In this paper, I will consider occupational science as a key to broadening

horizons in occupational therapy. I start by clarifying and defining what

occupational science is, and discuss the benefits that rigorous study of humans
as occupational beings may bring to occupational therapy.
I suggest that adopting occupational science will assist occupational
therapists to think in occupational rather than medical terms. This alone would
extend the profession’s domain of concern considerably, because it becomes
clear that it is not only the people with disorder of body or mind who are
occupationally handicapped. Humans have `occupational needs’ which are
related to maintaining health, and many health outcomes, either good or bad,
can be traced back to basic occupational determinants that people have created
over time.
Our twentieth century founders recognised that we needed such a science
and, even earlier, social philosophers wrote of its importance. If occupational
therapists work as agents of change according to a sound knowledge base built
upon the unique aspect of life and health which is their domain, they will be able
to respond and develop according to rapidly changing economies and values.
This keynote address was given on 4 July 2001 at the 25th Annual
Conference of the College of Occupational Therapists, held at the University of
Wales, Swansea.

Occupational Science: the Key to

Broadening Horizons
Ann A Wilcock

Introduction
I had a dream – on the morning of 14 December 2000.
I was in a meeting. A high-powered meeting around a
table in a university, and occupational therapy had been left
out of a committee which was planned to deal with
intervention for a group of people with some specific
problem that had been in the too-hard basket for a long,
long time. As is often the case in dreams, what the problem
was is forgotten and immaterial.
Other health science therapists had been invited to take
a role on the committee, but the chairman scarcely listened
when the senior occupational therapist claimed that her
profession should also be represented. Despite some support
from other members around the table, after both the senior
and I had tried again to propose that we had something of
value and significance to add, it was to no avail.
It was the age-old story. As other therapists were on the
committee, it was obviously not the therapy part of our
calling that was causing the problem. It had to be the
occupation bit. Once more we were being pigeon-holed by a
misunderstanding of the domain of our concern and our
inarticulateness, caused, in large part, by the complexity of
what we do and because we have failed to develop a
language or sufficient understanding of the occupational
needs of people to articulate it clearly.
In my dream, I was briefly given that gift. I asked for one
last chance to speak. I said something like this:
n We are all, at the moment, engaged in an occupation.
When we leave this room, we will go on to others
throughout the day. The rest of our days will be filled
with a plethora of doing. Some occupations will be
complex, like this; others will be simple. Some will
provide physical exercise, some the use of language,
some complex cognitive activity and thought, and some
sharing with others, but they are not simply made up of
those capabilities or more obvious needs. They are a
complex mixture, which provides meaning, purpose,
structure, contentment and happiness as well as the
other requirements of life and health.
Occupation is so complex yet so fundamental to life
that I am not surprised that it has taken longer than
other areas of thought to achieve the recognition that it
requires a discipline with regard to its own study. Yet it
forms a part of all other disciplines’ ideas, because
occupation is what people do minute by minute, hour by
hour, day by day, week by week and year by year.
Throughout time, long before the advent of medical
science, what people did was central to their state of
health. Early physicians recognised the link, yet they
could only deal with parts of it, and they divided it into
rules which dealt with particular, simpler and more

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 obvious factors, such as what people should eat or drink,
when and for how long they should sleep, the quality of
the air they should breathe, and the whys and hows of the
simple exercise and activity that the people should follow.
This was called the Regimen Sanitatis – Rules for Health.
All therapies are complex and, in terms of the length
of time people have lived on earth, it has taken
thousands of years for their sciences to be articulated.
Occupation is even more complex, and fundamental,
and so has taken even longer to get to the point at which
people have realised that it needs serious study because
it is so important. This committee needs to include
occupational therapists who will bring this science with
a new perspective to solving the problem.
I woke up – and still do not know if we got put on that
university committee.
What were the issues in that dream?
n There was the difficulty that occupational therapists find
in explaining their professional difference
n There was the lack of appreciation from other people
about what occupation had to offer
n There was a notion of its antiquity and the fact that it
pre-existed many other disciplines of thought
n There was mention of its links with health
n There was the erroneous notion that occupation is
ordinary and simple when it is amazingly complex, even
though it is a part of the everyday ordinary life of every
person.
Occupation is a ‘paradox’ – in the words of W S Gilbert
– ‘a most intriguing paradox’. Occupational science is the
study of that paradox, and in the words of A A Wilcock – a
most intriguing science. I believe that that intriguing science
is the key to broadening the practice of occupational
therapy: in attempting to research and study the paradoxical
issues of, for example, what is work for some is rest for
others; what is interesting for some is boring for others;
what makes some people feel alive and special is deadly
boring for others; why some children thrive on painting
pictures and others want to climb trees; and why some aged
persons work happily until they die, others die when they
stop work, and others cannot wait for a chance to play.
To suggest how we should go about finding some
answers to the paradox, I shall talk about what occupational
science is, how it evolved, how it fits into the profession,
how it relates to health and its potential place in the world.
What is occupational science?
So what is occupational science? In clarifying what it is, it is
useful to start with what it is not. It is not a frame of
reference or a model of practice, as some people have
supposed, but an emerging discipline first envisaged at the
University of Southern California, and named by Elizabeth
Yerxa. A discipline, in this sense, is a branch of knowledge.
As a discipline, occupational science does not belong to any
one group or person, and will grow according to research
that extends its foundation knowledge which, on the whole,
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has been drawn from occupational therapy beliefs and
philosophies.
To understand further what it is, it is helpful to consider
what the words ‘occupation’ and ‘science’ mean. Most of us
would understand that, in this case, the word ‘occupation’ is
used to include all the things that people do. If we read all
the various descriptors that occupational therapists have
used, we realise that occupation can be defined in many
different ways because it is so complex. All add some
viewpoint for further discovery.
Occupational scientists have made inroads into such
discovery and exploration. One of these that I believe is
useful is McLaughlin Gray’s (1997) finding that the essence
of occupation is that it is goal directed, carries meaning, is
repeatable and is perceived as ‘doing’ by those engaged in it.
My own historical studies have led me to the view that
occupation is more than ‘doing’. At the World Federation of
Occupational Therapists’ (WFOT’s) International Congress
in 1998, I described it as a synthesis of doing, being and
becoming. As one of my Master’s research students put it, ‘It
is through doing that people become what they have the
potential to be’ (Archer C, personal communication).
My research has also pointed to the importance of
recognising that occupation is not only engaged in by
individuals. Occupation is carried out at family, community,
national and international levels, for cultural, social and
political purposes. It is the biological mechanism for human
health and survival and, therefore, all people have inbuilt
needs to engage in occupation. We are, in fact, all
occupational beings.
I have found that for many people when they are
thinking about occupational science, the word ‘science’
tends to be the stumbling block. It immediately conjures up
the laboratory scientist concentrating upon finding the
absolute truth to complex but usually minute questions,
according to strict rules and procedures. Occupational
therapists, who like to think about the ‘art’ of therapy and
have always had a tendency towards holism and the
pragmatics of ‘real life’, often feel uncomfortable with
‘science’ of this kind. But the original meaning of science is
knowledge that has been accumulated through systematic
and rigorous study, and it is the gathering of ‘knowledge’
that is the meaning given to the ‘science’ in occupational
science. The simplest definition of occupational science,
then, is that it is the rigorous study of humans as
occupational beings (Yerxa et al 1989).
While this is easy to say, and is becoming part of the
rhetoric of our profession, when one tries to understand the
depth of this definition we find that it is anything but simple.
At the very least, it suggests that engagement in occupation
is an innate behaviour; that it is an integral aspect of
humanness; that it may even define humanness; that doing
and being have an intimate relationship; and that
occupation has evolutionary and biological as well as social
functions. Indeed, this definition touches on some of the
most fundamental theories suggested, or questions asked, by
scholars of many disciplines throughout recorded human
history. I will mention the ideas of John Locke as an example.
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9, 2015 of Occupational Therapy August 2001 64(8) 413
 One of the most respected of the new age English
philosophers, John Locke (1632-1704), called by some the
father of psychology, influenced modern concepts of liberal
democracy and education. In the case of the latter, he
advised a broad curriculum which demonstrated an
understanding of the breadth of human occupational
capacities, and the need to enable children to learn to
balance their own particular talents. Indeed, well ahead of
his time, he recommended the inclusion of artistic, cultural,
domestic and handiwork subjects, and physical exercise,
whilst children were assisted to develop ‘satisfactory
characters, and good judgments, habits and manners’
(Macdonald 1981, p73).
Locke obviously studied his subject in terms of day-to-
day life, in An Essay Concerning Humane Understanding,
making rare but commonsense recommendations to do with
people accepting themselves as they are, making the most of
their talents and skills, and not hankering after what is out
of reach and impossible to attain. He advised:
...it will become us, as rational Creatures, to employ our
Faculties about what they are most adapted to, and follow the
direction of Nature, where it seems to point us out the way. For
’tis rational to conclude, that our proper Imployment lies in
those Enquiries, and in that sort of Knowledge, which is most
suited to our natural Capacities, and carries in it our greatest
interest, ... (Locke MDCXC, p327).
In terms of a science of occupation – Locke made a plea
for what he considered to be the right approach for the
acquisition of knowledge and ‘scientific’ understanding,
which would eventually benefit humankind. He defined
science as the means to explore, discover and understand
the whys and wherefores of the world as far as it was
possible, and argued that it could be divided into three
distinct fields. His ideas differed somewhat from what would
be considered mainstream science in the present day, and
underlines his basic rationale – that science should add to
knowledge in a way that betters the human experience. The
three sciences he recommended included, in closest to
modern-day terms, biological science, communication
science and occupational science:
All things that can fall within the compass of humane
Understanding, being either,
First, [Biological science]
The Nature of Things, as they are in themselves, their
Relations, and their manner of Operation:
Or, Secondly, [Occupational science]
that which Man himself ought to do, as a rational and
voluntary Agent, for the Attainment of any Ends, especially
Happiness:
Or, Thirdly, [Communication science]
The ways and means, whereby the Knowledge of both the one
and the other of these, are attained and communicated;
I think, Science may be divided properly into these Three sorts.
(Locke MDCXC, p361).
The one that resembles occupational science, he called
ethics.
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Locke was not alone in recognising the importance of
what people ‘do’ in more than economics. Many other
important figures in history did too. Why, then, I ask, is our
philosophical base such a well-kept professional secret?
I suggest that we have been tight-lipped because we have
not studied humans as occupational beings and do not really
understand what that means. Look at most of the knowledge
base subjects in our undergraduate education programmes.
The subjects that the academics who develop curriculum
took as occupational therapy students are often similar to
the core subjects or philosophical underpinnings in today’s
programmes. Those did not include subjects related to a
science or a philosophy of occupation and, mostly, that
remains the case. Instead, anatomy, physiology, psychology,
sociology and perhaps anthropology provide our
disciplinary knowledge base. Occupation has largely been
taught in subjects applied to the medical model or been of a
purely practical nature. While subjects of that kind are
important, they give more credence to knowledge external
to our domain of concern.
Many occupational therapists cannot explain effectively
what the occupation part of our title has to do with health;
many of us have wished that we were called something
different; and, indeed, some welcome being described in
other ways, such as hand therapists or sensory integrative
therapists. This scenario says to me that we need occupation
knowledge base subjects as well as applied occupational
therapy subjects. This means that we need to assemble into
a logical theoretical whole what we do believe about
occupation in relation to people and health: we need to test
it, share it, and develop it further for evermore. We need a
science of occupation as the primary knowledge base of the
profession, in which occupation is so central that it forms
part of its nomenclature.
How did occupational science
evolve and how does it fit into
occupational therapy?
So how did occupational science evolve, what are its roots,
and how does it fit into occupational therapy? The founders
of the world’s first Occupational Therapy Society recognised
that the profession needed such a science; that it was one of
the keys to the continuing development of the profession.
Many of you will recall from studies about the history of
occupational therapy the objectives of the National Society
for the Promotion of Occupational Therapy in the USA in
1917. Let me draw them to your attention once more. They
were:
the advancement of occupation as a therapeutic measure;
the study of the effect of occupation upon the human being;
and the scientific dispensation of this knowledge
(Constitution of the National Society for the Promotion of
Occupational Therapy, Inc. 1917, p1).
These objectives suggest that those founders saw the
profession developing a unique or distinctive perspective,
which would provide three keys to a practice that could be
useful to all people and not just those in medical care.
We lost, or set aside, two of those keys almost
immediately. In order to use the other – ‘the advancement of
occupation as a therapeutic measure’ – we were forced to
use others’ keys. In the beginning, many of these were
provided by social activists, philosophers and
educationalists, and from these earliest days we expected
and still expect the medical profession to open doors. In
more recent times, we have sought access to practice
through keys held by psychologists, sociologists,
neuroscientists and other health professionals. In fact, we
have become so good at looking for keys, and at adaptation
when we think that we have found one that nearly fits, that
we no longer know that we need our own keys. Mostly, we
fit into a practice situation snugly and competently, adopting
whatever its chosen philosophy might be along with its
orientation to occupation.
Some of the reasons for this lie in our history. It is
possible to trace occupational therapy’s origins:
n From pre-history and biblical history as a form of self-
health
n From classical and renaissance medicine which valued
occupation as exercise
n From the mix of ideas about people’s need to use their
particular talents to grow and flourish which emerged
during the renaissance, the enlightenment, moral
treatment, the settlement movement, socialism and the
arts and craft movement.
George Cheyne, a physician who wrote self-health texts
in the 1700s, for example, wrote:
We proceed in the next place, to the consideration of exercise
and quiet, the due regulation of which is almost as necessary to
health and long life as food itself (Cheyne 1724, p89).
Cheyne not only made that statement, which was later
picked up and paraphrased by Dunton, one of our American
pioneers, but also demonstrated a scientist’s approach when
he observed in relation to scholarly occupations:
All the Nations and ages have agreed that the morning season
is the proper time for speculative studies, and those
employments that require the faculties of the mind. For then
the stock of the spirits is undiminished, and in its greatest
plenty; the head is clear and serene, the passions are quieted
and forgot (Cheyne 1724, pp85-86).
Although directly influenced by ideas from those early
times, occupational therapy also came into being, in its
present form, because of change in social institutions,
activities and values towards helping the handicapped at the
end of the nineteenth century and early in the twentieth, as
a result of the horrors of industrialisation, the rise of
education, proto-feminism, and action taken to overcome
the effects of a world war. Our founders, and early
therapists, who were, on the whole, female, accepted the
inevitability of their world as it was, and against that
background sought to revitalise the lives of the sick by
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occupations that they believed would remediate mental or
physical illness. At the same time, they established the
tradition of occupational therapists working within a
medical model, under the direction of doctors (Dunton
1913, 1917).
By taking such action, and despite their enormous
commitment to establishing practical ‘occupation-based’
programmes fitted to the needs of the day, the exploration of
humans as occupational beings and the impact of this on
health was lost at this very early stage of our growth. It is
still an unknown.
The re-emergence of
occupational science and how
it relates to health
Occupational science re-emerged as an issue in our
profession at the end of the 1980s. In some ways it can be
seen as a manifestation of some leaders in the field,
principally academics, envisaging the need for a return to
our fundamental beliefs and purposes. Others saw it as
another model or frame of reference in competition with
their own, or rejected the whole idea because they saw no
need for a specific foundation science or disliked the notion
of ‘science’ because of its ‘reductionist’ nature. Those who
supported it saw the science as one way to halt the potential
disintegration of occupational therapy.
Occupational therapy’s adaptability had made it
vulnerable to changing and diversifying practice to such an
extent that its uniqueneness was becoming blurred and hard
to recognise from the offerings of a mass of other health
professionals. Some therapists welcomed this blurring to
eliminate the difficulty in articulating what occupational
therapy has to offer. From an external, political point of
view, the appearance of generic health scientists suited the
purposes of the economic rationalist policies of today.
Fortunately, today, as a result of work by people such as
Reilly, Yerxa and Kielhofner, many of us have recognised the
need to conceptualise the value of occupation to health as a
major part of the study of humans as occupational beings, to
become occupational scientists or to combine occupational
therapy and occupational science. Occupational science is
now being developed by occupational therapists in many
parts of the world. There are specific societies in Australasia,
the USA and the UK and an overarching International
Society of Occupational Scientists. There is also an advisory
group to WFOT, which is the first of such advisory groups.
The potential place of
occupational science in the
world
This leads me to consider what occupational science’s
potential place in the world could be. With a global
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9, 2015 of Occupational Therapy August 2001 64(8) 415
 perspective it is important to ask: what benefits does
occupational science hold for the future wellbeing of our
planet and its peoples?
The way I see it, occupational scientists study people’s
occupational natures across a broad spectrum of concern,
that is, they explore any other perspective, philosophy or
idea from the point of view of the human need for
occupation (Wilcock 1991). So, for example, they
reconsider, research and advise on politics, spirituality,
education, social structures, science and technology, the
media, work, growth, development and creativity, and
health from an occupational perspective. If they are
thorough, that will encompass reductionist as well as
holistic perspectives and exploratory methods.
So, for the discipline to grow and develop most
effectively and quickly, it would be best for it to be studied
internationally across many disciplines. Some interest by
other discipline groups is apparent, in part through the
Journal of Occupational Science and occupational science
symposia, which have encouraged important scientists from
other fields to contribute. These have included political,
ecological and social scientists, human geographers,
physicists, anthropologists and psychologists. Occupation
crosses so many boundaries that there are hardly any areas
of study which could not contribute to what is essentially a
new way of looking at the world and its peoples. It is a new
perspective which has much to offer in the next century.
Present social and political thinking largely fails to
acknowledge a human need for occupation for its own sake,
apart from paid employment for monetary reasons. In fact,
an economic perspective of life has been imposed upon
everyone. Even we consider occupation and health, along
with everything else, from a material perspective. People,
occupational therapists, have often told me to get real and to
think of the economics of the situation, to accept a less than
satisfactory outcome because that is how it is. But I am an
occupational therapist and an occupational scientist and my
job is to consider the occupational consequences of any
situation and to enable occupational health to the best of my
ability: to fight for people’s occupational rights and
occupational health.
As well as this economic perspective, most health
workers, including occupational therapists, consider health
from the perspective of medical science. Medical science
values are so integral to the post-industrial culture’s thinking
that it is difficult for those brought up in such a society to
perceive health from other than this perspective. Because of
the dominance of this medical science view of health, it is
seldom that adequate recognition is given to the health-
promoting effects of occupational wellbeing or to the
susceptibility to ill-health that results from occupational
injustice, deprivation, alienation or imbalance.
Medical science looks at parts of occupation from its
reductionist viewpoint, and for direct cause and effect
relationships, but not holistically and not from an
occupational needs point of view. With a well-developed
and well-researched background, it will be possible in the
future for us to make a significant and complementary
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contribution to medical science which challenges it from a
different perspective entirely. This would place us in a much
stronger position to increase awareness of the importance of
occupation to health than our present supplementary role,
which is dependent on others’ domains of concern.
Additionally, to make sure that individuals and society are
enabled to engage in occupations for health, it is imperative
for us to promulgate broadly information about humans as
occupational beings and the health consequences of this.
We need to establish ourselves as advisers at all levels of
society to increase awareness and understanding. However,
this is a huge undertaking and I think it is fair to say that
most occupational therapists, in the past, have been poor at
proclaiming our distinctive views whenever legislative
change or departmental policy have compromised them.
There is such a lot to do. If we do adopt occupational
science as the discipline upon which our profession rests, it
will not, necessarily, be a comfortable seat. I suspect we will
find that, in the future, we have many contradictory and
competing as well as compatible theories, which together
give us some understanding of our occupational natures.
Contrary to many who seek a single and simple model for
our profession, I think this would be great. Today, for
example, it must be understood that I am giving you part of
my version of which doors occupational science keys could
open. Other occupational scientists would provide different
keys.
In this way, we stand in the tradition of other disciplines,
such as psychology which started from a clinical base and
became recognised as having prime importance in almost
every other sphere. Who, for example, would expect
Skinner, Maslow or Csiksentmihalyi to offer the same keys
to psychological practice? We can only benefit from diverse
growth and the development of a multiplicity of ideas. Then,
instead of adopting other disciplines’ ideas in entirety, we
can view and analyse them from our own occupational
perspectives and offer distinctive opinions to not only our
traditional client group but also the general population, as
well as to political, medical and social planners. This, I am
sure, is what our founders intended to happen from the first
if we had not mislaid the keys.
Occupational science can inform traditional practice, but
it can also provide a point of departure towards adventures
into the world of enabling occupation to enhance and enrich
the lives of many who are experiencing occupational
dissatisfaction. This may be at a personal level using a
wellness approach, which is a useful model to consider in
conventional practice venues such as hospitals, as well as in
the wider community.
Working at a personal or community level, a preventive
approach may be appropriate not only in the obvious
occupational health and safety venues but in the public
health arena, looking at the underlying occupational
determinants which lead ultimately to disease, disability,
handicap or death. What, for example, are the occupational
experiences of people who later develop addictions and
what was it in the occupational structure of societies that led
to such experiences? Also at community levels, an
 occupational It is possible to argue that as occupational therapy is
approach might essentially a highly developed practical skill operating through
be taken to another discipline such as medicine, we could be better defined
enable in this way. However, to be called a technocrat casts certain
communities to aspersions upon our endeavours for it implies a certain
overcome narrowness of outlook and an ignorance of the broader issues
occupational at stake. But by calling ourselves ‘professionals’ do we
injustice and to immediately become more broad-minded? (Goble 1968, p23.)
develop their
She added a challenge by arguing that the only effective way
communities so
to ensure that the apprenticeship to becoming a profession
that
was well served was for therapists ‘to encourage the study,
occupational
improve the practice and advance the knowledge of
satisfaction is
occupational therapy’ (Goble 1968, p23).
the norm. These
Dr Ann Wilcock An occupational perspective does not provide a
approaches may
prescriptive programme of therapy. It does provide a way of
well involve the therapists who are encouraging community
thinking in whatever area of practice you pursue; a way to
health from an occupational perspective to start tackling
consider individual and community needs; a way to
problems at a political level.
approach individuals, families, communities, doctors,
In yet another arena, occupational therapists with an
bureaucrats and politicians; and a way to enable health
occupational science background may well choose to tackle
through occupation. If it does for you what it has for me, it
occupational issues at an ecological level. It is important to
could change your life and give you an assurance and
the health of us all and to the health of future generations
confidence that this should and could be one of the most
that we find ways to transform the occupational needs of
important professions of the 21st century. But, we have to
people in such a way that the ecology is enriched rather than
find the keys we mislaid all those years ago and study
degraded.
humans as occupational beings, and disseminate the
But if we choose to continue in our present directions,
knowledge as widely as we are able.
occupational science still provides a key to rethinking issues.
The first step, as I see it, is perhaps the hardest, although it
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perhaps we could more appropriately be termed technocrats – Health Care, 6(4), 1-17.
who may be defined as persons conversant with the
technicalities of a particular subject and skilled in the Author: Ann A Wilcock, PhD, DipCOT, BAppScOT, GradDipPH, President of
techniques or mechanical parts of an art, or, more simply, the International Society of Occupational Scientists. ISOS e-mail:
‘persons skilled in a practical art’. wicks@shoal.net.au

British
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