Occupation in Stressful Times
By Mary Ann McColl, B.Sc., M.H.Sc., Ph.D.
Queen's University, Kingston, Ontario, Canada
January 2002
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The events of September 11, 2001 have indeed changed the world forever (Schuster et al., 2001). As occupational therapists, we struggle to respond to both the tangible and intangible consequences of these events, for ourselves, our clients, our families, our profession and our society. I'm sure many of you have been confronted, as I have, with the question of whether as an occupational therapist, you have a contribution to make to the restoration of health and well-being in the wake of these events. Commentators and experts tell us that the fall-out from major tragic events continues for years after the event itself, but that a critical period of distress follows between 3 and 9 months later. The American Occupational Therapy Foundation has convened a group of interested individuals to attempt to formulate a response from the profession. This group has discussed initiatives that might reach out to people in distress due to the events, and also that might help occupational therapists come to grips with their role vis a vis their clients and their communities. One of the initiatives of this group is a paper that will appear in full in AJOT, and that is abstracted here. The paper is an attempt to understand how occupation might be a source of healing and relief in stressful times.

As long as human history has been recorded, we have known that it is important for human beings to be occupied in meaningful ways. Long before the profession of occupational therapy was conceived, the word occupation was used colloquially in much the same way that occupational therapists now use it - to refer to a meaningful way to use time. However, it was not until the twentieth century that we began to understand the full impact of occupation on human health. This article explores how occupation exerts a powerful effect on health and well-being. We will consider seven ways that occupation provides a bridge to health in difficult times.

1. SURVIVAL
First and foremost, occupation refers to doing things, and to the extent that the things done actually address the problem at hand, occupation has survival value. Research has shown that occupation is essential for human beings, both for health and survival (Willcock, 1998a) and that it is the vehicle through which humans meet safety and sustenance needs (Willcock, 1998b). As such, it is an essential tool to help people to survive difficult times, and to address the source of stress.

2. DIVERSION
Second, doing something provides a diversion from the negative aspects of stressful situations. Diversion was one of the original ideas responsible for the development of the profession of occupational therapy at the beginning of the twentieth century. However, in the wake of the scientific revolution of the 1950's and 60's, the unscientific nature of diversional activity came into question. In a thoughtful article, Friedland (1988) asks if diversion "deserves its bad name?", reminding us of this history and the compassionate roots of the profession.

3. MASTERY
Third, occupation reminds us of our capacity for exercising some measure of control over our circumstances. It validates in us our sense of being able to master a situation, turn it to our advantage, come out of it intact. Occupation makes individuals agents of their situation, rather than victims of it - origins vs. pawns (Burke, 1977). Occupation is intrinsically motivated, and it is the vehicle for overall adaptation or mastery (Schkade & Schultz, 1992a & b).

4. HABIT
Fourth, being occupied in usual ways in the midst of a crisis reinforces in us our normal daily habits. It reassures us that the world continues to turn and that there is the possibility of a normal life again. Habits and habit training were another of the original ideas that spawned the profession of occupational therapy. In the last five years, the concept of habits has taken a huge leap forward due a focussed initiative of research on the topic. Several authors have explored the neuroscientific principles underlying the presence and effect of habits (Clark, 2000; Dunn, 2000). Habits have been shown to increase occupational skill, decrease fatigue, free attention and protect the individual against the stressful effects of difficult situations.

5. SUPPORT
Very often, being occupied during difficult times involves helping others, providing support to the coping efforts of others, and contributing to the sense of community and cohesion. When difficult times arise, social support has been repeatedly shown to be one of the factors that helps people to achieve positive outcomes and to weather stress without undue negative consequences for their health. The occupation of providing support in the midst of stressful circumstances has a twofold positive effect - it has a well-documented positive effect of the recipient of support, but it also has a positive effect for the provider of support.

6. IDENTITY
Occupation reminds us of who we are. Through the things we do, we shape, modify and express our identity. We are what we do, and occupation is an essential part of the formation and maintenance of the self. Difficult times threaten the integrity of the self, and to the extent that occupation reinforces identity, it assists us in remaining healthy. Occupation provides the mechanism through which the past, present and future of an individual's life are integrated into a whole self (Christiansen, 1999). In the face of difficult circumstances, occupation grounds the individual to his or her past identity, expresses the essence of the self in the midst of the crisis, and offers potential for the development of a fuller, more integrated self once the crisis resolves.

7. SPIRITUAL CONNECTION
Finally, much has been written lately about the expression of spirit through occupation. Many people believe that through occupation, we are spiritually connected to the self, to others, to the natural world and to a supreme power (McColl, 2000). Whereas in earlier times, people might have turned to religion to restore meaning, in the contemporary world of secular pluralism, occupation may be the most effective medium available through which individuals can affirm these connections. In stressful times, being occupied may provide this sense that one is not alone, both literally and also in the most profound sense.

We have considered seven ways in which occupation has been shown, both historically and empirically, to offer help, hope, grounding and connection in the midst of difficult times. While the discussion offers us no answers about what to do or how to react as occupational therapists, I hope it affirms some things that we already knew: that being occupied promotes health and well-being, both for the therapist and for the person receiving his or her help.

Acknowledgement: My thanks to the members of the AOTF Task Force, its leadership and staff, for assistance with this paper and with the ideas underlying it. They are: Debra Ben Avram, Carolyn Baum, Mary Binderman, Janice Burke, Charles Christiansen, Nedra Gillette, Georgiana Herzberg, Martha Kirkland, Diana Ramsay, Jane Rourk, Marjorie Scaffa and Julie Wolf.

Note: As the only Canadian on the AOTF task force, I am acutely aware that aspects of the September 11th experience are uniquely American. I have been grateful for the opportunity to learn from American colleagues at this troubled time, and hope that I am not being presumptuous to comment on it from a short distance away - that is, from the perspective of a neighbour and friend.

References

Burke, J.P.(1977). A clinical perspective on motivation: Pawn versus origin. American Journal of Occupational Therapy, 31, 24-8.

Christiansen, C. (1999). Defining lives: Occupation as identity. An essay on competence, coherence and the creating of meaning. American Journal of Occupational Therapy, 53, 439-46.

Clark, F. (2000). The concepts of habit and routine: A preliminary theoretical synthesis. Occupational Therapy Journal of Research, 20, 123-37s.

Dunn, W.W. (2000). Habit. What's the brain got to do with it. Occupational Therapy Journal of Research, 20, 6-20s.

Friedland, J. (1988). Diversional activity: Does it deserve its bad name? American Journal of Occupational Therapy, 42, 603-8.

McColl, M.A. (2000). Spirit, occupation and disability. Canadian Journal of Occupational Therapy, 67(4), 217-28.

Schkade, J.K., & Schultz, S. (1992). Occupational adaptation: Toward a holistic approach for contemporary practice. Part 1. American Journal of Occupational Therapy, 46, 829-37.

Schultz, S., & Schkade, J. (1992). Occupational adaptation: Toward a holistic approach for contemporary practice. Part 2. American Journal of Occupational Therapy, 46(10), 917-25.

Schuster, M.A., Stein, B.D., Jaycox, L.H., Collins, R.L., Marshall, G.N., Elliott, M.N., Zhou, A.J., Kanouse, D.E., Morrison, J.L., & Berry, S.H. (2001). A national survey of stress reactions after the September 11, 2001 terrorist attacks. New England Journal of Medicine, 345(20), 1507-12.

Wilcock, A.A. (1998a). Reflections on doing, being and becoming. Canadian Journal of Occupational Therapy, 65, 240-56.

Wilcock, A.A. (1998b). An occupational perspective on health. Thorofare NJ: Slack Inc.