This study shows how the organization of occupational therapy determines occupational therapists' potential and limits for enabling the empowerment of adults who attend mental health day programmes. Drawing from the full ethnography, this paper shows how the organization of practice determines invisibly whether occupational therapists are more likely to involve people in simulations or in the real occupations of their everyday world. The study explores the use of simulations versus real occupations by tracing everyday practice to the locations, facilities, and scheduling context in which practice occurs. Practice is further traced to the philosophic and funding context of programmes. The final part of the analysis outlines how the use of simulations versus real occupations is shaped by particular ideas about mental health, professional practice, health services, welfare, and the market place. The analysis of an institutional ethnography offers a blueprint for change.
AnthonyW.CohenM.CohenB. (1983). Philosophy, treatment process, and principles of the psychiatric rehabilitation approach. New Directions for Mental Health Services, 6, 67–78.
2.
BeardJ.PropstR.MalamudT. (1982). The fountain house model of psychiatric rehabilitation. Psychosocial Rehabilitation Journal, V(1), 47–53.
3.
BelenkyM.F.ClinchyB.MGoldbergerN.R.TaruleJ.M. (1986). Women's ways of knowing: The development of self, voice and mind.New York: Basic Books.
4.
BrookfieldS.D. (1986). Understanding and facilitating adult learning.San Francisco: Jossey-Bass.
BrookfieldS.D. (1987b). Learning democracy: Eduard Lindeman on adult education and social change.London: Croom Helm.
7.
BrosioR.A. (1990). Teaching and learning for democratic empowerment: A critical evaluation. Educational Theory, 40, 69–81.
8.
BrownL.D. (1985). People-centred development and participatory research. Harvard Educational Review, 55, 69–75.
9.
Canadian Association of Occupational Therapists. (1991). Occupational therapy guidelines for client-centred practice.Toronto, ON: CAOT Publications.
10.
Canadian Association of Occupational Therapists. (1993). Occupational therapy guidelines for client-centred mental health practice.Toronto, ON: CAOT Publications.
11.
Canadian Association of Occupational Therapists. (1994). Position statement on everyday occupations and health. Canadian Journal of Occupational Therapy, 61, 294–297.
Carswell-OpzoomerA. (1990). Muriel Driver Memorial Lecture: Occupational therapy - our time has come. Canadian Journal of Occupational Therapy, 57, 197–203.
14.
CassinA.M. (1990) The routine production of inequality: A study in the social organization of knowledge. Unpublished doctoral dissertation, University of Toronto, Toronto, ON.
15.
CheckowayB.NorsmanA. (1986). Empowering citizens with disabilities. Community Development Journal, 21, 270–277.
16.
CondeluciA. (1990). Interdependence: The route to community.FL: PMD Publishers Group.
17.
ClarkF.A. (1993). Occupation embedded in a real life: Interweaving occupational science and occupational therapy. American Journal of Occupational Therapy, 47, 1067–1078.
18.
ClarkF.A.ParhamD.CarlsonM.E.FrankG.JacksonJ.PierceD.WolfeR.J.ZemkeR. (1991). Occupational science: Academic innovation in the service of occupational therapy's future. American Journal of Occupational Therapy, 45, 300–310.
19.
De JongG. (1979). Independent living: From social movement to analytic paradigm. Archives of Physical Medicine and Rehabilitation, 60, 435–446.
20.
DunstC.J.TrivetteC.M. (1989). An enablement and empowerment perspective of case management. Topics in Early Childhood Special Education, 8, 87–102.
21.
FayB. (1987). Critical social science: Liberation and its limits.New York: Cornell University Press.
22.
FlorinP.WandersmanA. (1990). An introduction to citizen participation, voluntary organizations, and community development: Insights for empowerment through research. American Journal of Community Psychology, 18, 41–54.
23.
FrankG. (1992). Opening feminist histories of occupational therapy. American Journal of Occupational Therapy, 46, 989–999.
24.
FreireP. (1970). Pedagogy of the oppressed: The letters to GuineaBissau.New York: Continuum Books.
25.
FreireP. (1972). Cultural action for freedom.Harmondsworth: Penguin Books.
26.
FreireP. (1973). Education for critical consciousness.New York: Continuum Books.
27.
FreireP. (1976). Education: The practice of freedom.London: Writers and Readers.
28.
FreireP. (1985). The politics of education: Culture, power and liberation, Trans. by D. Macedo.South Hadley, MA: Bergin & Garvey Publishers.
29.
GiddensA. (1991). Modernity and self-identity: Self and society in the late modern age.Stanford, CA: Stanford University Press.
30.
GlaserB.StraussA. (1967). The discovery of grounded theory: Strategies for qualitative research.Chicago: Aldine Press.
31.
GraceV.M. (1991). The marketing of empowerment and the construction of the health consumer: A critique of health promotion. International Journal of Health Services, 21, 329–343.
32.
GradyA.P. (1994). Eleanor Clarke Slagle Lecture. Building inclusive communities: A challenge for occupational therapy. American Journal of Occupational Therapy, 49, 300–310.
33.
GruberJ.TrickettE.J. (1987). Can we empower others? The paradox of empowerment in the governing of an alternative public school. American Journal of Community Psychology, 15, 353–371.
34.
HabermasJ. (1984). The theory of communicative action: Volume ***1, reason and the rationalization of society.Boston: Beacon Press.
35.
HallB.L. (1981). Participatory research, popular knowledge and power: A personal reflection. Convergence, 3, 6–17.
36.
HammersleyM.AtkinsonP. (1983) Ethnography: Principles and practice.New York: Tavistock Publications.
37.
KariN.MichelsP. (1991). The Lazarus project: The politics of empowerment. American Journal of Occupational Therapy, 45, 719–725.
38.
KatzR. (1984). Empowerment and synergy: Expanding the community's healing resources. Prevention in Human Services, 3, 201–226.
39.
KiddJ.R. (1973). How adults learn.New York: Association Press.
40.
KiefferC. (1984). Citizen empowerment: A developmental perspective. Prevention in Human Services, 3, 9–36.
41.
KielhofnerG. (1992). Conceptual foundations of occupational therapy.Philadelphia: F.A. Davis.
42.
KielhofnerG. (1995). A model of human occupation: Theory and application, 2nd Edition. Baltimore: Williams and Wilkins.
43.
KilianA. (1988). Conscientization: An empowering, nonformal education approach for community health workers. Community Development Journal, 23, 117–123.
44.
KnowlesM.S. (1975). Self-directed learning: A guide for learners and teachers.Chicago: Follett Publishing.
45.
KolbD.A. (1984). Experiential learning. Experience as the source of learning and development.Englewood Cliffs, NJ: Prentice-Hall.
46.
KuyekJ.N. (1990). Fighting for hope: Organizing to realize our dreams.Montreal, PQ: Black Rose Books.
47.
LabonteR. (1989a). Community empowerment: The need for political analysis. Canadian Journal of Public Health, 80, 8788.
48.
LawM. (1991). Muriel Driver Memorial Lecture: The environment: A focus for occupational therapy. Canadian Journal of Occupational Therapy, 58, 171–180.
49.
LibermanR. (1988). Psychiatric rehabilitation of chronic mental patients.Washington, DC: American Psychological Press.
50.
LincolnY.S.GubaE.G. (1985). Naturalistic enquiry.Newbury Park, CA: Sage Publications.
51.
LitterstT.A.E. (1992). Occupational therapy: The role of ideology in the development of a profession for women. American Journal of Occupational Therapy, 46, 20–25.
52.
LukesS. (1974). Power: A radical view.New York: MacMillan Press.
53.
LukesS. (1986). Power.New York: New York University Press.
54.
McCollM.A.LawM.StewartD. (1993). The theoretical basis of occupation: An annotated bibliography of occupational therapy theory in the 20th century in North America.Thorofare, NJ: Slack.
55.
McCollM.A.PrangerT. (1994). Theory and practice in the occupational therapy guidelines for client-centred practice. Canadian Journal of Occupational Therapy, 61, 250–259.
56.
McKnightJ.L. (1989). Health and empowerment. Canadian Journal of Public Health, 76, (supplement 1), 37–38.
57.
MeyerA. (1922). The philosophy of occupational therapy. Archives of Occupational Therapy, 1, 1–10.
MezirowJ. (1991). Transformative dimensions of adult learning.San Francisco: Jossey-Bass.
60.
Mezirow, J., & Associates. (1990). Fostering critical reflection in adulthood: A guide to transformative and emancipatory learning.San Francisco: Jossey-Bass.
61.
PinderhughesE.B. (1983). Empowerment for our clients and ourselves. Social Casework: The Journal of Contemporary Social Work, 64, 331–338.
62.
PinderhughesE.B. (1990). Understanding race, ethnicity and power: The key to efficacy in clinical practice.New York: The Free Press.
63.
PizziM. (1992). Women, HIV infection, and AIDS: Tapestries of life, death, and empowerment. American Journal of Occupational Therapy, 46, 1021–1027.
64.
PolatajkoH.J. (1992). Muriel Driver Memorial Lecture: Naming and framing occupational therapy: A lecture dedicated to the life of Nancy B. Canadian Journal of Occupational Therapy, 59, 189–200.
65.
Qualis Research Associates. (1988). The ethnograph: A user's guide (Version 3.0).Littleton, CO: Author.
66.
ReillyM. (1962). Occupational therapy can be one of the great ideas of 20th century medicine. American Journal of Occupational Therapy, 16, 1–9.
67.
RoseS.M.BlackB.L. (1985). Advocacy and empowerment: Mental health care in the community.Boston: Routledge and Kegan Paul.
68.
SmithD.E. (1987) The everyday world as problematic: A feminist sociology.Toronto, ON: University of Toronto Press.
69.
SmithD.E. (1990a). Texts, facts, and femininity: Exploring the relations of ruling.New York: Routledge.
70.
SmithD.E. (1990b). The conceptual practices of power: A feminist sociology of knowledge.Toronto, ON: University of Toronto Press.
71.
SteinemG. (1993). A book of self-esteem: Revolution from within.Toronto, ON: Little, Brown.
72.
SumsionT. (1993). Client-centred practice: The true impact. Canadian Journal of Occupational Therapy, 60, 6–8.
73.
TateS. (1974). The scope for occupational therapists in the community in the future. Canadian Journal of Occupational Therapy, 41(2), 7–9.
74.
TownsendE. (1993). Muriel Driver Memorial Lecture: Occupational therapy's social vision. Canadian Journal of Occupational Therapy, 60, 174–184.
75.
TownsendE. (1994). Enabling empowerment or managing medical cases? Occupational therapy's mental health work. Unpublished doctoral dissertation. Dalhousie University, Halifax, NS.
76.
WallersteinN. (1992). Powerlessness, empowerment, and health: Implications for health promotion programs. American Journal of Health Promotion, 6, 197–205.
77.
WharfB. (1979). Community work in Canada.Toronto, ON: McLelland and Stewart.
78.
WharfB. (1992). Communities and Social Policy in Canada.Toronto, ON: McLelland and Stewart.
79.
WoodsideH. (1984). Community care for the mentally ill. Canadian Journal of Occupational Therapy, 51(4), 182–187.
80.
WoodsideH. (1991). National Perspective. The participation of mental health consumers in health care issues. Canadian Journal of Occupational Therapy, 58, 3–5.
81.
YoungI.M. (1990). Justice and the politics of difference.Princeton, NJ: Princeton University Press.
82.
YerxaE.J. (1992). Some implications of occupational therapy's history for its epistemology, values, and relation to medicine. American Journal of Occupational Therapy, 46, 79–83.
83.
ZolaI.K. (1984). Disincentives to independent living: Monograph 1.University of Kansas, KS: The Research and Training Centre on Independent Living.
