Reviewing the historical materialism in occupational therapy: the professional, ethical and political role in the contemporary

Abstract

Occupational therapy in Brazil has been consolidating a diversity of actions in different fields that reflects the engagement of occupational therapists in Brazilian society. At the end of the 1980s, some theoretical formulations around occupational therapy epistemological bases, especially the materialist-historical perspective, contributed to the reflection and review of professional practice, defending professional engagement in social demands. Through a systematic literature review, this text aims to reflect and update on the concepts brought by materialism-historical adding for the discussion of the ways of life and their projection in the methodological field theoretical background of the intervention of occupational therapy. Through an analysis of profession “classic” texts from the 1980's and 1990's decades, that discussed the materialist historical perspective, the arguments presented are related trough their relevance and contemporaneity in theoretical perspective defending a professional practice that is based on professional, ethical and political approaches, responding to the demands and challenges of contemporary society.

Keywords:
Occupational Therapy/Trends; Knowledge; Politics

Resumo

A terapia ocupacional no Brasil vem consolidando uma diversidade de ações nos seus diferentes campos de atuação que reflete o engajamento dos profissionais nas reais e desafiantes demandas da sociedade brasileira. No fim da década de 1980, algumas formulações teóricas em torno das bases epistemológicas da terapia ocupacional, em especial a perspectiva materialista-histórica, contribuíram para a reflexão e a revisão da prática profissional, defendendo o engajamento profissional nas demandas sociais. Por meio de uma revisão assistemática da literatura, este texto objetiva refletir e atualizar acerca dos conceitos trazidos pelo materialismo histórico frente ao campo metodológico de embasamento teórico e intervenção em terapia ocupacional. Por meio de uma análise de textos “clássicos” da profissão, que lançaram a discussão da corrente materialista-histórica nos anos de 1980 e 1990, apresentam-se argumentos acerca da pertinência e atualidade desta linha de pensamento na defesa de uma prática profissional que seja técnica, ética e política, respondendo às demandas e desafios da sociedade contemporânea.

Palavras-chave:
Terapia Ocupacional/Tendências; Epistemologia; Política

1 Introduction

The discussion on historical materialism has been explicit as a key to reading occupational therapy practices in Brazil since the 1980s, constituting a pertinent and current theoretical basis for understanding part of the performance of Brazilian contemporary occupational therapy. Thus, Soares (1987), Francisco (1988), Galheigo (1988), Medeiros (1989), Pinto (1990), and Lopes (1991) were precursors in their academic studies within this reasoning aspect, as they problematized the role of the occupational therapist in society (Lopes, 2004). This movement reflects an important milestone about critical thinking in Brazilian occupational therapy, questioning only its technical and procedural role, often as a “social adapter” (Galheigo, 1997), moving towards a technical-political commitment (Galheigo et al., 2018).

The classic studies of Jussara Mesquita Pinto in 1990 and Berenice Rosa Francisco in 1988 showed the concern in the search for a theoretical foundation as a key to reading the professional practice of the occupational therapist. In the nominal option of “methodological trends”, based on the philosophy for reading the practices performed, the authors are based on positivism, humanism, and historical materialism as references that could contribute to the understanding of occupational therapy practices in Brazil.

Continuing this debate, this text aims to reflect on the theoretical propositions that have already been problematized in other historical moments in Brazilian occupational therapy, with emphasis on historical materialism, as a theoretical and methodological basis for understanding practical actions with the target audience for occupational therapeutic intervention. It starts from the re-reading of such classic studies in the area for the debate about the ethical-political role of the occupational therapist in contemporary times, integrating an updated set of works that have been dedicated to the theme, for example, Galheigo et al. (2018) and Shimouguiri & Costa-Rosa (2017).

2 Notes on Historical Materialism

The historical materialist dialectic can signal several paths of understanding and debate of specific studies in this area. The understanding proposed here, without the intention of deepening the theme, is guided by the methodological conception of historical materialism, conceptualized by Marx and Engels in the “German Ideology”, as worked by occupational therapists, and presented by some commentators of his work, such as Lowy (1991). For the author, the ideological production processes are not made in the individual area but from the social classes, configuring an organic set as “[...] a way of thinking about the world” (Lowy, 1991, p. 95).

Dialectics can be understood as the development and transformation of facts within the relationships between the historical and the reality. Therefore, materialism becomes imperative due to the conception of the social production of existence, that is, from an interpretation of reality, the world, and even human existence based on the historical and social configuration (Frigotto, 2000). In this understanding, the contributions brought by Vazquéz (2011) are great interest in occupational therapy because based on the thinking of Marx and Engels, the emergence of the concept of praxis is highlighted.

For Vazquéz (2011), praxis is understood based on the activity, that is, an act or a set of acts in which an agent (physical, biological, or human) modifies the given raw material (physical body, human being, psychic experience, group, relationship or social institution), resulting in a process of transforming the activity into a product that can be a concept, an instrument, an artistic work or a new social system. The author highlights that the difference between human activity and activity, in general, occurs through the action of individuals when facing the reality, transforming an object, and resulting in an effective and real product (Galheigo, 2012). Thus, praxis is based on the construction of reality based on human activity, through instruments and knowledge that result in a final product, in the materialization of a project (Galheigo, 2012).

In this way, historical materialism sought to construct the explanation about social life through the knowledge plan of the dialectic of the real, that is, in the search for understanding of the different agents running in concrete material life, seeking to reflect and critically analyze reality (Frigotto, 2000). This foundation is based on the questioning of the conditions for the reproduction of material life, on the understanding that the capitalist social structure shapes society into stratified social classes and has its condition of existence in inequality (Marx & Engels, 2001). Thus, for social cohesion, work acts with an organizational centrality in the mechanisms of exploitation (Castel, 2002) and also in the configuration of established social relationships (Alves, 2010).

In this perspective, Gramsci (1966) integrates the historical materialist discussion adding the concepts of hegemony and counter-hegemony. The author reports that the presence of disputed projects in the social arena that tension hegemony is a great social relevance, because, even if they are “defeated” in democratic debates, they can modify the hegemonic pattern. Furthermore, the author points out that hegemonic thinking is minimized when we think of the inseparability between the public and individual relationships. The constitution of each individuality in society goes through its organic relationship with the macrosocial dimension, characterizing the individuals that are not only individuals but also collective. Thus, acquiring individual awareness, which can be mediated by technical processes of those who have the social function of “intellectual”, as defined by Gramsci (1991) as organic intellectuals, is to seek to modify the hegemonic set in which social relationships are involved, contributing to new disputes in society (Gramsci, 1966).

Gramsci (1991) defines political awareness as one of the essential elements for the execution of the technical and scientific role since from this place, the interests of society are organized. Technical action alone does not fail to fulfill the ideological function of the dominant strata, the political attitude can reverse this logic, given by social conscience (Gramsci, 1991).

3 The Occupational Therapist: from a Consensus Employee to a Technical, Ethical and Political Agent

Inspired by this thought, questioning the relationship between technical action and political attitude, from the 1980s, Brazilian occupational therapists promoted reflections that were contextualized by the struggles to expand social rights and the offer of conditions more humanitarian with the people in which the profession already worked, such as people with psychological distress and with disabilities.

Occupational therapists who worked together with the mental health area, health reform and linked to struggles for rights of different population groups began to ask these questions with the same Gramscian theoretical inspiration, questioning the role of technicians in the Institutions (Barros, 1990), and their actions carried out in the name of “social peace”, that is, the maintenance of order (Basaglia & Ongario, 1977). According to these authors, the technician can act for the consolidation of a hegemonic action, around the interests of the dominant classes, or build a counter-hegemonic position, seeking the transformation of the current social order and the debate of new projects in the public arena (Lopes, 2016).

Within the historical materialist approach, overcome the limitations of the individual and qualify the social space as inseparable from professional practice is imperative, seeking to transpose it into the collective action of the population groups that the occupational therapy works. This perspective can collaborate with the publicization of new projects in the political sphere that dispute another social order, contributing to the counter-hegemonic production. Such a process can qualify professional performance so that, initially, it is dedicated to guaranteeing social rights to the populations assisted by occupational therapists.

Lopes (1991) discusses the hegemonic interests that are represented in the occupational therapist’s professional training. For that, he traces a historical contextualization of occupational therapy at the beginning of the 20^th century, emerging in developed countries, such as the USA, England, and Canada, originating from the social demands of the end of the 19^th century, which made the State responsible for the financing of social work in juxtaposition social class conditions. The post-war context together with national reconstruction and the economic losses of developed countries, enhanced a necessary axis of work in the social area, opening space for occupational therapy to work within the logic of re-adaptation and re-habilitation (Lopes, 1991). With the legal consolidation of the profession in those countries in the 1940s and 1950s and the advance of industrial capitalism, which lost important markets with the Second World War, those countries turned to underdeveloped nations, needing support from industrial capital, as in the case of Brazil, investing in the entry of the profession in the country, in areas of interest and “[...] intervention of the Capitalist State in the social sphere” (Lopes, 1991, p. 27).

Faced with the ideological role of the State, the author questions the practical action of occupational therapy in the public context, that is, whether it was not reinforcing the predominant assistentialist view in the area of health in the current context (Lopes, 1991). In this same direction, Soares (1991) addresses the reductionist aspect that occupational therapy has taken, in the assistance perspective aligned with the logic of productivity for the maintenance of the profession in spaces that already had legitimacy. To this end, the author questions about the absorption of techniques from developed countries, showing efficiency over the people assisted by the occupational therapy, not seeking to reflect on the institutional space, much less on the social environment of the individuals involved in the occupational therapeutic practice (Soares, 1991).

As Lopes (1991) argues, the “ultra-specialization” of the profession has become misaligned to global knowledge, incapacitating the critical understanding of the objective of the work of occupational therapeutic action and ignorance of the very role in society, determined by alienating logic that prevented transformation through conscious political action. For this conception, the occupational therapist's action could be endowed with a material and morally oppressive face, characterized by the capitalist way of production (Lopes, 1991).

The issues regarding the professional practice of that period, together with the proposal of a historical materialistic methodological trend, can be questioned based on the Gramscian conception of the role of the organic intellectual. The “crisis of hegemony” occurs when “[...] a given social group, not yet dominant, manages to reach a consensus among the other groups, consigning the social body and giving them the political and cultural direction” (Soares, 1991, p. 37). The definition of the role of the organic intellectual becomes fundamental in directing, organizing, and synthesizing the needs and contradictions within its grouping (Soares, 1991). In this relationship, we can discuss how many occupational therapists can envision acting as organic intellectuals to operate counter-hegemonic actions and new ways of thinking with their target audience, valuing the intrinsic knowledge of that group and seeking to overcome the condition of subordination that the system imposes on them, through technical-professional actions that make up the counter-hegemony (Yazbek, 2014).

It is the defense of professional performance that should be based on the understanding that demand must be addressed dialectically, between the singular and plural need it represents. In this way, technical action necessarily encompasses dialogue with political spheres, in the search for that population's access to established social rights. Such work should not be reduced to an explanation about political militancy (which, in part, is still the case), but the discussion includes this aspect during the professional technical action of the occupational therapist.

4 Resuming the Historical Materialist Conception in Occupational Therapy

Through this rescue of the initial paths of the profession in Brazil, the criticisms of occupational therapists to the referential, models and actions adopted until then in the profession are highlighted, and in their opinions, they needed to be reviewed, pointing out the elaboration of a new paradigm for occupational therapy, in this case, the historical materialist perspective.

This perspective contributed to answer and face questions about professional identity (Galheigo, 1988). This situation strengthened the debate about the directions and models the profession should take, requalifying the humanistic theoretical support until now prevalent (Pinto, 1990).

Francisco (1988) pointed out that the occupational therapist always had the formal purpose of his work to develop the autonomy of the human being. However, the therapeutic action was limited to the maintenance of the social structure, the preservation of alienation and conformism, through institutional actions. According to Guihard (2001), the autonomy sought and the relevant issues from motor acquisitions/treatments should be characterized by the act of making politics because when projected under a singular individual, it exposes historical and social contexts, explaining the orders formally established in the social and public space.

Such inquiries inspired every discussion of the 1980s about the social context and the insufficiency of the health sector to address the demands of the individuals we work with (Barros et al., 1999). Thus, the occupational therapist was encouraged to reflect not only on the individual's physical rehabilitation, which is a topic of great relevance and magnitude but also to mediate actions along with the issues that touch or focus on the social aspect (Barros, 1990). The denial of the reality in which the individual is inserted leaves the occupational therapist closed and imprisoned under a supposed therapeutic vocation that, at times, is characterized as an abstract and distant translation from the real (Barros, 1990).

The historical materialism proposed by Marx considers the human being as socially constructed by his needs to produce life materially, a condition essentially accomplished by the work (Marx, 2011). In this concept, the authors of this aspect define occupational therapy as a practice that is used “[...] primarily with socially hired work to enable people to become citizens” (Pinto, 1990, p. 75).

Thus, from a conceptual perspective, Pinto (1990, p. 77) elaborates a reflection on the technical and political function in the occupational therapeutic process, which, in the attributions of the historical materialist trend, breaks with other orientations regarding the individuality of the therapeutic action. Therefore, these notes question the performance with the individual as if he was decontextualized from society, being necessary a critical posture of the current social organization that “causes, aggravates and chronicles the problem as an individual”.

Then, the practice is conceptualized as part of the social organization, “When working materialist-historically the professional opts for the transforming role, which means working on different lines, in addition to their specific work area and place of work, along with other forces of the community” (Pinto, 1990, p. 77). The transformative and creative character surpasses the abstract and alienating character of occupational therapeutic action, promulgating reductionist models (Soares, 1991). The human being is seen from his capacity to be able to invent his ways of life, although always influenced by the macrosocial determinants, as he has a political field at the base, which supports his ability to create, change and act (Guihard, 2001).

When reflecting on occupational therapy practices, Francisco (1988) approaches the historical materialist perspective as contributing to the occupational therapist acting as an agent of social transformation through “doing”, seeking to raise awareness about the oppression of class society and which must seek “revolutionary forms” (Francisco, 1988, p. 66) for the solution of existing problems. By breaking with the neutral stance towards the individual and his problematic, the historical materialist line discusses the production of knowledge and action with the search for mediations for better conditions for the development of the ways of life of all people in society (Medeiros, 1989; Pinto, 1990).

From the 1980s to the present, this trend started to base practices in different areas, policies, and populations assisted by occupational therapy, especially in those where the work of the occupational therapist was beyond technical applicability, but also in its articulation together with social movements (Oliver et al., 2003; Ribeiro, 2001; Ribeiro & Machado, 2008; Lopes et al., 2014). It is relevant to mention the psychiatric reform, the movement for the defense of rights for people with disabilities, specific rights for children and adolescents, and the struggle and defense for housing (Lopes, 2004).

The actions proposed through this aspect also consolidated important areas of the practice of the occupational therapist, such as mental health, social occupational therapy, and public health through the Unified Health Care System (SUS) (Santos, 2016).

Seeking to list some examples of professional practice in contemporary times, showing the dialectical articulation for understanding the demand, we present three situations. The proposed examples are not intended to show a direct relationship with the authors who outlined the historical discussion about the historical materialist trend but problematize contemporary demands that demonstrate the need for dialectical approaches between the individual and the collective individual, in the challenges experienced by Brazilian society.

The first situation is the monitoring of adolescent authors of an infraction who wish to resume their formal education and unable to obtain a place in public school. This circumstance leads to a dialogue with school managers to ensure this vacancy, and when this negotiation is not effective in favor of the adolescent’s right to access education, other intersectoral instances and networks must be activated - such as the Guardianship Council and the Child and Youth Court. As this is a very recurrent situation in adolescents who have committed an infraction, it is necessary that the occupational therapist, together with other social actors, can debate the issue of access to school, sensitizing managers, teachers, and the community to welcoming this audience (Borba, 2012).

The second example encompasses the public health area, from a community perspective, in interdisciplinary teams in the Family Health Strategy, focusing specifically on the population with physical disabilities. Primary health care can be understood as a place where they can develop, monitor, and guide issues about access to public facilities and policies focused on the population with disabilities, and without this guaranteed assistance, they do not have the minimum elements for participation in social life. Thus, the initial work of the occupational therapist is the search for access to services (Oliver et al., 2016).

The third example is from the propositions of Psychosocial Rehabilitation (Saraceno, 1998) in the mental health area, aiming at building and strengthening social networks to support individuals with psychological distress. It starts from the understanding that every social individual, regardless of their physical, psychological, and/or social condition, is an individual of rights, including the possibility of access to work and the construction of their social place also in this central dimension. Intervention in occupational therapy should seek to experience real citizenship (Morato & Lussi, 2018).

However, the expansion of the profession to different areas and contexts, added to the technological advancement and the specificities of each area, meant that the articulation between technical and political was not considered as a guiding element for the practice in the different spaces. One factor that can explain this ideological barrier, as stated by Guihard (2001), is linked to institutional organizations that, with exceptions, operate mostly by normative, concrete, and objective values, imposed by the financial economy that governs such institutions.

The development of the profession in Brazil has a strong insertion in public state institutions. For the capitalist state, although the bourgeoisie is dominant over the social policies, they are the way that disadvantaged population groups access social goods (Hofling, 2001). The occupational therapist, direct or indirect technician of the State for the implementation of social policies, should act to mediate processes that favor the social insertion/reintegration of the individuals and groups he works with (Malfitano, 2016).

Situating ourselves in line with the current debates about the marked need for advancing questions and developing knowledge and methodologies for working in occupational therapy, it is essential to reach the context of broad social relationships, in which the capitalist society is configured, more specifically in the context in which the State conducts the social issue, in the target of its political intervention (Bezerra & Trindade, 2013). Thus, occupational therapy still needs to expand its representativeness in different areas of action, ensuring greater political engagement, offering material conditions for professional practice to develop the political role through professional activities, “[...] capable of deciphering the reality and build creative work proposals that are capable of preserving and effecting rights, based on emerging demands in daily life” (Cavalcante et al., 2008, p. 32).

Therefore, this is a current and necessary debate for a critical analysis of the social role of the occupational therapist. Rescuing the discussion about the historical materialist trend of the profession, with the risk of being classified as ancient or utopian¹, aims to promote the reflection of the occupational therapist in his role of technical-political and ethical articulator performed through his professional activities.

5 Final Considerations

The discussion held by occupational therapists in the 1980s and 1990s about a theoretical and methodological basis for the profession's practical actions was fundamental in Brazil to open new work areas and to question the role of occupational therapists in their institutional contexts. Within the technical action, the discussion about the historical materialist trend remains current and important for the social projection of the profession because, when we align the individual and his social context, we can intervene in instances that value the social, community, and territorial aspects, seeking to create tensions that act in a counter-hegemonic way, understanding the social inequalities that the individuals and groups assisted by occupational therapists experience.

It is essential to reflect on technical, ethical, and political action for occupational therapy. As presented here, there is no novelty in the use of a historical materialist conceptual reading, nor closed responses. However, we defend that it is a solid and current theoretical reference with contributions to the positioning of occupational therapy in contemporary times and with relevant possibilities dialogues with other theories.

• 1
  At the international level, other perspectives have also been developed, seeking to promote the return to the predominantly political factor of the occupational therapist, with the denomination of a critical perspective in occupational therapy. It is about replacing the social context as a relevant space for action, in a questioning about the insufficiency of a technical and functionalist dimension of the actions carried out, breaking with methodologies that still encompass fragmented conceptions, in which the social context becomes tangible for investigations and interventions (Córdova, 2012; Galheigo, 2012; Algado, 2015; Morán & Ulloa, 2016; Jara et al., 2016). Other reflections on historical materialism and the need to approach other social markers to understand social life have been carried out through the “Social Markers of Difference” (Zamboni, 2014; Silva, 2014), results of the symbolic production of culturally constructed identities and their implicated power relationships, structuring class society from the exclusion or not of difference. Such theories, although pertinent and current, will not be addressed here, planning their specific discussion in future studies.
• How to cite: Barreiro, R. G., Borba, P. L. O., & Malfitano, A. P. S. (2020). Reviewing the historical materialism in occupational therapy: the professional, ethical and political role in the contemporary. Cadernos Brasileiros de Terapia Ocupacional. Ahead of Print. https://doi.org/10.4322/2526-8910.ctoRE1950

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Publication Dates

• Publication in this collection
  16 Oct 2020
• Date of issue
  Oct-Dec 2020

History

• Received
  31 May 2019
• Reviewed
  24 July 2019
• Accepted
  16 Aug 2019