Occupational therapists (OTs) are among my favourite professionals to work with. These allied health practitioners have a unique and often overlooked take on the world – the “occupational lens” – through which they understand human experience in terms of our occupations: the things we want, need, and have to do in our lives.
Today’s therapists and occupational scientists understand that human lives are comprised of occupations; that occupations can become dysfunctional and harmful; and that occupation itself can become a way of offering therapy and putting things right.
Bex (Rebecca) Twinley of Plymouth University is an occupational science researcher who coined the phrase “dark side of occupation”. Health professionals have traditionally and understandably focussed on occupations which they see as positive and productive for individuals, groups, and communities. Yet when we think of the total sum of human occupation, its many facets must include dark – meaning less explored – sides, too.
What happens when occupational science chooses not to look away from those facets, and instead pays attention to the darkness?
Occupational therapy as a profession has always been focussed on links to health and wellbeing, identifying and supporting those occupations which are healthy to do.
The reality is that people don’t engage in positive occupations all of the time – yet these are not spoken about in our literature or explored in much of our practice. This limits the authenticity of the understanding between client and practitioner.
I imagine that there is also some scope for debate about who gets to define health and wellbeing, and what institutional values are imposed by the health system. (It’s making me think of that Radiohead song, “Fitter Happier”).
What drew you to the notion of this “dark side” of occupation?
I started questioning the occupations that we were ignoring from as early as my student days.
It was all well and good studying healthy, “wholesome” occupations like cooking and horticulture, but I was a smoker at the time. I was in a lecture, thinking I wanted a smoke. Cigarette smoking could be an occupation: I found it had a purpose, it was often calming, an opportunity to socialise or a way of getting space and time to yourself.
It made me realise that if you were my occupational therapist and you approached me on the basis of “wholesome” occupations, there would be a whole side of my life that your questioning would never uncover. If you didn’t notice or address my smoking, for instance, you wouldn’t really know me as an occupational being.
“Dark side” seems like quite a prickly label. I understand there have been some tensions within the profession around your use of this term – some people saying there are connotations of evil and witchcraft! What’s your response?
The term served to draw attention to the concept. The darkness is like the dark side of the moon – the side which you can’t see and which eventually you must explore if you want to understand it in totality. It’s not about the practitioner’s subjective assessment, and in fact the notion that the darkness is evil or negative comes from other people’s assumptions.
A group of commentators published an article in which they assert the same as myself – that the prioritisation of ‘… healthy and health-promoting occupations affords a limited or partial understanding of occupation’ (Kiepek et al, 2018). However, they prefer use of the term ‘non-sanctioned occupations’, which for me is problematic as this denotes that others have the authority to permit or encourage an individual’s engagement in certain occupations, as well as suggesting all of these occupations are things that defy social norms.
Kiepek and colleagues refer to my concept, stating: ‘Note that while Twinley (2013) also called for attention to oft-silenced aspects of occupation, labelling these the ‘dark side’ of occupation seems a pejorative framework’. I found it a shame this group of commentators did not, firstly, discuss this with me. But also, they have misunderstood my use of this term; I am very clear that it is not used to name other’s occupations as ‘dark’ but that I am talking about the side of occupation that has not been explored and has been left in the dark, as it were. I do not, therefore, use the term to express contempt or disapproval. Far from it.
It sounds like there are fairly intense debates going on over these labels, and that the precise label matters for what it implies.
Craig Greber wrote a response to my piece on the dark side of occupation in Australian Occupational Therapy, asking, if an individual finds meaning and purpose in unhealthy or antisocial activities, do we have any right to act as a moral filter on those client-chosen occupations?
“I was asked to consider naming this concept something else because of concern with using the phrase “dark side,” which has been assumed to be suggestive of something to do with witchcraft or the dark arts. I reflected at length regarding the use of this phrase and, to be very clear, naming this concept the dark side of occupation was primarily because it derived from my perception that the dark side portrays something less known: occupations that remain unexplored and uncovered and are left in the dark.”
– Twinley, ‘The Dark Side of Occupation’, in Occupational Therapy Essentials for Clinical Competence
You talk about the importance of higher education in defining or framing “occupation” – first year students are given a definition to steer by and that can endure into a professional career where there’s less time for reflection on values and core terms.
Recognising the whole occupational being of your client, including the dark – less explored or considered – sides, needs to start from the beginning of students’ education, but it’s also something that must be addressed in continuing professional development if we really want to implement some kind of change.
I’ve spoken at events with a mix of students and practitioners, and worked with units that were interested in implementing changes to the way they interacted with clients or users.
In day-to-day work, it’s not always possible to get philosophical about one’s profession: what are the practical benefits to exploring the dark side?
I did some work with women working in an eating disorder service, some of whose clients had really acute cases. Thinking in terms of the dark side caused a switch in language: the point of exploring these areas is that the professional shouldn’t label or judge; instead it helps service users to talk about their (self-labelled) dark or unseen occupations.
Where previously, practitioners felt they had been experienced as distant and users were uncomfortable with the use of professional labels like “self-harm” or terms like “ligature”, now they could say, “I’ve done a dark occupation” and talk about it without using the more clinical label.
This acknowledgement that there was an unseen territory between them broke down the barrier between professional and client, creating space to talk about occupations that might not be healthy. It lets people know we are open to discussing this stuff as well.
If a client brings up their use of drugs or pornography, practitioners don’t know how to react if they draw on their traditional training, but a reflection on the dark side of occupation lets them acknowledge that they are open to discuss this with their client – helping us to understand them fully as occupational beings.
“Expanding your understanding of occupation by considering the dark side of occupation means that you are open to challenging the pervasive belief in the causal relationship between occupation and health. It also places you in a position that recognizes people find value and meaning in, for example, health compromising, deviant, and destructive occupations. In your work with individuals, groups, and communities, it is crucial to appreciate the subjective experience of occupation, and the context within which occupation is experienced.”
– Twinley, ‘The Dark Side of Occupation’
Sometimes we see that engaging in restricted eating or other occupations gets people through periods of their life. It is always an ethical dilemma – we can’t enable such behaviours, even if they do help people. If we are open to discussing these areas – what does the occupation mean to you, what does it fulfil? – we can explore alternative options.
With offenders and drug or alcohol users, we look at repeated use or offence as an occupation which we are not currently addressing. What is it about these occupations which is pulling them back again and again? Drug use can be as much about opportunities to socialise, ways of creating habits and routines, as anything.
“Could we understand violence better, and work with people who experience violence or who are violent, by recognising and examining it as an occupation?”
– Bex Twinley and Gareth Addidle, “Considering violence: the dark side of occupation“
Breaking down barriers between professionals and clients can be challenging. What safety lines do professionals need when working in these territories?
The usual ones you’d expect in a health context: that the professional continues to abide by their code of ethics, as defined by the relevant body. If a client is going to harm themselves or someone else, we report that. We need to make sure this is understood when preparing the ground for any such conversation, so they are aware of the actions we might be professionally obliged to take.
Are we always talking about behaviours like drug use or self-harm or criminal violence when we explore the dark side of occupation?
No, there are a lot of other occupations or aspects of occupation which go unseen.
Work, for example, isn’t always productive. There can be occupational imbalance, or people doing work which does not interest them or bear much meaning for them, and there can be harmful behaviours like harassment and bullying which may have an impact not just on people’s work but also their wider lives. Even the demanding processes we go through to get promoted may present occupational issues.
Academia is an example of a relentless and demanding workplace…it might never be boring, but immense demands are placed on practitioners, and in some contexts there is less and less scope for creativity. These, too, could be seen as dark occupational issues that warrant examination. In a recent post in the Guardian, an anonymous academic wrote about feeling underpaid, undervalued, and over-monitored, stating: ‘It strikes me that we need to start asking serious questions about why academics are subject to so much more scrutiny and surveillance than their administrative peers’. There are certainly some really interesting aspects to the occupation of work to be uncovered and scrutinised.
Elsewhere, you’ve given an example of how the most apparently innocuous occupation could be shown to have its darker elements. You quote a person who talked about knitting:
“… knitting, that’s making something, so that’s a nice thing to be doing, and it’s creative and it might be making a scarf that is going to keep you or some-
one else warm… But in order for the yarn to be existing, then a lot of other things need to have happened beforehand, and a lot of those might have involved transport… Some of those things are not necessarily good for the environment… how was the wool made, how were the needles made?”
– Twinley, ‘The Dark Side of Occupation’
Will practitioners start examining the dark side, question the larger context for occupations, and find they have to advocate for major social or political changes?
This has the potential to be an activist take on occupation. By looking clearly at the issues that occupational science has chosen to ignore, it is bound to raise challenges and demand changes in our approach. It’s not easy to venture into this territory.
How much institutional support is there for investigating the dark side?
I’m an academic on a “balanced pathway” between teaching and research, which means there’s a big drive for research outputs. Currently that requires me to develop research to back up the concept of occupation’s dark side.
I seek grants and funding, but I’m also up for collaboration with people looking at other areas. There’s massive scope for interdisciplinary work with occupational science – we should be drawing from human geography, sociology, psychology, for instance, as we seek to understand human occupation in its totality.
Yes – that happened quite organically. I was on a course with my co-writer Gareth; he had nursing in his past, so that gave him some understanding for the work of OTs.
I let him know my thoughts about the dark side of occupation and that I wasn’t sure how to start writing about it, so we brainstormed it together.
And social media has been a place for these kind of conversations, too? There was a chat on the #OCChat Twitter hashtag in 2012 where social media users teased out some of the discussion from your initial conference presentation where you proposed the concept.
Yes — social media is enormously beneficial for developing new concepts. So many people are online now, and regular discussions on Twitter and other forums can even go global.
Social media can be a safe place to raise issues which cannot easily be brought up in formal supervision. These are places to test your thoughts, hear from your peers, float new ideas, and to “feel less alone with a way of thinking”.
What would you like to see happen next with the concept of the dark side of occupation?
I hope to work with other disciplines and professions to explore its practical application to aspects of human occupation that are not at all or only partially understood from an occupational perspective. My personal interest is in the area of trauma and the occupations people engage in to survive a traumatic event, such as rape or sexual assault. Further research would definitely see the concept and its application in education, research, and practice expand. I am more than happy for people to get in touch with ideas… this was never intended to be an independent venture!
Read more about Bex’s work at her Dark Side of Occupation website. Occupational therapists and occupational scientists make great collaborators across a range of disciplines – including librarianship – and perhaps you see a way to partner with Bex or incorporate her research into your own thinking.
But…additionally…could you look at your own profession and wonder – like the dark side of the moon, or the dark side of occupation – what is it about your field that you are not currently seeing or discussing?
What is the dark, less explored side of librarianship, of anthropology, of therapy, of teaching, of authorship, of human resources?