The concept of work in occupational therapy: a historical review.

This historical review traces the con­ cept of work throughout the develop­ ment of occupational therapy. Para­ digm shifting is used as a framework for describing the conceptual defini­ tions and therapeutic uses of work in four developmental stages. T he concept of work is funda­ mental to our profession; the terms occupation and therapy con­ note the strong relationship be­ tween healing and work. Through­ out our profession's struggle to es­ tablish its credibility in the health care field, the therapeutic use of work has remained a central tenet. It is derived from two basic as­ sumptions-the human need for mastery and self-actualization, and the occupational nature of the in­ dividual. Although the meaning of work has changed as the profession has developed, work has always been acknowledged as one concept that distinguishes occupational therapy from other health disci­ plines. However, our profession has not always translated its con­ ceptual and philosophical impor­ tance into clinical practice. This paper is a historical review of the concept of work and its use as a therapeutic medium in occu­ pational therapy. In his 1981 Eleanor Clarke Slagle lecture (a scholarly historical review of the profession), Bing (1) stated that the history of occupational therapy is the most neglected aspect of the profession. This paper, by review­ ing the past, reveals the importance of work as a concept in daily prac­ tice and serves to remind therapists of their responsi bility in addressing this area of human occupation. The majority of information for this historical review is drawn from The American Journal of Occupa­ tional Therapy. Particularly with re­ gard to the early years of the profession, I relied heavily on the works of acknowledged historians, such as Hopkins (2) and Bing (1), who have produced scholarly com­ ments on the development of the profession. I chose these secondary sources because of their excellence and because of the practical diffi­ culty in obtaining original sources. The theory of paradigm shifting, as applied to occupational therapy by Shannon (3) and Kielhofner and Burke (4), is used as a framework for the historical review. The con­ cept of paradigm developed by Kuhn (5) sought to clarify shifts in scientific thought. Its applicability to professions is a contentious is­ sue, but as Kielhofner and Burke