OCCUPATIONAL THERAPY GLOBAL HISTORY

Pre-history (1700-1899)

• History Context: Age of Enlightenment (also known as the age of Reason) – an intellectual movement that challenged authority and conventional thinking.
  • Egalitarianism and idealism are prevalent in several European countries.
  • Common themes: goals of progress, increased tolerance, and dedication to removing historical abuses of the church and state (e.g., persecution and corruption).
  • Beginning of the Industrial Revolution: mass production and printing/wide distribution of books to spread ideas efficiently.
  • Human migration and major social changes: emergence of adaptability, moving people from rural to urban areas.
  • Conflict: workers rebelling against exploitation and poor working conditions.
  • Moral treatment towards persons with mental and/or physical illness.
  • Health and illness were viewed as related to patient character and spiritual development.
  • Emergence of humanitarian treatment influenced the development of therapeutic communities and the emphasis on engagement and groups in productive activities (Whiteley, 2004).
• The Civil War (12th of April, 1861): a clash of moral values and economic traditions affecting care systems.
• Hull House: a settlement house in Chicago started by Jane Addams and Ellen Gates Starr.
  • Aimed to create opportunity, participation, and dignity for poor people living in urban Chicago.
  • Hull House and Henry Street Settlement in New York were funded by wealthy donors to help people escape poverty and become productive members of society.
  • These concepts would later become the basis for a movement to use curative occupations in mental illness and eventually influence the development of occupational therapy.
• People and Ideas that influenced Occupational Therapy (1700-1899):
  • John Locke: Father of modern liberalism; influenced philosophy and practices of occupational therapy, including sensory learning and pragmatism.
  • Philippe Pinel: Superintendent of the Bicêtre and Salpêtrière asylums in Paris; ordered removal of chains from some inmates; pioneer of humanitarian treatment of the insane; actions described as emblematic of the moral treatment movement.
  • William Tuke: Father of the moral treatment movement; founded the York Retreat (1796); promoted humane treatment procedures for mental health; eliminated physical punishments and restraints, replacing them with environments where patients could engage in work and leisure activities to develop self-control and self-esteem.

1900-1919: History Context

• This was a period of bold optimism in the U.S. to innovate and lead globally.
  • Assassination of President McKinley by an anarchist protesting corruption and social inequities tied to industrialization.
  • The Progressive Era, followed by presidencies Taft and Wilson.
  • In 1917, the United States entered The Great War (World War I 1914–1918).
  • The war resulted in about 15{,}000{,}000 deaths worldwide, with 7{,}000{,}000 soldiers sustaining wounds resulting in permanent disability.
  • Mobilized plans for care of wounded soldiers requiring rehabilitation and vocational reeducation (reconstruction at the time).
  • The idea of sending reconstruction aides to Europe was novel and reflected bold optimism.
  • Allied victory created a wave of pride; reconstruction aide experiments were deemed successful and propelled reconstruction aides (and later a field called rehabilitation) into a permanent place within American medicine.
• People and Ideas Influencing Occupational Therapy (1900-1919):
  • Clifford Beers: Wrote A Mind That Found Itself; critical account of asylum treatment and recovery; led to the mental hygiene movement.
  • Herbert J. Hall: Adopted a work-based approach to treating neurasthenia (functional nervous disorder tied to stress of societal change and emphasis on productivity).
  • Susan E. Tracy: Trained nurses; in 1910 wrote Studies in Invalid Occupations (the first book on the "work cure approach"); applied William James's pragmatism; involved in first course on occupations for patients at Massachusetts General Hospital (MGH).
  • William Rush Dunton Jr.: Psychiatrist at Sheppard and Enoch Pratt Asylum; taught courses on occupations; wrote a book on occupational therapy (1912).
  • Eleanor Clarke Slagle: Believed curative occupations could be applied to idle patients at Kankakee; promoted curative occupations therapy with Adolf Meyer at the Phipps Clinic in Baltimore; collaborated with Dunton and Slagle in training.
  • George Edward Barton: Architect and patient who inspired the early use of occupations in recovery; helped found the Society for the Promotion of Occupational Therapy; later resigned as president but remained influential.
  • Thomas B. Kidner: Canadian architect and vocational education expert; advised the U.S. Surgeon General; consulted on hospitals and sanitoria; interested in the relationship between occupational therapy and vocational training; contributed to early development of the field.

1900-1919: Developments in Occupational Therapy

• Before World War I, independent efforts converged in 1917 at Consolation House in Clifton Springs, NY, led by George Edward Barton.
  • Barton helped found the Society for the Promotion of Occupational Therapy but resigned as its president within a year and did not actively shape the profession thereafter.
• By the time the U.S. entered the war, several training programs for occupational workers existed (some for nurses, others independent or linked to settlement houses).
• Demand grew due to mental hygiene reform, mental health improvements, and care for physical injuries and chronic illnesses like tuberculosis.
• The U.S., anticipating high wartime casualties, expanded rehabilitation via training both men and women, adapting existing programs, and creating new ones in major East Coast cities.
• Wartime development: rapid creation of war-training courses for reconstruction aides; in the military, physical therapists focused on orthopedic care, exercise, and massage, while occupational therapists provided handicrafts, supported orthopedic patients, and worked with those with psychiatric conditions.
• Although many qualified reconstruction aides were trained, their early placement was difficult as some physicians dismissed occupational therapy as a fad; this perception shifted after aides were assigned to a base hospital in Bordeaux, France, where their value became clear.
• By the end of the war in November 1918, over 200 reconstruction aides served in 20 French base hospitals, and from 1917 to early 1920, nearly 148{,}000 wounded men were treated in 53 U.S. reconstruction hospitals.
• Military guidelines defined occupational therapy as a medical tool for early convalescence to engage soldiers’ minds; however, the aides’ roles and functions remained unclear and ambiguous.
• After George Barton, Dr. William Rush Dunton Jr. became AOTA president in 1917, followed by Eleanor Clarke Slagle. Their leadership promoted recruiting high-quality trainees, and the successful deployment of reconstruction aides in Europe boosted momentum and legitimacy for the young profession entering the 1920s.

1920-1939: History Context

• World War I ended; the Treaty of Versailles was negotiated; President Wilson proposed a League of Nations but failed to win ratification in Congress due to a stroke.
• 1920 to 1939 saw continued social transformations: women gained the vote; Prohibition from 1919 to 1933; the Roaring Twenties celebrated manufacturing, transportation, and communication advances; followed by the Great Depression after the 1929 crash; Franklin D. Roosevelt elected in 1932 and launched New Deal programs.
• The founders of the National Society for the Promotion of Occupational Therapy (NSPOT) set events in motion for the rapid evolution of the profession.
• In 1917, Dr. William Rush Dunton Jr. became president after Barton’s resignation; helped advance NSPOT with a focus on standardizing programs; Dunton embraced Adolf Meyer’s psychobiology theory as a practical framework for treating mental illness (Holistic, habit-disorganization perspective).
• Adolf Meyer’s psychobiology viewed humans as holistic beings; believed that people organize time through doing and that a balance of work and rest is essential for well-being. Engagement in occupations could ward off depression and foster self-confidence to motivate further progress (Christiansen, 2007).
• Meyer’s ideas were overshadowed later by Freud’s psychoanalytic theory and other perspectives (Scull, 2005; Eysenck, 1985).
• Other theories circulating included the notion that mental conditions could be caused by focal infections, leading to aggressive, sometimes harmful surgeries in institutionalized patients due to lack of patient consent (Scull, 2005).
• Electroconvulsive therapies and lobotomies emerged with mixed consequences; controversy persists (Fink & Taylor, 2007; Pressman, 1998).
• Frank H. Krusen, MD, influenced post-WWI to mid-20th century rehabilitation; Krusen argued OT was a special application of physical therapy and should merge the two disciplines (Krusen, 1934).
• The 1920s-30s saw the use of occupational therapy in caring for tuberculosis, a disease stigmatized by immigration and poverty.
• Thomas B. Kidner remained in the United States after Clifton Springs; he advised and designed hospitals and sanitoria with work spaces for OT and vocational training (Friedland & Silva, 2008).
• Kidner was interested in the relationship between occupational therapy and vocational training, yet a firm conclusion remained undecided beyond his death in 1932; this debate would reemerge later as “occupational behavior” (Kielhofner & Burke, 1977; Reilly, 1962).
• Developments in Occupational Therapy (1900-1919):
  • Before WWI, Consolation House in Clifton Springs, NY, helped institutionalize an early movement.
  • The NSPOT’s early work and the new emphasis on standardization laid groundwork for a formal profession.
  • War-time rehabilitation created demand for occupational and physical therapy across medical facilities.
  • By the mid-to-late 1920s, professional networks, associations, and accreditation began to take shape, laying the foundation for modern OT practice.

1940-1959: History Context — Onset of WWII

• WWII and its global impact changed healthcare, economics, and social structures.
  • Germany’s aggression and the global impact of the war transformed international relations and health policy.
  • The U.S. opposed Hitler; Neutrality Acts limited involvement initially; women entered the workforce to replace drafted men; exposure to toxic chemicals caused long-term health issues (fevers, hepatitis).
  • WWII caused over 60{,}000{,}000 deaths globally; significant economic growth alongside persistent social concerns.
  • U.S. legislation to fund research and services for returning veterans expanded the healthcare system: Public Health Service Act authorized NIH funding for non-federal research; the 1944 GI Bill supported veterans’ reintegration; the 1946 Mental Health Act funded mental health services and research.
  • Rehabilitation services expanded as veterans received support to return to work.
  • Vocational Rehabilitation Acts amendments in 1945 and 1954 highlighted physical and mental restoration, leading to growth of curative workshops.
  • Psychological effects of war received less priority than physical injury treatment; Cold War era beginnings.
  • Postwar economic growth, polio triumph, DNA double helix, pacemaker development, and the Joint Commission (JCAHO) foundation; ongoing public health challenges included overcrowded psychiatric institutions, rising alcoholism, and juvenile delinquency.
  • Chlorpromazine (Thorazine) introduced as an antipsychotic; deinstitutionalization began, with new social and healthcare challenges.
• Occupational Therapy (1940-1959): Post–World War II demand
  • Large increase in demand for health professionals.
  • Occupational therapy shifted from purely arts and crafts toward scientifically based rehabilitation techniques.
  • Focus on reintegrating veterans into society through activities of daily living, ergonomics, and vocational rehabilitation within therapeutic communities.
• Prosthetics and orthotics training
  • OT training included developing prosthetics and orthotics; used adapted tools to restore functional abilities.
• Educational program changes
  • Curricula reorganized to align with hospital-based therapy and expanding rehabilitation services.
  • First U.S. OT textbook published: Willard & Spackman; significant in standardizing knowledge.
  • By 1950, seven OT educational courses were implemented in England and one in Scotland.
  • 1952: Preliminary discussions began for forming the World Federation of Occupational Therapists (WFOT).
  • 1959: WFOT recognized by the World Health Organization (WHO).
  • Introduction of Occupational Therapy Assistants (OTAs):
  • 1956: OT assistants introduced to meet workforce demands.
  • 1958: AOTA accredited assistant-level OT programs.
  • International adoption varied; Canada, Australia, and the United Kingdom created allied positions.
• People and Ideas Influencing Occupational Therapy (1940-1959):
  • Karl and Berta Bobath: Pioneers of neurodevelopmental treatment (NDT), originally for cerebral palsy, later applied to various neurological deficits; emphasized using normal play environments and natural contexts for neurological development; techniques widely used by OT and PT.
  • Ruth A. Robinson: Army colonel; developed OT educational programs for military service preparation; proposed accelerated training during the Korean War; served as AOTA president (1955-1958).
  • Margaret Rood: OT and PT; early motor control theorist; emphasized reflexes in early development and the use of facilitation/inhibition techniques; Bobaths expanded on her work.

1960-1979: History Context

• 1964: Under the presidency of Wilma West, there was a reorganization of AOTA to emphasize scientific endeavors in OT.
• The practice of OT during this period was heavily influenced by medical rehabilitation, continuing a mechanistic paradigm focused on neuromotor and musculoskeletal systems and their impact on function (Kielhofner, 2009).
• The American Occupational Therapy Foundation was founded in 1965 to advance the science of the field and improve public recognition; this fostered more graduate education and the development of practice theories, models, and frames of reference.
• There was increased regulation of practice through state licensure legislation as governments sought cost containment for outpatient therapy.
• Advances in neuroscience motivated OT theorists to expand practice:
  • A. Jean Ayres applied neuroscience to practice; studied perceptual-motor issues in children; developed a theory of sensory integration; created tools like the Sensory Integration and Praxis Test (SIPT, Bowman, 1989).
• Other major models and theorists emerged:
  • Gail Fidler emphasized occupation as a means for emotional expression; influenced by interpersonal theory, self-esteem, and ego development (Miller & Walker, 1993).
  • Ann Mosey expanded Fidler’s ideas with the object relations/psychodynamic frame of reference for understanding activities and groups in therapy (Mosey, 1973).
  • Lorna Jean King (1974) applied sensory integration to schizophrenia; Claudia Allen developed cognition-based theories (Allen Cognitive Network, 2011).
  • Kielhofner and Burke (1977) advocated an occupational therapy paradigm focused on human adaptation and occupation, later foundational to MOHO (Model of Human Occupation) (Kielhofner & Burke, 1980).
  • Elizabeth Yerxa emphasized advancing theory to benefit practice, as a successor to Mary Reilly.
• 1960-1979 also saw the emergence of major practice models such as MOHO, PEOP, Ecology of Human Performance, Occupational Performance Process Model, and Canadian Model of Occupational Performance.

1980-1999: History Context

• The end of the Cold War and global changes shaped international influences on OT.
• 1960s–1970s: Ongoing influence of MOHO and neuropsychology, with a growing emphasis on occupational science as a discipline.
• 1965: The American Occupational Therapy Foundation strengthened OT science and research infrastructure.
• 1989: Elizabeth Yerxa helped establish occupational science as an academic discipline; the field expanded its theoretical and research bases.
• 1980s-1990s: International influence intensified; Ann Wilcock emphasized the occupational nature of humans and the need for meaningful occupation for health; Gary Kielhofner’s MOHO gained global prominence.
• Other influential figures and concepts during 1980-1999:
  • Florence Clark: USC-based scholar; focused on lifestyle-oriented activity programs for older adults to stay in their homes and communities; involved in guidelines for consulting, research, education, and practice; member of the AOTF.
  • Gary Kielhofner: Developed MOHO; studied humans as complex systems with volition, habituation, and performance subsystems; authored extensively; influenced OT globally.
  • Ann Wilcock: Advocated for the global, population-health perspective of occupation; stressed that occupational engagement is essential for health and survival.
• The 1980s-1990s also saw increased professional regulation, licensure, and emphasis on research-backed practice; integration of neuroscience and cognitive approaches into OT.

2000-Present: History Context

• 2000s: Global recession and increasing globalization; the U.S. economy integrated with world markets (Friedman, 2006).
• 2008: Barack Obama elected as the first African-American president; faced political divisions affecting policy progress.
• Digital revolution reshaped society: rapid growth of digital devices (smartphones, tablets, e-readers); internet-enabled health information access.
• Health care policy: Prescription drug benefit (Part D) under Medicare; Affordable Care Act (ACA, 2010) expanded health insurance access and regulation of insurers.
• Healthcare and education reforms influenced OT practice:
  • Population-based care, prevention, and health promotion emphasized in policy.
  • Demographic shifts: increased cultural diversity and aging populations required attention to health disparities and home-based management of chronic conditions.
  • Cost containment and evidence-based practice increased demand for research in OT.
  • Hospitals faced pressures to reduce inpatient lengths of stay; more therapy occurred on an outpatient or home health basis.
  • OT developed globally, with international models being examined and challenged by a growing workforce (Asia-Pacific, South America, EU).
• Key development: Kawa Model (Iwama, 2006, 2009) offered culturally relevant OT perspectives through Asian Pacific and collectivist cultures.
• International perspectives: Emergence of societies for occupational science; SSO:USA organized in 2002; developments across Asia Pacific, Canada, and Europe.
• 2007: AOTA and AOTF published the Research Agenda for Occupational Therapy, emphasizing infrastructure for research to demonstrate efficacy of OT services.
• Practice patterns in 2010: School-based and early intervention (27%), Hospitals (28%), Long-term care (16%), Home health/community (7%); mental health practice declined to ~3% (AOTA, 2010).
• War-era innovations: Wounded warriors drove innovations in military OT; emphasis on polytrauma (brain injuries, burns, amputations).
• OT education: Growth of clinical doctorate programs; online and hybrid formats expanded access to education.
• People and Ideas Influencing OT (2000-Present):
  • M. Carolyn Baum (AOTA president, 2004): Initiated Centennial Vision to position OT for success in 2017 and beyond; focus on research, evidence-based practice, diversity, and leadership (AOTA, 2006).
  • Ann Wilcock (Australia) and Elizabeth Townsend (Canada): Pioneered population health, occupational justice movements; Townsend co-developed the concept of occupational justice (Townsend & Wilcock, 2004).
  • Townsend and Wilcock promoted that meaningful occupation is a prerequisite to health and well-being; revision of the WHO International Classification of Impairment, Disability, and Handicap led to the International Classification of Functioning, Disability, and Health (ICF) (World Health Organization, 2001).
  • Townsend (Dalhousie University) and Enabling Occupation: A Canadian framework emphasizing enabling occupation within daily life.
• The Centennial Vision and occupation-based practice continued to guide research, policy, and education; global perspectives and diverse models (MOHO, PEOP, EHP, OPCP, CMOP) shaped contemporary OT.

2000-Present: People and Ideas Influencing Occupational Therapy (2000-Present)

• Florence Clark: Pioneered lifestyle-oriented activity programs; leader in OT education and research; advocate for community-based practice and aging in place.
• Gary Kielhofner: MOHO developer; emphasized human as a complex system with volition, habituation, and performance; broad international influence on practice.
• Ann Wilcock: Advocated for the occupational nature of humans and population health; connected occupation to health outcomes; promoted equity and access through occupation-based practice.
• Elizabeth Yerxa: Proponent of advancing theory to benefit practice; contributed to shaping OT theory and research foundations.
• M. Carolyn Baum: Led AOTA strategic planning (Centennial Vision); emphasized evidence-based practice, research, and leadership; helped set the profession on a growth trajectory toward 100th anniversary.
• Townsend & Wilcock: Development of occupational justice framework; influence on policy and international practice; alignment with WHO ICF revision.
• World Health Organization (ICF): Revisions reinforced the value of occupation-focused practice in health outcomes.
• International study and collaboration: The emergence of international occupational science societies and cross-border practice standards; global OT communities contribute to evolving practice models and education.

References and Additional Context

• Willard & Spackman’s Occupational Therapy (12th ed.) – Schell, B. A., et al. (2013) reference for historical framing and foundational concepts.

Key Concepts and Models to Remember

• Model of Human Occupation (MOHO): A dynamic systems theory of motivation, habitation, and performance; foundational framework by Kielhofner & Burke (1980).
• Sensory Integration and Praxis Test (SIPT): Neurodevelopmental and sensory processing assessment framework developed from Ayres's work (Bowman, 1989).
• PEOP (Person-Environment-Occupation-Performance): Model addressing interaction of person, environment, and occupation.
• Ecological models: Ecology of Human Performance; Canadian Model of Occupational Performance (CMOP).
• Occupational justice: Townsend & Wilcock concept linking meaningful occupation to health and social equity.
• Kawa Model: Culturally grounded OT model from Japan via Iwama, focusing on life flow and community in a river metaphor.
• Role of reconstruction aides: War-time OT and PT roles during WWI and their impact on professional legitimacy.
• Education and policy milestones: NSPOT founding, AOTA formalization, WFOT establishment, accreditation milestones, IDEA, ADA, and BALANCED BUDGET ACT effects on OT practice.

Formulas and Numerical References (LaTeX)

• Global war impact: 15{,}000{,}000 deaths during WWI era globally; 7{,}000{,}000 wounded soldiers with permanent disability.
• Reconstruction aides and treatment figures: 200 aides in 20 base hospitals in France; 148{,}000 wounded treated in 53 U.S. reconstruction hospitals (1917–1920).
• Historical timeframes and mandates referenced: 1700–1899, 1900–1919, 1920–1939, 1940–1959, 1960–1979, 1980–1999, 2000–present.
• Population and policy numbers: Provisional figures for membership and institutional counts (e.g., ~1{,}000 AOTA members by 1929).

Connections to Real-World Relevance

• The moral treatment origin informs today’s emphasis on dignity, engagement, and activity as therapeutic factors.
• Wartime rehabilitation established occupational therapy as a medical discipline with a clear role in convalescence and vocational reeducation, shaping modern rehab and disability policy.
• The evolution of OT models (MOHO, CMOP, PEOP, EHP) reflects a shift from craft-based activities to theory-driven, evidence-based practice designed for diverse populations.
• Legal and policy shifts (IDEA, ADA) expanded OT's reach into education and community settings, influencing practice in schools and across life stages.
• The centennial vision, occupational justice, and global collaboration highlight OT’s ongoing commitment to health equity, population health, and interdisciplinary practice.

Quick Reference Table (Selected Dates and Milestones)

• 1700-1899: Age of Enlightenment, moral treatment, Hull House, York Retreat, Pinel/Tuke; early humanitarian movements.
• 1917-1920: NSPOT formed; reconstruction aides deployed in WWI; AOTA leadership; groundwork for professional standards.
• 1920-1939: World War I aftermath, accreditation beginnings (AMA involvement); Bobath, Rood, Robinson, Slagle, Dunton contributions; TB care expansion.
• 1940-1959: WWII; GI Bill; medical rehabilitation growth; OT training in prosthetics/orthotics; Willard & Spackman textbook; OTA programs.
• 1960-1979: MOHO development; foundations for occupational science; licensure and regulation; emphasis on research and graduate education.
• 1980-1999: OT science expansion; population health; international influence; ISA (Institute for Occupational Science) and OT research emphasis; IDEA and ADA influence practice.
• 2000-Present: Centennial Vision; population health and occupational justice; ICF integration; international OT societies; Wounded warrior OT innovations; online/digital education.