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Australian Occupational Therapy Journal (1999) 46, 1–11

Feature Article OA 174 EN

Reflections on doing, being and becoming*

Ann Allart Wilcock

School of Occupational Therapy, University of South Australia, Adelaide, South Australia, Australia

Occupation, and its relationship with health and well-being, is very complex. It can be described in many
different ways by the profession within which it is so central that it provides its name. A simple way to talk about
occupation that appears to appeal to a wide range of people is as a synthesis of doing, being and becoming. In the
present paper I reflect on how a dynamic balance between doing and being is central to healthy living and
wellness, and how becoming whatever a person, or a community, is best fitted to become is dependent on both.
Doing is often used as a synonym for occupation within our profession and is so important that it is impossible to
envisage the world of humans without it. Being encapsulates such notions as nature and essence, about being true
to ourselves, to our individual capacities and in all that we do. Becoming adds to the idea of being a sense of
future and holds the notions of transformation and self actualization. It is a concept that sits well with enabling
occupation and with ideas about human development, growth and potential. Occupational therapists are in the
business of helping people to transform their lives through enabling them to do and to be and through the process
of becoming. In combination doing, being and becoming are integral to occupational therapy philosophy, process
and outcomes, and some attention is given as to how we may best utilize these in self growth, professional
practice, student teaching and learning, or towards social and global change for healthier lifestyles.

K E Y W O R D S balance, becoming, being, doing, occupation, potential.

INTRODUCTION occupational dysfunction and occupational wellness that is

not constrained by a medical view of disorder.
I describe myself as an occupational scientist as well as an A medical view of disorder has had a very constraining
occupational therapist. Over the past decade I have devel- influence on the growth of our profession. Like most other
oped a view of the occupational nature of humans as a health professions, and the public at large, we talk, write
result of a historical inquiry into the relationship between and think about handicap, illness and dysfunction, as well
occupation and health. During the same time, I immersed as health and wellness, using the concepts and words of
myself in notions of health from a public health perspec- medical science. As a result of my research, I believe we
tive. The insights I gained of a very broad concept of should no longer do this because a medical science view
health and occupational needs has led to a perspective of masks the very strong relationship that exists between

A. Allart Wilcock DipCOT, BAppScOT, GradDipPublicHealth, PhD; Associate Professor of Occupational Therapy, School of Occupational Therapy,
University of South Australia, Adelaide, South Australia, Australia.
Correspondence: Box 128, Normanville, SA 5204, Australia.
*This paper is republished with kind permission from the Canadian Journal of Occupational Therapy. The paper was first published as: Allart
Wilcock, A. (1998). Doing, being, becoming. Canadian Journal of Occupational Therapy, 65, 248–257.
Accepted for publication October 1998.
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2 A. A. Wilcock

occupation and health; that occupation is the natural bio- the notion at least since the earliest written records of
logical mechanism for health. In this vein, I welcome the thought. ‘Being’ is a fundamental notion in ontology,
opportunity to encourage you to break down the barriers metaphysics, idealism and existentialism (Norton, 1995).
that have constrained our understanding of the potential Heidegger, an existentialist, is worthy of special note
and importance of occupational therapy. because his ideas about being (Krell, 1993) are incor-
Occupational dysfunction can result from bodily dis- porated within ontological research approaches that are
order or mental disease, but as long as we are constrained beginning to appeal more and more to occupational
by these categories we fail to see and work towards allevi- therapy researchers. Another of note, the psychologist
ating occupational dysfunction from social, political and Maslow, wrote his view in ‘Towards a Psychology of Being’
ecological causes that are reaching epidemic proportions (1968) and within this and subsequent texts introduced the
all over the world. These causes impact on our traditional notion of self actualization and transcendence, which are a
client group, but we feel powerless to act in the larger part of the notion of becoming. Fidler recognized the rela-
struggle because we have not thought about ourselves as tionship between self actualization and doing in a paper
the profession with expertise about the occupational entitled ‘Doing and becoming: Purposeful action and self
nature of people, but rather about serving the needs of a actualisation’ (1978) and the geographer Rowles (1990)
small group of people with occupational dysfunction of a presents a view that occupational therapists should con-
medically determined nature. If we start to think and act sider being as a central concept of the profession. My own
from the perspective of people’s occupational nature, we views have been greatly influenced by Whiteford in our
will meet the needs of our traditional client group better discussions over her research about ‘being and becoming
and begin to address the occupational health of popula- culturally competent occupational therapists’ (G. White-
tions at large. In order to do this, we have to appreciate ford, pers. comm., 1995–98) and by a book called ‘Medita-
that our profession embraces a unique understanding of tions for Women Who Do Too Much’ (Wilson Schaef,
occupation that includes all the things that people do, the 1990), both of which provide some key thoughts in the
relationship of what they do with who they are as humans present paper.
and that through occupation they are in a constant state of As a result of my research, I believe that a very strong
becoming different. relationship exists between occupation and health, to the
In the present paper I discuss doing, being and becom- extent that occupation is the natural biological mechanism
ing and reflect on how a dynamic balance between doing for health. To provide a light-hearted look at my public
and being is central to healthy living and how becoming health view of the potential place of occupation in health
whatever a person is best fitted to become is dependent on care, I will share with you a fairy story I devised for the
both. Becoming is a concept that sits well with enabling Hong Kong International Congress in 1997. I call it a piece
occupation, which has been so well described in the recent of occupational science fiction.
book of the same name, researched and written for the
Once upon a time there was a group of friends, Creatus,
Canadian Association of Occupational Therapists
Dextrus, Mathus, Runna, Scolla and Singa. They all lived
(CAOT) and edited by Townsend (Canadian Association
in a small village and were very happy because the vil-
of Occupational Therapists, 1997). In combination, doing, lagers knew them as individuals and made them feel that
being and becoming are integral to occupational therapy each had ‘something special’ to contribute to community
philosophy, process and outcomes because, together, they life.
epitomise occupation.
One day they decided it was time to explore the world
In reflecting on what may appear to be very
and develop their special talents further. They set off with
metaphilosophical concepts, I intend to do so in a way that
high hopes for the Kingdom of Oz, which, they saw from
attempts to satisfy the practical souls of most occupational
the news on their television sets, was very rich and very
therapists by addressing them in the simple, straight- go ahead. The ruler of Oz, King Oczomby, believed in
forward way that I have come to understand them. But equality for the people. He decreed that, according to
first, I need to acknowledge a few of the many others who age, virtually everyone should do the same things for the
have gone before, particularly with regard to the notion of same length of time for the same rewards according to
being. Philosophers, such as Aristotle, have pondered over the economic growth of the country. In order to help him
 14401630, 1999, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1046/j.1440-1630.1999.00174.x by South African Medical Research, Wiley Online Library on [07/02/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Reflections on doing, being and becoming 3

achieve these goals he had three supervisors, I believe the concept of occupation is very complex
Ocalianashan, Ocdeprevashan and Ocimbalans. They and that it can and must be described in many different
made sure that everyone obeyed and valued the rules. ways by the profession within which it is so central that it
There was one major problem in the Kingdom of Oz. provides its name. A simple way to describe it that
People were always getting sick. The hospitals had long appears to appeal to a wide range of people is to talk
waiting lists and there were many ‘fat file’ patients who about occupation as a synthesis of doing, being and
kept coming back. The doctors couldn’t offer an explana- becoming. Additionally, consideration of this synthesis
tion. Creatus, Dextrus, Mathus, Runna, Scolla and Singa points out some important issues for us to keep in mind
all got sick too. Creatus became hypertensive, Dextrus
and some directions for future practice. I will start the
experienced stress-related allergies, Mathus suffered
process by considering doing, being and becoming as indi-
from anxiety attacks, Runna had a problem with obesity,
vidual concepts so that it is possible to appreciate the syn-
Scolla became bored and depressed and Singa started to
smoke and drink too much. thesis more clearly.

It was during the time that they were in hospital that

King Oczomby decided he had to tackle this problem in a
DOING
new way. He had heard that a new science was emerging
called occupational science and that this was closely asso-
Doing is so important that it is impossible to envisage the
ciated with occupational therapy. He knew very little
about occupational therapists or scientists but decided to humans without it.
invite one of each of Oscie and Ottie to consult and ‘People spend their lives almost constantly engaged in
advise at the hospital. purposeful ‘doing’ even when free of obligation or neces-
Oscie and Ottie talked to Creatus, Dextrus, Mathus, sity. They ‘do’ daily tasks including things they feel they
Runna, Scolla and Singa. They listened to the tales of must do, and others that they want to. Human evolution
their happy life in the village and of their dreams. They has been filled with ongoing and progressive ‘doings’,
also talked to the King and to Ocalianashan, Ocdepre- which, apart from enabling the species to survive, has
vashan and Ocimbalans about the values, rules and struc- stimulated, entertained and excited some people and
tures they had established in Oz. They helped all of them bored, stressed, alienated or depressed others according
to understand that although people have many similar to what was done’ (Wilcock, 1998).
needs, everybody has unique potential and that health
In a case study about occupational change in early
and well-being depend on all people having the chance to
retirement by Kendall (1998), the subject was reported as
develop their potential. The rules and structures of the
land have to encourage and enable occupation that has saying:
meaning and value to individuals and communities and ‘You do get satisfaction, peace of mind, happiness and all
health and well-being are more important than economic those things from doing what you want to do or what you
growth, but economic growth depends on the health, enjoy doing.’
well-being and occupational satisfaction of the people.
Steps were taken to change existing values and structures and
so that people were encouraged to aim towards their
‘I always wanted to do everything and get frustrated if I
occupational potential. Gradually, the sick lists became
can’t.’
smaller and the people were happier. The King was so
impressed that he decreed the land would henceforth be Doing or not doing are powerful determinants of well
known as the Kingdom of Op (the Land of Occupational being or disease. Florence Nightingale provided an insight
Potential) and he presented Oscie and Ottie with the
of this when, at the age of 26, she observed that some
keys to the Kingdom.
women have ‘… gone mad for lack of things to do’ (Wood-
ham-Smith, 1952). Wilson Schaef (1990) points us in a sim-
At the end of this paper I will share an update of that
ilar direction. She says:
fairy story with another piece of occupational science fic-
tion that relates directly to a balance of doing, being and ‘… just as nature needs balance, people need balance. We
becoming. need time to be whole persons, and this means balance …
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4 A. A. Wilcock

A human being is multi dimensional. A human doing cerned with enabling occupation wisely to promote health
may be more like a drawn line than a faceted gem.’ and well being.
In the present day there is an imbalance in the experi-
Doing ‘… provides the mechanism for social inter- ence of doing, ‘… between the haves and the have nots;
action, and societal development and growth, forming the between the rich and the poor; between the informed and
foundation stone of community, local and national identity the illiterate; and between the employed and the unem-
… to the extent of national government or to achieve ployed’ (Wilcock, 1998). Within the employed population,
international goals’ (Wilcock, 1998). Anthropologists for example, time for leisure occupations has decreased
describe this unique human trait as ‘culture’ and suggest: (Schor, 1991) and, in a 1995 article in The Weekend Aus-
tralian newspaper, Gare presented evidence from several
‘Humans are different, not so much for what we do …
major postindustrial nations that suggests that many
but rather the fact that we can do more or less what we
want. That is what having a highly developed culture people in paid employment are now expected to do too
really means’ (Leakey & Lewin, 1978). much and that health breakdowns from this cause are
increasing. Counter to this present trend, Wilson Schaef
Doing is a word that appears to be gaining popularity (1990) suggests that:
in our profession as one that is synonymous with occupa-
‘True passion and doing what is important to us does not
tion. Along with ‘do’, it appears in many definitions of
require us to destroy ourselves in the process.’
occupation (Nelson, 1988; Clark et al., 1991; Canadian
Association of Occupational Therapists, 1995; Christian- However, people may be doing just that. Our occupa-
sen et al., 1995; Kielhofner, 1995). As well as these defini- tional nature is not only driving us to ‘do too much’, it is
tions, McLaughlin Gray’s (1997) definition of the essence leading us to embrace technology with a gay abandon that
of occupation includes that it is perceived as ‘doing’ by may destroy us and the planet unless we start to consider
those engaged in it. Despite thinking that it can give a less the consequences of our occupational natures and begin to
than complete idea of the broad concepts that occupation recognize the need to be true to our nature as part of the
embraces, I too have used ‘doing’ to define occupation natural world. With this in mind, I concur with the sugges-
because it is a notion that is easy to assimilate. Under my tion put forward by Christiansen and Baum (1997) that ‘…
direction, the Journal of Occupational Science: Australia there is something beyond the active or doing process that
marketed football guernseys with the slogan ‘Occupa- defines occupation’. I think what is beyond the process is,
tional scientists study doing, Occupational therapists at least partly, about self, which brings us to the notion of
enable doing, Together they help the world do better’. being.
And, I recall in the 1970s, the profession marketed T-shirts
emblazoned with ‘Occupational therapists help make
doing possible’. Such slogans and the professions’ litera- BEING
ture tend to suggest that doing per se is good for health
and, indeed, it is doing that exercises, maintains and In dictionaries, ‘being’ is described with words such as
develops physical and mental capacities on which health is existing, living, nature and essence. Maslow (1968)
dependent. describes it as the ‘… contemplation and enjoyment of the
In addition, what people do creates and shapes the inner life’, which is a different kind of action, ‘… antithet-
societies in which we live, for good or bad. Our profession ical to action in the world’. It produces ‘… stillness and
though, optimists that we are, have scant research to date cessation of muscular activity’. ‘Being in a state of being
about how doing may be injurious to health and well- needs no future because it is already there. Then, becom-
being, except with regard to work and employment haz- ing ceases for a moment …’ as one is part of ‘… the peak
ards. One can wonder whether this is akin to the medical experiences in which time disappears and hopes are ful-
profession only researching and writing about what is filled’. This view has some similarity to what Hegel, in the
good about the medicine they prescribe and ignoring the 19th century, described when discussing Buddhism as
detrimental health effects. Surely we need to consider ‘insichsein’, of ‘being-within-self’, the essential character
both if occupational therapists accept that we are con- of which is ‘… nothing but thought itself’ in which human
 14401630, 1999, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1046/j.1440-1630.1999.00174.x by South African Medical Research, Wiley Online Library on [07/02/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Reflections on doing, being and becoming 5

beings can allow themselves to be absorbed and can find Indeed, we tend to imbue the state of being with the
repose (Hodgeson, 1987). notions of doing particularly when we use it to describe
‘Being’ is about being true to ourselves, to our nature, occupational roles as in being a parent, being a student,
to our essence and to what is distinctive about us to bring being a sportsperson or being an occupational therapist.
to others as part of our relationships and to what we do. While the notion of being is important to us in this way,
To ‘be’ in this sense requires that people have time to dis- the cultural drives to do better and better alters ways of
cover themselves, to think, to reflect and to simply exist. being in particular roles and overwhelms with a huge
As Kendall’s (1998) subject said about occupational range of beings in each of which we are expected to
change in early retirement: become perfect.

‘… you might never get a completely happy balance, but

now I have the time and can think as well as do, I’m get-
ting where I want to be.’
BECOMING

My thoughts about being have also grown from A dictionary meaning of ‘becoming’ as a noun is ‘… as a
hypotheses that exist about the health experiences of coming to be’ (Landau, 1984). This adds to the notion of
people engaging in occupations based more on natural being a sense of future, even though in many ways becom-
biological needs than those that are socioculturally ing is dependent on what people do and are in the present
derived. There is a large body of opinion throughout and on our history, in terms of cultural development.
recorded history that asserts that, apart from the correc- ‘Life is a process. We are a process. Everything that has
tive benefits of recent medical science, people living in a happened in our lives … is an integral part of our becom-
state of nature were able to enjoy a greater sense of health ing’ (Wilson Schaef, 1990).
and well being than at present and probably had more
time to themselves than we do. One could ask whether In Kielhofner’s Health Through Occupation, Fidler
people have changed so much that natural needs are no (1983) discusses three aspects of becoming: (i) becoming I;
longer relevant, but this does not seem to be the case and (ii) becoming competent; and (iii) becoming a social
many of today’s stress-related and degenerative diseases being. In all these scenarios, becoming holds the notions
can be traced to a lack of understanding of our ‘being’ as of potential and growth, of transformation and self actual-
well as our ‘doing’ needs. ization. Indeed, one dictionary defines potential as ‘…
Maslow (1968) prescribed a need to discover our capable of being or becoming; ability or talent not yet in
essential biologically based inner nature, which is easily full use’ (Makins, 1996). Occupational therapists are in the
overcome by ‘… habit, cultural pressure and wrong atti- business of helping people transform their lives by facili-
tudes’. Along the same lines Wilson Schaef (1990) asks: tating talents and abilities not yet in full use through
enabling them to do and to be. We are part of their
‘Do we recognize that time for solitude is just as impor- process of becoming and I believe that we should con-
tant to our work as keeping informed, preparing reports, stantly bear in mind the importance of this task. To
or planning? … We have to give ourselves time. We have
achieve well being, individual people or communities need
to give our ideas time. If we don’t neither we nor they can
to be enabled towards what they are best fitted and want
‘gently shine’ (Brenda Uleland), and we cannot hear the
to become.
voice of our inner process speaking to us.’
This puts an onus on our profession not to accept,
without thought, the imperatives put upon us by current
She suggests:
economic-driven health care rationales. For occupational
‘Unfortunately, even when others do not demand perfec- therapy to become what it has the potential to become,
tion of us, we who do too much demand it of ourselves. We what it is best fitted to become, means that it has to be
forget that when push comes to shove the only standard of
true to itself, to its essence, to its own nature, to the beliefs
perfection we have to meet is to be perfectly ourselves.
that it rests upon. As Wilson Schaef (1990) says:
Whenever we set up abstract, external standards and try
to force ourselves to meet them, we destroy ourselves.’ ‘Trying to be what others want us to be is a form of slow
 14401630, 1999, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1046/j.1440-1630.1999.00174.x by South African Medical Research, Wiley Online Library on [07/02/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
6 A. A. Wilcock

torture and certain spiritual death. It is not possible to get her and, indeed, for Maggie herself, her being was that of
all our definitions from outside and maintain our spiritual a cripple. Maggie, whose eyesight was also poor, had spent
integrity. We cannot look to others to tell us who we are, much of her childhood in and out of hospitals and had
give us our validity, give us our meaning, and still have
little chance to make friends, develop skills or for formal
any idea of who we are. When we look to others for our
education. She was poor at reading and writing and spent
identity, we spend most of our time and energy trying to
most of her early to middle adult life with her mother, my
be who they want us to be.’
grandmother.
There is so much substance in the relationship Maggie walked with crutches or manipulated a self-
between occupation and health that has not been consid- propelled wheelchair, which I recall had a great bar on the
ered or acted upon that there is no need for occupational back and on which two or three children (like me) could
therapists to look for our identity outside the very wide stand as Maggie sped down hills after Sunday school. We
boundaries of our profession or the emerging science that had many spills, but it was such fun for all of us. I think
can inform it. That is, we should not be restricted in our that was the time that she had fun in her life.
thinking by medical science, psychology, sociology or During the 1930s my parents married and, I am told,
economists’ views of the world, nor by previous occupa- that my mother recognized that Maggie, her new sister-in-
tional therapy practice. We should be true to our beliefs, law, needed an interest outside preparing the vegetables,
be prepared to test them, expand them and to articulate a washing up or gossiping with Grandma’s friends. She
distinctive view of any issue or situation, because becom- taught her to knit. If my mother had known how, it could
ing through doing and being is part of daily life for all peo- have been clog making for profit or book-keeping or any
ple on earth not just those in hospital or health centre. other occupation. By chance and the right intent, my
mother enabled Maggie to engage in an occupation that
‘No one else has the capacity to know us as well as we can
provided meaning and purpose. When I knew her, Maggie
know ourselves. It is in the awareness of ourselves that
our strengths lie. And awareness of every aspect of our- knitted all the time. Mainly, she knitted for other people:
selves allows us to become who we are … Owning for me or my brother, for my dolls, for other children, for
ourselves is probably the richest goldmine any of us will relatives or socks for soldiers (her war effort). In doing
ever possess’ (Wilson Schaef, 1990). this occupation, in which she developed great skill, her
crippled being was subtly altered. She did for others. She
became an occupational being, rather than an occupation-
ally deprived being. She became a person in her own right.
DOING, BEING AND BECOMING The imbalance between her doing and being had inhibited
her becoming a contributing social being. Maggie had had
I suggest, then, that a synthesis of doing, being and becom- too much time for being, being a cripple, and not enough
ing can help us to clarify important issues, both personally for doing, especially for doing for others.
and as a profession. To provide some recent professional and personal
At this point I would like to share with you a simple reflections on doing, being and becoming, I asked a group
story that expresses the transformative nature of doing, of research Master’s students at the University of South
being and becoming and that was probably very influential Australia for their views. One, who works as a senior occu-
in my becoming an occupational therapist, although it pational therapist in aged care, said:
started long before I knew of the existence of such a
‘… my life is full of doing, days filled with … purpose and
profession.
meaning … In part it is due to the circumstances of my
My father’s sister, my Aunt Maggie, was born with a life, family, work, friends and community involvements. It
disability. The cause is shrouded in history, but the story is also an attitude, … integral to my being, which has
goes that, as an infant, she walked on her toes as a result allowed me to embrace many experiences and opportuni-
of a congenital disorder, had surgery to correct the defect ties which have taken me beyond where I have felt com-
and became ‘a cripple’. That was the term used in those fortable and secure. In so doing I have learnt so much
days. I grew up with it and did not associate it with any- more about what I can be and who I can become. Yet I
thing discriminatory or stigmatizing, but for those around often feel that I am not in control of my life as the doing
 14401630, 1999, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1046/j.1440-1630.1999.00174.x by South African Medical Research, Wiley Online Library on [07/02/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Reflections on doing, being and becoming 7

becomes all consuming of my time and energies … through our journey we made the transition to another rut
‘Being’ makes me think of the present … For me it is a on the track called activities of daily living (ADL). There
mental and spiritual experience of allowing myself to are a few smaller ruts in which others travel. They are
withdraw from engagement in activity, to mentally step good ruts: all of them, even the crafty one, because they
back and allow myself to experience in a much fuller way,
are all about one aspect or other of this very important
the present moment … Maybe I need to be more aware
concept of humans as occupational beings, which is so lit-
of the being so that I can become more reflective of the
tle understood in the modern world; what I believe to be
doing and its impact on the becoming’ (V. Pols, pers.
our main track; our different and distinctive track; the
comm., 1998).
track along which we can offer something of immense
Some of the students found this process fascinating. I value to the world at large.
hope you, too, will reflect on doing, being and becoming in Imagine a track, the track to ‘becoming what we have
your own lives, as I have found this to be useful for myself the potential to become’. I suspect that no one reading
and for considering the potential of the profession. this paper believes we have got there or even remotely
Indeed, in this way, I have reflected on the profession’s near there. Too often the cry is heard ‘… people don’t
doing, being and becoming from its 20th century genesis know what we do’ or ‘… we must market the profession
and through my personal experience of it in the 40 years better’. To establish a notion of what the track looks like, I
since I commenced as a student. My reflections led to the go back to the visions of the founders. I would like you to
belief that we are in a rut, a valuable rut, but a rut for all recall the objectives of the first National Society for the
that. We are not alone. Every other profession is in a rut Promotion of Occupational Therapy in the USA drawn up
too. The ruts are made of professional habits. They are in 1917. They were:
well worn and comfortable. They do not necessarily follow
‘the advancement of occupation as a therapeutic
beliefs, for if ruts are followed long enough, beliefs
measure;
become hidden in the dust and are eventually lost, except the study of the effect of occupation upon the human
to rhetoric. Professions are kept in their ruts by social being;
expectations, by the media and, today especially, by the and the scientific dispensation of this knowledge’
dominance of managerial and fiscal policies. For long- (AOTA, 1967).
established professions this is, perhaps, acceptable but, for
one as young as ours, still trying to explore its potential, We got in a rut almost immediately, the rut called ‘the
the rut is inhibiting our becoming what we have the poten- advancement of occupation as a therapeutic measure’, and
tial to become. In limiting our doing to what is expected I think that, over time, we have largely lost sight of the
and deemed as necessary by resource managers who have broad track. Many, such as Reilly and Yerxa, have called
not undertaken a course of study towards the set of beliefs us back to it, and I know of therapists who are desperate
that we hold is to accept that their beliefs are more impor- to tread it, especially in recent years, but the rut is so deep
tant than ours or that ours are not worth fighting for. now that it’s hard to get out of it. We know the way of our
Many papers from around the world presented at the rut and others expect us to be in it. They don’t expect us to
Montreal Congress of the World Federation of Occupa- talk about what the track is about or where it is going.
tional Therapists belie such a proposition. They are, And we don’t. We talk about that part within our rut. I
instead, testament to the dedication of our profession to a hear many more people talking about personal indepen-
set of beliefs that are distinctive to us. The papers also dence as our central belief (the deepest rut) than about
demonstrate that, in order to work according to our occupation as an agent of health and well being (the main
beliefs, persistence, ingenuity and adaptation is often track). We will never reach our potential while we travel
required because the way we want to progress is blocked only in familiar time- and work-worn, albeit important,
by policy, resources or the ideas of others. ruts. Without knowing where the track could lead we are
So, let us consider our comfortable rut. Just as for doing without becoming what we have the potential to
other professions, our track gets worn and rutted along the become. We are not being ourselves.
lines that we take most often. Early in the piece we took a The objectives suggest that our founders saw the pro-
remedial and craft-orientated rut, then about half-way fession developing a unique or distinctive occupational
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8 A. A. Wilcock

perspective that would follow a track that could be useful else for that matter, at least not in those particular terms,
to all people, not just those in medical care. With this in and because we are in that RUT.
mind, I would like to consider a broad track of health and But what about the ecology? It seems a long way from
occupation that incorporates the notions of doing well, our personal independence rut, but not, I think, from con-
well-being and becoming healthy through satisfying partic- sidering health from an occupational point of view.
ipation in occupation. Indeed, Meyer (1922) talked about humans as active
beings who maintain and balance themselves by living in
harmony with their own nature and the nature about
DOING, BEING AND BECOMING IN them. An ecological model of health, the ‘… promotion of
TERMS OF ECOLOGICAL AND GLOBAL healthy relationships between humans, other living organ-
isms, their environments, habits, and modes of life’, is per-
CONCERNS AND TOWARDS SOCIAL haps, the least understood and the most vital in terms of
CHANGE FOR HEALTHIER LIFESTYLES the long-term health of all. And consider, human occupa-
tion has been the primary force in ecological degradation.
An occupational view of health can encompass the rela- Experts in understanding the occupational nature of
tionship between doing well, well-being and becoming humans need, as soon as possible, to focus on how people
healthy at cellular to global, biological to socio-cultural can meet their creative potentials, their need to do, to be
and microscopic to macroscopic levels. This is so because and to become without damaging the environment. Gov-
doing, being and becoming affects health on an individual ernments will require help to understand the importance
basis through the integrative systems of the organism, on a of the human need for occupation in such a way that will
social level through shared activity, the continuous growth maintain natural environments yet will provide sufficient
of occupational technology and socio-political activity and challenge to people’s capacities and potential so that indi-
on a global level through occupational development viduals and communities can flourish as an integrated part
affecting the natural resources and ecosystems. Any or all of the ecology. We don’t want people to say of us that:
of these can have negative or positive effects on health
‘We have reneged on our responsibility to this society and
and all are inextricably linked. This fits well with World
this planet. It is time that we courageously put our
Health Organization (WHO) views about health. thoughts, ideas, and values out there and let them stand
Many occupational therapists consider that their role for themselves’ (Wilson Schaef, 1990).
extends to the promotion of optimal states of health in
line with WHO philosophies, such as that of the 1986 Let us now consider in terms of current practice doing,
Ottawa Charter for Health Promotion (WHO et al., 1986). being and becoming in occupational therapy philosophy,
This primary source of contemporary health directions process and outcomes and education.
argues for us to ‘… take care of each other, our communi- Despite much current rhetoric, I believe that many
ties and our natural environment’. It also recognizes the occupational therapists are still not acting on the concept
benefits of occupation. Health, it states, ‘… is created and of enabling occupation (doing, being and becoming)
lived by people within the settings of their everyday life; favouring, instead, techniques, splints and aids to daily liv-
where they learn, work, play and love’ and that: ing. While these can be valuable adjuncts to what we offer,
by focusing on these we have failed to include in, or dis-
‘… to reach a state of complete physical, mental and
card from, our professional repertoire much that is power-
social well-being, an individual or group must be able to
identify and to realize aspirations, to satisfy needs, and to ful in terms of people’s real lives, their health, their
change or cope with the environment’ (WHO et al., well-being and in terms of them becoming. That may seem
1986). somewhat harsh, but I have another tale.
This is about my mother. On top of two knee replace-
Now is an opportunity for our profession to reassert its ments, at 85, some 41⁄2 years ago, she had a stroke. Because
primary values loudly and widely. We are in tune with the the damage was primarily in the left posterior occipital
espoused philosophies of the WHO, but I suspect they region, her major presenting feature was right homony-
don’t know that because we haven’t told them or anyone mous hemianopia, with some visuospatial disorder and
 14401630, 1999, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1046/j.1440-1630.1999.00174.x by South African Medical Research, Wiley Online Library on [07/02/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Reflections on doing, being and becoming 9

dysphasia. She did not have hemiplegia and looked physi- sundry with great pride. She no longer ties tissues. Her
cally capable. During her rehabilitation, the occupational health and well being have improved to such an extent
therapists assessed that she could take a shower indepen- that, at 89, she is now once more a being at peace with her
dently. She refused to make a cup of tea if they were not nature, she ‘does’ and she is still becoming.
going to share it with her and they did not pursue that There is a moral to this story that is illustrative of the
assessment. This assessment did not uncover what was rut I talked about earlier. I think that great skill is
probably, in my evaluation, a gross ideational apraxia that, required to do the job the carer does with my mother. She
when coupled with her visual and dysphasic problems, enables my mother to be an occupational being in a way
resulted in her being a-occupational for approximately 2 that no amount of being able to sit on the toilet indepen-
years. She could not read nor make sense of television, dently will do. I am not implying that independent self
could not put together an edible meal by herself, although care is not also important, but that we have not put up a
she did try (her chocolate and mintie-flavoured casseroles good enough fight for the basic business of our profession,
were quite sensational), and she did not make a cup of tea which surely is about that meaningful occupation: doing
by herself for years. My mother, quite simply, could not well, well being and becoming what people are best fitted
‘do’ without someone doing with her, guiding and select- to become is essential to health.
ing according to what had meaning for her, except for
‘We can get so involved in a new technique that the tech-
sweeping and what I called ‘tissue tying’. This entailed
nique itself becomes another monster in our lives and we
tearing tissues into strips, tying them together into long become slaves to it’ (Wilson Schaef, 1990).
bandages and binding up whatever part of her was feeling
pain. It was an intricate and very time-consuming occupa- There is, however, renewed interest in occupation as
tion that was very inward looking that was trying to stop the basis of our profession and this has led some occupa-
the pain of not being what she had been. She had ceased tional therapists to engage in research from an occupa-
to ‘be’ her. With her ‘doing’ gone, so had her ‘being’. She tional perspective. Cherie Archer, another Master’s
‘became’ depressed. student at the University of South Australia, who practises
After falling, she was hospitalized, thought she had in neurological rehabilitation, is a case in point. She has
been ‘put in a home’, gave up and came very close to just completed a study using focused ethnography to
death. The gerontologist thought she should not return to explore the occupational sequelae of apraxia. She took as
her home, but finally agreed to let us try with some help one aspect of the conceptual framework of her study that
from a carer: 5 h/week to help her shower, get up and go ‘… it is through ‘doing’ that humans ‘become’ what they
back to bed. In line with the health care system in South have the capacity to ‘be’’ (Archer, 1998). Both her prac-
Australia, the occupational therapist assessed her home tice and assessment methods have changed as a result of
and recommended rails in the bathroom and a raised toilet her study.
seat. Hygiene is more valued by the system than enabling From this and other studies along similar lines, I am
occupation with meaning, other than personal indepen- left with the impression that evaluation of a client’s per-
dence. I visit every day and my mother spends each week- ceptions of their doing, being and becoming should
end with us but, as I have a pretty busy life, I decided we become part of standard practice. Indeed, Kendall’s sub-
should pay her carer to come more often to help her ‘do’. ject said of the in-depth interview process:
The carer is a registered nurse. She spends an extra couple
‘It has helped me to be able to express how I feel and
of hours each weekday working in the house or the garden
what I am doing better I think. In actual fact, having
with my mother, helping with her meals and sometimes these sorts of deep conversations I find really fascinating.
taking her out. The carer does this so well that my mother I get quite a buzz out of it. I can think deep down and it
thinks she is responsible for the immaculate garden, the all comes out’ (Kendall, 1998).
clean and shining house, that she is totally independent
and that the carer comes simply to spend time with her These reflections on graduate student research led to a
because she likes her and is her friend. brief mention of doing, being and becoming for student
My mother’s repertoire of independent occupations teaching and learning. During the past year I have found
has increased, including showing off her home to all and that students respond well to the concept of doing, being
 14401630, 1999, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1046/j.1440-1630.1999.00174.x by South African Medical Research, Wiley Online Library on [07/02/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
10 A. A. Wilcock

and becoming as ingredients of occupation. The concept to make sure that all the people obeyed and valued the
of occupation is complex, and these three words have rules of the land according to the economic growth of the
helped first year students come to grips with many of the country. Ocimbalans had been so impressed by the health
benefits facilitated by Oscie, an occupational scientist,
complexities in a deeper way than discussing work, rest or
and Ottie, an occupational therapist, that he determined
play has done in the past. Fourth year students embraced
to become an occupational therapist himself. So enam-
the notion so strongly that a group of them had T-shirts
oured was he of his new calling that, apart from helping
made emblazoned with ‘doing, being and becoming’ that
others to reach their occupational potential, he couldn’t
they wore at the final year conference that marks their stop trying to reach his own.
transition from student to professional. I, too, have such a
T-shirt. He was on the go, busily ‘doing’ all hours of the day and
night. Ocimbalans sought personal meaning in his work
for a pharmaceutical company, putting in many extra
hours as he went from community to community demon-
CONCLUSIONS strating the value of the company’s products for people
with occupational dysfunction. He took up graduate stud-
I love being an occupational therapist, but I would like ies on top of his heavy work commitments, as well as
our profession to not only work with people with stroke, office in the local occupational therapy association, to
hand injury, schizophrenia, developmental delay or cere- which he was very committed. He also tried to ensure
bral palsy, for example, but also with those suffering from that his social responsibilities were carried out with flair,
disorders of our time, such as occupational deprivation, so that any anniversary or special occasion was marked
occupational alienation, occupational imbalance and occu- with a function, which of course he arranged bigger,
pational injustice. I believe that such a profession would brighter and different from any other. In his personal life,
enable occupation for personal well being, for community too, he had many interests, such as keeping up his health
and fitness regimens and playing sport. This summer, on
development, to prevent illness and towards social justice
top of everything else, he and his wife built their own
and a sustainable ecology. In order for us to achieve this,
swimming pool.
we have to appreciate that our profession embraces a
unique understanding of occupation that includes all the Because he was so busy doing, Ocimbalans was always
things that people do, the relationship of what they do late for appointments, he missed some classes altogether
with who they are as human beings and that through occu- and his assignments were submitted later and later. He
always apologised though, on his mobile phone, as he
pation they are in a constant state of becoming different.
raced from venue to venue, enthusiasm high, never saying
To assist this process, in the present paper I have dis-
no, always doing and always out of breath, but unable to
cussed doing, being and becoming and reflected on the
stop. He never questioned his state of occupational well
need for a dynamic balance between them from an indi-
being, for hadn’t he learned that if his occupations had
vidual wellness to a professional growth perspective. I meaning his health and well-being would flourish?
have suggested that, in combination, doing, being and
becoming are integral to health and well being for every- As part of his graduate studies with Oscie, the occupa-
tional scientist, he began to be challenged about the place
one and to occupational therapy philosophy, process and
of ‘being’ in his life and in the lives of those he advised.
outcomes, because together they epitomise occupation.
‘Being’ he learnt was about being true to himself, about
With this trilogy in mind, I believe our profession could
having time to reflect, to simply exist as part of the nat-
reach its potential to enable people in all walks of life, ural world. He was asked how he tempered ‘doing’ with
across the globe, to achieve health through occupation. time for ‘being’. He began to understand that simply
I will finish, as I promised, with a second piece of occu- striving for a balance of doing between work, leisure and
pational science fiction, the central character being based social occupations was not conducive to him becoming
on a graduate student. what he was best fitted to become. He needed to balance
time for doing with time for being.
Once upon a time, in the land of OP, there lived an occu-
pational therapist called Ocimbalans. You will recall that Ocimbalans, as you expect, adopted these new-found
he had once been a supervisor for King Oczomby, helping ideas with enthusiasm. Always one to do things bigger
 14401630, 1999, 1, Downloaded from https://onlinelibrary.wiley.com/doi/10.1046/j.1440-1630.1999.00174.x by South African Medical Research, Wiley Online Library on [07/02/2023]. See the Terms and Conditions (https://onlinelibrary.wiley.com/terms-and-conditions) on Wiley Online Library for rules of use; OA articles are governed by the applicable Creative Commons License
Reflections on doing, being and becoming 11

and better than others, he set up a DBB Wellness Centre Hodgeson, P. C. (Ed.). (1987). Hegel Lectures on the
for the community and sought and obtained help from Philosophy of Religion: Vol. II. Determinate Religion.
the King for resources. The results of the centre, and the Berkeley: University of California Press.
research it carried out, was featured as stories and docu-
Kendall, A. (1998). An exploration of change in occupa-
mentaries on all television stations in Op and Ocimbalans
tion following early retirement: Jane’s early retirement,
became a ‘star’. His stardom influenced the young people
of Op, who strove to change their own lives to his ‘cool’ a case study. Unpublished Masters thesis. University of
concept of doing, being and becoming. Its popular image South Australia, Adelaide, South Australia.
ensured that it became part of Op’s occupational policy Kielhofner, G. (1995). A Model of Human Occupation:
towards health and wellness for all. Theory and Application (2nd edn). Baltimore: Williams
and Wilkins.
Krell, D. F. (Ed.). (1993). Basic Writings: Martin Heideg-
ger. London: Routledge.
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