Resituating the meaning of occupation in the context of living Kirk Reed A thesis submitted to ...

186 Pages·2008·1.49 MB·English

Resituating the meaning of occupation in the context of living

Kirk Reed

A thesis submitted to Auckland University of Technology
in partial fulfilment of the requirements of the degree of
Doctor of Health Science (DHSc)

2008

School of Rehabilitation and Occupation Studies

Primary Supervisor: Liz Smythe
CONTENTS
CONTENTS ..................................................................................................................................... I
LIST OF TABLES ........................................................................................................................ IV
ATTESTATION OF AUTHORSHIP .......................................................................................... V
ACKNOWLEDGEMENTS ......................................................................................................... VI
ABSTRACT................................................................................................................................. VII
CHAPTER ONE ............................................................................................................................. 1
INTRODUCTION ............................................................................................................................. 1
Purpose of the Study ................................................................................................................ 2
Selecting the Methodology ...................................................................................................... 6
Pre-understandings and Horizons ........................................................................................... 6
The Researcher and the Research Process ............................................................................. 7
Occupational Therapy Practice .............................................................................................. 8
Post Graduate Study ................................................................................................................ 9
A Different Kind of Practice .................................................................................................... 9
Professional and Theoretical Contexts of the Research ........................................................ 10
Occupational Therapy Context ............................................................................................. 10
Occupational Science ............................................................................................................ 12
Structure of the Thesis ........................................................................................................... 13
CHAPTER TWO .......................................................................................................................... 15
LITERATURE REVIEW .................................................................................................................. 15
Introduction ........................................................................................................................... 15
The Scope of the Literature Review ....................................................................................... 16
Occupation in Western History ............................................................................................. 17
The Bible .......................................................................................................................................... 18
The Ancient Greeks ......................................................................................................................... 19
The Ancient Romans ........................................................................................................................ 20
Middle Ages ..................................................................................................................................... 20
Renaissance and Reformation .......................................................................................................... 22
Industrial Revolution ........................................................................................................................ 23
Summary .......................................................................................................................................... 24
Etymology of Occupation ...................................................................................................... 25
Occupation as the Basis of Occupational Therapy ............................................................... 26
Summary .......................................................................................................................................... 34
Contemporary Understandings of Occupation ...................................................................... 35
Social Perspective ............................................................................................................................ 38
Making a Link between Meaning and Occupation ........................................................................... 39
Summary .......................................................................................................................................... 47
Conclusion ............................................................................................................................. 48
CHAPTER THREE ...................................................................................................................... 49
PHILOSOPHICAL UNDERPINNINGS ............................................................................................... 49
Phenomenology ..................................................................................................................... 49
Heidegger the Person ....................................................................................................................... 50
Heidegger’s Phenomenology ........................................................................................................... 52
The Meaning of Being ........................................................................................................... 52
Dasein .............................................................................................................................................. 53
Being-in-the-world ........................................................................................................................... 53
Meaning ........................................................................................................................................... 54
Being-in-the world with Others ........................................................................................................ 55
Understanding ....................................................................................................................... 56
Moving to Interpretation .................................................................................................................. 56
Adding the Philosophical Thoughts of Gadamer .................................................................. 57
Prejudice .......................................................................................................................................... 58
Horizon ............................................................................................................................................ 58
Importance of Language ....................................................................................................... 59
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Hermeneutic Circle ............................................................................................................... 60
Conclusion ............................................................................................................................. 61
CHAPTER FOUR......................................................................................................................... 62
METHOD ..................................................................................................................................... 62
Principles of Phenomenological Hermeneutic Inquiry ......................................................... 62
Approval for the Study ........................................................................................................... 64
Recruiting and Selecting Participants ................................................................................... 64
Consent, Confidentiality and Anonymity ............................................................................... 66
The Study Participants .......................................................................................................... 66
Were There Enough Participants? ........................................................................................ 67
Collecting the Data ............................................................................................................... 69
Working with the Data .......................................................................................................... 71
Trustworthiness ..................................................................................................................... 73
Is the Research an Understandable and Appreciable Product? ......................................................... 74
Is the Process of Inquiry Understandable? ....................................................................................... 74
Is the Research a Useful Product? .................................................................................................... 74
Is this an Appropriate Inquiry Approach? ........................................................................................ 75
Conclusion ............................................................................................................................. 75
CHAPTER FIVE .......................................................................................................................... 76
THE CALL .................................................................................................................................... 76
Overview ............................................................................................................................... 76
Underpinnings from Heidegger ............................................................................................. 77
The Call ............................................................................................................................................ 78
The Call as Passion .......................................................................................................................... 79
The Call as Poised and Ready to Respond ....................................................................................... 81
The Call as Thinking Ahead............................................................................................................. 82
The Call as Tending to Relationship ................................................................................................ 83
The Call as Thinking ........................................................................................................................ 84
The Call as Responsibility ............................................................................................................... 85
The Call as Getting Myself Together ............................................................................................... 86
The Call as Having to Choose .......................................................................................................... 87
The Call as Angst ............................................................................................................................. 88
The Call as Living with Loss ........................................................................................................... 89
The Call as Fulfilling Responsibility ................................................................................................ 91
The Call as Worry ............................................................................................................................ 91
The Call as Being Saved From Worry ............................................................................................. 92
The Call as All Consuming .............................................................................................................. 94
Summary ................................................................................................................................ 94
CHAPTER SIX ............................................................................................................................. 97
BEING-WITH ................................................................................................................................ 97
Introduction ........................................................................................................................... 97
Underpinnings from Heidegger and Buber ........................................................................... 97
Being With as Being Wanted ........................................................................................................... 98
Being With as Being There ............................................................................................................ 100
Being With as Calling on Experience ............................................................................................ 101
Being With as Timing .................................................................................................................... 102
Being With as Intimacy .................................................................................................................. 103
Being With as Spending Time Together ........................................................................................ 105
Being With as Finding The Time ................................................................................................... 105
Being With as Working Together .................................................................................................. 106
Being With as Sharing an Interest .................................................................................................. 107
Being With as A Special Bond ....................................................................................................... 108
Being With as Going Back ............................................................................................................. 109
Being With as Contact ................................................................................................................... 110
Summary .............................................................................................................................. 111
CHAPTER SEVEN..................................................................................................................... 113
POSSIBILITIES ........................................................................................................................... 113
Underpinnings from Heidegger ........................................................................................... 113
ii
Showing Self as Personal Space ..................................................................................................... 114
Showing Self as Open to Possibilities ............................................................................................ 116
Showing Self as Standing Back ..................................................................................................... 118
Showing Self as Being Seen ........................................................................................................... 119
Showing Self as Stamina ................................................................................................................ 120
Showing Self as New Self: New Mood .......................................................................................... 122
Showing Self as Pushing Boundaries ............................................................................................. 124
Summary .............................................................................................................................. 126
CHAPTER EIGHT ..................................................................................................................... 127
DISCUSSION .............................................................................................................................. 127
Introduction ......................................................................................................................... 127
Overview of the Findings .................................................................................................... 127
Back to the Literature .......................................................................................................... 132
Implications of this Study .................................................................................................... 142
Implications for Practice ................................................................................................................ 143
Implications for Occupational Science ........................................................................................... 146
Implications for Future Understandings of Occupation ................................................................. 147
Implications for Education ............................................................................................................. 149
Limitations and Future Research ........................................................................................ 150
Reflection............................................................................................................................. 152
REFERENCES ........................................................................................................................... 154
APPENDIX 1: ETHICS APPROVAL ............................................................................................... 163
APPENDIX 2: LETTER OF SUPPORT ............................................................................................ 164
APPENDIX 3: PARTICIPANT INFORMATION SHEET ..................................................................... 166
APPENDIX 4: PARTICIPANT INFORMED CONSENT FORM............................................................ 169
APPENDIX 5: TYPIST CONFIDENTIALITY AGREEMENT .............................................................. 170
APPENDIX 6: PARTICIPANT LETTER .......................................................................................... 171
APPENDIX 7: MIND MAP – THE CALL ....................................................................................... 172
APPENDIX 8: MIND MAP – BEING-WITH ................................................................................... 173
APPENDIX 9: MIND MAP – POSSIBILITIES ................................................................................. 174

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List of Tables

TABLE 1: PARTICIPANT INFORMATION ............................................................................................ 67

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Attestation of Authorship

I hereby declare that this submission is my own work and that, to the best of my
knowledge and belief, it contains no material previously published or written by
another person (except where explicitly defined in the acknowledgments), nor
material which to a substantial extent has been submitted for the award of any
other degree or diploma of a university or other institution of higher learning.

Signed ……………………………….

Dated ………………………………...

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Acknowledgements

I wish to acknowledge and thank the many people who have contributed to the
journey of this study. I am reminded of the Maori proverb;

He aha te mea nui o te ao?
He tangata! He tangata! He tangata!

What is the most important thing in the world?
It is people! It is people! It is people!

I would like to especially thank the participants who so generously shared their
time and stories. Your stories are a gift which I shall treasure.

A special thank-you goes to my supervisors, Liz Smythe and Clare Hocking.
Their wisdom and guidance has made this journey an amazing one. They
supported me along the way, opening new paths and bringing me back when I was
lost. I would also like to thank Glenis Cameron for her transcribing skills and
Shobha Nayar for her editing skills.

There are many people have helped to create space in my life to complete this
work, especially my colleagues at AUT University, particularly those in the
Department of Occupational Therapy. During this journey I have been an absent
friend, son and brother. A special thanks to my friends who are too many to list
here, they have provided respite from thinking and writing and have tolerated me
talking about occupation and Heidegger, time and time again. I must also thank
my family, my mother Heather, my father Doug, and my sisters Kim and Fiona.

Lastly to my dog Geordie, his constant need for a walk and his antics have kept
me grounded in occupations that have brought clarity to my thinking.

This study was approved by the Auckland University of Technology Ethics
Committee (ref no: 04/66 April 2004).
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Abstract

This study explores the meaning of occupation, defined as a “conceptual entity…
[which] includes all the things that people do in their everyday life” (Sundkvist &
Zingmark, 2003, p. 40). Using a phenomenological hermeneutic method informed
by the writings of Martin Heidegger (1889-1976) and Hans-Georg Gadamer
(1900-2002), this study provides an understanding of the meaning of occupation
interpreted from the perspective of 12 New Zealand adults who experienced a
disruption to their occupations.

The review of the literature suggests that early writers from the time of the Bible
identified that occupation is not ‘wide open’, there are many factors that shape
how and when a person engages in an occupation, which in turn shapes the
meaning of occupation. Within the occupational therapy literature, discussion of
the meaning of occupation is overshadowed by describing and defending practice.
In occupational science scholars and researchers have focused largely on
understanding occupation from a conceptual perspective rather than the
ontological meaning of occupation. The exploration of the meaning of occupation
is being advanced by only a few.

In this study participants told their stories about their occupations. Data were
analysed by indentifying key themes and engaging in a hermeneutic thinking
process of going back to the work of Heidegger and Gadamer. Writing and re-
writing was the method used to bring new understandings to the data. The
findings of this thesis suggest that the meaning of occupation is complex, and
tends to remain hidden. Analysis focuses on the call, Being-with, and possibilities.
The call to occupation seems to be in response to what it is we care about or what
concerns us. Being-with others while engaging in an occupation creates a bond
and mood; the meaning of occupation changes depending on who the occupation
is done with or without. The meaning of occupation is also revealed in the
possibilities that are opened up or closed down. Occupation shows both ourselves
and others what it is we are capable of in the journey of who it is we are
vii
becoming. Each of these facets of meaning work in unison and can be likened to
three cogs in a wheel, each interconnected with the others.

The thesis concludes by recognising that not all voices have been heard and
argues for uncovering more about the meaning of occupation from the perspective
of lived experience. A challenge is made to consider the meaning of occupation
not as something that is individually derived but as something that is connected to
the broader context of the world and others in the world.
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CHAPTER ONE

Introduction

As an occupational therapist who worked with people with severe and enduring
mental health problems for many years, I often reflected on what it was about
occupation that was so fundamental in recovery from mental ill health. As a recent
graduate I ran a weekly cooking group for people who had been admitted to an
acute mental health unit. I remember from the cooking group that what I saw was
occupation in action. What I noticed was often in conflict with the reports from
medical and nursing staff. I observed people fully engaged in what they were
doing, able to concentrate, work together, seek assistance when need be, and who
were genuinely pleased with their finished product. The occupation seemed to
have a positive impact on the health and well-being of the people that attended,
but there was never enough time to find out more about why this was. My sense
was that although the notion of meaningful occupation seemed to be at the heart
of practice of occupational therapy, there was nothing I read or learnt about in my
occupational therapy education that gave me any real insights into the meaning of
occupation. I could see it in action, but the literature to support this was not
something that I was aware of.

As I became increasingly interested in the meaning of occupation, I began to think
about the meaning of occupation. Were the meanings I associated with what I did
the same as those of others? I believed that it was important to understand more
about the meaning of occupation if I was to be an effective occupational therapist.
Talking with my colleagues I discovered that they had experienced similar
tensions when trying to work with clients and had turned to psychology in
particular for the explanations they were looking for. However the answers
seemed to focus on attempting to understand what motivated a person to engage
in an occupation or what a person’s usual routine of occupations were. It seemed
to me, as an occupational therapist, that the meaning of occupation was at the crux
of understanding occupation and therefore working with the notion
therapeutically, but this had somehow been side-stepped by the profession. It was
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