Occupational therapy and culture: dimensions in dialog ¹

Abstract

This manuscript aims to deepen and enrich discussions surrounding the intersection of occupational therapy and culture. It explores the relationship between these fields across three different dimensions: i) the cultural aspects of human activities in occupational therapy; ii) the influence of culture in the historical evolution and constitutive processes of occupational therapy, where the arts play a central role; and iii) the potential for culture to serve as a field of practice for occupational therapists, informed by cultural policies and the recognition of culture as a human right. In this framework, culture acquires different contours, providing insights into its relevance for human activities within the scope of occupational therapy. The present debate proposes that culture should be considered in the context of individual, community, and territorial human activities. These activities also participate in hegemonic processes of power that require an occupational-therapeutic approach, one that is cognizant of the complexities of cultural reproduction, hierarchical systems, classifications, violations, and colonization processes, as well as resistance to these factors. The study posits that the links between art, culture, and occupational therapy are merely coincidental but are important to the profession’s historical development and ongoing practice. Moreover, it contends that there exists a specialized field of action directly related to cultural policies, one that requires its own set of theoretical and methodological frameworks. This, in turn, enables potential collaboration with health, social assistance, education, and other sectors.

Keywords:
Culture; Occupational Therapy; Occupational Therapy/Trends

Resumo

Este manuscrito visa ampliar e fortalecer debates e diálogos sobre terapia ocupacional e cultura. Para isso, apresenta uma proposição a respeito da relação entre esses campos em três diferentes dimensões: i) os aspectos culturais das atividades humanas na terapia ocupacional; ii) as marcas da cultura nos processos históricos e constitutivos da terapia ocupacional, nos quais as artes são protagonistas; e iii) a cultura como campo de trabalho do terapeuta ocupacional com base nas políticas culturais e no entendimento de cultura como um direito. Assim, a cultura adquire diferentes contornos, oferecendo pistas sobre sua composição para as atividades humanas em uma retrospectiva reflexiva no campo da terapia ocupacional. O presente debate propõe considerar a cultura em relação às atividades humanas singulares, comunitárias e territoriais, que também participam de processos hegemônicos de poder, o que requer uma ação terapêutico-ocupacional consciente de suas reproduções, hierarquias, classificações, violações e colonizações, bem como de suas resistências. Reflete-se que os vínculos entre arte, cultura e terapia ocupacional estão diretamente ligados a marcos históricos para a construção da profissão e estão presentes em todas as áreas de atuação profissional. Debate-se que existe um campo de atuação diretamente relacionado às políticas culturais que requer referenciais teóricos e metodológicos próprios, que por sua vez estabelece possíveis interfaces com as políticas e setores de saúde, assistência social, educação, entre outros.

Palavras-chave:
Cultura; Terapia Ocupacional; Terapia Ocupacional/Tendências

Introduction

This essay is part of doctoral research that addresses the relationship between occupational therapy and culture. The reflection presented here stems from a theoretical construction on this theme, combined with occupational-therapeutic experiences and practices developed in a research group that carries out integrated university teaching, research, and extension projects in this field.

Seeking to understand the dialogue between occupational therapy and culture, the relationship between these fields is explored across three different important dimensions: i) the first refers to the cultural aspects of human activities in occupational therapy; ii) the second revisits the influence of culture in the historical evolution and constitutive processes of occupational therapy, where the arts play a central role; iii) the third focuses on the potential for culture to serve as a field of practice for occupational therapists, informed by cultural policies and the recognition of culture as a right.

The reflections presented can only be understood if we consider culture as polysemic concepts that are often in dispute. By addressing culture uniformly, we run the risk of relativizing, classifying, and/or minimizing everyday human activities, considering that the world is composed of various ways of life and multiple cultural practices.

The Cultural Aspects of Human Activities in Occupational Therapy

According to Chauí (2008), culture presupposes a set of expressions that structure everyday human life present in various ways of life.

Human activities² are immersed in cultures, and for this reason, they can be understood as collective, community, and singular cultural expressions, unique to each time and way of life (Phelan & Kinsella, 2009).

As a field of knowledge, occupational therapy gathers concepts, conceptions, and frameworks that support its theoretical-practical propositions (Silva et al., 2019), which structure practices, attitudes, and ethics (World Federation of Occupational Therapists, 2010).

In Brazil, at the beginning of the 1990s, Brunello (1991) already expressed her concern about understanding, considering, and fully grasping the culture of each individual in occupational-therapeutic practices, relating directly to the meaning of each human activity and affirming this relationship with the collective, contexts, and realities of people.

Later on, we adopted the concept of everyday life in occupational therapy from the socio-historical and contextualized perspective of the subject. This understanding incorporated “[…] subjectivity, culture, history, and social power as elements that influence knowledge about the phenomenon” (Galheigo, 2003, p. 108).

Considering culture in the conceptual and theoretical-methodological constructions developed in occupational therapy reflects not just an item to be measured or verified. Still, it is about an ethical-political commitment, because:

Occupational therapy works directly with sensitive issues, such as purposes, meanings, and what people do. Ignoring how culture is connected to these aspects can lead to unethical or even iatrogenic practices, from the individual to the global levels. The result of this is the denial of the diversity and richness of local practices (Castro et al., 2014, p. 412).

Lima (2003, p. 70) points out that the ethical-political commitment of occupational therapists to the subjects and collectives assisted is linked to the defense of rights and the desire for difference. “And to desire dissent, alterity, and difference is only possible when we assume the multiplicity that composes us”. Considering and desiring our multiplicity is directly related to culture and understanding it as a structure of life.

Hall (2017) highlights the centrality of culture in interpreting reality and actions, as well as its constitutive role in all aspects of social life, in the construction of subjectivity and identity.

Thus, discussing culture demands reflection: which culture are we talking about? Who speaks? Who can speak? Questions that Spivak (2010) urges us to ask.

According to Bhabha (1998), culture symbolizes power structures: cultural elements represent artistic and political relations, blending the past and present, the public and private, being not only a form of expression but also a means of survival. Thus, when we do not mention, reflect, or position ourselves about which perspectives are structuring the knowledge and practices in occupational therapy, it means that hegemonic models are being operated based on their logic.

In occupational therapy, we must also question which culture or cultures is being considered for intervention with individuals, groups, or communities.

Al Busaidy & Borthwick (2012) emphasize the inconsistencies of Western models of occupational therapy compared with those of Eastern and Arab/Islamic countries. For them, certain practices share beliefs, values, and attitudes that are quite different from each other and may pose risks, as well as be deemed inappropriate or irrelevant. This is about recognizing dominant values and ideologies producing their logic. In this case, these authors discuss how hegemonic theories underscore the importance of individual responsibility, stemming from neoliberal perspectives, contrasting with community values prioritizing responsibility toward family and social groups, which may be judged as having insufficient autonomy or empowerment capability (Al Busaidy & Borthwick, 2012).

Iwama et al. (2008) view occupational therapy as a cultural entity and discuss how diversity and worldviews exist within our communities. Therefore, they warn of the dangers of theoretical colonialism, present when cultural imperatives are privileged.

In Brazil, for instance, one cannot overlook the historical enslavement of African black people, genocide, and violence perpetrated by various mechanisms that stigmatized black people as inferior and savage and exalted the process of whitening elevated to the pinnacle of ‘racial democracy’, which, under the concepts of assimilation, acculturation, and miscegenation, violated, assaulted, silenced, and exerted power. In other words, racism was institutionalized in a diffuse and deeply penetrating manner within the social, psychological, economic, political, and cultural fabric of Brazilian society (Nascimento, 2016).

Thus, when referring to the cultural dimensions of occupational-therapeutic practices, we also refer to the entire power relationship exerted from different social markers, the intersectionality expressed in the identities and subjectivities of all people with whom we interact (Ambrosio & Silva, 2022).

Therefore, we corroborate Pino & Ulloa (2016, p. 425), as this debate leads us to take a radical ethical-political-cultural stance, an “[…] epistemic detachment in the social sphere, a movement that goes from a hegemonic universalist understanding to a pluriversality of occupational therapy”.

Interculturality is another crucial theme correlated here, as the concept arises from the integration between different cultures, considering the power relations inevitably established between them. Fernández (2008) points out that the term refers to establishing relations between people under the balanced use of power, in which participants display a willingness for active learning and mutual respect.

For occupational therapy, interculturality can mean intervention in favor of human development, inclusive and pluralistic democracy, and new citizenship, adopting the framing of cultural issues together with socioeconomic and civic-political policies (Zango, 2017).

The Influence of Culture in the Historical Evolution and Constitutive Processes of Occupational Therapy, Where the Arts Play a Central Role

In this dimension, it is paramount to acknowledge the importance of the arts in the realm of occupational therapy. The arts are understood as an integral part of human expression and cultural production. There is a direct association between the arts and occupational-therapeutic practices across all areas and fields of intervention. Furthermore, historical landmarks pivotal to the profession’s development deserve our attention (Castro & Silva, 2002; Perruzza & Kinsella, 2010).

Morrison Jara (2018) elucidates that even before the establishment of the profession’s first paradigm, a myriad of theories, accompanied by their respective political and ideological movements, began shaping what became known as occupational therapy. Notably, the Pragmatic Philosophy, the Moral Treatment, the Arts and Crafts Movement, and the initial wave of feminism were of the essence.

The Arts and Crafts Movement held a foundational role in laying the groundwork for occupational therapy. The movement was of prime significance in settlement houses, such as the Hull House. Intriguingly, the founders of Hull House were affiliated with the Arts and Crafts Movement in Chicago, USA. They firmly believed in harnessing the power of art to uplift, educate, and bridge gaps between diverse communities, especially during the industrial work crisis era (Quiroga, 1995).

Deeply rooted in Romanticism and utopian socialism, the Arts and Crafts Movement was a counter-response to the drastic shifts induced by Capitalism and the Industrial Revolution. The ethos of the movement was a rebellion against the escalating impoverishment of the working class. It championed a unique ontological spirit, wherein everyday life, the human body, the arts, craftsmanship, community networks, homes, and families coalesced to foster an ecologically minimalistic yet fulfilling existence (Almeida & Costa, 2019).

In the Brazilian context, the groundbreaking work of psychiatrist Nise da Silveira stands as a monumental reference. Her contributions bear immense significance at the juncture of psychiatry, the arts, and occupational therapeutics. Silveira endeavored to underpin her methodologies with a robust scientific basis. Her innovative approach involving artists and art critics alike, turned into a museographic treatment of her patients’ creations (Castro & Lima, 2007).

Even though these are foundational milestones, occupational therapy has evolved, generating a diverse array of reflections, practices, and propositions at the crossroads of culture, the arts, and health care. It is pivotal to underscore that this symbiotic relationship has been a sustained and representative hallmark in the profession. A pressing concern is that many predominant occupational-therapeutic models have drifted away from this confluence, moving closer to biomedical and rehabilitation practices. Consequently, the role played by the arts in the profession has been marginalized or under-emphasized (Thompson & Blair, 1998). However, transcending these dichotomies is imperative, as they do not innately present exclusionary relationships.

The significance of the arts has been constantly underscored throughout the psychiatric reform movement and the anti-asylum struggle. This prominence aimed at devising mental health care methodologies that would challenge the conventional psychiatric paradigm, the medicalized hospital-centric model, and the total institutions (Shimoguiri & Costa-Rosa, 2017). These movements opposed controls, abuses, violations, tortures, and deaths, which were at times sanctioned by the State, professionals, and society at large, under the guise of mental illness treatment methods (Arbex, 2013).

Between the 1980s and 1990s, a significant turning point was observed in the evolution of occupational therapy. The battles for democratization and rights, combined with the formulation of theories, studies, and practices, significantly widened critical discussions in the field. This expansion was “[…] linked to the birth of a resistance culture fostered through participation in various social movements and dialogue with music, theater, literature, and the arts” (Lima, 2021, p. 161).

The journey of occupational therapy, with its foray into the cultural realm stemming from artistic practices, played a crucial role in undermining the dominant medical knowledge-power dynamic. It facilitated a shift from rigid diagnostic perspectives, broadening the health concept, and care scope for individuals and collectives, and incorporating ethical commitments associated with community and territorial practices, social participation, and citizenship, among others (Castro et al., 2016; Castro & Silva, 2002).

In this way, it was possible to induce changes in the understanding of sensitivity, the work, and the creations produced at the boundary with the clinical field, resulting in a shift in the relationships between art, madness, and contemporary clinical practice (Lima, 2006, p. 328).

Given the increasing involvement of occupational therapists in devices developed at the interface between social, health, and cultural practices, it becomes increasingly important to reflect upon and discuss issues related to the social and cultural participation strategies of individuals who, for various reasons, face vulnerability situations (Castro et al., 2016, p. 838).

Siegmann (2018) corroborates these reflections, aiming to enhance the creative and expressive dimensions of life. She opposes the traditional models of representation and normalization of bodies, favoring an inventive perspective of occupational therapy, intertwined with expressive, artistic, and cultural activities.

In their work with young people, Takeiti & Vicentin (2016) unveil new ways to engage with the peripheral youth using artistic and cultural expressions. They view these young individuals as powerful agents shaping cultures and creating activities.

Prado et al. (2020) highlight culture as a professional field and discuss the integration of young artists and cultural producers, thereby fostering new work-related relationships as a means of social engagement and positioning.

Silva & Teixeira (2021), in their work with young people involved in the hip-hop movement, underscore the challenges of working within the cultural domain concerning public authority. They outline their counter-strategies such as collective organization, dissemination and funding of the arts, and the establishment of spaces for dialogue and social recognition. After all, the power of hip-hop is recognized as a form of artistic expression, activism, and social transformation.

Lavacca (2018) analyzes body and musical expressions, dance, and theater as tools in public schools to create spaces where young people and adolescents can create and recreate collective identities and meanings for their contexts and everyday lives, in interventionist spaces where dialogue, affection, and freedom exist.

Another important thematic concept for discussion is the work with the body, concerning the arts and culture. After all, we have a series of experiences that value bodily action to promote hybrid spaces between care, art, and body.

By hybridizing the arts and occupational therapy, it is understood that the creation of poetic art spaces, with the potential to open up to sensitivity, perception, and imagination, motivates the affection of a body in encounters with other bodies, and from this closeness, creates new bodies and new ways of living, revitalizing a permanent state of art (Elmescany et al., 2018, p. 153).

Almeida (2011) adopts the concept of body art to express the possibility of organizing “territorialized” bodies that hold the potential to form a work and the craft-body, which consists of the ability to model, create, and produce a body, the result of a process of insistence, through the repetition of everyday doing.

If we consider practices deemed more traditional to the profession, we also have numerous examples of how the arts are presented as a part or strategy, whether in hospitals, clinics, or general health services, with the most diverse populations. Nalasco & Martins (2007, p. 26) present the arts both as diagnostic and treatment tools depending on their therapeutic effects. “By expanding perception, externalizing feelings, awakening motivation, and rescuing self-esteem, which results in the patient’s increased capacity to be creative and expressive”.

Lima (2005) presents proposals for aging with quality, based on artistic production, at the interfaces of occupational therapy, the arts, and gerontology.

Leite et al. (2013) report the insertion of occupational therapy in the context of health care for individuals infected with HIV through expressive activities that influence everyday life, enabling discoveries that lead to self-appropriation and well-being.

Many other practices and studies could be mentioned; the fact is that we recognize the health-culture interface transversally in the field of occupational therapy, as well as in other areas and international organisms³ .

The Potential for Culture to Serve as a Field of Practice for Occupational Therapists, Informed by Cultural Policies and the Recognition of Culture as a Human Right

Galheigo et al. (2018) present the theoretical-methodological perspectives and theoretical-practical frameworks of Brazilian occupational therapy from 1956 to 2017; among the four main movements cited, the relationship with culture is most prominent in the third movement: “[…] constitution of the fields of knowledge and practice of occupational therapy through sociopolitical contextualization, theoretical-conceptual problematization, and proposition of emancipatory practices” (identified between 1997 and 2005).

Culture appears: i) identified as a field of professional activity, related to the expansion of public social policies; ii) represented in the consolidation of a shift in the conception of activity as an element of culture, of a polysemic and complex nature, based on a sociopolitical and affective dimension of the human condition; iii) considered in the contexts of people and groups in professional practices aimed at territorial and community work (Galheigo et al., 2018).

For this essay, let us focus on the first item, which emphasizes culture as a field of professional action. We can perceive the direct relationship, from this perspective, between culture and the professional field.

After all, the policies conceived by Minister of Culture Gilberto Gil (2003-2008) focused on the active role of the State in formulating and implementing cultural policies, scoping actions, conceiving culture, and connecting with society. For Rubim (2008, p. 196), “[…] this conceptual and operational openness signifies not only the abandonment of an elitist and discriminatory view of culture but represents a counterpoint to authoritarianism and the search for democratization of cultural policies”.

Although the cultural policies of this period were extremely embryonic and insufficient in their punctuality to promote culture in constant debate with the demands of neoliberal rationality (Silva et al., 2019), between 2016 and 2022, there was complete disinvestment, bankruptcy, and neglect, with few actions resistant to dismantling.

Nevertheless, the cultural policies and the dialogues that occupational therapy and culture were able to construct guided important developments regarding the guarantee of rights, citizenship, and cultural diversity, and projects that fostered inventive identity and ethical-political commitment (Silvestrini, 2019).

Occupational therapy takes culture as a decentralizing part of more traditional assistance models, giving voice to expressions, identities, subjectivities, and creations. Culture comes to be understood as a basic need and a fundamental right of beings. According to Sato & Barros (2016, p. 16), we must include this agenda in academic education and knowledge construction.

It is essential, therefore, that occupational therapy dialogue with these new dynamics, creating initiatives for practice and education that work on cultural, social, and life plurality, interacting and moving in line with these new realities and trends of contemporaneity.

Silva et al. (2019) point out that occupational-therapeutic practices focused on culture, involved with ensuring cultural rights and the exercise of citizenship, invest in strategies, from different interfaces, and are active concerning new social interactions with and alongside people who suffer the most from inequality and exclusion of hegemonic power processes.

In this regard, occupational therapists can contribute to the production of strategies, reflections, and counter-hegemonic, anti-colonial, anti-hetero-cis-patriarchal, and anti-racist practices in search of breaking and overcoming the impacts generated by hegemonic and violent practices in ways of life and human relations (Silva et al., 2019, p. 934).

In the field of cultural accessibility, for example, we have experiences that involve direct action in cultural spaces, graduate education, inclusion of topics in undergraduate studies, reformulation of courses and curricula in occupational therapy, expansion of studies and productions, and involvement with projects and new laws, which renew the dialogue between occupational therapy and culture (Dorneles et al., 2018).

This shift brings challenges for occupational therapists to perform roles such as management, production, promotion, and cultural dissemination. Thus, occupational therapists develop practices that respond to the unique universe of culture, with possibilities of enjoyment, production, and management, as suggested by Silva et al. (2019).

By entering spaces as agents or producers of culture, occupational therapists focus on new action profiles and management skills, involved in all the demands and abilities for cultural promotion that are engaged, situated, committed, and aware of the work in the field of culture, as essential for changing any society, and breaking with hegemonic processes of domination.

These perspectives must be understood in conjunction with the economic dimension of culture because: “Culture constitutes a fundamental dimension of the development process and contributes to strengthening the independence, sovereignty, and identity of nations” (Instituto do Patrimônio Histórico e Artístico Nacional, 1985, p. 3).

It is possible to think of occupational therapy at the interface with culture as a device transversal to various fields and ways of doing and recognizing oneself, “[…] affirming choices and paths as life enhancers (ethics); exercising the dimension of creative invention (esthetics), and taking responsibility for the effects produced (politics)” (Takeiti & Vicentin, 2016, p. 35).

The professional action of occupational therapy in the field of culture shapes new ways of understanding its practices, as they are tied to the ethical-political commitment, also composed by the defense and struggle for the expansion of human rights and citizenship and respect for diversity and social participation (Silvestrini, 2019).

According to Silvestrini (2019, p. 147), the challenges of occupational therapy in the field of culture involve aspects related to cultural management, access to cultures, and political and economic obstacles. Similarly, “[…] this potency is represented by the idea of collective, dialogical, and engaged doing, interested in empowerment and formats that break with hierarchies, aiming at the expansion of the power of being and acting in the world”. “The importance of seeking justice, equity, and respect for human and environmental diversity is understood, and their transformations necessarily pass through the cultural dimension of human lives” (Silvestrini, 2019, p. 934).

Final Remarks

This essay is the result of reflections on the importance of considering the relationship between culture and occupational therapy. Thus, this manuscript proposed three main dimensions in which culture takes on different designs, symbolizing the multiple and diverse ways of life, everyday routines, activities, and occupations inherent in human life. Therefore, they are unique, collective, and community-based, participating in hegemonic power processes. This demands an occupational therapeutic intervention aware of these processes, as well as their reproductions, hierarchies, classifications, violations, and colonizations.

The arts, culture, and occupational therapy are directly connected, with significant historical milestones for the profession’s construction, and are present in all areas of professional practice. Thus, their interfaces with various esthetic movements are highlighted under the bodily, community, and territorial perspectives, and especially the ethical-political stance to confront life’s abuses, violations, and controls.

What we suggest is that culture, in addition to the dimensions discussed here, can be considered a field of study and action for occupational therapy, especially in its relationship as a right and transformation. There is an area of action directly related to cultural policies, which centers the work in certain spaces, with certain ethics, functions, and purposes specific to this relationship with the cultural sector. Moreover, there is a vast relationship of this work with culture and its possible interfaces with the policies and sectors of health, social assistance, and education, among others.

This article sought to bring part of a framework on culture to construct reflections and dialogues about the possibilities of debates on culture and occupational therapy. It is hoped that this work can contribute to building new bridges and horizons encompassing the themes of culture—in its multiple dimensions—and occupational therapy.

• 1
  The reflections presented in this text arise from the theme of Antonio Lavacca’s doctoral research, under the supervision of Carla Regina Silva, in collective theoretical construction at the Human Activities and Occupational Therapy Laboratory (AHTO).
• 2
  The term ‘human activities’ is important for occupational therapy, especially in the Brazilian context. In this essay, the use of this term is adopted following the understandings in line with Cardinalli (2022).
• 3
  The report “What is the evidence on the role of the arts in improving health and well-being? The scoping review”, published by the WHO, is a good example. It synthesizes global evidence, from more than 3,000 studies, on the role played by the arts in health prevention, promotion, and management (Fancourt & Finn, 2019).
• How to cite: Lavacca, A. B., & Silva, C. R. (2023). Occupational therapy and culture: dimensions in dialog. Cadernos Brasileiros de Terapia Ocupacional, 31, e3455. https://doi.org/10.1590/2526-8910.ctoEN264934552

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Edited by

Section editor

Profa. Dra. Ana Paula Serrata Malfitano

Publication Dates

• Publication in this collection
  04 Dec 2023
• Date of issue
  2023

History

• Received
  15 Nov 2022
• Reviewed
  02 Mar 2023
• Reviewed
  01 June 2023
• Reviewed
  06 July 2023
• Accepted
  14 July 2023