Friday, October 16, 2015

Thought exercise for occupational therapists

Thought exercise:
Take special note of the 'Service to society' section 
[my emphasis added].  Are we still providing this service? 
Or are we now chasing some other objectives that are out of 
sync with this original intent? 




Registrar, Boston School of Occupational Therapy 

Boston, 1920.
Description of occupation 

Occupational therapy is one of the new professions for 
young women. The necessity and importance of this work 
was firmly established in military hospitals during the late 
war and its future success is secure. The civilian hospitals 
are waiting for trained workers, and we believe that it is but 
a short time before every hospital and institution will employ 
at least one aide. 

The training is designed to develop not only artistic and 
mechanical skill and dexterity, but also ability to cooperate 
with every branch of the hospital service in order that there 
may result the highest standard of efficiency. This latter 
ability is quite as important as the former. 

Among the crafts used for their special therapeutic value 
are: Applied design, basketry, block printing, bookbinding, 
chair-seating, jewelry, leather work, modeling, rug-making, 
textiles, tin-can work, typewriting, weaving, wood-carving, 
woodwork and whittling. Also minor curative occupations; 
bead work, colonial mats, cord work, crocheting, knitting, 
netting. The work is carried on in hospital wards and shops 
and, when possible, with private cases. 

Preparation or training necessary 

General education, equivalent at least to high-school educa- 

Previous training in any of the following subjects with satis- 
factory credentials will be credited the student upon entrance 
to the schools of Occupational Therapy: nursing, social 
service, physical education, mechanical drawing, psychology, 
arts and crafts. 
Training may be secured at the following schools: 

Boston School of Occupational Therapy, 7 Harcourt Street, 

Teachers College, Occupational Therapy Department, New 
York City. 

Flavell School, Chicago, Illinois. 

Philadelphia School of Occupational Therapy, Philadel- 

Downing College, Milwaukee, Wisconsin. 

School of Occupational Therapy, St. Louis, Missouri. 
Qualifications necessary for success 

Strong physique, understanding of human nature, common 

sense, initiative and adaptability. 
Financial return 

Average, from $1200 to $1800 per year. 
Extent of occupation 

Occupational therapists are in demand in institutions such 
as State hospitals, private hospitals, Army and Navy hospi- 
tals, dispensaries. Government public health departments, 
work with private patients both in hospitals and at home. 
The demand for well-trained aides far exceeds the supply. 
Service to society 

To restore a patient's courage and his, or her, maximum men- 
tal, nervous, and physical ability is to add an asset to the 
community where there might have been a liability. To bring 
work out of idleness has economic value in time, morality, 
production, health, and happiness, and is elevating to the 
individual and to the entire world. 
Suggested reading 

"Ward Occupation in Hospitals," Bulletin No. 25. Issued by 
Federal Board of Vocational Training, Washington, D.C., 1918. 
"Handicrafts for the Handicapped" — Dr. Herbert J. Hall. 
"The Work of Our Hands" — Dr. Herbert J. Hall. 
"Teaching the Sick" — George Edward Barton. 
"Invalid Occupations" — Susan Tracy. 

Tuesday, October 06, 2015

A tale of two Mertons

In her famous Slagle lecture, Reilly describes the importance of criticism in professions in general and in occupational therapy in particular.  She stated that
"...a card-carrying critic must do more than merely engage in critical thinking. Judgments made by a critic must emerge from a discreet use of techniques which are difficult to master and dangerous to apply. Basically, the skill is dependent upon an ability to analyze, interpret and synthesize. A critic must have a sharply developed capacity to see deficiencies in data and fallacies in interpretation. The best stock in trade that any critic has is a discerning eye for trends and an ability to pattern and verbalize them. Whether a critic is worth listening to is usually decided by an ability to use language well, by a creativeness in synthesizing new relations and by courage to propose provocative hypotheses. Ultimately, however, a good critic rests his case upon how well he has been able to restructure the issue so that the necessary powers for its resolution can be freed."

Reilly understood that these were difficult standards because in her estimation criticism was not commonly employed or understood in professional affairs at the time she gave her lecture.

Unfortunately, not much has changed in this regard in 50 years.  The AOTA is proposing changes to the Bylaws that create an environment that will discourage member participation.  The current proposed revisions are posted online at

The new Bylaws create a process where any member can complain and call for the removal of another member based on the poorly defined concept of 'cause.'  Such complaints would be the type of complaints that would not rise to a full ethics violation.

There is an ugly history of people using association processes to air their personal disputes. Just ten years ago there were published allegations that the SEC (ethics commission) was becoming a place where "conflicts of interest or personality disputes [were] coming before the commission."  (Glomstad, 2005).  An AOTA member made a motion to eliminate the SEC because "The story behind the motion reveals that the SEC also has become an arena for airing personal conflicts among AOTA leaders and members." (Glomstad, 2005).

There was a lack of specificity in the new proposal.  After it was pointed out that there was no procedure for managing complaints, a document was created.  It does not appear that the brand new "Standard Operating Procedure for Investigation and Determination of Complaints to Terminate Membership" has even been reviewed by the BPPC or approved by the Board.  That leaves the impression that this is being made up on the fly.

After pointing out that there was no real definition of "cause" some clarification was given.  The FAQ was updated and now states that "This definition of “cause” is consistent with the longstanding description of “cause” used in AOTA policies for removing volunteer leaders from their positions."

It does not make sense to apply standards associated with volunteer leaders to members because the conditions do not apply to members.  The definition of 'cause' as stated in Policy 1.15 Removal and Appeal have no application to normal members.
That policy states:

1. All elected and appointed volunteer leaders may be removed for:
    a. Failure to accurately report or maintain qualifications for the office or position held, including maintaining the credentials and criteria for eligibility for the office, or
    b. Failure to perform official duties of the office or position held as defined in the governance documents, or
    c. Failure to declare a material conflict of interest in violation of the Association’s official policy or other action/omission of influence, or
    d. Misuse of proprietary or confidential information, or
    e. Violation of any fiduciary duty, or
    f. Proven unethical behavior in the conduct of the position held or proven conduct that reflects negatively on the reputation of the profession or Association.

None of this applies to regular members, except ethics concerns, which should be handled by the ethics commission.  Therefore, there is no compelling definition of 'cause' to apply to members and that reinforces the concern that this has the potential for serious misuse and abuse.

Additionally, the "Standard Operating Procedure for Petition to Challenge Association Action" places the Board in a position where it is essentially investigating itself and hearing appeals on its own actions.  That is not a functional process and any organization that hears appeals of its own decisions without some kind of external and independent arbitration is not offering any 'reasonable opportunity' for defense.

It is difficult to understand what the purpose of this new policy is.  It creates an environment where members can complain about each other and where there is  show trial conducted by a Board that has not really defined a due process procedure or opportunity for any reasonable defense.  The Board would be better off spending its time on governance.  Since there is already an Ethics Commission it is very difficult to know what kind of 'lesser' complaints and interpersonal grievances might be heard by this new process.

If this new policy goes into effect the AOTA will have a new mechanism for quelling member participation.  Who would want to speak out about anything or even participate in AOTA if that means that someone might complain about what you are saying and subject you to some whimsical Board process that can lead to membership revocation?

Considering this new proposed policy is what caused me to review Reilly's statements about criticism.  In her lecture she quoted Robert Merton who was a sociologist; he wrote about the role of professional associations and how they are supposed to foster exchange of ideas.  Merton (1960) wrote:
It is here that they can exchange ideas, experiences, and information that have not yet found there way to the printed page.  Some of this exchange is of the kind that seldom, if ever, gets into print.  That is why even the best of scientific journals is not a complete substitute for the give-and-take that, in the effective professional association, is provided by national meetings and all manner of other conferences.  That is why the professional society is the indispensable complement to schools and universities.  It provides for an interchange that would otherwise not take place.

Such profound words, and such a shame that interchange would be threatened by policies that allow members to complain about each other and attempt to have each other's membership revoked.  Criticism, debate, and information exchange is impossible in such a context.

In Reilly's Slagle lecture she invokes a very unusual term when talking about this topic.  She states that according to Merton (1960), "criticism stings a profession into a new and more demanding formulation of purpose and maintains a policy position of divine discontent with the state of affairs as they are."

"Divine discontent" is the unusual term that stands out, because it is an entirely DIFFERENT Merton that is commonly associated with that term.

Trappist monk and Catholic writer/social activist Thomas Merton (1948) was also a 'card carrying critic.'  He was chronically discontented with the way things were.  Although his path was tortured, his criticisms and questioning were always oriented toward growth.  His inherently critical nature did not make for an easy path because he constantly acted as a pebble in the shoe of nearly every authority figure that he met.  That led others to even take steps to silence him and to forbid him from writing or speaking on certain topics that would cause 'trouble' or 'embarrassment' for his superiors.

That reminds me a lot of this new proposal from AOTA.  It is a policy that threatens people who want to be card carrying critics and it is an oppressive action that will limit exchange of ideas.  Such policies have no legitimate place in a professional association that I want to participate in, so I ended my own membership.

I will just borrow a line from that other Merton (1948) that Reilly oddly and accidentally brings to mind:

Sit finis libri, non finis quaerendi.


Direct links, and...

Glomstad, J. (2005, April 4). A stormy transition.  Advance for occupational therapy practitioners, available at

Merton, T. (1948) The Seven Storey Mountain.  New York: Harcourt Brace.

Merton, R.K. (1960). The search for professional status.  American Journal of Nursing, 60, 662-664.

Reilly, M. (1985). The 1961 Eleanor Clarke Slagle Lecture: Occupational therapy can be one of the great ideas of 20th century medicine in AOTA (Ed.), A Professional Legacy: The Eleanor Clarke Slagle Lectures in Occupational Therapy, 1955-1984, (pp. 87-105). Rockville: AOTA.