History of occupational therapy

Early therapy The earliest evidence of using occupations as a method of therapy can be found in ancient times. In c. 100 BCE, Greek physician Asclepiades initiated humane treatment of patients with mental illness using therapeutic baths, massage, exercise, and music. Later, the Roman Celsus prescribed music, travel, conversation and exercise to his patients. However by medieval times the use of these strategies with people considered to be insane was rare, if not nonexistent.[3]

In 18th-century Europe, revolutionaries such as Philippe Pinel and Johann Christian Reil reformed the hospital system. Instead of the use of metal chains and restraints, their institutions utilized rigorous work and leisure activities in the late 18th century. This was the era of Moral Treatment, developed in Europe during the Age of Enlightenment, where the roots of occupational therapy lie.[4] Although it was thriving abroad, interest in the reform movement waxed and waned in the United States throughout the 19th century. It re-emerged in the early decades of the 20th century as Occupational Therapy.

The Arts and Crafts movement that flourished between 1860 and 1910 also impacted occupational therapy. In a recently industrialized society, the arts and crafts societies emerged against the monotony and lost autonomy of factory work .[4] Arts and crafts were utilized as a way of promoting learning through doing and provided an outlet for creative energy and a way of avoiding the boredom that was associated with long hospital stays, both for mental illness and for tuberculosis.

Although only a small percentage of occupational therapists continue to work in the field of mental health, many universities place a strong emphasis on training students in psycho-social occupational therapy.

Health profession The health profession of occupational therapy was conceived in the early 1910s as a reflection of the Progressive Era. Early professionals merged highly valued ideals, such as having a strong work ethic and the importance of crafting with one’s own hands with scientific and medical principles.[3] The National Society for the Promotion of Occupational Therapy, now called the American Occupational Therapy Association (AOTA), was founded in 1917 and the profession of Occupational Therapy was officially named in 1920.

The emergence of occupational therapy challenged the views of mainstream scientific medicine. Instead of focusing on purely physical etiologies, occupational therapists argued that a complex combination of social, economic, and biological reasons cause dysfunction. Principles and techniques were borrowed from many disciplines—including but not limited to nursing, psychiatry, rehabilitation, self-help, orthopedics, and social work—to enrich the profession’s scope. Between 1900 and 1930, the founders defined the realm of practice and developed supporting theories. By the early 1930s, AOTA had established educational guidelines and accreditation procedures [5] In a short 20-year span, they successfully convinced the public and medical world of the value of occupational therapy and established standards for the profession.[3]

World War I forced the new profession to clarify its role in the medical domain and to standardize training and practice. In addition to clarifying its public image, occupational therapy also established clinics, workshops, and training schools nationwide. Due to the overwhelming number of wartime injuries, “reconstruction aides” (an umbrella term for occupational therapy aides and physiotherapy aides, now known as physical therapists) were recruited by the Surgeon General. Between 1917 and 1920, nearly 148,000 wounded men were placed in hospitals upon their return to the states. This number does not account for those wounded abroad. The success of the reconstruction aides, largely made up of women trying to “do their bit” to help with the war effort, was a great accomplishment. Post-war, however, there was a struggle to keep people in the profession. Emphasis shifted from the altruistic war-time mentality to the financial, professional, and personal satisfaction that comes with being a therapist. To make the profession more appealing, practice was standardized, as was the curriculum. Entry and exit criteria were established, and the American Occupational Therapy Association advocated for steady employment, decent wages, and fair working conditions. Via these methods, occupational therapy sought and obtained medical legitimacy in the 1920s.[3]

 
Occupational therapy. Toy making in psychiatric hospital. World War 1 era.The profession has continued to grow and expand its scope and settings of practice. Occupational science, the study of occupation, was created in 1989 as a tool for providing evidence-based research to support and advance the practice of occupational therapy, as well as offer a basic science to study topics surrounding "occupation".[6]