Occupational Therapy

by Barry Drogin

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Author's note: Unlike some other questionable "therapies" such as "music therapy" and "shopping therapy" and the like, "occupational therapy" is a form of physical therapy, not psychotherapy. At the time I wrote the following I was too uneducated to know that. I have great respect for physical rehabilitation and the patient trained therapists who help people recover from strokes, injuries, and other illnesses which may effect people both physically and mentally, in real quantifiable ways that have nothing to do with the sham of treating normal people as if they are sick.

Dear Carol:

Education is not supposed to be about learning a secret language or getting inducted into an exclusive society; it is supposed to be about opening minds and free inquiry. It is curious, then, that I should have to suggest the following readings as part of your obtaining a degree in "occupational therapy." First I'll explain why I know about this stuff. Although I made it clear at the party that my training is as an Electrical Engineer (I just lost my job in August, so it's imperative I stress this for professional reasons), I also have a music and theatre background (two years at Emerson College) and am hard at work on an opera entitled "The Psychoterrorists." As such, I have done a lot of research on psychotherapy and many areas connected to it, from reading Freud and Jung to literature on schizophrenia and insane asylums to testimonials and autobiographies by the "mentally ill." I have quite a collection, and it is from this that I recommend:

Erving Goffman: "Asylums" (four essays, including "The Medical Model and Mental Hospitalization: Some Notes on the Vicissitudes of the Tinkering Trades"). In this final essay, he first describes the concept of the "service model" (it takes him a good 20-30 pages), and the difficulty in applying it to medicine ("Another problem is that the body is one possession that cannot be left under the care of the server while the client goes about his other business.") Then he gets to "mental health" and points out the further difficulties ("Menials who prepare the patient to see the psychiatrist can presumably exercise through this preparation about as much psychiatric intervention as the psychiatrist himself, the domain of face-to-face social contact being one in which every participant is equally licenced to carry and use a scalpel.") An excellent piece.

Erving Goffman: "Interaction Ritual" (Six essays, including "Mental Symptoms and Public Order"). A short (12 pages) essay on the social invention of diagnosis ("Given that many psychotic symptoms are instances of situational impropriety, we must ask whether all situational improprieties are instances of psychotic symptoms...[O]bviously, there are many situational improprieties apparently unconnected with mental disorder. There is the unmannerly conduct of the culturally alien, the arrogant, the eccentric, the insolent, the vicious, the celebrant, the intoxicated, the aged and the youthful.") He concludes that, as a sociologist, "mental illness" has no independent, objective identifiers.

Thomas Szasz: "The Myth of Psychotherapy" (especially the final two chapters, grouped under the heading "The Politics of Psychotherapy"). Yes, Szasz is a bit of a nut, but there's good mixed in with the bad (he's written 20 books attacking the psychiatric profession, so he's hard to avoid in any discussion of this sort). The last chapter includes a compilation of "therapies" from various news sources (including "divorce therapy," "poetry therapy," even "shopping therapy"!). As an "occupational therapist," you may want to consider the logic of this litany. I was a theatre major, and, in a summer job as a camp counselor, led a drama class. If I gave the same class in a mental hospital, home for emotionally disturbed children, or nursing home, and had a degree in "occupational therapy," would I be able to bill the insurance company for medical services provided? As Goffman describes, is it the "professional detachment" that gives you the right to do the same thing but call it medical? Isn't the difference in your mind, not in the mind of the "patient"? Some serious questions you may or may not have answers for. There are other books (I especially enjoy recommending anything by Masson), but I'll let it rest. To change the subject to something on everyone's mind, state-funded health care, there's an ominous paragraph in the Szasz which is worth considering:

"[M]ost people now believe that it is a good thing that the state defines what is sickness and what is treatment and that the state pays for whatever treatment people need. What most people do not understand, indeed seem disinclined to understand, is that the state may, and therefore will, define as sickness whatever the people might want to do for themselves; that it may, and therefore will, define as treatment whatever the government might want to do to the people; and that it may, and therefore will, tax the people for 'medical' services that range from denying Laetrile to those persons who want it to imposing psychiatric imprisonment on those who do not want it. Clearly, the future scope of such 'services' promises to include an array of therapeutic prohibitions and prescriptions of truly Orwellian proportions."

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Last Updated: August 4, 2007