Women, feminism, and Occupational Therapy: A critical analysis of the literature on gender issues impacting the profession
• revisión •
Received: February 22, 2023 • Submitted for modification: March 17, 2023 • Accepted: May 16, 2023
Lima, E. M. F. A. & Paula, I. L. (2023). Women, feminism and Occupational Therapy: A critical analysis of the literature on gender issues impacting the profession (L. R. Pereira, Trad). Revista Ocupación Humana, 23(2), 88-103. https://doi.org/10.25214/25907816.1583
Mujeres, feminismo y Terapia Ocupacional: un análisis crítico de la literatura sobre las cuestiones de género que afectan a la profesión
Translation:
Lynne Reay Pereira 3
Mulheres, feminismo e Terapia Ocupacional: uma análise crítica da literatura sobre questões de gênero que impactam a profissão
Elizabeth Maria Freire de Araújo Lima 1
Isabella Lima de Paula 2
Lima, E. M. F. A. & Paula, I. L.
1. Occupational therapist. Master and PhD in Clinical Psychology. Professor, Universidad de São Paulo. São Paulo, SP, Brazil. beth.lima@usp.br
......... http://orcid.org/0000-0003-0590-620X
2. Occupational therapist. Graduate student, Faculdade de Ciências Médicas da Santa Casa de São Paulo. Instituto Nacional de Tecnologia e Saúde e Centro de Atenção Psicossocial da Infância e Juventude, Cidade Ademar. São Paulo, SP, Brazil. isabelladepaulato@gmail.com
https://orcid.org/0000-0002-5242-6746
3. Bachelor of Arts in Language and Literature. Post-Graduate Certificate in Education. Lynne’s English - cursos de inglês Ltda. Santos, SP, Brazil. lynnereay@gmail.com
Abstract
Gender bias has been present in Occupational Therapy since its early years in the United States of America, but it was only in the last decades of the 20th century that this fact began to be problematized. This article presents a critical literature review that aims to summarize, analyze and discuss articles that address the presence and role of women and the impact of gender segregation in the profession. The review was conducted by surveying and identifying relevant material in the Occupational Therapy literature in English, Portuguese and Spanish, and no time frame was established. Twenty-nine articles were analyzed and discussed under four topics: gender concept in the texts; women and feminism in the history of Occupational Therapy; gender segregation: female stereotypes and women’s culture; gender and power relations: the struggle for recognition. The analyses pointed to the importance of recovering the connections with feminism present in the emergence of the profession. The feminist perspective can strengthen Occupational Therapy’s theoretical and philosophical bases and help understand and address the gender inequalities in the lives of occupational therapists.
Keywords: Occupational Therapy, gender-based division of labor, feminism, review
Resumo
O desequilíbrio de gênero está presente na Terapia Ocupacional desde o surgimento da profissão nos Estados Unidos da América, mas foi somente nas últimas décadas do século XX que este fato começou a ser problematizado. Este artigo apresenta uma revisão crítica de literatura que teve por objetivo sintetizar, analisar e discutir artigos que abordam a presença e o papel das mulheres e o impacto da segregação de gênero na profissão. A revisão foi realizada através de levantamento e identificação de material relevante na literatura de Terapia Ocupacional em espanhol, inglês e português sobre o tema, sem recorte temporal. Foram analisados e discutidos 29 artigos, sob quatro tópicos: concepção de gênero presente nos textos; mulheres e feminismo na história da Terapia Ocupacional; segregação de gênero: estereótipos femininos e cultura das mulheres; gênero e relações de poder: a luta pelo reconhecimento. As análises apontaram para a importância de recuperarmos as conexões com o feminismo que estavam presentes no surgimento da profissão. A perspectiva feminista pode fortalecer as bases teóricas e filosóficas da Terapia Ocupacional e ajudar a compreender e a enfrentar as iniquidades de gênero que atravessam a vida das terapeutas ocupacionais.
Palavras-chave: Terapia Ocupacional, divisão do trabalho baseada no gênero, feminismo, revisão
Resumen
El desequilibrio de género ha estado presente en la Terapia Ocupacional desde sus inicios en los Estados Unidos de América, pero fue solo en las últimas décadas del siglo XX que este hecho comenzó a ser problematizado. Este artículo presenta una revisión crítica de la literatura que tuvo como objetivo sintetizar, analizar y discutir artículos que abordan la presencia y el papel de las mujeres y el impacto de la segregación de género en la profesión. La revisión se llevó a cabo mediante la búsqueda e identificación de material relevante en la literatura de Terapia Ocupacional en español, inglés y portugués sobre el tema, sin corte temporal. Fueron analizados y discutidos 29 artículos, bajo cuatro temas: concepto de género presente en los textos; mujeres y feminismo en la historia de la Terapia Ocupacional; segregación de género: estereotipos femeninos y cultura de las mujeres; género y relaciones de poder: la lucha por el reconocimiento. Los análisis señalan la importancia de recuperar las conexiones con el feminismo que estuvieron presentes en el surgimiento de la profesión. La perspectiva feminista puede fortalecer las bases teóricas y filosóficas de la Terapia Ocupacional y ayudar a comprender y abordar las desigualdades de género que atraviesan la vida de las terapeutas ocupacionales.
Palabras clave: Terapia Ocupacional, división del trabajo basado en el género, feminismo, revisión
Introduction
Occupational Therapy emerged as a profession in the United States of America at the beginning of the 20th century. Research on the history of the profession has related its appearance to the two world wars, the process of industrialization, the arts and crafts movement, pragmatic philosophy, the feminist movement, and to the entry of White women into the labour market (Frank & Zemke, 2009; Melo, 2015; Wilcock, 1998). However, its development and the effort to achieve recognition in the medical and scientific field weakened the presence of the critical element, that of philosophy and activism in the professional field (Frank & Zemke, 2009; Wilcock, 1998). This enabled the maintenance, without criticism, of the idea that Occupational Therapy is a profession for women (Figueiredo et al., 2018; Lima, 2021; Miller, 1992).
In 1990, the American Occupational Therapy Association (AOTA) reported, in its Member Data Survey, that around 95% of occupational therapists in the United States of America were women (AOTA, 1990, as cited in Miller, 1992). The divulgation of this information occurred in the same period in which there was an intensification of debates on gender issues in the profession. Two years later, the American Journal of Occupational Therapy published a special issue on Feminism and Gender in Occupational Therapy. Rosalie Miller (1992) noted that despite the long-standing factor of identifying Occupational Therapy as a female profession, very little had been said about the gender disproportionality in the profession, and its implications had rarely been directly addressed. According to the author, this disadvantaged the profession in the predominant, markedly patriarchal culture.
The guest editors – Roxie Hamlin, Kathryn Loukas, Jeanette Froehlich, and Nancy MacRae – presented the issue, which would become a landmark in the discussions on gender in Occupational Therapy. In their text “Feminism: an inclusive perspective,” they point out some concepts shared by Occupational Therapy and feminism: caring, connection, empowerment, nurturing, communication, and relationships. The authors underlined the lack of the feminist perspective and gender discussions in the Occupational Therapy literature, questioning why the profession had not embraced feminist culture and knowledge as nursing and social work had done. For them, the inclusive model of feminism, oriented towards liberation, empowerment, and social justice, could enable more occupational therapists to recognize this important force for change and the struggle against sexism, racism, and other forms of oppression (Hamlin et al., 1992).
In the same issue, Gelya Frank (1992) told the history of Occupational Therapy from a feminist perspective, discussing gender segregation and the influence of class and race markers in creating opportunities for occupational therapists. According to the author, however, the analysis of gender issues had been almost totally forgotten, a surprising absence for a field in which most professionals are women. Frank (1992) believed that this discussion could help situate Occupational Therapy’s achievements within the historical context of American women’s entry into and advancement within the workforce.
Also, in this issue, Roxie Black Hamlin (1992) proposed a re-examination of the profession’s history, theory, and practice from a feminist point of view, seeking to understand its current state and strengthen the profession for its entry into the 21st century. This author points out that, although the AOTA had a strategic plan to face questions of ethnicity and multiculturalism at the beginning of the 1990s, the issue of gender had still not been systematically discussed.
The desire to understand how the debate on gender developed in the field led us to critically review the literature. This review aimed to synthesise, analyse, and discuss articles that problematized gender issues; and the presence and role of women in the Occupational Therapy field, its history, limitations, and possibilities. The research was guided by the following orienting question: How do discussions about the impact of gender inequalities and gender-based labour divisions on the profession’s development take place in the Occupational Therapy field?
The findings are presented as a narrative text in this article. Discussing and understanding the impacts of gender inequalities in the profession and their consequences for how power is distributed in professional and academic environments contribute to facing these inequalities and strengthening the profession and of occupational therapists.
Methodological approach
This article presents a critical literature review, with narrative form and conceptual discussion (Grant & Booth, 2009), carried out through a survey and the identification of relevant material in Occupational Therapy literature which discusses the presence and the role of women and problematises the impact of gender inequalities in professional fields.
The bibliographic survey was carried out in the following databases: Web of Science, LILACS, SciELO, and PubMed, accessing texts published in journals in the field of Occupational Therapy or interdisciplinary journals in which there are publications by occupational therapists. The search was completed through a consultation on Google Scholar, which gave access to publications in journals not indexed in those databases, but which were accessible on the world wide web. The descriptors utilized were: “occupational therapy” AND “gender” OR “feminism” OR “feminist” OR “feminine” OR “woman” OR “women.”
Aiming to cover diverse historical and geographical contexts, the search was conducted in Spanish, English, and Portuguese, with no time frame. The search was finalized in 2021; the oldest text found was published in 1975. Criteria for the inclusion of articles were: 1) a peer-reviewed publication; 2) written by an occupational therapist; 3) discusses the presence and the role of women and the impact of gender issues on the professional field. From the material collected, we removed duplicated articles, texts not written by occupational therapists or unrelated to the occupational therapy field, short texts, editorials, letters to the editor, and articles not accessible on the internet nor available in the libraries consulted.
The orienting question and the proposed objective guided the remaining material’s pre-analysis (Bardin, 1977). A floating reading of abstracts and complete texts allowed us to identify articles that were not within the scope of the review since they dealt with issues of masculinity, the experiences of LGBTQIA+ people, and those that discussed people assisted by Occupational Therapy from the perspective of gender. These texts were excluded. The path to identifying the material to be analysed in the research is described in the figure 1.
Lima, E. M. F. A. & Paula, I. L.
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With the research corpus constituted, we began the process of analysis, initiated by an in-depth reading of the texts, from which units of meaning related to the research purposes were defined. Then, we constructed relations between the units to define and name the thematic categories of analysis based on the information contained in the corpus, enabling new syntheses and new understandings related to the theme investigated. An analytical metatext was composed to express the meanings of the reviewed articles (Moraes, 2003).
The material was analysed using qualitative textual analysis, a methodological proposal between content analysis and discourse analysis, working with meanings constructed from a set of texts (Moraes, 2003). Given that all reading is an interpretation conducted from a theoretical standpoint, we clarify that this research is founded on Foucault’s historical-critical perspective, which allows for constructing a problematisation rooted in the present. Designed to analyse the processes that shaped us into the professionals we are, this research also sought to identify the points at which transformation is possible and necessary (Foucault, 2000).
Results and discussion
Twenty-nine (n=29) studies published in English, Spanish, or Portuguese written by occupational therapists from 1975 to 2021 were included. Of the total, 38% (n=11) were published in North American journals, and 52% (n=15) in South American journals. As shown in Table 1, eleven studies were from the United States of America, nine from Brazil, two from Colombia, two from Chile, one from Argentina, one from Bolivia, one from the United Kingdom, one from Spain, and one from Australia. As for the nationality of the authors, we accessed texts written by authors from Argentina, Brazil, Chile, Spain, the USA, France, and Sweden, with 10% of the texts being the fruit of collaboration between researchers from two countries (table 1).
Figure 1. Bibliographic survey paths
Source: prepared by the authors.
Lima, E. M. F. A. & Paula, I. L.
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Table 1. Corpus of articles
Source: prepared by the authors.
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Lima, E. M. F. A. & Paula, I. L.
The full-text review allowed us to choose four thematic categories for analysis: the concept of gender in the texts; women and feminism in the history of occupational therapy; gender segregation in Occupational Therapy: female stereotypes and women’s culture; gender and power relations: the struggle for recognition. We will present the full-text review from these thematic categories in the following section.
Concept of gender present in the articles
From the total of the texts considered in this critical review, 59% address the place of women and the gender issues that impact Occupational Therapy, revisiting the history of the profession; 45% deal with these issues from a feminist perspective and/or reflect on the relations between feminism and Occupational Therapy.
Although the idea or perspective of gender is present in 36% of the 14 articles published between the last quarter of the twentieth century and the first decade of the twenty-first century, only one discusses the concept of gender. Reese (1987) defines gender, using Lopata and Thorne (1978), as learned behaviour distinct from biological sex, seeking to open a space for new understandings of gender based on experience and women’s point of view.
The gender perspective is present in 87% of the 15 articles published since 2010, and the concept of gender used by the authors is explained in 33% of them. There is a convergence for the difference between sex and gender, which is already present in Reese’s (1987) definition and is expanded in these articles. Gender, according to the authors, is a social construction, the result of social practices that constitute everyday life (Sarmiento et al., 2018); it is produced by daily human interactions (Liedberg et al., 2010), within historical and political relations, in such a way that someone becomes a woman in specific social and cultural contexts (Figueiredo et al., 2018).
Sharing this perspective, Testa & Spampinato (2010) state that gender is the symbolic form of sexual difference founded culturally in a set of practices, ideas, and discourses. Gender systems involve social mechanisms that justify inequalities using sexual differences as a foundation. Thus, talking about gender differences implies making power relations visible and accepting that they are not based on biology or anatomy but on the inequalities that societies construct (Testa & Spampinato, 2010).
Morrison and Araya (2018) believe that Occupational Therapy helps people understand how their actions and behaviours constantly reproduce a gender construction. We make gender through our occupations and frequently reproduce sexist and patriarchal models. Men and women are shaped by the gender system throughout their lives, participate in the maintenance and reproduction of these relationships, and can also transform them through their actions3.
Women and feminism in the history of Occupational Therapy
Professions arise and develop in specific social and cultural contexts inside a network of relations and actions. The meaning of the entanglement of actions that created Occupational Therapy can only emerge from a retrospective look that allows for constructing narratives, revealing partial perspectives.
Morrison (2015) and Monzeli et al. (2019) consider that the development of practices by women with professional training under the direction of men is a common theme among the various perspectives on how Occupational Therapy was established and institutionalized. Since then, these men have written these narratives and appear as the profession’s founders and leading figures in its growth.
Considering that power relations define histories, Morrison (2015) proposes an alternative version of the history of Occupational Therapy, applying a feminist approach to the participation of women who contributed significantly to the emergence of the profession. The author advances the cause of gender equality by reclaiming women’s legacy for future generations and claims that the historical events surrounding Occupational Therapy require us to live up to our ethical obligations in light of the marginalization of women researchers and practitioners and our undeniable historical debt to them.
In several of the reviewed articles an effort is made to present alternative perspectives in the history of the profession: proposing a consideration of parallels between the development of feminism and the development of Occupational Therapy (Gilligan, 1976); reclaiming the role of women and their link with the feminist movement in the first years of the profession (Frank, 1992; Lima, 2021; Morrison, 2015, 2016); problematising the efforts that converged for the profession to be identified as suitable for women, in the context of labour relations since the turn of the 20th century (Benetton & Varela, 2001; Froehlich, 1992; Litterst, 1992; Vogel et al., 2002); and, studying and describing the creation and expansion of the profession in Latin America (Figueiredo et al., 2018; Monzeli et al., 2019; Testa & Spampinato, 2010).
Understanding the inherent connection between the origins of Occupational Therapy in the United States of America and the opportunities that White women from urban elites there had to participate in educational, charitable, and care institutions at the beginning of the 20th century is crucial for this set of approaches. The emergence of the profession in Latin American nations was also connected to this issue due to the expansion of women’s mobility and their integration into various social contexts, which gave them new opportunities, frequently in subordinate roles and careers (Gómez et al., 2016; Monzeli et al., 2019; Testa, 2012).
The articles that revisit the history of Occupational Therapy also associate the role of the feminist movement, the Arts and Crafts movement, and the philosophical perspective of Pragmatism in the emergence of the profession (Lima, 2021; Morrison, 2016, 2021). Morrison (2015) states that, from an androcentric perspective, the history of Occupational Therapy begins with moral treatment. From a feminist perspective, however, this history starts with a social settlement that allowed many women to participate politically in the public sphere and start experimenting with alternative forms of social engagement, moving away from those connected to marriage and family.
One of the social settlements, Hull House, established by socialist activists Jane Addams and Ellen Gates Starr at the end of 1880, played a significant role in the development of Occupational Therapy. They would later be joined by Julia Lathrop, Eleanor Clarke Slagle, and numerous other women who would use community life as a tool to address the social, economic, and health issues that come with a capitalist society, particularly those that affect immigrants and other minority communities deprived of their rights. These women were associated with the feminist movement in its early years and exchanged volunteering in religious entities for political involvement and the public sphere to enact social change. Their actions would lead to suggestions that firmly distinguish Occupational Therapy (Frank, 1992; Metaxas, 2000; Monzeli et al., 2019; Morrison, 2011, 2016).
Besides Eleanor Clarke Slagle, the social assistant who participated in Hull House and who is one of the best-documented women in the history of Occupational Therapy, the first occupational therapists were: Susan Elizabeth Tracy, a nurse who belonged to the first generation of professional women in the United States of America and systemized her research, carried out since 1904, around arts and crafts as treatment; and Susan Cox Johnson, a graduate in arts, languages, and nursing, who was a teacher of arts, crafts and Occupational Therapy, and developed a theoretical focus centred on the re-educational aspect of occupation (Morrison, 2015).
Occupational Therapy was established as a profession in 1917 in the United States of America in the same year that the country entered the First World War, which demanded training in rehabilitation and vocational reorientation. This confluence of events made the profession, which had roots in political and social movements and strong ties with the feminist movement, linked up to the American Army and the American Medical Association, two of the most powerful, conservative, and patriarchal institutions in the country, which provoked a transformation in the initial perspectives adopted (Lima, 2021; Morrison, 2015).
Occupational Therapy was institutionalized with the support of strong, conservative social classes under the authority of medicine and gave up political activism in favour of an effort to strengthen the field scientifically. It emerged from social practices that were articulated to humanist and socialist knowledge. In this process, there was an increasing validation of so-called “female characteristics” for the performance of the professional practice, which resulted in gender segregation (Lima, 2021).
This Occupational Therapy arrived in Argentina, Brazil, Chile, and Colombia from the 1950s onwards, propelled by different international cooperation projects. The emergence of the profession and the first training courses in these countries were related to the poliomyelitis epidemics and moral treatment in large asylums. There, the emergence of Occupational Therapy was part of a historical process of creation of professions auxiliary to medical treatment, which enabled the insertion of women into higher education, in technical careers, albeit in a subordinate position (Gómez et al., 2016; Monzeli et al., 2019).
Occupational Therapy emerged in Brazil as a technical-level profession, subordinate to medicine, suitable for women. It grew and strengthened due to the country’s re-democratization at the start of the 1980s when feminist approaches gained ground following the military dictatorship. In the same period, the accelerated process of industrialization and urbanization, and the increase in the level of schooling among White women, increased their opportunities for entering and remaining in the labour market (Figueiredo et al., 2018).
In Argentina, a gender system that established hierarchies, privileges, and inequalities also intersected with the process. The group of women who outlined the career profile in the nation forged a path within the context of uncertainty and urgency that the epidemic represented, demonstrating the relevance and effectiveness of women’s actions at the political level even though physicians guided them and did not challenge the structures of power (Testa, 2012; Testa & Spampinato, 2010).
In Colombia, Occupational Therapy was born in a conservative patriarchal environment where women could not make decisions that implicated responsibility. In this context, occupational therapists were part of women’s struggle to acquire the right to participate politically, economically, and socially. Thus, the profession was an opportunity for women to fight for their autonomy, development, and capacity to contribute to society (Gómez et al., 2016).
Besides enabling spaces for women’s collective struggle, Frank (1992) argues that the profession gave women career opportunities at a time when doors to other more prestigious, lucrative professions were closed to them. In addition, the author contends that many occupational therapists from the middle classes and the elites enjoyed a professional environment moulded by women’s culture, emphasizing care and not competition. We address these issues in the following section.
Gender segregation in Occupational Therapy: female stereotypes and women’s culture
Frank (1992) borrowed Strober and Lanford’s definition of gender segregation as a disproportionality between the number of women and men in a given profession, considering the adult population engaged in productive activity in a particular place or region. The fact that men and women choose their occupations according to social stereotypes, without considering talents and skills, and the difference in pay between men and women in the same job are two examples of how this disproportionality affects the world of work in Western modernity (Frank, 1992). Since its inception, Occupational Therapy has been marked by gender segregation. In addition to the fact that the first occupational therapists were women interested in entering the labour market, the founders, both male and female, believed that women had the personality, skills and abilities needed to be occupational therapists (Benetton & Varela, 2001; Figueiredo et al., 2018; Hamlin, 1992; Litterst, 1992; Testa, 2012).
According to Litterst (1992), the perception of Occupational Therapy as a job suitable for women was a tactic used to expand the prevailing ideas about their roles and responsibilities to support their performance in a different task. As a result, during the First World War, many women were hired as reconstruction aides in the United States of America, quelling the mounting demands of women to participate in the war effort and the labour market.
After the war, stereotyped correspondences between the traits suggested for the profession and the presumptive characteristics of women were offered as additional ideological support for maintaining Occupational Therapy as a female profession. The early 20th-century century American ideology, still prevalent today in the United States of America and many other nations, claimed that women were intellectually, psychologically, and sexually distinct from men and would naturally be more attentive and selfless (Litterst, 1992). The early 20th-century American ideology, still prevalent today in the United States of America and many other nations, claimed that women were intellectually, psychologically, and sexually distinct from men and would naturally be more attentive and selfless (Litterst, 1992). This view expresses the sexual division of labour in capitalism. It reserves the role of reproductive care and private life for women and the role of public space and political life for men. Because of this, Occupational Therapy was developed in some nations as a profession that was only open to things deemed to be naturally feminine. It covered the development of daily activities, crafts, and childcare during a time when women’s traditional roles in the home were being extended outside the home, increasing their employment options (Testa & Spampinato, 2010).
Loukas (1992) also draws attention to the fact that occupational therapists added the responsibilities of caregivers and nurturers in the professional setting to those of caregivers in the family setting. As a result, married women in full-time employment spent an average of 85 hours per week on paid work, unpaid work, and childcare activities.
Occupational therapists themselves contributed to the persistence of gender stereotypes in the field. For example, in the United States of America, the National Society for the Promotion of Occupational Therapy (NSPOT) recommended that occupational therapists should be women over 25 years old with manual skills and should also be caring, maternal, inventive, enthusiastic, attentive, versatile, adaptable and, preferably, single, which expresses the incompatibility between marriage and a career for the cultural model of the time (Hamlin, 1992). For Eleanor Clarke Slagle, the occupational therapist should present a good balance between politeness, gentleness, patience, honesty, firmness, and the ability to adapt, which would make it possible to meet the needs of each patient (Benetton, 2008; Frank, 1992).
In this context, the characteristics considered necessary to be a good occupational therapist corresponded to the conventional ideas about femininity at the time. The naturalization of these gender characteristics originated at the beginning of the 19th century, with the “cult of domesticity,” when middle-class men and women began experimenting with a more explicit social demarcation between work and home. This was expressed culturally by an increased emphasis on the emotional attributes of women versus the male attributes of productivity and efficiency (Cott, 1977, as cited in Frank, 1992). According to Hamlin (1992), the qualities required of female occupational therapists correlated with the systematic undervaluation of women in a deeply ingrained patriarchal society. The traits associated with men, on the other hand, were more highly regarded in society, the academy, science, and medicine.
The imbalance between the number of men and women in the profession seems to have been maintained up to the present in different countries. Research carried out by the College of Occupational Therapists in Chile in 2014 observes a predominance of the female gender (80%) working in this profession (Rivera et al., 2017).
Morrison (2011) believes that the profession’s eminently practical nature has contributed to Occupational Therapy remaining a female occupation: while several men studied the profession and its effects on health and well-being, women were the ones who monitored the patients, observed what they were doing, and restructured their routines, thus maintaining intellectual work as a male activity and the practice and work of caring as female. Figueiredo et al. (2018) draw attention to the proximity between domestic life and daily activities, while Vogel et al. (2002) mention the intrinsic relation between Occupational Therapy and care. Hamlin (1992) adds that since caring is associated with women’s unqualified, unpaid work, any profession that practices it is devalued.
Miller (1992) believes that increasing the number of men in the profession would do little to combat this devaluation. According to the author, the power of Occupational Therapy may lie in the valuing of qualities that are undervalued in modern Western culture, which are often identified as female qualities, as well as in the strengthening of the philosophical perspective that founded it, which was woven with the duplicate threads that constitute feminism.
Gender and power relations: the struggle for recognition
Power relations, marked by gender inequalities and strongly present in the health field, have made it difficult for female occupational therapists to affirm their profession’s philosophical, ethical, and political principles founded in values traditionally related to women.
Occupational therapists’ efforts to gain legitimacy had to go through the rationalization of work to scientific validation in the positivist paradigm, transforming practice, theory, and methodologies in the field (Morrison, 2011). Furthermore, hierarchies in the health field and the academic environment relegated occupational therapists to a subservient role in the structures of services and institutions that placed men in positions of power, leading many women to believe that only through an alliance with Medicine would they be able to achieve the recognition they deserved (Litterst, 1992). Furthermore, hierarchies in the health field and the academic environment relegated occupational therapists to a subservient role in the structures of services and institutions that placed men in positions of power, leading many women to believe that only through an alliance with medicine would they be able to achieve the recognition they deserved (Litterst, 1992). The result of this uncritical attempt to form alliances with medicine was an unequal distribution of roles in the production of knowledge that had a significant impact on the profession: men with medical authority were charged with building the scientific foundation of Occupational Therapy, developing theories, and publishing articles, while women were charged with developing therapeutic practice (Metaxas, 2000 as cited in Morrison, 2011).
This was exacerbated by the lack of problematization of the profession’s gender segregation. Reese (1987) questions female therapists’ lack of awareness, claiming that the resulting silence is often a form of consenting to their oppression.
Elizabeth Yerxa asked female occupational therapists in 1975 how their gender influenced their professional lives. The most common response was that it did not make a difference. According to the author, discussions about the feminist movement were rare, and the fight for equal rights was seen as separate from professional concerns (Yerxa, 1975). According to Frank (1992), this lasted until the 1990s, when feminist perspectives began to call into question health concepts based almost entirely on a male and medical perspective.
During this time, Hamlin (1992) pointed out that understanding our role in the medical-patriarchal system could help us recognise our wisdom and strength and value the field’s unique blend of Occupation Science and the art of care. Two decades later, Liedberg et al. (2010) invited female occupational therapists to raise their awareness of gender issues. Additionally, Testa and Spampinato (2010) state that ignoring gender issues depoliticizes professional practice and renders invisible the consequences of power asymmetries, constituted by facts, devices, events, and processes reproduced socially and subjectively.
To Miller (1992), the medical establishment did not take our techniques and philosophy seriously because they were outside the biomedical model. For her, the knowledge that emerges from the field asks for other epistemologies. To face gender segregation and its consequences, she proposes investing in, supporting, and facilitating female leadership; developing innovative strategies for a feminist organization at work; including these discussions in the training of occupational therapists; and sustaining our efforts as a feminized profession confronting in each one of us our gender prejudices.
For Morrison and Araya (2018), feminism is a crucial contribution to understanding our position in the world, denaturalizing systematic practices of injustices and arbitrariness, and producing practices of resistance.
Aside from that, the goals of Occupational Therapy are consistent with the feminist perspective of interdependence (Loukas, 1992). As Pollard and Walsh (2000) confirm,
Occupational Therapy and feminist philosophy share common threads, which should continue to be explored if Occupational Therapy strives for a wholly inclusive and a reflective practice which takes full account of the impact of gender and class in the profession. (p. 430)
Moreover, intersectional approaches have enriched critical perspectives in the professional field by articulating discussions of gender with issues of diversity, mental health, disabilities, colonialities, race, class, and ethnicity, and how they participate in systems of oppression (Ferrufino et al., 2019; Froehlich, 1992; Pollard & Walsh, 2000).
Conclusion: Open perspectives for a feminist approach
to Occupational Therapy
In this article, we address how publications in the field of Occupational Therapy problematized gender issues and discuss the presence and role of women in the professional field. We used qualitative textual analysis to provide a broad view of the ideas already published on the topic and to build an understanding of the current debate in the field, giving visibility to the processes that shaped us as professionals. This can help us see the points at which a transformation is possible and required.
The textual production that emerged from this analysis of the material is a problematization rooted in the present, thus, characterized by its incompleteness, which is also an invitation to dialogue.
The reviewed articles question the imbalance in the number of men and women, the reasons for this, and its relationship with establishing professional contours linked to gender stereotypes. They also discuss the role that power relations arising from gender inequalities, which mark the division of labour in the health sector, have played in challenges to the profession’s recognition; and recover the profession’s history, highlighting the first connections with feminism.
The analyses highlight the significance of recovering these connections. The feminist perspective can strengthen Occupational Therapy’s theoretical and philosophical foundations and assist in understanding and confronting the gender inequalities that permeate occupational therapists’ lives, recognizing the historical opportunity to radically question the foundations of a patriarchal science. An alliance with feminist epistemologies can highlight the fight against all forms of oppression and violence and the construction of know-how grounded in supportive relationships.
Finally, the feminist movement and perspective discussions about paid and unpaid care work have contributed to valuing women’s work and affirming that without care, we cannot imagine a world where we can live. According to Grandón (2023), the convergence with feminism allows for the consolidation of a shift in market, medical, and technical logic, as well as valuing the dimension of care, allowing us to experience times of human relationships, affections, and community life.
Today, caring implies looking after everyone, human and non-human. It implies caring for the world and life so that we can move forward.
4. For a deeper discussion of how to understand the gender construct that prevails in human occupation studies, we recommend reading the article by Alonso-Ferreira et al. (2022), which presents a wide-ranging review that investigated how the concept of gender has been dealt with in occupational therapy and in occupational science research.
Lima, E. M. F. A. & Paula, I. L.
Lima, E. M. F. A. & Paula, I. L.
Lima, E. M. F. A. & Paula, I. L.
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References
Lima, E. M. F. A. & Paula, I. L.