as individuals
Introduction
In the last chapter we explored Frankl’s notion that people have come to see their lives as empty and lacking in meaning and purpose, with a corresponding decline in a sense of well-being. Elaborating on Frankl’s proposition, Royce (1964, p. 76) went so far as to propose that: ‘about all that remains of humanity is an outer shell, for the ‘inner man’ is on his last legs. And the 20th century neurosis is the neurosis of purposelessness, meaninglessness, value-lessness, hollowness, or emptiness’. We concluded that meaningfulness may not always be associated with happiness (and perhaps not even wellbeing), but happiness was connected with meaningfulness. In his Ruth Zemke lecture in occupational science Rowles (2008) stated that: ‘The ultimate focus of each human life is a search for meaning’ (p. 127). He went on to emphasize that: ‘once the essentials of survival have been met, a primary focus of life is the discovery of meaning’ (p. 128). In this book, we argue that occupational therapists and occupational scientists have the skills to help people meet this desire to discover meaning in their lives. The profession has developed a specialized knowledge that can be used to assist people in making choices and strategizing about how to adequately perform daily occupations that maximize meaning in their lives.
Of course helping people experience their lives as meaningful is a relevant domain of practice for many other professionals including psychologists, philosophers, and psychological counsellors among others. However, occupational therapists and occupational scientists are particularly suited to understand the role of daily occupations in this endeavour. The current belief among occupational therapy and occupational science scholars is that meaningful occupation is associated with a sense of well-being among human beings (Christiansen, 2000, 1999; Matuska & Christiansen, 2008; Tatzer, van Nes, & Jonsson, 2011), and ‘Meaningfulness’ is one of the core constructs in the new occupational therapy paradigm (American Occupational Therapy Association [AOTA], 2014; Canadian Association of Occupational Therapists [CAOT], 2002; Kielhofner, 2009).
Since the 1990s, many occupational therapy and occupational science scholars have investigated the relationship between daily occupations and meaning in life. Schemm and Gitlin (1993) noted that using meaningful activity as a medium for therapeutic interventions created a sense of fulfilment and investment in therapy among occupational therapy clients. However, they acknowledged that identifying meaningful occupations for use in therapy is a complex process. Hasselkus (2002) investigated how meaningful daily occupations provided the medium through which life flowed for individuals living in long term care facilities. Hammell (2004) stated that depression, which is prevalent in the Western Societies in spite of material affluence, can be averted if people are able to find meaning in every-day activities. Matuska and Christiansen (2008) explored the relationship between occupation and life balance. They proposed that the creation of meaning and the ability to identify aspects of life as meaningful was an essential component of a positive and healthy life balance.
Christiansen (1999) proposed that life stories derived from an understanding of what people do in contexts was the occupational basis for development of personal identities. Tatzer, van Nes, and Jonsson (2011) used life stories to demonstrate how a small group of women maintained their occupational identities over their lifetimes, one aspect of which was their sense of struggle. Earlier Lentin (2002) had explored how the concept of survival was significant in creating a life despite traumatic experiences, and had suggested that the experience of trauma may be widespread in human society.
Lentin (2002) made a claim that ‘meaningfulness’ is a core professional construct, but understanding it in occupational therapy and occupational science terms is quite different from applying it in practice. Over the same period in which these studies relating occupation and meaning have been conducted, criticism has come from both within (Townsend 1998; Townsend, Langille, & Ripley, 2003) and outside occupational therapy, challenging the profession’s claim that it is occupation-centered (based on use of meaningful occupations as therapeutic media) and client-centered (Abberley, 1995). Many occupational therapists have noted that it is difficult to always use meaningful occupations as therapeutic media within a biomedical framework of practice (Wilding & Whiteford, 2007), which is increasingly constrained by budgetary and productivity concerns. Occupational therapists, like many other health care professionals and clients themselves, are concerned with what Rowles (2008) calls ‘essentials of survival’, which include paying the bills and staying in work rather than adhering to the core values such as occupation-based and client-centered practice (Hammell, 2010, 2008, 2007; Rebiero-Gruhl, 2009). The pressures generated by the need to reconcile core professional philosophy with economic survival pose a concern as to whether occupational therapy can remain true to its tenets that justify its existence in the first place, and still continue to remain viable.
Common experiences found in every-day occupations are depicted as the medium through which meaning in life emerges. Through engagement in daily occupations and subsequent experiences in occupational participation, the individual constructs meaning in his/her life by: connecting to something bigger than him/herself; engaging in self-exploration and creativity; connecting to other people; having a sense of social responsibility; having a sense of efficacy, competence, and independence; having a sense of dignity; affirming his/her unique identity; perceiving the experiences as relevant to his/her developmental stage; negotiating change and adapting; transitioning through life; and having a sense of temporal and cultural belonging.
Figure 2-1. Web of meaning through daily occupational performance.
To be able to practice in a way that is consistent with the professional value of meaningfulness occupational therapists need to clearly and comprehensively define what makes occupations meaningful. Without this clarity it is difficult for them to play their proper role in helping people to counter the contemporary concern about meaninglessness. In the previous chapter, we suggested that a concept of meaningfulness may have emerged as part of a culturally dominant set of middle class individualistic values which are rarely challenged. Christiansen (2000, p. 99) for example discussed the concept of ‘personal projects’ or long term goals that people saw as defining them and towards which they strived. All other activities had to be consistent with such personal projects. Furthermore, such personal projects were linked to peoples’ social positions and stages in life. Thus, a young person in emerging adulthood would perhaps see establishing a career and personal position in the social world as critical personal long term goals. The youngster’s daily occupations would largely be directed towards those goals. Similarly, a person who is middle aged would see helping teenage children transition to responsible adulthood and preparing for retirement as important personal projects. An older person would perhaps prioritise passing on wisdom to younger generations, and perform daily occupations in a way that would
