Friday, 28 November 2014

Occupational Therapy: history behind the photographs

As I am coming to the end of my ten week internship at LHSA, working on the photograph collection, I have come across a selection of photographs from the Royal Edinburgh Hospital (REH) that led me to do some further investigation. The following set of photographs show patients from the REH carrying out activities in occupational therapy (OT). OT, in principal, endeavours to improve mental and physical health by providing practical support and activities, for individuals suffering from a wide range of conditions. OT helps individuals apply themselves in practical activities, from day-to-day tasks, such as preparing meals, to work and leisure.  This helps to bring purpose to people’s lives and helps them to live as independently as possible, which plays a key role in rehabilitation and helping the recovery of many health related conditions. Improving general outlook and well-being are also key concepts of the role of occupational therapy.[1]

A garden created by the patients at MacKinnon House over the past few years and now maintained by them, P/PL7/P/068

Keep fit class, P/P7/P/066

Whilst the roots of the development could be arguably traced back to China in 2600 BC, when Cong Fu was taught as “medical gymnastics” where physical training was believed to promote health[2]; I decided to try and track the developments at a more local level. It was not until around the eighteenth century that new approaches were beginning to take shape in the treatment of psychiatric patients by founding fathers, such as French physician Philippe Pinel, in moral treatment. This was a more humane approach to treatment of the mentally ill that preferred the use of practical therapy over incarceration or punishment. In his book published in 1801 Pinel prescribes, “physical exercises and manual occupations” for mental illness because “rigours executed manual labour is the best method of securing good morale discipline. The return of convalescent patients to their previous interests, to the practice of their profession, to industriousness and perseverance have always been for me the best omen of finial recovery”.[3]  Whilst OT was also evolving in the treatment of physical conditions, it was this relationship between OT and the treatment of mental illness, where some pioneering work was demonstrated in Edinburgh hospitals. 

An important recent development is the introduction of industry into the hospital through the co-operation of outside firms, P/PL7/P/065

A cooking lesson, P/PL7/P/067

Dr D.K. Henderson (1884 – 1965) was a Scottish born physician. He was a Physician Superintendent of the REH and a Professor of Psychiatry, through the hospital’s links with the University of Edinburgh.  The pictures from this collection would have been taken at a much later date, from Dr Henderson’s time at REH but they demonstrate some of his founding work there. A balance of farming, gardening work, as well as domestic and craft activities tailored to the patient’s condition, are examples of OT that he believed could, “increase a person’s self-esteem [due to the] ability to accomplish something”.[4] These sorts of activities could also create structure and organisation to a patient’s day, creating a balance between work, rest and play. Henderson believed this ultimately helped individuals adapt and removed feelings of hopelessness. By 1932 he had encouraged the founding of the Scottish Association of Occupational Therapy. 
Instruction in typing P/PL7/P/061

A corner of the farm, P/PL7/P/062
For individuals suffering from more physically debilitating conditions, OT was also being encouraged as a form of treatment. Casualties resulting from the First World War saw many men facing adapting back into civilian life with debilitating injuries and a lack of employment support. Curative workshops were opened within military hospitals, based on similar workshops already established in the United States, and were equipped with tools and machinery to exercise joints and muscles. Application in work based tasks could, therefore, help in physical healing and strengthening help but also in rehabilitating into society with permanent disabilities. Based on these workshops the first occupational therapy department in Scotland was opened in 1936 at the Astley Ainslie Institution in Edinburgh. The Astley Ainslie grew from being a convalescent hospital to become a leading rehabilitation centre and school for training occupational therapists.

An important recent development is the introduction of industry into the hospital through the co-operation of outside firms, P/PL7/P/064

Brush up your baking, P/PL7/P/063

From these early days of establishing the role that OT could play in improving health and wellbeing, we can see that as the profession has grown, it is still very relevant in society today.

[1] College of Occupational Therapists:  Last Accessed 27/11/14.
[2] Hopkins, H. An Historical Willard and Spackman’s Occupational Therapy (Sixth Edition, USA:1983), p. 3.
[3] Ibid, p. 4.
[4] Creek, J. Occupational Therapy and Mental Health (Elsevier:2008), p.9.

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