The Wonders (?) of Self-Care

On a recent warm day, I sat at our breakfast table and watched a robin splashing about in the birdbath in the back yard.  After a fair amount of time at this activity, he hopped out of the water and flew to perch on a nearby trellis. There he engaged in a  rather extended effort to shake the water off his wings and to preen his feathers.  After what seemed like several minutes of this thorough grooming, the robin flew right back to the birdbath and proceeded to once again splash around in the water.  It made me laugh right out loud, thinking that we humans would likely never do that, i.e. spend time getting ourselves groomed to perfection and then, immediately afterwards, undo all that we had worked so hard to achieve. So what was that preening all about?

It dawned on me, as this little drama of the robin unfolded, that one of our treasured domains in occupational therapy — self-care (grooming included) — is likely a universal domain of all animal life.  On one level, this seems obvious, yet I had never thought of it in quite that way before.  In a New York Times article a year ago, titled Our Animal Natures, the authors made the following statement:  “Grooming is as basic an activity for many creatures as eating, sleeping and breathing” (Natterson-Horowitz & Bowers, NYTimes, June 10, 2012). Grooming, eating, sleeping and breathing — these are perhaps the very core occupations of self-care in human beings.

I remember when our now 16-year-old granddaughter was an infant, her parents had a baby monitor on her bed so that we could detect any signs and sounds of trouble from wherever we were in the house. The little rustling of the sheets that accompanied her smallest movements as she adjusted her body during sleep filled me with a sort of wonder.  This tiny baby was already able to take care of herself in some ways, one of them being the ability to seek and find a comfortable position  during a nap.

Within a developmental framework, self-care in humans gradually shifts across our lifespans from the  simple to the increasingly complex — from adjusting our body position in bed to the intricate processes of getting ready for and carrying out the self-care demands of school and work and family and beyond. In the presence of illness and disability, this continuum across the lifetime can be a jumble of self-care starts and stops rather than a smooth ride from simplicity to complexity.  For example, when I slipped on ice a couple winters ago, I injured the rotator cuff in my right shoulder; turning over in bed at night was one of the moves that I found extremely difficult. The injury took me right back to square one in terms of some aspects of self-care.

In Chapter 9 in my book, the chapter on creativity in occupation, I present a  therapist’s narrative about a very satisfying experience in practice (Hasselkus & Dickie, 1994).  Her story is about a young man who fell off a roof the week before he was to enter medical school, fracturing both of his arms “pretty seriously.”  The resulting disablement took this fellow, too, right back to square one in terms of basic self-care occupation.  The therapist recounted her work with him in this way:

“He was casted, both arms were casted in a position where his elbows were in flexion and he really could do nothing for himself.  He had the option to wait, postponing med school for a year, or learning how to adapt and do things for himself.  And so with creative creating, I guess, we spent a lot of time and adapted everything from the fork, the spoon, the toothbrush, something for him to wipe himself with, and came up with techniques for just about anything you can think of that you needed to do.  He ended up going to med school, and the only thing he couldn’t do for himself was completely shower, he needed someone to help get the baggies on his arms so he wouldn’t get the casts wet.  That stands out as something that really made a difference in somebody’s life immediately.  And it was really an OT-type thing to be able to be creative and design equipment.”  

Once again, disablement had pushed this young man’s self-care needs all the way back to the basic level.  The therapist derived much satisfaction from working together with him to find ways to recapture those fundamental skills.  But don’t these  basic skills — feeding himself, wiping himself, using a toothbrush — juxtaposed with the hugely complex skill of being able to go to “med school,” constitute a wonderful example of what we profess to believe in as occupational therapists?  That the many varieties of everyday occupations that exist in our lives are interdependent and intertwined.  That the grooming, eating, sleeping and breathing occupations are as important to our personhood as are the complex everyday occupations derived from family, school, work and play.  That we as occupational therapists may break the patterns of daily occupational engagements into pieces and seek to resolve problems that exist at that reductionistic level — but then we sweep our gaze back to the larger picture, the larger rhythms of the days, the larger hopes and dreams of an individual about his or her life — the going to med school or whatever else it may be.

Back to the robin in the birdbath.  Who knows what leads a bird to seek out a little basin of water to splash around in?  Who knows why the robin follows his water exercises with a time of serious preening?  Who knows why the robin then goes directly back to the birdbath for more splashing around?  What I do know is that, in its own way, the robin, too, is carrying out his own very basic everyday occupations.  The robin, too, has a larger life that this bathing and preening support, for he and his mate have a nest up in the corner of our backyard pergola, with the promise of a family in view.  He will be involved in the difficult tasks of working with the female to “raise” his babies, to help them fledge and begin to fend for themselves, and then to lead them south in the late fall as they migrate to warmer climes.  It’s not too much of a stretch to say that the scenario of the robin seems almost on a par with the complex demands of going to med school.  Almost.

Hasselkus, B.R., & Dickie, V.A. (1994).  Doing occupational therapy:  Dimensions of satisfaction and dissatisfaction.  American Journal of Occupational Therapy, 48, 145-154.

4 thoughts on “The Wonders (?) of Self-Care

  1. Hello Betty,
    This is the first post I’ve read since you came to visit at UNC-CH last spring. I’m currently on FW where I find myself somewhat distanced from the eloquence of how you and professors at UNC conceived occupation. Thank you for bringing me back and refreshing my idea of occupation so that I may better think of it in practice.

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  2. I love this post Betty. I can relate to it on many levels. I had emergency surgery for cauda equine syndrome in 2011. Overnight I lost the ability to independently care for my then 2.5 year old son, my most valued role. I was bereft. On a lighter note I was also undone by shaving my legs! How I wished for a long handled razor! Without doubt in the early days post surgery a dressing stick and bed lever were the two aids that helped me to perform the most simple self care acts. And over time I taught my son to lie on the sofa for his nappy change so I could start to perform that basic daily occupation for him again too. Together we all learned and adapted.

    I will use your post in my teaching this coming year. Thank you!

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  3. Your reflections are always great! They remind me that one of the (many) gifts of being older is that we are more contemplative and can give our “working knowledge” new life.

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