History of OT
Many people believe that Occupational Therapy is a new profession. As you will see, this is not so. It’s development is woven into the fabric of human existence; as, “occupation” has been central to our survival since the beginning of time.
Many different ideas have been presented throughout history concerning; who should work, what type of work should be performed, what is considered to be “work”, who should play, and when the “playing” should begin and end. Health and occupation have evolved to become intertwined, after all, when health suffers, so too does the ability to perform an “occupation” and take part in daily activities.
In the 1700’s, during the “Age of Enlightenment”, Occupational Therapy began to emerge.It was during this period that revolutionary ideas were evolving regarding the “infirmed” and mentally ill. At that time in history, the mentally ill were treated like prisoners; locked up and considered to be a danger to society.
It wasn’t until 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, that a new understanding, philosophy and treatment would emerge.
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” (I know, what a bizarre concept huh? Boy, have we come a long way… thank goodness!). Tuke felt occupations, religion (which helped bring in the concept of family), and purposeful activities should be prescribed in order to maximize function and minimize 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. A whole new approach was just about to emerge!
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.
Luckily, a nurse by the name of Susan Tracy came along just in time (in the early 1900’s)! She successfully brought back the use of “occupation” with the mentally ill. She began to specialize in this field and even 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 1914, two people began a series of correspondences concerning the founding of an organization for individuals interested in “Occupation Work” (as Occupational Therapy was originally known until this time). George E. Barton, an architect, contacted Dr. William R. Dunton, Jr. because he was interested in learning about the response of the human body to the therapeutics of occupation.
On March 15, 1917, the National Society for the Promotion of Occupational Therapy (NSPOT) was founded. Charter members included; Eleanor Clarke Slagle (a partially trained social worker), George Edward Barton (a disabled architect), Adolph Meyer (a psychiatrist), Susan Johnson, Thomas Kidner, Isabel G. Newton (Barton’s secretary who later became his wife), and Susan Tracy.
This organization 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 organized medicine, thus creating a more “scientific approach” to this field of study. It is also this organization that would later be known as the American Occupational Therapy Association of today.
Following the Great Depression, however, it was difficult to find therapists due to low budgets an poor staffing of clinics. But, then came World War I, which necessitated the use of every available therapist possible! It was this time that Occupational Therapists were called on to develop programs and treat injured soldiers, of which there were too many!
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 the war, there was a surge in the demand for Occupational Therapists (or, OT’s as we now call ourselves). At this point, OT’s were not only treating the mentally ill who were already institutionalized, but began treating physical disabilities due to the injuries sustained in battle. Besides the mentally ill, the injured war veterans, OT’s also became called upon to treat an ever increasing number of survivors of “modern medicine’s miracles”. Now OT’s hit physical disabilities at high speed with the aforementioned, 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 finally published. Occupational Therapists finally achieved military status. This recognition provided other opportunities to gain financial support from the federal government for the education of OT personnel, and it provided leadership training skills for members of the American Occupational Therapy Association.
In 1956 The Certified Occupational Therapy Assistant (COTA) position was created to alleviate the demand for OT’s who were required to attend 4-6 years of schooling. The COTA required only minimal training and was utilized as an assisting body and aide.
The field of Occupational Therapy kept growing. During the 1960’s, as medicine became “specialized”, so did OT. Occupational Therapists were also called upon and qualified to treat in the fields of pediatrics and developmental disabilities. And, with de-institutionalization came an even greater need to help mentally ill, physically infirmed, and developmentally challenged individuals become independent and productive members of society. It was Occupational Therapists that could easily fill this role, and the surge for competently educated therapists was on.
In 1965, under the amendments to the Social Security Acts, Medicare now covered inpatient occupational therapy services.
In 1975, The Education of the Handicapped Act was passed and Occupational Therapy was included in the schools as a “Related Service”.
During the 1980’s and 1990’s, Occupational Therapy began to focus more on 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 certainly an ever-evolving and dynamically moving profession. You will find Occupational Therapists working in a variety of settings with several different age groups and disabilities. Anyone with a physical, emotional, or developmental deficit can be referred by his/her physician, school, or parent for any one of the following reasons: prematurity, birth defect, spina bifida, attention deficit disorder, developmental disabilities, cerebral palsy, sensory dysfunction, autism, hyperactivity, down syndrome, amputation, stroke, arthritis, burns, head injury, dementia, diabetes, or cardiac conditions.
Occupational Therapy is a product of, and dependent on, a social environment that values the individual and believes that each person has the capacity to act on his/her own behalf to achieve a better state of health through occupation. Many challenges still need to be met… the future is now!