The Challenge of Language

klavesniceLanguage, and specifically the meaning of the words we choose is something that fascinates me. In healthcare it feels very important that we pay attention to the words we (as service-users/patients/clients, carers or professionals) use. There may not be a way of agreeing words that are acceptable to everyone but in exploring the words chosen, a dialogue about the implications and meaning can occur; allowing reflection, insight or understanding to develop.

I remember reading this post by Lisa Egan and it causing me to reflect. As I read I thought, “Yes, she’s absolutely right, I hadn’t considered it that way before” and yet while I fully accepted her reasoning and argument it didn’t feel ‘right’ for my own situation. That was something Lisa was clear about – how a person identifies it entirely up to them. So, I decided to write this post to explore why for me I felt it was important to refer to myself as a person with ‘x’ condition. Also, as is typical for me I wanted to explore the occupational perspective.

I recently read a chapter of an occupational therapy textbook that referred to someone as ‘suffering from [a mental health condition]’ and a ‘personality disordered individual’. I had a strong response to it but those two examples highlight two different issues. I’ll deal with the ‘suffering’ one first…

Suffering the use of the word suffering.

Well, no, actually I don’t ‘suffer’ the use of the word. It upsets me and I feel irritated, but I don’t think I am suffering. In an old post I explored this concept a bit more – wondering about the potential for it to put the person with the condition they were ‘suffering’ with into a helpless and passive role. I also wondered if the widespread use of the word for everything from ‘suffering from a cold’ to ‘suffering with schizophrenia’ had lead to it being used without question. I recently heard a news story on BBC News that emphasised just how routine this use of suffering has become. The feature was discussing a new medical test that could diagnose several conditions that had not yet shown symptoms that a person was ‘suffering’ from. Well, if the person is unaware of their illness I really question that they could be suffering. It could be argued that everyone knows that when ‘suffering’ is used it is actually shorthand for ‘is living with’, ‘is experiencing the symptoms of’ or some other form, but I question how damaging it could be in suggesting an acceptance of powerlessness to the condition. Also, what about the times when people really do feel their experience is of extreme suffering – will we be unable to hear their distress due to the normalising of the word? My final issue with it is the level of (often unquestioned) assumption by the person using it. The experience of illness, injury and disability is an incredibly personal one – the only person who can say they are suffering is the person who has that condition, and therefore experience.

Being ‘bulimic’.

I have recovered from anorexia, bulimia and borderline personality disorder (BPD). When I was unwell I often referred to myself as my condition. At the times I was fighting the urge to binge or purge and would then find myself eating vast quantities of food I would often say to myself with disgust, ‘I’m bulimic, it’s what I do, it’s the only thing I’m any good at’. So yes, I would probably have happily accepted labelling myself with diagnostic conditions as it felt so closely tied up to my identity at the time. Was it helpful? Probably not. I’ve written before about the meaning the eating disorder held for me, and how it really was a valued occupation and so it fits that ‘being bulimic’ was my occupational identity. Given that in society we often base our identities in the occupations we engage in (I’d describe myself now as an occupational therapy student and a rower as they are the two most significant occupations I engage in), it fits that at that time I was ‘a bulimic’ as the occupations related to having an eating disorder took up the majority of my day. My earlier explorations of occupations that were self-defeating helped me understand why they were so powerful for me and this realisation then makes me wonder about the effect of viewing myself as a bulimic occupational being. It feels congruent to how the experience was, and for that reason I can really understand why other people who are ill may refer to themselves as their condition, but I also think it was quite dangerous as it meant I had little reason to change. I had an identity, albeit not a desirable one but it was something, and all I had.

The issue of being ‘personality disordered’ is a little bit different. My main objection to this is to do with the level of stigma associated with the diagnosis. In my mind it evokes memories of professionals who use the term pejoratively and with a tone of hopelessness (‘personality is fixed; change cannot occur’). There is perhaps need for a separate blog post about the right name for BPD, but in the context of this one I really do feel that being a person with BPD is more helpful. There can be a tendency for people to become lost behind the stigma of the diagnosis and consideration of language choices can be a good starting point in preventing this.

Is there a ‘right’ choice of words to use?

Probably not. I think there are some uses of language to be avoided, but another person might not find the same things as unhelpful as I do, and equally may not like the words I use. Like many things I believe we need to listen (properly) to the person whose experience it is, question, reflect and be prepared to challenge our own views.

Advertisements

Pro-Eating Disorder Websites – a Personal, Occupational Perspective.

1-1259162961jHiYI have a number of issues with Channel 4’s ‘Supersize vs. Superskinny’ programme, which returned for a new series last night. However, I often find myself watching to ‘keep an eye’ on the messages they are promoting. There are so many areas I could discuss but the purpose of this post is the reflections it prompted for me on the topic of pro-eating disorder (pro-ED) websites (often referred to as pro-ana or pro-mia sites, using the abbreviated versions of the illness names to promote a familiarity  with, or even personification of , the condition), which they included as a feature in the first episode. I wanted to consider my view on the ‘should they be banned’ debate, as well as analyse my own experience of engaging with them from an occupational perspective.

What was my experience?

When I had an eating disorder (ED) I initially drifted towards some excellent recovery forums and websites designed to provide peer-support to people who had EDs. They provided me with some understanding and insight into my experience and I could tell I wasn’t alone, but they didn’t quite ‘fit’. The problem was that I wasn’t in recovery. I wasn’t ready to consider it and so any support given wasn’t congruent with the situation I was in. I soon discovered the world of pro-ED sites. While I did come across the type often cited in the media – those promoting anorexia as a normal lifestyle choice, or those involving high levels of competitiveness between members – the majority were simply spaces for people living with a very challenging illness to find a shared understanding and support.

The site I mostly used allowed sections for posting ‘thinspo’ (images designed to motivate people to meet their goals), and also posted things like the foods we’d eaten or binged on that day, however tip-sharing was strictly prohibited by a moderating team. Along side the ‘encouraging’ posts there were serious posts about emotions, challenges, recovery as well as a forum full of games and distractions to help cope with the isolation often experienced when eating disordered. I’ve already acknowledged in Self-Defeating Meaningful Occupation that these sites provided me with a level of companionship. I made real friends there – some of whom I am still in contact with now that we’ve made our individual steps into a life after an eating disorder. I never felt that the sites prevented recovery – when someone was ready to recover they were supported to do so genuinely and sensitively. The nature of social media use meant that supportive friendships could be maintained through sites like Facebook or via MSN Messenger (it was a little while ago…) for those who wanted to step away from the site. For me, the pro-ED site definitely maintained my eating disorder – it provided a space where I was accepted and some level of comfort. However, I feel things could have been much worse without it.

Should pro-ED sites be banned?

I was never under any illusion that my eating disorder was healthy, ‘normal’ or ‘OK’ but I felt I needed it and was unable to stop. It provided me with a means to cope with high levels of distress and really was a lifeline at a very difficult point in my life, as well as nearly killing me. That’s the thing with eating disorders, they are full of conflict; allowing survival whilst simultaneously contributing to demise. Perhaps that’s the reason why it’s hard to have a clear view on pro-ED sites – they sustained my life AND my eating disorder.

I don’t feel proud of my engagement in the site – I hate to think I could have encouraged someone else to develop or maintain an eating disorder by discussing what I’d eaten that day, however, I was very unwell and have compassion for myself. I also worry about those people for whom a pro-ED site makes their eating disorder worse (mine was very serious long before I found the websites). I don’t believe, however, that a website like that can create an eating disorder that doesn’t already exist. Perhaps the question should be, ‘Do pro-ED sites encourage eating disorders to be sustained and potentially cause harm?’. I suspect they do. I also suspect that their existence saves an equal number of lives by providing a level of understanding that pro-recovery sites cannot, for those not ready to consider recovery. I feel very sad that there are still thousands of people out there who will tonight be posting on a pro-ED site, I wish there was a way to take away all of their problems this instant. Sadly that’s not realistic. I don’t know how I feel about banning the pro-ED sites. I don’t want to glorify them or say they’re OK, they really aren’t, BUT they do provide something very valuable and I really feel that without them I would not still be alive. Perhaps a greater understanding of the function they serve would be more useful that debating whether they should exist?

What did the occupation of being involved in a Pro ED site involve?

The occupation of posting on a pro-ED site involved so much! It was something I felt was a classic ‘self-defeating meaningful occupation’ meeting many of the occupational needs highlighted in the linked blog post. The forum provided a frame for my day – allowing conversation about emotional issues, current affairs or ‘fun’ topics as well as a space to report the food-based occupations I’d participated in. I developed habits relating to times of day I would post in the various sub-types of forum (evenings were about food, day time about distraction). Also, due to the international nature of participants, there would always be someone online to chat with when chronic insomnia meant you were wide awake at 4am. I also established roles; from ‘newbie’, to established member, to friend. At a time in my life when relationships were very challenging this was significant and valued. I understand my engagement with this occupation as being one that synthesised experiences of productivity, pleasure and restoration (Pierce, 2003) in such a way that made it very fulfilling and important to me. The pro-ED site was a perfect record of all the energy I was putting into my eating disorder – there were significant elements of productivity involved and this almost felt like the ‘office-end’ of the job – the public (but anonymous) record of my work. The pleasure came from elements of satisfaction at this productivity as well as the connections with others and the light-hearted conversations that were had (which, when in a dark, all-consuming abyss of an eating disorder, was quite remarkable). The restoration was experienced as it was a place of acceptance of, and occasionally peace with, the chaotic world I was living in. I did not have to hide the life I was living (I use the term loosely), I could be me – someone in the grips of a very serious eating disorder.

I hope this post provides a little more insight into what the experience of engaging in pro-ED sites was really like, for me at least. I think the image portrayed in the media is very short-sighted and the problem is much more complex than described.I honestly don’t know what the answer is, but I think it might need to be the ‘question’ that is reconsidered first.

Reference

Pierce, D (2003). Occupation by Design, Building Therapeutic Power. Philadelphia: F.A. Davis Company.

OT: Disdain to Delight.

In  https://pd2ot.wordpress.com/2012/05/21/ot-is-for-thick-people/ ‎ I explored my first encounters with Occupational Therapists and why I felt their intervention was, at best, pointless. I think it’s only fair to explore the process of moving from being the client who got themselves banned from OT to the passionate student engaging in their first placement. I expect the reflection to highlight that when the issues that limited the success of earlier interventions were resolved I benefited from therapeutic occupation, but I anticipate there may  be other influences, too.

I remember I was slightly less resistant to OT sessions at periods when I was detained on a psychiatric intensive care unit (PICU). I was feeling somewhat less depressed than the period before, when OT just felt like too much effort and totally overwhelming, but the slight elevation in mood had increased my self-destruction, hence the transfer to PICU. I think, at that point, I only engaged because it was an opportunity to get off the ward (albeit to the adjacent PICU OT room, with everything locked away). However, I do feel it was a useful experience because it reduced my agitation that resulted from the containment (and tedium of 24:7 coverage of the Beijing Olympics, which was the only other realistic occupation).

But on the whole, my experience of OT in psychiatric hospital was not a good one. In fact, when I finally agreed that I would transfer to a Therapeutic Community (TC) my Consultant thought it was some kind of ironic karma that the TC allocated the OT as my keyworker. I have to admit I was convinced it would never be a happy, or useful relationship, but how wrong I was!

So, how did it all turn around?

Unsurprisingly, the fact that the OT at the TC was a highly intelligent (both emotionally and intellectually) woman that was passionate about the role of occupation was a big factor in my change in attitude. Her belief in OT was infectious, even to a sceptic like myself. She also worked at my level. She explained enough theory to me, found that my inner geek loved playing with pie charts/statistics and so encouraged me to chart my time use in graphs that I could compare month on month. But, importantly, she listened when I said ‘this is all bull****, I appear to have ‘occupational balance’ but my sleep is distressed and filled with flashbacks, I hate every aspect of my leisure – it’s all fuelled by a compulsion to exercise, and this ‘self-care’ is just me complying with the expectations of the programme to eat/cook/wash, I don’t actually want to do that for myself’. This was vital. One of my biggest resistances to OT was based on the misguided belief that OT was only about just doing the correct (correct in terms of what society believed was right, not what I wanted) occupations, and fear that I could do them and be left with the emotional torture of how it felt to be ‘doing the right thing’. Over time we worked through the aspects and found ways for me to achieve occupational balance that actually felt ‘ok’. It was a slow process and it also required input from the TC, psychotherapy and dialectical behavioural therapy (DBT).

I could go through all of the steps, but it would take forever! So, I’ll just mention the part I attribute to my recovery being transferable and sustainable to, and in, life in the community. I was incredibly fortunate to secure funding for an additional 4 months in the TC as a day patient. This gave me the opportunity to practice the new skills in the real world, to experience the likely problems I would encounter and discuss them with the community and to build up occupations that I could continue on discharge. It was an incredibly testing and emotional period and things only seemed to fall into place in the last month. The OT talked through the options I had with me, but in such an empowering way. She simply nudged me in the right direction while providing a safe space to thoroughly explore worries I had and the emotions and thoughts evoked by engaging in the new occupations. While I had done considerable work on meal preparation in the OT Kitchen at the TC, I found that when I tried to do it at my flat I was either enveloped by distress or avoided the task entirely. One of the most crucial points of the therapy was a supported cooking session in my own kitchen. At this point I truly understood the influence of context on occupations; I was a capable (albeit unsure, due to eating disordered thoughts) cook, had a well equipped kitchen and no physical limitations, but I failed to appreciate the barrier imposed by the difference in emotional experience in my own space, compared to an OT Kitchen that I could convince myself I was just performing and complying, rather than choosing to engage for myself. In terms of finding leisure activities that I wanted to participate in we discussed the issue with the eating-disordered fuelled ones and tried to discover what might provide more healthy, yet meaningful, experience. Once I, tentatively, said I wanted to dance again we explored the issues around it for me in terms of links to a difficult childhood. Once those had been problem-solved I was left to investigate and decide on the exact class and location. My hand was not held and I had autonomy. The process was not straightforward, but issues were discussed rather than the idea being abandoned as ‘too risky’ and the outcome was a more positive body image, some incredible opportunities and a group of fantastic, supportive friends.

When I left the TC I felt fairly confident that OT was the pivotal influence in me having a life I wanted to engage in and I knew meaningful occupation was essential to ensure my continued recovery. I felt I was ready for more of a challenge and knew study was the next step for me. I decided on an Access course to provide some structure without being too demanding academically. I was also preoccupied by the thought that I wanted to become an OT. I was concerned I was feeling that way to either try and find an identity in copying the career of the person who facilitated my recovery or too ‘fragile’ to so soon be considering the transition from service-user to professional. I spent a lot of time reflecting on this and also spoke to, and visited, a lot of OTs in other settings to find out if the profession interested and inspired me outside of the area I had experience of. Encouragingly, it did. In fact, the more I read and saw, the more I wanted to be part of it. The experience of the degree course has been mainly positive, at times I’ve been frustrated with feeling patronised or hand-held by lecturers, but I’ve also had equal experience of fantastic lectures and workshops and am currently on placement in a setting I had fairly low expectations of, and I’m loving every minute.

So yes, OT does delight me. I strongly feel that for me, when it was applied in a person-centred way (so, for me, including the theoretical aspects), as well as being empowering then it can enable sustainable recovery from a condition that is often felt to be a bit of a life sentence.

Self-defeating Occupation

I had intended to explore the topic of how I moved from a disdain of OT to training to become an Occupational Therapist as my next blog post, but I discovered some literature relating to a topic I’ve always been interested in and decided to explore it first. I also have created a page with my intended future blog posts to help keep track of them.

‘Self-defeating Occupation’

This is a concept I’ve given thought to for a long time, including several years before I understood the importance of meaningful and purposeful activities to the practice of occupational therapy. For the purposes of this post I will refer to ‘self-defeating behaviour’ as SDB and define them to include behaviours I exhibited when diagnosed with Borderline Personality Disorder (BPD), namely: self-harm (primarily cutting/burning), suicidal ideation/suicide planning and eating disordered behaviours of over-exercise, restriction, bingeing and purging.

I recently read a paper by Elliot (2012) that explored the concept of ‘Occupations of Illness’, in particular relating to the effect of eating disorders on daily occupations. I found I could relate many of my own SDBs to constructs discussed in the paper, particularly to the ideas that eating disordered behaviour can turn previously neutral occupations into ones of significant meaning, and the role of such occupations influencing identity.

The Role of Self-Defeating Occupation, for me.

With regard to BPD I’m never terribly sure about whether I should refer to it as an ‘illness’, or something that happened at a certain age, due to being aware that I always had the issues that escalated to become what was diagnosed as BPD. However, for the purposes of this blog I am considering the time I had BPD to be the period of my life where it became all-consuming and significantly limited my engagement in occupation.

On reflection, I feel my goal at the time was self-destruction. I was not particularly aiming for death but more behaving in a violent and aggressive way against myself. I do remember hoping that death might occur, but didn’t feel worthy of releasing myself from the chaotic life I was living. I am also aware of just how ‘all-consuming’ the SDBs were for me. It was only later in my recovery that I was able to acknowledge that the behaviours themselves were not the issue, but the emotions and experiences that drove me to try and manage by engaging in occupations that were detrimental to my health.

I also remember feeling that there was nothing that could ever replace the power of a binge/purge to suffocate difficult emotions, or the release and calm from seeing blood flow. For this reason I decided to attribute the components of my self-defeating occupations to the occupational needs defined by Doble and Santha (2008):

Accomplishment: It is often cited that people with eating disorders feel accomplishment with seeing lower numbers on the scales or clothes becoming too baggy. While this was true for me, I also felt a sense of achievement and power for every person I could hide my problems from, becoming sicker, and weaker, almost invisibly. Similarly, being able to create huge wounds on my body ‘proved’ that I had the power to destroy and make myself more ugly.

Affirmation: My cognitions told me that engaging in SDBs and the occupations that supported them were the only thing of worth in my life. I obtained tangible results, but possibly more importantly I had a way to manage and survive. On reflection now, I do believe that while I nearly didn’t survive BPD, the behaviours kept me alive for long enough to engage in recovery.

Agency: The role of ‘control’ in eating disorders is often recognised. I think I also, mistakenly, felt that the ‘control’ of being able to put in, and remove, vast quantities of food from my body was my evidence that I had power over everything.

Coherence: For me, the coherence of SDBs with my sense of self and internal world was one of the key driving forces. I felt worthless, scum-like and evil. Therefore, abusing the body of the person that housed such a disgusting ‘person’ (I really didn’t even feel human) felt entirely appropriate. At that time, the concept of ‘being kind to myself’ would have been impossible to entertain but finding newer and more serious ways to hurt myself aligned completely with the value I attributed to my existence. My goal was punishment and destruction and repeated SDBs felt like the least I could do.

Companionship: SDBs are isolating. However, before I started using them my internal world was incredibly isolated from the rest of the world. For this reason the behaviours gave me structure, and almost a sense of ‘company’. Self-harm and eating disorders felt like part of me. While in the early years my behaviour was disclosed only to myself, latterly I did use self-help/recovery websites, and also even ‘pro’ self-harm/eating disorder websites. These forums provided the companionship of some great people, who didn’t judge but listened and just understood.

Pleasure: While I would never say that I enjoyed engaging in SDBs or say I was ‘happy’, I know that there was a real sense of contentment provided by having occupations to engage in that were ‘mine’, I did not rely on anyone else for them and I was ‘safe’ while I was occupied with them. SDBs also fought off boredom and chaotic emotion, meaning I didn’t have to engage with the ‘real world’ and was protected from it.

Renewal: I often described bingeing and purging as a sense of ‘oblivion’. Once I started into the cycle all other emotions were forgotten. The binge squashed difficult emotions while the purging felt like letting them go. I followed almost every binge/purge with self-harm, I was numb but found the sensation of the blood grounding. After both behaviours I had a sense of calmness and peace that wasn’t afforded to the rest of my life. It was temporary, often nearly fleeting, but it did provide the sense of renewal.

Replacing Self-Defeating Occupations with Occupations Facilitating a ‘Life Worth Living’.

It is understandable why, after exposing the multi-faceted nature of self-defeating occupations, replacing these occupations with new, healthier occupations was never going to be straightforward. I believe there had to be a series of stages to the process, probably even involving the stage of being contained and ‘kept safe’ in hospital for many months/years before the process could begin. I doubt I ever could have just given up the SDBs and have found new ways to manage my time without significant therapeutic input from dialectical behavioural therapy, psychotherapy, a therapeutic community, medication AND occupational therapy. However, I do believe the latter is the key to my continued recovery and successful rehabilitation. For me, finding meaningful, yet health promoting occupations to engage in was challenging: I had little experience of letting myself have ‘fun’ and enjoy things. So, while it might have seemed easy for someone like me to go shopping, or take part in leisure activities, there were so many issues surrounding this. For example; I was a competent cook and could happily create a meal for a group of 10 people, yet cooking a meal for myself left me in a state of high distress and unable to engage. Even the small things like making a cup of tea or having a bubble bath were so tied up with SDBs that it felt impossible to separate them, never mind challenge the cognitions with regard to not punishing myself.

I’m happy to say that my life now is full of meaningful, health promoting, and even ‘fun’ occupations. I hope to explore more the role of OT in recovery from BPD, particularly relating to the challenges surround doing ‘nice things for yourself’ and the role of SDBs in making neutral occupations self-defeating.

References

Doble S, Caron Santha J (2008) Occupational well-being: Rethinking occupational therapy outcomes. Canadian Journal of Occupational Therapy 75(3) 184-190

Elliot M (2012) Figured world of eating disorders: Occupations of illness. Canadian Journal of Occupational Therapy, 79(1) 15-22

‘OT is for Thick People.’

Now, before you post angry responses, let me explain.

I do not believe this to be true but it is a direct quote from myself, when I was a service-user. I also believe I have, in the past, said the same in relation to dialectical behavioural therapy (DBT). So, now that I’m training to become an OT I started musing on how the person who had such disdain for the profession came to want to be part of it. I also have been wondering, in retrospect, what my statement really meant.

I consider myself to be a fairly intelligent person, by no means a genius, but I have always enjoyed using my brain and I am naturally quite reflective. When I was ill I found this to be a bit of a nemesis; I challenged a lot of what the professionals told me (in my head, I was always outwardly fairly compliant), always thought I knew better and didn’t believe any of their interventions could help me. So, when it came to OT I failed to believe that attending sessions on baking, relaxation, computer skills and woodwork could possibly make my chaotic and hellish world ‘all better’. Especially as someone who was very good at putting a front on and ‘performing’ and ‘engaging’ in structured activities, only to suffer the emotional fall-out once back on the ward.

There were several issues with my first experiences of OT (on an acute ward and psychiatric intensive care unit). As a student the emphasis on the need for occupation to be meaningful in order for participation to be therapeutic is frequently stated, yet as a service user this wasn’t evident. Generally, my OT timetable was selected based on the sessions that had spaces and the times that I wasn’t in psychotherapy or ward round. I realise that the NHS is always going to be limited in what it can provide and know that the OTs were working with the resources they had. However, I do feel the service failed those with fairly high functional levels. I remember attending a computer workshop where I was taught how to make a basic poster in Word. As a recent university drop out (due to my mental health problems) this provided evidence that I was indeed worthless and incapable of anything more challenging. I also think that if an OT had explained to me some of the theory around occupational therapy, such as setting goals and finding a way to grade my return to the things I wanted to engage in, then I might have been better able to see the value in what I was doing. I don’t know if the OTs had any ‘grand plan’, it certainly felt that they were, at best, attempting to stave off boredom.

I’m also now using my experience to reflect on the role of the OT to challenge the choices I made. It is part of the profession that OTs have to sit with uncomfortable feelings when a client selects a goal that is not in their best interests. Park (2009) explains that if a client is competent to understand the risk involved in the choices they make, then it can be a helpful to engage in a level of risk. However, in my situation, choices to attend a woodwork session (to gain access to materials to self-harm with) or to attend cookery sessions (despite being underweight and obsessed with food, delighting in taking a plate of cakes back to the ward to ‘feed’ the staff with, never daring to eat one myself) were never challenged. These examples are of occupations that did actually hold meaning for me, perhaps just not such positive meaning as one might like. Were the OTs being incredibly client-centred in letting me choose to engage in destructive activities because they held meaning, or were they just not thinking about me and my likely volition at all. I suspect the latter. So what would I do if the roles were reversed? I think my subsequent experience of being part of a therapeutic community (TC) has taught me the value of questioning the rationale behind every behaviour. As an OT I’d try and discover why they were selecting the activities they were, and explore how it enabled goals they wished to achieve.

I often wonder why I had such disdain for OT. I do believe that the absence of understanding the rationale of the therapy was a major barrier. When you are endlessly handed sheets of colouring in to do, with felt tip pens that have nearly dried up because you can’t be trusted with a pencil sharpener, it’s understandable that you feel somewhat infantilised. Especially as art was a pretty traumatic experience at school. If someone had said, ‘what areas do you feel you can’t do the things you want and need to do in?’ and ‘Ok, let’s look at the steps we might take to get you back to that level of functioning’ I might have been more co-operative. I also would have been more convinced that I wasn’t trying to be distracted from being a nuisance on the ward if I’d been given age-appropriate (and perhaps intellect-appropriate) things to do.

This reflection has also got me back to thinking about the common topic of why occupational therapy isn’t clearly understood by non-OTs. I know when I was a service user that the staff in the multi-disciplinary team didn’t explain OT as anything other than activities to pass the time. Is it because the profession is so based on utilising activities that are essentially ‘normal’, that non-OTs don’t endeavour to understand the approach? It’s not like medicine where there are medications or procedures, or even physiotherapy where there are exercises and ‘hands-on’ treatments. For OT there is substantial theory (and increasingly, evidence) behind what we do, the methods require extensive training before the professional is ‘let loose’ and yet, because the therapy is based on things we are all familiar with and so heavily focus on enabling the client to do things for themselves, I believe the complexity of the process is often overlooked. I think it’s important that as an OT I remember this, not every client will be interested in the theory but I hope that by ensuring that, at the very least, I work collaboratively and explain the process we won’t always be seen as ‘activities co-ordinators’. I know that once I worked with an OT that explained the rationale for the intervention I was certainly more willing to engage and less resistant to being able to be helped by carefully chosen goals using occupational engagement.

Finally, on a personal level, I want to consider why I was so adamant that OT was for ‘thick people’. Mostly the answer is in the above reflection, I didn’t understand OT and felt insulted by what the staff were suggesting I do. As a person who had had an eating disorder for years I had long since mastered the art of distracting myself from a ravening hunger (or more precisely, using the eating disorder to distract myself from emotions and thoughts that felt like they had the power to annihilate me), so I felt I didn’t need people to give me further tips. I was also scared. On so many levels. I was scared that OT might help me. What if I started to be able to cook nutritious balanced meals again? I was convinced I’d be left with all the feelings and a tool-kit of functional skills that would make the disparity between my internal and external worlds even greater. I was also scared that someone would realise that I was dissociating through all of the ‘relaxation’ workshops when any of the male patients got agitated, and work out why that might be so. I got so scared that I used an OT session to seriously (and unusually for me, publicly) hurt myself so that I was banned from future sessions. So essentially, for someone who is bright, being deprived of information ensured that any OT intervention was set to fail.

I’m aware that I haven’t covered how I managed to move from this view to one of advocating occupational therapy as a profession I believe in, and want to be part of. That’s a topic for another day!

Reference

Park, S (2009) Goal Setting in Occupational Therapy: a Client-Centred Perspective. In Duncan, E. Skills for Practice in Occupational Therapy. Edinburgh: Churchill Livingstone Elsevier.