Meanings and representations of human activity for occupational therapists in Brazil

Abstract

The constitution of professional terminologies, as in the case of occupational therapy, is interfered by linguistic, sociocultural and political contexts, provided by power relations. The statement “human activity” is expressive in the Brazilian context, but is faced with the use of other terms and little investigation into its meanings, deepening and conceptual contradictions. This research sought to map the construction of conceptual meanings and cultural representations of the statement “human activity” in the speeches of occupational therapists in Brazil. An archaegenealogical and cartographic intervention research was carried out, with the composition of three excavations on: scientific discourses, professional reports and narratives about experiences. Each excavation advances in contextual immersion and records meanings of a statement interwoven by criticism and sensitivity, which has been supported by experiences of transformation. Based on experiential meanings, it delved deeper into possible cultural representations that favored this statement in the process of professional empowerment, bringing together six marks of social, political and epistemological formation in the context: positioning opposition to oppression; expression of popular empowerment through social transformation; constitution of the professional perspective as a social right; expansion of the professional fundamentals base; focus on the process, with a transdisciplinary tendency; and a search for criticism, coherence and responsibility in the face of the dilemmas of the world and the production of knowledge.

Keywords:
Occupational Therapy; Human Activities; Cultural Diffusion; Epistemology; Discourse

Resumo

A constituição de terminologias profissionais, como acontece no caso da terapia ocupacional, sofre interferência dos contextos linguísticos, socioculturais e políticos, providos de relações de poder. O enunciado “atividade humana” tem expressividade no contexto brasileiro, mas se depara com o uso de outros termos e pouca investigação sobre seus sentidos, aprofundamentos e contradições conceituais. Esta pesquisa buscou mapear a construção de sentidos conceituais e as representações culturais do enunciado “atividade humana” nos discursos de terapeutas ocupacionais no Brasil. Foi realizada uma pesquisa-intervenção de caráter arquegenealógico e cartográfico, com a composição de três escavações sobre: discursos científicos, relatos profissionais e narrativas sobre experiências. Cada escavação avança na imersão contextual e registra sentidos de um enunciado entretecido por crítica e sensibilidade, que vem sendo sustentado por experiências de transformação. Com base nos sentidos experienciais, aprofundou-se em possíveis representações culturais que favoreceram esse enunciado no processo de empoderamento profissional, reunindo seis marcas da formação social, política e epistemológica no contexto: posicionamento de oposição à opressão; expressão de empoderamento popular pela transformação social; constituição da perspectiva profissional como direito social; ampliação da base de fundamentos profissionais; enfoque no processo, com tendência transdisciplinar; e uma busca por crítica, coerência e responsabilidade frente aos dilemas do mundo e da produção de conhecimento.

Palavras-chave:
Terapia Ocupacional; Atividades Humanas; Difusão Cultural; Epistemologia; Discurso

Introduction

The study of terminologies is central to understanding the processes of constitution and transformation of fields of knowledge and practice, whose historical analyses help to show how terms emerge and acquire meanings, deepening and contradictions, as they involve different theoretical perspectives and a conceptual polysemy (Barros, 2016).

National and international publications in occupational therapy present a wide range of terminologies; however, “occupation” appears hegemonically in the global literature as a representation of the professional object, while “activity” holds significance in the historical discourse of Brazil. The field of debate about these terms has recorded a dispute, a hierarchy, or even an exchange between them, rather than investigating their meanings, deepening and contradictions, or even their proximities and differences (Castro et al., 2001; Pierce, 2003; Chan, 2007; Quarentei, 2007; Ivarsson & Müllersdorf, 2008; Magalhães & Galheigo, 2010; Bauerschmidt & Nelson, 2011; Lima et al., 2011, 2013; Magalhães, 2013; Salles & Matsukura, 2016; Figueiredo et al., 2020; Cardinalli & Silva, 2021; Martins Cazeiro et al., 2022).

Hammell (2009) questions the fact that literature from the Global North rarely contests basic assumptions that end up being maintained regarding how “occupation” is understood, as it has been culturally determined, despite being considered natural and universal. The hegemonic Anglo-Saxon production in occupational therapy promotes a positive, unitary, and neutral scientific perspective, with little dialogue with the human and social sciences, accusing other perspectives of not defending the profession's strengthening. This uncritical acceptance reveals messianic traits towards texts that end up being considered sacred, and their assumptions, values, and beliefs perpetuate ethnocentrism and theoretical imperialism as a form of intellectual colonialism (Hammell, 2009).

The occupational therapy predominantly disseminated in Brazil relates to the U.S. historical-social context of the early 20th century, with a high dominating power in its process of imperialist rise. This contrasts with Latin American territories, which were its privileged targets, enduring centuries of plunder and exploitation by colonization, culminating in authoritarian governments, financed for capitalist progress, which implemented processes of cultural homogenization. Occupational therapy played a providential role with its promotion of occupation, rehabilitation, and professional insertion, representing a technical-scientific foundation in the discursive modernization (Maroto, 1991; Monzeli, 2019).

Concrete unequal conditions are complementary within the global power dynamics, and this relationship is also sustained by the reproduction of symbols and concepts from the dominant to the dominated discourse. Uncritical reproduction, under the guise of scientific neutrality, does not exempt the ethical-political contradictions in which we have been immersed since colonial domination, but it is guided by homogeneity, not by the diversity of experiences and existential contexts.

Language is a cultural element that expresses ways of living and understanding existence, revealing the strength of dominant power. It is estimated that over a thousand indigenous languages were spoken in Brazilian territory until the early 16th century, and over two hundred African languages were introduced between 1550 and 1850; today, multilingualism has been reduced to two percent of the population, considering dozens of European and Asian immigrant languages (stimulated in a racial whitening project at the turn of the 20th century) and hundreds of indigenous languages on the verge of extinction (Lucchesi, 2017).

Focusing on the etymology of the dominant language (Brazilian Portuguese), from the Indo-European family, we see that the proximity between “occupation” and “activity” refers to their common origin, “action,” but they diverge in meaning. “To occupy” expresses power and dominance, “to be in possession of” and “to conquer,” representing social prominence. “Active” refers to the quality of being alive, agile, “exerting action, acting,” establishing existential relationships (Cunha, 2010).

The Michaelis dictionary (Michaelis, 2021), which reflects the popular use of language in its sociocultural and political processes, shows that “occupation” refers to an “activity of any order that is carried out for a certain period of time” or “paid work that constitutes a person's main activity; job, profession, service,” naming the Brazilian Classification of Occupations and the Occupational Health sector, for example. It would also be an “act or effect of occupying or seizing something,” “generally in an arbitrary manner,” frequently used in legal and military discourse to indicate invasion, possession, and control of a space/time (Michaelis, 2021).

Meanwhile, the term “activity” refers to the “quality of being active,” “due to being alive,” and can represent a “set of specific tasks, actions, or functions carried out for a particular purpose.” Its expression is present in educational, philosophical, and psychological discourses, revealing a singular empowerment: “a mode of being that acts or has the capacity to act, not being merely receptive or passive” (Michaelis, 2021).

In this context, the aim was to map the construction of conceptual meanings and the cultural representations of the term “human activity” in the discourses of occupational therapists in Brazil. It is important to note that this research did not propose a comparative study between professional discourse concepts; the choice of the non-globally dominant term was made out of respect for Brazil's singular trajectory and the desire to affirm anti-colonial experiences. In a field permeated by various affections, it is not a matter of exalting competition between distinct processes or seeking to restrict possibilities of use and composition between terms used by the profession.

Methodology

Language has unequivocally indicated that memory is not an instrument for prospecting the past; it is, rather, the means. It is the environment in which the experience took place, just as the soil is the environment in which ancient cities are buried. Anyone who intends to get closer to their own buried past must act like a man who digs (Benjamin, 2012, p. 245).

The intervention-research of an archaeogenealogical and cartographic nature, summarized here, is the result of a doctoral process in Occupational Therapy (Cardinalli, 2022), which was dedicated to investigating the statement “human activity” in the discourses of occupational therapists in Brazil. The archaeology of knowledge seeks to uncover the conditions of formation of statements, reconstructing moments and events of their emergence and transformation, while the genealogy of power looks for the asymmetrical relations that structure this knowledge, also proposing an insurrection against them to criticize and transform them (Souza, 2014).

The investigation of the statement was proposed in three excavations within scientific discourse, professional reports, and narratives about experiences. Statements, in this context, can be words or expressions that are also events, and thus are not exhausted by language or meaning (Foucault, 2016). By advancing the recognition of enunciative vectors, investigative and analytical processes are reconfigured to reach the experiential expression of events, activating a cartographic character, which follows processes of knowledge-making, their developments, and their potential to trigger the creation of new meanings (Barros & Silva, 2014).

The first excavation, conducted in 2019, involved a literature review to understand the uses, foundations, and meanings of the terminology in national and international journals in the field. The search for the descriptors “human activity(ies)” and “occupational therapy” involved the following databases: Portal de Periódicos of Coordination of Superior Level Staff Improvement – CAPES, Scientific Electronic Library Online – SciELO, and Literatura Latino-Americana e do Caribe em Ciências da Saúde – LILACS; in addition to the journals: Cadernos Brasileiros de Terapia Ocupacional, Revista de Terapia Ocupacional of the University of São Paulo, and Revista Interinstitucional Brasileira de Terapia Ocupacional – REVISBRATO.

The second excavation, conducted in 2020, after analyzing the data from the first phase and obtaining research approval from the Ethics Committee¹ , sought reports from professionals working in Brazil through an online questionnaire with ten questions about: professional profile, use of terminologies, and understanding of the statement. At the end, there was an inquiry about interest in participating in the subsequent phase of the research. The questionnaire was disseminated via social media, representative bodies, research groups, and requests for sharing among colleagues.

The third excavation, in the same year, following the data analysis and selection of participants from the previous phase, began with an invitation to write narrative letters about experiences that described human activity in action, whether in professional or personal scenes, observed or experienced, and their elaborations of meanings.

In the following three sections, we will present the results of each excavation, qualitatively describing their meanings and specificities, revealing non-standard thematic categories. For the cartography, the focus is on the expression of lines of visibility, sayability, the strength of words and things, and subjectivation that invent ways of existing, which requires openness to the mobilizing encounters of the research process (Kastrup & Barros, 2012).

In the two sections of analysis and discussion, a composition of the three excavations is presented, highlighting experiential meanings of the statement and six marks of the social, political, and epistemological formation of the context, which indicate possible cultural representations of the statement “human activity” for occupational therapy in Brazil.

Excavation 1: conceptual nuances in literature

The searches presented 93 findings, with the criteria for inclusion in the analysis: having authors who are Brazilian occupational therapists, having an article format and mentioning the human activity(ies) stated in the file metadata. 60 articles were included² in the general analysis, as they presented the statement in the title, abstract or descriptors, however, of these, only 49 articles were included in the conceptual analysis, as they mentioned the statement throughout the text (Figure 1).

Figure 1
PRISMA Flowchart on the literature review.

The 60 articles were published between 1991 and mid-2019, with an upward trend in publications starting in the 2000s. A total of 44 occupational therapists were involved in authorship, and in terms of regional distribution, 50 articles (83%) referred to the Southeast, five (8.3%) to the Northeast, four (6.7%) to the South, and one (2%) to the Central-West. These articles were published in 11 journals, with 46 (75%) in Brazilian occupational therapy journals, and 12 (20%) in national interdisciplinary or other area journals. Only three articles (5%) were published in foreign journals, two of which were in occupational therapy and one in health.

Regarding the 49 articles of conceptual analysis, there were 143 instances of the statement, with 80 (56%) of them referenced. Two citations referred to the publications of the Federal Council of Physical Therapy and Occupational Therapy – COFFITO and the Occupational Therapy Program Brochure from the University of São Paulo Medical School – FMUSP, from 1997. The knowledge areas of the remaining citations were as follows: 51 in occupational therapy, nine in philosophy, five in ergonomics, five in sociology, three in social sciences, two in psychology, and one each in anthropology, education, ergology, geography, pedagogy, psychoanalysis, psychiatry, and medicine. The analysis of the statement's use in these publications was based on the use of concepts in the social sciences (Barros, 2016), classifying each of the 143 instances as follows:

1. Term: The statement is mentioned when describing a technical procedure in occupational therapy, indicating an implicit general notion, as it is not directly described (24 instances in 18 articles);

2. Category: The statement is also mentioned without a description of its meaning, appearing related to other predominant concepts such as “work,” “play,” “eating,” and “art,” which are considered human activities, or as part of a larger category like “ergology” and “occupational therapy” (25 instances in 20 articles);

3. Concept employed: The statement is accompanied by an understanding grounded in another field of knowledge, particularly the human and social sciences, with an emphasis on philosophy (24 instances in 10 articles). A. S. Vazquez, M. Kagan, Y. Schwartz, S. Kemmis, H. Lefebvre, F. Guattari, A. C. Gil, L. Durrive, and F. Rotelli were cited authors. Excerpts from these citations were recorded in Atlas.ti 8 software to generate a word cloud that visually displays the proportion of the most repeated words, providing insights into the concept employed (Figure 2).

   

   Figure 2
   Word cloud that involves the use of the concept employed.
   

1. Elaborated concept: In most cases, the statement is conceived from occupational therapy reasoning, even though it engages in dialogue with authors from other fields. Of the 70 mentions (in 22 articles), 29 proposed conceptualizations, 34 referenced other occupational therapists, and seven referenced authors from philosophy (H. T. Engelhardt Jr., K. Marx, P. Dardot, and Y. Schwartz), sociology (C. Laval, R. Antunes, and R. Castel), geography (D. W. Harvey), and ergology (L. Durrive). The most frequent words from the referenced excerpts were used to generate a word cloud, with the support of Atlas.ti 8, revealing the meanings of the elaborated concept (Figure 3).

   

   Figure 3
   Word cloud of words involving the elaborated concept.
   

In an analysis of the meanings of the 70 mentions of the developed concept, six categories of conceptual meanings of human activity for occupational therapy were proposed, after reading, combining, and repeatedly synthesizing all related excerpts. The ways to name these synthesized categories and their order of presentation were defined by the researchers' linguistic and theoretical-methodological repertoire in occupational therapy; however, it is understood that their understandings are complex and that these elements can only be comprehended in relation to one another. Therefore, similarities among the subcategories are perceived.

1. Qualities of human activities (32 occurrences): they mobilize ways of perceiving oneself, the world, and the realization of life; they translate an experiential space-time available for creation; they trigger a transformative relationship between subject and world; they articulate inseparable contextual levels;

2. Contextual dynamics of human activities (14 occurrences): they involve contextual spheres such as history, social reality, daily life, lifestyle, culture, paradigm, etc.;

3. Possible developments of human activities (five occurrences): they activate singular perceptions about oneself and/or their belonging collectives;

4. Human activities as a technical resource (five occurrences): they involve expectations about the therapeutic or beneficial use of activities;

5. Human activities understood as knowledge (29 occurrences): they represent a complex and transdisciplinary know-how based on experience; their knowledge fundamentally composes occupational therapy (OT);

6. Human activities shape conceptions of occupational therapy (16 occurrences).

Excavation 2: reported elaboration by professionals

The virtual questionnaire received 81 responses; however, seven indicated that they do not use the term “human activity,” resulting in 74 responses for conceptual analysis.

Regarding the profile of the 81 participants, 95% indicated that they have completed or are in the process of obtaining a postgraduate degree (lato or stricto sensu), with 65% reporting technical work in assistance or clinical settings, followed by teaching in higher education (33%), academic or independent research (20%), and consulting, management, or entrepreneurship (15%). Among the regions of operation in the country, 75% are from the Southeast, 14% from the South, 6% from the Northeast, 2.5% from the North, and 2.5% from the Central-West. The indicated areas of expertise included: mental health (54%); disabilities (42%); foundations (41%); development (39%); culture (36%); social (33%); arts (32%); collective health (31%); body work (26%); education (26%); rehabilitation (24%); hospital (12%); worker health (6%); labor (6%); and 1% in others, such as: ethnic-racial relations, gender and sexuality; integrative practices; and environment and sustainability.

Regarding the use of terminology, there was a closed question indicating 14 terms pre-selected by the researchers, with responses conditioned to three frequencies of use (always; sometimes; or never used). The suggested terms were: action, human action, activity, human activity, act, human act, daily life, doing, human doing, way of life, occupation, human occupation, praxis, and everyday life. The most frequently used terms were: daily life (60 responses for “always”), activity (59), human activity (52), everyday life (50), doing (50), human doing (41), and way of life (38). The terms used sometimes were action (34 responses), human action (31), praxis (30), human doing (28), occupation (28), and human occupation (22). The least used were human act (51 responses for “never”) and act (47).

The 74 individuals who proceeded to the specific section on understanding the statement answered open-ended questions: In your understanding, what do human activities represent for occupational therapy? How are human activities related to your practice, research, and/or teaching? Do you indicate any theoretical-methodological references, authors (occupational therapists or otherwise), or fields of knowledge that help you think about human activities?

Regarding references, 67 participants totaled 354 indications³ among areas of knowledge, themes or theories, authors, works, and organizations. Among the areas: occupational therapy; philosophy; anthropology; arts; mental health; sociology; psychology; biology; cognitive sciences; social sciences; social context; culture; education; body studies; indigenous studies; quantum physics and chemistry; history; language; literature; health; public health; work. And among the themes: everyday life; cosmopolitics; postcolonial studies; ecological perspective; Amerindian perspectivism; Latin American reality; complexity theory.

In the analysis of the meanings of the statement, after reading, composing, and synthesizing the responses, the researchers proposed four categories related to the reported professional reasoning. Unlike the conceptual analysis of the literature, the meanings were more self-centered on professional experiences, with each response encompassing more than one category. However, for didactic purposes, they will be presented in order from most to least expressed in the written accounts.

1. Technology of Action: human activities are proposed during occupational therapy practice as a starting point for elaboration, indicating intervention demands. They are seen as evaluative, interventive, or propositional devices and as objectives of practice (109 responses involved);

2. Theoretical-Practical Knowledge: human activities are considered knowledge of great relevance for occupational therapy, professional basis, synthesis of professional specificity, or even exclusivity of the field. They are named as object, element, axis, focus, form, mode, concept, lexicon, reference, study, theme, know-how, field, center, core, foundation, essence, science, or “everything”—a knowledge that emerges from the elaboration of their practices (60);

3. Relational Action: human activities are described as mediators of encounters, an investment in being, acting, and doing together, agents of/for displacements, activators, and articulators of the collective-social-cultural fabric. This relational characteristic is valued for connecting bodies, subjects, collectives, and territories, occupational therapists and the people they accompany, being highlighted as a sensitive and singular part of the process and its displacements and developments in mapping, expressing, affirming, problematizing, agency, enhancing, cultivating movements, new paths, transformation, expansion, broadening limits and horizons, recreation, invention, production, or deconstruction (60);

4. Cultural Dimension: human activities are understood as an expression of who one is and how one lives, cultural productions related to contexts, daily lives, characterizing gestures and generating new modulations, independent of occupational therapy practice. It appears as a singular expression intrinsic to collectivity, culture, life, and social groups, also involving non-human elements, which includes the production of meanings, significations, and re-significations of ways of existing actively, creatively, and transformatively in the world (55).

Excavation 3: narratives of experience

After analyzing and proposing the categories from the previous excavation, the researchers highlighted the responses from participants that encompassed the four categorized meanings, which led to the identification of 18 participants for the next excavation.

Considering the cartographic research-intervention, which tracks flows and affects, this new stage was designed to embrace the elaboration of experiences in a sensitive manner, based on memories of how each occupational therapist thinks about and engages in human activity. The invitation to write narrative letters became a device for reflecting on human activity as it unfolds. According to Foucault (2014), the act of writing letters, along with their reading by the recipient, establishes relationships with oneself and with others that can generate different effects.

The 18 participants received the invitation, also in letter format, asking them to write letters describing a scene in which they perceived human activity occurring, with no requirement for it to be part of an occupational therapy process or for the writer to be the protagonist. Considering the context of the Covid-19 pandemic, four individuals explained their non-participation, resulting in the receipt of 14 narrative letters.

The letters addressed events related to the participants' own daily lives and ways of living (eight letters) and/or their work in occupational therapy (eight letters), with two narrating both processes. In terms of the time span involved, eight letters presented specific scenes, three recounted an extended period of weeks to months, and three spanned years to decades of their professional trajectories.

The narrated scenes highlighted four analytical themes that, for cartography, are elements aimed at revealing processes that de-naturalize sterile generalizations, denying any intention of simplification for uncritical reproduction, and synthetically showing the unspoken aspects of the event (Barros & Barros, 2014).

1. Singularities: narrating human activities called forth daily dynamics, ways of life, affective memories, and prior connections. Historical, social, and cultural contextualizations, among others, were presented, forming a singular constellation situated within the conditions surrounding such events. There was a complex interplay of different elements in these happenings, relating people, contexts, and cultural expressions (material and/or immaterial) of the involved activity and their multiple intrinsic relationships. The observation/analysis of human activity in its complexity provided an opportunity for awareness of its cultural meanings, based on the context in which one lives, and the possibility of transforming those meanings uniquely;

2. Relationships and Agency: human activities as they occur were narrated as involving encounters with other people, objects, and things in the world, requiring a quality of presence and a body available for mediation. Participants recounted moments of openness for investments, propositions, agency, bets, or invitations that were accepted and shifted the situation into new movements, transformations, or creations, leading to new relationships and connections that occurred in the moment or later. In this writing, reflective questions frequently arose when something unexpected happened, not questions seeking closed answers, but rather openings to new reflective flows that called for enduring follow-ups and new meanings to be experienced and recognized in process;

3. Shared Processes and Productions: the scenes emphasized a “being with” and “doing together,” showcasing a collective-historical-cultural-ancestral record. Descriptive highlights were given to the form and rhythm of what was done, the encounters facilitated, and the collaborative action, as well as the care taken in preparing for this encounter and welcoming what might derive from it. This composition seemed to generate a more prepared collective body to perceive and face whatever might happen, even when initial expectations were not met or did not materialize as anticipated, which was not seen as a loss or failure. Everything lived together was considered an interesting process and product for life, making it easier to confront the unpredictable;

4. Appreciation of Life in Action: in these engagements, the different developments, the beauty of witnessing life in its complexity, were appreciated, sustaining and/or transforming the act of living in the world together. They were narrated in terms of feelings, formative impacts, learnings from experience, elaborations and reflections, accumulated know-how, memories, and meanings from their professional/personal repertoire, recognizing all the production of affects, knowledge, and marks that was accompanied, recorded, affirmed, and celebrated as part of the production of life.

Meanings of Human Activity: Knowledge Sustained by Experience

The first phase of excavation, based on scientific writing, reveals a concern with highlighting the potential of human activity, considering its qualities, dynamics, and implications for practice, grounded in social and human scientific foundations in occupational therapy. It makes explicit a robust and critical conceptual development process, guided by the theoretical-practical relationship in knowledge production and the socio-historical discourse of the professional field.

In the second excavation, in professional accounts, the understanding of human activity as both a tool of practice and scientific knowledge is revisited. However, the scope of meaning expands by incorporating elements of professional experience through lived, learned, and embodied memory, which propels the construction of this knowledge. Its relational, communicative, and connective nature is emphasized, along with the perception that human activity expresses a cultural dimension, being part of people's lives and independent of occupational therapy itself. Here, the statement did not appear as a closed concept to guide practice but as an evolving process that depends on professional experience as a trigger for reflection.

The writing of letters in the final excavation enhanced the experiential nature by presenting a singularized narrative professional reasoning, immersed in relational and shared life, in its incessant production and appreciation. Narrating the events highlighted the importance of gestures, ways of doing, relationships, contexts, and conditions that are followed in occupational therapy processes, weakening a disciplinary or protocol-based logic that depends on controlling results. It also enabled the perception of the activity itself, in one's own life experience, which generates and accumulates a repertoire for professional practice, while reminding that activities do not exist alone in an abstract form, they are neither inherently good nor bad, exemplary or ideal, and are thus particularly interesting for analytical and propositional exercises. Human activity shows life being made in its challenges and contradictions, hence its complexity as a field of knowledge construction.

As a concept, which aids in professional communication and dissemination, the Brazilian definition aligned with the World Federation of Occupational Therapists (2017) is revisited, where human activity serves as a guiding and central element of occupational therapy practice. However, the expansion of its experiential meanings restores its condition as a living, singular, and cultural event, whose analyses and elaborations were expressed narratively. The narrative proved to be a powerful tool, inviting “to think, suspend, and question our positions of knowledge and power to open ourselves to the collective”, as it activates the “potential to be affected”, critically working to dismantle moral rationalism and affirm “embodied knowledge” (Pozzana, 2014, p. 63).

In half of the letters, it was made clear how the writing experience generated mobilizations, with some participants indicating that it was the first time they reflected on their own activities to consider occupational therapy concepts. This was facilitated by the perspective that research is also an intervention, sparking new affects and creations, which forms part of data production in cartography and invites the invention and transgression of positive functionalism, to follow the research flows, of participants and researchers alike, generating analyses open to becoming (Barros & Barros, 2014).

Narrativity calls for a relational weaving of actions in their events, as a device, with its lines of visibility, speakability, force, and subjectivation producing movements of reference and differentiation of knowledge, clarifying processes of subjectivation of experiences, and transforming and producing a new existential territory (Kastrup & Barros, 2012), in opposition to hegemonic rationality. For Foucault, the writing of the self can be considered an ethical device of structural denunciation of power, by envisioning procedures that twist the forces of subjectivation, following freer forms. Moreover, authoring oneself in the face of knowledge-power domination becomes a technology of care, a transgressive device that cares for who one is (Butturi Junior, 2016).

Cultural Representations of Human Activity

A critical study of terminologies requires considering the conditions and events involved in the relationship between words and things (Foucault, 2016b), as the meanings of each word change depending on the contexts (Meillet, 2021). This is because language is cultural and ideological, involving meanings that are not always explicit (Volóchinov, 2018), in which power relations are exercised in search of legitimation and domination (Giordani, 2011).

Benjamin (2017) explains that the predominance of languages considered universal is sustained by myths of creation, essentialisms, and ontologies messianically reproduced by those in power, who ultimately silence those considered deprived (historically objectified as the pagan, the mad, the savage, the woman, and all those who were/are coerced into interventions, for example). “Language never provides mere signs” (Benjamin, 2017, p. 63, author's emphasis).

This corroborates Hammell’s (2009) perception that universalism in occupational therapy often exalts accusations against divergent perspectives, as if they represent a weakening of professional foundations or a lack of scientific grounding. This discredit is an ancient oppressive mechanism aimed at preventing disobedience and insubordination to colonial, sexist, and racist domination, among others that underpin positivist science. However, subversion also reveals its strength of resistance, creativity, and diversification, adding empowerment to the profession, which is, after all, predominantly composed of women.

For Freire (2022, p. 108), “[…] only beings capable of reflecting on their own limitations are capable of liberating themselves”. And the process of becoming aware of conditions of oppression involves recognizing cultural dynamics, which is why his pedagogy is understood as a liberating cultural action (Freire, 2022).

Freire realized that the Brazilian colonial experience created a culture of silence, with restricted access to knowledge and a disconnection between regions where wealth and technology were concentrated. In addition, the domination and exploitation of indigenous peoples and enslaved individuals solidified the absence of social dialogue, which is essential for building communal, supportive, and democratic relationships (Lima, 2011). Such experiences converged into strategic mutism, and in this lack of awareness and critical thinking, cultures of domination are easily reproduced, justified as a natural condition, and reinforcing a cultural submission to the dominating model (Freire, 2022).

Carneiro (2005) explained how the deprivation of the rationality, culture, and civilization of the “other” generates epistemicide, a constitutive element of the racist logic of biopower in Brazil (though not limited to Brazil), as it involves the denial, nullification, and devaluation of the knowledge of subjugated peoples, as well as the cultural seizure and assimilation imposed on them.

In this context, we question the neglected cultural meanings in occupational therapy when considering the stimulus to occupation as inherently beneficial. In common usage, the word is seen as an action performed with certain goals or meanings; however, without awareness and critical thinking about these desired outcomes, one may act in favor of dominant powers. This is because good intentions do not neutralize words, cultures, and historical oppression that are deeply rooted, making transformative cultural actions necessary. In this sense, activity, even in popular usage, expresses “power” from the person who acts, demonstrating an active being who can empower themselves even in an unequal and unfavorable reality.

Based on the experiential meanings of human activity for occupational therapists in Brazil, we delve deeper into the debate, seeking possible cultural representations that have favored this narrative in the process of professional empowerment – as a response to the oppressive perspective of devaluation – identifying six hallmarks of social, political, and epistemological formation in this context.

The first hallmark is a dark reminder of the oppressive meaning associated with the word “occupation” in the Brazilian colonial context. The occupation of territory by colonization, beginning in 1500, had explicit meaning and purpose of exploitation. The proclamation of the Republic, only in 1889, refers to a very recent and still fragile democratic construction after nearly 400 years as a colony of exploitation. This marked the 20th century with a succession of more or less authoritarian governments, constructing a national-developmentalist discourse in the country, aimed at accelerating capitalist development (Cepeda, 2012). The most recent dictatorship had military occupation and eugenic medicine as allies in political repression and the social cleansing of marginalized populations, particularly in institutional contexts, which propelled the professional inclusion of occupational therapists in institutions with a moralizing treatment perspective (Nascimento, 1991; Soares, 1991; Salles & Matsukura, 2016).

The abolition of slavery, enacted in 1888, made Brazil the last country in the Americas to abolish it and the largest slaveholding territory in the Western Hemisphere, establishing a profound history of structural racism (Gomes, 2019). A narrative of racial democracy was proposed and spread by the privileged European-descendant elites, erasing African and Indigenous roots, as well as the impacts of colonization on them, as yet another strategy of Brazilian racial genocide (Nascimento, 1978). The institutionalization of asylums and welfare was widely implemented to contain social differences, dispossess existential identities, and control dissident bodies, amplified by the lack of reparative policies for the formerly enslaved population. Racist biopower and the state’s necro politics (Mbembe, 2016) extended their violations in the form of treatment and professional rehabilitation, based on moral and disciplinary grounds, admitting a controlled “resocialization.”

Occupational therapy, initially, was intended for those seen as idle, suffering from an “existential void,” and in the context of isolation in total institutions, their only possibility for action was seen as work and social reintegration, as many were tasked with maintaining the institution itself, with no real prospect of discharge. The occupation of idle time had work as its aim, as the poor could not enjoy leisure or contemplation, reinforcing the meaning of work/employment to occupation, but permeated by the dominant oppressive and exploitative logic (Nascimento, 1991; Soares, 1991; Galheigo, 2012). This supports the reflection that, without awareness and critique of the established power structure, one ends up acting in its favor.

The second hallmark is the empowerment of the popular movement for social transformation, which incorporated critique into occupational therapy and exalted the use of the term human activity. With the weakening of the Military Dictatorship, the process of re-democratization, and the emergence of the anti-asylum movement, reforms in health and psychiatry in the 1980s offered the profession a new record of hope for social and political transformation. All forms of health promotion and treatment, including occupational therapy, were achieved as a right for all citizens, no longer exclusive to objectified subjects or those who could afford it. This transformation, based on deinstitutionalization and investment in community care, changed not only practices but also the discourses of occupational therapists toward social emancipation.

During this period, the incorporation of the term human activity and references from the human and social sciences were associated with the rise of critical perspectives among professionals (Galheigo et al., 2018). While occupation referred to an imposition expected to be overcome, activation fueled new intentions, engagements, hopes, and empowerment to actively transform macro-political conditions. The experience of living through change, realizing dreams, experimenting, and creating redefined the intentionalities of occupational therapy, converging into practices that blurred the lines between art, clinic, politics, and everyday life. All these relationships incorporate reflections that redefined occupational therapy in the 1990s as

[…] a field of knowledge and intervention in health, education and the social sphere, bringing together technologies aimed at the emancipation and autonomy of people who, for reasons linked to specific problems (physical, sensory, mental, psychological and/or social), present temporary or definitely difficulty in insertion and participation in social life. Occupational therapy interventions are scaled by the use of activity, a centralizing and guiding element, in the complex and contextualized construction of the therapeutic process (World Federation of Occupational Therapists, 2017, p. 11).

The third hallmark encompasses social rights in contrast to the economic discourse as a strengthening factor for occupational therapy. The technical dimension of the profession is directed toward its therapeutic, educational, and social functions, referring to the promotion of actions already imbued with beneficial meanings. This functionalist approach, when focused on individual performance as evidence of success, does not need to consider context, complexity, subjectivity, or expressions of power in relation to the person being assisted (viewed as a client or patient). The focus on segmented demands aims to serve market niches, which commercialize health products and services in the same way they sell super-specializations to professionals, positioning both the client and the therapist as consumers. The logic of capital, present since the profession's implementation in the country (Soares, 1991), contrasts with the understanding of care as a collective right, which provided the opportunity to assist people, communities, and daily lives through various activities, broadening the discourse toward citizenship and its possibilities for contributing to social emancipation.

The fourth hallmark shows the expansion of professional foundations, questioning the predominance of modern scientific rationality as the only valued foundation. When experience guides the singular, contextualized, and complex construction, it leads to an embodied and narrative knowledge that supports the knowledge related to lived practices, in opposition to the dominant discourse that overvalues scientific evidence as the only relevant basis for professional practice. To accompany, experiment together, dream, and create calls for counter-hegemonic bases and mobilizes other forms of knowledge production, which are sometimes seen as fragile and accused of undermining professional strength, as Hammell (2009) points out. In conceptual development, this knowledge aligns with references from philosophy, the arts, and social sciences, which have strengthened an ethical, aesthetic, political, and cultural understanding of human activities, with critique and sensitivity (Cardinalli & Silva, 2021; Cardinalli et al., 2021; Cardinalli, 2022).

The fifth hallmark focuses on the process of accompaniment, assistance, and care, which is flexible, adaptable, and expands relationships, with a tendency toward transdisciplinarity. Life is a “continuous flow of activities,” as Quarentei (2001, p. 2) states, which is easy to perceive when the focus is on raising awareness of actions and the process of accompanying life projects. More than the achievement of results or purposes of action, the emphasis is on the “how.” In this sense, human activity is not confined to a professional niche, nor does it become an exclusive goal or object, and its understanding is not restricted to those in the field. Facilitating transitions between knowledge, professions, inter- and transdisciplinary practices, and with the population being assisted reflects its sensitive, available, welcoming, and communicative construction and diffusion, seeking common and communal uses. In its meanings, activation shows empowerment and calls for openness to creative movement, highlights processuality, establishes relationships and changes in meaning, shows transformation and uniqueness, being a statement in progress, alive.

The sixth and final hallmark speaks to the critical and self-critical openness in this knowledge production in search of coherence – especially when analyzing the impacts of human activity, not just the positive ones, since it also harms human health when overstimulated by neoliberal productivity, for example, and can be highly destructive to life on the planet, considering the worsening climate crisis. There is an awakening to responsibility and the search for ways to confront macro-structural issues. In this sense, disputes and universalism have also caused harm to the professional field, diverting focus from care actions and generating accusations and exclusions in knowledge production, which truly restricts the field's strengthening. On the other hand, the diversity of statements expresses the scope of the various ways of doing, thinking, feeling, and creating in occupational therapy, in an effort to respond to contemporary dilemmas and demands. The coexistence of different ways of articulating events and the different understandings contained in the same statement is a result of the field's growth, which also needs to question its own statements so they can expand as the living knowledge they are.

Final Considerations

The excavation of meanings attributed to the term “human activity” by occupational therapists in Brazil showed that delving into singularized contexts and experiences enhanced its understanding, including its recognition as knowledge supported by experience. This involved problematizing the hegemonic scientific logic in its production of value, power, and relevance, as well as broadening the mapping of its meanings, such as: qualities, contextual dynamics, and developments of a theoretical-practical knowledge; its relational action and cultural dimension as an event; and the occupational therapists' involvement in their singularities, agencies, shared processes and production, and appreciation of life in action. These categories and analyzers suggest elements to support narrative analyses of activities, daily lives, and processes in occupational therapy.

In the discussion that deepens this archeogenealogical cartography, six social, political, and epistemological hallmarks are highlighted, indicating possible cultural representations of human activity that accompany the strengthening of occupational therapy in the country: positioning in opposition to oppression; expression of popular empowerment for social transformation; the establishment of the professional perspective as a social right; expansion of the foundation of professional principles; a focus on the process, with a transdisciplinary tendency; and a search for critique, coherence, and responsibility in response to the dilemmas of the world and the production of knowledge.

Among the movements generated by this research, we highlight the methodological construction, produced uniquely to accompany the research activity and its thematic field of the production of doings and knowings based on counter-hegemonic experiences. This process moves towards decolonization, guided by quilombola and indigenous perspectives, and the production of confluence, as proposed by Antonio Bispo Santos:

The day universities learn that they do not know, the day universities agree to learn indigenous languages – instead of teaching them – the day universities agree to learn indigenous architecture and to learn what the plants of the caatinga are for, the day they agree to learn from us the way we once learned from them, then we will have a confluence. A confluence between knowledge systems. A process of balance between the diverse civilizations of this place. A decolonization (Santos, 2018, p. 9).

Universalist constructions reinforce the effect and reproduction of hegemonic power, which is rewarded when institutionalized, showing that the production and control of wealth depend on the production of truths (Foucault, 2018). In tracing the shifts that led to the term “human activity,” we encounter existential rather than identity-related questions, after all, what types of productions have we generated and want to generate as occupational therapists? What have we done and what do we want to do in the face of established powers?

We believe that asserting statements and their uses in occupational therapy studies and practices relates to the production of meanings and realities. Each statement carries with it different dimensions, potentialities, and limits aligned with certain perspectives and ways of being and conceiving worlds. May we be more aware of the choices, adoptions, reproductions, resistances, and creations we make. And may we dare to minimize the discrepancies between discourse and action, so that discourse in action produces the necessary transformations in a world that urgently needs them.

• 1
  Human Research Ethics Committee of Universidade Federal de São Carlos, whose opinion number is 3.402.197.
• 2
  The list of articles was not included in this text, but can be accessed in full in appendix 1 of Cardinalli (2022, p. 90-95).
• 3
  The complete list of indicated references with the quantity of their correspondence, can be accessed in Cardinalli (2022, p. 76-77).
• How to cite: Cardinalli, I., & Silva, C. R. (2024). Meanings and representations of “human activity” for occupational therapists in Brazil. Cadernos Brasileiros de Terapia Ocupacional, 32, e3855. https://doi.org/10.1590/2526-8910.ctoAO397138552
• Funding Source
  Coordination for the Improvement of Higher Education Personnel – CAPES – Code 001.

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Edited by

• Section editor
  Profa. Dra. Patrícia Leme de Oliveira Borba

Publication Dates

• Publication in this collection
  10 Jan 2025
• Date of issue
  2024

History

• Received
  19 May 2024
• Reviewed
  31 July 2024
• Accepted
  22 Aug 2024