The things I find via Facebook!
Of all the misunderstandings I’ve heard or read about what OT is and/or what we supposedly do, this one is a real corker:
According to a blog by a British OT with whom I’ve connected on Facebook, a member (I assume by her title: Baroness Finley) of the House of Lords suggested in 2008 that OTs should be involved in evaluating the mental capacity of people requesting assistance to die!
But wait: that isn’t what I consider to be the misunderstanding! Usually it’s non-OTs thinking we’re less than what we are, not so skilled as to literally be involved in an evaluation with life or death consequences. After all, in the U.S., OTs are often treated as 2nd-class citizens in professional hierarchies: we can’t open a home health case; we have to fight at the state level to be recognized as "qualified" mental health service providers; we still need a physician’s referral even for an initial evaluation…. When I first read Baroness Finley’s comment, I thought, wow, at least with politicians, the British OTs seem to have a more exalted place in their health system than we Americans do!
No, the misunderstanding about OT in the context of Baroness Finley’s statement was from OTs themselves, as reflected in the blogger’s (Sarah Bodell) description of her reaction to Baroness Finley’s remark, as well as in comments from Ms. Bodell’s readers. It seems they don’t really see the ways in which OTs can make a positive difference in how a person perceives his/her quality of life – and thus possibly change the person’s mind about dying of “unnatural” causes, at least for awhile. So I think the blog missed an opportunity for a stimulating exchange on a touchy subject.
I thought maybe OTs don’t work in hospice in the U.K., so I did an online search. The sites that came up1 mentioned pain management, ADLs and leisure activities as things OTs help people with, but not in ways I believe distinguish OT in end-of-life contexts from “rehab.” situations. In other words, there was nothing to indicate that dying is, in a way, a distinct occupation to which OTs can contribute in ways no one else can.
Bear with me here. There are what I consider to be unique roles and activities associated with the knowledge that death is no longer an abstract inevitability, but staring one in the eye. I believe that maintaining as much independence and participation as possible has more layers of meaning in one’s final chapter than when either recovery or learning to live with chronic challenges is the goal. Therefore, in a sense, we OTs are uniquely skilled in “helping someone die”, even though we aren’t doing anything to actually end someone’s life.
Depression that results from loss of abilities in a terminal situation has elements I believe are distinct from depression in people who don’t have a terminal diagnosis. Saying goodbye is unlike any prior farewell experience when you’re the one who’s leaving forever, no turning back, no do-overs; and it’s a lot of work for anyone trying to do it (or trying to avoid doing it, as the case might be), not to mention for the people trying to help them do it. There’s a lot of rather unique “doing” going on: who better than OTs to help navigate those unfamiliar activities?
After I read Ms. Bodell’s blog, my local newspaper reported the death of the “world’s oldest person” at 115 years old. The article mentioned that the woman said 8 months before that she was happy to be alive, and would happily live another 100 years. She went on to say “I enjoy nothing but eating and sleeping.” That’s a pretty narrow range of occupations, plus it’s the two most commonly associated with depression when done to the exclusion of everything else. Yet this person said she was happy. Do we take context into enough account when we label someone as “depressed”? When it comes to a hot-button issue like “assisted dying”, I think people sometimes hide behind the “convenience” of mental health labels, and fail to see what else might be going on. The discussion on Ms. Bodell’s blog suggests that OTs have difficulty seeing what we have to offer when “recovery” or “rehab” aren’t part of the equation.
1Norfolk Hospice;
St. Catherine’s Hospice