“Garden of occupations”: care strategies in the face of occupational losses and mourning

Abstract

Situations experienced as stressful, such as the death of loved ones, loss of jobs, dreams, projects and others, have directly or indirectly affected people's routinely occupations, resulting in disruptions, changes and withdrawals from daily occupational preferences - both externally and the ones carried out in the domestic environment - which can impact the person and the way in which they engage and participate in social life. This article presents a proposal for intervention and care in the conditions of significant loss and mourning and promotes reflections on this subject from an occupational perspective, correlating concepts from Occupation Science, Logotherapy and Existential Analysis by Viktor Frankl. Therefore, it is based on the interventional strategy of care in mourning, called “Garden of occupations”, which uses elements such as metaphors and drawing as possibilities to create approximations with the theoretical foundation anchored in Occupational Science, from the perspective of existential tension and values of meaning by Viktor Frankl. The interventional proposal “Garden of occupations” is considered a participatory, reflective instrument, with the potential to deepen reflections and understandings about the meanings of life and engagement in occupations in the face of losses suffered.

Keywords:
Bereavement; Mourning Activities of Daily Living; Professional Practice

Resumo

Situações vivenciadas como estressoras, tais como a morte de entes queridos, perda de emprego, sonhos, projetos e outros têm afetado direta ou indiretamente as ocupações rotineiras das pessoas, resultando em rupturas, mudanças e afastamentos das preferências ocupacionais diárias, tanto as externas como as realizadas no ambiente doméstico, o que pode impactar a pessoa e a maneira como se ocupa e participa da vida social. O presente artigo apresenta uma proposta de intervenção e cuidados nas condições de perdas significativas e luto e fomenta reflexões a esse respeito sob uma perspectiva ocupacional, correlacionando conceitos da Ciência da Ocupação, Logoterapia e Análise Existencial de Viktor Frankl. Para tanto, baseia-se na estratégia interventiva de cuidado no luto, denominada “Jardim de Ocupações”, a qual emprega elementos como a metáfora e o desenho como possibilidades para criar aproximações com a fundamentação teórica ancorada na Ciência Ocupacional, sob a ótica da tensão existencial e valores de sentido de Viktor Frankl. Considera-se a proposta interventiva “Jardins de Ocupações” como um instrumento participativo, reflexivo, com potencial para aprofundar reflexões e compreensões sobre os sentidos de vida e o engajamento em ocupações ante às perdas sofridas.

Palavras-chave:
Perdas; Enlutamento; Atividades Cotidianas; Prática Professional

Introduction

Occupations can be understood as an active and intentional way of composing, structuring and intervening in the world, being with oneself and with others, as we are occupational beings (Wilcock, 2005; Carin-Levy & Jones, 2007; Dickie, 2011). Occupation is, for people, a self-initiated and self-organized need directed and contextualized in occupational environments, in which time and energy are invested, and which has form, function and meaning (Yerxa, 2000; Dickie, 2011).

Thus, being busy involves people's daily lives, under the different ways of exercising it, and can be influenced by factors such as illness and hospitalizations, which can have repercussions on routinely and significant occupations, resulting in ruptures, changes and withdrawals from daily occupational preferences (Almeida et al., 2017). These changes in the occupational repertoire can also be observed in the routine of people who are being or have been directly or indirectly affected by bereavement due to the loss(es) of someone or something significant, as an example of what has been happening during the period of the COVID-19 pandemic.

In the aforementioned conditions, sudden changes are required, including distancing, illness or loss of loved ones, changes in funeral rituals, difficulties in using time at home, which is where most occupations are taking place, changes in the sleep-wakefulness cycle, financial losses, and also, the loss of the possibility of occupying oneself may be occurring, in the case of people infected with more severe forms of SARS-CoV-2 (Bezerra et al., 2020; Fontes et al., 2020).

In this context, the unpredictability of the course of the pandemic and the potentially disorganizing and disruptive effect of the pandemic scenario on subjectivity can favor the aggravation of stressful feelings, such as fear, anxiety, anger and others (Fontes et al., 2020), and have repercussions on the elaboration of mourning (Crepaldi et al., 2020).

The experience of grief can be understood as an individualized experience of adaptation through loss(es) and that has variable effects on people (Dahdah et al., 2019; Crepaldi et al., 2020). As discussed by Dahdah et al. (2019), the debate about grief related to reactions to the loss of a significant person, whether the real or imminent death of a loved one, has prevailed.

Corrêa (2010) presents and discusses the occupational losses that can occur due to the interruption in the performance of co-occupations, that is, activities carried out with and/or for that loved one who died. However, there is a precarious investment in the understanding, discussion and intervention of occupational demands in the face of the various processes of loss and grief that can be experienced (Dahdah et al., 2019), including the losses imposed by COVID-19, which may be related to people, but also to occupations.

Therefore, the objective is to present a proposal for intervention and care in mourning conditions designed to favor (some) reflections about the impacts of the pandemic from an occupational perspective, relating it to concepts of Logotherapy and Existential Analysis by Victor Frankl.

Contextualizing the Interventional Proposal of Care in Mourning

This work is theoretical in nature and followed a contextualized and critical interpretation of the intervention strategy and the meanings of the texts, chosen for convenience, in an attempt to correlate concepts of Occupational Science, Logotherapy and Existential Analysis by Viktor Frankl. The interventional strategy of care in mourning, called “Garden of occupations”, employs elements such as metaphors and drawings to create simultaneity and approximations with the theoretical foundation anchored in Occupational Science from the perspective of existential tension and Viktor Frankl's values ​​of meaning.

The care strategy in the face of occupational losses and bereavement, the “Garden of occupations”, uses visual resources to provide an opportunity for people to express themselves, both individually and in a group dynamic, in order to visualize the symbolic representations of occupying themselves daily, providing information and reasoning that are not accessible through traditional assessment instruments, so it can be applied in the context of care.

It is noteworthy that the “Garden of occupations” strategy can be used to mediate the process of reflexive communication between therapist-person/client on a variety of occupational issues (what I do, how I do it, why I do it) that may be altered due to of the loss of something or someone dear, and also has the potential to offer meanings, experiences and/or insights into what is happening in people's lives.

Thus, the objectives of the strategy involves identifying occupations that are being carried out or significant occupations to be carried out; to encourage the prioritization and/or (re)organization of occupations; to assess their occupational form(s), function(s) and meaning(s); and to promote reflection on possible overloads, limitations or risk factors for the “to do” occupational dimensions, by causing imbalance (excessive demands to occupy oneself), by “being” (possibility of alienation from the prevailing culture) and by “becoming ” due to the possibility of causing occupational deprivation (Townsend & Marval, 2013; Hitch et al., 2014).

For an individualized approach, the person is invited to design their “Garden of occupations”, include the occupations carried out on a typical day of the week and encouraged to speak freely about issues that may arise as an unfolding of the production. Subsequently, a reflection is made on the impact(s) of significant loss(s) and mourning in occupations based on what can be revealed in the drawing.

Then, the person is invited to include elements in their drawing based on the following question “What can you plant or replant in your Garden of occupations today?”. At the end, the occupational therapist makes a retrospective to provoke reflections and offer support to the occupational demands that can be revealed by the filled panel (Figure 1) and the possibilities of realizing values ​​of meaning in the perspective of Viktor Frankl (creative, experiential and attitudinal). In the case of a face-to-face service, the steps can be carried out in a single meeting, while in teletherapy, in the first step, the occupational therapist can ask the person to draw their “Garden of occupations” asynchronously.

Figure 1
Garden of occupations.

Teleservice or telehealth can be characterized as a service carried out at a distance by electronic means of users previously attended in person in the service in which they work when face-to-face services are not possible, practical and/or when it is mutually accepted by the client (Brasil, 2020; World Federation of Occupational Therapist, 2020). According to the World Federation of Occupational Therapy, this type of care should be as similar as possible to the standards of services offered in person, complying with the jurisdictional, institutional and professional regulations that govern the practice of occupational therapy (World Federation of Occupational Therapist, 2020). The guidelines for procedures in a virtual environment published by the National Research Ethics Commission (Comissão Nacional de Ética em Pesquisa, 2021) can also be applied.

For a group meeting, the procedures chosen for the “Garden of occupations” activity include reflecting with the group about the impact(s) of significant losses and bereavement in the occupations, as well as the possibilities of realizing meaningful values ​​through engagement in meaningful occupations. Occupational therapists can use metaphors, images and texts organized in power point.

At the end of the reflection, participants are shown a panel with potted plants and empty pots with the following question: “What can we plant or replant in our Garden of occupations today?”. Afterwards, the discussion is opened and the participants are invited to list occupations to fill the empty pots or occupations that need to be “(re)planted”. In the panel, keywords indicated by the participants are included. At the end, the panel with the contributions of the participants is shown; then, the occupational therapist makes a retrospective in order to provoke reflections from what is revealed by the filled panel.

Mourning and occupations

From the perspective of Parkes (2010, 2000), grief can comprise a period of adaptation to the discrepancies between the internal world that was supported by the existence of the other person and the “suddenly” unknown world without the loved one or what was lost. And it can lead to disorder and psychological pain in the face of the loss of the bond, and the person can suffer atypical or pathological grief that can present itself in different ways: prolonged, delayed, chronic, complicated (Parkes, 2000, 2010).

Corrêa (2010, p. 41) states that “[...] mourning crosses human existence in multiple configurations, in the diversities of experiences related to loss”. Therefore, it may be an existential condition in which those who lose something or someone are thrown (Michel & Freitas, 2019). Through loss and grief, there may be changes that impact (impede/limit) the way people occupy themselves or give meaning to their occupations (Corrêa, 2010).

Thus, the experience of a significant loss of someone or something in which one is sensibly intertwined, where there was personal and occupational investment, provides a moment in life in which the usual, singular functions and patterns, typical of the lost relationship; what one is, what one did or was intended to do with who and/or what was lost is also lost (Parkes, 2010; Frizzo & Corrêa, 2017; Michel & Freitas, 2019).

Therefore, in the atypical grieving process, there may be occupational losses and the feeling of regret in allusion to the destitution of the possibility of continuity and investment of occupations performed and/or shared before the loss. Through occupational mourning, impacts of bereavement on daily activities can be observed in the little investment in self-care, daily activities, work and others (Corrêa, 2010; Lopes & Corrêa, 2013; Frizzo & Corrêa, 2017).

In addition, in case of mourning, occupational deprivation may be possible, understood as the limitation of occupational opportunities to participate in necessary or desired occupations (White, 2011), once performed at another pace, in other ways, in other places, on another level of relationships and affections, mainly related to daily activities performed together (Corrêa, 2010).

From the perspective of Hitch et al. (2014), the term occupational deprivation refers to situations where people are prevented from doing what is necessary and meaningful in their occupational environments because of external constraints and occupational choices.

In other words, occupational deprivation can arise from situations where a person's needs for engaging in meaningful and health-promoting occupations remain unmet, which can severely impair the occupational functioning of important areas of a bereaved person's life and related feelings to “not knowing what to do” (Corrêa, 2010; Crepeau et al., 2011a, 2011b). These emotions and feelings can surface intensely, and are related to the experiences we have lived in the past, to the experiences we are living in the present and to future expectations, in an oscillation between engaging in experiences sometimes aimed at loss, sometimes at the restoration of life (Corrêa, 2010; Frizzo & Corrêa, 2017).

Corrêa (2010) points out that it is necessary to expand care for the bereaved, also considering their occupational activities. It is noteworthy that the grieving process leaves marks and changes the way of life, as it requires a period of elaboration regarding the changes and adjustment of daily occupations. Thus, we are provoked to engage in the difficult task of renouncing, adapting actions, excluding and including new occupations (Frizzo & Corrêa, 2017).

From the aspects related to occupations, losses/suffering and values ​​of meaning that are discussed by authors such as Corrêa (2010), Frankl (2017) and Frizzo & Corrêa (2017), it is understood that it is possible to develop intervention strategies centered on occupations that provide the (re)knowledge and understanding of the occupations that make up or can become part of the occupational repertoire and the change of attitude towards life. In this way, interventional strategies centered on occupation can be an important instrument both for coping, expressing experiences, experiencing emotions and feelings related to loss issues, as well as for the possibility of rescuing and restoring life.

“Garden of occupations”: what does that mean?

The word garden comes from the Hebrew word “gan”, which means to protect, defend and “eden”, which means pleasure. In general, a garden is associated with the idea of ​​a pleasant and protected place (Bellé, 2013; Ribeiro, 1994). Therapeutic intervention based on occupation can use different strategies to develop preventive actions or minimize the occurrence of pathological manifestations that are harmful to people's mental and occupational health (Ribeiro & Oliveira, 2005; Dickie, 2011).

The choice of the garden as a possible resource for an interventional proposal of an occupational nature was due to its curative, restorative and therapeutic properties widely associated with direct or indirect, active or passive, autonomous or assisted contact with nature and its elements (Sousa, 2016).

In this sense, based on the assumption that specialists in occupation can train new ways of seeing and intervening in essential elements of occupation and occupational processes (form, purpose and meaning), considering the need to direct people to introject, observe and understand their occupation(s) (Dickie, 2011), and inspired by the scope of interventional and/or research strategies classified as reflective and participatory, such as activity workshops (Corrêa, 2010), metaphors in therapy (Paschoal & Grandesso, 2014), therapeutic garden (Stark & ​​Ringaert, 2011), body maps (Solomon, 2002), among others, is why the “Garden of occupations” was thought of as a metaphorical and reflexive strategy of intervention and care in mourning conditions. Pedral & Bastos (2013), from the perspective of Rui Chamone Jorge, characterize it as a 'reflecting' activity of thought.

It is considered that in a “garden of functional occupations”, we can see a diversity of forms with purposes that are intrinsic in routine activities and produce occupational experiences loaded with unique meanings that meet people's basic and emotional needs, promoting health (Dickie, 2011; Castro et al., 2017). In “gardens of dysfunctional occupations”, we can identify difficulty and/or little interest or impoverishment of the daily occupational repertoire of the bereaved person, including even neglect with personal care (Corrêa, 2010; Frizzo & Corrêa, 2017). Some Gardens may even be overloaded and disorganized as a way of “forgetting” what has happened or is happening (Santos, 2020).

Through occupational impacts, such as those previously described, to favor a “functional garden of occupations”, therapeutic interventions that encourage the bereaved to use their own resources to overcome the loss are needed (Corrêa, 2010), giving them the opportunity to gather fragments of their experiences and transform them into elements of investment in everyday life (Ribeiro & Oliveira, 2005), and also to avoid restricting the repertoire of occupations and help the restoration and/or promotion of life projects proposition (Frizzo & Corrêa, 2017).

It is inferred that the “Garden of occupations”, as an intervention strategy, has the potential to manage and face occupational demands, unveil values ​​and meanings, among other aspects of the existence of a bereaved person through a movement of personal and occupational self-assessment that can provide information about how participation in occupations relates to or affects people's lives. It can make visible the choices of occupations to be performed, help the understanding of responsibility for health care, the exercise of choices, and contribute to the rescue and/or discovery of interests, skills, potentialities, forms and meanings of engagement in everyday activities.

“Garden of Occupations” As a Strategy in the Face of Occupational Losses and Grief

Occupations include everyday activities and actions, from the simplest actions-tasks-activities, such as washing hands and sleeping, to more complex ones, such as studying, working and cleaning (Yerxa, 2000; Silva, 2013). In this sense, the subjective experience of occupation comprises the symbolic aspect of the experiences perceived in occupation and, therefore, is singular and unique (Carrasco & Olivares, 2008; Larson et al., 2008). Uniqueness can also be present in gardens composed of a diversity of dynamic elements, such as plants and flowers of multiple species, textures, aromas and colors (Delphim, 2005).

It can also be said that occupations include tasks that we need, want and hope to have on a daily basis. Thus, as we get involved in occupations, these occupations become our own garden (Figure 1), with all the repertoires of doings of different types, shapes and purposes. Thus, it is emphasized that we, human beings, fulfill our lives by occupying ourselves (Carin-Levy & Jones, 2007) with our garden.

Sometimes, due to feelings of grief related to a significant loss, there is a lack of interest in performing activities and an impoverishment in the repertoire of daily occupations of the bereaved (Corrêa, 2010; Frizzo & Corrêa, 2017). Without care, our garden can gradually give rise to “weeds”; the weeds can grow disorderly, eliminating the “sprouts” and smothering the seeds, which can run out of space to grow, becoming an abandoned and lifeless area.

The literature (Carrasco & Olivares, 2008; Castro et al., 2017) emphasizes that occupations can be maintained or modified according to a multitude of determinants to which we are subject. Thus, given the losses and uncertainties that accompany life, the way we were used to occupying ourselves, that is, taking care of our “garden”, may have to change at some point, and we may experience a temporary distance from the occupations that we need, like and/or choose daily.

In relation to the impacts caused by occupational losses, perhaps we can speak of occupational imbalance - when there is suppression of unfulfilled or fulfilled occupational roles and needs due to the excess or decrease of time dedicated to an area(s) of occupation to the detriment of others (Townsend & Polatajko, 2007) - or perhaps highlighting that these impacts generate tension; however, Frankl (2012) emphasizes that tension is not something to be unconditionally avoided. The tension of a situation where one is entangled can favor a focus of direction and instigate us to exercise responsible choices in the face of the challenges that arise, contributing to the quality of our life through the values ​​of meaning.

In this way, it is possible to perceive the existence of a constant movement of a coming-to-be, of a tension resulting from the attempt of adequacy between the possibilities and the concrete and responsible human action and, also, the relationship between what people do and who they are as occupational beings (Yerxa, 2000; Frankl, 2012).

So, can we see that taking care of our “gardens of occupations” can be one of the daily challenges we experience, at the same time that it can present itself as a possibility to evaluate and review how our actions are presented? Did they become difficult to carry out? Why? How has getting involved in the actions that we have been able to accomplish in the current moment of life unraveled? The answers to these questions can show us significant clues about what can contribute to our production of health and well-being. In the period of a pandemic, coping strategies can start in the “way that”, in the “how”, with “what” and “what for” we occupy our daily lives.

Engagement in an occupation offers the ability to exercise choices (Carin-Levy & Jones, 2007). Frankl (2012) emphasizes that the freedom of the human will is to decide in the face of any situation/condition that the person must face, and the possibilities that can be continuously presented to people in the form of meaning values ​​can be creative (offering to the world - for example, a work, a task), experiential (receiving from the world, such as the experience of nature and/or love) and attitudinal (positioning oneself in the face of inevitable suffering, for example) (Frankl, 2012, 2017), of which the people are free to embark on the realization of that meaning or not.

After all, as the metaphor reflects the gardening and life of unknown authorship, the true gardener of our own lives:

Is the one who takes responsibility for what they have in their Garden: preparing the land; sowing; fertilizing; irrigating; pruning; removing weeds; making sure pests […] do not decimate the plants […]. Even [...] if unpredictability has a certain weight on the result of the Garden, the gardener understands that they will never get anywhere without doing their “homework”. [...]. It is necessary to execute many tasks for the project to walk. [...] each stage overcome adds to the great journey of life. But the gardener also [...] accepts the fact tht many things are out of their control: making it rain, changing the weather; making sprout; making the flowers bloom; making them fruitful […]. We may even wish that things were different [...]. [But] the rain will only come in its own time. Therefore, [...] for a life with senses, we need to take responsibility [for the garden] […] without hiding from what you have to do […]. [Excerpts from the Metaphor ‘between the Garden and life] (Mamãe Plugada, 2015).

Soon, we will sow, we will cultivate, we will say yes to life! We will take care of transforming the arid present into a flourishing and fruitful future. It should be noted that skilled “occupational gardeners” will be those who understand that their “garden of occupations” needs regular and continuous daily care - I understand that, at times, we can offer or need help to take care of our garden and overcome the difficulties, suffering, guilt and death; therefore, we can seek or offer listening, reception or specialized assistance to (re)signify the ways of experiencing this process of caring for our “garden” (or the “garden” of the other) through significant losses.

It is inferred that major or minor difficulties have always been and will be part of our daily lives. We must, yes, rescue what is up to us in caring for the others and ourselves, but it is also responsible to admit that we have limitations and, even in difficult times, there can be learning that remains. Thus, we have the possibility to deal with the good and bad things of the grieving process; thus, the care of other people's garden (health care) and the care of our own garden now walk through a labyrinth of trials, successes and errors that are adjusted over time.

It is noteworthy that it is not about erasing the past, forgetting something or a lost loved one; however, realizing that life can go on, and this can be done through the engagement and restoration of our occupations (Frizzo & Corrêa, 2017), which can help answer larger existential questions about the meaning of life (Hocking, 2011; Hocking & Valerie, 2011).

From this perspective, we cannot change or extinguish the damage caused by the losses suffered; however, we can dictate the flow of occupations, “plant” new occupations, or “(re)plant” those that already make up our garden. Thus, when making responsible decisions in the midst of the processes of coping with losses, mourning and the construction of new meanings that can allow us to have new ways of being, living, and doing in our daily lives. In this way, I invite readers to reflect on “What can we plant or replant in our ‘garden of occupations’ today?” (Figure 2).

Figure 2
What can we plant or replant in our “garden of occupations” today?.

Final Considerations

The “Garden of occupations” is configured as a participatory, reflective strategy that can promote awareness and expand the deepening of reflections and understandings about the meanings of life and engagement in occupations to be explored by the target subjects of our care in health, aspects that are important in the care of people with occupational demands in the face of loss and grief processes. It is hoped that this study can support or encourage debates and reflections on different ways of intervening, researching and approaching occupation.

• How to cite: Nascimento, C. A. V., Souza, A. M., & Corrêa, V. A. C. (2022). “Garden of occupations”: care strategies in the face of occupational losses and mourning. Cadernos Brasileiros de Terapia Ocupacional, 30, e3128. https://doi.org/10.1590/2526-8910.ctoEN239631281

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Edited by

Section editor

Prof. Dr. Milton Carlos Mariotti

Publication Dates

• Publication in this collection
  09 Dec 2022
• Date of issue
  2022

History

• Received
  11 Aug 2021
• Reviewed
  22 Nov 2021
• Reviewed
  23 Mar 2022
• Accepted
  02 Aug 2022