Exploring the Art of Occupation

The World Federation of Occupational Therapists (WFOT) defines occupational therapy as:

“Occupational therapy is a client-centred health profession concerned with promoting health and well-being through occupation. The primary goal of occupational therapy is to enable people to participate in the activities of everyday life. Occupational therapists achieve this outcome by working with people and communities to enhance their ability to engage in the occupations they want to, need to, or are expected to do, or by modifying the occupation or the environment to better support their occupational engagement.” (WFOT, 2010)

This definition emphasises the role of occupational therapy in enabling individuals to engage in meaningful activities by addressing both the person and their environment.

“Isms,” such as racism, sexism, ableism, and other forms of discrimination, can significantly impact the primary goal of occupational therapy as defined by the World Federation of Occupational Therapists (WFOT). These “isms” can create barriers that hinder individuals from fully participating in everyday activities by challenging the effectiveness of occupational therapy in promoting health and well-being.

Impact of “Isms” on Occupational Therapy

Racism is one of the most widely recognised “isms.” It refers to the belief that one race is superior to others, leading to systemic oppression. Racism manifests in various forms, from overt acts of violence and hate speech to more subtle expressions such as racial profiling, biased hiring practices, and unequal access to resources. The legacy of racism is deeply embedded in many countries’ histories, resulting in significant disparities in wealth, education, and health among different racial groups.

Racism also contributes to unequal access to healthcare services, including occupational therapy, due to systemic biases and discrimination within healthcare systems. The World Health Organisation (WHO) highlights that racial and ethnic disparities in healthcare are influenced by these biases and structural barriers. For instance, patients from marginalised racial groups often receive fewer referrals for rehabilitation services, including occupational therapy, due to implicit biases and institutional discrimination (WHO, 2020; PM&R KnowledgeNow, 2020). This reduced access can lead to poorer health outcomes, lower quality of care, and ultimately diminish the effectiveness of therapy.

To address these disparities, occupational therapists (OTs) must be aware of these issues and strive to provide culturally competent care, ensuring that treatment plans are tailored to meet the unique needs of each patient, regardless of their race or ethnicity (PM&R KnowledgeNow, 2020).

Sexism is the belief that one gender is inherently superior to another, and it often manifests as discrimination against women and gender non-conforming individuals. This form of prejudice is evident across various aspects of society, particularly in the workplace, where women frequently experience pay disparities, limited opportunities for advancement, and biased expectations that restrict their roles. Studies have shown that workplace discrimination contributes to significant socio-economic disadvantages for women, affecting their earnings, career progression, and overall well-being (European Institute for Gender Equality, 2024).

For example, research indicates that women are often steered away from leadership roles or positions deemed physically demanding, while men may face stigma when participating in roles considered traditionally feminine. These biases can severely limit the range of activities and occupations that individuals feel comfortable pursuing, impacting their overall well-being and the effectiveness of occupational therapy interventions (Pew Research Center, 2017).

Occupational therapists must be particularly mindful of these biases and actively work to empower all clients, regardless of gender, to engage in meaningful activities that align with their interests and abilities. By challenging societal norms when necessary, therapists can help ensure that everyone has the opportunity to pursue occupations that enhance their quality of life, promoting equality and improving outcomes for individuals affected by sexism.

Ableism refers to discrimination and social prejudice against people with disabilities, rooted in the belief that typical abilities are superior. This often leads to the marginalisation of individuals with physical, mental, or developmental disabilities. Ableism manifests in various ways, including inaccessible buildings, exclusion from activities, and negative stereotypes. Society often views disabled individuals as objects of pity or as “less than” their able-bodied counterparts, further entrenching these prejudices (Hehir, 2002; Deal, 2007).

Ableism significantly impacts individuals with disabilities by creating physical and social barriers that limit their ability to participate fully in daily activities. These barriers can include inaccessible environments, a lack of necessary accommodations, and societal attitudes that devalue the capabilities of disabled individuals. Such obstacles pose challenges for occupational therapists, who must address both environmental and societal factors alongside individual therapy to help clients engage in meaningful occupations (Shakespeare, 2013; Thomas, 2007).

While often used interchangeably with ableism, disablism specifically refers to discrimination against people with disabilities. Disablism encompasses systemic barriers and social attitudes that disadvantage individuals, such as a lack of accommodations in workplaces or educational institutions (Reeve, 2012).

Ableism and disablism directly influence how individuals with disabilities are perceived and treated in society. These forms of discrimination can restrict access to buildings, education, employment, and social participation, all areas where occupational therapists provide vital support. Occupational therapists play a critical role in advocating for accessibility and inclusivity, helping clients navigate these barriers and promoting adaptive strategies that enhance independence and participation (Llewellyn & Hogan, 2000; Hammell, 2006).

Ageism is a form of discrimination based on a person’s age, and it can affect individuals at any stage of life, though it is most commonly associated with prejudice against older adults. This form of discrimination manifests in various ways, including stereotypes that portray older individuals as less capable or assumptions that younger people are not suited for leadership roles due to their age. Such biases can lead to social isolation, unemployment, and a reduction in the quality of life for those affected (North & Fiske, 2012; Nelson, 2016).

Ageism often results in stereotypes that suggest older adults are less capable or less deserving of certain opportunities, which can significantly influence the types of occupational therapy interventions they receive. This bias may lead to older individuals being excluded from activities they are fully capable of enjoying or benefiting from, thereby diminishing their quality of life and reducing the overall effectiveness of therapy (Kane, 2005; Abrams et al., 2015).

Occupational therapists must actively challenge these stereotypes by focusing on the abilities and goals of older clients rather than their age. By doing so, occupational therapists can help older adults maintain their independence and engage in meaningful activities, thereby improving their overall quality of life (Wressle, Eeg-Olofsson, & Marcusson, 2002; McCallum, 2017).

Classism refers to prejudice or discrimination based on social class, encompassing systemic inequalities that favour individuals from higher socioeconomic backgrounds while marginalising those from lower-income families. This form of discrimination can manifest in various aspects of society, including access to education, healthcare, and the justice system, where wealthier individuals often receive more favourable treatment. These systemic inequalities perpetuate the cycle of poverty and significantly limit social mobility for those in lower socioeconomic classes (Munt, 2000; Phelan, Link, & Tehranifar, 2010).

Classism can have a profound impact on access to occupational therapy services, particularly for individuals from lower socioeconomic backgrounds. Financial barriers, a lack of resources, and limited access to healthcare facilities can prevent these individuals from receiving the therapy they need. This can result in ongoing difficulties in participating in everyday activities, as occupational therapists may struggle to provide adequate support without addressing these broader socioeconomic issues (Smith, 2005; Townsend & Wilcock, 2004).

Occupational therapists must be acutely aware of these disparities and work to provide equitable care. This may involve advocating for community-based programmes, implementing sliding scale fees, or finding other resources to make therapy accessible to all, regardless of socioeconomic status. By doing so, occupational therapists can help ensure that everyone has the opportunity to benefit from occupational therapy, promoting greater social mobility and well-being across all social classes (Whiteford, 2011; Hammell, 2009).

Homophobia refers to the fear, hatred, or discomfort towards individuals who are attracted to members of the same sex. This form of prejudice can manifest in various ways, ranging from derogatory language and bullying to more severe acts such as hate crimes and discriminatory laws. Homophobia can also be internalised, leading *LGBTQIA+ individuals to struggle with their own identity and mental health (Herek, 2004; Meyer, 2003). Despite significant progress in many parts of the world, homophobia remains a substantial barrier to equality and full participation in society (Human Rights Campaign, 2021).

Transphobia, similarly, is a form of prejudice against transgender individuals whose gender identity differs from the sex they were assigned at birth. Transphobia can manifest through discrimination in employment, housing, and healthcare, as well as through physical and verbal abuse. Like homophobia, transphobia can also be internalised, leading to significant mental health challenges for transgender individuals. Societal norms and a lack of understanding often fuel transphobia, making it a pervasive issue (Levitt & Ippolito, 2014; Serano, 2007).

These forms of prejudice can create significant barriers for *LGBTQIA+ individuals in accessing healthcare, including occupational therapy. Discrimination, fear of being misunderstood, or previous negative experiences with healthcare providers may deter *LGBTQIA+ clients from seeking help. Occupational therapists must strive to create an inclusive and affirming environment by using gender-affirming language, respecting clients’ identities, and being sensitive to the unique challenges faced by *LGBTQIA+ individuals (Wilkerson, Rybicki, Barber, & Smolenski, 2011; American Psychological Association, 2015).

In healthcare settings, including occupational therapy, homophobia and transphobia can make the environment unwelcoming for *LGBTQIA+ individuals. Fear of discrimination, lack of understanding from healthcare providers, or past negative experiences can prevent individuals from fully engaging in the therapeutic process. This, in turn, can hinder their ability to participate in meaningful occupations that align with their identities and needs. Therefore, it is essential for occupational therapists to actively work against these barriers to ensure that all clients receive the support they need to thrive (Baker & Beagan, 2014; McCann & Brown, 2019).

Religious discrimination involves treating individuals or groups differently based on their religious beliefs. This form of discrimination can manifest in various ways, including acts of violence, social exclusion, and legal restrictions. Historically, many religious groups have faced persecution, a reality that continues in various forms today. Religious discrimination often intersects with other forms of prejudice, such as racism and xenophobia, creating complex layers of discrimination that further marginalise affected groups (Council of Europe, 2019; Fox, 2021).

Religious beliefs significantly influence a person’s values, routines, and preferences, which are essential considerations in occupational therapy. Occupational therapists must respect and accommodate these beliefs, ensuring that therapy plans align with the client’s spiritual needs and practices. This may involve adjusting therapy schedules, respecting dietary restrictions, or incorporating spiritual activities into therapy sessions (Hodge, 2006; Jacobs, 2015).

Religious discrimination can greatly impact how individuals’ beliefs and practices are accommodated in occupational therapy. If a therapist does not respect or understand a client’s religious practices, it can be challenging to integrate these into the therapy plan, potentially limiting the client’s engagement in meaningful occupations that align with their values. Therefore, occupational therapists need to be culturally and spiritually sensitive, ensuring that all clients feel respected and supported throughout their therapeutic journey (Swinton & Pattison, 2010; Canda & Furman, 2010).

Xenophobia is the fear or hatred of foreigners or strangers, often manifesting as prejudice against individuals from other countries or cultures. This form of discrimination can lead to social exclusion, violence, and restrictive immigration policies. Xenophobia is frequently fuelled by stereotypes and fear-mongering, and it can have devastating effects on individuals and communities, particularly in multicultural societies (Boehnke, 2001; Esses, Veenvliet, Hodson, & Mihic, 2008).

Xenophobia can result in immigrants or people from different cultural backgrounds feeling alienated or receiving substandard care. In the context of healthcare, including occupational therapy, this can severely impact the quality of care received. Occupational therapists must practise cultural humility, which involves a commitment to understanding and respecting the diverse backgrounds of their clients. This includes being mindful of language barriers, cultural norms, and the unique challenges that immigrants may face in adapting to a new environment (Tervalon & Murray-García, 1998; Hammell, 2013).

In occupational therapy settings, xenophobia can cause immigrants or individuals from different cultural backgrounds to feel alienated or receive inadequate care. Language barriers, cultural misunderstandings, and prejudice can prevent these individuals from fully participating in the therapeutic process, thereby impacting their ability to engage in daily activities that are meaningful to them. Occupational therapists must be vigilant in addressing these challenges to ensure that all clients receive the care and support they need to thrive (Whiteford & Wright-St. Clair, 2005; Iwama, 2006).

Finial Thoughts

The recent surge in awareness and discourse surrounding racism and other forms of discrimination has underscored the urgent need for the occupational therapy profession to confront its historical and current practices. Now, more than ever, it is vital for the profession to acknowledge its past failings in addressing the impacts of discrimination on those who access therapy. This recognition is essential for moving forward and embracing anti-discrimination practices that actively challenge systemic bias.

The Royal College of Occupational Therapists (RCOT) and other professional bodies have increasingly emphasised the importance of equity, diversity, and inclusion within occupational therapy. They advocate for the profession to lead by example in promoting social justice, which involves recognising and addressing the ways in which occupational therapy has been complicit in systemic discrimination. This commitment includes adopting anti-racist, anti-discriminatory, and anti-oppressive practices to ensure that all individuals, regardless of their background, can access and benefit from therapy (RCOT, 2024).

Additionally, the American Occupational Therapy Association (AOTA) has called for the profession to go beyond merely acknowledging cultural competence and to actively engage in cultural humility. This approach involves continuous self-reflection and a commitment to understanding and dismantling the systemic inequities that affect marginalised groups (AOTA, 2020).

By embracing these practices, the profession can work towards creating a more inclusive and equitable environment for both practitioners and clients, ensuring that occupational therapy truly serves the needs of all individuals, irrespective of their social or cultural background.

Understanding these various forms of discrimination, or “isms,” is highly relevant to occupational therapy. Occupational therapists (OTs) are dedicated to helping individuals achieve the highest level of quality of life, regardless of their circumstances. However, discrimination can create significant barriers that hinder a person’s ability to participate fully in daily activities and occupations. These barriers are particularly challenging for individuals who experience intersectional discrimination, as their access to care and support may be further compromised (Hammell, 2013; Beagan, 2015).

Occupational therapists are uniquely positioned to address the impact of these “isms” by promoting inclusion, advocating for equal access to services, and tailoring interventions to meet the diverse needs of their clients. By understanding and actively combating these forms of discrimination, OTs can help ensure that all individuals have the opportunity to engage in meaningful activities and achieve their fullest potential, regardless of the societal barriers they may face. This approach not only improves individual outcomes but also contributes to broader social change, aligning with the core values of the occupational therapy profession (Townsend & Polatajko, 2007; Whiteford & Hocking, 2012).

“Isms” can create significant barriers that hinder the goal of occupational therapy, which is to enable people to participate in the activities of everyday life. Occupational therapists must recognise and address these forms of discrimination to ensure that all clients have the opportunity to engage fully in meaningful occupations. By doing so, therapists can help mitigate the impact of these societal issues, promoting a more inclusive and equitable approach to health and well-being (Rudman, 2014; Hammell, 2020).

*LGBTQIA+ is an inclusive acronym that represents a spectrum of sexual orientations and gender identities:

• L: Lesbian – Women who are attracted to women.
• G: Gay – Men who are attracted to men, though sometimes used more broadly.
• B: Bisexual – People attracted to more than one gender.
• T: Transgender – Individuals whose gender identity differs from the sex assigned at birth.
• Q: Queer or Questioning – “Queer” is an umbrella term for non-normative sexual and gender identities; “Questioning” refers to individuals exploring their sexual orientation or gender identity.
• I: Intersex – Individuals born with physical sex characteristics that don’t fit typical definitions of male or female.
• A: Asexual – Individuals who do not experience sexual attraction, or Ally – People who support the LGBTQIA+ community.
• +: The “+” symbol is used to include other identities that are not specifically covered by the acronym, such as pansexual, genderqueer, non-binary, and others.

The term LGBTQIA+ emphasises the diversity and inclusivity of the community, ensuring that a broad range of identities are recognised and respected.

References

Abrams, D., Swift, H. J., & Drury, L. (2015). Old and unpopular? The impact of age and perceived age discrimination on well-being and social inclusion. 

Ageing and Society, 36(6), 1295-1313. Cambridge University Press.

American Psychological Association (2015). Guidelines for Psychological Practice with Transgender and Gender Nonconforming People. American Psychologist, 70(9), 832-864.

AOTA. (2020). Occupational Therapy’s Commitment to Diversity, Equity, and Inclusion. The American Journal of Occupational Therapy. Available at: https://research.aota.org (Accessed: 18 August 2024).

Baker, K., & Beagan, B. L. (2014). Making Assumptions, Making Space: An Anthropological Critique of Cultural Competency and Its Relevance to Queer Patients. Medical Anthropology Quarterly, 28(4), 578-598.

Beagan, B. L. (2015). Working with LGBTIQ patients: Occupational therapy student experiences and strategies. Canadian Journal of Occupational Therapy, 82(1), 34-45.

Boehnke, K. (2001). Xenophobia: A Contemporary Issue in Psychology. Peace and Conflict: Journal of Peace Psychology, 7(3), 233-248.

Canda, E. R., & Furman, L. D. (2010). Spiritual Diversity in Social Work Practice: The Heart of Helping. Oxford University Press.

Collins, P. H., & Bilge, S. (2016). Intersectionality. Polity Press.

Council of Europe (2019). Combating Religious Discrimination and Intolerance. Available at: https://www.coe.int/en/web/compass/religion-and-belief (Accessed: 18 August 2024).

Crenshaw, K. (1989). Demarginalising the Intersection of Race and Sex: A Black Feminist Critique of Antidiscrimination Doctrine, Feminist Theory and Antiracist Politics. University of Chicago Legal Forum, 1989(1), 139-167.

Deal, M. (2007). Aversive disablism: Subtle prejudice toward disabled people. Disability & Society, 22(1), 93-107.

European Institute for Gender Equality (2024). Sexism at work: how can we stop it? Available at: https://eige.europa.eu/publications/sexism-at-work-how-can-we-stop-it (Accessed: 17 August 2024).

Esses, V. M., Veenvliet, S., Hodson, G., & Mihic, L. (2008). Justice, Morality, and the Dehumanization of Refugees. Social Justice Research, 21(1), 4-25.

Fox, J. (2021). Political Secularism, Religion, and the State: A Time Series Analysis of Worldwide Data. Cambridge University Press.

Hammell, K. W. (2006). Perspectives on Disability and Rehabilitation: Contesting Assumptions; Challenging Practice. Churchill Livingstone.

Hammell, K. W. (2009). Sacred Texts: A Sceptical Exploration of the Assumptions Underpinning Theories of Occupation. Canadian Journal of Occupational Therapy, 76(1), 6-22.

Hammell, K. W. (2013). Occupation, Well-being, and Culture: Theory and Cultural Humility. Canadian Journal of Occupational Therapy,

Hammell, K. W. (2013). Occupation, Well-being, and Culture: Theory and Cultural Humility. Canadian Journal of Occupational Therapy, 80(4), 224-234.

Hammell, K. W. (2020). Engagement in Living: Critical Perspectives on Occupation, Rights, and Well-being. Canadian Scholars.

Hehir, T. (2002). Eliminating ableism in education. Harvard Educational Review, 72(1), 1-32.

Herek, G. M. (2004). Beyond “Homophobia”: Thinking About Sexual Prejudice and Stigma in the Twenty-First Century. Sexuality Research & Social Policy, 1(2), 6-24.

Hodge, D. R. (2006). Spiritual assessment: A handbook for helping professionals. North American Association of Christians in Social Work.

Human Rights Campaign (2021). The State of LGBTQ Equality. Available at: https://www.hrc.org/resources/state-of-lgbtq-equality.

Iwama, M. K. (2006). The Kawa Model: Culturally Relevant Occupational Therapy. Elsevier Health Sciences.

Jacobs, M. R. (2015). Faith, Values, and Health: A Framework for Integration. Journal of Religion and Health, 54(4), 1263-1277.

Kane, R. L. (2005). The Challenge of Quality of Care. Journal of Aging & Social Policy, 17(1), 7-26. Routledge.

Levitt, H. M., & Ippolito, M. R. (2014). Being Transgender: Navigating Minority Stressors and Developing Authentic Self-Presentation. Psychology of Women Quarterly, 38(1), 46-64.

Llewellyn, G., & Hogan, K. (2000). The changing context of occupational therapy. Disability & Rehabilitation, 22(11-12), 522-532.

McCallum, T. J. (2017). Occupational Therapy Interventions for Older Adults: Addressing Ageism in Clinical Practice. American Journal of Occupational Therapy, 71(6).

McCann, E., & Brown, M. (2019). Homophobia and Health Care: A Review of Issues for Practice and Policy. Journal of Nursing Management, 27(4), 700-707.

Meyer, I. H. (2003). Prejudice, Social Stress, and Mental Health in Lesbian, Gay, and Bisexual Populations: Conceptual Issues and Research Evidence. Psychological Bulletin, 129(5), 674-697.

Munt, S. R. (2000). Cultural Politics: Queer Reading. Routledge.

Nelson, T. D. (2016). Promoting healthy ageing by confronting ageism. American Psychologist, 71(4), 276-282. American Psychological Association.

North, M. S., & Fiske, S. T. (2012). An Inconvenienced Youth? Ageism and Its Potential Intergenerational Roots. Psychological Bulletin, 138(5), 982-997. American Psychological Association.

Pew Research Center (2017). 42% of US working women have faced gender discrimination on the job. Available at: https://www.pewresearch.org (Accessed: 16 August 2024).

Phelan, J. C., Link, B. G., & Tehranifar, P. (2010). Social Conditions as Fundamental Causes of Health Inequalities: Theory, Evidence, and Policy Implications. Journal of Health and Social Behavior, 51(S), S28-S40.

RCOT. (2024). Equity, diversity and belonging. Available at: https://www.rcot.co.uk (Accessed: 18 August 2024).

Reeve, D. (2012). Psycho-emotional disablism and internalised oppression. In N. Watson, A. Roulstone, & C. Thomas (Eds.), Routledge Handbook of Disability Studies (pp. 78-92). Routledge.

Rudman, D. L. (2014). Occupational Therapy and Occupational Science: Building Critical and Transformative Discourses. World Federation of Occupational Therapists Bulletin, 70(1), 38-44.

Serano, J. (2007). Whipping Girl: A Transsexual Woman on Sexism and the Scapegoating of Femininity. Seal Press.

Shakespeare, T. (2013). Disability Rights and Wrongs Revisited. Routledge.

Smith, L. (2005). Occupation-Centred Practice: The Challenge of Classism. British Journal of Occupational Therapy, 68(7), 299-305.

Swinton, J., & Pattison, S. (2010). Spirituality and Mental Health Care: Rediscovering a “Forgotten” Dimension. Jessica Kingsley Publishers.

Tervalon, M., & Murray-García, J. (1998). Cultural Humility versus Cultural Competence: A Critical Distinction in Defining Physician Training Outcomes in Multicultural Education. Journal of Health Care for the Poor and Underserved, 9(2), 117-125.

Thomas, C. (2007). Sociologies of Disability and Illness: Contested Ideas in Disability Studies and Medical Sociology. Palgrave Macmillan.

Townsend, E., & Polatajko, H. J. (2007). Enabling Occupation II: Advancing an Occupational Therapy Vision for Health, Well-being, & Justice Through Occupation. CAOT Publications ACE.

Townsend, E., & Wilcock, A. A. (2004). Occupational Justice and Client-Centred Practice: A Dialogue in Progress. Canadian Journal of Occupational Therapy, 71(2), 75-87.

Whiteford, G. (2011). Occupational Therapy and the Elusive Concept of Participation: A Case for Occupational Justice. Australian Occupational Therapy Journal, 58(3), 159-166.

Whiteford, G. E., & Hocking, C. (2012). Occupational Science: Society, Inclusion, Participation. John Wiley & Sons.

Whiteford, G. E., & Wright-St. Clair, V. A. (2005). Occupation and Practice in Context. Elsevier Health Sciences.

Wilkerson, J. M., Rybicki, S., Barber, C. A., & Smolenski, D. J. (2011). Creating a Culturally Competent Clinical Environment for LGBT Patients. Journal of Gay & Lesbian Social Services, 23(3), 376-394.