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Review Article • Cad. Bras. Ter. Ocup. 32 • 2024 • https://doi.org/10.1590/2526-8910.ctoAR278336242   copy

Political action in occupational therapy: an integrative review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Introduction

Political actions are inherent to all everyday processes, both to maintain hegemony or to develop new projects in society.

Objective

To understand the discussions about political action referenced in the occupational therapy bibliography.

Methodology

An integrative review of the literature produced in the last five years, indexed by Web of Science, SciELO, Scopus and Lilacs databases, was carried out. The search equations “política” and “terapia ocupacional” were used in Spanish and in Portuguese; and “Occupational Therapy” and (politic OR policy OR policies), in English. The process was described according to the PRISMA proposal to relate identification, selection, and integrative analysis, as well as to propose documentary eligibility.

Results

The corpus consisted of 14 articles distributed in five journals, three of them from South America. It is evident that the discussions about political action have developed particularly in the South. The documents were analyzed under four categories: hegemony, resistance, tensions, and contradictions, present in the conceptual constructions and practices described. Two disputes about the political action of occupational therapists emerge: the first is related to the profession, and the second to the political place of the occupational therapist.

Conclusion

It is imperative to promote the construction of new hegemonies within professional actions, which are also political actions. Likewise, it is necessary to advance in epistemological, ontological, ethical, and political developments that support the proposed new common senses. Social occupational therapy in Brazil shows progress in this direction.

Keywords:
Politics; Occupational Therapy; Ethics

Resumen

Introducción

La acción política es inherente a todos los procesos cotidianos, tanto para mantener la hegemonía como para desarrollar nuevos proyectos en la sociedad.

Objetivo

Comprender las discusiones sobre acción política referenciadas en la bibliografía de terapia ocupacional.

Metodología

Se realizó una revisión integradora de la literatura producida en los últimos cinco años, indexada en las bases de datos Web of Science, SciELO, Scopus y Lilacs. Se utilizaron las ecuaciones de búsqueda política AND “terapia ocupacional”, en español y portugués; y, “Occupational Therapy” AND (politic OR policy OR policies), en inglés. El proceso se describió según la propuesta PRISMA para relacionar la identificación, selección y análisis integrador, así como para proponer la elegibilidad documental.

Resultados

El corpus quedó conformado por 14 artículos distribuidos en cinco revistas, tres de ellas de América del Sur. Es evidente que las discusiones sobre acción política se han desarrollado particularmente en el Sur. Los documentos fueron analizados bajo cuatro categorías: hegemonía, resistencia, tensiones y contradicciones, presentes en las construcciones conceptuales y en las prácticas descritas. Emergen dos disputas sobre la acción política de los terapeutas ocupacionales: la primera está relacionada con la profesión, y la segunda con el lugar político del terapeuta ocupacional.

Conclusiones

Es imperativo propender por la construcción de nuevas hegemonías al interior de las acciones profesionales, que también son acciones políticas. Igualmente, es necesario avanzar en desarrollos epistemológicos, ontológicos, éticos y políticos que soporten los nuevos sentidos comunes propuestos. La terapia ocupacional social en Brasil muestra avances en este sentido.

Palabras clave:
Política; Terapia Ocupacional; Ética

Resumo

Introdução

A ação política é inerente a todos os processos cotidianos tanto para a manutenção da hegemonia quanto para novos projetos na sociedade.

Objetivo

Compreender a discussão sobre a ação política na bibliografia em terapia ocupacional.

Metodologia

Foi realizada uma revisão integrativa da literatura produzida nos últimos cinco anos e indexada nas bases de dados Web of Science, SciELO, Scopus e Lilacs. Se utilizaram as combinações de procura política AND “terapia ocupacional”, em espanhol e português; e “Occupational Therapy”AND (politic OR policy OR policies), em inglês. O processo se baseou na proposta PRISMA para a identificação, seleção e elegibilidade, assim como para a análise documental.

Resultados

Foram encontrados 14 artigos em cinco revistas, três delas da América do Sul. Explicitou-se que as discussões sobre a ação política foram desenvolvidas principalmente no Sul. Os documentos foram analisados sob quatro categorias: hegemonia, resistência, tensões e contradições, que foram identificadas nas construções conceituais e nas práticas descritas. Emergiram duas disputas sobre a ação política dos e das terapeutas ocupacionais: uma primeira relacionada com a profissão e a segunda com o lugar político do terapeuta ocupacional.

Conclusão

É imperativo propor a construção de novas hegemonias no interior das ações profissionais, que também são ações políticas. Igualmente, é necessário avançar em desenvolvimentos epistemológicas, ontológicos, éticos e políticos que sustentem os novos sentidos comuns propostos. A terapia ocupacional social, no Brasil, mostra avanços nesse sentido.

Palavras-chave:
Política; Terapia Ocupacional; Ética

Introduction

Professions are social actors that make up the social organization, with political participation that is expressed in their actions. Occupational therapy was created at the beginning of the 20th century as a female profession (Gómez Valencia et al., 2017Gómez Valencia, L. L., Palma Arroyo, D. V., & Rodríguez Mendoza, L. V. (2017). Mujer ciudadana, universitaria y terapeuta ocupacional. Contrastes contextuales de los años sesentas y setentas desde la Universidad del Valle y la Universidad Nacional de Colombia. Revista Ocupación Humana, 16(2), 81-92.; Testa, 2019Testa, D. (2019) Cuando cien no son nada: feminización y terapia ocupacional. In A. L. Martin, G. Queirolo & K. Ramacciotti (Coords.), Mujeres, saberes y profesiones. Un recorrido desde las Ciencias Sociales (pp. 107-119). Buenos Aires: Editorial Biblos.), intended to take care of people who are not socially integrated. At first, it was expected that as “good women” they would be in charge of these people’s occupations. However, professions have spaces for disputes and tensions, with encounters and disagreements, which generate movements and fractures in the notion of the profession as a stable and homogeneous concept (Guajardo, 2017aGuajardo, A. (2017a). Foreword. In D. Sakellariou & N. Pollard (Eds.), Occupational Therapies without borders: integrating justice with practice. Edinburgh: Elsevier.). Historically, it is a profession that transforms and is transformed, it is contextualized and localized (García Ruiz, 2017García Ruiz, S. (2017). Occupational Therapy in a glocalized world. In D. Sakellariou & N. Pollard (Eds.), Occupational Therapies without borders: integrating justice with practice (pp. 185-193). Edinburgh: Elsevier.). It can work for the maintenance of order or for its social transformation, that is, the exercise of its political action.

In political action, recreating Gramsci (1981)Gramsci, A. (1981). Cuadernos de la cárcel. Mexico City: Ediciones Era. and Pachón Soto (2021)Pachón Soto, D. (2021). Sentido común, lenguaje y acción política. Con y más allá de Gramsci. Amauta, 19(37), 73-101., there is a dispute for the common sense of society, in order to build a new one, as an alternative to the hegemony that wants to be transformed. Common sense is a conception of the world imposed by social groups in which everyone is automatically involved (Gramsci, 1981Gramsci, A. (1981). Cuadernos de la cárcel. Mexico City: Ediciones Era.). Therefore, in professional practice, political action refers to the present elements and concepts, which are expressed in hegemonies, resistances, tensions, and contradictions. Advancing in the understanding of political action in occupational therapy implies understanding how all these elements are generated in their actions.

For Gramsci, hegemony is the reproduction of a pattern of domination that is woven into culture, is part of common sense and, at times, is imperceptible, becoming something natural (Gramsci, 1981Gramsci, A. (1981). Cuadernos de la cárcel. Mexico City: Ediciones Era.; Pachón Soto, 2021Pachón Soto, D. (2021). Sentido común, lenguaje y acción política. Con y más allá de Gramsci. Amauta, 19(37), 73-101.). Consequently, hegemonic practices try to establish an order in a context of contingency, leaving out other possibilities; they are the expression of power relationships; they establish a relationship of structures and suprastructures (Errejón & Mouffe, 2016Errejón, I., & Mouffe, C. (2016). Construir pueblo: hegemonia y radicalización de la democracia. Barcelona: Icaria.), and use communication and education to preserve hegemony (Pachón Soto, 2021Pachón Soto, D. (2021). Sentido común, lenguaje y acción política. Con y más allá de Gramsci. Amauta, 19(37), 73-101.) or to change it.

Resistances are opposed to hegemony. These originate when there is a coalition to carry out economic, corporate, or political transformations; some tend towards homogeneity and others towards heterogeneity (Gramsci, 1999Gramsci, A. (1999) Cuaderno 13: notas breves sobre la política de Maquiavelo. In C. N. Coutinho, M. A. Nogueira & L. S. Henriques (Eds.), Cuadernos de la cárcel (pp. 13-92). Mexico City: Ediciones Era.). Resistances are antagonistic when their characteristics are counterhegemonic or they are subaltern when they act within the limits of the system. In short, they are ways of acting in line with life in social, political, and economic contexts, as opposed to hegemonic positions.

Hegemony generates tensions and contradictions. For Gramsci (as cited in Balsa, 2016), there can be tensions between ideology and science, between objectivity and subjectivity, which have repercussions on the practice of ideological struggle and on the idea that scientific truths are definitive, that is, they are actions that generate tension between opposing forces, one of which has more power.

The contradictions of political action can be expressed in the use of conservative, misoneist, conformist, resigned, uncritical, disintegrated, and incoherent language about the world, which highlights the ideological differences within a culture or a group, which implies that there is no political struggle without language and without a world constructed categorically, in concepts. Finally, it is language that shapes a way of life (Pachón Soto, 2021Pachón Soto, D. (2021). Sentido común, lenguaje y acción política. Con y más allá de Gramsci. Amauta, 19(37), 73-101.). Accordingly, the drama of life can be found in contradictions (Gramsci, 1999Gramsci, A. (1999) Cuaderno 13: notas breves sobre la política de Maquiavelo. In C. N. Coutinho, M. A. Nogueira & L. S. Henriques (Eds.), Cuadernos de la cárcel (pp. 13-92). Mexico City: Ediciones Era.).

In the context of occupational therapy, some of the concerns of the practices and their reflections have to do with recognizing the political and non-technical origin of the profession (Guajardo, 2017bGuajardo, A. (2017b). Lecturas y relatos históricos de la Terapia Ocupacional en Suramérica. Una perspectiva de reflexión crítica. Revista Ocupación Humana, 16(2), 110-117.), with the hegemony of the production of Anglo-Saxon knowledge (Malfitano et al., 2023Malfitano, A. P. S., Borba, P. L. O., & Lopes, R. E. (2023). Palabras, conceptos y contextos históricos y culturales: la pluralidad en Terapia Ocupacional. Revista Ocupación Humana, 23(2), 104-135.), with the ethical and political responsibility of the profession (Valderrama Núñez, 2019Valderrama Núñez, C. M. (2019). Terapias Ocupacionales del Sur: una propuesta para su comprensión. Cadernos Brasileiros de Terapia Ocupacional, 27(3), 671-680.), with the social, political and economic tensions of practices (Guajardo, 2016Guajardo, A. (2016). Construcción de identidades, epistemes y prácticas en Terapia Ocupacional en América Latina. In S. Simó, A. Guajardo-Córdoba, F. C. Oliver, S. M. Galheigo & S. García-Ruiz (Eds.), Terapias Ocupacionales desde el Sur: derechos humanos, ciudadanía y participación (pp. 41-62). Santiago: Editorial USACH.), with the place of the profession in the processes of public policies, among others.

Therefore, in our actions as occupational therapists, we may be perpetuating dominant orders through the implementation of policies, plans, programs, projects, and budgets; that is, we can collaborate with the reproduction of consensus, at the service of a hegemony. The problem is that we act in their favor without realizing it, without understanding where the threads are that make us acting as system instruments. So, speaking and understanding our political action is an opportunity to promote informed and coherent actions with ourselves and with the people whom we work with.

Therefore, it is necessary to recognize which hegemonies, resistances, tensions and contradictions are part of the professional action; understand if in the professional practice of occupational therapy a hegemonic action or a dispute of common senses is promoted, if hegemonies are maintained, if they are tense or proposals for transformation are made.

Methods

The objective of the study is to advance the understanding of political action in occupational therapy. For this, the evaluation, criticism, and synthesis of available professional literature were used, through an integrative review that contributes to reflections on the topic. This type of review often requires creative data collection, as the purpose is generally not to cover all published articles on the topic, but rather to combine perspectives and knowledge from different fields or research traditions (Snyder, 2019Snyder, H. (2019). Literature review as a research methodology: an overview and guidelines. Journal of Business Research, 104, 333-339. http://dx.doi.org/10.1016/j.jbusres.2019.07.039.
http://dx.doi.org/10.1016/j.jbusres.2019... ). It focuses on synthesizing knowledge, methods and results of research carried out, outlining a conclusion on a specific topic (Guirao Goris, 2015Guirao Goris, S. J. A. (2015). Utilidad y tipos de revisión de literatura. Ene, 9(2). http://dx.doi.org/10.4321/S1988-348X2015000200002.
http://dx.doi.org/10.4321/S1988-348X2015... ).

From this perspective, the literature produced in the profession in the last five years and indexed on Web of Science, SciELO, Scopus and Lilacs databases was reviewed. The keywords searched were political AND “occupational therapy”, in Spanish and Portuguese, and “Occupational Therapy” AND (politic OR policy OR policies), in English.

These bases were reviewed in March 2022 without a time limit, finding 1,820 articles. For this reason, we decided to work on the last five years, that is, with 482 texts, of which duplicates and those that were not related to occupational therapy were excluded, obtaining 260 documents.

For this group, all the summaries were reviewed, emerging a first thematic classification of the articles: 1) related to health policies, systems and services (39%); 2) referring to the participation of occupational therapy in the processes of formulation, implementation, monitoring, and evaluation of public policies with different population groups (56%); 3) related to the ethical and political reflection of the occupational therapists’ actions, that is, their political action (5%). Latter, a small group of 14 articles constituted the corpus of analysis of this study.

The review process was supported by the PRISMA (Preferred Reporting Items for Systematic Review and Meta-Analysis) proposal for identification, selection, and documentary eligibility (Page et al., 2021Page, M. J., McKenzie, J. E., Bossuyt, P. M., Boutron, I. H., Tammy, C., & Mulrow, C. (2021). Declaración PRISMA 2020: una guía actualizada para la publicación de revisiones sistemáticas. Revista Española de Cardiología, 74(9), 790-799. http://dx.doi.org/10.1016/j.recesp.2021.06.016.
http://dx.doi.org/10.1016/j.recesp.2021.... ). The results are presented on Figure 1.

Figure 1
Identification, selection, and documentary eligibility. Source: own elaboration based on the PRISMA guide.

The documentary file to carry out the complete reading and thematic analysis of each article in the documentary corpus included: year of publication, name of the authors, origin country of the authors, title of the article, journal where it was published, abstract. The questions that guided the reading were: How is political action understood? In what scenarios is political action discussed?

Results

Fourteen articles constitute the corpus of the review (Table 1), distributed in five journals, three of which are published in South American countries (Figure 2). The authors (n=38) come from seven countries (Figure 3). The discussion took place in Brazil, Argentina, Chile, Colombia, USA, the United Kingdom, and Canada (Figure 3).

Thumbnail
Table 1
List of articles.
Figure 2
Distribution of articles by journal and country of publication. Source: own elaboration.
Figure 3
Distribution of authors by geographic origin. Source: own elaboration.

To understand political action in occupational therapy, the analysis is presented in four categories: hegemony, resistance, tensions, and contradictions that are identified in conceptual constructions and practices. See Figure 4.

Figure 4
Political action in occupational therapy. Source: own elaboration.

What do the articles tell us, when talking about political action, in terms of hegemony, resistance, tensions, and contradictions?

Hegemony

Understood as the reproduction of a pattern of domination, which is woven into culture, and which is sometimes imperceptible in everyday life (Gramsci, 1981Gramsci, A. (1981). Cuadernos de la cárcel. Mexico City: Ediciones Era.). In the reviewed texts, a hegemonic consolidation of the profession is observed, which is expressed in epistemological orientations, in the presence of the neoliberal world and in its existence in the shadow of medicine. In relation to the epistemological orientations of his actions:

Pragmatism (a distinctly American philosophy) has been widely accepted historically as the primary philosophical foundation of Occupational Therapy, […] Northern Occupational Therapy has largely been represented by the mechanistic paradigm […] Therefore, many of the basic epistemologies, values, and terminology of Northern Occupational Therapy have been Professional neocolonialism in occupational therapy: a historical review and critique incorporated, resulting in a professional neocolonialism (Taff & Putnam, 2022, pTaff, S. D., & Putnam, L. (2022). Professional neocolonialism in occupational therapy: a historical review and critique. Cadernos Brasileiros de Terapia Ocupacional, 30, e2986.. 2).

Regarding existence in a neoliberal context, the authors point out an omnipresent, hidden neoliberal agenda, associated with financial interests (Taff & Putnam, 2022Taff, S. D., & Putnam, L. (2022). Professional neocolonialism in occupational therapy: a historical review and critique. Cadernos Brasileiros de Terapia Ocupacional, 30, e2986.), which causes “[…] an increase in situations of vulnerability of the population. This heterogeneity of demands, in the daily routine of precarious services, favors a superficial and fragmented reading of the social issue” (Bezerra et al., 2022, pBezerra, W. C., Lopes, R. E., & Basso, A. C. S. (2022). As estruturas da vida cotidiana e a terapia ocupacional: tensionando limites e possibilidades no/do exercício profissional. Cadernos Brasileiros de Terapia Ocupacional, 30, e3031.. 8) and puts professionals “[…] at the service of the modern/colonial/capitalist/patriarchal system” (Díaz-Leiva & Malfitano, 2021, pDíaz-Leiva, M. M., & Malfitano, A. P. S. (2021). Reflexiones sobre la idea de América Latina y sus contribuciones a las terapias ocupacionales del sur. Cadernos Brasileiros de Terapia Ocupacional, 29, e2568.. 9). It is also used as a hegemonic means as it “[…] participates in the meeting of the needs of the working class at the same time that this action is re-functionalized to the interests of the dominant classes”, highlighting the limits of professional autonomy under wage relations (Bezerra et al., 2021, pBezerra, W. C., Pereira, B. P., & Braga, I. F. (2021). Estado e sociedade civil em Gramsci: notas para discutir a institucionalização das demandas sociais no capitalismo e a dimensão social da terapia ocupacional. Cadernos Brasileiros de Terapia Ocupacional, 29, e2048.. 6).

One more expression of hegemony is its historical existence in the shadow of medicine, as Pollard & Block (2017, pPollard, N., & Block, P. (2017). Who occupies disability? Cadernos Brasileiros de Terapia Ocupacional, 25(2), 417-426.. 418) point out: “[…] occupational therapists professional status but under the aegis of medicine”. In this way, the texts show the persistence of patterns of domination related to the contexts and ways in which the profession has been defined and established.

Resistance

Resistance is here understood as the form of creating alternatives for other actions beyond hegemony. There is a variety of ways to create and generate resistance. In the articles analyzed, these are built on reflections of practice; in the recognition of the social, political and economic contexts that the people we work with live; in the recovery of stories; in the fights for human rights; and transcending the frameworks or reference models that standardize professional actions.

The presence of discussions about professional action in line with social life, political and economic contexts is verified, which means incorporating permanent reflections on practice. It is observed on the following texts: “[…] they developed and dreamed of the profession of a way that is committed and consistent with its political ideals” (Briglia et al., 2018, pBriglia, J., García, V., Maiani, A., Nogueras, M. S., Popritkin, M. C., Rosemblat, F., & Portela, A. (2018). Silvia Rivadera, la huella de una colega desaparecida en la última dictadura argentina. Aportes a la memoria y a la perspectiva histórica-ética-política de la Terapia Ocupacional. Revista Chilena de Terapia Ocupacional, 18(1), 73-82.. 75, free translation), which meant “[…] unmasking and enabling reflection and awareness of one's own positioning regarding our ways of seeing the world” (Briglia et al., 2018, pBriglia, J., García, V., Maiani, A., Nogueras, M. S., Popritkin, M. C., Rosemblat, F., & Portela, A. (2018). Silvia Rivadera, la huella de una colega desaparecida en la última dictadura argentina. Aportes a la memoria y a la perspectiva histórica-ética-política de la Terapia Ocupacional. Revista Chilena de Terapia Ocupacional, 18(1), 73-82.. 79, free translation). Recovering history, as a form of resistance, means understanding the events in a historical context, giving meaning to the events. In the words of Briglia et al. (2018, pBriglia, J., García, V., Maiani, A., Nogueras, M. S., Popritkin, M. C., Rosemblat, F., & Portela, A. (2018). Silvia Rivadera, la huella de una colega desaparecida en la última dictadura argentina. Aportes a la memoria y a la perspectiva histórica-ética-política de la Terapia Ocupacional. Revista Chilena de Terapia Ocupacional, 18(1), 73-82.. 72, free translation), “[…] recover and make history visible […] as a way to generate contributions to memory and the historical-ethical, political perspective of occupational therapy”.

In participating in the struggles for the rights of the people and groups with whom one interacts, it is necessary to assist and support protesters, participate in struggles and social causes of them and the participants of the programs (Pollard & Block, 2017Pollard, N., & Block, P. (2017). Who occupies disability? Cadernos Brasileiros de Terapia Ocupacional, 25(2), 417-426.), by “[…] reflections that were contextualized by the struggles to expand social rights” (Barreiro et al., 2020, pBarreiro, R. G., Borba, P. L. O., & Malfitano, A. P. S. (2020). Revisitando o materialismo histórico em terapia ocupacional: o papel técnico, ético e político na contemporaneidade. Cadernos Brasileiros de Terapia Ocupacional, 28(4), 1311-1321.. 1,314) or as “[…] the engagement with the struggle by a fairer society, or less unequal” (Farias & Lopes, 2020, pFarias, M. N., & Lopes, R. E. (2020). Social occupational therapy: formulations by freirian references. Cadernos Brasileiros de Terapia Ocupacional, 28(4), 1346-1356.. 1,346) including the “[…] ethical and political commitment of occupational therapy professionals to the collective interests of the subaltern classes” (Bezerra et al., 2021, pBezerra, W. C., Pereira, B. P., & Braga, I. F. (2021). Estado e sociedade civil em Gramsci: notas para discutir a institucionalização das demandas sociais no capitalismo e a dimensão social da terapia ocupacional. Cadernos Brasileiros de Terapia Ocupacional, 29, e2048.. 1).

Those excerpts above demonstrate the discussions about possibilities of resistance. Others in this direction are based on propositions beyond reference frameworks or standardized intervention models that do not allow for the contemplation of questions about context, notably in contexts of social inequality. This is one of the resistances present in the texts and has connections with the theoretical references proposed here. Also it is connected with struggles related to the contexts where life happens, transcending the proposals based on fixed models, which colonize thought with ideals created in other latitudes and related to others localities.

In relation to the above, social occupational therapy is developed in Brazil as an alternative to the dominant models of the profession. This proposal “[…] seeks to forge a professional project, refusing to transplant inadequate and inoperative solutions to problems in the context” (Farias & Lopes, 2020, pFarias, M. N., & Lopes, R. E. (2020). Social occupational therapy: formulations by freirian references. Cadernos Brasileiros de Terapia Ocupacional, 28(4), 1346-1356.. 1.349); nourished with the contributions of social science authors such as Paulo Freire (Farias & Lopes, 2020Farias, M. N., & Lopes, R. E. (2020). Social occupational therapy: formulations by freirian references. Cadernos Brasileiros de Terapia Ocupacional, 28(4), 1346-1356.), Antonio Gramsci (Bezerra et al., 2021Bezerra, W. C., Pereira, B. P., & Braga, I. F. (2021). Estado e sociedade civil em Gramsci: notas para discutir a institucionalização das demandas sociais no capitalismo e a dimensão social da terapia ocupacional. Cadernos Brasileiros de Terapia Ocupacional, 29, e2048.) and other authors.

Tensions

Tensions are part of all political action in its processes of dispute between the hegemonic and the counter-hegemonic. They are expressed through commitment and ethical-political reflection and with responses consistent with the social, political, and economic contexts.

Speaking of Latin America, Díaz-Leiva & Malfitano (2021, pDíaz-Leiva, M. M., & Malfitano, A. P. S. (2021). Reflexiones sobre la idea de América Latina y sus contribuciones a las terapias ocupacionales del sur. Cadernos Brasileiros de Terapia Ocupacional, 29, e2568.. 8) emphasize the need for contexts to always be in a historical perspective and not reinforce the colonization processes intrinsic to the profession. For they:

[…] based on the specific historical contexts of the region and of each country, no longer as a product of imitation of the center towards the periphery, but as a possibility of recognizing the social, political, and economic contexts that are giving it other forms.

The authors point out that beyond the exercise of practice, ethical, and political reflection on professional work is necessary. This means that it is necessary to break the limits of professional practices and seek coherence with the needs of the people and groups with whom one interacts. These tensions are expressed by Rojas Castillo et al. (2020, pRojas Castillo, C. P., Sánchez López, P. A., Ramos Ramos, L. D., & Herrera Páez, D. G. (2020). Terapia Ocupacional en la ruralidad: una experiencia en La Macarena, Meta. Revista Ocupación Humana, 19(2), 86-102.. 99), in terms of “[…] a practice […] that focuses on the creation of links [and the recognition of] ignored ways of life” (free translation) and in which “[…] ethical duty and commitment to perspectives and practices […] do not reproduce [certain] kinds of relationships” (free translation).

The authors of the articles in this review propose answers in context, through which it is possible to get closer to the realities of people in their daily lives, such as when

[…] rhythms that dance with the communities and the people with whom we work are proposed […] social animations, artistic, recreational or physical activities, exchange of experiences and many more […] that cannot be defined within the framework of established limits (Rojas Castillo et al., 2020, pRojas Castillo, C. P., Sánchez López, P. A., Ramos Ramos, L. D., & Herrera Páez, D. G. (2020). Terapia Ocupacional en la ruralidad: una experiencia en La Macarena, Meta. Revista Ocupación Humana, 19(2), 86-102.. 100, free translation).

To achieve this, Bezerra et al. (2021, pBezerra, W. C., Pereira, B. P., & Braga, I. F. (2021). Estado e sociedade civil em Gramsci: notas para discutir a institucionalização das demandas sociais no capitalismo e a dimensão social da terapia ocupacional. Cadernos Brasileiros de Terapia Ocupacional, 29, e2048.. 9), consider that “[…] the association between the micro and macrosocial dimensions, between a technical and political analysis of the place, and the individuals with whom it works” (based on Malfitano, 2016).

Contradictions

Contradictions make up the political process. In this literature review, they are identified both in professional education and in practices, from discourse and action. For a long time, the distances between educating from the university and the experiences in the workers practices have been pointed out, where we find situations such as:

If they do not pay close attention to the level of freedom they can exercise, it may be more difficult for occupational therapists to see how existing regimes may be unequal and oppressive, and how they may be perpetuating them (Turcotte & Holmes, 2021, pTurcotte, P.-L., & Holmes, D. (2021). The (dis)obedient occupational therapist: a reflection on dissent against disciplinary propaganda. Cadernos Brasileiros de Terapia Ocupacional, 29, e2924.. 3).

Another field discussed about contradictions is located in the expansion of work based on public policies, which is expressed in situations such as:

[…] on the one hand, the expansion of policies and actions resulted in the expansion of the job market for occupational therapists, on the other hand, this took place in the context of changes in the State, via a managerial logic (privatization and/or underfunding of public services, access targeting, productivity goals, etc.), reaching not only users, but also workers. (Bezerra et al., 2022, pBezerra, W. C., Lopes, R. E., & Basso, A. C. S. (2022). As estruturas da vida cotidiana e a terapia ocupacional: tensionando limites e possibilidades no/do exercício profissional. Cadernos Brasileiros de Terapia Ocupacional, 30, e3031.. 7).

There are distances between the statements and the actions that are developed, or in which one is involved. For example, Briglia et al. (2018, pBriglia, J., García, V., Maiani, A., Nogueras, M. S., Popritkin, M. C., Rosemblat, F., & Portela, A. (2018). Silvia Rivadera, la huella de una colega desaparecida en la última dictadura argentina. Aportes a la memoria y a la perspectiva histórica-ética-política de la Terapia Ocupacional. Revista Chilena de Terapia Ocupacional, 18(1), 73-82.. 80, free translation) says about the contradictions of work: “[…] occupational therapists, within a logic of modes of production, understanding work from its intrinsic contradiction: being alienating or emancipating”.

Discussion

This literature review aimed to understand political action and its qualities in occupational therapy. In political action there is a dispute over common sense (Gramsci, 1981Gramsci, A. (1981). Cuadernos de la cárcel. Mexico City: Ediciones Era.), which is the starting point, which can offer a model of hegemonic ideological construction, whose objective is to overcome it, to create another and more appropriate conception of the leading group (Gramsci, 2022Gramsci, A. (2022). La hegemonía de los excluidos: materiales para una vida auténtica. Barcelona: Biblioteca Nueva.).

When taking these approaches to occupational therapy and reviewing the selected texts under this glass, at least two disputes over common sense emerge. The first is located within the occupational therapy profession; the second relates to the political place of the occupational therapist.

In the first dispute we are faced with an occupational therapy that is characterized by being institutional, decontextualized, which is subsumed to the universe of medicine, to biomedical knowledge, based on standards. It is developed from models and frameworks of reference with claims of universality. In this way, they respond to neoliberal standards. It is, then, about admitting the hegemonic nature of this occupational therapy and the way in which it establishes a social order in a context of contingency, but also it can be transformed by counterhegemonic practices that will try to install other hegemonies (Errejón & Mouffe, 2016Errejón, I., & Mouffe, C. (2016). Construir pueblo: hegemonia y radicalización de la democracia. Barcelona: Icaria.).

This hegemonic nature of occupational therapy, following Gramsci's approach, generates disputes over common sense that seek to build a new one. We have lived these disputes over common sense in experiences such as in Colombia, Brazil, Argentina, Chile, and South Africa. These experiences have built alternatives to the occupational therapy field, such as those based on human rights, community, critical, Southern, feminist, others; where resistance processes are delimited as a collective action, which generates tensions and contradictions, with a mark in the South (Díaz-Leiva & Malfitano, 2023Díaz-Leiva, M. M., & Malfitano, A. P. S. (2023). Controversias y debates en torno a terapia ocupacional: un análisis de las producciones bibliográficas en América del Sur (2010-2018). Cadernos Brasileiros de Terapia Ocupacional, 31, e3344.). It is important highlight that all these approaches are little recognized in Anglophone literature (Pollard & Block, 2017Pollard, N., & Block, P. (2017). Who occupies disability? Cadernos Brasileiros de Terapia Ocupacional, 25(2), 417-426.).

Recognizing the plurality in the profession, even in the critical perspectives that are developing in counter-hegemonic movements, according to this literature review, the construction of a new common sense becomes more evident in the so-called “social occupational therapy”. It proposes a critical understanding of social issues, social inequalities that limit the participation and citizenship of vulnerable groups. Occupational therapist should occupy the role of social articulator, beyond the biomedical knowledge and supported by the social sciences knowledge (Lopes & Malfitano, 2023Lopes, R.E., & Malfitano, A.P.S. (2023). Terapia ocupacional social: desenhos teóricos e contornos práticos. São Carlos: EdUFSCar.). Social occupational therapy has been highlighted in many discussions due to its academic trajectory and the possibilities of research at different levels of studies (Lopes & Malfitano, 2023Lopes, R.E., & Malfitano, A.P.S. (2023). Terapia ocupacional social: desenhos teóricos e contornos práticos. São Carlos: EdUFSCar.). These conditions of deeper research and, as a consequence, the development of reflections, knowledge production, and publications in the field, bigger than others theoretical approaches, when comparing with the development of occupational therapy in other Latin American countries; may be explanations for the greater presence of this approach in the results of this literature review.

The second dispute is regarding the political place of occupational therapists, who, following Gramsci (1981)Gramsci, A. (1981). Cuadernos de la cárcel. Mexico City: Ediciones Era. could recognize themselves as a collective of intellectuals, who declare a political ideology and live a political action that may or may not be consistent with their ideology. The need for occupational therapists to reflect on their technical-political and ethical role is eminent, so they can overcome the lack of education to disobey or to be dissident (Barreiro et al., 2020Barreiro, R. G., Borba, P. L. O., & Malfitano, A. P. S. (2020). Revisitando o materialismo histórico em terapia ocupacional: o papel técnico, ético e político na contemporaneidade. Cadernos Brasileiros de Terapia Ocupacional, 28(4), 1311-1321.). Also, their existence as employees of consensus (Lopes, 1999Lopes, R. E. (1999). Cidadania, políticas públicas e terapia ocupacional, no contexto das ações de saúde mental e saúde da pessoa portadora de deficiência no município de São Paulo (Doctoral thesis). Universidade Estadual de Campinas, Campinas.) assume their political role within the practice, participating in social transformation processes (Lopes, 1996Lopes, R. E. (1996). A direção que construímos: algumas reflexões sobre a formação do terapeuta ocupacional. Revista de Terapia Ocupacional da Universidade de São Paulo, 4-7, 27-35.), in the movements and struggles of society, in the construction of new social relationships and in a project to human transformation (Bezerra et al., 2021Bezerra, W. C., Pereira, B. P., & Braga, I. F. (2021). Estado e sociedade civil em Gramsci: notas para discutir a institucionalização das demandas sociais no capitalismo e a dimensão social da terapia ocupacional. Cadernos Brasileiros de Terapia Ocupacional, 29, e2048.). A reflection for occupational therapists, with political awareness, that is, with knowledge, skills and critical attitudes that allow them to respond to people's needs (Pollard et al., 2008Pollard, N., Kronenberg, F., & Sakellariou, D. (2008). A political practice of occupational therapy. Edinburgh: Elsevier.; Walsh & Pollard, 2020Walsh, S., & Pollard, N. (2020). ‘Seeing the bigger picture’: a post- graduate online learning community facilitates political competence for occupational therapists. Journal of Further and Higher Education, 44(7), 971-983.). Political subjects (García Ruiz, 2016García Ruiz, S. (2016). Terapeuta ocupacional: sujeto político. Revista Ocupación Humana, 16(1), 84-90.) in contrast to the reproduction of the neoliberal model with its practices and theories, with emphasis on the individual, alien to the social structures that permeate experiences (Farias & Lopes, 2023Farias, M. N., & Lopes, R. E. (2023). Terapia ocupacional e a armadilha neoliberal progressista: desafios para uma práxis antiopressiva. Revista de Terapia Ocupacional da Universidade de São Paulo, 33(1), 1-9.).

Conclusions

It is important to note that all literature reviews are limited by the databases chosen, the search keywords, the period of time, the language, etc. But even so, they are a tool for elaborating synthesis and understanding of the production of a knowledge field . In this way, like any systematic review, the reflections contained herein are limited to the corpus of documents that were part of it. For future studies, it is possible to expand the corpus to books, videos, conferences, and other sources of information, including unwritten ones, based on the experiences of professionals and their oral history. Therefore, a synthesis of the recent debate about political action in indexed articles and components of the field of occupational therapy is presented here.

It was found that it is necessary to transcend the disputes of common sense to the construction of new common senses, that is, new hegemonies within professional actions, which are also political actions. In Latin America we have developed disputes against the dominant common sense from human rights, from community practices, from political reflections, from social issues, among others. For its transformation we require epistemological, ontological, and methodological constructions that provide foundation for the new common meanings that are proposed. From this literature review, it is concluded that there are advances in this sense, generating names, techniques, theoretical and methodological foundations for the proposals in occupational therapy coming from social occupational therapy, originally from Brazil.

The reflections continue about the political dimensions of the profession, because it is necessary to continue questioning the social and political place that we have within society, permanently questioning the common sense that dominates us and create and recreate ways to generate new common senses, which are consistent with ethical and political ideals to constitute the social place and contributions in today's world.

Reading the political action of occupational therapy from a Gramscian understanding is an opportunity to recognize the political places of the profession construction its technical and political power, when working with the social fabric. It is the people's existence, the everyday life, moving forward in the construction and reflection of the ethical-political project of the profession. It is important to keep the question of the political meaning of occupational therapy current; a question that has arisen in some countries for many years and that must be permanently updated.

  • How to cite: García Ruiz, S., & Malfitano, A. P. S. (2024). Political action in occupational therapy: an integrative review. Cadernos Brasileiros de Terapia Ocupacional, 32, e3624. https://doi.org/10.1590/2526-8910.ctoAR278336242
  • Funding Source
    Coordination of Superior Level Staff Improvement – CAPES – Code 001.

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Edited by

Section editor

Prof. Dr. Daniela Edelvis Testa

Publication Dates

  • Publication in this collection
    26 Feb 2024
  • Date of issue
    2024

History

  • Received
    05 Aug 2023
  • Reviewed
    03 Nov 2023
  • Accepted
    21 Nov 2023
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