1. RCOT June 2018 Tina McGrath PhD MAOTI @DrTinaMcGrath
OCCUPATIONAL SUFFERING Critical and political perspectives on subjective lived experiences of occupational loss
RCOT June 2018
Tina McGrath PhD MAOTI
@DrTinaMcGrath

2. Occupation-centred definitions
HEALTH (Wilcock, 2006; Law, Steinwender & Leclair,1998)
Emphasises the performance of everyday occupations in order to meet basic biological needs, preserve and protect the self, develop capacities and ultimately, explore, express and expand occupational identity
MENTAL HEALTH (McGrath, 2015, p.32)
Component of overall health that dictates the quality and success of personal interactions with the unpredictability and challenge of everyday life
Occupational resilience demonstrates discerning and flexible functioning that continually seeks to maximise performance, participation and potential
WELLBEING (Doble & Santha, 2007;2008)
A subjective state that emerges in response to an individual’s positive evaluation of personal occupational engagement
Refers to the satisfaction, purpose and meaning that people gain from their self-appraised successful negotiation of their occupational lives
Tina McGrath PhD RCOT 2018

3. Wellbeing
“Close attention needs to be paid to the relationship between occupational well-being and individual subjectivity because subjective well-being is experienced and emerges from a person’s occupational engagement”
“Well-being concerns a person’s individual response to the activities that they do. It is linked to satisfactory occupational engagement, and, thus, must involve the ‘doing’ of occupation”
(McGrath, 2015, p.33)
Occupations are bodily lived in the material world
(McGrath, 2017)
Tina McGrath PhD RCOT 2018

4. Theoretical Framework
Human occupation as unifying concept
Being and belonging. Doing becoming.
Occupation as “a practical form of subjectivity” that is bodily lived
(McGrath, 2017, p.137)
Critical Theory
“Attempts to examine the multiple contexts of people’s lives such as the socio-cultural, historical and structural in order to challenge the often hidden and taken-for-granted ideologies that make up the circumstances within which people strive to build personhood and identity” (McGrath, 2017 p.136).
Existential Phenomenology
Emphasis on the sentience and emotionality of the experiencing occupational being’s self-interpreted material existence
(McGrath, 2017)
Tina McGrath PhD RCOT 2018

5. The Occupational Subject
Actively builds a personal occupational identity with and for others
Occupational identity developed over the occupations of a lifetime results in an expected experience of occupational performance that provides a sense of stability and coherence
(McGrath, 2017)
Tina McGrath PhD RCOT 2018

6. Occupational Fidelity
Describes the drive to calibrate one’s doing with one’s being in order confirm an intuitive ideal of occupational performance, experienced as a subjective feeling of rightness in one’s doing, that affirms occupational identity and nourishes one’s becoming” (McGrath, 2014, p.51)
Subjectively validated occupational fidelity contributes to a sense of stable and coherent occupational identity that is consubstantial with a personal sense of health and wellbeing
(McGrath, 2014, pp 51-52)
Tina McGrath PhD RCOT 2018

7. OCCUPATIONAL LOSS A particular type of occupational transition
Occurs when people cannot engage in established valued occupations to their own satisfaction within their lived contexts
Micro – short term, critical impact
Meso – long term/permanent/progressive
Macro - Sudden disruption of many/all occupations, groups
Negative impact on health and wellbeing
Meaning, purpose, values and occupational rights
(CAOT, 2007)
Tina McGrath PhD RCOT 2018

8. Suffering Integral embodied experience
Affliction of the person, not the body (Cassell, 1999)
Threat to subjective coherence of self in world
Symptom or process that challenges narrative (Mattingly, 1998)
Alienation
Self-conflict
Shame
Loneliness (Younger, 1995)
Tina McGrath PhD RCOT 2018

9. Occupational Suffering
Premised on the perception of a “felt core occupational self” described as an imaged and wordless conscious representation of the occupational self that over time and through repetitive experiences, becomes the self-identified occupational being
(McGrath, 2013, p. 48)
Tina McGrath PhD RCOT 2018

10. Occupational Suffering
“An intimate subjective experience that is distinct from occupational disruption which is seen as temporary, or occupational deprivation which occurs as a result of external factors”
“An existential response”
“Is complexly related to senses of loss, challenges to occupational identity and threats to subjective narrative coherence”
(McGrath, 2014, p. 51)
Tina McGrath PhD RCOT 2018

11. Audre Lorde - The Cancer Journals
“I have periods of persistent and distracting visceral discomfort that are totally intrusive and energy consuming. I say this rather than use the word pain, because there are too many gradations of effect and response that are not covered by that one word. One of the worst things about intrusive pain is that it makes me feel impotent, unable to move against it and therefore against anything else, as if the pain swallows up the ability to act” (1996, p.330)
Tina McGrath PhD RCOT 2018

12. Paul Kalanithi – When Breath Becomes Air
“In physical therapy, I was not even lifting weights yet, just lifting my legs. This was exhausting and humiliating. My brain was fine, but I did not feel like myself. My body was frail and weak – the person who could run half marathons was a distant memory – and that, too, shapes your identity. Racking back pain can mold an identity; fatigue and nausea can as well (2016, p.140) I had passed from the subject to the direct object of every sentence in my life. In fourteenth century philosophy, the word patient simply meant ‘the object of an action’, and I felt like one” (2016, p.141)
Tina McGrath PhD RCOT 2018

13. Marianne A Paget – A Complex Sorrow
“Dying is a very ambiguous process, not at all a simple straightforward event. But it’s happening. Each day I lose ground. Each day my breathing diminishes. Each day I weaken. But my spirit too weakens in my body, seeks a quiet place, seeks rest. Even so I miss my vitality. I hate being weak. I hate not getting better. I hate complaining about my ailments. I hate having ailments to complain about. I’ve been like this more or less for six weeks, since I caught a cold” (1993, p.122)
Tina McGrath PhD RCOT 2018

14. Arthur W Frank – At the Will of the Body
“Doing with the body is only part of what needs to be done for the person. What happens when my body breaks down happens not just to that body but also to my life, which is lived in that body. When the body breaks down, so does the life. Even when medicine can fix the body, that doesn’t always put the life back together again” (1991, p.9)
Tina McGrath PhD RCOT 2018

15. Conclusion
Through an appreciation of the concept of occupational suffering, occupational therapists can enter more fully into the subjective and intersubjective aspects of lived occupational loss
The concept of occupational suffering can inform deeper understandings of lived occupational identity in health and illness
Tina McGrath PhD RCOT 2018

16. References Tina McGrath PhD RCOT 2018
CAOT. (2007). Enabling Occupation II: Advancing an Occupational Therapy vision for health, well-being,& justice through occupation. Ottowa: CAOT Publications ACE
Cassell, E.J. (2004). The nature of suffering and the goals of medicine (2nd Ed.). Oxford: Oxford University Press
Doble, S.E., & Santha, J.C. (2007). Occupational well-being from the perspective of Susan Doble and Josiane Caron Santha. In E. Townsend & H.J. Polatajko (Eds.), Enabling Occupation II: advancing an occupational therapy vision for health, well-being, and justice through occupation, (pp ). Ottowa: CAOT Publications ACE.
Doble, S.E., & Santha, J.C. (2008). Occupational well-being: rethinking occupational therapy outcomes. Canadian Journal of Occupational Therapy, 75 (3), )
Frank, A.W. (1991). At the will of the body: reflections on illness. New York: Mariner Books.
Gallagher, M.P. (2016). Into extra time: living through the final stages of cancer and jottings along the way. Dublin: Messenger Publications.
Kalanithi, P. (2016). When breath becomes air: what makes life worth living in the face of death. London: Vintage
Kleinman, A. (1988). The illness narratives: suffering, healing and the human condition. USA: Basic Books
Law, M., Steinwender, S., & Leclair, L. (1998). Occupation, health and well-being. Canadian Journal of Occupational Therapy, 65 (2),
Lorde, A. (1996). The Audre Lorde compendium: essays, speeches and journals. London: Pandora.
Mattingly, C. (1998). Healing dramas and clinical plots: the narrative structure of experience. Cambridge: Cambridge University Press.
McGrath, T. (2017). In our own hands and in the eyes of others: the emanicipatory imperative of occupational witnessing for becoming and belonging. In: N. Pollard and D. Sakellariou (Eds.). Occupational Therapies without borders: integrating justice with practice (2nd. Ed.). (pp 134 – 142). Edinburgh: Elsevier
McGrath, T. (2015). Health, mental health and well-being: occupation-centred perspectives in the Irish context. Irish Journal of Occupational Therapy, Special Issue: Mental Health, 43, 29-34
McGrath, T. (2014). Occupational Therapy News: PhD Conferring. Living to tell the tale: Narratives of occupational engagement, creativity and living with breast cancer. Irish Journal of Occupational Therapy 42, (1), 51-52
McGrath, T. (2013). Irish insights into the lived experience of breast cancer related lymphoedema: implications for occupation focused practice. WFOT Bulletin, 68,
Paget, M.A. and M.L. DeVault . (Ed.).(1993). A complex sorrow: reflections on cancer and an abbreviated life. Philadelphia: Temple University Press.
Younger, J.B. (1995). The alienation of the sufferer. Advances in Nursing Science, 17(4), 53-72
Wilcock, A.A. (2006). An occupational perspective of health (2nd Ed.). Thorofare, N.J: SLACK Inc.
Tina McGrath PhD RCOT 2018

17. Contact details
Tina McGrath PhD MAOTI McGrath
Tina McGrath PhD RCOT 2018