Conceptual Implications for Occupational Science

The utilization of institutional ethnography (Smith, 1987, 2005; DeVault, 2006) as theory and methodology has many implications for occupational science. Most salient is that it views the everyday world as a matrix of experiences that are organized by relations bound by larger processes, as well as by locally organized practices (Campbell & Gregor, 2004; Griffith & Smith, 2014; Smith, 1987, 1990), and that the control of human action is becoming increasingly discursive and textual (Smith 2005). This theoretical stance in institutional ethnography is complementary to the transactional perspective (Cutchin & Dickie, 2012; Dickie, Cutchin, & Humphry, 2006), governmentality (Rudman, 2012, 2013), and occupational justice (Nilsson & Townsend, 2010; Stadnyk, Townsend, & Wilcock, 2010; Whiteford, 2000). It is also useful in deepening the discipline’s conceptualization of occupation.

7.3.1 The Transactional Perspective

A transactional perspective on occupation posits that individuals are co-constituted and co-defined with their environment, and that occupations offer a means through which individuals become functionally coordinated with their indeterminate or unstable environment (Dickie, Cutchin, & Humphry, 2006; Cutchin & Dickie, 2012). In other words, individuals’ experiences of the environment are constituted by their interrelationship with it and occupation is used to

understand how human action emerges in that relationship. This perspective is holistic in that it unpacks the richness and complexity of occupation – deepening the discipline’s understanding that the act of doing (occupation), individually and collectively, is influenced by an amalgam of the physical, social, cultural, temporal, political, economic, and historical ideals. Institutional ethnography complements the transaction perspective on occupation in that its theoretical approach includes the historical, socio-cultural, socio-political, and temporal aspects to

understanding contexts through which human action unfolds. In its concept of the problematic, institutional ethnography also seeks to discover and understand the uncertain and

unacknowledged work or “action” that is occurring within a dynamic world.

Institutional ethnography is also complementary to the notion that the individual as the unit of study is necessary to understanding these processes but insufficient (Dickie, Cutchin, & Humphry, 2006). This dissertation serves as an exemplar that institutional ethnography can be utilized to examine phenomena that occur with groups or populations. Additionally, institutional ethnography also recognizes that past experiences can infiltrate and shape the expectations and constructions of present action, as well as connects possibilities of future action; however, it adds that these constructions of action are also tied to institutions and discourses of power. This tenet of institutional ethnography complements the understanding of action that is inherent in

governmentality studies (Rudman, 2013). 7.3.2 Governmentality Studies

Rudman (2013) stated, “…governmentality studies provide a way to consider how such perceptions are shaped through technologies of government which enact power in accord with broader systems of thought regarding how best to govern populations and individuals” (pp. 52- 53). In other words, governmentality consists of the ways various institutions – such as national

individuals by prescribing specific ways of doing or being in everyday life. The practices of governmentality also include the shaping of discourses that influence how people construct reality, themselves, and the needs of groups they serve (e.g. the habilitation technicians and adults with ID), in ways that align with the interests of those authorities (Rudman, 2013). Institutional ethnography is complementary to governmentality studies in that it considers how power and ruling relations are infiltrated and perpetuated textually. These ruling relations come to be seen as “true” as they are linked to sources of power that construct and circulate particular discourses and texts that serve to align people to particular objectives.

Institutional ethnography is also complementary in that it emphasizes that perceptions of reality are shaped over time and that these perceptions are in flux – they serve a purpose in a specific socio-historical context (Rudman & Molke, 2009). Both governmentality and institutional ethnography assert that as ruling relations change, perceptions of reality change. Whereas governmentality and institutional ethnography attend to the ways power and discourse are perpetuated through texts, institutional ethnography makes visible and problematizes work that is hidden or unacknowledged within discourses.

7.3.3 Occupational Justice

Scholars in occupational science and occupational therapy offered occupational justice as a model to critique of access and participation in occupation because they believed social justice did not adequately address the right to participation in daily life activities (Stadnyk, Townsend, and Wilcock, 2010). Social justice addresses the issues of equal worth of all citizens, rights, and opportunities; occupational justice theorists suggest that occupational justice moves beyond the equity of individuals and groups and addresses the rights to occupation (Durocher, Gibson, & Rappolt, 2013). A theory of social justice encompasses rights to and opportunities for engaging

for all individuals and can result in the following injustices: alienation, apartheid, imbalance, marginalization, and deprivation. Institutional ethnography adds to the evolving theory of occupational justiceas it allows the researcher to make visible to complexes through which phenomena (e.g., barriers to accessing occupation) emerge. It provides the political leverage linking what people are able to do or not able to do back to material texts and technologies. This dissertation offers empirical evidence to demonstrate how institutional ethnography addresses issues of power with systematic and social practices, opportunities and possibilities for engagement in daily life activities from a critical perspective informed by theory originating outside of occupational science.

7.3.4 Reflections on Occupation

Findings from this dissertation have challenged my conceptualizations of occupation and participation. In particular, it challenged the idea of occupation being defined in the lexicon of the culture (Yerxa, et al, 1990); that is, the dominant beliefs, customs, and values in society that determine what is or what is not considered occupation, when occupations are performed, spaces occupations occur, who participates, tools used, and their duration. Occupational science has been critiqued for its Judeo-Christian, able-bodied, Anglo, middle-class, female perspective, which has served as the dominant purview of the discipline (Hammell, 2009; Hocking, 2012). Additionally, this dissertation critiqued pluralism in the discipline by arguing that the standpoints of those who are unable to provide phenomenological perspectives or those who may not

perform occupation in conventional ways (i.e., institutionalized adults with ID) have not been taken up in occupational science discourse. Taking up the standpoint of institutionalized adults with ID who are not able to emit control over their lives is perhaps the best example of a commitment to pluralism. While few scholars in occupational science have taken up the

been paid to understanding the occupations of institutionalized individuals with ID. The concept of work in institutional ethnography (Smith, 1987, 2005) is also

complementary to occupation in that it constitutes the paid and unpaid everyday activities that people perform. Much like the discipline’s focus on understanding the micro, meso, and macro level influences on occupation (Rudman & Molke, 2009), the concept of work also has utility across multiple contexts and for making connections between those contexts through an examination of texts. This adds to the discipline’s conceptualization of occupation as trans- contextual and orients occupational scientists to critically evaluate how occupations emerge across contexts in textually mediated ways. In essence, institutional ethnography bridges important concepts from the transactional perspective and governmentality in its ability to critically evaluate how situations come to be, and thus, aligns to the discipline’s current focus on critically situating occupation as embodied action (Aldrich & Cutchin, 2012; Farias & Rudman, 2016).