THE ISSUE Is Psychosocial Occupational Therapy: Time to Cast Off the Gloom and Doom F or almost twO decades now the alarm has been sounded for the impending doom of psy- chosocial occupational therapy. The warnings have been heard bmh in the United States (Bonder, 1987; Scon, 1990) and in Canada (Brinrnell, 1989; MacKinnon, 1985). Decreasing starus and declining numbers in psychosocial occupation;)1 therapy <Ire of gre<lt con- cern to everyone in the profession. Var- ious reasons can be offered to explain this perilous state of affairs; for exam- ple, the rebinh of the medical model in [Jsychiatry, deinstirutionalization, the <It- traction of the more concrete science within physical medicine areas, and the I<lck of rewal'd ro therarists who work with chronic [Jopul<ltions. However, most of the literature on this to[Jic has <I nm-so-subrle subtext of blame and the folloWing piece of advice is generally of- fered: if psychosocial occup<ltional ther- a[JY is to survive, it had bener get its house in order. Before such advice is acted uron and psychosocial occu[Jational thera- pists go about making wholesale change to their [Jractice, some questions must be asked. The answers to these ques- tions may, in rum, alter our view of the problem and, more importanrly, our ideas about solutions We must examine more carefully how this srate of affairs came to be. We also wanr ro question \vhether the [Jarameters of the crisis, as described, are appropriately defined. If, as we believe, a new definition of [Jsy- chosoci<ll occu[J,Hional therary is evolv- ing, then a different view of the future may well be justified. And if this is the case, then perhars the gloom and doom can be dispelled. Background of the Current State of Affairs To underswnd the current state of af- fairs, we need to consider issues specif- Judith Friedland, Rebecca M. Renwick Judith Friedland. Ph/) OUO is Director and Associate Pro/essor, Division 0/ Oc- cupational Therapv. Department of Re- hahililat ion JIiledicine. UniverSitv 0/ To- ronto, 256 /1IfcCaul Street, Toronto, Onlario, Canada, JIil5T lW5 I?ehecca Aif. Renwick. PbIJ. OT(C). is Asso- ciate Pro{essor. Division o{ Occupa- tional Therapv, Department o{ Reha- bilitation iVledicine, and !Vlember, Centre/or Health Promotion, Universi- tv 0{Tor011l0, Toronto, Ontario, Canada. This article was accepred fOI' publication MalTh 17, 1992 ic to the profession and nm only those th;)t a[Jply to practice jn psychiatl)'. In panicular, we need to review the devel- opmenr of the profession of occupation- al therapy <lnd how it came to be di- chotomized into the areas of physical medicine and psychiatry. The work that occupational thera- piStS did with soldiers injured dUI'ing World War I or with rersons with tuber- culosis in the eady 1920s was neither physical medicine occupational therapy nor psychosocial occurational therapy. The occupational therarist was nm helping ro cure the physical disorder, nor did the client have a psychiatric ill- ness, but the treatmenr was clearly oc- cupational therapy. Persons were helred to adjust and adapt to theil' ill- nesses, ro keep as active and inde- pendent as rossible, and to maintain their morale (Bockhoven, 1972; Fried- land, 1988). However, with the groWing predominance of the reductionist per- spective in medicine in the decades that followed, occupational therapy also be- came more narrowly focused and we now find ourselves without the holism with which we began. Kielhofner (1983) has documented the crises and resul- tant ral'adigm shifts within the profes- sion. However, we have not as yet fully acknowledged- and certainly not la- mented - that in this evolutionary pro- cess, we lost Sight of the whole person and began to label him or her diagnosti- cally. Clients were segregated for treat- ment depending on whether they were physically ill or mentally ill, and thera- pists, once proud to be holistic, became specialized and segregated themselves accordingly. Naturally, the number of therapists working with clients wjth psy- chiatric diagnoses would not equal the number of the therarists who worked with clients having diagnoses of physical disorders. This is the case, of course, because there are many more categor- ies of phYSical disorder (e.g., onhopae- dics and neurology) and sub-categories (e.g., arthritis and fractures, cerebrovas- cular accident and cerebral palsy) and greater numbers of clients diagnosed with physical disordel-s. The separation into two distinct areas of practice based on diagnoses soon became a cause of concern to the profeSSion. In 1974, the American Occu- pational Therapy Association (AOTA) Task Force on Target Populations stated that if the profession of occupational therapy was to survive, "the schisms within the profession related to diag- nostic or disability entities need to be removed" (p. 159). Not only has this ad- vice gone unheeded, but the schism has widened. Although our educational in- stitutions might have been expected to lead the way in bringing practice areas within the profession back tOgether, in- stead they have tended to perpetuate the dichmomy through the organization of their curricula. "lbe American Journal or Occupational "lherapl' 467 Downloaded from http://ajot.aota.org on 06/08/2020 Terms of use: http://AOTA.org/terms