I May Not Heal, But I Will Live Better Thanks to Occupational Therapy
Last year I learned how to chop a carrot with my eyes closed. While being filmed. Sounds like one of those crazy reality cooking shows, like “Cutthroat Kitchen,” doesn’t it?
Actually, I was in the model kitchen at the Lighthouse Guild for the Blind in New York City, and the filmmakers were Joseph Lovett and Mike Thibodeau. We were shooting a brief documentary designed to teach ophthalmologists when and how to refer patients for low vision therapy. I was grateful for the care offered to me by the Lighthouse Guild, and I had agreed to be a sample patient for the film.
The occupational therapist laid out my parer, knife, and cutting board on a bright red tray that contrasted well with the black tools and white counter. She showed me how to hold the parer and the carrot, and how to find the right place on the carrot by bringing my hands into contact, rather than by trying to look at the carrot. After that task, she showed me how to measure a slice of carrot with my finger, then bring my knife hand to meet my cocked knuckle, protecting my fingers. After a few practice slices, she stopped me. “Shut your eyes.” I was startled. “But I don’t need to be able to do this completely blind!” She smiled. “Just try it. Shut your eyes.” I felt embarrassed protesting too much on camera, so I followed her order.
I immediately felt my body relax. I typically spend a lot of time leaning forward, squinting, trying to get some reasonable angle on my work — an angle that will never again exist for me since multiple sclerosis damaged my visual field two years ago. With my eyes shut, my body calmed. I focused my attention on my hands and my sense of touch, which thankfully are fine (knock wood). And I cut the carrot with my eyes shut. It was slow work, but not stressful. I opened them at the end, and surprise! I had a respectably-cut carrot.
All afternoon, I worked with the Lighthouse Guild’s occupational therapists, who asked me to describe the aspects of my life that had been disrupted by my visual impairment, and asked which tasks caused me the most struggle. We worked in the kitchen because I had complained that I had cut and burned myself several times trying to make dinner, and a half-joked that I feared I would cut off a finger one of these days. I also learned exercises to practice finding the beginning of a line of text when I read and sampled software that helpfully highlighted and magnified elements of my desktop and word processor. I tried some strategies for reaching out and touching objects in my environment, such as signposts and mailboxes, when I feel disoriented and confused by my brain’s optical illusions on the street. These were all strategies for living that I desperately needed. Occupational therapists can’t fix the damage to my visual field, but they can ameliorate the damage to my functioning.
Occupational therapy began in the early twentieth century as a treatment for institutionalized mentally ill patients. The idea was that keeping patients “occupied” with arts and crafts helpfully structured their lives, and preserved habits of industriousness.1 Physicians saw that unoccupied minds and bodies deteriorated in the hospital, and activities such as basket weaving and metalworking gave patients focus, purpose, and a reason to socialize with other people.2
Occupational therapy boomed in the aftermath of World War I, when war veterans returned home with a variety of mental and physical ailments. Occupational therapists taught carefully calibrated lessons in new craft skills that helped patients with shellshock be able to focus and remain calm, and gave recuperating soldiers something to do while they were treated for their physical wounds. The therapy became “occupational” in a new sense, offering new skills to disabled veterans who were not capable of returning to their former trades.3
Occupational therapy also expanded to reach those disabled by accident and illness. One of the founders of the field, George Edward Barton, was wheelchair-bound and suffered from tuberculosis. He developed many techniques and therapies in his own home, on his own body.4 Occupational therapy was above all a practical and experience-based discipline, a link from medical treatment back to the pathways of life in one’s community.
Despite its demonstrated value, occupational therapy is too seldom prescribed to those who could benefit from it. Physicians are not always aware of its effectiveness, or the range of its uses, and don’t think to prescribe it for their patients. I have spoken about my experiences at the Lighthouse Guild with a number of older friends and colleagues who find themselves struggling with aging-related visual problems. They have been told that nothing can be done, and they are left to struggle with impairments on their own.
Occupational therapy may look simple, but it is based in a powerful combination of scientific understanding of physical development, debility, and adaptation, as well as a professional corpus of best practices. Instead of leaving patients floundering and struggling to reinvent the wheel, occupational therapy draws upon the accumulated wisdom of their profession to give patients proven strategies for handling their disabilities.
In addition to the afternoon of filming, I went to eight weekly occupational therapy sessions. Between sessions I faithfully did my daily exercises: tracing tangled-yarn lines with a pencil, picking out doubled letters on a page full of print, navigating chair-mazes in my living room, and practicing pushing spinach in sweeping circles toward the middle of the pan when I sautéed it. I touched all the sign poles and trees I passed on the sidewalk, even though I knew I looked a bit eccentric, to teach my brain to understand how their physical placement correlated to my distorted and blurry visual field. After the sessions, I could navigate my world with more confidence, and I had strategies to build my ongoing rehabilitation into my daily life.
I suspect all of us could benefit from a little occupational therapy. I shared some of my knife safety skills with my nine-year-old would-be chef, and now I feel much better about his cooking projects. For anyone whose abilities are atypical, and for whom the world doesn’t quite fit, occupational therapy is a life-enhancing treatment as important as the medical care it supplements. As the country debates who will get health care and how, it is important that we see occupational therapy not as an add-on to real health care, but as an integral component of making people as well and functional as they can be.
Lara Freidenfelds is a historian of health, reproduction, and parenting in America. She is the author of The Myth of the Perfect Pregnancy: a History of Miscarriage in America and The Modern Period: Menstruation in Twentieth-Century America. Sign up for her newsletter and find links to her op-eds and blog essays at www.larafreidenfelds.com.