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History of OT in Mental Health

The history of Occupational Therapy(OT) had it's origin in the 1700's during Europe's "Age of Enlightenment". At this time, radical new ideas were emerging for the infirm and mentally ill. Normally, they were excluded from work activities and were treated like criminals and locked in prisons. During this new era concern was given to their mental well being. This dramatic change can be attributed to two very different men, Phillipe Pinel, a French physician, scholar and natural philosopher and William Tuke, an English Quaker.

Phillipe Pinel was of the belief that morally treating the mentally ill meant treating their emotions. The doctrine of Moral Treatment utilized occupation; man's goal directed use of time, interests, energy , and attention; in combination with purposeful daily activity for treatment. Music and various forms of literature, physical exercise and work were used as a method to release the mind from emotional stress and thereby improve the individual's activities of daily living.

William Tuke and his family were also redefining the direction of mental health care. Because Tuke was appalled at the inhumane treatment and the deplorable conditions which existed in the public insane asylums, he developed several principles for the moral treatment of this population. The main approach use was that of the moral concepts of kindness and consideration. He also encompassed the concept of religion which created an atmosphere of family life. Occupations and purposeful activities were prescribed in order to minimize the patient's disorder.

The progression of moral treatment continued into the 1900's as Sir William Ellis and his wife came to be in charge of England's county asylums. This community became a family atmosphere and the men and women both were encouraged to enhance their previous trades or establish new ones in order to support purposeful activity. Sir and Lady Ellis were able to prove that the mentally ill were not dangerous with tools, and were far less dangerous than other unoccupied individuals. The Ellis' were also responsible for developing the idea of an "after care" house, very similar to the halfway houses of today. These places functioned as stepping-stones from total care to limited assistance living care.

The Progressive Era of the twentieth century in the United States initially was not progressive at all for the mental health field. The moral treatment philosophy had waned during the civil war and nearly disappeared with no one to carry on the philosophy. A lack of concern and lack of moral treatment was ushered in with the use of sterilization of the "mental defectives", the insitutionalized insane. Fortunately, in the early 1900's, Susan Tracy, a nurse, employed occupation for mentally ill patients. She also initiated activity instruction to student nurses and coined the term "Occupational Nurse" for this specialty.

Other professionals involved in the rebirth of OT include Eleanor Slagle, a partially trained social worker; George Edward Barton, a disabled architect; Adolph Meyer, a psychiatrist; and William Dunton, a psychiatrist. These professionals, along with Susan Tracy, formed the backbone of modern occupational therapy and ensured acceptance as a medical entity with the establishment of the National Society for the Promotion of Occupational Therapy leading to the present day American Occupational Therapy Association.

Occupational therapy has continued to develop from a deeply-rooted belief in the critical importance of "doing"; of active enjoyment in purposeful activity as a catalyst in the development of self, fulfillment in social membership, social efficacy and self-actualization.

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