Gelya Frank PhD, MPW

This publication develops a keynote presented at the 27th USC Chan Occupational Science Symposium, “Occupations disrupted: Pandemics and the reshaping of everyday life,” on November 5, 2021. I used the social theory of occupational reconstructions — shared problem-solving through narrative alignments and collective action — to reflect on occupational science’s progress since its founding 30 years ago. I argue that (1) the science of occupation has stalled in today’s neoliberal university; and that (2) ‘consequential questions’ must be formulated across the discipline to develop useful knowledge from different locations, positionalities, and contexts. A ‘consequential question,’ I propose, produces knowledge useful to solving problems of wide concern to the discipline, other disciplines, and the public; and sets up a scientific research program that progresses empirically and theoretically. I explain why the founders’ pragmatist framing of occupation as mind-body experience remains important to recent critiques of the discipline and its future advancement. Likewise, I explain how pragmatism can and must transact with various critical (Marxist, poststructuralist) philosophies and other (positivist, alternative) epistemologies regarding societal problems such as occupational justice, human rights, decolonization, political polarization, and the erosion of democracy. I suggest that federally funded biomedical research in the neoliberal university is not currently designed to advance a science of occupation, although it could if occupational scientists were to face the discipline’s contradictions under neoliberalism and reconstruct its common purpose.

Keywords. Occupational science; Pragmatism; Critical social theory; Racial justice

This article proposes that ‘meliorism’—a philosophical belief in people’s abilities to improve lived experience through engaged problem-solving—is a useful concept to describe and orient occupational science research, given the challenges of our time. This proposal derives from an intensive period of discussion through occupational science seminars, strategic planning sessions, and other activities at the University of Southern California’s Mrs. T. H. Chan Division of Occupational Science and Occupational Therapy, including preparations for the 26th Occupational Science Symposium in 2019. While many disciplines and professions express a melioristic intent, we believe that occupational science and occupational therapy exemplify a particular understanding of meliorism, given the view of occupation that they share, as: 1) engaged activity that has meaning and purpose; and 2) a powerful tool that builds consciousness and practices that can promote desired change. We suggest that occupational scientists’ aim to develop impactful research manifests these conceptual foundations. Further, we argue that a commitment to meliorism requires concerted efforts to mobilize knowledge by intentionally planning for stakeholder engagement and societal impact across all phases of research. We suggest that active knowledge mobilization will enhance the knowledge base of occupational science and help to realize its meliorist potential in both research and practice contexts.

Keywords. Occupational science; Knowledge mobilization; Meliorism; History of academic disciplines; Pragmatism

Musculoskeletal sonography is rapidly extending beyond radiology; however, best practices for successful integration into new practice contexts are unknown. This study explored non-physician experiences with the processes of training and integration of musculoskeletal sonography into rehabilitation. Qualitative data were captured through multiple sources, and iterative thematic analysis was used to describe two occupational therapists' experiences. The dominant emerging theme was competency, in three domains: technical, procedural, and analytical. In addition, three practice considerations were illuminated: (a) understanding imaging within the dynamics of rehabilitation, (b) navigating nuances of interprofessional care, and (c) implications for post-professional training. Findings indicate that sonography training for rehabilitation providers requires multi-level competency development and consideration of practice complexities. These data lay a foundation on which to explore and develop best practices for incorporating sonographic imaging into the clinic as a means for engaging clients as active participants in the rehabilitation process to improve health and rehabilitation outcomes.

This article examines six cases of publicly funded Applied Behavior Analysis (ABA) therapy for Latino children with autism spectrum disorder (ASD) to contribute to thinking about occupational justice. In this ethnographic study of six Latino families of children with ASD in Los Angeles County, all families were offered ABA for their children, but five families experienced occupational challenges leading them to insist on modifications of ABA or to opt out of the service. We consider in each case (a) how the families' experiences can be understood occupationally, (b) how ABA affected the functionings and capabilities of the children and their families, and (c) how the parents' accounts relate to occupational justice. Applying the capabilities approach can help operationalize the concept of occupational justice as a tool to evaluate social policy across cases.

Sonography is a relatively inexpensive imaging modality that provides real-time, dynamic views of anatomical structures. This session will discuss the results of a qualitative descriptive study that revealed a wide range of uses for sonography by occupational therapists.

Objective. To identify the potential utility of musculoskeletal sonographic imaging in upper-extremity rehabilitation.

Method. Two occupational therapists in an outpatient hand rehabilitation clinic were recruited by convenience, were trained in the use of sonography, and implemented sonographic imaging in their clinical practice. Qualitative data were obtained during and after the implementation period by means of questionnaires and interviews. Data collection, analysis, and interpretation were completed in an iterative process that culminated in a thematic analysis of the therapists' perceptions.

Results. The data indicate four potential areas of utility for musculoskeletal sonography in upper-extremity rehabilitation: (1) mastering anatomy and pathology, (2) augmenting clinical reasoning, (3) supplementing intervention, and (4) building evidence.

Conclusion. Numerous potential uses were identified that would benefit both therapist and client. Further exploration of complexities and efficacy for increasing patient outcomes is recommended to determine best practices for the use of musculoskeletal sonography in upper-extremity rehabilitation.

Objectives. Non-physician rehabilitation providers (e.g., occupational/physical therapists) have requisite expertise for effective use of point-of-care musculoskeletal sonography (MSKUS); however, professional curriculums provide only introductory-level image interpretation, at best. This multi-method study evaluated post-professional competency development and the complexities of clinical integration of MSKUS by non-physician rehabilitation providers.

Methods. Three occupational therapists (OTs) received weekly, 2-3 hour, hands-on training from a RMSK-credentialed OT for 3 months. Training included ultrasound physics, imaging protocols, image acquisition, optimization and analysis. Prior to implementing MSKUS in the hand therapy clinic, minmum competency for selecting protocols, acquiring and interpreating images was determined using patient scenerios. During a 10-month implementation, therapists self-rated competency in image acquisition and interpretation on a 10-point visual analogue scale following each MSKUS use. Data were divided into early, mid, and late time periods to evaluate competency development. Semi-structured interviews throughout and following implementation provided deeper understanding of the complexities of clinical integration. Three researchers identified themes through interative anlaysis of interview transcripts and multiple consensus meetings.

Results. Competency for acquiring images significantly increased (p < .05) between the early and mid phase (4.9 to 6.9), whereas competency for image interpretation did not show a significant increase until the late phase (5.8 to 7.6). Qualitative themes included numerous technical competencies nested within real-time interaction with the client, as well as perceived clinical use and professional constraints.

Conclusions. Utilization of MSKUS by non-physician rehabilitation providers diverged from diagnostic techniques to patient-centered applications (e.g., education, biofeedback). Post-professional MSKUS training programs for these providers will require an unique approach to address the various nested competencies and clinical considerations that differ from training provided to physicians and sonographers.

This article introduces a new way to think about social transformation in occupational science. The theory of occupational reconstructions is presented through examples of collective action by disempowered communities to achieve racial justice. An 'occupational reconstruction' is defined as what people do to remake ordinary life in response to a problematic situation. Occupational reconstructions are characterised by: (1) problematic situations; (2) meaningful and purposeful action; (3) embodied practices; (4) narrative structure; (5) creative transformations; (6) voluntary engagement; and (7) hopeful experimentalism. We apply the theory of occupational reconstructions here to large-scale situations of political activism in the American Civil Rights movement and the South African struggle against apartheid. The authors suggest that occupational reconstructions offer a distinctive theory of social transformation that can help occupational science and occupational therapy engage in both mass movements and more local situations relating to human rights and social justice.

The transactional metaphysics of philosopher John Dewey (1859-1952) is applied in this article to the study of cultures and occupations among the Pueblo, Navajo, and Ohlone peoples. The data on these peoples’ occupations come from presentations by New Mexico-based scholars Dr. Theodore S. (Ted) Jojola, Dr. Kathleen Whitaker, and Dr. Les W. Field, at the 6th Annual Research Conference of the Society for the Study of Occupation (SSO:USA) in Albuquerque, New Mexico, in 2007. This article makes use of Dewey’s concept of ‘situation’ to emphasize responses to problems that break into the continuous, emergent nature of human experience in specific regions or locales over time. The author proposes viewing occupations as the sites within Deweyan situations where cultures undergo transformation through the actual doing of things. Further, this article takes a transdisciplinary perspective, drawing on resources in occupational science, geography, anthropology, and postcolonialist perspectives to explore the relevance of Deweyan concepts to occupational science as an emerging and evolving discipline.

Postcolonial and indigenous scholars suggest that creating alternative histories is a necessary activity for Native peoples in their recovery from the destructive emotional, behavioral, and political effects of colonial domination. The literature on history-making as a restorative process has focused on mental health, reversing negative representations of indigenous people in mainstream histories, and using Native histories to reclaim land and rights. In 2004, the Tule River Indian Tribe of Central California initiated an innovative history project to engage tribal elders in contributing historical information about themselves and their families for preservation by the Tribe. Theories and methods from postcolonial scholarship, anthropology, and occupational therapy (and its academic discipline occupational science) focused the Tule River Tribal History Project on providing meaningful and enjoyable activities—creating family trees, a tribal photo archive, interviews with elders, social gatherings and community discussions, and a website. The products were made available to participants in digital and printed formats. Copies have since been archived by the Tribal Council and also made available for tribal use at the Towanits Education Center on the Tule River Reservation. Pre-test and post-test survey data indicate: (1) the tribal elders' high valuation of the history-making activities; and (2) the positive impact of the program on social integration and spiritual well-being.

A profession exists that shares interests with medical anthropology and applied anthropology to promote health and well-being through everyday activities, meaningful routines, and social participation. The profession is occupational therapy. Increasing numbers of anthropologists have professional credentials as occupational therapists, or work with occupational therapists, and collaborate also with disability studies scholars and activists. They share a mission is to define and clear new pathways to health, well-being, and social justice.

A major shift has taken place since the 1960s concerning disclosure to patients that they have a diagnosis of cancer and that their disease is considered terminal. Full disclosure is now considered the patient's right in the United States. However, there remain many countries in which nondisclosure is still the norm. When patients from those countries are diagnosed with cancer in America, differences in attitudes and expectations can cause conflict and misunderstanding.

This article describes the organization, curriculum, and outcomes for New Stories/New Cultures, an activity-based program for after-school enrichment in five schools in the low-income neighborhood near a major American university. The program encourages students (70% Hispanic-American, 30% African-American) to experience themselves as producers of culture, not just as consumers. Its methods include (a) creative team use of video equipment and other expressive media and (b) lessons about media literacy (i.e., making critical choices about images and activities depicted in popular culture and commercials). Outcome measures with the cohort of fifth and sixth graders support the programs occupation-based philosophy. They show that students are more likely to experience themselves as building skills when engaged in activities that are both challenging and enjoyable. The students reported greatest engagement and enjoyment in activities that were creative, team-based, and involving media production. These same activities were correlated with increased self-esteem. The term direct cultural intervention is used to describe the application of occupational principles and critical perspectives to provide a population with conceptual tools and skills for interpreting and successfully navigating the social world.

After a survey of 800 seniors from four different ethnic groups showed that Korean-American and Mexican-American subjects were much less likely than their European-American and African-American counterparts to believe that a patient should be told the truth about the diagnosis and prognosis of a terminal illness, we undertook an ethnographic study to look more deeply at attitudes and experiences of these respondents. European-American and African-American respondents were more likely to view truth-telling as empowering, enabling the patient to make choices, while the Korean-American and Mexican-American respondents were more likely to see the truth-telling as cruel, and even harmful, to the patients. Further differences were noted in how the truth should be told and even in definitions of what constitutes “truth” and “telling”. Clinical and bioethics professionals should be aware of how their cultural and economic backgrounds influence the way they perceive ethical dilemmas and remember to make room for the diverse views of the populations they serve.

Anthropologist Melville J. Herskovits’ (1895-1963) work helped to shape how African-Americans in the United States were viewed and viewed themselves. By 1930, he challenged the prevailing view that “Negro” life-ways were only an incomplete and pathological version of mainstream American culture. In contrast, he contributed a scholarly foundation to the claim that elements of African culture had survived in the Americas. His work supported the New Negro movement and the emergence of pan-African identity. Curiously, however, Herskovits argued that the Jews, another diasporic group, had no distinctive culture nor were they a people. This paper reviews the development of Herskovits’ views in relation to: (1) concepts of race and culture in modern anthropology; (2) public controversies concerning assimilation versus particularism of blacks and Jews in the 1920s and 1930s; and (3) Herskovits’ Jewish identity.

The ethical and legal implications of decisions to withhold and withdraw life support have been widely debated. Making end-of-life decisions is never easy, and when the cultural background of doctor and patient differ, communication about these issues may become even more difficult. In this study, we examined the attitudes of people aged 65 and older from different ethnic groups toward foregoing life support. To this end, we conducted a survey of 200 respondents from each of four ethnic groups: European-American, African-American, Korean-American and Mexican-American (800 total), followed by in-depth ethnographic interviews with 80 respondents. European-Americans were the least likely to both accept and want life-support (p < 0.001). Mexican-Americans were generally more positive about the use of life-support and were more likely to personally want such treatments (p < 0.001). Ethnographic interviews revealed that this was due to their belief that life-support would not be suggested if a case was truly hopeless. Compared to European-Americans, Korean-Americans were very positive regarding life-support (RR = 6.7, p < 0.0001); however, they did not want such technology personally (RR = 1.2, p = 0.45). Ethnographic interviews revealed that the decision of life support would be made by their family. Compared to European-Americans, African-Americans felt that it was generally acceptable to withhold or withdraw life-support (RR = 1.6, p = 0.06), but were the most likely to want to be kept alive on life-support (RR = 2.1, p = 0.002). Ethnographic interviews documented a deep distrust towards the health care system and a fear that health care was based on one's ability to pay. We concluded that (a) ethnicity is strongly related to attitudes toward and personal wishes for the use of life support in the event of coma or terminal illness, and (b) this relationship was complex and in some cases, contradictory.

A two-year, multidisciplinary study (N = 800) was conducted on attitudes about end-of-life decision making among elderly individuals in four ethnic groups (African American, European American, Korean American, and Mexican American). On a quantitative survey, Korean Americans reported negative attitudes about the use of life-sustaining technology for themselves but positive attitudes about its use in general. This article reports on an interview with a 79-year-old typical Korean American respondent to explain the contradiction in the survey data. Expectations among elderly Korean Americans include protecting family members with a life-threatening illness from being informed of their diagnosis and prognosis, and doing everything to keep them alive. Two conclusions, one substantive and the other methodological, are drawn: First, the bioethics discourse on individual rights (patient autonomy) is insufficient to explain the preferences of many Korean Americans and must be supplemented with a discourse on relationships. Second, the rigorous use of qualitative, narrative methods clarifies quantitative data and should not be dismissed as "anecdotal."

Interest in the concept of occupation as a basic human phenomenon, and the establishment of the discipline of occupational science, are prompting a renewed appreciation among occupational therapists of the temporal dimension of patients' lives in and out of the clinic. Although most clinicians know that the orchestration of activities in daily life can support or hinder treatment, the organization of occupations into daily routines has not yet been studied extensively in occupational therapy or occupational science.

The present study examines the adaptation of families raising children with attention deficit hyperactivity disorder (ADHD) in terms of the extraordinary work they perform to construct daily schedules within the ordinary pattern of time use. Seventeen families with children with ADHD were interviewed about their daily schedules and routines. This paper focuses on parents explanations of their family's afternoon (i.e. after-school) schedules, particularly how the parents scheduled times for homework, dinner, and free time. Parents' scheduling considerations included their children's abilities to concentrate, the children's other physiological and emotional needs, and parental work schedules. The cultural relevance of the afternoon schedule and its importance for designing occupational therapy intervention at the homes of children with special needs is discussed.

Standard histories of American anthropology have downplayed the preponderance of Jewish intellectuals in the early years of Boasian anthropology and the Jewish identities of later anthropologists. Jewish histories, however, foreground the roles and deeds of Jews. This essay brings together these various discourses for a new generation of American anthropologists, especially those concerned with turning multiculturalist theories into agendas for activism. Although Boas's anthropology was apolitical in terms of theory, in message and purpose it was an antiracist science.

Ethnographic methods were used to study daily occupations and weekly routines of four young Orthodox Jewish couples living in Los Angeles. Data from interviews and participant observation demonstrate the importance to the couples of fulfilling God's commandments [Hebrew, mitzvot], which organize and sanctify the otherwise mundane activities of daily living, such as eating, bathing sleeping, and rising. The article focuses on the couples' experiences in (a) observing the Sabbath, (b) studying and praying, and (c) keeping a kosher home. Orthodox Jewish ritual, practice, and spirituality are time bound and action oriented. Occupational therapists can benefit from understanding how Orthodox Jews invest and experience spiritual meaning in seemingly mundane occupations and routines.

Ethnographic research should not be limited by categorization and typology. Disciplined self-reflection can enrich such studies through systemic examination that can lead to new insights.

Craft production occurs in all sectors of the global economy. This paper provides a context for the study of the occupations of producing and selling crafts. Embedded in the world’s political economy, crafts are a vehicle for individuals and societies to adapt to changing systems of production, a means for economic and cultural expression, and a voice of resistance against domination and oppression. Through crafts, tradition is maintained and/ or invented, and marketed to consumers who find other meanings in the objects. Study of the mode of craft production offers insight into new occupational strategies to respond to de-industrialization, using pre-industrial forms. Romanticized by the Arts and Crafts Movement, the qualities of craft work took on therapeutic as well as economic significance in European and American society. Today, throughout the world, the marketing of crafts has economic and social significance. Study of work in crafts illustrates the contested nature of occupations and adds to the body of knowledge of occupational science.

Artisanal work has been used through the late 20th century by individuals and groups to resist domination. This article presents a conceptual framework for viewing occupations, including crafts production, as political phenomena. The author’s research in Israel and the Occupied West Bank in 1986 provides examples of crafts used to support competing national struggles and claims to contested territory. Although often relegated to the category of pre-industrial folk arts and assumed irrelvant to post-industrial economies, crafts are a strategy for economic and cultural self-determination. Further, they show how everyday activities rooted in cultural traditions can be used to mobilize community development.

This article defines and compares several narrative methods used to describe and interpret patients' lives. The biographical methods presented are case histories, life-charts, life histories, life stories, assisted autobiography, hermeneutic case reconstruction, therapeutic employment, volitional narratives, and occupational storytelling and story making. Emphasis is placed the clinician as a collaborator and interpreter of the patient's life through ongoing interactions and dialogue.

Older adults are at increased risk for a variety of physical and functional limitations that threaten their ability to lead independent and fulfilling lives. Consequently, they stand to benefit from personalized strategies of adaptation that enable them to achieve successful outcomes in their daily activities and desired goals. In the current investigation, a qualitative descriptive methodology was used to document the perceived life domain of importance and associated strategies of adaptation of 29 residents of Angelus Plaza, a federally subsidized apartment complex in downtown Los Angeles for low-income, well older adults. On the basis of interview data, 10 life domains were identified, and within each domain, a typology of adaptive strategies was derived. The domains were activities of daily living (ADL), adaptation to a multicultural environment, free time usage, grave illness and death–spirituality, health maintenance, mobility maintenance, personal finances, personal safety, psychological well-being and happiness, and relationships with others. Although the typology should not be generalized to a geriatric population, therapists may wish to refer to it to gain a sense of the extent to which certain adaptive strategies may be applicable to the lives of particular older adults to whom they deliver services. The teaching of these adaptive strategies could then be incorporated into an individualized treatment plan.

The typology also provides a broad picture of the kinds of adaptive strategies used by the older adults as a way of coping and adapting to their setting. Although some of the domains do not differ from those typically addressed in occupational therapy textbooks on geriatric care (e.g., ADL, health maintenance), others seem uniquely tailored to the specifics of the Angelus Plaza context (e.g., personal safety). Finally, certain domains emerged that may be highly relevant to older adults in most settings but are not typically the focus of occupational therapy programs (e.g., grave illness and death–spirituality, relationships with others). The emergence of these domains from our data suggests that therapists may wish to consider them more in treatment if they are convinced that they possess local relevance.

Objective. To study differences in the attitudes of elderly subjects from different ethnic groups toward disclosure of the diagnosis and prognosis of a terminal illness and toward end-of-life decision making.

Design. Survey.

Setting. Thirty-one senior citizen centers within Los Angeles County, California.

Respondents. A stratified quota sample of 200 subjects aged 65 years and older self-identified as being from each of four ethnic groups: European American, African American, Korean American, or Mexican American (N = 800).

Main Outcome Measures and Results. Korean Americans (47%) and Mexican Americans (65%) were significantly less likely than European Americans (87%) and African Americans (88%) to believe that a patient should be told the diagnosis of metastatic cancer. Korean Americans (35%) and Mexican Americans (48%) were less likely than African Americans (63%) and European Americans (69%) to believe that a patient should be told of a terminal prognosis and less likely to believe that the patient should make decisions about the use of life-supporting technology (28% and 41% vs 60% and 65%). Instead, Korean Americans and Mexican Americans tended to believe that the family should make decisions about the use of life support. On stepwise multiple logistic regression, ethnicity was the primary factor related to attitudes toward truth telling and patient decision making.

Conclusions. Korean-American and Mexican-American subjects were more likely to hold a family-centered model of medical decision making rather than the patient autonomy model favored by most of the African-American and European-American subjects. This finding suggests that physicians should ask their patients if they wish to receive information and make decisions or if they prefer that their families handle such matters.

Objectives. An ethnographic approach was used to study the relationship between temporal perspective in persons with chronic schizophrenia and their ability to function in chosen occupations and participate in the routines of a board and care home. Components of future time perspective (extension, coherence, and density) are associated with the ability to organize and implement goal-directed activities. The study focused on how future time perspective occurs in a board and care home, with particular emphasis on how the institution influences temporality.

Methods. Participant observation and interviewing were used to gather data on 10 subjects.

Results. The pervasive influence of the facility's institutional rules and expectations is revealed in the findings of subjects' present time orientation and limited future time perspective.

Conclusions. An examination of the fit between the demands of available roles within one's environment and occupations is proposed.

This paper frames the history of occupational therapy in feminist terms. It focuses on gender segregation in occupational therapy, the influence of class and race in shaping opportunities for occupational therapists, and the place of feminism in the goals and achievements of the occupational therapy profession. Such issues have been addressed by feminist scholars in histories of women in medicine, nursing, and other helping professions. These sources help place the achievements of occupational therapy within the context of women's historic entry and advancement in the American work force.

The following case describes 5 years of a mother's care for her child with multiple chronic conditions, in the neonatal intensive care unit and at home. Because caregiving is primarily a female activity, a feminist approach is used. This mother's efforts on behalf of her son show how work within the domains of direct medical care, normal mothering care, coordination of equipment and supplies and professionals, and synthesis of meaning emanated from her definition of motherhood. The case suggests interventions in family-centered care, offers an examination of two levels of feminist analysis for their usefulness to occupational therapy, and provides an opportunity to examine the topic of motherhood within feminism.

Occupational science is a new scientific discipline that is defined as the systematic study of the human as an occupational being. A doctoral program in occupational science has been established at the University of Southern California, Los Angeles. With its emphasis on the provision of a multidimensional description of the substrates, form, function, meaning, and sociocultural and historical contexts of occupation, occupational science emphasizes the ability of humans throughout the life span to actively pursue and orchestrate occupations. In this paper, occupational science is described, defined, and distinguished from other social sciences. A general systems model is presented as a heuristic to explain occupation and organize knowledge in occupational science. The development of occupational science offers several key benefits to the profession of occupational therapy, including (a) fulfillment of the demand for doctoral-level faculty members in colleges and universities; (b) the generation of needed basic science research; and (c) the justification for and potential enhancement of practice.

An ethnographic approach was used to study adaptation to independent living of a 53-year-old woman with cerebral palsy in a West Coast Canadian city. The subject's adaptation through her use of technology (including augmentative communication systems and a powered wheelchair), activity routines, and social supports was documented with the life history method. Short-term accommodations to disruption or breakdown of stable adaptations were observed through participant observation. The criterion of function alone was found insufficient to account for the subject's choice of adaptive techniques, routines, and social supports. Adaptive choices appeared to depend on the subject's desire to be perceived as able, especially as mentally competent, to the greatest extent possible. The way field experiences may be used to challenge professionals' assumptions, in this case, concerning disability and treatment, is modeled for future ethnographic research in occupational therapy.

Ethnographic methods were used to examine how an experienced occupational therapist assesses and treats a pediatric patient within a relatively long-term clinical relationship. Treatment goals for this preverbal child with Hirschsprung disease, who began occupational therapy at 22 months of age, included (a) introduction of oral feeding to reduce dependence on total parenteral nutrition through intravenous feeding and (b) facilitation of exploratory play, which had been developmentally delayed during extensive periods of immobilization during medical care. This article shows how the meaning of therapeutic activities changes for the patient over time, as the occupational therapist builds trust through affect attunement, validates his or her empathic interpretations, and develops common understandings with the patient's family and others within the social and cultural contexts of chronic care.

Occupational science is an emerging basic science which supports the practice of occupational therapy. Its roots in the rich traditions of occupational therapy are explored and its current configuration is introduced. Specifications which the science needs to meet as it is further developed and refined are presented. Compatible disciplines and research approaches are identified. Examples of basic science research questions and their potential contributions to occupational therapy practice are suggested.

Goffman's (1963) theory of stigma holds that rejection by “normals” leads people with disabilities to adopt practices that help them to pass as normal or cover the immediate impact of their physical difference. However, such an attempt to mitigate the effects of stigma does not characterize the life histories of three adults with severe multiple congenital limb deficiences described in this paper. For them, self-display, within the context of American culture in the 1980s, is a strategy for self-empowerment in which the primary focus is the experience of the person with disabilities rather than the reactions of people who are “normal.” Their adaptations suggest some limitations to the applicability of Goffman's theory in a changing social context.

The relationship of mind and body is an issue of importance for Western medicine and psychiatry. An area to which this problem particularly applies is that of physical disability. In evaluating treatment of persons with physical disabilities, the concept of adjustment in social psychology may not deal sufficiently with ambiguities arising in varied cultural settings. The related concept of stigma in sociology is also limited, covering the cosmetic aspect of the mind-body relationship only. This paper applies the more abstract and inclusive concept of embodiment from the phenomenological movement in philosophy to the life history of a 35-year-old American woman born with quadrilateral limb deficiencies. The resulting description of her functioning and self-image over time calls into question the cultural assumptions of rehabilitation medicine and highlights the more general cultural demands upon persons with severe physical disabilities in the United States since the 1950s.

Life histories can be used to describe adaptation over time to disabling conditions and the context and meaning of disabilities. Data from the life history of Diane DeVries, a 33-year old woman born with quadralateral limb deficiencies (upper extremity hemimelia, lower extremity amelia) illustrate a model for eliciting, presenting and interpreting life histories of persons with disabilities. Substantively, the life history of Diane DeVries indicates, at this time, survival within a niche of institutional supports that include marriage, church membership, and government for the disabled. Her life history is also characterized by choices that support independent living in the community and a cognitive orientation toward her own cultural normality.