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Susan Cox Johnson and the National Society for the Promotion of Occupational Therapy

The late 19th and early 20th centuries were encouraging times for appearing of such science as Occupational Therapy. It seemed like all the necessary circumstances concurred. One of them was connected with «changes in the effectiveness and ways of provision of health care and influenced by the burgeoning emphasis on the relationship between chronological age and appropriate roles in life.” (Radomsky, 2008, p. 23) In the cultural, economic, and social context of that time, considering their private experience, the founders of Occupational Therapy had the general view of its usage – in particular, to restore the patient’s mental and physical functions. Thanks to occupational therapy many people could acquire self-confidence again and not worry about their inferiority. Thus, it became the foundation of the Medical Department reconstruction programs for the wounded and mentally ill soldiers of World War I.

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Occupational Therapy Background

Occupational Therapy as a science was founded by several people. On March 17, 1917, the founders held a meeting in Clifton Springs, New York. They all came from different backgrounds and with different experiences, which gave Occupational Therapy a well-rounded foundation. The five founders at the meeting were: William Rush Dunton Jr. – a psychologist, known as “the father of Occupational Therapy”; Eleanor Clarke Slagle – a welfare worker, known as “the mother of Occupational Therapy”; George Edward Barton – an architect, who understood the value of occupations from his own experience; Susan Cox Johnson – an arts and crafts teacher and an advocate of the use of crafts in OT and Thomas Bessell Kidner, who was the special adviser to the US government in the problems of rehabilitation. The most important investment was made by William Rush Dunton, Jr., who became president at the Second Annual Meeting of the Society in 1918. At that meeting, he explained the efficacy of occupational therapy, especially in treating shell shock, and mentioned the need for occupational workers for injured soldiers. Since then, he insisted on developing the main principles of Occupational Therapy, making the whole view of it clear to the people. Dunton believed that Occupational Therapy is vitally needed for everyone, so he wrote a reconstruction therapy at wartime in his book:

That occupation is as necessary to life as food and drink. That every human being should have both physical and mental occupation. That all should have occupations which they enjoy. These are more necessary when the vocation is dull or distasteful. Every individual should have at least two hobbies, one outdoor and one indoor. A greater number will create wider interests, a broader intelligence. That sick minds, sick bodies, sick souls, maybe healed through occupation. (Peloquin, 1990, p. 734)

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The wartime experience of occupational work confirmed the increasing need for such practices and their usefulness. It was even prescribed to “restore usefulness, overcome deformities or teach to the remaining portion of a limb or another member new functions” (Peloquin, 1990). World War I favored the development of occupational therapy in general. It induced the founders to decide the principles of occupational therapy and to determine the qualities, needed for the practitioners. Due to wartime, everything had to be settled in short terms because soldiers, lying in the hospitals, couldn’t wait. Thus, it appeared that the best candidates for such kind of work would be women with medical education, who understood the use of occupation, according to the demands of that time: «The war also caused a shift in the population that OTs worked with. Before World War I, the occupation had been used chiefly with the mentally ill. Afterward, however, the emphasis was put more on patients with physical limitations. The wartime experience with occupation used to restore physical function opened a new area of practice to the early practitioners in the field». (Punwar, 2000, p. 28)

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Despite the fact, that Occupational Therapy appeared in such extreme circumstances, its founders wanted it to be framed scientifically. Dunton (Peloquin 1990) reasoned that much had to be done before occupational therapy could be considered a science. At that time Dunton and his followers were mainly looking for answers, trying to find out, how people learned and what their motivations were. That’s why much of the early literature on occupational therapy centered on the latest researches in psychology and education.

Occupational Therapy as a Science

As much as Dunton wanted occupational therapy to become a science, Susan Cox Johnson always aspired to make it professional. Susan Cox Johnson studied and taught high school arts and crafts in Berkeley, California. In 1912 she moved to the Philippines and taught crafts there for two years. After she came back home, she got involved in the program of patient occupations for the municipal hospitals of New York. At that time she became interested in the connection between the crafts and the recovery of sick and disabled patients. After that, she accepted a position at Blackwell’s Island Hospital and became a director of the occupation committee for the Department of Public Charities of New York State. Due to that, she could observe the effects that occupational therapy had on her patients. Gradually, she ascertained that occupations could improve the mental and physical condition of injured patients and have a spiritually elevating influence. She maintained the restorative potential of occupation, and that was the first step that made her close to the new science.

Her work didn’t remain unnoticeable. It inspired George Barton to agree on both with her and the Occupational Therapy Society. Shortly after that Johnson started teaching occupational therapy at Teacher’s College of Columbia University. At the same time, she organized an occupational therapy department at Montefiore Home and Hospitals in New York. She started writing articles, regarding the training of personnel and the function of occupational therapy in the hospital. All five of them were published in Modern Hospital. As far as Johnson was a teacher herself, she always insisted on high educational requirements for practitioners, who had to be well-trained and competent. Afterward, she developed a course in teaching methods in occupational therapy and published a textbook for that. She wrote:

What seems to be a difference… is often not a real difference at all, but is a misunderstanding due to our failure to keep always before us the several natural divisions of our work and the different purposes, of each, as well as the fact that each must overlap and merge one into another instead of being separate and aloof. No standards for training teachers can be set without the recognition of these different elements. (Johnson, 1919, p. 221)

Johnson (1919) was the first person, who understood the meaning or the proper individual approach in occupational therapy. Due to that, she created different training programs, suitable for working with specific populations. She believed that people underestimate teachers’ work in this field and that was her primary concern: “great field of occupation would never bear full fruit until the dignity and importance of the position of the teacher in this field are recognized” (Johnson, 1919, p. 223). She also worried about how to combine a nurse and a teacher in one person. Later that led to the idea that teachers, specially trained for this work, quite could be non-medical people. But before that Johnson demanded all her occupational workers to gain all necessary skills for their work. She believed that all teachers of occupation needed “an understanding of the psychology of both normal and abnormal minds” and a grounding “in the principles and methods of teaching the sick,” regardless of their practice settings (p. 222).

Another specific feature of Johnson’s approach was that she raised the question of the quality of the patient’s work product. She wanted to “maintain high standards in the products of occupation” (Johnson, 1919, p. 223). Understanding that occupational therapy was a new field, she minded any hasty standardization, asking the Society instead to provide “practical aid to the teacher in maintaining the best standards in products” Johnson, 1919, p. 223). In response to her request the Society established in 1920 an occupational therapy bureau in Boston to investigate the market and sell products of occupation at a low price.

Occupational Therapy During the World War I

Finally one would notice that occupation therapy was something very expected during World War I. The founders shared a common belief that the right occupation could help people in need, and the War increased the number of such people with no time to delay. Examples of the early occupational therapy literature reflect each founder’s unique understanding use of occupation therapy. It shows that Dunton’s followers were divided by the type of training required to teach occupations. Some people believed that the main point was to know some craft; others considered medical education to be the most important, saying that most qualified were nurses.

Nevertheless, the thing that distinguished Johnson from many other founders was her background. After spending many years teaching crafts, she knew exactly how to organize and promote the standardization of occupational therapy. No one knows how this science would look like if Susan Johnson didn’t elaborate the principles of teaching, insisting on high educational requirements for practitioners, or didn’t develop the course in teaching methods in occupational therapy. Due to her views and questions, which arose from her competencies, she had a balanced view of occupational therapy as a part-medical, part-teaching function. That’s why her books would be useful for those who want to see the whole picture of those days’ therapy. A lot of current therapists might better understand their heritage of caring and compare it with current practices after reading Johnson’s books.

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