Occupational therapy is currently emerging from a biomedical paradigm and moving toward a new paradigm that values client-centred practice, occupation, understanding the client's perspective, active engagement and empowerment, and balancing art and science (Kielhofiner, 1997). As occupation is a major focus of this emerging paradigm, the assumptions about occupation in the occupational therapy discourse need further investigation. In particular, the occupational therapy assumption that meaningful and purposeful occupation can promote health and wellbeing requires exploration.
This thesis aims to address four general questions at a conceptual level. These are: a) How do individuals constitute meaning and purpose? b) How do individuals interpret the personal meanings and purposes of others? c) How might occupational therapists most easily access the meanings and purposes of the occupations of their clients? and d) Does an understanding of personally meaningful and purposeful occupation add to an understanding of the mutually influencing relationship between being and action and, if so, how? In addressing these conceptual questions, it draws upon the interpretivist approaches of Phenomenology and Hermeneutics to explore the individually constructed nature of meanings and the interpretive processes involved in sharing with or eliciting from others those meanings. Narrative is presented as a way that occupational therapists might most easily access the meanings and purposes of occupations developed by the clients with whom they work. In this thesis, it is proposed that occupational therapists' understanding of the concepts of meaningful and purposeful occupation require investigation and these concepts of occupation are explored in the context of narrative.
At a methodological level, an interpretive approach is used to address these questions. Elements of the Hermeneutic Case Reconstruction methodology were used to guide the interpretation of narratives. This method was originally developed by Gabrielle Rosenthal (1993,1997,1998), for the analysis of narrative data generated through interview. However, pathographies were selected as the source of data and only elements of the method were appropriate to their analysis.
Elements of the Hermeneutic Case Reconstruction method were used in this research for the analysis of three published autobiographical accounts of experiences of brain impairment. Three books, written by women who had received intervention within the Australian healthcare system, were selected for the study. Doing Up Buttons (Durham, 1997) detailed the experiences of a teacher who acquired a brain injury as a result of a motor vehicle accident. Two other books. Speechless: My recovery from stroke (Gordon, 1994) and When Half is Whole (Hewson, 1982) provided narrative accounts of two women who had experienced cerebrovascular accidents (CVA).
The Hermeneutic Case Reconstruction method aims to highlight the selective processes used in the construction of narratives through the identification of the main theme or themes that structure a narrative. Rather than 'cutting and pasting' narrative data into themes, as typically occurs in many qualitative approaches to data analysis, this method attends to the sequence in which events and experiences are told.
The analysis of the three texts described above resulted in the identification of the overall case structure for each book. Then, one "thematic field" (using the term field in the phenomenological sense) was selected from each case structure to use as the basis for a discussion of the relevance of such analysis of narratives to occupational therapy practice. These thematic fields were as follows. Firstly, the analysis of Doing Up Buttons (Durham, 1997) generated the thematic field of 'innocent victim'. Secondly, a thematic field that was labeled 'lack of a loving relationship' was identified as structuring Speechless: My recovery from stroke (Gordon, 1994). Finally, When Half is Whole: My recovery from stroke (Hewson, 1982) appears to have been structured within a thematic field of 'loss of human dignity and humanity'.
This thesis discusses the results of these analyses of narratives in relation to the occupational therapy concern for being and action. In particular, it explores the way each woman's biography and self-identity, both aspects of being, related to her occupational behavior and performance, that is, action. This discussion was based on a process of 'mapping' thematic fields on to the Person-Environment-Occupation Model (PEOM) (Law, Cooper, Strong, Stewart, Rigby & Letts, 1996). This process of mapping highlighted the dynamic nature of the PEOM by emphasizing its temporal dimension. Each narrative illustrates a different strategy to re-establish the author's sense of identity and engagement in occupation.
The elements of the Hermeneutic Case Reconstruction method used in this thesis are also discussed in relation to occupational therapy practice. Four of the method's elements are discussed in detail. These are sequence, the construction of a life history, triangulation and form of language. The potential application for a hermeneutic perspective to clinical reasoning in occupational therapy is also discussed.