Being
'Well Occupied'-
A
"cure" for head injury
It is much more difficult to describe the condition of being
well occupied without referring to very particular occupations.
Every occupation has its own particular associations each would
deserve a thesis in itself. However, while the idea of describing
all the manifestations of satisfactory engagement is impossible
here, there are some things which are common to all. In the first
place it is not difficult to understand.
Understanding the person with head injury
It is because we share a world that is common to us all that
we can understand the behaviour of others. We take for granted
that it is possible to understand motives and behaviour without
doing a complex psychoanalysis or measurement of cognitive status.
In general we think that an impartial and discerning spectator
is a better judge of a person’s prevailing motives, as
well as of his habits, abilities, and weaknesses than is that
person himself, a view which is directly contrary to the theory
which holds that an agent possesses a Privileged Access to the
so-called springs of his own actions and is, because of that
access, able and bound to discover, without inference or research,
from what motives he tends to act and from what motive he acted
on a particular occasion.
I discover my or your motives in much, though not quite
the same way as I discover my or your abilities. The big practical
difference is that I cannot put the subject through his paces
in my inquiries into his inclinations as I can in my inquiries
into his competences. To discover how conceited or patriotic
you are, I must still observe your conduct, remarks, demeanour,
and tones of voice, but I cannot subject you to examination-tests
or experiments which you recognise as such. You would have a
special motive for responding to such experiments in a particular
way. From mere conceit, perhaps you would try to behave self-effacingly,
or from mere modesty you might try to behave conceitedly. None
the less, ordinary day to day observation normally serves swiftly
to settle such questions. To be conceited is to tend to boast
of one’s own excellences, to pity or ridicule the deficiencies
of others, to daydream about imaginary triumphs, to reminisce
about actual triumphs, to weary quickly of conversations which
reflect unfavourably upon oneself, to lavish ones society upon
distinguished persons and to economise in association with the
undistinguished (Ryle 1986 p. 164).
Within a world which is common to us all, it is possible to find
a way of knowing the right thing to do.
living life after head injury
Wittgenstein (1953) explored a multitude of dimensions of ‘understanding’
and one of the concepts which he expressed among ‘album
of sketches’ is the idea of ‘knowing how to go on’.
He expressed it thus:
Paragraph 151. But there is also this use of the word “to
know”: we say “Now I know!” – and similarly
“Now I can do it!” and “Now I understand!”
Let us imagine the following example: A writes series
of numbers down; B watches him and tries to find a law for the
sequence of numbers. If he succeeds he exclaims: “Now
I can go on!” – So this capacity, this understanding
is something that makes its appearance in a moment…
Paragraph 155. Thus what I wanted to say was: when he
suddenly knew how to go on, when he understood the principle,
then possibly he had a special experience – and if he
is asked: “What was it? What took place when you suddenly
grasped the principle?” perhaps he will describe it much
as we described it above – but for us it is the circumstances
under which he had such an experience that justify him in saying
in such a case that he understands, that he knows how to go
on.
This idea of ‘knowing how to go on’ is critical to
the sense of being ‘well-occupied’ which is being
described here. It is only when one knows how to go on that one
is really well occupied. Until that point one is constantly coming
to a halt, needing something more than the present moment is supplying.
Ways of understanding the person with head injury
Wittgenstein goes on to talk about rules and games in a way which
is echoed in Ryle (1949). In both authors there is attention paid
to the rules of what is to be done, and this tells what is to
be done, once one has started.
A person who cannot play chess can still watch games of
chess. He sees the moves being made as clearly as does his neighbour
who knows the game. But the spectator who does not know the
game cannot do what his neighbour does - appreciate the stupidity
or cleverness of the players. What is this difference between
merely witnessing a performance and understanding what is witnessed
? What, to take another example, is the difference between hearing
what a speaker says and making sense of what he is heard to
say.
Advocates of the double-life legend will answer that understanding
the chess-player’s moves consists in inferring from the
visible moves made on the board to unwitnessable operations
taking place on the player’s private stage. It is a process
of inference analogous to that by which we infer from the seen
movements of the railway-signals to the unseen manipulations
of the levers in the signal-box. Yet this answer promises something
that could never be fulfilled. For since, according to the theory,
one person cannot in principle visit another person’s
mind as he can visit signal-boxes, there could be no way of
establishing the necessary correlation between the overt moves
and their hidden causal counterparts.
It would follow that no one has ever yet had the slightest
understanding of what anyone else has ever said or done. We
read the words which Euclid wrote and we are familiar with the
things which Napoleon did, but we have not the slightest idea
what they had in their minds. Nor has an spectator of a chess
tournament or a football match ever yet had an inkling of what
the players were after.
But this is patently absurd. Anybody who can play chess
already understands a good deal of what other players do, and
a brief study of geometry enables an ordinary boy to follow
a good deal of Euclid’s reasoning. Nor does this understanding
require a prolonged grounding in the not yet established laws
of psychology. Following the moves made by a chess-player is
not doing anything remotely resembling problematic psychological
diagnosis. (p.51)
A game has a point and it is defined by its rules, this ensures
that one knows what to do. The idea of a game and a craft are
somewhat similar. A game has not got a product, but there is a
point to it. A table is an end product. It is a product which
can be expected to have four legs and a top surface. There are
rules to be followed in making something which meets the definition
of a table. It is the thing itself, in this case, which tells
you what to do. It could be seen therefore that every occupation
has its associated aspects, the way that it must be done if it
is to be the thing that it is. This might be called the ambience
of the activity.
To understand the person with head injury you need first to
understand the activity in which they are engaged
In getting started and knowing then how to go on it is important
that the need to do something can be recognised. It comes because
one is immersed in the situation. At this point it is possible
to tell when materials, purpose and need have come together. Aristotle
(in Caulton 1997) describes the close relationship between materials
and purpose.
- The
material cause - that from which, as its constitutive material,
something comes, e.g. the wood under the house.
-
The formal cause - an account of what the thing is, ie a door.
-
The efficient cause - the source of the first beginning of change
ie Barry.
-
The final cause - the purpose, for which the thing is done,
ie a covering is being made which will open in a certain way
and give access to the space under the house.
Part of ‘knowing how to go on’ is to know the thing
that is being dealt with itself. The most important kind of knowledge
is of this kind, and other kinds of knowledge matter only peripherally.
Collingwood gives an excellent example of an analysis of a particular
thing, in this case craft. The Greek philosophers worked out the
idea of craft and the work which is done by a handyman would constitute
craft, the definition of which is: “the power to produce
a preconceived result by means of consciously controlled and directed
action” (Collingwood 1938) The chief characteristics of
craft according to Collingwood are:
A. Craft always involves a distinction between means and ends,
each clearly conceived as something distinct from the other
but related to it. The term ‘means’ is loosely applied
to things that are used in order to reach the end, such as tools,
machines, or fuel. Strictly, it applies not to the things but
to the actions concerned with them: manipulating the tools,
tending the machines or burning the fuel. These actions (as
implied by the literal sense of the word means) are passed through
or traversed in order to reach the end, and are left behind
when the end is reached. This may serve to distinguish the idea
of means from two other ideas with which it is sometimes confused:
that of part, and that of material. The relation of part to
whole is like that of means to end, in that the part is indispensable
to the whole, is what it is because of its relation to the whole
and may exist by itself before the whole comes into existence;
but when the whole exists the part exists too, whereas, when
the end exist, the means have ceased to exist.
B. It involves a distinction between planning and execution.
The result to be obtained is preconceived or thought out before
being arrived at. The craftsman knows what he wants to make
before he makes it. This foreknowledge is absolutely indispensable
to craft: if something, for example stainless steel, is made
without such foreknowledge, the making of it is not a case of
craft but an accident. Moreover, this foreknowledge is not vague
but precise. If a person sets out to make a table, but conceives
the table only vaguely, as somewhere between tow by four feet
and three by six, and between two and three feet height, and
so forth, he is no craftsman.
C. Means and end are related in one way in the process of planning;
in the opposite way in the process of execution. In planning
the end is prior to the means. The end is though out first and
afterwards the means are thought out. In execution the means
come first, and the end is reached through them.
D. There is a distinction between raw material and finished
product or artifact. A craft is always exercised upon something,
and aims at the transformation of this into something different.
That upon which it works begins as raw material and ends as
finished product. The raw material is found ready made before
the special work of the craft begins.
E. There is a distinction between form and matter. The matter
is what is identical in the raw material and the finished product;
the form is what is different, what the exercise of the craft
changes. To describe the raw material as raw is not to imply
that it is formless, but only that it has not yet the form which
it is to acquire through the ‘transformation’ into
finished product.
F. There is a hierarchical relation between various crafts,
one supplying what another needs, one using what another provides.
There are three kinds of hierarchy; of material, of means and
of parts.
a) The raw material of one craft is the finished product of
another. Thus the silviculturist propogates trees and looks
after them as they grow, on order to provide material for the
felling-men who transform them into logs; these are the raw
material for the saw-mill which transforms them into planks;
and these, after a further process of selection and seasoning,
become raw material for a joiner.
b) In the hierarchy of means, one craft supplies another with
tools. Thus the timber-merchant supplies pit-props to the miner;
the miner supplies coal to the blacksmith; the blacksmith supplies
horseshoes to the farmer; and so on.
c) In the hierarchy of parts a complex operation like the manufacture
of a motor-car is parcelled out among a number of trades: one
firm makes the engine, another the gears, another the chassis,
another the tyres, another the electrical equipment, and so
on. The final assembling is not strictly the manufacture of
the car but only thebringing together of these parts. In one
or more of these ways every craft has a hierarchical character;
either as hierarchically related to other crafts, or as itself
consisting of various heterogenous operations hierarchically
related among themselves.
This is one example of a particular type of analysis, there could
be many others done in a study of the different occupations. However,
one important common part of doing things is the ability to recognise
when one has arrived and to be able to stop at this point. There
is a qualitative difference about the experience which comes about
at the point of finishing something. When an object is finished
it could be said that this object then goes on to have a life
of its own, there is a whole set of circumstances which will now
attend to it beyond those of the person who made it. Within the
subject of ‘occupation’ as it is taught, we call these
the ‘associative aspects’ and a recognition of the
ambience which can be created by these is a critical part of the
understanding necessary to the practitioner of this approach.
The importance of achievement for the person with head injury
Ryle (1986) distinguishes between the ‘try it’ verbs
and the ‘got it’ verbs in a manner which suggests
a multitude of associations with the achievement of something.
The differences between kicking and scoring, treating and
healing, hunting and finding, clutching and holding fast, listening
and hearing, looking and seeing, travelling and arriving, have
been construed, if they have been noticed at all, as differences
between coordinate species of activity or process, when in fact
the differences are of quite another kind....one big difference
between the logical force of a task verb and that of a corresponding
achievement verb is that in applying an achievement verb we
are asserting that some state of affairs obtains over and above
that which consists in the performance, if any, of the subservient
task activity. For the runner to win, not only must he run but
also his rivals must be at the tape later than he; for a doctor
to effect a cure, his patient must both be treated and be well
again; for the searcher to find the thimble, there must be a
thimble in the place he indicates at the moment when he indicates
it.
It is important to hold on to the idea of the associations with
achievement, which are over an above the simple process of getting
there. It may seem unnecessary to labour the point, but there
is frequent confusion about the relative importance of the process
and the product.
The need for real experience after a head injury
Marx identifies the associative factors with the system in which
we live. He show that it is the means of production which subordinates
all of our human senses to the one sense of avarice. He clearly
shows that avarice is something created by the system in which
we are living and is not something that is purely natural. Avarice
then leads to an alienation of our senses, where everything is
reduced to having rather than experiencing
in a real human way. At yet, almost at the same moment as he describes
it he points a way out of the dilemma.
…it is only when objective reality everywhere becomes
for man in society the reality of human faculties, human reality,
and thus the reality of his own faculties, that all objects
become for him the objectification of himself. The objects then
confirm and realize his individuality, they are his own objects,
i.e., man himself become the object. The manner in which these
objects become his own depends upon the nature of the object
and the nature of the corresponding faculty; for it is precisely
the determinate character of this relation which constitutes
the specific real mode of affirmation. The object is not the
same for the eye as for the ear, for the ear as for the eye.
The distinctive character of each faculty is precisely its characteristic
essence and thus also the characteristic mode of its objectification,
of its objectively real, living being. It is therefore not only
through thought, but through all the senses that man is affirmed
in the objective world (Marx 1844 p. 133)
The person with head injury needs to real work
It is only when the world makes sense to each of our senses that
we have really experienced it and made it our own. There is a
very particular way of making sense brought about by the different
things that we do. Again Arendt (1958) is useful in elucidating
the associative aspects of work and labour. She talks about the
joy associated with labour. There is the elation felt by the exertion
of strength measured against the force of the elements. There
is a kind of bliss which comes from being in tune with the earth.
And there is pleasure and satisfaction too in the momentary order
which is brought about by our eternal efforts. Contemplatives
from many different religions seem to recognise something in labour
which has the potential to bring one close to god. The mind is
free to contemplate when the body is engaged, and it seems that
labour at its most elevated (or mundane) has something to say
to the human soul.
She also talks about the way that the joy and the success of
work is self satisfaction, self assurance and self confidence.
It is also assuredly a way of making the self. But the worker
makes more than themselves (although this is also the outcome),
the worker also makes the world. Everything that is put between
us and nature has come in some way from the worker. The world
that we live in is a human creation, it is our home. The condition
of work is actually one of home building / making, though our
labour is used to maintain the house.
Green (1968) outlines a theory of work and leisure, which builds
and extends some of the ideas used by Arendt in her basis distinction
between work and labour. He suggests that there are three ways
in which it is appropriate to consider work. Briefly summarised
these are -
- Labour: mere activity characterised by necessity and futility.
The goods produced by labour are consumed and have no enduring
quality. A man is not free whose whole life is totally absorbed
in labour. His energies are spent in response to necessity,
under the aegis of forces outside himself, forces he cannot
control. He is not master himself as he himself is master.
- Job: The occupation which one does for pay. It may be
seen as obligatory and done of necessity (labour) and/or engendering
activity which is purposeful and meaningful to the individual
(work).
- Work: Activity producing an enduring object. Work requires
self-investment, skill, craft and personal judgement. Work is
purposeful and meaningful. Work is distinct from labour and
often must be discovered independently from one’s job
(from Caulton 1997).
The person with head injury can get hope from real work
Given that we have ‘work’ (jobs) which tend to bring
about some measure of alienation and ‘leisure’ (free
time) which hangs heavy on our hands we have a problem, the solution
to which, he said, is not to help to make jobs more meaningful,
but ‘for more people to discover a work to be accomplished’.
He connects the idea of work with potency and hope.
Work without hope is not simply work without the belief
that the object of one’s efforts can be realised; it is
work with the belief that the object of one’s efforts
cannot be accomplished. That is the essential character of labour.
Work with hope is work that is performed in the kind of world
that will sustain one in the effort to accomplish his goal.
It is confidence and trust in one’s world, and is therefore
activity that is filled with expectation and anticipation. The
structure of hope is not simply this logical structure that
we have been discussing; it is the structure of a certain kind
of world, a world that will provide and sustain what I have
called space for action. It is precisely this discovery of the
space in which one will be able to discover and reveal one’s
self that we described as the discovery of potency. It is also
the prerequisite for the discovery of a work as distinguished
from a job (p.136)
The discovery of this ‘space’ suggests that there
is an aspect to being well occupied which is, in a sense, the
culmination of and the reflection of, all the doing that has previously
been discussed. Arendt discusses this and calls it ‘action’.
It is the third aspect of the human condition, which she discusses
after labour and work. Action creates the condition for remembrance,
that is, for history. It involves the conviction that the greatest
that a man can achieve is his own appearance and actualization.
Against the idea of action stands the conviction of homo faber
that man’s products may be more – and not only more
lasting – than he is himself, as well as the animal laborans
firm belief that life is the highest of all good. Both are strictly
speaking unpolitical, and will incline to denounce action and
speech as idleness and idle talk and generally will judge public
activities in terms of their usefulness to supposedly higher ends,
to make the world more useful and beautiful in the case of homo
faber, to make life easier and longer in the case of animal laborans.
However, they are not free to dispense with a public realm altogether,
for without a space of appearance, and without trusting in action
and speech as a mode of being together, neither the reality of
one’s self, nor the reality of the surrounding world can
be established without doubt. The human sense of reality demands
that men actualise the sheer passive givenness of their being,
not in order to change it, but in order to make articulate and
call into full existence what otherwise they would have to suffer
passively anyhow. This actualization resides and comes to pass
through action.
The person who acts and speaks is a ‘hero’ in the
original sense of the word in Homer. “The connotation of
courage, which we now feel to be an indispensable quality of the
hero, is in fact already present in a willingness to act and speak
at all, to insert one’s self into the world and being a
story of one’s own” (Arendt 1948 p. 166). It is only
in action that we seen who a man is, rather than what he is. The
exposing of self can only be prevented by complete passivity or
silence. Yet who one is remains invisible to the actor and can
usually only be perceived by an audience or community :
“(I)t is more than likely that the “who,”
which appears so clearly and unmistakably to others, remains
hidden from the person himself, like the daimon in Greek religion
which accompanies each man throughout his life, always looking
over his shoulder from behind and thus visible only to those
he encounters. This revelatory quality of speech and action
comes to the fore where people are with others and neither for
nor against them-that is, in sheer human togetherness. Although
nobody knows whom he reveals when he discloses himself in deed
or word, he must be willing to risk the disclosure, and this
neither the does of good works, who must be without self and
preserve complete anonymity, nor the criminal, who must hide
himself from others, can take upon themself. Both are lonely
figures, the one being for, the other against, all men; they,
therefore, remain outside the pale of human intercourse and
are, politically, marginal figures who usually enter the historical
scene in times of corruption, disintegration, and political
bankruptcy. Because of its inherent tendency to disclose the
agent together with the act, action needs for its full appearance
the shining brightness we once called glory, and which is possible
only in the public realm.” (Arendt 1958 p. 160)
The person with head injury finds their community through the
work they do
Collingwood (1938) also describes this way that community arises
from the reflections made by the artist. He says that the artist
tells the community their own secrets. And he says that the reason
why the community needs the artist is because “no community
altogether knows its own heart”. Art, for Collingwood, is
the community’s medicine. If one combines his idea of art
together with Arendt’s ideas of action, one comes up with
an idea that a very important part of being well occupied is the
way that we find meaning in what we do. This may be through Arendt’s
‘action’ or through Collingwood’s idea of ‘art’.
I call it here a ‘reflection’ of what has been done,
in the sense that a mirror reflects.
Much of the time in life when we do things there is no reflecting
back of what we have done. If this happens to us too often there
begins to be sense of futility, which suggests that something
about the action of reflecting is an intrinsic part of how we
garner meaning from what we do. Of course there are things that
we do that have a particular use, or a purpose, but if this is
achieved and there is nothing else to it, then there is a sense
that the action is hollow. There can be a loneliness about doing
things. Of course things have to be done, and this sense of connection
with meeting the needs of our subsistence is one of the critical
aspects of being well-occupied. But doing things does not necessarily
reveal our full humanity to ourselves and to others. There seems
to be something else that is necessary to make a communication
happen that is a real acknowledgement of who we are. This is the
communication that happens when one is in a community where one
really has a part. Within this community the things that are said
have a space in which they can be heard and an audience of some
kind to receive them. Yet community does not spring into being
out of nothing. Community is built only when people have the courage
and the ability and the means to express themselves. The community
is built when what is expressed is a reflection of what has already
been sharing together in what the community has done. This sense
of building a community and then dwelling within it comes from
reflecting the community to itself, showing it what it is. Without
this knowledge of itself the community dies, because it does not
understand what it is and it falls back into the nothingness of
individuality.
What does this work of reflecting back consist of? In the first
place it presupposes that people share a common reality. In taking
part in what needs to be done one does share that reality, because
we are all together meeting common needs to build our world and
to maintain it and ourselves within it. The person who has taken
part has had an experience, which they sense in some way and may
want to give form to the sense that they have of it. In trying
to give form to this sense an idea comes about. The clarity of
this idea can then be communicated in some way. It might find
expression in a poem; or it might be that chocolate fudge which
was chanced on in one occasion, is brought back as a part of a
special celebration which therefore carries echoes of that first
fudge; a beer garden is made and a collection of photos is put
together and laminated to celebrate the building of the garden;
a Christmas present is sent and a thank-you letter is returned
with a story of what happened to the present; my son does something
funny one day and the story is told because it makes a good story;
a new game is played in a group of people with head injury and
one of them takes the time to write out the rules on his computer
because it’s just so great;
The reflecting that happens is a very special kind of outcome
of an activity. The purpose of the activity can be fulfilled without
this reflection. The beer garden can be made without the photos
being taken; the fudge does not have to reappear a second time;
the thank-you letter does not have to be sent; the story does
not have to be told; the rules of the game do not have to be written.
In each case the purpose of the activity had already been achieved.
The fudge had been eaten, the garden made, the present given,
the funny thing done, the game played. But in making this list
it becomes clear that it would be very sad if the reflection was
not done. In some way the reality of the thing does not exist
so clearly without the resonance that comes from the reflection.
Next page: The practitioner
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Story 2 - The OT arrives
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Story 5 - The door
Story 6 - At work
Story 7 - The letterbox
Story 8 - Employment
Occupation in Literature -
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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
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Conclusion
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