Therapy and Empowerment – Coercion and Punishment: Historical and Contemporary Perspectives on Labour and Occupational Therapy. Oxford Brookes University, 26.06.2013-27.06.2013.
Reviewed by Thomas Müller
Published on H-Soz-u-Kult (December, 2013)
Therapy and Empowerment – Coercion and Punishment: Historical and Contemporary Perspectives on Labour and Occupational Therapy
This international research symposium, organised by Oxford Brookes University and supported by the Wellcome Trust, brought together scholars and practitioners from eight different countries, including Australia, Japan and Canada, to consider how the role of labour and occupational therapy has evolved in various national contexts, according to prevailing social, medical and political conditions.
The first panel, chaired by Yolanda Eraso (Oxford), featured papers concerning late nineteenth- and early twentieth-century work therapy in the British West Indies, India, Canada and Japan. LEONARD SMITH (Birmingham) outlined how the therapeutic aspects of work were sacrificed to achieve economic aims in asylums in Jamaica, Guiana and Trinidad between 1860 and 1900. WALTRAUD ERNST (Oxford) found a similar situation in late nineteenth-century Indian asylums, where goals of self-sufficiency and desires to “combat idleness” and “prevent malingering,” were at odds with the idea of work as therapy. KATHRYN MCKAY (British Columbia) showed how British Columbian mental hospitals between 1885 and 1920 were keen to demonstrate that patients contributed to their care and were not a drain on society.
OSAMU NAKAMURA (Osaka) reported how, in late nineteenth-century and early twentieth-century Iwakura, local families cared for mentally ill patients from the surrounding area. The unpaid patients helped the families with tasks such as wood-chopping, carrying water and farming, duties which contributed to a sense of self-worth and of being part of a community. AKIRA HASHIMOTO (Aichi) outlined how work and activity programmes evolved in modern Japan from forced labour regimes before World War II to “life therapy,” a system of habit training designed to control patients, through to American-style occupational therapy in the 1960s.
The second panel, chaired by Beryl Steeden (London), featured speakers from Germany and Austria. THOMAS MUELLER (Ravensburg/Ulm) focused on psychiatric institutions in the former kingdom of Wuerttemberg, where patients were engaged in a variety of activities, ranging from agricultural and office work to handicraft within and outside the asylum. The quality of therapy and patients' experience were variable, depending on changing regimes. SONJA HINSCH (Vienna) examined the goal of “improvement through forced labour”, which underpinned activities in Austria’s correctional houses between the wars. MONIKA ANKELE (Hamburg) explored the wider socio-political context for work at the Hamburg-Langenhorn Asylum, where patients had to produce their own food and other basic items. The Weimar government regarded work as both a right and a duty, and wished to see all patients re-integrated into full employment.
Jenny Butler (Oxford) chaired the third panel. Exploring the relationship between work and health, JENNIFER LAWS (Durham) highlighted the therapeutic effect of human relationships forged in the context of work, drawing upon Samuel Tuke’s 1813 description of the ‘hollow gardener’ at the Retreat at York and on a contemporary work project also based near York involving an unconventional, yet highly empathetic and effective practitioner. In both cases, the human relationships forged in the context of work appeared more therapeutic than the work itself, leading Laws to conclude that more attention should be paid to fostering human interaction in the development of work therapy programmes. SARAH CHANEY (London) reported that when the “malingering” diagnosis of women who self-harmed was replaced by one of “hysteria,” the notion of turning these women into “useful members of society” through work was undermined in late nineteenth-century British asylums. JUDITH PETTIGREW (Limerick) assessed the detrimental effects of “occupation deprivation” on patient health at the Central Criminal Lunatic Asylum in Dublin, where overcrowding, increased security and staff shortages in the late nineteenth century caused the withdrawal of work therapy.
Both JOHN HALL (Oxford) and SALLY DENSHIRE (Sydney) outlined the social profile of the “pioneer” generation of occupational therapists, which they found to be young, white, middle-class, female and culturally privileged in both Britain and Australia. In Australia this resulted in a lack of awareness regarding the cultural appropriateness of different activities, while in Britain their backgrounds tended to steer occupational therapists towards smaller private or charitable hospitals. The profile of occupational therapists today is still mainly white, urban, middleclass, female and young (under 35 years), a profile in part dictated by the cost of training. Denshire asked whether there was room in the current bureaucratic, professionalised occupational therapy regimes for innovative, inspired treatments from practitioners who might be considered mavericks; she believes there is a need to re-discover the “magic” of occupational therapy.
LEISLE EZEKIEL and CAROL MYTTON (Oxford) highlighted the discrepancy between the occupational therapists’ aim to be “person centred” and the rules and regulations limiting such treatment. Young, middle-class, female occupational therapists practising thirty years ago were uncomfortable standing up for what they considered best practice. Today, other constraints, such as the political environment and competition for resources, impinge upon the ability of therapists to deliver person-centred interventions. In Iran and Jordan, where FARZANEH YAZDANI (Oxford) trained and practised, occupation was not as seen as therapy or work, but as a means of keeping patients busy in order to relieve nurses. Yazdani’s experience in Iran and Jordan highlighted the need for occupational therapists to observe cultural differences (in particular with regard to religion and spirituality), at the same time as developing the profession according to current global practice.
The symposium ended with a tour of the Dorset House Archives, based at Oxford Brookes University, by CATHERINE LIDBETTER (Oxford). Dorset House was the first school of occupational therapy in the UK, established in 1930 by Dr Elizabeth Casson. The archive comprises 17 shelves of books and 29 boxes containing personal papers of Dr Casson and Dorset House Principals, as well as photographs, cine films and scrap books. On display for the symposium attendees to view was a selection of press cuttings, photographs of the school in its various locations, copies of the school prospectus, exam papers, letters from past students, scrap books recording the school’s early years including theatre productions staged by staff and students, and invitations to reunions and fundraising events. Further details about the Dorset House Archive can be found at www.brookes.ac.uk.library or by contacting the archivist, Eleanor Possart at email@example.com.
The opportunity to examine occupational therapy in so many different national contexts, both past and present, was a fascinating and enriching experience. It became clear, over the course of the two-day symposium, that work and occupational therapy have played a number of different roles and that not all of these roles have sat comfortably alongside each other. While on the one hand, work has been seen as therapy, as a diversion, as giving patients a sense of purpose and usefulness, on the other, its function has been punishment, a way of controlling patients and a means of achieving economic self-sufficiency in asylums. The work has not always been voluntary and in some cases food has been withheld or rationed if a patient was not keen or able to work. While it is chastening to observe how work therapy can be abused, it is also important to remember that “occupation deprivation” can be detrimental to a patient’s health, as was evident in the Japanese and Irish case histories.
In terms of lessons to be learned and applied to contemporary practice, the symposium highlighted the need for greater sensitivity when developing treatment plans, taking into account religious and spiritual factors as well as issues of class, gender, age and culture. It seems that human relationships in the context of work are perhaps given insufficient attention, as practitioners tend to focus on the more rational, practical aspects of developing work programmes. This in turn reflected the inherent danger of our over-bureaucratised modern method of delivering treatment which threatens to overlook individual needs in favour of a one-size-fits-all approach. The desire to recapture the “magic” of occupational therapy seemed to be common – from the superintendent of the Retreat at York in the early nineteenth century, to the contemporary therapist in Australia – and this seems to be dependent on the ability of the therapist to stand up for what s/he believes to be best practice. The social profile of the pioneer generation of practitioners and of contemporary therapists is important in this regard; the tendency for white, middle class, young women to bow to those in “authority” and toe the line has been slow to change. The hope was expressed that the relatively recent training emphasis on occupational therapy theory will help to empower practitioners and enable them to deliver patient-focused treatment.
Overall, the symposium stimulated a great deal of thought-provoking discussion of both past practice and contemporary issues. It was illuminating to learn how practitioners from different national contexts and different time periods came up against similar problems to those which are experienced today.
Leonard Smith (Birmingham): “A Powerful agent in their recovery:” Work as treatment in British West Indian Lunatic Asylums, 1860-1900.
Waltraud Ernst (Oxford): “Useful both to the patients as well as to the State.” Work therapy in British India c.1860-1940.
Kathryn McKay (British Columbia): “From blasting powder to tomato pickles:” Patient Labour at the Provincial Mental Hospitals in British Columbia, c. 1885-1920.
Osamu Nakamura (Osaka): The problem of inoccupation and isolation of mentally ill patients; its relation to the Japanese Government’s policy and to mechanisation.
Akira Hashimoto (Aichi): Freedom and Control: The changing context of work and activity in mental hospitals in modern Japan.
Thomas Mueller (Ravensburg/Ulm): “Patient Work” in rural asylums between therapeutic instrument and exploitation of labour force. The case of German asylums in Wuerttemberg.
Sonja Hinsch (Vienna): On “betterment,” imprisonment and support. The aims of placements in forced labour facilities in Austria from 1918-1938.
Monika Ankele (Hamburg): The patient’s view on occupational therapy and its practical aspects: The Hamburg-Langenhorn Asylum during the Weimar Period.
Jennifer Laws (Durham): Therapeutic mechanisms of the “work cure:” The hollow gardener and other case studies.
Sarah Chaney (London): Useful members of society or motiveless malingerers? Occupation and self-injury in late nineteenth-century British asylum psychiatry.
Judith Pettigrew (Limerick): The therapeutic use of occupation at the Central Criminal Lunatic Asylum, Dublin, 1850-1890.
John Hall (Oxford): From occupation to occupation therapy: Policy, practice and professionalisation in English mental hospitals from 1919 to 1959.
Sally Denshire (Sydney): Re-inscribing the gendered, white, classed beginnings of occupational therapy in the wake of the Dawkins reforms to higher education.
Leisle Ezekiel (Oxford): An exploration of changing occupational therapy roles in working with older people over the last 30 years.
Farzaneh Yazdani (Oxford): Balancing the boat. Global, international and local factors in establishing and developing a profession in Iran and Jordan.
Catherine Lidbetter (Oxford): The Dorset House Archive and the history of the first school of occupational therapy in the UK.
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