After reading this chapter, the reader will be able to do the following: • Identify major social influences that gave rise to the field of occupational therapy • Name individuals who were involved in the inception of occupational therapy • Recognize how societal influences shaped the field of occupational therapy • Describe the concepts that have persisted throughout the history of occupational therapy • Describe the influence of historical concepts on the current practice of occupational therapy • Identify and describe key pieces of federal legislation that have influenced the practice of occupational therapy Americans with Disabilities Act of 1990 American Occupational Therapy Association (AOTA) Civilian Vocational Rehabilitation Act Education of All Handicapped Children Handicapped Infant and Toddlers Act Individuals with Disabilities Education Act (IDEA) National Society for the Promotion of Occupational Therapy Technology Related Assistance for Individuals with Disabilities Act of 1988 Robert Bing, an occupational therapist, advises, “We exist in the present, yet are future oriented. To make sense of the present or future, we must have knowledge about and an appreciation of the past.”5 Moral Treatment was grounded in the philosophy that all people, even the most challenged, are entitled to consideration and human compassion. Whereas previously the “insane” were confined and frequently abused, the Moral Treatment Movement sought ways to make the existence of those confined more bearable. One of the ways was involvement in purposeful activity. Two men from different parts of the world are credited with conceiving the Moral Treatment Movement: Philippe Pinel and William Tuke.4 Philippe Pinel, a physician in France, introduced “work treatment” for the “insane” in the late 1700s. He used occupation to divert the patients’ minds away from their emotional disturbances and toward improving their skills. He used physical exercise, work, music, and literature in his treatment. In addition, he introduced farming as an important element of institutional life.4 The Society of Friends, also known as Quakers, had a great influence in England. An English Quaker and wealthy merchant, William Tuke, became aware of the terrible conditions in an asylum in York, England, and he suggested establishing the York Retreat.4 Tuke and Thomas Fowler, the appointed visiting physician, believed that Moral Treatment methods were preferable to using restraint and drugs. The environment at the York Retreat was like that of a family in which the patients were approached with kindness and consideration.4 After the publication of Pinel’s work in 1801 and Tuke’s work in 1813 on the use of Moral Treatment, many hospitals in both Europe and the United States implemented reforms.4 In the United States, a Quaker named Benjamin Rush was the first physician to institute Moral Treatment practices. In reaction to the expanding use of tools and machines, a contingency of proponents of the arts and crafts developed. Led by John Ruskin and William Morris, the Arts and Crafts Movement was started in England. Ruskin was an English author, poet, artist, and art critic. Morris was an English poet, designer, and socialist reformer. Proponents of the Arts and Crafts Movement in both England and America were opposed to the production of items by machine, believing that this alienated people from nature and their own creativity. They sought to restore the ties between beautiful work and the worker, by returning to high standards of design and craftsmanship not found in mass-produced items. They believed that using one’s hands to make items connected people to their work, physically and mentally, and thus was healthier.17 Arts and crafts societies were created to allow people to experience the pleasure of making practical and beautiful items for everyday use. These societies had a long-lasting effect on communities. These events brought together several individuals who all had a shared belief in the benefits of occupation as treatment and were influential in the founding of the profession in the United States. These individuals had backgrounds in a variety of disciplines that included psychiatry, medicine, architecture, nursing, arts and crafts, rehabilitation, teaching, and social work. Their backgrounds served to enrich the depth and breadth of the profession of occupational therapy.17 This fledgling form of treatment was called by various names during this period of development, including ergo-therapy, activity therapy, occupation treatment, moral treatment, and the work cure. The origination of the term occupation therapy is ascribed to William Rush Dunton. Later, George Barton recommended that the term be changed to occupational therapy. At the turn of the century, chronic illness and disability, such as tuberculosis, neurasthenia, and industrial accidents, were on the rise as people became victims of the urban and industrial life. Adapting the Arts and Crafts Movement for medical purposes was a treatment concept developed by Herbert Hall, a physician who graduated from Harvard Medical School. He worked with invalid patients, providing medical supervision of crafts for the purpose of improving their health and financial independence.17 In 1904, he established a facility at Marblehead, Massa-chusetts, where patients with neurasthenia worked on arts and crafts as part of treatment. Neurasthenia, a disorder that was commonly seen in women, caused severe weakness during the performance of work activities. The treatment usually prescribed at the time was total rest. Hall’s alternative to the “rest cure” was arts and crafts activities, beginning with participation on a limited basis from bed and gradually increasing the level of activity until the patient went to the workshop, in which she worked on weaving looms, ceramics, and other crafts.17 He called this approach the “work cure.” In 1906, he received a grant of $1000 to study the “treatment of neurasthenia by progressive and graded manual occupation.” Hall was also a prolific writer. George Edward Barton was a dynamic and resourceful architect who studied in London under William Morris, one of the leaders of Britain’s Arts and Crafts Movement. Later, he returned to Boston to incorporate the Boston Society of Arts and Crafts. After personally experiencing a number of disabling conditions—tuberculosis, foot amputation, and paralysis of the left side of his body—Barton was determined to improve the plight of convalescent individuals. In 1914, Barton opened Consolation House for convalescent patients in Clifton Springs, New York, where occupation was used as a method of treatment. William Rush Dunton, Jr., considered the father of occupational therapy, was a psychiatrist who spent his career treating psychiatric patients. In 1891, he was hired as the assistant staff physician at the Sheppard Asylum (later named the Sheppard and Enoch Pratt Hospital) in Towson, Maryland. Having studied the treatment programs of Pinel and Tuke, he was interested in implementing a similar program at the Sheppard Asylum. In the early 1910s, the hospital introduced a regimen of crafts for its patients. While hospital staff performed necessary medical procedures and provided a structured environment, the patients were expected to actively participate in their rehabilitation by working in the workshop.17 Dunton was known for his writings on the value of occupation for treatment. In 1915, he published Occupational Therapy: A Manual for Nurses. It describes simple activities that the nurse can use or adapt in the treatment of patients. Dunton served as Treasurer and President of the National Society for the Promotion of Occupational Therapy and edited the association’s journal for 21 years. Often referred to as the mother of occupational therapy,17 Eleanor Clarke Slagle began her career as a student in social work (Figure 2-1). She attended training courses in curative occupations in 1908 at the Chicago School of Civics and Philanthropy, which was affiliated with Hull House and Jane Addams. After this training, she worked at state hospitals in Michigan and New York. In 1912, she was asked by Adolf Meyer to direct a new occupational therapy department at the Henry Phipps Psychiatric Clinic of Johns Hopkins Hospital in Baltimore, Maryland. It was at this time that Slagle developed the area of work for which she is most noted, “habit training.” Habit training is described as a “re-education program designed to overcome disorganized habits, to modify other habits, and to construct new ones, with the goal of restoring and maintaining health.”5,6 Habit training involved all hospital personnel and took place 24 hours a day. Slagle summarized it as a “directed activity, and [it] differs from all other forms of treatment in that it is given in increasing doses as the patient improves.”11 In 1914, Slagle returned to Chicago, where she lectured at the Chicago School of Civics and Philanthropy and started a workshop for the chronically unemployed.17 Soon after, she organized the first professional school for OT practitioners, the Henry B. Favill School of Occupations. Susan Tracy was a nursing instructor involved in the Arts and Crafts Movement and in the training of nurses in the use of occupations. She was hired in 1905 to work at the Adams Nervine Asylum, a small mental institution in Jamaica Plain, Massachusetts. While at this institution, she supervised the nursing school, developed the occupations program, and conducted postgraduate courses for nurses.17 Tracy’s book, Studies in Invalid Occupations,21 is the first-known book written on occupational therapy. In it she describes the selection and practical use of arts and crafts activities for patients. Throughout her career, Tracy was involved in teaching many training courses. She believed only nurses were qualified to practice occupations, and she tried to make patient occupations a nursing specialty. Tracy was involved with her work and not able to attend the first meeting of the National Society for the Promotion of Occupational Therapy, but she actively served as Chair on the Committee of Teaching Methods. Susan Cox Johnson was a designer and arts and crafts teacher from Berkeley, California. She later became the Director of Occupations at the New York State Department of Public Charities. In this position, she sought to demonstrate that occupation could be morally uplifting, that it could improve the mental and physical state of patients and inmates in public hospitals and almshouses, and that these individuals could contribute to their self-support.13 Following her work in this capacity, she joined the faculty of Teachers College in the Department of Nursing and Health, where she taught occupational therapy. She was an advocate for high educational standards and for the training of competent practitioners versus training large numbers of practitioners. Thomas Kidner was a friend and fellow architect-teacher of George Barton. He was influential in establishing a presence for occupational therapy in vocational rehabilitation and tuberculosis treatment. In 1915, he was appointed Vocational Secretary of the Canadian Military Hospitals Commission. In this position, he was responsible for developing a system of vocational rehabilitation for disabled Canadian veterans from World War I. As a Canadian architect, he was recognized for constructing institutions for individuals with physical disabilities. In many of his architectural drawings for these facilities, he included workshops for occupational therapy. When the United States passed the Vocational Rehabilitation Act in 1920 (see the following section), Kidner encouraged OTs to capitalize on this opportunity. He became very interested in tuberculosis when he realized that many men disabled in World War I were diagnosed with the disease. He helped promote the movement to hospitalize individuals with the disease and designed hospitals in both Canada and the United States for the treatment of tuberculosis patients.17 At one point, he served as Secretary of the National Tuberculosis Association. The formal “birth” of the profession of occupational therapy can be traced to a specific event. On March 15, 1917, a small group of people from varied backgrounds convened the initial organizational meeting and produced the Certificate of Incorporation of the National Society for the Promotion of Occupational Therapy, in Clifton Springs, New York. Included in this group were George Barton, William Dunton, Eleanor Clark Slagle, Susan Cox Johnson, Thomas Kidner, and Isabel Newton, who attended in the capacity as Barton’s secretary (later his wife) and was, in fact, made Secretary of the new organization. Reportedly, George Barton rejected William Rush Dunton’s nomination of Hall for inclusion at the founding meeting.13 Miss Tracy could not attend but was made a charter member of the Association. The object of the Association as set forth in its Constitution was “to study and advance curative occupations for invalids and convalescents; to gather news of progress in occupational therapy and to use such knowledge to the common good; to encourage original research, to promote cooperation among occupational therapy societies, and with other agencies of rehabilitation.”1 In September 1917, 26 men and women held the first annual meeting of the organization. Early in these formative years, a set of principles was developed (Box 2-1). Dunton presented the principles in 1918 at the second annual meeting of the National Society for the Promotion of Occupational Therapy.
Looking Back
A History of Occupational Therapy
Eighteenth and Nineteenth Centuries
Moral Treatment
Early Twentieth Century and the Beginning of the Occupational Therapy Profession
Founders of the Profession
Herbert Hall
George Edward Barton
Dr. William Rush Dunton, Jr.
Eleanor Clarke Slagle
Susan Tracy
Susan Cox Johnson
Thomas Kidner
National Society for the Promotion of Occupational Therapy
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Looking Back
