South occupational therapies: a proposal for its understanding

Abstract

This essay is a proposal to approach one of the possible routes that would allow understanding Occupational Therapies of the South. This text begins by defining what is meant by the South and its diverse possibilities. Then, it resorts to the historicization of the discipline, that is, the recognition of the theoretical, practical and reflective work developed several years ago by the occupational therapists that are located in the South. Through a critical and reflective dialogue proposed by these authors, the main ideas of what is understood by the Occupational Therapies of the south are proposed and developed, specifically in the topics that are considered to be constitutive of Southern Occupational Therapies, such as they are “the social”, the political, decolonization, human rights, collective occupations, and feminism. Finally, a horizon is proposed towards which these Occupational Therapies of the south could advance, based on the concept of interculturality.

Keywords:
Occupational Therapy; Cultural Competence; Feminism; Capitalism

Resumen

Este ensayo es una propuesta para acercarnos a una de las posibles rutas, que permitirían comprender las Terapias Ocupacionales del Sur. Este texto, comienza definiendo qué se entiende por Sur y la posibilidad de varios Sures. Luego, se recurre a la historización de la disciplina, es decir al reconocimiento del trabajo teórico, práctico y reflexivo desarrollados hace varios años por los y las terapeutas ocupacionales que se sitúan en el Sur. A través de un diálogo crítico y reflexivo con lo planteado por estos autores, se plantea y desarrollan las ideas principales de lo que se entiende por las Terapias Ocupacionales del Sur, específicamente en las temáticas que se estiman son constitutivas de las Terapias Ocupacionales del Sur, como son “lo social”, lo político, la descolonización, los derechos humanos, las ocupaciones colectivas y el feminismo. Finalmente se propone un horizonte hacia el cual podrían avanzar estas Terapias Ocupacionales del Sur, a partir del concepto de interculturalidad.

Palabras claves:
Terapia Ocupacional; Interculturalidad; Feminismo; Capitalismo

Resumo

Este ensaio é uma proposta para abordar uma das possíveis rotas que nos permitiriam entender as Terapias Ocupacionais do Sul. Este texto começa definindo o que se entende por Sul e a possibilidade de vários Sures. Em seguida, recorre-se à historicização da disciplina, ou seja, ao reconhecimento do trabalho teórico, prático e reflexivo desenvolvido há vários anos pelos terapeutas ocupacionais que se localizam na região Sul. Por meio de um diálogo crítico e reflexivo com o que foi proposto por esses autores, propõem-se e desenvolvem-se as principais ideias do que é entendido pelas Terapias Ocupacionais do Sul, especificamente nos temas considerados constitutivos das Terapias Ocupacionais do Sul, como são “o social”, política, descolonização, direitos humanos, ocupações coletivas e feminismo. Finalmente, propõe-se um horizonte para o qual estas Terapias Ocupacionais do Sul poderiam avançar, com base no conceito de interculturalidade.

Palavras-chave:
Terapia Ocupacional; Interculturalidade; Feminismo; Capitalismo

1 Introduction

This work reflects on the author develops, based on his participation in three events as an exhibitor. The first event was the discussion of the re-launching of the book “Occupational Therapies from the South, Human Rights, Citizenship and Participation”, carried out in November 2017, at the International Book Fair in Santiago. The second event was the 8^th Latin American Conferences of Social Sciences, CLACSO, which took place on November 2018, in the city of Buenos Aires. Finally, the event of “First Encounter of Occupational Therapies from the South...Latin American praxis” that took place on December 2018 in Santiago de Chile.

One of the questions made in this last meeting by the organizers, speakers, and assistants was: “What are Occupational Therapies of the South? What are we talking about when we talk about Southern Occupational Therapies (TTOO of the South)?”. The author of this text will develop one of the different possible answers to these questions, contributing to the understanding and construction of the TTOO of the South.

This text begins by defining what is meant by South and the possibility of one than one South. Then, the main ideas of the TTOO of the South are raised and developed. To this end, a critical dialogue was developed by the authors who, in their opinion, have developed their work from this place called the South. Finally, a horizon is proposed towards the South TTOO could advance.

1.1 What is the South and what would be a possible relationship with Occupational Therapy?

[...] all the silent, all, all the omitted, all, all the invisible All, all, all, all, all, all (TIJOUX; MANSOUR, 2014).

To explain what the South is, Santos (2017) is checked who points out that the South is a metaphor to identify the systematic suffering by a vast world population due to capitalism, colonialism, and patriarchy. The metaphor implies that there are cardinal points that determine ways of living and being. In this case, the North determines the dominant and hegemonic forms. The north is also the center, the focus, the concentration of those who dominate and the South is the periphery, the margin dominated and excluded, the subaltern or inferior. However, in each North there is a South and in each South there is a North, therefore, there are different South, for example, in the patriarchy, the North is man and the South would be woman; in the colonialism, the European is the North, the indigenous is the South; and in capitalism, technology and science is the North and the nature and ancestral knowledge is the South.

To contextualize this idea on Occupational Therapy (OT), Hammell (2018) proposes that the dominant OT (the North) is the one that has transmitted an English-speaking knowledge, produced by white men and women, well-educated, of the urban middle class, and of Judeo-Christian religious preference.

In other words, the knowledge that dominated Occupational Therapy in several countries of the world comes from countries of Eurocentric thinking, particularly from England and the United States, as in the case of most of the Latin American countries and some Europeans (GUAJARDO, 2016a; NABERGOI; BOTTINELI, 2016; GARCÍA-RUIZ, 2016; SIMÓ, 2016a); and in African countries such as Ghana that formed Occupational Therapists in London (BEGUIN, 2013). Thus, for many years, in the development of the discipline, Eurocentric knowledge and practices decontextualized from the idiosyncrasies of the countries in which it was implemented were reproduced.

Hammell (2018) proposes that the assumptions underlying the theories or practices of dominant or traditional OT belong to the neoliberal ideology. This fact would imply that the theories and models of the discipline are aimed at favoring individualism, competence, productivity, personal interests, and self-fulfillment.

According to all this, it would be possible to reaffirm that the epistemic-methodological foundation of the discipline is characterized by belonging to positivist and functionalist rationalities to the social system, as pointed out by (ROMERO, 2007; LOPES et al., 2015; GUAJARDO, 2016a). Therefore, the role of the OT is to normalize the subjects of intervention for their integration into social life, as pointed out by (CUERVO et al., 2017; MEDEIROS, 2008; GUAJARDO, 2016b). The implications of this issue are that the OT in its performance in the social area maintain the prevailing social order, becoming an instrument that favors the maintenance of inequality when these social conditions that generate such inequalities and injustices are not modified in the practices of OT.

The South in OT would be everything that does not belong to this North, to this traditional OT. This OT is insurgent to that Eurocentric/capitalist/colonizing/patriarchal identity, as a political and ethical act of rebellion, that invites to problematize the need for an OT located in the social reality. This OT is at the service of the excluded, of the subalterns, marginalized and oppressed people, transforming the conditions of oppression and domination.

2 A Proposal to Understand the TTOO of the South

Guajardo (2016a) stated that the TTOO of the South could be presented as several occupational therapies, such as social OT, Latin American OT, OT based on Human Rights (HR), political OT, among others. This text is a proposal to understand the TTOO of the South, through a critical dialogue with the knowledge and practices developed mainly by Occupational Therapists women and men, who would be positioned in the South. It will not be possible to incorporate them all, but it is an effort that must be made and initiated.

2.1 The TTOO of the South are essentially social

According to Lopes et al. (2015), the Social OT has its origins in the 70s in Brazil. It was born in this place due to the need for addressing the social and cultural contradictions that capitalism produces, such as inequality and poverty in that country.

Thus, considering what Munguba, Malfitano and Lopes (2018) propose, the Brazilian social OT uses the concept of the social issue to show the relationship between capitalism, work, and social problems, allowing the occupational therapists to have a broader and more complex view of the structural conditions that produce the social problems that ultimately affect individuals and groups.

Based on this, three fundamental considerations are established for the understanding of the social area in the TTOO of the South:

First, according to Barros, Ghirardi, and Lopes (2007), it becomes fundamental to know the way in which people experience their daily lives, to know their needs, their aspirations, their support networks, their closest and concrete reality.

Second, it is necessary to understand that the individuals act in relation to the elements of culture, economy, politics since social exclusion, marginalization, and social violation are the product of the capitalist way of life. Then, the problem is in the lack of access to basic social rights and participation in social and political life (GALHEIGO, 2007, 2012).

Third, as indicated by Simó and Galheigo (2012), the Interventive actions of Occupational Therapy must be associated to the daily life of the individuals, communities, and collectives, generating individual or collective actions that allow the individuals, vulnerable groups and communities access to rights and contributing to reducing social inequalities. In this context, the action is aimed at social articulation, through networking, local actions, respect for diversity and human rights.

The TTOO of the South invites to overcome the health area as the only one of knowledge and practice of occupational therapies, as well as other authors (MUNGUBA; MALFITANO; LOPES, 2018; BARROS; GHIRARDI; LOPES, 2007). That is, it is an urgent need to understand areas such as education, justice, social protection, work, the community, among others, given that the capitalist/colonial system produces a series of social problems, in which occupational therapists are called to solve.

Finally, the TTOO of the South is considered historically, socially and culturally, as the authors propose (POLLARD, 2017; POLLARD; SAKELLARIOU, 2017; SILVA et al., 2017; TOLVETT, 2016; RAMUGONDO, 2018). Thus, the knowledge and practices from and in OT can only be understood when considering the conditions and the daily life in which it occurs, and from there, as proposed by Escobar (2000) with the idea of “place-based practices”, to promote local aspects over global aspects, generating economic, social and cultural alternatives different from those imposed by the capital, in such a way that symmetrical relationships of power can be restructured among the different social actors.

Therefore, the of the TTOO of the South is only possible in the “social” area, constituting the individuals and communities the place where their lives, their emotions, and feelings, joys, sorrows, hopes, and despair occur.

2.2 TTOO of the South are policies

The OT and the occupation have a political nature, that is, the action of the OT must contemplate that its actions are aimed at transforming the conditions that generate exclusion, discomfort, inequalities, and injustices, building a just and dignified world, collectively and cooperative, as indicated by the following authors: Pollard and Sakellariou (2017), Guajardo and Galheigo (2015), Guajardo, Kronenberg, and Ramugondo (2015), Ramírez and Schliebener (2014) and Guajardo (2014b).

This means that the TTOO of the South is a call to occupational therapists in which their actions are directed to be aware in the professional development, in the encounter with the sufferer, with the historically defined as subaltern or inferior. The TTOOs have the ethical and political responsibility to 1. Question their position of power in this encounter with the other, with the different otherness, so as not to reproduce the power relationship that subordinates the other, as it could reproduce the relationship of the oppressor and oppressed, transforming the OT into the oppressor; 2. Consider the social conditions that produce exclusion, inequality, and injustice, and to develop strategies in their professional practice to help overcome them; 3. Considering what Ramugondo (2018) states, our action is political because it strengthens the conscience, self-determination, and self-sufficiency of the people and communities that constitute the Global South, the South that is oppressed, subaltern, relegated and excluded. 4. Then, the foregoing means that the TTOO of the South should be willing to be transformed into a tool and a platform from which the subalterns and the oppressed can manifest their own will, so they can dispute the possibility of improving their dignity and life conditions.

In summary, the political means that the practices are aimed at generating possibilities for emancipation, collective freedom and the rescue of dignity.

2.3 The TTOO of the South are decolonizing in their knowledge and practices

Ingkakeiñ, taiñkimünnormogen, femayaiñ, witxapaiñfillpülemapuazkintüin. We will defend our knowledge, the correct living. We will do it, we will be standing in all the lands (PORTAVOZ; LUANKO, 2018).

The TTOO of the South is decolonized in an epistemological and interventive way. In this sense, several authors have pointed out the importance of reviewing the colonizing foundations and their relevance in the Latin American context and moving towards decolonizing practices (RAMÍREZ; SCHILIEBENER, 2014; TOLVETT, 2017a). Also, Guajardo (2014b) and Hammell (2018) invite a triangulation of knowledge to recognize the diversity of the discipline and to question the assumptions that have dominated the profession.

On the other hand, Pino and Ulloa (2016) raise the idea of critical epistemological disobedience, highlighting an ethical-political-cultural position that allows overcoming the pretension of a hegemonic universal knowledge and highlighting the diversity of the discipline.

From the TTOO of the South, the decolonization of knowledge would imply the rescue of the knowledge of native people, mixed with the socio-political context and local cultures, as proposed by García-Ruiz (2016) and Simó (2016b). This means to consider the individuals, groups, and communities of intervention that historically have been submitted by coloniality, imperialism, patriarchy, and capitalism, as people bearers of knowledge that allows them to live, make decisions and rethink reality. From this knowledge, the OT can be re-though, without seeking its own validation, but validating precisely the knowledge of others and learning from them.

Finally, the TTOO of the South would privilege the generation of knowledge by methods based on practice, that is, it rescues experiential knowledge, intuitive, practical, creative, relational and common sense, which are produced collective and participative with the subjects and communities (GUAJARDO, 2014b; JARA; GUAJARDO; SCHLIEBENER, 2016; RAMUGONDO, 2018). This is undoubtedly one of the most important aspects to consider, as the TTOO of the South could be the materialization of decolonizing and libertarian practices¹.

2.4 The ethical/value-based fundamentals of the TTOO of the South could be human rights

The ethical/value fundamentals of the TTOO of the South could be human rights (HR); as the possibility of building recognition, based on community coexistence, daily and free of legal systems. Human Rights is the possibility of building citizenship, legitimized in the same social relationship, in the community (GUAJARDO; GALHEIGO, 2015; GUAJARDO; KRONENBERG; RAMUGONDO, 2015).

For this text, the proposal by Cantero et al. (2016) and by Guajardo and Galheigo (2015) is considered appropriate for the constructed argument since these authors consider that human rights are a social, concrete and material production, are the effect of the appropriation of historical experience and the cultural heritage, but at the same time, it is the place where the contradictions of the neoliberal capitalist system are found.

For the OT, Galheigo (2011) points out that the challenge of the discipline is the appropriation of human rights as a foundation, and the development of ethical responsibility and political awareness by occupational therapists is necessary.

As stated above, human rights in the TTOO of the South are a basis for establishing a new order in the practices with the individuals, communities, and groups of intervention. This order establishes the legitimacy of the other, recognition of the other as the right, that is, an order that allows the exercise of the right by the mere fact that the individual is the right, not implying the freedom from the universal conventions that protect or promote human rights since they are necessary. On the other hand, it implies deepening the capacity of the communities to create, exercise and validate their rights, in their territories, in a local and historical manner.

2.5 Collective Occupations are an expression of the TTOO of the South

From the South, it becomes relevant to understand the Occupation as a collective act of the individuals, and not merely from the individual action in a given context, highlighting the social and critical nature of it. Ramírez and Schliebener (2014) and Guajardo (2014a) show that occupation is a social, historical, situated practice, belonging to a field of collective relationships.

Considering this vision of the occupation implies defining that it has a transforming character and its development is not exempt from power relationships and that the occupational practice collectively constituted in the historical and relational, building subjectivity, that is, producing the occupational being as a subject, a process that is always done in the collective.

Ramugondo and Kronenberg (2015) define Collective Occupations (CO) as

[...] occupations carried out by individuals, groups, communities and/or societies in everyday contexts; they may reflect an intention towards social cohesion or dysfunction, and/or progress or aversion to a common good (p. 10).

In that process, they are developed, which

[...] cohesion around welfare or discomfort, when the value of being together is for the common good, or, when together making us aware of the discomfort [...] (p. 35)

raised by Tolvett (2017b) is developed, which is defined as historically situated ways of being.

In these definitions, the occupations by themselves would not only have a positive value for individuals and communities but the occupations transit, wander between dichotomies such as well-being/malaise, liberation/oppression, function/dysfunction. This conception of occupations is a call to overthrow the naive romanticism that occupation is a virtue in itself.

Another fundamental element to consider a CO is related to Simaan (2017) who proposes that the COs are a practice of resistance to injustice. This implies that, as they are aware of themselves and their own practices, they are an instrument to overcome conditions of discomfort and oppression. In this same line, Huff et al. (2018) propose that occupations and different forms of it can be a catalyst for resistance and restore inequalities suffered by women, and at the same time these occupations allow to overcome westernized understandings of occupations.

Finally, it is relevant to highlight from the South “Why is it necessary to talk about CO?” First, to talk about occupations is to highlight a position in which plurality, the diversity of occupations is claimed, as opposed to the universalist and hegemonic pretension of the perspectives of the North. Second, to speak of collectives is to highlight a position of insurgency and rebellion before the social and material conditions that neoliberal capitalism produces, characterized by individualism, immediacy, hedonism, and competitiveness, that is, collective occupations is to claim the collective, ancestral, collaboration and mutual support. Then, the COs from the TTOO of the South corresponds to the hegemonic expression of the human occupation of traditional OT.

2.6 The TTOO of the South are feminists

[...] Not submissive nor obedient, strong insurgent woman, independent and brave. Breaking the chains of the indifferent, not passive or oppressed, a cute woman who gives life, emancipated in autonomy, anti-patriarch, and joy. To liberate [...] (TIJOUX, 2014).

According to Sarmiento et al. (2018), Morrison (2011, 2016) and Valenzuela (2017), it is possible to point out that Occupational Therapy has an important historical debt with the feminist movement and feminisms.

For the TTOO of the South, feminisms could be understood as knowledge and practices of a political nature that like strands, they allow weaving a much dense, forceful and anti-hegemonic emancipation project to neoliberal capitalism. Above all, it is because of the close relationship that exists between capitalism/colonialism/patriarchy, whose practices account for the position of domination of the masculine.

In the case of OT, this has meant that given the capitalist/colonizing/patriarchal conception of human occupation, a complicity in the reproduction of the domain system since in these practices, the stereotypes that there are occupations are perpetuated which are specific to women and others belonging to men, just as there are occupations for children and others for adults, some for the poor and others for the rich, some for peasants and others for the urbanized, etc.

To transform all this that has just been raised, it is necessary for OT to consider feminism as a movement that fundamentally demands the rights of women, and is guided in overcoming stereotypes and injustices practiced against people who are recognized as female.

In this sense, as Morrison and Araya (2018) highlighted, feminisms are presented in the TTOO of the South as a possibility to broaden the epistemic and interventionist horizon, given that they enable to visualize the intersection of different types of oppression that suffer women and the female gender, for example, disability/gender/poverty, migration/women, indigenous/gender/poverty, work/women, old age/women/poverty, rurality/gender/disability, among others.

3 Where are the TTOO of the South Advancing?

To answer this question, it is necessary to review and construct two routes. The first one is an interior route of the same OT as a discipline and the second, a route from the OT to the outside, towards the world of life.

To explain both routes, the concept of interculturality proposed by Albán and Rosero (2016) will be the guiding axis, who understand that interculturality is a socio-historical construction that must face those epistemic/political/ethical forces (adult centrism, patriarchy, heteronormativity, miscegenation/white, capitalism), which exclude and discriminate against communities and collectives, denying their existence and building despair. Thus, interculturality points to a profound change in today's society, and for this reason, it considers reasonable conflict necessary since, in this way, it is possible to establish conditions of equity, for a true and full intercultural dialogue.

Based on the proposal of Simó (2016b), interculturality in OT becomes a way to defend the diversity of Occupational Therapies, rescuing the knowledge and praxis generated in the different South. Also, as indicated by Martín and Millares (2013), multiculturalism in OT allows critically analyzing and transforming power relationships at a disciplinary level, generating the conditions for respectful dialogue, as well as for the exchange of experiences and learning. That is, interculturality would be a foundation to recognize and respect the different Occupational Therapies that are developed.

This idea makes more sense if we consider that the TTOO is a historical construction that contains the characteristics of the culture that produces them. Therefore, the dominant and colonial OT would reproduce some of the characteristics typical of the euro/ethnocentric western culture such as individualism, the reification of nature and the social environment, the imperative need to control oneself and the environment, and above all, the pretension to universalize its rationality in different socio-cultural contexts (IWAMA; ALGADO, 2008; PINO; ULLOA, 2016; MARTIN; MEAULLE; GARLITO, 2012).

Then, Martin et al. (2015) state that interculturality in OT is a call to occupational therapists to be critical of the dominant culture of OT to be able to expand and incorporate new perspectives. In this context, the TTOO of the South requires an intercultural dialogue with the dominant OT, to enrich the discipline and make visible other expressions of it.

In the OT area, there has been an important advance to overcome this situation, and the different occupational therapies can be recognized. However, it is necessary to continue the internal conflict², to continue the reflection and the construction of a diverse, democratic and pluralist discipline. From the TTOO of the South, some considerations to advance in this sense are proposed.

1. a

   To recognize and legitimize other forms of knowledge disclosure in OT, for example, through the spoken word, or in the case of the written word, to modify the “scientific” criteria of publication and disclosure. This allows narratives that include the expression of emotions, as well as the opinion of communities and groups, without intermediaries or translations of experts.

2. b

   According to Simó (2016b) and Magalhães et al. (2018), English ceases to be the official language for the transmission of knowledge, both in written literature and in speech at the world congresses organized by the World Federation of Occupational Therapy, in such a way that all the possible languages (Spanish, Italian, Portuguese, etc.).

3. c

   To recognize art and other cultural expressions as knowledge and as tools for intervention practices that favor heterogeneity, the creation of bonds that improve life experiences and promote social transformation (CASTRO et al., 2016; SILVA et al., 2017; POLLARD, 2017).

4. d

   To incorporate the following themes into the curricula against hegemonic: feminism, the decoloniality of power, the world view and/or epistemologies of indigenous people, modes of production different from capitalism, such as cooperativism and the social solidarity economy, among others themes.

5. e

   To include subjects that address different forms of speech in professional training, to develop the necessary tools for respectful dialogue with groups historically violated, especially the objective is to materialize practices and knowledge in the framework of interculturality, such as sign languages, languages of native people, among others.

6. f

   To create a large network of Occupational Therapists, who are identified by the principles of the TTOO of the South, to share and exchange experiences, in which everyone is a part and can participate in a deliberative manner.

Regarding the second route indicated above, the proposal of interculturality as an emancipating and transforming project of Albán and Rosero (2016), and the approaches of authors located in the Global South of the discipline are considered, which reflect the desire that OT to achieve these purposes such as Tolvett (2017a), Correia and Rocha (2016) and Simó (2016b).

The TTOO of the South need to move towards the materialization of conditions for a decent existence, so all individuals and communities fully enjoy their rights, protect nature as the space and place that allows all forms of life, encourage the participation in conditions of equity of those considered subaltern, favor the development of the cultural, territorial, educational and organizational autonomy of the communities and collectives, among other.

The “among others...” is an invitation to those who are interested and feel the motivation, to continue contributing in these and other ideas, that allow to deepen and expand the knowledge and practices of the TTOO of the South and of the different expressions of occupational therapies they can contain.

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• 1
  Libertarian practices mean a set of actions that express the desires of emancipation of the human race, based on self-determination and full freedom to achieve the greatest collective welfare and overcome society divided into social classes. Within the reference of this text, the libertarian is synergistic with those practices that are designed for social transformation and the possibility of overcoming the relationships and conditions of oppression generated by the ruling classes (capitalism/colonialism/patriarchy), among them, the feminisms, environmental struggles, anti-capitalist, mutual support and self-management, the union of the oppressed and violated in general, among others.
• 2
  The internal conflict in the South TTOO refers to the need to continue discussing the assumptions and foundations considered dominant in the discipline, practices and their implications in the disciplinary and social order. As well as the need to continue to dispute the spaces of decision making and power at the disciplinary level.

• Erratum

  In the article “Terapias Ocupacionales del Sur: una propuesta para su comprensión”, Cristian Mauricio Valderrama Núñez, DOIhttps://doi.org/10.4322/2526-8910.ctoARF1859, published in Cadernos Brasileiros de Terapia Ocupacional, v. 27, n. 3, p. 671-680, on page 671:
  Where it reads:
  "South occupational therapies: a proposal for your understanding"
  It should be read:
  "South occupational therapies: a proposal for its understanding"

Publication Dates

• Publication in this collection
  29 Aug 2019
• Date of issue
  Jul-Sep 2019

History

• Received
  02 Jan 2019
• Reviewed
  20 Feb 2019
• Accepted
  10 May 2019