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History of Occupational Therapy

Occupational therapy’s development is woven into the fabric of human existence; as, “occupation” has been central to our survival since the beginning of time.

In the 1700’s, during the “Age of Enlightenment”, occupational therapy began to emerge. At that time in history, the mentally ill were treated like prisoners, locked up and considered to be a danger to society. But two gentlemen:  Phillipe Pinel (a French physician, philosopher, and scholar), and William Tuke (an English Quaker) started to challenge society’s beliefs about the mentally ill and a new understanding, philosophy and treatment emerged.

In 1793, Phillipe Pinel began what was then called “moral treatment and occupation”, as an approach to treating people with mental illness. He firmly believed that moral treatment meant treating one’s emotions. This moral treatment movement then began to define occupation as “man’s goal-directed use of time, energy, interests, and attention”. Treatment for the mentally ill thus became based on purposeful daily activities. Pinel began advocating for, and using, literature, music, physical exercise, and work as a way to “heal” emotional stress, thereby improving one’s ability to perform activities of daily living (“ADL’s as we now call them).

Around the same time, William Tuke was also trying to challenge society’s beliefs about how the mentally ill should be treated. He too was disgusted by the way patients were treated and the horrendous conditions they had to endure in the insane asylums. Tuke therefore developed many principles that would advocate “moral treatment” for the mentally ill. His basic premise which underlined these principles was to treat these people with “consideration and kindness” Tuke felt occupations, religion (which helped bring in the concept of family), and purposeful activities should be prescribed in order to maximize function and minimise the symptoms of the patient’s mental illness. Tuke then became a unique and positive influence when he founded a retreat center in England based on some of the same ideas. He encouraged patients to learn and grow by engaging them in a variety of employment or ‘amusements’ (what we now call leisure activities) that were best adapted to their level of functioning and interests.

1840-1860 were the ‘golden years’ for the application of moral treatment and occupation in American hospitals. It was during this time that the benefits of arts and crafts began to be noticed. Arts and crafts thus became a highly used activity to promote both relaxation and feelings of being productive, at the same time.

Unfortunately, during the 19th century, in the U.S., moral treatment almost became extinct in the chaos and aftermath of the Civil War. It became less of a priority and there seemed to be no one to carry on the ideas and insightful philosophies from Tuke and Pinel.

In the early 1900’s a nurse by the name of Susan Tracy successfully brought back the use of occupation with the mentally ill. She began to specialise in this field and initiated educating student nurses on the therapeutic use of activities as part of treatment. Tracy coined the term “occupational nurse” for those she successfully trained in this specialty.

In 1917, the National Society for the Promotion of Occupational Therapy (NSPOT) was founded and it flourished through the 1920’s and 1930’s until the Great Depression. It was during this time that occupational therapy became more closely related to and aligned with organised medicine, thus creating a ‘scientific approach’ to this field of study. It is also this organisation that would later be known as the American Occupational Therapy Association of today.

From the 1940’s through the 1960’s, the ‘rehabilitation movement’ was in full force. With the thousands of injured soldiers (physically and mentally) returning home from World War One, there was a surge in the demand for occupational therapists. Occupational therapists also began treating physical disabilities, plus survivors of spinal cord injuries, amputations, traumatic brain injuries, and cerebral palsy.

In 1947 The journal, Occupational Therapy and Rehabilitation and the first major textbook, Willard & Spackman’s Principles of Occupational Therapy, were published. The field of occupational therapy kept growing. During the 1960’s, as medicine became ‘specialised’, so did occupational therapy. Occupational therapists became qualified to treat in the fields of pediatrics (children) and developmental disabilities. And, with de-institutionalisation came an even greater need to help mentally ill, physically infirmed, and developmentally challenged individuals to become independent and productive members of society.

During the 1980’s and 1990’s, occupational therapy began to focus back towards a person’s quality of life, thus becoming more involved in education, prevention, screenings, and health maintenance. Goals of occupational therapy could now focus on prevention, quality, and maintaining independence.

Today, occupation is the main focus of the profession. It is an ever-evolving and dynamically moving profession.

Adapted and abridged from http://tinyurl.com/7y4fex9.  Thank you to [name name and permission granted notes]

 

Where do we come from?

Rowena Scaletti MHSc(occther) MOTNZ-WNA

 

French psychiatrist Phillippe Pinel (1745-1826). Pinel favoured a more humane approach to mental problems.

Occupational  therapy emerged from the work of Phillipe Pinel who practised in the 18th and 19th centuries in Paris and Toulouse. He was born on April 20, 1745 in his mother’s family chateau, the son of a country doctor of small means. His mother’s family had since the 17th century produced a number of physicians, apothecaries and surgeons. His early education was essentially a literary one, and he was greatly influenced by Rosseau and Voltaire. Pinel died on October 25, 1826 in Paris aged 81.

At first, in 1767, Pinel enrolled in the Faculty of Theology in Toulouse later changing to the Faculty of Medicine and graduated MD, with brilliancy, on 2 December 1773.  By the following year, he was frequenting medical schools and hospitals where he began to formulate and practice what he later recommended to his students. “Take written notes at the sickbed and record the entire course of severe illness.” (p.2 http://www.pinelschool.org/pp.htm)

A noted French academic, writer and medical doctor, he held several professorships, was a master of internal medicine and one of the founders of psychiatry. He commenced work as a physician working on the mechanics of bones, joints and the jaw, using systematic observation and recording case histories. He also began visiting confined private mental patients after a friend of his became insane, ran into the countryside and was eaten by wolves. From that time on he specialised in mental illness.

At the insistence of friends, Pinel accepted the position of Chief Physician at the Hospice de Bicêtre in 1792, where he was assisted by Jean-Baptiste Pussin a previous patient who had chosen to be part of the nursing staff. At the Bicêtre, variously described as part prison, part hospital, part home for the aged poor, part asylum for incurably insane men, he found appalling conditions. Patients were chained to the walls – many of whom had been restrained for 30-40 years –  treated like beasts and put on display to the public who paid admission to see them. It was here that the humane treatment of the insane began. At the Bicêtre, Pinel forbade the use of chains and shackles, removed patients from dungeons, provided them with sunny rooms and allowed them to exercise within the asylum grounds. These events are commemorated in paintings and popular prints.

Dr. Philippe Pinel at the Salpetriere, 1795. He is seen removing the chains from patients at the Paris Asylum for insame women. Image public domain: by Robert Fleury

Pinel is quoted as saying, “I cannot here avoid giving my decided sufferage in favour of the moral qualities of maniacs. I have nowhere met, excepting in romances, with fonder husbands, more affectionate parents, more impassioned … than in the lunatic asylum, during their intervals of calmness and reason.” (p. 1 http://www.pinelschool.org/pp.htm)

By now Pinel was 48 years old and France was in the midst of a revolution. This was the year King Louis XVI and Marie Antoinette were guillotined. Pinel, described as a frail timid man, found the courage to ask permission to speak for the rights of mentally ill patients. Pinel had a good argument as the revolution had declared all men to be free and equal. He won his case but was told he would be guillotined if his experiment failed. No idle threat as many intellectuals met this fate.

Pinel discarded the long-popular equation of mental illness with possession by demons, regarding mental illness as the result of excessive exposure to social and psychological stresses, and in some measure of heredity and psychological damage. Pinel did away with many of the traditional treatments of the day favouring a therapy which included close and friendly contact with the patient – that is, discussion of personal difficulties, and a programme of purposeful activities. His treatment was marked by gentleness, understanding and goodwill. He was opposed to violent methods, although he did use restraint and force feeding where necessary. He recommended close medical attendance during convalescence, and emphasised the need for hygiene and physical exercise, together with a programme of purposeful work for the patient. In his Traité of 1801 he gives an account of several patients with whom occupations were used to promote recovery. This approach encompassed what Pinel named his ‘moral treatment.’

Pinel fostered the notion that activity, or work, is beneficial to wellness. As we know, the principles of occupational therapy are certainly not new; manual, recreational and educational activities have been used for centuries in the management and care of patients. The Egyptians used music and games to assist the recovery of mental patients. Galen in A.D. 172 wrote, “Employment is nature’s best physician and is essential to human happiness” , and to quote Confucious, “I hear and I forget, I see and I remember, I do and I understand”.

Articles in the American Journal of Insanity first published in 1884, and later to become the American Journal of Psychiatry in 1921, contain many references to the use of occupations as remedial measures. The terms employment, labour, moral treatment, recreation, amusement, occupation, exercise, and diversion have been used by different writers at various times to describe occupational therapy.

The value of occupational therapy was particularly recognised during WW1 but it really came to the fore in New Zealand during WW2 when it was used in dynamic rehabilitation programmes established for returned servicemen and women. Some earned income for their families which acknowledged their value as breadwinners. It was at this time, in 1940, that the first  Occupational Therapy Training School was established at the Auckland Mental Hospital. Today occupational therapy sits at the junction of activity and wellness, participation and health.

As occupational therapy evolves over time, Pinels’ work continues to be validated. It is truly said that we stand on the shoulders of those who have gone before.

This paper was presented to a meeting of Takapuna U3A, Auckland on 6 October 2010. A transcript of the unabridged paper, including references, can be obtained from the author.