CONSTRUCT 5: CORE ELEMENTS OF OCCUPATIONAL PERFORMANCE

This construct acknowledges the body-mindspirit interactionist paradigm that has long been recognised as key to physical and mental health and well being (Townsend, Brintnell & Staisey, 1990) (Fig. 6).

Figure 6: Core Elements and their relationship to other constructs in the Occupational Performance Model.

Although each aspect of this construct is described in this section, they cannot be functionally separated, reduced, or understood as unique elements. This is not a new concept in occupational therapy. In 1922, Meyer (1922/1977) advocated this premise by stating, “our body is not merely so many pounds of flesh and bone figuring as a machine, with an abstract mind or soul added to it” (1922/1977, p.640). Instead, he described the process of ‘doing’ and ‘knowing’ as, “pleasurable ease” (1922/1977, p. 640). Although never defined by Meyer, pleasurable ease could be interpreted from the perspective of research in psychoneuroimmunology that has linked alterations of mood, pain and pleasurable response to a variety of both mental and physical activities (Ader & Cohen, 1993; Pelletier & Herzing, 1988). In this model, body, mind and spirit are viewed as core elements both corporeal (physical and tangible) and incorporeal (intangible and without material existence).

Acknowledging the core element of the physical body affirms that within the boundaries of our understanding, aspects of human performance can be described in terms of their smallest known structure such as cells, molecules and tissues. April, 1997, Monograph 1 12

The interaction within and between these structures contributes to occupational performance by providing the intrinsic physical elements required for occupational performance.

Body Element is defined as all of the tangible physical elements of human structure.

The core element of the mind has been conceptualised by theorists in many different forms. Some models of the mind are simple, mechanical and reductionist, and compare the human mind to a simple input-output model. Other approaches attempt to describe the mind by means of biological processes such as neuronal models. Still other models of the human mind are more abstract. Fischbach (1992), for example, equates the mind with consciousness, or a subjective sense of self-awareness. He uses the metaphor of ‘the mind’ as, “a vigilant inner core that does the sensing and moving…and produces urges, moods, desires and subconscious forms of learning” (Fischbach, 1992, p.24-25). Most theorists agree that the product of the mind is thought which, in turn, produces the individual paradigms of reality from which we plan our daily routines, tasks and subtasks.

Mind Element is defined as the core of our conscious and unconscious intellect that forms the basis of our ability to understand and reason.

The notion of spirituality as a fundamental essence of a person was applied to occupations by Egan and DeLaat (1994) who described human spirituality as the essence of a person that is expressed in everyday actions. This view mirrors earlier interpretations of spirituality in occupation as expressed by Meyer (1922/1977) who observed that as people live their life through daily occupations, they concern themselves, not only with the performance of occupations but with deriving meaning from them. Spirituality, as distinct from religiosity, therefore, is not viewed as separate from everyday occupations, but as a part of every level of occupational performance.

Although many idiosyncratic definitions of spirituality have been derived in health literature, three concepts appear to recur and relate to notions of ‘meaning’ (Dossey & Guzzetta, 1994), ‘hope’ (Bruhn, 1984; Dufault & Martocchio, 1985; Fine, 1991; Forbes, 1994) and a sense of ‘interconnectedness’ (Canadian Association of Occupational Therapists, 1991). The link between human occupations and meaning is at the heart of ‘purposefulness’ of life.

Within the Occupational Performance Model (Australia), spirituality is expressed in all constructs. At the level of occupational performance routines, tasks and subtasks it contributes to the person’s perception of meaning and purpose when creating, thinking about, and doing desired and needed occupations. People, in carrying out occupations either in thought or action feel compelled to create and develop their inner purposefulness (Breines, 1989; Urbanowski & Vargo, 1994). At this level, where occupational performance is not perceived as having purpose, it becomes meaningless, lacking ‘spirit’. Philosophers have suggested that loss of meaning is perhaps the greatest personal and collective crisis facing people in everyday life (See for example, Frankl, 1959; Fromm, 1968; Marx, 1932/1977; Popper, 1981; Trueblood, 1951). For example, Trueblood (1951, p.49) stated, “What is terrible for men and women is the conviction that they are not needed, that they contribute nothing, and that their lives add up to no enduring meaning”.

At the component level in the Occupational Performance Model, spirituality, as defined through meaning and hope, contributes to cognitive operations that involve imagination, decision-making and the ability to reflect. Intrapersonal aspects of meaning and hope relate to notions of a personal locus of control, intention, will, motivation. Interconnectedness is fundamental to the desire for and the development of interpersonal operations that simultaneously satisfy a personal need and ‘fit’ with the external social world.

At the level of occupational role performance, spirituality in terms of personal meaning, connectedness and hope contribute to the ‘being’ dimension of roles and the satisfaction derived from carrying out chosen or needed roles.

Feeling hope through an imagined future is a dimension of time. Reminiscence through time gives people a connectedness with their past and affirms perceptions of their life meaning. Ultimately, peoples’ personal life stories, embedded in occupation, allow them to connect Occupational Performance Model (Australia) 13 to universal visions of themselves, as they are liked to whole societies, cultures and traditions.

Early in the history of the profession, spirituality was recognised as an integrated aspect of human function and inseparable from mind/body elements. Subsequent development in the profession has devalued this aspect of human function to the point where it is ignored. This model does not view spirituality as one human subsystem, but a fundamental core element that is embedded in all aspects of occupational existence. It is viewed as being highly personal, and at the same time, linking people to others and allowing them to create their own personal notions of humanity. Spirituality refers to the existential aspect of humans that acknowledges an existing ‘mystery’ to life. The acknowledgment of a spiritual dimension presupposes that humans engage in reflection on the nature and meaning of their lives (Canadian Association of Occupational Therapy, 1991; de Rozario, 1994). Many myths and beliefs are expressions of spirituality. Some authors suggest that these are our attempts to explain the world to ourselves. What this construct acknowledges is the experience of consciousness, of will and of harmony that influences every aspect of human performance (Kuhn, 1962; Popper, 1981). For centuries, philosophers have linked the spiritual dimension of humans with the development of ethical contexts for human behaviour which in turn, is linked to many of the sociocultural norms that determine how we perform daily occupations.

Acknowledgment of a spiritual dimension to human occupational performance in this model is not a rejection of physicalist explanations of human behaviour, but an affirmation that at this stage in human knowledge development, physical explanations are incomplete.

Spirit Element is defined loosely as that aspect of humans which seeks a sense of harmony within self and between self, nature, others and in some cases an ultimate other; seeks an existing mystery to life; inner conviction; hope and meaning.

Together the body, mind, and spirit form the human body, the human brain, the human mind, the human consciousness of self and the human awareness of the universe (Popper, 1981). Relative to occupational performance, the bodymind- spirit core element of this model translates into the ‘doing-knowing-being’ dimensions of performance. These doing-knowing-being dimensions are fundamental to all occupational performance roles, routines, tasks and subtasks and components of occupational performance. That interaction can occur between the core elements is illustrated by dotted lines contained within this level of the model. The arrows which link the Core Elements to the Occupational Performance Components (Fig. 6) reflect the influence between the core elements and other levels of the model.

Analysis of Occupational Performance: Core Elements of Performance

Analysis of occupational performance at this level makes reference to:

• specific body system pathology that interferes with occupational performance such as swelling, soft tissue shortening, inflammation, compromised cardiovascular system pathology, compromised respiratory system pathology and other compromised body systems.
• specific pathologies of the mind which arise from compromised central nervous system function and interfere with occupational performance such as disordered neuronal transmission, brain damage and disordered neurochemistry.
• specific pathologies of the spirit which interfere with occupational performance such as loss of hope, loss of resolve, loss of ‘connectedness’, loss of purpose