Occupational Disruption: An Undeniable Reality for Occupational Beings, Part I

Dr. Ricardo C. Carrasco PhD, OTR/L, FAOTA

Dr. Shirish Lala EdD, MHS, OTR/L

Abstract

Life happens and any experience related to an event that disturbs a person’s state of affairs, positive or negative, can result in the disruption of otherwise reliable routines or roles.  In occupational science and occupational therapy, this construct is called occupational disruption .  This descriptive paper brings forward information about occupational disruption to understand what it means, trace how it evolved and know how to measure the severity of its occurrence and facilitate adaptations.  For example, receiving a new diagnosis may disrupt one’s ability to work and may put finances in jeopardy.  Similarly, the occurrence of a natural disaster such as a hurricane may cause changes in living conditions and the ability to feel secure and safe .  However, the birth of a baby, or getting engaged, or moving to a new home requires a different mindset and adaptations that provide opportunities for growth and healthy milestones. The authors’ literature search and reflections on positive stressors and human responses to life altering events revealed a disproportional emphasis on negative disruptions (i.e. natural disasters, terminal diagnoses, etc.), but hardly anything on positive experiences such as getting married or finding unknown relatives.  Therefore, this paper illustrates both ends of the disruption spectrum and introduces the Scale of Occupational Disruption as a useful assessment for identifying the presence and severity of occupational disruption.  The authors describe occupational disruption as a basic construct in occupational science to serve as a foundation for expanded understanding and application for the practice of OT and other disciplines with interest in humans as occupational beings. 

Keywords: occupational disruption, life altering events, Scale of Occupational Disruption

The birth of occupational science in the early 1980s opened the door to the use of more descriptive terminology related to human occupation as well as scholarly conversations about humans as occupational beings.  The new basic science allowed occupational scientists the opportunity to use words that describe the human experience, including occupational disruption (OD). Responding to the increased use of the term, Nizzero et al. (2017) conducted a scoping review of peer-reviewed articles to see how the construct was used in the literature.  The study revealed that the literature used OD in varying contexts that related to occupational identity, adaptation strategies, social relationships, and valued occupations.  It concluded that there is a need to refine the construct so it can be useful in comprehending the impact of the disruption as applied to different populations.  Moving forward, they recommended use of a definition of OD adapted from Wilcock (1998): 

OD is a temporary state, characterized by a significant disruption of identity associated with changes in the quantity and/or quality of one’s occupations subsequent to a significant life event, transition, or illness or injury.  It has the potential to affect multiple areas of functions, including social and emotional functioning.  (Nizzero et al., 2017, pp. 125-126)

This paper and the current initial validation study of the Scale of Occupational Disruption (SOD; Carrasco et al., personal communication, 2024) will apply the above definition while recognizing that OD may occur within the spectrum of negative to positive effects in human functioning and adaptation.  In other words, adapting strategies may involve modifying previous occupations rather than creating new ones.  This spectrum is evident when a young couple gets engaged or plans a family  modifying their current adaptive mechanisms  in preparation to care for their new family (see Figure 1). However, the adaptive strategies employed by someone after a life-threatening surgery may be entirely different as  the person adjusts  or redesigns their life to a new cadence and approach that aligns with  their new abilities.  Regardless of the direction of disruption, occupational scientists must enhance their understanding of OD, and persist in studying challenges and opportunities for doing, being, becoming and belonging (Wilcock, 1998).  Likewise, OT practitioners can also benefit from the information to better address the needs of their clients through overarching comprehensive information and guidance to measure occupational performance and enhance their intervention strategies.

Figure 1

A visionary groom awaits his bride for a mock Malaysian wedding

 Khaliq (2008). CC BY-NC-ND 4.0

The purpose of this paper is threefold:  a) provide information to promote scientific understanding of OD, b) introduce an assessment called the SOD, designed to identify areas of, and the degree of OD after a life-altering event, and c) to provide realistic OD illustrations that supplement the understanding and application of the construct.  All purposes are founded on Wilcock’s framework (1998) that has historically championed the relationship between occupation and wellness, and in the occupation of doing, being, becoming and belonging.  The authors are occupational scientists and OT practitioners with vast experience as healthcare providers and academic scholars whose individual positionalities include a blend of western and indigenous personal and professional backgrounds.  These experiences have provided them with a lens of observing and analyzing human beings in diverse cultural, environmental, and geographical contexts, and studying them intently with internal and external exposure in both their personal life and chosen careers.

Methodology

This descriptive paper explains the OD construct through published primary sources, secondary publications, and gray literature.  Primary sources are scientific evidence reported in publications from refereed journals, while secondary sources comprise secondhand information, commentary, or scholarly books (Alvarez, 2023).  Gray literature refers to various publications from different sources and organizations for whom publishing is not the primary function, and whose digital and hard copy production formats are not controlled by commercial or academic publishing agencies (Paez, 2017).  Some examples include conference proceedings, white papers, annual reports, videos, PowerPoint presentations, and others available through digital platforms like YouTube.

The authors searched all three sources—primary, secondary, and gray—synthesized the materials to achieve the purpose of this paper and completed the following steps of the research topic delineation, data assemblage, and synthesis process in writing the manuscript sequentially in Table 1: 

 Literature Review

Although OD was previously defined in this paper's literature, two similar occupational science constructs must be operationally defined too.  These two terms are occupational deprivation (ODep) and occupational dysfunction (ODys).  Despite being unique in their descriptions, they can be confused by others.  All three may be experienced by an individual or a population.  OD tends to be temporary or transient, and given the appropriate adaptation or support is resolved in time. For example, a town may recover slowly after a severe hurricane with adequate assistance from local governments and the Federal Emergency Management Agency (FEMA; see Figure 2).  

Figure 2

FEMA personnel survey damage after Hurricane Maria

 : Irizarry (2017). CC BY-NC-ND 4.0 

 On the other hand, ODep has historical and contemporary associations.  It is rooted in historical subordination and colonialism that have precluded certain individuals or populations from engaging in meaningful occupations and exercising their occupational freedom (Whiteford, 2000).  For example, a common belief in the Philippines is that during three centuries of Spanish colonization, indigenous Filipinos, known locally as indios, were mandated to wear their transparent pocketless shirts untucked. This practice was so that male indios, at least in the manner of dress, could be easily differentiated from the ilustrados who represented the educated Filipinos and colonizers (see Figure 3). Unfortunately, this mandate explicitly discriminated against the indios, as it was predominantly used to demonstrate that the Filipinos were not hiding anything that could have been assumed to be stolen from the ruling, privileged class (Anonymous, 2019). It was a constant reminder of the indios’ status as lower-class citizens, and served as an intentional, preventive measure to impede social inclusion in the Philippines. In current parlance, ODep may be experienced by individuals or populations who may be less privileged and marginalized due to varied social issues not limited to poverty, access to technology, immigrant status, sexual preference, criminal background history, etc.  

Figure 3. 

An indigenous Filipino wearing an untucked shirt, and three ilustrados in formal European attire.

Anonymous. (2019). Copyright 2019 by Vinta.

A simplified distinction of ODys from OD and ODep may be to view ODys as deficits in occupational performance, because of either OD, ODep, or both (Whiteford, 2000).  For example, a female child from a minority group, who grew up in an orphanage, may not acquire sensorimotor skills necessary for eating a variety of nutritious meals due to scarce resources that limit her opportunities to experience various dietary textures, tastes, smells, and colors, during her formative years (Cermak & Daunhauer, 1997). Similarly, ethnic groups, immigrants, persons with disabilities, inmates, and people of color are most likely to be negatively impacted by wide-spread epidemics, climate crises, monoculturalism, and nationalistic politics that may result in ODys. Any unresolved or repeated incidents of OD, combined with associated trauma responses, ODep, and toxic stress will likely result in ODys in these marginalized populations (Hammell, 2020). The costs associated with ODys can be immense as they may restrict self-efficacy, identity formation, and meaningful time use in the minority workforce. Maladaptive responses in the form of sleep deprivation, risk of self-harm, suicide, addiction, and social isolation, stemming from chronic depression may further impede efforts to integrate the marginalized populations as productive citizens in our neighborhoods and communities (Whiteford, 2000).              

Conclusion

This concludes part one of this paper. Part two of this article will discuss additional literature and information about the development of the SOD. The concepts of OD, ODep, and ODys may tend to overlap and shift as an individual experiences a life-altering event and reconstructs their life after occupational chaos. Although the application of these concepts may differ among distinct cultural backgrounds, intersectional identities, and ethnic groups, occupational science provides guidance when exploring the gestalt of narratives, and scientific studies related to occupational beings. 

 References

Alvarez, C. (April 4, 2023) What is the Difference Between a Primary and Secondary Source? WGU Blog. https://www.wgu.edu/blog/what-difference-between-primary-secondary-source2304.html#:~:text=When%20writers%20use%20primary%20sources,commentary%20made%20by%20other%20researchers.

Anonymous. (2019). The rich and interesting history of the Barong Tagalog (2019) . Vinta. https://vintagallery.com/blogs/news/the-rich-and-interesting-history-of-the-barong-tagalog

Cermak, S. & Daunhauer, L. A., (1997). Sensory processing in the post-institutionalized child. American Journal of Occupational Therapy, 51, 17, 500-507. doi:10.5014/ajot.51.7.500

Flickr, (2017). FEMA surveys damage after Hurricane Maria. CCO 1.0 License, https://www.rawpixel.com/image/8729561/photo-image-public-domain-people

Hammell, K. W. (2020). Engagement in living during the COVID-19 pandemic and ensuing occupational disruption.Occupational Therapy Now, 22(4), 7-8. https://www.proquest.com/trade-journals/engagement-living-during-covid-19-pandemic/docview/2426494381/se-2

Irizarry, H. (2017). U.S. Army Brig. Gen. Isabelo Rivera, the Adjutant General of Pureto Rico, and Puerto Rico Governor Ricardo Rosselló, visited the areas affected by Hurricane María in the municipalities of Loiza, Canóvanas and surrounding areas, Sept. 21, 2017. [Photograph]. Rawpixel. https://www.rawpixel.com/image/8729561/photo-image-public-domain-people (2017). 

Khaliq, S.A. (2008). The visionary groom. [Photograph]. Flickr. Licensed under CC by 2.0. https://www.flickr.com/photos/88575173@N00/2791040573

Nizzero, A., Cote, P., & Cramm, H. (2017). Occupational disruption: A scoping review, Journal of Occupational Science, 24:2, 114-127, doi: 10.1080/14427591.2017.1306791

Paez, A. (2017). Gray literature – An important resource in systematic reviews. Journal of Evidence-Based Medicine.10:233–240. doi:10.1111/jebm.12266

Whiteford, G. (2000). Occupational deprivation: Global challenge in the new millennium. British Journal of Occupational Therapy, 63(5), 127-128. doi:10.1177/030802260006300503

Wilcock, A. (1998). An occupational perspective of health. Thorofare, NJ: Slack.