Social occupational therapy, social justice, and LGBTI+ population: with whom we produce our reflections and actions?

Abstract

This reflection article had the purpose of discussing possible relationships between social occupational therapy, the concept of social justice, and possible justifications for the production of knowledge and practices with the LGBTI+ population. For this, the conceptual production of social justice developed by Nancy Fraser was taken as a basis, which for the author can be analyzed through demands for redistribution, recognition, and representation. Furthermore, the main elements for the identification and conceptual delimitation of the subjects with which this theoretical-methodological perspective decides to focus its reflections and actions together were sought in the history of the constitution of social occupational therapy. It was possible to highlight the relevance of the themes of genders and sexualities for the production of reflections and practices from the theoretical-methodological perspective of social occupational therapy, since the dissident subjects and groups of genders and sexualities experience, in their daily lives, social inequalities, and injustices that prevent them from accessing certain social rights, exercising their citizenship, having their demands represented in state political dimensions and having their existence recognized in different social realities. This proposal for reflection is not based on the understanding that these subjects and groups demand professional actions because they are considered “vulnerable”, but because they understand that by producing experiences that go beyond gender and sexuality norms, these subjects and groups go through numerous situations of violence and oppression, different forms of social injustice, and neglect of social rights.

Keywords:
Social Occupational Therapy; Social Justice; Gender; Sexuality

Resumo

Este artigo de reflexão teve a proposta de discutir possíveis relações entre terapia ocupacional social, o conceito de justiça social e as possíveis justificativas para a produção de conhecimentos e práticas junto à população LGBTI+. Para isso, tomou-se como base a produção conceitual de justiça social elaborada por Nancy Fraser, o que, para a autora, pode ser analisada por meio de demandas de redistribuição, reconhecimento e representação. Além disso, buscou-se, na história de constituição da terapia ocupacional social, os principais elementos para a identificação e delimitação conceitual dos sujeitos junto aos quais essa perspectiva teórico-metodológica decide focar suas reflexões e ações em conjunto. Foi possível destacar a relevância dos temas de gêneros e de sexualidades para a produção de reflexões e práticas pela perspectiva teórico-metodológica da terapia ocupacional social, uma vez que os sujeitos e grupos dissidentes de gêneros e sexualidades experienciam, em seus cotidianos, desigualdades e injustiças sociais que os impedem de acessar determinados direitos sociais, exercerem sua cidadania, terem suas demandas representadas nas dimensões políticas estatais e terem suas existências reconhecidas nas diferentes realidades sociais. Esta proposta de reflexão não parte da compreensão de que esses sujeitos e grupos demandam ações profissionais por serem considerados “vulneráveis”, mas por compreender que, ao produzir experiências para além das normas de gêneros e de sexualidades, esses sujeitos e grupos passam por inúmeras situações de violências e opressões, diferentes formas de injustiças sociais e negligências de direitos sociais.

Palavras-chave:
Terapia Ocupacional Social; Justiça Social; Gênero; Sexualidade

Introduction

The proposal of this text aims to articulate the discussions on occupational therapy and social justice, as a relevant concept for the theoretical foundation of these productions. In this sense, I propose here some possibilities for reflection that can contribute both to the advance in the theoretical design and the proposition of practices of some occupational therapies, specifically in social occupational therapy.

I present a task and challenge, the elucidation of three important points in this debate: the conceptualization of social justice located in the works of Nancy Fraser, possible points of contact with some contributions of social occupational therapy, and, finally, the exemplification of this articulation in a proposed theoretical design to justify possible reflections and actions with the LGBTI+ population (lesbians, gays, bisexuals, transvestites, transsexuals, and intersex). The symbol “+” in the acronym refers to other identity possibilities of sexual orientations and gender expressions.

The Concept of Social Justice for Nancy Fraser: Redistribution, Recognition, and Representation

Nancy Fraser is a philosopher, feminist, white, American, affiliated with Critical Theory, and who has focused part of her studies on the creation of the concept of social justice, especially emerging in the post-Cold War context.

The main works that marked the thought of this philosopher, specifically on social justice, were “Justice Interruptus: Critical Reflections on the “Postsocialist” Condition” (Fraser, 1997), “Redistribution or Recognition? A Political - Philosophical Exchange” (Fraser & Honneth, 2003), and “Scales of Justice: Reimagining Political Space in a Globalizing World” (Fraser, 2009).

In this context of intense social transformations, important demands emerge for the analysis of social relations, which the author will call a new grammar of political demands (Fraser, 2009), which are essential to attack some of the main points that produce injustices in capitalist societies, pointing to a three-dimensional categorization based on redistribution, recognition, and representation.

An important point in this argument is that the bet for understanding social justice concerns more a proposal of analysis than an empirical reality, since the author emphasizes that, in different social realities, injustices coexist and are articulated differently. For example, when analyzing class and race, which for some societies appear inseparable.

Thus, Fraser questions split formulations for the analysis of the theme, pointing out that sectarian views on social injustice end up being incompatible with a broader notion of social justice, which, for the author, stands as an interpretation of democratic-radical justice (Gonçalves, 2020).

The first important dimension of analysis on the concept of social justice, for the author, refers to the issue of redistribution. This dimension encompasses the traditional concerns of the so-called theories of distributive justice, especially related to poverty, exploitation, inequality, and class markers, some of them quite close to the references that are based on historical materialism.

According to the author,

From a distributive point of view, injustice arises in the form of class-like inequalities based on the economic structure of society. Here, the quintessence of injustice is maldistribution, in a broad sense, encompassing not only income inequality but also exploitation, deprivation, and marginalization or exclusion from labor markets (Fraser, 2002, p. 11).

For this dimension, a possible solution proposal would be based on redistribution, understood as encompassing not only the transfer of income but, above all, the reorganization of the division of labor, the transformation of property relations, and the democratization of production processes (Fraser & Honneth, 2003).

The second dimension of analysis on social justice must encompass the concerns stated by philosophies of recognition, especially those dealing with issues such as inequality and disrespect, cultural imperialism, and questions about identity and difference. For the author,

From the point of view of recognition, by contrast, injustice appears in the form of subordination of status, based on institutionalized hierarchies of cultural value. The paradigmatic injustice, in this case, is false recognition, which must also be taken in a broad sense, encompassing cultural domination, non-recognition, and disrespect (Fraser, 2002, p. 12).

The solution bet for this dimension lies in the recognition dimension, to encompass not only proposals of visibility and subjective valorization of identities but mainly to value differences for the transformation of symbolic orders (Fraser & Honneth, 2003).

The third dimension of social justice refers to representation, an essential theme for the dimension of the political in the strict sense, that is, the power of action of the State and the elaboration of rules for decision-making that overcome social conflicts.

This dimension tells about the procedures through which claims become part of the political agenda of both nation-states and international organizations (Fraser & Honneth, 2003).

For this dimension, the bet on overcoming injustice implies fighting institutionalized structures that prevent some individuals from taking their place as integral partners in social interaction.

In this way, Nancy Fraser's theoretical bet highlights the discussion of social injustices, which, as will be presented below, can dialogue with the historical construction of social occupational therapy and the delimitation of individuals, groups, and communities in which we produce actions together.

Social Occupational Therapy: with Whom Do We Produce Our Actions?

At this point, I will approach how social occupational therapy, historically, has listed and delimited the possibilities of understanding the individuals with whom it has developed its reflections and actions. The bets of social occupational therapy have taken different meanings, from resources for surveying demands, to the production of technologies to solve the problems listed by different individuals, groups, and communities, strategies designed and produced together with different social actors.

The term social occupational therapy was used for the first time in the text “Report of an experience in occupational therapy in the social field” (Barros et al., 2007a). However, the proposal of social occupational therapy as a theoretical-methodological perspective¹ has its origins in the text “Occupational Therapy and Society” (Barros et al., 1999), although the term “social occupational therapy” has not yet been used in this publication.

Based on this text, social occupational therapy begins to be designed with its specific references, methods, and techniques and beyond the possibilities of professional action in the field of health. Instead of segregating and segmenting professional practice, it has contributed directly to the expansion of the fields of action and the possibilities of professional insertion in sectors of public policies until then not occupied by occupational therapists.

The main ideas and proposals of these authors were deepened in the following texts such as in “Social Occupational Therapy” (Barros et al., 2002) and “Metuia Project – Occupational Therapy in the social field” (Barros et al., 2002).

We matter here to understand how these authors begin to design the proposal of social occupational therapy, more specifically how they articulate and define the individuals with whom this perspective can produce reflections and practices to identify demands and propose joint solutions to problems faced in their different daily lives.

In the first cited text, Barros et al. (1999) emphasize that the concern with social problems, arising from a process of redemocratization of Brazilian society, together with criticisms about the processes of medicalization of social problems, led to the questioning of traditional ways of conceiving the possible fields of occupational therapy. This process led to the questioning of ways of understanding the individuals, requiring the overcoming of separate views that divided them into physical, mental, and social aspects, pointing to a perspective that would allow the expansion of that understanding to an idea of an individual that it is produced in a direct relationship with their social reality (Barros et al., 1999).

Another important point of this text is the reflection that occupational therapy should start the discussion of problems that were not necessarily classified as health demands, which the authors will call demands arising from segregation processes. This proposal arises, at least at first, linked to the questioning of the institutionalization processes of populations that are already traditional in the work of occupational therapists in Brazil. However, the change in perspective is characterized by the proposition of actions no longer by the treatment bias, which would mean the need to expand the theoretical and methodological repertoire for the scope of occupational therapy.

At this point, the authors propose that a good part of the individuals with whom occupational therapy produced practices at that time were institutionalized children and elderly people. At this point, the authors call on Castel (1994), who introduces the concept of “social waste”. It appears a first possibility of demarcating the discussion about which individuals would be listed as priorities for social occupational therapy and which, as we will see later, will be worked out in a more defined way in the next texts of these authors.

A final point to be highlighted in this text is the idea that individuals have a central role in proposing collective responses, since understanding the demands of these populations is based on the recognition of reality and the way of understanding the world. The defense of this idea is very important for future propositions of social occupational therapy, which follow this interpretation that individuals are not subordinated to technical knowledge; on the contrary, they are an essential part of understanding both their demands and a priority part in the productiomn of creative responses to solve problems.

In the second text, entitled “Social Occupational Therapy”, Barros et al. (2002) no longer locate an idea of “social problems”, and point to the concept of “social question”, theoretically demarcating a type of social analysis influenced by historical materialism, which will have great repercussions for the initial formulation of social occupational therapy, including the understanding of possible audiences accompanied by this theoretical-methodological perspective.

In this text, the main references inserted in the proposals of social occupational therapy are Franco Basaglia and Franca Basaglia with their reading about institutions of violence and the influences of the Psychiatric Reform in Italy, Ervin Goffman, and the discussion about total institutions. Also, Antonio Gramsci, who, from the perspective of historical materialism, questioned the role of the intellectual in class relations, which will become quite useful for the discussion on the political role of technicians.

Along with the reading of these authors, the discussion produced by Castel (1999) is intensified about a new configuration of the so-called social issue, bringing the centrality of work and relational insertion to the discussion of concepts such as social vulnerability and processes of disaffiliation.

In this understanding, the technical action of occupational therapists should take place with the individuals, understanding them as concrete interlocutors of their needs, which, according to the authors, could provoke a collective awareness and expand the spaces of freedom for multiple experiences. (Barros et al., 2002).

Based on these references, the authors propose what they called “two target groups of the action of the disciplinary discourse”, and which constitute the population to be focused, at that moment, by social occupational therapy:

1. Those who suffer the exclusion process. The attribute of social danger was applied to them, which justified their institutionalization, that is, processes of social exclusion for their recovery, education, and/or repression [...].

2. Social groups that, due to social transformations, are directly exposed to the precariousness of work, to relational vulnerability, and, therefore, to marginalization and the rupture of social networks (Barros et al., 2002, p. 101).

This excerpt summarizes the authors' proposal regarding the delimitation of individuals that social occupational therapy should produce joint actions: the first linked to the history of the institutionalization of people considered “deviant”, especially for the perception of demands that are not necessarily health; and the second linked to groups in the process of breaking social networks and who are in precarious work situations and weakening of social bonds (Castel, 1999).

In the third text, entitled “Metuia Project – Occupational Therapy in the social field”, Barros et al. (2002) continue the process of defining social occupational therapy, counting the process of creation of the Metuia Project², in 1998, as an inter-institutional group.

In this text, the authors reaffirm the need to establish an occupational therapy that focuses its actions on the social field and that develops strategies with individuals who experience the weakening of work processes and social bonds (Castel, 1999), following an alignment theoretical already put in the previous text, and that will follow in the next texts, as in Barros (2004) and Lopes (2006).

In the text entitled “Social occupational therapy: diversity, culture and technical knowledge”, Barros et al. (2007b) propose the insertion of new theoretical perspectives for the foundation of social occupational therapy. Based on that in Brazil, the coexistence of identities from different matrices with the intensification of the issue of difference and inequalities places new demands for the training and performance of occupational therapists, which requires a review of concepts and procedures of the profession, seeking to contributions to studies on culture.

It is important to highlight that, in the first decade of the 21^st century, social occupational therapy ended up producing two main theoretical movements that will contribute to future publications in the area. On one hand, the foundations are influenced by a historical materialist perspective; and, on the other hand, discussions based on socio-anthropological studies on culture.

These two main perspectives help in the conceptual delimitation and expansion of the ideas about the individuals with whom social occupational therapy decides to produce its actions together, pointing to problems that arise from the social question and others that are built by readings about cultural differences and interculturality.

Regarding the readings inspired by historical materialism, studies, and practices with families and the struggle for housing (Lopes et al., 2001), poor childhoods and youth (Lopes, 2006), youth and public school (Lopes, 2006) begin to appear (Lopes et al., 2011; Silva, 2011; Lopes et al., 2011; Pereira, 2014; Pan, 2019), infraction (Borba, 2012; Morais, 2013), actions with the Unified Social Assistance System (Almeida et al., 2012; Oliveira, 2020), use of psychoactive substances (Bardi, 2013), education in the countryside (Farias & Faleiro, 2017; Farias et al., 2019), theoretical reviews on the relationships between historical materialism and occupational therapy (Barreiro et al., 2021), notes on Paulo Freire's references (Farias & Lopes, 2020), and theoretical contributions by Gramsci (Bezerra et al., 2021), among others.

Regarding the studies on culture, they begin to work with homeless people (Galvani & Barros, 2010; Almeida et al., 2011), practices at cultural points (Barros et al., 2013), peoples and communities (Macedo, 2010; Costa, 2012), mobility and refugee situations (Sato & Barros, 2016; Galvani et al., 2016), different cultural perspectives on childhood (Pastore, 2020), dissident populations of genders and sexualities (Monzeli, 2013; Monzeli et al., 2015; Melo, 2016; Leite Junior & Lopes, 2017), anti-racist references and practices (Farias et al., 2020), and theoretical studies on social markers of difference (Melo et al., 2020), among others.

It is important to highlight that these two referential axes, despite reflecting the theoretical paths that social occupational therapy has been producing articulations, are configured more as a didactic division than exactly a fixed and immutable proposition. This is because some of these studies propose to produce dialogues between these theoretical references. Sometimes, these two trends of thought present great epistemological approximations, such as the possibility of thinking about individuals through their historical and relational dimensions.

In this sense, this brief historical tour of how social occupational therapy delimits its conceptions about who would be the individuals with whom it decides to produce reflections and actions helps us to understand the possible justifications for the beginning of the production of research and practices together with the LGBTI+ population.

Social Justice, Social Occupational Therapy, and the LGBTI+ Population

At this point, based on the previous conceptualization of social justice, having as main dimensions redistribution, recognition, and representation, and on the historical analysis of social occupational therapy, specifically to possible understandings about the populations with which they propose reflections and joint actions highlight the need to identify the LGBTI+ population as an important group for the production of knowledge and practices from the perspective of social occupational therapy.

Since the 2010s, social occupational therapy has produced different reflections and actions with the LGBTI+ population, such as a literature review on the relationships between occupational therapy and sexuality (Monzeli & Lopes, 2012), the work with young transvestites, and the relationship with spaces of sociability (Monzeli, 2013; Monzeli et al., 2015), training in occupational therapy and gender and sexual issues (Leite Junior, 2015; Leite Junior & Lopes, 2017; Melo et al., 2018), reflections on social occupational therapy and trans people (Melo, 2016), possible articulations of social occupational therapy with the themes of gender and sexualities (Monzeli, 2016) and the daily lives of dissidents of gender and sexualities in the current context of the crisis of Brazilian democracy (Braga et al., 2020).

In this recent history, social occupational therapy begins to show the need to discuss the themes of gender and sexualities, mainly by understanding them as categories of social difference, that is, discussing unequal situations and places of social experiences that are based on the experiences that produce dissident genders and sexualities, that is, these categories appear as relevant to the understanding of situations of oppression, violence, and neglect of social rights and, therefore, should be considered for the actions of social occupational therapy.

The concept of gender and sexual dissidence begins to be used in the 2000s in opposition to the idea of “diversity”, which is being produced and articulated by an understanding of normalization, very close to the multicultural and neoliberal discourse of tolerance (Colling, 2015).

In this reading, the idea of a particular identity is not activated, but the focus is placed on the critical production of political positioning, that is, on the claims that are based on the experience of different subjects and groups that do not fit into the binary logic of gender (male or female) and sexuality (heterosexual or homosexual), encompassing experiences that subvert this binary and stable logic.

These readings articulate references from cultural studies and Queer Theory to demarcate a specific understanding of the discussions of gender and sexualities, not based on essential identity experiences and before social reality but understood based on analyzes as the device of sexuality (Foucault, 2005) and gender performativity (Butler, 2003).

For some proposals of social occupational therapy, the reflections and actions with the LGBTI+ population are not supported by the understanding that these individuals and groups demand professional actions because they are considered “vulnerable”. However, by understanding that, by producing experiences that go beyond the norms of gender and sexuality, these individuals and groups go through countless situations of violence and oppression, different forms of social injustice, and numerous neglects of social rights.

Historically, these individuals and groups have, in Brazil, restricted access to basic social rights such as education, health, social assistance, work, as well as the non-recognition of their experiences (Braga et al., 2020).

However, I am not based on the understanding that the LGBTI+ population is vulnerable, since vulnerability, as much as it brings historical, relational, and contextual elements to explain certain situations and positions of individuals and groups, ends up giving greater emphasis to those who are understood. as “vulnerable” than to the processes by which violence and oppression are operated. That is, leading to possible understandings that, at the limit, individuals and groups are “vulnerable” and, in this sense, the agents of violence and oppression.

Furthermore, vulnerability is not a term used by individuals and groups to define themselves, that is, the use of this term to refer to individuals and groups can also be an act of violence. The terms and concepts we use to refer to certain individuals and groups with whom we develop our reflections and actions reflect our technical, ethical, and political positions.

In this way, instead of justifying the reflections and actions of social occupational therapy with the LGBTI+ population by the notion of vulnerability, I bet on the justification that this is a population that, when producing their dissident genders and sexualities, are targets of various forms of violence, oppression, and neglect of social rights, even betting that the redistribution dimensions of recognition and representation help us in this process.

According to data from Grupo Gay da Bahia, 329 people identified as LGBTI+ were victims of violent death in Brazil in 2019. Also, more than half of the murders of LGBTI+ people in the world took place in Brazil (Oliveira & Mott, 2020; Wareham, 2019).

According to data from the National Association of Transvestites and Transsexuals, in 2020, Brazil remained in first place in the ranking of murders of trans people in the world, with 184 reports being reported, a number probably much lower than the reality (Benevides & Nogueira, 2021).

On the topic of political representation, in a survey carried out by the VoteLGBT collective, 90 candidates were identified in the 2020 municipal elections in 17 states and 72 cities across the country. In the 2018 elections, for state deputy, federal deputy, senators, governors, and president, according to data released by the National LGBTI Alliance, 160 LGBTI+ candidates were elected.

However, elections for LGBTI+ candidates are still scarce and, when elected, they suffer daily persecution, violence and, in some cases, they are forced to leave the country, as in the case of former federal deputy Jean Wyllys, or they are murdered, as in the case of former councilor Marielle Franco, among many other persecutions that occurred with LGBTI+ representatives both in the executive and in the legislature.

These data contribute to the deepening of the understanding that individuals and dissident groups of genders and sexualities experience social injustices in their daily lives that refer to the dimensions of redistribution, recognition, and representation, that is, their experiences beyond gender norms and sexuality are placed in unequal places of existence, either in guaranteeing decent access to income, either by not recognizing their existence or by the low executive and legislative representation to guide specific policies that dialogue with their real demands.

Final Considerations

To conclude this text, but not the debate raised here, I reiterate the need for social occupational therapy to continue to produce reflections and practices with the LGBTI+ population, since these are relevant themes for contemporary Brazilian society.

The articulation of these themes with the history of social occupational therapy points to the need to produce strategies that are coherent with the real demands of these populations, expanding life and different ways of living, constitutional guarantees of a democratic society.

Through the reflections carried out here, we can highlight that redistribution, recognition, and representation are dimensions of the idea of social justice that can help social occupational therapy in the process of delimiting the populations in which they produce their practices.

In this sense, I propose that the understanding of redistribution, recognition, and representation can contribute both to densification to the objectives of social occupational therapy and to be domains of reflection and practice for this theoretical-methodological perspective.

I also highlight the need for social occupational therapy to produce theoretical and practical strategies that provide the understanding that individuals and dissident groups of genders and sexualities produce their experiences in an articulated way with other social markers of difference that are essential to foster an understanding more accurate about their different demands. In other words, it is not possible to think and produce actions that do not consider the social markers of race, social class, generation, regionality, religiosity, among others so important to social reality.

I propose to take the focus off a supposed vulnerability that would be located in individuals who can identify as LGBTI+ and understand the subtleties and intensities of the processes of social injustice through which these individuals and groups experience when producing and expressing their genders and sexualities.

• 1
  “Theoretical-methodological perspective” is used in this article, as suggested by Galheigo et al. (2018), that is, as a set of knowledge related to certain philosophical perspectives that express a vision of human beings and society.
• 2
  Currently, the Metuia Network has six active centers, namely: University of São Paulo, Federal University of São Carlos, Federal University of São Paulo, Federal University of Espírito Santo, University of Brasília and the nucleus composed of an articulation between the Federal University of Paraíba and the State University of Health Sciences of Alagoas.
• How to cite: Monzeli, G. A. (2022). Social occupational therapy, social justice, and LGBTI+ population: with whom we produce our reflections and actions? Cadernos Brasileiros de Terapia Ocupacional, 30, e3095. https://doi.org/10.1590/2526-8910.ctoARF234130952

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Edited by

Section editor

Profa. Dra. Patrícia Leme de Oliveira Borba

Publication Dates

• Publication in this collection
  08 June 2022
• Date of issue
  2022

History

• Received
  19 July 2021
• Reviewed
  16 Sept 2021
• Accepted
  26 Oct 2021