The social markers of the difference: contributions to social occupational therapy

Abstract

This text results from an effort to reflect on the theoretical aspects that have been parameterizing social occupational therapy in Brazil, and those on which “social makers of difference” are based, aiming at formulations that enable the proposition of occupational therapy methodologies and actions that take into account the daily lives of different subjects. These reflections arise from the contemporary demands of various social segments and concerns about a better conformation of the theoretical contribution subsidizing social occupational therapy practices. For that purpose, we take up the historical constitution of the “social” as a field of action for occupational therapy, as we present the perspective of social difference markers and, in this interlacement, the discussion about their possibilities and approaches in and with social occupational therapy. It is pointed out that the social makers of difference can constitute an important conceptual lens for social occupational theory practice since it includes the constitution of differences in its references - gender, race, ethnicity, class, sexuality, generation, etc. - as a starting point for the understanding of social inequalities.

Keywords:
Occupational Therapy/Trends; Occupational Social Therapy; Social Inequity; Differences

Resumo

Este texto decorre de um esforço de reflexão em torno dos aspectos teóricos que vêm parametrizando a terapia ocupacional social no Brasil e aqueles sob os quais se fundamentam os “marcadores sociais da diferença”, visando a formulações que viabilizem a proposição de metodologias e ações terapêutico-ocupacionais que considerem os cotidianos que constituem a vida de diferentes sujeitos. Tais reflexões surgem com base nas demandas contemporâneas de diversos segmentos sociais e de preocupações quanto a uma melhor conformação do aporte teórico e metodológico que subsidia as práticas da terapia ocupacional social. Para tanto, retoma-se o processo histórico de constituição do social como um campo de ação da terapia ocupacional, apresenta-se a perspectiva dos marcadores sociais da diferença e, nesse entrelaçamento, o diálogo acerca das possibilidades e aproximações da e com a terapia ocupacional social. Pontua-se que os “marcadores sociais da diferença” podem se constituir como uma importante lente conceitual para informar a prática da terapia ocupacional social, à medida que inclui em seu arcabouço a constituição das diferenças – gênero, raça, etnia, classe, sexualidade, geração, entre outras – como ponto de partida para a compreensão das desigualdades sociais.

Palavras-chave:
Terapia Ocupacional/Tendências; Terapia Ocupacional Social; Desigualdade Social; Diferenças

1 Presentation

The discussions that take the social markers of difference as a starting point date back to the mid-1980s and advanced in the late 1990s with an academically demarcated scope of considerations and reflections. It is a field of studies of the social sciences aimed at the debate about how inequalities and hierarchies between individuals are socially constituted, and the way they operate in social life, based on production and in the reproduction of difference (Almeida, 2012; Moutinho, 2014; Zamboni, 2014).

In this perspective, the individual is a socially and culturally human being in discursive plots, in which gender, sexuality, race, class, religion, nationality, sexuality, generation, among others, are not independent variables, but are interwoven in a different way that the individual's differentiation axis constitutes the other and at the same time that it is constituted by the others (Brah, 2006), both for the configuration of social classification systems and the constitution of bodies and collective identities. According to Mello & Gonçalves (2010), these social constructions pre-exist at our birth and are articulated in a way to produce greater or lesser social inclusion/exclusion, depending on how much they confront the hegemonic social identities.

The plots of social life have been a field of interest for occupational therapy as they offer elements for understanding the ways of living, the construction of daily life and the stories and life projects of the individuals facing the several aspects that go through them, especially for those professionals who dedicate their action efforts to the social area.

If we consider that there is an interrelation between the profession and the country's socioeconomic and political condition, as pointed out by Pinto (1990), nowadays, this relationship becomes increasingly close and evident. Thus, if there are ruptures and intersections caused by advances in overcoming gaps and demands placed by the context of professional practice, there is also permanency in the encounter of occupational therapy with the individual: the potential for social participation.

Thus, between breaks and permanence, the history of occupational therapy in Brazil was constructed, through paradigms that contributed to its professional configuration, but at a given moment were strained, especially due to technical, political, and historical issues. Considering the social occupational therapy specifically, we highlight its search for the aggregation of subsidies for the development of actions around the emancipation and autonomy of the individuals that have impediment and/or socioeconomic difficulties to access their social rights (Malfitano, 2016), so that the understanding of the mechanisms and social dynamics that relegate them to a place on the margins becomes essential for the development of techniques and methodologies of action in this area.

In Brazil, the social aspects of occupational therapy have been forming since the 1970s and 1980s, but only at the end of the 1990s, it begins to be named as a specific field of professional practice, consolidating the legitimacy of its name, as discussed by Malfitano (2016). In the articulation of social occupational therapy¹, new concerns are brought to the professional category, bringing the problem of the social issue in capitalist society and concepts such as social vulnerability, social disaffiliation, social support networks, and integration through work as relevant to social reading and configuration of contributions that inform the practice of the occupational therapist.

The link to this line of thinking enabled not only to anchor the development of professional practices with the expansion of population groups, but also the political positioning of the dynamics of social participation, rights and citizenship. This concept subsidized and has been subsidizing therapeutic-occupational actions with different populations, such as the experiences developed in the METUIA Project (Lopes et al., 2014; Almeida et al., 2011; Morais & Malfitano, 2016). New demands emerge from the contemporary scenario and together, there is the need for a theoretical device that also covers such issues. The marginal experiences of transvestites on street corners, residents of Cracolândia, black mothers, outsourced cleaning women, migrants in the southeast, refugees in the north and south of the country, for example, go beyond the catalogs of abjection² and different socio-cultural demands, making concrete concerns for occupational therapists working in the social area.

Thus, with the complexity of contemporary life and the possibilities of social mediation that the occupational therapist can exercise, this text aimed to articulate the theoretical contributions that anchor the “Social Occupational Therapy” and the “Social Markers of Difference”, to debate references that enable to deal with new demands within the scope of professional practice.

2 Social Occupational Therapy

Social occupational therapy emerges in occupational therapy as a search for professional responses to demands that arise outside the health-disease axis or that cannot be understood within this binomial (Barros et al., 2002a). It was based on the perspective of social relations in capitalist society and on the gathering of a theoretical contribution that would enable the understanding of macro-social processes, so that intervention methodologies could be developed. Lopes (2016) highlights the fact that the historical materialism proposed by Antonio Gramsci contributed significantly for the understanding of possible places for the technician in the consolidation of the hegemonic consensus around the conservation of the interests of the dominant social class or in the construction of a dissent counter-hegemonic that sought to transform the current order.

The action of the occupational therapist extrapolates the limits of the individual, taking the collective as a nodal point and based on the understanding of the position that this collective assumes in the face of social dynamics. In this sense, their work requires that individual, collective and institutional needs be reconciled and connected (Malfitano, 2016).

If, until then, occupational therapy was based on the assumptions of health, at that moment, dialogue with the human sciences is essential, especially to understanding the dynamics that life assumes in the face of contexts that are crossed for politics, history, and culture.

The values hegemonization ​​of the dominant classes in institutional spaces and the criticism about the role of the technician in the face of professional and political action, inspired by Gramsci (Barros et al., 2002a), become part of the scenario of concerns of occupational therapists. In the challenge of creating strategies to deal with the social field, they found a theoretical contribution in the work of the French sociologist Robert Castel, especially in his discussion of social support and integration networks through work, a theoretical contribution that would enable the discussion of actions in therapy occupational. For the author, it is possible to think about the social insertion of individuals in society by outlining two fundamental axes: their relationship with work and their relationship with social support networks, which delimit areas of social participation or “non-participation”. According to Castel (1999), the more these axes are preserved and strengthened, the more socially integrated individuals will be. The author circumscribes three zones within the social dynamics: integration, vulnerability, and disaffiliation so that it is the strengthening, the fragility, and/or the rupture of these axes that move the transit of the individuals in such zones.

The relationship between the economic growth and the increase in poverty is directly linked to the wage society, defined by the author as being

[…] a society in which most of the social individuals have their social insertion related to the place they occupy in the wages, that is, not only their income but also their status, their protection, their identity (Castel, 1999, p. 243).

Thus, as the current social order, capitalism is the driving force behind the processes of exclusion, participation, and vulnerability.

Therefore, until then, social class was the main marker that guided the theoretical debate and the construction of a technical device. Nevertheless, recognizing social inequality as a defining characteristic of Brazilian society, when we take the reality of the country as a starting point for this debate, we are faced with factors of other orders that directly influence the dynamics of life that people and groups assume in social reality. Work and relational bonds are organizing and conducting axes of daily life, however, the experiences marked by inequalities of gender, sexuality, generation, race, and regionality are very markedly expressed in social transits and the construction and reinvention of ways of life, demanding from us other efforts of action that do not focus “only” or specifically on the intersections of those two axes, or better, on the social question in capitalist societies.

These inequalities, called here as social markers of difference, allow us to shed light and add other references to think about daily life, activities, and social participation, in the context of intense social inequalities. Therefore, the possibility of composing the referential of the Social Markers of Difference to use in social occupational therapy is defended. Thus, the concrete needs of the individuals must guide the theoretical reference necessary to understand the theme and organization of a socially responsive practice.

3 The Social Markers of Difference: Adding Lenses for Reading the Social

Since the 19^th century, economic inequalities (class differences) have been central to social movements that question the current social order (Zamboni, 2014). This centrality is due to:

[…] the influence of the tradition of Marxist thinking and the strength of the socialist and communist movements. For a long time, other forms of social inequality, such as race and gender differences, for example, were thought secondarily, as by-products of capitalist domination that would tend to disappear with the success of a socialist revolution (Zamboni, 2014, p. 9).

The problematization about the centrality of class identity as the basis of political organization, central to the debate on the so-called emergence of “new social movements” (Gohn, 1997), brings other markers to the scene, such as women's rights, sexual freedom, racial equality and the rights of the elderly population.

However, this type of movement aimed at identity issues but existing for a long time located between the lines of political debates. At least, since the beginning of the 19^th century, for example, women and black people have formed organizations to fight for equal rights, and, we can see, throughout the 20^th century, homosexuals fighting discrimination (Zamboni, 2014). However, the uprisings in May 1968 marked a moment of unprecedented proliferation, which would place this multiplicity of demands and subjects of action at the center of political life.

The perspective of the social markers of difference appears in this scenario, bringing together researchers from the racial relations area and the gender and sexuality area (Piscitelli, 2008, 2012). Therefore, it is a theoretical-conceptual tool for the analysis of classification systems and categories that organize social life, enabling the understanding of systems of inequality and production of asymmetries.

Unlike the identity categories, which produce and imprison through normative discourses, the categories of analysis are tools that contribute to apprehend the dynamics between differences and inequalities, as they enable the understanding of how these inequalities are socially constructed (Brah, 2006).

Thus, the approach of social markers of difference starts from Gramsci's view of hegemony, in which “[…] the hegemonic is what establishes the parameters of a discussion and struggles, limits and pressures that we cannot escape, even if either to oppose them or to fight them” (Piscitelli, 2008, p. 270). However, in power relations, these categories are intertwined, referring to an idea of “articulatory practice”, which modifies the identities resulting from processes of subjectivation (Vega, 2008), opening space for other ways of being in the world and building/live life projects.

Thud, the difference is proposed as the basis on which life is analyzed, by which the dynamics of conflicts and social inequalities are understood (Batista & Perez, 2016) and, consequently, the basis on which the struggle for fundamental rights is based. When there is a reference to groups marked socially by differences, it means that there are people within society who are characterized by specificities that differentiate them from others, and that these characteristics are culturally constructed by the collectivity, resulting in their naturalization (Moutinho, 2014). The transformation of difference into a factor that delimits the dynamics of inequality is done using the social markers of difference; in Bourdieu's terms, it is a symbolic capital, to negotiate perspectives on one's subjectivity and that of others (Vega, 2008), assigning values constantly negotiated.

According to Brah (2006), apprehending the difference means referring to the variety of ways in which specific discourses about/of difference are constituted, contested, reproduced, and re-signified.

Some constructions of difference, such as racism, propose fixed and immutable boundaries between groups considered to be inherently different. Other constructions can present the difference as relational, contingent, and variable. In other words, the difference is not always a marker of hierarchy and oppression. Therefore, it is a contextually contingent question whether the difference results in inequality, exploitation, and oppression, or egalitarianism, diversity, and democratic forms of a political agency (Brah, 2006, p. 374).

More than understanding how these categories add or subtract access or disenfranchisement, for example, it is necessary to understand how they articulate with each other in the experiences of those who experience them, how they translate into social life, what the practices and the actors involved in these processes and under which speeches are reinforced (Vencato, 2014). In addition to the markers and belongings, it is necessary to observe them as they appear in different contexts, given the need to know the possibilities of agency of the individuals, marked by different axes of oppression.

That is why these combinations, in certain power relations, are capable of generating new types of oppression, aggravated and deepened through different dimensions (Piscitelli, 2012), which means that an inequality relationship must not be analyzed only through an isolated marker since the relationship is capable of exercising domination (Vencato, 2014).

Within the perspective of the social markers of difference, these combinations are called intersectionality (Brah, 2006). Intersectionality aimed to capture the structural and dynamic consequences of the interaction between two or more axes of subordination and to understand how these markers produce, reinforce, and dynamize inequalities. It refutes the confinement and hierarchy of the main axes of social differentiation, which are the categories of sex/gender, class, race, ethnicity, age, disability, and sexual orientation. The intersectional approach goes beyond the simple recognition of the multiplicity of oppression systems that operate based on these categories and postulates their interaction in the production and reproduction of social inequalities (Bilge, 2010), as it allows the understanding that the individuals act through their limits and mainly that they do it contingently, moving between these forms of categorization.

In other words, intersectionality is a proposal that considers the multiple sources of identity, although it does not intend to propose a new globalizing theory of identity. Thus, visibilities, invisibilities, and silences are articulated in regimes of control, discipline, and social organization, marking power dynamics that create a social, corporal, and behavioral geography, producing more and more marginal bodies and lives.

4 The Production of Inequalities by Difference: Adding Lenses for Actions in Social Occupational Therapy

For the occupational therapy action, it is essential to ask: Who are these individuals? Historically, politically, economically, and culturally, how are their lives involved? And, faced with these implications, what is up to the professionals or their action? First, we need to recognize these individuals by the way they are named, how they are named and how these “names” produce access or inaccessibility, alternatives or limitations, rights, or their denial. When discussing the new meanings assumed by social occupational therapy, taking the 1990s as a starting point, Barros et al. (2002a, p. 101) pointed out the “[…] need to build an approach to problems from the learning of the recognition of needs and the development of the ability to seek creative solutions” as an implication (p. 101). Therefore, answering these questions will certainly lead us to understand the flows and counter-flows that these individuals experience daily, in the micro and macrosocial relationships of such transits and how these dynamics affect their occupations and daily lives.

From a sociological point of view, individuals marked by experiences of social inequalities based on genders, sexualities, generations, races, ethnicities, disabilities, classes, and regionalities³, to some extent, share life experiences outside normative and/or hegemonic molds. In this sense, they analytically demand the reconstruction of the cultural and historical conditions of contemporary experiences that insert them into broader processes that create the unmarked, those that benefit from the condition of being presupposed as a social norm. According to Mello & Gonçalves (2010), this issue is the social definition of who can and cannot claim the feeling of belonging to socially respected groups in economic, political and cultural terms, considering the racial identity attributes, religious, sexual, gender, age, class, among many others. The social consequences of these differences usually point to the inequalities that result in the absence of employment, weaknesses present in relational bonds, in sociability circuits, in the construction of affective bonds, in the feeling of belonging, in (absence of) social participation, among others.

Sometimes, the deprivation of access is due to the non-recognition of individuals belonging to some social segments within the assumptions of citizenship, so that the demands that involve, for example, the production of visibilities of other ways of living and their recognition as legitimate, being as important as economic demands. In other words, the structural economic exclusion, the social issue that focuses on it, although present for the majority, is not the only and, in many cases, not even central during so many forms of oppression. Thus, we talk about how to compose equality and recognition (Fraser, 2006).

If we think about the intervention strategies of social occupational therapy in the face of these contexts, in the sphere of collective actions, the approaches would need to deal with cultural confrontations, even though the needs for advancement in the legal field and access to goods and services are recognized, especially in the production, formulation, and reformulation of specific laws that can protect those populations and demands for public policies that enable them to be represented in the political field.

In this sense, for example, if we speak of a transvestite, black, homeless in the city of São Paulo, we will be facing multiple markers that cross his experiences. Giving attention that meets the real demands of occupational therapists implies considering the contribution of a theoretical device of a less universalist nature, in terms of the possibility of understanding more specific unequal dynamics, and the evident advances that were built in the area and less universalist considering that this prism is placed as one of the pillars of the modern society project. According to Mello & Gonçalves (2010, p. 170), “[…] the marked needs to reaffirm their humanity in the political arena and fight, often alone, to have access to social rights supposedly guaranteed to all and seen as intrinsic and universal in democratic regimes”. Before that, in daily life, he needs to be recognized as someone worthy of benefiting from such rights, even though they claim to be universal.

Such consideration is similar in the reflections of Barros et al. (2002a), when he affirms that occupational therapy in its action area finds a look specifically focused on the individuals, the human doing and the meanings and resignifications of this doing in daily life. Thus, it is:

To problematize the relationship between occupational therapy and society and the culture in which its action is inscribed, outlining methodological principles that allow thinking about practice, transcending the empirical moment without imprisoning reflection in reducing theories or even in predefined models, which they cannot understand the movement of reality, history and life in its context (Barros et al., 2002a, p.102).

Demands such as the use of public space by black trans women from the periphery, for example, show the need for dialogue between theories that operate for social redistribution and indemnity recognition. Certainly, the social issue is present, and the situation of these women also demonstrates structural inequality; however, the place of the “different” mobilizes a symbolic dimension, which involves the need for existence and its visibilities. These demands also tell us about the absence of freedom to come and go, they talk about the deprivation of relationships that make up daily life, judgments that prevent people from looking for a job, of the father's shame in going out with his daughter and his black (and lesbian) girlfriend; they speak of the demands for social recognition.

Taking as a reference a theoretical aspect that proposes not to hierarchize oppression, implies a political position and inserts a disposition in occupational therapy to think about actions in contexts of social inequalities, based on a perspective that extrapolates the look to consequences of an oppressive production system. Looking at poverty, for example, leads to actions that consider the mark of social class as an axis that articulates inequalities, which was and has been of paramount importance to locate the possible actions to be developed by occupational therapists. However, despite the undeniable contributions of this theoretical proposition, it is necessary to consider dialogue with new/other theoretical devices that help us to think about people's reality and our place as technicians (Gramsci, 1977). Thus, for many situations, such as black trans women from urban peripheries, it is necessary to consider the difference as a locus of inequality, without losing sight that the agency of these actors is also directly related to the cultural constructs that offer and build the repertoire of their identities, their movements, and negotiations.

5 Final Considerations: Epistemological Challenges

There are countless expressions of social inequalities generated amid difference and their consequences in social life. In the scenario of daily practices, these differences result in increasingly precarious lives, subjected to practices of violence and prejudice, with the deprivation of fundamental rights. The individual of these processes is what was socially, historically and culturally constructed as the “Other”, which means belonging to subalternate groups and, consequently, invisible in the hegemonic logic of social recognition, experiencing, especially in the political-relational field, and experiences of everyday life marked by processes of marginalization. Facing these places of marginalization is only possible with displacements referenced in dialogue with epistemes that problematize hegemonic knowledge and practices, questioning places of enunciation, considering the markers that are socially built around differences, and allowing the fluidity of possibilities transformation.

If occupational therapy has been built based on the concrete demands of the lives of the individuals they work (Barros et al., 2002a), we need to develop methodologies for understanding and intervention that aim at autonomy, participation, and social emancipation for all, in the weaving of the meanings that are attributed to the unique reality of the microsocial, creating coping strategies also in the macrosocial sphere.

Therefore, our intention with this text is to propose a discussion about the social markers of difference in the scope of social occupational therapy as a way of reflecting on the possible responses to the current demands placed by different population segments, to social inequalities and developments in everyday life. Thus, the social markers of difference are an important lens to inform the practice of social occupational therapy.

Whether through epistemes that treat the capitalist system as the great driving force behind social inequalities, epistemes that recognize cultural processes as central to social dynamics, or even the combination of multiple epistemes that recognize this infinity of factors that demarcate places, groups, and individuals, the multiple faces of social life, their influences and their consequences need to be apprehended by the occupational therapist as a way to build methodologies and actions that meet the individuals´ daily lives, as daily resistance and reinventions.

• 1
  Social occupational therapy was primarily driven by the creation and development of the METUIA Project (Barros et al., 2002b) and its centers across the country (Lopes & Malfitano, 2016).
• 2
  Concept proposed by Kristeva (1982) and widely debated by Butler (2003) to talk about the experiences of all types of bodies whose lives are not considered “lives”, and whose materiality is understood as “not important”, so that their humanity is questioned.
• 3
  According to Zamboni (2014), there is no closed and definitive list stating which are the social markers of the difference. Those mentioned in the paragraph have been frequently studied and were fundamental to understanding contemporary Brazilian society.
• How to cite: Melo, K. M. M., Malfitano, A. P. S., & Lopes, R. E. (2020). The social markers of the difference: contributions to social occupational therapy. Cadernos Brasileiros de Terapia Ocupacional. Ahead of Print. https://doi.org/10.4322/2526-8910.ctoARF1877
• Funding Source This work was supported by the Coordenação de Aperfeiçoamento de Pessoal de Nível Superior – Brasil (CAPES), financing code 001.

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Publication Dates

• Publication in this collection
  04 Sept 2020
• Date of issue
  Jul-Sep 2020

History

• Received
  17 Jan 2019
• Reviewed
  03 Mar 2019
• Accepted
  17 Aug 2019