OCCUPATIONAL THERAPY AND IDEOLOGY: A CRITICAL INVESTIGATION Tania van der Merwe 2006 Dissertation submitted in full requirements for the Master’s Degree in Occupational Therapy, Faculty of Health Sciences, University of the Free State. Supervisor: Prof. Johann Visagie, Department Philosophy, UFS. Co-supervisor: Mrs. Rita van Heerden, Department Occupational Therapy, UFS. Dedicated to all philosophers in/of Occupational Therapy. Read not to contradict and confute; nor to believe and take for granted; nor to find talk and discourse; but to weigh and consider. (Francis Bacon, 1561-1626) CONTENTS Acknowledgements i Preface ii Synopsis vi Sinopsis viii INTRODUCTION AND OVERVIEW 1. A Question of Being Relevant: The Occupational Therapy Identity 1 2. The OT Identity and Critical Self-Reflection: Choosing and Articulating a Suitable Epistemology 5 3. The OT Profession Engaging in Systematic Self-Clarification: Investigating Ideology Theory as a Means of Critical Self-Reflection 7 4. Clarification of Terminology Often Used 10 5. Overview of This Study 12 CHAPTER 1 1. The Nature of this Study: A Journey Between Two Paradigms 14 1.1 Introduction 14 1.2 Type of Research 19 1.3 Theoretical Frameworks 21 1.3.1 The positivist theoretical framework 22 1.3.2 The interpretivist theoretical framework 23 1.3.3 The critical theoretical framework 24 1.4 The study design 25 1.5 Method of analysis 26 1.5.1 Trustworthiness 30 1.5.1.1 Credibility 31 1.5.1.2 Transferability 31 1.5.1.3 Dependability 32 1.5.1.4 Confirmability 33 1.6 Ethical Aspects 34 1.7 Conclusion 34 CHAPTER 2 2. Identity and Ideology (Part I): A Brief Contextual History of Occupational Therapy in the Western World 36 2.1 Introduction 36 2.2 Therapeutic Occupation Prior to the Age of Enlightenment 39 2.3 Moral Treatment 42 2.3.1 The first steps to Moral Treatment: The Age of Reason 42 2.3.2 The high times of Moral Treatment 46 2.3.3 The decline of Moral Treatment: Moral Treatment making way for the ‘Science of Industrialisation’ 51 2.4 The Birth of Occupational Therapy: A Formative Period 55 2.4.1 1910s – World War I 59 CHAPTER 3 3. Identity and Ideology (Part II): A Brief Contextual History of Occupational Therapy in the Western World 64 3.1 1920s – The Beginning 64 3.2 1930s – A Female Profession Requiring Supervision 66 3.3 1940s – World War II: A Profession’s Growing Spurt 68 3.4 1950s – Founding an International Voice 69 3.5 1960s – Making a Paradigm Shift to a Reductionist Approach 71 3.6 1970s – OT Proving Itself Scientifically 74 3.7 1980s – A Profession Self-Reflecting 78 3.8 1990s – Comprehending Human Rights 81 3.9 Summary of Identified Ideologies in the History-Profile of OT 84 3.10 A Very Brief Account of the History of OT in South Africa 86 3.11 Conclusion 91 CHAPTER 4 4. Ideology and Occupational Therapy: a Systematic Perspective 92 4.1 Introduction 92 4.2 A Model for Ideology Critique 93 4.3 Occupational Therapy and the Ideological Environment 99 4.3.1 The realm of Discursive Domination 99 4.3.1.1 The ITM steering powers 100 4.3.1.2 The supporting ideals for the steering powers 106 4.3.1.3 Integrating discourses 108 4.3.1.4 Protective power 111 4.3.1.5 Pastoral havens 112 4.3.1.6 The spheres of the Discursive Realm 115 4.3.2 The realm of Social Domination 121 4.4 Conclusion 123 CHAPTER 5 5. Occupational Therapy and Ideology: the Practical Issues 124 5.1 Introduction 124 5.2 Nature and Purpose of Chapter 5 127 5.3 Specific Ideology Concerns for (some) OT Practitioners 129 5.3.1 Clare – the Academic 129 5.3.2 Lerato – the Manager 135 5.3.3 Monica – the Medico-legal Expert 138 5.3.4 Jane – the Life-skills Specialist 141 5.4 Common Ideology Concerns for (some) OT Practitioners 146 5.4.1 Moral consciousness 146 5.4.2 The protective power of ‘Medicalism’ 151 5.4.3 Gender and Race/Culture 154 5.5 Conclusion 158 EPILOGUE 1. Concluding Remarks: Chapters 1-5 160 2. Possible Strategies for Treating the Ideology Infection of OT 166 APPENDIX A 170 (Informed Consent) 171 APPENDIX B 173 (Interview Transcriptions with Ideology Analysis) 174 LIST OF REFERENCES 228 LIST OF DIAGRAMS Diagram I The Circular Relations between Critical Reflection, Professional Craft Knowledge, Professional Epistemology and Professional Identity 6 Diagram 1.1 A Model of Ideology Theory: Two Spheres of Hypernormative Domination: ‘Discursive’ and ‘Social’ 28 Diagram 4.1 A Model of Ideology Theory 95 Diagram 4.2 Diagram of Discursive / Cultural Realm of Domination 100 Diagram 4.3 Diagram of Discursive / Cultural Realm of Domination: Steering Powers and Supporting Ideals (Rationalisations) 106 Diagram 4.4 Diagram of Discursive/Cultural Realm of Domination: Steering Powers, Supporting Ideals, Level of Protective Power 111 Diagram 4.5 Diagram of Discursive/Cultural Realm of Domination: Steering Powers, Supporting Ideals, Level of Protective Power and Level of Pastoral Havens 113 Diagram 4.6 Model of Ideology Theory: Spheres of Discursive Realm 115 Diagram 4.7 Model of Ideology Theory: Realm of Social Domination 121 LIST OF TABLES Table 1.1 Types of Study 21 Table 3.1 Summary of Identified Ideologies 84 The only philosophy which can be responsibly practiced in the face of despair is the attempt to contemplate all things as they would present themselves from the standpoint of redemption. Knowledge has no light but that shed on the world by redemption: all else is reconstruction, more technique. Perspectives must be fashioned that displace and estrange the world, reveal it to be with its rifts and crevices as indigent and distorted as it will appear one day in the messianic light. To gain such perspectives without velleity or violence, entirely from felt contact with its objects – this alone is the task of thought. It is the simplest of all things, because the situation calls imperatively for such knowledge, indeed because consummate negativity, once squarely faced, delineates the mirror image of its opposite. But it is also the utterly impossible thing, because it presupposes a standpoint removed, even though by a hair’s breadth, from the scope of existence, whereas we well know that any possible knowledge must not only first be wrested from what is, if it shall hold good, but is also marked, for this very reason, by the same disproportion and indigence which it seeks to escape. The more passionately thought denies its conditionality for the sake of the unconditional, the more unconsciously, and so calamitously, it is delivered up to the world. Even its own impossibility it must at last comprehend for the sake of the possible. But beside the demand thus placed on thought, the question of reality or unreality of redemption itself hardly matters. (Theodor Adorno cited in Handelman 1991: iv-v) i ACKNOWLEDGEMENTS I wish to express my deepest gratitude and appreciation toward the following individuals/institutions: My supervisor, Prof. Johann Visagie (Department of Philosophy, UFS) for his enduring guidance, support and commitment to this project and ultimately for masterfully schooling me in what it means to be a teacher. My co-supervisor, Mrs. Rita van Heerden (Department of Occupational Therapy, UFS) for her input and consistent encouragement from the commencement of this project in 2002. All family (including my sisters Eloïse and Lorette), friends and colleagues for their continuous support. All members of the Philosophy Department (UFS), including Joey, Martin and Matau for their assistance and encouragement in this study. Mr. Nico Benson on behalf of the Strategic Fund, UFS for the monetary aid that contributed in realising this project. Mr. Cloete Greeff (UFS), for his generosity in patience and technical assistance in the re-construction of the diagrams depicted in this study. Mrs. Carol Keep for the professional and timely proof-reading and editing of the study. All of the participants for their time and partaking in this project. My parents, Len Rauch and Miems Rauch who selflessly afforded me the luxury of tertiary education after school. JC van der Merwe, my husband and true companion for his invaluable, unrelenting and self-sacrificing support and contributions throughout this project that in the end also allowed for its completion. My son, Heyter who invariably leaves me in awe when I witness the meaning of creativity… The Power of the Divine in all of its magnificence and subtleness. ii Preface Occupational Therapy is the art and science of the use of daily activities in order to treat or prevent sickness and thus learning necessary skills, or to compensate for the loss thereof, as required for successful personal independence, work, play and recreation (Information brochure, School for Allied Health Professions, UFS, 2003). A very competent and experienced practitioner in occupational therapy asked me recently what made me choose to go into the field of occupational therapy. While it is certainly an important but difficult decision to make at the age of 18, I recall that I knew I wanted to go into the ‘helping business’. While studying to be a medical practitioner seemed the obvious and most prestigious choice, it was too expensive. (I will return to the aspect of prestige during the course of my theoretical analysis). Subsequently, psychology seemed to be the next best option. Nevertheless, in my mind’s eye, it appeared that I would have difficulty sitting passively, ‘only listening to people’s problems’. Thus, I heard from one of my classmates that her sister was studying occupational therapy. Until now, I cannot remember how she defined it, but I do remember her ‘definition’ included working with sick/ill people and being creative in the process.