A multi perspective approach to understanding the development of occupational therapy in the UK

Scholarly articles are meant to stimulate discussion, but sometimes they do for unintended reasons. A recent article in the Christmas issue of The BMJ by one of us (Neil McLennan) did just this, provoking strong reactions and new discussions on social media and a number of rapid responses on bmj.com. The article profiled Wilfred Owen’s physician Arthur John Brock and his approach to the treatment of Owen’s shell shock. The piece suggested links between that era and the current covid-19 pandemic and its impact on people’s mental health. 

The article intended to highlight that Brock might not have received the recognition he deserves for his part in Owen’s recovery in literary biographies of Owen’s life. In the literary world Brock’s impact on Owen’s recovery and poetry is often overshadowed by that of Owen’s fellow Craiglockhart War Hospital patient and poet, Siegfried Sassoon. This position has become the popular narrative and has also transferred into medical writing, enhancing Sassoon’s role. This is perhaps inevitable when literary scholars write about the First World War poets through a literary lens. The BMJ article was based on McLennan’s research over the past decade into Owen’s education, “re-education” and the impact of his “Edinburgh enlightenment” while Owen was a patient at Craiglockhart War Hospital for “shell-shocked” officers while also promoting “multi-perspective” methodology. By viewing influences on Owen through a multi-perspective lens, new light can be shed on his life and literary outputs.  

The recent article unintentionally caused concern among some occupational therapists for citing historic ergotherapy, but not citing modern occupational therapists or occupational therapy explicitly. That omission has been discussed in the rapid responses to the article online and in a response by the author. Many of the responses highlighted the role of contemporary occupational therapy in supporting health and wellbeing. 

It is interesting to consider how Brock brought new perspectives to his field and how this helped him to pioneer innovative approaches to treatments in 1917. Brock was a civilian doctor in uniform, and a temporary Captain in the Royal Army Medical Corps. His approach was different to some of the medical military cures practised at the time, possibly because he had no formal psychiatry training and fresh perspectives can bring new ideas and understanding to disciplines. His early thinking on how to cure men affected by the physical and mental impact of the war was influenced in part by correspondence with biologist, town planner and polymath Patrick Geddes. Those ideas shared before the First World War helped shape Brock’s practice as a military doctor. Loughran (2009) has noted there was progress in pre-war conceptual frameworks which allowed doctors to recognise the emotional origins of shell shock on the outbreak of war. However, draconian disciplinary approaches still existed. 

Medical practice also evolved during this time and Brock can be seen as one of the humanist medics of the era with not only an interest in Greek medical thinking, but also Scottish Gaels.  His ideas were a reaction against modernity, seeking a return to earlier thinking.      

In 1911, Brock called Ergotherapy the “occupation cure”.  Occupational therapy was adopted as the profession’s name in the United Kingdom while the term Ergotherapy was retained in parts of Canada and Europe. While the activities and occupation used today may differ to those employed by Brock, occupational therapy provides practical support to empower people to facilitate recovery and overcome barriers that prevent them from doing the activities (or occupations) that matter to them. This increases people’s independence, sense of identity and satisfaction in all aspects of life such as self-care, work or leisure (RCOT accessed 15th December 2020). 

Occupational Therapy has grown conceptually and adapted to meet complex needs during its long history, but it has retained many of the practical foundations from the First World War. 

Crisis, war, and conflict are often catalysts for change. The current global pandemic is a crisis, in which occupational therapists have risen to the challenge and demonstrated how their impact on people’s mental and physical health and wellbeing has been changed.

The chain of events from the initial article to this current response (and hopefully beyond) shows the potential of multiple-perspectives to shed new light and views on extant topics and thinking.  Without this new thinking knowledge cannot evolve.  Being able to reflect, respond and revise knowledge will be vital if we are to continue to pioneer new thinking confidently.   

Neil McLennanSenior Lecturer and Director of Leadership Programmes, University of Aberdeen

Diane L CoxChair of Council, Royal College of Occupational Therapists, Emeritus Professor of Occupational Therapy, University of Cumbria

Competing interests: none declared

Further reading on this topic:

Brock, A. J. (1911). ” Ergotherapy” in Neurasthenia. Edinburgh Medical Journal6(5), 430.

Brock, A. J. (1934). Occupational Therapy. British medical journal2(3839), 231.

Cantor, D 2005 ‘Between Galen, Geddes and the Gael: Arthur Brock, Modernity and Medical Humanism in Early Twentieth-Century Scotland’, Journal of the History of Medicine and Allied Sciences 60(1): 1–41.

Cox, D. L. (2017). The Dr Elizabeth Casson Memorial Lecture 2017: Life as an occupational being. British journal of occupational therapy80(9), 525-532. 

Hibberd, D (1977) ‘A Sociological Cure for Shellshock: Dr. Brock and Wilfred Owen, The Sociological Review, 1 May 1977.

Hibberd, D. (1986) Owen the Poet (Macmillan, London).

Hibberd, D. (2002), Wilfred Owen: A New Biography (Weidenfield & Nicolson, London)

Loughran, TL (2009) ‘Shell-shock and psychological medicine in First World War Britain.’ Social History of Medicine, 22 (1). 79 – 95. ISSN 0951-631X

McLennan, NDR (2020) BMJ 2020: 371:m4587

McLennan, NDR (2020b) BMJ 2020: 371:m4587 ‘Rapid Response’ 

McLennan, NDR 2018a, ‘Six o’ Clock in Princes Street: An analysis of Wilfred Owen’s Edinburgh ‘re-education”, Proceedings of the Society of Antiquaries of Scotland, vol. 148, no. 2018, pp. 333- 351.[ONLINE] DOI: HTTPS://DOI.ORG/10.9750/PSAS.148.1256; 

McLennan, NDR 2018b, ‘Regeneration, re-education and an anthem for peace: Insights for education from the re-education of Wilfred Owen during his 1917 convalescence at Craiglockhart War Hospital’ British Educational Research Association Blog. [ONLINE] DOI: HTTPS://WWW.BERA.AC.UK/BLOG/REGENERATION-RE-EDUCATION-AND-AN-ANTHEM-FORPEACE;

McLennan, NDR 2018c, ‘War Poets’ Trail’ History Scotland, vol. 19, no. 3, pp. 27; 

McLennan, NDR 2018d, ‘Wilfred’s Walk: Princes Street, Edinburgh (2)’, Wilfred Owen Association Journal, vol. 2018, no. 1,

  1. 20-24.

McLennan, NDR 2018e, ‘‘Owen and Sassoon’s Strange Meeting Reconsidered?’’, Siegfried’s Journal, vol. 33, pp.10-16; 

McLennan, NDR 2017a, ‘War Poet’s Walk: Princes Street, Edinburgh’, Siegfried’s Journal.

McLennan, NDR 2017b, ‘Wilfred’s War’ History Scotland, vol. 2017, no. 4, pp. 48-48.

McLennan, NDR 2017c, ‘‘Wilfred’s Walk [1]: Princes Street Edinburgh’’, Wilfred Owen Association Journal, vol. 2018, no. 1, pp. 20-24; 

McLennan, NDR 2016, ‘Edinburgh’s Pentland Hills: Wilfred Owen’s ‘Oxford University”, Wilfred Owen Association Journal, vol. 2016-1, no. 1, pp. 14-17; 

McLennan, NDR 2010 ‘A Very Special English Teacher: Wilfred Owen and the Lost Boys of Tynecastle High School’, Western Front Association Journal – Stand To! 88, 2010.

Murtagh, David Lee. “Occupational therapy: First World War centenary–growth from conflict.” British Journal of Occupational Therapy, vol. 77, no. 7, 2014, p. 329.

Perryman-Fox, M &; Cox, D (2020) ‘Occupational Therapy in the United Kingdom: Past, Present, and Future’, Annals of International Occupational Therapy. 2020;3(3):144-151.

RSA (2017) Good Work: The Taylor Review of Modern Working Practices https://www.thersa.org/globalassets/pdfs/reports/good-work-taylor-review-into-modern-working-practices.pdf     

Stallworthy, J. (1974) Wilfred Owen (OUP, Oxford), p. 192.

Stradling, R. (2003) Multiperspectivity: A guide for history teachers (Council of Europe, Germany) 7079-Multiperspectivity-E (coe.int)

Welland, D. (1978) Wilfred Owen: A Critical Study (Chatto & Windus, London