The contributions of Jane Addams on the development of occupational therapy

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The contributions of Jane Addams on the development of occupational therapy

Rodolfo Morrison

University of Chile

Santiago, Chile



Abstract

In 1915, the first occupational therapy school was founded by Jane Addams at Hull House (Chicago, USA). In that process, Addams inspired the first generation of occupational therapists, especially Eleanor Clarke Slagle. Thus, this article seeks to highlight the contribution of Jane Addams to the development of Occupational Therapy through an in-depth bibliographic review, from primary sources. Thereby, this article is divided into two parts. The first part explores the relationships within the foundation of occupational therapy at the Hull House, in the early twentieth century. In this context, female vindication in the United States started when middle-class women began to carry out a series of public activities, which separated them from their traditional roles. As a result, the relationships and influences between the residents of the Hull House and the first occupational therapists in Chicago were identified. The second part takes into consideration some reflections on some Jane Addams influences in the development and current identity of occupational therapy, mainly in one of its collaborators, Slagle. Jane Addams was a role model for many of the first occupational therapists, especially for Slagle. She learned from Addams her tenacity and leadership skill, central aspects for the first school of occupational therapy foundation. Also, Addams, as a pragmatism philosopher, extended ideas that prioritizes practice by theory, not in a segmented dichotomy, but from a holistic perspective, through which each one is constantly presented, which gives the basis of doing and knowing as professionals in the occupational therapy field. On the other hand, pragmatist conceptions invite us to create a reality consistent with the maximum utility of the ideas and beliefs of our society. Some of these aspects are valid in the current practice of occupational therapy. Today, more than 100 years after its foundation, occupational therapy has much to learn yet, from the philosophy of Jane Addams.

Keywords: history of science; pragmatism; professional identity; progressive era; United States of America

Родольфо Моррісон

Чилійський університет, Чилі

Внесок Джейн Аддамс у розвиток соціотерапії Анотація. У1915 році Джейн Аддамс заснувала першу школу соціотерапії в Чикаго, США. У цьому процесі Аддамс надихнула перше покоління соціотерапевтів, особливо Елеонор Кларк Слагл. В цій статті висвітлюється внесок Джейн Аддамс у розвиток соціотерапії через поглиблений бібліографічний огляд першоджерел. Стаття розділена на дві частини. У першій частині досліджуються основи соціотерапії на початку двадцятого століття. У цьому контексті реабілітація жінок у Сполучених Штатах почалася, коли жінки середнього класу почали виконувати низку робіт, які відрізняли їх від їхніх традиційних занять. У результаті було виявлено стосунки та взаємозв'язки між мешканцями школи та першими соціотерапевтами в Чикаго. В другій частині представлені до уваги роздуми про вплив Джейн Аддамс на розвиток і сучасну ідентичність соціотерапії. Джейн Аддамс була взірцем для багатьох перших соціотерапевтів, особливо для Слейла. Вона навчалася в Аддамса своїй наполегливості та лідерським навичкам, центральним аспектам першої школи соціотерапії. Крім того, Аддамс, як філософ прагматизму, поширювала ідеї, які віддають перевагу практиці через теорію. З іншого боку, прагматичні концепції закликають створити реальність, яка відповідає максимальній корисності ідей і вірувань нашого суспільства. Деякі з цих аспектів справедливі в сучасній практиці соціотерапії. Сьогодні, більше ніж через 100 років після заснування, соціотерапія має ще чому навчитися у філософії Джейн Аддамс.

Ключові слова: історія науки; прагматизм; професійна ідентичність; прогресивна епоха; Сполучені Штати Америки



Introduction

Jane Addams philosophy is not widely known in the training of occupational therapists in Latin America (Colegio de Terapeutas Ocupacionales de Chile et al., 2015; Morrison, 2016a; Morrison, 2016b; Morrison, 2022). However, there are different elements that are highly relevant and that relate to the foundation of the profession that is inspired by her philosophy and figure. Therefore, this article, written by a Latin American author, has reviewed ancient writings and other texts related to the origins of occupational therapy, and has set out the objective of recognizing in Jane Addams an exemplary and crucial figure in the constitution of the profession. And therefore, a character necessary to publicize in the formation of the discipline.

For this purpose, this paper will be divided into two parts, the first exploring the relationships within the foundation of occupational therapy at the Hull House, in the early twentieth century in Chicago. For this, an in-depth bibliographic review was used, from primary sources, identifying the relationships and influences between the residents of the Hull House and the first occupational therapists in Chicago. sociotherapy rehabilitation chicago society

Jane Addams was a role model for many of the first occupational therapists. Thus, the second part considers some reflections on some Addams influences in the development, practice, values and current identity of occupational therapy. This reflection focuses mainly on one of her collaborators Eleanor Clarke Slagle, who would have worked closely with Addams.



First part: Foundation of occupational therapy at Hull House

The Chicago Civic and Philanthropy School was supported by a group of women belonging to one of the most influential social settlements of its time, the Hull House. This place was founded by Jane Addams and Ellen Gates Starr in 1889. Many influential women of the time such as Julia Lathrop participated in its operation. Many young women, mainly driven by the feminist movement, participated in this place (Addams, 1912). This place is very relevant, since Eleanor Clarke Slagle founded the first vocational school of occupational therapy in 1915. But, to understand this milestone, it is necessary to review the influences that allowed women to think that their work could be formalized in a context where androcentrism was present.

Addams, Starr, Lathrop and Slagle belonged to the first generation of women who exchanged "volunteering" for professional work. Women who worked without compensation began to leave their homes and managed to validate their professional activity by giving them a place in society. This happened in the feminist context of the time.

In the so-called second wave of feminism, between the end of the 19th century and the beginning of the 20th century (Freedman, 2003), political actions were directed towards more than the achievement of the right to vote for women. The change of the legislation, the economy and the society itself was sought (Miranda, 2007). Women sought the emancipation of the male yoke and end inequality between gender roles.

Thus, female vindication in the United States was accentuated in the midnineteenth century, when middle-class women began to carry out a series of public activities, which separated them, little by little, from their traditional roles (Quiroga, 1995). This movement was gestated along with the development of the Industrial Era and to the extent that the rural Christian Era began to be replaced (Metaxas, 2000).

When Addams and Starr founded the Hull House, the social settlement considered “the heart of women's reform in Chicago” (Quiroga, 1995, p. 37), this institution contributed to the political, professional and labor training of many women, in addition to provide support to hundreds of families, mainly immigrants, in the context of the industrial era (Addams, 1912; Addams, 1916; Knight, 2005; Kuiper, 2010; Miranda, 2007). And one of the objectives of the Hull House was to create a bond between women, and some progressive middle-class men with groups of poor people and immigrants, who were part of the industrialized city of Chicago (Addams, 1912).

In charge of Addams the Hull House led the movement of social settlements in the United States, and expanded the domain of “the feminine” redefining new roles for thousands of women, who began to leave more and more of their homes (Wade, 2005). In 1911, there were 215 social settlements, and 53% were female only (Quiroga, 1995, p. 35). This motivated many women to take on new roles and empower themselves in the face of social reforms in the country.

In this process the pragmatist philosophy was an important and constituent ideology of the Hull House and the entire progressive movement that would have found the occupational therapy. The feminist movement and its objectives of vindication of women found a theoretical support in pragmatism, which promoted constant reflection on the notions of truth; in turn, pragmatism found in the Hull House the “start-up” of many of its ideas about social transformation. Many pragmatists at the University of Chicago, including John Dewey and George Herbert Mead, put their ideas on social change and reforms into practice at Hull House, thanks to Addams and Lathrop.

The Hull House, in addition to being the main center of pragmatism operations, was a meeting point for other ideologies and movements that would lead to what we know today as occupational therapy.

In 1897, the Chicago Arts and Crafts Society was founded, organized in the Hull House by Rabbi Emil Gustave Hirsch and Julia Lathrop, in response to the diseases generated by the industrial revolution (Breines, 1986a; Breines, 1986b; Breines, 1992; Metaxas, 2000). Since then, a series of artistic and craft began to be studied as a way to resist the industrial era, seeking to achieve one of the objectives of the Society: to recreate the ideal of artisans (Quiroga, 1995). The arts and crafts movement sought to reposition the value of artisanal work in the industrialized era at the beginning of the twentieth century (Hopkins et al, 1998) humanized work and the activities carried out by workers.

Social activists, aligned to pragmatism, claimed that the occupation was a means to promote and restore health (Breines, 1986a), so many workshops were opened in the community in specific areas, such as pottery, metal, glass, wood and textile products. Craft work would provide opportunities for the working class to experience productive and meaningful activities, preventing and fighting against alienation generated by the industrial era and modern life (Quiroga, 1995).

Addams and Lathrop, as well as Dewey and James, believed that education was essential to change social or inequality situations, so they founded a museum in the

Hull House to instruct and educate different citizens about the importance of craft work (in opposition to industrial work); in this way, “a continuous reconstruction of the experience” would be favored (Quiroga, 1995, p. 41).

Julia Lathrop who, in addition to belonging to the Hull House, worked in arts and crafts, was one of the first to relate this movement to Mental Hygiene. She sustained the need to reform treatments for people with psychiatric illnesses, so her ties with the director of the Chicago Civic and Philanthropy School led to different courses on occupations, occupations and mental health. From this perspective, more than just an “influence”, the arts and crafts movement is crucial for the development of occupational therapy, mainly because of its political actions.

Lathrop can be considered, along with Addams, as one of the most unknown female figures for the official history of occupational therapy. In the Hull House, thanks to the contributions of Lathrop (Addams, 1935) and Addams (Breines, 1986a; Breines, 1986b; Breines, 1992) occupational therapy began to develop, which took special force when Eleanor Clarke Slagle (Quiroga, was integrated) nineteen ninety- five).

In 1893 Lathrop met Adolf Meyer (psychiatrist and recognized as one of the founders of occupational therapy) and invited him to join the Hull House and support his social causes. Meyer, who was 26 years old at the time, is very surprised to meet Jane Addams. Lathrop and Meyer formed a strong alliance to respond to the criticisms of the time about the absence of “science” in the “new methods” used in psychiatry (Addams, 1935). This may have been one of Meyer's main motivations to begin investigating the relationship between occupations and the balance in people's lives.

Lathrop contributed to many of these investigations to examine how mental health interventions are performed and the development of social programs. Due to these works, which are generally ignored by the official history of occupational therapy, attributing only theoretical development to Meyer.

Lathrop continues to work with Addams, Dewey and other members of the Chicago Civic and Philanthropy School where a social work program was offered that lasted two years and chaired by Graham Tylor (1851 -1938) (also had the influence of Clifford Beers, with whom she was on the National Mental Hygiene Committee). Thus, as Lathrop and Hirsch introduced a training course in occupations as we noted earlier.

Taylor, the director of the School, and very close to Lathrop and Addams (Deegan, 2005, p. 114), convinced the state hospital to finance the special course of Healing and Recreational Occupations, which was aimed at nurses and staff linked to the health area. One of the innovations of this course, in addition to the methodology, was the abandonment of the term “custody” concept used for long years towards the patients, for a new one: education (Quiroga, 1995, p. 50). For the development of occupational therapy in the hands of Slagle this course developed at the Hull House would be central.

When she was 34, Slagle began studying social work, a career taught at the Hull House, being her mentors Addams, Starr and Lathrop, among others and other important representatives of the “social school” of Chicago (Frank, 1992; Loomis, 1992; Suzuki, 1982). Here, I would begin to take a series of courses based on therapeutic occupations and be closely linked with the women of the Hull House. This link led her to lead a group of students in a summer course “Occupations for the sick ” in New York in 1909 It is unknown what Slagle's first link with the Hull House was. Most documents indicate that she did a first course with Lathrop and Addams in 1911 (Bing, 1981; Metaxas, 2000; Frank, 1922; Kielhofner, 2009; Pollard et al., 2009; Sanz & Rubio, 2011), but Slagle refers in a 1936 document (a) that led a group of students to New York to take a course with Julia Lathrop in 1909. It is strange that she was not part of this course, either as a student or instructor. Most likely, since her integration into the Hull House she was in constant training in “therapeutic occupations” and formally enrolled in the course of 1911. In another document of 1934 (c) she states that “the School of Civics and Philanthropy from Chicago, in 1908-1909, she gave a summer course in occupational therapy and recreation, which seems to have been the first in this field” (p. 291). But it is not clear if she participated in the course, or at what level it was linked, or if it is the same course referred to two years later. (Slagle, 1936).

However, it was in 1911, when she was about 40 years old, that she began to be interested in health reform driven by the mental hygiene movement. Advised by Addams and Lathrop, Slagle takes the course “Curatives occupations and recreations ” at the Chicago Civic and Philanthropy School, belonging to the Hull House and taught by Julia Lathrop and Rabbi Emil G. Hirsch (Bing, 1981; Metaxas, 2000; Frank, 1922; Kielhofner, 2009; Pollard, Sakellariou, & Kronenberg, 2009; Sanz & Rubio, 2011). The methodology of this course was very innovative for the time, the students learned through theoretical readings and received training in trades, as well as clinical experience. Also, she sought to teach how occupations allowed the muscles and mind to work together, which was reflected through games and exercises. This course had been taught since 1908 and was aimed at both nurses and hospital assistants and was supported by Adolf Meyer (Addams, 1935; Loomis, 1992; Quiroga, 1995).

When she finished the course, Slagle worked in different hospitals in Michigan and New York where she organized, executed and subsequently analyzed her re- educational classes for people with serious mental illnesses. These classes, which were considered a type of treatment through activities, were created by incorporating the knowledge of Lathrop and other mentors. Therefore, together with her excellent performance and outstanding participation, in 1912 she administered the fifth session of the course (Loomis, 1992).

Little by little, the recognition for her work in the application of occupations as an educational treatment was growing, and her contact with the leaders of the mental hygiene movement and recognized characters who spoke about the “therapeutic occupations” was increasing. Her innovative method of reeducation led her to lead the first department of occupational therapy in Baltimore at the Henry Phipps Psychiatric Clinic of Johns Hopkins Hospital, led by Meyer (Breines, 1986a; Metaxas; 2000, Quiroga, 1995; Suzuki, 1982).

Meyer, who had been attending the Hull House for a while, asked Lathrop for a person to help him organize the city's first occupational therapy department. Lathrop, without hesitation, urged Slagle to work with him (Loomis, 1992). Later Meyer would point out that Slagle was a model in the service of occupational therapy (Meyer, 1937).

Working with Meyer, she developed the first method of occupational therapy intervention, training in habits, which sought a balance between work, rest and play.

This method was based, in part, on the theoretical foundations of the pragmatism of Addams, James, Dewey, Peirce and Mead, from their theorizations about habits, demands of the environment, creativity and experience within their meanings for individual change and social (Bing, 1992; Breines, 1986a; Breines, 1986b; Kielhofner, 2009; Loomis, 1992; Pollard, Sakellariou, & Kronenberg, 2009; Sanz & Rubio, 2011; Suzuki, 1982). In this way, Meyer recognized her as the first to systematize a method of training in occupations during her stay at the Psychiatric Clinic, applying a systematized activity in the pavilions of an institution. Also, he pointed out that his proposal to combine clinical work with visits to the homes of patients was very helpful for his theories (Meyer, 1922; Meyer, 1937). In addition, during the period in which Slagle remained at the Meyer institution, it began to be valued as the first elite hospital of medicine in the United States, becoming a model for hospital center recommendations (Frank, 1992).

Slagle significantly improved her methods by working with Meyer. Her technique was aimed at “reeducating” patients with chronic diseases and sought the development of new “decent”, “worthy” and necessary habits for life; as well as the substitution of harmful habits within an individualized program, whereby new ways of replacing these habits for “better” ones or those that benefit health (Slagle, 1944) were investigated.

While working with Meyer for two years (1912-1914) (Bing, 1981; Bing, 1992; Frank, 1992; Sanz & Rubio, 2011), she began to interact with a well-known psychiatrist, William Rush Dunton, and with his wife Edna Dunton, a who visited frequently Slagle and Dunton would have met at a meeting of the American Medical-Psychological Association in Baltimore (Quiroga, 1995; Sanz & Rubio, 2011). (Suzuki, 1982). Thus, they began to formulate the idea of organizing an association that promoted the use of occupations as a treatment, so, and following the division of gender roles of the time, Dunton worried about being a spokesman and diffuser through scientific articles , books and papers at medical conferences explaining the theoretical relationships between occupational therapy and psychiatry, including Meyer's theoretical contributions; while Slagle was responsible for increasing their clinical experience and promoting occupational therapy through women's social networks, formal institutions and at the political level, and conducting different consultations to Dunton at the Sheppard Pratt Institute on occupation, in addition to publishing different writings, from scientific articles (Breines, 1986a; Quiroga, 1995), conference proceedings, editorials, and government reports to bibliographic reviews.

In 1913 she attended the Maryland State Conference on Mental Hygiene meeting, where she met again with Graham Taylor, director of the Chicago Civic and Philanthropy School, whom she met at the Hull House. Taylor, after visiting the clinic in which Slagle worked, said he was “amazed”, an assessment that he would transmit in a letter to Julia Lathrop, indicating that there was mixed “work, science and sympathy” (Taylor, 1913 in Quiroga, 1995, p. 46). Slagle suggested to Taylor and Lathrop (who was the vice president of the School in that period) the importance of the continuity of the course that both taught, arguing that in the coming years the demand for professionals trained in occupational therapy would increase considerably (Quiroga, 1995).

Thus, Taylor saw the importance of occupational therapy in mental health, but also in its possible applications in the prevention and treatment of people with tuberculosis. As a result, in 1914, he invited Slagle to return to Chicago to give a series of lectures on occupational therapy at the School of Civics and Philanthropy. Thus, she began to participate, full time, in the expansion of occupational therapy and mental health reform movements, integrating herself into the mental hygiene movement (James, 1971; Metaxas, 2000; Pollard, Sakellariou, & Kronenberg, 2009; Quiroga, 1995).

Under the support of the Illinois Society for Mental Hygiene, Slagle began teaching community workshops for unemployed people with chronic diseases to strengthen their occupational skills. Initially, the Experimental Station as the workshop was called, was aimed at people with chronic mental illness; However, the demand grew considerably, so the workshop was opened to people with different degrees of physical disability and personality disorders, among others (Pollard, Sakellariou, & Kronenberg, 2009; Quiroga, 1995; Sanz & Rubio, 2011).

Finally, in 1915, integrating the feminist movement, pragmatism and Addams influences, Slagle would found the first professional school of occupational therapy in the United States, belonging to the Hull House and under the jurisdiction of the Illinois Mental Hygiene Society and the support of Jane Addams (Breines, 1986a, Gordon, 2002; Pollard, Sakellariou, & Kronenberg, 2009; Sanz & Rubio, 2011). Thus, Slagle would be known as: “Jane Addams of occupational therapy ” for her great contributions to the profession (Metaxas, 2000; Quiroga, 1995).

This first school, The Henry B. Favill School of Occupations was established in the occupational department of the Illinois Mental Hygiene Society and in 1917 this School was named after Dr. Favill, a Chicago physician who worked in preventive medicine, public health and civic reform. In addition, she was the first vice president of the Society and supported the constitution of the occupational department (Loomis, 1992; Pollard, Sakellariou, & Kronenberg, 2009).

Under the direction of Slagle, the courses of the School began to incorporate contents of medical instruction, physiology, psychology and sociology, at the same time as arts, crafts and physical recreation. Its objective was to train students for work with people with mental and physical illness, disabled soldiers and school-age children with learning disabilities (Slagle, 1934a). It followed the particular style of the Hull House, which was unique. In addition to training professionals, she was dedicated to helping people with disabilities through their workshops. These workshops worked during the time that the School offered professional training.

Dunton noted that the School was the best place in the United States to train occupational therapists, who served as assistants in post-war reconstruction. He also indicated that the other schools that appeared later, such as those in Boston, Philadelphia or New York, took as an example the one that Slagle founded. The School trained virtually all "reconstruction aides" in the Midwest under the direction of Slagle.

Observing the evidence of the work, the Mental Hygiene Society began to be interested in the role of occupational therapy for patients with tuberculosisWhere the occupation was applied to teach guidelines in the daily routine, which helpe d in the improvement of patients.. Thus, their programs were complemented, both in training for people with physical, mental illness, work with disabled soldiers, as in the treatment of children with disabilities of school age (Pollard, Sakellariou, & Kronenberg, 2009). Together with men and women involved in the mental hygiene and tuberculosis movement and with philanthropist women's groups, who financed their projects, Slagle made alliances with physical rehabilitation hospitals, clinics and psychiatric hospitals, and with many nurses, among which her relationship with Susan Tracy (Metaxas, 2000), in order to extend the novel occupational therapy.

Slagle remained in Chicago for some years (until 1922), dedicating herself to creating contacts with other cities, where different people began to argue that this “new therapy” could constitute an autonomous professional field (Quiroga, 1995, p. 52). Thus, it was the basis for the organization of the foundation of the profession in 1917. Together with Dunton, they met a group of professionals in Clifton Springs (New York) and welcomed other doctors and activists who supported occupational therapy, like Herbert Hall, George Barton and Meyer (Pollard, Sakellariou, & Kronenberg, 2009, p. 124).

Part Two: The Jane Addams effect on the values and identity of occupational therapy

Some learning about Jane Addams' philosophy, applied to occupational therapy, is expressed in different ways.

From the proposals of the interclass spaces, occupational therapy has considered diversity as one of its core values. This aspect has been valued since the creation of the discipline in the Hull House. In this sense, Addams was hardly criticized for validating, in the same way, the opinions of migrant women as important representatives of the city, because she considered that the power of democracy involved listening to those who had no voice in all the processes of taking decisions.

This is linked to lateral progress. Concept that has allowed us to understand social development from an ethical and mutual perspective.

Jane Addams has invited us to understand that it is possible to build realities from the social questions of what we have been told reality is. From their perspective, it is possible to reflect and criticize the “given reality” to propose alternatives, always from their social ethical perspective.

For Addams, the truth is a social construction that obeys rules agreed by people and that they develop based on problems, so they should not, in any sense, stay, if it is obstructing the development of society (Addams, 1899).

He understood that social inequalities represented learning and habits rooted in society, which, with effort, could be modified (Addams 1902, 1916). This has been another of the central elements for the practice of occupational therapy since, from the

beginning, the first therapists began to work with displaced people excluded from society, and with whom “no one else” wanted to work. An example of this is Slagle's work in psychiatric hospitals, where she managed to advance in an occupational treatment for patients who had unfavorable prognosis.

Along with these lines, the proposals for social reconstruction are central to the values of occupational therapy. Understanding that social segregation can be understood as an established belief as much as a habit, following the logic of pragmatism, it is a basis for understanding what can be modified, in the way we question them and stop taking them for granted.

In this sense, inequality, from their perspective, occurs when a small group imposes its truth in a non-democratic space. Therefore, the development of a dialogue and active listening, apart from a comprehensive understanding, is central to the processes of social transformation. Perhaps, this is one of the most consistent elements that occupational therapy has inherited from its vision, since the way in which the profession has been related to its patients establishes that premise as a foundational condition. For example, from a perspective that involves social ethics, occupational therapists have learned active listening, without making value judgments, refining our conceptions of “good or bad” a priori.

Addams suggested that there is no single religious or moral truth, but there is consensus and ethics that should focus on the mutual benefit of social classes and individuals (Addams, 1895, pp. 183-204). This has been expressed in the ways that occupational therapy has developed its world view.

In Addams's proposal, theorizing and putting into practice, and vice versa, was a recursive, dynamic and constant process, since it was of no use just theorizing without making a real contribution to society. This is another aspect that occupational therapy has taken into account.

Another of the central aspects is her radical pragmatism, expressed in her support for the labor movement, in the feminist revolution of the time and in the pacifist movement. Many occupational therapists were trained in this context, observing how Addams was able to gather large masses of people and fight for the rights of people.

Following the above, there are principles that guided its practice, among them: teach by example, practice cooperation and practice social democracy (Addams, 1912).

In another of her writings, Slagle notes that Jane Addams and Julia Lathrop were important figures and pioneers in social work and in the usage of therapeutic occupations. And that occupational therapy programs had a great development in Illinois thanks to the two of them along with Adolph Meyer (Slagle, 1936). The latter would have been the influential one for the occupations to be applied more and more into clinical settings (Slagle, 1934c).

Addams' example led to Slagle worrying about valuing women's work. She never hesitated to make public recognition in her role as a speaker (Slagle, 1929), and invited them to integrate into the world of work. Initially, she suggested that older women were the most suitable for working with mental patients (Slagle, 1922), with time she would broaden her gaze towards younger women and men (Slagle, 1936). Concluding that the most relevant is the responsibility and take the great weight that means working with other people, and not only the skills you have, but the character and understanding the behavior as symptoms in a scientific way.

Thus, she would defend the formation of women groups, indicating that many have proven to be brilliant, always to be alert and that they have developed excellently in the clinic receiving many gratifying compliments for their intervention in hospitals. In addition, thanks to them, occupational therapy is being more recognized, Slagle (1934a) said.

For pragmatists, a theoretical thought is political per se. An ideal must be justified from theory, practice, and above all, from social action. Addams' approaches are an example of this. Her type of pragmatism is linked to a political and social movement and has great similarities with Slagle. Both women, pioneers in their respective fields of action, performed critical reflection and practical application as a whole, away from the theory / practice dichotomy.

Addams served as an example for Slagle in two aspects, first as previously reported, as a female figure with power and leadership characteristics; and second, to build an epistemology based on one's experience. And it is that both women combine in their writings: life experiences with philosophy and social movements. Addams' social ethics and life experiences influenced all of Slagle's theoretical practice and development.

According to Addams (1902), social ethics is achieved to the extent that citizens take charge of it. Slagle knew this, so her occupational therapy sought to validate people with mental illness as members of society “people”, which was not considered at that time. As for Dewey, James, Mead and Peirce, for Addams, habits are responsible for human behavior and especially for social inequalities (Addams, 1902; Addams, 1916).

The integration of people with mental illnesses and other disabilities into society is the way through which Slagle approaches Addams' social ethics, contributing to the change in the “ideas / habits of truth”. For Addams (1895) the expression and visibility of minorities contributes to social equality, facilitating respect and dignity in society. Slagle advocates the integration of people with mental illness promulgating Addams radical pragmatism.

Addams' radical pragmatism that defies established power structures, changing social reality, is one of the characteristics of Slagle's exercise. Thus, she denied the option that patients lived in degrading conditions, which she argued, led to types of behavior that disturbed the structure of their personality (Guillette, 1973, pp. 51-130). This is why she promoted their social adaptation defending their rights and dignity, from the pragmatic foundations of equality and respect and under the possibility of the permutability of ideas. For both Slagle and Addams, the practice is a priority for social equality and will be the one that nourishes and sustains the theory, as well as the development of new habits will favor social equality.

Slagle defended the rights of children (Slagle, 1934b) and struggled to eliminate back yards, that is, hospital rooms where patients with unfavorable diagnoses were kept (Slagle, 1922); she also used the concept of “habilitation” instead of “charity” (Breines, 1986b) and ideas also adopted by the activists, regardless of their faith and that in their usual practices they used therapeutic occupations and sought social equality.

In one of her writings, Slagle (1936) asks about the challenges of occupational therapy in the social context. It addresses the gender perspective to ask if all women (their patients) are satisfied with their life and domestic work or in “the field of sewing”, wondering if the occupations that are being used are the most suitable for them.

In this way, she continues to wonder what a sick person is. If a sick person is equal to someone unhappy, and if this is so, how different are they from the hospital patients to an ordinary person? And what would happen if they were replaced by “normal people”? Are there any differences? Slagle wonders what we consider “normal” or not, questioning the reality and established structures, and suggesting that occupational therapy can take care of these issues.

In her professional performance she was able to realize that when working with people with mental illness, the prejudices quickly dissipate, and it can be seen that they are “people like any others”, and that many of the prejudices of society are those that limit their integration. Thus, the occupations employed from a gender perspective are also questioned, implicitly arguing that the most relevant thing is how a person is happy doing the occupation she wants, and not an occupation imposed without considering their opinion.

These approaches, which are the basis of current occupational therapy, make us recognize Addams and Slagle as two of the most relevant women in disciplinary development and value their life and work, recognizing the influence of pragmatism in their occupational therapy.

Discussion

Addams and Lathrop were two exemplary women for many occupational therapists who followed suit and observed that there were female models that could influence public policies, contribute to social reforms and make theoretical developments in different areas of knowledge.

Occupational therapy was formulated as a product of the intersection between a series of social movements and ideologies, such as the arts and crafts movement and mental hygiene. At first, teaching arts and crafts to people with mental illness meant that the occupational therapist should possess skills as an educator (Johnson, 1919; Slagle, 1936), as well as knowledge of nursing and health care (Tracy, 1910). All this suggested that the profession was oriented towards a new generation of professional women (Metaxas, 2000).

From this perspective, the arts and crafts movement plays a central role in the development of therapeutic occupations. The first occupational therapists treated many patients with neurasthenia (a feeling of exhaustion caused by excessive work and overpopulation). Thus, occupational treatment was linked to the arts and crafts and when scientifically based, occupations began to be understood as "therapy", and not only as “treatment” Mainly, because it meant a strategy and a systematization in the way of using the occupation. In the moral treatment, occupations for patients were used according to the needs of the hospital (product marketing); Thus, the work itself was understood as beneficial, so it did not necessarily need a graduation or guidance. With the arts and crafts movement, the perspective of interest on the part of the patients was added. But with occupational therapy, the scientific foundation that validated occupations as a rehabilitative treatment was integrated, focusing on them as a means and not as an end. (Gordon, 2002; Laws, 2011). Along with the publications of medical men, pragmatist women, social workers, nurses and educators, were responsible for expanding occupational therapy throughout the country, which had an exponential boom when World War I broke out (1914-1918).

Occupational therapy has inherited from Addams pragmatism the value for practice in the production of scientific knowledge and the understanding of exchanging ideas, which has led it to reconstitute itself in more than one occasion (Morrison, 2021a; Morrison, 2021b). But, in this way some of the initial approaches have been lost, such as the consideration of Addams' social ethics or the aspects of Mead's social psychology. But, with the support from organizations and institutions of people with disabilities and their struggle for social acceptance and inclusion, they have begun to consider apparently hidden values during the boom of biomedical neopositivism in the mid-twentieth century, where the sole purpose of Occupational therapy was to recover the functionality of a “dichotomized” body in mind and matter, that is, increasing the range of joints or decreasing psychiatric symptoms without considering the subjective state of well-being of the person.

The return of pragmatism to the discipline is a path that different occupational therapists have already begun to travel a few years ago, but that has not yet been incorporated into the professional training of some universities, which is expressed in the lack of the concept in the main articles and official publications of the profession.

It does not stop attracting attention, that for more than a century, the pragmatist philosophy remains in force from its initial foundations and how, in these last decades, this philosophy is regaining more strength If compared to previous years. This pragmatism, based on the influences from Mill on utility, from Kant on the regulatory ideas of practical exercise, and from Darwin on evolution and constant change, led the first pragmatists to suggest that ideas are constructed describing ways of referring to the world, which would be true depending on its usefulness and not “the world as it is”. The ideas would correspond to an evolutionary strategy and would have allowed knowledge to develop in different ways over time, which implies that this knowledge is constantly changing. The above ensures that our ideas and conceptions about the world change frequently, which allows us to conclude that ideas are instruments of adaptation to the world.

These approaches are completely consistent with the professional practice of occupational therapists, firstly because of the work we do with people and communities, which implies endorsing, respecting, and often defending different conceptions of the world, involving the therapist as a professional being that redefines themselves in the relationship with clients or patients. And second, because of the value of the practical experience that, as Slagle postulated, it should constitute a professional exercise based on evidence, which places the pragmatist idea that prioritizes practice by theory, but not in a segmented dichotomy, but from a holistic perspective, in which each one is constantly present, which gives the basis of doing and knowing as professionals.

On the other hand, pragmatist conceptions invite us to create a reality consistent with the maximum utility of the ideas and beliefs of our society. This maxim involves the approaches of Addams, Dewey, Mead, James, Peirce and Slagle and guides the construction of a democratic, pluralistic and inclusive society, implying that occupational therapists are active and permanent agents in social transformation and democratization of our communities.

These ideas are based on the fact that knowledge is flexible, fallible and contingent, so it is impossible for it to be theoretically neutral, without time or independent of a particular historical or political context (Hooper & Wood, 2002). This implies that occupations such as doing science, politics, philosophy, or without going any further, occupational therapy, are spheres of the human - actions - and as such, based on transient, situated and mutable epistemological premises.

Following this idea, Slagle's pragmatist view allows us to reflect on the impossibility of eliminating individual values in professional practice and to consider that our individual and social values are an inherent part of our clinical practice, which rejects neo-positivist ideas. biomedical on the professional / personal dichotomy and on the absence of emotions and feelings in the professional role.



Conclusions

Although occupational therapists are not trained in philosophy, except in the aspects concerning the reflections on human occupation, they do share some common objectives with the philosophers, as Dewey and Addams could have raised. Philosophers, like occupational therapists, must be critical of the facts and social conflicts that are linked to our fields of action, favoring the democratic function of knowledge while maintaining social transformation as an ideal.

Dewey, Addams, Peirce, Mead, James and Slagle shared the idea of active criticism and thoughtful thinking, which was the basis of their respective careers. Occupational therapists must approach philosophy to obtain answers about our theoretical and practical professional practice. This first generation of occupational therapists, such as Slagle, Tracy, Johnson and Dunton, maintained an active and constant reflection on the profession, an inheritance that from time to time ten ds to overlap.

I think there is a first step, since pragmatism has been taught, although within the “hidden curriculum” of the discipline. Not with referents or explicit names, but in the holistic and focused on the subjectivity of patients. Of course, this should be strengthened by reviewing the pragmatist bases, which in one way or another, are also the roots of occupational therapy.

On the other hand, I consider it clear that both Tracy and Slagle and their references to pragmatism were not taken into account due to androcentrism. Both referred to pragmatists like Addams, Dewey and James, but were not considered.

Therefore, androcentrism limited the understanding of the theoretical foundations of occupational therapy. Today, more than 100 years after its foundation, occupational therapy has much to learn, again, from the philosophy of Jane Addams.



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