Abstract

In this reflection essay, the authors explore how meaning is represented in occupational therapy literature. A review of occupational therapy and occupational science literature uncovers framings of meaning, meaningful, and meaningfulness that are almost exclusively ‘positive’. Positioning of occupations as inherently ‘positive’ and assuming universal experiences of positive meanings for all members of society, overlooks individual and collective diversities. To perpetuate framings of occupations as inherently and exclusively ‘positively meaningful’ effectively silences experiences that do not conform to dominant assumptions and perspectives. Approaching concepts of ‘meaning’ more broadly may allow occupational therapists and scholars to better comprehend what people do and do not do, and why, better situating the profession to promote the espoused goals of equity, justice, and rights. Neglecting nuanced understandings of meaning may forfeit more complex examinations of occupation to other disciplines, thereby undermining disciplinary claims of expertise in the realm of occupation.

Keywords:
Occupational Therapy; Concept Formation; Social Justice

Resumo

Neste ensaio reflexivo, as autoras exploram como o significado é representado na literatura de terapia ocupacional. Uma revisão da literatura em terapia ocupacional e ciência ocupacional revela enquadramentos de significado, significativo e significância que são quase exclusivamente ‘positivos’. Posicionar as ocupações como inerentemente “positivas”, assumindo experiências universais de significados positivos para todos os membros da sociedade, ignora as diversidades individuais e coletivas. Perpetuar os enquadramentos de ocupações como inerente e exclusivamente “positivamente significativas” efetivamente silencia experiências que não estão em conformidade com as suposições e perspectivas dominantes. Aproximar os conceitos de “significado” de forma mais ampla pode permitir que terapeutas ocupacionais e acadêmicos compreendam melhor o que as pessoas fazem e não fazem e o porquê, situando melhor a profissão para promover os objetivos defendidos de equidade, justiça e direitos. Negligenciar entendimentos matizados do que é significativo pode privar exames mais complexos sobre as ocupações, oportunizando que outras disciplinas o façam, minando assim as reivindicações disciplinares de especialização no domínio da ocupação.

Palavras-chave:
Terapia Ocupacional; Formação de Conceito; Justiça Social

Introduction

The intent of this reflection essay is to critically examine how meaning is represented in occupational therapy literature. While meaning is central to the study of occupation, and the practice of occupational therapy, it remains poorly defined and often oversimplified, with determined emphasis on positive meanings. Greater attention to nuanced complexity of meanings, even contradictory meanings, may open greater conceptual space for understanding occupation more deeply.

‘Meaning’ in occupational therapy

Within occupational therapy and occupational science literature, ‘meaning’ (Reed et al., 2010Reed, K., Hocking, C., & Smythe, L. (2010). The interconnected meanings of occupation: the call, being-with, possibilities. Journal of Occupational Science, 17(3), 140-149. http://dx.doi.org/10.1080/14427591.2010.9686688.
http://dx.doi.org/10.1080/14427591.2010.... ), ‘meaningful’, and ‘meaningfulness’ tend to be viewed as central to definitions of occupation, positioning occupational therapists as “custodians of meaning” (Englehardt, 1986Englehardt, T. (1986). Occupational therapists as technologists and custodians of meaning. In G. Kielhofner (Ed.), Health through occupation (pp. 139-144). Philadelphia: F. A. Davis.). American occupational therapist Mary Reilly purported, “For us, in occupational therapy, the most fundamental area for research is, and probably always will be, the nature and meaning of activity” (as cited in Hasselkus, 1989Hasselkus, B. R. (1989). The meaning of daily activity in family caregiving for the elderly. The American Journal of Occupational Therapy, 43(10), 649-656. http://dx.doi.org/10.5014/ajot.43.10.649.
http://dx.doi.org/10.5014/ajot.43.10.649... , p. 654). The concept of meaning is associated with occupation as early as 1956, when it was observed that occupational therapy appeared to transform people’s lives through the meaning clients experienced when engaged in action (as cited in Helfrich & Kielhofner, 1994Helfrich, C., & Kielhofner, G. (1994). Volitional narratives and the meaning of therapy. The American Journal of Occupational Therapy, 48(4), 319-326. http://dx.doi.org/10.5014/ajot.48.4.319.
http://dx.doi.org/10.5014/ajot.48.4.319... ). In 1967, Elizabeth Yerxa espoused that central to occupational therapy was “commitment to the client’s realization of his [sic] own particular meaning” (as cited in Grajo & Da Cruz, 2017Grajo, L. C., & Da Cruz, D. M. C. (2017). A hundred-year journey and a return to our roots: occupation, adaptation through occupation, and client-centeredness. Cadernos Brasileiros de Terapia Ocupacional, 25(3), 445-446. http://dx.doi.org/10.4322/2526-8910.ctoED2503.
http://dx.doi.org/10.4322/2526-8910.ctoE... , p. 445). As Table 1 shows, ‘meaning’ is central to numerous definitions of occupation-related concepts. The first and fourth authors searched all national associations listed on the World Federation of Occupational Therapists (WFOT) website to include diverse countries, but many of these sites are, understandably, not in English.

Despite its centrality in the occupational therapy literature, ‘meaning’ as a concept is rarely interrogated. Borell et al. (2021Borell, L., Mondaca, M., & Luborsky, M. (2021). “Meaningful occupation” - challenges for occupational therapy research. Scandinavian Journal of Occupational Therapy, 29(3), 257-258. http://dx.doi.org/10.1080/11038128.2021.1954996.
http://dx.doi.org/10.1080/11038128.2021.... , p. 1), argue that the term ‘meaningful occupation’ “tends to be used in ways that adds ambiguity rather than specificity”. As a core concept it needs the kind of critical examination that even the term ‘occupation’ has been subjected to (Emery-Whittington, 2021Emery-Whittington, I. G. (2021). Occupational Justice – Colonial Business as Usual? Indigenous Observations From Aotearoa New Zealand: la justice occupationnelle : sous régime colonial comme d’habitude? Observations d’autochtones d’Aotearoa en Nouvelle-Zélande. Canadian Journal of Occupational Therapy, 88(2), 153-162. http://dx.doi.org/10.1177/00084174211005891.
http://dx.doi.org/10.1177/00084174211005... ; Malfitano & Lopes, 2021Malfitano, A. P. S., & Lopes, R. E. (2021). Preface. In R. E. Lopes & A. P. S. Malfitano (Eds.), Social occupational therapy: Theoretical and practical designs (pp. 13-21). Philadelphia: Elsevier.). The term “occupation” imbues pejorative meanings of negativity and coercion in countries like Brazil (Malfitano & Lopes, 2021Malfitano, A. P. S., & Lopes, R. E. (2021). Preface. In R. E. Lopes & A. P. S. Malfitano (Eds.), Social occupational therapy: Theoretical and practical designs (pp. 13-21). Philadelphia: Elsevier.), reflecting potential adversarial interpretations associated with colonial and/or military occupation. To distance from such imbued connotations, the words “activity” and, more recently, “cotidiano” (similar to “everyday life”) are more commonly used (Malfitano & Lopes, 2021Malfitano, A. P. S., & Lopes, R. E. (2021). Preface. In R. E. Lopes & A. P. S. Malfitano (Eds.), Social occupational therapy: Theoretical and practical designs (pp. 13-21). Philadelphia: Elsevier.). Similarly the term ‘meaning’ has been widely used but poorly explicated.

Despite being widely discussed in the occupational therapy and occupational science literature, there is no consensus about definitions of meaning, meaningful, and meaningfulness (Kielsgaard et al., 2021Kielsgaard, K., Horghagen, S., Nielsen, D., & Kristensen, H. K. (2021). Approaches to engaging people with dementia in meaningful occupations in institutional settings: a scoping review. Scandinavian Journal of Occupational Therapy, 28(5), 329-347. http://dx.doi.org/10.1080/11038128.2020.1791952.
http://dx.doi.org/10.1080/11038128.2020.... ). Ellerin (2015Ellerin, B. E. (2015). The meaning is in the making: a linguistic perspective on human occupation. Journal of Occupational Science, 22(4), 403-421. http://dx.doi.org/10.1080/14427591.2015.1016998.
http://dx.doi.org/10.1080/14427591.2015.... , p. 404) cautions that without a rigorous definition of meaning, studies of occupation “may be incomplete, over-reaching, or misplaced.” It is not the intent of this reflection essay to conduct a scoping review or systematic review of these concepts in the context of occupational therapy; rather, we provide an overview of select literature that exemplifies how these terms have been defined, described, and contextualised within the English-language literature.

Approach

The fourth author conducted a search of databases through EBSCO Host, which included Academic Search Premier, APA PsycArticles, CINAHL, Gender Studies Database, Social Work Abstracts, and SPORTDiscus. Search terms included “meaning” OR “meaningful” OR “meaningfulness” AND “occupational therapy” OR “occupational science” in the title, abstract, or keywords. The search resulted in 3001 articles, books, theses, commentaries, or reviews; with 307 duplications, this resulted in 2694 sources. The first and fourth authors contributed to initial screening of the title and abstract. Papers were included if they specifically discussed the meaning of occupation. Excluded sources were: empirical studies about the meaning of particular occupations among particular populations; a focus on meaning-making; meaning related to a concept other than occupation (e.g., meaning of therapy); providing an analysis of meaning embedded in research findings; not published in English. The vast majority of excluded sources at this stage used the term “meaningful occupation” as a synonym for “occupation,” without elaborating on “meaning” in any way. Thirty-five sources were included for full text review with a further 20 excluded due to lack of detail specifically related to ‘meaning’ as a concept related to occupation. The first author undertook an expanded review of reference lists in order to identify additional sources, which included 20 sources; this resulted in a total of 35 sources reviewed and included in Table 2.

As seen in Table 2, occupational therapy literature has taken up the notions of meaning, meaningful, and meaningfulness of occupation in multiple ways, framed predominantly, though implicitly, in relation to ‘positive’ experiences and outcomes. Among those who acknowledge meanings of occupation are not inherently positive are de Mello et al. (2020)Mello, A. C. C., Dituri, D. R., & Marcolino, T. Q. (2020). The meaning making of what is meaningful: Dialogues with Wilcock and Benetton. Cadernos Brasileiros de Terapia Ocupacional, 28(1), 352-373. http://dx.doi.org/10.4322/2526-8910.ctoEN1896.
http://dx.doi.org/10.4322/2526-8910.ctoE... , Hammell (2004)Hammell, K. W. (2004). Dimensions of meaning in the occupations of daily life. Canadian Journal of Occupational Therapy, 71(5), 296-305. http://dx.doi.org/10.1177/000841740407100509.
http://dx.doi.org/10.1177/00084174040710... , Hocking (2009)Hocking, C. (2009). The challenge of occupation: describing the things people do. Journal of Occupational Science, 16(3), 140-150. http://dx.doi.org/10.1080/14427591.2009.9686655.
http://dx.doi.org/10.1080/14427591.2009.... , Ikiugu et al. (2019)Ikiugu, M. N., Lucas-Molitor, W., Feldhacker, D., Gebhart, C., Spier, M., Kapels, L., Arnold, R., & Gaikowski, R. (2019). Guidelines for occupational therapy interventions based on meaningful and psychologically rewarding occupations. Journal of Happiness Studies, 20(7), 2027-2053. http://dx.doi.org/10.1007/s10902-018-0030-z.
http://dx.doi.org/10.1007/s10902-018-003... , Keponen & Kielhofner (2006)Keponen, R., & Kielhofner, G. (2006). Occupation and meaning in the lives of women with chronic pain. Scandinavian Journal of Occupational Therapy, 13(4), 211-220. http://dx.doi.org/10.1080/11038120600672975.
http://dx.doi.org/10.1080/11038120600672... , Roberts & Bannigan (2018)Roberts, A. E. K., & Bannigan, K. (2018). Dimensions of personal meaning from engagement in occupations: A metasynthesis. Canadian Journal of Occupational Therapy, 85(5), 386-396. http://dx.doi.org/10.1177/0008417418820358.
http://dx.doi.org/10.1177/00084174188203... , Rowles (2008)Rowles, G. D. (2008). Place in occupational science: a life course perspective on the role of environmental context in the quest for meaning. Journal of Occupational Science, 15(3), 127-135. http://dx.doi.org/10.1080/14427591.2008.9686622.
http://dx.doi.org/10.1080/14427591.2008.... , and Wada (2011)Wada, M. (2011). Strengthening the Kawa model: japanese perspectives on person, occupation, and environment. Canadian Journal of Occupational Therapy, 78(4), 230-236. http://dx.doi.org/10.2182/cjot.2011.78.4.4.
http://dx.doi.org/10.2182/cjot.2011.78.4... ; though this is generally mentioned in a single clause with no elaboration. Nelson et al. (1982)Nelson, D. L., Thompson, G., & Moore, J. A. (1982). Identification of factors of affective meaning in four selected activities. American Journal of Occupational Therapy, 36(6), 381-387. http://dx.doi.org/10.5014/ajot.36.6.381.
http://dx.doi.org/10.5014/ajot.36.6.381... similarly noted that affective meaning of occupations may not be positive. White et al. (2013)White, C., Lentin, P., & Farnworth, L. (2013). An investigation into the role and meaning of occupation for people living with on‐going health conditions. Australian Occupational Therapy Journal, 60(1), 20-29. http://dx.doi.org/10.1111/1440-1630.12023.
http://dx.doi.org/10.1111/1440-1630.1202... observes that it is possible for occupations with [presumably positive] meaning to simultaneously pose a risk to health.

Our search strategy for Table 2 excluded empirical studies of meaning of particular occupations for particular people. It was our intent to examine how meaning is described as a construct in occupation therapy and occupational science literature. In our brief scan of excluded articles, definitions of meaning often referred to one of the articles cited in Table 2. It may be the case that more nuanced findings of meanings are undercover in discussion with informants; if so, these complex and nuanced meanings have not been comprehensively integrated into conceptual framings or models in the occupational therapy or occupational science literature.

Multiple theorists have influenced occupational therapists’ thinking about meaning. Drawing selectively on theorists such as Frankl and Csikszentmihalyi, and to some extent Heidegger (e.g., Reed et al., 2010Reed, K., Hocking, C., & Smythe, L. (2010). The interconnected meanings of occupation: the call, being-with, possibilities. Journal of Occupational Science, 17(3), 140-149. http://dx.doi.org/10.1080/14427591.2010.9686688.
http://dx.doi.org/10.1080/14427591.2010.... ; Reed et al., 2013Reed, K., Smythe, L., & Hocking, C. (2013). The meaning of occupation: a hermeneutic (re)view of historical understandings. Journal of Occupational Science, 20(3), 253-261. http://dx.doi.org/10.1080/14427591.2012.729487.
http://dx.doi.org/10.1080/14427591.2012.... ), Gadamer (e.g., de Mello et al., 2020Mello, A. C. C., Dituri, D. R., & Marcolino, T. Q. (2020). The meaning making of what is meaningful: Dialogues with Wilcock and Benetton. Cadernos Brasileiros de Terapia Ocupacional, 28(1), 352-373. http://dx.doi.org/10.4322/2526-8910.ctoEN1896.
http://dx.doi.org/10.4322/2526-8910.ctoE... ; Reed et al., 2010Reed, K., Hocking, C., & Smythe, L. (2010). The interconnected meanings of occupation: the call, being-with, possibilities. Journal of Occupational Science, 17(3), 140-149. http://dx.doi.org/10.1080/14427591.2010.9686688.
http://dx.doi.org/10.1080/14427591.2010.... ; Reed et al., 2013Reed, K., Smythe, L., & Hocking, C. (2013). The meaning of occupation: a hermeneutic (re)view of historical understandings. Journal of Occupational Science, 20(3), 253-261. http://dx.doi.org/10.1080/14427591.2012.729487.
http://dx.doi.org/10.1080/14427591.2012.... ), Nietzsche (e.g., Ikiugu, 2005Ikiugu, M. N. (2005). Meaningfulness of occupations as an occupational-life-trajectory attractor. Journal of Occupational Science, 12(2), 102-109. http://dx.doi.org/10.1080/14427591.2005.9686553.
http://dx.doi.org/10.1080/14427591.2005.... ), Ricouer (e.g., Borell et al., 2021Borell, L., Mondaca, M., & Luborsky, M. (2021). “Meaningful occupation” - challenges for occupational therapy research. Scandinavian Journal of Occupational Therapy, 29(3), 257-258. http://dx.doi.org/10.1080/11038128.2021.1954996.
http://dx.doi.org/10.1080/11038128.2021.... ), Merleu-Ponty (e.g., Borell et al., 2021Borell, L., Mondaca, M., & Luborsky, M. (2021). “Meaningful occupation” - challenges for occupational therapy research. Scandinavian Journal of Occupational Therapy, 29(3), 257-258. http://dx.doi.org/10.1080/11038128.2021.1954996.
http://dx.doi.org/10.1080/11038128.2021.... ), Mezirow (e.g., de Mello et al., 2020Mello, A. C. C., Dituri, D. R., & Marcolino, T. Q. (2020). The meaning making of what is meaningful: Dialogues with Wilcock and Benetton. Cadernos Brasileiros de Terapia Ocupacional, 28(1), 352-373. http://dx.doi.org/10.4322/2526-8910.ctoEN1896.
http://dx.doi.org/10.4322/2526-8910.ctoE... ), and others, it is implied that occupations contribute [positively] to life’s meaning, intents, and purposes, are [positively] valued, and [positive] meanings arise through engagement in occupation. Positive outcomes of meaningful engagement include belonging, autonomy, continuity, self-esteem, enjoyment, stimulation, satisfaction, mastery, self-worth, quality of life, sense of purpose, fulfilment, happiness, mental health, physical health, and well-being (Chio et al., 2018Chio, F. H. N., Mak, W. W. S., Chan, R. C. H., & Tong, A. C. Y. (2018). Unraveling the insight paradox: one-year longitudinal study on the relationships between insight, self-stigma, and life satisfaction among people with schizophrenia spectrum disorders. Schizophrenia Research, 197, 124-130. http://dx.doi.org/10.1016/j.schres.2018.01.014.
http://dx.doi.org/10.1016/j.schres.2018.... ; Du Toit et al., 2019Du Toit, S. H. J., Shen, X., & McGrath, M. (2019). Meaningful engagement and person-centered residential dementia care: a critical interpretive synthesis. Scandinavian Journal of Occupational Therapy, 26(5), 343-355. http://dx.doi.org/10.1080/11038128.2018.1441323.
http://dx.doi.org/10.1080/11038128.2018.... ; Eakman et al., 2018Eakman, A. M., Atler, K. E., Rumble, M., Gee, B. M., Romriell, B., & Hardy, N. (2018). A qualitative research synthesis of positive subjective experiences in occupation from the Journal of Occupational Science (1993-2010). Journal of Occupational Science, 25(3), 346-367. http://dx.doi.org/10.1080/14427591.2018.1492958.
http://dx.doi.org/10.1080/14427591.2018.... ; Eakman et al., 2010bEakman, A. M., Carlson, M. E., & Clark, F. A. (2010b). The Meaningful Activity Participation Assessment: A measure of engagement in personally valued activities. International Journal of Aging & Human Development, 70(4), 299-317. http://dx.doi.org/10.2190/AG.70.4.b.
http://dx.doi.org/10.2190/AG.70.4.b... ). In contrast it has been suggested that lack of meaningful occupation contributes to experiences of boredom, negative rumination, depression, and disconnection (Christiansen, 1999Christiansen, C. H. (1999). The 1999 Eleanor Clarke Slagle Lecture. Defining lives: Occupation as identity: An essay on competence, coherence, and the creation of meaning. The American Journal of Occupational Therapy, 53(6), 547-558.; Marshall et al., 2019Marshall, C. A., Davidson, L., Li, A., Gewurtz, R., Roy, L., Barbic, S., Kirsh, B., & Lysaght, R. (2019). Boredom and meaningful activity in adults experiencing homelessness: A mixed-methods study. Canadian Journal of Occupational Therapy, 86(5), 357-370. http://dx.doi.org/10.1177/0008417419833402.
http://dx.doi.org/10.1177/00084174198334... ).

Frankl and Csikszentmihalyi are two theorists whose work have shaped the profession following World War II (e.g., de Mello et al., 2020Mello, A. C. C., Dituri, D. R., & Marcolino, T. Q. (2020). The meaning making of what is meaningful: Dialogues with Wilcock and Benetton. Cadernos Brasileiros de Terapia Ocupacional, 28(1), 352-373. http://dx.doi.org/10.4322/2526-8910.ctoEN1896.
http://dx.doi.org/10.4322/2526-8910.ctoE... ; Eakman et al., 2010aEakman, A. M., Carlson, M. E., & Clark, F. A. (2010a). Factor structure, reliability, and convergent validity of the engagement in meaningful activities survey for older adults. OTJR, 30(3), 111-121. http://dx.doi.org/10.3928/15394492-20090518-01.
http://dx.doi.org/10.3928/15394492-20090... ; Hocking, 2000Hocking, C. (2000). Occupational science: a stock take of accumulated insights. Journal of Occupational Science, 7(2), 58-67. http://dx.doi.org/10.1080/14427591.2000.9686466.
http://dx.doi.org/10.1080/14427591.2000.... ; Ikiugu, 2019Ikiugu, M. N. (2019). Meaningful and psychologically rewarding occupations: characteristics and implications for occupational therapy practice. Occupational Therapy in Mental Health, 35(1), 40-58. http://dx.doi.org/10.1080/0164212X.2018.1486768.
http://dx.doi.org/10.1080/0164212X.2018.... ; Law, 2002Law, M. (2002). Participation in the occupations of everyday life. The American Journal of Occupational Therapy, 56(6), 640-649. http://dx.doi.org/10.5014/ajot.56.6.640.
http://dx.doi.org/10.5014/ajot.56.6.640... ; Persson et al., 2001Persson, D., Erlandsson, L. K., Eklund, M., & Iwarsson, S. (2001). Value dimensions, meaning, and complexity in human occupation - A tentative structure for analysis. Scandinavian Journal of Occupational Therapy, 8(1), 7-18. http://dx.doi.org/10.1080/11038120119727.
http://dx.doi.org/10.1080/11038120119727... ; Roberts & Bannigan, 2018Roberts, A. E. K., & Bannigan, K. (2018). Dimensions of personal meaning from engagement in occupations: A metasynthesis. Canadian Journal of Occupational Therapy, 85(5), 386-396. http://dx.doi.org/10.1177/0008417418820358.
http://dx.doi.org/10.1177/00084174188203... ; Rowles, 2008Rowles, G. D. (2008). Place in occupational science: a life course perspective on the role of environmental context in the quest for meaning. Journal of Occupational Science, 15(3), 127-135. http://dx.doi.org/10.1080/14427591.2008.9686622.
http://dx.doi.org/10.1080/14427591.2008.... ). Both these men sought to understand the meaning of life at times of deep suffering. Csikszentmihalyi wondered how some people maintained decency, integrity, and purpose and “held the key to what humans could be like at their best” (Seligman & Csikszentmihalyi, 2000Seligman, M. E., & Csikszentmihalyi, M. (2000). Positive psychology. An introduction. The American Psychologist, 55(1), 5-14., p. 7), while others became “helpless and dispirited” (Seligman & Csikszentmihalyi, 2000Seligman, M. E., & Csikszentmihalyi, M. (2000). Positive psychology. An introduction. The American Psychologist, 55(1), 5-14., p. 6). Frankl was imprisoned in four concentration camps, including Auschwitz. Through his experiences and observations, he proposed sources of meaning in life to maintain courage and hope for the future, such as completing “unfinished work” or connecting with a loved one (Frankl, 2006Frankl, V. E. (2006). Man’s search for meaning. Boston: Beacon Press., p. 80).

Csikszentmihalyi (1990Csikszentmihalyi, M. (1990). Flow: The psychology of optimal experience. New York: Harper Perennial., p. 216) presents three ways “meaning” is used. The first is a purpose, significance, or end, such as, “What is the meaning of life?”. The second is related to intention or pursuit of goals, such as, “She means to be supportive.” The third pertains to ordering information, such as, “When the baby cries, it means it’s hungry.” Csikszentmihalyi proposes that people who “find their lives meaningful” experience “optimal experience” and act with “unified meaning” however, he acknowledges living a meaningful life does not inherently produce positive outcomes. He presents Napolean as an example of a person who may have achieved optimal experience, serving an inner purpose; yet, in Napolean’s pursuit of power, he sacrificed the lives of hundreds of thousands of French soldiers (Csikszentmihalyi, 1990Csikszentmihalyi, M. (1990). Flow: The psychology of optimal experience. New York: Harper Perennial., p. 217) Csikszentmihalyi (1990)Csikszentmihalyi, M. (1990). Flow: The psychology of optimal experience. New York: Harper Perennial. further notes that excelling and finding meaning in a single occupation does not ensure satisfaction or optimal experiences in other areas of life.

Moving beyond theory and concepts, occupational therapy assessments have been developed to evaluate ‘meaningful activity,’ ensuring the positive connotations of ‘meaningful’ become embedded in practice. The criteria that is common in assessment measures reflect positive constructs of meaning (Table 3), such as competence, mastery, pleasure, self-expression, personal fulfillment, achievement, pleasure, and social connection.

Certainly, efforts to understand positive aspects of meaning in relation to occupation are of value to a profession founded on a vision of enhancing health and well-being through occupation. At the same time, neglecting to examine meanings that are not framed as positive limits the profession to partial understandings of occupation, meaning, and lived experience. When an assumption of positive meaning underpins occupation-based scholarship, this can limit opportunities to elicit information that might contradict or contest that assumption.

Understanding meaning from an epistemological standpoint

Uncovering nuanced understandings of meaning in occupational therapy may be strengthened by situating ‘meaning(s)’ and ‘meaningfulness’ with respect to underlying epistemological and theoretical perspectives that may facilitate critical reflection on assumptions and biases. As with other concepts prominent in occupational therapy, it is important to ensure conceptual clarity, take into account theoretical work from other disciplines, and consider contextual influences (Durocher et al., 2014Durocher, E., Gibson, B. E., & Rappolt, S. (2014). Occupational justice: a conceptual review. Journal of Occupational Science, 21(4), 418-430. http://dx.doi.org/10.1080/14427591.2013.775692.
http://dx.doi.org/10.1080/14427591.2013.... ). It is thus important to situate understandings of meaning as influenced by one’s epistemological and theoretical perspective.

Epistemology is defined by Hamlyn (as cited in Crotty, 1998Crotty, M. (1998). The foundations of social research: meaning and perspective in the research process. Thousand Oaks: SAGE., p. 8) as “the nature of knowledge and its possibility, scope and general basis” while a theoretical perspective is defined as “a way of looking at the world and making sense of it” (Crotty, 1998Crotty, M. (1998). The foundations of social research: meaning and perspective in the research process. Thousand Oaks: SAGE., p. 8). Within objectivist epistemologies and positivist theoretical approaches, things (in this case, occupations) “exist as meaningful entities independent of consciousness and experience, that they have truth and meaning residing in them as objects (‘objective’ truth and meaning, therefore), and that careful (scientific) research can attain that objective truth and meaning” (Crotty, 1998Crotty, M. (1998). The foundations of social research: meaning and perspective in the research process. Thousand Oaks: SAGE., p. 5-6). Constructionist epistemologies and interpretivist theoretical approaches appear to align more closely with the descriptions of meaning listed in Table 2. From these perspectives, meaning is thought to arise in different ways for different people, taking into consideration factors such as time, place, and culture. In contrast, epistemologies of subjectivity approach meaning as ascribed to objects (e.g., occupations) from external influences, such that “[...] meanings are thus at once objective and subjective, their objectivity and subjectivity being indissolubly bound up with each other [...]” (Crotty, 1998Crotty, M. (1998). The foundations of social research: meaning and perspective in the research process. Thousand Oaks: SAGE., p. 48). However, this definition of ‘subjectivity’ differs from the predominant ways ‘subjective meaning’ is used in the occupational therapy literature. In those instances, ‘subjective’ typically refers to meaning that arises from an interaction between the object (occupation) and subject (person), where the subject attributes or experiences meaning(s) in relation to the object. In an epistemology of subjectivism, meaning is created outside the subject (Crotty, 1998Crotty, M. (1998). The foundations of social research: meaning and perspective in the research process. Thousand Oaks: SAGE.). In occupational therapy literature, the meaning of occupation is understood, to some extent, outside the subject, with dominant social and cultural meanings identified; however, depending on theoretical and methodological approaches, these meanings may reflect subjectivist or objectivist epistemologies.

Aligned with the ways meaning is predominantly described in occupational therapy, meaning has been described as “qualities of human ‘experience’ or ‘subjectivity’” (Parker, 2005Parker, I. (2005). Qualitative psychology: introducing radical research. Maidenhead: Open University Press., p. 137). Some common interpretivist theoretical perspectives that guide research methodologies in occupational therapy to examine meaning include phenomenology, symbolic interactionism, and hermeneutics. The influence of phenomenology is evident in the amount of research exploring meanings of human occupation (Absolom & Roberts, 2011Absolom, S., & Roberts, A. (2011). Connecting with others: the meaning of social eating as an everyday occupation for young people. Journal of Occupational Science, 18(4), 339-346. http://dx.doi.org/10.1080/14427591.2011.586324.
http://dx.doi.org/10.1080/14427591.2011.... ; Alsaker & Josephsson, 2010Alsaker, S., & Josephsson, S. (2010). Occupation and meaning: narrative in everyday activities of women with chronic rheumatic conditions. OTJR, 30(2), 58-67. http://dx.doi.org/10.3928/15394492-20100312-01.
http://dx.doi.org/10.3928/15394492-20100... ; Berger, 2011Berger, S. (2011). The meaning of leisure for older adults living with vision loss. OTJR, 31(4), 193-199. http://dx.doi.org/10.3928/15394492-20101222-01.
http://dx.doi.org/10.3928/15394492-20101... ; Degrace, 2004Degrace, B. W. (2004). The everyday occupation of families with children with autism. The American Journal of Occupational Therapy, 58(5), 543-550. http://dx.doi.org/10.5014/ajot.58.5.543.
http://dx.doi.org/10.5014/ajot.58.5.543... ; Eriksson & Tham, 2010Eriksson, G., & Tham, K. (2010). The meaning of occupational gaps in everyday life in the first year after stroke. OTJR, 30(4), 184-192. http://dx.doi.org/10.3928/15394492-20091123-01.
http://dx.doi.org/10.3928/15394492-20091... ; Gibbs & Klinger, 2011Gibbs, L. B., & Klinger, L. (2011). Rest is a meaningful occupation for women with hip and knee osteoarthritis. OTJR, 31(3), 143-150. http://dx.doi.org/10.3928/15394492-20101122-01.
http://dx.doi.org/10.3928/15394492-20101... ; Križaj et al., 2019Križaj, T., Roberts, A., Warren, A., & Slade, A. (2019). Early hour, golden hour: an exploration of Slovenian older people’s meaningful occupations. Journal of Cross-Cultural Gerontology, 34(2), 201-221. http://dx.doi.org/10.1007/s10823-019-09369-5.
http://dx.doi.org/10.1007/s10823-019-093... ; Pereira & Stagnitti, 2008Pereira, R. B., & Stagnitti, K. (2008). The meaning of leisure for well‐elderly Italians in an Australian community: implications for occupational therapy. Australian Occupational Therapy Journal, 55(1), 39-46. http://dx.doi.org/10.1111/j.1440-1630.2006.00653.x.
http://dx.doi.org/10.1111/j.1440-1630.20... ; Reed et al., 2011Reed, K. D., Hocking, C. S., & Smythe, L. A. (2011). Exploring the meaning of occupation: the case for phenomenology. Canadian Journal of Occupational Therapy, 78(5), 303-310. http://dx.doi.org/10.2182/cjot.2011.78.5.5.
http://dx.doi.org/10.2182/cjot.2011.78.5... ). An advantage of phenomenology is the view that “meaning in people’s lives is given by the context of the world in which they live” (Wilding & Whiteford, 2005Wilding, C., & Whiteford, G. (2005). Phenomenological research: an exploration of conceptual, theoretical, and practical issues. OTJR, 25(3), 98-104. http://dx.doi.org/10.1177/153944920502500303.
http://dx.doi.org/10.1177/15394492050250... , p. 100). The influence of social interactionism is also apparent. Symbolic interactionism is grounded on the belief that the meaning something holds for a person impacts how they act and this meaning arises through social interactions and individual interpretations (Blumer, 1969Blumer, H. (1969). Symbolic interactionism: perspective and method. Englewood Cliffs: Prentice-Hall.). Understandings are framed through the lens of individuals, whereby, “The situation must be seen as the actor sees it, the meanings of objects and acts must be determined in terms of the actor’s meanings, and the organization of a course of action must be understood as the actor organizes it” (Psathas, 1973 as cited in Crotty, 1998Crotty, M. (1998). The foundations of social research: meaning and perspective in the research process. Thousand Oaks: SAGE., p. 75). Hermeneutics involves systematic interpretation of meaning(s). Dithley (as cited in Weinberg, 2008Weinberg, D. (2008). The philosophical foundations of constructionist research. In J. A. Holstein & J. F. Gubrium (Eds.), Handbook of constructionist research (pp. 13-39). New York: The Guilford Press., p. 29) suggested that, “because it is purposeful, meaningful, and creative, social life cannot be explained by natural laws but can be grasped only through Verstehen, or interpretive understanding” Giddens (as cited in Crotty, 1998Crotty, M. (1998). The foundations of social research: meaning and perspective in the research process. Thousand Oaks: SAGE., p. 56) observes that social scientists engage in ‘double hermeneutics,’ whereby they are simultaneously “entering and grasping the frames and meanings involved in the production of social life by lay actors” and “reconstituting these within the new frames of meaning involved in technical conceptual themes”.

Outside occupational therapy literature, the concept of ‘meaning’ is not exclusively associated with positive attributions. For instance, ‘negative meanings’ are explored in relation to pain or certain diagnoses (Chio et al., 2018Chio, F. H. N., Mak, W. W. S., Chan, R. C. H., & Tong, A. C. Y. (2018). Unraveling the insight paradox: one-year longitudinal study on the relationships between insight, self-stigma, and life satisfaction among people with schizophrenia spectrum disorders. Schizophrenia Research, 197, 124-130. http://dx.doi.org/10.1016/j.schres.2018.01.014.
http://dx.doi.org/10.1016/j.schres.2018.... ; Du Toit et al., 2019Du Toit, S. H. J., Shen, X., & McGrath, M. (2019). Meaningful engagement and person-centered residential dementia care: a critical interpretive synthesis. Scandinavian Journal of Occupational Therapy, 26(5), 343-355. http://dx.doi.org/10.1080/11038128.2018.1441323.
http://dx.doi.org/10.1080/11038128.2018.... ; Eakman et al., 2010bEakman, A. M., Carlson, M. E., & Clark, F. A. (2010b). The Meaningful Activity Participation Assessment: A measure of engagement in personally valued activities. International Journal of Aging & Human Development, 70(4), 299-317. http://dx.doi.org/10.2190/AG.70.4.b.
http://dx.doi.org/10.2190/AG.70.4.b... ). Indeed, in fields outside occupational therapy, meanings of activities/occupations are examined with complex attention to nuanced experiences. Meanings of “family work” (e.g., domestic chores, childcare) are recognized to potentially include love and care, as well as subordination and powerlessness (Kroska, 2003Kroska, A. (2003). Investigating gender differences in the meaning of household chores and child care. Journal of Marriage and the Family, 65(2), 456-473. http://dx.doi.org/10.1111/j.1741-3737.2003.00456.x.
http://dx.doi.org/10.1111/j.1741-3737.20... ); a potential meaning of parenting is “role captivity,” described as feeling trapped in the parenting role and attributed to experiences of emotional strain (Nomaguchi & Brown, 2011Nomaguchi, K. M., & Brown, S. L. (2011). Parental strains and rewards among mothers: the role of education. Journal of Marriage and the Family, 73(3), 621-636. http://dx.doi.org/10.1111/j.1741-3737.2011.00835.x.
http://dx.doi.org/10.1111/j.1741-3737.20... ). Another example is meanings around the occupation of coaching sports, which are complexly linked to safety, trust, and protection of children, as well as the perceptions around potential vulnerability and risks for child abuse (Garratt et al., 2013Garratt, D., Piper, H., & Taylor, B. (2013). ‘Safeguarding’ sports coaching: Foucault, genealogy and critique. Sport Education and Society, 18(5), 615-629. http://dx.doi.org/10.1080/13573322.2012.736861.
http://dx.doi.org/10.1080/13573322.2012.... ). In numerous fields of inquiry other than occupational therapy, meaning is explored as complex, nuanced, contextual, variable, shifting, and contradictory.

It is reasonable that when historically establishing occupational therapy as a legitimate and valued profession, the therapeutic potential of occupation was emphasized and occupations, as outcomes, were described as inherently positive. These types of arguments were rhetorically persuasive and politically advantageous. As the profession matures and scholarship expands, such longstanding epistemic ‘myths’ are being confronted. Critical perspectives need not be viewed as threatening to the legitimacy of the profession; rather these form a part of an ongoing conversation that builds on – rather than negates – preceding scholarship. Integrating understandings of occupation beyond presumed positive meanings of occupations can better inform occupational therapy assessment and, subsequently, approaches and intervention.

Future directions

‘Negative’ meanings may be more prominently acknowledged in newer literature regarding non-sanctioned occupations; however, to avoid inadvertently reifying dominant and potentially stigmatising understandings it is important to approach ‘meanings’ as diverse and complex. For instance, whereas Huglstad et al. (2020)Huglstad, M., Halvorsen, I. L. I., Jonsson, H., & Nielsen, K. T. (2020). “Some of us actually choose to do this”: the meanings of sex work from the perspective of female sex workers in Denmark. Journal of Occupational Science, 29(1) 68-81. http://dx.doi.org/10.1080/14427591.2020.1830841.
http://dx.doi.org/10.1080/14427591.2020.... uncover ‘positive meanings’ of sex work (framed in the article as a non-sanctioned occupation) with respect to self-identifying as a sexual being, personal development, interpersonal relationships, professional pride, and well-being and quality of life, they also identify that negative meanings were viewed as emerging from public perspectives and sociocultural and political contexts that infringed on one’s sense of belonging. Personally speaking, in the first author’s work, the perspective of occupations as being positively meaningful was adopted as a means of bringing credibility to positioning of substance use as a legitimate occupation (Kiepek & Magalhães, 2011Kiepek, N., & Magalhães, L. (2011). Addictions and impulse-control disorders as occupation: a selected literature review and synthesis. Journal of Occupational Science, 18(3), 254-276. http://dx.doi.org/10.1080/14427591.2011.581628.
http://dx.doi.org/10.1080/14427591.2011.... ) and to challenge predominant one-sided assumptions of this occupation as inherently negative (Kiepek et al., 2019Kiepek, N., Beagan, B., & Phelan, S. (2019). Substance use to enhance occupational performance and experience: a critical interpretive synthesis. Cadernos Brasileiros de Terapia Ocupacional, 27(4), 843-857. http://dx.doi.org/10.4322/2526-8910.ctoAR1926.
http://dx.doi.org/10.4322/2526-8910.ctoA... ). When occupations are assumed to be positively meaningful, research may inadvertently be designed to more explicitly elicit these types of experiences, potentially overlooking approaches (e.g., interview questions) that will simultaneously elicit meanings of occupation that are not positive.

Despite acknowledgements in scholarship of occupations that meaning may not always be positive, this perspective remains underdeveloped. Furthermore, there is a need to shift attention from reinforcing dualistic perspectives of meaning being either positive or negative. Meaning is diverse, fluid, temporal, contextually situated, and multiple. If occupational therapists (and occupational scientists) are to be “custodians of meaning” (Englehardt, 1986Englehardt, T. (1986). Occupational therapists as technologists and custodians of meaning. In G. Kielhofner (Ed.), Health through occupation (pp. 139-144). Philadelphia: F. A. Davis.), it is essential to explode understandings of meaning beyond an oversimplified emphasis on positive valuation. To perpetuate framings of occupations as inherently and exclusively positively meaningful effectively silences experiences that do not conform to dominant assumptions and perspectives. Approaching ‘meaning’ more broadly may allow occupational therapists and scholars to better comprehend what people do and do not do, and why, better situating the profession in espoused goals of promoting equity, justice, and rights. Neglecting diverse experiences of meaning can inadvertently contribute to oppressive practices that silence non-idealized experiences.

Conclusion

Understandably, as a profession whose purpose is to facilitate health, wellbeing, and rights-based outcomes, the positive potential of occupation is liberally discussed in occupational therapy literature. At the same time, it is essential to deliberately examine diverse and varied meanings of occupations, for collectives as well as individuals and for these types of findings to inform concepts, models, and assessments. To neglect nuanced meanings risks undermining the credibility of our professional knowledge base and, subsequently, our practices. Assuming that occupations socially constructed as “positive” will necessarily have exclusively positive meanings, or that occupations constructed as “negative” cannot hold positive meanings (or worse yet, are “meaningless”), undermines claims to person-centredness. Furthermore, neglecting nuanced understandings of occupations, focusing solely on the positive, forfeits more complex examinations to other disciplines, thereby undermining occupational therapy’s claim to expertise in the realm of occupation. It is essential to critically reflect on how personal, cultural, social, and professional views influence the degree to which nuanced and varied experiences and interpretations of meaning are legitimized and voiced. Greater attention to nuanced complexity of meanings, even contradictory meanings, may open greater conceptual space for understanding occupation more deeply and further contribute to occupational therapy assessment and intervention.

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