Occupational Therapy Assignment
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The anthropologist Bateson (1996) has written that
The capacity to do something useful for yourself or others is key to personhood, whether it involves the ability to earn a living, cook a meal, put on shoes in the morning, or whatever other skill needs to be mastered at the moment. (1986, p. 11)
In this article, I assert that occupations are key not just to being a person, but to being a particular person, and thus creating and maintaining an identity. Occupations come together within the contexts of our relationships with others to provide us with a sense of purpose and structure in our day-to-day activities, as well as over time. When we build our identities through occupations, we provide ourselves with the contexts necessary for creating meaningful lives, and life meaning helps us to be well.
In this article, an important distinction is made between being well and being healthy. The ultimate goal of occu- pational therapy services is well-being, not health. Health enables people to pursue the tasks of everyday living that provide them with the life meaning necessary for their well-being. As Englehardt said in describing the virtues of occupational therapy, “people are healthy or diseased in terms of the activities open to them or denied them.” (1977, p. 672)
Overview
In addressing the complex topic of personal identity, I begin by reviewing key concepts from the literature, noting particularly how our use of language gives us important insights into how we think about ourselves. I then discuss how identity is thought to be formed during the crucial developmental stages of our lives, and how it seems to be of immense importance to us as we make our way through the stages of life. After this, I consider how daily occu- pations serve the important purpose of enabling us to experience or realize our personal identities. I then address the implications of incomplete or blemished identities on personal well-being, and conclude with observations on the implications of identity-making for the practice of occupational therapy in the new millennium.
Propositions
My presentation is based on four propositions, all centered on the assertion that one of the most compelling needs that every human being has is to be able to express his or her unique identity in a manner that gives meaning to life. This assertion was influenced greatly by an ethnographic study of adaptive strategies reported in The Ameri- can Journal of Occupational Therapy (McCuaig & Frank, 1991). That study described a middle-aged woman [Meghan]
1999 Eleanor Clarke Slagle Lecture
Defining Lives: Occupation as Identity: An Essay on Competence, Coherence,
and the Creation of Meaning
Charles H. Christiansen, EdD, OTR, OT(C), FAOTA
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Originally published 1999 in American Journal of Occupational Therapy, 53, 547–558. https://doi.org/10.5014/ajot.53.6.547
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https://doi.org/10.5014/ajot.53.6.547
A PROFESSIONAL LEGACY
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with severe athetoid cerebral palsy who had great difficulty with voluntary movement that profoundly affected her mobility and speech. Somehow, without much professional assistance, the woman was able to devise adap- tive strategies so that she could use her limited voluntary movement and assistive technology to get along in daily life. Despite rather considerable postural deformities and difficulty with hearing, she was able to live in an apart- ment, requiring only modest assistance of friends and neighbors to live independently.
In considering the study, I found Meghan’s motivations for choosing strategies, rather than the nature of her adaptations, of greatest interest. It seemed that one very important consideration underlying her choices—especially when they were to be viewed by others—was whether or not they would show her to be an intelligent, competent woman. In short, they were issues of identity.
I remember being surprised by this observation, thinking that someone as disabled as she was would be driven by the functional necessities of life, with little reserve time or energy to be consumed by thoughts of how she might be viewed in the eyes of others. But as I thought about it more deeply, I realized that life around me was teeming with indications1 that people (with disabilities or without) are universally concerned about their social identity and acceptance by others. The ethnographic study also pointed squarely to the reality that daily occupation was the pri- mary means through which the woman was able to communicate her identity as a competent person.
My further thinking and study about the relationships between daily occupations and selfhood led to four premises that may be useful to the process of considering identity issues in occupational therapy. Because there is yet much work to be done in establishing the validity of theories of how identity is constructed and maintained, each proposition must be viewed as tentative.
Proposition 1: Identity is an overarching concept that shapes and is shaped by our relationships with others.
Personal identity can be defined as the person we think we are. It is the self we know. Note that this is not the same as self-concept nor is it the same as self-esteem, although these important concepts are related to identity. Baumeis- ter (1986, 1997), an often-cited authority on the study of identity, has noted that the most obvious things in daily life are sometimes the most difficult to define. We use the word self in our everyday language several times a day. When we say self,we include the direct feeling we have about our thoughts and feelings and sensations. This begins with the awareness of our body and is augmented by our sense of being able to make choices and initiate action. It also encompasses the abstract and complex ideas that embellish the self.
The term self-concept refers to the inferences we make about ourselves. It encompasses our understanding of per- sonality traits and characteristics, our social roles, and our relationships. We are motivated as adults to achieve some consistency in terms of how we view ourselves, and we want this view to be favorable. In general, we strive to main- tain favorable views and to dispute or avoid feedback that is discrepant from our view of self (Swann, 1987; Swann & Hill, 1982). To the extent that we perceive discrepancies between our perceived and ideal selves, we are motivated to change.
A third concept is self-esteem. This refers to the evaluative aspect of the self-concept. Self-esteem is related to iden- tity in the sense that our esteem is related to our ability to demonstrate efficacious action, which gains social approval and thus influences our overall concept of self (Baumeister, 1982; Franks & Marolla, 1976).
Finally, identity refers to the definitions that are created for and superimposed on the self. Identity is a composite definition of the self, and includes an interpersonal aspect (e.g., our roles and relationships, such as mothers, wives, occupational therapists), an aspect of possibility or potential (that is, who we might become), and a values aspect (that suggests importance and…
