Where Did Occupational Therapy Get Its Name?

A Brief History of the Origin of OT

Occupational therapy during WWI: bedridden wounded knitting. "Reeve 41457" by Otis Historical Archives Nat'l Museum of Health & Medicine

At first glance, you may think occupational therapy had its origin in finding people employment. But, honestly, our history is far more interesting than that. Think: asylums and basket-weaving.

Below is a brief history of how the common-sense idea to give patients therapeutic activities to occupy their time gave birth to a new profession.

The Condition of Hospitals and Asylums Following the Civil War

Patients of hospitals and asylums following the Civil War did not find themselves in great hands.

The institutions were often overcrowded and poorly staffed by professionals with minimal training. The care was often custodial, as many ailments were beyond the medical expertise of the time. Hospitals had the reputation of being houses of death.

A trip to the hospital was no overnight affair. The average length of stay was several weeks, down from a month or more decades before. In asylums, people were often hospitalized for life.

In many ways, it would have been better to be in an institution, particularly an asylum, before the Civil War. A movement called Moral Treatment was at its zenith in the United States. Moral treatment made its way via Quakers from Europe. The basic tenant of the movement was that people with mental illness deserved to be treated with moral dignity, as opposed to the barbaric conditions they had often been kept in prior. Thus, asylums were designed to be small, for individualized care, and staffed with highly trained individuals.

However, in the United States, as in Europe, Moral Treatment died out by the turn of the century, uprooted by the medical model, funding problems, and general upheaval following the war.

The decrepit condition of hospitals and the last glimmers of Moral Treatment are what set the stage for the emergence of occupational therapy.

George Barton, one of occupational therapy’s founders, summed up the situation in this way– “It is time for humanity to cease regarding the hospital as a door closing upon a life which is past and to regard it henceforth as a door opening upon a life which is to come.”

Occupational Therapy is Born

In the early 1900s, from several corners of the medical field, a movement began to arise. The idea was simple– give patients activities to occupy their time, make them feel ownership over the healing process, and specifically address their ailment.

The founders of occupational therapy believed that engagement in activity was an integral part of wellness, along with rest and sleep. Of course people who languished in hospital beds for weeks, months or even years did not get better. Through their individual practices, the founders of occupational therapy concluded that creating a healthy balance of activity and rest was more effective than many of the medications on the market at the time. In this vein, William Rush Dunton, Jr. wrote: “It has been found that a patient makes more rapid progress if his attention is concentrated upon what he is making and he derives stimulating pleasure in its performance.”

Activities could not randomly be assigned and there was no blanket treatment. This was not the equivalent of instructing a patient to idle away their time on Candy Crush Saga. Practitioners emphasized understanding a person’s social history, their current medical state, and what their life would look like when they discharged.

For example, if the patient has a hand injury, give them basket weaving to practice fine motor skills. If the person struggles with anxiety, perhaps try watercolor.

Examples of occupations included:

  • Paper folding
  • Knitting
  • Weaving
  • Leatherwork
  • Quilting
  • Printing
  • Repairs

Engagement in activity had the added benefit of preparing patients for discharge. As one can imagine, many patients at the time left their lengthy stays in hospitals unprepared to re-engage with the demands of daily life.

“I say to discharge a patient from the hospital, with his fracture healed, to be sure, but to a devastated home, to an empty desk and to no obvious sustaining employment, is to send him out to a world cold and bleak,” said George Barton

The New Profession Named and Defined

In the first decade of the 20th century, practitioners across the country began using the term occupational therapy for this new mode of treatment. Eleanor Clarke Slagle, one of the founders, described occupational therapy's name to be “an awkward term” but felt “it has been well defined as a form of remedial treatment consisting of various types of activities . . . which either contribute to or hasten recovery from disease or injury.”

In 1919, one of the first definitions of occupational therapy was popularized. At a meeting in Chicago of the National Society for the Promotion of Occupational Therapy, this definition was given:

“occupational therapy may be defined as any activity, mental or physical, definitely prescribed and guided for the distinct purpose of contributing to and hastening recovery from disease or injury.” 

Continual Redefinition

Since its birth, the role of occupational therapy has been continually redefined, based on the needs of the time and advancing research in wellness and health. The name occupational therapy, however, has stuck. A reminder that a little common sense and work/life balance can go a long way. 


Bing, R. K. (1981). Occupational history revisited: A paraphrastic journey. Eleanor Clarke Slagle Lecture, San Antonio. 

Starr, P. (1982). The social transformation of american medicine.

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