I don’t socialize with a lot of people outside the group and talk to anybody […] it [taking care of the plant] does get me out of the house early in a morning and it does get me in a weekly routine. And that helps me a great deal, cause you wake up in a morning and you think ‘Monday!, Ah I can go somewhere,’ you start feeling you belong somewhere, to me. And even later in the week, Thursday, I can go somewhere, even if I didn’t have somewhere to go that’s two days in the week I can have talks with people and possibly if I had a full weekly routine I wouldn’t get a situation like this where I can talk to people like this, so this would still be beneficial no matter what situation.
In their work, occupational therapists and occupational scientists can help people choose to engage in occupations that contribute not only to connection with other people, but also that facilitate connection to a cause that transcends personal “desires for pleasure or power” which would lead to “a meaning-saturated attitude” (Mascaro & Rosen, 2005, p. 987). By helping people create meaning in their lives through what they do as described above, occupational therapists and occupational scientists would be enabling them to develop personal and social strategies to resolve their perceptions of meaninglessness.
Furthermore, because occupational therapists and occupational scientists are educated to understand the form, function, and nature of occupations (Clark et al., 1991), it may seem that they are well placed to help people structure their occupational lives in such a way as to counter the experience of life as lacking meaning. Yet, there is little evidence that occupational therapists and scientists are proactively responding to this challenge to take their rightful place in serving humanity. That is perhaps why clients have repeatedly expressed disappointment with the services they receive from occupational therapists, while at the same time pointing out the potential of the profession to play a crucial role in helping people find meaning in their lives.
A good example of the above mentioned disappointment was by the world renowned astrophysicist Steven Hawking (1996), who wrote the following:
Now, however, people with disabilities and other previously disadvantaged groups, such as women and blacks, are demanding that they should be able to play a full part in society. As I see it, your job as occupational therapists is to make sure that they can. I cannot say that professional occupational therapists have been much help in my case, but may be I just did not encounter the right therapists. (p. 27, emphasis mine).
Hawking went on to suggest that:
With modern technology, it ought to be possible for many people with disabilities to lead a life in the community and to contribute to society. It is the task of occupational therapists to enable them to do this. The important jobs involve mental and organizational abilities rather than physical strength and dexterity. This is the direction in which people with disabilities should be encouraged rather than being put onto carpet making and basket weaving, which are inappropriate for those who are mentally alive. (p. 28, emphasis mine)
Occupational therapists need to respond to Hawking’s criticism by deemphasizing physical strengthening and focusing on helping people do things that make their lives meaningful. Although strengthening and re-education in motor functioning is indicated for some clients, these strategies should not be central to occupational therapy practice but only adjunctive to helping people engage in valued occupations. Criticisms similar to the one by Hawking have been leveled to occupational therapists by other famous clients, such as the eminent cultural and field anthropologist Robert Murphy (2001), who developed a spinal cord tumor in 1976 and described his experience in occupational therapy during his rehabilitation as a degrading, meaningless exercise.
If occupational therapists focus on helping their clients experience a meaningful existence by participating in society through engagement in valued occupations, they may answer Frankl’s challenge to help people deal with the problem of meaninglessness resulting from an existential vacuum. In recent years, with the emergence of the new professional paradigm focusing on occupation-based, client-centered, and collaborative practice, meaningful occupations are being rediscovered as the foundational media for authentic occupational therapy practice (American Occupational Therapy Association [AOTA], 2014; Kielhofner, 2009). Numerous theoretical conceptual practice models have been developed to guide therapeutic interventions with meaningful occupational performance and participation in life as the overarching goal of therapy. Examples of such theoretical frameworks include the Model of Human Occupation [MOHO] (Kilehofner, 2009), Canadian Model of Occupational Performance (Law, Polatajko, Baptiste et al., 2002), and the Occupational Adaptation frame of reference (Schultz & Schkade, 1992; Schkade & Schultz, 1992; Cole & Tufano, 2008).
The notion of occupational meaningfulness and in particular how occupations are used in meaning-making has been explored extensively in the occupational science literature (Aguilar, Boerema, & Harrison, 2009; Hocking, 1994; Ikiugu, 2005; Kumar, 2010; Rozario, 1994; Shank & Cutchin, 2010). However, the constructs of life meaning, meaninglessness, meaningful occupation, etc. have not been clearly defined in the occupational therapy and occupational science literature. Similarly, the question of how individuals can be assisted to structure their occupational lives in order to enhance meaning in their lives has not been adequately answered. In order to meet the challenge posed by Hawking, Murphy, and others, we have to negotiate with people to facilitate their full access to participation and the pursuit of the important goals to which they aspire in their lives. Meaningful occupational performance may be one way of doing this.
Meaningful occupational performance is, as Seibers (2008) writes, a functional challenge especially for people with disabilities. For such people, meaningful occupational performance means
living] with their disability, to come to know their body, to accept what it can do, and to keep doing what they can for as long as they can. (p. 69)
Initially Seibers’ statement seems to be offensive, a point which he acknowledges. However, he goes on to explain that for people with disabilities to be properly represented in social discourse, they have to be recognized as who they really are, even as we recognize that the needs of every disabled person cannot be addressed, because there are neither the remedies nor the resources. If we recognize a need to mediate Frankl’s problem of meaninglessness, we have to recognize that it is a problem which cuts across all demographics in a society which disables. The problem of meaninglessness in the sense suggested by Frankl is experienced by all people including those excluded from society due to disability. As Snyder and Mitchell (2006) point out, the basis of this exclusion is paradoxically located in the notion of individual equality. The idea inherent in the construct of equality is that we are all equal in this society. Unfortunately some are unable to participate fully because their disabilities prevent them from doing so. In that case, the answer is therapy and occupational therapy in particular.
Where does this leave occupational therapists? Perhaps a beginning point may be recognizing that while there is a range of technical skills, strategies, and interventions with which they can address the needs of people with disabilities, they (and all their multidisciplinary colleagues) may not have answers. Consequently, they have to navigate to a solution by working with their clients rather than patronizing them. This denotes that client-centeredness has to be critically explored as a way for occupational therapists as professionals to work in collaboration with their clients to optimize availability of resources to enable clients participate fully in society. If they are to employ a concept like meaningful occupation, occupational therapists have to be clear about what they mean by meaningfulness. An attempt will be made to explore this construct from multiple perspectives in the rest of this book.
Organization of the book
The book can be conceptualized as consisting of four parts:
1. Foundational knowledge about meaningfulness/meaninglessness;
2. The role of occupations in meaning-making;
3. Guidelines for action to facilitate meaning-making through occupational performance; and
4. Thoughts about the future of occupational therapy and occupational science in helping people