Occupation for Heal h

Ann A Wilcock

A Keynote lecture, given on 24 June 1998 at the 22nd Annual Conference of the College of
Occupational Therapists, held at the University of Ulster at Jordanstown.

needs and requirements for survival. For example, they find

Introduction food and water, select or make shelter, interact with others,
The conference theme - 'Occupation for Health' - states the educate their young, explore, play and observe their world. It
essence of our profession. It is also a timely reminder of our is through such occupations that the animals maintain and
past, present and potential contribution to the health of those
enhance physical fitness, stimulate their mental capacities
we serve. It is timely because it echoes the calls made by the
towards future challenges and build a supportive community
World Health Organisation (1978, 1986) for an acceptable
which will be protective in times of need. They keep in good
level of health for all by the year 2000 while stressing the shape and keep healthy through their continuing interaction
need for the reorientation of all health professionals towards
with the environment; through what they do; and through
the pursuit of health, and it is timely because of the current
being true to their species' nature.
legislative direction of national pOlicies toward a similar goal.
The same is true of the life of early humans. They, too,
In this paper I suggest, as other occupational therapists
kept in good shape and kept healthy through their continuing
before have argued (West 1970, Finn 1977), that our profes-
interaction with the environment; through what they did; and
sion's distinctive and unique contribution to the pursuit of
through being true to their species' nature (Stephenson 1972,
health lies in the relationship between it and occupation. This
McNeill 1979). Dunton was quite correct when he suggested
suggestion follows many years of historical exploration into the
in his credo 'that occupation is as necessary to life as food
relationship between occupation and health, covering ideas
and drink' (Presidents of the American Occupational Therapy
held about the occupational behaviours of early humans some
Association 1917-1967, p271). Our species' nature, made
two and a half million years ago, how these changed during
up of homo characteristics, capacities and needs, was decid-
sociocultural and occupational evolution and the health con-
edly occupational. Archaeological and anthropological opinion
sequences of such changes (Wilcock 1998a).
suggests that, throughout the existence of our species,
humans and earlier hominids engaged in occupation in a
more complex manner than other animals (Bronowski 1973,
The relationship between Campbell 1988, Jones et al 1992). Philosophers throughout
occupation and health recorded history have recognised this trait. From Plato comes
It appears that humans have 'occupational needs' which are the notion that humans are fitted by nature for different activi-
related to health. They prompt occupation to overcome physi- ties because of their particular aptitudes and interests; from
ological, psychological or social discomfort, and to maintain Marx and Hegel that labour is our species' nature; and from
the well-working of the organism through use. In fact, they are the existentialists the concept that individuals are unique and
the species' primary health mechanism, motivated to provide that meaning, purpose and choice in human life is as impor-
for other basic requirements as well as enabling individuals to tant as scientific or metaphysical truths (Wilcock 1998a).
use their biological capacities and potential, adapt to or These views support the central premises of our profession.
change different environments, meet sociocultural expecta- So, too, does the fact that the particular mix of human
tions and, as a result of all this, to flourish (Wilcock 1998a). characteristics and capacities has enabled us to survive
These occupational 'health' needs, of course, predate medical healthily and successfully as a species because of our occu-
science by several million years, if early hominids are consid- pational natures. The adaptive capacity of the human brain
ered. allows the innate drive for purposeful occupation to respond
That is a monumental claim which needs to be supported, to cultural forces and values which add a social dimension to
and I think may be easier to understand if first we consider it the relationship between occupation and health.
in respect to animals other than human beings. Animals that Over the past 2-3 million years, human occupation has
lead a natural life within their ecological niche, which is not become extremely complex because of continual cultural evo-
affected by environmental degradation, tend to be healthy and lution, the development of occupational technology, and the
to exhibit the appearance of wellbeing and satisfaction. This social structures and values that accompany it. It is made
does not mean that all live a long life, nor that high infant more complex by the fact that what people 'do' is so much a
mortality is not the norm, but that those who survive are more part of the ordinary fabric of life that it is taken for granted
than able to resist disease and infection because they are and its health benefits largely ignored. As well, although peo-
adapted to the resident pathogens, risks and predators which ple engage in different occupations according to their experi-
are part of their eco-systems. As a part of their natural ence, their culture or society and its values, the meaning of
lifestyle, the animals engage in occupations to meet their occupations differ for each individual. Teasing out the relation-

Ann A Wilcock, PhD, DipCOT,BAppScOT,GradDipPH,Associate Professorof OccupationalTherapy, Universityof South Australia, North Terrace,
Adelaide, South Australia 5000, Australia.

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ship between occupation and health has become equally Also useful is McLaughlin Gray's (1997) definition of the
complex, as one might expect. essence of occupation as that it is goal directed, carries
Despite the current complexity, in claiming that engage- meaning, is repeatable and is perceived as 'doing' by those
ment in occupation is the major evolutionary mechanism for engaged in it. Occupation, though, is more than 'doing'. It is a
health, I refer to health as a natural phenomenon closely synthesis of doing, being and becoming which is engaged in
linked to survival, which is recognised as the primary drive of not only by individuals but also at community, national and
humans as of all other animals (Lorenz 1983). Survival of international levels for cultural, social and political purposes.
individual humans is the outcome of occupations which pro- It is the outcomes of such group occupation which have long-
vide for the essential needs of the organism. Health is the term, but often unforeseen, effects upon the health of individ-
outcome of each organism having all essential sustenance uals.
and safety needs met, and of having physical, mental and
social capaCities maintained, exercised and in balance. This is
achieved through a range of occupations, through what peo- Health
ple do day by day, which in turn depends on a level of health So, how am I defining health? It is true to say that ideas
able to provide the energy, drive and functional attributes nec- about what health is differ according to cultural and spiritual
essary for such engagement (Wilcock 1998a). philosophies, socially dominant and individual views, where
people live, the type of economy and the health technology
Def"ming 'occupation' and 'health' available, but for a general purpose definition of health it is
hard to better that of the World Health Organisation, coined as
Most people in post-industrial societies consider health from
early as 1946:
the perspective of medical science, which is attuned to the
task of restoring health following illness or from preventing ill- Health is a state of complete physical, mental and social wellbeing
not merelythe absence of diseaseor infirmity.
ness occurring. In contrast to this view, I believe that occupa-
tional therapists, with an interest in occupation for health, Add to this, the view of health given in the World Health
should focus on the natural health-giving functions of occupa- Organisation's 1986 Ottawa Charter for health promotion:
tions just as nutritionists focus on the natural health-giving To reach a state of complete physical, mental and social wellbeing
functions of foods. With a well-developed, well-researched an individualor group must be able to identify and to realise aspira-
background, it will be possible in the future for us to make a tions, to satisfy needs, and to change or cope with the environ-
significant and complementary contribution to medical sci- ment.
ence, which challenges from a different perspective entirely. I We find then that there are primary links between health
maintain that this would place us in a much stronger position and occupation because occupation is the fundamental
to increase awareness of the importance of occupation to mechanism by which people realise aspirations, satisfy needs
health than our present supplementary role which is depen- and cope with the environment (Wilcock 1993b).
dent on others' domains of concern. However, because of the dominance of a medical science
The first steps to providing a direction for reorientating view of health in post-industrial societies, it is often difficult to
future practice according to an occupation for health perspec- conceptualise health as more than the absence of disease or
tive appear to be threefold: infirmity. An exploration of health and lifestyles, undertaken in
An increased understanding of human engagement in the United Kingdom by Blaxter (1990), is helpful in this
occupation regard. Her survey of 9000 adults revealed that people
- An increased understanding of ideas about health describe health variously and that for themselves these
- The development of theories about the relationship descriptions could be categorised as having no views, never
between health and occupation, from an occupational per- being ill or diseased, physical fitness, energy, being function-
spective. ally able or being psychologically fit.
To do this we have to be clear about what we mean by About 15% of people could not think of anyone who was
occupation and health. healthy and about 10% could not describe how it felt or did
not think about health. Of this group, those who were elderly
Occupation often saw their own health as poor. The others tended not to
Occupation has been defined in many different ways because value health highly (Blaxter 1990).
it is so complex. I favour a composite of occupational thera- Some people described health as 'not suffering any symp-
pists' definitions which goes like this. Occupation can be toms, never having anything more serious than a cold, never
described as: seeing the doctor, having no aches and pains' (Blaxter 1990,
• 'Purposeful use of time, energy, interest and attention' p20) or really serious illnesses and 'never having had to go to
(American Journal of Occupational Therapy 1972) in work, hospital' (p22). This 'not-ill' description of health was
leisure, family, cultural, self-care and rest activities 'markedly associated with the [respondent's] own state of
• A 'natural human phenomenon' which is taken for granted health' and was 'more frequently used by the better educated
because it forms 'the fabric of everyday lives' (Cynkin and and those with higher incomes' (p21).
Robinson 1990) Some people with disability or 'suffering from serious con-
• 'Activities that are playful, restful, serious and productive' ditions' were called 'healthy because they coped so well'
which are 'carried out by individuals in their own unique (Blaxter 1990, p22). 'Indeed, many disabled and/or elderly
ways' based on societal influences, their own needs, people insisted on calling their health "excellent''' (p32). This
beliefs and preferences, 'the kinds of experiences they notion has some similarity with the idea of a 'reserve of
have had, their environments and the patterns of behaviour health' which some respondents believed could be inborn.
they acquire over time' (Kielhofner 1985) Health was sometimes defined in terms of behaviour or as
• A 'primary organiser of time and resources' which is cultur- the healthy life, particularly by young people or those with less
ally sanctioned (Yerxa et al 1989) education. Their responses identified health with 'virtuous'
• Enabling humans to survive, control and adapt to their eating patterns and exercise and not drinking or smoking.
world, to be economically self-sufficient (Yerxa et al 1989) These" respondents 'stressed the role of "bad habits" in the
and to experience social relationships and approval, as well causation of disease and the importance of self-responsibility'
as personal growth (Wilcock 1993a). (Blaxter 1990, p24).

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 Among the younger people, physical fitness was also 1998) research, which only asked about perceptions of health
strongly identified with health. But whilst young men 'stressed or about wellbeing.
strength, athletic prowess, [and] the ability to play sports', the
young women frequently defined 'physical fitness in terms of
its outward appearance', commonly mentioning body size and Consequences of misunderstanding
the condition of complexion, eyes and hair (Blaxter 1990, 'occupation for health'
pp24-25). These findings seem to point to the fact that occupation is
Energy was 'the word most frequently used by all women poorly understood as a holistic concept. In addition, it is diffi-
and older men to describe health, and for younger men it cult to consider the purpose and meaning of occupation, or its
came a close second to fitness'. This included physical energy relationship to health, in an holistic way because occupation
and psychosocial vitality or a combination of the two. has been arbitrarily divided into work, play, leisure and rest,
Respondents talked about health as being '''lively''. "alert". particularly within post-industrial societies. Health too is sel-
"full of get up and go", "full of life", "not tired", "not listless •.·.
dom viewed, at least within a health professional sphere, as
For many young men 'not staying in bed appeared to mark deviating from a medical perspective. Unless. as a profession-
really positive healthiness'. whilst for older men the 'concept al responsibility, we do something to overcome the miscon-
of energy and vitality was most often expressed as enthusiasm ception about the nature of occupation and its relationship to
about work' as it was for women of any age. These also health, people are unlikely. in the future, to recognise the
'defined health as ... "doing everything easily", "feeling like importance of occupational wellbeing, and be more suscepti-
conquering the world", "being keen and interested", "lots of ble to illness as a result of continuing occupational injustice,
get up and go" ... [and] "having the energy to be with other deprivation, alienation or imbalance.
people'" (Blaxter 1990, pp25-26). Let us now consider the 'all day - every day' stressors such
Indeed, 'women were considerably more likely to define as three of those I have just mentioned: occupational imbal-
health, especially for themselves, in terms of their relation-
ance. deprivation and alienation. 'Occupational imbalance
ships with other people. They said "You're more willing to
occurs when people engage in too much of the same type of
meet people and help people". or "I could do anything, help
activity.' This limits the exercise of their various physical. men-
anyone'" (Blaxter 1990, p27). In some studies undertaken by
tal and social capacities. When factors beyond them, such as
me and by some postgraduate students at the University of
disability or poverty, inhibit an individual's choice or opportuni-
South Australia, the notion of helping others is appearing as a ty they can experience 'occupational deprivation'. Alternatively,
greater need than self-care for people with dysfunction, such
people can become occupationally alienated if they feel
as stroke or those undergoing haemodialysis, and points to a 'estranged' from themselves because they are unable 'to meet
need for appreciating this in our intervention programmes.
basic occupational needs, or use their particular capacities'
Of particular interest to us is the notion of 'health as func-
because of 'the way society is' and the demands it makes on
tion' which overlaps with the concepts of health as energy and
them. With the 'evolved complexity of human lifestyles, cultur-
as social relationships. This notion was most frequently men-
al values, societal rules, sophisticated technology and subse-
tioned in the study by Blaxter (1990) by older people and
quent ecological detachment'. the prevalence and incidence of
incorporated ideas about being able to perform physically
occupational imbalance, deprivation and alienation have
demanding work. 'social, family and community activity', to
increased. As a result stress-related illness has also increased,
'work despite an advanced age', to do 'extra work' or 'being fit
in part, because occupational adaptation is being called for at
to work'. as well as 'being mobile or self-sufficient'. Some,
a rapidly increasing rate (Wilcock 1998b).
including the young, saw health as 'being able to do what you
Ornstein and Sobel (1988) suggested that the possibility of
want to when you want to' and a few said 'simply and explicit-
more radical changes in occupation could result in serious
ly that "health is freedom'" (p28).
health consequences. They stated that because parts of the
The concept of health as psychosocial wellbeing was often
brain are rooted in earlier species' inheritance, people are
associated with health as energy, as social relationships or as
only able to respond with biological reactions which are either
function. For some it was a separate concept used to describe
'obsolete' or 'inappropriately elicited' (Ornstein and Sobel
spirituality. mental alertness. happiness. enjoyment and a
1988). Similarly, Dubos (1968) warned that although humans
relaxed attitude. For those in 'the middle years [it] was the
may appear to adapt to new environments, their biological
most popular concept' for describing health for self, particular-
inheritance only enables adaptation up to a point and that
ly for women and by those with 'more education' (Blaxter
chronic disease states can develop over time. These warnings
1990, p29).
are an echo of some of Maslow's (1971) concerns that
Blaxter (1990) concluded that views of health differ over
mankind is at a point in history unlike anything before with
the life course, have clear gender differences. and are, for
'huge acceleration' in the growth of 'facts', 'knowledge', 'tech-
most, a multidimensional concept.
niques', 'inventions' and 'advances in technology'. The Ottawa
In considering Blaxter's (1990) outcomes, it appears as
Charter also recognised that there were health concerns asso-
though a considerable number of people do link health and
ciated with socio-ecological change and called for a 'system-
occupation. although not in those terms but. rather. in the
atic assessment of the health impact of a rapidly changing
way that health might be talked about in the media, such as
environment, particularly in areas of technology, work, energy
physical fitness, exercise. energy, relationships and mental
production and urbanisation' (World Health Organisation et al
health. In a study exploring people's perceptions and experi-
1986). Such an assessment would need to take into account
ences of wellbeing, a strong link was again obvious but only
the concept of alienation or 'estrangement', which is perhaps
after specific factors, such as leisure, achievement. selfless
the hardest of these concepts to understand and so requires
activity. religious practice and work, were grouped into an
more explanation.
occupation category (Wilcock et al 1998). In contrast to this
outcome. in another (unpublished) study about whether elder-
ly people, when they looked back over their lives. recognised Occupational alienation
links between their occupations and their health, we found To illustrate the concept of alienation, let us return to consider
that they did not. In that study. the questions were specifically other animals. Think of an animal born in captivity: a lion, for
targeted to the relationship between occupation and health. example, who has only ever known a world of a cage, of other
unlike the Blaxter (1990) or the wellbeing (Wilcock et al animals living solitary lives in their own cages, and of people

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who feed and care for them but who demand particular activi-
ty and behaviour from time to time. It is possible to under-
stand that the lion will experience needs and instincts that
relate to natural responses to the natural environment in
which he would have lived in the wild, but with no means of
really appreciating or satisfying them. He feels estranged or
alienated from his species' nature, from his activities and from
other animals but, because he has never known a natural
lifestyle, does not understand why he feels unhappy or frus-
trated or has the need to escape to 'something' different.
Humans because of their occupational species' nature
have constructed, over time, their own cages. The bars are
the products and results of their occupations, such as the
social values of any culture or society, its laws and rules, its
political direction and its economic structure, including the
day-by-day occupational opportunities and demands on each
individual. Like the lion, humans are estranged from their
species' nature, from others, from what they 'do' and from the
results of their activities (Wilcock 1995).
Alienation is a central concept of Karl Marx's views about
human nature (Petrovic 1991). He believed that alienating
activities along with division of labour are 'forced upon individ-
uals by the society which they themselves create' (Mohun
1991, p155).

Underlying occupational factors in

health outcomes
With this in mind, it is not hard to see that health outcomes
too, whether good or bad, can be traced back to underlying
occupational factors that people have created, such as the
type of economy, policies and priorities of governments, and
societal values based on occupational concepts like the divi-
sion of labour or the work ethic. Such factors lead to the
establishment of particular institutions and activities, such as
social and health care services, legislation, employment and
leisure opportunities. These determine how long, and in what
circumstances, people carry out obligatory or chosen occupa-
Dr Ann Wilcock is congratulated on her keynote lecture.
tions. They can therefore be pOSitive influences upon commu-
nity, family or individual health if they provide for equitable demics of illness at various workplaces and schools undertak-
opportunity for all people to develop potential, creativity and en by the (American) National Institute for Occupational
balanced use of capacities; to experience satisfaction, mean- Safety and Health (Colligan and Murphy 1979).
ing and purpose, stability and support, belonging and sharing,
and being able to contribute in a way that is socially valued.
With such opportunities in place, it is possible to look for
Potential role for occupational
the occupational indicators of good health, which include therapy in public health
involvement in a range of activities, commitment, energy, I believe that to make sure that individuals and society are
alertness, flexibility, interest, contentment, the ability to relax enabled to engage in occupations for health, it is imperative
and sleep, time for others and openness to new challenges. for us to promulgate information about humans as occupa-
These have been found to increase the experience of positive tional beings and the health consequences of this. We need
health and wellbeing and are likely to be compatible with to establish ourselves as advisers at all levels of society to
more conventional health status indicators, such as appropri- increase awareness and understanding. However, this is a
ate height/weight ratios and normal blood pressure, choles- huge undertaking and I think it is fair to say that most occupa-
terol level and lung function. Alternatively, established activi- tional therapists, in the past, have accepted the inevitability of
ties and institutions can result in risks to health through what is happening in our world at a sociopolitical and health
occupational stress, injustice, alienation, deprivation and service level rather than proclaim our distinctive views when-
imbalance. These produce preclinical health disorders, such ever legislative change or departmental policy compromised
as boredom, burnout, depression, sleep disturbances or sub- them. Many do the same today, perhaps for a quite under-
stance abuse, which lead ultimately to poor health and even standable need for comfort and security, which is associated
death (Wilcock 1998a). with the status of the medical profession; to be in line with
When work is perceived as stressful, boring or meaning- economists' views of what is important; because we are not
less, people experience numerous symptoms and stress and clear about our own philosophical base; or because we may
tend to drink or smoke more than those who are satisfied with consider that it is too hard to do anything else even if we have
what they do (Verbrugge 1982). Additionally, Justice (1987), thought we could do a better job if only 'things' were different.
in Who gets Sick: Thinking and Hearth, argued that the likeli- And, indeed, to change in this direction will be hard. In the
hood of 'mass illness' is increased. Along with a mountain of King's Fund report Professions Allied to Medicine and Public
other evidence (Warr 1985, Warr 1987, Winefield and Health (Levenson and Farrell 1998), some of the obstacles
Tiggerman 1991, Winefield et al 1992, Winefield et al 1993), British occupational therapists face to expand practice
this claim is backed up by material from studies of 16 epi- towards this public health focus are outlined. They include:

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 • The dominance of the medical model through enabling occupation. We say that we do this, but I do
• Lack of understandingof role of professionsallied to medicine not believe that this is our current focus. We are distracted by
• Problemsof resources, investment and re-investment the tools we use, such as aids to daily living, neurological
• Trainingand professionaldevelopment issues assessments, discharge plans, splints and computers. I am
• Researchissues not advocating that we discard these, only that we make sure
that they are used, and reported, as tools to facilitate pOSitive
• Information (ppl0-12).
health and wellbeing, integral to the philosophy of occupation-
Despite these difficulties, many occupational therapists al therapy, by:
have recognised the need to conceptualise the value of occu- • Being responsive to the individual's and the community's
pation to health and that it is important to call attention to goals
humans as occupational beings, and some have tilted at • Facilitating all people's participation and quality of life in
sociopolitical windmills in their attempts to facilitate change in occupation that provides meaning and satisfaction
this direction. Even so, I suggest that it is seldom that day-to- • Preventing ill-health through occupational injustice
day practice is habitually considered from the point of view of • Enabling people to maximise not only their independence
such a relationship; it is more often considered from the rou- but potential and self-growth too, if necessary through
tines of practice concerned with activities of daily living, or political advocacy.
techniques, or equipment, or splints, for example. At least, I It seems to me that at the start of any 'therapy', if practi-
have found this to be the case in many parts of the world. tioners believe that humans are occupational beings and that
When this extended practice paradigm is proposed, some occupation and health are inextricably linked, the questions
occupational therapists have said that they don't have time, a they should ask themselves are:
few that it is not our concern, others that it does not fit the • How best can I enable this person/community to reach a
paradigms of their work setting, and still others that we should state of complete physical, mental and social wellbeing ...
not even try to be idealistic because of the pressures of mod- to identify and to realise occupational aspirations, to satis-
ern practice. Such lack of action is similar to doctors fixing up fy occupational needs, and to change or cope with the
patients following a heart attack, but not addressing the environment so that they experience occupational balance
underlying dietary and lifestyle factors that lead to such prob- and satisfaction? How am I going to enable them to recog-
lems. But not understanding how the underlying factors of nise and minimise occupational deprivation, alienation or
engagement in occupation lead to positive or negative health imbalance? And what can I do to combat the occupational
outcomes could be seen as negligent. inequities that may mean less than optimal health and
But what a future we could have. When one considers wellbeing in the future?
health in occupational terms, not only do we find a distinctive We have to recognise, debate and discuss openly how
and perhaps valuable tool in identifying directions for current occupational opportunities for people differ from community
and future practice, it also becomes clear that we could have to community. Exploration of the underlying reasons for these
as much to offer in the arena of public health as we presently differences, and how they impact on health and wellbeing,
offer in individually based services. Indeed, I suspect our pro- needs to be undertaken within and by the community. The
fession's underlying beliefs fit better with the 'New Public exploration process and outcomes need to be well publicised.
Health' ideologies than with the current economically driven This is one of the best approaches to increase awareness and
and reductionist hospital or community-based services. As promote action about the causes and effects of occupational
Bockhoven (1972, p219) foresaw, if we take this perspective alienation, deprivation and imbalance, and also to provide
'the occupational service worker' will be 'divorced from medi- support and encouragement for self-reliant, self-chosen occu-
cine' to 'belong to the educational and economic life of the pation which gives meaning, purpose, social approval, health
community, to which he will contribute a much-needed kind of and wellbeing.
knowledge, and in which he will be a force in fostering respect
for occupations'. Here and now we could make a start in our
day-to-day practice. This would require therapists to reassert Summary
and talk openly about occupation's fundamental role in Health and wellbeing result from being in tune with our 'occu-
health, and to extend the domain of their concern to include pational' nature. For health and wellbeing to be experienced
all people, sick or well and individuals or communities. by individuals and communities, engagement in occupation
The first step sounds easy, but my personal experience needs to have meaning and be balanced between capacities,
belies this. It involves starting to think about ourselves as provide optimal opportunity for desired growth in individuals or
occupational beings in all aspects of our lives and being pre- groups, and be flexible enough to develop and change accord-
pared to change. The next step is to start to think about the ing to context and choice. Such engagement, if it is in accord
people we work with as occupational beings rather than as with sociocultural values and the natural world, will enable
patients or clients; to consider each person's unique occupa- individuals, families and communities to flourish. Rigorous
tional needs that have meaning for him or her, that give him exploration and sharing of this ideal, and taking action to
or her satisfaction and that allow him or her to grow; and to ensure that it is considered wisely, could be our contribution
think about the individual as part of a family or community to publiC health.
that has family or community occupational needs. We need A short poem may help recall some of the ideas you may
our assessment sheets to record what this person, and these like to think about:
people, need to do to help them to grow and flourish, and to At JordanstownI heard one day
experience wellbeing. We need to listen to them, watch them An OTto an old man say,
and ask them. We need to develop new skills and expand 'You look so happy and so fit
evaluation tool-kits to explore occupational hopes and dreams Can you tell me the cause of it?'
as well as functional activities of daily living, physiological 'It's what you do. It's being true
deficits, mental states and previous roles. Occupational thera- To all the talents given you.
pists should consider these before medical diagnoses and Totaking time, and listening to
handicap. Your inner needs in all you do.
In this vein, occupational therapists would, I believe, find it 'If you do this you will become
useful to regard themselves as agents for promoting health A person full of love and fun

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 A happy soul who's fit and well McLaughlin Gray J (1997) Application of the phenomenological
By doing what your needs foretell. method to the concept of occupation. Journal of Occupational
Science: Australia, 4(1),5-17.
'If doing does not meet your needs McNeill WH (1979) Plagues and people. London: Penguin.
Your health will suffer with your deeds. Mohun S (1991) Division of labour. In: T Bottomore, ed. A dictionary of
Not being true to nature's lore Marxist thought. 2nd ed. Oxford: Blackwell, p155.
You can become sick to the core.' Ornstein R, Sobel D (1988) The healing brain: a radical new approach
to health care. London: MacMillan, p206.
The old man smiled at the OT.
Petrovic G (1991) Alienation. In: T Bottomore, ed. A dictionary of
He said, 'Help people do and be Marxist thought. 2nd ed. Oxford: Blackwell, 11-16.
Help them transform their lives this way Presidents of the American Occupational Therapy Association 1917-
By living health day by day.' 1967 (1967) American Journal of Occupational Therapy, 21, 271.
Stephenson W (1972) The ecological development of man. Sydney,
It's very simple, but so hard
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