The connection between Occupation and Neurology

The title of the thesis gives more than a passing reference to the work of Oliver Sacks, whose writing has done some much to popularise the area of neurology. However, it is offered tongue in cheek, since although I have read and enjoyed most of the work done by Sacks, I am not trying to emulate his work of making the brain injury comprehensible to a wider audience. His writing is essentially that of a neurologist explaining the ways that the abnormality plays itself out in everyday life. Some of his extended studies, eg on Tourettes or autism, are particularly fascinating. However, it is always the difference that is fascinating with him, and in this thesis I am trying to emphasise the commonality.

The ‘Troll’ story is an attempt to show that a technical rational mode of thinking is more useful when applied to work with objects than it is with people. The whole idea of seeing people as having problems which are to be solved seems to take the wrong direction. I prefer here to look at needs which must be met in some way. I pose the quandary of getting out of bed in the morning as one way of looking at this. This is something that is experienced as a problem by everyone who comes in contact with Barry, it provides a daily confrontation with the fact of his brain injury which cannot be escaped by either him or his facilitators. Everything that could conceivably be used has been attempted as a way of solving this problem. It took a stunning glimpse of the obvious to pose the issue in another way. Instead of tacking it as a problem, we decided to believe that he would get up when he had something to get up for, that is, when he needed to. This is more or less what did happen. The bed issue could easily have been explained in terms of the list of deficits which his brain injury has left him with and this explanation would have been correct, but not useful.

Similarly, when the facilitator could not persuade him to make a cover for his fish pond, his behaviour might have been explained in terms of deficits in the areas of problem solving and initiation. Except that such an approach would not have made sense. When a student does not understand something one does not say that it is because they have a deficit in the area of problem solving, one asks first whether the teacher could find another way of presenting the issue. The naming of deficits is a useful way of demonstrating some extra effort might need to be put into the way that something is presented. It should never be used as a reason to blame the person with the head injury for our difficulty in explaining something, or making an activity accessible. I think the allure of words which seem to explain our behaviour in terms of neurology or neuropsychology is almost irresistible. But if the explanations are not helpful in terms of telling one what to do, there is a good reason not to use them, except as factors which are to be taken into account.

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Abstract
Introduction
Methods and Ethics

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Brain damage stories-
Stories intro
Story 1 - The accident
Story 2 - The OT arrives
Story 3 - The CD rack
Story 4 - The troll
Story 5 - The door
Story 6 - At work
Story 7 - The letterbox
Story 8 - Employment

Occupation in Literature -
Literature intro
Occupation
Alienation
Being "well occupied"
The practitioner / OT
The person with brain injury

Discussion -
The need for occupation
Becoming well occupied
Facilitation
Ethical concerns
Occupation and neurology
Future research
Conclusion

Works cited
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