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Journal of Occupational Science

ISSN: 1442-7591 (Print) 2158-1576 (Online) Journal homepage: http://www.tandfonline.com/loi/rocc20

Pioneering occupational therapy and occupational


science: Ideas and practitioners before 1917

Kathlyn L. Reed

To cite this article: Kathlyn L. Reed (2017): Pioneering occupational therapy and occupational
science: Ideas and practitioners before 1917, Journal of Occupational Science, DOI:
10.1080/14427591.2017.1296369

To link to this article: http://dx.doi.org/10.1080/14427591.2017.1296369

Published online: 14 Mar 2017.

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Download by: [University of Western Ontario] Date: 14 August 2017, At: 08:02
JOURNAL OF OCCUPATIONAL SCIENCE, 2017
http://dx.doi.org/10.1080/14427591.2017.1296369

Ruth Zemke Lecture in Occupational Science 2016

Pioneering occupational therapy and occupational science: Ideas


and practitioners before 1917
Kathlyn L. Reed
PhD OTR FAOTA MLIS, Associate Professor Emerita, School of Occupational Therapy, Texas Womans University,
Houston, Texas, USA

ABSTRACT ARTICLE HISTORY


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The concept of using occupation with patients or clients was well Received 1 February 2017
established by the time the founders of the American professional Accepted 14 February 2017
organization met in 1917, but the origins that focus on using occupation
KEYWORDS
as a change agent for individual patient benefit remain unclear. Occupation and health;
Therefore the questions for this paper are: (1) When did occupation Historical criticism; Work
begin to be used as a change agent for individual benefit? (2) Who were cure; Habit training; Invalid
the people that first advanced the notion of occupation as a potential occupation; Diversional
positive change agent? and (3) What were their ideas about how therapy
occupation could be applied? The answers were found by searching the
journal literature using multiple terms, about 25, related to the concept
of occupation since the term occupational therapy did not appear in
print until 1915. Ninety-five articles were located published in North
American between 1897 and 1916. Six early practice models were
identified by terms used in the authors publications: institutional
occupation, diversional occupation, work cure, habit training, specialized
workshops and invalid occupation. The authors of the articles were
organized into four professional groups: physicians, other professionals
(psychologists, nurses, and artists), occupation workers, and occupational
therapy personnel. Selected individuals from each group were reviewed
along with a sample of their work. The earliest identified published
example among the authors was the occupation of gardening, initiated
in 1896 but not published until 1917. The earliest identified article
describing the value of occupation was published in 1897.

Clients had been occupied performing occu- that first advanced the notion of occupation as a
pations within American and Canadian insti- potential positive change agent? and (3) What
tutions for many years before the founding of were their ideas about how occupation could
the American professional organization in be applied? In other words, when did the con-
1917. Occupations such as farm hand, gardener, cept of individualized beneficial use of occu-
seamstress and cook are recorded by state super- pation begin, who started publishing the ideas
intendents in their annual reports of insti- and what were those occupations intended to
tutional activities. Such occupations benefitted accomplish?
the institution by reducing costs but not necess-
arily the individual clients (Thayer, 1908). The
question posed in this study are (1) When did Methodology
occupation begin to be used as a change agent To answer the questions, a type of historical
for individual benefit? (2) Who were the people research called historical criticism or the

CONTACT Kathlyn L. Reed klreed3@juno.com


2017 The Journal of Occupational Science Incorporated
2 K. L. REED

historical-critical method was used (Krentz, and descriptions cover the years from 1896
1975). Within the historical method is an 1925. Ninety five articles were located which
approach called source criticism or information were available full text in English and met the
evaluation. Garraghan (1947) suggested that criteria of describing the use of occupation as a
source criticism should include six points of change agent for the benefit of individual clients.
inquiry: date, localization, authorship, analysis, Based on the key words identified within the
integrity, and credibility. The first five items articles, they were organized into six categories
are known as external criticism, or the origin, that described one or more approaches to
and the last item is considered internal criticism, using occupation as a change agent with clients
or the content of the source (Lucey, 1984). in institutional or community settings. The six
Source criticism was selected as the method- categories were labeled as institutional occu-
ology because the method supports the ideas of pation, diversional occupation, work cure,
identifying and locating the early published lit- habit training, specialty workshops or invalid
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erature and the people who wrote about the occupation. See Table 3. A seventh approach
use of occupation as a change agent for individ- known as kindergarten methods or schools for
ual benefit. To begin the process, the literature
was searched using key words to identify occu- Table 2. Examples of Dates a Term First Appeared in the
pation and related concepts that focused on Literature
occupation as a change agent for individual Term First Source
benefit. Articles, biographies, and reports were Diversional Frost, 1911; Herring, 1912
primary sources. A list of key words and phrases occupation
Ergotherapy Reid, Aug. 1914
developed to identify the literature appears in Functional activity Blumer, 1897; Dercum in Thayer, 1908
Table 1. The literature covers the time period Habit training Haviland, 1912
from 1897 to 1916 (see Table 2), however, Industrial Blumer, 1897
employment
descriptions of some early North American pro- Industrial Husted, 1913
grams were not published until several years occupation
after the program was initiated. The programs Industrial training La Moure, 1910
Industrial work Luther, Jan, 1914; Cameron, Aug, 1914;
Husted, 1919
Invalid occupation Tracy, (1906) 1910
Table 1. Names and Concepts for a Profession Occupation work Dunton, 1919
Occupational Editorial, 1911
Activity therapy or activity treatment treatment
Curative work or Curative therapy Occupational Crumbacker, 1913
Diversional occupation or diversional treatment training
Ergotherapy Reeducation Burnet, 1909
Fingercraft instruction Systematic teaching La Moure, 1910
Functional therapy or functional treatment Therapeutic Herring et al., 1913; Ricksher, 1913
Habit training occupation
Industrial training or employment Work cure Thayer, 1908; Hall, 1910
Invalid occupation Work treatment Reid, Aug. 1914
Finger therapy or finger treatment
Functional remediation
Occupation work/worker
Occupational diversion Table 3. Early Conceptual Models of Practice Using Occupation
Occupational therapeutics
Occupational training (vs vocational training) Name Purpose
Occupational treatment Institutional Use of Reduce cost of patient care, improve
Occupations and amusements Occupation staff morale
Occupations and diversions Diversional Counteract idleness, improve morale
Reconstruction therapy Occupation
Re-education or functional re-education or Work Cure Substitute work for rest using graded
systematic re-education occupation
Systematic occupation Habit Training Re-education in scheduled,
Therapeutic diversion organized daily life activities
Therapeutic occupation Specialized Workshops Vocational exploration, education
Work cure and training
Work therapy Invalid Occupation Constructive use of time through
Work training doing and creativity
JOURNAL OF OCCUPATIONAL SCIENCE 3

the insane was not included because the concept of diversion appears earlier (Atwood,
approach is based on group instruction or 1907; Frost, 1911; Herring, 1912). Diversional
focused on preschool academic subjects and occupation was developed to provide occupation
exercises rather than the use of occupation for clients who were viewed by institutional staff
(Hamlin, 1901; Hutchings, 1912). Keywords or as unfit to be assigned duties or roles in main-
phrases for institutional settings were associated taining the institution. Terms used to describe
with maintaining the institution and its residents the concept of a client in need of diversional
such as growing and harvesting crops, grounds occupation were unfit for work assignment,
keeping, building new cottages, cleaning the unable or unwilling to work, restless, mischie-
wards, or preparing food (Davenport, 1917). vous, degenerate, too sick or ill, too untidy, too
Institutional use of occupation was included disorderly, or too deteriorated (Herring, La
because many articles and reports discuss the Moure, & Richardson, 1913). Institutional occu-
difference between institutional use of occu- pations developed to keep the institution func-
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pations and diversional occupations in terms of tioning when financial resources provided by
management and behavioral approaches with the state or endowment were insufficient to
clients. Institutional occupation as a category is maintain the institution (Thayer, 1908). Clients
not discussed as a change agent focused on occu- provided free labor or in kind labor in lieu of
pation for the benefit of individual clients. payment for care when families could not afford
For diversional occupation key words or to pay. Institutional occupation benefitted the
phrases were idle or idleness, bored or boredom, institution primarily. Such occupation may also
morbid thoughts, inability to work, substitution, have benefitted the client, but individual benefit
deterioration, destructive, messy, untidy or dis- was secondary to services needed to maintain the
orderly. Work cure articles centered on the con- institution.
cepts of graded occupation in terms of In contrast, the chief objective of diversional
increasing time or task difficulty, work and rest occupation was to benefit the client and the hos-
periods, or being able to perform the occu- pital atmosphere, as opposed to its economic or
pations involved in a normal day of living. financial basis (Herring et al., 1913). Diversional
Searches for articles on habit training focused occupations counteracted destructive behavior
on schedules or scheduling, organizing periods on the ward (Herring et al., 1913), thus benefit-
of time and activity, purposeful activity, reeduca- ting the staff as much or more than the clients,
tion in institutional settings, or Adolf Meyer because they were easier to manage. Individual
M.D. Terms related to specialty workshops benefit was enhanced if the staff members
included work skills, vocational training, wages, helped clients to select occupation with the cli-
products, industry, and work settings. Finally ents objectives in mind. In the report of the sur-
invalid occupation addressed adapting occu- vey conducted in 1913, 54 different occupations
pations, invalid or invalids, or made reference are listed as part of a diversional occupation pro-
to Susan Tracy R.N. This article provides a gram from the 111 replies received (Herring
brief overview of selected individuals that devel- et al., 1913). In addition, 55 recreational activi-
oped programs based on five approaches that ties were reported.
focused on the beneficial application of occu- The work cure was designed to teach or
pation to individual clients based on interven- reteach skills needed to return the person to
tion programs developed before 1917. his or her daily activities by starting with short
work periods and easily performed tasks and
then gradually increasing the amount of time
Approaches to Change through the
and complexity of the tasks. People who had
Use of Occupation
broken down under the stress of their daily
Two approaches, institutional occupation and lives were candidates for the work cure. The dis-
diversional occupation, are interrelated or con- orders of neurasthenia and tuberculosis are cited
nected concepts. The term diversional occu- as disorders for which the work cure would be a
pations first appeared in the literature in 1912 useful approach (Cabot, 1909; Hall, 1905; Hills,
in Herrings committee report; although the 1909). The work cure was also the antithesis of
4 K. L. REED

the rest cure described by Silas Weir Mitchell Substitution involved changing idle time to
(18291914), who felt people with neurasthenia occupied time and was also called diversion or
had over worked themselves and needed more replacement (Herring, 1912). Substitution was
rest (Hall, 1905; Mitchell, 1884). designed to divert or replace disruptive, disor-
Habit training is the name by which the derly, or untidy behaviors with behaviors and
therapeutic approach proposed by Adolph actions that were purposeful (Haviland, 1912).
Meyer is best known, but other names were Grading was the process of gradually increasing
used such as systematic reeducation (La the amount or complexity of time, space, tasks,
Moure, 1910) and re-educational measures actions, steps or equipment needed to complete
(Singer, 1915). Whichever term is used, the prin- an occupation. The client might start with a
ciple concept was to create a schedule based on simple sewing task, such as a running stitch,
everyday occupations to be performed at certain while seated in bed and gradually move to sitting
times of day for certain lengths of time (La on a bench to weave on a floor loom in a shop
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Moure, 1910). The sequence of skills used in space for four hours per day (Hall, 1910). Adapt-
such tasks and routines may be described and ing, altering or modifying involved changing the
followed as well. The approach was used most original form of the equipment or supplies to
frequently with clients labeled as dementia prae- simplify the task or allow the task to be per-
cox or schizophrenic (La Moure, 1910). formed in an environment not usually associated
Specialized workshops were developed with that task (Bott, 1918).
initially for clients with tuberculosis or war inju-
ries, post-surgery or convalescent clients, or
Conflicting Ideas
those in need of economic support (Bott, 1918;
Brown, 1914; Husted, 1913; Luther, 1902; Put- Conflicting ideas were already apparent before
nam, 1915). Workshops developed primarily 1917. Writers disagreed about the role of occu-
for physically disabled clients, known as curative pation in supporting the institution versus indi-
workshops, were established later (Goodman, vidual benefit. Some writers felt the client owed
1920). The focus of the specialized workshops the institution, in terms of labor to defray the
was most often on providing work training and expenses of care if the client or family could
experience for socially marginalized workers not pay for it (Moher, 1907; Thayer, 1908).
(Brown, 1914). Associated with payment was the belief that
Invalid occupations were developed to aid in individualized occupation was unnecessary, as
the adjustment to illnesses with prolonged mental illness was, according to some, incurable.
recovery times, especially those requiring bed Why waste time on therapeutic goals if the client
rest. Occupations were selected to meet the con- was never going to be well again? Why waste
ditions such as the clients age, environmental time on an unachievable objective? Using occu-
conditions, ability level and the materials avail- pation for the clients benefit just wasted valu-
able (Tracy, 1910). Tracy believed the use of able resources needed to keep the institution
occupation as a change agent was a nursing functioning (Haviland, 1912).
responsibility, thus the early discussions of inva- Another major discussion point was the
lid occupation is dominated by nurses. relationship of health or normal occupation to
idleness and boredom. Idleness was viewed as
a contributing factor to mental and physical
Change Concepts
deterioration. Engagement in occupation was
Four major change concepts were identified: the antidote (Blumer, 1897).
normalizing, substituting, grading, and adapting. A fourth conflicting idea was the difference
Normalizing involved using time, space, task, between using occupation as a curative or thera-
actions, and equipment in the usual or ordinary peutic agent, as opposed to vocational education
manner accepted by society and culture (Hall, and training. Again, some writers felt that time
1905). Normalization includes the concept of spent on curing or benefiting clients could
engaging the person in doing, participating, be better spent teaching them a marketable job
and building habits and routines (Cabot, 1909). skill that allow them to work for a living instead
JOURNAL OF OCCUPATIONAL SCIENCE 5

of being a burden on society. Therefore, voca- vegetables or flowers when ready. Dr. Davenport
tional or occupational training was viewed as reported on progress of the women in terms of
more valuable than beneficial focused occu- competition, responsibility and social inter-
pation (Brown, 1914). action. One of the people who observed Dr.
A final area of conflict concerned the role of Davenports experiment was Adolph Meyer,
training a person to become a therapist in occu- M.D., who would report about her gardening
pation versus the role of craftsperson. Some project in his speech and publication (Meyer,
people felt that knowledge of crafts was all that 1922).
was needed while others, such as Tracy, felt Arthur P. Herring (18751928) was a
that training as a nurse was important to better physician in Maryland and the secretary of the
understand the needs of the client and the nature Maryland State Lunacy Commission. From
of the disorder or disease with which the client 19121916, he was Chair of the Committee on
was diagnosed. Teachers College at Columbia Diversional Occupation for the American Med-
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University offered classes in invalid occupation ico-Psychological Association. He described


(Collins, 1914). Others got on-the-job training diversional occupation as a therapeutic agent
as a therapist, since there were no formal train- to be prescribed after a careful study of each
ing programs in occupational therapy. The first case and should be in charge of a competent
suggested course of training appeared in 1917 director (Herring, 1912, p. 44). He also stated
and the first minimum standards of training that without diversional occupation life of the
were approved in 1923 (AOTA, 1924; Collins, patients falls into a dull and monotonous routine
1917). and many cases become hospitalized who other-
wise might be restored to the community (Her-
ring, 1912, p. 44). William Rush Dunton, Jr.
Diversional Occupation
M.D., a founding member of the National
Proponents of five of the six early models will be Society for the Promotion of Occupational
discussed by briefly reviewing the works of the Therapy (NSPOT), was a member of Dr. Her-
leading proponents and their contribution to rings committee.
advancing the study and use of occupation for Reba G. Cameron (18851959) was a nurse
the benefit of clients. For diversional occupation, who worked at Taunton State Hospital, in Taun-
the proponents discussed are Dr. Davenport, ton, Massachusetts. She stated that occupation
Dr. Herring, Reba Cameron, Winifred Brainerd is one of the best therapeutic agents that we
and Louis Haas. have. It can act as a stimulant, a sedative, or a
Isabel Montgomery Davenport (18601939) tonic in the hands of one who understands its
was both a doctor of medicine and a doctor of use (Cameron, 1915, p. 344). In addition she
osteopathy. In 1896 she was the physician in wrote we feel that the sooner we can get their
charge of the womens wards at Eastern Illinois minds off their own troubles and interest and
Hospital for the Insane (later Kankakee State amuse them, that one-half of the battle is won
Hospital). She was concerned that there were (Cameron, 1914, p. 69). Although the profession
few outdoor occupations for women as opposed of occupational therapy would later develop its
to the many outdoor occupations available to own training programs and educational stan-
men, although most related to helping build or dards, during the early years, nurses were fre-
maintain the institution. For women, the main quently the primary instructors in occupation
outdoor occupation was going for walks around and their insights increased the understanding
the grounds. Dr. Davenport decided to try gar- of occupation as a beneficial tool in promoting
dening and secured permission from the hospi- and restoring health.
tal superintendent to divide some land near Winifred Brainerd (18821975) was an art
one of the womens colleges into small sections teacher before she started working at Clifton
where vegetables and flowers could be grown Springs Sanatorium in December, 1912. She
(Davenport, 1917). Each woman was assigned also taught briefly at the University of Toronto
an individual section for which she was respon- at the request of Thomas B. Kidner, another
sible for planting, tending, and picking the founding member of the NSPOT. Later, she
6 K. L. REED

was director of occupation at Presbyterian Hos- treatment occupation, properly systematized


pital in Chicago, Illinois which had been started and diversified, is of immeasurable greater con-
by Susan Tracy. Brainerd developed her ideas at sequence (Blumer 1897, p. 158). Blumers com-
Clifton Springs but did not write about them ment regarding bottle medicine and drug
until 1919. She felt that the application of occu- treatment pre-dates Bartons statement that
pation should be divided into two classes, work the first thing to be done is for occupational
in the shop or garden and work in the clients therapy to provide an occupation which will
rooms. In her opinion, individual needs and pre- produce a similar therapeutic effect to that of
ferences should govern the choice of project in every drug in materia medica (Barton, 1915,
each case (Brainerd, 1919). p. 139. Italics in original). Both, however, sup-
Louis James Haas (18881969) was educated port the concept that work and occupation
in both fine arts and mechanical arts before have beneficial potential to clients.
becoming Director of Mens Occupation at Herbert James Hall, M.D. (18701923) is the
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Bloomindale Hospital, White Plains, New York primary proponent of the work cure approach at
from 19151956. Haas is one of the first male his facilities in Marblehead, Massachusetts. In
occupational therapists and served as secretary 1905, Hall received $1,000 in grant money
to the NSPOT from 19171920. He began writ- from the Proctor funds at Harvard College
ing about occupation in 1916 (Haas, 1916). He (now Harvard University) to study the effects
stated that occupation would be of value of graded occupation as a treatment approach
because, in the treatment of mental disorders, in contrast to the rest cure proposed by Silas
being occupied would divert the patients Mitchell (Hall, 1905). In 1909 he received a
thoughts from himself and his condition and second grant and published his results the fol-
would employ the time usually spent in idle lowing year (Hall, 1910). Dr. Hall stated that
brooding and possibly give him a good deal of occupation of hand and mind is a very potent
satisfaction in the doing (Haas, 1916, p. 516). factor in the maintenance of physical, mental
Haas also admitted that it was difficult to find and moral health in the individual and in the
occupations of interest to men and it was dif- community (Hall, 1910, p. 12). He also stated
ficult to find persons competent to teach such that to be busy at some actual worth-while
subjects to sick persons (Haas, 1916, p. 516). task is a necessary part of life, it is as necessary
Both issues, occupations of interest to male as food and drink (Hall, 1919, p. 45). His state-
patients and finding persons to teach those sub- ment is similar to a statement in the Credo writ-
jects, would continue as subjects of discussion in ten by William Rush Dunton, Jr. M.D. which
the field (Haas, 1920, 1925). states that occupation is as necessary to life as
food and drink (Dunton, 1919, p. 10).
Thomas James Moher, M.D. (18631914)
The Work Cure
was Superintendent at Cobourg Hospital for
The term work cure first appears in the litera- the Insane in Canada. He stated that careful
ture in an article by Thayer (1908), who study should be made of the temperament of
reviewed early examples of the use of occupation each patient before deciding the kind of labor
for the benefit of clients. Examples of propo- suitable and that previous occupation or
nents of the work cure are Dr. Blumer, Dr. social condition should not be the only deter-
Hall and Dr. Moher. George Alder Blumer mining factor (Moher, 1907, p. 1666). In
established programs of occupations and amuse- addition, he felt that attendants should be
ments at Utica State Hospital in New York and selected with care and carefully instructed and,
Butler Hospital in Providence, Rhode Island. In furthermore, patients should never receive
1897 he stated that we should not for a moment wages because payment was sure to create trou-
allow ourselves to think that bottle medicine, to ble (Moher, 1907, p. 1666).
which the layman pins his faith, is scientific Physicians who supported the work cure
treatment for the insane, while work as a cura- approach were consistent in their view that
tive agency is not (Blumer, 1897, p. 158). His occupation was useful as a means of restoring
contention was that compared with drug health and performing daily living tasks. There
JOURNAL OF OCCUPATIONAL SCIENCE 7

was disagreement as to whether the client should Although Dr. La Moure had moved to Con-
receive wages, since vocational training was not necticut, C. Floyd Haviland, M.D. (18751930)
the primary focus of the work cure. In other remained in New York City at the Manhattan
words, the physicians agreed on the benefit of State Hospital. Dr. Haviland was familiar with
focusing attention, time and energy on the pro- Dr. Meyers idea that disorganized habits were
cess of doing and performing daily life occu- a symptom of dementia praecox. He stated
pations but not on whether wages were needed that habit training was the aim of all occu-
as a reward. pational re-education (Haviland, 1912,
p. 249). Haviland also stated that through the
use of scheduled occupation, some form of pur-
poseful activity could be provided for the
Habit Training
majority of the patients in any institution
The first physician to publish an article on the (Haviland, 1915, p. 325). His use of the term
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experimental use of the approach called habit purposeful activity is the first recorded in the
training was Charles Ten Eyck La Moure, M.D. occupational therapy literature. Haviland
(18721950). Dr. La Moure was a resident with would later become president of the American
Adolf Meyer, M.D. at the Phipps Clinic in Balti- Occupational Therapy Association in 1928,
more, before joining the medical staff at Roche- although his term would be cut short when he
ster State Hospital in New York State. Dr. Meyer died while traveling in Egypt in 1930.
is credited with creating the concept of habit Another early proponent of the concept of
training or systematic teaching and re-edu- habit training was Mary Lawson Neff, M.D.
cation, as Dr. La Moure labelled the concept (18621945). Dr. Neff started writing about the
(La Moure, 1910). In 1909, La Moure selected use of occupation in 1910 when she worked at
10 women who were apathetic, untidy, nosy, Long Island State Hospital, in New York, and
assaultive and idle to attend a 3-hour class later in Boston, Massachusetts when she worked
designed to arouse their interest and attention at the State Board of Insanity. She quoted Dr.
(La Moure, 1910, p. 405). The participants Meyer stating that occupation is a matter of
slowly improved in the class but reverted to prescription and that training in normal
undesirable behaviors on the ward, so the time activities and cultivation in fruitful interests is
was increased to 6 hours. Occupations included the sanest and only efficient point of attack
gymnastic exercises, dancing, singing, marching, (Neff, 1910a, p. 187). She further observed that
sewing, weaving rugs, making baskets and doing whatever plan or classification is followed, a
fancy work or embroidery. The patients regular schedule of occupation which accounts
improved but the lack of trained teachers forced properly for every hour of the patients time is
Dr. La Moure to abandon the program (Slagle, essential (Neff, 1910a, p. 187). Neff also sup-
1936). ported La Moures contention that the schedule
In explaining the need, Dr. La Moure stated should not be decided by the patient nor left to
that these teachers should teach the patients the initiative of the attendant; the doctor must
moral hygiene, habits of industry and proper be involved. She did suggest that various apti-
methods of living (La Moure, 1910, p. 407). tudes of the staff and patients could be used,
He further stated that every hour of the day especially praise, competition, and an appeal to
should be occupied by those young cases of the aesthetic sense. The articles made should
dementia praecox in some form of diversion or be useful but quickly finished, so that results
occupation (La Moure, 1910, p. 408). Slagle are not delayed, and should have color or form
had corresponded with La Moure while he was that gave an esthetic value (Neff, 1910b).
at Rochester State Hospital and was aware of In 1915 Harold Douglas Singer, M.D. (1875
his work, even though he had moved to Connec- 1940) reported on studies he called re-edu-
ticut before she became Director of the Bureau of cational experiments (Singer, 1915). He is the
Occupational Therapy in the New York State first person to publish charts showing the pro-
Department of Mental Hygiene in 1922 (Slagle, gress of selected clients in personal habits such
1936). as dressing, toileting and eating; work and
8 K. L. REED

play; spontaneous activity; and total improve- The workshops were designed for clients with
ment. In addition, he provided an example of a identified diseases and disorders which contrib-
scale used to chart progress in dressing. The uted to them needing to learn or relearn work
scale had four levels: practically no attempt to skills. One of these specialized workshops was
dress self (0), aids a little but does not button started by Philip King Brown, M.D. (1969
dress, etc. (1), dresses self but takes no especial 1940). In 1911, he founded and directed the Are-
care of hair, etc. (2) and dresses self and cares quipa Sanatorium in Arequipa, California to
for hair, etc. (3). The program of reeducation serve women with tuberculosis who were unable
was carried out by nurses at Kankakee State to afford care elsewhere. Within the sanatorium
Hospital in Kankakee, Illinois. There is no men- was a workshop designed to teach the women
tion of occupation workers either as instructors work skills they could use when they left the
or data collectors. sanatorium (Brown, 1914). The primary occu-
The first person trained as an occupation pation in the workshop was pottery making.
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worker to write about habit training was Hen- The women mostly did the light manual work
rietta Cowman George Price (18871983), who such as cleaning the green ware after it was
worked for Dr. Meyer and Mrs. Slagle at the removed from a mold and preparing glazes to
Phipps Clinic in Baltimore, Maryland and later be applied to the pottery as decoration. The
at the Sheppard & Enoch Pratt Hospital, also heavy work of preparing the clay was done by
in Baltimore. Her article, published in 1919, is staff. Clients began working 1 hour a day, but
a reflection on the years she worked at the could work up to 2 or 3 hours a day (Brown,
Phipps Clinic from 19131919. Mrs. Price 1914).
emphasized the criteria for the selection of occu- Mary Irving Husted (18691937) was an
pations more than the daily schedule of occu- accomplished weaver before she started working
pations. In her opinion, occupations are at Clifton Springs Sanitarium in Clifton Springs,
chosen so as to assure reasonably rapid satisfac- New York where George E. Barton, another
tion from finished results (Price, 1919, p. 50). founder of the NSPOT, was a client. Husted sta-
She further advised that the cultivation of inter- ted that the use of crafts as treatment [is a]
est in the use and purpose of what one makes means [by] which sick people may regain both
is an important factor and that interests should physical power and self-confidence (Husted,
dovetail with more lasting interest after dis- 1913, p. 28). She also felt that establishing sev-
charge (Price, 1919, p. 50). eral industries on a firm business basis would
Habit training was more than the adherence give employment to many persons unable to
to an hourly schedule of occupation. The occu- return to old vocations (Husted, 1913, p. 28).
pations were selected based on the needs of the After Husted left Clifton Springs, she worked
clients and the goal was to bring them up to a for the Tide Over League in Boston, Massachu-
decent level of living (Slagle, 1936, p. 152). setts, another specialized workshop serving
Habit training was a technique used primarily homebound clients (Husted, 1919).
with so called back ward or chronic patients. R. Tait McKenzie M.D. (19671938) helped
Application of the technique required special- develop the program at Hart House in Toronto,
ized training and commitment on the part of Canada and later the physical medicine program
the staff because it required additional effort at the University of Pennsylvania in Philadel-
and resources not readily available in insti- phia. The program at Hart House was focused
tutional settings. Habit training would become on helping Canadian soldiers wounded in
one of the topics with which occupational thera- World War I to regain physical function. As
pists were familiar through Slagles (1922, 1936) one of the programs physicians, Dr. McKenzie
publications. was instrumental in helping to differentiate the
role of occupational therapy from that of voca-
tional training. He asserted that in occupational
Specialized Workshops
therapy the movements are given as treatment,
Specialized workshops addressed a specific need and the work done is a secondary consideration.
for occupational skills and occupational training. In vocational training the object is to make a
JOURNAL OF OCCUPATIONAL SCIENCE 9

good box by sawing the board in definite lengths historic order and sequence, and illuminate
and the arm exercise is secondary (McKenzie, them by correlated art and literature, historical
1916, p. 106). In other words, the objective or lectures, with charts, diagrams and maps. The
goal determined the difference. Movement and word museum was purposely used in preference
exercise were related to therapy goals, while saw- to school, because the latter is distasteful to
ing boards to length to create a box were voca- grown-up people and the word museum
tional. Dr. McKenzie also stated that retains fascination of the show (Luther, 1902,
treatment by occupation differs from all other p. 2).
forms in that the remedy is given in increas- Elizabeth Greene Upham (Davis) (1980
ing doses with its patients improvement 1988) started teaching art classes in jewelry
(McKenzie, 1916, p. 105). and mental work at Milwaukee-Downer College
Edward (Ned) Alexander Bott (18871974) in 1911 (Davis, 1977). Her teaching is credited as
was a psychologist and the founder of the pro- being the first at a college or university that
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gram that became known as Hart House. Orig- would lead to the development and accreditation
inally, Bott started a program he called of an occupational therapy educational program
functional re-education at the College Street (Hospital Service, 1938). She also started the first
Military Hospital but he moved the program to curative workshop in Milwaukee, Wisconsin.
Hart House as more space was needed. Bott She held the view that a well-defined program
also created the term mechanotherapy to of work means the adapting of work suitable
describe the adaptations to equipment he made for special abnormalities (Upham, 1917,
to facilitate specific movements of certain parts p. 409). In addition, the work is not to overtax
of the body. In essence, Bott is one of the earliest the patient, or to exploit him, but to teach him to
individuals to create adaptive therapy equip- help himself, to utilize to the full his limited
ment. In describing his program he wrote that capacity, and whenever it is possible, to increase
the principle underlying re-educational work that capacity to greater physical and mental
is to put within a patients reach the proper vigor through the training of hand and mind
apparatus, assistance, and encouragement for (Upham, 1917, p. 409).
practicing such physical movements, or mental Specialized workshops addressed issues
processes as may have been interfered with or related to job training and earning a living.
have entirely disappeared through injury or The blending of occupational therapy and voca-
shock (Bott, 1917, p. 293). Special appliances tional training was successful in the early years.
he continued, should be designed for specific Occupational therapy provided the physical
functions, and have a metrical indication of reconstruction of movement and endurance,
range of movement and amount of load. They and vocational training provided the work skills
should be simple, be strongly made, fit well for and practice. However, the United States gov-
right or left as possible, and have no loose attach- ernment would separate the two, mandating
ments that may be misplaced (Bott, 1918, that occupational therapy was a medical field
p. 445). and vocational training an educational field
Jessie Luther (18601952) was an artist when (United States Committee on Public Infor-
she was hired by Jane Addams to start the Hull mation, 1918). Funding would be separate and
House Labor Museum in 1901. After leaving thus the blending came to an end.
Hull House, she met Dr. Hall at a convalescent
facility in New Hampshire. She agreed to help
Invalid Occupation
him start his practice in Marblehead, Massachu-
setts where she specialized in weaving. Still later, The primary proponent of invalid occupation
she helped teach rug weaving to residents in was Susan Edith Tracy, R.N. (18841928). In
Labrador and Newfoundland, in Canada, so 1906 she began teaching the concepts of invalid
they could earn a living during the winter occupation to nurses at the Adams Nervine Hos-
when the weather was too cold to fish for cod. pital in Jamaica Plain, Massachusetts. She
Luther explained that the Labor Museum was believed that occupational therapists should be
designed to put the various processes into trained first as nurses, because of the skills that
10 K. L. REED

nurses learned. In an address to nursing superin- gradually increasing participation in work and
tendents, she outlined some of her philosophy of productivity, and as having tools and equipment
training personnel. She described how a craft- that could be adapted to meet the needs for res-
shop teacher may be brought in but the toration of function.
work narrows down to the nurse who learns Events have overtaken the early development
her patients capacities, limitation, and moods of conceptual models and theories. Diversional
as does no other person (Tracy, 1910, p. 180). occupation developed a negative reputation by
Regarding the use of occupation for therapeutic those who considered it busy work and not
purposes, she asserted it should never be forgot- real therapy. The concepts of grading used in
ten that the occupation is a means rather than an the work cure existed in activities of daily living,
end and that it is far better that one have the which often began with bedside activities and
sense of being occupied than that the time gradually increased in length of session and diffi-
go by unemployed save by morbid thought culty of task as the client improved. The schedul-
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(Tracy, 1910, p. 180). ing aspect of habit training was integrated into
One of people who helped teach others about nursing management and child development pro-
Tracys concept of invalid occupation was Eve- grams. Specialty workshops have become more
lyn Lawrence Collins (18711953). Collins associated with vocational rehabilitation and shel-
taught a course for nurses and social workers tered workshops. The concepts of invalid occu-
called Occupations for Invalids in the Colum- pational advocated by Tracy have been
bia University Extension program from 1914 to integrated in occupational therapy education.
about 1920. The course content included the his- A final thought: Occupation began to be con-
tory and development of invalid occupations; sidered as of value in teaching control of the self
understanding of need, value and scope of such and as a means of restoring health (Ricksher,
work; and a rudimentary working knowledge 1913, p. 380). The recognition and use of occu-
of a few simple crafts. The crafts included bask- pation as a change agent for the benefit of clients
etry, chair caning, rush seating, women seats, has its roots long before the founders gathered
leather work, pamphlet binding, knitting, cro- together in March, 1917 in Clifton Springs,
cheting, rake knitting, rug making, and light New York to start the National Society for the
woodwork (Collins, 1917). Promotion of Occupational Therapy.

Summary
References
The first article identified in the literature that
American Occupational Therapy Association. (1924).
stated the case for the use of occupation for indi- Minimum standards for courses of training in occu-
vidual benefit was written by Blumer in 1897. pational therapy. Archives of Occupational Therapy,
However, Davenport reported that her appli- 3(4), 295299.
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