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Occupational Therapy International, 9(2), 111–120, 2002 © Whurr Publishers Ltd 111

Occupation reconsidered

CHARLOTTE BRASIC ROYEEN School of Pharmacy and Allied Health

Professions, Creighton University, Omaha, NE 68178, USA

ABSTRACT: The current article delineates the need for the profession of occupa-
tional therapy to maintain relevance and be responsive to current trends. As part of
such responsivity, this article proposes a reconsideration of the concept of occupation
as an ‘adaptive response’ to the current societal need for clarification regarding occu-
pational therapy. Reconsideration of what is meant by occupation for general use is
discussed and illustrated by the ambiguous use of the term occupation as both a
means and an end. Although occupational therapists are comfortable with such
ambiguous use because of their apparent ease with complexity, use of the term in an
ambiguous manner makes it harder for society to understand what is meant by occu-
pation. Related to this, an annotation of literature on the definitions of occupation is
presented in summary form. Furthermore, the political need to reconsider the term
occupation is argued in light of the revision of International Classification of Func-
tioning, Disability and Health (ICF), which includes the use of the word activity.
Finally, this article proposes that occupation should be considered as the process of
doing with meaning, and that activity should be the outcome. Such reconsideration
renders us consistent with ICF and paves the way to reduce ambiguity in the use of
the term occupation with the general public.

Key words: occupation, occupational therapy, professional development

Introduction
In order for a profession to maintain its relevance it must be responsive to the trends of
the times (Finn, 1971: 209).

This statement is as true now as it was nearly 30 years ago: responsivity is

necessary for professional relevance. In 1978, Lorna Jean King introduced
the concept of the science of adaptive responses as a cornerstone of the
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112 Royeen

profession of occupational therapy: this article is submitted as theoretical

discussion, a ‘professional-level’ adaptive response to trends in rehabilita-
tion as well as the general lack of knowledge about what occupational
therapy is and what it can do. The adaptive response would be for each of
us as occupational therapists to reconsider just what occupation really
means and how we use the term.
The dictionary definition of occupation follows: ‘An activity in which one
engages . . . a way of passing the time . . . the principal business of one’s life’
(Webster’s Third New International Dictionary, unabridged, 1993: 1560).

Occupation

Occupation-centred practice is the focus of occupational therapy (Nielson,

1998; Toth-Fejel et al., 1998; Wood, 1998) and is instrumental in curricular
reform in occupational therapy (Wood et al., 2000). It is, however, difficult to
define, apply and research – as well as lobby for – occupation-centred educa-
tion and practice when a clear understanding of the term occupation is
lacking. Thus, one of the key challenges facing occupational therapy, and
occupational therapy education, is to come to terms with the profession’s own
use of key terminology such as occupation. Regarding occupation, occupation-
al therapists have been attempting to define the word, and hence ourselves,
ever since the field began. Many will react to this article with a dismissive
thought such as, ‘Oh no, here we go again!’ or, ‘When will the field simply
move forward?’ or, ‘The politics of language are not critical!’
An invitation to reconsider and think about exactly what is meant by
occupation is put forth, because, as humans, our thoughts are expressed as lan-
guage. And language shapes actions and politics. Thus, let us think about
occupation as a term because our use of it shapes societal politics and actions.
This charge is consistent with Hocking (2000) and Gray’s (1998) work related
to one focus of occupational science’s scholarship in defining occupation.

Occupation and the means/end dilemma

Occupation as currently used in the field makes use of the term as both ‘means
and end’ (Hasselkus, 2000: 127) or as a process as well as a product or out-
come. Occupation as a process, or as a means, refers to occupation as a
method of intervention (Rebeiro and Cook, 1999), as a dynamic aspect of
engagement in life and as an unfolding of interaction between a person and
the world. Occupation as a product refers to the outcome of the process of
engaging in occupation. In this use of the term, a state or condition such as
being a mother or being a gardener is described. The use of term in this latter
sense connotes a static condition.
Use of the word occupation by occupational therapists exemplifies our
longstanding values epitomizing complexity. Complexity refers to the dynamic
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Occupation reconsidered 113

process of becoming (Porush, 1991: 61). It seems that occupational therapists

are comfortable with complexity, and therefore we live comfortably with the
ambiguity of occupation as both a means and an end. As Hasselkus (2000:
128; emphasis in original) identified, we occupational therapists ‘have no
trouble conceptualizing occupation as means and ends!’
What we mean by ‘occupation’ is very clear to us as occupational therapists.
Yet, what we mean is not clear to those outside of occupational therapy, such as
the general public, third-party payers, other healthcare professionals, teachers
and so on. Research suggests that what we mean by the term is not even clear to
the clients whom we serve (McAvoy, 1992). We are, therefore, challenged by a
political reality: occupational ambiguity! Occupational ambiguity refers to our
profession’s use of the term occupation in an ambiguous manner (as a process as
well as a product), which diffuses and obfuscates long-needed public clarifica-
tion of what we do and how we do it (Royeen and Marsh, 1988).
The ambiguity of the word occupation is acknowledged by many (Nelson,
1988; Clark et al., 1991; Breines, 1995; Lin et al., 1997; Wu and Lin, 1999).
Furthermore, as part of a larger study into informal neuroscience education
with children (Zardetto-Smith et al., 2000), preliminary study of children’s
perceptions of what occupational therapists do, closely related to perceptions
of what the term occupational therapy means, reveals that children, for the
most part, have no idea whatsoever of what is meant by ‘occupational thera-
py’ (Royeen et al., 2001). It is clear that occupational ambiguity is a problem
for society in general, if not for the profession.

The dilemma: Is it occupational ambiguity or ambiguity of terminology?

The question may be posed: Do we really have occupational ambiguity or sim-

ply ambiguity of terminology? My answer is that it doesn’t matter since the end
result is the same. That is, it has been my experience that the general public as
well as most professionals have a limited, confused, or wrong conceptualization
of occupation and occupational therapy. That is hardly an auspicious state of
affairs for occupational therapy as we enter the 21st century.

Literature review: Chronological annotation of the term occupation as used

in occupational therapy literature

A selected review of the use of the term occupation in the occupational ther-
apy literature is provided in the next section of the paper.1 Review of journal
articles in occupational therapy produced the following annotation of defini-
tions of occupation, which is presented in chronological order in Figure 1.
Review of this annotation reveals a longstanding dilemma for occupational
therapy: lack of a consistent, clear and cohesive focus on what constitutes
occupation for use by society.2 Such a lack lends credence to the need to
reconsider our use of the term occupation.
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114 Royeen

Political need to reconstruct use of the term occupation

The field of occupational therapy may benefit from re-examining the tenet of
occupation-as-means (process) and occupation-as-end (product) for very prag-
matic, political reasons. During the July 1999 American Occupational
Therapy Foundation Consensus Conference in Asilomar, CA, Dr Don Lollar
from the Office on Disability and Health, Centers for Disease Control and
Prevention in Atlanta shared his view on a fundamental problem preventing
occupational therapy from moving forward in the public eye. He challenged
the field’s use of the term occupation, identifying that we use it in an ambigu-
ous manner – for example, as a process as well as a product. He identified that
it adds to the general confusion and misunderstanding of what occupational
therapy is. He suggested that practitioners of occupational therapy clarify
what is meant by the term occupation and use it to refer to either a product or
process, but not both (Lollar, 1999). I humbly suggest that it behooves our
field to take Dr Lollar’s comments most seriously and deliberate on what he
suggests, as well as the implications thereof. Regardless of our internal scholar-
ly debate and development, the public persona of, and communication from, a
profession should clarify a term and not confuse it. Currently, our use of the
word occupation obfuscates it in the public eye.
Dr Lollar’s suggestion has not been acted on. The field of occupational thera-
py is challenged to consider Dr Lollar’s sage advice and enact a necessary political
strategy and clarify what is meant by the term occupation. Reconsideration of
our language in reference to others is essential, particularly in regard to the Inter-
national Classification of Functioning, Disability and Health (ICF), over which
Dr Lollar has been instrumental. This challenge is created by (1) the aforemen-
tioned ambiguity of occupation-as-means and occupation-as-end, and (2) our
equivocal use of the respective terms of occupation and activity. The difficulties
surrounding the terms activity and occupation will now be addressed.

Activity

Activity is one of the four main classification sections in the ICF (the others
being body structure/function, participation and environment) (Lollar, 1999).
The purpose of the ICF is to provide a global, common framework for users
and professionals in rehabilitation services (Stagnetti and Unsworth, 2000).
Great confusion and confounds are likely to occur if occupational therapy
maintains that ‘activity’, be it purposeful or otherwise, is the exclusive domain
of occupational therapy. This is postulated to be true because the ICF is an
international, interdisciplinary categorization to be used by all professions for
(1) describing correlates of health conditions, (2) using a common language
across professionals and consumers, (3) developing a coding scheme for health
information, (4) comparing data across cultures and countries and over time,
and (5) collecting data on facilitators and barriers limiting participation and
OTI 9(2)_3rd/crc 10/5/02 12:48 PM
Reference
Clark et al., 1991: 300
Clark et al., 1991: 300
Katz and Sachs, 1991: 38
Law, 1991: 171–9
Peloquin, 1991: 352–60
Lang et al., 1992: 608
Wilcock, 1993: 18
Yerxa, 1994: 587
Ambrosi and Schwartz,
1995: 828–32
Breines, 1995: 459
Christiansen et al., 1995: 1015
Trombly, 1995: 961
Wood, 1995: 45
Law et al., 1996: 9–23
Nelson, 1997: 12
Crabtree, 1998: 205–14
Fisher, 1998: 509–12
Hasselkus, 1998: 430
Page 115
Occupation reconsidered 115
Definition of occupation
‘Occupations are ordinary and familiar things that people do everyday’
‘Chunks of activity that are normed in the lexicon of the human
culture, that are characterized by active participation, and that hold
personal and socialcultural meaning’
‘Whereas occupation, which comprises self care, work, and play/leisure,
is the purposeful activity’
‘Occupation is defined as groups of self directed, functional tasks and
activities in which a person engages over the lifespan’
‘Occupations are from work, play, self care’
‘Occupation allows for therapeutic exercise as well as the personal
satisfaction gained from completion of the project’
‘Occupation is the mechanism by which individuals demonstrate the
use of their capabilities by achievements of value and worth to their
society and the world’
‘Occupation, as engagement itself – initiated, self directed, adaptive,
purposeful, culturally relevant, organized activity’
Occupation ‘was viewed as people going back to work around
the 1970’s’
‘Occupation, representing the consensual aspect (?). This third aspect
is often described in terms of vocation or work, but also represented
interactive play or other endeavors in which one collaborates,
completes or otherwise engages with or for others in socially
responsible behaviors’
‘Occupation has been used to refer to an individual’s active
participation in self-maintenance, work, leisure, and play’
‘Occupations are the ordinary and familiar things that people do
everyday’
‘Occupations can be broadly explained as having both performance
and contextual dimensions because they involve acts within defined
settings’
‘Basic unit of occupation is activity’
‘That is, as first expressed by occupational therapy’s founding
philosopher, Adolph Meyer (1922), it is through engagement in
occupation, and hence through an orchestrated balance of the daily
temporal rhythms of work, rest, play, and sleep, that persons are able
to solve the problems of adaptation that continuously arise in daily life’
‘Defined as those clusters of activities and tasks in which the person
engages in order to meet his/her intrinsic needs for self
maintenance, expression and fulfillment’
‘Occupation is defined as the relationship between occupation form
and occupational performance’
‘Occupation is intentional human performance organized in number
and kind to meet the demands of self maintenance and identify in
the family and community’
‘The term occupation is a noun of action. Occupation is defined as
the action of seizing, taking possession of, or occupying space or time.
It is also defined as the holding of an office or position, such as one’s
role. Finally, in the sense of action, occupation refers to the being
engaged in something’ (referencing the Oxford English Dictionary, 1989)
‘Occupation is activity that is both meaningful and purposeful to the
person who engages in it’
‘The occupation itself, that is, the activity that takes place within
that space is the occupational place’
Continued
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116 Royeen

Yerxa, 1998: 366 ‘Occupation may be organized into a view of the human as a
multileveled, open system acting upon and responding to the
environment over a developmental trajectory, from birth to death’
‘At the cultural level occupation refers to the units of organized
activity within the ongoing stream of human behavior that are
named and classified by a society according to the purposes they serve’

FIGURE 1: A selected, chronological annotation of the term ‘occupation’ in the occupational therapy
literature, 1990–2000

activities of those who have disabilities. Furthermore, nursing (Breur and

Anderson, 2000), education (Brigham and Snyder, 1986) and physical thera-
py (Veda and Shimada, 2000) are increasingly looking at activity as a concept
and as a function.
Activity is defined as ‘the quality or state of being active’ (Webster’s Third
International Dictionary, unabridged, 1993: 22). It may be time for occupation-
al therapy to better serve society by viewing ‘activity’ as the outcome of the
process of occupation: multiple disciplines have valid interests in activity and
its measurement. In this way, occupation-as-process would remain the unique
domain of occupational therapy and a legitimate discipline of study. Without
such differentiation, the already-ambiguous notion of occupation may become
even more confused in relation to the term activity.

Occupation reconsidered

Occupation is occupational therapy’s powerful, unique, intervention or tool.

As Anne Fisher stated in her 1998 Eleanor Clarke Slagle Lecture, ‘Our
uniqueness lies in our use of occupation as a therapeutic agent’ (Fisher, 1998:
509). The power of occupation as an intervention tool should no longer be
mitigated or compromised with confusion about it as an outcome or end state.
Rather, the outcome of occupation should be congruent with the ICF cate-
gories and be discussed in terms of ICF terminology resulting in outcomes
such as activity and participation. This would align use of the term with the
mainstream of the United States, and – in fact – the world in reference to
ICF.
It is, therefore, time to remove occupational ambiguity in thinking and in
practice. Let us refrain from using the term occupation as an outcome and
focus on it as a process, an intervention or what has been termed authentic
occupational therapy (Yerxa, 1996). To reduce ambiguity and equivocacy,
occupation, as used by occupational therapy and as understood by the com-
mon person, should refer to occupation as the process of doing with meaning.3
More clearly, activity and participation should be the observable outcomes of
the process of occupation. This would be one more step in the ‘explication’ of
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Occupation reconsidered 117

the idea of occupation identified by Yerxa (1998: 365). As further identified

by Rebeiro and Cook (1999: 176), ‘Occupational therapy practice is based
upon the belief that the use of occupation-as-means can promote the health
and sense of well being of individuals with disability’. ‘Occupation as a medi-
um of change’ (Wood et al., 2000: 590) is the profession’s strength and we
should promote it. Such a radical change in occupational therapy’s use of lan-
guage could help crystallize its public face to the world.

Implications for the proposed solution to the profession

What conundrum might result if, indeed, the profession of occupational ther-
apy uniformly adopted conceptualization of occupation as a means or process
and activity as the observable outcome of the occupational process? I don’t
know.
What I do know, however, and how I know it is reminiscent of the role
intuition and emotional knowing plays in human survival as discussed by
Damasio (1999). That is, according to Damasio, our survival skills give us cer-
tain non-conscious abilities to determine a correct choice of actions for our
survival as an individual. So, too, I believe that focus on occupation as the
process of doing with meaning, with activity as the observable outcome,
would allow occupational therapy to refocus and refine its public image for
the survival of the profession in service to society.
Reconsideration of occupation in this way renders it dynamical, free of
temporality and truly unique. It would require that the field give up trivial-
ization of occupation as a thing or event, and acknowledge the
phenomenological aspects of the occupational process. Such a reconstruction
would require major change on the part of occupational therapy. Without it,
however, we may be condemning ourselves to perpetual confusion and isola-
tion.

Conclusion

This article has put forth an argument for the need to reconsider the notion of
occupation to reflect occupation-as-means or as a process with activity being
the end product. By doing so, the transformational nature of occupation
would have increased legitimacy and ambiguity surrounding the term would
be reduced. To summarize, Figure 2 presents core constructs about occupation
and activity germane to this article in a conceptual manner.
Finally, research in occupation-as-means such as exemplified by the study
by Rebeiro and Cook (1999) is where the future of occupational therapy lies.
The goal of this article is to assist in forming an adaptive response to get there,
by inviting reconsideration of our conceptualization of the term occupation to
increase clarity and ease of understanding on the part of the general public.
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118 Royeen

Occupation as process Activity as product

= activity + meaning = occupation - meaning

= covert = overt
= doing + purpose = doing with or without purpose, internal feelings
not germane
= grounded in meaning + relevance = manifestation of one dimension of occupation
= unique to occupational therapy = common to many professions or disciplines
= transformational = an occurrence
= means = end

FIGURE 2: Summary concepts for reconstruction of occupation and activity

Limitation

This theoretical review of occupation has been limited to English. Those who
communicate in languages other than English will have to determine the
applicability of this discussion and call to action for their own language.

Acknowledgements
This article was based, in part, on a paper presented at the Educational Spe-
cial Interest Section (EDSIS) Workshop, American Occupational Therapy
Association Annual Conference (29 March 2000). Sincere appreciation is
extended to my former research assistant, Tanya O’Callaghan, whose library
skills have been invaluable.

Notes
1. Only peer-reviewed articles published in English-language journals in occupational therapy
indexed by CINAHL since 1990 were used. Only those definitions of occupation that oper-
ationalized occupation in some way were used and the best or clearest examples of
occupation defined were then selected for the annotation. Textbooks were not a source of
definitions.
2. Please note that this article addresses the need for a general understanding of occupation. It
is beyond its scope to address scholarly definitions for use in research and theory. Please
refer to Wu and Lin (1999) for such an analysis.
3. This definition has evolved out of the author’s 25 years of practice, education and research
in occupational therapy.

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Address correspondence to Charlotte Brasic Royeen, PhD, OTR, FAOTA, Associate Dean for
Research and Professor in Occupational Therapy, School of Pharmacy and Allied Health Pro-
fessions, Creighton University, 2500 California Plaza, Omaha, Nebraska 68178, USA. Email:
croyeen@creighton.edu