Northern philosophies and professional neocolonialism in occupational therapy: a historical review and critique

Filosofias do norte e neocolonialismo profissional na terapia ocupacional: uma visão histórica e crítica

ABSTRACT

In this article, the authors conduct a historical review of recent philosophies influencing the Occupational Therapy profession in the United States (analytic philosophy and Continental varieties such as neopragmatism). Four philosophical categories are explored: epistemology, axiology, ontology, and praxis. The dominant strand of analytic philosophy is characterized by reductionist views of knowledge and reality, with little sustained attention to ethics and practical action. Competing but lesser recognized Continentally-inspired philosophies offer a critical and more phenomenological approach which values human subjectivities, narratives, and social agency. The authors argue that the dominance of analytic philosophy has created the intellectual foundations for neoliberalism to thrive and permeate the profession of Occupational Therapy in its curricula, practice models, reimbursement systems, and research agenda. As this Northern (United States) version of Occupational Therapy expands globally, the danger exists for professional neocolonialism to occur which can negatively influence or contradict more local ways of knowing and doing. The article concludes by offering strategies to unmask, disentangle, and dismantle Occupational Therapy from its Northern roots towards wider acceptance of Southern epistemologies, ethics, and collective action.

Keywords:
Philosophy; Occupational Therapy; Professional Practice; Colonialism; Politics

RESUMO

Neste artigo, os autores apresentam uma visão histórica das filosofias recentes que influenciaram a profissão da terapia ocupacional nos Estados Unidos da América (variantes da Filosofia Analítica e Continental, como o neopragmatismo). Quatro categorias filosóficas são exploradas: epistemologia, axiologia, ontologia e práxis. A vertente dominante da filosofia analítica é caracterizada pela visão reducionista do conhecimento e da realidade, com pouca atenção voltada para a ética e ação prática. Competindo com ela, mas com menor reconhecimento, correntes inspiradas na filosofia continental oferecem uma abordagem crítica e mais fenomenológica que valoriza a subjetividade humana, as narrativas e a agência social. Os autores argumentam que o domínio da filosofia analítica criou as bases intelectuais para o neoliberalismo prosperar e permear a profissão da terapia ocupacional em seus currículos, modelos de prática, sistemas de reembolso e agenda de pesquisa. À medida que esta versão do Norte (Estados Unidos) da terapia ocupacional se expande globalmente, existe o perigo de ocorrer o neocolonialismo profissional, que pode influenciar negativamente ou contradizer formas mais locais de saber e de fazer. O artigo conclui oferecendo estratégias para desmascarar, desembaraçar e desmantelar a terapia ocupacional de suas raízes do Norte em direção a uma ampla aceitação das epistemologias do Sul, da ética e da ação coletiva.

Palavras-chave:
Filosofia; Terapia Ocupacional; Prática Profissional; Colonialismo Profissional; Política

Introduction

The profession of Occupational Therapy (OT) originated in the United States- the ‘Global North’- and has therefore been strongly influenced by Northern perspectives in terms of its purpose, values, and supposed best methods. Despite more recent counterarguments (Taff & Babulal, 2021), pragmatism (a distinctly American philosophy) has been widely accepted historically as the primary philosophical foundation of Occupational Therapy, and, as such, has influenced all facets of the profession. Pragmatism, with its rejection of metaphysical consideration and focus on experience and experimentation, was easily assimilated into the positivist and reductionist medical model paradigm to which the young profession of Occupational Therapy aligned itself early in its history (Taff & Babulal, 2021). Despite the occasional emergence of more occupation-centered approaches over its history, Northern Occupational Therapy has largely been represented by the mechanistic paradigm as implemented in rehabilitation-centered practice focused on body structures and return of function (Kielhofner, 2009; Soares, 1991). In the instances where the profession has accepted occupation as a more fundamental consideration, healthcare systems and reimbursement structures based upon reductionist and neoliberal philosophical assumptions have limited its potential (Gupta & Taff, 2015). Even the meaning of the core concept of the profession, occupation, is imbued with assumptions and lexicons of the North (Babulal et al., 2021; Hammell, 2009). As Occupational Therapy has expanded globally in the past 100 years, many nations where the profession is developing have typically either adopted the Northern (United States) model or modified it to fit their local context (Christiansen, 2017; Drummond & Cruz, 2018). Regardless of which path taken, the foundations remain. Therefore, many of the basic epistemologies, values, and terminology of Northern Occupational Therapy have been incorporated, resulting in a professional neocolonialism which does not adequately represent Southern, or more local cultural traditions and views of health. Southern philosophical traditions are increasingly being recognized and welcomed as critical to informing the doing of Occupational Therapy and as ways to push back against the Northern neocolonialism of the profession and the people it serves (Connell, 2007; Guajardo et al., 2015; Kronenberg, 2013).

In this paper, we conduct a historical review of the foundational philosophies which currently inform Occupational Therapy in the United States and explore how these Northern philosophical influences impact professional education, research, and practice not only domestically, but also worldwide. We first discuss the history and some common themes, concepts, and thinkers in contemporary philosophy in the United States using the organizing categories of epistemology, axiology, ontology, and praxis. Within each of these categories, we discuss both the dominant analytic tradition as well as the less accepted resistance of Continental variants of philosophy, namely neopragmatism. We then proceed to briefly discuss how these reductionist philosophical foundations support neoliberal social structures and thus manifest themselves in how Occupational Therapy educates students, studies the essentials and outcomes of the profession, and delivers services for individuals and communities. Simultaneously, we offer a critique of the consequences of the Northern philosophical orientation and, finally, examine potential opportunities that exist to minimize the professional neocolonialism of Northern Occupational Therapy and inform a more global philosophical paradigm aimed at equitable health and wellbeing for all people.

Contemporary Philosophy in the United States

In the United States of the 1930’s and 1940’s, the discipline of philosophy was unstructured and directionless (Putnam, 1998). Classic pragmatism was on the wane, championed only by John Dewey in educational contexts. The social reconstructionism of George Counts, Harold Rugg and Theodore Brameld found limited influence, mainly in pockets of progressive educationalists, due to fears surrounding its radical proposals; essentially that schools can be the vehicle for social reform and training agents of change (Stanley, 1992). Into this void stepped the philosophy of analysis, which was welcomed as the logical successor to American pragmatism, extending that philosophy’s “secular, scientifically-oriented creed” (Kuklick, 2001, p. 257). The philosophy of analysis, or analytic philosophy, as it was known in the United States, was initially influenced by- but later broke away from- logical positivism and the philosophers of the Vienna Circle. Although not as narrowly prescribed as sometimes portrayed, analytic philosophy has typically been guided by some version of the following central tenets (Dummett, 1993; Gettier, 1963; Glendinning, 2006; Schwartz, 2012):

1. 1

   Conceptual clarity is the primary objective;

2. 2

   In epistemology, knowledge is more than simply justified true belief;

3. 3

   Clarity can be achieved only through formal logic and linguistic semantics;

4. 4

   The analysis of language is prior to the analysis of thought;

5. 5

   Philosophy must be aligned with the methods of contemporary science;

6. 6

   A priority on a reductionist perspective where precision and narrowly-defined questions are favored over broad, metaphysical discussions;

7. 7

   A relative disregard for historical context and the history of philosophical development and connections to other disciplines.

Despite adherence (mostly) to the above core principles, the analytic philosophy movement is in actuality quite varied and disagreements between its various proponents are common (Kuklick, 2001; Putnam, 1998). In the United States, analytic philosophy quickly gained prominence in the two decades following World War II, led by thinkers including W.V.O. Quine, Hilary Putnam, Donald Davidson, and Nelson Goodman, among others (Kuklick, 2001; Putnam, 1998). With its decidedly objective nature, analytic philosophy found an easy home in postwar America, where thought traditions resistant to ideology and supportive of technical advancement were welcomed (Putnam, 1998).

Scholars have suggested that the philosophical history of Occupational Therapy is comprised of a series of alternating swings between pragmatism and structuralism (Hooper & Wood, 2002), while others have proposed that positivism (as both a predecessor and contemporary correspondent of analytic philosophy) has consistently been an influence on the profession since its inception (Taff & Babulal, 2021). Regardless of these perspectives and occasional challenges to its basic tenets (for example, Thomas Kuhn’s (Kuhn, 1962) iconic book, The Structure of Scientific Revolutions, Herbert Marcuse’s (Marcuse, 1964) One-Dimensional Man, and John Rawls’ (Rawls, 1970) A Theory of Justice), analytic philosophy has remained the dominant stream of thought in the United States for the past 70 years and continues to reinforce a reductionist perspective of human occupation and health that has generally characterized biomedicine and American healthcare and reimbursement systems.

Notwithstanding the unquestioned dominance of analytic philosophy in the United States, there has been sporadic opposition, first in the early 1960’s with The Port Huron Statement and the rise of the New Left (Kuklick, 2001), and again in the late 1970’s and early 1980’s, led by Richard Rorty, Cornel West, Stanley Cavell, and the internal realism of Hilary Putnam. Each of these attacks on the rationality of the analytic tradition and its abandonment of the public intellectual role of philosophy were directly informed by philosophies deriving from Continental backgrounds. Continental philosophy is not easily or succinctly defined, but generally refers to a system of thought that began with Immanuel Kant’s Critique of Pure Reason (1781) (Kant, 1998) and Critique of the Power of Judgment (1790) (Kant, 2000) and continues in various forms today (Critchley, 2001). Continental philosophy seeks to address “existential, moral or ethical and aesthetic questions: questions about the nature of existence and the meaning of life, questions of right and wrong or of the meaning of art and beauty” (West, 2010, p.5). Continental philosophies are in focus and method the converse of analytic philosophy and tend towards the study of change as elicited through critique, praxis, and emancipation (Critchley, 2001). Schools of thought often associated with the Continental tradition include existentialism, Marxism, phenomenology, critical theory, and deconstruction. This collection of Continental variants can be quite diverse, but all share the proclivity to address problems not with logic, mathematics, or ‘rigorous’ science as analytic philosophy would, but rather through means both textual and contextual (Critchley, 2001).

In the mid-1980’s, Rajchman & West (1985) gathered a variety of philosophers-including many who had identified as analytic philosophers for some or most of their careers- to author influential essays under the banner of ‘post-analytic philosophy’. Post-analytic philosophy expresses some of the themes typically present in Continental streams of thought, focusing on literary theory, history of science, and moral-political philosophy, all fields where “great social questions were at stake” (Rajchman, 1985, p. 25). These post-analytic topics of concern found voice in the writings of Rorty (in particular), West, Cavell, and also Putnam to a degree, albeit through the filter of realism. Even with this renewal of Continental thought in American philosophy, cracks in the pervasiveness of analytic philosophy in academia have not been widespread; Putnam (1998, p. 219) noted the exclusion of Continental philosophy, stating that “the leading PhD-granting institutions rarely include texts by Foucault or Derrida in their courses, and the work of Jürgen Habermas has only begun to receive attention- and then usually only in ethics courses- fairly recently”. While even a partial history or conceptual exploration of either analytic or Continental philosophy is well beyond the scope of this paper, we suggest with confidence that the current American philosophical landscape in 2021 is a mix of mostly analytic philosophy accompanied by a smaller measure of neopragmatism predisposed to a Continental mindset. This philosophical amalgam underpins the physical and social sciences, thus informing a variety of policies, institutions, and professions (including healthcare professions such as Occupational Therapy).

Method

The method for this historical review consisted of two major steps. First, we separated out the three broad elements historically present in every philosophy (Pritchard, 2016): epistemology (knowledge), axiology (ethics), and ontology (reality) and added the dimension of praxis (action) as the organizing criteria for analyzing literature. Next, within each of those four dimensions, we conducted a literature review extending from 1920 to 2020, identifying ideas and representative philosophers whose thoughts have been intellectually, socially, and professionally influential in the United States, with particular focus on the past three or four decades. The literature review used the following search terms: axiology, epistemology, ethics, ontology, philosophy, philosophers, praxis, and United States. A basic content analysis using frequency counts to identify leading philosophical schools and thinkers was supplemented by (and compared to) historical texts documenting the evolution of philosophy in the United States over the past 100 years.

Results

Epistemology

Epistemology, the exploration of knowledge, is expressed in the United States mostly through the lens of the scientific language and methods of analytic philosophy but is occasionally opposed through the perspectives of neopragmatism and other variants of Continental philosophy. Analytic philosophy generally views philosophy and empirical science as one in the same. Quine (1969, p. 69) suggests that knowledge should only be “concerned with the foundations of science”. Within that paradigm, knowledge is produced through precise, controlled scientific methods. Quine rejects the notion that approaches other than rigorous science can serve as explanatory mechanisms; only observation and verification through empirical exploration can supply a true understanding of the world. Quine views human knowledge as a belief system that is either: 1) confirmed through empirical science, 2) modified and re-tested, or 3) rejected outright. In this view, humans cannot possess knowledge prior to experimentation. Meaning, as an element of knowledge, “[...] is ill-suited for use as an instrument of philosophical and scientific clarification and analysis [...]” (Quine, 1981, p.185). Analytic philosophy rejects knowledge as a useful term for science, although it is acceptable for everyday use. That said, knowledge can be embodied in language, and since language can be broken down into discrete, measurable units, it is therefore suitable for scientific study. Semantically, Quine prefers the use of the term ‘theories’ to ‘knowledge’, as it is more precise and speaks to the need to test our theories through scientific investigation. While Quine’s work- and that of others sharing similar views-was very influential, there does exist a wider continuum of analytic thought. That said, the template of philosophy-as-science, with its strict focus on empirical methods that are reductionist and rigorous, is a hallmark of conventional analytic philosophy. It was this basic paradigm that medicine adopted as the foundation of biomedical science relatively early in the 20^th century.

Nelson Goodman, another philosopher who falls within the realm of the analytic tradition, holds a wider conception of epistemology than many of his peers. For Goodman (1978), science, art, and philosophy all contribute to the development of human understanding, or “worldmaking”. Therefore, epistemology, or knowledge, is a wide-ranging enterprise where our concepts establish a structure for us to construct ‘versions’, or worlds. Goodman’s perspective is important in that it marks a nexus of epistemology with ontology, as the version or world we ascribe to as ‘real’ only exists within our conceptualizations of it, and not independently. Words and language are critical here, but not in the same way as the more common linguistic scrutiny of many analytic philosophers. Here, words name and give shape to aspects of our worlds, thus making them real. Goodman’s focus on the role of words and language can also be viewed as linking analytic philosophy with the Continental traditions of postmodernism and deconstruction.

Richard Rorty spent considerable time in his career pondering issues surrounding epistemology and how our categorization of and approach towards exploring knowledge is complicated in the everyday world of applied philosophy. Rorty, another thinker who originally started in the analytic tradition, gradually developed a version of neopragmatism which had much more in common with Continental postmodernism than conventional analytic philosophy. In his view, questions of epistemology are foundational to ask, however, there are no objective truths to be discovered and thus no one theory of knowledge is better than another. A neopragmatic viewpoint suggests that one cannot describe experiences or knowledge objectively because every person’s perspective is uniquely theirs, and that is sufficient to guide them in their everyday lives. No universal or scientifically-proven knowledge is necessary.

Thus, a healthy skepticism is at the core of Rorty’s perspective on epistemology. The entire concept of one theory of knowledge is simply confusion between offering a causal explanation for beliefs rather than a justification for why one believes something to be true (Rorty, 1979). Therefore, the only truth which is beyond doubt is the fact that humans all have thoughts and emotions that matter only in their personal contexts. To think of knowledge as an issue about which we ought to have a singular theory is a vestige of the seventeenth century. Rorty wonders when people will stop asking questions such as “what is knowledge” that were inherited from previous philosophical conversations that have no relevance to the issues we face today: “an ironist hopes that by the time she has finished…introducing brand new words, people will no longer ask questions phrased in the old words” (Rorty, 1989, p.78). Rorty’s epistemological skepticism suggests that individual beliefs are justifiable based upon utility and contextual best fit, not some non-existent universal truth. The development of knowledge “does not consist in getting our descriptions and theories closer to an independently existing reality” (Kolenda, 1990, p. 8).

Human knowledge is therefore best represented as the behavior and words we use in our day-to-day lives (Rorty, 1979). For Rorty (1979, p. 379), the “vocabularies of the day” are what frame knowledge as useful; knowledge is ‘true’ only insofar as it serves a practical purpose. The context of our daily vocabularies is all we can ‘know’, and therefore our goal should not be a quest for objective truth, but rather to simply keep the conversation going.

Axiology

For much of its early history, analytic philosophy did not have much to say regarding the axiological dimensions of philosophy, relegating such thoughts to personal attitudes and feelings which were beyond logical or mathematic analysis. Aside from G.E. Moore’s (Moore, 1994) Principia Ethica, most analytic philosophers considered ethical values, like those of aesthetics, as not provable and thus not worthy of rigorous examination (Glock, 2011; Preston, 2019). Shortly after World War II, a small group of British philosophers (led by R. M. Hare) in the analytic tradition explored ‘metaethics’, a neutral analysis of moral concepts and configurations of moral arguments (Glock, 2011). Metaethics, however, was not a study of ethical dilemmas themselves, but rather “the logical study of the language of morals” (Hare, 1952, p. 5). In the United States of the 1960’s, the triple catalysts of the Civil Rights movement, the Vietnam War, and the beginning of environmental awareness nudged new discussions of ethics, culminating with John Rawls’ landmark book, A Theory of Justice (1970).

In his seminal work, A Theory of Justice (1970), Rawls’ main assertion is that justice may be equated to fairness, wherein the process of deciding what it means to live in a just society, requires agreement amongst all parties regarding that which is fair. In his view, conditions which are fair should nullify the ‘accidents of natural endowment’ and ‘contingencies of social circumstance’ into which different people are born. Such a view is clearly reflected in the Western society’s reverence for self-determination. In the United States specifically this is exemplified by an emphasis on the fictional equality of opportunity for all. Nowhere is this more obvious than the nation’s unyielding belief in the “American Dream”, wherein societal institutions set up to ensure equality of opportunity are considered enough to facilitate the upward mobility, prosperity and success of everyone, providing they are willing to work hard, take risks, and make sacrifices (Barone, 2020).

According to Rawls, designing this social contract for justice requires a clear delineation of the ideal circumstances under which fairness may be rationally agreed upon, a theoretical situation that Rawls terms ‘the original position’. As part of this original position for idealized, rational decision-making, members of a society must exist within a theoretical ‘veil of ignorance’ in which they are unaware of any specific information about their own lives or circumstances. In stripping individuals of their own personal concerns, morally prudent conclusions about what is most fair for everyone can be reached as self-interest and the irrationality that comes with it, have been removed from the equation. It is this specific and careful cultivation of conditions for rational decision-making that can be clearly tied back to analytic philosophy’s preoccupation with logic, rationality, and precision of language. Rather than relying on some spiritually transcendent or intuitive ethical framework to guide society’s moral consciousness, rationality rules the day.

In the real world, however, such an ideal ‘original position’ in which self-interest does not factor is not practical. In a society where individualism and self-determination are deeply wrapped up in narratives about equality of opportunity rather than equality as an outcome, such principles cannot be universally adopted or maintained. Here, Rawls and analytic paradigms are at odds, as knowledge and thus our truth and beliefs about the world, created by and reflected in our ability to relay them in language, are only valuable insofar as they correspond to reality, and thus may be applied practically. This dissonance between reality and the rational conditions of justice and fairness proposed by Rawls is reflected practically in the many social ills and inequalities that persist in the United States, and is another stark reminder of the divided, binomial struggle between the dominant analytic paradigm challenged by post-analytic perspectives influenced by Continental thought.

Richard Rorty’s postanalytic neopragmatism offers another Continental perspective on ethics which is grounded in the concept of solidarity, a situation of continual expansion of those accepted as ‘us’ that is achieved through imagination in the form of novels and film but at best through personal narrative and sharing mutual experiences (Rorty, 1989). Solidarity is “[...] created by increasing our sensitivity to the particular details of the pain and suffering of other, unfamiliar sorts of people. Such increased sensitivity makes it more difficult to marginalize people different from ourselves” (Rorty, 1989, p. 15). Rorty’s suggestion that language and conversation replace knowledge focuses on epistemology, but also has ethical implications. Authentic conversation has as its aim better understanding of another person; part of that understanding is getting to know another’s values, practices, and hopes. In present-tense conversations, people not only learn each other’s hopes, but also create hope for that very conversation (Cooke, 2004). Understood in this way, Rorty’s push to ‘keep the conversation going’ is a fundamentally ethical plea, for if we keep talking, solidarity increases and cruelty decreases. In Rorty’s view, the end goal of any ethical project is not some ultimate or universal moral maxim, but rather creating a more just society. The key to creating such societies is to strike a balance between supporting individual freedoms and limiting societal cruelty, and to do away with moral imperatives and replace those with “imaginative identification” that recognizes the suffering of other people (Rorty, 1989, p. 93).

Stanley Cavell is another philosopher who began his career in the analytic tradition but developed an eclectic philosophical style that ranged from linguistics to film. Cavell never wrote explicitly about ethics or moral philosophy; rather he offers an “implied ethics” (Sparti, 2000, p. 82) best illustrated by the concept of ‘responsiveness’. Responsiveness as an ethical aim is directly opposed to the more typical human reaction of avoiding the pain and suffering of others. For Cavell, we become ethical when we acknowledge others as humans connected by subtle but universally existing emotions and states such as anxiety, pain, joy, and fear. Responsiveness involves taking others’ perspectives; realizing that others may feel what we feel is the very thing we should proactively acknowledge. This is not simply responding to another’s words or actions; ideally we acknowledge our connection: “precisely because the others are in fact acknowledgeable, that their existence and their presence – their being present to us – need not be subject to epistemic justification” (Sparti, 2000, p. 87). This ethical implication- responsiveness- is not simply a recognition; however, there is a corresponding call for action. In this way, Cavell always views ethics and praxis as linked.

Responsiveness is the acknowledgement, and its subsequent action is what fully allows us into knowing another’s life space. This ‘knowing’ calls upon us to confront, heal, and soothe. In this way, responsiveness functions as ethics, praxis, ontology, and epistemology all at once. Ethics, for Cavell, involves us facing our responsibility (not avoiding) to know others and act to help them. Overcoming our natural inclination to avoid such existentially terrifying situations is at the heart of Cavell’s implied ethics; it is essentially an intersubjective knowing that supports both interpersonal relationships and democratic citizenship. Cavell’s concept of knowing is closely related to the Continental view of Levinas’ ‘ethics of the other’ (Levinas, 1969).

Another Cavellian concept that has implications for contemporary American axiology is perfectionism, or, more specifically, moral perfectionism. Moral perfectionism as a philosophical concept has nothing to do with the characteristic of being meticulous in every detail of life; rather, it is a worldview tied closely to beliefs that describe how humans examine the direction of their lives (Arcilla, 2012, p. 31). In Conditions Handsome and Unhandsome, Cavell (1990) spells out what he means by moral perfectionism and its “[...] contribution to thinking about the moral necessity of making oneself intelligible (one’s actions, one’s sufferings, one’s position)…as if the threat to one’s moral coherence comes most insistently from that quarter, from one’s sense of obscurity to oneself”.

Moral perfectionism is not simple or even deep self-knowledge. Instead, it centers on the general understanding of one’s identity as lived in the practical world with other self-intelligible beings (Arcilla, 2012). This basic understanding of oneself amounts to a confidence in knowing who one is, and what one stands for. People need this minimal level of self-intelligibility in order to be morally coherent and therefore fully responsive to others needs. Responsiveness in emotion and action is at the core of Cavell’s conceptualization of an everyday ethics. The reciprocal nature of moral perfectionism illustrates not only our own anxiety about self-intelligibility and how we should live a good life, but also that we each have a responsibility to help others navigate those same dilemmas in their lives. Finding one’s way (or helping another do likewise) in a complex world is the essence of moral perfectionism and brings to light the educational aspects of Cavell’s ethical aims.

Moral perfectionism is thus a sort of ethical mandate- learning about others in order to help raise them from self-obscurity is a moral enterprise that contributes to our ability to live fully connected with each other in a democratic society. Education (learning) is therefore in itself an ethical act and our mutual education (of oneself and any other) serves as an ethical journey. We ourselves do not represent humanity individually; it is through each individual helping others be their best selves that we strive for moral perfectionism. This constant striving- an education- for others forms another strand of an ethical foundation that pushes back against traditional American norms of rugged individualism, self-reliance and competitive social Darwinism.

Ontology

The nature of reality, existence or being- ontology- owns a similar recent history to axiology (ethics) in the United States. Symons (2010, p. 349) aptly describes ontology as “[...] a slippery business which is usually characterized via the claim that it is the inquiry into the nature of existence or the attempt to determine the kinds of things that exist”. The recent history of ontology within analytic philosophy paints a dynamic picture where attitudes fluctuated widely and quickly. In the early 1900’s, the analytic tradition made room for discussions regarding ontology. However, as the discipline approached mid-century and focused primarily on language and logic, analytic philosophers generally had little to say about ontological questions that belonged in the realm of metaphysics, and were thus not verifiable. Starting in the late 1950’s and early 1960’s, discussions of ontology in analytic circles reemerged in a “very robust and unapologetic manner” (Symons, 2010, p. 350) due in the large part to Quine’s (1969) criticism of the analytic-synthetic demarcation and Strawson’s (1959) discussion of the metaphysical assumptions that impact ordinary speech and thought.

The emergence of metaphysics (specifically ontology) as a valid aspect of debate within analytic philosophy reached a tipping point with Saul Kripke’s (Kripke, 1972) influential Naming and Necessity. In that book, Kripke successfully argues for a distinction between metaphysics and epistemology, thus shattering the Kantian notion that “we are unable to know the world apart from our experiential or epistemic apparatus” (Symons, 2010, p. 350). Towards the end of the twentieth century, variants of post-analytic philosophy reflected a move towards a more neo-pragmatic approach and offered increased possibilities for discussions of ontological questions within contemporary analytic philosophy. Symons (2010) suggests three sometimes incompatible principles which characterize much of the recent exploration of ontology within analytic philosophy: 1) preservation of common sense explanations wherever possible, 2) rejection of epistemic criticisms of metaphysics, and 3) commitment to a view that language, logic, and ontology are linked. While we do not venture into further discussion of these principles and their application and/or implications, we do briefly discuss American philosophical ontology in its most recent form through the perspectives of Richard Rorty and Hilary Putnam. The standing of ontology in the contemporary philosophical landscape of the United States reveals yet another example of the sometimes tense dichotomy between dominant forms of positivist-leaning analytic philosophical traditions tempered by Continentally-influenced elements of a post-analytic perspective.

Rorty (1979) suggests that there is no such thing as a human ‘essence’, an unchangeable or mystic entity that makes humans ‘human’. Likewise, there is no inner eye of the mind that is presented with knowledge of what is ‘real’. Rorty sees the traditional merger and conditional nature of ontology and epistemology as problematic, instead insisting that what is knowable, and thus real, is wholly dependent upon the unique contexts of everyday life. The world is not something to be found but something to be made, and language is the most useful tool for this endeavor. Rorty therefore “[...] invites us to shift our attention to the substance of being in the world, namely our concrete activities of coping manifested in successful uses of language” (Kolenda, 1990, p. 4).

For Rorty, language offers us the most reliable access to reality. To say that truth is not ‘out there’ is simply to say that where there are no sentences, there is no truth, and that sentences, as elements of human languages, are human creations. We must set aside any notion that our intrinsic nature as humans is waiting to be discovered. We form our sense of self through noting the patterns of behavior we use to cope, predict and control. Rorty views coping as an amalgam of knowledge, action and hope and that our purpose in life- our being- is to strive for ways to be “good at being human” (Kolenda, 1990; Rorty, 1982, p. 27). Therefore, if there is no essence of human nature, then human life should be allowed to seek fulfillment in whatever ways each individual finds meaningful, with solidarity (being, or living with) as the goal.

Every individual has an unconscious need to develop a sense of self in their own words as they describe the events, influences, and choices that culminate in their being (Rorty, 1989). Rorty’s ontological view here is quite compatible to the quintessentially Continental school of existentialism and its centerpiece idea that humans are ever-evolving, self-creating beings whose choices and actions comprise their ‘essence’ and impact not only themselves but also the world at large (Rorty, 1989; Sartre, 1943). In existentialism, as in Rortyian neopragmatism, human existence is full of contingencies, and there are no guarantees that individuals re-describe themselves to better overcome the adversities they face. In the United States of 2021, such existential views of ontology have diffused outside of academic circles and into the mainstream where the Black Lives Matter movement has surfaced overdue discussions focused on the historical and structural limitations placed upon the ability of marginalized persons to ‘be’, to exist in authentic ways where they have the freedom of re-description on their own terms.

In contrast, Hillary Putnam, another giant of the post-modern analytic tradition, positions himself somewhere in between what he views as Rorty’s cultural relativism and the equally popular scientific realism. A position he brands ‘internal realism’ in his work Realism with a Human Face, where he presents his own critical examination of post-modern metaphysics (Putnam, 1992). In accordance with Rorty, he regards the norms and standards by which we judge a belief’s congruency with reality as historical products that evolve with time (Putnam, 1992). Thus, also like Rorty, he believes these standards are capable of reform. He also agrees in that much of human understanding about reality and what it means to exist is contextually dependent (Rockwell, 2003). For him, scientific realism ignores nuance, as nothing can be experienced outside of our own conceptual schemes, a metaphor he describes as the formation of our own individual ‘pictures’ (Putnam, 1992). From Putnam’s perspective, it is not bad to have pictures in philosophy, he too admits to having his own, but he begins to see a problem when we “forget they are pictures and treat them as ‘the world’” (Putnam, 1992, p. 40).

Here he breaks with Rorty’s view that the world is something to be made, shaped by human willpower or “our disposition to talk in certain ways” (Putnam, 1992, p. 29). He values the practical importance of context for human understanding (and meaning making) of reality, but he also affirms the existence of a reality that is completely independent of human action or belief. Just because the two may conflict at times, does not mean we should abandon the joint exploration of ontology (being) and epistemology (knowledge or truth) entirely. For Putnam, common-sense intuitions about the world should be preserved regardless of the ever-evolving nature of the standards and norms by which we judge their acceptability (Moran, 2000). From his point of view, the truth is indeed ‘out there’.

True to the analytic tradition, he draws this conclusion by expanding upon a logical premise for warranted assertibility (true belief). He argues that if some beliefs are to be judged as ‘warranted’ while others are not, there must be then an ultimate reality on which this justifiability is based, or else these judgements would have no real legitimacy. For Putnam, (1) rightness cannot be subjective and (2) must go beyond justification (Putnam, 1992). In his view then, for all things that exist, there are real, identifiable criteria by which to define their essence, but equally important is that those criteria are, to an extent, determinable by us (Putnam, 1992). It’s a view rife with philosophical controversy, and the potential for ‘rival pictures’, but for Putnam, it is a controversy and philosophical enterprise that is important to preserve. Where Rorty’s individual re-descriptions and abandonment of any determinate reality have fueled new, progressive fire in today’s society, such as within the Black Lives Matter Movement, by Putnam’s estimation, such critical consciousness raising is not based solely on an improvement in our descriptions and standards. The legitimacy of such movements is not a matter of relevance; the existence of a uniquely Black identity in the United States has always been and will always be. Applying Putnam’s perspective, the growing awareness for the issue is simply a matter of historical standards catching up to this very real and tangible experience. As we move forward as a society then, Putnam would argue we must reject Realism, while ‘revitalizing the realistic spirit’ (Putnam, 1992, p. 42).

Praxis

As a concept, praxis has deep historical roots going back as far as one of Aristotle’s three key human activities: thinking, making, and doing (Lobkowicz, 1967). Praxis later became a key feature of Marxist thought, referring to actions through which humans create and change their world (Petrovic, 1991). Praxis and action have often been used interchangeably, however, unlike Marxism’s attention to praxis as activities in the context of living, in more recent analytic philosophy the focus has been on describing action as comprised of motives, intentions, and reasons (Bernstein, 1971). Early on, the concept of action “played an insignificant role” (Bernstein, 1971, p. 233) in the thinking of analytic philosophers. The reductionism of analytic philosophy is clear in the idea that “everything that we can legitimately describe and explain about human behavior or action can, in principle, be described and explained in terms of “motions of the body” or “the purely descriptive language available to physical science” (Bernstein, 1971, p. 236). Bernstein (1971, p. 237) notes this materialist stance where humans are conceived as “nothing but a complex physical mechanism” as typical of much of analytic philosophy’s history.

In The Logical Structure of the World, Rudolf Carnap, an early analytic philosopher and member of the Vienna Circle, helped set the foundations for the reductionist paradigm by suggesting a ‘constructional system’ where it was possible to reduce all psychological concepts to physical concepts (Carnap, 1967). In Carnap’s system, human action could be described in clear language “[...] whereby all statements concerning action could be transformed into statements about more basic elements” (Bernstein, 1971, p. 244). The goal here was not to explore human action and how it occurs in daily life; rather it was to understand the linguistic concept of action, its connections to other concepts, and how it could be reduced to more basic concepts (Bernstein, 1971). As time wore on, some analytic philosophers slowly began to question, if not the methods of analysis, at least the end goals of reductionism, and that the concept of action is a “fundamental one, and since it cannot be reduced or translated into a language that is exclusively mechanistic, it turns out to be a conceptual truth” (Bernstein, 1971, p. 258, 319). In 1971, Bernstein was hopeful that “younger analytic philosophers are becoming skeptical of the injunction that the exclusive job of the philosophy is to describe”. However, more recent literature has not consistently borne out Bernstein’s optimism that analytic philosophy has moved towards a greater engagement with everyday human praxis, despite the rise of the post-analytic strand. Rorty (1999) echoes the resilience of the classic analytic tradition into the twenty-first century, stating his skepticism about rigid philosophical methods or claims to ‘scientific’ expertise: “It is one thing to say that philosophers should form a distinct expert culture, but quite another to suggest that they ought to be more like mathematicians than like lawyers, or more like microbiologists than like historians” (Rorty, 1999, p. 12).

As with matters of axiology and ontology, the attention directed to praxis in American philosophy has been minimal, although this shows signs of slowly evolving as post-analytic and Continental variants of philosophical thought provide resistance to the reductionist and mechanistic inclinations of the analytic tradition. In this section, we briefly explore two perspectives of human praxis inspired by the Continental tradition: the existentialism of Jean-Paul Sartre and the neopragmatic contextualism of Richard Rorty. Although uncommonly evoked in Occupational Therapy education, research, or practice, existentialism has long supported the central role of human action as the primary means of growth and being in everyday life (Babulal et al., 2018). Existentialists remind us of the totality of human experience where action is framed as choices fraught with emotions, motivation, and imagination (Cooper, 1999; Marino, 2004). The choices which constitute our continual evolution (i.e., we choose what we become) are inherently individual in nature, as Bernstein (1971, p. 117-119) notes, “human action is not to be confused with social praxis, or indeed, any of its manifestations. Action here is a form of inwardness”. Bernstein further avers that “our existential problem as unique individuals cannot be spoken to in terms of anyone else’s thought”. That said, we can confront the inwardness of our actions and critically reflect on the possible consequences of individual choices on others. Indeed, for Sartre, action merges with ethics to form a semblance of praxis within the concept of freedom: “The ultimate meaning of the acts of honest men is the quest for freedom…in wanting freedom we discover that it depends entirely on the freedom of others…I can take freedom as my goal only if I take that of others as a goal as well” (Sartre, 1960, p. 82-83). Sartre’s position here has been criticized as methodologically shallow by professional philosophers (Bernstein, 1971), however, we view the solidarity of contingent collective freedom as a form of praxis which has valuable implications for living well together.

Much of Richard Rorty’s thought culminates in varieties of praxis; his entire philosophical project can be seen as an attempt to focus on practical action applying what we believe to be true today, knowing that what we have to say and our way of describing a phenomena is not the only one (Rorty, 1979). Rorty’s epistemology, for example, stresses individual knowledge-making, but in the name of collective good that makes us more tolerant and humane (Kolenda, 1990). Similarly, inventing new vocabularies is a creative act that can be transformative. Rorty’s views on ethics are also framed with praxis in mind. Avoiding cruelty within social institutions requires “[...] maximizing the quality of education, freedom of the press, educational opportunity, and opportunities to exert a political influence [...]” (Rorty, 1989, p. 67). Guignon (1982, p. 361) notes that the distinctly Rortyian question “Are we using the right means to attain our ends?” is more focused on the action (means) than the unanswerable question of whether we have identified the ‘correct’ ends. Rorty’s emphasis on avoiding cruelty, building solidarity, and achieving human consensus all speak to the value of collective human praxis in effecting change towards a more just world.

Discussion

Although there appears to be a slowly increasing diversity in philosophies (post-analytic and/or Continental varieties, specifically) in American academic circles, those most commonly translated or expressed in everyday policies, legislation, processes, and infrastructure continue to be based on traditional analytic methods. In an era defined by the global concerns of systemic racism, climate chaos, and the COVID-19 pandemic, crucial issues which would clearly benefit from a much wider problem-solving approach, why is this? We suggest that a major driver is the influence of a pervasive but often hidden neoliberal agenda and associated intrusion of financial and special interests which ignore, override, or- in some cases- deliberately marginalize and stifle competing philosophical or ethical considerations. Simply put, in the analytic paradigm, accepted epistemologies and lack of sustained attention to ethics and praxis provide reductionist philosophical foundations that support neoliberalism. Under a neoliberal paradigm, most facets of society are economized and privatized, thus there is ample motivation to develop systems and structures which sustain the priority of the free market and the transactional nature and commodification of daily life (Birch, 2015; Brown, 2006). Market fundamentalism, a key assumption of neoliberalism, suggests that markets unfettered by regulation can self-correct and essentially provide the social stability to deliver not only economic gain, but also freedom and quality of life (Block, 2007; Block & Somers, 2016). In reality, free markets are not ethically neutral despite propaganda to the contrary (Sandel, 2012). Therefore, market fundamentalism (as a key element of neoliberalism) marginalizes social goods which are not subject to economic metrics and provides conditions ripe for neocolonial oppression and injustice.

Northern Occupational Therapy is therefore part of the neoliberal apparatus and the epistemologies, lexicons, ways of practice, educational priorities, research methodologies, and ethical considerations have been perpetuated as elements of professional neocolonialism. Neocolonialism can be broadly defined as foreign (typically Northern capitalist) influence on and exploitation of another nation. Rather than the direct military and political domination typical of historical colonialism, neocolonialism manifests itself in more subtle economic, cultural, or intellectual ways that can result in financial dependency and subversion of local ways of thinking and doing (Nkrumah, 1966; Sartre, 2001). By ‘professional neocolonialism’, we refer to the hegemonic phenomenon where the theoretical imperialism (Mohanty, 1994; Hammell, 2009; Hammell, 2011) that permeates many of the concepts and modes of Northern Occupational Therapy (e.g. client-centered practice, independence, and productivity) are assumed to be universal and are therefore imposed globally as the profession expands. What results is the violence that occurs when the profession’s minority assumptions dominate and diminish Occupational Therapy’s potential benefit on the well-being of local collectives.

In addition to the symbiotic relationship between neoliberalism and analytic reductionism, philosophy in the United States remains ensconced in the Academy; deep, critical discussion and the use of philosophical perspectives to solve the problems facing the public have rarely (see United States Progressive Era, 1890-1920, particularly the pragmatist John Dewey in educational circles) been commonplace. Kuklick (2001, p. 227) laments that philosophy in the United States has been “an inward-looking organization that had its own set of professional questions and seldom reached out to the wider culture”. These two contextual features have merged to create a situation where the intellectual foundations underlying the very fabric of society can serve as scaffolds for oppression, marginalization, and injustice. While neoliberalism is not a new idea and certainly present worldwide, its expression in the United States has been particularly strong and globally influential (Harvey, 2005; Jones, 2014).

Northern Occupational Therapy, while publicly advocating for a holistic perspective and client-centered approach, is a profession that has historically used reductionist philosophies to help gain legitimacy and power in the healthcare landscape (Gillette & Kielhofner, 1979; Kielhofner & Burke, 1977; Quiroga, 1995; Taff & Babulal, 2021). However, this relationship between the often subtle (the philosophical touchstones for Occupational Therapy have never been clearly delineated or routinely applied throughout the past century (Breines, 1987; Taff & Babulal, 2021) but significant impact of mainly positivist philosophies on various facets of the profession has not been deeply examined or addressed in largely unmet needs for consistent, honest critique. In addition, while its perhaps surprising that Americans as a generally pragmatic people have not embraced praxis as a possibility, or even a responsibility of every citizen, the American fable forged of a mix of rugged individualism, capitalist free-market competition, and social Darwinism has diminished the possibility of praxis (as directed, beneficent action) being utilized for the common good on a widespread basis. Humanist concern for the collective is often shoved aside by the myth of meritocracy, far-right conservative political ideology, and other expressions of neoliberalism (Sandel, 2020).

Under such a system where the main motives are profit-driven, theoretical imperialism and professional neocolonialism are effective tools to maintain the status quo; Northern Occupational Therapy features these elements as subtly integrated in all aspects of its practice, education, and research. A reductionist, mechanistic philosophical underpinning lays the foundation for the neoliberal system to thrive without concern for the human aspects of subjectivity and the distinct power of narratives of lived experience. Analytic philosophies generally do not consider ethics or subjective phenomenology as priorities, and this intellectual context minimizes the chances for enriching the discourse of research and policy as translated to everyday life. Subsequently, voices calling for accountability, person-directed services and collective wellbeing in practice are often silenced (Taff et al., 2014). Similarly, the context for education bears the impact of reductionist philosophies. This is particularly evident in curricular content, accreditation standards, and certification examinations, but also in certain instructional strategies and assessment methods.

Conclusion: Opportunities to Redirect the Discourse and Impact of Philosophy

In this historical review, we set out to explore the evolution of philosophies in the United States and demonstrate how the dominant analytical tradition helps support neoliberalism, and in the specific case of Occupational Therapy, creates a context of professional neocolonialism as it expands globally. Admittedly, the above criticisms are sweeping statements, and the complexity and entanglements of neoliberalism within current healthcare cannot be easily or adequately explained in any arena, let alone in a single paper. However, it is clear these are issues which Occupational Therapy must unmask, disentangle, and dismantle in order to minimize the damage caused by professional neocolonialism and its root catalyst, neoliberalism. As we summarize our discussion, we now briefly offer some recommendations to address Northern neocolonialism in professional education, research, and practice:

Unmasking

• Expose the impact of reductionist philosophies on the current professional lens and how those assumptions limit our approaches to intervention and understanding of occupational engagement

• Expand the skepticism and relativist leanings within neopragmatic philosophies in conjunction with the Southern emphasis on recognizing power inequalities in relation to what constitutes knowledge within our profession (and who makes those decisions)

• Honor both Southern and neopragmatic viewpoints that there is an inherent tension between private pursuits (self-actualization) and moral or community obligations in relation to occupational choice. Specifically expanding the influence of Southern viewpoints that there is an “inseparability of the collective dimension and individual needs” (Malfitano et al., 2014, p. 303).

• Embrace principles of critical consciousness raising in students and practitioners as a means of unmasking underlying assumptions within Northern theories guiding professional models of practice

• Re-examine explicit and implicit values within the profession, especially language used in research, professional documents, jargon, and even deficits-based documentation (for example, the AOTA Code of Ethics removal of social justice from the 2015 version’s principles) (Mahoney & Kiraly-Alvarez, 2019). What ‘reality’ does the language within our central documents and process reflect?

Disentangling

• Disassociate research from reductionism’s lack of nuance by placing priority on the real-life contexts and contingencies that traditional analytic paradigms tend to minimize or ignore for scientific standards of evidence;

• Abandon the century-old quest for acceptance and acknowledgement of our legitimacy as a profession within a biomedical paradigm; shift to new practice areas that meet people within the contexts in which they actually perform their activities;

• Disentangle the profession from rigid standards for function/recovery-based reimbursement systems driven by neoliberalism; we must choose between values of the power of the meaning we make from doing and the overemphasis on the how and what of doing;

• Pursue and publish more research that explores the real-life contexts, nuances, or contingencies related to occupational engagement that traditional analytic paradigms overlook or undervalue.

Dismantling

• Advocate to dismantle the systems reinforcing the more oppressive aspects of Northern ideologies. This should include applying the Southern emphasis on praxis and social activism to move towards an occupational therapy that emphasizes the role of clinical practitioner as political agent;

• Design curricula that prepare students to be activists, not technicians;

• Explicitly connect the accountability of practitioners to the well-being of the people they serve;

• Prioritize our duty to address social injustices at community and population levels (e.g., social determinants of health, systemic racism) and their impact on human health and well-being.

In conclusion, we suggest that Southern Occupational Therapies (Guajardo et al., 2015; Malfitano et al., 2019) offer a path forward that can be complemented by integrating elements of Continentally-inspired philosophies such as neopragmatic contextualism (Taff et al., 2014) to buffer the impact of Northern neocolonialism. Not only is it an ethical responsibility, it also bodes well for the re-imagination and growth of Occupational Therapy as a profession which focuses on individual capabilities and collective wellbeing in stark awareness of its potential, and responsibility, as an inherently political endeavor (Pollard et al., 2008).

• How to cite: Taff, S. D., & Putnam, L. (2022). Professional neocolonialism in occupational therapy: a historical review and critique. Cadernos Brasileiros de Terapia Ocupacional, 30, e2986. https://doi.org/10.1590/2526-8910.ctoAO22642986

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Edited by

Section editor

Prof. Dr. Daniel Marinho Cezar da Cruz

Publication Dates

• Publication in this collection
  07 Jan 2022
• Date of issue
  2022

History

• Received
  18 Mar 2021
• Reviewed
  20 Aug 2021
• Accepted
  02 Sept 2021