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Destigmatising dependency
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It is in the very nature of humans to be interdependent. It has been the core of civilisations and society since time immemorial. We depend on others such as farmers and fishermen for food, janitors and street sweepers for cleanliness, and factory workers for our daily commodities as much as other people depend on us for healthcare services, consultations, and to be confidants. As the saying goes, no man is an island. As such, we have to position the dependency of certain forms of impairment within the inevitable dependency of being human and reimagine society whilst centralising the disability experience. When we recognise that dependency is an aspect of humanity, society can begin to confront our biases against dependency and disability (Kittay, 2011Kittay, E. F. (2011). The ethics of care dependence, and disability. Ratio Juris, 24(1), 49-58. http://dx.doi.org/10.1111/j.1467-9337.2010.00473.x.
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). As such, it is fine for a person to not necessarily need to learn independent activities and can be dependent on a caregiver (i.e., after a fall, an elderly person does not need to meet an OT goal of being able to cook independently on their own because they have a caregiver to help them with that task). |
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Acknowledging Crip Time
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Time is experienced differently by disabled people. It takes a lot of time and effort to do something in this ableist world with an ableist way of doing. Rather than pressuring and bending the disabled person to fit the ableist time, we need to understand how time and timeliness are associated with the social construction of ability (Ljuslinder et al., 2020Ljuslinder, K., Ellis, K., & Vikstrom, L. (2020). Cripping time understanding the life course through the lens of ableism. Scandinavian Journal of Disability Research, 22(1), 35-38. http://dx.doi.org/10.16993/sjdr.710.
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). We need to acknowledge that people, especially those disabled, need more time and flexibility – this is crip time (Kafer, 2013Kafer, A. (2013). Time for disability studies and a future for crips. Bloomington: Indiana University Press.). Crip time applies not only to physically disabled people but to all disabled people such as neurodiverse individuals. |
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Co-creating inclusive curricula
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Curriculum review in the health sciences, including OT, must be performed through team editing with service users (Grenier, 2021Grenier, M. L. (2021). Patient case formulations and oppressive disability discourses in occupational therapy education. Canadian Journal of Occupational Therapy, 88(3), 266-272. http://dx.doi.org/10.1177/00084174211005882.
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). Webinars, small-group discussions, further readings, and other participatory activities (i.e. privilege awareness, student-led discussions, brainstorming interventions to overcome barriers) may be conducted to tackle “[...] ableism, social model of disability, disability history and culture, and health disparities” (Borowsky et al., 2021Borowsky, H., Morinis, L., & Garg, M. (2021). Disability and ableism in medicine: a curriculum for medical students. MedEdPORTAL, 17, 1-8. http://dx.doi.org/10.15766/mep_2374-8265.11073.
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, p. 2). More importantly, curriculum and fieldwork placements shall be made flexible and provide the necessary support for disabled people to facilitate their entry and successful completion of OT programs (Phelan, 2011Phelan, S. K. (2011). Constructions of disability: a call for critical reflexivity in occupational therapy. Canadian Journal of Occupational Therapy, 78(3), 164-172. http://dx.doi.org/10.2182/cjot.2011.78.3.4.
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). At present, it’s hard to become an OT practitioner if you’re disabled, and often discouraged by the university and department administration. |
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Utilising non-ableist narrative
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Stories and narratives have been used as part of advocacy and are an integral part of positioning disabled individuals as experts. However, rather than the narrative of ‘fixing’ and presenting inspirational narratives of the few disabled individuals who are privileged to cope and integrate with the ableist society, we propose the use of narratives that are highly contextualised and highlight the personhood of the disabled individual. An example of this is to allow other disabled people to tell their tales rather than letting ‘outsiders’ speak for them. This can be through looking at the works of disabled writers, self-advocates, and qualitative studies where disabled people are made experts of their stories. When narratives of disabled people are geared towards highlighting their humanity - disability is regarded as part of their identity instead of a lack. Meaningful relationships are formed and maintained in life when ableist notions of our society are brought to light - thus, helping the disabled person unpack and tackle their internalised ableism. |
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Allying with the Disability Justice Movement
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The Disability Justice movement acknowledges the intersectionality of identities, uniqueness of all bodyminds, that all bodyminds are essential and have both strengths and needs that must be met, and that disabled people are powerful because of the complexities of their bodyminds (Berne, 2019Berne, P. (2019). Skin, tooth, and bone: the basis of movement is our people. Denver: Dancers Group.). To ally with the movement is to acknowledge our privilege and to resist the ableist society with disabled people by living in a manner that’s sensitive to those deemed least by society. We advocate with disabled people through espousing love as envisioned by Mingus (2012)Mingus, M. (2012). On collaboration: starting with each other. Retrieved in 2022, April 12, from https://leavingevidence.wordpress.com/2012/08/03/on-collaboration-starting-with-each-other/
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. By espousing love, it means being committed to one another by investing time, energy, and action. If we are committed to standing with disabled people, we cannot stay silent when we know they are dealing with inaccessibility beyond the four walls of the clinic/hospital and they are being excluded by society. |
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Promoting critical reflexivity
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Critical reflexivity can be developed by encouraging students and practitioners to think about how they construct realities and identities (Cunliffe, 2004Cunliffe, A. L. (2004). On becoming a critically reflexive practitioner. Journal of Management Education, 28(4), 407-426. http://dx.doi.org/10.1177/1052562904264440.
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). Inculcated during education and early training, critical reflexivity exercises may be given through storytelling, journaling, interdisciplinary service-learning programs, and cultural safety guidelines among others (Landy et al., 2016Landy, R., Cameron, C., Au, A., Cameron, D., O’Brien, K. K., Robrigado, K., Baxter, L., Cockburn, L., O’Hearn, S., Oliver, B., & Nixon, S. (2016). Educational strategies to enhance reflexivity among clinicians and health professional students: a scoping study. Forum Qualitative Social Research, 17(3). http://dx.doi.org/10.17169/fqs-17.3.2573.
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). Beyond monitoring and analysing one’s thoughts and actions, it is necessary to recognize the presence of oppression through overt and covert ableist practices, the role of social power structures that influence our actions and interactions, and the urgency to change certain practices. Exploring and challenging one’s assumptions, actions, beliefs, and biases are part of the process as students and practitioners work with disabled people who may also be unaware of ableist practices imposed upon self and/or others. OT students and practitioners can be guided by the seven-step framework for critical analysis by Nixon et al. (2017)Nixon, S. A., Yeung, E., Shaw, J. A., Kuper, A., & Gibson, B. E. (2017). Seven-step framework for critical analysis and its application in the field of physical therapy. Physical Therapy & Rehabilitation Journal, 97(2), 249-257. http://dx.doi.org/10.2522/ptj.20160149.
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. The framework follows an iterative process consisting of the following: 1) name the specific aspect of practice being analysed, 2) identify the intended purposes of this aspect of practice 3) uncover the assumptions that support these intended purposes, 4) identify who benefits, 5) identify who is disadvantaged, 6) link these specific ideas to society- level patterns, and 7) conceive of alternatives that mitigate actual or potential harms. The intentional exercise of looking into the overall context and recognizing the presence of oppression through ableism shall be established as early as fieldwork education. |
