The Beginnings of Occupational Therapy

“To treat a patient is in part to orient that patient or client to the values set at jeopardy by illness and disability and to aid in making a new and successful adaptation. To attempt to acquire and renew skills so that a patient or client can again become successfully engaged in life is not only a mechanistic undertaking . Human adaptation is never adaptation simply to a physical environment. Our environments are shaped by ideas, obligations, and values. “ Engelhardt, 1986

Holistic From the Start

At the tail end of the Moral Treatment era, a small group of diverse professionals came together to create a brand new profession with the goal of tying together the best of each profession for a more holistic approach to care.

Founders of Occupational Therapy

Back row from left to right: Dunton, Newton, Kidner
Front row from left to right: Johnson, Barton, Slagle

William Rush Dunton, Jr.

The father of occupational therapy: Born and raised in the Philadelphia region (Chestnut Hill). His father was a pharmacist and his mother studied at the Philadelphia School of Art Needlework. Nephew of Benjamin Rush, (Father of American psychiatrist and signer of the Declaration of Independence). Dunton was a graduate of UPenn with a degree in medicine – psychiatry. Dunton married a nurse and moved to Baltimore to become a professor at Johns Hopkins (Sheppard Asylum), and later the director of occupational therapy as well as medical director of a sanitarium near Baltimore. Dunton was also the founder of the society of occupational therapists, and president of AOTA.

Editor, publisher and author, Dunton established a column about occupations in the Maryland Psychiatric Quarterly and started the first professional journal of occupational therapy, Occupational Therapy and Rehabilitation. Dunton spread the knowledge of Occupational Therapy (particularly in the area of mental illness) through books such as “Occupational Therapy: a manual for nurses” and “Reconstruction Therapy”.

Dunton believed healing could be achieved through purposeful activities, or daily occupations, such as metalwork, quilting, poetry, and music. Leading by example, personal interests of Dunton’s were quite varied and included: fishing, gardening, singing, theatre, playing multiple instruments, writing, and collecting different items such as stamps. Dunton was a believer that all individuals should have at least two hobbies to prevent mental illness – one indoor, and one outdoor.

Eleanor Clarke Slagle

The Mother of Occupational Therapy: Social worker, director of the department of Occupational Therapy at Johns Hopkins Hospital and educator of habit training, also founded original headquarters of AOTA.

Visited Hull House and created the first school of its kind, Favill School of Occupational Therapy.

Visited Canada to learn how to better treat wounded soldiers and returned to the US to direct the training of other occupational therapists.

Herbert Hall

Physician who advocated for a treatment path that combined the arts and crafts movement with “traditional” medicine, especially for those with nervous disorders. Hall’s main goal was to regain self-esteem, confidence in daily living, and health through prescription of occupation.

Treatment focused on productive and manual work over rest in order to normalize daily life through regulation of personal interests.

Adolph Meyer

Most influential psychiatrist of his time and one of the biggest supporters of the establishment of the occupational therapy profession. His spouse was a social worker who implemented activity in the mental health wards.

Supporter of Mental Hygiene Movement which utilized community programs to support mental health along with habit training where community members would learn coping strategies such as how to modify or establish healthy behaviors and proper use of time.

Meyer believed that we respond to the rhythms of the day centered on purposeful activities: sleep/wake, hunger/satiation, work/play. And so, Meyer advocated for the influence of the environment on an individual, the application of preventative services using a public health approach, and the importance of collaboration with other professionals.

George Edward Barton

Having traveled widely, Barton was exposed to the arts and crafts movement. Barton supported the return to craftsmanship over industrialization having observed the stress of rapid change and working conditions led to increased mental illness (such as what is now known as fatigue syndrome) and the expansion of asylums. Physicians at this time would prescribe time in fresh air and exercise, “the rest cure”, “the water cure”, and “the work cure”.

Barton developed tuberculosis and his physician prescribed time in nature, so Barton turned to Denver, where he recovered from tuberculosis and returned to his career as an architect. Because of Barton’s interest in productive work and craftsmanship, Barton was a great fit for an architect project in Colorado Springs for a “home” for the poor and elder. The home included space for productive work such as gardening, and space for crafts.

Later in life Barton lost two toes to frostbite and recovered in Clifton Springs, New York at a sanitarium located near a natural spring to participate in “the water cure”. Here in New York Barton learned about the importance of the mind-body connection, and working off the model from Colorado Springs, Barton designed a rehab center: “Consolation House”.

Barton’s curiosity in the therapeutic use of occupation led him to discover the works of Dr. Herbert Hall and Dr. William Rush Dunton, Jr. This lead to a collaboration between Barton, Dr. Hall, Dr. Dunton as well as Nurse Susan Tracy.

Barton organized a meeting to advocate for “the work cure” leading to the development of a new profession, occupational therapy. Interestingly, Barton was hesitant to include physicians as he was afraid that the changes happening in organized medicine at the time would distract from the true objective: “live life to the fullest” – still a strong moto in the world of occupational therapy.

Barton believed in the effect of the environment, the science of movement (kinesiology), and combining motion and occupations (such as carpentry and/or gardening).

Isabel Newton (Barton)

Founder and secretary of what would become AOTA, married Edward Barton, another founder of AOTA.

Thomas Besell Kidner

Vocational Secretary of Canadian military hospitals (and architect – Kidner consulted on hospital architecture until the time of his death), Kidner provided vocational training to injured Canadian war veterans to assist in adjusting to normal living and return to meaningful work. Vocational training included graded occupations and adaptive environments.

Kidner served as vocational rehab advisor to the United States and served as president of AOTA for six years.

Kidner was responsible for the integration of occupational therapy and medicine (for better or worse!).

Susan Cox Johnson

Nurse, teacher, and advocate for arts and crafts in therapy.

Jane Addams and Hull House

Originally from London and inspired by what she observed at Toynee Hall in London, Addams came to the United States to promote communal service learning (still incorporated into occupational therapy programs), earning her the Nobel Peace Prize (first American woman to do so).

Founder of Hull House in Chicago (along with Ellen Gates Starr) – a home for the underserved; a place for shelter, education and meaningful daily living through the use of arts and crafts. Residents were able to bring meaning back to their daily lives by changing perceptions and focusing on the individual’s contribution to the final product.

Many occupational therapists went through Hull House, such as Eleanor Clarke Slagle and Adolf Meyer. Slagle started the Favill School of Occupational Therapy at Hull House, first of its kind.

Arts and Crafts Movement

Originated in the United Kingdom to counter-balance the industrial age. John Ruskin was one of the major thinkers of the movement believing that creating arts and crafts used both the mental and physical.

Another major thinker of the movement was William Morris. With a background in architecture and theology, Morris turned to crafts as a way to restore community during the industrial age. Morris felt the industrial age was impeding the ability for people to natural group together.

Unfortunately as the arts and crafts movement moved from the United Kingdom to North America much of the socialist ideals were lost in order to harmonize with industry, shifting focus solely to the health and wellbeing of the individual. However, the arts and crafts movement still played a part in settlement houses such as Hull House.

The founders of Hull House were part of the Chicago Arts and Crafts Society, and friends with Morris. One of the founders of Hull house, Starr believed in the use of art to uplift, civilize, and connect the diverse, local communities during a time of demoralizing repetitiveness of industrial work. Starr believed that diversity among a community could benefit all.

World War I and Reconstruction Aides

Occupational therapy has had a strong relationship with the military from the beginning of the profession. What was old is now new again. Occupational therapy is currently researching the effectiveness of occupational therapy for treating PTSD, but treating our military using occupational therapy is not new! Occupational Therapists have been facilitating soldiers mental AND physical healing since WWI.

The arts and crafts movement was solidly in place and implemented in treatment with soldiers. Due to the length of the war, it was evident more needed to be done to restore the health and wellbeing of soldiers who were at risk of psychological problems and in need of skills for employment, as well as assist the soldiers in transitioning back to normal life.

Because of Occupational Therapists role with the US military during WWI, the profession of occupational therapy was exposed to the world. The incorporation of emotional “reconstruction” is what separated occupational therapists from physical therapists, and soon occupational therapy became a formal organization with a successful relationship with medicine (even before physical therapy!).

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