April is the month that we celebrate occupational therapy in the US every year. As we begin the last week of April this year, we have been sheltering in place for 5 weeks. As a discipline, occupational therapy began over 100 years ago in response to circumstances that mirror those we are struggling with today in many ways. We began using “occupation” as therapy with people who were deprived of the basic routines and habits that we are today again realizing are so important to our health and wellbeing.

First, we began supporting people with mental illness who had been confined to the abysmal insane asylums in the late 1800s and early twentieth century. They were isolated from home and routine, and often subjected to cruel and inhumane treatment. In response the Moral Treatment movement sought to elevate the standard of care and advocated use of conversation, recreation, and light manual labor to build regular routines that were restorative. At the same time the Arts and Crafts movement was decrying the loss of craftsmanship and routines secondary to the industrial revolution. Occupational therapy began at the junction of these two movements with the use of daily routines and patterns that included crafts as well as activities of daily living.

Later, occupational therapy was extended to other populations who had disruptions in their daily occupations such as people confined to tuberculosis asylums, and those returning from war with what was then called shell shock. In mental health practice, we stayed in psychiatric hospitals until fairly recently when those hospitals largely shifted to for profit models that meant decreases in skilled staff. I worry about how people are faring in those institutions without us but that is another conversation.

I came to occupational therapy after Aaron was shunned by every other therapy in my community. Their understanding of mental illness and their roles as helpers did not match his needs and they were not sure that the tools they knew would be effective. We were on our own. When he landed on the streets at 15 years old, I decided to become a therapist that could help families like mine. I knew that I needed a skill set that went beyond the expectation of fixing mental illnesses. We had been through counseling since kindergarten and while it gave us some useful skills, they were at a loss as to what they could do to help. I really needed a framework that would equip me to help youth like Aaron figure out how to have a life anyway.

I had found that my work as an artist opened the door with some youth, but I needed to know what to do with those opportunities. As an occupational therapist who works in mental health pretty much exclusively, I use doing as my intervention. It is still very much about building health promoting routines and habits. I teach about the ordinary rhythms that make up days and nights and how to facilitate them. It is about helping people craft a life that enables them to do what they want and need to do. Sometimes that is building and practicing communication or organization skills, or just ordinary self care. It is about building community and relationships. That includes advocating for the capacity to have fun, voices that are heard, and safe spaces. Sometimes it is just about living life anyway.

So what does all of this have to do with Covid 19 and the social distancing we find ourselves in? We have had our routines disrupted, sometimes our relationships feel far away, and for some even their livelihood is threatened. As an occupational therapist, my intervention is all about that gap between what people need and want to do, and where they find themselves instead.  Usually my work is about sparking creativity and hope, and what we call an adaptive response, which enables people to build opportunities to thrive. Sometimes it is also about adapting environments to help those enable ordinary occupations rather than disable people. I work with people to help them figure out how to succeed every day. I am an occupational therapist!