Controversies and debates around occupational therapy: an analysis of bibliographic productions in South America (2010-2018)

Abstract

Considering that occupational therapy practices act in spaces of daily life where there is a plurality of existences, it is imperative to build heterogeneous practices from the historical-social contexts that produce them. In South America, debates have emerged that challenge the prevailing north-Eurocentric and Anglocentric discourse due to its claim to universality, objectivity, and neutrality, bringing with its positivist scientific reasoning and dualistic logic. This article aims to present seven debates identified in some of the written productions of Brazil, Argentina, Colombia, and Chile between 2010-2018, both in older occupational therapy journals in the region and in books of collective authorships that discuss occupational therapy. A mapping of controversies is carried out through a documentary review and analysis of 133 journal articles and 53 book chapters. The issues they discuss are related to occupational therapy practices around the social; communities and territories; human rights; knowledge and knowledge production; the critical; gender and feminisms; and Latin America and the global south. It is possible to conclude that each debate condenses different historical moments, from which plural and unfinished forms of occupational therapy are produced that make visible controversial issues that have given them richness and heterogeneity, allowing to stress the asymmetries of power and give political relevance to the practices that are produced from South America for the local-global context.

Keywords:  Occupational Therapy; Knowledge; Latin America

Resumen

Considerando que las prácticas de terapia ocupacional actúan en espacios de la vida cotidiana donde existe una pluralidad de existencias es un imperativo construir prácticas heterogéneas a partir de los contextos históricos y sociales que las producen. En América del Sur, han emergido debates que ponen en controversia el discurso noreurocéntrico y anglocéntrico predominante debido a su pretensión de universalidad, objetividad y neutralidad, lo que trae consigo un razonamiento científico positivista y una lógica dualista. El objetivo de este artículo es presentar siete debates identificados en algunas de las producciones escritas de Brasil, Argentina, Colombia y Chile entre los años 2010-2018, tanto en revistas de terapia ocupacional de mayor antigüedad en la región como en libros de autorías colectivas que discuten sobre terapia ocupacional. Se realiza un mapeo de controversias a través de una revisión y análisis documental de 133 artículos de revistas y 53 capítulos de libros. Los asuntos que discuten se relacionan con las prácticas de terapia ocupacional en torno a lo social; las comunidades y territorios; los derechos humanos; los saberes y la producción de conocimientos; lo crítico; género y feminismos y; América Latina y el sur global. Es posible concluir que cada debate condensa diferentes momentos históricos, desde los cuales se producen formas plurales e inacabadas de hacer terapia ocupacional, que visibilizan asuntos controversiales que le han dado riqueza y heterogeneidad. Esto ha permitido tensionar las asimetrías de poder y dar relevancia política a las prácticas que se producen desde América del Sur para el contexto local-global.

Palabras clave:  Terapia Ocupacional; Conocimiento; América Latina

Resumo

Considerando que as práticas de terapia ocupacional atuam em espaços da vida cotidiana onde há uma pluralidade de existências, é imperativo construir práticas heterogêneas a partir dos contextos sociohistóricos que as produzem. Na América do Sul, surgiram debates que desafiam o discurso predominante norte-eurocêntrico e anglocêntrico em sua pretensão de universalidade, objetividade e neutralidade, trazendo consigo o raciocínio científico positivista e a lógica dualista. O objetivo deste artigo é apresentar sete debates identificados em algumas das produções escritas do Brasil, Argentina, Colômbia e Chile, entre os anos 2010-2018, tanto em periódicos de terapia ocupacional mais antigos da região quanto em livros de autoria coletiva, sobre terapia ocupacional. Foi realizado um mapeamento das controvérsias por meio de revisão documental e análises de 133 artigos de periódicos e 53 capítulos de livros. As questões que discutem estão relacionadas às práticas da terapia ocupacional em torno do social; comunidades e territórios; os direitos humanos; conhecimento e produção de conhecimento; o crítico; gênero e feminismos; e América Latina e o sul global. É possível concluir que cada debate condensa diferentes momentos históricos, a partir dos quais se produzem formas plurais e inacabadas de fazer terapia ocupacional, que visibilizam questões controvérsias que lhes deram riqueza e heterogeneidade, permitindo tensionar as assimetrias de poder e dar relevância política às práticas que são produzidas desde a América do Sul para o contexto local-global.

Palavras-chave: Terapia Ocupacional; Conhecimento; América Latina

Context¹

The XV World Congress of Occupational Therapists, held in Chile in 2010, gave rise to a multiplicity of debates at a regional and intercontinental level that showed several controversial subjects already discussed in South America. Among the controversial issues, the criticism of the predominant Eurocentric and Anglocentric discourses anchored in positivist logics of modern science stands out (Díaz-Leiva & Malfitano, 2021), whose pretension is to generate uniformity, universality, objectivity, and neutrality. This has been expressed especially in paradigms of a functional medical (Trujillo Rojas, 2000; Meyer, 2009; Barker, 2005) nature that assume a series of excluding and contradictory binarisms (Ramugondo & Kronenberg, 2015) in which other perspectives proposed plural forms of occupational therapy of a civic-political nature (Oliver, 1990; Barros, 1991; Lopes, 1999; Guajardo & Zurita, 1994; Malfitano, 2005; Paganizzi, 2005; Paganizzi et al., 2007; Kronenberg et al., 2007; Guajardo & Algado, 2010).

After this event in South America — 59 years after the first formal meeting of the World Federation of Occupational Therapists held in England in 1951 (Zango, 2018), there are a series of debates of historical and social contexts that produce situated practices and that recognize the heterogeneity in the region of Brazil, Argentina, Colombia, and Chile in the production in occupational therapy journals and books of collective authorship. These places and spaces of situated production constitute “[...] a spatial dimension, in which all the flows, forces and interests of the local processes converge” (Sánchez, 2013, p. 104).

Many of these debates address controversial issues that have been circulating for several decades. For example, in Argentina, in the 1960s and 1970s, there was a response with “a movement to question education” (Nabergoi & Botinelli, 2016, p. 65). The same thing happened in Brazil where the final years of the 1970s manifests new trends: “It must be emphasized that the historical-social scenario, in which Brazilian Occupational Therapy is produced in this period, is characterized by the increasing concentration of wealth and social inequality” (Galheigo & Oliver, 2016, p. 70). In Colombia, it is established that the historical data derived from the armed conflicts demand a rupture with the biomedical approaches “we left the offices more than 20 years ago and we started to work with life and the situations of the citizens, those that came from the sorrows of life, the pain of wars” (García, 2016, p. 82). In the case of Chile, a similar situation occurs because of the military dictatorship “Particularly in the context of the military dictatorship that makes professional practices and conceptualizations emerge that question knowledge and the disciplinary method (the ahistoricism-individualism)” (Guajardo, 2016b, p. 77).

In this scenario, it is important to map debates and controversies between 2010-2018 to contribute to showing the state of the discussion in South America. For this, seven debates were considered that allowed enriching and giving greater heterogeneity to occupational therapy practices, which tensions the asymmetries of power and political relevance to the practices that are produced from South America to a local-global context.

The Relevance of the Debates and Controversies

Debates are spaces for the intersection of positions that, more than a discussion of concepts or categories, discuss certain practices that leave traces over time in various media, such as journals and academic books (Certeau, 1996). They are within the borders of relevant knowledge (Santos, 2018), respond to the interests of certain groups (Latour, 2008), condense a certain historical time (Segato, 2015; Mignolo, 2003, 2007), and not only fulfill the task of transmitting information about certain topics but rather involve more complex processes of identification and appropriation of the meaning of the past and the present (Jelin, 2002). In these debates, controversial issues that are understood as concurrences of dissenting voices become visible. The latter are organized according to their principles and are the result of the delineation of different groups, in which some spokespersons speak in favor of their existence (Latour, 2008). Controversies are an assemblage of practices, experiences, similar ideas, and contradictory ideas that become opportunities to establish agreements. In the debates, the actors question what was taken for granted and make it suddenly prominent, debatable, and discussed (Venturini, 2009), which generates “[...] a field of know-how deeply rooted in each of the local settings” (Testa et al., 2016, p. 1) that allows the development of new perspectives regarding their actions and practices.

Therefore, the debates bring to the fore old and new dilemmatic knots and are often crossed, inevitably, by the epistemological colonialism (Rivera Cusicanqui, 1984, 2010; Quijano, 2000; Paredes, 2008; Cabnal, 2010) that survives in many disciplines. This matrix inscribes differential power relations in subjectivities and bodies that only allow the production of certain knowledge and practices as a result of processes of domination. In this sense, controversies can account for convergent and divergent issues; however, they are also an opportunity to make visible the construction of collective existence.

Methodological Procedures

The research was part of a qualitative methodological approach with a focus on social discourse analysis (Cottet, 2006). Its central interest is the objectification of a subject as a collective and its knowledge as an opinion, as “a structure of meaning that establishes positions, a set of places in which each place is concerning the rest of the set of places” (Cottet, 2006, p. 199).

The selection of the debates arises from the interest in knowing the state of the question in occupational therapy in South America during two unprecedented events: the XV World Congress of Occupational Therapists, held in 2010 in Chile, with the theme “Occupation from Latin America” and the XVII World Congress of Occupational Therapists of WFOT (World Federation of Occupational Therapists), held in the African continent, “Connecting with diversity: a position to impact”, in 2018. In addition, the possible number of subjects for analysis was also considered, which was verified in the stipulated period from 2010 to 2018.

From this, seven provisional debates were chosen that indicated the development of the discussion from the global south, as well as the diversity of the practices of different occupational therapy groups. In this way, the search is made from a perspective of understanding reality (Bourdieu, 1996) that could contribute to many understandings about the profession. In this way, we chose the debates around the: social; communities and territories; human rights; knowledge and the production of knowledge; the critical; gender and feminisms; and Latin America and the global south. Afterward, the search of the bibliographical references confirmed the presence of the seven subjects just named in the literature of the area.

To carry out the mapping, a review and documentary analysis process was carried out (Valles, 1999) of collectively authored journals and books in Brazil, Argentina, Colombia, and Chile. The journals were chosen for concentrating the reference productions for their countries and the continent. The books of collective authorship were chosen because they represent the articulation of researchers and/or professionals around a topic and may contain more debates involved. Brazil, Argentina, Colombia, and Chile were chosen for concentrating active participation in the debates within the South American region, for having the oldest undergraduate programs in the continent, and for having a greater number of occupational therapists. For these reasons, there is a greater academic and professional institutionalization in the region, resulting in more publications and references for the profession, in the format of academic journals and books.

The selection of the material was carried out in four stages:

1. ¹

   Selection of books and journals according to the following inclusion criteria: a) the oldest occupational therapy journals in Brazil, Argentina, Colombia, and Chile with open online access; b) occupational therapy books published between 2010-2018 in Brazil, Argentina, Colombia, and Chile by collective authors (compilations that bring together authors from the same country or Latin America); c) articles and chapters of books in Spanish or Portuguese.

2. ²

   Tracking of information units in selected books and journals using keywords associated with each debate: social, psychosocial, biopsychosocial; communities, territories; human rights, citizenship; knowledge production (about the object of the study: activity, occupation, everyday life); the critic, problematization; gender, feminisms; and Latin America, global south.

3. ³

   Reading of abstracts for selection and disposal of information units considering the following exclusion criteria: a) articles and book chapters that do not discuss any of the 7 provisional debates and do not mention a discussion, debate, proposal, or controversy in occupational therapy; b) articles and book chapters that do not make proposals that transcend a specific field or propose actions for the disciplinary field in general, even when the context of their practice is a particular area; c) the origin of at least one of its authors is not from the four countries investigated.

4. ⁴

   Reading of complete articles for selection and disposal of final information units.

Regarding the information analysis techniques, an analysis matrix was built (see Table1) with four axes of analysis consistent with the specific objectives of the research. Each axis of analysis contemplates different dimensions in which the material is interrogated “through implicit questions” (Ruiz Olabuénaga & Ispizua, 1989, p. 120) that allow the respective fragments or citations to be codified, grouped, and organized in a database.

Table 1
Analysis matrix.

Specific objectives	Axes	Dimensions	Axis Guiding Questions
To characterize the main debates and controversial issues that have occurred in articles published in five occupational therapy journals from Argentina, Brazil, Colombia, and Chile and in eight collectively authored occupational therapy books.	Characterization of the debates	- Reasons or events that activate the debates.	- Why does it arise?
		- Issues under discussion.	- What does it discuss?
		- Main controversies - Propositions	- What does it propose?
To describe the places and spaces of action located from where the debates are raised, and their main spokespersons and actors involved.	Positions	- Article position.	- What groups do they belong to institutions, organizations, study groups, and others?
		- Places, media, and actions where the topic is discussed (mediations)	- Where and how are or were these controversies discussed?
To describe the continuities and discontinuities of the debates concerning previous periods.	Continuities and discontinuities	- Acknowledgment of previous debates.	- Are the debates before 2010 recognized?
		- No recognition of previous debates	- Are previous discussions omitted?
To describe the convergences and divergences between the debates proposed by occupational therapy groups	Convergences and divergences	- The usual	- What common aspects do the explanations (practices and theories) have in which the controversies are argued?
		- The different	- What is different?

We selected 186 information units —133 correspond to journal articles and 53 to book chapters—. Regarding each debate, 22 correspond to the debate on the social area; 24 on communities and territories; 20 on human rights; 49 on knowledge production; 27 on the critical; 23 on gender and feminisms, and 21 on Latin America and the global south. The central aspects of each debate are presented below.

Results

Five journals (Table 2) and eight occupational therapy books (Table 3) were selected.

Table 2
Selected journals.

Nº	Current name of the Journal	Origin	Year of creation
1	Revista de Ocupación Humana [Human Occupation Journal]	Colombia	1984
2	Brazilian Journal of Occupational Therapy (previously Cadernos de Terapia Ocupacional da UFSCar [UFSCar Occupational Therapy Journal)	Brazil	1990
3	Revista de Terapia Ocupacional da USP [Journal of Occupational Therapy of University of São Paulo]	Brazil	1990
4	Revista Chilena de Terapia Ocupacional [Chile Occupational Therapy Journal]	Chile	2001
5	Revista Argentina de Terapia Ocupacional [Argentina Occupational Therapy Journal]	Argentina	2015

Table 3
Selected books.

Nº	Reference
1	Trujillo, A., Sanabria, L., Carrizosa L., Parra E., Rubio S., & Uribe J. (2011). Ocupación: sentido, realización y libertad, diálogos ocupacionales en torno al sujeto, la sociedad y el medio ambiente [Occupation: meaning, realization and freedom, occupational dialogues around the subject, society and the environment]. Bogotá: Universidad Nacional de Colombia.
2	Oyarzún, N., Palacios, M., & Zolezzi, R. (2012).Hacia las prácticas comunitarias de Terapia Ocupacional: Desde una Mirada Socio-histórica en Chile [Towards occupational therapy community practices: From a socio-historical perspective in Chile]. Ed. Académica Española.
3	Santos, V., & Donatti, A. (2014). Cuestiones contemporáneas de terapia ocupacional en América del Sur [Contemporary issues in occupational therapy in South America]. Curitiba: Editora CRV.
4	Navarrete, E., Cantero, P., Guajardo, A., Sepúlveda, R., & Moruno, P. (2015). Terapia Ocupacional y Exclusión Social: Hacia una praxis basada en los derechos humanos [Occupational Therapy and Social Exclusion: Towards a praxis based on human rights]. Charleston: Ed. Segismundo.
5	Algado, S.S., Guajardo Córdoba, A., Oliver, F.C., Galheigo, S.M., & García-Ruiz, S (2016). Terapias Ocupacionales desde el sur. Derechos humanos, ciudadanía y participación [Occupational Therapy Without Borders: Human rights, citizienship and participation]. Santiago de Chile: Editorial USACH.
6	Lopes, R. E., & Malfitano, A. P. S. (2016). Terapia ocupacional social: Desenhos teóricos e contornos práticos [Social occupational therapy: theoretical and practical designs]. Sao Carlos: EdUFSCar.
7	Rojas, C. (Ed.). (2016). Ocupación humana: diversos contextos, diversas miradas [Human occupation: different contexts, different perspectives]. Bogotá: Universidad Nacional de Colombia.
8	Oudshoorn, S. (Ed) (2016). Las otras cornisas de la terapia ocupacional [The other ledges of occupational therapy]. Argentina: Editorial MB.

• Source:Trujillo et al. (2011), Oyarzún et al. (2012), Santos & Donatti (2014), Navarrete et al. (2015), Algado et al. (2016), Lopes & Malfitano (2016), Rojas (2016) and Oudshoorn (2016).

On the practices of occupational therapies around social issues

In several articles, the term social acts as a polysemic, generic, or multi-use concept that ends up becoming a trivialized universal. It is commonly used as an adjective, a factor, a condition, a determinant, a field, an issue, a dimension, an approach, a model, a paradigm, or a perspective. However, there are groups in Brazil and Argentina that problematize and conceive “the social” as a field of knowledge and practice. Also, they incorporate this term as an adjective or differentiating quality: social occupational therapy, and psychosocial occupational therapy. The first is associated with social occupational therapy in Brazil, which since the late 1970s has been questioning professional actions aimed at the adaptation of the subjects without considering the social and political contexts as producers of inequalities and vulnerability of the population, an issue that worsened with the neoliberal avalanche of the 1990s (Lopes, 2016).

Defending social occupational therapy as a sub-area of occupational therapy means saying that it has its specialty, with actions aimed at the social inclusion of people whose central issue is the socioeconomic factors that prevent and/or hinder their social participation and inclusion. The work requires the professional to have their care technologies aimed at the social dimension of life, in a predominant dialogue with the human and social sciences, emphasizing that the contributions coming from the field of health are insufficient, if not inadequate, for the constitution of their theoretical framework- methodological (Malfitano, 2016, p. 124).

The main controversy occurs with the dominant medicalizing and ahistorical discourse that does not recognize the importance of the social, institutional, and political demands that different groups of occupational therapy face, especially due to the social movements that occurred between 1970-80. Together, the potential of occupational therapy to work beyond the field of health is defended, with specificity in the social, which can be situated in social assistance, education, culture, and justice, among other sectors.

The second group is related to psychosocial occupational therapy, influenced by the debates set up by Franco Basaglia's international movement for psychiatric reform, which began in 1960. It should be noted that the exchanges of experiences developed by occupational therapists in Brazil² within the framework of Psychosocial rehabilitation are relevant for the deconstruction of the dominant medical-biologist conception in occupational therapy and the mental hospital conception of the traditional institutional provision (Paganizzi, 2014). These new perspectives install strong controversies regarding the need to introduce the social context and work with the community as part of professional actions in mental health beyond the institutional walls.

Following the approaches of social occupational therapy and psychosocial occupational therapy, in countries like Argentina, Chile, and Colombia, since the 1980s, the discussion also occurs in some groups from the organization of new care models in the field of mental health, community psychiatry, psychosocial rehabilitation, and community-based rehabilitation linked to primary health care policies. In these new scenarios, an ontological displacement is advocated that moves from the subject as an abnormality (Goffman, 1998; Foucault & Marchetti, 2001) to the subject as a historical-social production that is based on the social issue that affects the region and produces precariousness of life, unemployment, the fragility of social ties, violence and denial of rights that prevent participation. “The social” ceases to be a “factor” or a “component of the environment” and moves towards an understanding that politicizes its definition. In this way, the words 'citizenship', 'culture', 'networks', and 'rights' become central to the expansion of theoretical references (Galheigo, 2016) and the defense of the work of the occupational therapists with other population groups, outside the health-disease axis (Lopes & Malfitano, 2016).

In summary, the most decisive thing is that it reveals the importance of discussing the professional role in the concert of a capitalist society (Bezerra, 2011), an issue that is controversial given the founding mandate of an episteme based on methodological, ahistorical individualism that locates the problem in a sick subject (Guajardo Córdoba, 2017). This debate enables to establish an understanding of the social as a fundamental part of the problem, that is, the problems that occupational therapy addresses cannot be separated from their historical and social context, both for actions in the field of health and outside of it, which does not imply a single foundation or methodological theoretical body.

On occupational therapy practices around communities and territories

Similar to the debate on the social, the questioning of positivist and medical-functional logic is present transversally in the reviewed texts on communities and territories. The imprint of that professional education to the mandate of biomedicine and the performance of functions restricted to the field of rehabilitation without a subject and a context is cardinal to think about and assume other practices and positions. Professional education focused on “[...] diagnosing, assisting, rehabilitating and deciding actions on the lives of others, which uses the strategy of knowledge to identify what is missing” is questioned (Cella & Polinelli, 2017, p. 37). In a certain way, education focused on notions such as occupational dysfunction, occupational adaptation, and occupational performance, among others, focused primarily on the task of rehabilitating to readapt subjects to their “environment”, generates a series of controversies.

So, to comply with the community intervention and promote inclusion, people must be integrated or re-adapted, we must at least ask we are working for whom. What interest is there at the base of that intervention? Thus, making visible the social conflict that is generated and understanding why some communities resist intervention (Palacios Tolvett, 2017, p. 86).

Although at the end of 1960, community practices are reduced due to the political scenario of that time and/or its scarce systematization, political, social, and economic changes make it necessary to link social reality with professional practices. The latter are constituting at the same time spaces of resistance to the profession before the biologist logic in health and the problems derived from the capitalist society (Bianchi, 2018). This leads to stressing the isolation and confinement of certain social groups, giving rise to projects that favor exchange and articulation in territories and communities beyond institutional spaces (Oliver et al., 2016; Yujnovsky, 2016). The idea of community and territory acquires centrality in the discussions, not because of a mere terminological matter, but because of its ontological, epistemological, methodological, and ethical implications, alluding to a position that contributes to the emancipation of communities (Cella & Polinelli, 2017).

Therefore, different theoretical-methodological approaches arise when considering historical moments and the different theoretical references are incorporated (Vinzón, 2018; Bianchi, 2018; Cella & Polinelli, 2017; Palacios Tolvett, 2017; Oyarzún et al., 2012; Pino & Ceballos, 2015). Military dictatorships and the imposition of neoliberal public policies are among the historical moments that have a profound impact and leave behind community work as a path for participation, emancipation, and popular power (Brieger, 2002). These aspects are the axes of a Social State, where population work, self-management, and popular education enabled the communities to take a leading role and their demands for a dignified life (Recabarren Hernández, 2016). In Chile, for example, many of the community actions become clandestine work, motivated by conscience and political militancy rather than a technical matter and even in the university curriculum community work is made invisible as a field of knowledge and practices (Oyarzún et al., 2012).

Regarding theoretical-methodological approaches, some occupational therapy groups opt for work in territories as the place where identity, the foundation of work, place of residence, material and spiritual exchanges, and the exercise of life are combined (Bianchi, 2018). In this sense, it is crucial to aim at the development of political, epistemic, and professional strategies that can contribute to the local development of communities in the face of processes of economic, political, and cultural domination (Correia, 2018). In summary, this debate shows the need to assume a controversial position against the instrumental and medicalizing logic that sees community work as a new setting stripped of its political character (Palacios Tolvett, 2017).

On the practices of occupational therapy around human rights

This debate began to be discussed in the region in the 1970s together with the debate on the social and on communities and territories. It acts as a key mediator to produce critical and transformative practices in South American occupational therapies that are in the four countries in this research. It is a complex debate that takes different directions depending on the contexts of practice and the theoretical references that are assumed about rights.

The military dictatorships and the militarization processes that have occurred in the region since 1950 are events highlighted by this debate (Briglia et al., 2018). They produce a significant impact and crisis in various Latin American countries due to the implementation of State terrorism as the main violation of human rights, added to the proliferation of neoliberalism that defends the corporate interests of capital, at the cost of violating and denying human rights. These different episodes in the recent history of Latin America also impact professional fields, especially universities, public institutions, and social organizations. The installation of authoritarian and freedom-denying logic directly affects certain groups of occupational therapists who assume a commitment to defend human rights and who experience repression, exoneration, exile, and disappearance (Briglia et al., 2018). This is how dismissals or removal in universities and institutions, closure of programs, dismissal of positions, and marginalization and silencing of the occupational therapy device are described (Herrera Sandoval & Valderrama Nuñez, 2013). Simultaneously, the occupational therapy groups committed to the restitution, defense, and affirmation of human and social rights inject into their practices a political ethical component that broadens their field of action towards the care of victims of political repression, population work, and popular education in health (Guajardo Córdoba, 2017).

The last military dictatorship in Argentina (1976-1983) left horrific and devastating consequences in our country. What happened in Occupational Therapy during that period? How did state terrorism impact the students and colleagues? How does what happened to affect us today? These are some of the questions that prompted us to carry out this work (Briglia et al., 2018, p. 75).

Between 1960 and 2000, South America is highlighted by major political and social changes (Navarrete et al., 2015) along with the strengthening of important democratic movements in defense of political, civil, and social rights (Fernández & García, 2014, p. 168). Some examples are the anti-asylum struggle movement (1970), the independent life movement (1960-70 years), the World Action Program for People with Disability (1981), the introduction of Community-Based Rehabilitation (RBC) (the 1980s), Uniform Norms on equal opportunities for people with disabilities (the 1993) and the promulgation of the International Convention on Human Rights for People with Disabilities (the 2008), just to mention the most emblematic ones.

This debate reinstates other ways of understanding occupational therapy practices as a political practice (Duarte Cuervo et al., 2017; Recabarren Hernández, 2016; Nabergoi & Botinelli, 2016; Castro et al., 2016; Algado et al., 2016; Galheigo, 2016; Lopes et al., 2015; Guajardo Córdoba & Galheigo, 2015; Lopes, 2013) which implies overcoming the treatment-patient relationship for that of the social-citizen articulator. Also, it requires revealing the institutional, state, and structural violence that violates the rights of different minority groups, which implies recognizing the political role of occupational therapy in contexts of vulnerability and the role of the professional as a “political subject” (García, 2016, p. 85).

On the practices of occupational therapies around knowledge and the production of knowledge

The discussion about the production of knowledge in occupational therapy has been present since the founding moment of the profession or discipline (Ospina, 2004). The Anglo-Saxon hegemony around the production of knowledge is the most controversial issue that stands out. The relationship between dependency and tutelage that exists concerning the knowledge produced in the global north is questioned and a greater role in the production, negotiation, and definition of what could be understood as occupational therapy is urged “there is an Anglo-Saxon hegemony in the definitions of occupation and little knowledge and visibility of the knowledge that emerges in the work of local Occupational Therapy (OT)” (Caro-Vines, 2018, p. 55).

Another controversial subject is the definition of the fundamentals of occupational therapy (Bezerra & Trindade, 2014). It is possible to say that there is a kind of utopia for establishing the principles or foundations that would give formality and validity to the profession, an issue that is disputed and that has become the leitmotiv of occupational therapy: a search for bringing a foundation of universal explanation for the different fields of action of occupational therapy, which makes existing productions invisible.

The difficulty in establishing an understanding and definition of Occupational Therapy arises from the incapacity that occupational therapists have shown when raising a satisfactory ontological project of the discipline. Given this scenario, it is inevitable not to ask the following: what is the occupation? This supposed object of study is submerged in a deep nebula from which it can hardly escape if there is not an existential questioning exercise, that is, wondering what the meaning of occupation and taking care would be” (Olivares et al., 2015, p. 126).

It is a paradoxical matter since for decades these questions have been a cause for concern and have ceased to be a nebula thanks to the sustained work of various study groups, undergraduate and postgraduate training programs, thematic networks, societies, groups, and research centers, especially in Brazil, Argentina, Colombia, and Chile.

Regarding the object of study of occupational therapy, some studies indicate that there is no convergence. On the contrary, it is a controversial issue, since different central categories for the profession are validated such as activity, occupation, daily life, doing, and action (Galheigo et al., 2018; Rojas, 2016; Salles & Matsukura, 2016; Lima et al., 2011, 2013; Trujillo et al., 2011), that is, there is no a single object of study and/or intervention. The terminology used depends on what is defined in each production context, which in turn prescribes certain practices. What is most emphasized is that the different definitions, conceptions, categories, and practices account for a constitutive multiplicity of the field.

Through the readings carried out, it can be observed that the concept of activity is an unfinished construction, located in a historical, territorial, and cultural context that, due to its importance, sees determining paths for the profession and for the action of two occupational therapists. As stated by Barros et al. (2002, p. 102), the concept of activity in OT is a construct, a concept “[...] initial; universal because it is trans-situational, which has different meanings in each particular situation and only gains meaning in the context of exchange and the practices in which it is carried out (Lima et al., 2013, p. 252).

It should be noted that the occupation category is more deeply rooted in Chile and Colombia (Olivares et al., 2015; Trujillo et al., 2011) due to the influence of the framework of the American Association of Occupational Therapy and its models of occupational therapy: the model of human occupation, and the Canadian Model of Occupational Performance Measure, among others. In the case of Brazil, the everyday life category [originally: cotidiano] has a strong presence, being a central construct for many groups (Galheigo et al., 2018; Salles & Matsukura, 2015), which guides the theory and practice of various occupational therapists based on a sociopolitical and theoretical-conceptual contextualization that points towards emancipatory practices (Galheigo et al., 2018). In the case of Argentina, the activity category has an important presence (Paganizzi, 2014), however, in different countries, these categories coexist, which prevents generalizing or universalizing its scope, understanding, and use.

Another important debate that has aroused controversy refers to the Occupational Science, which has been developing different receptions within the profession in Latin America (Morrison et al., 2016). On the one hand, there is a favorable assessment as an academic and scientific discipline, due to the contributions it could make to the foundation of the profession (Araújo et al., 2011, 2018). On the other hand, it is considered unnecessary for various reasons: its discourse makes invisible the scientific practices that other groups had been doing for several decades under other conceptualizations more rooted in the region; it installs a duality between doing and knowing or between practice and theory; it establishes a new configuration of roles between occupational therapists and occupational scientists; and it establishes the discourse of science and the scientific method as the only way of legitimation (Pérez Acevedo, 2016; Guajardo, 2016a). It should be noted that within it, the Science of Occupation is debating about the individualistic accent, both in occupational therapy and in English-speaking occupational science, conceptual fragility, and the need to overcome reductionist dichotomies, broadening the discussion towards the sociopolitical dimension of occupations considering the various existing models (Magalhães, 2013).

On the practices of occupational therapy around the ‘critical’

‘Critical’ has different meanings. On the one hand, the critical is conceived as erudition or discernment linked to the study of texts, authors, and ideas, whose purpose is to keep updated the information around a topic, for example, in systematic reviews of literature. In addition, the critical is understood as an ability to reflect on the world, a knowledge that questions the relationships of subordination and domination through a critical reflection of daily life (Galheigo, 2016; Guajardo, 2014a, 2016b). For this reason, it is assumed as a position (historical materialism, critical theory of the coloniality of power, feminisms, decolonial theories, among others) and praxis of liberation in the face of class, gender, and racial oppressions in favor of processes of social transformation (Galheigo et al., 2018; Díaz-Leiva, 2018; Morán & Ulloa, 2016; Lopes & Malfitano, 2016; Cavalcante Bezerra & Prédes Trindade, 2013; Pérez Acevedo, 2016; Valderrama, 2013; Testa & Spampinato, 2010). Some titles of articles and books that account for this position are: “El pueblo, el populismo y otros asuntos” [People, populism and other issues] (Pérez Acevedo, 2014), “Una Terapia Ocupacional crítica como posibilidad” [A critical Occupational Therapy as a possibility] (Guajardo, 2014a), Terapia Ocupacional Social: Desenhos teóricos e contornos práticos [Social occupational therapy: theoretical and critical designs] (Lopes & Malfitano, 2016), “Perspectiva crítica desde latinoamérica: hacia una desobediencia epistémica en terapia ocupacional contemporánea” [Critical perspective from Latin America: towards an epistemic disobedience in contemporary occupational therapy] (Morán & Ulloa, 2016), “Produção de conhecimento, perspectivas e referências teórico-práticas na terapia ocupacional brasileira: marcos e tendências em uma linha do tempo” [Knowledge production, perspectives and theoretical-practical references in Brazilian occupational therapy: frameworks and trends in a timeline] (Galheigo et al., 2018), among others. In its various expressions, there is a criticism of conservative occupational therapy anchored in the following aspects: a) modern dualistic thinking, b) positivist scientific reasoning, c) the maintenance and reproduction of the modern-colonial-patriarchal-capable order, d) the discourse of ground zero, of universality, objectivity, neutrality, and apolitically. In opposition to this, it proposes a) a historical and decolonial materialist criticism of society, and b) criticism of all atomistic forms of reasoning that see social, political, economic, and cultural conditions as an objective, related, but essentially external externality. independent of the subjects.

The OT of a critical-political order, from the so-called South OT (Latin America, South Africa, and some relevant actors in Spain and the United Kingdom) preferably whose center is the political, human rights, and the proposal of other occupational therapies [...] is its historicity, its social foundation and the critical purpose of social transformation (Guajardo, 2014b, p. 159).

In summary, this debate has a counter-hegemonic character that is expressed, on the one hand, as a field of knowledge and practices and, on the other hand, as a transversal element that is present in all the debates in this study.

About the practices of occupational therapies around gender and feminism

This is a strong debate within the discussions in occupational therapy in recent years. Indeed, the struggles of the feminist movements against the patriarchal system and its surreptitious and overt forms of violence crossed the whole of society. One of the issues that have aroused controversy relates to the critique of the single histories that dominate the occupational therapy literature. On the one hand, it is argued that there is a gender bias in the ways of telling the story (Morrison, 2015), which has made the leading participation of many women invisible; on the other hand, the hierarchies established between the different professions have been evidenced, also making invisible the social and cultural representations that determine the gender-profession relationship. This has made occupational therapy a feminized profession, which, added to its “para-medical” nature, produces a double subordination (Testa, 2012).

The foregoing has stressed the role of academic programs as reproducers of these invisibility dynamics, specifically due to the absence of gender and, especially, feminist approaches within the curricula. This not only impacts the ways of telling the stories of the profession and the gender-profession subordination within the system of hierarchical knowledge but also produces a homogeneous and sexist vision of the problems that occupational therapy addresses. For example, in the field of disability, there is a homogeneous vision that does not allow observing the conditions that affect and oppress the lives of women with disabilities, their bodies are considered asexual, maternity is denied to them, and they do not have accessible information about their sexual and reproductive rights.

[…] this article seeks to call us to non-conformism, not to consider our reflections finished, but to question what we conceive as knowing. It urges us to develop critical epistemologies and resistance to what we hold as knowledge, seeking not only what is evident, and what exists, but also examining those things that have been produced as absences in history (Grandón Valenzuela, 2017a, p. 43).

Violence is another issue present in a transversal way within this debate that also affects other social groups due to the conditioning of the gender system (Testa & Spampinato, 2010). For example, women who experience physical violence as a result of the macho mandate (Spikermann, 2017), trans people, and dissident genders who experience heteronormative violence daily (Monzeli et al., 2015; Melo, 2016; Leite Junior & Lopes, 2017; Almeida & Lugli, 2018) or women affected by forced displacement and the armed conflict in Colombia, product of structural violence (Albarracín Cerquera & Contreras Torres, 2017; Mogollón Cárdenas, 2016).

A large part of the articles that discuss this debate insists on the need to urgently review and update academic curricula since these issues are usually invisible or are addressed superficially or focused. As long as the gender approach and feminisms are not mainstreamed as comprehensive frameworks and for action against inequalities, the dominance and subordination of different social groups, medicalizing and functionalist practices will continue to be perpetuated with irrelevant theoretical references, which ends up reproducing in our practices the existing phenomena of stigmatization and structural exclusion (Leite Junior & Lopes, 2017).

On occupational therapy practices around the idea of Latin America and the global south

The XV World Congress of Occupational Therapists held in Chile in 2010 is mentioned in various articles as a controversial moment that marks a position from Latin America and that seeks to discuss the importance of situating practices, rescuing locally produced stories, and making visible the knowledge production, and decolonial and border critical practices. It is named as a “privileged period to reflect on and problematize the foundations, practices and historical contexts in which Occupational Therapy (OT) has been developed” (Guajardo, 2016a, p. 41) and as a “meeting that invited us to reconsider our role in the face of different social issues and cultural contexts and to question the dominant points of view of OT” (Zorzoli et al., 2014, p. 23).

As previous discussions already point out, socioeconomic and geographic aspects in the region become important in understanding local professional performance. In addition, new theoretical-political references are incorporated such as Latin American thought, especially, the perspective of Boaventura de Sousa Santos, decolonial feminisms, the critical theory of the coloniality of power by Aníbal Quijano and the modernity/coloniality group, among many other. In this debate, the question of identity reappears, and the necessary differentiation between Latin American occupational therapies from the global south concerning Eurocentric-Anglo-Saxon occupational therapy becomes evident. However, it is pointed out that more than identity, it is an ongoing identification with Latin America (Galheigo, 2014). In this sense, the Anglo-Saxon production per se is not questioned, but rather the asymmetries of power that have existed and have been reproduced since occupational therapy migrated to Latin America (Díaz-Leiva, 2018). This is how questions arise, such as: what are the historical conditions that lead us to reflect on identities, episteme, and practices? What can be the limits of this construction? What are the conditions of possibility in the Latin American context or another sense, Ibero-American? (Guajardo, 2016a).

In this debate, the processes of cognitive colonization expressed in the preponderant place that North-Eurocentric academic production has in the curricula are problematized, the maintenance of the myth that affirms that “there is no bibliography” (Testa et al., 2016, p. 1) and, which leads to the establishment of colonial libraries and a restricted circulation of bibliography produced in Latin America, all of which makes it lose the historical-territorial sense, the cultural relevance of the interventions and the political-social role of the discipline (Muñoz Muñoz, 2014). For this reason, the idea of “decolonizing” the practice of occupational therapy is raised before the mandate to homogenize and standardize, which allows the recognition of the existing plurality and conceives “occupational therapy conjugated in the plural” (Testa et al., 2016, p. 1). In this same line, some articles raise the need for epistemic disobedience in contemporary occupational therapy (Morán & Ulloa, 2016), which implies taking a radical ethical-political-cultural position, and epistemic detachment, a movement that abandons the hegemonic universalist understanding and proposes a multi-versatility of occupational therapy. This epistemic disobedience is necessary for the face of globalization and monopolization of a single project expressed in languages, theoretical models, methods, and all kinds of political, epistemic, methodological regulations, etc., which are assumed to be legitimate and, therefore, establish asymmetric and of subalternization.

This debate is controversial because it criticizes the background of the dominant mandate that has prevailed in the region since the first occupational therapy careers were created and that imposes a universal view of the field. For this reason, the different occupational therapy groups are invited to become aware of unequal class, gender, generational, racial, and epistemic relations as key issues that intervene in all daily forms of life. In the same way, a perspective from the south turns toward the recognition of the plurality of existences:

From such an anthropophagic decolonial commitment we invite readers of this book to assume those sections that expose perspectives and ways of understanding occupational therapy and human occupation from the logic that privilege, for example, the scientific method and Anglo-Saxon production, not only to warn and resist foreign ways that limit and devitalize our practices as a result of understandings that do not agree with our visions and realities but also to integrate our localized ways (Latin American, southern, Andean) of being and doing occupational therapy ways others who are in tune with our perspectives. (Pérez Acevedo, 2016, p. 9).

Final Discussion

Among many other debates that span South America, seven debates produced in Brazil, Argentina, Colombia, and Chile between 2010-2018 were presented, taking the indicated documentary material as a reference. This research is only a part of this, since we assume that it is impossible to cover the multiplicity of practices and discussions that exist in occupational therapies in the region, many of which circulate through oral practices. It should be noted that many of these debates have lines of continuity with previous periods and others have become clearer in recent decades, in the same way, some report points of convergence and points of controversy that consider the voices and proposals of different occupational therapy groups.

The issues in controversy in all the debates are related to the predominant Eurocentric and Anglocentric foundational discourse and the critique of the “traditional inherited” paradigms of a medical-functional nature versus perspectives of a citizen-political nature that have emerged, especially from the global south. The latter are not homogeneous, they do not imply a single foundation or methodological theoretical body, and they depend on the social-historical contexts from which they emerge. From here, there is the criticism of the ‘ground zero’ discourse, that has been in force in occupational therapy for decades (called in these articles as dominant, conservative, positivist, and/or nor-Eurocentric), and that has had the claim of universality, objectivity, and neutrality. This situation has brought positivist scientific reasoning and dualistic logic (Pérez, 2012). From this, occupational therapy has been understood as a dehistoricized and apolitical practice that reproduces the modern-colonial-patriarchal-capable order. Hence, the importance of debates on the social; communities and territories; human rights; gender and feminisms; as well as on the knowledge production and positioning from Latin America and the global south. All these debates have in common their critical nature even when they focus on different issues.

These controversies have enabled to affirm of the very existence of various groups (Latour, 2008) and in each debate, the deployment of an ecology of knowledge (Santos, 2010), which has diversified occupational therapy practices, the generation of fields of knowledge and the opening of new performance spaces. In this sense, some debates and controversial issues have been fields of action for transformation, criticism, and resistance to the modern-capitalist-capable discourse. Others have emphasized a critique of the modern-patriarchal-colonial discourse, pointing to the necessary decolonization of bodies, territories, forms of organization, memories, and knowledge.

In this way, it is possible to affirm that occupational therapy practices act in spaces of everyday life where there is a plurality of existences and it is imperative to build heterogeneous practices from which new ways of thinking-doing are rewritten, in the ontological strata, epistemological, methodological, and especially political way. As these debates show, a critical reading of reality is necessary, of national and international social, movements political struggles, of rights claims, and of the processes of epistemic colonization that continue to permeate South America. The social inequality product of the modern-colonial system, globalization, the neoliberal model, patriarchy, and racism, continues to produce the marginalization of the majority (Certeau, 1996). Considering it, it is imperative a situated knowledge, practices, and discourses productions, from the different ways of acting and conceiving the world, capable of dialogue from the local to the global.

To conclude, each debate should condense different historical moments that are spinning plural and unfinished ways of doing occupational therapy and that make visible controversial issues that give richness and heterogeneity to the field, which allows stressing power asymmetries and giving political relevance to practices that occur from different parts of South America.

• 1
  This article cites references by authors from different countries. Some countries there is a tradition of citations by the last surname, and in others by the first surname. Considering this, the citations presented here are as the original ones, seeking to maintain what is established by the APA 7 standards. Therefore, it may be authors appearing with their first surname, with the second one or both of them.
• 2
  More information in the book of Barros (1994)Jardins de Abel: Desconstrução do Manicômio de Trieste [Abel's Gardens: Deconstruction of the Asylum in Trieste]. Lemos editorial.
• How to cite: Díaz-Leiva, M. M., & Malfitano, A. P. S. (2023). Controversies and debates around occupational therapy: an analysis of bibliographic productions in South America (2010-2018). Cadernos Brasileiros de Terapia Ocupacional, 31, e3344. https://doi.org/10.1590/2526-8910.ctoAO256433442
• Funding Source
  Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – CAPES – Code 001.

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Edited by

• Section editor
  Prof. Dr. Vagner dos Santos

Publication Dates

• Publication in this collection
  14 Apr 2023
• Date of issue
  2023

History

• Received
  07 June 2022
• Reviewed
  28 June 2022
• Reviewed
  10 Oct 2022
• Accepted
  01 Jan 2023