's engagement

in occuPations
and their reaction to the changes can read to ilhress
if the change is alienating,
when work is perceived
even in high demand iobsrsz. justice argues that
as

stressful, boring or meaningless the likelihood of "mass illness" is

increased,tSs, and this is backed' uP by a review of material from sixteen
epidemics of illness at various work places and schools undertaken by staff

and Heahþise'
from the (American) National Institute for occupational safety
There is convincing evidence that the health benefits
of paid employment
depend on it's qualitylso, and those who are dissatisfied with work life
tend to drink or smoke more
experience numerous symptoms and stress, and
than those who are satisfiedl'67,

Alienation for workers, unions and labour managers

will continue to
'deskilled' and lose their
increase as prod.uction and service jobs become
capacity to inte¡est those doing them, because "many jobs that have been
transformed by new technology are characterised by high levels of
people are experiencing
boredom"162. Along with this, Naisbitt suggests that
hard to anticipate as they
turbulence which may well have health implications
are caught in the rapid, 'mega'change from an industrial to an information
tal health
CulturalbarrierstomentalhealthcaredeliveryinAlaska.|ournalofmen
adm i ni n 799 4; 21'(1): 60-7 0'
stratio
disease in women'
157 ¡1ur¡ss SG. Type A behavior, employment status, and coronary heart
Behnaiotral updntelíea,iø@), L1-15: See alsoJustice B'Who gets sick: "'
^ra¡¡"i
llness in organizations: An overview' lournnl of

ent and health...; WalrP'Work, unemployment

Publications ,1987; Winefield A, Tiggerman M'

7993;
ical health' lournal of community health7982;
7(4): t62-283' of
1.62pu**orth L. An exploration of skill as an issue in unemployment and employment' lournal
seealio: Adler P, Technology and us'
occttpational science, Aystrqliarggs;2(7):22-29;
Soci'atist reuiew 1986;85: 67-96'
 246
Chapter 6: Ill-health: Occupational risk factors

society. For those emPloyed in intellectual occuPations such as educators'

stresses caused by what he
administrators, scientists, and health professionals,
callsthe "chaos of information pollution" are frequently described as
overwhelmingl63.

,,Technological change is often hailed as a signPost of human Progress and a

pollard observes that the belief in progress is
vehicle for human liberatisn"164.
an assurance that science and technology will continue
to Provide more and

more material benefits, as well as mastery over

the environmsnll6S' So much
is progress accorded in today's world that
the 'natural' health needs of
respect

people pale into insignificance beside the drive

to create more and mofe
sophisticated technology. How technological Progless
in entertainment
shared social occupations is a case
equipment has altered. the character of many
by technological
in point. other leisure occupations also have been influenced
is more attainable' Examples
advancements, supposedly so that excellence
potions as well as
include the sporting activities for which chemical
have been developed and
mechanical, biophysical and electronic apparatus
unrealised feats. such
marketed so that individuals may achieve previousry
technology subtly alters the elements of human
toil, the pure skill' and the

mental and social exercise comPonents drawn

from within any participant'
and it is suggested that the
This is also true in the arena of paid employment,
have been used remain as in
way in which technology and division of labour
the industrial revorution "antagonistic to individual
growth"166. This
potentials via technology, which
reduction in the use of human energies and
and natural environments'
drastically changes utilisation of human creativity

York wamer Books,

1.63¡u¡r5¡ J. Megatrends; Ten new ditections transforming our liu¿s' New
7982, P-24.
of women' In: Wright BD'
164¡¡u¿¿"¿ CJ. Technology, industrialisation, and the economic status
saÀper MLD, Asher R, Clasper K' editors. women, uork
Ferree MM, Mellow G-O, Lewis t-H,
Press' 1987' p'33'
and technology. USA: The University of Michigatt Alden&Mowbray'1968'
165 pog¿r¿ S. The idea of progress: History and society' Oxford:
New York:
166 ¡4u¡6¡ H.Ttrc creatiaí imp,,tse in inelustry: A proposition for
educators'

E.P.Dutton and Co', 1918' P' 135'

 247
Chapter 6: Ill-health: Occupational risk factors

is primarily to meet market PurPoses rather than human needs and thus is

alienating.

that goes along with rapid

other maiof and Potentially alienating change,
increase in the urge to accumulate
technological advances, has been a marked
material goods and ProPerty, without a thought
for the potential of
materialism to destroy our ecosystem' Many erroneously equate material
wealth with happiness and health, mistaking
the means for the ends'

Mumford suggests that "over-charges of emPty

stimuli'"'materialistic

repletion,...costly ritual of consPicuous waste/...and highly organised

purposelessness" are part of the "clinical picture of the cultural disease from

which the world 5sffs1s"167 . He goes so far as to assert that

Middle Ages was closer to
an øge zuhich føncies that the
øbundance' will automaticallY
licitY"tea'

primary need and is regarded' by

The acquisition of assets is now seen as a
state with the potential to cause
Lorenz, as having reached a 'pathological'
symptoms of cultural ill-health' He
mental and social disruption deemed to be
asserts that the apparent rush to acquire
material wealth undermines health'
is propelled by greed' for this alone
although "man rushes, not only because he
he is driven" by
would not ind,uce him to ruin his own health, but because
fear769.

Throughout this chapter it has been indicated that occupational alienation'

have the potential to lead to strese

along with deprivation and imbalance,
albeit briefly despite it's
related illness which will now be considered'
considerable imPortance'

167¡4*r¡ord,L. The Condition of Mnn"' p' 380

L68¡4*o¡o¡d.L' The Condition of Man"' p'748
769yorsn7K. Ciailizect nnn's eight deadly sins
 248
Chapter 6: Ill-health: Occu pationa I risk factors

Stress is a basic phylogenic mechanism, which under norlnal circumstances

works to maintain physiological equilibrium in times of physical and
level, suscePtibility to
emotional pressure. If prolonged at an unacceptable
illness is increased. Adolf Meyer is credited
with recognising, early in this
this regulatory system became
century, that d.isease aPPeared to occur when
subjected to over1oad170, and Hans Selye,
in !936, described the 'general
adaptation syndrome'171 in which he hypothesised
that the adaptive resPonse

can break down due to:

innate ects, oaerstress ' or psychological

understress
" def ' peptic
mismønøgement. The most common stress diseases"'øreneraous
utcers...tigh blood pressure, heart øccidents, and
fli5945æ"172'

work based on selye's hypothesis has, largely,

sustained it' A well publicised
coronary heart diseaselT3 and
study by French and Caplan links stress with
with disorders of the musculo-
others have suggested that stress is associated
depressive iilness' Roskies and
skeletal, digestive, immune systems174, and
everyday stress has more effect on
Lazantspropose that the ability to cope with
episodes themselveslTs' and in
physical, mental and social heatth than stress
similar vein, Moore argues that:
,,Iong term chronic stress and especially chronic unpredictable
stress can restút in ttn eørlier cle,mise
or long term ..disøbility
(mental ancl/or physicøI), unless therøpeutic interaention cøn
reaerse the indi'piãucú's way tf '?.q'!8
and/or reaerse the
" L/Ô'
situations ttsltich øre causing the stress

1706¿urns ]D, editor. l.Jnderstanding and managirtg stress: A book

of teadings' CA': University
Associates lnc., 1980'
171gu1y" g. diverse nocuous agents' Natute7936;738:.32'
772g"1r. y1. editors' Stress nnd coping: an anthology' 2nd ed' New
York: C \985' P'25'
173pr"r.,6¡ |RP, Caplan RD. Organizational stress and individual
strain' [n: Marrow' AJ' editor'
-success'
The falture of New York: Ama
174 ¡4.q,ru¿e W, Aikman A' Sfress' New
74'

175¡1or¡iss E, Lazarus Rs. Coping theory and

skills' tn: Davidson Po'
lit'estyles' New York:
Davidson SM, editors . Beihauio"al ntedic
Brunner/Mazel, 1980'
therapy' Unpublished lecture
176¡4qo¡s lC. Neurosciences nntl tlteir appticati2tl^ to ,ocuryationøI
1989' p'185'
notes Ádehide: Neuroscience Conference'
 249
Chapter 6: Ill-health: Occu risk factors

The type of illness exPerienced as a result of stress is

thought,by selye, to

express any individual's weakest pointsl77, so any genetic or familial

predisposition, such as mental breakdown, arthritis
or cardiac failure, can be
aISues that there is little
activated by prolonged stress178. Temoshok, however
pathways
empirical evidence either "to support or refute potential biological
Iinking stress factors and disease initiation or progression for
any disorder".
which probably
He suggests that this reflects the complexity of the connections
incrude person and situation variables, interaction effects including
physiological and psychological predispositions, as
well as social, cultural'
economic and political contextslTe

Moderating factors, such as dis1180, medicatiottrsl, physical

activity and

rewarding occupational rolesl82, aS well as relaxation techniquesls3

can

provid.e resistance to disorders' For example, it has been

stress-related
"one is using the mind and
suggested that playing sport is relaxing because
body the way they were intended to be used in fighting
or running away" in
responseto the fight or flight reactionls4' Such argument leads to the view
is more likely to be maintained if individuals have
held by Eisler, that health

the skills and resources to coPe effectively with the diversity

of life's

stress as increased blood pressure,, heart rate'

Moore lists some effects of chronic unpreditable
levels, decreased peristalsis' lymphocytes' T
respiration, muscle tension and blooá-glucose
andBcells,immuneresPonse/destabilizationoflyosomesandhyper.alertstates.
777g.¡r" H.The stress of lrle. New York: Mcgraw-Hill, 1956,1976'
178çe6¿5¿ SC, Maddi SR, Courington S. Personality and constitution as mediators
in the stress-
ilkress relationsÀip. Jotrnal"of health and social behaaiotl981';22:368-378'
1291"*or¡ok L. On atiempting to articulate the biopsychosocial model: Psychology--
ÉS, editor' Personality and disense' New
psychophysiological hämeästasis. ln; Frielm*
V*f., Jõtlt Wiley & Sons, 1990, p'211"
18096o. RE. Nufrifio nal reaiews: Present knowlcdge in ruúrition 5th ed' Washington'
DC:

Nutrition Foundation, 1984'

181yy"¡.,". H.Psychobiotogy snd lutman disease. New York: Elsevier,1977'
their risks for chronic disease' Colloquium
public health, Houston. Reported in ]ustice B'

er. New York: Delta, 1977

Personality
184¡4u¿¿¡ sR. Issues and interventions in stress masterl' tn; Friedman HS' editor'
& pJ32'
nnd clisense. New York: John Wiley Sons' 7990'
 250
Chapter 6: Ill-heal th: Occu pational risk factors

challengertss, and to the questions asked by Antonovsky about not whether

,bad, for health, but for whom and, under what conditions is it 'good'
stress is

or ,bad,. He specul.ates that the mechanisms

for the relationship between a
,sense of coherence' and health includes experience of successful coping with

the functional caPacities of

stressors. lndeed moderate stress which augments
and vitality as well as
all systems is necessary for maintaining positive health
"Heart attacks are not the result of
providing a reserve against extreme stress.
shovelling snow or running for a train..'they are the product of a lifetime of
not doing things like shovelling snow or rururing
for ¿ ¡¡¿i¡"186'

alienation, deprivation and

stress related illness as a result of occupational

imbarance have undoubtedry increased. during

occupationar evolution, despite
world rather than that
the obvious benefits in living in today's post-industrial
societies' there is
of hunter-gatherers. Now, for those living in post-industrial
'miraculous' advances in
longer life expectancy, lower infant mortality, and
reverse the effects of much
technological and pharmaceutical medicine to
disease, disabiiitY and trauma'

"Since the 1'940's"'the imPøct

health ndministration u7on cond

and cheerfulness is hard to

exøggerat¿"187 '

These advances ensure that more people are

provided with a stable base from

towards the experience of positive health and well-being'

on
which to more
thewhole,though,healthandwell-beingseemstosituneasilyamidsttherush
of present day occupational structures which humans
have
and. stresses
and mortality resulting from
constructed over the years, with much morbidity

In: Mattarazzo lD,

1859ir1". RM. Promoting health through interPersonal skills develoPment'
SM, editors. Belnuiournl health: A lnndbook
Weiss SM, Herd jA, Miller NE, Weiss and Sons, 1984'
"f
York: WileY
Iunlth enlnncement and disense preacntion. New John
tinrcs t976; 4$0\: 6a-74'
18661rr^O TG' How much exercise to avoid heart attacks? Medicat
187¡4.¡"i11 wH' Plngrres nnd people
 257
Chapter 6: Ill-health: Occupational risk factors

rack of individuar or community awareness about the relationship between

occupation and ill-health. This is, in large measure, because of a lack of
or holistic of occupation
research based uPon a sufficiently broad PersPective
health'
a resultant dearth of intervention strategies from public
social'
and.

political or national Policies'

In another time of rapidly changing occupational conditions, early this

hygienists like Adolf Meyer'
century, a small grouP of idealists such mental
trade union activist Helen Marot, and founders of
the arts and crafts
recognised and acted on
movement (based on Morris's ideology) in America
This was
the apparent link between health, well-being and occupations'
'health through occupation' to counteract
sufficient to lead to the concept of
the maladaptive effects of industrialisation and occupational
deprivation'

imbalance and alienation for those who were

ill, being adopted by social
activists and pioneer occuPational therapists early
in the twentieth century'
The next two chapters discuss the genesis of
this concept and how the message

became d,immed by general acceptance

of the changed shape of occupational

structures, and by a change of emphasis

within health services'
 Chapter 7

The genesis of occuPational therapy

concemed with people
As occupational therapy claims to be fundamentally
attaining health through occupation, it is useful, from a public health
to consid,er the distinctive phitosophical and practice base of
perspective,
their expertise in the drive to
occupational therapists, with a view to utilising
,health for all'. To this end, this chapter explores the genesis of
enable
occupational theraPy at the beginning of the 20th century in America' it's
predecessor, 'moral treatment', and some of
the ideas which influenced its

such as 'industrialisation', the 'arts and crafts

movement''
emergence/
'pragmatism', and 'feminism'

century although the

occupational TheraPy is a profession of the twentieth
have a very long historyl ' It
philosophies and rationales on which it is based
reflects natural, biological and 'common Sense'
truths about health and well-
of human activity'
being. Its simplest claim is that occupation, or any form
has effects upon the health of the individual engaged
in the activity' Human

occupationmaybechosenwiselytoenhanceormaintainhealth'toreduceill-
handicap aPPear irreversible'
health, or to help the adaptation Process should
therapy was originally more concemed with promoting
or
occupational
maintaining health, for those without access to
'normal' human activity

because of chronic ill¡ress, than being

remedial for people with acute illness'
at large' although
Nor was it applied to 'welf ind,ividuals or the community
itappearstohavegrownfromcommunityProgramsaddressingsocial
problems, as well as moral treatment for the
insane'

lMcDonald EM, editor. Ocutpational therapy tt7 rehabilitntion London: Bailliere, Tindall and
Cassell, 7960 and 1964'
 253
7: The of occu

understood by the public' other

It is a complex Profession which is poorly
From its
health workers, educational institutions and govemments'
medicine and health care'
beginnings it has sat PeriPheral to conventional
associated with medicine' and
probably because, although it has always been
much of the impetus for its establishment came from psychiatrists and

does not share the same reductionist base of practice'

Views of
physicians, it
illness and perspectives of treatment possibilities between occupational
the genesis of occupational
therapy and medicine began to differ shortly after
changes in medical services
therapy from the 1920s on. From about that time
intervention and
occurred in which red.uctionist practice, pharmaceutical
personal skill development of
technology-based skills gained importance, and
became devalued'
a simpler kind, in which occupational therapy specialised,
Despite this, occupational therapy is recognised
as a health profession
perhaPs remarkable that the
compatible with conventional medicine' It is
centred on the short stay
profession is still attached to health care systems
essential by occupational
acute hospital, as many interventions thought
therapists address problems that demand time
and long term programs to

achieve results.

of the relationship between occuPation, ill-health' health

The complexities

and well-being have already been discussed,

so how it is viewed and defined

by the profession is of interest. At present, the world Federation of

Occupational Therapists defines it as:

" assessment and treatment thro

um function and indePendence

aironments.'2

Paris: 1976'
2 World Federation of Occupational Therapists.
 254
7: The genesrs of occupational therapy

This fairly traditional definition can be applied to occuPational

therapy

particularly by its
practitioners throughout the world. In some ways,
reference to 'assessment and treatment', to be 'designed by the occupational

reflects the association occuPational theraPy has had with

the
therapist', it
to
medical model. Each countly tends to further define its practice according
adopted by the Australian
local needs and conditions. One of the definitions
that:-
Association of occupational Therapists ín 1987 stated
d with human occuPøtion ønd

esigned to
low.
2) restore e fmctionøl cøPacitY'
3,)facilitallsandflmctionessentialfor
adøpt itY' ..^
4) Promo health"'3:

Early definitions and descriptions were simpler' For example,

in 1917 the
Therapy was
(American) National society for the Promotion of Occupational
and Thomas Bessell KidneÉ;
formed when architects, George Edward Barton4
social worker, Eleanor clarke slagle; physician,
william Rush Dunton6; and

3 Australian Association of Occupational Therapists. 1987.

and a
with
an

who called the first meeting of occupational

and popularising the name 'occupational
therapists, and who is credited with coining
theraPY'.
5 Thomas Kidner, Barton's fellow architect, added international flavor
to the founding group'
vocational secretary in the Military Hospitals
Bom in England, he worked in Canada as
Commissioi, where he developed a vocation

tNR.Prescribing occupational therapy'

 235
Chapter 7: The genesis of

teacher Susan Cox Johnsoil, who were all working

in the field' met at Clifton

springs, New York state, to write the 'certificate of Incorporation'8' The

of the society were "the advancement of occupation as a
objectives
therapeutic measure; the study of the effect of occupation upon the human
of this knowledge'e' Those particular
being, and the scientific dispensation
value to public health' so it is
objectives could well be seen as having current
developed'
useful toexplore the historical context in which the notions

Hopkins' and McDonald's historic perspective on

occupational therapy

states that the importance of occupation

in health was recognised and utilized
the Greeks' the Persians
thousands of years ago by, for example, the Chinese,
and the Egyptianslo. Macdonald provides as one of several examples'
ÉIomer's tale of Hephaistos, the noble craftsman god who was lame' being
equipment by Thetis and Euronyme which enabled
him to become
given
skilled in much 'cunning handiwork'11'

,moral, treatment which many people describe as the

However, it is
occupational therapy today' As one product of
the 'Age of
forerunner of
Enlightenment' this humane approach to the
insane revolutionised

psychiatric institutions during the LSth and

19th centuries' The genesis'
is a fascinating, but cautionary, tale'
success and demise of moral treatment

Dunton Jr WR' Licht S' Ocurya tional theraPY:

Springfield lll.: Charles C Thomas' \928;
ii¡*¡ptrt and practice' Springfield inlll':occupational therapy at Columbia UniversitY, NewYork
Charles C Thomas' 1'950
7lo ptZ,Susan fohnson was lecturer
City.
SReedKL,SandersonSR. Concepts of ocuryational therapy' 2nd ed' Baltimore: Williams and
Wilkins, 1983.
of occupational
9 certificate of lncorporation of the National society for the^Promotion
rherapy Association,
Therapy, t^". (1g1ñ:il;;'o"aiir, 1.9L7-1-976. American occupational
7967, PP.4-5.
therapy' 7th ed'
10 Hopkins HL, Smith HD, editors. Wiuard and Spackman's Ocutpational
Donald EM, Editor. ocutpational Therapy in
Philadelphia: } B Lippincott Co, 1988; Mc
Rehabili tatio n-. "
ll Homer' The lliad' Book XVIII'
 256
Chapter 7: The of occupational therapy

that
The fascination starts with the nomenclature 'moral', which implies
what it replaced was 'immoral'. In today's terms it certainly
aPPears so, as the

traditional treatment meted out to 'lunatics in mad-houses',

prior to the

nineteenth century, included whipping and chaining,

along with many other

approaches for "coercing patients into straight thinking

and accepting reason"

such as "vomits, purges,...surprise baths, coPious bleedings and meagfe

argued that
diets,,l2 Eminent doctors of the mad., such as Wiltiam Cullen,
,,restraining the anger and aiolence of madmen is always necessary fo'
areaenting" their hïrting themselaes or others; but
this restraint is also to
'be
consilered as a remedY'"73

This treatment, far from being condemned by people of the time, provided

entertainment for the curious, when, for a penn/, the inmates were exhibited
George III' during
through the open doors of Bethlem Hospital' In fact, even
bouts of mania, was subjected to similar treatment by
his physician Francis
and
willis. "FIe was sometimes chained to a stake. He was frequently beaten

starved, and at best he was kept in subjection by menacing and violent

language,,14. Whether or not behaviour is perceived as humane or

the world view and
inhumane, moral or immoral depends on the context,
of the
the values of those perceiving. Scull argues that "the subjugation
madman, the breaking of his will by means of extemal discipline and

constraint',
.were consistent with the view that "in losing his reason, the
as a
essence of his humanity, the madman had lost his claim to be treated
humanbeing,,lS.Inturn,thisviewwascongruentwiththetheologicaland
supernatural beliefs and values of an agrarian economy
in which 'God' and

12 Hunter RA, MacAlp inel.Three httndred years

of psychiatry' London: Oxford University
Press, 1963,P.475.
in the practice of physic, 4 v-olumes.'4th ed' (Edinburgh: Elliot'
1808) In:
13 C.rll".r W. First lines
Hunter RA, MacAlPtnel'Tttiee htmdred years
of psychiatry"'p'478'
14 Th" words of Countess Harcourt reported in: Bynum W' Rationales
for therapy in British
mad-doctors and mndmen: Tlrc social
psychiatry, 1Z80-1835. ln: Scull A, editor. Maclúottses, of Pennsylvania Press'
University
history of psycniaiÇ-in the Victotrian era. Philadelphia:
1981.
in the
15 Scull A. Moral treatment reconsidered.: Some sociological comments on the episode
Mãdhotrces, mnd-doctors and madmen"'
history of British pry.nl",.y. ln: Scull A, editor.
p.1,08.
 257
Chapter 7: The of occupational therapY

,Nature, dominated, and humans, on the whole, did not seek, or think
arose as a result
possible, self-transfofmation. Moral treatment, he suggests,
along with
of a change in "the cultural meaning of madness" which emerged
nature to reliance
the change from agriculnlre to industry, from reliance on
human activity and invention in the transformation of
natural resources
on
into marketable products. In fact, as industrialists Sought to "make such

machines of man that cannot err"16 they curtivated

in workers a new belief in
,,,rational' self interest (which was) essential if the market system were to

work". So to, in Moral treatment, were "lunatics"'made over in the image Of

bourgeois rationalitY"lT'

same time as Pinel liberated and removed the prison

chains of
At about the
the insane constrained in the dungeons of Bicêtre, in
France, william Tuke

established moral treatment in Britain, specifically

for Quakers at the York

Bs1¡s¿118 1e. He based his revolutionary approach on beliefs that self

were the keys to
discipline and hard work, rather than external control,
to education of children
rehabilitation of the insane, just as they were the keys
for in a world which had begUn to recognise the capacity for human
success

improvement2o. Reflecting the Quaker work ethic, as

well as religious
discipline, treatment at the Retreat encouraged individuals
to regain self
which the patients may be
control through occupation, as "of all the modes by
to restrain themselves, regular employment is perhaps the most
induced

and factory discipline' Historical

16 w"dg*ood ]. Cited in McKendrick N. |osiah wedgwood
lournal 1964;1'l.46.
17S".r[ A. Moral treahment reconsidered:"'p'115'
18 Foucault M. Madness and ciailization: A h try of í"!o"!V, in the
age of reason' New York:
r.ir,íoor¡. TukeS. Description of the Retreat'
RandomHouse, tüz,l.z+2.(originalinF
York: Alexander, 18t3, p'14L'
d Long Fox from
aches: See Ferriar ]'
7795,2:111-112; Fox
, sittnte neor Bristol. Bristol: for the author'
1806. (Cited in Scull')
a school for girls'
20 prio. to sething up the York Retreat William Tuke established Ackworth'
 258
Cha 7: The eenesis of

"in itself, work Possesses a

generally efficacious"2l, Tuke recognised that
physical coercion", because of "the
constraining power suPerior to all forms of
(and) the obligation to
regularity of the hours, the requirements of attention,
self esteem which Tuke valued
produce a result"22. It is also a Ïequisite of
highly.

pinel's'mofal' approach differed in several ways from Tukes', particularly

religion' a domain of
in that his asylum was "a religious domain without
recognised the value of
pure morality, of ethical uniformity"23 but it, too,
occupation:
,it is the most constønt and unanimous result of ex,perience that
as in prisons andhospitals, the surest and
in øII pubtic' àsylams,
perhøpsthesotegttørøntee.ofthemaintenanceofheølthandgood
habits and order" is the tøw of rigorously executed
mechanical

u)0rk"24.
'occupation' theme continued after Pinel's time; we read'
for example' of
The
Leuret, a nineteenth century French psychiatrist, who included exercise'
stressed improvements of habits
drama, music, reading and manual labor and
his treatment
and the development of a consciousness of society within
that 'madness' became
programs25. It was from Tuke's and Pinel's Programs
eighteenth century ideas that
associated with medicine, and from these
modern notions of rehabilitation have grown'

Despite the fact that America still retained

a predominantly agricultural

economy, it was "rapid.ly developing a

new liberal philosophy of the
individ.ual,, and it, too, embraced the concept
of Moral treatment26' in part'

21T.,k" S. Descriptionof tlrc Retreat- York: Alexander, 1813' p'156'

22Foucault M.Madness nnd ciailization: "'p'247'

23Foucault M.Madness and ciailizntion: "'p'247 '
1801) p'265' ln Foucault
24pir,"l p. Traite medico-philosophique sui I'ali"r',ation mentale (Paris,
M. Madness and ciailization""p'258' therapy source
2sleuret F. 1g40. On the Moral Treafment of lnsanity. In: Licht s' ocaryational
book. Baltimore: Williams and Wilkins'
1948'
7963'p'772'
26Bockoven JS.Morøt trentnrcnt in Anrcrican socicty' New York: Springer'
 259
Chapter 7: The genesis of

and also through the

throughthe efforts of William Tuke's son Samu"¡Z7,
insPired by the writings of
reforms of Benjamin Rush, who like Pinel, was
physician-philosopher,IotrnLocke2s.HopkinsSuggestsitmaywellbe
treatment began at a
significant that the develoPment of this Person-centred
the rights and equalities of men were being fought over
on both
time when
sides of the Atlantic2e.

opened in 1833'
The Worcester State Hospital in Massachusetts, which
served as a proving ground for moral treatment
in America' demonstrating
,'beyond doubt that recovery was the rule"3O. Thomas Story Kirkbride' who'

inl.S44,wasoneofthirteenfoundersoftheAssociation
of Medical

Superintendents of American Asylums for

the Insane' also played an

not least by his writings about

important role in establishing moral treatment,
treatment in the
the construction of asylums3l. He implemented moral
private institution which
Pennsylvania Hospital for the Insane, a prestigious
reports aimed at' amongst others'
he headed for forty years. He wrote annual

prospective customers and their families in

which he detailed over fifty
light gymnastics' fancy work'
occupations available to inmates. Thuy included
in order to meet the intellectual
magic lantern displays and lecture series and,
"intelligent and educated
and artistic needs of more cultivated clients,
feelings" were employed to
individuals with courteous manners, and refined
encourage reading, handiwork and, music
on the wards'32' He assured

2zCorsini Rj, editor. Encylopedia psychology, Vot. 2' NewYork: johnWiley & Sons' 1984'
"f
rks were 'An essny concerning httman
ent', which were both published in 1690'
Spackman's occuPational theraPY
rcntal health New York: Springer Publishing

irkebride's philosophy of asylum construction

mad-doctors qnd madmen:' See: Kirkebride
arrangements of hospitals fot the insane'

nia Hospital for the Insane'1845p'38'1846'

in Tomes N]. A generous confidence: ""
 260
7: The the
Chapter

prospective patrons that cure could be expected

in many cases' esPecially if
requiring long term care moral
treatment was PromPt, but that even in cases
moral treatment was rePorted
and humane cond.itions would' aPPly. In fact,
as curative by the suPerintendents of
the asylums who ran the programs' with
recording success rates of up to
some hospitals, such as the Hartford Retreat,
g0"/"3s. An example of the recovery statistics of patients admitted to the
used to attract ProsPective
worcester state Hospital between L833-1852 and
customers, is provided as Table 7 'T'

patients patients
5 year Period patients admitted improved
recov ered

300 211, (70 %) 3e (8.3%)

t833-37 14 (3.2%)
434 324(74.6%)
t838-42 34 (4.6%\
742 474 (63.e%)
t843-47 37 (4.7%)
791, 485 (67.3%)
1848-52

worcester state Hospital who

Table 7.1 Outcome In Patients Admitted To
Reports of the Hospital3a)
were Ill Less Than one Year (Data from Annual

of moral treatment despite

The cautionary part of the tale lies in the decline
in which it was used
its reputed success. As most of the American asylums
wefe small private hospitals, access was limited
to the affluent' but with the
social reformers pushed for
touting of the curative effects of moral treatment,
successful in
it to be available to all, not just the 'well-to-do" Th.y were so
their endeavours that the asylums became overcrowded, often with
wards, and as resources
immigrant 'insane paupers'3S, activity rooms became
the treatment deteriorated
were limited, due to a Civil war-taxed economy,
into custodial care36. Indeed, in the aftermath
of the Civil War' and the
social values and the economy were
change from agriculture to industry, both
in a state of flux. Humanistic social values were being gradually replaced by

33 peloquin sM. Moral treatment: Contexts considered. The

Anrcrican iournal of occupational
t h er aPY. 1989, 43(8) 537-544'
34 g*kou"n in community nrcntal health "'p't4'
JS-Morat trentment
35Bockoven JS.Moral treatment in American society.NewYork: springer,
1963'

36 peloquin sM. Moral treatment: Contexts consictered...

 26a
Chapter 7: The genesis of occupational therapy

'reductionist, mechanical' values associated with industrialisation' and in

suggests that as
some quarters by social Darwinism3T. Peloquin also
occupational programs deteriorated because of these factors, medicine was

reconsidering the causes of insanity in the light of new physiological

knowredge in which ideas about occupation did not seem
important. Indeed,

it seems almost inevitable that as positivist, medical science developed,

doctors would try to make their role in the treatment
of the insane fit with
doctor's role in moral
their view of their own skills, beliefs and purpose. The
treatment in the early days was as a wise authority
figure, Pinet and Tuke both

asserting that "his moral action was not necessarily linked

to any scientific

competence,,38. Foucault points out this gradually

led to a 'magical' belief in

psychiatrists and ultimately to the transfer of the potential to cure from

'natural' would be overtaken
asylum to doctor39. It was unavoidable that the
by the 'scientific'. The reported success of moral treatment was
challenged as

exaggeration, and d.isappeared from psychiatric

practice' Peloquin concludes

that:
,' Moral treatment's decline reløtes closely to a lack of inspired ofd
com,mitted leadership willing to arliculate ønd redefine .the-
[!i' ,r! *T:!n::,,,110 ,,:i:,"":r
-i!'i#:i: i! Ti[Ï] n. #,
ngei thøt had graduallY made the
-
"iii'iio,
practice ønd sLrccess of moral treatment airtuølly impossible
led to
the erroneolts concluiion thnt occupation was not an effective
interuention. "4o

about
As the effects of the industrial revolution accumulated, ideas
Such
humans being regarded as 'cogs in a machine' gained
respectability'

3TSerrett KD, editor. Ptritosophical and historical roots of ocutpational thernpy' NewYork:
The Haworth Press Inc', 1985'
3SFoucault M.Madness and ciailization: "'p'275'
as a."certain
3gFoucault M.Maclness and ciuilizntion: ...P.279 describes. psychiatric practice
'o¡ the eighteenth' centttry' pieserued in the rites of
ntoral tnctic ,ont*pornry ,i¡tl, th, ,na
n-ryt",* Iife, ancl oiertniã by the nrytls of
positiaism"'
0 pãtoq,rir, SM. Moral treatment: Contexts considered.....
 The genesis of occupational therapy 262
Chapter 7:

ideas were promoted during the late nineteenth century by the work of people

such as Frederick Taylor who developed the scientific management

movement4l. This movement sought ways to use people effectively in
industrial organisations and viewed behaviour from the vantage point of job
analysis focussed on work efficiency, particularly from a physiological

perspectivea2. Even before Taylor, though, "the drive for maximum

productivity and control led managers to divide labor into repetitive, minute
tasks. Lrdividual workers could neither envision the larger PurPose of their
labor nor exert much control over their working lives". Even for
professionals and white collar workers, such as clerks "the new bureaucratic

view of work often fragmented their labor and reduced their sense of
autonomy"43.

The rhetoric of Helen Marot's Creatiue lmpulse in Industry provides an

indication of the mood of the industrial era: "industry is the great field for
adventure and growth". "If America wants industrial efficiency, it must have
efficient workers if it holds its place among nations"44' The machine age

appeared, to herald a new way of thinking, working, living and researching.

Ackoff suggests that, as the three dominant intellectual styles of this time
were red.uctionism, analysis, and mechanism (in terms of cause and effect),
consideration of environmental factors was deemed irrelevant4S. In
medicine, as in other sciences, 'machine age thinking' led to a reductionist
view that everything could best be studied by considering comPonent parts.
In psychiatry and psychology, for example, "the observation by pathologists of

41Taylo. FW. The principles of scientific management. In: Taylor Fü'I. Scientific Management.
New York: HarPer,1947'
42IJoy WK, Miskàl CG.Educational administration, theory, research snd practice,second
ediiion. New York Random House, 1978'
Antimoderuism and the transþrmation of American culture
¡ackson Lears TJ. No place of grace:
43
L880-1.920. NewYork: Pantheon books, 1981, p' 60'
44Marot H.Creatiue Inrpilse in Industry. New York Amo Press, 7977,p. xix-xx. (Originatly
published by E.P. Dutton & Company, NewYork, 1918) '
45A.koff R. Redesigning tlrc fúur¿' NewYork: Wiley, 7974'
 occupational therapy 263
Chapter 7:

microscopic lesionsin the central nervous system of patients who had been
mentally ill" led to their conclusion that the study of behaviour and
envirorunental factors would not yield understanding of disease Processes
because it was "looked uPon as a result of mechanical defect"46.

As the therapeutic use of occupation diminished, it seems that, at least in

some instances, it was again replaced by restraint in hospitals for the insane.

In Occtryation øs ø sttbstitute for restrøint in the treøtment of the mentally ill:

A history of the pøssage of two bills through the Massøchusetts legislatur*T,

Vernon Briggs explains that in LgLL three bills proposing the introduction of
occupation into mental institutions, along with training in occupation, for
attendants, were "Strenuously opposed by certain men in high positions, most

of them connected with private hospitals as proprietors, or with the State

service for the care and treatment of the mentally ill as officials or trustees".
In his opening address to the Committee on Public Charitable Institutions he
described how patient's engagement in occupation has a positive effect on
their health and improves the work environment of attendants. He based his
information on several 'occupational' initiatives occurring in various parts of
the country; a training school for nurses and attendants in lllinois; New York

supervisors and Maine nurses sent to receive training at the Chicago School
of philanthropics, and in turn New York hospitals providing training for
nurses from Boston. With the passing of the first of the bills, Dr Mary Lawson

Neff, a psychiatrist, was appointed as director or instructor of occupational

therapy. Apart from establishing programs for patients, she reported in her
Résumé of zuork of 191.2 in deaeloping therapeutic occupations in the Støte
hospitals of Massnchusetts on the staging of an education exhibition which
visited eight hospitals and was attended by more than two thousand people;

46 Bockoven !5.Moral treatment in Atnericnn society"'p"l'89'

47v"*or, Briggs L. ocuryation as a substihtte for restraint in the treatnrent of the ntentally ill: A
"ite passag'e of tuo bitts througit tlrc Massncltttsetts legislature. (1911) New York:
Iristory of
Amo Press, 1973
 264
Cha 7: The qenesis of occupational

invitations to lecture at a variety of hospitals, universities and public

at Danvers' Worcester'
departments; a course of lectures for nurses delivered
(see figure 7'l lor
Taunton, Westbororrgh, Medfield, Boston and Waverley'
an outline of Dr Neff's lectures); and a conference on occuPational theraPy
which nearly 100 people attended4s'

Lawson Neff' M'D'

Outline of a Cotrse of Lectures on Psr¡chology W Mory

I The Nervous Mechanism

"'Tis strange that a harp of a thousand strings
Should keeP in tune so long"'

II. Fatigue
Eight-four-two-one'
il. How to PlaY
is work
"There is work that is work; there is play that is play; there
that woik - and in only one of these lies
that is play; there is play is
hapPiness"' - Gnrerr Bunc¡ss'
IV. How to Work
more
"He that hewes with a dull axe must put thereto the
strength. - TrrE Boox'
V. How to Rest
---'''It'Saheapeasiertowantwhatyougitthantogitwhatyou
want." - UNcluMosE'

VI. Habit and PersonalitY

"All the days of iot"gott" virtue work their health into
this." - Eltenso¡¡.
VII. Suggestion
,,Advice is like snow; the softer it falls and the longer it liès, the more
good it does."

VIII. Mental HYgiene

"I consider how I may exhibit my soul before the ]udge in
a healthy
condition." - PLAro'

Figure 7.1 Outline of Dr Neff's lectures

Briggs may well have

Another occupation training scheme which vernon
some credit as being the first
utilised was provided by Susan Tracey, whom
occupational therapist of the twentieth century4e. A trained nurse and

48N"ff lML. Rés,mé of work of 1'91'2 in dmeloping therapeutic occupntions in the State hospitals

Massaclutsetts'
"f KL, Sanderson SR. Concepts
49Reed of ocarpational tlrcrapy, 2nd ed' Baltimore: Wiliams and
Wiikins, 1983.
 265
Chapter 7: The senesis of

in invatid occuPations for nurses in 1906 at

teacher, she established a course
and published
the Adams Nervine Asylum, Jamaica Plains, Massachusetts,
in 19r.0s0. In the introduction
her teaching materiars in a book first pubrished
the interest of the
to this text Daniel Fuller explains how Tracey stimulated
practice came back to consult'
nufses she trained, how graduates in private
and how exhibitions and lectures were provided
to superintendents of other

schools. one interesting observation made by Fuller'

is that "the
training
elimination from the patient's mind of the idea
of 'prescription' or 'temedy'
to be desired"' He
in connection with the occupation is doubtless often much
sake enabled patients to make it
recognised that interest developed for its own

anongoingpartoftheirlifeandtomaintainandenhancetheirhealthst'This
and professionalism grew/ so
valuable concept became lost as reductionism
norm'
that 'prescribed occupation' became the accepted

\Atrhen presenting the proposed legislative change, vemon Briggs called

experts to support his claims, including Adolph
Meyer' This
upon several
,mental hygienist' is so important to the history of occupational therapy that a

brief biography is in order. Adolf Meyer was bom in Zurich in 1866' and
migratedtoAmericain]'Sg2aftercompletinghismedicalstudiesinZurich,
and studying in England, scotland and Paris with
eminent neurologist
at the Illinois Eastern Hospital
Hughtings Jackson and others. He worked first
Lunatic Hospital in
forthe Insane at Kankakee, and then at Worcester
Massachusetts. In both institutions he instigated
far reaching institutional
the leader of the advanced guard in
reforms and "began to impose himself as
viewpoint which held that life
American Psychiatry" with a then, radical

50"Th" fundamental Point in the psYchologY of occupation is that

it maintains a balance between
of experience"
the intellectual and the practical Phases
for the sick. In: TraceY
5lFuller DH. Introduction: The need of instruction for nurses in occuPations
attendnnts. Boston: Whitcomb &
SE. Studies Inaalid ocutpations: A manual for nurses and
in
Barrows, 1970, P.2'
 266
7: The of occu therapv

in the aetiology of mental diseases52' In

experiences play an imPortant role
view' Meyer was one
repudiating the reductionist, analytical and mechanistic
view which was strongly
of 'the new bleed of humanists' who took a holistic
influenced by the ideas of pragmatism propounded
by william James and the
School of Functionalism led
related theories of the newly emerging Chicago
the development of a science of
by John Deweys3. Meyer was committed' to
psychology which was both academic and
practical' He embraced ]ames's

revolutionary view that the chief PurPose

of the mind' "is to enable
achieve specific goals" and that
ind,ividuals...to Pursue specific interests and
use, "in the ordinary' practical
psychologists should study the mind in
Mead and Dewey' Meyer professed
situations of everyd.a! life"54. Along with
and that the activities expressed
that ,,doing, action and experience are being",
This view rejected commonly
in living demonstrate mind body synthesisss'
held Descartian notions of the time'

Muncie describes the fundamental concept of

Meyer's psychobiological

approach as being 'integration', with the

view that living individuals can

onlybestudiedaswholepeopleinaction,whichofnecessityincludessociety
use of the "concept of habit" as
as part of the whole56. Meyer also made
"cumulative effect of
formulated by Pierce, ]ames and Dewey, arguing that the
early faulty habit patterns was to produce
abnormal or inefficient behaviour

in later life"S7.

ow: The correspondence between

52Leys R, Evans R, Evans B, editors. Defining American PsYchoI
Titchener .. Baltimore and London: The ]ohns HoPkins
Adolf Meyer and Edzuard Bradt'ord
UniversitY Press, 7990, p.43
53l"ys R, Evans R, Evans B, editors. Defining Ameilcnn PsYcltologY:..-P'59
54l"ys R, Evans R, Evans B, editors. Defining American PsYchologY:. "P'44-45
practice New JerseY: Geri-Rehab, lnc,
55 Breines E. origins and adaPtations; A philosoPhY of
1986, p 46. See also: Golley FB.
A history of tlrc ecosys tem concePt ln ecology. Yale: Yale
UniversitY Press, 1993
Anrcrican Handbook of
56Muncie W. The psychobiological aPProach, ln: Arieti S, editor.
lnc., 1959.
Psychiatry, VoL 2. New York: Basic Books,
57L.yt R, Evans R, Evans B, editors. Defining Ametican Psychology:"'p46
 267
The genesrs of occu therapy
Cha oter 7:

MeyerwasaPPointedProfessorofpsychiatryattheJohnsHopkins
L941' His Psychobiological model
university in 1908, a Position he held until
Mental Hygiene Movement in
of human nature was fundamental to the
exPanded the scope of
which he played an imPortant role. This movement
the family, schools, workplace and
psychiatry into community settings such as
education as an imPortant component of mental
health'
prisons, and ascribed
EstelleBreinesexplainsthatitwasMeyer'sparticipationinthemental
hygienemovementwhichlinkedhimwithsocialactivists,JaneAddamsand
Julia Lathrop who worked
at Hull House in Chicago and were teachers of

Eleanorclarkeslagle,apioneeroccupationaltherapistwholaterworkedwith
Meyer at Phipps Clinic in Baltimoress

today despite the assertion

The work of Adolf Meyer is not well known
d'ominated American psychiatry for
made by some medical historians that he
remained influential until his death
the first twenty yeafs of this century and
early in his career'
in195059. His interest in occupation was demonstrated
He remarks in his L921. PaPer "Philosophy of occupational Therapy"' given at

the fifth annual meeting of the National society

for the Promotion of
TheraPY, that the first medical PaPer he presented
in the early
Occupational
1gg0,s sought ideas from his colleagues about appropriate occupations for use

with American patients. He d'escribes a long association with occupational

organised during the first
programs which his wife Mary, amongst others,
as an interest in the tyPes of education
decade of the twentieth century, as well

programs being offered at Hull House to

train nurses in play and occupation'

Meyer,sPaPeronoccuPationaltherapyphilosophywaslaterpublishedinthe
occupational
first edition of t,,e Archiaes of occupational Therøpy60.

SSBreines E.Origins nntl adaptntions; A philosophy of practice""

59l"ys R, Evans R, Evans B, editors. Defining Atnerican Psyclnlogy: "'p'162'
Ocuryational therapy 7922;
60,M"y", A. The philosophy of occupatior,ãl ,h"rupy . Archiaes "f
l.: 1-10;
 268
ChaPter 7: The genesis of occu

therapists claim him as their phitosoPher but, despite his obvious interest'
he considered
there is little evidence in his mainstream writings that
occupational therapy to be the focal point of
his life's work' Ironically'
occupational therapists are still espousing his philosophies today' whilst
mainstream psychiatry has bgpassed his ideas in favour of psycho-analysis'
behaviourism, and neuro-chemistry, for example. His approaches were,

'new' values Pertaining to health

however, remarkably congruent with many
and well-being.

Several factors alluded to in the outline of Meyers' work require further

discussion. These include elaboration of the roles of 'Hull House' in chicago'
and Eleanor Clarke
the peopte who worked there such as Jane Addams,
House was a 'settlement'
slagle, and the philosophy of pragmatism. Hull
health problems of new
house developed to meet the social, economic and
industrial society of
immigrants, and assist them to adiust into the American
which aimed at
the tum of the century. The settiement movement,
developing and improving community or neighbourhood
life as a whole'
when Samuel Barnett'
rather than providing particular social services, began
Hall in a poor
his wife and invited university students, settled at Toynbee
area of London in 1884. The movement quickly spread to America'
Neighbourhood Guild, New York (now University
Settlement) being

established in 1886, and Hull House in Chicago in 188961' The movement

continued to grow throughout Europe and Asia, and it can be seen as a

forerunner to today's community development
movement' Hull House was

to many of Chicago's ethnic communities, and served as

a second
central
polish, Russian and Bohemian
home Greek, Italian, Jewish, German,
to
aid, professional' trade'
immigrants. It Provided the venue for many mutual
and diseases. (1908).
seealso:MeyerA.Theproblemsofmentalreactiontypes,mentalcauses
Adolf Meyer' Baltimore: The Johns HoPkins
In: winters EE, editor. The collected papets of
Press, 1950-52;2:598'
Hall and the American settlement movement' Socinl seraice
Reaiau
61 Reind"rs RC. Toynbee
7982;56(1): 39-54.
 269
Chapter 7: The genesis of occupational

and grouPs62' and

educational, athletic, theatrical and musical organisations
investigative
was a centre in which, from it's inception, 'civic betterment"
research, and joint ventures with activist scholars from the university of
Chicago towards social reform, took place63'

Hull House was founded and developed by women. As such

it was an
important stepping stone in the history of feminism
and women in the
'Enlightenment' ideas
helping professions. Feminism Srew from the same
that sparked humane and moral treatment, so it is
not surprising to discover

Mary wollstonecraft's document 24. aindication tf

rights tf women was
concemed themselves
published as earlY as 179264' Early feminist activists
with securing legal rights for women in education, marriage
and

employment, with anti-slaverl, and with evangelical movements, and later

with the struggle for votes65. By the end of the nineteenth
century

educational opportunities wefe beginning to open

up for women' although
infancy66. Jane Addams was
courses on the status of women were in their

educated at one of numerous women's colleges in the American North-East'

the confidence needed to

which, it has been suggested, provided women with
forge a new type of tifestyle for women' It is interesting'
from the perspective
of occupational
of this thesis, to note her description of her own experience
later beliefs and approaches at
deprivation and imbalance which coloured her
societies in Plymouth'
Hull House. In a paper given to the Ethical Culture
Massachusetts in t8g2 she applied her own exPerience to that of other

Chicago. Grand Rapids, Michigan: William B

Eerman's
62HoUi MG, |ones P, editors. Ethnic
Publishing Co., 1984'
63Firh VK. Hull House: Pioneer in urban research during its creative yeats'
History of Sociology

1985; 6(1): 33-54'

1792' Reprint with
64wo[stonecraft M. A aindication of rights of zuomen' London: ]' ]ohnson'
England: Penguin Books' 1975'
introduction Uy Xramnick MB, ediior.-Harmondsworth,
65cri*rhu* A. Feminism. ln: Bullock A, Stallerbrass O, Trombley S, editors' The Fontana
ãirtiorory of modern thought,2nd ed' Lond
66On" of the earliest known courses on the s
étãtl"gy at the University ofJ(ansas in
es'

In: Kuper A, Kupei ¡, editárs' Th¿ socittl

8e'

7989, P.902.
 270
7:

educated young PeoPle who "have been shut

off from the common labor by
physical health' They
which they live which is a great source of ?noral and
coordination between
feel a fatal want of harmony in their lives, a lack of
"u ProPer outlet for active
thought and action" which can be provided by
faculties". She recognised that lack of occupational opportunity
is not
restricted to the and that "this young life, so sincere in its emotion and
Poor,
as pitiful as the other great
good phrases and yet so undirected, seems to me
mass of destitute lives". She described the
Hull House Settlement as "an
and industrial problems
experimental effort to aid. in the solution of the social
great city"'It is an attempt
which are engendered. by the conditions of life in a
at one end of society and
to relieve at the same time, the over accumulation
the destitute at the other"67'

Addam's beliefs about meaningful occupation, formed

by her experience'

also led to her involvement in the establishment

of the Chicago Arts and

ln !897, along with prominent business and professional

Crafts Society
Chicago, and the co-founder
people, faculty members from the university of
the first professor of fine
of Hull House, Erlen Gates starr68. Charres Norton,
arts at Harvard, and a close friend of John Ruskin,
is credited with bringing
movement to America'
the ideolo gy of Ruskin's and Morris's Arts and Crafts
Morris's views about work, and a simple life on
a 'human scale' away from
"particularly fertile ground in late
materialistic, alienating cities found
influenced along similar
nineteenth century America", which had long been
functionalist religious grouPs such as Puritans and
shakers6e'
lines by
DifferentgrouPsacceptedtheideologyilldifferentways.
,,WhileSimple-Lifersstressedfamiliør.airtuesof.discipline.and
'embodied o ir* styte tf high consumption
utork, aesthltes and
øppropriate to the deaeloping c-onsumer economy '
67Addr-, !.The subjectiue necessity for social settlements' Paper
to the Ethical Culture
Societies, Plymouth, Massachusetts' 1892'
68¡ackson Lears TJ. No place of grace: "'P 67'
Faber' 1994' p'603'
6gMacCarth y F. Wiltiant Mor-ris: A life for ottr tinte' London: Faber and
 277
7: The of therapY

educational
-*t:d, reformers offered manual training as a__ therapeutíc
of adjustment to íft'arorld of utork'"'7g
corPorate

However, because the Puritan work ethic was

so central to American

culture, Ruskin's and Morris's concePtualisation

of a 'pre-industrial
craftsperson', unhurried. and absorbed in his own creativity became
reinterpreted in America, so that eventually
no distinction was made between
"Labor! all Labor is noble and holy"
modern and pre-industrial work habits.
Ed.ward Pearson Pressey, Unitarian minister
and the founder of the New

Clairvaux handicraft community proclaimedTl' He was not alone in thiS

along with their
view, a view which enabled Arts and' Craft's leaders'
,Progressive' Contempo tatiesTz,to draw back from fundamental social change
,,a which fitted individuars
for sociar justice in favour of new kind of reform"
into emerging hierarchies, and aimed instead
at "manipulating psychic well-

being"73'

with 19th
This notion of "mental and moral growth" was compatible
which was central to capitalism'
century American ideas about individualism
on human rightsT4 zs'
its liberal democracy ideology and values focussing
Indeed, individualism, in Arieli's view "supplied the nation with a

rationalisation of its characteristic attitudes, behaviour patterns and

aspirations. It endowed the past, the present and the future with the
perspective of unity and progress"T6, and it provided an exciting and

ol, Industries and Settlement' Country

itY was named after St Bemard of

heights' Illinois: Harlan

72 See,for example: Link AS, McCormick RL. Progress ioism'- Arlington
Davidson, lnc., 1gg3; Resek c, editor.
The pågressiaes. Indianopolis and New York The
Bobbs-Merrill ComPanY, lnc" t967'
73¡ackson Lears TJ. No place of grace: "'P 79'
Reaiew 1839; VI: 208ff'
ThTh"course of civilizatio n. lJnited states Magaziye y!- Democratic
21.1.Citedin:LukesS.Indiuidtlalism'oxford:BasilBlackwe||,L973.
75l..rk"t S' I n d ia id u al i s m" "
Mass': Harvard
76Ari"li Y.Indiaiclualism and ncttionnlism in Americnn ideology' Cambridge'
UniversitY Press, 1964, PP'345-6'
 272
Ch¡pter 7: The qenesis of occu

william Draper
challenging dream for each of it's citizens. Historian John
social development of the
describes the "wonderful", "unceasing" activity and
operating in
North, fotlowing the civil war, as "the result of individualism;
an unbounded theat¡e of action. Everyone was seeking to do all that he could

himself"77. For R.W. Emerson, America's favourite Poet of

the late
for
nineteenth century, individualism was
"the route to perfection - a
reliant, and fully developed
spontaneous social order of self determined, self
humans,,78. Not for Draper and. Emelson the belief
of Marx, Ruskin and
humans in tune with
Morris, that socialism was the path to fully developed
their creative natures'

Morris's photographs
Similarly, even in Hull House, where Ruskin's and
respect for their work' the
had pride of place, as evidence of it's Founder's
Arts and Crafts ideology was reinterpreted from a socialist
to an
demonstrated her
individualistic focusTe. For example, Starr' who
'Art and Labor', devoted herself
understanding of Morris's ideals in her essay,
than "the freeing of
in her work with immigrants to "the sorace of art" rather
enabling them to work in
the art power of the whole nation and' race by
gladness and not in woe"80. Likewise, Addams
dismissed anti-modemism
of the ind,ustrial system, so that instead of
and. accepted. the inevitability
fighting for social justice against the division of
labour and occupational
sought to revitalise working
inequities produced by mass production, she
class lives by education towards best utilising
the industrial economy and
leaders she accepted that
personal fulfilmentsl. Like other Arts and Crafts
,manualtraining'was'the'solutionforindustrialproblems'focussingonthe

1867-70' Vol 1,
77Drup", l&.History of the American Ciail War,3 Volumes' NewYork: Harper'
pp.207-8-
78E-"rro., RW. New England reformers (1844) ln:Complete writings Vol' 1' NewYork 1929
étr*^utit"d by Lukes "pp'29'
S' I n d ia í d u a I i s nt "
TgMacCarthy F.Wiltiam Morcis: A Iiþ for our time....p.604'
papers' NewYork: Thomas Y
SQstarr EG. Art and labor. ln: Addams !.HtilI House mfips nnd
Crowell,1895.
81 Lears TJ. No place of grnce:"'p'79-80'
¡ackson
 273
ChaPter 7: The of occupational therapy

in contrast to others who "began with the

,,factory hand's need for fulfilment"
manual training as a
factory owrter's need for efficiency. They Presented
practical business ProPosition - a way to rePlace shiftless
or incompetent
employees with conscientious graduates of trades schools"82' This focus
helped the transformation to the twentieth century work culture
which

separates 'work' from 'living' and' from

joyful occupation, reinforcing the

belief that the work people do for a living will, and indeed should be, tedious

and demanding83.

the direction
In terms of the role of women in American society at the time,
Il1 order to
taken by the women leaders at Hull House was inevitable'
establish positions in which they could exercise their previously untapped

capacities and potential, women need'ed to demonstrate their ability to work

change, even
within dominant social values, rather than lead massive social
perceived this to be necessary, which is doubtful' Establishing
a
if they had
female workforce in the professions, and bringing to these a feminine' caring'
moral viewpoint that flowed over from their earlier, often
unacknowledged'
to the social
family or charitable duties , was, in itself, sufficiently challenging
these strong women demonstrated their abilities' and right
to
ord,er. Indeed,
be where they were, through developing their'professionalism'
in a way that

was adaptive and politically expedient'

'growth' focus nor the anti-

FIowever, neither the 'capitalist', individualist
modern socialist 'revolution' focus was successful in
creating global

awareness of the need to consider people's occupational nature in future

social planning, although both went some way

in that direction' The choice
can be viewed as one factor
of individual education rather than social revolt
a broadly based' lasting
which led to the diminution of the development of

82¡ackson Lears TJ. No place of grace: P.81'

83¡ackson Lears TJ. l'tr0 Tslnce of grace' P.83'
 274
ter 7: The of

,occupational
PersPective', and cielayed
the consideration of this view until

the present post-industrial difficulties once more raised some collective

consciousness as to it's importance' Despite
the enormous energy and
commitment of strong leaders, the exploration of
humans as occupational

beings was lost in their zeal to establish Practical ProSrams which were based
could be best
on their own concepts of how humans' occupational natures
fitted to emerging social environments. As part of this process'
the

humanist and socialist

burgeoning occupational therapy which Srew from
ideas, became bound to individualist, and medical, or other models for years

to come.

It is not surprising that workers in such an environment, in which the

recognised and utilised'
therapeutic benefits of occupation were so well
instigated classes for attendants and nurses of
the insane to learn about
,invalid occupations'. Úx 1908 Julia Lathrop, Rabbi Hirsch and Dr Graham
and Recreation at
Taylor held the first special Course in curative occupations
Hull House84. Eleanor clarke slagle completed the fourth class,
in 1911'

civics and Philanthropy as

following her enrolment in the chicago school of
a social work studentss. "FIer vigorous and
unrelenting teaching, organizing'

and championing of 'occupational training'...came from exPosure

to this

course and a subsequent commitment to these

principles"S6' She
being 'borrowed' to work
immediately assumed a teacher role herself, before
phipps clinic for action"87. In 1915 she
with Adolf Meyer in establishing "the
the Henry B. Favill School of
retumed to Hull House to become Director of
occupations, which is said to be the first
formal school of occupational

84 Breines E. Origins and adaptations: philosophy of prnctice:"'

A
85Reed KL, Sanderson SR. Concepts of ocuryational therapy...'
on the 60th
S$Cromwell FS. Eleanor Clarke Slagle, the leader, the woman: ln retrospect
anniversaryortn"ioï.,ángof thãAoTA. Tlrc American iournal of ocurpational tlrcrapy,977;
31(10): 645'648' and
87M"y", A. Address in honor of Eleanor (llarke slagle. In: serrett KD, editor. Philosoplrical -
Yõrk and London: The Haworth Press' 1985'
Itistoricat roots of occrryational tlrcrapy. New
pp.109-113.
 27
7: The of

therapyss. This started as a Community workshop

for cases of "doubtful
to usefulness if given a
insanity" whom the courts considered might retum
,,proper environment and trade"89, and incorporated a Programme of study

in curative occupations and recreation. Slagle built upon the

foundation

by Julia LathroP, incorporating the ideas of Addams' James and

established

Meyer into a program which focussed on "'habit training'

through
including the concept that
meaningfuI use of time and purposeful activity"e',
"for the most part, our lives are made up of habit reactions" and that
seraes to oaercome some habits, to
-to remedially
occupation ttstmlly
,,

modifu others and construci neTlr ones to the end that habit reactions
e\
wilt be føaourøble to the restorøtion and møintenance of heøIth'"
Director of the Bureau of
Following the school's closure in 1920 she became
occupational Therapy of the New York state Department of Mental
"re-education in decent
Hygienee2. she concentrated much of her effort on
development as normal
habits of living", following "the same growth and
education", for patients who had' deteriorated
for many years in the 'back
which spanned 24
wards' of mental institutionsg3. Her training programs,
hours each day, had the stated PuIPose of re-education
of "the patient, (a)

mentally; (b) physically, and (c) socialty according

to the individual need and
ultimate aim of the patients
to the highest capability of the patient", with the
career she developed and
return to the communityea' During her illustrious
the feminist cause' by
demonstrated, her 'professionalism', and furthered
Therapy Association'
serving in ail the offices of the American occupational
Clarke slagte Lectureship
she is commemorated by the prestigious Eleanor

88 Henry B Favill was a Chicago physician issues'

Baird Faailt: i.860-1-91.6.

89 Eu.,riti l. Henry 7977,p'87'
gOCromwell FS. Eleanor Clarke Slagle, the lea
glstagle EC.Training aides for mentnl Paper read at the fifth annual Meeting of the
.hospitats. Th"tupy' Baltimore: October 20-22' 1927'
National Society fo. ttt" Píomotion of Occupatio"ul
al Therapy of the NewYork State Department of

of ntrses in occtryational tlrcrapy' Utica, N]:

94 Shgle EC, Robeson ]HA.Syllabus for training of nurses ....P'19'

 276
7: The of therapy

awarded annually by the American Association

to an occuPational therapist
contribution to the
who is regarded as having made an outstanding
profession.

ThephilosophyofpragmatismProPound.edbyWilliam}ameswascentral
her syllabus - "the moment
to Slagle's workes. She even quoted his words in
one tries to define what habit is, one is
led to the fundamental properties of
with which our acts are
matter...habit diminishes the conscious attention
performed"e6. This utilisation of ]ames's philosophy is not surprising
in which,
because of the close association between the University of Chicago,
time, the study of pragmatism flourished, and
Hull House which was a
at this
were tried on the communityeT'
centre where the themes of pragmatism

articulated by Charles
Although a philosophy of pragmatism was first
Sanders Pierce (183g-1g!4), who believed
that an idea or the significance of
,meaning' could be understood best by examining it's consequences on
known pragmatist
human activityes, william James is the better
philosopheree.Thisphilosophy,with'functionalist'and'utilitarian'
metaphysical philosophies, and
overtones, was the antithesis of European
was closely associated with the American
way of life at the tum of the century'

James, like Marx, was much influenced by Hegel and Darwin' and
these same ideas through two routes:
occupational therapy was influenced by

of tntth. Cleveland and New York:

95 W. Prngnatis m, and four essaYs from the meaning
¡ames
Co.,1970. (Pragma tism was first Published in 1907,
Meridian Books, The World Publishing
andThe meaning of truth rn 1909).
96 slagle EC, Robeson IJ.A. SYIIa bus for training of ntffses
in ocuryntional tlwapy. Habit
Arts
through the Meyer influence, but is also central in
training is adopted from pragmatism Dewey School: The tab school of
KC, Edwards AC.The
and Crafts movement' See: Mayhew 7936, p.206'
York: APPleton-CenturY,
the LlniaersitY of Chicago' 1.896-1.903. New
97 Breines E. Pragma dsm as a foundation for occupational therapy curricula' T/te American
journal of ocurPational tlrcrapy L987 ; 41(8): 522-525'
P. 7937-7935; Vols 7-8'
98Pi"t"" CSS'Collected PnPers Vols L-6. Edited bY Hartshomes C, Weiss
UniversitY Press, 1958'
Edited bY Burkes W' Cambridge: Harvard Green
99¡ames W.Pragmatism: A new name for sonre old ways of thinking' New York: Longmans'
and Co.,1907
 277
ch 7: The genes:þ of

one from Hegel and Darwin, to Marx, to Morris,

to Hull House; the other
to Hull House'
from Hegel and Darwin, to ]ames, to Meyer and Dewey,

Mead worked at the

The pragmatists John Dewey, and George Herbert
and James' had
University of Chicago, and Dewey, along with Meyer
significant influence on therapy. This trio's influence was
occupational

because of their particular interpretations of

pragmatism' Whilst
perhaps
pierce focused on a scholarly and general concept of the philosophy' and Mead

emphasised the "subjective and relational

role of the individual in society"'

focussed on a psychological approach, as it

affected individuals' Meyer'
James

on psychiatric practice which saw "personality

is fundamentally determined
by performance", and stressed the integration
of mind and body, activity and
on education and social
habit, time and environment, in real life, and Dewey
reconstruction seeing knowledge as the resurt
of "experience in 1i1" ¡ur¡s"100.

there as counsellor and

Dewey was a trustee of Hull House, and worked
remained strong' and
lecturer. Although he left Chicago in L904 his influence
theory1O1' Indeed Tracey
undoubtedly was absorbed into occupational therapy
cites Dewey in her text o¡ 1916102 and
it is arso easy to appreciate that his belief
his view that
in active occupation as a modifier of learning and health,
a

faculties, such as 'perception',

child,s mind. is "possessed of a number of
,memory" 'reasoning', and. that these Powers develop by training like that

required for the fixing of a muscular habit", and that "to learn through work'

one experienced happiness, to win that point

of view as a daily habit is
perhaps the greatest gift bestowed"1O3,
wef€ accepted as central tenets of the

100 Br"¡r."sE.Origins and ndaptations:"'P'67'

L01¡4¡1, CW.Sociotogy and pragmatism: Tlrc higher learning in America'
NewYork:Oxford
UniversitY Press, 1964, P30
102¡.,. Tracey Sl.Sttñies in inanlid occttpations: A mamnl for rurses
and attendants"'p'2"
103¡r1¿yhs\ / KC, Edwards AC' T/re Deury Schotil:"'p'459'
 278
Chapter 7: The of occupational therapv

that PeoPle as creatures of

professionlO4. So too, is the Practical understanding
here-and-now Problems to
this world, spend their lives with a "succession of
adaptation and growthlOs'
be solved" The solving of these Problems result in
early texts he used words such as 'PurPosive activity' and
'active
In his
'holistic systems aPPfoach'' all
occupations'106, and with Meyer anticipated an
and rhetoric today107'
of which remain Part of occuPational therapy theory

foundation of the
Despite the threefold objectives formulated at the
from papers and books
National Society tn Ig17, mentioned earlier, it appears
written around the time that interest was much more centred
on the
and dissemination
therapeutic application of occupation, than upon research
therapy and their
of knowledge so generated. The founders of occupational
associateswho influenced this focus, were themselves educated, on the
orientation' The value
whole, in disciplines with a reflective, philosophicat
so that training Programs
of such a base Seems to have been taken for granted,
became based on practice. Slagle, who had
a firm concept of the profession's
all curricula until the
founding philosophies, was responsible for approving
1930's when The Essentials of an Acceptøble school
of occupøtional Therapy
were adopted by the Council on Medical Education
and Hospitals of the
'Essentials' stipulated
American Medical Association in 1935. "The original
content, but did not stipulate why that content
was to be included" and the
,,principles which the 'Essentials' were based became increasingly
upon
of the American scene, but of occupational
obscure"10a. This is true not only

therapy education world-wide. My own experience

in England' in the late

p"*", An introdttction to the philosoplry of education' Toronto:

104 J. Democracy and eclttcation:
Collier-MacMillan, 1976'
Paul' p'43'
105¡4oo." T,N. Educationnl theory:An introdttction' London: Routledge & Kegan

I wltol
grottps as We

fíce general
tne tion' nnd
í of tluln porrn uoted in:
W.W. Norton, L9

1086."¡"5 E. Origins nnd adaptations: "'p t7

 279
7: The of occupational therapy

1950's was a case in Point. The complexity of ideas which culminated in

occupational therapy were PerhaPS difficult to piece together into a cohesive
backgrounds and
whole by u small grouP of people, coming from different
working in different centfes, miles aPart. Indeed, the
importance of

documenting the foundation of the ideas which

contributed to occupational
as they formed part of the
therapy may well have been largely unappreciated
mass consciousness of the era, and because of
the seeming 'truth'of the value
that there was a need
of occupation to health it may not have been recognised
to conceptualise this value in philosophical terms' Unfortunately "the
diversity of organisation and perspective...in the absence
of a well analysed

and encompassing philosophical conceptualisation, contributes

to the

confusion and insecurity experienced, by occupational

therapists"lO9

The lack of a formalised philosophicai base

did not inhibit the zeal of early

workers who, through their actions, demonstrated

their assumption that
activity is necessary
opportunity for expression and self-actualisation through
for health. In those formative years occupational therapy was focussed

toward,s activity programs in institutions where inhabitants stayed long term

institutions were able to

for one cause or another. what the occupants of the
and by the
do was limited by the physical environment of the institutions
as psychotic disorders, tuberculosis
reason for the inmates' confinement, such
as in the garden or
or violent crime. Programs varied from 'real' work such
such as music or
laundry to physical training or dance. Leisure activities
hand-craft were also used regularly' The effects
of the Arts and Crafts
movement remained powerful, and it is of interest to note that of the thirteen
and Crafts Society in l'904
American states known to have at least one Arts
\920110' The seeds
nine d.eveloped occupational theraPy Programs before

1093¡s¡s5 E. Origins and adaptations: "'P'14'

110vysr¡ M. The Revival of handicrafts in America. Btreau of Labor BulletinlgjL;55:7573'
Eleanor Clarke Slagle Lecture
1622; Reed ff-. iooft of practice: Heritage "t-!lgg:.q:?-1986
i,*r¡rnn lottrnal of Occìrpntional Therapy 1986; a}Q):597-605'
 therapy 280
Chapter 7: The senesis of

therapy is limited to
were laid early of the widely hetd belief that occuPational
relating health
certain types of activity, despite the fact that the assumPtion
with human occupation is of much wider aPPlication. This limitation
to

the realities of life'

what was perceived. as pleasurable activity not linked to
led to the myth that occupational therapy is solely involved
in 'diverting'
impetus to meet the
patients minds from their problems. Because of the
became associated, also
needs of those deprived of occupation the profession
such as the chronically
at an early date, with people with long term problems

handicapped. The emphasis, whether reality or myth, on diversion and

chronicity, eroded the idea of using occupational programs for health and

social problems in a wider community context' Many of the ideas about the
value of human occupation in community adaptation,
in giving a PurPose to
learning and health'
life, in maintaining a balance in life, and as a modifier of
were hidden in hospital bound remedial Pfograms,
and its potential value to
the passage of time
public health on a broad scale appeared. to diminish with
affected the development
and events. Exploring how these issues, and others,
and about health will
of the professions fundamental ideas about occupation
be a focus of the next chaPter'
 Chapter 8

occupational therapy's relationship with

occuPation and health

Occupational therapy's view of 'occupation' and of 'health' has fluctuated

\
to changing values and
through its relationship with medicine and according
needs in the community and structural demands
of health service delivery'
in part' as a
This chapter explores those fluctuations and developments'
resPonsetow.H.o.andAustralianhealthauthorities'stressonthe
importance of health professionals reorienting their emphasis of practice

professionals who accept that

towards the positive pursuit of healthl. Health
basic id'eologies' current practice and
emphasis take on an obligation to review

potential for development or change. That

kind of review implies an attempt
perceptions and attitudes of
to d.iscover, analyse and understand the present
from exploring these by
the profession towards health promotion. Apart
analysing ideas which are Prevalent in debate
within the profession, an inquiry
Australian occupational therapists
to that end has been carried out in a study of
are found in appendix IV'
reported briefly in this chapter. The details

congruent with much

The basic ideologies of occupational therapy are
of healthy and quality
current health promotion ideology and the pursuit
therapy's
for clients has always been a major focus of occupational
lifestyles
subject to pressures toward
practice. Flowever, the profession has also been
affected the use of and value
reductionist, curative expectations which have
giventooccupation.ThefollowingaccountofthosePressuresonthe
profession's reaffirmation of basic
development of the profession suggests the

1 One of the five major imperatives proposed in the Ottawa Charter

for Health Promotion is the
the purs¡'it of health' The Better Health
reorientation of health professionals towards
in 1988'
Commission of Australå accepted this proposal
 with occuPation and health 282
Chapter 8:

ideologies which reflect a health promotion

orientation through occupation. It

also leads to an aPPreciation of the ways in

which occuPational theraPists may

contribute to community and public health'

,,Occupational therapy suffers from a limitation imposed uPon it by its

"regarded itself as part of a
origin in the setting of medical cafe" because it has
Throughout its
larger endeavour masterminded by the medical discipline'z'
to medicine'
twentieth century life, occupational therapy has been subservient
dominates other health Professions by "subordination",
"limitation"
which
and ,,exclusion" because it has "control over the work situation,
professional

occupational sovereignty
autonomy within the medical division of labour and
relationship has
over related and neighbouring occupations"3' This unequal
changing focus of
influenced decisively the growth, development and
medical science orientation of
occupational therapy and has contributed to the
therapists to
its knowled.ge base. More recently, the reaction of occupational
and the struggle for
that inequality has shaped the drive for professional status
emanating from
recognition. The chapter consid.ers four principle dynamics
the
this association which have shaped occupational therapy: prescription,
feminine gender bias, the pursuit of professionalism,
and scientific
reductionism. These wil be discussed in some detail
in order to clarify the

core values of occupational therapy and its potential

for development or
change.

of the American National

Dunton, one of the founders and second president
an important role in establishing the
Society of Occupational Therapists, played
medical model' under
tradition of occupational therapists working within a

ted source of community rehumanisation'

mental health. New York: Springer Publishing

Inbour inAustralian henlth care' Sydney:

edge, skill and occupational strategy: The
nily heaklt sttñies7985; 5(7): 38-47,
 and health 283
relationshiP with
ch 8:

the direction of physician#. A doctor himself,

he gained suPPort from his
or referral for patients to
medical colleagues of the necessity for a PrescriPtion
receive occupational theraPy which placed occuPational theraPists in the role

of technicians who would carry out treatment, in much the same way as
instructions' . Indeed, in his
nurses administer medications on a physician's
aimed at educating
book Prescribing occttpntional Therapy which was
and principles' Dunton
physicians about occupational therapy's philosophies
assistants whom the physicians
described occupationar therapists as technical
would d,irecÉ. In Dunton's prescription, "the division
of labor between
traditional patterns regarding
physicians and occupational therapists followed
menand.women",withconceptualisationandthecontrolbeinginthehands
of the women' Because the
of men, and the 'doing' being firmly in the hands
,,conceptualisations and the intellectual foundations" were represented as
profession"' it was not hard' in
coming from "outside the boundaries of the
add,ition, to represent outside instruction
of the occupational therapist as a
prescriptions wefe still required to practice when I
necessityT. Technically,
completed my basic training in England in 1961" I recall going through an

important 'little' ceremony, by one each graduate signed a declaration to

aS one

therapy only according to a

the effect that she would administer occupational
medical PrescriPtion'

that' until
A tong term effect of this early d.ivision of labour has been
conceptualisations were not
recently, intellectual foundations and detailed
as major comPonents of occupational
therapy education' Interest in
add.ressed
in part, because the growth of
conceptual matters became more important,

record 7913; 83: 388-389; Dunton

4 D.rr,tor, WR Jr. Occupation as a therapeu tic measure. Medical
WR Jr. HistorY of occuPational theraPY
Modern hosPital 1917;8:380-381
The American iournal of
5 Woodside HH. The develoPment of occuPational therapy 1970-1929,
ocutpational tlrcraP y 1971; XXV (5): 226-230'
Charles C Thomas, 1928'
6Dunton Jr [NR. Presctibing occupational tlrcraPY 2nd ed. Springfield:
New York: The
7 Serrett KD. Philosophical and historical roots of ocaryational therapy.
Haworth Press Inc', 1985, P'1'9-20'
 and health 2A4
8: Ooccupational relationshiP with
Cha

post- graduate programs Provided an environment

for serious reflection and
debate and the beginnings of a research
ethic. This led to a renaissance of the
therapy, and a renewed focus
original id.eas behind fhe genesis of occupational
on the need to develoP a science of occuPation9'

therapy has inhibited

The histo ry of occuPational theraPy as a Prescribed
ad'equateresearchordeveloPmentofitsuniqueviewofhealth.Because
therapy is mechanical, whereas unPrescribed therapy
is necessarily
prescribed
inquisitive and. imaginative, it has restricted the potential evolution of

so that, in many instances' the

occupational therapists as Service providerslO
,,potential to hetp clients...stagnated at the level of applying technical skills"1l'
by another discipline' much of
Additionally, because the service was Prescribed
"not arisen from' and do(es) not aPPear
the specialisation that has occurred has
which is unique to
to support the development of a core concept or Paradigm"
occupationaltherapyl2.AlthoughDuntonrecognisdtheneedforprescribers
when he
to understand the nature and scoPe of the services requested
addressed his text to referring physicians, it is unlikely that it became
Perhaps for some years there
compulsory reading in many medical schools'
'occupational' treatment Programs from those
was a degree of commitment to
intrigued by this
,new,, therapy. Indeed, the professionar riterafure of the early
which describe their occupational
years is sprinkled with PaPers by physicians

inar on research in occupational therapy in an

research commitment' Yerxa EJ, Gilfoyle E'
ccupational therapy. 1976;N:509-5t; In
as åstablisheà:n1979, and AAOT Research

awards were established in 1988' .. .,, ^

1917, as one of the objectives of the- American

pational therapy. The American iournal of

it it tlt restrictions imposed by
"
en very imaginative'
Authentic occupational therapy' The American
:7-9.
isation onthe and
iotrnal of oc 979;33(1):
to the issue of lisation'
 with occuPation and health 285
8: Ooccu pationa I therapy's

'newness' of occuPational theraPy wore

therapy programs. Howevef, as the
fascinated by an increasing
off, it is probable that most doctors, simultaneously
knowledge base within their own sphere, spent
little time considering the
'enablers' such as occuPational therapists,
benefits of peripheral therapies and
base other than medical
operating from a different premise with a concePtual
receives only Passin8 mention
science. Lr fact, at Present, occupational theraPy

in undergraduate medical training. As a result, PrescriPtions, if even

either very general' or specific to

considered, are limited to superficial requests

doctors' own treatment interests'

welcomed the
The early literature suggests that occupational therapists
association with med.icine, and. showed some
pride in the 'prescriptive'
application of occupation, which became part of early definitionsl3' This
need for a medical prescription
alignment with medicine and acceptance of the
therapy educator' to be " a
is considered by Griffin, an Australian occupational
significant
custom occupational therapy practice" which is now undergoing
in
"there are clients who benefit
change. Increasingly, therapists recognise that
need to be referred
from occupational therapist intervention but who do not
is inappropriate
via medical prescription". For example, medical prescription
for people in schools, community centres, local government
or industrial
(such as
settings, or those presenting "to the medical system with problems
cannot be identified as a disease
occupational performance difficulties) which
from occupational therapy
process"14. In such cases, clients likely to benefit
will not be referred because of lack of understanding of possible interventions

or outcomes.

occttpationnl therapy journal 1988;

14 Grilfir, S. Conflicts in professional practice. Attstralian
35(1): 5-12.
 and health 286
8: relationshiP with

In common with other 'subordinate' health professions, occuPational

therapy was identified early in the piece as women's

work' Indeed, by 1938
male students and for at least
only one training school in America accepted
another decade aboutz.s% of occupationar therapists were men15. At the
'nly
Australian schools' even in
university of south Australia, which is typical of
male students make uP, at the most, approximately L0%
of the first
the 1990's,
year intake. Anderson and Betl suggest that the female nature of the
may in fact reflect its growth during two world wars when
most
profession
"able-bodied men" were COmmitted "tO the front line"' and "their

rehabilitation had to be und,ertaken by women"16, but Frank argues that this

not account for the very low representation of men in

the profession in
d.oes

subsequent decadeslT. In common with

other 'subordinate' hearth professions,

the founding physicians and therapists claimed

that women have special

aptitudefor such work and that assumption remains widely acceptedls'

"less educated or advantaged

The female founders, who blazed a trail for
women',, were, on the whole, from the upper
middle class, well educated, and

immersed in the advancement of careers for women as well as the conceptual

found,ations of occupational theoriesle. Despite
their proto-feminist impetus
to medicine' in
and convictions about occupation they accepted subordination
of uPPer middle class
away similar to the gender segregation that was a part
domestic arrangements of the day. From about 1750 to 1950' in America'

Spackman's Occttpøtional therapy' Sth ed'

.4.
lace in Australia's history'sydney: N'S'W'
p.2.
ational therapy.The American iournal of

hia: WB Saunders, 1915; Fuller D, Introduction'

.'.A manual for nurses and attendanls' Boston:

"*"

o: Frank G. Opening feminist histories of

occuPational theraPY"'
 287
Chapter 8: Ooccu relationship with occupation and health

increasing industrialisation, accomPanied by a growing

demarcation between

the world of paid employment and home, generated

a "cult of domesticity", a
'feminine ideal'2.. The
recognition of difference in gender traits and of the
voice, gentleness' patience'
attributes of this feminine ideal, such as "a kindly
abitity and seeming vision, adaptability...and...an ability
to be honest and firm"
and fostered a 'service to
were deemed important for occupational therapistszl,
medicine,orientation.The bias cast by the 'feminine ideal' was conducive to
attention to children
therapists tending the sick and infirm, $iving particular
homemaker and
and the elderly, and choosing self care and care giving,
creative occupations in preference to social activism which challenged
occupational practices of the day. Úr some countries, until recently' this was

reinforced, in part, by legislation which separated medical and vocational

rehabilitation22.

The gend,er-biased focus remains true of today's practice although the

occupational health and safety
current emphasis on, and legislative changes in,
have opened the doors to increasing numbers of
occupational therapists

working within the 'employment' arena. Another attribute

of the 'domestic
therapy practice
cult', which was frequently incorporated into occupational
until recently,was the skill of 'making-do' to save money' for example'
making splints out of discarded materials, or begging for equipment or

hardship such thrift

materials for patient's projects23. In times of economic
services reflect the dominance
should be admired, yet the most lauded health
advanced and
of materialistic values and are those that are technologically

New
20cott NF. The bonds of womanhood: "Women's sphere" ln: Neø England 1780-1835'
Haven: Yale UniversitY Press, L977'
2lstagle EC. Training aides for mental patients. Archiues of ocuryational therapy|g22;7:71'-17'
P.L2.
Z}iacobsK. Occupational therapy: Work related
Little, Brown and ComPanY,1985'
ù
o

's lristory.-..P.147
 and health 288
Chapter 8: OoccuPational therapy's relationship with occupation

of the new and exPensive has also

hence, very expensive. This privileging
services whenever economic
contributed. to reductions in occupational therapy
(a medical work) has been
retfenchment was aPplied. Similarly, life saving
protected during retrenchment relative to quality of life (the sPhere of

subordinate therapies). Such Protection is also

held to reflect the value given
Saving the life
to saving lives (whatever the outcome), over quality of life2a'
of brain damaged motor vehicle accident victims, at great
financial and

expense, to live the life of a vegetable, is a case

in point' The life
emotional
commitment to long term
saving procedure is given Preference over economic
disabled such as
rehabilitation for them or even for others who are chronically
after the first
for many fotlowing stroke, in which Programs usually stop
for at least two years'
couple of months, but potential for recovery continues
Occupationaltherapists,who,,aredrivenbyamoralconcemforthe
have been (largely unheard) advocates for the long term
individ.ual"2s,
of the chronicaily disabled. Bockoven describes occupational
rehabilitation
therapists as veterans "of many battles fought to
win respect for the
and valuable assets as a
ind.ividual". He suggests they have acquired unique
acquaintance of every
result of "many decades of adversity", of "first hand
insecure people"' and
conceivable kind of deprivation endured by imprisoned,
a token performance because they
of being forced by circumstances to engage in
had. available to them "only a tiny fraction of
what was needed to meet their

needs"26.

of a century
In Australia, in a way similar to North America, but a quarter
later, ,,pioneering occupational therapists and members
of other female

24 Shuot o.t suggests that the medical model was committed to a science
and technology successful
life worth living.(Sharuron, PD. The
in prolonging life but ignoring conditions that make
iournal of ocuryational therapy,
American 1977;
derailment of occuPa tional theraPY. The

ted source of community rehumanisation'

y mental henlth. New York: Springer Publishing

cted source. -.P.220.

 pation and health 289
Chapter 8: Ooccupational therapy's relationshi p with occu

dominated. professions at the time...accepted their role within the health

service structure which placed men in the position

of Power", believing that
"receive the
"only through the medical profession could occuPational theraPy
it deserved2T. This remained true until the more
status and independence
recent challenges of feminism brought about a questioning of health Practices

based almost wholly on a male view of the world'

Gender segregation has Provided some advantages

to women occuPational
their success in
therapists in terms of their own 'economic emPowerment',
from male comPetition' and
seeking advancement because they were sheltered
their contribution to "a professional environment shaped
by women's culture'
This caring culture was
with its emphasis on care rather than competition"2s'
sympathetic to the needs of mothers to work part-time as more and more
female professionals' remained
occupational theraPists, in common with other
in, or retumed. to, the workforce?g. However, Some see that these feminine
profession3O' Eventually the
advantages also weakened. efforts to upgrade the
female work-force, the small numbers3l, the difference
in the
predominantly
discipline's emPhasis, aggravated by the division
between concept and

implementation, led many occupational therapists

to Perceive that
professional colleagues and, society undervalued
what they had to offer' This

in turn led to them und.er-valuing their own contribution' tending not to

27¡¡1¿s¡sqnB,BelI l.Occtryational therapy: Its place in Australia's history""pp'5'

221"

28r.uok G. opening feminist histories of occupational therapy...

rapists. Part 1- Descriptive study'

'T:HI^';:I:',j'i,ffi,,*,
married: Damaging to the occupational therapy
ional therapy t975; 29(10): 601-605'

1983;30(4): 761'-164'
 290
Chapter 8: Ooccu relationship with occupation and health

being willing to adapt these

broadcast their distinctive and different views, and
to socially valued and dominant Practices'

The most obvious symbol of medical autholity was the long

standing

therapy professional
pfactice of having physicians at the head of occupational
associations. With the exception of Slagle, the presidents of the (American)
mostly from the medical
National Society for its first three decades were men,
profession. when the Australian Association of occupational
Therapists

(A.A.O.T.) was formed, the Articles of Association required

that the president'
for membership of'
and,one vice presid.ent, had. to be a member of, or eligible
the B.M.A.. The South Australian branch of A'A'O'T' had
a physician as
medicine might have been
president untit 1976. A collegiate association with
one manifestation of occupational therapists seeking professional
stahrs'

equates professional
although the classic conflict sociology of professionalism
appeared to
status with autonomy and self-control3z. Medical Patronage
provide the security of fecognition and acceptance of
the 'specialty" growth

through referral of clients, and allies in the exclusion of potential

competitors33. It also provided one boundary of
professional interdependence
from other
from which to negotiate other boundaries with health workers
over division of
disciplines, with whom there was a potential for conflict
Iabour, such aS physiotherapists, social workers, nurses
and orthotists3a'
and expansion of roles
Indeed, tension around issues relating to preservation
amongst health care workers has continued throughout
this century3s'

.The making of rehabilitation: A polítical

Berkeley: iJniversity of Califomia Press, 1985'
op. XIV-XV.
3a.^crit"". G, Arluke A.The making of tehabilitation:...pp.707-8.
35 For example: In a forum to discuss t al imperatives and the boundaries of professional
physiotherapists, nurses' social workers'
practice ir, ,"t uUitiiu;i"" " panel of
trists,
 with occupation and health 297
Chapter 8: therapy' s relationship

offerings of such
Medical acceptance, and Preference for Particular
"autonomy and independent
professionals, acted in a way which restricted
decision making"36'

is a much discussed phenomenon of the health domain in

Professionalism
with the limited
the twentieth century37' The next Paragraph deals' briefly'
occuPational therapy's
question of whether Professionalism has affected
to the association between occuPation and health' It is clear
that'
commitment
in order to carry out their work as part of the medical team, it was essential for
other members and therefore to
occupational therapists to aim for parity with
aspire to being a Profession.such parity would give credibility to the
occuPation and health and
proclaimed importance of a relationship between
knowledge' and a
justify ,,prolonged specialised training in a body of abstract
collectivity or service orientation" based on asPects
of this relationship3s' On
towards professionalisation'
the debit side "the striving of occupational therapy
based on a male medical model, has led
to mental struggle for its practitioners

who feel unclear about their role and where they fit
into the health care

delivery SlStem"39. Indeed, when responsiveness to

medicine'

more importance than

professionalism and. 'market place'survival assumed

issue, that all have experienced a "sense of

and occuPational therapists agreed on onlY one
occupational boundaries. See: Rothberg JS.
threat, attack and hostility" with regard to
practice in rehabilitation.
Territorial imPerati ves and the bor:ndaries of professional p.397
Archiaes of PhYsica I medicine and rehabilitationl9Tt;52:
397-412,

36criffit S. Conflicts in professional practice""

ssionalism: A sociological analysis' Berkeley:

Calrf.ornia, 7977-
38 Goode W. Theoretical limits
semiProþssional and their
39c.ifflrr S. Conflicts in Profess
occupational therapy as a professionalgrou Criffin
occupational therapy, Cumberland College
S. Cånflicts in professional practice""
 occu pation and health
292
Chapter 8: Ooccu pational therapy's with

the original premise of occupational therapy, as

it did for the large number of
during the sixties and
occupational therapists who reiected occuPation
seventiesin favour of interventions such as 'counselling', 'handling
reduced its unique
techniques', or 'biofeedback" occuPational therapy
of occupation illustrates how
contribution to health services4'. The rejection
way, as a deterrent for
the need for professional recognition acted, in some
based on the central concePt of the profession
during these decades' but
practice
the need for an exclusive body
ironically it was also responsible for prompting
of knowledge which culminated eventually in a return to older
values

associated with occuPation'

in clinical research' by
At about the same time, an interest was also generated
pressure for scientific proof of effectiveness
from the medical profession as a

requirement of their recognition of the profession's

worth' occupational
from medicine to be
therapists seem to have welcomed the Pressure
,scientific', to develop a reductionist base for practice and to bring their practice

in line with more conventional remedial approaches. Although, in recent

quantitative' reductionist'
times, many are questioning the appropriateness of
contextual behaviour, research
research methods in the study of complex and
to occur, and methodological appropriateness
within these boundaries began

was seldom debated'

'doing'
In the light of current thinking the basic philosophy that actual
development, achievement and
provid.es people with a vehicle for growth,
occupational therapists this
health appears to be a holistic concept. To earlier
mechanistic and
same philosophy appeared compatible with the reductionist'
 293
8: OoccuPational rela tionship with occupation and health

For example' early as

prescriptive notions of much of the twentieth century'
as

'occupation' as specific
Igt4 Barton sought to discover and' Provide an
and muscle4l' and many
treatment for diseases of every seParate organ, ioint
early texts descrlbe steP by step Procedures
for
Particular occuPatiofìs for

particular problems. Swain and Taylor, a case

in point, found that "a joint will

increase its rangeof motion with the correct amount and kind of work' but
will stiffen if the treatment is the least bit overdone", and so devised a system
strength which they recorded on
of measuring joint movement and muscle
these charts and the condition of
charts. The "work (was) govemed entirely by
the of measurement was also used with tuberculous and
join1,,4Z. This type
today in neurological'
neurological patients and is still deemed important
cardiacandhandrehabilitation.Eveninthetreatmentofpatientswith
psychological problems reductionist, analytical emphasis was evident'
a
analyses action into steps'
Canton explains that just as a "psychologist
emotions into simpler component feelings,
a thought Process into its various

aspects" so should an occuPational therapist

clearly define and analyse the

work into "its various phase5"43'

'time and motion' tradition of

The practice of 'activity analysis', in the
Frederick Taylor, and in which occupations
were systematically analysed for

comPonentpartswhichmaybeusefulforparticular'treatment'effects,was
and diversification of
first implemented in the 1920saa. Continued growth
Reaiew 79L5;54:138-140
41 Barton G. Occupational therapy.Trained Nurse Hospital
2swain LT, Taylor M. occupational therapy f9r ure patient crippled by chronic
91$onjedic
disease. occupatio,iat theiapy and
rrlubilitotionlg2s; rV(3): 171-175.
43currton EL. Psychol ogy ofoccupational therapy' Ocurpational therapy
and rehabílitation

t923;2:347.
44woü" Rt.History of occupationat
'""*.:::i;tiÍï,i"",iiiil;:î:,YïJ"""îU;iiäti"ä"
hostile
propu.ties of ocËupatións such as creativity'
åahiy testing and group relatedness' She later
clude other p-f"íti", ,.rãh ur rñotoi, sensory
integrative, cognitive
piåler'CS' Psychological evaluation of occupational
and socio-cultural components. S"e' th"'pyt948;1:284-287;FidlerGS'
therapy activitiis.ihä American ¡0"*A- of occip.ati2nil
therapy. New York: Macmillan' 1954;
Fidler Jw.lntroaictiotn to psychia'tric occipationøt
commttnicàtiot process in psychiatry' New
Fidler GS, Fidler fr'.Onn,prtíonol thera,py:'A
 and health 294
ter 8: Ooccupational therapv's relationshiP with

occuPationaltherapyusingthismethodologywasencoura8edwithinthe
'certain' and 'rapid'recovery from disease
medical model. To ensure the most
in occuPational
or injury, occupational therapists became exPerts
,reductionism', analysing the rates of resPfuation and blood circulation
strength and extent of
resulting from activities, measuring the character,
movements utilised by activities, and
judging the quality of mental Processes

reasoning, judgement, attention and emotion which

may
such as motivation,
from activities4s' Kielhofner and Burke suggest that
be demanded by or result
years to psychoanalytical'
occupational therapy was limited for many
which provided Precise and
kinesiological and. neurological treatment models'
extensive methodology, despite loss of the Profession's underlying
models and
philosophfi6. This adherence to medical science reductionist
priorities, Shannon argues, resulted in 'the derailment of occupational

theraPY'a7.

philosophical premise was

However, the reduction of the profession's basic
following Prevalent "medical"
probably gradual and never comPlete: although,
treat symptoms' it was usual
model values most therapists d,id evaluate and
the perspective of a client's social as
practice to view aims of treatment from
Russell, for
well as psychological and physical needs. In 1938,
example'

because activity also provided a

described activity as nature's best physician
happiness, to leam to relate
medium for patients to gain self esteem and
effectively with others, and to re-establish a path towards the realities of

to competence' The American journal of

York: Macmillan, 1963; Fidler GS. From crafts
Fidler GS. The activitY Iaboratory: A structure for
occupat ional theraPY 198L; 35:567-573;
and behavioral strategies. (P 795-207) In:
observing and assessing PerceP tual, integrative
ln psychiatric occupational therapy' Thorofare,
Hemphill B, editor. The eaaluation process
NJ.: Charles B Slack, 1982. C Thomas'
45 Dunton JI'NR. Presctibing occupational therapy,2nd ed' Springfield: Charles
t946.
46 Kie[rofner G, After 60 Years' Anterican journal of
ocuryational
therapy The American jottrnal of ocuryational
47 Shannon, p D
theraP Y, 7977 ; 37(4): 229 -234'
 295
8: onal therapvrs relationshi p with occupation and health

community lifeas. This view Prevailed into the time

of my own exPerience
sixties, in an occuPational
when working in physicat rehabilitation in the early
a founding British occuPational
therapy program established by Mary s Jones,
Despite a very
therapist who had originally trained as a Physiotherapistae'
patients who attended five
reductionist orientation which, for the hundred
day', included specific attention to
days a week for a large Part of each'working

a dysfunctional body part, the intervention used occupation for treatment

in their everyday
which would lead to 'occupational health and wellness'
Iifestyles. For examPle:

the fibula
Allyearold fitter and turner who sustained a fracture of
and tibia in a motor cycle accident progressed through
an

occupationalprogramworkingonwoodandmetalturninglathes,
seatedonabicyclestoolwithhisl.gslungtostrengthenhis
quad.ricepsduringthenon-weightbearingperiod;standingand
progressivelyincreasingtherangeofmovementofhisleg,
that he could
maintaining work tolerance and skills, and ensuring
return not only to his paid employment but to his
other maior

interestinfootball.(Seeplates8.]._3.6onthenextPage.)

A 56 year old man had an arthrodesis of the hip

to reduce pain and

dysfunction due to osteoarthritis' His occuPational Program

included alternative methods of self care to maintain his

independence,re-educationofmobilitypatternsutilisinguneven
groundingardeningtasks,checkingouthispotentialtoretumtohis
formeremploymentasabuilder,anddevelopingnewskillsto

4SRussell Jl. TIrc ocuryational treatntent of mental íIlnes. London: Bailliere' Tindall and Cox,

1938.
49 An approach to ocuryational therapy' London: Butterworths' 1960'
¡ones MS.
 and health 296
Cha 8: therapv's relations hip with

Fig. 8,2: Increasing range of movement Fig' 8'3: Managing uneven surface
Fig. 8.1: Strengthening quadticeps

rtill

Fig. 8.4: Work hatdening

Fig. 8.6: Leisure skills

Fig.8.5: Workskills
 p and health 297
Chapter 8: Ooccupational therapy's relationshi with

.'å,

Fig. 8.7: Alternative self care skills

Fig, 8.8: Mobility/balance practice

Fig.8.9: Assessing potential to return

to previous emPloYment Fig. S.1û Revision of skills for new employment'

Fig, 8.12 New emPloYment

Fig. 8.11: Practicing public transport

 and health 298
Chapter 8: therapy's relationshiP with

enable re-entry into employment in a different caPacity as a building

site foreman. (see plates 8.7 - 8.12 on the preceding
page.)so

In the foreword to Jones's Approaches to occupøtional Therapy c'w'

realise how great is the part
Guillebaud notes that "the reader is brought to
(patients) to an active and
which occuPational theraPy...can play in restofing
and valuable economic as
productive existence", in providing a "highly useful
as human service" which is "of the greatest importance for
the
well
psychotogical well-being of the individ'ua1"51. In her final summary Jones
identifies the necessity for occupational therapists to experience "wider
opportunities for studying productive activities"
and to "spread from the

corrective to the preventive fields of study"S2

developed as a result
As part of the "fapid" expansion of knowledge which
of the work of specialist therapies during the early part
of the century'
,rehabilitation' developed a new medical specialty with which occupational
as

therapy aligned itself closely, and which remained

a clearly identified
component of health care for about twenty yearss3'
It grew from the earlier
theories with physical
notions of 'reconstruction' which combined ed.ucation
had been developed to
medicine and, especially, from the programs which
The aftermath of this war led to
rehabilitate the second world war's wounded'
a rapid growth of allied medical services,
including occupational therapy' in
growth was aimed at
many countries including Australiasa. In part, this
photographed for display at the
50 Th"s" examples of patients' occupational programs-were held in Phitadelphia 1962'
World Federation o'f Occupationài tneraiistJ Conference '
MS. An npproach to occupational therapy' l¡ndon
51 G,rill"b.und CW. Foreword. ln: ]ones
Butterworths, 7960'
S2¡onesMS.An npproaclt to ocuryational theraT¡""p' 312'
53Krrrr"., FK. History and development of phy:fu_l *"in-: rn: watkins
AL, editor' Pltysical
jB Lippincott' 1946' PP'5'8'
medicine in geneial practice' Þnitua"tpftia:
ft Society of Queensland, part 2: lÂ/hatever
:73-76.
ground' in Australia until the nineteen
iitn"d and influential here as it was in the
becnnrc inaolaed with remedinl teaclúng for
 with occupation and health 299
Chapter 8: therapv's relationshi p

social, vocational
meeting patients' complex, multiPle physical, Psychological,
in
and economic needs. occupational theraPy benefited from being obviously
tune with the stated rationale of rehabilitation
but it was the 'physical' asPects
factor, rehabilitation's medical
of rehabilitation which became the dominant
specialty being known as 'Physical medicine'.
An indication of this dominance
who reviewed
is available in a study by Canad.ian occupational therapists
1950 and 1969 and found
articles published in their national journal between
on some asPect of physical medicine' and only 27'/"
on psyche
73o/o focttssed

social concernsss.

The biased emphasis on the physical aspects

of rehabilitation was part of the

reason why the "vogue enjoyed by physical medicine and rehabilitation in the

The specialty has since been rejected

late 1940's and early L950's passed' quickly'
few "pockets of
by much of mainstream med.icine", and by the l'980's only a
institutional strongholds" remain56. In Australia,
the huge rehabilitation
service have been closed
centres built for the commonwearth Rehabilitation
in favour of a 'case management' system which buys in specialist
down
services according to individual need57.
The newer model meets the needs of

those with recent problems, rather than those

of the chronically disabled who
There are now few
were seen as a major target grouP for rehabilitation'
servicesfor this latter grouP, but Shannon suggests that the rehabilitation
goal of total care of the
movement was not able to achieve its holistic
into a reductionist mould' and
chronically disabled because it too was Pfessed
was poorly resourced. The Poor resourcing, even
at a time of
also because it
apparent public affluence, reflects medicine's lack of "professional

returned seruicemen in the enrly years of

the 1'914-L9L8 zuar and' in fact, went into recess to

(p'73)'
ftilty dwote itsetf to tlrcse aims" sixties"'
S5grinu'r"ll ES, et al. The fifties and
56c.itr", G, Arluke A.Ttrc making "f rehabilitntion..p.158.
in Australia
57Thi, organisation is the largest single employer of occupational therapsts
 with tion and health 00
8:

enthusiasm" in the specialty which, to some extent, became the 'dumping'

59'
ground for medicine's castoffs5s

There can be no doubt that ongoing responsiveness

to a philosophical base

espoused, and
other than that which occupational therapy originally
occupational
prescriptive interventions applied 'second hand', encapsulated
therapyformanyyearsasaprofessionworkingtoremediatesickpeoplewithin
During the long
institutional settings operating on a medical model'
association with medicine occupational therapy adapted its practice as new
id.eas and developments occurred. It particularly embraced the concepts of
neurophysiology' normal
psychobiology, reconstruction, rehabilitation,
treatment
developmentand, more recently, community health care' Specialist

programs waxed and waned accord'ing to medical Progress' priorities' interest

andfashion.ForexampleMeyer'spsychobiologicaltheories,whichmeshedso
with occupational therapy, were gradually discarded as
"naive and
well
which fitted better with
oversimplified" in favour of Freudian psychoanalysis
reductionist fervour60. Although less comfortable
with this approach'
therapists worked at opening "avenues for need
fulfitment and
occupational
activities so that
ego maturation", and included regression in treatment
gratifiCation" to meet unsatisfied
patients could achieve "actual or symbolic
needs61. Graduated activity, according to physical and respiratory demands
with tuberculosis' declined
which were developed. for the treatment of people

5SPiersol GM. Editorial, The doctor shortage in physical medicine.

American iournal of physical
Howard Rusk's statements about the very few PhYsicians who
medicine 1956;35(8): See also
of rehabilitation in Rusk HA. Tomorrow is not
attended his lectures addressing the toPic
Archioes of physical medicine and
rehabilitationT966; 47(5):
yesterdaY.
jotrnal of occupational
S9shuttttot, P D. The derailment of occuPational therapy The Ametican
th er aP Y, 1977 ; 31(4): 229-234'
60 Serrett KD, editor. Philosopltical and historicnl roots of ocutpntional-- thernpy.New York:
an
1985, p.22; See as mple of the þrocess and effects of the change from
ap rches: Kubie L'The Riggs sfory' New York:
fty.fit*"fydcal
and practice in ocuryationøI therapy'
61 Ki"[.ofr,er G.Health throttgh occupation: Theory Lnique contributions of occupational
philadelphia: FA Ourri, Collg 83, p.36t Fidler G] Some
therapy ir, t.eurrnJri'.1ih" schizåphrenic.
Tlrc American iournnl of ocurpational therapy
7958;12(9): 36'
 301
Ooccupational relationshiP with occupation and health
Chapter 8:

and Prevalence of the disease62' With

as chemotherapy reduced the incid'ence
disease graduated
the increase of 'modern epidemics' such as cafdiovascular
affected by such diseases to
programs have been reinvented to assist PeoPle
were developed to
return to 'normal living'. specific techniques which
the physical problems of children following the polio
epidemics of
ovefcome
the 1.940s became obsolete for that PurPose with the decline of the disease

Flowever these
foltowing the sabin or salk vaccine prevention Programs'
techniques provided the basis for other work
aimed at neurologically-impaired

and adults with physical disability' As patients

with permanent or
child.ren
began to be discharged to their
temporary physical or psychological disability
occupational therapists
homes and jobs more frequently and earlier63,
expanded their practice to include activities
of daiþ living (ADL) and of work'

therapists increasingly
From the late l-950's to the present, occupational
for all types and age
followed compensatory rather than remedial objectives
gfoups of clients, as retraining in activities of
daily living (ADL)' aimed at

independent self care, assumed priority in

a health care environment
committed to ,fast turnover, of patients. It is arguable that ADL is currently
thetermusedbythemajorityofoccupationaltherapiststodescribethecentral
in a variety of ways
their domain of concem, although it is a term used
focus of
ranging from self care activities such
according to the focus of the intervention

as showering and dressing to the whole range

of domestic or vocational
pursuits6a.

62Arrd"rronB,Bell J.Ocuryational therapy: Its plnce in Australia's history""pp'

39,!5 4,156,158,200 -202,223'
In this article Frank Dargan, a Sydney trai¡ed
versals of old theories" such as patients being
being enabled to retum to home and work '
n of"the Sydney Occupational Therapists'
Club)
therapy expertise'
64 Thornton G, Rennie Activities of daily fivlqt-fn.Tea of occupational
H.
49-58'
Atstralian ocutpationnl therapy iournnl1988; 35(2):
 and health 302
8: onal with occu

occupational therapy has also been adapti're

to the influences of other

it has been closely associated throughout its historY' h

professions with which
educators, psychologists, physiotheraPists and social
workers'
particular to
Integrated within the profession's Programs are interventions and strategies
based around work as diverse as that of Piaget, Ericson' Frostig' Voss' Kabot'
Rogers, skinner, Luria' Benedict
Brunnstrom, Bobath, Kubler Ross, Maslow,
Mead, Maxwell ]ones and Travis.
in both remedial and
Its interest

compensatory equipment and devices and

splints to aid in overcoming

has also made it receptive to technological development

of new
disabitity
materials and computers. Its commitment
to an integrated view of mind' body
berief that it offers 'holistic'therapy,
and environment has red to a professionar
'sick' rather than'well' populations'
despite its more obvious concern with
and individuals rather than communities'

been discussed in the

Within the context of the dynamics which have
previous paragraphs, the chapter now turns
to consider the renaissance of
theory and practice'
occupation as central to the profession's

Againstabackgroundofwesternsociety,swidespreaddissatisfactionwitha
'new' critical social science with
materialistic, technologically-driven society, a
an activist conception of human beings began
to emergees' based on notions

propounded by Marx in his earlier works66,

to a lesser extent on Rousseau's
'free will' and a capacity for
view that humans in a 'state of nature' express
,self improvement'67 and, more recently, by critical sociologists of the

65FrankJurt H' Freedom of will and the concePt of a Person' lournal

of PhilosoPhY L971,;67(1):5-
Cambridge UniversitY Press,1976 (chapter 3).
20; Bennett J. Lingistic behaaior. Cambridge:
See also TaY lor C.Hunun agencY
and language. Philosophical PaPers, Series I. Cambridge:
Cambridge UniversitY Press, 1985, Part
1, L3-114.
reader. 2nd ed. New York Norton, 1978'
66See for examPle: Tucke r RC, editor.The Marx-Engels
GDH. London: Dent,1968'
67Ro,ttt"unlJ' Discourse on the origin of inequity' Translated by Cole
 and health 303
8: therapv's ¡elationshiP with

that
'Frankfurt school'68. Fay argues that critical social science assumes
,,humans are active creatures", who as a consequence of their "intelligent,
"transform themselves and their
curious, reflective, and wilfuI" behaviour can
societies within certain wide limits"'"6e'

Similar social and intellectual d'iscontents were expressed

by occupational

therapists, who had their own Perceptions of

the inadequacy of reductionism'

began to question the 'medical' establishment

and their own direction and' in

Some cases, returned to the earlier conception

of humans aS 'occupational
(active) beingsJ Mary Reilly, an occupational therapy educator at the
Southern Califomia led the way by looking backwards
at the
University of
('slagle') lecture
profession's basic premises. Lr the 1.96L Eleanor Clarke slagle

she proposed that the original hypothesis

of occupational therapy can be stated
,,that man through the use of his hands as they are energised by mind and
as:
that although
will, can influence the state of his own health"70. she postulated
the'First Principle', from which medical science draws its premise' explains
'Second Principle' is for humans to
the nature of humans is to be alive, the
growandbeproductiveandshemaintainedthatoccupationaltherapyshould
principles "merge into a
derive its premise from this principle. The lwo
concept of function which asserts that both
the existence and the unfolding of
the same thing"' In language
the specific powers of an organism ale one and
as part of the health-
in line with my own theories about occupational needs
"the power to act creates a need
survival 'package' set out in chapter s 2, 5 and 6,
results in dysfunction and
to use the power, and the failure to use the power
the 'sensitivity" 'adaptability''
unhappiness,,. Reilly's concept was based on
,durability' and 'creativity' of humans in tune with their environments' based

6sHorkheim er M.Criticnl theory.1968 (1972); Marcuse H' Eros nnd

ciailisation' London:
nrtd httman interests" Translated by McCarthy T
Sphere books, rgos;'Hou"Ãu í¡.xrowkag,
Bãston: Beacon Press, 1973'
University Press'
69 Fay B. Critical socinl science: Liberntion and its /lrr¡ifs' New York: Comell
1987, p'57.
70 nei[y M. 1961 Eleanor Clarke Slagle Lecbure""
 304
Chapter 8: Ooccupational therapy's with occupation and health

and laboratory testing

on ideas from theorists such as Lerner and From-71,
such as that on sensory deprivatioil2'

over the sPan of some

Foltowing this inspiring lecture, in a series of articles
15 years, Rei[y initiated the development of an
'Occupational Behaviour'
recognised might help overcome
paradigm of practiceT3, which other therapists
occupational therapy's tendency to comPromise
"its unique philosophical
philosoPhy" of other
traditions in order to accommodate to the Predominant
'occupational Behaviour' as "the entire
medical specialtiesT4. Reilly defined
deveropmental continuum of play and work"75.
The definition acknowledged
that motivated and
the importance of economic skills, attitudes and interests
enabled clients to survive in an increasingly complex technological world' Her
'wired'' into humans through the
model, which accepted that occupation is
of evoluti oî76,stressed the importance of examining life
roles relative
process
the various skills that support these
to community adaptation; of identifying
relevant behaviour can be evoked
roles; of creating an environment where the
focus of behaviour
and practiced.; and using occuPation as the integrative
change. By placing emphasis on interpersonal relationships and on
individual's ability with the community and with changes in life
to coPe

situations, and because "both the well and

the sick population" could be

E'The fear of
71L"m". M. America as a cittilisation' New York: Simon and Schuste r 1957;Fromm
is associated with
Routledge and Kegan Pa ul Ltd, 1960. Note: Fromm
fr e ed om. London: School.
'critical social science' and the Frankfurt
University Press'
72solo*ot P, et al. Sensory dePriaa tion. Cambridge, Massachusetts: Harvard
7961.

ional theraPY, 1977 ; 31(L0): 673'

al therapy for community health, The American

an iournal of occupational therapy \969;23:299-

307.
76 Reiuy M. plny as explorntory learning. Beverly Hills, Ca: Sage Publications' \974'
 health 305
Chapter 8:O occupational therapy's relationshiP with occupati on and

accommodated "without altering the model"'

her paradigm offered
health Practice of the time77
appropriate structures for developing community

and the need for

Reilly's wofk re-emPhasising the importance of occupation
occupational thelaPists to value their unique base
of practice introduced new
some of the Professions
directions for theory development which recovered
Reilly also had a
philosophical foundation. As Director of Graduate Programs,
Gary Kielhofner's
huge influence on the work of her grad'uate studentsTs'
Occupation'' for example'
papers and. books articulating 'A Model of Human
grew out of his work as a master's degfee student
with Reilly' One of the best
now at the
known figures of occupational therapy today, Kielhofner,
one of Reilly's basic
university of Chicago, developed his model from
assumptions, that "occupation is a central aspect
of the human experience" and
tendency of
that"all human occuPation arises out of an innate, spontaneous
the human system - the urge to explore and master the environment"T9'
occuPational therapy should
According to his Model of Human Occupation,
opportunities for directed experiences, that is, participation
in life
provide
tasks, for people described as having occupational dysfunction' The

therapeutic aims of such Pro8rams include

improvement in organisation'
achievable
function, and adaptation within occupational performance'
new
through changes attained in self-image, skill development'
habits'

acquired roles and environmental changes. Some

of the most important

concepts within this frame of reference

are that humans are viewed as 'open

systems,8o, that there is a continuttm

of 'occupational function and

TTLaukaranVH. Toward a model of occupational therapy"'

FM' Shortridge SD'
78vun Deusen J. Mary Reilly. Chapter 6. ln: Miller BRJ, Sieg KW' Ludwig
the praåtice óf ocatpational therapy' Rockville'
VanDeusen l.Six perspectiaes on theory for
Maryland: AsPen Publication, 1988'
79 Ki"lhofrrer G, Burke JP. A model of human occupation' Pltj^1,
conceptual framework and
1980;34:572-581' (p'573)'
conrent. The ArrcÃcl-n journnl of ocuryational
therapy
80 Ki"il,ofner G. General systems theory: Implications for theory
and action in-occupational
therapy.fn, ¡)niirni'iorrral o¡ occupàtional tlrcrapy'97';32(10):637-645'
 with and health 306
8: I re

to adaptation' so that
dysfunctiofi'8l, that engagement in occupation is central
dysfunction is a threat to health and well-being,
and that occupation is

govemedbythreesub.Systems,namelyVolition,habituation,and
performance. The concePts are principally applied
to occupational therapy
have potential for wider
practice within traditional health care settings but
application. The model entails occupational therapists rethinking
their

learning a new set of terminology'

approaches and Practices fairly radically and
pubrication established
The recognition Kierhofner,s moder received following
philosophical foundation'
an intemational trend of the profession back to its

of whom'
In addition to her students, Reilly influenced her colleagues, one
Elizabeth Yerxa, in her 'slagle' lecture, proposed
that 'authentic'occupational
through choice' self
therapy should be aimed at client 'self actualisation'
purposeful activities, reality orientation and perception of
self and
initiated
the development of a
environments2. She became a Powerful advocate for
science of occupation complementary to the applied
science of
basic
occupationaltherapys3.Occupationalscienceisdefinedbyher,andher
associates at the university of southern califomia,
as:

,,the study of the human as an occupationøl being,, including .the

need for and capøcity to engage in and ^orchestrøte
døily occupations
84'
in the enaironment oaer the lifespan"
of such a science to occupational
She suggested that one of the advantages
therapY is that:

identifuing and articulating a - scientific . foundation for

,,by practice,

o-riui,poti'íra"l science could p"roaide prortitiõrert

with support fo'
ompetence and achievement'
incompetence and
n: Theory and aPPlication'
, pp.63-75.
82, Yerxa EI.1966 Eleanor Clarke Slagle Lecture""
of southem
83Y"."a developed a doctoral Program in occu rational science at the university
California.
84 Y"rta E|, et al. An introduction to occupational science:"'
 307
relationshiD with occuDation and health
Chapter 8:

whøt theY do, jttstifu the significance of occupational therapy , to

"ocóttpational therapy -
health, and differentiate from other
disciplines -"85

for the emerging science' academics

In setting up specifications and criteria

instrumental in the establishment of a Doctoral Program in occupational

proposed that it study
science at the University of Southem California'
on People, "not on a
individuals in interaction with their environment, centre
the complexities of
cell or reflex", be developmental in nature, and address
ideas considered in this
occupations6. Those criteria mesh with the central
thesis, but, in order for the discipline to be holistic,
it is just as relevant for
Some occupational scientists to stu'dy 'occupational humans' at cell or reflex
What is important is for
level, as it is to study them at the ecological level'
occupational scientists to make a subtle change
from considering humans who

use occupation from a biological or cultural perspective, to considering

of the human need for

biological or cultural issues from the broad perspective
occupation.

The notion of viewing humans from this different perspective holds a

particular promise within the arena of public health, not least
in challenging
deprive or alienate humans
many socio-cultural and political structures which
their health' The
from exercising their occupational natures to enhance
to
following consideration of occupational therapists resPonse
the

this challenge and promise'

development of a science of occupation illustrates

Despite a degree of acceptance and excitement

around the world there is also

some diffidence, even conflict, within the profession with regards to the

85 y"rru E], et al. An introduction to occupational science:..'p'3'

86clur future.
occ ational
TIrc
scie
occupational science: Australia 1993; 1(1): 3-10'
 with occupa tion and health 308
8: Ooccup ational therapy's relationship

There are a variety

development of a basic discipline of occupational sciencesT'
reasons for this lack of acceptance. For examPle,
some occuPational
of
therapists view occtlPational science as
just another model or theory which is

in competition with their own theory of occuPation' They do not suPPort the
their own model could fit'
notion of a many faceted generic science, into which
with either medicine
Others hold to the clinical tradition and close association
or other already developed social sciences and see no need for a Particular
,occupational' perspective. still others asPire to a simple all-embracing theory
hold a
which can effectively describe their puqpose but individual therapists
the word 'occuPation'
gteat varieb/ of views. In addition, they avoid using
because it is so often misunderstoodss. On
both counts they view with
increase the complexity of
disfavour a generic science of occupation which may
explanation because of contradictory ideas'

occupational science 8fows, there is no doubt that

If it will increase
many 'models'' 'frames of
complexity of understanding because it will include
reference', and theories, changing direction according
to socio-cultural change

and advances in biological knowledge. Complexity

will lead to heated debate
humanist' social'
between scientists, iust as behavioural, clinical, experimental'
all argue with each other
occupational, transcendental, or neuro psychologists
Heated debate about
but collectively contribute to the science of psycholo8y'
the profession's foundation beliefs is not Part of occupational
therapists'

where the first international, interdisciplinary

1s2.)
88 A gronP of 25
exercises base
demonstrated
 309
8: relationship with occupation and health
Chapter

degree of apprehension in
tradition and discussion with theraPists reveals a
this apprehension' debate
moving towards this as a Possible scenario. Despite
therapy journals about whether
and challenge is being voiced in occupational
was
thereis a need. for a science of occupation, whether, indeed' occupation
central in the discipline's early historyse, or
whether occuPational science
therapists' Anne cronin
should be developed and resourced by occupational
Mosey, for example, who in her 'Slagle' lecture advocates for occuPational
approaches' and regards
therapists taking pluralistic rather than monistic
,occupational' models in the latter lighteO, argues for the comPlete partition of

occupational science and occupational therapyel,

a partition with which

Florence Clarke and her associates at the University

of Southern California
disagreestronglyg2.ThedebatebetweenMoseyandClarkeisrepresentativeof
divisionwithintheprofessionaboutthisissue.

Despite such debate, d,ifferent theories pertaining

to human's occupational
there is a large declaratory
natures have proliferated in recent yearsg3 and
riterature about occupation. Much of this is
linked with notions of health and

wellbeing as discussed in earlier chapters. I have used some examples to

including:
illuminate a range of the disciplines conceptions,

7-12, and 55(2):5-60')

90 Mosey describes as monistic Lloren's developmental theory'
Reilly's occupational behavior'
human occupation
King's adaptive i"ro.,r"r, and Keihofner's
Fidler,s p.rrpor"r'i;,irny,
glMosey AC. partitiono d occupational therapy' The American journal of
occupationattherapyeyAC.Partitionofoccupationalscienceand
.'The American journal of occupational therapy
occupational therapy:
1993; 47 (8):777-23'
92 Clark F, Zemke R, Frank G, (1993); Carlson M, Dunlea A' Further thoughts on the pitfalls of
it , ¿,*ir¡ron journal of ocuryational therapy 1995; 49(7):73-
partition: n ,"rpo*" to Mosày.
81.

,1991.
 and health 310
8: therapv's relationship with

oFidler,s ideas about enablin8 'doing' to satisfy intrinsic and extrinsic needs

and the needs of others;

with'
that 'doing' skills are dependent upon' and change
à8e'

developmental level, biology and culturee4;

self value and self

that competency, mastery, adaptation, self esteem,
worth result from successful 'doing', and are interrelated9s'

.Mosey'sphilosophicalassumptionsaboutthematuration'socialnatureand
structure of the sPecies;

each individual's needfor occupational balance, to reach potential

through purposeful interaction with the environment'

the context of
each ind.ividual's need to be understood within
familY, communitY and culturee6'

oMoore's linking of human's occupational behaviour with limbic system

a homeostatic balance in favor
function so that "the normal system maintains
or non-rewarding stimuli";
of pleasurable rewards and away from painful

that occupational behavioural needs vary because of "individual

genetic and biochemical differences as
well as"'multiple and highly
variablerelationshipswith'.(the)environment''97

of health98'
olloren,s emphasis on occuPational therapy as a growth model

self actualisation' Th
94Fidl". GS, Fidler fW Doing and becoming: Purposeful action and
e

apy t97 8 ¡ 32: 305-31 0'

Americnn iournal of ocarpational ther
95Fidt"t GS. From crafts to comPetence TIrc American
journal of ocuryational therapy 1981.;35:
ocarPa tional thernPY in men tal lrcalth.
PrePared by the
567-573: Fidler GS' Oueruiew of
p of the American PsYchiatric association on
American occupational theraPY task grou
psychiatric theraPies, 1981' 1986'
g6MoseI AC. Psychosocial components of occupational therapy' New York: Raven Press'
p.6.
g7Moo." the limbic syst_eIl. ¡|-1-". Y?Ileanor
clarke slagle Lecture'
' )C. Behavior, bias and 71-79
Ãiuirn, lournal of ocuryational therapy 1976; 30(1):Facilitating Growth and.development:
98 Llo."r,, LA. The t9ãg Eteanor Clarke Siagle Lecture'
of ocuryational therapy 7970;
The promis"of o...rputiár,uf tn"rupy.fi;; Anrcrican iottrnal
XXIV(2): 93-101'
 and health 311
8: therapv's relationshiP with occu

therapists focus on 'occuPational

od.o Rozario's concePtion that occuPational
'being and doing" and health' well-
role and performance', the integration of
being and sustainabilitY;

model of practice'
pfovide an "'empowering and transformational
asaProcessinenhancingpeople'ssenseofmeaning,valueand
satisfaction in dailY life"ee'

view of "occupational therapy's social vision" which

promotes
oTownsend,s

social justice by enabling development

of occupational potential and utilising
"participate as valued members of
practical approaches so that people can
societydespitediverseorlimitedoccupationalpotenli¿}''l00.

to academic Programs based on the study of

Such contributions have led
humanengagementinoccupationbecomingmorecommoninmostwestern
undergraduate
Indeed,, about three quarters of the Australian
economies1o1.

occupational therapy Progfams have moved

in this direction over the last ten
and the change toward 'occupation'-based models
of practice is the
years
a change in research interest is also
current trend in Australasia. Evidence of
studies to consideration of occupational
emerging, from purely clinically based
meanings of paid
within the community, such as in patterns and
issues
to studies of how particular
employment or lack of paid employmen¡102,
 with occupation and health 372
Cha 8: Ooccupational therapy's relationshi p

groupings of people use their tilne103, to broader theses linking occuPational

and occuPational behaviour of other

concepts to ecological sustainabilitylo4,
primateslos

on occuPational therapists'
In the way that Previous Pages have concentrated
section of the chapter considers their
changing interest in occupation; the next
are not unconnected' since the
interest in health Promotion. These interests
as occupational beings grew with
evolving fascination of the study of humans
well-being, and with the emerging
changing societal views about health and
objective of the w.H.O. for "the attainment
by all PeoPles of the highest
was established in 1946 as a
possible level of þs¿l¡þ"106. Although w.H.O.
,,specialist agency for health", the world Federation of occupational Therapists

did not join it until :Ig5g. In a 7963 rePort in the British lournøI tf
occupøtional Therøpy Hend.erson points out that w'H'O' "pursues an
does not discuss the role of
unlimited. ideal and. an immense task", but
in helping to achieve ¡þi5 1¿51107' Indeed' despite the
occupational therapists
therapists, in line with
broad health aims of the W.H.O. most occupational

Thesis in Progress
upon the relat.ionship of engagement in ocutpation
to
1.051yee¿ lflH.Enaironmental influences
.chimp,n,,,,'
PhD thesis, University of Southem Califomia,
ndnptation amonS natiae
1995.
world Health organisation
106 4¡¡¡s1s L of the constitution of the world Health organisation'
(First) Intemational Health Conference.
New York, Ù'S'e' 19th June-22nd ]uly 1946' ln:
Commonweuttno"pu,r*entofCommunityServicesandHealth.WorldHealth
organisation, A ;ri:f;;*mary of its
uork. Canberra: Australian Government Publishing
Service, 1988, PP'3-10'
107g"r.,¿"¡ron CLE. World Health. Britistt iottrrnl of ocuryational tlrcrapy7963;26(4):3-4'
 with and health 313
Cha 8: Ooccu therapY's relationshiP

most other health disciplines, continued

to esPouse a role more attuned to
than holistic' wellness
reductionist, ilhress models aimed at individuals'
models aimed at the health of communities'

to improve health and quality

However, the w.H.O.',s interest in approaches
from the early
of life was in line with community interest which escalated
lifestyleslOs' In common with
!960's, along with exploration of alternative
therapists have speculated on
many modem historians, some occupational
and have suggested that it erupted from
reasons for this community interest
reasons' such as the advances in
the illness-oriented medical model for several
technology and the concurrent escalation
of health care costs' the increase of
the dominant role of physicians
health care knowledge generally leading to
producing a societal reaction
being challenged, and. technological development
towards simpler more natural remedies for disease controllo9' Johnson
of the human potential and countercultural
suggests that the interest was part
women and minorities'
movements, in which many grouPs, particularly
to social forces that seemed to ignore their individual'
perceived
reacted
with medicine and perceived
needs110. She also cites growing dissatisfaction
along with
dehumanisation in the medical care system as important factors,

increasingrecognitionofwaysinwhichtheworldwasbeingpolluted.

arguing, from an occupational

so, at about the same time that Reilly was
perspective,foroccupationaltherapiststorecognisethelinksbetween
and health, a gfouP of leaders in the field
with a preventive and
occupation
were encouraging them to aim, through
health Promotion PersPective
optimum health rather than...intermittent
occupation, at "maintaining

Cape' 1970;Roszak T'The making of a counter

L08¡"u¡11s R. PIay Pouer'London' New York:
crtlture. New York: Doubleday' 1969'
FS, editor' Soci ocultural
1093,o*,.. KM. Wellness: Past visions, future roles. In: Cromwell 1987.
inrylicntions in plnnning in occrryational therapy' HaworthPress'
'''^"*til
11O¡qilsonl A. Wellness; A context fot liuing ' New Jersey: Slack' 1986'
 and health 37.4
8: Ooccupational therapv's relationshiP
with occu
Cha

of acute disease and disability"rrr. wilma west envisaged

that
treatment
would "emPhasise human development
health and med.ical care in the future
byProgramsdesignedtoPromotebetteradaptation,ratherthan
technologically-oriented. Programs offering
specific solutions to sPecific
therapist should function as
disabilities,,. She also held that each occupational
a,,healthagent(ratherthan'therapist')withresponsibilitytohelpensure
more fully the "socio-
normal growth and development", considering
well as biological causes of disease and dysfunction",
economic and cultural as

of an earlier prototypetl2' $þ6¡fly

but all in a "new mould" rather than a recast
of WFOT, in 1979, she proposed a
afterwards, at the Sth Intemational Congress
based on the assumption that
health model for occupational therapy practice
as concerned. with prevention as with
health care in the decade ahead wourd be
of both client
rehabilitation. Therefore, she advocated increasing involvement

andcommunityinmoreeffectivemethodstoenhanceandenrich
social and vocational abilities'
development of physical, mental, emotional,
therapists' "long time
and suggested a "timely translation" of occupational
focusonactivitiesofdailylivingforthedisabledtoadvocacyofthebalanced
regimen of age appropriate, work Play activities
for man in the Pre-
such a role required only a "broader
disease/disability phass"tta. Her view that
the effects of activity - or its absence -
application of existing knowledge about
onhealth,,.wasaninvitationtooccupationaltherapiststorevisitandutilise
theirunderlyingphitosophyinawayadvocatedinthisthesis.

Cromwell stated a
At the same congress, and along similar lines, Florence
about the global trend towards
need for occupational therapists to think

tf
 and health 315
8: relationship with

preventive rather than curative programs' about

world health care, and about

searching for more universal systems of care

by considering' for example' how
She said that
differentnationscombattheProblemsfacinglþgm114.
arena of 'Well Care', as
occupational therapists should' move into the
environments where patients live'
specialists in human behaviour in ordinary
work and play. Yet another, Geraldine Finn, addressed
The occupøtional
Therapist in preuention programs as the topic of her 'slagle' lecture i'.197rrr5'
majority of therapists who
In an update of that PaPer she observed that, for the
was a trend to select Programs
practiced in the community at that time, there
prevention, an observation
and services at the levels of secondary and tertiary
occuPational therapy
which still holds some truth. In ord.er to encourage
Reilly, she proposed the
involvement in primary prevention, in line with
the issue of the significance of
development of a moder of practice adciressing
as primary prevention is directed
occupation to human life. she argued that,
between the basic structural
toward an understanding of both the relationship
keeps people in a state of health'
elements of society and health and of what

occupational therapists should make their

contribution with a greater
health116. These views were
understanding of the effects of occupation on
about the nature of health held
compatible with emerging conceptualisations
Mosey and Fidler' Mosey
by other leaders in the field at that time, such as
that must be met for
defined health needs aS "inherent human requirements
psychological and social well-
an individual to experience a sense of physical,
beingl11 and Fidler held that health is the
ability to carry out activities which

in the seventies. Occupational therapy today- tomorrow'

1146.o^*sll FS. Our challenges
-ith
lroirraing, of tii lnirrrotional congress. Zurich 1970, pp 232-238. :_
1rs --
,îJ"':iff"""
A foundation for
occuPational

therapist in prevention
116p¡¡n GL. Update of Eleanor Clarke Slagte Lecture:.The occupational
7977;37(10): 658-659'
programs. rn, ¿,ärr¡äi ¡orrnot of oiuryational
thernpy
L17¡4or"rAC.Meetinghealthneeds. TIrc A'merican iotrnal of ocuryntional therapyl973;27:14-
t7. (PJa)
 with occuPation and health 316
Chapter 8: therapy's relationship

and meeting of
are essential for developmentally aPProPriate self-maintenance
intrinsic needs according to the social contextlls'

few real changes to

west's prophecies and encoufagement wefe optimistic:
which affected
practice eventuated, PerhaPS because economic constraints'
health care budgets, curbed the development of new trends towards
prevention which were not yet a priority in health
planning' Also' as
less defined, less sophisticated'
Grosman suggests, the work itself may aPPear
less measurable, more isolatedin the face of the massive social, economic and
The latter issues seem
political conditions that interfere with ¡"u1¡¡11e'
considering these
similarly daunting to present day post graduate students
a recognition that these particular conditions are those that
issues, despite
Laukaran, suggests as other
require most emphasis if change is to occur120'
incentives for service in
reasons,limited opportunities or lack of professional
competition with other
positions not designated for occupational therapists;
professionals; and inability to cross boundaries
to work in community
by long held values' growing from
institutionsl2l. These are comPounded
based medicine' that
occupational therapists' association with clinically
than well (or even all) people'
occupational therapy is concerned with ill rather
(developing from those values)
and that existing occupational therapy models
Such values
timit practice, and result in gaps in knowledge and theory122'
limit occupational therapists' ability to recognise occupational dysfunctions'
as risk factors which can lead to
such as alienation, deprivation, and imbalance,

disease, disability and death, and has meant

that such dysfunction has not been
has it been appreciated that
identified as a primary Prevention focus. Neither

p
1.18pi¿1". çg, fuI action and self actualisation""
119ç¡6s¡n¿¡1¡. togramming ' TIrc Ametican journal of
occuPationa
:ience' and'Health promotion-for.occupatiorral
120 ç6r, ¿¡r.., (occupational Therapy)' university of south
therapists'. Masters degree in Health science
Australia, 1992-95'
health"'
121¡urr¡urun VH. Toward a model of occupatiorral therapy for community
health"'
Til}youyurun VH. Toward a model of occupational therapy for community
 with occuPation and health 377
Chapter 8: therapv's

people in need of "preventive occuPational theraPy services", for examPle' are

since they are not diseased
unlikely to be "referred through medical channels,
but are d,isengaged from daily 1ife"123'

community health
It is also conceivable that a major change of focus towards
were caught, in the 1970s'
was inhibited in part, because occuPational therapists
in a conflict between history, tradition and value systems, changes
in the
health care system and consumer expectations
within societyl24' The seventies
of its philosophical
were a time of crisis because, although the deterioration
base was starting to be recognised, the rejection
of occupation as central to
leaving it with no common
occupational therapy practice was at its greates¡12s,
because at the same time
unifying concepts126. This was made moÏe complex
,altemative, ideas about life and health permeating the western world

generated fearsthat reductionism, which occupational therapy had accepted'

could not provide all the answers in health care127'

amongst its members led

The strength of the interest in health promotion
the American Association of Occupational Therapists,
at the end of the

turbulent seventies and, again a decade later, to

put out position PaPers

ad.dressing the issues. However, in defining

how occupational therapists may
still articulate a
be instrumental in health promotion the position PaPers

system of the future' In:

L23Johrson ], Kielhofner G. Occupational theraPy in tLL health care
'throttgh and practice in occupational
ocurya'tion: Theory
Kielhofner G, Edi-tor.¡1, alth
theraPY.PhiladelPhia: F'A' Davis
and
124
¡ohnson JA. Humanitarianism
itr oott't anniversity, The Ametican

4-73.
on the professionalisation and
126 6¡1s¡1s N, Kielhofner G. The impact of specialisation
survival of occupational therapy"'
127ç¡"¡1.,o¡r.er G, Burke |P. y After 60 Years' The American iournal of
ocutpationaltlterapy,li{elhofnerG'editor'nmodelofhunnn
'ind re: Williams and Wilkins' 1985'
theory
occttpation,
 and health 18
8: Ooccu
with

For example' the

model aimed more at the individual than at communities'
1979 paPer states that:

nøture ønd imPortance of goal

the maintenance of heølth ønd
It øs in rehøbilitation tf the

The occuPøtionøt 'rrirl'iOtirli,

of lrf:, for the ,tøs therapy
to deoeloP mode.s
.-
c^
accent on
'fip*r"iits unique
makes 'hi,uman
i, a special contribution to
..,øctiaity, ,o'd of' human enterprise"'l2&
understanding the significance ønd worth

concelned about the level of

Atthough many occupational therapists remain
promotion and community
occupational therapists' involvement in health
ongoing with leading theorists
health, it is apparent that interest has been
the profession continuously addressing
the topic' For example' Elnora
within
Gilfoyle in Trønsformation a profession advocates that occupational
'f
social' economic' and political
therapists increase their "awareness to include
"the value of occupation and the
factors,, towards new understandings of

patients' occupational process in promoting

their own þs¿hþ"129' Johnson
and Kielhofner point out that "occupation
is a necessary prerequisite to health"
conditions deprive the individual
arguing that "when social systems or other
is a clear threat to the mental and
of satisfying engagement in occupation, there
physical integrity of the person", and' that
the responsibility of occupational
"remediate the conditions of work and play'
therapists of the future will be to
that disrupt normal patterns of
and the social, economic, and other factors
occupation"l30. Interest is also apparent
from the number of articles in

Position PaPer on the role of occuPational

1284*"ti6* Association of OccuPational Therapists,
of disabilities. The American iournal of
therapy in Promotion of health and Prevention
occupational theraPY t979;33t 50 -51
of a profession' The
129çi1¡6y1s EM. The 1984 Eleanor Clarke Slagle Lecture. Transformation
1984; 38(9): 575-584.
American iournal of ocuryatíonal theraPY
130ç¡"¡1",o¡¡,er G. Hea Ith through ocutPntion: Theory and practice
in occupationøl therapy
...p.191
 and health 319
therapv's wl th occu
Cha pter 8:

occupational theraPy joumals which

lelate to the topic' For example' twelve of

sixtyfour articles (lg%) in six occupational Therøpy

in Health Care journals
topics which can be classified as'health
dated between 1984 and IgSg,dealt with
'disease prevention', and a further twelve can be classified
as
promotion' or
'health issues from a socio-cultural PersPective"

The last quarter of &ic century has provided

time for the development of
from an occupational theraPy
theories of a unique view of health Promotion
perspective but practice stilt lags behind
ideas' A shortage of exPefienced
models and developing frames of
occupational therapists working as role
keen to work in the community but
reference for younger therapists who are
as a constraint to
are not yetready for a leadership role, has been identified
has been compounded by a lack of
community health practice. That weakness
service administrators'
knowledge about occupational therapy by community
confusion' and lack of
lack of professional visibility and identity, role
occupationaltherapyinputintotheplanningofcommunityservicesl3l.
In America tod.ay occupational therapy practice
in the community is limited

totheprovisionofserviceswhicharereimbursableaccordingtothel99t
Medicare guid,elines132. Britain, aithough many therapists' work is based in
Ûn

the community, their role is also determined

by legistation relating to disability

989;56(4): 165-170'
132¡ackson B. Home based occupational therapy: Then and
now' The American ioutnal of
'
ocurpationat therapy 7992; 36(1)t 84-85'
 p with occu and health 320
Cha 8: theraovts

therapists seem to be currently

and community care133. Canadian occupational
community health' which is
leading occupational therapy initiatives within
their country as a wholel3a'
reflective of the health Promotion initiatives of
has "the potential to become a
and their recognition that occuPational theraPy
in assisting (the) national vision to become a reality"l3s'
maior contfibutor
found, as I have' that
Even there, Madill, Townsend and. schultz, who
meshes well with health
occupational therapy's client-centred' approach
promotion as outlined in the ottawa Charter, ProPose that substantial

occupationaltherapyed,ucationalProgramsarerequiredtoreflectthe
d.evelopments in the field. They note,
in particular, the need to generalise

',client-centred issues to the broader social and economic

envirottment"'

suggestingthatoccupationaltherapistshavearoleincommunityaction,
prevention, the work place, and in public
educationl36'

community health
In Australia, Burnett, in a recent review of Australian
centresfoundapaucityofbothoccupationaltherapistsandliteraturel3T.
move to community based practice'
Indeed, all of the factors which inhibit the
bearing on occupational
identified earlier, would. seem to have had some
therapyPrograms,fromthetimewhencommunityinitiativesstarted,
up to the present day' Because
nationwide, during the nineteen seventies,
effective amounts of resources have not been directed away from curative

services, jobs within community health are scarce for health professionals such
already established' better resourced'
as occupational therapists, whilst jobs in
new visions' British journal
133¡1i"¡ut¿s S. CommunitY occupational therapy: Past dreams and
tf occuPational tlrcraPY 7992;55(7)t 257-259 Cønadian
1341o*tlt"t d E. DeveloPing comunity occuPa tional theraPY services in Canada.
M, Malcolm C. CommunitY
therapy 1988;55(2): 69-74;lMcColl
Cnnadian
and volunteers: A survey of utilisation and satisfaction.
therapy 1985; 52: 52-66'
opportuniy for occupational therapy
135¡¿*¿t¿s J. National perspective: Health promotion; An
Canadian journal oJ ocutPationa I tlærapy
\990;57(1): 5-7
strategy in occupational
136 ¡4u¿i11H, Townsend E, schultz P' Implementing a health Promotion
journal of occupational therapy 7 989;56(2): 67-72.
therapy education and practice' Cø nadian
Ptoceedi ngs of the 16tlt
1'379.t¡¡s¡¡ T. Occupa tional theraPY in comm unity healtlr centres.
Association of ocaryationnl therapists, Adelaide,
1991.
Federal Confetence of tlrc Austral ian
 relationshi with and health 2l
Cha 8:

services are still availabrel3'. This effectivery continues to limit the potential
with ill or disabled people'
of occupational therapy in Australia to working

but largely in jobs that

occupational therapists do work in the community,
are related, to the management of
disability, rather than in Programs aimed at

'occupation and health'. Because of lack of understanding

of the scope of

occupational therapy, community agencies

may only consider therapists for
as needing to be addressed within
jobs if particular ill-health problems aIe seen
employing them at all' For
any particular community, or may not consider
L993 the
example, in a survey conducted' in south Australia in one

occupational therapist employed in a metropolitan community health centre

seen as appropriate' In
was highly valued and, her skills and philosophies
centres which had never employed an
occupational therapist those surveyed

wefeunsureofoccupationaltherapists'skills,convincedtheirphilosophical
base was inappropriate, and 60% would
not consider employing one if funds

were availablel39'

'an interaction between occupation

It is somewhat ironical that the notion of
'new' public health in which occupational
and health, is more in line with the
medicine
therapistsdo not (on the whole) work, than it is with conventional
wheretheydowork.Althoughcompatiblewithearliermodelsofhealthcare'
and entirely compatible with those proclaimed
by public health in documents
'health and occupation' is largely
as the ottawa Charter, the id.ea of
such
incompatible with the orientation of the services currently provided þ
 with and health 322
Chapter 8: Ooccup ational therapy's

conventional medicine, and receives little,

if any, consideration in community

centres

are exPosed to poPulation

Additionally although occuPational therapists
are not trained to consider research
health issues during their education, they
their core
of intervention from this perspective, and So are unable to translate
concept in the most meaningful way. Not recognising this' many try to adapt
frames of reference developed for and suited to conventional medicine'
from a PersPective
Alternatively they may address health Plomotion Problems
less effective programs than
identified by other disciplines, thereby providing
focus' They become unsure that
they could, and thus losing their distinctive
is of value' This reinforces most
what they can contribute to health promotion
therapists continuing with clinical models, in conventional settings' and may
the past, demonstrated a bias towards
be why occupational therapists have, in

Programs for ,individual' client problems. From my own experience,

particularlyfrombeinginvolvedwithstud'enteducationaboutthetopic'there
with conventional
is st'r an erement of excitement and status associated
hospital-based services which is appealing to young students entering the

training' by most fieldwork

profession. This is built uPon, during their
settings because of fewer opportunities
experience taking place in conventional
community, health promoting practice' along
with exposure to
to experience
the many traditional practice frames of
reference' The idea of a relationship

between occupation and health is addressed

in many of these frames of
mean that there is little
reference, but current economrc conditions
services, and the
opportunitY to implement them in clinicallY based
consider do not focus on training
community health frames of reference they
because of lack of
in population based measures of intervention, in part,
¡ims1a0

740 In the last three years the final fieldwork experience

in south Australia for graduating
community åg"nci", or places where or may
not have a well
students has been undertaken in (ctient) need in a
they develop pro[.u*t based on agency
established pr"r"r,.".--There
 with o and health 323
Cha 8: thera

It is hardly surprising, if this is the case, that rather than trail blaze in
isolated community agencies most therapists
still oPt for the security of
however. Papers Presented
institutional positions. There afe hints of change,
at the 1gg5 Austrarian Association of occupationar rherapists conference
aimed at health such as a
suggest a broadening of interest towards Programs
,model of occupational harmony', appiicable to diverse cultures' in which a

balance of tife roles is taken as the essence

of health and well-being1,l' and to
for example, who focussed on the
programs aimed at political lobbying. Dwyer,
people, proposed that to enable
needs of non-English speaking and indigenous

them
,,to exercise their civil and political rights, it could be claimed that they

in a state of 'holistic health'. So to be politicised and politically

need to be
physically and mentally"142' In
active could be indicative of a state of wellness,

similar vein, be argued that occupational therapists' because of a

it can
of their potential within the medical model, have not enjoyed
restriction
,holistic health, and ,wellness, aS a profession, and that this has inhibited their
just as Fay argues
political activism, although they are not aware of this effect,
in trying to satisfy their desires
that "human history is the story of people who,
cultures but who are not able or
and their ideals, create social institutions and
witting to see that that is what they have done"143' Those occupational

of living and working in the 'new

therapists who have taken up the challenge
'community development' have found it exciting' challenging
and
land' of
their purpose for
futfilling. such therapists are thriving, "have rediscovered
beingand'aremakingvaluablecontributionstotheir'newSociety'''Sothat
and
has been extremely effective in changing attitudes
research and evaluation mode' This
recognising Potential'
of well-being: A model for occupational
ryationalThirapists ,18th Federal and
s, Hobart: 1995.
in multicultural Australia in the 21st century'
7h¿lqryists
'Lilth Fecteral nnd inaugural Pacific

workshops for occupational therapists on

ttuough lobbYing"
its limits. New York: Cornell University Press'
1987, P.53.
 p with and health 324
Chapter 8: Ooccupational

,,return to the hostile, inequitable, under-resourced ord world from

nonewould
which theY cams"144'

the perceptions and

Two surveys, both undertaken in L989, have exPlored
towards health Promotion and
attitudes of Australian occupational therapists
Australian occuPational therapists
public health. The first was a survey of 378
'new public health model', such
which found that attitudes which reflect the
and holistic attitudes to
as client-therapist interaction, client responsibility
(over thirty)
health care prevail, especially with old'er, experienced
of a random sample of Australian
therapistslas. The second, a national survey
occupational therapists hold positive
occupational therapists also found. that
benefits they perceive as emanating
attitudes towards health promotion, the
be involved in it
from it, and their belief that occupational therapists should
and having a special contribution to make'
whilst the recognition of their
to translate the core concept of
potential for health promotion, and of the need
,occupation and health' into community action is strong' Some change of
(This
emphasis in occupational therapy undergraduate education is required'
study is detailed in aPPendix IV)

therapy's assumptions about the relationships

In summary, occupational
throughout the profession's
between occupation and health have changed
because of its smallness' its gender
development. This has been, in large part,
imbalance, its dependence on medicine, its difference' and the difficulty of
of its origins
explaining, or understanding its promise without an aPpreciation
as feminist and other social
and rich philosophical history. In recent years,
traditional values' and as an
action has challenged and changed some

L44 TwibleR'Journeyingtoanewlandofhope-Apromiseforoursurvival.Keynoteaddress'
Association of ocuryational Tìterapists
18th Federnl and inaugural Pncific
The Australian
Rim Conference Proceedings' Hobart: 1995'
145 AdamsonB},Sinclair-r-"gæG,CusickA,.Nord,holmL.Attitudes,valuesandorientationto
of
orofessional practice: A study of Australian occupational therapists' Britislt iournal
äcrtpational tlrcrapy, 199a; 57(72): 476-48O'
 325
Chapter 8: Ooccu therapy's rela tionship with occupation and health

appreciation has growTl of the valueof its difference' occuPational therapists

have begun to articulate theory which has the
potential to offer a unique

contribution in many arenas, including public

heatth' This can only occur'
Profession changes its overwhelming
if the focus towards
however,
researches and develops
individuals with disability, to one which recognises'
centred on the occupational needs of all people,
communities and
practice
cultures. In way, similar to the increased' understanding of the whole
a
population regarding the relationship of nutrition
to health, it is only when

there is a general appreciation that engagement

in occupation is a principle
Occupational therapists are
mechanism for health, that real changes can occur'
of understanding by
still limited, however, by their small numbers, by lack
others of their potential contribution, and by Political, social and economic
factors which restrict their practice to within
a diminishing institutional scene.
Also necessary is an acceptance of the importance
of this idea by public health'

along with opportunities for occupational therapists

to undertake population
studies to test and measure the id,ea, and implement appropriate strategies'

therapists could
The next and final chapter witl suggest how occupational
contribute to community and public health
if these restrictions were
health focus'
overcome, and if they themselves accepted the value of a public
at social action for
by taking a strong educational and' political stance aimed
health and well-
change relating to maximising the effects of occupation on
beingforthewidercommunity,aswellasindividualswithdisability'
 Chapter 9

occupational therapy and public health

which have emerged from

This final chapter brings together the major ideas
the explorations of humans as occupational beings,
of occupational evolution'
well being and of the
of the part occupation plays in ill-health, health and
therapists have to offer to
theories, values and skills which occupational
therapists with a well developed
promote health. It suggests that occupational
conceptoftherelationshipbetweenpeople'Sengagementinoccupationand
and for developing public
health are a primary source of expertise for research
chapter gives examples of
health practice based on the relationship. The
therapists and suggests an action-
existing programs provided by occupational
researchframeworkwhich,byextendingtheircontributiontotakeinthebroad
and health discussed in
notions about the relationship between occupation
models of health promotion'
earlier chapters, can be used in many different
Five different models are considered in detail'

itu/as that their

In Chapter Snmade clear that many occupational therapists consider

role extends beyond the amelioration of illness

to the promotion of optimal

states of health in line with w.H.o.

philosophies, and that they could play an
conceived' However' if
important role in public health as it is currently
occupational therapists are to deliver
the promise of the understanding of

humans as occuPational beings as part of

the total picture of an evolving
present biases of public health as they
ecology, they should, not conform to the
to conventional medicine. They must bring
to public health their
have
of the 'occupational human', and be prepared
to challenge and analyse
concept
from this perspective' At
public health research directions and strategies
occupational therapists could
present, because the distinctive contribution
 327
Chapter 9: Occupational Therapy and Public Health

health workers
bring to health promotion is barely recognised by other public
and health
the understand.ing of the comPlex interaction between occuPation
is lostl. The following examples from Australia and North
America Provide

an ind.ication of some recent Proglams offered by occupational

therapists

are little known

which address concerns of public health but, because they
about, are unacknowledged contributions:
. Until its closure, the Mount Lyetl Copper Mine in Tasmania employed an

fulI time in occupational health and safety Practice'

occupational therapist
Rudge provided education on health and safety for
all levels of the
workforce, ergonomic assessment and adaptation of
heavy vehicles and

mining equipment being used in geographically hostile environments'

set up an on-site
monitored work methods and practices of employees, and
Rehabilitation Centre. She reported challenges such
as "a working
environment knee deep in muddy, dark, noisy tunnels", "mastering

of
mining terminology and technology", and "gaining an understanding
the implications of living in an isolated mining town"2'
. In the New south wales coal mining industry, Arvier and Bell provide a
backinjurymanagementandpreventionProgramandreportan
Back Programs since the
encouraging trend "in the types of clients attending

Service firstbegan", "from miners with long term or chronic injuries'

P'219)' ,-i. -L--- Tire

Tt.^ Australian
2 R,rdg" MA. Occupational therapy in the undergroundmining industry' ^.,.t-.t'
rtirnpist's Federctl confcrence. sydney: 1988.
Association o¡ orrr',piüi".nt 1.5th
 and Public Health 328
Chapter 9:

of back
through to uninjured workers who are an'xious to learn something
cârer"3.

a Schwartz Provided an industrial accident/injury Primary Prevention

distribution
program for a group of 110 workers at a major Texas grocery
centre, similar to traditional "back school" training, but
based uPon
were trained
educational psychology principles. Workers and supervisors
in environmental modification, work simplification, and ProPer body
mechanics in small grouPs at their actual work stations' Results of the
program were positive, and the Program has continued
to expand into a

comprehensive accident/injury Prevention project

within the companf'
a In contrast to these work related' Programs, Deily describes
the development
and operation of a home safety Program for older adults
in Virginia' USA'

A disproportionately .high number of older adults are involved

in home
the nation' The Program
accidents at considerable cost to individuals and

provided education about ways to modify the environment

or activities of
improvements for
daily living to lessen the risk of accidentai injury, safety
individ,ual homes, and community educationS. In South
Australia'
Health Service also
occupational therapists at the Noarlunga Community
played a major role in a recent state 'prevention of falls in the elderly'

Program.
In a more traditional health setting, stout outlines an'Automotive
safety
a

for children program, based at a children's hospital in

Indianapolis, which

injury management and prevention in the New South Wales coal mining
3 Arvier R, Bell A. Back 'Líth Federal conference'
industry. The Austrnlini associntion of ocaryàüonal therapist's
SydneY: 1988.
4 Schwartz RK. Cognition and leaming in industrial accident injury prevention:
An occuPational
E, editors. Health promotive and preventive
therapy perspectiuã. n, ¡otoron Jä, Jaffe tlrctapy in healt¡ care
programs: Models ãf occupatior,ui th".upy practice. Ocaryntional
1989;6(1): 67-85'
5 Deily I. Home safety program for older adults. ln: Johnson JA' Jaffe E'
editors' Health
prã*otiu" and prevãntive program s: "'pp'113-124'
 329
9z Occu pational Therapv and Public Health

as well as societal trends,

meets the demands of federal and state legislation,
physical handicap$'
for enabling the safe transPortation of children with
by an
. A parent-child activity grouP was introduced and developed
occuPationaltherapistasPartofacommunityoutreachPlogramwhich
psychiatric disorders'
focused on preschool children at risk for developing
The program was instituted collaboratively by u maior teaching hospital
used play and grouP ProcessT'
and a local day care centre in New York, and

occupational therapists in
These examples clearly illustrate scoPe for
preventive medicine to red,uce work hazards
from an occuPational health and
at retarding the effects of disability' at working with
clients
safety perspective,
and by enabling practice of safe
and relatives to help reduce at-risk behaviours,
progression of disorders and early
and satisfying activities which may retard
death.

some occupational therapists also utilize community

development

countries' Kerry Thomas' a

approaches particularly in socially disadvantaged
example, during a few years as
South Australian occupational therapist, for
described an integrated rural
regional training adviser for south East Asia,
development projectin Pakistan in which she was responsible for training the
training' health education with
local trainers, and which includ.ed health care
rearing, vocational training and
school aged children, agro-forestry, poultry
marketingoflocalcraftssuchascarpets.TheProcessofcommunity
wefe mostly illiterate and they
development was slow because the villagers
people who were participating before
needed to see the results of activities of
and education was practical'
many of them became enthusiastic. Training

for the handicaPPed. lnr

6 stout fD. occupational therapists' involvement in safe transportation
"lr*son and preventive Prograrns :...pp.45-56.
À luff" E, editors, Health promotive
parent-child activity group trea tment in Preventive
7 órco^ L, Heanery C, Soppas-Hoffman B.
pry.nã,ty' 1,.'' Hluiüi þromotive and preventive programs: "'29-43'
 alth 330
9 and Public

locally made pictures because of the low

assisted by role plays, story telling and

literacy skills8

overseas program demonstrates the principles of

whilst this tyPe of
community development in empowering local people toward self reliancee'
occupational therapists closer to home have been using the same principles
and, theories on a smaller scale. The following Australian examples
demonstrate a range of such Programs :

. work with remote and rural aboriginal communities' such as in the Top
based rehabilitation
End of the Northern Territory using community
models, and with the Tjalku warra Community
to improve conditions'
improved quality of lifei0;
promote independence, healthier lifestyles and
Integration Poticy Project'
. Planning and implementing a 'Community
aimed at increasing access for disabled people
to Melton Shire Council's

Programs,employmentopportunities,decisionmakingProcessesand
analysis of all the shire's
physical facilities. The profect progressed through
functions, at all levels, and across all departments; staff development

sessions; poliry development and implementationll;

o Participation in a Community Liaison Team
at Manly Hospital "to assist

homes' to support
raising the commtmities ideas about nursing

8 Thomas K. A letter from Nepal. ln: Wilcock AA, editot.

Health promotion and occupational
Therapists Congress' Melboume' 1990'
workbook: world Federation of occupational
ther aPY.
9 Burkley S. Peoplefrst:Agttidetoselfreliantparticipatoryntaldanelopment'London:Zed
books' 1993'
I rehabilitation with remote area Aboriginal

ence. SYdneY:1988'
tiary consultant in a local govemment agency'
,rnpirt't L5th Federsl Conference' Sydney:
1988.
 331
9: Occu and Publ ic Health

community groups and, to assist Patients discharged

from formal treatment

to involve themselves in the community"l2'

o Design, development and implementation of a quality
of life proiect with
based on
the elderly for the Department of Veterans Affairs, Sydney'
,Nominal Group Technique'l3. Consumer participants(422 people from Ll'
affected the quality of their
locations over 6 weeks) identified issues which
everyd,ay 1ives14, and the Process emPowered
them to establish a "Getting

Out and About Club"l5'

Communal 'doing' for the common, and' for

individual, good has always
of the 20th century this has
been part of human activity. In modern societies

become superseded by governmental initiatives which lack a genuine

community base. occupational therapists, as community development

enabling people to recognize the
workers, utilise their philosophical beliefs by
take action' to 'do' something'
needs of others as well as their own, and to
This extends occupational
about meeting those needs more effectivelyl6'
therapy into the socio-political arenalT'

The Australian association tf

12 Mnt.o ]. CommunitY liaison team, Manly District Hospital'
Conference. Sydney: 1988'
occupntional theraPist's L5th Federutl
program planning
13 Delbecq AL, Van de Ven AH, Gustaffson DH. Group techniqtrcs for
Glenview: Scott, Foresman and ComPanY,1975. A case studY
14 T*ibi" RL. Consumer participation in planning health promotion Programmes:
therapy journal L992;39(2)
using the Nominal Group technique' The
Australian occupational
13-18' therapy' The
promise for occupational
-and
is 1.8th Federal Inaugural Pacific Rim
95.

ty mental health grouP designed-by

and preventive programs',"'pp'57 -
66).
17 T*ibl" RL. Joumeying to a new land of hope:"'
 332
9z Occupational and Pub lic Health

Inthelastquarterofthetwentiethcenturypublichealthhasbeendefinedby
Last, who might be called a biographer of
public health, as "the combination of

sciences, skills and beliefs that is directed to the maintenance and

He suggests that it is a "dynamic
improvement of the health of atl the people"'
social and
which has to be resPonsive to a "rapid'ly changing
discipline"
public health goals' such as
biological environment" where many factors set
human
the ,'historical cultural context", "available facts about perceived
and,
technical capability to intervene
need", "social values", and "scientific and
effectivelY"lS.

For public health to accept the conceptualisation

of occupation as a powerful

on health it is necessary to suggest a direction

that occupationally
influence
basedpubtichealthcanesPouse.Articulationofthisdirectionformsthemain
I propose an action-research approach which
grew from
thrust of this chapter.
thesis, many of the which already
the exploration of ideas presented in this
demonstrated in the examples given
have a place in occupational therapy as
these ideas and provides a more
above. However this new synthesis extends
as an important tool in public health
integrated view of occupational therapy
practice. It requires therapists, among others, to re-assert occupation's
fundamental role, their attitudes, extend the domain of their
to change

concern to include all people (sick or

well) and a commitment to action-
communities and the global population, as
research which is applied to groups'

well as individuals'

the key features and factors to be

The starting point is a clear description of
to health promotion' These are:
incorporated into this alternative approach
. a balance of physical, mental and social well-being attained through valued
occupation

1 987, p.3'
18 Last J]v^. Pubtic healtlt nnd preaentiae nrcdicine'Connecticut: Appleton and Lange'
 JJJ
9: Occupational and Public Health

. enhancement of species common, and individually unique caPacities and

potential
. justice for all people and communities
occupational and social support and
valued'
o community cohesion through Politically suPPorted and socially

well-balanced, occupational oPPortunity

. research and action aimed at enabling, med'iating and advocating for
human needs rather than
healthy public policy which is resPonsive to
a sustainable ecology
materialistic wants all within, and as Part of,
. health care aimed. at the maintenance and enhancement
of physical'
psychological,spiritualand'socialfunctioningofindividualsand
towards maximum potential and quality in everyday
living'
communities
ininteractionwiththenaturalworldthatsustainsallcreatures,andina
way which ensures it's healthy survivalle'

Iadvocateanaction-researchapproachinlinewithcriticalsocialscience'
socio-historical development of
which recognises people as "participants in the
aims at facilitating
human action and. understanding"zo' Action-research
sociai change through self reflective inquiry
and consciousness raising which
hegemony issues, collective sharing of
enlightens participants about equity and
leading to collective planning
critical self reflections, dialogue and questions,
critical social science has beliefs
and actio î2't,22.I suggest this approach because
the assumption that
in common lvith my occuPational perspective, specifically
,,humans are active creatures,, and that people shape both natural and social

79

20

p.377-
on action research' Theory into practice 1990;
21 M.c,rt"heon G, Jung B. Altemative perspectives
mstock sugge s

the interPret
ional and Po
d social action'
 334
9z
and Public Health

Because people are largely unaware of

environments through their activity.
themserves or their curtures as
"the 'objects' they have created", their activity
defeating way" which can result
,,is
carried out in a disorganised and often self
To overcome the
in less than optimum conditions or opportunities23'
associated with this lack of awareness'
it is essential to use
problems
approaches which raise consciousness,
as well as providing support for
and health services' can be
reflection and informed action. Environments,
shaped through participatory action-research'
If occupational therapists
the communities they worked with
adopted such an approach, it would enable
ecology, in which individuals as well
to create a way of life, in balance with the
their needs for occupational
as their communities would be able to meet
satisfaction, increased well-being and
health'

The action-research model I espouse includes

four interlinking phases'

and occupational change by

research, awareness and education, activism,
communities as well as at socio-techno-political
levels' These
individuals and
phases are never complete, each one
leading to the next' but available to be
suggests new Possibilities' The
revisited to check or alter as new evidence
The research phase centres on exploring
phases may be fleshed out as follows.

issues about occupational deprivation, alienation, imbalance' meaning'

satisfaction, at individual, community,
capacities, potentiais, balance and,
quantitative or qualitative
national, global and ecological levels, using
phase invoives a multi-level
methodologies. The awareness and education
strategy to raise consciousness of this
way of viewing health'
educational
The phase of activism aims at
technology, societies and global activities'
occupation (on a globai scale) which is in
grad.ual social change towards human
flourishing and a
line with biological needs, social justice, intra-species
sustainable ecology. The final phase
is occupational change through socio-

23 Fuy,B. Criticat social science: Liberntion and is limits""p'47-53'

 Health 335
Chapter 9: Occupational Therapy and Public

needs of people as Part of the

techno-political resPonse to the global and local
wants'
natural world rather than materialistic and Power-based

exploration to monitor the

The interlinking involves ongoing research and
change and
effects,to feed back into education, activism, socio-techno-political

so on in a continuous sPiral. The comPonents of the aPProach afe not

them is ongoin$' reflective and
compaftmentalised, and interaction between
to multiple truths in a way
dynamic, in order to investigate and act according
meet them as they occur' and
which is flexible and able to anticipate needs or
The research and awareness
which can take corrective action when required'
The action and occupational
raising phases will now be considered separately'
change phases wilt be considered within
the five models discussed later'

are most
The exploratory phase would utilise whatever methodologies
has always favoured an
suited to the research question. Ptrblic health
approach and this remains an aPProach of choice
for clinically
epidemiological
based aspects of occupation studies. such empirical studies can be used to
public at large, and used in
inform the action-research participants, and' the
occupational scientists' in
combination with other types of exploration'
contrast to public health epidemiologists, have
favoured qualitative

approaches in order to explore the complexities

of humans as occupational
experiences and the individual meaning given
to engagement in
beings, their
of the fear that reductionist
occupation2a. This preference is strong because
will remain predominant to the detriment of in-depth work
on the
study
of people interacting with their environment2S' Indeed' the
complexities
qualitative research has arisen because of concem
that
preference for
therapists have been overly influenced by the
positivistic
occupational
true knowledge is scientific, in the sense of describing
,,a11 the
assumption that

24 y"r^uEf, et al. An introduction to occupational science...

25 personal communication (Yerxa to Wilcock, Adelaide1990)'
 336
9: and Public

coexistence and succession observable Phenomenà"26' and that

of
philosophical and theoretical observations
are only significant if they are
numerical, data' This has limited
constructed from ernpirical, preferably
past, to explorations such as surveys or
occupational theraPists' research, in the
as a result' many questions of an
clinical trials in the medical science tradition;
philosophical foundations'
holistic natufe, important from the Professions
have the potential to answer
remain unanswered. Qualitative approaches
"extend traditionar views of 'truth' to
some of these questions because they
from a participant's point of
include multiple realities, values and meanirtgr"
story telling' time-
view. Data can be collected, for example, by interviews'
documenting conversations'
diaries, experience sampling, observation,
reviewing records
and activities, focus grouPs, searching out and
interactions
an¿ written document ationz7, all of which can "produce meaningful

"offer explanations of how

descriptions and interpretations of social Processes"'
persist"' and provide "the basis for
certain conditions came into existence and
realistic proposals" for improving social environments2s'

Intheproposed'action.researchapproachnoonemethodologyisfavoured:
rather,appropriatecombinationsofresearchmethodswouldallowforthe
research to be exploratory, descriptive
or explanatorY' and for analysis to be
researchers' particularly'
empirical, interpretative or critical2g. Qualitative
recognise the complementary value of
quantitative and qualitative approaches

rather than their incompatibility.In combination they can add rigour and
breadth and, provide a more complete
picture than either aPProach can used

TrombleY S, editors. Tfte Fontana

26quinton A. Positivism. ln: Bullock A, StalleYbrass O,
London: Fontana Press, 1988, p.669.
dictionary of modern thought . 2nded.
studies. Plenum, chaPter
2Twilcock AA. Biological and socio-culhural perspectives on time-use
inPress. , t.t -^-:-t
28 interactionism: APPlied social and
blications, :DeO, P'ZZ; Becker or'
Observations on methodologY
Selected papers' Evanston' IIi': Nort
986'

pp.83-102.
29W'itcoct ee. Biological and socio-cultural perspectives""'
 337
9: Occupational Thera and Public Health

of knowing about humans as

alone30. Different blends will lead to new ways
occupational beings, and will help to provid'e
different PersPectives of PeoPle's

experience of in occupation, of the organisation and balance of

engagement
lifestyte throughout lifespan, and the relationshiP of each
to
occupations in
adaptation, social exPectations, tife satisfaction and health3l' Extended

methods of inquiry will enable the study of underlying factors which PromPt

people to do the things they do, day by day, often

or occasionally, why different
and whether current socio-
social groups and cultures use time differently,
values which will enable
cultural structures and institutions are based on
humans to continue evolving in directions which are appropriate and
necessary to the ecology and our species
survival and well-being'

science should provide the major research

base of an
whitst occupational
occuPational health Promotion approach,
it will need to draw uPon the
and behavioural sciences' as well
expanding knowledge of the medical, social
crosses all
as the natural and biological Sciences' Human occupation
cod.es, cellular system formation' biological
capacity
bound.aries from genetic
social and political domains
and personal ideas, through family, community,
to have effects uPon the world ecology' Within
all these domains there is a
choices
need for research to begin to understand' and influence occupation
national and
towards healthier bodies, minds, lifestyles, environments,
international Policies'

be accessible to the public at

Findings from this diverse research need to
large. In action-research terms they
must lead to an education-awareness

ln: Leininger M'

3Otripp- Reimer T. Combining qualitative and quantitative methodologies.
Orlando: Grune and Stratton , \985, p'179;
editor. Qualita tiae research methods in nursing
sociologY Vermont, USA: Gower Publishing
Silverman D. Qualitn tiue methodologY nnd jP,
G. HistorY of educational research. In: Keeves
Company Ltd., 1985, p 17; De Landsheere
measuremen f. Oxford: Permagon Press, 1'988,
editor. Ed ucational research, methodologY ønd
P.10.
31 i"r*u EJ, et al. An introduction to occupational science:"
 38
9: and Public Health

behaviour and lifestyle by

phase including approaches which Promote healthy

increasing understanding of how engagement in occupation can prevent

demonstrate how Political'
illness and promote health and well-being, and
technological structures facilitate or inhibit achievement
of
social and
which could be used to
occupational satisfaction and. Potential. Strategies
or individual awareness include social
increase political, public, community
planning which, in turn, includes problem solving based on data gathering
and goal setting; social action, such as rallies and
boycotts' conferences'

fairs, brochures and circulars

workshops, seminars, in-Service training, health
inlibraries; grouP discussion and individual counselling
in community
workplace, as well as in routine
agencies, health centres, schools, and the

health provider-consumer interactions'

Behaviour modification or mass propaganda principles which provide

warnings on cigarette packets'
information about healthy living, such as health
that at least some people
or in the televised 'Life Be In It' campaigns, assume
of the message'
accessing the information will adiust behaviours as a result
be expected in the long term and
The effects of such Programs can usually only
some who would deny this as a
are d,ifficult to measure and, indeed., there are
heatth education approach. Green, Kreuter
and Deeds suggest that health

requires voluntary participation of the consumer32'

and for
education
individ'ualstochangehabitualpatternsofbehaviourthisisprobablythemost
sought by people
effective approach. Unless information is specifically
can only occur after
motivated to utilise it, learning, which is cumulative'
exposure to an idea. However, in the case
of increasing awareness
repeated
health it may be necessary to
about the relationship between occupation and
is so little understood'
utilise such approaches, because the basic relationship
mass media exPosure of the
For example awareness can be raised following
ideas in topical in documentaries, and as themes in 'soapies'' in
Programs,
32 G."er, L, Kreuter M, Deeds S, Partridge K. Henlth edttcation planning: A diagnostic approaclt

ðalifornia, Mayfield Publishing Co'' 1980' p'8'

 339
9t Oc and Public Health

as about nutrition or
much the same way as other health messages, such
abortion, have been conveyed to the public'

the media' in part because

Occupational therapists are not skilled at accessing
values a medical
health message is not und.erstood in a society which
their
health. Even for the film 'Gorillas in the Mist'
science 'illness' aPProach to
was portrayed as a
Dianne Fossey, originally an occuPational therapist'
If occupational therapists do take up the challenge of public
physiotherapist.
and public relations skills to
health practice they wilt need to develop advocacy
are accessible. Alternatively their
ensure that their health education messages
pubtic health partners, experienced in disseminating information could
role, most occupational therapists
become their advocates. In their traditional
daily work with many 'at risk'
are skilled in health education because of their
example, one occupational
and disadvantaged individuals and grouPs. For
therapy educational strategy, to assist people
with psycho-social dysfunction to

change habit pattems, includ,es

'invalidation' of current patterns of behaviour'

exploration of "through thought and action"' followed by

alternatives
altemative behaviour33'
habituation and integration over time of the chosen

trained in individual and grouP

Undergraduate occupational therapists are
other health professions' would
counselling and teaching skills but,like many
not see their primary role as health educators.
A greater emphasis on this
aspect of practice is required. Jungfer,
a general practitioner who pioneered an
of
integrated health service in south Australia, believed that every member
moment to explain fully to the
health care teams "must seize every teachable
patienttheparthemustPlayinmaintaininghishealth'',because
increased awareness34' Increased
reinforcement from many sources facilitates
themselves the most appropriate action
awareness enables people to decide for

clinical PersPective for

33Ki"lhofr,"r G, Barris R, Watts f. Habits and habit dysfunction: A
thernpy': mentnl health 1982;2: 1-27
p"ycnosociat occ.rpational therapy',Ocuryationnl
ty s c i a n I97 9 ; 8: 219 -227
- an attitude of mind' Attstrnlian family pl
i
3a
i.,ngfer C. Prevention
 340
Chaoter 9: Occupational and Public Health

to promote healthy living, to understand and define

their owTl health
action they can take using their
problems and. needs, and to understand what
own resources

aimed at
some occupational therapists also Provide sPecific Pro8rams
awareness and educating about health matters. !aff.e,
for example,
increasing
and health education
describes the Medical Marketplace health Promotion
program in the American corporate world in
which an occuPational therapist
federally funded research
was the principal investigator. The project was
consumer education and
designed to assess the effectiveness of a health
training program on the reduction of health care
costs' The training was

intend,ed to increase the knowledge and skills

of employees' making them wise

consumers of health services; to improve the

quality of health
and informed
care more quickly and directly; and
care, by helping consumefs find appropriate

to reduce employee health costs, by eliminating the use of unnecessary or

In a more trad'itional context' Breen describes an
inappropriate services35.
approachdevelopedforusewithelderlypeopleinanursinghomewherethe
programs, which encouraged
concept of self-help arising from traditional
deterioration and
patientsto assist themselves in their daily needs to prevent
of patient education
to promote recovery, was expanded into a formal Program
valid
in health-enhancing strategies36. Both these examples demonstrate
approacheswhichareinlinewithconventionalhealthpromotionideologies.
on Kielhofner's 'model of
In contrast, Rosenfeld. suggests an approach based
of important lifestyle
human occupation' which utilises "didactic presentation
concepts, self reflection, goal identification,
and concrete planning" and
and the development of personal
includes examination of "the doing Process
and four planes of existence (physical'
competence,...Iife roles, the use of time,

education: Health promotion in the workplace'

ln: Johnson lA,
35
Jaffe ER. Medical consumer health promotion ønd
laffe E,editors.. Oict,patnnat !u:(Vt
Program deaelopment 'fo'
Press' 1989'
preaentiae ser?rces'Nów York: The Haworth
in a nursing home'
368r""r, VW. Education with activity: A health promoli91-qrogram
"òlrirp*io"ol
therapy in h:alth cnre ' 7989;6 (1): 101-111'
 341
Cha 9: and Pu blic Health

emotional, intellectual, and spiritual)"37. He suggests

that illness or
dysfunction which disrupt life Processes facilitate
an 'occuPational shift'
recognition of intricate
because "disruption leads to a novel and clear
that weave the fabric of life"38'
occupational patterns, places and circumstances

action-research model
The education-awareness phase of this public health
information' and more
requires more than occupational therapists providing
than participants in any one SrouP engaging in a change-growth
experience'

for the exploratory phase

important though these may be. Just as I have argued
so I argue for this phase
of the approach to be contextual as well as individual,
to be context-dependent. The education-awareness phase should
link
processes with the problems
structuralism and individualism, broad.er social
people face in their daily life, occupational behaviours, meanings and health
socio-political structural change
outcomes, and should. be viewed. as an agent of

which can emPower and enhance individual awareness of optimum

personal potential39' It
physiological functioning, role perforlnance, and
determinants which can
should, for example, encomPass the occupational
contribute to health and well-being discussed
in chapter 5, or contribute to the

health disorders, and ultimately to disease, disability

or death' as
pre-clinical
discussed in chaPter 6'

according to the problem

The third, action phase of the approach will vary
and strategies
but will be based on 'doing', and on developing techniques
national and
which may facilitate imProved personal, community,
international occupational health' Five models, which are not mutuallY

of house fire victims' Th¿

3TRosenfeld MS. Occupational disruption and aclaptatiol:A study
';*t;:i;r" jottrnal oi ocaryational therapy 7989; 43: 89-96'
3gRosenfeld MS. Lifsiyle education und ,".risior, for the worried
well' W o r k 7992; 2(3): 27-27 '
h: The ideologY of victim
80; French J, Adams L. From
ucation journal 7986; 45(2): 7L-
ancl prnctice' Geelong, Victoria: Deakin
UniversitY, 1992'
 342
Cha oter 9: Occupational Theraov and Public Health

9.L on the next Page for an overview'

exclusive, are discrssed here. See Table
social justice' community
The models are wellness, Preventive medicine,
which are defined in accordance
development, and ecological sustainability,
about each aPProach' The five
with id.eas expressed by a maiority of works
approaches represent significant ideas
which have emerged during this thesis:
might be
an overview of the differing ideologies of each reveals how they
approach could take from an
integrated, and what direction an action-research
dividing out differing aspects of
occupational persPective. This method of
services aiming at health promotion
provides us with ways of seeing
and' deploying resources) and
(und.erstanding), organising (setting obiectives

doing (research, strategies and programs)'

All are important' and need not be

separated in Practice'

because, theoretically, it fits

The wellness model is the first to be considered
traditional orientation, and courd be
most closery with occupationar therapist's
medical environments'
utilised in practice in afenas, such as conventional
wheremanyoccupationaltherapistsstillwork.Inlg54HalbertDunn,a
'wellress' as "an integrated method of
physician, conceptualised and. defined
the potential of which the
functioning which is oriented toward maximising
individuar is capabre within the environment where he is functioning"4..

words such as'meaning'' 'purpose"

This, plus other definitions which include
'holism' are clearly compatible
'philosophy of living', 'a state of being', and
have chosen to highlight the
with occupational therapy phitosophyal, but I
of wisconsin because it is
following definition by Hettler, from the university

RW BeattY, 1954'
future roles' Socioc ultural implications
Haworth Press, 1987; 4(1): 155-164;
ion and motivation' In: DosseY BM'

WFOT , Zv¡ich,7970
 ô
Ð

.D
Base Definition Ft

P
o
'An active Process through Health and Disseminate research findings É
Individual satisfacti Individual counselling
Illness -Wellness whidr individuals become Personal skill develoPment
Þ
aware of and make choices meafung I o
Reductionist - Holistic I I towards occuPational
Wellness Medical I Socíal I toward a more successful
equity potential Þ
Behavioural sciences existence.
Person centred
Underlying OccuPational Disseminate Researdt fi ndings
Populations / Individuals determinants Individual and group
Preventive Illness, occupational tou riselling and ¡¡
Reductionist Droeranìs Þ.
Medicine Epidemiol ocy / Behavioural
' Medical lSocial science intercepting Sdciafand Individual change E
of structures
Informative disease d
Participatorv analysis of Disseminate Researdr findings
Commr¡rities cominunitY occuþational Facilitate occuPationa I change o
Wellbeing structure and grrowth ôf communitY ¡¡
CommunitY Holistic Local resources Develoóment of communitY
Social-Political science accoiding to their Perceived
Development Self sustaining/ local resources needs an-d using local
/ person centrêd / ParticiPatory resources

Disseminate Research findings

Groups/communities Facilitate social action for
Ineqtiities = Ill health
Social Holistic
Justice Social - Political science
Person centred / ParticiPatory Social

Disseminate Research findings

Global Facilitate social action for
Species well being chanee toward sustainable
Ecological F{olistic occuõational constructs of
SustainabilitY Biological and Natural sciences beneht to all species and
Self-sustaining occupational ñealth of
people.

(¡)
È
(¡)

Table 9.1: Overview of health models

 344
9: tional and Pub lic Health

appropriate to an action-research approach and my occupational theory

Wellness is:

process through which indiaiduals become aware

"an actiae tf
ønd møke choices towørd a tnore successfitl existence"42

According to Dossey, this health model assumes that

every individual has

innate capacities for healing, nurture, self reflection'

taking risks' and for

change towards wellness; that all people are searching

for answers
making
and that health is also
about the life process, about meaning and purpose;
about ind,ividuals being able to rive according to theiq
beliefsa3. wellness
referring to work, play and
embraces a multi-dimensional concept of balance,
rest, to nutritional balance, to balance between use
of physical, psychological,
self, environment and
intellectual and spiritual capacities, as well as within
synonymous with health
culture44. The health model is seen by some as
promotion and ill-health prevention45, especially
in America where it has
become a preferredapproach at many industrial, business and corporate work
'at-risk' behaviours
sites46,where programs aimed at preventing illness and
are the most often described. Its acceptance
in the corporate sector reflects the

strong 'self responsibility', 'individualist' approach in American

society'

responsibility can lead to

Another view is that too much emphasis on self

79. Inl. Matarazzo

42Hettler W Wellness - the lifetime goal of a university exPerlence. Chapter
health' A handbook of health en hancentent and disease
JD, et al., editors. Behnaioutal 1990, P' 1117
preoention New York: ]ohn WileY and Sons,
43Dossey BM, Guzzetta CE. Wellness, values clarification and motivation... P 70.
44S"e for example, Howard RB. Wellness: Obtainable goal or impossible
dream. Posf graùtate
Past visions' future roles...
medicine t983;73(1 ): 15-19; Brown KM. Wellness:

nce the wellness of its members through

rt"
henthy otganizational cttltures'
.ng

; 72(2): 1'48-1'64.
 345
Cha 9: Occupational and Public Health

light of epidemiological data

victim blaming which may be unfounded in the
as maiof contributors to ill-
that points to environmental and social conditions
healthaz. European approaches, in contrast
to American, emPhasise union
work site health issues48'
initiated structural and legislative changes to

health circles as a'serious'

In Australia, 'wellness' is not recognised in public
to medicine'
model. Rather, it is viewed as a 'trend.y' concept, PeriPheral
change in public attitude
which displays an encouraging ind,ication of a
towardshealthconcerns.Thisleflectstheconservatismofthehealthcare
dominance of the A'M'A' in health
system, in some ways as a result of the
are, on the whole, left to
matters. Individualised health promotion strategies
This peripheralising of
the private sector and alternative health providers'
,wellness' maintains the dominance of an illness approach to individual

once more, a health value which is

health within conventional medicine and,
in accord with occupational therapy is trivialised'

In the light of the complex, interactive nature of

the relationship between

and health it can be questioned whether an

individual wellness
occupation
approach has any value. I believe it can offer a useful starting point to increase

influences
awareness of individual needs and. potential and how underlying
ancl action consider the context as well as
affect health, particularly if research

the individual Additionally, because the wellness model follows the tradition

47 furtonovsky A.Thesenseofcoherenceasadeterminantofhealth.In:Matarazzo|D,etal.,
editors. Behnai oural health the
disingenuous to, howeuer,talk about getting enough sleeP while disregnrding
to
" ...it is
of people, which compel them to moonlight or
work extra
economic Pressures on tens of millions to talk
shifts; to talk about eating well
but saY nothittg of the powerfril adaertising industry;
be blind to to the manþld socinI stressors that
of not smoking and drinking moderatelY Yet coping resPonses" (P. t24).
AS nøladaptiae
tead peoPle to use smoking and drinking
4Sweintt"in M. Lifestyle, stress and work: Strategies for heal th promotion. Health Promotion

12 trade unions in the United Kingdom' along

uity and social justice were most often
.,.,ion membership(Whitston C, Waddington J

ß9a;7Q29): 36-38.)
 346
Cha 9: and Public Health

it is an aPProach suited to all

of the ,growth' id,eologies discussed earliel,
d'isabled and disadvantagedae:
people including those who are handicapped,
person-centred rehabilitation Progfams
and wellness aPProaches all aim at self

esteem, performance, roles and quality

of life skills to Promote Personal
"when PeoPle are undef varying
growth and well-being. Dossey exPlains that
degrees of stress or illness, they can
lose their appreciation for life's Pu{Pose

andmeaning'Itisatthesetimesthatthepractitionerfacilitatesthejoumey
This suggests that the wellness
toward understanding the wellness process"SO'
medicinesl' to counteract the
model may be a useful adjunct to conventional
with a focus on high technology
trend towards increasingry restricted acute care
rather than participatory'
which is expensive, and which expects a passive,
attitude from consumers'

Rehabilitation concerned with clients' personal skill development and

life, which was an extension of

aimed at maximising potential and quality of
over the last twenty years
conventional medicine, has declined in importance
to a token service. Now occupational therapy in
conventional medicine is

as bed tum over increases and resources

are stretched to cover
being reduced
specialties' Even n 1966
other more acute and technologically sophisticated
Reilly recognised that it was becoming harder
for occupational therapists to
,,advocate patients to practice a healthy balance of work'
rest and play
for
and eventually within the
within the oT clinic, the institution as a whole,
Occupational therapy interventions are
larger community environment"S2.

eeds".

50 Dossey BM, Guzzetta CE. Wellness, values clarification

and motivation"" p'69'
medicine, see; Levenstein s'
51 Fo, a critique of the wellness movement as oppos"d_þ 1o-"::"tional
W"tltt"rr, Ïealth, Antonovsky Adaances 799a;10(3): 2G29'
'
therapist' The American journal of
EA. From hosPital to communitY -
ffe E, editors. Occupational Therapy I

and Preventive Services"'

 347
Chapter 9z Occupational Therapy and Public Health

becoming limited to formalised' and pre-determined assessment rather than

life skill development and, increasingly, use comPensatory and counselling

which take longer'
appfoaches rather than facilitatory remedial aPProaches
'axed' include evaluation of
The types of program which are gradualty being
skills health
peoples caPacities, values and occuPational Performance
education relating to occuPational balance' symPtom reduction through
engagement in occupation, retraining in the context of occupations of daily
living, environmental modification, self management' relaxation'
stress

management, and work simplification'

which conform to
Limitation of practice occufs even in community agencies
Care services
a conventional medical model, such as the regional Domiciliary
in south Australia which aim to assist peopte with long term disabilities'
regardless of àgp, at risk of premature or inappropriate admission to

institutions. Limited resources for a large numbers of

referrals mean that
in being able to practically
occupational therapists have experienced difficulty
implement their beliefs in health rather than ill-health approaches'

focus on primary care and

Domiciliary care service guidelines establish a clear
rehabilitation but study undertaken in south Australia
in !gg7 revealed that,
expressed a belief that
although 80% of the occupational therapists surveyed
promotion Programs'
domiciliary care provides an aPProPriate base for health
therapists were able to
which they were keen to offer, only 9% of occupational
provide this type of interventions3'

Given these concerns, important to consider what direction the

it is
proposed action-research approach could take,
if public health supported
therapy wellness Research, education' and action for
Programs.
occupational
well-being'
this approach could aim at the 'positive influences on
and

53 Wilcock AA. Domiciliary Care, occupational therapists and health

promotion' The
proceeclings of the Austínlinn Association of ocaryational rherapist's
15th Federal
Conference. SYdneY: 1988
 348
9: and Public Health

,occupational indicators of health status' as shown in figure 5'1' Other

and Practice of health workers in

possibilities include exPlofation of attitudes
federal health bodies' of the public'
hospitals, of health planners, of state and
raising, action and change;
and of consumers, with subsequent awareness
of the effects of focussing on illness, in the short term, at
the
evaluation
expense of long term wellness utilising, for example, longitudinal clinical
outcome studies of people with disability
who experience wellness' growth and

increased potential Plograms against controls

who do not; exploration of the
alienation' balance' satisfaction'
degree of occupational wellness (d'eprivation,
'fat file' patients or out-patient attenders'
etc) experienced by accident victims,
followedbypubliceducationandactionsuchastheintroductionof'welhtess,
practice or community centres;
groups in hospital ward.s or in general medical

and, possiblymost important, aimed at discovering and enhancing

Plograms

the occupational potential of children according

to their genetic strengths'
what they do' how they
whilst enabling them to recognise the links between
environmentss4.
feel, and' the effects on social and ecological

medicine'' is the most closely

The second model to be discusse'd, 'preventive
health, both historically and at present' Based
on a wide
linked to public
variety of preventive med'icine literature I define
it as:

,The application of westem medical and social science to prevent

prolong life and promote health in the community

through
disease,

intercepting disease processes''

'ilbiress' model aimed at

Like conventional medicine it is a reductionist,
individualsalthoughitoftenutilisespopulationbasedstudiesasafoundation

54

):

1.15-LZ3
 349
9z
and Public Health

disease agents by methods

for its approaches which aim at Protection against
as immunisation, vaccination, screening, and social
and envirorunental
such
engineering. It emphasises early diagnosis with consequent retardation of

disability, and focuses on Pfeventing illness

rather than promoting wellness'
(I believe, erroneously) as
although, as stated earlier, it is viewed, by many,
equivalent to health promotionss'

prevention of itl-health through epidemiological research aimed at 'early

pre-clinical factors' (a medical science approach

to public health) remains the
resources, desPite a stated
strongest influence, and attracts the most
commitment to social health. An example
of this commitment is provided in
Commonwealth Depaltment of Community Services
and
the Australian
Health's brief summary of w.H.O.'s work
which states, at Clause 24' that:

' U by the
inødditiontotheaaøitabilityofsuitableheatthseraicesøtacostthe
Year 2000) also means a
-health
støte of thøt enables each
d economicøllY Productiae ltft'
continue to consider obstacles to
mølnutrition, Poor housing,
unemploymentandcontaminateddrinkingzuøterjust.asimportant
ønd doctors, drugs,
øs other conii.derations sttch as the løckof- nurses
aaccines, or hosPitøl beds"'56

Preventive medicine's strong committment

to epidemiology is
the needs of public health
demonstrated by Last's assertion that although
hygienists and sanitary engineers
workers such as health educators, industrial
aÍe different all "share a common reliance on
one scientific discipline'
of epidemiology' he says' is to
epidemiology". The most fundamental purpose
,'supplyinformation,andwaystointerpretit,forthediagnosisand

imed at smoking cessation, reduced alcohol use'

rol of aiolent belnaiour""'
ine... P.4.
56co**orrwealth Departrnent of Community services and Health' world
Health
Australian Govemment Publishing
Organization, A brif srnlmnry of its
uork. Canberra:
Service, 1988, P'10'
 350
9z and Public Health

measurement of the health Problems of the population"ST' Whilst

epidemiological research
occupational therapists do not focus on developing
intervention on epidemiological
skills at undergrad.uate lever, they could focus
However the interventions should be
evidence provided by other researchers'
perspective' For
interpreted and extended according to an occupational
considered alongside occupational
example, substance abuse habits could be
the underlyitg
behaviour, the negative effects of occupational deprivation and
To do this occupational therapists
d,eterminants which read to the deprivation.

may utilise other research tools of a qualitative nature as adiuncts to

interested in social health have
epidemiology, just as public health workers
done.

in this thesis it will be

In order to realise the implications of the ideas raised
social and health
necessary to challenge many ideas that are central to political'
post-industrial societies with an
ideologies. This is particularly so, because in
economic-technological-power focus, rather
than one aimed primarily at
in a way which recognises ecological strengths
meeting the needs of humans
health services are fostered and
and constraints, highly-technical, illness based
applauded.ThistyPeofserviceencouragespeopletocontinuestressful'
and unnatural lifestyles because it offers to undo
many
regulated, time-dictated

of the obvious effects of consumer societies

with sPare parts and chemical

remedies: it is esentia[y anti_dotar. The

whole societal configuration inhibits,
which may help prevent
by default, the establishment of alternative systems
illness.Thisimpliesthatthetheoreticalfoundationsofthisaction-research
approach must address structural as
well as individual prevention issues'

Occupationaltherapistshaveasurprisi.glylonghistoryofinterestin
that as early as 1934' in canada' it
prevention, although many will be unaware
that occupational therapists had a potential role in
the
was being recognised

57Last J}d.Public health and prnentiae nrcdicine"' p'6

 351
Cha 9: and Public Health

that,
community preventing ilt-hearth. At that time Le Vesconte suggested
in
in combination with social workers, occupational therapists should
be

that endss' unfortunately'

involved in social and economic reofganisation to
offerings, and did not
this direction got lost in medicalisation of professional
1969 paper The growing importance
re-emerge tmtil about the time of West's

of preaention. This introduced occupational therapists to the concept of

involvement in primary and secondary prevention, to prevent the occurrence

at a
and. progression of disease or injury, and to not being limited to working
disabilitys9,
tertiary prevention level to minimise and reduce

therapists already offer were

Examples of the types of programs occupational
occupational therapy action-
provided at the start of the chapter. The proposed
research approach to would extend contributions such as those'
prevention
such as 'division of labour''
aiming at occupational institutions and activities
,technologyindailyliving,and'legislation'thatleadto'riskfactorsimpinging

on the individual, such as 'lack of opportunity to develop potential',

alienation' as well as 'early' pre
occupational imbalance, deprivation and
'bumout" or 'Sleep disturbance'aS
clinical health disorders' such as 'boredom',
showninfigure6.L.Thismaywellinclude:helpingindividualstoidentify
occupational factors which lead to Stress,
drug abuse, child abuse' women in

transition, or other crises; practical and effective parenting; developmental

clubs'
screening; youth activities; elder citizens' activity grouPs and social

community model'
The 'Social justice' model of health is a participatory'
which, in light of the literature' I define as
the:

work Planning. Canadian iournal

58L" V"t.ot te HP. The Place of occupational theraPY in social
Le Vesconte HP. Expanding fields of occupational
of occupn tional theraPY1934; 2:13-t6; 3: 4'12'
1935;
thera py. Canadinn journal "f ocaryational
theraPY

59 W"tt W. The growing imPortance of prevention' The American iournn I of ocutpational

thet aP Y t969 ; 23 223-237'
 352
9: and Pu blic Health

,Promotion of social and. economic change to increase individual'

oPPortunities for
community and political awaleness, resources and
health'.
Social justice is based on the belief that ilt health is often an outcome of
from factors such as
inequitable distribution of resources and Power, resulting
and cultural values' It
the type of econom/, national priorities and policies
aims to change those underlying determinants
of ilt-health60' In the Alma Ata

and Ottawa Charter documents social iustice surfaces

as one of the
of health. Both claim that for 'health for all by
the
fund.amental prerequisites
'have
year 2,000' it is essential to "to close the gap between the 'haves' and
nots"' and to achieve:-
heøtth resources within and
rential øllocøtion to those in
Ith sYstem ødequatelY coaers all

has been the subject of

The relationship between social justice and' health
notable Hart found that' in the
numerous investigations. In one of the most
care tends to vary inversely
united Kingdom, the availability of good medical
where there is the greatest
with the need of the population served, and in areas
practitioners and hospitals have
proportion of illness and d.eath, both general
caseloads and the least resources62. A little
later the BIøckReport on
the largest
,Inequalities in Health' in Britain gave an account of the inverse relation

betweenhealthstatusandsociallocationandcalled'foraradicaloverhaulof
in Australia, Broadhead
health service activities and resources63. Similarly,

60

Routledge, 1992.
61 w.H.o. Formttlating strategies for heatth for alt by the year 2000.'.
1979'

62 HartJT. The ir,.r"Ã" care law. The Lancet797l;Feb27:.405-412'

Hart fT' The Black report: A
63 Report of. a t977 working party_, chaired by Sir_D-o_uglas Black;
.iräh"g" to politician"' fl" Lancetl992;læ 2:35-36'
 353
Chapter 9: Occupational Therapy and Public Health

and affluence were

found, in an investigation in which occuPation, education
of morbidity - recent
used as variables of social stafirs, that the four indicators
illnesses, chronic conditions, days of reduced activity, and mental health

showed significant relationships to affluence for both sexes' after

l'983, approximately L5% of the
standardisation fot age6a. According to Opit, in
Australian population suffered from Poverty and
from lack of autonomy or
injudicious alcohol
power, with subsequent anxiety, depression, risk-taking,
consumption, and, premature death ali exacerbated
by the inabitity to take

advantage of the limited resources committed to

their welfare' Those suffering
large families
most were Aboriginals, many single parents, the unemployed,
and the degree of
with a single wage eamer, the old, and many recent migrants,
deprivation and the numbefs were increasing6s' The rhetorical commitment
economies cannot be
to social justice and egalitarianism in most liberal
"there is no sign that any Western
achieved without structural change and
will to make the massive redistribution involved
democracy has the political

in recommendations such as those of the 'BIøck Report"'66'

between health and social

In the interests of understanding the relationship
justice, Gallagher and Ferrante call for a critical analysis
of the cultural
social concern
processes that shape both the medical care system and the broad
care, because standard rehearsals of equity,
in the liberal tradition'
with medical
ignore the underlying determinants and Processes
of health experiences' and
individual control6T' Ilx
the extent to which they arise from factors beyond

and welfare problems which so affect poor

peoPle.
inverse care law in Australia ' Næu doctor
65 Opit Lf. Economic policy and health care: The
1983.
66 Bunton R, Macdonald G, editors Health promotion: Disciplines and diaersity"' p'17I'
.
researchlgST; l(3):
67 Gallagher EB, Ferrante J. Medicalisation and social justice-' Socinl ittstice
Socinl jttstice rcsearchl9g7;7(3):257.
377.392;Le Grand J. Equity, health and health care.
 354
Chapter 9z Occupational Therapv and Public Health

terms of societal preconditions for need satisfaction

Doyal and Gough have

identified civil and political rights, the right of access

to 'need satisfiers" and

political participation. In occupational terms I have

identified underlying

factors such as the type of economy, nationar

priorities and policies, and
The action-research approach
societal values as determinants of health status.

I propose would, focus debate on the underlying occupational factors'

choice, satisfaction'
institutions and activities which reduce occupational
balance and. meaning, which prevent people
from reaching their potential' and
and deprivation' early
which lead to the experience of occupational alienation
pre.clinicalhealthdisorders,diseaseanddisability..

Occupational therapists have an implicit concern

with social justice as part of

their philosophicalbase but it has not been central in their documented

approach to health promotion even though, from my own experience/ more

clients from socially disadvantaged groups than

from affluent groups receive
suggested that occupational
occupational therapy services. Townsend has
"the sociar vision which forms the
therapists need to become conscious of how
"narrowed to comply with dominant
found,ation of occupational therapy" is
community, managerial and medical approaches
to disability and ageing"' She

advances the idea that "enabling people to

participate as valued members of
centrar within the vision68.
society despite diverse or rimited potentiar" is
justice for, and with' the disabled
According to Hodges, action toward social
"need to be
does not occur6e. Health promoting and risk notification Progfams
affirmatively motivating and empowering (them)
of to make
capable
appropriate, constructive responses", in order
to protect the health of the

matters see: Sen A' Comnndities and caPabilities.

274. Foran economist's account of the same
Amsterdam: Elsevier, 1985'
68To*nr"r,d E. 1993 : Occupational therapy's social vision' Canadian
jitrnal of occuPat 4\ 174-184'
69Hodg"s A. Health e prevention for the disabled' lournnl of allied
health1986; Nov:
 355
9: and Public Health

disabled and pursue "their justified legal

remedies"To' These are obvious

starting points for occupational therapists

to become involved in social justice
as well as PeoPle' and to influence
issues, to promote change to environments
laws71' Another direction
the d.evelopment of person centred policies and
invorves being more responsive to
"the concept of ilness as a condition of the
This would enable
total human being, including the spiritual d'imension"'
therapists to work "with conditions within
the patients primary systems"'to
to health (such as Poor
bring about changes in conditions that are detrimental
living cond,itions, inadequate infant nutrition, or
nuclear proliferation)"'

johnson proposes the settin8 uP of laboratories in which

"patients acquire

environments"T2' Such a
skills they need to influence change in their
be envisaged as part of critical action' and is in
line with the
laboratory could
action-research approach I propose'

designed to approach
From an occupational point of view interventions
socialjusticemightinvolvedevelopingcommunityawarenessabout
occupational opportunities through the use of
social action
inequities in
along with providing individual
involving community $ouPS and the media,
skills which lead to political
and community 'laboratories' to practice relevant
tobbying for structural change. An example of how increasing community

awareness can read to social action comes

from Kinnel's account of how rising
in
which resulted from the increased emphasis on education
levels of literacy,
Englandduringthelateeighteenthandearlynineteenthcenturies,fosteredthe
the books dealt increasingly with
growth of trade in children's books' Since
themes such as the right to exercise
individual moral iudgement and social
in disseminating radical ideas and
justice, this development was instrumental

science, technologY and human

T0Needleman C. Ritualism in communicating risk information.
a n I tt e s L987 ; 12(34): 20-25'
71To*r,r"r, dE. 1993 Muriel Driver Lecture"'
72¡ohnson wellness and occupational therapy. The
American iottnal of ocurpationnl
fA.
theraP Y 1986; 40 753-758'
 356
Cha ter 9: and Public Health

of and dissentT3' This

raising the level PeoPle's Political consciousness
justice and health'
example suggests that information about occuPational
manner, PerhaPs using
packaged in an attractive and consumer oriented
internet or popular magazines, might be one way
to aPProach consciousness

raising on a PoPulation scale'

oPPortunity for
An occupationally just society would be one which Provided
than be expected to fit into socio
people to develop their own potential, rather
are strait jacketed into roles set by
economically established roles. Many people
communities: for example, there is enormous Pressure
on adolescents
their
and'evenyoungchildrentodowellatschoolinarestrictedrangeofsubjects,to
In many instances a child's
be fitted for particular jobs or to go to university'
particular talents are set aside in the interests
of potential material reward'
scenario is not surprising within
educational and societal expectations. This
"economic division of labor
basic national frameworks characteri zed by
need"; a gender based division
organized for private profit rather than human
from recognised and
of occupation "that separates privatised child rearing
remunerated work"; "Paid labor markets that generate a marginalised

underclass"; and a globalised intemational political economy which

increasingty subjugates its poorest workers

and must then "engage in crrsls
In
managemen t in the form of segmented social welfare concessions"T4'
addition, legislative changes that reduce risks' individuality' and
opportunity and satisfaction and can
experimentation also reduce occuPational
and imbalance' Even social justice
lead to occupational alienation, deprivation
towards current social' economic'
and equity models afe, on the whole, biased

educational and health opportunities,

which can lead to reduced occupational

ScePtreless, free, uncircumscribed?

radicalism, dissent and early children's books'
73 Kinnell M.
36(1): 49-71'
Britistt iournal of educntional sttñies 1988;
uiltrLral UK and Cambridge USA:
sttrclies. Oxford,
T4Denzin NK. SYrøbolic interactionism and
practices. Minneapolis: University of Minnesota
Blackwell 1992, P I45; Fraser N.Unily
Press, 7989, P'107
 J5t
ChaPter 9: Occupational Therapv and Pub lic Health

choice social justice approaches requile exPansion

to encomPass egalitarian

ideas about ind.ividual and community uniqueness, and occupational

therapists could take up this particular aspect

of social justice'

Community development is the fourth model

to be considered' From
d,efinitions, descriptions, and views found
in community development

literature, I define it as:

Communityconsultation,deliberationandactiontopromote
individual, family and community wide responsibility
for self

sustaining development, health and well-being"

a community's social
It is an holistic, participatory model, aimed at facilitating
analysis, use of lqcal
and economic development, based on community
resources, and self sustaining Programs.
It was widely used in African and
war to stimulate local
Asian colonial administrations after the second world'
aimed at mass literacy and educatiods'
lead.ership and, later, in rural Programs

In the in the united states of America and the united Kingdom'

I960's,

community development strategies were adopted

for use in socially
d.isadvantaged urban areas to stimulate
self help and innovative solutions

which were cost efficientT6'

based health care in

Similarly, the move towards mofe community
Australia can be seen as a resPonse aimed
at the social and environmental
interest in health
originsof much iit-health and, also, at meeting the growing
issues by large sections of the community'
In the !970's' Australiaintroduced a

Community Health Program which offered

a framework for funding public

er A, Kuper J, editors. The social scíence

London: Routledge & Kegan Paul' 1982'

 358
Chapter 9: Therapy and Public Health

and private group projects for community based Preventive,

diagnostic,

therapeutic and rehabilitation services based

in l0cal centres and
by home care, day care, health education, mental health'
complemented
alcohol and drug abuse ProgramsTT. This resulted
in a great variety of
care, with traditional health
community based services, some,like domiciliary
values and others which tended. to challenge
vigorously conventional health
Perhaps because of these wide
ideologies, as some women's health groups did.
'health services based
ranging community initiatives, it is common to confuse
in the community' with 'community development''

Health services in the community can adopt a community development

by encouraging community consultation as the basis of the service'

approach
and by being responsive to underlying social factors which affect health in the
long term. such an aPProach is a means of enabling
all people to become
and changing circumstances
involved in planning, implementing, questioning
within their own communities so that they are economicaily and socially
advantaged: this, it is believed, leads to improved health and to improved
of
community health care provisions. or this reason, the strengthening
health promotion prescribed
community action is one of the five strategies for
the essential voice in
in the ottawa Charter which "accepts the community as
mattersof its health, living conditions and well-being" and asserts that
,,empowerment of communities, their ownership and control of their own

endeavours and destinies" are "at the heart"

of the community development

processTs. It is often the restrictions imposed

by govemment funding bodies
approaches' and maintain a
which inhibit the use of community development
'top down' deliverY of services'

TTmosnicofAttstraliancommunityhealthpolicy.Australia:
ervices and health, 1988'
78 Promotion"'
 359
ter 9:
and Public Health

systems of primary health

Initiatives aimed. at helping communities develoP
utilise available resources and are
care that cater for their specific needs,
in economically disadvantaged countries
sustainable are used more commonly
post-industrial societies' such
with poorly d,eveloped health services than in
utilize various aPProaches such as the Prevention and
control
programs may
of diseases through immunisation, the improvement of environmental

and the development of skills

conditions, the training of local health workers,
to make most use of available resources
for community growth' An examPle

by a reportedly very successful action-research project in

two
is provided
1986 and 1990' community
Egyptian villages which took place between
to work within' and as part of'
members, and especially the women, learned
as they participated in
the organisational structure of their local government
facilities. At the same
the construction and improvement of local sanitation
with the need for proper
time they took part in health education concerned
sanitationT9.

Occupational therapists leading the profession

in community development
above; an example is
often work in programs similar to the one described
in the chapter. Thomas, who has also worked
Thomas,s work, outlined early
in Ethiopia, sudan and Cambodia, as well as in community development
promotes occupational therapy
pfograms with Aboriginal grouPs in Australia,
entry into community
as ,,one of the best health-related bases" for
is compatible with "independence
development work, because its philosoPhy
approach"' the "broad based
and self reliance", its "practical and functional
training,, and skills in "responsible problem solving"' However she believes
or training is required to enhance
specialised post graduate experience
and particularly to assist in
knowledge of community development processes

79 el Katsha S, Watts S. Environmental health interventions

in Egyptian villages' CommunitY
ãeaelopment iotrrnal 199a; 29(3): 232-238'
 360
Chapter 9: TherapY and Public Health

Political, economic and social

of factors and
analysis and mediation
consequences of interventionsS0'

theraPists to utilise an action-

one good starting Point for more occuPational
researchaPProachtocommunitydevelopmentis'CommunityBased
community development
Rehabilitation'which is defined as "strategy within
and social integration of all
for the rehabilitation, equalisation of opportunity
"implemented through the combined efforts of
people with disabilities". It is
disabled people themselves, their families
and communities' and the
social services"8l' The
appropriate health, education, vocational and
further, however, to include all
occupational perspective should be taken
for people differ from
people, not just those who are disabled. opportunities
to community. Exploration of the underlying reasons for
these
community
differences, and how they impact on health and well-being needs to be

participatory approach' This is

undertaken using a community development,
oneofthemostsuitableapproachestoincreaseawarenessandpromoteaction
aboutthecausesandeffectsofoccupationalalienation,deprivationand
with the advantage of potential to also provide support
and
imbalance,
for the self reliant, self chosen occupation which gives
encouragement
earlier chapters demonstrated'
meaning, purpose and social approval which,
are integral to health and well-being'

The last of the models to be considered

is an ecological sustainability model
and the most vital in terms of the
of health. It is, perhaps, the least understood
several definitions' I define it as
long term health of all people. Aggregating
the:

ln: Wilcock AA, editor, Health

Federation of OccuPational

rehnbilitation Geneva: W.H'O' 1994'

 361
Chapter 9: Therapv and Public Health

,promotion ofhealthy relationships between humans, other

Iiving organisms, their envirorunents, habits, and modes of life''

Based on biological and natural sciences, it, too, is an holistic model with much

in common with social justice and community developments2' Community

development wofkers are recognising the urgency of
including ecological
For example'
sustainabitity as part of just, people centred initiativess3'
and
Atkinson and Vorratnchaiphan suggest that to redress the socio-economic
ecological imbalance caused in Thailand by development
evolving from

European priorities, it is necessary to d.ecentralise Power and resources to local

action planning that
authorities and communities, and, for them to undertake
focuses on improved management of the environment
for the benefit of local

peoplesa.

The l992United Nations Conference in Rio d.e ]aniero on Environment and

ecological sustainability
Development focused world attention on the issue of
but, according to the sustainable development lobby, failed to
consider

The lobby argue that the

adequately the necessary transformational changesss'
poticy prescriptions of a market industrial system based on economic

and that that

rationalism are unable to deal with emerging world complexity
degradation and an ever
system will lead to a continuation of environmental

82pott", VR. Bioethics, the science of survival. Perspectiaes in biology and medicine7970;74:
L27-t53.
S3lntemational lnstitute for environment and development' Whose Ed
al
their wildlife resources. IIED perspectiaes
DC.
communitie, to
^äug"
Sustainable Uaaltooalt Redefining the global
*":.',r;:';t:;ff t ent

ciPles for a
ek J. Human
oÍunon Future, 1993.
g4Atkir,ron A, Vorratnchaiphan Cp. urban environmental management in.a.lTFlg
development contexh Tt" .ur" of Thailand. Thitd
world planning rnirw t994; 76(2): 147-
769.
development foru1,..
85 Th" Asian NGO Coalition, IRED Asia, The people centred of sustaínability.
Econonty,ecotogy and spirituality: Totonrd
à titrory and prnctice 1993
 362
9: Therapy and Public Health

Indeed' "those who

widening gaP between the'haves and the have nots'86'
control accumulated financial credits seek out ecological
stocks wherever
resubordination of countries
envirorunental frontiers remain"87, and effect the
Such actions support
that appeaf to be breaking through to developed statusss'
the myth that human survival is an "economic
and poriticar science problem"
,,assumes that man is free or could be free from the forces of nature"89.
which

The alternative is a reduction of population growth, a restructuring of

economic goals and societal values, reformation

of resource policies to reflect
and biologicat in ecological
community interests, a merging of the economic
decision making, and changes to make human
activity more sustainableeo'
Emerging' shown
Figuresg.l and 9.2, from Bernard. Campbell'sHumankind
of maintaining a sustainable
on the next page, illustrate the increasing problem
technological progress and resource
ecology against global population growth,
fundamental change to
depletion. Curbing those three Processes will require
assumptions and values about wealth that
are at the heart of business
is a major factor in
relationshipsgi. The accumulation of monetary wealth
and place' in the
alienating individuals' from a sense of community
',homogenisationofculturesandofunsustainability'sustainabilityrequires

mic Summit (TOES)' Dialectic

oalition, IRED Asia' Economy,ecology and
stainable developmenr" Scientific American

d,75-80% of the human burden on earth's

of humanity who live in a state of absolute
lifestyles aie disrupted by the promise of
nd occuPational injustice'
87Th" Asian NGO Coalition, IRED Asia.Economy,ecology and spirituality: "'
88 B"llo W. Dark Victory: The United States, structttal adiustment,
and global poaerty' I¡ndon:
& Transnational
pluto (In association íuiU" tt'," Institute for Food and Development Policy
Institute), 1994.
89 Pott", VR' Bioethics, the science of survival""
.'; Egger G, SPark R, Lawson l' Health
a*-Èill, 1990,p.107; corson wH'
ainable future. F tttttr es 799 4; 26(2): 206-223 ;
1...

glstead WE, Stead |. Can humankind change the-ecological.myth?-Paradigm shifts necessary

for ecologicatty sustainable busine"". iui'Ïn'nt
of orginizntioiat change ruanagement1994;7(4):
15-31.
 363
I and Pu blic Health

25,000 B.P. 6,000 B.P.

1,000,000 B.P 300,000 B.P
g6"5oo,ooo
1,000,000 3,34o,ooo
125,ooo
.1 2.6
.01 .03

,dl
,l

\ì'

2000 A.D. Year

1750 A.D. fSSo Lo.
6,000,000,000 Population
728,000,000 2,400,000,000
120 Persons per
42.5
12.7 square mile

worldwide PoPulation-control Policy or by e) per

;hi.h appeär ?rom 6,000 BP onwarás pre;ent visually the density of population
square mile.)

Larger
Population

More resources
\ More technological
needed PfoSress

\ More
of finite natural
environment

Figure 9.2: This positive feedback loop is the most dangerous

to"us, since it is aicelerating very raPidly and involves
envi¡onmental destruction:With the resource base of our
livelfüood seriously depleted, the survival of even our
present number is threatened.
 364
Cha pter 9: Therapy and Public Health

which "distributes and roots economic Power in place and

decentralisation

communítY"sz.

public health has long recognized that the health and well-being of
people

cannot be divorced from the environment.

Its gteatest triumphs were the
some diseases which emanated from
identification and virtual eradication of
'sick environments'. The 'sick environments' were,
on the whole' the result
the living and working
of human activity, the most obvious of which were
mentioned in earlier
conditions imposed by widespread industrialisation'
led to improved physical'
chapters. Improvement in these environments
sustainability model, which is
mental and social health. The ecological
as reactive, extends the pubtic health approach
from specific
proactive as well
social environments to global, natural
environments' New models for public

health are emerging to address these concerns93'

force in ecologicai degradation and'

Human occupation has been a primary
therefore, requires urgent consideration
and change aimed at ecological
served to protect people
rehabilitation. Although occupational d,evelopment
from the discomfort and unhealthy effects of
natural phenomenaga' people
'doing' in the 'technosphere of human
who live in cities and spend their days
creation,e5 have a loss of connection with ecological reality. For example'
regarded and treated as if their only
other animals and plants have become
widespread practices of replacing natural
purpose wefe to serve humans. The

plants with exotics, hunting and. fishing

for sport rather than need, and the

92The Asian NGO Coalition, IRED Asia. Economy,ecology

and spirituality:"'
93 Labonte, an intemational leader of the health

1s6). 1981' p'10'

g4Ehrenfeld D.The Arrogance of httnunism' New York Oxford University Press'
g5D.rborR.Ontyoneearth'London:Doubleday'1988'
 365
Cha oter 9: Therapv and Public Health

killing of any animal that d'ares to attack a human demonstrate this ProPensity'

In addition, the very successful pubric health initiatives which condemned

disease, linked' with the hygienic''domesticity
cult''
animals as the carfiers of
still further from other sPecies' It maintained the human
separated humans
for material wants to be considered
superiofity argument, and gave Permission
more important than an ecological way
of life in which all are dependent on
of people from
each other. Darwinian theories failed to halt the segregation

researchers are demonstrating substantial

other Species and even today, when
remain many rules which restrict
health benefits of pets to humans, there
of humanism is in question
human - animal partnershipse6. The philosophy
world of Nature and the affairs of men
here. The drive to "reaffange both the
and women so that human life will prosper", despite Nature, is humanism

goneawrygT.Spiritualandoccupationalalienation,andconsequentlossof
unrecognised sequelae' Many believe that'
in the short
well-being, is a largely

term, an ecological sustainability model

is essential to decrease widespread
loss of contact with the natural
spiritual alienation resulting from peoples'
world which, it is supposed, may acount
for increasing levels of stress and
responsiveness to marketing
violence, the use of drugs and addictive
In the long term an ecological sustainability model is also
strategieses.
for basic sustenance of life'
necessary to maintain the requirements

the
Clark Slagle Lecture: Behaviour, bias, and
96 S"" for examPle: Moore ]C' 1975 Eleanor 1L-19; Vombrock ]
limbic sYstem. The American iournal
of occuPational therapy 197 6; 3O(1):
inteventions Journa tof behaaiournl medicine 1988; ii(5):
Cardiovascular dect of human-Pet mentally ill.
509-517; HundleY I. The use
of Pet facilitated theraPY among the chronicallY
for the homebound
nursing 7991'; 2e(6) 23-26; Hatris M.
Pet theraPY
lournal of psychosocial Chinner T. An exPloratorY study on the viability and
elderlY Caring 1990; 9(9): 48-51; of tiue cnre 7991;
project within a hospice. lournal PaIIia
efficacy of a pet facilitated theraPY of nursing home
of an animal in social interactions
7(4): t3-20; Fick KM. The influence t993; 47(6):529-
American journal of ocuryational therapy
residents in a grouP setting. TIrc
533.
97 Ehrenfeld D.
gSSoutheast Asi ln otr lnnds' Southeast Asia Regional
tal Sustainable Development: Towards
Consultation s 1991'
UNCED and
 366
9:
and Public Health

should, as soon as Possible' focus

The occupational action-research aPProach
onhowPeoPlecanmeettheircreativepotentialswithoutdamagingthe
well-being is ensuredeg' Critical
environment, so that future health and
this process if they heed Bronner's ca[ "to
theorists courd be potentiar ailies in
the notion of progress and' human well-being"10o'
other research'
reconsider
discovering the natural balance of
education and action would focus on
and wisdom of indigenous PeoPle with
occupation in daily life, of the richness

regards to occupation and the ecology,

of natural ontogenetic timing of
occupational drives and needs, and attributes
of humanism which include
what promotes the health and potential of
all species and environments'

different
The five models have iust discussed were chosen, in part' because
I
occupational health are demonstrated and,
in part' because together
aspects of
promotion practice' They also' in
they represent a holistic paradigm for health
Iargemeasure,summarisetheoutcomesoftheexplorationundertakeninthis
history of ideas. Wellness is aimed at
individual maintenance and

improvement in health, including biological needs and physiological factors

growth towards potential and self
such as homeostasis, mental and' spiritual
and supported mores. Individual
actualisation within socio-curturarly approved
balance, satisfaction, creativity, choice, and
patterns of occupation, occupational
meet unique capacities and potential are important
here'
opportunity to
preventive medicine is concerned with preventing people from
experiencing

which impinge uPon

negative health outcomes and, with limiting risk factors

7993.
and Cambridge' USA: Blackwell'
100gro*1"¡ SE.Of criticnl tlrcory and its tlrcorists' Oxford' UK
7994, p.349
 367
Occu and Public Health
Chapter 9:

the health of individuals and communities. Individual and community

occupations and occuPational institutions
which erode health and lead to

disability, disease and death are central to

this approach' Social justice
access to
approaches aspire to a more equitable experience of health, equitable
hearth services for all people.
conditions which are heatth giving and to
universally, affecting health
occupational inequities and injustices prevail
outcomes negatively: action-research towards
identifying and eradicating both

inequities and injustice is required urgently' Community development

approaches seek community health and
well-being in a broad perspective which

concentrates on socio-cultural institutions and activities in conjunction with

approach is based on development of
particular health strategies. Much of this
self sustaining occupational infrastructures
which will support community life

so that its members exPerience increased

and ongoing health and well-being'

Ecological sustainability approaches strive towards the transformation of

human values and actions to halt the
economic, political, socio-cultural and
destruction of the eco-system so that the
worrd and. it's interdependent life

systems and organisms will survive healthily in the long term' As the
occupational nature of people is, in large part, to blame for the underlying
factorswhichhaveleadtothepresentunacceptablestateoftheecology,the
transformationof occupational behaviours, which meet both human and
ecological needs is essential'

The action-research approach chosen corresponds with the philosophical

therapy outlined in the

tradition and directions of the founders of occupationar
1917 obiectives of the American National
society for the Promotion of
phase is in tune with "the
occupationat Therapy. The exploratory-research
study of the effect of occupation upon
the human being"; the education-
awareness raising phase is in accord
with "the scientific dispensation of this
knowledge,,;andtheactionandcommunitychangephaseshavemuchin
commonwiththenotionof,'theadvancementofoccupationaSatherapeutic
 368
Chapter 9: Occupational Therapy and Public Health

measure,,101, if therapy is considered aS ',activity...intended to remedy or

alleviateadisorderorund.esirablecondition''102.

The major change necessary from current research

in occupational therapy, is
occuPational issues
to an emphasis on underlyit g socio-cultural and ecological
from current practice is an
and the use of critical research aPProaches, and
emphasis on communities, occuPational justice and socio-ecological-political
will make such changes'
action. It is debatable whether occuPational theraPists
they have the philosophical Persuasion and the potential
to contribute
although
in the arena of public
a wide ranging and holistic occupational PersPective
"the occupational service worker"
health. As Bockoven foresaw, if this occurs
growth outside the hospital.
w*r be ,,divorced from medicine" with a "base of
life of the community' to which
He will belong to the educational and economic
and in which he will be a
he will contribute a much-needed kind of knowledge,
force in fostering respect for occupations"l03'

This expansion of role would' recomPense for the failure to act on the
natures by industry and capital at the
challenge posed to human's occupational
the profession's genesis, as d'iscussed in chapter seven'
I believe that
time of
continue to influence the
failure to recognise the underlying factors which
between occupation and hearth, and failure to
accept responsibility
rerationship
be negligent' However' there is a
for research and action in this domain would
to be largely unrecognised as a
major problem. occupational therapy continues
scientificdisciplinewithadistinctiveandimportantcontributiontomaketo
publichealth,and.forittoarticulateandfollowadirectiondifferentfrom
has 'to stick it's neck out'' A
dominant paradigms implies that the profession

Society for the Promotion of Occupational

L01ç".¡i¡isate of Incorporation of the National
'l'91'7-1976' American Occupational Therapy Association,
Therapy, lnc. (rsrtí lti'ln n'd nou:
t967, PP.4-5'
Row' Publishers 1984'
1021h"ru', : Ftmk and Wagnall's stnndard clesk dictionnry' Harper &
p.707.
1033o.¡¡oven JS. Occupational therapy: A neglected source of community
rehumanization...P'21'9'
 369
Chapter 9: Therapy and Public Health

that although in current society

leading Australian social commentator suggests
,,need to encourage new ideas, dissident views, debates and critics",
there is a
those who argue have had
"to speak the same language and work from similar
Does this mean that occupational
sets of assumptions to those ifl power"104'
heard unless they modify them? What of
therapists' d,ifferent views will not be
directions? peopre ristening to
making use of the ottawa Charter's occupationar
own perspective' In the case of the
new ideas often only interpret from their
that health is inextricably
ottawa Charter I contend that although it recognises

bound. up with what people do, it has been interpreted within public health

occupational elements have been

from it's own dominant paradigms, and the
question as to whether public health
largely disregarded. This leaves a major
willwelcomeorevenrecognisethepotentialcontributionsofoccupational
therapy's distinct and different viewpoint'

Istarted the thesis with a strong belief

in a relationship between occupation
therapists could make a unique
and health, and a conviction that occupational
However, it was not until after
and valuable contribution to public health.
several years of study that I came
to understand the relationshiP it terms of a
therapist's potential contribution in
theory of human nature, and occupational
the broad approach outlined here'
Within the confines of the thesis it was

possibletoexploreonlysomeofthemoreobviousconnectionsand
implies' These have' however' tested
philosophical associations such a theory
thetheoryinmanydirections,andinthemain,supporteditscontentions.

the biological characteristics that all

A theory of human nature must consider
relating the theory to health and survival'
humans share. As well, because I was
of
it appeared wise to subject it to other notions about health and survival a

The 1'995 Boyer lecturcs.

104ço* E. A truly civil society: Lecbure
et' 7995'
Australia: Radio Ñational'Transcrip 's Reith lectures'
The Boyer lectures are an analoguè'
 Public Health 370
Chapter 9z Occupational

biological nature which have been subjected

to rigorous study by scientists of
ideas held by evolutionary scientists
many disciplines. For this reason I explored
and geneticists, and considered the theory in terms
of neuroscientific

understanding of human behaviour. This

furthered my belief that physiological
behaviour to such an extent that the
systems support and. Promote occuPational
,to do' is so natural; so much a Part of being, that humans have failed to
need
reduced the holistic concePt of
recognise it as an entity. Instead they have
occupation by dividing it, and. then made
it more complex by endowing specific
aspects with Particular value'

altered with its evolution and

The value and the division of occupation has
human's occupationai nature has
because of cultural diversity, in part, because

immense variability, so that no two people have the same occupational

potential or needs, and these are susceptible

to and developed according to

environmental d.emands. Despite the variability

it was possible to tease out four

major functions of occupation which provide

for Sustenance' self care and
and the environment;
shelter; safety from and superiority over predators
exercise of personal capacities; and the enabling
of individual
balanced
development so that each Person and the species
will flourish' These form a

three way link with survival and health'

made it important to subject

The variability between PeoPle and cultures
this reinforced a view held by
cultural evolution to an occupational perspective:
culture, and is' in turn shaped by
many that human action (occupation) shapes
pursuits, for exploring ways of
culture. people,s potential for new and different
time for chosen occupations
making their lives easier, and giving themselves
and results of human occupation
has led. to a situation in which the products
than'natural' human need or the
appear to have assumed a greater importance
humans depend.
hearth and survival of the ecosystem on which
 37L
Chapter 9z Occu pational Therapy and Public Health

health, well-being and

An exploration of the history of ideas which surround
concerns arising from
ill-health was a natural extension of the issues and
chapters 2,3 and.4. It uncovered underlying determinants which have resulted
base of societies, the
from human's occupational natLlres, from the economic
from them' The
ways of structuring them, and the values that emanate
and their effect
institutions and activities resulting from these foundations'
communities can lead to
upon the occupational experience of individuals and
positive or negative health outcomes. Although some
of these have been
recognised by world, and public health authorities there is little action to
an occuPational perspective'
promote the positive or inhibit the negative from

therapy and
In an analysis of the foundation philosophies of occupational
a

emefges of a profession with

review of its unique but repressed histor/, a picture
particular strengths in conceptualising humans from an occupational

which have been represented

perspective. Not only that, they have other assets
health promotion rhetoric as essential, such as a Person
centred' enabling
in
as physiological factors' In
approach which considers environmental as well
reviewing attitudes to a change of emphasis towards
a health promotive
approach, most therapists aPPear to be already
committed in that direction' Yet

despite all this in their favour, community agencies are hesitant to employ
them, and I know of no departments of pubtic health with occupational

theraPists on their team'

health promotion ' may not be

Occupational therapists, whilst interested in
It is possible
willing to change direction to the extent of the approach I suggest'
be more appealing. However, I
that a modified or less extensive approach may
am convinced that the study of health, from
this perspective, requires serious

and immediate consideration, research and action at

individual' community

levels. Action-research developed from the same

and environmental

conceptual base as occupational therapy, and is an obvious choice of

 372
9z Occupational and Pub lic Health

the underlying determinants

methodology, alongside epidemiology, to exPlore
of health and ill-health from an occuPational PefsPective'

a future in which "the bioshere of

Dubos observed. that humans are faced with
- are out of balance'
his inheritance, (and) the technosphere of his creation
debate about the conflict between
indeed potentiarly in deep çsnfliç¡"105. The
nurture remains critical' Occupation is central
in both' This is a
nature and
a long way into the future, but will not
matter which will affect health scientists
besolvediftheoccupationalnatureofhumansisnotconsidered.

1o5Pr'r6es k OnlY one enrth"'

 373

APPendix I

Anexploratorystudyofpeople'spefcePtion
and exPeriences of well-being'

Introduction.
study of people's
This appendix reports briefly on a tggl' exploratory
grouP of third year
perception and experiences of well-being, by a
me' To reduce repetitiOn, readers are
occupational therapy students led by

referred to the literature relating to 'wellbeing' in

chapter 5'

of
with the current trend of health initiatives towards the promotion
related
it is being recognised that health and 'well-being' are closely
health
and are linked with everyday life, with opportunity
for personal
and. with caring communitiesl However,
the literature
development,
as most studies assign
relating to how people perceive well-being is limited,
pre-determined criteria for its measurement.
In these, well-being has been
social supports'
variously related to income, financial status, employment'
religious attitudes' beliefs
community cohesion, marital state, education and
and activitiesZ'

Despite the many and various definitions of well-beitg by 'experts'' it is

necessary to explore what well-being means

to people generalþ; if it can be

defined; or if, Iike health, it is a feeling that can be experienced differently'

and explained in many ways. It is necessary because health professionals

the people with whom
need to understand well-being if they are to enable
health and reduce ilbress'
they work to maximise this experience, to enhance

This study predicts that what constitutes well-being

for different people
beings' but because
will vary, not only because of the uniqueness of human
 374

social dimensions
of the potential for variation in the physical, mental and
may assign
frequently used to describe well-being, and because individuals

different levels of significance and meaning to these

dimensions'

Method
in and around the
The study was conducted as a two part questionnaire,
Adelaide in south Australia. section A asked
five oPen ended
city of
about well-being' and
questions in order to obtain each individual's ideas
section B collected demographic data'

Seven convenience cluster samples were selected

20
High school students
20
ElderlY citizen villagers
20
FamilY units
20
A neighbourhood
20
City mall users
20
Church attenders
30
Fourth year occupational therapy students

A questionnaire was designed by the research grouP, then trialed on

Respondents were
twelve people known to them before being finalised'
asked to complete section A without assistance'
If required' the researchers
for section B which was always completed after
section
offered. clarification

A. This procedure was determined' to reduce the risk of

demographic

given about well-being'

questions influencing the content of responses

varied according
The specific method of administering the questionnaire
to the nature of each cluster, for example the
city shopping mall users were

approached randomly and asked to participate,

but students were given the
 375

researcher collected data from

questionnaire in a grouP in a classroom. Each

one cluster.

Results

Description of the samPle:

Thetotalnumberofcompletedquestionnairesavailableforanalysiswas
138, with 3g.1% of respond,ents being
between l'3 and 21 years of age' 24'6%
and 50 years, only 5'1% between 5l'
between 22 and,35 years, rg,B%between 36

and 65 years and, I7.4"/' between 66 and 90

years' sixty nine percent were
themselves as Australians'
female, and 3L% were male, and,76.8% identified

with atl but 6 of the remainder identifying with areas in Europe'

Approxim ately 37'/"were in married or in de facto relationships' and 62"/"

of subjects identified
were single, divorced, or widowed. seventy-one Percent
and of these approximately
themselves as belonging to a christian religion,
identified themselves as active members'
About half of the respondents
490/o

had not yet completed their formal education, ild only 6 identified

themselves as unemployed, excluding the

retired, volunteer workers and

homemakers, and over 75o/o rcceived some

income' These variables were
in any significant way'
not found to influence the descriptions of welt-being

well-being or
Almost 90o/oolthe responses to how subjects would describe
wellness. could be coded according to 9
distinct categories' The
positive
remainderareincludingin'other'(11.6%).Thethreemostcommon
responses described. we[-being as being
mentally sound', having a physically
was
,good, body and being huPPy, and the fourth most frequent resPonse

being
,healthy'. The next most popular resPonse concemed concepts such as

confid.ence and 'feeling good about

oneself' (These are
self esteem, self
and' frequency of categories is
included in the category 'self). The range
displayed in Table 1 and Figure L, and
the total number of responses is
than one answer'
greater than the sample because some gave more
 376

Table 1: Respondents' descriptions of well-being

self relation- other occuPa- sÞlr¡- material
Description mird body happi- healthy tüal stic
ness ships tion
2l 16 L1 9 5
Frequency 58 57 53 M 4T
31.91o 29.7% L5.2% 11.6% 8% 6.5%
Percentage 42% 41.3% 38.4fo

Figure 1: Respondents' description of well-being

materialistic

spiritual

occuPation

other
relationships

self

healthY

happiness

bodY

mind

0102030405060

well-being'
In answer to a question about whether they had experienced
and there were 4 missing
t27 (g4.8%) affirmed they had, seven had not,

values (see Table 2). who had not experienced the feeling were
Those
directed to section B because they would be unable to describe what they had

not felt

Table2:Respondentswhoexperiencedwell-being(n=1.38)
Yes No Missing Values

7 4
Total 127
Percentage 92% 5%

The majority of respondents exPerienced well-being frequently' Coded

of the
under ,frequent' were resPonses such as '2-3 times a week','75%
 s77

,daily', 'more often than not" and 'most of the time'' see Table 3 and
time,,
Figure 3

of well-being (n=131)
Table 3 Frequency of respondents' awatenesses
rarely always other never
Occurence frequently occasionallY

t2 4 1
70 26 17
Frequmcy 2.9% 0.7s%
t8.8% 12.3% 8.7%
Percentage 50.7"/o
)

of well.being
Figure 3: Frequency of respondents' awarenesses

never

other

alwaYs

rarelY

occasionallY

frequentlY

zo 40 60 80
0

Responses to the type situations or envirorunents which fesPondents

of
associated with well-being wefe coded
into 13 categories' with a fourteenth'
,other' category for those which did not fit any of these' The most common

fesponses concerned relationships with

others (56'5%) and surroundings
to frequency in Table 4
(37%). The range of categories are itemised according

and FigUre 4. The number of responses

is greater than the samPle because
answer'
some resPondents gave more than one

Table 4: situations of environments with

which respondents associated
well-being
work self
ffiõundings leisure
Situation -relationshiPs -aihievement -spiritual
Frequency 78 51 27
15.2"/" 9.4% 8.7% 8J%
s6.5% 37% 19.6%
Percentage
other self care religious
selfless lifestyle Drachce
rest -health
10 I 7 7
2.2"/o 1.4"/o
s.r% 5.1"/" 5.7%
7.27o s.8%
 378

associated
Figure 4: situations or environments with which respondents
well-being

religious pract¡ce
self care
other
lifestYle
selfless activ¡tY
health
rest
self
sPiritual
work
achievement
leisure
surroundings
relationshiPs

zo 40 60 80
0

to describe the sorts of

In answer to question 5, which invited resPondents
the outstanding
feeling they associated with the experience of welÞbeing'
were
response was happiness (52.g%). other feelings rePorted frequently
peace (35.5%), and, confidence (22.5%). It is perhaps surprising that sadness

was included as a feeling associated with well-being

by two of the

feelings are displayed in Table 5

respondents. The range and frequencies of

and Figure 5. The number of responses is greater than the sample because

some respondents gave more than one answer'

associated with well-being'

Table 5: Respondents' descriptions of feelings
confidence energy belonging fulfilment
happiness Peace

?5 22 20
73 49 31
75.9"/" 14.5"/o
35.5"/" 22.5% 78.t%
Percentage 52.9%

relation fortunate sadness

control other health freedom
loving
4 2
18 1.0 8 I 8 7
7.4%
5.8"/" 5.7% 2.9%
13.0% 7.2% 5.8% 5.8%
 379

with well-being'
Figure 5: Respondents'descriptions of feelings associated

sadness
fortunate
elation
freedom
health
other
control
loving
fulfilment
belonging
energy
confidence
peace
happiness

40 60 80
0 zo

Discussion
what constitutes well-being for different people
will
The prediction that
the descriptions of well
vaty,was indeed, found. to be the case, although

beingprovidedbytheresPondentstothisstudyareconsistentwiththe
of the most common
literature relating to both health and well-being' Three
responses which described. well-being as being
mentally sound' having a

physically'good'body, and being'healthy' appear to

be reasonably consistent

support my argument' in
with Blaxters findings 3, and'being huPPy' seems to
chapter 5, that happiness is a primary human
need' The frequency of the
body seems to reflect the fact
responses relating to having a physically'good'

that a large number of the respondents were

und'er the age of
21' years' and

physicalaspectsofhealthaPPeartobemoreimportanttothisSrouPthanto
older people.

experienced well-being and

The fact that most people identified that they
occurrence' may also be
that it was, for over 50% of these people, a frequent
was not fulty representative of the
an artefact created by a sample which
 380

unemployed' the
population. The age and gender bias, the small numbers of
lack of cultural diversity, and the large number of school
or university
results, and it would be
students may well have given a particular cast to the
representative sample'
interesting to carry out similar studies with a more
and with particular groups, such as the unemployed,
ethnic communities or

the disabled, for comParison'

Despite the inadequacies of the sample, the strength

of 'relationships' as a

situation which many respondeñts associated with

the experience of well-
that health and social
being supports many other studies which have found
relationships are inextricably and' strongly associated
with each other'
hrteresting also are the number of occupational categories such as wotk'
care and achievement
leisure, rest, religious practices, selfless activity, self
This total does not take
which when added together total 83 resPonses (60%)'
with social
into account any occupations carried out in conjunction
so it could well
relationship or spiritual (as opposed' to religious) situations'
occupational situation or
be that most of the sample identified some form of
environment as one of the circumstances associated
with their experience of

well-being.

The feeting of happiness that respondents associated

with their own

experience of well-being was consistent with

how they described well-being
Charter such as Peace
per se. Some words used, reflect those in the Ottawa
control and
and freed.om,and other words, such as confid.ence, energy,
The descriptions are
fulfilment the occupational associations noted above'
in tine with health promotion rhetoric, but seem fat removed
from

the experience of well-

conventional medical priorities. The insights into
being provided by this study, notwithstanding
the d'istortions resulting from
procedure needed to
the sampling, suggests that more than a particular
people to experience well-
prevent or reverse illness may be required for
 381

are firstly' whether

being. Two important follow up questions to consider
and secondly' whether well-
well-being is the concern of health professionals
has a protective effect against
being, which is a requisite of positive health,
illness and disease
International
1 World Health Organisation. Constitution o[_th-e- World .He.alth Organisation'
york, 1946; worrd i{eatth organisation, Health and Welfare
Health conference, New
canada, Canadian putüc Health Association.
The )ttawa clurter for health promotion.
Ottawa, Canada: l'986.

295-308.
3 Blaxter M. Heatth and liþstyles. London: Tavistock / Routledge,lgg0'
 382

Appendix II

Occupational therapist's vlews of the

relationshiP between health and occupation
occupational therapistswho
This appendix documents a l99l survey of fifteen
were the total number of attende", ur'u seminar'
fhtit were all female' and
it pl"f.ssional experience varied frorr L to 25 years'
"it
Subjects were given an A4 sheet
between occuPátion and health?"
words OCCUPATION AND HE
outwards. Subjects were asked to re
question at the end of each line'

also noted' These are

frequencies. The most common resPonses were
recôrded in the table below:

category frequency
common

mental 28.5'/' self esteem, motivation, meanlng'

satisfaction, concentration
tS,
function t6%
ties,
energy, tone,
physical L3.5%
cardiovascular fitness
status, relationships, v
social L2.5T"
unity, caPacitY
body/brain L0%

7% q
quality of life
comP taty,
nature of relationshiP 6%
ln
al
environment 2.5%
to PY
Other 4"/o

of the relationship between

Table 1: Fifteen occupational therapists' views
occuPation and health'
 383

APPendix III
between occuPational balance
The relationship
^health:
and A Pilot studY'

Introduction.
undertaken in 1992 by a
This append.ix reports briefly on a pilot study
ted by me' The research
group of third year occupational therapy students
one concept of occupational balance and
the relationship
group investigated
referred to the
between it and health. To reduce repetition, readers are
literature relating to balance, physical, mental,
and social well-being' sleep and
thesis'
rest which is considered' in the body of the

for health and well-

A balanced lifestyle is widely acclaimed as necessary
base of occupational therapy
being. This notion is central to the philosophical
the
providedby Adolf Meyer in t922, and reaffirmed many times throughout

profession'shistoryl'Rogers'forexample'in1984'heldthat"occupational
play' work and rest is
therapy rests on the belief that a balance of self-care'
essential for healthy living", and that occupation
is the means by which
achieved, and physical and mental well being
attained2' Although
balance is
necessity for occupational
the validity of the beliefs and claims about the
anecdotal and observational data tends
balance has not been widely researched,

to supPort its truth.

and health have focussed on

Whilst most studies of occupational balance
decided by the research group
that
the interplay of work, rest and leisure, it was

terms are culturally defined, with no clear

physiological
because these
'occupational balance" Instead' the
boundaries, they may not truly measure
consider occupational balance in terms
to of physical'
researchers chose
mental, social and rest occupations, more
or less in line with the w'H'o'
 384

categories embrace both

definition of health, but including rest, because these
biological and socio-cultural factors'

Method

subjects were chosen using a cluster sampling method' involving seven

The
clusters of peoplein d.ifferent living situations and of a broad age fange'
age SIouP' an elderly group'
sample includ,ed three family clusters, a school
and one from the country'
and two working age grouPs, one from the city
known to the researchers
There were L46 respondents, SOme of whom were
particular circumstances' such as belonging
to a
and selected because of their
three generational family. Others were selected
by door-knocking' and yet

others by asking for volunteers at school or

office' Anonymity of subjects was
kept
ensured as untreated data was only handled by the research grouP and
not identify respondents in any
confidential, and, the demographic data did
way
of it's size' Random
Note: The sample was restricted to caucasians because
of this pilot study but would
sampling was not possible within the constraints
ensure generalisability of results in a larger
study and provide interesting
between cultural grouPs'
comparisons of possible balance variations

Respondents were asked

A questionnaire was designed by the researchers'
current' and secondly' their
to rate, on a table as shown below, firstþ, their
and rest occupations according to
ideal involvement in physical, mental, social
and high'
a four point scale - none, low, moderate'
 385

none low moderate high

Physical

Mental
Social

Rest

They were also asked to rate their health on a

five point scale' where one

was poor health and five was excellent health'

scale for the occupation categories, and
a six point scale for
Note: A five point
the scale may have increased
health with more than two descriptive terms on
the sensitivity of the instrument'

for 'user
The questionnaire was tested. on acquaintances, and
adiusted

friendliness accordingto their feedback' To improve inter-researcher

the researchers devised procedures for administering
the
reliability,
questions
questionnaire and answering respondent's

between the student

The work of gathering the d,ata was divided evenly
researchers, with each being responsible
for a cluster of a least twenty
respondents.

Results
to 85 years, with a mean o1 409
The ages of the respond.ents ranged from l'3
percent (N=69) were male and fifty-
years (sD=20.57). Forty-seven point three
percent (N=77) were female' Seventy-four
point seven
two point seven
area'
percent(N=1.09) of the respondents were
from the Adelaide metropolitan

and twenty-five point three percent(N=37) were

from South Australian
gender and urban/rural
country afeas. The sampling closely mirrored
distributions in South Australia (See Table L)'
 386

% of the Research SamPle of tLe South Australian

Sample Population
-"/o
Gender 49.33
47.3
Male 50.67
52.7
Female
Environment 68.33
74.7
City 3t.67
25.3

Tablel.ComparisonoftheresealchSamPleto-thepopulationofSouth
Australia (Australian Bureau of statistics, october
1992)'

ideal balance were

The responses to the questions about current and
methods section' As the level of
collected on a table as shown in the
rated from
involvement in physical, mental, social and rest occupations was

O=none to 3=high, two four digit patterns emerged for each respondent' one
balance and the other their
indicating their current perceived occupational
respond'ent's current balance may be
perceived ideal balance. For example a
which indicates they have a low level of involvement
in physical
tgzz
occupations, a high level in mental occupations and a moderate level of social
occupational balance may be 3333
and rest occupations. In contrast their ideal
indicating that a high level of involvement
in physical' mental' social and rest
hundred and fifty-six pattern
occupations is their perceived ideal. Two
configurations are Possible'

variation among respondents

The patterns of current balance showed wide
of these were
with fifty five different patterns being chosen, but only two
frequently chosen of the current
chosen more than eight times. The most
occupationalpatterns(10.3%ofrespond.ents[N=15])wasmoderate
involvement in physical, mental, social
and rest occupations (2222)' The
(8'2% of respondents [N=12]) was high
second most frequently chosen pattern
the other
involvement in mental occupations, with moderate involvement in
three categories (2g22). Nine point three
percent of respondents [N=13]
 387

repofted a current balance with no involvement

in one or more categories'
(See table 2).

pattem of of
Number

15 1
1
21n2 8.2%
1 t2
2322 15.
23 23
Pattem chosen once
96 65.75"/o
30
P attem chosen 2 to 8 times 100%
55 t46
Total
chosen by the total study
Table 2. Current occupational pattem configurations
population.

The patterns of ideat balance showed less

variation' Thirty nine different
more than eight times' They
pattems were chosen, with 4 patterns chosen
2222,3322,3332, and 3333. The most
frequentþ chosen pattem of ideal
were
in all four categories (2222)'
occupational balance was moderate involvement
This was chosen by 42 respondents (28.8%). A pattern of high levels of

involvement in all categories (3333) was the next most frequently chosen
pattern,and.includedtgofrespondents(8.8%).Furthermore,tlzof
configuration consisting of at least
responde nts (76.7%) chose an ideal balance
categories' (see table 3)
moderate involvement for all four occupational

pattem Number Percentage of

Number

42 28.8%
1
2222 6.2%
1 9
3322 62%
1 9
3332 8.8%
L 13
3333 15.1"/"
D. 22
Pattem dlosen once
5L v.9%
Pattem chosen 2 to I times 1.3

55 L46
Total

chosen by the total study

Table 3. Ideal occupational pattern configurations
population.

pattems see table 4'

For a comparison of ideal and current
 388

)2r') 3322 3332 3333 Total

Ideal Once 2 to I times
only
Current 2 ?3
8 9 4
Once onlY 15.75%
3 9 9 96
12 38 ?5
2 to 8 times 65.75"/o

2 15
1 11
z'rn 1
10.3%
2 't2
3 2 4
2322 1 8.2%
9 13 Lß
Total n 51 42 9
100%

confi8urations by ideal
Table 4. Crosstabulation: Current occupational,pattern
occupational pattein configurations
for-the total study PoPulation'

health on a five Point scale' The mean

Respondents were asked to rate their
(SD=.88), with the scores ranging
healthscore on the five point scale was 3.58
occuPational balance'
from L to To simplify the comParison of health with
5.
(1g respondents [8'9%])were classified as
those with health scores of I' to 2
having 'poor health', those with scores
of 3 to 4 (ILZ respondents 176'7'/'l) as
,fair health', and those with 5 (21 respondents l1'4'4%l) as having
having
excellent health. (See table 5)'

Fair Excellent Total

Health Poor

Current Pattem 5 15
10
2222 70.3%

10 2 t2
2322 8.2%
2 ?3
2 19
once onlY 15.75%

73 12 %
2 to I times 11
65.75%
146
13 t12 27
Total 76.7/" 14.4% 100.00P/'
8.9%

health
TableS.Crosstabulation:Currentoccupationalpattemconfigurationsby
for the total studY PoPulation'

found which was capable of

Because no approPriate statistical technique was
analysingthecompositebalancescores,inordertocomparehealthagainst
 389

developed by the researchers for each

current and ideal balance, a score was
categories that changed between
respondent on the number of occupational
if the current pattern was l'32L and the
current and ideal balance. For exampre
that changed is 3' that is physical' social
ideal was 3333 the number of categories
and rest levels changed, but mental levels
of involvement did not (see FigUre

1).

Men ta I S ocla Res

Ph ysical
1 3 2 L
Current Pattern 3 3
J 3
Ideal Pattem
Note 1 for anY change
between current & ideal 1+ 0+1+1 J

number of categories changed

Figure Example of method to obtain the total
1.
bJween current and ideal patterns'

health scores' using a oneway

This score was comPared to the three category
result was obtained (F=1.0.476,dr=z/143,
analysis of variance, and a significant

P=.0001).

was developed according to how

To further refine this analysis a second score
balance was to their ideal balance'
close respondent's current occupational
changes between current and ideal
This score indicated the total number of
balance patterns, and was obtained
by subtracting the lowest from the highest
used above where the current pattern
rating in each category. In the example
difference is 5' that is' 2+0+L+2=5 (see
was 132L and the ideal was 3333 the
Figure 2). Although a crude measure,
this procedure showed that the lower
involvement are to the ideal'
the score the closer current levels of
Men tal Social Rest
Ph ysical
1 3 2 1.

Current Pattem 3 J
3 3
Ideal Pattem
Subtract lowest from
highest in each categorY 2+ 0+1+2 5

the total number of changes between

Figure 2. Example of method to obtain
current and ideal Patterns'
 390

of variance was also used to compare these scores to

the
A oneway analysis
reveared a significant result (F=L0.165,
three categories of hearth. Again this
df=z/t43,P=.0001)'

comPared with health

Tabte 6 illustrates the relationship of these two scores
the mean difference of the
scores for the three categories of health. It provides
and ideal pattems' and the mean of
total number of changes between current
the number of categories changed'

mean difference mean

total no. of changes between number of categories changed
Health
current and ideal Patterns
3.462 2.923
Poor
2.232 7.973
Fair 1..19
Excellent L.238

number of changes-between current

Table 6. The mean difference of the total
number of categories changed by health
and ideal patterns and the mean oi tt "
groupings.

of health revealed that

A comparison of mean scores for the three categories
configurations of current and ideal
the less the difference between the two
occupationalbalance,thehealthierthegroupwas.TableTwhichshowsthe
chosen current and ideal
mean health score and the most commonly
for each age grouP also illustrates this point
occupational pattem configuration

as the 65-85 age grouP had

the highest health score' and the least diffefence

between current and ideal pattern'

Curmt Number & IdeaI Number &

Age grouP Numberin Health
pattem percentage pattem percentage
score
souP respondent respondent
S
s
7 9
46 3.63 ?322
I L3-24 t% 9
3.& 2322 3
24-44 42
?332 4 (12.5%) ')))) 12
45-64 32 3.37
(37.5%)

65-85 26 3.65 ?222 7 (26.e%) )1'.)? 72

(46.2%\

the most commonly chosen current and

Table 7. The mean health score and
each age grouP'
ld"ul occupational pattern configuration for
 391

respondents (12.3%), had identical current

and ideal balances' however
or,ly 18

eachoftheserespondentsreportedtheirhealthtobefairorexcellent.ofthose
health was scored as excellent, 8 (38.1%) were
in the grouP
respondents whose

thatrecord'ednochangebetweencurrentandidealbalance.

Discussion
into the relationship between
This pilot study reveals some important insights
which merits further
one concept of occupational balance and health
who reported their current and
investigation, particularly as those respondents
also reported their health to be fair or
ideal occupational balance to be identical
excellent, whilst none of the respondents
who reported poor health rated their
balance'
current balance as identical to their ideal

to be significantly different in terms of

The three health groupings were found'
and' in the number of
the d,ifference between current and ideal balance,
categories which required change to
attain id'eal rather than current balance'
related to closeness to ideal
The difference indicated, that health is strongly
balance. This was also true according to age groupings, with those who
the greatest difference between their
reported the poorest health also recording
were in the middle age bracket from
current and ideal balance patterns. These
45 to 64yearc. The oldest grouP,
between 65 and 85 years reported the highest

healthScoreandtheleastdifferencebetweentheircurrentandidealbalance
patterns.

of ideas explored in the thesis'

one factor, which, in the light of the history
balance' measured in this way'
does not seem surprising, is that occupational
patterns showed wide variation
varies between people. Current occupational
amongrespondentsand,foralmostg0o/ooftherespondents,current
 392

to how ideal occupational balance was

occupational balance was different
perceived.

balance began to emerge'

Despite the differences, a picture of ideal occupational
an ideal balance of moderate to high
as over three quarters of the sample chose

involvement in all four categories. However a small number of respondents

with fair or excellent health reported no involvement
in one or more category'
an unlikely scenario it may
which, for a few included no rest. As this aPPeafs
question fully' and that some
be that some respondents did not understand the

of the data is flawed'

some justification for the claims

These results ale Promising as they provide
balance is an important
made by occupational therapists, that occupational
further study is required and' from
aspect of the health experience. Flowever,

these results, warranted. This should be

a large population study with a
group was, in some degree'
random sample, because although this sample
representative of the South Australian population, cultural or socio-economic

factors were excluded because of the size

of the study'

101rr.
therapy'Archiy11- .of occupational therapy'
1 M"y", A. The philosophy of occupational
'occupationat therapv, teTT;31(10): 63e-642'
t,i-äi ïi]' i--Áír*¡iü'¡oirnot of journal of occupational therapy 79&4;
zRog"rs sfudy human occupation? The American
IC.I¡¡hy
38 47-49.
 393

APPendix IV

Australian occuPational therapists' views on

health Promõtion: A national sun¡ey.

Introduction.
This appendix provides a concise report of a Lg89 national survey of
on health promotion' To
Australian occupational therapists about their views
readers are referred to chapters
reduce repetition , as abackground to this study,
and interest in health
7 and,8 which describe occupational therapists'history
and health Promotion '

so it too is based on
This study provided the starting point for the thesis,
all health professionals towards
health authority's calls for the reorientation of
to be well integrated with
the pursuit of health, and for preventive measures
measuresl' In line with this it has
curative, rehabilitative and environmental
'new' discipline'
been suggested that health promotion should not be seen as a
which are an accepted part of their
but should be provided by health care teams
and economical2'
clients' social networks, which seems sensible

For such a change of emphasis to become reality

it is necessary for
agencies and institutions'
occupational therapists as part of health services,
be aware of the changing emphasis in
along with other health professionals, to
promotion philosophy and how to
global health policies, to understand health
it into their work. Additionally, a clear understanding of their
incorporate
is required' so that strategies
current awareness, attitudes, values and practices
to facilitate change can be formulated'
As an educator in occupational therapy I am
interested in addressing the
health promotion' but feel
identified need for a change of emphasis towards
change must also be responsive
that to be effective and accepted any ProPosed
 394

To this end this study

to attitudes, interests and current professional direction'
surveyed occupational therapists, throughout
Australia, to discover how they
involved in health
feel about health promotion, whether th"y are already
need for postgraduate
promotion programs and whether they exPfess a
education on health promotion issues and strategies
to meet new policies'
attitudes and Practices'

Method
Questionnaires were used in a national, cross-sectional study' A random

each state' In 1988 there were

sample of approximately L0% was taken from
Australia' but because
approximately 4000 occupational therapists throughout
registration is not common to all states, it was difficult to obtain an accurate
count. Registration lists were used as the population parameter
in Northern
Territory, Queensland,South Australia, and Western Australia' The size of
therapists (see
the sample population from these states was 155 occupational
Table L).

OTs Sample
State
29 3
Northem Terri
670 67
303 30
South Australia
548 55
Westem Australia

Tablel:Samplesizesfromstateswithregistration

Tasmania, and victoria'

In Australian capital Territory, New south wales,
from State Associations'
which do not have registration, estimates wefe sought
Bureau of statistics. Population
state Health commissions and the Australian
estimated predicted numbers for
parameters from these states used regression
based on growth figures in those states with
registration between the 1986
Lgg8,
Adjustment was
Australian Bureau of statistics figures and 1988 registrations'
state) based on informed
made to the Tasmanian estimate (no school, island
 395

discussion with practicing therapists.

The size of the sample population from

thesestateswas3].3occupationaltherapists(seeTable2).

Estimate Sam
State 7
70
A.C.T 152
Wales 1522
New Sou 9
90
Tasmania 145
1450
Victoria

Table2:Samplesizesfromstateswithoutregistration
The total samPle size was 468'

from questions used in a

self administered questionnaires were d'eveloped
surveyed s'A' domiciliary care
pilot study carried out during tg87 which
and' approaches to health
occupational therapists about their attitudes
promotion. The questionnaires were posted to occupational therapists
states with registration' and from
randomly selected from listings of those
states' Questionnaires ready for
Association membership lists in the other
Australian capital Territory, New south wales
and
posting were sent to
of
victoria for addressing and posting. In the latter two' random selection
officials because of confidentiality
names was made by their state Association
was included for the reply'
requirements. A stamped addressed enveloPe
questionnaires not returned'
Reminder follow-ups were sent for

Results
of these only 207
A total of 252 ques tionnaires were returned' However'
occuPational therapists' and abie to
were from those currently employed as
answef all questions. This accounts
for the high rate of missing values for
aPProximately 95o/o of the sample which
some questions. women made uP
hadameanageof35years(SD8.675)andarangeof2Iro64years.Themean
therapists was 10'037 yeats (sD=
number of years in practice as occupational
7.174),rangingfromlto34years.Nearly3S"/"workedinhospitalsor
health services being the next largest
rehabilitation centres, with community
 396

worked in aged care' spastic

employers of approximately 13%. The remainder
health and
and crippled childrens centres, private practice, occupational
a few' in a range of
vocational rehabilitation, the department of health and'
such as independent living centres, schools,
toy libraries' arthritis
agencies
disabled' see Table 3 and
foundations, and with the deaf, blind or intellectually

Figure 3.

Count Percentage
Workplace
(sample
207)
b 72 34.78
Centres
th 27 13.04
CommunitY
Centres
2T 10.15
oc. 20 9.66
Rehab.
ractice 20 9.66
Private
of He 15 7.25
10 4.
astic Crippled
children
22 1-0.63
-
therapists worked'
Table 3: organizations in which occupational

Spastic/CriPPled
children
Departments of
Health

Private Practice

Occ.Health/Voc.
Rehab.

Aged Care

CommunitY Health
Centres
Hospitals/Rehab.
Centres

Other

20 40 60 80
0

therapists worked.
Figure 3: organizations in which occupational
 397

The client / patient populations with whom the occupational therapists

young children to the
worked was fairly evenly spread across the lifespan, from
but of these only
very old. Most clients (mean = almost 60%) were Australians,
were Australian Aboriginals, and these were seen by only
up to 35% of the
17o

occupational therapists who responded. The remainder

of the clients were
50% of the
mainly European and, British, with about 3% Asian. Approximately
clients were identified as aged pensioners, pensioners
for other reasons/
visited clients homes in
unemployed, or single parents, anð, 56.7% of therapists
the course of their work.

Thirty percent of the sample responded that they spent

no time in activities

they would describe as 'health promotion'. In contrast,

three therapists (1'%)
seventy percent spent
spent 100% of their time on health promotion activity.
some time on such activities with the mean being
2I% (sD= 25'896)' Forty

point nine percent said they were involved in particular

health promotion
The types of activity
strategies at the time they answered the questionnaire.
education about back care'
they described, as health promotion included' health
diet' activity
joint protection, lifting techniques, head injuries, work positions'
smoking and so on;
and exercise, lifestyle, mental health, stress, screenings,
building design' crisis
problem solving with clients about access, home safety,
etc., counselling and
situation management, child care to prevent child abuse,
empowerment of clients with cardiac conditions, cvA, head injury' arthritis
carers how to handle their
and others; teaching independent living skills and
advising in shopping centres,
disabled child, spouse, aged relative; community
so on'
schools, service clubs, self help grouPs and

These,andotheractivitieswerecocledintocategoriesaccordingtothree
different criteria - firstly, the conditions given priority
by the Better Health
diseases
Commission for preventive Programs, that is cardiovascular disease'
nutrition, injury, cancer, communicable diseases, and
mental health3;
of
 398

is personal skill development'

secondly, the Ottawa Charter directives, that
creating supportive environments, strengthening
community action'

reorientating health professionals, and building

heattþ public polic/; and'
that is within
thirdly, seven d.ifferent approaches to health promotion'
conventional medicine, preventive medicine,
health education' social justice'
sustainabilitys' See Tables
community development, wellness and ecological
occupational therapists' activities
and Figures 4,5 and 6 for a frequency count of

according to these criteria'

Count Percentage
BHC Target
(Sample = 207)
Disorders
1 0.48
ommunlc le
diseases
4 1..93
ancer
nutrition 23 11.LL
Diseases
In uries 6t 29.47
dio 32.86
disease
-68 89 43.00

at Better Health commission

Table 4: occupational therapist activities aimed
target diseases.

Communicable
diseases

Cancer

Diseases of
nutrition

lnjuries

Cardio
vascular

Mental health

0 20 40 60 80 '100

aimed at Better Health Commission

Figure 4: Occupational therapist activities
target diseases.
 399

Count Percentage
Ottawa Charter directions ( = 207)
t 55
su ve environment 96
action 1 6.28
comm
5.79
L 0

at ottawa chartet directives

Table 5: occupational therapist activities aimed

Public PolicY

Re-orient health
professionals

CommunitY action

Supportive
environment

Personal skills

o 20 40 60 80 100 120 140 'l 60

at Ottawa Charter directives

Figure 5: Occupational therapist activities aimed

Count Percentage
Type of aPProach (Sample
=207*)
ve medicine 115
tion 11,4
31.40
W
lClne 48 23.79
T7 8.27
unl
0
0
u1

to Health Promotion
Table 6: occupational therapist activities according greater than sample size
one answer' Total
approaChes. *Responclents gaveLore than
 400

CommunitY
development
Conventional
medicine

Wellness

Health
education

Preventive
medicine

0 50 100 150

to Health Promotion
Figure 6: Occupational therapist activities accofding
a pproaches.

One hund,red and eighty resPondent s

(71.a%\ said thffit satisfied with the

amount of health promotion they were able to do in the course of their work'
for this L18 said they
In response to a series of questions probing the reasons
time to develop or
wefe constrained by a heavy workload and lack of
implement program s,ggbylimited staff and resources,
37by their employing
policy, and 15 by fear of invading individual rights. See
Table 7.
agency

Response
Count

amount of health promotion done in iob 72.0

180
NO 47 18.8
YES 23 9.2
DON'T KNOW
252 r.00
TOTAL*
1.18 46.8
Constrained time to
118 46.8
Constrained workload
99 39.3
Constrained limited staff and resources
37 14.7
Constrained
15 6.0
Constrained fear of in individuals
18 7.1.
Other constraints

TableT:Constraintstoprovidinghealthpromotionincurrentwork.
Total greater than sample size
*Respondents gaie more than one answer.
 401

Askediftheyhadaparticularinterestinanyillnessordisabilityforwhicha
L09 therapists(43'3%)
health promotion intervention would be appropriate,
said. they had, and well over 50% fett that
they were able to offer
intervention/strategies to or reduce significant health, social or
minimise
course of their work' Less
environmental problems they came across in the
than 20% felt they were not able, and the remainder
did not answer this
question.

health promotion
The respondents indicated that the benefits of increasing
(68'7%), home
would incrude hearthier community and individuar rifestyles
currently (52'8%)'
and community problems being addressed better than
targetted programs for risk grouPs (54%), Pro8rams
for relatives (50'8%)'

(69%), and a reduction in ill

increased client responsibility for their own health

healthandhospital/institutionadmissions(61%).SeeTable8.

Response
Count
173 68.7
healthier community and individual lifestyles

133 52.8
home and community problems bette¡ addressed

136 54.0
allow targetted programs for risk grouPs

128 50.8
provide health promotion Programs for relatives

174 69.0
promote client responsibility for own health

153 61.0
reduce ill health and hospitaUinstitution admissions

TableS:ThebenefitsifhealthpromotionProgfamswefeincreased.
*Respondentsgavemorethanoneanswer.Totalgreaterthansamplesize

In answer to a question about the adequacy of occupational therapy

36'5o/" thought it inadequate'

education as a basis for health promotion practice
 402

very adequate. There were

4l.g%that it was adequate, and 4.8% that it was
44(17.5%) missing values. One hundred
and sixty eight respondents expressed
strategies' This included
a need for further ed.ucation on health promotion
(413%)'
education about risk factors (31%), principles of lifestyle modification

counselling skills (54%), public policy on

health matters (38'5%)' multi

disciplinary health professional education (44.8%),

and multi disciplinary

intersectorial education (31'3%)' See Table 9'

it is for occupational to be involved in

therapists
Asked how important
unimportant, 63(25%) thought it
health promotion, only one Person thought it
and 145(57.5%) thought it very important' seventeen point
one
important,
percent gave no answer'

Response
Count

Feel need for further training on health

promotion strategies
84 33.3
NO 168 66.7
YES
252 100
TOTAL
78 31.0
Need education on risk factors

¡nodification 104 4t.3

Need education on principles of lifestyle

736 54.0
Need training in counselling skills

97 38.5
Need education on public policy re health

113 44.8
education
Need multi disciplinary health professional

79 31.3
Need multidisciplinary intersectorial education

50 20.0
Need other education and training

Table 9: Further education requirements' Total greater than sample size

*Respondents gave lhu., one answer.
^or"
 403

Discussion
The occupational therapists who took part in this
survey present a picture of

a profession which is pred.ominantly youn8 and female' Most work

in

hospitals or rehabilitation centres, which seems

to support the historical
influencesof the philosophy that occupational therapy is concerned with ill
clients' homes in the
rather than well people. However, as about half visit
work is now
course of their work and many have contact with relatives, the
and addresses the
often carried out in real environments in the community,
need.s of more than just the immediate client
grouP' This picture illustrates a
which has access to
potential workforce for health promotion initiatives'
wellness, both within acute and
people who require particular help to achieve
longtermhealthcarefacilities,aswellasinthecommunity.

Many of occupational therapist's clients, of all ages,

fit into categories found to

be socially disadvantaged and at increased risk

of ill-health, namely the poor
their offspring, the
and the aged, such as pensioners, single parents and
unemployed, aboriginal and some ethnic grouPs'
If the therapists' who are an
accepted part of their clients' social networks,
were to be invited' directed and

resourced to use health promotion as part of

their curative and rehabilitative

measures it would seem to be an excellent

and economical use of scarce

resources.

identifying what they do as

The fact that so many of the therapists are already
have interest in a
health promoting aÍe using health promotion strategies'
,
particular condition which is appropriate for
health promotion intervention'
health' social or environmental
and feel confident in intervening in particular
should encourage national and
problems which they encounter in their work,
departments to recognise that
state health authorities and public health
are one health profession with a growing interest
and
occupational therapists
in practical health promotion interventions'
expertise
 404

at the time of this surveYr was in line

Occupational therapists' direction,
with not all of the Better Health commission's priorities, namely
some, but
prevention' In terms of the
mental health, cardio-vascular disease and injury
ottawa Charter directives, those surveyed, not surprisingly,
demonstrated

development and creating

particular interest and expertise in personal skill
supportive environments. The lack of activities aimed at community
professionals towards positive
develoPment the re-orientdon of health
that these are areas
health, and in building healthy public policy suggests
which need to be developed if occupational therapists are to be considered to
in viewing the total lack of
have a central role in health promotion. similarly
sustainable aPProaches' and
reported activity in social equity or ecologically
much lower levels incommunity d.evelopment approaches suggests a bias
concerns, and a lack of interest in
towards individual rather than community
illness or wellness experiences'
the underlying occupational determinants of

This may be harsh or unfair comment in the

light of the reasons given for
surveyed who identified their
the large proportion of occupational therapists
much as they would like
inability to be involved in health promotion as
of many reasons, but mostly because of lack of time
and resources'
because
fesources being unequitably shared
This may be yet another example of health
between public and conventional health models,
or a lack of recognition by
much to offer in terms of
pubtic health that occupational therapists have
may also be a result of lack
health promotion. The particular cast of activities
of health promotion' Many of
of education regarding the scoPe and dimension
ideas about prevention and health
the activities provided as examples reflect
about the nature of health
education which comprise a popular misconception
promotion, restricting it to the prevention
of illness' lndeed' therapists
about health promotion' and in
identified a strong need for further education
lifestyle modification and risk
particular about counselling skills, public policy'
 405

maln,
factors. Foroccupationaltherapistssucheducationwould,inthe
both
address theunderlyingoccupationalriskfactorswhichrequire
community action and. changes to public policy
to effect improvement' Since
graduate opportunities for
this survey was completed., the number of post
addressing some of the
occupational therapists has increased, and courses
there is no cause for
identified education needs are now available, although
complacency6.

The overwhelming result in this survey is the importance given by

occupational therapists to health promotion,
the benefits they perceive as

emanatingfromit,and.theirbeliefthatoccupationaltherapistsshouldbe
involved in it.

Followuptothisstudyshouldbethefurtherdevelopmentofeducational
meet the need
at both undergraduate and' postgraduate levels' to
opportunities
awareness of
perceived by clinicians, and. a Program aimed at raising the
public health departments'
national and state health authorities, as well as
occupational therapists to health
about the interest, skills and committment of
promotion.
anberra:
PrimnrY health
1'978; World
Association' The
Canada: 1986.
ptomotion1986;1 (1)
2stott NCH. The role of health promotion in primary health carc' Health
3 B"tt"t Health Commission, ibid'
4 Ottu*u charter, ibid'
ts of occupation, health and health promoLion'
200-203.
'Health
subjects such as 'Occupational science"
me asPects of these issues'
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Adams JD, editor . tJnderstanding ønd manøging stress:

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