LAUSR

Founded 100 years ago, in the United States of America, the profession of occupational therapy’s first practitioners were highly skilled at engaging their patients in remedial activity. However, they did not have their own theoretical knowledge base and worked under the direction of doctors. An occupational therapy textbook from 1948, entitled Theory of Occupational Therapy, begins with a brief presentation of the aims and scope of occupational therapy, includes four chapters suggesting suitable activities for patients with different disorders and concludes with three chapters on how to organise an occupational therapy department (Haworth and Macdonald, 1948). There is nothing in the book that we would recognise today as occupational therapy theory. In 1957, the American Journal of Occupational Therapy published the findings of a survey of psychiatric occupational therapy ‘in Canada and parts of the North-Eastern United States’ (Azima and Wittkower, 1957: 2). The authors complained that ‘the underlying principle of most of the recorded theories of occupational therapy seems to be the assumption that by diverting the patient from his fantasmic [sic] preoccupations, and by normalizing his environment (normal according to an unidentified standard) he will abandon his fantasies and undertake a ‘‘normal’’ occupation’ (Azima and Wittkower, 1957: 2). They concluded that the lack of theory in occupational therapy, in particular the absence of a framework of basic concepts, ‘aroused anxiety in the occupational therapist because of her weakness in a theoretical field’ (Azima and Wittkower, 1957: 6). In the following decades, the profession produced a number of fine scholars who tackled the deficit with a proliferation of new theories, addressing subjects such as: the meaning of objects (Fidler and Fidler, 1963); the components of occupational performance (Mosey, 1986); motivation (Reilly, 1974); the environment (Dunning, 1972), and many others. This flow of scholarship gradually slowed, from the mid-1990s, as occupational therapy journals began to withdraw from publishing scholarly or theoretical papers, in favour of research, practice and education. Unfortunately, theory development came to a halt before agreement had been reached on the fundamental conceptual framework underpinning occupational therapy, as called for by Azima and Wittkower (1957). So, today, we have models for practice that are not built on firm conceptual foundations; we try to research interventions that are not adequately conceptualised, and we wonder why occupational therapists find it so difficult to say what we do (Creek, 2016). Yes, the profession needs more high-quality research to build an evidence base for the effectiveness of our interventions, but we also have to address the chronic weakness of our knowledge base through scholarly activity. If we acknowledge that much of the anxiety about our professional role and identity stems from ignoring our ‘weakness in a theoretical field’ (Azima and Wittkower, 1957: 6), then perhaps the tide will turn and theorising will once more become a valued occupation.