Southern occupational therapies: Emerging identities, epistemologies

and practices

Alejandro Guajardo, Lic. OT, Lic. Family Therapy, Dipl. Geriatrics and Gerontology
Associate Professor, Director of the Occupational Therapy Masters Programme, School of Occupational Therapy, Faculty of
Rehabilitation Sciences, Universidad Andres Bello, Santiago de Chile, Chile

Frank Kronenberg, BSc OT (Zuyd University), BA Education (De Kempel)

International guest lecturer in Occupational Therapy, PhD candidate, University of Cape Town, Director Shades of Black Works

Elelwani L Ramugondo, BSc OT (UCT), MSc OT (UCT), PhD (UCT)

Associate Professor, Division of Health and Rehabilitation Sciences, Faculty of Health Sciences, University of Cape Town

For over a decade, debates in occupational therapy have extended into the profession’s theoretical foundations as well as epistemological
underpinnings thereof. A series of proposals have emerged from around the world that aim to link the definition of occupational therapy,
its knowledge and practices to contemporary social, political, cultural and economic conditions. Contributing to this is the increasing
ABSTRACT

precariousness of the global social life, the economic crises of many social systems, and the deterioration of the ecological environment.
The current paper critically reflects on the historical conditions that shape the institution of occupational therapy, particularly in the regions
of South America and Africa. This involves a political, ethical, and epistemological rethinking of the foundations that underpin identities,
knowledge and practices of occupational therapy and their effects on society. These foundations may favour processes of exclusion and
ahistorical and individualist views of human occupation, as opposed to social perspectives expressed in collective occupations and human
rights promoting practices. The authors propose to problematise the construction of a professional identity, knowledge and practices
of occupational therapy, emphasising the need for a liberating discipline, committed to and acting alongside people and communities
who are in situations of social exclusion. This implies the necessary positioning of occupational therapy within social transformation.

Key words: Southern, critical, epistemologies, human occupation, human rights

“Al fin y al cabo, somos lo que hacemos para cambiar lo que somos”1:111. here the term ‘southern’ from the Australian sociologist Raewyn
3
(“At the end of the day, we are what we do to change who we are”). Connell who uses it “not to name a sharply bounded category of
Eduardo Galeano, 1998 - Uruguay states or societies, but to emphasise relations—authority, exclusión
and inclusión, hegemony, partnership, sponsorship, appropriation—
“The question of what Africa means stands unanswered at the ideologi- between the intelectuals and institutions in the dominant European
cal core of Pan-Africanism, negritude, nationalism, decolonization, and and North American metropole and those in the world peripheries,
all other projects through which Africans have sought to understand those groups and identities that sit outside the hegemonic concep-
and restore their violated humanity”2:IX. tion of society”3:viii-ix.
The intention in 2010 was to inconvenience the prevailing
Pius Adesanmi, 2011 - Nigeria discourse of occupational therapy and to promote a critical, re-
flexive stance on the profession itself. This discussion paper seeks
INTRODUCTION to re-energise collective professional thought and conversation
See Note 1. in anticipation of the 2018 WFOT congress in Cape Town, South
Africa has for the first time been afforded the opportunity to host Africa.
the congress of the World Federation of Occupational Therapy
(WFOT) in 2018. This is a great opportunity for the continent to PROFESSIONAL CONGRESSES:
share how occupational therapy has been and is being shaped in CONTESTED INSTITUTIONAL SPACES
this particular region of the world since it was first introduced by
Professional congresses can be privileged places to reflect and
colleagues from the global north in South Africa in 1942. South
problematise the foundations, practices and historical contexts in
America was granted the same space in 2010, during which key-
which a discipline is developed. But congresses can also become
note speakers invited considerations of the construction of identi-
complacent spaces of institutional narcissism in which the actions,
ties, epistemologies and practices of occupational therapy in Latin
actors and methods of the profession’s constituencies are legitimised
America and Africa, two continents which are still largely portrayed
through self-referential presentations, dialogue and publication.
as a ‘developing world’ or ‘southern’ societies. The authors adopt
Congresses often have more to do with the social validation of the
institutional discourse, than with promoting the exercise of citizen-
Note 1: This paper presents an updated, blended version of the first two ship of individuals and groups to which the profession dedicates its
authors’ keynotes at regional occupational therapy conferences, respec- service. While the former is of interest, the profession must also
tively: “The Construction of Identities, Episteme and Practices of Oc- place the advancement of the civic freedoms of individuals and their
cupational Therapy in Latin America”, Confederación Latino Americano communities always at the center of its collective deliberations such
de Terapia Ocupacional (CLATO) in Sao Paulo-Brazil, 11-14 October
2011; and “Expanding Horizons: Occupational Therapy for a Develop-
as those that unfold at congresses.
ing World”, Occupational Therapy Africa Regional Group (OTARG) in A review of the international literature suggests that profes-
Livingstone, Zambia, 12-16 September 2011. It also reflects a complex sional discourse is currently influenced by an historical period that is
intercultural dialogue which had to be negotiated in Spanish and English marked by the ideologies of neo-liberalism and pragmatism, which
between two continents which share similar historical socio-political deny the existence of society and position individuals by themselves
conditions, attempting to bridge the WFOT world congresses of South at the centre, dissociated from relations and the community, and
America (Santiago de Chile, 2010) and in Africa (Cape Town, 2018). the focus is on skills competition and self-management4,5,6,7,8,9,10,11,12.

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South African Journal of Occupational Therapy — Volume 45, Number 1, April 2015
 These and other economic and socio-political ideologies exert diverse society towards greater connectivity in building national
pressure on professions such as occupational therapy to legitimise unity. A number of phrases have been coined to describe this
their existence for example the increased emphasis on evidence- near-miracle transition in the context of social diversity. At that
based practice as a means of demonstrating cost-effectiveness and time, Emeritus Archbishop Desmond Tutu referred to South
instrumental efficiency13,14,15. While the macro systemic contexts in Africa as the ‘Rainbow Nation’. Another well-known phrase, first
the ‘developed’ global north and ‘developing’ south may differ, they uttered by Nelson Mandela, regarded widely as the father of the
inevitably shape the discourse and various identities of the profes- South African nation, appears in the preamble of the national
sion in locally particular ways. The dynamics at play call for reflection constitution: “South Africa belongs to all who live in it, united in
and a critical look at the conditions under which our professional our diversity”16.
congresses come about. It is important to interrogate the historical The meaning of the word ‘impact’ is debatable, depending on
conditions that have led to our present identities, epistemologies the particular leanings of practice which different communities
and practices: What may be the limits of our constructions? What of occupational therapy subscribe to. Those with occupational
are the conditions of possibility in the ‘southern contexts’ of Latin justice leanings may for example argue that, in line with human
America, Africa and, perhaps we can add, the peripheries of local occupation-centred practice, ‘impact’ implies that the profession
societies globally3:viii-ix? increasingly positions itself to contribute to the eradication or at
least, reduction of the social conditions that create barriers to
Constructing the legitimacy of institutions meaningful human occupation. Foregrounding notions of ‘con-
We will first focus on the institution of occupational therapy, a nectedness’, ‘diversity’, ‘impact’ and positionality in the lead theme
social entity or instrument. By institution we also mean a material, of an international professional congress, raises expectations that
organisational, symbolic structure, which mandates the actions of critical reflexivity will occur about institutional constructions that
individuals or groups of people in a given setting. An institution may have legitimised some knowledge’s, practices and identities
transcends the wills of individual members and, presumably, orients to the exclusion of others.
them towards a particular social good for those who constitute it.
As representations of society, institutions are also products of his- • The lead theme and examining institutional
tory, which claim to meet social needs. In this sense, institutions constructions
are based on social or societal demands. This socially oriented If occupational therapy is a social institution convened to contribute
mandate implies that institutions, including occupational therapy, to solving social problems, what then are the ethical and political
are part of the body of society and oriented to the purpose that implications of pursuing particular foci such as human occupation
a particular society has defined for its members. In other words, in the context of social diversity? Social problems are not abstract.
institutions contain standards and principles that sustain them. In our They are about people, groups, specific groups, some of whom
case, occupational therapy is primarily an institution that is located are privileged (‘Minority World’) whilst others (‘Majority World’)
in the scientific sphere—a discipline, one of social intervention—a are situated in marginality, vulnerability, suffering and loss of social
service profession. well-being, contextual conditions that have profound implications
As an institution, occupational therapy has methods, practices, for human occupation17. If occupational therapy is an effect, an
discourses, schools, books and and academic spaces such as con- institution that arose as a consequence of social realities, then the
4
gresses, which legitimise it as a recognisable service profession that profession cannot examine itself without putting itself in the context
can be accredited by state institutions. Its practice of scholarship of these realities. Given these realities, how then do we construct
is further legitimised as distinct by a focus on human occupation our identities, knowledge and practices?
as an object of study. A distinguishing and therefore legitimising Social problems do not affect everyone equally. Important
function of occupational therapy is its exploration, explication questions to ask thus are: who are the people with whom we
and application of human occupation as a means towards health work? And who are we to also serve, as mandated by the World
and well-being and as an end in itself. The processes of gaining Federation of Occupational Therapists’ (WFOT) position papers on
and maintaining institutional legitimacy involve relations of power, Community Based Rehabilitation (2004)18, Human Rights (2006)19,
and the ability to manage strategies of influence, domination, and Disaster Preparedness and Response (2007)20, and Diversity and
social positioning including ways to shape the world and knowing Culture (2010)21.
how to operate in it. Consensus, contradictions and controversies
characterise the distinctive focus on the construct and construc- • The lead theme and institutional realities:
tion of human occupation and therefore warrant institutional Southern examples
consideration. Currently in Chile, there is significant growth of the workplace
Knowing, knowledges, practices and identities are constructed and the employability of occupational therapists, including work
in the context of a social institution and never outside of it. All know- in prisons. There are more jobs, better salaries, greater social
ing, that can be called science, and any practice that can be called legitimacy, and a gradual increase in the number of occupational
professional in occupational therapy, falls within the institutional therapy training programs (particularly at private universities) and
realm and not outside of it. Herein lays a risk, which is further government mandated occupational therapy services22,23.
elaborated on throughout this discussion paper with the aim of In South Africa, marginal growth is apparent in access to oc-
precipitating institutional reflexivity about the potential contribution cupational therapy for communities with no historical exposure
of the WFOT 2018 congress to professional legitimacy. to the profession24. In private practice, the authors have observed
that emergent black middle class children with barriers to learn-
WFOT 2018 Congress: institutional implications ing have become a valuable client group. The sedentary lifestyles
of the lead theme associated with technology have limited childrens’ engagement in
In ushering the WFOT 2018 Congress to African shores, the opportunities for physically active play. Occupational therapy offers
theme arrived at in consultation with the Occupational Therapy them potential benefits for postural control, fine motor coordination
Association for South Africa (OTASA) is boldly, “Connected through and visual-motor integration25.
diversity, positioned for impact”. A focus on diversity in the theme, From these and other developments within the profession,
given the location of the congress in South Africa, will not come South African and Chilean occupational therapists build personal
as a surprise to many occupational therapists. South Africa is per- life projects and gain sustained employability. While there is nothing
ceived all over the world as a country that managed to navigate a wrong in occupational therapists making themselves available for
potentially politically explosive period ‘without’ bloodshed during clients who can pay for services, it is important to recognise the
the transition from an Apartheid State to a democracy in 1994. ethical and political foundations that should guide access to our
The peaceful political transition, supported by an internationally services, especially when the majority of the population continues
acclaimed Constitution, plotted a way forward for its extremely to face different forms of social exclusion6.

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South African Journal of Occupational Therapy — Volume 45, Number 1, April 2015
THE IMPLICATIONS OF INSTITUTIONAL
Vignette 1 – ‘The Spring Project’ at Lentegeur
REFLEXIVITY Hospital, Cape Town
The inclusion of those that are currently excluded from occupa-
tional therapy services cannot happen without constant institutional The Lentegeur Spring Project, in which the occupational therapy
reflexivity using a set of normative principles. A caveat applies. It department plays a key-role, was initially conceived in mid-2010
will always be dangerous for professions as institutions including and with the backing of hospital staff and the CEO adopted by
occupational therapy to place themselves at the centre of reflexive a newly established Facility Board at the hospital made up of
processes. The danger lies in the disruptions that may ensue when community members. The ultimate purpose of the project is
the status quo of institutional practices are challenged. Different to re-design what a psychiatric hospital looks like, feels like, is
professional formations stand to gain or lose when institutional and does, using the metaphor of spring (as the natural rebirth
reflexivity seeks to reorientate practice towards people who do of hope) to transform it from a place of rejection into a centre
not have the economic means to pay for services. Resistance to of healing for individuals, communities and the environment.
institutional reflexivity that leads to radical change is therefore One initiative of the project is the ‘NORMALITEE and
understandable. In the next section, we explore the points where MALADJUSTED T-shirt Campaign’. It was developed by Dr
resistance may emerge and where transformative institutional John Parker and Mr David “Porky” Hefer a well-known Cape
reflexivity may occur. Town designer as a personal response to the two problems: 1)
the stigmatisation of those who are identified with psychiatric
• Nodal points for faciliating institutional disorders coupled with a global denialism on many levels,
reflexivity from the personal to the political of the extremely high and
Inverting dominance growing prevalence of such disorders; and 2) the widespread
In order to invert the dominance that continually pushes the poor phenomenon of social and moral breakdown, which together
and the marginalised to the peripheries of our traditional practice, with rampant consumerism, is leading to multiple problems
it makes sense to place such communities at the center of this on our planet.
reflective process6,18,19,20,21. If these communities are placed at The quotes on the backs of shirts further emphasise this con-
the center, what would our institutional identities, knowledges cept by questioning our assumption that “normal” as a measure
and practices then be? What position or place would we adopt in of being well-adapted to a society that is plagued by multiple
relation to their identities, knowledges and practices? Invertion of problems, is inherently a good thing. Quotes on the front and
dominance will involve the deconstruction of ‘taken-for-granted’ the back of the T-shirts read: (front) ‘Nor-Mal’ – (back) “It is
occupational therapy. It would therefore not be an occupational no measure of health to be well-adjusted to a profoundly sick
therapy that promotes the adaptation of people to the dominant society” (Krishnamurti) and (front) ‘Mal-Adjusted’, (back) “…
social system; that adapts people who are vulnerable and excluded there are some things in the world to which we should never
from the system that excludes them or that focusses on the de- be adjusted” (Martin Luther King).
velopment of skills and know-hows so that the subjects become There has been wide consultation with regards to the ac-
integrated into a marginalising context without the possibility of ceptability of this campaign and support was from members
of the Western Cape Mental Health Review Board, Cape 5
personal and social transformation. In fact, that is exactly the kind
of occupational therapy that we are challenging in this paper. We Mental Health, CCAB, the Consumer group of the Gauteng
should not want more employability, more jobs, to emerge as a Mental Health Society, Ubuntu and large numbers of people
result of perpetuating existing injustices. Instead, what is required with lived experience of mental illness, all of whom have given
is an occupational therapy that transforms, that promotes other their enthusiastic support (source: personal communication Dr
forms of social relations and alternative forms of living. In other John Parker, 8 Sept 2014) (Facebook: https://www.facebook.
words, inverting dominance means looking and working beyond com/lentegeurspringproject Youtube: https://www.youtube.
dominant occupational therapy institutional frames to allow other com/watch?v=qaeTq7neOPw Finding the spring: John Parker at
occupational therapy institutions to come about. TEDxPrinceAlbert).

• Generating ruptures
Inverting dominance is only possible if the first transformation is
a disruption of existing institutional foundations. The institution Vignette 2 – ‘Grandmothers Against Poverty
itself, the profession and discipline, with ‘us’ needs to become
the specific subject of transformation. As Ignacio Martin Baró had and Aids’, Khayelitsha, Cape Town
proposed for psychology26, it is occupational therapy itself which The Khayelitisha-Cape Town based NPO Grandmothers
should transform at its foundations, (re)orienting it to generate a Against Poverty and Aids (GAPA) may was founded in 2001 by
liberating practice27. Foundational rupturing demands that we com- a group of ten grandmothers and the South African occupa-
mit to freeing ourselves from the dominant institutional discourse tional therapist Kathleen Brodrick. An initial assessment of the
and practice. Going beyond its bounderies, generating ruptures, lived realities in context was carried out by the grandmothers
dissonance and disequilibrium in what is considered stable and themselves, supported by the occupational therapist. It quickly
enduring. The outcome of the first transformation is likely to be became clear that the many challenges, which included but
an occupational therapy that goes beyond borders and margins set went beyond medical issues (eg. poverty, lack of education,
to produce other occupational therapies15. domestic violence) required the organisation to go beyond
a traditional institution-based, biomedical model, individual
• Confronting paradigmatic bias client approach, towards a community-based, collective (oc-
A rupture such as the one we propose calls for an occupational cupations), self-help groups approach. A program was created
therapy produced from practices, and everyday life experiences that allowed the grandmothers to come together, to share, to
that are locally situated and unfold, alongside specific communities. listen, to learn, to plan and to implement the types of support
Ruptures happen when we question paradigmatic biases that situate that they required in order to meet their extremely challenging
social processes as tangential (of little relevance) to the work of the everyday needs. In this regard, occupational therapy became ‘a
insitutution. Not thinking about our paradigmatic biases is called multiple dimensions resource’ to support the grandnothers to
a-historicism; when what we do is placed in an abstract position, support themselves and each other. (Website: http//www.gapa.
de-ideologised and naturalised. An example of a paradigmatic bias org.za/ Facebook: https//www.facebook.com/pages/GAPA-
is extreme individualism in the understanding of and actions in our Grandmothers-Against-Poverty-and AIDS/108121155934330).
professional practices8,10,12 (see Vignette 1).

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South African Journal of Occupational Therapy — Volume 45, Number 1, April 2015
 • Tapping into historical existences and histories. We are interested in the effects of our professional
An occupational therapy that promotes autonomy of choice, and actions, both as reproducers and transformers of the existing social
engaged citizenship and which considers the community as an act- order. Ramugondo’s notion, ‘occupational consciousness’ explicitly
ing subject is a producer of its own institutional reality. Generating speaks to this interest; defined as an ongoing awareness about the
practices of occupational therapy that are recognised within com- dynamics of hegemony, and how through what people do every
munities and that are regarded as having an effect on them means day dominant practices are sustained, with implications for personal
tapping into local histories. These communities possess a historical and collective health and wellbeing34,35. It is imposible to escape the
existence. Their current stories are concretely situated in intergen- political and ethical implications of our actions6. Recognising the
erational narratives. They emerge from realities that are socially existence of multiple occupational therapies and therefore identi-
produced in defined contexts. Tapping into historical existences ties results precisely in appreciating these effects and implications
allows occupational therapy to be produced through and in the in the production of subjects and realities.
same scenarios, contexts and places (see vignette 2 on page 5). • What is the role of occupational therapy?
• Moving beyond the single story As occupational therapists we have often reflected on ourselves
We speak of identities because consensus exists that identity can as subjects. At how many conferences do we ask ourselves what
only be understood in relation with others, hence plural. Plural is the role of occupational therapy? Our mandate in answering this
identities do not only refer to differences in place, context, and question has for a long time been the pursuit of a singular role, a
historical positions but also in understandings or foundations9. Basi- specific social function, clear and defined. This pursuit unfolded
cally, identities refer to a symbolic universe in which a set of socially within rationalist, objective, positivist modernity, where it was
produced meanings converge28, intersubjectively, which orders possible to think of a unique, homogeneous, absolute and stable
and structures the life of the institution. Talking about the danger world, one in which a uniform institutional identity was able to ex-
of the single identity or story, the Nigerian author Chimamanda ist. In today’s post-modern age, the objective and the permanent
Ngozi Adichie states that ‘the single story creates stereotypes, is no more, they are gone. There is no one truth or essence. The
and the problem with stereotypes is not that they are [necessar- objective is replaced by relativism and the contingent.
ily] (inserted by authors) untrue, but that they are incomplete […] • How do we avoid reductionism?
they make one story become the only story’29. There is no single How can we ensure that, via the construction of identities, we
story, and neither does a single identity exist in a single person, a are not looking for this bounded or determined area, which of
household, a community or a country. So too, in our occupational course, separates us from other disciplines, as if the world could
therapy institution there exists no single identity9. Since the 31st of be simplified, reduced to precise and fixed limits? Morin’s and
October 2011, it is estimated that there are more than seven billion Hegel’s grand idea of ‘totality’ and socio-historical approaches
humans inhabiting the earth30. And they or really we, are all both have warned us about this propensity for reductionism36,37. Morin
the same and yet singularly unique. Given that every human being tells us that reality, thinking and knowledge are all complex and
is unique, thus every occupational therapist is also unique, as well that is why we must use complexity to understand the world36.
as all the people whom we work8. In the theory of complex thought devised by Morin, it is said that
6 Thus, it does not seem appropriate to speak of occupational reality is understood and explained simultaneously from all possible
therapy as a kind of ‘monoculture’, but of occupational therapies, perspectives, which strongly resonates with ‘human occupation for
or perhaps rather of ‘an ecology of human occupation-based prac- health’, the fundamentally transdisciplinary conceptual lens that
tices’, which include but are not limited to traditional occupational inspired the foundation and promotion of the occupational therapy
therapy9. profession in the early twentieth century38. It is understood that
• Challenging institutional monoculturalism a specific phenomenon can be analysed through the most diverse
Monoculturalism refers to the privileging of a dominant culture areas of knowledge, through a trans-disciplinary understanding, or
as the singular point of reference for institutional existence. Cur- as Chana and Alburquerque propose ‘transaberes’ (Spanish), trans-
rent debates about practices and the construction of a diversity of knowledges39 and de Souza Santos ‘an ecology of knowledges’40,
foundations clearly puts the mono-cultural view of occupational avoiding the usual reduction of the problem to an exclusive matter
therapy into question9,18,19,20,21,27, 31,32,33. or question of science in which we participate41.
Here we refer not only to geographic or epistemological posi- • Which historical conditions have produced
tions, but mainly to the foundation of monoculturalism located in
‘the dominant European and North American Metropole’3, that these identities?
has served as reference point for substantiating our understanding Therefore, the authors think the question is less about identities,
of reality subjects and human occupations. There is no such thing but about conditions of possibility and production from which
as ‘no place’, neither just ‘one place’. There are many places of professional identities emerge, that is, the historical conditions
institutional articulation creating different knowledge foundations that produce these identities. We must critique the naturalisa-
(epistemologies), axiological (value) orientations and ontological tion of identities. But identities also possess certain temporary
(concerned with the nature of being) assumptions, all of which ‘fixations’, or particular perspectives on ‘human occupation’ or
help us to understand and produce occupational therapy, both its ‘human occupations’ – the central focus of our profession. Like
disciplinary and professional aspects. That is, there are occupational our identities, human occupations are also socially and historically
therapies9. In the next section we examine some of the dynamics produced. There is no human occupation that exists by itself. Any
at play in the emergence of southern occupational therapies.We singularisation is the manifestation in a subject of an occupational
propose critical issues of identities, epistemologies and practices field that is relational in character. What we collectively construct
that warrant consideration at collective institutional gatherings such within the profession as ‘human occupations’ relate to our episte-
as international congresses. mologies, that is, to scientific knowledges. Next we will offer a set
of reflections in this regard.
EMERGING SOUTHERN IDENTITIES
Appreciating the notion occupational therapies implies recognis- EMERGING SOUTHERN EPISTEMOLOGIES
ing identities, diversity, difference, and a variety of positions and First, why speak of epistemologies, and not epistemology? Is there
articulations of understandings of the real. As a social institution, not only one kind of science and one way of conceiving it? Episte-
professionally and academically, occupational therapists are chal- mology is a discourse, a discourse of science41, which pertains to
lenged to address seemingly irreconcilable north-south identity things that are said about something, for example, human occupa-
differences. This challenge is not primarily a conceptual issue, tion. Epistemology is not asking about the object of study, but about
pertaining to knowledge, but primarily—one of values, practices the discourses referring to the object. Discourse, i.e. the things

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South African Journal of Occupational Therapy — Volume 45, Number 1, April 2015
that are said, are spoken by someone who is situated in a specific, If we say that our discipline is science and art, is the foundation of
social reality. In our case, this someone or subject is the institution the above just epistemological, scientific?
of occupational therapy. If the center of the work of occupational therapy is the com-
Secondly, what may be good for one is not good for another. It munity or groups, as previously alluded to, then the center of
involves a democratisation of the profession, knowledge and know- knowing and knowledge will also be here, not as objects but the
ing, which resonates with what the Indian scholar Shiv Visvanathan community as an acting operant subject. From this perspective, the
coined ‘cognitive justice’42. He commented on the destructive centrality in the community is the everyday, the world of everyday
impact of hegemonic Western science on ‘developing countries’ life (see vignettes).
and non-Western cultures, calling for the recognition of alterna- This realm calls for a rationality that is common sense. Common
tive sciences or non-Western forms of knowledge. He argued that sense as knowledge, of individuals and groups with whom we work.
different knowledges are connected with different livelihoods and This is not an empirical knowledge, but an experiential practical
lifestyles and should therefore be treated equally42. Boaventura de knowledge, phronesis or practical wisdom8. It is the natural ability
Sousa Santos also employs ‘cognitive justice’ as a critique on the of groups and communities to operate from a shared symbolic
dominant paradigm of modern science, promoting the recognition code, which allows the perception of reality, and the attribution of
of alternative paradigms or alternative sciences by facilitating and meaning to people, objects or situations, which result as obvious
enabling dialogue between often incommensurable knowledges40,43. to the common members of that community.
Every discipline is constituted through an object of study and a Carlos Peréz, referred to earlier, noted that common sense is
method. The scientific method is generally used for the object of a complex historical construction of an unsuspected depth, that
study of occupational therapy. Although there are knowledges and we operate successfully in it on a daily basis in most of our actions,
ways of knowing that are derived from experience, the empirical and that we rarely need to go beyond their formulations to solve
is most often regarded as substantive knowledge. common problems41. It has also been called ‘reasonableness’, being
reasonable, which is different from being rational. It is about a com-
• Which discourses sustain occupational mon space, a set of beliefs that emerges from and is sustained by the
therapy? daily practices at micro and macro social levels, intersubjective in
Questions that unearth the underlying discourses in occupational nature and that has the character of knowledge. Also, we ought to
therapy and human occupation are: What is said about occupational assimilate what Bourdieu has called ‘practicalities’, which concerns
therapy and why was this said? From what foundation is what is more so an internalisation of the externality, of the knowledge that
said about human occupation, said? Here the intent is not to look seeks to incorporate the need of the social world45. Occupational
at the object, but at the subject that speaks about the object. In therapy does not have a unique way of knowing and to know. If this
this case, we assert that the subject which speaks is the institution were so, it would enclose us and restrict us. Occupational therapy
of occupational therapy. has the possibility of various ways of knowing and knowledge and
Epistemology is the resource that affords scientific status, a science, a particular kind, is one of them. As noted by Kronenberg,
discipline’s autonomy, to no longer being a supplement of something Pollard and Ramugondo: “... occupational therapy is fundamentally a
else, alongside others, but to be itself. How much of the construc- posibilities-based practice, which generates evidence-based practice
tion of epistemologies is concerned with knowledge—knowing, via practice-based evidence”46:11. 7
and how much has this to do with the political need for validation
as a scientific entity? For example, in its 2017 Centennial Vision, • How can substantive institutional knowledges
the American Occupational Therapy Association insists that oc- be built?
cupational therapy (among other qualifications) is a ‘science driven Can knowledge for occupational therapy be built from experience
profession’44. and from the empirical? What we regard as central to occupational
Our task in this paper is to investigate the grounds which sustain therapy is the common sense knowledge of daily practice, the
the epistemological discourses of occupational therapy. This is not a everyday sense, and science is to be articulated, anchored in this
cognitive process, but the ontological rationality which establishes knowledge. It ought to be articulated with a multiplicity of actors,
the assumptions of the reality of being, of human occupations. This bringing about ways of knowing and forms of knowledge with real
is not an idea, cognition or a thought, but an operation of thinking people and communities in their everyday life contexts, guided
that suggests the thought41. It is fundamentally a political rationality. by their interests, allowing our profession to become a particular
Reflecting on the foundation of something is asking ourselves what knowledge in service of the community (see vignettes)9,27.
constitutes us, what makes us understand and see what is real, what Occupational therapy knowledge is found in the practices
is reality in one way and not another. These are the conditions of themselves, in human occupations, not outside of them. It is found
possibility of our discourses. in occupational experiences. The human occupations are not some-
Questioning the foundations is interrogating our selves. The thing external to the subjects, a method to achieve the essence
prominent Chilean epistemologist, Carlos Pérez points to which through this phenomenon called ‘human occupation’. The human
foundations, i.e. under what historical conditions something is said occupations are social practices, relationships, in which subjects
about something41. That is, questioning as occupational therapists, are constituted and produced. Occupational therapy knowledge
under what social and historical conditions we say about human is not beyond that. The knowledge is in the subjects themselves,
occupation what we say it is? in many places, in many actors. Science is but another way of
We are all situated in a historic, concrete, epistemological understanding and knowing these knowledges. But it is in critical
place. As noted by our Colombian colleague Lyda Pérez: ‘we all reflection, a problematising of the actors themselves, a questioning
have ways of knowing and forms of knowledge, though we may of common sense, from which emerges a substantive knowledge
not be aware of these’ (personal communication, 13 October for the profession. Simultaneously, we must also problematise the
2011). The challenge, then, is to have self-awareness of it. For assumptions that underly all scientific knowledge.
this, we must historicise the conditions of knowledge production. To do this, calls for critical thinking, an interrogation of reality,
Historicising from what foundations we speak and act. Thus, there that is not regarding it obvious, questioning if things are as they are
are multiple places, various assumptions of what is real, and various or may be otherwise. Critical here means questioning the method of
epistemologies. This implies that identities are constructed from thinking as the main aspect of knowledge construction. To be critical
various epistemologies. is to interrogate the assumptions of occupational therapy, question-
ing that which is considered the obvious and the natural9,27,31,32,33.
• Why is science not the only way to know in Critical, is not only thinking about the political, ethical and economic
occupational therapy? issues that are affecting the community and the implications for
Another aspect of the epistemological, relates to knowing and occupational therapy, but also involves questioning from where,
knowledge. Is science the only way to know in occupational therapy? which and how knowledge emerges, i.e. the critical itself becomes

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South African Journal of Occupational Therapy — Volume 45, Number 1, April 2015
 a form of knowledge. In the next section we provide examples of recycle, relocate, reduce, and reuse resources available to us. We
institutional assumptions that warrant critique. can conceive of human occupation as a dialogue between human
Critiquing, for example… That human occupation is healthy, beings and the natural environment. This Simó called occupational
that being occupied produces wellbeing and that without human ecology50.
occupation we get sick. Under what historical conditions did these Also referring to practices, Ramugondo invites us to become
assumptions about human occupation arise? In a capitalist world more ‘occupationally conscious’ of what we do everyday. How
of consumption where identities manifest as individualism, with what we do comes about, and implications thereof for individual
competition gone wild, which human occupations really are healthy and collective wellbeing34,35.
and generate well-being? If we are produced by what we do, that
is through human occupations, and these are embodied in specific • What ought to be the foundations of
socio-economic contexts, then how can one ensure in the kind occupational therapy practices?
of alienating, materialistic, throw-away society in which we live, The issues above refer not to technical or methodological mat-
that human occupations are ‘outside’ of this scenario and do not ters of practices, or two of Aristotle’s three intellectual virtues,
produce damage or ill-health? Is it possible to maintain that human namely episteme (scientific knowledge) and techne (applied scientific
occupations are ‘outside’ of social reality, immune and external to knowledge), which according to Flyvbjerg produce ‘instrumental
the subjects themselves and their relationships? Social alienation is rationality’51. On the contrary, these issues correspond with po-
sustained through alienating, dehumanising occupational practices litical and ethical considerations regarding what ought to be the
(see vignette 1). foundation of occupational therapy practices. Such considerations
Critiquing, for example… That human occupation exists, resonate with Aristotle’s third intelectual virtue phronesis (practical
singularly, as in individuality. As previously suggested, no human wisdom), which Flyvbjerg says produces ‘value and power rational-
occupation is understood as an abstract entity separate from its ity’51, which relates to Pérez’s ‘reasonableness’.41. Practices are not
relationships with others. Every human occupation is linked to primarily instrumental. In their foundation, what underlies practices
culture, meaning, and relationships. are political and ethical conceptions of those who and that which
Critiquing, for example… That human occupation is an object must be transformed. In this regard, in her closing keynote at the
of study. Human occupation is not a thing, an indeterminate. It is 2010 world congress of the World Federation of Occupational
not a mineral, a rock, a molecule, or a tissue. Human occupation is Therapists in Chile, Galheigo highlighted the need to reflect on the
people, relationships. In occupational therapy, the object of study political and ethical dimensions of occupational therapy6.
is not an object but a subject that thinks, acts, decides. Human Correspondingly, all occupational therapy practice is a political
occupation is not separate from the subject. The subject is ‘being’ practice52,53. It is political because it deals with a concrete world,
in human occupation. It is neither a mediating element to the en- with a particular society, with a world that we want to build. It
vironment, nor a method of intervention. To successfully separate relates to the kind of subjects that are produced by our actions in
human occupation from people would mean that we have reified, a neoliberal society and market, with a desired type of governance.
naturalised and dehumanised the subjects. Our practices would as It is political because we produce ourselves from social problems.
a result negatively affect the wellbeing of people. And because we question ourselves from a reality in which we are
8 The examples presented here suggest that a major challenge of and take part in.
to building substantive institutional knowledges is to overcome the • What value judgements guide our
duality between subject and human occupation. institutional practices?
We propose to understand ‘the occupational’ in the Hegelian
If this is so, it necessarily involves value judgments, forms of re-
sense, as ‘totality’37. That is, there are no subjects who occupy or
lationships that allow establishing what is fair and what is not fair,
subjects who acquire subjectivity in the psychological sense in the act
which relates to Kronenberg’s occupational therapy adage ‘doing
of occupying. Instead, there is a field of social relations that produces
well—doing right together’8. Such a practice is political as it has to
reality and subjects as two entities in the same space. This field as
do with the common good and the public. It requires consideration
‘totality’ is human occupation, not as a particular fact, but as ‘totality’.
of who the other or others are. This involves ethics, in terms of
acknowledging the existence of otherness. However, the ethical
EMERGING SOUTHERN PRACTICES and political dimensions of occupational therapy have been denied,
Whether interventional or theoretical, we regard both occupa- subtracted from the foundation of occupational therapy. Subtracted
tional therapy scholarship and practice fields as practices. Basically, by rigorous militancy, by the needs of professional associations
practices are collective occupations, they are the foundation of and unions, and the need for social legitimacy of being a positivist
occupational therapy. Ramugondo and Kronenberg propose the scientific discipline33. The scientific foundation that has dominated
following working definition of collective occupations: “Human us is a-historic, a-septic, and neutral.
occupations that are engaged in by individuals, groups, communities But there is no science that is not political. Accordingly, ethics
and/or societies in everyday contexts, which may reflect an inten- are an imperative. One possible ethic is Ubuntu and human rights
tion towards social cohesion or dysfunction, and/or advancement another. Not the human rights of the Western capitalist world, char-
or aversion of a common good”12:8. Practices must be concrete and acterised by the human rights of white, liberal and individual men,
situated which in this discussion paper is in the contexts of Latin but human rights that support multiple ways of existence including
America and Africa. ‘cognitive justice’40,43. At stake here is a value system of human
All practice is a social act. No practice is individual, not even rights that endorses many othernesses, on a basis of equity and on
when it is carried out by a single person. All human occupation acceptance of distinction and not on similarity or complementarity.
makes reference to a context, to a personal sense, to a process of Human rights as appreciating equality in difference. Such a system
cultural appropriation. All that can be called individual is the singular of human rights would recognise wellbeing as an effect of citizen-
materialisation of a collective occupational field. ship, a way of life. Valentini described it as a lifestyle characterised
Our central concern are communities and specific groups and by a multi-ethnic world to be reflected on clandestine lives, the
the fundamental purpose, as noted by Nobel Peace Prize laureate lives of those who are homeless, about the lives marked and led
Desmond Tutu, is to help bring about the welfare of people associ- by the abuse of alcohol and drugs, the lives cut short by profound
ated with the struggles against injustice47. Or as Kronenberg puts loneliness, about the lives of those fleeing countries where they
it, contributing to prospects of humanising collective occupations face terrible wars, as well as lives that invoke instances of justice,
(see vignettes), advancing society’s understanding and appreciation intelligent solidarity, hope in a possible future and a meaningful
of ‘doing well—doing right together’8,48,49. existence that can always be revised and shared54. Where human
Likewise, Simó asserts that practices must be consistent with rights are not something that can be accessed, arrived at, obtained
sustainable development, since human occupation is the means to in relation to shortages, but where rights are collective and lead

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South African Journal of Occupational Therapy — Volume 45, Number 1, April 2015
to community action for the protection of vulnerable groups and plication, that if the subject is a product of a particular occupational
individuals. Where occupational therapy practices within the human field (‘we are human occupation’), then all action in the professional
rights framework, it is not about rehabilitating capacities as a prag- realm must assume that there is no individual human occupation that
matic exercise of the right, but the rights as producers of capacities. is not social and that any intervention requires assuming collective
occupational perspectives for understanding human occupation as
• How may we disrupt overly individualistic a personal, individual fact. As the profession moves towards 2018,
practices? we anticipate increased engagement with Southern identities,
As we are human occupation, at the same time, we are the right, epistemologies and practices for the advancement of the global
which is the political ethical ideal that should guide the enactment of institution of occupational therapy.
occupational therapy. In practice, we ought to break the individual
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