Culture and occupational therapy: meeting the challenge of relevance in a global world
Michael Iwama PhD, OT(c), MSc, BScOT, BSc
First published: 26 October 2007Full publication history
Culture is fundamentally important to this great profession. The eminent place of culture in occupational therapy is embedded – almost hidden – in its magnificent promise; to enable people from all walks of life to engage or participate in activities and processes that have value. This seemingly simple, yet powerful, promise is a complex challenge and has a bearing on the viability of occupational therapy both locally and across social and geographical frontiers. The diversity of humanity represented in both occupational therapists and clients of occupational therapy, and in the dynamic of assessing value to objects and phenomena in human spheres of experience, are essentially conditions and processes relating to culture. The value of occupational therapy to society hinges on how relevant (Iwama, 2003) occupational therapy is to our clients’ occupational needs and day to day realities. It forms a basis to the important issue of relevance that may ultimately determine the value of the profession in an increasingly global world.
The essence of the promise of occupational therapy compels us to comprehend culture and its place in the flow of this profession in a much more profound way. Until recently it has been much too easy to limit and discourse culture as being synonymous with matters of race and ethnicity, locating it as a static marker of distinction in our clients, and conveniently as a dependent variable in our empirical enquiries. It is hoped that studies which admonished therapists to treat patients categorized along ethnic groupings in a certain special way, or broader health studies which tied treatment outcomes to racial markings, are on their way out. These approaches characteristically tended to situate the ‘problems’ of culture and relevancy of occupational therapy squarely on the individual therapist and individual client, consequently removing the profession of occupational therapy itself and the contexts of its knowledge, theory and practices from critical scrutiny. In such cases, matters of relevance had much to do with how our clients might be ‘cultivated’ to meet the cultural norms of occupational therapy and perhaps less with how occupational therapy and its agents might be cultivated to comprehend the needs of our clients’ unique worlds of day to day living.
If we can broaden our conception of culture to mean also ‘shared spheres of experience and the ascription of meaning to objects and phenomena in the world’, then occupational therapists ought to comprehend culture more fundamentally, taking it beyond individual embodiment and the mere markings of distinction that define the therapist and client, to the very form, function and meanings of occupational therapy itself. Matters of culture not only speak to issues of diversity and inclusion but also to the creation of knowledge, theories and the structures and contents of occupational therapy practices. In these ways, culture is at the core of occupational therapy and should compel all occupational therapists to consider its integral nature and place within all facets of this great profession.
Translated metaphorically (Lackoff and Johnson, 1980), culture may be likened to large rocks (Iwama, 2006) that are situated squarely in the middle of the various streams of occupational therapy. Regardless of the geographical location of an occupational therapy stream or river, the diverse social contexts in which they are situated form the channel walls and bottom that determine the volume and quantity of flow around these cultural ‘rocks’. In some contexts, where occupational therapy has devolved to a state of cultural irrelevance, the flow of occupational therapy, impeded by these large rocks and the narrowing contexts that surround them, may result in weaker flows, falling far short of the simple yet powerful promise of occupational therapy. Practitioners experience this compromised state of flowing whenever the diverse and special circumstances of occupational therapy’s clientele are passed over by universal methods and theory which have been imported as is from some other (unfamiliar) cultural context. The client’s real day to day needs can become trivialized, and the promise and sustainability of occupational therapy to society diminished. An occupational therapy lacking in local cultural relevance is like a river slowed to a trickle, falling well short of its powerful, enabling, flow.
If the water, enabled and shaped by the social context of occupational therapy, addresses the rock well – by abrading its surface and even focusing its power directly onto it – thereby possibly fragmenting it to create multiple channels around and through it, occupational therapy can advance powerfully towards fulfilling its promise. As in real life, the rocks in a river are rarely obliterated nor do they disappear completely. Like the nature of culture in this profession in all of its diverse interpretations and related implications, the rocks become less of an impediment to the stream but a necessary and integral part of the promising flow of occupational therapy.
This special issue of Occupational Therapy International, on the theme of culture and occupational therapy, is a collection of articles written by occupational therapists situated around the world that collectively presents a random set of ‘snapshots’ of how the current river of occupational therapy looks with respect to the large rock of culture in its surging channels. Culture cannot be universally defined and there are no static, definitive explanations of culture in occupational therapy. According to diverse spheres of shared experience of occupational therapists located in varying contexts of time and place, we construct its meanings and contemplate its consequences and implications. Transcending the limitations of culture constructed as individual embodiment or a static marker of distinction, the occupational therapists who have written the articles for this special edition have each taken their own situated views of culture in occupational therapy as a vantage from which to contemplate a particular aspect of their shared profession. Some have chosen to examine culture and its interface with occupational therapy from an ideological and philosophical approach. Others have taken the tack of the interface of culture with matters of occupational therapy theory and models. All the contributors have assembled their papers with the necessity of connecting their views and findings to culturally relevant occupational therapy practice.
When putting together this collection of articles, it would have been much easier to treat culture as comprising mere static individual attributes. Collecting papers that addressed issues of practising occupational therapy in culturally sensitive or competent ways and adapting our practices to meet the needs of specific cultural groups would have been a relatively easy and seemingly benign approach to take. But the resulting work may not have differed much from how occupational therapists in the last three decades have more or less constructed and discoursed on culture. Differences, or the features and aspects of shared experience that make for an appreciation for diversity and its social implications, could have easily been glossed over and the opportunity to advance the promise of occupational therapy might have been lost. The eminent challenge of the relevance of occupational therapy would have remained largely overlooked.
This special issue is not intended to be a set of universal instructions for how occupational therapists should tackle the challenges of an increasingly multicultural clientele. Nor were the separate papers intended to directly instruct about how culture ought to be discoursed in occupational therapy. This is a diverse collection of papers that speak to various aspects of culture at the leading edge of our shared profession. Insights on culture spread among authors located across four continents, these articles are presented as sets of artefacts to enable the reader to examine various aspects of our shared spheres of experience and consider both where we happen to be in regard to how we are progressing towards becoming a more relevant profession to the societies we serve, and how we are doing with regard to delivering on our powerful, challenging and complex promise. The reader becomes a cultural analyst, challenged to make sense of the issue of the relevance of occupational therapy to his or her own familiar spheres of shared experience.
Like any (situated) view of a river, and like many aspects of culture, this is merely a series of representations of various aspects of occupational therapy caught in a particular place in time. Together they form a social perspective on the construction (Berger and Luckmann, 1966) of occupational therapy which spans the ideological, theoretical, methodological and practical.
Writing from Belfast, in the UK, Kelly and McFarlane begin their provocative examination of the mythological nature of occupational therapy with the spectacular assertion that ‘there is no such thing as occupational therapy – it is a myth’. By drawing on a metaphorical comparison, these authors treat us to a compelling reflection on the culture (or cult!) of occupational therapy. From Toronto, Canada, Martin and Reid discover new insights into occupation and sociocultural context by examining the transitional experiences of immigrant women from various origins in South Asia, as they move into a new life in one of North America’s largest urban centres. From Limerick, Republic of Ireland, Carmody and colleagues demonstrate the sophisticated cultural process of exploring the use of a (new) model of occupational therapy across cultural contexts. The transplantation of theoretical material from East Asia to Eire reveals both challenges and possibilities for occupational therapists and opens an intellectual window into how culture is fundamentally embedded in theory and affected by contexts of application. Situated in Brisbane, Australia, Nelson offers a critical exploration of occupational therapy with indigenous Australians by employing critical race theory and uncovers the challenges of conducting cross-cultural research in a culturally safe and equitable manner. From Pittsburgh, USA, Munoz provides a compelling case for re-thinking cultural competence. This author examines how occupational therapy practitioners conceptualize culture and use their understanding of a client’s culture to provide ‘culturally responsive caring’. And from Vancouver, Canada, Brooke et al. examine occupational choice and uncover similarities and dissonance in how activities are categorized between clients and occupational therapists. Their research illuminates the important issue of relevance in occupational therapy, pointing to discrepancies that can occur between professionals’ and clients’ constructions of occupational taxonomies.
In these papers, the frontiers of culture in occupational therapy are both familiar and novel. Some are affirming, yet others are necessarily provocative and even loom ominously – like a big rock in the middle of a narrow section of a river. These papers should not only stimulate profound thinking and reflection on this important facet of occupational therapy, they will also move some readers into uncomfortable and unfamiliar places, revealing impeding rocks, structures and channels of flow that had escaped earlier views within their own streams of occupational therapy.
Together these articles form a point of reference from which occupational therapists may look upstream and gauge the degree to which the issue of culture in occupational therapy has evolved over its history. They raise the spectre of the importance of social equity, cultural safety (Ramsden, 1990) and relevance in practice. In the current situation, readers might examine matters of culture and relevance in their own practices, theory development and knowledge production. This collection of articles may also necessarily serve as a set of benchmarks from which to gaze downstream and consider ways to increase the volume of flow past the large rock of culture that looms in front of this profession.
Perhaps within a decade of this publication another special issue on culture and occupational therapy will be commissioned, when occupational therapists might collectively, as an international body, critically examine how well the challenges of culture in our diverse social contexts of practice have been met. If the papers that follow in this volume are any indication of how we will address the challenge of culture in the years to come, there is full reason to anticipate the evolving power and relevance of occupational therapy as it endeavours to make good on its simple yet profoundly complex promise.
I am grateful to Dr Frank Stein and the board of Occupational Therapy International for giving me the privilege to assemble this landmark special issue on culture and occupational therapy.
Berger P, Luckmann T (1966). The Social Construction of Reality; A Treatise on the Sociology of Knowledge. Garden City, NY: Anchor Books.
Iwama M (2003). The issue is … toward culturally relevant epistemologies in occupational therapy. American Journal of Occupational Therapy 57: 582–588.
CrossRef | PubMed | Web of Science® Times Cited: 11
Iwama MK (2006). The Kawa Model: Culturally Relevant Occupational Therapy. Edinburgh: Churchill Livingstone Elsevier.
Lakoff G, Johnson M (1980). Metaphors We Live By. Chicago, IL: University of Chicago Press.
Ramsden I (1990). Kawa Whakaruruhau: Cultural Safety in Nursing Education in Aotearoa. Wellington: Ministry of Education.