Near the beginning of Chapter 1 in my book, The Meaning of Everyday Occupation, I quote from an interview with an occupational therapist who responded to the question, “Can you tell me about a very dissatisfying experience you have had in practice?” The interview was part of a phenomenological research study that Virginia Dickie and I did in which we focused on the experience of doing occupational therapy (Hasselkus & Dickie, 1994). For her response, the therapist thought back to her time as a fieldwork student and described a situation when she had been assigned to a 90-year-old patient who was semi-conscious. “I never did understand why he was referred for OT. From the beginning it was evident that he was not able to respond . . . After several days of therapy, we were notified that the man had died” (p. 4).
Why did I use this therapist’s story of very dissatisfying practice to introduce the concept of meaning so early in the book?
In the Instructor’s Manual that accompanies my book, I suggest that students be asked to think about my reasons for introducing the concept of meaning in Chapter 1 with a narrative about a student therapist working with a patient who was not responsive and who died. One take on this student therapist’s experience would be to call it meaningless; as she said in the interview, she “never did understand” the situation and she did not indicate learning anything of value from the experience. And yet, she told us this story when asked to share a “very dissatisfying” practice experience. In other words, the meaning of the experience is that it was very dissatisfying — so dissatisfying, in fact, that the event from several years past is still vivid in the therapist’s memory. It is full of meaning. So another take on the experience is that it was meaningful.
Meaningfulness can be positive or negative or neutral or whatever. The inclusion of this therapist’s very dissatisfying experience at the beginning of the book is to serve as a reminder that the terms meaning and meaningful do not only refer to positive everyday occupational experiences of happiness, success, and accomplishment, but they also include experiences that are deeply stressful, sad, puzzling and disturbing. In his book about meaning and medicine, Moerman summed it up in his statement that meaning “will be there, doing its thing, whether you want it there or not” (2002, p. 130). Meaning is present in all of life.
And yet, still, the concept of meaning is illusive.
Recently, I went to visit a friend in a nearby nursing home; Evelyn was there for rehabilitation after a fall and a hip fracture. The occupational therapist who was at the facility and who was working with her greeted me in the hall before we both went into Evelyn’s room. The therapist had been a student in OT while I was on faculty and we talked briefly about our career involvements of the moment. When I mentioned the second edition of my book, including the title (The Meaning of Everyday Occupation), she smiled and said she had fond memories of learning and thinking about “meaning” while in OT classes, but she followed with the added statement that she hadn’t “been able to think about meaning for a long time.”
I looked at her, and images of goniometers and pinch meters and dynamometers floated in my head. How could one possibly not think about meaning while carrying out therapy? And, in fact, she couldn’t. I stayed with her during her exchanges with Evelyn that morning as they planned together for Evelyn’s trial visit home to see how she would be able to manage.What was important to Evelyn? What did Evelyn see as problems? Was there anything that Evelyn was fearful about? A week later I gave Evelyn a ride to her home for that trial visit. I saw the skill the therapist had as she and Evelyn worked together to establish needs and priorities for making her home functional and safe for her upcoming return. The therapy sessions both at the nursing home and during the home visit were flooded with “meaning” and health-promoting “meaningfulness.” But, somehow, the therapist didn’t recognize it.
So, meaning can be difficult to comprehend. In one way, meaning and meaningfulness are larger than life — present in all of life, there whether we want them to be or not, even in the experience of a patient who dies or of a patient who is getting ready to go home from a rehabilitation facility. In another way, meaning and meaningfulness are so close to home that we fail to recognize them in our everyday lives as occupational therapists, even when they are deeply imbedded in our day-to-day work with people. Meaning is derived from our efforts to make sense out of what we are experiencing in our daily lives. And as Frankl has said, we are beings “in steady search of meaning” (1978, p. 20).
Frankl, V.E. (1978). The unheard cry for meaning. New York, NY: Simon and Schuster.
Hasselkus, B.R., & Dickie, V.A. (1994). Doing occupational therapy: Dimensions of satisfaction and dissatisfaction. American Journal of Occupational Therapy, 48, 145-154.
Moerman, D. (2002). Meaning, medicine and the “placebo effect.” Cambridge, UK: Cambridge University Press.