Self-care, productivity, and leisure, or dimensions of occupational

experience? Rethinking occupational “categories”

Karen Whalley Hammell

Key words
I Occupation I Theory I Well-being

Mots clés
I Occupation I Théorie I Bien-être

Abstract
Background. Critics contend that occupational therapy’s theories of occupation are culturally specific, class-bound, and ableist,
and that the division of all occupations into three simplistic categories of self-care, productivity, and leisure is arbitrary, lacks
supportive evidence, and promotes a doctrine of individualism. Purpose. To add to the work of critics who advocate a
fundamental rethinking of occupational therapy’s conceptualizations of occupation in terms of subjective qualities of experience
that address intrinsic needs. Key issues. This paper suggests that if categories of occupation were informed by the ways in which
people experience their occupations, these might be labelled as restorative, as ways to connect and contribute, as engagement
in doing, and as ways to connect the past and present to a hopeful future. Implications. If occupational therapists enabled
diverse clients’ perspectives to inform occupational categories, perhaps relationships between occupations and well-being might
more easily be identified in theory and addressed in practice.

Résumé
Description. Certains critiques affirment que les théories sur l’occupation sont teintées de capacitisme et qu’elles sont associées
à certaines cultures et classes; ils considèrent que la division de toutes les occupations en trois catégories simplistes, soient les
soins personnels, la productivité et les loisirs, est arbitraire, qu’elle n’est pas justifiée par suffisamment de données probantes et
qu’elle favorise une doctrine de l’individualisme. But. Ajouter aux travaux des critiques qui préconisent le besoin de revoir
fondamentalement les concepts de l’occupation en ergothérapie en fonction des qualités subjectives des expériences qui
répondent à des besoins intrinsèques. Questions clés. Cet article suggère que si les catégories d’occupations étaient définies par
les expériences vécues par les gens à travers leurs occupations, il serait alors possible de les désigner comme des façons de se
rétablir, des façons d’établir des liens et de participer, des façons de participer en accomplissant des choses et des façons de relier
le passé et le présent à un avenir fondé sur l’espoir. Conséquences. Si les ergothérapeutes prenaient en compte les diverses
perspectives des clients pour définir les catégories d’occupations, il serait peut-être plus facile de définir théoriquement les
relations entre les occupations et le bien-être et de les aborder dans la pratique.

t is claimed that the assumptions underpinning occupa- privileged categories, and the idea that leisure and work are

I tional therapy’s theories of occupation are culturally

specific, class-bound, ableist, and lacking in supportive
evidence (Hammell, 2009). The belief that all occupations are
divisible into the three categories of self-care, work, and play
(Kielhofner, 2002) or self-care, productivity, and leisure
(Creek, 2003; Townsend & Polatajko, 2007) is viewed as
particularly problematic (Hammell, 2009); these categories
have been portrayed as “simplistic, value laden, decontextu-
alized, and insufficiently descriptive of subjective experience”
(Pierce 2001, p. 252). Occupations that are motivated by
connections to and care for others do not fit within the three
divisible concepts is found to be an urban and classist notion
that is specific to certain minority-world cultures (Hammell,
2009). Furthermore, although theories of occupation assume
a positive relationship between occupation and well-being,
this assumption lacks evidence-based support (Law,
Steinwender, & Leclair, 1998; Piškur, Kinebanian, &
Josephsson, 2002).
Critics have also noted that “current conceptualizations
of occupation reflect a direction in thinking that addresses
societal and political needs rather than how occupation
relates to human development and well-being” (Jonsson,

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 WHALLEY HAMMELL
2008, p. 3). The value that occupational therapists place on
independence in self-care activities (and consequent
denigration of interdependence), the priority they place on
participation in productive occupations that contribute to the
economic fabric of communities (rather than on volunteering
or caring for others), and their advocacy of leisure that
involves consumerism (such as many sporting activities,
rather than time spent in nature) suggest that occupational
therapy’s values not only reflect but promote specific political
and economic agendas, and that these values may have little
to do with human development or well-being. Indeed,
human well-being has rarely been the focus of occupational
therapy theorists. Moreover, the preoccupation with
objectifying and classifying occupations without seeking to
understand the experience of occupational engagement and
the impact of economic, political, and social structures on
opportunities for occupational engagement reflects an
unchallenged positivistic approach to knowledge (Townsend,
1997) that is incompatible with a profession ostensibly
concerned with clients’ perspectives.
The genesis of this paper lies in a study into the quality
of life experienced by people with complete high spinal cord
injury (Hammell, 2004a). Analyzing the qualitative data
made it apparent that engagement in personally meaningful
occupations was of great importance to the study partic-
ipants. However, their experience of occupation did not fit
neatly into categories of self-care, productivity, and leisure,
and they identified important occupational experiences—
such as contributing to others and doing things with others—
that fell outside the parameters of existing theories of
occupation. Indeed, the occupational experiences of this
group challenged traditional occupational therapy dogma.
Subsequently, the issues of importance to the participants in
that study were seen to recur in the analyses of researchers
from various academic disciplines who had studied many
different populations, and a pattern of common findings was
noted. These common themes appeared to suggest the
beginnings for an alternative way of thinking about occupa-
tional therapy’s central concern—occupation and its contri-
bution to human well-being—especially in terms of relevant
and important categories of occupation.
The intent of this paper is twofold. The first aim is to add to
the work of critics (Doble & Caron Santha, 2008; Eklund &
Leufstadius, 2007; Hammell, 2004b; Jonsson, 2008; Pierce, 2001)
who support a fundamental rethinking of conceptualizations of
occupation. By sketching alternative categories of occupation,
the second aim of this paper is to suggest a possible direction
for future research to develop client-centred theory elucidating
the contribution of occupation to human well-being.
Underlying assumptions
This paper is based on three assumptions, which should be
made explicit. The first assumption is that occupational
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therapists should be concerned with human well-being
rather than being preoccupied solely with people who have
impairments or ill health (Christiansen, 1999; Hammell,
2008; Watson, 2004). An essential element underpinning
principles of human rights (Kallen, 2004), well-being is
understood to include “the pursuit of personal aspirations
and the development and exercise of human capabilities,
within a context of mutual recognition, equality, and interde-
pendence” (Hay et al., 1993, p. 5). Well-being in this paper
refers to a state of overall contentment—or perceived state of
harmony—with one's physical/mental health, self-esteem,
sense of belonging, personal and economic security, and with
one’s opportunities for self-determination, meaningful
occupation, maintenance of valued roles, and ability to
contribute to others (Hay et al.; Law et al., 1998; Wilcock et
al., 1998). Theorist-identified definitions of well-being
abound; however, occupational therapists have not expended
much effort in determining how present or potential clients
define well-being (although see Wilcock et al.). Krause
(1998) sought to understand subjective well-being from the
perspectives of people with spinal cord injury and found that
the most important dimension was “engagement,” or an
active and engaging lifestyle incorporating social activities,
life opportunities, accomplishments, and interpersonal
relationships. This is congruent with Ryff and Singer’s (1998)
observation, that “human well-being is ultimately an issue of
engagement in living” (p. 2).
The second assumption is that occupations are anything
that people do in their daily lives (McColl, Law, & Stewart,
1993). Occupational scientists and occupational therapists
have developed a plethora of definitions of occupation and,
recently, have endeavoured to develop taxonomic codes
(Townsend & Polatajko, 2007) to differentiate occupations
from activities in a hierarchy that is informed by a specific
culture and that privileges certain occupations over others.
Clearly, placing occupations in a hierarchy easily justifies
placing the doers of those occupations in a similar hierarchy.
Further, while it may be true that well-educated, able-bodied,
“learning-abled”, urban, middle-class, white, Western
theorists perceive accountancy to be an occupation, whereas
writing reports only an activity (Townsend & Polatajko), this
might not be the perception of those people for whom
preparing reports constitutes the substance of their working
life. Moreover, although tea drinking may be just an activity
for theorists (Townsend & Polatajko), it might be an
important occupation for others in different cultures and
contexts or in the company of certain people. Indeed, in
Japan, tea drinking is the focus of an elaborate and
meaningful ceremony.
When people are enabled to define their own occupations,
their definitions are found to vary at different times according
to their mood, goals, environmental context, and the presence
of other people (Primeau, 1996; Shaw, 1984). This illustrates
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the problem with categorizing occupations—or activities—
according to their objective characteristics (Erlandsson &
Eklund, 2001). Because few attempts have been made to
ground either definitions or taxonomies of occupation in
evidence derived from a broad range of perspectives, the
definition of occupation that appears the most useful, least
judgmental, and least culturally specific is that provided by
McColl et al., (1993); who defined occupation as being
anything that people do in their daily lives.
The third assumption underpinning this paper is that
the theoretical base of a self-proclaimed client-centred
profession ought to be grounded in research evidence derived
from a wide range of perspectives from past, present, and
potential clients. Client-centred practice, it is argued, merits
client-centred theory that is informed by client-centred
research (Hammell, 2006, 2007a). It is puzzling that
researchers have attempted neither to enable diverse people
to contribute to a definition of “occupation,” nor to determine
whether people generally perceive “occupation” as exclusively
comprising activities that might be labelled self-care, produc-
tivity, or leisure. Indeed, it is unclear what evidence informed
the division of occupations into these three specific
categories. The reality that this framework is “simple ... and
allows for a fairly comprehensive categorization of
occupations” (Townsend & Polatajko, 2007, p. 42) is
inadequate justification for its use. Moreover, a framework is
either comprehensive, or it is not.
Occupational therapists have only rarely explored the
experience of occupational engagement (Erlandsson &
Eklund, 2001; Hammell, 2004b; Unruh, Smith & Scammell,
2000; Vrkljan & Miller-Polgar, 2001). Attempts to understand
how people might label or categorize these experiences are
even more uncommon. However, Borell, Asaba, Rosenberg,
Schult, and Townsend (2006) studied the daily occupational
experiences of individuals living with chronic pain. Notably,
no one labelled these experiences as self-care, productivity or
leisure, but instead spoke of making choices and of doing
things that were physical, social, or that contributed to others.
If occupational therapists are to take human well-being as
their issue of concern and the relationship between well-
being and engagement in occupations as their unique focus,
it would appear that a new way of categorizing occupations
will be required.
The aims of this paper are, therefore, to build on the
work of those theorists who suggest that occupation should
be understood in terms of the qualities of experience that
clients describe rather than those categories of self-care,
productivity, and leisure, on which theorists place a high
priority (Erlandsson & Eklund, 2001; Hammell, 2004b;
Jonsson, 2008).
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WHALLEY HAMMELL
Capturing client-centred
occupational categories
Hemmingsson and Jonsson (2005) claim that over the past 20
years occupational therapy theory “has progressed from
focusing on performance components to emphasizing the
person’s subjective experience of participation in daily life”
(p. 572). However, there is little evidence to support this
claim. Indeed, occupational therapy theory has changed very
little in the past 20 years. Occupational therapists
acknowledge that the subjective importance, satisfaction,
significance, and meaning given to and derived from
occupations varies among individuals, and they contend that
this seriously limits the usefulness and relevance of the
International Classification of Functioning, Disability and
Health (ICF; World Health Organization [WHO], 2001),
which ignores the subjective experience of meaning in
occupation and disregards the individual’s will, values, and
choices (Borell et al., 2006; Häggström & Lund, 2008;
Hammel et al., 2008; Hammell, 2004c; Hemmingsson &
Jonsson; Kjeken & Lillemo, 2006). However, occupational
therapy’s own theories classify occupations in terms of those
categories prioritized by therapists rather than in terms of
those qualities of subjective experience or dimensions of
meaning that are important to clients (Hammell, 2004b).
A growing body of research supports the premise that
occupational therapy theory ought to focus on people’s
subjective experience of engagement in daily life
(Hemmingsson & Jonsson, 2005) and that theory would look
different if it did. For example, Eklund and Leufstadius
(2007) explored relationships between occupational
performance, health, and well-being among people with
persistent mental illness and reported that “the health-
promoting ingredients in occupations seemed to be
determined by the way occupations were perceived, rather
than by the doing per se” (p. 311). Persson, Eklund, and
Isacsson (1999) explored the experience of everyday
occupations and reported that “health was not so much
influenced by quantitative factors like the configuration and
balance of occupational categories as by meaning and
satisfaction, i.e., qualitative factors related to the participants’
experiences of their occupations” (p. 14). Surely, this should
not be surprising.
Thompson and Bunderson (2001) explored the concept
of work/nonwork conflict and noted that much research in
this area evokes the metaphor of balancing time. They note:
“Balance imagery is restrictive because it neglects the
perceptual experience of time and the subjective meanings
people assign to it” (p. 17). The metaphor of balance has been
a recurrent feature in theories of occupation. However, while
Piškur et al. (2002) found that well-being among people in
Slovenia was associated with a sense of balance among one’s
daily occupations, the ways in which balance was defined
were individual and related to aspirations, interests, and
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values. Similarly, Nagle, Cook, and Polatajko (2002) explored
the occupational experiences of people who had severe and
persistent mental illnesses and found that their participants’
understanding of balance pertained not solely to what they
did, but also to whom they did it with and how they felt while
engaged in occupation.
The findings of these studies suggest that occupational
therapists’ theories of occupation might become more useful,
inclusive, and relevant if occupations were categorized in
terms of how people experience their occupations (Jonsson &
Persson, 2006; Jonsson, 2008), that is, as containers of
meaning (Thompson & Bunderson, 2001).
Meeting intrinsic needs
through experience-based
categories of occupation
Law et al. (1996) stated that occupations meet the person's
"intrinsic needs for self-maintenance, expression and
fulfilment" (p. 16), suggesting that occupations might
usefully be explored in terms of how they meet intrinsic
needs. Building on this suggestion, Hammell (2004b) drew
from the work of philosophers and qualitative researchers to
identify four intrinsic human needs: meaning, purpose,
choice and control, and a positive sense of self-worth. She
noted that there was a substantial evidence base for the claim
that these dimensions contribute to well-being and for the
premise that occupation can be a source of these four
dimensions. Hammell (2004b) suggested that a renewed
understanding of occupation ought to encompass these
important dimensions of meaning in people’s lives.
The literature base that informs the following sections is
neither exhaustive nor comprehensive. It draws from
recurrent themes in the work of qualitative researchers to
sketch four experience-based categories of occupation—
restorative, ways to connect and contribute, engagement in
doing, and ways to connect the past and present to a hopeful
future. These categories address the four intrinsic needs
noted above and were identified from themes that occurred
and recurred within and across multiple studies, only a
selection of which can be outlined here. It has been suggested
that a qualitative study is credible or authentic, "when it
presents such faithful descriptions or interpretations of a
human experience that the people having that experience
would immediately recognize it from those descriptions or
interpretations as their own" (Sandelowski, 1986, p. 30).
Although this paper does not constitute qualitative research,
I contend that occupational therapy clinicians and
researchers will recognize the following interpretations of
occupational experience as credible from their personal and
clinical experiences as well as from their forays into the
research literature. As such, these preliminary categories
might be viewed as starting points for researchers seeking to
develop client-centred occupational categories. Clearly,
110 AVRIL 2009 I REVUE CANADIENNE D’ERGOTHÉRAPIE I NUMÉRO
however, these preliminary categories must be regarded as
tentative, not least because the literature cited below is
specific to the minority world.
Restorative occupations
Restorative occupations are identified as occupational
experiences that contribute to well-being, especially for those
confronting difficult life challenges, such as high spinal cord
injuries or amyotropic lateral sclerosis (Hammell, 2004a;
Young & McNicholl, 1998). Restorative occupations are
reported to include reading, needlework, creative arts,
gardening, prayer, meditation, viewing art or listening to
music, tai chi, yoga, being with special people, and enjoying
nature either actively (e.g., by cross-country skiing, walking,
canoeing, or horseback riding) or passively (e.g., by
absorbing the sights, sounds, and smells that constitute the
beauty of our natural world) (Hammell, 2004a; Pierce, 2001).
Such occupations may be neither goal orientated nor
purposeful, yet may be experienced as profoundly
meaningful and rewarding (Jonsson & Persson, 2006).
Experiences identified as being associated with this form of
occupation may include rest, reflection, pleasure, “being in
the moment,” harmony, peace, appreciation, inspiration,
tranquillity, rejuvenation, and relaxation. Sleep—an
occupation of fundamental importance to human well-being
that is usually ignored by occupational therapists (Green,
2008; Green, Hicks, & Wilson, 2008)—is obviously a form of
restorative occupation (Pierce).
Occupations fostering belonging,
connecting, and contributing
Studies among people with illnesses and impairments from
countries as diverse as Bangladesh, Canada, China, and
Slovenia have noted that the ability to contribute to others in
reciprocal relationships (e.g., partners, families, friends and
extended communities) that foster perceptions of value,
competence, self-worth, and a sense of connection and
belonging are important to one’s sense of well-being (e.g.,
Hammell, 2004a; Hampton & Qin-Hilliard, 2004; Piškur et
al., 2002; Waldie, 2002). These studies suggest that this
experienced-based category of occupation might have broad
cultural relevance (Ryff & Singer, 1998). Indeed, in collective
societies that place high value on social relationships,
belonging is more highly valued than doing (Iwama, 2006).
Moreover, disabled feminists criticize masculinist ideals of
autonomy, independence and individual rights that construe
people as separate from each other, endorsing instead ethics
that recognize interdependence, relationships, and responsi-
bilities (Morris, 2001).
Duncan (2004) observed that “doing valued occupations
with and for others fosters a sense of connectedness—a sense
of belonging, purpose, and meaning that affirms the worth of
the individual” (p. 198). Experiences associated with this form
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of occupation may include belonging, connecting, contributing,
caring, and feeling cared for and needed. Research demon-
strates that these occupations are associated with self-worth
(feeling valued by others and valuable to others) and with
higher levels of physical and emotional well-being (Hammell,
2009). Perceptions of self-worth and feelings of being valued
and valuable have, in turn, been associated with well-being
and with quality of life (Hammell, 2004d).
The importance of doing things with others and for
others was identified as significant in a study exploring the
experience of occupational participation among people in
Sweden (Borell et al., 2006). Similarly, people with severe,
persistent mental illness have identified the importance of:
social interaction and inclusion, doing things with and for
people, caring for others, and gaining from them a sense of
belonging (Nagle et al., 2002; Rebeiro, Day, Semeniuk,
O'Brien, & Wilson, 2001). Indeed, achieving a sense of
connectedness with others and of belonging has been
identified as key to the experience of quality of life by people
with schizophrenia (Laliberte-Rudman, Yu, Scott, &
Pajouhandeh, 2000). Women with multiple sclerosis also
identified the value of having the opportunity and ability to
contribute to others: “Continuing involvement in caring
relationships seemed to provide a vital experience of
continuity, self-worth, and fulfilment” (Reynolds & Prior,
2003, p. 1237). Occupations may, therefore, be chosen specif-
ically to foster social connectedness and to enable individuals
to make contributions to others (Häggström & Lund, 2008;
Hammell, 2004a; Laliberte-Rudman et al.; Nagle et al.), even
in the face of life-threatening illnesses (Lyons, Orozovic,
Davis, & Newman, 2002). Kitwood and Bredin (1992)
observed that “persons exist in relationships; interde-
pendence is a necessary condition of being human. Perhaps
everyday life would be more fulfilling, and each individual’s
existence both richer and more secure, if this was widely
acknowledged” (p. 284).
Engaging in doing occupations
This experience-based category encompasses occupations
that contribute to a sense of purpose and meaning in
everyday life, and, thus, to a sense of well-being. By fostering
capability and accomplishment, these occupations may be
experienced as contributing positively to a sense of self-
worth. Occupations categorized as “doing” might include
activities concerned with self-care as well as with various
forms of productivity, such as paid employment, volunteer
work, educational pursuits, home and garden maintenance,
financial activities, correspondence, and the fulfilment of
obligatory roles. Descriptors of experiences associated with
this form of occupation may include, for example, interest,
reward, responsibility, commitment, routine, doing,
obligation, being busy, absorption, accomplishment, and
doing things that have to be done. It is important to note that
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WHALLEY HAMMELL
occupations characterized as “doing” are not necessarily
interesting, fulfilling, or rewarding, but instead might be
mundane or boring, associated with responsibility or duty, or
the consequence of limited choices or coercion.
People with severe, persistent mental illnesses have
identified the motivation derived from having something to
do (or to keep busy) and for which to get up in the morning
(Laliberte-Rudman et al., 2000; Nagle et al., 2002). People
with high spinal cord injuries similarly identified the need to
be busy and to have something to wake up for. Moreover,
they felt that the opportunity to engage in doing occupations
they experienced as purposeful and meaningful contributed
to self-perceptions of capability and value (Hammell, 2004a).
Research literature supports the premise that engagement in
doing purposeful occupations is associated with well-being,
but it does not support the cultural assumption that work is
the optimal or only occupational route to well-being (e.g.,
Ville & Ravaud, 1996). Research in France among people
with spinal cord injuries, for example, found that participation
in any work, including voluntary, unpaid work or leisure
occupation (with the exception of watching television) was
associated with increased subjective well-being, (Ville,
Ravaud, & Tetrafigap Group, 2001). Clearly, these findings
cannot be extrapolated to those in other socio-political or
economic milieus, for whom engagement in occupations may
be dangerous and degrading (Hammell, 2009).
Occupations reflecting life continuity
and hope for the future
This category of experience is identifiable in the narratives of
people enduring life crises, but it is unlikely to be identified
by those people who believe their lives to be predictable.
People in the study of quality in life following high spinal
cord injury (Hammell, 2004a) identified the importance of
envisioning future time engaged in meaningful occupations
and of working towards goals that generated a feeling of hope,
and that counteracted a sense of hopelessness in which their
future appeared devoid of meaningful occupations. This
finding has also been identified, for example, in studies of
people with schizophrenia (Laliberte-Rudman et al., 2000) and
multiple sclerosis (Reynolds & Prior, 2003). One dimension of
this form of occupation is achieving biographical continuity, or
life coherence, such that enjoyable, meaningful, and rewarding
occupations of the past and present may be envisioned as
continuing in the future, although perhaps in modified forms
to accommodate changed abilities or opportunities (Reynolds
& Prior). Words and phrases used to express this experience of
occupation may include dreams, aspirations, goals, continuity,
focusing on what I can do, finding ways to enjoy the same
things, getting life on track and reassembling the pieces of my
life (Hammell, 2004a, 2007b; Reynolds & Prior). For people
who have sustained a life-altering injury or illness, the process
of refocusing on abilities, interests, and personal goals often
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 WHALLEY HAMMELL
entails redefining one’s values and rethinking one’s priorities
(Haggstrom & Lund, 2008; Hammell, 2007b; Reynolds &
Prior).
Discussion
This paper has echoed calls for a renewed theoretical
understanding of occupation, one derived from client-
centred research evidence. It has suggested four important
categories, or dimensions, of occupational experience that
recur in the literature and that can be seen to address those
intrinsic needs for meaning, purpose, choice and control, and
a positive sense of self-worth that occupational therapists
have identified as important to human well-being.
In reality, of course, the experience of being occupied
cannot be neatly divided. For example, while gardening, a
man might experience a sense of accomplishment in tackling
a job that needs doing, such as attaching a trailing
honeysuckle to a trellis, while also enjoying working in
cooperation with his partner and simultaneously appreciating
a sense of rejuvenation from the warm sunshine and the
sweet smell and beauty of the flowers. Moreover,
accomplishing this occupation might be experienced as an
expression of hope for the future. If this man has a severe
physical impairment, these experiences might occur despite
an absence of physical engagement in the occupation,
confirming that the experience of engagement in an
occupation is more important than its outward expression.
In reviewing the literature it is apparent that when study
participants speak of their relationships with family and
friends it is frequently in the context of activities, such as
using public transportation or going out to restaurants, bars,
theatres, and concerts. This suggests that many occupations
experienced as “doing” may be inseparable from occupations
experienced as “belonging” (Hammell, 2004d). Thus, while
different experiences of occupation may contribute to human
well-being in different ways, the relationships between these
experiences are complex and cannot be neatly separated.
A growing body of literature critiques the metaphor of
balance and its conceptualization within theories of
occupation (Backman, 2004; Westhorp, 2003). Several
occupational therapists have suggested that occupational
balance relates, not to time expenditure, but to qualities and
experiences of occupation (Hagedorn, 1995; Jonsson &
Persson, 2006; Primeau, 1996). Occupational balance is most
appropriately determined by the individual concerned,
congruent with her or his priorities, needs, and values.
Someone recovering from a severe illness or injury, for
example, might feel the need to spend considerable time in
restorative occupations—listening to music or birdsong,
walking in nature, painting, or reading—and little time in
doing occupations that are purposeful, goal oriented, or
socially sanctioned. Instead of trying to assess whether
clients’ use of time in self-care, productive, and leisure
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activities is balanced, occupational therapists might more
usefully ascertain whether people perceive a satisfying
balance among different experiences of occupation
congruent with their own priorities and needs.
Conclusion
Hammell (2009) posed the following question: What might
occupational therapy's theories of occupation and well-being
look like if they were not informed solely by the perspectives
of middle-class, minority-world theorists, but rather by those
of other cultural groups and ill and disabled people? This
paper has sought to sketch some of the features that might be
incorporated into the profession’s theories of occupation if
these were informed by ill and disabled people’s perspectives.
Instead of categories of self-care, productivity, and leisure,
occupations might be categorized according to the ways in
which people say they experience them: as restorative; as
ways to contribute and achieve a sense of connectedness; as
ways of fulfilling duties, responsibilities, and interests; and as
ways to connect the past and present to a hopeful future.
However, the four categories of occupational experience
identified in this paper are not intended to be authoritative,
but rather to be used to suggest a possible direction for future
client-centred research and development of theory.
Considerable research needs to be undertaken to explore the
occupational experiences and perspectives of those whose
cultures differ from the minority (developed) world, English-
speaking, White, middle-class norms of occupational
therapy’s traditional theorists (Hammell, 2009).
Occupational therapists have generated little data to
support the premise that engagement in occupation – self-
care, productive and leisure - contributes positively to human
well-being (Law, et al., 1998; Piškur, et al., 2002). Given the
difficulties with defining leisure, the reality that engaging in
productive occupations may result in physical and mental
damage, and the possibility that self-care occupations might
have at best a tenuous relationship to well-being, this should
not be surprising.
Research findings sketched in this paper suggest that if
occupational therapists categorized occupations according to
how people experience them, they might identify closer
correlations between occupational engagement and well-
being that could provide an evidence-based foundation for
more relevant occupational therapy practice.
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acquired brain injury. Journal of Rehabilitation Medicine, 40, 89-

Key messages 95.
Hammel, J., Magasi, S., Heinemann, A., Whiteneck, G., Bogner, J., &
• Occupational therapy’s current categorizations of
occupation lack a supportive evidence base. Rodriguez, E. (2008). What does participation mean? An insider
perspective from people with disabilities. Disability and
• As a self-described client-centred profession, occupa-
Rehabilitation, 30, 1445-1460.
tional therapy’s theories of occupation should reflect
Hammell, K. W. (2004a). Quality of life among people with high
the priorities and occupational experiences of a
spinal cord injury living in the community. Spinal Cord, 42, 607-
diversity of people.
620.
• Instead of being categorized as self-care, productivity, Hammell, K. W. (2004b). Dimensions of meaning in the occupations
and leisure, research findings suggest that occupation
of daily life. Canadian Journal of Occupational Therapy, 71, 296-
could more usefully be categorized according to
305.
people’s experiences of occupational engagement.
Hammell, K. W. (2004c). Deviating from the norm: A sceptical
interrogation of the ICF. British Journal of Occupational Therapy,
67, 408-411.
References Hammell, K. W. (2004d). Using qualitative evidence to inform
Backman, C. L. (2004). Occupational balance: Exploring the
theories of occupation. In K.W. Hammell & C. Carpenter (Eds.),
relationships among daily occupations and their influence on
Qualitative research in evidence-based rehabilitation (pp.14-26).
well-being. Canadian Journal of Occupational Therapy, 71, 202-
Edinburgh, UK: Churchill Livingstone.
209.
Hammell, K. W. (2006). Perspectives on disability and rehabilitation:
Borell, L., Asaba, E., Rosenberg, L., Schult, M-L., & Townsend, E.
Contesting assumptions; challenging practice. Edinburgh, UK:
(2006). Exploring experiences of “participation” among
Churchill Livingstone Elsevier.
individuals living with chronic pain. Scandinavian Journal of
Hammell, K. W. (2007a). Reflections on...a disability methodology for
Occupational Therapy, 13, 76-85.
the client-centred practice of occupational therapy research.
Christiansen, C. (1999). Defining lives: Occupation as identity: An
Canadian Journal of Occupational Therapy, 74, 365-369.
essay on competence, coherence, and the creation of meaning.
Hammell, K. W. (2007b). Quality of life after spinal cord injury: A
American Journal of Occupational Therapy, 53, 547-558.
meta-synthesis of qualitative findings. Spinal Cord, 45, 124-139
Creek, J. (2003). Occupational therapy defined as a complex
Hammell, K. W. (2008). Reflections on...well-being and occupational
intervention. London: College of Occupational Therapists.
rights. Canadian Journal of Occupational Therapy, 75, 61-64.
Doble, S. E., & Caron Santha, J. (2008). Occupational well-being:
Hammell, K. W. (2009). Sacred texts: a sceptical exploration of the
Rethinking occupational therapy outcomes. Canadian Journal of
assumptions underpinning theories of occupation. Canadian
Occupational Therapy, 75, 184-190.
Journal of Occupational Therapy, 76, 6-13.
Duncan, M. (2004). Promoting mental health through occupation. In
Hampton, N. Z., & Qin-Hilliard, D. B. (2004). Dimensions of quality
R. Watson & L. Swartz (Eds.), Transformation through occupation
of life for Chinese adults with spinal cord injury: A qualitative
(pp.198-218). London: Whurr.
study. Disability and Rehabilitation, 26, 203-212.
Eklund, M., & Leufstadius, C. (2007). Relationships between occupa-
Hay, D., Clague, M., Goldberg, M., Rutman, D., Armitage, A., Wharf,
tional factors and health and well-being in individuals with
B., et al. (1993). Well-being: A conceptual framework and three
persistent mental illness living in the community. Canadian
literature reviews. Vancouver: Social Planning and Research
Journal of Occupational Therapy, 74, 303-313.
Council of BC.
Erlandsson, L-K., & Eklund, M. (2001). Describing patterns of daily
Hemmingsson, H., & Jonsson, H. (2005). An occupational
occupations: A methodological study comparing data from four
perspective on the concept of participation in the International
different methods. Scandinavian Journal of Occupational
Classification of Functioning, Disability and Health – some
Therapy, 8, 31-39.
critical remarks. American Journal of Occupational Therapy, 59,
Green, A. (2008). Sleep, occupation and the passage of time. British
569-576.
Journal of Occupational Therapy, 71, 339-347.
Iwama, M. K. (2006). The Kawa model. Culturally relevant occupa-
Green, A., Hicks, J., & Wilson, S. (2008). The experience of poor sleep
tional therapy. Edinburgh, UK: Churchill Livingstone Elsevier.
and its consequences: A qualitative study involving people
Jonsson, H. (2008). A new direction in the conceptualization and
referred for cognitive-behavioural management of chronic
categorization of occupation. Journal of Occupational Science, 15,
insomnia. British Journal of Occupational Therapy, 71, 196-204.
3-8.
Hagedorn, R. (1995). Occupational therapy. Perspectives and processes.
Jonsson, H., & Persson, H. (2006). Towards an experiential model of
Edinburgh, UK: Churchill Livingstone.
occupational balance: An alternative perspective on flow theory
Häggström, A., & Lund, M. L. (2008). The complexity of participation
analysis. Journal of Occupational Science, 13, 62-73.
in daily life: A qualitative study of the experiences of persons with
Kallen, E. (2004). Social inequality and social justice. A human rights

© CAOT PUBLICATIONS ACE VOLUME 76 I NUMBER 2 I CANADIAN JOURNAL OF OCCUPATIONAL THERAPY I APRIL 2009 113
 WHALLEY HAMMELL

13, 1225-1251.
perspective. Basingstoke, UK: Palgrave.
Ryff, C. D., & Singer, B. (1998). The contours of positive human
Kielhofner, G. (2002). A Model of Human Occupation: Theory and
health. Psychological Inquiry, 9, 1-28.
application (3rd ed.). Baltimore, MD: Williams & Wilkins.
Sandelowski, M. (1986). The problem of rigor in qualitative research.
Kitwood, T., & Bredin, K. (1992). Towards a theory of dementia care:
Advances in Nursing Science, 8, 27-37.
Personhood and well-being. Aging and Society, 12, 269-287.
Shaw, S. M. (1984). The measurement of leisure: A quality of life issue.
Kjeken, I., & Lillemo, S. (2006). Exploration of the link between
Society and Leisure, 7, 91-107.
occupational therapy models and the International Classification
Thompson, J. A., & Bundersson, J. S. (2001). Work-non-work conflict
of Functioning, Disability and Health: A response from
and the phenomenology of time. Beyond the balance metaphor.
colleagues in Norway. Australian Occupational Therapy Journal,
Work and Occupation, 28, 17-39.
53, 142-143.
Townsend, E. (1997). Occupation: Potential for personal and social
Krause, J. S. (1998). Dimensions of subjective well-being after spinal
transformation. Journal of Occupational Science: Australia, 4, 18-26.
cord injury: An empirical analysis by gender and race/ethnicity.
Townsend, E. A., & Polatajko, H. (2007). Enabling occupation II:
Archives of Physical Medicine and Rehabilitation, 79, 900-909.
Advancing an occupational therapy vision for health, well-being &
Laliberte-Rudman, D., Yu, B., Scott, E., & Pajouhandeh, P. (2000).
justice through occupation. Ottawa, ON: CAOT Publications
Exploration of the perspectives of persons with schizophrenia
ACE.
regarding quality of life. American Journal of Occupational
Unruh, A. M., Smith, N., & Scammell, C. (2000). The occupation of
Therapy, 54, 137-147.
gardening in life-threatening illness: A qualitative pilot project.
Law, M., Cooper, B., Strong, S., Stewart, D., Rigby, P., & Letts, L.
Canadian Journal of Occupational Therapy, 67, 70-77.
(1996). The Person-Environment-Occupation Model: A
Ville, I., & Ravaud, J-F. (1996). Work, non-work and consequent
transactive approach to occupational performance. Canadian
satisfaction after spinal cord injury. International Journal of
Journal of Occupational Therapy, 63, 9-23.
Rehabilitation Research, 19, 241-252.
Law, M., Steinwender, S., & Leclair, L. (1998). Occupation, health and
Ville, I., Ravaud, J-F., & Tetrafigap Group. (2001). Subjective well-
well-being. Canadian Journal of Occupational Therapy, 65, 81-91.
being and severe motor impairments: The Tetrafigap survey on
Lyons, M., Orozovic, N., Davis, J., & Newman, J. (2002). Doing-being-
the long-term outcome of tetraplegic spinal cord injured persons.
becoming: Occupational experiences of persons with life-
Social Science and Medicine, 52, 369-384.
threatening illnesses. American Journal of Occupational Therapy,
Vrkljan, B., & Miller-Polgar, J. (2001). Meaning of occupational
56, 285-295.
engagement in life-threatening illness: A qualitative pilot project.
McColl, M. A., Law, M., & Stewart, D. (1993). Theoretical basis of
Canadian Journal of Occupational Therapy, 68, 237-246.
occupational therapy. Thorofare, NJ: Slack.
Waldie, E. (2002). Triumph of the challenged. Conversations with
Morris, J. (2001). Impairment and disability: Constructing an ethics
especially able people. Ilminster, Somerset: Purple Field Press.
of care that promotes human rights. Hypatia, 16(4), 1-16.
Watson, R. (2004). A population approach to transformation. In R.
Nagle, S., Cook, J. V., & Polatajko, H. J. (2002). I’m doing as much as I
Watson & L. Swartz (Eds.), Transformation through occupation
can: Occupational choices of persons with a severe and persistent
(pp. 51-65). London: Whurr.
mental illness. Journal of Occupational Science, 9, 72-81.
Westhorp, P. (2003). Exploring balance as a concept in occupational
Persson, D., Eklund, M., & Isacsson, Å. (1999). The experience of
science. Journal of Occupational Science, 10, 99-106.
everyday occupations and its relation to sense of coherence: A
Wilcock, A. A., van der Arend, H., Darling, K., Scholz, J., Siddall, R.,
methodological study. Journal of Occupational Science, 6, 13-26.
Pierce, D. (2001). Occupation by design: Dimensions, therapeutic Snigg, C., et al. (1998). An exploratory study of people's
power, and creative process. American Journal of Occupational perceptions and experiences of wellbeing. British Journal of
Therapy, 55, 249-259. Occupational Therapy, 61, 75-82.
Piškur, B., Kinebanian, A., & Josephsson, S. (2002). Occupation and World Health Organization. (2001). International Classification of
well-being: A study of some Slovenian people’s experiences of Functioning, Disability and Health. Geneva, Switzerland: Author.
engagement in occupation in relation to well-being. Young, J. M., & McNicholl, P. (1998). Against all odds: Positive life
Scandinavian Journal of Occupational Therapy, 9, 63-70. experiences of people with advanced amyotrophic lateral
Primeau, L. (1996). Work and leisure: Transcending the dichotomy. sclerosis. Health and Social Work, 23, 35-43.
American Journal of Occupational Therapy, 50, 569-577. Author
Rebeiro, K. L., Day, D., Semeniuk, B., O'Brien, M., & Wilson, B.
(2001). Northern Initiative for Social Action: An occupation- Karen Whalley Hammell, PhD, OT(C), is Honorary Research
based mental health program. American Journal of Occupational Associate, Department of Occupational Science and
Therapy, 55, 493-500. Occupational Therapy, Faculty of Medicine, University of
Reynolds, F., & Prior, S. (2003). “Sticking jewels in your life”: British Columbia, Vancouver, Canada. Box 515, Oxbow,
Exploring women’s strategies for negotiating an acceptable Saskatchewan, S0C 2B0, Canada. Phone/fax: +306 483 2380
quality of life with multiple sclerosis. Qualitative Health Research, ik.hammell@sasktel.net

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