The meaning crisis and occupational therapy

What does the discipline of occupational therapy have to offer our collective existential crisis?

Just over two years ago, I accepted an offer to study a Master of Occupational Therapy at the University of Sydney. I have just received my registration certificate from the Australian Health Practitioner Regulation Agency (AHPRA), and I am on my way to practice as a new graduate OT.

The majority of my 20s involved a significant amount of exploration, successes, and supposed failures—which turned out to be important learnings—as I sought to find meaning in a vocational path. Now, after completing my OT training, I can honestly say with gratitude that I’ve found a profession that aligns well with me, my values, and the way I seek to serve others.

It is somewhat ironic, then, that OT so highly values meaning. At the heart of the discipline lies the notion that engagement in meaningful activity is vital for human wellbeing as both a means and an end and is therapeutic within and of itself. Thus, OTs are health professionals who help enable and empower people to engage in meaningful activities despite illness, impairment, injury or other life barriers. One could say that OTs specialise in meaning: we work to increase meaning in peoples’ lives in practical and evidence-based ways.

It is striking, then, that some have made the claim that we—including most of what we would term the developed world—are amidst a meaning crisis. According to Dr John Vervaeke, a cognitive psychologist and professor at the University of Toronto, our modern life is characterised by a profound lack of meaning. We feel increasingly disconnected from ourselves, one another, and the natural world. Suicidality, rates of mental illness, loneliness, and hopelessness continue to rise in materially affluent societies.

What is the antidote to this crisis? In seeking to answer this question, Vervaeke turns to the cognitive sciences, philosophy, and various wisdom traditions. His lecture series, Awakening from the Meaning Crisis, provides a comprehensive and integrated account of how we can respond. Vervaeke argues that two key things can help improve this perennial crisis: transformative spiritual practices and genuine human community. Both work to increase our sense of selfawareness and connectedness, which are necessary ingredients for the cultivation of wisdom. Vervaeke insists it is ultimately a recovery of wisdom that will provide the cure to our crisis of meaninglessness.

The notion that we’re currently in such a crisis has gained traction amongst many. Clinical psychologist turned public intellectual Jordan Peterson is a prominent but controversial example. We don’t need to delve far into the past to encounter important figures who have pointed to the importance of meaning and how aspects of modern life breed meaninglessness, from the Jewish-Austrian psychiatrist and Auschwitz survivor Viktor Frankl to the existential psychiatrist Irvin Yalom, to the psychiatrist and founder of analytical psychology Carl Jung. A persistent lack a of a sense of meaning is not only detrimental to the individual but also reverberates out into families and societies.

What does this mean for OT? What can it offer this crisis and what can it learn from the likes of Vervaeke and his colleagues?

Through my studies, I’ve been energised by the way OT places meaning and people at the centre of its practice. That is, the therapeutic process is guided by individuals and their hopes, dreams and goals. The lived experience of the person is central: they define what is meaningful and what it means to live fully. Backed by rigorous science, OTs prescribe interventions that are both evidence-based and holistic. Indeed, holism is a core philosophical principle of OT. All aspects of the human person and experience are considered without giving in to any form of reductionism. Each person is viewed as an integrated human being within a wider web of relations, as opposed to merely being viewed as a list of pathological symptoms.

As someone who has lived experience of mental illness and engaging services as a mental health consumer, I can attest to the centrality of person-centeredness, meaning, and a genuinely holistic approach in fostering my own recovery. My friend Reverend Graham Long often says that “people are not problems to be solved but people to be met”. We are bio-psycho-social-spiritual creatures and treatments must take this into account if they are to be holistic. The services and clinicians/therapists I most benefited from in my recovery were those who were able to do this carefully, compassionately and patiently. They were able to treat me as a whole person rather than a particular diagnosis or list of symptoms. I have witnessed this in both my placements and previous work: bad outcomes would often follow where services were inflexible, rushed, reductionistic, and/or not attentive to the lived experience of those seeking treatment.

Whilst OT is holistic in its theoretical underpinnings, it is still developing and evolving as a profession. Ask those not involved with the profession what occupational therapy is, and you’ll be lucky to get an accurate response! And, for those that do have some idea, OT is often associated with physical therapy alone. It is less known that you’ll find OTs working in all kinds of settings, including across the mental health sector. Even in its origins, OT began within psychiatric settings caring for returned, traumatised war veterans.

When it comes to the meaning crisis, OT has an opportunity to play to its strengths as a discipline that places an emphasis on the centrality of meaning. As a deeply pragmatic profession, OT has the potential to offer evidence-based, practical solutions to the ways in which this crisis manifests in peoples’ everyday lives, particularly if it is leading to serious illness, injury, and/or occupational deprivation (which Vervaeke and his colleagues would insist it is). What could OT provide to someone living with chronic, debilitating major depression or those journeying through the end-of-life process? Could greater links be made to pastoral/spiritual care professionals working in various clinical and community settings? What about the current “psychedelic renaissance”? Could OT-specific research be conducted into the functional outcomes of psychedelic-assisted therapies? And, in the academic space, what insights might be gained through productive dialogue between occupational therapists, other health disciplines, and philosophers/theologians?

These are just some of the many questions that have been sparked for me as I transition from student to graduate OT. The more I learn and reflect, the more I’m convinced that OT has something uniquely important to offer not just healthcare but society as a whole during this critical moment.

About the Author

Shane Fenwick is a new graduate OT who recently completed a Master of Occupational Therapy through the University of Sydney. He has degrees in psychology and theology and has previously worked in youth homelessness, disability care, community development, and with those seeking asylum.