Abstract

Introduction

This paper presents an analytical approach to occupational therapy practice grounded in historical dialectical materialism. It understands occupational therapy professional practice as work within a capitalist system, and thus subject to analysis through the labor process theory.

Objective

To propose an analytical approach to occupational therapy practice aimed at supporting the development of an emancipatory practice framework based on the dialogue between Social Occupational Therapy and Latin American Collective Health.

Method

Utilizing emancipatory action research methodologies, this study conducted 10 workshops with 10 occupational therapists aimed at collective knowledge production.

Results

Human activity is identified as the object of occupational therapy working process, defined by the category work in its ontological dimension. Radical participation is set as the intended product of this process, which entails engaging in efforts to transform the social determination of collective living conditions. The individuals in this process include occupational therapists and the followed-up individuals, groups, and/or communities, all viewed as social beings collaborating toward social transformation. Four theoretical-methodological tools are identified: emancipatory analysis of human activities, emancipatory proposition of human activities, operationalization of radical participation, and interventions in the social fabric.

Conclusion

Occupational therapy, as a form of social practice, offers a specific contribution to the development of a collective revolutionary praxis. This praxis, aimed at realizing a concrete utopia, seeks to generate the means to create a new society.

Keywords:
Epistemology; Critical Theory; Concept Formation; Occupational Therapy

Resumo

Introdução

Este artigo apresenta uma abordagem analítica da prática da terapia ocupacional baseada no materialismo histórico dialético, compreendendo que a prática profissional da terapia ocupacional é considerada trabalho no sistema capitalista, podendo ser analisada à luz da Teoria do Processo de Trabalho.

Objetivo

Propor uma abordagem analítica com o intuito de apoiar o desenvolvimento de práticas de terapia ocupacional emancipatórias, baseadas no diálogo entre a Terapia Ocupacional Social e a Saúde Coletiva Latino-Americana.

Método

Com base na pesquisa-ação emancipatória, foram realizadas dez oficinas com dez terapeutas ocupacionais visando à produção coletiva de conhecimento.

Resultados

A atividade humana foi identificada como objeto do processo de trabalho da terapia ocupacional, definida pela categoria trabalho em sua dimensão ontológica. A participação radical foi proposta como o produto intencionado deste processo, sendo entendida como a participação na luta por transformar elementos da determinação social das condições coletivas de trabalho e vida. Os sujeitos desse processo são os terapeutas ocupacionais e os indivíduos, grupos e/ou comunidades acompanhados, todos entendidos como seres sociais em parceria para a transformação social. São identificadas quatro ferramentas teórico-metodológicas: análise emancipatória de atividades humanas, proposição emancipatória de atividades humanas, operacionalização da participação radical e intervenções sobre o tecido social.

Conclusão

A terapia ocupacional como prática social oferece uma contribuição específica para o desenvolvimento de uma práxis revolucionária coletiva que, voltada para a realização de uma utopia concreta, poderá gerar os meios para produzir uma nova sociedade.

Palavras-chave:
Epistemologia; Teoria Crítica; Formação de Conceito; Terapia Ocupacional

Resumen

Introducción

Este artículo presenta una aproximación analítica a la práctica de la terapia ocupacional basada en el materialismo histórico dialéctico. Entiende la práctica profesional de terapia ocupacional como trabajo bajo el capitalismo y, como tal, puede ser analizada bajo la teoría del proceso de trabajo.

Objetivo

Proponer un enfoque analítico de la práctica de la terapia ocupacional con la intención de apoyar el desarrollo posterior de un marco para la práctica de la terapia ocupacional emancipadora basada en el dialogo entre la Terapia Ocupacional Social y la Salud Colectiva Latinoamericana.

Método

A partir de una investigación acción emancipadora, se realizaron 10 talleres con diez terapeutas ocupacionales con el objetivo de la producción colectiva de conocimiento.

Resultados

La actividad humana es identificada como objeto del proceso de trabajo de la terapia ocupacional, definida por la categoría trabajo en su dimensión ontológica. La participación radical se establece como el producto previsto del proceso, es decir, la participación en la lucha por los elementos transformadores de la determinación social de las condiciones de vida colectivas. Los sujetos del proceso de trabajo son los terapeutas ocupacionales y los individuos, grupos y/o comunidades acompañados, todos entendidos como seres sociales en colaboración para la transformación social. Se identifican cuatro herramientas teórico-metodológicas: análisis emancipatorio de las actividades humanas, propuesta emancipadora de las actividades humanas, operacionalización de la participación radical e intervenciones en el tejido social.

Conclusión

La terapia ocupacional como práctica social ofrece una contribución específica al desarrollo de una praxis revolucionaria colectiva que, dirigida a realizar una utopía concreta, puede generar los medios para producir una nueva sociedad.

Palabras clave:
Epistemología; Teoría Crítica; Formación de Conceptos; Terapia Ocupacional

Introduction

This study presents an analytical approach to occupational therapy practice based on the dialogue between social occupational therapy and the Latin American Collective Health field of theories and practices. This approach has evolved through a collaborative research and knowledge-production process undertaken during a doctoral investigation conducted with occupational therapists between 2017 and 2021 (Godoy-Vieira, 2021Godoy-Vieira, A. (2021). Fundamentação do processo de trabalho da terapia ocupacional em saúde coletiva: uma abordagem materialista histórico-dialética (Tese de doutorado). Universidade de São Paulo, São Paulo.). There exists a common ground between the parts of Social Occupational Therapy and Latin American Collective Health that are founded on the theoretical approach of historical dialectical materialism. Both are fields of practices and knowledge production and assume a radicality related to the emancipatory role of our collective work, recognizing that there is a social determination of individuals’ everyday life (Spiegel et al., 2015Spiegel, J. M., Breilh, J., & Yassi, A. (2015). Why language matters: insights and challenges in applying a social determination of health approach in a North-South collaborative research program. Globalization and Health, 11(9), 1-17.).

Emancipatory practices are understood as those practices that allow reflection about the social origin of the problems faced by the individuals in the society. Aimed at providing tools to individuals to have access to and fight for their rights, these practices encourage values of solidarity and recognize the human condition as inherently social, countering the notion of individuals merely as biological entities (Campos, 2013Campos, C. M. S. (2013). Necessidades de saúde como objeto das políticas públicas: as práticas do enfermeiro na Atenção Básica (Tese livre-docência). Universidade de São Paulo, São Paulo.). Such practices are implemented in both collective health (Campos et al., 2014Campos, C. M. S., Silva, B. R. B., Forlin, D. C., Trapé, C. A., & Lopes, I. O. (2014). Emancipatory practices of nurses in primary health care: the home visit as an instrument of health needs assessment. Revista da Escola de Enfermagem da USP,48(spe), 119-125.) and social occupational therapy (Gonçalves & Malfitano, 2021Gonçalves, M. V., & Malfitano, A. P. S. (2021). Social occupational therapy, impoverished youth, and everyday urban mobility. South African Journal of Occupational Therapy, 51(4), 32-40.).

It is crucial to state that interventions focused on the social aspects of everyday life do not automatically translate to practices of social transformation (Pollard & Sakellariou, 2013Pollard, N., & Sakellariou, D. (2013). A commentary on the social responsibility of occupational therapy education. Journal of Further and Higher Education, 37(3), 416-430.). In other words, a critical discourse that addresses the social question as a backdrop for practice is not enough to change aspects of the foundation of social issues. According to historical dialectical materialism, the social question must be integrated into the practice object, radically situated in history and seeking to avoid neoliberal perspectives on social policies that focus on individual solutions to problems erroneously deemed inevitable (Netto, 2006Netto, J. P. (2006). 5 notas sobre a questão social. In J. P. Netto. Capitalismo monopolista e serviço social (pp. 41-49). São Paulo: Cortez.).

A significant contribution of collective health to this discussion is the assertion that health practices are forms of work, and professionals are workers. This implies that individuals sell their labor power to obtain living conditions by consuming goods within a capitalist system. Two main implications of this condition are relevant for occupational therapy: a) occupational therapists, alongside other workers who contribute to the construction of society, including the individuals they support, are all workers, and the relationship between these people must be recognized and nurtured as a partnership; b) occupational therapy labor process can be analyzed theoretically, allowing for the development of a systematic approach to contribute to occupational therapy for the production system and social reproduction.

Considering these points and underscoring the dialectical nature of this investigation, this article, after presenting the research problem and objective, in the section Theoretical Basis, initiates a theoretical dialogue between occupational social therapy and Latin American Collective Health. The Methodological Procedures section outlines the emancipatory action-research foundations and processes. The Results and Discussion are presented together, reflecting the inseparability inherent in the radically participatory methodological approach utilized. The organization of the results and discussion is structured around the following analysis categories: object, individuals, final product, and theoretical-methodological tools.

Research Problem and Objective

There is a challenge in making radical critical practices feasible, amidst the contradictions inherent in the capitalist labor process, especially within the neoliberal context where such practices are enacted. Occupational therapy is a profession that operates within the capitalist mode of production and, as such, manifests the result of a struggle between the following aspects: the efforts of workers for their own social reproduction, their intentionality in relation to their contribution to the social totality and the interests of the dominant class (Viana et al., 2013Viana, N. S., Soares, C. B., & Campos, C. M. S. (2013). Reprodução Social e processo saúde-doença: para compreender o objeto da saúde coletiva. In C. B. Soares & C. M. S. Campos (Orgs.), Fundamentos e saúde coletiva e o cuidado de enfermagem (pp. 7-142). Barueri: Manole Ltda.). Consequently, a critical perspective adopted by workers may not suffice to initiate emancipatory processes (Godoy-Vieira et al., 2018Godoy-Vieira, A., Soares, C. B., Cordeiro, L., & Campos, C. M. S. (2018). Inclusive and emancipatory approaches to occupational therapy practice in substance-use contexts. Canadian Journal of Occupational Therapy, 85(4), 307-317.). Thus, this study aims to contribute to the creation of tools that foster collective inquiry, revealing the mechanisms of oppression and the roots of inequality in cotidiano [everyday life].

This study aims to present an analytical approach to occupational therapy practice, grounded in historical dialectical materialism, to aid in developing an emancipatory occupational therapy framework supported by the dialogue between the principles of social occupational therapy and the Latin American Collective Health.

Theoretical Basis

Social occupational therapy

Practice beyond healthcare

Since the 1970s, Brazil has seen the advocacy for social occupational therapy, It is a sub-area of ​​occupational therapy that focuses on social issues, defending a specific praxis. This approach adopts Castel’s (2003)Castel, R. (2003). From manual workers to wage laborers: transformation of the social question. London: Routledge Taylor & Francis. concept of social question, which asserts that the capitalist social structure is fundamentally based on the labor-capital relationship, positioning work and wages as primary vehicles for social inclusion. According to Castel (2003)Castel, R. (2003). From manual workers to wage laborers: transformation of the social question. London: Routledge Taylor & Francis., the social question is reflected in the interplay between an individual’s work and their social networks.

The radicality proposed by social occupational therapy is based on the incorporation of the social issue into the object of practices, reformulating them. A reasoning was developed that seeks connections between the results of social processes, manifested in individuals, and perceptions about the role and impact of human activity as a mediator of social relations (Lopes, 2021Lopes, R. E. (2021) Citizenship, rights, and social occupational therapy. In R. E. Lopes & A. P. S. Malfitano, (Orgs.), Social occupational therapy: theoretical and practical designs (pp. 169- 176). Philadelphia: Elsevier.). From this perspective, a dissociation from the health field of practices is necessary, since there is a need to break with the restricted biologizing discourse, confronting it with the complexity of life in community (Barros et al., 2002Barros, D. D., Ghirardi, M. I. G., & Lopes, R. E. (2002). Terapia ocupacional social. Revista de Terapia Ocupacional da Universidade de São Paulo, 13(3), 95-103.).

Social occupational therapy practice unfolds along two main axes: a) as a theoretical and methodological framework for analysis and action focusing on social life; and b) through the implementation of specific social practices outside the health sector. It underscores the importance of crafting care actions that prioritize the social aspects of life. In this paper, we leverage the first axis to explore how this theoretical and methodological framework can be applied to analyze occupational therapy practices, drawing on the principles of historical dialectical materialism.

Cotidiano [everyday life]: the locus of expression of social reproduction¹ 1 Social reproduction is a continuous process of production and consumption within a society. The capitalist production process aims to produce commodities, surplus value, and capitalist relations. The maintenance and reproduction of the working class are conditions necessary for the reproduction of capital. Each social class has its particular forms of production and consumption. The conditions under which each similar group within a social class works and consumes are structurally connected to the manifestation of their singular everyday life (Marx, 1984).

Since the 1980s, the concept of cotidiano [everyday life] has been discussed in Brazil as an essential element of occupational therapy practices. During that period, the country was rebuilding democracy after 21 years of military dictatorship (from 1964 to 1985). The focus at that time was on producing emancipatory practices to improve the concrete conditions of existence for individuals and social groups (Galheigo, 2003Galheigo, S. M. (2003). O cotidiano na terapia ocupacional: cultura, subjetividade e contexto histórico-social. Revista de Terapia Ocupacional da Universidade de São Paulo, 14(3), 104-109., 2020Galheigo, S. M. (2020). Occupational therapy, everyday life and the fabric of life: theoretical-conceptual contributions for the construction of critical and emancipatory perspectives. Cadernos Brasileiros de Terapia Ocupacional, 28(1), 5-25.).

Cotidiano is considered the locus of work for social occupational therapy, as it is a central element in creating intervention strategies. This choice of terminology implies a practice that is deeply rooted in the context, personal, social, and territorial resources of people’s lives (Malfitano & Lopes, 2021Malfitano, A. P. S., & Lopes, R. E. (2021). Preface. In R. E. Lopes & A. P. S. Malfitano (Orgs.), Social occupational therapy: theoretical and practical designs (pp. 13-21). Philadelphia: Elsevier.). This perspective is critical to the concept of Activities of Daily Living (ADLs), which was historically created to operationalize the practice (Francisco, 1988Francisco, B. R. (1988). Terapia ocupacional. Campinas: Papirus.), but which must be situated in context and recognized as strongly oriented to the capitalist interest in recovering and maintaining the labor force of the working class.

Almeida (2017)Almeida, A. V. (2017). Fundamentos ontológico-marxistas da vida cotidiana. Revista Cadernos de Ciências Sociais da UFRPE, 1(10), 145-176. systematized cotidiano based on the ontological perspective of historical dialectical materialism:

Barros et al. (2002)Barros, D. D., Ghirardi, M. I. G., & Lopes, R. E. (2002). Terapia ocupacional social. Revista de Terapia Ocupacional da Universidade de São Paulo, 13(3), 95-103.² 2 “Dialectics is the method of reasoning that aims to understand things concretely, in all their movement, change, and interconnection, with their opposite and contradictory sides in unity.” (Marxists Internet Archive, 2023b). considering the historical contribution of social occupational therapy, describe the dialectical complexity that the analysis of cotidiano allows us to apprehend, against the simplified duality of positivist thoughts:

The concept of cotidiano provides an opportunity to identify the complexity of the experience of situated human activity.

Latin American Collective Health

Collective health is a Latin American movement that gained importance in the second half of the 20th century, thanks to scholars and professionals who incorporated the social perspective as central to the object of their health practices. Unlike the public health paradigm, which aims to achieve specific improvements for the population as an abstraction without affecting social structures, collective health aims at radical changes to shake and remove the social pillars that produce health problems (Breilh, 1995Breilh, J. (1995). Nuevos conceptos y técnicas de investigacion: guia pedagógica para um taller de métodologia (epidemiologia del trabajo). Quito: Centro de Estudios y Asesoría em Salud.).

Latin American scholars have built (and are still building) a solid theoretical foundation for practices. Among them, we highlight those affiliated with historical dialectical materialism. They situate health practices within the social division of labor, responding to manifestations of inequality and oppression in human bodies. They are based on the statement that there is a social determination of health (Spiegel et al., 2015Spiegel, J. M., Breilh, J., & Yassi, A. (2015). Why language matters: insights and challenges in applying a social determination of health approach in a North-South collaborative research program. Globalization and Health, 11(9), 1-17.).

Drawing on the reasoning of social determination health, social needs—including health needs—are produced according to the work and life conditions arising from the insertion of individuals and social groups into the different social classes, i.e., the forms of social reproduction (Campos & Soares, 2013Campos, C. M. S., & Soares, C. B. (2013). Necessidades de saúde e o cuidado de enfermagem em saúde coletiva. In C. B. Soares & C. M. S. Campos (Orgs.), Fundamentos de saúde coletiva e o cuidado de Enfermagem (pp. 265-292). Barueri: Manole Ltda.). The insertion of a given social group in the mode of production—that is, their jobs, types of bonds, salary ranges, and hours of dedication, among others—determines the consumption possibilities of this group, that is, the types of housing, transportation, access to infrastructure services, etc. Both the insertion in the mode of production and consumption have the potential for strengthening (for example, a stable salary with spendable income, and comfortable housing) and extenuating (for example, minimum wage, and poor housing conditions). The balance-imbalance between these potentials results in the health-disease spectrum of this group, which will be expressed in individual bodies and thus mediated by genetic inheritance, among other elements (Laurell, 1983Laurell, A. C. (1983). A saúde-doença como processo social. In E. D. Nunes (Org.), Medicina social: aspectos históricos e teóricos (pp. 133-158). São Paulo: Global., 1989Laurell A. C. (1989). Social analysis of collective health in Latin America. Social Science & Medicine (1982),28(11), 1183-1191.; Laurell & Noriega, 1989Laurell, A. C., & Noriega, M. (1989). Processo de produção e saúde: trabalho e desgaste operário. São Paulo: Hucitec.; Breilh, 1991Breilh, J. (1991). Epidemiologia: economia, política e saúde. São Paulo: Ed. UNESP.; Queiroz & Salum, 1996Queiroz, V. M., & Salum, M. J. L. (1996). Reconstruindo a intervenção de enfermagem em saúde coletiva face a vigilância a saúde. In Anais do Congresso Brasileiro de Enfermagem (pp. 361-385). São Paulo: Aben.; Campos & Soares, 2013Campos, C. M. S., & Soares, C. B. (2013). Necessidades de saúde e o cuidado de enfermagem em saúde coletiva. In C. B. Soares & C. M. S. Campos (Orgs.), Fundamentos de saúde coletiva e o cuidado de Enfermagem (pp. 265-292). Barueri: Manole Ltda.).

From a restricted perspective of health, the response to health needs will be confounded with the implementation of health services, with healthcare procedures and goods, associating needs with the results of health practices (Campos & Soares, 2013Campos, C. M. S., & Soares, C. B. (2013). Necessidades de saúde e o cuidado de enfermagem em saúde coletiva. In C. B. Soares & C. M. S. Campos (Orgs.), Fundamentos de saúde coletiva e o cuidado de Enfermagem (pp. 265-292). Barueri: Manole Ltda.). From this perspective, it would not make sense, for instance, to advise an individual with repetitive strain injury related to work conditions to avoid repetitive movement, as this would interfere with the capitalist production mode. In this case, the evaluation would associate the individual’s pain with a need for painkillers. The health goods, then, from this restricted perspective, determine the satisfaction of restricted needs: a pain related to working conditions is medicated, and medication is the response expected by the person in pain, so they may keep working in the same way.

From a collective health perspective, health care services are understood as social practices connected to other social practices, with the task of assuring social rights: health practices must not reiterate restricted needs but rather should support the identification of wider social needs, based on the complex processes of social determination of health.

Methodological Procedures

Type of research

This study employed the emancipatory action research (EAR) methodology. This research approach allows and principles the involvement of social groups in decision-making processes (Thiollent, 2011Thiollent, M. (2011). Metodologia da pesquisa-ação (18. ed.). São Paulo: Cortez.; Toledo, 2011Toledo, R. F. (2011). Pesquisa ação nas áreas de educação, saúde e ambiente: um panorama do desenvolvimento nas universidades estaduais paulistas. São Paulo: FSP USP. Apresentado no seminário: Pesquisa-ação na interface educação, saúde e ambiente.), wherein participants are encouraged to actively engage across three axes: participation, knowledge production, and social transformation (Cordeiro et al., 2017Cordeiro, L., Soares, C. B., & Rittenmeyer, L. (2017). Unscrambling method and methodology in action research traditions: theoretical conceptualization of praxis and emancipation. Qualitative Research, 17(4), 395-407. https://doi.org/10.1177/1468794116674771
https://doi.org/10.1177/1468794116674771... ). Data production is operationalized through workshops aimed at collective knowledge producion (Soares et al., 2018Soares, C. B., Campos, C. M. S., Souza, H. S., Godoy-Vieira, A., Cordeiro, L., Lopes, I. O., & Cavalcanti, B. S. G. (2018). Oficinas emancipatórias como intervenção em saúde do(a) trabalhador(a). Revista Brasileira de Saúde Ocupacional, 43, 1-11.).

In the theoretical dimention, the workshops rely on the labor process theory serving as the foundational framework for data analysis (Mendes Gonçalves, 2017). In an ontological dimension, the participants of the process are taken as historical social beings, and emancipation is understood as the historical overcoming of the estrangement and the exploitation of humans by other humans. In the methodological dimension, historical dialectical materialism informs the emancipatory educational process aimed at a praxiological production of knowledge (Soares et al., 2018Soares, C. B., Campos, C. M. S., Souza, H. S., Godoy-Vieira, A., Cordeiro, L., Lopes, I. O., & Cavalcanti, B. S. G. (2018). Oficinas emancipatórias como intervenção em saúde do(a) trabalhador(a). Revista Brasileira de Saúde Ocupacional, 43, 1-11.).

EAR workshops are designed to imbue work with meaning while generating robust, historically contextualized knowledge about practice. This process empowers workers to contribute to collective efforts toward justice, equality, and freedom for all. It involves a dialectical process that highlights and discusses the dynamics and interconnections between elements, with participants acting as internal researchers (Soares et al., 2018Soares, C. B., Campos, C. M. S., Souza, H. S., Godoy-Vieira, A., Cordeiro, L., Lopes, I. O., & Cavalcanti, B. S. G. (2018). Oficinas emancipatórias como intervenção em saúde do(a) trabalhador(a). Revista Brasileira de Saúde Ocupacional, 43, 1-11.).

Participants

The study aimed to include occupational therapists from any practice area who were interested in critically examining their practice with the goal of social transformation. Eligible participants needed to have at least one year of experience and be able to attend weekly meetings focused on occupational therapy practices informed by historical dialectical materialism. Prior knowledge of the theoretical framework was not required, as the workshops included an educational component.

The initial recruitment utilized social media (e.g., Facebook, and WhatsApp groups of occupational therapists) and direct invitations from the primary author’s professional network, employing a snowball sampling strategy (Christopoulos, 2010Christopoulos, D. (2010). Peer esteem snowballing: a methodology for expert surveys. In INSNA 29th annual Conference, Corfu.) to expand participant outreach. A total of 26 occupational therapists expressed interest. A survey was then conducted to determine the most convenient days and times for meetings, with the schedule set based on the majority’s preferences. After finalizing the agenda, 15 researchers confirmed their participation, but only 10 consistently engaged, attending at least 50% of the workshops. Among these, two could only attend fortnightly, participating in five sessions, while another, facing commutes from the city’s outskirts, managed to attend six out of ten sessions. Participants with more absences still demonstrated commitment by viewing recorded sessions and actively contributing to theoretical and methodological discussions. Five participants withdrew from the study, including two mothers who mentioned childcare challenges, while three did not maintain further communication.

Data production and analysis

The meetings were conducted both in person at a room in the University of São Paulo (USP) and via internet video calls for those outside the city of São Paulo, from August to October 2019. A total of 10 meetings, each lasting three hours, were held. The discussions were recorded, resulting in approximately 30 hours of video and audio archives and producing a transcription of 489 pages. A field journal was maintained by the primary researcher, in collaboration with the research advisors (co-authors of this paper), who supported the entire process of analysis and methodological adjustments.

The theoretical framework for analyzing collective productions was based on the labor process theory (Marx, 1984Marx, K. (1984). O capital. São Paulo: Difel.; Mendes-Gonçalves, 2017Mendes-Gonçalves, R. B. (2017).Práticas de saúde: processo de trabalho e necessidades. In J. R. C. M. Ayres & L. Santos (Orgs.), Saúde, sociedade e história (pp. 298-374). São Paulo: Hucitec.) and the ontology of social being (Lukács, 1980Lukács, G. (1980). The ontology of social being: 3. London: Merlin Press.).

The workshops were conducted in cycles of critical reflexivity aimed at collective knowledge production and the transformation of social practices. The synthesis generated by the group, as presented in this study, is regarded as the outcome of an epistemologically situated educational process and a manifestation of a transformative process related to participation in the workshops (Alves & Jackson Filho, 2017). This comprehensive dialectical methodology seeks to understand reality rather than merely verify it. Therefore, the results are presented as a reconstruction of the concrete in its inner laws, not merely as an exposition of data (Lefebvre, 2009Lefebvre, H. (2009). Dialectical Materialism. Minneapolis: University of Minnesota Press.).

Ethical procedures

The project was approved by the Ethical Committees at the University of São Paulo (USP) and the official online governmental platform for monitoring and reporting research involving human participants (Portal do Governo Brasileiro, 2023Portal do Governo Brasileiro. (2023). Plataforma Brasil. Recuperado em 9 de agosto de 2023, de https://plataformabrasil.saude.gov.br/.
https://plataformabrasil.saude.gov.br/... ).

Results and Discussion

When analyzed through the lens of the labor process theory, social practices are regarded as human actions undertaken by people to meet human needs. They aim to fulfill a purpose and to achieve this, humans devise and utilize tools to transform the object into a product (Mendes-Gonçalves, 2017Mendes-Gonçalves, R. B. (2017).Práticas de saúde: processo de trabalho e necessidades. In J. R. C. M. Ayres & L. Santos (Orgs.), Saúde, sociedade e história (pp. 298-374). São Paulo: Hucitec.). This study examines the occupational therapy labor process based on four theoretical components: object, individuals, final product and tools. Each element will be introduced at the start of its respective section in the analysis that follows.

Object: the ontological dimension of human activities in cotidiano

The object of a labor process is that which is transformed through work. In the context of occupational therapy practice, human activity—defined as the intentional transformation humans make to materials, relationships, and their environment to meet their needs, thereby changing themselves in the process—serves as the object. This conceptualization draws on the Marxist definition of labor as the intentional transformations made by human beings to satisfy their needs (Marx, 1984Marx, K. (1984). O capital. São Paulo: Difel.), with a particular focus on the ontological aspects of this process for the current discussion. Ontology, understood here as the philosophical study of social beings (Lukács, 1980Lukács, G. (1980). The ontology of social being: 3. London: Merlin Press.), concentrates on how humans become social beings through social relations mediated by their intentional transformation of everyday life elements around them. This is crucial because analyzing human activity reveals ontological processes, illuminating what a person is ontologically engaged in when acting – in other words, how individuals constitute themselves as social beings through human activity.

From the historical dialectical materialism methodological perspective, the analysis of how a human being becomes a social being is based on how each person is connected to another in a complex net of human activities throughout time, in cotidiano (Heller, 1987Heller, A. (1987). Everyday life. London: Routledge and Kegan Paul.). Occupational therapists, employing this theoretical and methodological framework, can dialectically examine: intention; the coordination of resources; the possibility of consciously choosing, accessing, and utilizing tools; awareness of how this process affects both themselves and others; the link between intention and the final product to achieve a specified goal. This represents the singular contribution of occupational therapy to the collective endeavor of social transformation through social practices.

The definition of the object of occupational therapy practice, based on the theoretical assumptions of the collective health, was extensively discussed in a previous study (Godoy-Vieira et al., 2020Godoy-Vieira, A., Soares, C. B., & Cordeiro, L. (2020). Occupation and labour: towards emancipatory practices. In H. V. Bruggen, S. Kantartzis & N. Pollard (Eds.), 'And a seed was planted...' Occupation based approaches for social inclusion (pp. 307-317). London: Whiting and Birch.), where the Marxist concept of labor³ 3 The Marxist concept of labor is distinguished from the capitalist form of work that alienates workers, as employment. This distinction is further elaborated in Godoy-Vieira et al. (2020). was introduced to define what would constitute an emancipatory occupation. The term emancipatory occupation was initially proposed to facilitate dialogue with an Anglophone audience. However, with further research and development, we opted to directly translate the term atividade humana (human activity) from the original Brazilian theoretical framework to provide a more accurate description. Occupational therapists and other professionals transform only those aspects of reality they perceive as changeable. Their analysis of social needs is crucial in determining their response to these needs (Hammell, 2016Hammell, K. R. (2016). Empowerment and occupation: a new perspective. Canadian Journal of Occupational Therapy, 83(5), 281-287.; Mendes-Gonçalves, 2017Mendes-Gonçalves, R. B. (2017).Práticas de saúde: processo de trabalho e necessidades. In J. R. C. M. Ayres & L. Santos (Orgs.), Saúde, sociedade e história (pp. 298-374). São Paulo: Hucitec.), as the perception of the problem dictates which aspects of reality will receive intervention. In striving for an egalitarian society, professionals must recognize how inequality influences human activity and cotidiano. Also, must evaluate how the tools for analysis and the proposal of activities allow the unveiling of the social determination of individuals’ limitations and opportunities for initiating emancipatory movements.

It is necessary to highlight that the emancipatory perspective of the object is conferred by the occupational therapist’s intention, rather than by the activity itself. Understanding the historical constitution of each individual and group is essential, as human beings

Thus, maintaining a constant analytical focus on the historical and concrete conditions shaping emancipatory social movements, work, and education is vital for fostering significant transformation.

Human activity is not perceived as a “thing” but as a process that tangibly influences human existence over time, within specific historical and material (economic, political, cultural) contexts. From a critical occupational therapy standpoint, human activities are seen as both the outcomes of and the means through which humans construct themselves as social and historical beings (Medeiros, 2003Medeiros, M. H. R. (2003). Terapia ocupacional: um enfoque epistemológico e social. São Carlos: Edufscar.).

Considering human activity as the object of the work process entails assuming individuals engaged in activities as the tangible matter with which the occupational therapist interacts. Human activity can be identified by observing individuals in their cotidiano, engaging in activities that meet their needs. From brushing teeth to performing office tasks, any activity wherein the individual expends effort based on an intention, and which manifests as social relations, may be deemed an object for occupational therapy practice.

Individuals: occupational therapists and followed-up individuals in their collective dimensions

In a work process, individuals are those who exert energy to transform the object of work (Mendes-Gonçalves, 2017Mendes-Gonçalves, R. B. (2017).Práticas de saúde: processo de trabalho e necessidades. In J. R. C. M. Ayres & L. Santos (Orgs.), Saúde, sociedade e história (pp. 298-374). São Paulo: Hucitec.). In occupational therapy practice, both occupational therapists and the followed-up individuals actively participate in transforming the object, namely human activity. The collective dimension of individual life is expressed in the tools and knowledge utilized every day in our lives. Almost all the knowledge we use has been developed historically by humanity. Furthermore, our actions have collective impacts. Awareness of this affects how we participate in society and also affects how we connect or disengage from collective action towards social transformation that impacts the social determination of our lives. Hence, we see occupational therapy practice more as a partnership than a unilateral intervention, with both therapists and followed-up individuals being transformed by the process (Godoy-Vieira et al., 2022Godoy-Vieira, A., Soares, C. B., Malfitano, A. P. S., Farias, A. Z., Rodrigues, C., Bricoli, C. A., Okuma, D., Leite Júnior, J. D., Antunes, J. R., Laranjeira, L. S., Cordeiro, L., Pastore, M. N., Camargo, M., & Fialho, N. (2022). Working process analysis of critical occupational therapy practice Everyday life as means to build occupational revolution towards social transformation. In WFOT Congress 2022 (pp. 307-317). Paris.).

Both occupational therapists and the people they follow up work together in the professional process (Francisco, 1988Francisco, B. R. (1988). Terapia ocupacional. Campinas: Papirus.). Emancipation is a collective process, and in this context, occupational therapy contributes tools for collaboration. The followed-up individuals are engaged, challenged, and equipped with tools by the professionals, sparking a process of self-transformation. Through this lens, the individuals take themselves as the object of their own ontological and emancipatory working processes.

The occupational therapist is the mediator of a transformation process, equipped with a series of tools and the intention to produce freedom with others. Although individuals may have a clear intention in the production of an object during an activity, they may not (yet) recognize the connection between that singular work and the complex process of connections that can lead to the emancipatory process. The emancipatory objective is related to the transformation of the individual's consciousness, that may be restricted to individual perceptions and concerns, into a consciousness that apprehends the collective determination and impact of his or her work and life in a given society (Galheigo, 2003Galheigo, S. M. (2003). O cotidiano na terapia ocupacional: cultura, subjetividade e contexto histórico-social. Revista de Terapia Ocupacional da Universidade de São Paulo, 14(3), 104-109.).

Malfitano et al. (2021)Malfitano, A. P. S., Whiteford, G., & Molineux, M. (2021). Transcending the individual: the promise and potential of collectivist approaches in occupational therapy. Scandinavian Journal of Occupational Therapy, 28(3), 188-200. identify that the struggle to overcome an individualistic practice in occupational therapy is related to the recognition of the collective ontological condition of the human being. They indicate that the emancipatory perspective is not inherent to the occupational therapy perspective in capitalism: it is possible to work with communities and populations and, at the same time, contribute to inequality. For example, the inclusion of people with disabilities in low-paid jobs as a supposed form of social participation is insufficient. True radical transformative change requires an analysis of the social factors that influence such situations. It is crucial to collectively examine the broader social implications of these activities. It is not a question of not doing it, but of better localizing the transformative potentiality of the intervention, and its objective: when developing skills for low-paying jobs, in a process of emancipatory occupational therapy, the shared analysis of the activity must support individuals in their connection with others to criticize this limited and distorted form of inclusion, actively participating in efforts to achieve social transformation.

There is a gap in the literature that describes and explains how to conduct emancipatory occupational therapy processes with communities and populations, and the collective organization of activities, as well as the methodologies for them (Malfitano et al., 2021Malfitano, A. P. S., Whiteford, G., & Molineux, M. (2021). Transcending the individual: the promise and potential of collectivist approaches in occupational therapy. Scandinavian Journal of Occupational Therapy, 28(3), 188-200.). Drawing on historical dialectical materialism, the collective dimension of individuals is related to their ontological condition of being historical social beings. It means, for example, that the social class insertion shapes an individual's participation in society. Individuals manifest the accumulation of knowledge and actions that came before them, and they bring this into their participation in the society. Without this critical analysis, simply gathering individuals to discuss social issues will not suffice to address the social determination of unequal living conditions.

This discussion acknowledges that in an emancipatory occupational therapy process, individuals share their unique experiences, yet are part of the same social whole. Through this process, they transform, deepening their understanding of their condition, which is dialectically reflected in both individual and collective human activities.

Theoretical-methodological tools

Tools represent the specific technical elements employed by workers to transform the object into the product (Mendes-Gonçalves, 2017Mendes-Gonçalves, R. B. (2017).Práticas de saúde: processo de trabalho e necessidades. In J. R. C. M. Ayres & L. Santos (Orgs.), Saúde, sociedade e história (pp. 298-374). São Paulo: Hucitec.). In this analysis, four theoretical-methodological tools are proposed, acknowledging Francisco’s (1988)Francisco, B. R. (1988). Terapia ocupacional. Campinas: Papirus. assertion that occupational therapy is an applied profession, yet its practice transcends the mere application of techniques. As follows:

Emancipatory analysis of human activity

The emancipatory analysis of human activities is the investigation of the labor processes activated and executed in cotidiano. Individuals must actively engage in understanding reality. To comprehend reality beyond the appearance or form of the object (material or immaterial) transformed in each activity, occupational therapists need to grasp its essence, structure, and dynamics. This involves viewing human activity as a process. Success in this endeavor requires the use of knowledge, creativity, and imagination to uncover the connections between its determinations (Netto, 2011Netto, J. P. (2011). Introdução ao estudo do método de Marx. São Paulo: Expressão Popular.).

The goal of the emancipatory analysis of human activities is to empower the individuals involved by awakening them to the possibility of consciously participating in the creation of their history. It is worth noting that even when the individual in need of support cannot fully engage in the analysis (e.g., infants, people with severe mental impairments, or individuals with dementia), the opportunity for shared analysis remains. Families, caregivers, other professionals, and the broader society should be as involved as possible in this analysis, aiming to elevate collective awareness about the social determination of one’s condition. This issue concerns everyone, as the emancipatory overcoming of oppression and inequality will only be achievable through collective action.

By engaging in reality using more and improved analytical resources, participants in occupational therapy processes can start to recognize their role in collective reality—both as products and producers—dialectically. Through successive rounds of analysis-activity-analysis, the complexity of the process becomes increasingly apparent. The intention is for individuals to broaden their perspective on their own position in social reproduction, while identifying the possibility of responding to their social needs.

Inviting individuals to analyze their necessities encourages them to consider how to feasibly meet their social needs. This requires the organization of concrete action and the selection of tools, relationships, and means of social engagement. It establishes new complex processes of teleology and thus ontological processes of self and collective determination. These processes are expected to occur during the experience of human activities proposed by occupational therapists, in conjunction with analysis processes.

An example of applying the emancipatory analysis of human activity could be in a case where an individual seeks clinical hospitalization to address substance abuse, as reported by one of the internal researchers. The awareness-raising potential of occupational therapy’s emancipatory practice could promote an analysis of substance use as a human activity, rooted in intention and part of a complex process yielding products. In this scenario, the occupational therapist proposed a collaborative analysis of the experience, prompting a reevaluation of the individual’s needs in light of their actions’ outcomes, highlighting the contradictions between intention and action results. This process was described as broadening the individual’s perception and interpretation of reality, revealing that the desire for consumption is not merely personal but influenced by various social factors. Moreover, this analysis opened up possibilities for identifying broader social needs, leading to alternative demands, activity choices, and a restructured cotidiano. Consequently, the individual might opt to begin a community treatment process instead of solely relying on hospitalization.

Emancipatory proposition of activities

The emancipatory proposition of activities is intended to provide the experience of social relationships established during human activities. These experiences should promote the identification of contradictions in the problematic condition that activated the search for the occupational therapeutic process. Cycles of experience and analysis are designed to increase awareness about active participation in key social relationships in cotidiano [everyday life].

The goal is to unveil alternative perspectives and analytical approaches to one’s conditions for managing one's life. Francisco (1988)Francisco, B. R. (1988). Terapia ocupacional. Campinas: Papirus. depicted the conscious experience of human activity as potentially transformative of society toward emancipation, stating: “A doing that reveals the social determination of life seeks to uncover revolutionary forms and highlights the contradiction and conflict of health in a class-based society” (Francisco, 1988, pFrancisco, B. R. (1988). Terapia ocupacional. Campinas: Papirus.. 78, free translation). This must be a dialectical process where analysis without experience fails to yield significant transformation, and experience without awareness does not lead to overcoming the repetitive patterns of the initial condition.

The emancipatory proposition of activities must aim to experience transformation movements in oneself, during the transformation process carried out by the activity (which could be carpentry, caring for a child, a work task or participation in a social movement. ). The choice of activity depends on the moment of the ongoing work process: for example, the initial mapping of needs, or the moment of awareness of a major contradiction, or the intention to identify an oppressive ideological belief. The chosen activity must consider the possibility of highlighting the process of action, highlighting the potential for real transformation possible from the activity itself.

The emancipatory aspect of the process is introduced through the occupational therapist’s activation of mediation elements inherent in human activity. In the dialogical relationship, the emphasis should be on engaging in the tangible aspects of transformations in reality.

An example may shed light on the emancipatory orientation of the propositions. An occupational therapist could propose a game to an individual: the experience of different ways of walking down the street. They could walk together in small steps, then with big movements, then looking down, and then looking into people's eyes. They could watch how people react to them, talk about how it makes them feel, and how they think people feel about them. The intention of this proposal could be to raise awareness about the social perception of an individual's body language. From this activity of intentionally producing effects on others as a playful experience, and analyzing how it happens, it could be possible to better understand what people feel towards them as a communication process. From there, they could identify in themselves a need to learn or develop other forms of social expression, with the aim of using better ways of communicating and relating to others.

In this example, the ontological process occurs through an experience that fosters the emergence of a new need based on a consciousness pocess, leading to a teleological transformation. This differs from a scenario where a professional conducts the analysis independently and recommends learning communication skills. The emancipatory process is based on the possibility of inhabiting the dialectical process, sharing the possibility of wanting and producing something new for themselves.

Accordingly, the emancipatory proposition of activities, either at the individual level or at the specific social groups level, should be articulated to an expanded collective reflective process (Lopes et al., 2014Lopes, R. E., Malfitano, A. P. S., Silva, C. R., & Borba, P. L. O. (2014). Recursos e tecnologias em terapia ocupacional Social: ações com jovens pobres na cidade. Cadernos Brasileiros de Terapia Ocupacional, 22(3), 591-602. http://dx.doi.org/10.4322/cto.2014.081.
http://dx.doi.org/10.4322/cto.2014.081... ). It is not about abolishing the spontaneous structure of cotidiano [everyday life] to make it less alienated, but to unmute the individual-society relationship. The propositions in this manner take the form of an invitation to produce new forms of conducting life that allow a new order, based on a conscious, provoking, ethical relationship to cotidiano [everyday life] (Galheigo, 2020Galheigo, S. M. (2020). Occupational therapy, everyday life and the fabric of life: theoretical-conceptual contributions for the construction of critical and emancipatory perspectives. Cadernos Brasileiros de Terapia Ocupacional, 28(1), 5-25.).

Social tension is expected to emerge in response to the exposed contradictions, prompting a reassessment of initial explanations for these contradictions, as well as the naturalized and crystallized ways of carrying out activities up to that point. At this juncture, the occupational therapist shares their emancipatory analysis of the phenomena, offering alternative explanations or new experiences to broaden the individual’s interpretive and explanatory capabilities regarding their living conditions. With a new perspective on their reality, individuals are expected to recognize needs beyond those that are alienated and individualized. Repeating this process through successive cycles of consciousness complexification empowers individuals to conduct their own lives and to contribute to the strengthening of the social groups to which they belong.

Operationalization of radical participation

In the field of occupational therapy, this methodological tool is manifested through social inclusion efforts focused on accessibility, which are aimed at enhancing social participation. Operationalizing social relations is a key factor in enabling all individuals to engage actively in shaping their social lives. Making social participation feasible for everyone requires interventions in spaces, objects, institutions, and relationships. This involves specific technical interventions tailored to individual needs, such as adjusting a wheelchair, providing training in social skills, teaching financial management, or offering support to a person with dementia or their family. These actions are part of emancipatory practices that create opportunities for linking individual and collective experiences (Godoy-Vieira et al., 2022Godoy-Vieira, A., Soares, C. B., Malfitano, A. P. S., Farias, A. Z., Rodrigues, C., Bricoli, C. A., Okuma, D., Leite Júnior, J. D., Antunes, J. R., Laranjeira, L. S., Cordeiro, L., Pastore, M. N., Camargo, M., & Fialho, N. (2022). Working process analysis of critical occupational therapy practice Everyday life as means to build occupational revolution towards social transformation. In WFOT Congress 2022 (pp. 307-317). Paris.).

In the practice of social occupational therapy, this element is identified as a social technology designed as individual and territorial follow-up. It is based on the perception and interaction of people's daily lives and contexts, interlinking their stories and trajectories, their current situations and their social networks.

Examining the mediating activities that manifest between individuals and the broader social context allows for the identification of obstacles and enablers that influence the performance of activities catering to individual needs. The operationalization of experiences involves the application of specific technical expertise from various occupational therapy fields of practice. Depending on the context, a diverse array of knowledge, techniques, and tools are employed to generat the concitions for the individual to undertake each activity.

For instance, in a homecare setting, one of the internal researchers recognized the significance of social engagement for a young man living with mental illness and suggested outings. As his mother seemed to resist, feeling insecure and explaining to the professional her concerns, the occupational therapist asked the young man what wanted to do, considering his maturity and capability. At this point, the occupational therapist created a field of negotiation that was not possible before this moment, because the decisions were always made between the mother and the professionals. With this intervention, the power relations were shaken, and the young man could decide to go out, establishing another possible role in that moment within the family, with the occupational therapist’s endorsement.

Another example provided by the internal researchers involves addressing the needs of an individual with a hand injury to eat independently, which might include modifying cutlery. This adaptation is enabled through careful observation and analysis, based on specialized knowledge about hand functionality, the individual’s needs, and the materials available for customization.

Considering the dialectical aspect of the labor process is essential, which underscores the inseparability of the activation of operational tools, the emancipatory intentionality, and the object human activity in its collective dimention. These elements must be activated during the cycles of analysis-activity-analysis. For example, in the case of the aforementioned young man, the negotiation with his mother, absent an emancipatory aim, could focus merely on the act of going outside without sparking deeper reflection on social and familial dynamics or the young man’s autonomy in decision-making. Similarly, perfectly adapting cutlery for independent eating does not ensure that the individual’s living environment supports this autonomy.

Interventions in the social fabric

Intervening in the social fabric entails actions that extend beyond providing direct support to individuals, groups, and families. This is a theoretical-methodological tool activated in response to the analysis of the social determination of identified needs. Therein lies one of the profession's contributions to the reorientation of the mode of production: the qualified analysis of human activity’s mediations in the collective cotidiano. The analysis and propositions in this vein are part of emancipatory practices that aim to address the root causes of issues, striving to reconcile and connect individual, collective, and institutional needs (Malfitano & Lopes, 2021Malfitano, A. P. S., & Lopes, R. E. (2021). Preface. In R. E. Lopes & A. P. S. Malfitano (Orgs.), Social occupational therapy: theoretical and practical designs (pp. 13-21). Philadelphia: Elsevier.), as a component of a broader process of social transformation.

Interventions that highlight the contradictions in racial, social, cultural, economic, and historical relations in specific cases analysis may generate meaningful tension. The intention is to reframe the collective social condition as an integral aspect of the work of the entire stakeholder network, rather than viewing it merely as a backdrop for technical processes or as obstacles to technical achievements. Political articulation, technical network meetings, and community engagement actions are examples of the application of this tool (Godoy-Vieira et al., 2022Godoy-Vieira, A., Soares, C. B., Malfitano, A. P. S., Farias, A. Z., Rodrigues, C., Bricoli, C. A., Okuma, D., Leite Júnior, J. D., Antunes, J. R., Laranjeira, L. S., Cordeiro, L., Pastore, M. N., Camargo, M., & Fialho, N. (2022). Working process analysis of critical occupational therapy practice Everyday life as means to build occupational revolution towards social transformation. In WFOT Congress 2022 (pp. 307-317). Paris.).

Lopes & Malfitano (2021)Lopes, R.E., & Malfitano, A. P. S. (Org.). (2021). Social occupational therapy: theoretical and practical designs. Philadelphia, USA: Elsevier. propose, from the perspective of social occupational therapy, the importance of viewing coexistence promotion as a fundamental principle of a practice dedicated to social transformation. Creating and sustaining spaces that encourage collective experiences in addressing common needs facilitates the identification and development of coexistence strategies. Consequently, promoting institutional, community, and political changes based on identified collective needs constitutes a part of the effort toward broader social change and the creation of an environment conducive to the identification of other needs.

An illustration of this is provided by an internal researcher, an occupational therapist working in a primary health care service. In preparation for a Children’s Day celebration at the health unit, the occupational therapist took the lead in organizing the event. A young woman approached the occupational therapist, who seized the opportunity to foster a coexistence space by inviting her to assist with the party preparations. Noticing some young woman’s challenges, the therapist adjusted the pace of some tasks while engaging in an analysis of her needs within the context of the community primary health care service. As they filled balloons in the building hallway, some colleagues passing by humorously inquired if the occupational therapist was working or playing. Her response, both gentle and assertive, was that she was indeed working, thereby creating a moment of tension. Later that day, during the staff meeting, she brought up the scene, proposing a discussion about the purpose of the practices, producing a reflection with the entire team and a review of their own perspectives on their work objects. She was evidencing, through an analysis of the cotidiano [everyday life] of the institution, a possible medicalizing reduction of the object of practices of the so-called community-based institution, restricted to procedures within the offices.

Even small actions or brief exchanges, when informed by an awareness of their political dimension, can reveal contradictions and push the collective toward embracing the emancipatory aspect of their practice. Ultimately, reevaluating labor processes through the lens provided by occupational therapists in this perspective can lead to a redefinition of the institution’s collective mission, shifting from a mosaic of practices to a unified, coherent project.

At this point, it is possible to affirm a structural element of practice based on the recognition of the political dimension of the profession:

Lopes et al. (2021)Lopes, R. E., Malfitano, A. P. S., Silva, C. R., & Borba, P. L. O. (2021). Resources and technologies in social occupational therapy: actions with poor urban youth. In R. E. Lopes & A. P. S. Malfitano (Orgs.), Social occupational therapy: theoretical and practical designs (pp. 169- 176). Philadelphia: Elsevier. systematized social technologies as resources in social occupational therapy. Two of them are presented to illustrate the potential application of the theoretical-methodological tool Intervention on the social fabric. The first is The Articulation of Resources in the Social Field, encompassing a spectrum of actions at the individual, group, or collective level, and extending to the realms of politics and service management. This strategy lies in organizing practices across various complexity levels, aiming to support a common goal and leveraging available financial, material, relational, and emotional resources to shape interventions, whether macro or micro-social. The second is the Dynamization of the Social Care Network, aiming to map, promote, and solidify all programs, projects, and actions targeted at a specific population group and/or their community. The goal is to enhance interaction and integration among these people, linking different sectors and support levels to improve the effectiveness and direction of strategies.

Intervening in the social fabric means sharing this analysis and arguing, both technically and politically, for recognizing and redirecting the focus of network attention to the collective social needs. This tension calls for collective technical discussions, political coordination, and theoretical refinement. This approach can elicit responses from the entire network based on jointly evaluated complex social needs, rather than each service conducting its specific technical analysis.

Without this broader perspective, it is often observed that complex cases prompt significant mobilization to provide individualized responses to “save” an individual or family as if they were exceptional cases. Yet, it is not uncommon for the same complex cases to reoccur or for the same families or individuals to return to the services, being deemed failures despite the considerable effort by professionals. This is not due to individual failure, but rather to the misinterpretation of social needs as individual needs. Without significant improvements to the collective conditions of work and life, people cannot sustain a new way of living, conduct their activities, and write their history.

Intervention in the social fabric will not always manifest as disputes but also as invitations for collaboration. An example shared and validated during the knowledge production process was the idea of a school community that revises its evaluation and academic success criteria for all students, inspired by one or more of them with special needs. This could result from an emancipatory occupational therapy intervention with a student with special needs, who might then begin to actively discuss and demand more appropriate teaching processes based on their specific social needs.

This theoretical-methodological tool transcends the relationship between occupational therapists and individuals, emphasizing the interconnection among macrosocial structures, politics, rights, citizenship, and social policies (Malfitano et al., 2021Malfitano, A. P. S., Whiteford, G., & Molineux, M. (2021). Transcending the individual: the promise and potential of collectivist approaches in occupational therapy. Scandinavian Journal of Occupational Therapy, 28(3), 188-200.) involved in all social relations of production. During the use of this tool, an ontological process is expected to occur in the individual who actively participates in social transformation movements. Working from this perspective with the cotidiano of individuals is only possible when starting from the intention and action for a possible life for all, and necessarily implies active participation in the construction and maintenance of social security policies (Malfitano et al., 2020Malfitano, A. P. S., Cruz, D. M. C., & Lopes, R. E. (2020). Terapia ocupacional em tempos de pandemia: seguridade social e garantias de um cotidiano possível para todos. Cadernos Brasileiros de Terapia Ocupacional, 28(2), 401-404.).

Recognizing the needs of the followed-up individuals as social needs entails acknowledging that the object of the labor process can only be transformed within the realm of social relations of production⁴ 4 Social relations of production are the objective material relations that exist in any society independently of human consciousness, formed between all people in the process of social production, exchange, and distribution of material wealth (Marxists Internet Archive, 2023a). . This is because these needs are generated by the impacts of social reproduction on individual lives, as a result of the capitalist mode of production. The relationships that workers establish with ideological, institutional, political, and social structures serve as occupational therapy resources for practice when linked with the emancipatory analysis of human activity. Therefore, the tangible scope of technical actions is not idealized as immediate emancipation for individuals. It is based on the establishment of collective processes, creating spaces for the radical participation of individuals, and aligning efforts with other emancipatory social practices aimed at overcoming inequality.

Product: the ontological dimension of human activity transformed toward radical participation

The product of a labor process is the object itself, that was transformed by the worker’s labor. In other words, the product manifests as the result of the labor process (Mendes-Gonçalves, 2017Mendes-Gonçalves, R. B. (2017).Práticas de saúde: processo de trabalho e necessidades. In J. R. C. M. Ayres & L. Santos (Orgs.), Saúde, sociedade e história (pp. 298-374). São Paulo: Hucitec.). Considering the ontological dimension of human activity as the object of occupational therapy practice, the final product will be the transformed ontological dimension of human activity. This transformation will manifest in the individual’s social relations, activated during the activities they perform. This means the product will manifest in the social relations mediated by an individual’s activities that incorporate the tools presented by the occupational therapist (and others they may have encountered or created), achieving a more complex understanding of themselves and society. The impact of emancipatory occupational therapy is visible as individuals and social groups that actively participate in their personal and collective lives, demonstrating increased agency compared to their previous states.

Awareness of the connection between the individual needs and the structural organization of society may activate a movement of radicalization around the idea of participation. For example, to radically open space for genuine participation in social life beyond segregated spaces for impaired people, broad political participation will be required concerning the transportation conditions, building regulations, and working legislation of a city.

The concept of radical participation is intentionally proposed to qualify and critique the idea of participation that acknowledges social relations of power without considering their social determination. Radical participation is characterized by the progressive appropriation by individuals of the mediations of human activities embedded in cotidiano, related to their social participation. From this awareness-raising process, people elevate their participation to a condition where they become capable of questioning the economic, cultural, institutional, social, and even clinical structures toward their participation in the collective development of new responses to their social needs.

Radical participation is relevant as a product of occupational therapy practice, considering the ontological constitution of social beings. This constitution results from the complex instauration of countless transformation processes embedded in the activities of cotidiano, dialectically producing a society between singularity and social totality.

The shared processes of analysis-activity-analysis undertaken with the followed-up individuals and groups allow for awareness-raising, generating new creative processes, and establishing new possibilities for individual and social transformation. To identify, reject, and transform alienated forms of existence, these cycles are proposed in chains of activities throughout cotidiano. The conscientious intentionality behind this process involves actively challenging oppressive life conditions through political imagination and engagement in intentional and creative activities.

In this perspective, access to social rights as an element of occupational therapy practice will be considered part of the complex actions to produce emancipatory processes. That is because particular achievements hardly challenge the main historical and economic structure based on social problems if taken alone. Nevertheless, the individual or restricted social group of individuals who struggle to achieve observance of a social right, for example, transform themselves through the series of activities undertaken for this accomplishment. This ontological transformation is the very emancipatory process we aim at, what is identified in health practices as “therapeutic”. The collective result is the transformed individuals who will then be better equipped to join the collective struggle for overcoming inequality in social totality, which will not happen through isolated struggles or through the practice of just one profession.

Conclusion

This study presents an analytical approach to occupational therapy practice to support the development of a framework for emancipatory occupational therapy practice grounded in the dialogue between Social Occupational Therapy and Latin American Collective Health. Human activity is identified as the object of the labor process of occupational therapy, conceptualized by the category "work" in its ontological dimension. Radical participation is established as the intended product of the process, that is, participation in the struggle for the transformative elements of the social determination of collective working and living conditions. The subjects of the labor process are the occupational therapists and the individuals, groups and/or communities followed; both understood as social beings in an alliance for social transformation. Four theoretical-methodological tools are identified: emancipatory analysis of human activities, emancipatory proposition of human activities, operationalization of radical participation and interventions in the social fabric.

Referências

Edited by

Section editor

Publication Dates

History