296 DÉCEMBRE 2004 ■REVUE CANADIENNE D’ERGOTHÉRAPIE ■NUMÉRO 5 ■VOLUME 71 Dimensi

296 DÉCEMBRE 2004 ■REVUE CANADIENNE D’ERGOTHÉRAPIE ■NUMÉRO 5 ■VOLUME 71 Dimensions of meaning in the occupations of daily life Key words ■Human activity and occupations ■Life change events ■Quality of life Résumé Description. Selon les philosophes existentialistes, le sens, le but et le choix sont des éléments essentiels à la qualité de vie. Des chercheurs menant des études qualitatives sur les perspectives de personnes ayant eu des problèmes de santé ont également découvert qu’après avoir traversé une période de crise,les personnes avaient besoin de trouver un sens et un but à leur vie,tout en ayant la possibilité d’exercer des choix. Bien que la théorie en ergothérapie reconnaisse l’importance des occupations significa- tives,elle est principalement axée sur les occupations utiles,ce qui semble inadéquat pour aborder des questions associées au sens dans la vie des gens.But.Selon les auteurs de cet article,l’ergothérapie devrait être fondamentalement orientée sur le sens que les occupations peuvent apporter dans la vie d’une personne, ce qui suppose que l’on pourrait considérer que l’occupation comporte des dimensions relatives au sens,soient : faire,être,appartenir et devenir.S’inspirant des perspectives et des recherches de philosophes, de chercheurs en science sociale et d’ergothérapeutes, cet article propose de considérer l’occupation selon une nouvelle perspective, c’est-à-dire en fonction des dimensions du sens plutôt que sous l’angle d’activités associées aux soins personnels, à la productivité et aux loisirs.Conséquences pour la pratique.En mettant l’accent sur les occupations significa- tives plutôt que sur les occupations utiles, la profession se rapprocherait davantage de son objectif, qui est de contribuer à l’amélioration de la qualité de vie. Karen Whalley Hammell Abstract Background.According to the existential philosophers,meaning,purpose and choice are necessary for quality of life.Qualitative researchers exploring the perspectives of people who have experienced health crises have also identified the need for meaning, purpose and choice following life disruptions. Although espousing the importance of meaning in occupation, occupational therapy theory has been primarily preoccupied with purposeful occupations and thus appears inadequate to address issues of meaning within people's lives. Purpose.This paper proposes that the fundamental orientation of occupational therapy should be the contributions that occupation makes to meaning in people's lives, furthering the suggestion that occupation might be viewed as comprising dimensions of meaning: doing, being, belonging and becoming. Drawing upon perspectives and research from philosophers,social scientists and occupational therapists,this paper will argue for a renewed understanding of occupation in terms of dimensions of meaning rather than as divisible activities of self-care,productivity and leisure.Practice implications. Focusing on meaningful, rather than purposeful occupations more closely aligns the profession with its espoused aspiration to enable the enhancement of quality of life. doing of self-care, productive and leisure activities, is inade- quate to address issues of meaning in people's lives (Hammell, 2003a). However, the belief that occupation is a primary source of life's meaning (CAOT, 2002), and recogni- tion that enablement of meaningful occupation (not spiritu- ality) falls squarely within our mandate requires that occupa- tional therapists explore the concept of occupation as this relates to the experience and expression of meaning in people's lives. This paper examines the contribution that occupation makes to the experience of meaning and quality of life following profound biographical disruption. In so doing, it draws upon theories and research from philosophers, social C anadian occupational therapists have placed spiritual- ity at the centre of their Canadian Model of Occupational Performance (Canadian Association of Occupational Therapists [CAOT], 2002) and have declared that: "Spirituality is a universal concern, growing where people feel alienated, isolated, lonely, oppressed, marginal- ized, demoralized, or trapped in bureaucracy, abuse or meaningless occupation" (Townsend, DeLaat, Egan, Thibault & Wright,1999, p.3). It has been suggested that Canadian occupational therapists are wrestling with issues pertaining to spirituality because clients who are facing life disruptions consistently raise issues of meaning, values and purpose (Hammell, 2003a). Yet current theory, with its focus on the © CAOT PUBLICATIONS ACE HAMMELL VOLUME 71 ■NUMBER 5 ■CANADIAN JOURNAL OF OCCUPATIONAL THERAPY ■DECEMBER 2004 297 © CAOT PUBLICATIONS ACE scientists and occupational therapists to support an alternate vision for theorizing occupation in terms of "the sources of meaning found in occupation and the contributions that occupation makes to meaning in our lives" (Hasselkus, 2002,p.xi). The concept of occupation in occupational therapy theory Current occupational therapy theory states that occupation "is everything people do to occupy themselves, including looking after themselves (self-care), enjoying life (leisure), and contributing to the social and economic fabric of their communities (productivity)" (CAOT, 2002, p.34). This definition does not delimit occupation to three categories but subsequent statements in the same publication list the "purposes" of occupation as being self-care, productivity and leisure (CAOT, 2002,p.37). This is neither a random nor an alphabetical ordering (Suto, 2004), but a hierarchy that reflects the specific values and priorities of physically independent, employed theorists (Hammell, 2004a). Some disability theorists would argue that by prioritizing self-care and productive (economic) activities, occupational therapists act as agents of the state, actively perpetuating ideologies that denigrate those deemed dependent or unproductive (Hammell, 2004b). Indeed, categorizing the occupations of others is not a neutral enterprise but value-laden and inher- ently political: "The labels attached to activities establish and justify their social worth" (Devault, 1990, p.110). The categorisation of occupations into three divisions is problematic for other reasons. Some of the most meaningful occupations cannot be made to fit any of the three categories. For example, caring for one's children, partner, parents or companion animals; simply being with special people or physically expressing love are not self-care activities, nor are they necessarily socially or economically productive or expe- rienced as leisure (a word which has few equivalents in other languages) (Kelly & Kelly, 1994). Rather, they are an expres- sion through occupation (time, energy, interest) of some- thing much more important: of a connectedness and of a sharing of oneself. Further, due to age, culture, socioeconomic status or lifestyle, an occupation may be labelled by some people as leisure and by others as productive. Indeed, the perception of a leisure/work dichotomy is not universal, but rather, cultur- ally specific (Primeau, 1996). Moreover, the same individual may define an occupation differently at different times, dependent upon mood, goals, context and the presence of other people (CAOT, 2002; Kelly & Kelly, 1994; Primeau, 1996; Shaw, 1984). Thus, "it is impossible to give an individ- ual's occupation any meaning other than the subjective meaning that they, themselves, choose to give it" (Weinblatt & Avrech-Bar, 2001, p.169). Because the three categories are unstable, establishing an optimal balance among them is problematic, yet as Christiansen (1996) has stated: "One of the most widely cited philosophical beliefs in occupational therapy is that a balance of occupations is beneficial to health and well-being" (p.432). The notion of balance is also problematic. While this assumption may be valid, it "fails to define work, leisure, or what constitutes a balance; does not specify the aspects of health that are promoted; and is not seriously subjected to the possibility of disconfirmation" (Clark et al., 1991, p.306). Neither is it clear who is privileged to determine balance or imbalance, nor whose values these judgements might reflect. In addition, the idea that one can engage in one occupation at a time (a clear requirement for classification) represents a particularly ableist stance. Ableism refers to social practices and relations that assume and privilege able-bodiedness. Engaging in one occupation at a time may be impossible for those people with severe physical impairments for whom self-care activities intrude into every other occupation (Hammell, 2004a). Occupational therapy theory has demonstrated a clear difficulty with differentiating between the concepts purposeful and meaningful, sometimes using the terms interchangeably and tending to extol the notion of meaningful occupation while focusing instead on purposeful, goal-oriented, socially- sanctioned use of time and energy in doing (e.g. Christiansen & Baum, 1997; Wilcock, 1993, 1998a; Yerxa, 1998; Yerxa et al., 1989). It is stated that: "Occupations are meaningful to peo- ple when they fulfil a goal or purpose that is personally or culturally important" (CAOT, 2002, p.36). This implies that meaningful is a positive term, yet all occupations are mean- ingful; they all have some meaning for the individual engaged in them. When occupations are dictated by the agendas of occupational therapists for example, the meaning clients derive from them can be "humiliating" (Helfrich & Kielhofner, 1994,p.321). The current triad of privileged occupations has only partial resonance with the experiences of people whose lives have been disrupted, for example by impairment or illness, war, unemployment, bereavement or geographic dislocation. However, recent incorporation of qualitative methods into occupational therapy research has enabled the exploration of different ways of understanding occupation and disruption, creating the possibility for the perspectives of various client groups to infiltrate professional theory. Consistent themes across diverse studies suggest that occupation might best be understood, not as divisible activities of self-care, productiv- ity and leisure but as dimensions of meaning. Law et al. (1996, p.16) state that occupations meet the person's "intrinsic needs for self-maintenance, expression and fulfilment"; suggesting that occupations might usefully be explored, not in terms of categories, but in uploads/Philosophie/ 10-1-1-91-8638-pdf.pdf

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