Occupational therapy (OT) is a healthcare profession focused on enabling individuals to participate in the activities of daily life, or “occupations,” that they need or want to do. These occupations range from basic self-care tasks like dressing and bathing to more complex activities like managing finances and engaging in social life. The core principle of OT is that purposeful activity can prevent disability, restore function, and enhance an individual’s quality of life. The history of this therapeutic approach stretches back well before its official founding, evolving through social and philosophical movements that recognized the healing power of work and routine.
The Philosophical Roots
The intellectual foundation of occupational therapy is rooted in 18th and 19th-century social reforms, particularly the Moral Treatment Movement. Originating in Europe and brought to the United States, this movement advocated for humane care for individuals with mental illness, contrasting sharply with the harsh confinement and institutionalization previously common. Proponents believed that mental illness could be alleviated through kindness, dignity, and engagement in recreational and occupational activities. This approach emphasized the use of conversation, recreation, and light manual labor to build regular, restorative routines.
A parallel influence came from the Arts and Crafts Movement in the late 19th and early 20th centuries. This movement championed the therapeutic value of handwork and traditional craftsmanship as a reaction against the impersonal nature of industrialization. Engaging the mind and hands in productive, purposeful activity—such as weaving, pottery, or woodworking—was considered inherently beneficial for both physical and mental well-being. These two movements converged, establishing the concept that meaningful engagement, or “occupation,” was an effective tool for health and rehabilitation.
Formal Establishment of the Profession
The formal establishment of occupational therapy occurred in 1917 with the founding of the National Society for the Promotion of Occupational Therapy (NSPOT). This pivotal meeting took place in Clifton Springs, New York, bringing together six founders from varied backgrounds, including architect George Edward Barton, psychiatrist Dr. William Rush Dunton Jr., and social worker Eleanor Clarke Slagle. The initial mission centered on “habit training,” focusing on creating balanced daily routines of work, rest, and leisure to promote well-being. NSPOT established the first professional journal in 1922 and eventually changed its name to the American Occupational Therapy Association (AOTA), solidifying its role as the national professional body.
Growth Through World Conflicts
The profession’s scope and recognition accelerated dramatically in response to global events, particularly World War I. The United States military enlisted NSPOT to recruit and train civilian women, known as “Reconstruction Aides,” to help with the rehabilitation of wounded soldiers. These aides utilized arts, crafts, and vocational activities to boost morale, address mental health needs like “shell shock,” and improve physical function in military hospitals.
World War II further cemented the field’s role in physical rehabilitation. The volume of service members returning with severe physical injuries necessitated a stronger focus on orthopedic care and the use of adaptive techniques. Emergency training programs were established to quickly meet the demand for therapists, leading to broader professional recognition and expansion of practice into areas like prosthetic rehabilitation. This period forced a shift toward the medical model, integrating OT more closely with doctors and other medical professionals and promoting standardization of treatment.
Modern Professionalization and Scope
Following the wartime expansions, the mid-20th century marked a period of formal professionalization and diversification. Educational standards were formalized, moving toward required master’s degrees and establishing clear licensure requirements for practitioners. The profession expanded its focus beyond mental health and physical rehabilitation to address new areas, including pediatrics, geriatrics, and specialized fields like sensory integration.
Federal legislation played a significant role in solidifying occupational therapy’s place in modern healthcare and education. The creation of Medicare in 1965 and the Individuals with Disabilities Education Act (IDEA) mandated the inclusion of OT services, ensuring access for a wider population. These changes transformed OT from a niche specialty into an established component of the healthcare system, recognized for its role in enabling participation across the lifespan and in diverse settings.