Discourses Without Borders Rappaport: Commi artves ler ‘of tet ad jo, J Cannanisy Pog 2881-24, 2000 Rew L, Tor Secafer M, Thomas NY, at Comes of esteace a hemeles edooscent, J Ns Sele 3323340, 20 Saleebey D: The Sirens Paspcive Suet Worl Pract, od Btn, 200s, Pesos Bacon. Simé-AldS, Burgman Oceupaiont harapy intervention with eileen arto of wan Keener Simo-Algde, Para N, eters (eepatonl Thorpy Witt Bans: Learning from the Spe of Survie, Ldn, 2005, Beers, pp 25-260, Simé-Alado 8, Gregor JMR, Egan M: ‘Spintnky ina Refugee Camp Cand (Geeup Ther 64138-14519 Stare Ge Supporting resident of arava para Principe promise race, Reweaste, Assi, 2007, Feely Aion Cente ‘Tenbeien 5: My Path Lads 1 Tibet, "New Yer, 2002, Arsds, ‘Tenberken 5, Kronenberg: There to ‘be Bind who bang dbl Tn KronentergF, Siege S, Plied Ny eter: Occapaton| ‘Therapy Wit Borders: Laing ram the Sprit of Survives, London, 2005, Huei, 9 31-39, 102 “Theol Re Occupation an he rebulling of el rcky: tes fom the war 2mm, Jura of Oosprinal Sconce 938-47, 2002, “Tabesul Foner heaing through ‘cecupaton the ete of the Condon nut Jour of Oceana Sense st138-158, 20026. ‘Tomas : Chhood an ght: Tellesion on the UN Cannon on the Right ofthe Ch, Cldhonde ‘oa 2, 208. One. Arable a npd/arwechildhoodsedny. ay Journal. Accesed ebay 18, 2008, “Toast E: Inches community timersionof spite, Caml Oxesp ‘Thor 64146-135, 1997 ‘ovasend E: Reflections on power and sie i ening oruption, Can) cep Thr 70:74, 2003. Townend E, Plt HU: Enabling ‘renpation :adontng a ‘cexpatnal herapy itor fr heath, ‘rele bong, and use ough ‘ecipation, Ota, Ontario, 207, caor. “Toeg K, Every A: Eating Abc) Cpowerment progam the case of Enmiy Welbeig. ee 2) Fe Heal 2508-914, 2000 United Nations: Unita Nations ‘Canevtan ov he Rigs of he Cid United Navn Gael Asn (Beslan 4/25), New Yer, 198, United Nations. Une AM, Vernal J, Kee N: ‘Splut unphggr «review of ‘tmmonsfie and content ands ‘esltion, Can} Oop Ter ‘os-19, 2002 Waller MA, Paterson S: Neal beng ‘snd resitence oa Dine (sa) emmy, Fay and Solty 373-84, 2002 iite G: Taitag abe Spray Heals Care Pcie Resour for the Mali-pofstant Tear, Lao, 2006, Jain Kinsey. Yoath Ketion For: 2008, Oslin. “Aaah thew elo ath yan/hisiry nl. Acces December 2,208, Youth Nabe: 2008, Online. Arable isp//reyoutnote.cond NyCoelefaue a a-inde. ‘Acted Decenber 24, 2008. ans, Wadley D, Ward, ‘A place ply Soloeooi sad Fatal tos lens psc civ, Actraian Occpenal Thorp) Journal 582-11, 208. Zul K, Raman 8, Baeaer Dy ta “Towards beter het efogse clileen sed young poplin Austra Sn New Zsa The Roy ‘Assasin Collegeof Fiystans farspectv, Paty Child Heit 4822-826, 2007. The challenge for occupational therapy in Asia: becoming an inclusive, relevant, and progressive profession x | Kee Hean Lim R. Lyle Duque OVERVIEW ‘Gecupationat thorapy is a relatively young profession in Asia and attempting to capture the Status and future ofthis dynamic and ever-evolving profession inan equally dynamic and diverse region ‘bf te world isan enormous task. Asia is home fo ‘more than 60% of the world's human population {and covers a third of the earths land area. IReneempacoss a muttade of nallono,toreteioe, ‘cultures, ethrie groups, languages, an rligions. ‘Asia alvaye hed and continues to have e significant ‘and crucial role in world economics, polis, social Iniatvee, tronds, and cultur. "This chapter has a fourfld objective: to examine Historical factors that have shaped the growth and development of occupational therapy in Asi, ‘explore and examine the afferent social, political ‘and cultural factors that Impact occupational therapy education, practice, and research; identity ifferent factors that have the potential to shape the profession's future; and outline some stratogies that can help Asian occupational therapists ensure ‘thatthe profession will romain viable, relevant, progressive, and Inclusive in tho yoars to como. ‘To avoid inappropriate generalizations, we have focused on specife cases and examples of ‘innovative and contextually relevant practice, culturally appropriate resoarch, and creative linioal and educational inatives inthe region, Introduction ‘is evidenddd by. the increasing number of countries where occupational therapy is offered or * where occupational therapy educational progeams fave been developed (Lim 20075). To date, there are 19 national asseiations of occupational Uherapy, which ere members of the World Federation of Occupatonel Therapists (WFOT 2004s). This growth and development has been parlled, and in some instances spurred, by factor such as the increase in umber of persons with disabilities, chose aris rom chron of ifesryle diseases, and vets of armed confi, an spire population, and an increaein the incidence of natural esters (United Nations Economie end Socal Commission for Asa and the Paifie (UNESCAP) 2007), Given these Sce- rao, iis reasonable to assume that occuptlonal therapy fees a promising, abet challenging, Fuca inthis par ofthe word tis ta critical stage where its survivals dictated to great exten by ow fener sates the ever-changing socal, poltel, economic, and cultural lendseapes inthe region The impact of occupational therapy’s historical roots on its future ‘An examination of the history of occupational ther- apy in Asia highlights some historical tes chat bind the different counties, including the rale of armed conflicts (such as the world wars) in the genesis of the profession; the importation of cccupational ther apy from Western countries; and the strong link of ‘occupational therapy’ withtinedicine. These have and contioue to impact Mie development of the pfofession in the region.ze = Diecourses without Bordars The need for the rehabitation of those inured in wars and other armed conficts spurred the develop- rent of occupational therapy in many Asian counties. Inmmostcaes, twas introduced by practitioners from ‘Wester countries. For example, the Americans intro- daced occupational therapy tothe Pilippines (Bondoc 2005) and South Korea (Kang & Lee 2003); and the Danish introduced it to Iran (Rassafioni & Zeinali 2007). In Singopore, occupational therapy was Fst introduced in the 1930 by the British. However, it twas only aftr the Second World War when it became 2 formal service within the Singaporean hospital y= tem that its popularity inreased (Yang etal 2006) ‘The influence of wars and srmned conflces continu to impact the development of occupational therapy inthe region and raises issuec related tothe allocation of healthcare resources, the development of educo- tonal programs and the configuration of occupational therapy services, Theseissucs wllbediscussedin detail Inter inthe chapter ‘Withthe increasing popularity ofandneedferoccu- petional therapists in Asia came thenecesity Zor more prctitoners. However, given the absence of any edi ‘ational progzam in Asia until 1962, most local practi- fioners sere trained in Western countries such as the United States, United Kingdom, Australi, and [New Zealand (Bondoc 2005, Lim 2007b, Rassefinani & Zeina 2007}. These Western-rained practitioners Drought back with them philosophies, values, and practice models steeped in Western culture. This consequently bes contributed to the very "Western complexion’ of occupational therapy in Asia, pro- nounced in areas such as practice models utilized (lwama 2008, Yau 2007), educational curricula {Coronel & Cebatan 2007), and practice patterns snd trends (Liu etal 2006) ‘The development of occupational therapy in Asi, dst like inthe West (Yersa 1992), has hal strong his- torical links with medicine (Chan 2007, Yarg etal 2006). Tisstrongafilationwithmedicinecan beseen ~ os the result ofthe confluence of several factors: the predominantly medical-orentod content ofearly occu potion therapy curricula; the provision of oecups- tonal therapy in hospials in the early years (Bondoc 2005, Kang & Lee 2003); andthe ‘political necessity’ foe ocupational therapy to align itself with medicine uring its infancy (Yerxa 1992). The implications of occupational therapy’s historical ink with med cine ere both profound and pervasive. An examination oF'occupational tharapy provision in several Asian countries underscores theinfiuenceofthemedicalpar- saigm on occupational therapy practice and research 404 Diring its infancy in South Korea, occupational *herapy had 2 predominantly biomedical perspective ad practice was influenced by eientfiereduction- ism (Kang & Lee 2003). This media eientation, wile sel ifiuental, has become less dominant (Gceupationa therapy in South Kores has recently adopted a more social model of care and treatment, focusing on isus of quality fle, potient involve: ment integration, en socal inlsion. ‘Occupational therapists in ndiaare often schooled tn medical universities, spending a yeer acquiring Knowledge on anotomy, physiology, and psychology alongside medics) students. ‘Ths initial edie grounding and estemig of the medical hierarchy ‘maypredispasesome czupetiona therepiststoadept rolesand Fanetions tadsionlly associated with more ‘medial or pyseal forms of practice (Chaven 2007) ‘Whileknovledgeofmedicinecan serve practoners, itis important to secogize that ‘we need to under seand medical hinkig without adopting the medical paradigm’ (Yerea 1992, p. 82) Confusing the pls ‘phy and domsin of practice of medicine with that of occupational therapy may limit the opportunities for diniians to exercise. cheice end implement ‘ccupation-based intervention, ‘Strong historical tes with medicine have also, in some cases, resulted inthe encroachment of madi dlocterson the professional eutonany of accupatona therapists. In countries such as India (Srivastava 2008), China (Zhow 2005) and the Pailppines {Duque & de Leon 2006), occupational therapy pre ‘ice and education are sl lrgely egulated by medi al doctors, and practitioners are strugling 10 differentiate _themseles fom physiotherapists If, as Foto (1998) asserted, ‘the decisive dimension of professional stat isthe achievement and mainte ‘ance of autonomy’, then occupational theropist in many Asian countries ae fced withthe formideble hallenge of aserting their rights to regulate thelr ‘own education and practice (soe Chapter 14. Sociocultural influences on occupational therapy practice, Although itis inappropriate to make generalizations, {iE ssimportant to recognize that there are cerczin values, belief, traditions and ways of being that fare commaily shared by various sociothaic ‘groups in Asia. In Asian societies, hierarchical status, ‘restos sno hay ea callctive oles, and responsbiltes are highly fegaded, snd lders and those in auhorey ae Igy especedandesteemed (Helman 2007, Kondo 2004 Lim & ama 2006)-A related concep, sing face” having respect fo someone in authority or an der eqns taveding ny form fection o:com- spent that may adversely impace‘another’ credibly, ‘ots, ard public age (Lia 2007b, 2008), ‘Members within such hlerarchical societies are ot encourged to question, ervcize, or cllenge the status qu; netheristaceptabl to contemplate tkeratve points of view spare from those callec- tively accepted (VTeman 2007, Li 20082). Indes, ding tobe diffeert, questioning, speaking to the contrary, or challenging the norm is considered Highly diseopectfl and cn led to the individ and thee family being excladed, isolated, end even ‘ecaized (Fujimoto & Iwama 2005, Lim 20076) Sicha stuton can make dfcal fo oceupatonsl therapists in these countries and communities to caligue established prtters of practice or question ‘xcepted points of vies es voicing any alternative panpectives may be deemed highly dsrspectful EBuimota & Iwama 2008, Lim 20078). Cultural relevance of occupational therapy concepts ‘The importation of occupational therapy from the ‘West has meant that several occupational therapy theories, frameworks, and modela replete with ‘Western values and beliefs have been promoted in ‘Asi with litle examination of their applicebiiey ‘tthe local context (Iwara 2007, Yeu 2007). The popularity of and uncritical acceptance of many ‘Western occupational therapy models by Asian prac- titoners can be attributed to an underiyng mindset that "West is Best’ ~ probably a legacy of colonial history (Lim 20076). Duque (2005} has called this colonial practice ~ the uncritical application of the- ies and prectice models borrowed from foreign countries into the realities of people who have their own unique perspectives of trith, vale, and reality. Clonal practice has several unwanted consequences on therapist—lient inceractions in partieslar and the image of occupational therapy 2s a humanistic and .lientcentered profession in general (Duque 2008). 3 akowerey?in recent years, there has been an ‘creating awareness of the ned for theories (64. Due 2005; Rassfint & Zena, personal commu "cation, 15 May 2007), practice models (eg. Iams, 2003, 2005), eduestionsl programs (WFOT 2008), and research agenda that are more attuned to lecal needs. This has been paralleled by an increasing awareness of the need for culturally relevant and culturally safe practice (Iwama 2005, Lim 2008b, ‘Wetson 2006, Wittman f Velde 2002, Yang et a 2006). Several authors have pointed out that many of occupational therapy’s concepts and values are not congruent with other cultures such af those in Asia (Duque 2005, Iwama 2003, Kinebanian & Stomph 1992, 2009, Whiteford & Wilcock 2000). For example, in Singapore, clients generally do not View achieving independence as @ priority (Lim 2007a, Yang ta 2006); what is valved isthe concept ‘of interdependence ~ individuals atively supporting ‘one snother (Lim 2008s), Family members often adopt caringrole for teil orinividual with dsabil- ity, and ensure that their needs and wants are met. ‘Community members have clear roles and eocetal resporsibilties, and are expected vo full certain functions and duties in the interest ofthe wider com. ‘munity Fsjimoto & Iwarse 2005, Lim 20088). “The collective structure and context is reflected ‘in many Asian countries, where a shared, common destiny poets interdepenronre (sens. 2003). Individual ambitions are secondary and therefore far less important than echicving a shared collective outcome {Lim & Iwama 2006). The concent of independence, esteemed in the West, i viewed df ferently in Baternsocievies (Kondo 2004, Odawara 20085, 2007, Yau 2007). The desire to be indepen- dent may be associated with isolating oneself from ‘one's family and community; consequently, the indi- vidual is marginalized and left without support from family and friends (Fujimoto & Iwarna 2005, Lim 20088). ‘This increased appreciation of the di tinetiveness of Asian culture and the avalabily of Easternideologies has encouraged Asian occupational therapists to explore the benefits of Easter and traditional approaches in promoting and restoring health and wellbeing. This has led to the develop- ment of interventions that showease the melding of East and West In Hong Kong, for example, the benefits of si (Chi Chuan and Qi Gong, trediional methods of restoring health, balance, and wellbeing, are being ‘explored. Cheung et al (2007), in an experimental study, examined the benefits of Tai Chi Chuan in promoting-cardiovascular and pulmonary function ‘nd shoulder range: of motion of ‘people with Joye limb disability: Results from the study ind cated improvements in the intervention group.| Discourses Without Borders Although only improvements inthe range of shoulder motion were found to be statistically signican, the study highlighted the cultural and contextual appro Pisteness of the incerention and the over psycho. logical, physical, and participatory value of Tat Chi (Chuan for the participants, ‘At the ‘Self Help Group for Brain Damaged! « self-help and user-ed organiation supported by the Hong Kong Society for Rehabilitation (HKSR), occupational therapists teach poststroke patients basic Qi Gong techniques to facilitate breathing, posture control, channeling of life enezey, promo- tion of limb movement, and stain. Group mem- bers ate then encouraged ro teach the Qi Gong techniques and skills to other members. The bene= fits and value of Qi Gong in promoting rehablica- tion and recovery is ariculted by one of its members: ‘I have found these Qi Gong ressions to be very helpful for my stoke condition. Before T started, I could not move or use my left arm, but now {can do much more. I like Qf Gong as it helps me with my breathing, physical movement ‘nd Funderstand hove i ean help my overall health and well being. (Self Help Group for Broin Dam- eed, perwnnal eoramunietion 2008). Apart from its physical benefits, the practice of Qi Gong also contributes tothe establishment of a community. In their ethnographic study, Bratun & Azaba (2008) found that finding calm and a sense of self inthe present (being) as well as performing move ‘ments, actions, and thoughts (doing) involved in the practice of Qi Gong, contribute to community because it eestes venues for communiation bath within and with others’ (p. 82). ‘An innovative end creative program for children with autism in Chang Ma, Thailand is the ‘Elephant ‘Therapy project. Launched in April 2007, iia col- laboration between the National Elephant Insttate (NED, end the Occupational Therapy Department and Faculty of Asocisted Medical Seiences at the (Chang Mai University. Children who qualify under- take a three-week program of ‘elephant therapy’ ‘Through a graded program of expesite, the children are matched with the respective elephants and gee {involved in feeding and bathing the elephants and eventually riding the elephants, Initial ndings From the ‘elephant therapy’ research project indicates Some potenti benefits including increased calm nes, reducedtfess level improved concentration, physical strengthening, dexterity, self contel, and improvements in socal interaction. (One mother commented: ‘Before joining the pro- tam, my son had difficulty communicating with other people. He dida't trust anyone. He didn’t have any friends. He just drew pictues and played with dolls. But at the camp, he played with every- body’ (wwwasianclephentresearch.com, accessed {6 December 2008). Further research is being caried ut to examine the potential benefits of ‘elephant therapy’ with other client groups and also the eco- logic and emotional benefits to the elephants that are part ofthe project (bttp//wwrwthallandga.com/ forum/showthread php, accessed 6 December 2008) While the aforementioned interventions are relatively new and need more research to dacurnent their effectiveness, they reflect a growing awareness among Asian occupational therapists ofthe need for cultuzlly safe and culrally relevant practice, More importantly, they highlight hepossibleparadigm shift ‘occurring where East can be blended with the West. Education ‘Occupational therapy education and research n Asio reflect prowing awareness of the need for practice thst is attuned to the local and global contexts. Educational curricula and research agendas have become more ozcupation-based and geared towards international collaboration. All countries need to examine their educational programs to ensure that they comply with the acw minimum standards of ‘educational competency of the WFOT (Hocking & [Ness 2002), and more crucially ensure that the curriculum they provide is inclusive, relevant, and progressive in meeting the unique requirements of the local context However, producing practitioners who critically ‘examine the cultural safety and relevence of their practice requires the nurturing of ertial thinkers ‘who are encouraged to question and exchange ideas. ‘The opportunities to engage in educational and cultural exchange isa positive step toward encourag- ing debate, examining practice, sharing. perspec- tives, challenging trends, and promoting discourse (Lim 20078), ‘Cultural immersion A unique progr edablihed”t6” promote and ‘thao erosveulurllestaing vamongoseupe Aina therapy scdets from Carin Unveriy newness | musi), Brel Univesty (London ete ng Ponte Unread Pista Cae (Shiga) eh Sa jee, Ong coneted B ean Univesity, it provides students, trough Cain a marin, the opportunity eessepen their own cultural awareness, enhance their pe ot ee Tipo fom Curtin ary nd oct Sere a or eos eg a cs ee rin of oe cee, flies ses OO he seine vp ee Ce Senate Tem nate anda he Bodesenve, {Best tO aoc hea pee Feo neh ees Research “The quality of occupations therapy research bes Improved stantial in As ovr the past decade, wth stadesbocring more complex (Chen 2007 Wrasse Cla cal 2004, Wong & Lite Dar, calloborative (Hocking el 2008), and exe tony elevant (Cheung 2007) Occupations theray research in As i ceasing reflecting {he need for ssecments (Chan etal 2006, Tay fe a 2007) and nerventions (Chuang etal 2007) tobemore cael inv, lean ed sespon- Se othe needs ofthe lol eontet, highlgng the imprint fvings a eon of el therapists rine’ dled I a range of (Secch approaches nd etd tt wl promote ‘Sieualy cafe and intve aaipatinal therapy arch However, many Asan procisonr tll do ot cogage in evear For nstace, Dug (2007 highs fpheed the aficuly stvcstad with bul¥ing « orc tradition in developing courses such 6 {he Philippines, He ced several resone for che Tow poy for tesearey te constr ak of (ep inoroctre and sear: pottones bik of serch comets «genre perception Of the ‘lca sesenrcher divide; ain dain and Colonial prnctce, He proposed three pronged ta Sqyconcdressthe clam: devlopment of research ‘eres and competences among. practiones peovin of inistratere ard resources to Spor Parc and formation of networks and inter jrofestionalcallaborstan Politics, economics, and occupational therapy “The development of ecestional therapy in the ‘Motif ar counts cotiestobe veo BpSreg pall spends, demphie chnses mreSipoeyintaves anf conomicreource alc ‘io fn 2007). Tor cal, Jordan, geoph Sty oteed an re. of comtquas pelo Chie aed est he kag War, the Plena! {Bhat war andthe unable Uheese situation) ix Steonted ‘by config hess pines and SPirands Questor arena 0 wheter tek fs ressrces nd funcng Soul Be Foose on aie fuer om aren of conf o reserved 107Discourses Without Bordors for heheh needs of 5 om tens (AD Here evonal communion 2008) The plea soto! cura and coor debate in deciding esourees Stowren,tesenen porte, snd cote mange Inet’ coca a uimatlyiniencer ee CTeupatinn therapy viewed within the Jeéefon once Al Here (peso communication 2008) insted tat soos views on ty, the Smportence of eblation snd dsgreemen with resource allostion for hove with ftupe sans is Toran has spent nflence on Row sess avon! herpyterventon and fester ne preted The osm and source of fini fo hel ser vies inuence which ear of cocupoto therapy practice are pristine. In counts such as lpary Tatwn, Signpre, South, Koren an Missy, whore therein ina proportion af ley Fesons, mere iwetnent hs Howe into sees {int spor the ned of this spect poplton Sima essere ss conconted in schly reared seas such ay sche ond aie rebabi ‘tin, community schabtaton en edits wees, wht resoure fr ental eth serves sn pp inked a zr napa, here heath apd oil care ts pid for through the Nation Insarnce Sse, the rovaion of occupational therapy dof inked wath shew insure payments, Occupational he ts within Jpen are requred co subwanate tet Practice cine eagh reser none to sccre ‘tition funding. The phasis more on aun By-rcsed steames ater than ues of uly of life snd tnprovemert in an inciidal's Cope ce oftheir pen! recovery {libs Suey reponse: occupational therpy dan unpised dats 2008, Yeshitaws, pero communicates 2008). i In Chins, wher there itor no sate benefit srabie fr hei sees and cles oy heath services ent of thes own pocket cps is plc on rehabtation (Sua al 2007, Zhe 2005). let and she ais are keno Sete Sng medical or therpysevics tin late seh baton sed promate precy. Retring to vork esting employment se seiocatrel tad enorme protiee Perors wih dailies choos op for therapies they peresve vl ans hc psf nd ee Jeroen. Taefore! bie able to wl snd dey ay be snide ore of anon en 108 beng slew perform perl site of da ling, chs tog reed an eed (Oy 2007) Tiss bec bing ble to walk pendent i sens hvig# Sc al vo Bg Produce, ing enplopmen nd ene Providing fal ert amy. the noel Rereducine ch eset poy tat wie smybe viewed epee war he Wes ak Ss asening dar lta vice spo work reba, wel guided win ch Set Tn many part of Ain aces to ectption ‘hepy trices ined det trea ss Sicha he sary of pucifoncs and he pie tt ch seer On pn th Wasi to repens tothe chloe a ‘Thera-Free. ce ‘THERA-FREE: LIBRENG THERAPY PARA SA PILIPINO (THERA-FREE: FREE THERAPY FOR FILIPINOS) hip Ptenn ecramtectegere niepare cee deems, Seeger meer eediaesamaaes Sesion ies heey en espe ioe mannan toa SES ara ey Capen cere rere Sroniiteaee susrce ee Set ciptencast tare Serco ae eer, er eee i hese tects pelican cenit eet cine enereegeremenae So Seiicn meeomes Seemeereesrt Siar oanreaememe cerca Eogneeeneneaea mareves See eee Sra tora eaenen aclaemttc eet oer ae era iecieratnta Erin sees ee a By Bott Thera-Fre program objectives 1. Provider, ans, rd cay oct Sees Sect taapy and moc engine sneepbpy coven Fates who cnet ey Sar aueh sores 2 otae pubs arenes ear th Denes ropprtne tnsepy 4, moma eoskl averse ar sens of sc sonahy arg Fp frei ard ‘Sepren or tes wh ba ese Scenes E.G atures an inkage betwen ‘oraputs an or ath pena, at ‘Sil rato end oon commun foo 5, Poe avenue for reserch 5 ccarmuniis re susly oid troush he 2 4 pewars of he en I sare cases, ce! goverment ‘Fins G0) tal have head the progran enue Tear CAMPAS to had ToraFea the commu ror to hang There-Fre na community, he TOM an ae an Fe eas sees gah Foowisige ofthe cre Needs and sources We J cemmonty. Factors ee es coranon health condone in re cormunty eacoeconom, posal and educator $ packgrund othe community, anquagelseonken, ota) ‘osile and ome andes resouces eal fg. he 5 presenca of conmurty Real werk, gonads + Fats that con bo uted for ray nied. These 1 feel n elang cocons roprdng te choco “ounces and propraon of eduatenarening rates | Qugue & de eon 2005. othe mae of vontors are dur ole COANE, Be ute of ra Unnorey of Pitpnres era, 2 at ebtlaed wish, thay ere ‘consdeod lore ng Bayan (zhots of ho Nao South eee aune corescertharecves indeed tothe Papo paople who, vou th taxes, pave sty pa for tha colege edvostin. Ie Ws sense br indabteces that nderane Te Sense of olitesrem and sot! sparsity (Duque & ce Leen 2009, Tne was eloquent pone cut by ene ofthe veunoes Iwesaway frre togrobecktothecomemunty lam {erwrr graft to Porn nd is ava a peace © Deo sendoo to others and touch tar Ives. {ean Newe 05 ‘The sucess of any Thar Fea project nga one Cotaboraton of eet aeacaricins and LOU ers Ne, Gnicaneprovco nerapysandes 2d ren rember of th local coreruny, Atademicers ropa ~ Fame ogre, easeatoral 2 traning mates, and ‘The challenge for occupational therapy in Asia eon need, vans hese to ool languages oF (Bact. Tho LGUs end NGOs proud log suppor 1 {ho vlnler,welideg ceardnaing wih he eommunty Ieoders,powding Waraporaton, fod, and wars, ‘coonedaton for veer. So fr, 64 Theres Soooons revo Deen hei 1 provisos and {Bien Over 1600 therapy sessions and 1200 madcl fd alles haath consaons have been grove by ‘ore tan 250 therapists end ino lle sty ‘rfesinas. Al theso vale to mero than 1.5 mifon esos wath of ko sonics, ‘inl tha pogiam ras actioned ot ing ts hot entre, several chalangos rem ce for Io sy ee and esr othe needs ofthe County owse volunteers a to brah een nding ‘Stppar fm NGOs ad LGUs; sk of pote! actan tohate Thera 60 neoporind io abl ad ‘pana ath esas end alck of merpowe © ‘Srize data that ean used as 2 resource oc prog evsuaton and poy fomston (Duque & (0 Leon 2005. Challenges for the future: reflection, innovation, political action “The futuce of occupational therapy in Asia is contin- gent on is ability to respond to the ever-evolving octal, cltural, economic, and political challenges in the region. Aca time of seemingly incressing poit- teal conflce end worsening ccologieal and economic crises, fis imperative thet Asian occupational thers- pists become reflective, innovative, and political. More Smportantly, collaboration amoag Asian counties is ‘needed. While Asin practitioners have become more Cognizant ofthe need tobe more critical of trends they fdopt from outside cheir counties, there is sill a Continuing need to develop practice models that are attuned to the needs and realities of local contexts (Lim 20075, Yang et al 2006); develop frameworks for service delivery that are relevant and responsive thedlstinctive needs of the people served and develop Innovative interventions to respond to the evolving needs of the population (Lira 2007, 20080) "The tragic events of the Asian Tsunomi in December 2004 and the China earthquake in 2008 highlight the need for practitioners ¢© acquire the slils in the areas of dizester response, trauma assess- meng andceeendelefmanagomentGeeChape:20), ‘These tragedies served ab impetus for occupational therapist in Thailand (Sakarasitian 2007), Indonesia (Gantesa et al 2007) and China (Hong Kong 109 | || petted Diecourses Without Borders Occupstioel Therapy Assocation (HKOTA) 2008) to develop stssteper for stktng victims and their Fares deal wth he emotional, peychlogeal, occ ational and physel consequences of the dase Frocttiners have been involved in physi and rychosocil habitation, curculum development, Community ‘ining. and sebiking, occupational? functions asessment end vocational ain (HKOTA 2008, Sakorson 2007, Sonos a $007, Whitford 2007) “The increagein the occurence of maturl dssters fs been tributed to cimste change brought about by exvienmental degradstion, Healthcare profes sionals are begining to recognize thei olen this aren (Heath Care Without Harm ne), However, ‘ccspationa! therapists, despite their work on dis. ter esponz, have ben slower to involve shemales in ecological isos ee Chapter 26}. A pesble expen for then lame om he se ment of + young Filpine cccapationl therapist invclied with an environmental protection group “Findings connection between! or profeion and environmentalism snay be sbi challenging bt rot impale’ (Ochavo, personal commoneaton, 17 December 2008). Fion & Aoyama, (2008 ». S48) argue thet oecspatonal ther can eon: tribute t environmental conservation thee areas ‘understanding how people negotiate an ous hele daily activo in stations of ecological and socal stress interections that link the coneratin of bicaversiy withthe consertion of ccupations; anda renewed focus on blanc inthe every ac ites of people inthe industrialized world This ira practice area tht Asian practitioners need explore, ‘Kronenberg etal (2005) and Pollard etal (2008) asserted that ocrupationl therapists need to become tmore politely aware and engaged in influencing cision raking a al levels on scl tsi, They coined the term pADL (Polieal Activities of Daly Ling, eerngto pois spartan parcel of lly hhumn'cccupation and engagement. with other Rolle! acon Is needed in several fronts: profes sional autonomy advaceey for the people we Sere, change that ams to advance peace, scl justice and csquaity; change within the profession to make Tt ‘more socal responsive, progressive, and incusve of diverse populations, culture nd perspectives ‘This focus oa being mere polfcal has had mixed sucess with occupational trerapg The pals rengement,of Asan occupational theapits has focused more on ging, professional. sutonomy (Duque & de Leon 2006; Srivastava 2008) and 10 Increasing the public's swareness ofthe unique con- tribution the profession can make (Duque & de Leon 2006). However, Asian occupational. therepists politics! action to advance isnues such as human Fights and occupational justice in th region has ben less pronounced, This lokewaem reception of politi= cal action may be attributed to prevailing social forms and a misunderstanding of what polite means. Asian practitioners are faced with the formi- dlabl task of balancing the need to function within social structures that have striet norms with being critical of the existing. practice, social, political, and educational structures that influence thie prac tice, roles, functions, end responsibilities (Yang et el 2006). ‘They need to start to view che process of objectively critiquing prectice and established norms 81 positive step towards improving the quality of care and service delivery (Lim 20076}, Conclusion Occupational therapy in Asia har made significant progress inthe past decades. Its Future is contingent ‘upon how it can navigate the evee-rhanging sia, political, economic, and cultural landscapes In the fegion. Asian occupational therapists have myriads ‘of opportunities to contribute t9 the development of the profession werldwide thraugh innovations in practice, education, and research, However, this is dependent on their ability to capitalize on the gains they have made thus far; recognize and act on the need to attune practice, education, and research 1 local and global needs; muster the political will to assert thelr autonomy and advocate forthe people they serve: and work collaboratively towerds the achievement of s shared vision for an inclusive, progressive and relevant profession. Acknowledgment We would like to acknowledge the contebtion ofall ‘the occupational therapists who have responded to ‘ur inquiries and provided us with valuable resources {ohelp us write this chapter. In particular, we thank Mr Lim Hua Beng for sharing his valuable insights into the development and future of occupational therapy in Asia. Lastly, we hope that we hive ake the Asiin occupation therapy community and profession justice by prodding an inclusive and respectful chapter. ‘The challenge for occupational therapy in Asia eae References oto Me The Men fair ceating or ‘cg inten forte fre ay. int Oop Ther S209, TE met H, iva Mad cen cecil ae opuese Scent Kemnbrg F, Apts 3A Fats N dere Octo! ‘raps Wie Borers. 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Sshorsstian $: Th eperins of That ecuptnal herp nhl the Euro from na zeta, rg Kong. 2007, eh Asa Pre Oempeton Tharpy Congress Ssnose TE, Kenor, Ban The rer ‘ception! heap ator te Discourses Without Borders prepared and response, Hong Kong 2007, dts Ave Pace Oceipatinl Therapy Coes, Srv A Eitri lesa of Occupational Therapy 41, 208, ‘Toy G, Khu LT, Hobmon I ts “Ac so: avd Singapore Version) Pehaneai proper Hong Koog, 2007, th A Pcie Occupational Therapy Congress Ther-Fee News Vaanter speak ut Pf, 14, Jona Jane, 2003 Usted Navons Economic and Soi ‘Commision for he As ad the Pale: Satta! 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" Wold Fedkion of Ospina “Top: Edatona Ppa, 2008, Online Aste se hep tnewitor scoala ‘Accsed My 17 2008 ‘wight lar, Dinars W, “Stator 8 tal Oeing Food trditone of de Tt women et Sceghr, Joma of Octane Soon Tale aot Yo Shek MP, Tea , Ln HD ‘hid noes om cepa Siete race Sipe pe say Geip Ther at a o-1S Es ‘Yau Mathove User nd ‘alu Spec In Osteo ‘hep Pret: trom ong Reng oS lg Kong al of eatin Tera 0-64, 207 ‘ers Bt Sone inpteiens of cipal rar any fo te {itemelny, aay nl ren fo Asin dt Ona Ther 478-8, Toe ho DH: Opprtniy of delopig ‘ziti therapy Oh, Per preset emacr cnfrencn Osxaron They, sen, Chin, 205 oy DEL: reve sation nd tre deeopnent of ception ey. in Chae 000 Fong Kong Seep hry hing Hong Kengiounal f csp ‘Thay, 1 208 2-25, Influencing social challenges through occupational performance © Moses N. Tkiugo ovERVIEW ectpatona thorapicts knowledge uniquely ceubs the to contioute substantial 0 sclressing many soe challenges that may be Stubuted to oocupationa choaes ard pevformanee, inthe chapor a ramework (Modified Insramenaiam in Occupational erapy WOT) is presented asa conceptual mode hat herp! {cu cee to gue empowerment of nave Src groups so that they can ater ths occupational hole and pertermance pattems in an endeavor foladcress such challenges, A case sty resented fo iutrate now ihe framework may bo Tipled, Occupational therapists can uses, utes to sty tuncng of eommunty-Dased Sccupational therapy series, Introduction ‘The ubiquity of occupation and it link ¢© human wellbeing Reilly 1962) mandates occupational thera ists to contribute cheir nique knowledge to dkani- nating many occupation-related social. challenges beyond the medical settings. As Wilcock (2006) states: ‘Occupational therapists have a veluable con: ‘eton to make to the prevention of ins fr all people, not just those who ace sick and disable (275). Many occupational therapy leaders and scholars have started exploring that possibility. Townsend & Wilcock (2004) introduced the con- struct of occupational injustice es. human condition that occupational therapists cin helpidcess, sepa- “ate from the more recognized issue of socilinjusice.. ‘They argued that oecupational therapists havea duty +0 empower-those who are affected by occupational Se ay deprivation, aeration, disruption, and/or imbalance, tabling them to choose and partcpae In occups- tions thxt are meaning to ther, their familes, and communities, Their pioneering Conceptual work prompted inquiry by a numberof occepationa ther= 2 scholars suchas Duncan & Watson (2004) and Fourie tal (2004) among others Similarly, Werner (2003) argued thet occupe- tional theripy should embrace ‘the human strug to bd healthier communis ~ and imately to bold» ciation ~ which both celebrate diversity and provide equal opportnities fra (px). Thugs (200) explored waysin which occupational ther pists and occupational scientists could contribute o Suing oranzitions that wereeslthier for workers; Ilpingreslre pertinenglobalstuesofeutmesuch as poverty, economic ineques, disses, environ- mental damageand subsequent climate change, ver- Population et. In this chapter [ad tothe above Endeavrs + proposed conceptual fmework for guiding empowerment of lodividle and comm tiesto emble them to adres sci challenges through cecpatonal performance The framework vedo th intr ureatabsmin Occupational Ther- apy IO theoretical conceptual model of practice tea deve by hs OD edo th plilocphy of pregmatism and the chaocompley Synaral ystems theory (ee also gu 2007, ups Anderson 2007) In the resto the chaps Tw ineoduce the model. ts spplction as «conceptual framework for guiding therapists in empowering indians co aes ses of concen to uma through ogcuptional performance wil be discised In the dscusion, consistent with, Kronenberg & Polla’s 20050)” call for more lnchsveness inSai got" Uh Sonstruet of instrumentalism for clinical applic SY Gon. Constructs fom chaos/ dynamical systens thoy that appeared te be more appropriate then Dacwin's evolutionism for explajing the complex Discourses Without Bordors the profes wt wisn opt eee et ecage wile eered i ce clade Ee ee eg ukge ot et Evolution of the modified instrumentalism in occupational therapy Instrumentals in Occupational Therapy wascreste in responce to the conclusion reached by ¢ umber of scholars that the philosophical oundstion of occupa tonal therapy was Amperiin pragmtsm (Breines 1986, Cutchin 2004, rugu 200, Haug Schule 2006, Wilcock 1998) Pragmatsmicaschool opis. ophy developed by Charles Sanders Perce bated on the premise thatthe human mind exists lo one of ‘0 mater: bei oF doube (Ptce 1955), According to Peirce, belie is the prefered state of the mind because doube creates confit. Human beings seek to dispel doubt by extablshing belief Once belief is extablished, action is Inted to produce conse- quences to confirm its veracity IF the consequences seas expected itis confirmed I they ar ther than expected state of doubt ensues and further ection s senerated to investigate nd re-establish belie inorder to dispel doub, Therefore, a Perce's view al aman Jnquiy and actions are way of confirming (or fing) bel. Hl concluded that bel fa rule for action Gil scons emanate from belief). ‘William James (1981) and leter Jn Dewey (1981) elaborated on this idea by suggesting that rough beliefs as a basis for action, the mind can beconstrued asa means of guiding actions that shape fhe etvizonment. In that senge the mid is stool lke any other that human beings use to shope the cvionment to make i suppertive oftheir Survival {adaptation according to Darin (1985), whose the ‘ory of evolution was regarded highly by Peirce anc calleguer and which influenced the development of pragmatic philosophy (Buchlr 1955, McDermott, 1981). Dewey called the notion ofthe minds tol for adaptation instramonaion. Tag (20040-c) developed a theoretical conceptual model of prac- fice for occupational therapy” by cperationaliing na ‘phenomenon of occupational performance (Kielhof- ner 2004, Roycen 2003) were borrowed to develop ¢ ‘theoretical care for the model, Following are the basic propositions of the moxlel, Consistent with the theoretical propositions of the Sepatonin te or — Theat ayant DOt te uertes clot cmrpaers fo porer unvor's nso v ee non stmes, selpermaneopeies ‘eerste pe so etecioder it ne gos eos expats parenarce sear ababnesby paren aera th (rope gore conta arama nacre sels ee v congas oe 8 mB ‘stg De CB v Reaseaeri dost snagecd wn “econo cota nat 3. sy Oceana et 12: +e Mode snetanin onto Tey 040 tere DO, Neo Motes Asse anderen Hater fr harman n Ozapstena Tre OFC, (Cexupatona Pariormance Caleulsion Gude. (Occupational Inventory (DON; and che Occupation performance Calculation Guide (OPCG). The DO and OPCG are used together, with the DOL a5 « mensofdoumtng osu permed within 1 epecified period of time a ssa guide for computation of performance scores based on those ocupattons. TheMAIIOT > This assessment consists of four parts Part | Porters engage in a visualization exercise in which fy imagine what people in their life (fmly Imumber hinds, eles at wok/thool/ ther productive sctvies, community members) would {ay about them f they were no Tonge living mong them. Based on te imagined statements, e mission sateen Specifying the partner's desire legacy in the world is ereted. The statement consis of achievements thet would lead to imagined postive Statements by people in four areas ofthe partner'sDizoouree Without Genders le: family {including snvieste partners); social- ration (partner's friends and peers); werh/school/ other productive occupstional colleagues [inchud- ing colleagues in occupations such as volunteering, home management, ec as defined by the American Occupational Therapy Assocation (AOTA 2008), ‘According tothe AOTA, sco! qualifies as 9 produce tive occupation and thereforeis categorized as work); and community members (including acquaintances in vetwal neeworks (the internet). Part it Partners chaose upto two occupations in each of the four aress of the mission stztement, for 4 possible otal of eight occupations, which they believe that ifperormed consistently nel adequately would lead toachievement of the sated mission. In terms of the chaos/dynamical systems theory, establishing a mis= sion statement and choosing occupations that are likely to lead to achievement of the mission intro duce perturbation to the system and push it in the desired direction away froma sable, steady, bt ral adaptive state. Reorganization into a more adaptive system (Okes 2003), throuth performance with slestred frequency and adequacy of mesningFl occu pations, enables partners to develop pttenne that are conducive to achieving their missions in life, Part il Foreach ception toda Par, te pe tes ‘ial fo se feng wh cess ie perfumed Perce of pefrencesaticton wih perfomance at Bel tne aig to perform he cca th Gesed feuengy doen Each oes bal on founpon Uke perp ad operons Raed dependently. Por camp seperate fen alee fom 1 the scp wed octet Hesponsesn he ela ge om Tt dosoebelve tt Lam cpl cessing the wcipnion to" tla ern npn he Sczpatinalnqnely to ndependenty lage orp fo Part IV for each occupation whose satisfaction with perfor mance is rated at less than 4. The goals ae designed to facilitate setion that would lead t improved per formance of the occupations in question with the fe ‘quency and adequacy desired bythe partner, leading ‘achievement of the stated mission, The therapist and partner decide on a time of reassessment. The DOI This isan inventory in which the partner documents occupations engayed in for a specific period of time (4, 7, 14 days, etc) on an hourly basis from 6:00am through 1200 midnight. One may notice hat occupstions performed sfter midnight are not accounted for. The partner and therapist may decide to document occupations in the 12:00 am through {6.00 pm time cycle if that period would illuminate better the pertnee's wnigue occupational perfor ‘mance patterns. This instrument was developed to provide a window through which the partners occi- pationa life trajectory may be belly observed. ‘Therefore, it is not deemed necessary to account for all occupations performed at any one time. Just sample of the oscupations is considered adequate forthe purpose of analyzing « segment of the tsjec- tory to indicate ies adaptiveness o¢ maledaptiveness (Gee Ukiugu & Rosso 2005). The partner completes the DOIs and submits them to the therapist who compiles a list ef occupations and the frequency of engagement in each of them before the MAIIIOT assessment ( administered, The OPCG ‘After the MAIIOT administration, partners sre Presented with alist of eccupations compiled from the DOIs submitted to the therapist earlier and asked to rank them inorder of importance in helping thei achieve the missions arculated during part 1 ‘of the MAIIIOT assessment. Using the OPCG atidelins, the top ive ranked occupations are used 1ocalcalatea performance score forthe partner using the following formule (Ikiugu & Rosso 2005): Pe = SPI = DE x PN, where P, = total performance ‘Score, P= performance score associated with each of the five occupations, F = eequency of engegement in ‘The ratings are aggregated to produce a quantitative. tHe oceupation and Pl — performance index accord. score for each scale (For details, se the above cited source), Finally, the partners, in-callabortion with thetherapistestablish shorttermand long-term goals 116 ing > he occas rank ("= 5 for cceuaton nked umber 1,4 fr umber 2, 3 for number 2 for number sd 1 for mabe 3) “The resultant quantitative score (Pj) is sensitive to change in frequency of performance of valued occupa+ {io (velued beexuse they conrtbute the most toreal- tation of the desired Tegacy In life). The partner's progress towards established goals ean be determined byreadminitering the asessmentsatreasonableinter tals From the outcome of reassessment, the partner nd therapist collaboratively make a decision regarding ‘Shether fo terminate the partnership (if established {ots have been achieved), or to re-evaluate the par- Ser belies, mission statement, and/or gos. Internal and external validity of the MIOT assessments _ “The assessments desorbed above ate new and theie salidity aod relinbilty have aot been determined conclusively, Face valkity was established through ‘extensive literature review and Feedback from at lest three colleagues who are well versed with client-cen- tered occupational therapy practice Plot validity and reliably sudies indieate thatthe assessments show promise of being valid and reliable measures of eccupa- nal paGamaae acioss a rage of partner group (Ukiugu 8 Ciaravino 2006, Tug & Resto 2005, Iiugu ‘al 2008) Effores are being made to conduct more studies with robust samples to reach firm conclusions about the validity and reliabily of che asessments Because the MIOT framework focuses on occupations thatare perceived by the partner tobe aprionity, it does not zeck to impose any notion of eultual performance appropriateness end therefore should present no cul- tural validity problem. The partner males decisions shout the personal mision, occupations to help them achieve i, and acceptable level of performance. The ‘heraist merely facilitates the process. Application of the MIOT framework community empowrecment means. For individuals, itrefersto facilitation of'a sense of control over one’s lifeinpecconality,copnitionand motivation’ (Koelen 7" Hindstrom 2008, p. $11). Empowered individuals “Fae an inner sense of control over their lives, and of Silty to change the world round them, Community empowerment could be defined as promotion of Inftaeacing social challenges through occupational parformenoe a | Increased perticipation of community members ina discourse geared towards creating abetter community Iifeand improved socal justice (Wallerstein 1992}, oF ‘occupational justice (ee Whiteford & Townsend ele ‘where inthis book). Given the above definitions, the x propositions on which application of the MIOT framevrork is based are: 4, Pooplein disadvantaged situations (the disabled, the poor, minorities of al types, and all those who are Gicenfranchiced in any way) often get stuck in unfavorable circumstances not because they are completely powerless, but because they learn to accept thelr ciccumstances as inevitable, This ‘phenomenon is refered t as learned helplessness (Kayeeal2000, Meyer 2005, Yale University School of Medicine 2001). Powerlessness is experienced ‘when individuals ace placed in situations of ‘oppression forsolong that they come toaceept the ‘Stuation a inevitable, and to believe thet they can never change things by ther own efforts because snctural arsers ae to formidable to confront. Even when circumstances change and opportunites for selF-improvement present themselves, the individuals are unable to take advantage of those epportunition bocaure thay do not believe tat they cin make a difference, o becase they have not Teamed to take advantage of such opportunities. For example, a child who grows up in poverty may not scored in school even when presented with an ‘opportunity to acquire an education and may drop ‘out school altogether. Sometimes, his inability to take advantage of opportunities may be due to an Irerslized sense of inferiority, ora feeing that one ‘snatdeserving (consequence of elFalienationand, possblelos of identity a discussed by Fanon (2005) ‘and wa Thiong’ (1997), fllowed by posible selPhatred (see wa Thioeg’o 1981). 2. The experience of powerlessness often results fom abdicating one's power to other people, such 4 political leaders, administrators ete, and evating them while devaluing oneself. This abdication of power is accompanied by habitual ‘ways of thinking, feeling, and acting chat are ‘consistent with perception of oneself a lacking in valuein comperison to those inpositions of power, and at ineffective in the world and therefore ‘powerless (Meyer 2005). One way in which .oceupational therapists can empower peoples by ‘chthelping thm break their habitul way of thinking so that they can actin new ays and thus exercise their egency in the world "78, As pointed out by Meyer (2005), complete “baication of one's power Is not logical beeanse irrespective of circumstances, people have a certtin Red of influence, however limited, by wirtue of whom they interact with and affects by their actions on a day-to-day basis. Its therefore Jmpereant that people exercise their agency within cher field of influence as individuals and 18 cornmunities so as to effect change for the better. For example, an economically impoverished parent may commit to attending ‘Town Hall discussions inorder to ensure that concerns about educetonal accessbility for poor children are pact of political discourse, Sach actions may contribute to policy change forthe better In regard to poor families in the community. In my opinion te the responsibility cof occupational therapist in the community to ‘ssst individuals to recognle their oven fields of influence so that they can be proactive in ‘changing circumstances within their power for the good of their communities through what Kronenberg & Pollard (2005) teren the political ctvities of dally liteg (PADLS) 4. Empowering individuals in the community means in part assisting chem to break anray from typical solf-defeatng habits and edopting new, adaptive ways of thinking, feeling, and acting so that they can take buck their personal power and exert it Within their fled of influence, This means that change has to begin from with the individual, notion that is consistent with the pragmatic Principle of beliefs asa rule for action (Peice 1958). If one modifies beliefs to reflect the ‘thought that their actions could lead to desired ‘consequences, then they are mativated £0 ct in ‘order to achieve those consequences, The MIOT framework sims to guide the partner in addressing issues of priority at the individual level, by changing belifs about self, other people, ard the ‘world, This facilitates change in occupational performance for berter adaptation to the environment. Of cours, the therapist can only Work with partners wo ae ready to change snd to act for the common good. Otherwise, the ‘therapist's role i confined to sensitizing Individuals and communities to the need to consider change, Also, I would like to point out at grat a9 o go chrough this ‘ranifrinaive change themselves'so thet they adopt new habity of thinking, ecling, ond acting 18 Discoursoe Without Borders that are consistent with their own power before ‘hey can work with partners effectively 6. True empowerment comes from self- enlightenment by individuals eo that they realize thatthe most meaningful existence is that characterized by creative action, love for nother bersonor thing, anda fecuson the future and onthe ‘welfare of others beyond the self (Frankl 1997) In ‘other words, meaningful existence calls for self. transcendence, and meaningful existence is extremely empowering. The MIOT framework _uldes the collaborative creston of circumstances favorable tosuch meaningful existence by focusing ‘on the partners selftranscendence articulated ‘trough a mission statement. The mission promotes competency through cretive ‘eccupational performancemativatedby the loveof ‘one's family, fiends, colleagues, and community. 6. True community empowerment begins at the grassroots, with whae Kronenberg & Pollard (2005s, p. 71) termed 'people-cenered self empowerment’. Therefore, by supporting individual so that they feel empowered, the ‘ocupational therapist ultimately supports the communityinashichtharsindividvale belong, When people individually act onthe basis of missions that are elF-transcendens, collectively they can creste 2 better community for everybody. In other word, ‘community empowerment begine with rescuing of individual responsibility (Kronenberg & Pollard 2006), bysheddinglight onthe fac thatindviduals are responsible not only for thei own existence but lsoforthe worn whichtheylive.Ielsimportantto point out that theonusofchangeisnotpurelyon the individual. Many ofthe challenges that threaten human wellbeing are global in nature and require systemic solutions (for example legleton to allocste resources more equitably) Elsewhere in this bool, Whiteford and Tewnsend discuss in depth how such systemic problems can be acgressed in order to achieve occupotional justice. ‘This chapter bighlights the fact that structural barriers notwithstanding, ndvidusle are not pieces ina game of chess to be moved around at will by ‘whatever powers that may be. They havea field of influence through which they can cause change in the desired direction, however limited. Bearing in mind thg above propositions inBox 12.1 | ilhustrate the appication'of the MIOT framework, (Note: Thecaseof Muitaisbasedon the author'sclni experience but doesnot describe any specific partner.) Infuencing socal chatenges through eccupationat performance f ] Bex 124 ‘Application of the MIOT framework: the case of Multa tna 6028 your-dmantrom art Gtr Province ifs He gacatod om Nah ashen witha pete SdtreKanya Gariente cttciesion SCO xara Seageot yous He waathofarehisinan economical Sorting poor ry of ght AI Ne sings Red Fejeedectecooovnsrcasos asa wh ‘Taors oy hope fr ater ite, Sho had Pat he (ougtagoodedusten, tan unis ga). 2rd Tppotina end is res an ats. "he mnimam ade or acmissen evo ay fhe rourverties Konya os Cr, snd a grado 8 as ‘Gyured tr amas io pubic universe, Teo, Wa cd not met there oar. Aer _posiabon hobecane hoa andhabehevr orate He ous say oto hae not ota am hs Troar wan ha woud bo tng heme Hi reer ‘posed at he wos nein bang aman sa, commen tced-ateng dug Kory. Se equsted ‘cei tno who nan aga en ceeuptons! hero fotok fo tota ad ie ut et waa happeing Te cconnanpracieintatouy care beret wo ffataoer prove couesing fos young Whon he ‘berpitakdto Mita, he wasverytepaie Mof at Te sysem wos ret ae anata re i thats rraherto anna senvghtoraphimauccaes He ouch Tats gesanadto ge ealogs aaraion anda es Samy ear to cheno en sos onc he {edad ne woud bo woreng foe coment he erat ped out fo Mt at as cecarsandauittatnounsangy oecamate nought "soba ie comer a fle tm. He aod Fito er abou what hey Sau oo. cron tat "es des id tly fe ecrton into ‘Saige, ate rtacon, Ma acted hat ho was frobaby party lo lao fr he proieaart sce nohee fev enclod tar eth pass ous wel The Trapatecapesd ht he coon atte sanion rom Sraer perspec. instons of ng that ater Se tn cemnntyha ag et cexseaneapuaTc Shtcaton es 2 pdge wich he cold ute sore Str peo ater tan ut ro own cal conor ‘Shetrepit garehimssigementsconsstngot erie ‘ieousg te lof ection a soosy an hs ‘sponses o educated peopl. ‘ost ofthe Docket a ead eetanrtoKenyan ster for example, Ngugl wa Thong o's Ween ‘ottes ie) and becoomang fe Mind, os wet as Frars Fanos 200) Tho Voted ef tear. Tea fours wore ean not otf conten him about ow West covston igh have shape hs nly 2s $y Avan man fat eles on ia ‘onthly ae ene vn ha Doe veg to ecate Tne edaton eng ation out comment change terth god of howe who seein ie Back Ain ‘Sots osreb enter post ter nner th ap hopet at Saulbeg ety eves hat wold tet no Shame ne views coat nocd sot nae ay thojrorica'gpine etsnoogy. persons, Soong ya aubsoqut mesg was a Mt inom ttt tt ren aagnn estes at ‘Sesion was ou cone ar ban ano ae Shorcenctt he saa ie ones no gaan ‘Soaion bat sme terse eso ene Socen te ages tat ero gue node o She uth toa onthe avaaroae MOT ‘Sasson wes dase Fotowhg te oucoe Gino assert + it domeried occupation tien he ogee ‘oe oto a eur dye (aay wrth ey At Sound oftetor da, eth ate 3 sonpaions in ih hn ean 2 Sn op fo NOT. aa wate te ‘town evar consonance) errs a ney ta went iam tho wor my fy, ane enleapun on epee my ‘Srey so att wan er mn ho ar Crentae aes oren ‘Shorntes nr pope at ‘tyrone bare an ster cons adn ater enya forte grater ‘oe respon nin a egegesn Froioos for day tt nh we paar SSisingte mscon ae apoyo one rm diecvingher anal buna nabisrent He ‘ta ecupeton tn perce Fhe Cran he ceaon yon tae a Feenstra P= Sees sents towrnfecexooapaone aster proreance eit aetoschswonat Hotmail tho Fog, ade ond "acto a prearc ecto he Sevpaone endl dost ne abiyoforomeacet ‘a dstedtegny, ard eens. The prog sores on # WAI en ae Macro and Ku 24 he erate ‘une ata buts tm lew ox nar Sasscshorsom apa Long-term goals By the end of si yar, Ii 1 Hive grates fom a univers wit a bachelor’s Ceqrea in busiese stlstaion 2, Have aod : ‘Continved 10Discourses Without Borders | 80x 12.1 ‘Application of the MIOT frameworlc the case of Muita—cont'd 8, Be ithe process of constucing a ics house fr my 4. Be engages in polis and volume actos to ‘contute to Inprovernert ofthe ves of people in ‘oma. Short-term goals 1. Within sx moths, wale backin school andsticing har in peaparaton fora repeat ofthe KGE exam, 2. thin two weaks | ube werking onthe farm or helping om with business atleast sichour/dey, tee ayeesk 8. Within tee weeks, | wi have dcussed my fature Career wa a fess hee frends, 4. By the end of one month nl eve octet east three ergarizations that could sponsor meto ec at the wives anc lente sppcaton procedros to tae organzstons. 5. Uinhin eee nooks, wit bapertclpating nat stone ‘olunteer activity fer te hoursneek st my church, 6, Win tour woke, il have read Seale and tena peper about the process andeet oF Kenyan Plt on my communis aconome wolboig, ‘Aer four weeks of ipleesting the ren pn, al the ascacemots wore aamintered gal. At tat "ime, te fv top ranked cccupatoes rom Ns DO! were: Searching ora echool hat woud adm him 20 that ho eould ated elasses and repeat tho KE sa, alpng hs methar onthe farm sn nning ahee ‘ral comer aovtes paripatng in vourtser acts ins churn, educating nares about Poltical processes an thle! en his community's oonome wolberg, ard searching fr orgonzaons that woul sponaor hin for Unversity iio, He perlermance score at rasssucemant Pe) Wa ‘acute as folone: Conclusion ‘This chapter propoved that occupational therapists can contribute thei kxowledge of human occupation and occupational performance to help illuminate wider societal occupation-related challenges such os plbel warming. The accupational therapy profes: Son needs to engage in a process of strategically pos tioning ise ta fluence such global concerns. This means that ic opens itself to exploring how 120 ceupation (Wetea by rank) Searching fora 5 4 bigh soreo epg mam 4 7 8 onthe fam Vototeering in 3 2 6 Se cure ‘Safeduetion 2 ° 0 ‘out poll Seareting or 1 ae sources of france! Performance Frequoney —P, Index?) Sy xe) —55 'Muta’s aparceato WAIIOT eco at raeocoement wor: Ken = 4s Rey = 17, Yay = 12 td qe 2s pertormance score therfore changed by Sb pints (Pe-Py ~ 85-5 = 50) and hs aggregate MAINOT scores ‘hanged flows: Xap = 10-8 = 8, Xe Kee = 17-6 Spand es ho we ne Cloay, achangenad occuredin Muka cutock ine, ‘2nd ths change was rtstedn ations a dated by ‘Grangedoccupstonslperfomarce pate. sine n {asssaucnassewretingtoraccheo. saurchingloeourees of ‘nance suppor et nated that he was Docoing| empowered, He Was daveloning @aace tat he coud change crounstarasinhisiettroushisownefts ashe parernod daly occupatens. venta, thst ratumad to hoo repeated the KCE and ose a grade of was ‘admtectoaprhstauriverlyavngesciredaacholship ‘toms chech based orgarzatenthatcupported ecient ‘of young cpl om por fais understondingof human ocuption can be employed insecking ways to empower individual and commt- nities to create change through occupational choices tnd performance patterns, As the case stidy ils. tes, theroplsts could use the MIOP theoretical conceptual framework t0 guide this process of ‘empowering and sensitizing individuals and commu: nities to enablether to ieflvence indvidual and sfobal events pekitvely though judicioos gecupa- tional performance. Influencing social chalenges through occupational performance 2 Sas 8 706 References “Arricsn Ocevpatonl Therapy ssottien: Ocpatinl Thery racic Framework: Dowain aed S:164177, 20046 Proceso 2, Bates, MD, 2008, aga MN; Pyhezocal Coupe econ Practice Meals i Orcaptiona usiegthoighte J LitovehL, West: Therapy: Bulding Adept rel Pilg, New York, 1892, Capi, St Loui MO, 2007, Geld Univer Pres Eleven ries B: Origins anu dopa: hugu NN A proposed cmcepual Pop of Proctc, Letanen, NI, sede of erstoaton development 1036, Gerstahe, fr occupasial thers ad Bucher I: Plophicl Wang of | oceupatona scien, Ospina Bers, New York, 1955, Dover Therapy Joa of Reach Pubcon. 2863, 200k Cuchi MP: Using Deweynpilsophy sigs MN Oesprina Secs i the foveauve and fe Adgtaione Seve of Gala aw eay deverbing tortmirenment an Oecip Ther guile conduit of ocean See0s-s12, 2008 ‘ical tthettton of frvaling erwin ©The Ori of Specs, bel problrs,Sliece, 2008, ‘New York, 1985, Penguin Hooks, Publish Americ Dewey J From sbi > (bugs MN, Roso EM: Understanding ‘ierinetin. In MDemnot 1), He oso burma Big as ‘hor Me Philp of oor Dawes, SUPle drama adv sytem, Gihcigs 1981, Chicge Unveniy” — oapinal Therapy in Healt Care Pres pp 1-13 1948-65, 2008, ‘Duncan Watson Re Tenfaation tenugh occupa: A pote Ip Waten Swarts L, ctor Trarformatin Throgh Osun, Landaa, 2008, Whur pp 69-84 Fanon The Wretched of th arth, New "ork, 2005, Grove/tnte oui M, Galan B, Beton Hi: The ‘eepact of poverty Parental ot. Ie Wason', Swarts L, eters ‘Transformation Trough Oxspatio, Londen, 2004, Whur, pp 63-84 Fall VE Reem: Aucbiagaphy (ey J eset), Londo, 1997, Plena Pubs Fosse practi noratnal owl of PoychncielReebiltaton onion to adaliond eer ee sae ls : Ae Seen ce he, Biba gon et aap it irene So cena reese Sooo gh Tey ad ce ern tor le meinen ese Gai Try 35-76 se Ad ns 21 on Se ay Soo Pe aregeneas SS eee Nay a tn ee Ser mle ee ere, Eenlig cee cena hry an argument for 2 pegmatie concept modal of Brecon, Fertil So of Poyehoeca Realtaien 8109117, 2004, Bg DN ntrumenlin ia cecupaterl tery: Geet ove fo depp concept ‘pode! of pedrisTatemcional Jounal} PchersilRehabiltation ng0-102, z004b 1agu MN: Insramentail ecupadenal herp geen fer iofner G: Canepa fomdatioa of ccpaioial therapy, Pt, 2004, FA Devi elon Mf, intr 3: Making Trl chace ny choles: the rae fempanennent, Bir J Cl Nur SS (Goeg 1510-346, 2005. eoseae, Pollad N: Inodecon 0 “easing, tn Kronenberg ‘Agedo 88, Pld N, edit: Occupational Therapy Withee ‘orden Learning rm he St of Survizry, Eanburgh, 20082, lever Churchill Livingstone, “KcoeabeeF Polar N: Overcoming (ecupoal prai a relma elon ofthe poised ntureet ‘Sccupatona therapy In Occpanal “horapy When orders Learning rte Spit Survivors Eee, 20S, Eerie Charhl Linge pestis MeDermat 3: The Phesply of oe aney, Chega, 1981, ater of Chico Pret ‘Chances of prosvtve ston: 10 ‘hese, From Forge 17-23, 206, (es D: Comply theory simplifies es, Quality Progress 3635-7, 2003, Peirce CS: The ation of bli Bucher, editor Php Writings of Bice, New York, 1855, Dover Palentrs,pp 5-22 edly Me Ocsspatonl therapy can be oncof the rest eas of 20h century ‘medicine, A] Ocrip Ther 16-3, 1512, Reyeen C: The 2003 Hlemor Clarke ‘Sete leer = Chote scepstions ‘hezapy:Collecve wisdom for 3 ‘complex profesion, n Oczi Ther Steos-ebs, Son Townsend E, Wilcock A: Occpstionsl use sad ered peace: ‘A spucin-progress, Can) Orig ‘Ter Te75-87, 2004, Waleestein N: Poveresoess, “mposrement and healt Iiplelons for hss prometion progems, And Health Frome 109-208, 1992 so Thina'o Ne-Deolniing th Mind ‘The Pals ff Langue tn Arian irate, Porsmeuthy NH, 1997; Hehemarna £ ] pox 121 ‘Application of the MIOT framework: the case of Multa—cont’d 8. Be nthe process ofconevusting ance howe for my 4, Be enauged in pola and volar ectivios to ‘Sontrbute to moreverent ota es of poop nay community. shortserm goats + Wena tbe bn schoo and eihing tah porwr arwat ovis Ror oaes 2. Win wo west ate wry on fe aro ‘pomomsnouinets sesh es coe 4. inn ee west, Wn diet my fe Cave won seas vo ne, 4 Byte enon monty are aad ats rc erst it ol sponges ste trey at ora oputonpcesooes these genta 6. Wminevoass wie peptone Votre sty ro aac ny 6. Within rook tvs en ors na write paperanian teen felts tr my cormunty tore wang tert wot moeratig ts eerie, ait cso et ces ep ar fe tn rep rand copter oh 8 wor: seh nse! tat eu art Sato cou ara car oot KOE om, Parise eth ra ning ore “tat corer ston pesptng rer Snes noha ecg eat oan otic pense ho ene crus Sse wera ant seca fronton, ‘a ern ery oda rare sora eset ns ‘calculated as follows: hed Occupation Pertormance (Uistea by rr ust Index (2). Searchingtora 5 4 ‘igh sone Hepes mom 4 Te on tie farm sr busnese Yoluntoerng in s 2 6 the onen Set edvoation 2 oo bout polite! proceceee Searcting tor 1 1 1 ‘rane support Pe= Dea SP x f= 55 ‘Muta’sagaregate MAINOT acores at reassessment Wer: Non = 14 Nee = 17, Xen = 12, a Spe 2 He Darran score theretore changed by 80 punts (ParPy = 56-5 = 50) and his aggregate MAITOT scores Pied 2 flows: Kay HBB Kary = TD ‘Ges, a changehad occured in a’scutockin le, _ndithis change wes rected in scons asivdeated by changed occupational patermanoe pate, Hsintatvoin tastesocnasseacnng ereechool searching forsozcesot franc suppor. ee. roatns tat na was Becoming ‘epewered, He wes developing acer that ha cove change crounstarces nhs ie noughhisonnetorsashe peor daly eccupatins. Eventual, Muta retuned to Stool repeated the KOE anc eared 2 grade of Bs was, sdmitedtoapivatountesy,navngescuredssholaratip ‘toma chureh-basederarizatonthatsupporedecucaton ‘of young peopl fom peor mbes gag gr ggg Eg a a gee EEE Conclusion This chapter proposed thet occupational therapists ‘cen contribute their knowledge of man eccupation and occupational performance t0 help illuminste Wider societal occupetion-rlated challenges such as global warming, The occupational therapy profes- sion needs to engage ina process of strategically pos tloning itself to influence such global cojgeras. This means that it opens itself” to 120 understanding of human occupation can be employed fn socking ways to empower individuals and comnu- nities to create change through occupational choices and performance patterns. As the cage study illus trates, therapists could use the MIOT theoretical conceptual framework to guide this process of empowering and sensitning individuals and comme nies so enable them to influence individoal and tlobal cvents positively through judicious occups! tional performance. " Influencing gosta challenges through occupations! performance References a ei oe Fy Foie few ommeliley aera 612, Bathsts, MD, 2008, Lagu MN: ryhtscal Conca — Preto Model ix Ocuptonl Kelner Gi Conceptual omni of ‘patio therapy, Pads, 2008, FA Devi Koslen MA, Lindon B Maing Tey hoes easy choles: the rle pacts, eruatia our! of se soso}, Laboveh West: Trap: Bung Aaptoe fempweemere Br CN 9 ely New Yok 1224, Capit Se Le, AMO, 2007, (Soph 110-816, 205 Kronenberg E lard Ne Iereton: 2 ‘soning. 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He i cele anementfor TSEC lblty of x battery of Townsend E, Wicork A; Oocpetionl cxcupatal chante ir pow eciptonlprorance Tinie snd concentra pce prgraticoncetisl moet ESS trata ural faeces Can? cap Onfrd Unity Pros Basie Oris and Adpetions: “nyo bc ek foes Ger Ro. ae ileal Wag of Pc New Yr 198, Dove Rican, urkinih Ui Dovey pty Setume al Adne Sinton An! Osa Ter Soa be Darn Te Ort of pci, Siw Yorks 1008 Peg ese Dew Fe stant me este Mceeel a Bee ee veitieine ELIE. “see ee, cuir a Ea ae core forthe pragmatic concept kas) Taxman A, cberman JA 5187-205, 1982, ‘node of pectin, iematonal our of Pecan! Reb 180-162, 2008 Iiavgy MN: nse eceatonalherspy gases for ie MirBeliatry Beaviral Scene ad Cina Berta’ Companion to Tara, Key, Lsbrman Poyeha Phd, 2000, WB Sounders \w8Thlog'oN: Desonteng ke Moi The Plt of Language a Arian Latur, Porat, NE, 1997, Heberana,a Thien’ N. Wir in Bali, Loudos, 198, Heiermmn uct Boks ‘Werner D: Foreword In Keonesberg , ‘Algo SS, Poll Near Oxeupatonl Therapy Withut Bord Learning fo the Sr of Suites; Eanbsrg, 2005, vier? CharhlLsinpeoe, pp 3x ye2 Se Discourses Without Bordare Wilcock AA: An Osepatoal Pape of Heath, Therfue, 1905 Slack Wiel AA An Ocenpational Porpciveof Heated, Torte, Ni, 2008 Sack Yale University Schel of Mec ole Heal Racer Pregrn: Clie Workbook, New Elven, Connects, 2061, Onin, Arable si bip/Pinka med saleed pyc heps200132. Acces’ May 7, zai. ts (Re)habilitation and (re)positior Mershen Pillay OVERVIEW ‘The Relationship of Labouring Affinities (ROLA) fs presented as a theoretical ramework to expain the process of transforming rehabilitation practice. Gontextual demands force a shift from traditional ‘deficit based, modical model practices towards socually responsive, collaborative practioes ~ ‘framed broadly as domooratio practice. The Siaments of ROLA vie, communication, thinking, ‘and labor, af offered ss theoretical concepts 10 ‘explain the ways in which practices may be Tepositioned in tho Interests of social justice, and may be applied to a wide array of rehabilitation practices. Introduction ‘The focut of this chapter Is on the transformation of the nature of the clinical relationship between fehabiitation professionals (powerful experts) and people with disabilities (‘siek’ persons). By trans Formation of this relationship I mean a radical movement of ideologies, 9 continuous re-placing of thoughts and actions acress all forms of practice: higher education, research, and service. ‘This kind of professional transformation is a neces sary part of our development. Why? Rehsbiltetion practitioners ect as powerful arbi- ‘ators on behalf of (or wth) people iving with dise abilities. Intrinsic to this arbitration Function is the maintenance of an updemocratic. relationship between rebsbilitation “professional and’ potient. Rehabilitation practitioners have ~ predominantly — bbeen positioned as experts who decide diagnoses, ig the powerful expert and the sick person prognesticate oxtcomes, design and deliver incerven- tlons, report progress, and classify disabilities Rehsbilttion practitioners are undoubtedly regarded st powerfully intertwined with the lives of people living with dssbilites, x worthy experts who (Fe)produce knowledge of disebility, decide who deserves state-funded care/equipment, or ‘who are dominantly cited/referenced as authorita- tive sources on issues of disebility. There are progres- sive practitioners in countries such as Australia, South Africa, che United Kingdom, and the United States who postion theit work within disability sctivim. Such practitioners’ regard their socal and political biographies as dssembled away from being fexpens towsrd being, eg, caring collaborators invited as participants to work alongside disability survivors, Even then how the practitioner and person ‘with disability share power ought to be analyzed. We Thust ‘see’ ourselves not only a5 innocent profes- sionals but 2s powerful practitioners, people who sre politically endowed. In this chapter, I reveal how rehabilitation practice cannot be seen a5 an apo- litical, objective act. Insvend, I rouble this notion by presenting an analysis of deeply political profesion alization, including professions’ engagement with: + A specialist focus + A biologie metaphor + Deficit theories. Tn addition, three interelated processes are presented: + Disothering, “ + Bventilism| + Reductionism,Discourses Without Borders These processes directly contribute an undemo- and sick people ste considered Slee tee a Seer care tam eke Fane nh ts Perec cecal ners inate rs tire demo practice. Furthermore, a com: i Sane eplual framework developed out of 2 practice- ¢ ~ fle scy ly SHES) Spee ay ME Conk 185 p. 13-153 Lea meer peaene hied ay aeoeet een Steep ge eel eae ee ite fr copotnnthe power cree nce aca We athe tafe Same foward « more democratic relationship. eae ee Bui van of this chapter has been informed by 1 Bicloric metaphor fiers 7 for talogue searing professional * Deficit theories rmation in audiology and speech log + Dis-oth Clthrd ny 1355, 9904 208 Sate en St ya in yal gece Rebus }, fundamental intuitions and commur ieee 125), felon ein ad omni In corn itl ch other rehabilitation professi cs aRY iad forma, tis possible or one hesitant erates enc Seta ieee te fevirsr yuri ash aieaey ero ea cst se mre pel nie amy mess eed oat aha Sone yonkers apee ee ecemciabtince atic ce tr rl ce fx i gta ee “eietletcuicoKieuirrnd Pandit ey td rua hice Ky Seep le ee parte be peat eee ne Sap ren we meats ene Coe Seip i ne Canoe cones Stn os pecteear a pees hal er enteeietictrrd Rehabilitation processes engaged by powerful with sick people ae Many new/stadent rehabilita ine ueee Many nea ilitation prectitioners are | intone cn asked to ‘establish ceppor’ with ther cle | TP sion, nte/paticnts, which is intended to create a trusting 7 TPES tclasonshin coward postive terpesticend ang 7 TSE cad. However, in our effort to care, several poe * M2 The ecking. THe tong, Sapien Sieh Somrmantal weet vine ens ry a rein streets — images of patients through their medical "om erraate winless ng ise emit flere nisin see! Stel emusic cv iit ep ec era tg ede 7 inal, hosp ao habanero -arc recognized” gies, illgesses and diseases ‘oh ie quesie te * aha pacman Te ening obintheorhotued prays ee testi gt pockdsmatta ses ee 124 crate practtioner-client relationship. As this is a2 phies. In uncove ssheobine weap asta ona RSME miacy meade ae ve rma aeceatyeemgsic eae peynabitaton and (e)postoring the powertu exper end he six person Jem with efocus on the problem? experiences lesser, invisible. Pathology, disability, i a i yeaa et chs, functional abilities, possibites, and of ri ged esorces, The aint ot besutifal intimately elated ro aru of defi deories that I pee pent pce. Sick Disordered. ike che Afcan American wer (ethos desived from disrespect) ‘disses’ people. Hence the term pre sr een dest otro 2 oxpirment ‘But why do we dis-other? Consider where rebabil oe itation practitioners inay be if we did not focus on ee isabitcy pathology. The stutterer, the spinal cord injury, the devlonmenaly dyed ch, the atic ~ 1 Sins pthologia bel help play 2 pro- Eyl and Handicaps (CIDE) (World Health fessional realty. Sigaifsnty, our dsorder ‘osse eet enion (WHO) 1980). The WHO hs refor helps to keep ou legiimste space in society With: oer Gaticadon int r= out tw ay ce 0c (n ur reset fr prt Gian of Functioning (ICE) (WHO anyway), Boa Se ea porte eenmesr The onctioe ra he dathcedstin WR God p'. aknouh ICE atom cpused_ by eng eset pomgectes to define he Oe a Pa hatin they ave fale toques tov, xed exenc of thing (Thadas 1986), sex aan ee each af caving what relly ds allan hs produced Kreg of ‘deaf speech’ the 5 fone ae) Bren ths modern seem) which head ined alt oc the Frsing desled il Saree ee nneceni-ceatarycteifca- song plethora of eseatlzed notions Agua, aoe tthe uted bel that _ezenalt notos ae neces or expert practic. Fen ales must nearly be undet> Thoh, the question remain Ts ever psi © Toa asimperfec’ (Goldstein 1938) reste esence of any person - with o without a as peri (Golem ofohering os used Gsorder. Possible or rot jumonera enter Lae oy ett teoabenrcerinetotioee who armed wth concep eames belyng eset by sco ry cual and oval fre Clanton opstcms, ating scl, code Ft ne oe aeiie pacitoner ctheed sessment token therapy programs thirgs tha Se eat pia (1985) refers tocthering define ‘good ehaation. Pi eT eyo the means of interne: Inherited from the medical fraternity va emp a a i ance Otring a made posi csm i redetionism, whic is when esmplex phe {ation an corr clon proceves where the nomena xe. partioned into smaller seqments ae eee apslen fon ia, the clorizer thst are then Cea with piecemeal” (Dagbar 195, saa oreo) ovwoke’) torepresen the colo- p. 19). From even the nist level off damaged a Oy co legit the exis. coclcarhairel to the grander notions sbout emo- nue. Qubers a reset pouches, poner tonalbehevorl disorders in. astm, we ne re oF ee ongy came be defined Otherng. engaged reduction, The earstic device fmeth- See er serra he carly dominane, dole redutonam (Peck 1935) reducer the aoe eee) onto thc mpers joc: complesties of cowl inlueces (among ther Fone oe cd han dichowmies us & notions) to produce scientific farts. And all of thi aoe eee goek & white, abled & to. (Wonialy) understand he whole, Bren such dlbied Srasuceinavaton, that purport value people tle srs begin by, dough « medicl raze, atisacly, bobble Hehind an entrenched practice highlighting eter choacertice ofthe diorder of reductensm, Sighting ten cra to mormaave tera, Why sthisversion of cence dominant inebai- Son ore pjcc of ady, best repre- aon? Epsemelopcal, mpi scence es ong mipsel ep iri 190), Yee eee white, Wester cols fc Son Protest clr, devel’ (Vick man 1998) ths wry, empleo Fe are Re rcaly rescarchig/srvicng ny be regarded es an expresion of cara bier ese populations. Criteria are not only established regarding ‘the natute of people, relationships, know! Se rn ce co by rendering others cig, and of how knowledge should be create, Pa of which were comerstone theoretical notions BEE the International Classification of Impeirments 125FRE ncortn want rire re-created, seen and reseen, I do not suggest that ‘empirical science is serety within white, Westera culture. Ofsll the types of sciences, an empirical ei cence is valued by those who are politically, socially, and culturally dominant. In our recent history, itis still an empirical science that is served ky and best serves the cultural copital, vie: white, Western cal- tures, Ieis possible that ideologic allegiance to those with greater socal and pobities! power have seeped into rebabiltation practice. In South Africa, for example, the power triumvirate of rae, class, ane gender (white, middle-class, male) has influenced hhow cehabiltation best serves white (English and/ or Africans first language) clientele. At a glebsl level, itis certainly not an cccidental accident that cultural copital is matched to the community of rehabilitation proctiioners! Practitioners {even when gender is considered) are «product ofa soci ety (@ world) that has privileged the interests of sich white men, and this power base has precom- nontly influenced che development of the profes. sions. do not ascribe to this kind of power and ‘he expert pracitioner-sck person relationship this engenders. Sof this is unappealing, what else may we consider fora ure stave without occupational sportheid? Thave chosen to tur to ideas generate fom sub- jugstion and oppression, powerlessness and resis: tance: South Africa. Being a recent project on humanity, of how we relate to each other; South African policies represent’ a viable’ theoretial inspirational source for democratizing relationships ‘engaged by rehebiltation professionals Why policies? Why South African pol South Africa's policy statements may be positioned as '8 conceptual resource for our practice. Why? Post. Apartheid, South African policies (1994) contain ser ‘tal democratically aligned beliefs about how we relate t0 each other as people. The World Benk, the United Nations (UN), and (for my thematic focus) the WHO espouse liberal, democratic ideolo- ies (Storey 2000). Hence, ss'« political project, South Aftica may be synchronized as « world project fon humanity inasmuch as there has been an interest ‘on the act of Barack Obama's installation as thesfest African-American president, South Affican policy ‘ideologically interacts with globalized notions of 1268 democracy, of socal justice, and suchlike. These policies may be referred to a ideologic inspirations, ‘eflectingamapprecietion of Fansen’s (2001) esertion that policy which may be critiqued esun-implemen table ~ is largely symbolic. Ideologclly, current South African poliy is inspiring because it enmeshes resistance-polites emensting from organizations suchas the African National Congress and the South African Communist Party. Ie also focuses socialist epistemologies in healthcare, which interact with Sccial models of healthcare from, eg, the WHO. ‘There's ideological coherence emg most South African policies across heath, educstion, and social welfare ~ most of which makes direct reference to the South African constitution, Below, l make refer ‘ence to five paired ideslogic positions as contined within the South African Constitution and several other documents (for more details, see Pilley 2003). These ideologies inchide 1, Equality and antidscrimination 2 Human dignity and Bunt (oe rte ngwomnt gabantu, which, roughly translated fram South African cosmology means that's person sa person through other persons’) 8. Momacracy and a aw govemed sectety 4, Social justice and equity 5. Transparency and accountability ‘These wonderful ideologies represent a revolution away fom oppressive practices, However, what docs 4 cursory review of current realities how in "post states such as postcolonial Africa, postindependence India, post-oceupstion Palestine, post-Katrina, New Orlesns ~ and post-sparchoid South Afiies? Tor ‘example, in post-apartheid South Africa traditional hhalthcate facilites (clinics, hospital) remain inge- cessible to large sections of the population. It is @ place where in 2005-2007 over 6615 people devel. ‘oped malaria and up to 65 ded of eis curable illness (Department of Health (DOH) 2008s). Tuberculo- sisin South Africa is an epidemic growing at 20% per year (DOH 20086). Acquired immune deficieney syndrome (AIDS) remsins one of the top killers of ‘women, men, and their babies (DOH 20086). cis also where ‘the Poors’ (Desai 2000) and 30 082 of thelr chikiren (under 5 years) suffer severe malnutic ion (South Alrican Government 2007). Imagine in the face ofthese kinds of needs — how coulda prac. tiioner seriously negotiate issues of rehabilitation, of“ walking, er talking with someone who i, for exam- plesdying oF hungry? ons (Peshetitation and (re)posiioring the pewertl expert and the slck person Of exes, 1 write as an insider, beover move tho ba considered how my profeson {SUE reoveneflf round mens that prom cearunlestion 2s 2 fundamental, exental schl Srey forthe quality sf enone’ if So how do everest cuales, hw do we journey to the Meese n responce to ths querton, oer the BaIA (Psy 20038). Ar the pot, the reader Teepe oe on he flog questions + Consider what abel makes you comfortable lyon, te pro “person wth ds Why don't we eal fers th nya patient outside of Replied coten? ‘Think bout respons othe following headlines ts you rend theres thi chat, Wat the onnceion between there atest nd this chapter Hetero man prompts the se of er sctvam to enpowe less 6 "Deaf Mercan migrant wants sme ight 8 US eines fo eter es "Disbliyrigts roup reserves SOW of its cxceatve coal srs forthe non-abled © Sdge John Richards ules: Hub allowed to pba dead wifes tbe feds < ‘South Azan lack economic empowers deat inde wite worsen The RoLA: why ‘laboring’? why ‘affinities’? Communication and the RoLA ‘As rehabitation practitioners, we depend on com trunication to. derive empirical Enowledge of tients experiences. However, in. reilty, the Inedium of langage limits whit can be hoown {Bheslar 1989) as language (communication) isan inherently fable sytem to convey tve meanings patient’ experiences, Communication e freer ompounded by the narrowness of technology dlevved science that encourages use of expert lene ge, such a professionel jegon, This empirical) Een discoure may be weed to survey and onto cur patients in the way we describe ther lagnose repor: thir progres, and communicate their outcomes, Ina move democratic reltonship, sve aught to wock a eplcingsuerellance and con {ral (fer Foveaul 1976) toward amore meant person-centered interaction, Practical, thit Meant Termin to gun nights about the biologi reais of the patent. Ba, ott stop thee It also means developing ways to access what Te means forthe patient to experience ‘dborder. And eo do thie ine way thit (cotadicony, smelereosh) fekoledges has we cannot know she paste Sock fn epistemologal-ontolagiasife muse led to an animation of the validity of appropriate methodo- ie! choces. And thes where qualtseve meth- clogs amy offer the practioner in rserch, fervice, and profesional higher education vale Seratives to. experimental, techologaly- {ened method Tn this way, we sy (eonstict relational knowing of ves “Laboring’ positions the notion of work/Isbor as dy peal tansorig ‘Wor alluded thers bor fora very specifi purpose, Le, the transformation of professional efitics. ‘Affinities’ refer to the practi tloners’ attachment to ideologies thet have created them as powerful experts. ‘Laboring affinities’ is out working with and through professional attach- ments, collective professional theory, clinical wis dom, expertness and issues of power towards a different practice. Within the RoLA there are three core elements, i + Communication Communication as the object, subject, and medium One of the waye we may consider commanicaton wethin she pactonerfatient catnip ito Think shout wht conten effete commani on Wenn pstioncomonanction se astapoeti Mature Ves (1980) refer 0 stapes as = Proce within» stem tat mantra Tres by engafng hese sane ments nec Feshion this mpless ind of rodcton etary tien these element themes ae repre Fue I'l isa cngamate representation of this file nto ty: ting of commento. (gel dinetesthtcommncationcoldbe rine nd undertone wees the “* Bach of these elements ison ide : 2° wae generated by colluding with many theoretical” > perspectives as described below: 127ng ca be refered to in many Wye Hos nig es to wit we ncy we ti 1ow we think when interacting, and where we thi 2 Sigficantly,where'referstotocal, clean, ene tal and relited contents in which aking soe In cognitive psychology the move toward ur iden standing ‘where’ thinking occurs has resulted iy ae of many new theoretical nc ist such as situated cognition or distributed copnitig, {Sslmoe 1955) Ception ns aconrnae sen tote way of thinking about thinking thor any wl ie bene these rn copie a theorles primarily engage the use of a bi ee stn Whaat Tene_ Tots ca han Benes ' erapeutic communication) is simultancot any Gommunication end thinkis 7 cnt SechecsFausghomsicietor maceaey RGA Hoe habeedhgugkess se bcodedecaucetseman tye el pce Maite ‘uy dscores whet communication meansin comple Peat, and the werld at large : pec Wimurpnpefesnecoanatcae ete oe have ones Soeedbuee a ayigcy ol oman Sl ta Snare se) ane Hey Sura me wal ee ey ‘Shistin cme ee eyo rc ale ne eB os 4 ro rey ee oan ae bem adel THeciee comenaeecticasmensioe sesten yceaey ences ofthe citonapttelstnip, AY, dite uty, nd frm elie "The av ting a social relationship as a communicative inherently in conflict with the re ofan om Fewer hein epeecedicl Set inkngper mci we {hei (i, emarton)reiedineveryey me! Sd eran. Eortor, chink rm Ekediaycommeticor shall inity summon in) cede” i ory of commnienive ston known aus and eu or ret he any 9 that 'gmatics). Habermas (in Pusey 1987) argued Nt CABAEE Certainty and uncertain i me that people (interiocutors) engage issues ike truth, Rol iia fnaie, intelligibility, and identity. : remuneston an elemento the Ra canbe wed to sane how the poneeel one oa tot ever sin tol damieac Whe wee munication tc ie eng the onus of sa lives in meanis inge the ls nea oy ve bo clg seen ofp Weprecitenpetinsens kee ss emmis on lon owe ncn cnicing rok asdf Commision cree daewane pice ence ee a In thers worthls phi mua desi owe ee Rat races gs morals as epsiemologal gual on tothe next core element. nha OW ttm Fig. 19.4 » Conmuricaton and the Ro abering ates, eee Fig, 43:2 « Ticking and the ROLA fas met uncerianty and certainty, eacaee 128 EE proba — pojrmptaon ons eposttoning ie powers expert an es person to engage peorle living with dissbilities. This desta. ca fen seek common sound to cco bization i views a desirable when we wh to eer sdf thinking (vs Avisthe RoLA) engineer and matatain 2 meaningful relationship. PO ge &Caancaet Nether he pron with 2 day nr che pact ee tan oy Tey ponte one ny Kw wa lev dl ogres ee ee Eeenpy ty redace we commanietien may eth, Inch asc re tines moral snertanty tay allo or Cnking tobe ed with oe nce wh umbialnce, tobe neces amigos THis ees ergig_ css he potential o ait He, hoowlede, caged im pace: sod pacer wed iste 1 cn ect 2 A age casa wt develop cer Inse, whan Wed tno, te eee the whines of when we are uncer - magne the Hed of ol, Pe er epactaly doth” some tht. ay eco Deoeea pao and Fe acons,ogy people wth ties people with bes, {foveal deat ches ep ug wit, and HIV/AIDS, ss pes for i ee ATS eerie Labor and the relations Pee ee th uitin the Nola gare: Of laboring affinities tree a rarely of recconingy (Cin) B sad aout potiets with. progressive/termina cds This tay allow raliple commsnietion elements of the ROLA to emphasize thet ‘aboring b Meestons to cceur.To expan this, we may condet fits isesteatallyotelatonship of work Labor ‘Bvrow’s (1995) problematic integration theory for within RoLA, is charged with transformation Bow pose. Dabrow hasorgued that people sess [Fig 13.3). Wihinatransformatoryfremethe clement Pees The paiant prabehly can't of ivr hax heen understood in the flowing was, Fae stis ideas fom his memory” Adaiton- Labor i pesttoned relative to Marx's (Marx & They enum te moe/ese probable pss Engels 196) views of labor vehi cepts, which “An AIDS. patient fas an varelible ig the breoding ground of most professional prectr ones, We bave developed a core interest in exo nem gan eatve to our market of ‘sick peopl’ “How leamers" who constizute vile cepts repecive may assure that _yeinitially meet people with disabilities we, Jaber has been foregrounded ss one of the core wrehorp "These assessments of probebltisinterect wh evaluations, and they often c2-occur. In other = Words, probubites or uncertainties) and erase wee each ote In this way we integrate iprreste, An extreme Tek Gfearaingy(asesment of isl perepSion) rehebtton ‘patents ace necessary markets wit een Uicetaingy (pssblity ofa. nearloge out whom we (expert practioner) could not ext Tass). Tn engaging cvtinies with uncertsines wwe may consider Bradac’e (2001) assertion that Ureertinty (opty: probabilities) occurs within ea rena pate) frameworks thet account for the emotional context of thinking, We should consider how our thinkings "aa “bout the social, political, and cultural context of ‘our practice may became imbued with emotion. For example, not knowing the reasons for why an sult cannot dress o bathe himself may be perceived ‘3 professionl ingecurty. Hence, we become desta bilized as practitioners. Tis destabilication may per haps be experienced as ambiguity and confusion, The suggestion is to reposition these emotional thinkings serelah postive, contructive reso Buty 2°" Keagcoud Ue nag aces hk errs, (Pag e™ or : erm ‘ pethaps even creative ends? If we creatively engage uncertainty, to hamess our inability to know, &© then weneed ‘predic, and. Fig. 183 ¢ Labor and the RoLA 120Discourses Without Borders However, a less extreme stance may consider Marx's focus on capitalstic-riented labor (Engestrom & ‘Miettinen 1999) where labor is seen a 3 oint, collec tive activity. Essentially, this means labor in rehab tation is fecused on the solution of 2 problem, mediated by tools and performed in collaboration ‘with community of practtioners/other stake- Iholders like disability rights sctvist, The structure of our labor, however, is constrained by cultural Fc ‘ors including conveations (rues) and social stata {Givision of labor) within the healtheare/rchabilic- tion network. Therefore, we need to be cognizant ofthat as aboris part ofa network of several systems we necessarily have to collaborste. Habermos” (in Pusey 1987) theory of universal pragmatice may fur- ther situate the dialgic base of labor, where intel cutors (people) collaborate during interactions, at levels that supersede the individ. Labor is ideo logic, as well ar a practical enievor andi the eriical slement responsible forthe production of concepts and practical/material tools for transformation. In the RoLA (re}formulating the practitioners’ relation. ship with others must engage Inbor that is in itself conceptually and practically. transformative in inaare, Practitioners must think and do differently, ‘The production, development ard implementation oF such tools for thinking and working ae in them- selves mediated by several processes. For rehabilitation practitioners, we need to con- sider how people with disabilities positioned ae wath- ‘out agency (or at best 8 possessing limited agency) can now exercise power/eontrol ever the labor withio, clinics, hospitals, schools, their homes, and their ‘communities. AS stated earlier on, labor within a rmedicalized dficieradition has applied an objective science to measure the people's disabilities, sepsrat- ing them from their contexts for intervention. This ploces the person in a less than powerful postion within an expert-driven relationship, Within the RoLA, labor must be shared diferent. Such Inborsharing may create multiple understandings of the person with a disability andl seek to itersct ‘withthe very social, cultural, and political forces that have produced him or her. For example, this may mean collaborating to develop ‘advocacy’ or perhaps ‘activism’ as conceptual tools. Thismay be practically translated into the development of ergaizstions t0 + promote advocacy of potentially voiceless people lv singh disabilities’ rights in various socal institu tions. Anfexample of this nay be a social challenge to include'sign language/text options for television Programs, where the social institution of television 130 broadcasting (media) is made available relative to ‘he civil rights of nonhearing populations. Elsewhere, ‘we might argue forthe valuing of multiple commpeten- ‘ies drowing on life experiences and potentialities of people who repeatedly fall in a system which pro- motes singular ways of Knowing, single lterecies, Inclassrooms, for example, we might engage educa tors and learners on what might be the essence of healthy communication, end the intereationships Decween identity, rights, and communicstion as ¢ significant part of classroom experiences Conclusion ‘The inversion of political ideslogy in South Africa from an oppressive state to one that aspires for democracy provides the politcal context for substan tive social and cultural change, even transformation, to occur, For South Africa there are many fields of ‘opportunities, especialy for ideologic hits, changes, and/or transformations. However, a8 we celebrate the fertility of our geopolitical territory; we are also sare thatthe nature of thisideologlc context isnot nurtured (from ‘inside’ and from ‘outside’, then things such as the Relstionship of Labouring AFi- nities may have an untimely-simely death, We must remain vigilant of the multiple forces which impact ‘on change possibilities. As we celebrate 4 post apartheid territory on the inside, we are also a post. colonial territory from the outside. Perhaps it is this perspective that we offer for consideration to others in countries with dissimilar and srailer polit cal contexts. Positioning communication, thinking, and labor in a democracy with ideologies driv new practices secking to free minds comes with = Fresh sot of threats akin to the repressveness of apartheid. What ae these cheats? Ina world of globalizing countries that sre coaked Jn economic concerns, several threats exist in the smarketzation of policy (end practices) within duce tion and health, foregrounding econometzic con: ccems. This refers proctices and rehabilitation ‘outcomes to economic indices, monetary gaint or even, 25 Hammel (2007) has argued, «fiscal related accountability to employers! concerns versus client centered needs. Specifically, three forces threaten the RoLA: the dominant interests ofthe private edu cation 494 elth, sector; glebalizaion’s repressive markerzed vision of competence; and interrelated, surging fundamentalist constructions of social, political, cultural, religous, and racial identities (fejhabitation and tre)positoring the powerkl expert and the sck person “The complex interaction between those three forces must be rvderstood as yee another dialectic encoun {ecto resist. As ithas been with forces rach ae colo- nialsm, apartheid and the suchclike, our practioner relitionships must be considered relative to postco- Teniasm, seo-iberalse and neo-capitalism, ‘This ‘means that a5 we encounter these phenomens and ‘work throug our laboring affinities Wwe must be able References row AS: Commanicion end Problematic tegration ian Kner lore letere, Te bak of laughter nd Foret Contention Tey 295-130, oucul Mi The Bir ofthe Clie: an “Archawlegyof Medel Perpton, Tandon, 1975, Toto, Fes AW? The Warned Stogetrs ad ls ad Ets, Cra, 1986, 1985, Cheapo Univesity Pres to assess ther influence relative to the question of ‘Whose interests does our practice serve?” Acknowledgments Sandhya Chetty, Ayesha Mohamed for listening, reviewing and editing. Incenaional oar of Laren 139018, 2005. 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Kathe H, Play Me Stadt semen: alg and prtic inthe heat ienour es Poeadings ofthe 10th Aantal Confrence of th Seu ‘afcas Ascari for Acedee ‘Development, 30 Novenber 0 2 Deconber, Duan, 159, Une of ‘Sclens@aet rey Trenn 1, -KathardH, Play Innovator: engage praetor a (South Ate) eso Prelmigaryexporcion of the Pla ate ef ecopatnal therapy. In Onepianal Tray Wile Border: Leamine fro he Sprit ofSroers, Einbargh 208, Eberir/Charl Linngtons Pusey M. editor: “Copio e Relaono the ising, Derrek, 1980, Rel, Marg K, Engl F The Gera Ise, ‘Caza, 198, Univers of Chia Piliy Me Developing ere pectic: South Aan’ perspec it) Lang Connon Dord 338-9, 1508 A ebscoure of practice for shai onuntntion ne) Lang Conniay Disord 36351356, 2003. ly Us Uncetingy in eth ppofesionil edition et ‘Reco bn Prceedings of the Gaitareso Learning Coferene, 13-22 api, ghd, 20018, Univer of Bs lay M: Cees cabal practice: whats ‘relly about? Fale Phir Lagop 3:09-209, Jose Py Mt: (Reasoning the poet ‘per ead th sek pron cae of ommuncation pathology, Docenl ‘lusetaten, Drtan, South Ac, 2003, Unversty of Dubsn Wesvile 2 lig M, Kabard 1, Samuel MA: The uric of practice 0 conde Freon fr pret th # Black_Aficn fet guage cliente SA) Comma Dis 4109-117, 1987 Siloner Ger: Datrtd options, Pablo and Edicatonl Condaration, Cri, 1983, Cambie Universe Pres. South Aldean Goverment: Sth “Africa. Mint desopnont {pale Mido coir por, Seqenber 2007, 2007, SA I (Government Pres Spivak CO The Rant of Siu Tn Barker F Hulme Person M, tl edn: Euopeand ts Others, 132 Discourses Without Badr (Cochster, 1885, Unrest of sen Fres,p Storey A The word bank, noe essark Theis nd les, Thonn Ons, CN 1258 Sg Wien Me Wingy Mid ant Tens, and pores dicouse Leung Torda Serafin swag pre fii nan 5, al Unga 200 nt eeeiensea Thin: Sabb: Latin Dein Ingle, Dibra “Ancient and Meda Indi, London, Han Bene, Ain on Hana GC), Cen, 190, ‘Vidich U, Lyman SM: Chapter 2, ‘Qualia medhode char hatin ‘World Heath Organon (WHO): Tnteratonal Clan of ae mesons, EEE en FEB ieintow amc Ghanem ee Foucault, power, and - professional identities ‘Harel Mackey oe ovERVIEW ‘Tho aim ofthis chapter Isto outline some of tho key Insights of social Ristorian and philosopher, Michel Foucautt, which 1 argue have relevance for "re-reading ofthe professional identities of ‘occupational therapists. The purpose is to {gminate how occupational therapy identities are ‘constructed and understood and not to defi ‘ohat identity occupational tharaplsts as a grnun or Individuals possess. | frame the chapter within 2 ‘number of broad quastions concerned withthe ‘construction of professional identities. Typical ‘questions relating to profeastoal identity based on ‘aFoucauitian perspective are: ‘+ How are the professional identities of ‘ocoupational therapists constructed within a Spocite locality? “+ How do occupational therapists define and practice their work within rolationships of power? Foucauitian approaches are rooted ina recognition that professional Identities aro contested and ‘thus open to change rather than pro-determined. In this way, occupational therapy is a dynamic concept, chaped and reshaped over time by, ‘competing and often contradictory cleims. Such ‘pproaahes open up fields of possiblities for Citical reflection and strategic action. Introduction For many years Thad no theorfo diplsiethe profes: sional identities of occupational“teFipists. For me, * occupational therapy identity lay in a aumber of deeply felt assumptici, often not recognized as such, that shaped my everyday working life. Most often these beliefs were to do with the proper ‘conduct of occupational therapy relationships and ‘were entangled with issues of status, and a frustration bsed on some ways of existing in the world, being ‘more legitimate, more rewarded, and heard than ‘others. took comfort and refuge in the occupational therapy cellective, believing that we shared enunder- standing of our professional world. And then became involved in redesiging the occupational therapy workforce, io line with the modernization of the National Health Service (NHS) in Britain (Department of Health (DH) 2000, 2002). The introduction of a new grade of support worker, the ausistane practioner who could take on extended roles and do some activites that hed traditionally been within the role domain of the state registered ‘occupational therapist, forced me to examine my ‘ow boundaries, roles, end relationships (Nancarrow & Mackey 2005). At times, this process led me ito conflict with professional members of my own dis- CGpline. In my practice 1 fought co promote a vision ‘of what occupational therapy can and should be, ‘bute this vision bated on a professional identity that is shared with other occupational therapists, has it been constructed by my own experiences, or have 1 combination of forcas brought it about? ‘The importance of the concegt of professional {dentty les in es relationship to profesional know cedgeandaction, Laying claim tobeingan occupational therapist can be seen as a device for establish defending, explaining, and making seast of one's behavior snd career. People use che phrased em ae: ‘occupational therapist” co make sense of themselves and their actions, to find order abd-consstency overREEL eee Discourses Without Borders the pasige of ine to workout where they standin tclatiant others, and vo ake themes nd thelr inte vile and ince: Octupationl there pls wok togetor to construct and sustain heel. Icctive deny Instrtei terms 2 stongcalectve identity san ongoing proces which enables the sroup to recogion and defn tel, nd which aso fc tates sucessful cllectve action through chest tnt with ageed alms and interes Cena otis theory of pefesonl deni, bse on vcd ter. Uy theory Cael 1982), ancssentled socal] phenomenon thet governs occupational therapy feton. Typlel questions relating to profesin¢! ident bated on this understanding inde: + Wiis exupitiona therepy entity? + How may eecupatina therapists be distinguished from oer hes and socal care weer? Ie is asumed tha although cccuptionl therapists soa) workin diferent contexts end peses ne. et ws, endareth th preseation es ale deny. Soc dency thar explores te process offence betwee fester Put simply, according to social deny theory ecu patina therpits wrk at raimaning» postive Profecstonal dents by making fore Lona fons with other oceepatonl heaps, Thee. sllesinthesoilcognitveprocesesofimembezhip tnd the way that Belonging i both insted ands tained lvne & Gram 1954 ently furreaone why the identity of ecupationd therapists an important sue forthe peofesion to exatsne- They argue that for ocsptiona therpy toe elne s¢ profession brings ater ndeymbolc rewards beth toindividalsandhecollectve, hata sharediensy istemportnt in obiaining rection fc che publ, satan other heath and sca care workers cha Shared identity encourages ny acesloc ton, andluenatioaocepaoal serps endthatche terion of the profesional occusstood thea so Speteabeatedeo ret proeuabnds © concept ofthe professions! project (Eton 1968, Feeds 2001, Lason 1977) elas te methods by whicha groupofwarkersetscolectvely {© apie to ul profesional atu Although the fact characteris of fll pofesion wry fom futhor wo euthoy, the tain view ofa profession itasancrgnied body of experts whohaveesjtem- 4c, thenretial body of knowledge, have elaborate systems of entry levél° taining “usually university ised ve egultve code ofc, are peal crientted Yoeatdscommiy benef eer thax 134 selFinterent, perform tasks characterized by» high degre of eutonomy aad havea well developed sens of communis pal within te form ofa nary Intereatioa seosston (Greenwced 1957, Parca 1968). Occupational therapy has strived to acquire the characterise of «prfision (Wicd 2002, “Acempe 9 cet song profes deny ave teen made through change nthe ection cur, lim essing concep! founditen, predacng profesionspecitcmadel developing stengreseuch base and growing nevorke of practioner (lt & White’ 2001, Kiehofer 1987, Moun 1907 Wileosk 2001, Yersa 1986) The et as been the proc fact of rnd er ba the cecupstion therapist Consequently hats oF pefesna identity have dion ved contnsims of practices anoles thas preode: pa Sion identity inv sn ocd and sete story. Hower thsview of profession dent ssumes shoe the gals of india occupation cherie holy consistent with hoscofthe prfesonl kates, 2nd to recone the active rae played by nd taloceupeondl herpisinshpingter eve roe Sinaldenity. Th prtayalf occapatoalthepiste ingle univ eny leaves ite scape fo rhe Censideraton of invidelfference or the dere Setngs In which occpaton theapts pete ‘Watson 2005), tn er adres tothe Word Cones of Occupational Therapists argues that oceupatonal therapists hove fled to urderstand that whe hey sharea common professional foundation, ha practice ‘not asume unfemty gen the cul alge. nest of iffeert contexts, She elle forthe ‘ig of {ceupational ergy tobe dered ees the lobe ‘eth ela deri determining what octapeoral herp do and practice The aim af his chapter ito otine some of the key isighes of soci istran nd pilsoper Michel Foucase which Targa have rlewence for 4 rereading ofthe profesional dents of cccup Sonal therapists. ‘The pupae sc lumina howe occupational therpy Wnts are constructed and ‘ndersood and nt 9 define wn iceatiy ecco tinal therapist 8 group ora nda pose ‘Typical questions celting t0 professional denty based on a Foucaulan perspective ae *+ How are she professional Wenn of custo therapists contacted tina specie ecb? eee ea + Hlow do occupational therapists define ad prttce hee ook within retionshps of power? Foucault, power, and professional identities Foucault: an introduction Michel Foucault (1926-1984) has been one of the most ifluentiol thinkers of recent times and his vast teach extends across many disciplines. He wrote on the history of mental ines, medical practices, the penal system, and sexuality in Western culture. ‘These topics overlap end internk with the field of occupational therapy and, consequently, his writings tre intriguing and relevent to our profession. ‘Concepts from existing theories act as the lenses hough which we read situations. The ase of theory js reflective process. In the perpetual intercourse between ideas about the social world and data collected about i, theories work in two ways. First, the use of theery informs interpretation in a way that allows confirmation, refinement, or contestation of cevitng beliefs, values, and argurnents. Second, the- foviesuide the selection and interpretationoF evidence. ‘Thisisadynamicuse of theeryas opposed to theimpo- sition of a definitive structure, ané can lead toa much ipeater understanding of the many dimensions of ‘Complex ocial circumstances. As Foucault argues: “There fir deny way som uo bin a ‘to formulate the el eytematie theory wis lds ‘erp i lace bus fo aaj the spectcy of Inechanams of power, t lost the coated ‘extensoes, ob Tile by Bie strate owed. Farah 1980, 9.85) Poucaut's workis skeptical of claims ofuniversl ruth ‘onthe grounds that sich totalizing theories are redue- ‘onistic and exclssionary, privlaging some agendas ‘while excluding or marginaliing others. His aim Is to highlight the extent to which there are multiple and conflicting views ofthe world, some having more power and dominance thin others. Language docs not fimply describe orreflec, but actually creatasmeasing anduadlerstanding and the selfisassumed:obea prod- ‘scofsectal inveraction. Inchis light, Foucault intended Fis writing to beused as ‘tol box’ by those struggling ‘with and for socil transformation. The metaphor oF the toolbox may be used in en unsettling, troubling ‘way tharmaximize the potential for providingalterns- tive insights into questions of knowledge, truth, and power. As Foacasl suggests: ‘Amy books... arc tol bes If people wantto pen Can to eth exo Eedine er apener adbeast gies oemsh ‘ims of pour ialing evenly se from which ty books ve Serge so much he bee. = rca 978.511) Foucault's compositions offer informed enlighten- ‘ment onthe bellfs that guide profesional behaviors and relationships and how they acquire power. His work attempts to defamilarize present practice and categories in order to make them seem lest self evident and necessry. Consequently, hie work is ‘often considered complex and divergent. Ina diseus- sion on polities, Foucault explains his desire to see the iesue of identity a8 perpetually unsetled: “The prcem eps, to decide fi iraculy sete te lace oneself within nore to ser the rns one recagises andthe ass oe cept orf Feng rater nearest aia te futur formulation ‘ofa 'We pss by elsbortng he question. Beans it tse to me thi the we" must 20 be preous wo he ‘econ tan only be thereat -andnocezary ‘Ermer rele ofthe quero is pated che, now tems fa which ene formes cma 00 9 HN) By being skeptical of definitive answers, and contest ing the taken for granted assumptions which under- pn much of our everyday customs, Foucault's work affers 2 possibilty of re-envsioning occupational therapy practices. For Foucault, the netion ofa fed tnd unifte professional identity is difficult to accept (Mackey 2007). He stresses that identity is neither predetermined nor consistent but is constructed ‘within and by the relationships which make up os ocieties. Occupational therapists understanding of their own identities change as they are enacted and performed within the hospital, clinic, heme, of other workplaces, These interpretations may vary from situation to situation as the events and the stakes people hive in these events change. We all hhave many potential individual and collective ienti- ties, At the level of collective identity, occupational therapy identities are constructed in’the multiple intersections of experiences of the symbols, Jan ‘guages, and practices availble within the socio- ‘istoical context of the occupational therapy world. However, theres na neat separation of persona, pro fessional, and politcal identities as occupational therapists are also created within their belonging {or lack of) tothe positions within the various class, racial, gender, sexual orientation, economic, and ‘ther groups of society. As such there is = certain frifcality in dealing with occupational therapy Identities In isolation. IP aang “To illastrate the implication of Folcauian thought for océupational therapists, I will explore the narratives of Keith (pbeudonym). They arise from my owt work in progress towards a Doctor 135,Discourses Without Borders of Philosophy degre chat investigated the impact of oir direeed workforce redesign Inthe NHS on the profesional dette of eceupational therapists, ‘The’ empirical research as conducted ‘over 2-manth period (April 2006-March 2007), scross fe NHS nizations in England. ‘There were 15 partipants Over a period of12 months inter viewed Keith thee times, The maln focus of the interviews was on the way in which Keith exper enced himzelf end constricted his identity aan ccupational therapist. The interviews followed a semistructured format, and were geaced towards encourgng Keith to express himself in narative terms, elaborating on issues of Importance to bis ‘wmvrrkig ie and polices within the Uys they Gon be considered on gba cl ss ca arans of profesional experene, The examples wear beh tnd by no means exhaustive ofthe discourses or Subject postions within Kets narratives and were are available ina historically specific context, and Which shape our understanding of ourselves and ‘our sbilities to differentiate the truth from a false hhood, the beneficial from the dangerous, the right from the wrong (Donaher et al 2000) ‘We not oaly use discourses to explain our values, feelings and actions others, we use them to explain things to ourselves. Discourses consist of a set of common assumptions. They do not identify objects, rather they create and constitute ther, thus framing the way in which people understand snd respond. ‘There are a number of discourses which occupetional therapists draw on to describe and position them- Selves, For example ‘occupational therapy is an alied haelth profession’ (Cusick & Lannin 2005) or ‘occu pational therapy isa misunderstood profession’ (Har~ ries & Caan 1994, MeAvay 1994) ‘The status and dominance of a discourse is = product of power relations. Dominant discourses + and professional Konttios mobile and productive nctwork. Power can flow very {quickly ftom one point or area to anather, depending Gn changing alliances and cireumstances (Sawicki 1991). Consequently, dominant discourses are under constant challenge. Those groups benefiting from dominant discourses attempt to retsin and con firm status by filing to recognize as legitimate, the knowledge within competing discourses The normalizing professional discourse: producing the docile ‘Applying Foucault's concepts itis possible to argue that occupational therapy professional discourses regulate members of the occupational therepy pro- fession by upholding what can be claimed as true concerned with producing docile bodies thet can be utilized in work and regulated in terms of time and space. ‘Within the dlcourse of professional development wyolving a reflective seach for self-knowledge and selfimprovement, the development of professional ‘identity has long been held a5 9 central component of the training of occupational therepy students (kiugs & Rosso 2003) end researchers, managers, practitioners, and educationalists have spent much time in examining occupational therapy. self> concepts and value systems (Finlay 2000, Kanny 2003). Looking at this process from an alterative ‘Yewpoint based on a Fotcaultian power/knowledge position it is possible to claim that such education and knowledge i stracrured not so much to critically inform minds, but rather to preserve minds, to suppress differences, and to meld appropriete professional aitudes and behaviors. In this a, Discourses watt Borders and discourses. The reflexive ethical self involves individual occupational therapists making choices shout behavior. As Keith identifies KEITH'S NARRATIVE tn th pas, they nav aways san of ceed at re ‘ceupaton Deeps to proide th acy and thas ‘om not ange, are cute bain, ne is ptee curehee body any torn Pa me re cy o> ‘ona, wa are thae to spate coesaten theo {nerpouboinp.... “wo whalweese gorge doisracam the oscupton therapy cond ard we a aca et ‘2ingiobe teas co-oaeatars ante, sowecronot {ohg to do Bgo ons Monsay memeg and e ao Pct {gang fo do the crossnerd anmere, th sia ere the rursing stl want to use lta # thoy have goto = toy ‘want fo uso great, But vo ae nat gong to doit rymere, lca ember once where scrmbo3yatehy was sang we are you coring eet, arent 8 ‘alng the acu away anf aheg making te ar ‘eveonent wor for poor” How oboe tat?" Inthis mative we can see Keith struggling o ove come dilemma between voinconruentdscourses prenlencinoccupstioatherpy, The fistdacouse, based on he profesional projects based on ocrape ‘enaltheaplte ada reran om sua statis nd perondig others of ts expert ke by drawing back rom sngagementin iow sausacs ithe and epaing they the eablshment of ig. Fenced prestigious, specled activity, However, Bing an advocate fo the profesion inthis wy has ‘intended consequences in thi specie context, asit ches with rater porta couse within cccuptional therpy, thet of ocapation for hel References AbbereyP: Disingiolgy in heh Danser G, Serato, Webb Cndersondng Pouce, Leadon, sedelie= these of ccopion ‘erp, Din nd Sty 0221-252 1988, Cwsick 4 Unsin N Contctions of tied beaks Makrgcomered Eisen Watered, gh Se Vere Orpatin ee Proce fn Coe, Edinb, 2005, Church apne peli Degenerate hain a rt forte ied ent pos, ono, 2000, sd ; Depeche NS on Lodon 500, HMSO 2000, Soe ‘Tree ree 725-129, 2000 140) rom « Foucsultion perspective, [argue that ity in the attempt to overcome the struggles betwees powerful competing discourses that occupations! therapy identities are constructed as each therapist reates the specific localized, incidents according to the network of personal concerns, values and ‘aspirations against which events are judged ae dec sions made, In this way, occupational therapy fs 3 dynamic concept, shaped and reshaped over time by competing and often contradictory claims, Foucault, power, and profeccional entitles Nancrow SA Mackey He -The Taro ad eal of 2 the Hinoy ef Sealing the Atiaian QvatonalTherey ‘cna theray asian 34 pet a wl Gieiey R Jowne 41618 I ar 8 Pegi toy Kany E Cae as a ates of Tandon. rcuaiond therapy pat, i In Fano, eto fe Crepern ED, Coon S, Schell AB, eked Poult eto Wild an Sea's et ny ond Tut, Oxeainal rap, 10 "ort, 1987, New Pes, srone Tt Profesns, Jere "Beoelonedia of Soil Seine 128367547, 1968 Paistelpin 2000, pact ithofcr G; Concpeal oman of ceipationl Hayy, el 2, Phinclpio, 1907, FA Devs Company Fan E Poesonlo: the Third Genie 2001, Poly Pres. we E- ebues of profession, Work 235-85, 1957 Sounal $2166-172, 2006 Sit; Dipl Foca Panny, Per he Boy, on AW: Wn do pacinse as taf chk boat seal therapy, Erik Jura Spal Therapy 57219-2383, ia shine 5, Store Sa Eels ote tet: peli aseksingronon. Deu, Std the Catal Pls of iowten 20 141-187, 195 Conclusion Using Foucaultian concepts ssa toolbox’ to examine ‘he professional identities of occupational therapists has offered me the opportunity to develop and use a wide range of eheoretical resources. Becouse Poucault’s writings see expert, universal trth as just Lar eR of Presi, Sey, 16, Une of Eine Pr tea 5 Per at! View 2 Sungate. 5, Pe Nace : shay HE Do etme oceninte Muna od poe ‘Mosul of cond re, etn Cera Thy fel 3455-108 207 end 1991, Routledge. “Tafel Hs Social entity and Ieegop aon, Caige, 1982, Contre User watson Rv Beng etre doing The cites ne) Sepa! Thy areal SSAST-158, 2008, on A The Seprofesins andthe Orniains, New Yok, 1959, lay 1: The OT role: meting nd motives ian seria worl, Dri Snr of Therapy and Reeitaton “Fleming, Spler A: Working st « ‘fal dsxace,Impeatns for ows, subject and Grznisain 1815 oto M: Conpetence andthe ‘ccupatcal therapy enrepeney ‘An F ep Thar S065. 769, 1988 ‘one rath among many, they encourage me to relin- ‘quish positions ofcertsiny in favor of detailed, loca, and specific knowledges formulated by those: co ‘retely involved in the situation. This commitment to a plurality of occupational therapy ways of being ‘means that no one version of occupational therapy ' more correct than others. This produces more diverse, fragmented and heterogeneous occupations] therapy discourses, with different value systems ‘existing side by side within the profession, This docs not necesssrily rob occupational therapy of a coher. ent identity. Instead it acknowledges the ereation of localized and specific professional identities, where the self is defined by local meanings and practices slongsice a self-defined throug a global profession FouciukM: Cited by Patton F, OF power ‘peo In Moni, Paton? ers: Mill Fond, Power rah Sate. Spey, 1975, Fert Pubcon, p15, Foucul Mc Mic Fence, Pow) Teneladge:Sdeced veri ad (Other Writings, sigh, 1280, Harvester Prt. event Me Trth end power. Ta Rabinow Pesto: The Fenced, Reader, Nes Yok, 198, Panthetor, pp 51-15, Foucal M:Techalegles of the self ns Martin LH, Gutman 1, Hulten P ‘elo: A sina with Michal Foncot, Lando, 1988, Tanto, 173, 2005, fe, oso HM; Focitating poe er enti orp 5 say nadens, Qe Tier Toa 295, 2003 2, White E-Calege of costo bcos ec ed develope Sencpe sion acon pln, Seu oor of Octal Tlany 0270-27, 201 Aone, Crea J: Deon the Macey of pein Apeeequste Sengenche ns change mer MehrayE: Occpational wh? Newer heat of cam! An out of patent Tnceness of aeypationa thesis, Bruch oumel of Cccupational Tirapy 5:29-23, 1894 Monntin Ga ete’ of raters Tne eth Juial of Occopatiooal ‘Therapy 1985-1995, Bris oural Yer efOceetonal Therapy 60-80-435, iss asai2-17, 2001. (eruptions Ther. Tac fo eelfdefined frofeson, mJ Ocep Ther Euses-372, 1998 ‘Weal A Octupatin for Health 1A lone fon Preston to Sal ers den, 2002, Callens of proctor dsraian Oespainal “harapy ural §2:202-201, 2005 int nan, thins, pp 1OOS-1007- Pauisn Me OT outsanding talent. AX ‘entrepeneuril sprout practic, ‘Brsvabion Oxereoal Thora ‘eae AA: Occupation! een: the fey to broadening borzns, Brisk earl of Oeational Thera sa BI, Qeupation The keystone of vat‘aielom Occupational therapists — permanent persuaders in emerging roles? Nick Pollard overview ‘This chapter considers the potential for ‘occupational therapy as a critical dialog about ‘everyday lif from the parepective of some af Gramso's writing, drawing on a relationship ‘between Wileock’s (1998, 2006) and Hammelrs (2004) doing, being, becoming, and belonging, the occupational narratives of worker wrting and communty pupiching, and the analyses of ‘everyday Ife’ offered by De Cestoau and Lefebure. ‘The chapter offers an introduction to some of Gramsci's ideas and thelr relevance for ‘occupational therapists as individuals whose ‘work can be persuading people to mala changes inthe evenyday and ordinary but significant aspects of fie. Introduction The political philosopher Gramsci (1891-1937) wrote in the 1920s that the professional (then @ growing social clase of new workers in many sectors, particularly healthcare (Paterson 2002, Wileock 2002) has a socal transformational role ab a ‘new intellctuat’ who has to become an ‘zctive (purtic- pastor) in practical life, as constructor, organizer, ‘permanent persualer’, snd not just a simple orator (1971, p. 10). This seems to resonate withthe pree ent reassetion of occupational therapy’ eocal com- ‘mitment, bat also presents a challenge, a¢ Gremsci (OTIp-p. LZssays, the process is dificult, full of cdatradictions, and through it ‘the loyalty of the masses (for example, service users with fferentcul- ‘ul perspectives) is sorely tried’. Since service users 15 & d d B might also be among the ‘new intellectuals’, occ pational therapy's professional notions of lient- centeredness and negotiated outcomes may well be tested. Gramsci’s thought offers a proces of eritical consclousness and intercultural dialog thet may speak to occupational therapy's emerging role andthe new partnerships it will obsain as more prociionert engage in non-traditional settings sink consnuiy development projects in the present changing defini: ‘dons of the profession (Pollard etl 2008a). Gramsci has been a significant influence in the critique of cul ture, history, politic, and sociology. His work f= spplicdn the recognition ofthe value ofaccommodat- ing debate, difference, and adapeabilty to different ‘Our occupational engagement with the work! around us is one of the elements of our human nature: all people can potentially ply 2 transforms ‘ional role in society. Given the organization of mesl- ern socicry with its many strats ordered to Functions suchas the maintenance of health or socal care, there are many opportuites for individuals to medite or channel social outcomes. Occupational. therapists are members of what Gramsci called ‘the political society’ or the ‘civil society’ (1971, p. 12) depending fon which sector (state or private) they work for AAs ‘new intellectuals’ they carry out the operations cof society such as medlting care processes and sees sing entitlements to forms of treatment or state ben efits, These functions set them apart from service uwers since their professional status depende on managing such processes for others. Consequently ‘occupational therapists” social traneformcional role Isdimited but can have a critical role, for example generating evidence to raise awareness of conditionsDiscourses Without Borders and suppor intervention and colboaton. Occup ‘ional therapy is experiencing fils in een ing «constteny as benders tn heath and socal core ere bing redrawn, On thc ether hand, therapists are idetying new ares of werk in response to the oecupatonl needs of cukurally dere society curse the tdtional care enronmet and into the commonity large (Christe & Sinpeon 2008, Friedl etal 201, Fook & Kenney 2007, Pim & Russel 2008, The ts 2008, Whecer 2008) Wa, in the name ofeccpational esc, authors such a6 Meck nd Toms hae aed sci ve hin’ (2000, p84), Gramec (1971) eagpests tae the meta transformation trough occpston vould produc is soci efor in which the undergigCase ‘estionshipa that ecternnc option depron, 2d oecupationa inj remain Nonetheless, throughout te history some members ofthe prfesion hve attempted to each acros com Epes such a cliss, gener, ctrl, od rc dior ence through what Pelagin (2007, ee Chapter 7) as calle ite etheloic bel for example in comeing lives and personal enggenent. The profsion hea nos always been sures doing 20 an has beens led, perhaps in ome counts ‘mere than lhe, ‘nt the perception st tis. 0 white, mille as ad predominantly feral profession concerned wth tather quaint theapeuie activities (Began 2007, Pollard Walsh 2000, Saktlanon & Pollrd 2008, Wilcock 2002) overshadowed by its more dominant ales inthe healticae portheon, Nursing ad med cine not only command greater resturces fo educa tion and recach but also the public laginaon through ther gener cones with the pues ‘The vernacular understanding ofthe hospital exper ce, the naratves tha people tlland expect each ther in competing with cher stoves af werent So "etofen include occucional therapists yet aratve isa fecorin the sed and the developog sar. se ofthe profeson (Deore & Peyton 195, Schwamumle 1995). Fe occupational therapist sr ficeinth professindlltemturesof ther preesons, indeed most heath nd social cre pofecion plough aralelfurrowsinthedevelopmentoFchet dscouver (Peck & Norman 1999}; qn he value of occas tional therepy is incompletely cmmunicated across disciplines, oo trough the mattnes we tell but the stris others hear 144 eis often not unt people met an occupation ‘herp hat they begin tourdertand wht chey de (Cea eal 2001, Thew etl 2008) Practiones ommuniative exchanges ere frequen extra pe fesonl, reaching outside their pofesond! base tothe wold ofthe carer or service ae andthe crm runes they inhabit. Although thoy may alo bl the sane communi, and bead bck bak eas when they are out of uniform, thi fe an inceralual exchange: these communities do nce tue the echnicel vocabulary ofthe ntrdcitany process. Wilcock (1998, 2005) and Harel (2008) doing being, becoming and belonging (d+b°) is expressed in the vernacular languages: and practices of daly life. A puriietory process of negottng wich comonites abut thet needs ental dealng wih a diferent tof practices forms of vernacular knowledge that De Certeau (0988) and is colleagues (De Coens to 1958) Iavecaed the practice of every hfe easy tem td corporate insttions ay be slow to respond or even exclie those with cds that Can tot be acormodaeed inthe dominat culture A ‘econ report nt mental health enace wes weeds focused particularly onthe demoed or communi ‘on in ly language (Hoy tal 2007) The dso. tance or asonane betcen individual expesence tnd ln fa scl tos ch tions can be the pont at which people reopniae the poll dinenon tn thet al aceapatns (Poteet ol 2008), Grama (1871, p34, 323) sealed che impo. tance ofthe vernculr rom i ater in tgues sin feller: nthe every fotrccon pte Sioa share stores with eachother, peeps ass ‘wich service user, developing lore ox common fo narrative consciousness, and al on ocapaioa literacy (Palla 2008, Slwarnl 1996). rough sy active interes i community publishing an Worker wetng have read many txample of how Social opportunses shape the occupational ner ties ofboth indidal ad communis eed are indicated in everyday paces such asthe ko bow oF making Involved! ia cooking or am wringing washing (Gatehouse 196, Lawrence & Mace 1892) and often ndlste patel preferences oxculral interpretations that expresidentty (Far Bane 1999, Lawrence & Mace 199), These seoces contain what De Corton e al (1995) dese st ‘merhiores” of specific and intimate apes of community knowledge shout practices, tags sd ces of eecupatinal depron and occupation Occupational therapists ~ permanent persusders in emerging roles? erent, in acouts which emerge enough pa sle's resilience, determination to leern or to com- Fert theenpeince freer. The pole Moxon of section emerges from the daly erences of the wide commanty with whom apn theropiework (Kronenberg & Pall Sosa, Pll tt 2008) n clan ethereal foal aces "These experiences re the bas iB quetonng the stu qi, ofthe ection of Si ery sgplof oc ranformatin, Sot agency fr socal change Comma plied rte overex al qn tnd sment pmo od fhe Theugheame fis prcicerandtscceopatonly IBewedcomenthovebon dco nthe profein tee hoptr 18) bs understandably ne de 2 Se imac Such wig tf concn with = Ute wes acount fecdered othe ness ofthe wer ster han the reader a coneguent tan prove chlngig (ors, not len bene of Sreequatand sometimes cecbocry eof ect {Bef 205 Landy 1950, Morey & Wong 1982 Mice 981, Wood 2005s, Worpae 1984) is thewrten fam ftheoraleicbogphcal arate {i poole wun ch eegy Ive, thee or {hisind snd vied na fo vector wie mach fSoumorys muchas wten wl eetched endence who wae of ebjecinty (De Cans 1968, De eran c 198, Mosey & Worle 1582, On fhrotier nd, workings eubegophiel mre thes (or comple Hat eto 2008) re odeed to tbe om cf baorvuppetpectte racer a + thro order, Ts here i differen Bon exer fers oferta es (Grail 1585p 132- 133, Nat 3009), Ta Rowe (988) or Wins {136 ecto aly wa poplar oan, the cera he deere eon hemor ‘flor oconaetmnroge them devon ste Geren (985, p25) deseo tc vch aa perague City the wig) node to ge. Tit cers the wor omeone doe for hemacver we topuring tod the ob heya pad to do forthe {Wadoyer whieh De Cone dss aa ace of tppetingtocofom, Onepoplaranexpertnamole Perini (1974) Gonder, who mina confoable fe in tines of wat ‘ious Gains (1065) hastened impresion management ae Tris ne unknown for oad berate to deveip hese illo ode oe a oponty srextnecy erice were butt pronde ex He woud cng the profesional are: ch narratives are only epoken of in Goffman's (1968) backstage areas. The professional culture of occupa tional therapy is distinct from, and may not always readily admit a working class culture (Beagzn 2007, Sakellariow & Pollard 2008). In my classes seudents Ive often assumed that the experiences of financial insecurity, unemployment, hard and dangerous work, industrial acident or disability described in workers autobiographical writing is something from the past. Other students recognize the similarity of these experiences to that of relatives or themselves. Brom ley (1988) has deseribed how dominant middle-class culture has domesticated, concained, and made safe the challenges presented by harsh working realities by presenting them as historical events that have now been resolved. Working class students o¢ those with disebities often feel sllenced by normalizing pressures, or experience alackof comprehension fom their sosdent peers when they talk about chirgs that arise from differing social backgrounds to those domi fant in the academic environment (Abel et al 2008, Beagen 2007). Contact zones Pratt (1991), a teacher of community literacy, uses literary txts which talk about marginalized experi- ences in the classroom to explore different experi= ences with studenes who may not share these themselves. She calls this the contact zone, but the contact may be rather less direct in literature. Often the protagonist who provokes the resder's sympathy is sctully « middle-class person who has entered the working-class world, Olive, the famous Dickensian ‘orphan boy, isnot realy a member ofthe kumpen pro Tetarat but the child ofa fallen middle-clss woman. ‘Onell, though down and out in Paris (1940) and Lon don or on the road to Wigan Pier (1962), s really 2 gentleman, Despite the sympathy these characters tevoke, and the authors’ good intention, there is ne real contact zone, the true voice ofthe working-lass remains excladed. Despite the grimnes ofthe story, it is reportage. The audience are separated from tuncomfortable tuths by the reasonable tone of the suthor, telling thera where to ery or laugh. Occupation and hegemony, “The characters who end up inthe hospi dein Popuer UK sd US elev progam suchas Cie Uy, Holy City, or ER are smap-shotsterectypes ploti Discourses Without Borders dlestes which cannot tll tres writen hy ordinary thing which ae misnamed have to be re-explained Deore theateinte cece toric wor re = meno Oxo the tenes a irae ie mlberptemel tsetse popubrdnmas se sane chaste ee ese et tosctively and effectively command more they es mand more of the pop- in the popular dscaurse, Occoparnnn Suu Seuss to generate greater demand for thee have tocapin pactnes vcneeeee cee eis and interventions, users and perhaps other rider to mae anderen. osers and perhaps other workers inorder to mass tioninthe oer san Pa id Sg iti 08, Howe ‘Qrmalances wih theirusersby challenging the i= intereions fae toe ee eatin icmeaypecsericrere necemtoml cokes gece’ weabuy talk shut ey coughing l Platt 207. User dem canbe and cede dacln eget ee ee ‘among the tactics employed to achieve change (Abel int cen £41 2008, Polar & Kronenberg 2008, Poll cea 20080). Autcbicgraphical material or cultural repre- Cultural exchange {iustions of needs end inequalities can show how (Ven lack of occupational choice, lack of thin 1 become or belong to reduces self-worth, decree ' ° an entirely sept cate person-centered practice’ repeatedly call for flexi- users, ‘thus it is conc le tat although the ccd Lalty (Dewing et sl 2006, Lye et 2007), then aed eth ore oracle Sones orice me ee om deanons i cold abo become ia ts of he Bt apecuch oer docs ot ware Grewal dee es & Sakis 200), c2te environnents or community cing ven repent sae fbegtnon sien st ingallances (Grama 1978, 43), by whan ‘Cccupational therapists ~ permanent parsuaders in emerging roles? ws restricted to prvileged classes, but the Itan ioscalae (he dec of Florence) was concerned with widening variety of d-+b” activities —for exam- Jicof commerce end the organization of abor~ snd sual spereded i oven n educated une. ecste lt sconcered ith the practices of ey Tic the development of an itereualpracce fetteincarporete veranda element frm the cei fetal fom faundin tbe community. Occipationa {herp are ina potential good postion todo ths through tel contr with what people want or eed fo do, itt from eer aspects ofthe testment process ~ but ste forthe space in which to do fe Occpatonltheeits can, as Hormel (2007) spat ut, be ao contained by the proces in whch thy se contact immersed ard bond toby set employers, that tere ete oom Tor 8 true d-+b* equation to produce negotiated outcomes: be response to demands to prove the me of exposure to therapeutic occupations Working lives Those readers who are educators ove pri despaired at the pevennisl dissertation problem of topics concerning some novel accupational form to the profession — music, srt, dance, writing, you and so forth. 1 wat also guilty of this with creative ‘writing, My interest stemmed from a Tong involye= meat in comnvsity publication and worker writing, specifically the writing produced from a UK work ing-elass writing movement (cee Chapter 18). One ‘ofthe fest community publications I bought was Cea- ‘exprise's Working Lives (1977), Bachof itschaptersis ‘writen by someone then ving in Hackney, East London, with accompanying photographs of them that extend beyond a minima. "The etholopcal principles in occupational herapy’s working. The story that sold me the book was that profesional philosophy center on artistry and skill of Mike Christou (1977), © Greek Cypriot who (Peloquin 2007). Although practitioners have to take —desribes what it was like to run what was then my account ofriskfactorsond theneed to work within he loal chip shop. Working Lives has some elation to abilities ofthe people with whom they engage, they Berger and Mohr's photo-documentaries A Fortunate frequently wock spontanecusly (Sreines 2005). IFan Man (1903), about a country doctor’ life, snd a occupational opportunity is missed it may not arise SoventhMan (1975), concerning Turkishguest workers dyin, In my work ia enduring mental heath this in West Germany. Working (Hart eral 2008), written was frequently an isue, because the chance to do by members of SEUI199, a service workers union Something might be a rare occasion when # person which inluces health employees [see Chapter 18) is night demonstrate « hidden capacity. One service this community publishing genre's latest example. Tin describing aspects of work and involvement Berne (1964) describes the interpersonal transac. ons or games people play o obtain status and ros, 2gaition from each other, such es ‘broken skin which might be better understood a ‘my operation This ig ‘anexchange of stories of treatment processes and the the lack of other things to de prom things 0 do, prompted by he cur smal of people eehnng Fete ne ‘eon Sx ppl nw by Sn mats ne dept the darion af plage dhe and admission, eee ently ny operation’ ffs «se one fo sropl let something of ech ether erates foam af lacimcy vette to encase es ines the exchange of enacts Lege of cine nds Manan ats tre employed in evryapanguage td page ntuodertood. One dif tht cma he 46 socal osons and profesional power ae ain tained, However, professional power and the mate Fal ene from professional salaries and edestion se purchased through the power of sertiny oer aspects of ther lves given to therapists professional associations asa condition of membenhip Cline centered practice and catarel competency ‘nay at first sppea to be representations of such an allance. Both suggest incision and Be with the hols sdepinning om heh profes prac tice, paccual in profession concerned wi pascal fale S88 Dad the ee basis of culture, as might be shown in Gram loe {eadon ofthe Gnergerce of laa oe» resance lngusge through the development of commene for which it became a lingua franca, just as English Seine ae gn (0985, b, 170) Eatin had een the language of power, byt became increasing restricted to desriing the Function ofthe chuck while the functions of trade and the practices of ‘very life required new words. Edvestion in Latin a eee er and teller of jokes. He bad the vernacular “gift of oa (ce oe oo pe aoe arias may also stem fron ti¥"utopiisiam of the arts end. in erinatons tape serves ar priap qe hal (othe reed meer rl Mstry poet fan by the. Colle of OccepnonelToereps {ico 2002). These books rte he way at ferent worker octpation underpin te lol cornmunty, ro which capone theapits ao belong hugh comple of hegemonic tllances Connect with thr employers elon an profes Stl membevip ad ether ass. Lik hee Mlncn the cle the eveoped from them tnd thragh wich people fel ht they belo oruyceinandown lao mulayered (ramec Tats, 208206, Not 2003), Ina comm shee fall ecspations flo in + syria rzton- Shp ter han a ccler ofvocuresild aces Sock books duno specs scl capital, bt Shilaate wha con be of the eames Santas droped o pople-aré cacao ‘As ccupaiona ets, some octupational there te aresdy engage’ expenDiacoursse Without Borders ee a seule te oe Se ed lishers tend to develop these occupational narratives writing is about an often critical a with communities, rather than about them. The prin- ae gfemeneaieseeme Eeamrey seam tar hos would certainly apply to Experiences direct the cours z of t leration of Worker tersand Community usual xe mc areoficn ales ofthese EEaRE Morass mies recta dere: son reese Occupational therapists as literature of describing working fe this sccuncy & setae Occupation erie cig etic hs one persuaders ee A common exercise to enat reent 1981}. Peon hove leh od Wt concern things ¢ person has experienced on the. ‘The pace of al char Sc ‘way to work, or a short walk, and is built up rapidly often sts apelin Simos paterne wee eds eyo feria skiraedilg acs (tea eet tena Sing it comps cause community 2005). Much of it has simply been obltersted by Publithing need not ve the wren wed ht propre The FWWED empl! fanny he Bie cds Wich aj Gremanttch ttg Sulphide) Seeagerpecmec anti enshrined cand preted ‘publication’ to inchde many forms of dis. ‘ating dct les secon spoon cheer seen ikon tenes Seckienasnrmam x example, ins writing group) an occupa can appear insignificant (Morey male 1280 Sen stb Nm ie meter oc yt ls ee srmanent persuader 1, P. 10), someone and folk colle Stale So Sch eS mel a 1) Sie, nel rem oben moras oye yw orgies Sigmar tee Spent Cet sae Sap pemeey armel aee the written word, whether in their reading tion, often essionals who ralaatoaiae a ce Ee Tenses Ge espe mee sities oleae Selinger clsalteney sor ora pel pesade the phn hemes mer ay eee ee terapist is engaging in an intercultural English grammar and use some Latin ta (Land: ea is not just about reading literature but 1990, Vincent 1981). Other writer ie cou eda asinine et en Oh we Sl Sey ear Se et smi Seeley theese adie rene aoe (Not 2003). The prablem of the power dif- 2002, po 341) of ding and the acon of teehee alten yee role express 148 ‘Qecupational therapists - permanent persuaders in emerging roles? Pees Whileoccoptional therapistsneed to produce gen critical slog they use to describe the occupational - enluableinformationand tobesbletocompareinfor- envronmentiselitle removed fomitand solessable cea abeut occupations in uritary forms, using to accommodate essentially human aspects of it Br jascsaet ty the cent det of (fee 205) Two pales arom hoe cfantitjon the veraculat form of expressions are their analyses ofthe everyday are ranelated back nto Eee be cay rendered Inthe predetermined cate- everyday terms, they ae recognized by service users fired by sessment tons Instead they ae to. andothercolleaguesasexpressions of eoramon sense’ F Btscoveredin everyday occupations informsvwhich —butthe translation loses the critical perspective. This gee aaced bythe commanitcs we work with. In eificaly of representation ofthe everyday scent NE Wowk with Guatemalan Mayon refugees, Aldo othe cficuty the profession has imgeting the fun- Te Mgode & Cardona 2005) wsed diferent forms damental importance of eccupation heard above the tral engagement to get diferent generations medical trmult, The others that occupational ther- {S swork topeeher. Youths exchanged information —apy's profesional postion renders the translation in Shout the health effec asocated with slohol for narrower, ‘middle clas’ and perhaps Western dori- Be tnowiedge older community members bad of nant terms withthe consequence thatthe ‘commen yan taitons. Petsidou et a's (2005) description Sense’ lacks vluein theexperience ofthe service wer Uf theatre work with psychiatric clients ia Greece, _(lwama 2005, Lefebvre 2005). Kapandaze et ss (2008) description ofthe work of Occupational therapy hes ite been described as ‘Gergian occupational therapists with srt children, having an oral culture becuse itis centered in ‘doing Mecduleys (2008) work with local mental health elie (Detweiler & Peyton 1999, Schwammle 1996). The Uisin incoeshitesetng up ther ownarts orgaize- survital of many vernacular and folklore practices fos and the Voices Tak, Hands Write group of is largely todo with ther uty, perhaps in binding peor with learning difcuites in Grimsby (Pllard communities together and eaintsining thelr identity, Frar 20088) ste frther examples (6c also Chopter and perhaps alo because they ae fun, but healthcare Sip traf tse the partetpents clon begen to net easly connorte to the henith benefits of fe their occupational gendas, whether adapting frivolity. ‘The ephemeral ond. rmundane issues of the dialog of the plays they were to perform back everyday life are not as dramatic asthe defibllstors jn ther own villages in makeshift stages, or perhaps and flashing lights or the diagnosis of the doctor {i working » rapport of tust withthe Sccupstional leaving the quetened sick oom of popular cultural therapists and. Contbuting their own poetry and depictions of helth amas writing to a photography project, or contributing to the range of ats activities in thet own communities. Ieis in these everyday occupatioral actions that the N@\ ull p of politic, the fulerum of a process of con fienation can be found (Keonenberg. & Pellad Science hee to ioote something from ordinry hfe So0se, Pollard ct al 2008). This doesn't neceeeonily in order t present it as a science, but this pro- fequve an occupational therapy perception; many cess removes the aspect of life examined under its Community organizations, some run by people with Tens from its context (De. Certeau 1988, Lefebvre ‘Eesbles snd cognitive issues, are just getting on 1991). To make a study of the practice of everydey Sod doing pola or conscioushessralsing work. lifes, infect, to make other, to create a paradox ‘Occupational therepists havea particular dilemma where the subject becomes an object and loses in this imerculeual representation since though its point. Working with occupation appears to be they work with people with experences of dssbilty 30 ordinary that angone could doi (and everyone nu/or discbling conditions they often do not haves, by virtue of d#b*) and co ts effect on health this experonce themselves AS ‘new itelleczanlv, and wellbeing is not relly seen as imporcantas the practioner have gone through proceses of educa” other more obviously technica interventions invel~ Eon and acculturation that remove them from ing medicine, surgery, and regular monitoring with Nemacuae cultures and instil cia perepectives, sophisticated equipment and processes Wihich distance and objectify the community and, —“*Oneof thestrategies out ofthis impasse hasbeena sv hem ia vay that reece the dominant cultural view.” mand for research, but the relty has been tat i ‘ss therapits they have to take Bridges and develop is very chllenging to get the research published rapport in order to Taclitate and enable, but the where it wil be read by non-occupational therapists intellectualDiscourses Without Bordore and facilitate allances with those with the power to Implement it. There is the student's dissertation problem of where to start and what to concentrate ‘on given the enormous range of human occupations ‘we might research 25 treatment media. A further dif- Aculty identified by Lefebyee (2005) and De Certeat (1988) in the representation of cultures the rnge of choice offered by the media availble to us. Such is the range of production that while there is perhops less onus to do things ourcelves and more incentive to buy somethieg prepackaged, the immense range fof personal choices availeble make i increasingly dlifficlt to find common ground with others in the community arcund us. In the ‘developed’ world, ‘eccupation may be becoming les significant than the consumer (De Certeau prefers “user of ‘ife- style’ choices that we make and the vernaculars we use as a result. At the economically poorer end of the social spectrum it becomes increasingly difficult {0 catch up with the plethoro of choices. Being 2 'praticel porsualer’ as 1 proposed earice enables you to consider how ea be 2new intellectual in challenging times. Occupational therapy is bie ‘of @ mission, and being 2 professional requires a commitment. Occupational therapists’ role is sbowt ‘ding stuf? in a way that enables people to Balance their lives. Therapists must, above all, show that they are human, rather than commitment jankies, or damage the alliances that keep them human, ‘The profession retains its inspirational sttraction forme through the attention my collegues in occupa ‘onal therapy (and nursing and social work) have paid todeveloping purposefl acivties that are Fan nd t= _mulating with service users. As Breines (2005) collec ‘ion of creative anecdotes demonstrates, oceupational References i 8 Ck Mas The Tene nie ‘err of ins tocol ‘Sion nC Saks , ienmter etre Pola Pr Oca The, tar, 208 Ever Some mie A 8, Cerna The eu a ie Compaen taveson pet Pout Hs seth ayn cman oF Feng fovea rece Enea See Ap 5, Fold Nis Options Tray Whar ode anny SE Ligon, pe 34 742125-138, 2007 Berzer J, Moly J: Formate Man 480 rom the Spe of Survivor, Exisburgh, 2005, eer Chachi Besgan BL: Bapoinces of sce clas: Terai em ecapeonn thers std, Cand Osher The Sry ofa Camry ewer, Moly 3 Seenth Mon “The Siny3f a Migrant Workers Exrope, Hacrondsword, 1575," therapy is far more than a set of clinical treatment objectives, i is often about learning to enjoy fe. in secent times resources have been cut beck, and many ‘of the spontaneous things we organized ~ barbecues, walks, sports activites, and soon are often regarded as presenting risks before they can be considered as ‘opportunities, assessments which are often not 30 ported inthe practice of everyday hie A discrepancy between occupational therapists vision of change and their ability to implement it ‘was partly due tothe fac that most oftheir clients are referred to them by doctors or elge have to pay forthe services that they offer. A chellonge occupa: tional therapists continually face thatthe ordinary and everyday things that people want to do and enjoy in order to feel themselves, 445%, require « level of occupstional justice chats significant chal- lenge for maay to obtain. Yet occupation is natural, part of human nature and vernacular experience Occupational cherapists' challenge as ‘new intllec- tale’ is persuading those around us ofthe value of the ordinary, the vernscular wisdom thet arises from the everyday. To do this therapists need to ‘empower themselves and these they work with in demonsteating the vaie af thar knnwledgs, by the spontaneous and natural use of what Is going onaround us. Human beings are naturally construc tos, organizers oftheir environments, they are nat- urally disposed to Lives of action, and actions which are often accommodations, adaptations, or wanglet. Gramsci is often thought of as @ rather difficult, obscure theorist, bt he can remind us that change is not an abstract process, itis something that is resourced by the natural skills and abilities that people already possess Berne F: The Games Poole Play, Hirmondoworth, 1964, Feng, ra Boafin V: Once a rst child ow 2 leno the weld fe Kronenberg, Sime algace 5, PolardN, editors: Ocrpacial Therapy Witt Borders: Leaving fom the Spt of. ‘Survivor, Habu, 2005, Haein? Church vinetne, pp 19-30, Bean D: Luray in Amari ier, "New York, 2001, Cambridge: ert, 1868, Brelnes EB: Oeepatonal Therap “Activites for Pract ae Teaching eden, 3005, Whi. 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Grp Ther CB a01-07 thu Our Experi. Vor ‘Sa, Tana angled and Palen We oa sr ar Nonchen 1955, Guchoue = permanent porsuaders in emergng roles? Gotan E The Preeti of Sf era Life, Hermon IKronenbesg Fedor: Feit Practice Ocepatoal Terapy, 1969, Peng, "Edinburgh 2008, Eiseier Seen, Grae A Selections fom the Prien pp 163-10. Noteboos (Howe Q, tensor sd Kronenberg, PlardN: Overcoming Nowell Smith G, editor), London, ocupatial art, prety 1871, Lawrence sd Wishart ‘pletion ofthe pli mace of Grose A Sales from plical epson therapy. In Kronenberg, eriings 1981-1926 (Hone Sino Alnd S, Pau, dors ‘insor, edo} Landon, 1998, Oxrpatina Thea Witow Borde: Lnerence snd Wiha. Leaming fom he Spiro Sureiors, Grama A: Salen from Colao! Eaibur, 205, Eeie/ Chachi Writings (Forms O, Nowell Sich Uigsene, po S886 G eit, Roeiower W, warsazr. Kronenberg Pella N Invoduetion x Landon, 1885, Lawrence and Teor. tn Kronenberg F, So Wikre Algo S, Pele N, ear: Hammel KW: Dimensions in meaning Qeepatonal Thera Witut athe oocuptions of ereryday hf, Bader Learning from the Spr of Gan) Occup Ther 7h298-365, "—_-Surior, Enbrg, 20098, Soo Heer Choc Legon, pris Aan D: The Mes of Resistance, ‘hfstio Britto of ‘Combs, 1950, Combidee cepa! Therapy T026-268, _Unieaty Pets. 2007 Lawrence J, Mace : Remeber tn Hart G, Macgine ME, Murphy , “Groupes rom Rec and Sane ANG aes Waring an Hert Wor Cleo, 1582, ashy of Writing and Orat Hany Sots. Pleraso. Srscse 2008, New Ueebre Hi: Critique of Erenday Life Cary Commonty Frcs ond Syrcise (Wl I Moore wns), Lamon, Unecsty Pree 1891, Vero Hai Theo dS ond leaf H: Crit of ery ie Tornoe ith word wer (Pvt C, Foundations for a Scythe {Sins} Hanover 19, Hse (Moore J ena) Peng, (al 2) Landon, 203, Ver. Heh 38: Ways We Wards Language, Lefer He Critique of Eerie ‘if ant Work n Commas end From Merny wo Merton Clases, Combs, 188, (Elles), 13), nde, Gandedge Univers res. 2005, Vero. ckenbeny I Kayote dees, ‘ova At: alk Sng Eland, London, "Ameren Occowinal Thertpy 196, Pathe. ‘esocatin (ATA) Anal Loy, Caron, ety Caring Gonterence ng Expo, North Te neds frie wes inaled i Cerlinn, Ape 2066: Chrkte, pling and dieing ental eal ching C:Theromance oF ociptional —Sertes and ecaen, Wrexham het. lnereckl sen acer, North Wal 2007, North Hast Wale citar: Contemporary ses Inmate of Higher Ecaon Scerptine Thorapy,Chcheser, Olive: Arle se wr rath 2a We, pp 230 smeared ease Iinprocaloyd. Ranga. eae ee oat Reseed November 6 2008 Therapy Naor 1525, 207 Matic Te fad MBCA Go Iwan M: The Kaa ede caturlly Pall, Slain Dy van ecient hay Konner ers Pla Practice Edinburgh, 2006, Chacal $s Ocspaonal Therapy, Eb, ingstone/ Eber Zone, Door Scnce, pp 11-174, Kepace M, Depa M, dey B, Worple K, ert: The Sie Pale peace in‘ Repubiof Levers, Lao, 1962 oncupstinaltierapy in Geog, * | Camedia Jn Pola N, Sst, Not A Baler ‘people’ d peuple 9 oni: In Noe an ears Hammell KE Cletcened pracce (ila blgston professorsw+ fOcciptinal Mereny 342591, - Rethnpbowinderhtn, Accused Sou i eal ara Discourses Without Borders Amur Hey Basal de luethr Leiter: espinal Sia Alda, Pod N, ers Tires Bataan, ‘ray in Mena Heed, Gxepatonal Tosa We ‘ncn’ Peace 2008, Pubtenine Oc 2008, Boeer ence, Boneh nrg Mh de IUniversite de Provence, pp 557-577, of Survivors, Edinburgh, 2005, E petra Fell, ShearouD: Facing eH Chahl Ltstone, Oeule CreueWring eatin ""chalege semper masbaeg eS Git and Commanigs ier, hebetrgione cotee “Ta Por Werte Unions: ab , 205, kes. InatirdN Sats D, Lar ron Bae, Comige Ma, Crp: Danang Onis tars ond Keg eis Pla! Sah El oe Taner, amandewety, 190, acticin Oczna Therapy, Thaw M, pears A Con Dri Peogus Elnbeak, 2008, avr Scene, “Rs entre oPassieane i nel G: On the Road to Wigan Par, 2? 237-244 practice placement rece for ll Practices without borders Haontovoth 1962 Penn” Pllrd NAb A, Kenenbr ‘Shoe of opal hey Pauson CF Aho hacen Teconcepiig occaptha Soden, thom ‘ccursiood hengy hay. thaupy Bi ural Geapatin! Tony 148-355, incediehwrOepe!” Scapa Thraprsoszesos, SSR therapy in mental health, Edinburgh, 2008s. ‘Vincent D: Bread. Knowledge and 2002, Chacha Livingstone, pp3-14._PolardN, Stare P Talk Voices, Wete "onoeseSoude eek E, Noonan U: Working ogetierin Het: Voces tlk and hands wit, Nisan Ctr, Wein Cle ‘edu community mental heath {In Kronenberg F, Simo Algado S, Axiobiograply, London, 198), 16 Rebuilding lives and societies through occupation in post-conflict Serax Expy erpreferioad Pollrd Nice: Orr oe eos t lento iecnclef nad Then What det Leight cs sey aan ot areas and highly marginalized settings . Bese Ss tes Health 9:23)-242, 1999. from the Spivs of Survivors, practice, Occupational Therapy News community: building links for social change... - - . . + Pte SM: Hine Magers TOG [ute eteChurkll 28, 208 Aid Nadia tionel narratives end 'local publics’... 171 Ce ke i io 1 Wk A ye, 48 Community publishing: occupational ut Shionzpat Accenedoreeberg, Vokes Tak, Hane We tog, oe Tr 248-257, 49 Enabling play in the context of rapid social change eee sane Bree thor Wiad melee Ws At aon hg, 20 Natural disasters: challenging occupational therapists. 6... 2. 185 racic Ete Lil daeicats, Ha A oe a an 21 Ununtoursm: engaging dived peopie in post-apartheid vos hough the te ool natal Willams fine, pp 135-185 een South Africa... 2... Hn eee it Pint Muel Soul tcl ig Pon aHSSO. i WAGE Oean 22 Brazilan experiences in social occupational therapy... ss ‘hag need Tey Nae SSD M Hi del Lire ggg) ath Tete 25 From kites to ktchors:colabortve communiy-based cocupacnal 2008, rie de Langue Francais, wicces', Townsend Bs Occupation therapy with refugee survivors of torture... 6.0... ee nee Pollacd N; Notes towards an approach for Pars, 1986, Albin Michel. ‘termiaology interactive dialog Py teens use ofereativevnting Ross Tales of he Rel, Beal, 194, Geert tela 24 Argentina: social participation, activities, and courses of action. . . . bt In Senpacn fect Greate Sila D Pad The ses of Soph en Swe 784-98 28 Crossing borders in correctional institutions een ea Writ ath an Sel Care, cnet nd opens Wie Lien atc Fa, : iretoko Wor Tandon, 2004, Jesen Kingsley, eer and seal. In Pale Ge ae 26 Occupational apartheid and national parks: the Shirete oe PolndNetecoringteatince Bah DEER SHOE Son Hertage Sto eee eee reese "eal of OcetnalTerpy tT, Eda 2008 Ber ise eee ae! 27 The Kawa (river) model: culturally responsive occupational therapy _ Peds Adam ed eS Ree wien without borders... « aarp eae Adam delfand oe Schwleb Reesnson au ieee ‘me conpatoal henge Ucn The ord wan of ey ace abe, 28 Human occupation as a tool for understanding and promoting 60 aac Infebnd Ne Sopatend Geayy Cn) Ocag opilueicele eee aan see eee ce ‘Sakellatiou D, Kronenberg F, editors: Ther 63:62-66, 1996. ‘Woodin T: Mare writing than welding; human spirit ++ 279 Elica! rier Grapatinal Sire Uses Adiey Grou: Nothing" nung tr heer po 29 A reflective journey and exploration of the human spit... 5 ae ary. Edbgs 2098, cer Us Wiha Us Doarent sf pasts we : Scot sas oe ‘et ee Harr of acon 36561-378, 30 PAR FORE: a community-based occupational therapy program oli Wath §: Ocopatna Atte ew Wid T Maing the Wes: they pair andmertal ean pbb tects enya lahat erpecin Bevel herugtsbieaces/ age ct Ment wrkg cise catalogs, Rovember 6,208 i 2 Ware Ke Reading by Numbers Pele Nica Wang wah Soe P Abe iter aoe MRM Rede Nabors Pelee the sm In Cee, ber ker in ener, iter Png on Fo 152Rebuilding lives and societies through occupation in post-conflict areas and highly if 1 marginalized settings Rachel Thibeault OVERVIEW ‘This chapter sums up lessons leamed while ‘working collaboratively with people living with leprosy or HIVIAIDS and survvors of war, torture, and landmines. It offers an overview of the main ‘Sccupation-based modalities used with these populations through the course oftheir recovery, ‘yom trauma to full socal rlnsertion. Not an ‘exnaustve ict ot possipies, mie onapter ie maant ‘as m illustration of a process. At the conceptual level, the content is anchored in community-based rehabilitation (CBR) and community development ‘ensts and in the Pati Principles, the defintive ‘document on the treatment of children associated ‘with armed forces or armed groups. At the ‘grassroots level, it reports participatory action research findings rom Burkina Faso, Ethiopia, Laos, Lebanon, Mali, Nicaragus, Sierra Leone, ‘and Zambia, gathered between 1988 and 2008, ‘tho recut of community decision making inforrned by the priniptes of human rights, social inclusion, ‘sustainable ivelhoods, service integration, and ‘the rebuilding of ev society. FREETOWN, SIERRA LEONE 2000 Thecestycowaa rena sian aang, rcs teu, cargos ton fe mi end cance wo he Spree cay cated wens chad ed Scour tn hon Wobloued sp. Boe twos gt one ace urd wos oe She Sches tt ce eres ig Pe Nera ‘renagen shoo aginyreassoowa peer botched) amputation, as if jal happened to sorneone aise Sn yorsaps ee oro: wen crwrt 0k Blee, or Wo was there. A commen occurence in SSrataside ch war wre anoy on be ay we a @ ‘Tee goup ed, a stengy beat aa wean aches or «ors and wih a snapeng sound cs ho remaining tendon. Haling be do hand win ne cae, she puts eran arora ta gfe sours ae says so: "Tomorow marin, with your rearing and, you Wl o> fetch water fr otter gro your Dareck For 8 Western-trained cccupational therapist, these words rsogted with disbelief. How can anyone ask Daything of a young worn so wounded? Coulda ‘he il be eft alone to Find some peace afer the ror she had jst experienced? The group leader saw ‘ny unease an took me sie. ‘Do not judge ms dei- Sion by your own cular standards. Hee, i Sierra Leone, there sone path to heding: nding your place within your community. And this mezn contributing 48 soon as posible to collective wellbeing” Months ater, while discussing sigfcant moments in tele recoery, the gl vices of war all egreed thet rebuilding their individual identy through Securing s renin sole in thelr community had teen the most pivotal step. The performing of uefa ane valued tasks fod stered them away Irom drug dtuse and suicide, Te had saved them from despar ad provided them with renewed dignity. Thr tee ed on ony: an ccupiod the et earning essential lessons about occupation fromm Erepvers without any formal tering who hod Syontancouly trned to ft for the trestment and Teintgration of bighly marginalized group. Over the yer, im learing has taken place with awide variesy of popultions, from people living with lep= rosy’9¢ HIVIAIDS to survivors of wat, torture, aa llilisies.Each time, new insights were gained fd new posites arose from generously shared local knowledge and wisdom.Practices Without Borders This chapter stemps to um wp keons aed and offers a ovrnew a tan ocpaton bed odalis nad with tae foo gh the cour of th covery, ota ofl se reuerdon sot marta en exhate is poses trai an durin of eorsee ‘the concept! lee the content anchored enue chettaton (OBS) anders tty development ena he a Ponce, ‘eet coment ree SSsocted th ned feo armed gp (ON 2007) Ae he rots lvl rpatspapseny dion research ings rom Burka Fe, Bap toes, Lebanon, Ma, Mn, Slt Leone, ea Zsbia heed Been 1983 OD, he el ef ommanty decison ling foes an ple of oman righ, cline, sae lived, sere lnegatn and Be ners of il eaten. An occupational continuum, from individual trauma to collective rebuilding of civil society Occupatin-bsed modes conti the goken threat for cosa intrventon Tmscetiog iia hy on sn he whe oan, oe sume %0 sical rcntegaton and the reat Febuiing of el ace, wile crv apuce where meaning and healilg an be gen (angie ape “The taxonomy sted below to esi occpations sy suprise docs ot sem om ty rcp tee Foremeincogrvenewihaphenerenaoye {preach the sleced terms hae bre clned the parcipants themscvs and expres in thee wordy the Festre they covedrc key. For em, cpt fred employment en ess ‘Sed inanncomegencrtng content Semantic they orerahlnghypreferrwordssuchessey task dy reting, won tesponsbty ber sctontorendertieideaofenesing wht iot cater wer: Thir haces prod, Ase, the observations es soot eal offer aren wih ere mh. ty wo ving with sey oy fe the same ches asa young anid rod the ear tad keepin chat otal wlaealeomrasis ll wndertks on identical proce." lge degree 156 the lvl of sgme seme to determin the bea of occupational needs, the most signed seaast Jing the mest support” A ranking of ots arose te time, bated not‘on foil research, bt dered from snonymous coral group exereises and ver seructued Interiews with users of commen bealhareseriain Zab, Stop, Salo, and Nicaraput. Clear, people lag th ey fnpeared more extract than people Wing th ‘eral nes, vba in ura were wore margeatood than people ving with AIDS oe child sole Torture tin nd lndimine euros, on theothoy hn, faced less prejudice. Bocse of tht nay difernces, nt all groupe cequte the same rage oFinerventions decribed i tas chapter A cre Print: people with lprsy often strongly oppece social tegration, deeming it wil only arg then restr rejection and sufeing Such + comin equises Intensive Intervention in tea of incon, generation but mininalInvelveroet for extra soca networkng. They chore to rena lated, Femoved fiom society, decison that is aathems 1 st ohn wer nd on 9h sesins the grain that challenges out adherence a the pai of elen-comterednas Some occupations asso. with the acute tre: ted it phase Physical trauma occurring in a conflict area Following physical trauma usally caused by bullets, Tnndinines or machetes, mmediste medical needs saust be attended. Emergency care (cauterzing, snestheticng, csinfectng, bandaging, etc) obvi ‘ously supersede any other intervention. Only ser stabilization is achieved will we occupational therapists take into consideration isues of stump preperation, orthotics, adaptations, and other occu. Pational therapy modalities. These are not always ‘arred in a smooth, logical sequence and must rely fn the zesources et hand. Not infrequently, the ‘ceupatlonal therapist wil have to etl fr temper rary adoptations that will quickly become obsolete ‘once prosthetics become avilable. Typical of con. flict area are the acute Shortie f supplt,difcule delivery to the work ste, poor eraftdnanship, and arduous follow-up. Adoptabilty, boti'on the part ofthe client and the therapist is key. psychological trauma occurring ina conflict area B cperionce has shown thatthe treatment of peycho- Boral uma need not be postponed until physical Bling has bean. Is face, simultaneous paycholog’- sad phyal care seome to yield the best overall gutcomes. Without treatment of post-traumatic SH earning abies ae seriously impited, = Shenomencn tht impedes recovery. landmine e- hors renain oo traumatized to process what sid ey cannot grasp their own treatment plan hs lck ‘Sf ndrstanding can translate into fear and diene ipeement. Since in ts hmmedite, acate phase Parana shock disorder (PTSD) presents with raved psychomotor changes, hypervigilance, disor E funtion, and divisive elements (Kay et al $000), survivors often rect with fight or avoidance. qh some eases, hallaciatons and paranoia wil so 5 he put of the linia profile and extra care mist te taken to create a safe therapeutic space. From E sx cccupationl therapy perspective inthe contexts depicted above, sn oceapatonal categories have been shown to forter” centering, meaning, connectedness, sd healrg 4. Carta dais: In many non-Western cultures, the Celloctie identity outshines the individual one and onrbutng vo one's communi i sine qua mon enelon fee healing and recovery. In the Sera tse fic an pono euros of rape and amputation were quickly asked to put ‘heir residual bites inthe cence oftheir new {ound corarnty, Caring forthe elderly andthe cnphues appesed the preferred choices of those Surewots whose hyperiglance ad ceceded end owe social kl ad re-rnerged fs intact For shes nt ee of te FISD ae Solitary but sill ncaingfl occupations i Feeching wood or water, or doing the laundry, ‘brought sme sense of peace and usefulness, 2 Sail stats chart: With some subroups among vror survivors, the nse of dignity poses self etal. Por ample for those chil soldiers who Fe ile nd oe te reais reps selfrespect might seem utopian. To rebuild 8 digufied identity, matching the severity of enmumited totes with task of high soil vale hes proved fe fein ‘che blind tery cases with a Send of responsibility, ~ aur and tras that few oer cecopationshave “When, under earful supervision the cin who Aebuiting lvoe end sootsties through occupation Ine perptrted the worst crime trite with important dati, their slpercepionreccly {he long with tha of others Their occasional featur pons them a second chance to ssert. thenostes ina pest-conflet word, These cidcen sen oan on ecatin sce ‘tpi: baving ied aol for yar, hey soe were deneang Tey ve tac Tenders and often find their new Wetites in peel leadership oes. rnd, modeling actives: I the enospere of sspchusnessuounding any inge sai confi, trust becomes both ere emmodity anda necesary therapeutic goal or wae surevor, bring onsen simple tino ce gong tothe market, ending ‘hurc, ox weching Toes! soccer game may ‘epresnt on overelming challenge. Severe ‘Reletion rapes and mutations hove taken Duc in howe serngy armless concent an Zhe removes ae still wid. Yet, normal soi lie most recwme, Mentors caeflly elected fuses who have completed the rebbiltation proces ed can offer a stron, resusing Presence, tos lead neweomers in the relearing [Fat soc lle Together, hey setup tml boot a the ait round as sor segeables. Or they go asa sale group Send church or watch the game. Over te, ‘Sscteton ocurs and nome pater oF ineretons resurface. The programs rst on 70 lear therpextc tain eons but rather on three clei evens woven {be ocupational abico daly lie. Conversations Siac etme do take place on the vay tthe Inarket or tthe fiver but in«non-stlmatcng wirenment and ath srr who ea gue sethou contempt whl providing» role ode 4 Groin router When the ghosts of PTSD eappost war srvers express a need for “yh, soothing occupations tht bring them brokeocheiionnedine pyc ely ine pertle sence ay, Gad wh Tcitional oes, running preping singing all mest {heperpee. na proces that could be ikened 0 rmedation (card 2008), replr daily practice ems oo Lad to grater, deeper wellbeing Spun spe se and od sur ae fered the physical meng eanspiation, Sons, tapes, vsts from elias Rue, ete) to oonece moe realy wits thei sources of spiral solace 187Practoes Without Borders 5, Tasks for blonging: tng back into socety and ing genuinely port of I constitutes the most Ail sep for most War survives and other ‘alerable groups. Stigma remains haunting|y present and the sens ofcnnectednesat the core of all mental health becomes else. To recreate mesningfal webs, survivors often favor collective occupations thet canbe practiced with inion Interaction, Sifting ain with ‘other women at the kammee mil, weaving cotton Side by sid, fsing the nets when the beste cme to shore: these occupations requie some contact bu tle speech. They allow survivers to ‘ow familiar with their environment and contro their owa reintegration proces, s0ugng when its comfortable for ther to speak oF aot. A ground rule i established from the sar the mecting place i tobe safe, sacred space, where no pressure is applied and ‘where respect prevails 6. Prevocaronal sis: When the fear of socaliing has been conquered and community tes are being restore the dese fer financial svtonomy usualy takes hold. Survivors each a pint ‘where they wih to explore their Yoctonl potenti. Incermews are carried around coch survivor's history, ase, sbiltes, values nd reams, Occupations sre then found to capose survives to situations similar to what boo been identified inthe interview. I theres 3 good Ft, prevocaionl tuning sat, a series of Sequential occupation leading to the desired profile ‘more closely the regimen their content and References 290. Thay rere anche about et he changes and Girma, shaking wits laughter au args i art tog eosne the loo metal ang. Heest hs rit ag to landing, When he was & Canta, ‘The sna town of Povsoys ad alvays been a rsa ton forthe ic ks fem nigbotng Loon, eu beyond ‘hp try hare, thecal Fehon Wed hn ovety nd art ying to cops wth ho wouncs by tho we Scars vere overynbere nthe destled ens, the ‘cumbing heatearo and edwoaton sytem, te crene Unemployrant, ae sights il reling out between cx ‘herice Paeioyatadtaned rio the socal eqn ofa Drdjlandhe Hyde wastatheporuarourettiactin sand a beck communi nee of heal. Ilstatedoutwdhnachotengr ool trenebtaion senocet tm ex-reiee naval prego coucoriy sctoved trough ha caring of eanuroes ard progres, ‘Seep th enetrng tension, Once unton had been raseredanaincam govern beoue prose, ‘mcothance hones were designed ht Gemercod eve ‘loser colaboraton. Maney ae brit teas composed ot ‘exContas anc ox Sandrstas, whose nrc eunial ‘epandodon thr wi to work togthr Mss ray (ve way tosaldatyand, nts a commuy undeda feng cecperstve. Win tne suppor ot biog, Py ‘naire preci were sstarabloand kariod pow to ‘roto ti erveormant. The waren, ned as feeged price, sed tat pat cro prt to ecm ured and alow tho moat Wary ‘momber oghastane otha vein: the rehab fe ‘mango, an encangtes cost acolo al the ‘reproduction flndemainspedsandirthe protectin ‘foore drng rane cessor The fsheren ecg ‘tin olandandrenodaos ars, an eiganousand ‘ere gps tat ad verti rough owing a ‘ereraionene, Thareflesowyronvetnorngove ods ‘eu tah cemoboc, parts Bred and 2 sa ecto ‘ceopetetvels drow to baiaunenea Tha beats a Pens en cari ew sounds ne eons luda Pees BiyerC, Klenk, HabertrA:Auocistion Mena R: Microcredit forsef-ngloyed UNAIDS: Excetee summary of 2008 "of Teama nd PTSD Syrnpos with permas to reconlistionandfooig: feevenge ron ore: Upsan re ch sliders Jotmed Amor Mad Aes 298(9}:555-55, 2008, Defy Brocka E, Schiyten G, ‘De TeemeraenE: Pst tri sees informer Uranus cil ‘elders, Lame 358881-953, 2008 ay Toman A, herman JA "Bhi Behr See and“ ‘Cla! Exot, Pildlphin, 27000, WB Saunders." deladperoeinderlp ingen, 200s, Unpablsbed Onze Aafale sehtp/fmenunre/euldrea! oe. documentaries! PanaPrngpen EN pa Acese Fly 62008 Ricard Me Lar del madation, 2008, ‘NL Pais rey D: Education, lence and rsience in warafeced ers ‘Sire Lone fn ecotal approach, 2008, Unpabished diserstion Facaly of Education, Ulery of ‘Oca, Oras, Canad st ‘Report on he laa AIDS siden, 2008. Gntine Avie hep? usaridso/pub/Giobalepord 2p0g/FCIsit ORO ‘ExenutheSuimeny emp ‘Accs Jl 6, 2008. ‘nied Nations 207, The Pets Price, “Thepncilessadgstelns en cae socred wath aced faces oeoed (pougs mpufewwunoryten! afi im! PasPrincles ENE Yun M: Banter tthe aor, New Var, "203, Pale Af.an The CETRAM community: building links for social change Daniela Alburquerque Pedro Chana CETRAM Community OVERVIEW in thie chapter we share the social and community ‘experience of CETRAM (Centre for Movement, Disorders), 2 nongovernmental organization in Santiago, Chile, South America, which has. adaressed the haalt-dsoase concept by going beyond the conventional biomedical approach, hile 's @ country with extreme inequalities in cess to troatmont and rehabilitation programe, with vulnerable populations such as adults lho are physically disabled by chronie and progressive disease particularly at a disadventago, In this context, ccoupational therapy has ‘merged as a tool for change, by erecting awareness of issues In @ way that focuses ‘ot so much on the disease ise, but on the Social conditions that nurture the problem, ‘and ~ consequently ~ holping to develop the siralegies necessary to produce changes in local practices. CETRAM's practios focus on interdisciptnary work based on soot, Understancing of tho problem of hoalth, and Interventions directed toward the family and ‘community by tha health team, thereby strengthening leaders of disabled persons and ‘generating peltical and social intorest in change. Gccupational therapy has been the articulating ‘tux betwoen the contributions of ciferent Professionals, user, family and the community, ‘generating a joint understanding of the problom ‘and favoring toam work fo achieve both individual and collective abjactives. We hope ‘that our exparionce is able to show the ‘of eccupational therapy on the change of paradigm in understanding nésith’aneliow it & ‘key playor inthe generation of profound." ‘Social change. ~ 2 » » Introduction Chile is located in the extceme south of the Americas. In most Latin Amercon countries neguale ity sen inevitable consequence ofthe pliscal and economic climate, On one end ofthe sea the high est income group, which reprerente no more than 5h of the population, consumes an extraorinanly high poperton of the ean’ eavnces al pe tunities, while on the other end, groups withthe lowest incomes ere unable to satisfy even thelr most basic needs (Rosemblath 2005). ‘The economics ofthe health system reflec the same inequality with slack of democratic account ability in the distribution of services and zesources. In rehabilitation, ENDISC 2004 (First nationl sty con disability in Chile) hes idemied that of mare than 2 milion disabled Chileans (12.9% ofthe pop. ulation) only 134.000 gain ecess to rehabilitation, ‘ie. 6.5% of all disabled pevsons (Fondo Nacional de Ia Dscepacdad 2008). In this context nongovernmental organizations (NGOs) (ncing CETRAM) and groupe of disabled erson are crested seeking cooperstiveactiontotyto btsinbeneficsnotofered by thestte suchasthe pur chase of medicines and acces to zebsbitation thats not provided efficiently by any ofthe existing health systemsand to guaity of eof ts beneficiaries which isthe result of the impoverishment impli in being disabled in Chile ‘CETRAM was jointly created in 2001 by heath professionals and groups of users (Pandacién Disto- is and Agrupacién de Amigos de Parkins) (indi! ion Distonia 2008) to develop trestment programs for people with chronic debilitating diseases. The we "Practices Without Borders rain strategy, as agreed by all the stakeholder, adopted a quality of life approach to minimize the effects of the disease, Consequently, the Centro de Trsstornos del Movimiento (CETRAM) has tecame 2 reflection of the prevailing biomedical apreach "Today, we call our centre ‘Commie Cetra’. ‘We decided to keep the meme CETRAM az 4 symbol that paradorkcallyhighlghts the fact {fat the disease lone i not the only eh problem suffered by poople. Underlying cach agnosis complex realty produced by the dbl experience Comunidad Cetram is a group of actors frm duferene areas, people with, functional diversi, relaves, professionals anti, and an expanding net ‘workof social educational, nd health organizations Webeliveina differen soil health concept, based on the search for wellbeing, not only through the absence of dicate, bat alo though the right of every person have a good qulty of fe and tobe recog- ized as a tl part of society. We sand against inequality that ental lack of opposites, poverty, and discrimination, "Working from tis perspective, ou interventions sim for an inderstandng ofan inva salt “ation ina specific historical and socal context wh inclodes the ines. Thus programs to establish helt invalve not only drug therapy of functionals therspeude erateies, but edeo eduction, socal, analytical, nd political element, ight from the very firs ime «person conslts the docter. Here we present the way in which we have over come the reductionist vision of health, which Is prevalent in traditional helthesteproctics in Chile, and how occupational therapy ~ with it soci end Community perspective ~ har faced the change through the use of four Intenention methodologies Jeine Care, the Situational Approach, community lar der, and Calectivo Habitar. These methodologies sim toward set chang, ' movement forthe perma nent recteation of collective existence” (Montero 2004) ~ toward the freedom tobe diferent. Joint care, encountering collective histories ‘Those people opposed wo sal reforms wil never be samong the ranks of men Betting on tescendetel ig ers 4 a 104 Social change, a shared dream that drives the prac tices of Comunidad Cetram, i¢ a complex process thet, in our vision, implies a paradigm change. Kuhn says that paradigm changes are ‘immeasurable’ since they are not evolutionary processes but scientific revolutions in substance and form, lacking the con rity between the before and after (Pérez 1998). We call for a global change (Pérez 1998), for a break in paradigms, resulting from understanding reality from a social perspective, That in order to achieve health, we need to recognize that itis the historical, soca, politcal, and economic conditions that produce the health problem in the firse place. However, we believe this change should be slow and carefully thought through, beens it generates important individual and collective processes, such 4s the elimination of the supposed ‘power’ of heath professionals or the different ‘ast! of professionals, something that has existed for many yeers and gives Individuals a strong sense of security. Thus, we intco- duce social end health actors to thie understanding through the seduction of new ways to collectively ‘construct realities, which helps them recognize that in essence the social paradigm is participatory, as is the construction of reality. ‘The first stage in Comunidad CETRAM': pro- posed way to produce changes ie Joint Care, Joint Care refers to a collective space constructed by at least two members of the work team, They work withthe client and their companions to create a dia- fog that explores ther life history. Through thie cok lective setion Joint Care identifies how the existing situation (which may or mey aot be en illness) impacts the client's wellbeing by focusing on what the client identifies in ther contexts Ie takes into account individual and social needs as wells the pro- blems posed by unmet needs. The objective is not to deny the person's subjective experience of illness, bbat to broaden their perspective and understand the social factors thot produce the disability expert- ence given thst condition, which we describe posi tively as e health situation (Vidal 1980), ‘The Joint Care process ha three steps 41. Interdisciplinary team: Joint Care requires coordinated teamweorking based on the principles of interdisciplinry work. At this point itis Important to differentiate between the various concepts regarding teemvvorking, We understand ‘ pavnultibieipinary team at a group of professitnals who contribite their specific ‘knowledge to the understanding of a health” “The CETRAM community: buiding inks for social change Ei situation, with practice segmented or divided into fsolated elements. This type of organization sssumes power based and hicrarchichal relations between professionals, The main limitation of thistype of approach isthe dificoly in integrating knowledge with the understanding ofthe problem, ‘Traditionally, and in order to segment work, efforts hve been made to reduce knowledge to specific aspects. Aninterdsciphnary team is defined as ‘the ‘coming together and cooperation of two or more tliseiplines, where each one contributes his/her ‘own conceptual schemes, ways of defining problems and research methods’ (Ingott 1999). teint Care is provided by e team that shares knowledge and experiences in a horizontal dilog In this sense, occupational therapy has been fandamental 1 the establishment of commen ‘criteria to facilitate communication between professionals, such asthe prioritization of problems felated toqualty of hfe, occupational performance, peychotocial wellbeing and socal inclusion, among other gous. Different professionals find tots in their oun disciplines to contribute to this process. However, ifthe reality ofthe sitution is ‘understood haced on # toca or critical paradige, ‘eamrork must fllow teansdiscipinary prectice, in which the different aces are all coneibuting ‘within the same paradigm. Ieis an llimce whereby ‘eiferent theoretical approaches are able to come together harmoniously eround certain rmethodelogical assumptions through which {intervention procedures and techniques are ‘established. These can be developed by any profession or participant (In this ease neurologist, physiotherapist, eccupational therapist, speech therapist, paychoogist relatives, ‘users and more) thet intervenes inthe process without contradicting their own viewpoints (Unglote 1999). At presens, CETRAM works through interdsciplinary veams with the expectation of strengthening transdisciplinary experience within the center, which val be subsequently systematically organized end disseminated. 2 Historical narrative: The interdisciplinary team, facilitates the sharing of life histories. The tool usediethe interview, understoodas conversation wit 2 predetermined purpose and mutual “agskement between the interviewer and interviewee, This retiprocal agreement consists in the recognition of verbal and non-verbal cues a eae oat es hast i ie rere ab oe seer eee aoecta gino ence ered Se Seren ee ee Seay ae ee See aaa pe eel an ree ee ea her ae Ooch Sects ee ee eee Sntoraccoanice es eas eee eet erat gote Se free ee ae Fete peeeiorre ene eens oi eceea eee ee {Table 17.1). ee Cran eran ee ere ea ee for individual intervention. To address the problem 108one! sense of belonging and identity, as well a 3 Practices Without Borders Tbe 17.1 Determination of th problem and solution strategies, Forms of reasoning Dias faced actions taken "at btbers no est ten pape eo ate en ake “inst my ob beau wy aoc, sitarapy coleegues don hi ican_irenten be saat “iy ay oes eden tal cart career eration ave qe from a social perspective, three collective experi ences are developed. They arc described below as ‘practices without borders’ and are discused in order of increasing complexity of action and change pro duced: the Situational Approsch, community lea ders, and Colectivo Habilitar. “The barriers to overcome are poverty, socal deprivation, inequalicy, and the absence of a collective voice that is recog nized in the exercise of their rights. Situational Approach: interdisciplinary practice in a real context Wall kaw something. We algore someting. That vehy we alway Term ‘The Situational Approach isan exercise that consists of addressing the problem through interventions delivered by the heath tear at 8 community level. ‘The subject of the intervention in this case ie the community where the problem is being nurtured. ‘The community is understood asa dynamic, histo ‘al and culturally constructed and developed social group, ina state of constant transformation, where intertelationships between its members generate ¢ capaci wert the group as socal unit withthe poten tial t0 develop and use resources‘for its purposes (Montero 2006). 498 Probl rom the indldual Wewpoint) ‘nyt o ess on sat: etem and ‘maremart problema enon, Loss of wok lessee nary Problem from the soca viewpoint” ations tkon A etarn ets bocaso of eg tren nce of eecrnistoneavaten nasi reatne Functelt and proaieve pospeare ithe ‘sastcten of the ijecisocalprcopton ‘its, ronson Fri raver ft ell fhe sss” No canserao of any Sonsucon cl hath-nesoPatlpatry ofiaton att eh ‘This Sievationsl Approsch sims to strengthen Individuals and groups so that they may make trans- formations to improve their quality af life and access ‘0 goods and services within thelr society. AN EXAMPLE Backrcart tamiy uth consent ae irda vals, consist fa husan are ie hfs oi dougie, where the father nce hes basn te traadiwnna. Aver saan who mag eat els to ‘cverome the poverty and euron offs Schone to become a selempbyea envepranou who oad proudly ‘owe hath has previa ection frat hs ahve Tox ia Peath sian Prknso'e cess) provers tim am wering and is ey eres of names the ‘Slate dsabiny bans, when slice his cay ‘erponias Ard’ we ar coughs must ako chee of the aay buses ard he ergsniation truth ‘ches, ofthe tnances and separ tat As Used to hance, us eckcing heparin ay ie ‘Tay paceve a Breaidonn Merle aoa nan ana prove. For Ants, te probes his oss én both is ‘armani and vie the women of his erly as 3 ‘esutothis cabal. Theyhave boo abla founda he {asks e dl, ard athoush they marta a laonshp respect and afocon wit) him slater ane sean, thoy fe esramod tort of thr commen. eed ty Iolite Anais ore about is cay, ‘The rtedoopinary tances thee worn and a man, Ants esas rece stlonson om ve ‘gneral rentoning his srnojance about the dependency "ded cahorequies. The mani the iow ie nauoopet FH esalshesheinkbetnoen tn patontend the eam fer Baan therlsventon ais ble oeonaucts sca, bout Anas" Noy an present pant exrerenes, ‘Te est of the team engages with the women in a jain project that will address management of Andrés fpovement, cognitive, and emotional problems, Gen- der differences are analyzed together with how ble nce could be established between their performance a entrepreneurs and André participation in vars. tional decision making, recognizing his residual sills ssameans of being accepted by others in is emir. rent. Ieterventions with André" community are fain made through the women of the family, soho fave now acquired knowledge through participatory ecivcation and can talk otheirpeers about gender di fecences and ther soles in life Tn the above example, the roles of the team ere determined as 2 function of the problem ia s Ssxio-historial context (Montero 2000), The ply Gan conducts the interview £9 understand the life fistory eso result of link established on the basis of gender. At the same time, physiotherapy and oven. pational therapy intervene on te bass of the health problem and factitate a health edacation proces led by che caregivers. Community work is based on collective work (Gterdisciphinary and tronsdisciplinary), seeking to enhance the strengths and ations of the communtiy, ‘owards a beter quality off. Thus, the Situational Approach is the fist step tothe real context of the state ofhealth ofthe subject, Continuing inthis seme line of work are the nexestges inthe approach har- rnesing community leaders and Colectivo Habiltr Community leader: strengthening grassroots Culture is not the exclusive attribute ofthe bourgeoi- sie. The so-called ‘ignorent’ are cultured men and vwomen who have been denied the right to express themselves and are thus subjected t0 living in @ “culture of silence’ (Frere 2001), A group of community leaders was formed in response fo the need for organized participation on collective bass. The group collaborates with Cornu nided CETRAM through the practice of Joint Care snd Siteational Approach, end represents the inter= ‘est of their peers and genecates commitment within their community to overcome problems related yrr""to-tKe soca-health situations they experience "(nero 2008). “Traditionally, wayb to generte the partion of abject have Tocsed on the developmen ofthe ‘The CETRAM communtiy: buiting Inks for social change competencies, training, and ernployment, functional rehabilitation and recreation, but withost appearing to resolve the main problems. The concept of ‘empowerment, an Anglo-Saxen word adopted into the Spanish heslthcare terminology, has various rigs. For the purposes of this chapter ve will use Rappapor’s (1984) definition that refers to 'a process of acquiring that capacity to command and control. Empowerment would have 2 components: 1) Individual capacity to determinate one's own life and 2) The possibilty for democratic paricips= tion in the life of one's community through social structures, These actions of empowerment reinforce indivicalirn, Unlike wht has just been described, our practie ‘is based on the concept of strengthening, understood ss: the ‘process through which the members of 2 ‘community (ie. as an organized group, rather than an individual process) jointly develop capacities and resources to contol their life situation acting in 2 committed, conscious and crtiel manner to trans= form their environment in accordance with their ‘needs and aspirations, and transforming themselves in the process” (Mortero 2005). AN EXAMPLE, Coie 8038 Soy ror utente cethe neduraa @ baannton ale Steere tart psp in yi ab Merce com Cette ne Srpoesmetttencumn os een i ‘STonh ceng ben ss Famras guengen rence he peta satan ‘St coy pope bem anita ae oP Somcete bree bbe Fb” Sintra connote nates tan aot Satan ine totes weneeergas Fosdina ueiewinoeaacpuance aon Sonesen ons tosh con Oo feasts Gon 20 hy soe! arm Geno verre eect bar ncaa ‘us snscorran so ahen Te eg eas cee conrcito he anon soarg meow ft commniyalou date tregh Foret nd cab ne hate erent Paar sobehcs nary canes noe btenspogane Sea a ni we ‘Seundby n conmay ert ain Stponsyne sober tame coe | Senet owen = Soon cet epost of oer h “Gee gudehrertondooderowene Tey mec) Romcantuabeciins A eetagte ty cues penton dheathonessstonscey te Stans ty oy ay hr ose erprctoe te ince ration of cl slo groups, Feprocont tho corenunty rao programs ain he ‘madi, se wel devobpment of pubis poses local towel io facltste acca to soca aath progr nowe eons nomen. Wie have cscussec th pacts of CETRAM and the thearoses-practes contovton cf occupational heaey urea the change procs, Te ast paces wihout bards represents an acton tht nent mals ey ciao pripent, where he erat for toto overt het we constuctaeeity ater and more competence: Colcive Haba. Colectivo Habilitar: ‘dreaming about the right to be’ ‘At the bean he woce bec a seen, And the ‘seam rae boar Ad he oe bean collective dance And the dane came sc Ard the smach Became tite eae Coletvo Haiti grup comprising students of heath profesons, primary occupational Cheepy peopl with finton very. ates, ws, Sra, tes wh fe Compe to rents 2 space thet evdener the dyoancs of cxclson in ur society, and tht reas in rary cles Inbles'ieren simply because they fatto mere a esthetic, function, or posite assumption ese 2007, “The vison, calacevely consnatedy sates 1 following: J fs aba acacia aon inden cd inl tne fa Sep tat eae egal eee sand that such diversity enriches us all. e Weinerdo ene pce a wi eles rttbow front wete onic enerenceot tren n oft moj ey, eal She nd pprcis protig po Stina tal non eet ee, ‘coption od sce coco ate ce thames ny ten a ee nd ole bir nsiogrotpa bape he Seromcten of hcce = tr wae ‘that freedom Toe a eee (Cec Fain 008) ‘The exe if hi olecve bins wih the eval ation of cnet gros tht limit eee to Jess mobile people. iced bys trainee eceeatonl ‘tierapist, who has also been a wheelchair user for 168 mee then 10 yer, we evhute access ou im ey ses ofthe Cleon cope. The neo, ton seponse i aot conceaed with beter mobil training for wheelchairs users, but with the pable. 4 Snite @f wetect he be ‘stants to ne ropneie eee Se seth glnoyegeeng eens eee force in Chile. ae Acted On ane ues membec hve stretched the definition of interven, Soniye hvac! ated pene ‘econ wit acta pane Schade gee ghrens amd eee coi ols of ener one eet hee oo eee eee Benpat kann report fe poche wo mplorer pester [Sr ramabar re cier toesenn a eee eee eee Hosen the conmiy: The santas ee Sienna a Seales era the state (Rozas 2003). i The clone coroner sexo sigh eee eee ae Seta Sacre a ato nce Bu moc by nny seh ne ae dion seen iene Tes avon bewinien ed cer geet cole Toy, eae en ot ee ce ote cmerne cf Nocatee Cae Haar tk oe the ees docstoc hy ans of py ml scinied te stenon of paces af eee tnd thera to conte aficerosaee Goat pees ae cee tesuc tye Biodesign es deer deseo dhe ube ple rape see Siem nent eo main beth ton selec ae peed ca Create at pc nace daemons fella! roneae of ee ae the ncedsf vc cto areconaine mhistoed mveens, tee eae ane tansy ov ened ea da lee oes eo crf rcfome sini feee eae Soccacemaspeant epeyteae ne ‘retical extremes! One fh Vision of collective action Serpe ia et ean mnldoteyocda okey teeicheereeae Tnvtieobe a besos i care aeneof history and incon nd fn ei sgn of nc change (Ouveten 201) E “Colectivo Habilitar focuses on this last assertion, eto demons ae st part f the take Sa group hn nderaen bse on profound Miah eve the salt sep take we ather Mehrotra cic a ‘rong foundation for sacl change Begining Shite ist encounter tat the real of the dig E> nosis ofa person's health situstion from a social histor- tal pecpectie, trough Jone Care, on intervention feos genertd hragh comity woo where Soe interdscpnry tem conduc the Stunna ‘prem. Commurity leaders enhance the reach of the practices making ds peopl the mostimpor- tinoctrs of charge Fly, Habitar ihe as sae = athe procs that lend t clleciveeregthenng toda changin value an peje aboot any pe ef soil excison, thou abandoning the neds of Sheol patent yet moving oer tthe desired Src chnge ‘Oceupationel therapy appears a a key factor for those racine ocupatonalpcspecves) oF References ‘inngham W, Moore B Cie ‘Bt, Made, 1960, cones Ril. CCoesvoHsllar: 2008, nie ‘alba: epee bbilar °2F, Accessed May 17, 2010 Fedo Nacional de le Disp, ‘str ENDISC-CI Chile 2004 Prine Ero Nacional dee Direc ou Cie dirt rd Seige de Chil, 2008, Nectoal de Diep Freie, itor: La peracid Leer y ‘Proce de aerate, Saran 32 (Chie 2001, Et Sige XXIsp 1. Free 2 ecto: Wikipedia Le “ipa Libre, 2008, Online. Tn Goreten 3, CEPat. Widen Gesbode iit Sees Ad My 17,200. Fenacn Dt 2008, Ofte “alae ep tao fee Asan Ny 17, 2010 Merrepaina, ‘The CETRAM community: bulding links for socal cheng Divi de dere coil Neon Tina Santee de Che, 201, ends 5 Marre, Mack ta ‘yc cic ico ein nn toyed cy cea ois anc dr no, Tred de erro Bogs Cline 338-105, 2, let ai de slichlaced ones eqivor LOM Sh new ov ep esp 20,00 ee ey Monin: emp tS Geteee rctent ‘psicologia de I ibernciéa. In Vazquex ‘rn eter lia Srl Taste mare ate Elawed Ueied Antone Ieapalaps Cade oe and approsch(es) to promoting experiences of (social) heaich and wellbeing both with regards to disabled people, and also with the work tea, sbaring aninclusive and respectful vision of differences, look- ing at how a persons’ problems ate situated in the context of their history. “hey are sal things, hey don end pore they do't mike ws overcome underdevelopment thy dont cil the media, ad they doe expropeae Al Babe's ‘es But maybe they sleuth the hepines: of ding Sa east ht int ation, At the ead of the dy, = egupon eal and chong, vena ithe ‘only way to prove tht reaty can be ranlormed Acknowledgements Esch stepin this history belongs tous all To the man ‘or woman whe approaches CETRAM with the hope ‘of change, and slong that path ho understands that. itis the responsibilty of us sll. To work colleagues ‘who have no limits in their devotion to this struggle fora better society. To our families that accept our absence in pursuit of «collective dream. To those ‘who suffer, who stady and who lead ...to all of ‘hem, thank you very much. CGaretn Mi Cabos cles acorry Mento M: Cambio Seca: Intraducin cin clectva en Armée lan. “la Pscalegia Cannoli, esr Concer y Proce, Buenos Ales, 2008, Eda! PAIDOS, Moore Me Tera y Pain de la Paoli Coonoaria a Tonio Etre Conrad ySolded, Boens Aires, 2005, Earl PAIDOS, Pere C: Sobre Connpo “itrico de Cicada Episemvlgia Actual «a Dilesen, Stato de Chil, 1998, Eder itor Edo Ramis A: Cuando ee malta ‘deprive pnts y Refers sobre ol rina fae {celal Chien, Sento de Chil, 2005, Eaten Creras es Suenos, Rappaport I: Side jn empowerment: Tperadacton co these, Prev Hn Serv 31,1984, ‘ttc, 2000,Roremblath M Flt soci y by Pabres moderna ta editor Mair fn Pais Seiler y Gain Lea i Unterided ARCS. Plion scar dela cones nara cin Ssoiago de Chil, 205, Eton, Arce eas G: Polis Seely Plein i Commitee, Reve de Price 129-8, 2003. 170 ued L reduc Ia perseciva a Practioes without Borders Vid M: Dato Pasig y reps polis: un oodelo de manipula {steal InCINTRASContr dest ral) derek Ionana sere, ‘nowrraias N* 6, Santo de Chie, 1390, Earl CINTRAS ‘scupactna par horde de a Daeapridad en Cle cn dis Biota Sock la Froid Sal zal need CB, nied de Chl Con CCeiabrado en Bistica OMS Primer en, In Saag de Chie 2007, Earl Universidad de Ghle Community publishing: occupational narratives and ‘local publics’ | Nick Pollard Stephen Parks OVERVIEW ‘Community publishing engages people in Ldovaloping the means to express and negotiate ‘thelr own occupational goels, and evaluate ‘outcomes. It can empower poopie to challenge ‘occupational injustices for thomsolves. Its ‘outcomes are frequently celebratory narratives ‘of indlvidual and group achievement, enabling ‘people to recognize their own capactios, leading to Dither social and transformational outcomes both {through rising awareness and occupational spinvoffs arising from the actives i involves. {thas often been used with people whose. ‘marginalized situations, arse from thelr ethnicity, soolal status, or disable (og. Hart etal 2008, Lorenzo et al2002, Ott 2001), This chapter explores how the occupational thread of narrative can bo ‘applied to community publishing and gives some Practice examples. Introduction Occupational therapy, with its concerns in the enabling of people to do, be, become, and Belong (Hammell 2004, Wilcock 1999), is very much about the expression of narratives. As professionals. we learn to listen to all kinds of stores from the people we work with to advocate for them and to animate them sufficiently in the interprofesional discourses we engage in to give people the opportunities they ‘want and need for autonomy or for interdependence, rather than dependence, yet Frequentlythese voices and the nuances contained in thelr experiences are ‘unheard (Hammell 2007, Hammel et st 2007). When occupational therapy practitioners apply an cccupational justice appreach to socal and occupa tional needs with specific communities they are concerned wich enabling people to identify their reeds and ways in which they can work together 19 resolve issues they experience as a community. ‘The immediacy of these ‘local publics’ (Long 2007, p. 107) or interaeuon between individuals, ‘communities, and environmental factors enables them to develop ‘emergent narratives” in which people imagine end reste new possibilities fr therm selves (Mattingly 1998, 2000, p. 181). The we of narrative allows free and metaphorical exploration of experience, and lends itself ro uncovering nuances that may not be selected In traditional health and social care environments, the operation of institur tonal processes or socal stigmatization, which oper- ates to silence the voices of those people who are ‘otherwise seen as ‘hard co reach’ (Dunlap 2007, Goffman 1968, Osgood 2003). In opening the book to people with disabilities or other margnalizing ‘experiences there isa chance thatthe pigs may turn ‘0 conflict with dominant cultural taboos over sub- jecte auch ss sex, behaviors involving risk and disabil- ty. Some prictcioners who use writing sctvities with cienss have discouraged the expression ofthese ‘sss instead of working with them (Aubrey 2004, Dowling et al 2006, Levis 2002, Osgood 2003) OF course, there is the potential for conflict with employing organizations, and legitimate concerns, for example libel, have to be worked throug responsibly e. : ‘As a phenomenon, community publishing has existed as long as people have hed access to printPractices Without Borders to present their work. They see ites important that ‘other people with learning difficulties have the ‘opportunity to experience the enjoyment and occu ational opportunities they have, and recognize that zone ofthis s possible unless they both develop thele own group and agree that others can hear about it (Pollacd 2007 Pollard et al 2005, 2008). Practice examples DONCASTER DUMFRIES EXCHANGE ‘Arup of ending mena heath cen om Doncaster ‘ate Outen ons Cathy Rehan : Seno vst Dmitri course Seta e ‘Gare, te byte Lsmg Sis Gaurd olee & Stee 0 yen & Pole 122, Tove Wed by Dates er Gla Sir, pooper beostes "ced tl Meh age ad pots | cm wa ake eat tha rg sot, a ought thers one oars, tr care darn te i {pete ofamodon ces fuses nine ojeco ct | ‘eda igo Stator fn adn ed eas ‘Some paroertscotrued ne extn etonng \ areidartl une nurtrg uth te Don on j Stony Goon et Nesom Cogs ey Scan | {acy ree Doessa: rapt and pofonres Pk vm post to nui oun oe fe cnr 4 xno ya ~somating none oft oscar devote. tx onsen Soashatay mascot In Durst coving yea Agar, e moorarce ct weg ue te ents er protec pubsaters mas hrrenstedin a dase of ents cn arcs teathnd ecicaton mrageshopodie creo otras rata fe local psi the ate tus ene ‘ete iter ag eaten fa covered cous, NO RESTRAINTS: AN ANTHOLOGY ‘OF DISABILITY CULTURE, betta nel gen Ses grein tc enc iste seca, sna cag Steet eae a hla a ecstasy, seats rt Eacoeaniy eens | Soke, |, Sees ste Roost incest chatty Seige gems eee we Reece Com ‘MUSIC AND CREATIVE ACTIVITIES ‘The Musk Ad Creative Actes organza, based ‘n Seatre, United Kingdon, s 8 sateonsthtes earl arts organization sting soa eve {he toan ane crocuseg a cal anthloy of post nd at work Mey 2005. A day contro uth were snd pertrmancse a ace ats ctr 2007 avactes 200 pop, practioner, are, sevoa user, and ats wore ‘Those events gone rumercus oxo. patonat seth a ray tom hg estas {© ownzng peronmanceeaaces and psesy, ‘Thor signicane is hat pope aa alto {oy atipation Bem nd gan oct casa enjoment is often acarsiableachiverar fot Beaple wan ending mental Peat concicns Wie cuter canbe sir) pt oan ‘Se ard lay gut’, ot many peop eke up rarurents niet ara cherio rant ness VOICES TALK, HANDS WRITE ‘A win ns utsnng prot vith peop with learn difutios sending a ony save tho carer of is, Yrs, Unites Kingdom, asset lp i 2008 Polar 2007, Paid eto 2008, 2G) ‘Ake element oft expereince was the paieaton f poops wih ean cities ar er dscitas rom Pook Wal Cateye now Pech ening Corrmunty, ee Chaptr 2. Ths showed theater arian that they, 00, coud bs enable eke (neadig rls, such 26 Seng a “wing arf felts ches who coud not ae ts themeehes, enc to hk ebout hak oun ooouptoel pot, Tis sup boceme Vaces Tal, Hans Wit, aa onsite cammnty publishing coup whch pss anrocgy, voce ak han a 2008 he sas revashoweaon inch Cea Ton ab ‘th Lt Moss pes see Sich ovt we pra hig Wo an of be pacar, amenataing Se oshncrae toto fea oft commuy wc Woy hoe Gera tr oor mean roca tl sn oe oe pt. Forse by cowealvobnters fom alos vein cu en upp wots oa cee, ‘een conn ose ns pated sees arson uO oki ie as ts, Notas ost wert ewer Se, Laces thet abr can ost rrt ame Stops Stong te rane nese Blan pe th:scco ten fe {Pahaps to martn commana pees ‘reso ro soa. [rie TRANSATLANTIC FED emacs are proemasenrat etter Se its was sop, BBB Sates end Untied Kingdom-basad wrters from communi goewetensroneetin ra se eect Se ese cs epee tat cists sa Jit Sano oso Ceres» peas ins dracon mntronn tote ec isopentane eee Sase ii Soca eh ne sconces tata di rarer ints eo 2. bmn should ae acon el ericemert oe Sowa rere mete i ol cee cans, brfage, oe sexes [a Retest ne ehomsreay tea 9 ase Salvictenas womne tet E SRGRSM Sy ceva Teagan mate be states deamon (selec se 41s. Totase.an educational syste on any cther vakes Ghar, oiaetearcaeshenoras Sees ere seater oa eps ice acces nn aaeg Sees tea amecsyen ey Gets cronrgmen anes Sse " WORKING: AN ANTHOLOGY OF WRITING AND PHOTOGRAPHY/ UNSEENAMERICA Unseen Ogdlnenmysace ce! recommen) epansore y Bead aed Roses! {1580 52U, uno ht rprsants sonics wots tote enoatnoas hasts, Thgyo crotes cl thin pene stupeand presse emneareras ‘Srocors ar wating hes I 2008, Ucoonarecn petnewovnio grea a Sci Use 6 Elta wing organo he presram. Dito ooo poo hanno pct ee, Restore owt at el pens teaps ne i 0 esta Taras ebor how wrt, whon seen toms alt {i.e og borage terror Sak Salt acon ar poet wakes ne ess is rot wee publi n Vong, a bok dire tb Community publcning: cocupatoral narstives anc! tocal pubécs? od ker education ogame ad ues wae! or sue casos aon fe photoes rocon ema pret wes OSpyed ros Sootos anon cagencatone, wae ran 0 ‘aes Stats Capt Wasnrgon 0. Tre Lnesrace {5 awh opening 8 book oe se He. ‘rent, be Saas eangoent fhe prot has cro tong tel wakes ecard Rote Svssee cf ata ne marta ata ples pected flow Crossing boundaries/ negotiating practice ‘erected in the above nome, oma ching can sveve as a mean to negotiate the Power aferental beoreen therap the lent, End the commuities they Hive in. Each ofthe above projects works to cesta strate where a cole Uhre semiilty defines, develops, and executes © parc pet. Win sch es the wo SF the thorpist as primacy recorder of a pesos Experience and primary nepoator of how thet expe ences deployed for greater ind or callectve independence set withins lags sel-dened core thorl core In sch context, the theropis sils bre net enced but breugt into dialog ch = merging elf generated set of gals ~ goal whose Srplemenetion is cast as st of responses nd asthe must be lene bythe entire group. Por instance rather than the heaps cresting the process by which purticlr auraves are developed Trdrecorded the entre group dees the stactre dna proces of hove personal ncatives are generate, Instead of the therapist managing the creation of resting spaces conference sched, and pubic on matric the work i ditbuted throughout the ene group according to each person's aly twice on sch wo = Through such proces, te therapist i able to both witness and parnate fo the. development Gf a reflective process of defining inivicual and can gal Tat, Se wy pac of seeing nd peer crqing each cer wa sore Tee to improve tercysile~abough this war ceraaly an attbute of project ach ae Syrocin's Working and. the FWWCP/Syracue Universi Tense projet. Rather, the er ro, es of deciding what langage Bem epson a Stats experience to » lvger ati fs a treuns of eesing n callectiveSeniy = an was the Caan in project such as Vols Tuk, Hands WaitePracicas Without Bards and No Restraints. And within thie dynamic, the therapist sills in aeeas such as securing imtiztional resources or understanding how the ‘professional public’ will hear such work becomes‘ vakusble, bout not dominant, framework through which to orgs: nize the work of the writing/publishing group. ‘Ultimately, then the very nature of ‘community publicationsis to embed the development of ocupa tional sills (ceracy and organizational) into a larger effort to expand where those sills can be practiced ‘within the larger culture. To make this lear, might be useful to briefly invoke DeCerteau's (2002) dix tinction between a tactic and a strategy, DeCerteny argues thats tactic isan intervention that creates & small disruption or alteration in the dominant socil structures, An example might be the ways in which patients construc their particular persnal narratives ‘toler how a perticular program provides services to them, perhaps because these stories help to engage heath workers with the persoa being treated. A, strategy, however, isan attempt to creates new com munal space chat can demand insitutional change a 4 macroslevel ~ ¢ fundamentet change in society. DeCerteau’s notions of tactics’ and ‘teteny’ corre spond with Van Der Ej’'s (2001) “influence” and power,” respectively inthe ‘means’ atthe disposal oF social actors to develop thei inceress in conflict ‘or cooperation situations (eee eso Kronenberg & Pol- lard 2008, Polar ee al 20083). By cresting « process through which individuals can construct theit own publications, stating their self-defined communs! goals, community publishing can facilitate the move- ‘ment from individual tates to collective strategies ~ a5 was the case with the Doncaster Dumfries Exchange, No Restvaints, and the Tranafed projects, ‘The question of how therapeutic practice can get in the service of political rights moves from a marginal to. central aspect of the work, ‘Toreturn to our earlier discussion of Paulo Freire, 8 community publishing framework moves the References ‘Abel B, Clarke M, Pati S: The ‘ens fed frm nda ists of day to caletve Seton In Tall N,SakelsiosD, ‘onenbeg Fy eos Palin Prate i Oscspetienal Tarpy, Edibure, 2008, Claes Senet, pe 175-182 Autrey J The rot and pce of soci ‘en, Groupe 146-23, 208 ‘od cccpaticeal 2083, Basan BL: Beperin ters, Can JO: van2s-i33, 2007, ‘wand T: Cater, cultural eempetncy, Bengt De Litera i American lie the leans Bek Jounal of earned Therapy 85:956-962, ising for cepted therapy ynamic of thecal patient beyond cee hi ve te ork ais students have the illusion of scting throm tench on te esther coins he Oh [knowledge with his or her own profession iy, which she orhe sets inoppestiontooee of mers 200 p28) ea a posing’ process of learning is’ put in pj, dislog and common exploration help gt the Individual and communiles eee oP Hon and pce within tne lrger cron the bunds tin ep non-praesionlyacceped haowicdg ent knovledge, will require everyone imi reflect on their role in such a process, it is this y proves hat willed each rovends pees being. becoming, and belongs fo bak ea Conclusion ‘Community publishing offers many opportune beople rete of the nepal el engage with others through their narratives nda forms of creative expression such a8 perfor Aside from generating prin publications can pro ‘portunities to stage community events or pate is cemmuniy Festal 0 mate Ink wt ‘community agencies. tia tool for inerees Sarees and slate, reduces te inning disability coratives and provides opportunities people who may be prevented by their care e ‘ments tomake direct communication with dione [Risa apolitical ol thatserviceuseseanhanle control forthemselesinexpresing ods, sharing li tures, and eelebeting their own ecceptonl ‘within their own local publi; ond in 30 doings the process of erguing for resources withthe profe sional workers whe are werking slongide tem ‘Rew York, 001, Carter nverany Pre elas caption herein, or pret a aii, Lond 2008, Wane hanya reve of es feo is sup Thor 1987, Besta Bondi cdier Bt: Moe rl it, ‘Bestel, 1088, Bea! Boobs roadie eto: Bos! Lies, Bish community publshirs: oes er Se, — 7 tin ond wt fret Se ae PP teri apy TT fs conic ly oF oe cei ocy eect fen Onegin There, BS Elie Se Pade of he Oporese, rth, 1972, Peng BBP Technine cong of etic, In Batol D. Reo Wa of (Ar Ahly for Wi er, 200, Se ais Pes, rf Working Lise, The “f Pifeen Workers, from ser, 197, Catchewse nF Becae We Live Here Literary Beyond he Carica, Cres E2207 iempcon tr Stigma Nee Managonet of Spd iy, Ean, 1908, HE Hamondavorth, Hommel), Mig S, Helaemann ‘ccoupational narratives anc ifs S The exparince of ereative etiy aba tretmant ec $i Mout Heetie 17 48-63, 2007. Hockey Workers Fase c Tease: Sossestlon and Camere Working Lines olf, 1903-1945, Hecke, 1995, Heckaey WEA. 8 entre. enue a ee B SAR fe with, Mite Boe, Rod ‘Waa: does portion e5 Inte espa fram peor Gielen Das feted! 118, Stor Osle dvee ve Deepe//S= devon 180" a aeseanioless34. Accessed Ja 4208 if Hannel RW Dinennsof nearing, Whe seapalon of daly wie, Can J hey ther Saas, 2004 Hart RW, Chests practice Me aeons rfesions ‘tora’ Bah Sowa of Saaupion Tn 70:20 ‘oor Har, Mongoo ME Muh Z: "sie Sain Workin, ‘tg fig Fateh, Syate £208. Grane Urey Pes Ivan Me The Rona Medals Cuter? “uae Ocoee There PY Eas, 208, Chachi CregtenEe an, oerberg,PoardIerodastion. 2 Tegan tronentore Fe 5 fet’ Pla caer Depend Toray Without Dero wang Ha 165, he Spirit mi levesapesrmeat Seabed ie Kecehtfapparsh Ci aor, Pot otra rane ose ‘errant nga cebled SSR Fs London, 2004 Cra i Co es use Mi Ter Ons toate Fre have, Cape Town, 2002, ni Ott S. Manehleay 's002, sae publics! Zaneplo Dislty Univer of Cape Town ‘McNty C: The Sford MACA arp. In FllrdN, Sakelsriou D, Kronenberg edo: Pela! Practice of Ocaptinal Thera ding, 2008, Bele Seence, Motengy C: Occupation! thang 3 orb pecie: Body a2 mache Te MatuislyC, Fleming M, eters sea! Resoing Bara fn Ina Therpenie Prac, Piildeghin, 1994 FA Deis, pp 37-65 Matton C: Helin dramatic les, Cee 188, Comrie Univeraty res _Matagy C= Emergent roses Ta Watingy C, Gere LC, ets Narrator ad the Cutoal Constr of sau Heat Calter, 200, Berkely, pp st-2i Molin, Rick We Storied spposthe to undustnding tecuaton, Jornal of Ocnptinal Morley, Worpole K, eters The Repl of Laver, Loon, 182 Comes Osgood T Naor Rind the Qual, Fe! the Wisi Poraon Cote Planing Inplreietin ond Developme Dien Somes Canterbury. 2003, Est Kent Community NHS & Seva Parerchip Coe Tree ‘Ava a por pig shoal Arie nevemmadihequaliycdf Acesed Shine 26,2008 On G, edie: No Restate a ‘ios of Dizbiy Cae 1 ‘lab, Piodphin, 2001, New City Corns Pres. Pld N: Community pling a ‘ehsbltation Federation Magee Seie-ts, 20, Pole Ne Nees towards on apron or Thethenpeatiemeaf erie wring In gsnpatcoal hey. {hy Sampson F eto: Creal Wriig te Health and Soci Care, Hendon, 2008, desea Kingsley pp 180-206, Poll N Vets Talk, Hed We sstaning communi ublshine with poe th ean,