News & Research Reports

The Christian Heritage of Occupational Therapy
By Carol S. Stevenson, MS, OTR

Note: A portion of this article appeared in The Newsletter of International Occupational Therapists For Christ, Vol. 7, # 1 (Spring 2003) and is presented here in its entirety with minor editing.

When I went back to school, in preparation for a new career, my prayer was that I would be able to integrate my Christian faith into all that I did. That it would not be just something tacked on to the end of it all, like an exclamation point. I wanted it to truly permeate all that I am and all that I do. My prayer has been answered, both during my school years and later, while working as a mental health professional in a psychiatric hospital and then as Director of Human Services for the Salvation Army. Occupational Therapy has been a field of study and practice, which meshed well with my Christian values, interests and beliefs. I soon found out why, as I delved into the history of OT.

I was thrilled to learn that the roots of occupational therapy are rich with Christian overtones. My graduate school studies started me on a grand adventure pursuing the meaning of Spirituality in Occupational Therapy. I would like to share some of what I discovered, as I developed my Special Project on that topic.

The values, interests, and beliefs of the founders shaped the future of occupational therapy and had a profound influence on how it is viewed today. In order to understand how the spirituality of these individuals affected their emerging profession, one can simply listen to the words they spoke and wrote. One can also search for the major spiritual influences that were placed upon them during that period in history.

During the early years of occupational therapy, it was customary to open the meetings with prayer. In preparation for the fifth annual meeting of the National Society for the Promotion of Occupational Therapy President Hall asked the Rev. Charles A. Hensel to give the invocation (Archives of Occupational Therapy, 1922). It is quoted below in its entirety so that the reader can get the full flavor of what was going through the hearts and minds of this group of professionals as a corporate body:

During the early years of occupational therapy, it was customary to open the meetings with prayer. In preparation for the fifth annual meeting of the National Society for the Promotion of Occupational Therapy President Hall asked the Rev. Charles A. Hensel to give the invocation (Archives of Occupational Therapy, 1922). It is quoted below in its entirety so that the reader can get the full flavor of what was going through the hearts and minds of this group of professionals as a corporate body:

Direct us, O Lord, in all our doings with Thy most gracious favor, and further us with Thy continual help, that in all our works begun, continued and ended in Thee, and especially in the exercises of this hour, may we glorify Thy Holy Name: Thou Who alone canst uphold the minds of men, without Whose goodness and beauty our souls are unfed, without whose truthfulness our reasons wither; Thou Who are the Author of the world's joy, Bearer of the world's pain, make us glad that we are Thine and that we have inherited the world's burden. Grant us we pray Thee, the vision of Thy Being and of Thy Beauty, that in the strength of it, we may labor without haste and without rest. Stay the fever in our hearts by the revelation of Thine own eternity. We ask Thee not to rid us of pain, but in Thy mercy, grant that our pain may be free of waste, unsoiled by thought of ourselves, unfettered by rebellion against Thy will, but purified by love of our kind and devotion to Thy Kingdom, that all our pain and toil may be honored of Thee Who hast honored us with Thy love and fellowship. Hold us back when in our vulgarity we would go aside from the path and life of the lowly and from things that men call common: as our Savior made the carpenter shop and the daily tasks His school, and from them passed to the perfection of Calvary, so may we keep ourselves close to the lives of the great body of men, and pass through things common, into the things infinite and eternal. We ask it all for the sake of Him Whose Name is Love and Whose Kingdom is our hearts' desire, Thy Son, Jesus Christ, our Lord. Amen. (p. 143).

The Creed of Occupational Therapy

The collective spiritual influence of the founders is seen in the wording of the Pledge and Creed for Occupational Therapists adopted by the Association in 1926. Mosey (1981) concluded that the individuals who wrote this document were indeed influenced by the Hippocratic Oath which brought doctors into their profession by having them pledge to "keep holy both my life and my art" (p.64). The Creed reads as follows:

Reverently and earnestly do I pledge my whole-hearted service in aiding those crippled in mind and body. To this end that my work for the sick may be successful, I will strive for greater knowledge, skill and understanding in the discharge of my duties in whatsoever position I might find myself. I solely declare that I will hold and keep whatever I may learn of the lives of the sick. I acknowledge the dignity of the cure of disease and the safeguarding of health in which no art is menial or inglorious. I will walk in upright faithfulness and obedience to those under whose guidance I am to work, and I pray for patience, kindliness, and strength in the holy ministry to broken minds and bodies. (Cited in Mosey, 1981, p. 65)

Although the founders came together with a variety of different life experiences and professional backgrounds to share with one another, they were all well educated, dedicated Christians. This appears to be a common denominator. Their concept of spirituality was based on a very strong Judeo-Christian heritage and heavily flavored by fundamental Quaker beliefs. Writing upon writing of their works gave evidence that the founders placed high importance on the spiritual, not only in regard to their own lives, but in regard to the lives and treatment of their clients.

With one exception, all of the founders had a common bond with the reformer, Rev. Elwood Worcester. Worcester founded a method of church sponsored healing called the Emmanuel Movement. This movement focused on greater individual control over emotional well-being through self-help programs taught by religious leaders, using Christian ideals. Worcester constructed a non-reductionistic view of the person, which is much akin to the concept of client centered therapy that is being applauded today. He employed a unique concept of mind, body, spirit interrelationships in the healing of a wide variety of human problems.

Worcester felt that healing could require the services of physician, minister, and patient alike.(McCarthy, 1984). Rev. Worcester believed that good health was a spiritual matter. Worcester discussed at length in his writings on the Bible, the role of Christ as a healer and the importance of the healing tradition within Christianity" (McCarthy, 1984, p. 96) .

David Barton, a prominent architect, developed an interest in occupational therapy while counseling with the Rev. Worcester. Barton met Worcester while attending Emmanuelist classes at Clifton Springs Sanitarium. Barton had contracted tuberculosis. He also suffered from paralysis of his left side, had his left foot amputated, and consequently had become very discouraged about his future occupational outlook. After his encounter with Worcester, Barton was reported to have "found new purpose in life" (Quiroga, 1995, p. 117).

Barton (1920) felt his role as an occupational therapist was to help make a man "stronger physically, emotionally, and spiritually than he was before" (p. 308). As Peloquin (1991a) pointed out, Barton believed that a treatment plan could only be configured after considering the patient's goals, strengths, and ambitions in all three realms-physical, emotional, and spiritual. Barton went on to become an arts and crafts advocate and the first president of the National Society for the Promotion of Occupational Therapy.

During a speech to hospital workers in Boston, Massachusetts in 1914, Barton used the Bible and its collection of 66 books as an example of the variety and diversity of healing occupations that need to be employed in therapy. It was during this speech that the term occupational therapy was first introduced (Hopkins, 1988). Barton also suggested that the biblical Adam was given a prescription from God to earn a living by hard work when he was cast out of the Garden of Eden. He believed that man's prescription for health was the proper occupation in the necessary proportion to produce the desired physical, mental, and spiritual results (Peloquin).

The depth and strength of Thomas Bissnell Kidner's spirituality is readily apparent from the literature. In his 1929 graduation address to the students of Sheppard and Enoch Pratt Hospital, Kidner (1929) impressed upon his listeners the need for quality of service:

In your chosen field, a part of the noblest work of man- the care and relief of weak and suffering humanity- may you realize in increasing measure the value of certain spiritual things which are the real making of life, but which we call by many common names. Kindness, humility, decency, honor, good faith-to give these up under any circumstance whatever would be a loss greater than any defeat, or even death itself (p. 385).

Kidner (1929) in this speech, spoke about the successes of early therapists who were men and women of "vision and faith" (p. 380). This statement indicates that these early therapists went beyond their physical senses and called upon their spiritual resources. Kidner used an analogy about the days of chivalry to inspire new therapists to a higher level of care. In his analogy he proposed that occupational therapists needed some of the same benevolent characteristics that knights of old possessed. Among them were: loyalty, a spirit of cooperation , and faith in themselves and their work. He called the students to "realize in increasing measure, the value of certain spiritual things which are the real making of life, but which we call by many common names-kindness, humility, decency, honor, good faith" (p. 380). Kidner closed his speech by wishing the students Godspeed and success in their new profession.

Kidner was presiding as President of the American Occupational Therapy Association at the time of the seventh annual meeting in late October 1923. He called upon the Rev. F. G. Behner to pronounce the invocation (Archives of Occupational Therapy, 1924). The reader may note the strength and wisdom that these individuals hoped to derive from their corporate plea:

...we thank Thee....that we have felt the call, and that our interests are wrapped up in folk. In the approach of it, we think it is well to invoke Thy blessing, for Thou doth know the human heart, and the human frame better than any of us; Thy strength and Thy wisdom will rest well in our hearts and our minds in our attempts to do the work; be with us in these deliberations; bless these people who have come together, and may their hearts be so unselfish and so full of interest in humankind, that thir efforts may be kindly, and as helpful, and as true, even unto the measure of their capabilities. Bless us with Thy presence, not only today but in our work day to day, and Thine shall be the praise forever. Amen. (P. 145).

Kidner valued prayer enough to plan for it and to take time during the proceedings to incorporate it into the agenda. It was not an after thought. By his equating loss of spiritual things with loss of life itself, Kidner gave an indication of his solid stance on the importance of spirituality and the importance of occupational therapists taking a role in its preservation and restoration in the lives of individuals.

Eleanor Clark Slagle had grown up caring for her father, a severely wounded Civil War veteran, and her brother who had contracted tuberculosis. Later Slagle adopted her brother's son, who developed infantile paralysis, and in his adult years, became an alcoholic (Bing, 1997). She was well acquainted with adversity, and had a servant's heart. Slagle came from a strong Episcopalian upbringing, and was an advocate of moral reform. She felt "that a spiritual sickness covered the land....(and) that Christian morals were under attack, that the very soul of a well-ordered society might perish" (Bing, 1997, p. 222).

She often used the language of her religion to exhort her colleagues to remain loyal and devoted to occupational therapy. On one occasion she promised that they would "see in [their] own day...[their] work "ministering to the highest needs of man" (Quiroga, 1995, p. 213). In an editorial "From the Heart", Slagle (1937) concluded: "The integrity of your profession is in your hands. I bid you all Godspeed in your work" (p. 345). She felt that the work of therapists would fail if they lacked "spiritual vision" (Slagle, 1927, p. 126).

Slagle (1927), in her article on the organization of an occupational therapy department, described the necessary qualifications of a good occupational therapy director. Although she felt that adequate arts and crafts training were needed, she placed even more importance on the therapist’s personality and character. She believed that if the personal factor was lacking in understanding, give and take, and "spiritual vision" (p. 126), then therapy would be a failure. Her statements attest to her valuing of therapeutic use of self, including spiritual factors.

Susan Tracy, a nurse with a strong interest in arts and crafts, was considered to be the first practicing occupational therapist (Hopkins, 1983). During her nursing training, she utilized occupation to decrease nervousness and increase tolerance for bed rest. In 1910, she wrote the first known book on occupational therapy, a manual introducing nurses to invalid occupations (Reed, 1993). When speaking of Tracy, Quiroga (1995) described her as a "self-sacrificing lady" (p. 79). She helped to found the Rush-Presbyterian Hospital of the City of Chicago in 1917. This facility was funded through the women's auxiliary board made up of representatives from all of Chicago's Presbyterian Churches. It operated on principles derived from nineteenth-century traditions of women's charity and volunteer work.

Tracy (1913) believed that caregivers must go beyond the technical and mechanical aspects of their jobs to "minister to the individual as well as to the disease" (p. 131). When attempting to minister to the individual, Tracy exhorted that one should consider all three aspects of the personality-mind, body, and spirit (Hopkins, 1983).

As a teacher, Susan Cox Johnson helped to strengthen the educational core of occupational therapy. She promoted educational reform by calling for higher standards in the education of occupational therapists, wanting each to have a college degree and certification in order to practice (Quiroga, 1995). Johnson was interested in arts and crafts, and had written a book on textiles. She educated occupation teachers using "ward occupations" as her approach (Reed, 1993, p. 30). She felt that the occupations taught should be morally uplifting (Peloquin, 1991b), that they should have a "... moral and educational purpose added to the therapeutic" (Johnson, 1919, p. 221). Johnson held many important positions in New York's charity-based institutions for the chronically ill and carried a great deal of influence. She won converts to occupational therapy by focusing in on patient productivity as evidence of its efficacy (Quiroga, 1995).

Adolf Meyer often spoke of "sick souls" and the soul as a major part of a person's nature (Newberry, Serrett, Tabacco, & Trimble, 1985), stating that "Our body is not merely so many pounds of flesh and bone figuring as a machine, with an abstract mind and soul added to it" (Meyer, 1922, p. 5).

Herbert J. Hall in a chapter from his book, The Untroubled Mind, "expressed hope that physicians would not fail to address the spiritual side of care" (cited in Quiroga, 1995, p. 106), while calling for a balance which did not ignore the scientific. Hall felt that individuals had nervous breakdowns because they lacked depth and substance in their lives (Peloquin, 1991b).

References

Archives of Occupational Therapy (1922). The fifth annual meeting of the National Society for the Promotion of Occupational Therapy: First day, afternoon session, October 23, 1921, Author, 143.

Archives of Occupational Therapy (1924). The seventh annual meeting of the American Occupational Therapy Association: October 30, 1923, afternoon session. Author 145.

Barton, G. E. (1920). What occupational therapy may mean to nursing. Trained Nurse and Hospital Review, 64, 304-310.

Barton, G. E. (1920). What occupational therapy may mean to nursing. Trained Nurse and Hospital Review, 64, 304-310.

Bing, R. K. (1981). Occupational therapy revisited: A paraphrastic journey. American Journal of Occupational Therapy, 35, 499-518.

Bing, R. K. (1997). "And teach agony to sing": An afternoon with Eleanor Clark Slagle. American Journal of Occupational Therapy, 51, 220-227.

Breathnach, S. B. (1995). Simple abundance: A daybook of comfort and joy. New York: Warner.

Breines, E. (1987). Pragmatism as a foundation for occupational therapy curricula. American Journal of Occupational Therapy, 41, 522-525.

Gutman, S. A.. (1997). Occupational therapy's link to vocational reeducation, 1910-1925. American Journal of Occupational Therapy, 51, 907-915.

Gutman, S. A.. (1997). Occupational therapy's link to vocational reeducation, 1910-1925. American Journal of Occupational Therapy, 51, 907-915.

Hopkins, H. L. (1988). An historical perspective on occupational therapy. In H. L. Hopkins, & H. D. Smith (Eds.), Willard and Spackman's occupational therapy, (7th ed., pp. 16-37). Philadelphia: Lippincott.

Johnson, S. C. (1919). Occupational therapy, vocational re-education, and industrial rehabilitation. Modern Hospital, 12, 221-223.

Kidner, T. B. (1929). Address to the graduates. Occupational Therapy and Rehabilitation, 8, 379-385.

McCarthy, K. (1984). Psychotherapy and religion: The Emmanual movement. Journal of Religion and Health, 23, 92-105.

Meyer, A.. (1922). The philosophy of occupational therapy. Archives of Occupational Therapy, 1, 1-10.

Peloquin, S. M. (1991a). Occupational therapy service: Individual and collective understandings of the founders, Part 1. American Journal of Occupational Therapy,45, 352-360.

Peloquin, S. M. (1991b). Occupational therapy service: Individual and collective understandings of the founders, Part 2. American Journal of Occupational Therapy, 45, 733-744.

Quiroga, V. A.. (1995). Occupational therapy: The first 30 years, 1900 to 1930. Bethesda, MD: American Occupational Therapy Association.

Reed, K. L. (1993). The beginning of occupational therapy. In H. L. Hopkins, & H. D. Smith (Eds.), Willard and Spackman's occupational therapy, (8th ed., pp.26-43). Philadelphia: Lippincott.

Reed, K. L. (1984). Models of practice in occupational therapy. Baltimore, MD: Williams & Wilkins.

Reed, K. L. & Sanderson, S. R. (1983). Concepts of occupational therapy. (2nd ed.). Baltimore, MD: Williams & Wilkins.

Reed, N. M. (1998, January 12). You are the real source of spirituality. Advance for Occupational Therapists, 14(2), 4.

Slagle, E. C. (1927) To organize an "O.T." department. Occupational Therapy and Rehabilitation, 6, 125-130.

Slagle, E. C. (1937). Editorial: From the heart. Occupational Therapy Rehabilitation,16, 345.

Tracy, S. E. (1913). Studies in invalid occupation: A manual for nurses and attendants. Boston: Whitcomb & Barrows.